Dipstick Research Articles

Identification of Cryptococcus antigen in human immunodeficiency virus-positive Turkish patients by using the Dynamiker® lateral flow assay.

Cryptococcus neoformans causes life-threatening meningoencephalitis, particularly in human immunodeficiency virus (HIV)-positive individuals with low CD4 levels (<100 cells/μL). Although the burden of cryptococcal meningoencephalitis (CM) in Turkey is low (0.13 cases per 100000 persons), asymptomatic individuals at risk of cryptococcosis should be screened for antigenemia to prevent the disease and/or promote early CM diagnosis. A lateral flow assay (LFA) is used to detect Cryptococcus antigen (CrAg) in cerebrospinal fluid and serum. We determined Cryptococcus antigenemia prevalence in serum samples of HIV-positive and HIV-negative adult patients by using Dynamiker® CrAg-LFA, a point-of-care dipstick test. Patients' demographic data, CD4 count, HIV-RNA levels and anti-retroviral therapy status were recorded. CrAg was detected in 28 (11%) of 254 HIV-positive patients screened but not in 100 HIV-negative control individuals; a significant difference was observed in the CrAg-LFA positivity rate between HIV-positive and HIV-negative groups (x2 =11.970; P<.05). In CrAg-positive patients, the median CD4 level was 666cells/μL (115-1344cells/μL), with a median viral load of 23copies/mL (0-3.69×106 copies/mL). In HIV-positive CrAg-negative patients, the median CD4 level was 633cells/μL (31-2953cells/μL) and the median viral load was 12copies/mL (0-1.95×106 copies/mL; P>.05). Results indicate that HIV-positive patients with both low (<200cells/μL) and high (>200cells/μL) CD4 counts should be screened for asymptomatic cryptococcal antigenemia. HIV-associated asymptomatic cryptococcosis is not uncommon in Turkey, which warrants systematic screening. Updated strategies for CM prevention among HIV-positive patients should be used even in non-endemic countries.

Curative Efficacy of Fosfomycin Tromethamine Versus Ciprofloxacin in the Initial Therapy of Uncomplicated UTI—a Prospective Open-Label Randomised Controlled Clinical Study

The precise current role of fosfomycin in the management of uncomplicated UTI (uUTI) is not well defined in the published English literature (PubMed(™)). We aim to compare the overall curative efficacy, safety, and outcome of fosfomycin tromethamine vis-a-vis Ciprofloxacin therapy in the initial management of uncomplicated UTI in a select group of patients. After obtaining prior institutional ethical clearance and written informed consent, 120 consenting patients with uUTI were selected as per protocol (based on symptoms of uUTI, positive urine culture sensitivity (c/s), urine routine/microscopy (r/m) or positive urine leukocyte esterase dipstick (LED) test) and enrolled in this study. They were randomized by computer draw of lots, into two groups of 60 each, randomised to receive initial empirical therapy with either fosfomycin (F-intervention arm) or Ciprofloxacin (C-comparator arm), pending the urine culture report. Patients were followed up with urine culture analysis and other parameters. The primary outcome measures were clinical/bacteriological response/resolution of UTI documented by negative urine culture (sent on day 3), absence of pyuria, and negative urine LED on 3rd day. Urine c/s was sent at day 0, but treatment was started (based on randomization) for those with urine r/m positive and positive LED test, pending the result of c/s. If the urine c/s turned out to be negative, the patient was excluded from the study. For the patients who satisfied the inclusion criteria, urine c/s was again sent on day 3, based on which report, bacteriological cure was defined. Secondary outcomes included bacteriological spectrum, antimicrobial sensitivity pattern, incidence of UTI caused by extended spectrum beta-lactamase (ESBL) producing strains of Escherichia coli, possible risk factors for UTI, side effects, ADRs, and ADEs of the drugs. E. coli and Klebsiella were the commonest cause of UTI while ESBL uropathogens were detected in 14/120 (11.67% 11 and 3 in F/C groups, respectively) patients. The sensitivity of uropathogens to F and C was 86 and 50% respectively while the overall clinical curative efficacy (CCE) of same was 83 and 43% respectively. In the subset of 14 patients with UTI due to ESBL, the CCE of F and C was 91 and 67% respectively. Side effects (minor and self-limiting) were significantly more common with the F group (p < 0.001), with diarrhoea being the commonest. Hospitalization was the commonest risk factor for UTI (27%) though the association of risk factors with UTI was not significantly different (p = 0.609). Fosfomycin was safe and significantly more efficacious in treating uncomplicated UTI (p < 0.001) versus ciprofloxacin. The overall incidence of UTI due to ESBL strains was 12% in which the CCE of fosfomycin was significantly higher (p = 0.023).

Effect of shenyan xiaobai granule on nephrin and podocin of adriamycin-induced renal injury: A randomised controlled trial

Ethnopharmacological relevanceShenYanXiaoBai granules is a traditional Chinese herbal medicine, It is used widely for the treatment of proteinuria caused by various kidney diseases. Aim of the studyThis study investigated the mechanism of Shenyan Xiaobai Granule in the treatment of nephritis proteinuria. Materials and methods100 male wistar rats were divided into a blank group (n = 20) and a nephropathy group (n = 80) using random number table after 1 week adaptive feeded. Rats were injected with adriamycin (6.5 mg/kg) via the tail vein to induce nephropathy except for blank group. Every rat's urine protein was checked with urine protein dipstick test after three days that showed all rats in nephropathy group were successful modelled. Nephropathy group was divided into model group, benazepril group, ShenYanXiaoBai low dose group, ShenYanXiaoBai high dose group equally. Blank and model group were given distilled water 2 ml as control, then benazepril group received benazepril 0.90 mg/kg, ShenYanXiaoBai low dose group received ShenYanXiaoBai granules 1.80 g/kg as high dose group was given 3.60 g/kg, gavage for 6 days a week last for seven weeks. Urinary albumin/urinary creatinine were measured in seventh day every week. Three rats were randomly selected from each group to be executed in 3th and 5th weekend to detect the mRNA and protein expression level in kidney. The rest rats were as well. ConclusionsThe therapeutic effect of ShenYanXiaoBai high dose group was better than the two other treated groups from the 5th week to the 7th week, the comparison had a significant difference. The therapeutic effect of benazepril group was better than the ShenYanXiaoBai low dose group in the 7 weeks and the comparison had a significant difference.

Normality data of eGFR and validity of commonly used screening tests for CKD in an area with endemic CKD of unknown etiology; need for age and sex based precise cutoff values

BackgroundChronic Kidney Disease in certain part of Sri Lanka and increasing burden of CKD in some other countries is a global public health problem. While the underlying causes of majority of cases are unknown, effective control and prevention strategies are yet to be taken. Though the disease has been identify more than decade ago, baseline data on renal function are not available. This study reports the age and sex disaggregated data of renal functions among screening participants of the Anuradhapura, the district with the highest disease burden in Sri Lanka.MethodsThe screening prorgramme was done as a part of CKD control programme of Anuradhapura. All screening centers were visited and information and urine sample collection tubes were distributed before the screening date. A serum and urine sample was taken from all participants. In a subsample, urine sulfosalicylic acid test (SSA Test), urine dipstick test, urine albumin to creatinine ratio (UACR) and urine protein to creatinine ratio (UPCR) was done.ResultsThe study sample included 7768 apparently healthy people aging 18 to 93 years and females (n = 5522) accounted for 71.1% of the sample. Mean age of the participants was 45.9 (SD 14.1) years. Mean eGFR in this population was 90.8 mL/min/1.73m2(SD 24.6) with a significantly lower eGFR (88.1 mL/min/1.73m2) among males compared to female (92.8 mL/min/1.73m2). Mean eGFR was 115 mL/min/1.73m2 (SE .5) among participants aging less than 30 and this value drastically reduced to 59.1 mL/min/1.73m2 (SE 1.2) among people aging more than 70 years. Proportion of people having reduction of eGFR compatible with mild, moderate, severe and kidney failure categories was 33.9(32.7–34.8), 8.4(7.8–9.0), 1.5(1.2–1.7) and 0.7(0.5–0.9). The age and sex adjusted prevalence of eGFR less than 60 mL/min/1.73 m2 in a single sample in this population was 10.6%. Bayesian Latent Class model analysis shows that UPCR> 150 has the highest sensitivity to detect those who are with eGFR less than 60 mL/min/1.73 m2. UACR, the usual recommended test as a screening test was having a sensitivity of 35.3% in this population.ConclusionUPCR and UACR should be use as a screening tests in areas with high proportion of CKDu patients. More research are required to investigate the use of age and sex specific cut off values to diagnose CKD.

Laboratory diagnosis of an imported case of visceral leishmaniasis in Henan Province

To analyze the epidemiological and clinical data of an imported case of visceral leishmaniasis in Henan Province, and explore the method of laboratory diagnosis of kala-azar. The epidemiological and clinical data of an imported visceral leishmaniasis patient were analyzed. Leishmania donovani bodies in bone marrow smears were observed microscopically. The antibody was detected by using rK39 dipstick test strips. Two pairs of specific primers, K13A-K13B and LITSR-L5.8S, were used to amplify kinetoplast DNA and internal transcribed spacer of rDNA of the parasite, respectively. The patient had been in the epidemic area of visceral leishmaniasis, and had symptoms such as irregular fever, splenomegaly, pancytopenia, and inversed ratio of albumin and globulin. The amastigotes of L. donovani were found in the bone marrow smears, and rK39 test strip was positive, and the PCR products of K13A-K13B and LITSR-L5.8S were 87 bp and 285 bp respectively. The similarities of the two fragment sequences to the corresponding sequences of L. donovani were 94% and 100%, respectively. The case is diagnosed as visceral leishmaniasis according to the epidemiological data, clinical manifestations and laboratory test results of the patient, and the pathogen is L. donovani.

Дистанционный мониторинг показателей общего анализа мочи при лечении цитратными смесями пациентов с мочекислым уролитиазом

Oral dissolution therapy has been successfully used in urologic practice since 1950s. However, many doctors attempt to improve efficiency of this approach. Use of different medical personalized digital devices which are increasingly used in clinical practice, represent one of the solutions of this problem. Our aim was to assess efficiency of oral dissolution therapy with drug Blemaren in patients with uric acid stones using of portable urinary analyzer with system of remote monitoring. A total of 12 patients with uric acid stones were followed. All of them had kidney stone with a density less than 500 HU according to CT-urography. Oral dissolution therapy was performed with the drug Blemaren for 8-9 weeks. All patients were advised to maintain urine pH of 6.5-7.0. With aim of dynamic monitoring of urine parameters, a portable urine analyzer "ETTA AMP-01" was given to all patients for 2 months. Complete dissolution was achieved in 10 (83.3%) patients. In one case (8.3%) oral dissolution therapy was complicated by acute pyelonephritis. A stenting was performed and dissolution therapy was continued with a positive effect. In another case (8.3%) partial dissolution was seen, however, extracorporeal shockwave lithotripsy was decided to perform. Doctor who remotely monitored different parameters of urinalysis (n=11) followed urine pH, density, leukocytes, erythrocytes, level of nitrite, which provided a more comprehensive assessment of patients current state. If necessary, the specialist contacted the patient and adjusted the therapy. The possibility of remote monitoring of urinalysis and simple communication with urologist allows to titrate drug dose more convenient compared to conventional approach when outpatient urologist controls pH diaries based on dip-stick test. Moreover, such approach gives an opportunity to quickly identify complications and correct the therapy in a timely manner.

Présentation clinique et performance de la bandelette urinaire pour le diagnostic d’infection urinaire en population gériatrique

BackgroundUrinary tract infections (UTI) are the second cause of community-acquired bacterial infections in the elderly. Distinguishing symptomatic UTI from asymptomatic bacteriuria is problematic, as older adults are less likely to present with localized urinary symptoms. We evaluated characteristics of patients presenting UTI among elderly with sepsis. Moreover, we aimed to evaluate the sensibility and specificity of urine dipstick tests in the diagnosis of UTI in geriatric population. Patients and methodWe led a prospective, monocentric, observational study between April 2017 and January 2018. We included patients hospitalized in geriatric wards, who were prescribed urine culture for UTI symptoms or/and infection without primary sites for which a urine culture was prescribed. Dipstick urinalyses were performed for all patients.Clinical and biological characteristics of all patients were compared according to the final diagnosis of UTI. Moreover, results of dipstick tests were evaluated for the diagnosis of UTI in this population. ResultsAmong 165 patients, 67 (40.6 %) had a UTI and 98 (59.4 %) had another diagnosis. These two groups were comparable for age and daily-living activities. In the UTI group, the proportion of women was higher than in the other group (P<0.05), and mean MMSE score was lower (P<0.05).Positive urine dipstick test for leukocytes and/or nitrites had high sensitivity (92 %), but low specificity (50 %). Negative predictive value of this test was high (91 %). ConclusionFor suspicion of UTI among elderly, few criteria are specific. Negative dipstick tests can suggest an absence of UTI due to its high negative predictive value.

A multicentric evaluation of dipstick test for serodiagnosis of visceral leishmaniasis in India, Nepal, Sri Lanka, Brazil, Ethiopia and Spain

Visceral leishmaniasis (VL) is one of the leading infectious diseases affecting developing countries. Colloidal gold-based diagnostic tests are rapid tools to detect blood/serum antibodies for VL diagnosis. Lack of uniformity in the performance of these tests in different endemic regions is a hurdle in early disease diagnosis. This study is designed to validate a serum-based dipstick test in eight centres of six countries, India, Nepal, Sri Lanka, Brazil, Ethiopia and Spain with archived and fresh sera from 1003 subjects. The dipstick detects antibodies against Leishmania donovani membrane antigens (LAg). The overall sensitivity and specificity of the test with 95% confidence intervals were found to be 97.10% and 93.44%, respectively. The test showed good sensitivity and specificity in the Indian subcontinent (>95%). In Brazil, Ethiopia, and Spain the sensitivity and specificity of the dipstick test (83.78–100% and 79.06–100%) were better as compared to the earlier reports of the performance of rK39 rapid test in these regions. Interestingly, less cross-reactivity was found with the cutaneous form of the disease in Spain, Brazil, and Sri Lanka demonstrating 91.58% specificity. This dipstick test can therefore be a useful tool for diagnosing VL from other symptomatically similar diseases and against cutaneous form of leishmaniasis.

How accurate is the urine dipstick test for diagnosing urinary tract infection?

Objectives: Urine dipstick is the first step laboratory test to diagnose a urinary tract infection (UTI) which is a common infectious disease diagnosed in the laboratories. Early treatment of UTI is very important in order to prevent long-term complications. The gold standard to diagnose UTI is urine culture so there are a number of unnecessary urine culture requests. However, urine culture results are not available earlier than 24-36 hours. Besides, urine culture is expensive and causes time-consuming of treatment. Our aim in this study was to compare urine leukocyte esterase test and nitrite test of urine dipstick with urine culture to determinate the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Methods: Urine culture results and urine dipstick test results of patients who admitted to Selçuk University Hospital between May 2016 and May 2017 were collected retrospectively. The study included 11.169 patients and 3299 of them have positive urine cultures. Results: In total, 3299 (29.5%) patients have positive urine culture. Out of these culture positive samples, positive dipstick results’ ratios for leukocyte esterase and nitrite were 82.8% (n = 2733) and 22.4% (n = 774). Leukocyte esterase had 82.8% sensitivity and 68.1% specificity, with PPVs and NPVs of 52.1% and 90.5%, respectively. Conclusions: The NPVs are found significantly higher than PPVs and it shows that urinary dipstick is more reliable to exclude disease than to diagnose the disease. Clinicians should not order urine culture from all patients without ant clinic signs.

Diagnostic accuracy of dipsticks test among clinically suspected urinary tract infected patients at National Hospital, Tanzania

Dipstick test is a rapid test for diagnosis of urinary track infections (UTIs). Rapid test should be accurate so that does not give a lot of false results that may subject patients to wrong treatments especially when used alone.

MON-256 RELATIONSHIP OF RANDOM URINARY PROTEIN AND CREATININE RATIO WITH 24 HOUR URINARY PROTEIN IN THE PROTEINURIC INDIAN PATIENTS

The gold standard test for the assessment of proteinuria is 24-hour urinary collection. However, 24-hour urinary collection is cumbersome, time consuming and inconvenient. Urinary protein creatinine ratio is used as surrogate for the 24-hour urinary proteinuria. There are scant studies which have validated this ratio in the Indian population. The aim of the study was to evaluate the relationship between 24-hour urinary protein and spot urinary protein to creatinine ratio (P/C) in patients with proteinuria diagnosed using dipstick test.

Report of health checkup system for chronic kidney disease in general population in Okayama city: effect of health guidance intervention on chronic kidney disease outcome.

BackgroundFrom 2011, Okayama municipal government started the health checkup follow-up project to find those who were unaware of suffering chronic kidney disease and to prevent from aggravation of CKD stage. In this study, we aimed to evaluate the effect of 2 years' CKD-follow-up project regarding renal function and CKD risks.Patients and methodsThose who received a health checkup by the national health insurance in Okayama city in 2011 were recruited. The patients with lifestyle-related diseases or metabolic syndrome were excluded. Subjects who had an estimated glomerular filtration rate<50 mL/min/1.73 m2 or urinary protein positive by dipstick test were defined as compromised renal function group. They were recommended to visit a medical institution. Non-compromised renal function participants with two or more risks for CKD (hyperglycemia, higher blood pressure, dyslipidemia, hyperuricemia) were recommended to receive a health guidance (risk group). The change of renal function and CKD risks between 2011 and 2013 in each group was examined.ResultsA total of 28,309 people received a health checkup in 2011. In compromised renal function group, 39.5% (96/243) of the subjects improved their CKD stages in 2013 regardless of the visit of medical institutions or the frequency of receiving health checkup. In risk group, 63.4% (260/410) of the subjects decreased their CKD risks in 2013 independent of the reception of health guidance.ConclusionIn both compromised renal function group and risk group, more than half of subjects kept their kidney function (217/243) and decreased the number of CKD risks (260/410) in 2 years' follow-up. Receiving a health checkup itself and notification of one’s own health condition could exert a protective effect on kidney function.

SAT-173 RISK FACTORS AND DEFINITION OF KIDNEY DYSFUNCTION IN THE COMMUNITY SETTING: THE ISN 0BY25 INITIATIVE

Community-acquired acute kidney injury (CA-AKI) is common, but often unrecognized in resource- constrained settings. Risk factors for CA-AKI development have not been well studied in Low and Lower-Middle Income Countries (LLMIC). A key limitation is the heterogeneity of diseases and a lack of a standardized approach to evaluating renal dysfunction. Limited lab assessments and lack of information on the prior state of kidney health contribute to this lack of recognition. In this study, we evaluated the risk factors associated with acute kidney disease (AKD) and the efficacy of point of care (POC) serum creatinine (sCr) and urine dipstick tests to identify patients with kidney dysfunction at presentation to community health centers (CHC) and emergency departments (ED), as part of the International Society of Nephrology (ISN) 0by25 Pilot Feasibility Project. Patients (pts) presenting at CHC or ED were screened for signs or symptoms a priori associated with high/moderate risk of developing AKI. When presentation suggested AKI risk, they underwent an sCr POC test and a urine protein dipstick.At enrollment, pts were classified as chronic kidney disease (CKD) based on prior history, proteinuria (>1+) and/or baseline sCr within 12 mos by estimated GFR (CKD- EPI equation)) <60 mL/min/1.73 m2; normal renal function (NRF) (no proteinuria and eGFR >75ml/min/1.73 m2); and AKD neither meeting criteria for CKD or NRF. AKI was confirmed within 7 days by sCr increase or decrease of 0.3 mg/dl or 1.5x from the enrollment value. Pt outcomes: progression of AKI, need for RRT, hospitalization, mortality and renal functional recovery, were assessed at 7days and 1, 3 and 6 mos. 3577 pts were screened, 2101 enrolled; 91% adults, 9% children. At enrollment, 9% were CKD and 66% AKD. At 7 days, 30% of pts fulfilled criteria for AKI: 67 from NRF (13%), AKD 470 (33%) and CKD 91 (46%). In comparison to NRF, patients with AKD had a higher frequency of diabetes mellitus, hypertension, and chronic liver disease. The use of ACEI, tenofovir, and antibiotics other than aminoglycosides was more frequent in patients with AKD and AKI. Dehydration associated with vomiting and low oral intake was the most common risk factor for AKD, followed by diarrhea, hypotension and appetite loss. Mortality at discharge and at 6 months was 5% and 13%, respectively, 3.4% and 6.4% in those with no renal dysfunction, 3.1% and 13.7% in those with AKI, 7.3 % and 16.1% in those with AKD and 10.3% and 24.5% in those with CKD. Of 434 patients with 3 months sCr follow up, new onset CKD was encountered in 40 (26%) of AKD and 54 (33%) of AKI patients. Of patients dying from CKD and AKD groups, non-provision of dialysis occurred in 31 (11%). Community-acquired AKI is common in low resource settings. Comorbidities and a set of signs and symptoms can identify adult patients at risk for AKD and can be used to select patients that may benefit from sCr POC testing and protein dipstick in CHC and ED settings. POC creatinine and urine dipstick tests identified a significant number of patients with AKD that would otherwise go unrecognized. Applying the AKD criteria can help to identify patients with a higher risk of CKD progression and a higher mortality rate. Patients with AKD have threefold higher mortality than patients with normal renal dysfunction.

Screening for Urine Abnormalities Among School Children in Qalubyia

Background Early identification of kidney diseases in children and adolescents is an important initial step in prevention of chronic kidney diseases (CKD). The current study was undertaken to screen asymptomatic school children in Qalubyia governate, Egypt, and to detect the prevalence of renal disorders using urine dipstick method. Aim of Work The purpose of the study was to determine the prevalence of urinary abnormalities by dipstick test (reagent strips) in asymptomatic school children. Patients and Method This cross sectional study, was carried out in Qalubyia Governorate, from September 2018 to February 2019. It comprised (1000) school children of both sexes after obtaining an informed consent from the children's care givers. Ages of the children included in the study ranged from 6 to 12 years and they were 411 males (41.1%) and 589 females (58.9%). Results Out of total 1000 children, 411 (41.1%) were male children and remaining 589 (58.9%) were female students. During the first screening by urine dipstick method, 66 (6.6%) children were found to having urinary abnormalities which were further investigated by confirmatory complete urine analysis. Finally 33 were diagnosed having urinary abnormalities. The prevalence rate of isolated hematuria (IH) was 0.9%; isolated proteinuria (IP) was 0.4%; combined hematuria and proteinuria (CHP) was 0.1% and urinary tract infection (UTI) was 1.8% and Glycosuria was 0.1%. In microscopic urine examination, crystals was found positive in 0.8% of the cases. Abnormality in sonography of kidneys were found in 5 cases. Urine culture results were positive in 8 cases. Conclusions In conclusion, asymptomatic urinary abnormalities might be detected by urine screening program at school age.

DETECTION OF LEISHMANIA INFECTION IN STRAY DOGS IN HUMAN LEISHMANIASIS ENDEMIC AREA IN MYMENSINGH DISTRICT WITH ITS POSSIBLE PUBLIC HEALTH SIGNIFICANCE IN BANGLADESH

Background: Leishmaniasis is primarily caused by two species of Leishmania (L. donovani and L. infantum) of which clinical infection with L. infantum has been recognized in both humans and dogs as zoonotic disease with dogs as the main reservoir hosts in the Mediterranean, the Middle East, Asia and South America. Although L. donovani has been associated with both clinical and asymptomatic infection in humans but it is still associated with asymptomatic infection in dogs in Indian sub-continent without any evidence of zoonotic infection. Objectives: The objective of this research was to investigate the potentiality of dog as reservoir host for visceral leishmaniasis in the human leishmaniasis endemic regions in Bangladesh. Materials and Methods: A total of 20 stray dogs in the human VL endemic areas of Mymensingh district were captured for the detection VL during the period of November 2010 to May 2011. The dipstick test rK39 (Bios International; n = 20), Giemsa’s stained impression smears of liver and spleen (n = 6) and PCR with the tissue of liver and spleen (n = 6) were tested as per manufacturer instructions and conventional standard methods. Results: Out of 20 stray dogs examined, 4 (20.0%) were positive for L. donovani infection with rK39 strip test. Of the six randomly selected dogs tested with Modified Giemsa’s stained of impression smears of spleen and liver showed 2 (33.33%) positive whereas PCR technique detected 5 (83.33%) positive for L. donovani. Results of PCR showed 145bp amplicon, specific for L. donovani infection in 83.33% stray dogs. Conclusions: This study reveals that a high percentage of L. donovani asymptomatic carrier infections occur in dogs and evidence indicates that dogs and humans may potentially serve as a source of infection to sand fly vectors and accordingly dogs can be recognized as a probable animal reservoir for the Leishmania infection in the endemic region in Bangladesh. However, further studies are required to determine the ability of dogs to transmit the L. donovani to the vector sand fly in nature and its evidence on ‘One Health’ perspectives. Keywords: Visceral leishmaniasis, Endemic region, Stray dogs, rK39 strip test, Giemsa’s stained liver and spleen impression smears, PCR, Reservoir host, Mymensingh

Lateral Flow Dipstick Test for Serodiagnosis of Strongyloidiasis.

The conventional method of detecting Strongyloides stercoralis in fecal samples has poor diagnostic sensitivity. Detection of Strongyloides-specific antibodies increases the sensitivity; however, most tests are ELISAs that use parasite extract which may cross-react with the sera of other helminth infections. To improve the serological diagnosis of strongyloidiasis, this study aimed at developing a sensitive and specific lateral flow rapid dipstick test. Two recombinant proteins, recombinant NIE (rNIE) and recombinant Ss1a (rSs1a), were used in preparing the dipstick, with gold-conjugated antihuman IgG4 as detector reagent. In parallel, the corresponding ELISA was performed. Both assays demonstrated diagnostic sensitivity of 91.3% (21/23) when tested with serum samples of patients with Strongyloides infection, and 100% specificity with 82 sera of asymptomatic (healthy) and those with other parasitic infections. The ELISA and dipstick test results were positively correlated to each other (r = 0.6114, P = 0.0019). The developed lateral flow dipstick test may improve the serodiagnosis of strongyloidiasis and merit further validation studies.

The inappropriate use of antibiotics in hospitalized dengue virus-infected children with presumed concurrent bacterial infection in teaching and private hospitals in Bandung, Indonesia.

BackgroundDengue virus infection (DVI) among children is a leading cause of hospitalization in endemic areas. Hospitalized patients are at risk of receiving unnecessary antibiotics.MethodsA retrospective medical review analysis study was conducted to evaluate the prevalence, indication, and choice of antibiotics given to hospitalized patients less than 15 years of age with DVI in two different hospital settings (teaching and private hospitals) in the Municipality of Bandung. Epidemiological, clinical, and laboratory data were obtained using a pre-tested standardized questionnaire from patients’ medical records admitted from January 1 to December 31, 2015.ResultsThere were 537 (17.5%) out of 3078 cases who received antibiotics. Among 176 cases admitted to the teaching hospitals, presumed bacterial upper respiratory tract infection (URTI) and typhoid fever were found in 1 (0.6%) case and 6 (0.3%) cases. In private hospitals among 2902 cases, presumed bacterial URTI was found in 324 (11.2%) cases, typhoid fever in 188 (6.5%) cases and urinary tract infection (UTI) in 18 (0.6%) cases. The prevalence of URTI and typhoid fever were significantly lower in the teaching hospitals compared to the private hospitals (p<0.0001 and p<0.05 respectively). The diagnosis of URTI in both teaching and private hospitals was merely based on clinical findings. Amoxicillin was given to 1 patient in the teaching hospitals; the 3rd generation of cephalosporins, mostly intravenous, were given in 247 (67%) cases in private hospitals. The diagnosis of typhoid fever in the teaching hospitals was based on culture in 1 (16.7%) and reactive IgM anti-Salmonella in 5 (83.3%) cases while in the private hospitals, they were based on reactive IgM anti-Salmonella in 13 (6.5%) cases, single Widal test in 61 (32.5%), and without laboratory confirmation in 114 (60.6%) cases. Most of the cases in both hospital settings were treated mostly with 3rd generation cephalosporin. The diagnosis of UTI was based on positive leucocyte esterase and nitrite in urine dipstick test in 7 (38.9%) and leucocyturia alone in 11 (61.1%) cases and was treated with 3rd generation in 15 (83.3%) cases, amoxicillin, chloramphenicol and clarithromycin, each in 1 (5.6%) case.ConclusionThe use of antibiotics in private hospitals was inappropriate in most cases while the use of antibiotics in the teaching hospital was more accountable. This study indicated that interventions, such as the implementation of the antibiotics stewardship program, are needed especially in private hospitals to reduce inappropriate use of antibiotics.

Evaluation of the Clinitek\xae, a point-of-care urinalysis system for the measurement of clinically significant urinary metabolites and detection of haematuria in Schistosoma haematobium infected children in southern C\xf4te d\u2019Ivoire

BackgroundUrinary schistosomiasis, caused by Schistosoma haematobium, remains a significant public health problem worldwide, despite years of efforts to control it. Haematuria is one of the notable indirect indicators of S. haematobium infection and is commonly assessed along with other routine screens using a urinary dipstick test. A portable “field friendly” electronic analyser would offer an automated and thus more objective read-out compared to visual-read dipstick methods.MethodsWithin the framework of a Phase 2 praziquantel dose finding study in preschool- and school-aged children infected with S. haematobium, in southern Côte d’Ivoire, we compared a visual-read of the urine dipstick strips (Multistix PRO, Siemens Healthcare Diagnostics) to an automated reader (CLINITEK Status+ analyser™ Siemens Healthcare Diagnostics). Urine samples were collected from 148 pre-school aged and 152 school-aged children for urinalysis. Values were compared using a linear weighted kappa statistic and Bland–Altman analysis.ResultsA very good correlation between the two methods for nitrites and haematuria was observed (κ coefficient of 0.88 and 0.82, respectively), while a good correlation was observed for leukocytes (κ coefficient of 0.63) A moderate to fair correlation was calculated (κ coefficient ≤ 0.6) for all other parameters. When the results were stratified according to infection intensity, the agreements were stronger from the high infection intensity sample measurements, for most of the parameters.ConclusionOur results demonstrate the device’s utility in detecting haematuria and nitrites but underline the need for further development of this tool in order to improve its performance in the field.

Evaluation of the effect of urine dip vs urine drip on multi-test strip results.

Standard operating procedures, including World Health Organization guidelines for packed cell volume, are established for in-clinic laboratory tests. No independent, evidence-based guidelines exist for dipstick urinalysis; however, manufacturer's instructions state to dip the stick into urine. In veterinary medicine, small volume urine samples could preclude dipping; therefore, a single drip per pad from a pipette or syringe is often performed. This study aimed to examine the differences between these two urine application methods prior to analysis, with the hypothesis that the method type would not effect on test results of dipstick analysis. To standardize the strip analysis method, a Siemens Clinitek Status+analyzer was used with Multistix10SG dipsticks. Three investigators tested urines from 53 dogs with a range of diseases by both methods. Results were assessed for the degree of agreement between the methods and within method variability. Overall, the agreement between methods was high. Within each method, the drip method variability was higher than that of the dip method (P=0.012). Disagreements between methods were present, with pH and blood having the lowest agreement levels. Glucose was more likely to be positive on the drip compared with the dip methodology. This study demonstrates potential clinically relevant differences between the two methods and a higher level of variability with the drip methodology. Therefore, while the drip method could be used for practical reasons (eg, low sample volumes), this study supports the manufacturer's recommended method of dipping the dip stick into urine rather than dripping urine onto each pad with a pipette or syringe.

Glucosuria Predicts the Severity of Puumala Hantavirus Infection

IntroductionPuumala hantavirus (PUUV) causes a mild type of hemorrhagic fever with renal syndrome characterized by acute kidney injury (AKI), increased capillary leakage, and thrombocytopenia. Albuminuria and hematuria in dipstick urine test at hospital admission are known to predict the severity of upcoming AKI.MethodsWe analyzed dipstick urine glucose in 195 patients with acute PUUV infection at hospital admission, and divided them into 2 categories according to the presence or absence of glucose in the dipstick urine test. Determinants of disease severity were analyzed in glucosuric and nonglucosuric patients.ResultsAltogether, 24 of 195 patients (12%) had glucosuria. The patients with glucosuria had more severe AKI than patients without glucosuria (median maximum creatinine concentration 459 μmol/l, range 78–1041 μmol/l vs. 166 μmol/l, range 51–1499 μmol/l; P < 0.001). The glucosuric patients had more severe thrombocytopenia (median minimum platelet count 41 × 109/l, range 5–102 × 109/l vs. 62 × 109/l, range 3–249 × 109/l; P = 0.006), and more pronounced signs of increased capillary leakage (change in weight, maximum plasma hematocrit, minimum plasma albumin). The glucosuric patients were more often in clinical shock at admission (20.8% vs. 1.2%; P < 0.001) and the length of hospital stay was longer (median 7.5 days, range 4–22 days vs. 6 days, range 2–30 days; P = 0.009).ConclusionGlucosuria is relatively rare, but when present it predicts a more severe disease course in patients with acute PUUV infection.