Non-infectious Group Research Articles

Concordance between Clinical and Histopathological Diagnosis among Various Dermatoses in the Elderly: A 5-year Retrospective Cross-sectional Assessment from a Tertiary Care Center in Southern India

Background: Dermatoses in the elderly differ from those in the younger age group due to additional effects of intrinsic and extrinsic aging, increased prevalence of comorbidities, effects of polypharmacy, socioeconomic factors, and geographical factors. Various prevalence studies on the dermatoses in geriatric age group are available from the Indian subcontinent. Studies focusing on the agreement between their clinical and histopathological diagnosis, however, are scarce. Aims and Objectives: The study aimed at categorizing and describing the various dermatoses in the geriatric population subjected to biopsy and to determine the level of agreement between the clinical diagnosis made and the histopathological diagnosis offered in them. Materials and Methodology: Histopathological records of skin biopsies performed in patients belonging to the age group of ≥60 years in the past 5 years were analyzed. Demographic characteristics, clinical diagnosis made or the differential diagnoses considered, and histopathological diagnosis offered in each case were noted. The various dermatoses among the patients in whom a histopathological diagnosis was offered were categorized into inflammatory (infections and noninfectious dermatoses), neoplastic, and other dermatoses groups. The level of agreement between clinical and histopathological diagnosis was described as complete agreement, partial agreement, and disagreement. Statistical significance was assessed using the Chi-square test, and the strength of association was assessed using kappa statistics. Results: A total of 109 biopsies meeting the inclusion criteria were analyzed. The mean age of the study population was 67.02 ± 6.624 years, with a male-to-female ratio of 1.6:1. Majority of the dermatoses belonged to the noninfectious inflammatory group (52 [47.70%]) followed by neoplasms (28 [25.68%]). Overall, complete agreement between the clinical diagnosis made or one of the differential diagnoses considered and the histopathological diagnosis offered was seen in 91 of 109 cases (83.5%), which was statistically significant (P = 0.0001). A higher level of complete agreement was noted among the inflammatory dermatoses (67 of 79 cases [84.81%]) when compared to neoplastic dermatoses (22 of 28 cases [78.57%]). Among the inflammatory dermatoses, complete agreement was more for the noninfectious (46 [88.46%]) than the infectious (21 [77.78%]) dermatoses. All the cases (2) belonging to the other group of dermatoses showed complete agreement. Disagreement was highest among the neoplasms (6 [21.43%]), followed by the noninfectious inflammatory dermatoses (5 [9.62%]). Partial agreement with the clinical diagnosis was maximum for the infectious diseases (5 [18.51%]). Conclusion: This study noted a statistically significant high rate of concordance (Chi-square test –P = 0.0001) between the clinical and histopathological diagnosis among the dermatoses in the geriatric population when taken together as well as among individual categories. Noninfectious inflammatory dermatoses constituted the major group with the highest and statistically significant concordance between the clinical and histopathological diagnosis. Furthermore, there was almost perfect strength of association (kappa statistics –P = 0.000) noted among the individual categories of dermatoses.

Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in bacterial infections: contributions to diagnostic strategies in a tertiary care hospital in Tunisia.

Bacterial infections continue to pose a global health challenge, driven by antibiotic resistance and septicemia. This study aimed to assess the diagnostic utility of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in bacterial infections versus non-infectious causes of inflammation. A prospective study included 164 adult patients who were divided into two groups: a group of patients with confirmed bacterial infections and a second group of patients with other diagnoses (inflammatory pathologies, neoplasms, venous thromboembolic diseases, etc.). NLR and PLR values were compared between the bacterial infection group and the non-infectious causes group and the diagnostic performances of NLR and PLR for detecting bacterial infections were evaluated in comparison with other infection markers. NLR and PLR were significantly higher in bacterial infections (p < 10 ^-6), and NLR was correlated positively with inflammation markers. NLR and PLR demonstrated significant potential in diagnosing bacterial infections, with an AUC of 0.72 and 0.60, respectively, using the following cutoff values: 4.3 for NLR and 183 for PLR. These findings underscore the importance of NLR and PLR as adjunctive tools for bacterial infection diagnosis.

Clinical Spectrum of Dermatological Disorders at an Urban Health Center in East Delhi.

Dermatological disorders constitute a significant proportion of primary health care (PHC) setups. The pattern of dermatological disorders varies among different countries and different parts of the same country owing to climatic and geographical variations, level of education, access to health care, etc. To study the clinical spectrum of patients presenting with dermatological disorders at an urban health center (UHC) in East Delhi. To identify the various risk factors associated with dermatological disorders in study subjects. A total of 1,148 patients who reported skin diseases for the first time at the Dermatology Outpatient Clinic at UHC in East Delhi were recruited. Detailed demographic data, history, and examination and potential risk factors of skin diseases (socioeconomic status, level of education, occupation, comorbidities, and addictions) were recorded on a predesigned proforma. A total of 616 (53.7%) patients had infectious dermatoses and 532 (46.3%) had non-infectious dermatoses. Among the infectious dermatoses, fungal diseases (44.8%) were the most common followed by parasitic infections (31.17%) and bacterial infections (9.74%). Among the non-infectious group, eczematous disorders (28.01%) were the most common, followed by pigmentary disorders (21.62%) and acne (19.55%). A significant association between level of education, occupation, and comorbidities with the distribution of infectious and non-infectious dermatoses was found. As a significant proportion of patients with a vivid spectrum of dermatological disorders present at the PHC setups, therefore dermatologists supervise that specialty clinics should be held regularly at these centers along with the availability of all the basic investigations to aid diagnosis and management.

Evaluation of Clinical and Etiological Characteristics of Cases with Pediatric Lymphadenopathy

Lymphadenopathies are among the common causes of frequent hospital admissions in childhood.Lymphadenopathy (LAP) may be most frequently seen during the follow-up of infectious diseases, but some chronic, malignant, and autoimmune diseases may also be encountered in the etiology of lymphadenopathy.In this study we aimed to investigate the clinical, epidemiologic, and etiological characteristics of pediatric patients presenting with lymphadenopathy.A total of 380 pediatric patients with lymphadenopathy who were followed up in the Eskisehir Osmangazi University Pediatric Infectious Diseases Clinic between January 2015 and January 2023 were included in the study.The mean age of the patients was 84 months and 65% of the patients were male.According to etiologic characteristics; 359(94%) cases had infectious and 21(6) cases had non-infectious LAP.Most frequently nonspecific lymphadenitis (68%), Epstein-Barr Virus (12.8%), cytomegalovirus (3.6%), suppurative lymphadenitis (1.9%) and tuberculous lymphadenitis (1.8%) were observed in cases with LAP. Cases with non-infectious LAP had rheumatologic diseases (n:11), hemato-oncologic malignancies (n: 6), and congenital cysts (n:4). When infectious and non-infectious LAP cases were compared, involved lymph nodes were larger (p:0.04) in the non-infectious group.In the non-infectious group,lymph nodes were relatively harder and conglomerated(p:0.03, p:0.04).Computed tomography scan was more frequently performed in the non-infectious group(p:0.01).Although lymphadenopathy in childhood is mostly due to infectious causes, rheumatologic diseases, hemato-oncologic malignancies, and congenital cysts should be kept in mind, especially in prolonged, treatment-refractory cases. Detailed history and physical examination are the first and the most important steps in the differential diagnosis of cases presenting with lymphadenopathy to prevent the application of unnecessary tests and investigations

Outcomes of pars plana vitrectomy in the management and diagnosis of patients with infectious, non-infectious, and unidentified uveitis

PurposeTo present the outcomes of pars plana vitrectomy (PPV) in patients with infectious, non-infectious, and unidentified uveitis, focusing on visual and clinical outcomes, diagnostic yield, and surgery-related complications.MethodsThis retrospective, single-center study included patients who underwent 23-gauge PPV for the management of uveitis and had at least 6 months of follow-up. Patients were divided into infectious, non-infectious, and unidentified uveitis groups based on definitive diagnosis after surgery. Etiologies of uveitis, indications for surgery, diagnostic yield, visual outcomes, presence of cystoid macular edema (CME), immunosuppressive drugs, intraoperative and postoperative complications, and repeated vitrectomies were reviewed.ResultsThis study included 62 eyes of 54 patients. Twenty eyes were diagnosed with infectious uveitis, 24 eyes with non-infectious uveitis, and 18 eyes with unidentified uveitis. The diagnostic yield of vitrectomy was 41.7%. Mean BCVA significantly improved at postoperative 1 month compared to baseline and remained stable at following time-points in all groups. The most common early postoperative complication was increased intraocular pressure (17%), and late complication was cataract (36%). Nine eyes underwent re-vitrectomy and the most common cause was retinal detachment with proliferative vitreoretinopathy (PVR).ConclusionPPV seems to be effective in diagnosing cases of unknown origin, improving visual acuity, and reducing the need for systemic immunosuppressive drugs. PVR is the most serious complication with poor prognosis that requires repeated surgery in patients with uveitis.

Clinical profile and treatment outcomes in pediatric uveitis - A series from South India.

The purpose of the study was to look at the clinical spectrum, treatment options, and visual outcomes in a large cohort of pediatric uveitis from a tertiary eye care center in South India. This is a retrospective study carried out at a tertiary eye center in South India. Cases of pediatric uveitis between January 2012 and June 2022 were retrieved from the hospital's medical database. Uveitis was classified according to the Standardization of Uveitis Nomenclature criteria. Demographic details, clinical presentation, complications, medical and surgical management, and visual outcome were evaluated. Two hundred and six eyes of 132 cases were included, with a median age of 12 years. The male to female ratio was 1:1. Bilaterality was seen in 63.1% of cases. The mean duration of uveitis was 11.5 ± 18.5 months, and the mean follow-up period was 20.5 ± 25.1 months. Noninfectious uveitis was seen in 70.45% cases. Most common etiology in the noninfectious group was idiopathic (27.3%), while in the infectious group, it was tuberculosis (TB; 14.4%). Immunomodulators were used in 43.9% and biologics in 10.9% of cases. Most common complications were cataract (25.24%) and posterior synechiae (21.35%). Surgical procedures were done in 12.62%. The mean visual acuity was 0.81 ± 1.14 log of minimum angle of resolution (logMAR) at presentation and 0.49 ± 0.87 logMAR at the end of the study ( P = 0.002). Pediatric uveitis poses a challenge in comparison to adult uveitis. Our study highlights the need for early diagnosis and aggressive management to prevent sequelae. Multidisciplinary approach is a key in improving the overall visual prognosis.

Are intravitreal hyperreflective particles alike in eyes with acute toxoplasma chorioretinitis and non-infectious uveitis?

BackgroundTo compare distinctive features of hyperreflective particles observed on spectral-domain optical coherence tomography (OCT) sections in eyes with acute toxoplasma chorioretinitis (TC) and non-infectious uveitis (NIU). MethodsMedical records and the spectral-domain OCT images of the patients with TC and NIU were retrospectively reviewed. The TC and NIU groups were compared in terms of age, sex, mean OCT image quality, mean central macular thickness (CMT), presence of intraretinal fluid (IRF), presence of subretinal fluid (SRF), number of hyperreflective particles in the posterior vitreous area and mean particle measurement in the posterior vitreous area. ResultsNon-infectious uveitis group included nine patients (60 %) with Behcet's uveitis, five patients (33.3 %) with idiopathic posterior uveitis or panuveitis, and the remaining patient (6.7 %) with HLA-B27 associated uveitis. Comparison of the mean age, sex distribution, mean OCT image quality, mean CMT, presence of IRF, presence of SRF and the mean number of hyperreflective particles in the posterior vitreous area between the two groups showed no statistically significant differences (p = 0.085, p = 0.051, p = 0.748, p = 0.431, p = 0.109, p = 0.080 and p = 0.152, respectively). However, the mean length of the hyperreflective particles in the posterior vitreous area was 27.22 ± 8.60 μm in the TC group, and 21.91 ± 3.58 μm in the NIU group, with a significant difference between the two groups (p = 0.036). ConclusionThis pilot study aimed to assess the hyperreflective particles in the posterior vitreous area using spectral-domain OCT images and image processing software. Despite its limitations, such as the small sample size, limited understanding of the nature of hyperreflective particles, and the absence of differentiation between acute and chronic uveitis, our study points out the potential role of the measurement of the hyperreflective particle length located in the posterior vitreous in differentiating the acute infectious versus non-infectious uveitis as the hyperreflective particles tend to be larger in infectious cases.

Infectious and Noninfectious Corneal Ulcers in Ocular Graft-Versus-Host Disease: Epidemiology, Clinical Characteristics, and Outcomes

To evaluate the incidence, clinical characteristics, microbiological profile, and therapeutic outcomes of corneal ulcers in individuals with chronic ocular graft-vs-host disease (coGVHD). Retrospective clinical cohort study. Review of individuals diagnosed with coGVHD following hematopoietic stem cell transplantation (HSCT) who were seen at the Bascom Palmer Eye Institute between May 2010 and November 2021. Baseline demographics, clinical characteristics, microbiological profile, risk factors for corneal ulceration, and treatment outcomes were collected. Etiology was deemed infectious in individuals with a positive culture or appropriate clinical scenario (presence of stromal infiltrate or hypopyon); otherwise, ulcers were presumed to be noninfectious. Treatment success was defined as reepithelialization with infiltrate resolution, and treatment failure as progression to corneal perforation or keratoplasty. Kaplan-Meier survival analysis estimated the incidence of ulceration. Cox regression analyses examined demographic and risk factors. Infectious and noninfectious ulcer groups were compared using 2-way independent t tests, 1-way analysis of variances, and χ2 tests, as appropriate. 173 individuals were included (53.7±14.4 years old; 59.0% male). Thirty-three individuals developed an ulcer 74.5±54.3 months after HSCT, with estimated 5- and 10-year incidences of 14% and 30%, respectively. Twenty-two (66.6%) ulcers were deemed infectious (15 microbiologically confirmed, 7 clinically) and 11 (33.3%) were deemed noninfectious. Risk factors for corneal ulceration included Black race (hazards ratio [HR] 2.89, 95% CI 1.30-6.42, P < .01), previous ocular surgery (HR 9.16, 95% CI 3.86-21.72, P < .01), eyelid margin abnormalities (HR 3.44, 95% CI 1.69-6.99, P < .01), and topical steroid use (HR 2.74, 95% CI 1.33-5.62, P < .01). Conversely, contact lens use reduced the risk of corneal ulceration (HR 0.29, 95% CI 0.13-0.66, P < .01). Infectious ulcers had a significantly higher frequency of treatment failure than noninfectious ulcers (57.1% vs 20.0%, P=.04). Corneal ulceration is a potential complication of coGVHD, with several clinical features identified as risk factors. Infectious ulcers had worse outcomes than noninfectious ulcers.

Real-time optical detection of endodontic infection using bacterial autofluorescence

ObjectivesFor successful root canal treatment (RCT), it is essential to objectively assess the presence and activity of bacteria in the root canal system. However, current methods rely on subjective observations of root canal exudates. This study aimed to confirm whether real-time optical detection using bacterial autofluorescence can evaluate endodontic infection status by assessing the red fluorescence (RF) detected from root canal exudates. MethodsDuring RCT, endodontic paper points were used to collect root canal exudates scored using conventional organoleptic tests to assess the severity of root canal infections. RF on the paper points was assessed using quantitative light-induced fluorescence (QLF) technology. RF intensity and area from the paper points were quantified, and their correlations with infection severity were assessed using their organoleptic scores. The oral microbiome composition of RF samples was compared with non-red fluorescent (non-RF) samples. ResultsThe RF detection rate was nil and >98% in the non-infectious and severe groups. The RF intensity and area significantly increased with infection severity (p<0.001) and showed strong correlations with organoleptic scores (r=0.72, 0.82, respectively). The diagnostic accuracy for detecting root canal infection using RF intensity was good to excellent (AUC = 0.81−0.95) and increased with infection severity. The microbial diversity of the RF samples was significantly lower than that of the non-RF samples. Gram-negative anaerobic bacteria such as Prevotella and Porphyromonas were more predominant in RF samples. ConclusionsOptical detection using bacterial autofluorescence can objectively evaluate endodontic infection status in real-time by assessing the RF of endodontic root canal exudates. Clinical significanceThis real-time optical technology can be utilised to detect endodontic bacterial infection without conventional incubation, allowing clinicians to determine the endpoint of chemomechanical debridement and increase the positive outcomes of RCTs.

Incomplete Lead Removal During the Extraction Procedure: Predisposing Factors and Impact on Long-Term Survival in Infectious and Non-Infectious Cases: Analysis of 3741 Procedures.

The long-term significance of lead remnants (LR) following transvenous lead extraction (TLE) remains disputable, especially in infectious patients. Retrospective analysis of 3741 TLEs focused on the relationship between LR and procedure complexity, complications and long-term survival. The study group consisted of 156 individuals with LR (4.17%), and the control group consisted of 3585 patients with completely removed lead(s). In a multivariable model, a younger patient age at CIED implantation, more CIED procedures and procedure complexity were independent risk factors for retention of non-removable LR. Although patients with LR showed better survival outcomes following TLE (log rank p = 0.041 for non-infectious group and p = 0.017 for infectious group), multivariable Cox regression analysis did not confirm the prognostic significance of LR either in non-infectious [HR = 0.777; p = 0.262], infectious [HR = 0.983; p = 0.934] or the entire group of patients [HR = 0.858; p = 0.321]. 1. Non-removable LRs are encountered in 4.17% of patients. 2. CIED infection has no influence on retention of LRs, but younger patient age, multiple CIED-related procedures and higher levels of procedure complexity are independent risk factors for the presence of LR. 3. Better survival outcomes following TLE in patients with LRs are not the effects of their presence but younger patient and better health status.

Point-of-care neutrophil CD64 as a rule in diagnostic test for bacterial infections in the emergency department

IntroductionBacterial infections are frequently seen in the emergency department (ED), but can be difficult to distinguish from viral infections and some non-infectious diseases. Common biomarkers such as c-reactive protein (CRP) and white blood cell (WBC) counts fail to aid in the differential diagnosis. Neutrophil CD64 (nCD64), an IgG receptor, is suggested to be more specific for bacterial infections. This study investigated if nCD64 can distinguish bacterial infections from other infectious and non-infectious diseases in the ED.MethodsAll COVID-19 suspected patients who visited the ED and for which a definitive diagnosis was made, were included. Blood was analyzed using an automated flow cytometer within 2 h after presentation. Patients were divided into a bacterial, viral, and non-infectious disease group. We determined the diagnostic value of nCD64 and compared this to those of CRP and WBC counts.ResultsOf the 291 patients presented at the ED, 182 patients were included with a definitive diagnosis (bacterial infection n = 78; viral infection n = 64; non-infectious disease n = 40). ROC-curves were plotted, with AUCs of 0.71 [95%CI: 0.64–0.79], 0.77 [0.69–0.84] and 0.64 [0.55–0.73] for nCD64, WBC counts and CRP, respectively. In the bacterial group, nCD64 MFI was significantly higher compared to the other groups (p < 0.01). A cut-off of 9.4 AU MFI for nCD64 corresponded with a positive predictive value of 1.00 (sensitivity of 0.27, a specificity of 1.00, and an NPV of 0.64). Furthermore, a diagnostic algorithm was constructed which can serve as an example of what a future biomarker prediction model could look like.ConclusionFor patients in the ED presenting with a suspected infection, nCD64 measured with automatic flow cytometry, has a high specificity and positive predictive value for diagnosing a bacterial infection. However, a low nCD64 cannot rule out a bacterial infection. For future purposes, nCD64 should be combined with additional tests to form an algorithm that adequately diagnoses infectious diseases.

Characteristics, Etiology, and Clinical Outcome of Retinal Vasculitis in Tertiary Hospital in Thailand

ABSTRACT Objective To analyze characteristics, etiology, and outcome of retinal vasculitis in Central Thailand. Methods A retrospective cohort study. Results Retinal vasculitis was found in 10% of uveitis, 74 from 741 uveitis, noninfectious (64.9%) and infectious group (35.1%). The most common cause was Behcet’s disease (48.6%). Behcet’s disease was the most common cause of all types of vascular leakage on angiography, including capillary (80.4%), venous (56.3%), and arterial leakage (56%). Final visual acuity was 0.86 ± 0.97 logMAR. Cataract was the most frequent complication (42.5%). Acute clinical course (p = .025) and retinal neovascularization (p = .031) were associated with infectious group. Forty-three percent of vasculitis complicated by ischemia required photocoagulation (33%) and anti-VEGF injection (17%). Furthermore, 17% of vasculitis underwent vitrectomy. Conclusion One-half of the retinal vasculitis in Central Thailand were Behcet’s disease. Acute onset and retinal neovascularization may suggest infectious etiology. Retinal ischemia should be cautious and undergo early interventions to prevent sight-threatening complications.

Evaluation of The Efficiency of Glutaraldehyde Coagulation Test in Some Cattle Diseases: 2021-2022 Retrospective Study

Metabolic disorders occurring in negative energy balance (NEB) in cows cause diseases related to immunosuppression and economic losses. Although treatment, animal welfare, and herd immunity are possible with comprehensive clinical diagnostics combined with laboratory evaluation, the applicability and availability of these analytes in the farm setting are often limited. Therefore, the glutaraldehyde coagulation (GC) test, a fast, practical, and inexpensive test, help diagnose inflammatory diseases in cattle. This study aims to evaluate the effectiveness of the GC test in certain bovine diseases whose etiology is classified as infectious or non-infectious due to clinical and laboratory examinations. The animal material was 40 Holstein cows with various clinical findings brought to Harran University, Veterinary Faculty Animal Hospital for diagnosis and treatment. Following the anamnesis, physical examinations of all the cows were performed. As a result of the hemogram analysis of the venous blood samples (8-10 mL) along with the physical examination findings, the cows were divided into two subgroups, Infectious (n:14) and Non-Infectious (n:26); GC test was performed from the venous blood samples. In the physical examination, the respiratory rate, heart rate, and body temperature of the cows in the Infectious Group were higher than those of the Non-Infectious Group (p

202. Vintage or Vogue? The Utility of Procalcitonin for Identifying Secondary Infections in Patients With Influenza or Covid-19 Receiving Extracorporeal Membrane Oxygenation

Abstract Background Secondary infections in patients receiving extracorporeal membrane oxygenation (ECMO) are difficult to identify as many signs traditionally associated with infection, such as temperature, are partially controlled by the ECMO circuit. This study analyzes the utility of procalcitonin (PCT) as a diagnostic marker in identifying secondary infections in patients receiving ECMO with influenza or COVID-19. Methods A single center retrospective study was performed on patients receiving ECMO with underlying influenza or COVID-19 from November 2017 to October 2021. Patient demographics, time receiving ECMO, culture data, and PCT levels were extracted. The first PCT within three days of an infection designated positive was compared to negative values, PCT extracted from patients without an identified infection or any PCT 10 days after the most recent infection. Furthermore, PCT levels were compared by type of pathogen as well as site of infection via Mann-Whitney U tests. Results 84 patients (77% males) met inclusion criteria with median age of 43 (interquartile range (IQR): 35-51). Median ECMO time was 416 hours (IQR: 232-824), with 64 (76%) of the patients admitted for COVID-19. A total of 276 (3.3 per patient) PCT were ordered during the study period. Of the 92 infections identified, 33 (36%) had an associated PCT value with 19 (58%) PCT collected on the day of positive culture, 10 (32%) within one day, and 4 (12%) collected two to three days after positive culture. There was no significant difference between median PCT value among the infection group (1.0 IQR: 0.40-1.19) compared to the non-infectious group (1.27 IQR: 0.47-4.26, p= 0.19), between Gram-positive and Gram-negative infections (1.09 IQR: 0.43-2.70 vs. 0.95 IQR: 0.4-1.29 p= 0.35) or between bloodstream infections and respiratory infections (1.3 IQR 0.45-2.70 vs. 0.55 IQR: 0.4-1.38, p=0.35). PCT does not decline after infection is identified (Figure 1). Procalcitonin Trends Figure 1.Procalcitonin levels do not statistically decline over the course of an infection. Conclusion While PCT has been proposed as a potential diagnostic marker for secondary infections in patients receiving ECMO, this single center study did not demonstrate utility of PCT in identifying secondary infections. Furthermore, there was no association of PCT levels with either the site of infection or type of infectious organism. Disclosures All Authors: No reported disclosures.

Differential acute phase response due to infection in AIRDs: A cross-sectional multi-centre study based on RA and SLE

Aim: To explore the differences in acute phase responses between infection and disease flare and between viral and bacterial infections. Methods: The retro-prospective, cross-sectional, multi-center study considered subjects who had undergone treatment for infection or disease flare between 2019 to 2021. The patients fulfilling the ACR/EULAR 2010 criteria and 2019 EULAR/ACR criteria for RA and SLE respectively, were recruited from three centers. Patients who did not have autoimmune rheumatic disease or other immune-mediated diseases were considered as controls. The participants were classified into subgroups namely ‘overall’, ‘without autoimmune rheumatic disease’, ‘SLE’ and ‘RA’. The infectious and non-infectious groups, and the bacterial and viral disease groups were compared to evaluate the differences in the parameters namely age, gender, total leucocyte count (TLC), neutrophil count(N), lymphocytes count (L) NLR, CRP and procalcitonin. Student t-test was used for the evaluation of continuous data and chi-square test for categorical data. ROC curves were plotted. The cutoff points of variable at 80% and 90% sensitivity and specificity were estimated for each subgroup to differentiate infection and no-infection.

Geographic Influence Upon Noninfectious Diseases Accounting for Fever of Unknown Origin: A Systematic Review and Meta-Analysis.

BackgroundDiagnostic outcomes for fever of unknown origin (FUO) remain with notable numbers of undiagnosed cases. A recent systemic review and meta-analysis of studies reported geographic variation in FUO-related infectious diseases. Whether geography influences types of FUO noninfectious diagnoses deserves examination.MethodsWe systematically searched Medline (PubMed), Embase, Scopus, and Web of Science databases using medical subject headings published from January 1, 1997 to March 31, 2021. Prospective clinical studies investigating participants meeting adult FUO defining criteria were selected if they assessed final diagnoses. Meta-analyses were based on the random-effects model according to World Health Organization (WHO) geographical regions.ResultsNineteen studies with significant heterogeneity were analyzed, totaling 2667 participants. Noninfectious inflammatory disorders had a pooled estimate at 20.0% (95% confidence interval [CI], 17.0%–23.0%). Undiagnosed illness had a pooled estimate of 20.0% (95% CI, 14.0%–26.0%). The pooled estimate for cancer was 15.0% (95% CI, 12.0%–18.0%). Miscellaneous conditions had a pooled estimate of 6.0% (95% CI, 4.0%–8.0%). Noninfectious inflammatory disorders and miscellaneous conditions were most prevalent in the Western Pacific region with a 27.0% pooled estimate (95% CI, 20.0%–34.0%) and 9.0% (95% CI, 7.0%–11.0%), respectively. The highest pooled estimated for cancer was in the Eastern Mediterranean region at 25.0% (95% CI, 18.0%–32.0%). Adult-onset Still’s disease (114 [58.5%]), systemic lupus (52 [26.7%]), and giant-cell arteritis (40 [68.9%]) predominated among the noninfectious inflammatory group. Lymphoma (164 [70.1%]) was the most common diagnosis in the cancer group.ConclusionsIn this systematic review and meta-analysis, noninfectious disease diagnostic outcomes varied among WHO-defined geographies. Evaluations for FUO should include local variations in disease prevalence.

Metagenomic Sequencing of the Gallbladder Microbiome: Bacterial Diversity Does Not Vary by Surgical Pathology

IntroductionAlterations in the microbiome contribute to the pathogenesis of many gastrointestinal diseases. However, the composition of the microbiome in gallbladder disease is not well described. MethodsWe aimed to characterize the biliary microbiome in cholecystectomy patients. Bile and biliary stones were collected at cholecystectomy for a variety of surgical indications between 2017 and 2019. DNA was extracted and metagenomic sequencing was performed with subsequent taxonomic classification using Kraken2. The fraction of bacterial to total DNA reads, relative abundance of bacterial species, and overall species diversity were compared between pathologies and demographics. ResultsA total of 74 samples were obtained from 49 patients: 46 bile and 28 stones, with matched pairs from 25 patients. The mean age was 48 years, 76% were female, 29% were Hispanic, and 29% of patients had acute cholecystitis. The most abundant species were Klebsiella pneumoniae, Staphylococcus aureus, and Streptococcus pasteurianus. The bacterial fraction in bile and stone samples was higher in acute cholecystitis compared to other non-infectious pathologies (p < 0.05). Neither the diversity nor differential prevalence of specific bacterial species varied significantly between infectious and other non-infectious gallbladder pathologies. Multivariate analysis of the non-infectious group revealed that patients over 40 years of age had increased bacterial fractions (p < 0.05). ConclusionsMetagenomic sequencing permits characterization of the gallbladder microbiome in cholecystectomy patients. Although a higher prevalence of bacteria was seen in acute cholecystitis, species and diversity were similar regardless of surgical indication. Additional study is required to determine how the microbiome can contribute to the development of symptomatic gallbladder disease.

Computed tomography in secondary spontaneous pneumothorax: Reading the fine print.

Objectives:To identify specific characteristics, distribution and associated findings of lesions causing secondary spontaneous pneumothorax (SSP)Methods:Computed tomography (CT) chest of 37 patients (between October 2011 and January 2020) was evaluated by two radiologists. They were classified into ‘Infectious’ and ‘Non-infectious’ groups, based on cause of pneumothorax. A scoring system (score 0–10) was proposed based on parameters which were statistically significantResults:Out of 37 patients with pneumothorax, 18 could be attributed to infectious aetiology and remaining 19 were due to noninfectious causes. The most common infectious cause of spontaneous pneumothorax was tuberculosis and noninfectious cause was chronic obstructive airway disease (COAD). Statistically significant difference was found for lesion wall thickness and presence of solid component between these two groups. No significant difference was found between both groups when comparing age, gender, lesion size and lesion distribution. The presence of pleural thickening, consolidation and mediastinal lymphadenopathy were statistically significant. Pleural effusion was never present in the noninfectious group. The area under receiver operating characteristic for differentiating patients in the two groups was 0.931 (standard error, 0.038; 95% CI, 0.856–1.000), and optimal threshold score for identifying patients with infectious causes was 4.5, with 77.8% sensitivity and 89.5% specificityConclusion:Pneumothorax is almost equally common due to infectious and noninfectious causes. The most common infectious cause of spontaneous pneumothorax was tuberculosis and noninfectious cause was COAD. Based on certain CT findings, we have proposed a scoring system to differentiate between these two groups.

Feasibility of 16S rRNA sequencing for cerebrospinal fluid microbiome analysis in cattle with neurological disorders: a pilot study

Bacterial infection of the central nervous system (CNS) in cattle requires prompt and adequate antimicrobial treatment. The current gold standard for antemortem etiological diagnosis is cerebrospinal fluid (CSF) culture, which often yields false negative results. CSF has long been considered a sterile district in healthy patients, but this notion has been recently challenged. For this pilot study, we used 16S rRNA gene sequencing to investigate the microbial composition of CSF of cattle presenting with CNS disorders and to compare it between subjects with CNS infections and with CNS disorders of other nature. The study sample was 10 animals: 4 presenting with CNS infectious-inflammatory diseases and 6 with other CNS disorders, based on definitive diagnosis. Since the initial round of a standard 16S rRNA PCR did not yield sufficient genetic material for sequencing in any of the samples, the protocol was modified to increase its sensitivity. Bacterial genetic material was identified in 6 animals and 2 groups were formed: an infectious inflammatory (n = 3) and a noninfectious inflammatory group (n = 3). The most frequently expressed bacterial families were Pseudomonadaceae (44.61%), Moraxellaceae (19.54%), Mycobacteriaceae (11.80%); the genera were Pseudomonas (45.42%), Acinetobacter (19.91%), Mycobacterium (12.01%). There were no detectable differences in the CSF microbial composition of the samples from the two groups. Sequencing of bacterial DNA present in the CSF was possible only after increasing PCR sensitivity. The results of 16S rRNA sequencing showed the presence of a microbial community in the CSF in cattle with neurological disorders. Further studies, in which CSF samples from healthy animals and samples from the environment are included as controls, are needed.

Evaluating the diagnostic value of using metagenomic next-generation sequencing on bronchoalveolar lavage fluid and tissue in infectious pathogens located in the peripheral lung field.

Metagenomic next-generation sequencing (mNGS) exerts a vital part in accurately diagnosing pulmonary infection. However, the diagnostic value of different samples obtained by virtual bronchoscopic navigation (VBN) combined with mNGS for pathogen detection in infections located in the peripheral lung field (PLF) is still unclear. Patients infected from July 2018 to February of the following year were carefully analyzed and divided into two parts, namely, non-infectious disease group and the infectious disease group. Then bronchial expansion tests were performed for each subject, collected liquid specimens and tissue standards, and conducted regular mNGS and microbiological detection and analysis. The value of mNGS and culture in pathogen detection was compared, at the same time, the performance of tissue mNGS and bronchoalveolar lavage fluid (BALF) mNGS in the diagnosis process was compared. When discrete variables were processed, Pearson χ2 and Fisher's exact test could be used to perform categorical variables analysis. Continuous variables were analyzed and compared by Mann-Whitney U test. After mNGS diagnosis, Acinetobacter baumannii, Pseudomonas aeruginosa and Rothia mucilaginosa were the bacterial species showing the highest abundances. In addition, mNGS achieved the sensitivities in the detection of pathogens in tissues and BALF of 72.9% and 81.4%, respectively, and it is higher than conventional culture. Bacterial diagnostic sensitivity was significantly different between BALF and tissue using mNGS (95.0% vs. 62.5%, P=0.03). The sensitivity and specificity of BALF in detecting fungal infections were not significantly different from those of mNGS. A consistency test showed that these two methods had some degree of consistency (k=0.673, P=0.000). This study showed that the mNGS in BALF samples and the mNGS in tissue samples which could be used to test for pathogens in the lungs. The sensitivity will increase when mNGS is combined with culture. Also, mNGS of BALF and tissues had some degree of consistency to detect fungal infections, whereas mNGS of BALF had better sensitivity to detect bacterial infection than mNGS of tissues.