Detection of Mycobacterium tuberculosis complex by nested polymerase chain reaction in pulmonary and extrapulmonary specimens / Detecção do complexo Mycobacterium tuberculosis por nested polymerase chain reaction em espécimes pulmonares e extrapulmonares

OBJECTIVE: To compare the performance of nested polymerase chain reaction (NPCR) with that of cultures in the detection of the Mycobacterium tuberculosis complex in pulmonary and extrapulmonary specimens. METHODS: We analyzed 20 and 78 pulmonary and extrapulmonary specimens, respectively, of 67 hospitalized patients suspected of having tuberculosis. An automated microbial system was used for the identification of Mycobacterium spp. cultures, and M. tuberculosis IS6110 was used as the target sequence in the NPCR. The kappa statistic was used in order to assess the level of agreement among the results. RESULTS: Among the 67 patients, 6 and 5, respectively, were diagnosed with pulmonary and extrapulmonary tuberculosis, and the NPCR was positive in all of the cases. Among the 98 clinical specimens, smear microscopy, culture, and NPCR were positive in 6.00%, 8.16%, and 13.26%, respectively. Comparing the results of NPCR with those of cultures (the gold standard), we found that NPCR had a sensitivity and specificity of 100% and 83%, respectively, in pulmonary specimens, compared with 83% and 96%, respectively, in extrapulmonary specimens, with good concordance between the tests (kappa, 0.50 and 0.6867, respectively). CONCLUSIONS: Although NPCR proved to be a very useful tool for the detection of M. tuberculosis complex, clinical, epidemiological, and other laboratory data should also be considered in the diagnosis and treatment of pulmonary and extrapulmonary tuberculosis. .

OBJETIVO: Comparar o desempenho da técnica nested polymerase chain reaction (NPCR) com aquele de culturas na detecção do complexo Mycobacterium tuberculosis em espécimes pulmonares e extrapulmonares. MÉTODOS: Analisamos 20 e 78 espécimes pulmonares e extrapulmonares, respectivamente, de 67 pacientes hospitalizados com suspeita de tuberculose. Um sistema automatizado foi utilizado na identificação de culturas de Mycobacterium spp., e M. tuberculosis IS6110 foi utilizada como sequência alvo na NPCR. A estatística kappa foi utilizada para verificar a concordância entre os resultados. RESULTADOS: Entre os 67 pacientes, 6 e 5, respectivamente foram diagnosticados com tuberculose pulmonar e extrapulmonar, e a NPCR foi positiva em todos os casos. Entre os 98 espécimes clínicos, a baciloscopia, cultura e NPCR foram positivas em 6,00%, 8,16% e 13,26%, respectivamente. Comparando-se os resultados da NPCR com aqueles da cultura (padrão ouro) nos espécimes pulmonares, a sensibilidade e a especificidade foram 100% e 83%, respectivamente, enquanto essas nos espécimes extrapulmonares foram 83% e 96% respectivamente, com boa concordância entre os testes (kappa, 0,50 e 0,6867, respectivamente). CONCLUSÕES: Embora a NPCR tenha se mostrado uma ferramenta muito útil na detecção do complexo M. tuberculosis, No entanto, os resultados positivos da NPCR devem ser associados à clínica, dados clínicos, epidemiológicos e outros dados laboratoriais devem também ser considerados no diagnóstico e tratamento da tuberculose pulmonar e extrapulmonar. .

The lung in paracoccidioidomycosis: new insights into old problems

OBJECTIVES: Chronic paracoccidioidomycosis can diffusely affect the lungs. Even after antifungal therapy, patients may present with residual respiratory abnormalities due to fungus-induced lung fibrosis. METHODS: A cross-sectional analysis of 50 consecutive inactive, chronic paracoccidioidomycosis patients was performed using high resolution computed tomography, pulmonary function tests, ergospirometry, the six-minute walk test and health-related quality of life questionnaires. RESULTS: Radiological abnormalities were present in 98% of cases, the most frequent of which were architectural distortion (90%), reticulate and septal thickening (88%), centrilobular and paraseptal emphysema (84%) and parenchymal bands (74%). Patients typically presented with a mild obstructive disorder and a mild reduction in diffusion capacity with preserved exercise capacity, including VO2max and six-minute walking distance. Patient evaluation with the Saint-George Respiratory Questionnaire showed low impairment in the health-related quality of life, and the Medical Research Council questionnaire indicated a low dyspnea index. There were, however, patients with significant oxygen desaturation upon exercise that was associated with respiratory distress compared with the non-desaturated patients. The initial counterimmunoelectrophoresis of these patients was higher and lung emphysema was more prominent; however, there were no differences in the interstitial fibrotic tomographic abnormalities, tobacco exposure, functional responses, exercise capacity or quality of life. CONCLUSIONS: Inactive, chronic paracoccidioidomycosis patients show persistent and disseminated radiological abnormalities by high resolution computed tomography, short impairments in pulmonary function and low impacts on aerobic capacity and quality of life. However, there was a subset of individuals whose functional impairment was more severe. These patients present with higher initial ...

Perfil de patógenos nas exacerbações agudas da doença pulmonar obstrutiva crônica: resultados preliminares / Pathogenic profile in acute exacerbations of chronic obstructuve pulmonary disease: preliminary results

Objetivo: Descrever os patógenos isolados em cultura quantitativa de escarro, nas exacerbações agudas de doença pulmonar obstrutiva crônica, em pacientes internados no Hospital Nossa Senhora da Conceição – Tubarão/SC e no Hospital Nereu Ramos – Florianópolis/SC. Metodologia: Foi realizado um estudo de delineamento transversal, utilizando escarro coletado em pacientes internados, o qual foi submetido à cultura quantitativa. Foi utilizada como ponto de corte a presença de 106 ufc/mL. O uso da antibioticoterapia foi confrontado com o isolamento em cultivo de agente etiológico bacteriano, através do índice de concordância Kappa. Resultados: Foram avaliados consecutivamente 13 pacientes, sendo 69,2% pertencentes ao gênero masculino, com média de idade de 67,15. A cultura de escarro evidenciou o crescimento de 53,8% de Streptococcus viridans e 7,7% de Haemophilus influenzae. Em 38,5% das culturas, não houve crescimento bacteriano. Quantificou-se 38,5%(n = 5) das culturas com mais de 106 UFC e 23,1% (n = 3) com menos de 106 UFC. O índice de concordância Kappa entre o uso de antibioticoterapia e a presença de infecção foi de -0,519. Conclusão: Houve um predomínio de pacientes do gênero masculino, e o agente mais comumente isolado nas culturas foi o Streptococcus viridans. Ocorreu discordância entre o uso de antimicronianos e a presença ou ausência de infecção.

Objective: To describe the pathogens isolated through quantitative sputum culture, in acute exacerbations of chronic obstructive pulmonary disease in patients admitted to the Hospital Nossa Senhora da Conceição, Tubarão/SC and Hospital Nereu Ramos, Florianópolis/SC. Methodology: A cross-sectional study was conducted using sputum collected from hospitalized patients, which was subjected to quantitative culture. The presence of 106 cfu/mL was used as a cutoff point. The use of antibiotics was compared with isolation of bacterial culture from the etiologic agent by Kappa index of agreement. Results:Thirteen patients were consecutive evaluated, 69.2% out of them were male, mean age 67.15. Sputum culture showed 53.8% growth of Streptococcus viridans and 7.7% of Haemophilus influenzae. There was no bacterial growth in 38.5% of the cultures. Of the total, 38.5% (n = 5) contained more than 106 CFU and 23.1% (n = 3) contained less than 106 CFU. The Kappaindex of concordance between antibiotic use and the presence of infection was -0.519. Conclusion: There was a predominance of male patients, and the agent most commonly isolated in cultures was Streptococcus viridans. There was disagreement between antimicrobial use and the presence or absence of infection.

Detección de especies de nocardia aisladas de pacientes con compromiso pulmonar crónico en Tucumán (Argentina) / Detection of nocardia species isolated from patients with chronic pulmonary conpromise in Tucuman (Argentina)

Conociendo la escasa información médica sobre las nocardiosis broncopulmonares, nos abocamos a la detección de especies de nocardia en muestras enviadas para análisis bacteriológico de rutina. Se analizaron 250 muestras de esputo y lavado bronquial de pacientes con compromiso pulmonar crónico: bronquitis crónica, enfermedad pulmonar obstructiva crónica (epoc), asma bronquial y tuberculosis. Se aislaron 19 cepas de nocardia, las cuales se identificaron mediante características morfofisiológicas como: nocardia asteroides, n. brasiliensis y nocardia spp. Los resultados del presente estudio permiten alertar al clínico sobre la incidencia de nocardia en afecciones pulmonares en pacientes de nuestro medio

Experimental paracoccidioidomycosis in ethyl alcohol-fed rats

1. The course of experimental paracoccidioidomycosis was studied in alcohol-fed rats and compared with pair-fed and ad libitum controls. The alcohol-fed rats were fed a regular commercial solid diet plus a 32% (v/v) ethyl alcohol-25% sucrose (w/v) solution 4 weeks prior to the infection and throughout the study. The inoculum was standardized in terms of virulance, age of culture, percentage of multicellular fungal units containing 1-3 cells and viability. 2. Th extent of infection was measured by quantitative counts of fungal units (FU), colony-forming units (CFU) or Paracoccidioides brasiliensis from infected pulmonary tissue and histopathological examination of the main organs involved. The specific humoral response and cell-mediated immunity of the animals were assessed by measuring the specific serum antibody levels by counterimmunoelectrophoresis (CIE) and by the footpad swelling test (FST), respectively. 3. Alcohol-fed rats and pair-fed controls did not differ significantly in mean body weight or the extent of disease after 5 and 10 weeks of infection. In contrast, the alcohol-fed group when compared with the ad libitum group presented a significantly lower mean body weigh (301.6 ñ 0.6 vs 389.6 ñ 0.7g) and a larger number of fungi recovered from the lung: 81.1 ñ 4.1 x 10**4 vs 13.4 ñ 8.0 x 10**4 FU; 24.3 ñ 8.6 x 10**4 vs 2.9 ñ 0.5 x 10**4 CGU after 5 weeks of infection. There were no significant differences in the specific antibody levels, FST indices, histopathological pattern or frequency of disseminated lesions between groups. 4. We conclud tahta alcohol per se neither aggravated the infection by P. brasiliensis nor affected the especific humoral reponse and delayed hypersensitivity. However, the high alcohol intake resulted in malnourished animals associated with a more marked degree of infection