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Infection-Associated Ocular Cranial Nerve Palsies
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Hardeep Singh Malhotra, Imran Rizvi, Neeraj Kumar, Kiran Preet Malhotra, Gaurav Kumar, Manoj K. Goyal, Manish Modi, Ravindra Kumar Garg, Vivek Lal
MRI of the brain may show signs of pachymeningitis, sulcal or basal meningitis, cranial nerve enhancement, parenchymal changes, and infarct. Cerebral gummas arising from dura or pia matter in close connection with cranial nerves may be observed. Serological tests are diagnostic. At least one treponemal and one non-treponemal test should be sufficient to diagnose syphilis. Non-treponemal tests (semi-quantitative in nature: Venereal Disease Research Laboratory [VDRL] or rapid plasma reagin [RPR]), should be specified quantitatively in titers since the disease activity may correlate with the titers. The specificity of treponemal tests (Treponema pallidum hemagglutination test [TPHA], fluorescent treponemal antibody absorption test [FTA-ABS], and Treponema pallidum particle agglutination test [TPPA], immunoassays) ranges from 64% to 95%. Positive CSF and blood testing for treponema pallidum particle agglutination and VDRL may suggest the diagnosis of Neurosyphilis. Attempts must always be made to look for concomitant HIV-infection or a concomitant immunocompromised state. Intravenous crystalline penicillin-G 3-4 million units every 4 hours or intramuscular procaine penicillin-G 2.4 million units once a day with probenecid (500 mg orally four times a day) for 10–14 days is the treatment of choice. Other alternatives, especially when penicillin allergy is present, include parenteral ceftriaxone (2 mg/day) for 10–14 days and doxycycline (200 mg orally twice a day) for 3–4 weeks.
Diagnostic Stewardship
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Long turnaround times lead to delays in diagnosis and unnecessary use of antimicrobials or use of ineffective antimicrobial treatments. Factors that can influence turnaround times of diagnosis include: Culture: Most tests for bacterial infection still rely on prolonged incubation to grow bacteria on culture media.Serological tests rely on the detection of antibodies to the infection, and these may not appear for at least 10–14 days after the onset of the infection.Transport time.
Infectious diseases (and tropical medicine and sexually transmitted diseases)
Published in Shibley Rahman, Avinash Sharma, A Complete MRCP(UK) Parts 1 and 2 Written Examination Revision Guide, 2018
Shibley Rahman, Avinash Sharma
Serological tests can be divided into: cardiolipin tests (not treponeme specific)treponemal specific antibody tests
Serological testing for Lyme Borreliosis in general practice: A qualitative study among Dutch general practitioners
Published in European Journal of General Practice, 2020
Tjitske M. Vreugdenhil, Mariska Leeflang, Joppe W. Hovius, Hein Sprong, Jettie Bont, C. W. Ang, Jeanette Pols, Henk C. P. M. Van Weert
Diagnosis of LB is straightforward in patients with classic EM, as the typical annular rash is pathognomonic. Recognising disseminated LB is more difficult because it may mimic other more frequently occurring diseases, for example, Bell’s palsy. Diagnosis of disseminated LB is based on clinical symptoms and a history of a tick bite, confirmed by serological testing. The accuracy of the commonly used serological tests depends on the stage of the disease. The sensitivity ranges from approximately 50% in patients with EM to 77% in patients with neuroborreliosis and 97% in patients with acrodermatitis chronica atrophicans [6]. The specificity is approximately 80% in clinical practice and 95% in healthy controls, due to cross-reactivity and persisting antibodies after a resolved Borrelia infection. Discrimination between active and resolved infections based on test results may be difficult [8].
Anti-transglutaminase IgA antibody measurement in coeliac disease: Method comparison IDS-iSYS vs. Thermo Fisher Phadia
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2020
Birgitte Sandfeld-Paulsen, Tina Parkner, Cindy Soendersoe Knudsen
CD can lead to a variety of symptoms as diarrhoea, steatorrhea or weight loss, but also extra-intestinal symptoms, and therefore the diagnosis can be challenging and potentially delayed [1–4]. A delay in the diagnosis can have grave consequences for the patient and in worst case lead to osteoporosis, infertility, or even small bowel cancer [8]. Therefore, the need for fast automated serological tests is evident and serological testing is now available from several manufacturers. Recently, IDS has introduced a fully automated chemiluminescent autoimmune assay for use on the IDS-iSYS Multi-Discipline Automated System. When using immunological based assays, the importance to test the assay performance is evident since assays can vary tremendously due to the tTG antigen applied. The different antigens may vary in quality, purity, method of extraction and confirmation, leading to varying numbers of false positives and false negatives [1,7]. We found higher concentrations of tTG IgA assed by iSYS than Phadia with a median bias of 51% (95 CI: 43%−55%) which was independent of the actual concentration. However, when applying the clinical cut offs provided from the manufacturer suggesting presence of tTG IgA, the concordance was strong between the two assays with an agreement of 97%.
COVID-19 epidemic: a special focus on diagnosis, complications, and management
Published in Expert Review of Clinical Pharmacology, 2020
Leilei Ai, Liyu Jiang, Zhifei Xu, Hao Yan, Peihua Luo, Qiaojun He
ELISA and CLIA are suitable for first-line screening due to their high yield, short treatment time, and simple operation [39]. They both require to set a cutoff, which is better obtained by measuring a large number of negative specimens (thousands) and a certain number of known positive specimens (hundreds), however, inevitably false-positive results occur. If there are interfering substances (rheumatoid factor, heterophilic antibody, complement, lysozyme, etc.) in the body, or specimen reasons (hemolysis, contamination by bacteria, long storage time, incomplete coagulation, etc.), false positives may occur in antibody detection, which is to disturb clinical decision-making. Therefore, serological tests are generally not performed as the diagnostic basis alone, but should be combined with epidemiological history, clinical manifestations, and basic diseases to make a comprehensive judgment. Patients with clinical suspect of COVID-19 and negative nucleic acid test, or who are in convalescence and have a negative nucleic acid test, can be diagnosed by antibody test.