Posts filed under ‘REPORTS’

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

FIEBRE DE ORIGEN DESCONOCIDO EN PACIENTES INFECTADOS CON EL VIRUS DE LA INMUNODEFICIENCIA HUMANA

MEDICINA (Buenos Aires) 2000 V.60 N.5 P.623-630

SEBASTIAN A. MATHURIN, SERGIO LUPO, HECTOR O. ALONSO

Primera Cátedra de Clínica Médica y Terapéutica, Facultad de Ciencias Médicas, Universidad Nacional de Rosario; Hospital Provincial del Centenario, Rosario

La fiebre de origen desconocido (FOD) es frecuente en pacientes infectados por el HIV. Existen numerosas causas que pueden originar FOD y su frecuencia relativa depende de múltiples factores. Usualmente se debe a una infección oportunista agregada.

La evaluación diagnóstica depende de la presentación clínica y del estadio de la infección por HIV. Existe una asociación entre el recuento de linfocitos CD4 y ciertas enfermedades oportunistas que pueden originar FOD.

El área geográfica y la prevalencia local de infecciones endémicas es un factor importante. Las infecciones de distribución mundial como la tuberculosis siempre deben ser consideradas y otras como la histoplasmosis diseminada son causa frecuente de FOD en áreas endémicas como la Argentina.

La mayor utilidad diagnóstica se obtiene con los cultivos de esputo y hemocultivos para micobacterias, y entre los métodos invasivos con cultivos a partir de la aspiración/biopsia de ganglio linfático, la biopsia de médula ósea y la biopsia hepática.

La eficacia del tratamiento empírico ha sido documentada en ciertas infecciones.

FULL TEXT

http://www.medicinabuenosaires.com/revistas/vol60-00/5-1/fiebredeorigen.htm

November 21, 2017 at 8:34 am

HIV-1 persistence following extremely early initiation of antiretroviral therapy (ART) during acute HIV-1 infection: An observational study.

PLoS Med November 7, 2017 V.14 P.e1002417.

Henrich TJ et al.

Abstract

Background

It is unknown if extremely early initiation of antiretroviral therapy (ART) may lead to long-term ART-free HIV remission or cure. As a result, we studied 2 individuals recruited from a pre-exposure prophylaxis (PrEP) program who started prophylactic ART an estimated 10 days (Participant A; 54-year-old male) and 12 days (Participant B; 31-year-old male) after infection with peak plasma HIV RNA of 220 copies/mL and 3,343 copies/mL, respectively. Extensive testing of blood and tissue for HIV persistence was performed, and PrEP Participant A underwent analytical treatment interruption (ATI) following 32 weeks of continuous ART.

Methods and findings

Colorectal and lymph node tissues, bone marrow, cerebral spinal fluid (CSF), plasma, and very large numbers of peripheral blood mononuclear cells (PBMCs) were obtained longitudinally from both participants and were studied for HIV persistence in several laboratories using molecular and culture-based detection methods, including a murine viral outgrowth assay (mVOA). Both participants initiated PrEP with tenofovir/emtricitabine during very early Fiebig stage I (detectable plasma HIV-1 RNA, antibody negative) followed by 4-drug ART intensification. Following peak viral loads, both participants experienced full suppression of HIV-1 plasma viremia. Over the following 2 years, no further HIV could be detected in blood or tissue from PrEP Participant A despite extensive sampling from ileum, rectum, lymph nodes, bone marrow, CSF, circulating CD4+ T cell subsets, and plasma. No HIV was detected from tissues obtained from PrEP Participant B, but low-level HIV RNA or DNA was intermittently detected from various CD4+ T cell subsets. Over 500 million CD4+ T cells were assayed from both participants in a humanized mouse outgrowth assay. Three of 8 mice infused with CD4+ T cells from PrEP Participant B developed viremia (50 million input cells/surviving mouse), but only 1 of 10 mice infused with CD4+ T cells from PrEP Participant A (53 million input cells/mouse) experienced very low level viremia (201 copies/mL); sequence confirmation was unsuccessful. PrEP Participant A stopped ART and remained aviremic for 7.4 months, rebounding with HIV RNA of 36 copies/mL that rose to 59,805 copies/mL 6 days later. ART was restarted promptly. Rebound plasma HIV sequences were identical to those obtained during acute infection by single-genome sequencing. Mathematical modeling predicted that the latent reservoir size was approximately 200 cells prior to ATI and that only around 1% of individuals with a similar HIV burden may achieve lifelong ART-free remission. Furthermore, we observed that lymphocytes expressing the tumor marker CD30 increased in frequency weeks to months prior to detectable HIV-1 RNA in plasma. This study was limited by the small sample size, which was a result of the rarity of individuals presenting during hyperacute infection.

Conclusions

We report HIV relapse despite initiation of ART at one of the earliest stages of acute HIV infection possible. Near complete or complete loss of detectable HIV in blood and tissues did not lead to indefinite ART-free HIV remission. However, the small numbers of latently infected cells in individuals treated during hyperacute infection may be associated with prolonged ART-free remission.

FULL TEXT

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002417

PDF

http://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1002417&type=printable

 

 

November 21, 2017 at 7:27 am

Diagnostic Accuracy of PCR Alone and Compared to Urinary Antigen Testing for Detection of Legionella spp.-Systematic Review.

J Clin Microbiol. 2016 Feb;54(2):401-11.

Avni T1, Bieber A2, Green H2, Steinmetz T2, Leibovici L2, Paul M3.

Author information

1 Medicine E, Beilinson Hospital and Sackler Faculty of Medicine, Tel-Aviv University, Israel tomerav@clalit.org.il

2 Medicine E, Beilinson Hospital and Sackler Faculty of Medicine, Tel-Aviv University, Israel.

3 Infectious Diseases Unit, Rambam Medical Center and Rappaport Faculty of Medicine, Tehnion, Israel Institute of Technology, Haifa, Israel.

Abstract

The diagnosis of Legionnaires’ disease (LD) is based on the isolation of Legionella spp., a 4-fold rise in antibodies, a positive urinary antigen (UA), or direct immunofluorescence tests. PCR is not accepted as a diagnostic tool for LD. This systematic review assesses the diagnostic accuracy of PCR in various clinical samples with a direct comparison versus UA. We included prospective or retrospective cohort and case-control studies. Studies were included if they used the Centers for Disease Control and Prevention consensus definition criteria of LD or a similar one, assessed only patients with clinical pneumonia, and reported data for all true-positive, false-positive, true-negative, and false-negative results. Two reviewers abstracted data independently. Risk of bias was assessed using Quadas-2. Summary sensitivity and specificity values were estimated using a bivariate model and reported with a 95% confidence interval (CI). Thirty-eight studies were included. A total of 653 patients had confirmed LD, and 3,593 patients had pneumonia due to other pathogens. The methodological quality of the studies as assessed by the Quadas-2 tool was poor to fair. The summary sensitivity and specificity values for diagnosis of LD in respiratory samples were 97.4% (95% CI, 91.1% to 99.2%) and 98.6% (95% CI, 97.4% to 99.3%), respectively. These results were mainly unchanged by any covariates tested and subgroup analysis. The diagnostic performance of PCR in respiratory samples was much better than that of UA. Compared to UA, PCR in respiratory samples (especially in sputum samples or swabs) revealed a significant advantage in sensitivity and an additional diagnosis of 18% to 30% of LD cases. The diagnostic performance of PCR in respiratory samples was excellent and preferable to that of the UA. Results were independent on the covariate tested. PCR in respiratory samples should be regarded as a valid tool for the diagnosis of LD.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4733173/pdf/zjm401.pdf

November 20, 2017 at 11:32 am

High Rate of MCR-1–Producing Escherichia coli and Klebsiella pneumoniae among Pigs, Portugal

Emerging Infectious Diseases December 2017 V.23 N.12 P.2023-2029

Research

Nicolas Kieffer, Marta Aires-de-Sousa, Patrice Nordmann, and Laurent Poirel

Author affiliations: Université de Fribourg, Fribourg, Switzerland (N. Kieffer, P. Nordmann, L. Poirel); Escola Superior de Saúde da Cruz Vermelha Portuguesa, Lisbon, Portugal (M. Aires-de-Sousa); University of Lausanne and University Hospital Centre, Lausanne, Switzerland (P. Nordmann)

The mcr-1 (mobile colistin resistance 1) gene, which encodes phosphoethanolamine transferase, has been recently identified as a source of acquired resistance to polymyxins in Escherichia coli.

Using the SuperPolymyxin selective medium, we prospectively screened 100 pigs at 2 farms in Portugal for polymyxin-resistant Enterobacteriaceae and recovered 98 plasmid-mediated MCR-1–producing isolates.

Most isolates corresponded to nonclonally related E. coli belonging to many sequence types; we also found 2 Klebsiella pneumoniae sequence types. The mcr-1 gene was carried on IncHI2 or IncP plasmid backbones.

Our finding of a high rate of MCR-1 producers on 2 pig farms in Portugal highlights the diffusion of that colistin-resistance determinant at the farm level.

The fact that the pigs received colistin as metaphylaxis in their feed during the 6 weeks before sampling suggests selective pressure.

PDF

https://wwwnc.cdc.gov/eid/article/23/12/pdfs/17-0883.pdf

November 19, 2017 at 1:02 pm

LEPTOSPIROSIS – Guia para el Equipo de Salud – Ministerio Salud de la Nación Argentina

LEPTOSPIROSIS 

Guia para el Equipo de Salud – Ministerio Salud de la Nación Argentina

Abril 2014

  1. Introducción
  2. Manifestaciones clínicas
  3. ¿Cuándo sospechar leptospirosis?
  4. ¿Cómo confirmar leptospirosis?
  5. ¿Cómo notificar el caso de leptospirosis?
  6. ¿Cómo se trata el paciente con leptospirosis?
  7. Flujograma de manejo de casos sospechosos de leptospirosis
  8. Diagnóstico diferencial
  9. ¿Qué hacer si se confirma?
  10. ¿Cómo se tratan los casos caninos de leptospirosis?
  11. Prevención de la leptospirosis en la familia y la comunidad

PDF

http://www.msal.gob.ar/images/stories/bes/graficos/0000000489cnt-guia-medica-leptospirosis.pdf

November 18, 2017 at 10:05 am

LEPTOSPIROSIS – Puesta al día

Revista Chilena de Infectología Junio 2007 V.24 N.3 P.220-226

Zunino, P. Pizarro

We review epidemiological, clinical, laboratory and therapeutic aspects of leptospirosis. In relation to the epidemiology it is worth noting the importance of recreational and occupational risk factors, as well as the lack of date available in Chile before the year 2000, when leptospirosis became the object of epidemiological surveillance. There are many forms of clinical presentations for this disease and often signs and symptoms may be nonspecific. Thus, differential diagnosis must include many clinical entities. Laboratory diagnosis, on the other hand, is complex and not widely available. Although still controversial, a literature review supports antimicrobial treatment, with different antibiotics to choose from.

PDF

http://www.scielo.cl/pdf/rci/v24n3/art08.pdf

November 18, 2017 at 10:04 am

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