Patients HIV+ attending in a reference clinic, Southern Brazil. To compare the interferon-gamma-release assay (IGRA – QuantiFERON® TB Gold In-Tube) with the tuberculin skin test (TST – PPD-Rt 23) for latent tuberculosis infection (LTBI) in patients with HIV. Cohort study. Patients were simultaneously submitted to the TST and blood collection for the IGRA. A total of 140 subjects were included. Nine (6.4%) were IGRA+/TST+, 12 (8.6%) were IGRA+/TST−, 4 (3%) were IGRA−/TST+, and 115 (82%) IGRA−/TST−. There was poor agreement between tests (kappa = 0.2), and no correlation between these results and CD4+ T lymphocyte counts. During follow-up, one patient with negative results on both tests died from sepsis, and another with discordant results (IGRA+/TST−) exhibited TST seroconversion. Compared to the TST, IGRA showed a sensitivity and specificity of 69% and 90%, respectively. The IGRA detected 8% more positive results than the TST. All patients were followed up for 2 years. The higher accuracy of the IGRA would result in LTBI treatments being administered to patients who would have otherwise been overlooked, decreasing the number of active tuberculosis cases. The long-term survival of HIV carriers requires further evaluation.
Introduction: Urinary tract infection is quite frequent in a hospital environment, and the urine culture is the gold standard for diagnosis of this disease, because it allows bacterial identification and performing antimicrobial susceptibility testing. Culturenegative urine samples result of patients with strong suspicion of infection may occur due to the activity of antimicrobial residues, which can interfere with bacterial growth in vitro and produce false-negative results. Objective: Verify the occurrence of falsenegative urine cultures due to the presence of antimicrobial residues in samples of patients admitted to the Clinical Hospital of Parana Federal University. Material and methods: A total of 188 urine samples from hospitalized patients were randomly selected, during the period from July to December 2012. All samples were evaluated on the result of the urine culture, bacteriuria, and research on residues of antimicrobial activity by manual and automated techniques. Results: 44 (23.4%) presented positive urine culture, 121 (64.4%) negative urine culture, and 23 (12.2%) presented growth of many species. In 14 samples, negative urine cultures associated with the presence of bacteria and were positive for the research on antimicrobial residues activity (RARA), were observed. Conclusion: Automated technique showed better performance when compared to manual technique, with sensitivity of 92.8% and 71.4%, respectively. The presence of antimicrobial residues may affect the recovery of bacteria in the urine, producing a false-negative result.
Aim: Urinalysis is an important laboratory exam that gives helpful information for the diagnosis of urinary tract disease. Objective: The purpose of this study was to compare automated method results of test strips, microscopic analysis and counts with the manual methods. Material and Methods: Urine samples (n=275) were analyzed by I-Chem® Velocity (iQ200®). White and red blood cells (WBC/RBC) counts by iQ200® were compared with manual methods (Neubauer and KCell). Leukocyte esterase and hemoglobin detection provided by the test strips were also analyzed. Results: Leukocyte esterase was positive in 59.6% with 315,800±608,413 WBC/ml and negative in 40.4% with 24,838±34,152 WBC/ml (p<0.001). Hemoglobin was detected in 29.8% of the samples with 1,275,537±7,394,959 RBC/ml and negative in 70.2% with 26,316±46,424 RBC/ml (p=0.019). The iQ200® detected RBC in 159 samples, being 97.5% isomorphic cells and 2.5% unclassified iQ200® detected casts in 33 samples, classifying 36.4% as no inclusions and 63.6% with inclusions. Comparison of WBC/ RBC counts between Neubauer and K-cell® were equivalent (R2=0.87 and 0.75). Comparison of WBC/ RBC counts between iQ200 and manual methods showed higher values to the automation. Conclusion: Automated methods, such as iQ200® , seems to be a reliable tool for urinalysis in daily clinical practice, reducing the execution time and providing more accuracy. Distinction between isomorphic and dysmorphic RBC, casts and crystals identification still depend on microscopic examination. The use of automated device in urinalysis is a good practice, but it requires careful evaluation, taking into account the population, the volume of the analysis and the availability of skilled professional.
The antibacterial activity of plant extracts obtained from Bixa orellana L., Chamomilla recutita L., Ilex paraguariensis A. St.-Hil., Malva sylvestris L., Plantago major L. and Rheum rhaponticum L. has been evaluated against two reference strains and eleven clinical isolates of Helicobacter pylori. All the plant species chosen are used in popular Brazilian cuisine and folk medicine in the treatment of gastrointestinal disorders. Initial screening was made by the disk diffusion test and then minimum inhibitory concentration was determined by the agar dilution method. The results presented in this work demonstrated that among the plant preparations analyzed, B. orellana L., C. recutita L., I. paraguariensis A. St.-Hil. and M. sylvestris L. were capable of inhibiting the in vitro growth of H. pylori.
Xpert ® MTB/RIF has been widely used for tuberculosis (TB) diagnosis in Brazil, since 2014. This prospective observational study aimed to evaluate the performance of Xpert in different contexts during a two-year period: (i) laboratory and clinical/epidemiological diagnosis; (ii) HIV-positive and -negative populations; (iii) type of specimens: pulmonary and extrapulmonary. Overall, 924 specimens from 743 patients were evaluated. The performance of the assays was evaluated considering culture (Lowenstein Jensen or LJ medium) results and composite reference standard (CRS) classification as gold standard. According to CRS evaluation, 219 cases (29.5%) were classified as positive cases, 157 (21.1%) as ‘possible TB’, and 367 (49.3%) as ‘not TB’. Based on culture, Xpert and AFB smear achieved a sensitivity of 96% and 62%, respectively, while based on CRS, the sensitivities of Xpert, AFB smear, and culture were 40.7%, 20%, and 25%, respectively. The pooled sensitivity and specificity of Xpert were 96% and 94%, respectively. Metric evaluations were similar between pulmonary and extrapulmonary samples against culture, whereas compared to CRS, the sensitivities were 44.6% and 29.3% for the pulmonary and extrapulmonary cases, respectively. The Xpert detected 42/69 (60.9%) patients with confirmed TB and negative culture on LJ medium, and 52/69 (75.4%) patients with negative AFB smear results. There was no significant difference in the diagnostic accuracy based on the types of specimens and population (positive- and negative-HIV). Molecular testing detected 13 cases of TB in culture-negative patients with severe immunosuppression. Resistance to rifampicin was detected in seven samples. Herein, Xpert showed improved detection of pulmonary and extrapulmonary TB cases, both among HIV-positive and -negative patients, even in cases with advanced immunosuppression, thereby performing better than multiple other diagnostic parameters.
ABSTRACT Background: The timely diagnosis of tuberculous meningitis (TBM) is challenging. Molecular diagnostic tools are necessary for TBM, particularly in low- and middle-income countries. Objectives: We aimed to calculate the diagnostics characteristics of Xpert MTB/RIF for the detection of Mycobacterium tuberculosis in the cerebrospinal fluid (CSF) and the frequency of rifampicin (RIF)-resistance in the CSF samples. Methods: A total of 313 consecutive CSF samples were studied and categorized into TBM definite, probable, possible, or not TBM cases based on the clinical, laboratory, and imaging data. Results: For the definite TBM cases (n=7), the sensitivity, specificity, efficiency, and positive likelihood ratio were 100, 97, 97, and 38%, respectively. However, for the TBM definite associated with the probable cases (n=24), the sensitivity decreased to 46%. All CSF samples that were Xpert MTB/RIF-positive were RIF susceptible. Conclusion: Xpert MTB/RIF showed high discriminating value among the microbiology-proven TBM cases, although the values for the probable and possible TBM cases were reduced. Xpert MTB/RIF contributes significantly to the diagnosis of TBM, mainly when coupled with the conventional microbiological tests and clinical algorithms.
O parcial de urina é um exame simples e rápido com informações importantes sobre o funcionamento dos rins e do trato urinário. A introdução de novas tecnologias aumentou a exatidão e a produtividade, no entanto, a falta de padronização e a escassez de informação técnica são fatores limitantes que podem comprometer a interpretação do exame. O objetivo deste trabalho foi ampliar o conhecimento sobre automação em urinálise e torná-la mais consistente na prática laboratorial. Foram abordados os sistemas semi-automatizados, exame microscópico automatizado por citometria de fluxo, imagem digital com reconhecimento de partículas, sistema modular misto, microscopia digital com contraste de fase, além dos novos parâmetros: relação albumina/creatinina e proteína/creatinina. Foi observado que a automação da análise química evita as discrepâncias entre resultados e os erros analíticos nos métodos convencionais e que, a análise microscópica automatizada melhora a reprodutibilidade e permite uma maior padronização, no entanto, a liberação automática ou a necessidade de revisão microscópica serão definidas pela equipe profissional. Foi concluído que os diferentes sistemas de automação apresentam vantagens e desvantagens e a escolha do método depende do porte do laboratório, do custo-benefício e da população atendida com foco na confiabilidade dos resultados para um diagnóstico correto.
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