Laboratory Evidence Of Infection Research Articles

Application value of antibody titres and RNA detection in the early prediction of Mycoplasma pneumoniae pneumonia in children: a retrospective study

BackgroundChildren with Mycoplasma pneumoniae pneumonia (MPP) are prone to a missed diagnosis at the early stages of the disease, which greatly affects the prognosis of children. In this study, the application value of Mycoplasma pneumoniae (MP) antibody titres and RNA detection for diagnosing MP infection in children with community-acquired pneumonia (CAP) was evaluated. The present study aimed to seek appropriate detection methods and strategies for early rapid diagnosis in children with MPP.MethodsA retrospective study was conducted on 563 paediatric patients aged 1 month to 15 years with CAP who were admitted to Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science and Technology between July 2021 and February 2022. In all patients, throat swabs were collected for MP-RNA detection (simultaneous amplification and testing, SAT), and paired serum samples were collected for MP total antibody detection (particle agglutination, PA).ResultsThe classification as MPP or non-MPP was based on clinical diagnosis, serum MP antibody titre, and clinical or laboratory evidence of infection by other pathogen(s). Among the 563 patients with pneumonia, 187 patients were in the MPP group, and 376 patients were in the non-MPP group. The Kappa values between the particle agglutination test at different titres (1:80, 1:160) and MP-RNA detection were 0.612 and 0.660 (P<0.01), and the consistency of the three methods was acceptable. When the single screening method was used, MP-RNA had the highest sensitivity (93.05%), while PA (1:160) had the highest specificity (100%). PA (1:80), with an area under the curve (AUC) of 0.822, was better than PA (1:160), with an AUC of 0.783, and there was a significant difference. When the combined screening methods were used, the AUC of MP-RNA parallel PA (1:160) was significantly higher than that of titres (1:80) (z=-4.906, P < 0.01). Except for MP-80, the efficacy of the other three test methods in females was slightly better than that in males. Among the differences in age distribution, PA (1:80) was slightly less effective in the 13–72 months age group than at other ages, and MP-RNA parallel PA (1:160) was slightly better than the younger age group (≤ 36 m). In the older age group (> 36 m), PA (1:160) was just the opposite, while MP-RNA was slightly better than other age groups in the 13–72 months age group.ConclusionsFor the diagnosis of MPP in children at the early of the disease, the antibody titre (1:160) parallel MP-RNA should be given preference, and then the disease should be further classified according to the antibody titre level and the age of the child. The combined application of the two detection methods could complement each other and strengthen the advantages, providing reliable laboratory evidence for the clinical diagnosis and timely treatment of MPP. When using the PA method alone to provide a reference standard to clarify MP infection, the differential diagnosis ability of 1:80 for MPP is better than 1:160, especially for children younger than 36 months.

QLTI-17. PROPHYLACTIC VANCOMYCIN REDUCES OMMAYA RESERVOIR-ASSOCIATED BACTERIAL MENINGITIS: A 12-MONTH PROSPECTIVE STUDY

Abstract INTRODUCTION Intraventricular chemotherapy administered through an Ommaya reservoir (OR) constitutes the mainstay of therapy for adults with leptomeningeal metastases from solid and hematologic malignancies. Unfortunately, OR-associated bacterial meningitis remains a relatively frequent, costly, often morbid, and occasionally fatal complication, limiting the benefit of this approach. We investigated the potential efficacy, cost savings, and toxicity of intraventricular vancomycin co-administered with intraventricular chemotherapy. METHODS Detailed demographic, treatment, and outcome data were collected prospectively between 5/1/21 and 4/30/22 for 63 consecutive patients at our institution who underwent OR placement and subsequent intraventricular chemotherapy, co-administered with 10 mg of intraventricular vancomycin at each treatment. Reservoir-associated bacterial meningitis was defined as 2 consecutive positive cultures from the cerebrospinal fluid of the same organism or 1 positive culture in the presence of any other clinical or laboratory evidence of infection, or signs of infection at the surgical site. RESULTS The infection rate was 0% [95% CI 0-6.75%] among the 63 patients and 0% [0-0.76%] in the 501 consecutive treatments administered over the 12-month study period compared to 10.25% [7.39- 14.0%] in 322 patients and 1.71% [1.22-2.39%] in 1932 treatments over the preceding 5 years. The absolute risk reduction was 10.3% [3.83 - 14.04], p = 0.0049. The number needed to treat was 10 [7-26]. Cost per vancomycin dose was $10.00 ($5,010 over 12 months). The cost of non-surgical treatment of one OR-associated infection is $88,337.70, which translates into a $618,363.90 savings for the estimated 7 patients over 12 months spared an OR-associated infection. Savings were even further increased if OR removal and subsequent replacement was required. The only other covariate associated with (increased) infection risk on multivariable analysis was treatment number. No treatment-associated toxicity was observed. CONCLUSION Prophylactic intraventricular vancomycin eliminated OR-associated infection in patients receiving intraventricular chemotherapy. Dramatic cost savings were achieved without added toxicity.

The Spectrum of Erythema Migrans in Early Lyme Disease: Can We Improve Its Recognition?

Background and objective Diagnosis of early Lyme disease (LD) often relies on clinical recognition of the skin lesion, erythema migrans (EM), a diagnostic sign of disease when laboratory testing is insensitive.Because EM can present in morphologically distinct forms, its recognitionby clinicians can be challenging.This study aimed to characterize the clinical spectrum of lesions in patients presenting with suspected early LD in an ambulatory care setting to identify features that might help clinicians to be better prepared to recognize EM lesions. Methods Images of lesions from 69 participants suspected to have early LD were retrospectively evaluated by a dermatologist and a family practitioner with expertise in early LD.Reviewers made determinations on the diagnoses and morphological features of lesions.Agreement between reviewers and associations among lesion types and participant demographics, symptomology, and laboratory evidence of infection were examined using the kappa statistic and contingency tables, respectively. Results Challenges in diagnosing EM were evident in our study:initial concordance between reviewers was moderate [kappa statistic (95% CI): 0.45 (0.245 - 0.657)]. The final classification included 35 lesions (51%) that were agreed to be EM; 23 lesions (30%) were considered to be possible early EM or tick bite reactions, and 11 (16%) were thought notto be EM, but rather other diagnoses, including ringworm, allergic contact dermatitis, and mosquito bites.Only two lesions (6%) were observed with a classic bull's eye or ring-within-a-ring pattern.Most EM lesions were uniform (51%), pink (74%), oval lesions (63%), with well-demarcated borders (92%).Early EM or tick bite reactions were typically <5 cm in size (74%), red (52%), round lesions (61%), with a punctum present (100%).Lesions thought notto be EM also tended to be pink or red (64%), round (55%), or uniform (45%) lesions, but also had raised (25%) or irregular borders (33%), which were not commonly observed in the reviewer-classified EM or tick bite reaction lesions.Participants with lesions classified as EM reported that they had the lesions for more days (p = 0.043) and reported more symptoms (p = 0.017) than participants with other lesions.Only 14 (20%) participants overall had positive laboratory evidence for LD; these included 13 (37%) of the participants with EM-classified lesions. Conclusions EM commonly occurs in forms that are not the classic bull's eye.Patients often present with lesions that may represent the very early stage of EM or tick bite reactions, and most patients will test negative on currently available laboratory tests, challenging clinicians in making an LD diagnosis or treatment decisions.Additional studies to further characterize the morphological features of EM and how variation in skin lesions may be perceived among clinicians would be helpful for developing guidelines onimproving clinician recognition of EM.

POS-066 INFECTION-RELATED GLOMERULONEPHRITIS IN DEVELOPING COUNTRY-AN INSTITUTIONAL EXPERIENCE

Infection-related glomerulonephritis (IRGN) are a group of glomerulonephritis disorder with diverse infectious etiology; varied clinical presentation and a spectrum of histomorphology changes. Clinical or laboratory evidence of infection is required for the diagnosis. Infection can either precedes or occur at the onset of glomerulonephritis. Histopathology findings of IRGN cases vary with the time of biopsy after the onset of disease and somehow with a type of infection. Transient or persistent alternate complement pathway dysregulation plays an important role in the pathogenesis and prognosis.

Vaginal pH Estimation, an Additional Tool for RTI/STI Community Screening.

To study laboratory evidence of infection in STI/RTI cases managed by syndromic approach. To evaluate vaginal pH estimation as an additional supplementary tool for community screening of STI/ RTI cases. Study was conducted in department of Gynecology and Obstetrics, Mahila Chikiksalaya Sanganeri gate Jaipur in collaboration with Department of Microbiology, SMS Medical College Jaipur, Rajasthan. STI cases screened by syndromic approach attending the STI clinic were included in study. Vaginal pH of these cases was measured with help of Jaipur pink V strip. Cases with vaginal pH more than five and less than 5 were grouped separately. Evidence of infection was assessed in both groups by performing predefined battery of tests. Results of both the groups were analyzed. Laboratory evidence of infection was seen in 78% of syndromically screened RTIs/STI cases while screening by combined approach, i.e., syndromic approach and Vaginal pH estimation both, showed positive predictability of 92% with 75% sensitivity and 79% specificity. Laboratory evidence of infection was found in 92% of RTI/STI cases when screened by combined approach as compared to 78% in syndromic approach alone. Vaginal strips being user friendly can be used as additional tool for community screening of RTI/STI.

Dahi (an immunonutrient) in India Culture

Indian dahi, its history of origin, uses and benefits are reviewed. Studies were undertaken to observe effects of fermented milk in control of diarrhoea in children. India with high prevalence and severity of malnutrition, overpopulation and mainly vegetarian society are in need to develop protein sources with richness of minerals and vitamins; thus dahi (made with- lactobacillus bulgaricus and streptococcus thermophilus) and other vegetable source Berseem leaves (Trifolium Alexandrium) were studied in children patients suffering from protein energy malnutrition needing hospitalization, for acceptability and improvement in health i.e. appetite, weight gain, increase in haemoglobin. Study patients had clinical or laboratory evidence of infection, but only 32% patients were CRP positive (blunted response). The T cell lymphocytes CD3, CD4 and CD8 were in normal range and supplementation did not alter the counts. The baseline cytokine levels (TNFα, IFNγ, IL-10 and IL-4) were high in malnourished children. On feeding dahi and LPC diets the serum proinflammatory (TNFα, IFNγ), and anti-inflammatory (IL-10) cytokine levels, increased. The increase in IL-10 was higher in children receiving dahi diet. On comparing dahi diet against milk diet IL-1, IL-6 levels increased significantly on day 15th and at 6 weeks (p&lt;0.001), in both the groups. However, IL-10 showed rise on day 15th and 6 weeks on dahi diet, in contrast milk diet patients showed fall on 15th day with subsequent rise at 6 weeks. The mean initial absolute lymphocyte counts were 3707±1551 and 4553±1776/ µl on dahi and milk diets, after 6weeks of treatment the corresponding values increased to 6312±1937 and 3493±1418 µl, respectively, (p=0.004). Similar, trend was observed for CD3+, CD4+, CD8+, CD19+ and CD56+ cells in two treatment groups. These observations demonstrate that dahi has immunonutrient properties.

Long-Term Outcomes of Staged Revision Surgery for Chronic Periprosthetic Joint Infection of Total Hip Arthroplasty.

Periprosthetic joint infection (PJI) is a serious complication of total hip arthroplasty. Staged revision surgery is considered effective in eradicating PJI. We aimed to determine the rate of infection resolution after each stage of staged revision surgery (first stage, repeat first stage, second stage, excision arthroplasty, and reimplantation) and to assess functional outcomes and the mortality rate at ten years in a consecutive series of 30 chronic PJI of total hip arthroplasties. Infection resolution was defined as no clinical nor laboratory evidence of infection at 24 months after the last surgery and after a minimum of 12 months following cessation of antimicrobial treatment. Four patients died within 24 months of their final surgery. Nineteen patients, 73% (worst-case analysis (wca) 63%), were infection free after 1 surgery; 22 patients, 85% (wca 73%), were infection free after 2 surgeries; and 26 patients, 100% (wca 87%), were infection free after three and four surgeries. The median Harris Hip Score was 41 prior to first revision surgery and improved to 74 at twelve months and 76 at ten years after the final surgery. Thirteen patients died at a mean of 64 months from first revision, giving a mortality rate of 43% at ten years, which is approximately 25% higher than that of an age-matched general population. The results show that with repeated aggressive surgical treatment, most PJIs of the hip are curable. Ten years after successful treatment of PJI, functional outcomes and pain are improved and maintained compared to before initial surgery, but this must be balanced against the high 10-year mortality. Level of evidence: cohort studies.

Is DAIR Still an Effective Way to Eradicate Acute Prosthetic Joint Infections? Our Experience in the Jordanian Royal Medical Services.

Background:Prosthetic joint infections is estimated to occur in 1–2% of primary total joint arthroplasty. Debridement, antibiotics, irrigation and retention of prosthesis (DAIR) is the traditional treatment for acute prosthetic joint infections.Objective:To determine risk factors of treatment failure in subjects managed with debridement, antibiotics, irrigation and retention of prosthesis for acute prosthetic joint infections.Methods:Our prospective, double blind and randomized investigation included 70 subjects, of both sexes, aged 63-72 years, who were managed with debridement, antibiotics, irrigation and retention of prosthesis for total hip or total knee arthroplasty acute prosthetic joint infections at Prince Hashim military hospital and Queen Alia military hospital, Jordan, during the period October 2017-October 2020. The observation period was 3 years. Therapy success was defined as absence of infection following 3 years, retention of the prosthesis and no further antibiotics therapy. Prosthetic joint infection was defined based on one or more of: a) growth of the same microorganism in minimum 2 cultures; b) one positive culture and a purulent synovial fluid upon debridement; c) negative culture and minimum 2 of purulent synovial fluid upon debridement. A successful outcome was defined as no clinical and laboratory evidence of infection (serum C-reactive protein less than 10 mg/L) at 3 years. Subjects with chronic, suppressive antibiotics or with prosthesis removal were considered therapy failure. Parameters statistically and remarkably discrepant between success and failure groups were investigated with logistic regression. P less than 0.05 were considered statistically significant.Results:Amount of 46 subjects (65.7%) had no infection during the period of observation. Factors correlated with therapy failure were: history of Rheumatoid Arthritis, delayed infection (more than 1.5 years following arthroplasty), ESR at presentation of more than 50 mm/h and infection induced by coagulase-negative Staphylococcus. Symptoms duration of less than 5 days was associated with a better outcome. The use of Gentamicin sponges was statistically remarkably more in the success group and the use of beads was more in the failure group in the univariate but not in the logistic regression. Less surgical interventions were needed in the group managed with sponges than in the group managed with beads. Prosthetic joint infection induced by coagulase-negative Staphylococcus was associated with a less success rate and streptococcal infections were associated with an increased success rate.Conclusion:Rheumatoid arthritis, duration of symptoms of more than 5 days, ESR of more than 50 mm/h, delayed infection (more than 1.5 years following the index arthroplasty) and coagulase-negative Staphylococcus infections reduce the rate of a successful debridement, antibiotics, irrigation and retention of prosthesis therapy.

P851Incidence and prognostic impact of acute infection among patients with type 1 and 2 myocardial infarction

Abstract Background The incidence and impact of acute infection among patients with type 1 (T1MI) and 2 myocardial infarction (T2MI) is not well known. Inflammation and increased procoagulant activity can lead to T1MI, whereas cytokine release can cause hemodynamic alterations affecting myocardial oxygen consumption and contribute to T2MI. Purpose Determine the incidence and prognostic impact of acute infection among patients with T1MI and T2MI. Methods Post-hoc analysis of UTROPIA (NCT02060760), a prospective, observational cohort study involving 1,640 consecutive emergency department patients with serial cardiac troponin (cTn) I measurements obtained on clinical indication. The incidence of acute infection, antibiotic use, and/or laboratory evidence of infection were examined among patients with T1MI and T2MI. 5-year cumulative survival curves were plotted using the Kaplan-Meier method, frequencies were compared via Chi-Square, and a multivariate cox-proportional hazards model was used to assess the impact of infection on mortality. Results Among 217 patients with acute MI (T1MI, n=77 and T2MI, n=140), acute infection occurred in 63 (29%) of patients. Acute infection was more common in patients with T2MI than T1MI (35% vs. 18%, p=0.009). The predominant source of infection was pneumonia (59%), followed by urinary tract infections (11%). Patients with T2MI were also more likely than T1MI to have sepsis (11% vs. 1%, p=0.012), bacteremia (30% vs. 18%, p=0.057), and antibiotic use (35% vs. 17%, p=0.005). At 5-years, patients with acute MI and acute infection had a higher mortality rate than patients without infection (49% vs. 25%, p=0.0006) (Figure). Among the 31 deaths in MI patients with acute infection, most deaths were non-cardiac (65%) and occurred in those with T2MI (77%). Following adjustment for age, sex, and comorbidities in a Cox proportional hazards model, acute infection was an independent predictor of death (hazard ratio: 2.2, 95% CI: 1.3–3.5, p=0.0016). Conclusion Acute infection occurs in almost a third of patients that are diagnosed with acute MI during the index hospitalization. Most infections are due to pneumonia and occur most often in patients classified as having T2MI. Acute infection is an independent risk factor for 5-year mortality, with nearly half of all patients with acute MI in whom concomitant acute infection is present during the index hospitalization dead at 5-years. Most deaths are non-cardiac and the vast majority occur in patients with T2MI. Acknowledgement/Funding Abbott Diagnostics and Hennepin Healthcare Research Institute (formerly MMRF)e

Pathology of Gastrointestinal and Liver Complications of Hematopoietic Stem Cell Transplantation.

Despite advances in therapeutic and preventive measures, hematopoietic stem cell transplant recipients remain at risk for a variety of gastrointestinal and liver complications. To detail the pathologic features of the various gastrointestinal and liver complications occurring after hematopoietic stem cell transplantation in relation to their clinical context. The specific complications covered include graft-versus-host disease, mycophenolate mofetil-induced injury, timeline of infections, neutropenic enterocolitis, gastrointestinal thrombotic microangiopathy, sinusoidal obstruction syndrome, hepatic iron overload, and the controversy around cord colitis syndrome. The content of this article is based on pertinent peer-reviewed articles in PubMed, relevant textbooks, and on the authors' personal experiences. The final histopathologic diagnosis requires the integration of clinical and histologic findings and the exclusion of other competing causes of injury. Review of the clinical data, including the original disease pretransplant, the type of transplant, the timing of the gastrointestinal and/or liver manifestations, the timing of the biopsy after transplant, the presence of graft-versus-host disease in other organs and sites, the list of drug regimens, and the clinical and laboratory evidence of infection, is the key to reaching the proper histologic diagnosis.

Evaluation of Patients for Zika Virus Infection in a Travel Clinic in the Southeast United States, 2016.

Zika virus is an emerging infection that has posed vexing challenges to the US public health system. Improved characterization of patients with possible and confirmed infection is needed to better understand risks for infection in US travelers and to inform evolving evaluation guidelines. We performed a retrospective electronic health record review of patients evaluated for Zika virus infection at an academic travel clinic in Atlanta, Georgia, from January 1 through August 31, 2016. We evaluated 46 patients who presented to the clinic during this period for evaluation of possible Zika virus infection, including patients with Zika virus symptoms, asymptomatic patients with possible exposure to Zika virus, and referral visits for Zika virus testing. Among the 46 patients evaluated, 30 (65.2%) were tested for Zika virus, 8 of whom (17.4%) had laboratory evidence of infection (7 confirmed, 1 probable). Cases, including confirmed and probable infections, most commonly had fever, rash, conjunctivitis, headache, and myalgia, although differences compared with noncases were not statistically significant. Many patients evaluated were not tested because of stringent testing criteria. Our findings may help inform improvements in timely clinical decision making for Zika virus testing. This may assist clinicians and public health agencies. Wider access to accurate screening modalities will help providers evaluate and advise patients.

Prevalence of tuberculosis infection and disease in children referred for tuberculosis medical surveillance in Ontario: a single-cohort study.

There are few data about the utility of the Canadian tuberculosis medical surveillance system for detecting tuberculosis in children and adolescents. We sought to assess the prevalence of tuberculosis infection and disease in children and adolescents referred by the tuberculosis medical surveillance program who were evaluated at The Hospital for Sick Children (SickKids) tuberculosis program. We retrospectively studied clinical records, radiographic findings and results of interferon-γ release assays (IGRAs) of all children less than 18 years of age referred by the tuberculosis medical surveillance program and evaluated at SickKids between November 2012 and June 2016. The median age of the 216 children was 10.0 years. Most were born in the Philippines (157 [72.7%]) or India (39 [18.0%]). Of the 216, 166 (76.8%) had a history of prior treatment for tuberculosis, and 34 (15.7%) were federal-sponsored refugees from settings with a high tuberculosis burden. Negative IGRA results were found in 110/130 (84.6%) of those with prior tuberculosis treatment. Thirty-one children (14.4%) had any chest radiographic abnormality, of whom 4 had changes thought to be due to tuberculosis. No child received a diagnosis of active tuberculosis at assessment or during follow-up; 3 (1.4%) were treated for latent tuberculosis infection following IGRA testing at SickKids. A positive IGRA result was associated with contact with infectious tuberculosis (odds ratio [OR] 5.97, 95% confidence interval [CI] 2.06-17.52) and older age at first clinic visit (OR 2.98, 95% CI 1.24-8.30) but not with radiographic abnormalities or history of prior tuberculosis treatment. Most children were referred because of a history of prior treatment for tuberculosis; few had clinical or laboratory evidence of infection or prior disease. The tuberculosis medical surveillance process did not identify any children who required treatment for active disease and requires improvement.

J-101 Current challenges in HIV diagnostics–Time to revise our approach?

HIV infection remains a public health challenge; HIV testing serving as the gateway to entrance into the HIV care, treatment, and prevention cascade. Whether laboratory evidence of infection is generated by Point of Care test algorithms or highly sophisticated 4th and 5th generation immunoassay/supplemental serological and/or molecular confirmatory algorithms, diagnostic accuracy, correct classification of HIV infection status, is now challenged by the HIV field's most notable advances in the arenas of HIV Prevention and Intervention. Paradigms such as Test and Treat, Treatment as Prevention, Pre-exposure Prophylaxis (PrEP), and Post-exposure Prophylaxis (PEP) reduce viral burden, viral reservoir constitution, the potential for onward HIV transmission, and decrease the risk of serious AIDS related health outcomes. These highly effective strategies however, have also been shown to cause the delay, reduction, or reversal of evolution of serological responses to infection and/or reduce molecular markers to below limits of detection by currently employed assay. Lack of evolution and/or suppression of markers long used by the laboratory to generate evidence confirming or refuting HIV infection can thus lead to misclassification of status. This talk will focus on current HIV testing modalities, challenges of HIV testing under the aforementioned scenarios, presentation of case studies, and considerations for a revised approach.

Diagnostic accuracy of the alpha defensin lateral flow device (Synovasure) for periprosthetic infections in microbiologically complex situations: A study of 42 cases in a French referral centre.

Joint aspiration is currently the reference standard test for diagnosing periprosthetic joint infection (PJI) despite the high rate of false-negative results, of which a major cause is the fastidious nature of some microorganisms. A rapid diagnostic test that detects alpha defensin (Synovasure™, Zimmer, Warsaw, IN, USA) in joint fluid can provide the diagnosis of PJI within a few minutes across the full spectrum of causative organisms (including mycobacteria and yeasts). Its performance in detecting bacterial infections is unaltered by concomitant antibiotic therapy. Few studies of Synovasure™ have been conducted by groups that were involved in designing the test, which has not been validated in France. Assessments in referral centres where complex microbiological situations are common hold considerable interest. The objective of this prospective study was to determine the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and causes of error of Synovasure™ used to diagnose periprosthetic infection in complex microbiological situations. The rapid diagnostic test Synovasure™ has greater than 90% NPV for detecting periprosthetic infections in complex microbiological infections. Synovasure™ was used 42 times in 39 patients between October 2015 and October 2017 in challenging microbiological situations [discordant joint aspiration results (n=20), negative cultures with clinical or laboratory evidence of infection, (n=21), and concomitant antibiotic therapy (n=1)]. Of the 39 patients, 23 had total knee prostheses, 13 total hip prostheses, and 3 total femoral prostheses. The reference standard to which the Synovasure™ results were compared was the PJI criteria set developed by the Musculoskeletal Infection Society (MSIS). Synovasure™ was negative in 30 cases with negative joint fluid cultures (30/42, 71.4%). Of the 12 (28.6%) cases with positive Synovasure™ results, only 7 (7/12, 58.3%) had positive joint fluid cultures. According to the MSIS criteria 9 cases were infected, including 8 with positive and 1 with negative Synovasure™ results. Of the 33 cases that were not infected according to MSIS criteria, 29 had negative and 3 positive Synovasure™ results; the remaining case had a positive Synovasure™ result but was excluded when metallosis was found intra-operatively. NPV was 96.7%, PPV 72.7%, sensitivity 88.9%, and specificity 90.6%. The high NPV of Synovasure™ suggests a role for this test in microbiologically complex situations as a new tool for ruling in and, most importantly, ruling out infection in doubtful cases. III, prospective study of diagnostic accuracy.

Role of antibiotic-impregnated bone cement rod in control of bone infection and assessing its role in union in cases of infective nonunion of long bones

INTRODUCTION: Managing and treating infected nonunion is one of the most challenging clinical scenarios despite numerous advances in the fixation methods, soft-tissue management, and antibiotic therapy. The infection of the fracture site causes internal fixation to become unstable and it slows down fracture healing. AIMS AND OBJECTIVES: To assess role of antibiotic-impregnated bone cement rod in control of bone infection and assessing its role in union in cases of infective nonunion of long bones. MATERIALS AND METHODS: This was a prospective study comprising of 30 cases of established infected nonunion of long bones carried out in a tertiary care center in Western Maharashtra. Patients of nonunion of long bone diaphysis with established clinical and laboratory evidence of infection were included in the study. RESULTS: Twenty-one cases showed complete union at 6 months or earlier. Two more cases showed significant callus formation. In three cases, there was no callus formation at fracture site till 6 months. DISCUSSION: Various authors in their studies confirmed that gentamicin and vancomycin are antibiotics which maintain activity even after being exposed to the high temperatures resulting from poly (methyl methacrylate) hardening. CONCLUSION: From our study, we confirm that the use of antibiotic-impregnated bone cement rod has a significant role in control of bone infection and also assists in union in cases of infective nonunion of long bones.

It is All in My Genes: A Case Report of Recurrent Pleural Effusion

SESSION TITLE: Pulmonary Manifestations of Systemic Disease 3 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Pleural effusion is the excessive accumulation of fluid in the pleural space which develops when there is imbalance between fluid formation and fluid removal by lymphatics. CASE PRESENTATION: A 39 year old Yemeni born male with comorbidities of hereditary lymphedema, bilateral hearing loss, left sided pleural effusion status post video assisted thoracoscopic pleurodesis, pericardial effusion status post pericardial window 22 years ago, presented with dyspnea on exertion and right sided back pain for 1 week. Significant family history of consanguinity in his parents and first degree relatives. His sister also had bilateral pleurodesis and pericardial window for similar presentation, but his brother and other cousins only had lymphedema of bilateral lower extremities. Physical examination showed bilateral upper and lower extremity 2+ non-pitting edema, diminished breath sounds over right lungs field with dullness to percussion. Labs were unremarkable. Non-contrast CT Chest showed a large loculated right pleural effusion with compressive atelectasis. Patient underwent right VATS, decortication and talc pleurodesis with improvement in aeration. Pleural fluid analysis revealed lymphocyte predominant exudative effusion, negative cultures for bacteria, fungi, and TB, negative for malignant cells on cytology. Pleural biopsy showed chronic pleuritis with focal mesothelial proliferation and atypia. Patient was successfully discharged home. DISCUSSION: Hereditary lymphedema is an uncommon genetic defect in lymphatic system development, classified by age of onset as- 1) Congenital 2) Lymphedema praecox 3) Lymphedema tarda. Usual manifestations are lymphedema of extremities (lower limbs more commonly affected than upper), sometimes lymphedema involving other areas of body such as face, trunk and larynx. Commonly associated with recurrent cellulitis, yellow nails and hearing loss. In rare instances, patients may develop fluid collection in serous cavities such as pericardial/pleural effusion and ascites.[1] Our patient developed lymphedema at age 4 in his legs, eventually involving his arms. By age 18, he underwent left VATS/pleurodesis and pericardial window. He suffered bilateral hearing loss by age 34. His full sister has the same spectrum of disease but symptoms began at birth. CONCLUSIONS: In addition to pooling of multiple affected cases in this single family tree, lack of clinical, radiological or laboratory evidence of infection and malignancy, we can conclude that etiology of recurrent pleural effusion in our patient is one of the manifestations of lymphedema praecox.[2] Reference #1: http://www.atsjournals.org/doi/abs/10.1164/arrd.1978.117.3.595 Reference #2: http://pubs.rsna.org/doi/pdf/10.1148/82.2.246 DISCLOSURE: The following authors have nothing to disclose: Sandi Khin, Sapan Patel, Keerthana Keshava No Product/Research Disclosure Information

Role of Whole-Body Tc 99m MDP Bone Scintigraphy for Evaluating Skeletal Metastasis in Patients with Lung Cancer

Lung cancer is the third most common site of origin of metastatic cancer deposits in bone, after breast and prostate. It’s metastasis to bone is one of the most aggressive tumors and has a very unfavorable prognosis. This retrospective descriptive study was designed to detect the skeletal metastasis of carcinoma (Ca) lung patient by Tc 99m MDP bone scan. The medical records of all patients attended between January 2015 and July 2015 with a diagnosis of lung cancer were reviewed. Lung cancer in all patients was confirmed pathologically, and patients underwent whole-body bone scan for evaluating skeletal metastasis. Patient with clinical and laboratory evidence of infection, trauma, metabolic disease or arthropathy were not included in the study. Bone scan was done after three hours of intravenous administration of 20mci Tc 99m MDP (methylene diphosphonate) and images were obtained on a gamma camera. The mean age of the patients was Mean ± SD was 55.5 ± 12.5 with range from 31 to 90 years. Out of 47 cases, 36 (76.59%) were diagnosed as positive for skeletal metastasis by bone scan and 11 (23.41%) were negative for bony metastasis. Among 36 positive patients, 28 patients (77.86%) were histopathologically diagnosed as adenocarcinoma, 7 patients (19.44%) had squamous cell carcinoma and only one patient (2,7%) had small cell carcinoma. Bone scan findings were compared by either conventional X-ray/CT scan/MRI /pathologically. In present study, the distribution of lesions in bone scan had recorded. Maximum 47.22 % lesions were found in ribs, 27.77% lesions were in lumbar vertebrae, 19.44% in thoracic vertebrae, 19.44% in joints, 16.66% in long bones (femur and humerus), 11.11% in skull bones, 22.22% in pelvic bones, 5.55% in clavicle and 2.77% in scapula. Tc 99m MDP bone scan plays a pivotal role for detection of skeletal metastasis which is very essential to manage Ca lung patient. As bone scintigraphy is very cost effective in govt. nuclear medicine centre in comparison to other imaging modalities, so it can play a major role in detecting skeletal metastasis in ca lung patients in a developing country like Bangladesh.

Survey of Household Contacts of Infants With Laboratory-confirmed Pertussis Infection During a National Pertussis Outbreak in England and Wales.

Highest rates of pertussis occur in infants <3 months of age, too young to be fully vaccinated. The 2012 national outbreak provided a valuable opportunity to study sources of infection for these infants at highest risk of severe complications and death. Households of infants <3 months of age with laboratory-confirmed pertussis between August 2012 and October 2013 were invited to complete a questionnaire with information on household members' demographics, relationship with the infant, chronology of cough onset where relevant and vaccination history. Contacts were also invited to provide an oral fluid sample for antipertussis toxin IgG testing. Individuals with laboratory evidence of infection and cough onset up to 3 months before infant onset were considered probable sources of infection. In total, 220 contacts from 63 families were included in the analysis. In 86% of households (54/63), at least one positive result was found with 44% (97/220) of all contacts testing positive. Around 29% (31/108) of noncoughers tested positive. A probable source of infection was found for 46% (29/63) of infant cases. Mothers were the probable source in 38% of cases, followed by siblings (31%) and fathers (10%). Household contacts play an important role in the transmission of pertussis to infants and when identified, mothers were the main sources of infection. Immunization during pregnancy has a key role in preventing infant disease through passive protection from birth and reduced maternal exposure.

Constitutional Symptoms Trigger Diagnostic Testing Before Antibiotic Prescribing in High-Risk Nursing Home Residents.

To evaluate the use of diagnostic testing before treating an infection in nursing home (NH) residents suspected of having a urinary tract infection (UTI) or pneumonia. Prospective longitudinal study nested within a randomized trial, using data from control sites. Six NHs in southeast Michigan. NH residents with an indwelling urinary catheter, enteral feeding tube, or both (N = 162) with 695 follow-up visits (189 (28%) visits with an infection). Clinical and demographic data-including information on incident infections, antibiotic use, and results of diagnostic tests-were obtained at study enrollment, after 14 days, and monthly thereafter for up to 1 year. One hundred (62%) NH residents had an incident infection requiring antibiotics, with substantial variations between NHs. In addition to presence of infection-specific symptoms, change in function was a significant predictor of ordering a chest X-ray to detect pneumonia (odds ratio (OR) = 1.7, P = .01). Similarly, change in mentation was a significant predictor of ordering a urinalysis (OR = 1.9, P = .02), chest X-ray (OR = 3.3, P < .001), and blood culture (OR = 2.3, P = .02). Antibiotics were used empirically, before laboratory results were available, in 50 of 233 suspected cases of UTI (21.5%) and 16 of 53 (30.2%) suspected cases of pneumonia. Antibiotics were used in 17% of visits without documented clinical or laboratory evidence of infection. Constitutional symptoms such as change in function and mentation commonly lead to diagnostic testing and subsequent antibiotic prescribing. Antibiotic use often continues despite negative test results and should be a target for future interventions.

Characterizing Lyme Disease Surveillance in an Endemic State

Lyme disease (LD) is the most common vector-borne disease in Maryland and the United States. Surveillance for LD is valuable for understanding the burden of the disease, particularly to assess whether the disease is spreading and to appreciate who is affected. However, not all cases of LD in Maryland are reported, and surveillance practices vary across each of Maryland's 24 local health departments (LHDs). To better understand this variability and to systematically characterize the surveillance process, we surveyed Maryland's LHDs regarding LD surveillance. The Maryland Local Health Department Lyme Disease Surveillance Survey has been administered annually since 2011. Questions asked each year included whether all LD reports are investigated or only a subset, and how many reports are not entered into the surveillance database. Since 2011, Maryland has lost surveillance personnel for LD. Each year from 2009 to 2012, a median 3598 (range 2462 to 5722) reports were not entered into the surveillance database and hence not investigated. These reports represent 43-55% of all reports received for the year. Over time, more LHDs chose to streamline their LD investigation approach by investigating only those reports that met the criteria for laboratory evidence of infection: in 2008, 5 (21%) LHDs investigated only a subset of LD reports; by 2013, this increased to 15 (63%). There is wide variability across LHDs in how LD investigations are conducted. Maryland LHDs have experienced a loss of LD surveillance personnel with a concomitant increase in the number of LHDs adopting a streamlined approach to investigating cases. These findings underscore the tremendous burden of LD on the public health agencies and highlight the need for alternative approaches that can both reduce burden and preserve surveillance data quality.