scholarly journals A multicenter evaluation of viral bloodstream detections in children presenting to the Emergency Department with suspected systemic infection

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christina A. Rostad ◽  
Neena Kanwar ◽  
Jumi Yi ◽  
Claudia R. Morris ◽  
Jennifer Dien Bard ◽  
...  
Keyword(s):  
Emergency Department ◽  
Whole Blood ◽  
Bacterial Infections ◽  
Viral Infections ◽  
Systemic Infection ◽  
Common Symptom ◽  
Predictive Values ◽  
Healthcare Facilities ◽  
Tract Infections ◽  
Systemic Infections

Abstract Background Fever is a common symptom in children presenting to the Emergency Department (ED). We aimed to describe the epidemiology of systemic viral infections and their predictive values for excluding serious bacterial infections (SBIs), including bacteremia, meningitis and urinary tract infections (UTIs) in children presenting to the ED with suspected systemic infections. Methods We enrolled children who presented to the ED with suspected systemic infections who had blood cultures obtained at seven healthcare facilities. Whole blood specimens were analyzed by an experimental multiplexed PCR test for 7 viruses. Demographic and laboratory results were abstracted. Results Of the 1114 subjects enrolled, 245 viruses were detected in 224 (20.1%) subjects. Bacteremia, meningitis and UTI frequency in viral bloodstream-positive patients was 1.3, 0 and 10.1% compared to 2.9, 1.3 and 9.7% in viral bloodstream-negative patients respectively. Although viral bloodstream detections had a high negative predictive value for bacteremia or meningitis (NPV = 98.7%), the frequency of UTIs among these subjects remained appreciable (9/89, 10.1%) (NPV = 89.9%). Screening urinalyses were positive for leukocyte esterase in 8/9 (88.9%) of these subjects, improving the ability to distinguish UTI. Conclusions Viral bloodstream detections were common in children presenting to the ED with suspected systemic infections. Although overall frequencies of SBIs among subjects with and without viral bloodstream detections did not differ significantly, combining whole blood viral testing with urinalysis provided high NPV for excluding SBI.

scholarly journals Human Neutrophil Lipocalin as a Superior Diagnostic Means To Distinguish between Acute Bacterial and Viral Infections

2015 ◽  
Vol 22 (9) ◽  
pp. 1025-1032 ◽  
Author(s):  
Per Venge ◽  
Lena Douhan-Håkansson ◽  
Daniel Garwicz ◽  
Christer Peterson ◽  
Shengyuan Xu ◽  
...  
Keyword(s):  
Whole Blood ◽  
Human Neutrophil ◽  
Bacterial Infections ◽  
Viral Infections ◽  
Response Times ◽  
Clinical Performance ◽  
Point Of Care ◽  
Signs And Symptoms ◽  
Healthy Controls ◽  
Acute Infections

ABSTRACTThe distinction between causes of acute infections is a major clinical challenge. Current biomarkers, however, are not sufficiently accurate. Human neutrophil lipocalin (HNL) concentrations in serum or whole blood activated by formyl-methionine-leucine-phenylalanine (fMLP) were shown to distinguish acute infections of bacterial or viral cause with high accuracy. The aim was therefore to compare the clinical performance of HNL with currently used biomarkers. Seven hundred twenty-five subjects (144 healthy controls and 581 patients with signs and symptoms of acute infections) were included in the study. C-reactive protein (CRP), the expression of CD64 on neutrophils, procalcitonin (PCT), and blood neutrophil counts were measured by established techniques, and HNL concentrations were measured in whole-blood samples after activation with fMLP. All tested biomarkers were elevated in bacterial as opposed to viral infections (P< 0.001). CRP, PCT, and CD64 expression in neutrophils was elevated in viral infections compared to healthy controls (P< 0.001). In the distinction between healthy controls and patients with bacterial infections, the areas under the receiver operating characteristic (ROC) curves were >0.85 for all biomarkers, whereas for the distinction between bacterial and viral infections, only HNL concentration in fMLP-activated whole blood showed an area under the ROC curve (AUROC) of >0.90 and superior clinical performance. The clinical performance of HNL in fMLP-activated whole blood was superior to current biomarkers and similar to previous results of HNL in serum. The procedure can be adopted for point-of-care testing with response times of <15 min.

scholarly journals An ultra-sensitive, ultra-fast whole blood monocyte CD169 assay for COVID-19 screening

2020 ◽  
Author(s):  
Moïse Michel ◽  
Fabrice Malergue ◽  
Inès Ait Belkacem ◽  
Pénélope Bourgoin ◽  
Pierre-Emmanuel Morange ◽  
...  
Keyword(s):  
Whole Blood ◽  
Bacterial Infections ◽  
Viral Infections ◽  
Early Stage ◽  
Polymorphonuclear Neutrophil ◽  
Blood Monocyte ◽  
Rt Pcr ◽  
Neutrophil Cd64 ◽  
Asymptomatic Patients ◽  
Hla Dr

AbstractCoVID-19 is an unprecedented epidemic, globally challenging health systems, societies, and economy. Its diagnosis relies on molecular methods, with drawbacks revealed by current use as mass screening. Monocyte CD169 upregulation has been reported as a marker of viral infections, we evaluated a flow cytometry three-color rapid assay of whole blood monocyte CD169 for CoVID-19 screening.Outpatients (n=177) with confirmed CoVID-19 infection, comprising 80 early-stage (≤14 days after symptom onset), 71 late-stage (≥15 days), and 26 asymptomatic patients received whole blood CD169 testing in parallel with SARS-CoV-2 RT-PCR. Upregulation of monocyte CD169 without polymorphonuclear neutrophil CD64 changes was the primary endpoint. Sensitivity was 98% and 100% in early-stage and asymptomatic patients respectively, specificity was 50% and 84%. Rapid whole blood monocyte CD169 evaluation was highly sensitive when compared with RT-PCR, especially in early-stage, asymptomatic patients whose RT-PCR tests were not yet positive.Diagnostic accuracy, easy finger prick sampling and minimal time-to-result (15-30 minutes) rank whole blood monocyte CD169 upregulation as a potential screening and diagnostic support for CoVID-19. Secondary endpoints were neutrophil CD64 upregulation as a marker of bacterial infections and monocyte HLA-DR downregulation as a surrogate of immune fitness, both assisting with adequate and rapid management of non-CoVID cases.

scholarly journals Infections in Patients with Lymphoproliferative Diseases Treated with Target Therapy. Italian Multicentric Retrospective Study Seifem 2017

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4164-4164 ◽  
Author(s):  
Gianpaolo Nadali ◽  
Gessica Marchesini ◽  
Davide Facchinelli ◽  
Francesca Farina ◽  
Maria Chiara Tisi ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Board Of Directors ◽  
Bacterial Infections ◽  
Viral Infections ◽  
Life Experience ◽  
Cell Lymphoma ◽  
Real Life ◽  
P Value ◽  
Advisory Committees ◽  
Tract Infections

Abstract Introduction: in the last 5 years new "target drugs" to treat lymphoproliferative disorders have been introduced in clinical practice, such as monoclonal antibodies (obinutuzumab, ofatumumab, brentuximab), BTK inhibitors (ibrutinib) and PI3K inhibitors (idelalisib). Efficacy and safety of these drugs were assessed in registrative trials and data regarding infectious complications in the "real life" experience are currently unavailable. We aimed to assess the incidence of major infections in patients treated with the above mentioned drugs. Methods: 555 patients were treated, for registered indications, with idelalisib, ibrutinib, brentuximab, ofatumumab and obinutuzumab (single agents or in combination as licensed) in 13 hematology centres in Italy, from time of their commercial availability to December 2016. The observation period was one year after study entry. Patients in clinical trials or treated within patient named programs were excluded as well as patients with active infections at beginning of treatment. Results: in 132/555 patients (24%) infections occurred for a total number of 187 events, 56% of whom were of grade 3. The median age was 64 years (range 20-86), 46,2% (61/132) of patients were treated with 3 or more previous lines of therapy, 55/132 (42%) experienced 2 or more infective episodes. A bacterial cause of infection was reported in 35% of cases, viral in 22% and an invasive fungal infection (IFI) in 9% (17/187). In 2% of cases the infection was of mixed origin (bacterial/viral or bacterial/fungal) while in 32% of cases there was not microbiological documentation. The lower respiratory tract was the most frequent site of infection in 39% of cases (73/187) while the upper respiratory tract was involved in 30% of events (39/187). The urinary tract infections were 13% (24/187). Other sites involved were skin and soft tissue 7%, sepsis 7%, gastrointestinal site 5%, central nervous system 2% and fever of unknown origin 6%. Patients treated with idelalisib were 106 (80% affected by chronic lymphocytic leukemia - CLL- and 20% follicular lymphoma) and 35 (33%) experienced one ore more infections for a total of 49 episodes. The incidence of bacterial infections was 37%, of viral infections 37% and of IFI 6%. In 235 patients treated with ibrutinib, 70 (30%) had one ore more events for a total of 102 infective episodes. 60/70 (86%) patients had CLL and 10/70 (14%) had indolent or mantle cell lymphoma The incidence of bacterial infections was 50%, viral 20% and IFI 16%. Focusing on IFI, 17 events were reported in 15 patients. According to the EORTC criteria, 11 cases (4 possible, 1 probable, 6 proven) were reported in patients treated with ibrutinib, 3 cases of possible IFI in patients treated with idelalisib and 3 cases of proven IFI in patients treated with brentuximab. The incidence of IFI in patients treated with ibrutinib (11/102 events) and idelalisib (3/49 events) was not different (11% vs. 6% respectively; p-value = 0.55) even considering proven/probable cases only (3% in ibrutinib vs. 0% in idelalisib p-value = 0.11). The incidence of bacterial infections in patients treated with ibrutinib (35/102) was not statistically different compared to patients treated with idelalisib (18/49) (34% vs. 37% respectively p-value =0.87). Noteworthy, the incidence of viral infections in patients treated with idelalisib (18/49) was significantly higher compared to patients treated with ibrutinib (14/102) (37% vs. 14% respectively; p-value =0.015). Brentuximab was used in 175 patients, 70% of cases for Hodgkin Lymphoma and 30% for T cell lymphoma. The rate of infections was 11% for a total of 27 infection episodes. The incidence of bacterial, viral and fungal infections was 37%, 30% and 11% respectively. In 22% of cases the cause of infection could not be established. Patients treated with ofatumumab or obinutuzumab were 39 and in 7/39 (18%) an infective episode was reported (four of bacterial origin, one viral and four undetermined). All patients were affected by CLL. Conclusions: this "real life" experience confirm that the incidence of infections in patients treated with "target drugs" is not negligible. Ongoing analysis that take into account patient's clinical and demographical characteristics, may give insights on risk factors that will contribute to better characterizing patients at different risk levels. Figure. Figure. Disclosures Cattaneo: GILEAD: Other: Advisory Board. Candoni:Pfizer: Honoraria, Speakers Bureau; Janssen: Honoraria, Speakers Bureau; Celgene: Honoraria, Speakers Bureau; Merck SD: Honoraria, Speakers Bureau; Gilead: Honoraria, Speakers Bureau. Fanci:Gilead: Honoraria; Pfizer Pharmaceuticals: Honoraria; Merck: Consultancy, Honoraria, Speakers Bureau. Del Principe:Gilead: Membership on an entity's Board of Directors or advisory committees. Busca:Gilead: Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Merk: Honoraria, Speakers Bureau; Pfizer Pharmaceuticals: Honoraria, Speakers Bureau; Jazz Pharmaceuticals: Honoraria; Novartis: Speakers Bureau.

scholarly journals Clinical research assessment by flow cytometry of biomarkers for infectious stratification in an Emergency Department

2019 ◽  
Vol 13 (16) ◽  
pp. 1373-1386 ◽  
Author(s):  
Pénélope Bourgoin ◽  
Thomas Soliveres ◽  
Dalia Ahriz ◽  
Isabelle Arnoux ◽  
Christian Meisel ◽  
...  
Keyword(s):  
Emergency Department ◽  
Flow Cytometry ◽  
Clinical Research ◽  
Bacterial Infections ◽  
Viral Infections ◽  
Point Of Care ◽  
New Combination ◽  
Research Assessment ◽  
Rapid Flow ◽  
Clinical Records

Aim: Management of patients with infections within the Emergency Department (ED) is challenging for practitioners, as the identification of infectious causes remains difficult with current techniques. A new combination of two biomarkers was tested with a new rapid flow cytometry technique. Materials & methods: Subjects from the ED were tested for their CD64 on neutrophils (nCD64) and CD169 on monocytes (mCD169) levels and results were compared to their clinical records. Results: Among 139 patients, 29% had confirmed bacterial infections and 5% viral infections. nCD64 and mCD169 respectively showed 88 and 86% sensitivity and 90 and 100% specificity for identifying subjects in bacterial or viral conditions. Conclusion: This point-of-care technique could allow better management of patients in the ED.

scholarly journals CD64 and CD169 could help differentiate bacterial from viral infections in Emergency Department

2020 ◽  
Author(s):  
Pénélope Bourgoin ◽  
Thomas Soliveres ◽  
Alexandra Barbaresi ◽  
Anderson Loundou ◽  
Isabelle Arnoux ◽  
...  
Keyword(s):  
Emergency Department ◽  
Flow Cytometry ◽  
Bacterial Infections ◽  
Viral Infections ◽  
Rapid Flow ◽  
Syncytial Virus ◽  
Potential Improvement ◽  
Clinical Records ◽  
Diagnostic Outcomes ◽  
Febrile Syndrome

ABSTRACTBackgroundThe identification of a bacterial, viral or even non-infectious cause is essential in the management of febrile syndrome in the emergency department (ED) setting, especially in epidemic contexts such as flu or CoVID-19.ObjectivesThe aim of this study was to assess discriminative performances of two biomarkers, CD64 on neutrophils (nCD64) and CD169 on monocytes (mCD169), using a new flow cytometry procedure, in patients presenting with fever to the ED. Human leucocyte antigen-DR on monocytes (mHLA-DR), HLA-ABC ratio (rHLA-ABC), and CD64 on monocytes (mCD64) were also assessed.Methods85 adult patients presenting with potential infection were included during the 2019 flu season in the ED of La Timone Hospital. They were divided into four diagnostic outcomes according to their clinical records: no-infection, bacterial infection, viral infection and co-infection.ResultsmCD169 was elevated in patients suffering from Flu A virus or Respiratory Syncytial Virus, while nCD64 was mainly found elevated in subjects with Streptococcus pneumoniae. In total, 38 (45%) patients were diagnosed with bacterial infections, 11 (13%) with viral infections and 29 (34%) with co-infections. nCD64 and mCD169 showed 90% and 80% sensitivity, and 78% and 91% specificity, respectively, for identifying patients with bacterial or viral infections. Other biomarkers had lower discriminative performances.ConclusionsnCD64 and mCD169 have potential for accurately distinguishing bacterial and acute viral infections. Combined in an easy and rapid flow cytometry procedure, they constitute a potential improvement for infection management in the ED setting, and could even help for the triage of patients during emerging epidemics.

scholarly journals Update of a clinical prediction model for serious bacterial infections in preschool children by adding a host-protein-based assay: a diagnostic study

2019 ◽  
Vol 3 (1) ◽  
pp. e000416
Author(s):  
Chantal van Houten ◽  
Josephine Sophia van de Maat ◽  
Christiana Naaktgeboren ◽  
Louis Bont ◽  
R Oostenbrink
Keyword(s):  
Prediction Model ◽  
Bacterial Infections ◽  
Viral Infections ◽  
Interferon Γ ◽  
Host Protein ◽  
Diagnostic Study ◽  
Double Blind ◽  
C Statistic ◽  
Serious Bacterial Infections ◽  
Tract Infections

ObjectiveTo determine whether updating a diagnostic prediction model by adding a combination assay (tumour necrosis factor-related apoptosis-inducing ligand, interferon γ induced protein-10 and C reactive protein (CRP)) can accurately identify children with pneumonia or other serious bacterial infections (SBIs).DesignObservational double-blind diagnostic study.SettingTwo hospitals in Israel and four hospitals in the Netherlands.Patients591 children, aged 1–60 months, presenting with lower respiratory tract infections or fever without source. 96 of them had SBIs. The original Feverkidstool, a polytomous logistic regression model including clinical variables and CRP, was recalibrated and thereafter updated by using the assay.Main outcome measuresPneumonia, other SBIs or no SBI.ResultsThe recalibrated original Feverkidstool discriminated well between SBIs and viral infections, with a c-statistic for pneumonia of 0.84 (95% CI 0.77 to 0.92) and 0.82 (95% CI 0.77 to 0.86) for other SBIs. The discriminatory ability increased when CRP was replaced by the combination assay; c-statistic for pneumonia increased to 0.89 (95% CI 0.82 to 0.96) and for other SBIs to 0.91 (95% CI 0.87 to 0.94). This updated Feverkidstool improved diagnosis of SBIs mainly in children with low–moderate risk estimates of SBIs.ConclusionWe improved the diagnostic accuracy of the Feverkidstool by replacing CRP with a combination assay to predict pneumonia or other SBIs in febrile children. The updated Feverkidstool has the largest potential to rule out bacterial infections and thus to decrease unnecessary antibiotic prescription in children with low-to-moderate predicted risk of SBIs.

scholarly journals A review on antibiotic resistance and way of combating antimicrobial resistance

2021 ◽  
Vol 14 (2) ◽  
pp. 087-097
Author(s):  
Shifa Begum ◽  
Tofa Begum ◽  
Naziza Rahman ◽  
Ruhul A. Khan
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Antibiotic Resistance ◽  
Bacterial Infections ◽  
Viral Infections ◽  
Main Role ◽  
Revolutionary Era ◽  
Tract Infections ◽  
Effective Medication

Antibiotics are widely used most effective medication since the twentieth century against bacterial infections (Tetanus, Strep Throat, Urinary Tract Infections, etc.) and thus save one’s life. Before 20th-century infectious disease played the main role in the death. Thus, antibiotics opened a revolutionary era in the field of medication. These cannot fight against viral infections. Antibiotics are also known as an antibacterial that kill or slow down bacterial growth and prohibit the bacteria to harm. Resistance comes as a curse with antibiotics that occurs when bacteria change in some way that reduces or eliminates the effectiveness of drugs, chemicals or other agents designed to cure or prevent infections. It is now a significant threat to public health that is affecting humans worldwide outside the environment of the hospital. When a bacterium once become resistant to antibiotic then the bacterial infections cannot be cured with that antibiotic. Thus, the emergence of antibiotic-resistance among the most important bacterial pathogens causing more harm. In this context, the classification of antibiotics, mode of action of antibiotics, and mechanism of resistance and the process of overcoming antibiotic resistance are discussed broadly.

Systemic Infectious Diseases

2019 ◽  
pp. 189-211
Author(s):  
Leah Bauer ◽  
Carolyn Chooljian ◽  
Whitney Johnson
Keyword(s):  
Infectious Disease ◽  
Emergency Department ◽  
Infectious Diseases ◽  
Bacterial Infections ◽  
Viral Infections ◽  
Geographic Location ◽  
Clinical Effects ◽  
Appropriate Treatment ◽  
Wide Range ◽  
Patient’S History

Generalized complaints such as fever, chills, malaise, and body aches are common presentations to the emergency department (ED). Some of these are due to viral infections, and some are due to systemic bacterial infections. Clues to the specific infection can be found in the geographic location of the patient or the patient’s exposure to wildlife (e.g., ticks) and animals. The patient’s history and the timing of the illness play an important part in helping to identify the possible source or cause of the infection. This chapter presents questions related to the diagnosis, clinical effects, and most appropriate treatment of a wide range of these systemic infectious disease emergencies.

Infections and sepsis

2017 ◽  
Author(s):  
Janet Medforth ◽  
Linda Ball ◽  
Angela Walker ◽  
Sue Battersby ◽  
Sarah Stables
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Bacterial Infections ◽  
Viral Infections ◽  
Treatment Options ◽  
Potential Outcomes ◽  
Hiv Screening ◽  
Antenatal Screening ◽  
Group B ◽  
Tract Infections

This chapter includes the latest guidance on antenatal screening for infections, viral infections, bacterial infections, rubella antibodies (latest guidance), syphilis, HIV screening, and group B haemolytic Streptococcus. Other infections, such as coughs and colds, influenza, urinary tract infections, chickenpox, toxoplasmosis, and postnatal infections, and recognition and management of sepsis are included. Discussions includes diagnosis, the latest recommendations for treatment options, potential outcomes, and fetal effects.

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