Mycobacterium abscessus and Children with Cystic Fibrosis

We prospectively studied 298 patients with cystic fibrosis (mean age 11.3 years; range 2 months to 32 years; sex ratio, 0.47) for nontuberculous mycobacteria in respiratory samples from January 1, 1996, to December 31, 1999. Mycobacterium abscessus was by far the most prevalent nontuberculous mycobacterium: 15 patients (6 male, 9 female; mean age 11.9 years; range 2.5–22 years) had at least one positive sample for this microorganism (versus 6 patients positive for M. avium complex), including 10 with >3 positive samples (versus 3 patients for M. avium complex). The M. abscessus isolates from 14 patients were typed by pulsed-field gel electrophoresis: each of the 14 patients harbored a unique strain, ruling out a common environmental reservoir or person-to-person transmission. Water samples collected in the cystic fibrosis center were negative for M. abscessus. This major mycobacterial pathogen in children and teenagers with cystic fibrosis does not appear to be acquired nosocomially

An adult cystic fibrosis patient presenting with persistent dyspnea: case report

BACKGROUND: Persistent dyspnea is a common finding in the cystic fibrosis patient that typically leads to further work up of an alternative pulmonary etiology. Adult cystic fibrosis patients; however, are growing in numbers and they are living into the ages in which coronary artery disease becomes prevalent. Coronary disease should be included in the consideration of diagnostic possibilities. CASE PRESENTATION: A 52-year-old white male with cystic fibrosis was evaluated for exertional dyspnea associated with vague chest discomfort. Diagnostic testing revealed normal white blood cell, hemoglobin and platelet count, basic metabolic panel, fasting lipid profile, HbA1c, with chest radiograph confirming chronic cystic findings unchanged from prior radiographs and an electrocardiogram that revealed sinus rhythm with left anterior fascicular block. Stress thallium testing demonstrated a reversible anteroseptal perfusion defect with a 55% left ventricular ejection fraction. Heart catheterization found a 99% occlusion of the left anterior descending artery extending into the two diagonal branches, with 100% obstruction of the left anterior descending artery at the trifurcation and 70% lesion affecting the first posterior lateral branch of the circumflex artery. CONCLUSION: This case report represents the first description in the medical literature of a cystic fibrosis patient diagnosed with symptomatic coronary artery disease. Applying a standard clinical practice guide proved useful toward evaluating a differential diagnosis for a cystic fibrosis patient presenting with dyspnea and chest discomfort

Updating the approaches to define susceptibility and resistance to anti-tuberculosis agents: implications for diagnosis and treatment

11 páginas, 2 figuras, 1 tablaInappropriately high breakpoints have resulted in systematic false-susceptible AST results to anti-TB drugs. MIC, PK/PD and clinical outcome data should be combined when setting breakpoints to minimise the emergence and spread of antimicrobial resistance.I. Comas was supported by PID2019-104477RB-I00 from the Spanish Science Ministry and by ERC (CoG 101001038)Peer reviewe

Updating the approaches to define susceptibility and resistance to anti-tuberculosis agents: implications for diagnosis and treatment

Author : Antimycobacterial Susceptibility Testing Group - Sophia B. Georghiou (FIND, Geneva, Switzerland), Timothy C. Rodwell (FIND, Geneva, Switzerland, and Dept of Medicine, University of California, San Diego, CA, USA), Alexei Korobitsyn (Global TB Programme, World Health Organization, Geneva, Switzerland), Said H. Abbadi (Dept of Microbiology, Faculty of Medicine, Suez University, Suez, Egypt), Kanchan Ajbani (Dept of Microbiology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India), Jan-Willem Alffenaar (Sydney Institute for Infectious Diseases, University of Sydney, Sydney, Australia, Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, Australia, and Westmead Hospital, Sydney, Australia), David Alland (Dept of Medicine and the Public Health Research Institute, New Jersey Medical School, Rutgers University, Newark, NJ, USA), Nataly Alvarez (Unidad de Bacteriología y Micobacterias, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia), Sönke Andres (National and Supranational Reference Laboratory for Mycobacteria, Research Center Borstel, Borstel, Germany), Elisa Ardizzoni (Unit of Mycobacteriology, Dept of Biomedical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium), Alexandra Aubry (Sorbonne Université, INSERM, Centre d'Immunologie et des Maladies Infectieuses, U1135, AP-HP, Hôpital Pitié-Salpêtrière, Centre National de Référence des Mycobactéries et de la Résistance des Mycobactéries aux Antituberculeux, Paris, France), Rossella Baldan (FIND, Geneva, Switzerland, and Institute for Infectious Diseases, University of Bern, Bern, Switzerland), Marie Ballif (Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland), Ivan Barilar (Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany, and German Center for Infection Research, Partner site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany), Erik C. Böttger (Institut für Medizinische Mikrobiologie, Nationales Zentrum für Mykobakterien, Universität Zürich, Zürich, Switzerland), Soumitesh Chakravorty (Cepheid, Sunnyvale, CA, USA, and New Jersey Medical School, Rutgers University, Newark, NJ, USA), Pauline M. Claxton (Scottish Mycobacteria Reference Laboratory, Directorate of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK), Daniela M. Cirillo (Emerging Bacterial Pathogens Unit, IRCCS Ospedale San Raffaele, Milan, Italy), Iñaki Comas (Instituto de Biomedicina de Valencia IBV-CSIC, Spanish National Research Council, Valencia, Spain, and CIBER in Epidemiology and Public Health, Madrid, Spain), Chris Coulter (Queensland Mycobacterium Reference Laboratory, Pathology Queensland, Herston, Australia), Claudia M. Denkinger (FIND, Geneva, Switzerland, Division of Clinical Tropical Medicine, Centre of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany, and German Centre for Infection Research (DZIF), partner site Heidelberg University Hospital, Heidelberg, Germany), Brigitta Derendinger (DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research/South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa), Edward P. Desmond (State Laboratories Division, Department of Health, Pearl City, HI, USA), Jurriaan E.M. de Steenwinkel (Dept of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands), Keertan Dheda (Centre for Lung Infection and Immunity, Division of Pulmonology, Dept of Medicine and UCT Lung Institute, and South African MRC/UCT Centre for the Study of Antimicrobial Resistance, University of Cape Town, Cape Town, South Africa, and Faculty of Infectious and Tropical Diseases, Dept of Immunology and Infection, London School of Hygiene and Tropical Medicine, London, UK), Andreas H. Diacon (TASK, Cape Town, South Africa), David L. Dolinger (General Fluidics, Waltham, MA, USA), Kelly E. Dooley (Dept of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA), Matthias Egger (Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland, Centre for Infectious Disease Research and Epidemiology, University of Cape Town, Cape Town, South Africa, and Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK), Soudeh Ehsani (Joint Infectious Diseases Programme, Regional Office for Europe, World Health Organization, Copenhagen, Denmark), Maha R. Farhat (Dept of Biomedical Informatics, Harvard Medical School, Boston, MA, USA, and Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA), Lanfranco Fattorini (Dept of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy), Iris Finci (Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany, and German Center for Infection Research, Partner site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany), Laure Fournier Le Ray (Sorbonne Université, INSERM, Centre d'Immunologie et des Maladies Infectieuses, U1135, Paris, France), Victoria Furió (Instituto de Biomedicina de Valencia IBV-CSIC, Spanish National Research Council, Valencia, Spain), Ramona Groenheit (Dept of Microbiology, Public Health Agency of Sweden, Solna, Sweden), Tawanda Gumbo (Praedicare Inc, Dallas, TX, USA), Scott K. Heysell (Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA), Doris Hillemann (National and Supranational Reference Laboratory for Mycobacteria, Research Center Borstel, Borstel, Germany), Harald Hoffmann (Institute of Microbiology and Laboratory Medicine, Dept IML Red GmbH, WHO – Supranational Tuberculosis Reference Laboratory Munich-Gauting, Gauting, Germany, and SYNLAB Gauting, SYNLAB Human Genetics, Gauting, Germany), Po-Ren Hsueh (Depts of Laboratory Medicine and Internal Medicine, China Medical University Hospital, School of Medicine, China Medical University, Taichung, Taiwan, and Depts of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan), Yi Hu (School of Public Health and Key Laboratory of Public Health Safety, Fudan University, Shanghai, China), Hairong Huang (Beijing Chest Hospital, Capital Medical University, Beijing, China), Alamdar Hussain (National TB Reference Laboratory, National TB Control Program, Pakistan), Farzana Ismail (Centre for Tuberculosis, National and Supranational TB Reference Laboratory, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa, and Dept of Medical Microbiology, University of Pretoria, Pretoria, South Africa), Kiyohiko Izumi (Dept of Epidemiology and Clinical Research, Research Institute of Tuberculosis, Japan Anti-Tuberculosis Association, Kiyose, Japan), Tomasz Jagielski (Dept of Medical Microbiology, Institute of Microbiology, Faculty of Biology, University of Warsaw, Warsaw, Poland), John L. Johnson (Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland, OH, USA), Priti Kambli (Dept of Microbiology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India), Koné Kaniga (Johnson & Johnson Global Public Health, Division of Janssen Pharmaceutica, Titusville, NJ, USA), G.H.R. Eranga Karunaratne (Dept of Microbiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka, and Faculty of Science, Horizon Campus, Malabe, Sri Lanka), Meenu Kaushal Sharma (National Reference Centre for Mycobacteriology, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada), Peter M. Keller (Institute for Infectious Diseases, University of Bern, Bern, Switzerland), Ellis C. Kelly (Dept of Genetics, University of Cambridge, Cambridge, UK), Margarita Kholina (Faculty of Biology, Lomonosov Moscow State University, Moscow, Russia), Mikashmi Kohli (FIND, Geneva, Switzerland), Katharina Kranzer (Dept of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK, Dept of Infectious Diseases and Tropical Medicine, Ludwig Maximilian University of Munich, Munich, Germany, and Biomedical Research and Training Institute, Harare, Zimbabwe), Ian F. Laurenson (Scottish Mycobacteria Reference Laboratory, Directorate of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK), Jason Limberis (Dept of Medicine, Division of Experimental Medicine, University of California San Francisco, San Francisco, CA, USA), S-Y. Grace Lin (Microbial Diseases Laboratory, California Department of Public Health, Richmond, CA, USA), Yongge Liu (Otsuka Pharmaceutical Development and Commercialization, Inc., Rockville, MD, USA), Alexandre López-Gavín (Hospital Clínic, Universitat de Barcelona, Barcelona, Spain), Anna Lyander (Clinical Genomics Stockholm, Science for Life Laboratory, Solna, Sweden, and School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden), Diana Machado (Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, Lisbon, Portugal), Elena Martinez (Centre for Infectious Diseases and Microbiology – Public Health, Westmead Hospital and NSW Health Pathology, Sydney, Australia), Faisal Masood (National TB Reference Laboratory, National TB Control Program, Pakistan), Satoshi Mitarai (Dept of Mycobacterium Reference and Research, Research Institute of Tuberculosis, Japan Anti-tuberculosis Association, Kiyose, Japan), Nomonde R. Mvelase (Dept of Medical Microbiology, National Health Laboratory Service, Durban, South Africa, and School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa), Stefan Niemann (Molecular and Experimental Mycobacteriology, Research Center Borstel, Borstel, Germany, and German Center for Infection Research, Partner site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany), Vladyslav Nikolayevskyy (Dept of Infectious Diseases, Imperial College London, London, UK), Florian P. Maurer (National and Supranational Reference Laboratory for Mycobacteria, Research Center Borstel, Borstel, Germany, German Center for Infection Research, Partner site Hamburg-Lübeck-Borstel-Riems, Borstel, Germany, and Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany), Matthias Merker (Evolution of the Resistome, Research Center Borstel, Borstel, Germany), Paolo Miotto (Emerging Bacterial Pathogens Unit, IRCCS Ospedale San Raffaele, Milan, Italy), Shaheed V. Omar (Centre for Tuberculosis, National and Supranational TB Reference Laboratory, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa, and Dept of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa), Ralf Otto-Knapp (German Central Committee against Tuberculosis, Berlin, Germany), Moisés Palaci (Núcleo de Doenças Infecciosas, Universidade Federal do Espírito Santo, Vitória, Brazil), Juan José Palacios Gutiérrez (Unidad de Referencia Regional de Micobacterias, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain), Sharon J. Peacock (Dept of Medicine, University of Cambridge, Cambridge, UK), Charles A. Peloquin (College of Pharmacy and Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA), Jennifer Perera (Dept of Microbiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka), Catherine Pierre-Audigier (CMIP Institut Pasteur, Paris, France, and Laboratoire de Bactériologie, Hôpital Bichat-Claude Bernard, Paris France), Suporn Pholwat (Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA), James E. Posey (Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA), Therdsak Prammananan (National Center for Genetic Engineering and Biotechnology, National Science and Technology Development Agency, Pathum Thani, Thailand), Leen Rigouts (Unit of Mycobacteriology, Dept of Biomedical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium), Jaime Robledo (Unidad de Bacteriología y Micobacterias, Corporación para Investigaciones Biológicas (CIB), Medellín, Colombia, and Escuela de Ciencias de la Salud, Universidad Pontificia Bolivariana (UPB), Medellín, Colombia), Neesha Rockwood (Dept of Microbiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka, Dept of Infectious Diseases, Imperial College London, London, UK, and Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, South Africa), Camilla Rodrigues (Dept of Microbiology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India), Max Salfinger (University of South Florida College of Public Health and Morsani College of Medicine, Tampa, FL, USA), Marcos C. Schechter (Emory University School of Medicine, Dept of Medicine, Division of Infectious Diseases, Atlanta, GA, USA), Marva Seifert (Dept of Medicine, University of California, San Diego, CA, USA), Sarah Sengstake (Unit of Mycobacteriology, Dept of Biomedical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium), Thomas Shinnick (Independent Consultant, Atlanta, GA, USA), Natalia Shubladze (National Reference Laboratory, National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia), Vitali Sintchenko (Sydney Institute for Infectious Diseases, University of Sydney, Sydney, Australia, and NSW Mycobacterium Reference Laboratory, Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Sydney, Australia), Frederick Sirgel (DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research/South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa), Sulochana Somasundaram (National Institute for Research in Tuberculosis, Indian Council of Medical Research, Chennai, India), Timothy R. Sterling (Vanderbilt University Medical Center, Nashville, TN, USA), Andrea Spitaleri (Emerging Bacterial Pathogens Unit, IRCCS Ospedale San Raffaele, Milan, Italy, and Vita-Salute San Raffaele University, Milan, Italy), Elizabeth Streicher (DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research/South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa), Philip Supply (Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 – UMR 9017 – CIIL – Center for Infection and Immunity of Lille, F-59000 Lille, France), Erik Svensson (International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark), Elisa Tagliani (Emerging Bacterial Pathogens Unit, IRCCS Ospedale San Raffaele, Milan, Italy), Sabira Tahseen (National TB Reference Laboratory, National TB Control Program, Pakistan), Akiko Takaki (Dept of Mycobacterium Reference and Research, Research Institute of Tuberculosis, Japan Anti-tuberculosis Association, Kiyose, Japan), Grant Theron (DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research/South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa), Gabriela Torrea (Unit of Mycobacteriology, Dept of Biomedical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium), Armand Van Deun (Independent Consultant, Leuven, Belgium), Jakko van Ingen (Radboudumc Center for Infectious Diseases, Dept of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands), Annelies Van Rie (Tuberculosis Omics Research Consortium, Family Medicine and Population health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium), Dick van Soolingen (Tuberculosis Reference Laboratory, National Institute for Public Health and the Environment, Bilthoven, The Netherlands), Roger Vargas Jr (Dept of Biomedical Informatics, Harvard Medical School, Boston, MA, USA, and Center for Computational Biomedicine, Harvard Medical School, Boston, MA, USA), Amour Venter (TASK, Cape Town, South Africa), Nicolas Veziris (Sorbonne Université, Centre d'Immunologie et des Maladies Infectieuses (Cimi-Paris), UMR 1135, Département de Bactériologie, Hôpital Saint-Antoine, Centre National de Référence des Mycobactéries, APHP, Sorbonne Université, Paris, France), Cristina Villellas (Janssen Research and Development, Beerse, Belgium), Miguel Viveiros (Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, Lisbon, Portugal), Robin Warren (DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research/South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa), Shu'an Wen (Beijing Chest Hospital, Capital Medical University, Beijing, China), Jim Werngren (Dept of Microbiology, Public Health Agency of Sweden, Solna, Sweden), Robert J. Wilkinson (Dept of Infectious Diseases, Imperial College London, London, UK, Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, South Africa, and The Francis Crick Institute, London, UK), Caie Yang (Dept of Clinical Laboratory, The Eighth Medical Center of People's Liberation Army General Hospital, Beijing, China), F. Ferda Yılmaz (Ege University, Faculty of Pharmacy, Dept of Pharmaceutical Microbiology, Bornova, İzmir, Turkey), Tingting Zhang (Beijing Chest Hospital, Capital Medical University, Beijing, China), Danila Zimenkov (Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow, Russia), Nazir Ismail (Global TB Programme, World Health Organization, Geneva, Switzerland), Thomas Schön (Dept of Infectious Diseases, Kalmar County Hospital, Linköping University, Kalmar, Sweden, Unit of Infection and Inflammation, Dept of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden, and Dept of Infectious Diseases, Linköping University Hospital, Linköping, Sweden) and Claudio U. Köser (Dept of Genetics, University of Cambridge, Cambridge, UK).International audienc

Molecular detection of fluoroquinolone-resistance in multi-drug resistant tuberculosis in Cambodia suggests low association with XDR phenotypes

International audienceBackgroundDrug susceptibility testing (DST) remains an important concern for implementing treatment of MDR tuberculosis patients. Implementation of molecular tests for drug resistance identification would facilitate DST particularly in developing countries where culturing is difficult to perform. We have characterized multidrug resistant strains in Cambodia using MDTDRsl tests, drug target sequencing and phenotypic tests.MethodsA total of 65 non-MDR and 101 MDR TB isolates collected between May 2007 and June 2009 were tested for resistance to fluoroquinolones and aminoglycosides/cyclic peptides using the GenoType® MTBDRsl assay and gene sequencing. Rifampicin resistance (RMP-R) was tested using gene sequencing and genotyping was assessed by spoligotyping.ResultsA total of 95 of the 101 MDR strains were confirmed to be RMP-R by rpoB gene sequencing. Fourteen of the 101 MDR isolates (14%) carried a gyrA mutation associated with fluoroquinolone-resistance (FQ-R) (detected by the MTBDRsl assay and sequencing) compared with only 1 (1.5%) of the 65 non-MDR strains. Only 1 (1%) of the MDR isolates was found to be XDR TB. The MDR group contained a higher proportion of Beijing or Beijing like strains (58%) than the non MDR group (28%). This percentage is higher in MDR FQ-R strains (71%).ConclusionsThe new GenoType® MTBDRsl assay combined with molecular tests to detect RMP-R and isoniazid resistance (INH-R) represents a valuable tool for the detection of XDR TB. In Cambodia there is a low rate of XDR amongst MDR TB including MDR FQ-R TB. This suggests a low association between FQ-R and XDR TB. Strain spoligotyping confirms Beijing strains to be more prone to accumulate antibiotic resistance

The use of GeneXpert remnants for drug resistance profiling and molecular epidemiology of tuberculosis in Libreville, Gabon

International audienceMultidrug (MDR) and extensively drug resistant (XDR) Mycobacterium tuberculosis are major problems in global health. The GeneXpertMTB/RIF (Xpert) rapidly detects resistance to rifampicin (RIF-R), but detection of the additional resistance that defines MDR and XDR-TB, and for molecular epidemiology, specimen cultures and biosafe infrastructure are generally required. We sought to determine whether the remnants of sputa prepared for Xpert could be used directly to find mutations associated with drug resistance and for molecular epidemiology, and thus provide a precise characterization of MDR-TB cases in countries lacking BSL3 facilities for M. tuberculosis cultures. After sputa were processed and run on the Xpert instrument, the leftovers of the samples prepared for Xpert were used for PCR amplification and sequencing or line probe assay to detect mutations associated with resistance to additional drugs, and for molecular epidemiology with spoligotyping and selective MIRU-VNTR. Of 130 sputum samples from Gabon tested with Xpert, 124 yielded interpretable results, of which 21 were determined to be RIF-R (17%). Amplification and sequencing or line probe assay of the Xpert remnants confirmed 18/21 as MDR: 11/116 (9.5%) new and 7/8 (87%) previously treated TB patients. Spoligotyping and MIRU with hypervariable loci identified an MDR Beijing strain present in five samples. We conclude that the remnants of samples processed for Xpert in PCR reactions can be used to find mutations associated with the resistance to the additional drugs that define MDR and XDR-TB, and to study molecular epidemiology without the need for culturing or biosafe infrastructure

Théories-didactiques de la lecture et de l’écriture

Ce recueil est intitulé Théories – didactiques de la lecture et de l'écriture, comme un clin d'œil aux lecteurs avertis reprenant à une lettre près – le « s » à didactiques – le nom de l'équipe de recherche qu'Yves Reuter a fondée, connue sous l’acronyme de Théodile. Il regroupe les contributions de dix-huit chercheurs de renommée nationale et internationale dans le champ des didactiques, mais aussi de celui de la psychologie et de la sociologie pour rendre hommage aux travaux d’Yves Reuter. Les auteurs se sont emparés de débats concernant les fondements de la didactique du français, les concepts, les contours des disciplines scolaires, les dimensions épistémologiques ou encore les enjeux de cette discipline de recherche. Ces contributions contrastées retracent ainsi non seulement les objets et les questionnements qui ont jalonné les travaux d’Yves Reuter mais aussi les enjeux qui traversent le champ des didactiques.This book brings together the contributions of eighteen researchers of national and international renown in the field of didactics