C-reactive protein and complement components but not other acute-phase reactants discriminate between clinical subsets and organ damage in systemic lupus erythematosus.

BACKGROUND: Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by tissue injury mediated by inflammatory mechanisms. Nonetheless, several acute-phase proteins may remain normal or are decreased. We explore the association of diverse biomarkers with selected clinical features, disease activity, and organ damage in SLE. METHODS: One hundred and fifteen SLE patients were analyzed for clinical manifestations, disease activity, and organ damage. Serum C-reactive protein (CRP), complement C3, C4 and CH50%, alpha-1-antitrypsin (AAT), transferrin (Tf), procalcitonin, erythrosedimentation rate (ESR), and interleukin-6 were measured in patients and twenty-six healthy blood donors. Statistics include chi-square, Kruskal-Wallis (post hoc by Mann-Whitney) or one-way ANOVA tests (post hoc by t tests) as appropriate. Associations were evaluated by the Spearman's correlation coefficient (p). RESULTS: SLE patients have lower C3 (85 vs. 110 mg/dL; p < 0.0001) and C4 (14.2 vs. 24.2 mg/dL; p < 0.0001) than controls, while CRP (4.1 vs. 1.4 mg/L; p = 0.005) and AAT (147 vs. 138 mg/dL; p = 0.03) were higher, other biomarkers were irrelevant. Disease activity score positively correlated with ESR (p = 0.23, 95 % CI 0.04 to 0.4; p = 0.01) and CRP (p = 0.19, 0.0007 to 0.36; p = 0.04), while inverse correlations with C3 (p = -0.26, -0.43 to -0.08; p = 0.004), C4 (p = -0.18, -0.36 to 0.005; p = 0.04), CH50 % (p = -0.20, -0.38 to -0.01; p = 0.02), and Tf (p = -0.35, -0.53 to -0.12; p = 0.002) were found. According to clinical manifestations, patients with arthritis showed higher levels of ESR (34 vs. 20 mm/h), CRP (10 vs. 2.8 mg/L), and AAT (179 vs. 145 mg/dL), but lower Tf (192 vs. 226 mg/dL) than those without arthritis; whereas active nephritis was characterized by lower serum concentrations of complement C3 (73 vs. 92 mg/dL), C4 (10 vs. 15 mg/dL), CH50% (80 vs. 160 U/mL) and Tf (196 vs. 232 mg/dL) than those patients without this manifestation. No other significant differences were found. CONCLUSIONS: In patients with SLE, acute-phase proteins behave differently depending on the kind of organ damage evaluated. Serum complement proteins remained as the most reliable laboratory markers for nephritis, while CRP was determined the best in patients with arthritis. The muted CRP response seen in SLE patients with active nephritis could have important pathogenic implications.

[Yeast susceptibility isolated from blood cultures of patients at the National Cardiology Institute Ignacio Chávez]. / Susceptibilidad de levaduras aisladas de hemocultivos en pacientes del Instituto Nacional de Cardiología Ignacio Chávez.

INTRODUCTION: With the increasing prevalence of bloodstream infections caused by Candida sp. is necessary to establish the susceptibility of resistant strains in various geographical regions. OBJECTIVE: To determine the in vitro susceptibility to fluconazole, itraconazole, voriconazole and amphotericin B in yeasts isolated from blood through E test method. MATERIAL AND METHODS: In the period from 1992 to 2007, a total 112 strains of Candida species were isolated from blood of patients at the National Institute of Cardiology Ignacio Chavez. Susceptibility of these strains was performed to know the level of resistance to Itraconazole, Fluconazole, Voriconazole and Amphotericine B by E test method. RESULTS: C. albicans was the most common species (60.2%), followed by C. tropicalis (9.8%). A five percent of resistance to itraconazole, 1.8% to fluconazole; and 0.9% to amphotericine B and voriconazole were found. C. glabrata was the most resistant species to the four antifungal agents. CONCLUSION: The yeasts resistance to the four antifungal agents is still lower in our patients.

Evaluation of adenosine deaminase activity in the Mycobacterium tuberculosis culture supernatants

Background. Adenosine deaminase (ADA) catalyzes hydrolytic and irreversible deamination of deoxyadenosine into deoxyinosine and of adenosine into inosine, and is related to lymphocytic proliferation and differentiation. The measurement of ADA activity in body fluids is a useful tool in the evaluation of mycobacterial infections. Elevated ADA activity has, been found in pleural effusions of patients with pleural tuberculosis relative to those from patients with nontuberculous pleural diseases, and is mainly associated with cellular host factors such as monocyte-macrophages or lymphocytes. In contrast, there is little information about ADA activity measurement in mycobacteria culture supernatants. Methods. We evaluated ADA activity as described by Giusti in the culture supernatants of eight Mycobacterium tuberculosis isolates. Results. Mycobacteria culture supernatants did not display any ADA activity. Conclusions. This results supports the notion that Mycobacterium tuberculosis is not the source of ADA activity. However, increased ADA activity in biological fluids from tuberculosis patients might be due to the interaction of the mycobacterium with host factors

Utilidad diagnóstica del lavado broncoalveolar en la neumonía nosocomial asociada con ventilación mecánica en pacientes bajo tratamiento antibiótico / Diagnostic utility of bronchoalveolar lavage in mechanical ventilation-associated nosocomial pneumonia in patients under antibiotic treatment

Bajo los lineamientos de una prueba diagnóstica, determinamos la utilidad del cultivo con cuenta de unidades formadoras de colonias (UFC) en los cultivos de lavado broncoalveolar (LAB) de pacientes con sospecha de neumonía asociada a ventilación mecánica (NAVM) y bajo tratamiento con antibióticos sistémicos. Los cultivos con crecimiento de bacterias en 10 a la cuarta y 10 a la quinta YFC/ml fueron considerados positivos, mientras los cultivos sin crecimiento fueron considerados negativos. Los cultivos con crecimiento de 10 al cubo UFC/ml se consideraron como contaminación. El diagnóstico final de NAVM (estándar de oro) se hizo con criterios de tipo clínico, bacteriológico e histológico. Se estudiaron 12 pacientes con sospecha de NAVM y como grupo control se estudiaron seis pacientes bajo ventilación mecánica, pero sin evidencia de neumonía u otra infección. Todos los pacientes con sospecha de NAVM tuvieron cultivo positivo, mientras que todos los controles tuvieron cultivos negativos. La sensibilidad de la prueba fue de 100 por ciento y la especificidad de 75 por ciento, con un valor predictivo positivo de 88 por ciento y valor predictivo negativo de 100 por ciento. Concluimos que los cultivos con cuenta de UFC de LBA es un método útil para el diagnóstico de la NAVM, aun cuando el paciente se encuentra bajo tratamiento con antibióticos sistémicos