Melioidosis: Laboratory Investigations and Association with Patient Outcomes

2021 ◽  
Author(s):  
Ian Gassiep ◽  
Vibooshini Ganeshalingam ◽  
Mark D. Chatfield ◽  
Patrick N. A. Harris ◽  
Robert E. Norton
Keyword(s):  
Patient Outcomes ◽  
International Normalized Ratio ◽  
Limited Information ◽  
Blood Culture Result ◽  
Hemagglutination Assay ◽  
Indirect Hemagglutination ◽  
Laboratory Investigations ◽  
Time Of Presentation ◽  
Abundant Data ◽  
Diagnostic Investigations

Melioidosis is an infection caused by the bacterium Burkholderia pseudomallei. The most common presentation is bacteremia occurring in 38–73% of all patients, and the mortality rate ranges from 9% to 42%. Although there is abundant data representing risk factors for infection and patient outcomes, there is limited information regarding laboratory investigations associated with bacteremia and mortality. We assessed a range of baseline and diagnostic investigations and their association with patient outcomes in a retrospective cohort study in Townsville, Australia. About 124 patients’ medical and laboratory records were reviewed between January 1, 1997 and December 31, 2020. Twenty-seven patients died and 87 patients were bacteremic. The presence of lymphopenia (< 1.5 × 109 cells/L) was the highest risk for bacteremia (relative risk [RR] 2.2; 95% CI: 1.3–3.7, P < 0.001). Factors associated with mortality included lymphopenia, (RR: 1.4; 95% CI: 1.2–1.6, P = 0.004); uremia (RR: 1.7; 95% CI: 1.1–2.5, P = 0.03); and an elevated international normalized ratio (RR: 1.5; 95% CI: 1.2–2.0, P = 0.006). Median incubation to positive blood culture result was 28 hours with 15/82 (18%) positive in ≤ 24 hours. For serological testing during admission only 53/121 (44%) were indirect hemagglutination assay positive, 67/120 (56%) enzyme immunoassay IgG positive, and 23/89 (26%) IgM positive. Simple baseline investigations at time of presentation may be used to stratify patients at high risk for both bacteremia and mortality. This information can be used as a decision aid for early intensive management.

scholarly journals Recovery of new-onset kidney disease in COVID-19 patients discharged from hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nan-Hui Zhang ◽  
Yi-Chun Cheng ◽  
Ran Luo ◽  
Chun-Xiu Zhang ◽  
Shu-Wang Ge ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Kidney Diseases ◽  
Descriptive Statistics ◽  
Limited Information ◽  
High Discharge ◽  
Discharged Patients ◽  
Recovery Group ◽  
Abundant Data ◽  
New Onset

Abstract Background Coronavirus disease 2019 (COVID-19) has emerged as a major global health threat with a great number of deaths worldwide. Despite abundant data on that many COVID-19 patients also displayed kidney disease, there is limited information available about the recovery of kidney disease after discharge. Methods Retrospective and prospective cohort study to patients with new-onset kidney disease during the COVID-19 hospitalization, admitted between January 28 to February 26, 2020. The median follow-up was 4 months after discharge. The follow-up patients were divided into the recovery group and non-recovery group. Descriptive statistics and between-groups comparison were used. Results In total, 143 discharged patients with new-onset kidney disease during the COVID-19 hospitalization were included. Patients had a median age was 64 (IQR, 51–70) years, and 59.4% of patients were men. During 4-months median follow-up, 91% (130 of 143) patients recovered from kidney disease, and 9% (13 of 143) patients haven’t recovered. The median age of patients in the non-recovery group was 72 years, which was significantly higher than the median age of 62 years in the recovery group. Discharge serum creatinine was significantly higher in the non-recovery group than in the recovery group. Conclusions Most of the new-onset kidney diseases during hospitalization of COVID-19 patients recovered 4 months after discharge. We recommend that COVID-19 patients with new-onset kidney disease be followed after discharge to assess kidney recovery, especially elderly patients or patients with high discharge creatinine.

scholarly journals First report of Chlamydia psittaci seroprevalence in black-headed gulls (Larus ridibundus) at Dianchi Lake, China

2018 ◽  
Vol 13 (1) ◽  
pp. 250-252
Author(s):  
Hua Chang ◽  
Jiangqiang Han ◽  
Yan Yang ◽  
Gang Duan ◽  
Fengcai Zou ◽  
...  
Keyword(s):  
Human Health ◽  
Potential Risk ◽  
Wild Bird ◽  
Chlamydia Psittaci ◽  
Dianchi Lake ◽  
Serum Samples ◽  
Present Survey ◽  
Hemagglutination Assay ◽  
Larus Ridibundus ◽  
Indirect Hemagglutination

AbstractChlamydiosis is an important zoonosis which can transmit from birds to humans, and investigation first reported the seroprevalence of Chlamydia psittaci in black-headed gulls (Larus ridibundus) at the Dianchi Lake, China. A total of 1029 serum samples collected from black-headed gulls between 2012-2015 were analyzed. The gulls were randomly caught and blood collected at Dianchi Lake, China. All the samples were analyzed for the presence of antibodies to C. psittaci by indirect hemagglutination assay (IHA). In this survey, the total infection rate was 11.86% (122/1029). The results of the present survey documented the existence of relatively high C. psittaci seroprevalence in black-headed gulls, which have a potential risk to the wild bird health and human health. Comprehensive practical control approaches and measures should be executed.

scholarly journals International normalized ratio self-testing and self-management: improving patient outcomes

2016 ◽  
Vol Volume 12 ◽  
pp. 387-392 ◽  
Author(s):  
Matteo Pozzi ◽  
Julia Mitchell ◽  
Anna Maria Henaine ◽  
Najib Hanna ◽  
Ola Safi ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
International Normalized Ratio ◽  
Self Management ◽  
Self Testing

ASHP therapeutic position statement on the use of the International Normalized Ratio system to monitor oral anticoagulant therapy

1995 ◽  
Vol 52 (5) ◽  
pp. 529-531 ◽  
Keyword(s):  
Clinical Trials ◽  
Patient Outcomes ◽  
Anticoagulant Therapy ◽  
Oral Anticoagulant ◽  
Oral Anticoagulant Therapy ◽  
International Normalized Ratio ◽  
Position Statement ◽  
International Agreement ◽  
Warfarin Dosing ◽  
Improve Patient

Summary The INR system of standardizing PT measurements can minimize variability between laboratories, PT reagents, and instruments. The INR system can also facilitate international agreement on therapeutic ranges and allow direct comparison of clinical trials. This should provide greater uniformity in the management of oral anticoagulant therapy and ultimately may improve patient outcomes. ASHP supports the use of the INR system on the basis of studies demonstrating that this system permits warfarin dosing that is less dependent on the variability of thromboplastin reagent sensitivity.

scholarly journals Accuracy of Enzyme-Linked Immunosorbent Assay Using Crude and Purified Antigens for Serodiagnosis of Melioidosis

2006 ◽  
Vol 14 (1) ◽  
pp. 110-113 ◽  
Author(s):  
Narisara Chantratita ◽  
Vanaporn Wuthiekanun ◽  
Aunchalee Thanwisai ◽  
Direk Limmathurotsakul ◽  
Allen C. Cheng ◽  
...  
Keyword(s):  
Immunosorbent Assay ◽  
Diagnostic Tests ◽  
Burkholderia Pseudomallei ◽  
Enzyme Linked Immunosorbent Assay ◽  
Northeast Thailand ◽  
Hemagglutination Assay ◽  
Assay Sensitivity ◽  
Diagnostic Indices ◽  
Indirect Hemagglutination ◽  
Purified Antigen

ABSTRACT Five enzyme-linked immunosorbent assays developed to detect antibodies to different Burkholderia pseudomallei antigen preparations were evaluated as diagnostic tests for melioidosis in northeast Thailand. The highest diagnostic indices were observed for an affinity-purified antigen (sensitivity, 82%; specificity, 72%) and crude B. pseudomallei antigen (sensitivity, 81%; specificity, 70%), an improvement over the indirect hemagglutination assay (sensitivity, 73%; specificity, 64%).

Early experience with stent retrievers and comparison with previous-generation mechanical thrombectomy devices for acute ischemic stroke

2014 ◽  
Vol 121 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Eric M. Deshaies ◽  
Amit Singla ◽  
Mark R. Villwock ◽  
David J. Padalino ◽  
Sameer Sharma ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Mechanical Thrombectomy ◽  
Functional Independence ◽  
Limited Information ◽  
Arterial Tree ◽  
Specific Patient ◽  
Thrombectomy Device ◽  
Stent Retrievers ◽  
Solitaire Fr ◽  
Therapy Studies

Object There is limited information regarding patient outcomes following interventions for stroke during the window for endovascular therapy. Studies have suggested that recently approved stent retrievers are safer and more effective than earlier-generation thrombectomy devices. The authors compared cases in which the Solitaire-FR device was used to those in which a MERCI or Penumbra device was used. Methods This study is a single-center retrospective review of 102 consecutive cases of acute stroke in which patients were treated with mechanical thrombectomy devices between 2007 and 2013. Multivariate models, adjusted for confounding factors, were used to investigate functional independence (modified Rankin Scale [mRS] score ≤ 2, and successful reperfusion (thrombolysis in cerebral infarction [TICI] score ≥ 2b). Results Thrombectomy device had a significant impact on functional independence (mRS score ≤ 2) at discharge from the hospital (p = 0.040). Solitaire-FR treatment resulted in significantly more patients being discharged as functionally independent in comparison with MERCI treatment (p = 0.016). A multivariate model found the use of Solitaire-FR to improve the odds of good clinical outcome in comparison with prior-generation devices (OR 6.283, 95% CI 1.785–22.119, p = 0.004). Additionally, the use of Solitaire-FR significantly increased the odds of successful reperfusion (OR 3.247, 95% CI 1.160–9.090, p = 0.025). Conclusions The stent retriever Solitaire-FR significantly improved the odds of functional independence and successful revascularization of the arterial tree. New interventional technology for stroke continues to mature, but randomized trials are needed to establish the actual benefit to specific patient populations.

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