Posts filed under ‘Micobacterias’

Fiebre de origen desconocido en pacientes HIV positivos

ANALES DE MEDICINA INTERNA (Madrid), 2001 V.18 N.4 P.181-186

BARBA, J. GÓMEZ-RODRIGO, J. MARCO, P. RONDÓN, G. EROLES,

LÓPEZ-VARAS, R. TORRES

Departamento de Medicina Interna y Enfermedades Infecciosas. Hospital Severo Ochoa.

Leganés. Madrid

RESUMEN

Objetivos

Describir la presentación clínica y la utilidad de los de tests diagnósticos habitualmente recomendados en el estudio de la fiebre de origen desconocido (FOD) en los pacientes VIH positivos.

Pacientes y métodos

Incluimos en el estudio a los 54 pacientes con infección por el VIH que ingresaron en nuestro Hospital por FOD durante un periodo de 23 meses. La FOD fue definida de acuerdo con los criterios modificados de Petersdorf´s.

Resultados

La causa de la fiebre se identificó en 48 casos (89%). La tuberculosis, la micobacteriosis atípica y la leishmaniasis pueden explicar el 68% de los casos. El aspirado de médula ósea, la punción aspiración o la biopsia de los ganglios linfáticos y los cultivos para micobacterias fueron las pruebas diagnósticas más rentables.

Conclusiones

La infección por micobacterias debe ser el primer diagnóstico de sospecha en los pacientes VIH positivos con FOD. Es posible precedir el diagnóstico de tuberculosis con una alta precisión (90,5%) con un modelo de regresión logística basado en datos clínicos y analíticos fácilmente obtenibles.

PDF

http://scielo.isciii.es/pdf/ami/v18n4/original2.pdf

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November 21, 2017 at 8:41 am

2017-09 Antibacterial agents in clinical development – An analysis of the antibacterial clinical development pipeline, including tuberculosis. OMS 45 pags

Contents:

Acknowledgements

Abbreviations and acronyms

Executive summary

  1. Introduction
  2. Methods and search results

2.1 Scope and inclusion criteria

2.2 Assessment of activity against priority pathogens and innovativeness

  1. Agents in clinical development

3.1 Antibiotics potentially active against pathogens on the WHO priority  pathogens list

3.2 Combinations without new chemical entities

3.3 Agents in development for treating tuberculosis

3.4 Agents in development for treating Clostridium difficile infections

3.5 Biological agents

3.6 Agents that are not under active development or for which there is no  recent information

  1. Analysis of the clinical pipeline
  2. Outlook and discussion

5.1 The current clinical pipeline is insufficient against pathogens on the  WHO priority pathogens list and TB.

5.2 More innovative approaches are required, but there are scientific  challenges.

5.3 Outlook: More work is required to fill the pipeline.

5.4 Methodological considerations

  1. References

Annex 1. Search strategy and results

Annex 2. Declarations of interests of advisory group members

PDF

http://apps.who.int/iris/bitstream/10665/258965/1/WHO-EMP-IAU-2017.11-eng.pdf

 

September 22, 2017 at 8:03 am

Mycobacterial Osteomyelitis of the Spine Following Intravesical BCG Therapy for Bladder Cancer.

Cureus. 2016 Mar 26;8(3):e545.                                                 

Mackel CE1, Burke SM1, Huhta T1, Riesenburger R1, Weller SJ1.

Author information

1 Department of Neurosurgery, Tufts University School of Medicine/Tufts Medical Center.

Abstract

Osteomyelitis is an infection of the bone that can involve the vertebral column.

A rare cause of vertebral osteomyelitis is Mycobacterium bovis after intravesical Bacillus Calmette-Guerin (BCG) therapy for transitional cell carcinoma of the bladder.

In this report, we describe the case of a 64-year-old male presenting with constitutional symptoms, progressive thoracic kyphosis, and intractable T11 and T12 radiculopathies over the proceeding six months. A CT scan revealed erosive, lytic changes of the T12 and L1 vertebrae with compression of the T12 vertebra.

An MRI demonstrated T11-12 osteomyelitis with intervening discitis and extensive paraspinal enhancement with a corresponding hyperintensity on a short tau inversion recovery (STIR) sequence.

A needle aspiration grew out Mycobacterial tuberculosis complex that was pansensitive to all antimicrobial agent therapies, except pyrazinamide on culture, a finding consistent with an M. bovis infection.

The patient’s infection and neurologic compromise resolved after transthoracic T11-12 vertebrectomies with decompression of the spinal cord and nerve roots as well as T10-L1 instrumented fusion and protracted antimicrobial therapy.

The epidemiology and natural history of M. bovis osteomyelitis are reviewed and the authors emphasize a mechanism of vertebral inoculation to explain the predilection of M. bovis osteomyelitis in males after intravesical BCG therapy

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4846392/pdf/cureus-0008-000000000545.pdf

July 1, 2017 at 4:28 pm

Mycobacterium bovis Osteomyelitis of the Thoracic Spine Mimicking a Metastatic Lytic Lesion in a Patient Exposed to Intravesicular Bacille Calmette-Guérin Treatment.

Urol Case Rep. 2014 Jul 2;2(4):142-4.                                

Newman JR1, Clough LA1, Merino F1.

Author information

1 Division of Infectious Diseases, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA.

Abstract

An 80-year-old man with previous intravesicular bacille Calmette-Guérin therapy developed mass lesions of the lower thoracic spine. Metastatic disease was suspected.

The patient underwent a course of radiation; however, biopsy later demonstrated fibrosis and cultures grew Mycobacterium bovis.

The patient was treated with a course of isoniazid, rifampin, and ethambutol.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4735490/pdf/main.pdf

July 1, 2017 at 4:26 pm

The Incremental Value of Repeated Induced Sputum and Gastric Aspirate Samples for the Diagnosis of Pulmonary Tuberculosis in Young Children With Acute Community-Acquired Pneumonia

Clinical Infectious Diseases June 15, 2017 V.64 Suppl.3

David P. Moore; Melissa M. Higdon; Laura L. Hammitt; Christine Prosperi; Andrea N. DeLuca …

Background.

Mycobacterium tuberculosis (Mtb) contributes to the pathogenesis of childhood acute community-acquired pneumonia in settings with a high tuberculosis burden. The incremental value of a repeated induced sputum (IS) sample, compared with a single IS or gastric aspirate (GA) sample, is not well known.

Methods.

Two IS samples were obtained for Mtb culture from children enrolled as cases in the Pneumonia Etiology Research for Child Health (PERCH) study in South Africa. Nonstudy attending physicians requested GA if pulmonary tuberculosis was clinically suspected. We compared the Mtb yield of 2 IS samples to that of 1 IS sample and GA samples.

Results. 

Twenty-seven (3.0%) culture-confirmed pulmonary tuberculosis cases were identified among 906 children investigated with IS and GA samples for Mtb. Results from 2 IS samples were available for 719 children (79.4%). Of 12 culture-confirmed pulmonary tuberculosis cases identified among children with ≥2 IS samples, 4 (33.3%) were negative at the first IS sample. In head-to-head comparisons among children with both GA and IS samples collected, the yield of 1 GA sample (8 of 427; 1.9%) was similar to that of 1 IS sample (5 of 427, 1.2%), and the yield of 2 GA samples (10 of 300; 3.3%) was similar to that of 2 IS samples (5 of 300; 1.7%). IS samples identified 8 (42.1%) of the 19 culture-confirmed pulmonary tuberculosis cases that were identified through submission of IS and GA samples.

Conclusions.

A single IS sample underestimated the presence of Mtb in children hospitalized with severe or very severe pneumonia. Detection of Mtb is enhanced by combining 2 IS with GA sample collections in young children with acute severe pneumonia.

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/cid/64/suppl_3/10.1093_cid_cix099/5/cix099.pdf?Expires=1496600320&Signature=TIU6uc3Nu6l6ejBHfTFTMUROvfJ~1SStsVfbKHmeyh1GMGo4ekp42a-5IcoWiUswnp4DGES3~Ap5827LjXY6e0UjwS7Z0wYH8yUfjkYIg12zw09zDtXluMyr3c8HFx7L1b6vBYhbIqmQ1jAjHnhfk97cuCPlAmMJ685z16REmbHCEfLKZOMq2lQNAHeq4oeatp1aJNrBoGcfUNsjLGWTMGTWAA3LF7UgH0k0LXYeXvPtDW5feEPhi4C6-ugyTHzcvLmgXcBT0R4-zo0MV0mG0IBgj46V5TNcRjWFlWHMfU~689jWM3vDGOZqdU5tO83kxnGw4IefWgdH7WCqQS8CNQ__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

 

June 3, 2017 at 2:31 pm

Rifabutin Is Active against Mycobacterium abscessus Complex

Antimicrob. Agents Chemother. June 2017 V.61 N.6

Dinah Binte Aziz, Jian Liang Low, Mu-Lu Wu, Martin Gengenbacher, Jeanette W. P. Teo, Véronique Dartois, and Thomas Dick

aDepartment of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore

bDepartment of Laboratory Medicine, National University Hospital, Singapore

cPublic Health Research Institute, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey, USA

Lung infections caused by Mycobacterium abscessus are emerging as a global threat to individuals with cystic fibrosis and to other patient groups. Recent evidence for human-to-human transmission worsens the situation. M. abscessus is an intrinsically multidrug-resistant pathogen showing resistance to even standard antituberculosis drugs, such as rifampin. Here, our objective was to identify existing drugs that may be employed for the treatment of M. abscessus lung disease. A collection of more than 2,700 approved drugs was screened at a single-point concentration against an M. abscessus clinical isolate. Hits were confirmed with fresh solids in dose-response experiments. For the most attractive hit, growth inhibition and bactericidal activities against reference strains of the three M. abscessus subspecies and a collection of clinical isolates were determined. Surprisingly, the rifampin derivative rifabutin had MICs of 3 ± 2 μM (3 μg/ml) against the screening strain, the reference strains M. abscessus subsp. abscessus ATCC 19977, M. abscessus subsp. bolletii CCUG 50184-T, and M. abscessus subsp. massiliense CCUG 48898-T, as well as against a collection of clinical isolates. Furthermore, rifabutin was active against clarithromycin-resistant strains. In conclusion, rifabutin, in contrast to rifampin, is active against the Mycobacterium abscessus complex bacteria in vitro and may be considered for treatment of M. abscessus lung disease.

PDF

http://aac.asm.org/content/61/6/e00155-17.full.pdf+html

May 28, 2017 at 4:54 pm

An evaluation of automated chest radiography reading software for tuberculosis screening among public- and private-sector patients

Eur Respir J ERJ May 2017 V.49 N.5

Md Toufiq Rahman, Andrew J. Codlin, Md Mahfuzur Rahman, Ayenun Nahar, Mehdi Reja, Tariqul Islam, Zhi Zhen Qin, Md Abdus Shakur Khan, Sayera Banu, and Jacob Creswell

Computer-aided reading (CAR) of medical images is becoming increasingly common, but few studies exist for CAR in tuberculosis (TB). We designed a prospective study evaluating CAR for chest radiography (CXR) as a triage tool before Xpert MTB/RIF (Xpert).

Consecutively enrolled adults in Dhaka, Bangladesh, with TB symptoms received CXR and Xpert. Each image was scored by CAR and graded by a radiologist. We compared CAR with the radiologist for sensitivity and specificity, area under the receiver operating characteristic curve (AUC), and calculated the potential Xpert tests saved.

A total of 18 036 individuals were enrolled. TB prevalence by Xpert was 15%. The radiologist graded 49% of CXRs as abnormal, resulting in 91% sensitivity and 58% specificity. At a similar sensitivity, CAR had a lower specificity (41%), saving fewer (36%) Xpert tests. The AUC for CAR was 0.74 (95% CI 0.73–0.75). CAR performance declined with increasing age. The radiologist grading was superior across all sub-analyses.

Using CAR can save Xpert tests, but the radiologist’s specificity was superior. Differentiated CAR thresholds may be required for different populations. Access to, and costs of, human readers must be considered when deciding to use CAR software. More studies are needed to evaluate CAR using different screening approaches.

FULL TEXT

http://erj.ersjournals.com/content/49/5/1602159?etoc

PDF

http://erj.ersjournals.com/content/erj/49/5/1602159.full.pdf

May 27, 2017 at 8:36 am

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