RESUMEN
Direct detection of Mycobacterium tuberculosis was performed in parallel with the Amplicor M. tuberculosis test (Roche Diagnostic System, USA) and the LCx M. tuberculosis (Abbott Diagnostic Division, USA) on 697 samples, collected from 481 patients, in three different Italian laboratories. Though both systems are licensed only for pulmonary specimens, 113 extrapulmonary specimens (represented mainly by pleural fluids, cerebrospinal fluids and urines) were included in the study. Amplification results were compared with acid-fast microscopy, culture, and identification of isolates. Final clinical diagnosis was used to resolve discrepant results. M. tuberculosis was detected in 105 specimens by both assays, whereas 561 were agreeing negatives; 21 and 6 of the remaining true-positive samples scored positive with LCx only and with Amplicor only, respectively. There were three false-positives with LCx and one false-positive with Amplicor. The diagnostic sensitivity of both methods was significantly better when only respiratory specimens were considered (78% versus 59% in nonrespiratory samples with Amplicor, and 88% versus 65% with LCx). Our data reveal a significantly better sensitivity of the LCx (p = 0.026) and a slight better specificity of the Amplicor assay. It is noteworthy that 16 of the 21 Amplicor-negative specimens in which LCx detected M. tuberculosis were culture negative, thus suggesting that the higher diagnostic sensitivity of the latter assay is attributable to its better analytical sensitivity. However, the majority of such samples originated from patients under antimicrobial treatment, which makes uncertain the clinical significance of such increased sensitivity. Considering true-positive for LCx and true-negative for Amplicor, the 16 culture-negative/LCx-positive/Amplicor-negative specimens resulted true-positives after the resolution of discrepancies, the final overall sensitivity and specificity values of the LCx assay were not significantly different from the ones of the Amplicor assay.
Asunto(s)
Mycobacterium tuberculosis/aislamiento & purificación , Reacción en Cadena de la Polimerasa/métodos , Tuberculosis/diagnóstico , Tuberculosis/microbiología , Medios de Cultivo , Estudios de Evaluación como Asunto , Amplificación de Genes , Humanos , Laboratorios , Ligasas/metabolismo , Mycobacterium tuberculosis/crecimiento & desarrollo , Juego de Reactivos para Diagnóstico , Sensibilidad y Especificidad , Manejo de Especímenes , Esputo/microbiologíaRESUMEN
Interactions between HPA (Hypothalamic-pituitary-axis) and immune system seem to involve the EPO (endogenous opioid peptides) system, as shown by some recent findings. Possible relationships between beta-endorphin (beta-End) synthesis and severity rate of immunodeficiency have been studied in 48 HIV Ab positive patients, at different stages of infection. A statistically significant decrease in the beta-End synthesis was observed in these patients, as compared to a control group of 19 healthy subjects, but this decrease was not related to the CD4+T lymphocytes number. Plasmatic levels modifications of HPA-related peptides were not observed in the IVC1 CDC group.
Asunto(s)
Hormona Adrenocorticotrópica/metabolismo , Infecciones por VIH/metabolismo , Hidrocortisona/metabolismo , betaendorfina/metabolismo , Síndrome de Inmunodeficiencia Adquirida/sangre , Síndrome de Inmunodeficiencia Adquirida/líquido cefalorraquídeo , Síndrome de Inmunodeficiencia Adquirida/metabolismo , Hormona Adrenocorticotrópica/sangre , Hormona Adrenocorticotrópica/líquido cefalorraquídeo , Adulto , Infecciones por VIH/sangre , Infecciones por VIH/líquido cefalorraquídeo , Humanos , Hidrocortisona/sangre , Hidrocortisona/líquido cefalorraquídeo , Persona de Mediana Edad , betaendorfina/sangre , betaendorfina/líquido cefalorraquídeoRESUMEN
Thyroid function was evaluated in 119 human immunodeficiency virus (HIV) infected patients at different stages of infection, compared with euthyroid normal subjects and hepatitis C virus infected blood donors as control groups. The low T3 state, well documented in severe nonthyroidal illnesses, was not found in these HIV infected patients. They showed lower FT4 levels and higher TSH and TBG values than euthyroid normal controls. These findings suggested a thyroid hypofunction becoming more evident with the progression of the infection as also supported by the presence of antithyroid autoantibodies mainly found in the symptomatic stages of the infection.
Asunto(s)
Infecciones por VIH/sangre , Glándula Tiroides/fisiopatología , Tirotropina/sangre , Tiroxina/sangre , Triyodotironina/sangre , Adulto , Femenino , Infecciones por VIH/fisiopatología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To determine the prevalence of hepatitis B and C viruses, and human immunodeficiency virus infections in women of reproductive age attending a health care system. DESIGN: Prospective cross-sectional study. SETTING: Public Obstetric Clinic and Service for Pre- and Perinatal Prevention of Infectious Diseases, Rome, Latium Region, Italy. SUBJECTS: 1142 women attending our centres consecutively for delivery, miscarriage, voluntary interruption of pregnancy or screening for pre- and perinatal prevention of infectious diseases. INTERVENTIONS: Serum samples, collected after informed consent over a period of 2 months, were tested for hepatitis B virus markers (anti-HBc and HBsAg) by enzyme linked immunosorbent assay (ELISA), for antibodies against hepatitis C virus (by ELISA and, if positive, by RIBA) and for human immunodeficiency virus antibodies (by ELISA and, if positive by Western blot). RESULTS: The seroprevalence of hepatitis B virus was 14.4% (95% CI Poisson distribution 12.2-16.5) for anti-HBc and 1.6% (95% CI, 0.9-2.5) for HBsAg. Antibodies against hepatitis C virus were detected by ELISA in 2.4% (CI 1.6-3.5) and by first generation RIBA in 0.9% (CI 0.4-1.6). Human immunodeficiency virus seroprevalence was 1.0% (CI 0.5-1.7). No significant differences were observed by age or by reason for attending. CONCLUSIONS: Women attending our centres have a higher prevalence of hepatitis B virus, hepatitis C virus and human immunodeficiency virus infection than those observed in our country in larger national surveys of newborn babies, in reproductive-aged women or in other selected low-risk groups such as blood donors. This could be due to the attendance of women at increased risk such as drug addicts. The information has the additional value of emphasizing the need for adherence by health care personnel, to the recommendations issued for the prevention of occupational infections.