Esterase Test Research Articles

Evaluation of 3 esterase tests for the diagnosis of subclinical mastitis at dry-off and freshening in dairy cattle

Subclinical mastitis (SCM) and intramammary infection (IMI) increase esterase activity in the glandular secretions of dairy cattle. Our objective was to evaluate the clinical performance of 3 commercially available esterase tests for diagnosing SCM and IMI. Foremilk samples were collected from 380 quarters (96 cows) at dry-off and from 329 quarters (83 cows) within 4 to 7 d after calving. Quarter somatic cell count (SCC) was measured using the reference method (DeLaval cell counter; De Laval International AB, Tumba, Sweden) with SCM defined as SCC >200,000 cells/mL. Bacterial culture of foremilk samples was used to diagnose IMI based on the growth of ≥100 cfu/mL. The SCC was estimated using 3 PortaSCC tests (PortaCheck, Moorestown, NJ) from the measured esterase activity and the California Mastitis Test (CMT). Clinical performance was evaluated using logistic regression to determine the area under the receiver operating characteristic curve (AUC) and identify test sensitivity (Se) and specificity (Sp) at the optimal cut-point for diagnosing SCM and IMI. Test agreement was also evaluated using the kappa coefficient (κ) and weighted κ. The PortaSCC color test was the best-performing PortaSCC test for diagnosing SCM at dry-off (AUC = 0.90, Se = 0.91, Sp = 0.81, κ = 0.71) and at freshening (AUC = 0.86, Se = 0.74, Sp = 0.95, κ = 0.72), at an optimal cut-point of ≥250,000 cells/mL but required 45 min to produce a result. For comparison, the CMT required 2 min to produce a result and a CMT score of trace or higher was superior to the PortaSCC color test for diagnosing SCM at dry-off (AUC = 0.95, Se = 0.95, Sp = 0.86, κ = 0.81) and freshening (AUC = 0.88, Se = 0.79, Sp = 0.95, κ = 0.76). The PortaSCC quick test was the best-performing PortaSCC test for diagnosing IMI at dry-off (AUC = 0.81, Se = 0.81, Sp = 0.78 κ = 0.40) and required 5 min to produce a result, whereas the PortaSCC color test was the best performing PortaSCC test for diagnosing IMI at freshening (AUC = 0.80, Se = 0.75, Sp = 0.79 κ = 0.38). For comparison, the CMT was inferior to the PortaSCC quick test for diagnosing IMI at dry-off (AUC = 0.73, Se = 0.76, Sp = 0.60, κ = 0.20) but was equivalent to the PortaSCC color test at freshening (AUC = 0.79, Se = 0.58, Sp = 0.93, κ = 0.50). The PortaSCC color and quick tests and CMT were considered good tests for diagnosing SCM and IMI because clinically useful tests typically have an AUC >0.80 and κ >0.6. Based on the test sensitivity, cost, and analysis time, there does not appear to be a persuasive reason to select the PortaSCC tests over the traditional CMT for diagnosing SCM and IMI.

Effect of drug urine abnormality in adolescent age group

Adolescents have 2/3 of total population. This is a unique group with special needs and atention. Most adolescents with lifestyle issues fell in the age group of 16–18 years. A complete urinalysis includes physical, chemical and microscopic examinations. Midstream clean catch collection is acceptable in most situations, but the specimen should be examined within two hours of collection. Cloudy urine often is a result of precipitated phosphate crystals in alkaline urine, but pyuria also can be the cause. A strong odour may be the result of a concentrated specimen rather than a urinary tract infection. Dipstick urinalysis is convenient, but false-positive and false-negative results can occur. Specific gravity provides a reliable assessment of the patient’s hydration status. Glomerular, renal and urologic causes of microhaematuria often can be differentiated by other elements of the urinalysis. Although transient proteinuria typically is a benign condition, persistent proteinuria requires further work-up. Uncomplicated urinary tract infections diagnosed by positive leukocyte esterase and nitrite tests can be treated without culture.

Accuracy of leukocyte esterase test, endometrial cytology and vaginal discharge score for diagnosing postpartum reproductive tract health status in dairy cows at the moment of sampling, using a latent class model fit within a Bayesian framework

The objectives of this retrospective study were: 1) to determine the sensitivity (Se) and specificity (Sp) of leukocyte esterase test (LE), endometrial cytology (CYTO) and vaginal discharge score (VDS) for diagnosis of reproductive tract diseases in dairy cows at the moment of sampling; 2) to assess the impact of different thresholds on test accuracy and misclassification costs; and 3) to quantify herd prevalence of reproductive tract diseases in dairy farms from Québec, Canada.Data from 2092 cows (39 herds) enrolled in two randomized control trials were included. Cows were examined at 35 (± 7) days in milk using LE, CYTO, and VDS to determine their reproductive tract health status. A latent class model assuming conditional dependence of CYTO and LE was fit within a Bayesian framework. Non-informative priors were used for the Se and Sp of LE, CYTO, and VDS, while prior information for disease prevalence was obtained from expert opinions (mode = 20%, 5th percentile = 10%). Posterior inferences (median and 95% Bayesian credible intervals; BCI) were obtained using the WinBUGS statistical freeware. An initial model was built using thresholds of ≥ 1 (small amount of leukocytes), of ≥ 6%, and of ≥ 3 (mucopurulent discharge) for the LE, CYTO, and VDS, respectively. Then, the impact on tests accuracy and misclassification costs of using different thresholds was explored. Optimal thresholds balancing the need for good antimicrobial stewardship and animal health considerations were proposed. The optimal thresholds obtained in the final model were: LE ≥ 2 (moderate amount of leukocytes), CYTO ≥ 6%, and VDS ≥ 2 (mucus with flecks of pus). In the final model, median (95% BCI) Se for LE, CYTO and VDS were 42.6% (38.8–47.0), 45.9% (41.9–50.7), and 64.2% (59.1–70.3), respectively. Median Sp was 90.9% (88.0–93.6) for LE, 92.2% (89.2–94.9) for CYTO and 96.6% (91.3–99.8) for VDS. Median within-herd prevalence of reproductive tract disease was estimated at 47.9% (39.0–56.7). At a threshold ≥ 2 (mucus with flecks of pus), VDS had the highest Se and Sp among the tests evaluated. The LE is an interesting diagnostic alternative for detecting reproductive tract disease in dairy cows. At a threshold ≥ 2 (moderate amount of leukocytes), LE Se and Sp were comparable to those of CYTO.This is the first study reporting the accuracy of LE, CYTO, and VDS for diagnosing reproductive tract diseases in dairy cows at the moment of sampling.

Influence of microbiota in the susceptibility of parasitic wasps to abamectin insecticide: deep sequencing, esterase and toxicity tests.

The parasitic wasps Eretmocerus mundus, Eretmocerus eremicus and Encarsia formosa are important natural enemies of whiteflies. A broad understanding of their biology, ecology and behavior has been achieved, but the composition and role of their microbiota is not fully determined. The knowledge of the bacteria present in insects might be useful to manage species of human concern such as natural enemies or pests. Here, we performed a residual contact test to study a possible change in the susceptibility of E. mundus adults to abamectin insecticide after antibiotic treatment. Moreover, we assessed the microbiota present in adults of E. eremicus, E. formosa and two strains of E. mundus by MiSeq 16S rRNA amplicon sequencing. Finally, enzymatic tests were done to determine the influence of Arthrobacter species in the susceptibility of E. mundus to pesticides. The assays showed that when E. mundus adults were pretreated with antibiotic, the toxicity of abamectin was significantly higher. Among the different bacteria associated with parasitic wasps, Arthrobacter has been shown to be involved in the degradation of several kinds of pesticides. Four Arthrobacter species were detected in all the studied insects and the presence of esterases in this bacterial species was confirmed. The results suggest that the microbiota can modify the susceptibility of E. mundus to pesticides, which in turn supports the importance of the microbial community in natural enemies that it should be considered as a factor in risk assessment tests of pesticides. © 2018 Society of Chemical Industry.

Evaluation of leukocyte esterase test strips for rapid diagnosis of subclinical mastitis in dairy cows

Subclinical mastitis is difficult to detect because it has no visible indications and requires special tests to be detected. Therefore, an untimely and precise diagnosis of subclinical mastitis has been suggested. The purpose of this paper was to estimate the performance of the Analyticon reagent strip test application for the diagnosis of subclinical mastitis as a cow-side test. Milk samples from 111 dairy cows were collected and the leukocyte esterase (LE) test was performed with the reagent strip test. Leukocyte esterase activity was estimated following 10 (LE10) and 15 (LE15) min. Also, milk somatic cell count (SCC) obtained by an automated Fossomatic machine was considered as the gold standard for diagnosing subclinical mastitis. The specificity (Sp), sensitivity (Se), positive likelihood ratio (+LR), negative likelihood ratio (−LR), area under the receiver operating curve (AUC), and kappa coefficient (κ) were determined. The 75.7% (84/111) milk samples with SCC ≥ 200,000/mL were considered as the subclinical mastitis milk. A strong statistically significant correlation was found between SCC, LE test marker, and SCC scoring (0–3) in all milk samples. Based on the cutoff point, the LE15 test had Se = 80%, Sp = 100%, +LR = ∞, and −LR = 0.20. There was a very close relation between LE15 and SCC test with a kappa coefficient of 0.70 (P < 0.0001). Also, according to the cutoff point of 0.5, the LE10 test had Se = 64%, Sp = 100%, +LR = ∞, and −LR = 0.36. In addition, there was a very close relation between LE10 and SCC tests with a kappa coefficient of 0.50 (P < 0.0001). The LE activity was significantly higher (P < 0.05) in subclinical mastitis samples compared to that of healthy milk samples at the time of 10 and 15 min. In summary, these results showed a strong correlation among the LE test markers with the reagent strip test of Analyticon and SCC using the Fossomatic machine. Based on such findings, it is suggested that the LE activity could be used as a clinically useful cow-side test and a valid method for screening the subclinical mastitis.

Comparison of cow-side diagnostic techniques for subclinical endometritis in dairy cows

A limited number of cow-side diagnostic techniques exist for the diagnosis of subclinical endometritis (SCE) in dairy cattle. The objectives of this study were to compare results of endometrial cytology from samples collected by cytobrush (CB) and low-volume lavage (LVL) and to assess leukocyte esterase (LE) test strips and Brix refractometry as surrogate cow-side tests for SCE. Two samples were consecutively collected from 248 Holstein cows between 29 and 35 days postpartum, using CB and LVL techniques. Each sample was analyzed using cytology with a cut-point of ≥5% polymorphonuclear (PMN) cells, LE strips using cut-points of ≥1 and ≥ 2, and a Brix refractometer. Each diagnostic technique was compared intra-sample using the respective cytology as a gold standard and inter-sample using CB samples as the referent. The concordance correlation coefficient (CCC, ρc) for PMN% between CB and LVL was ρc = 0.59 [95% confidence interval (CI): 0.50 to 0.67] and the Kappa (κ) for agreement was κ = 0.35 [sensitivity (Se) = 0.88, specificity (Sp) = 0.45]. The optimal cut-point of LE ≥ 2 resulted in moderate agreement between CB and LVL samples, κ = 0.56 (Se = 0.89, Sp = 0.65). Agreement between LE and cytology using CB (κ = 0.49; Se = 0.89, Sp = 0.57) and LVL (κ = 0.44; Se = 0.77, Sp = 0.67) were similar. The correlation between Brix values from CB and LVL was ρc = 0.12 (CI -0.01 to 0.26). The correlation between CB cytology and Brix was ρc = 0.33 (CI 0.20 to 0.45) but ρc = −0.07 (CI -0.21 to 0.06) between LVL cytology and Brix. While LE strips with a cut-point of LE ≥ 2 had moderate agreement with cytology, Brix refractometry had poor performance for the diagnosis of SCE. Samples taken by CB and LVL produced comparable cow-side diagnostic results and either is a viable method for the diagnosis of SCE.

Effect of incomplete milking during the first 5 days in milk on udder and reproductive tract health: Results from a randomized controlled trial

The aim of this study was to investigate the effect of an incomplete milking on risk of mastitis and reproductive tract disease. Multiparous dairy cows (n = 878) from 13 commercial herds were enrolled in a randomized controlled trial. Cows were randomly assigned to either a control (milked conventionally) or a treatment group, which consisted of an incomplete milking (10-14 L of milk collected/d) from 1 to 5 d in milk (DIM). Quarter milk samples were collected at approximately 11 and 18 DIM to measure somatic cell count (SCC). Quarters were considered negative for intramammary infection if SCC was <100,000 cells/mL and positive if SCC was ≥200,000 cells/mL. To calculate intramammary infection incidence, negative quarters of the initial samples collected were tested again 1 wk later. This was done to deter incidence of positive quarters. To calculate elimination rate, positive quarters were tested again 1 wk later to detect mastitis elimination. Farmers recorded clinical mastitis events. Cows were also examined at approximately 35 DIM with a Metricheck device (Simcro, Hamilton, New Zealand) for detection of purulent vaginal discharge (PVD) and with an endometrial cytobrush for presence of leukocytes [endometrial cytology for smear (ENDO) and for leukocyte esterase test (LE)]. A threshold ≥3 was used to define a positive PVD or LE test, whereas a polymorphonuclear cell count ≥6% was used to define a positive ENDO. Five generalized mixed models with cow or herd as random intercepts were used to determine the effects of incomplete milking on odds of new intramammary infection, odds of intramammary infection elimination, and odds of a positive PVD, LE, or ENDO status. To investigate time until first clinical mastitis event, a Cox model with a herd frailty term was used. The odds of new intramammary infection and intramammary infection elimination for incompletely milked cows were 0.90 [95% confidence interval (CI): 0.49, 1.7] and 2.9 (95% CI: 1.4, 6.0) times those of conventionally milked cows, respectively. The hazard of clinical mastitis in incompletely milked cows was 0.96 (95% CI: 0.59, 1.6) times that of conventionally milked cows. The odds of PVD, LE, and ENDO for incompletely milked cows were 1.4 (95% CI: 0.89, 2.1), 1.3 (95% CI: 0.88, 1.8), and 1.2 (95% CI: 0.81, 1.7) times those of conventionally milked cows. These results suggest that incomplete milking during the first 5 DIM increases the odds of a decrease in SCC from 11 to 18 DIM but does not affect odds of increase in SCC in the same period. The incomplete milking had no effect on clinical mastitis incidence in the first 90 DIM or on reproductive tract health at 35 DIM.

LEUKOCYTE ESTERASE IN ASCITES FLUID FOR DETECTING SPONTANEOUS BACTERIAL PERITONITIS IN LIVER CIRRHOSIS

Spontaneous Bacterial Peritonitis (SBP) is a frequent complication in liver cirrhosis with ascites patients. Spontaneous bacterial peritonitis is often without symptoms, so diagnosis is often delayed. Ascites fluid analysis is expensive, while the ascites fluid culture, as the gold standard, takes a long time and is expensive too. Besides, not all hospitals have the facilities to do both tests. Dye strip test that detect leukocyte esterase, that was originally developed to detect the presence of polymorphonuclear cells in the urine was also sensitive and accurate for detecting the presence of polymorphonuclear cells in the ascites fluid. This examination is easy and quick to do and very cheap so that can be used for early detection of SBP. To determine the sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of dye strip leukocyte esterase test for early detection of SBP in liver cirrhosis with ascites patients were studied. This study used a dye strip leukocyte esterase (Combur10 Test®M) in 28 samples of ascites fluid and compared with the results of ascites fluid culture. The ability of the leukocyte esterase test as a diagnostic test was very good at a cut-off +2 with 94.1% specificity, 63.6% sensitivity, 35% PPV and 80% NPV. Examination leukocyte esterase in the ascites fluid could be used for early detection of SBP in liver cirrhosis with ascites patients and could help to exclude SBP..

Alpha-defensin and the Synovasure lateral flow device for the diagnosis of prosthetic joint infection: a systematic review and meta-analysis.

The aim of this review was to evaluate the available literature and to calculate the pooled sensitivity and specificity for the different alpha-defensin test systems that may be used to diagnose prosthetic joint infection (PJI). Studies using alpha-defensin or Synovasure (Zimmer Biomet, Warsaw, Indiana) to diagnose PJI were identified from systematic searches of electronic databases. The quality of the studies was evaluated using the Quality Assessment of Studies of Diagnostic Accuracy (QUADAS) tool. Meta-analysis was completed using a bivariate model. A total of 11 eligible studies were included. The median QUADAS score was 13 (interquartile range 13 to 13) out of 14. Significant conflicts of interest were identified in five studies. The pooled sensitivity for the laboratory alpha-defensin test was 0.95 (95% confidence interval (CI) 0.91 to 0.98) and the pooled specificity was 0.97 (95% CI 0.95 to 0.98) for four studies with a threshold level of 5.2 mgl-1 The pooled sensitivity for the lateral flow cassette test was 0.85 (95% CI 0.74 to 0.92) and the pooled specificity was 0.90 (95% CI 0.91 to 0.98). There was a statistically significant difference in sensitivity (p = 0.019), but not specificity (p = 0.47). Laboratory-based alpha-defensin testing remains a promising tool for diagnosing PJI. The lateral flow cassette has a significantly lower performance and pooled results are comparable to the leucocyte esterase test. Further studies are required before the widespread adoption of the lateral flow cassette alpha-defensin test. Cite this article: Bone Joint J 2018;100-B:703-11.

Standardised high dose versus low dose cranberry Proanthocyanidin extracts for the prevention of recurrent urinary tract infection in healthy women [PACCANN]: a double blind randomised controlled trial protocol

BackgroundUrinary tract infections (UTIs) are amongst the most common bacterial infections affecting women. Although antibiotics are the treatment of choice for UTI, cranberry derived products have been used for many years to prevent UTIs, with limited evidence as to their efficacy. Our objective is to assess the efficacy of a cranberry extract capsule standardized in A-type linkage proanthocyanidins (PACs) for the prevention of recurrent urinary tract infection.MethodsWe will perform a 1:1 randomized, controlled, double blind clinical trial in women aged 18 years or more who present ≥2 UTIs in 6 months or ≥ 3 UTIs in 12 months. One hundred and forty-eight women will be recruited and randomized in two groups to either receive an optimal dose of cranberry extract quantified and standardized in PACs (2 × 18.5 mg PACs per day) or a control dose (2 × 1 mg PACs per day). The primary outcome for the trial is the mean number of new symptomatic UTIs in women during a 6-month intervention period. Secondary outcomes are: (1) To evaluate the mean number of new symptomatic UTIs with pyuria as demonstrated by a positive leucocyte esterase test; (2) To detect the mean number of new symptomatic culture-confirmed UTIs; (3) To quantify urinary PACs metabolites in women who take a daily dose of 37 mg PACs per day compared to women who take a daily dose of 2 mg per day for 6 months; (4) To characterize women who present recurrent UTI based on known risk factors for recurrent UTI; (5) To describe the side effects of daily intake of cranberry extract containing 37 mg PACs compared to 2 mg PACs. This report provides comprehensive methodological data for this randomized controlled trial.DiscussionThe results of this trial will inform urologists, gynaecologists, family physicians and other healthcare professionals caring for healthy women with recurrent UTI, as to the benefits of daily use of an optimal dose of cranberry extract for the prevention of recurrent UTI.Trial registrationClinicaltrials.gov, identifier: NCT02572895 October 8th 2015.

Development and Validation of a Calculator for Estimating the Probability of Urinary Tract Infection in Young Febrile Children

Accurately estimating the probability of urinary tract infection (UTI) in febrile preverbal children is necessary to appropriately target testing and treatment. To develop and test a calculator (UTICalc) that can first estimate the probability of UTI based on clinical variables and then update that probability based on laboratory results. Review of electronic medical records of febrile children aged 2 to 23 months who were brought to the emergency department of Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania. An independent training database comprising 1686 patients brought to the emergency department between January 1, 2007, and April 30, 2013, and a validation database of 384 patients were created. Five multivariable logistic regression models for predicting risk of UTI were trained and tested. The clinical model included only clinical variables; the remaining models incorporated laboratory results. Data analysis was performed between June 18, 2013, and January 12, 2018. Documented temperature of 38°C or higher in children aged 2 months to less than 2 years. With the use of culture-confirmed UTI as the main outcome, cutoffs for high and low UTI risk were identified for each model. The resultant models were incorporated into a calculation tool, UTICalc, which was used to evaluate medical records. A total of 2070 children were included in the study. The training database comprised 1686 children, of whom 1216 (72.1%) were female and 1167 (69.2%) white. The validation database comprised 384 children, of whom 291 (75.8%) were female and 200 (52.1%) white. Compared with the American Academy of Pediatrics algorithm, the clinical model in UTICalc reduced testing by 8.1% (95% CI, 4.2%-12.0%) and decreased the number of UTIs that were missed from 3 cases to none. Compared with empirically treating all children with a leukocyte esterase test result of 1+ or higher, the dipstick model in UTICalc would have reduced the number of treatment delays by 10.6% (95% CI, 0.9%-20.4%). UTICalc estimates the probability of UTI by evaluating the risk factors present in the individual child. As a result, testing and treatment can be tailored, thereby improving outcomes for children with UTI.

Diagnostic Value of the Leukocyte Esterase Test for Early Detection of Pleocytosis in Cerebrospinal Fluid of Patients with Suspected Acute Bacterial Meningitis.

Rapid and accurate diagnosis of patients with suspected bacterial meningitis (BM) is crucial to prevent potential subsequent mortality and morbidity. The aim of this study was to explore the diagnostic value of the rapid leukocyte esterase (LE) strip test in identifying pleocytosis in cerebrospinal fluid (CSF) samples of patients with suspected BM. A total of 126 patients with suspected meningitis were enrolled in this prospective study. Microscopic examination (cell count and differential) and leukocyte esterase (LE) rapid strip test were performed on cerebrospinal fluid (CSF) samples. Sensitivity, specificity, positive predictive value and negative predictive value of the LE test were determined. Fifty-two patients (41%) had pleocytosis in the CSF, while 48 (38%) patients had a positive rapid LE strip test result. The diagnostic accuracy of this test for pleocytosis was translated to a sensitivity of 84.6% (95%CI 71.9, 93.1) and a specificity of 94.5% (95%CI 86.7, 98.5), with an area under the receiver operating curve of 0.88. The LE strip test, through rapid and accurate determination of CSF pleocytosis, could be considered as an additional test in the diagnosis of bacterial meningitis. It can be tested at bedside and is feasible to do in resource-limited settings.

The Leukocyte Esterase Test Strip Is a Poor Rule-Out Test for Periprosthetic Joint Infection

BackgroundThe urinary leukocyte esterase (LE) test strip has been suggested as a good screening test for periprosthetic joint infection (PJI). The purpose of this study is to compare the diagnostic profile of LE assays from different manufacturers and determine whether the LE test strip is a good rule-out test. MethodsSynovial fluid samples (N = 344), sent to 1 laboratory for PJI testing, were used in this prospective study. Four different tests for synovial fluid LE were simultaneously evaluated for their performance in detecting white blood cell (WBC) positive samples (>3000 cells/µL). ResultsBoth neutrophil elastase immunoassays demonstrated greater sensitivity than urinary LE test strips (92.0% and 90.8% vs 72.4% and 80.3%; all P < 0.011). Fifty-three percent of false-negative urinary LE test strip results clearly missed the presence of elevated levels of synovial fluid LE. Invalid urinary LE test strip results were 4-fold more likely among WBC (+) compared with WBC (−) samples (27.0% vs 6.8%; P < 0.0001). The combined failure to detect an elevated WBC count, because of either false-negative or invalid results, was 47.1% and 41.4% for the Roche and Siemens test strips, respectively. ConclusionsThis study agrees with the existing literature demonstrating that the LE test strips are among the lowest sensitivity tests for PJI. The urinary LE tests strips should not be used to rule-out PJI, as they often fail to detect abundant levels of LE in synovial fluid. Instead, it is more appropriate to use the (++) LE test strip result as a secondary confirmatory rule-in test for PJI because of its high specificity.

Prevalence and Genotype Distribution of Chlamydia trachomatis in Urine among Men Attending Sexually Transmitted Disease Clinics in Guangdong Province, China, in 2016.

Studies have rarely assessed the genotype distribution of Chlamydia trachomatis (CT) in urine among men attending sexually transmitted disease clinics (MSCs) in China. This study was aimed at investigating the prevalence and molecular epidemiology of CT infection by examining urine samples among MSCs from different geographic areas of Guangdong Province, China. A cross-sectional study was conducted among MSCs from 10 human immunodeficiency virus sentinel surveillance sites in Guangdong Province. CT DNA was extracted from male urine samples and analyzed using a Roche cobas 4800 CT/NG. The ompA genes were amplified by nested PCR and sequenced. The leukocyte esterase test was performed by routine urine analysis at local clinics. Of the 1,903 samples, 163 (8.6%, 95% confidence interval [CI] 3.8-16.3%) tested positive for CT. The highest prevalence (10.5%) of CT infection was observed among participants aged between 21 and 30 years. A total of 130 CT-positive samples (79.8%, 130/163) were successfully genotyped by nested PCR, resulting in 8 genotypes. The most prevalent genotypes were D, E, F, and J, with proportions of 20.8%, 20.0%, 17.7%, and 16.9%, respectively. There were no significant correlations between the geographical areas, leukocyte esterase test results and genotype distribution. Promotion of detection and molecular epidemiology research is needed for effective and comprehensive prevention and control programs.

Clinical value of urine heparin-binding protein in the diagnosis of urinary tract infection

Objective To dectect urine level of heparin-binding protein(HBP) in screening urinary tract infection(UTI). Methods A case-control study was performed. From June 2016 to December 2016, urine levels of HBP were detected by enzyme linked immunosorbent assay in 119 patients with definite UTI, 18 patients with probable UTI, 58 patients with no UTI and 52 normal controls who were enrolled at Fudan University Hua Shan Hospital North. Meanwhile, urine leukocyte esterase test(U-LE) and urine nitrite test(U-NIT) were performed by urine dipstick analyzer. And count of urine WBC (U-WBC) was performed by urine formed elements analyzer. The overall level of each group was compared using Kruskal-Wallis H test. Two independent samples were compared by Mann-Whitney U test. The correlation between U-HBP, U-LE and U-WBC were assessed using Spearman′s rank coefficient. Receiver operating characteristic curves were constructed to illustrate the diagnostic power of U-HBP, U-LE, U-NIT and U-WBC for UTI. Results In definite UTI group, probable UTI group, no UTI group and normal control group, the levels of U-HBP, U-LE, U-NIT and U-WBC were significantly different (H values were 166.73, 126.88, 47.92 and 144.05, respectively, P<0.05). Areas under the receiver-operating characteristics curves (AUC) of U-HBP, U-LE, U-NIT and U-WBC were 0.948, 0.836, 0.671 and 0.897 respectively for the diagnosis of UTI. When a cut-off value of 69.20 ng/ml was used in U-HBP, the sensitivity and specificity for detection of definite UTI were 89.9% (107/119) and 89.1% (114/128), respectively. When U-LE at a cut-off value of 4+ , the sensitivity was 76.5% (91/119) and specificity was 81.3% (104/128). When U-NIT at a cut-off value of 1+ , the sensitivity was 36.1% (43/119) and specificity was 97.7% (125/128). When U-WBC at a cut-off value of 233.6/μl, the sensitivity was 82.4%(98/119) and specificity was 82.8%(106/128). A strong correlation was detected between U-HBP and U-WBC (r=0.896, P<0.05). The correlation between U-HBP and U-LE was also strong (r=0.798, P<0.05). Conclusions Heparin-binding protein in the urine was significantly better in diagnosis of UTI, compared with the other markers. It could probably be acted as an important new biomarker for diagnosis of UTI.(Chin J Lab Med, 2017, 40: 953-958) Key words: Heparin-binding protein; Urine; Urinary tract infection; Urine leukocyte esterase test; Urine nitrite test; Count of urine WBC

Asymptomatic bacteriuria in pregnant women attending Boo-Ali Hospital Tehran Iran: Urine analysis vs. urine culture.

BackgroundAsymptomatic bacteriuria is one of the common problems in pregnancy. Asymptomatic bacteriuria is associated with pyelonephritis, preterm labor and low birth weight infants. The physiological and anatomical changes in pregnancy facilitate urinary tract infection (UTI) during pregnancy. Several tests are available for diagnosis of asymptomatic bacteriuria. The urine culture is a gold standard diagnostic test for asymptomatic bacteriuria but it is expensive and time-consuming. Screening methods may be useful in detecting high-risk pregnant women for asymptomatic bacteriuria.ObjectiveThe aim of the present study was to compare urine analysis as a rapid screening test to urine culture in diagnosis of asymptomatic bacteriuria.MethodsA total of 123 pregnant women attending the obstetrics clinic of Boo-Ali hospital in Tehran, Iran from March 2013 to September 2014 were included in the present diagnostic cross-sectional study. One hundred twenty three mid-stream urine samples were inoculated into cultures and were processed by dipstick (nitrite test and leucocyte esterase test) and microscopic pus cell count. The sensitivity, specificity, positive predictive value and negative predictive value of nitrite test, leucocyte esterase test and microscopic pus cell count were compared with urine culture in diagnosis of asymptomatic bacteriuria by using SPSS version 19.ResultsOf 123 urine samples, significant asymptomatic bacteriuria (≥104 cfu/Ml) was detected in 8 (6.5%) subjects. The sensitivity and specificity of nitrite test were 37% and 100% respectively. The sensitivity of pus cell count alone and leucocyte esterase test alone were 100% but the specificity of them were 64% and 65% respectively. We found high negative predictive value by Pus cell count and the leucocyte esterase test (100%) and low positive predictive value by them (16% and 17% respectively).ConclusionUrine culture is the most useful test for diagnosis of asymptomatic bacteriuria. None of our screening tests had a sensitivity and specificity of 100%, whereas we can only refer the pregnant women with positive leucocyte esterase test and significant pyuria to the urine culture.

Comparison of Leukocyte Esterase Testing of Synovial Fluid with Synovial Histology for the Diagnosis of Periprosthetic Joint Infection.

BackgroundPeriprosthetic joint infection (PJI) is a complication of total joint arthroplasty (TJA). The leukocyte esterase (LE) strip test and histology are diagnostic methods for PJI. The aims of this study were to determine the sensitivity and specificity of the LE strip test and to compare it with histology in the diagnosis of PJI.Material/MethodsBetween January and December 2015, 93 patients who underwent TJA with PJI were enrolled in the study. Synovial fluid samples were tested with an LE strip, and three synovial tissue samples from each patient underwent frozen section and formalin-fixed histology. Recent criteria from the Musculoskeletal Infection Society (MSIS) were used for the diagnosis of PJI.ResultsNinety-three patients studied included 38 cases of PJI and 55 non-infected cases. Sensitivity and specificity of the LE strip test were 92.1% (95% CI, 77.5–97.9%) and 96.4% (95% CI, 86.4–99.4%), respectively. There was no significant difference in sensitivity (p=0.249) or specificity (p=0.480) between frozen and paraffin sections for histology; the two methods were strongly correlated (ϕ=0.892). Comparison of the LE test results with histology showed a strong correlation (ϕ=0.758, and ϕ=0.840).ConclusionsThe findings of this preliminary study have shown that the LE strip test on synovial fluid showed similar sensitivity and specificity as histology for the diagnosis of PJI, indicating that that further controlled clinical studies should be performed to investigate the role of the LE strip test for the early diagnosis of PJI.

Antibiotic Overconsumption in Pregnant Women With Urinary Tract Symptoms in Uganda.

Urinary tract infections (UTIs) are one of the most common bacterial infections in women. During pregnancy physiological changes, like frequency, mimic UTI symptoms, and therefore bacteriological cultures are needed to confirm the diagnosis. However, in developing countries antibiotic therapy is commonly initiated without culture confirmation. We investigated the prevalence of bacteriuria among pregnant women with and without UTI symptoms in Uganda. In total 2 562 urine samples were evaluated with nitrite and leukocyte esterase tests, using urine culture and/or dipslide with species identification as reference. The prevalence of culture-proven UTI among pregnant women with UTI symptoms was 4%. Since treatment is initiated based only on the presence of symptoms, 96% were erroneously given antibiotics. Further, there is a high prevalence of resistance to commonly used antibiotics, with 18 % ESBL and 36 % multidrug resistant Escherichia coli strains. Nitrite, leukocyte esterase tests, and urine microscopy alone were of poor diagnostic value. Using dipslide, gynecologists and nurses, not trained in microbiology, were mostly able to identify E. coli and negative cultures. Mixed Gram-negative flora, suggesting fecal contamination was, however, in the majority of cases interpreted as a single pathogenic bacterium and would have resulted in antibiotic treatment. To prevent excessive use of antibiotics, dipslide possibly supported by a combination of nitrite and leukocyte esterase tests can be used. Trained frontline health care professionals correctly diagnosed E. coli UTI and negative urine cultures, which would help preventing antibiotic misuse. In addition, regular screening for antibiotic resistance would improve correct treatment.

Definition of periprosthetic joint infection of the hip and new tools for diagnosis

A diagnosis of periprosthetic joint infection after total hip arthroplasty remains a challenge without a simple solution. It can be difficult to distinguish from aseptic failure of a total hip but is a significantly worse complication. Recent research has gone into attempting to find a cost-effective laboratory test or imaging modality that can assist in definitive diagnosis of periprosthetic joint infection, but there is no single most effective test as of yet. There are several promising possibilities arising from a variety of serum and synovial laboratory values, including alpha-defensin and leukocyte esterase tests. This review provides information on the most recent advances in the literature with regards to diagnosis of periprosthetic joint infection after total hip arthroplasty.

Urinary tract infection in children: clinical aspects and utility of urine dipstick test

Background: Urinary tract infection (UTI) is a common genitourinary disease in children and accounts for significant morbidity. To prevent the potentially dangerous sequel, early detection of UTI in childhood is essential. This depends entirely on strong clinical suspicion and urine culture report. Recently, advances in investigations are taking place to diagnose UTI rapidly. Urine dipstick is one such bedside method to diagnose UTI. This study aims at studying the clinical features of UTI and evaluating sensitivity and specificity of urine dipstick in diagnosing UTI.Methods: This study was conducted at a tertiary care hospital in Vadodara from January 2013 to June 2014, on 60 children admitted with clinical suspicion of urinary tract infection. Along with study of clinical features, results of urine dipstick tests (Nitrite and Leukocyte esterase), urine microscopy and urine culture were compared. Accuracy of urine dipstick tests was assessed statistically by evaluating sensitivity, specificity, positive and negative predictive values considering urine culture as a gold standard.Results: Fever was found to be the most common presenting features (53%) in all the patients studied. The sensitivity of urine microscopy, Nitrite test and Leucocyte esterase test was 63.5%, 50% and 61% and specificity was 25%, 31% and 25% respectively. Combination of Nitrite and Leucocyte Esterase test had an improved sensitivity (68%).Conclusions: Urinary tract infection can present with variety of non-specific signs and symptoms especially in younger age. Dipstick test using Leucocyte Esterase and Nitrite together is better than urine microscopic examination alone. Urine culture as a confirmatory test still remains gold standard.