Immunoglobulin D and cardiac amyloidosis: development and a case illustration.

Amyloidosis results from extra-cellular deposition of proteins which interfere with tissue function. We report the case of a patient with pathological heart involvement which is caused by immunoglobulin D amyloidosis, and review current data on the amyloidois diagnosis and management.

Sensitivity of parasitological tests in imported Plasmodium vivax malaria in adults and impact of chemoprophylaxis and attack type.

BACKGROUND: Plasmodium vivax is the second most common species among cases of imported malaria diagnosed in Europe. The objective of this study is to describe the sensitivity of the parasitological tests in imported P. vivax malaria, and the impact of chemoprophylaxis and attack type (primary infection or relapse). METHODS: A retrospective study included the imported vivax malaria cases admitted in a French military hospital between 2001 and 2013. The reference diagnosis method was microscopy corrected by polymerase chain reaction (PCR). Thin and thick blood films examination, quantitative buffy coat (QBC) test, and a rapid diagnostic test (RDT) had been systematically performed. PCR had been carried out for ambiguous profiles. RESULTS: Eighty-nine cases recorded from 78 patients were included, 65 of them having recently traveled to French Guyana. Forty-two patients had properly followed chemoprophylaxis. Forty-six cases were primary infections while 43 were relapses. The sensitivity was 91% for the thin blood smear, 96% for the concentration techniques (Giemsa thick blood smear and QBC test), and 76% for the RDT. The combination of the three conventional tools has an imperfect sensitivity, both for the positive diagnosis of malaria (96%) and for the diagnosis of vivax species (80%). In 4% of the cases, the positive diagnosis was established only by the PCR. The species identification was established in 20% by the PCR. The sensibility of thin blood smear and of RDT decreased significantly with full compliance of chemoprophylaxis or primary infection, whereas the decrease of sensibility of concentration techniques was not significant. CONCLUSIONS: This study illustrates the difficulties encountered in vivax malaria diagnosis, especially in patients who properly followed chemoprophylaxis or with primary infection due to a lower parasitemia. It underlines the lack of sensitivity of RDT for P. vivax and emphasizes the need for systematically combining various diagnosis methods.

Effectiveness of latex agglutination slide test in the diagnosis of imported invasive amoebiasis in the emergency department.

We compared a latex agglutination test (LAT) with enzyme-linked immunosorbent assay and indirect hemagglutination assay in the diagnosis of invasive amoebiasis. A retrospective biological records review has included 639 patients for whom these three serological tests were performed. The sensitivity of the LAT was 97.8% and the specificity was 97%.

[Internal audit in medical laboratory: what means of control for an effective audit process?]. / Audit interne dans un laboratoire de biologie médicale: quels moyens de maîtrise pour un processus d'audit efficace ?

To prepare the French Accreditation Committee (COFRAC) visit for initial certification of our medical laboratory, our direction evaluated its quality management system (QMS) and all its technical activities. This evaluation was performed owing an internal audit. This audit was outsourced. Auditors had an expertise in audit, a whole knowledge of biological standards and were independent. Several nonconformities were identified at that time, including a lack of control of several steps of the internal audit process. Hence, necessary corrective actions were taken in order to meet the requirements of standards, in particular, the formalization of all stages, from the audit program, to the implementation, review and follow-up of the corrective actions taken, and also the implementation of the resources needed to carry out audits in a pre-established timing. To ensure an optimum control of each step, the main concepts of risk management were applied: process approach, root cause analysis, effects and criticality analysis (FMECA). After a critical analysis of our practices, this methodology allowed us to define our "internal audit" process, then to formalize it and to follow it up, with a whole documentary system.

[Heterophilic antibodies: be carefull!]. / Anticorps hétérophiles: restez vigilants !

The determination of plasma level of cardiac troponin I or T is recommended by the French Health Authority to diagnose myocardial infarction. However false positive results associated with the presence of heterophilic antibodies are described in the literature. This interference can lead to unnecessary invasive procedures, sometimes even dangerous. We report the case of a patient with falsely elevated troponin Ic concentration due to these antibodies. This case is characterized by the intensity of the abnormalities, the diversity of biological parameters affected and the discrepancies between biology and clinic. This case report confirms that modern immunoassays are always affected by heterophilic antibodies. We present here an example of such interference.

[Systemic amyloidosis revealed by an intense nephrotic syndrome]. / À propos d'une amylose révélée par un syndrome néphrotique intense.

We report the case of a patient with steroid-resistant nephrotic syndrome which is caused by a renal amyloidosis. This clinical case is characterized by intensity of clinicals and biologicals abnormalities and by its uncommun cause. We also review current data on the nephrotic syndrome as well as on the systemic amyloidosis and to evoke the indications of the immunoglobulin free-light-chains quantification in the diagnostic approach.