Sinusite récidivante due à Schizophyllum commune. À propos de deux nouveaux cas

Schizophyllum commune is a basidiomycete fungus of the agaricomycetes class. It is usually found in forest habitats in the form of saprophytic and lignicolous fungus. Its implication in human pathology is rare, only 50 clinical cases among which 18 cases of sinusitis have been described in the last 60 years. We report two new cases of sinusitis. The first was a 57-year-old woman with chronic sinusitis and the second was a 56-year-old man suffering from an allergic sinusitis. This basidiomycete was identified after isolation in culture both by macroscopic and microscopic aspect and molecular biology. In both cases, evacuation and drainage by surgical debridment were sufficient to obtain a cure. The main bioclinical characteristics of Schizophyllum commune infection are provided

Onychomycoses. Journal of Medical Mycology

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Diagnostic Accuracy of the Leishmania OligoC-TesT and NASBA-Oligochromatography for Diagnosis of Leishmaniasis in Sudan

The leishmaniases are a group of vector-borne diseases caused by protozoan parasites of the genus Leishmania. The parasites are transmitted by phlebotomine sand flies and can cause, depending on the infecting species, three clinical manifestations of leishmaniasis: visceral leishmaniasis (VL), post kala-azar dermal leishmaniasis (PKDL) and cutaneous leishmaniasis (CL) including the mucocutaneous form. VL, PKDL as well as CL are endemic in several parts of Sudan, and VL especially represents a major health problem in this country. Molecular tests such as the polymerase chain reaction (PCR) or nucleic acid sequence based assay (NASBA) are powerful techniques for accurate detection of the parasite in clinical specimens, but broad use is hampered by their complexity and lack of standardisation. Recently, the Leishmania OligoC-TesT and NASBA-Oligochromatography were developed as simplified and standardised PCR and NASBA formats. In this study, both tests were phase II evaluated for diagnosis of VL, PKDL and CL in Sudan

Usefulness of molecular biology performed with formaldehyde-fixed paraffin embedded tissue for the diagnosis of combined pulmonary invasive mucormycosis and aspergillosis in an immunocompromised patient

Immunocompromised patients who develop invasive filamentous mycotic infections can be efficiently treated if rapid identification of the causative fungus is obtained. We report a case of fatal necrotic pneumonia caused by combined pulmonary invasive mucormycosis and aspergillosis in a 66 year-old renal transplant recipient. Aspergillus was first identified during the course of the disease by cytological examination and culture (A. fumigatus) of bronchoalveolar fluid. Hyphae of Mucorales (Rhizopus microsporus) were subsequently identified by culture of a tissue specimen taken from the left inferior pulmonary lobe, which was surgically resected two days before the patient died. Histological analysis of the lung parenchyma showed the association of two different filamentous mycoses for which the morphological features were evocative of aspergillosis and mucormycosis. However, the definitive identification of the associative infection was made by polymerase chain reaction (PCR) performed on deparaffinized tissue sections using specific primers for aspergillosis and mucormycosis. This case demonstrates that discrepancies between histological, cytological and mycological analyses can occur in cases of combined mycotic infection. In this regard, it shows that PCR on selected paraffin blocks is a very powerful method for making or confirming the association of different filamentous mycoses and that this method should be made available to pathology laboratories

Interlaboratory Reproducibility of Etest Amphotericin B and Caspofungin Yeast Susceptibility Testing and Comparison with the CLSI Method

International audiencee This study aimed to assess the interlaboratory reproducibility at four university hospital laboratories in the southeast region of France of the Etest technique for the determination of caspofungin (CAS) and amphotericin B (AMB) MICs and to compare it to the CLSI broth microdilution reference method. Consecutive clinical yeast isolates (n ‫؍‬ 198) were included in the study. AMB and CAS MICs were read at 24 and 48 h. Interlaboratory reproducibility was estimated by using (i) an intraclass correlation coefficient (ICC), (ii) essential agreement (EA), and (iii) categorical agreement (CA). For Etest interlaboratory reproducibility for CAS, ICCs were 0.80 (95% confidence interval [CI], 0.76 to 0.84) and 0.81 (95% CI, 0.77 to 0.85) at 24 and 48 h, respectively. For AMB, the ICCs were 0.51 (95% CI, 0.43 to 0.58) and 0.69 (95% CI, 0.63 to 0.74) at 24 and 48 h, respectively. At 48 h, the between-center EAs ranged from 94.4 to 99.0% for both antifungals. For the comparison of the CLSI method and the Etest, the between-technique ICCs were 0.69 (95% CI, 0.63 to 0.74) and 0.62 (95% CI, 0.55 to 0.68) for CAS and AMB, respectively. The EAs ranged from 76.5 to 98.5% for CAS and from 90.3 to 97.4% for AMB according to the centers. CAs ranged from 87.9% to 91.4%, with four very major errors for 2 strains (1 Candida albicans strain and 1 Candida krusei strain), for CAS and from 97.5 to 99.5%, with four major errors, for AMB. In conclusion, the Etest showed a good interlaboratory reproducibility and a good correlation with the CLSI technique. It is well suited for the routine clinical laboratory and can thus be used to monitor clinical yeast iso-lates' in vitro susceptibilities in this setting. S ince the 1990s, knowledge about the diversity of yeast species involved in human infections, the incidence of drug-resistant isolates, and antifungal drug resistance mechanisms has significantly increase (6, 10, 16, 24). In vitro susceptibility tests are based on the measurement of growth with different drug concentrations so as to determine the MIC for the population of a given isolate, an in vitro-determined value that helps predict therapeutic efficacy (1). This has been achieved with some degree of confidence by using in vivo models to determine clinical breakpoints in invasive yeast infections, providing a useful indicator to guide therapeutic choices (20). The reference tests for susceptibility testing are the broth microdilution assays devised by the Clinical and Laboratory Standards Institute (CLSI) and by the European Committee on Antibiotic Susceptibility Testing (EUCAST) (5, 23). These reference methods are robust and reproducible; however, they remain time-consuming and poorly suited for the routine clinical laboratory setting. Moreover, the MIC values for amphotericin B are tightly clustered, and these methods rarely detect MIC values above 1 mg/liter (2). To overcome these limitations, many commercially available methods, such as the Etest, Sensititre Yeast-One, or disk diffusion methods, that are easy to use in the routine setting have been developed. These methods have been recently incorporated into routine clinical laboratory practice and thus generate a considerable amount of antifungal MIC data from clinical fungal isolates. Presently, the monitoring of antifungal drug susceptibility is usually restricted to national reference laboratories that use broth microdilution assays to test clinical isolates referred from collaborating clinical laboratories. These laboratories thus collect invaluable data for the monitoring of susceptibility trends on national and international scales. However, there is a need to develop antifungal susceptibility monitoring at a local or regional scale. This complementary approach to the national reference centers could also improve patient care and generate significant cost reductions given the prevalence of yeast infections, their morbidity, and the costly protracted treatments required. As a first step toward setting up a regional survey of in vitro antifungal susceptibility in the southeast region of France, the primary aim of the present study was to assess the interlaboratory reproducibility of MICs determined with the commercially available and routinely used Etest method for yeast isolated in first-line clinical mycology laboratories of the four regional teaching hospitals. The secondary aims were to validate the correlation of the MICs of amphotericin B and caspofungin obtained with the Etest and CLSI assays at 24 h and 48 h

MALDI-TOF mass spectrometry identification of filamentous fungi in the clinical laboratory2175

This study aimed to validate the effectiveness of a standardised procedure for the MALDI-TOF mass spectrometry (MS)-based identification on a large sample of filamentous fungi routinely identified in university hospitals&#039; laboratories. Non-dermatophyte filamentous fungi prospectively isolated in the routine activity of five teaching hospitals in France were first identified by conventional methods in each laboratory and then by MS in one centre. DNA sequence-based identification resolved discrepancies between both methods. In this study, of the 625 analysed filamentous fungi of 58 species, 501 (80%) and 556 (89%) were correctly identified by conventional methods and MS respectively. Compared with the conventional method, MS dramatically enhanced the performance of the identification of the non-Aspergillus filamentous fungi with a 31</p

Etude multicentrique des rhinosinusites fongiques en France en 2006 : la balle fongique est la présentation clinique la plus fréquente

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