scholarly journals Stroke in a Patient with Recurrent Meningeal Tuberculosis and HIV Coinfection

2021 ◽  
pp. 92-97
Author(s):  
Dilia Fontalvo-Rivera ◽  
Gustavo Mora-García ◽  
Gustavo Jiménez-Borré ◽  
Javier Segovia-Fuentes ◽  
Doris Gómez-Camargo
Keyword(s):  
Tuberculous Meningitis ◽  
Drug Sensitivity ◽  
Clinical Presentation ◽  
Sensitivity Study ◽  
Diagnostic Methods ◽  
Molecular Tests ◽  
Hiv Coinfection ◽  
Ischaemic Lesion ◽  
Low Sensitivity ◽  
Microbiological Confirmation

Recurrent tuberculous meningitis can have a non-specific clinical presentation when it presents as a co-infection with HIV and can resemble other causes of subacute and chronic meningitis, leading to unwanted outcomes; for this reason, timely diagnoses are required. The most widely used microbiological diagnostic methods can be of low sensitivity or have delayed results. The aim of this article is to present a clinical case of recurrent tuberculous meningitis with a clinical presentation of stroke due to a basal cistern ischaemic lesion in a patient co-infected with HIV, who had a microbiological confirmation and a drug sensitivity study with phenotypic and molecular tests.

scholarly journals Systematic Review into Diagnostics for Post-Kala-Azar Dermal Leishmaniasis (PKDL)

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Emily R. Adams ◽  
Inge Versteeg ◽  
Mariska M. G. Leeflang
Keyword(s):  
Diagnostic Accuracy ◽  
Clinical Symptoms ◽  
Statistical Modelling ◽  
Study Quality ◽  
Serological Tests ◽  
Molecular Tests ◽  
Kala Azar ◽  
Valid Estimate ◽  
Low Sensitivity ◽  
Control Designs

Identification of post-kala-azar dermal leishmaniasis (PKDL) is important due to the long and toxic treatment and the fact that PKDL patients may serve as a reservoir for visceral leishmaniasis (VL). We summarized the published literature about the accuracy of diagnostic tests for PKDL. We searched Medline for eligible studies investigating the diagnostic accuracy of any test for PKDL. Study quality was assessed using QUADAS-2. Data were extracted from 21 articles including 43 separate studies. Twenty-seven studies evaluated serological tests (rK39 dipstick, ELISA, DAT, and leishmanin tests), six studies molecular tests, eight microscopy, and two cultures. Only a few of these studies reported a valid estimate of diagnostic accuracy, as most were case-control designs or used a reference standard with low sensitivity. The included studies were very heterogeneous, for example, due to a large variety of reference standards used. Hence, no summary estimates of sensitivity or specificity could be made. We recommend well-designed diagnostic accuracy trials that evaluate, side-by-side, all currently available diagnostics, including clinical symptoms, serological, antigen, molecular, and parasitological tests and possible use of statistical modelling to evaluate diagnostics when there is no suitable gold standard.

scholarly journals The burden of congenital Chagas disease and implementation of molecular diagnostic tools in Latin America

2018 ◽  
Vol 3 (5) ◽  
pp. e001069 ◽  
Author(s):  
Albert Picado ◽  
Israel Cruz ◽  
Maël Redard-Jacot ◽  
Alejandro G Schijman ◽  
Faustino Torrico ◽  
...  
Keyword(s):  
Latin America ◽  
Chagas Disease ◽  
Diagnostic Algorithm ◽  
Diagnostic Methods ◽  
Diagnosis And Treatment ◽  
Molecular Diagnostic ◽  
Diagnostic Tools ◽  
Molecular Tests ◽  
Epidemiological Impact ◽  
And Performance

It is estimated that between 8000 and 15 000 Trypanosoma cruzi infected babies are born every year to infected mothers in Chagas disease endemic countries. Currently, poor access to and performance of the current diagnostic algorithm, based on microscopy at birth and serology at 8–12 months after delivery, is one of the barriers to congenital Chagas disease (CCD) control. Detection of parasite DNA using molecular diagnostic tools could be an alternative or complement to current diagnostic methods, but its implementation in endemic regions remains limited. Prompt diagnosis and treatment of CCD cases would have a positive clinical and epidemiological impact. In this paper, we analysed the burden of CCD in Latin America, and the potential use of molecular tests to improve access to early diagnosis and treatment of T. cruzi infected newborns.

scholarly journals Tuberculous Meningitis: The Microbiological Laboratory Diagnosis and Its Drug Sensitivity Patterns

2019 ◽  
Vol 3 (2) ◽  
pp. 35
Author(s):  
Titiek Sulistyowati ◽  
Deby Kusumaningrum ◽  
Eko Budi Koendhori ◽  
Ni Made Mertaniasih
Keyword(s):  
Mycobacterium Tuberculosis ◽  
Tuberculous Meningitis ◽  
Drug Sensitivity ◽  
Mycobacterium Tuberculosis Complex ◽  
Laboratory Diagnosis ◽  
Clinical Microbiology Laboratory ◽  
Tuberculosis Complex ◽  
First Line ◽  
Sensitivity Pattern ◽  
Microbiological Laboratory

Background: Tuberculosis continues one of the major challenges to global health. Mycobacterium tuberculosis complex can affect any organ other than the lung parenchyma, include central nervous system. The mortality rate of tuberculous meningitis (TBM) are high worldwide with up to half of survivors suffering irreversible sequelae. Diagnosis of TBM is difficult due to paucibacillary, various clinical manifestation, and invasive procedure to appropriate specimens. Objective: The objectiveis to study the positivity rate of microbiological laboratory diagnosis and its drug sensitivity patterns of TBM patients in Dr. Soetomo Hospital Surabaya during October 2015 until September 2016. Methods: Specimens were cerebrospinal fluids. Identification and drug anti TB sensitivity test were done by BACTEC MGIT 960 system in Clinical Microbiology Laboratory Dr. Soetomo Hospital Surabaya. Result: Most patients with TBM were women (54.29%). Based on age groups, most dominant was adult population (65.71%). Proportion percentage of positive M. tuberculosis complex among 180 specimens were 19.44%. First line anti TB drug sensitivity pattern of 35 isolates were 1 monoresistant, 1 poly-resistant, no multiple drug resistant (MDR), and 33 pan-susceptible. Conclusion: Positivity rate of Mycobacterium tuberculosis complex laboratory diagnosis from TBM suspect patients were low. There was no MDR TB in this study, but mono-resistant and poly-resistant. Microbiological diagnosis was important to give information of active disease and drug sensitivity pattern. Resistance to first line anti TB drugs is alarming to properly manage TBM patients.

scholarly journals An Autochthonous Outbreak of the SARS-CoV-2 P.1 Variant of Concern in Southern Italy, April 2021

2021 ◽  
Vol 6 (3) ◽  
pp. 151
Author(s):  
Daniela Loconsole ◽  
Anna Sallustio ◽  
Francesca Centrone ◽  
Daniele Casulli ◽  
Maurizio Mario Ferrara ◽  
...  
Keyword(s):  
Neutralizing Antibodies ◽  
Clinical Presentation ◽  
Southern Italy ◽  
Receptor Binding Domain ◽  
Gene Target ◽  
Health Measures ◽  
Molecular Tests ◽  
Laboratory Investigations ◽  
The Impact ◽  
Mild Clinical Presentation

The SARS-CoV-2 P.1 variant of concern (VOC) was first identified in Brazil and is now spreading in European countries. It is characterized by the E484K mutation in the receptor-binding domain, which could contribute to the evasion from neutralizing antibodies. In Italy, this variant was first identified in January 2021. Here, we report an autochthonous outbreak of SARS-CoV-2 P.1 variant infections in southern Italy in subjects who had not travelled to endemic areas or outside the Apulia region. The outbreak involved seven subjects, three of whom had received a COVID-19 vaccine (one had received two doses and two had received one dose). Four patients had a mild clinical presentation. Laboratory investigations of nasopharyngeal swabs revealed that all strains were S-gene target failure-negative and molecular tests revealed they were the P.1 variant. Whole-genome sequencing confirmed that five subjects were infected with closely related strains classified as the P.1 lineage. The circulation of VOCs highlights the importance of strictly monitoring the spread of SARS-CoV-2 variants through genomic surveillance and of investigating local outbreaks. Furthermore, public health measures including social distancing, screening, and quarantine for travelers are key tools to slow down the viral transmission and to contain and mitigate the impact of VOC diffusion, and rapid scaling-up of vaccination is crucial to avoid a possible new epidemic wave.

scholarly journals Mutations in NOTCH3 Gene may Promote the Clinical Presentation of Spinocerebellar Ataxia Type 37 Caused by Mutations in DAB1 Gene

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhao-Wei Wang ◽  
Li-Ping Wang ◽  
Ye Du ◽  
Qi Liu
Keyword(s):  
Spinocerebellar Ataxia ◽  
Sanger Sequencing ◽  
Autosomal Dominant ◽  
Bioinformatics Analysis ◽  
Clinical Presentation ◽  
Cerebellar Atrophy ◽  
Gene Mutations ◽  
Brain Magnetic Resonance Imaging ◽  
Diagnostic Methods ◽  
Spinocerebellar Ataxia Type

Background: Autosomal dominant spinocerebellar ataxia type 37 (SCA37) and Cerebral autosomal dominant arteriopathy with subcortical infarct and leukoencephalopathy (CADASIL) result from DAB1 and NOTCH3 gene mutations, respectively.Methods: In addition to conventional diagnostic methods, next-generation sequencing (NGS) and Sanger sequencing were performed to define and confirm the DAB1 and NOTCH3 gene mutation for a Chinese pedigree. Bioinformatics analysis was also applied for the mutated DAB1 and NOTCH3 protein using available software tools.Results: Brain magnetic resonance imaging shows diffuse leukoencephalopathy and cerebellar atrophy in the proband. NGS and Sanger sequencing identified two novel heterozygous mutations: NM_021080:c.318T > G (p.H106Q) in the DAB1 gene and NM_000435:c.3298C > T (p.R1100C) in the NOTCH3 gene. Bioinformatics analysis suggested that the DAB1 and NOTCH3 gene mutations are disease-causing and may be responsible for the phenotypes.Conclusion: This is the first report of a pedigree with both SAC37 and CADASIL phenotypes carrying corresponding gene mutations. Mutations in the NOTCH3 gene may promote the clinical presentation of spinocerebellar ataxia type 37 caused by mutations in the DAB1 gene. In addition to general examinations, it is vital for physicians to apply molecular genetics to get an accurate diagnosis in the clinic, especially for rare diseases.

scholarly journals Expression Levels of Candidate Circulating microRNAs in Early-Onset Neonatal Sepsis Compared With Healthy Newborns

2018 ◽  
Vol 11 ◽  
pp. 117863101879707 ◽  
Author(s):  
Benet B Dhas ◽  
Vijaya R Dirisala ◽  
B Vishnu Bhat
Keyword(s):  
Neonatal Sepsis ◽  
Inflammatory Responses ◽  
Diagnostic Techniques ◽  
Diagnostic Methods ◽  
Large Sample Size ◽  
Case Control Studies ◽  
Circulating Micrornas ◽  
Expression Levels ◽  
Sepsis Diagnosis ◽  
Low Sensitivity

The high mortality rate of neonatal sepsis is directly connected with time-consuming diagnostic methods that have low sensitivity and specificity. The need of the hour is to develop novel diagnostic techniques that are rapid and more specific. In this study, we estimated the expression levels of circulating microRNAs (miRNAs) that are involved in regulating immune response genes and underlying inflammatory responses, which may be used for sepsis diagnosis. The total circulating miRNA was isolated and the candidate miRNAs (miR-132, miR-146a, miR-155, and miR-223) were quantified by real-time polymerase chain reaction technique. Statistical analysis revealed that miR-132 ( P < .01) and miR-223 ( P < .05) were downregulated in septic newborns compared with healthy babies. The decrease in expression of miR-132 and miR-223 may be associated with increased expression of immune-related genes involved in TLR (Toll-like receptor) signaling pathway. Further case-control studies with large sample size are required to identify the potential of miRNAs in neonatal sepsis diagnosis.

A PROSPECTIVE STUDY ON CLINICAL PROFILE AND OUTCOME OF PATIENTS WITH TUBERCULOUS MENINGITIS AT A TERTIARY CARE CENTRE IN MAHARASHTRA

2021 ◽  
pp. 7-10
Author(s):  
Nupoor Vaghasia ◽  
Bharatsing D. Rathod ◽  
Vidya Nagar
Keyword(s):  
Tuberculous Meningitis ◽  
Tertiary Care ◽  
Epidemiological Data ◽  
Acute Onset ◽  
P Value ◽  
Western India ◽  
Care Hospital ◽  
Tertiary Care Centre ◽  
Altered Sensorium ◽  
Low Sensitivity

BACKGROUND: Tuberculous meningitis (TBM) is one of the most fatal forms of tuberculosis, early diagnosis and treatment of which can reduce morbidity and mortality. This study was undertaken to achieve data regarding clinical prole and outcome of patients from western India as epidemiological data is lacking from this region. METHODS: This prospective observational study was conducted on 136 patients admitted in medical ward and critical care unit of a tertiary care hospital in Maharashtra over 18 months. Clinical, biochemical, radiological and microbiological evaluation was done. Data was analyzed using SPSS 22 version software and p value of <0.05 as signicant. RESULTS: The mean age of cases was 35.2 ± 14.69 years, majority from age group of 18 - 40 years. Out of 136 cases, 62 (45.6%) were males and 74 (54.4%) females. Commonest clinical features were fever and headache, followed by altered sensorium and seizure. Symptoms were mostly of acute onset (<14 days). 42 cases (30.9%) were associated with present or past pulmonary tuberculosis and 34 (25%) with retroviral disease. 7 cases (5.2%) had hemiparesis and 3 (2.2%) had ophthalmoplegia. Mean ESR was 56.59 + 22.87. CSF showed lymphocytosis (mean 88.4 + 18.09 %), low glucose percentage (mean 39.57 + 0.2 %) and high protein (mean 146.02 + 106.62 mg/dl). 117 cases (86%) showed positive neuroimaging. Outcome was poor in stage III disease. CONCLUSION: Tuberculous meningitis usually presents as acute onset illness with fever, headache or altered sensorium. CSF Gene Xpert has low sensitivity as compared to neuroimaging. Advanced disease was associated with poor outcome.

scholarly journals Aetiology, Clinical Presentation, and Outcome of Meningitis in Patients Coinfected with Human Immunodeficiency Virus and Tuberculosis

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Smita Bhagwan ◽  
Kogieleum Naidoo
Keyword(s):  
South Africa ◽  
Human Immunodeficiency Virus ◽  
Tuberculous Meningitis ◽  
Clinical Presentation ◽  
Case Series ◽  
Antituberculous Therapy ◽  
Endemic Region ◽  
Neck Stiffness ◽  
Immunodeficiency Virus ◽  
Poor Outcomes

We conducted a retrospective review of confirmed HIV-TB coinfected patients previously enrolled as part of the SAPiT study in Durban, South Africa. Patients with suspected meningitis were included in this case series. From 642 individuals, 14 episodes of meningitis in 10 patients were identified. For 8 patients, this episode of meningitis was the AIDS defining illness, with cryptococcus (9/14 episodes) and tuberculosis (3/14 episodes) as the commonest aetiological agents. The combination of headache and neck stiffness (78.6%) was the most frequent clinical presentation. Relapsing cryptococcal meningitis occurred in 3/7 patients. Mortality was 70% (7/10), with 4 deaths directly due to meningitis. In an HIV TB endemic region we identified cryptococcus followed by tuberculosis as the leading causes of meningitis. We highlight the occurrence of tuberculous meningitis in patients already receiving antituberculous therapy. The development of meningitis heralded poor outcomes, high mortality, and relapsing meningitis despite ART.

Tuberculosis in a Spanish cohort of children living with HIV: the CHOTIS study (Childhood HIV & TB study)

2020 ◽  
Vol 24 (3) ◽  
pp. 303-309
Author(s):  
E. M. López-Medina ◽  
T. Sainz ◽  
S. Jiménez de Ory ◽  
M. J. Mellado-Peña ◽  
M. I. González-Tomé ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Foreign Born ◽  
Paediatric Hiv ◽  
Number Of Children ◽  
Hiv Coinfection ◽  
Immunodeficiency Virus ◽  
Combined Antiretroviral Therapy ◽  
Low Prevalence ◽  
Living With Hiv ◽  
Spanish Cohort

BACKGROUND: Tuberculosis (TB) is the leading opportunistic infection in children with human immunodeficiency virus (HIV), but is uncommon in low prevalence regions. We aim to describe the changing epidemiology and clinical presentation of TB-HIV co-infection in a cohort of HIV-infected children in Spain.METHODS: Children diagnosed with TB between 1995 and 2016 in the paediatric HIV cohort were identified. The incidence and clinical presentation were compared in three periods: 1995–1999 (P1, before initiation of combined antiretroviral therapy, cART), 2000–2009 (P2, increase in immigration), and 2010–2016 (P3, decrease in immigration).RESULTS: We included 29 TB cases among 1183 children aged <18 years (2.4%, 243/100 000 person-years). The proportion was stable in P1 and P2 (1.3%), but decreased in P3 (0.8%). The median age at TB diagnosis was 6.4 years (IQR 4–10.6); most children in P3 were aged >10 years (20% vs. 23.1% vs. 83.3%, P = 0.01). TB was diagnosed at HIV presentation in 11/29 children (37.9%). Foreign-born children accounted for respectively 0%, 8% and 67% of the total number of children in each period (P ≤ 0.0001). One third had extrapulmonary TB; four children died (13.8%).CONCLUSION: In our cohort, the incidence of TB-HIV co-infection decreased with decline in immigration. In regions with adequate cART coverage and low TB transmission, paediatric TB-HIV coinfection is uncommon, but associated with significant morbidity. Strategies for TB surveillance, diagnosis and treatment in this vulnerable population should be reinforced.

Sign in / Sign up

Export Citation Format

Share Document