RESUMO
We evaluated a new immunochromatographic assay (Legionella V-TesT, Coris BioConcept, Gembloux, Belgium) for its ability to detect Legionella pneumophila serogroup 1 antigen in urine. Test devices were read at various time points to determine the optimum incubation time regarding performance. The results were compared with those obtained with the BinaxNOW urinary antigen test. The sensitivity and specificity were 82.2% and 98.6%, respectively, for the Legionella V-TesT and 83.9% and 100%, respectively, for the BinaxNOW urinary antigen test after 15 min of incubation. When tests were examined after 60 min, the sensitivity for both tests increased to 91.5%.
Assuntos
Antígenos de Bactérias/urina , Técnicas Bacteriológicas/métodos , Legionella pneumophila/isolamento & purificação , Doença dos Legionários/diagnóstico , Humanos , Imunoensaio/métodos , Legionella pneumophila/imunologia , Sensibilidade e EspecificidadeRESUMO
We evaluated a new immunochromatographic assay (Oxoid Xpect Legionella test kit) for the ability to detect Legionella pneumophila serogroup 1 antigen in urine. The results were compared with those obtained with the Binax NOW urinary antigen test by following the manufacturers' instructions. The sensitivities and specificities were estimated to be 89 and 100%, respectively, for the Oxoid Xpect Legionella test kit and 86 and 100%, respectively, for the Binax NOW test.
Assuntos
Antígenos de Bactérias/análise , Legionella pneumophila/isolamento & purificação , Doença dos Legionários/diagnóstico , Urina/microbiologia , Humanos , Imunoensaio/métodos , Doença dos Legionários/microbiologia , Técnicas de Diagnóstico Molecular/métodos , Kit de Reagentes para Diagnóstico , Sensibilidade e Especificidade , Fatores de TempoRESUMO
We describe an outbreak of Legionnaires' disease in 2006 in Amsterdam, the Netherlands. Comparisons with the outbreak that took place in 1999 are made to evaluate changes in legionella prevention and outbreak management. The 2006 outbreak was caused by a wet cooling tower. Thirty-one patients were reported. The outbreak was detected two days after the first patient was admitted to hospital, and the source was eliminated five days later. The 1999 outbreak was caused by a whirlpool at a flower show, and 188 patients were reported. This outbreak was detected 14 days after the first patient was admitted to hospital, and two days later the source was traced. Since 1999, the awareness of legionellosis among physicians, the availability of a urinary antigen tests and more efficient early warning and communication systems improved the efficiency of legionellosis outbreak management. For prevention, extensive legislation with clear responsibilities has been put in place. For wet cooling towers, however, legislation regarding responsibility and supervision of maintenance needs to be improved.
Assuntos
Surtos de Doenças , Doença dos Legionários/epidemiologia , Doença dos Legionários/prevenção & controle , Ar Condicionado/instrumentação , Ar Condicionado/legislação & jurisprudência , Antígenos de Bactérias/análise , Antígenos de Bactérias/urina , Impressões Digitais de DNA , Notificação de Doenças , Surtos de Doenças/legislação & jurisprudência , Surtos de Doenças/prevenção & controle , Humanos , Legionelose/urina , Doença dos Legionários/diagnóstico , Doença dos Legionários/genética , Países Baixos/epidemiologiaRESUMO
During the period 6-28 July 2006, 30 confirmed cases of Legionella infection were identified in Amsterdam, 2 of which were fatal. All had a positive urinary antigen test, by which Legionella pneumophila serogroup I could be demonstrated. Consultations between the parties involved in the control of infectious diseases started on July 7th, as soon as it became clear that there was an outbreak. On July 10th it was established that relatively many of these patients lived in the eastern part of the city centre. After a study of the prevailing winds during the past 3 weeks, the search for installations containing water was started. A cooling tower in the town centre was closed on July 11th by way of precaution. During the following week, this tower was proven to be the source of the outbreak.
Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Legionella pneumophila/isolamento & purificação , Doença dos Legionários/epidemiologia , Ar Condicionado , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/mortalidade , Surtos de Doenças , Humanos , Legionella pneumophila/classificação , Doença dos Legionários/tratamento farmacológico , Doença dos Legionários/mortalidade , Países Baixos/epidemiologia , Microbiologia da ÁguaRESUMO
Human metapneumovirus (hMPV) is a paramyxovirus that causes respiratory tract infections ranging from mild upper airway infection to severe pneumonia. Patients with haematological disease, especially haematopoietic stem cell transplantation (HSCT) recipients, are more likely to develop more severe infections. We describe three cases of hMPV infection in HSCT patients. The most reliable diagnostic procedure for hMPV is multiplex ligation-dependent probe amplification (MLPA) on a nasopharyngeal swab. Sensitivity and specificity of MLPA to detect hMPV is high and time to diagnosis is short. A number of other respiratory pathogens can be tested in one test run. Treatment is mainly supportive and only a few antiviral agents are available for treating paramyxovirus infections. Ribavirin and immunoglobulins were reported to be effective in cases of HSCT patients with hMPV pneumonia but their efficacy has not been studied in randomised trials.
Assuntos
Transplante de Células-Tronco Hematopoéticas , Hospedeiro Imunocomprometido/imunologia , Infecções por Paramyxoviridae/imunologia , Infecções Respiratórias/imunologia , Idoso , Antivirais/uso terapêutico , Feminino , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Leucemia Mieloide Aguda/terapia , Leucemia Plasmocitária/terapia , Masculino , Metapneumovirus/genética , Pessoa de Meia-Idade , Mieloma Múltiplo/terapia , Reação em Cadeia da Polimerase Multiplex , Nasofaringe/química , Infecções por Paramyxoviridae/diagnóstico , Infecções por Paramyxoviridae/terapia , RNA Viral/análise , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/terapia , Ribavirina/uso terapêutico , Sensibilidade e EspecificidadeRESUMO
In three male patients with lower respiratory disease, aged 51, 32 and 63 years, Legionnaires' disease was diagnosed by urinary antigen test and culture of the respiratory-tract fluid. In the second patient, the bronchoalveolar fluid also contained Streptococcus pneumoniae and Haemophilus influenzae. All three patients recovered after treatment with azithromycin in the first, cefotaxime, vancomycin and levofloxacin in the second, and erythromycin and ciprofloxacin in the third, respectively. Legionella pneumophila pneumonia is clinically not clearly distinct from other pneumonias and has a high mortality rate when not treated with the proper antibiotics. For that reason, adequate and swift diagnosis is of great importance. The urinary antigen test meets both of these criteria. Still, it is advisable to use culture and serology as well if Legionnaires' disease is suspected in a patient, since the urinary antigen test has limitations. In addition, patient isolates are ofepidemiological importance for public health. By comparing available patient isolates with Legionella strains from water sources, it is possible to identify sources of infection. In 2002, based on this principle, a project was started in The Netherlands aimed at identifying sources of infection, thereby preventing outbreaks of Legionnaires' disease by swift elimination of the source. Since the start of the project, 29 sources have been identified. In the cases described above these were a sauna, a cooling tower and a caravan, respectively. In suspected cases, respiratory-tract fluid must be collected to make possible such a source investigation.
Assuntos
Antibacterianos/uso terapêutico , Legionella pneumophila/imunologia , Doença dos Legionários/diagnóstico , Pneumonia Bacteriana/diagnóstico , Adulto , Antígenos de Bactérias/urina , Surtos de Doenças/prevenção & controle , Humanos , Legionella pneumophila/isolamento & purificação , Doença dos Legionários/tratamento farmacológico , Doença dos Legionários/etiologia , Doença dos Legionários/patologia , Masculino , Pessoa de Meia-Idade , Isolamento de Pacientes , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/etiologia , Pneumonia Bacteriana/patologia , Resultado do TratamentoRESUMO
A review is presented of yeast and mould infections occurring in humans in the Netherlands. The occurrence of the dermatophytes Trichophyton rubrum and T. mentagrophytes tends to increase, while Microsporum canis and particularly Epidermophyton floccosum have become less common. The yeast Candida glabrata is particularly often involved in infections of the urinary tract. Candida krusei, C. parapsilosis and C. tropicalis have become less significant. Remarkable differences are found between the spectra of Aspergillus species causing infections in lungs and in ears; an entirely different pathogenesis is to be presumed. The number of systemic mycoses in the Netherlands is underestimated. The possibility of hundreds of cases each year cannot be excluded.
Assuntos
Micoses/classificação , Dermatomicoses/microbiologia , Ecologia , Humanos , Micoses/microbiologia , Países BaixosRESUMO
To estimate incidence and completeness of notification of Legionnaires' disease (LD) in The Netherlands in 2000 and 2001, we performed a capture-recapture analysis using three registers: Notifications, Laboratory results and Hospital admissions. After record-linkage, 373 of the 780 LD patients identified were notified. Ascertained under-notification was 52.2%. Because of expected and observed regional differences in the incidence rate of LD, alternatively to conventional log-linear capture-recapture models, a covariate (region) capture-recapture model, not previously used for estimating infectious disease incidence, was specified and estimated 886 LD patients (95% confidence interval 827-1022). Estimated under-notification was 57.9%. Notified, ascertained and estimated average annual incidence rates of LD were 1.15, 2.42 and 2.77/100 000 inhabitants respectively, with the highest incidence in the southern region of The Netherlands. Covariate capture-recapture analysis acknowledging regional differences of LD incidence appears to reduce bias in the estimated national incidence rate.
Assuntos
Notificação de Doenças , Doença dos Legionários/epidemiologia , Doença dos Legionários/prevenção & controle , Avaliação de Resultados em Cuidados de Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Grupos Diagnósticos Relacionados/estatística & dados numéricos , Feminino , Geografia , Humanos , Incidência , Lactente , Recém-Nascido , Doença dos Legionários/etiologia , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Países Baixos/epidemiologia , Admissão do Paciente , Sistema de RegistrosRESUMO
Toxoplasma gondii infections in heart transplant recipients were monitored by indirect enzyme-linked immunosorbent assay for immunoglobulin G (ELISA-IgG), indirect ELISA-IgM in serum IgM fractions, antibody capture ELISA-IgM, IgM-immunosorbent agglutination assay (ISAGA), and IgM immunoblotting. Basic immunosuppression consisted of cyclosporine and low-dose steroids. Before transplantation, 26 of 43 recipients showed serological evidence of infection. In serum samples from 15 (35%) recipients, specific antibodies were not detected. Approximately 50% of the heart donors, were toxoplasma seropositive. Eight of the fifteen seronegative recipients received hearts from toxoplasma-seropositive donors. In four of the eight recipients, seroconversion could be demonstrated with all tests used. In three of these four patients, clinical disease developed. One patient with strong serological evidence of toxoplasmosis died, but toxoplasma parasites and antigens were not detected at autopsy. In two patients, toxoplasma cysts were found in cardiac biopsies. Seroconversion was not prevented by the use of spiramycin prophylaxis in two recipients. Reactivations of latent infections or reinfections were detected by indirect ELISA in six (23%) seropositive recipients, but symptoms and signs of active T. gondii infection were not seen. Seroconversion and reactivation of infection were readily found by a combined use of indirect ELISA-IgG and ELISA-IgM and antibody capture ELISA-IgM. Discrepancies in results could be examined by immunoblotting. IgM-ISAGA retained stable positive values longer than IgM-ELISAs did. Cyclosporine treatment did not hamper detection of seroconversion but could cause antibody levels to remain relatively low in primary infections. Seronegative recipients should receive antitoxoplasma treatment on seroconversion.
Assuntos
Transplante de Coração , Imunoglobulinas/análise , Complicações Pós-Operatórias/diagnóstico , Toxoplasma/imunologia , Toxoplasmose/diagnóstico , Testes de Aglutinação , Animais , Anticorpos Antiprotozoários/análise , Anticorpos Antiprotozoários/biossíntese , Ensaio de Imunoadsorção Enzimática , Humanos , Immunoblotting , Imunoglobulina G/análise , Imunoglobulina G/biossíntese , Imunoglobulina M/análise , Imunoglobulina M/biossíntese , Técnicas de Imunoadsorção , Terapia de Imunossupressão , Toxoplasmose/imunologia , Toxoplasmose/patologiaRESUMO
To evaluate the importance of nasal carriage of Staphylococcus aureus as a risk factor for the development of wound infection at the sternotomy site after cardiac surgery, a case-control study was done. The study population consisted of 1980 consecutive patients. Cases were all patients who developed a sternal wound infection from which S. aureus was cultured. Forty cases were identified, and 120 controls were selected. Preoperative nasal carriage of S. aureus, insulin-dependent diabetes mellitus, and younger age were identified as significant risk factors. The crude odds ratio of nasal carriage was 9.6 (95% confidence interval, 3.9-23.7). The median postoperative length of hospital stay for cases was 30 days longer than for controls. Mortality was also significantly higher for cases than for controls (10.0% and 0.8%, respectively).