41 research outputs found

    A multicentre external quality assessment: A first step to standardise PCR protocols for the diagnosis of histoplasmosis and coccidioidomycosis

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    Background: In-house real-time PCR (qPCR) is increasingly used to diagnose the so-called endemic mycoses as commercial assays are not widely available. Objectives: To compare the performance of different molecular diagnostic assays for detecting Histoplasma capsulatum and Coccidioides spp. in five European reference laboratories. Methods: Two blinded external quality assessment (EQA) panels were sent to each laboratory that performed the analysis with their in-house assays. Both panels included a range of concentrations of H. capsulatum (n = 7) and Coccidioides spp. (n = 6), negative control and DNA from other fungi. Four laboratories used specific qPCRs, and one laboratory a broad-range fungal conventional PCR (cPCR) and a specific cPCR for H. capsulatum with subsequent sequencing. Results: qPCR assays were the most sensitive for the detection of H. capsulatum DNA. The lowest amount of H. capsulatum DNA detected was 1-4 fg, 0.1 pg and 10 pg for qPCRs, specific cPCR and broad-range cPCR, respectively. False positive results occurred with high concentrations of Blastomyces dermatitidis DNA in two laboratories and with Emergomyces spp. in one laboratory. For the Coccidioides panel, the lowest amount of DNA detected was 1-16 fg by qPCRs and 10 pg with the broad-range cPCR. One laboratory reported a false positive result by qPCR with high load of Uncinocarpus DNA. Conclusion: All five laboratories were able to correctly detect H. capsulatum and Coccidioides spp. DNA and qPCRs had a better performance than specific cPCR and broad-range cPCR. EQAs may help standardise in-house molecular tests for the so-called endemic mycoses improving patient management.This work was supported by research project PI21CIII/00007 from Spanish Fondo de Investigaciones Sanitarias of the Instituto de Salud Carlos IIIS

    Disseminated coccidioidomycosis: Monitoring of serologic markers for treatment response

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    We describe a patient with a disseminated coccidioidomycosis. Biomarkers in serum during itraconazole therapy showed a rapid clearing of Coccidioides DNA as detected by PCR. Coccidioides antibody detection by lateral flow assay became negative after one year and decreased from 1:64 to 1:8 in the complement fixation test after two years. The (1 → 3)-ß-D-glucan levels normalised after two years without increase after cessation of antifungal therapy. Biomarkers in serum may guide treatment decisions in disseminated coccidioidomycosis.Peer Reviewe

    Emergomykose: eine weltweit auftretende systemische Mykose durch thermal dimorphe Pilze

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    Unter Emergomykosen werden systemische, potenziell letal verlaufende Infektionen mit Lungenund/ oder Hautbeteiligung durch ein neu beschriebenes Genus thermal dimorpher Pilze verstanden. Emergomyces (Es.) gehören zur Familie Ajellomycetaceae, zu der auch obligat pathogene Pilze wie Histoplasma, Blastomyces und Paracoccidioides gehören.Peer Reviewe

    Histoplasmose: Epidemiologie und Diagnostik der häufigsten endemischen Systemmykose

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    Die Histoplasmose ist die weltweit am weitesten verbreitete endemische Systemmykose. Sie wird meist durch Inhalation des obligat pathogenen, thermal dimorphen Pilzes Histoplasma capsulatum ausgelöst. Sie manifestiert sich oft als selbst limitierende Lungeninfektion, kann aber auch als disseminierte Infektion verlaufen, die bei später Diagnose auch unter antimykotischer Therapie letal verlaufen kann. Wir fassen neuere Erkenntnisse zum Erreger, seinem Vorkommen in der Umwelt und vorhandenen diagnostischen Tests zusammen, damit bei Patienten mit kompatiblen Symptomen aufgrund anamnestischer Angaben und durch gezielten Einsatz von Labortests eine frühe Diagnose und spezifische Therapie ermöglicht wird

    Polyarthralgies chez un patient jeune, Ă  quoi devons-nous penser ?

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    Nous rapportons le cas d’un homme de 35 ans, ayant présenté tout d’abord des douleurs musculaires diffuses puis des douleurs articulaires, surtout au niveau lombaire et au niveau du genou droit. Le diagnostic de gonococcémie est effectué grâce aux hémocultures positives en absence de signes génitaux[Polyarthralgias in a young patient, what should we think about ?] We report the case of a 35 year old man, who first presented diffuse muscle pain and then joint pain, especially in the lumbar and right knee level. The diagnosis of gonococcal septicemia is done through positive blood cultures in the absence of genital signs

    Bacterial pneumonia in kidney transplant recipients

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    Bacterial pathogens are the most frequent cause of pneumonia after transplantation. Early after transplantation, recipients are at higher risk for nosocomial infections. The most commonly encountered pathogens during this period are gram-negative bacilli (Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa …), but gram-positive coccus such as Staphylococcus aureus or Streptococcus pneumoniae and anaerobic bacteria can also be found. Empirical antibiotic therapy should be guided by previous colonisation of the recipient and bacterial resistance pattern in the hospital. Six months after transplantation, pneumonias are mostly due to community-acquired bacteria (S. pneumonia, H. influenza, Mycoplasma, Chlamydia and others). Opportunistic pathogens take advantage of the state of immunosuppression which is usually highest from one to six months after transplantation. During this period, but also occurring many years later in the setting of a chronically depressed immune system, bacterial pathogens with low intrinsic virulence can cause pneumonia. The diagnosis of pneumonia caused by opportunistic pathogens can be challenging. The delay in diagnosis preventing the early instauration of adequate treatment in kidney transplant recipients with a depressed immune system, frequently coupled with co-morbid conditions and a state of frailty, will affect prognosis and outcome, increasing morbidity and mortality. This review will focus on the most common opportunistic bacterial pathogens causing pneumonia in kidney transplant recipients: Legionella, Nocardia, Mycobacterium tuberculosis/nontuberculous, and Rhodococcus. Recognition of their specificities in the setting of immunosuppression will allow early diagnosis, crucial for initiation of effective therapy and successful outcome. Interactions with immunosuppressive therapy should be considered as well as reducing immunosuppression if necessar

    Fever and lymphadenitis in an immunocompromised patient

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    OBJECTIVE AND IMPORTANCE: Bartonella henselae infections are among the most common causes of fever and lymphadenopathies, but can lead to severe complications in immunocompromised hosts; early recognition of these infections is of paramount importance in immunocompromised patients. CLINICAL PRESENTATION: Here we report the case of a renal transplant recipient who presented with fever, lymphadenopathies, and a splenic abscess secondary to Bartonella henselae infection, successfully treated with doxycycline. DISCUSSION AND CONCLUSIONS: We discuss the various clinical presentations of Bartonella henselae infections in immunocompromised patients and the available diagnostic tools for this potentially severe complication
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