Levels of (1→3)-β-D-glucan, Candida mannan and Candida DNA in serum samples of pediatric cancer patients colonized with Candida species

<p>Abstract</p> <p>Background</p> <p>Surveillance cultures may be helpful in identifying patients at increased risk of developing invasive candidiasis. However, only scant information exists on the effect of <it>Candida </it>colonization on serum levels of diagnostic biomarkers. This prospective surveillance study determined the extent of <it>Candida </it>colonization among pediatric cancer patients and its possible impact on serum levels of (1-3)-β-D-glucan (BDG), <it>Candida </it>mannan and <it>Candida </it>DNA.</p> <p>Methods</p> <p>A total of 1075 swabs originating from oropharynx (n = 294), nostrils (n = 600), rectum (n = 28), groin (n = 50), ear (n = 54), and axilla (n = 49) of 63 pediatric cancer patients were cultured for the isolation of <it>Candida </it>spp. Patients yielding <it>Candida </it>spp. from any sites were considered as colonized. Serum samples were collected from patients at the time of first surveillance culture for detection of BDG by Fungitell kit and <it>Candida </it>mannan by Platelia <it>Candida </it>Ag. <it>Candida </it>DNA was detected by using panfungal primers and identification was carried out by using species-specific primers and DNA sequencing.</p> <p>Results</p> <p>Seventy-five (7.6%) swab cultures from 35 (55.5%) patients yielded <it>Candida </it>spp. These isolates included <it>C. albicans </it>(n = 62), <it>C. dubliniensis </it>(n = 8), <it>C. glabrata </it>and <it>C. tropicalis </it>(n = 2 each) and <it>C. krusei </it>(n = 1). Eleven patients were colonized at three or more sites. Eight of 36 serum samples from 6 colonized patients yielded BDG values higher than the currently recommended cut-off value of ≥80 pg/ml. However, none of the serum samples yielded <it>Candida </it>mannan levels ≥0.5 ng/ml and PCR test for <it>Candida </it>DNA was also negative in all the serum samples of colonized patients. During the study period, only two colonized patients subsequently developed candidemia due to <it>C. tropicalis</it>. Besides positive blood cultures, <it>C. tropicalis </it>DNA, BDG and <it>Candida </it>mannan were also detected in serum samples of both the patients.</p> <p>Conclusions</p> <p>The present study demonstrates that while mucosal colonization with <it>Candida </it>species in pediatric cancer patients is common, it does not give rise to diagnostically significant levels of <it>Candida </it>mannan or <it>Candida </it>DNA in serum specimens. However, BDG values may be higher than the cut-off value in some pediatric patients without clinical evidence of invasive <it>Candida </it>infection. The study suggests the utility of <it>Candida </it>mannan or <it>Candida </it>DNA in the diagnosis of invasive candidiasis, however, the BDG levels in pediatric cancer subjects should be interpreted with caution.</p

Primary cytomegalovirus infection with accompanying Pneumocystis jiroveci pneumonia in a patient with large-vessel vasculitis

A 70 year-old female patient presented with fever, nausea and dyspnea. She had been receiving immunosuppressive therapy with methotrexate and prednisone for large-vessel vasculitis. The patient was shown to have coexistent Pneumocystis jiroveci pneumonia and primary cytomegalovirus (CMV) infection with presumed CMV pneumonitis and colitis. To our knowledge, this is the first case report on the occurrence of combined primary cytomegalovirus and Pneumocystis jiroveci infection in a patient with vasculitis. It illustrates the importance of being aware of the possibility of combined opportunistic infections in patients with rheumatologic diseases

Patterns of hepatitis C prevalence and seroconversion in hemodialysis units from three continents: The DOPPS

Background. Hepatitis C virus (HCV) remains a problem within hemodialysis units. This study measures HCV prevalence and seroconversion rates across seven countries and investigates associations with facility-level practice patterns. Methods. The study sample was from the Dialysis Outcomes and Practice Patterns Study (DOPPS), a prospective, observational study of adult hemodialysis patients randomly selected from 308 representative dialysis facilities in France, Germany, Italy, Japan, Spain, the United Kingdom, and the United States. Logistic regression was used to model odds of HCV prevalence, and Cox regression was used to model time from study entry to HCV seroconversion. Results. Mean HCV facility prevalence was 13.5% and varied among countries from 2.6% to 22.9%. Increased HCV prevalence was associated with longer time on dialysis, male gender, black race, diabetes, hepatitis B (HBV) infection prior renal transplant, and alcohol or substance abuse in the previous 12 months. Approximately half of the facilities (55.6%) had no seroconversions during the study period. HCV seroconversion was associated with longer time on dialysis, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), HBV infection, and recurrent cellulitis or gangrene. An increase in highly trained staff was associated with lower HCV prevalence (OR=0.93 per 10% increase, P=0.003) and risk of seroconversion (RR=0.92, P=0.07). Seroconversion was associated with an increase in facility HCV prevalence (RR=1.36, P<0.0001), but not with isolation of HCV-infected patients (RR=1.01, P=0.99). Conclusion. There are differences in HCV prevalence and rate of seroconversion at the country and the hemodialysis facility level. The observed variation suggests opportunities for improved HCV outcomes

Prosthetic valve endocarditis and bloodstream infection due to Mycobacterium chimaera

Prosthetic valve endocarditis (PVE) due to fast-growing nontuberculous mycobacteria (NTM) has been reported anecdotally. Reports of PVE with slowly growing NTM, however, are lacking. We present here one case of PVE and one case of bloodstream infection caused by Mycobacterium chimaera. Randomly amplified polymorphic DNA (RAPD)-PCR indicated a relatedness of the two M. chimaera strains. Both patients had heart surgery 2 years apart from each other. A nosocomial link was not detected