FluoroType® MTB in pleural fluid for diagnosing tuberculosis.

OBJECTIVES: This work aims to investigate the diagnostic accuracy of a nucleic acid amplification test (FluoroType MTB®) in pleural fluid (PF) and sputum to diagnose tuberculous pleural effusion (TPE). We also analyzed the increase in diagnostic accuracy of a second FluoroType MTB® test on a second thoracentesis sample when the first was negative. METHODS: We conducted a prospective single-center study that included 207 patients with pleural effusion (31 tuberculous and 176 due to other causes). Of the 31 cases of TPE, 21 (68%) were confirmed histologically or microbiologically; the other cases were considered probable. RESULTS: The operational characteristics of FluoroType MTB® in PF for identifying tuberculosis were a sensitivity of 13%, a specificity of 99%, a positive likelihood ratio of 11, and a negative likelihood ratio of 0.9. The diagnostic efficacy data for sputum samples were 21%, 91%, 2.4, and 0.9, respectively. PF and sputum cultures in solid and liquid media had greater sensitivity (36% and 31%, respectively). A second FluoroType MTB® test in PF was negative for 24 patients who had TPE and for whom the first FluoroType MTB® test was also negative. Only two (6.5%) patients with TPE had a confirmed diagnosis based exclusively on the positive results of the FluoroType MTB® in PF. CONCLUSION: Due to its low sensitivity, the FluoroType MTB® test in PF has a limited role in diagnosing tuberculous pleurisy.

FluoroType® MTB en líquido pleural para el diagnóstico de tuberculosis / FluoroType® MTB in pleural fluid for diagnosing tuberculosis

Objetivos This work aims to investigate the diagnostic accuracy of a nucleic acid amplification test (FluoroType MTB®) in pleural fluid (PF) and sputum to diagnose tuberculous pleural effusion (TPE). We also analyzed the increase in diagnostic accuracy of a second FluoroType MTB® test on a second thoracentesis sample when the first was negative. Métodos We conducted a prospective single-center study that included 207 patients with pleural effusion (31 tuberculous and 176 due to other causes). Of the 31 cases of TPE, 21 (68%) were confirmed histologically or microbiologically; the other cases were considered probable. Resultados The operational characteristics of FluoroType MTB® in PF for identifying tuberculosis were a sensitivity of 13%, a specificity of 99%, a positive likelihood ratio of 11, and a negative likelihood ratio of 0.9. The diagnostic efficacy data for sputum samples were 21%, 91%, 2.4, and 0.9, respectively. PF and sputum cultures in solid and liquid media had greater sensitivity (36% and 31%, respectively). A second FluoroType MTB® test in PF was negative for 24 patients who had TPE and for whom the first FluoroType MTB® test was also negative. Only two (6.5%) patients with TPE had a confirmed diagnosis based exclusively on the positive results of the FluoroType MTB® in PF. Conclusión Due to its low sensitivity, the FluoroType MTB® test in PF has a limited role in diagnosing tuberculous pleurisy (AU)

FluoroType® MTB in pleural fluid for diagnosing tuberculosis. / FluoroType® MTB en líquido pleural para el diagnóstico de tuberculosis.

OBJECTIVES: To assess the cost-effectiveness of a nucleic acid amplification test (FluoroType MTB®) in pleural fluid (PF) and sputum to diagnose tuberculous pleural effusion (TPE). We also analysed the increase in diagnostic yield of a second FluoroType MTB® test, obtained through a new thoracentesis, when the first had resulted negative. METHODS: We conducted a prospective single-centre study that included 207 patients with pleural effusion (31 tuberculous and 176 from other causes). Of the 31 cases of TPE, 21 (68%) were confirmed histologically or microbiologically; the other cases were considered probable. RESULTS: The operational characteristics of FluoroType MTB® in PF for identifying tuberculosis were a sensitivity of 13%, a specificity of 99%, a positive likelihood ratio of 11 and a negative likelihood ratio of 0.9. The diagnostic efficacy data for sputum samples was 21%, 91%, 2.4 and 0.9, respectively. The PF and sputum cultures in solid and liquid media had greater sensitivity (36% and 31%, respectively). A second FluoroType MTB® test in PF was negative for 24 patients with TPE, and a first FluoroType MTB® test also negative. Only 2 (6.5%) patients with TPE had a confirmed diagnosis based exclusively on the positive results of the FluoroType MTB® in PF. CONCLUSION: Due to its low sensitivity, the FluoroType MTB® test in PF has a limited role in diagnosing tuberculous pleurisy.

The Impact of Culturing the Organ Preservation Fluid on Solid Organ Transplantation: A Prospective Multicenter Cohort Study.

BACKGROUND: We analyzed the prevalence, etiology, and risk factors of culture-positive preservation fluid and their impact on the management of solid organ transplant recipients. METHODS: From July 2015 to March 2017, 622 episodes of adult solid organ transplants at 7 university hospitals in Spain were prospectively included in the study. RESULTS: The prevalence of culture-positive preservation fluid was 62.5% (389/622). Nevertheless, in only 25.2% (98/389) of the cases were the isolates considered "high risk" for pathogenicity. After applying a multivariate regression analysis, advanced donor age was the main associated factor for having culture-positive preservation fluid for high-risk microorganisms. Preemptive antibiotic therapy was given to 19.8% (77/389) of the cases. The incidence rate of preservation fluid-related infection was 1.3% (5 recipients); none of these patients had received preemptive therapy. Solid organ transplant (SOT) recipients with high-risk culture-positive preservation fluid receiving preemptive antibiotic therapy presented both a lower cumulative incidence of infection and a lower rate of acute rejection and graft loss compared with those who did not have high-risk culture-positive preservation fluid. After adjusting for age, sex, type of transplant, and prior graft rejection, preemptive antibiotic therapy remained a significant protective factor for 90-day infection. CONCLUSIONS: The routine culture of preservation fluid may be considered a tool that provides information about the contamination of the transplanted organ. Preemptive therapy for SOT recipients with high-risk culture-positive preservation fluid may be useful to avoid preservation fluid-related infections and improve the outcomes of infection, graft loss, and graft rejection in transplant patients.

A highly transmissible tuberculosis outbreak: the importance of bars.

The transmission of tuberculosis (TB) in bars is difficult to study. The objective was to describe a large TB outbreak in a company's bar and other leisure settings. A descriptive study of a TB outbreak was carried out. Contacts were studied in the index case's workplace bar (five circles of contacts) and other recreational areas (social network of three bars in the index case's neighbourhood). Chest X-rays were recommended to contacts with positive tuberculin skin tests (TST) (⩾5 mm). The risk of latent tuberculosis infection (LTBI) was determined using an adjusted odds ratio. The dose-response relationship was determined using the chi-square test for linear trend. We studied 316 contacts at the index case's workplace and detected five new cases of TB. The prevalence of LTBI was 57·9% (183/316) and was higher in the first circle, 96·0% (24/25), and lower in the fifth, 46·5% (20/43) (P < 0·0001). Among 58 contacts in the three neighbourhood bars, two TB cases were detected and the LTBI prevalence was 51·7% (30/58). Two children of one secondary TB company patient became ill. Bars may be transmission locations for TB and, as they are popular venues for social events, should be considered as potential areas of exposure.

Detección de la infección por Chlamydia Trachomatis en pacientes que consultan por una infección bacteriana de transmisión sexual / Detection of Chlamydia trachomatis Infection in Patients Seen at a Sexually Transmitted Infection Clinic

No disponible

Factores de riesgo asociados a pacientes tuberculosos con microscopía del esputo positiva / Risk factors associated to tuberculosis patients with positive sputum microscopy

Objetivo: El factor determinante para la producción de casos de tuberculosis por transmisión exógena es la existencia de pacientes con baciloscopias positivas. El objetivo de este estudio fue determinar los factores de riesgo asociados a pacientes con microscopía positiva en secreciones respiratorias. Métodos: Se estudiaron los casos incidentes de tuberculosis del período 1992-1998 en la provincia de Lleida. Las variables del estudio fueron: edad, sexo, infección por el VIH, uso de drogas por vía parenteral (UDVP), consumo de alcohol, existencia de cavernas y resultado de la microcopia del esputo. Se calculó la tasa de incidencia por 100.000 personas-año. La asociación de la variable dependiente -caso de tuberculosis con baciloscopia positiva- con el resto de variables independientes se determinó con la odds ratio (ORc, cruda, y ORa, ajustada mediante regresión logística no condicional) con su intervalo de confianza (IC) del 95 por ciento. Resultados: Se detectaron 905 casos nuevos de tuberculosis. La tasa de incidencia del período 1992-1998 decreció desde 38,8 a 30,8. El 44,9 por ciento de los casos (n = 406) presentó una baciloscopia positiva. El riesgo de ser bacilífero se asoció positivamente con la presencia de cavernas en la radiografía de tórax (ORa = 6,8; IC del 95 por ciento, 4,8-9,5), el género masculino (ORa = 1,8; IC del 95 por ciento, 1,3-2,6) y el consumo de alcohol (ORa = 1,6; IC del 95 por ciento, 1,1-2,3) y fue inferior en los menores de 15 años (ORa = 0,2; IC del 95 por ciento, 0,1-0,5) y coinfectados por el VIH (ORa = 0,5; IC del 95 por ciento, 0,3-0,9). Conclusiones: La infección por el VIH implica un reducido impacto en la endemia tuberculosa. El estudio de contactos y la implantación de tratamientos directamente observados se deben considerar no sólo para los coinfectados por el VIH y UDVP, sino para adultos varones, con consumo excesivo de alcohol, especialmente si presentan lesiones cavernosas (AU)

Nonsevere community-acquired pneumonia: correlation between cause and severity or comorbidity.

BACKGROUND: Community-acquired pneumonia frequently constitutes a nonsevere infection manageable at home. However, for these low-risk episodes, the epidemiological features have not been carefully analyzed. OBJECTIVES: To determine the cause of nonsevere community-acquired pneumonia and to investigate if a correlation exists between cause and severity or comorbidity. METHODS: During a 3-year period, all patients with nonsevere community-acquired pneumonia, according to the Pneumonia Patient Outcome Research Team prognostic classification (patients in groups 1-3), were included in the study. Causes were investigated through the following procedures: cultures of blood, sputum, and pleural fluid; serologic tests; and polymerase chain reaction methods to detect Streptococcus pneumoniae DNA in whole blood or Mycoplasma pneumoniae and Chlamydia pneumoniae DNA in throat swab specimens. RESULTS: Of 317 initially included patients, 247 were eligible for the study. A microbial diagnosis was obtained in 162 patients (66%), and the main pathogens detected were S pneumoniae (69 patients [28%]), M pneumoniae (40 patients [16%]), and C pneumoniae (28 patients [11%]). For the 58 patients in prognostic group 1, M pneumoniae was the most prevalent cause, and atypical microorganisms constituted 40 (69%) of the isolated agents. In contrast, for patients in prognostic groups 2 and 3, S pneumoniae was the leading agent, and a significant reduction of M pneumoniae cases and a greater presence of other more uncommon pathogens were observed. The existence of comorbid conditions was not a determining factor for particular causes. CONCLUSIONS: Among low-risk patients with community-acquired pneumonia, there was a certain correlation between severity and cause. In contrast, the existence of a comorbidity did not have a predictive causative value.

[Hepatitis C virus genotypes. Study of 302 patients coinfected by the human immunodeficiency virus]. / Genotipos del virus de la hepatitis C. Estudio de 302 pacientes coinfectados por el virus de la inmunodeficiencia humana.

BACKGROUND: To study the distribution of different HCV genotypes in HIV-infected patients. PATIENTS AND METHOD: This study was carried out in 302 HIV/HCV-coinfected patients who were followed-up at the HIV/AIDS Unit of the Arnau de Vilanova University Hospital of Lleida (Spain). HCV genotypes were determined by Inno-Lipa HCV II technique (Innogenetics, Belgium). RESULTS: 143 patients (51.43%) had a genotype-1, followed by genotype-3 (81 patients; 29.13%), genotype-4 (53 patients; 19.06%), and genotype-2 (one patient; 0.35%). It was not possible to know the genotype in 24 patients (NT). CONCLUSIONS: In our health care area, HCV genotype-1 was the commonest among HIV/HCV-coinfected patients. However, a given HIV-infected patient with HCV antibodies has practically the same probability of having a genotype-1 as a genotype non-1.

[Risk factors associated to tuberculosis patients with positive sputum microscopy]. / Factores de riesgo asociados a pacientes tuberculosos con microscopía del esputo positiva.

OBJECTIVE: The main factor responsible for producing new cases of tuberculosis by exogen transmission is the existence of Mycobacterium tuberculosis in the sputum of tuberculosis patients. The objective of this study was to determine the risk factors associated to positive smear tuberculosis cases in Lleida (Spain). METHODS: We studied new cases of tuberculosis over the period 1992-1998. The variables considered were: age, gender, coinfection with HIV, injection drug use (IDU), consumption of alcohol, existence of caverns in thorax X-ray, and laboratory results of direct smear examination. We calculated the incidence rates for 100,000 persons-year. The association between the dependent variable case of tuberculosis with positive Mycobacterium tuberculosis smear and the remaining independent variables were assessed obtaining odds ratios (OR) and 95% confidence intervals (CI) (crude cOR and adjusted aOR by non conditional logistic regression). RESULTS: We detected 905 new cases of tuberculosis. The rates in the period 1992-1998 decreased from 38.8 to 30.8. 44.9% of cases (n = 406) presented a positive direct smear. There was a positive association between the risk of being a positive smear patient and having caverns in thorax x-ray (aOR = 6.8; 95% CI, 4.8-95), being male (aOR = 1.8; 95% CI, 1.3-2.6) and consuming alcohol (aOR = 1.6; 95% CI,1.1-2.3) and this risk was significant lower in those under 15 years old (aOR = 0.2; 95% CI, 0.1-0.5), and coinfection with HIV (aOR = 0.5; 95% CI, 0.3-0.9). CONCLUSIONS: HIV infection implies a reduced impact in endemecity of tuberculosis. Study of contacts and the implementation of directly observed treatment must be considered not only for coinfected HIV cases and IDU but also for adult males, especially those who consume alcohol, particularly when they have caverns.