News about Health (Part 76)

Clinical presentation of patients with aseptic meningitis: Results — Anti-infective use

Meningitis

Further analysis (linear regression using the same characteristics as above) of the empirically treated group demonstrated that age older than 16 years was a determinant in the provision of acyclovir, accounting for 22.6% (n=38) of the variability between the administered and the nonadministered groups. By linear regression, those receiving both antibiotics and acyclovir were also more likely to be adults. An age older than 16 years was responsible for 14.5% of the variance within the group who received both anti-infectives, headache for those receiving only acyclovir (20.6 % variance explained), and age older than 16 years and nausea (22.6 % and 10.0 % variance, respectively) for those receiving antibiotics alone (n=38). In the adult population, ANOVA demonstrated that a higher CSF glucose level was associated with acyclovir use (P=0.008, n=37), while a lower CSF glucose level was associated with antibiotic use (P=0.015, n=37). The presence of headache also played a role in the prescription of antibiotics, accounting for 20.6% of the variance between the treated group and the untreated group (n=38), by linear regression.

Clinical presentation of patients with aseptic meningitis: Methods

Subsequent to appropriate ethics approval from both institutions, patients seen at Capital District Health Authority (CDHA) (Halifax, Nova Scotia) hospitals or the Izaak Walton Killam (IWK) Hospital (Halifax, Nova Scotia) whose CSF samples were tested for the presence of enterovirus by means of PCR from January 2006 to December 2008 were identified from the laboratory information systems. All adults from CDHA with either positive or negative EV PCR test results were reviewed. Due to the large volume of pediatric charts, all EV-positive children were reviewed and date-matched to an equal number of EV-negative pediatric patients. For the examination of the seasonality of EV meningitis all 372 Nova Scotian EV PCR-tested patients were included.

Clinical presentation of patients with aseptic meningitis: part 2

Enteroviral (EV) meningitis can often present with signs and symptoms that broadly overlap with those of other forms of meningitis. Consequently, patients presenting with EV meningitis are sometimes admitted for observation and treatment until definitive testing can be performed. However, EV meningitis is usually self-limiting and many patients could probably be discharged if clinical or laboratory findings were more discriminating. Features of EV meningitis may also overlap with those of central nervous system herpes infections, in which case acyclovir is often beneficial. Enteroviruses are the most common cause of viral meningitis, accounting for 80% to 92% of aseptic meningitis cases in which a causative agent has been identified. Enterovirsues are of fecal-oral origin and EV meningitis is highly seasonal, usually occurring between the late summer and the fall.

A cerebrospinal fluid (CSF) sample is routinely obtained from patients presenting with meningitis and is analyzed for markers of infection. When the Gram stain is negative, the clinician must decide whether there is enough evidence to confidently discount bacterial infection and to discharge the patient.

Clinical presentation of patients with aseptic meningitis: part 1

aseptic meningitis
Clinical presentation of patients with aseptic meningitis factors influencing treatment and hospitalization, and consequences of enterovirus cerebrospinal fluid polymerase chain reaction testing.

Introduction: Clinical and laboratory features of enteroviral meningitis may overlap with those of bacterial meningitis. In the present retrospective review, we compared features of enteroviral (EV)-positive and -negative patients to determine those that were most influential in admission, discharge and in anti-infective administration.

Methods: Data were analyzed from the records of 117 pediatric and adult patients who underwent cerebrospinal fluid (CSF) EV testing over a three-year period.

Helicobacter pylori anti-CagA antibodies: DISCUSSION Part 3

DISCUSSIONDifferences in the frequencies of the immunoreactive bands to the six antigens between the symptomatic and asymptomatic subjects in the present study were attributed to individual and strain variability. In addition, the human gastric mucosa colonized by H pylori shows a variety of responses that may vary greatly in the intensity and distribution of the histological responses and correlation with the clinical outcome. The detection of CIM did not seem to add any further information to the interpretation of the results.

Helicobacter pylori anti-CagA antibodies: DISCUSSION Part 2

DISCUSSIONImmunoblotting is a more sensitive serological test than ELISA for the diagnosis of H pylori infection and the detection of specified antigens. With immunoblot testing, no significant age difference in the response to CagA antigen between patients older than 45 years and those younger than 45 years of age was found, indicating that the prevalence of CagA-positive strains is not restricted to older age and that subjects in different age groups mount a good antibody response to the CagA antigen.

Helicobacter pylori anti-CagA antibodies: DISCUSSION Part 1

DISCUSSIONIn this study, the prevalence of H pylori in gastric biopsies of symptomatic subjects was determined by CLO, culture and histology. If one test was positive, patients were considered to be infected. Others have reported using a similar approach. In comparison with the biopsy-based tests, serology proved to be useful for the detection of H pylori infection. A review of the overall performance of the commercially available serology kits that measure IgG antibodies showed that serology is an accurate method of diagnosing H pylori in patients. Comparison between serology and the combination of CLO, histology and culture revealed 94% sensitivity and 88% specificity. Compared with the biopsy-based tests, ELISA was 89% sensitive and 100% specific in detecting H pylori infection in symptomatic subjects. These results were in agreement with those of an earlier study.

H pylori is associated with several gastroduodenal diseases such as gastritis, gastric ulcer, duodenal ulcer, gastric adenocarcinoma and mucosa-associated lymphoid tissue (MALT) lymphoma. CagA has been associated with the development of peptic ulcer disease and gastric cancer. It is expressed in approximately 60% of the isolates and the protein is highly immunogenic, while vacA gene, although present in nearly all strains, is expressed in only 50% of the isolates.

Helicobacter pylori anti-CagA antibodies: RESULTS Part 2

Asymptomatic subjects
Among the 119 asymptomatic subjects, 76 (64%) were found to be H pylori positive by ELISA. The sera from 40 of these subjects (randomly selected) were analyzed by immunoblotting. Table 3 compares the immunoblot results of H pylori antigens in symptomatic and asymptomatic subjects. Immunoblots revealed antibodies to CagA antigen in 26 (87%) symptomatic and 33 (83%) asymptomatic subjects. The frequencies of immunoreactive bands to VacA and to other antigens in the immunoblots of both groups were variable. The CIM was detected in 35 of 40 (87%) positive strips. Figure 1 shows representative immunoblot strips from H pylori-positive, asymptomatic subjects.

Helicobacter pylori anti-CagA antibodies: RESULTS Part 1

Symptomatic subjects
Biopsies were taken, and the presence of H pylori was determined through CLO, culture and histology. Patients were considered to be infected if one test was positive. Fifty-seven of 66 patients were found, by either one of the biopsy-based tests, to be infected with H pylori. Results of the ELISA test were compared with those of the biopsy-based tests. ELISA was shown to have 89% sensitivity (95% CI 81.5 to 95.5%), 100% specificity, 100% positive predictive value and 67% negative predictive value (95% CI 55.5 to 78.3%). Among the 66 symptomatic subjects included in the study, 32 of 38 (84%) men and 22 of 28 (79%) women were found to be H pylori-positive by ELISA – a total of 54 of 66 (82%) subjects.

Immunoblot assay was performed on 30 randomly selected ELISA-positive sera from symptomatic subjects. Table 1 shows the correlation between the prevalence of CagA antibodies and age. Twelve of 14 (86%) patients older than 45 years of age and 12 of 16 (75%) patients younger than 45 years of age were positive for CagA antibodies. Statistical analysis showed no significant difference between these age groups. CagA antibodies were detected in patients with the following histological findings: 11 of 14 (79%) with chronic gastritis, 12 of 13 (92%) with duodenal ulcer and three of three (100%) with gastric cancer (one patient also had gastric ulcer) (Table 2). VacA antibodies were detected in eight of 14 (57%) subjects with chronic gastritis, 11 of 13 (85%) with duodenal ulcer and two of three (67%) with gastric cancer. Antibodies to the other four antigens varied also in their frequency pattern (Table 2). The CIM appeared in 25 of 30 (83%) positive strips.

Helicobacter pylori anti-CagA antibodies: SUBJECTS AND METHOD Part 3

Immunoblot assay
The Helico-Blot 2.1 (Genelabs Diagnostics, Singapore) was used to test the ELISA-positive serum samples from both groups. The test is based on Western blot assay of H pylori whole-cell antigens that is made from bacterial lysate of a strain of H pylori that is known to cause ulcers. Strips were marked at the 116 (CagA), 89 (VacA), 37, 35, 30 and 19.5 kDa antigen lines and at an additional antigen line, designated the current infection marker (CIM). The recommended criteria for determining H pylori seropositivity as specified by the manufacturer is any one of:

• the detection of 116 kDa (CagA) band with one or more bands of 89, 37, 35, 30 (UreA) and 19.5 kDa together, or with CIM;

• any one band of the 89, 37 or 35 kDa, with or without the CIM; or

• detection of both the 30 and 19.5 kDa bands, with or without the CIM.

Imaging and analysis of immunoblots were done using Gel Doc 2000 and Quantity One quantification software (BioRad, USA).

Statistical analysis
Data were analyzed using SPSS 10.1 (SPSS Inc, USA). P<0.05 was considered to be statistically significant.

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