Scielo RSS <![CDATA[Brazilian Journal of Infectious Diseases]]> vol. 12 num. 6 lang. en <![CDATA[SciELO Logo]]> <![CDATA[<b>Asymetric testicular schistosomal infection</b>]]> <![CDATA[<b>Species determination of Brazilian mammals implicated in the epidemiology of rabies based on the control region of mitochondrial DNA</b>]]> Identification of animals that are decomposing or have been run over or burnt and cannot be visually identified is a problem in the surveillance and control of infectious diseases. Many of these animals are wild and represent a valuable source of information for epidemiologic research as they may be carriers of an infectious agent. This article discusses the results obtained using a method for identifying mammals genetically by sequencing their mitochondrial DNA control region. Fourteen species were analyzed and identified. These included the main reservoirs and transmitters of rabies virus, namely, canids, chiroptera and primates. The results prove that this method of genetic identification is both efficient and simple and that it can be used in the surveillance of infectious diseases which includes mammals in their epidemiologic cycle, such as rabies. <![CDATA[<b>A coronavirus detected in the vampire bat <i>Desmodus rotundus</i></b>]]> This article reports on the identification of a group 2 coronavirus (BatCoV DR/2007) in a Desmodus rotundus vampire bat in Brazil. Phylogenetic analysis of ORF1b revealed that BatCoV DR/2007 originates from a unique lineage in the archetypical group 2 coronaviruses, as described for bat species elsewhere with putative importance in Public Health. <![CDATA[<b>Transgenic lettuce seedlings carrying hepatitis B virus antigen HBsAg</b>]]> The obtainment of transgenic edible plants carrying recombinant antigens is a desired issue in search for economic alternatives viewing vaccine production. Here we report a strategy for genetic transformation of lettuce plants (Lactuca sativa L.) using the surface antigen HBsAg of hepatitis B virus. Transgenic lettuce seedlings were obtained through the application of a regulated balance of plant growth regulators. Genetic transformation process was acquired by cocultivation of cotyledons with Agrobacterium tumefaciens harboring the recombinant plasmid. It is the first description of a lettuce Brazilian variety "Vitória de Verão" genetically modified. <![CDATA[<b>Alteration in the erythrocyte sedimentation rate in dengue patients</b>: <b>analysis of 1,398 cases</b>]]> A study of the erythrocyte sedimentation rate during the first hour (ESR) in dengue patients would help determine how this parameter is affected by this disease, as well as whether it can be used for diagnosis. One thousand, three hundred and ninety-eight cases of dengue attended at the Dengue Treatment Center, Campos dos Goytacazes Rio de Janeiro, Brazil, were included. The ESR values were classified as normal or elevated and compared by gender and clinical form of the disease. Among the 1,398 cases ESR was normal in 81.25% (n = 1,136), while in 18.75% (n=262) it was elevated. In 83.92% (n=514) of the male dengue patients ESR was normal, while in 16.08% (n=98) it was elevated. Among female dengue patients, 79.17% (n=622) had normal ESR, and in 20.83% (n=164) ESR was elevated (p=0.05). Among patients with classic dengue, 77.28% (n=961) had normal ESR, while in 22.72% (n=282), it was elevated. Also in 85.81% (n=133) of patients with hemorrhagic dengue, ESR was normal, while in 14.19% (n=22) ESR was elevated (p=0.026). We concluded that ESR was within normal ranges in most dengue cases, independent of gender or clinical presentation. Given the high frequency of normality and the ease of determination of this parameter, ESR data can help in the differential diagnosis of dengue. <![CDATA[<b>Incidence and clinical characteristics of the infection by the Respiratory Syncytial Virus in children admitted in Santa Casa de São Paulo Hospital</b>]]> The purpose of this study was to identify the rate of infections due to RSV and other viruses in children. In addition we have analyzed demographic data and clinical characteristics of the RSV-positive patients comparing with patients infected by other respiratory viruses. We also described the seasonality of the RSV occurrence in a hospital in São Paulo. Children below 5 years old admitted in Santa Casa de São Paulo Hospital between February 2005 and September 2006 due to acute respiratory infections (ARI) were included. A nasopharyngeal specimens were obtained with sterile No. 5 French feeding catheters as soon as possible (usually within 24 h). Specimens were kept refrigerated at 4ºC and transported to Adolfo Lutz Institute, where the indirect immunofluorescent assay was performed. Virus identified by these assay included RSV, Adenovirus, Influenza A and B virus and Parainfluenza 1, 2, and 3. Clinical data from each group was compared. Four hundred and fifty five cases were included in the study, with 30% positive for some type of virus. Viruses that were identified included Respiratory Syncytial Virus (73.03%), Influenza (8.42%), Parainfluenza (8.42%) and Adenovirus (3.37%). We divided the subjects in 3 groups: Group 1 RSV-Positive, Group 2 Other Positive Viruses and Group 3 Negative for Respiratory Virus. Mean age (months) was of 7.5 for RSV-positive children, 7.6 for other viruses, and 8 for negative for respiratory virus. The RSV-Positive Group was significantly younger than the Group Negative for Respiratory Virus (p<0.05). Signs of UAI were more present in the Positive RSV Group (p<0.05). General mortality was of 2.41%. There was a higher incidence of RSV between the months of March and August in the two years of the study. Our study indicates RSV as the most prevalent viral agent in children admitted due to (ARI), especially in infants below 3 months old. We have also found that infections due to RSV can occur in months others than the classic seasonal period. <![CDATA[<b>Anti-<i>Trypanosoma cruzi</i> antibody detection in blood donors in the Southern Brazil</b>]]> Trypanosoma cruzi, the causal agent of Chagas' Disease, is a widely spread protozoa in America. Blood transfusion is the secondly most important way of acquiring the infection. In blood banks, tests are performed to eliminate potentially infected blood. This study aimed to evaluate the positivity for T. cruzi in blood samples of donor's candidates in Southern Brazil. The study was based on a sampling containing all blood donors of Hemopel - a Pelotas City Blood Center, Rio Grande do Sul State, Brazil, from 2004 to 2005. Serological study was performed using ELISA Chagatest. Sampling containing values ± 20% cut off were evaluated using ELISA Chagatek, ELISA Alka/Adaltis, IHA Chagatest and IIF Imunocruzi. TESA-Blot was used as a confirmatory procedure in situations where blood samples showed conflicting results. From 4,482 samples collected in 2004 and 2005, the reactivity for anti-T. cruzi was 0.96% (43). Among those, 21 cases (0.47%) were confirmed as positive - most of them were female, with low school level and averaging 47.2% years old. Interestingly, the blood donors are not aware of being contaminated and this fact makes it difficult for controlling the disease. Chagas' Disease was one of the main reasons for discarding blood bags through serological control in Southern Brazil. Sampling reactivity showed variation among the different techniques used for anti-T. cruzi research. In order to obtaining more secure and conclusive results, more than one diagnostic technique must be used. <![CDATA[<b>CD4+ cell counts in patients with different clinical manifestations of tuberculosis</b>]]> Tuberculosis is the prototype of infections that require a cellular immune response for their control. It has been shown that CD4+ T-lymphocytes are most important in the protective response against Mycobacterium tuberculosis. CD8+ T-lymphocytes are also important for effective T-cell immune response. This study compares CD4+ and CD8+ baseline values in patients with different manifestations of tuberculosis. CD4+ and CD8+ in three groups of patients with tuberculosis (pulmonary, lymphadenitis, meningitis/milliary involvement) and a group of healthy volunteers were enumerated using flowcytometry. Twenty-six patients with pulmonary tuberculosis, 10 with adenitis, 16 with meningitis or milliary tuberculosis and 16 healthy volunteers entered the study. Mean CD4 in meningitis/milliary group was significantly lower than all other groups (p<0.05). Mean CD4 counts of patients with pulmonary tuberculosis was also significantly lower than control group (p=0.01). Mean CD8 in meningitis/milliary group was significantly lower than control group (p=0.02). No relation was found between results of TSTs and CD4 values in three groups. CD4 depletion is an expectable phenomenon in patients with tuberculosis. This study shows that patients with more severe form of disease had the lowest number of both CD4 and CD8 cells which can be a sign of suppressed cellular immunity in these patients. <![CDATA[<b>Molecular genotyping and epidemiology of <i>Mycobacterium tuberculosis </i>isolates obtained from inmates of correctional institutions of Campinas, Southeast Brazil</b>]]> The objective of this study was to investigate the possible transmission of tuberculosis among 39 inmates with positive Mycobacterium tuberculosis smears in four correctional institutions located in Campinas City, SP, Brazil over a 19-month period. Fifty-one M. tuberculosis isolates from these inmates were characterized according to the number of IS6110 insertion elements present in their genomic DNA. The number of insertion elements in M. tuberculosis isolates varied from two to twelve. The dendrogram of similarity resulted in the grouping the isolates in six main clusters. These results, associated to epidemiological data, suggested the transmission of tuberculosis among inmates of the same and different institutions inmates. Univariate analysis of epidemiological data (total delay for beginning of treatment, previous treatment, and HIV status) and clustering occurrence showed that only "previous treatment" (OR = 7.65, p = 0.032) was associated with the possible transmission of tuberculosis in the studied prisons. <![CDATA[<b>Analysis of the use of imipenem at a University Hospital following the restructuring of an antimicrobial audit system</b>]]> This study analyzed the use pattern of imipenem following the restructuring of the antimicrobial audit system at a University Hospital. It was an observational study before and after the restructuring of the antimicrobial audit system in a University Hospital from May to August and then from September to December 2006. The criteria of the rational use of imipenem were obtained from a non-systematic revision of the literature. The collection of data on the general characteristics and clinical state of the patient, the infection and the established therapy was carried out in a previously tested instrument. Data was recorded, revised and analyzed in a database built with the software SPSS® for Windows® PC, version 10.0. The statistical analysis had a descriptive character: frequencies, mean, median and standard deviation. No differences were encountered in relation to the appropriate indication, consumption and clinical outcomes of patients. However, there was a reduction of 4 to 1 (75.0%) in the number of associations with spectrum superposition and an increase of 4 to 8 (50.0%) in the change of therapy. The restructuring of the antimicrobial audit system in the studied hospital did not reflect significantly the increase of the appropriate indication of imipenem. It contributed, however, to the reduction of the inappropriate associations of this antibiotic and to changes of therapy, without, however, compromising the quality of services rendered to patients. <![CDATA[<b>Risk factors and evolution of Ventilator-associated pneumonia by Staphylococcus aureus sensitive or resistant to oxacillin in patients at the intensive care unit of a Brazilian University Hospital</b>]]> This study investigated the participation and risk factors of VAP by resistant (ORSA) or sensitive (OSSA) S. aureus to oxacillin and evaluated the implications of adequate or inadequate empirical antimicrobial therapeutics in its evolution in patients interned in a mixing ICU of adults. A patient control-case study with PAVs by ORSA and OSSA was carried out from May 2005 to April 2007 involving 993 patients. VAP was defined based on clinical, radiological, and microbiological (> 106 CFU/mL count in the tracheal aspirate) criteria. Four hundred and seventy four (47.7%) patients were submitted to mechanical ventilation with 141 (29.7%) VAPs, with S. aureus as the most frequent agent (41.2%). The phenotype ORSA accounted for 47.5% and OSSA for 52.5%, predominant in late-onset VAPs with frequencies of 93.1% and 68.7%, respectively. Age > 60, use of corticoid and previous antibiotic therapy were related (p<0.05) with the development of VAP by ORSA. Mortality rate was higher (p>0.05) in the group with VAP by ORSA (37.9%). S. aureus was the main agent of VAPs, around half by ORSA, associated with age, late-onset VAP development and previous use of antibiotics and corticoids, but with no significant difference in mortality compared with VAP by OSSA. <![CDATA[<b>Prevalence and risk factors for <i>Staphylococcus aureus</i> in health care workers at a University Hospital of Recife-PE</b>]]> Staphylococcus aureus is the main human pathogen that colonizes individuals in general population. The objective of the study was evaluate the epidemiological and sensitivity profile of S. aureus lineage, isolated in health care workers (HCW) of a University Hospital in Pernambuco state, Brazil. Biological samples of hands and nasal cavities were sown in agar sheep blood. Colonies under suspicion of being S. aureus were identified using Gram staining, catalase test and coagulase, mannitol-salty agar fermentation and DNAse agar. The resistance to mupirocin was analyzed through the Kirby Bauer technique. In relation to methicillin and vancomycin the determination was by the minimum inhibitory concentration method (E-test). From the 202 HCW evaluated, 52 were colonized by S. aureus (25,7%). The factors associated to the colonization by S. aureus were: age-group, professional category, use of individual protection equipments (frequency and numbers). All S. aureus isolate lineages were sensitive to mupirocin and vancomycin, and three of them were identified as methicillin-resistant. The prevalence of MSSA and MRSA among HCW was considered low and was below the results described in the literature. The isolate S. aureus lineages have shown low resistance profile. <![CDATA[<b><i>Pseudomonas aeruginosa</i></b><b> infections</b>: <b>factors relating to mortality with emphasis on resistance pattern and antimicrobial treatment</b>]]> A retrospective case-control study was conducted to investigate the risk factors for death among intensive care unit patients with Pseudomonas aeruginosa infection. Out of 131 patients investigated, 67 (51.1%) died within 30 days of being diagnosed with this infection. The mean duration of hospital stay before this diagnosis was 28.5 ± 26.5 days. No association was found between bacterial resistance and death in this study (multiresistant p= 0.26; panresistant p= 0.42), but the adequacy of the initial treatment was inversely proportional to the degree of resistance. There was a tendency towards greater mortality among patients who received combination therapy (empirical p= 0.09; definitive p= 0.08), despite the greater frequency of appropriate treatment in these patients and the similar degree of severity in the two groups. This finding may be explained by pharmacodynamic parameters that were not studied or by the extensive use of aminoglycosides in the combination therapy, which play a controversial role in combination therapy due to their potential for renal toxicity. The multivariate analysis in our study demonstrated that age [odds ratio (OR) 1.04], septic shock (OR 15.4) and hypoalbuminemia (OR 0.32) were independent risk factors for death. <![CDATA[<b>Phenotypic detection and occurrence of extended-spectrum beta-lactamases in clinical isolates of <i>Klebsiella pneumoniae</i> and <i>Escherichia coli </i>at a tertiary Hospital in Trinidad & Tobago</b>]]> The incidence and distribution of ESBL producing microorganisms such as E. coli and K. pneumoniae have been demonstrated and varies in different health care facilities and as well as other countries This study was carried out to determine the frequency of occurrence and the antimicrobial susceptibility pattern of ESBL producing E. coli and K. pneumoniae species from clinical isolates at a tertiary hospital in Trinidad & Tobago. Standard microbiological procedures and automated MicroScan System was used to identify, screen for putative ESBL production and determine antimicrobial susceptibility of 1,118 clinical isolates of Enterobacteriaceae species at the microbiology laboratory of the Eric Williams Medical Science Complex, Trinidad & Tobago over a 36 months period. All ESBL producing isolates flagged by the automated system were further confirmed by E-test method. The E-test confirmed a 15.2% ESBL rate among the K. pneumoniae isolates and 9.3% among the E. coli isolates. There was also a 1.8% rate of ESBL production in K. pneumoniae and 0.2% in E. coli isolates from specimens received from community health facilities into the laboratory. Isolates recovered from the intensive care unit of the hospital had 2.1% E. coli and 8.2% K. pneumoniae ESBL producers. Although all ESBL positive isolates were completely susceptible to imipenem and meropenem; and all positive K. pneumoniae isolates were susceptible to amikacin, there was a low susceptibility of ESBL positive E. coli to the aminoglycosides. However, susceptibility of these ESBL producing isolates to the fluoroquinolones varied. There is a high rate of ESBL production among isolates of E. coli and K. pneumoniae at this hospital that is linked to the extensive inappropriate use of third generation cephalosporins in the country. Further molecular studies are needed to characterize the types of these ESBL prevailing in the country. <![CDATA[<b>Donovanosis</b>]]> Donovanosis is a chronic bacterial illness frequently associated with sexually transmitted infections (STI) and is under diagnosed both in endemic areas as well as in countries in which doctors have little experience with tropical diseases. The utilization of syndromic diagnosis and treatment of STIs in various parts of the world and the previous use of antibiotics make it difficult to find Donovan bodies in the cytodiagnostic and hystopathological exams, requiring the utilization of technology that is neither routine nor often accessible to confirm the hypothesized diagnosis. Therefore, it is necessary to bring medical professionals up to date about this infectious disease. <![CDATA[<b>Biofilms</b>: <b>microbes and disease</b>]]> Bacteria that attach to surface aggregate in a hydrated polymeric matrix of their own synthesis to form biofilms. These represent microbial societies with their own defense and communication system. Transitioning from acute to chronic infection is frequently associated with biofilm formation.Bacteria in biofilms are innately more resistant to antimicrobial agents. The presence of indwelling medical devices increases the risk for biofilm formation and subsequent infection. The current antibiotic therapies are of limited effectiveness in resolving biofilms infection.This review attempts to discuss the stages in biofilm formation, their pathogenic mechanisms, effect of antimicrobial agents, detection and eradication of the biofilms. <![CDATA[<b>Vascular access-related infections in HIV patients undergoing hemodialysis</b>: <b>case description and literature review</b>]]> Poor immune status, the use of a vascular access different from an AV fistula, and intravenous drug use (IDU) may favor increased rates of vascular access infections among HIV infected patients on hemodialysis. Staphylococcus spp. and Streptococcus spp. are the main cause of these infections, but Gram-negative rods and fungi have been found as well. Using an AV fistula when possible, and eliciting a history of IVDU on every visit may prevent this type of infection. When infections are present, coverage for both Gram-positive and negative organisms is recommended. Additional studies specifically addressing the issue of vascular access infection in HIV infected patients are required. <![CDATA[<b>Association of HTLV-I with Arnold Chiari syndrome and syringomyelia</b>]]> HTLV-I is associated with a broad spectrum of manifestations, including tropical spastic paraparesis and adult T-cell leukemia/lymphoma. Arnold Chiari syndrome is a condition characterized by herniation of the cerebellar tonsils through the foramen magnum. This condition should be suspected in all patients with headache and impaired motor coordination. Syringomyelia is a developmental anomaly that leads to the formation of an intramedullary cavity. Its clinical presentation is classically characterized by syringomyelic dissociation of sensation, with suspended distribution in the proximal portion of the trunk and upper limbs and preservation in other regions. We report here a case of association of the three diseases, which is rare in clinical practice, illustrating the difficulty in the diagnosis and therapeutic management of these conditions. <![CDATA[<b>Spontaneous splenic rupture due to dengue fever</b>: <b>report of two cases</b>]]> Dengue is a febrile illness caused by Flavivírus and mainly transmitted by the mosquito Aedes aegypiti which have been a serious epidemic in Rio de Janeiro. In most of cases it was a self limited disease. We report two cases of a serious and rare complication of this viral infection. <![CDATA[<b>First reported case of infective endocarditis caused by community-acquired methicillin-resistant <i>Staphylococcus aureus</i> not associated with healthcare contact in Brazil</b>]]> We report here the first case of endocarditis due to CA-MRSA not associated with healthcare contact in Brazil in Brazil. A previously healthy patient presented with history of endocarditis following a traumatic wound infection. Patient had multiple positive blood cultures within 72 h of admission and met modified Duke's criterion for infective endocarditis. The isolate was typed as Staphylococcal cassette chromosome (SCC) mec type IV and was positive for presence of Panton-Valentine leukocidin (PVL). Increased incidence of CA-MRSA endocarditis is a challenge for the internist to choose the best empirical therapy. Several authors have suggested an empirical therapy with both a beta-lactam and an anti-MRSA agent for serious S. aureus infections. Our patient was treated with Vancomycin and made complete recovery in 3 months. <![CDATA[<b>Spondylodiscitis and infectious endocarditis</b>: <b>a round-trip to be considered</b>]]> The association between spondylodiscitis and endocarditis was first reported in 1965 by de Sèze et al. The most common clinical picture of this association is musculoskeletal symptoms preceding endocarditis diagnosis, but we report here a case of spondylodiscitis complicating endocarditis in its late course. A 70-year-old man, with an established diagnosis of mitral valve endocarditis caused by Streptococcus intermedius, early submitted to surgical treatment because of heart failure, who had an uneventful recovery up to the 12th day of antibiotic therapy when he presented intensive backache, with tenderness in the two lower lumbar vertebras. Spondylodiscitis was confirmed by a magnetic resonance imaging and the treatment was non-esteroidal anti-inflamatory and analgetics drug, with good results, and prolongation of antibiotic treatment up to 3 months. Appropriate diagnosis of this association has important consequences, as the need of a longer antibiotic therapy course, which can range from 6 weeks to 3 months. <![CDATA[<b>Intrathecal use of amikacin</b>: <b>a case report</b>]]> Meningitis caused by Acinetobacter baumannii is rare and are mostly hospital acquired after neurosurgical procedure. We report a case of a 40-year old man was admitted to the intensive care unit due to subarachnoid haemorrhage. Our patient developed a ventriculitis due to A.baumannii treated successfully with sulbactam IV and intrathecal amikacin. <![CDATA[<b><i>Aeromonas caviae</i></b><b> septicemia in immunocompetent gastrointestinal carriers</b>]]> Aeromonas caviae strains have been isolated from blood and stool cultures of three immunocompetent patients, residents of Northern India, who presented with community acquired septicemia without any recent history of diarrhea. Cell culture infectivity test performed on Hep-2 cells have shown substantial degree of invasiveness in the isolated strains. This case unleashes a possibility of asymptomatic gastrointestinal carriage of such strains of A. caviae in a very large population of India, as several areas of India have very high rates of Aeromonas induced acute diarrhea/gastroenteritis (up to 13%). It needs to be appraised further in India as well as other countries having high rates of Aeromonas induced acute diarrhea/gastroenteritis. <![CDATA[<b>Cases of Opsi syndrome still candidate for medical ICU</b>]]> Splenectomized patients are likely to suffer from severe infections, such as sepsis and meningitis, which is called overwhelming postsplenectomy infection (OPSI) syndrome. It seems to be more common in children, but occurs at all ages. The risk is greatest in the early months and years after operation, but never disappears entirely. The course is rapid, the clinical symptoms are serious, and the prognosis is very poor. In this paper, three cases of OPSI syndrome are described, in which infection developed 8, 8 and 15 years after splenectomy; two of the patients died. With the help of these case reports, we want to again emphasize the importance of vaccination, antibiotic prophylaxis and seeking earlier medical attention in splenectomized patients. <![CDATA[<b>Emphysematous cystitis</b>: <b>a case report</b>]]> Emphysematous Cystitis is a primary infection of the bladder with production of gas by bacteria. The infection is uncommon, still has obvious clinical importance due to its morbidity and mortality potential, as the following case enlightens. We report a clinical case of a patient admitted with acute myocardial infarction who developed an acute emphysematous cystitis, a further complication in his long and complex period of hospitalization. <![CDATA[<b>Chronic meningitis by histoplasmosis</b>: <b>report of a child with acute myeloid leukemia</b>]]> Meningitis is a common evolution in progressive disseminated histoplasmosis in children, and is asymptomatic in many cases. In leukemia, the impaired of the T cells function can predispose to the disseminated form. The attributed mortality rate in this case is 20%-40% and the relapse rate is as high as 50%; therefore, prolonged treatment may be emphasized. We have described a child with acute myeloid leukemia (AML), that developed skin lesions and asymptomatic chronic meningitis, with a good evolution after prolonged treatment with amphotericin B deoxycholate followed by fluconazole. <![CDATA[<b>Usefulness of hybrid SPECT/CT for the <sup>99m</sup>Tc-HMPAO-labeled leukocyte scintigraphy in a case of cranial osteomyelitis</b>]]> Cranial osteomyelitis is a potentially fatal lesion. White blood cell scanning (WBC) with 99mTc-hexamethylpropylene amine oxime (HMPAO) has proven highly sensitive and specific in the diagnosis and follow-up of patients with suspected osteomyelitis. In this report we show the usefulness of SPECT and transmission CT performed simultaneously using a hybrid imaging device for the functional anatomic mapping of soft tissue and cranial bone infections. 99mTc-HMPAO-labeled leukocytes scintigraphy was performed on an elderly diabetic man with an intracranial mass lesion and with suspected temporal bone infection. Planar scans were acquired 30 min, 4 h, and 24 h after injection. SPECT/CT was obtained 6 h after tracer injection, using a dual-head camera coupled with a low-power X-ray tube. The scintigraphic results were matched with the results of surgery and of clinical follow-up. The planar images alone were true-positives for abscess in this patient. SPECT/CT improves the accuracy of99mTc-HMPAO scintigraphy especially in discriminating between soft-tissue and bone involvement. In fact, SPECT/CT also showed temporal bone osteomyelitis. This result indicates that SPECT/CT performed using a hybrid device can improve imaging with 99mTc-HMPAO-labeled leukocytes in patients with suspected osteomyelitis by providing accurate anatomic localization and precise definition of the extent of infection.