Bordetella pertussis adenylate cyclase activity in nasopharyngeal aspirates for rapid diagnosis of whooping cough in relation to culture and serology.

Adenylate cyclase activity, measured in 201 nasopharyngeal aspirates from patients presenting with own or parental suspicion of whooping cough, was compared to diagnosis made by culture and by serology in the culture negative cases. The median amount of cyclic AMP in samples from culture negative patients (n = 145) was 0.60 pmoles which differed significantly (p less than 0.001) from the median value 3.28 in samples from culture positive patients (n = 56). The median value 0.70 pmoles of cyclic AMP in samples from culture negative patients who were positive by serology (n = 54) did not differ significantly from the value of 0.57 pmoles in samples from serology negative patients (n = 91). With a limit for positive cyclic AMP set at 2 pmoles, 45 samples were positive. The sensitivity of the assay was 66% (37/56) in culture positive patients while the specificity was 93% (85/91) in the serology negative patients. The positive predictive value for the c-AMP test was 82% (37/45) in relation to culture and 87% (39/45) in relation to culture and/or serology. The results confirmed that measurement of adenylate cyclase activity in nasopharyngeal aspirates by an 1-h incubation method can serve as an early and rapid diagnostic method of pertussis infection. The low sensitivity of the c-AMP assay in samples from serology positive but culture negative patients indicates however, that this assay will have to be supplemented by serology for a high diagnostic sensitivity in all cases of pertussis.     

Preoperative Complications of Gallstones and their Relevance to Treatment and Prognosis: Experience with 451 Cases

Of 451 patients with cholelithiasis, 273 suffered from 396 preoperative complications; the common ones were acute cholecystitis (n = 120), jaundice (n = 135), and acute pancreatitis (n = 52). Of the 195 patients under the age of 50 years 48% had complications, compared with 70% of the 256 above the age of 50 years. For acute cholecystitis and acute pancreatitis, an interval cholecystectomy was carried out 3-6 wk after initial conservative treatment. Except in the 33 cases with obstructive jaundice of indeterminate etiology (n = 15) or jaundice associated with uncontrollable cholangitis (n = 18), surgery in icteric patients was deferred until serum bilirubin became normal or reached a plateau. Routine intraoperative radiology detected unsuspected stones in common bile ducts in 11 cases. In all, 139 choledochotomies were carried out; the frequency of ductal exploration rose after the age 50 years. Operative elimination of sphincter of Oddi (by sphincteroplasty or by choledochoduodenostomy) was required in 82 cases. Bile culture was positive in only 17 of 178 cases without preoperative complications but in 97 of 273 with preoperative complications. Of the 21 cases who died, 19 had preoperative complications and 66% had positive bile culture. Nine of 139 requiring choledochotomy died. Mortality after 60 years was 15 of 119.     

Results of culture from colonoscopically obtained specimens for bacteria and fungi in HIV-infected patients with diarrhea

Background: The aim of our study was to determine the diagnostic yield of culture for bacteria and fungi from colonic biopsy specimens in 290 consecutive HIV-infected patients with diarrhea. Methods: During each colonoscopy, three biopsy specimens were homogenized and cultured on media for Salmonella and Shigella and for Campylobacter and Yersinia, on Loewenstein medium and on Sabouraud medium. Results: Cultures were found positive for one (n = 32) or two (n = 5) infectious agents in 37 cases, i.e., in 12.8% of the patients. Bacteria were isolated in 24 cases, and identified as Campylobacter jejuni-coli (n = 14), Salmonella (n = 2), Shigella (n = 1), or Pseudomonas aeruginosa (n = 7). Among the 14 patients with C. jejuni-coli intestinal infection, 11 had normal-appearing mucosa at colonoscopy, and 3 had a concomitant stool culture negative for Campylobacter. Mycobacterial cultures were positive for Mycobacterium avium intracellulare in 6 patients, who were already known as having a disseminated M. avium intracellulare infection from positive blood cultures. Fungal cultures were positive for Candida in 10 cases, without clear clinical significance. Conclusions: The overall yield of culture for bacterial pathogens from colonic tissue in HIV-infected patients with diarrhea is low, but some individual cases of C. jejuni-coli infections may be detected from colonic tissue culture and not diagnosed by concomitant stool culture. (Gastrointest Endosc 1996;44:663-6.)     

诺卡菌感染26例临床特点分析

目的 分析诺卡菌感染病例的临床特点,提高对该病的诊治水平.方法 回顾性分析北京协和医院1990年1月至2010年1月收治的26例诺卡菌感染病例的临床资料.结果 26例中,男10例,年龄29～80岁,平均(52±14)岁;女16例,年龄15～71岁,平均(42±17)岁.其中增殖性疾病2例,慢性肾病3例(1例接受肾移植),糖尿病、胸部外伤史及库欣综合征各1例,无基础病、自身免疫病及慢性肺部疾病者各6例;26例中11例曾服用过糖皮质激素.临床表现为中高度发热25例,咳嗽22例,咳痰19例,胸膜炎性胸痛10例,咯血8例,肺部湿性啰音10例,5例合并皮肤感染,4例合并颅内脓肿.影像学表现为肺部斑片状及实变影21例,空洞10例.合并胸腔积液13例,双侧胸部受累15例.26例中仅4例经合格痰培养确诊,胸腔积液培养阳性8例,BALF培养阳性2例,支气管镜下吸取物培养阳性1例,皮下脓肿液培养阳性4例,CT引导下经皮肺穿刺组织培养阳性7例,颅内病变部位组织培养阳性1例;细菌培养结果显示,巴西诺卡菌9例,星形诺卡菌6例,豚鼠耳炎诺卡菌1例及未能分类的诺卡菌10例;药敏试验结果遗失10例,7株耐磺胺甲噁唑/甲氧苄啶.治疗及转归:5例单用磺胺甲噁唑/甲氧苄啶治疗,1例单用米诺环素治疗,其余均为2种及以上药物的联合治疗(包括磺胺甲噁唑/甲氧苄啶、阿米卡星、头孢呋辛、头孢曲松、阿莫西林+克拉维酸、链霉素、左氧氟沙星、环丙沙星、米诺环素和亚胺培南等).4例死亡,2例复发,其余20例均治愈.结论 机体抵抗力下降的患者,尤其是使用糖皮质激素者,出现中高度发热及呼吸系统症状、合并皮肤感染及颅内脓肿、胸部影像学显示斑片状或实变影,特别是合并空洞及胸腔积液时,应警惕诺卡菌感染的可能;尽早获取病原学及药敏试验结果,并给予早期、足疗程治疗,可以改善患者的预后.     

Legionella pneumonia in cancer patients

Legionella is an important cause of nosocomial and community-acquired pneumonia in both immunocompetent and immunosuppressed patients worldwide; however, the clinical course and optimal antibiotic therapy of Legionella pneumonia (LP) in patients with cancer is uncertain. We studied retrospectively the risk factors, clinical manifestations, and outcome of 49 cancer patients with a positive Legionella culture or direct fluorescent antibody (DFA) over a 13-year period (1991-2003). The majority of patients (82%) had an underlying hematologic malignancy, and 37% were bone marrow transplant recipients; 80% of the patients had active malignancy. Lymphopenia (47%), use of systemic corticosteroids (41%), and chemotherapy (63%) were the most common underlying conditions. The laboratory diagnosis was established by positive Legionella culture (n = 8, 16%), DFA (n = 29, 59%), or both (n = 12, 25%). In 4 patients (8%), a positive DFA was deemed to represent false-positive results. There was no temporal or geographic clustering of cases. The majority of the cases had multilobar (61%) or bilateral (55%) pulmonary involvement.The mean time to response to therapy was 8 days; 18 patients (37%) developed complications requiring prolonged duration of treatment (mean, 25 d). The case-fatality rate was 31%. Two patients had relapse of LP despite appropriate therapy. Improved outcome, especially in those with severe pneumonia, seemed to correlate with the use of a combination of antibiotics. LP is an uncommon infection in our patient population but is associated with significant morbidity and mortality. Treatment of LP in cancer patients may require a prolonged course with a regimen that includes a newer macrolide or quinolone.     

Office practice-based confirmation of onychomycosis: a US nationwide prospective survey

BACKGROUND: Onychomycosis is sufficiently prevalent to be seen and treated by primary care physicians. The diagnosis of onychomycosis is most often confirmed from nail specimens by microscopy and fungal culture done at a central laboratory; these are relatively expensive tests with a turnaround time of a month or more. This study was conducted (1) to evaluate the use of in-office dermatophyte test medium (DTM) culture, and (2) to determine the epidemiology of onychomycosis in a large, nationwide sample of patients who were not participants in a clinical trial. METHODS: A nationwide sample of primary care physicians and podiatrists enrolled 670 patients with clinical signs of toenail onychomycosis. Dermatophyte test medium cultures were performed in the office and the results were compared with fungal cultures performed by a central laboratory. RESULTS: Central laboratory fungal cultures were positive in 44% (n = 297) of patients and DTM cultures in 51% (n = 345). Dermatophytes accounted for 93% of the confirmed infections and nondermatophyte molds the rest. In the 617 patients with paired dermatophyte test medium and laboratory fungal culture results, the 2 tests were in agreement (both positive or both negative) in 68% of cases (kappa, 0.37; asymptotic SE, 0.04; 95% confidence interval, 0.299-0.441). CONCLUSIONS: A DTM culture is a relatively rapid, easy, and inexpensive method to confirm dermatophyte infections in patients with signs of onychomycosis in the primary care setting. Because the available drugs for treating onychomycosis are effective against all dermatophyte species, the confirmation of dermatophyte infection, without further identification of genus and species, is sufficient evidence to begin treatment.     

腹腔镜胆囊切除术患者抗生素应用的研究

目的 探讨腹腔镜胆囊切除术（ＬＣ）患者抗生素应用的意义。结果 ＬＣ时抽取１５０例胆汁做培养和药敏试验,并将３８０例ＬＣ者分５组;第一组急性炎症组３２例,第二组镜下炎症组５１例,第三组术中胆囊剥破组２８例,第四组单纯结石或息肉组７２例;分别配合不同的抗生素治疗方法。结果 胆汁需氧菌检出率７７．３％厌氧菌检出率６２．７％。药敏试验：第三代头孢菌素及甲硝唑、夫硝唑有效率高。第一组、第二组术后血白细胞计数     

Q fever endocarditis: over 14 years of surgical experience in a referral center for rickettsioses

BACKGROUND AND AIM OF THE STUDY: Q fever endocarditis caused by Coxiella burnetii is the most important etiology of negative blood culture endocarditis. Without specific clinical findings, diagnosis is difficult and prevalence of this life-threatening disease is underestimated. METHODS: Q fever endocarditis was assessed in 19 patients (15 men, four women; age range: 36-79 years) by evaluating clinical and echocardiographic criteria and specific serology. All patients had evidence of pre-existing valvular disease, and 10 had a valvular prosthesis. Diagnosis was assessed in: the presence of unexplained fever (n = 5), heart failure with valvular dysfunction (n = 10), hemolysis (n = 1), glomerulonephritis (n = 1) and stroke (n = 2). A late diagnosis was made in eight patients, either during or after surgery. RESULTS: In all cases, usual blood cultures remained negative, despite specific serology being positive. Transthoracic and transesophageal echocardiography were conclusive in only six cases (four vegetations, two periannular abscesses). Surgery was indicated in 15 patients for heart failure or valvular dysfunction (n = 12), hemolysis (n = 1) and periannular abscess (n = 2). Intraoperative findings were suggestive of endocarditis in seven cases; valvular cultures were positive in 92% of cases. All patients were treated with combined doxycycline/ hydrochloroquine or quinolone, for a mean of 24 months (range: 6-60 months). Mean follow up was 40 months (range: 6-144 months). Two patients died from heart failure, one patient was lost to follow up, and 16 patients had no late relapses. CONCLUSION: Q fever is an underestimated cause of endocardititis, and early diagnosis is the key to good prognosis. The need for systematic serologic examination in case of valvular dysfunction, with or without endocarditis symptoms, is emphasized.     

Spontaneous bacterial peritonitis in patients with hepatic cirrhosis: evaluation of a treatment protocol at specialized units.

INTRODUCTION: Spontaneous bacterial peritonitis is a common and severe complication in patients with cirrhosis and ascitis. Its prognosis clearly depends on its precocious clinical recognition and efficacious therapy. AIM: To optimize a treatment protocol, after auditing clinical efficacy and describe microorganisms implicated at our institution. MATERIAL AND METHODS: Retrospective study of clinical files of patients with hepatic cirrhosis with positive culture of ascitic fluid (AF) and/or an AF polymorphonuclear (PMN) count of more than 250/mm3, treated at our units between 1st January, 2000 and 31st December, 2001 (n = 38). Patients showed a median age of 49 years (30-76), 63% of which were male. Forty-eight percent were classified as belonging to Child-Pugh B class, and 52% to C. RESULTS: First, considering cases with PMN > 250/mm3 (n = 29), antibiotics were given to all patients (cefotaxime and ampiciline). Fifty-two percent had hepatic encephalopathy, 42% had fever, 66% abdominal pain. In 42% a microorganism was isolated. Although 24% of fatal cases (only two related to infection), we noted a 73% clinical and laboratorial response. Five patients (72%) that died, showed renal failure by the time of death. Second, in all cases with positive culture of ascitic fluid (n = 21), 42% of which with PMN > 250/mm3 and 9 monobacterial nonneutrocytic bacterascites' cases, one only agent was found: E. coli in 36%, Streptococci (37%), Staphylococci (14%), and other (14%): Klebsiella oxytoca, n = 1; Salmonella enteritidis, n = 1; Enterococcus faecium, n = 1, Acinectobacter anitratus, n = 1. Only one of the agents, E. faecium (3%) showed in vitro sensitivity exclusively to ampiciline; all other were cefotaxime sensitivite. CONCLUSIONS: Our protocol will be modified, to treat patients with spontaneous bacterial peritonitis with cefotaxime, as monotherapy. Albumin infusion will also be added to the protocol, as, we found renal failure to be an important negative prognosis factor.     

Incidence of bacteremia in transesophageal echocardiography: a prospective study of 140 consecutive patients

The incidence of bacteremia related to transesophageal echocardiography was studied in 140 consecutive patients (71 women and 69 men with a mean age of 53.7 +/- 15 years). Thirty-four patients had one or more prosthetic heart valves. Blood cultures were obtained from each patient through separate venipuncture sites immediately before and after transesophageal echocardiography. An additional late blood culture was obtained in 114 patients 1 h later. The skin was cleaned with povidone-iodine and venipunctures were performed with separate butterfly needles with use of sterile gloves and drapes. Blood samples were drawn into separate syringes, transferred to aerobic and anaerobic culture bottles and processed with use of a semiautomated system. The overall incidence of blood cultures positive for bacteremia was 2% (8 of 394 bottles) and all positive cultures grew in a single blood culture bottle. Positive cultures occurred in 4 (1.4%) of 280 bottles before the procedure, in 2 (0.7%) of 280 bottles immediately after the procedure and in 2 (0.9%) of 228 late (1-h) blood culture bottles. Bacterial isolates were coagulase-negative staphylococci (n = 5), Propionibacterium (n = 2) and Moraxella (n = 1). All were considered contaminants. Mean endoscopic time in these patients was not significantly different from that in the other patients. Follow-up of patients with a blood culture positive for bacteremia revealed no clinical evidence of systemic infection. It is concluded that 1) the incidence of bacteremia related to transesophageal echocardiography is very low, and 2) the incidence of blood cultures positive for bacteremia after transesophageal echocardiography is indistinguishable from the anticipated contamination rate.     

Wegener's granulomatosis in patients with rheumatoid arthritis

OBJECTIVE: To describe 2 cases of coexisting rheumatoid arthritis (RA) and Wegener's granulomatosis (WG), and to summarize the clinical and serological data for all 6 patients reported in the English literature since 1966. METHODS: Medline review over a 35-year period (1966-2002) revealed 4 reported cases of RA associated with WG. Patients were diagnosed based on symptoms, radiographic changes, bronchoalveolar lavage fluid analysis, hematuria, serology, and biopsy. We describe 2 additional cases of WG developing in Caucasian women with RA. These are the first reported patients to possess positive antineutrophil cytoplasmic antibodies (ANCA) and autoantibodies to proteinase 3 (PR3). RESULTS: All 6 cases of coexisting RA and WG were female. The diagnosis of RA preceded WG diagnosis in all cases; mean age at RA onset was 43.7 +/- 15.0 years, duration of RA prior to WG diagnosis 7.9 +/- 9.1 years. Clinical findings included erosive articular disease on radiographs (n = 4; 67%), positive rheumatoid factor (n = 6; 100%), upper respiratory involvement (n = 5; 83%), lower respiratory signs (n = 4; 67%), renal involvement (n = 2; 33%), and positive ANCA (n = 2/3; 67%). Five patients were treated with corticosteroids and cyclophosphamide, with clinical improvement. CONCLUSION: Although rare, WG may develop in patients with preexisting RA and may present with end-organ involvement.     

Mechanism of syncope in patients with positive adenosine triphosphate tests

OBJECTIVES: We prospectively evaluated the mechanism of syncope in patients with positive adenosine triphosphate (ATP) tests (defined as the induction of atrioventricular [AV] block with a ventricular pause >/=6 s after an intravenous bolus of 20 mg ATP). BACKGROUND: Patients with unexplained syncope tend to have more positive ATP tests results than those without syncope. METHODS: An implantable loop recorder (ILR) was inserted in 36 ATP-positive patients (69 +/- 10 years; 22 women; median of 6 syncopal episodes); 15 of them also had a positive response to tilt testing. RESULTS: During the follow-up of 18 +/- 9 months, 18 patients (50%) had syncopal recurrence and 16 (44%) had an electrocardiographically documented episode: AV block (n = 3: paroxysmal in 2 and permanent in 1), AV block followed by sinus arrest (n = 1), sinus arrest (n = 5), sinus bradycardia <40 beats/min (n = 2), normal sinus rhythm (n = 2), sinus tachycardia (n = 1), rapid atrial fibrillation (n = 1), and ectopic atrial tachycardia (n = 1). Bradycardia was documented in a total of 11 cases (69%), and a long ventricular pause (4 to 29 s) was present in eight cases (50%). All three patients with ILR-documented AV block had previously had a negative tilt test, whereas seven of eight with ILR-documented sinus bradycardia or sinus arrest had previously had a positive tilt test. CONCLUSIONS: In patients with adenosine-sensitive syncope, the mechanism of syncope is heterogeneous, although bradycardia is the most frequent finding. Adenosine triphosphate-induced AV block predicts AV block as the mechanism of spontaneous syncope in only a few tilt-negative patients.     

Microbiological profile of septic complication in patients with cardiogenic shock following acute myocardial infarction (from the SHOCK study)

We sought to assess the microbiologic profile of patients with suspected sepsis who participated in the SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK? (SHOCK) trial, a randomized controlled trial of early coronary revascularization in patients with cardiogenic shock complicating acute myocardial infarction. A protocol-mandated SEPSIS form was completed prospectively for 54 patients (18%) with fever or leukocytosis suggestive of sepsis. These patients were divided further into those with positive (n = 40) or negative (n = 14) culture results. The predominant pathogen isolated in patients with positive culture results was Staphylococcus aureus (32%), followed by Klebsiella pneumoniae and Pseudomonas aeruginosa. Patients with both positive and negative culture results had longer median durations of mechanical ventilation (p <0.001 and p = 0.02), intra-aortic balloon pump (IABP) support (p = 0.074 and p = 0.021), and hospital stay (p <0.001 and p = 0.048) than controls. Sepsis was predicted by both duration of IABP support (p = 0.007) and use of multiple central catheters (p = 0.026). In conclusion, clinical sepsis is common after cardiogenic shock complicating acute myocardial infarction, particularly in patients who received prolonged IABP support or had multiple central catheters.     

Omeprazole Plus Amoxicillin: Efficacy of Various Treatment Regimens to Eradicate Helicobacter pylori

In five subsequent open clinical studies, 180 patients with Helicobacter pylori (HP)-associated ulcer disease (n = 163) or severe functional dyspepsia (n = 17) requiring therapy were treated with either 40 mg omeprazole plus 4 × 500 mg amoxicillin suspension for 1 wk (group I, n = 35), 2 × 40 mg omeprazole plus 4 × 500 mg amoxicillin for 1 wk (group II, n = 50), 2 × 20 mg omeprazole plus 4 × 500 mg amoxicillin for 2 wk (group III, n = 62), 2 × 20 mg omeprazole (day 1–14) and 4 × 500 mg amoxicillin (day 8–14) (group IV, n = 22) or with 2 × 20 mg omeprazole for 2 wk (group V, n = 11). The HP eradication rates determined with a biopsy urease test, microscopy of a mucosal smear, specific culture, and histology after modified GIEMSA staining in the 5th wk after discontinuation of study medication were 61.3% in group I, 61.7% in group II, 82.8% in group III, 28.6% in group IV, and 0% in group V. Apart from clinical insignificant pharyngeal paresthesias (n = 6), nine patients (5.7%) with combined therapy complained of important side effects (stomatitis: n = 3, diarrhea: n = 3, allergic exanthema: n = 3) that led to termination of amoxicillin treatment in four cases (2.5%). We conclude that omeprazole-enhanced amoxicillin antibiosis is a simple and effective approach to the eradication of HP colonization.     

Neuromeningeal Listeria infections in adults. Clinical, biological and therapeutic aspects. Apropos of 36 cases

In this retrospective study, 36 cases of Listeria monocytogenes meningitis were reviewed. A bacteriological confirmation was obtained for every patient either by lombar puncture or blood culture. The clinical picture and the composition of the cerebrospinal fluid were polymorphous. Most patients were previously in good health, while 10 of them (28%) had a predisposing factor: pregnancy, gastrectomy, diabetes mellitus, alcoholism or immunosuppression. The outcome was favorable in 23 patients (64%); 8 patients were cured with sequelae (22%); 5 patients died (14%). Death occurred in patients suffering from concomitant underlying disease, such as coronary insufficiency (n = 1) or immunosuppression (n = 2), or in the case of delayed diagnosis and treatment (n = 2).     

Seroprevalence and disease association of antineutrophil cytoplasmic autoantibodies and antigens in HIV infection

Summary This prospective study was designed to determine the role of antineutrophil cytoplasmic autoantibodies (ANCA) in HIV-infected patients. Immunofluorescence tests (IFT) and enzyme-linked immunosorbent assays (ELISA) were applied to sera of 199 consecutive outpatients. In the IFT 20% were positive. An atypical ANCA pattern was demonstrated in 67% of these, 33% revealed a perinuclear staining (pANCA). Specific ELISA revealed proteinase 3 (n=2), myeloperoxidase (n=1), lysozyme (n=2), lactoferrin (n=1), cathepsin G (n=1), and human leukocyte elastase (HLE, n=6). The target antigen remained unidentified in 26 patients. Perinuclear ANCA-positive patients showed atypical antigens in eight of 13 cases; all six patients with anti-HLE revealed a pANCA pattern. The antigens of atypical ANCA-positive patients remained unidentified in 21 of 26 (81%) cases. No signs of vasculitis were present in the ANCA-positive patients. ANCA are frequently found in the sera of HIV-positive patients. They bind to a variety of antigens. No correlation was found between ANCA positivity and autoimmune or opportunistic diseases.     

Treatment of severe immune thrombocytopenia associated with systemic lupus erythematosus: 59 cases

OBJECTIVE: To evaluate the response to treatment in a large cohort of patients with systemic lupus erythematosus (SLE) associated with autoimmune thrombocytopenia. METHODS: Response to treatment was assessed retrospectively in 59 patients with SLE, either definite (n = 44) or incomplete (n = 15), associated with frank autoimmune thrombocytopenia (defined as platelet count < 50 x 10(9)/l). Response to treatment was classified as complete (CR: platelet count > 150 x 10(9)/l), partial (PR: platelet count > 50 x 10/l), or failure (FR) in the other cases. RESULTS: Oral prednisone alone was used in 50 of the 59 patients (mean initial dose 1 mg/kg body weight/day). A response was obtained in 80% of cases (CR in 28. PR in 12) but only 11 (22%) had a sustained response (CR, n = 7; PR, n = 4). In contrast, combined treatment with prednisone and either danazol (n = 18) or hydroxychloroquine (n = 11) resulted in 50% (7 CR, 2 PR) and 64% (4 CR, 3 PR) longterm responses, respectively, allowing prednisone to be withdrawn or the dose tapered below 0.2 mg/kg body weight/day. High dose methylprednisolone pulses (n = 10) and intravenous immunoglobulin (IVIG) (n = 31) resulted in positive responses in 60% (4 CR, 2 PR) and 65% (12 CR, 8 PR) of cases, respectively, but the response was transient in each case. Splenectomy (n = 17) resulted in 65% longterm responses (10 CR, 1 PR). Only 2 longterm partial responses were obtained with the 22 immunosuppressant-containing regimens administered to 14 patients. At the end of the study. a response was observed in 52 (88%) patients [CR: 36 (61%), PR: 16 (27%)], mainly as a result of splenectomy or combined treatment with prednisone and either danazol or hydroxychloroquine. CONCLUSION: Longterm remission was obtained in the majority of patients. The major treatments inducing remission were splenectomy and prednisone combined with danazol or hydroxychloroquine.     

病原体检测对慢性阻塞性疾病并发肺炎的诊断价值

目的 分析慢性阻塞性肺疾病并发社区获得性肺炎(chronic obstructive pulmonary disease complicated with community acquired pneumonia, COPD-CAP)患者的临床特征及多种病原体检测对该疾病的诊断价值。方法 选择2019年1月至2021年1月我院收治的COPD-CAP患者95例为对象,按是否行宏基因测序(metagenome next-generation sequencing, mNGS)病原体检测分为对照组79例,观察组16例。对照组病原体检测采用传统培养,观察组在此基础上采用支气管肺泡灌洗液(bronchoalveolar lavage fluid, BALF) mNGS,分析COPD-CAP病原体分布、阳性率及炎症指标情况。结果 COPD-CAP患者病原体检测结果以革兰氏阴性菌为主,其中肺炎克雷伯杆菌22例(23.16%)、铜绿假单胞菌13例(13.68%)、鲍曼不动杆菌11例(11.58%)、嗜麦芽窄食单胞菌7例(7.37%)、大肠杆菌2例(2.11%)。传统培养(痰液、灌洗液、血液培养)病原体...     

Prevalence of the activating JAK2 tyrosine kinase mutation V617F in the Budd-Chiari syndrome

BACKGROUND & AIMS: Budd-Chiari Syndrome (BCS) results from obstruction to hepatic venous outflow, with myeloproliferative disorder (MPD) accounting for up to 40% of cases. A number of BCS cases labelled as "idiopathic" do not fulfill the diagnostic criteria for MPD but have features suggestive of a latent form based on hyperplastic bone marrow and erythroid progenitor cell culture; these cases may subsequently develop overt MPD. A clonal mutation in JAK2 tyrosine kinase (JAK2V617F) occurs in a high proportion of patients with MPD and is of use in the characterization of latent MPD in BCS. METHODS: We performed allele-specific polymerase chain reaction to screen for JAK2V617F in subjects with BCS (n = 41) and polycythemia vera (PV) (n = 20) and in hematologically normal controls (n = 27). RESULTS: AK2V617F was detected in 24 of 41 (58.5%) subjects with BCS, 19 of 20 PV controls, and 0 of 27 hematologically normal controls. Mean hemoglobin concentration and hematocrit were significantly higher in patients with JAK2V617F. Bone marrow was hyperplastic in 16 of 41 subjects (12/16 JAK2V617F positive). Nine of 33 (27.3%) showed endogenous erythroid colony formation (7/9 JAK2V617F positive). Eleven of 41 subjects developed overt MPD (8/11 essential thrombocythemia, 3/11 PV) after the diagnosis of BCS (median, 49 months; range, 8-87 months), and in 90.9% of these JAK2V617F was detected. CONCLUSIONS: JAK2V617F occurs in a high proportion of patients with BCS. Latent MPD was missed in a substantial number of our subjects by using standard techniques. Such cases should be screened for JAK2V617F and carefully observed for the subsequent development of overt MPD.     

Combined assay for two-hour identification of Streptococcus pneumoniae and Neisseria meningitidis and concomitant detection of 16S ribosomal DNA in cerebrospinal fluid by real-time PCR

The main object was to examine the diagnostic performance of a novel combination of a specific real-time PCR (combined real-time PCR) for immediate and simultaneous detection of Streptococcus pneumoniae and Neisseria meningitidis and of a real-time PCR of the 16S rRNA gene (16S DNA). During 12 months, 1015 routine CSF samples were consecutively collected from patients in the County of Aarhus, Denmark. The samples were cultured, examined by microscopy, and, in parallel, CSF DNA was automatically purified and subjected to real-time PCR. Melting curve analysis discriminated between the 2 specific pathogens and 16S DNA positive samples were sequenced. Clinical data were extracted from patients having positive samples. Clinically, 35 of 46 (76%) patients with positive samples had bacterial meningitis. 18 of these 35 patients had a concomitant culture and real-time PCR-positive sample. The remaining 17 patients were either culture positive (n =7) or real-time PCR-positive (n = 10). The aetiology of bacterial meningitis was revealed by microscopy in 18/35 (51.4%), culture in 24/35 (68.6%) and combined real-time PCR in 27/35 (77.1%) patients, respectively. In conclusion, the combined real-time PCR strategy is superior to microscopy and a valuable supplement to routine culture to establish the aetiology of bacterial meningitis.