Performance of two Aspergillus IgG EIA assays compared with the precipitin test in chronic and allergic aspergillosis.

Detection of Aspergillus IgG antibodies is important in the diagnosis of chronic pulmonary aspergillosis and allergic bronchopulmonary aspergillosis. Immunoprecipitation techniques to detect these antibodies appear to lack sensitivity and accurate quantitation compared with enzyme immunoassays (EIA). This study assessed the performance of two commercial EIAs compared with counterimmunoelectrophoresis (CIE). This was a prospective cohort study of 175 adult patients with chronic or allergic pulmonary aspergillosis. Aspergillus IgG antibodies were detected using CIE, Phadia ImmunoCap Aspergillus IgG and Bio-Rad Platelia Aspergillus IgG. Inter-assay reproducibility was determined for each method and 25 patients had two serum samples analysed within a 6-month interval. When compared with CIE, both ImmunoCap and Platelia Aspergillus IgG had good sensitivity (97 and 93%, respectively) for detection of Aspergillus IgG antibodies. The level of agreement between the two EIAs for positive results was good, but the concentration of antibodies was not correlated between the tests or with CIE titre. ImmunoCap IgG inter-assay coefficient of variation was 5%, whereas Platelia IgG was 33%. Median ImmunoCap IgG values for CPA and allergic aspergillosis were 95 and 32 mg/L, respectively, whereas Platelia IgG values were >80 and 6 AU/mL. The direction of CIE titre change over 6 months was mirrored by ImmunoCap IgG levels in 92% of patients, and by Platelia IgG in 72% of patients. Both ImmunoCap and Platelia Aspergillus IgG EIAs are sensitive measures of Aspergillus IgG antibodies compared with CIE. However, ImmunoCap appears to have better reproducibility and may be more suitable for monitoring patient disease.

Multifocal papular deep bacterial pyoderma in a Boxer dog caused by Pseudomonas aeruginosa.

A young adult Boxer dog was presented with a papular dermatitis on the dorsal back and ventral neck that had developed while it was being treated with cyclosporine and cephalexin for atopic dermatitis and secondary superficial staphylococcal pyoderma, respectively. Histopathology demonstrated nodular to diffuse pyogranulomatous dermatitis with focal furunculosis. Numerous bacterial rods, free in the tissue and engulfed by neutrophils and macrophages, could be demonstrated on stained samples (haematoxylin-eosin; Giemsa). Bacterial culture from an aseptically collected skin biopsy punch sample yielded a pure growth of Pseudomonas aeruginosa, sensitive to a variety of antimicrobials. Successful treatment was accomplished following discontinuation of cyclosporine and an extended course of enrofloxacin. There has not been a recurrence of the pseudomonal pyoderma during the subsequent 2 years.

Laparoscopic vs. open wedge biopsy of the liver.

This study was a post-hoc evaluation of laparoscopic versus open wedge biopsy of the liver performed as part of prospective phase I antibiotic trial. Consenting patients undergoing elective cholecystectomy were enrolled in a protocol which required samples of bile, blood, the gallbladder, and 1 gram of liver tissue. The study occurred during the evolution of laparoscopic surgery. Liver biopsy was done in standard fashion and laparoscopic liver biopsy was accomplished with cauterized scissors. Twenty-four patients, 4 male and 20 female averaging 42.1 years of age, were entered in this study. Eighteen patients underwent laparoscopic surgery and six patients underwent open surgery. They did not differ significantly in age (43.9 vs 42.1 years), operating room time (58.3 min vs 55.8 min), or complications (2/18 vs 2/6). Patients undergoing laparoscopic surgery, however, did have a shorter hospital stay (1.1 days vs 3.5 days, p < 0.001). All liver specimens were considered adequate. There were no complications related to the liver biopsy. Laparoscopic wedge biopsy of the liver is both a feasible and viable alternative to open wedge biopsy.