RESUMEN
A loop-mediated isothermal amplification assay was evaluated as a surrogate marker of treatment failure in Chagas disease (CD). A convenience series of 18 acute or reactivated CD patients who received anti-parasitic treatment with benznidazole was selected-namely, nine orally infected patients: three people living with HIV and CD reactivation, five chronic CD recipients with reactivation after organ transplantation and one seronegative recipient of a kidney and liver transplant from a CD donor. Fifty-four archival samples (venous blood treated with EDTA or guanidinium hydrochloride-EDTA buffer and cerebrospinal fluid) were extracted using a Spin-column manual kit and tested by T. cruzi Loopamp kit (Tc-LAMP, index test) and standardized real-time PCR (qPCR, comparator test). Of them, 23 samples were also extracted using a novel repurposed 3D printer designed for point-of-care DNA extraction (PrintrLab). The agreement between methods was estimated by Cohen's kappa index and Bland-Altman plot analysis. The T. cruzi Loopamp kit was as sensitive as qPCR for detecting parasite DNA in samples with parasite loads higher than 0.5 parasite equivalents/mL and infected with different discrete typing units. The agreement between qPCR and Tc-LAMP (Spin-column) or Tc-LAMP (PrintrLab) was excellent, with a mean difference of 0.02 [CI = -0.58-0.62] and -0.04 [CI = -0.45-0.37] and a Cohen's kappa coefficient of 0.78 [CI = 0.60-0.96] and 0.90 [CI = 0.71 to 1.00], respectively. These findings encourage prospective field studies to validate the use of LAMP as a surrogate marker of treatment failure in CD.
RESUMEN
Clostridioides difficile infections (CDI) are among the leading causes of health care-associated infections. The epidemiology of CDI has undergone major changes in the last decade, showing an increase in incidence, severity, and rate of relapse. These guidelines were developed by specialists from four scientific societies: Sociedad Argentina de Infectología (SADI), Sociedad Argentina de Gastroenterología (SAGE), Sociedad Argentina de Bacteriología, Micología y Parasitología Clínicas (SADEBAC) and Asociación de Enfermeras en Control de Infecciones (ADECI). The objective of these intersociety guidelines is to provide national recommendations on CDI diagnosis, treatment and prevention. The methodology used involved the systematic review of the bibliography available up to December 2018, which was performed by six groups formed ad hoc: Epidemiology, Diagnosis, Treatment, Fecal Microbiota Transplantation, Special Populations, and Infection Control. The conclusions were presented and discussed in meetings held by each individual group and plenary meetings. In this document, updated diagnosis algorithms, therapeutic options (including fecal microbiota transplant) for immunocompetent and immunocompromised patients are presented, as well as strategies for the control of C. difficile infection.
Las infecciones por Clostridioides difficile están entre las principales causas de infecciones asociadas al sistema de salud. Su epidemiología ha sufrido importantes cambios en la última década con aumento en incidencia, gravedad y frecuencia de recidivas. El objetivo de este documento es brindar recomendaciones nacionales para el diagnóstico, el tratamiento y la prevención de las infecciones por C. difficile. Estas recomendaciones fueron elaboradas por especialistas pertenecientes a cuatro sociedades científicas de la República Argentina: Sociedad Argentina de Infectología (SADI), Sociedad Argentina de Gastroenterología (SAGE), Sociedad Argentina de Bacteriología, Micología y Parasitología Clínica (SADEBAC) y Asociación de Enfermeros en Control de Infecciones (ADECI). La metodología utilizada consistió en la revisión sistemática de la evidencia publicada hasta diciembre 2018. Seis grupos de especialistas fueron formados a tal fin: Epidemiología, Diagnóstico, Tratamiento, Trasplante de Microbiota Fecal, Poblaciones Especiales y Control de Infecciones. En reuniones individuales de grupo y plenarias se presentaron y discutieron las conclusiones y se elaboraron las recomendaciones. En este documento se actualizan los algoritmos diagnósticos, las opciones terapéuticas, incluido el trasplante de microbiota fecal, en paciente inmunocompetentes e inmunocomprometidos, y las medidas de control de infecciones por C. difficile.