scholarly journals Risk of Ruling out Severe Acute Respiratory Syndrome by Ruling in another Diagnosis: Variable Incidence of Atypical Bacteria Coinfection Based on Diagnostic Assays

2006 ◽  
Vol 13 (1) ◽  
pp. 17-22 ◽  
Author(s):  
George Zahariadis ◽  
Ted A Gooley ◽  
Phyllis Ryall ◽  
Christine Hutchinson ◽  
Mary I Latchford ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Community Hospital ◽  
Present Report ◽  
Significant Risk ◽  
Chlamydophila Pneumoniae ◽  
Clinical Suspicion ◽  
Serological Evidence ◽  
Positive Serology ◽  
Diagnostic Assays ◽  
Atypical Pathogens

BACKGROUND: Severe acute respiratory syndrome (SARS) caused the first epidemic of the 21st century and continues to threaten the global community.OBJECTIVE: To assess the incidence of coinfection in patients confirmed to have SARS-associated coronavirus (SARS-CoV) infection, and thus, to determine the risk of ruling out SARS by ruling in another diagnosis. METHODS: The present report is a retrospective study evaluating the incidence and impact of laboratory-confirmed SARS-CoV and other pulmonary pathogens in 117 patients. These patients were evaluated in a Toronto, Ontario, community hospital identified as the epicentre for the second SARS outbreak.RESULTS: Coinfection with other pulmonary pathogens occured in patients with SARS. Seventy-three per cent of the patient population evaluated had laboratory-confirmed SARS-CoV infection. Serology showing acute or recentChlamydophila pneumoniaeorMycoplasma pneumoniaeinfection revealed an incidence of 30% and 9%, respectively, in those with SARS. These rates are similar to previously published studies on coinfection in pneumonia. All nucleic acid diagnostic assays were negative forC pneumoniaeandM pneumoniaein respiratory samples from patients with SARS having serological evidence for these atypical pathogens.CONCLUSIONS: Diagnostic assays for well-recognized pulmonary pathogens have limitations, and ruling out SARS-CoV by ruling in another pulmonary pathogen carries significant risk. Despite positive serology for atypical pathogens, in a setting where clinical suspicion for SARS is high, specific tests for SARS should be performed to confirm or exclude a diagnosis.

scholarly journals Comparison of Five Serological Assays for the Detection of SARS-CoV-2 Antibodies

Diagnostics ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. 78
Author(s):  
Anja Dörschug ◽  
Julian Schwanbeck ◽  
Andreas Hahn ◽  
Anke Hillebrecht ◽  
Sabine Blaschke ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Blood Donor ◽  
Immunoglobulin G ◽  
The Other ◽  
Specific Antibodies ◽  
Diagnostic Assays ◽  
Immunoglobulin Class ◽  
Corona Virus ◽  
Immunoglobulin Subclass

Serological assays can contribute to the estimation of population proportions with previous immunologically relevant contact with the Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) virus. In this study, we compared five commercially available diagnostic assays for the diagnostic identification of SARS-CoV-2-specific antibodies. Depending on the assessed immunoglobulin subclass, recorded sensitivity ranged from 17.0% to 81.9% with best results for immunoglobulin G. Specificity with blood donor sera ranged from 90.2% to 100%, with sera from EBV patients it ranged from 84.3% to 100%. Agreement from fair to nearly perfect was recorded depending on the immunoglobulin class between the assays, the with best results being found for immunoglobulin G. Only for this immunoglobulin class was the association between later sample acquisition times (about three weeks after first positive PCR results) and positive serological results in COVID-19 patients confirmed. In conclusion, acceptable and comparable reliability for the assessed immunoglobulin G-specific assays could be shown, while there is still room for improvement regarding the reliability of the assays targeting the other immunoglobulin classes.

Comorbidity and severity-of-illness risk adjustment for hospital-onset Clostridioides difficile infection using data from the electronic medical record

2020 ◽  
pp. 1-7
Author(s):  
Stephanie M. Cabral ◽  
Katherine E. Goodman ◽  
Natalia Blanco ◽  
Surbhi Leekha ◽  
Larry S. Magder ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Risk Adjustment ◽  
Community Hospital ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Bivariate Analysis ◽  
Patient Admissions ◽  
Clostridioides Difficile ◽  
Risk Adjustment Model

Abstract Objective: To determine whether electronically available comorbidities and laboratory values on admission are risk factors for hospital-onset Clostridioides difficile infection (HO-CDI) across multiple institutions and whether they could be used to improve risk adjustment. Patients: All patients at least 18 years of age admitted to 3 hospitals in Maryland between January 1, 2016, and January 1, 2018. Methods: Comorbid conditions were assigned using the Elixhauser comorbidity index. Multivariable log-binomial regression was conducted for each hospital using significant covariates (P < .10) in a bivariate analysis. Standardized infection ratios (SIRs) were computed using current Centers for Disease Control and Prevention (CDC) risk adjustment methodology and with the addition of Elixhauser score and individual comorbidities. Results: At hospital 1, 314 of 48,057 patient admissions (0.65%) had a HO-CDI; 41 of 8,791 patient admissions (0.47%) at community hospital 2 had a HO-CDI; and 75 of 29,211 patient admissions (0.26%) at community hospital 3 had a HO-CDI. In multivariable regression, Elixhauser score was a significant risk factor for HO-CDI at all hospitals when controlling for age, antibiotic use, and antacid use. Abnormal leukocyte level at hospital admission was a significant risk factor at hospital 1 and hospital 2. When Elixhauser score was included in the risk adjustment model, it was statistically significant (P < .01). Compared with the current CDC SIR methodology, the SIR of hospital 1 decreased by 2%, whereas the SIRs of hospitals 2 and 3 increased by 2% and 6%, respectively, but the rankings did not change. Conclusions: Electronically available patient comorbidities are important risk factors for HO-CDI and may improve risk-adjustment methodology.

Serological evidence of toxocariasis in patients from Spain with a clinical suspicion of visceral larva migrans

1997 ◽  
Vol 71 (1) ◽  
pp. 9-12 ◽  
Author(s):  
S. Fenoy ◽  
C. Cuéllar ◽  
J.L. Guillén
Keyword(s):  
Urban Areas ◽  
Clinical Suspicion ◽  
Larva Migrans ◽  
Visceral Larva Migrans ◽  
Elisa Method ◽  
Serological Evidence ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
Secretory Antigen ◽  
Excretory Secretory Antigen

AbstractSera from patients with clinical characteristics of toxocariasis were assayed using the ELISA method and larval excretory-secretory antigen. Four hundred and seven samples of Toxocara serology were received at the laboratory of ‘Ciudad Sanitaria Juan Canalejo’ Hospital of Corunna, Spain, from 1984 to 1989. Of these, 30 were from adults, 332 from children and 45 from patients of unknown age, resulting in Toxocara seroprevalences of 23.3%, 32.8% and 17.7% respectively. The reasons for these serological differences in the rural and urban areas of Galicia, Spain are discussed.

Nosocomial Acquisition of Methicillin-ResistantStaphylococcus aureusDuring an Outbreak of Severe Acute Respiratory Syndrome

2005 ◽  
Vol 26 (2) ◽  
pp. 134-137 ◽  
Author(s):  
Susan M. Poutanen ◽  
Mary Vearncombe ◽  
Allison J. McGeer ◽  
Michael Gardam ◽  
Grant Large ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Infection Control ◽  
Retrospective Cohort ◽  
Healthcare Workers ◽  
Community Hospital ◽  
Tertiary Care ◽  
Appropriate Use ◽  
Contact Precautions ◽  
Control Education ◽  
Tertiary Care Hospitals

AbstractObjective:The four hospitals assessed in this study use active surveillance cultures for methicillin-resistantStaphylococcus aureus(MRSA) and contact precautions for MRSA-positive patients as part of routine infection control practices. The objective of this study was to determine whether nosocomial acquisition of MRSA decreased in these hospitals during an outbreak of severe acute respiratory syndrome (SARS) when barrier precautions were routinely used for all patients.Design:Retrospective cohort study.Setting:Three tertiary-care hospitals (a 1,100-bed hospital; a 500-bed hospital; and an 823-bed hospital) and a 430-bed community hospital, each located in Toronto, Ontario, Canada.Patients:All admitted patients were included.Results:The nosocomial rate of MRSA in all four hospitals combined during the SARS outbreak (3.7 per 10,000 patient-days) was not significantly different from that before (4.7 per 10,000 patient-days) or after (3.4 per 10,000 patient-days) the outbreak (P= .30 andP= .76, respectively). The nosocomial rate of MRSA after the outbreak was significantly lower than that before the outbreak (P= .003). Inappropriate reuse of gloves and gowns and failure to wash hands between patients on non-SARS wards were observed during the outbreak. Increased attention was paid to infection control education following the outbreak.Conclusions:Inappropriate reuse of gloves and gowns and failure to wash hands between patients may have contributed to transmission of MRSA during the SARS outbreak. Attention should be paid to training healthcare workers regarding the appropriate use of precautions as a means to protect themselves and patients.

scholarly journals Development, Characterization, and Application of Monoclonal Antibodies against Severe Acute Respiratory Syndrome Coronavirus Nucleocapsid Protein

2010 ◽  
Vol 17 (12) ◽  
pp. 2033-2036 ◽  
Author(s):  
Dipankar Das ◽  
Sriram Kammila ◽  
Mavanur R. Suresh
Keyword(s):  
Monoclonal Antibodies ◽  
Severe Acute Respiratory Syndrome ◽  
Western Blotting ◽  
Nucleocapsid Protein ◽  
Epitope Mapping ◽  
High Specificity ◽  
Diagnostic Assays ◽  
Hybridoma Technology ◽  
Recombinant Nucleocapsid Protein

ABSTRACT Five monoclonal antibodies (MAbs) against recombinant nucleocapsid protein (NP) of severe acute respiratory syndrome (SARS)-causing coronavirus (CoV) were developed by hybridoma technology. Epitope mapping by Western blotting showed that these anti-SARS-CoV NP MAbs bind to distinct domains of NP. These anti-SARS-CoV NP MAbs, with their high specificity, are potentially ideal candidates for developing early and sensitive diagnostic assays for SARS-CoV.

scholarly journals Co-infection of SARS-CoV-2 with Chlamydia or Mycoplasma pneumoniae: a case series and review of the literature

2020 ◽  
Author(s):  
Alessandra Oliva ◽  
Guido Siccardi ◽  
Ambra Migliarini ◽  
Francesca Cancelli ◽  
Martina Carnevalini ◽  
...  
Keyword(s):  
Mycoplasma Pneumoniae ◽  
Chlamydia Pneumoniae ◽  
Present Report ◽  
Case Series ◽  
Respiratory Pathogens ◽  
The Novel ◽  
Global Pandemic ◽  
Large Teaching Hospital ◽  
Atypical Pathogens ◽  
Novel Coronavirus

Abstract The novel coronavirus SARS-CoV-2 has spread all over the world causing a global pandemic and representing a great medical challenge. Nowadays, there is limited knowledge on the rate of co-infections with other respiratory pathogens, with viral co-infection being the most representative agents. Co-infection with Mycoplasma pneumoniae has been described both in adults and pediatrics whereas only 2 cases of Chlamydia pneumoniae have been reported in a large US study so far. In the present report, we describe a series of 7 patients where co-infection with C. pneumoniae (n=5) or M. pneumoniae (n=2) and SARS-CoV-2 was detected in a large teaching hospital in Rome. An extensive review of the updated literature regarding the co-infection between SARS-CoV-2 and these atypical pathogens is also performed.

scholarly journals An Insight Into COVID-19: A 21st Century Disaster and Its Relation to Immunocompetence and Food Antioxidants

2021 ◽  
Vol 7 ◽  
Author(s):  
Faisal Siddique ◽  
Rao Zahid Abbas ◽  
Muhammad Khalid Mansoor ◽  
Etab Saleh Alghamdi ◽  
Muhammad Saeed ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Global Economy ◽  
Clinical Laboratory ◽  
Current Knowledge ◽  
Rna Virus ◽  
Significant Risk ◽  
World Health ◽  
High Nucleotide Sequence Identity ◽  
Effective Vaccine ◽  
Near Future

Coronavirus Disease 2019 (COVID-19) ranks third in terms of fatal coronavirus diseases threatening public health, coming after SARS-CoV (severe acute respiratory syndrome coronavirus), and MERS-CoV (Middle East respiratory syndrome coronavirus). SARS-CoV-2 (severe acute respiratory syndrome coronavirus type 2) causes COVID-19. On January 30, 2020, the World Health Organization (WHO) announced that the current outbreak of COVID-19 is the sixth global health emergency. As of December 3, 2020, 64 million people worldwide have been affected by this malaise, and the global economy has experienced a loss of more than $1 trillion. SARS-CoV-2 is a positive-sense single-stranded RNA virus belonging to the Betacoronavirus genus. The high nucleotide sequence identity of SARS-CoV-2 with the BatCoV RaTG13 genome has indicated that bats could be the possible host of SARS-CoV-2. SARS-CoV-2 penetrates the host cell via binding its spike protein to the angiotensin-converting enzyme 2 (ACE2) receptor, which is similar to the mechanisms of SARS-CoV and MERS-CoV. COVID-19 can spread from person to person via respiratory droplets and airborne and contaminated fomites. Moreover, it poses a significant risk to smokers, the elderly, immunocompromised people, and those with preexisting comorbidities. Two main approaches are used to control viral infections, namely, vaccination, and biosecurity. Studies to analyze the antigenicity and immunogenicity of SARS-CoV-2 vaccine candidates are underway, and few vaccines may be available in the near future. In the current situation, the Human Biosecurity Emergency (HBE) may be the only way to cope effectively with the novel SARS-CoV-2 strain. Here, we summarize current knowledge on the origin of COVID-19 as well as its epidemiological relationship with humans and animals, genomic resemblance, immunopathogenesis, clinical-laboratory signs, diagnosis, control and prevention, and treatment. Moreover, we discuss the interventional effects of various nutrients on COVID-19 in detail. However, multiple possibilities are explored to fight COVID-19, and the greatest efforts targeted toward finding an effective vaccine in the near future. Furthermore, antioxidants, polyphenols, and flavonoids, both synthetic and natural, could play a crucial role in the fight against COVID-19.

scholarly journals Thirty-Day Unplanned Readmission after Total Knee Arthroplasty at a Teaching Community Hospital: Rates, Reasons, and Risk Factors

2019 ◽  
Vol 33 (02) ◽  
pp. 206-212 ◽  
Author(s):  
Kalain K. Workman ◽  
Nathan Angerett ◽  
Ronald Lippe ◽  
Alex Shin ◽  
Scott King
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Community Hospital ◽  
Significant Risk ◽  
The United States ◽  
Administrative Database ◽  
Unplanned Readmission ◽  
Teaching Community ◽  
Total Knee

AbstractUnplanned readmission after total knee arthroplasty (TKA) has an increasing prevalence in the United States. Readmissions are now a metric for hospital quality of care, yet there are mixed results and variables associated with unplanned readmission. In this changing healthcare, it is critical for community healthcare institutions to identify risk factors for unplanned readmissions following TKA. Retrospective chart review and a hospital administrative database query to report causes, demographics, and medical comorbid risk factors result in 30-day readmission after undergoing primary TKA between 2011 and 2016 at a teaching community hospital. This study identified 7,482 primary TKA procedures of which 210 (2.8%) were unplanned readmissions. Gastrointestinal bleed (9.05%) and periprosthetic infection (8.10%) were the most common causes of readmission. Age 65 and older (odds ratio [OR], 1.64; 95% confidence interval [CI], 1.21–2.21; p = 0.0012), male (OR, 1.37; 95% CI, 1.03–1.83; p = 0.0302), length of stay > 3 days (OR, 2.04; 95% CI, 1.45–2.86; p < 0.0001), and discharge to rehab (OR, 2.21; 95% CI, 1.49–3.26; p ≤ 0.0001) were correlated significantly with risk of 30-day readmission. Chronic airway disease (OR, 2.81; 95% CI, 1.54–5.14; p = 0.0008) and obesity (OR, 1.45; 95% CI, 1.006–2.10; p = 0.0463) were significant risk factors. Higher Charlson comorbidity index was not a predictor of time to readmission within 30 days after TKA.

scholarly journals The Spectrum of Manifestations of Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV2) Infection in Children: What We Can Learn From Multisystem Inflammatory Syndrome in Children (MIS-C)

2021 ◽  
Vol 8 ◽  
Author(s):  
Salvatore Panaro ◽  
Marco Cattalini
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Molecular Mimicry ◽  
Severe Infection ◽  
Myocardial Inflammation ◽  
Toxic Shock ◽  
Positive Serology ◽  
Hemodynamic Compromise ◽  
Inflammatory Syndrome ◽  
Post Infectious ◽  
System Organ

Multisystem Inflammatory Syndrome in Children (MIS-C) is defined as a clinically serious condition requiring hospitalization with fever, multi-system organ disfunction, inflammatory biomarkers increase. The syndrome develops in the context of a probable or ascertained Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV2) infection, but other possible etiologies should be ruled out for definitive diagnosis. On the clinical side, along with the multi-system involvement, myocarditis with heart failure and shock is the most striking feature. Capillary leak is another fundamental feature of MIS-C. In fact, shock and hemodynamic compromise in MIS-C can occur also in the absence of laboratory evidence of myocardial inflammation, with preserved cardiac function and rapid reversibility. Since the first observations of MIS-C patients, it was evident that there is a delay between the peak of adult cases of Coronavirus disease 19 (COVID-19) and the MIS-C peak. Moreover, SARS-Cov2 isolation in children with MIS-C is not always possible, due to low viral load, while positive serology is far more commonly observed. These observations lead to the interpretation of MIS-C as a post-infectious disease. Although the exact pathogenesis of MIS-C is far from being elucidated, it is clear that it is a hyperinflammatory disease with a different inflammatory response as compared to what is seen in acute SARS-CoV-2 infection and that the disease shares some, but not all, immunological features with Macrophage Activation Syndrome (MAS), Kawasaki Disease (KD), Hemophagocytic Lymphohistiocytosis (HLH), and Toxic Shock Syndrome (TSS). Different mechanisms have been hypothesized as being responsible, from molecular mimicry to antibody dependent enhancement (ADE). Some evidence has also been collected on the immunological profile of patients with MIS-C and their difference from COVID-19. This review is focused on critical aspects of MIS-C clinical presentation and pathogenesis, and different immunological profiles. We propose a model where this hyperinflammatory disease represents one manifestation of the SARS-CoV2 spectrum in children, going from asymptomatic carriers to the post-infectious MIS-C, through symptomatic children, a low number of which may suffer from a severe infection with hyperinflammation (pediatric Hyper-COVID).

scholarly journals Serological Evidence of IncreasedCoccidioides immitisInfections in Western Canada in 1996

1998 ◽  
Vol 9 (6) ◽  
pp. 377-381 ◽  
Author(s):  
Errol Prasad ◽  
Patricia Diediw ◽  
Donna Fernandes ◽  
Lorreen Hodge ◽  
Katherine Ower ◽  
...  
Keyword(s):  
Enzyme Immunoassay ◽  
Clinical Presentation ◽  
Disease Process ◽  
Pulmonary Infiltrate ◽  
Immunoglobulin M ◽  
Western Canada ◽  
Coccidioides Immitis ◽  
Serological Evidence ◽  
Positive Serology ◽  
The Mean

OBJECTIVE: To investigate the epidemiology ofCoccidioides immitisinfection in persons returning to western Canada fromC immitisendemic zones in southwestern United States.DESIGN: Review ofC immitisserology requests from 1996.METHODS: Data were based on review of enzyme immunoassay and immunodiffusion results from 1993 to 1996 inclusive. Detailed information on clinical presentation, treatment and outcome of disease process was obtained through questionnaires and interviews with physicians who submittedCoccidioidesserology requests in 1996.RESULTS: Positive serology forC immitisincreased from 4.7% to 5.2% (between 1993 and 1995 inclusive) to 10.7% in 1996. Enzyme immunoassay for immunoglobulin G and/or immunoglobulin M or immunodiffusion was positive in 25 patients in 1996. The mean age of these patients was 62 years, and the predominant clinical presentation was pulmonary infiltrate with fever. All patients with positive serology were known to have travelled to central or southwestern Arizona or southern California.CONCLUSIONS: Travel to a defined coccidioidomycosis endemic zone presents a risk for the older traveller. Serology forC immitissupported the clinical, histological and microbiological diagnoses in patients who had travelled to this defined endemic zone.

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