Fałszywie ujemne wyniki testów serologicznych w kierunku Borrelia burgdorferi jako efekt kompleksemii w przebiegu choroby z Lyme

Problem seronegatywności, jeśli chodzi o obecność swoistych przeciwciał dla Borrelia burgdorferi (B. bg.), dotyczy od około 40% surowic pacjentów z podejrzeniem boreliozy z Lyme — włączając w to pacjentów z potwierdzonymi w wywiadzie incydentami pokąsania przez kleszcza i wystąpieniem objawu patognomonicznego, jakim jest rumień wędrujący (Erythema migrans). Pomimo że dysponujemy szerokim wachlarzem testów bakteriologicznych, serologicznych czy molekularnych (PCR), diagnostyka boreliozy nastręcza wielu trudności i może prowadzić do uzyskiwania wyników zarówno fałszywie ujemnych, jak i fałszywie dodatnich. Przyczyn jest dużo i zostaną uwzględnione w niniejszej pracy. Praca dotyczy surowic seronegatywnych pod względem przeciwciał anty-B. bg. pacjentów, u których wolne przeciwciała anty-B. bg., prawdopodobnie związane przez antygeny bakteryjne, utworzyły krążące kompleksy immunologiczne (CIC). Celem pracy była analiza CIC pod kątem obecności przeciwciał przeciwko B. bg. w surowicach pacjentów trudnych diagnostycznie, u których obraz kliniczny wskazywał na zakażenie krętkiem z rodzaju B. bg. Badania przeprowadzono na surowicach od 107-osobowej grupy pacjentów z podejrzeniem boreliozy. Zastosowano nową metodycznie analizę obecności swoistych przeciwciał dla B. bg. Polega ona na wytrącaniu i dysocjacji CIC, a następnie oznaczaniu w uzyskanej frakcji y przeciwciał swoistych dla B. bg. W 74 surowicach (ze 107 badanych), ujemnych w teście ELISA, wykryto metodą Western- -blotting we frakcji g aż w 82% obecność przeciwciał swoistych dla B. bg. Najczęściej wykrywano przeciwciała dla antygenów: VIsE, p100, p41, p39, OspC i p18, co oznacza, że wyniki uzyskane powszechnie stosowaną metodą ELISA należy uważać za fałszywie ujemne i dlatego konieczne jest oznaczanie przeciwciał dla B. bg. także we frakcji CIC. Autorzy mają nadzieję, że opracowane przez nich nowe podejście, po niezbędnych dla celów rutynowej diagnostyki uproszczeniach, znajdzie zastosowanie w serodiagnostyce boreliozy i w sposób znaczący zmniejszy liczbę wyników fałszywie ujemnych. Forum Medycyny Rodzinnej 2011, tom 5, nr 3, 201–20

Inflammatory markers in the diagnostic workup of pacemaker- and defibrillator-related infections in patients referred for transvenous lead extraction

Background: Infectious complications can be life‑threatening in patients with permanent transvenous pacemakers and their diagnosis can be challenging. Aims: The aim of the study was to assess the diagnostic utility of white blood cell (WBC) count and C‑reactive protein (CRP) concentrations in infectious complications in patients with cardiac pacemakers. Methods: The prospective study included patients who underwent transvenous lead extraction (TLE) due to various indications. The diagnosis of lead‑dependent infective endocarditis (LDIE) was based on the modified Duke criteria, and the diagnosis of local infection was based on symptoms related to device pocket. The study population consisted of 640 patients: 63 (9.9%) with LDIE, 61 (9.5%) with local infection, and 516 controls (80.6%) referred for TLE due to noninfectious indications. We evaluated WBC count and CRP concentrations in each group of patients and assessed the predictive value of these tests for the diagnosis of LDIE and local infection. Results: Patients with local infection did not differ in terms of median WBC and CRP values compared with controls (P = 0.99 and P = 0.13, respectively), whereas patients with LDIE had higher median WBC count and CRP level (P < 0.001 and P < 0.001, respectively). In the LDIE group, WBC diagnostic test showed 46.0% sensitivity, 95.3% specificity, 90.5% accuracy, 51.8% positive predictive value, and 94.2% negative predictive value. The diagnostic test based on CRP levels showed 84.1% sensitivity, 81.8% specificity, 82.0% accuracy, 33.5% positive predictive value, and 97.9% negative predictive value. Conclusions: In patients undergoing TLE due to infectious indications, inflammatory markers (WBC count, CRP level) were within normal range in the local‑infection group and markedly elevated in the LDIE group. Inflammatory markers were useful to determine the extent of the infection in patients with local infection

Relationship between changes in selected thrombotic and inflammatory factors, echocardiographic parameters and the incidence of venous thrombosis after pacemaker implantation based on our own observations

Introduction: Thrombosis (VTh) is a rare dangerous complication of pacemaker implantation (PM). The aim of the study was to determine the dynamics of change in selected thrombotic and inflammatory factors after PM. Material and methods: The study involved 81 patients (30 female, mean age: 71.1 years) with PM, divided into two groups. Group A (71 patients) consisted of patients without VTh, whereas group B (10 patients) comprised the patients with VTh. A transthoracic echocardiogram (TTE) and a venous ultrasound (VU) examination were performed. The levels of D-dimers, fibrinogen, tissue factor (TF), factor VII, plasminogen activator inhibitor-1 (PAI-1), interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hsCRP) were determined in the venous blood. After PM, the TTE and VU examinations were repeated at 6 and 12 months, and blood analyses were performed within 7 days after PM, and subsequently at 6 and 12 months. Results: In 10 patients of group B, symptomatic VTh occurred at a mean time of 13.06 months after PM. Initially, the levels of IL-6, hsCRP, D-dimers, fibrinogen, TF, VII factor and PAI-1 were considerably higher in group B than in group A. In all patients the levels of these factors kept on increasing for up to 7 days after the procedure. In group A they subsequently decreased, whereas in group B they continued to rise. Conclusions: Increased levels of inflammatory and thrombotic factors were observed in patients with VTh before and after PM. The factors of highest risk of VTh occurrence were D-dimers, fibrinogen and TF

The usefulness of SPECT-CT with radioisotope-labeled leukocytes in diagnosing lead-dependent infective endocarditis

Background. Lead-dependent infective endocarditis (LDIE) is a life-threatening complication of permanent transvenous cardiac pacing. According to the 2015 European Society of Cardiology (ECS) guidelines, the diagnosis of LDIE is based on the modified Duke criteria (MDC), while single-photon emission computed tomography with conventional computed tomography (SPECT-CT) with radioisotope-labeled leukocytes serves as an additional tool in difficult cases. The major challenge is to differentiate between true vegetation and a thrombus.   Objectives. The aim of the study was to evaluate the usefulness of SPECT-CT with radioisotope-labeled leukocytes in diagnosing LDIE in patients with intracardiac masses (ICMs).   Material and Methods. The prospective registry included 40 consecutive patients admitted with an ICM on the lead and suspicion of LDIE. The confirmation or rejection of the LDIE diagnosis was made according to an algorithm based on the MDC. The cohort was divided into 2 groups: patients with definite and possible LDIE diagnoses based on the MDC (the LDIE-positive group), and patients with negative LDIE diagnoses according to the MDC (the LDIE-negative group). All patients underwent SPECT-CT with radioisotope-labeled leukocytes. The diagnostic ability of SPECT-CT was compared to the gold standard MDC.   Results. The LDIE-positive group with diagnosis based on the MDC consisted of 19 patients (LDIE definite – 11; LDIE possible – 8). The LDIE diagnosis was rejected on the basis of the MDC in 21 patients. The SPECT-CT results were compared with the MDC results and showed 73.7% sensitivity, 81.0% specificity, 77.5% accuracy, 77.8% positive predictive value (PPV), 77.3% negative predictive value (NPV), likelihood ratio positive (LR+) 3.868, likelihood ratio negative (LR–) 0.325, and moderate agreement (κ = 0.548, p < 0.001). After the exclusion of 5 patients treated with antibiotics at the time of the SPECT-CT, LR+ and LRimproved to 5.250 and 0, respectively, and inter-test agreement amounted to almost perfect concordance (κ = 0.773, p < 0.001).   Conclusion. Single-photon emission computed tomography with conventional CT with radioisotopelabeled leukocytes is a useful, efficient, single-step test for diagnosing LDIE

Indications for transvenous lead extraction and its procedural and early outcomes in elderly patients : a single‑center experience

Introduction Due to the prolonged survival of patients with cardiovascular implantable electronic devices, leads often need to be removed in elderly individuals. Objectives We aimed to analyze indications for transvenous lead extraction (TLE), procedure effectiveness and safety, as well as 30‑day follow‑up in younger patients (≤80 years) and octogenarians (>80 years). Patients and methods This prospective study included 667 patients who underwent TLE: 90 octogenarians (13.5%) at a mean age of 83.8 (range, 80.4–93) years and 577 younger patients (86.5%) at a mean age of 64.2 (range, 18.9–79.9) years. Results Octogenarians had a greater number of comorbidities, fewer implantable cardioverter‑defibrillators implanted, and more frequently had infection as an indication for TLE, as compared with younger patients (33.3% vs 17.1%; P <0.001). In octogenarians, 138 leads were extracted, as compared with 894 leads in younger patients. Octogenarians and younger patients had similar rates of complete lead removal (98.6% and 97.1%, respectively; P = 0.48), total procedural success (97.8% and 96%, respectively; P = 0.7), major complications (0% and 1.6%, respectively; P = 0.45), and minor complications (2.2% and 1.6%, respectively; P = 0.45). There was 1 death associated with TLE in younger patients. Non–procedure‑related deaths within 30 days after TLE were more frequent in octogenarians than in younger patients (5.6% vs 1.9%; P = 0.04). Conclusions We showed that TLE in patients older than 80 years seems to be as effective as in younger patients; however, it is associated with significantly higher non–procedure‑related 30‑day mortality

Malnutrition, inflammation, atherosclerosis syndrome (MIA) and diet recommendations among end-stage renal disease patients treated with maintenance hemodialysis

Malnutrition-inflammation-atherosclerosis syndrome is one of the causes of increased mortality in chronic kidney disease (CKD). The aim of the study was to assess the inflammation and nutritional status of patients in end-stage kidney disease treated with maintenance hemodialysis. The study included a group of 98 hemodialyzed patients with stage 5 CKD (38 women and 60 men). Albumin, prealbumin (PRE), and C-reactive protein (CRP) were measured in serum samples collected before mid-week dialysis. Fruit and vegetables frequency intakes were assessed with a questionnaire. CRP was above the reference limit of 5 mg/L in 53% of patients. Moreover, the Glasgow Prognostic Score (GPS) indicated the co-occurrence of inflammation and protein calorie malnutrition in 11% of patients, and the presence of either inflammation or malnutrition in 25%. The questionnaire revealed that hemodialyzed patients frequently exclude fruit and vegetables from their diets. Nearly 43% of the interviewed patients declared frequently eating vegetables, and 35% declared frequently eating fruit, a few times per week or less. The most frequently selected fruit and vegetables had a low antioxidant capacity. The strict dietary restrictions in CKD are difficult to fulfill, and if strictly followed, may lead to protein-calorie malnutrition

Serum metabolomics approach to monitor the changes in metabolite profiles following renal transplantation

Systemic metabolic changes after renal transplantation reflect the key processes that are related to graft accommodation. In order to describe and better understand these changes, the 1HNMR based metabolomics approach was used. The changes of 47 metabolites in the serum samples of 19 individuals were interpreted over time with respect to their levels prior to transplantation. Considering the specific repeated measures design of the experiments, data analysis was mainly focused on the multiple analyses of variance (ANOVA) methods such as ANOVA simultaneous component analysis and ANOVA-target projection. We also propose here the combined use of ANOVA and classification and regression trees (ANOVA-CART) under the assumption that a small set of metabolites the binary splits on which may better describe the graft accommodation processes over time. This assumption is very important for developing a medical protocol for evaluating a patient’s health state. The results showed that besides creatinine, which is routinely used to monitor renal activity, the changes in levels of hippurate, mannitol and alanine may be associated with the changes in renal function during the post-transplantation recovery period. Specifically, the level of hippurate (or histidine) is more sensitive to any short-term changes in renal activity than creatinine