RESUMO
INTRODUCTION: Blood cultures have low sensitivity for candidemia. Sensitivity can be improved by the culture-independent system T2 Magnetic Resonance (T2). SeptiCyte RAPID is a host response assay quantifying the risk of infection-related inflammation through a scoring system (SeptiScore). We investigate the performance of SeptiScore in detecting persistent candidemia as defined by conventional cultures and T2. METHODS: This is a prospective multicentre observational study on patients with candidemia. Blood cultures and blood samples for assessment by T2 and SeptiCyte were collected for 4 consecutive days after the index culture. The performance of SeptiScore was explored to predict persistent candidemia as defined by (1) positive follow-up blood culture (2) either positive follow-up blood culture or T2 sample. RESULTS: 10 patients were enrolled including 34 blood collections assessed with the 3 methods. Overall, 4/34 (12%) follow-up blood cultures and 6/34 (18%) T2 samples were positive. A mixed model showed significantly higher SeptiScores associated with persistent candidemia when this was defined as either a positive follow-up blood culture or T2 sample (0.82, 95%CI 0.06 to 1.58) but not when this was defined as a positive follow-up blood culture only (-0.57, 95%CI -1.28 to 0.14). ROC curve for detection of persistent candidemia by SeptiScore at day 1 follow-up showed an AUC of 0.85 (95%CI 0.52-1.00) when candidemia was defined by positive follow-up blood culture, and an AUC of 1.00 (95%CI 1.00-1.00) when candidemia was defined according to both methods. CONCLUSION: Integrating transcriptome profiling with culture-independent systems and conventional cultures may increase our ability to diagnose persistent candidemia.
Assuntos
Hemocultura , Candidemia , Humanos , Candidemia/diagnóstico , Candidemia/microbiologia , Candidemia/sangue , Estudos Prospectivos , Masculino , Feminino , Hemocultura/métodos , Idoso , Pessoa de Meia-Idade , Candida/genética , Candida/isolamento & purificação , Sensibilidade e Especificidade , Idoso de 80 Anos ou mais , Curva ROCRESUMO
BACKGROUND: Persistent Staphylococcus aureus bacteremia is associated with metastatic infection and adverse outcomes, whereas gram-negative bacteremia is normally transient and shorter course therapy is increasingly advocated for affected patients. Whether the prolonged detection of pathogen DNA in blood by culture-independent systems could have prognostic value and guide management decisions is unknown. METHODS: We performed a multicenter, prospective, observational study on 102 patients with bloodstream infection (BSI) to compare time to bloodstream clearance according to T2 magnetic resonance and blood cultures over a 4-day follow-up. We also explored the association between duration of detectable pathogens according to T2 magnetic resonance (magnetic resonance-DNAemia [MR-DNAemia]) and clinical outcomes. RESULTS: Time to bloodstream clearance according to T2 magnetic resonance was significantly longer than blood culture clearance (HR, .54; 95% CI, .39-.75) and did not differ according to the causative pathogen (P = .5). Each additional day of MR-DNAemia increased the odds of persistent infection (defined as metastatic infection or delayed source control) both in the overall population (OR, 1.98; 95% CI, 1.45-2.70) and in S. aureus (OR, 1.92; 95% CI, 1.12-3.29) and gram-negative bacteremia (OR, 2.21; 95% CI, 1.35-3.60). MR-DNAemia duration was also associated with no improvement in Sequential Organ Failure Assessment score at day 7 from infection onset (OR, 1.76; 95% CI, 1.21-2.56). CONCLUSIONS: T2 magnetic resonance may help diagnose BSI in patients on antimicrobials with negative blood cultures as well as to identify patients with metastatic infection, source control failure, or adverse short-term outcome. Future studies may inform its usefulness within the setting of antimicrobial stewardship programs.
Assuntos
Bacteriemia , Sepse , Humanos , Prognóstico , Staphylococcus aureus , Estudos Prospectivos , Sepse/tratamento farmacológico , Bacteriemia/tratamento farmacológico , Espectroscopia de Ressonância Magnética , Antibacterianos/uso terapêuticoRESUMO
BACKGROUND: A prompt diagnosis of bacteraemia and sepsis is essential. Markers to predict the risk of persistent bacteraemia and metastatic infection are lacking. SeptiCyte RAPID is a host response assay stratifying patients according to the risk of infectious vs sterile inflammation through a scoring system (SeptiScore). In this study we explore the association between SeptiScore and persistent bacteraemia as well as metastatic and persistent infection in the context of a proven bacteraemia episode. METHODS: This is a prospective multicentre observational 14-month study on patients with proven bacteraemia caused by Staphylococcus aureus or Gram-negative bacilli. Samples for assessment by SeptiCyte were collected with paired blood cultures for 4 consecutive days after the index blood culture. RESULTS: We included 86 patients in the study, 40 with S. aureus and 46 with Gram-negative bacilli bacteraemia. SeptiScores over the follow-up were higher in patients with Gram-negative compared to S. aureus bacteraemia (median 6.4, IQR 5.5-7.4 vs 5.6 IQR 5.1-6.2, p = 0.002). Higher SeptiScores were found to be associated with positive blood cultures at follow-up (AUC = 0.86, 95%CI 0.68-1.00) and with a diagnosis of metastatic infection at day 1 and 2 of follow-up (AUC = 0.79, 95%CI 0.57-1.00 and AUC = 0.82, 95%CI 0.63-1.00 respectively) in the context of Gram-negative bacteraemia while no association between SeptiScore and the outcomes of interest was observed in S. aureus bacteraemia. Mixed models confirmed the association of SeptiScore with positive blood cultures at follow-up (p = 0.04) and metastatic infection (p = 0.03) in the context of Gram-negative bacteraemia but not S. aureus bacteraemia after adjusting for confounders. CONCLUSIONS: SeptiScores differ in the follow-up of S. aureus and Gram-negative bacteraemia. In the setting of Gram-negative bacteraemia SeptiScore demonstrated a good negative predictive value for the outcomes of interest and might help rule out the persistence of infection defined as metastatic spread, lack of source control or persistent bacteraemia.
Assuntos
Bacteriemia , Infecções Estafilocócicas , Humanos , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus , Bacteriemia/diagnóstico , Estudos Prospectivos , Bactérias Gram-NegativasRESUMO
The COVID-19 (coronavirus disease 2019) pandemic is associated with far-reaching psychological consequences, such as anxiety. The incidence and severity of this anxiety depend on several individual, family and social factors that need to be identified and planned for effective interventions. One of these factors is health literacy (HL). The aim of this study was to determine the relationship between HL and demographic characteristics with COVID-19 anxiety in adults living in Iran at the time of coronavirus outbreak. This is a descriptive and correlational study conducted in Iran in 2021. Convenience and snowball sampling methods were used, and as the result, the number of samples reached to 560. Data were collected online through the demographic questionnaire, COVID-19 anxiety scale (CAS) and health literacy questionnaire for adults (HLQ for adults). Data were analyzed using Amos 26, SPSS 26 software and structural equational modeling (SEM) based on covariance. Significance level in this study was considered 0.05. The results of this study showed that the fit of the modify model is confirmed and HL explains 54% of the changes in anxiety in the model (ß = -0.709). The variables of gender, history of chronic disease, positive history of COVID 19 and receiving social support have a moderating role in the relationship between HL and COVID-19 anxiety. Due to the great predicting role of HL in COVID-19 anxiety, it is recommended that programs be developed and implemented during the outbreak of the disease by experts and the public health policy makers to increase HL in physical and mental dimensions.
RESUMO
Legionella pneumophila is a well-known cause of pneumonia that is infrequently cultured in clinical practice. We report a case of an immunocompromised patient with persistently positive L. pneumophila cultures from invasive respiratory samples despite prolonged treatment with appropriate antibiotics. In vitro testing showed that the isolate remained susceptible to ciprofloxacin and azithromycin.
RESUMO
GNE myopathy is an autosomal-recessive distal myopathy. It is caused by a hypomorphic GNE gene, encoding the rate-limiting enzyme in sialic acid synthesis. This myopathy is prevalent in the Iranian Jewish (IJ) descendants because of a founder mutation GNE: p. M712T. We report a 52-year-old IJ woman who presented with a 20-year history of progressive distal muscle weakness. Physical examination and magnetic resonance imaging revealed lower-extremity weakness and atrophy. Electromyography confirmed myopathy. Genetic testing showed no mutations on the GNE gene. Muscle histochemistry demonstrated no rimmed vacuoles. The analysis of polysialylated neural cell adhesion molecule Western blot pattern was negative. Non-GNE myopathy with quadriceps sparing presentation has been previously described in a few cases of non-IJ descents. To the best of our knowledge, this is the first case of an IJ patient, presenting with quadriceps sparing myopathy, without associated GNE mutations and/or tubule-filamentous inclusions.
Assuntos
Miopatias Distais/diagnóstico , Debilidade Muscular/fisiopatologia , Miopatias Distais/diagnóstico por imagem , Miopatias Distais/fisiopatologia , Feminino , Humanos , Irã (Geográfico) , Judeus , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Debilidade Muscular/diagnóstico por imagem , Mutação , Músculo Quadríceps/diagnóstico por imagem , Músculo Quadríceps/fisiopatologiaRESUMO
AIM: Our aim was threefold: first, to determine the incidence of active TB in our cohort, second to investigate the risk factors for active TB and third, to understand current screening practices. The ultimate goal was to use our findings to inform development of local and national guidelines. METHODS: The records of all adult patients who underwent renal transplantation at our centre from 2005 to 2014 were retrospectively reviewed to assess current screening practices, the risks for and burden of active TB. RESULTS: A total of 660 individuals underwent renal transplantation during this period, totalling 3647 person years of follow up. Two patients were diagnosed with active TB after renal transplant, resulting in an incidence of 55 per 100 000 person-years. Of 656 transplant recipients, 102 (15.5%) were born in high TB incidence countries and 89 (13.5%) had an interferon gamma release assay (IGRA) at any point. Individuals born in high TB risk countries had a much higher incidence of active TB (353 per 100 000 person-years). Ten individuals had positive IGRA tests, of whom two were treated for active TB, two received chemoprophylaxis and six were not treated. CONCLUSIONS: In the absence of formal guidelines, IGRA-based screening for LTBI was infrequently performed. Our data suggest that screening and treatment of renal transplant recipients born in high incidence countries is an important preventive measure.
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Transplante de Rim/efeitos adversos , Tuberculose Latente/microbiologia , Mycobacterium tuberculosis/patogenicidade , Infecções Oportunistas/microbiologia , Adulto , Emigrantes e Imigrantes , Emigração e Imigração , Feminino , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Incidência , Testes de Liberação de Interferon-gama , Tuberculose Latente/diagnóstico , Tuberculose Latente/imunologia , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/imunologia , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/imunologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Vitória/epidemiologiaRESUMO
Tuberculous granulomatous vasculitis is commonly associated with meningitis and retinitis. We describe a 39-year-old male, with a history of pulmonary tuberculosis (TB) who presented with progressive weakness, pain, tingling and numbness in the bilateral lower extremities. Significant atrophy and weakness of the lower extremities were evident along with absent reflexes. Nerve conduction studies and electromyography showed severe axonal polyneuropathy and denervation on the lower extremities. Nerve biopsy demonstrated small vessel leukocytoclastic vasculitis without any granuloma formation. Muscle biopsy was consistent with denervation and atrophy with target fiber changes. Tuberculosis-related vasculitis causing peripheral neuropathy is extremely rare and our case is unique in manifesting this presentation.
Assuntos
Farmacorresistência Viral , Genótipo , Infecções por HIV/virologia , Inibidores de Integrase de HIV/farmacologia , Integrase de HIV/genética , HIV/efeitos dos fármacos , HIV/enzimologia , Adulto , Austrália , Feminino , HIV/genética , HIV/isolamento & purificação , Humanos , Mutação de Sentido IncorretoAssuntos
Gânglios Sensitivos/fisiopatologia , Doenças do Sistema Nervoso Periférico/complicações , Síndrome de Sjogren/complicações , Feminino , Gânglios Sensitivos/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Condução Nervosa/fisiologia , Doenças do Sistema Nervoso Periférico/diagnóstico por imagem , Doenças do Sistema Nervoso Periférico/fisiopatologia , Síndrome de Sjogren/diagnóstico por imagem , Síndrome de Sjogren/fisiopatologia , Vértebras Torácicas/diagnóstico por imagemRESUMO
Nocardia infection of the central nervous system (CNS) is an uncommon but clinically important disease, often occurring in immunocompromised individuals and carrying a high mortality rate. We present 20 cases of microbiologically proven CNS nocardiosis diagnosed in Queensland from 1997 to 2015 and review the literature from 1997 to 2016.Over 50% of cases occurred in immunocompromised individuals, with corticosteroid use posing a particularly significant risk factor. Nine (45%) patients were immunocompetent and 3 had no comorbidities at time of diagnosis. Nocardia farcinica was the most frequently isolated species (8/20) and resistance to trimethoprim-sulfamethoxazole (TMP-SMX) was found in 2 isolates. Overall, 35% of our patients died within 1 year, with the majority of deaths occurring in the first month following diagnosis. Interestingly, of the 7 deaths occurring at 1 year, 6 were attributed to N farcinica with the seventh isolate being unspeciated, suggesting the virulence of the N farcinica strain.
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Infecções Bacterianas do Sistema Nervoso Central , Nocardiose , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Bacterianas do Sistema Nervoso Central/diagnóstico , Infecções Bacterianas do Sistema Nervoso Central/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nocardiose/diagnóstico , Nocardiose/tratamento farmacológico , Queensland , Estudos RetrospectivosAssuntos
Doenças Transmissíveis Emergentes/transmissão , Viagem , Infecção por Zika virus/transmissão , Adulto , Austrália/etnologia , Doenças Transmissíveis Emergentes/diagnóstico , Doenças Transmissíveis Emergentes/epidemiologia , Estudos Transversais , Serviço Hospitalar de Emergência , Humanos , Masculino , Melanesia , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/epidemiologiaAssuntos
Ataxia/complicações , Síndrome de Cogan/complicações , Adulto , Negro ou Afro-Americano , Apraxias/congênito , Ataxia/genética , Síndrome de Cogan/genética , DNA Helicases , Humanos , Imageamento por Ressonância Magnética , Masculino , Enzimas Multifuncionais , Mutação/genética , RNA Helicases/genéticaRESUMO
BACKGROUND: Acute onset of a sensory alien hand phenomenon has been observed only from a supratentorial lesion involving the non-dominant hand, mostly from a right posterior cerebral artery infarction. A single acute vascular lesion resulting in a dominant hand sensory alien hand syndrome has not been previously documented. CASE REPORT: A 78-year old right-handed woman exhibited right sensory alien hand phenomenon from a left pontine hemorrhage. Disturbance of proprioceptive input and visuospatial perception are likely to play a role in manifesting the sign. CONCLUSIONS: Dominant-hand sensory alien hand phenomenon may occur in an acute setting from a left pontine hemorrhage.
Assuntos
Anticoagulantes/efeitos adversos , Toxidermias/etiologia , Doenças Palpebrais/induzido quimicamente , Pele/patologia , Varfarina/efeitos adversos , Idoso de 80 Anos ou mais , Feminino , Implante de Prótese de Valva Cardíaca , Humanos , Necrose/induzido quimicamente , Pele/efeitos dos fármacosRESUMO
PURPOSE: To study the characteristics and outcomes of choroidal neovascularization (CNV) developing after surgery for idiopathic macular holes. METHODS: Retrospective, noncomparative case series. Search of diagnostic and procedure databases of four participating institutes identified nine eyes of eight patients with CNV after surgery for idiopathic macular hole. Demographic, clinical, and fundus fluorescein angiographic data were abstracted from patients' medical records. RESULTS: Choroidal neovascularization developed 6 weeks to 30 months after macular hole surgery. The macular hole was closed in all cases. The CNV complex involved the foveal region in 9 (100%) eyes, was predominantly classic in 8 (89%) eyes, and was associated with moderate to severe leakage of fluorescein in 8 (89%) eyes. The CNV was crescent-shaped and spared the central area of retinal pigment epithelial mottling that corresponded to the site of the macular hole in 6 (67%) cases. Other fluorescein angiographic features included retinal pigment epitheliopathy in 6 (67%) eyes and presence of drusen in 7 (78%) eyes. The final visual acuity after a mean follow-up period of 11.2 months (range, 3-16 months) was 20/50 to 20/80 in 2 (22%) eyes, 20/100 to 20/200 in 1 (11%) eye, and less than 20/200 in 6 (67%) eyes. CONCLUSION: Choroidal neovascular complexes occurring after macular hole surgery tend to share certain characteristics, including foveal involvement, frequent sparing of the central area corresponding to the site of the closed macular hole, and generally poor visual outcomes. Therapeutic modalities including photodynamic therapy and surgical options may be considered in these patients.