scholarly journals Relationship of a Multiplex Molecular Pneumonia Panel (PN) Results with Hospital Outcomes and Clinical Variables

2021 ◽  
Author(s):  
K H Rand ◽  
S G Beal ◽  
K Cherabuddi ◽  
H Houck ◽  
K Lessard ◽  
...  
Keyword(s):  
Bronchoalveolar Lavage ◽  
Inflammatory Responses ◽  
White Blood Cells ◽  
Laboratory Data ◽  
Turnaround Time ◽  
Atypical Pneumonia ◽  
Bonferroni Correction ◽  
Group 2 ◽  
Maximum Temperatures ◽  
Relationship Of

Abstract Background Antibiotic treatment decisions in severely ill patients must often be made in the absence of microbiologic results. The recently FDA-cleared BioFire® FilmArray® Pneumonia Panel (PN) detects fifteen bacteria semi-quantitatively, three atypical pneumonia bacteria, eight viruses, and seven antimicrobial resistance markers by multiplex PCR in ~1 hour in the laboratory. Previous reports have shown the PN panel bacterial detections are highly accurate, even when routine culture had no growth. Methods Consecutive bronchoalveolar lavage and endotracheal specimens submitted for culture between June-September 2018 from 270 patients with sufficient clinical and laboratory data were tested with the PN panel. Patients were divided into 3 groups: 1) both culture and PN panel positive, 2) PN panel positive but culture uninformative (no growth or normal flora) and 3) patients with no PN panel detections. Results Groups 1 and 2 had significantly higher maximum temperatures on the day of culture (p=0.00036, ANOVA with Bonferroni correction), higher levels of an inflammatory response as measured by % polymorphonuclear leukocytes in bronchoalveolar lavage (p=0.00025, ANOVA with Bonferroni correction) and the gram stain report of white blood cells, as previously reported 4. Conclusions Both group 1 (culture and PN panel positive), and group 2 (PN panel positive but culture uninformative) had higher levels of host response inflammatory responses compared with group 3 that had no targets detected, suggesting PN panel detections need to be interpreted in the clinical context, even if cultures are discordant. Depending on laboratory turnaround time, there could be opportunity for improved diagnosis and antibiotic stewardship.

scholarly journals Hematologic Presentations of COVID-19 Can be Misinterpreted as Acute Myeloid Leukemia

2021 ◽  
Vol 6 (3) ◽  
pp. 231-233
Author(s):  
Hedieh Moradi Tabriz ◽  
Elham Nazar ◽  
Fatemeh Jazayeri ◽  
Arezoo Eftekhar Javadi
Keyword(s):  
Bone Marrow ◽  
Acute Myeloid Leukemia ◽  
Peripheral Blood ◽  
Myeloid Leukemia ◽  
Inflammatory Responses ◽  
White Blood Cells ◽  
Laboratory Data ◽  
Human Beings ◽  
Cytopathic Effects ◽  
Acute Myeloid

Introduction: COVID-19 infection prompts inflammatory responses and acute lung injury in human beings. Complete blood count with differential is essential investigative tool in its managing. However, very few studies revealed the variations of blood cell morphology in this disease.Case report: We reported a 39-years- old female patient complained of respiratory distress one week prior to hospitalization. The patient suffered from cough, fever, and molecular test was reported positive for COVID-19 infection. Laboratory data revealed severe permanent leukopenia and peripheral blood smear examination showed blastoid cells after remission of respiratory signs. Patient underwent bone marrow biopsy for rule out acute myeloid leukemia. But, on bone marrow sample, only viral cytopathic effects were seen. COVID-19 virus stimulates inflammatory cells to produces various inflammatory cytokines and as a result, viral cytopathic effects on white blood cells is seen. Conclusion: We have described how the characteristic peripheral blood findings of COVID‐19 infection can be misinterpret as acute myeloid leukemia.

scholarly journals Clinical Significance of Increased Serum Levels of Troponin I in Patients from the Emergency Department of a County Hospital

2020 ◽  
Vol 71 (2) ◽  
pp. 68-73
Author(s):  
Paul-Mihai Boarescu ◽  
Ioana Chirila ◽  
Adriana Elena Bulboaca ◽  
Razvan Olimpiu Mada ◽  
Cerasela Mihaela Goidescu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Clinical Significance ◽  
Myocardial Injury ◽  
Troponin I ◽  
White Blood Cells ◽  
Laboratory Data ◽  
Serum Levels ◽  
Discharge Diagnosis ◽  
Group 2

Elevated cardiac troponin I (cTnI) levels are diagnostic for myocardial injury. Moreover, they are essential for risk stratification in patients with acute cardiac ischemia and heart failure. However, their usefulness is not limited to the previous clinical conditions. The aim of this study was to evaluate the clinical significance of cTnI levels in the emergency department.In 324 patients, out of the 4147 referred to the emergency department, serum levels of cTnI were evaluated and represented the study population. Subjects were divided into 2 groups: Group 1 (66 patients) with cTnI ≥ 0.04 ng/mL and Group 2 (258 patients) with cTnI level [ 0.04 ng/mL. The clinical characteristics, laboratory data, ECG findings, echocardiographic abnormalities and discharge diagnosis were compared between the two groups. Patients with cTnI ≥0.04 ng/mL had more often a history of ischemic heart disease, lower levels of oxygen saturation, higher levels of blood glucose, increased white blood cells count, higher heart rate and deeper ST-segment depressions on ECG. The most common discharge diagnosis was heart failure. Although an elevated level of cTnI is highly suggestive for myocardial injury, it should always be interpretated in the clinical context. Heart failure is an important diagnosis in patients with elevated cTnI levels.

scholarly journals Routine blood tests as a potential diagnostic tool for COVID-19

2020 ◽  
Vol 58 (7) ◽  
pp. 1095-1099 ◽  
Author(s):  
Davide Ferrari ◽  
Andrea Motta ◽  
Marta Strollo ◽  
Giuseppe Banfi ◽  
Massimo Locatelli
Keyword(s):  
Blood Test ◽  
Hematological Parameters ◽  
False Negative ◽  
White Blood Cells ◽  
Turnaround Time ◽  
Test Analysis ◽  
Infected People ◽  
Reactive Protein ◽  
Routine Blood ◽  
Glutamyl Transpeptidase

AbstractObjectivesThe outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to date, the epidemic has gradually spread to 209 countries worldwide with more than 1.5 million infected people and 100,000 deaths. Amplification of viral RNA by rRT-PCR serves as the gold standard for confirmation of infection, yet it needs a long turnaround time (3–4 h to generate results) and shows false-negative rates as large as 15%–20%. In addition, the need of certified laboratories, expensive equipment and trained personnel led many countries to limit the rRT-PCR tests only to individuals with pronounced respiratory syndrome symptoms. Thus, there is a need for alternative, less expensive and more accessible tests.MethodsWe analyzed the plasma levels of white blood cells (WBCs), platelets, C-reactive protein (CRP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ-glutamyl transpeptidase (GGT), alkaline phosphatase and lactate dehydrogenase (LDH) of 207 patients who, after being admitted to the emergency room of the San Raffaele Hospital (Milan, Italy) with COVID-19 symptoms, were rRT-PCR tested. Of them, 105 tested positive, whereas 102 tested negative.ResultsStatistically significant differences were observed for WBC, CRP, AST, ALT and LDH. Empirical thresholds for AST and LDH allowed the identification of 70% of either COVID-19-positive or -negative patients on the basis of routine blood test results.ConclusionsCombining appropriate cutoffs for certain hematological parameters could help in identifying false-positive/negative rRT-PCR tests. Blood test analysis might be used as an alternative to rRT-PCR for identifying COVID-19-positive patients in those countries which suffer from a large shortage of rRT-PCR reagents and/or specialized laboratory.

scholarly journals Association of Lower Genital Tract Inflammation With Objective Evidence of Endometritis

2000 ◽  
Vol 8 (2) ◽  
pp. 83-87 ◽  
Author(s):  
Jeffrey F. Peipert ◽  
Roberta B. Ness ◽  
David E. Soper ◽  
Debra Bass
Keyword(s):  
Tract Infection ◽  
Blood Cells ◽  
Genital Tract ◽  
White Blood Cells ◽  
Genital Tract Infection ◽  
Lower Genital Tract ◽  
Objective Evidence ◽  
Group 2 ◽  
Upper Genital Tract Infection ◽  
Group 1

The purpose of this report is to evaluate the association between lower genital tract inflammation and objectively diagnosed endometritis. We analyzed the first 157 patients enrolled in the PEACH study, a multicenter randomized clinical trial designed to compare the effectiveness of outpatient and inpatient therapy for PID. Women less than 38 years of age, who presented with a history of pelvic discomfort for 30 days or less and who were found to have pelvic organ tenderness (uterine or adnexal tenderness) on bimanual examination, were initially invited to participate. After recruitment of the first 58 patients (group 1) we added the presence of leukorrhea, mucopurulent cervicitis, or untreated positive test forN. gonorrhoeaeorC. trachomatisto the inclusion criteria (group 2, N = 99). We compared rates of endometritis in the two groups and calculated the sensitivity, specificity, and predicted values of the presence of white blood cells in the vaginal wet preparation. The rate of upper genital tract infection in group 1 was 46.5% (27/58) compared to 49.5% (49/99) in group 2. Microbiologic evidence of eitherN. gonorrhoeaeorC. trachomatisincreased from 22.4% in group 1 to 38.3% in group 2. The presence of Vaginal white blood cells or mueopus has a high sensitivity (88.9%), but a low specificity (19.4%) for the diagnosis of upper genital-tract infection. Assessment of the lower genital tract for evidence of infection or inflammation is a valuable component of the diagnostic evaluation of pelvic inflammatory disease. The presence of either mucopus or vaginal white blood cells is a highly sensitive test for endometritis in patients with pelvic pain and tenderness. Infect. Dis. Obstet. Gynecol. 8:83–87, 2000.

Candida albicans Shunt Infection: Report of Two Cases

Neurosurgery ◽  
1986 ◽  
Vol 19 (1) ◽  
pp. 111-113 ◽  
Author(s):  
David J. Gower ◽  
Kerry Crone ◽  
Eben Alexander ◽  
David L. Kelly
Keyword(s):  
Candida Albicans ◽  
Blood Cells ◽  
White Blood Cells ◽  
Shunt Infection ◽  
Cerebrospinal Fluid Shunts ◽  
Previous Therapy ◽  
Relationship Of ◽  
The Relationship ◽  
Overall Mortality

Abstract Infection of cerebrospinal fluid shunts with Candida albicans is reported in two patients. Scanning electron microscopy in one case demonstrates the relationship of the Candida hyphae to the white blood cells and to silicone plastic. A review of 10 previously reported cases of Candida shunt infection indicates that the infection usually follows a major bacterial infection or direct contamination or occurs spontaneously, Previous therapy has usually involved removal of the shunt, and the role of parenteral antifungal therapy is still unclear. Overall mortality to date is 25%.

Urinary Tract Infections in Febrile Infants Younger Than 8 Weeks of Age

PEDIATRICS ◽  
1990 ◽  
Vol 86 (3) ◽  
pp. 363-367 ◽  
Author(s):  
Ellen F. Crain ◽  
Jeffrey C. Gershel
Keyword(s):  
Emergency Department ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
White Blood Cells ◽  
Laboratory Data ◽  
Pediatric Emergency ◽  
Urine Specimen ◽  
High Power Field ◽  
Tract Infections

In this prospective study of 442 infants younger than 8 weeks of age who attended a pediatric emergency department with temperature ≥100.6°F (38.1° C), urinary tract infections (UTIs) were found in 33 patients (7.5%), 2 of whom were bacteremic. Clinical and laboratory data were not helpful for identifying UTIs. Of the 33 patients with UTIs, 32 had urinalyses recorded; 16 were suggestive of a UTI (more than five white blood cells per high-power field or any bacteria present). Of the 16 infants with apparently normal urinalysis results, three had an emergency department diagnosis suggesting an alternative bacterial focus of infection. If the physician had decided on the basis of apparently normal urinalysis results to forgo obtaining a urine culture, more than half of the UTIs would have been missed. Bag-collected specimens were significantly more likely to yield indeterminate urine culture results than either catheter or suprapublic specimens. In addition, uncircumcised males were significantly more likely to have a UTI than circumcised boys. These results suggest that a suprapubic or catheter-obtained urine specimen for culture is a necessary part of the evaluation of all febrile infants younger than 8 weeks of age, regardless of the urinalysis findings or another focus of presumed bacterial infection.

The complexity of coagulopathy pathogenesis in COVID-19.

2020 ◽  
Author(s):  
Е.П. Харченко
Keyword(s):  
Antiviral Effect ◽  
Surface Proteins ◽  
Structural Proteins ◽  
Atypical Pneumonia ◽  
Positive Polarity ◽  
S Protein ◽  
Immune Systems ◽  
Hemostasis System ◽  
Relationship Of

Введение. Коронавирус SARS-CoV-2 является новым вирусом, обладающим способностью осуществлять трансмиссию воздушно-капельным путем, вызывая тяжелое течение атипичной пневмонии, нередко сочетающейся с коагулопатиями. Роль структурных белков коронавируса в их патогенезе неизвестна. Цель исследования: с помощью биоинформационного анализа выявить в структурных белках коронавируса SARS-CoV-2 последовательности, гомологичные белкам системы гемостаза, и рассмотреть возможные сценарии их участия в патогенезе коагулопатий при COVID-19, а также объяснить существование вирусостатического эффекта гепарина. Материалы и методы. Для компьютерного анализа были использованы доступные в Интернете базы данных первичных структур белков коронавирусов и их рецепторов, а также поверхностных белков других вирусов, белков системы гемостаза и иммунной системы. Сравнивали аминокислотный состав белков и распределение оснόвных аминокислот (аргинина и лизина) в их первичных последовательностях. С целью выявления пептидного (иммуноэпитопного) родства структурных белков коронавирусов с белками системы гемостаза человека был выполнен поиск гомологичных последовательностей в их белках. Результаты. В структурных белках коронавируса SARS-CoV-2 выявлено множество последовательностей, гомологичных белкам системы гемостаза и иммунной системы. В отличие от коронавирусов SARS-CoV и MERS-CoV, S1-субъединица S-белка коронавируса SARS-CoV-2 имеет положительную полярность. Заключение. Множество последовательностей в структурных белках коронавируса SARS-CoV-2, гомологичных белкам системы гемостаза, потенциально способны вы- зывать различные сценарии патогенеза коагулопатий. Положительная полярность S1-субъединицы S-белка коронавируса SARS-CoV-2 позволяет объяснить неспецифическое взаимодействие ее с гепарином и его вирусостатический (неантикоагулянтный) эффект. Background. The coronavirus SARS-CoV-2 is a new virus capable of human-human transmission and inducing a severe atypical pneumonia often associated with coagulopathy. A role of SARS-CoV-2 structural proteins in coagulopathy pathogenesis is unknown. Objectives: to use a bioinformation analysis to identify SARS-CoV-2 sequences in the structural proteins that are homologous to hemostasis system proteins, regard their possible participation in coagulopathy pathogenesis and explain the antiviral effect of heparin. Materials / Methods. For computer analysis, Internet databases were used of the primary structures of coronavirus proteins and their receptors, as well as surface proteins of other viruses, proteins of hemostasis and immune systems. The amino acid composition of proteins and the distribution of basic amino acids (arginine and lysine) in their primary sequences were compared. For detection of peptide (immunoepitopic) relationship of coronaviruses structural proteins with human hemostasis proteins, a search for homologous sequences in their proteins was performed. Results. Many sequences have been identified in structural proteins of SARS-CoV-2 coronavirus that are homologous to the proteins of hemostasis and immune systems. In contrast with SARS-CoV and MERS-CoV coronaviruses, the S1-subunit of SARS-CoV-2 coronavirus S-protein has a positive polarity. Conclusions. Many sequences in SARS-CoV-2 structural proteins that homologous to hemostasis system proteins are potentially responsible for coagulopathy pathogenesis. The positive polarity of the S1-subunit of SARS-CoV-2 S-protein explains its nonspecific interaction with heparin and its virostatic (non-anticoagulant) effect.

Reporting altered test results in hemolyzed samples: is the cure worse than the disease?

2017 ◽  
Vol 55 (8) ◽  
pp. 1112-1114 ◽  
Author(s):  
Giuseppe Lippi ◽  
Gianfranco Cervellin ◽  
Mario Plebani
Keyword(s):  
Laboratory Data ◽  
Turnaround Time ◽  
Reliable Data ◽  
Test Results ◽  
The Past ◽  
Laboratory Test Results ◽  
Performance Specifications ◽  
Life Threatening ◽  
The Many ◽  
Definition Of

AbstractThe management of laboratory data in unsuitable (hemolyzed) samples remains an almost unresolved dilemma. Whether or not laboratory test results obtained by measuring unsuitable specimens should be made available to the clinicians has been the matter of fierce debates over the past decades. Recently, an intriguing alternative to suppressing test results and recollecting the specimen has been put forward, entailing the definition and implementation of specific algorithms that would finally allow reporting a preanalytically altered laboratory value within a specific comment about its uncertainty of measurement. This approach carries some advantages, namely the timely communication of potentially life-threatening laboratory values, but also some drawbacks. These especially include the challenging definition of validated performance specifications for hemolyzed samples, the need to producing reliable data with the lowest possible uncertainty, the short turnaround time for repeating most laboratory tests, the risk that the comments may be overlooked in short-stay and frequently overcrowded units (e.g. the emergency department), as well as the many clinical advantages of a direct communication with the physician in charge of the patient. Despite the debate remains open, we continue supporting the suggestion that suppressing data in unsuitable (hemolyzed) samples and promptly notifying the clinicians about the need to recollect the samples remains the most (clinically and analytically) safe practice.

scholarly journals Chondrosternal Arthritis in Infant: An Unusual Entity

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Athina Nikolarakou ◽  
Dana Dumitriu ◽  
Pierre-Louis Docquier
Keyword(s):  
Clinical Symptoms ◽  
Therapeutic Option ◽  
White Blood Cells ◽  
Laboratory Data ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
History Of ◽  
Local Tenderness ◽  
Wait And See

Primary arthritis of chondrosternal joint is very rare and occurs in infants less than 18 months of age. Presentation is most often subacute but may be acute. Child presents with a parasternal mass with history of fever and/or local signs of infection. Clinical symptoms vary from a painless noninflammatory to a painful mass with local tenderness and swelling, while fever may be absent. Laboratory data show low or marginally raised levels of white blood cells and C-reactive protein, reflecting, respectively, the subacute or acute character of the infection. It is a self-limiting affection due to the adequate immune response of the patient. Evolution is generally good without antibiotherapy with a progressive spontaneous healing. A wait-and-see approach with close follow-up in the first weeks is the best therapeutic option.

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