Archive for November 29, 2016

The C-Reactive Protein May Not Detect Infections Caused by Less-Virulent Organisms

Journal of Arthroplasty September 2016 V.31 N.9 P.152–155

Carl A. Deirmengian, Patrick A. Citrano, Simmi Gulati, Erick R. Kazarian, James W. Stave, Keith W. Kardo

Background

The aim of the present study was to evaluate the influence of organism type on the performance of the synovial fluid C-reactive protein (CRP) test.

Methods

We retrospectively reviewed the results of 21,422 synovial fluid samples sent to one common laboratory for the purpose of diagnostic testing for periprosthetic joint infection. Both a synovial fluid CRP result and a positive culture were present for 1789 submitted samples. The cultured organisms were grouped by species, virulence, and gram type; and the median CRP level was determined for each group.

Results

The median synovial fluid CRP level was significantly lower for less-virulent organisms, when compared to those organisms classified as virulent (15.10 mg/L vs 32.70 mg/L; P < .0001). Some less-virulent species such as yeast and Staphylococcus epidermidis were associated with a 4-10 times lower CRP response than those of virulent organisms such as Streptococcus agalactiae and Staphylococcus aureus (P < .0001). Bacterial gram type had no influence on the median CRP result. The rate of false-negative CRP values was 50.9% for yeast, 29.4% for S. epidermidis, 28.5% for all less-virulent organisms, and 11.6% for all virulent organisms.

Conclusion

The CRP response appears to be highly dependent on the infecting organism and is more likely to provide false-negative results in the setting of less-virulent organisms. Although the use of a CRP level is an important part of the workup for periprosthetic joint infection, surgeons must be aware that this protein may yield a false-negative result in the setting of less-virulent organisms.

 

PDF

http://www.arthroplastyjournal.org/article/S0883-5403(16)00259-X/pdf

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November 29, 2016 at 1:30 pm

Coexisting cytomegalovirus infection in immunocompetent patients with Clostridium difficile colitis.

J Microbiol Immunol Infect. 2016 Jan 12.

Chan KS1, Lee WY2, Yu WL3.

Author information

1Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan City, Taiwan.

2Department of Pathology, Chi Mei Medical Center, Tainan City, Taiwan; Department of Pathology, Taipei Medical University, Taipei City, Taiwan.

3Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan City, Taiwan; Department of Medicine, Taipei Medical University, Taipei City, Taiwan. Electronic address: yuleon_md@yahoo.com.tw

Abstract

Cytomegalovirus (CMV) colitis usually occurs in immunocompromised patients with human immunodeficiency virus infection, organ transplantation, and malignancy receiving chemotherapy or ulcerative colitis receiving immunosuppressive agents.

However, CMV colitis is increasingly recognized in immunocompetent hosts.

Notably, CMV colitis coexisting with Clostridium difficile infection (CDI) in apparently healthy individuals has been published in recent years, which could result in high morbidity and mortality.

CMV colitis is a rare but possible differential diagnosis in immunocompetent patients with abdominal pain, watery, or especially bloody diarrhea, which could be refractory to standard treatment for CDI. As a characteristic of CDI, however, pseudomembranous colitis may be only caused by CMV infection.

Real-time CMV-polymerase chain reaction (PCR) for blood and stool samples may be a useful and noninvasive diagnostic strategy to identify CMV infection when treatment of CDI eventually fails to show significant benefits. Quantitative CMV-PCR in mucosal biopsies may increase the diagnostic yield of traditional histopathology.

CMV colitis is potentially life-threatening if severe complications occur, such as sepsis secondary to colitis, massive colorectal bleeding, toxic megacolon, and colonic perforation, so that may necessitate pre-emptive antiviral treatment for those who are positive for CMV-PCR in blood and/or stool samples while pending histological diagnosis

PDF

http://www.e-jmii.com/article/S1684-1182(16)00008-6/pdf

November 29, 2016 at 7:54 am

Cytomegalovirus related fatal duodenal diverticular bleeding: Case report and literature review.

World J Gastroenterol. 2016 Aug 21;22(31):7166-74.

Makker J1, Bajantri B1, Sakam S1, Chilimuri S1.

Author information

1Jasbir Makker, Sridhar Chilimuri, Division of Gastroenterology, Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY 10457, United States.

Abstract

Involvement of gastrointestinal tract by cytomegalovirus (CMV) is common. CMV infections mainly run their course without any clinical signs in immunocompetent hosts.

In contrast, CMV can cause severe infections with serious consequences in a immunocompromised state typically associated with organ transplants, highly immunosuppressive cancer chemotherapy, advanced HIV infection or treatment with corticosteroids.

The incidence and severity of these manifestations of CMV is directly proportional with the degree of cellular immune dysfunction, i.e., CD8+ Cytotoxic T-cell response.

Clinical manifestations of CMV can become apparent in different situations including reactivation of CMV from latency, primary infection in a seronegative host, or exposure of a seropositive host to a new strain of CMV.

As the clinical signs of CMV in immunodeficient patients are usually sparse, physicians should be highly vigilant about CMV infection, a treatable condition that otherwise is associated with significant mortality.

Here we report a rare case of severe gastrointestinal CMV infection with sustained immunodeficiency secondary to treatment with steroids manifesting as fatal duodenal diverticular bleeding.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4988300/pdf/WJG-22-7166.pdf

November 29, 2016 at 7:51 am


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