An overview of mycetoma and its diagnostic dilemma: Time to move on to advanced techniques

The neglected tropical disease mycetoma can become extremely devastating, and can be caused both by fungi and bacteria; these are popularly known as eumycetoma and actinomycetoma respectively. The classical triad of the disease is subcutaneous swelling, multiple discharging sinuses and the presence of macroscopic granules. The present study aims to highlight the existing diagnostic modalities and the need to incorporate newer and more advanced laboratory techniques like pan fungal/pan bacterial 16S rRNA gene polymerase chain reaction (PCR) and sequencing, Matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS), rolling circle amplification (RCA), loop-mediated isothermal amplification (LAMP) and recombinase polymerase amplification (RPA). It is important for the medical team to be aware of the various diagnostic options (both existing and future), so that diagnosis of such a debilitating disease is never missed, both by clinicians and microbiologists/pathologists. The newer diagnostic methods discussed in this article will help in rapid, accurate diagnosis thus facilitating early treatment initiation, and decreasing the overall morbidity of the disease. In the Indian context, newer technologies need to be made available more widely. Making clinicians aware and promoting research and development in mycetoma diagnostics is the need of the hour.

Is Follow-up Co-Morbidity Assessment via Laboratory Investigations in Older High Energy Trauma Patients Justified? - A Prospective-Retrospective Study

@#Introduction: The objective of the current study was to test our hypothesis that older patients sustaining high energy trauma need to be evaluated for their comorbidities similar to geriatric patients sustaining low energy trauma. Materials and methods: This study was a retrospectiveprospective analysis of 173 patients of more than 50 years of age enrolled between November 2017 and December 2018. Herewith, we have compared retrospectively collected laboratory investigations of 124 fragility fracture patients with prospectively collected laboratory investigations of 49 patients with high energy trauma. The laboratory investigations, including the liver function tests, renal function tests, indices of calcium metabolism, serum electrolytes, complete blood counts, and bone mineral density (BMD) scores. Results: Both groups were similar to each other as far as baseline demographic characteristics were concerned. The proportion of female patients and patients with nonosteoporotic range BMD (T-score >-2.5) was significantly higher in the high-energy fracture group (P value <0.05). Hypoalbuminemia (<3.4gm/dl) 17.3%, abnormalities sodium (<135mmol/L or >148mmol/L) 23.2%, Anaemia (<10g/dl) 12.7%, Hypercalcemia (>10.4mg/dl) 16.3%, Vitamin D deficiency (<20ng/ml) 17.3% are the common laboratory abnormality found in study population. No statistically significant difference was found among the two groups in terms of laboratory investigation abnormalities. Conclusion: The laboratory investigation abnormality in an older patient with a clinical fracture is independent of the mechanism of injury. The results of the current study emphasise the need for a comprehensive laboratory workup in older patients with either high- energy fractures or fragility fractures.

Progress in research on Coxsackievirus A6 / 中国生物制品学杂志

@#Hand-foot-mouth disease(HFMD) is an infectious disease that seriously affects the health of infants and young children and has become a major public health problem worldwide,especially in the Asia-Pacific region.HFMD can be caused by a variety of enteroviruses,the most common being enterovirus 71(EV71) and Coxsackievirus A16(CVA16).In recent years,with the significant increase of HFMD caused by Coxsackievirus A6(CVA6) infection,CVA6 has gradually become the main pathogen of HFMD in many countries and regions around the world.CVA6 is not only susceptible to children,but also infects adults with normal immune function.The paper reviewed the CVA6 related etiology,epidemiology,clinical symptoms,laboratory diagnosis and development of vaccine.

Emphasis of rapid and accurate laboratory diagnosis of insect-borne infectious diseases / 中华检验医学杂志

In recent years, with the change of natural and social factors, such as climate warming, urbanization, land reclamation, human population growth, change of life customs, and convenient transportation, the human infectious diseases transmitted by insect vectors, well known as insect-borne infectious diseases, has increased significantly, causing a serious threat to public health. This paper focuses on the epidemiology, clinical characteristics, especially laboratory diagnosis of insect-borne infectious diseases, and emphasizes that medical institutions should pay attention to the rapid and accurate laboratory diagnosis of insect-borne infectious diseases. Metagenomic next generation sequencing has potential value in the diagnosis of insect-borne infectious diseases with unknown causes.

Manejo de la estrongiloidiasis: revisión de la literatura con enfoque en la epidemiología en Bolivia

La estrongiloidiasis es una de las enfermedades parasitarias más desatendidas. Tiene una elevada morbilidad y mortalidad en personas tratadas con corticosteroides o con una inmunidad reducida por otros motivos. En Bolivia los estudios realizados han demostrado una alta prevalencia y su transmisión en diversas regiones tropicales y de los valles interandinos. Aunque la enfermedad no se transmite en climas fríos, todas las regiones de Bolivia pueden verse afectadas debido a la migración interna de la población. Las personas pueden infectarse al viajar a regiones endémicas décadas antes de presentar síntomas, porque si se deja sin tratar, puede persistir de por vida La baja sensibilidad de las pruebas diagnósticas coproparasitológicas utilizadas de rutina dificultan su diagnóstico, pero existen técnicas de diagnóstico más eficientes a bajo costo como la técnica de Baermann modificada. La ivermectina es el tratamiento de elección, muy eficaz, bien tolerado cuando es prescrito a dosis adecuada, accesible y disponible en Bolivia.

Strongyloidiasis is one of the neglected parasitosis. Strongyloidiasis has a high morbidity and mortality among people treated with corticosteroids or with reduced immunity for other reasons. In Bolivia, the studies have shown its transmission and high prevalence in various tropical regions and the inter-Andean valleys. Although the disease is not transmitted in cold climates, people living in all regions of Bolivia can be affected due to internal migration. Infection can occur during travel to endemic areas decades before the onset of symptoms, because if left untreated, the strongyloidiasis can persist for life. This disease is one of the most neglected mainly due to the low sensitivity of the coproparasitological tests routinely used in clinical laboratories. There are more efficient diagnostic methods, such as the modified Baermann technique. which can be applied in Bolivia at low cost. Ivermectin is the treatment of choice, effective, well tolerated in adequate dosis, cheap and available in Bolivia.

Baseline laboratory parameters for preliminary diagnosis of COVID-19 among children: a cross-sectional study

ABSTRACT BACKGROUND: Clinical judgment of initial baseline laboratory tests plays an important role in triage and preliminary diagnosis among coronavirus disease 2019 (COVID-19) patients. OBJECTIVES: To determine the differences in laboratory parameters between COVID-19 and COVID-like patients, and between COVID-19 and healthy children. Additionally, to ascertain whether healthy children or patients with COVID-like symptoms would form a better control group. DESIGN AND SETTING: Cross-sectional study at the Institute for Child and Youth Health Care of Vojvodina, Novi Sad, Serbia. METHODS: A retrospective study was conducted on 42 pediatric patients of both sexes with COVID-19. Hematological parameters (white blood cell count, absolute lymphocyte count and platelet count) and biochemical parameters (natremia, kalemia, chloremia, aspartate aminotransferase [AST], alanine aminotransferase [ALT], lactate dehydrogenase [LDH] and C-reactive protein [CRP]) were collected. The first control group was formed by 80 healthy children and the second control group was formed by 55 pediatric patients with COVID-like symptoms. RESULTS: Leukocytosis, lymphopenia, thrombocytosis, elevated systemic inflammatory index and neutrophil-lymphocyte ratio, hyponatremia, hypochloremia and elevated levels of AST, ALT, LDH and CRP were present in COVID patients, in comparison with healthy controls, while in comparison with COVID-like controls only lymphopenia was determined. CONCLUSIONS: The presence of leukocytosis, lymphopenia, thrombocytosis, elevated systemic inflammatory index and neutrophil-lymphocyte ratio, hyponatremia, hypochloremia and elevated levels of AST, ALT, LDH and CRP may help healthcare providers in early identification of COVID-19 patients. Healthy controls were superior to COVID-like controls since they provided better insight into the laboratory characteristics of children with novel betacoronavirus (SARS-CoV-2) infection.

Alterações de parâmetros laboratoriais em pacientes com COVID-19: uma revisão sistemática / Changes in laboratory parameters in patients with COVID-19: a systematic review

O objetivo deste estudo foi identificar e reunir os principais achados disponíveis no começo da pandemia, acerca das alterações laboratoriais de pacientes internados com COVID-19 e discutir a predominância dessas alterações na gravidade do curso da doença. Trata-se de uma revisão sistemática de literatura, restringida a publicações até abril de 2020, utilizando as bases de dados Lilacs e Pubmed. Um total de 381 publicações foram encontradas nas bases de dados consultadas e destas, 17 publicações foram elegíveis para análise conforme os critérios de inclusão e exclusão. Parâmetros laboratoriais como a redução de linfócitos e elevação de D-dímeros, lactato desidrogenase e proteína C reativa parecem estar ligados à infecção pelo SARS-CoV-2 e podem servir como indicadores prognósticos da doença. A linfocitopenia e o aumento de D-dímeros são marcadores relacionados ao agravamento da doença e a desfechos desfavoráveis como óbito.

The objective of this study was to identify and gather the main findings available at the beginning of the pandemic, regarding laboratory alterations of hospitalized patients with COVID-19 and to discuss the predominance of these alterations in the severity of the course of the disease. This is a systematic literature review, restricted to publications until April 2020, using the Lilacs and Pubmed databases. A total of 381 publications were found in the consulted databases and of these, 17 publications were eligible for analysis according to the inclusion and exclusion criteria. Laboratory parameters such as the reduction of lymphocytes and the elevation of D-dimers, lactate dehydrogenase and C-reactive protein appear to be linked to SARS-CoV-2 infection and may serve as prognostic indicators of the disease. Lymphocytopenia and increased D-dimers are markers related to disease worsening and unfavorable outcomes such as death.

Delays in HIV-1 infant polymerase chain reaction testing may leave children without confirmed diagnoses in the Western Cape province, South Africa

Background: Early diagnosis and confirmation of HIV infection in newborns is crucial for expedited initiation of antiretroviral therapy. Confirmatory testing must be done for all children with a reactive HIV PCR result. There is no comprehensive data on confirmatory testing and HIV PCR test request rejections at National Health Laboratory Service laboratories in South Africa.Objective: This study assessed the metrics of routine infant HIV PCR testing at the Tygerberg Hospital Virology Laboratory, Cape Town, Western Cape, South Africa, including the proportion of rejected test requests, turn-around time (TAT), and rate of confirmatory testing.Methods: We retrospectively reviewed laboratory-based data on all HIV PCR tests performed on children ≤ 24 months old (n = 43346) and data on rejected HIV PCR requests (n = 1479) at the Tygerberg virology laboratory over two years (2017­2019). Data from sample collection to release of results were analysed to assess the TAT and follow-up patterns.Results: The proportion of rejected HIV PCR requests was 3.3%; 83.9% of these were rejected for various pre-analytical reasons. Most of the test results (89.2%) met the required 96-h TAT. Of the reactive initial test results, 53.5% had a follow-up sample tested, of which 93.1% were positive. Of the initial indeterminate results, 74.7% were negative on follow-up testing.Conclusion: A high proportion of HIV PCR requests were rejected for pre-analytical reasons. The high number of initial reactive tests without evidence of follow-up suggests that a shorter TAT is required to allow confirmatory testing before children are discharged.

Laboratory diagnosis for malaria in the elimination phase in China: efforts and challenges / 医学前沿

Malaria remains a global health challenge, although an increasing number of countries will enter pre-elimination and elimination stages. The prompt and precise diagnosis of symptomatic and asymptomatic carriers of Plasmodium parasites is the key aspect of malaria elimination. Since the launch of the China Malaria Elimination Action Plan in 2010, China has formulated clear goals for malaria diagnosis and has established a network of malaria diagnostic laboratories within medical and health institutions at all levels. Various external quality assessments were implemented, and a national malaria diagnosis reference laboratory network was established to strengthen the quality assurance in malaria diagnosis. Notably, no indigenous malaria cases have been reported since 2017, but the risk of re-establishment of malaria transmission cannot be ignored. This review summarizes the lessons about malaria diagnosis in the elimination phase, primarily including the establishments of laboratory networks and quality control in China, to better improve malaria diagnosis and maintain a malaria-free status. A reference is also provided for countries experiencing malaria elimination.

Predictors of poor short-term outcome in patients with autoimmune encephalitis / 中华检验医学杂志

Objective:To analyze the risk factors of poor short-term outcome in patients with autoimmune encephalitis (AE).Methods:The data were collected retrospectively from patients hospitalized in the First Affiliated Hospital of Fujian Medical University from March 2016 to January 2021. According to the Modified Rankin Scale (mRS), eighty-one patients with AE were divided into the good prognosis group (mRS≤2, n=48) and the poor prognosis group (mRS>2, n=33). The clinical data, including the basic demographic data, main clinical manifestations, cranial MRI and electroencephalogram, as well as laboratory indicators from blood and cerebrospinal fluid (CSF), were compared between two groups, and the risk factors for poor outcome were analyzed by multivariate logistic regression. The receiver operating characteristic (ROC) curve was used to determine the cut-off value of these risk factors on predicting the poor short-term outcome for the AE patients. Results:The time of hospitalization was significantly longer in the poor prognosis group than in the good prognosis group ( P<0.05). Prevalence of severe disease course at admission, abnormal mental and behavior, δ wave and δ brush of abnormal EEG was significantly higher in the poor prognosis group than in the good prognosis group (all P<0.05). Serum leukocyte count, neutrophil count, lymphocyte count, mononuclear cell count, C-reactive protein, procalcitonin(PCT), alanine aminotransferase, aspartate transaminase, lactate dehydrogenase, creatine kinase, creatine kinase isoenzyme, apoA1/B, calcium, sodium, anion gap in serum, CSF oligoclonal bands, CSF-IgG index and antibody titer were significantly different between the two groups (all P<0.05). Severity of illness at admission ( OR=1.816, 95% CI 1.250-2.639, P=0.002), PCT ( OR=1.345, 95% CI 1.008-1.794, P=0.044), antibody titer in serum ( OR=1.422, 95% CI 1.071-1.888, P=0.015), CSF-IgG index ( OR=1.802, 95% CI 1.035-3.138, P=0.037) and anionic gap ( OR=1.640, 95% CI 1.191-2.259, P=0.002) were the independent risk factors for the poor short-term prognosis of patients with AE. The AUC value of combing the above 5 indexes to predict the poor short-term prognosis in patients with AE was 0.920 (95% CI 0.834-0.971), with 83.87% sensitivity and 88.37% specificity. Conclusion:Severity of illness at admission, PCT, antibody titer in serum, CSF-IgG index and anionic gap are the independent risk factors of poor short-term prognosis in patients with AE and the combination of these 5 indexes can sufficiently predict the poor short-term prognosis in patients with AE.

Clinical evaluation of laboratory diagnosis of Mycoplasma pneumoniae / 中华实用儿科临床杂志

Objective:To compare the laboratory diagnostic methods of Mycoplasma pneumonia(MP) and evaluate its clinical value.Methods:A prospective study.Throat swabs and double sera of children with MP infection were collected from December 2016 to January 2017 in Shengjing Hospital Affiliated to China Medical University; throat swab samples of healthy children aged 3 to 5 in Chaoyang District, Beijing were collected from March to May 2017.Passive agglutination (PA) was used to detect the double serum.Taking the 4-fold increase or decrease of the specific antibody titer of the double serum as the gold standard, the receiver operating characteristic curve (ROC) was drawn, and the laboratory methods for detecting MP infection were compared and evaluated.Results:(1)A total of 93 children with MP infection were clinically diagnosed, including 42 males (45.2%) and 51 females (54.8%), with an average age of 5.5 years.Sixty cases (64.5%) of MP infection were diagnosed.There were 349 healthy children, 198 males and 151 females, with an average age of 4.3 years.The positive rate of throat swab culture was 0.6% (2 cases), and the positive rate of fluorescent quantitative PCR(qPCR) was 18.9% (66 cases). (2) The culture specificity was the highest (100.0%) and the sensitivity was the lowest (65.0%). PA and enzyme linked immunosorbent assay (ELISA) were used to detect a single serum in the acute phase, the sensitivity was 71.7% and 86.5% respectively.ROC curve suggested that the current clinical diagnostic threshold MP specific antibody IgM ≥ 1∶160 was not the best diagnostic threshold.Molecular biological diagnostic methods were the most sensitive, RNA simultaneous and testing (SAT) was 85.0% and qPCR was 93.0%; while the specificity was low, 75.7% (SAT) and 63.6% (qPCR), respectively.(3) At the same time, MP nucleic acid (SAT, PCR) of throat swabs and a single serum (ELISA, PA) of children in acute phase were detected, the sensitivity was increased to 95.0%-100.0%, and the specificity was 63.6%-75.7%.Conclusions:Molecular biology is highly sensitive in diagnosing MP infection.It has asymptomatic infection or is carried after infection.Whether it needs treatment needs to be combined with clinical practice, when MP detection is positive.The detection of a single serum in the acute phase with a course of about 1 week has high sensitivity and is of reference value for the diagnosis of MP infection, but the diagnosis needs to be combined with clinical practice.The sensitivity and accuracy of detecting MP infection by single serological test combined with SAT in acute phase are higher than that by single application.

Advances and utility of laboratory investigation in diagnosis of pediatric allergic diseases / 中华检验医学杂志

The rapid increase of childhood allergic disorders has become one of the major challenges in the pediatric health care system. Laboratory diagnosis is essential in order to determine appropriate strategies towards best clinical practice strategies, including accurate diagnosis, prophylaxis and optimized management. Once there are sufficient clinical grounds to support a diagnosis of allergy, confirmatory in vivo and in vitro tests should be performed. In vivo tests mainly include skin prick tests and allergen provocation tests. Provocation tests are the gold standard for diagnosing allergic diseases. In vitro tests mainly include allergen-specific IgE antibody, Th2 related cytokines, and mast cell activity markers. These tests can clarify the immune state status of the patient and lead to optimized treatment, such as avoiding allergens avoidance, allergens-specific immunotherapy, and anti-IgE therapy. Controlling disease progress and preventing relapses can benefit children who are suffering from the consequences of allergies.

Technical performance of a lateral flow immunoassay for detection of anti-SARS-CoV-2 IgG in the outpatient follow-up of non-severe cases and at different times after vaccination: comparison with enzyme and chemiluminescent immunoassays

ABSTRACT This study assessed the technical performance of a rapid lateral flow immunochromatographic assay (LFIA) for the detection of anti-SARS-CoV-2 IgG and compared LFIA results with chemiluminescent immunoassay (CLIA) results and an in-house enzyme immunoassay (EIA). To this end, a total of 216 whole blood or serum samples from three groups were analyzed: the first group was composed of 68 true negative cases corresponding to blood bank donors, healthy young volunteers, and eight pediatric patients diagnosed with other coronavirus infections. The serum samples from these participants were obtained and stored in a pre-COVID-19 period, thus they were not expected to have COVID-19. In the second group of true positive cases, we chose to replace natural cases of COVID-19 by 96 participants who were expected to have produced anti-SARS-CoV-2 IgG antibodies 30-60 days after the vaccine booster dose. The serum samples were collected on the same day that LFIA were tested either by EIA or CLIA. The third study group was composed of 52 participants (12 adults and 40 children) who did or did not have anti-SARS-CoV-2 IgG antibodies due to specific clinical scenarios. The 12 adults had been vaccinated more than seven months before LFIA testing, and the 40 children had non-severe COVID-19 diagnosed using RT-PCR during the acute phase of infection. They were referred for outpatient follow-up and during this period the serum samples were collected and tested by CLIA and LFIA. All tests were performed by the same healthcare operator and there was no variation of LFIA results when tests were performed on finger prick whole blood or serum samples, so that results were grouped for analysis. LFIA's sensitivity in detecting anti-SARS-CoV-2 IgG antibodies was 90%, specificity 97.6%, efficiency 93%, PPV 98.3%, NPV 86.6%, and likelihood ratio for a positive or a negative result were 37.5 and 0.01 respectively. There was a good agreement (Kappa index of 0.677) between LFIA results and serological (EIA or CLIA) results. In conclusion, LFIA analyzed in this study showed a good technical performance and agreement with reference serological assays (EIA or CLIA), therefore it can be recommended for use in the outpatient follow-up of non-severe cases of COVID-19 and to assess anti-SARS-CoV-2 IgG antibody production induced by vaccination and the antibodies decrease over time. However, LFIAs should be confirmed by using reference serological assays whenever possible.

Anthelmintic resistance of Haemonchus contortus from sheep flocks in Brazil: concordance of in vivo and in vitro (RESISTA-Test©) methods / Resistência anti-helmíntica de Haemonchus contortus em rebanhos ovinos no Brasil: concordância de métodos in vivo e in vitro (RESISTA-Test©)

Abstract This study evaluated the resistance status of Haemonchus contortus from sheep flocks in the state of São Paulo, Brazil, through comparison between the fecal egg count reduction test (FECRT) and the larval development test (LDT). For the FECRT, 35 sheep were selected in each of five flocks and divided into groups treated with: benzimidazole, levamisole, ivermectin, monepantel and control. Feces were collected for EPG and fecal cultures. The LDT was performed using thiabendazole (TBZ), levamisole (LEV), ivermectin aglycone (IVM-A) and Zolvix (ZLV). Resistance to all drugs was detected using FECRT in 100% of the flocks, except in relation to ZLV (40% resistant and 20% suspected of resistance). LDT indicated resistance to TBZ and IVM-A in all flocks, to LEV in 80% of flocks and to ZLV in 10%. Total agreement was obtained between the two tests for TBZ and IVM (k = 1.0), while for LEV (k = 0.8) and ZLV (k = 0.9), substantial and almost perfect agreement were obtained, respectively. The concordance between the tests was significant, thus showing that it is possible to use the outcome of the LDT to predict the FECRT, and hence validating the former as a fast diagnostic test for use by sheep farmers in Brazil.

Resumo Este estudo avaliou o status de resistência de Haemonchus contortus em rebanhos ovinos do estado de São Paulo, Brasil, através de um estudo comparativo entre o teste de redução da contagem de ovos nas fezes (TRCOF) e o teste de desenvolvimento larvar (TDL). Para o TRCOF, 35 ovinos foram selecionados em cada um dos cinco rebanhos e divididos em grupos tratados com: benzimidazol, levamisol, ivermectina, monepantel e controle. Fezes foram coletadas para OPG e coproculturas. O TDL foi realizado com tiabendazol-TBZ, levamisol-LEV, ivermectina aglicona-IVM-A e Zolvix-ZLV. Resistência a todos os fármacos foi detectada por meio do TRCOF em 100% dos rebanhos, exceto para ZLV (40% resistentes e 20% suspeitos de resistência). O LDT indicou resistência ao TBZ e IVM-A em todos os rebanhos; em 80% dos rebanhos ao LEV e 10% ao ZLV. Foi obtida concordância total entre os dois testes para TBZ e IVM (k = 1,0), enquanto para LEV (k = 0,8) e ZLV (k = 0,9) foram obtidas concordância substancial e quase perfeita, respectivamente. A concordância entre os testes foi significante, sendo possível usar o resultado do LDT para prever o do TRCOF, validando-se o primeiro como um teste diagnóstico rápido para criadores de ovinos no Brasil.

Persistent cutaneous canine leishmaniasis caused by Leishmania (Viannia) braziliensis in an area with predominance of Nyssomyia neivai in the state of São Paulo, Brazil / Leishmaniose cutânea canina persistente causada por Leishmania (Viannia) braziliensis em uma área com predomínio de Nyssomyia neivai no estado de São Paulo, Brasil

Abstract American cutaneous leishmaniasis (ACL) is a neglected zoonotic disease caused mainly by Leishmania (Viannia) braziliensis, which is endemic throughout Brazil. Canine ACL cases were investigated in a rural area of Monte Mor, São Paulo, where a human ACL case had been confirmed. Dogs were evaluated through clinical and laboratory diagnosis including serology, cytological tissue preparations and PCR on skin lesions, lymph node and bone marrow samples. Entomological investigations on sandflies trapped in the surroundings of the study area were performed for 14 months. Nyssomyia neivai was the predominant phlebotomine species, comprising 94.65% of the captured specimens (832 out of 879). This species was the most abundant in all trapping sites, including human homes and dog shelters. Ny. whitmani, Migonemyia migonei, Pintomyia monticola, Evandromyia cortellezzii, Pi. fischeri and Expapilata firmatoi were also captured. Two of the three dogs examined were positive for anti-Leishmania IgG in ELISA using the antigen Fucose mannose ligand and skin samples were positive for L. (V.) braziliensis in PCR, but all the samples collected were negative for L. (L.) infantum. One of the dogs had a confirmed persistent infection for more than one year.

Resumo A leishmaniose tegumentar Americana (LTA) é uma doença zoonótica negligenciada, causada principalmente por Leishmania (Viannia) braziliensis, sendo endêmica em todo o Brasil. Foram investigados casos de LTA canina em uma área rural da cidade de Monte Mor, São Paulo, onde foi confirmado um caso humano de LTA. Os cães foram avaliados por diagnóstico clínico e laboratorial, incluindo sorologia, esfregaços microscópicos e PCR de amostras em lesões de pele, linfonodos e medula óssea. Também foram realizadas investigações entomológicas durante 14 meses, usando-se armadilhas luminosas para flebotomíneos nas proximidades da área de estudo. Nyssomyia neivai foi a espécie de flebotomíneo predominante com 94,65% dos espécimes capturados (832 de 879). Essa espécie foi a mais abundante em todos os locais de captura, incluindo-se abrigos para humanos e cães. Foram também capturadas as espécies Ny. whitmani, Migonemyia migonei, Pintomyia monticola, Evandromyia cortellezzii, Pi. fischeri e Expapilata firmatoi. Dos três cães examinados, dois apresentaram IgG anti-Leishmania positivo no ELISA, usando-se o antígeno "Fucose mannose ligand", PCR da lesão de pele positivo para L. (V.) braziliensis e negativo em todas amostras para L. (L.) infantum. Um dos cães apresentou infecção persistente por mais de um ano.

Research progress of phytosterolemia and its laboratory diagnosis / 中华检验医学杂志

Phytosterolemia is a rare, severe autosomal recessive sterol storage disorder caused by homozygous or compound heterozygous mutations in one of the ABCG5 and/or ABCG8 adenosine triphosphate binding cassette (ABC) genes. The most prominent features of phytosterolemia are the significantly increased serum content of plant sterols. Present review focused on the laboratory diagnosis of phytosterolemia, briefly described the metabolism of phytosterols, and introduced the latest research progress on phytosterolemia diagnosis, its relationship with ASCVD and laboratory diagnostic methods (including the detection of serum concentrations of phytosterols, ABCG5/G8 gene mutation). We hope this article could improve readers′ awareness and attention on this disease.

Development and validation of colorectal cancer risk prediction model based on the big data in laboratory medicine / 中华检验医学杂志

Objective:We aimed to explore a colorectal cancer risk prediction model through machine learning algorithm based on the big data in laboratory medicine.Methods:According to the labeling of colonoscopy combined with pathology or referring to the ICD-10 code, the colonoscopy patients in Shanghai Changhai Hospital from 2013.1.1 to 2019.6.30 and the outpatients and inpatients from 2010.1.1 to 2019.6.30 were divided into colorectal cancer groups and non-colorectal cancer group. Four machine learning algorithms, Extreme gradient boosting(Xgboost),Artificial Neural Network(ANN),Support Vector Machine(SVM),Random Forest(RF), are used to mine all routine laboratory test item data of the enrolled patients, select model features and establish a classification model for colorectal cancer. And the effectiveness of the model was prospectively verified in patients in the whole hospital of Changhai Hospital from 2019.7.1 to 2020.8.31.Result:A colorectal cancer risk prediction model (CRC-Lab7) including 7 characteristics of fecal occult blood, carcinoembryonic antigen, red blood cell distribution width, lymphocyte count, albumin/globulin, high-density lipoprotein cholesterol and hepatitis B virus core antibody was constructed by the XgBoost algorithm. The AUC of the model in the validation set and prospective validation set were 0.799 and 0.816, respectively, which was significantly higher than that of fecal occult blood (AUC was 0.68 and 0.706, respectively). It also has high diagnostic accuracy for colorectal cancer with negative fecal occult blood or under 50 years old.Conclusion:In this study, a colorectal cancer risk prediction model was established by mining routine laboratory big data. The model′s performance is better than fecal occult blood, and it has high diagnostic accuracy for colorectal cancer in patients with negative fecal occult blood and younger than 50 years old.

Significance and progress in laboratory diagnosis of Mycoplasma pneumoniae pneumonia / 中华实用儿科临床杂志

Mycoplasma pneumoniae pneumonia (MPP) is a clinical common respiratory tract infectious di-sease.In recent years, the number of children with severe and refractory MPP has increased significantly.Clinical symptoms of MPP are usually atypical, and some MPP cases are accompanied with extrapulmonary complications.In addition, imaging features of MPP also lack specificity.The diagnosis of MPP, as a result, often relies on laboratory examinations.The present study demonstrated the clinical significance in laboratory diagnosis of Mycoplasma pneumoniae (MP) infection, and the method to distinguish present infection, previous infection or carriers in healthy children′s respiratory tract.Moreover, the method to determine macrolide-resistant MP was also described in this study.This study aims to improve the understanding, diagnosis and treatment of MP infection.

Estudo epidemiológico e caracterização de coorte de pacientes com infecção por Clostridioides difficile internados no Hospital das Clínicas da UFMG / Epidemiological study and characterization of a cohort of patients with Clostridioides difficile infection hospitalized at the Hospital das Clínicas of UFMG

Introdução: a infecção por Clostridioides difficile (ICD) é a principal causa bacteriana de diarreia infecciosa associada aos cuidados de saúde e é responsável por significativa morbimortalidade, assim como por custos elevados relacionados ao tratamento em todo o mundo. Na Europa e nos Estados Unidos a densidade de incidência varia entre 2,9 e 8,3 casos/10.000 pacientes-dia. Não existem dados precisos sobre a taxa de incidência na América Latina. Objetivos: obter a medida da densidade de incidência da ICD associada aos cuidados de saúde em hospital de alta complexidade e descrever o perfil desta coorte de pacientes. Métodos: foi realizada busca ativa diária de casos de diarreia durante o período de 3 meses, entre abril e julho de 2021. Os casos suspeitos foram submetidos ao teste rápido para pesquisa da glutamato desidrogenase (GDH) e das toxinas A e B de C. difficile. Nas amostras positivas apenas para o GDH, a confirmação diagnóstica foi feita por meio da cultura toxigênica. Resultados: foram identificados 104 pacientes com diarreia e o C. difficile toxigênico foi responsável por 21 casos. A densidade de incidência foi de 9,2 casos para cada 10.000 pacientes-dia. A mediana de idade dos pacientes com ICD foi de 63 (19-80) anos, 57,1% eram do sexo masculino e a média do Índice de Comorbidades de Charlson foi de 4,10 (±2,49). Dezessete pacientes (81%) fizeram uso de antibiótico (ATB) nos 3 meses que precederam a infecção e a média do número de ATB foi de 3,29 (±2,72). A ICD foi considerada grave em 11 pacientes (52,4%). Vancomicina foi opção inicial de tratamento em 14 pacientes (66,7%), e 11 pacientes (52,4%) apresentaram resposta até o quinto dia. Dois pacientes estavam no segundo episódio de ICD e um paciente apresentou recorrência após período de recrutamento. Ocorreram três óbitos, provavelmente não relacionados à ICD. Conclusão: a medida da densidade de incidência foi alta e aponta para a necessidade de medidas que visem melhor controle da infecção. A amostra de pacientes foi caracterizada como complexa, com múltiplas comorbidades, uso recente de vários ATB e mortalidade alta.

Introduction: Clostridioides difficile (ICD) infection is the leading bacterial cause of healthcare-associated infectious diarrhea and it is responsible for significant morbidity and mortality rates, as well as treatment-related costs worldwide. In Europe and the United States, the incidence density varies between 2.9 and 8.3 cases/10,000 patient-days. There is no precise data about the incidence rate in Latin America. Objectives: get the measure of the incidence density of healthcare-related ICD in a high-complexity hospital and to define the profile of this cohort of patients. Methods: daily active search for diarrhea cases was carried out during a 3-month period, between April and July 2021. Suspected cases were submitted to a rapid test for glutamate dehydrogenase (GDH) and C. difficile toxins A and B. In samples positive only for GDH, diagnostic confirmation was made through toxigenic culture. Results: 104 patients with diarrhea were identified and toxigenic C. difficile was responsible for 21 cases. The incidence density was 9.2 cases for every 10,000 patient-days. The median age of patients with ICD was 63 (19-80) years, 57.1% were male and the mean Charlson Comorbidity Index was 4.10 (±2.49). Seventeen patients (81%) used antibiotics (ATB) in the 3 months preceding the infection and the mean number of ATB was 3.29 (±2.72). ICD was considered severe in 11 patients (52.4%). Vancomycin was the initial treatment option in 14 patients (66.7%) and 11 patients (52,4%) responded by the fifth day. Two patients were in the second episode of ICD and one patient had recurrence after the recruitment period. There were three deaths, probably unrelated to CDI. Conclusion: The measure of incidence density was high and points to the need for measures aimed at better infection control. The sample of patients was characterized as complex, with multiple comorbidities, recent use of multiple ATB and high mortality.

Concordance Between Clinical and Laboratory Diagnosis of Abnormal Vaginal Discharge in Chilean Women / Concordância entre o diagnóstico clínico e laboratorial de corrimento vaginal anormal em mulheres chilenas

Abstract Objective To determine the concordance between the clinical diagnosis of women with abnormal vaginal discharge (AVD) and laboratory results using molecular detection and observation of the vaginal microbiota. Methods Cross-sectional study conducted in 2018 in Temuco, Chile. A total of 25 midwives from 12 health centers participated. A total of 125 women>18 years old, volunteers, were recruited. The sample of the posterior vaginal fornix was obtained by speculoscopy. Characteristics of the discharge and of the external and internal genitalia were observed. Gram staining was used to observe vaginal microbiota, blastoconidia and pseudohyphae, and polymerase chain reaction was used for the detection of Trichomonas vaginalis and Candida albicans. The Cohen kappa coefficient was used in the concordance analysis. Results Out of a total of 125 women with AVD, 85.6% consulted spontaneously and 14.4% were diagnosed clinically during a routine check-up. Absolute concordance was significant (p=0.0012), with an agreement of 13.6%. The relative concordance was significant, but fair for bacterial vaginosis (Kappa=0.21; p=0.003) and candidiasis (Kappa=0.22; p=0.001), and slight for trichomoniasis (Kappa=0.14; p=0.009). The percentage of coincidence of the diagnoses (single or mixed) by laboratory and midwives was: bacterial vaginosis 63.2% (12/19), candidiasis 36.5% (27/74), and trichomoniasis 12.5% (4/32). There was 20% coinfection. A total of 36% of the clinical diagnoses of AVD had negative laboratory tests. Conclusion The vulvovaginitis conditions candidiasis and trichomoniasis appear to be overdiagnosed, and bacterial vaginosis appears to be underdiagnosed by the clinical diagnosis when compared with the laboratory diagnosis. The low concordance obtained shows the importance of complementing the clinical diagnosis with a laboratory study of AVD, particularly in women with failed treatments and/or coinfections with unspecific and varying signs and symptoms.

Resumo Objetivo Determinar a concordância entre o diagnóstico clínico de mulheres com corrimento vaginal anormal (AVD) e os resultados laboratoriais por meio da detecção molecular e observação da microbiota vaginal. Métodos Estudo transversal realizado em 2018 em Temuco, Chile. Participaram 25 parteiras de 12 centros de saúde. Um total de 125 mulheres>18 anos, voluntárias, foramrecrutadas. A amostra do fórnice vaginal posterior foi obtida por especuloscopia. Foram observadas características da secreção e da genitália externa e interna. A coloração de Gram foi usada para observar a microbiota vaginal, blastoconídios e pseudo-hifas, e a reação em cadeia da polimerase foi usada para a detecção de Trichomonas vaginalis e Candida albicans. O coeficiente kappa de Cohen foi usado na análise de concordância. Resultados De um total de 125 mulheres com AVD, 85,6% consultaram espontaneamente e 14,4% foram diagnosticados clinicamente durante um check-up de rotina. A concordância absoluta foi significativa (p=0,0012), com concordância de 13,6%. A concordância relativa foi significativa, mas razoável para vaginose bacteriana (Kappa =0,21; p=0,003) e candidíase (Kappa=0,22; p=0,001), e leve para tricomoníase (Kappa=0,14; p=0,009). O percentual de coincidência dos diagnósticos (solteiros ou mistos) por laboratório e parteiras foi: vaginose bacteriana 63,2% (12/19), candidíase 36,5% (27/74) e tricomoníase 12,5% (4/32). Houve 20% de coinfecção. Umtotal de 36% dos diagnósticos clínicos de AVD tiveram exames laboratoriais negativos. Conclusão As condições de vulvovaginite candidíase e tricomoníase parecem ser sobrediagnosticadas, e a vaginose bacteriana parece ser subdiagnosticada pelo diagnóstico clínico quando comparado com o diagnóstico laboratorial. A baixa concordância obtida mostra a importância de complementar o diagnóstico clínico comestudo laboratorial de AVD, principalmente emmulheres com falha de tratamento e / ou coinfecções com sinais e sintomas inespecíficos e variáveis.