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OBJECTIVES: Nontuberculous mycobacteria (NTM) bone and joint infections (BJIs) are uncommon. We evaluated the characteristics of BJIs and identified differences according to immune status. METHODS: We performed a multicenter retrospective study in France involving patients with documented NTM BJI over a 9-year period. We collected the clinical and microbiological characteristics, management, and clinical outcomes of the patients. RESULTS: Overall, 95 patients were included, of whom 50.5% (48/95) were immunosuppressed. Tenosynovitis was more frequent in the immunocompetent group, and native arthritis more common in the immunosuppressed group. Mycobacerium marinum and M. abscessus complex were significantly more frequent in the immunocompetent group, and M. avium and M. xenopi were significantly more frequent in the immunosuppressed group. The combination of antibiotherapy with surgery tended to be more frequent in the immunocompetent than the immunosuppressed group (63.8% (30/47) vs 47.8% (22/46), respectively); of the latter, 45.7% (21/46) received antimicrobial therapy alone, a higher frequency than in the immunocompetent group (23.4%, 11/47). The median duration of antimicrobial treatment was similar in the two groups (11 months). Mortality was significantly higher in the immunosuppressed group. CONCLUSIONS: Although the clinical presentations and the NTM species involved in BJI differed according to immune status, most recovered completely after treatment.
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Antibacterianos , Infecciones por Mycobacterium no Tuberculosas , Micobacterias no Tuberculosas , Humanos , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Infecciones por Mycobacterium no Tuberculosas/inmunología , Infecciones por Mycobacterium no Tuberculosas/mortalidad , Infecciones por Mycobacterium no Tuberculosas/microbiología , Estudios Retrospectivos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Micobacterias no Tuberculosas/inmunología , Resultado del Tratamiento , Antibacterianos/uso terapéutico , Francia/epidemiología , Huésped Inmunocomprometido , Anciano de 80 o más Años , Adulto , Artritis Infecciosa/microbiología , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/inmunología , Artritis Infecciosa/mortalidadRESUMEN
Background: To harmonize with the EUCAST breakpoints, the French Society of Microbiology introduced a change in the inhibition diameter breakpoint (17â mm versus 20â mm previously) of temocillin. We assessed the impact of the new breakpoints on categorizing susceptibility of Enterobacterales to temocillin. Methods: This was a multicentric retrospective study including all Enterobacterales isolates routinely tested for temocillin susceptibility with the disc diffusion method between 1 January 2016 and 31 July 2022 in four centres. Categorization using the breakpoints of 20â mm (French guidelines CA-SFM/EUCAST 2020 v.1.1) and 17â mm (French guidelines CA-SFM/EUCAST 2021 v1.0 and EUCAST guidelines v11.0) was performed. Results: Overall, 36â416 Enterobacterales isolates were included. The overall rate of temocillin resistance decreased from 11.3% to 4.7% (relative difference of 58.5%) when using the 17â mm breakpoint instead of the 20â mm breakpoint, respectively. The relative change ranged from -44.0% in Klebsiella aerogenes to -72.7% in Klebsiella oxytoca. The median inhibition diameter was 23â mm (IQR 21-25). The isolates with a diameter of 20â mm appeared overrepresented, whereas those with a diameter of 18 and 19â mm were underrepresented. We therefore reviewed the diameters between 18 and 21â mm of 273 isolates. Thirty-two (11.7%) of them categorized as susceptible at first measure were controlled resistant at second measure. Conclusions: The new breakpoint induced a decrease in the rate of isolates categorized as resistant to temocillin, increasing therapeutic choice including for Extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-PE). We suggest the bias in measuring the inhibition diameter is probably related to the fact that temocillin is considered remarkably stable against broad-spectrum ß-lactamases.
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OBJECTIVES: Extrapulmonary tuberculosis (EPTB) can be difficult to diagnose, especially in severe forms. The Xpert MTB/RIF Ultra test introduced an additional category called trace to reference very small amounts of Mycobacterium tuberculosis complex (MTBC) DNA. The objective of our multicenter study was to evaluate whether the trace result on an extrapulmonary (EP) sample is a sufficient argument to consider diagnosing tuberculosis and starting treatment, even in severe cases. METHODS: A retrospective, multicenter cohort study was conducted from 2018 to 2022. Patients strongly suspected of EPTB with a trace result on an EP specimen were included. Hospital records were reviewed for clinical, treatment, and paraclinical data. RESULTS: A total of 52 patients were included, with a severe form in 22/52 (42.3%) cases. Culture was positive for MTBC in 33/46 (71.7%) cases. Histological analysis showed granulomas in 36/45 (80.0%) cases. An Ultra trace result with a presumptive diagnosis of TB led to the decision to treat 41/52 (78.8%) patients. All patients were started on first-line anti-TB therapy (median duration of 6.1 months), with a favorable outcome in 31/35 (88.6%) patients. The presence of a small amount of MTBC genome in EPTB is a sufficient argument to treat patients across a large region of France.
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In a retrospective study, we used sequencing to investigate Trichomonas vaginalis-positive specimens (genital, rectal and pharyngeal) with the Allplex™ STI Essential or the Anyplex™-II-STI-7 assays. Our results confirm that majority of T. vaginalis-positive genital and pharyngeal specimens contained T. vaginalis DNA and actually T. tenax DNA, respectively.
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Enfermedades de Transmisión Sexual , Vaginitis por Trichomonas , Trichomonas vaginalis , Humanos , Femenino , Trichomonas vaginalis/genética , Reacción en Cadena de la Polimerasa Multiplex/métodos , Estudios Retrospectivos , Bioensayo , Vaginitis por Trichomonas/diagnósticoRESUMEN
Although Candida spp are aerobic microorganisms, some Candida strains, mainly Candida glabrata, can be recovered from anaerobic blood culture vials. We assessed the contribution of the anaerobic vials for the diagnosis of candidemia, especially for C. glabrata. We conducted a multicenter retrospective study including eight university or regional hospitals. A single episode of monomicrobial candidemia per patient was included from September 1st, 2016, to August 31st, 2019. The characteristics of all aerobic and anaerobic blood culture vials sampled within 2 h before and after the first positive blood culture vials were recorded (type of vials, result, and for positive vials time-to-positivity and Candida species). Overall, 509 episodes of candidemia were included. The main species were C. albicans (55.6%) followed by C. glabrata (17.1%), C. parapsilosis (4.9%), and C. tropicalis (4.5%). An anaerobic vial was positive in 76 (14.9%) of all episodes of which 56 (73.8%) were due to C. glabrata. The number of C. glabrata infections only positive in anaerobic vials was 1 (2.6%), 1 (11.1%), and 15 (37.5%) with the BACT/ALERT 3D the BACT/ALERT VIRTUO and the BACTEC FX instrument, respectively (P < 0.01). The initial positivity of an anaerobic vial was highly predictive of the isolation of C. glabrata with the BACTEC FX (sensitivity of 96.8%). C. glabrata time-to-positivity was shorter in anaerobic vial than aerobic vial with all instruments. Anaerobic blood culture vials improve the recovery of Candida spp mainly C. glabrata. This study could be completed by further analyses including mycological and pediatric vials. LAY SUMMARY: Although Candida spp are aerobic microorganisms, C. glabrata is able to grow in anaerobic conditions. In blood culture, the time-to-positivity of C. glabrata is shorter in anaerobic than aerobic vials. Only the anaerobic vial was positive in up to 15 (37.5%) C. glabrata bloodstream infections.
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Candidemia , Anaerobiosis , Animales , Cultivo de Sangre/veterinaria , Candida , Candida albicans , Candida glabrata , Candidemia/diagnóstico , Candidemia/veterinaria , Humanos , Estudios RetrospectivosRESUMEN
In the context of increasing antimicrobial resistance in Enterobacterales, the management of these UTIs has become challenging. We retrospectively assess the prevalence of antimicrobial resistance in Enterobacterales isolates recovered from urinary tract samples in France, between 1 September 2017, to 31 August 2018. Twenty-six French clinical laboratories provided the susceptibility of 134,162 Enterobacterales isolates to 17 antimicrobials. The most frequent species were E. coli (72.0%), Klebsiella pneumoniae (9.7%), Proteus mirabilis (5.8%), and Enterobacter cloacae complex (2.9%). The overall rate of ESBL-producing Enterobacterales was 6.7%, and ranged from 1.0% in P. mirabilis to 19.5% in K. pneumoniae, and from 3.1% in outpatients to 13.6% in long-term care facilities. Overall, 4.1%, 9.3% and 10.5% of the isolates were resistant to cefoxitin, temocillin and pivmecillinam. Cotrimoxazole was the less active compound with 23.4% resistance. Conversely, 4.4%, 12.9%, and 14.3% of the strains were resistant to fosfomycin, nitrofurantoin, and ciprofloxacin. However, less than 1% of E. coli was resistant to fosfomycin and nitrofurantoin. We identified several trends in antibiotics resistances among Enterobacterales isolates recovered from the urinary tract samples in France. Carbapenem-sparing drugs, such as temocillin, mecillinam, fosfomycin, cefoxitin, and nitrofurantoin, remained highly active, including towards ESBL-E.
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Zoonotic species of Capnocytophaga genus belong to the oral microbiota of dogs and cats. They may be responsible for serious human infections, mainly after animal bites, with a high mortality rate. In France, only few cases have been reported and no multicenter study has been conducted. Our aim was to describe the French epidemiology of Capnocytophaga zoonosis. We conducted a multicenter (21 centers) retrospective non-interventional, observational study in France describing the epidemiology of Capnocytophaga zoonosis (C. canimorsus, C. cynodegmi, C. canis) over 10 years with regard to clinical and bacteriological data. From 2009 to 2018, 44 cases of Capnocytophaga zoonotic infections were described (C. canimorsus, n = 41; C. cynodegmi, n = 3). We observed an increase (2.5 times) in the number of cases over the study period (from the first to the last 5 years of the study). The most frequent clinical presentations were sepsis (n = 37), skin and soft tissue infections (n = 12), meningitis (n = 8), osteoarticular infections (n = 6), and endocarditis (n = 2). About one-third of patients with sepsis went into septic shock. Mortality rate was 11%. Mortality and meningitis rates were significantly higher for alcoholic patients (p = 0.044 and p = 0.006, respectively). Other comorbidities included smoking, splenectomy, diabetes mellitus, and immunosuppressive therapy are associated to zoonotic Capnocytophaga infection. Eighty-two percent of cases involved contact with dogs, mostly included bites (63%). Despite all isolates were susceptible to the amoxicillin-clavulanic acid combination, three of them were resistant to amoxicillin.
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Alcoholismo , Mordeduras y Picaduras , Enfermedades de los Gatos , Enfermedades de los Perros , Infecciones por Bacterias Gramnegativas , Animales , Mordeduras y Picaduras/complicaciones , Mordeduras y Picaduras/epidemiología , Capnocytophaga , Enfermedades de los Gatos/microbiología , Gatos , Enfermedades de los Perros/microbiología , Perros , Infecciones por Bacterias Gramnegativas/microbiología , Humanos , Estudios Retrospectivos , Zoonosis/epidemiología , Zoonosis/microbiologíaRESUMEN
In this multicentric study performed in 12 French hospitals, we reported that 26.9% (14/52) of the amoxicillin-clavulanate-resistant Proteus mirabilis isolates produced the OXA-23 carbapenemase. We found that an inhibition zone diameter of <11 mm around the amoxicillin-clavulanate disc was an accurate screening cutoff to detect these OXA-23 producers. We confirmed by whole-genome sequencing that these OXA-23-producers all belonged to the same lineage that has been demonstrated to disseminate OXA-23 or OXA-58 in P. mirabilis.
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Proteus mirabilis , beta-Lactamasas , Combinación Amoxicilina-Clavulanato de Potasio/farmacología , Antibacterianos/farmacología , Proteínas Bacterianas/genética , Pruebas de Sensibilidad Microbiana , Prevalencia , Proteus mirabilis/genética , beta-Lactamasas/genéticaRESUMEN
Tularemia, caused by the bacterium Francisella tularensis, is an infrequent zoonotic infection, well known in immunocompetent (but poorly described in immunocompromised) patients. Although there is no clear literature data about the specific characteristics of this disease in immunocompromised patients, clinical reports seem to describe a different presentation of tularemia in these patients. Moreover, atypical clinical presentations added to the fastidiousness of pathogen identification seem to be responsible for a delayed diagnosis, leading to a" loss of chance" for immunocompromised patients. In this article, we first provide an overview of the host immune responses to Francisella infections and discuss how immunosuppressive therapies or diseases can lead to a higher susceptibility to tularemia. Then, we describe the particular clinical patterns of tularemia in immunocompromised patients from the literature. We also provide hints of an alternative diagnostic strategy regarding these patients. In conclusion, tularemia should be considered in immunocompromised patients presenting pulmonary symptoms or unexplained fever. Molecular techniques on pathological tissues might improve diagnosis with faster results.
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BACKGROUND: Ureaplasma parvum is usually part of the normal genital flora. Rarely can it cause invasive infections such as genitourinary infections, septic arthritis, or meningitis. CASE PRESENTATION: Here we present the first description of chronic ureterocystitis in a 56-year-old immunocompromised patient, complicated first by reactive arthritis and secondarily by contralateral septic arthritis due to U. parvum infection. U. parvum was detected in synovial fluid and in a urine sample. Treatment consisted of double-J stenting and targeted antibiotic therapy. Evolution showed resolution of urinary symptoms and clinical improvement of arthritis despite functional sequelae. CONCLUSIONS: Given the high prevalence of U. parvum colonisation, this diagnosis should remain a diagnosis of exclusion. However, because of the difficulty in detecting this microorganism, it should be considered in unexplained subacute urethritis or arthritis, including reactive arthritis, especially in immunosuppressed patients. Real-time PCR positivity in the absence of a differential diagnosis should not be overlooked.
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Artritis Infecciosa , Artritis Reactiva , Infecciones por Ureaplasma , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/tratamiento farmacológico , Humanos , Huésped Inmunocomprometido , Persona de Mediana Edad , Ureaplasma , Infecciones por Ureaplasma/diagnóstico , Infecciones por Ureaplasma/tratamiento farmacológicoRESUMEN
Mycoplasma genitalium is an emerging agent of sexually transmitted infections, associated with urethritis, cervicitis, and pelvic inflammatory disease. Over the past decade, a remarkable increase in macrolide-resistant M. genitalium, the first-line treatment, is observed all over the world. In some regions, an increase in fluoroquinolone-resistance, the second-line treatment, is also noticed. It therefore seems important to have a knowledge of the local epidemiology as well as the means of detecting these resistances in order to best adapt the treatment. Our study aimed to determine the prevalence of macrolide and fluoroquinolone-resistant Mycoplasma genitalium at the University Hospital of Tours in 2018, using a real-time PCR technique followed by Sanger sequencing. The prevalence of macrolide resistance in our population was 15.4 %. No FQ resistance-conferring mutations were observed in our study. Furthermore, we evaluated the performance of the commercial kit S-DiaMGRes® (Diagenode Diagnostics, Belgium), allowing the detection of 23S rRNA mutations conferring resistance to macrolides.
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Infecciones por Mycoplasma , Mycoplasma genitalium , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , ADN Bacteriano , Farmacorresistencia Bacteriana , Femenino , Fluoroquinolonas/farmacología , Hospitales Universitarios , Humanos , Macrólidos/farmacología , Mutación , Infecciones por Mycoplasma/diagnóstico , Infecciones por Mycoplasma/tratamiento farmacológico , Infecciones por Mycoplasma/epidemiología , Mycoplasma genitalium/genética , PrevalenciaRESUMEN
Temocillin is used for several years in some European countries but, only since 2015 in France. We assessed the susceptibility of Enterobacterales strains isolated from blood culture 1 year before (2014) and 2 years after (2017) its use in France. 1,387 strains were included by 17 clinical laboratories located throughout France: 363 in 2014 and 1,024 in 2017. The rate of resistance to temocillin was 4.6% and 26.7% in 3rd generation cephalosporin (3GC) susceptible and resistant strains respectively. Cephalosporinase-overproducer (COPE) strains were significantly more resistant to temocillin (37.7%) than ESBL-producer (ESBL-PE) (23.5%) (P < 0.01). The rate of temocillin resistance was correlated to the number of inactive beta-lactams. The rate of resistance to temocillin trend to increase from 13.9% in 2014 to 23.9% in 2017 (P < 0.01). Temocillin remains highly active against Enterobacterales but the trend in resistance should be assessed over time.
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Antibacterianos/farmacología , Farmacorresistencia Bacteriana , Infecciones por Enterobacteriaceae/microbiología , Enterobacteriaceae/efectos de los fármacos , Penicilinas/farmacología , Relación Dosis-Respuesta a Droga , Infecciones por Enterobacteriaceae/epidemiología , Francia/epidemiología , Humanos , Pruebas de Sensibilidad MicrobianaRESUMEN
Primary fungal infection of the central nervous system (CNS) is rare but often associated with severe prognosis. Diagnosis is complicated since cerebrospinal fluid (CSF) samples obtained from lumbar puncture usually remain sterile. Testing for fungal antigens in CSF could be a complementary diagnostic tool. We conducted such measurements in CSF from patients with CNS fungal infection and now discuss the usefulness of ventricular puncture. Mannan and (1â3)ß-D-glucan (BDG) testing were retrospectively performed in CSF samples from three patients with proven chronic CNS fungal infection (excluding Cryptococcus), and subsequently compared to 16 controls. Results from lumbar punctures and those from cerebral ventricles were confronted. BDG detection was positive in all the CSF samples (from lumbar and/or ventricular puncture) from the three confirmed cases. In case of Candida infection, mannan antigen measurement was positive in 75% of the CSF samples. In the control group, all antigen detections were negative (n = 15), except for one false positive. Faced with suspected chronic CNS fungal infection, measurement of BDG levels appears to be a complementary diagnostic tool to circumvent the limitations of mycological cultures from lumbar punctures. In the event of negative results, more invasive procedures should be considered, such as ventricular puncture.
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Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Antígenos Fúngicos/líquido cefalorraquídeo , Infecciones Fúngicas del Sistema Nervioso Central/líquido cefalorraquídeo , Infecciones Fúngicas del Sistema Nervioso Central/diagnóstico , Infecciones Fúngicas del Sistema Nervioso Central/tratamiento farmacológico , Mananos/líquido cefalorraquídeo , Triazoles/uso terapéutico , beta-Glucanos/líquido cefalorraquídeo , Adulto , Anciano , Biomarcadores/líquido cefalorraquídeo , Líquido Cefalorraquídeo/microbiología , Enfermedad Crónica , Pruebas Diagnósticas de Rutina , Femenino , Voluntarios Sanos , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
In the present study, we assessed a recently-marketed molecular test, the S-DiaMGTV™ kit (Diagenode), which provides simultaneous detection of Mycoplasma genitalium and Trichomonas vaginalis in urogenital samples. Performance characteristics of the S-DiaMGTV™ kit were compared to an in-house PCR for detection of M. genitalium and, for first time, with direct observation of genital secretions in wet mounting microscopy for T. vaginalis, a routine laboratory method. For M. genitalium, out of 66 samples, two negative with the in-house PCR were found positive with the S-DiaMGTV™ kit and two positive with the in-house PCR were found negative with the kit. For T. vaginalis, four samples were found positive by the molecular test. Among them, two were previously tested by the wet mounting observation and only one was positive. The kit allows an increase of T. vaginalis detection even in a low incidence country. Performances of the kit are in favor of its use in routine laboratory practice.
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Técnicas de Diagnóstico Molecular/métodos , Mycoplasma genitalium/genética , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Infecciones del Sistema Genital/diagnóstico , Trichomonas vaginalis/genética , Adulto , ADN Bacteriano/análisis , ADN Bacteriano/aislamiento & purificación , Pruebas Diagnósticas de Rutina/métodos , Femenino , Humanos , Recién Nacido , Masculino , Técnicas Microbiológicas/métodos , Infecciones por Mycoplasma/diagnóstico , Infecciones por Mycoplasma/microbiología , Mycoplasma genitalium/aislamiento & purificación , Valor Predictivo de las Pruebas , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/microbiología , Juego de Reactivos para Diagnóstico/normas , Infecciones del Sistema Genital/microbiología , Sensibilidad y Especificidad , Enfermedades de Transmisión Sexual/diagnóstico , Enfermedades de Transmisión Sexual/microbiología , Vaginitis por Trichomonas/diagnóstico , Vaginitis por Trichomonas/microbiología , Trichomonas vaginalis/aislamiento & purificación , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/microbiologíaRESUMEN
(1) Background: Leptospirosis infection can lead to multiple organ failure, requiring hospitalization in an intensive care unit for supportive care, along with initiation of an adapted antibiotic therapy. Achieving a quick diagnosis is decisive in the management of these patients. (2) Methods: We present here a review of leptospirosis cases diagnosed in the intensive care unit of our hospital over seven years. Clinical and biological data were gathered, and we compared the differences in terms of diagnostic method. (3) Results: Molecular biology method by Polymerase Chain Reaction (PCR) allowed quick and reliable diagnosis when performed in the first days after the symptoms began. Moreover, we identified that sampling blood and urine for PCR was more efficient than performing PCR on only one type of biological sample. (4) Conclusions: Our results confirm the efficiency of PCR for the quick diagnosis of leptospirosis and suggest that testing both blood and urine early in the disease might improve diagnosis.
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Of 69 clinical isolates of Finegoldia magna tested, 36% presented high-level MICs of erythromycin (>256 µg/ml), harboring erm(A) (n = 20) or erm(B) (n=5). Of nine isolates exhibiting an inducible resistance phenotype to macrolides-lincosamides-streptogramins B, four (44%) were susceptible with a potential risk of treatment failure due to emergence of resistant mutants.
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Farmacorresistencia Bacteriana Múltiple/genética , Firmicutes/efectos de los fármacos , Firmicutes/genética , Lincosamidas/farmacología , Macrólidos/farmacología , Metiltransferasas/genética , Estreptograminas/farmacología , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/farmacología , Proteínas Bacterianas/genética , ADN Bacteriano/genética , Femenino , Firmicutes/aislamiento & purificación , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Masculino , Persona de Mediana Edad , ARN Ribosómico 23S/genética , Adulto JovenRESUMEN
BACKGROUND: Tularemia is a rare zoonotic infection caused by bacterium Francisella tularensis. It has been well described in immunocompetent patients but poorly described in immunocompromised patients notably in solid organ transplant recipients. CASE PRESENTATIONS: We report here two cases of tularemia in solid organ transplant recipients including first case after heart transplant. We also carried out an exhaustive review of literature describing characteristics of this infection in solid organ transplant recipients.
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Tularemia/diagnóstico , Zoonosis/diagnóstico , Animales , Antibacterianos/uso terapéutico , Quimioterapia Combinada , Francisella tularensis/aislamiento & purificación , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Trasplante de Órganos , Índice de Severidad de la Enfermedad , Receptores de Trasplantes , Tularemia/tratamiento farmacológico , Tularemia/parasitología , Tularemia/patología , Zoonosis/tratamiento farmacológico , Zoonosis/parasitología , Zoonosis/patologíaRESUMEN
We report a disseminated infection caused by Spiroplasma apis, a honeybee pathogen, in a patient in France who had X-linked agammaglobulinemia. Identification was challenging because initial bacterial cultures and direct examination by Gram staining were negative. Unexplained sepsis in patients with agammaglobulinemia warrants specific investigation to identify fastidious bacteria such as Spiroplasma spp.
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Agammaglobulinemia/complicaciones , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/etiología , Spiroplasma , Adulto , Agammaglobulinemia/diagnóstico , Agammaglobulinemia/terapia , Antibacterianos/uso terapéutico , Biopsia , Francia , Enfermedades Genéticas Ligadas al Cromosoma X/complicaciones , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/microbiología , Humanos , Masculino , ARN Ribosómico 16S/metabolismo , Piel/microbiología , Piel/patología , Spiroplasma/clasificación , Spiroplasma/genética , Resultado del TratamientoRESUMEN
BACKGROUND: PCR-based techniques for the diagnosis of community- acquired severe lower respiratory tract infections are becoming the standard of care. However, their relative ability to identify either atypical bacteria or viruses that cause LRTI from clinical samples from various sources is yet to be determined. OBJECTIVES AND STUDY DESIGN: The aim of our study was to compare the diagnostic yield of nasopharyngeal aspirates with that of pulmonary samples for the etiological diagnosis of severe acute lower respiratory tract infections by multiplex PCR. Patients were adults with community-acquired pneumonia or acute exacerbation of chronic obstructive pulmonary disease. RESULTS: We obtained concordant results for 81 (79%) of the 103 pairs of samples. In 14 of the 22 discordant results, more pathogens were evidenced in the lower respiratory tract samples. CONCLUSIONS: Pulmonary samples had a similar diagnostic sensitivity for virus detection by multiplex PCR as nasopharyngeal aspirates. In contrast, in our study, the diagnostic efficacy of pulmonary samples for Legionella pneumophila over simple aspirates was clearly superior.
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Bacterias/aislamiento & purificación , Infecciones Comunitarias Adquiridas/diagnóstico , Reacción en Cadena de la Polimerasa Multiplex , Infecciones del Sistema Respiratorio/diagnóstico , Virus/aislamiento & purificación , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/virología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nasofaringe , Neumonía/diagnóstico , Neumonía/microbiología , Neumonía/virología , Infecciones del Sistema Respiratorio/microbiología , Infecciones del Sistema Respiratorio/virología , Sensibilidad y Especificidad , Succión , Adulto JovenRESUMEN
The patient is a 36 year old female who presented breast cancer with leptomeningeal involvement. A systematic lumbar puncture was performed and sent to the laboratory for CSF analysis. CSF examination using wet mount preparation showed a large number of round spherules. After discussion with the ordering physician, we learnt that the patient had received intrathecal liposomal cytarabine injection 19 days earlier. Cytarabine liposomes are spherules with a granular interior and range in size from 10-30 µm. It can be confused with leukocytes and lead to spurious elevation of CSF leukocytes count. Care needs to be taken in interpreting CSF results in patients who have received intrathecal liposomal cytarabine.