Apport de la PCR et du séquençage au diagnostic de sinusite fongique (à propos de 42 cas diagnostiqués au laboratoire de Parasitologie-Mycologie du CHU de Rennes)

Les sinusites chroniques atteignent le rang de 2ème maladie inflammatoire chronique des pays industrialisés, et constituent donc un enjeu majeur en santé publique. L'étiologie fongique des sinusites est fortement suspectée par les cliniciens lors de sinusites maxillaires unilatérales chroniques. Le diagnostic repose sur un faisceau d'arguments tels que les signes cliniques, l'aspect des sinus au scanner, l'étude histologique et mycologique des prélèvements de sinus, réalisés lors d'une intervention chirurgicale à visée thérapeutique. La sensibilité des cultures étant médiocre, l'objet de l'étude a été de mettre au point l'amplification des régions ITS1/ITS2 situées dans le gène de l'ADNr, suivie du séquençage des champignons. Cette étude a été réalisée à partir des prélèvements de sinus envoyés à des fins diagnostiques au laboratoire de mycologie de l'hôpital Pontchaillou, de mai 2010 à avril 2013. Le type de sinusite chronique fongique retrouvé le plus fréquemment a été la balle fongique (88% des cas) d'origine dentaire (57%), Aspergillus fumigatus étant le champignon le plus souvent identifié dans les prélèvements (69%). Les tableaux cliniques et l'identification moléculaire des champignons sont discutés dans ce travail, qui apporte des données épidémiologiques intéressantes sur les sinusites fongiques.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF

Quel est l'intérêt de la recherche des anticorps anti-nucléolaires dans la sclérodermie systémique ?

International audienc

Quel est l'intérêt de la recherche des anticorps anti-nucléolaires dans la sclérodermie systémique ?

International audienc

Antinucleolar autoantibodies are indicative of Scleroderma when present at high level, with a homogeneous staining, and with a nuclear pattern.

International audienc

Autoimmune hepatitis related autoantibodies in an unselected chronic hepatitis population: prevalence

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Spondylodiscitis Due to Aspergillus terreus in an Immunocompetent Host: Case Report and Literature Review

International audienceAspergillus terreus, a saprophytic fungus, is recognized as an emerging pathogen responsible for various infections in human beings. However, bone and joint involvement is uncommon. We report a rare case of A. terreus spondylodiscitis in a 20-year-old male with a past history of recurrent, incompletely treated pulmonary tuberculosis. Clinical signs at the time of admission included cough, low-grade fever, general weakness and left-sided back pain. Histological examination of spinal biopsy samples revealed lesions of necrosis, granulomatous inflammation and septate hyphae with acute-angle branching. A. terreus was recovered from culture. The patient received antifungal therapy with voriconazole plus caspofungin and underwent surgical debridement. Further investigations revealed no cause of primary immunodeficiency such as chronic granulomatous disease, severe combined immunodeficiency syndrome or disorders of the IL-12/IFNγ signaling pathway. Moreover, HIV serological tests resulted negative and the patient was not under immunosuppressive therapy. Unfortunately, owing to precarity and medication non-adherence, vertebral sequelae occurred. This new report emphasizes the need to consider a fungal infection in patients with spondylodiscitis, regardless of the immune status

Contribution of molecular tools for the diagnosis and epidemiology of fungal chronic rhinosinusitis

International audienceChronic rhinosinusitis (CRS) rank second at chronic inflammatory diseases in industrialized countries and are an important public health concern. Diagnosis relies on a set of arguments including clinical signs, imaging, histopathologic and mycological analyses of sinus specimens, collected during nasal endoscopy. The sensitivity of fungal cultures is reported to be poor, even when direct examination is positive, thus the epidemiology of fungal chronic sinusitis is ill-known. This study evaluated the sensitivity of molecular diagnosis in 70 consecutive samples (61 patients with CRS) analysed at the University Hospital of Rennes during a 3-year period. DNA detection was performed using a conventional PCR method targeting the ITS1/ITS2 sequence and the resulting amplification products were sequenced. Fungal CRS was proven in 42 patients (69%), of which only 20 (48%) had a positive culture. 37/42 (88%) patients were diagnosed with a fungus ball, 3 with allergic fungal CRS and 2 with undetermined fungal CRS. PCR was positive in all 42 cases and direct sequencing allowed to identify fungi in all cases but one, and detected multiple infection in 3. Aspergillus fumigatus was present in 69% of patients; Cladosporium cladosporoides in 9.5%, Scedosporium sp., A. nidulans and A. flavus in 7% each. In 2/19 patients with negative direct examination, sequencing analysis revealed the presence of Capnobotryella sp. and C. cladosporoides, in clinical settings compatible with fungal sinusitis. In conclusion, ITS1/ITS2 PCR had a twice better sensitivity than culture, and combined sequencing provides accurate epidemiological data on fungal CRS