6 research outputs found
Nasopharyngeal bacterial load as a marker for rapid and easy diagnosis of invasive pneumococcal disease in children from Mozambique
Background
Current diagnostic methods for detection of Streptococcus pneumoniae in children with suspected invasive pneumococcal disease have limitations of accuracy, timeliness, and patient convenience. This study aimed to determine the performance of pneumococcal load quantified with a real-time polymerase-chain reaction in nasopharyngeal samples to diagnose invasive pneumococcal disease in children.
Methods
Matched case-control study of patients <5 years of age with invasive pneumococcal disease admitted to the Manhiça District Hospital (Mozambique) and asymptomatic controls recruited in different periods between 2006 and 2014. Cases were confirmed by a positive bacterial culture for S. pneumoniae in blood or cerebrospinal fluid. Nasopharyngeal aspirates were collected from cases and controls and pneumococcal density was quantified by lytA real-time polymerase-chain reaction.
Results
Thirty cases (median age 12.8 months) and sixty controls (median age 11.7 months) were enrolled and 70% of them were male. Nasopharyngeal pneumococcal carriage was high in both groups: 28/30 (93.3%) for cases vs. 53/60 (88.3%) for controls (p = 0.71). Mean nasopharyngeal pneumococcal load was identified as a marker for invasive pneumococcal disease (7.0 log10 copies/mL in cases vs. 5.8 log10 copies/mL in controls, p<0.001) and showed good discriminatory power (AUC-ROC: 82.1%, 95% CI 72.5%-91.8%). A colonization density of 6.5 log10 copies/mL was determined as the optimal cut-off value to distinguish cases from controls (sensitivity 75.0%, specificity 73.6%).
Conclusion
Use of non-invasive nasopharyngeal aspirates coupled with rapid and accurate quantification of pneumococcal load by real-time polymerase chain reaction has the potential to become a useful surrogate marker for early diagnosis of invasive pneumococcal disease in childr
Nasopharyngeal bacterial load as a marker for rapid and easy diagnosis of invasive pneumococcal disease in children from Mozambique
Background
Current diagnostic methods for detection of Streptococcus pneumoniae in children with suspected invasive pneumococcal disease have limitations of accuracy, timeliness, and patient convenience. This study aimed to determine the performance of pneumococcal load quantified with a real-time polymerase-chain reaction in nasopharyngeal samples to diagnose invasive pneumococcal disease in children.
Methods
Matched case-control study of patients <5 years of age with invasive pneumococcal disease admitted to the Manhiça District Hospital (Mozambique) and asymptomatic controls recruited in different periods between 2006 and 2014. Cases were confirmed by a positive bacterial culture for S. pneumoniae in blood or cerebrospinal fluid. Nasopharyngeal aspirates were collected from cases and controls and pneumococcal density was quantified by lytA real-time polymerase-chain reaction.
Results
Thirty cases (median age 12.8 months) and sixty controls (median age 11.7 months) were enrolled and 70% of them were male. Nasopharyngeal pneumococcal carriage was high in both groups: 28/30 (93.3%) for cases vs. 53/60 (88.3%) for controls (p = 0.71). Mean nasopharyngeal pneumococcal load was identified as a marker for invasive pneumococcal disease (7.0 log10 copies/mL in cases vs. 5.8 log10 copies/mL in controls, p<0.001) and showed good discriminatory power (AUC-ROC: 82.1%, 95% CI 72.5%-91.8%). A colonization density of 6.5 log10 copies/mL was determined as the optimal cut-off value to distinguish cases from controls (sensitivity 75.0%, specificity 73.6%).
Conclusion
Use of non-invasive nasopharyngeal aspirates coupled with rapid and accurate quantification of pneumococcal load by real-time polymerase chain reaction has the potential to become a useful surrogate marker for early diagnosis of invasive pneumococcal disease in childr
Descriptive study of severe hospitalized cases of laboratory-confirmed influenza during five epidemic seasons (2010–2015)
Objective: The Plan of Information on Acute Respiratory Infections in Catalonia (PIDIRAC) included the surveillance
of severe hospitalized cases of laboratory-confrmed infuenza (SHCLCI) in 2009. The objective of this study was to
determine the clinical, epidemiological and virological features of SHCLCI recorded in 12 sentinel hospitals during fve
infuenza seasons.
Results: From a sample of SHCLCI recorded during the 5 infuenza epidemics seasons from 2010–2011 to 2014–2015,
Cases were confrmed by PCR and/or viral isolation in cell cultures from respiratory samples. A total of 1400 SHCLCI
were recorded, 33% required ICU admission and 12% died. The median age of cases was 61 years (range 0–101 years);
70.5% were unvaccinated; 80.4% received antiviral treatment (in 79.6 and 24% of cases within 48 h after hospital
admission and the onset of symptoms, respectively); infuenza virus A [37.9% A (H1N1)pdm09, 29.3% A (H3N2)] was
identifed in 87.7% of cases. Surveillance of SHCLCI provides an estimate of the severity of seasonal infuenza epidemics
and the identifcation and characterization of at-risk groups in order to facilitate preventive measures such as vaccination
and early antiviral treatment
Detection of cytomegalovirus drug resistance mutations in solid organ transplant recipients with suspected resistance
BACKGROUND: Current guidelines recommend that treatment of
resistant cytomegalovirus (CMV) in solid organ transplant (SOT)
recipients must be based on genotypic analysis. However, this
recommendation is not systematically followed. OBJECTIVES: To
assess the presence of mutations associated with CMV resistance
in SOT recipients with suspected resistance, their associated
risk factors and the clinical impact of resistance. STUDY
DESIGN: Using Sanger sequencing we prospectively assessed the
presence of resistance mutations in a nation-wide prospective
study between September 2013-August 2015. RESULTS: Of 39
patients studied, 9 (23%) showed resistance mutations. All had
one mutation in the UL 97 gene and two also had one mutation in
the UL54 gene. Resistance mutations were more frequent in lung
transplant recipients (44% p=0.0068) and in patients receiving
prophylaxis >/=6 months (57% vs. 17%, p=0.0180). The mean
time between transplantation and suspicion of resistance was
longer in patients with mutations (239 vs. 100days,
respectively, p=0.0046) as was the median treatment duration
before suspicion (45 vs. 16days, p=0.0081). There were no
significant differences according to the treatment strategies or
the mean CMV load at the time of suspicion. Of note,
resistance-associated mutations appeared in one patient during
CMV prophylaxis and also in a seropositive organ recipient.
Incomplete suppression of CMV was more frequent in patients with
confirmed resistance. CONCLUSIONS: Our study confirms the need
to assess CMV resistance mutations in any patient with criteria
of suspected clinical resistance. Early confirmation of the
presence of resistance mutations is essential to optimize the
management of these patients
Current preventive strategies and management of Epstein-Barr virus-related post-transplant lymphoproliferative disease in solid organ transplantation in Europe. Results of the ESGICH Questionnaire-based Cross-sectional Survey
There is limited clinical evidence on the utility of the monitoring of Epstein-Barr virus (EBV) DNAemia in the pre-emptive management of post-transplant lymphoproliferative disease (PTLD) in solid organ transplant (SOT) recipients. We investigated current preventive measures against EBV-related PTLD through a web-based questionnaire sent to 669 SOT programmes in 35 European countries. This study was performed on behalf of the ESGICH study group from the European Society of Clinical Microbiology and Infectious Diseases. A total of 71 SOT programmes from 15 European countries participated in the study. EBV serostatus of the recipient is routinely obtained in 69/71 centres (97%) and 64 (90%) have access to EBV DNAemia assays. EBV monitoring is routinely used in 85.9% of the programmes and 77.4% reported performing pre-emptive treatment for patients with significant EBV DNAemia levels. Pre-emptive treatment for EBV DNAemia included reduction of immunosuppression in 50.9%, switch to mammalian target of rapamycin inhibitors in 30.9%, and use of rituximab in 14.5% of programmes. Imaging by whole-body 18-fluoro-deoxyglucose positron emission tomography (FDG-PET) is used in 60.9% of centres to rule out PTLD and complemented computer tomography is used in 50%. In 10.9% of centres, FDG-PET is included in the first-line diagnostic workup in patients with high-risk EBV DNAemia. Despite the lack of definitive evidence, EBV load measurements are frequently used in Europe to guide diagnostic workup and pre-emptive reduction of immunosuppression. We need prospective and controlled studies to define the impact of EBV monitoring in reducing the risk of PTLD in SOT recipients