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1.
C. Maoz D. Shitrit Z. Samra N. Peled L. Kaufman M. R. Kramer J. Bishara 《European journal of clinical microbiology & infectious diseases》2008,27(10):945-950
To identify the clinical and radiological features distinguishing Mycobacterium simiae respiratory infection from pulmonary tuberculosis, the demographics, underlying conditions, and clinical and radiological
findings of 121 consecutive patients with pulmonary tuberculosis and 102 with M. simiae respiratory infection were compared retrospectively. In the M. simiae group, the patients were older (mean age 69 ± 16 years vs. 47 ± 21 years, p = 0.0001), with a female predominance (62% vs. 45%, p = 0.008). Only 4% were of Ethiopian origin compared to 25% of the tuberculosis group (p = 0.0001). M. simiae infection was associated with significantly higher rates of smoking history, underlying chronic obstructive pulmonary disease,
zero human immunodeficiency virus (HIV) infection compared to 10% in the tuberculosis group (p = 0.001), blunted symptoms, and noncavitary infiltrates in the lower/middle lobes on chest X-ray. HIV-negative patients with
M. simiae respiratory infection are distinguishable from patients with pulmonary tuberculosis by several demographic, clinical, and
radiological features. These findings have important diagnostic and therapeutic implications. 相似文献
2.
Wahiba Sakly Amani Mankaï Nabil Sakly Yosra Thabet Achouak Achour Leila Ghedira-Besbes Moncef Jeddi Ibtissem Ghedira 《Endocrine pathology》2010,21(2):108-114
Anti-Saccharomyces cerevisiae antibodies (ASCA) have been described in many autoimmune diseases in which there is an increased intestinal permeability.
Also in type 1 diabetes (T1D), there is an increased intestinal permeability. Since no data are available about ASCA in T1D,
we evaluated, retrospectively, the frequency of ASCA in this disease. ASCA, IgG, and IgA, were determined by ELISA in sera
of 224 T1D patients in which coeliac disease has been excluded and 157 healthy control group. The frequency of ASCA (IgG or
IgA) was significantly higher in T1D patients than in the control group (24.5% vs. 2.5%, p < 10−7). The same observation was found in children and in adult patients when we compare them to healthy children and blood donors
group respectively. Compared to children, adult patients with T1D showed significantly higher frequencies of ASCA of any isotype
(38% vs. 13.7%, p < 10−4), both ASCA IgG and IgA (12% vs. 1.6%, p = 0.002), ASCA IgG (35% vs. 9.8%, p < 10−5) and ASCA IgA (15% vs. 5.6%, p = 0.001). The frequency of ASCA was statistically higher in females of all T1D than in males (30.8% vs.17.7%, p = 0.03), in girls than in boys (22% vs.6.2%, p = 0.017), and significantly higher in men than in boys (35.7% vs. 6.2%, p < 10−4). The frequency of ASCA IgG was significantly higher than that of ASCA IgA in all T1D patients (21% vs. 9.8%, p < 0.002), in all females (26.5% vs. 10.2%, p < 0.002), in women (37.9% vs. 12%, p < 0.001). The frequency of ASCA was significantly higher in all long-term T1D than in an inaugural T1D (29% vs. 14.5%, p = 0.019). The same observation was found in adults (45.8% vs. 17.8%, p = 0.01). In long-term T1D patients, ASCA were significantly more frequent in adults than children (45.8% vs. 14.5%, p < 10−4). The frequency of ASCA IgG was significantly higher in long-term T1D than in an inaugural T1D (25.2% vs. 11.6%, p = 0.03). Patients with T1D had a high frequency of ASCA. 相似文献
3.
V. G. Alexiou A. Michalopoulos G. C. Makris G. Peppas G. Samonis M. E. Falagas 《European journal of clinical microbiology & infectious diseases》2012,31(4):557-566
We sought to identify risk factors for postoperative infections, caused by multi-drug-resistant gram-negative bacteria (MDR-GNB)
in surgical patients. This was a retrospective cohort study among patients hospitalized in the intensive care unit (ICU) for
more than 5 days, following general surgical operations. Comparison of patients who developed infection caused by MDR-GNB
with the remainder of the cohort showed that every minute of operative time, use of special treatments during hospitalization
(antineoplastic, immunosuppressive or immunomodulating therapies), every day of metronidazole, and every day of carbapenems
use, increased patients’ odds to acquire an infection caused by MDR-GNB by 0.7%, 8.9 times, 9%, and 9%, respectively [OR (95%
CI): 1.007 (1.003–1.011), p = 0.001; 8.9 (1.8–17.3), p = 0.004; 1.09 (1.04–1.18), p = 0.039; 1.09 (1.01–1.18), p = 0.023, respectively]. The above were adjusted in the multivariable analysis for the confounder of time distribution of
infections caused by MDR-GNB. Finally, the secondary comparison, with patients that did not develop any infection, showed
that patients who had received antibiotics, within 3 months prior to admission, had 3.8 times higher odds to acquire an infection
caused by MDR-GNB [OR (95% CI): 3.8 (1.07–13.2), p = 0.002]. This study depicts certain, potentially modifiable, risk factors for postoperative infections in patients hospitalized
in the ICU for more than 5 days. 相似文献
4.
Y. Bitterman A. Laor S. Itzhaki G. Weber 《European journal of clinical microbiology & infectious diseases》2010,29(4):391-397
The purpose of this study was to identify differences in the sensitivity of anatomical sites sampling for methicillin-resistant
Staphylococcus aureus (MRSA) colonization related to age, gender, clinical situation, and acquisition source as a base for screening protocols.
We used a database that included all MRSA-positive cultures (Carmel Medical Center, 2003–2006) taken from nares, throat, perineum,
and infection sites. The study population of 597 patients was divided into: “screening sample” (SS), which were cases of routine
screening, and “clinical diagnostic sample” (CDS), which were patients with concurrent MRSA infection. MRSA acquisition sources
were classified as internal medicine, surgical, referral patients, or intensive care unit (ICU). CDS patients were older than
SS patients (median age 78 vs. 74 years, p = 0.0002), more commonly throat colonized (47.5% vs. 31.8%, p = 0.0001), and colonized in more multiple sites (65.7% vs. 43.3% were colonized in three sites in the CDS and SS groups,
respectively, p < 0.001) than SS patients. In the SS, group throat colonization was higher in internal medicine wards than in the ICU (odds
ratio [OR] = 3.98, p < 0.0001). In the CDS group, perineal colonization was more common in referral patients than in the ICU (OR = 4.52, p < 0.05). Patient age was the most influential factor on nares and multiple sites colonization in the SS and CDS groups, respectively.
Our data support multiple sites sampling. Throat cultures are crucial in MRSA-infected patients and internal medicine ward
patients. Multiple body sites colonization is more likely in older or MRSA-infected patients, affecting decisions regarding
eradication using topical antibiotics. 相似文献
5.
6.
Leh S Hultström M Rosenberger C Iversen BM 《Virchows Archiv : an international journal of pathology》2011,459(1):99-108
In chronic renal disease, the temporal and spatial relationship between vascular, glomerular and tubular changes is still
unclear. Hypertension, an important cause of chronic renal failure, leads to afferent arteriolopathy, segmental glomerulosclerosis
and tubular atrophy in the juxtamedullary cortex. We investigated the pathological changes of hypertensive renal disease in
aged spontaneously hypertensive rats using a large number of serial sections, where we traced and analyzed afferent arteriole,
glomerulus and proximal tubule of single nephrons. Our major finding was that both afferent arteriolopathy and glomerular
capillary collapse were linked to tubular atrophy. Only nephrons with glomerular collapse (n = 13) showed tubules with reduced diameter indicating atrophy [21.66 ± 2.56 μm vs. tubules in normotensive Wistar Kyoto rats
(WKY) 38.56 ± 0.56 μm, p < 0.05], as well as afferent arteriolar wall hypertrophy (diameter 32.74 ± 4.72 μm vs. afferent arterioles in WKY 19.24 ± 0.98 μm,
p < 0.05). Nephrons with segmental sclerosis (n = 10) did not show tubular atrophy and tubular diameters were unchanged (35.60 ± 1.43 μm). Afferent arteriolar diameter negatively
correlated with glomerular capillary volume fraction (r = −0.36) and proximal tubular diameter (r = −0.46) implying reduced glomerular and tubular flow. In line with this, chronically damaged tubules showed reduced staining
for the ciliary protein inversin indicating changed ciliary signalling due to reduced urinary flow. This is the first morphological
study on hypertensive renal disease making correlations between vascular, glomerular and tubular components of individual
nephron units. Our data suggest that afferent arteriolopathy leads to glomerular collapse and reduced urinary flow with subsequent
tubular atrophy. 相似文献
7.
M. L. Fernández Guerrero J. González López M. Górgolas 《European journal of clinical microbiology & infectious diseases》2010,29(10):1271-1275
The purposes of this paper was to discover whether cirrhosis is a predisposing cause of infectious endocarditis (IE) and to
determine the microbiology, prognosis and the role of cardiac surgery on mortality. A review of cases of IE at a university-affiliated
hospital over a period of 10 years was conducted. Thirty-one (9.8%) patients among 316 cases of IE had hepatic cirrhosis.
Valve disorders were present in 62.2% of cirrhotic patients and infection occurred on the aortic (48%) and mitral valves (45%).
Endocarditis was hospital-acquired in 14 (45%) and 11 (17.7%) cirrhotic patients and controls, respectively (odds ratio [OR]
3.82; 95% confidence interval [CI]: 1.46–9.99; p = 0.005). Staphylococcus aureus was the most common causative microorganism, but β-hemolytic streptococci were most frequently isolated in cirrhotic patients
(OR 8.75; 95% CI: 1.7–45.2; p = 0.001). Renal failure was more frequent in patients with cirrhosis (OR 8.23; 95% CI: 3.06–22.2; p = 0.001). Cirrhotic patients had a higher mortality (51% vs. 17.7%; OR 4.95; 95% CI: 1.89–12.91; p = 0.001) associated with the severity of liver disease. Valve replacement was performed less frequently in cirrhotic patients
(56.2% vs. 92%) and the operative mortality was extremely high in patients at stages B and C. Hepatic cirrhosis is a frequent
comorbid condition in patients with endocarditis. Due to the presence of severe hepatic dysfunction, cardiac surgery is not
undertaken even when indicated and mortality is high in stages B and C. Endocarditis is a serious hazard for hospitalized
cirrhotic patients. 相似文献
8.
Outinen TK M?kel? S Huhtala H Hurme M Meri S P?rsti I Sane J Vaheri A Syrj?nen J Mustonen J 《European journal of clinical microbiology & infectious diseases》2012,31(6):957-963
Our aim was to investigate whether plasma levels of the long pentraxin-3 (PTX3) associate with the severity of Puumala hantavirus-induced
nephropathia epidemica (NE). Sixty-one prospectively identified consecutively hospitalized NE patients were examined. Plasma
PTX3, interleukin (IL)-6, terminal complement complex SC5b-9, complement component C3, C-reactive protein (CRP), creatinine,
sodium, kynurenine, and tryptophan levels, as well as the blood cell count, were determined for up to five consecutive days
after hospitalization. Receiver operating characteristic (ROC) analysis revealed that the maximum PTX3 level >101.6 ng/ml
(high PTX3) showed a sensitivity of 71% and a specificity of 89% for detecting platelet level <50 × 109/l, with an area under the curve (AUC) value of 0.78 (95% confidence interval [CI] 0.63–0.94). High PTX3 level was also associated
with several other variables reflecting the severity of the disease: patients with high PTX3 level had higher maximum blood
leukocyte (16.1 vs. 9.7 × 109/l, p < 0.001), plasma IL-6 (16.9 vs. 9.0 pg/ml, p = 0.007), and creatinine (282 vs. 124 μmol/l, p = 0.007) levels than patients with low maximum PTX3 level. They also had longer hospital stays (8 vs. 5 days, p = 0.015) compared to patients with low PTX3 level. High plasma PTX3 levels are associated with thrombocytopenia and the overall
severity of NE. 相似文献
9.
Ramani P Dungwa JV May MT 《Virchows Archiv : an international journal of pathology》2012,460(2):183-191
Neuroblastoma (NB) accounts for 15% of all childhood cancer deaths. The majority of patients have widespread lymphatic and/or
haematogenous metastases at diagnosis, but lymphangiogenesis has not been well documented. Sixty-seven NBs were immunostained
for the lymphatic endothelial marker, LYVE-1, and the lymphatic density (LD) and lymphatic invasion (LI), were counted in
LYVE-1-expressing lymphatics. LYVE-1-stained lymphatic vessels and LI were present in 26/67 (39%) and 14/67 (21%) of the NBs,
respectively. Central LD (CLD) and LI were higher in NBs from stage 4 (p = 0.012, p = 0.004, respectively), high-risk group (p = 0.030, p = 0.002), NBs with high mitosis karyorrhexis index (MKI) (p = 0.011, p = 0.005), unfavourable histology group (p = 0.040, p = 0.017) and distant lymph node metastasis (LNM) (p < 0.001 for each). Marginal LD (MLD) was higher in patients with LNM (p < 0.001). CLD and MLD correlated with LI (p < 0.001 each). Total LYVE-1 protein levels, quantified by a sensitive enzyme-linked immunosorbent assay (n = 55), were also higher in NBs from patients with stage 4 disease (p = 0.046), high-risk group (p = 0.028), MYCN-amplified NBs (p = 0.034) and LNM (p = 0.038). Kaplan–Meier analysis showed that the presence of CLD was associated with both worse OS at 5 years (77% [95% CI:
62–87%] versus 60% [95% CI: 32–80%], p = 0.062) and EFS (74% [95% CI: 58–85%] versus 43% [95% CI: 15–69%], p = 0.070) and LI with OS (71% [95% CI: 57–81%] versus 56% [95% CI: 26–78%], p = 0.055). Significant upregulation of LYVE-1 and the presence of LI in patients with stage 4 and high-risk disease, MYCN-amplification and LNM suggests that LYVE-1 may have value as predictors of outcome. 相似文献
10.
Joong Kyong Ahn Ji-Min Oh Jaejoon Lee Eun-Kyung Bae Kwang-Sung Ahn Hoon-Suk Cha Eun-Mi Koh 《Inflammation》2010,33(6):381-388
Survivin belongs to the family of inhibitor of apoptosis proteins and plays an important role in the hyperplastic growth of
tissues and tumors. In this study, we assessed the expression of survivin in rheumatoid synovial fluids (SF) and synovial
tissues (ST) of rheumatoid arthritis (RA) patients in order to investigate the role of extracellular survivin in the pathogenesis
of RA. The survivin level from SF was significantly higher in RA patients (n = 38) than in osteoarthritis patients (n = 18; 10.68 ± 2.76 vs. 1.0 ± 0.56 pg/ml, p = 0.02). In addition, SF survivin level was higher in erosive RA patients (n = 23) than in non-erosive RA patients (n = 15; 15.26 ± 4.26 vs. 4.47 ± 1.12 pg/ml, p = 0.05). SF survivin level in RA was positively correlated with disease activity score 28, but did not reach statistical
significance (r = 0.309, p = 0.07). RA SF survivin level was also positively correlated with peripheral blood leukocyte counts (r = 0.443, p = 0.005). The immunohistochemical staining and Western blot analysis revealed survivin expression in the ST and fibroblast-like
synoviocytes of RA patients, respectively. These findings suggest that extracellular survivin may be produced from rheumatoid
FLS and may play an important role in the destructive RA process. 相似文献
11.
Prognostic value of procalcitonin in <Emphasis Type="Italic">Legionella</Emphasis> pneumonia 总被引:1,自引:0,他引:1
J. Haeuptle R. Zaborsky R. Fiumefreddo A. Trampuz I. Steffen R. Frei M. Christ-Crain B. Müller P. Schuetz 《European journal of clinical microbiology & infectious diseases》2009,28(1):55-60
The diagnostic reliability and prognostic implications of procalcitonin (PCT) (ng/ml) on admission in patients with community-acquired
pneumonia (CAP) due to Legionella pneumophila are unknown. We retrospectively analysed PCT values in 29 patients with microbiologically proven Legionella-CAP admitted to the University Hospital Basel, Switzerland, between 2002 and 2007 and compared them to other markers of infection,
namely, C-reactive protein (CRP) (mg/l) and leukocyte count (109/l), and two prognostic severity assessment scores (PSI and CURB65). Laboratory analysis demonstrated that PCT values on admission
were >0.1 in over 93%, >0.25 in over 86%, and >0.5 in over 82% of patients with Legionella-CAP. Patients with adverse medical outcomes (59%, n = 17) including need for ICU admission (55%, n = 16) and/or inhospital mortality (14%, n = 4) had significantly higher median PCT values on admission (4.27 [IQR 2.46–9.48] vs 0.97 [IQR 0.29–2.44], p = 0.01), while the PSI (124 [IQR 81–147] vs 94 [IQR 75–116], p = 0.19), the CURB65 (2 [IQR 1–2] vs 1 [1–3], p = 0.47), CRP values (282 [IQR 218–343], p = 0.28 vs 201 [IQR 147–279], p = 0.28), and leukocyte counts (12 [IQR 10–21] vs 12 [IQR 9–15], p = 0.58) were similar. In receiver operating curves, PCT concentrations on admission had a higher prognostic accuracy to predict
adverse outcomes (AUC 0.78 [95%CI 0.61–96]) as compared to the PSI (0.64 [95%CI 0.43–0.86], p = 0.23), the CURB65 (0.58 [95%CI 0.36–0.79], p = 0.21), CRP (0.61 [95%CI 0.39–0.84], p = 0.19), and leukocyte count (0.57 [95%CI 0.35–0.78], p = 0.12). Kaplan-Meier curves demonstrated that patients with initial PCT values above the optimal cut-off of 1.5 had a significantly
higher risk of death and/or ICU admission (log rank p = 0.003) during the hospital stay. In patients with CAP due to Legionella, PCT levels on admission might be an interesting predictor for adverse medical outcomes.
Jeannine Haeuptle, Roya Zaborsky, and Rico Fiumefreddo contributed equally to this article. 相似文献
12.
D. Viasus C. Gudiol N. Fernández-Sabé I. Cabello C. Garcia-Vidal M. Cisnal R. Duarte M. Antonio J. Carratalà 《European journal of clinical microbiology & infectious diseases》2011,30(1):77-82
Although it has been suggested that statins have a beneficial effect on the outcome of bloodstream infection (BSI) in immunosuppressed
patients, prospective studies testing this hypothesis are lacking. We performed an observational analysis of consecutive cancer
patients and transplant recipients hospitalized at two tertiary hospitals in Spain (2006–2009). The first episode of BSI occurring
in statin users was compared with those occurring in non-statin users. During the study period, 668 consecutive episodes of
BSI in 476 immunosuppressed patients were recorded. Underlying diseases were solid tumor (46.2%), hematologic malignancy (35.1%),
and transplantation (18.7%). Fifty-nine (12.4%) patients were receiving statins at the onset of BSI. Comparing with statin
non-users, patients on statin treatment were older (67.3 vs. 58.7 years; p < 0.001) and had higher frequency of comorbidities (74.6% vs. 40.6%; p < 0.001). There were no significant differences in intensive care unit admission (6.8% vs. 7.7%; p = 1) and overall mortality (15.3% vs. 24%; p = 0.13) between groups. In a multivariate analysis, prior statin use was not associated with increased survival (odds ratio
[OR], 0.52; 95% confidence interval [CI], 0.22–1.23; p = 0.14). In conclusion, prior statin use is not associated with increased survival in immunosuppressed patients with BSI.
Caution is warranted in attributing beneficial effects to statin use in infections among immunocompromised patients. 相似文献
13.
Y.-L. Kuo S.-J. Shieh H.-Y. Chiu J.-W. Lee 《European journal of clinical microbiology & infectious diseases》2007,26(11):785-792
Necrotizing fasciitis is a soft-tissue infection with a high risk of fatality. Infection with Vibrio vulnificus can lead to development of necrotizing fasciitis and primary septicemia, and occurs mostly in immunocompromised host-associated
diseases such as hepatic disease, diabetes mellitus, chronic renal insufficiency, and adrenal insufficiency. Early recognition
and treatment of the infection, which are unclear, are vital to patient welfare. We studied the disease epidemiology and reviewed
the prognosis and clinical features of patients treated using our developed protocol. Clinical manifestations and outcomes
were retrospectively analyzed for 67 patients with V. vulnificus-mediated necrotizing fasciitis and sepsis. All patients who had contacted seawater or raw seafood with positive culture for
vibrio were included. Patients were divided into two groups based on the timing of first fasciotomy and injury; within 24 h
(group A) and beyond 24 h (group B). Twenty-three of the 67 patients (40%) had hepatic disease, 17 (25.4%) had chronic renal
insufficiency, and 12 (17.9%) exhibited adrenal insufficiency. The most common site of infection was the upper extremity (74.7%).
Group B presented with more clinical symptoms including fever (p = 0.02), hemorrhagic bullae (p < 0.0001), and shock (p = 0.007). Group A patients exhibited enhanced survival compared to group B (in hospital mortality: 4.9% vs. 23%; p = 0.005). We conclude that early and appropriate diagnosis for V. vulnificus infection should be made, especially in patients presenting with atypical clinical findings. Early fasciotomy within 24 h
remains the highest priority and decreases the mortality rate. 相似文献
14.
Fleischmann A Rocha C Saxer-Sekulic N Zlobec I Sauter G Thalmann GN 《Virchows Archiv : an international journal of pathology》2011,458(6):741-748
Patients with nodal positive prostate cancers are an important cohort with poorly defined risk factors. CD10 is a cell surface
metallopeptidase that has been suggested to play a role in prostate cancer progression. CD10 expression was evaluated in 119
nodal positive prostate cancer patients using tissue microarrays constructed from primary tumors and lymph node metastases.
All patients underwent radical prostatectomy and standardized extended lymphadenectomy. They had no neoadjuvant therapy and
received deferred androgen deprivation. In the primary tumor, high CD10 expression was significantly associated with earlier
death from disease when compared with low CD10 expression (5-year survival 73.7% vs. 91.8%; p = 0.043). In the metastases, a high CD10 expression was significantly associated with larger total size of metastases (median
11.4 vs. 6.5 mm; p = 0.015), earlier death of disease (5-year survival 71.5% vs. 87.3%; p = 0.017), and death of any cause (5-year survival 70.0% vs. 87.2%; p = 0.001) when compared with low CD10 expression. CD10 expression in the metastases added independent prognostic information
for overall survival (p = 0.029) after adjustment for Gleason score of the primary tumor, nodal tumor burden, and resection margins. In conclusion,
a high CD10 expression in prostate cancer predicts early death. This information is inherent in the primary tumors and in
the lymph node metastases and might help to personalize patient management. 相似文献
15.
Dinleyici EC Eren M Dogan N Reyhanioglu S Yargic ZA Vandenplas Y 《Parasitology research》2011,108(3):541-545
Although many Blastocystis infections remain asymptomatic, recent data suggest it also causes frequent symptoms. Therapy should be limited to patients
with persistent symptoms and a complete workup for alternative etiologies. The goal of this study was to compare the natural
evolution (no treatment) to the efficacy of Saccharomyces boulardii (S. boulardii) or metronidazole for the duration of diarrhea and the duration of colonization in children with gastrointestinal symptoms
and positive stool examination for Blastocystis hominis. This randomized single-blinded clinical trial included children presenting with gastrointestinal symptoms (abdominal pain,
diarrhea, nausea–vomiting, flatulence) more than 2 weeks and confirmed B. hominis by stool examination (B. hominis cysts in the stool with microscopic examination of the fresh stool). The primary end points were clinical evaluation and
result of microscopic stool examination at day 15. Secondary end points were the same end points at day 30. Randomization
was performed by alternating inclusion: group A, S. boulardii (250 mg twice a day, Reflor?) during 10 days; group B, metronidazole (30 mg/kg twice daily) for 10 days; group C, no treatment.
At day 15 and 30 after inclusion, the patients were re-evaluated, and stool samples were examined microscopically. On day 15,
children that were still symptomatic and/or were still B. hominis-infected in group C were treated with metronidazole for 10 days. There was no statistically significant difference between
the three study groups for age, gender, and the presence of diarrhea and abdominal pain. On day 15, clinical cure was observed
in 77.7% in group A (n, 18); in 66.6% in group B (n, 15); and 40% in group C (n:15) (p < 0.031, between groups A and C). Disappearance of the cysts from the stools on day 15 was 80% in group B, 72.2% in group
A, and 26.6% in group C (p = 0.011, between group B and group C; p = 0.013, between group A and group C). At the end of the first month after inclusion, clinical cure rate was 94.4% in group
A and 73.3% in group B (p = 0.11). Parasitological cure rate for B. hominis was very comparable between both groups (94.4% vs. 93.3%, p = 0.43). Metronidazole or S. boulardii has potential beneficial effects in B. hominis infection (symptoms, presence of parasites). These findings challenge the actual guidelines. 相似文献
16.
17.
D. Conde-Estévez S. Grau J. Albanell R. Terradas M. Salvadó H. Knobel 《European journal of clinical microbiology & infectious diseases》2011,30(1):103-108
The purpose of this investigation was to compare the risk factors, clinical features and outcomes in cancer patients with
bacteraemia caused by vancomycin-susceptible Enterococcus faecalis and E. faecium. A retrospective, observational 7-year study was carried out in a 450-bed, acute-care university-affiliated hospital. We
performed univariate comparisons between the two groups and then multivariate analysis to identify patient risk factors for
E. faecium isolation. Seventy-three patients were included in the analysis: 54 (74.0%) with bacteraemia caused by E. faecalis and 19 (26.0%) by E. faecium. The Simplified Acute Physiological Score (SAPS) value was significantly greater in E. faecium isolates (40.7 vs. 35.2; p = 0.009). Diabetes mellitus was more frequently diagnosed in patients with E. faecium bacteraemia (52.6% vs. 24.1%; p = 0.021). Prior penicillin exposure was more frequent in patients with E. faecium bacteraemia (68.4% vs. 29.6%; p = 0.003). There was a trend toward higher mortality in E. faecium bacteraemia patients (47.4% vs. 25.9%; p = 0.084). Independent patient risk factors for E. faecium isolation were prior penicillin exposure (odds ratio [OR], 6.479; p = 0.003) and SAPS > 34 (OR, 6.896; p = 0.009). When compared to E. faecalis bacteraemia, E. faecium bacteraemia in cancer patients is independently associated with more severe illness and prior use of penicillins; therefore,
empiric treatment which would cover E. faecium should be considered in cancer patients suspected of having bacteraemia. 相似文献
18.
Chen CY Sheng WH Lai CC Liao CH Huang YT Tsay W Huang SY Tang JL Tien HF Hsueh PR 《European journal of clinical microbiology & infectious diseases》2012,31(6):1059-1066
We retrospectively analyzed the clinical and microbiological characteristics of adult patients with hematological malignancy
and nontuberculous mycobacteria (NTM) infections from 2001 to 2010. During the study period, 50 patients with hematological
malignancy and tuberculosis (TB) were also evaluated. Among 2,846 patients with hematological malignancy, 34 (1.2%) patients
had NTM infections. Mycobacterium avium-intracellulare complex (13 patients, 38%) was the most commonly isolated species, followed by M. abscessus (21%), M. fortuitum (18%), and M. kansasii (18%). Twenty-six patients had pulmonary NTM infection and eight patients had disseminated disease. Neutropenia was more
frequently encountered among patients with disseminated NTM disease (p = 0.007) at diagnosis than among patients with pulmonary disease only. Twenty-five (74%) patients received adequate initial
antibiotic treatment. Five of the 34 patients died within 30 days after diagnosis. Cox regression multivariate analysis showed
that chronic kidney disease (p = 0.017) and neutropenia at diagnosis (p = 0.032) were independent prognostic factors of NTM infection in patients with hematological malignancy. Patients with NTM
infection had higher absolute neutrophil counts at diagnosis (p = 0.003) and a higher 30-day mortality rate (15% vs. 2%, p = 0.025) than TB patients. Hematological patients with chronic kidney disease and febrile neutropenia who developed NTM infection
had significant worse prognosis than patients with TB infection. 相似文献
19.
Alagarasu K Selvaraj P Swaminathan S Narendran G Narayanan PR 《Journal of clinical immunology》2009,29(2):196-204
Introduction Vitamin D receptor (VDR) gene polymorphisms in the 5′ regulatory region (Cdx2 and A-1012G), coding region (FokI), and 3′ untranslated region (UTR; BsmI, ApaI, and TaqI) were studied to find out whether these polymorphisms are associated with susceptibility to or protection against HIV-1
and development of tuberculosis (TB) in human immunodeficiency virus (HIV)-1-infected patients.
Study Subjects and Methods The study was carried out in 131 HIV patients without TB (HIV+ TB−) and 113 HIV patients with TB (HIV+ TB+; includes 82 patients
with pulmonary TB (HIV+ PTB+) and 31 with extra pulmonary TB), 108 HIV-negative pulmonary TB patients (HIV− PTB+), and 146
healthy controls.
Results Among the 5′ regulatory and coding region polymorphisms, significantly increased frequency of G/A genotype of Cdx-2 was observed
in HIV+ TB− group compared to controls (p = 0.012, odds ratio (OR) 1.89 95% confidence interval (CI) 1.14–3.15). In the 3′ UTR genotypes, a decreased frequency of
b/b genotype of BsmI in total HIV patients (p = 0.014, OR 0.54 95% CI 0.32–0.89) and increased frequencies of A/A genotype of ApaI in HIV+ TB+ patients (p = 0.041, OR 1.77 95% CI 1.02–3.06) and t/t genotype of TaqI in HIV+ PTB+ patients (p = 0.05, OR 2.32 95% CI 0.99–5.46) were observed compared to controls. Haplotype analysis revealed significantly increased
frequencies of 3′ UTR haplotype B-A-t in HIV+ TB+ and HIV+ PTB+ groups (Pc = 0.030, OR 1.75 95% CI 1.14–2.66) and decreased
frequencies of b-A-T haplotype in total HIV patients (Pc = 0.012, OR 0.46 95% CI 0.27–0.77), HIV+ TB− (p = 0.031 OR 0.48 95% CI 0.25–0.89), and HIV+ PTB+ groups (Pc = 0.04, OR 0.47 95% CI 0.23–0.89) compared to controls.
Conclusions The results suggest that VDR gene 3′ UTR haplotype b-A-T may be associated with protection against HIV infection while B-A-t
haplotype might be associated with susceptibility to development of TB in HIV-1-infected patients. 相似文献
20.
Gisah Amaral de Carvalho Gilberto Paz-Filho Teresa C. Cavalcanti Hans Graf 《Endocrine pathology》2009,20(4):204-208
Thyroid nodules can be biopsied by fine needle aspiration (FNA) or fine needle capillary (FNC) biopsies. However, there is
controversy on whether one technique is superior to another. In a randomized cytopathologist-blinded cross-sectional study,
260 patients (238 females, age 43.2 ± 12.6) with nodular (82.7%) and diffuse goiter (17.3%) underwent 520 FNAs and 520 FNCs
(not guided by ultrasound). Smears were scored for sample adequacy, and diagnosed as malignant, benign, suspicious, or nondiagnostic.
Diagnostic accuracy was calculated based on the histological findings of 58 patients submitted to surgery. Intra-technique
diagnostic accuracy and sample adequacy was seen in all samples. FNA and FNC provided similar cytological diagnosis, respectively
(benign: 75.8% vs. 74.2%, p = 0.600; malignant: 3.8% vs. 3.8%, p = 0.871; suspicious: 10.4% vs. 10.8%, p = 0.913; and nondiagnostic: 10.0% vs. 11.2%, p = 0.598). Adequacy scores were similar by FNA (7.94 ± 2.84) and FNC (7.96 ± 2.81, p = 0.909). The same proportion of adequate or superior samples was seen in both techniques (91.6%). Sensitivity was equal
to 85.7% for FNA and 100% for FNC. Similarly, specificity was 100% for both techniques. FNA and FNC provide the similar sample
adequacy and diagnostic accuracy. The choice of technique should be based on the operator’s personal preferences and experience. 相似文献