Tuberculine reaction measured by infrared thermography

Setting: The infection with Mycobacterium tuberculosis gives a delayed immune response, measured by the tuberculine skin test. We present a new technique for evaluation based on automatic detection and measurement of skin temperature due to infrared emission.; Design: 34 subjects (46.8+/-16.9 years) (12/22, M/F) with suspected tuberculosis disease were examined with an IR thermal camera, 48h after tuberculin skin injection.; Results: In 20 subjects, IR analysis was positive for tuberculine test. Mean temperature of injection area was higher, around 1 degrees C, for the positive group (36.2+/-1.1 degrees C positive group; 35.1+/-1.6 degrees C negative group, p < 0.02 T test for unpaired groups).; Conclusion: IR image analysis achieves similar estimation of tuberculin reaction as the visual evaluation, based on higher temperature due to increased heat radiation from the skin lesion.Peer ReviewedPostprint (author's final draft

Nuevas técnicas diagnósticas de las enfermedades respiratorias : análisis de imagen

In the present thesis 3 detailed studies were carried out that spring from 3 different diagnostic techniques that include bronoscopy, tuberculine bacillus infection diagnosis, and the control of oxygen therapy in chronic patients. All three studies were based on image analysis. In the first study we applied ultrasound techniques through broncoscopy (EBUS) and evaluated the images of 12 malignant ganglios and 11 benign mediastine ones in patients suspected as having pulmonary neoplastic disease. A previous process was applied to improve the quality of the image and enhance their features. Morfologic and texture parameters were anaylized such as texture of the ultrasounds and fractal dimensión that express the relation between the area and the perimeter of the structures that appear in the image, as well as characteristics of internal structure convolucionated of the hiliary and mediastine structures. The fractal dimensión was lower in the malignant ganglios compared to non-malignant ones (1.47(0.09), 1.53(0.10) mean (SD), respectively, Mann Whitney U test p<0.005)). In conclusion the fractal dimensión of ultrasound images of the mediastine ganglios obtained through endobronquial ultrasound differ depending on whether they are benign or malignant. In the second study a new method of evaluation was implemented of the tuberculine skin reaction with an Infrared camera. In this study 34 subjects participated that had been in contact with people infected with the bacillus. (46.8± 16.9 years), (12/22 men/women). The test reading was performed by the standard exploratory method and after taking an image of the puncture site on the forearm, using an Infrared Fluke Camara (320x240) situated 40 cm above the forearm. The IR image was processed using conventional image processing techniques (Canny edge detection, Hough transformer). From the previously segmented regions the following parameters are extracted: Maximum temperature , mean and mínimum in Cº, surface area and diameter of the area of segmented reaction. Results: 3 areas of segmentation were established: Area 1, called "papule", area 2 "eritema" and area 3 "background". The differences in temp between areas 1 and 2 in the group with positive IR reaction were significant with a mean temp. difference of 0.45 Cº ( T Test, p<0.05). The difference between the mean temp. of the central area of both groups was 1.11 Cº (T Test, p<0.05). The regression coefficient between the diameter measured by examination was R=0.65, R2=0.42, ( p<0.001), in all subjects with a positive PPD. We can conclude that the tuberculine injection produces an inflammatory reaction that can be easily readed with a IR application. The third study yielded data regarding the effects that applied oxygen therapy over a short period to time has on the psychomotor status of patients with chronic hypoxemia. Eight patients (7 men and 1 woman, mean age 69.5 (9.9) years (mean SD) affected by Hypoxemia (Pa O2 62.2(6.9) mmHg, participated. They performed drawings: a house and a clock. The tests were undertaken before and after inhaling O2 during 30 minutes. Results: The speed of drawing increased after inhaling O2 while making the house drawing (speed 27.6(5.5) mm/s basal, 30.9(7.1) mm/s with O2, mean(SD), p<0.025, Wilcoxon Test). The drawing time "down" decreased (i.e. For the house; "down time" 20.7 (6.6) s basal, 17.4 (6.3) s with O2 , p<0.017, Wilcoxon Test). The drawing time "down" or the fraction of time that the pencil is in contact while performing the drawing decreased. ((i.e. For the house: "time down" 20.7(6.6) s basal, 17.4(6.3) s con O2 , p<0.017, Wilcoxon Test). In conclusion, this study shows that in patients with chronic hypoxemia, the administration of O2 at a low concentration during a short period of time produces changes in psychomotor function that can be measured through the drawing analysis.En esta tesis se han realizado tres estudios aplicando tres técnicas diagnósticas diferentes que incluyen broncoscopia, diagnóstico de la infección por el bacilo de la tuberculosis y el control de la oxigeno terapia en pacientes crónicos. Todos los estudios están basados en el análisis de imagen. En el primer estudio mediante la técnica de ultrasonografia a través de broncoscopio (EBUS) se evaluaron las imágenes de 12 ganglios mediastinitos malignos y 11 benignos en pacientes con sospecha de neoplasia pulmonar. Un procesamiento previo de la imagen fue aplicado para mejorar la cualidad de la misma. Se analizaron parámetros de textura y morfología así como la dimensión fractal que expresa la relación entre área y perímetro de las estructuras que aparecen en la imagen. La dimensión fractal fue más baja en los ganglios malignos comparados con los benignos (1.47(0.09), 1.53(0.10) (media(sd)) respectivamente. (Mann Whitney U test p<0.005). En conclusión la dimnensión fractal de las imágenes de ultrasonidos de los ganglios mediastinitos (EBUS) difieren dependiendo de si son o no malignos. En el segundo estudio se implemento un nuevo método de evaluación de la reacción dérmica a la tuberculina mediante una cámara de infrarrojos (IR). Participaron 34 sujetos que habían estado en contacto con pacientes infectados con el bacilo tuberculoso (46.8±16.9 años), (12/22 hombres/mujeres). La lectura fue realizada mediante exploración convencional y una cámara IR Fluke (320x240) situada a 40 cm del antebrazo en el lugar de punción. La imagen IR se proceso mediante detección Canny y la transformación de Hough). Resultados: Se describieron 3 áreas de segmentación, área 1 o pápula, área 2 o eritema y área 3 o background. Las diferencias de temperatura entre la 1 y 2 en el grupo IR positivo fue de 0.45 Cº (T test, p<0.05). La diferencia de Temp. Entre ambos grupos fue de 1.11 Cº (T test, p<0.05). El coeficiente de regresión entre ambos métodos fue de R=0.65, R20.42 (p<0.001) en los IR +. Concluimos que la inyección de tuberculina produce una reacción inflamatoria que puede ser medida por una cámara IR. En el tercer estudio se estudiaron los efectos de la oxigenoterapia a corto plazo sobre el estado psicomotor de los pacientes afectos de hipoxemia crónica. Participaron 8 pacientes afectos de hipoxemia (7/1 hombres/mujeres, edad 69.5(9.9) años (PaO2 62.2(6.9) mmHg). Desarrollaron dibujos (una casa y un reloj) antes y después de la inhlación de O2 durante 30 min. Resultados: La velocidad del trazado aumento con la casa((27.6(5.5) mm/s basal, 30.9(7.1) mm/s con O2 , p<0.025) Wilcoxon test). El tiempo abajo (contacto lapiz-tabla) disminuyo para la casa (20.7(6.6)s basal 17.4(6.3)s con O2, p<0.017, Wilcoxon test). En conclusión este estudio indica que en pacientes con hipoxemia crónica, la administración de O2 a bajas concentraciones durante un periodo corto de tiempo produce cambios en la función psicomotora que pueden ser medidos mediante el análisis del trazado de dibujosPostprint (published version

Acute phase proteins in dairy calves and reindeer : changes after birth and in respiratory infections

The early protection mechanism of the host against infection, trauma or other tissue damage comprises a set of reactions known as the acute phase response (APR). During APR, circulating concentrations of acute phase proteins (APPs) change. These proteins can serve as indicators of host response during various inflammatory conditions. In this thesis, APR in reindeer was investigated for the first time. Systemic concentrations of APPs during the neonatal period were studied in reindeer and cattle. APPs were also investigated during spontaneous bovine respiratory disease (BRD) in dairy calves. Escherichia coli endotoxin challenge in adult reindeer increased concentrations of serum amyloid A (SAA) in all animals. Haptoglobin (Hp) showed a less pronounced increase. SAA and Hp were concluded to be acute phase reactants in reindeer. In reindeer calves SAA concentrations increased during the first 2 weeks of life and decreased afterwards. Serum Hp concentrations increased throughout the first month after birth. In dairy calves SAA and lipopolysaccharide binding protein (LBP) concentrations changed similarly during first month of age as in reindeer calves. However, Hp concentrations generally remained low after birth. SAA rise in calves were not derived from colostrum as mammary specific SAA isoforms were not found from calves serum samples. Results of these two studies indicated that newborn reindeer and dairy calves have an inflammatory response during the first weeks of life and the age of young animals should by considered when interpreting APP concentrations. Very similar SAA changes in the two ruminant species also suggest that this inflammatory response may have role in the adaptation process of newborns to extrauterine life. The effect of different bovine respiratory pathogens on concentrations of APPs (SAA, LBP, Hp, alpha1-acid glycoprotein and fibrinogen) was studied in calves. Isolation of Pasteurella multocida was associated with increased concentrations of all APPs tested. In another study, concentrations of APPs were investigated in dairy calves during an outbreak of BRD. Initial cause for BRD outbreak was bovine respiratory syncytial virus (BRSV) infection. Concentrations of SAA and LBP increased in parallel with clinical symptoms at week 1 and peaked at week 3 of outbreak. Some calves had high Hp concentrations at week 3. Higher SAA, LBP and Hp concentrations at a later stage of BRD (week 3) were associated with lower BRSV-specific IgG1 production, suggesting that these calves had enhanced inflammatory response to secondary bacterial infection. In conclusion, APPs proved to be useful in exploring host response in bovine respiratory infections.Eläimen sairastuessa tai saadessa kudosvaurion tapahtuu elimistössä niin kutsuttu akuutin vaiheen vaste. Akuutin vaiheen aikana joidenkin plasmaproteiinien pitoisuus kohoaa, koska niiden tuotanto maksassa lisääntyy. Mittaamalla akuutin vaiheen proteiineja verenkierosta voidaan tutkia tulehduksen vaikutusta elimistöön ja elimistön vastetta haasteeseen. Tässä väitöskirjatyössä tutkittiin ensimmäistä kertaa akuutin vaiheen proteiineja porolla. Siinä selvitettiin proteiinien pitoisuuksien vaihtelua heti syntymän jälkeen poronvasoilla ja vasikoilla ja arvioitiin akuutin vaiheen proteiinien käyttöä vasikoiden hengitystietulehduksissa taudinaiheuttajien elimistövaikutusten tutkimisessa. Escherichia coli - endotoksiini aiheutti seerumin amyloidi A:n (SAA) pitoisuuksien nousun aikuisilla poroilla. Haptoglobiinin (Hp) nousu ei ollut niin selvä, mutta tämä tutkimus osoitti, että molemmat proteiinit toimivat akuutin vaiheen proteiineina myös porolla. Poronvasoilla nousi SAA:n pitoisuus ensimmäisen kahden elinviikon aikana ja laski sen jälkeen. Hp:n pitoisuudet nousivat vasoilla tasaisesti ensimmäisen elinkuukauden aikana. Vasikoilla SAA:n ja lipopolysakkariidia sitovan proteiinin (LBP) pitoisuudet muuttuivat samalla tavalla kuin SAA poronvasoilla, mutta Hp pysyi yleisesti alhaisena syntymän jälkeen. Koska maidon SAA:n isoformia ei löytynyt vasikoiden verinäytteistä, niin havaittu veren SAA:n nousu heti syntymän jälkeen ei johdu SAA:n imeytymisestä ternimaidosta. Nämä kaksi tutkimusta osoittivat, että poronvasoilla ja vasikoilla on heti syntymän jälkeen ohimenevä tulehdusreaktio. Tästä syystä on tärkeätä ottaa huomioon eläinten ikä akuutin vaiheen proteiinien tulosten tulkinnassa nuorten eläinten sairauksien yhteydessä. Hyvin samanlaiset SAA:n muutokset poronvasoilla ja vasikoilla viittaavat siihen, että tulehdusvasteella on rooli vastasyntyneiden märehtijöiden sopeutumisessa kohdunulkoiseen elämään. Kaikkien tutkittujen akuutin vaiheen proteiinien (SAA, LBP, Hp, hapan alfa1 glykoproteiini ja fibrinogeeni) kohonneet pitoisuudet olivat yhteydessä Pasteurella multocida - löydökseen keuhkohuuhtelunäytteestä hengitystietulehdukseen sairastuneilla vasikoilla. Toisessa tutkimuksessa seurattiin vasikoita luonnollisen respiratory syncytial(RS)-viruksen aiheuttaman hengitystietaudinpurkauksen aikana. SAA:n ja LBP:n pitoisuudet nousivat vasikoilla samanaikaisesti kliinisten hengitystieoireiden ilmaantumisen kanssa seurannan ensimmäisen viikon aikana ja korkeimmillaan pitoisuudet olivat viikolla 3. Joillakin vasikoilla myös Hp-arvot olivat kohonneet viikolla 3. Korkeammat akuutin vaiheen proteiinien pitoisuudet taudinpurkauksen myöhemmässä vaiheessa oli vasikoilla, joilla oli vähäisempi RS-viruksen vasta-aineiden tuotanto. Tämä viittaa siihen, että matalampi vasta-aineiden tuotanto altisti vasikoita voimakkaammalle sekundaariselle bakteeritulehdukselle virustartunnan jälkeen. Nämä kaksi tutkimusta osoittivat että akuutin vaiheen proteiinit ovat hyödyllisiä tutkittaessa vasikoiden luonnollisia hengitystietulehduksia

Tuberculine reaction measured by infrared thermography

Setting: The infection with Mycobacterium tuberculosis gives a delayed immune response, measured by the tuberculine skin test. We present a new technique for evaluation based on automatic detection and measurement of skin temperature due to infrared emission.; Design: 34 subjects (46.8+/-16.9 years) (12/22, M/F) with suspected tuberculosis disease were examined with an IR thermal camera, 48h after tuberculin skin injection.; Results: In 20 subjects, IR analysis was positive for tuberculine test. Mean temperature of injection area was higher, around 1 degrees C, for the positive group (36.2+/-1.1 degrees C positive group; 35.1+/-1.6 degrees C negative group, p < 0.02 T test for unpaired groups).; Conclusion: IR image analysis achieves similar estimation of tuberculin reaction as the visual evaluation, based on higher temperature due to increased heat radiation from the skin lesion.Peer Reviewe