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1.
BMC Infect Dis ; 21(1): 287, 2021 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-33743629

RESUMO

BACKGROUND: Talaromyces marneffei (T. marneffei) is an opportunistic pathogen that infects immunodeficient children. The aim of the study is to determine the clinical features and peripheral immune state of Talaromyces marneffei (T. marneffei) infections in children for early detection and diagnosis. METHODS: We retrospectively reviewed 21 pediatric patients who were diagnosed with T. marneffei infections and were followed up in the Guangzhou Women and Children's Medical Center from January 2010 to January 2020. For each patient, we collected and analyzed clinical characteristics, peripheral immunological results, genetic tests, complications and prognosis. RESULTS: Common clinical features of the patients included fever (20/21, 95.24%), cough (17/21, 80.95%) and hepatomegaly (17/21, 80.95%). Severe complications included septic shock (12/21, 57.14%), hemophagocytic lymphohistiocytosis (HLH) (11/21, 52.38%), acute respiratory distress syndrome (ARDS) (10/21, 47.62%), multiple organ dysfunction syndrome (MODS) (9/21, 42.86%), and disseminated intravascular coagulation (DIC) (7/21, 33.33%). Eleven children (11/21, 52.38%) eventually died of T. marneffei infections. All patients were HIV negative. Seven cases revealed reduced antibody levels, especially IgG. Higher levels of IgE were detected in 9 cases with an obvious increase in two patients. Ten patients showed decreased complement C3 levels, some of whom had low C4 levels. Three patients displayed decreased absolute T lymphocyte counts, including the CD 4+ and CD 8+ subsets. A reduction in NK cells was present in most patients. No patient had positive nitro blue tetrazolium (NBT) test results. Nine patients were screened for common genetic mutations. Of the cases, one case had no disease-specific gene mutation. Four children had confirmed hyperimmunoglobulin M syndrome (HIGM) with CD40LG variation, one case had severe combined immunodeficiency (SCID), and one case had hyper-IgE syndrome (HIES). One patient was identified as having a heterozygous mutation in STAT3 gene; however, he showed no typical clinical manifestations of HIES at his age. One patient had a mutated COPA gene with uncertain pathogenic potential. Another patient was diagnosed with HIES that depended on her clinical features and the National Institutes of Health (NIH) scoring system. CONCLUSIONS: T. marneffei infections in HIV-negative children induced severe systemic complications and poor prognosis. Children with T. marneffei infections commonly exhibited abnormal immunoglobulin levels in peripheral blood, particularly decreased IgG or increased IgE levels, further suggesting possible underlying PIDs in these patients.


Assuntos
Anticorpos Antifúngicos/sangue , Micoses/imunologia , Criança , China , Diagnóstico Precoce , Feminino , Soronegatividade para HIV , Humanos , Masculino , Micoses/diagnóstico , Estudos Retrospectivos , Talaromyces
2.
PLoS One ; 15(9): e0238855, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32976540

RESUMO

BACKGROUND: Early recognition and diagnosis of allergic bronchopulmonary aspergillosis (ABPA) is critical to improve patient symptoms, and antifungal therapy may prevent or delay progression of bronchiectasis and development of chronic pulmonary aspergillosis. OBJECTIVE: A recently commercialized lateral flow assay (Aspergillus ICT) (LDBio Diagnostics, Lyons, France) detects Aspergillus-specific antibodies in <30 minutes, requiring minimal laboratory equipment. We evaluated this assay for diagnosis of ABPA compared to diseased (asthma and/or bronchiectasis) controls. METHODS: ABPA and control sera collected at the National Aspergillosis Centre (Manchester, UK) and/or from the Manchester Allergy, Respiratory and Thoracic Surgery research biobank were evaluated using the Aspergillus ICT assay. Results were read both visually and digitally (using a lateral flow reader). Serological Aspergillus-specific IgG and IgE, and total IgE titres were measured by ImmunoCAP. RESULTS: For 106 cases of ABPA versus all diseased controls, sensitivity and specificity for the Aspergillus ICT were 90.6% and 87.2%, respectively. Sensitivity for 'proven' ABPA alone (n = 96) was 89.8%, and 94.4% for 'presumed' ABPA (n = 18). 'Asthma only' controls (no bronchiectasis) and 'bronchiectasis controls' exhibited 91.4% and 81.7% specificity, respectively. Comparison of Aspergillus ICT result with Aspergillus-specific IgG and IgE titres showed no evident immunoglobulin isotype bias. Digital measurements displayed no correlation between ImmunoCAP Aspergillus-specific IgE level and ICT test line intensity. CONCLUSIONS: The Aspergillus ICT assay exhibits good sensitivity for ABPA serological screening. It is easy to perform and interpret, using minimal equipment and resources; and provides a valuable simple screening resource to rapidly distinguish more serious respiratory conditions from Aspergillus sensitization alone.


Assuntos
Anticorpos Antifúngicos/sangue , Aspergilose Broncopulmonar Alérgica/diagnóstico , Aspergillus/imunologia , Imunoensaio/métodos , Testes Sorológicos/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antifúngicos/imunologia , Aspergilose Broncopulmonar Alérgica/epidemiologia , Aspergilose Broncopulmonar Alérgica/microbiologia , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Imunoglobulina M/sangue , Imunoglobulina M/imunologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Reino Unido/epidemiologia , Adulto Jovem
3.
Arerugi ; 69(3): 204-208, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32435021

RESUMO

A 5-year-old girl living in Koriyama, Fukushima Prefecture was admitted in April with cough persisting for 1 month and fever. Chest X-ray showed diffuse ground-glass shadows in both lungs. After treatment with antibiotics, her fever went down on the 2nd day, and her cough subsided gradually. She was discharged on the 7th day, but her symptoms relapsed on the 8th day. Due to her worsening symptoms, she was readmitted on the 16th day. Chest CT scans showed enhancement of interstitial density. Serum anti-Trichosporon asahii antibody was positive. Her symptoms rapidly improved on a steroid regimen, and she was discharged on the 23th day. She was diagnosed as having summer-type hypersensitivity pneumonitis (SHP). She was instructed not to use a moldy humidifier and not to go to her grandmother's 57 years old wooden house. She has had no symptom after discharge. However, suspected mold was not found at her grandmother's house, and a provocation test there was negative. The HLA typing of the patient showed HLA-DQ8, which was previously described as SHP-sensitive.


Assuntos
Alveolite Alérgica Extrínseca/microbiologia , Umidificadores , Estações do Ano , Tricosporonose/etiologia , Anticorpos Antifúngicos/sangue , Pré-Escolar , Feminino , Humanos , Trichosporon
4.
Artigo em Inglês | MEDLINE | ID: mdl-32428065

RESUMO

Candida is one of the most frequent pathogens of bloodstream infections, which is associated with high morbidity and mortality rates. Rapid immunological detection methods are essential in the early diagnosis of candidemia. Anti-mannan is one of host-derived biomarkers against cell wall components of Candida. We conducted this study to evaluate the diagnostic performance of two anti-mannan assays (IgM, IgG) for candidemia through the analysis of 40 candidemia patients, 48 participants with Candida colonization and 213 participants with neither Candida colonization nor Candida infections (13 patients with other bloodstream infections, 145 hospitalized patients and 55 healthy controls). The performance of the two assays were evaluated by calculating their sensitivity and specificity. The sensitivity ranged from 0.78 to 0.80 for the IgM assay and 0.68 to 0.75 for the IgG assay. The specificity ranged from 0.97 to 0.98 for the IgM assay and 0.91 to 0.94 for the IgG assay. The diagnostic performance of the anti-mannan IgM assay was better than that of IgG, with higher sensitivity and specificity. Combining the two assays (positive results of single or both assays are both considered as positive) could improve the sensitivity up to 0.93 (0.79-0.98) and only slightly reduce the specificity (0.93(0.89-0.95)). The anti-mannan IgM, IgG assays are rapid and cost-effective assays that may be probably useful in the diagnosis of candidemia.


Assuntos
Anticorpos Antifúngicos/sangue , Candidemia/diagnóstico , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Mananas/sangue , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Adulto Jovem
5.
Respir Med ; 166: 105955, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32321630

RESUMO

BACKGROUND AND OBJECTIVE: Chronic pulmonary aspergillosis (CPA) is associated with mortality in patients with Mycobacterium avium complex lung disease (MAC-LD). However, the clinical significance of the positivity of Aspergillus precipitating antibody (APAb), a serodiagnostic test for pulmonary aspergillosis (PA), at the time of MAC-LD diagnosis is unknown. The objective of this study was to investigate the effects of APAb test results on the clinical outcomes of patients with MAC-LD. METHODS: We retrospectively analyzed patients who were newly diagnosed as having MAC-LD between 2007 and 2014 in our hospital and checked for APAb at the time of diagnosis. RESULTS: We enrolled 131 patients in this study. Of these patients, 20 (15.3%) tested positive for APAb at the diagnosis of MAC-LD. The APAb-positive patients were more frequently male (70.0% vs. 37.8%, P = 0.013) and more frequently had pulmonary emphysema (60.0% vs. 13.5%, P < 0.001) and interstitial pneumonia (15.0% vs. 1.8%, P = 0.025) compared with the APAb-negative patients. During a median follow-up period of 4.0 years, PA developed in 12 of the APAb-positive patients (60.0%, CPA: 9 and allergic bronchopulmonary aspergillosis: 3) and 12 APAb-negative patients (10.8%, CPA: 12) (P < 0.001). The APAb-positive patients had a significantly higher rate of mortality than did the APAb-negative patients (P = 0.004). A multivariate analysis indicated that older age, lower albumin, fibrocavitary or fibrocavitary and nodular/bronchiectatic radiographic features, and APAb positivity were negative prognostic factors. CONCLUSIONS: APAb-positive patients with MAC-LD more frequently develop PA and may have an unfavorable prognosis.


Assuntos
Anticorpos Antifúngicos/sangue , Aspergillus/imunologia , Complexo Mycobacterium avium , Infecção por Mycobacterium avium-intracellulare/diagnóstico , Infecção por Mycobacterium avium-intracellulare/mortalidade , Aspergilose Pulmonar/diagnóstico , Aspergilose Pulmonar/etiologia , Testes Sorológicos/métodos , Idoso , Biomarcadores/sangue , Estudos de Coortes , Comorbidade , Feminino , Humanos , Doenças Pulmonares Intersticiais/epidemiologia , Masculino , Pessoa de Meia-Idade , Infecção por Mycobacterium avium-intracellulare/complicações , Infecção por Mycobacterium avium-intracellulare/epidemiologia , Prognóstico , Aspergilose Pulmonar/epidemiologia , Aspergilose Pulmonar/mortalidade , Enfisema Pulmonar/epidemiologia , Estudos Retrospectivos , Fatores Sexuais
6.
Int J Mol Sci ; 21(4)2020 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-32085663

RESUMO

Individuals with intestinal barrier dysfunction are more prone to autoimmunity. Lipopolysaccharides (LPS) from gut bacteria have been shown to play a role in systemic inflammation, leading to the opening of the gut and blood-brain barrier (BBB). This study aims to measure antibodies against LPS and barrier proteins in samples positive for anti-Saccharomyces cerevisiae antibodies (ASCA) and anti-neutrophil cytoplasmic antibodies (ANCA) and compare them with these same antibodies in controls to determine whether a correlation between LPS and barrier proteins could be found. We obtained 94 ASCA- and 94 ANCA-positive blood samples, as well as 188 blood samples from healthy controls. Samples were assessed for antibodies to LPS, zonulin+occludin, S100B, and aquaporin-4 (AQP4). Results show significant elevation in antibodies in about 30% of ASCA- and ANCA-positive sera and demonstrate positive linear relationships between these antibodies. The findings suggest that individuals positive for ASCA and ANCA have increased odds of developing intestinal and BBB permeability compared to healthy subjects. The levels of LPS antibodies in both ASCA- and ANCA-positive and negative specimens showed from low and moderate to high correlation with antibodies to barrier proteins. This study shows that LPS, by damaging the gut and BBBs, contribute to the extra-intestinal manifestation of IBD. We conclude that IBD patients should be screened for LPS antibodies in an effort to detect or prevent possible barrier damage at the earliest stage possible to abrogate disease symptoms in IBS and associated disorders.


Assuntos
Anticorpos Anticitoplasma de Neutrófilos/sangue , Anticorpos Antifúngicos/sangue , Ácido Aspártico Endopeptidases/imunologia , Bactérias/imunologia , Lipopolissacarídeos/imunologia , Proteínas de Saccharomyces cerevisiae/imunologia , Saccharomyces cerevisiae/imunologia , Aquaporina 4/imunologia , Estudos de Casos e Controles , Humanos , Razão de Chances , Subunidade beta da Proteína Ligante de Cálcio S100/metabolismo
7.
Am J Respir Cell Mol Biol ; 62(6): 767-782, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32048861

RESUMO

Pneumocystis is an unusual, opportunistic fungal pathogen capable of causing Pneumocystis pneumonia (PCP) in immunocompromised hosts. Although PCP was discovered >100 years ago, its pathogenesis remains unclear. The inhibitory receptor PD-1 (programmed death 1), a negative regulator of activated T cells, has been reported to take part in tumor escape, immune tolerance, and infection immunity. In this study, we examined the role of the PD-1/PD-L1 (programmed death-ligand 1) pathway in patients with PCP and in mice. The expression levels of PD-1/PD-L1 in patients with PCP and in mice were measured by real-time PCR and flow cytometry. The effects of PD-1 deficiency are demonstrated using wild-type and PD-1-/- mice. Our data show that Pneumocystis infection promotes PD-1/PD-L1 expression; PD-1 deficiency enhances the phagocytic function of macrophages and the pulmonary T-helper cell type 1 (Th1)/Th17 response, which might contribute to Pneumocystis clearance; and PD-1 deficiency affects the polarization of macrophages. PCP mice treated with anti-PD-1 antibody showed improved pulmonary clearance of Pneumocystis. Collectively, our results demonstrate that the PD-1/PD-L1 pathway plays a role in regulating the innate and adaptive immune responses, suggesting that manipulation of this pathway may constitute an immunotherapeutic strategy for PCP.


Assuntos
Antígeno B7-H1/fisiologia , Ativação de Macrófagos/fisiologia , Pneumonia por Pneumocystis/imunologia , Receptor de Morte Celular Programada 1/deficiência , Células Th1/imunologia , Células Th17/imunologia , Imunidade Adaptativa , Adulto , Idoso , Animais , Anticorpos Antifúngicos/sangue , Antígeno B7-H1/biossíntese , Antígeno B7-H1/genética , Feminino , Humanos , Imunidade Inata , Hospedeiro Imunocomprometido , Imunoterapia , Pulmão/imunologia , Pulmão/metabolismo , Pulmão/microbiologia , Macrófagos/microbiologia , Masculino , Camundongos , Camundongos Knockout , Pessoa de Meia-Idade , Óxido Nítrico/metabolismo , Infecções Oportunistas/imunologia , Pneumocystis/imunologia , Pneumonia por Pneumocystis/genética , Receptor de Morte Celular Programada 1/biossíntese , Receptor de Morte Celular Programada 1/genética , Receptor de Morte Celular Programada 1/fisiologia , Reação em Cadeia da Polimerase em Tempo Real , Transdução de Sinais
8.
Rev. esp. quimioter ; 33(1): 1-10, feb. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-196176

RESUMO

The introduction of non-culture-based diagnostic techniques is revolutionizing the world of microbiological diagnosis and infection assessment. Fungi are no exception, and the introduction of biomarkers has opened up enormous expectations for better management of these entities. Biomarkers are diverse, their targets are also diverse and their evaluation has been done preferably in an individualized use and with deficient designs. Less is known about the value of the combined use of biomarkers and the impact of the negativity of two or more biomarkers on antifungal treatment decisions has been poorly studied. Given the paucity of prospective, randomized and definitive studies, we have convened experts from different fields, with an interest in invasive fungal infections, to answer some questions about the current relevant use of fungal biomarkers. This document summarizes the answers of these experts to the different questions


La introducción de técnicas de diagnóstico no basadas en cultivo está revolucionando el mundo del diagnóstico microbiológico y de la aproximación a las infecciones. Los hongos no son una excepción, y la introducción de biomarcadores ha abierto enormes expectativas para una mejor manejo de estas enfermedades. Hay diversos biomarcadores cuyo significado es también diverso pero su evaluación se ha hecho preferentemente en un uso individual y con estudios con distintos diseños. Se sabe menos sobre el valor de la combinación de biomarcadores y el impacto de la negatividad de dos o más de los mismos en las decisiones de tratamiento antifúngico ha sido poco estudiado. Dada la escasez de datos prospectivos, en estudios aleatorizados y definitivos, hemos convocado a expertos de diferentes campos con un interés en las infecciones micóticas invasivas, para responder a algunas preguntas sobre el uso actual y relevante de los biomarcadores fúngicos. Este documento resume las respuestas del grupo de expertos a las preguntas que se les formularon sobre el tema


Assuntos
Humanos , Biomarcadores/sangue , Infecções Fúngicas Invasivas/diagnóstico , Anticorpos Antifúngicos/sangue , Aspergilose/sangue , Aspergilose/diagnóstico , Aspergillus/imunologia , Lavagem Broncoalveolar , Candida/imunologia , Candidemia/sangue , Candidemia/diagnóstico , Reações Falso-Positivas , Técnica Indireta de Fluorescência para Anticorpo/métodos , Glucanos/sangue , Unidades de Terapia Intensiva , Infecções Fúngicas Invasivas/sangue , Infecções Fúngicas Invasivas/tratamento farmacológico , Sensibilidade e Especificidade
9.
Mycoses ; 63(1): 38-42, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31532045

RESUMO

BACKGROUND: Paracoccidioidomycosis (PCM) is highly prevalent in Latin America, but no commercial system is available for diagnosing this endemic mycosis. OBJECTIVES: To check the performance of (1 â†’ 3)-ß-D-glucan assay (BDG) for diagnosing  PCM in 29 patients with proven fungal disease and compared with double immunodiffusion assay for detecting anti-Paracoccidioides antibodies. PATIENTS AND METHODS: We selected 52 serum samples sequentially obtained from 29 patients with active PCM (12 chronic and 17 acute form). Samples were collected at baseline, and for 16 patients, additional serum levels were obtained after 3 and 6 months of antifungal treatment. Detection of BDG in serum was performed by using the Fungitell® assay. For the double immunodiffusion assay, Paracoccidioides exoantigen was used in latex agglutination tests to detect serum anti-Paracoccidioides antibodies. RESULTS: Despite exhibiting good sensitivity in the diagnosis of patients with PCM, we failed to demonstrate any correlation between the postdiagnosis kinetic profile of BDG serum levels and clinical response to antifungal therapy. This finding may be related to the maintenance of quiescent foci of fungal infection in several organs and tissues, a phenomenon that has been previously reported by other authors and helps to understand why so many relapses are documented in patients treated for short periods of time. Finally, we did not find any correlation between BDG quantification and specific anti-P brasiliensis antibodies serum titres in patients with PCM. CONCLUSIONS: In conclusion, BDG is detected in serum samples of most patients with PCM but is probably not useful for predicting clinical response to antifungal therapy.


Assuntos
Paracoccidioides/imunologia , Paracoccidioidomicose/diagnóstico , Adolescente , Adulto , Idoso , Anticorpos Antifúngicos/sangue , Antifúngicos/uso terapêutico , Antígenos de Fungos/imunologia , Criança , Pré-Escolar , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Glucanos/imunologia , Humanos , Lactente , Recém-Nascido , América Latina , Masculino , Pessoa de Meia-Idade , Paracoccidioidomicose/tratamento farmacológico , Paracoccidioidomicose/microbiologia , Adulto Jovem
10.
Vet Dermatol ; 31(2): 111-115, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31696563

RESUMO

BACKGROUND: Elevated immunoglobulin E (IgE) levels to Malassezia or Staphylococcus species in human atopic dermatitis are related to the skin severity index; a similar association has not been reported in atopic dogs. OBJECTIVES: To investigate serum levels of allergen-specific IgE, total specific IgG and IgG subclasses (IgG1 and IgG2) for M. pachydermatis and S. pseudintermedius, and to correlate them with the severity of dermatitis in dogs. ANIMALS: Serum samples were collected from dogs categorized by age and disease status. Groups 1 and 2: <3-year-old healthy (n = 9) and atopic dogs (n = 9), respectively; and groups 3 and 4: ≥3-year-old healthy (n = 11) and atopic dogs (n = 14), respectively. METHODS AND MATERIALS: Antibody levels were measured by ELISA. The Canine Atopic Dermatitis Lesion Index (CADLI) was analyzed in relation to antibody levels. RESULTS: Specific IgE and total IgG against M. pachydermatis and S. pseudintermedius were significantly increased in atopic dogs of all ages. Although differences between atopic and healthy dogs, with regard to specific IgG1 and IgG2 levels to each microbe, varied in significance within age groups. No significant relationships were found between the CADLI and any specific immunoglobulin levels for both microbe types. CONCLUSIONS AND CLINICAL IMPORTANCE: In dog skin, microbes may act as allergens triggering inflammatory responses via IgE- and IgG-dependent pathway(s). The affinity of the IgG subclass produced may vary according to antigen type. Specific IgE levels may be related to clinical disease in dogs and not to skin lesion severity.


Assuntos
Anticorpos Antibacterianos/sangue , Anticorpos Antifúngicos/sangue , Dermatite Atópica/veterinária , Dermatomicoses/veterinária , Doenças do Cão/imunologia , Infecções Cutâneas Estafilocócicas/veterinária , Animais , Dermatite Atópica/imunologia , Dermatite Atópica/microbiologia , Dermatomicoses/imunologia , Dermatomicoses/patologia , Doenças do Cão/microbiologia , Doenças do Cão/patologia , Cães , Imunoglobulina E/sangue , Imunoglobulina G/sangue , Malassezia , Pele/microbiologia , Pele/patologia , Testes Cutâneos , Infecções Cutâneas Estafilocócicas/imunologia , Infecções Cutâneas Estafilocócicas/patologia , Staphylococcus
11.
J Feline Med Surg ; 22(2): 129-137, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30784342

RESUMO

OBJECTIVES: The goal of this study was to describe the clinical presentation, diagnosis and treatment of coccidioidomycosis in cats residing in a region endemic for Coccidioides species. METHODS: A retrospective review of records was performed at both primary and tertiary care veterinary practices in Tucson and Phoenix, Arizona, USA. Data collected included signalment, clinical signs, physical examination findings, diagnostic test results, treatment and outcome. RESULTS: Fifty-one feline cases were identified from six veterinary hospitals. Cats presented with clinical signs and laboratory abnormalities similar to what has been seen in dogs, including respiratory illness (n = 20/51), neutrophilia (n = 24/31), monocytosis (n = 17/31) and hyperglobulinemia (n = 16/30). However, cats at diagnosis were typically significantly ill, with 31/51 having disseminated infection, most commonly to the skin (n = 22). Additionally, 43/44 cats that had serum antibody tests performed were positive, and median titer at diagnosis was 1:32 (range 1:4 to ⩾1:256). Serum antibody titers were significantly reduced (P ⩽0.001) in cats that responded to treatment compared with cats that did not clinically improve. Forty of 46 cats that were treated with oral fluconazole responded and did not require additional therapy. Fourteen cats developed recurrent disease and all but one had antifungal therapy successfully reinstituted. CONCLUSIONS AND RELEVANCE: Coccidioidomycosis is a disease of concern for cats residing in the regions endemic for Coccidioides species. Disease is most often disseminated at the time of diagnosis, possibly due to delays in presentation for care and recognition of the infection. Suspicion of disease, serum chemistries, blood cell counts, presence of antibody and imaging aid in the diagnosis of coccidioidomycosis in cats. Serum antibody reduction during treatment frequently correlated with an adequate response to medication. Consideration of coccidioidomycosis as a cause of illness will lead to earlier diagnosis and potentially better treatment outcomes in cats.


Assuntos
Doenças do Gato , Coccidioidomicose , Animais , Anticorpos Antifúngicos/sangue , Arizona , Doenças do Gato/diagnóstico , Doenças do Gato/epidemiologia , Doenças do Gato/terapia , Gatos , Coccidioidomicose/diagnóstico , Coccidioidomicose/epidemiologia , Coccidioidomicose/terapia , Coccidioidomicose/veterinária , Estudos Retrospectivos
12.
Med Mycol ; 58(3): 328-332, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31212311

RESUMO

Coccidioidomycosis in dogs can range from mild respiratory disease or vague, chronic malaise to acute, severe life-threatening illness. The diagnosis of coccidioidomycosis in dogs is based on clinical presentation and serology. Spherule identification is not typical because of low numbers of organisms in specimens, and the invasive nature of sampling tissues and lungs. Conventional serological assays require samples to be submitted to a reference laboratory and results take several days to one week. The sona Coccidioides Antibody Lateral Flow Assay (LFA) (IMMY Diagnostics) is a rapid, bench-side test used for detection of Coccidioides antibodies that is available and FDA-cleared for use in humans but has not been evaluated in dogs. The goal of this study was to compare the LFA to conventional agar gel immunodiffusion (AGID). Paired serum samples were collected for screening by the LFA and submitted to a commercial reference laboratory for AGID screen and titer. Of 56 paired serum samples analyzed, 30 were positive and 26 were negative on the sona Coccidioides antibody LFA. The overall percentage agreement plus 95% confidence interval (CI) was 87.5% (76.20-93.99). Positive percent agreement was 89.7% (73.38-96.65) and negative percent agreement was 85.2% (67.25-94.36). The kappa coefficient to assess agreement was 0.749 (95% CI, 0.576-0.923), which is interpreted as good agreement between the tests (>70%). The sona Coccidioides antibody LFA provided rapid, point-of-care results with a high level of agreement to standard AGID serology in dogs clinically suspected to have coccidioidomycosis, and may aid in diagnosis of coccidioidomycosis in dogs.


Assuntos
Coccidioidomicose/veterinária , Doenças do Cão/diagnóstico , Técnicas Imunoenzimáticas , Sistemas Automatizados de Assistência Junto ao Leito , Animais , Anticorpos Antifúngicos/sangue , Cromatografia de Afinidade , Coccidioides , Coccidioidomicose/diagnóstico , Doenças do Cão/microbiologia , Cães , Imunoglobulina G/sangue , Imunoglobulina M/sangue
13.
Hepatology ; 71(2): 522-538, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31228214

RESUMO

Chronic alcohol consumption causes increased intestinal permeability and changes in the intestinal microbiota composition, which contribute to the development and progression of alcohol-related liver disease. In this setting, little is known about commensal fungi in the gut. We studied the intestinal mycobiota in a cohort of patients with alcoholic hepatitis, patients with alcohol use disorder, and nonalcoholic controls using fungal-specific internal transcribed spacer amplicon sequencing of fecal samples. We further measured serum anti-Saccharomyces cerevisiae antibodies (ASCA) as a systemic immune response to fungal products or fungi. Candida was the most abundant genus in the fecal mycobiota of the two alcohol groups, whereas genus Penicillium dominated the mycobiome of nonalcoholic controls. We observed a lower diversity in the alcohol groups compared with controls. Antibiotic or steroid treatment was not associated with a lower diversity. Patients with alcoholic hepatitis had significantly higher ASCA levels compared to patients with alcohol use disorder and to nonalcoholic controls. Within the alcoholic hepatitis cohort, patients with levels of at least 34 IU/mL had a significantly lower 90-day survival (59%) compared with those with ASCA levels less than 34 IU/mL (80%) with an adjusted hazard ratio of 3.13 (95% CI, 1.11-8.82; P = 0.031). Conclusion: Patients with alcohol-associated liver disease have a lower fungal diversity with an overgrowth of Candida compared with controls. Higher serum ASCA was associated with increased mortality in patients with alcoholic hepatitis. Intestinal fungi may serve as a therapeutic target to improve survival, and ASCA may be useful to predict the outcome in patients with alcoholic hepatitis.


Assuntos
Disbiose/etiologia , Disbiose/imunologia , Hepatite Alcoólica/complicações , Hepatite Alcoólica/imunologia , Intestinos/microbiologia , Micobioma , Adulto , Idoso , Anticorpos Antifúngicos/sangue , Candida/imunologia , Estudos de Coortes , Disbiose/sangue , Feminino , Hepatite Alcoólica/sangue , Humanos , Fenômenos do Sistema Imunológico , Masculino , Pessoa de Meia-Idade , Saccharomyces cerevisiae/imunologia
14.
Reumatol. clín. (Barc.) ; 15(6): 360-362, nov.-dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-189654

RESUMO

OBJETIVO: Valorar la relación entre la calprotectina fecal, ASCA y marcadores de enfermedad en espondiloartritis (Spa). MÉTODOS: Se evaluaron pacientes ≥18años que cumplían criterios ASAS o criterios modificados de Nueva York. Se analizan criterios de actividad, función física, analíticos y datos demográficos. RESULTADOS: Se incluyeron 33 pacientes. Todos excepto uno tenían valores normales de ASCA. Encontramos correlación significativa entre calprotectina y PCR pero no con otros parámetros, ni entre los niveles de calprotectina y la toma de AINE (p = 0,001). Tampoco entre los niveles de PCR y el uso de AINE. Después de retirar los AINE no encontramos diferencias en los niveles de calprotectina (p = 0,9). CONCLUSIÓN: La calprotectina fecal está elevada en pacientes con Spa y se correlaciona positivamente con la PCR. La elevación de la calprotectina fecal no se ve alterada por el uso de AINE. La cantidad de ASCA no cambia y no se correlaciona con ningún parámetro clínico en el estudio poblacional


OBJECTIVE: To assess the relationship between the increase of fecal calprotectin, anti-Saccharomyces cerevisiae antibodies (ASCA) and disease markers in a group of patients with spondyloarthritis. METHODS: We evaluated patients who were at least 18-years-old and met the Assessment in Spondyloarthritis International Society (ASAS) criteria for spondyloarthritis or the New York modified criteria. We analyzed activity criteria, physical function, analytical criteria (human leukocyte antigen [HLA] B27, fecal calprotectin, presence of ASCA, among others) and demographic data. RESULTS: We included 33 patients. All but one patient had normal ASCA values. We found statistical significance in the correlation of calprotectin with C-reactive protein (CRP) but not with other parameters. We also found a relationship between calprotectin levels and nonsteroidal anti-inflammatory drug (NSAID) intake (P=.001). We found no relationship between CRP levels and NSAID use. After discontinuation of NSAIDs for one month, we found no significant differences in calprotectin levels (P=.9). CONCLUSION: Fecal calprotectin is elevated in patients with spondyloarthritis and correlates positively with CRP. Level of fecal calprotectin is not altered by NSAID use. The amount of ASCA present does not change and does not correlate with any clinical parameters in the study population


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Anticorpos Antifúngicos/sangue , Fezes/química , Complexo Antígeno L1 Leucocitário/análise , Saccharomyces cerevisiae/imunologia , Espondilartrite/diagnóstico , Espondilartrite/metabolismo , Biomarcadores/análise , Proteína C-Reativa/análise , Espondilartrite/sangue
15.
Mycopathologia ; 184(5): 661-666, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31583528

RESUMO

Blastomycosis is a systemic fungal disease of humans and other animals produced by the thermally dimorphic fungal organism, Blastomyces dermatitidis. Recent studies have focused on the utilization of antibody and antigen detection in the development of immunoassays for the diagnosis of blastomycosis. This study was designed to evaluate four B. dermatitidis yeast lysate antigenic preparations from human isolates (591, 592, 597, 598) from an outbreak of blastomycosis in Eagle River, Wisconsin. The indirect enzyme-linked immunosorbent assay (ELISA) was used to compare these four antigens for their ability to detect antibodies in 28 serum specimens from immunized rabbits and in 18 sera from dogs with blastomycosis. This study also compared antibodies prepared from each of the four B. dermatitidis lysate antigens for their ability to detect antigen using the competitive enzyme-linked immunosorbent assay in 18 urine specimens from the same dogs as above with blastomycosis. All four reagents proved to be immunoreactive and were able to detect antibody in the rabbit and dog sera and antigen in each of the urine specimens with only slight variations in the mean absorbance values evidenced. Antibody detection, mean absorbance values with the four lysates, ranged from 1.522 (592 antigen) to 2.047 (597 antigen) in the rabbit sera and from 1.504 (591 antigen) to 1.878 (597 antigen) in the dog sera. Antigen detection, sensitivity values obtained with the antibodies prepared from the four lysates, ranged from 89% (598 serum) to 100% (591 and 592 serum specimens).


Assuntos
Anticorpos Antifúngicos/sangue , Blastomyces/imunologia , Blastomicose/imunologia , Animais , Antígenos de Fungos/imunologia , Surtos de Doenças , Cães , Humanos , Coelhos
16.
Mycoses ; 62(11): 1049-1055, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31479538

RESUMO

Antifungal treatment options for allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitisation (SAFS) are largely limited to itraconazole based on the outcome of randomised controlled trials. It is unclear if nebulised amphotericin B deoxycholate (Fungizone® ) is a viable therapeutic option. We evaluated the safety and efficacy of nebulised Fungizone® in the long-term treatment of various forms of pulmonary aspergillosis. We assessed the records of 177 patients with various forms of pulmonary aspergillosis attending the National Aspergillosis Centre in Manchester who had received Fungizone® . Patients first received a challenge test with nebulised Fungizone® in hospital with spirometry pre/post-Fungizone® and nebulised salbutamol given pre-Fungizone® . Tolerability and changes in Aspergillus IgE, Aspergillus IgG and total IgE were evaluated. Sixty-six per cent (117/177) were able to tolerate the test dose of Fungizone® and in all cases, the reason for discontinuation of the first test dose was worsening breathlessness. Twenty six (21%) stopped therapy within 4-6 weeks, and the commonest reason cited for discontinuation of therapy was increased breathlessness, hoarseness and cough. Eighteen (10.2%) patients continued the Fungizone® for >3 months of which 5 (27.8%) recorded an improvement in total IgE, Aspergillus-specific IgE and Aspergillus IgG. Eleven had ABPA, four had SAFS, two had Aspergillus bronchitis and one had Aspergillus sensitisation with cavitating nodules. Among these 18 patients, sputum fungal culture results went from positive to negative in five patients, became positive in one patient, remained positive in three patients, and remained negative in seven patients. Nebulised Fungizone® appears to be a poorly tolerated treatment for pulmonary Aspergillosis with high dropout rates. There appears to be both clinical and serological benefits following sustained treatment with nebulised Fungizone® in some patients.


Assuntos
Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Ácido Desoxicólico/uso terapêutico , Adesão à Medicação/estatística & dados numéricos , Nebulizadores e Vaporizadores , Aspergilose Pulmonar/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anfotericina B/efeitos adversos , Anticorpos Antifúngicos/sangue , Antifúngicos/efeitos adversos , Aspergillus/efeitos dos fármacos , Ácido Desoxicólico/efeitos adversos , Vias de Administração de Medicamentos , Combinação de Medicamentos , Avaliação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Reino Unido , Adulto Jovem
17.
J R Coll Physicians Edinb ; 49(3): 207-216, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31497788

RESUMO

Sepsis is a major cause of death in hospitalised patients accounting for mortality rates as high as 60% and, hence, is called 'a hidden public health disaster'. Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis is not a disease but is a clinical syndrome, where the initial features are nonspecific resulting in delayed diagnosis. Lack of specific laboratory tests to diagnose the syndrome adds to the diagnostic confusion. Failure to identify sepsis in the early stages itself delays effective treatment resulting in high morbidity and mortality. Various biomarkers and newer laboratory tests help to address these issues. However, to date there is no ideal test to diagnose sepsis. The most commonly used markers are C-reactive protein (CRP) and procalcitonin (PCT). There are around 180 biomarkers reported to be useful in sepsis. In addition to CRP and PCT, various emerging laboratory markers, such as like serum amyloid A, soluble triggering receptor expressed on myeloid cell-1, mannan and antimannan antibodies, and interferon γ inducible protein-10 etc., have been reviewed and their clinical usefulness discussed in this paper.


Assuntos
Sepse/diagnóstico , Proteínas da Fase Aguda , Adrenomedulina/sangue , Anticorpos Antifúngicos/sangue , Biomarcadores/sangue , Proteína C-Reativa/análise , Proteínas de Transporte/sangue , Complemento C5a/análise , Citocinas/sangue , Proteína HMGB1/sangue , Hepcidinas/sangue , Hexosaminidases/sangue , Humanos , Receptores de Lipopolissacarídeos/sangue , Mananas/imunologia , Glicoproteínas de Membrana/sangue , Neutrófilos/metabolismo , Fragmentos de Peptídeos/sangue , Receptores de IgG/sangue , Sepse/sangue , Proteína Amiloide A Sérica/análise , Componente Amiloide P Sérico/análise , Receptor Gatilho 1 Expresso em Células Mieloides/sangue , Ativador de Plasminogênio Tipo Uroquinase/sangue
18.
Mycoses ; 62(12): 1108-1115, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31408547

RESUMO

BACKGROUND: An early diagnosis of chronic pulmonary aspergillosis (CPA) at the stage of simple aspergilloma (SA) remains a challenge in low- and middle-income countries, where imaging may not be routinely available. OBJECTIVE: We investigate the role of Aspergillus fumigatus-specific IgG in serum, and galactomannan (GM) in bronchoalveolar lavage fluid (BALF) and serum for the diagnosis of SA. METHODS: We included 46 consecutive treatment-naïve subjects with SA. The 81 controls were subjects of treated pulmonary tuberculosis with residual radiological abnormality and minimal symptoms; and subjects with pulmonary disorders other than CPA who underwent bronchoscopy. The diagnosis of SA was based on consistent clinical features along with radiological manifestations (cavity with fungal ball). RESULTS: Using receiver operating characteristic (ROC) curve analysis, the best cut-off value for A fumigatus-specific IgG was 27.3 mgA/L (AUROC, 0.839; sensitivity, 63.5%; specificity, 98.3%). The best cut-off value for serum and BALF-GM was 0.7 (AUROC, 0.636; sensitivity, 32%; specificity, 96.2%) and 2.5 (AUROC, 0.833; sensitivity, 63.7%; specificity, 97.1%), respectively. A combination of A fumigatus-specific IgG (>27 mgA/L) or serum GM (≥0.7) or BALF-GM (≥2.5) had a sensitivity and specificity of 82.6% and 96%, respectively. CONCLUSIONS: A combination of serological tests has the best sensitivity in diagnosing SA. More studies are needed to confirm our findings.


Assuntos
Anticorpos Antifúngicos/sangue , Imunoglobulina G/sangue , Mananas/imunologia , Aspergilose Pulmonar/diagnóstico , Adulto , Anticorpos Antifúngicos/imunologia , Aspergillus fumigatus , Líquido da Lavagem Broncoalveolar/imunologia , Líquido da Lavagem Broncoalveolar/microbiologia , Feminino , Humanos , Imunoglobulina G/imunologia , Masculino , Pessoa de Meia-Idade , Aspergilose Pulmonar/imunologia , Curva ROC , Sensibilidade e Especificidade , Testes Sorológicos , Tomografia Computadorizada por Raios X
19.
BMC Infect Dis ; 19(1): 694, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387539

RESUMO

BACKGROUND: Chronic pulmonary aspergillosis (CPA) is an underdiagnosed and misdiagnosed disease and now increasingly recognised. However, the diagnosis of CPA remains challenging. In this study, we aimed to investigate the diagnostic values of serum Aspergillus-specific IgG, IgA and IgM antibodies in patients with CPA. METHODS: The prospective study was performed at Chinese People's Liberation Army General Hospital in Beijing, from January 2017 to December 2017. Adult patients with lung lesions presented as cavity, nodule, mass, bronchiectasis or severe fibrotic destruction with at least two lobes in CT imaging were enrolled. One hundred healthy persons were also enrolled as additional controls. The serum levels of Aspergillus-specific IgG, IgA and IgM antibodies and galactomannan (GM) levels were measured simultaneously by plate ELISA kit. RESULTS: A total of 202 patients were enrolled in this study, including 42 CPA patients, 60 non-CPA patients and 100 healthy persons. The most common underlying lung diseases in CPA patients were bronchiectasis (28.6%) and COPD (19.0%). The most common symptoms in the CPA patients were cough (76.2%), sputum (71.4%), and fever (45.2%); chest pain (4.8%) was infrequent. Receiver operating characteristic (ROC) curve analysis revealed that the optimal CPA diagnostic cut-off of Aspergillus-specific IgG, IgA and IgM assays and GM test were 89.3 AU/mL, 8.2 U/mL, 73.3 AU/mL and 0.5µg/L, respectively. The serum levels of Aspergillus-specific IgG and IgA in CPA patients were higher than these in non-CPA patients or healthy persons. The sensitivities and specificities of Aspergillus-specific IgG, IgA, IgM tests and GM test were 78.6 and 94.4%, 64.3 and 89.4%, 50.0 and 53.7% and 71.4 and 58.1%, respectively. CONCLUSIONS: The sensitivity and specificity of serum Aspergillus-specific IgG assay are satisfactory for diagnosing CPA, while the performance of Aspergillus-specific IgA assay is moderate. Aspergillus-specific IgM assay and serum GM test have limited value for CPA diagnosis. TRIAL REGISTRATION: NCT03027089 . Registered 20 January 2017.


Assuntos
Isotipos de Imunoglobulinas/sangue , Aspergilose Pulmonar/diagnóstico , Adulto , Idoso , Anticorpos Antifúngicos/sangue , Aspergillus/imunologia , Doença Crônica , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Humanos , Masculino , Mananas/sangue , Pessoa de Meia-Idade , Estudos Prospectivos , Aspergilose Pulmonar/sangue , Aspergilose Pulmonar/etiologia , Curva ROC , Sensibilidade e Especificidade
20.
J Clin Microbiol ; 57(9)2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31217272

RESUMO

Detecting Aspergillus-specific IgG is critical to diagnosing chronic pulmonary aspergillosis (CPA). Existing assays are often cost- and resource-intensive and not compatible with resource-constrained laboratory settings. LDBio Diagnostics has recently commercialized a lateral flow assay based on immunochromatographic technology (ICT) that detects Aspergillus antibodies (IgG and IgM) in less than 30 min, requiring minimal laboratory equipment. A total of 154 CPA patient sera collected at the National Aspergillosis Centre (Manchester, United Kingdom) and control patient sera from the Peninsula Research Bank (Exeter, United Kingdom) were evaluated. Samples were applied to the LDBio Aspergillus ICT lateral flow assay, and results were read both visually and digitally. Results were compared with Aspergillus IgG titers in CPA patients, measured by ImmunoCAP-specific IgG assays. For proven CPA patients versus controls, sensitivity and specificity for the LDBio Aspergillus ICT were 91.6% and 98.0%, respectively. In contrast, the routinely used ImmunoCAP assay exhibited 80.5% sensitivity for the same cohort (cutoff value, 40 mg of antigen-specific antibodies [mgA]/liter). The assay is easy to perform but challenging to read when only a very faint band is present (5/154 samples tested). The ImmunoCAP Aspergillus IgG titer was also compared with the Aspergillus ICT test line intensity or rate of development, with weak to moderate correlations. The Aspergillus ICT lateral flow assay exhibits excellent sensitivity for serological diagnosis of CPA. Quantifying IgG from test line intensity measurements is not reliable. Given the short run time, simplicity, and limited resources needed, the LDBio Aspergillus ICT is a suitable diagnostic tool for CPA in resource-constrained settings.


Assuntos
Anticorpos Antifúngicos/sangue , Aspergillus/imunologia , Imunoensaio/métodos , Aspergilose Pulmonar/diagnóstico , Testes Sorológicos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Reino Unido
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