Antifungal Resistance in Dermatophytes: Genetic considerations, Clinical Presentations and Alternative Therapies

Numerous reports describe the emergence of resistance in dermatophytes, especially in T. rubrum and T. mentagrophytes/indotineae strains. We here present a review of the current status of resistance in dermatophytes worldwide. Resistance to terbinafine is mainly discussed, with dif-ferent mutations found in the squalene epoxidase gene also considered. Resistance to azoles is also approached. Clinical presentations caused by resistant dermatophytes are presented, to-gether with alternative therapies that help to better manage these kind of infections

Cryptococcosis in people living with HIV in Kinshasa (DRC): Epidemiological and molecular study

Cryptococcose chez les personnes vivant avec le VIH à Kinshasa : contribution à l'étude épidémiologique et moléculair

National cartography of water points for the presence of Vibrio spp. in Belgium

peer reviewedIntroduction: Most Vibrio spp. are environmental and non-pathogenic, but they can also cause illnesses such as wound infections and gastroenteritis. Invasive clinical cases of vibriosis have also been described in Belgium after water contact (De Keukeleire et al., 2018). These recent years, an universal increase occurred in the number of reports of human infections involving non-O1, non-O139 V. cholerae and other Vibrio spp. Waters for recreational use such as lakes and sea water are not yet monitored for Vibrio spp. That is why the Belgian national reference center conducted a study, by doing a cartography of Belgian water points for the presence of Vibrio spp. to evaluate its possible impact on public health. Methods: Sampling of waters was performed monthly between May and September 2021. These were done in different areas in Wallonia (Butchenbach, Robertville, Warfaaz lakes) and in Flanders (Blaarmeersen, Donk, Donkvijver, Boerenkreek lakes) including samplings in the North Sea (Knokke). The temperature and pH of the water were systematically recorded. The collected water was then filtrated, cultured and the “most probable number” method was used for bacterial quantification. The growing colonies were identified by Maldi-Tof and multiplex PCR. Results: No Vibrio spp. was found in the screened water points in Wallonia. However, several Vibrio spp. (Non -O1, Non-O139 Vibrio cholerae, Vibrio alginolyticus and Vibrio parahaemolyticus) were isolated at notable concentrations from different water points of Flanders (Blaarmeersen, Donkvijverand and Boerencreek) and from the North Sea. The monthly calculated concentration of Vibrio spp. was correlated with an increase of the water temperature as in June (22°C) the Vibrio cholerae concentration was evaluated at 110 CFU/ml while in August (24.2°C), the concentration reached >11000 CFU /ml. No impact of the pH was observed. Conclusion: Our study demonstrate the presence of Vibrio spp. at concentrations able to cause human infections in different water points mostly in the North of Belgium. This study supports the recommendation to include Vibrio spp. in water quality controls in order to define if water recreational activities are harmless for humans in Belgium

Isolated pelvic bone involvement as a presentation of alveolar echinococcosis.

peer reviewe

Evaluation of the knowledge on alveolar echinococcosis among general practitioners in the province of Liege : impact of a formative intervention

editorial reviewedL’échinococcose alvéolaire est une zoonose autochtone provoquée par le développement tissulaire de la larve d’un petit ténia, Echinoccocus multilocularis. Mal- gré une faible incidence en Belgique, avec une moyenne de 10 cas recensés par an, cette parasitose pose un réel problème de santé publique car elle reste souvent difficile à diagnostiquer et potentiellement mortelle en l’absence de traitement. Les médecins généralistes sont en première ligne, mais ils ne connaissent pas toujours suffisamment la maladie, ce qui retarde le diagnostic et compromet le pronostic. La présente étude visait à évaluer les connaissances à propos de l’échinococcose alvéolaire des médecins généralistes de la province de Liège via un questionnaire approprié et à accroître leur niveau de connaissance via une intervention formative sous forme de capsule vidéo. Nous avons réalisé une étude à visée expérimentale randomisée contrôlée qui a montré que les médecins généralistes de la province de Liège ont des connaissances partielles sur la symptomatologie, les outils de diagnostic et le traitement. L’intervention formative réa- lisée a permis d’augmenter leur niveau de connaissances à propos de cette maladie.Alveolar echinococcosis is an indigenouszoo- nosis caused by the growth of the larval stage of a small tapeworm, Echinococcus multilocularis. Despite a low inci- dence in Belgium, with about 10 cases on average recorded per year, this parasitosis poses a real public health pro- blem because it often remains difficult to diagnose and is potentially fatal in the absence of treatment. General prac- titioners are on the frontline, but they do not always know enough about the disease, which causes a delay in the diagnosis and impacts the prognosis. The present study aims to assess the level of knowledge of alveolar echino- coccosis among general practitioners in the province of Liège via a questionnaire, on the one hand, and to increase their level of knowledge via a formative intervention using a video capsule, on the other hand. We have performed a randomized controlled experimental study, which showed that general practitioners in the province of Liège have limited knowledge on alveolar echinococcosis. This mainly concerns symptomatology, diagnostic tools and treatment. The formative intervention carried out allowed increasing their level of knowledge about this disease

Prospective survey of digestive tract colonization with enterobacteriaceae that produce ESBLs in intensive care units

peer reviewe

Analyse de la sensibilité aux antifongiques des souches de Cryptococcus spp. provenant de Kinshasa (RDC), substitution intronique du gène ERG11 dans une des souches résistantes au fluconazole

Background The management of cryptococcal meningitis (CM) remains a real challenge specifically in the context of antifungal resistant strains emergence, mainly against fluconazole which is the most widely administered antifungal in poor world regions. Objective We focused here on the common used antifungal susceptibility testing of Cryptococcus spp. from people living with HIV (PLHIV) with CM. Moreover, the sterol 14-α-demethylase gene (ERG11) substitutions that would underlie the fluconazole high minimum inhibitory concentrations (MICs) were explored in the relevant strains. Methods Twenty-three strains of Cryptococcus neoformans (VNI), five strains of C. curvatus, and one strain of C. laurentii were analysed. MICs were determined according to the EUCAST E.Def 7.3.1 protocol. The ERG11 gene sequence was extracted from the cryptococcal genome NGS data and then analysed in comparison to the wild-type sequence of the C. neoformans ERG11 gene. Results Among the included strains, only C. laurentii was resistant to amphotericin B. Strains with high MICs values to 5-flucytosine were identified in 6.8% of cases (2/29), including the single C. laurentii and one C. neoformans isolates. Regarding the strains’ susceptibility to fluconazole, 13.8% (4/29) exhibited high MICs values (16-32 mg/L), among them, two of five (40%) C. curvatus strains and two of 23 (8.7%) C. neoformans strains. No statistical difference of mean MICs values was found comparing the major sequence type (ST)-MLST of C. neoformans strains (ST93) and the less common ST-MLST (ST53, ST31, ST5, ST4, ST659, and ST69). One of the two Cryptococcus neoformans strains showing high MICs to fluconazole wore three ERG11 gene substitutions, including two exonic silent point substitutions and one intronic point substitution located within a potential sequence involved in the splicing of the pre-mRNA (g.315C > T), which is suspected to be the underlying mechanism to this high MIC. The ERG11 gene sequence of Cryptococcus curvatus with high MIC to fluconazole was not analysed due to a lack of her wild-type gene sequence in NCBI database. Conclusions While slight disparities in antifungal susceptibility were found between Cryptococcus species, no significant differences were observed within C. neoformans strains with different ST-MLST. We suspect that an intronic point substitution in a sequence that may be involved in the pre-mRNA splicing of the ERG11 gene could be responsible for fluconazole resistance of C. neoformans. We consider that more elaborate and in-depth investigations to draw definitive conclusions are needed.Cryptococcose chez les personnes vivant avec le VIH à Kinshasa : contribution à l'étude épidémiologique et moléculaire3. Good health and well-bein

Profiles of opportunistic infections in people living with HIV followed at the Military Hospital of Kinshasa Reference (Camp Kokolo), DRC

peer reviewedContext: The in-house techniques or experimental methods are increasingly recommended for their low-cost reagents for the determination of the Viral Load (VL) in resource-limited settings. The objective of this study was to compare the determination of VL from HIV-1 non-B samples by an in-house technique with the COBAS AmpliPrep/TaqMan version 2.0. Method: In this cross-sectional study, 39 plasma samples from patients infected with HIV type 1 non-B from N’Djamena and Kinshasa were used to determine the VL using the two techniques. Results: The mean values of VL are respectively 4.68 ± 1.26 and 4.58 ± 1.33 log10 RNA copies/ml for the COBAS AmpliPrep/TaqMan assays and the in-house assays. A good correlation (Spearman Correlation) was obtained, with a coefficient (R2) of 0.9452. Conclusion: This study demonstrates that there is no significant difference between the results of VL determined by the COBAS AmpliPrep/TaqMan assays and the in-house assays used

Comparative evaluation of Fungitest, Neosensitabs and broth microdilution method for yeasts susceptibility testing

The need of a simple and reliable method for routine yeasts susceptibility testing led us to evaluate two commercially available methods. We investigated the in vitro susceptibility of 67 clinical isolates (26 C. albicans, 32 C. glabrata, 4 C. krusei, 2 C. tropicalis, 2 C. kefyr and 1 S. cerevisiae) to 6 drugs flucytosine (FC), amphotericin B (A), fluconazole (FZ), itraconazole (IT), kétoconazole (K), miconazole (M), comparing two methods Fungitest (Sanofi Pasteur) and Neosensitabs (Rosco). A broth microdilution adaptation from the NCCLS-M27A procedure was used as reference method. Fungitests consist of individually packed 16 wells microplates containing 6 drugs at two critical concentrations in buffered medium. Reading was performed after 24 and 48h incubation. Neosensitabs is an agar diffusion method on Shadomy agar using antifungals tablets. Reading was performed after 24h. For all strains Neosensitabs was in concordance with NCCLS M27-A for FC (94%), A (98%), FZ (55%) I (53%) with p<0.05. Fungitest correlated with NCCLS method for all antifungals after 24 and 48h incubation time (p<0.05) with respectively 95/95% for FC, 100/100% for A, 80/76% for FZ, 81/55% for I and 93/75% for K, and 88/81 for M. Candida glabrata gave the poorest result with Neosensitabs with 28% concordance for FZand 39% for I; therefore the method can't be recommended for this species. Fungitest concordance observed was 55% for I after 48h. Our results suggest that Fungitest is appropriate for routine yeast susceptibility testing. However itraconazole testing has to be improved with this method