Scandinavian journal of infectious diseases
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Scand. J. Infect. Dis. · Jan 2008
The impact on community acquired pneumonia empirical therapy of diagnostic bronchoscopic techniques.
The aim of the present study was to examine the modification of initial empirical treatment based on the microbiological results of bronchoscopic techniques after comparing the diagnostic yield of protected specimen brush (PSB) and bronchoalveolar lavage (BAL) in the immunocompetent patient with community acquired pneumonia (CAP) with results obtained from conventional sputum cultures. 88 patients with presumptive diagnosis of CAP necessitating hospitalization were prospectively studied. Fibreoptic bronchoscopy with quantitative PSB and BAL cultures for common pathogens, mycobacteria and fungi was performed. Conventional sputum cultures were also obtained. ⋯ M. tuberculosis was isolated in 6.8% of patients. Modification of treatment ensued in 27.3% of patients because of the application of the cultures of sputum and invasive technique. PSB and BAL added significant information to the aetiological diagnosis of hospitalized immunocompetent patients with CAP.
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Scand. J. Infect. Dis. · Jan 2008
Comparative StudyTime-course of neopterin levels in patients suffering from severe sepsis treated with and without Drotrecogin-alpha (activated).
Neopterin is secreted by activated monocytes/macrophages upon stimulation with interferon-gamma. The release of this pro-inflammatory mediator permits the activation status of cell-mediated immune system to be examined. We assayed neopterin plasma concentrations in septic patients under treatment with (n=10) and without Drotrecogin-alpha (activated) (n=10) on d 1 and 6 of severe sepsis. ⋯ Neopterin levels correlated significantly with creatinine with regard to all patient groups (range of correlation coefficient, r: 0.73-0.92; p<0.05). In conclusion, Drotrecogin- alpha (activated) was associated with a significant decrease of neopterin plasma levels in septic patients. Neopterin concentrations appear to depend on renal function and enterohepatic circulation.
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Scand. J. Infect. Dis. · Jan 2008
Aetiological diagnosis of community acquired pneumonia: utility of rapid microbiological methods with respect to disease severity.
The present study investigated the utility of rapid microbiological methods in the aetiological diagnosis of community acquired pneumonia (CAP) according to the severity of CAP. Between 1999 and 2004, 384 adult patients with CAP were studied prospectively. In addition to standard microbiological methods, PCR and antigen detection techniques were used to identify pathogens. ⋯ Only 1 case of Chlamydia pneumoniae was identified by PCR. In conclusion, besides yielding the aetiological diagnosis rapidly, new methods add to the total diagnostic yield in CAP. The diagnostic yield of rapid methods differs according to the severity of the pneumonia.
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Scand. J. Infect. Dis. · Jan 2008
Invasive candidiasis in long-term patients at a multidisciplinary intensive care unit: Candida colonization index, risk factors, treatment and outcome.
The incidence of fungal infections in hospitalized patients has increased, and due to demographic changes and increasingly advanced medical methods, the intensive care units (ICU) have emerged as epicentres for fungal infections. The aim of the present study was to investigate Candida colonization pattern and colonization index (CI), in combination with other risk factors and its relation to invasive candida infection (ICI), in 59 consecutive patients with at least 7 d length of stay (LOS) at a multidisciplinary ICU. Surveillance samples were collected on d 7 and then weekly during the ICU stay. ⋯ Overall ICU mortality was 30%. We could demonstrate that both a high colonization index and recent extensive gastroabdominal surgery were significantly correlated with ICI, while a decreased level of HLA-DR (< or = 70%) was not predictive for ICI in this high-risk population. The results indicate that ICU patients exposed to extensive gastroabdominal surgery would benefit from early antifungal prophylaxis.
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Scand. J. Infect. Dis. · Jan 2008
Simkania negevensis may be a true cause of community acquired pneumonia in children.
Simkania negevensis, a recently found Chlamydia-like organism, has been associated with bronchiolitis and pneumonia in children. S. negevensis findings have been common also in healthy, non-symptomatic subjects. Antibodies to S. negevensis were measured by microimmunofluorescence in 174 frozen paired sera obtained from children with community acquired pneumonia in a population-based study. ⋯ All diagnoses were based on the presence of specific IgM antibodies. The numbers of S. negevensis cases increased from 2 (4%) at <24 months to 7 (15%) at > or = 10 y of age. 12 (67%) were mixed infections with viruses or other bacteria. 16 children (9%) had measurable IgG antibodies to S. negevensis, but significant rises were not found in any cases. Thus, S. negevensis may be a real, though rare, cause of CAP in children, occurring often in mixed infections with viruses and other bacteria.