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1.
J Clin Microbiol ; 57(10)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31315954

RESUMO

Recommendations for first-line and second-line drug testing and organism group, specific methodologies, and reporting recommendations have been addressed by the Clinical and Laboratory Standards Institute (CLSI) and are important in the selection of appropriate antimicrobial treatment regimens for nontuberculous mycobacteria (NTM) disease. This review also includes recent information on new antimicrobials proposed for the treatment of NTM but not yet addressed by the CLSI and molecular (gene sequencing) methods associated with the detection of antimicrobial resistance of two major therapeutic antimicrobials, clarithromycin and amikacin.


Assuntos
Antibacterianos/farmacologia , Testes de Sensibilidade Microbiana , Infecções por Mycobacterium não Tuberculosas/microbiologia , Micobactérias não Tuberculosas/efeitos dos fármacos , Antibacterianos/uso terapêutico , Técnicas Bacteriológicas , Humanos , Testes de Sensibilidade Microbiana/métodos , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Micobactérias não Tuberculosas/crescimento & desenvolvimento
2.
J Pediatr Adolesc Gynecol ; 31(2): 146-148, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28838864

RESUMO

BACKGROUND: Mycoplasma hominis frequently colonizes the urogenital and respiratory tracts of healthy individuals. It has also been associated with genitourinary tract and extragenital syndromes. CASE: We present a 14-year-old girl who developed a pelvic abscess secondary to M. hominis after a vaginal laceration during sexual intercourse. Despite drainage and broad-spectrum antimicrobial therapy, the patient remained symptomatic until M. hominis was identified and specific therapy instituted. SUMMARY AND CONCLUSION: Health care providers need to be aware of the potential for M. hominis as a causal agent in patients who present with pelvic abscesses after vaginal trauma. This case highlights the challenges that exist in the diagnosis and treatment of M. hominis, because bacterial cultures are often negative and empiric antimicrobial agents do not provide adequate antimicrobial coverage.


Assuntos
Lacerações/complicações , Infecções por Mycoplasma/diagnóstico , Mycoplasma hominis/isolamento & purificação , Vagina/lesões , Abscesso/tratamento farmacológico , Abscesso/cirurgia , Adolescente , Antibacterianos/uso terapêutico , Drenagem , Feminino , Humanos , Lacerações/microbiologia , Infecções por Mycoplasma/complicações , Infecções por Mycoplasma/tratamento farmacológico , Tomografia Computadorizada por Raios X , Vagina/microbiologia
3.
Int J Pediatr Otorhinolaryngol ; 102: 86-89, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29106883

RESUMO

OBJECTIVE: To review histopathologic diagnoses from tonsillectomy specimens and determine whether routine pathologic exam is necessary. METHODS: Pathology reports of patients undergoing tonsillectomy from 2005 to 2014 at our pediatric tertiary care hospital were reviewed. Histopathologic diagnoses were recorded with special attention to identification of malignancy. RESULTS: A total of 8807 paired tonsil specimens were sent to pathology over a 10-year course. Gross analysis was performed on all. Microscopic histopathologic analysis was performed on 612 (6.95%) specimens with all but one demonstrating strictly reactive lymphoid hyperplasia. The single specimen (0.16%) demonstrated follicular hyperplasia with focal necrotizing granulomatous lymphadenitis without organisms identified on special staining. The surgeon requested pathologic diagnosis to rule out lymphoma in 4 of 8087 (0.05%) of the specimens. No malignancies were identified. The approximate charges for gross examination of a paired tonsillectomy specimen and microscopic examination were $136.10 and $294.54, respectively. Over the 10 year period of the study, total charges were estimated at $1,115,340 (gross) and $180,258 (microscopic). DISCUSSION: Microscopic analysis of tonsil specimens is unlikely to identify abnormal pathology that changes patient management. This study suggests that neither gross nor microscopic pathologic examination of tonsillectomy specimens is necessary on a routine basis. Histologic analysis of tonsils should be requested only on a case by case basis when clinical suspicion for malignancy is high. Avoiding routine pathologic exam of tonsils may be cost effective and medically safe.


Assuntos
Tonsila Palatina/patologia , Patologia Cirúrgica/estatística & dados numéricos , Tonsilectomia/estatística & dados numéricos , Criança , Pré-Escolar , Análise Custo-Benefício , Feminino , Hospitais Pediátricos , Humanos , Masculino , Patologia Cirúrgica/economia , Estudos Retrospectivos , Atenção Terciária à Saúde
4.
Clin Infect Dis ; 64(2): 111-115, 2017 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-28052967

RESUMO

BACKGROUND: Individuals infected with Mycobacterium tuberculosis (Mtb) may develop symptoms and signs of disease (tuberculosis disease) or may have no clinical evidence of disease (latent tuberculosis infection [LTBI]). Tuberculosis disease is a leading cause of infectious disease morbidity and mortality worldwide, yet many questions related to its diagnosis remain. METHODS: A task force supported by the American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America searched, selected, and synthesized relevant evidence. The evidence was then used as the basis for recommendations about the diagnosis of tuberculosis disease and LTBI in adults and children. The recommendations were formulated, written, and graded using the Grading, Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS: Twenty-three evidence-based recommendations about diagnostic testing for latent tuberculosis infection, pulmonary tuberculosis, and extrapulmonary tuberculosis are provided. Six of the recommendations are strong, whereas the remaining 17 are conditional. CONCLUSIONS: These guidelines are not intended to impose a standard of care. They provide the basis for rational decisions in the diagnosis of tuberculosis in the context of the existing evidence. No guidelines can take into account all of the often compelling unique individual clinical circumstances.


Assuntos
Tuberculose/diagnóstico , Adulto , Fatores Etários , Criança , Humanos , Tuberculose Latente/diagnóstico , Tuberculose Latente/microbiologia , Mycobacterium tuberculosis/genética , Tuberculose/epidemiologia , Tuberculose/microbiologia , Tuberculose/transmissão , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/microbiologia
5.
Clin Infect Dis ; 64(2): e1-e33, 2017 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-27932390

RESUMO

BACKGROUND: Individuals infected with Mycobacterium tuberculosis (Mtb) may develop symptoms and signs of disease (tuberculosis disease) or may have no clinical evidence of disease (latent tuberculosis infection [LTBI]). Tuberculosis disease is a leading cause of infectious disease morbidity and mortality worldwide, yet many questions related to its diagnosis remain. METHODS: A task force supported by the American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America searched, selected, and synthesized relevant evidence. The evidence was then used as the basis for recommendations about the diagnosis of tuberculosis disease and LTBI in adults and children. The recommendations were formulated, written, and graded using the Grading, Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS: Twenty-three evidence-based recommendations about diagnostic testing for latent tuberculosis infection, pulmonary tuberculosis, and extrapulmonary tuberculosis are provided. Six of the recommendations are strong, whereas the remaining 17 are conditional. CONCLUSIONS: These guidelines are not intended to impose a standard of care. They provide the basis for rational decisions in the diagnosis of tuberculosis in the context of the existing evidence. No guidelines can take into account all of the often compelling unique individual clinical circumstances.


Assuntos
Tuberculose/diagnóstico , Adulto , Fatores Etários , Criança , Humanos , Tuberculose Latente/diagnóstico , Tuberculose Latente/microbiologia , Mycobacterium tuberculosis/genética , Tuberculose/epidemiologia , Tuberculose/microbiologia , Tuberculose/transmissão , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/microbiologia
6.
Microbiol Spectr ; 4(4)2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27726808

RESUMO

The immunocompromised host is at increased risk of Mycobacterium tuberculosis complex and nontuberculous mycobacteria infection. Although Mycobacterium tuberculosis complex is a significant mycobacterial pathogen, nontuberculous mycobacteria causes substantial disease in those with suppressed immune responses. Mycobacterial infections can cause significant morbidity and mortality in this patient population, and rapid identification and susceptibility testing of the mycobacterial species is paramount to patient management and outcomes. Mycobacterial diagnostics has undergone some significant advances in the last two decades with immunodiagnostics (interferon gamma release assay), microscopy (light-emitting diode), culture (automated broth-based systems), identification (direct PCR, sequencing and matrix-assisted laser-desorption ionization-time of flight mass spectrometry) and susceptibility testing (molecular detection of drug resistance from direct specimens or positive cultures). Employing the most rapid and sensitive methods in the mycobacterial laboratory will have a tremendous impact on patient care and, in the case of Mycobacterium tuberculosis complex, in the control of tuberculosis.


Assuntos
Técnicas Bacteriológicas/métodos , Testes Diagnósticos de Rotina/métodos , Suscetibilidade a Doenças , Hospedeiro Imunocomprometido , Infecções por Mycobacterium/diagnóstico , Humanos , Infecções por Mycobacterium/prevenção & controle , Infecções por Mycobacterium/terapia
7.
Am J Infect Control ; 44(6): 727-9, 2016 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-26922103

RESUMO

A multiclonal methicillin-resistant Staphylococcus aureus (MRSA) outbreak with 91 infections occurred in our Veterans Affairs (VA) community living center over 46 months. Both similar and unique strains were shown by repetitive polymerase chain reaction to contribute to the outbreak, including 1 strain causing infections over a 33-month period. Most infections were soft tissue infections (67%). For 21 months after the initiation of the VA MRSA bundle, no infections were identified, and low rates of infection have been sustained an additional 4 years. The average annual rate of MRSA infection decreased by 62% (P < .001) from 0.6 per 1,000 resident days for 4 years prior to the bundle implementation to 0.09 per 1,000 resident days for 4 years after the bundle implementation.


Assuntos
Infecção Hospitalar/epidemiologia , Surtos de Doenças , Variação Genética , Staphylococcus aureus Resistente à Meticilina/classificação , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Humanos , Controle de Infecções/métodos , Assistência de Longa Duração , Staphylococcus aureus Resistente à Meticilina/genética , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/prevenção & controle , Veteranos
8.
Chest ; 147(4): e140-e147, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25846538

RESUMO

A 66-year-old woman presented with acute onset of fever, chills, and productive cough associated with right-sided chest pain. During a recent hospitalization for dyspnea, she had been diagnosed with Coombs-positive autoimmune hemolytic anemia and had been taking a tapering dose of prednisone starting approximately 6 weeks prior to admission. In the interim, her dyspnea had resolved on treatment with steroids. At the time of presentation, her prednisone dose was 40 mg. Additional medical history included VTE, for which the patient was receiving anticoagulation therapy, and steroid-induced diabetes mellitus. Many years earlier, she had been treated for TB in her home country. The patient had immigrated to Queens, New York, from a Nepalese village 8 years prior. While still in Nepal, she had worked on a farm and had been in close proximity to cows. In Queens, she lived with her family in a house with a small garden but had no pets. Recent travel included a visit to Nepal 9 months ago and a trip to Syracuse, New York, one month prior to presentation. She was a never smoker and did not consume alcohol.


Assuntos
Blastomicose/complicações , Tosse/etiologia , Febre/etiologia , Imunidade Celular , Doenças da Língua/etiologia , Língua/patologia , Idoso , Biópsia , Blastomicose/diagnóstico , Blastomicose/imunologia , Broncoscopia , Tosse/diagnóstico , Diagnóstico Diferencial , Feminino , Febre/diagnóstico , Humanos , Nepal/etnologia , Cidade de Nova Iorque/epidemiologia , Radiografia Torácica , Tomografia Computadorizada por Raios X , Língua/microbiologia , Doenças da Língua/diagnóstico , Doenças da Língua/microbiologia , Viagem
9.
Ann Am Thorac Soc ; 11(3): 296-302, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24446969

RESUMO

RATIONALE: IFN-γ release assays (IGRAs) including the QuantiFERON-TB gold in-tube test (QFT-GIT) are increasingly used in place of the tuberculin skin test (TST) in surveillance programs for Mycobacterium tuberculosis infection in the United States. However, data on conversions, reversions, and predictive value of QFT in such programs for health care workers (HCWs) are limited. OBJECTIVES: The purpose of this study is to assess long-term reproducibility and conversion and reversion rates of QFT-GIT among HCWs who underwent serial testing at a tertiary care center in the United States. METHODS: Retrospective chart review of HCWs at the Central Arkansas Veterans Healthcare System (CAVHS) who underwent serial testing with QFT-GIT as a part of their employee screening between November 1, 2008 and January 31, 2011. MEASUREMENTS AND MAIN RESULTS: A total of 2,303 HCWs had at least 2 QFT-GITs 1 year apart. The initial QFT-GIT was positive for 69 and 2 were indeterminate. Of these 69 HCWs, 31 (45%) reverted on repeat testing, and 25 of 31 (80.6%) HCWs who reverted had a negative look-back TST. Of the 2,232 HCWs with an initial negative QFT-GIT, 71 (3.2%) converted on repeat testing. A third QFT-GIT assay was performed in 41 of the 71 converters and 90% (37 of 41) reverted back to negative. Only two HCWs had TST and QFT-GIT conversion. CONCLUSIONS: Poor IGRA reproducibility and a low predictive value of QFT-GIT conversions indicate that QFT-GIT with current interpretation criteria should not be used for serial screening of U.S. HCWs. Negative TSTs have higher reproducibility than QFT-GIT for serial testing of HCWs in low tuberculosis incidence settings.


Assuntos
Pessoal de Saúde , Testes de Liberação de Interferon-gama , Mycobacterium tuberculosis , Tuberculose/diagnóstico , Adulto , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Tempo , Estados Unidos
10.
J Clin Microbiol ; 51(10): 3389-94, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23946523

RESUMO

Amikacin is a major drug used for the treatment of Mycobacterium avium complex (MAC) disease, but standard laboratory guidelines for susceptibility testing are not available. This study presents in vitro amikacin MICs for 462 consecutive clinical isolates of the MAC using a broth microdilution assay. Approximately 50% of isolates had amikacin MICs of 8 µg/ml, and 86% had MICs of ≤16 µg/ml. Of the eight isolates (1.7%) with MICs of 64 µg/ml, five had an MIC of 32 µg/ml on repeat testing. Ten isolates (2.1%) had an initial amikacin MIC of >64 µg/ml, of which seven (1.5%) had MICs of >64 µg/ml on repeat testing. These seven isolates had a 16S rRNA gene A1408G mutation and included M. avium, Mycobacterium intracellulare, and Mycobacterium chimaera. Clinical data were available for five of these seven isolates, all of which had received prolonged (>6 months) prior therapy, with four that were known to be treated with amikacin. The 16S mutation was not detected in isolates with MICs of ≤64 µg/ml. We recommend primary testing of amikacin against isolates of the MAC and propose MIC guidelines for breakpoints that are identical to the CLSI guidelines for Mycobacterium abscessus: ≤16 µg/ml for susceptible, 32 µg/ml for intermediate, and ≥64 µg/ml for resistant. If considered and approved by the CLSI, this will be only the second drug recommended for primary susceptibility testing against the MAC and should facilitate its use for both intravenous and inhaled drug therapies.


Assuntos
Amicacina/farmacologia , Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Complexo Mycobacterium avium/efeitos dos fármacos , Complexo Mycobacterium avium/genética , Mutação Puntual , RNA Ribossômico 16S/genética , Amicacina/uso terapêutico , Antibacterianos/uso terapêutico , Feminino , Humanos , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Complexo Mycobacterium avium/isolamento & purificação , Infecção por Mycobacterium avium-intracellulare/tratamento farmacológico , Infecção por Mycobacterium avium-intracellulare/microbiologia
11.
Can Respir J ; 19(2): 84-8, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22536576

RESUMO

BACKGROUND: Interferon-gamma release assays including the QuantiFERON-TB Gold In-Tube test (QFT-GIT [Cellestis Ltd, Australia]) may be used in place of the tuberculin skin test (TST) in surveillance programs for Mycobacterium tuberculosis infection control. However, data on performance and practicality of the QFT-GIT in such programs for health care workers (HCWs) are limited. OBJECTIVES: To assess the performance, practicality and reversion rate of the QFT-GIT among HCWs at a tertiary health care institution in the United States. METHODS: Retrospective chart review of HCWs at Central Arkansas Veterans Healthcare System (Arkansas, USA) who underwent QFT-GIT testing as a part of their employee screening between November 1, 2008 and October 31, 2009. RESULTS: QFT-GIT was used to screen 3290 HCWs. The initial QFT-GIT was interpreted as positive for 129 (3.9%) HCWs, negative for 3155 (95.9%) and indeterminate for six (0.2%). Testing with QFT-GIT was repeated in 45 HCWs who had positive results on the initial test. The QFT-GIT reverted to negative in 18 (40.0%) HCWs, all of whom had negative TST status and initial interferon-gamma values of 0.35 IU/mL to 2.0 IU/mL. CONCLUSION: The QFT-GIT test is feasible in large health care setting as an alternative to TST for M tuberculosis infection screening in HCWs but is not free from challenges. The major concerns are the high number of positive test results and high reversion rates on repeat testing, illustrating poor short-term reproducibility of positive QFT-GIT test results. These results suggest adopting a borderline zone between interferon-gamma values of 0.35 IU/mL to 2.0 IU/mL, and cautious clinical interpretation of values in this range.


Assuntos
Pessoal de Saúde , Testes de Liberação de Interferon-gama/métodos , Programas de Rastreamento/métodos , Tuberculose/diagnóstico , Adulto , Estudos de Viabilidade , Feminino , Humanos , Interferon gama/metabolismo , Linfócitos/metabolismo , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Teste Tuberculínico , Estados Unidos
12.
J Clin Microbiol ; 50(4): 1270-80, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22219309

RESUMO

Antimicrobial susceptibility testing (AST) of clinical isolates of Nocardia is recommended to detect resistance to commonly used antimicrobial agents; such testing is complicated by difficulties in inoculum preparation and test interpretation. In this study, six laboratories performed repetitive broth microdilution testing on single strains of Nocardia brasiliensis, Nocardia cyriacigeorgica, Nocardia farcinica, Nocardia nova, and Nocardia wallacei. For each isolate, a total of 30 microdilution panels from three different lots were tested at most sites. The goal of the study was to determine the inter- and intralaboratory reproducibility of susceptibility testing of this group of isolates. Acceptable agreement (>90% agreement at ±1 dilution of the MIC mode) was found for amikacin, ciprofloxacin, clarithromycin, and moxifloxacin. After eliminating MIC values from single laboratories whose results showed the greatest deviation from those of the remaining laboratories, acceptable agreement was also found for amoxicillin-clavulanic acid, linezolid, minocycline, and tobramycin. Results showed unsatisfactory reproducibility of broth microdilution testing of ceftriaxone with N. cyriacigeorgica and N. wallacei, tigecycline with N. brasiliensis and N. cyriacigeorgica, and sulfonamides with N. farcinica and N. wallacei. N. nova ATCC BAA-2227 is proposed as a quality control organism for AST of Nocardia sp., and the use of a disk diffusion test for sulfisoxazole is proposed as a check of the adequacy of the inoculum and to confirm sulfonamide MIC results.


Assuntos
Antibacterianos/farmacologia , Testes de Sensibilidade Microbiana/normas , Nocardia/efeitos dos fármacos , Ensaio de Proficiência Laboratorial , Testes de Sensibilidade Microbiana/métodos , Reprodutibilidade dos Testes
15.
Clin Microbiol Rev ; 23(2): 367-81, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20375357

RESUMO

Blastomycosis is endemic in regions of North America that border the Great Lakes and the St. Lawrence River, as well as in the Mississippi River and Ohio River basins. Men are affected more often than women and children because men are more likely to participate in activities that put them at risk for exposure to Blastomyces dermatitidis. Human infection occurs when soil containing microfoci of mycelia is disturbed and airborne conidia are inhaled. If natural defenses in the alveoli fail to contain the infection, lymphohematogenous dissemination ensues. Normal host responses generate a characteristic pyogranulomatous reaction. The most common sites of clinical disease are the lung and skin; osseous, genitourinary, and central nervous system manifestations follow in decreasing order of frequency. Blastomycosis is one of the great mimickers in medicine; verrucous cutaneous blastomycosis resembles malignancy, and mass-like lung opacities due to B. dermatitidis often are confused with cancer. Blastomycosis may be clinically indistinguishable from tuberculosis. Diagnosis is based on culture and direct visualization of round, multinucleated yeast forms that produce daughter cells from a single broad-based bud. Although a long course of amphotericin B is usually curative, itraconazole is also highly effective and is the mainstay of therapy for most patients with blastomycosis.


Assuntos
Blastomyces , Blastomicose/diagnóstico , Blastomicose/terapia , Feminino , Humanos , Masculino
16.
J Clin Microbiol ; 48(4): 1442-4, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20164273

RESUMO

Correct identification of nonfermenting Gram-negative bacilli (NFB) is crucial for patient management. We compared phenotypic identifications of 96 clinical NFB isolates with identifications obtained by 5' 16S rRNA gene sequencing. Sequencing identified 88 isolates (91.7%) with >99% similarity to a sequence from the assigned species; 61.5% of sequencing results were concordant with phenotypic results, indicating the usability of sequencing to identify NFB.


Assuntos
Técnicas Bacteriológicas/métodos , Bactérias Gram-Negativas/classificação , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/diagnóstico , Técnicas de Tipagem Bacteriana , DNA Bacteriano/química , DNA Bacteriano/genética , DNA Ribossômico/química , DNA Ribossômico/genética , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Dados de Sequência Molecular , RNA Ribossômico 16S/genética , Sensibilidade e Especificidade , Análise de Sequência de DNA
18.
Clin Infect Dis ; 46(9): 1412-22, 2008 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-18419445

RESUMO

BACKGROUND: Galactomannan is an Aspergillus-specific polysaccharide released during aspergillosis and is detected by the quantitative serum galactomannan index (GMI) test. Preclinical and preliminary clinical reports have suggested a good correlation between GMI and aspergillosis outcome. METHODS: We reviewed the literature to assess the strength of correlation between GMI and aspergillosis outcome using the kappa correlation coefficient. We included 27 studies that enrolled patients with hematological cancer and proven or probable aspergillosis and that used sequential GMI testing. We examined the 3 following outcomes: survival (survival vs. death), global outcome (survival vs. death [including autopsy findings]), and autopsy outcome (autopsy findings only). RESULTS: Overall, 257 patients fulfilled criteria for proven or probable aspergillosis and were eligible for outcome evaluation. Correlation between GMI (within

Assuntos
Aspergilose/patologia , Aspergillus/metabolismo , Neoplasias Hematológicas/complicações , Mananas/sangue , Aspergilose/sangue , Aspergilose/complicações , Aspergillus/efeitos dos fármacos , Galactose/análogos & derivados , Humanos , Metanálise como Assunto , Prognóstico , Análise de Sobrevida , Resultado do Tratamento
19.
J Clin Microbiol ; 46(5): 1835-9, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18367576

RESUMO

Repetitive-sequence-based PCR (rep-PCR) using the DiversiLab system was investigated for identification of Aspergillus. Ninety-five clinical isolates, identified by conventional methods, and five ATCC strains were tested. Sequencing of the internal transcribed spacer (ITS) region (ITS1-5.8S-ITS2) was performed on 2 isolates with discrepant rep-PCR and conventional results and 15 randomly selected outlier isolates. One isolate not identified by sequencing was excluded from analysis. After resolving discrepancies, all but one A. glaucus strain had >or=85% similarity to one or more strains of the same Aspergillus species in the mold database, thereby providing accurate identification. No isolate was misidentified.


Assuntos
Aspergillus/classificação , Aspergillus/genética , Reação em Cadeia da Polimerase/métodos , Sequências Repetitivas de Ácido Nucleico , Aspergillus/isolamento & purificação , Análise por Conglomerados , DNA Fúngico/química , DNA Fúngico/genética , DNA Espaçador Ribossômico/química , DNA Espaçador Ribossômico/genética , Humanos , Sensibilidade e Especificidade , Análise de Sequência de DNA
20.
Cancer ; 110(4): 830-4, 2007 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-17607669

RESUMO

BACKGROUND: Determining the outcome of patients with aspergillosis can be particularly difficult because patients with aspergillosis are at risk for other conditions that mimic this infection. Galactomannan is an Aspergillus-specific antigen released during invasive aspergillosis and is detected by the quantitative serum galactomannan index (GMI) test. METHODS: Using a kappa correlation coefficient test (KCC), the strength of correlation was determined between GMI and survival outcome of aspergillosis among 56 adults with hematologic cancer (90% had myeloma) who underwent serial GMI monitoring until hospital discharge or death. RESULTS: All 56 patients received antineoplastic therapy (myeloablative followed by stem cell transplantation [autologous in 21 patients and allogeneic in 3 patients] or nonmyeloablative therapy [32 patients]). The overall correlation between survival outcome and GMI was excellent (KCC = 0.8609; 95% confidence interval [95% CI], 0.7093-1.000 [P < .0001]) and was comparable among neutropenic and nonneutropenic patients (KCC = 0.8271; 95% CI, 0.6407-1.000 [P < .0001] and KCC = 1.0; 95% CI, 1-1 [P = .0083], respectively). CONCLUSIONS: The survival outcome of patients with aspergillosis strongly correlated with serum GMI. These findings have important implications for patient care and clinical trials of mold-active antifungal agents.


Assuntos
Antígenos de Fungos/sangue , Aspergilose/diagnóstico , Aspergillus/imunologia , Neoplasias Hematológicas/complicações , Mananas/sangue , Adulto , Idoso , Aspergilose/sangue , Aspergilose/complicações , Aspergillus/crescimento & desenvolvimento , Terapia Combinada , Dexametasona/uso terapêutico , Feminino , Galactose/análogos & derivados , Glucocorticoides/uso terapêutico , Neoplasias Hematológicas/tratamento farmacológico , Neoplasias Hematológicas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/complicações , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/cirurgia , Valor Preditivo dos Testes , Prognóstico , Transplante de Células-Tronco , Análise de Sobrevida
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