Toward an Objective Diagnostic Test for Bacterial Cellulitis.
Toward an Objective Diagnostic Test for Bacterial Cellulitis.
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DOI：
10.1371/journal.pone.0162947
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Murphy GF
中科院分区：
文献类型：
--
作者：
Pallin DJ;Bry L;Dwyer RC;Lipworth AD;Leung DY;Camargo CA Jr;Kupper TS;Filbin MR;Murphy GF
先前的研究反复表明，诊断为“蜂窝组织炎”的皮肤病变培养物通常呈阴性。然而，缺乏诊断的黄金标准（可以根据哪种培养物进行判断）和未能评估人体免疫反应是先前工作的重要限制。在这项初步研究中，我们的目的是制定细菌性蜂窝织炎研究的标准，评估降钙素原对细菌性蜂窝织炎的敏感性，并利用基因表达分析来寻找其他候选诊断标记物。我们通过活检、16s rRNA 基因检测、培养和组织病理学对病变进行分类。我们量化了血液中降钙素原的表达。我们还使用纳米线技术来量化免疫调节剂的转录，这可以将病例与炎症对照区分开来。 28 名参与者中，15 名临床诊断为蜂窝组织炎，6 名诊断为非感染性皮炎，7 名是正常志愿者。在“蜂窝组织炎”患者中，三名（20%）分离出病原体，并被指定为确诊病例。在这三者中均检测不到降钙素原。确诊病例中 HLA-DQA1 的表达量是对照组的 34 倍（几何平均值的倍数变化）。描述多重基因表达分析的热图揭示了确诊病例相对于比较者的独特基因表达谱。大多数“蜂窝织炎”患者的活检结果微生物学呈阴性。在确诊的细菌病例中，降钙素原检测不到，HLA-DQA1 升高。多变量转录组分析结果支持我们的算法识别患有真正细菌性蜂窝织炎的患者的能力。更大的样本可能会发现能够在临床实践中区分细菌性蜂窝织炎与其模拟物的免疫学特征。
Prior studies repeatedly showed that cultures of skin lesions diagnosed as "cellulitis" are usually negative. However, lack of a gold standard for diagnosis (against which culture might be judged) and failure to assess the human immune response are important limitations of prior work. In this pilot study, we aimed to develop a criterion standard for research on bacterial cellulitis, to evaluate the sensitivity of procalcitonin for bacterial cellulitis, and to use gene expression analysis to find other candidate diagnostic markers. We classified lesions via biopsies, 16s rRNA gene detection, culture, and histopathology. We quantified procalcitonin expression in blood. We also used Nanostring technology to quantify transcription of immunomodulators that may distinguish cases from inflamed controls. Of 28 participants, 15 had a clinical diagnosis of cellulitis, six had a diagnosis of non-infectious dermatitis, and seven were normal volunteers. Of the “cellulitis” patients, three (20%) had pathogens isolated, and were designated confirmed cases. Procalcitonin was undetectable in all three. HLA-DQA1 was expressed 34-fold more in confirmed cases vs. controls (fold change of geometric mean). Heat maps depicting multiplex gene expression analysis revealed a distinct profile of gene expression in confirmed cases relative to comparators. Most “cellulitis” patients had microbiologically-negative biopsies. Procalcitonin was undetectable, and HLA-DQA1 elevated, in confirmed bacterial cases. Multivariable transcriptomic profiling results supported our algorithm’s ability to identify patients with true bacterial cellulitis. A larger sample may allow discovery of an immunological signature capable of distinguishing bacterial cellulitis from its mimics in clinical practice.
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影响因子：
158.5
作者：
Swartz, MN
通讯作者：
Swartz, MN
影响因子：
3.1
作者：
Pallin, Daniel J.;Camargo, Carlos A., Jr.;Schuur, Jeremiah D.
通讯作者：
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作者：
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DOI：
10.1007/s10096-014-2274-9
发表时间：
2015-04-01
影响因子：
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作者：
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通讯作者：
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影响因子：
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作者：
Pallin, Daniel J.;Espinola, Janice A.;Camargo, Carlos A., Jr.
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