Diagnosis Of Infectious Complications Research Articles

The possibility of using synovial C-reactive protein, interleukin-6 and presepsin in the diagnosis of periprostheticjoint infection.

The diagnosis of infectious complications in joint prosthetics remains a pressing issue, especially in cases where pathogens do not grow during the seeding of biological material. This study analyzed the potential use of synovial biomarkers for the diagnosis of periprosthetic infections (PPI), based on literature data. The aim was to determine the significance of synovial C-reactive protein (CRP), interleukin-6 (IL-6), and presepsin in diagnosing PPI. Materials and methods: A prospective, single-center, blinded study was conducted on patients undergoing revision arthroplasty for both infectious and aseptic inflammation in the endoprosthetic area. The study included 66 patients, divided into two groups: Group I included 17 patients with periprosthetic infection diagnosed according to the ICM Philly criteria of 2018; and Group II included 49 patients with aseptic inflammation in the endoprosthetic region.Synovial fluid samples from all participants were analyzed for bacteriological and cytological analysis to determine the levels of CRP, IL-6, and presepsin. Receiver operating characteristic (ROC) analysis was performed to determine sensitivity, specificity, and accuracy, as well as thresholds for laboratory data. Results: The greatest reliability for diagnosing infectious and aseptic inflammations was shown for the number of leukocytes in synovial fluids, with an area under the curve (AUC) of 0,928 (95% confidence interval [CI]: 0,837-0,977; p0,0001), as well as for synovial CRP with an AUC of 0,776 (95% CI: 0,656-0,87; p=0,0004), and IL-6 with an AUC of 0,712 (95% CI: 0,583-0,82, p=0,0048). While the presepsin level was significantly different between groups, AUC was 0,582 (95% CI: 0,453-0,703, p=0,3344). Threshold values were calculated for CRP at 5,6 mg/L and presepsin – 1212,0 pg/mL and IL-6 – 988,5 pg/mL. The sensitivity, specificity, and accuracy of the diagnosis of PPI were 62,5%, 85,71%, and 80%, respectively for CRP; 68,5%, 63,04%, and 68,7% for IL-6; and 43,75%, 79,59%, and 70,77% for presepsin. Conclusion: IL-6 has the highest sensitivity for PPI, but it has lower accuracy and specificity than CRP. Presepsin has the lowest sensitivity, specificity and accuracy for the diagnosis of PPI.

Secondary infections and long-term outcomes among hospitalized elderly and non-elderly patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and treated with baricitinib: a comparative study from the national centre of Hungary

Baricitinib is considered a first-line treatment for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected adult patients with an associated cytokine storm syndrome (CSS). Our objective was to compare rates of secondary infections and long-term outcomes of elderly and non-elderly patients who received baricitinib for COVID-19. We conducted a single-centre observational study between November 2020 and September 2023, focusing on hospitalized adult SARS-CoV-2 patients with CSS, categorized as elderly (≥ 65 years) and non-elderly (< 65 years). Enrolment, severity stratification, and diagnosis of infectious complications followed predefined criteria. Outcomes of all-cause mortality and rates of non-severe and severe secondary infections were assessed at 1-year post-treatment initiation. Kaplan–Meier analysis was performed for survival analysis. In total, 490 patients were enrolled (median age 65 ± 23 (21–100) years (years, median ± IQR, min–max); 49.18% elderly; 59.59% male). Elderly patients were admitted to the hospital significantly earlier (7 ± 5 days vs. 8 ± 4 days; p = 0.02), experienced a higher occurrence of severe COVID-19 (121/241, 50.21% vs. 98/249, 39.36%; p = 0.02), and required the use of non-invasive ventilation at baseline (167/225, 74.22% vs. 153/236, 64.83%; p = 0.03). At 1 year, all-cause mortality was significantly higher in the elderly subgroup (111/241, 46.06% vs. 29/249, 11.65%; p < 0.01). At 90 days and 1 year, rates of any severe secondary infection were also more prevalent among the elderly (56/241, 23.24% vs. 37/249 14.86%; p = 0.02 and 58/241, 24.07% vs. 39/249, 15.66%; p = 0.02). In conclusion, elderly SARS-CoV-2-infected patients experience a more severe clinical course, higher secondary infection rates, and increased risk for long-term mortality, regardless of immunomodulatory therapy.

Infectious Complications of Pulmonary Sarcoidosis.

In this review, the infectious complications observed in sarcoidosis are considered from a practical point of view to help the clinician not to overlook them in a difficult context, as pulmonary sarcoidosis makes the recognition of superinfections more difficult. An increased incidence of community-acquired pneumonia and of opportunistic pneumonia has been reported, especially in immunosuppressed patients. Pulmonary destructive lesions of advanced sarcoidosis increase the incidence of chronic pulmonary aspergillosis and infection by other agents. Screening and treatment of latent tuberculosis infection are crucial to prevent severe tuberculosis. Severity in COVID-19 appears to be increased by comorbidities rather than by sarcoidosis per se. The diagnosis of infectious complications can be challenging and should be considered as a potential differential diagnosis when the exacerbation of sarcoidosis is suspected. These complications not only increase the need for hospitalizations, but also increase the risk of death. This aspect must be carefully considered when assessing the overall health burden associated with sarcoidosis. The impact of immune dysregulation on infectious risk is unclear except in exceptional cases. In the absence of evidence-based studies on immunosuppressants in the specific context of pulmonary sarcoidosis, it is recommended to apply guidelines used in areas outside sarcoidosis. Preventive measures are essential, beginning with an appropriate use of immunosuppressants and the avoidance of unjustified treatments and doses. This approach should take into account the risk of tuberculosis, especially in highly endemic countries. Additionally, parallel emphasis should be placed on vaccinations, especially against COVID-19.

Specific features of antimicrobial therapy in patients with severe respiratory failure receiving veno-venous extracorporeal membrane oxygenation (ECMO)

In modern medicine, the extracorporeal membrane oxygenation (ECMO) is becoming increasingly common in the treatment of severe respiratory failure. The development of infectious complications in patients receiving ECMO often leads to an increase in the duration of the procedure and significantly increases the risk of death. Dosing of antimicrobials during ECMO remains uncertain and requires further research. Diagnosis of infectious complications during ECMO is a difficult and requires the development of diagnostic protocols and the use of routine microbiological studies. The use of antimicrobials during ECMO could be complicated due to decrease in effective plasma concentration. The adsorption of antibacterial drugs in the ECMO circuit and oxygenator, the use of infusion therapy, the development of hypoalbuminemia, as well as the high incidence of acute renal and hepatic dysfunction in critically ill patients lead to an inevitable change in the volume of distribution and clearance of antibacterial drugs. These conditions require an individual approach to the choice of antimicrobials and optimization of dosing regimens in critically ill patients receiving ECMO.

Diagnosis of infectious complications in patients with acute pancreatitis

BACKGROUND: Up to 30% of patients with acute pancreatitis suffer from the severe form of the disease, of which 30% of cases are lethal, significantly rising to 80% at the development of infectious complications.&#x0D; AIM: To improve treatment results of patients with acute pancreatitis due to early diagnostics of infectious complications.&#x0D; MATERIALS AND METHODS: Expression of CD64 antigen on neutrophil membrane (DC64 index of neutrophils) was studied using a flow cytometer Cytomics FC500 (Beckman Coulter, USA) using 3-color combination of direct monoclonal antibodies Beckman Coulter: СD14FITC/CD64PE/CD45PC5. Material was whole blood.&#x0D; RESULTS: A direct correlation of moderate strength with the development of sepsis was found for both the procalcitonin value and C-reactive protein concentration at this period of illness. However, no relations of endogenous intoxication markers with the development of infectious complications were found (correlation coefficients less than 0.4). Thus, it should be noted that the difference in the indices of the studied parameters of the CD64 antigen expression in the groups began to increase exactly during the 23rd week of the disease.&#x0D; CONCLUSION: Based on the literature data, we formulated a working hypothesis, which states that the degree of CD64 receptor expression on peripheral blood neutrophils is an early marker of infectious complications of acute pancreatitis. The value of average fluorescence intensity index of molecules CD64 equal to 10 conventional units was accepted as a threshold value with regard to the development of IE, and the value of 15 conventional unitsas a threshold value with regard to sepsis. The study was conducted in a prospective group of 28 patients. In accordance with the provision of the working hypothesis, the patients were divided into 3 groups depending on the level of average fluorescence intensity index of molecules CD64. Expression of the CD64 receptor on peripheral blood granulocytes as an early laboratory marker of infectious complications of the disease was studied for the first time. We determined sensitivity and specificity, optimal terms of the given research, detected regularities of CD64 expression changes in the course of acute pancreatitis, correlations with other clinical and laboratory indexes, including prospective markers of infection (procalcitonin, C-reactive protein), with the integral scales of severity estimation of patients with acute destructive pancreatitis. Determination of the level of the receptor CD64 expression on the peripheral blood neutrophils showed that this marker reflects the dynamics of the disease course and gives the possibility of the early diagnostics of the infectious complications of acute pancreatitis. The use of this method provides additional information about the development of the surgical infection. It is important that the changes of CD64 antigen expression in dynamics outrun other markers of systemic inflammatory response and sepsis. CD64 antigen expression data on peripheral blood neutrophils is an additional factor in determining differentiated surgical tactics in phase I of the diseases development with regard to acute fluid collections in patients with acute pancreatitis.

Роль інтерлейкіну-6 у діагностиці інфекційних ускладнень у постраждалих із політравмою

Проблема сучасної діагностики інфекційних ускладнень у постраждалих із політравмою й ефективного контролю за перебігом захворювання в даний час є досить актуальною. На прикладі 116 постраждалих із політравмою та різними клінічними формами інфекційних ускладнень було висвітлено роль ІЛ-6 у ранній діагностиці розвитку запалення. Було виявлено прямий кореляційний зв’язок між рівнем ІЛ-6 та тяжкістю перебігу інфекційного ускладнення, а також можливість його діагностування без наявної клінічної картини. Рівень ІЛ-6 дозволяє диференціювати розвиток локальної та генералізованої інфекції, що дає можливість призначати лікування та визначати прогноз у постраждалих із політравмою.

669. Metagenomic Plasma Microbial Cell Free DNA-Sequencing Assists in Diagnosis of Infections and Critical Antimicrobial Changes in Immunocompromised Hosts

BackgroundMetagenomic next-generation sequencing of plasma cell-free DNA (Karius®) (plasma mcf-DNA-seq) is a noninvasive approach that may have a unique role for the diagnosis of infectious complications in immunocompromised patients. The rapid turn-around time and noninvasive nature makes this a promising supplement to standard of care. MethodsThe aim of this study is to investigate the utility of plasma-mcf-DNA-seq in clinical practice; how it changes management, correlations between organism abundance over time from symptom onset and the value of negative tests. Retrospective review of plasma-mcf-DNA-seq performed, January 2020 -March 2021. Organism abundance was displayed as a heat map and graphed over time from initiation of antimicrobials. Management changes and concordance with standard of care results were compared for positive and negative tests. This study was approved by the Virginia Commonwealth University Institutional Review Board.ResultsThirty-six adult patients included: 92% immunosuppressed (11 with T cell deficits (solid organ transplant, malignancy, human immunodeficiency virus), 8 with B-cell deficits (hematologic malignancy, diabetes mellitus), and 14 with both (hematopoietic stem cell transplant, aplastic anemia)). Most tests evaluated fever (67%) and/or pneumonia (72%). Patients received a median 7 days of antimicrobials prior to testing. Twenty-one (58%) tests detected 1-5 organisms (14/21 bacteria, 8/21 fungi, and 6/21 viruses). A positive test prompted therapy changes in 14/21 patients. Of the bacterial species identified, 8/20 were considered clinically pathogenic, 3 prompted targeted treatment; 7/8 fungi identified were clinically pathogenic and resulted in antifungal therapy changes to target the species identified. Antimicrobials were de-escalated in 3 patients with negative tests. There was an exponential relationship between the abundance of pathogenic fungi over time from symptom onset, but no such relationship was seen with bacteria. Abundance of fungi and bacteria detected on plasma mcf-DNA-seq test Abundance of bacteria and fungi detected on plasma mcf-DNA-seq test. Data classified by organism and level of immunosuppression. Abundance is expressed in microbial cell free DNA per microliter. Warmer colors towards red represent higher abundance.Figure 1. Bacteria abundance from date of symptom onset. There was no clear trend in bacterial abundance over time from symptom onset. Most bacteria detected were not considered clinically pathogenic.Figure 2. Fungi abundance from date of symptom onset There was an increasing trend in the abundance of fungi detected from time of symptom onset. Seven of the 8 fungi detected were considered clinically pathogenic.ConclusionPlasma-mcf-DNA assisted in making critical management changes including initiation of treatment for identified organisms and de-escalation of antimicrobials. Plasma-mcf-DNA is a promising approach for a non-invasive rapid diagnosis. Disclosures All Authors: No reported disclosures

The importance of developing new mannan tests in the diagnosis of invasive candidiasis in oncology patients

The regimens of anticancer therapy have been intensified and methods of high-dose chemotherapy (HDCT) have been introduced for recent years which made it possible to achieve significant progress in the results of tumor treatments. Intensification of chemotherapy regimens in cancer patients leads to the emergence of risk factors of invasive candidiasis (IC) development: agranulocytosis, disruption of the integrity of the mucous membranes, prolonged use of CVC, repeated antibiotic therapy, long-term parenteral nutrition. Thus, intensification of anticancer therapy may be accompanied by an increase in infection-mediated mortality.IC is the most common invasive mycosis in Russia. More than 11 thousand cases of IC occur in our country every year. The frequency IC in Russia is 8.29 per 100 thousand of the population, which corresponds to the results of the LIFE study in European countries where this indicator varies from 2.2 to 11 per 100 thousand of the population. There are no clinical signs or symptoms specific for IC. It develops in patients with concomitant diseases, which significantly complicates the diagnosis. In this regard, an urgent issue is to improve the diagnosis of candidal infectious complications in cancer patients in order to optimize treatment by studying serological markers that have the greatest value in the diagnosis of infectious complications in cancer patients.

COVID-19 management in heart transplanted recipients: registry of Almazov National Medical Research Centre.

Aim This study presents the experience of managing patients with COVID-19 after cardiac transplantation (CT).Material and methods Infectious complications (IC) following CT are a leading cause for morbidity and mortality. A prolonged incubation period, atypical IC symptoms, and originally altered results of laboratory and instrumental diagnosis are characteristic of recipients due to immunosuppression. In 2020, the coronavirus infection (COVID-19) rapidly spread worldwide, and timely diagnosis and searching for effective treatments for this disease became a major challenge. From January 2010 through July 2020, 148 patients received orthotopic heart transplants at the V.A. Almazov National Medical Research Center; 34 of these patients died by the present time and were excluded from this analysis. 114 patients were included into the retrospective evaluation of results. These patients had been a part of the group followed up at the Center for more than a month.Results From March through July 2020, 12 (10.5 %) of 114 CT recipients were infected with the virus SARS-CoV-2. In 75 % (n=9) of the sick patients, the COVID-19 infection developed after more than one year after CT. From the first day of clinical symptoms, mycophenolic acid/everolimus were temporarily suspended. The outpatient treatment was started on the first day and included an antiviral therapy (oseltamivir), mucolytics (bromhexine), vitamin C, and anticoagulants. If the disease onset was associated with pyretic fever the empiric antibacterial levofloxacin treatment was administered due to a high risk of mixed infection. Hospitalized patients with moderately severe COVID-19 (n=3) were treated with oxygen inhalation through nasal cannula and prone position with a positive effect.Conclusion Remote counseling of patients after CT and consistency of the outpatient treatment with recommendations of managing transplant physicians provided timely diagnosis of IC, early administration of treatment, and the absence of COVID-19 complications. Reducing the regimen of immunosuppressive therapy (antiproliferative agents) for up to 14 days facilitated infection control and was not associated with acute rejection crisis and/or impairment of the transplant function.

Clinical and epidemiological characteristics of catheter-associated bloodstream infections in patients with hematological profile

Patients with hemoblastosis, especially recipients of hematopoietic stem cells, are the most immunocompromised group of patients, especially during prolonged episodes of drug-associated granulocytopenia. The aim of the study . To characterize catheter-associated bloodstream infections in patients with hematological profile. Materials and methods . During June to October 2017, catheter-associated bloodstream infections were detected in six patients in the oncogematology department. Results and discussion . All patients came from different regions of the Russian Federation. The diagnosis of infectious complication: catheter-associated bloodstream infection was established only in 33.3 %. When determining laboratory markers of sepsis, high numbers of procalcitonin were observed in 50.0 % of patients, presepsin in 100.0 The growth of the bacterium Burholderia cepacia was observed in both central venous catheters (CVCs) and blood taken from CVCs. Phentotypically, all isolated cultures of Burholderia cepacia can be divided into three types: pan-resistant; polyresistant; polyresistant, but keeping sensitivity to co-trimoxazole. Multilocus sequencing of their DNA was carried out. The same sequence type was found in four patients. Given that the patients came from different regions, had not previously been in the same medical organization, care for CVC in the department of oncogematology was carried out by the same medical staff it can be assumed that four cases were caused by the same hospital strain Burkholderia cepacia.

Clinical value of procalcitonin in critically ill patients infected by SARS-CoV-2.

Background Blood procalcitonin (PCT) levels usually increase during infectious diseases and might be helpful to differentiate bacterial from non-bacterial origin. COVID-19 patients could present co-infections at initial presentation in the Emergency Department and nosocomial infections during stay in the ICU. However, the published literature has not established whether PCT changes could aid in the diagnosis of infectious complication during the COVID-19 pandemic. Methods Retrospective, single-center, cohort study, including COVID-19 patients admitted between March and May 2020. The data were prospectively collected for department purposes; laboratory results were collected automatically at admission and during the whole patient admission. Results 56 patients were analyzed (female 32%, male 68%), 35 were admitted to ICU, and 21 received general ward care. 21 ICU patients underwent mechanical ventilation (88%), and 9 died during admission (26%). Non-survivors had higher initial blood PCT levels than survivors at ICU admission (p.

MICROBIOLOGICAL METHODS APPLICATION EXPERIENCE IN THE SEVERE INJURIES INFECTIOUS COMPLICATIONS

Modern clinical medicine and surgery problems are associated with infections complications after medical care. In recent years, surgery has made substantial progress related to the new organizational approaches and medical technology specialized medical care to the wounded and injured. However, these gains are offset by a high rate of infectious complications that require finding effective measures emerging infectious complications timely diagnosis and their prevention. Clinical manifestations are often nosocomial in patients with severe injuries and are largely determined by the influence of clinical and pathogenetic risk factors. Such infectious complications require a comprehensive assessment, including microbiological testing. The main causative agents of infectious complications in surgical hospitals are S. aureus, K. pneumoniae, P. aeruginosa, Acinetobacter spp., which can cause bloodstream infections, soft tissue, respiratory and urinary tract infections, especially in debilitated and immunocompromised patients and patients in intensive care units. These micro organisms are dangerous to patients and medical staff, as they can survive for a long time in the hospital environment, as well as to spread from patient to patient in violation of isolation restrictive measures and requirements for hygiene of medical workers hands. Clinical patterns of infection associated with medical care for severe injuries are to the possibility of serial and parallel development, both in different and in the same time frame of local, visceral and generalized infection with prevalence of combined forms of patients surgical hospital with a high risk of nosocomial infection against the background of factors, diagnostic and treatment process and hospital environment, introduction of the agent. Early etiological diagnosis allows timely assign empirical causal treatment and arrange for infection control to prevent the spread of microorganisms in the hospital. The use of chromogenic (fluorogenic) environments in the study samples of clinical material at the stage of primary seeding makes it possible to obtain rapid response (1824 h). Microbiological monitoring in the diagnosis of infectious complications in patients with severe injuries and epidemiological surveillance for infections associated with medical care can detect agents capable of becoming the leading pathogens, form stable intra and inter group associations and change the nature of the infection on persistence type superinfection and reinfection, as well as the features of the multi year and intra change frequency allocation pathogens.

INFECTION ASSOCIATED WITH THE IMPLANTATION OF CARDIOVASCULAR IMPLANTABLE ELECTRONIC DEVICES

Data on the frequency, nature, risk factors and diagnosis of infectious complications (IC) in patients with cardioimplanted electronic devices (CED) — artificial rhythm drivers, cardiodefibrillators, devices for cardiosynchronizing therapy — often prognostically unfavorable, accompanied by high mortality, are given in the article. The data of a large-scale retrospective analysis of 200 219 patients with CED are given during the 3-year period after implantation. It was noted that among persons with IC there was a higher mortality rate compared to patients without signs of infection. In the analysis of cases of IC, the main risk factors for their development are identified, including. Presence of concomitant pathology. This article discusses the basic types of microorganisms were isolated from patients with the presence of IC, IC clinical symptoms, provides a diagnostic algorithm for suspected IC. A feature of the clinical case presented in the article is a relatively early development of IC with damage to the valve structures (tricuspid valve) — the first symptoms of bacterial damage appeared 6 months after the operation. Usually infectious endocarditis in patients with CED was verified at various times after implantation — from 1 to 72 months, and in most cases not earlier than 3 months later. The main clinical manifestations of the disease were recurrent fever, which is why the patient was repeatedly hospitalized for several months in various medical institutions. In each hospital, the patient management tactics were different and did not meet the accepted standards of diagnostic search in a febrile patient with CED. Only with the third hospitalization of the patient (November 2015) during the transthoracic echocardiography were revealed vegetations on the valves of the tricuspid valve. The given clinical observation testifies not only to the difficulties of diagnosing IE in patients with the presence of CED, but also about the inevitable mistakes in maintaining this category of patients when the standards for diagnosis and treatment of IE are not complied with. The authors emphasize that in the course of diagnostic search, and later in the development of treatment tactics, it is necessary to follow the ESC Guidelines for the management of infective endocarditis in 2015.

Perineal flap reconstruction following oncologic anorectal extirpation: an outcomes assessment.

The poorly healing perineal wound is a significant complication of abdominoperineal resection. The authors examined criteria for immediate flap coverage of the perineum and long-term cross-sectional surgical outcomes. Patients who underwent abdominoperineal resection or pelvic exenteration for anorectal cancer were retrospectively analyzed. Demographic characteristics, premorbid and oncologic data, surgical treatment, reconstruction method, and recovery were recorded. Outcomes of successful wound healing, surgical complications necessitating intervention (admission or return to the operating room), and progression to chronic wounds were assessed. The authors identified 214 patients who underwent this procedure from 1995 to 2013. Forty-seven patients received pedicled flaps and had higher rates of recurrence and reoperation, active smoking, Crohn disease, human immunodeficiency virus, and anal cancers, and had higher American Joint Committee on Cancer tumor stages. Thirty-day complication rates were equivalent in the two groups. There were no complete flap losses or reconstructive failures. Perineal wound complication rates were marginally but not significantly higher in the flap group (55 percent versus 41 percent; p = 0.088). Infectious complications, readmissions for antibiotics, and operative revision were more frequent in the flap cohort. A larger proportion of the primary closure cohort developed chronic draining perineal wounds (23.3 versus 8.5 percent; p = 0.025). Immediate flap coverage of the perineum was less likely to progress to a chronic draining wound, but had higher local infectious complication rates. The authors attribute this to increased comorbidity in the selected patient population, reflecting the surgical decision making in approaching these high-risk closures and ascertainment bias in diagnosis of infectious complications with multidisciplinary examination. Risk, III.

Usefulness of daily monitoring of procalcitonin and C-reactive protein in the early diagnosis of infection after elective colonic surgery

The diagnosis of infectious complications after elective colonic surgery is frequently misleading, delaying its resolution. Recently several biomarkers, namely procalcitonin (PCT), have been described as more specific in infection diagnosis.

Bedside consultations and battlefield microbiology

Clinical microbiologists are unique laboratorians whose professional specialty transcends the borders of medicine and infectious diseases. While they are mainly laboratory oriented, because of the need for “on the spot” diagnosis of infectious complications in critically ill patients, clinical microbiologists should be able to provide hands-on consultative services from the bedside to the laboratory. Dynamic grasp of microbial subtleties, visualized in stained smears or other preparations, allows either definitive or presumptive diagnosis. When followed by traditional methods, these are the underpinnings for providing “battlefield microbiology.”

Serum levels of interleukin 6, interleukin 8, and C-reactive protein after human allogeneic bone marrow transplantation.

Serum levels of interleukin 6 (IL-6) and C-reactive protein (CRP) were measured every second day from day -6 to day +86 in 24 patients undergoing allogeneic (n = 23) and syngeneic (n = 1) bone marrow transplantation (BMT). Endogenous serum levels of IL-6, IL-8, and CRP were further analyzed during complications after BMT, such as fever of unknown origin (FUO), severe infectious complications and acute graft-versus-host disease (GVHD). In addition, CRP levels were measured in 10 patients with interstitial pneumonitis of various origins (CMV, idiopathic). In all 24 patients IL-6 and CRP levels showed a characteristic monophasic pattern. After a slight decrease in the first days after BMT, a significant increase was observed, starting on day +3/+5 (P < 0.05) and reaching peak levels on day +9/+11 (P < 0.01). CRP had a similar pattern, with an increase in serum levels on day +3/+5 and maximum levels one to three days after the IL-6 peak was reached. The magnitude of the peak was related to the development of complications in the further course of BMT and was high in patients with and low in patients without complications. Serum levels of both molecules returned to baseline after day 14 posttransplant. Increased IL-6 and CRP levels were observed in the further course of BMT during severe infections or FUO either on the day of clinical onset (IL-6) or three days later (CRP), but not during acute GVHD grade III/IV. CMV interstitial pneumonitis (CMV-IP) was accompanied by an increase in CRP levels, while no such elevations were observed in patients with idiopathic interstitial pneumonitis (IIP). Elevated IL-8 serum levels occurred during bacterial infections, but to a lesser amount also during GVHD and CMV-IP. In conclusion, a characteristic pattern of IL-6 and CRP was observed after allogeneic BMT and a further increase associated with infectious complications. Since no significant elevations were seen in patients with GVHD, we conclude that both molecules are not involved in the induction of GVHD and might be useful diagnostic tools for the prediction and diagnosis of infectious complications after BMT. In contrast, assessment of IL-8 serum values does not permit clinical complications to be specified.

Indium-111 white blood cell scan in the diagnosis of infectious complications in patients undergoing regular dialysis treatment.

Indium-111 white blood cell scan in the diagnosis of infectious complications in patients undergoing regular dialysis treatment.