New diagnostic tools for neonatal sepsis: the role of a real-time polymerase chain reaction for the early detection and identification of bacterial and fungal species in blood samples.

Early diagnosis and treatment of neonatal sepsis are essential to prevent severe and life threatening complications. Consequently, rapid diagnostic tests capable to differentiate infected from non-infected newborns have the potential to make a significant impact on neonatal care. A new real-time polymerase chain reaction (PCR; LightCycler SeptiFast test M GRADE) has been proposed in the routine assessment of neonatal sepsis for the detection and identification of bacterial and fungal DNA from microorganisms which cause approximately 90% of all blood stream infections. The LightCycler SeptiFast test can detect and identify simultaneously the 25 most important bacterial and fungal species causing bloodstream infections within few hours by using a small volume of a single whole blood sample. Real-time PCR can be easily incorporated into the hospital setting for term or near-term infants admitted to the neonatal intensive care unit for sepsis evaluation.

Mycobacterial diseases and HIV infection.

OBJECTIVES: Evaluation of the incidence of mycobacterial diseases in patients infected with human immunodeficiency virus (HIV) and analysis of survival after diagnosis of mycobacteriosis. METHODS: Retrospective analysis of clinical and laboratory data of HIV-infected patients admitted in our hospital from January 1st, 1985 to March 31st, 1992. RESULTS: We observed 82 infections in 81 patients with an increase in the annual percentage from 2.2% to 6.4%. M. tuberculosis more than atypical Mycobacteria was found in patients with pulmonary infection (p = 0.03). Forty patients had a previous diagnosis of acquired immunodeficiency syndrome (AIDS) and 24 evolved in AIDS because of mycobacterial infection. We observed infection due to M. tuberculosis in patients with advanced HIV-infection (20/27 patients with tuberculosis had CD4+ cell count < 200/cm3). Mean survival after diagnosis and treatment was 329 days with better survival in patients with CD4+ cell count > 200/cm3 (p = 0.03). We did not find a statistically significant difference in survival between patients with tuberculosis and other mycobacteriosis. CONCLUSIONS: Mycobacterial infections are increasing in HIV-infected patients, and tuberculosis is observed also in patients with advanced immunodeficiency. Survival is influenced by the severity of immunodeficiency more than by the mycobacterial species.

[Cutaneous tuberculosis with multifocal visceral involvement]. / Tubercolosi cutanea con coinvolgimento viscerale multifocale.

The case of a young Senegalese man who developed a form of cutaneous tuberculosis associated with a disseminated disease, successfully treated with appropriate antitubercular chemotherapy is reported. We found Mycobacterium Microti in the cutaneous ulcers, the only organism isolated after many cultural and microscopical examinations of different exudates and tissues. This mycobacterium was considered up to now to be pathogenic to rodents, but not man. Its possible pathogenicity to man (under certain situations) is also suggested, and it is expected that this possibility will be supported by other reports in the near future. In addition, stress is laid on the problems of diagnosis and classification of the cutaneous tuberculosis, so uncommon in the Western Hemisphere, and its possible association with leprosy.