RESUMEN
Tuberculosis (TB) is one of the top 10 causes of death worldwide. Abdominal TB is an uncommon presentation of TB and is challenging to diagnose due to its insidious onset. The most common forms in children are peritonitis and lymphadenitis. Diagnosis is based on radiological and histopathological findings. Specific PCR amplification confirms the diagnosis quicker than conventional cultures. The treatment includes a 6-month therapy and a close follow-up. This article describes the different methods allowing to confirm the diagnosis of abdominal TB.
La tuberculose (TB) fait partie du top 10 des maladies mortelles dans le monde. La TB abdominale est difficile à diagnostiquer car ses symptômes sont insidieux. Les formes les plus fréquentes chez l'enfant sont la TB péritonéale et la TB ganglionnaire. Le diagnostic repose sur l'anamnèse, l'imagerie, la culture microbiologique et l'histologie. La polymerase chain reaction (PCR) confirme le diagnostic plus rapidement que la culture. Le traitement consiste en une quadrithérapie de 2 mois, suivie d'une bithérapie de 4 mois. Cet article décrit les différentes méthodes d'exploration permettant d'étayer le diagnostic de TB abdominale.
Asunto(s)
Peritonitis , Tuberculosis , Niño , Humanos , Reacción en Cadena de la Polimerasa , Guías de Práctica Clínica como Asunto , RadiografíaRESUMEN
BACKGROUND: There is lack of recent multicenter epidemiological data on invasive aspergillosis (IA) among solid organ transplant recipient (SOTr) in the mold-acting antifungal era. We describe the epidemiology and outcomes of IA in a contemporary cohort of SOTr using the Swiss Transplant Cohort Study. METHODS: All consecutive SOTr with proven or probable IA between 01.05.2008 and 31.12.2014 were included. A case-control study to identify IA predictors was performed: 1-case was matched with 3-controls based on SOT type, transplant center, and time post-SOT. RESULTS: Among 2868 SOTr, 70 (2.4%) patients were diagnosed with proven (N: 30/70, 42.9%) or probable (N: 40/70, 57.1%) IA. The incidence of IA was 8.3%, 7.1%, 2.6%, 1.3%, and 1.2% in lung, heart, combined, kidney, and liver transplant recipients, respectively, Galactomannan immunoassay was positive in 1/3 of patients tested. Only 33/63 (52.4%) of patients presented with typical pulmonary radiographic findings. Predictors of IA included: renal insufficiency, re-operation, and bacterial and viral infections. 12-week mortality was higher in liver (85.7%, 6/7) compared to other (15.9%, 10/63; P < .001) SOTr. CONCLUSIONS: Invasive aspergillosis remains a rare complication post-SOT, with atypical radiographic presentations and low positivity rates of biomarkers posing significant diagnostic challenges. Although overall mortality has decreased in SOTr, it remains high in liver SOTr.
Asunto(s)
Aspergillus/aislamiento & purificación , Terapia de Inmunosupresión/efectos adversos , Aspergilosis Pulmonar Invasiva/epidemiología , Trasplante de Órganos/efectos adversos , Adolescente , Adulto , Anciano , Biomarcadores/análisis , Estudios de Casos y Controles , Femenino , Estudios de Seguimiento , Rechazo de Injerto/prevención & control , Humanos , Incidencia , Aspergilosis Pulmonar Invasiva/diagnóstico , Aspergilosis Pulmonar Invasiva/microbiología , Pulmón/diagnóstico por imagen , Pulmón/microbiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Radiografía , Factores de Riesgo , Suiza/epidemiología , Receptores de Trasplantes , Adulto JovenRESUMEN
OBJECTIVES: Protection induced by acellular vaccines can be short, requiring novel immunization strategies. Objectives of this study were to evaluate safety and capacity of a recombinant pertussis toxin (PTgen) -coated Viaskin® epicutaneous patch to recall memory responses in healthy adults. METHODS: This double-blind, placebo-controlled randomized trial (Phase I) assessed the safety and immunogenicity of PTgen administered on days 0 and 14 to healthy adults using Viaskin® patches applied directly or after epidermal laser-based skin preparation. Patch administration was followed by Boostrix®dTpa on day 42. Antibodies were assessed at days 0, 14, 28, 42 and 70. RESULTS: Among 102 volunteers enrolled, 80 received Viaskin-PT (Viaskin-PT 25 µg (n = 25), Viaskin-PT 50 µg (n = 25), laser + Viaskin-PT 25 µg (n = 5), laser + Viaskin-PT 50 µg (n = 25)), Viaskin-placebo (n = 10) or laser + Viaskin-placebo (n = 2). Incidence of adverse events was similar across groups (any local event: 21/25 (84.0%), 24/25 (96.0%), 4/5 (80.0%), 24/25 (96.0%), 8/10 (80.0%), 10/12 (83.0%), respectively). Direct application induced no detectable response. On day 42, PT-IgG geometric mean concentrations were significantly higher following laser + Viaskin-PT 25 µg and 50 µg (139.87 (95% CI 87.30-224.10) and 121.76 (95% CI 95.04-156.00), respectively), than laser + Viaskin-placebo (59.49, 95% CI 39.37-89.90). Seroresponse rates were higher following laser + Viaskin-PT 25 µg (4/5 (80.0%), 95% CI 28.4-99.5) and 50 µg (22/25 (88.0%), 95% CI 68.8-97.5) than laser + Viaskin-placebo (0/12 (0.0%), 95% CI 0.0-26.5). CONCLUSIONS: Viaskin-PT applied after laser-based epidermal skin preparation showed encouraging safety and immunogenicity results: anti-PT booster responses were not inferior to those elicited by Boostrix®dTpa. This study is registered at ClinicalTrials.gov (NCT03035370) and was funded by DBV Technologies.