Cytomegalovirus Infection in Children Undergoing Open-Heart Surgery

A group of 124 children undergoing open-heart surgery was followed prospectively in order to estimate the risk of cytomegalovirus (CMV) infection due to transfused blood.     

血液病患者的巨细胞病毒感染

用间接酶联免疫吸附实验(ELISA)对新近诊断的179例血液病患者血清巨细胞病毒(HCMV)IgM和IgA抗体进行了检测。阳性率分别为11,17％11,73％,明显高于对照人群(4,76％和3,97％),提示血液病患者由于免疫功能下降,易于发生HCMV活动性感染。     

肿瘤患者化疗后人巨细胞病毒活动性感染检测

探讨肿瘤患者化疗后人巨细胞病毒感染检测方法的应用价值。使用免疫组化法、酶联免疫吸附试验检测IgG/M抗体,以及实时荧光定量(FQ-PCR)检测HCMV DNA。47份全血标本中抗原阳性率为48.9%,平均抗原阳性细胞数7.9±8.1(1-65)/5×104WBC,HCMV DNA阳性率19.1%(10/47),HCMV DNA含量均值为6.320×105copies,白细胞HCMV-DNA阳性率51%(25/47),HCMV DNA含量均值为3.830×107 copies,HCMV pp65抗原阳性率为48.9%(23/47),IgG抗体均阳性,IgM抗体阳性率为23.4%(12/47),以PP65抗原阳性为对照,IgM抗体检测的敏感率仅为49.3%。在连续动态检测HCMV多种指标时,结合DNA及抗原动态检测具有更高临床应用价值。     

Candiduria in Hospital Patients: A Study Prospective

Tinea capitis is rare in adults. We report a case of adult tinea capitis due to Trichophyton violaceum in China. The female patient was immunosuppressed with prednisone due to the underlying disease of vulgaris pemphigus and was treated successfully with terbinafine. We also reviewed published cases of adult tinea capitis in China and compared these data with the characteristics of published cases in other regions in the world.     

豚鼠妊娠期感染巨细胞病毒的研究

本实验观察了豚鼠巨细胞病毒感染对怀孕豚鼠的影响。从皮下和心腔接种病毒感染动物,接种病毒的时间在动物妊娠早期。接种病毒后,二组动物都出现病毒血症,从动物的脾、肺和唾液腺均分离到病毒。病毒在唾液腺持续存在。皮下接种组和心腔接种组各有38％和44％的孕鼠的胚胎感染了病毒,各有27％和25％的孕鼠发生流产,皮下接种组还有63％的孕鼠怀有死胎。本实验为研究巨细胞病毒感染提供了动物模型,证实了血源途径也可以引起豚鼠的先天性巨细胞病毒感染。     

Symptoms and Clinical Course of EHEC O104 Infection in Hospitalized Patients: A Prospective Single Center Study

Objectives

Shiga-toxin producing O157:H7 Entero Haemorrhagic E. coli (STEC/EHEC) is one of the most common causes of Haemolytic Uraemic Syndrome (HUS) related to infectious haemorrhagic colitis. Nearly all recommendations on clinical management of EHEC infections refer to this strain. The 2011 outbreak in Northern Europe was the first to be caused by the serotype O104:H4. This EHEC strain was found to carry genetic features of Entero Aggregative E. coli (EAEC) and extended spectrum β lactamase (ESBL). We report symptoms and complications in patients at one of the most affected centres of the 2011 EHEC O104 outbreak in Northern Germany.

Methods

The courses of patients admitted to our hospital due to bloody diarrhoea with suspected EHEC O104 infection were recorded prospectively. These data include the patients’ histories, clinical findings, and complications.

Results

EHEC O104 infection was confirmed in 61 patients (female = 37; mean age: 44±2 years). The frequency of HUS was 59% (36/61) in our cohort. An enteric colonisation with co-pathogens was found in 57%. Thirty-one (51%) patients were treated with plasma-separation/plasmapheresis, 16 (26%) with haemodialysis, and 7 (11%) with Eculizumab. Patients receiving antibiotic treatment (n = 37; 61%) experienced no apparent change in their clinical course. Twenty-six (43%) patients suffered from neurological symptoms. One 83-year-old patient died due to comorbidities after HUS was successfully treated.

Conclusions

EHEC O104:H4 infections differ markedly from earlier reports on O157:H7 induced enterocolitis in regard to epidemiology, symptomatology, and frequency of complications. We recommend a standard of practice for clinical monitoring and support the renaming of EHEC O104:H4 syndrome as “EAHEC disease”.     

Measurement of Heart Rate Variability to Assess Pain in Sedated Critically Ill Patients: A Prospective Observational Study

Introduction

The analgesia nociception index (ANI) assesses the relative parasympathetic tone as a surrogate for antinociception/nociception balance in sedated patients. The aim of this study is to determine the effectiveness of ANI in detecting pain in deeply sedated critically ill patients.

Methods

This prospective observational study was performed in two medical ICUs. All patients receiving invasive mechanical ventilation and deep sedation were eligible. In all patients, heart rate and ANI were continuously recorded using the Physiodoloris^® device during 5 minutes at rest (T1), during a painful stimulus (T2), and during 5 minutes after the end of the painful stimulus (T3). The chosen painful stimulus was patient turning for washstand. Pain was evaluated at T2, using the behavioral pain scale (BPS). The primary objective was to determine the effectiveness of ANI in detecting pain. Secondary objectives included the impact of norepinephrine on the effectiveness of ANI in detecting pain, and the correlation between ANI and BPS.

Results

Forty-one patients were included. ANI was significantly lower at T2 (Med (IQR) 69(55–78)) compared with T1 (85(67–96), p<0.0001), or T3 (81(63–89), p<0.0001). Similar results were found in the subgroups of patients with (n = 21) or without (n = 20) norepinephrine. ANI values were significantly higher in patients with norepinephrine compared with those without norepinephrine at T1, and T2. No significant correlation was found between ANI and BPS at T2.

Conclusions

ANI is effective in detecting pain in deeply sedated critically ill patients, including those patients treated with norepinephrine. No significant correlation was found between ANI and BPS.     

Micro-Economic Impact of Congenital Heart Surgery: Results of a Prospective Study from a Limited-Resource Setting

Introduction

The microeconomic impact of surgery for congenital heart disease is unexplored, particularly in resource limited environments. We sought to understand the direct and indirect costs related to congenital heart surgery and its impact on Indian households from a family perspective.

Methods

Baseline and first follow-up data of 644 consecutive children admitted for surgery for congenital heart disease (March 2013 – July 2014) in a tertiary referral hospital in Central Kerala, South India was collected prospectivelyfrom parents through questionnaires using a semi-structured interview schedule.

Results

The median age was 8.2 months (IQR: 3.0– 36.0 months). Most families belonged to upper middle (43.0%) and lower middle (35.7%) socioeconomic class. Only 3.9% of families had some form of health insurance. The median expense for the admission and surgery was INR 201898 (IQR: 163287–266139) [I$ 11989 (IQR: 9696–15804)], which was 0.93 (IQR: 0.52–1.49) times the annual family income of affected patients. Median loss of man-days was 35 (IQR: 24–50) and job-days was 15 (IQR: 11–24). Surgical risk category and hospital stay duration significantly predicted higher costs. One in two families reported overwhelming to high financial stress during admission period for surgery. Approximately half of the families borrowed money during the follow up period after surgery.

Conclusion

Surgery for congenital heart disease results in significant financial burden for majority of families studied. Efforts should be directed at further reductions in treatment costs without compromising the quality of care together with generating financial support for affected families.     

巨细胞病毒感染与SARI肺炎病例的相关性研究

探讨巨细胞病毒感染与住院严重急性呼吸道感染(SARI)肺炎的相关性.以67例符合严重急性呼吸系统感染临床诊断标准的住院病例为研究对象,同时以81例流感样门诊病例作为对照,使用荧光定量PCR方法检测所有研究对象的巨细胞病毒感染情况.采用二分类logistic回归模型分析巨细胞感染与住院严重急性呼吸道感染肺炎病例的关联.巨细胞病毒在呼吸道感染病例中有较高的阳性率,阳性率随年龄呈下降趋势.80％以上巨细胞病毒阳性病例存在与其他常见呼吸道病原共感染情况.Logistic回归分析表明:年龄和多病原共感染是SARI肺炎发生的危险因素,单独CMV阳性与SARI肺炎的发生没有显著相关性.SARI肺炎中CMV与其他呼吸道病原共感染概率高,临床上应加强对呼吸道感染病例的巨细胞病毒检测.     

Calprotectin and Lactoferrin Faecal Levels in Patients with Clostridium difficile Infection (CDI): A Prospective Cohort Study

Measurement of both calprotectin and lactoferrin in faeces has successfully been used to discriminate between functional and inflammatory bowel conditions, but evidence is limited for Clostridium difficile infection (CDI). We prospectively recruited a cohort of 164 CDI cases and 52 controls with antibiotic-associated diarrhoea (AAD). Information on disease severity, duration of symptoms, 30-day mortality and 90-day recurrence as markers of complicated CDI were recorded. Specimens were subject to microbiological culture and PCR-ribotyping. Levels of faecal calprotectin (FC) and lactoferrin (FL) were measured by ELISA. Statistical analysis was conducted using percentile categorisation. ROC curve analysis was employed to determine optimal cut-off values. Both markers were highly correlated with each other (r² = 0.74) and elevated in cases compared to controls (p<0.0001; ROC>0.85), although we observed a large amount of variability across both groups. The optimal case-control cut-off point was 148 mg/kg for FC and 8.1 ng/µl for FL. Median values for FL in CDI cases were significantly greater in patients suffering from severe disease compared to non-severe disease (104.6 vs. 40.1 ng/µl, p = 0.02), but were not significant for FC (969.3 vs. 512.7 mg/kg, p = 0.09). Neither marker was associated with 90-day recurrence, prolonged CDI symptoms, positive culture results and colonisation by ribotype 027. Both FC and FL distinguished between CDI cases and AAD controls. Although FL was associated with disease severity in CDI patients, this showed high inter-individual variability and was an isolated finding. Thus, FC and FL are unlikely to be useful as biomarkers of complicated CDI disease.     

Staphylococcus aureus Bloodstream Infection and Endocarditis - A Prospective Cohort Study

ObjectivesTo update the epidemiology of S. aureus bloodstream infection (SAB) in a high-income country and its link with infective endocarditis (IE).MethodsAll consecutive adult patients with incident SAB (n = 2008) were prospectively enrolled between 2009 and 2011 in 8 university hospitals in France.ResultsSAB was nosocomial in 54%, non-nosocomial healthcare related in 18% and community-acquired in 26%. Methicillin resistance was present in 19% of isolates. SAB Incidence of nosocomial SAB was 0.159/1000 patients-days of hospitalization (95% confidence interval [CI] 0.111-0.219). A deep focus of infection was detected in 37%, the two most frequent were IE (11%) and pneumonia (8%). The higher rates of IE were observed in injecting drug users (IE: 38%) and patients with prosthetic (IE: 33%) or native valve disease (IE: 20%) but 40% of IE occurred in patients without heart disease nor injecting drug use. IE was more frequent in case of community-acquired (IE: 21%, adjusted odds-ratio (aOR) = 2.9, CI = 2.0-4.3) or non-nosocomial healthcare-related SAB (IE: 12%, aOR = 2.3, CI = 1.4-3.5). S. aureus meningitis (IE: 59%), persistent bacteremia at 48 hours (IE: 25%) and C-reactive protein > 190 mg/L (IE: 15%) were also independently associated with IE. Criteria for severe sepsis or septic shock were met in 30% of SAB without IE (overall in hospital mortality rate 24%) and in 51% of IE (overall in hospital mortality rate 35%).ConclusionSAB is still a severe disease, mostly related to healthcare in a high-income country. IE is the most frequent complication and occurs frequently in patients without known predisposing conditions.     

Differential Effect of Viral Hepatitis Infection on Mortality among Korean Maintenance Dialysis Patients: A Prospective Multicenter Cohort Study

The role of infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) in terms of survival among dialysis patients remains incompletely understood. In the present multicenter prospective cohort study, we investigated the prevalences of HBV and HCV infection among 3,321 patients receiving maintenance dialysis in Korea, and assessed the impacts of these infections on survival. All included patients underwent hepatitis B antigen (HBsAg) and HCV antibody (Ab) testing, which revealed that 236 patients (7.1%) were HBsAg-positive, and 123 patients (3.7%) were HCV Ab-positive. HBsAg-positive and HCV Ab-positive patients were matched to hepatitis virus-negative patients using a propensity score at a ratio of 1:2. The prevalences of HBV and HCV infection did not significantly differ according to dialysis modality. Linear-by-linear association analysis revealed that hepatitis B prevalence significantly increased with increasing dialysis vintage (p = 0.001), and hepatitis C prevalence tended to be higher with increasing dialysis vintage (p = 0.074). We compared the survival of HBsAg-positive and HCV Ab-positive patients to that of hepatitis virus-negative patients. After propensity score matching, cumulative survival did not differ between HBsAg-positive and HBsAg-negative patients (p = 0.37), while HCV Ab-positive patients showed significantly lower survival than HCV Ab-negative patients (p = 0.03). The main conclusions of the present study are that HBV infection prevalence increased with longer dialysis vintage, and that both HBV and HCV infections were most prevalent among patients with the longest dialysis vintage. Additionally, HCV infection among maintenance dialysis patients is associated with an increased risk of mortality.     

Alteration of Plasma Trace Elements in Patients Undergoing Open Heart Surgery

Trace elements may contribute to myocardial dysfunction and susceptibility of the phospholipid cell membrane to free-radical damage and oxidative changes. We studied the concentration of trace elements copper, zinc, and magnesium in cardiac surgery. Fifty-four consecutive patients for elective coronary artery bypass grafting (n?=?30) and valve replacement (n?=?24) were studied. Blood samples were collected every 30 min (T1–T5) during cardiopulmonary bypass and postoperatively (T6–T9). Plasma concentrations of copper, zinc, and magnesium were measured with flame atomic absorption spectrophotometry. The concentrations of copper, zinc, and magnesium were significantly different during and after cardiopulmonary bypass (p?<?0.01). The zinc concentration at T7 and T8 (p?<?0.01) and the copper concentration at T1, T9 (p?<?0.05) were significantly different between two groups. However, the magnesium concentration had no significant differences between the two groups (p?>?0.05). In patients undergoing valve replacement or coronary artery bypass grafting, the concentrations of copper and zinc decreased significantly during cardiopulmonary bypass. Our study suggests that the current cardiopulmonary bypass protocol is adequate in the maintenance of c magnesium. However, the low copper and zinc concentrations found in the present study may suggest that in the future, supplementation particularly of copper and zinc may become a necessary procedure in cardiac surgery with cardiopulmonary bypass.     

急危重症患者中心静脉置管相关性感染危险因素分析

对2010年12月~2013年9月在我院留置的急危重症患者的病历资料进行回顾性分析,分析中心静脉置管相关性感染(CVCRI)发生情况以及危险因素,并提出相应的干预措施。880例患者共有61例发生CVCRI,发生率为6.9%;分离出病原菌株65株,其中G+菌28株,G-22株,真菌15株;将这61例视为感染组,单因素分析显示,年龄、病情严重程度评分、免疫功能、导管留置时间及插管时机的差异具有统计学意义(p<0.05),进一步对上述因素进行多因素Logistic回归分析显示,病情严重程度评分、免疫功能和导管留置时间是CVCRI发生的独立危险因素。     

Pathogenesis of Experimental Rhesus Cytomegalovirus Infection

Human cytomegalovirus (HCMV) establishes and maintains a lifelong persistence following infection in an immunocompetent host. The determinants of a stable virus-host relationship are poorly defined. A nonhuman primate model for HCMV was used to investigate virological and host parameters of infection in a healthy host. Juvenile rhesus macaques (Macaca mulatta) were inoculated with rhesus cytomegalovirus (RhCMV), either orally or intravenously (i.v. ), and longitudinally necropsied. None of the animals displayed clinical signs of disease, although hematologic abnormalities were observed intermittently in i.v. inoculated animals. RhCMV DNA was detected transiently in the plasma of all animals at 1 to 2 weeks postinfection (wpi) and in multiple tissues beginning at 2 to 4 wpi. Splenic tissue was the only organ positive for RhCMV DNA in all animals. The location of splenic cells expressing RhCMV immediate-early protein 1 (IE1) in i.v. inoculated animals changed following inoculation. At 4 to 5 wpi, most IE1-positive cells were perifollicular, and at 25 wpi, the majority were located within the red pulp. All animals developed anti-RhCMV immunoglobulin M (IgM) antibodies within 1 to 2 wpi and IgG antibodies within 2 to 4 wpi against a limited number of viral proteins. Host reactivity to RhCMV proteins increased in titer (total and neutralizing) and avidity with time. These results demonstrate that while antiviral immune responses were able to protect from disease, they were insufficient to eliminate reservoirs of persistent viral gene expression.     

献血员巨细胞病毒感染的研究

用PCR法和DNA杂交法检测同一献血员的白细胞及血清中的HCMV-DNA,并用ELISA法检测血清中的HCMV-IgM、IgG(测四个滴度),连续两年共检测白细胞和血清样本各200人份.PCR法检测白细胞中的HCMV-DNA阳性率分别为63%和70%,DNA杂交法检测的阳性率为42%和50%.PCR法检测血清中的HCMV-DNA的阳性率为49%和53%,DNA杂交法检测的阳性率为33%和39%.HCMV-IgM阳性率两年均为5%.HCMV-IgG阳性率分别为54%和58%.     

黄芩素抑制人巨细胞病毒感染星形胶质细胞的实验研究

目前对人巨细胞病毒(human cytomegalovirous,HCMV)感染尚无特异有效的治疗和预防手段,研究通过观察黄芩素(baicalein,BAI)抑制HCMV体外感染人星形胶质细胞引起的IE、pp65 mRNA及蛋白表达的变化,探讨黄芩素抗HCMV感染的机制。运用MTT法检测BAI组、HCMV组、HCMV+BAI组和对照组细胞的细胞活性,观察BAI对HCMV感染致人星形胶质细胞增殖异常的抑制作用;Real-time PCR检测不同组之间IE、pp65 mRNA表达的变化;免疫荧光、Western blot技术检测IE、pp65蛋白表达的变化。MTT结果显示,20μmol/L BAI+HCMV组的吸光值在24、48、72 h均高于HCMV组(P0.05);形态学观察病毒感染48 h时,HCMV组细胞出现明显的细胞病变效应(CPE),而20μmol/L BAI+HCMV组细胞状态较好,CPE不明显;Real-time PCR结果显示在感染48和72 h时20μmol/L BAI+HCMV组IE、pp65的mRNA表达明显低于HCMV组(P0.05);免疫荧光、Western blot结果显示20μmol/L BAI+HCMV组细胞的IE、pp65蛋白表达明显低于HCMV组(P0.05)。以上结果显示,适当浓度的黄芩素能抑制HCMV感染所致的细胞增殖异常,同时降低IE及pp65的mRNA和蛋白表达量。     

献血员巨细胞病毒感染的研究

用ＰＣＲ法和ＤＮＡ杂交法检测同一献血员的白细胞及血清中的ＨＣＭＶ－ＤＮＡ,并用ＥＬＩＳＡ法检测血清中的ＨＣＭＶ－ＩｇＭ、ＩｇＧ（测四个不度）,连续两年共检测白细胞和血清样本各２００人份。ＰＣＲ法检测白细胞中的ＨＣＭＶ－ＤＮＡ阳性率分别为６３％和７０％,ＤＮＡ杂交法检测的阳性率为４２％和５０％。ＰＣＲ法检测血清中的ＨＣＭＶ－ＤＮＡ的阳性率为４９％和５３％,ＤＮＡ杂交法检测的阳性率为３３％和３９％。Ｈ     

关于HCMV 潜伏感染与激活感染研究的新进展

人巨细胞病毒(HCMV)是疱疹病毒科中最大的病毒,结构复杂,其感染在人群中非常普遍,近年来免疫妥协(immunocompromised)群体尤其是移植群体中的HCMV潜伏感染和激活感染越来越受到临床重视。本文就HCMV的感染与免疫、HCMV的致病机制、宿主的抗感染与免疫、HCMV的免疫逃逸、HCMV的潜伏与激活及HCMV相关研究的困境与展望近年来此方面研究新进展作一简要综述。