The combination of PCR and serology increases the diagnosis of Pseudomonas aeruginosa colonization/infection in cystic fibrosis.

BACKGROUND: Early diagnosis of Pseudomonas aeruginosa colonization/infection in patients with cystic fibrosis (CF) using microbiological culturing methods may be difficult. Serology and polymerase chain reaction (PCR) may be useful techniques for early detection of P. aeruginosa in children with CF. METHODS: A cross-sectional analysis comparing results obtained by three different methods for P. aeruginosa identification was performed in 87 CF patients with a mean age of 9.7 years. Microbiological culturing and PCR targeting the algD GDP mannose dehydrogenase gene of P. aeruginosa were performed in sputum or oropharyngeal swabs samples, and serum antibodies against three P. aeruginosa antigens (elastase, alkaline protease, and exotoxin A) were assessed once. RESULTS: It was possible to isolate P. aeruginosa by culture in samples from 42 patients (48.2%), while PCR was positive in 53 (60.9%) patients. Serology was positive in 38 patients (43.6%), with a higher positivity for elastase (37.9%), followed by alkaline protease (29.9%) and exotoxin A (19.5%). The difference among the three isolated methods was not statistically significant. The combination of PCR + serology was significantly superior to single methods, to PCR + culture and also to culture + serology. CONCLUSIONS: PCR identified a higher number of patients with P. aeruginosa than serology and conventional culture, but the difference did not reach statistical significance. Any of the combination methods that included PCR resulted in significantly statistical differences in relation to isolated microbiological or serology methods, but not to the PCR method alone, suggesting that PCR may be the main additive method for P. aeruginosa identification.

Migraine in the elderly: a comparison with migraine in young adults.

OBJECTIVE: In this study we compare the clinical features of migraine attacks occurring in the elderly (60 to 70 years) and in younger migraineurs (20 to 40 years). BACKGROUND: Studies comparing the clinical features of migraine at different ages are still lacking. These studies are important for a better comprehension of the natural history of migraine, as well as to refine our recognition of the disease. METHODS: We retrospectively assessed subjects seen from 1995 to 2000 in a university-based outpatient headache clinic in Brazil. We reviewed 144 charts from patients 60 to 70 years (mean = 66.4). We applied a questionnaire based on the first edition of the International Classification of Headache Disorders (criteria for episodic migraine remained unchanged in the second edition). Controls were migraineurs from 20 to 40 years (mean = 32.6). RESULTS: Migraine occurred in 25% of the elderly and 29% of younger migraineurs (NS). A lower proportion of migraine attacks in the elderly were unilateral (38% vs. 57%, P < .01), or with associated symptoms (nausea = 75% vs. 86%, P = .05; vomiting = 30% vs. 54%, P < .05, photophobia and phonophobia = 83% vs. 94%, P < .05). Other symptoms such as paleness (P = .0441), dry mouth (P = .0093), and anorexia (P = .05) were more common in the elderly. CONCLUSION: Migraine is less typical in the elderly and more frequently associated with vegetative symptoms. Therefore, the diagnosis of migraine in elderly subjects may be more challenging, and many seniors with this primary headache can be misdiagnosed.

Fibrose cística - uma apresentação incomum e grave: hipoproteinemia, edema e anemia / Cystic fibrosis - an uncommon and severe clinical presentation: hypoproteinemia, edema and anemia

Objetivo: alertar para a suspeita do diagnóstico de fibrose cística em lactentes com desnutrição grave, edema, hipoproteinemia e anemia. Descrição do caso: descreve-se um lactente que iniciou quadrode febre, anemia e dema generalizado com 1 mês de vida, recebendo o diagnóstico de sepse com hipoalbuminemia durante internação hospítalar. Não havia história de quadro diarréico. Na terceira internação, por quadro clínico semelhante e acompanhado de pneumonia e desnutrição grave, foi diagnosticada fibrose cística por meio de duas dosagens de cloro no suor alteradas. Comentários:a fibrose cística é a doença autossômica recessiva letal mais comum na população branca, cujo prognóstico depende muito do diagnóstico precoce e da instituição imediata da terapêutica específica. A sísdrome da desnutrição protéico-calórica é uma forma de apresentação incomum que incide em aproximadamente 5 por cento a 13 por cento dos lactentes fibrocísticos e está associada à alta morbidade e mortalidade. Caracteriza-se pela tríade de anemia, hipoalbuminemia e edema. Esses pacientes podem apresentar apetite preservado, porém o ganho ponderoestatural é baixo, decorrente da má absorção intestinal. Costuma ser erroneamente tratada como alergia ao leite de vaca, o que compromete ainda mais o prognóstico desses pacientes. Essa forma clínica de apresentação do quadro pulmonar ou referência de esteatorréia evidente, deve ser reconhecida pelos pediatras para que o diagnóstico e início imediato da terapêutica sejam realizados.