Diagnosis of latent tuberculosis infection in patients with immune-mediated inflammatory chronic diseases (IMIDs) can be challenged as diagnostic test reliability could be impaired by ...immunosuppression. We retrospectively analyzed the Quantiferon Gold-Test in-Tube (QFT-G-IT) results of all patients with IMIDs seen at the Department of Internal Medicine of Son Llàtzer Hospital, Palma de Mallorca (Spain), looking for the factors related to QFT-G-IT indeterminate results. During the study period (2008–2015), 520 patients met the inclusion criteria. Factors associated with indeterminate QFT-G-IT results in a univariate analysis were inflammatory bowel disease, disease activity, lymphopenia, and medium-to-high doses of corticosteroids. In a subsequent multivariate analysis, only lymphopenia (defined as < 1500 cells) was associated with indeterminate QFT-G-IT results. Lymphocyte count was the only factor independently associated with an increased number of indeterminate QFT-G-IT results in patients with different autoimmune diseases. Others factors such as the use of medium-to-high doses of corticosteroids should be considered before testing with QFT-G-IT.
Pulmonary Infective Endocarditis Prieto-Arévalo, Raquel; Muñoz, Patricia; Cuerpo, Gregorio ...
Journal of the American College of Cardiology,
06/2019, Letnik:
73, Številka:
21
Journal Article
Abstract
Background: Interferon-γ release assays (IGRAs) are increasingly used for the diagnosis of latent tuberculosis infection (LTBI). Because of the lack of a gold standard for the diagnosis of ...LTBI, IGRAs are compared to the tuberculin skin test (TST) and yield conflicting results. We assessed the usefulness of an IGRA test, QuantiFERON®-TB Gold In-Tube (QFT-G-IT), for diagnosing LTBI compared with TST in the setting of a contact screening study. Methods: A prospective comparison between the QFT-G-IT and the TST in TB contact subjects in a low TB burden area was conducted sequentially between January 2006 and December 2012. Results: A moderate concordance between the two tests (κ = 0.44 for TST cut-off of 5 mm and κ = 0.56 for TST cut-off of 15 mm) was found. A better agreement was shown in younger contacts and in non-vaccinated contacts when using a TST of 15 mm. Independent risk factors for a TST+/QFT-G-IT- discordance were history of BCG vaccination and age between 31 and 59 years. Discordance was also more frequent using a TST cut-off value of 5 mm. QFT-G-IT+/TST- was infrequent and was found in older contacts. Conclusions: Based on our data, we cannot recommend the use of QFT-G-IT as the only test to rule out LTBI, especially in older patients.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Q fever is a widespread zoonotic infection caused by Coxiella burnetii (C. burnetii). Acute infection varies from a self-limited flu-like illness to pneumonia or hepatitis.
A retrospective case study ...from March 2003 to December 2011 was conducted in the Hospital Son Llàtzer in Palma de Mallorca. Acute Q-fever was diagnosed in a patient with clinical suspicion and IgM in phase ii positive (≥ 1/40), with a positive IgG (≥1/80), or when IgG seroconversion was observed during convalescence. A total of 87 cases of acute Q fever were diagnosed. The median age was 50 years (range 21-89), and 69 (79.3%) were male. Fever and headache were the most common symptoms. Pneumonia was diagnosed in 39 (44.8%) patients, febrile episode in 21 (24.1%), and acute hepatitis in 23 (25.6%). Increased serum transaminases were observed in 19 (21.8%). Doxycycline was prescribed in 29 cases (33.4%). There were 30 (34.5%) patients lost to follow up after hospital discharge. A favorable outcome was observed in all other cases. Only one new case progressed to chronic Q fever.
A total of 87 cases of acute Q fever were diagnosed. The median age was 50 years (range 21-89), and 69 (79.3%) were male. Fever and headache were the most common symptoms. Pneumonia was diagnosed in 39 (44.8%) patients, febrile episode in 21 (24.1%), and acute hepatitis in 23 (25.6%). Increased serum transaminases were observed in 19 (21.8%). Doxycycline was prescribed in 29 cases (33.4%). There were 30 (34.5%) patients lost to follow up after hospital discharge. A favorable outcome was observed in all other cases. Only one new case progressed to chronic Q fever.
Acute Q fever acute is common our environment. Pneumonia was the most common clinical presentation. Even although doxycycline was prescribed in a small number of patients, a favorable outcome was observed in all cases.
Resumen Introducción La fiebre Q (FQ) es una zoonosis de distribución mundial causada por Coxiella burnetii ( C . burnetii) . La infección aguda puede cursar asintomática o producir síndrome febril, ...hepatitis o neumonía y la infección crónica se suele presentar como endocarditis. Los datos sobre FQ en las islas Baleares son escasos. Métodos Se presenta una serie de casos con información retrospectiva desde marzo de 2003 a diciembre de 2011 de los casos con serología y cuadro clínico compatible con FQ aguda en el Hospital Son Llàtzer de Palma de Mallorca. Se consideró FQ aguda cuando, en un paciente con sospecha clínica, el título de IgM en fase ii fue positivo (≥ 1/40), con IgG positiva (≥ 1/80) o cuando existió en fase de convalecencia seroconversión del título de IgG a C. burnetii . Se diagnosticaron 87 casos de FQ aguda. La mediana de edad fue de 50 años (rango intercuartílico: 21-89) y 69 (79,3%) eran hombres. La fiebre y la cefalea fueron los síntomas más frecuentes. El diagnóstico fue de: neumonía en 39 (44,8%) pacientes, síndrome febril aislado en 21 (24,1%), hepatitis aguda en 19 (21,8%) y el resto otras entidades. En 52 casos (59,8%) existió alguna elevación de enzimas hepáticas. El tratamiento con doxiciclina (solo o en combinación) fue prescrito en 29 (33,4%). El seguimiento se realizó en 57 (65,5%) de los pacientes. La evolución fue favorable en la mayoría, solamente un paciente con FQ aguda presentó durante el seguimiento títulos compatibles con FQ crónica. Resultados Se diagnosticaron 87 casos de FQ aguda. La mediana de edad fue de 50 años (rango intercuartilíco: 21-89) y 69 (79,3%) eran hombres. La fiebre y la cefalea fueron los síntomas más frecuentes. El diagnóstico fue de: neumonía en 39 (44,8%) pacientes, síndrome febril aislado en 21 (24,1%), hepatitis aguda en 19 (21,8%) y el resto otras entidades. En 52 casos (59,8%) existió alguna elevación de enzimas hepáticas. El tratamiento con doxiciclina (solo o en combinación) fue prescrito en 29 (33,4%). El seguimiento se realizó en 57 (65,5%) de los pacientes. La evolución fue favorable en la mayoría, solamente un paciente con FQ aguda presentó durante el seguimiento títulos compatibles con FQ crónica. Conclusión La FQ aguda sintomática es frecuente en nuestro medio. La afectación pulmonar fue predominante. Solo un tercio de los pacientes fueron tratados con doxiciclina. No hubo ningún seguimiento tras la primera determinación serológica en 30 pacientes (34,5%). No se evidenciaron complicaciones significativas en el curso de la infección.
PDF
