Does multiple gastric aspirate collection increase sensitivity of M. tuberculosis detection in children with pulmonary tuberculosis?

This study aims to investigate the sensitivity of microscopy, culture and polymerase chain reaction on three gastric aspirates (GAs) in the microbiological confirmation of active pulmonary tuberculosis (TB) and to identify possible changes in sensitivity derived from the collection of a different number of aspirates. Children with clinical and radiological diagnoses of active pulmonary TB who underwent three GAs between March 2007 and June 2019 were retrospectively evaluated. Clinical, radiological, and microbiological data were collected. The sensitivity of microbiological tests on GAs was calculated. Moreover, differences in sensitivity according to age and radiological pattern were investigated. Overall, 156 children with active pulmonary TB were enrolled with a median age of 51.5 (IQR: 25.2-113.2) months. Microbiological investigations on the first GA showed a sensitivity of 34% (95%CI 26.7, 42), the cumulative sensitivity of first and second GAs was 40.4% (95%CI 32.7, 48.5) and of the three GAs was 47.4% (95%CI 39.8, 55.2). The collection of three GAs leads to an overall increase in sensitivity of the first GA by 13.4% (95%CI 2.8, 24.1%; p=0.014). Moreover, the increase in sensitivity was significantly higher in children ≤ 4 years of age and in those with uncomplicated TB (p=0.008).Conclusions: Performing a higher number of GAs increases the sensitivity of microbiological confirmation of active pulmonary TB, particularly in children ≤ 4 years and with an uncomplicated radiological pattern. What is known: • The diagnosis of paediatric tuberculosis is a challenge for paediatricians • Despite their low sensitivity gastric aspirates represent the standard sample for microbiological confirmation of active pulmonary tuberculosis in children • Most international guidelines recommend performing three sequential gastric aspirates on three consecutive days What is new: • A significant increase in global sensitivity by 13.4% was found by the collection of three gastric aspirates compared to the first one • Performing a higher number of gastric aspirates increases the sensitivity of microbiological confirmation, particularly in children ≤ 4 years and with an uncomplicated radiological pattern.

Cryptic severe Plasmodium falciparum malaria in a Moroccan man living in Tuscany, Italy, August 2018.

In August 2018 a Moroccan man living in Tuscany developed Plasmodium falciparum malaria. The patient declared having not recently visited any endemic country, leading to diagnostic delay and severe malaria. As susceptibility to P. falciparum of Anopheles species in Tuscany is very low, and other risk factors for acquiring malaria could not be completely excluded, the case remains cryptic, similar to other P. falciparum malaria cases previously reported in African individuals living in Apulia in 2017.

Fusariosis diseminada refractaria debida a Fusarium verticillioides en un paciente con leucemia mieloide aguda que experimentó recidiva después de un alotrasplante de células progenitoras hematopoyéticas: informe del caso y revisión de los estudios publicados / Refractory disseminated fusariosis by Fusarium verticillioides in a patient with acute myeloid leukaemia relapsed after allogeneic hematopoietic stem cell transplantation: A case report and literature review

Fundamento. Fusarium es uno de los principales patógenos fúngicos que provoca infecciones invasoras en pacientes portadores de neoplasias malignas hematopoyéticas. Las especies del género Fusarium implicadas habitualmente en las infecciones del ser humano son Fusarium solani, Fusarium oxysporum y Fusarium verticillioides. No obstante, la identificación es una tarea lenta y que consume mucho tiempo. Fusarium spp. es resistente in vitro a numerosos fármacos antimicóticos y el tratamiento de la fusariosis no está bien definido. Objetivos. Destacar las dificultades en la identificación de Fusarium spp. por los métodos convencionales y la necesidad de disponer de nuevas técnicas moleculares rápidas para obtener un diagnóstico más precoz y un tratamiento apropiado. Métodos. En un paciente portador de una leucemia mieloide aguda con neutropenia refractaria, que experimentó recidiva tras alotrasplante de células progenitoras hematopoyéticas se documentó una infección diseminada por Fusarium debida a Fusarium verticillioides. Resultados. A pesar de recibir un tratamiento combinado con anfotericina B y voriconazol liposómicos y de la sensibilidad in vitro de los preparados administrados, el paciente falleció. Sólo después de su muerte se obtuvo la identificación morfológica y molecular de Fusarium verticillioides. Conclusiones. El caso descrito en el presente informe destaca el desenlace desfavorable de las micosis invasivas debidas a Fusarium en pacientes con aplasia de médula ósea. La identificación de los miembros del género Fusarium sigue limitándose a laboratorios seleccionados y debe introducirse en el diagnóstico micológico sistemático. En el huésped inmunocomprometido el diagnóstico de fusariosis se relaciona directamente con el estado del paciente. Se describen los métodos diagnósticos y las opciones terapéuticas actuales(AU)

Background. Fusarium species are among the leading fungal pathogens to cause invasive mould infections in patients with hematopoietic malignancy. The Fusarium species most frequently involved in human infections are Fusarium solani, Fusarium oxysporum and Fusarium verticillioides. However, identification is a cumbersome and time-consuming task. Fusarium is resistant in vitro to many of the antifungal agents and the management of fusariosis is not well defined. Objectives. To emphasise the difficulty of identifying Fusarium spp. by conventional methods and the need of new rapid molecular tests to achieve earlier diagnosis and appropriate therapy. Methods. A disseminated Fusarium infection due to F. verticillioides was documented in a neutropenic refractory patient with acute myeloid leukaemia, relapsed after allogeneic hematopoietic stem cell transplantation. Results. The patient died despite liposomal amphotericin B and voriconazole combination and “in vitro” susceptibility of agents employed. Morphological and molecular identification of F. verticillioides was obtained only after the death of the patient. Conclusions. This case highlights the poor outcome of an invasive fungal disease caused by Fusarium in aplastic patients. Identification of members of Fusarium genus remains restricted to selected laboratories and should be introduced into routine mycological diagnostics. In immunocompromised patients, diagnosis of fusariosis is directly related to prompt diagnosis and to patient's status. Current diagnosis methods and therapeutic options are discussed(AU)

Refractory disseminated fusariosis by Fusarium verticillioides in a patient with acute myeloid leukaemia relapsed after allogeneic hematopoietic stem cell transplantation: a case report and literature review.

BACKGROUND: Fusarium species are among the leading fungal pathogens to cause invasive mould infections in patients with hematopoietic malignancy. The Fusarium species most frequently involved in human infections are Fusarium solani, Fusarium oxysporum and Fusarium verticillioides. However, identification is a cumbersome and time-consuming task. Fusarium is resistant in vitro to many of the antifungal agents and the management of fusariosis is not well defined. OBJECTIVES: To emphasise the difficulty of identifying Fusarium spp. by conventional methods and the need of new rapid molecular tests to achieve earlier diagnosis and appropriate therapy. METHODS: A disseminated Fusarium infection due to F. verticillioides was documented in a neutropenic refractory patient with acute myeloid leukaemia, relapsed after allogeneic hematopoietic stem cell transplantation. RESULTS: The patient died despite liposomal amphotericin B and voriconazole combination and "in vitro" susceptibility of agents employed. Morphological and molecular identification of F. verticillioides was obtained only after the death of the patient. CONCLUSIONS: This case highlights the poor outcome of an invasive fungal disease caused by Fusarium in aplastic patients. Identification of members of Fusarium genus remains restricted to selected laboratories and should be introduced into routine mycological diagnostics. In immunocompromised patients, diagnosis of fusariosis is directly related to prompt diagnosis and to patient's status. Current diagnosis methods and therapeutic options are discussed.