3851
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van Hoek B, de Rooij BJ, Verspaget HW. Risk factors for infection after liver transplantation. Best Pract Res Clin Gastroenterol 2012; 26:61-72. [PMID: 22482526 DOI: 10.1016/j.bpg.2012.01.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Revised: 11/10/2011] [Accepted: 01/13/2012] [Indexed: 01/31/2023]
Abstract
Infection is a common cause of morbidity and mortality after liver transplantation. Risk factors relate to transplantation factors, donor and recipient factors. Transplant factors include ischaemia-reperfusion damage, amount of intra-operative blood transfusion, level and type of immunosuppression, rejection, and complications, prolonged intensive care stay with dialysis or ventilation, type of biliary drainage, repeat operations, re-transplantation, antibiotics, antiviral regimen, and environment. Donor risk factors include infection, prolonged intensive care stay, quality of the donor liver (e.g. steatosis), and viral status. For the recipient the most important are MELD score >30, malnutrition, renal failure, acute liver failure, presence of infection or colonisation, and immune status for viruses like cytomegalovirus. In recent years it has become clear that genetic polymorphisms in innate immunity, especially the lectin pathway of complement activation and in Toll-like receptors importantly contribute to the infection risk after liver transplantation. Therefore, the risk for infections after liver transplantation is a multifactorial problem and all factors need attention to reduce this risk.
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3852
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Abstract
Staphylococcus lugdunensis is a virulent coagulase-negative staphylococcus (CoNS) that behaves like Staphylococcus aureus. Toxic shock syndrome, osteomyelitis, septic arthritis and postoperative endopthalmitis have been observed. Endocarditis complicated by heart failure, periannular abscess formation and embolic phenomenon have brought particular attention to this CoNS. Mortality rates for endocarditis appear higher when compared with other CoNS. Owing to the laboratory methods used, identification may be misleading. β-lactam antimicrobials are recommended pending sensitivities. Evaluation for endocarditis should be pursued in bacteremic patients due to its pathogenic potential.
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Affiliation(s)
- Elizabeth Babu
- Department of Surgery, Division of Critical Care Medicine, The Mount Sinai School of Medicine, New York, NY 10029, USA
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3853
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Estébanez-Muñoz M, Soto-Abánades CI, Ríos-Blanco JJ, Arribas JR. Updating our understanding of pulmonary disease associated with HIV infection. Arch Bronconeumol 2012; 48:126-32. [PMID: 22257776 DOI: 10.1016/j.arbres.2011.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 11/24/2011] [Accepted: 12/11/2011] [Indexed: 02/02/2023]
Abstract
The introduction of highly active antiretroviral therapy (HAART) has resulted in a reduction of opportunistic infections associated with cellular and humoral immunosuppression. However, what is still unclear is the impact of HAART on the development of other diseases not associated with AIDS, such as lung cancer and COPD. The aim of this paper is to review the most innovative and relevant aspects of lung pathology in patients infected with HIV.
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Affiliation(s)
- Miriam Estébanez-Muñoz
- Unidad de VIH, Servicio de Medicina Interna, Hospital Universitario La Paz, IdiPAZ, Madrid, España.
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3854
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Caïola D, Karras A, Flandre P, Boutolleau D, Scieux C, Agut H, Legendre C, Gautheret-Dejean A. Confirmation of the low clinical effect of human herpesvirus-6 and -7 infections after renal transplantation. J Med Virol 2012; 84:450-6. [DOI: 10.1002/jmv.23206] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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3855
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Abstract
The unique redox potential of iron makes it an ideal cofactor in diverse biochemical reactions. Iron is therefore vital for the growth and proliferation of nearly all organisms, including pathogenic bacteria. Vertebrates sequester excess iron within proteins in order to alleviate toxicity and restrict the amount of free iron available for invading pathogens. Restricting the growth of infectious microorganisms by sequestering essential nutrients is referred to as nutritional immunity. In order to circumvent nutritional immunity, bacterial pathogens have evolved elegant systems that allow for the acquisition of iron during infection. The gram-positive extracellular pathogen Staphylococcus aureus is a commensal organism that can cause severe disease when it gains access to underlying tissues. Iron acquisition is required for S. aureus colonization and subsequent pathogenesis. Herein we review the strategies S. aureus employs to obtain iron through the production of siderophores and the consumption of host heme.
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Affiliation(s)
- Neal D Hammer
- Department of Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-2363, USA.
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3856
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Abstract
PURPOSE OF REVIEW Non-HIV-infected populations are increasingly identified as being at risk for developing Pneumocystis jirovecii pneumonia (PJP). These patients typically present with severe disease and poorly tolerate invasive diagnostic procedures. This review examines recently reported risks for PJP in non-HIV populations and summarizes new diagnostic techniques. RECENT FINDINGS PJP is associated with immunomodulatory drug therapies, including monoclonal antibody therapies such as tumour necrosis factor α antagonists, and calcineurin inhibitors. Underlying disease states include solid-organ transplantation, connective tissue and rheumatologic disorders, inflammatory bowel disease, haematological malignancies, and solid tumours. Modern diagnostic techniques [conventional PCR, quantitative PCR, (1→3)-β-D-glucan assays, and PET] are reviewed with respect to predictive value and clinical utility. In particular, current literature regarding validation and specificity of molecular diagnostic techniques is summarized, including application to minimally invasive specimens. SUMMARY HIV-negative populations at risk for PJP can be identified. Conventional PCR increases diagnostic sensitivity but may detect asymptomatic colonization. Quantitative PCR demonstrates potential for distinguishing colonization from infection, but clinical validation is required. Serum (1→3)-β-D-glucan may be elevated in PJP, although standardized cut-off values for clinical infection have not been determined. Further validation of serum markers and molecular diagnostic methods is necessary for early and accurate diagnosis in non-HIV populations.
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3857
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Fernández-Hidalgo N, Almirante B. [Infective endocarditis in the XXI century: epidemiological, therapeutic, and prognosis changes]. Enferm Infecc Microbiol Clin 2012; 30:394-406. [PMID: 22222058 DOI: 10.1016/j.eimc.2011.11.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 11/03/2011] [Indexed: 12/15/2022]
Abstract
Infective endocarditis (IE) is an uncommon and severe disease. Nowadays, in developed countries, IE patients are older, usually have a degenerative heart valve disease, and up to 30% acquire this infection within the health care system. In consequence, staphylococci species are the most frequently isolated microorganisms. Antimicrobial treatment for IE has significantly changed over the last decades. In IE episodes due to Staphylococcus aureus, cloxacillin-resistance makes antimicrobial election more difficult. Other microorganisms, such as enterococci and some species of streptococci, show high rates of resistance to antimicrobial agents established in guidelines. Despite improvements in the diagnosis, and medical and surgical treatment of IE, this disease continues to be associated with high rates of in-hospital mortality. At present, due to epidemiological changes, antimicrobial prophylaxis can avoid few cases of IE. Prevention of nosocomial bacteremia, an early diagnosis of IE, prompt identification of IE patients at a higher risk of mortality, and a multidisciplinary approach of this disease could be valid strategies in order to improve the outcome of these patients.
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3858
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Abstract
Serratia marcescens has been reported to cause infective endocarditis among intravenous drug users, but it is extremely rare in non-intravenous drug users in Japan. In this article, we report an 85-year-old woman with diabetes mellitus who presented with low-grade fever and general fatigue. She was administered intravenous prednisolone under a diagnosis of right Bell's palsy before this admission. Blood cultures revealed positive Serratia marcescens, which was complicated by multiple cerebral infarctions after admission. Transthoracic echocardiography on day 5 revealed vegetation on the mitral valve, which was diagnosed as infective endocarditis. An operation could not be performed because of the presence of multiple cerebral infarctions. She died on day 65 because of uncontrolled heart failure.
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Affiliation(s)
- Yoshiro Hadano
- Department of General Internal Medicine, Rakuwakai Otowa Hospital, Japan.
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3859
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Moreno A, Cervera C, Fortún J, Blanes M, Montejo E, Abradelo M, Len O, Rafecas A, Martín-Davila P, Torre-Cisneros J, Salcedo M, Cordero E, Lozano R, Pérez I, Rimola A, Miró JM. Epidemiology and outcome of infections in human immunodeficiency virus/hepatitis C virus-coinfected liver transplant recipients: a FIPSE/GESIDA prospective cohort study. Liver Transpl 2012; 18:70-81. [PMID: 21898772 DOI: 10.1002/lt.22431] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Information about infections unrelated to acquired immunodeficiency syndrome (AIDS) in human immunodeficiency virus (HIV)-infected liver recipients is scarce. The aims of this study were to describe the prevalence, clinical characteristics, time of onset, and outcomes of bacterial, viral, and fungal infections in HIV/hepatitis C virus (HCV)-coinfected orthotopic liver transplant recipients and to identify risk factors for developing severe infections. We studied 84 consecutive HIV/HCV-coinfected patients who underwent liver transplantation at 17 sites in Spain between 2002 and 2006 and were followed until December 2009. The median age was 42 years, and 76% were men. The median follow-up was 2.6 years (interquartile range = 1.25-3.53 years), and 54 recipients (64%) developed at least 1 infection. Thirty-eight (45%) patients had bacterial infections, 21 (25%) had cytomegalovirus (CMV) infections (2 had CMV disease), 13 (15%) had herpes simplex virus infections, and 16 (19%) had fungal infections (7 cases were invasive). Nine patients (11%) developed 10 opportunistic infections with a 44% mortality rate. Forty-three of 119 infectious episodes (36%) occurred in the first month after transplantation, and 53 (45%) occurred after the sixth month. Thirty-six patients (43%) had severe infections. Overall, 36 patients (43%) died, and the deaths were related to severe infections in 7 cases (19%). Severe infections increased the mortality rate almost 3-fold [hazard ratio (HR) = 2.9, 95% confidence interval (CI) = 1.5-5.8]. Independent factors for severe infections included a pretransplant Model for End-Stage Liver Disease (MELD) score >15 (HR = 3.5, 95% CI = 1.70-7.1), a history of AIDS-defining events before transplantation (HR = 4.0, 95% CI = 1.9-8.6), and non-tacrolimus-based immunosuppression (HR = 2.5, 95% CI = 1.3-4.8). In conclusion, the rates of severe and opportunistic infections are high in HIV/HCV-coinfected liver recipients and especially in those with a history of AIDS, a high MELD score, or non-tacrolimus-based immunosuppression.
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Affiliation(s)
- Asunción Moreno
- Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona
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3860
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Quint J, Brown JS. Pneumonia in the Non–HIV-Infected Immunocompromised Patient. Clinical Respiratory Medicine 2012. [DOI: 10.1016/b978-1-4557-0792-8.00028-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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3861
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Moon J, Smith T, Sahud AG, Bhanot N. An unusual etiology of infective endocarditis: Enterobacter cloacae. J Infect Chemother 2012; 18:925-30. [DOI: 10.1007/s10156-012-0376-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 01/22/2012] [Indexed: 11/26/2022]
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3862
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Lee JA, Kang CI, Joo EJ, Ha YE, Park SY, Chung DR, Peck KR, Lee NY, Song JH. Clinical and Microbiological Characteristics of Healthcare-Associated Infections in Community-Onset Klebsiella pneumoniaeBacteremia. Infect Chemother 2012. [DOI: 10.3947/ic.2012.44.2.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jeong-a Lee
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Division of Infectious Disease, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Cheol-In Kang
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Jeong Joo
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Eun Ha
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - So Yeon Park
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo Ryeon Chung
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyong Ran Peck
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Nam Yong Lee
- Department of Laboratory Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Hoon Song
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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3863
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Kang SJ, Jang MO, Jang HC, Jung SI, Shin JH, Park KH. A Case of Candida pelliculosaProsthetic Valve Endocarditis Treated with Anidulafungin and Valve Replacement. Infect Chemother 2012. [DOI: 10.3947/ic.2012.44.6.499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Seung Ji Kang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Mi Ok Jang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hee Chang Jang
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sook In Jung
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jong Hee Shin
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung Hwa Park
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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3864
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Lucena CM, Martínez-Olondris P, Badia JR, Xaubet A, Ferrer M, Torres A, Agustí C. [Fiberoptic bronchoscopy in a respiratory intensive care unit]. Med Intensiva 2012; 36:389-95. [PMID: 22195599 DOI: 10.1016/j.medin.2011.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 09/27/2011] [Accepted: 11/04/2011] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the indications, diagnostic performance and safety of fiberoptic bronchoscopy (FOB) performed in a respiratory intensive care unit (RICU). DESIGN A prospective, observational study was carried out. SETTING A 6-bed RICU in a tertiary university hospital. PATIENTS Patients admitted to RICU who required FOB. INTERVENTIONS None. MAIN MEASUREMENTS FOB indications and complications, endoscopic procedures, time required to perform FOB. RESULTS Sixty-nine out (23%) of the 297 patients admitted to the RICU underwent a total of 107 FOB. Sixty-eight percent of FOB were performed in patients on mechanical ventilation. FOB was performed for diagnostic and therapeutic purposes in 88 (82%) and 19 cases (18%), respectively. The study of pulmonary infiltrates was the main indication for diagnostic FOB (44 cases; 50%), particularly in immunocompromised patients (24 cases; 27%). In immunocompromised patients the diagnostic performance of FOB was significantly higher than in immunocompetent subjects (48% vs 30%; p<0.01). No major complications were recorded. Only a significant drop in PaO(2)/FiO(2) ratio was observed (182 ± 74 vs 163 ± 79; p<0.005) in patients undergoing bronchoalveolar lavage. Overall mortality in patients in the RICU was 14%. In patients requiring a single FOB procedure, mortality was 25%, versus 45% among those requiring more than one FOB procedure. CONCLUSIONS These results show that FOB is used commonly in the RICU. It is a safe and fast procedure that contributes significantly to clinical management. Patients requiring additional FOB during admission to the RICU show high mortality.
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3865
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D'Ascenzo F, Cerrato E, Biondi-Zoccai G, Moretti C, Omedè P, Sciuto F, Bollati M, Modena MG, Gaita F, Sheiban I. Acute coronary syndromes in human immunodeficiency virus patients: a meta-analysis investigating adverse event rates and the role of antiretroviral therapy. Eur Heart J 2011; 33:875-80. [PMID: 22187508 DOI: 10.1093/eurheartj/ehr456] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIMS Highly active antiretroviral therapy (HAART) dramatically reduces human immunodeficiency virus (HIV)-associated morbidity and mortality, but adverse effects of HAART are becoming an increasing challenge, especially in the setting of acute coronary syndromes (ACS). We thus performed a comprehensive review of studies focusing on ACS in HIV patients. METHODS AND RESULTS MEDLINE/PubMed was systematically screened for studies reporting on ACS in HIV patients. Baseline, treatment, and outcome data were appraised and pooled with random-effect methods computing summary estimates [95% confidence intervals (CIs)]. A total of 11 studies including 2442 patients were identified, with a notably low prevalence of diabetes [10.86 (4.11, 17.60); 95% CI]. Rates of in-hospital death were 8.00% (2.8, 12.5; 95% CI), ascribable to cardiovascular events for 7.90% (2.43, 13.37; 95% CI), with 2.31% (0.60, 4.01; 95% CI) developing cardiogenic shock. At a median follow-up of 25.50 months (11.25, 42; 95% CI), no deaths were recorded, with an incidence of 9.42% of acute myocardial infarction (2.68, 16.17; 95% CI) and of 20.18% (9.84, 30.51; 95% CI) of percutaneous coronary revascularization. Moreover, pooled analysis of the studies reporting incidence of acute myocardial infarction in patients exposed to protease inhibitors showed an overall significant risk of 2.68 (odds ratio 1.89, 3.89; 95% CI). CONCLUSION Human immunodeficiency virus patients admitted for ACS face a substantial short-term risk of death and a significant long-term risk of coronary revascularization and myocardial infarction, especially if receiving protease inhibitors.
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Affiliation(s)
- Fabrizio D'Ascenzo
- Division of Cardiology, University of Turin, S. Giovanni Battista 'Molinette' Hospital, Corso Bramante 88-90, Turin 10126, Italy.
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3866
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Abstract
Staphylococcus lugdunensis is an infrequent cause of native valve endocarditis. A case of triple-valve involvement of Staphylococcus lugdunensis with intracardiac fistula formation in a 47-year-old woman was managed successfully with surgery. The importance of early diagnosis and prompt referral for surgical treatment is highlighted.
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Affiliation(s)
- Amul K Sibal
- Department of Cardiothoracic Surgery and Cardiology, Waikato Hospital, Hamilton, New Zealand
| | - Zaw Lin
- Department of Cardiothoracic Surgery and Cardiology, Waikato Hospital, Hamilton, New Zealand
| | - Dilesh Jogia
- Department of Cardiothoracic Surgery and Cardiology, Waikato Hospital, Hamilton, New Zealand
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3867
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Ben Hamad M, Cornelis F, Marzouk S, Chabchoub G, Bahloul Z, Rebai A, Fakhfakh F, Ayadi H, Petit-Teixeira E, Maalej A. Association study of CARD8 (p.C10X) and NLRP3 (p.Q705K) variants with rheumatoid arthritis in French and Tunisian populations. Int J Immunogenet 2011; 39:131-6. [PMID: 22128899 DOI: 10.1111/j.1744-313x.2011.01070.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The objective of the study was to investigate the association of caspase activating and recruitment domain 8 (CARD8) and nucleotide-binding oligomerization domain, leucine-rich repeat and pyrin domain containing 3 (NLRP3) polymorphisms with rheumatoid arthritis (RA) in Tunisian and French populations. CARD8 (c.30T>A, rs2043211) and NLRP3 (c.2113C>A, rs35829419) single nucleotide polymorphisms (SNPs) were genotyped in 100 French RA trio families and 141 Tunisian patients with RA and 191 unrelated healthy controls, using TaqMan(®) allelic discrimination assay. The genetic analyses for the association and linkage in French families were performed using the comparison of allelic frequencies (AFBAC), the genotype relative risk (GRR) and the transmission disequilibrium test (TDT). Data for case and control samples were analysed by chi-square-test, GRR and odds ratio (OR). No significant differences between alleles and genotypes frequencies were detected in French trio and Tunisian patients with RA and controls, either with CARD8 or with NLRP3 SNPs both in French and in Tunisian populations. Moreover, stratifying patients according to the presence of rheumatoid factor (RF), anti-cyclic peptides antibodies (ACPA), erosion, nodules, other autoimmune disease or HLA-DRB1*04-positive subgroups did not show any significant association with CARD8 or NLRP3 (P ≥ 0.05). This study suggests that variations in the innate immunity genes CARD8 (p.C10X) and NLRP3 (p.Q705K) have no effect on RA susceptibility either in the Tunisian or in the French population.
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Affiliation(s)
- M Ben Hamad
- Laboratory of Human Molecular Genetics, Faculty of Medicine, Sfax, Tunisia.
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3868
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Samuel CM, Whitelaw A, Corcoran C, Morrow B, Hsiao NY, Zampoli M, Zar HJ. Improved detection of Pneumocystis jirovecii in upper and lower respiratory tract specimens from children with suspected pneumocystis pneumonia using real-time PCR: a prospective study. BMC Infect Dis 2011; 11:329. [PMID: 22123076 PMCID: PMC3254081 DOI: 10.1186/1471-2334-11-329] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 11/28/2011] [Indexed: 12/02/2022] Open
Abstract
Background Pneumocystis pneumonia (PCP) is a major cause of hospitalization and mortality in HIV-infected African children. Microbiologic diagnosis relies predominantly on silver or immunofluorescent staining of a lower respiratory tract (LRT) specimens which are difficult to obtain in children. Diagnosis on upper respiratory tract (URT) specimens using PCR has been reported useful in adults, but data in children are limited. The main objectives of the study was (1) to compare the diagnostic yield of PCR with immunofluorescence (IF) and (2) to investigate the usefulness of upper compared to lower respiratory tract samples for diagnosing PCP in children. Methods Children hospitalised at an academic hospital with suspected PCP were prospectively enrolled. An upper respiratory sample (nasopharyngeal aspirate, NPA) and a lower respiratory sample (induced sputum, IS or bronchoalveolar lavage, BAL) were submitted for real-time PCR and direct IF for the detection of Pneumocystis jirovecii. A control group of children with viral lower respiratory tract infections were investigated with PCR for PCP. Results 202 children (median age 3.3 [inter-quartile range, IQR 2.2 - 4.6] months) were enrolled. The overall detection rate by PCR was higher than by IF [180/349 (52%) vs. 26/349 (7%) respectively; p < 0.0001]. PCR detected more infections compared to IF in lower respiratory tract samples [93/166 (56%) vs. 22/166 (13%); p < 0.0001] and in NPAs [87/183 (48%) vs. 4/183 (2%); p < 0.0001]. Detection rates by PCR on upper (87/183; 48%) compared with lower respiratory tract samples (93/166; 56%) were similar (OR, 0.71; 95% CI, 0.46 - 1.11). Only 2/30 (6.6%) controls were PCR positive. Conclusion Real-time PCR is more sensitive than IF for the detection of P. jirovecii in children with PCP. NPA samples may be used for diagnostic purposes when PCR is utilised. Wider implementation of PCR on NPA samples is warranted for diagnosing PCP in children.
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Affiliation(s)
- Catherine M Samuel
- Division of Medical Microbiology, University of Cape Town and National Health Laboratory Service, Cape Town, South Africa.
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3869
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Pereira EM, Teixeira CAA, Alvarenga ALM, Schuenck RP, Giambiagi-deMarval M, Holandino C, Mattos-Guaraldi AL, Dos Santos KRN. A Brazilian lineage of Staphylococcus lugdunensis presenting rough colony morphology may adhere to and invade lung epithelial cells. J Med Microbiol 2011; 61:463-469. [PMID: 22116983 DOI: 10.1099/jmm.0.033001-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Staphylococcus lugdunensis is an unusually virulent coagulase-negative species, which causes serious infection similar to S. aureus. We evaluated the expression of virulence factors such as S. lugdunensis synergistic haemolysin (SLUSH), fibrinogen-binding protein (Fbl), biofilm production and biofilm-production-related genes in 23 S. lugdunensis clinical isolates and one type strain that had been previously characterized for their genotypes. In addition, the biofilm composition and the ability of isolates to adhere to and invade human epithelial lung cells were also investigated. The PCR method used detected the presence of slush and intercellular adhesin (ica) virulence genes in all isolates. All isolates produced the Fbl protein and, with the exception of the type strain, all isolates produced the SLUSH haemolysin. Fourteen (60.9 %) isolates produced biofilms. The detachment assay, using sodium metaperiodate or proteolytic enzymes to analyse the biofilm composition, showed protein-mediated biofilms in two representative isolates, one for each colony type (rough and smooth). All strongly biofilm-producing isolates, including three with rough colony morphology, had the same prevalent PFGE pattern. However, among the representative strains tested, only the S. lugdunensis isolate that formed rough colonies was able to adhere to and invade A549 cell monolayers in the same quantities as those observed with S. aureus isolates (P = 1.000). No significant adhesion or invasion was observed for the other isolates in comparison with the S. aureus isolate, independent of biofilm production or clonality. Our results could explain the incredible ability of this pathogen to cause infections that are as aggressive as S. aureus. In addition, the ability of S. lugdunensis to adhere to and invade eukaryotic cells was also noticed for isolates with rough colony morphology, reinforcing the increased virulence in this species.
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Affiliation(s)
- Eliezer M Pereira
- Federal Institute of Education, Science and Technology of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Medical Microbiology, Institute of Microbiology, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | | | - Ana Luiza M Alvarenga
- Federal Institute of Education, Science and Technology of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Medical Microbiology, Institute of Microbiology, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Ricardo P Schuenck
- Department of Medical Microbiology, Institute of Microbiology, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Márcia Giambiagi-deMarval
- Department of Medical Microbiology, Institute of Microbiology, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Carla Holandino
- Faculty of Pharmacy, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | | | - Kátia R N Dos Santos
- Department of Medical Microbiology, Institute of Microbiology, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
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3870
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Kiefer T, Park L, Tribouilloy C, Cortes C, Casillo R, Chu V, Delahaye F, Durante-Mangoni E, Edathodu J, Falces C, Logar M, Miró JM, Naber C, Tripodi MF, Murdoch DR, Moreillon P, Utili R, Wang A. Association between valvular surgery and mortality among patients with infective endocarditis complicated by heart failure. JAMA 2011; 306:2239-47. [PMID: 22110106 PMCID: PMC5030065 DOI: 10.1001/jama.2011.1701] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Heart failure (HF) is the most common complication of infective endocarditis. However, clinical characteristics of HF in patients with infective endocarditis, use of surgical therapy, and their associations with patient outcome are not well described. OBJECTIVES To determine the clinical, echocardiographic, and microbiological variables associated with HF in patients with definite infective endocarditis and to examine variables independently associated with in-hospital and 1-year mortality for patients with infective endocarditis and HF, including the use and association of surgery with outcome. DESIGN, SETTING, AND PATIENTS The International Collaboration on Endocarditis-Prospective Cohort Study, a prospective, multicenter study enrolling 4166 patients with definite native- or prosthetic-valve infective endocarditis from 61 centers in 28 countries between June 2000 and December 2006. MAIN OUTCOME MEASURES In-hospital and 1-year mortality. RESULTS Of 4075 patients with infective endocarditis and known HF status enrolled, 1359 (33.4% [95% CI, 31.9%-34.8%]) had HF, and 906 (66.7% [95% CI, 64.2%-69.2%]) were classified as having New York Heart Association class III or IV symptom status. Within the subset with HF, 839 (61.7% [95% CI, 59.2%-64.3%]) underwent valvular surgery during the index hospitalization. In-hospital mortality was 29.7% (95% CI, 27.2%-32.1%) for the entire HF cohort, with lower mortality observed in patients undergoing valvular surgery compared with medical therapy alone (20.6% [95% CI, 17.9%-23.4%] vs 44.8% [95% CI, 40.4%-49.0%], respectively; P < .001). One-year mortality was 29.1% (95% CI, 26.0%-32.2%) in patients undergoing valvular surgery vs 58.4% (95% CI, 54.1%-62.6%) in those not undergoing surgery (P < .001). Cox proportional hazards modeling with propensity score adjustment for surgery showed that advanced age, diabetes mellitus, health care-associated infection, causative microorganism (Staphylococcus aureus or fungi), severe HF (New York Heart Association class III or IV), stroke, and paravalvular complications were independently associated with 1-year mortality, whereas valvular surgery during the initial hospitalization was associated with lower mortality. CONCLUSION In this cohort of patients with infective endocarditis complicated by HF, severity of HF was strongly associated with surgical therapy and subsequent mortality, whereas valvular surgery was associated with lower in-hospital and 1-year mortality.
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Affiliation(s)
- Todd Kiefer
- Duke University Medical Center, Durham, NC 27710, USA
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3871
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Toyokawa N, Kokubu T, Fujioka H. MYCOBACTERIAL TUBERCULOUS TENOSYNOVITIS OF THE EXTENSOR TENDON OCCURRING AFTER LIVER TRANSPLANTATION: A CASE REPORT. ACTA ACUST UNITED AC 2011; 13:37-40. [DOI: 10.1142/s0218810408003797] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Accepted: 02/28/2008] [Indexed: 11/18/2022]
Abstract
Mycobacterial tuberculous tenosynovitis of the hand is a rare manifestation of extrapulmonary tuberculosis, while mycobacterial tuberculous tenosynovitis of the extensor tendon sheath is extremely rare. We report a case of tuberculous tenosynovitis of the extensor tendon of the finger, occurring in a man receiving immunosuppression following a liver transplantation. Symptoms improved clinically after conservative treatment with anti-tuberculous drugs.
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Affiliation(s)
- Narikazu Toyokawa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Takeshi Kokubu
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Hiroyuki Fujioka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
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3872
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Gould FK, Denning DW, Elliott TSJ, Foweraker J, Perry JD, Prendergast BD, Sandoe JAT, Spry MJ, Watkin RW, Working Party of the British Society for Antimicrobial Chemotherapy. Guidelines for the diagnosis and antibiotic treatment of endocarditis in adults: a report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 2011; 67:269-89. [PMID: 22086858 DOI: 10.1093/jac/dkr450] [Citation(s) in RCA: 294] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The BSAC guidelines on treatment of infectious endocarditis (IE) were last published in 2004. The guidelines presented here have been updated and extended to reflect developments in diagnostics, new trial data and the availability of new antibiotics. The aim of these guidelines, which cover both native valve and prosthetic valve endocarditis, is to standardize the initial investigation and treatment of IE. An extensive review of the literature using a number of different search criteria has been carried out and cited publications used to support any changes we have made to the existing guidelines. Publications referring to in vitro or animal models have only been cited if appropriate clinical data are not available. Randomized, controlled trials suitable for the development of evidenced-based guidelines in this area are still lacking and therefore a consensus approach has again been adopted for most recommendations; however, we have attempted to grade the evidence, where possible. The guidelines have also been extended by the inclusion of sections on clinical diagnosis, echocardiography and surgery.
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Affiliation(s)
- F Kate Gould
- Department of Microbiology, Freeman Hospital, Newcastle upon Tyne, UK.
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3873
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Al-Tamtami N, Al-Lawati J, Al-Abri S. Native valve endocarditis caused by coagulase negative staphylococci; an appeal to start outpatient antimicrobial therapy: an unusual case report. Oman Med J 2011; 26:269-70. [PMID: 22043433 DOI: 10.5001/omj.2011.65] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 06/11/2011] [Indexed: 11/03/2022] Open
Abstract
Coagulase negative staphylococci (CNS) were a rare cause of native valve endocarditis. However, they are emerging as an important cause of native valve endocarditis (NVE) in both community and healthcare settings. We describe a 64 yrs. old male who developed mitral valve endocarditis caused by coagulase negative staphylococci. There were no predisposing conditions or underlying cardiac disease that could have been the risk factor for the development of native valve infection. The patient had good recovery after six weeks of treatment with anti-staphylococcal antibiotics.
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3874
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Rasmussen RV, Høst U, Arpi M, Hassager C, Johansen HK, Korup E, Schønheyder HC, Berning J, Gill S, Rosenvinge FS, Fowler VG, Møller JE, Skov RL, Larsen CT, Hansen TF, Mard S, Smit J, Andersen PS, Bruun NE. Prevalence of infective endocarditis in patients with Staphylococcus aureus bacteraemia: the value of screening with echocardiography. Eur J Echocardiogr 2011; 12:414-20. [PMID: 21685200 DOI: 10.1093/ejechocard/jer023] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS Staphylococcus aureus infective endocarditis (IE) is a critical medical condition associated with a high morbidity and mortality. In the present study, we prospectively evaluated the importance of screening with echocardiography in an unselected S. aureus bacteraemia (SAB) population. METHODS AND RESULTS From 1 January 2009 to 31 August 2010, a total of 244 patients with SAB at six Danish hospitals underwent screening echocardiography. The inclusion rate was 73% of all eligible patients (n= 336), and 53 of the 244 included patients (22%; 95% CI: 17-27%) were diagnosed with definite IE. In patients with native heart valves the prevalence was 19% (95% CI: 14-25%) compared with 38% (95% CI: 20-55%) in patients with prosthetic heart valves and/or cardiac rhythm management devices (P= 0.02). No difference was found between Main Regional Hospitals and Tertiary Cardiac Hospitals, 20 vs. 23%, respectively (NS). The prevalence of IE in high-risk patients with one or more predisposing condition or clinical evidence of IE were significantly higher compared with low-risk patients with no additional risk factors (38 vs. 5%; P < 0.001). IE was associated with a higher 6 months mortality, 14(26%) vs. 28(15%) in SAB patients without IE, respectively (P < 0.05). CONCLUSION SAB patients carry a high risk for development of IE, which is associated with a worse prognosis compared with uncomplicated SAB. The presenting symptoms and clinical findings associated with IE are often non-specific and echocardiography should always be considered as part of the initial evaluation of SAB patients.
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Affiliation(s)
- Rasmus V Rasmussen
- Department of Cardiology, Copenhagen University Hospital, Gentofte, Niels Andersens vej 65, post 4210, 2900 Hellerup, Denmark.
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3875
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Wilson JW, Limper AH, Grys TE, Karre T, Wengenack NL, Binnicker MJ. Pneumocystis jirovecii testing by real-time polymerase chain reaction and direct examination among immunocompetent and immunosuppressed patient groups and correlation to disease specificity. Diagn Microbiol Infect Dis 2011; 69:145-52. [PMID: 21251557 DOI: 10.1016/j.diagmicrobio.2010.10.021] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 10/20/2010] [Accepted: 10/22/2010] [Indexed: 01/13/2023]
Abstract
We used real-time polymerase chain reaction (PCR) targeting the cdc2 gene and direct fluorescent microscopy examination (DFME) to evaluate the prevalence of Pneumocystis jirovecii among immunocompetent patients without clinical pulmonary infection and immunosuppressed patients evaluated for opportunistic pulmonary infections. Among 102 bronchoalveolar lavage samples collected from immunocompetent patients without infection, none tested positive for P. jirovecii by either DFME or real-time PCR despite the presence of other comorbidities. Among patients with suspected pulmonary infection and tested with either assay, real-time PCR produced a higher number of positive results compared to DFME and increased P. jirovecii detection by 7% when added to DFME-negative samples. Real-time PCR may have increased sensitivity for P. jirovecii detection over DFME and decrease the risk of sample contamination compared to conventional and nested PCR. The use of single-copy gene targets (e.g., cdc2) may lower the rate of "colonization" detection and confer a high predictive value for Pneumocystis pneumonia.
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3876
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Pérez JL, Ayats J, Fortún J, de Oña M, Pumarola T. Microbiología del trasplante. Enferm Infecc Microbiol Clin 2011; 29:683-90. [DOI: 10.1016/j.eimc.2011.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 03/23/2011] [Indexed: 01/09/2023]
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3877
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Abstract
OBJECTIVE To evaluate the clinical relevance and impact of an emerging bacterial pathogen, Staphylococcus lugdunensis, in a large teaching hospital. METHODS Three-year retrospective microbiological and clinical review of all S. lugdunensis isolates from a single medical center. RESULTS Seventy-seven isolates were identified; 70 had complete data. Soft tissue, bone, joint, central nervous system, urine and bloodstream infections occurred. Soft tissue infections were primarily abscesses. There were four infections of prosthetic joints and nine cases of osteomyelitis. There were 21 bacteremias, 5 of which were associated with endocarditis; 2 died. Most isolates were penicillin resistant. CONCLUSION S. lugdunensis has emerged as a major human pathogen, capable of causing significant infections at many sites. It should never be dismissed as a contaminant without careful review.
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3878
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Tatar E, Gungor O, Firat O, Kircelli F, Arda B, Harman M, Toz H, Hoscoskun C. Differential Diagnosis of an Unusual Pelvic Mass in a Renal Transplant Recipient: Multidrug-Resistant Abdominopelvic Tuberculosis. Ren Fail 2011; 33:1040-2. [DOI: 10.3109/0886022x.2011.618921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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3879
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Imai S, Ito Y, Hirai T, Imai H, Ito I, Maekawa K, Chin K, Ichiyama S, Uemoto S, Mishima M. Clinical features and risk factors of tuberculosis in living-donor liver transplant recipients. Transpl Infect Dis 2011; 14:9-16. [DOI: 10.1111/j.1399-3062.2011.00680.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 06/16/2011] [Accepted: 08/04/2011] [Indexed: 12/27/2022]
Affiliation(s)
- S. Imai
- Department of Respiratory Medicine; Kyoto University; Kyoto; Japan
| | - Y. Ito
- Department of Respiratory Medicine; Kyoto University; Kyoto; Japan
| | - T. Hirai
- Department of Respiratory Medicine; Kyoto University; Kyoto; Japan
| | - H. Imai
- Departments of Hepato-Biliary-Pancreatic and Transplant Surgery; Kyoto University; Kyoto; Japan
| | - I. Ito
- Department of Respiratory Medicine; Kyoto University; Kyoto; Japan
| | - K. Maekawa
- Department of Respiratory Medicine; Kyoto University; Kyoto; Japan
| | - K. Chin
- Departments of Respiratory Care and Sleep Control Medicine; Kyoto University; Kyoto; Japan
| | - S. Ichiyama
- Department of Clinical Laboratory Medicine; Kyoto University; Kyoto; Japan
| | - S. Uemoto
- Departments of Hepato-Biliary-Pancreatic and Transplant Surgery; Kyoto University; Kyoto; Japan
| | - M. Mishima
- Department of Respiratory Medicine; Kyoto University; Kyoto; Japan
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3880
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Kaasch AJ, Fowler VG, Rieg S, Peyerl-Hoffmann G, Birkholz H, Hellmich M, Kern WV, Seifert H. Use of a simple criteria set for guiding echocardiography in nosocomial Staphylococcus aureus bacteremia. Clin Infect Dis 2011; 53:1-9. [PMID: 21653295 DOI: 10.1093/cid/cir320] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Infective endocarditis (IE) is a severe complication in patients with nosocomial Staphylococcus aureus bacteremia (SAB). We sought to develop and validate criteria to identify patients at low risk for the development of IE in whom transesophageal echocardiography (TEE) might be dispensable. METHODS Consecutive patients with nosocomial SAB from independent cohorts in Europe (Invasive S. aureus Infection Cohort [INSTINCT]) and North America (S. aureus Bacteremia Group [SABG]) were evaluated for the presence of clinical criteria predicting an increased risk for the development of IE (ie, prolonged bacteremia of >4 days' duration, presence of a permanent intracardiac device, hemodialysis dependency, spinal infection, and nonvertebral osteomyelitis). Patients were observed closely for clinical signs and symptoms of IE during hospitalization and a 3-month follow-up period. RESULTS IE was present in 13 (4.3%) of 304 patients in the INSTINCT cohort and in 40 (9.3%) of 432 patients in the SABG cohort. Within 14 days after the first positive blood culture result, echocardiography was performed in 39.8% and 57.4% of patients in the INSTINCT and SABG cohorts, respectively. In patients with IE, the most common clinical prediction criteria present were prolonged bacteremia (69.2% vs 90% for INSTINCT vs SABG, respectively) and presence of a permanent intracardiac device (53.8% vs 32.5%). In total, 13 of 13 patients in the INSTINCT cohort and 39 of 40 patients in the SABG cohort with documented IE fulfilled at least 1 criterion (sensitivity, 100% vs. 97.5%; negative predictive value, 100% vs 99.2%). CONCLUSIONS A simple criteria set for patients with nosocomial SAB can identify patients at low risk of IE. Patients who meet these criteria may not routinely require TEE.
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Affiliation(s)
- Achim J Kaasch
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany.
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3881
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Patil R, Patil T, Hussain KMA. Staphylococcus lugdunensis native tricuspid valve endocarditis: a case report and review of literature. J Gen Intern Med 2011; 26:1209-11. [PMID: 21538169 PMCID: PMC3181301 DOI: 10.1007/s11606-011-1718-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Revised: 03/24/2010] [Accepted: 03/29/2011] [Indexed: 11/24/2022]
Abstract
Coagulase negative staphylococci are skin commensals and are generally disregarded as contaminants in clinical specimens. Repeated isolation of coagulase negative staphylococci in blood cultures should warrant a species identification to recognize unusually virulent organisms that demand aggressive treatment, such as Staphylococcus lugdunensis. Staphylococcus lugdunensis is known to cause a wide variety of infections, including a predominant left-sided endocarditis. We report a rare case of native tricuspid valve Staphylococcus lugdunensis endocarditis in a non-intravenous drug user and include a brief literature review.
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Affiliation(s)
- Ritesh Patil
- Millard Fillmore Gates Circle Hospital, Buffalo, NY 14209, USA.
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3882
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Casas S, Muñoz L, Moure R, Castellote J, Guerra MR, Gonzalez L, Andreu A, Rafecas AG, Alcaide F, Santin M. Comparison of the 2-step tuberculin skin test and the quantiFERON-TB Gold In-Tube Test for the screening of tuberculosis infection before liver transplantation. Liver Transpl 2011; 17:1205-11. [PMID: 22279622 DOI: 10.1002/lt.22375] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The ability of interferon-gamma release assays (IGRAs) to detect latent tuberculosis (TB) infection before liver transplantation (LT)is not well established. The aims of this study were (1) to compare the ability of the tuberculin skin test (TST) and the QuantiFERON-TB Gold In-Tube (QFT-IT) test (a whole-blood IGRA) to diagnose latent TB infections in patients awaiting LT and (2) to correlate the results with the severity of liver disease. We conducted a prospective, cross-sectional study of patients who were evaluated for LT between July 2008 and July 2010. The 95 patients who were included underwent the 2-step TST and the QFT-IT test. The mean Model for End-Stage Liver Disease (MELD) score was 13.8. Forty-four patients (46.3%) had positive TST results, 42 (44.2%) had positive QFT-IT results, and 2 (2.1%) had indeterminate QFT-IT results. Simultaneous TST and QFT-IT testing yielded a positivity rate of 55.8% [95% confidence interval (CI) = 45.3-65.9] with either test, and the 2-step TST yielded a positivity rate of 46.3% (95% CI = 36.1-56.8); the difference was 9.5% (P = 0.004). In an adjusted analysis, the rates for positive TST results were lower in patients with MELD scores > or = 18 [odds ratio (OR) = 0.2, 95% CI = 0.04-0.7], lower in Child-Pugh-Turcotte (CPT) class C patients versus CPT class A patients (OR = 0.1, 95% CI = 0.02-0.6), and higher in males (OR = 6.4, 95% CI = 1.9-22.0). In contrast, only being male (OR = 3.5, 95% CI = 1.1-11.0) was associated with positive QFT-IT results; no association was found with the MELD score (OR = 0.8, 95% CI = 0.2-2.8) or the CPT class (OR = 0.3; 0.05-1.4). In conclusion, the QFT-IT test is better than the TST for detecting latent TB infection in patients with more advanced liver disease. Our results support the regular use of the QFT-IT test for screening patients with end-stage liver disease for latent TB infection before LT.
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Affiliation(s)
- Susana Casas
- Department of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Barcelona, Spain
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3883
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Nelson CA, Zunt JR. Tuberculosis of the central nervous system in immunocompromised patients: HIV infection and solid organ transplant recipients. Clin Infect Dis 2011; 53:915-26. [PMID: 21960714 DOI: 10.1093/cid/cir508] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Central nervous system (CNS) tuberculosis (TB) is a devastating infection with high rates of morbidity and mortality worldwide and may manifest as meningitis, tuberculoma, abscess, or other forms of disease. Immunosuppression, due to either human immunodeficiency virus infection or solid organ transplantation, increases susceptibility for acquiring or reactivating TB and complicates the management of underlying immunosuppression and CNS TB infection. This article reviews how immunosuppression alters the clinical presentation, diagnosis, treatment, and outcome of TB infections of the CNS.
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Affiliation(s)
- Christina A Nelson
- Department of Neurology, Global Health, Medicine, and Epidemiology, University of Washington School of Medicine, Seattle, Washington, USA
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3884
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Ruhnke M, Rickerts V, Cornely OA, Buchheidt D, Glöckner A, Heinz W, Höhl R, Horré R, Karthaus M, Kujath P, Willinger B, Presterl E, Rath P, Ritter J, Glasmacher A, Lass-Flörl C, Groll AH. Diagnosis and therapy of Candida infections: joint recommendations of the German Speaking Mycological Society and the Paul-Ehrlich-Society for Chemotherapy. Mycoses 2011; 54:279-310. [PMID: 21672038 DOI: 10.1111/j.1439-0507.2011.02040.x] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Invasive Candida infections are important causes of morbidity and mortality in immunocompromised and hospitalised patients. This article provides the joint recommendations of the German-speaking Mycological Society (Deutschsprachige Mykologische Gesellschaft, DMyKG) and the Paul-Ehrlich-Society for Chemotherapy (PEG) for diagnosis and treatment of invasive and superficial Candida infections. The recommendations are based on published results of clinical trials, case-series and expert opinion using the evidence criteria set forth by the Infectious Diseases Society of America (IDSA). Key recommendations are summarised here: The cornerstone of diagnosis remains the detection of the organism by culture with identification of the isolate at the species level; in vitro susceptibility testing is mandatory for invasive isolates. Options for initial therapy of candidaemia and other invasive Candida infections in non-granulocytopenic patients include fluconazole or one of the three approved echinocandin compounds; liposomal amphotericin B and voriconazole are secondary alternatives because of their less favourable pharmacological properties. In granulocytopenic patients, an echinocandin or liposomal amphotericin B is recommended as initial therapy based on the fungicidal mode of action. Indwelling central venous catheters serve as a main source of infection independent of the pathogenesis of candidaemia in the individual patients and should be removed whenever feasible. Pre-existing immunosuppressive treatment, particularly by glucocorticosteroids, ought to be discontinued, if feasible, or reduced. The duration of treatment for uncomplicated candidaemia is 14 days following the first negative blood culture and resolution of all associated symptoms and findings. Ophthalmoscopy is recommended prior to the discontinuation of antifungal chemotherapy to rule out endophthalmitis or chorioretinitis. Beyond these key recommendations, this article provides detailed recommendations for specific disease entities, for antifungal treatment in paediatric patients as well as a comprehensive discussion of epidemiology, clinical presentation and emerging diagnostic options of invasive and superficial Candida infections.
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Affiliation(s)
- Markus Ruhnke
- Medizinische Klinik m S Onkologie u Hämatologie, Charité Universitätsmedizin, Charité, Campus Mitte, Berlin, Germany.
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3885
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Alastruey-Izquierdo A, Cuesta I, Ros L, Mellado E, Rodriguez-Tudela JL. Antifungal susceptibility profile of clinical Alternaria spp. identified by molecular methods. J Antimicrob Chemother 2011; 66:2585-7. [PMID: 21921077 DOI: 10.1093/jac/dkr365] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To analyse the susceptibility pattern of a collection of Alternaria spp. clinical isolates. METHODS The antifungal susceptibilities of 35 isolates identified by means of sequencing the internal transcribed spacer region of rDNA were analysed by European Committee on Antimicrobial Susceptibility Testing (EUCAST) methodology. RESULTS AND CONCLUSIONS No clear differences among the activity of antifungals against Alternaria alternata and Alternaria infectoria were detected, except for echinocandins.
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Affiliation(s)
- Ana Alastruey-Izquierdo
- Servicio de Micología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda (Madrid), Spain.
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3886
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3887
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Hanses F, Park S, Rich J, Lee JC. Reduced neutrophil apoptosis in diabetic mice during staphylococcal infection leads to prolonged Tnfα production and reduced neutrophil clearance. PLoS One 2011; 6:e23633. [PMID: 21912601 PMCID: PMC3166063 DOI: 10.1371/journal.pone.0023633] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Accepted: 07/21/2011] [Indexed: 12/19/2022] Open
Abstract
Diabetes is a frequent underlying medical condition among individuals with Staphylococcus aureus infections, and diabetic patients often suffer from chronic inflammation and prolonged infections. Neutrophils are the most abundant inflammatory cells during the early stages of bacterial diseases, and previous studies have reported deficiencies in neutrophil function in diabetic hosts. We challenged age-matched hyperglycemic and normoglycemic NOD mice intraperitoneally with S. aureus and evaluated the fate of neutrophils recruited to the peritoneal cavity. Neutrophils were more abundant in the peritoneal fluids of infected diabetic mice by 48 h after bacterial inoculation, and they showed prolonged viability ex vivo compared to neutrophils from infected nondiabetic mice. These differences correlated with reduced apoptosis of neutrophils from diabetic mice and were dependent upon the presence of S. aureus and a functional neutrophil respiratory burst. Decreased apoptosis correlated with impaired clearance of neutrophils by macrophages both in vitro and in vivo and prolonged production of proinflammatory tumor necrosis factor alpha by neutrophils from diabetic mice. Our results suggest that defects in neutrophil apoptosis may contribute to the chronic inflammation and the inability to clear staphylococcal infections observed in diabetic patients.
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Affiliation(s)
- Frank Hanses
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sunny Park
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jeremy Rich
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jean C. Lee
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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3889
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Theodoropoulos N, Lanternier F, Rassiwala J, McNatt G, Preczewski L, DeMayo E, Stosor V, Ison M. Use of the QuantiFERON-TB Gold interferon-gamma release assay for screening transplant candidates: a single-center retrospective study. Transpl Infect Dis 2011; 14:1-8. [DOI: 10.1111/j.1399-3062.2011.00666.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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3890
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Husain S, Mooney ML, Danziger-Isakov L, Mattner F, Singh N, Avery R, Ison M, Humar A, Padera RF, Lawler LP, Fisher A, Drew RJ, Gould KF, Sole A, Studer S, Munoz P, Singer LG, Hannan M. A 2010 working formulation for the standardization of definitions of infections in cardiothoracic transplant recipients. J Heart Lung Transplant 2011; 30:361-74. [PMID: 21419994 PMCID: PMC7172457 DOI: 10.1016/j.healun.2011.01.701] [Citation(s) in RCA: 158] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 01/17/2011] [Indexed: 02/06/2023] Open
Affiliation(s)
- Shahid Husain
- Division of Infectious Diseases, Transplant Infectious Diseases, University Health Network, University of Toronto, 100 Elizabeth Street, Toronto, Ontario, Canada.
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Wu KS, Lee SSJ, Tsai HC, Wann SR, Chen JK, Sy CL, Wang YH, Tseng YT, Chen YS. Non-nosocomial healthcare-associated infective endocarditis in Taiwan: an underrecognized disease with poor outcome. BMC Infect Dis 2011; 11:221. [PMID: 21849057 PMCID: PMC3179455 DOI: 10.1186/1471-2334-11-221] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 08/17/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-nosocomial healthcare-associated infective endocarditis (NNHCA-IE) is a new category of IE of increasing importance. This study described the clinical and microbiological characteristics and outcome of NNHCA-IE in Taiwan. METHODS A retrospective study was conducted of all patients with IE admitted to the Kaohsiung Veterans General Hospital in Kaohsiung, Taiwan over a five-year period from July 2004 to July 2009. The clinical and microbiological features of NNHCA-IE were compared to those of community-acquired and nosocomial IE. Predictors for in-hospital death were determined. RESULTS Two-hundred episodes of confirmed IE occurred during the study period. These included 148 (74%) community-acquired, 30 (15%) non-nosocomial healthcare-associated, and 22 (11%) nosocomial healthcare-associated IE. Staphylococcus aureus was the most frequent pathogen. Patients with NNHCA-IE compared to community-acquired IE, were older (median age, 67 vs. 44, years, p < 0.001), had more MRSA (43.3% vs. 9.5%, p < 0.001), more comorbidity conditions (median Charlson comorbidity index [interquartile range], 4[2-6] vs. 0[0-1], p < 0.001), a higher in-hospital mortality (50.0% vs. 17.6%, p < 0.001) and were less frequently recognized by clinicians on admission (16.7% vs. 47.7%, p = 0.002). The overall in-hospital mortality rate for all patients with IE was 25%. Shock was the strongest risk factor for in-hospital death (odds ratio 7.8, 95% confidence interval 2.4-25.2, p < 0.001). CONCLUSIONS NNHCA-IE is underrecognized and carries a high mortality rate. Early recognition is crucial to provide optimal management and improve outcome.
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Affiliation(s)
- Kuan-Sheng Wu
- Divison of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung 813, Taiwan
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Harris JR, Marston BJ, Sangrujee N, DuPlessis D, Park B. Cost-effectiveness analysis of diagnostic options for pneumocystis pneumonia (PCP). PLoS One 2011; 6:e23158. [PMID: 21858013 PMCID: PMC3156114 DOI: 10.1371/journal.pone.0023158] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 07/07/2011] [Indexed: 12/16/2022] Open
Abstract
Background Diagnosis of Pneumocystis jirovecii pneumonia (PCP) is challenging, particularly in developing countries. Highly sensitive diagnostic methods are costly, while less expensive methods often lack sensitivity or specificity. Cost-effectiveness comparisons of the various diagnostic options have not been presented. Methods and Findings We compared cost-effectiveness, as measured by cost per life-years gained and proportion of patients successfully diagnosed and treated, of 33 PCP diagnostic options, involving combinations of specimen collection methods [oral washes, induced and expectorated sputum, and bronchoalveolar lavage (BAL)] and laboratory diagnostic procedures [various staining procedures or polymerase chain reactions (PCR)], or clinical diagnosis with chest x-ray alone. Our analyses were conducted from the perspective of the government payer among ambulatory, HIV-infected patients with symptoms of pneumonia presenting to HIV clinics and hospitals in South Africa. Costing data were obtained from the National Institutes of Communicable Diseases in South Africa. At 50% disease prevalence, diagnostic procedures involving expectorated sputum with any PCR method, or induced sputum with nested or real-time PCR, were all highly cost-effective, successfully treating 77–90% of patients at $26–51 per life-year gained. Procedures using BAL specimens were significantly more expensive without added benefit, successfully treating 68–90% of patients at costs of $189–232 per life-year gained. A relatively cost-effective diagnostic procedure that did not require PCR was Toluidine Blue O staining of induced sputum ($25 per life-year gained, successfully treating 68% of patients). Diagnosis using chest x-rays alone resulted in successful treatment of 77% of patients, though cost-effectiveness was reduced ($109 per life-year gained) compared with several molecular diagnostic options. Conclusions For diagnosis of PCP, use of PCR technologies, when combined with less-invasive patient specimens such as expectorated or induced sputum, represent more cost-effective options than any diagnostic procedure using BAL, or chest x-ray alone.
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Affiliation(s)
- Julie R Harris
- Mycotic Diseases Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
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Csoma E, Mészáros B, Gáll T, Asztalos L, Kónya J, Gergely L. Dominance of variant A in human herpesvirus 6 viraemia after renal transplantation. Virol J 2011; 8:403. [PMID: 21843348 PMCID: PMC3166939 DOI: 10.1186/1743-422x-8-403] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 08/15/2011] [Indexed: 11/18/2022] Open
Abstract
Background Human herpesvirus 6 (HHV-6), mostly variant B reactivation in renal transplant patients has been published by other authors, but the pathogenetic role of HHV-6 variant A has not been clarified. Our aims were to examine the prevalence of HHV-6, to determine the variants, and to investigate the interaction between HHV-6 viraemia, human cytomegalovirus (HCMV) infection and clinical symptoms. Methods Variant-specific HHV-6 nested PCR and quantitative real-time PCR were used to examine blood samples from renal transplant patients and healthy blood donors for the presence and load of HHV-6 DNA and to determine the variants. Active HHV-6 infection was proved by RT-PCR, and active HCMV infection was diagnosed by pp65 antigenaemia test. Results HHV-6 viraemia was significantly more frequent in renal transplant patients compared to healthy blood donors (9/200 vs. 0/200; p = 0.004), while prevalence of HHV-6 latency was not significantly different (13/200 vs. 19/200; p > 0.05). Dominance of variant A was revealed in viraemias (8/9), and the frequency of HHV-6A was significantly higher in active infections compared with latency in renal transplant patients (8/9 vs. 2/13; p = 0.0015). Latency was established predominantly by HHV-6B both in renal transplant patients and in healthy blood donors (11/13 and 18/19). There was no statistical significant difference in occurrence of HCMV and HHV-6 viraemia in renal transplant patients (7/200 vs. 9/200). Statistical analysis did not reveal interaction between HHV-6 viraemia and clinical symptoms in our study. Conclusions Contrary to previous publications HHV-6A viraemia was found to be predominant in renal transplant patients. Frequency of variant A was significantly higher in cases of active infection then in latency.
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Affiliation(s)
- Eszter Csoma
- Institute of Medical Microbiology, University of Debrecen, Nagyerdei krt, 98, Debrecen, Hungary.
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3895
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Boulware DR, Hullsiek KH, Puronen CE, Rupert A, Baker JV, French MA, Bohjanen PR, Novak RM, Neaton JD, Sereti I. Higher levels of CRP, D-dimer, IL-6, and hyaluronic acid before initiation of antiretroviral therapy (ART) are associated with increased risk of AIDS or death. J Infect Dis 2011; 203:1637-46. [PMID: 21592994 DOI: 10.1093/infdis/jir134] [Citation(s) in RCA: 252] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Substantial morbidity occurs during the first year of antiretroviral therapy (ART) in persons with advanced human immunodeficiency virus (HIV) disease despite HIV suppression. Biomarkers may identify high-risk groups. METHODS Pre-ART and 1-month samples from an initial ART trial were evaluated for biomarkers associated with AIDS events or death within 1-12 months. Case patients (n = 63) and control patients (n = 126) were 1:2 matched on baseline CD4 cell count, hepatitis status, and randomization date. All had ≥ 1 log(10) HIV RNA level decrease at 1 month. RESULTS Case patients had more frequent prior AIDS events, compared with control patients (P = .004), but similar HIV RNA levels at baseline. Pre-ART and 1-month C-reactive protein (CRP), D-dimer, and interleukin 6 (IL-6) levels and pre-ART hyaluronic acid (HA) levels were associated with new AIDS events or death (P ≤ .01). Patients who experienced immune reconstitution inflammatory syndrome (IRIS) events had higher pre-ART tumor necrosis factor α (TNF-α) and HIV RNA levels and significant 1-month increases in CRP, D-dimer, IL-6, interleukin 8, CXCL10, TNF-α, and interferon-γ levels, compared with patients who experienced non-IRIS events (P ≤ .03). Individuals with baseline CRP and HA levels above the cohort median (>2.1 mg/L and >50.0 ng/mL, respectively) had increased risk of AIDS or death (OR, 4.6 [95% CI, 2.0-10.3]; P < .001) and IRIS (OR, 8.7 [95% CI, 2.2-34.8] P = .002). CONCLUSIONS Biomarkers of Inflammation (CRP, IL-6), coagulation (D-dimer), and tissue fibrosis (HA) measured pre-ART and at 1 month are associated with higher risk of AIDS events, IRIS, or death, warranting additional study as risk stratification strategies.
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3897
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Lyu J, Lee SG, Hwang S, Lee SO, Cho OH, Chae EJ, Lee SD, Kim WS, Kim DS, Shim TS. Chest computed tomography is more likely to show latent tuberculosis foci than simple chest radiography in liver transplant candidates. Liver Transpl 2011; 17:963-8. [PMID: 21506252 DOI: 10.1002/lt.22319] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Although the detection and treatment of latent tuberculosis infections (LTBIs) in transplant candidates are essential, current diagnostic methods for LTBIs are limited, especially in immunocompromised subjects. Pretransplant chest computed tomography (CT) may reveal more LTBI foci and thus predict the development of posttransplant tuberculosis (TB) more efficiently; however, this hypothesis has not yet been investigated. Thirty-six liver transplantation (LT) recipients who developed TB (the TB group) and 144 LT recipients who did not develop TB (the control group) were retrospectively enrolled into a study with a nested case-control design, and their clinical characteristics and radiological findings were compared. Tuberculin skin tests (TSTs) were not performed, and none of these patients had been treated for LTBIs. Thirty-six of 2549 LT recipients (1.4%) were diagnosed with TB after LT (median = 10 months, range = 1-80 months). Twenty-eight patients (77.8%) successfully completed the treatment. There were no significant differences in the clinical characteristics of the 2 groups. Abnormal CT findings (40.0% versus 17.3%, P = 0.018) and chest X-ray (CXR) findings (25.0% versus 11.8%, P = 0.044) suggestive of healed TB were significantly more frequent in the TB group versus the control group. Of the 10 patients who underwent chest CT and developed TB, 5 (50%) showed abnormal findings only on chest CT scans, whereas their CXR results were normal. In conclusion, a pretransplant chest CT scan is more likely to show an LTBI than a CXR in those with post-LT TB. The usefulness of chest CT along with traditional methods such as TSTs for LTBI screening should be further investigated.
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Affiliation(s)
- Jiwon Lyu
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, South Korea
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Abstract
BACKGROUND Renal transplantation is the most common type of solid organ transplantation. Recipients are susceptible to a variety of pulmonary complications, in particular during intense immunosuppression therapy. OBJECTIVE To evaluate pulmonary complications during the first year after renal transplantation. MATERIALS AND METHODS Medical records were reviewed retrospectively for all patients who underwent renal transplantation between 2007 and 2010. Data pertinent to pulmonary complications were obtained including patient demographics, findings at chest radiography and pulmonary function testing, concentrations of C-reactive protein and albumin, and white blood cell count. RESULTS The study included 136 patients (71.3% men), with mean (SD) age of 36.3 (12.2) years. The most frequently prescribed immunosuppression therapy included prednisolone plus cyclosporine, tacrolimus, or rapamycin. Fifteen patients developed complications during the first year after surgery including respiratory infections in 12 (80%), namely, bacterial pneumonia in 10 (66.6%), and tuberculosis (caused by Mycobacterium tuberculosis) in 2 (33.3%). Pneumonia developed within the first 5 months after transplantation in 6 patients, and tuberculosis after the third month. Microbiologic agents were detected in 3 of the 6 patients (20%), and empyema, postoperative atelectasis, and pulmonary embolism, respectively, in the other 3 patients. No association was observed between complications and baseline pulmonary function test results. C-reactive protein concentration was significantly increased in patients with pulmonary complications. No invasive procedures were performed to diagnose complications, all of which resolved with appropriate treatment. CONCLUSION Pulmonary infections are a primary complication in renal transplant recipients, and are observed most frequently in the first 6 months after surgery. Immunosuppression therapy is the most likely cause of these complications, and rigorous monitoring of drug concentrations is essential. An invasive diagnostic approach may not always be necessary to determine the early specific therapy.
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Affiliation(s)
- E Kupeli
- Department of Pulmonary Diseases, Baskent University School of Medicine, Ankara, Turkey.
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3899
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Abstract
The susceptibility to infection, the pathogenesis and the clinical manifestations of tuberculosis (TB) depend on the immunological status of the host. Immunological status is largely determined by age and comorbidities, but is also affected by other less well known factors. In Spain, most incidental cases of TB arise from the reactivation of remotely acquired latent infections and are favored by the aging of the population and the use of aggressive immunosuppressive therapies. The diagnosis and management of TB in these circumstances is often challenging. On the one hand, the atypical presentation with extrapulmonary involvement may delay diagnosis, and on the other, the toxicity and interactions of the antituberculous drugs frequently make treatment difficult. Immigration from resource-poor, high incidence TB countries, where the social and economic conditions are often suboptimal, adds a new challenge to the control of the disease in Spain. This chapter summarizes our current knowledge of epidemiological, clinical and treatment aspects of TB in particularly susceptible populations.
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Affiliation(s)
- Miguel Santín Cerezales
- Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge, IDIBELL, Departamento de Ciencias Clínicas, Universidad de Barcelona, Red Española de Investigación en Patología Infecciosa, Instituto de Salud Carlos III, Barcelona, Spain.
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Haley KP, Janson EM, Heilbronner S, Foster TJ, Skaar EP. Staphylococcus lugdunensis IsdG liberates iron from host heme. J Bacteriol 2011; 193:4749-57. [PMID: 21764939 DOI: 10.1128/JB.00436-11] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Staphylococcus lugdunensis is often found as part of the normal flora of human skin but has the potential to cause serious infections even in healthy individuals. It remains unclear what factors enable S. lugdunensis to transition from a skin commensal to an invasive pathogen. Analysis of the complete genome reveals a putative iron-regulated surface determinant (Isd) system encoded within S. lugdunensis. In other bacteria, the Isd system permits the utilization of host heme as a source of nutrient iron to facilitate bacterial growth during infection. In this study, we establish that S. lugdunensis expresses an iron-regulated IsdG-family heme oxygenase that binds and degrades heme. Heme degradation by IsdG results in the release of free iron and the production of the chromophore staphylobilin. IsdG-mediated heme catabolism enables the use of heme as a sole source of iron, establishing IsdG as a pathophysiologically relevant heme oxygenase in S. lugdunensis. Together these findings offer insight into how S. lugdunensis fulfills its nutritional requirements while invading host tissues and establish the S. lugdunensis Isd system as being involved in heme-iron utilization.
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