The Unyvero P55 'sample-in, answer-out' pneumonia assay: A performance evaluation.

BACKGROUND: O'Neill's recent Review on Antimicrobial Resistance expressed the view that by 2020 high-income countries should make it mandatory to support antimicrobial prescribing with rapid diagnostic evidence whenever possible. METHODS: Routine microbiology diagnosis of 95 respiratory specimens from patients with severe infection were compared with those generated by the Unyvero P55 test, which detects 20 pathogens and 19 antimicrobial resistance markers. Supplementary molecular testing for antimicrobial resistance genes, comprehensive culture methodology and 16S rRNA sequencing were performed. RESULTS: Unyvero P55 produced 85 valid results, 67% of which were concordant with those from the routine laboratory. Unyvero P55 identified more potential pathogens per specimen than routine culture (1.34 vs. 0.47 per specimen). Independent verification using 16S rRNA sequencing and culture (n = 10) corroborated 58% of additional detections compared to routine microbiology. Overall the average sensitivity for organism detection by Unyvero P55 was 88.8% and specificity was 94.9%. While Unyvero P55 detected more antimicrobial resistance markers than routine culture, some instances of phenotypic resistance were missed. CONCLUSIONS: The Unyvero P55 is a rapid pathogen detection test for lower respiratory specimens, which identifies a larger number of pathogens than routine microbiology. The clinical significance of these additional organisms is yet to be determined. Further studies are required to determine the effect of the test in practise on antimicrobial prescribing and patient outcomes.

Two new Eimeria species parasitic in corncrakes (Crex crex) (Gruiformes: Rallidae) in the United Kingdom.

In this study we describe 2 new species of coccidia (Apicomplexa: Eimeriidae) parasites isolated from the feces of corncrake (Crex crex) (Gruiformes: Rallidae), bred in captivity in the U.K. Oocysts of Eimeria crecis n. sp. were approximately spherical and measured 15.3 µm (13-18) × 14.3 (12-16), providing an oocyst shape index of 1.1. A micropyle and oocyst residuum were absent, but a polar granule was present. Oocysts of Eimeria nenei n. sp. were ellipsoidal and measured 23.6 (21-26) × 18.1 (17-20), providing an oocyst shape index of 1.3. A micropyle and polar granule were present. Surveying free-living, wild adult corncrakes in Scotland (U.K.) demonstrated both parasite species to be widespread. These are the first species described to infect the corncrake, and they are distinct from those previously found to infect members of the closely related crane family (Gruiformes: Gruidae). Partial amplification and sequencing of the 18S rRNA gene and internal transcribed spacer 2 indicated a close relationship between the 2 proposed new species as a group distinct from the Eimeria species known to infect cranes. These newly identified parasite species have been associated with enteric disease in corncrakes being prepared for reproduction in captivity and reintroduction into England (U.K.).

A statistical chronicle of tuberculosis in Canada: Part II. Risk today and control.

This report marks over 50 years of publication by Statistics Canada of annual reports on Tuberculosis Statistics. These years have witnessed what has been described as a conquest of tuberculosis in Canada. To quote George Jasper Wherrett in the Miracle of the Empty Beds: One hundred years ago the word consumption (as tuberculosis was then called) struck horror in human hearts. Today, in the western world, it barely evokes any emotion save a too easy surprise that it still exists. This statistical chronicle of tuberculosis in Canada is divided into two parts. Part I: From the Era of Sanatorium Treatment to the Present pulls together data from yellowed-with-age reports on tuberculosis and vital statistics, historical accounts, and modern computer files, to document the changes in tuberculosis incidence and mortality over past decades to the present. Part II: Risk Today and Control takes a closer look at those most vulnerable to contracting tuberculosis. It also looks at the future, the need for maintaining and, indeed, strengthening vigilance, and the work yet to be done to eradicate tuberculosis in Canada. The fight against tuberculosis is far from over.

A statistical chronicle of tuberculosis in Canada: Part I. From the era of sanatorium treatment to the present.

This report marks over 50 years of publication by Statistics Canada of annual reports on tuberculosis statistics. These years have witnessed what has been described as a conquest of tuberculosis in Canada. To quote George Jasper Wherrett in The Miracle of the Empty Beds: One hundred years ago the word consumption (as tuberculosis was then called) struck horror in human hearts. Today, in the western world, it barely evokes any emotion save a too easy surprise that it still exists. This statistical chronicle of tuberculosis in Canada is divided into two parts. Part I: From the Era of Sanatorium Treatment to the Present pulls together data from yellowed-with-age reports on tuberculosis and vital statistics, historical accounts and modern computer files, to document the changes in tuberculosis incidence and mortality over past decades to the present. Part II: Risk Today and Control takes a closer look at those most vulnerable to contracting tuberculosis. It also looks at the future, the need for maintaining and, indeed, strengthening vigilance, and the work yet to be done to eradicate tuberculosis in Canada. The fight against tuberculosis is far from over.

Comparative blood levels and metabolism of INH and an INH-matrix preparation in fast and slow inactivators.

Two groups of tuberculosis patients, phenotyped as either slow or fast inactivators of isoniazid, participated in a preliminary bioavailability study of a new INH-matrix preparation with sustained action. The absorption, excretion and metabolic patterns of the new form were compared with those of standard INH tablets in both sets of patients, using a crossover technique.The INH-matrix was more slowly absorbed by both slow and fast inctivators. When the latter were treated with 30 mg./kg. of the matrix formulation the blood levels attained were comparable with those observed in slow acetylators treated with 10 mg./kg. normal INH. Although this dose is three times that normally recommended with standard INH, blood levels remained within safe limits owing to the drug's slow release from the matrix.

Treatment of chronic drug-resistant pulmonary tuberculosis with rifampin and ethambutol.

Twenty patients with chronic pulmonary tuberculosis completed eight months of rifampin-ethambutol treatment. Half the patients received daily 600 mg. rifampin and 25 mg./kg. ethambutol for the first two months and subsequently 15 mg./kg. The others received the same dosage of ethambutol and 450 mg. rifampin daily. The average time of sputum conversion was seven weeks and 11 weeks in the two groups respectively. The patients tolerated these drug regimens well.Rifampin blood levels and urinary excretion were studied monthly during the therapy. They indicated that after a short period of treatment the elimination of this drug became faster owing to increased excretion of rifampin, and particularly of its desacetyl metabolite, in the bile. Liver damage resulted in a slower excretion rate. Rifampin should be taken on an empty stomach because simultaneous food intake reduces the peak blood concentration.

Inactivation of isoniazid by Canadian Eskimos and Indians.

Phenotyping for isoniazid inactivation in Canadian Eskimos and Indians showed that the former are all fast acetylators, while only 63.4% of the Indians examined belonged to the same group. Further studies are suggested to confirm this initial finding.During the investigation metabolic studies were carried out to devise a reliable urine test for phenotyping of isoniazid inactivators, to replace the fall-off technique which required venipunctures. The simplicity of the new urine test makes it suitable for mass examinations.