Amoebic Liver Abscess: Potential Application of New Diagnostic Techniques for an Old Pathogen.

Amoebic liver abscess is a severe and potentially life-threatening infection requiring prompt diagnosis and early targeted treatment. Diagnosis is challenging because conventional diagnostic methods such as light microscopy and serology are often unreliable. Molecular techniques have emerged as an additional diagnostic tool, suddenly becoming the new diagnostic reference standard. More recently, commercial multiplex PCR panels, including FilmArray, have been introduced, which permit the simultaneous detection of several enteric pathogens including Entamoeba histolytica in stool samples. We report a case of an amoebic liver abscess promptly diagnosed by FilmArray gastrointestinal panel performed on liver drainage fluid.

[Pneumocystis jiroveci and cytomegalovirus pneumonia in patients with alcoholic hepatic cirrhosis]. / Polmonite da Pneumocystis jiroveci e Cytomegalovirus in pazienti con cirrosi epatica alcolica.

We have described a fatal case of interstitial pneumonia with pleuritis in woman, 54 years old, suffered from end stage liver disease caused by ethanolic hepatic cirrhosis. Broncholavage microbiological culture was negative but biomolecular assays with polymerase chain reaction demonstred Pneumocystis jiroveci and Cytomegalovirus. She died despite aetiological therapy with cotrimoxazole and gancyclovir. Immunodeficiency of the delayed immune response, related to the severe liver disease and ethanol use, explains the occurrence of these opportunistic infections in ethanolic cirrhotic patients too.

Bloodstream infections caused by multidrug-resistant Klebsiella pneumoniae producing the carbapenem-hydrolysing VIM-1 metallo-beta-lactamase: first Italian outbreak.

OBJECTIVES: To investigate the first Italian outbreak of bloodstream infections caused by multidrug-resistant (MDR) Klebsiella pneumoniae producing metallo-beta-lactamase (MBL), which occurred in three wards of one large tertiary-care hospital in Genoa, Italy, from September 2004 to March 2005. METHODS: MBL production was screened by an imipenem-EDTA disc synergy test and confirmed by a conventional hydrolysis test. Antibiotic susceptibility was determined by broth microdilution or disc diffusion. PFGE was used to study the genetic relatedness of isolates. PCR and sequencing were carried out to identify the beta-lactamase genes and to analyse the genetic context of the MBL gene. Outer membrane protein (OMP) profiles were analysed by SDS-PAGE. RESULTS: Nine cases of bloodstream infections caused by an MDR strain of K. pneumoniae producing the VIM-1 MBL and the SHV-5 extended-spectrum beta-lactamase (ESBL) were identified. The isolates exhibited various carbapenem resistance levels (imipenem MICs ranged from 4 to 64 mg/L) and were resistant to other beta-lactams, fluoroquinolones, trimethoprim/sulfamethoxazole and chloramphenicol. The isolate with the highest imipenem MIC also lacked the k36 OMP. The bla(VIM-1) gene cassette was part of the variable region of a class 1 integron that also included an aac(6')-IIc cassette. The ESBL and MBL genes were transferable by conjugation. CONCLUSIONS: This is the first report on the emergence of an MDR strain of K. pneumoniae producing the VIM-1 MBL, causing an outbreak of bloodstream infections in an Italian hospital. The strain evolved through OMP alterations generating a mutant with increased carbapenem resistance.

Inexpensive homemade models for ultrasound-guided vein cannulation training.

STUDY OBJECTIVE: To test the hypothesis that low-cost homemade models may be used to acquire the basic skills for ultrasound-guided central vein puncture. DESIGN: Training study. SETTING: University transplantation department. MEASUREMENTS: Training was performed using three different homemade models (A, B, and C). Segments of a common rubber tourniquet (V1) and Silastic tube (V2) were used to simulate vessels within agar-based models. Overall cost for each model was less than 5 euro (US$7). For each test (test I, A-V1; II, A-V2; III, B-V1; IV, C-V2), the number of punctures and attempts needed to locate the needle inside the lumen were recorded. Each test was considered completed when participants punctured the vessels at the first attempt for three consecutive times. MAIN RESULTS: In test I, the mean number of punctures and attempts were 3.85 +/- 1.26 and 4.95 +/- 3.05; in test II, 4.60 +/- 1.14 and 6.30 +/- 2.51; in test III, 4.80 +/- 1.06 and 4.65 +/- 2.21; and in test IV, 4.45 +/- 1.23 and 6.05 +/- 2.92, respectively. For each test, no statistical difference was found by comparison of number of punctures and attempts for anesthesiologists versus nonanesthesiologists, men versus women, or previous experience versus no experience with central vein cannulation (CVC). Video game users obtained better results than did nonusers in test I (punctures, P = 0.033; attempts, P = 0.038), test II (punctures, P = 0.052; attempts, P = 0.011), and test IV (punctures, P = 0.001; attempts, P = 0.003). A posttraining questionnaire showed favorable opinions about the clarity of the instructions, aptness of the models, and adequacy of the training. In our operative unit, the use of ultrasound guidance for CVC increased from 2% to 23% in the first month after training. CONCLUSION: Low-cost homemade models are useful in acquiring basic coordination skills for ultrasound-guided CVC.

Transjugular intrahepatic portosystemic shunt, mechanical aspiration thrombectomy, and direct thrombolysis in the treatment of acute portal and superior mesenteric vein thrombosis.

A patient was admitted because of severe abdominal pain, anorexia, and intestinal bleeding. Contrast-enhanced multidetector computed tomography demonstrated acute portal and superior mesenteric vein thrombosis (PSMVT). The patient was treated percutaneously with transjugular intrahepatic portosystemic shunt (TIPS), mechanical aspiration thrombectomy, and direct thrombolysis, and 1 week after the procedure, complete patency of the portal and superior mesenteric veins was demonstrated. TIPS, mechanical aspiration thrombectomy, and direct thrombolysis together are promising endovascular techniques for the treatment of symptomatic acute PSMVT.