Altered peripheral lymphocyte subsets in untreated systemic lupus erythematosus patients with infections

The leading cause of death in systemic lupus erythematosus (SLE) patients is infection. The objective of this study was to evaluate the distribution of lymphocyte subsets in untreated SLE patients with infections. This was a cross-sectional study. Data from January 2017 to May 2018 were collected. Flow cytometry was used to measure the peripheral lymphocyte subsets including CD3+T cells, CD4+T cells, CD8+T cells, CD19+B cells, CD3-CD16+CD56NK cells, and CD3+CD16+CD56NKT cells in 25 healthy controls and 52 treatment-naive SLE patients, among whom 13 were complicated with infections. Association between the lymphocyte subsets and infections was further analyzed. SLE patients with infections (n=13) showed a significantly higher incidence rate of fever (84.6 vs 28.2%) and serositis (84.6 vs 23.1%), increased level of erythrocyte sedimentation rate (60.5±30.1 vs 37.4±27.1 mm/h), serum C-reactive protein (CRP) (102.7±94.9 vs 9.4±14.9 mg/L), procalcitonin (PCT) (1.07±0.08 vs 0.16±0.13 μg/L), and lower blood hemoglobin (Hb) (93.0±20.5 vs 110.4±16.0 g/L) level compared with non-infection patients (n=39) (all P<0.05). In comparison with non-infectious SLE patients (387.9±261.6/μL), CD4+T cells count decreased significantly in infectious SLE patients (217.8±150.4/μL) (P<0.05), and it was negatively correlated with infection-related indicators including PCT (r=−0.573, P=0.041) and CRP (r=−0.596, P=0.032) levels. Our findings suggested that abnormalities of peripheral lymphocyte subsets were related to the immune disorder of lupus itself, regardless of immunosuppressive treatment. Monitoring lymphocyte subsets, especially CD4+T cells, may be helpful for identifying the presence of infection in SLE patients.

T cell subsets and immunoglobulin G levels are associated with the infection status of systemic lupus erythematosus patients

Systemic lupus erythematosus (SLE) is a chronic, autoimmune disorder that affects nearly all organs and tissues. As knowledge about the mechanism of SLE has increased, some immunosuppressive agents have become routinely used in clinical care, and infections have become one of the direct causes of mortality in SLE patients. To identify the risk factors indicative of infection in SLE patients, a case control study of our hospital's medical records between 2011 and 2013 was performed. We reviewed the records of 117 SLE patients with infection and 61 SLE patients without infection. Changes in the levels of T cell subsets, immunoglobulin G (IgG), complement C3, complement C4, globulin, and anti-double-stranded DNA (anti-ds-DNA) were detected. CD4+ and CD4+/CD8+ T cell levels were significantly lower and CD8+ T cell levels were significantly greater in SLE patients with infection than in SLE patients without infection. Additionally, the concentrations of IgG in SLE patients with infection were significantly lower than those in SLE patients without infection. However, complement C3, complement C4, globulin, and anti-ds-DNA levels were not significantly different in SLE patients with and without infection. Therefore, clinical testing for T cell subsets and IgG is potentially useful for identifying the presence of infection in SLE patients and for distinguishing a lupus flare from an acute infection.

Eritrosedimentación extremadamente elevada en una población de adultos en la ciudad de Buenos Aires / Extremely elevated erythrosedimentation in an adult population in the City of Buenos Aires

Resumen Introducción: Una velocidad de eritrosedimentación (VHS) extremadamente elevada, definida como mayor o igual a 100 mm/h, se ha asociado a condiciones graves subyacentes como enfermedades infecciosas, enfermedades del colágeno u oncológicas. Objetivo: Analizar un grupo de pacientes para determinar los diagnósticos de base y las características que se asocian con valores de VHS mayores a 100 mm/h en nuestro medio. Pacientes y Métodos: Estudio tipo observacional de corte transversal, con recolección retrospectiva de datos de pacientes adultos con al menos un valor de VHS mayor o igual a 100 mm/h, registrado en el laboratorio entre enero de 2002 y agosto de 2014 en el Hospital Italiano de Buenos Aires. Resultados: Durante el período evaluado se analizaron 879 pacientes mayores de 18 años. La mediana de los valores de VHS fue 111 mm/h (Rango intercuartil 105-120). La etiología prevalente de VHS elevada fueron las enfermedades infecciosas (41,6%), seguida de malignidad (21,6%) y de autoinmune/inflamatoria (12,9%). El diagnóstico individual más frecuente fue el de neumonía (11,4%), seguido por causa indeterminada (5,9%). Conclusión: En pacientes internados, la causa más frecuente de VHS ≥ 100 mm/h fue las enfermedades infecciosas, mientras que en pacientes ambulatorios la causa más frecuente fue la malignidad.

Background: An extremely elevated erythrosedimentation rate (ESR), defined as equal or higher than 100 mm/h, has been linked to serious underlying conditions, such as infections, connective tissue and oncologic disease. Aim: To analyze a group of patients in order to determine the underlying diagnosis and the characteristics associated with extremely elevated ESR in our environment. Methods: Cross-sectional study of adult patients, who presented with at least one ESR equal or higher than 100 mm/h at Hospital Italiano, in Buenos Aires (Buenos Aires, Argentina) between January 2002 and August 2014. Results: During the previously stated period of time, we analyzed the results of 879 patients. All patients were over 18 years of age. The median for the ESR results was 111 mm/h (interquartile range 105-120). The most prevalent etiology of an elevated ESR was infectious (41.64%), followed by malignancies (21.62%) and autoimmune / inflammatory diseases (12.97%). The most frequent individual diagnosis found was pneumonia (11.49%), followed by undetermined causes (5.92%). Conclusion: When comparing inpatient versus outpatient populations, the most frequent cause was infectious in the former group, while malignancies were the most frequent diagnosis in the latter.

Characterization of nCD64 expression in neutrophils and levels of s-TREM-1 and HMGB-1 in patients with suspected infection admitted in an emergency department / Caracterización de la expresión de nCD64 en neutrófilos y de los niveles de s-TREM-1 y HMGB-1 en pacientes con sospecha de infección admitidos en el departamento de emergencias

Introduction: The nCD64 receptor, the soluble triggering receptor expressed in myeloid cells (s-TREM-1), and the high mobility group-box 1 protein (HMGB-1) have been proposed as significant mediators in sepsis. Objective: To evaluate the prognostic value of these markers in patients with suspected infection recently admitted in an emergency department (ED). Materials and methods: All patients who presented to the ED with suspected infection were eligible for enrollment in this study. Baseline clinical data, Sequential Organ Failure Assessment score (SOFA) score, APACHE II score, HMGB-1 levels, s-TREM-1 levels, and nCD64 levels were analyzed. The HMGB-1 and sTREM-1 serum concentrations were determined using commercially available ELISA kits, and CD64 on the surface of neutrophils was measured by flow cytometry. Results:. A total of 579 patients with suspected infection as their admission diagnosis were enrolled in this study. The median patient age was 50 years (IQR = 35-68). Morbidity during the 28-day followup period was 11.1% (n=64). The most frequent diagnosis at the time of admission was communityacquired pneumonia (CAP) in 23% (n=133) patients, followed by soft tissue infection in 16.6% (n=96), and urinary tract infection in 15% (n=87). After multivariable analysis, no significant association was identified between any biomarker and 28-day mortality. Conclusion: In the context of a tertiary care hospital emergency department in a Latin-American city, the nCD64 receptor, s-TREM-1, and HMGB-1 biomarkers do not demonstrate prognostic utility in the management of patients with infection. The search continues for more reliable prognostic markers in the early stages of infection.

Introducción. El receptor CD64, receptor soluble ´desencadenador´ expresado en células mieloides (sTREM-1) y la proteína del grupo Box-1 de alta movilidad (HMGB-1), se han propuesto como mediadores en la sepsis. Objetivo. Evaluar el valor pronóstico de estos marcadores en pacientes con sospecha de infección, recientemente admitidos en un departamento de emergencias. Materiales y métodos. Se incluyeron en el estudio pacientes que consultaron al hospital con sospecha de infección. Se analizó la base de datos clínica, el puntaje SOFA, el puntaje APACHE II, los niveles de HMGB-1, los niveles de sTREM-1 y los niveles de nCD64. Se determinaron las concentraciones en suero de HMGB-1 y sTREM-1, usando kits de ELISA disponibles comercialmente, y la de CD64 se midió por citometría de flujo. Resultados. Se analizaron 579 pacientes con sospecha de infección al ingreso. La edad media fue de 50 años (rango intercuartílico=35-68), y 11,1 % (n=64) murieron durante el seguimiento de 28 días. El diagnóstico más frecuente en el momento del ingreso fue neumonía adquirida en la comunidad, en 23 % (n=133) de los pacientes, seguida de infección de tejidos blandos, en 16,6 % (n=96), e infección urinaria, en 15 % (n=87). Después de un análisis multivariado, no hubo asociación significativa entre ningún biomarcador y la mortalidad a los 28 días. Conclusión. Los resultados sugieren que en el contexto de un departamento de emergencias de tercer nivel de una ciudad latinoamericana típica, los tres marcadores evaluados no ofrecieron ninguna ventaja en el pronóstico de infección. La búsqueda de marcadores pronósticos más confiables en estadios tempranos de la infección aún continúa abierta.

Serum zinc and neutrophil function in lower, middle and upper socioeconomic groups

To assess the serum zinc and neutrophil function levels in different socioeconomic groups. A total of 100 healthy subjects of 10-30 years of age, both male and female were investigated. Out of these, 50 [25 males and 25 females] belonged to the lower socioeconomic [LSEC] group and 50 [25 males and 25 females] belonged to the upper / upper middle socioeconomic [USEC] group. Serum zinc was determined by colorimetric method and neutrophil function was estimated by the Nitroblue Tetrazolium reduction test [NBT]. Both the parameters were compared in the two socioeconomic [SEC] groups. It was found that serum zinc was significantly lower in the LSEC group. Similarly NBT percentage phagocytosis was also significantly lower in the LSEC group as compared to the USEC group. NBT percentage phagocytosis did not show significant gender difference in the LSEC group, however it was significantly higher in females than in males in the USEC group. Generally a significant positive correlation was found between serum zinc and neutrophil phagocytic function. The LSEC class has low serum zinc levels and low NBT percentage phagocytosis and hence is at greater risk of developing infections.

Revisão sistemática e metanálise sobre o valor preditivo da proteína C-reativa em infecção pós-operatória / Systematic review and meta-analysis of the predictive value of C-reactive protein in postoperative infections / Revisión sistemática y meta-análisis sobre el valor predictivo de la proteína C-reactiva en infección postoperatorias

Revisão sistemática sobre a proteína C-reativa (PCR) a fim de identificar seu valor preditivo no prognóstico/diagnóstico de infecção em pacientes cirúrgicos. As fontes de busca foram: COCHRANE, EMBASE, LILACS, MEDLINE E OVID, e referências bibliográficas dos estudos encontrados. Em todos os estudos a elevação dos níveis de PCR foi observada após a cirurgia e na presença de infecções pós-operatórias (PO), em oito estudos um pico de PCR entre o segundo e o terceiro PO foi relatado como aspecto normal da curva de PCR, declinando em pacientes sem complicações pós-operatórias, e elevando em pacientes com complicações. A metanálise revelou média de 85 por cento (sensibilidade), 86 por cento (especificidade), a área sob a curva SROC foi de 0,9060, e a Odds Ratio foi de 23,56. A PCR com outras intervenções clínicas apresenta alto valor no prognóstico/ diagnóstico de infecção pós-cirúrgica.

This systematic review on C-reactive protein (CRP) was performed with the purpose to identify its predictive value in the prognosis/diagnosis of infection in surgical patients. The sources used in the search were: COCHRANE, EMBASE, LILACS, MEDLINE and OVID, and bibliographic references of the located studies. All studies found increased CRP levels after surgery in cases of postoperative infection (PO), in eight studies a CRP peak between the second and third PO was reported as normal aspect of the CRP curve, reducing in patients without postoperative complications and increasing in patients with complications. The meta-analysis revealed an average of 85 percent (sensitivity), 86 percent (specificity), the area under the SROC curve was 0.9060, and the Odds Ratio was 23.56. Along with other clinical interventions, CRP is considerably valuable in the prognosis/diagnosis of postoperative infections.

Revisión sistemática sobre la proteína C-reactiva (PCR) para identificar su valor predictivo en pronóstico/diagnóstico de infección en pacientes quirúrgicos. Las fuentes de búsqueda fueron: COCHRANE, EMBASE, LILACS, MEDLINE y OVID, y referencias bibliográficas de los estudios encontrados. En todos los estudios la elevación de los niveles de PCR fue observada después de la cirugía y en presencia de infecciones postoperatorias (PO), en 8 estudios un pico de PCR entre el 2º y el 3º PO fue definida como aspecto normal de la curva de PCR, declinando en pacientes sin complicaciones postoperatorias, y elevándose en pacientes con tales complicaciones. El meta-análisis determinó una media de 85 por ciento (sensibilidad), 86 por ciento (especificidad), el área bajo la curva SROC fue de 0,9060, y el Odds Ratio fue de 23,56. La PCR junto a otras intervenciones clínicas presenta alto valor en el pronóstico/diagnóstico de infección post quirúrgica.

Enxerto aorto bi-ilíaco com veia femoral superficial: uma opção nas infecções de próteses e endopróteses aórticas - relato de caso / Aorto biiliac bypass with superficial femoral vein: an option in aortic grafts and endografts infection - a case report

Uma das complicações mais temidas na cirurgia vascular é a infecção do enxerto sintético. Afeta 2 por cento dos procedimentos cirúrgicos convencionais e 0,3 a 6 por cento dos procedimentos endovasculares. Relatamos o caso de paciente tratada de aneurisma de aorta abdominal por ambos os métodos e que, após seis anos, foi submetida a retirada das próteses devido à infecção. A veia femoral superficial bilateral foi usada como substituto, com sucesso.

One of the most feared complications in vascular surgery is the infection of synthetic graft. It affects 2 percent of conventional surgery procedures and about 0.3 to 6 percent of endovascular procedures. We report the case of a patient treated for abdominal aortic aneurysm with both methods; after six years, this patient had the prosthesis removed because of infection. Bilateral superficial femoral vein were used as substitute with success.

Projeto para prevenção de infecção de corrente sanguínea relacionada a cateter: avaliação de um indicador de processo / Project for prevention of infection of catheter-related bloodstream: evaluation of a process indicator

O Cateter Venoso Central (CVC) é indispensável na prática médica atual...

Síndrome de Lemierre: relato de caso / Lemierre syndrome: case report

A síndrome de Lemierre é uma doença rara, mais comum em jovens, causada frequentemente pelo Fusobacterium necrophorum. Inicia-se com faringite e propaga-se até a veia jugular interna, promovendo uma fonte de bacteremia contínua e êmbolos sépticos pulmonares. Manifestações clínicas incluem febre, alterações respiratórias e massa cervical. O diagnóstico é realizado por tomografia computadorizada e duplex scan, além de hemocultura ou cultura direta. O tratamento é realizado com antibióticos beta-lactâmicos resistentes a beta-lactamases, sendo a cirurgia raramente necessária. Paciente do sexo feminino, 34 anos, com quadro de orofaringite, evoluiu em 48 horas com queda do estado geral, febre, aumento de volume e dor em região cervical esquerda...

Lemierre syndrome is a rare disease. It often affects young adults and is most frequently caused by Fusobacterium necrophorum. The initial event is pharyngitis, which extends to the internal jugular vein, serving as source of continuous bacteremia and septic pulmonary emboli. Clinical manifestations include fever, respiratory distress, and swollen cervical lymph nodes. Diagnosis is established based on blood culture or direct blood culture and confirmed by computed tomography and/or duplex scan. Treatment consists of administration of beta-lactamase resistant beta-lactam antibiotics...

Influence of infection on iron profile in severely malnourished children.

Objective. To study the iron profile and find out an accurate diagnostic tool which reflects iron status in different types of infection in severely malnourished children aged 12 months to 71 months. Methods. Hundred and Eight (108) children of whom 72 children were infected and 36 non infected severely malnourished children according to WHO criteria in the age group of 12-71 months were interrogated. 36 healthy control in the same age group were also interrogated. Results. Mean serum iron, total iron binding capacity (TIBC), ferritin concentration in normal children were significantly higher (P<0.001) than non-infected severely malnourished children. On the other hand mean serum ferritin concentration was significantly higher (P<0.001) in infected group than non-infected group but still lower than normal. Mean serum TIBC concentration significantly reduced in severely malnourished children than normal children but no significant difference was observed between non-infected and infected group. Mean serum iron, and transferrin saturation were significantly reduced (P<0.05) in parasitic infestation. Conclusion. Severely malnourished children had reduced mean serum iron profile. Parasitic infestation influenced the marked reduction of mean serum iron concentration and transferrin saturation level. Mean serum iron concentration was reduced in acute respiratory infection(ARI) and parasitic infestation than other infections. Serum ferritin concentration was elevated in all types of infection as acute phase protein but still lower than normal. So Iron, TIBC and Transferin saturation <16% constitute good evidence for iron deficiency in both infected and non-infected severely malnourished children.

Significance of C-reactive protein during febrile neutropenia in pediatric malignancies.

Fifty episodes of febrile neutropenia (FN) in 33 children with malignancies were studied to evaluate the usefulness of C-reactive protein (CRP) levels as an indicator of infection, and the efficacy of antibiotic therapy. Nineteen FN episodes occurred in children with documented infection whereas, 9 and 22 episodes occurred with probable infection and fever of unknown origin, respectively. CRP positivity during episodes of documented and probable infection was significantly higher than with febrile episodes of unknown origin. Blood culture was positive in 15 episodes; of these, CRP was positive in 11. CRP declined to normal on 7th day of antibiotic therapy. CRP is a useful indicator of infection in neutropenic children and also in determining the efficacy of antibiotic therapy.

Reactive thrombocytosis following acute infection and pancytopenia

A 15-year-old girl was admitted with a fifteen day history of high grade intermittent fever with chills along with passage of loose watery stools, 6-8 times/day, not containing any blood or mucus. On examination, she was thin lean girl, who was markedly pale but fully conscious and well oriented. Initial laboratory investigations were suggestive of pancytopenia with haemoglobin of 4.7 g/dl; white cell count 1.3x10[9]/1 and a platelet count of 13x10[9]/1. Mean corpuscular volume [MCV] was 99.3 fl, while peripheral blood film showed macrocytosis, anisocytosis and poikilocytosis. Erythrocyte sedimentation rate was 120 mm at the end of 1st hr and C-reactive proteins were elevated. Her ALT was raised to 70 U/L, bilirubin and alkaline phosphatase were with in normal limits. Serology for Hepatitis B and C was negative. Reticulocyte count was 1%. Her bone marrow aspiration and trephine biopsy showed hypercellularity with megaloblastic as well as dyserythroblastic cells suggesting a differential diagnosis of either myelodysplasia secondary to some infections or aplastic anemia in evolution. Injection Trividox B1, B6, and B12] and folic acid were also added to treatment because her serum B12 level was found to be at lower normal limit. Complete picture repeated 15 days showed a platelet count of 1610 x 10[9]/L. This high countindicated reactive thrombocytosis confirming bone marrow recovery. The probable cause of this reactive thrombocytosis was recovery from acute infection or Vit B12 supplementation

Construções e redefinições: as toxoplasmoses / Constructions and redefinitions: the toxoplasmosis

Esta tese tem como objeto o processo de redefinição da categoria diagnóstica infecção/doença Toxoplasmose. É um estudo qualitativo, inserido no campo science studies, de abordagem crítica reformista e de natureza empírico-analítica. Vincula-se à linha de pesquisa intitulada Instituições, saberes e práticas em saúde e ao projeto Os médicos e a ciência do Instituto de Medicina Social da Universidade do Estado do Rio de Janeiro. As unidades de análise foram: 1) Agentes envolvidos na produção do conhecimento científico em nível local; 2) Documentos normativos locais; 3) Documentos normativos nacionais e internacionais; 4) Instituição: Laboratório Reconhecer do Centro de Biociências e Biotecnologia (CBB), da Universidade Estadual do Norte Fluminense Darcy Ribeiro (UENF/Darcy Ribeiro). Como técnicas de pesquisa foram utilizadas a observação etnográfica, entrevistas e pesquisa documental da produção científica. Os pressupostos foram de que essa redefinição seja decorrente de uma construção (Hacking, 1999; Latour, 1997, 2000, 2001) e realizada em uma arena transepistêmica (Knor-Cetina, 1981). Foram acrescidos a esses conceitos, os de referência circulante (Latour, 2001) e os da taxonomia dos elementos dos objetos da ciência laboratorial, ou seja, os conceitos idéias, marcas e coisas (Hacking,1992). Considerando essa dinâmica, as redefinições em relação a essa infecção/doença estariam em um período de pouca estabilização, embora elas não se definiriam completa e eternamente pela dependência que possuem do invólucro espaço-temporal (Latour, 2001) e da referência circulante.

This thesis has as object the process of redefinition of the disgnostic categoryinfection/illness "Toxoplasmosis". It is a qualitative, inserted study in the field "science studies", of reformist critical boarding and empiricist- analytical nature. The line of intitledresearch is associated to it "Institutions, to know and practical in health" and to the project "the doctors and the science" of the Institute of Social Medicine of the University of the Stateof Rio De Janeiro. The units of analysis had been: 1) "involved Agents" in the production of the scientific knowledge in local level; 2) local normative Documents; 3) national and international normative Documents; 4) Institution: Laboratory To recognize of the Center of Biosciences and Biotechnology (CBB), of the State University of the Of the state of Rio deJaneiro North Darcy Ribeir (UENF/Darcy Ribeiro). As research techniques had been used the etnografic observation, interviews and documentary research of scientific production. The estimated ones had been of that this redefinition is decurrent of a "construction" (Hacking,1999; Latour, 1997, 2000, 2001) and carried through in a "transepistemic arenas" (Knor-Cetina, 1981). They had been increased to these concepts, of “circulating reference” (Latour, 2001) and of the taxonomy of the elements of objects of laboratorial science, that is, the concepts "ideas", “marks” and “things” (Hacking, 1992). Considering this dynamics, the redefinitions in relation to this infection/illness would be in a period of little stabilization, even so they are not defined completely and perpetual for the dependence that possess of the "pack space-weather" (Latour, 2001) and of the "circulating reference".

Pantoea agglomerans bloodstream infection in preterm neonates

To report an uncommon incidence of sporadic bloodstream infection [BSI] caused by Pantoea agglomerans in preterm neonates. Case Presentation and Intervention: Fives cases of nosocomial BSI with P. agglomerans in preterm neonates [weight 1,500 g; age 8-17 days; gestational age 26-30 weeks] are presented. All cases were late onset neonatal sepsis [> 7 days of age]. Lethargy, skin mottling and bradycardia were often present. Although there was no evidence of pneumonia, desaturation was a common feature. Thrombocytopenia developed in 4 patients, metabolic acidosis in 2 and jaundice in 2. No bleeding tendency or disseminating intravascular coagulation was recorded. Organisms cultured from blood were identified by the Vitek-2 system [bioMerieux, France] and the findings confirmed by testing the isolate on the API 20E system. All isolates shared in vitro susceptibility to gentamicin, amikacin, ciprofloxacin, piperacillin/tazobactam and meropenem. One patient was treated with a cefotaxime/amikacin combination, 2 with meropenem and the remaining 2 with tazocin. All patients responded well to antibiotic treatment and survived. P. agglomerans is an unusual pathogen in the etiology of neonatal sepsis. Despite significant clinical deterioration, early detection and proper antibiotic therapy carry a favorable outcome

Epidemiologia das infecções da corrente sanguínea / Bloodstream infections epidemiology

As infecções da corrente sangüínea (ICS) são patologias graves que afetam, principalmente, pacientes criticamente enfermos internados em Unidades de Terapia Intensiva (UTI) e submetidos a procedimentos invasivos, entre eles cateter venoso central (CVC). Os dados mais relevantes, na maioria dos trabalhos revisados neste estudo foram: a incidência de sepse na ordem de 1,3 por cento, o aumento anual da taxa de incidência de 8,9 por cento, a inversão do predomínio de Gram-negativos para Gram-positivos, a diminuição da mortalidade e o aumento na incidência de disfunção orgânica ao longo dos anos. A taxa de ocorrência de sepse grave variou de 0,26 por cento, em pacientes de enfermaria, a 27 por cento, em pacientes de UTI e a taxa de mortalidade por sepse ocorreu em torno de 30 por cento. Os principais responsáveis pelas ICS foram: as condições do hospedeiro, os fatores microbiológicos, terapêuticos e ambientais. A uniformização dos conceitos mostrou-se essencial para a comparabilidade dos estudos científicos e o estabelecimento do perfil epidemiológico das ICS

Concurrent increased high sensitivity C-reactive protein and chronic infections are associated with coronary artery disease: a population-based study.

BACKGROUND: An elevated serum level of C-reactive protein (CRP) is an independent predictor of coronary artery disease (CAD). Chronic infections have also been implicated in the pathogenesis of CAD. AIMS: To investigate how concomitant chronic infection and CRP related to electrocardiogram-defined CAD in a general population. SETTING AND DESIGN: A population-based cross-sectional study, which was conducted in three Iranian ports in the northern Persian Gulf. MATERIALS AND METHODS: For evaluation of CAD, we used Minnesota coding criteria of a 12-lead resting electrocardiogram in 1,754 subjects, aged 25 years and over, selected by cluster random sampling. Sera were analyzed for IgG antibodies to Chlamydia pneumoniae (C. pneumoniae), Herpes simplex virus type 1 (HSV-1), Helicobacter pylori (H. pylori) and cytomegalovirus (CMV) using ELISA. Measurement of CRP by a high-sensitivity CRP assay was done. STATISTICAL ANALYSIS: Multiple logistic regression analysis was used. RESULTS: None of the infectious agents (CMV, H. pylori, C. pneumoniae and HSV-1) showed a significant association with electrocardiogram-defined CAD after adjusting for sex and age. Elevated CRP levels did not show significant association with electrocardiogram-defined CAD independent of seropositivity to one of the four infectious agents, but concurrent elevated CRP levels (>10.0 mg/L) and anti-C. pneumoniae [OR = 1.68 (CI, 1.24-2.59; P=0.04)], H. pylori [OR = 1.98 (CI, 1.26-3.13; P=0.003)], CMV [OR = 1.66 (CI, 1.10-2.49; P=0.01)] or HSV-1 [OR=1.79 (CI, 1.18-2.72; P=0.006)] IgG antibodies were associated with prevalence of electrocardiogram-defined CAD in the general population, after adjustment for multiple risk factors, including age, sex and the components of the metabolic syndrome. CONCLUSIONS: Beyond traditional cardiovascular risk factors, concomitant chronic infection and elevated CRP are significantly correlated with electrocardiogram-defined CAD.

Bacterial isolates from fatal cases of bloodstream infections at a university hospital in Central, Saudi Arabia

To describe the microbiology, underlying medical conditions and risk factors contributing to bloodstream infection [BSI] and mortality at a University Hospital in Riyadh, Kingdom of Saudi Arabia. We conducted this study at King Khalid University Hospital, Riyadh, Saudi Arabia, wherein clinical data from patients who died with BSI were collected. All isolates from these patients, from 1 January to 31 December 2004, were identified and antimicrobial susceptibilities were determined. Of the total 778 patients with BSI, 82 [10.5%] died. Among which 34 [41.5%] were elderly. Half of the patients were from the intensive care units [ICUs]. Cardiovascular diseases were the most common diagnosis in 14 [17.1%] patient, followed by malignancy 13 [15.9%], and respiratory diseases 12 [14.6%]. Eleven [13.4%] had chronic liver diseases, 6 [7.3%] with renal diseases, sepsis in 5 [6.1%], 4 [4.8%] were post- surgical cases, 3 [3.7%] cases had systemic lupus erythematosus [SLE] and 3 premature infants. The majority of BSI episodes were monobacterial, 71[86.5%]. Over 90% of the isolates were hospital acquired. Coagulase negative Staphylococci [CoNS] were the most common organisms representing 25 [30.5%] of all organisms isolated, while Gram positive as a whole represented 50 [61%]. Thirty one [38%] were Gram negative bacteria among which Pseudomonas species 6 [7.3%] and Escherichia coli [E. coli] 5 [6%] were the most common. Two [2.4%] of isolates were Candida glabrata. Mortality in our patients with BSI was attributed to old age and underlying medical conditions. The risk factors for nosocomial BSI were ICU admission, intravascular catheterization and respiratory tract infections