Positive Bacteriological Results Research Articles

Childhood tuberculosis outcomes and factors associated with unsuccessful treatment outcomes in selected public hospitals of Lusaka Zambia from 2015 to 2019.

Treatment outcomes of tuberculosis in children are rarely evaluated. Childhood tuberculosis has been a low priority for tuberculosis programs due to difficulties in diagnosis and treatment. This study evaluated childhood tuberculosis outcomes and factors associated with unsuccessful treatment outcomes in selected public hospitals in Lusaka, Zambia from 2015 to 2019. This was a cross-sectional study conducted in eight public hospitals in Lusaka. All children aged 0-14 years, treated with tuberculosis and had treatment outcomes evaluated were included. The WHO tuberculosis treatment outcomes were grouped into successful treatment outcome (cured, treatment completed) and unsuccessful treatment outcome (death, loss to follow-up, failure). Taking unsuccessful treatment outcome as the outcome variable, logistic regression models were performed. All analyses were done at a 95% confidence interval. Out of 2,531 children managed for TB from 2015 to 2019, only 1,495 (59.1%) had treatment outcomes evaluated. Out of 1,495 participants, majority were 5 to 14 years old (50.9%), males (51.1%), HIV-negative (58.7%), and had pulmonary tuberculosis (74.2%). Bacteriological tests were performed on 59.8% of children, where 21.6% had positive bacteriological results. Bacteriologically confirmed TB was higher in children over 5 years (29.5%), pulmonary TB (25.6%), and retreatment (28.6%). The majority of children (84.2%) completed treatment, while 10.7% were cured, 1.5% were lost to follow-up, 3.1% died, and 0.5% failed treatment. Overall, unsuccessful treatment outcome was 5.1% while successful treatment outcome was 94.1%. Extrapulmonary tuberculosis was associated with unsuccessful treatment outcomes (AOR 1.64; 95% CI: 1.02-2.62). The tuberculosis successful treatment outcome met the World Health Organization's threshold goal of 90%. Children with extrapulmonary tuberculosis should be targeted as a high-risk group to improve treatment outcomes. Tracking children whose treatment outcomes were not evaluated would provide more precise estimates of TB treatment outcomes.

Blood biochemical changes upon subclinical intramammary infection and inflammation in Holstein cattle

The aim of this study was to investigate the associations between subclinical intramammary infection (IMI) from different pathogens combined with inflammation status and a set of blood biochemical traits including energy-related metabolites, indicators of liver function or hepatic damage, oxidative stress, inflammation, innate immunity, and mineral status in 349 lactating Holstein cows. Data were analyzed with a linear model including the following fixed class effects: days in milk, parity, herd, somatic cell count (SCC), bacteriological status (positive and negative), and the SCC × bacteriological status interaction. Several metabolites had significant associations with subclinical IMI or SCC. Increased SCC was associated with a linear decrease in cholesterol concentrations which ranged from -2% for the class ≥50,000 and <200,000 cells/mL to -11% for the SCC class ≥400,000 cells/mL compared with the SCC class <50,000 cells/mL. A positive bacteriological result was associated with an increase in bilirubin (+24%), paraoxonase (+11%), the ratio paraoxonase/cholesterol (+9%), and advanced oxidation protein product concentration (+23%). Increased SCC were associated with a linear decrease in ferric reducing antioxidant power concentrations ranging from -3% for the class ≥50,000 and <200,000 cells/mL to -9% for the SCC class ≥400,000 cells/mL (respect to the SCC class <50,000 cells/mL). A positive bacteriological result was associated with an increase in haptoglobin concentrations (+19%). Increased SCC were also associated with a linear increase in haptoglobin concentrations, which ranged from +24% for the class ≥50,000 and <200,000 cells/mL (0.31 g/L) to +82% for the SCC class ≥400,000 cells/mL (0.45 g/L), with respect to the SCC class <50,000 cells/mL (0.25 g/L). Increased SCC were associated with a linear increase in ceruloplasmin concentrations (+15% for SCC ≥50,000 cells/mL). The observed changes in blood biochemical markers, mainly acute phase proteins and oxidative stress markers, suggest that cows with subclinical IMI may experience a systemic involvement.

The effect of diabetes mellitus on tuberculosis in eastern China: A decision-tree analysis based on a real-world study.

The public health system faces major challenges due to the double burden of diabetes mellitus (DM) and tuberculosis (TB) in China. We aimed to investigate the prevalence and impact of diabetes on patients with TB. Stratified cluster sampling was used to select 13 counties as study sites in the Zhejiang province. Patients who visited designated TB hospitals in these areas participated in this study between 1 January 2017 and 28 February 2019. Multiple logistic regression models were performed to investigate the association between DM and bacteriological and imaging results. A decision tree was used to predict the bacteriology and imaging results under the influence of DM. Of 5920 patients with newly diagnosed pulmonary tuberculosis, 643 (12.16%) had DM. Patients with pulmonary TB and DM were more likely to have pulmonary cavities (adjusted odds ratio [aOR], 2.81; 95% confidence intervals [95% CI]: 2.35-3.37) and higher rates of positive bacteriological tests (aOR, 2.32; 95% CI:1.87-2.87). Decision-tree analysis showed similar results. Concurrence of DM and pulmonary TB makes patients more likely to have positive bacteriological results and pulmonary cavities. Therefore, appropriate measures are necessary to promptly identify and manage patients with TB and DM.

Leptin levels in childhood tuberculosis and its correlation with body mass index, IFN-γ, and TNF-α in an Indonesian population

BackgroundLeptin plays a key role in the regulation of energy and inflammation in tuberculosis (TB). However, its correlation in children with TB remains unclear. Therefore, this study aimed to evaluate the correlations between body mass index, IFN-γ, TNF-α, and leptin levels in children with TB. MethodsThis was a cross-sectional study of children aged 2–14 years with TB. Sputum examination, chest radiography, and tuberculin skin test findings and clinical symptoms were considered for TB diagnosis. Data on body weight; height; mid-upper arm circumference (MUAC); body mass index (BMI); food intake; and IFN-γ, TNF-α, and leptin levels were collected and analyzed. ResultsOf the 64 diagnosed TB subjects, 2 subjects had positive bacteriological results. The median age was 6 (2–14) years, body weight was 17.7 (9.45–55) kg, height was 114 ± 21.46 cm, and Z score BMI was −0.85 ± 1.14 kg/m2. Malnourished was observed in 17.2% of the subjects. The median calorie intake was 1448.5 (676–4674) kcal, carbohydrate intake was 182.5 (63–558) g, protein intake was 57.9 (15.8–191.0) g, and fat intake was 81.6 (23.6–594.1) g. The median leptin level was 1.2 (0.2–59) ng/mL, IFN-γ was 2.5 (0.9–161) pg/mL, and TNF-α was 13.0 (5.7–356) pg/mL. Correlations were observed between leptin and MUAC (r = 0.251, p = 0.02), Z score (r = 0.453, p = 0.00), and IFN-γ (r = 0.295, p = 0.018). ConclusionThere were positive correlations between BMI and leptin levels, whereas IFN-γ and MUAC showed weak correlations.

A Genome-Wide Association Study for Tolerance to Paratuberculosis Identifies Candidate Genes Involved in DNA Packaging, DNA Damage Repair, Innate Immunity, and Pathogen Persistence

Although the genetic susceptibility to diseases has been extensively studied, the genetic loci and the primary molecular and cellular mechanisms that control disease tolerance are still largely unknown. Bovine paratuberculosis (PTB) is an enteritis caused by Mycobacterium avium subsp. paratuberculosis (MAP). PTB affects cattle worldwide and represents a major issue on animal health. In this study, the associations between host genetic and PTB tolerance were investigated using the genotypes from 277 Spanish Holstein cows with two distinct phenotypes: cases) infected animals with positive PCR and bacteriological culture results but without lesions in gut tissues (N= 24), and controls) animals with negative PCR and culture results but with PTB-associated lesions (N= 253). DNA from peripheral blood of the study population was genotyped with the Bovine EuroG MD Bead Chip, and the corresponding genotypes were imputed to whole-genome sequencing (WGS) data. A genome-wide association study was performed using the WGS data and the defined phenotypes in a case-control approach. A total of 142 single nucleotide polymorphisms (SNPs) were associated (false discovery rate ≤ 0.05, P values between 1.5 × 10-7 and 5.7 × 10-7) with tolerance (heritability= 0.55). The 40 SNPs with P-values < 5 × 10-7 defined 9 QTLs and 98 candidate genes located on BTA4, BTA9, BTA16, BTA25, and BTA26. Some of the QTLs identified in this study overlap with QTLs previously associated with PTB, bovine tuberculosis, mastitis, somatic cell score, bovine diarrhea virus persistent infection, tick resistance, and length of productive life. Two candidate genes with important roles in DNA damage response (ERCC4 and RMI2) were identified on BTA25. Functional analysis using the 98 candidate genes revealed a significant enrichment of the DNA packaging process (TNP2/PRMI1/PRM2/PRM3). In addition, the TNF-signaling (bta04668; TRAF5/CREB5/CASP7/CHUK) and the toxoplasmosis (bta05145; TGFβ2/CHUK/CIITA/SOCS1) pathways were significantly enriched. Interestingly, the nuclear Factor NF-κβ Inhibitor Kinase Alpha (CHUK), a key molecule in the regulation of the NF-κB pathway, was enriched in both pathways. Taken together, our results define a distinct immunogenetic profile in the PTB-tolerant animals designed to control bacterial growth, modulate inflammation, limit tissue damage and increase repair, thus reducing the severity of the disease.

Зміни ротоглоткового мікробіому у хворих на вірусно-бактеріальну пневмонію, асоційовану із сovid-19 на фоні терапії антибіотиками та моніторинг антибіотикорезистентних штамів

The relevance of the infection caused by COVID-19 today is beyond doubt. According to the Protocol “Provision of medical care for the treatment of coronavirus disease (COVID-19)” approved by the order of the Ministry of Health of Ukraine dated April 2, 2020 № 762, antibacterial drugs are prescribed only in the presence of confirmed bacterial co-infection ( after receiving positive bacteriological results) blood and / or sputum analysis). But given that the results of the analysis must wait a few days, antibiotics, under certain indications, can be prescribed empirically. The aim of our work was to analyze the structure of the oropharyngeal microbiome, patients with viral and bacterial pneumonia who received antibiotics, to determine clinically significant strains and their sensitivity to antibacterial agents. In the structure of the oropharyngeal microbiome, fungi of the genus Candida significantly prevailed, which were found in 50 (45.6%) subjects, in second place in terms of frequency of detection were S. pneumoniae – 29 (26.4%). Much less often from the oropharynx of patients with viral-bacterial pneumonia associated with COVID-19 were isolated K. pneumoniae – 13 (11.8%), S. aureus – 11 (10.0%) and E. coli – 7 (6.4 %). Among the isolated S. pneumoniae, the maximum number of resistant strains was detected for such fairly new antibiotics as ceftriaxone – 37.9% and azithromycin – 31.0%. Among fungi of the genus Candida resistant to nystatin and amphotericin were 38.5% and 26.9%, respectively. Therefore, the administration of antibacterial agents, taking into account the sensitivity of clinically significant strains, will guarantee effective treatment, prevent the development of antibiotic resistance, prevent the development of oropharyngeal and intestinal dysbiosis, and thus reduce the cost of treatment of antibiotic side effects, including probiotics.

Identification of loci associated with susceptibility to bovine paratuberculosis and with the dysregulation of the MECOM, eEF1A2, and U1 spliceosomal RNA expression

Although genome-wide association studies have identified single nucleotide polymorphisms (SNPs) associated with the susceptibility to Mycobacterium avium subsp. paratuberculosis (MAP) infection, only a few functional mutations for bovine paratuberculosis (PTB) have been characterized. Expression quantitative trait loci (eQTLs) are genetic variants typically located in gene regulatory regions that alter gene expression in an allele-specific manner. eQTLs can be considered as functional links between genomic variants, gene expression, and ultimately phenotype. In the current study, peripheral blood (PB) and ileocecal valve (ICV) gene expression was quantified by RNA-Seq from fourteen Holstein cattle with no lesions and with PTB-associated histopathological lesions in gut tissues. Genotypes were generated from the Illumina LD EuroG10K BeadChip. The associations between gene expression levels (normalized read counts) and genetic variants were analyzed by a linear regression analysis using R Matrix eQTL 2.2. This approach allowed the identification of 192 and 48 cis-eQTLs associated with the expression of 145 and 43 genes in the PB and ICV samples, respectively. To investigate potential relationships between these cis-eQTLs and MAP infection, a case–control study was performed using the genotypes for all the identified cis-eQTLs and phenotypical data (histopathology, ELISA for MAP-antibodies detection, tissue PCR, and bacteriological culture) of 986 culled cows. Our results suggested that the heterozygous genotype in the cis-eQTL-rs43744169 (T/C) was associated with the up-regulation of the MDS1 and EVI1 complex (MECOM) expression, with positive ELISA, PCR, and bacteriological culture results, and with increased risk of progression to clinical PTB. As supporting evidence, the presence of the minor allele was associated with higher MECOM levels in plasma samples from infected cows and with increased MAP survival in an ex-vivo macrophage killing assay. Moreover, the presence of the two minor alleles in the cis-eQTL-rs110345285 (C/C) was associated with the dysregulation of the eukaryotic elongation factor 1-α2 (eEF1A2) expression and with increased ELISA (OD) values. Finally, the presence of the minor allele in the cis-eQTL rs109859270 (C/T) was associated with the up-regulation of the U1 spliceosomal RNA expression and with an increased risk of progression to clinical PTB. The introduction of these novel functional variants into marker-assisted breeding programs is expected to have a relevant effect on PTB control.

Comparison of different bacteriological testing strategies and factors for bacteriological confirmation among pulmonary TB patients: a retrospective study in Tianjin, China, 2017\u20132018

BackgroundBacteriological confirmation (BC) proportion among notified pulmonary TB patients in China is among the lowest in the world. This study was to understand the yield of BC using different testing strategies and patient-level factors associated with BC among pulmonary TB patients in Tianjin, China during 2017–2018.MethodsA retrospective study was conducted, enrolling pulmonary TB patients reported to National TB Information Management System (TBIMS) in Tianjin during 2017–2018. BC was defined as a positive result by any of the followings: smear microscopy, culture, or nucleic acid amplification test. Individual characteristics were compared between patients with positive and negative bacteriological results using contingency tables and χ2 test. Multivariable logistic regression was applied to analyze factors associated with BC, calculating adjusted odds ratios (aOR) and 95% confidence intervals (CI) (α = 0.05).ResultsOf 6364 reported patients, 4181 (65.7%) were bacteriologically confirmed. Positivity proportion was 43.1% (2746/6364) for smear microscopy, 57.7% (3380/5853) for culture, 61.7% (1608/2605) for Xpert® MTB/RIF assay (Xpert) and 73.4% (1824/2484) for combination of the three. The unemployed (aOR = 1.5, 95% CI: 1.0–2.2) and farmers (aOR = 1.7, 95% CI: 1.1–2.8) compared with students; diagnosis by inpatient hospitals compared with TB clinics (aOR = 3.4, 95% CI: 2.6–4.4); having symptoms for ≥2 weeks (aOR = 1.4, 95% CI: 1.1–1.8); cough (aOR = 2.2, 95% CI: 1.8–2.8); blood sputum (aOR = 1.5, 95% CI: 1.0–2.2); cavitation on chest X-ray (aOR = 3.3, 95% CI: 2.5–4.3); bilateral lung lobes affected (aOR = 1.7, 95% CI: 1.4–2.2) were factors associated with BC.ConclusionsCombination test was an effective way to improve BC among pulmonary TB patients. Being unemployed, farmers, having prolonged symptoms, and more severe in TB condition were factors associated with BC. We recommend combination of tests to improve BC for pulmonary TB patients, especially who are in early stage of the disease or with conditions tend to be bacteriologically negative.

Northern Ireland farm-level management factors for prolonged bovine tuberculosis herd breakdowns.

This study determined farm management factors associated with long-duration bovine tuberculosis (bTB) breakdowns disclosed in the period 23 May 2016 to 21 May 2018; a study area not previously subject to investigation in Northern Ireland. A farm-level epidemiological investigation (n = 2935) was completed when one or more Single Intradermal Comparative Cervical Test (SICCT) reactors or when one or more confirmed (positive histological and/or bacteriological result) lesion at routine slaughter were disclosed. A case-control study design was used to construct an explanatory set of management factors associated with long-duration bTB herd breakdowns; with a case (n = 191) defined as an investigation into a breakdown of 365 days or longer. Purchase of infected animal(s) had the strongest association as the most likely source of infection for long-duration bTB herd breakdowns followed by badgers and then cattle-to-cattle contiguous herd spread. However, 73.5% (95% CI 61.1-85.9%) of the herd type contributing to the purchase of infection source were defined as beef fattening herds. This result demonstrates two subpopulations of prolonged bTB breakdowns, the first being beef fattening herds with main source continuous purchase of infected animals and a second group of primary production herds (dairy, beef cows and mixed) with risk from multiple sources.

Application of endobronchial ultrasonography using a guide sheath and electromagnetic navigation bronchoscopy in the diagnosis of atypical bacteriologically-negative pulmonary tuberculosis.

In the absence of a positive sputum bacteriological result, pathological and bacteriological examinations of lung lesion biopsies are important methods to confirm bacteriological-negative tuberculosis. Endobronchial ultrasonography with guide sheath (EBUS-GS) and electromagnetic navigation bronchoscopy (ENB) are two new endobronchial diagnostic techniques, the combination of which has greatly facilitated the diagnosis of peripheral pulmonary lesions and is an especially useful, minimally invasive, effective diagnostic method for bacteriologically-negative tuberculosis cases. A total of 78 patients were included in this study with suspected pulmonary tuberculosis based on clinical manifestations, laboratory tests, and imaging studies. The patients underwent a high-resolution chest CT scan before bronchoscopy, A method was selected (EBUS-GS alone, or EBUS-GS + ENB) based on the lesion site and the level and angle of the bronchus involved. After the lesion was found, a puncture needle, biopsy forceps, and brushing forceps were used to collect a tissue sample. Forty-four patients were diagnosed with tuberculosis; 1, nontuberculous Mycobacteria (NTM) lung disease; 15, lung cancer; 15, pulmonary infection; 1, allergic bronchopulmonary aspergillosis (ABPA); and 2, pneumoconiosis. A total of 25 patients of TB (56.8%) were successfully diagnosed with EBUS-GS plus ENB. Among the patients with confirmed diagnosis, 9 were diagnosed with pathological examination; 4, genetic analysis; 11, positive smear; and 14, positive culture. The introduction of EBUS and ENB in China has provided a new direction for the diagnosis of atypical bacteriological-negative tuberculosis, as the techniques are less invasive and less expensive than thoracoscopy.

Endometrial histopathology, bacteriology and cytology outcomes in mares with early embryonic death (EED): a field study.

Early embryonic death (EED) is one of the causes of infertility in the mare. We compared endometrial environment in 9 mares with EED and 13 mares in diestrus phase. Cotton swab (CS), cytobrush (CB) and uterine biopsy (B) samples were obtained for the cytological, bacteriological and histopathological examinations. In the first step we compared CS and CB methods to biopsy as a reference method, as B revealed the highest number of positive results in cytological and bacteriological examinations in both groups. In turn, we also compared cytological, bacteriological and histopathological findings between EED and control animals using the B sampling. Although the differences between these groups were not statistically significant (p≥0.05), there was a tendency to a higher prevalence of subclinical endometritis in the control group, than in the EED group (62% vs 22%). In general, positive bacteriological results were similar in both groups (62% vs 55%), whereas positive cytological results were higher in the control group (62% vs 22%; p≥0.05). In histopathological examination in EED mares endometrial degeneration was better expressed (all mares were with grades IIB and III on the Kenney-Doig scale); however, the differences between both groups were not statistically significant (p≥0.05). We could not confirm a clear difference in uterine environment between the two groups. Moreover, the uterine biopsy seemed to be the most reasonable sampling method for diagnosis of endometrial state.

Short communication: Diagnosis and classification of clinical and subclinical mastitis utilizing a dynamometer and a handheld infrared thermometer

In times of ongoing automatization of dairy cow husbandry, objective and reliable tools for mastitis diagnostic are highly in demand. The objective of this study was to investigate the diagnostic value of a handheld dynamometer and an infrared thermometer to diagnose and score clinical and subclinical mastitis and to compare those values with results from palpation of the udder tissue. Overall, 218 cows with clinical mastitis (i.e., 46 mild, 106 moderate, and 66 severe cases), 142 with subclinical mastitis, and 68 healthy cows were enrolled. Our data provide evidence that the dynamometer is an accurate diagnostic tool to differentiate between healthy udder quarters, and those with subclinical and clinical mastitis. Furthermore, the severity score of clinical mastitis can be estimated by dynamometer. The firmness threshold for the detection of clinical mastitis was 1.002 kg. Using a threshold of 1.175 kg in clinical mastitis quarters, it was possible to differentiate between negative and positive bacteriological results. A differentiation between healthy and clinical mastitis quarters with the infrared thermometer was possible, albeit udder surface temperatures were highly influenced by ambient temperature. Udder surface temperature increased by 0.15 to 0.18°C for each degree of ambient temperature. In conclusion, the utility of an infrared thermometer to estimate the udder health status of dairy cows is limited, whereas the handheld dynamometer appeared to be an accurate and objective method.

Aerobic etiology of intraabdominal infections in a public hospital. Surveillance and antibiotic resistance

Background: The treatment of intrabdominal infections are empirically performed on the basis of existing epidemiological data. There are data in Argentine that present an increased resistance more than 30% to Ciprofloxacin and Ampicilin/sulbactam in E. coli and K. pneumoniae. The following study is performed in order to know the etiology and antimicrobial resistance in our region. Methods & Materials: Retrospective, descriptive and observational study. The patients included not only had intraabdominal infection diagnosis but also any kind of surgery in order to control the source in the “Hospital Escuela de Agudos Dr. Ramón Madariaga” with positive aerobic bacteriological results between January 1st, 2016 and December 31st, 2016. Data were analyzed by the statistical support of IBM SPSS statistics v. 19.0. Epidemic registries were done. The analysis of bacteriological samples were developed in the “Laboratorio Nacional de Referencia del Instituto Carlos Malbrán (LNR)”. Results: There were analyzed 69 intrabdominal infections, 59 acute appendicitis, male 45/69 (65.2%), middle aged 41 (15-86), comorbidities 23/69 (33%), previous use of antibiotics 10/69 (14.5%), previous hospital admission 4/69 (5.8%). The empirical treatment used was based on one drug with activity against aerobic pathogens in 68 cases (98.6%). The most frequent active drugs used were ciprofloxacin plus metronidazole 62/69 (89.9%) and ampicillin/sulbactam 4/69 (5.8%). 94 aerobic bacterias were isolated (1.4 bacterias/episodes), gram negative bacteria 82/94 (87.2%), Escherichia coli 55/94 (58.5%), Klebsiella pneumonia 10/94 (10.6%) and Pseudomonas aeruginosa 8/94 (8.5%). The resistance profile of the enterobacterias was ampicillin/sulbactam 27/69 (39%), ciprofloxacin 18/70 (26%), gentamicin 8/71 (11%), cefotaxime 4/71(6%) and piperacillin/tazobactam 3/71 (4%). In E. coli was ampicillin/sulbactam 23/55(42%), ciprofloxacin 15/55 (28%), gentamicin 6/53 (11%), amikacin 1/28 (4%), piperacillin/tazobactam 1/55 (2%) and cefotaxime 2/55(4%). In K. pneumoniae was ampicillin/sulbactam 3/10 (30%), ciprofloxacin 3/10 (30%), gentamicin 2/10(20%), piperacillin/tazobactam 2/10 (20%), cefotaxime 2/10 (20%), amikacin 0/5 (0%). There were no resistant in P. aeruginosa. Beta lactamase of extended spectrum 4/71. Conclusion: The microbiological findings of this study provide information to base the election of antibiotic empirical treatments in our hospital. This findings lead us to ask the necessity of reconsider the antibiotics schemes empirically outlined to intrabdominal infection

Indicators for prediction of Mycobacterium tuberculosis positivity detected with bronchoalveolar lavage fluid

BackgroundThe diagnosis of active pulmonary tuberculosis (TB) remains a challenge in clinic, especially for sputum negative pulmonary TB. Bronchoalveolar lavage fluid (BALF) has higher sensitivity than sputum for detection of Mycobacterium tuberculosis (Mtb). However, bronchoscopy is invasive and costly, and not suitable for all patients. In order to make TB patients get more benefit from BALF for diagnosis, we explore which indicator might be used to optimize the choice of bronchoscopy.MethodsA total of 1539 sputum-smear-negative pulmonary TB suspects who underwent bronchoscopy were recruited for evaluation. The sensitivity, specificity and accuracy of Mtb detection in sputum and BALF were compared. Odds ratios and 95% confidence intervals were used to assess variables that associated with positive acid-fast bacilli (AFB) smear, Mtb culture and nucleic acid amplification test (NAAT) of BALF in sputum-negative and non-sputum-producing pulmonary TB suspects.ResultsBALF has significantly higher sensitivity (63.4%) than sputum (43.5%) for Mtb detection by culture and NAAT. 19.7% (122/620) sputum-negative and 40.0% (163/408) non-sputum-producing suspects had positive bacteriological results in BALF. Among sputum-negative and non-sputum-producing pulmonary TB suspects, the positivity of Mtb detection in BALF is associated with a younger age, the presence of pulmonary cavities and a positive result of interferon-gamma release assay (IGRA). Sputum-negative patients under 35 years old with positive IGRA and pulmonary cavity had 84.8% positivity of Mtb in BALF.ConclusionsOur study indicated that combination of age, the presence of pulmonary cavity, and the result of IGRA is useful to predict the positivity of Mtb detection in BALF among sputum-negative and non-sputum producing pulmonary TB suspects. Those who are under 35 years old, positive for the presence of pulmonary cavity and IGRA, should undergo bronchoscopy to collect BAFL for Mtb tests, as they have the highest possibility to get bacteriologically confirmation of TB.

Infective endocarditis: Importance of molecular biological techniques in etiological diagnosis

To investigate the specific features of conventional bacteriological methods and current molecular biological techniques for the etiological diagnosis of infective endocarditis (IE). Examinations were made in 53 patients treated at City Clinical Hospital Sixty-Four, Moscow Healthcare Department, in 2012-2015 who underwent simultaneous bacteriological and molecular biological (polymerase chain reaction (PCR) or PCR with further sequencing) examinations of blood or resected cardiac valve tissues. The investigation included 53 patients (31 men; median age, 62 years) with IE (Duke 2009); its primary form was observed in 32 (60.4%) patients. Blood bacteriological tests and PCR assays were positive in 28 (52.8%) and 34 (64.2%) patients, respectively. There were concordant results in 21 of the 28 positive blood culture cases and discordant results in 7 (25%); at the same time 3 cases showed a compete discordance in the detected causative agents (the growth of Enterococcus spp. was revealed by bacteriological examination and that of Staphylococcus spp., Streptococcus spp., and Escherichia coli by DNA PCR) and a pathogen could not be identified by DNA PCR in 4 patients who had positive blood bacteriological results. The positive PCR results for cocci and fungi were obtained in 10 of the 25 (47.2%) examinees with culture-negative IE. Rare causative agents were not revealed. The tissues obtained from 8 resected damaged heart valves displayed a wider spectrum of pathogens than did blood samples, which was associated with the formation of bacterial films. The etiological agent of IE was revealed in venous blood by bacteriological examination in 52.8% of the examinees, by PCR in 64.2%, and by either in 71.7%. There were concordant and discordant results in 67.9 and 32.1% of the patients, respectively; among whom 18.9% were found to have pathogen DNA revealed by PCR in culture-negative IE.

The influence of the rearing period on intramammary infections in Swiss dairy heifers: A cross-sectional study

Healthy replacement heifers are one of the foundations of a healthy dairy herd. Farm management and rearing systems in Switzerland provide a wide variety of factors that could potentially be associated with intramammary infections (IMI) in early lactating dairy heifers. In this study, IMI with minor mastitis pathogens such as coagulase-negative staphylococci (CNS), contagious pathogens, and environmental major pathogens were identified. Fifty-four dairy farms were enrolled in the study. A questionnaire was used to collect herd level data on housing, management and welfare of young stock during farm visits and interviews with the farmers. Cow-level data such as breed, age at first calving, udder condition and swelling, and calving ease were also recorded. Data was also collected about young stock that spent a period of at least 3 months on an external rearing farm or on a seasonal alpine farm. At the quarter level, teat conditions such as teat lesions, teat dysfunction, presence of a papilloma and teat length were recorded. Within 24h after parturition, samples of colostral milk from 1564 quarters (391 heifers) were collected aseptically for bacterial culture. Positive bacteriological culture results were found in 49% of quarter samples. Potential risk factors for IMI were identified at the quarter, animal and herd level using multivariable and multilevel logistic regression analysis. At the herd level tie-stalls, and at cow-level the breed category “Brown cattle” were risk factors for IMI caused by contagious major pathogens such as Staphylococcus aureus (S. aureus). At the quarter-level, teat swelling and teat lesions were highly associated with IMI caused by environmental major pathogens. At the herd level heifer rearing at external farms was associated with less IMI caused by major environmental pathogens. Keeping pregnant heifers in a separate group was negatively associated with IMI caused by CNS. The odds of IMI with coagulase-negative staphylococci increased if weaning age was less than 4 months and if concentrates were fed to calves younger than 2 weeks. This study identified herd, cow- and quarter-level risk factors that may be important for IMI prevention in the future.

Diagnostic value of 99mTc-HMPAO-labeled leukocytes scintigraphy in suspicion of post-sternotomy mediastinitis relapse

BackgroundThe diagnostic value of radiolabeled white blood cells (WBCs) scintigraphy in mediastinitis is well established, but data in the specific context of relapse are lacking. The present study aimed at evaluation of the diagnostic value of WBCs scintigraphy in suspicion of mediastinitis relapse after prior surgical revision. Methods and ResultsMultiple planar incidences of the chest were acquired 4 and 20 hours after injection of labeled WBC in 43 patients. In case of non-conclusive scintigraphy, a second scan was performed 2-3 weeks after the first one. The diagnosis of infection was based on positive bacteriological results; otherwise patients were followed up for at least 1 year. Out of 39 analyzable patients, 17 (44%) were diagnosed with mediastinitis relapse. After the first scan, 32 of 39 were correctly classified, 2 were false positive, and 5 were not conclusive. After completion of an additional scan in the latter 5 patients, 36 of 39 were correctly classified and 3 were false positive (100% sensitivity, 86% specificity, 85% positive predictive value, and 100% negative predictive value). ConclusionsIn the specific context of suspicion of mediastinitis relapse, the optimal diagnostic value was achieved by repeating the scan when the first one was not conclusive. In this context, a negative WBC scintigraphy was able to rule out infection, with potential major impact on therapeutic management in patients with poor clinical status.

Risk factors associated with negative in-vivodiagnostic results in bovine tuberculosis-infected cattle in Spain

BackgroundDespite great effort and investment incurred over decades to control bovine tuberculosis (bTB), it is still one of the most important zoonotic diseases in many areas of the world. Test-and-slaughter strategies, the basis of most bTB eradication programs carried out worldwide, have demonstrated its usefulness in the control of the disease. However, in certain countries, eradication has not been achieved due in part to limitations of currently available diagnostic tests. In this study, results of in-vivo and post-mortem diagnostic tests performed on 3,614 animals from 152 bTB-infected cattle herds (beef, dairy, and bullfighting) detected in 2007–2010 in the region of Castilla y León, Spain, were analyzed to identify factors associated with positive bacteriological results in cattle that were non-reactors to the single intradermal tuberculin test, to the interferon-gamma (IFN-γ) assay, or to both tests applied in parallel (Test negative/Culture + animals, T-/C+). The association of individual factors (age, productive type, and number of herd-tests performed since the disclosure of the outbreak) with the bacteriology outcome (positive/negative) was analyzed using a mixed multivariate logistic regression model.ResultsThe proportion of non-reactors with a positive post-mortem result ranged from 24.3% in the case of the SIT test to 12.9% (IFN-γ with 0.05 threshold) and 11.9% (95% CI 9.9-11.4%) using both tests in parallel. Older (>4.5 years) and bullfighting cattle were associated with increased odds of confirmed bTB infection by bacteriology, whereas dairy cattle showed a significantly lower risk. Ancillary use of IFN-γ assay reduced the proportion of T-/C + animals in high risk groups.ConclusionsThese results demonstrate the likelihood of positive bacteriological results in non-reactor cattle is influenced by individual epidemiological factors of tested animals. Increased surveillance on non-reactors with an increased probability of being false negative could be helpful to avoid bTB persistence, particularly in chronically infected herds. These findings may aid in the development of effective strategies for eradication of bTB in Spain.

Correlation between placental bacterial culture results and histological chorioamnionitis: a prospective study on 376 placentas

ObjectiveTo study the correlation between the bacteriological and histopathological findings in placentas from women with suspected or proven chorioamnionitis (CA).MethodsOver a 1-year period, 376 placentas were prospectively collected and processed...

Tuberculous Peritonitis: The Closer You Go, the More Confused You Get

We read the article entitled ‘‘Comparison between Laparoscopy and Noninvasive Tests for the Diagnosis of Tuberculous Peritonitis’’ by Hong et al. [1] with great interest. The authors presented a retrospective study of 60 patients who underwent diagnostic laparoscopy for either undiagnosed ascites (n = 19) or a condition that needed to be differentiated from peritoneal carcinoma (n = 41). Forty-one patients were diagnosed with tuberculous peritonitis (TBP). The positive and negative results of diagnostic laparoscopy were compared with ascitic deaminase levels [30 U/l and ascitic lactate dehydrogenase levels [90 U/l. The authors concluded that laparoscopy with combined biopsy is the most sensitive and the quickest method for diagnosing tubercular peritonitis. We would like to make the following observations regarding this article. The authors chose to present their results as mean ± SD. This method is always not representative, especially if data is nonuniform. This is apparent by looking at the duration of symptoms in the patients with TBP: 40 ± 57 (range, 3–360). Median ± interquartile range is a preferable method to represent the nonuniform data compared with mean ± SD [2]. The diagnosis of TBP was considered definitive by the authors, on the basis of either caseous granuloma or positive bacteriological results for M. tuberculosis. The diagnosis was considered probable in the presence of suggestive clinical and laparoscopic findings and noncaseous granuloma without positive bacteriologic findings. The authors did not mention how many patients were in the category of probable diagnosis or how many of them actually proved to be definitive case of TBP after favorable clinical response to antituberculosis therapy. The authors reported that biopsy tissues were deemed inadequate for the diagnosis in 12 of 60 cases. However, all of these patients were considered while assessing the presence of granuloma/caseous granuloma under the heading of laparoscopy in Table 4 [1]. This needs further clarification. The diagnosis of abdominal tuberculosis is classically based on microbiological confirmation [3]. Although the yield may be less, positive acid fast staining (AFB) and M. tuberculosis culture results confirm the diagnosis of tuberculosis unequivocally. The authors performed AFB of peritoneal biopsy specimen in 22 and culture for M. tuberculosis in 6 of 60 patients. Selective use of these investigations rules out the opportunity of exploring their full potential in the diagnosis of TBP. The authors mentioned that ascites was present in 92.7% (38/41) of patients of TBP. Table 2 shows that acid fast staining was conducted in 48 patients, and M. tuberculosis culture and PCR was undertaken in 48 and 39 patients respectively. The authors did not indicate why these investigations were selectively performed in a few patients and not in all patients. We believe that AFB staining, which is an inexpensive and freely available investigation, should be performed in the ascitic fluid of all patients suspected to have TBP. The authors stated that an abnormal chest X-ray was seen in 20 of 41 patients of TBP and active concomitant pulmonary disease was present in 8 patients (20%). It becomes imperative to know whether the sputum of these patients was examined for the presence of AFB. It will be interesting to know how many of these sputum AFBpositive patients were ultimately found to have TBP. P. K. Garg (&) B. K. Jain D. Mohanty Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi 110095, India e-mail: dr.pankajgarg@gmail.com