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      El diagnóstico convencional de Mycoplasma pneumoniae como agente causal de Neumonías Adquiridas en la Comunidad (NAC) Translated title: Conventional diagnosis of Mycoplasma pneumonia as causative agent of Community Acquired Pneumonia (CAP)

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          Abstract

          Resumen Las enfermedades infecciosas constituyen un importante problema de salud y específicamente la neumonía se encuentra entre las diez primeras causas de muerte a nivel mundial y en novena posición entre las principales causas de muerte en Venezuela. La Neumonía Adquirida en la Comunidad (NAC), se define como aquella que se presenta en pacientes no hospitalizados en los siete días previos al diagnóstico, o durante las primeras 48 horas de ingreso en pacientes hospitalizados. Entre los principales agentes etiológicos de la NAC, ocupando un segundo lugar en orden de frecuencia, se encuentra Mycoplasma pneumoniae. Los patógenos implicados en la neumonía extra-hospitalaria, difieren de aquellos causales de neumonías originadas en el hospital, y existe una notable diferencia en cuanto a su frecuencia de aparición y patrones de sensibilidad a drogas, por lo que es importante la identificación del agente causal. En este trabajo revisaremos los principales métodos convencionales (cultivo y serología) para el diagnóstico de este microorganismo, y analizaremos sus limitaciones, las cuales a menudo resultan en la aplicación de tratamiento de forma empírica

          Translated abstract

          Abstract Communicable diseases. among them specifically pneumonia, constitute an important public health problem, and they appear among the ten most important causes of death at a world wide level, and in the ninth place of causes of death in Venezuela. Community Acquired Pneumonia (CAP) is defined as that which occurs in non hospitalized patients during the seven days prior to diagnosis, or during the first 48 hours after internment in hospitalized patients. Mycoplasma pneumoniae is one of the main etiological agents of CAP, occupying the second place in order of frequency. Pathogens implicated in extra-hospital pneumonia differ from those that produce hospital originated pneumonia and there is a notable difference regarding their frequency of occurrence and drug sensibility patterns; therefore, it is important to identify the causative agent. In this study we will revise the main conventional diagnostic methods (culture and serology) for this microorganism, and we will analyze their limitations, that often are consequence of empirically applied treatments

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          Community-acquired pneumonia

          Summary This seminar reviews important features and management issues of community-acquired pneumonia (CAP) that are especially relevant to immunocompetent adults in light of new information about cause, clinical course, diagnostic testing, treatment, and prevention. Streptococcus pneumoniae remains the most important pathogen; however, emerging resistance of this organism to antimicrobial agents has affected empirical treatment of CAP. Atypical pathogens have been quite commonly identified in several prospective studies. The clinical significance of these pathogens (with the exception of Legionella spp) is not clear, partly because of the lack of rapid, standardised tests. Diagnostic evaluation of CAP is important for appropriate assessment of severity of illness and for establishment of the causative agent in the disease. Until better rapid diagnostic methods are developed, most patients will be treated empirically. Antimicrobials continue to be the mainstay of treatment, and decisions about specific agents are guided by several considerations that include spectrum of activity, and pharmacokinetic and pharmacodynamic principles. Several factors have been shown to be associated with a beneficial clinical outcome in patients with CAP. These factors include administration of antimicrobials in a timely manner, choice of antibiotic therapy, and the use of a critical pneumonia pathway. The appropriate use of vaccines against pneumococcal disease and influenza should be encouraged. Several guidelines for management of CAP have recently been published, the recommendations of which are reviewed.
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            Evaluation of 12 commercial tests and the complement fixation test for Mycoplasma pneumoniae-specific immunoglobulin G (IgG) and IgM antibodies, with PCR used as the "gold standard".

            Serology and nucleic acid amplification are the main diagnostic tools for the diagnosis of Mycoplasma pneumoniae infection. Since no reference standard is generally accepted, serologic assays for M. pneumoniae have not been evaluated on a broad scale. In this study, 12 commercially available serologic assays (for immunoglobulin G [IgG] and IgM) and the complement fixation test (CFT) were evaluated by using M. pneumoniae DNA detection by real-time PCR as the "gold standard." The assays tested were Platelia EIA (Bio-Rad), SeroMP EIA (Savyon), Serion classic EIA (Virion/Serion), Biotest EIA (Biotest), Ridascreen EIA (r-Biopharm), AniLabsystems EIA (Labsystems), Novum EIA (Novum Diagnostica), Diagnosys EIA (MP products), Genzyme/Virotech EIA, ImmunoWell EIA (Genbio), ImmunoCard EIA (Meridian), and SerodiaMycoII microparticle agglutination (Fujirebio). Serum samples (n = 46) from 27 PCR-positive patients with a known first day of disease and sera (n = 33) from PCR-negative controls were obtained from prospective studies of acute lower respiratory tract infections. Additionally, control sera (n = 63) from patients with acute viral or bacterial respiratory infections other than those caused by M. pneumoniae were tested. The results showed low specificities for both the Novum and the ImmunoCard IgM assays. The IgM assays with the best performances in terms of sensitivity and specificity were AniLabsystems (77% and 92%, respectively), SeroMP (71% and 88%, respectively), and CFT (65% and 97%, respectively). Good receiver operating characteristic areas under the curve were found for CFT (0.94), the Platelia assay (0.87), and the AniLabsystems assay (0.85). We conclude that there are few commercial serologic assays for the detection of M. pneumoniae infections with appropriate performances in terms of sensitivity and specificity and that PCR has become increasingly important for the diagnosis of M. pneumoniae infections in defined groups of patients.
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              Nucleic acid amplification tests for the diagnosis of pneumonia.

              Molecular diagnostic techniques, such as polymerase chain reaction (PCR), are promising tools for the rapid etiological diagnosis of pneumonia. PCR offers potential advantages over conventional tests for the detection of Mycoplasma pneumoniae, Legionella species, and Chlamydia pneumoniae. For pneumococcal pneumonia in adults, PCR adds little to existing diagnostic tests and is unable to distinguish pneumococcal colonization from infection when testing respiratory samples. Although PCR is probably more sensitive than are conventional microscopy-based methods for diagnosing Pneumocystis carinii pneumonia, the specificity is uncertain, because P. carinii can occasionally be detected in the absence of clinical symptoms. PCR is useful for the diagnosis of viral pneumonia in immunocompromised patients. Further work is required to better characterize the role of PCR versus the role of other tests for diagnosing pneumonia and to develop standard PCR assays that can be readily adopted by routine diagnostic laboratories.
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                Author and article information

                Journal
                rsvm
                Revista de la Sociedad Venezolana de Microbiología
                Rev. Soc. Ven. Microbiol.
                Organo Oficial de la Sociedad Venezolana de Microbiología. (Caracas, DF, Venezuela )
                1315-2556
                2007
                : 27
                : 2
                : 73-78
                Affiliations
                [01] Caracas orgnameUniversidad Central de Venezuela orgdiv1Facultad de Medicina orgdiv2Sección de Bacteriología Instituto de Medicina Tropical Venezuela
                Article
                S1315-25562007000200004 S1315-2556(07)02700204
                dcab7e67-fc83-4b10-8d5a-962aa2aec70e

                http://creativecommons.org/licenses/by/4.0/

                History
                : 22 January 2007
                : 21 May 2007
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 30, Pages: 6
                Product

                SciELO Venezuela

                Categories
                Revisiones

                conventional diagnostic methods,Mycoplasma pneumoniae,Community Acquired Pneumonia,Mycoplasma pnemoniae,serología,cultivo,métodos de diagnóstico convencional,Neumonía Adquirida en la Comunidad,serology,culture

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