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PubMed1997

Clinical evaluation of technetium-99m infecton for the localisation of bacterial infection.

The aim of the study was to distinguish infection from inflammation in patients with suspected infection using technetium-99m Infecton. Ninety-nine patients (102 studies) referred for infection evaluation underwent imaging with 400 MBq 99mTc-Infecton at 1 and 4 h. Most patients had appropriate microbiological tests and about half (56) had radiolabelled white cell scans as well. No adverse effects were noted in any patient. The clinical efficacy of 99mTc-Infecton depended in part on whether imaging was undertaken during antibiotic therapy for infection or not. In consultation with the microbiologist, 5-14 days of appropriate and successful antibiotic therapy was considered adequate to classify some results as true-negatives. The figures for sensitivity and specificity of 99mTc-Infecton for active or unsuccessfully treated infection were 83% and 91% respectively. It is concluded that 99mTc-Infecton imaging contributed to the differential diagnosis of inflammation. It is being used as the first imaging modality when bacterial infection is suspected.

Adolescent↗
PubMed1993

Hip aspiration: a cost-effective and accurate method of evaluating the potentially infected hip prosthesis.

PURPOSE: The accuracy of fluoroscopy-guided hip aspiration in the diagnosis of infection in hip prostheses was evaluated. MATERIALS AND METHODS: Results from 147 preoperative aspiration cultures were compared with results of operative cultures. The relative costs of aspiration and nuclear medicine studies were also compared. RESULTS: With the operative culture results as the standard, sensitivity of hip aspiration was 92.8% and specificity was 91.7%. The negative and positive predictive values were 99.2% and 54.2%, respectively. Aspiration arthrography costs approximately 20% as much as complementary technetium sulfur colloid-indium-111 granulocyte scans, the most accurate nuclear medicine study used to evaluate potentially infected hip prostheses. CONCLUSION: Hip aspiration is an accurate and cost-effective method of evaluating the potentially infected hip prosthesis.

Bacteria↗
PubMedDate not supplied

CT evaluation of mediastinal infections.

Of 104 patients evaluated for thoracic sepsis by CT, 22 patients had both CT and clinical evidence of mediastinal infections. The CT findings in these patients were reviewed and compared with a control group of seven postoperative patients following uncomplicated median sternotomy. Based on CT appearance, patients were classified into one of three groups: (a) diffuse soft tissue infiltration with or without gas (i.e., mediastinitis) (10 patients); (b) focal mediastinal abscess (four patients); (c) mediastinal infection associated with empyema or subphrenic abscess (eight patients). Computed tomography proved reliable in distinguishing diffuse mediastinitis from a localized drainable abscess. However, in the absence of mediastinal gas, CT could not differentiate mediastinitis from benign postoperative changes. Computed tomography was helpful in identifying associated empyemas and a variety of other secondary complications. In five of six patients with mediastinal abscess, CT demonstrated communication or contiguity with four empyemas and one subphrenic abscess. Closed chest tube drainage of the empyemas and percutaneous drainage of the subphrenic abscess combined with antibiotic therapy were successful in treating the mediastinal abscess in these five patients. Although overall mortality for mediastinal infection in this series was 27%, there was a 50% mortality for patients with diffuse mediastinitis.

Abscess↗
PubMed2006

Association between intestinal parasitic infections and type of sanitation system in rural El Salvador.

OBJECTIVE: To identify demographic, behavioural and environmental determinants of intestinal parasitic infection, evaluate the impact of a variety of dry sanitation systems on intestinal parasitic infection, and evaluate the safety of using stored biosolids in agriculture in order to guide future sanitation interventions in rural areas of El Salvador. METHODS: Interviews were conducted with 109 households in eight communities where double-vaulted and solar urine-diverting desiccating latrines, pit latrines or no latrines were used. Faecal samples from 499 individuals were tested for enteric helminths and protozoa. RESULTS: Users of solar desiccating latrines had the lowest prevalence of enteric parasite infection. Double-vault, urine-diverting desiccating latrines effectively reduced the transmission of some pathogens, but may not achieve the conditions sufficient for the complete destruction of the more environmentally persistent pathogens, Ascaris lumbricoides and Trichuris trichiura. Contact with inadequately treated latrine biosolids was associated with an increased risk of Ascaris infection. CONCLUSIONS: Solar latrines were associated with the overall lowest prevalence of enteric parasitic infections. Members of households where latrine biosolids were used in agriculture had a higher prevalence of infection than those where biosolids were buried. We therefore recommend the promotion of solar latrines in rural areas of El Salvador over other dry sanitation systems, and recommend that stored biosolids not be used in agriculture.

Adolescent↗
PubMed2006

Inappropriate use of antibiotic prophylaxis to prevent infective endocarditis in obstetric patients.

OBJECTIVE: To evaluate infective endocarditis prophylaxis practices during the intrapartum period and to assess obstetric providers' adherence to the American Heart Association and American College of Obstetrics and Gynecology guidelines for infective endocarditis prophylaxis. METHODS: We performed a chart review of pharmacy, electronic nursing, and physician records to report this case series of obstetric patients who received infective endocarditis prophylaxis during the intrapartum period at a single tertiary referral care center during a 1-year study period from August 1, 2004, to July 31, 2005. RESULTS: Fifty patients received antibiotics for infective endocarditis prophylaxis. Three of the 50 patients who received infective endocarditis prophylaxis had high-risk cardiac lesions and three other patients had moderate-risk cardiac lesions and evidence for intrapartum infection. Thus, only six patients (12.0%, 95% confidence interval 4.5%-24.3%) met the American Heart Association and American College of Obstetricians and Gynecologists criteria for an appropriate indication for infective endocarditis prophylaxis. Of these six patients who had an appropriate indication for infective endocarditis prophylaxis, only three (50.0%, 95% confidence interval 11.8%-88.2%) received appropriate antibiotic regimens. CONCLUSION: Antibiotics are frequently given to obstetric patients during pregnancy. Although many obstetric patients receive antibiotics for recommended indications, some patients, as our study shows, do not. A concerted effort by all practitioners and institutions to reduce the amount of inappropriate antibiotics given to obstetric patients will have positive public health effects in addition to benefiting individual mothers and neonates.

Anti-Bacterial Agents↗
PubMed1984

Timentin versus piperacillin or moxalactam in the therapy of acute bacterial infections.

In a randomized comparative study, 116 patients with acute bacterial infections were treated with timentin (ticarcillin plus clavulanic acid) or a comparative agent (piperacillin for respiratory or urinary tract infections, and moxalactam for soft tissue infections). There were 91 clinically evaluated infections (timentin, 46; piperacillin, 29; moxalactam, 16). Twelve patients were bacteremic. A satisfactory clinical response occurred in all 46 patients treated with timentin and in 42 of the 45 treated with a comparative agent. Two clinical failures were due to superinfection (a Staphylococcus aureus pneumonia in the piperacillin group and an enterococcal skin infection in the moxalactam group), and one clinical failure was due to a primary S. aureus skin infection (moxalactam group). One wound isolate of Pseudomonas aeruginosa developed resistance to timentin during therapy (despite clinical improvement). Adverse reactions were uncommon but did include one patient treated with timentin who developed unexplained hallucinations.

Acute Disease↗
PubMed1997

Duration of Borrelia burgdorferi infectivity in white-footed mice for the tick vector Ixodes scapularis under laboratory and field conditions in Ontario.

The duration of Borrelia burgdorferi infectivity in white-footed mice (Peromyscus leucopus) experimentally inoculated or infested with infected Ixodes scapularis nymphs was evaluated. Infectivity was assessed by infesting these mice with unfed I. scapularis larvae at 7, 21, 35 and 49 days post-inoculation (DPI) or post-infestation (PI). At 7 DPI, B. burgdorferi was transmitted from 18 of 24 syringe-inoculated mice and all three tick-infected mice to I. scapularis larvae which fed upon them. However, at 21, 35 and 49 DPI, significantly fewer mice were infective. Borrelia burgdorferi was isolated from tissues of 14 of 22 syringe-inoculated mice about 56 DPI, and from all three tick-infected mice. However, the level of agreement between xenodiagnosis and bacterial culture was no greater than would be expected by chance alone. We also determined if B. burgdorferi infectivity of mice varied in relation to periods of tick feeding in the field. White-footed mice were trapped during April, July and August 1993 from two habitats on Long Point peninsula (Ontario, Canada), where B. burgdorferi is endemic. Mice from each habitat were infested with laboratory-reared I. scapularis larvae. Ticks from each mouse were subsequently examined by immunofluorescent assay for B. burgdorferi infection and mice were cultured for B. burgdorferi. None of 3577 I. scapularis larvae fed on 62 mice captured within the cottonwood dune habitat were infected with B. burgdorferi, although it was isolated from six of these mice. Within the maple forest habitat, 0/24, 8/21 (38%) and 1/21 (5%) mice transmitted B. burgdorferi to I. scapularis larvae during April, July and August, respectively. Most mice from the maple forest with B. burgdorferi-positive tissues (14/21) were collected during July, although the level of agreement between xenodiagnosis and tissue culture was poor. Because B. burgdorferi infectivity in mice appears to be of short duration, overwintered I. scapularis larvae and nymphs may have to feed upon infected hosts at the same time of year in order for a cycle of B. burgdorferi infection to be maintained on Long Point. Infected I. scapularis nymphs, rather than persistently infected vertebrate hosts, likely serve as the overwintering "reservoir" for B. burgdorferi on Long Point.

Animals↗
PubMed1989

Antimicrobial agents in the management of urinary tract infection: an experimental evaluation.

Persistent and recurrent infections of the urinary tract are a formidable clinical problem, but several recently developed antibiotics have properties that suggest an increased ability to eradicate such infections. Three of the new-generation antibiotics were compared with established agents by using animal models of urinary tract infection. Of the antibiotics tested, gentamicin and ceftriaxone alone were capable of eradicating infection from acute and chronically infected kidney tissue. Chronic lower urinary tract infection was best managed by using norfloxacin or ceftriaxone. Gentamicin, aztreonam, cotrimoxazole and ampicillin were much less effective. In subacute pyelonephritis, gentamicin, aztreonam, norfloxacin and ceftriaxone successfully eliminated microorganisms from most of the infected kidneys, whereas ampicillin and cotrimoxazole had little effect on bacterial numbers. The data have provided an experimental basis for the selection of antibiotics in the management of persistent urinary tract infection.

Acute Disease↗
PubMed1995

Household contact study of Bordetella pertussis infections.

Household contacts of primary pertussis cases were evaluated. Infection was determined by culture, direct fluorescent antibody assay, and serological criteria. Agglutinin titers and values of ELISA IgG and IgA antibodies to lymphocytosis-promoting factor, filamentous hemagglutinin, and pertactin were determined. In 39 households 255 subjects were exposed; 114 remained well (group 1), 53 had mild illness (group 2), and 88 had pertussis (group 3). The infection rates were 46% (group 1), 43% (group 2), and 80% (group 3). In a subgroup of subjects seen within 14-28 days of exposure, it was found that none with clinical pertussis had a value of IgG antibody to pertactin in acute-phase sera of > or = 50 ELISA units (EU) per mL or an agglutinin titer of > 256. Of the primary cases, 53% were > or = 13 years of age. These data point out the importance of Bordetella pertussis infections in adolescents and adults as a source of infection in young children. Our subgroup data suggest that high values of antibody to pertactin and high agglutinin titers may be predictive of protection against clinical pertussis.

Adhesins, Bacterial↗
PubMed2003

Evaluation of cytomegalovirus infections transmitted via breast milk in preterm infants with a real-time polymerase chain reaction assay.

OBJECTIVE: Preterm infants are at greater risk of symptomatic cytomegalovirus (CMV) infection than term infants. Breast milk is the main source of perinatal CMV infections. This study evaluated the kinetics of CMV load in breast milk and the rate of postnatal CMV transmission via breast milk from mothers to their preterm infants. METHODS: This was a prospective study of 30 mothers and their 43 preterm infants. The infants either had a gestational age of <34 weeks or weighed <2000 g at birth. Breast milk, serum, and urine samples were collected every 2 weeks until discharge, and screened for CMV infection using a real-time PCR assay. Most of the breast milk had been preserved at -20 degrees C before feeding to the preterm infants. RESULTS: Twenty-four mothers (24 of 30, 80%), who had 34 preterm infants, were CMV immunoglobulin G positive. Twenty-one (87.5%) of the 24 seropositive mothers, who had 30 preterm infants, had detectable CMV deoxyribonucleic acid (DNA) in breast milk during the study period. Most breast milk became positive for CMV DNA 2 weeks after delivery. Viral DNA copy numbers increased until they peaked at 4 to 6 weeks. Afterward, the CMV DNA copy numbers decreased. Of the 30 infants who were fed CMV DNA-positive breast milk, CMV infection was confirmed in 3 infants. However, they had no clinical symptoms of CMV infection. CONCLUSIONS: Despite the high rate of CMV DNA in breast milk, symptomatic infections in the preterm infants did not occur. These results might be associated with the method of breast milk preservation and the population we studied. CMV infections transmitted via breast milk feeding did not have much impact on preterm infants in our institutes.

Antibodies, Viral↗
PubMed1983

Polymorphonuclear leukocytes: dedicated professional phagocytes.

Polymorphonuclear leukocytes are termed professional phagocytes because they are specially equipped to seek and destroy invading microorganisms. Polymorphonuclear leukocytes are formed in the bone marrow and released into the circulation, where they are transported to the tissues. At sites of tissue invasion by microorganisms, humoral factors are released that induce these cells to leave the bloodstream and enter the tissues. Chemotactic substances guide polymorphonuclear leukocytes to the infecting organisms. Antibody and complement can function as opsonins and enhance the ability of polymorphonuclear leukocytes to engulf microbes. Ingested organisms are killed by oxidative or nonoxidative systems. Defects in the various aspects of polymorphonuclear leukocyte function may be found in patients with recurrent, severe, or unusual infections. Evaluation of selected patients with recurrent infections should include tests of polymorphonuclear leukocyte function.

Bacterial Infections↗
PubMed1993

Primary human immunodeficiency virus type 1 infection: review of pathogenesis and early treatment intervention in humans and animal retrovirus infections.

Primary human immunodeficiency virus type 1 (HIV-1) infection can present clinically as the abrupt onset of a febrile illness resembling acute mononucleosis. The symptoms coincide with high titers of culturable plasma viremia, cell-associated virus, and antigenemia, which rapidly decrease coincident with the emergence of detectable HIV-specific antibody and HIV-specific cytotoxic T lymphocytes. This article reviews the human and animal model data on the virologic and immunologic events that occur during primary HIV-1 and animal retrovirus infections, evaluates the prophylactic treatment experience of retrovirus infections in the animal model, and provides a plausible rationale for treatment intervention of primary HIV-1 infection in humans. Recent work delineating the pathogenesis of primary HIV-1 infection provides insight into the major mechanisms of viral dissemination and host immune response. The results from retrovirus-infected animal models treated with antiviral agents suggests that therapy at the time of viral dissemination may be an effective strategy that may modify disease progression. Clinical trials to evaluate this approach are in progress.

Animals↗
PubMed2005

[Postoperative endophthalmitis: 2000-2002 results in the XV-XX National Ophthalmologic Hospital].

PURPOSE: Prevention of nosocomial infection is a priority for the Infection Control Committee (ICC). Following their recommendations, the XV-XX National Ophthalmologic Hospital's ICC conducted a survey on cases of infection and we report these results for the 2000-2002 period. METHODS: During the 2000-2002 period, 21,384 programmed intraocular surgeries were done. Every day, a hygiene coordinator was informed of each bacterial or fungal laboratory test on intraocular samples and for all patients who were hospitalized for endophthalmitis. After data analysis with a referent ICC physician, resulting infection was declared postoperative nosocomial endophthalmitis. For these patients, prophylactic antibiotic use, the surgery report, and bacterial laboratory test results were reviewed. RESULTS: The overall 3-year incidence of suspected postoperative endophthalmitis after intraocular surgery was 2.0 per 1000 (42 cases). Confirmed microbiological growth was demonstrated in 19 cases (45%). For cataract surgery, the incidence was 1.0 per 1000 for acute-onset culture-proven postoperative endophthalmitis, 0.1 per 1000 for delayed culture-proven postoperative endophthalmitis, 2.1 per 1000 for acute-onset suspected postoperative endophthalmitis and 0.5 per 1000 for delayed suspected postoperative endophthalmitis. Gram-positive cocci were isolated in 77%. Twenty-one patients received systemic prophylactic antibiotics. Bacterial growth was positive in five of these 21 cases. For two cases, organisms were resistant to the prophylactic antibiotics used. CONCLUSION: Monitoring postoperative nosocomial infection is mandatory to detect incidence variation and evaluate infection control management. Prophylactic antibiotic efficacy remains to be evaluated.

Adult↗
PubMed2001

Evaluating HIV-infected patients with headache: who needs computed tomography?

OBJECTIVE: To empirically test a clinical prediction rule for evaluating HIV-infected patients complaining of headache and to identify those at low risk for intracranial mass lesion who do not need immediate computed tomography of the head. DESIGN: Two retrospective clinical cohorts of HIV-infected patients clinically evaluated for headache. METHODS: To describe the headache clinical outcomes, medical records were abstracted from all HIV-infected patients evaluated for headache with computed tomography of the head at two urban hospitals. Patients were categorized as low, intermediate, or high risk based on clinical criteria (focal neurological signs, altered mental status, history of seizure) and immune status (CD4 lymphocytes < or =200 microL). Records were abstracted from a second unselected cohort of HIV-infected outpatients with headache who were all treated and followed in primary care (N=101). RESULTS: Of 101 unselected HIV-infected outpatients followed in primary care after headache, 1% (95% confidence interval [CI], 0% to 6%) had a treatable intracranial lesion. Of 364 HIV-infected patients with headache sent for evaluation with computed tomography of the head, the rate of any abnormality was zero in the low-risk group (95% CI, 0% to 10%; n=35); 9% in the intermediate-risk group (95% CI, 2% to 16%; n=242); and 21% in the high-risk group (95% CI, 12% to 29%; n=87). CONCLUSION: Most HIV-infected patients with headache may be treated with analgesics and followed up clinically. Those without focal neurological signs, altered mental status, seizure, or decreased CD4 lymphocytes are unlikely to have intracranial mass lesions.

Adult↗
PubMed1999

Effects of the human CD38 glycoprotein on the early stages of the HIV-1 replication cycle.

CD38 displays lateral association with the HIV-1 receptor CD4. This association is potentiated by the HIV-1 envelope glycoprotein gp120. The aim of this work was to evaluate the CD38 role in T cell susceptibility to HIV-1 infection. Using laboratory X4 HIV-1 strains and X4 and X4/R5 primary isolates, we found that CD38 expression was negatively correlated to cell susceptibility to infection, evaluated as percentage of infected cells, release of HIV p24 in the supernatants, and cytopathogenicity. This correlation was at first suggested by results obtained in a panel of human CD4(+) T cell lines expressing different CD38 levels (MT-4, MT-2, C8166, CEMx174, Supt-1, and H9) and then demonstrated using CD38 transfectants of MT-4 cells (the line with the lowest CD38 expression). To address whether CD38 affected viral binding, we used mouse T cells that are non-permissive for productive infection. Gene transfection in mouse SR.D10.CD4(-).F1 T cells produced four lines expressing human CD4 and/or CD38. Ability of CD4(+)CD38(+)cells to bind HIV-1 or purified recombinant gp120 was significantly lower than that of CD4(+)CD38(-) cells. These data suggest that CD38 expression inhibits lymphocyte susceptibility to HIV infection, probably by inhibiting gp120/CD4-dependent viral binding to target cells.-Savarino, A., Bottarel, F., Calosso, L., Feito, M. J., Bensi, T., Bragardo, M., Rojo, J. M., Pugliese, A., Abbate, I., Capobianchi, M. R., Dianzani, F., Malavasi, F., and Dianzani, U. Effects of the human CD38 glycoprotein on the early stages of theHIV-1 replication cycle.

ADP-ribosyl Cyclase↗
PubMed1985

Evaluation of spinal infections by plain radiographs, computed tomography, intrathecal metrizamide, and CT-guided biopsy.

16 cases of spinal infection were reviewed to evaluate the usefulness of plain radiographs, noncontrast computed tomography (CT), computed tomographic metrizamide myelography (CTMM), plain film metrizamide myelography, and CT-guided biopsy techniques. Noncontrast CT was more useful than plain films in the evaluation of disc space and bony involvement and soft tissue extension of infection into the paraspinal spaces. CTMM was needed for evaluation of epidural or subdural involvement of infection in the cervical and thoracic spine, while plain film metrizamide myelography was useful as a survey for CTMM. CT-guided biopsy was definitive in establishing the etiology of the offending organism.

Adolescent↗
PubMed1976

A modified leukocyte nitroblue tetrazolium test in acute bacterial infection.

The increased ability to leukocytes to reduce nitroblue tetrazolium (NBT) has been used to detect the presence of systemic bacterial infection. This test has been utilized to evaluate infections and leukocyte dysfunction in children, but has not been extensively applied to traumatized patients or infected volunteers. Moreover, the technic as originally described presented methodologic difficulties. In this study of 889 such patients, a modified NBT test provided excellent differentiation of 63 systemic bacterial infections (NBT score greater than or equal to 10%) from non-infectious fevers, local enteric diseases, and certain viral and plasmodial infections (NBT score less than or equal to 9%). Splenectomy was associated with a transient false-positive score and clinical typhoid fever with a false-negative response

Acute Disease↗
PubMed2000

Adoptive transfer of immunity with intraepithelial lymphocytes in Cryptosporidium parvum-infected severe combined immunodeficient mice.

BACKGROUND: Intestinal infections with the protozoan parasite Cryptosporidium parvum are prevalent in both immunocompetent and immunocompromised hosts. Although C parvum is an important cause of outbreaks and opportunistic infections worldwide, little is known about protective mucosal immune responses. This is in part because animal models of infection are limited to those with genetic or induced immunodeficiencies. METHOD: In this report, we isolated immune (primed) or nonimmune (unprimed) intraepithelial lymphocytes (IEL) from BALB/cJ mouse intestines, adoptively transferred them into C parvum-infected severe combined immunodeficient (SCID) mice, and evaluated infection and cell phenotype responses. RESULTS: Control SCID mice that received no IEL shed large numbers of oocysts throughout the experimental period (day 18 to day 72). Transfer of primed IEL significantly reduced fecal oocyst shedding in recipient SCID mice compared with SCID mice that received unprimed IEL or no IEL. SCID mice transferred with unprimed IEL shed variable numbers of fecal oocysts that increased and decreased in bursts until day 57 after infection. SCID mice transferred with primed IEL exhibited significantly higher proportions of T-cell receptor (TCR) alphabeta+, CD8+, and CD8alphabeta+ EL compared with inoculated SCID mice that received unprimed or no IEL. CONCLUSION: We conclude that primed IEL from immunocompetent mice may influence protective mucosal response against cryptosporidiosis when transferred into SCID mice. In addition, the increased percentage of TCR alphabeta+, CD8+, CD8alphabeta+ IEL in recipient SCID mice may reflect mucosal cell populations involved in these responses during chronic C parvum infection.

Adoptive Transfer↗