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Biomedical subjects

I Nachamkin

Publications and source records attributed to I Nachamkin.

At least 55 records · Page 3Linked to original sources
PubMed1992

Spectrum bias in the evaluation of diagnostic tests: lessons from the rapid dipstick test for urinary tract infection.

OBJECTIVE: To determine if the leukocyte esterase and bacterial nitrite rapid dipstick test for urinary tract infection (UTI) is susceptible to spectrum bias (when a diagnostic test has different sensitivities or specificities in patients with different clinical manifestations of the disease for which the test is intended). DESIGN: Cross-sectional study. PATIENTS: A total of 366 consecutive adult patients in whom clinicians performed urinalysis to diagnose or exclude UTI. SETTING: An urban emergency department and walk-in clinic. MEASUREMENTS: After the patient encounter, but before dipstick test or culture was done, clinicians recorded the signs and symptoms that were the basis for suspecting UTI and for performing a urinalysis and an estimate of the probability of UTI based on the clinical evaluation. For all patients who received urinalysis, dipstick tests and culture were done in the clinical microbiology laboratory by medical technologists blinded to clinical evaluation. Sensitivity for the dipstick was calculated using a positive result in either leukocyte esterase or bacterial nitrite, or both, as the criterion for a positive dipstick, and greater than 10(5) CFU/mL for a positive culture. RESULTS: In the 107 patients with a high (greater than 50%) prior probability of UTI, who had many characteristic UTI symptoms, the sensitivity of the test was excellent (0.92; 95% CI, 0.82 to 0.98). In the 259 patients with a low (less than or equal to 50%) prior probability of UTI, the sensitivity of the test was poor (0.56; CI, 0.03 to 0.79). CONCLUSIONS: The leukocyte esterase and bacterial nitrite dipstick test for UTI is susceptible to spectrum bias, which may be responsible for differences in the test's sensitivity reported in previous studies. As a more general principle, diagnostic tests may have different sensitivities or specificities in different parts of the clinical spectrum of the disease they purport to identify or exclude, but studies evaluating such tests rarely report sensitivity and specificity in subgroups defined by clinical symptoms. When diagnostic tests are evaluated, information about symptoms in the patients recruited for study should be included, and analyses should be done within appropriate clinical subgroups so that clinicians may decide if reported sensitivities and specificities are applicable to their patients.

Adolescent↗
PubMed1992

Local immune responses to the Campylobacter flagellin in acute Campylobacter gastrointestinal infection.

Intestinal immunoglobulin A (IgA) anti-campylobacter flagellin antibodies were measured by an enzyme-linked immunosorbent assay in patients with and without campylobacter infections. The level of fecal IgA antiflagellin antibodies was significantly higher in patients than in controls, but only 12 of 29 patients (41.4%) with a campylobacter infection had detectable IgA antibodies against flagellin (optical density, greater than or equal to 0.100). Further testing of fecal IgA antibodies from 10 patients with homologous and heterologous purified flagellins showed strain specificity in 1 patient. Cross-reactivity of fecal IgA antibodies with heterologous flagellins did not correlate with the Lior serotype of the isolate.

Antibodies, Bacterial↗
PubMed1992

Niacin-positive Mycobacterium kansasii isolated from immunocompromised patients.

Niacin-positive Mycobacterium kansasii was isolated from three patients, two with respiratory infections and one with a perirectal abscess. The isolates were phenotypically similar to other strains of M. kansasii, differing only in their ability to produce niacin. This phenotype has been reported only twice in the literature, during the 1960s.

Adult↗
PubMed1991

Common and variable domains of the flagellin gene, flaA, in Campylobacter jejuni.

The organization of the flagellin gene locus in Campylobacter jejuni strain IN1 (Lior 7) was determined using the polymerase chain (PCR) reaction and a series of oligonucleotide primers. Two tandemly arranged flagellin genes of approximately 1.7 kb were found to be joined by an intervening segment of c.0.2kb, similar to that reported for Campylobacter coli. The 5' flagellin gene, flaA, was generated by PCR and both strands sequenced. Comparison of the deduced amino acid sequence for C. jejuni FlaA with the published sequence for C. jejuni FlaA with the published sequence for C. coli FlaA showed 77% identical amino acids between the proteins. Two common regions, C1 and C2, comprising the N-terminal 170 amino acids and C-terminal 100 amino acids, exhibit amino acids 94% and 96% identical to those of C. coli, respectively. The variable region, V1, comprising the middle of the protein, shows 61% identical residues with C. coli. Comparison of these regions with other bacterial flagellins reveals a similar pattern but with much less identity. Several areas within the V1 region correspond to predicted surface-exposed regions and may represent areas in which surface epitopes are located.

Amino Acid Sequence↗
PubMed1990

Inappropriate testing for diarrheal diseases in the hospital.

To assess the degree to which routine stool cultures, ova and parasite examinations, and Clostridium difficile toxin assays may be inappropriately ordered on hospitalized patients, we conducted a retrospective study to determine the relative yield of these tests on specimens collected from outpatients and inpatients as a function of time after admission. During a 3-year period, only 1 of 191 positive stool cultures and none of the 90 ova and parasite examinations with positive results were from the group of patients who had stool specimens submitted after 3 days of hospitalization. Analysis of laboratory work load for a 1-year period showed that specimens from this patient group contributed nearly 50% of the more than 3000 specimens received each year. In contrast, approximately 25% (range, 17% to 33%) of samples, regardless of admission status, were positive for C difficile toxin. Eliminating routine stool cultures and ova and parasite examinations on hospitalized patients would significantly reduce hospital and patient costs without altering patient care. Nationwide, such a policy might achieve a cost savings of +20 to +30 million per year.

Adult↗
PubMed1990

Infection of adult Syrian hamsters with flagellar variants of Campylobacter jejuni.

Two variants of Campylobacter jejuni IN1 differing in the expression of flagella, IN1 (Fla+ Mot+, wild type) and IN1-NM (Fla- Mot-), were tested for their ability to establish infection in adult hamsters. Animals were challenged intracecally with 2 X 10(9) to 5 X 10(10) CFU and monitored for evidence of infection. None of the challenged animals developed illness. There was a significant difference, however, in the ability of IN1 to infect hamsters (35 of 43) compared with that of IN1-NM (1 of 42) (P less than 0.01). Additionally, eight animals challenged with IN1-NM excreted only the campylobacters of Fla+ phenotype, which were shown to be identical with the parental Fla+ Mot+ type. Both groups of animals developed serum immunoglobulin G antibodies to outer membrane proteins of IN1 as measured by an enzyme-linked immunosorbent assay; however, only animals that excreted Fla+ organisms developed antiflagellin antibodies. In vitro reversibility from Fla+ to Fla- occurred with a frequency of 9.2 X 10(-6) per cell per generation; however, reversion from Fla- to Fla+ could not be detected in vitro. Further characterization of IN1-NM showed that it produced a cytoplasmic 62K flagellin subunit protein, but this protein lacked six epitopes detected in IN1 and also differed in its two-dimensional gel electrophoresis pattern. The results of these studies support the concept that an intact flagellum is necessary for intestinal infection with C. jejuni and that this model may be useful for studying the immune response to C. jejuni.

Animals↗
PubMed1990

Culture confirmation of Campylobacter spp. by latex agglutination.

A commercial latex agglutination test [Meritec-Campy (jcl), Meridian Diagnostics, Cincinnati, Ohio] was evaluated for identification of Campylobacter jejuni, C. coli, C. laridis, and other Campylobacter isolates. The test had 100% sensitivity in detecting C. jejuni and C. coli but low sensitivity with C. laridis isolates. C. upsaliensis strains reacted with the test. The test had 100% specificity for 101 non-Campylobacter organisms.

Campylobacter↗
PubMed1990

DNA probe culture confirmation assay for identification of thermophilic Campylobacter species.

We studied the ability of a new DNA probe-based assay system to correctly identify isolates of the thermophilic campylobacters Campylobacter jejuni, C. coli, and C. laridis grown in vitro. We examined 424 organisms, including 214 Campylobacter isolates and 210 other aerobic and anaerobic isolates. The probe assay, which uses a new homogeneous system in which all reactions take place within a single tube, demonstrated 100% accuracy, producing neither false-positive nor false-negative results. The assay does not, however, distinguish among C. jejuni, C. coli, and C. laridis.

Campylobacter↗
PubMed1989

Comparison of gentamicin immunoassays using univariate and multivariate analyses.

Gentamicin concentrations, pharmacokinetic parameters, and calculated doses from enzyme multiplied immunoassay (EMI) and fluorescence polarization immunoassay (FPIA) were compared in 79 samples from 39 patients. Associations between patient factors and the differences between assay results were also assessed. Concentrations were lower when measured by EMI than by FPIA in 71 of the 79 samples (p less than 0.001). Mean EMI values for elimination rate constant, volume of distribution, clearance, dose, and daily dose were 10-20% higher than mean FPIA values (p less than or equal to 0.01). Dosing intervals calculated from EMI and FPIA data were different in 20 pairs of intervals and varied depending on the length of calculated interval. Univariate and multivariate analyses revealed that renal function and the presence or absence of cardiovascular disease, cimetidine, or ranitidine, and heparin were related to differences between the assay results. EMI and FPIA yielded different results for gentamicin concentrations, pharmacokinetic parameters, and calculated daily doses in the clinical setting. Such differences could result in toxic or subtherapeutic doses being administered and may be related, in part, to various patient factors.

Adult↗
PubMed1989

Human antibody response to Campylobacter jejuni flagellin protein and a synthetic N-terminal flagellin peptide.

We measured isotype-specific human antibodies directed against Campylobacter jejuni native flagellin and a synthetic peptide derived from the N-terminal amino acid sequence of the protein by using a microdilution enzyme-linked immunosorbent assay (ELISA). Serum samples from patients with gastrointestinal infection caused by C. jejuni (n = 20) and control samples (number from normal subjects = 20; number from patients with diarrhea other than campylobacter = 20) were tested in this assay. Serum specimens from patients with campylobacter infection showed statistically significant higher isotype-specific antiflagellin antibody titers than control samples did. Detection of immunoglobulin G (IgG) antibodies was less specific (70%) than detection of either IgA or IgM antibodies in infected patients (95%). The sensitivity of testing for any of the isotypes ranged from 64 to 100% in acute-phase serum specimens and 85 to 95% in convalescent-phase serum specimens. An ELISA with an N-terminal synthetic peptide derived from the flagellin protein as antigen was not sensitive (60%) for detecting campylobacter infection but was very specific (97.5%). In conclusion, detection of serum IgA or IgM against C. jejuni flagellin may be a useful marker of infection. Although the N-terminal synthetic peptide was antigenic in a few patients with infection and showed good specificity in the ELISA, additional amino acid sequences with better sensitivity for detecting infection need to be identified.

Amino Acid Sequence↗
PubMed1989

Investigation of apparent false-positive urine latex particle agglutination tests for the detection of group B streptococcus antigen.

In our nursery, we identified neonates with positive urine latex particle agglutination (LPA) tests for group B streptococcus (GBS) antigen who did not have corroborating cultural evidence of infection. To investigate the mechanisms underlying these apparent false-positive reactions, we examined the urine LPA test in an unselected population of neonates suspected of sepsis. Urine specimens for LPA testing and culture and simultaneous perirectal cultures were obtained from 134 neonates with suspected sepsis. Six infants had positive blood cultures for GBS; four of the six were positive by LPA testing. An additional 20 infants had positive LPA tests but negative blood cultures; of these, 13 had mothers who received antibiotic treatment prior to delivery. Two infants with positive LPA results and negative blood cultures had bacteria isolated from urine cultures obtained in a nonsterile fashion (GBS, Escherichia coli). GBS was not isolated from perirectal swabs of infants with positive LPA tests and negative blood cultures. In conclusion, (i) a high proportion of neonates evaluated for sepsis gave positive LPA tests and negative blood cultures, (ii) local contamination of the perirectal skin or urinary tract with GBS was an unlikely source of false-positive LPA reactions, and (iii) maternal antibiotic pretreatment during labor may represent an important cause of apparent false-positive LPA reactions.

Anti-Bacterial Agents↗
PubMed1988

In vitro activity of amdinocillin in combination with other beta-lactam antibiotics against aminoglycoside-susceptible and resistant gram-negative bacteria.

Amdinocillin alone and in combination with other beta-lactam antibiotics was tested for in vitro activity against aminoglycoside-susceptible and resistant gram-negative bacteria. Amdinocillin alone or in combination with ampicillin, ticarcillin, piperacillin, cefazolin, cefoxitin, and cefamandole had little to no activity against aminoglycoside-resistant E. coli, E. cloacae, K. pneumoniae, and S. marcescens. There was better activity with aminoglycoside-susceptible organisms, however, Overall, there was significantly more antagonism of amdinocillin combinations when tested with aminoglycoside-resistant organisms than with aminoglycoside-susceptible strains.

Amdinocillin↗
PubMed1988

Direct wet mounts versus concentration for routine parasitological examination: are both necessary?

The authors evaluated the usefulness of direct wet mount microscopic examination of stool samples for routine parasitologic diagnosis compared with formalin-ethyl acetate concentration detection. Over a three-year period, there were no instances in which an intestinal parasite was detected only by the direct wet mount examination. Elimination of routine direct wet mount examinations can reduce laboratory cost and save significant technologist time without decreasing the sensitivity of microscopic examinations for common parasitic agents.

Costs and Cost Analysis↗
PubMed1988

Evaluation of a latex agglutination test for the detection of Salmonella and Shigella spp. by using broth enrichment.

We evaluated the Bactigen Salmonella-Shigella Latex Agglutination Slide Test (Wampole Laboratories, Div. Carter-Wallace, Inc., Cranbury, N.J.) for detection of Salmonella and Shigella spp. in enrichment broth cultures (gram-negative broth incubated for 24 h) as part of the routine testing of stool samples. A total of 1,128 stool samples were screened by using this test. Of 29 samples culture positive for Salmonella spp., 25 were positive with the Salmonella test (sensitivity, 86.2%; specificity, 96.2%). Of four stool samples culture positive for Shigella spp., two were detected with the Shigella latex reagent. Overall, the Shigella test had a specificity of 99.2%. Testing of enrichment broth cultures after 24 h of incubation was more sensitive than was testing after 6 h of incubation. When used for direct culture identification, both reagents had a specificity of greater than 98.0%. We conclude that the Salmonella test may be useful as an enrichment broth screening test to detect Salmonella spp.; however, we cannot make any conclusions about the Shigella test because of the low number of culture-positive specimens in this study.

Diarrhea↗
PubMed1988

Multiply high-level-aminoglycoside-resistant enterococci isolated from patients in a university hospital.

Enterococci isolated from different body sites were tested for high-level gentamicin resistance. A total of 259 enterococcal isolates were screened for resistance (MIC, greater than 2,000 micrograms/ml) by a broth-tube method. Thirty-nine (15.1%) were found to exhibit resistance and were confirmed by agar screening (1,000 micrograms/ml) and agar dilution MIC determinations. The majority of isolates also showed high-level resistance to kanamycin and streptomycin. The remaining isolates showed high-level resistance to gentamicin and kanamycin but not streptomycin. Synergy testing of several isolates confirmed the correlation between lack of synergy and high-level resistance. A retrospective clinical review was performed. Most patients had a source of definite or likely infection (79%). Serious infections such as endocarditis or meningitis were not observed during the course of this study. Retrospective clinical data suggest that in cases not involving endocarditis or meningitis, neither infection refractory to therapy nor relapse of infection is a common sequela of infection with gentamicin-resistant enterococci in hospitalized patients.

Anti-Bacterial Agents↗