RESUMEN
Pneumocystis jirovecii DNA was detected using a polymerase chain reaction assay in air samples collected using an air-liquid impaction device at 1 m distance from three out of 14 infants who had developed Pneumocystis primary infection. P. jirovecii genotype identification was successful in one out of three pairs of air samples. Matching of P. jirovecii genotypes between the nasopharyngeal and air samples suggested that P. jirovecii was effectively exhaled by the infected infant. These original results represent a proof of concept of the role of infants with primary pneumocystis infection as infectious sources of P. jirovecii in hospitals and in the community.
Asunto(s)
Pneumocystis carinii , Pneumocystis , Neumonía por Pneumocystis , Espiración , Hospitales , Humanos , Lactante , Pneumocystis carinii/genética , Neumonía por Pneumocystis/epidemiologíaRESUMEN
The genus Scedosporium, which comprises at least five clinically relevant species, i.e. Scedosporium apiospermum, Scedosporium boydii, Scedosporium aurantiacum, Scedosporium dehoogii and Scedosporium minutisporum, ranks the second among the filamentous fungi colonizing the airways of patients with cystic fibrosis (CF). This colonization of the airways is thought to contribute to the inflammatory reaction leading to a progressive deterioration of the lung function. Additionally, these colonizing fungi may lead to severe disseminated infections in case of lung transplantation. Therefore, considering the low susceptibility of Scedosporium species to all current antifungal drugs, preventive measures should be defined to reduce the risk of exposure to these fungi for non-colonized CF patients. With this in mind, several studies have been conducted to elucidate the ecology of these fungi and to define possible sources of patient contamination. This review will summarize the major outcomes of those studies, including: the clear demonstration that ecological niches of Scedosporium species are strongly impacted by human activities, and the ability of Scedosporium species to degrade aliphatic and aromatic pollutants which supports the high occurrence of these species in contaminated soils and polluted waters and makes them promising candidates for bioremediation purposes. Finally, prospects for future research in this field are proposed.
Asunto(s)
Fibrosis Quística/complicaciones , Fibrosis Quística/microbiología , Enfermedades Pulmonares Fúngicas/microbiología , Scedosporium/crecimiento & desarrollo , Scedosporium/aislamiento & purificación , Exposición a Riesgos Ambientales , Humanos , Scedosporium/clasificaciónRESUMEN
BACKGROUND: Twenty-five patients, of whom 22 were renal transplant recipients, developed Pneumocystis jirovecii infections at the nephrology department of Reims University Hospital (France) from September 2008 to October 2009, whereas only four sporadic cases had been diagnosed in this department over the 14 previous years. AIM: This outbreak was investigated by analysing patient encounters and P. jirovecii types. METHODS: A transmission map was drawn up. P. jirovecii typing at DHPS, ITS and mtLSU rRNA sequences was performed in the patients of the cluster (18 patients with Pneumocystis pneumonia (PCP) and seven colonized patients), 10 unlinked control patients (six PCP patients and four colonized patients), as well as 23 other patients diagnosed with P. jirovecii (nine PCP patients and 14 colonized patients) in the same department over a three-year post-epidemic period. FINDINGS: Eleven encounters between patients harbouring the same types were observed. Three PCP patients and one colonized patient were considered as possible index cases. The most frequent types in the cluster group and the control group were identical. However, their frequency was significantly higher in the first than in the second group (P < 0.01). Identical types were also identified in the post-epidemic group, suggesting a second outbreak due to the same strain, contemporary to a disruption in prevention measures. CONCLUSIONS: These results provide additional data on the role of both PCP and colonized patients as infectious sources. Longitudinal screening of P. jirovecii types in infected patients, including colonized patients, is required in the investigation of the fungus's circulation within hospitals.
Asunto(s)
Infección Hospitalaria/epidemiología , Brotes de Enfermedades , Genotipo , Infecciones por Pneumocystis/epidemiología , Pneumocystis carinii/clasificación , Pneumocystis carinii/aislamiento & purificación , Anciano , Análisis por Conglomerados , Infección Hospitalaria/transmisión , ADN de Hongos/química , ADN de Hongos/genética , ADN Espaciador Ribosómico/química , ADN Espaciador Ribosómico/genética , Transmisión de Enfermedad Infecciosa , Femenino , Francia/epidemiología , Humanos , Estudios Longitudinales , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Epidemiología Molecular , Filogenia , Infecciones por Pneumocystis/transmisión , Pneumocystis carinii/genética , Análisis de Secuencia de ADN , Adulto JovenRESUMEN
To understand the epidemiological significance of Pneumocystis detection in a lung tissue sample of non-immunosuppressed individuals, we examined sampling procedures, laboratory methodology, and patient characteristics of autopsy series reported in the literature. Number of tissue specimens, DNA-extraction procedures, age and underlying diagnosis highly influence yield and are critical to understand yield differences of Pneumocystis among reports of pulmonary colonization in immunocompetent individuals.
Asunto(s)
Autopsia/métodos , Pulmón/microbiología , Técnicas Microbiológicas/métodos , Pneumocystis/aislamiento & purificación , Neumonía por Pneumocystis/diagnóstico , Manejo de Especímenes/métodos , Humanos , Neumonía por Pneumocystis/microbiologíaRESUMEN
OBJECTIVE OF THE STUDY: Recent data demonstrate the usefulness of (1,3) ß-d-glucan (BG) detection in serum samples to distinguish patients developing Pneumocystis pneumonia and patients who are colonized by the fungus. In contrast, data of BG detection in bronchoalveolar lavage (BAL) samples from these patient populations are still rare. PATIENTS: In this context, we determined BG levels in BAL samples from 11 Pneumocystis pneumonia (PCP) patients, 10 colonized patients, and 24 Pneumocystis-uninfected patients. MATERIALS AND METHODS: BG levels were determined on each BAL sample using the Fungitell(®) kit (Associates of Cape Cod, Inc., Cape Cod, MA, USA) according to the manufacturer's instructions applied to serum sample examination. RESULTS: The BG levels in BAL samples from the PCP patient group (mean value 20 588 pg/mL) were significantly higher than those in the colonized patient group (mean value 105 pg/mL) (P=0.0001, Mann-Whitney test) and than those in the Pneumocystis-uninfected patient group (mean value 74 pg/mL) (P<0.0001, Mann-Whitney test). The BG levels in BAL samples from the colonized patient group did not differ significantly from those in the Pneumocystis-uninfected patients group (P=0.21). CONCLUSION: The results suggest that measurements of BAL BG levels may facilitate the differential diagnosis of PCP and pulmonary colonization with Pneumocystis.
Asunto(s)
Líquido del Lavado Bronquioalveolar/química , Pulmón/microbiología , Neumonía por Pneumocystis/diagnóstico , beta-Glucanos/análisis , Adulto , Anciano , Anciano de 80 o más Años , Líquido del Lavado Bronquioalveolar/microbiología , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pneumocystis carinii/crecimiento & desarrollo , Pneumocystis carinii/aislamiento & purificación , Neumonía por Pneumocystis/sangre , Neumonía por Pneumocystis/microbiología , Valor Predictivo de las Pruebas , Adulto JovenRESUMEN
We report a case of microsporidiosis in a 72-year-old woman presenting with prolymphocytic leukemia. The underlying conditions 7 months after leukemia was diagnosed were pancytopenia and immunosuppression due to alemtuzumab and pentostatin. The patient's status had worsened and she presented with dysuria. Urine cultures for bacteria were repeatedly negative. She was first empirically treated with broad-spectrum antibiotics. Three months later, urinary symptoms were persisting. Her blood lymphocyte count was 90/microl. Urine examination was positive for microsporidia using modified trichrome staining and Uvitex 2B fluorescence. Microsporidia were also detected in stools. The patient was cured by albendazole. This was consistent with an infection due to Encephalitozoon sp. Concurrently, disseminated toxoplasmosis was diagnosed. Toxoplasma gondii was detected in bone marrow, broncho-alveolar lavage and cerebrospinal fluid. She was successfully treated with sulfadiazine-pyrimethamine. Four cases of microsporidiosis in myeloid leukemic patients have been already described. The present case in a patient with lymphoid leukemia is the first to be reported.
Asunto(s)
Encefalitozoonosis/complicaciones , Leucemia Prolinfocítica de Células T/complicaciones , Anciano , Albendazol/uso terapéutico , Animales , Médula Ósea/parasitología , Encephalitozoon/aislamiento & purificación , Encefalitozoonosis/tratamiento farmacológico , Heces/microbiología , Femenino , Humanos , Leucemia Prolinfocítica de Células T/microbiología , Toxoplasma/aislamiento & purificación , Toxoplasmosis/complicaciones , Toxoplasmosis/tratamiento farmacológicoRESUMEN
Airborne transmission of Pneumocystis sp. from host to host has been demonstrated in rodent models and several observations suggest that interindividual transmission occurs in humans. Moreover, it is accepted that the Pneumocystis organisms infecting each mammalian species are host specific and that the hypothesis of an animal reservoir for Pneumocystis jirovecii (P. jirovecii), the human-specific Pneumocystis species, can be excluded. An exosaprophytic form of the fungus cannot be strictly ruled out. However, these data point toward the potential for the specific host to serve as its own reservoir and for Pneumocystis infection in humans as an anthroponosis with humans as a reservoir for P. jirovecii. This review highlights the main data on host-to-host transmission of Pneumocystis in rodent models and in humans by the airborne route and provides a rationale for considering the occurrence of nosocomial infections and measures for their prevention
Asunto(s)
Microbiología del Aire , Reservorios de Enfermedades/veterinaria , Interacciones Huésped-Patógeno , Infecciones por Pneumocystis/transmisión , Pneumocystis carinii/patogenicidad , Animales , Infección Hospitalaria , Reservorios de Enfermedades/microbiología , Transmisión de Enfermedad Infecciosa , Humanos , Infecciones por Pneumocystis/microbiología , Infecciones por Pneumocystis/prevención & control , Neumonía por Pneumocystis/microbiología , Neumonía por Pneumocystis/prevención & control , Neumonía por Pneumocystis/transmisión , Especificidad de la EspecieRESUMEN
This study describes the initial data concerning molecular typing of Pneumocystis jirovecii in a patient having developed granulomatous Pneumocystis pneumonia (PCP). Three types, B(1)a(3), B(1)a(4), B(1)b(2), were identified. All three had been described in reports concerning patients with common diffuse alveolar PCP. The present data show that identical microorganisms can be involved in both granulomatous PCP and diffuse alveolar PCP and that the pathogenesis of the granulomatous response to P. jirovecii may more likely be related to host factors.
Asunto(s)
Granuloma/microbiología , Leucemia Linfocítica Crónica de Células B/complicaciones , Pneumocystis carinii/aislamiento & purificación , Neumonía por Pneumocystis/microbiología , Técnicas de Tipificación Bacteriana , Resultado Fatal , Genes Bacterianos , Genotipo , Granuloma/complicaciones , Humanos , Huésped Inmunocomprometido , Masculino , Persona de Mediana Edad , Pneumocystis carinii/clasificación , Pneumocystis carinii/genética , Neumonía por Pneumocystis/clasificación , Neumonía por Pneumocystis/complicaciones , Neumonía por Pneumocystis/patologíaRESUMEN
INTRODUCTION: Granulomatous pneumocystis pneumonia (PCP) is a rarity whose presentation may be misleading. CASE REPORT: We report the case of a patient suffering from chronic lymphatic leukaemia presenting with acute respiratory insufficiency, with a fatal outcome, due to granulomatous PCP. Broncho-alveolar lavage (BAL) remained negative and the diagnosis could only be made later by open lung biopsy. CONCLUSION: Although infrequent, granulomatous PCP should be recognised because in this situation the standard investigation (BAL) may be negative. New, more sensitive, methods of investigation such as the polymerase chain reaction (PCR) may permit earlier diagnosis.
Asunto(s)
Granuloma/complicaciones , Leucemia Linfocítica Crónica de Células B/complicaciones , Pulmón/patología , Neumonía por Pneumocystis/complicaciones , Biopsia , Lavado Broncoalveolar , Resultado Fatal , Granuloma/patología , Humanos , Masculino , Persona de Mediana Edad , Neumonía por Pneumocystis/patología , Insuficiencia Respiratoria/etiologíaRESUMEN
INTRODUCTION: Human non-visceral dirofilariasis, a mosquito-borne disease of carnivores (dogs), is chiefly due to Dirofilaria repens in France and is well known in the Mediterranean basin. This zoonosis can be misdiagnosed in northern areas of France. We present and discuss two human cases diagnosed in Abbeville and Amiens (Picardy) by histological examination. EXEGESIS: The former case appeared as an axillary tumefaction occurring in a 41-year-old women 6 months after holidays in Montauban (southwestern France), the other as an intraorbital 'tumor' in a 53-year-old man who travelled for professional purposes in Central Europe and North America. Morphological, clinical, and epidemiological data of these human infections are discussed and the diagnostic features in tissue sections for species identification are reviewed. CONCLUSION: Increasing travel customs during the last decades favour the emergence of zoonotic parasites unusually in human hosts. Outside known enzootic areas, diagnosis is often delayed until pathological examination. In France, the incidence of human dirofilariasis has steadily increased and must be considered in the workup of cutaneous or intraorbital nodules.
Asunto(s)
Dirofilariasis/diagnóstico , Oftalmopatías/parasitología , Enfermedades de la Piel/parasitología , Viaje , Adulto , Animales , Diagnóstico Diferencial , Dirofilariasis/patología , Femenino , Francia , Humanos , Incidencia , Masculino , Persona de Mediana Edad , ZoonosisRESUMEN
Cryptosporidium parvum is usually considered the agent of human cryptosporidiosis. However, only in the last few years, molecular biology-based methods have allowed the identification of Cryptosporidium species and genotypes, and only a few data are available from France. In the present work, we collected samples of whole feces from 57 patients from France (11 immunocompetent patients, 35 human immunodeficiency virus [HIV]-infected patients, 11 immunocompromised but non-HIV-infected patients) in whom Cryptosporidium oocysts were recognized by clinical laboratories. A fragment of the Cryptosporidium 18S rRNA gene encompassing the hypervariable region was amplified by PCR and sequenced. The results revealed that the majority of the patients were infected with cattle (29 of 57) or human (18 of 57) genotypes of Cryptosporidium parvum. However, a number of immunocompromised patients were infected with C. meleagridis (3 of 57), C. felis (6 of 57), or a new genotype of C. muris (1 of 57). This is the first report of the last three species of Cryptosporidium in humans in France. These results indicate that immunocompromised individuals are susceptible to a wide range of Cryptosporidium species and genotypes.
Asunto(s)
Criptosporidiosis/parasitología , Cryptosporidium/clasificación , Cryptosporidium/genética , ARN Ribosómico 18S/genética , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/parasitología , Adolescente , Adulto , Anciano , Animales , Secuencia de Bases , Niño , Preescolar , Criptosporidiosis/epidemiología , Cryptosporidium/aislamiento & purificación , Heces/parasitología , Femenino , Francia/epidemiología , Genes de ARNr , Humanos , Inmunocompetencia , Huésped Inmunocomprometido , Lactante , Masculino , Persona de Mediana Edad , Datos de Secuencia Molecular , Análisis de Secuencia de ADNAsunto(s)
Bronquiolitis/microbiología , Dihidropteroato Sintasa/genética , Inmunocompetencia , Nasofaringe/microbiología , Pneumocystis/clasificación , ADN de Hongos/análisis , Femenino , Humanos , Lactante , Masculino , Técnicas de Tipificación Micológica , Pneumocystis/enzimología , Pneumocystis/genética , Pneumocystis/aislamiento & purificación , Neumonía por Pneumocystis/microbiología , Reacción en Cadena de la Polimerasa/métodos , Polimorfismo de Longitud del Fragmento de RestricciónAsunto(s)
Bronquiolitis/microbiología , Inmunocompetencia , Nasofaringe/microbiología , Pneumocystis/aislamiento & purificación , Neumonía por Pneumocystis/microbiología , Reacción en Cadena de la Polimerasa/métodos , Preescolar , ADN de Hongos/análisis , Femenino , Humanos , Lactante , Masculino , Pneumocystis/genéticaAsunto(s)
Portador Sano/microbiología , Pneumocystis/clasificación , Neumonía por Pneumocystis/microbiología , Adulto , Anciano , Anciano de 80 o más Años , Líquido del Lavado Bronquioalveolar/microbiología , ADN de Hongos/análisis , ADN Espaciador Ribosómico/análisis , Femenino , Humanos , Masculino , Persona de Mediana Edad , Técnicas de Tipificación Micológica , Pneumocystis/genética , Reacción en Cadena de la Polimerasa/métodosRESUMEN
To test the viability of Pneumocystis carinii f. sp. hominis, an RT-PCR assay that employs specific primers from the Heat Shock Protein 70 gene was developed. Using this method, the viability of P.c. hominis in bronchoalveolar lavage fluids from patients developing PCP and in the environment of PCP patients was established.
Asunto(s)
Microbiología del Aire , Líquido del Lavado Bronquioalveolar/microbiología , Proteínas HSP70 de Choque Térmico/genética , Pneumocystis/crecimiento & desarrollo , Neumonía por Pneumocystis/microbiología , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Contaminación del Aire Interior , ADN de Hongos/análisis , Humanos , Pneumocystis/genética , Pneumocystis/aislamiento & purificación , ARN de Hongos/aislamiento & purificaciónRESUMEN
The metronidazole and albendazole susceptibility of 11 clinical isolates of Giardia duodenalis from France was determined using a neonatal mouse model and compared with the outcome in patients after standard metronidazole therapy (0.75 g/day for 5 days). All isolates found to be clinically resistant to metronidazole (4/11) exhibited an ID50 > 120 mg/kg in the mouse model. This therefore appears to be a suitable animal model in which to explore drug failures in human giardiasis.
Asunto(s)
Albendazol/farmacología , Antiinfecciosos/farmacología , Antiprotozoarios/farmacología , Heces/parasitología , Giardia lamblia/efectos de los fármacos , Metronidazol/farmacología , Albendazol/uso terapéutico , Animales , Animales Recién Nacidos , Antiinfecciosos/uso terapéutico , Antiprotozoarios/uso terapéutico , Gerbillinae , Giardiasis/tratamiento farmacológico , Humanos , Metronidazol/uso terapéutico , RatonesRESUMEN
The authors report a case of recurrent strongyloidiasis in a former French soldier of the Indochina colonial war (1946-54). Strongyloidiasis was associated with inaugural renal failure (acute steroid-resistant interstitial-type), requiring permanent hemodialysis. Despite antiparasitic treatment, relapse with digestive and pulmonary symptoms occurred 10 years later, following chronic eosinophilia. This observation emphasises that in dialysed subjects, eosinophilia should always stimulate a search for parasitic etiologies before incriminating dialysis-material allergy. Strongyloidiasis is a self-perpetuating helminthiasis whose distribution area is far greater than the intertropical zone. It can be completely asymptomatic, appear as late digestive complications and be responsible for bacteraemic peaks with septic visceral localizations. It causes a chronic oscillating eosinophilia. Diagnosis is usually performed by iterative stool examinations by Baermann technique in order to detect Strongyloides stercoralis rhabditoid larvae. In dialysed patients with unexplained eosinophilia awaiting renal transplant, the options of systematic thiabendazole (50 mg/kg) or ivermectine (0.2 mg/kg) single-dose to overcame the risk of disseminated strongyloidiasis induced by immunosuppressive post-transplantation therapy could be debated.