EDITOR’S CHOICE For RBCs, orders outside hospital
guidelines decreased (from 23.9% to 17.1%, P<0.001), and utilisation decreased by 12% (P<0.035). For plasma and PLTs, both orders outside guidelines and utilisation changed minimally. Overall cost avoidance was $181,887/year by acquisition cost (and from $582,039 to $873,058/year by activity-based cost), 93% of which was attributed to reduction in RBC utilisation. Length of stay, morbidity and mortality were unchanged. The authors’ findings demonstrate a
greater opportunity for reducing RBC compared to plasma and PLT utilisation. A properly implemented PBM programme has the potential to reduce unnecessary transfusions and their associated risk and costs, without compromising clinical outcomes.
Parasitology Irritable bowel syndrome and intestinal parasites: a view from South America. Vasquez-Rios G, Machicado JD, Terashima A,Marcos LA. Rev Gastroenterol Peru 2016; 36 (2):153–8.
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder of uncertain aetiology. Several studies have proposed the possible role of intestinal parasites in the pathogenesis of IBS. The study aims to summarise the epidemiological studies that describe a possible link between intestinal parasites and IBS, with special interest in endemic areas for intestinal parasitism such as South America. A comprehensive review of the literature
was conducted using the keywords: irritable bowel syndrome, intestinal parasites, protozoan infection, soil-transmitted helminths and South America. Giardia lambliamay cause IBS symptoms that can persist for several years after effective treatment. Dientamoeba fragilis can cause IBS-like symptoms, but low-sensitivity parasitological techniques may fail to detect it. Entamoeba histolytica can cause a chronic non-dysenteric colitis, but several studies have failed to find an association with IBS. The role of Blastocystis hominis in IBS remains controversial. In addition, epidemiological studies
evaluating the effect of soil-transmitted helminths in IBS are scant. Symptoms elicited by intestinal parasites may resemble those in IBS, especially in endemic areas such as South America, where both the prevalence of IBS and intestinal parasitism are high. Whether these organisms are the cause or contributing factors in IBS remains a subject of study. Routine parasitological examination of stools in individuals who fully fit the criteria for IBS should be included upon initial assessment in endemic countries.
THE BIOMEDICAL SCIENTIST AUGUST 2016
Molecular detection of common intestinal parasites: a performance evaluation of the BD Max Enteric Parasite
Panel.Batra R, Judd E, Eling J, Newsholme W, Goldenberg SD. Eur J Clin Microbiol Infect Dis 2016 Jul 9 (Epub ahead of print).
This study aims to evaluate the level of agreement of the BD Max Enteric Parasite Panel (EPP) with microscopy for the detection of Giardia duodenalis, Cryptosporidiumspp. and Entamoeba histolytica in stool samples. A total of 372 stool samples (partly
collected on the basis of positive microscopy and partly unselected consecutive samples submitted for parasite investigation) were tested with EPP according to the manufacturer’s instructions and also using microscopy according to standard techniques. Discrepant samples were further tested using PCR by the national Parasitology Reference Laboratory. Levels of agreement and laboratory turnaround times were measured and compared. Overall, positive and negative percentage
agreement was high between the two methods. However, microscopy resulted in four false positives and one false negative for G. duodenalis, and two false positives for Cryptosporidium. Additionally, microscopy could not differentiate between E. histolytica and E. dispar. Median laboratory turnaround time was 65 hours for microscopy; results from EPP could be available after four hours. Blastocystis hominiswas detected by microscopy in one sample and would have been missed if only EPP was performed. The EPP was a good alternative to
microscopy, detecting a small number of additional positives that were missed by microscopy. The assay is significantly faster than microscopy and allows laboratory workflows to be streamlined. The risk of missing parasites that are not included in the EPP appears to be minimal in the studied population; however, there may be certain patient groups that would benefit from microscopic examination of stools.
Detection of parasites in children with chronic
diarrhea.Maçin S, Kaya F, Çada D et al. Pediatr Int 2016; 58 (6): 531–3.
The aim of this study was to investigate the frequency of intestinal parasites in patients with chronic diarrhoea and clarify the importance of these parasitic pathogens in such cases. A total of 60 paediatric patients with chronic diarrhoea between June 2012 and October 2014 were enrolled in the study. Out of 60 stool samples, five were
positive for Giardia lamblia, two Dientamoeba fragilis, and one Blastocystis hominis. One stool sample was positive for Entamoeba hartmanni and B. hominis, another one was positive for G. lamblia and
B. hominis, another G. lamblia and E. hartmanni and one sample was positive for Enterobius vermicularis, D. fragilis and B. hominis. Parasitic infection, which decreases
quality of life and increases susceptibility to other infections, should not be neglected, particularly in patients with chronic diarrhoea. Accurate diagnosis decreases morbidity and mortality in patients with parasite infection.
Associations between common intestinal parasites and bacteria in humans as revealed by qPCR. O’Brien Andersen L, Karim AB, Roager HM et al. Eur J Clin Microbiol Infect Dis 2016 May 26 (Epub ahead of print).
Several studies have shown associations between groups of intestinal bacteria or specific ratios between bacterial groups and various disease traits. Meanwhile, little is known about interactions and associations between eukaryotic and prokaryotic microorganisms in the human intestine. In this study, the authors investigate potential associations between common single-celled parasites such as Blastocystis spp. and Dientamoeba fragilis and intestinal bacteria. Stool DNA from patients with intestinal
symptoms were selected based on being Blastocystis spp.-positive (B+)/negative (B–) and D. fragilis-positive (D+)/negative (D–), and split into four groups of 21 samples (B+ D+, B+ D–, B–D+, and B– D–). Quantitative PCR targeting the six bacterial taxa Bacteroides, Prevotella, the butyrate-producing clostridial clusters IV and XIVa, the mucin-degrading Akkermansia muciniphila, and the indigenous group of Bifidobacteriumwas subsequently performed, and the relative abundance of these bacteria across the four groups was compared. The relative abundance of Bacteroides
in B– D– samples was significantly higher compared with B+ D– and B+ D+ samples (P<0.05 and P<0.01, respectively), and this association was even more significant when comparing all parasite-positive samples with parasite-negative samples (P<0.001). Additionally, the data revealed that a low abundance of Prevotella and a higher abundance of clostridial cluster XIVa was associated with parasite-negative samples (P<0.05 and P<0.01, respectively). The data support the theory that
Blastocystis alone or combined with D. fragilis is associated with intestinal microbiota characterised by low relative abundances of Bacteroides and clostridial cluster XIVa and high levels of Prevotella.
Other recent Editor's Choice items have focused on proteins (May, page 271), lymphoid malignancy (June, page 328) and polio eradication (July, page 386).
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