Posts filed under ‘Biología Molecular’

Chronic active Epstein–Barr virus infection associated with hemophagocytic syndrome and extra-nodal natural killer/T-cell lymphoma in an 18-year-old girl: A case report

MEDICINE May 2015 V.96 N.19 P.e6845

Xing, Yawei; Yang, Junwen; Lian, Guanghui; Chen, Shuijiao; Chen, Linlin; Li, Fujun

Rationale:

Chronic active Epstein–Barr virus infection (CAEBV) associated with hemophagocytic syndrome (HPS) and extra-nodal natural killer (NK)/T-cell lymphoma (ENKL) is a rare life-threatening disorder. This disease is easily misdiagnosed because of its varied presentations.

Patient concerns:

An 18-year-old girl was admitted to our hospital with a history of edema in the lower limbs and intermittent fever lasting for more than 1 month. At admission, she had severe liver injury of unknown etiology. Laboratory test results revealed pancytopenia, hyperferritinemia, hypertriglyceridemia, and hypofibrinogenemia. Results of serologic tests for EBV were positive. Results of a skin biopsy indicated EBV-positive NK/T-cell lymphoma, and bone marrow aspiration revealed focal hemophagocytosis and atypical lymphoid cells.

Diagnosis:

On the basis of these findings, we diagnosed the case as extra-nodal NK/T-cell lymphoma-associated HPS (natural killer/T-cell lymphoma-associated hemophagocytic syndrome), which is commonly induced by CAEBV.

Interventions:

Treatment consisted of general management of hepatitis, supplemented with albumin and empirical antibiotic therapy.

Outcomes:

The patient died from massive gastrointestinal hemorrhage a week after she was discharged from the hospital.

Lessons:

ENKL and HPS present with varied features and are generally fatal; therefore, clinicians should proceed with caution in suspected cases. HPS should be considered when the patient presents with fever, hepatosplenomegaly, pancytopenia, and liver failure. When HPS is suspected, clinicians should determine the underlying cause, such as severe infection, including infection with viruses such as EBV; genetic predisposition; or underlying malignancies, especially lymphoma because of its strong association with HPS.

FULL TEXT

http://journals.lww.com/md-journal/Fulltext/2017/05120/Chronic_active_Epstein_Barr_virus_infection.38.aspx

PDF (download haciendo CLIC en “Article as PDF”)

 

May 12, 2017 at 3:35 pm

Quantification of circulating Mycobacterium tuberculosis antigen peptides allows rapid diagnosis of active disease and treatment monitoring.

Proc Natl Acad Sci USA. Apr 11, 2017 V.114 N.15 P.3969-3974.

Liu C1,2,3, Zhao Z4, Fan J1,3, Lyon CJ1,3, Wu HJ1,5, Nedelkov D6, Zelazny AM4, Olivier KN7, Cazares LH8, Holland SM9, Graviss EA10, Hu Y11,2,3.

Author information

1 Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX 77030.

2 School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ 85287.

3 Virginia G. Piper Biodesign Center for Personalized Diagnostics, The Biodesign Institute, Arizona State University, Tempe, AZ 85287.

4 Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD 20892.

5 Department of Chemical Engineering, Texas A&M University, College Station, TX 77843.

6 Molecular Biomarkers Laboratory, The Biodesign Institute, Arizona State University, Tempe, AZ 85287.

7 Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute, Bethesda, MD 20892.

8 Molecular and Translational Sciences, US Army Medical Research Institute of Infectious Diseases, Frederick, MD 21702.

9 Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD 20892.

10 Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX 77030.

11 Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX 77030; tyhu@asu.edu.

Abstract

Tuberculosis (TB) is a major global health threat, resulting in an urgent unmet need for a rapid, non-sputum-based quantitative test to detect active Mycobacterium tuberculosis (Mtb) infections in clinically diverse populations and quickly assess Mtb treatment responses for emerging drug-resistant strains. We have identified Mtb-specific peptide fragments and developed a method to rapidly quantify their serum concentrations, using antibody-labeled and energy-focusing porous discoidal silicon nanoparticles (nanodisks) and high-throughput mass spectrometry (MS) to enhance sensitivity and specificity. NanoDisk-MS diagnosed active Mtb cases with high sensitivity and specificity in a case-control study with cohorts reflecting the complexity of clinical practice. Similar robust sensitivities were obtained for cases of culture-positive pulmonary TB (PTB; 91.3%) and extrapulmonary TB (EPTB; 92.3%), and the sensitivities obtained for culture-negative PTB (82.4%) and EPTB (75.0%) in HIV-positive patients significantly outperformed those reported for other available assays. NanoDisk-MS also exhibited high specificity (87.1-100%) in both healthy and high-risk groups. Absolute quantification of serum Mtb antigen concentration was informative in assessing responses to antimycobacterial treatment. Thus, a NanoDisk-MS assay approach could significantly improve the diagnosis and management of active TB cases, and perhaps other infectious diseases as well.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5393254/pdf/pnas.201621360.pdf

May 11, 2017 at 11:28 am

Powassan Virus Disease in an Infant – Connecticut, 2016.

MMWR Morb Mortal Wkly Rep. Apr 21, 2017 V.66 N.15 P.408-409.

Notes from the Field:

Tutolo JW, Staples JE, Sosa L, Bennett N.

PDF

https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6615a3.pdf

May 11, 2017 at 11:20 am

Guidelines – Recommendations on hepatitis C screening for adults

Canadian Medical Journal Association April 24, 2017 V.189 N.16

Canadian Task Force on Preventive Health Care

An estimated 0.64%–0.71% of Canadians (220 000–245 000 people) have chronic hepatitis C virus (HCV) infection,1 and approximately 44%2 of those may be undiagnosed. HCV can be transmitted directly through percutaneous exposure (e.g., through inadequately sterilized medical equipment) or through receipt of contaminated blood products.3 People who inject drugs are at highest risk, but recipients of unscreened blood products, tissues or organs and patients undergoing long-term hemodialysis are also at increased risk.3 Less common modes of transmission include vertical transmission, high-risk sexual contact, unsterilized tattoo or piercing equipment, and occupational exposure.3 Not all people with chronic HCV infection will develop cirrhosis or signs or symptoms indicative of liver disease.4 It is estimated that approximately 84% of people infected with HCV do not develop cirrhosis 20 years after acute infection, and 59% after 30 years.5,6 Progression of liver fibrosis is variable and influenced by factors such as alcohol consumption, age at time of infection, male sex and HIV coinfection.7

PDF

http://www.cmaj.ca/content/189/16/E594.full.pdf+html

May 9, 2017 at 3:35 pm

Sexually acquired Zika virus: a systematic review

Clinical Microbiology and Infection May 2017 V.23 N.5

Moreira, T.M. Peixoto, A.M. Siqueira, C.C. Lamas

1) Instituto Nacional de Infectologia Evandro Chagas, Fundaçao Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil ~

2) Universidade do Grande Rio (Unigranrio), Rio de Janeiro, Brazil

3) Unidade de pesquisa cardiovascular, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil

Background:

Zika virus (ZIKV) is transmitted to humans primarily by Aedes mosquito bites. However, circumstantial evidence points to a sexual transmission route.

Objectives:

To assess the sexually acquired ZIKV cases and to investigate the shedding of ZIKV in genital fluids.

Data sources:

PubMed, Scopus, Pro-MED-mail and WHO ZIKV notification databases from inception to December 2016.

Selection criteria:

Reports describing ZIKV acquisition through sex and studies reporting the detection or isolation of ZIKV in the genital fluids were included.

Risk-of-bias assessment:

The risk of bias was assessed using the National Institute of Health Tool.

Results:

Eighteen studies reporting on sex-acquired ZIKV and 21 describing the presence of ZIKV in genital fluids were included. The overall risk of bias was moderate. Sexual transmission was male efemale (92.5%), femaleemale (3.7%) and maleemale (3.7%). Modes of sexual transmission were unprotected vaginal (96.2%), oral (18.5%) and anal (7.4%) intercourse. The median time between onset of symptoms in the index partner and presumed sexual transmission was 13 days (range 4e44 days). ZIKV RNA was detected in semen as late as 188 days (range 3e188 days) following symptom onset, and infectious virus was isolated in semen up to 69 days after symptom onset. No study reported ZIKV isolation from female genital samples, but detection did occur up to 13 days after symptom onset.

Conclusions:

ZIKV is potentially sexually transmitted and persists in male genital secretions for a prolonged period after symptom onset

PDF

http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)30659-0/pdf

May 9, 2017 at 8:26 am

Real-Time Electronic Tracking of Diarrheal Episodes and Laxative Therapy Enables Verification of Clostridium difficile Clinical Testing Criteria and Reduction of Clostridium difficile Infection Rates

Journal of Clinical Microbiology May 2017 V.55 N.5 P.1276-1284

Cynthia Y. Truong, Saurabh Gombar, Richard Wilson, Gopalakrishnan Sundararajan, Natasa Tekic, Marisa Holubar, John Shepard, Alexandra Madison, Lucy Tompkins, Neil Shah, Stan Deresinski, Lee F. Schroeder, and Niaz Banaei

aDepartment of Pathology, Stanford University School of Medicine, Stanford, California, USA

bDigital Solutions, Stanford Health Care, Stanford, California, USA

cDivision of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA

dInfection Control and Prevention, Stanford Health Care, Stanford, California, USA

eStanford Antimicrobial Safety and Sustainability, Stanford Health Care, Stanford, California, USA

fDepartment of Pathology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA

gClinical Microbiology Laboratory, Stanford Health Care, Stanford, California, USA

Health care-onset health care facility-associated Clostridium difficile infection (HO-CDI) is overdiagnosed for several reasons, including the high prevalence of C. difficile colonization and the inability of hospitals to limit testing to patients with clinically significant diarrhea. We conducted a quasiexperimental study from 22 June 2015 to 30 June 2016 on consecutive inpatients with C. difficile test orders at an academic hospital. Real-time electronic patient data tracking was used by the laboratory to enforce testing criteria (defined as the presence of diarrhea [≥3 unformed stools in 24 h] and absence of laxative intake in the prior 48 h). Outcome measures included C. difficile test utilization, HO-CDI incidence, oral vancomycin utilization, and clinical complications. During the intervention, 7.1% (164) and 9.1% (211) of 2,321 C. difficile test orders were canceled due to absence of diarrhea and receipt of laxative therapy, respectively. C. difficile test utilization decreased upon implementation from an average of 208.8 tests to 143.0 tests per 10,000 patient-days (P < 0.001). HO-CDI incidence rate decreased from an average of 13.0 cases to 9.7 cases per 10,000 patient-days (P = 0.008). Oral vancomycin days of therapy decreased from an average of 13.8 days to 9.4 days per 1,000 patient-days (P = 0.009). Clinical complication rates were not significantly different in patients with 375 canceled orders compared with 869 episodes with diarrhea but negative C. difficile results. Real-time electronic clinical data tracking is an effective tool for verification of C. difficile clinical testing criteria and safe reduction of inflated HO-CDI rates.

PDF

http://jcm.asm.org/content/55/5/1276.full.pdf+html

May 9, 2017 at 8:23 am

Commentaries – Strategies for Optimizing the Diagnostic Predictive Value of Clostridium difficile Molecular Diagnostics

Journal of Clinical Microbiology May 2017 V.55 N.5 P.1244-1248

Larry K. Kociolek

Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Division of Infectious Diseases, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA

Because nucleic acid amplification tests (NAATs) do not distinguish Clostridium difficile infection (CDI) and asymptomatic C. difficile carriage, the diagnostic predictive value of NAATs is limited when used in patients with a low probability of CDI. In this issue of the Journal of Clinical Microbiology, Truong et al. (J. Clin. Microbiol., 55:1276–1284, 2017, https://doi.org/10.1128/JCM.02319-16) report significant reductions in hospital-onset CDI and oral vancomycin utilization at their institution following implementation of a novel intervention that leveraged their clinical bioinformatics resources to prevent C. difficile testing of stools from patients without clinically significant diarrhea and in patients with recent laxative use….

PDF

http://jcm.asm.org/content/55/5/1244.full.pdf+html

May 9, 2017 at 8:22 am

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