Near-Fatal Multiple Organ Dysfunction Syndrome Induced by Plasmodium malariae

International audienc

Comparison of Leishmania typing results obtained from 16 European clinical laboratories in 2014.

Leishmaniasis is endemic in southern Europe, and in other European countries cases are diagnosed in travellers who have visited affected areas both within the continent and beyond. Prompt and accurate diagnosis poses a challenge in clinical practice in Europe. Different methods exist for identification of the infecting Leishmania species. Sixteen clinical laboratories in 10 European countries, plus Israel and Turkey, conducted a study to assess their genotyping performance. DNA from 21 promastigote cultures of 13 species was analysed blindly by the routinely used typing method. Five different molecular targets were used, which were analysed with PCR-based methods. Different levels of identification were achieved, and either the Leishmania subgenus, species complex, or actual species were reported. The overall error rate of strains placed in the wrong complex or species was 8.5%. Various reasons for incorrect typing were identified. The study shows there is considerable room for improvement and standardisation of Leishmania typing. The use of well validated standard operating procedures is recommended, covering testing, interpretation, and reporting guidelines. Application of the internal transcribed spacer 1 of the rDNA array should be restricted to Old World samples, while the heat-shock protein 70 gene and the mini-exon can be applied globally

Outbreak of Leishmania braziliensis cutaneous leishmaniasis, Saül, French Guiana [letter]

New World cutaneous leishmaniasis (CL), a zoonotic disease, is increasingly seen among travelers returning from Latin American countries, particularly from Bolivia, Belize, and French Guiana (1). The epidemiology of CL in the Americas is heterogeneous and has complex variations in transmission cycles, reservoir hosts, and sandfly vectors. Changing human activities that affect these factors may have resulted in the emergence of species with distinct pathogenic potentials and responses to therapy. In the Guianan ecoregion complex, leishmaniasis is endemic, and 5 coexisting Leishmania parasite species are known to infect humans: L. guyanensis, L. braziliensis, L. amazonensis, L. naiffi, and L. lainsoni. Among these species, L. guyanensis accounts for ≈85% of CL cases (2). We report an outbreak of 7 cases of L. braziliensis CL that occurred among 24 scientists who participated in a field mission at Limonade Creek in Saül, French Guiana, during October 10–25, 2013. Saül is an isolated village in the Amazonian rainforest (3°55′18′′N, 53°18′02′′W)

Analyse fonctionnelle du promoteur du gène de la Fétuine-A humaine (alpha2-HS-glycoprotéine) dans l'hépatocyte quiescent ou lors d'une inflammation aiguë systémique

La Fétuine-A (alpha2-HS-glycoprotéine) est une protéine plasmatique d'origine hépatique impliquée dans la désactivation des macrophages, la prolifération cellulaire, l'inhibition d'activités protéasiques, l'homéostase calcique ou encore l'ostéogenèse. La transcription hépatique du gène de la Fétuine-A humaine est sous la dépendance des facteurs de transcription NF-1 et C/EBP, dont les sites de fixation se situent aussi bien au niveau du promoteur proximal du gène qu'au niveau d'éléments régulateurs distaux. Dans l'hépatocyte quiescent, la transcription du gène de la Fétuine-A humaine est sous la dépendance de la fixation des facteurs NF-1 et des formes longues des facteurs C/EBPalpha et C/EBPbeta qui se lient au niveau du promoteur proximal du gène FETUA. L'activité transcriptionnelle résultante est modulée par la présence d'éléments distaux de régulation qui agissent comme activateur de transcription (Element II) ou inhibiteurs de transcription (Eléments I, III, IV). La régulation négative liée à l'élément I a pu être attribuée à la fixation d'un facteur NF-1 au niveau de la région -338/-274. Le niveau plasmatique de la Fétuine-A chute de façon transitoire au cours de l'inflammation aiguë systémique. Nous avons pu montrer que cette diminution était sous la dépendance de la fixation des formes courtes des facteurs de transcription C/EBPalpha et C/EBPbeta au niveau des deux sites C/EBP situés au sein du promoteur proximal du gène de la Fétuine-A.Fetuin-A is a plasma protein of hepatic origin that participates in macrophage deactivatio, cellular proliferation, inhibition of protease activities, Calcium homeostasis and osteogenesis. Hepatic transcription of the Fetuin-A gene is influenced by the transcription factors NF-1 and C/EBP when they bind their respective sites, located in the proximal promoter as well as in distal regulatory element. In quiescent hepatocyte, Fetuin-A gene transcription depends on binding of NF-1 and long C/EBPalpha and/or C/EBPbeta isoforms within the proximal promoter of the FETUA gene. Resulting transcriptional activity is modulated by different distal regulatory elements that act as transcription enhancer (Element I) and as silencers (Elements I, II, IV). Negative regulation observed with the Element I has been ascribed to the binding of NF-1 within the segment covering the nt -338/-274. Fetuin-A plasma level transiently falls during the inflammatory acute phase. We demonstrate that this phenomenon depends upon the binding of short C/EBPalpha and/or C/EBPbeta isoforms on the two C/EBP boxes located in the proximal promoter of the FETUA gene.ROUEN-BU Sciences (764512102) / SudocSudocFranceF

Aspergillus antibody detection: diagnostic strategy and technical considerations from the Société Française de Mycologie Médicale (French Society for Medical Mycology) expert committee

International audienceUntil now, there has been no consensus on the best method for the detection of anti-Aspergillus antibodies, a key diagnostic tool for chronic aspergilloses. To better appreciate the usage of and confidence in these techniques, the Société Française de Mycologie Médicale (French Society for Medical Mycology; SFMM) performed a two-step survey of French experts. First, we administered an initial survey to French labs performing Aspergillus serology to depict usage of the different techniques available for Aspergillus serology. Second, an opinion poll was conducted of 40 experts via an online questionnaire. Each item was rated from 1 to 9 according to the level of agreement. The initial survey revealed that enzyme-linked immunosorbent assay (ELISA) (81%) and immunoelectrophoresis (IEP) (67%) were the most commonly used techniques for screening and confirmation, respectively. The distinction between screening and confirmation techniques was confirmed by the experts (median = 7) with a 44.2% variation coefficient. Only ELISA for screening and IEP and Western blot (WB) for confirmation were clearly considered valuable methods (median ≥8 with variation coefficients less than 30%). The use of a confirmation technique was recommended in the case of a positive result in a compatible clinical context (cystic fibrosis, for example) or during the patient's follow-up. In the case of discordant results between the screening and confirmation techniques, the experts recommended greater confidence in the results obtained with the confirmation technique. All experts emphasized the need to standardize Aspergillus serology techniques and to better define the place of each of them in the diagnosis of aspergillosis

Improving the diagnosis of invasive aspergillosis by the detection of Aspergillus in broncho-alveolar lavage fluid Comparison of non-culture-based assays

International audienceObjectives This study aimed to evaluate new tools to diagnose invasive aspergillosis (IA) directly from broncho-alveolar lavage (BAL) samples.Methods All consecutive patients with suspected IA who underwent bronchoscopy with BAL were prospectively included. Mycological culture and ELISA detection of galactomannan (GM) were performed on BAL. Two in-house and two marketed PCR assays were used on BAL DNA extracts to detect Aspergillus species. Susceptibility testing was performed after culture; marketed PCR assays detected mutations in the CYP51A gene associated to resistance.Results Within 3 years, 1555 BAL samples were processed, including 413 samples from 387 immunosuppressed patients. IA diagnosis was no-IA, possible, probable or proven IA in 326, 23, 37 and 1 patients, respectively. PCR assays sensitivity for Aspergillus detection ranged from 61% to 74%, below GM (87%), but contrasting with 47% for cultures. Combining PCR to EORTC/MSG criteria increased the sensitivity to 100%. Interestingly, tests performance in non-hematological patients ranged from 60% to 75%, and were higher than in hematological patients, and those with prior exposure to antifungals. All 16 isolates of Aspergillus fumigatus were susceptible; PCR did not detect any resistance marker in the 37 A. fumigatus PCR-positive samples.Conclusion The molecular detection of Aspergillus directly in BAL samples greatly improved the diagnosis of IA, particularly in non-hematological patients. (C) 2017 The British Infection Association. Published by Elsevier Ltd. All rights reserved

Outbreaks of nosocomial candidiasis in France 1996-2006.

International audienc

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

Pisum sativum infection by the pathogen Aphnomyces euteiches: role of border cells in plant defense; new tools to cope with plant infection

International audienc

Role of root border cells in plant defense, case study: Infection of pea by the pathogen Aphanomyces euteiches

National audienc