Streeklab Haarlem

BackgroundThe ability to accurately distinguish bacterial from viral infection would help clinicians better target antimicrobial therapy during suspected lower respiratory tract infections (LRTI). Although technological developments make it feasible to rapidly generate patient-specific microbiota profiles, evidence is required to show the clinical value of using microbiota data for infection diagnosis. In this study, we investigated whether adding nasal cavity microbiota profiles to readily available clinical information could improve machine learning classifiers to distinguish bacterial from viral infection in patients with LRTI.ResultsVarious multi-parametric Random Forests classifiers were evaluated on the clinical and microbiota data of 293 LRTI patients for their prediction accuracies to differentiate bacterial from viral infection. The most predictive variable was C-reactive protein (CRP). We observed a marginal prediction improvement when 7 most prevalent nasal microbiota genera were added to the CRP model. In contrast, adding three clinical variables, absolute neutrophil count, consolidation on X-ray, and age group to the CRP model significantly improved the prediction. The best model correctly predicted 85% of the ‘bacterial’ patients and 82% of the ‘viral’ patients using 13 clinical and 3 nasal cavity microbiota genera (Staphylococcus, Moraxella, and Streptococcus).ConclusionsWe developed high-accuracy multi-parametric machine learning classifiers to differentiate bacterial from viral infections in LRTI patients of various ages. We demonstrated the predictive value of four easy-to-collect clinical variables which facilitate personalized and accurate clinical decision-making. We observed that nasal cavity microbiota correlate with the clinical variables and thus may not add significant value to diagnostic algorithms that aim to differentiate bacterial from viral infections.

ABSTRACTBackgroundThe specificity of molecular methods for the detection of Streptococcus pneumoniae carriage is under debate. We propose a procedure that increases the accuracy of molecular detection of live pneumococci in polymicrobial respiratory samples.MethodsCulture and qPCR methods were applied to detect S. pneumoniae and pneumococcal serotypes in 1549 nasopharyngeal samples collected in the Netherlands (n=972) and England (n=577) from 946 toddlers and 603 adults, and in paired oropharyngeal samples collected exclusively from 319 Dutch adults. Samples with no live pneumococci isolated at primary diagnostic culture yet generating pneumococcus-specific signal in qPCRs were re-examined with a second, qPCR-guided culture. Optimal Cq cut-offs for positivity in qPCRs were determined via receiver operating characteristic (ROC) curve analysis using isolation of live pneumococci from the primary and qPCR-guided cultures as reference.ResultsDetection of S. pneumoniae and pneumococcal serotypes with qPCRs in cultured (culture-enriched) nasopharyngeal samples exhibited near-perfect agreement with conventional culture (Cohen’s kappa: 0.95). Molecular methods also displayed increased sensitivity of detection for multiple serotype carriage. Among paired samples from adults, the sensitivity of S. pneumoniae detection in primary nasopharyngeal plus oropharyngeal cultures was significantly lower compared with molecular detection in both culture-enriched samples together (p<0.0001) and also in culture-enriched oropharyngeal samples alone (p<0.05).ConclusionsThe sensitivity of S. pneumoniae carriage surveillance can be greatly improved by complementing conventional culture with qPCR and vice versa. The specificity of molecular methods for the detection of live pneumococci can be enhanced by incorporating statistical procedures based on ROC curve analysis. The procedure we propose improves detection of S. pneumoniae carriage in adults in particular and enhances specificity of serotype carriage detection.

Syphilis is a sexually transmitted disease, caused by the spirochete Treponema Pallidum. Many different manifestations exist, which can complicate diagnosis. A 36-year-old man with a known HIV infection, presented himself with rectal blood loss and abdominal pain. Abdominal ultrasound and abdominal CT were suspicious for malign liver metastases. During subsequent colonoscopy, benign looking rectal lesions were found, possibly caused by either lymphogranuloma venereum or syphilis. Additional diagnostics confirmed an active syphilis infection. After treatment with benzylpenicillin, patient's complaints resolved, as well as the lesions in rectum and liver. We describe a rare case of a patient with secondary syphilis, presenting with rectal lesions and liver lesions suspicious for malign metastases.

The declining economy of the Dutch Republic obliged city governments in the eighteenth century to take measures to undo the effects of the social deterioration. They therefore founded schools for the poor and sometimes gave full financial support. After 1795, the Batavian Revolution proclaimed that primary education was a state affair, but after a contest for hegemony between political elites, funding of schools in particular was left to provinces and communities. The desolate finances of the Batavian Republic made it nearly impossible for the national government to intervene with financial resources. After 1813 the situation did not change much; under King William I the decentralised funding model remained despite his absolutist activity. The constitution from 1848 offered freedom but after the new law of 1857 confessional politicians promoted private education because they found the neutral character of public education unacceptable for their children. Liberals aggravated the demands for primary education and were responsible for the fact that communities received state support to fulfil the demands in the law of 1878. But liberal hegemony broke down and confessional politicians succeeded in gaining state support for private schools in 1889 in exchange for their cooperation with the extension of suffrage. This process was repeated after 1913 when liberals negotiated with Christian politicians concerning general suffrage and equal funding of the private schools. The Dutch state dominated through that result in 1920 primary education but did not gain a monopoly.

In the histopathology of malignant mesotheliomas three different types (epithelial, connective tissue and mixed type) are distinguished. Some authors believe all tumours to be of mixed type, but consider that due to inadequate sampling or small biopsies this may be missed frequently. In this study the relationship between the histopathological diagnosis and the amount of tissue examined was investigated. In a series of 124 cases of malignant pleural mesothelioma a high percentage of mixed type tumours was found (55%). In cases where the decisive diagnostic procedure had been an Abrams biopsy (the "small-specimen" technique) mixed-type histology was found in 36%. If thoracoscopy, thoracotomy or autopsy (the "large-specimen" techniques) had delivered a definite diagnosis, mixed-type histology was found in 63%. Apparently diagnosing the mixed-type variety depends on the amount of tumour tissue obtained. However, the assumption that all mesotheliomas are of mixed type cannot be confirmed.

Click to increase image sizeClick to decrease image size Zusammenfassung Ein Forschungsbericht Der Verfasser gibt zunächst einen allgemeinen Überblick über die hauptsächlichen Schwerpunkte der Feuerbach-Forschung. Neben der Untersuchung des Werks von Feuerbach steht dabei vor allem sein Verhältnis zu Marx, Hegel sowie zur Theologie im Vordergrund. Das Verhältnis zur Theologie wird im vorliegenden Forschungsbericht näher beleuchtet. Im ersten Abschnitt geht der Verfasser auf die theologischen Reaktionen ein, die Feuerbachs Werk im 19. und 20. Jahrhundert hervorrief. Als zentrales Motiv kristallisiert sich dabei der Wunsch der Theologen heraus, auf die von Feuerbach gestellten Fragen zu antworten. Die Antworten, die in der Vergangenheit gegeben wurden, standen jedoch nicht immer im Gegensatz zu Feuerbach. Im nächsten Abschnitt wird das Verhältnis zwischen Feuerbach und Karl Barth dargestellt. Barth hatte sich ernsthaft mit Feuerbach auseinandergesetzt. Aus der Forschung ergab sich dabei eine doppelte Interpretation des genannten Verhältnisses. Einerseits verwendete Barth Feuerbach, um die Theologie seiner Zeit zu kritisieren. Dies geschah unter dem Motto, daß die Theologie die Religionskritik von Feuerbach erst möglich macht. Andererseits wird aber auch aufgewiesen, daß Barth und Feuerbach in der Ansicht über gesellschaftliche und politische Elemente in der Religion und in der Auffassung über deren emanzipatorischen Aspekt übereinstimmen. Im abschließenden Abschnitt kommt das Verhältnis zwischen Feuerbach und Schleiermacher zu Wort. Dabei handelt es sich um ein schwieriges Gebiet, über das noch keine Klarheit herrscht. Auch hier gibt es jedoch eine Entwicklung in der Forschung zu verzeichnen, die von der offenkundigen Leugnung jeder Beziehung bis hin zur vorsichtigen Anerkennung von Berührungspunkten verläuft. Als allgemeiner Eindruck läßt sich festhalten, daß eine erschöpfende Analyse der genannten Beziehung als Forschungsgebiet noch brach liegt. Einige Forscher erwarten sich von einem derartigen Projekt sehr viel, während andere zu entsprechenden Ergebnissen zunächst einmal sehr kritisch eingestellt sind.

An abstract is not available for this content so a preview has been provided. As you have access to this content, a full PDF is available via the ‘Save PDF’ action button.