Posts filed under ‘Micobacterias’

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

Concentration-Dependent Antagonism and Culture Conversion in Pulmonary Tuberculosis

Clin Inf Dis May 15, 2017 V.64 N.10

Neesha Rockwood; Jotam G. Pasipanodya; Paolo Denti; Frederick Sirgel; Maia Lesosky

The relationship between drug concentrations, minimum inhibitory concentrations, and sputum culture conversion in tuberculosis is unclear. We identified concentration-dependent antagonism between isoniazid and rifampicin that was associated with poorer 2-month sputum conversion.

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/cid/64/10/10.1093_cid_cix158/2/cix158.pdf?Expires=1494188795&Signature=TeTh9nAC4CxyRjW-XRWYyEgZQgrkAXh3bcVJvUvSPB-JgDO4OxZ-uZ08IyqLaNonrvSJNc75eAR-InIa7LvO9tI2~jQX2gRjY8wsnR6ZyhcwNrb2pYlRGE4C1mRh3UINsfF4vEADoUKGNwG1bBYfCeT-ymbqVDacJtRReXMhX1NJrSLyq8ie8KNdBBmhkJAFF86LiGnJEiQLpwRei~eNdyVZhOQQzetL0dVwcZnXLHmPyO9Z4dF-uW0U~LZVkpG8~L4-iMlT07~WZHvbYr~TB3KILDi5bhY1x2b-JBU1z~MRqkEK0NqIFRaxwWOssktJYqpPibUt9TJw6jHBbKQVdA__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

May 6, 2017 at 3:53 pm

World Health Organization treatment guidelines for drug-resistant tuberculosis, 2016 update

European Respiratory Journal March 2017 V.49 N.3

Dennis Falzon, Holger J. Schünemann, Elizabeth Harausz, Licé González-Angulo, Christian Lienhardt, Ernesto Jaramillo, and Karin Weyer

Antimicrobial resistance is a major global concern. Tuberculosis (TB) strains resistant to rifampicin and other TB medicines challenge patient survival and public health. The World Health Organization (WHO) has published treatment guidelines for drug-resistant TB since 1997 and last updated them in 2016 based on reviews of aggregated and individual patient data from published and unpublished studies. An international expert panel formulated recommendations following the GRADE approach. The new WHO guidelines recommend a standardised 9–12 months shorter treatment regimen as first choice in patients with multidrug- or rifampicin-resistant TB (MDR/RR-TB) strains not resistant to fluoroquinolones or second-line injectable agents; resistance to these two classes of core second-line medicines is rapidly detectable with molecular diagnostics also approved by WHO in 2016. The composition of longer regimens for patients ineligible for the shorter regimen was modified. A first-ever meta-analysis of individual paediatric patient data allowed treatment recommendations for childhood MDR/RR-TB to be made. Delamanid is now also recommended in patients aged 6–17 years. Partial lung resection is a recommended option in MDR/RR-TB care. The 2016 revision highlighted the continued shortage of high-quality evidence and implementation research, and reiterated the need for clinical trials and best-practice studies to improve MDR/RR-TB patient treatment outcomes and strengthen policy.

PDF

http://erj.ersjournals.com/content/erj/49/3/1602308.full.pdf

April 12, 2017 at 8:10 am

Neumonía adquirida en la comunidad – Guía práctica elaborada por un comité intersociedades

Medicina (B. Aires) Julio/Agosto 2003 V.63 N.4

Luna C. M.1, Calmaggi A.2, Caberloto O.1, Gentile J.2, Valentín R.1, 3, Ciruzzi J.1 , Clara L.2, Rizzo O.1, Lasdica S.1, 3, Blumenfeld M.2, Benchetrit G.2, Famiglietti A.4, ApezteguIa C.1, 3, Monteverde A.1 y Grupo Argentino de Estudio de la NAC

1 Asociación Argentina de Medicina Respiratoria (AAMR),

2 Sociedad Argentina de Infectología (SADI),

3 Sociedad Argentina de Terapia Intensiva (SATI),

4 Sociedad Argentina de Bacteriología Clínica (SADEBAC), Asociación Argentina de Microbiología (AAM),

5 Sociedad Argentina de Virología (SAV),

6 Sociedad Argentina de Medicina (SAM), Buenos Aires

Resumen

Las guías para neumonía adquirida en la comunidad (NAC) contribuyen a ordenar el manejo de los pacientes. La NAC presenta cambios en su etiología, epidemiología y sensibilidad a antibióticos que obligan a la revisión periódica de las guías. Un comité intersociedades elaboró esta guía dividida en tópicos y basada en guías y estudios clínicos recientes. La NAC afecta anualmente al 1% de la población; la mayoría de los pacientes requiere atención ambulatoria, en otros reviste gravedad (representa la 6ª causa de muerte en Argentina). La etiología es diferente si el paciente es ambulatorio, requiere internación en sala general o en terapia intensiva, pero no hay forma segura de predecirla clínicamente. Los predictores de mala evolución son: edad, antecedentes personales y comorbilidades y hallazgos del examen físico, del laboratorio y de la radiografía de tórax.  Entre 10 y 25% de los pacientes que se internan deben hacerlo en terapia intensiva para ventilación mecánica o soporte hemodinámico (NAC grave), tanto inicialmente como durante su evolución. Estos pacientes presentan alta mortalidad; algunos criterios ayudan a reconocerlos. Embarazo, EPOC e internación en institutos geriátricos requieren consideraciones especiales. El diagnóstico es clínico, los métodos complementarios ayudan a determinar la etiología y la gravedad: la radiografía de tórax debe practicarse en todos los pacientes; el resto de los estudios están indicados en internados. El tratamiento inicial es empírico y debe iniciarse precozmente usando antibióticos activos frente a los gérmenes blanco, evitando el uso inapropiado que induce el desarrollo de resistencias. El tratamiento no debe prolongarse innecesariamente. Hidratación, nutrición, oxígeno y el manejo de las complicaciones complementan al tratamiento antibiótico. La prevención se basa en la profilaxis antinfluenza y antineumocóccica, evitar la aspiración y medidas generales.

PDF

http://www.scielo.org.ar/pdf/medba/v63n4/v63n4a09.pdf

March 22, 2017 at 3:46 pm

Prosthetic Joint Infection due to Mycobacterium avium-intracellulare in a Patient with Rheumatoid Arthritis: A Case Report and Review of the Literature.

Case Rep Infect Dis. 2017;2017:8682354. doi: 10.1155/2017/8682354. Epub 2017 Feb 9.

Ingraham NE1, Schneider B2, Alpern JD3.

Author information

1 Department of Internal Medicine, University of Minnesota, Minneapolis, MN, USA.

2 Department of Internal Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.

3 Department of Infectious Disease, University of Minnesota, Minneapolis, MN, USA.

Abstract

Nontuberculous mycobacteria (NTM) are a rare cause of prosthetic joint infections (PJI). However, the prevalence of NTM infections may be increasing with the rise of newer immunosuppressive medications such as biologics. In this case report, we describe a rare complication of immunosuppressive therapies and highlight the complexity of diagnosing and treating PJI due to NTM. The patient is a 79-year-old Caucasian male with a history of severe destructive rheumatoid arthritis on several immunosuppressive agents and right hip osteoarthritis s/p total hip arthroplasty 15 years previously with several complex revisions, presenting with several weeks of worsening right hip and abdominal pain. A right hip CT scan revealed periprosthetic fluid collections. Aspiration of three fluid pockets was AFB smear-positive and grew Mycobacterium avium-intracellulare. The patient was deemed a poor surgical candidate. He underwent a limited I&D and several months of antimycobacterial therapy but clinically deteriorated and opted for hospice care. PJI caused by NTM are rare and difficult to treat. The increased use of biologics and prosthetic joint replacements over the past several decades may increase the risk of PJI due to NTM. A high index of suspicion for NTM in immunosuppressed patients with PJI is needed.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5322427/pdf/CRIID2017-8682354.pdf

March 18, 2017 at 10:42 am

Mycobacterium goodii: A Case Report and Review of the Literature

Infectious Diseases in Clinical Practice March 2017 V.25 N.2 P.62-65

Salas, Natalie Mariam; Klein, Nicole

Mycobacterium goodii, a rapidly growing nontuberculous mycobacterium, is an emerging pathogen in nosocomial infections.

Its inherent resistance patterns make it a challenging organism to treat, and delays in identification can lead to poor outcomes.

We present a case of cardiac device pocket infection with M. goodii, complicated by both antibiotic resistance and drug reactions that highlight the challenges faced by clinicians trying to eradicate these infections.

We also present a brief review of the English literature surrounding this disease, including a table of all reported cases of M. goodii infections and their outcomes to act as guide for clinicians formulating treatment plans for these infections.

A clear understanding of diagnostic methods and treatment caveats is essential to curing infections caused by these organisms.

PDF (CLIC on PDF)

 

February 28, 2017 at 5:05 pm

Guía de práctica clínica sobre el uso de las pruebas de liberación de interferón-γ para el diagnóstico de TBC

Enf Inf & Microb Clinica Mayo 2016 V.34 N.05 e1-e13

Consensus statement

Miguel Santin, José-María García-García, José Domínguez

a Service of Infectious Diseases, Bellvitge University Hospital-IDIBELL, Barcelona, Spain

b Department of Clinical Sciences, University of Barcelona, Barcelona, Spain

c Clinical Unit of Pneumology, Hospital San Agustín, Avilés, Asturias, Spain

d Service of Microbiology, Research Institute Trias i Pujol, Hospital Gremans Trias i Pujol, Barcelona, Spain

e Department of Genetics and Microbiology, Universidad Autónoma de Barcelona, Barcelona, Spain

f CIBER Respiratory Diseases, Madrid, Spain

Introducción

Las técnicas de detección in vitro de interferón-gamma (IGRA, del inglés interferon-gamma release assays) están ampliamente implantadas para el diagnóstico de infección tuberculosa en países de baja prevalencia. Sin embargo, no hay consenso sobre su aplicación. El objetivo fue desarrollar una guía de práctica clínica para el uso de los IGRA en los diferentes escenarios clínicos en España.

Métodos

Un grupo de expertos compuesto por especialistas en enfermedades infecciosas, enfermedades respiratorias, microbiología, pediatría y medicina preventiva, junto con un metodólogo formularon las preguntas clínicas y los desenlaces de interés, llevaron a cabo una búsqueda sistemática de la literatura, sintetizaron la evidencia y graduaron su calidad, y formularon las recomendaciones siguiendo la metodología Grading of Recommendations of Assessment Development and Evaluations (GRADE).

Resultados

El grupo de trabajo formuló las recomendaciones sobre el uso de los IGRA para el diagnóstico de infección tuberculosa en el estudio de contactos (adultos y niños), trabajadores sanitarios, pacientes inmunosuprimidos (pacientes infectados por el virus de la inmunodeficiencia humana, pacientes afectos de enfermedades inflamatorias inmunomediadas candidatos a terapias biológicas y pacientes que requieren trasplante de órganos), y en el diagnóstico de enfermedad tuberculosa activa. La mayor parte de las recomendaciones fueron débiles, principalmente debido a la falta de evidencia de calidad para establecer un balance entre beneficios y daños de los IGRA en comparación con la prueba de la tuberculina.

Conclusión

Este documento proporciona una guía basada en la evidencia para el uso de los IGRA en el diagnóstico de infección tuberculosa en pacientes en riesgo de tuberculosis o con sospecha de enfermedad activa. Esta guía es aplicable en la atención especializada y primaria, y salud pública.

PDF

http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=90452011&pident_usuario=0&pcontactid=&pident_revista=28&ty=22&accion=L&origen=zonadelectura&web=www.elsevier.es&lan=en&fichero=28v34n05a90452011pdf001.pdf

 

February 11, 2017 at 7:21 pm

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