Molecular diagnostics in FUO

Molecular diagnostics in FUO QJM: An International Journal of Medicine, 2018, 209 doi: 10.1093/qjmed/hcy013 Advance Access Publication Date: 17 January 2018 Correspondence CORRESPONDENCE O.M.P. Jolobe From the Medical Division, Manchester Medical Association, Simon Building, Brunswick Street, Manchester M13 9PL, UK. email: oscarjolobe@yahoo.co.uk context, adjunctive evaluation of urine lipoarabinominnan (derived from the m tuberculosis cell wall) generates timely Although the polymerase chain reaction (PCR) identifies the cul- identification of 88% of HIV-positive subjects with positive m tu- prit pathogen in central nervous system infections, and in in- berculosis blood cultures. fective endocarditis (IE), it did not feature, even as an adjunct, Conflict of interest: None declared. in the work-up of patients recently reported with fever of un- known origin, in whom blood-stream infections were only iden- tified by blood culture (BC). In the tertiary centre, where PCR References was included in the evaluation of the cerebrospinal fluid (CSF), 1.Javali M, Acharya P, Mehta A, John AA, Mahale R. Srinivasa R a commercially available multiplex PCR system generated a de- Use of multiplex PCR based molecular diagnostics in diagnosis tection rate of 42.18% and clinical specificity of 100%. The de- of suspected CNS infections in tertiary care setting-A retro- tection rate amounted to 10 times higher than conventional spective study. Clin Neurol Neurosurg 2017; 161:110–6. tests. In suspected IE, among 53 patients with simultaneous BC 2.Kotova EO, Domonova EA, Karaulova YL, Milto AS, Pisaryuk and PCR of a blood sample, BCs and PCR were positive in 52.8% AS, Silveistrova OY. Infective endocarditis: importance of mo- and 64.2% of patients, respectively. Positive PCR results for lecular biological techniques in etiologic diagnosis. Ter Arkh cocci and fungi were obtained in 10 of the 25 examinees with 2016; 88:62–7. Article in Russian: Abstract in English. negative BCs. 3.Mulders-Manders CM, Pietersz G, Simon A, Bleeker-Rovers CP. BC is hampered by diagnostic delay, low positivity rate Referral of patients with fever of unknown origin to an expert- (amounting to approximately one third in patients with sepsis) ise center has high diagnostic aid and therapeutic value. QJM and false negative results due to previous antibiotic use. 2017; 110:793–801. Septifast, the most widely used PCR for blood-stream infections, 4.Tziolos N, Giamarellos_Bourboulis EJ. Contemporary can detect 9 gram positive cocci, 10 gram negative bacteria and approaches to the rapid molecular diagnosis of sepsis. Expert 6 fungal species. A recent review also showed that ‘the impact Rev Mol Diagn 2016; 16:1201–7. of [previous] antibiotic administration in BCs is a major problem 5.Kerkhoff AD, Barr DA, Schutz C, Burton R, Nicol MP, Lawn solved by Septifast.’ Furthermore, in immunocompromised pa- SD, et al. Disseminated tuberculosis among hospitalised HIV tients, PCR is significantly (P¼ 0.0339) superior to BCs in detect- patients in South Africa: a common condition that can be ing polymicrobial infections. PCR also has a role in m rapidly diagnosed using urine-based assays. Sci Rep 2017; 7: tuberculosis bacteremia, either in the evaluation of a blood sample or in the evaluation of a urine sample. In the latter V C The Author(s) 2018. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com Downloaded from https://academic.oup.com/qjmed/article-abstract/111/3/209/4816269 by Ed 'DeepDyve' Gillespie user on 16 March 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png QJM: An International Journal of Medicine Oxford University Press

Molecular diagnostics in FUO

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Oxford University Press
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© The Author(s) 2018. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com
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1460-2725
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1460-2393
D.O.I.
10.1093/qjmed/hcy013
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Abstract

QJM: An International Journal of Medicine, 2018, 209 doi: 10.1093/qjmed/hcy013 Advance Access Publication Date: 17 January 2018 Correspondence CORRESPONDENCE O.M.P. Jolobe From the Medical Division, Manchester Medical Association, Simon Building, Brunswick Street, Manchester M13 9PL, UK. email: oscarjolobe@yahoo.co.uk context, adjunctive evaluation of urine lipoarabinominnan (derived from the m tuberculosis cell wall) generates timely Although the polymerase chain reaction (PCR) identifies the cul- identification of 88% of HIV-positive subjects with positive m tu- prit pathogen in central nervous system infections, and in in- berculosis blood cultures. fective endocarditis (IE), it did not feature, even as an adjunct, Conflict of interest: None declared. in the work-up of patients recently reported with fever of un- known origin, in whom blood-stream infections were only iden- tified by blood culture (BC). In the tertiary centre, where PCR References was included in the evaluation of the cerebrospinal fluid (CSF), 1.Javali M, Acharya P, Mehta A, John AA, Mahale R. Srinivasa R a commercially available multiplex PCR system generated a de- Use of multiplex PCR based molecular diagnostics in diagnosis tection rate of 42.18% and clinical specificity of 100%. The de- of suspected CNS infections in tertiary care setting-A retro- tection rate amounted to 10 times higher than conventional spective study. Clin Neurol Neurosurg 2017; 161:110–6. tests. In suspected IE, among 53 patients with simultaneous BC 2.Kotova EO, Domonova EA, Karaulova YL, Milto AS, Pisaryuk and PCR of a blood sample, BCs and PCR were positive in 52.8% AS, Silveistrova OY. Infective endocarditis: importance of mo- and 64.2% of patients, respectively. Positive PCR results for lecular biological techniques in etiologic diagnosis. Ter Arkh cocci and fungi were obtained in 10 of the 25 examinees with 2016; 88:62–7. Article in Russian: Abstract in English. negative BCs. 3.Mulders-Manders CM, Pietersz G, Simon A, Bleeker-Rovers CP. BC is hampered by diagnostic delay, low positivity rate Referral of patients with fever of unknown origin to an expert- (amounting to approximately one third in patients with sepsis) ise center has high diagnostic aid and therapeutic value. QJM and false negative results due to previous antibiotic use. 2017; 110:793–801. Septifast, the most widely used PCR for blood-stream infections, 4.Tziolos N, Giamarellos_Bourboulis EJ. Contemporary can detect 9 gram positive cocci, 10 gram negative bacteria and approaches to the rapid molecular diagnosis of sepsis. Expert 6 fungal species. A recent review also showed that ‘the impact Rev Mol Diagn 2016; 16:1201–7. of [previous] antibiotic administration in BCs is a major problem 5.Kerkhoff AD, Barr DA, Schutz C, Burton R, Nicol MP, Lawn solved by Septifast.’ Furthermore, in immunocompromised pa- SD, et al. Disseminated tuberculosis among hospitalised HIV tients, PCR is significantly (P¼ 0.0339) superior to BCs in detect- patients in South Africa: a common condition that can be ing polymicrobial infections. PCR also has a role in m rapidly diagnosed using urine-based assays. Sci Rep 2017; 7: tuberculosis bacteremia, either in the evaluation of a blood sample or in the evaluation of a urine sample. In the latter V C The Author(s) 2018. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com Downloaded from https://academic.oup.com/qjmed/article-abstract/111/3/209/4816269 by Ed 'DeepDyve' Gillespie user on 16 March 2018

Journal

QJM: An International Journal of MedicineOxford University Press

Published: Mar 1, 2018

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