BackgroundThe lack of an effective diagnostic tool for Carrion’s disease leads to misdiagnosis, wrong treatments and perpetuation of asymptomatic carriers living in endemic areas. Conventional PCR approaches have been reported as a diagnostic technique. However, the detection limit of these techniques is not clear as well as if its usefulness in low bacteriemia cases. The aim of this study was to evaluate the detection limit of 3 PCR approaches.Methodology/Principal FindingsWe determined the detection limit of 3 different PCR approaches: Bartonella-specific 16S rRNA, fla and its genes. We also evaluated the viability of dry blood spots to be used as a sample transport system. Our results show that 16S rRNA PCR is the approach with a lowest detection limit, 5 CFU/μL, and thus, the best diagnostic PCR tool studied. Dry blood spots diminish the sensitivity of the assay.Conclusions/SignificanceFrom the tested PCRs, the 16S rRNA PCR-approach is the best to be used in the direct blood detection of acute cases of Carrion’s disease. However its use in samples from dry blood spots results in easier management of transport samples in rural areas, a slight decrease in the sensitivity was observed. The usefulness to detect by PCR the presence of low-bacteriemic or asymptomatic carriers is doubtful, showing the need to search for new more sensible techniques.
Abstract. A 22-day-old male was admitted with a 2-day history of irritability, dyspnea, jaundice, fever, and gastrointestinal bleeding. A thin blood smear was performed, which showed the presence of intraerythrocyte bacteria identified as Bartonella bacilliformis, and subsequently, the child was diagnosed with Carrion's disease. The diagnosis was confirmed by specific polymerase chain reaction. The child was born in a non-endemic B. bacilliformis area and had not traveled to such an area before hospitalization. However, the mother was from an endemic B. bacilliformis area, and posterior physical examination showed the presence of a wart compatible with B. bacilliformis in semi-immune subjects. These data support vertical transmission of B. bacilliformis.
Background: Leptospira and dengue can affect many different human tissues, producing a wide array of clinical manifestations, ranging from a mild undifferentiated febrile illness to severe multi-organ failure and death especially in tropical countries. Early differentiation between both the diseases is necessary since management of either condition varies considerably. Study was undertaken to compare clinical and laboratory parameters of dengue and leptospirosis and to identify parameters for early differentiation.Methods: The study was undertaken at patients admitted at the Kasturba Hospital, Manipal, Indiafor 3 yrs. This was a prospective study and included 200 patients with 100 each of dengue and leptospirosis. A detailed history and examination were performed. Laboratory investigations included hematological, biochemical, radiological and microbiological studies.Results: Of the 100 cases of each, 73 leptospirosis patients and 68 dengue patients were male and the rest female. The mean age was 46.19 years for leptospirosis and 34.8 years for dengue cases. Oliguria, icterus and muscle tenderness were more commonly seen in leptospirosis. Low hemoglobin, low total leukocyte count, thrombocytopenia, elevated ESR were more common in leptospirosis as compared to dengue. Renal and liver functions alteration and ARDS were altered more in leptospirosis. Mortality was 18% in leptospirosis as compared to 1% in dengue.Conclusion: Leptospirosis had a greater incidence of muscle tenderness, icterus, oliguria and pancreatitis as compared dengue. Mortality is significantly high in leptospirosis than dengue.
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