Actinomyces israelii and Fusobacterium nucleatum brain abscess in an immunocompetent patient: case report.

peer reviewed[en] INTRODUCTION: Brain abscess is the most common focal infectious neurological injury. Until the nineteenth century this condition was fatal, however the development of neuroimaging for early diagnosis, neurosurgery and antibiotic therapy in the twentieth century has led to new therapeutic strategies decreasing mortality from 50 % in the 1970s to less than 10 % nowadays. In this context we report a case of brain abscess with a dental origin. CASE REPORT: A immunocompetent man without any addiction presented to the emergency department with dysarthria and frontal headache at home. The clinical examination was normal. Further investigations revealed a polymicrobial brain abscess as a consequence of an ear, nose or throat (ENT) infection with locoregional extension with a dental starting point involving Actinomyces israelii and Fusobacterium nucleatum . In spite of a rapid diagnosis and a neurosurgical management associated with an optimal treatment by a dual therapy made of ceftriaxone and metronidazole the patient unfortunately died. CONCLUSION: This case report shows that despite a low incidence and a good prognosis following the diagnosis, brain abscesses can lead to patient's death. Thereby, when the patient's condition and urgency allow, a thorough dental examination of patients with neurological signs following the recommendations would improve the diagnosis made by the clinician. The use of microbiological documentation, the respect of pre-analytical conditions, the interaction between the laboratory and the clinicians are indispensable for an optimal management of these pathologies

Contribution of hematology analyzers (Sysmex XN-Series) in the rapid diagnosis of malaria : case reports

peer reviewedLe paludisme est une maladie potentiellement sévère sévissant particulièrement en Afrique. En Europe, les cas de paludisme proviennent majoritairement de voyageurs revenant de zones endémiques. La symptomatologie non spécifique peut ne pas alerter le clinicien si cette notion de voyage n’est pas abordée. Or, le diagnostic et l’instauration rapide d’un traitement empêchent l’évolution vers les formes graves, notamment en cas d’infection à Plasmodium falciparum, capable d’engager le pronostic vital en 24h. La microscopie sur frottis mince et en goutte épaisse est la méthode de référence pour le diagnostic mais certains automates d’hématologie ont démontré leur capacité à participer au diagnostic précoce. Nous décrivons deux cas illustrant la contribution de la chaine automatisée Sysmex XN-9100 dans le diagnostic de la malaria. Le premier cas clinique est celui d’un jeune homme infecté par de nombreux gamétocytes de Plasmodium falciparum. Ceux-ci forment une population additionnelle visualisable sur les scattergrammes des leucocytes WNR (numération des leucocytes) et WDF (formule leucocytaire). Le second cas concerne un homme atteint de neuropaludisme, avec une parasitémie élevée à Plasmodium falciparum. Les hématies parasitées forment une discrète double population sur le scattergramme des réticulocytes, située à la limite de discrimination des globules rouges matures et des réticulocytes. Les anomalies des scattergrammes, visualisables en quelques minutes, offre une anticipation du diagnostic de malaria en comparaison à la microscopie sur frottis mince et goutte épaisse, technique nécessitant un temps et une expertise non négligeable

Biochip array technology for new psychoactive substances detection in biological samples: Evaluation of the specificity of the Randox Evidence Investigator®.

peer reviewed[en] BACKGROUND: The need to detect new psychoactive substances in biological samples is of crucial interest. In this paper, the specificity of a benchtop immunoanalyzer commercialized by Randox was evaluated on real patient samples. METHOD: The Evidence Investigator was assessed to screen for NPS on 80 serum and urine samples coming from patients admitted to the emergency department. Targeted NPS were included in various categories such as synthetic cannabinoids, opioids and benzodiazepines. Results were compared with a chromatographic technique coupled with mass spectrometry. RESULTS: No NPS was detected by the reference technique. Concerning immunoanalysis, some piperazines were positive, caused by the presence of medicine containing this chemical structure. Clonazepam and fentanyl derivatives were confirmed in some cases, but sometimes the positivity was explained by other opiates or benzodiazepines, which also explained two samples falsely positive for etizolam. CONCLUSIONS: The Randox Evidence Investigator was rapid and easy to use. It can be used as a first intention but always followed by a more specific technique in order to detect false positive result