RESUMO
Background: An early initiation of antifungal therapy in invasive fungal infections (IFIs) is critical in reducing the high mortality rate. Current diagnosis of fungal infection relies on microscopy, culture, antigen, antibody specific tests and histological diagnosis. However, these tests either lack sensitivity or specificity. There is thus the need for a rapid, specific and accurate diagnostic method. Objective: The aim of our study was to establish PCR for the rapid detection of Candida and Aspergillus species in clinical specimens with improved sensitivity and specificity. Materials and Methods: A total of 71 proven cases of IFI (confirmed by culture) were collected. A total of 15 healthy, 15 patients suffering from bacterial sepsis and 15 patients with HIV, HBV viral infections were included as controls. Clinical specimens were subjected to a standardized nested amplification to produce Round I (504 bp) and Round II (150 bp) amplicons. Restriction digestion was performed on these products for further identification. Results: Analytical sensitivity was determined using 10 6 -10 CFU/ml of cell suspension. The lower detection limit of the assay was 10 CFU/ml of blood. This test was 100% sensitive and specific with a positive predictive value of 100% and a negative predictive value of 96.7%. Conclusion: The assay was found to be effective for the rapid detection of Candida and Aspergillus in clinical specimens.
Assuntos
Aspergilose/diagnóstico , Aspergillus/genética , Aspergillus/isolamento & purificação , Candida/genética , Candida/isolamento & purificação , Candidíase/diagnóstico , Diagnóstico Precoce , Fungemia/diagnóstico , Humanos , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Diagnóstico Molecular/normas , Micologia/métodos , Micologia/normas , Reação em Cadeia da Polimerase/métodos , Reação em Cadeia da Polimerase/normas , Sensibilidade e EspecificidadeRESUMO
Infectious purpura fulminans is associated with high mortality and morbidity despite standard antimicrobial therapy. We report satisfactory clinical outcome in two children with sepsis associated purpura fulminans who were treated with activated protein C (APC). There is need for proper evaluation of the efficacy of this extremely expensive therapeutic modality by randomized controlled trials before it is made standard of care in childhood infectious purpura fulminans.
Assuntos
Doença Aguda , Anticoagulantes/uso terapêutico , Fatores de Coagulação Sanguínea/efeitos dos fármacos , Pré-Escolar , Humanos , Lactente , Masculino , Proteína C/uso terapêutico , Vasculite por IgA/tratamento farmacológico , Receptores de Superfície Celular/efeitos dos fármacos , Resultado do TratamentoRESUMO
In todays world, good infection control practices in high pressure intensive care units is of vital importance. Endogenous infections from the patients own microbial flora now cause the majority of nosocomial infections as the exogenous infections are curtailed to a large extent with aggressive surveillance and prevention of infection. We analysed absolute numbers of microbial isolates as an indirect reflection of infection rate in the intensive care unit (ICU) for 6 months in 1992, 1994 and 1996. We demonstrated that inspite of the total admission to the ICU increasing, the impact of infection control is certainly felt with strict inforcement of protocols.