Integrating HBV, HCV and HIV screening in tuberculosis entry screening for migrants in the Netherlands

We evaluated uptake and diagnostic outcomes of voluntary hepatitis B (HBV) and C virus (HCV)

screening offered during routine tuberculosis entry screening to migrants in Gelderland and Amsterdam, the Netherlands, between 2013 and 2015. In Amsterdam, HIV screening was also offered. Overall, 54% (461/859) accepted screening. Prevalence of chronic HBV infection (HBsAg-positive) and HCV exposure (anti-HCVpositive) in Gelderland was 4.48% (9/201; 95% confidence interval (CI): 2.37-8.29) and 0.99% (2/203; 95% CI: 0.27-3.52), respectively, all infections were

newly diagnosed. Prevalence of chronic HBV infection, HCV exposure and chronic HCV infection (HCV RNA-positive) in Amsterdam was 0.39% (1/256; 95% CI: 0.07-2.18), 1.17% (3/256; 95% CI: 0.40-3.39) and 0.39% (1/256; 95% CI: 0.07-2.18), respectively, with all chronic HBV/HCV infections previously diagnosed. No HIV infections were found. In univariate analyses, newly diagnosed chronic HBV infection was more likely in participants migrating for reasons other than work or study (4.35% vs 0.83%; odds ratio (OR) = 5.45; 95% CI: 1.12-26.60) and was less likely in participants in Amsterdam than Gelderland (0.00% vs 4.48%; OR = 0.04; 95% CI: 0.00-0.69). Regional differences in HBV prevalence might be explained by differences in the populations entering compulsory tuberculosis

screening. Prescreening selection of migrants based on risk factors merits further exploration.

No added value of performing Ziehl-Neelsen on auramine-positive samples for tuberculosis diagnostics

SETTING

Regional Laboratory for Tuberculosis, Amsterdam, The Netherlands.

BACKGROUND

There is a push to switch from Ziehl-Neelsen (ZN) to auramine microscopy. Despite World Health Organization guidelines that one staining method is sufficient, in some countries national guidelines prescribe that auramine-positive samples should be confirmed by ZN.

OBJECTIVE

To investigate the added value of confirming auramine-positive samples using ZN.

DESIGN

Using diagnostic data from 10 276 respiratory samples collected from 5525 patients tested for tuberculosis (TB) at the Municipal Health Service of Amsterdam between May 2006 and October 2011, we determined the diagnostic accuracy of auramine alone and of confirmation of auramine-positive samples using ZN.

RESULTS

Of 141 M. tuberculosis complex-positive samples detected using auramine on which ZN was performed, 32 (22.7%) were ZN-negative. A similar percentage (6/25, 24.0%) of negatives was found for samples containing non-tuberculous mycobacteria (NTM) species, thus making it impossible to distinguish between TB and NTM on the basis of ZN results.

CONCLUSIONS

A positive auramine result followed by a negative ZN result could not be used to exclude TB or to indicate the presence of NTM species. Confirming auramine-positive samples using ZN in this setting thus provided no clinically informative information and was a waste of resources.

Two cases of mild IgM-negative measles in previously vaccinated adults, the Netherlands, April and July 2011

We describe two cases of mild, modified measles in fully vaccinated adults in the Netherlands. The mildness of disease, the lack of an IgM antibody response, the relatively low amounts of virus detected and the fact that no additional cases were reported, suggests that these vaccinated patients were less contagious than unvaccinated patients.

Two cases of mild IgM-negative measles in previously vaccinated adults, the Netherlands, April and July 2011

We describe two cases of mild, modified measles in fully vaccinated adults in the Netherlands. The mildness of disease, the lack of an IgM antibody response, the relatively low amounts of virus detected and the fact that no additional cases were reported, suggests that these vaccinated patients were less contagious than unvaccinated patients.

The value of postmortem computed tomography as an alternative for autopsy in trauma victims: a systematic review

The aim of this study was to assess the role of postmortem computed tomography (PMCT) as an alternative for autopsy in determining the cause of death and the identification of specific injuries in trauma victims. A systematic review was performed by searching the EMBASE and MEDLINE databases. Articles were eligible if they reported both PMCT as well as autopsy findings and included more than one trauma victim. Two reviewers independently assessed the eligibility and quality of the articles. The outcomes were described in terms of the percentage agreement on causes of death and amount of injuries detected. The data extraction and analysis were performed together. Fifteen studies were included describing 244 victims. The median sample size was 13 (range 5–52). The percentage agreement on the cause of death between PMCT and autopsy varied between 46 and 100%. The overall amount of injuries detected on CT ranged from 53 to 100% compared with autopsy. Several studies suggested that PMCT was capable of identifying injuries not detected during normal autopsy. This systematic review provides inconsistent evidence as to whether PMCT is a reliable alternative for autopsy in trauma victims. PMCT has promising features in postmortem examination suggesting PMCT is a good alternative for a refused autopsy or a good adjunct to autopsy because it detects extra injuries overseen during autopsies. To examine the value of PMCT in trauma victims there is a need for well-designed and larger prospective studies.

Clinical features of liver involvement in adult patients with listeriosis. Review of the literature

Clinical features of liver involvement due to Listeria monocytogenes infection in adults are rarely reported in literature. This is surprising, regarding the current opinion that the portal system is extensively involved in the first stages of pathogenesis in invasive L. monocytogenes disease. A literature search in the PubMed and Embase database revealed 34 cases with clinical features of hepatic involvement due to listeriosis. We systematically analyzed all case reports with respect to clinical manifestations, treatment and outcome. In addition, we added clinical information on a patient diagnosed with a solitary liver abscess due to L. monocytogenes, who was seen at our institution. This review describes the different presentations of liver-involvement reported in listeriosis; solitary liver abscess, multiple liver abscesses and diffuse or granulomatous hepatitis. Distinction between these different forms of liver involvement is clinically relevant as they have a different outcome. We delve into the different pathogenic events leading to different forms of liver involvement. In addition, diagnostic modalities and possible treatments are reviewed.

Lack of discriminating signs and symptoms in clinical diagnosis of influenza of patients admitted to the hospital

Objectives:

Rapid diagnosis of influenza in hospitalised patients is important to prevent the transmission of the infection in the hospital. This prospective observational cohort study was designed to determine the relationship between the clinical diagnosis of influenza made by the physician at admission and the presence of influenza virus in patients with respiratory tract infections.

Methods:

This prospective observational cohort study was conducted in a large Dutch teaching hospital in a period of four weeks during the influenza season 2004/2005. All patients of 18 years and older, admitted with respiratory tract infections were included in the study. Clinical and laboratory parameters, chest radiograph (CR), blood and sputum cultures and nasopharyngeal swab for polymerase chain reaction (PCR) were obtained for each patient. In addition, the physicians opinion at admission whether this patient had influenza was recorded.

Results:

A total of 78 patients were hospitalized with respiratory tract infections. In 41 (53%) of them influenza virus was detected by PCR. Among the patients that were positive for influenza virus by PCR, a clinical diagnosis of influenza was made in 18 cases (44%). Conversely, clinical diagnosis of influenza was made in 16 out of 37 patients in whom influenza virus was not detected by PCR. Neither C-reactive protein, leucocytes count nor an infiltrate on CR were helpful in determining the cause of the respiratory tract infection.

Conclusions:

The present findings failed to demonstrate a significant relationship between the clinical diagnosis of influenza and PCR detection of the virus. Also, the virus was present at least twice more often than influenza was clinically diagnosed. As a consequence, the decision to take protective measures to control spread of the virus should not rely on the clinical diagnosis.