ABSTRACT
Introducción: el interrogatorio clínico es un instrumentoeficaz para evaluar la alergia a los antibióticos. El objetivo denuestro trabajo es valorar su prevalencia y su fiabilidad para ladetección de alergias en las historias clínicas.Métodos: análisis observacional de la presencia del datode alergia a los antibióticos en las historias de un hospital general.Comprobación mediante interrogatorio dirigido de lafiabilidad del dato.Resultados: se evalúan 610 historias. En 98% de los casosconstaba interrogada la alergia a antibióticos. Setenta y un pacientes(12%) tenían registrada alergia a algún antibiótico. Enla valoración por el investigador, sólo un 5% (33 de 610 casos)resultó tener alergia. De detectó un 44% de falsas alergia. Lascausas más frecuentes de confusión fueron lipotimia e intoleranciagástrica.Conclusiones: la presencia del dato de alergia o no a losantibióticos es prácticamente constante en todas las historiasclínicas. La prevalencia de alergia a algún antibiótico medianteinterrogatorio dirigido es del 5%. Es necesario explicar periódicamenteal colectivo sanitario el significado de la alergia a losantibióticos y la importancia del interrogatorio dado que ésteconstituye un instrumento rápido, sencillo y muy eficaz(AU)
Objectives: Antibiotic allergy questionnaire is a usefultool for prescribing antibiotics. The objective of thisstudy is to assess the prevalence and clinical reliabilityof antibiotic allergy in medical records.Patients and method: Observational analysis of clinicalrecords. Assessment of antibiotic allergy by directinterview conducted by the investigator.Results: 610 medical records were evaluated. Antibioticallergy was checked in 98%, mainly in medicalwards. In 12 % of patients, antibiotic allergy was suspected,but after investigator interview only 5% of patientsfulfilled clinical criteria for allergy. 44% of falsesallergies were recorded. The most frequent cause of confusionwas faint and gastric intolerance.Conclussion: The questionnaire about antibioticallergy is present in almost all medical records. Howeverits reliability is low, less than 50%. Prevalence of veritableantibiotic allergy is 5% in this study. Antibioticallergy questionnaire in medical records is a practical tool.However periodical training about antibiotic allergydefinition is necessary for nurses and medical staff(AU)
Subject(s)
Humans , Male , Female , Anti-Bacterial Agents/adverse effects , Immunologic Techniques/trends , Immunologic Techniques , Medical Records/standards , Allergy and Immunology/organization & administration , Allergy and Immunology/trends , Hypersensitivity/complications , Hypersensitivity/diagnosis , Syncope/complications , Surveys and QuestionnairesABSTRACT
OBJECTIVES: Antibiotic allergy questionnaire is a useful tool for prescribing antibiotics. The objective of this study is to assess the prevalence and clinical reliability of antibiotic allergy in medical records. PATIENTS AND METHOD: Observational analysis of clinical records. Assessment of antibiotic allergy by direct interview conducted by the investigator. RESULTS: 610 medical records were evaluated. Antibiotic allergy was checked in 98%, mainly in medical wards. In 12 % of patients, antibiotic allergy was suspected, but after investigator interview only 5% of patients fulfilled clinical criteria for allergy. 44% of falses allergies were recorded. The most frequent cause of confusion was faint and gastric intolerance. CONCLUSIONS: The questionnaire about antibiotic allergy is present in almost all medical records. However its reliability is low, less than 50%. Prevalence of veritable antibiotic allergy is 5% in this study. Antibiotic allergy questionnaire in medical records is a practical tool. However periodical training about antibiotic allergy definition is necessary for nurses and medical staff.
Subject(s)
Anti-Bacterial Agents/adverse effects , Drug Hypersensitivity/diagnosis , Medical History Taking/methods , Surveys and Questionnaires , Humans , Reproducibility of ResultsABSTRACT
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Subject(s)
Male , Aged , Humans , Corynebacterium Infections , Species Specificity , Rheumatic Heart Disease , Mitral Valve , Endocarditis, Bacterial , CorynebacteriumSubject(s)
Corynebacterium Infections/microbiology , Corynebacterium/isolation & purification , Endocarditis, Bacterial/microbiology , Aged , Anti-Bacterial Agents/therapeutic use , Corynebacterium Infections/drug therapy , Corynebacterium Infections/pathology , Echocardiography, Transesophageal , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/drug therapy , Humans , Male , Treatment OutcomeABSTRACT
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Subject(s)
Aged , Male , Humans , Echocardiography, Transesophageal , Treatment Outcome , Anti-Bacterial Agents , Corynebacterium Infections , Corynebacterium , Endocarditis, BacterialABSTRACT
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Humans , Communication , Physician-Patient Relations , Professional Competence , Education, MedicalABSTRACT
Alpha-1 antitrypsin (AAT) deficiency is an under-diagnosed disease and screening programs have therefore been recommended for patients with chronic obstructive pulmonary disease (COPD). We present the results of the pilot phase of a screening program for AAT deficiency in order to evaluate the technique used, the procedures for transporting samples and the results obtained. Over a period of one month, five centers collected samples from all COPD patients for whom plasma concentrations of AAT or Pi phenotype had not yet been determined. Capillary blood spots were dried on filter paper and then sent by surface mail to a central laboratory for study. An immunonephelometric assay was used to determine AAT and DNA phenotyping was done by use of a Light Cycler. Samples were analyzed from 86 COPD patients (76 men, 10 women) with a mean age of 68.2 years. AAT deficiency was ruled out for 74 patients (86%) who had concentrations above the cutoff established, although one of them was MZ heterozygote by genotype. Among the 12 remaining patients (13.9%), only two also had a Z allele. The rest were individuals with concentrations below the established threshold and no evidence of a Z allele (10 patients, 11.6%). The Z allele frequency observed (3/172; 1.74%) was very similar to that found in the general population. The results of this pilot study allowed us to confirm that the method used to collect samples worked well. The sampling method is applicable, easy and well-accepted by participating physicians. It allowed AAT concentrations and Z allele deficiency to be determined. The method correlates well with standard techniques used for samples in whole blood.
Subject(s)
Mass Screening/methods , Pulmonary Disease, Chronic Obstructive/blood , alpha 1-Antitrypsin Deficiency/blood , Aged , Alleles , Female , Genotype , Humans , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/genetics , Spain , alpha 1-Antitrypsin/geneticsABSTRACT
El déficit de 1-antitripsina (AAT) es una enfermedad infradiagnosticada, por lo que se recomienda establecer programas de cribado en pacientes con EPOC. Presentamos los resultados de la fase piloto de un programa de cribado del déficit de AAT, con el objetivo de evaluar la técnica utilizada, los circuitos de envío de muestras y los resultados obtenidos. Participaron en el estudio 5 centros, que recogieron durante el período de un mes muestras de todos los pacientes con EPOC en los que nunca se hubieran determinado las concentraciones plasmáticas de AAT o el fenotipo Pi. Se aplicaron gotas de sangre capilar sobre discos de papel secante, que posteriormente se enviaban por correo postal al laboratorio central del estudio. Las muestras se procesaron para la determinación cuantitativa de los valores de AAT mediante un método de inmunonefelometría y, para la determinación del genotipo de AAT, con un analizador de ADN del tipo LightCycler. Se analizaron muestras de 86 pacientes con EPOC (76 varones, 10 mujeres) con una edad media de 68,2 años. En 74 pacientes (86 per cent) se descartó el déficit por presentar concentraciones de AAT por encima del punto de corte establecido, aunque uno de ellos fue heterocigoto MZ por genotipificación. De los 12 restantes (13,9 per cent), sólo 2 individuos presentaban también un alelo Z. El resto correspondió a pacientes con concentraciones por debajo del umbral establecido y sin evidencia del alelo Z (10 pacientes; 11,6 per cent). La frecuencia observada del alelo Z (3/172; 1,74 per cent) es muy similar a la encontrada en la población general. Los resultados de esta fase inicial permiten comprobar el correcto funcionamiento del circuito utilizado para la obtención y envío de las muestras. Es un método aplicable, cómodo y bien aceptado por los médicos participantes y permite la cuantificación de AAT, así como la detección del alelo deficitario Z en las muestras con una excelente correlación con las técnicas estándar que usan muestras de sangre total (AU)
Subject(s)
Middle Aged , Aged , Male , Female , Humans , Spain , alpha 1-Antitrypsin Deficiency , Pulmonary Disease, Chronic Obstructive , Alleles , alpha 1-Antitrypsin , Mass Screening , GenotypeABSTRACT
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Subject(s)
Aged , Male , Humans , Myotonia , Muscular Diseases , Colchicine , Gout SuppressantsABSTRACT
AIM: To study hepatitis B virus (HBV) replication in a series of patients with HBV infection and to analyze the frequency of associated hepatitis C virus (HCV) and hepatitis D (HDV) infection. PATIENTS AND METHOD: Serological markers of HBV, HCV and HDV, transaminase values and HBV DNA were studied in serum samples from 463 patients with chronic HBV infection. RESULTS: Three hundred ninety-six (85.5%) were classified as hepatitis B, 33 (7.1%) as hepatitis B and C, 17 (3.6%) as hepatitis B and D and 17 (3.6%) as hepatitis B, C and D. Sixty-seven percent of patients with hepatitis B and 33% of those with chronic hepatitis B were asymptomatic HBsAg carriers. HVB DNA was identified in 27.7% of patients with hepatitis B, in 24% of those with hepatitis B and C, in 11.7% of those with hepatitis B and D and in 29.4% of those with hepatitis B, C and D. HBV DNA and elevated transaminase levels were found in 63% of HBeAg-positive patients and in only 16% of those who were anti-HBe-positive. These latter were considered candidates for antiviral treatment. CONCLUSIONS: In our environment, most patients with HBV infection are asymptomatic HBsAg carriers. Viral replication and elevated alanine aminotransferase levels were found in 22% of the patients. Consequently, these patients are candidates for antiviral treatment. Between 3.6% and 7.1% of patients with hepatitis B presented coinfection with HCV or HDV, or both. No significant differences were found in HBV replication among the different groups.
Subject(s)
Hepatitis B virus/physiology , Hepatitis B, Chronic/virology , Adult , Alanine Transaminase , DNA, Viral/blood , Female , Hepatitis Antibodies/blood , Hepatitis B Surface Antigens/blood , Hepatitis B virus/isolation & purification , Hepatitis B, Chronic/complications , Hepatitis B, Chronic/drug therapy , Hepatitis B, Chronic/immunology , Hepatitis C/complications , Hepatitis C/immunology , Hepatitis D/complications , Hepatitis D/immunology , Humans , Male , Middle Aged , Prospective Studies , Virus ReplicationABSTRACT
A sensitive and accurate HBV DNA quantification assay is essential for monitoring hepatitis B virus (HBV) replication. This study evaluated a real-time PCR method performed in the LightCycler analyser for quantitative HBV DNA assay. HBV DNA results with this method were compared with those obtained using a branched-chain DNA (bDNA) solution hybridization assay. Real-time PCR was performed using two adjacent fluorescently labelled probes and primers corresponding to the HBV core gene. The same standard employed in the bDNA assay was used for calibration. Serum samples came from 193 HBV surface antigen (HBsAg)-positive patients (34 HBV e antigen (HBeAg)-positive and 93 with antibody to HBeAg (anti-HBe)), and 66 asymptomatic HBV carriers. In addition, we analysed serum samples from 8 anti-HBe-positive patients who had been receiving lamivudine treatment for more than three years. A linear standard curve was seen in the range from 10(3) to 10(8) copies/mL. In the reproducibility analysis, intra-assay coefficient of variation (CVs) at two known HBV DNA concentrations were 4% and 2% and interassay CVs were 6% and 4%. The median of serum HBV DNA by real-time PCR was 9.2 x 10(8) copies/mL in HBeAg-positive patients with persistently elevated alanine aminotransferase (ALT) levels, 1.3 x 10(7) copies/mL in anti-HBe-positive cases with persistently elevated ALT levels, 3.7 x 10(4) copies/mL in anti-HBe-positive patients with fluctuating ALT levels and 10(4) copies/mL in asymptomatic HBV carriers. The differences in HBV DNA levels among the various groups studied were statistically significant (P < 0.05). The cut-off between chronic hepatitis patients and asymptomatic carriers was found to be at a serum HBV DNA concentration of 5 x 10(4) copies/mL. Of the 109 serum samples with a viral load < 7.5 x 10(5) (negative by bDNA assay) 44 (40%) were positive by real-time PCR: 24 (56%) chronic hepatitis and 20 (33%) asymptomatic carriers. There was a positive association between HBV DNA levels determined by real-time PCR and ALT levels (P < 0.05), which was not observed with the bDNA assay for HBV DNA quantification. At 12 months of lamivudine treatment, 6 patients (75%) showed HBV DNA levels < 5 x 10(4) copies/mL (range < 10(3)-2 x 10(3)), significantly lower than at baseline. At 36 months, 2 of 8 (25%) showed HBV DNA levels persistently lower than 5 x 10(4) copies/mL (1.7 x 10(3), 6 x 10(3)). The LightCycler quantitative real-time PCR is a practical, sensitive, reproducible single-tube assay with a wide dynamic range of detection. The assay is automatic except for DNA extraction and the running time is only 70 min. The LightCycler real-time PCR is useful for identifying different states of HBV infection and for evaluating the efficacy of viral therapy.
Subject(s)
DNA, Viral/blood , Hepatitis B virus/isolation & purification , Polymerase Chain Reaction/methods , Fluorescent Dyes , Hepatitis B Surface Antigens/analysis , Hepatitis B e Antigens/analysis , Hepatitis B virus/genetics , Hepatitis B virus/immunology , Humans , Reproducibility of Results , Sensitivity and Specificity , Taq PolymeraseABSTRACT
Some subunit vaccines composed of herpes simplex virus (HSV) glycoproteins have been shown to protect guinea pigs against primary and recurrent genital infection by HSV-2. However, these vaccines were ineffective or only marginally effective in clinical trials. To attempt to define an animal model that would better discriminate the protective capacity of different vaccine formulations, we have examined the requirements for vaccine-induced protection against HSV-2 infection and disease in a mouse genital model. Unlike the guinea pig model where inactivated viral vaccines can protect nearly as well as live viral vaccines, inactivated viral vaccine afforded little protection in this mouse model. Using replication-defective mutant viruses as a form of live viral vaccine, we found that the extent of protection conferred by live vaccine was proportional to the amount of replication-defective mutant virus inoculated, over doses from 10(4) to 10(6) PFU. Furthermore, the mouse genital model showed quantitative differences in the degree of protection induced by various viral vaccine constructs. An HSV-2 replication-defective mutant virus protected better than an HSV-1 replication-defective mutant that expressed HSV-2 glycoprotein D, which in turn protected better than an HSV-2 replication-defective mutant virus. We conclude that this mouse genital model can rank different vaccine constructs for their capacity to induce protective immunity. Thus, genital infection of the mouse with HSV-2 may provide a stringent animal model that can predict the relative capacity of viral vaccines to stimulate protective immunity against HSV-2.
Subject(s)
Herpes Genitalis/prevention & control , Herpesvirus 1, Human/immunology , Herpesvirus 2, Human/immunology , Vaccines, Synthetic/immunology , Viral Vaccines/immunology , Animals , Chlorocebus aethiops , Disease Models, Animal , Female , Herpesvirus 1, Human/genetics , Herpesvirus 1, Human/physiology , Herpesvirus 2, Human/genetics , Herpesvirus 2, Human/physiology , Humans , Immediate-Early Proteins/genetics , Immediate-Early Proteins/immunology , Mice , Mice, Inbred BALB C , Mutagenesis , Vaccines, Synthetic/genetics , Vero Cells , Viral Envelope Proteins/genetics , Viral Envelope Proteins/immunology , Viral Proteins/genetics , Viral Proteins/immunology , Viral Vaccines/genetics , Virus ReplicationABSTRACT
The interactions among hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis delta virus (HDV) were studied by measuring HBV-DNA and HCV-RNA levels and by determining the influence of viral genotypes and mutations in HBV basal core promoter (BCP) and precore regions. We included 65 consecutive patients, 25 HBV/HCV, 18 HBV/HDV, and 22 HBV/HCV/HDV. Controls consisted of 55 patients with chronic HBV and 55 with chronic HCV infection. HBV-DNA and HCV-RNA levels were lower in coinfections than in single infections (P <.05). HBV/HCV coinfection was associated with lower HBV viremia (8.2 x 10(4) copies/mL) and lower HCV-RNA levels (7 x 10(5) IU/mL), than the corresponding control group (P <.05), with more marked decrease in HBV replication (P <.05). Moreover, in HBV/HCV coinfection and in triple coinfection we observed an inverse relationship between HBV-DNA and HCV-RNA levels (P <.05). HBV/HDV coinfection was associated with lower HBV viremia (2.5 x 10(4) copies/mL) than that found in HBV infection (P <.05). Patients with triple coinfection showed lower HBV-DNA and HCV-RNA levels than control groups (P <.05). Prevalence of precore mutations was lower in HCV coinfections (P <.05). No significant association was observed between HCV-RNA levels and HBV precore mutations, BCP mutations or HBV genotypes, or between HBV-DNA levels and HCV genotypes (P <.05). In conclusion, HCV exhibited stronger inhibitory action in the reciprocal inhibition seen in HBV/HCV coinfection. HDV was the dominant virus in HBV/HDV coinfection and in triple coinfection, and had a greater unfavorable influence on HCV than on HBV replication. The reciprocal inhibition of viral replication seemed to be little influenced by the inherent genomic factors studied.
Subject(s)
Hepacivirus/physiology , Hepatitis B virus/physiology , Hepatitis B/complications , Hepatitis C/complications , Hepatitis D/complications , Hepatitis Delta Virus/physiology , Adult , DNA, Viral/blood , Female , Genotype , Hepacivirus/genetics , Hepatitis B Core Antigens/genetics , Hepatitis B e Antigens/analysis , Hepatitis B virus/genetics , Hepatitis B virus/immunology , Hepatitis Delta Virus/genetics , Humans , Male , Middle Aged , Mutation/physiology , Promoter Regions, Genetic/genetics , RNA, Viral/blood , Virus ReplicationABSTRACT
Assessment of viremia in hepatitis A virus (HAV) infection is not frequently performed with conventional methods because the techniques used are laborious, have low sensitivity are usually performed in feces. The aims of this study were to develop a polymerase chain reaction (PCR) and Southern blot technique to detect HAV-RNA in the serum of patients with acute HAV infection and to determine the relationship between HAV-RNA and anti-HAV IgM and alanine aminotransferase (ALT) levels. The presence of HAV-RNA was studied in 26 serum samples from 21 patients with acute hepatitis A. We also studied 11 samples from patients with acute hepatitis B and 15 samples from patients with non-A, non-E hepatitis. HAV-RNA was detected in 10 (38%) of the 26 serum samples from patients with acute hepatitis A. Simple PCR was positive in 5 samples and PRC-Southern blot was positive in 10. All the serum samples obtained during the first week of onset were HAV-RNA positive and 50% of those obtained during the second week were positive. None of the serum samples obtained after the second week of onset were HAV-RNA positive. None of the serum samples from the 11 patients with acute hepatitis B or from the 15 patients with non-A, non-E acute hepatitis were positive for HAV-RNA. No significant relationship was detected between HAV-RNA detection and an IgM anti-HAV or ALT positive result. In conclusion, the presence of HAV-RNA in acute hepatitis A is frequent but the PCR Southern blot technique is required for detection, which is transitory during the first weeks after onset.
Subject(s)
Hepatitis A/virology , Polymerase Chain Reaction , Viremia/virology , Acute Disease , Blotting, Southern , Hepatovirus/genetics , Humans , RNA, Viral/analysis , Sensitivity and SpecificityABSTRACT
A number of studies have shown that replication-defective mutant strains of herpes simplex virus (HSV) can induce protective immunity in animal systems against wild-type HSV challenge. However, all of those studies used viruses with single mutations. Because multiple, stable mutations provide optimal levels of safety for live vaccines, we felt that additional mutations needed to be engineered into a candidate vaccine strain for HSV-2 and genital herpes. We therefore isolated an HSV-2 strain with deletion mutations in two viral DNA replication protein genes, UL5 and UL29. The resulting double deletion mutant virus strain, dl5-29, fails to form plaques or to give any detectable single cycle yields in normal monkey or human cells. Nevertheless, dl5-29 expresses nearly the same pattern of gene products as the wild-type virus or the single mutant viruses and induces antibody titers in mice that are equivalent to those induced by single deletion mutant viruses. Therefore, it is feasible to isolate a mutant HSV strain with two mutations in essential genes and with an increased level of safety but which is still highly immunogenic.
Subject(s)
Gene Deletion , Herpesvirus 2, Human/genetics , Viral Proteins/genetics , Viral Vaccines/genetics , Animals , Blotting, Southern , Blotting, Western , Cell Line , Chlorocebus aethiops , Enzyme-Linked Immunosorbent Assay , Female , Herpesvirus 2, Human/metabolism , Herpesvirus 2, Human/physiology , Humans , Mice , Mice, Inbred BALB C , Mutagenesis, Site-Directed , Phenotype , Sequence Analysis, DNA , Vero Cells , Viral Plaque Assay , Viral Proteins/analysis , Viral Proteins/biosynthesis , Viral Proteins/immunology , Viral Vaccines/biosynthesis , Viral Vaccines/immunology , Virus ReplicationABSTRACT
The use of dried blood spot (DBS) specimens in quantitative alpha1-antitrypsin (alpha1-AT) detection or genetic analysis is limited because protein levels in the samples are low and they contain components that can interfere with polymerase chain reaction amplification. A methodological adaptation was developed to overcome these drawbacks which is discussed here. The study population consisted of 200 healthy volunteers and 300 patients with chronic obstructive pulmonary disease (COPD). DBS specimens were tested for alpha1-AT concentration using a modified nephelometric assay and phenotyped with an isoelectric focusing method. Genetic diagnosis was established by deoxyribonucleic acid sequencing using a simple purification procedure to remove contaminants. The nephelometric method showed a detection limit of 0.284 mg x dL(-1), corresponding to a serum concentration of 13 mg x dL(-1). The correlation coefficient between alpha1-AT concentrations in DBS versus serum samples was R2=0.8674 (p<0.0001). All 200 healthy individuals had DBS alpha1-AT concentrations >1.9 mg x dL(-1), corresponding to 114 mg x dL(-1) in serum samples. One hundred and twenty-five COPD patients (42%) showed alpha1-AT values <1.8 mg x dL(-1). Twenty patients with the PIZ phenotype had alpha1-AT values lower than 0.64 mg x dL(-1). On the basis of genotyping, one COPD patient was classified as heterozygous (PIMM(heerlen)). Selective elution of contaminants resulted in optimal alpha(1)1-antitrypsin genotyping. Because of its sensitivity and excellent correlation with the standard method, the dried blood spot quantitative assay is a reliable tool for routine measurement of alpha1-antitrypsin.
