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1.
Ann Allergy Asthma Immunol ; 126(1): 3-12, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32771354

RESUMO

OBJECTIVE: Atopic dermatitis (AD) is a chronic inflammatory skin disease that is complicated by an increased risk for skin and systemic infections. Preventive therapy for AD is based on skin barrier improvement and anti-inflammatory treatments, whereas overt skin and systemic infections require antibiotics or antiviral treatments. This review updates the pathophysiology, diagnosis, management, controversy of antibiotic use, and potential treatments of infectious complications of AD. DATA SOURCES: Published literature obtained through PubMed database searches and clinical pictures. STUDY SELECTIONS: Studies relevant to the mechanisms, diagnosis, management, and potential therapy of infectious complications of AD. RESULTS: Skin barrier defects, type 2 inflammation, Staphylococcusaureus colonization, and cutaneous dysbiosis are the major predisposing factors for the increased infections in AD. Although overt infections require antibiotics, the use of antibiotics in AD exacerbation remains controversial. CONCLUSION: Infectious complications are a comorbidity of AD. Although not common, systemic bacterial infections and eczema herpeticum can be life-threatening. Preventive therapy of infections in AD emphasizes skin barrier improvement and anti-inflammatory therapy. The use of antibiotics in AD exacerbation requires further studies.


Assuntos
Dermatite Atópica/complicações , Infecções/etiologia , Biomarcadores , Dermatite Atópica/etiologia , Gerenciamento Clínico , Suscetibilidade a Doenças , Desenvolvimento de Medicamentos , Disbiose , Humanos , Controle de Infecções , Infecções/diagnóstico , Infecções/terapia , Terapia de Alvo Molecular
2.
PLoS One ; 15(12): e0243795, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33320881

RESUMO

Survival rates for pediatric acute leukemia vary dramatically worldwide. Infections are a leading cause of morbidity and mortality, and the impact is amplified in low and middle-income countries. Defining the epidemiology of infection in a specific health care setting is paramount to developing effective interventions. This study aimed to define the epidemiology of and outcomes from infection in children with acute leukemia treated in a large public pediatric hospital in the Dominican Republic. A retrospective cohort was assembled of children newly diagnosed with acute leukemia between July 1, 2015 to June 30, 2017 at Hospital Infantil Dr. Robert Reid Cabral in Santo Domingo. Patients were identified from the Pediatric Oncology Network Database (PONDTM) and hospital admissions from the Oncology admissions logbook. Medical records and microbiology results were reviewed to identify all inpatient invasive infections. Distance from a child's home to the hospital was determined using ArcGIS by Esri. Infection rates were described in discrete time periods after diagnosis and risk factors for invasive infection were explored using negative binomial regression. Overall, invasive infections were common and a prominent source of death in this cohort. Rates were highest in the first 60 days after diagnosis. Gastroenteritis/colitis, cellulitis, and pneumonia were most frequent, with bacteremia common early on. Multidrug resistant bacteria were prevalent among a small number of positive cultures. In a multivariate negative binomial regression model, age ≥ 10 years and distance from the hospital > 100 km were each protective against invasive infection in the first 180 days after diagnosis, findings that were unexpected and warrant further investigation. Over one-third of patient deaths were related to infection. Interventions aimed at reducing infection should target the first 60 days after diagnosis, improved supportive care inside and outside the hospital, and increased antimicrobial stewardship and infection prevention and control measures.


Assuntos
Hospitais Pediátricos/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Infecções/complicações , Pacientes Internados/estatística & dados numéricos , Leucemia Mieloide Aguda/complicações , Adolescente , Criança , Pré-Escolar , República Dominicana , Feminino , Humanos , Lactente , Infecções/diagnóstico , Leucemia Mieloide Aguda/diagnóstico , Leucemia Mieloide Aguda/tratamento farmacológico , Masculino , Prognóstico , Estudos Retrospectivos
3.
Khirurgiia (Mosk) ; (10): 29-35, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33047583

RESUMO

OBJECTIVE: To determine diagnostic value of neutrophil CD64 index (iCD64n) in the diagnosis of postoperative infectious complications after colorectal resections. MATERIAL AND METHODS: Seventy-three patients underwent colorectal surgery for the period from January to December 2018. These patients were included into a single-center study. Peripheral blood samples were taken on 3 and 6 postoperative days (POD) to check iCD64n level. We analyzed incidence of postoperative infectious complications, sensitivity (Se) and specificity (Sp) of postoperative iCD64n level on the 3rd and 6th POD. RESULTS: Postoperative infectious complications developed in 10 (13.7%) patients. Median iCD64n was significantly higher (p=0.0017 for POD 3; p=0.018 for POD 6) in patients with infectious complications (1.6 on POD 3; 1.3 on POD 6) compared to those without complications (1.1 on POD 3; 0.9 on POD 6). Area under curve (AUC) on the 3rd POD was 0.8 with the cut-off value of 1.4, Se - 70%, Sp - 93.7% (p=0.002). On the 6th POD, AUC was 0.91 with cut-off value of 1.23, Se - 80%, Sp - 93.7% (p<0.001). CONCLUSION: Neutrophil CD64 index is a valuable predictor for the diagnosis of postoperative infectious complications after colorectal resections. It is a useful tool to ensure a safe early discharge.The study is registered on the website «clinictrials.gov¼ (registration number NCT03559335).


Assuntos
Colectomia/efeitos adversos , Neoplasias Colorretais/sangue , Neoplasias Colorretais/cirurgia , Infecções/sangue , Infecções/diagnóstico , Receptores de IgG/sangue , Biomarcadores/sangue , Humanos , Infecções/etiologia , Infecções/imunologia , Neutrófilos/imunologia , Receptores de IgG/imunologia
6.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(6): 686-690, 2020 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-32684213

RESUMO

OBJECTIVE: To investigate the level and changing trend of microparticles (MPs) in super-elderly infected patients, and explore its early warning effect on infection. METHODS: The infected patients ≥ 85 years old admitted to the Second Medical Center of Chinese PLA General Hospital from December 2018 to March 2019 were selected as the observation group, and the healthy volunteers ≥ 85 years old in the same period were selected as the control group. Venous blood samples were collected at the 2nd hour, the 2nd day and the 7th day after fever, and the inflammatory markers such as white blood cell count (WBC), neutrophil percentage (NEUT), C-reactive protein (CRP) and procalcitonin (PCT) were measured. The levels of MPs were determined by flow cytometry. Annexin V labeled CD11b positive MPs (Annexin V+/CD11b+ MPs) represented leukocyte microparticles (LMPs), and Annexin V labeled CD66b positive MPs (Annexin V+/CD66b+ MPs) represented neutrophil microparticle (NMPs). The differences of each index at different time points between the two groups were compared, and the predictive value of each index to the infection of elderly patients was analyzed by receiver operating characteristic (ROC) curve. RESULTS: A total of 38 subjects were enrolled, including 28 cases in the observation group and 10 cases in the control group. The levels of LMPs and NMPs in the observation group increased to the peak at the 2nd hour after fever, and were significantly higher than those in the control group [LMPs (cells/µL): 55.0 (28.8, 197.2) vs. 19.0 (13.5, 28.3), NMPs (cells/µL): 226.5 (123.3, 516.5) vs. 26.5 (22.0, 48.8), both P < 0.01]. With the control of the disease, LMPs and NMPs decreased gradually. The NMPs on the 2nd day was significantly lower than that at the 2nd hour of fever [cells/µL: 106.0 (40.0, 309.0) vs. 226.5 (123.3, 516.5), P < 0.05], and the LMPs and NMPs on the 7th day were significantly lower than those on the 2nd day [LMPs (cells/µL): 17.0 (12.5, 43.8) vs. 42.0 (13.0, 117.0), NMPs (cells/µL): 30.0 (15.8, 62.0) vs. 106.0 (40.0, 309.0), both P < 0.05]. There was no significant difference in the levels of LMPs and NMPs between the two groups on the 7th day. Among the inflammatory markers, the NEUT in the observation group was significantly higher than that in the control group at the 2nd hour of fever (0.70±0.09 vs. 0.59±0.04, P < 0.01), but there was no significant difference in WBC, CRP and PCT between the two groups. On the 2nd day, the inflammatory markers in the observation group reached the peak and were significantly higher than those in the control group [WBC (×109/L): 9.33±2.44 vs. 6.37±1.28, NEUT: 0.78±0.08 vs. 0.57±0.04, CRP (mg/L): 5.67±2.99 vs. 0.33±0.18, PCT (µg/L): 0.80±0.67 vs. 0.07±0.03, all P < 0.01]. On the 7th day, the inflammatory markers in the observation group decreased significantly, and there was no significant difference between the observation group and the control group. ROC curve analysis showed that the area under ROC curve (AUC) and 95% confidence interval (95%CI) of LMPs and NMPs on the day of fever were higher than those of WBC, NEUT, CRP and PCT [0.888 (0.763-1.000), 0.973 (0.931-1.000) vs. 0.679 (0.346-0.811), 0.829 (0.700-0.958), 0.607 (0.404-0.811), 0.554 (0.358-0.749)]. CONCLUSIONS: LMPs and NMPs are significantly increased in the early stage of fever, which can predict the incidence of infection in the super-elderly patients.


Assuntos
Infecções/diagnóstico , Idoso , Proteína C-Reativa , Calcitonina , Peptídeo Relacionado com Gene de Calcitonina , Humanos , Pró-Calcitonina , Prognóstico , Precursores de Proteínas , Curva ROC , Estudos Retrospectivos
7.
Int J Infect Dis ; 97: 60-65, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32502663

RESUMO

METHODS: A priority-setting process (PSP) was launched to define priorities for patient-centered antimicrobial resistance (AMR) surveillance and research in low- and middle-income countries (LMICs). A list of uncertainties related to AMR surveillance in human health was generated using an online survey of stakeholders in LMICs, which asked for unanswered questions about diagnosis, treatment, or prevention of antibiotic resistance. RESULTS: A total of 445 respondents generated 1076 questions that were mapped to a final shortlist of 107 questions. The most common theme was the treatment of drug-resistant infections, followed by diagnosis, then prevention, and requests for local AMR data. The most asked question was a request for local AMR data, revealing the lack of basic information in many LMICs to guide actions to tackle AMR. The steering group recommended three research areas to be prioritized for funding in the next five years: infection prevention and control in LMICs, improved electronic patient records, starting with laboratory information management systems, and sustainable behavior change among doctors and other health care professionals with a focus on diagnostic stewardship.


Assuntos
Resistência Microbiana a Medicamentos , Infecções/tratamento farmacológico , Adulto , Feminino , Pessoal de Saúde , Inquéritos Epidemiológicos , Humanos , Controle de Infecções , Infecções/diagnóstico , Masculino , Pessoa de Meia-Idade , Assistência Centrada no Paciente , Fatores Socioeconômicos , Adulto Jovem
8.
PLoS One ; 15(6): e0234055, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32497101

RESUMO

OBJECTIVE: Adequate resources are required to rapidly diagnose and treat pediatric musculoskeletal infection (MSKI). The workload MSKI consults contribute to pediatric orthopaedic services is unknown as prior epidemiologic studies are variable and negative work-ups are not included in national discharge databases. The hypothesis was tested that MSKI consults constitute a substantial volume of total consultations for pediatric orthopaedic services across the United States. STUDY DESIGN: Eighteen institutions from the Children's ORthopaedic Trauma and Infection Consortium for Evidence-based Study (CORTICES) group retrospectively reviewed a minimum of 1 year of hospital data, reporting the total number of surgeons, total consultations, and MSKI-related consultations. Consultations were classified by the location of consultation (emergency department or inpatient). Culture positivity rate and pathogens were also reported. RESULTS: 87,449 total orthopaedic consultations and 7,814 MSKI-related consultations performed by 229 pediatric orthopaedic surgeons were reviewed. There was an average of 13 orthopaedic surgeons per site each performing an average of 154 consultations per year. On average, 9% of consultations were MSKI related and 37% of these consults yielded positive cultures. Finally, a weak inverse monotonic relationship was noted between percent culture positivity and percent of total orthopedic consults for MSKI. CONCLUSION: At large, academic pediatric tertiary care centers, pediatric orthopaedic services consult on an average of ~3,000 'rule-out' MSKI cases annually. These patients account for nearly 1 in 10 orthopaedic consultations, of which 1 in 3 are culture positive. Considering that 2 in 3 consultations were culture negative, estimating resources required for pediatric orthopaedic consult services to work up and treat children based on culture positive administrative discharge data underestimates clinical need. Finally, ascertainment bias must be considered when comparing differences in culture rates from different institution's pediatric orthopaedics services, given the variability in when orthopaedic physicians become involved in a MSKI workup.


Assuntos
Infecções/cirurgia , Doenças Musculoesqueléticas/cirurgia , Ortopedia/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Criança , Feminino , Humanos , Infecções/diagnóstico , Infecções/microbiologia , Masculino , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/microbiologia , Estudos Retrospectivos , Estados Unidos
10.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(Z1): 32-37, 2020 Jul 10.
Artigo em Chinês | MEDLINE | ID: mdl-32594723

RESUMO

Colorectal surgery patients have severe intestinal flora disorders and antibiotic resistant bacteria due to the disease itself and preoperative treatment, as well as the influence of dietary structure and environmental factors. Perioperative anesthesia and operative stress can cause gastrointestinal motility disorders. In addition, the widespread use of prophylactic broad-spectrum antibiotics and antiacids aggravate intestinal flora disorders and induces severe postoperative infectious diarrhea, such as pseudomembranous enteritis and fatal enteritis. The clinical manifectation are severe infectious diarrhea with high fever and abdominal distension after surgery. The disease progresses rapidly. When the diagnosis and treatment are delayed, the patient can quickly develop shock and other serious complications such as anastomotic leakage, even die of multiple organ failure. Therefore, early diagnosis and treatment are crucial.


Assuntos
Doenças do Colo/cirurgia , Diarreia/diagnóstico , Diarreia/terapia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Doenças Retais/cirurgia , Doenças do Colo/microbiologia , Doenças do Colo/fisiopatologia , Diarreia/etiologia , Diarreia/microbiologia , Humanos , Infecções/diagnóstico , Infecções/etiologia , Infecções/microbiologia , Infecções/terapia , Intestinos/microbiologia , Intestinos/fisiopatologia , Cuidados Pré-Operatórios/efeitos adversos , Doenças Retais/microbiologia
11.
Int J Hematol ; 112(3): 409-417, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32557124

RESUMO

We conducted a nationwide questionnaire-based survey in 2019 following 2001, 2007 and 2013 surveys to clarify the real-world management of infection during chemotherapy for acute leukemia in Japan. An online questionnaire was sent through SurveyMonkey® to member institutions of the Japan Adult Leukemia Study Group in June 2019. The questionnaire consisted of 52 multiple-choice questions covering prophylactic measures, screening and diagnostic tests, empirical antibiotic therapy, antifungal management, the usage of granulocyte-colony stimulating factor, and vaccinations against influenza and pneumococcus during intensive chemotherapy for acute leukemia. Questions associated with antimicrobial stewardship were also included. Usable responses were received from 163 of 218 (74.8%) institutions. Approximately, half (52.2%) of the institutes did not have infectious disease department. As antibiotic prophylaxis, fluoroquinolones (62%) were most commonly used in induction chemotherapy for acute myeloid leukemia. No prophylaxis accounted for 19% of the institutions, which has gradually increased compared to previous surveys. In empirical antibiotic therapy for febrile neutropenia, monotherapy with ß-lactam antibiotics was the most commonly used first-line therapy. De-escalation was not considered in 42.2% of the institutions. In conclusion, this study clarified the real-world management of infection during intensive chemotherapy for acute leukemia in 2019 and raised future issues in Japan.


Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia/estatística & dados numéricos , Gestão de Antimicrobianos , Quimioterapia de Indução , Controle de Infecções/métodos , Leucemia/tratamento farmacológico , Doença Aguda , Antifúngicos/administração & dosagem , Uso de Medicamentos , Feminino , Fluoroquinolonas/administração & dosagem , Humanos , Infecções/diagnóstico , Japão , Masculino , Inquéritos e Questionários , Vacinação
12.
Sci Rep ; 10(1): 8095, 2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32415144

RESUMO

Systemic inflammatory response syndrome (SIRS) reportedly has a low performance for distinguishing infection from non-infection. We explored the distribution of the patients diagnosed by SIRS (SIRS patients) or a quick sequential organ failure assessment (qSOFA) (qSOFA patients) and confirmed the performance of the both for predicting ultimate infection after hospital admission. We retrospectively analyzed the data from a multicenter prospective study. When emergency physicians suspected infection, SIRS or the qSOFA were applied. The area under the receiver operating characteristic curves (AUC) was used to assess the performance of the SIRS and qSOFA for predicting established infection. A total of 1,045 patients were eligible for this study. The SIRS patients accounted for 91.6% of qSOFA patients and they showed a higher rate of final infection than that of non-SIRS patients irrespective of the qSOFA diagnosis. The AUCs for predicting infection with SIRS and a qSOFA were 0.647 and 0.582, respectively. The SIRS significantly predicted an ultimate infection (AUC, 0.675; p = 0.018) in patients who met the SIRS and qSOFA simultaneously. In conclusion, the SIRS patients included almost all qSOFA patients. SIRS showed a better performance for predicting infection for qSOFA in those who met both definitions.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Hospitalização/estatística & dados numéricos , Infecções/diagnóstico , Escores de Disfunção Orgânica , Sepse/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/complicações , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Infecções/etiologia , Infecções/patologia , Masculino , Prognóstico , Estudos Prospectivos , Curva ROC , Estudos Retrospectivos
13.
Artigo em Inglês | MEDLINE | ID: mdl-32349313

RESUMO

Characterizing child immunological responses to enteric infections with antibody detection in serum can be challenging in resource-constrained field settings, because sample collection requires trained individuals and its invasive procedure may lead to low response rates, especially among children. Saliva may present a promising non-invasive alternative. The objectives of this research were to compare salivary antibody levels in children to enteric infections and biomarkers of environmental enteric dysfunction (EED). We collected saliva samples from children aged one to six years enrolled in a sanitation trial in Maputo, Mozambique, and characterized salivary secretory immunoglobulin A (SIgA) concentrations with enzyme-linked immunosorbent assays. We used multilevel linear models to analyze cross-sectional associations between salivary SIgA and the number of concurrent enteric pathogen infections, as well as EED biomarkers in matched stool samples. Median salivary SIgA concentrations in this study population were 54 µg/mL (inter-quartile range (IQR): 34, 85 µg/mL), and SIgA levels were similar between children of different ages. SIgA was lower in children experiencing a higher number of concurrent infections -0.04 log µg/mL (95% confidence interval (CI): -0.08 to -0.005 log µg/mL), but was not associated with any of the included EED biomarkers. Contrary to evidence from high-income countries that suggests salivary SIgA increases rapidly with age in young children, the high prevalence of enteric infections may have led to a suppression of immunological development in this study sample and could in part explain the similar SIgA levels between children of different ages.


Assuntos
Saúde Ambiental , Gastroenteropatias , Imunoglobulina A Secretora , Infecções , Biomarcadores/análise , Pré-Escolar , Estudos Transversais , Biomarcadores Ambientais , Gastroenteropatias/diagnóstico , Gastroenteropatias/microbiologia , Humanos , Imunoglobulina A Secretora/análise , Lactente , Infecções/diagnóstico , Masculino , Moçambique , Complexo Repressor Polycomb 2 , Saliva/química
14.
JAMA Netw Open ; 3(5): e205191, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32427324

RESUMO

Importance: Risk scores used in early warning systems exist for general inpatients and patients with suspected infection outside the intensive care unit (ICU), but their relative performance is incompletely characterized. Objective: To compare the performance of tools used to determine points-based risk scores among all hospitalized patients, including those with and without suspected infection, for identifying those at risk for death and/or ICU transfer. Design, Setting, and Participants: In a cohort design, a retrospective analysis of prospectively collected data was conducted in 21 California and 7 Illinois hospitals between 2006 and 2018 among adult inpatients outside the ICU using points-based scores from 5 commonly used tools: National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), Between the Flags (BTF), Quick Sequential Sepsis-Related Organ Failure Assessment (qSOFA), and Systemic Inflammatory Response Syndrome (SIRS). Data analysis was conducted from February 2019 to January 2020. Main Outcomes and Measures: Risk model discrimination was assessed in each state for predicting in-hospital mortality and the combined outcome of ICU transfer or mortality with area under the receiver operating characteristic curves (AUCs). Stratified analyses were also conducted based on suspected infection. Results: The study included 773 477 hospitalized patients in California (mean [SD] age, 65.1 [17.6] years; 416 605 women [53.9%]) and 713 786 hospitalized patients in Illinois (mean [SD] age, 61.3 [19.9] years; 384 830 women [53.9%]). The NEWS exhibited the highest discrimination for mortality (AUC, 0.87; 95% CI, 0.87-0.87 in California vs AUC, 0.86; 95% CI, 0.85-0.86 in Illinois), followed by the MEWS (AUC, 0.83; 95% CI, 0.83-0.84 in California vs AUC, 0.84; 95% CI, 0.84-0.85 in Illinois), qSOFA (AUC, 0.78; 95% CI, 0.78-0.79 in California vs AUC, 0.78; 95% CI, 0.77-0.78 in Illinois), SIRS (AUC, 0.76; 95% CI, 0.76-0.76 in California vs AUC, 0.76; 95% CI, 0.75-0.76 in Illinois), and BTF (AUC, 0.73; 95% CI, 0.73-0.73 in California vs AUC, 0.74; 95% CI, 0.73-0.74 in Illinois). At specific decision thresholds, the NEWS outperformed the SIRS and qSOFA at all 28 hospitals either by reducing the percentage of at-risk patients who need to be screened by 5% to 20% or increasing the percentage of adverse outcomes identified by 3% to 25%. Conclusions and Relevance: In all hospitalized patients evaluated in this study, including those meeting criteria for suspected infection, the NEWS appeared to display the highest discrimination. Our results suggest that, among commonly used points-based scoring systems, determining the NEWS for inpatient risk stratification could identify patients with and without infection at high risk of mortality.


Assuntos
Escore de Alerta Precoce , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Infecções/mortalidade , Unidades de Terapia Intensiva/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Idoso , California/epidemiologia , Feminino , Humanos , Illinois/epidemiologia , Infecções/diagnóstico , Infecções/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Sensibilidade e Especificidade
15.
Infection ; 48(3): 323-332, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32239441

RESUMO

BACKGROUND: Stroke has relevant morbidity and mortality despite appropriate treatments and early diagnosis. Beside common risk factors such as diabetes and atrial fibrillation, infections can be involved in stroke pathogenesis, probably causing a systemic release of cytokines and other inflammatory mediators, triggering a latent pro-thrombotic state or damaging the vascular endothelium. In other cases, infections can occur as stroke-like syndromes, requiring a high grade of suspicion to avoid a delay in establishing a correct diagnosis. RESULTS: Treatment of stroke or stroke-like syndromes of infectious origin can be difficult. When a previous infective event triggers stroke, Alteplase administration can be associated with a higher incidence of bleeding and the extension of the ischaemic area can be major than expected. On the other hand, when stroke is part of some infectious diseases' presentation as in endocarditis, bacterial or tuberculous meningitis and meningo-vascular syphilis, a correct diagnosis can be difficult. The management of these stroke-like syndromes is not standardised because common treatments proven to be effective for patients with stroke of vascular origin can worsen the prognosis, as it can be demonstrated after to be incorrect Alteplase administration to patients with endocarditis with septic embolism to the brain is associated with an increase of the risk of haemorrhage. CONCLUSIONS: Stroke or stroke-like syndrome of infectious origin can be observed in an important proportion of case presenting with sensory-motor deficit of unknown origin; their accurate diagnosis has a considerable impact in terms of treatment choices and outcome.


Assuntos
Infecções , Acidente Vascular Cerebral , Humanos , Incidência , Infecções/diagnóstico , Infecções/epidemiologia , Infecções/microbiologia , Infecções/terapia , Prognóstico , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/microbiologia , Acidente Vascular Cerebral/terapia
16.
Artigo em Chinês | MEDLINE | ID: mdl-32306695

RESUMO

Objective: To explore the application value of heparin binding protein (HBP) in the diagnosis of severe infection in patients with silicosis. Methods: A prospective study was conducted on 150 patients with silicosis in the pneumoconiosis department of the General Hospital of Xuzhou Mining Group from January 2017 to March 2018. Among them, 100 were severely infected with silicosis and 50 were non-infected with silicosis. 30 patients were selected in the same period of physical examination as the control group. HBP, C-reactive protein (CRP) , procalcitonin(PCT) , white blood cell count (WBC) , neutrophil percentage, and absolute neutrophil count(ANC) were detected in all participants. Using the receiver operating characteristic curve(ROC) to analyze the diagnostic value of indicator above in patients with different stages of severe silicosis infection. Results: Plasma HBP levels in patients with severely infected silicosis group[(50.39±35.64) ng/ml] were higher than those in the non-infected group[(10.71±1.47) ng/ml] and the control group[(9.24±1.83) ng/ml] (P<0.05) , and with the increase of silicosis stages, there is an increasing trend (P<0.05). The ROC curve showed that the AUC of HBP in the patients with severe silicosis in the first, second, and third stages were 0.932, 0.977, and 0.964, which were higher than those of WBC, CRP, and PCT. Correlation analysis showed that HBP was positively correlated with WBC, CRP and PCT (r=0.711, 0.359, 0.729, P<0.01). Conclusion: HBP has high diagnostic efficacy in the diagnosis of severe infections in patients with silicosis, which may become a clinical screening indicator for severe infections in patients with silicosis and an auxiliary examination indicator for the stage of silicosis patients.


Assuntos
Peptídeos Catiônicos Antimicrobianos/sangue , Infecções/diagnóstico , Silicose/complicações , Biomarcadores/sangue , Proteínas Sanguíneas , Proteína C-Reativa/análise , China , Humanos , Infecções/complicações , Contagem de Leucócitos , Neutrófilos/citologia , Pró-Calcitonina/sangue , Estudos Prospectivos , Curva ROC
17.
PLoS One ; 15(4): e0230746, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32243456

RESUMO

BACKGROUND: The incidence and etiologies of chronic pulmonary infection (CPI) in patients with idiopathic pulmonary fibrosis (IPF) have been poorly investigated. METHODS: We conducted a retrospective study of 659 patients with IPF to assess the incidence, etiologies, and risk factors of CPI development. CPI was defined if the etiology of infection was diagnosed one or more months after the onset of symptoms or upon the appearance of new shadows on pulmonary radiological images. RESULTS: At IPF diagnosis, 36 (5.5%) patients had CPI, and 46 (7.0%) patients without CPI at IPF diagnosis developed CPI over a median follow-up period of 6.1 years. The incidence density of CPI development was 18.90 cases per 1000 person-years. Detected organisms from these 46 patients were Mycobacterium avium complex in 20 patients, other nontuberculous mycobacteria in 4, M. tuberculosis in 7, Aspergillus spp. in 22, and Nocardia sp. in one. In a multivariate Cox regression hazard model, PaO2 <70 Torr and KL-6 ≥2000 U/mL were associated with CPI development. CONCLUSIONS: Nontuberculous mycobacteria, M. tuberculosis, and Aspergillus and Nocardia spp. were the four most frequent etiologies of CPI in patients with IPF. During follow-up of IPF, clinicians should pay attention to the development of CPI, especially in patients with PaO2 <70 Torr or KL-6 ≥2000 U/mL.


Assuntos
Fibrose Pulmonar Idiopática/complicações , Infecções/epidemiologia , Infecções/etiologia , Idoso , Doença Crônica/epidemiologia , Feminino , Humanos , Infecções/diagnóstico , Infecções/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
18.
Z Rheumatol ; 79(4): 325-331, 2020 May.
Artigo em Alemão | MEDLINE | ID: mdl-32221711

RESUMO

The differential diagnosis of fever, especially in the context of autoimmune diseases is broad. Accordingly, the spectrum of diagnostic procedures is extensive and the therapeutic consequences are partly contradictory. Fever is basically the manifestation of an increased cell proliferation, such as classically seen in tumors, infections or autoimmune inflammation. Systemic lupus erythematosus (SLE) is one of the most multifaceted rheumatological diseases. Fever is one component of the new classification criteria which help to classify and possibly diagnose SLE. The differential work-up of fever is a special challenge for clinicians particularly in the context of the initial diagnosis of SLE or another autoimmune disease and also in the course of the disease in patients with autoimmune diseases. Based on a case report this article discusses differential diagnostic considerations and proposes a concrete differential diagnostic procedure. The patient's history is highlighted as an extremely important source of relevant information. Without claiming completeness various factors are listed, which help to differentiate fever as a consequence of SLE activity versus fever as a consequence of an infection.


Assuntos
Febre/etiologia , Infecções/diagnóstico , Lúpus Eritematoso Sistêmico , Doenças Autoimunes , Diagnóstico Diferencial , Progressão da Doença , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico
19.
Semin Oncol ; 47(1): 40-47, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32164955

RESUMO

Infectious complications are still a major cause of morbidity and mortality in children receiving therapy for cancer or undergoing hematopoietic stem cell transplantation. Current supportive care strategies consider numerous factors for defining the risk for an infection, but these risk-prediction models need to be refined to ultimately personalize anti-infective measures for an individual patient. It has been recognized that the performance of diagnostic tools including serum markers and imaging may differ between children and adults, and future studies have to assess in the pediatric population the combination of specific diagnostic tools in order to improve the early and reliable diagnosis of an infection. There is an ongoing debate on systemic anti-bacterial and antifungal prophylaxis, as these strategies have to weigh individual benefits of reducing infectious complications against the risk of increasing resistance rates in patients and within institutions. Although there was considerable progress in supportive anti-infective care strategies in children and adolescents over the last 2 decades, which resulted in the development of pediatric specific clinical practice guidelines, major effort is needed to close the open research gaps.


Assuntos
Hospedeiro Imunocomprometido , Infecções/epidemiologia , Infecções/etiologia , Animais , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Criança , Pré-Escolar , Modelos Animais de Doenças , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Controle de Infecções , Infecções/diagnóstico , Infecções/terapia , Neoplasias/complicações , Neoplasias/epidemiologia , Neoplasias/terapia , Medição de Risco , Fatores de Risco
20.
Sci Rep ; 10(1): 4289, 2020 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-32152401

RESUMO

Mastitis in dairy cattle is extremely costly both in economic and welfare terms and is one of the most significant drivers of antimicrobial usage in dairy cattle. A critical step in the prevention of mastitis is the diagnosis of the predominant route of transmission of pathogens into either contagious (CONT) or environmental (ENV), with environmental being further subdivided as transmission during either the nonlactating "dry" period (EDP) or lactating period (EL). Using data from 1000 farms, random forest algorithms were able to replicate the complex herd level diagnoses made by specialist veterinary clinicians with a high degree of accuracy. An accuracy of 98%, positive predictive value (PPV) of 86% and negative predictive value (NPV) of 99% was achieved for the diagnosis of CONT vs ENV (with CONT as a "positive" diagnosis), and an accuracy of 78%, PPV of 76% and NPV of 81% for the diagnosis of EDP vs EL (with EDP as a "positive" diagnosis). An accurate, automated mastitis diagnosis tool has great potential to aid non-specialist veterinary clinicians to make a rapid herd level diagnosis and promptly implement appropriate control measures for an extremely damaging disease in terms of animal health, productivity, welfare and antimicrobial use.


Assuntos
Criação de Animais Domésticos , Indústria de Laticínios/métodos , Infecções/diagnóstico , Aprendizado de Máquina , Mastite Bovina/microbiologia , Modelos Estatísticos , Animais , Bovinos , Feminino , Infecções/microbiologia
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