The Perils of Multiplex Gastrointestinal Pathogen Panels: Pseudo-outbreaks of Salmonellae and Entamoeba histolytica in Immunocompromised Hosts

2018 ◽  
Vol 39 (07) ◽  
pp. 867-870 ◽  
Author(s):  
Elizabeth Robilotti ◽  
Eleanor Powell ◽  
Shauna Usiak ◽  
Ying Taur ◽  
N. Esther Babady ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Entamoeba Histolytica ◽  
False Positive ◽  
Tertiary Care ◽  
Cancer Center ◽  
Spatial Overlap ◽  
Gastrointestinal Pathogen ◽  
True Infection ◽  
Immunocompromised Hosts ◽  
Positive Results

Two distinct clusters of gastroenteritis due to Salmonellae and Entamoeba histolytica (EH) were identified using a multiplex gastrointestinal pathogen panel (GPP) at a tertiary-care cancer center. Despite temporo-spatial overlap, our investigation did not corroborate transmission or true infection. In clinical practice, GPPs may render false-positive results.Infect Control Hosp Epidemiol 2018;867–870

scholarly journals Anti-Nuclear Antibodies in Daily Clinical Practice: Prevalence in Primary, Secondary, and Tertiary Care

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Thomas Y. Avery ◽  
Mart van de Cruys ◽  
Jos Austen ◽  
Frans Stals ◽  
Jan G. M. C. Damoiseaux
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Tertiary Care ◽  
Descriptive Study ◽  
Clinical Settings ◽  
Antibody Prevalence ◽  
Autoimmune Rheumatic Diseases ◽  
Dsdna Antibody ◽  
Alternative Approaches ◽  
Positive Results

For the diagnosis of systemic autoimmune rheumatic diseases (SARD), patients are screened for anti-nuclear antibodies (ANA). ANA, as assessed by indirect immunofluorescence (IIF), have a poor specificity. This hampers interpretation of positive results in clinical settings with low pretest probability of SARD. We hypothesized that the utility of positive ANA IIF results increases from primary to tertiary care. We retrospectively determined ANA, anti-ENA, and anti-dsDNA antibody prevalence in patient cohorts from primary (n=1453), secondary (n=1621), and tertiary (n=1168) care settings. Results reveal that from primary care to tertiary care, ANA prevalence increases (6.2, 10.8, and 16.0%, resp.). Moreover, in primary care low titres (70% versus 51% and 52% in secondary and tertiary care, resp.) are more frequent and anti-ENA/dsDNA reactivities are less prevalent (21% versus 39% in secondary care). Typically, in tertiary care the prevalence of anti-ENA/dsDNA reactivities (21%) is lower than expected. From this descriptive study we conclude that positive ANA IIF results are more prone to false interpretation in clinical settings with low pretest probabilities for SARD, as in primary care. Whether alternative approaches, that is, immunoadsorption of anti-DFS70 antibodies or implementation of anti-ENA screen assays, perform better, needs to be determined.

scholarly journals 734. Post-exposure Management of Influenza in Roommates at a Tertiary Care Cancer Center

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S263-S264
Author(s):  
Sandra Carlino ◽  
Mini Kamboj
Keyword(s):  
Single Case ◽  
Tertiary Care ◽  
Resistance Testing ◽  
Cancer Center ◽  
Breakthrough Infection ◽  
Spatial Overlap ◽  
Post Exposure ◽  
Baseline Testing ◽  
Viral Testing ◽  
Therapeutic Doses

Abstract Background Post-exposure antiviral chemoprophylaxis with neuraminidase inhibitors (NI) is 80% effective in preventing influenza in household members. In hospital settings, management of exposed roommates has not been specifically addressed in clinical studies. Some experts recommend immunocompromised individuals exposed to influenza to receive therapeutic doses of NI as a preventive measure regardless of duration of exposure. The objective of this study was to determine optimal intervention in high-risk patients exposed to influenza based on duration of spatial overlap and viral testing at the time exposure is recognized. Methods MSK is a 473-bed tertiary care cancer center. Infection Control performs contact investigation for cases diagnosed with influenza including baseline testing of exposed roommates using a multiplex PCR test. The primary team is notified of exposures and makes recommendations regarding prophylaxis. Retrospective review of patients considered exposed to influenza during three seasons was performed. Information on spatial overlap, prophylaxis, and viral testing was extracted. Results Out of 64 patients exposed, five (8%) developed influenza (table). Baseline testing was done in 51 (80%): none with overlap of <4 days were symptomatic or tested positive; 2/12 with overlap >4 days tested positive. Attack rate for those with exposure time <4 days who did not receive prophylaxis was 2.6%. No breakthrough infection occurred in the prophylaxis group. Post exposure follow-up revealed two more cases for those overlapping >4 days; a single case of breakthrough infection developed at 7 days, resistance testing was not performed, and patient responded to therapeutic doses of NI without persistent shedding. Conclusion Duration of overlap in semi-private rooms correlates with secondary cases of influenza. Prophylactic doses of NI are safe and effective for asymptomatic individuals with exposure <4 days to index case. For patients with spatial overlap >4 days, baseline testing is recommended to recognize cases early and interrupt nosocomial transmission. Disclosures All authors: No reported disclosures.

Critical Evaluation of Impedance Phlebography for the Diagnosis of Deep Vein Thrombosis

1974 ◽  
Vol 31 (02) ◽  
pp. 273-278
Author(s):  
Kenneth K Wu ◽  
John C Hoak ◽  
Robert W Barnes ◽  
Stuart L Frankel
Keyword(s):  
Deep Vein Thrombosis ◽  
False Positive ◽  
False Negative ◽  
Critical Evaluation ◽  
Original Method ◽  
Vein Thrombosis ◽  
Negative Results ◽  
False Negative Results ◽  
Deep Vein ◽  
Positive Results

SummaryIn order to evaluate its daily variability and reliability, impedance phlebography was performed daily or on alternate days on 61 patients with deep vein thrombosis, of whom 47 also had 125I-fibrinogen uptake tests and 22 had radiographic venography. The results showed that impedance phlebography was highly variable and poorly reliable. False positive results were noted in 8 limbs (18%) and false negative results in 3 limbs (7%). Despite its being simple, rapid and noninvasive, its clinical usefulness is doubtful when performed according to the original method.

Comparison of two rapid tests for the detection of legionellaceae in water: a microbiological-immunological method and a commercial gene-probe testkit

1995 ◽  
Vol 31 (5-6) ◽  
pp. 403-406 ◽  
Author(s):  
E. Frahm ◽  
U. Obst
Keyword(s):  
Monoclonal Antibodies ◽  
Conventional Method ◽  
Standard Method ◽  
False Positive ◽  
Gene Probe ◽  
Immunological Method ◽  
Probe Test ◽  
Rapid Tests ◽  
Positive Results

Two recently developed Legionella detection tests, a microbiological-immunological method based on monoclonal antibodies (carried out as a colony-blot assay) and a commercial gene-probe testkit (the EnvironAmp Legionella Kit), are compared with the standard method. The colony-blot assay is faster than the conventional method; the gene-probe test is much faster still and is the most sensitive, but in consequence is at greater risk of false-positive results.

397 Intra-tumor immunotherapy injections utilizing image guidance in interventional radiology: clinical trial experience at a tertiary care cancer center

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A422-A422
Author(s):  
Ravi Murthy ◽  
Rahul Sheth ◽  
Alda Tam ◽  
Sanjay Gupta ◽  
Vivek Subbiah ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Interventional Radiology ◽  
Real Time ◽  
Image Guidance ◽  
Tertiary Care ◽  
Cancer Center ◽  
Imaging Guidance ◽  
Image Guided ◽  
Real Time Image ◽  
Time Image

BackgroundImage guided intra-tumor administration of investigational immunotherapeutic agents represents an expanding field of interest. We present a retrospective review of the safety, feasibility & technical nuances of real-time image guidance for injection & biopsy across a spectrum of extracranial solid malignancies utilizing the discipline of Interventional Radiology.MethodsPatients who were enrolled in image guided intratumoral immunotherapy injection (ITITI) clinical trials over a 6 year period (2013–19) at a single tertiary care cancer center were included in this analysis. Malignancy, location, imaging guidance utilized for ITITI & biopsy for injected (adscopal) & non-injected (abscopal) lesions were determined and categorized. Peri-procedural adverse events were noted.Results262 pts (146 female, 61 yrs median) participating in 29 immunotherapeutic clinical trials (TLR & STING agonists, gene therapy, anti CD-40, viral/bacterial/metabolic oncolytics) met study criteria. Malignancies included melanoma 88, sarcoma 32, colorectal 29, breast 23, lung 17, head & neck 15, ovarian 8, neuroendocrine 7, pancreatic adenocarcinoma 6, 3 each (cholangioCA, endometrial, bladder, GI tract), 2 each (RCC, thymicCA, lymphoma, merkel cell, prostate) & others 1 each (CUP, GIST, dermatofibrosarcoma, DSRT, neuroblastoma, thyroid). All 169 & 93 patients received the intended 1371 ITITI in parietal (abdominal/chest wall, extremity, neck, pelvis) or visceral (liver, lung, peritoneum, adrenal) locations respectively; 83 patients received lymph node injections within either location. Imaging guidance was US in 68% of the cohort (US 161, CT+US 19); CT was used in 30% (81) & MRI in 1 patient. Median diameter of the ITITI lesion was 32 mm (8–230 mm). Median volume of the ITITI therapeutic material/session was 2 ml (1–6.9 ml). Lesions were accessed using a coaxial technique. ITITI delivery needles used at operator preference & tailored to lesion characteristics were either a 21G/22G Chiba, 21G Profusion (Cook Medical), 22G Morrison (AprioMed), 25G hypodermic (BD) & 18G Quadrafuse (Rex Medical). 2840 core biopsies (>18G Tru-cut core, Mission, Bard Medical) were performed in 237 patients during 690 procedures; biopsy sessions were often concurrent & of the ITITI site. 137 patients also underwent biopsy of a non-ITITI site (89 parietal location). Dimensions of the non-ITITI lesion were median 10 mm (7–113 mm); US image guidance was used in 97 patients (72%) to obtain a total of 1257, >18G Tru-core samples. 1.3% of injections resulted in SAE (NCI CTC AE >3) and 0.5% of 4097 biopsies developed major complications (SIR Criteria); both categories were manageable.ConclusionsUtilizing real time image guidance, ITITI to the administration of a myriad of investigational immunotherapeutic agents with concomitant biopsy procedures to date are associated with a high technical success rate & favorable safety profile.AcknowledgementsJoshua Hein, Mara Castaneda, Jyotsna Pera, Yunfang Jiang,Shuang Liu, Holly Liu and Anna LuiTrial RegistrationN/AEthics ApprovalThe study was approved by Institution’s Ethics Board, approval number 2020-0536: A retrospective study to determine the safety, feasibility and technical challenges of real-time image guidance for intra-tumor injection and biopsy across multiple solid tumors.Consent2020-0536 Waiver of Informed ConsentReferenceSheth RA, Murthy R, Hong DS, et al. Assessment of image-guided intratumoral delivery of immunotherapeutics in patients with cancer. JAMA Netw Open 2020;3(7):e207911. doi:10.1001/jamanetworkopen.2020.7911

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