Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.122
Filtrar
1.
Euro Surveill ; 25(8)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32127123

RESUMO

A novel coronavirus (SARS-CoV-2) has been identified as the causative pathogen of an ongoing outbreak of respiratory disease, now named COVID-19. Most cases and sustained transmission occurred in China, but travel-associated cases have been reported in other countries, including Europe and Italy. Since the symptoms are similar to other respiratory infections, differential diagnosis in travellers arriving from countries with wide-spread COVID-19 must include other more common infections such as influenza and other respiratory tract diseases.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Técnicas de Diagnóstico Molecular , Pneumonia Viral/diagnóstico , Algoritmos , Betacoronavirus/genética , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Diagnóstico Diferencial , Surtos de Doenças , Humanos , Influenza Humana/diagnóstico , Itália/epidemiologia , Programas de Rastreamento , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Diagnóstico Molecular/normas , Pneumonia Viral/epidemiologia , Vigilância da População , Infecções Respiratórias/diagnóstico , Viagem
2.
Exerc Immunol Rev ; 26: 56-78, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32139349

RESUMO

PURPOSE: Habitual intense exercise may increase the incidence of upper respiratory symptoms (URS) in elite athletes. This study investigated whether immune gene expression could identify gene markers that discriminate athletes with a higher prevalence of URS. METHODS: This cross-sectional analysis of elite Australian athletes from various sports investigated whether athletes retrospectively reporting URS for two days or more in a month (n=38), had an altered immune gene expression profile compared with asymptomatic athletes (n=33). Peripheral blood samples were collected during Olympic selection events with corresponding URS data collected for the one-month period before sampling. Digital immune gene expression analysis was undertaken using the NanoString PanCancer Immune Profiling panel. RESULTS: Fifty immune genes were differentially expressed between the groups (p<0.05) and approximately 78% of these genes were more highly expressed in athletes reporting URS. Many of these genes were interferon-stimulated genes or genes involved in the Jak/Stat signalling pathway. Only interferon alpha inducible protein 27 (IFI27), an interferon stimulated gene involved in viral response, remained significantly higher in athletes reporting URS (log2 fold-difference=2.49, odds ratio 1.02 per unit increase; p<0.01) post-adjustment and discriminated athletes reporting URS from asymptomatic athletes with 78% accuracy. CONCLUSIONS: Expression of IFI27 could differentiate athletes reporting URS from asymptomatic athletes, a gene that is upregulated in the immune response to viral infection. Upregulation of viral signalling pathways provides novel information on the potential aetiology of URS in elite Olympic athletes.


Assuntos
Atletas , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/genética , Transcriptoma , Austrália , Estudos Transversais , Humanos , Proteínas de Membrana/genética , Estudos Retrospectivos
3.
J Med Virol ; 92(4): 408-417, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31944312

RESUMO

Respiratory tract viral infection caused by viruses or bacteria is one of the most common diseases in human worldwide, while those caused by emerging viruses, such as the novel coronavirus, 2019-nCoV that caused the pneumonia outbreak in Wuhan, China most recently, have posed great threats to global public health. Identification of the causative viral pathogens of respiratory tract viral infections is important to select an appropriate treatment, save people's lives, stop the epidemics, and avoid unnecessary use of antibiotics. Conventional diagnostic tests, such as the assays for rapid detection of antiviral antibodies or viral antigens, are widely used in many clinical laboratories. With the development of modern technologies, new diagnostic strategies, including multiplex nucleic acid amplification and microarray-based assays, are emerging. This review summarizes currently available and novel emerging diagnostic methods for the detection of common respiratory viruses, such as influenza virus, human respiratory syncytial virus, coronavirus, human adenovirus, and human rhinovirus. Multiplex assays for simultaneous detection of multiple respiratory viruses are also described. It is anticipated that such data will assist researchers and clinicians to develop appropriate diagnostic strategies for timely and effective detection of respiratory virus infections.


Assuntos
Infecções por Adenovirus Humanos/diagnóstico , Infecções por Coronavirus/diagnóstico , Influenza Humana/diagnóstico , Infecções por Picornaviridae/diagnóstico , Infecções por Vírus Respiratório Sincicial/diagnóstico , Infecções Respiratórias/diagnóstico , Humanos , Imunoensaio , Testes Imunológicos , Reação em Cadeia da Polimerase Multiplex , Técnicas de Amplificação de Ácido Nucleico , Reação em Cadeia da Polimerase em Tempo Real , Rhinovirus , Vírus/crescimento & desenvolvimento , Vírus/isolamento & purificação
4.
Medicine (Baltimore) ; 99(2): e18504, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914021

RESUMO

We aimed to evaluate the clinical significance of bacterial coexistence and the coinfection dynamics between bacteria and respiratory viruses among young children. We retrospectively analyzed clinical data from children aged < 5 years hospitalized with a community-acquired single respiratory viral infection of influenza, adenovirus, or RSV during 2 recent consecutive influenza seasons. Remnant respiratory specimens were used for bacterial PCR targeting Moraxella catarrhalis, Haemophilus influenzae, Streptococcus pneumoniae, and Staphylococcus aureus.A total of 102 children were included; median age was 0.8 years and 44.1% had underlying comorbidities. Overall, 6.8% (7/102) of cases were classified as severe diseases requiring intensive care unit admission and/or mechanical ventilation and ranged from 8.8% for a patient with RSV and 7.6% for those with adenovirus to 0% for those with influenza viruses. The overall viral-bacterial codetection rate was 59.8% (61/102); M catarrhalis was the most frequent (33.3%), followed by H influenzae (31.4%). Influenza cases showed higher bacterial codetection rates (80.0%; 8/10) compared with those with adenoviruses (69.2%; 9/13) and RSV (55.7%; 44/79). S pneumoniae and H influenzae codetections were associated with reduced severity (aOR, 0.24; 95% CI, 0.07-0.89), and reduced risk of wheezing (aOR, 0.36; 95% CI, 0.13-0.98), respectively.We observed the interactions between respiratory viruses and bacteria and the clinical significance of viral-bacterial coexistence in upper airway on disease severity. Future study will be necessary to elucidate the active interactions between different viruses and bacteria and give clues to risk stratified strategy in the management of respiratory infections among young children.


Assuntos
Adenoviridae/isolamento & purificação , Haemophilus influenzae/isolamento & purificação , Infecções Respiratórias/microbiologia , Infecções Respiratórias/virologia , Infecções por Adenoviridae/diagnóstico , Infecções por Adenoviridae/virologia , Bactérias/genética , Pré-Escolar , Coinfecção/microbiologia , Coinfecção/virologia , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/virologia , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Influenza Humana/diagnóstico , Influenza Humana/virologia , Masculino , Prevalência , Sons Respiratórios/diagnóstico , Sons Respiratórios/etiologia , Infecções por Vírus Respiratório Sincicial/diagnóstico , Infecções por Vírus Respiratório Sincicial/virologia , Vírus Sinciciais Respiratórios/genética , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Staphylococcus aureus/isolamento & purificação , Streptococcus pneumoniae/isolamento & purificação , Vírus/genética
5.
BMC Infect Dis ; 20(1): 7, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31900105

RESUMO

BACKGROUND: Mycoplasma sp. are well recognized as etiological agents of respiratory and sexually transmitted disease. Mycoplasma penetrans, a species of Mycoplasma sp., has been frequently detected in HIV-positive patients and associated with the progression of HIV-associated disease. To date, there is only a single case report describing M. penetrans as the causative agent of a severe respiratory tract infection in a HIV-negative patient. CASE PRESENTATION: In this report, we describe the case of M. penetrans bacteremia in a HIV-negative, 38-year-old, female, immunocompromised, solid organ transplant patient (combined kidney and pancreas transplantation in 2016), who was admitted to our hospital with anemic uterine bleeding and fever of 38.3 °C. Several hours before her admission at our university hospital, a latex bladder catheter was inserted into her uterus and she complained about fatigue, dizziness and ongoing vaginal bleeding. Laboratory examination showed severe anemia, but microbiological examination was inconspicuous (culture negative vaginal and cervical smears, negative urine culture). Bacterial blood cultures showed a growth signal after 4 h, but microscopic examination with Gram staining and subcultures on different agar media did not identify bacterial pathogens. To identify the bacterial cause of malignancy in the patient, metagenomic sequencing of the blood culture was performed that identified M. penetrans. CONCLUSION: Metagenomic sequencing identified M. penetrans in an immunosuppressed patient with culture-negative bacteremia. Clinicians should be aware of the opportunistic potential of M. penetrans that may cause severe infections in certain vulnerable patient populations and the limitations of culture and Gram staining for confirming the presence of fastidious bacterial pathogens like Mycoplasma spp.


Assuntos
Bacteriemia/diagnóstico , Hospedeiro Imunocomprometido , Metagenômica , Infecções por Mycoplasma/diagnóstico , Mycoplasma penetrans , Infecções Respiratórias/diagnóstico , Adulto , Bacteriemia/genética , Bacteriemia/microbiologia , Análise Mutacional de DNA/métodos , Diabetes Mellitus Tipo 1/imunologia , Diabetes Mellitus Tipo 1/terapia , Feminino , Soronegatividade para HIV , Humanos , Transplante de Rim , Metagenoma , Metagenômica/métodos , Infecções por Mycoplasma/genética , Infecções por Mycoplasma/microbiologia , Mycoplasma penetrans/genética , Mycoplasma penetrans/isolamento & purificação , Transplante de Pâncreas , Infecções Respiratórias/genética , Infecções Respiratórias/microbiologia , Análise de Sequência de DNA
6.
Clin Biochem ; 75: 30-34, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31672649

RESUMO

OBJECTIVES: The aim of this study was to explore the auxiliary diagnostic value of neutrophil gelatinase-associated lipocalin (NGAL) and anti-citrullinated alpha-enolase peptide 1 (CEP-1) in lower respiratory tract infections (LRTIs). METHODS: Blood samples were collected from 99 in-patients with LRTIs [62 community-acquired pneumonia (CAP), 14 acute exacerbated chronic obstructive pulmonary diseases (AECOPD), 23 other diseases] and 50 healthy subjects. NGAL, CEP-1 and IL-6 were measured and compared. IL-6 was tested by electrochemiluminescence assay kit on Roche E601 immunology analyzer, CEP-1 was assessed with enzyme-linked immunosorbent assay kit, and NGAL was detected by latex immunoturbidimetric assay kit on Beckman Coulter AU2700. RESULTS: Compared with healthy controls, NGAL and IL-6 levels were significantly increased in the patients with LRTIs, the area under the curves (AUC) was 0.97 and 0.88 respectively (P < 0.01). The sensitivity and specificity of NGAL at a cut-off of 86 ng/ml were 93.0% and 96.0%, respectively, in which the sensitivity was consistent with IL-6 (P = 0.21) and the specificity was better than IL-6 (P < 0.01). CEP-1 slightly increases in the patient group, however the difference was not significant (P = 0.41). The levels of NGAL and IL-6 was no differences in different diseases, the P-value was 0.50 and 0.29, respectively. LRTIs with and without underlying diseases have similar NGAL and IL-6 values. CONCLUSIONS: NGAL, rather than CEP-1, may be appealing adjuncts for diagnosis of LRTIs. NGAL proved to be a better biomarker than IL-6.


Assuntos
Interleucina-6/sangue , Lipocalina-2/sangue , Infecções Respiratórias , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Respiratórias/sangue , Infecções Respiratórias/diagnóstico
7.
Ann Otol Rhinol Laryngol ; 129(1): 82-86, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31522522

RESUMO

OBJECTIVE: The identification of rare sources of laryngeal infection in immunocompetent patients. Recovered organisms were Mycobacterium tuberculosis (laryngeal tuberculosis [LTB]), Mycobacterium fortuitum (laryngeal Mycobacterium fortuitum [LMF]), and Blastomyces dermatiditis (laryngeal blastomycosis [LB]). METHOD: Single institution retrospective case series of three patients over a 2.5-year period and review of the literature on laryngeal infections by three atypical organisms. RESULTS: Three patients presented with hoarseness and cough; one additionally had throat pain (LTB). Indirect laryngoscopy demonstrated diffuse laryngeal ulceration (LTB, LMF) and an exophytic, contiguous glottic mass (LB). Direct microlaryngoscopic biopsies and cultures established the diagnoses, including a frozen section in one case (LB), which prevented a simultaneously planned surgical resection. Appropriate antimicrobial therapy yielded dramatic laryngeal and corresponding vocal improvement, for which we provide unique photo and audio documentation. In the last 10 years, fewer than 500 cases of LTB have been reported in the English language medical literature, principally outside the United States. To date, there have been reports of only 34 LB and no cases of LMF. CONCLUSION: Atypical infections of the larynx may be localized and mimic laryngeal cancer on endoscopy. Tissue examination as well as microbiologic samples are diagnostic and complementary.


Assuntos
Blastomicose/diagnóstico , Neoplasias Laríngeas/diagnóstico , Laringoscopia , Infecções por Micobactéria não Tuberculosa/diagnóstico , Tuberculose Laríngea/diagnóstico , Adulto , Biópsia , Blastomyces , Blastomicose/complicações , Blastomicose/patologia , Tosse/etiologia , Técnicas de Cultura , Diagnóstico Diferencial , Feminino , Rouquidão/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Micobactéria não Tuberculosa/complicações , Infecções por Micobactéria não Tuberculosa/patologia , Mycobacterium fortuitum , Infecções Respiratórias/complicações , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/patologia , Tuberculose Laríngea/complicações , Tuberculose Laríngea/patologia
9.
FP Essent ; 486: 11-18, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31710453

RESUMO

Upper respiratory tract infections (URTIs) include the common cold, rhinosinusitis, pharyngitis, and acute otitis media (AOM). URTIs account for billions of dollars in annual health care costs; acute respiratory tract infections are the most common reason for acute care appointments. Although URTIs typically are viral, these infections are the most common reason for prescription of antibiotics in adults. Recommended therapy for the common cold involves symptom management with over-the-counter drugs, though the Food and Drug Administration advises against use of these drugs in children younger than 6 years. Acute rhinosinusitis also typically is viral. A bacterial etiology is more likely if symptoms last longer than 10 days, the temperature is greater than 39°C (102.2°F), or if symptoms worsen after initial improvement. Antibiotics are not recommended unless symptoms worsen or do not improve after an additional 7 days. Acute pharyngitis also typically is of viral origin. Antibiotics for streptococcal pharyngitis should be prescribed only if test or culture results are positive. AOM can be managed without antibiotics except in children younger than 6 months, children ages 6 to 23 months with bilateral AOM, children older than 2 years with bilateral AOM and otorrhea, and certain high-risk patients.


Assuntos
Otite Média , Faringite , Infecções Respiratórias , Rinite , Sinusite , Doença Aguda , Adulto , Antibacterianos/uso terapêutico , Criança , Humanos , Lactente , Otite Média/diagnóstico , Otite Média/tratamento farmacológico , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/tratamento farmacológico , Rinite/diagnóstico , Rinite/tratamento farmacológico , Sinusite/diagnóstico , Sinusite/tratamento farmacológico
10.
FP Essent ; 486: 19-25, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31710454

RESUMO

Acute bronchitis and pneumonia are conditions commonly diagnosed in inpatient and outpatient settings. Acute bronchitis is a lower respiratory tract infection characterized by cough, with or without sputum production, lasting 1 to 3 weeks. It typically is viral. Testing for influenza should be obtained in patients at high risk of influenza complications. Antibiotics are not indicated in patients without chronic lung disease unless Bordetella pertussis infection is suspected. If pertussis is confirmed, macrolide antibiotics should be prescribed. Otherwise, symptom control and patient education are key to management. Community-acquired pneumonia (CAP) is a leading cause of death in children and adults. Diagnosis is based on symptoms and imaging study results. Ultrasonography is more accurate than chest x-rays. Severity scoring systems are used to aid clinical judgement in selecting inpatient versus outpatient management. Antibiotics should be administered according to current guidelines. Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are nosocomial infections with high mortality rates. Microorganisms responsible for HAP and VAP have high rates of resistance and vary based on geographic regions. Implementation of prevention protocols has decreased rates of VAP.


Assuntos
Infecção Hospitalar , Influenza Humana , Pneumonia Associada à Ventilação Mecânica , Infecções Respiratórias , Adulto , Antibacterianos/uso terapêutico , Criança , Humanos , Influenza Humana/diagnóstico , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/tratamento farmacológico
11.
BMC Infect Dis ; 19(1): 975, 2019 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-31747887

RESUMO

BACKGROUND: The current evidence of extra length of stay (LOS) attributable to healthcare-associated infection (HCAI) scarcely takes time-dependent bias into consideration. Plus, limited evidences were from developing countries. We aim to estimate the extra LOS and risk factors of mortality attributable to HCAI for inpatients. METHODS: Multi-state model (MSM) was adopted to estimate the extra LOS attributable to HCAI of each type and subgroup. COX regression model was used to examine the risk of mortality. RESULTS: A total of 51,691 inpatients were included and 1709 (3.31%) among them developed HCAI. Lower respiratory tract infection and Acinetobacter baumannii were the most prevalent HCAI and causative pathogen in surveyed institute. Generally, the expected extra LOS attributable to HCAI was 2.56 days (95% confidence interval: 2.54-2.61). Patients below 65 had extra LOS attributable to HCAI longer about 2 days than those above. The extra LOS attributable to HCAI of male patients was 1.33 days longer than female. Meanwhile, age above 65 years old and HCAI were the risk factors of mortality for inpatients. CONCLUSIONS: HCAI contributes to an increase in extra LOS of inpatients in China. The effect of HCAI on extra LOS is different among subgroups, with the age below 65, male and medicine department more sensitive.


Assuntos
Infecção Hospitalar/diagnóstico , Tempo de Internação , Infecções Respiratórias/diagnóstico , Acinetobacter baumannii/isolamento & purificação , Fatores Etários , Idoso , China , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Infecções Respiratórias/microbiologia , Infecções Respiratórias/mortalidade , Fatores de Risco , Fatores Sexuais , Taxa de Sobrevida
12.
BMC Infect Dis ; 19(1): 976, 2019 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-31747890

RESUMO

BACKGROUND: Diagnosing pneumonia can be challenging in general practice but is essential to distinguish from other respiratory tract infections because of treatment choice and outcome prediction. We determined predictive signs, symptoms and biomarkers for the presence of pneumonia in patients with acute respiratory tract infection in primary care. METHODS: From March 2012 until May 2016 we did a prospective observational cohort study in three radiology departments in the Leiden-The Hague area, The Netherlands. From adult patients we collected clinical characteristics and biomarkers, chest X ray results and outcome. To assess the predictive value of C-reactive protein (CRP), procalcitonin and midregional pro-adrenomedullin for pneumonia, univariate and multivariate binary logistic regression were used to determine risk factors and to develop a prediction model. RESULTS: Two hundred forty-nine patients were included of whom 30 (12%) displayed a consolidation on chest X ray. Absence of runny nose and whether or not a patient felt ill were independent predictors for pneumonia. CRP predicts pneumonia better than the other biomarkers but adding CRP to the clinical model did not improve classification (- 4%); however, CRP helped guidance of the decision which patients should be given antibiotics. CONCLUSIONS: Adding CRP measurements to a clinical model in selected patients with an acute respiratory infection does not improve prediction of pneumonia, but does help in giving guidance on which patients to treat with antibiotics. Our findings put the use of biomarkers and chest X ray in diagnosing pneumonia and for treatment decisions into some perspective for general practitioners.


Assuntos
Biomarcadores/análise , Pneumonia/diagnóstico , Infecções Respiratórias/diagnóstico , Adulto , Idoso , Antibacterianos/uso terapêutico , Proteína C-Reativa/análise , Calcitonina/análise , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Países Baixos , Pneumonia/complicações , Pneumonia/tratamento farmacológico , Atenção Primária à Saúde , Prognóstico , Estudos Prospectivos , Infecções Respiratórias/complicações , Infecções Respiratórias/tratamento farmacológico , Tórax/diagnóstico por imagem
13.
Niger J Clin Pract ; 22(11): 1590-1599, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31719282

RESUMO

Background: Biological sex is an important factor that influences childhood morbidity and mortality but its role in acute respiratory infections (ARI) in children is not well understood. We investigated the trends in sex-specific prevalence of childhood ARI episodes and associated factors in Nigerian children from 1990 to 2013. Methods: This secondary analysis used data from the Nigerian Demographic Health Surveys (NDHS) collected in 1990, 1999, 2003, 2008 and 2013. Variables extracted include: two ARI-related questions, household characteristics, children's anthropometry and vaccination status. We defined ARI as maternal report of cough accompanied by short, rapid breathing. Univariate and bivariate analyses were carried out to estimate prevalence of suspected ARI and compared between male and female children. Results: We found an initial increase followed by a decreasing trend in prevalence of ARI-related symptoms among under-5 children; from 6.7% in 1990 to 11.6% in 1999 then to 3.8% in 2013 without consistent sex differences regardless of other factors except malnutrition. In the 2003 survey, more male than female children had ARI among underweight [OR = 1.22 (95% CI: 1.04, 1.43)] and stunted [OR = 1.23 (95% CI: 1.07, 1.43)] children. Similarly, the 2008 survey showed that more male (5.8%) than female (5.4%) children in the wasted category had ARI [OR = 1.13 (95% CI: 1.07, 2.01)]. The highest prevalence of suspected ARI was consistently recorded in the North-East region. Conclusion: The Nigeria Demographic Health Surveys demonstrated no consistent sex differences in burden and trends of childhood pneumonia-like episodes over a 24-year period. Malnutrition has some influence on the burden of ARI-related symptoms.


Assuntos
Infecções Respiratórias/epidemiologia , Doença Aguda , Distribuição por Idade , Pré-Escolar , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Masculino , Morbidade , Nigéria/epidemiologia , Prevalência , Infecções Respiratórias/diagnóstico , Distribuição por Sexo , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários
14.
Pediatrics ; 144(5)2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31653675

RESUMO

OBJECTIVES: Xpert Mycobacterium tuberculosis and rifampicin (MTB/RIF) Ultra assay has increasingly been used in adult tuberculosis diagnosis, but data relating to its diagnostic accuracy in children are lacking. Because a qualified sputum specimen is difficult to obtain in children, this study evaluated the diagnostic value of Ultra in childhood tuberculosis using bronchoalveolar lavage fluid. METHODS: The accuracy of Ultra was calculated by using bacteriologic results and clinical evidence as reference standards. Concordance between Ultra and Xpert MTB/RIF assays was assessed by using к coefficients. RESULTS: In total, 93 children with pulmonary tuberculosis and 128 children with respiratory tract infections were enrolled. The sensitivity of Ultra, in all pulmonary tuberculosis cases and in bacteriologically confirmed tuberculosis cases, was 70% and 91%, respectively. Ultra could detect Mycobacterium tuberculosis in 58% of cases with negative culture or acid-fast-staining results. The specificity of Ultra was 98%. There was no significant difference in sensitivity between samples with a volume ≤1 and >1 mL (66% vs 73%; P = .50; odds ratio [OR] = 0.71). Among 164 children for which Ultra and Xpert were simultaneously performed, the sensitivity was 80% and 67%, respectively, indicating good agreement (к = 0.84). An additional 6 children were identified as Ultra-positive but Xpert-negative. The positive rate decreased from 93% to 63% after 1 month (P = .01; OR = 0.12) and to 71% after 2 months (P = .03; OR = 0.18) of antituberculosis treatment. CONCLUSIONS: Ultra using bronchoalveolar lavage fluid has good sensitivity compared with bacteriologic tests and adds clinical value by assisting the rapid and accurate diagnosis of pulmonary tuberculosis in children.


Assuntos
Líquido da Lavagem Broncoalveolar/microbiologia , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Pulmonar/diagnóstico , Adolescente , Criança , Pré-Escolar , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Masculino , Técnicas de Diagnóstico Molecular/métodos , Infecções Respiratórias/diagnóstico , Estudos Retrospectivos , Sensibilidade e Especificidade
15.
BMC Infect Dis ; 19(1): 862, 2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31623573

RESUMO

BACKGROUND: Idiopathic CD4 lymphocytopenia (ICL) is a rare clinical disease with relative CD4 deficiency in the absence of HIV infection. The pathogenicity of ICL is poorly understood with an unclear incidence rate in the general population. Sequelae of ICL includes AIDS-defining infections, which most commonly includes Cryptococcus neoformans. Typically, C. neoformans infections present with CNS involvement but rarely with extra-CNS manifestations. Here, we present a rare case of ICL with exclusively primary pulmonary cryptococcus and a review of the literature. CASE PRESENTATION: A 56-year-old female presented to our tertiary care hospital requiring a right hip open reduction intervention. The patient became febrile during admission, prompting a work-up that included a chest X-ray showing a peripheral pulmonary solitary nodule. Transthoracic biopsy revealed encapsulated yeast forms in keeping with C. neoformans. CD4 counts, repeated at least one month apart, were < 200 cells/mm3, with negative HIV testing. Flow cytometry and genetic testing were completed to elucidate the etiology of the immune deficiency, both of which were unremarkable. She was subsequently treated with 12 months of posaconazole with clinical resolution. CONCLUSIONS: Our patient highlights a rare clinical disease, which a review of literature revealed only five cases in the literature with exclusive pulmonary Cryptococcus in ICL/ This case demonstrates the strong clinical acumen required to properly diagnose and ultimately manage the patient.


Assuntos
Criptococose/diagnóstico , Cryptococcus neoformans/isolamento & purificação , Linfopenia/diagnóstico , Infecções Respiratórias/diagnóstico , Antifúngicos/uso terapêutico , Contagem de Linfócito CD4 , Criptococose/tratamento farmacológico , Criptococose/microbiologia , Feminino , Humanos , Pulmão/microbiologia , Pulmão/patologia , Linfopenia/etiologia , Pessoa de Meia-Idade , Infecções Respiratórias/complicações , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/microbiologia , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Triazóis/uso terapêutico
16.
Adv Exp Med Biol ; 1222: 55-62, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31529287

RESUMO

In uncomplicated bronchiolitis, chest radiography (CR) is not routinely recommended, yet it is still frequently made. This study seeks to evaluate the use of CR in children with bronchiolitis due to a lower respiratory tract infection (RSV-RTI) with respiratory syncytial virus (RSV) and the influence of CR on patient treatment during the 2010-2017 seasons. There were 581 children included into the study: 459 with bronchiolitis (390 RSV-RTI and 69 non-RSV), 65 with RSV pneumonia and 57 with RSV bronchitis. We found that CR was performed in 28.6% (166/581) patients. CR was much more frequent in patients with RSV than non-RSV infections (61% vs. 31%). CR prognostic sensitivity and specificity in guiding antibiotic treatment was low, 78% and 58%, respectively. Positive and negative predicted values of CR were 78% and 58%, respectively and the number needed to diagnose was 2.777. Children in whom CR was performed (irrespective of the result) were at 22.9-fold higher risk of antibiotic therapy (95%CI: 14.1-37.1; p < 0.01), while those with a positive CR were only at 4.4-fold higher risk of antibiotic therapy (95%CI: 2.2-8.9; p < 0.01). Children with CR required a longer hospital stay than those without it (10 vs. 8 days, respectively; p < 0.01). The percentage of CR decreased from 78% in 2010 to 33% in 2017, with the lowest value of 11% in 2015. The additional cost of CR, which had no influence on treatment, would have been €381 had it been performed in each patient, which amounts to 1% of the total hospitalization cost. We conclude that CR is overused and in most cases it has no influence on the patient management. The recognition of practical meaning of CR is essential to avoid unnecessary radiation of children.


Assuntos
Bronquiolite/diagnóstico por imagem , Hospitalização/estatística & dados numéricos , Radiografia/métodos , Infecções por Vírus Respiratório Sincicial/epidemiologia , Infecções Respiratórias/epidemiologia , Bronquiolite/epidemiologia , Bronquiolite/virologia , Pré-Escolar , Humanos , Lactente , Tempo de Internação , Pneumonia/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Infecções por Vírus Respiratório Sincicial/diagnóstico , Vírus Sincicial Respiratório Humano/isolamento & purificação , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/virologia
17.
Clin Lab ; 65(9)2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31532091

RESUMO

BACKGROUND: Pulmonary hamartoma is one of the most common benign tumors of the lung, the symptoms are often atypical, so its diagnosis is not so easy. We presented an elderly man with elevated D-dimer combined persistent acupuncture-like chest pain misdiagnosed as pulmonary embolism finally proved as lung hamartoma with secondary lung infection by bronchoscopy biopsy. METHODS: Appropriate laboratory tests were carried out. The chest computed tomography (CT) scan and bronchoscopy were performed for diagnosis. RESULTS: Laboratory tests showed D-dimer was 2,615.88 ng/mL, the chest CT scan showed the right lung portal occupying lesions accompanied by obstructive changes in the middle of the right lung and mediastinal lymphade-nopathy with partial calcification. Bronchoscopy showed the new spherical neoplasm in the middle of the right lung completely blocked the opening of the bronchus, the surface of the neoplasm was smooth and blood vessels were abundant, pathological result was lung hamartoma. CONCLUSIONS: Elevated D-dimer is not a specific index of pulmonary embolism. When a patient's D-dimer rise combined with severe chest pain, the physician should be wary of pulmonary embolism, myocardial infarction, aortic dissection, and other emergencies, and should also take into account serious infections, tumors, and other diseases. Diagnosis needs further related examination. Chest CT scan has guidance function, and when the chest CT scan suggests the occupying lesion, the pathology examination is the key to identify the benign tumor.


Assuntos
Dor no Peito/diagnóstico , Produtos de Degradação da Fibrina e do Fibrinogênio/metabolismo , Hamartoma/diagnóstico , Neoplasias Pulmonares/diagnóstico , Embolia Pulmonar/diagnóstico , Infecções Respiratórias/diagnóstico , Idoso , Broncoscopia , Diagnóstico Diferencial , Erros de Diagnóstico , Humanos , Masculino
18.
Aerosp Med Hum Perform ; 90(10): 908-910, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31558201
19.
BMC Infect Dis ; 19(1): 764, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477038

RESUMO

BACKGROUND: Environmental bacteria, nontuberculous mycobacteria (NTM), are recognized as one of the major human infection pathogens. NTM are prone to be mistaken as multidrug-resistant Mycobacterium tuberculosis and challenge our fight against TB. In addition, treatment of NTM per se is intractable. Remarkably, the distribution of NTM pathogenic species is geographically specific. Thus, it is very important to summarize the prevalent features and clinical symptoms of NTM pulmonary disease. However, In Nanjing district, southeast China, there is no such a report. METHODS: Through investigating electronic medical records and analyzing data of clinical examination system (Lis), we retrospectively summarized the NTM species from 6012 clinical isolates from May 2017 to August 2018, and analyzed the association between NTM species and clinical symptoms. RESULTS: Of 6012 clinical specimens, 1461 (24.3%) could grow in the MGIT 960 broth. Among these positive isolates, 1213 (83%) were M. tuberculosis, 22 (1.5%) were M. bovis, and 226 (15.5%) were NTM. After deducting redundancy, those NTM specimens were confirmed from 154 patients, among which, 87 (56.5%) patients met the full ATS/IDSA NTM disease criteria. The most common etiologic agent was M. intracellulare (70.1%). NTM infection was associated with age, based on which 68.6% male patients and 77.8% female patients were over 50 years old. The older patients were more likely to have hemoptysis, but the younger patients were more likely to manifest chest congestion. Male patients were more likely to have shortness of breath and females were more likely to have hemoptysis. The most common radiographic presentation of NTM pulmonary disease was bronchiectasis, accounting for 39.1%. Remarkably, multiple and thin-walled cavities were outstanding. The most frequent comorbidity of NTM disease was previous tuberculosis (64%), followed by clinical bronchiectasis (19.5%), HIV (19.5%), and 6.9% chronic obstructive pulmonary disease (COPD). There was no association between NTM species and clinical symptoms. CONCLUSION: This study retrospectively investigated the prevalence of NTM pulmonary disease in Nanjing district, southeast China. Similar to Beijing area, north China, M. intracellulare was the major pathogenic NTM species. Clinical symptoms of the disease were not species-specific. Previous TB and HIV infection immensely enhanced risk of NTM disease.


Assuntos
Pneumopatias/diagnóstico , Pneumopatias/epidemiologia , Infecções por Micobactéria não Tuberculosa/diagnóstico , Infecções por Micobactéria não Tuberculosa/epidemiologia , Micobactérias não Tuberculosas/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Bronquiectasia/diagnóstico , Bronquiectasia/epidemiologia , Bronquiectasia/microbiologia , China/epidemiologia , Comorbidade , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/microbiologia , Humanos , Pneumopatias/microbiologia , Masculino , Pessoa de Meia-Idade , Infecções por Micobactéria não Tuberculosa/microbiologia , Micobactérias não Tuberculosas/classificação , Prevalência , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/microbiologia , Estudos Retrospectivos , Adulto Jovem
20.
BMC Infect Dis ; 19(1): 770, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481020

RESUMO

BACKGROUND: We sought to assess reporting in China's Pneumonia of Unknown Etiology (PUE) passive surveillance system for emerging respiratory infections and to identify ways to improve the PUE surveillance system's detection of respiratory infections of public health significance. METHODS: From February 29-May 29, 2016, we actively identified and enrolled patients in two hospitals with acute respiratory infections (ARI) that met all PUE case criteria. We reviewed medical records for documented exposure history associated with respiratory infectious diseases, collected throat samples that were tested for seasonal and avian influenza, and interviewed clinicians regarding reasons for reporting or not reporting PUE cases. We described and analyzed the proportion of PUE cases reported and clinician awareness of and practices related to the PUE system. RESULTS: Of 2619 ARI admissions in two hospitals, 335(13%) met the PUE case definition; none were reported. Of 311 specimens tested, 18(6%) were seasonal influenza virus-positive; none were avian influenza-positive. < 10% PUE case medical records documented whether or not there were exposures to animals or others with respiratory illness. Most commonly cited reasons for not reporting cases were no awareness of the PUE system (76%) and not understanding the case definition (53%). CONCLUSIONS: Most clinicians have limited awareness of and are not reporting to the PUE system. Exposures related to respiratory infections are rarely documented in medical records. Increasing clinicians' awareness of the PUE system and including relevant exposure items in standard medical records may increase reporting.


Assuntos
Notificação de Doenças , Necessidades e Demandas de Serviços de Saúde , Pneumonia/epidemiologia , Pneumonia/etiologia , Vigilância da População , Adulto , China/epidemiologia , Doenças Transmissíveis Emergentes/diagnóstico , Doenças Transmissíveis Emergentes/epidemiologia , Diagnóstico Diferencial , Notificação de Doenças/métodos , Notificação de Doenças/normas , Feminino , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/normas , Hospitalização , Humanos , Influenza Humana/epidemiologia , Masculino , Notificação de Abuso , Testes Obrigatórios/normas , Pessoa de Meia-Idade , Projetos Piloto , Pneumonia/diagnóstico , Vigilância da População/métodos , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Avaliação de Programas e Projetos de Saúde , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/etiologia , Engajamento no Trabalho
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA