Infection-Associated Ocular Cranial Nerve Palsies
Vivek Lal in A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
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.
Candida
Dongyou Liu in Laboratory Models for Foodborne Infections, 2017
Thus, serological tests can be performed by detecting antigens and antibodies. Such tests are used in combination with conventional techniques for improving the diagnosis. The mannan and (1,3)-β-d-glucan detection is widely used. The mannan constituent of the Candida cell wall is a polysaccharide used as a target of many serological tests performed in serum or plasma specimens since it induces a strong antibody response.40 Tests based on the detection of antibodies directed against the mannan antigen are recommended in combination with those based on Candida antigens for improving the sensitivity and the specificity of the diagnosis.41 The commercial Platelia Candida antigen and antibody tests (Bio-Rad Laboratories) are the most commonly used serological methods for detecting Candida based on mannan.41,42 However, since the antibodies could be not produced in immunocompromised patients, it is very complicated to diagnose Candida infections in them.34,41 (1,3)-β-d-Glucan is also a cell wall component not only of Candida species but also of most of the other fungi. Several assays have been developed for quantifying such compounds in blood as a tool in the diagnosis of many pathogenic fungi including Candida.40,43
The epidemiology of malaria
David A Warrell, Herbert M Gilles in Essential Malariology, 2017
One useful, and widely used, measure of malaria endemicity is the prevalence of peripheral blood-stage infections among a community. This is strictly a ratio and not a rate and provides only a crude indication of transmission intensity as it is categorical rather than a continuous variable. Saturation of infection combined with the longevity of infection does not allow for an estimate of the incidence of infection, with the exception of the study of infants (see below). Information is best collected through random, community-based samples. The use of clinic attendees, school children or non-random samples biases estimates of community infection rates. The techniques of blood examination are discussed in Chapter 3. Parasite counts should be made for each Plasmodium and their sexual versus asexual forms separately. The average microscopist can examine 100 thick-film, high-magnification fields in 5 minutes. This represents about 0.1–0.25 μL of blood, and some scanty infections may escape detection. To improve parasite detection, polymerase chain reaction (PCR) techniques or dipsticks can be used (Chapter 3). However, such approaches make comparisons with previous microscopic methods difficult during comparative studies. A rubric for sample-size estimation is provided in Table 5.1. The use of serological tests for epidemiological purposes is discussed in Chapter 3.
A Belgian student with black eschars
Published in Acta Clinica Belgica, 2023
Astrid Van Reempts, Liesbet De Meester, Koen Blot, Ann-Sophie Candaele, Hilde Beele, Jo Van Dorpe, Diana Huis in ‘t Veld
The physical examination revealed several black eschar lesions with a central necrotic crust and raised vesicle-like margins on the chin (2x), the scalp (4x) and the pubic region (1x). Enlarged lymph nodes were palpable in the upper right cervical region. She also displayed a symmetrical maculopapular skin eruption on both flanks and the inner side of the upper arms. Laboratory investigations showed an elevated white blood cell count of 12,700/µL, an elevated C-reactive protein of 37.3 mg/L and elevated liver function tests (aspartate aminotransferase (AST) 87 U/L, alanine aminotransferase (ALT) 195 U/L, gamma-glutamyl transferase (GGT) 127 U/L, alkaline phosphatase (ALP) 65 U/L). Electrolytes, renal function tests and coagulation tests were normal. Serological tests could exclude toxoplasmosis, cytomegalovirus (CMV) and Epstein-Barr Virus (EBV) infection, hepatitis A, B and C, syphilis, human immunodeficiency (HIV) infection, Lyme disease, tularaemia, rickettsiosis and leishmaniasis. Wound culture was positive for Staphylococcus aureus, without presence of Bacillus anthracis. Ultrasound of the right neck region visualized pronounced oedema of the skin and subcutaneous tissue and prominent lymphadenopathy. There were neither signs of a local abscess nor thrombosis of the internal jugular vein.
Bayesian compartmental model for an infectious disease with dynamic states of infection
Published in Journal of Applied Statistics, 2019
Marie V. Ozanne, Grant D. Brown, Jacob J. Oleson, Iraci D. Lima, Jose W. Queiroz, Selma M. B. Jeronimo, Christine A. Petersen, Mary E. Wilson
This analysis is based on historical data; the original study was published by Lima et al. in 2012. During the months of January-February and June-July 2006, a study was conducted in Parnamirim, a city of 180,000 located next to Natal, to determine the covariates that were significantly associated with disease state. Households were chosen according to a random point process; 345 individuals were included in the study. Skin and serology tests were administered once to each study participant, and these test results were used to group people into infection status categories. These tests included an ELISA SLA serology test (SLA24].
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].
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