Sternal wound infection caused by Gordonia bronchialis: identification by MALDI-TOF MS

Introduction: Gordonia spp. infections are uncommon. However, a few clinical cases have been reported in the literature, particularly those involving immunocompromised hosts. Advanced microbiology diagnosis techniques, such as matrix-assisted laser desorption ionization-time of flight MS (MALDI-TOF MS), have been recently introduced in clinical microbiology laboratories in order to improve microbial identification, resulting in better patient management. Case presentation: Here, we present a new clinical case of persistent wound infection caused by Gordonia bronchialis in a 64-year-old woman after a mitral valve replacement, using two MALDI-TOF-based systems for identifying this micro-organism. Conclusion: Both MALDI-TOF systems were able to identify Gordonia spp.; thus, providing a useful tool that overcomes the current limitations of phenotypic identification associated with this micro-organism. Although the technique validation deserves additional verification, our study provides guidance about MALDI-TOF as a fast and easy method for Gordonia spp. identification

Detection of latent tuberculosis infection in peritoneal dialysis patients: new methods

Introducción: El riesgo de tuberculosis (TB) está aumentadoen pacientes con insuficiencia renal crónica y en diálisis. Laprueba de la tuberculina (PT) es el test de cribado clásico enestos pacientes, a pesar de su baja sensibilidad. En los últi-mos años se han desarrollado nuevos métodos diagnósticosque se basan en la producción de interferón gamma tras laestimulación con antígenos de M. tuberculosis. El objetivo deeste estudio fue evaluar si el Quantiferon®TB-gold In Tube(QFT-GIT) puede contribuir en el diagnóstico de la infeccióntuberculosa en pacientes en diálisis peritoneal (DP). Pacien-tes y métodos:Se incluyeron 54 pacientes en DP. Se valoróla posibilidad de infección tuberculosa latente mediante elQFT-GIT, la PT y la valoración clinicorradiológica por parte deun neumólogo experto. Se estudiaron las concordancias en-tre los tests. Resultados: La prevalencia de un resultado posi-tivo para el test de la tuberculina fue del 29,6% para el pri-mer test y del 31,5% para el segundo (valorando el efectobooster). Una radiografía de tórax positiva aumentaba la de-tección de infección tuberculosa latente hasta un 42,6% y ladel neumólogo hasta un 44,4%. El nivel de correlación entreel QFT-GIT y la PT fue moderado (kappa = 0,36; p = 0,006), aligual que entre la PT y la valoración del neumólogo (kappa= 0,257, p = 0,06). Conclusiones: El QFT-GIT aporta algunasventajas en el diagnóstico de la infección tuberculosa en pa-cientes con insuficiencia renal crónica en DP, y puede com-plementar a la prueba de la tuberculina.Objective: The risk for tuberculosis (TB) is increased in patients with chronic renal failure and dialysis. Tuberculin skin test (TST) is the classical diagnostic method for screening despite its low sensitivity. New methods based on interferon-gamma have been developed. The aim of this study was to evaluate if Quantiferon® TB-gold In Tube (QFTGIT) could be useful in the diagnosis of TB infection in patients on peritoneal dialysis (PD). Patients and methods: Fifty-four patients on PD were included in the study. They were evaluated for latent tuberculosis with QFT-GIT, TST and an assessment by an expert pulmonologist using patients medical history and x-rays. Agreement between test results was determined. Results:The prevalence of a positive TST was 29.6% for the first test and 31.5% for the second (booster effect). A positive chest x-ray increased the rate of detection of patients with latent TB infection up to 42.6% and the expert physician?s evaluation to 44.4%. The correlation between QFT-GIT and TST was fair ( =0.36; P=.006), as it was between TST and expert physician?s evaluation ( =0.257; P=.06). Conclusions: According to our experience QFT-GIT represents an important advantage in the diagnosis of latent TB infection in chronic renal failure patients on PD. It may complement but not replace TST

Post-traumatic Endophthalmitis Caused by Nocardia nova

Introduction: Nocardia nova complex has been associated with infections in both immunocompetent and immunocompromised patients. Infection can be localized or disseminated, affecting skin and soft tissues, the respiratory system, bones and joints, the circulatory system and especially the central nervous system. Ocular infections such as keratitis, scleritis, conjunctivitis, dacryocystitis, orbital cellulitis and endophthalmitis due to Nocardia spp. are infrequently reported, and usually described after penetrating corneal trauma or ocular contact with plants and soils. Case presentation: An immunocompetent male presented with a history of penetrating ocular trauma that had evolved to infectious endophthalmitis, which was refractory to different antibiotic treatments. No micro-organisms were isolated from repeated conjunctival smear and corneal scraping cultures between the ocular trauma (August 2014) and the endophthalmitis diagnosis (November 2015). After this period, N. nova sensu stricto was isolated in aqueous humour aspirate. Treatment was adjusted and clinical improvement was obtained after an adequate microbiological procedure, including an optimal sampling and an antimicrobial-susceptibility testing report. Conclusion: Nocardia identification to the species level and performance of antimicrobial-susceptibility tests are both essential tools for treatment adjustment and clinical improvement

Tsukamurella pulmonis bloodstream infection identified by secA1 gene sequencing

Recurrent bloodstream infections caused by a Gram-positive bacterium affected an immunocompromised child. Tsukamurella pulmonis was the microorganism identified by secA1 gene sequencing. Antibiotic treatment in combination with removal of the subcutaneous port healed the patient

Microenvironment Eradication of Hepatitis C: A Novel Treatment Paradigm

OBJECTIVES: Prisons are major reservoirs of hepatitis C virus (HCV) in which a therapeutic approach has been particularly difficult so far. Our aim was to create a permanent program of HCV elimination in a prison based on a "test and treat" strategy. METHODS: This open-label clinical trial was conducted in the Spanish prison "El Dueso" between May 2016 and July 2017. Viremic patients were treated with a ledipasvir-sofosbuvir regimen (8-12 weeks) according to the 2015 Spanish Guidelines. A teleconsultation program was established to follow-up patients from the hospital. Non-responders were submitted for a phylogenetic analysis and offered retreatment. An evaluation of new cases of HCV infection was performed every 6 months and upon release in all inmates. RESULTS: 847 (99.5%) inmates accepted to participate. HCV antibodies were present in 110 (13.0%) and 86 (10.2%) had detectable viremia. Most of them were genotype 1 or 3 (82.6%) and had <F2 fibrosis (52.2%). Treatment was started in the 69 inmates whose stay in prison was longer than 30 days. Sustained virological response was achieved in 64 out of 66 patients (96.9%), three of whom were successfully rescued with a salvage regimen after treatment failure. Two patients were lost to follow-up and three are currently on treatment without viremia. As a result, by July 2017 none of the 409 imprisoned was viremic, and neither reinfections nor de novo infections were detected. CONCLUSIONS: A sustained "test-and-treat" strategy against HCV in prisons is feasible and beneficial. Spreading this strategy should entail a public health impact.Supported by Plan Nacional de I+D+i 2013–2016 and Instituto de Salud Carlos III, Ministerio de Economía, Industria y Competitividad, cofinanced by European Development Regional Fund “A way to achieve Europe”,Operative program Intelligent Growth 2014–2020 and grant PIE15/00079. This study received funding assistance from Gilead Sciences, Spain (IN-ES-337-2089), C/Vía de los Poblados, 3, 28033 Madrid, Spain, http://www.gilead. com/about/worldwide-operations/europe/spain; phone number: +34 913789830), who played no part in study design, data analysis, or in the preparation of the manuscript. All study investigators declare to be independent from funders

Applied diagnostics in liver cancer. Efficient combinations of sorafenib with targeted inhibitors blocking AKT/mTOR

Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related deaths worldwide. There is increasing interest in developing specific markers to serve as predictors of response to sorafenib and to guide targeted therapy. Using a sequencing platform designed to study somatic mutations in a selection of 112 genes (HepatoExome), we aimed to characterize lesions from HCC patients and cell lines, and to use the data to study the biological and mechanistic effects of case-specific targeted therapies used alone or in combination with sorafenib. We characterized 331 HCC cases in silico and 32 paired samples obtained prospectively from primary tumors of HCC patients. Each case was analyzed in a time compatible with the requirements of the clinic (within 15 days). In 53% of the discovery cohort cases, we detected unique mutational signatures, with up to 34% of them carrying mutated genes with the potential to guide therapy. In a panel of HCC cell lines, each characterized by a specific mutational signature, sorafenib elicited heterogeneous mechanistic and biological responses, whereas targeted therapy provoked the robust inhibition of cell proliferation and DNA synthesis along with the blockage of AKT/mTOR signaling. The combination of sorafenib with targeted therapies exhibited synergistic anti-HCC biological activity concomitantly with highly effective inhibition of MAPK and AKT/mTOR signaling. Thus, somatic mutations may lead to identify case-specific mechanisms of disease in HCC lesions arising from multiple etiologies. Moreover, targeted therapies guided by molecular characterization, used alone or in combination with sorafenib, can effectively block important HCC disease mechanisms.FUNDING: Grants from ISCIII, co-financed by the European Union (FEDER) (PI16/00156), Ramón and Cajal research program from MINECO (RYC-2013-14097) and FUNDACIÓN LUCHAMOS POR LA VIDA to JPV. Grants from ISCIII (RD06/0020/0107-RD012/0036/0060) to MAP. Grant from ISCIII (Ref. PIE15/00079) to JC & JPV. NGD is a recipient of a UC-IDIVAL pre-doctoral fellow. I.V. was also supported by the Ramón and Cajal research program

Método de diagnóstico molecular para la detección de Brucella abortus y en diferenciación de la cepa vacunal B19.

Se describen una serie de métodos de diagnóstico molecular que permiten a diferenciación entre la estirpe vacunal Brucella abortus B19 y todas las demás estirpes del género Brucella. En un caso se aplica la amplificación de genoma, usando como iniciadores oligonucleótidos derivados de la región que contiene los genes codificantes de la ruta de utilización del eritritol. Otro grupo de métodos se basa en la hibridación de ADN genómico usando como sondas oligonucleótidos de la mencionada región eri. En este caso pueden aplicarse según la técnica denominada “hibridación tipo Southern" o alternativamente por el procedimiento del “Dot blot". Finalmente se aplican estos métodos para la identificación de gérmenes del género Brucella en cualquier muestra biológica. Los nuevos procedimientos son ventajosos sobre los métodos tradicionales, inmunológicos o de cultivo, aportando mayor especificidad y rapidez.Solicitud: 9302728 (16.12.1993)Nº Pub. de Solicitud: ES2078174A1 (01.12.1995)Nº de Patente: ES2078174B1 (16.08.1996