Pyogenic liver abscess caused by Burkholderia pseudomallei in Taiwan.

Pyogenic liver abscess in Taiwan is a well-known disease entity, commonly associated with a single pathogen, Klebsiella pneumoniae. Melioidosis is an endemic disease in Taiwan that can manifest as multiple abscesses in sites including the liver. We report three cases of liver abscesses caused by Burkholderia pseudomallei. The first patient was a 54-year-old diabetic woman, who presented with liver abscess and a left subphrenic abscess resulting from a ruptured splenic abscess, co-infected with K. pneumoniae and B. pseudomallei. The second patient, a 58-year-old diabetic man, developed bacteremic pneumonia over the left lower lung due to B. pseudomallei with acute respiratory distress syndrome, and relapsed 5 months later with bacteremic abscesses of the liver, spleen, prostate and osteomyelitis, due to lack of compliance with prescribed antibiotic therapy. The third patient was a 61-year-old diabetic man with a history of travel to Thailand, who presented with jaundice and fever of unknown origin. Liver and splenic abscesses due to B. pseudomallei were diagnosed. A high clinical alertness to patients' travel history, underlying diseases, and the presence of concomitant splenic abscess is essential to early detection of the great mimicker, melioidosis. The treatment of choice is intravenous ceftazidime for at least 14 days or more. An adequate duration of maintenance oral therapy, with amoxicillin-clavulanate or trimethoprim-sulfamethoxazole for 12-20 weeks, is necessary to prevent relapse. Liver abscess in Taiwan is most commonly due to K. pneumoniae, but clinicians should keep in mind that this may be a presenting feature of melioidosis.     

甘南地区儿童青少年近视筛查与矫正情况分析

目的:了解甘肃省甘南地区儿童青少年近视筛查与矫正情况,为近视的防控提供指导依据。方法:采用横断面分层整群抽样研究,抽取甘肃省甘南地区合作市和舟曲县2所幼儿园及12所中小学,每个年级随机抽取2个班,以整班为单位进行筛查,收集儿童青少年近视筛查及矫正情况进行统计学分析。结果:共抽取儿童青少年5 072人,剔除不合格记录后,最终纳入有效数据4 806例。总体近视患病率为45.55%,近视患病率随着年级的升高而呈现上升趋势(P<0.001),女生的近视患病率(48.66%)高于男生(42.18%)(P<0.001)。近视患病率随年龄增长呈现上升趋势(P<0.001),10-12岁为近视增长最快的年龄段,由25.62%增长至60.57%。随着年级的升高,中度近视和高度近视均呈现上升趋势(均P<0.001)。甘南地区总体戴镜率为28.55%,足矫率为50.72%,戴镜率随着学段升高呈现上升趋势(P<0.001),女生戴镜率(30.84%)高于男生(26.69%)(P=0.008)。初中学段低、中、高度近视的足矫率均为3个学段中最低。在各个学段中,高度近视的足矫率均最低...     

Intramyocardial variability in integrated backscatter: effects of coronary occlusion and reperfusion

The present study was undertaken to characterize regional myocardial alterations of reflected ultrasound during the cardiac cycle in normal, ischemic, and postischemic reperfused myocardium. Time-averaged integrated backscatter (IB) and cardiac cycle-dependent amplitude modulation were measured from subepicardial, midmyocardial, and subendocardial regions of the left ventricular apex and the midportion of the right ventricular free wall under normal conditions (n = 5), after 1 hr of 100% acute left anterior descending (LAD) occlusion (n = 8), and after 15 min LAD occlusion plus 120 min reperfusion (n = 5) in anesthetized, ventilated open-chest dogs. A significant increase in time-averaged IB was observed in the subepicardium, the midmyocardium, and the subendocardium during ischemia and reperfusion, but there was no intramyocardial variability. Cardiac cycle-dependent amplitude modulation of IB was significantly higher in the normal subendocardium than in the subepicardium (4.3 +/- 0.6 vs 2.9 +/- 0.8 dB, p less than .01) and midmyocardium (2.8 +/- .05 dB, p less than .01). This transmural gradient in amplitude modulation was abolished during ischemia and reperfusion. We conclude that cardiac cycle-dependent amplitude modulation in IB has a transmural dependence in the normal myocardium and this is abolished during acute myocardial ischemia.     

High Prevalence of Latent Tuberculosis Infection in Patients in End-Stage Renal Disease on Hemodialysis: Comparison of QuantiFERON-TB GOLD, ELISPOT, and Tuberculin Skin Test

Abstract Background:   Individuals with end-stage renal disease (ESRD) are 10- to 25-fold more likely than immunocompetent people to develop active tuberculosis (TB) and are candidates for being treated for latent TB infection (LTBI). However, diagnosis using the tuberculin skin test (TST) is doubly difficult due to cutaneous anergy and cross-reactions with Bacille–Calmette–Guérin (BCG) vaccination. Materials and Methods:   This was a prospective, doublematched, cohort study in which 32 ESRD patients and 32 age-matched, healthy controls were enrolled. The TST and two new interferon-γ blood tests, QuantiFERON-TB Gold (QFT-G) and T-SPOT.TB (ELISPOT), were performed. The subjects were followed up 2 years for active TB disease. ELISPOT was done in ESRD patients only. Results:   Compared to the healthy controls, a high prevalence of LTBI was found in the ESRD patients by TST (62.5%, 95% confidence interval [CI] 43.7–78.9), QFT-G (40.0%, 95% CI 22.7–59.4), and ELISPOT (46.9%, 95% CI 29.1–65.3). Agreement was moderate (kappa [κ] = 0.53) for QFT-G and ELISPOT but only slight between TST and QFT-G (κ = 0.25) and fair between TST and ELISPOT (κ = 0.32). ESRD (p = 0.03) and diabetes mellitus (p = 0.04) were significant risk factors for QFT-G positivity on the multivariable analysis. The overall rate of active TB was 1.66 cases per 100 person-years (pys), with the rate higher in patients with ESRD (3.53 per 100 pys) and those with positive (3.40 per 100 pys) and indeterminate QFT results (30.16 per 100 pys), although the difference was not statistically significant. Sensitivity, specificity, and positive and negative predictive values of QFT-G for active TB was 100%, 62.1%, 8.3% and 100%. Conclusion:   This pilot study is the first to compare QFT-G, ELISPOT, and TST in ESRD patients on hemodialysis and demonstrates a high prevalence of LTBI in this population. In our study, the QFT-G was the more accurate method for identifying those truly infected with Mycobacterium tuberculosis, even in BCG-vaccinated individuals. The results of this study have been previously reported in part, in the form of an abstract, at the 46th Annual Meeting of Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), 27–30 September, 2006. San Francisco, USA. Abstract D460: S.S. Lee, Y.Y. Ni, T.S. Huang, K.R. Chou, H.C. Fang, H.C. Tsai, Y.S. Chen, S.R. Wann, H.H. Lin, Y.C. Liu. QuantiFERON-TB GOLD for Diagnosis of Latent Tuberculosis Infection in Patients with End-Stage Renal Disease in Taiwan.     

Serial echocardiographic appearance of healing bacterial vegetations.

Serial M mode and cross-sectional echocardiograms were obtained from six patients who had been treated with antibiotic drugs for infectious endocarditis. Three to six M mode echocardiograms and one to six cross-sectional echocardiograms were obtained from each patient over a follow-up period averaging 50 weeks (range 10 to 108 weeks). On echocardiography, vegetations were observed to have become smaller and more echo-reflective with healing. A dramatic change was seen in two patients after peripheral embolization. M mode echocardiography was particularly helpful in determining the quality of echo reflection by vegetations; cross-sectional echocardiography was more helpful in judging the size and shape of a vegetation. Echocardiography is ideally suited for the serial visualization of healing vegetations in patients who do not require early valve replacement. It may prove helpful to examine serially valve vegetations with both M mode and cross-sectional echocardiography when following up patients with infectious endocarditis treated with antibiotic agents.     

Ultrasonic tissue characterization of normal and ischemic myocardium

Cardiac ultrasonic tissue characterization is designed to use the alterations in acoustic signals from the myocardium to differentiate normal from ischemic or infarcted tissue due to their characteristic backscatter attenuation. Various approaches such as use of a gray scale, color display, or quantitative image analysis have been used for tissue characterization, but all depend on subjective assessments and are not necessarily reproducible. The most promising method has been the use of "raw" radiofrequency signals and measure changes in the ultrasonic attenuation with an index of backscatter to distinguish normal from abnormal myocardium called "integrated backscatter" (IB). Various studies have demonstrated the changes in the ultrasonic backscatter with ischemia or infarction. In this review we summarize our experience with a research prototype instrument in tissue characterization and differentiation of normal, ischemic, infarcted, and post ischemic reperfused myocardium in anesthetized open chest dogs. Currently we are investigating the role of ultrasonic tissue characterization to estimate infarct size and plan to apply these observations to patients in order to detect viable myocardium and quantitate infarct size.