scholarly journals Diagnosis of Pulmonary Infections Due to Endemic Fungi

Diagnostics ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 856
Author(s):  
Victoria Poplin ◽  
Clarissa Smith ◽  
Dominique Milsap ◽  
Lauren Zabel ◽  
Nathan C. Bahr
Keyword(s):  
Respiratory Infections ◽  
Fungal Infections ◽  
Immunosuppressive Agents ◽  
Diagnostic Testing ◽  
Clinical Manifestations ◽  
Antibiotic Use ◽  
Pulmonary Infections ◽  
Dimorphic Fungi ◽  
Delay In Diagnosis ◽  
Endemic Mycoses

Endemic mycoses including Histoplasma, Blastomyces, Coccidioides, Paracoccidioides, and Talaromyces are dimorphic fungi that can cause a variety of clinical manifestations, including respiratory infections. Their pulmonary presentations are variable, and diagnosis is often delayed as they can mimic other infectious and non-infectious causes of pulmonary disease. Delay in diagnosis can lead to unnecessary antibiotic use, repeat hospitalizations, and increased morbidity and mortality. The diagnosis of endemic fungal pulmonary infections often relies on multiple diagnostic tests including culture, tissue histopathology, antigen assays, and antibody assays. Due to the increased use of immunosuppressive agents and the widening geographic ranges where these infections are being found, the prevalence of endemic fungal infections is increasing. Physicians need to be aware of the clinical manifestations of pulmonary infections due to endemic fungal in order to ensure that the proper diagnostic work up is obtained promptly. A high index of suspicion is particularly important in patients with suspected pulmonary infections who have failed to improve despite antibiotics in the appropriate setting. We present a review diagnostic testing for pulmonary infections due to endemic mycoses.

Risk factors for the delayed diagnosis of extrapulmonary TB

2021 ◽  
Vol 25 (3) ◽  
pp. 191-198
Author(s):  
M. K. Lee ◽  
C. Moon ◽  
M. J. Lee ◽  
Y. G. Kwak ◽  
E. Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Outpatient Clinic ◽  
Diagnostic Testing ◽  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
Diagnosis And Treatment ◽  
Delay In Diagnosis ◽  
Microbiological Characteristics ◽  
Significant Difference ◽  
Basic Characteristics

BACKGROUND: Extrapulmonary TB (EPTB) is more difficult to diagnose than pulmonary TB. The delayed management of EPTB can lead to complications and increase the socio-economic burden.METHODS: Patients newly diagnosed with EPTB were retrospectively enrolled from 11 general hospitals in South Korea from January 2017 to December 2018. The basic characteristics of patients were described. Univariable and multivariable analyses were performed between early and delayed diagnosis groups to identify risk factors for delayed diagnosis and treatment in EPTB.RESULTS: In total, 594 patients were enrolled. Lymph node TB (28.3%) was the predominant form, followed by abdominal (18.4%) and disseminated TB (14.5%). Concurrent lung involvement was 17.8%. The positivity of diagnostic tests showed no significant difference between the two groups. Acute clinical manifestations in disseminated, pericardial and meningeal TB, and immunosuppression were associated with early diagnosis. Delayed diagnosis was associated with outpatient clinic visits, delayed sample acquisition and diagnostic departments other than infection or pulmonology.CONCLUSION: The delay in diagnosis and treatment of EPTB was not related to differences in microbiological characteristics of Mycobacterium tuberculosis itself; rather, it was due to the indolent clinical manifestations that cause referral to non-TB-specialised departments in the outpatient clinic and delay the suspicion of TB and diagnostic testing.

scholarly journals Allergic Bronchopulmonary Aspergillosis in Children with Cystic Fibrosis: An Update on the Newest Diagnostic Tools and Therapeutic Approaches

Pathogens ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. 716
Author(s):  
Claudia Lattanzi ◽  
Giulia Messina ◽  
Valentina Fainardi ◽  
Maria Candida Tripodi ◽  
Giovanna Pisi ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Lung Disease ◽  
Diagnostic Criteria ◽  
Respiratory Infections ◽  
Fungal Infections ◽  
Early Recognition ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Clinical Manifestations ◽  
Diagnostic Tools ◽  
The Impact

Cystic fibrosis (CF), the most common autosomal-recessive genetic disease in the Caucasian population, is characterized by frequent respiratory infections and progressive lung disease. Fungal species are commonly found in patients with CF, and among them, Aspergillus fumigatus is the most frequently isolated. While bacteria, particularly Pseudomonas aeruginosa, have a well-established negative effect on CF lung disease, the impact of fungal infections remains unclear. In patients with CF, inhalation of Aspergillus conidia can cause allergic bronchopulmonary aspergillosis (ABPA), a Th2-mediated lung disease that can contribute to disease progression. Clinical features, diagnostic criteria and treatment of ABPA are still a matter of debate. Given the consequences of a late ABPA diagnosis or the risk of ABPA overdiagnosis, it is imperative that the diagnostic criteria guidelines are reviewed and standardized. Along with traditional criteria, radiological features are emerging as tools for further classification as well as novel immunological tests. Corticosteroids, itraconazole and voriconazole continue to be the bedrock of ABPA therapy, but other molecules, such as posaconazole, vitamin D, recombinant INF-γ and Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) modulators, have been showing positive results. However, few studies have been conducted recruiting CF patients, and more research is needed to improve the prevention and the classification of clinical manifestations as well as to personalize treatment. Early recognition and early treatment of fungal infections may be fundamental to prevent progression of CF disease. The aim of this narrative review is to give an update on ABPA in children with CF.

scholarly journals Delayed Diagnosis of Respiratory Syncytial Virus Infections in Hospitalized Adults: Individual Patient Data, Record Review Analysis and Physician Survey in the United States

2019 ◽  
Vol 220 (6) ◽  
pp. 969-979 ◽  
Author(s):  
Nelson Lee ◽  
Edward E Walsh ◽  
Ian Sander ◽  
Robert Stolper ◽  
Jessica Zakar ◽  
...  
Keyword(s):  
Respiratory Syncytial Virus ◽  
Individual Patient Data ◽  
Respiratory Infections ◽  
Diagnostic Testing ◽  
Delayed Diagnosis ◽  
Antibiotic Use ◽  
The United States ◽  
Patient Data ◽  
Diagnostic Strategies ◽  
Syncytial Virus

AbstractBackgroundDespite the prevalence of respiratory syncytial virus (RSV) in adults hospitalized with acute respiratory infections, guidelines for the diagnosis and management of RSV have not been established. This analysis evaluated the role and timeliness of RSV diagnostic testing and its potential impact on clinical outcomes.MethodsWe analyzed individual patient data from hospitalized adults with confirmed RSV infections during 2 North American RSV seasons. Participating physicians reported clinical, virologic diagnosis, and outcome variables using a standardized online case form.ResultsAcross 32 US states, 132 physicians reported 379 RSV cases. Polymerase chain reaction–based diagnostics were the most common type of test ordered (94.2%) with <5% ordered specifically to diagnose RSV. Most tests (67.6%) were ordered in hospital wards or intensive care units. Overall, 47.4%, 30.9%, and 21.7% of patients had RSV diagnosed <12, 12‒24, and >24 hours after hospital admission, respectively. Later diagnosis was associated with longer hospital stays (n = 145; R = +0.191; P < .05) and greater antibiotic use.ConclusionDiagnosis of RSV infection in hospitalized adults is often delayed, which may affect clinical management and outcomes. Our findings indicate the need to improve the diagnostic strategies in this patient population.

scholarly journals Effective of antiviral therapy of HIV infection and intercurrent diseases in children

2017 ◽  
Vol 8 (1) ◽  
pp. 50-54
Author(s):  
Vladimir N Timchenko ◽  
Elena B Yastrebova ◽  
Oksana V Bulina
Keyword(s):  
Hiv Infection ◽  
Viral Infections ◽  
Respiratory Infections ◽  
Fungal Infections ◽  
Clinical Manifestations ◽  
Undetectable Viral Load ◽  
Pneumocystis Pneumonia ◽  
Saint Petersburg ◽  
Perinatal Hiv ◽  
Acute Respiratory Diseases

The study included 366 HIV-infected children (under-23) and 350 children with perinatal contact with HIV infection (R-75), consisting on the dispensary account in the Department of motherhood and childhood of the Saint Petersburg city AIDS center. The vast majority of children with perinatal HIV receive HAART (95.0%) with high efficacy (undetectable viral load, normalization of CD4 lymphocytes, the absence of clinical manifestations). In the structure of opportunistic viral infections (herpes, respiratory infections) 40.0%, bacterial (bronchitis, tonsillitis, pyoderma, pulmonary tuberculosis) - 28.6%, fungal infections (candidiasis mucous membranes of the oral cavity) and Pneumocystis pneumonia - 31.4%. Complex therapy (etiotropic, pathogenetic, symptomatic) acute respiratory viral infections in children with B-23 and R-75, allows us to achieve in the early stages (6 days treatment) of the regression of the main symptoms of acute respiratory diseases.

scholarly journals Clinical and Genetic Study of X-linked Agammaglobulinemia Patients (The Benefit of Early Diagnosis)

2020 ◽  
Author(s):  
Zahra Alizadeh ◽  
Parisa Dashti ◽  
Marzieh Mazinani ◽  
Maryam Nourizadeh ◽  
Leila Shakerian ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Bacterial Infections ◽  
Respiratory Infections ◽  
Clinical Manifestations ◽  
Cell Receptor ◽  
Kinase Domain ◽  
Screening Tests ◽  
Ph Domain ◽  
Delay In Diagnosis ◽  
Study Results

X-linked agammaglobulinemia (XLA) is a primary immunodeficiency caused by genetic defects in the Bruton tyrosine kinase (Btk) gene. XLA is characterized as an antibody deficiency by recurrent bacterial infections, the absence of peripheral B cells, and profound reductions in all immunoglobulin isotypes. This study aims to report the clinical and genetic features of five Iranian patients with XLA. Five male cases with recurrent bacterial infection entered this study based on clinical evaluation and Immunological screening tests. The levels of T-cell receptor excision circle (TREC) and kappa-deleting recombination excision circle (KREC) were also measured in dried blood spot (DBS) samples. Sanger sequencing was applied to PCR products of DNA samples of the patients for genetic studies. All patients were from unrelated families with a mean age of 6.7 years (2.5-11) at the time of diagnosis with 4.8 mean years of delay in diagnosis. The most frequent clinical manifestations were recurrent respiratory infections and arthritis. In these patients, five previously reported mutations were found including four mutations (p.Q496X, p.Q497X, p.R520X, and p.R641H) in the Kinase domain besides one mutation (p.L37P) in the pleckstrin homology (PH) domain. Evaluations of KREC and TREC level in patients’ DBS showed low-to-undetectable copies of KREC (0-2 copies/3.2mm DBS) with normal copies of TREC. As patients with XLA have complete immunoglobulin defects and develop severe and recurrent infections, early diagnosis would be beneficial for the improvement of their quality of life. The study results may provide valuable information for the diagnosis, genetic counseling and prenatal diagnosis for the patients and their family members and emphasize performing KREC as an early diagnostic test in patients with XLA.

scholarly journals 1718. Respiratory Syncytial Virus (RSV) Surveillance in the Department of Veterans Affairs (VA), 2010-2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S843-S843
Author(s):  
Cynthia Lucero-Obusan ◽  
Patricia Schirmer ◽  
Gina Oda ◽  
Mark Holodniy
Keyword(s):  
Respiratory Syncytial Virus ◽  
Respiratory Infections ◽  
Diagnostic Testing ◽  
Fold Increase ◽  
Respiratory Illness ◽  
Veterans Affairs ◽  
Department Of Veterans Affairs ◽  
Management And Development ◽  
Syncytial Virus ◽  
National Trends

Abstract Background Respiratory Syncytial Virus (RSV) is an increasingly recognized cause of acute respiratory illness in older adults, leading to an estimated 177,000 hospitalizations and 14,000 deaths each year in the US. In adult populations, diagnostic testing for RSV has historically been underutilized. Herein, we examine national trends in RSV testing and infection across the Veterans Affairs (VA) healthcare system. Methods Electronic RSV laboratory testing results, ICD-coded hospitalizations and outpatient encounters were obtained from VA’s Praedico Surveillance System (1/1/2010-12/31/2018). Patients were reviewed for positive results, repeat testing, and demographics. Antibody tests were excluded. Results A total of 102,251 RSV results were included. Overall, 4,372 (4.3%) specimens from 4,263 unique individuals were positive with a median age of 67 years (range 0-101) and 90% were male. 1,511 individuals (35.4%) also had an RSV-coded hospitalization. RSV type was specified for only 7.8% of positives (Table). During 2010-2018 there were 2,522 RSV-coded hospitalizations (median length of stay = 4 days) among 2,444 unique individuals, which included 413 ICU stays (16.4%) and 98 deaths (3.9%) during the RSV-coded hospitalization. Approximately 78% of RSV-coded hospitalizations within VA (excluding all non-VA hospitalizations) had a documented positive test result. A greater than 15-fold increase in RSV tests performed, hospitalizations and outpatient encounters was observed from 2010-2018, although the percent testing positive remained relatively stable (Figure, Table). Figure. Testing for Respiratory Syncytial Virus (RSV), Department of Veterans Affairs, 2010-2018. Table. Select RSV Surveillance Metrics, Department of Veterans Affairs, 2010-2018 Conclusion RSV testing and identification of patients with RSV infection increased dramatically during the time period analyzed, likely due to increased availability of PCR-based multi-pathogen panels and duplex assays. While the percentage of tests positive for RSV remained relatively stable, the rise in coded hospitalizations may be due to increased testing for RSV among hospitalized Veterans with severe respiratory infections. These surveillance data may allow for further characterization of RSV disease burden estimates which can help inform clinical management and development of interventions for adults, such as vaccines and antiviral therapies. Disclosures All Authors: No reported disclosures

scholarly journals Risk of infection associated with targeted therapies for solid organ and hematological malignancies

2021 ◽  
Vol 8 ◽  
pp. 204993612198954
Author(s):  
Isabel Ruiz-Camps ◽  
Juan Aguilar-Company
Keyword(s):  
Hematological Malignancies ◽  
Opportunistic Infections ◽  
Respiratory Infections ◽  
Fungal Infections ◽  
Checkpoint Inhibitors ◽  
Janus Kinase ◽  
Prolonged Treatment ◽  
Solid Organ ◽  
Risk Of Infection ◽  
Increased Risk

Higher risks of infection are associated with some targeted drugs used to treat solid organ and hematological malignancies, and an individual patient’s risk of infection is strongly influenced by underlying diseases and concomitant or prior treatments. This review focuses on risk levels and specific suggestions for management, analyzing groups of agents associated with a significant effect on the risk of infection. Due to limited clinical experience and ongoing advances in these therapies, recommendations may be revised in the near future. Bruton tyrosine kinase (BTK) inhibitors are associated with a higher rate of infections, including invasive fungal infection, especially in the first months of treatment and in patients with advanced, pretreated disease. Phosphatidylinositol 3-kinase (PI3K) inhibitors are associated with an increased risk of Pneumocystis pneumonia and cytomegalovirus (CMV) reactivation. Venetoclax is associated with cytopenias, respiratory infections, and fever and neutropenia. Janus kinase (JAK) inhibitors may predispose patients to opportunistic and fungal infections; need for prophylaxis should be assessed on an individual basis. Mammalian target of rapamycin (mTOR) inhibitors have been linked to a higher risk of general and opportunistic infections. Breakpoint cluster region-Abelson (BCR-ABL) inhibitors are associated with neutropenia, especially over the first months of treatment. Anti-CD20 agents may cause defects in the adaptative immune response, hypogammaglobulinemia, neutropenia, and hepatitis B reactivation. Alemtuzumab is associated with profound and long-lasting immunosuppression; screening is recommended for latent infections and prevention strategies against CMV, herpesvirus, and Pneumocystis infections. Checkpoint inhibitors (CIs) may cause immune-related adverse events for which prolonged treatment with corticosteroids is needed: prophylaxis against Pneumocystis is recommended.

scholarly journals Evaluation of Antibiotic Supply Decisions by Community Pharmacists in Thailand: A Vignette Study

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 154
Author(s):  
Sisira Donsamak ◽  
Marjorie C. Weiss ◽  
Dai N. John
Keyword(s):  
Respiratory Infections ◽  
Acute Diarrhoea ◽  
Community Pharmacists ◽  
Antibiotic Use ◽  
Educational Interventions ◽  
Community Pharmacies ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Case Vignettes ◽  
A Chain

In Thailand, antibiotics are available lawfully from community pharmacies without a prescription. Inappropriate supply of antibiotics from Thai community pharmacies to the public for common, self-limiting diseases has been reported. The study aimed to evaluate the appropriateness of antibiotics selected by community pharmacists in Thailand in response to vignettes. A cross-sectional survey of community pharmacists across Thailand was conducted using a self-administered questionnaire including nine case vignettes with three conditions, namely upper respiratory infections (URIs), acute diarrhoea and simple wounds. A total of 208 questionnaires were completed and analysed (20.8% response rate). In response to vignettes relating to URIs, 50.8% of pharmacist recommendations were not in accordance with antibiotic guidelines. Inappropriate recommendations for diarrhoea and wound cases were 20.8% and 16.7%, respectively. A higher proportion of younger pharmacists, those with less experience, Pharm. D. graduate pharmacists, employee pharmacists and those pharmacists who worked in a chain pharmacy were more likely to recommend appropriate antibiotic treatment in response to the vignettes (p < 0.05). These findings will be useful to promote educational interventions for community pharmacists regarding common infectious disease management in order to improve appropriate antibiotic use.

scholarly journals Clinical Features and Maternal-fetal Results of Pregnant Women in COVID-19 Times

2021 ◽  
Vol 43 (05) ◽  
pp. 384-394
Author(s):  
Ana Paula Nogueira Godoi ◽  
Gilcelia Correia Santos Bernardes ◽  
Leilismara Sousa Nogueira ◽  
Patrícia Nessralla Alpoim ◽  
Melina de Barros Pinheiro
Keyword(s):  
Pregnant Women ◽  
Vertical Transmission ◽  
Postpartum Period ◽  
Scientific Literature ◽  
Respiratory Infections ◽  
Clinical Manifestations ◽  
Fetal Distress ◽  
Medical Subject Headings ◽  
Substantial Evidence ◽  
The Subject

Abstract Objective Coronavirus disease 2019 (COVID-19) is a disease caused by a newly discovered coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which usually leads to non-specific respiratory symptoms. Although pregnant women are considered at risk for respiratory infections by other viruses, such as SARS and Middle East respiratory syndrome (MERS), little is known about their vulnerability to SARS-CoV-2. Therefore, this study aims to identify and present the main studies on the topic, including the postpartum period. Methods In this narrative review, articles were searched in various databases, organizations, and health entities using keywords compatible with medical subject headings (MeSH), such as: COVID-19, pregnancy, vertical transmission, coronavirus 2019, and SARS-CoV-2. Results The review of the scientific literature on the subject revealed that pregnant women with COVID-19 did not present clinical manifestations significantly different from those of non-pregnant women; however, there are contraindicated therapies. Regarding fetuses, studies were identified that reported that infection by SARS-CoV-2 in pregnant women can cause fetal distress, breathing difficulties and premature birth, but there is no substantial evidence of vertical transmission. Conclusion Due to the lack of adequate information and the limitations of the analyzed studies, it is necessary to provide detailed clinical data on pregnant women infected with SARS-CoV-2 and on the maternal-fetal repercussions caused by this infection. Thus, this review may contribute to expand the knowledge of professionals working in the area as well as to guide more advanced studies on the risk related to pregnant women and their newborns. Meanwhile, monitoring of confirmed or suspected pregnant women with COVID-19 is essential, including in the postpartum period.

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