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PubMedDate not supplied

Intestinal parasites in Cambodians: comparison of diagnostic methods used in screening refugees with implications for treatment of populations with high rates of infestation.

We performed a retrospective review of screening parasitology examinations on a Cambodian refugee population served by an urban neighborhood health center. Five-hundred twenty of 1084 patients were examined for ova and parasites either by purged stool, which was examined immediately, or preserved stool, examined at a teaching hospital and proprietary laboratories. Overall, 335 (64 percent) of the tested patients had at least one parasite. The prevalence of infection varied by test technique (purged stool examined immediately, 86 percent; preserved stool examined at a hospital, 65 percent; preserved stool sent to a proprietary laboratory, 31 percent, P less than 0.01). In this population where Entamoeba histolytica infection was 44 percent as measured by the purged warm stool technique, the cold preserved stool test had a measured relative sensitivity of 33 percent. Assuming a selectivity of 99 percent, it would take eight negative tests to reach a greater than 95 percent negative predictive value. The high rate of intestinal carriage of pathogenic parasites in this population and the insensitivity of commonly available diagnostic tests make routine presumptive treatment of intestinal parasites an option when the purged stool examination is unavailable.

Adolescent↗

PubMed1966

Recent observations on leptospirosis in Northern Ireland and their bearing on current diagnostic methods.

An investigation was undertaken to assess the present importance of leptospiral infections in Northern Ireland, and in particular to look for evidence of infection by leptospiral serotypes other than L. icterohaemorrhagiae and L. canicola. Blood samples from 335 patients, sent to the laboratory for a variety of tests, were examined. After initial screening with five groups of pooled antigens, tests for leptospiral agglutinins were completed with formolized antigens prepared from 13 different serotypes. In seven patients a diagnosis of acute leptospirosis was made while nine others showed serological evidence of previous leptospiral infection. Attempts to isolate leptospirae by culture from 29 blood samples were unsuccessful. The serological results indicate that two additional leptospiral serotypes, namely L. ballum and L. bratislava, are causing human infection in Northern Ireland, and presumably also in other parts of the British Isles. Some clinical and epidemiological features associated with different types of leptospiral infection are described. It is stressed that leptospirosis is essentially a febrile illness, that meningeal symptoms are common, and that (contrary to popular belief) jaundice is by no means a constant occurrence. The implications of these findings are discussed, with special reference to the diagnosis of leptospiral infections. Laboratory diagnostic procedures are briefly reviewed, and the possible deficiencies of the agglutination test commonly used in Britain are pointed out. Some suggestions are made concerning both clinical and laboratory aspects of diagnosis, and the need for a reliable screening test for all forms of leptospiral infection is emphasized.

Adolescent↗

PubMed1979

CT as a primary diagnostic method in evaluating intraabdominal abscess.

In 19 cases, a correct diagnosis of intraabdominal abscess was made by CT body scanning. There was one false-positive diagnosis and initially one false-negative diagnosis. CT proved to be an efficient imaging method for diagnosis, for planning of therapeutic procedures, and in monitoring response to operative or conservative treatment. It has advantages over ultrasound and gallium scanning especially in severely ill, postoperative, and obese subjects. In addition, needle aspiration under CT control is readily performed and can be undertaken at the same examination. Confirmation of the diagnosis and therapeutic aspiration with or without introduction of a drainage catheter can then be undertaken.

Abdomen, Acute↗

PubMed1977

[Diagnostic methods in the bulbus duodeni. Agreement and disagreement between endoscopic, roentgenological and histological examinations (author's transl)].

In a collective of 1012 patients (700 m., 312 f.), 346 (268 m., 78 f.) had pathological endoscopic findings in the bulbus. Diseases of the bulbus appeared in women about 10 years later than in men. In comparison to the endoscopic findings, roentgen findings showed disagreement in about 35% which mainly arose from contradictions in the assessment of cicatricial changes in the bulbus. False negative ulcer findings amounted to about 21%, the false positive to 19%. Endoscopic and histologically confirmed malignancies were not overlooked in a single case.

Adult↗

PubMed2002

[Evaluation of diagnostic methods and characteristics of patients operated on for cervical cancer in Lithuania, 1998-2000].

The total number of new cases of cervical cancer for the three-year period was 1392 patients. The number of cases was fairly evenly distributed among the years of the study period 1998-2000. The total number of new cases of Stages I and II of cervical cancer was 713 (51.2%) cases, and that of Stages III and IV was 623 (44.8%) cases. The number of the new cases with an unknown stage of the disease was found to be 56 (4.0%) cases. The number of patients with Stage IIIB disease was the highest (69 cases) among all the stages of cervical cancer for the study period 1998-2000. The second most common stage was Stage IB disease with 52 patients belonging to this category. One-half (50.0%) of all operated patients because of cervical cancer during the study period 1998-2000 were women of 44 years of age and younger. Therefore, major considerations are to be given for women of reproductive age where effective screening and early detection of cervical pathology could help to avoid a lot of invasive cases of the disease and thus decrease mortality due to it. Generally, the diagnostic work-up and examinations of cervical cancer patients were insufficient, especially in cases of advanced stage disease. Stages III and IV were diagnosed in 44.8% of all cases. Overall, cystoscopy was performed in 39.4% (42 cases) of the total number of cases in Stages IIB through IVA of cervical cancer. Overall, rectosigmoidoscopy was performed in 6.4% (7 cases) of the total number of cases in Stages IIB through IVA of the disease. Finally, the proportion of CT that was performed in cases of Stages IIB through IVB of cervical cancer was 8.4% only. Clinical staging correlates well with pathologic staging in Stage I, particularly Stage IA (88.91%). The data also indicates that parametrial involvement would seem to be the most difficult problem, as 28.59% of Stage IIB and 32.3% of Stage IIIB were down-staged on the basis of pathological findings. This would suggest that in some cases the basic clinical staging rules are not being followed, or clearly understood. Kappa statistics (p = 0.05), diagnostic agreement 86.9% +/- 8%.

Adenocarcinoma↗

PubMed2000

[3D SPECT reconstruction - a diagnostic method in oral and maxillofacial surgery].

Computer-aided three-dimensional (3D) reconstruction of conventional (99m)Tc-DPD SPECT data was used for basic investigations of different disease entities of the orofacial area, with the aim of improving primary diagnosis and, in selected cases such as microvascular bone reconstruction, for a more comprehensive control after therapy. So far, the new 3D technique has been applied in 49 patients with different indications based on commonly acquired sets of data without any further hazard for the patients. In comparison to conventional planar scintigrams, the advantage of this sophisticated technique is a higher image contrast and a clear-cut signal of the investigated bone areas without any superimposing effects. Therefore, the anatomical description of the process is better, which is particularly important in cases of osteomyelitis and after microvascular reconstruction of skull bone defects. In addition, the follow-up investigations can assess treatment results far better and outcome predictions are much more reliable. A higher sensitivity and specificity in cases of squamous cell carcinoma as regards bone infiltration could not be achieved so far. In summary, computer-aided 3D reconstruction of conventionally acquired (99m)Tc-DPD-SPECT data represents a significant improvement in radionuclide imaging technique, providing a much better diagnostic interpretation of selected disease entities in the oral and maxillofacial area.

Adult↗

PubMed2004

[The importance and use of laser microdissection in clinical research and diagnostic method development].

The molecular biological analysis of rare cell samples has become increasingly important in medical research and applications. Using laser microdissection and special macromolecule isolation techniques allows us to understand the biological information even in a single cell and to examine the genetical and proteomical features of biologically homogenous cell populations. There are several type of laser microdissectors which have a very user-friendly actuation. In practice the most difficult parts are the sample preparation and the macromolecule extraction from rare cell samples. The aims of this study are to summarize current practical experiences and to foreshow the application possibilities of this quite new technique in clinical practice.

Animals↗

PubMedDate not supplied

Experimental infection of chickens with an atypical Mycoplasma gallisepticum strain: comparison of diagnostic methods.

Fifteen chickens were inoculated with the atypical Mycoplasma gallisepticum (MG) K703 strain. On different dates post inoculation, tracheal swab samples were collected for mycoplasma culture and blood samples were analysed by slide agglutination test (SA) with commercial or homologous antigen and enzyme-linked immunosorbent assay (ELISA) with three different kits. Results showed that MG isolation rate was low on several sampling dates. The SA with commercial antigen did not yield positive results, although birds were positive when tested with homologous antigen. With commercial ELISA kits, the numbers of positive samples remained low. These results illustrate the difficulty of diagnosis of infections with such MG variant strains.

Agglutination Tests↗

PubMed1981

[Reliability and limitation of various diagnostic methods including nuclear medicine in myocardial disease (author's transl)].

Electrocardiography (ECG), echocardiography, nuclear method, cardiac catheterization, left ventriculography (LVG) and endomyocardial biopsy (biopsy) were performed in 40 cases of cardiomyopathy (CM), 9 of endocardial fibroelastosis (EFE) and 19 of specific heart muscle disease (SHMD), and the usefulness and limitation of each method was comparatively estimated. In CM, various methods including biopsy were performed. The 40 patients were classified into 3 groups, i.e., 1) hypertrophic (17), 2) dilated (20) and 3) non-hypertrophic . non-dilated (3) on the basis of left ventricular ejection fraction (LVEF) and hypertrophy of the ventricular wall assessed by LVG and/or echocardiography. The hypertrophic group was divided into 4 subgroups: 9 septal, 4 apical, 2 posterior and 2 anterior. M-mode scan was useful for detecting hypertrophy at the site of the ventricular septum and posterior wall, but not at the site of the anterior wall and apex. The hypertrophy was detected in 18 out of 20 cases using nuclear method. The posterior wall was hypertrophic but the septum was normal in 2 cases. In 2 of 3 non-hypertrophic . non-dilated cases, the left ventricle was oval in shape by LVG, echocardiography was normal, but significant pathological changes were seen in the biopsy, and there were abnormal ECG findings. There was no correlation between the ECG findings and the site of ventricular hypertrophy. Left ventricular ejection fraction measured by LVG (Kasser) had a closer correlation to LVEF obtained by nuclear method (multigated blood pool scan; r = 0.97) than LVEF by echocardiography (Teichholz; r = 0.79), although LVEF obtained by nuclear method was slightly higher than LVEF obtained by LVG. Myocardial perfusion defect was found in 10 of 20 cases of dilated cardiomyopathy (DCM) and the site of relative hypokinesis coincided with the site of the defect in 6 of 7 cases. A semi-quantitative myocardial perfusion defect index (PDI) and histo pathological contractility failure index (HCFI) obtained by the biopsy were devised. HCFI is the score of myocardial degeneration, fragmentation and fibrosis. The PDI plus HCFI had a close correlation with LVEF (r = -0.898). In 9 cases of DCM, LVEF was more reduced than right ventricular ejection fraction. The perfusion defect was also found in 4 cases of EFE and 4 cases of SHMD, i.e., sarcoidosis, postmyocarditis, Kugelberg-Welander disease and cardiac tumor. We conclude that the nuclear study is useful in assessing the site of the abnormal ventricular thickening, perfusion defect and ventricular function. Echocardiography is most useful in detecting ASH. The biopsy gives the sole diagnostic clue, especially in non-hypertrophic . non-dilated cardiomyopathy. ECG is useful in all cases but correlation with the site of disproportional hypertrophy was not obtained.

Adolescent↗

PubMed2005

Viral encephalitis: a review of diagnostic methods and guidelines for management.

Viral encephalitis is a medical emergency. The spectrum of brain involvement and the prognosis are dependent mainly on the specific pathogen and the immunological state of the host. Although specific therapy is limited to only several viral agents, correct immediate diagnosis and introduction of symptomatic and specific therapy has a dramatic influence upon survival and reduces the extent of permanent brain injury in survivors. We searched MEDLINE (National Library of Medicine) for relevant literature from 1966 to May 2004. Review articles and book chapters were also included. Recommendations are based on this literature based on our judgment of the relevance of the references to the subject. Recommendations were reached by consensus. Where there was lack of evidence but consensus was clear we have stated our opinion as good practice points. Diagnosis should be based on medical history, examination followed by analysis of cerebrospinal fluid for protein and glucose contents, cellular analysis and identification of the pathogen by polymerase chain reaction (PCR) amplification (recommendation level A) and serology (recommendation level B). Neuroimaging, preferably by magnetic resonance imaging, is an essential aspect of evaluation (recommendation level B). Lumbar puncture can follow neuroimaging when immediately available, but if this cannot be obtained at the shortest span of time it should be delayed only in the presence of strict contraindications. Brain biopsy should be reserved only for unusual and diagnostically difficult cases. All encephalitis cases must be hospitalized with an access to intensive care units. Supportive therapy is an important basis of management. Specific, evidence-based, anti-viral therapy, acyclovir, is available for herpes encephalitis (recommendation level A). Acyclovir might also be effective for varicella-zoster virus encephalitis, gancyclovir and foscarnet for cytomegalovirus encephalitis and pleconaril for enterovirus encephalitis (IV class of evidence). Corticosteroids as an adjunct treatment for acute viral encephalitis are not generally considered to be effective and their use is controversial. Surgical decompression is indicated for impending uncal herniation or increased intracranial pressure refractory to medical management.

Central Nervous System↗

PubMed2000

A diagnostic method for suspected Alzheimer's disease using H(2)15O positron emission tomography perfusion Z score.

We developed cerebral perfusion Z score map (Z map) images using H(2)15O and positron emission tomography (PET), and examined their use in diagnosing Alzheimer's disease (AD). Cerebral blood flow (CBF) images were obtained using the PET and H(2)15O autoradiographic method. The best region for normalising the CBF value to remove individual variantion was determined. Then CBF images were transformed to Talairach's standard space, and each pixel value of an individual's image set was normalized to the mean value of the sensorimotor area. Based on the CBF images of 20 normal volunteers, normative mean and standard deviation (SD) CBF images were constructed. Then, each pixel value of the axial CBF images in 28 patients with probable AD and 10 further normal volunteers was converted to a Z score (Z = [normal mean--individual value]/normal SD). A Z map, showing pixels exceeding a threshold of Z score > 2 on MRI of standardised anatomical space was demonstrated. These 38 Z maps were interpreted by four radiologists. When regions in the temporoparietal area were found with Z scores > 2, the subject was diagnosed as having AD. A receiver operating characteristic (ROC) analysis was performed to compare the conventional CBF images and Z maps. The diagnostic performance of the Z map was superior to that of visual inspection of conventional CBF images (mean areas under the ROC curve of the four radiologists were 0.946 and 0.584, respectively). These results indicate that a Z map obtained in this way is superior to conventional PET for diagnosing AD.

Aged↗

PubMed2006

Clinical imaging of the vulnerable plaque in the coronary arteries: new intracoronary diagnostic methods.

Rupture of a vulnerable plaque is the main cause of acute coronary syndromes and myocardial infarction. The features of rupture-prone atherosclerotic plaques have been previously described by pathologists. However, identification of vulnerable plaques in vivo is essential to study their natural history and to evaluate potential treatment modalities. Coronary angiography is the gold standard for the diagnosis of coronary artery disease, but it is unable to distinguish between stable and unstable plaques and to accurately predict future cardiac events. This current perspective describes the recently developed invasive imaging techniques to detect atherosclerotic vulnerable plaques in the coronary tree.

Angioscopy↗

PubMed1998

A comparison of diagnostic methods for the detection of bovine respiratory syncytial virus in experimental clinical specimens.

Virus shedding was monitored in nasal secretions of 12 calves experimentally infected with bovine respiratory syncytial virus (BRSV) using an antigen capture enzyme-linked immunosorbent assay (ELISA) detecting the nucleoprotein (NP) antigen of BRSV, by a polymerase chain reaction (PCR) amplifying the fusion protein of BRSV, and by a microisolation assay combined with immunoperoxidase staining for the F protein of BRSV. Under the conditions of this study, similar limits of detection and quantitative results were obtained from all three assays. BRSV was detected in nasal secretions of all calves for a minimum of 4 d. Virus shedding began on Day 2 after infection, peaked on Days 3-5, and was cleared in most calves by Day 8. The PCR, and to a lesser extent the ELISA, may detect virus shedding for a longer period after infection than virus isolation, possibly due to neutralization of the virus by rising mucosal antibody. Simulated environmental conditions likely to be experienced during transport of clinical field specimens markedly reduced the sensitivity of virus isolation but had a minimal effect on the results of the NP ELISA. Actual field transport conditions (overnight on ice) had minimal apparent effect on the results of the PCR assay. The less stringent specimen handling requirements, combined with low limits of detection, of both the nucleoprotein ELISA and PCR, indicate either of these assays are more suitable for diagnostic applications than virus isolation.

Animals↗

PubMed2002

The use of chosen serological diagnostic methods in Lyme disease in horses. Part II. Western blot.

In this investigation the Western blot test was treated as a method verifying results of the IFA, commercial ELISA and standardized ELISA tests (described in Part I). The verifying investigations were performed on 82 serum samples, which in the commercial ELISA were positive in 36 cases, dubious in 31 cases and negative in 15 cases as well as on 5 serum samples obtained from horses infected with Leptospira spp., which in the ELISA commercial were dubious (total of 87 sera samples). The antigens, against which the immunological response in horses was directed, were also established. The Milenia--Blot--Borrelia IgG test (MIDBO IgG-Kit 30 TESTS: DPC Bierman GmbH) was used in the investigation. In view of species differences, rabbit anti-horse IgG (whole molecule) alkaline phosphatase conjugate, no A6063 SIGMA-ALDRICH was used interchangeably. Also the control sera were substituted with the horse control sera. It was demonstrated that the Western blot test is the most reliable in the serological diagnosis of B. burgdorferi infection in horses. The commercial ELISA and standardized ELISA tests represent a lower diagnostic value than the Western blot test, although similar to each other, while the value of the IFA is minimal. In the Western blot test antigens were established against which the immunological response in horses in mostly directed. In the sera evaluated in this test as positive the presence of antibodies, mainly against antigens with the following molecular weights: 41 kDa, 62/60 kDa, 93 kDa, 72 kDa, 34 kDa (OspB), 66 kDa was noted. At the same time, antibodies contained in the sera accepted as negative, in 55.5% cases also reacted with the antigen of 41 kDa. It points to its minimal specificity. On the basis of the results obtained it is recommended that serological examination of horses should be with the ELISA and that positive or dubious results should be verified with the Western blot test.

Animals↗

PubMed1984

Evaluation of Minitec and API as rapid diagnostic methods for anaerobic bacteria.

The performance of the miniaturized biochemical differentiation systems API 20 anaerobe System and Minitek was compared with pH reactions in PRAS media of 58 anaerobic or capno-aerophilic bacterial strains from recent clinical specimens. The overall correlation of the Minitek reactions was 87% and of the API reactions 85%. The reactions of acid formation from carbohydrates was slightly higher for Minitek. This resulted in a correct diagnosis in 90% after Minitek and 86% after API. If corrected for 3 strains of Clostridium perfringens for which double haemolysis would have prevented reporting of another diagnosis, 95% of the strains would have been correctly identified by Minitek compared to 91% with API. The errors were mostly due to lack of sensitivity of the reactions of the test kits.

Bacteria, Anaerobic↗

PubMed2001

Development and optimization of polymerase chain reaction-based malaria diagnostic methods and their comparison with quantitative buffy coat assay.

Polymerase chain reaction (PCR)-based assays targeting the small-subunit rRNA were developed and evaluated, allowing for the simultaneous diagnosis of Plasmodium falciparum and Plasmodium vivax DNA in human blood samples. The PCR methods and quantitative buffy coat (QBC) were compared in 402 patients. The heminested PCR method showed a sensitivity of 97.4%, which was superior to the sensitivity of the QBC method (91.7%, P < 0.05), to simple PCR (84.6%, P < 0.001), and to PCR with digoxigenin labeling (PCR-DIG) (88.5%, P < 0.001). The PCR-DIG and QBC analyses were more sensitive than simple PCR (P < 0.003 and P < 0.05, respectively). There was no significant difference between the sensitivities of the QBC assay and the PCR-DIG assay. The specificity for the 3 PCR-based methods was 100%, superior to the specificity calculated for the QBC assay (88.95%, P < 0.009). The frequency of a positive result in groups from endemic areas but without detectable parasitemia increased, in order, from simple PCR, QBC test, PCR-DIG, to heminested PCR. An association between a positive PCR result and a history of malaria was also found. Taken together, these data suggest that this technology could be further developed to screen people with oligoparasitemia and to monitor malaria treatment.

Adolescent↗

PubMed2006

Detection of West Nile virus in formalin-fixed, paraffin-embedded human tissues by RT-PCR: a useful adjunct to conventional tissue-based diagnostic methods.

BACKGROUND: West Nile virus (WNV), a member of genus Flavivirus, causes febrile illness, encephalitis, meningitis, myelitis, and occasional deaths in humans. Although several reverse transcription-polymerase chain reaction (RT-PCR) assays have been developed for detection of WNV in serum, cerebrospinal fluid, and fresh tissues, the usefulness of WNV RT-PCR assays for RNA extracted from formalin-fixed human tissues has not previously been demonstrated. OBJECTIVE: The objective of this study was to evaluate the application of a RT-PCR technique for the detection of WNV in routinely processed, formalin-fixed, paraffin-embedded (FFPE) human tissues, and to compare it with conventional serology and immunohistochemistry (IHC). STUDY DESIGN: We performed two WNV-specific nested RT-PCR assays targeting the viral capsid, premembrane, and envelope genes in FFPE central nervous system tissue samples from 27 patients with fatal WNV encephalitis, as confirmed by serology or IHC, and compared the results. The presence of WNV in RT-PCR-positive samples was confirmed by amplicon sequencing. RESULTS: Twenty (74%) patients were WNV RT-PCR positive while 24 (89%) were seropositive. WNV IHC staining of neurons and neuronal processes was positive in fourteen (52%) patients. The concordance between IHC and serology was 41% (11/27) and between RT-PCR and serology was 63% (17/27). All 11 seropositive/IHC-positive patients and 6 (46%) of 13 seropositive/IHC-negative patients were RT-PCR positive while all 3 seronegatives were positive by both IHC and RT-PCR. CONCLUSIONS: In this study, RT-PCR was significantly more sensitive than IHC in detecting WNV infections and provided specific sequence information about the infecting virus. RT-PCR on FFPE tissues may be a particularly useful diagnostic tool in patients who die relatively soon after disease onset and for whom serology may be negative. Combined use of serology, IHC, and RT-PCR would be expected to have the best overall sensitivity and improve detection of fatal WNV infection.

Adult↗

PubMed2003

[Clinical evaluation of performance of a new diagnostic method for deep mycosis by measuring beta-glucan concentration in the blood].

beta-Glucan Test MARUHA for high sensitive diagnosis of deep mycosis which was developed recently detects (1-->3)-beta-D-glucan, a component of the cell wall. The performance of beta-Glucan Test MARUHA is evaluated in this report. Although existing methods to detect (1-->3)-beta-D-glucan have trouble with sulfa drugs, hemolysis, and immunoglobulin G (IgG), these problems were overcome by the beta-Glucan Test MARUHA: No effect was observed for beta-Glucan Test MARUHA at lower than 200 micrograms/ml, 500 mg/dl, and 6,000 mg/dl of sulfa drugs, hemoglobin, and IgG, respectively. The effect of drugs administrated on the measurement value of beta-glucan Test MARUHA was checked at several concentrations. However, almost no effect of drugs, such as, 5 kinds of antifungals, 8 kinds of antibiotics, a kind of antibacterial, 2 kinds of infusions, and a kind of contrast media was observed at the practical concentrations.

Biomarkers↗