ABSTRACT
BACKGROUND: A test for diagnosis of active Tuberculosis (TB) from peripheral blood could tremendously improve clinical management of patients. METHODS: Of 178 prospectively enrolled patients with possible TB, 60 patients were diagnosed with pulmonary and 27 patients with extrapulmonary TB. The frequencies of Mycobacterium tuberculosis (MTB) specific CD4(+) T cells and CD8(+) T cells producing cytokines were assessed using overnight stimulation with purified protein derivate (PPD) or early secretory antigenic target (ESAT)-6, respectively. RESULTS: Among patients with active TB, an increased type 1 cytokine profile consisting of mainly CD4(+) T cell derived interferon (IFN)-γ was detectable. Despite contributing to the cytokine profile as a whole, the independent diagnostic performance of one cytokine producing T cells as well as polyfunctional T cells was poor. IFN-γ/Interleukin(IL)-2 cytokine ratios discriminated best between active TB and other diseases. CONCLUSION: T cells producing one cytokine and polyfunctional T cells have a limited role in diagnosis of active TB. The significant shift from a "memory type" to an "effector type" cytokine profile may be useful for further development of a rapid immune-diagnostic tool for active TB.
Subject(s)
T-Lymphocytes/immunology , Tuberculosis/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Antigens, Bacterial , Bacterial Proteins , CD4-Positive T-Lymphocytes/immunology , CD8-Positive T-Lymphocytes/immunology , Cytokines/immunology , Female , Humans , Interferon-gamma , Interleukin-2 , Male , Middle Aged , Mycobacterium tuberculosis/immunology , Tuberculin TestABSTRACT
BACKGROUND AND PURPOSE: Levosimendan is a new calcium sensitizer that enhances the contractile force of the myocardium and exhibits additional vasodilating properties. The present study describes the hemodynamic effects of levosimendan in patients with acute predominant right heart failure in need of inotropic therapy. PATIENTS AND METHODS: 18 patients (15 male, age 60 +/- 17 years) with acute heart failure, predominant right ventricular dysfunction, left ventricular ejection fraction (LVEF) < or = 30%, cardiac index (CI) < or = 2.5 l/min/m(2), right atrial pressure (RAP) > or = 10 mmHg, and pulmonary capillary wedge pressure (PCWP) > or = 15 mmHg were investigated. Following a loading dose, levosimendan was administered intravenously for 24 h. RESULTS: After 24 h, CI and left ventricular stroke work index increased from 1.7 +/- 0.4 to 2.3 +/- 0.6 l/min/m(2) (p < 0.001) and 14 +/- 6 to 17.3 +/- 8 g-m/m(2)/beat (p < 0.05), respectively. PCWP and systemic vascular resistance decreased from 25 +/- 7 to 21 +/- 5 mmHg (p < 0.01) and 1,724 +/- 680 to 1,096 +/- 312 dyne * s * cm(-5) (p < 0.0001), respectively. RAP was reduced from 15 +/- 5 to 10 +/- 3 mmHg (p < 0.001), whereas decreases in mean pulmonary artery pressure and pulmonary vascular resistance were not significant. Right ventricular stroke work index (RVSWI) increased from 4.8 +/- 1.8 to 7.6 +/- 3.4 g-m/m(2)/beat (p < 0.01). CONCLUSION: Levosimendan therapy is feasible and improves hemodynamics in patients with acute predominant right heart failure. Augmentation in RVSWI indicates an increase in right ventricular contractility rather than reduction in afterload as a possible pathophysiological mechanism.
Subject(s)
Heart Failure/drug therapy , Hydrazones/administration & dosage , Hydrazones/adverse effects , Pyridazines/administration & dosage , Pyridazines/adverse effects , Ventricular Dysfunction, Right/drug therapy , Cardiotonic Agents/administration & dosage , Cardiotonic Agents/adverse effects , Female , Heart Failure/complications , Humans , Male , Middle Aged , Simendan , Treatment Outcome , Ventricular Dysfunction, Right/complicationsABSTRACT
To investigate the presence of diarrheagenic Escherichia coli in Lambaréné, Gabon, 150 children with diarrhea were screened for enteroaggregative E. coli (EAEC), enterotoxigenic E. coli (ETEC), enteropathogenic E. coli (EPEC), enterohemorrhagic E. coli (EHEC), and enteroinvasive E. coli (EIEC) using polymerase chain reaction and an HEp-2 cell culture techniques. Isolates of EAEC were detected in 57 children, two thirds of them between six months and two years of age, and isolates of ETEC were detected in seven patients. Isolates of EPEC, EHEC, and EIEC were not present in this population. Among the EAEC, the pCVD432 plasmid, a heat stable (ST)-like (ST-like) enterotoxin (EAST), and a plasmid-encoded heat-labile toxin (PET) were detected in 19, 34, and 42 cases, respectively. Detection of pCVD432, EAST, and PET were significantly associated with EAEC identified by the HEp-2 cell assay. Although detected only in 16 patients, the presence of the fimbriae AAF I (aagA) and AAF II (aafA) were more likely to occur in EAEC than in non-EAEC (odds ratio [OR] = 4.1, 95% confidence interval [CI] = 0.5-38.6, and OR = 2.3, 95% CI = 1.0-5.3, respectively). The EAEC isolates exhibited decreased susceptibility for ampicillin, tetracycline, and trimethoprim.
