Abstract Background The development of sonication protocols over the last few years has improved the sensitivity of conventional cultures for the diagnosis of prosthetic-joint infection (PJI). ...However, the development of a new, specifically designed kit for the molecular diagnosis of PJI could provide a major improvement in this field. Methods Prostheses retrieved from patients who underwent implant removal from May 2014 to May 2015 were sent for culture, and processed according to a previously defined protocol that included sonication. Furthermore, 180 microlitres of sonication fluid were used to carry out the multiplex PCR test (Unyvero i60 system® ). A comparison of the sensitivity, specificity, positive (PPV) and negative (NPV) predictive value, was performed. The study was approved by the Clinical Research Ethics Committee. Results The analysis included 88 prostheses from 68 patients (1.29 prostheses/patient). The type of prostheses studied were knee ( n = 55), total hip ( n = 26), partial hip ( n = 5), and shoulder ( n = 2). Twenty-nine patients were diagnosed with a PJI (15 delayed, 12 acute, and 2 haematogenous infections). In 24 cases, the result of the PCR was positive, all but 1 corresponding to patients with clinical criteria of PJI. Nine resistance mechanisms were detected from 5 samples. The Unyvero i60 system® showed slightly better results than traditional culture in terms of specificity and PPV. Conclusions The Unyvero i60 system® may play a role in rapid diagnosis of PJI, due to its high specificity and PPV. However, despite these results, cultures have to be performed to detect organisms not detected by the system.
Cryptococcal meningoencephalitis (CM) is an uncommon entity, but remains a major cause of morbidity and mortality in patients with AIDS.
Review of CM cases in a university hospital. The diagnosis was ...determined by isolation of Cryptococcus neoformans in cerebrospinal fluid. Morbidity and mortality was assessed at 12 weeks (early mortality) and between 3 and 18 months after diagnosis (late mortality).
We analyzed 32 patients from 2269 AIDS cases (1.41%). 10 patients between 1990 and 1996 and 22 between 1997 and 2014. Cryptococcal antigen in CSF was positive in all cases, with titers >1024 in 19 patients (63%); this group had lower CD4+ counts (40±33 versus 139±78cell/μl) and greater disseminated involvement. After a first CM episode the relapse rate was 34%. Global mortality rate was 28% (9/32), much higher in the pre-HAART era.
CM morbidity and mortality is related to severe immunodeficiency, disseminated disease, high titers of antigen in CSF and delayed initiation of HAART.
La meningoencefalitis criptocócica (MC), aunque infrecuente, sigue siendo una importante causa de morbimortalidad en pacientes con sida.
Revisión de los casos de MC en un hospital universitario (1990-2014). El diagnóstico se determinó mediante el aislamiento de Cryptococcus neoformans en el LCR. Se analizó la morbimortalidad temprana (< 12 semanas) y tardía (3-18 meses).
Se analizaron 32 pacientes de los 2.269 diagnósticos de sida (1,41%): 10 entre 1990-1996 y 22 entre 1997-2014. El antígeno criptocócico en el LCR fue positivo en todos los casos, con títulos > 1.024 en 19 pacientes (63%), presentando este grupo unos recuentos de CD4+ menores (40±33 frente a 139±78cél/μl) y mayor afectación diseminada que el resto. Tras el primer episodio de MC la tasa de recaídas fue del 34%. La mortalidad global fue del 28% (9/32), muy superior en el período pre-TARGA.
La morbimortalidad de la MC viene determinada por padecer una inmunodeficiencia grave, la presencia de enfermedad diseminada, títulos elevados de antígeno en el LCR y el retraso en el inicio del TARGA.
Abstract Background To determine the clinical and epidemiological characteristics, etiology, underlying conditions, and outcomes of patients with primary septic arthritis and no prosthetic joints at ...a university hospital. Methods A retrospective study was performed between 2005 and 2012. Records from the Microbiology Department were reviewed, and patients with a positive culture of synovial fluid or biopsy were selected for the study. Clinical charts were reviewed using a designed protocol. Results 41 patients were diagnosed with septic arthritis with a positive culture. Most were diagnosed with monoarticular (85.37%) and monomicrobial (92.68%) arthritis. The most commonly involved joint was the knee (34.15%). The most frequent underlying conditions were hypertension and diabetes mellitus. Staphylococcus aureus was the most common pathogen (58.54%). Two cases of chronic arthritis, both caused by Mycobacterium tuberculosis were detected. The most frequently used antibiotic combinations were cloxacillin + ciprofloxacin and vancomycin + ciprofloxacin. Surgical treatment included needle aspiration, open joint debridement, or arthroscopic techniques. Twelve cases had a poor outcome (destructive articular disease), and 3 patients died from staphylococcal sepsis. Conclusions In our hospital, septic arthritis is primarily acute, monoarticular, and monomicrobial; affects higher joints, is caused by S. aureus , and occurs in adult patients with underlying diseases. Outcome is good in most patients, although more than 25% of cases had articular sequels.
Abstract
Background
Coronavirus disease 2019 (COVID-19) patients on haemodialysis (HD) have high mortality. We investigated the value of reverse transcription polymerase chain reaction (RT-PCR) and ...the dynamic changes of antibodies (enzyme-linked immunosorbent assay immunoglobulin M (IgM) + IgA and/or IgG) in a large HD cohort.
Methods
We conducted a prospective observational study in 10 Madrid HD centres. Infection rate, anti-SARS-CoV-2 antibody dynamics and the incidence of asymptomatic SARS-CoV-2 infection (defined by positive RT-PCR, IgM + IgA and/or IgG) were assessed.
Results
From 1 March to 15 April 2020, 136 of 808 (16.8%) HD patients were diagnosed with symptomatic COVID-19 by RT-PCR of nasopharyngeal swabs and 42/136 (31%) died. In the second fortnight of April, RT-PCR and anti-SARS-CoV-2 antibodies were assessed in 763 of the surviving patients. At this point, 69/91 (75.8%) symptomatic COVID-19 patients had anti-SARS-CoV-2 antibodies. Four weeks later, 15.4% (10/65) of initially antibody-positive patients had become negative. Among patients without prior symptomatic COVID-19, 9/672 (1.3%) were RT-PCR positive and 101/672 patients (15.0%) were antibody positive. Four weeks later, 62/86 (72.1%) of initially antibody-positive patients had become negative. Considering only IgG titres, serology remained positive after 4 weeks in 90% (54/60) of patients with symptomatic COVID-19 and in 52.5% (21/40) of asymptomatic patients. The probability of an adequate serologic response (defined as the development of anti-SARS-CoV-2 antibodies that persisted at 4 weeks) was higher in patients who had symptomatic COVID-19 than in asymptomatic SARS-CoV-2 infection {odds ratio OR) 4.04 95% confidence interval (CI) 2.04–7.99} corrected for age, Charlson comorbidity index score and time on HD. Living in a nursing home OR 5.9 (95% CI 2.3–15.1) was the main risk factor for SARS-CoV-2 infection.
Conclusions
The anti-SARS-CoV-2 antibody immune response in HD patients depends on clinical presentation. The antibody titres decay earlier than previously reported for the general population. This inadequate immune response raises questions about the efficacy of future vaccines.
Graphical Abstract
El tratamiento antifúngico combinado, simultáneo o secuencial, se ha considerado, con frecuencia, como una alternativa adecuada para mejorar los resultados que se obtienen con la monoterapia. Las ...equinocandinas, grupo de fármacos al que pertenece la anidulafungina, poseen un mecanismo de acción diferente del de los demás fármacos antifúngicos, lo que aventura cuando menos buenas posibilidades de sinergia con otros grupos. Sin embargo, la mayoría de los datos disponibles sobre la eficacia de las diferentes combinaciones procede de modelos de infección en animales, datos in vitro y comunicación de casos clínicos, mientras son muy escasos los datos procedentes de ensayos clínicos controlados. Los datos disponibles no permiten afirmar que el tratamiento combinado tenga una eficacia significativamente superior a la de la monoterapia; sin embargo, puede ser adecuado para el tratamiento de micosis invasoras graves asociadas a una elevada tasa de mortalidad, tales como las formas de aspergilosis que cursan con afección del sistema nervioso central o afección pulmonar extensa, cavitada o con insuficiencia respiratoria, y las infecciones causadas por hongos multirresistentes.
En estas recomendaciones se analizan diferentes aspectos del diagnóstico de laboratorio de las infecciones fúngicas invasivas en pacientes inmunodeprimidos.
Son recomendaciones basadas en las ...indicaciones establecidas en diferentes estudios y en opiniones de expertos. Además, se adjuntan los niveles de evidencia para cada recomendación.
The guidelines presented herein, which are based on the indications established by various studies and expert opinions, analyze several issues related to laboratory diagnosis of invasive fungal infections in immunosuppressed patients.
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