Evaluation of 18S rRNA PCR in the Diagnosis of Neonatal Fungal Sepsis

2017 ◽  
Vol 13 (01) ◽  
pp. 037-041
Author(s):  
Pallavi Sonika ◽  
Geeta Gathwala ◽  
Nidhi Goel ◽  
Sandeep Lather ◽  
Dhara Dhaulakhandi
Keyword(s):  
Disease Burden ◽  
18S Rrna ◽  
Fungal Infections ◽  
Initial Therapy ◽  
Causative Organism ◽  
Prolonged Incubation ◽  
Polymerase Chain ◽  
Fungal Sepsis ◽  
Time Amplification ◽  
Significant Disease

AbstractNeonatal fungal infections constitute a significant disease burden in India. In the absence of an ideal diagnostic test for the detection of fungal sepsis, the management of sepsis remains enigmatic. At present, blood culture is the method of choice for neonatal fungal sepsis, but it is not 100% sensitive. Together with the requirement for prolonged incubation, blood cultures are of limited utility in investigating neonates for invasive fungal infections, and especially for guiding initial therapy. For quite some time, molecular methods based on polymerase chain reaction (PCR) for detecting microorganisms are gaining prominence in clinical practice, particularly due to their precision, specificity, sensitivity, and shorter reporting time. Amplification of the 18S rRNA subunit gene by PCR from the DNA extracted from patient's blood specifically identifies the causative organism at least at genus level. Here, we evaluate the diagnostic utility of 18S rRNA PCR in neonatal fungal sepsis as part of a prospective cohort study in a tertiary health care setting.

Polymerase chain reaction in the diagnosis of parotid gland tuberculosis

1998 ◽  
Vol 112 (5) ◽  
pp. 494-496 ◽  
Author(s):  
Enis Alpin Güneri ◽  
Ahmet Ömer İkiz ◽  
Nese Atabey ◽  
Özlem İzci ◽  
Semih Sütay
Keyword(s):  
Polymerase Chain Reaction ◽  
Differential Diagnosis ◽  
Parotid Gland ◽  
Mycobacterial Infection ◽  
Social Characteristics ◽  
Causative Organism ◽  
Chain Reaction ◽  
First Case ◽  
Polymerase Chain ◽  
High Degree

AbstractA parotid gland mass with presenting features of malignancy is a diagnostic and therapeutic challenge. The histological nature of the lesion must be clearly determined before proceeding with facial nerve sacrificing surgery. Although rare, tuberculosis of the parotid gland must be included in the differential diagnosis of a parotid gland mass especially when the social characteristics of the patient suggests a mycobacterial infection. Primary tuberculosis of the parotid gland is generally encountered among populations with a high incidence of pulmonary disease. The difficulty in the differential diagnosis of a parotid gland malignancy may be helped by a high degree of clinical suspicion, since laboratory tests generally do not identify the specific causative organism. This article reports the first case of parotid gland tuberculosis with clinical and radiodiagnostical features simulating malignancy in which the diagnosis was confirmed by the polymerase chain reaction (PCR).

scholarly journals Measuring ACPA in the general population or primary care: is it useful?

RMD Open ◽  
2020 ◽  
Vol 6 (1) ◽  
pp. e001085
Author(s):  
Axel Finckh ◽  
Delphine Courvoisier ◽  
Celine Lamacchia
Keyword(s):  
Rheumatoid Arthritis ◽  
Primary Care ◽  
General Population ◽  
Disease Burden ◽  
Screening Strategy ◽  
Screening And Prevention ◽  
Significant Disease ◽  
Diagnostic Properties ◽  
Peptide Antibodies ◽  
Subsequent Onset

Rheumatoid arthritis (RA) is associated with a significant disease burden and high costs for society. Because the disease has identifiable preclinical stages, screening and prevention have become a possibility in RA. Anticitrullinated peptide antibodies (ACPAs) are arguably the most likely candidate biomarker to screen for RA. This paper reviews the evidence for the use of ACPAs as a screening test in the broader general population, to identify individuals at high risk of subsequent onset of RA. We will review the diagnostic properties of the test and its positive and negative predictive value in different settings. We will discuss how ACPA testing could effectively be integrated in a broader screening strategy for RA.

scholarly journals 457. Cutibacterium (Propionibacterium) acnes Infection Rate and Optimization of Surgical Culture Duration

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S224-S225
Author(s):  
Carlos Christian Cueva ◽  
Robert Odrobina ◽  
Jakrapun Pupaibool ◽  
Mark Fisher
Keyword(s):  
Salt Lake ◽  
Normal Skin ◽  
Salt Lake City ◽  
Causative Organism ◽  
Prolonged Incubation ◽  
Clinical Criteria ◽  
Surgical Infections ◽  
Cutibacterium Acnes ◽  
Culture Duration ◽  
The Mean

Abstract Background Cutibacterium acnes is part of the normal skin and gastrointestinal tract flora that is increasingly recognized as a causative organism of surgical infections. Distinguishing between infection and contamination is difficult. The standard culture duration for C. acnes has not been determined. As a slow-growing organism, a prolonged incubation of 10–14 days is adopted in many laboratories. Ideally, only samples with high pretest probability for infection should be worked up this way, otherwise resources are overutilized with likely no benefits and potential harms to patients. We conduct a study to assess the optimal incubation duration for C. acnes. Methods We retrospectively reviewed microbiologic and clinical data of patients who underwent surgical procedures at the Veterans Affairs (VA) Hospital and the University of Utah Hospital in Salt Lake City, Utah, between 2015 and 2018 for which prolonged incubation of surgical samples was requested. Samples that grew C. acnes were divided into three groups (infection, contaminant, indeterminate) based on the quantity of growth and the number of positive samples (Figure 1). Samples in the “indeterminate” group were re-classified into the other two groups based on clinical criteria (Figure 2). Time to culture positivity (TTP) was calculated for each group. Results 741 patients contributed to a total of 909 surgical cases. There were 2,401 samples collected resulting in 4,408 bacterial cultures. C. acnes grew in 131 cases (14.41%). Fifty-five cases (44%) fulfilled the criteria for true infections and 70 cases (56%) were contaminants. 6 cases were lost to follow-up. The mean TTP of the infection and the contamination groups were 5.60 + 0.76 days and 8.67 + 0.81 days, respectively. The TTP of C. acnes from specimens of true surgical infections was significantly shorter than that of contaminants by the mean of 3.07 days (95% CI: -4.22 to -1.92); P < 0.001. Conclusion Using our microbiological and clinical criteria to differentiate infections and contaminations, this study provides evidence that surgical sample cultures should be held no longer than 7 days to limit the effect of contaminated C. acnes on cultures and reduce unnecessary antimicrobial use. Disclosures All authors: No reported disclosures.

Procalcitonin Elevation Suggests a Septic Source

2014 ◽  
Vol 80 (9) ◽  
pp. 906-909 ◽  
Author(s):  
Kara E. Friend ◽  
Jessica N. Burgess ◽  
Rebecca C. Britt ◽  
Jay N. Collins ◽  
Leonard N. Weireter ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Fungal Infections ◽  
Infection Type ◽  
Causative Organism ◽  
Patient Records ◽  
Gram Negative ◽  
Good Marker ◽  
Infection Source ◽  
Antibiotic Duration ◽  
Reason For Admission

Procalcitonin is used as a marker for sepsis but there is little known about the correlation of the procalcitonin elevation with the causative organism in sepsis. All patients aged 18 to 80 years who were admitted to the surgery service from June 2010 to May 2012 and who had a procalcitonin drawn were evaluated. Culture data were reviewed to determine the causative organism. Infections analyzed included pneumonia, urinary tract infection (UTI), bloodstream infection, and Clostridium difficile. Other parameters assessed included reason for admission, body mass index, pressor use, antibiotic duration, and disposition. Two hundred thirty-two patient records were reviewed. Patients without a known infection/source of sepsis had a mean procalcitonin of 3.95. Those with pneumonia had a procalcitonin of 20.59 ( P = 0.03). Those with a UTI had a mean procalcitonin of 66.84 ( P = 0.0005). Patients with a bloodstream infection had a mean procalcitonin of 33.30 ( P = 0.003). Those with C. difficile had a procalcitonin of 47.20 ( P = 0.004). When broken down by causative organisms, those with Gram-positive sepsis had a procalcitonin of 23.10 ( P = 0.02) compared with those with Gram-negative sepsis at 32.75 ( P = 0.02). Those with fungal infections had a procalcitonin of 42.90 ( P = 0.001). These data suggest that procalcitonin elevation can help guide treatment by indicating likely causative organism and infection type. These data may provide a good marker for initiation of antifungal therapy.

Diagnostic accuracy of the 1,3-β-D-glucan test for pneumocystis pneumonia in a tertiary university hospital in Denmark: A retrospective study

2018 ◽  
Vol 57 (6) ◽  
pp. 710-717 ◽  
Author(s):  
Anne Line Engsbro ◽  
Sara Najat ◽  
Karin Meinike Jørgensen ◽  
Jørgen A L Kurtzhals ◽  
Maiken Cavling Arendrup
Keyword(s):  
Bacterial Infections ◽  
Fungal Infections ◽  
Positive Likelihood Ratio ◽  
Pneumocystis Pneumonia ◽  
University Hospital ◽  
Optimal Cutoff ◽  
Moderate Agreement ◽  
A Cell ◽  
Polymerase Chain ◽  
Stored Blood

Abstract 1,3-β-D-glucan (BG), a cell-wall component of most fungi including Pneumocystis (PC), is recommended by international guidelines for screening for pneumocystis pneumonia (PCP) in hematologic patients. We retrospectively validated the BG test in our tertiary university hospital. Forty-five patients (median age 53 years, 33% female) tested for PC by polymerase chain reaction (PCR) and/or immunoflourescence (IF)-microscopy with a stored blood sample within ±5 days of the PC test were tested by the Fungitell (cutoff <60 and >80 pg/ml). Cases had symptoms and radiology compatible with PCP and positive IF-microscopy (proven PCP, n = 8) or positive PCR (probable PCP, n = 10). Controls had no compatible symptoms/radiology and negative tests for PC on conventional testing (no PCP, n = 24), or positive PCR/IF-microscopy (colonized, n = 3). Median BG-levels were 1108 pg/ml (proven PCP), 612 pg/ml (probable PCP), 29 pg/ml (colonized), and 48 pg/ml (controls, P < 0.001). Compared to the PCP case/control classification, the BG test showed sensitivities of 83–89% and specificities of 64–74%, positive likelihood ratio (LR) of 3.2 and negative LR of 0.23 at recommended cutoff and moderate agreement between tests. Optimal cutoff was ≥73 pg/ml. In PCR-positive cases, the agreement between the BG test and IF-microscopy was 78–89% with fair/moderate agreement. Elevated BG levels were seen in controls with probable invasive fungal infections (n = 4), hemodialysis, bacterial infections and/or betalactams. To conclude, 11% of patients with PCP would be missed if the BG test had been used for diagnosing PCP. Specificity was moderate. Among PCR-positive patients, the BG test identified more cases than IF-microscopy. BG testing is potentially helpful but sensitivity is insufficient to exclude PCP.

Predictive Value and Cost-Effectiveness Analysis of a Rapid Polymerase Chain Reaction for Preoperative Detection of Nasal Carriage of Staphylococcus aureus

2003 ◽  
Vol 24 (5) ◽  
pp. 327-333 ◽  
Author(s):  
Nabin K. Shrestha ◽  
Kenneth M. Shermock ◽  
Steven M. Gordon ◽  
Marion J. Tuohy ◽  
Deborah A. Wilson ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Polymerase Chain Reaction ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Nasal Carriage ◽  
Initial Therapy ◽  
Cost Effectiveness Analysis ◽  
Chain Reaction ◽  
Effectiveness Analysis ◽  
Polymerase Chain

AbstractObjective:To determine the accuracy and cost-effectiveness of a polymerase chain reaction (PCR) for detecting nasal carriage of Staphylococcus aureus directly from clinical specimens.Cross-Sectional Study:This occurred in a tertiary-care hospital in Cleveland, Ohio, and included 239 consecutive patients who were scheduled for a cardiothoracic surgical procedure. Conventional cultures and a PCR for S. aureus from nasal swabs were used as measurements.Cost-Effectiveness Analysis:Data sources were market prices and Bureau of Labor Statistics. The time horizon was the maximum period for availability of culture results (3 days). Interventions included universal mupirocin therapy without testing; initial therapy, with termination if PCR negative (treat-PCR); initial therapy, with termination if culture negative (treat-culture); treat PCR-positive carriers (PCR-guided treatment); and treat culture-positive carriers (culture-guided treatment). The perspective was institutional and costs and the length of time to treatment were outcome measures.Results:Sixty-seven (28%) of the 239 swabs grew S. aureus. Rapid PCR was 97.0% sensitive and 97.1% specific for the detection of S. aureus. For populations with prevalences of nasal S. aureus carriage of up to 50%, the PCR assay had negative predictive values of greater than 97%. PCR-guided treatment had the lowest incremental cost-effectiveness ratio ($1.93 per additional day compared with the culture strategy). Among immediate treatment strategies, treat-PCR was most cost-effective. The universal therapy strategy cost $38.19 more per additional day gained with carrier identification compared with the PCR strategy.Conclusion:Rapid real-time PCR is an accurate, rapid, and cost-effective method for identifying S. aureus carriers for preoperative intervention.

Liposomal Amphotericin B (L-AMB) as Initial Therapy for Invasive Filamentous Fungal Infections (IFFI): A Randomized, Prospective Trial of a High Loading Regimen vs. Standard Dosing (AmBiLoad Trial).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3222-3222 ◽  
Author(s):  
Oliver A. Cornely ◽  
Johan Maertens ◽  
Mark Bresnik ◽  
Raoul Herbrecht
Keyword(s):  
Drug Treatment ◽  
Invasive Aspergillosis ◽  
Hematological Malignancies ◽  
Fungal Infections ◽  
Prospective Trial ◽  
Study Drug ◽  
Initial Therapy ◽  
High Loading ◽  
Double Blind Study ◽  
Overall Response

Abstract Background: L-AMB exhibits non-linear pharmacokinetics, with maximal values for Cmax and AUC achieved at a dose of 10 mg/kg/d. Maximal tolerated dose is >15 mg/kg/d. In animal models improved efficacy has been demonstrated with higher doses of L-AMB, but comparative clinical data for efficacy of higher than standard doses of L-AMB are lacking. A randomized, double blind study was performed to compare the efficacy and safety of a high loading dose regimen (HD) to standard dosing (SD) as initial therapy of IFFI. Methods: Patients with proven or probable IFFI by modified EORTC/MSG criteria were randomized to receive L-AMB 3 or 10 mg/kg/d x14d, then 3 mg/kg/d until investigator-defined end of study drug treatment (EOT). Study drug was blinded for the first 14 days of treatment. The primary endpoint was favorable overall response (FOR) assessed at EOT. FOR=complete responses + partial responses. Survival was followed up to 12 wks. An independent Data Review Board (DRB) confirmed all IFFI diagnoses and response assessments. Results: 201 patients with DRB confirmed IFFI diagnoses comprised the MITT population. 107 received SD, 94 HD. Groups were well matched in terms of risk factors. 93% of patients in each group had underlying hematological malignancies. 16% of SD and 19% of HD patients had allogeneic SCT. Neutropenia was present at baseline in 73% of patients overall, and persisted through EOT in 42%. Invasive aspergillosis (IA) accounted for 97% of cases. Median duration of study drug treatment was SD 15d (range 1–60d) and HD 14d (range 1–57d). FOR at EOT was 50% for SD vs. 46% for HD (p= NS). No significant differences in FOR by treatment group were seen for the subsets of IA, allo-SCT, neutropenia subsets, or site of IFFI. Survival at 12 wks was 72% SD vs. 59% HD (p= NS). Nephrotoxicity (serum creatinine ≥ 2x baseline) occurred in 14% SD vs. 31% HD (p<.01). Grade 3 or greater hypokalemia (K+<3.0 mmol/L) developed in 16% SD vs. 30% HD (p<.02), but no difference was found in grade 4 hypokalemia (K+ ≤ 2.5 mmol/L) 3% SD vs. 4% HD (p= NS). Conclusions: In a population of highly immunocompromised patients (93% with underlying hematological malignancies, 73% with neutropenia at study entry), L-AMB as initial treatment of invasive aspergillosis and other filamentous fungal infections at a standard dose of 3 mg/kg/d had an overall favorable response rate of 50% and a 12 wk survival rate of 72%. L-AMB given as a high loading regimen of 10 mg/kg/d x14d did not demonstrate any benefit in overall response or survival, and was associated with higher rates of nephrotoxicity and hypokalemia.

scholarly journals Polymerase chain reaction screening for fungemia and/or invasive fungal infections in patients with hematologic malignancies

2006 ◽  
Vol 14 (5) ◽  
pp. 469-474 ◽  
Author(s):  
Patrícia Ribeiro ◽  
Fátima Costa ◽  
Alexandra Monteiro ◽  
Joana Caldas ◽  
Madalena Silva ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Fungal Infections ◽  
Hematologic Malignancies ◽  
Invasive Fungal Infections ◽  
Chain Reaction ◽  
Polymerase Chain

Infrared body temperature measurement of mice as an early predictor of death in experimental fungal infections

2003 ◽  
Vol 37 (2) ◽  
pp. 126-131 ◽  
Author(s):  
P. A. Warn ◽  
M. W. Brampton ◽  
A. Sharp ◽  
G. Morrissey ◽  
N. Steel ◽  
...  
Keyword(s):  
Body Temperature ◽  
Temperature Measurement ◽  
High Performance ◽  
Fungal Infections ◽  
Infection Model ◽  
Body Temperature Measurement ◽  
Fungal Sepsis ◽  
Early Predictor

Temperatures of mice were measured using an infrared high performance non-contact thermometer, after the device had been calibrated using implantable microchips containing temperature transponders. Mice were infected with three species of Candida (isolates) and the resultant disseminated infections monitored. Mouse temperatures could be reliably measured using the infrared device and this measurement caused little distress to the mice. We were further able to demonstrate that mice rarely recovered if their body temperature dropped below 33.3°C (sensitivity 68%, specificity 97%). Adoption of a 33.3°C endpoint in fungal sepsis experiments measured by infrared non-contact thermometer would significantly reduce the suffering in the terminal stages of this type of infection model.

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