Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 936
Filtrar
1.
J Med Microbiol ; 69(5): 712-720, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32368996

RESUMO

Introduction. Given the limited number of candidaemia studies in Iran, the profile of yeast species causing bloodstream infections (BSIs), especially in adults, remains limited. Although biochemical assays are widely used in developing countries, they produce erroneous results, especially for rare yeast species.Aim. We aimed to assess the profile of yeast species causing BSIs and to compare the accuracy of the Vitek 2 system and 21-plex PCR.Methodology. Yeast blood isolates were retrospectively collected from patients recruited from two tertiary care training hospitals in Tehran from 2015 to 2017. Relevant clinical data were mined. Identification was performed by automated Vitek 2, 21-plex PCR and sequencing of the internal transcribed spacer region (ITS1-5.8S-ITS2).Results. In total, 137 yeast isolates were recovered from 107 patients. The overall all-cause 30-day mortality rate was 47.7 %. Fluconazole was the most widely used systemic antifungal. Candida albicans (58/137, 42.3 %), Candida glabrata (30/137, 21.9 %), Candida parapsilosis sensu stricto (23/137, 16.8 %), Candida tropicalis (10/137, 7.3 %) and Pichia kudriavzevii (Candida krusei) (4/137, 2.9 %) constituted almost 90 % of the isolates and 10 % of the species detected were rare yeast species (12/137; 8.7 %). The 21-plex PCR method correctly identified 97.1 % of the isolates, a higher percentage than the Vitek 2 showed (87.6 %).Conclusion. C. albicans was the main cause of yeast-derived fungaemia in this study. Future prospective studies are warranted to closely monitor the epidemiological landscape of yeast species causing BSIs in Iran. The superiority of 21-plex PCR over automated Vitek 2 indicates its potential clinical utility as an alternative identification tool use in developing countries.


Assuntos
Fungemia/diagnóstico , Fungemia/epidemiologia , Fungemia/microbiologia , Reação em Cadeia da Polimerase Multiplex , Análise de Sequência de DNA , Leveduras/classificação , Leveduras/genética , Idoso , Idoso de 80 Anos ou mais , DNA Intergênico , Feminino , Fungemia/história , História do Século XXI , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase Multiplex/métodos , Reação em Cadeia da Polimerase Multiplex/normas , Análise de Sequência de DNA/métodos , Análise de Sequência de DNA/normas
3.
Rev. iberoam. micol ; 36(3): 155-159, jul.-sept. 2019. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-191406

RESUMO

Background: Ocular involvement in AIDS patients is a common event mainly caused by inflammation or infection. Despite the high prevalence rate of cryptococcosis in these individuals, ocular features have been occasionally described. Case report: A 20-year-old Brazilian female with HIV infection recently diagnosed was admitted with a respiratory profile presumptively diagnosed as Pneumocystis jirovecii pneumonia; an ophthalmologic exam suggested choroiditis by this agent as well. She was complaining of headaches and blurred vision which led to cryptococcal meningitis diagnosis by a CSF positive India ink stain and Cryptococcus neoformans positive culture. Despite therapy based on amphotericin B plus fluconazole, her clinical state progressively worsened and the patient died one week later. At necropsy, disseminated cryptococcal infection was evidenced in several organs including eyes, which presented bilateral chorioretinitis. Conclusions: Cryptococcal ocular involvement in AIDS patients has been occasionally proved among the cases already reported. Thus, the post mortem exam is still pivotal to improve the quality of the clinical diagnosis, especially in limited-resource settingsl


Antecedentes: La afectación ocular en pacientes con sida es una circunstancia común provocada principalmente por procesos inflamatorios o infecciosos. A pesar de la alta prevalencia de criptococosis en estos individuos, los hallazgos oculares solo se describen ocasionalmente. Caso clínico: Una mujer brasileña de 20 años, diagnosticada poco tiempo antes de infección por el VIH, fue hospitalizada por dificultad respiratoria con el presunto diagnóstico de neumonía por Pneumocystis jirovecii; el examen oftalmológico sugirió también la existencia de coroiditis por el mismo agente etiológico. Las quejas de la paciente por cefalea y visión borrosa orientaron el diagnóstico hacia la criptococosis meníngea, confirmada por el examen directo y el crecimiento de Cryptococcus neoformans en el cultivo del líquido cefalorraquídeo. A pesar de haber comenzado un tratamiento con anfotericina B y fluconazol, el estado clínico empeoró progresivamente y la paciente falleció una semana después. La necropsia mostró criptococosis diseminada en varios órganos, incluidos los ojos, que presentaban coriorretinitis bilateral. Conclusiones: La criptococosis ocular en pacientes con VIH se ha descrito ocasionalmente en los casos publicados. Por este motivo, la necropsia todavía es fundamental para mejorar la calidad del diagnóstico clínico de esa enfermedad, especialmente en regiones con recursos limitados


Assuntos
Humanos , Feminino , Adulto Jovem , Infecções por HIV/complicações , Corioidite/microbiologia , Fungemia/diagnóstico , Criptococose/complicações , Cryptococcus neoformans/isolamento & purificação , Pneumonia/microbiologia , Meningite Criptocócica/complicações , Coriorretinite/microbiologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Cryptococcus neoformans/patogenicidade , Diagnóstico Diferencial , Endoftalmite/microbiologia , Técnicas de Genotipagem/métodos , Evolução Fatal
4.
Am J Health Syst Pharm ; 76(7): 460-469, 2019 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-31361820

RESUMO

PURPOSE: Antimicrobial stewardship programs (ASPs) can be aided by using rapid diagnostics (RDT). However, there are limited data evaluating the impact of ASPs and RDT on sepsis outcomes in the setting of the new Sepsis-3 guidelines. This study evaluates the impact of a low-resource method for ASPs with RDT on sepsis outcomes. METHODS: This was a prospective, quasi-experimental study with a retrospective double pretest. Patients ≥ 18 years old with sepsis and concurrent bacteremia or fungemia were included; patients who were pregnant, had polymicrobial septicemia or who were transferred from an outside hospital were excluded. In the first pretest (O1), polymerase chain reaction was used to identify Staphylococcal species from positive blood cultures, and traditional laboratory techniques were used to identify other species. Matrix-assisted laser desorption ionization time-of-flight mass spectroscopy and FilmArray were implemented in the second pretest (O2), and twice daily blood culture review was implemented in the posttest (O3). RESULTS: A total of 394 patients (157 in O1, 176 in O2, 61 in O3) were enrolled. Clinical response was 73.2%, 83.5%, and 88.5% in O1, O2, and O3, respectively, p = 0.013. By Cox regression, the O3 was associated with improved time to clinical response (hazard ratio, 1.388; 95% confidence interval, 1.004-1.919) as compared with O1. Mortality, hospital length of stay, and intensive care unit length of stay were unchanged between groups. CONCLUSION: Twice-daily blood culture review may be useful for implementing rapid diagnostics within low-resource ASPs. Further research is needed to identify the optimal method of blood culture follow-up within low-resource settings.


Assuntos
Gestão de Antimicrobianos/métodos , Bacteriemia/tratamento farmacológico , Hemocultura/métodos , Procedimentos Clínicos , Fungemia/tratamento farmacológico , Idoso , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Gestão de Antimicrobianos/economia , Gestão de Antimicrobianos/normas , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Hemocultura/economia , Feminino , Fungemia/diagnóstico , Fungemia/microbiologia , Fungos/efeitos dos fármacos , Fungos/isolamento & purificação , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/economia , Fatores de Tempo
5.
Clin Microbiol Infect ; 25(10): 1289.e1-1289.e4, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31175961

RESUMO

OBJECTIVES: The aim of this study was to evaluate the possibility of using a PCR-based panel to identify bacterial and fungal bloodstream infections in the setting of suspected or confirmed viral haemorrhagic fever. METHODS: The accuracy of the FilmArray® Blood Culture Identification Panel (BCID) assay was assessed to identify the common bacterial and fungal pathogens associated with bloodstream infections after positive blood culture inactivation using a guanidinium thiocyanate containing buffer lysis that is commonly used for viral haemorrhagic fever molecular diagnostics. RESULTS: The FilmArray® BCID panel assay detected 95% (19/20) of the pathogens analysed in this study by using both protocols with and without inactivation. Absolute consistency (100%) was observed in all isolates with phenotypes compatible with the presence of the antibiotic resistance genes mecA, vanA, vanB and blaKPC. CONCLUSIONS: The FilmArray® BCID panel assay coupled to inactivation using a guanidinium thiocyanate containing buffer lysis represents a convenient, sensitive and specific diagnostic tool to detect some of the most pathogens associated with bloodstream infections in the context of a suspected or confirmed viral haemorrhagic fever.


Assuntos
Bacteriemia/diagnóstico , Hemocultura , Fungemia/diagnóstico , Febres Hemorrágicas Virais/complicações , Técnicas de Diagnóstico Molecular/métodos , Reação em Cadeia da Polimerase/métodos , Manejo de Espécimes/métodos , Desinfetantes/farmacologia , Guanidinas/farmacologia , Humanos , Sensibilidade e Especificidade , Tiocianatos/farmacologia , Inativação de Vírus
6.
Eur J Clin Microbiol Infect Dis ; 38(8): 1435-1441, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31065826

RESUMO

The diagnosis of bloodstream infection requires the optimum combination of media in an automated blood culture system for maximum recovery of pathogens with the earliest time to detection. In a previous work, we showed that for patients admitted to the Emergency Department of our hospital, the combination of BACTEC lytic anaerobic and BACTEC aerobic vials was more efficient than BACTEC anaerobic and BACTEC aerobic vial. In this study, we extended the work including a broader patient population, representative of all hospital. A total of 8629 cultures were collected during the pre-lytic phase, from 01 July 2013 to 30 June 2014 and 7940 cultures during the post-lytic phase, ranged from 01 July 2015 to 30 June 2016. The number of positive blood cultures was higher during the post-lytic phase (19.74%) than in the pre-lytic phase (17.52%), particularly for Escherichia coli, Staphylococcus spp., Enterococcus spp., and anaerobes. We also observed a significant decreased of the time to detection, with the mean and median in the post-lytic phase of 17.68 and 13.05 h compared with 19.49 and 14.47 h in the pre-lytic phase. Whereas the time to detection was the same for organisms recovered in the aerobic Plus bottles for both time periods, time to detection for the anaerobic lytic bottles was significantly faster than with the anaerobic Plus bottles. This study carried out on a long time observation reported that a simple modification of composition of blood culture set could lead to better results in bloodstream infection detection.


Assuntos
Bactérias/isolamento & purificação , Hemocultura/instrumentação , Técnicas Microbiológicas/instrumentação , Sepse/diagnóstico , Aerobiose , Idoso , Idoso de 80 Anos ou mais , Anaerobiose , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Feminino , Fungemia/diagnóstico , Fungemia/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
7.
Arch Argent Pediatr ; 117(3): e279-e283, 2019 06 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31063317

RESUMO

Systemic lupus erythematosus (SLE) is a multisystem disease with protean manifestations. Lupus pancreatitis is the second most common disease associated with SLE-related acute abdomen. Although acute pancreatitis is rare it is clinically important because this condition can be life threatening if not treated promptly. Here, we report a case of a 10-year-old girl who developed SLE-associated pancreatitis after steroids therapy that was subsequently complicated by fungal septicaemia. Her clinical symptoms and signs markedly improved after administration of glucocorticoids and cyclophosphamide.


Assuntos
Ciclofosfamida/administração & dosagem , Glucocorticoides/administração & dosagem , Lúpus Eritematoso Sistêmico/complicações , Pancreatite/etiologia , Doença Aguda , Criança , Feminino , Fungemia/diagnóstico , Humanos , Imunossupressores/administração & dosagem , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Pancreatite/diagnóstico
9.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 37(5): 335-340, mayo 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-189223

RESUMO

OBJETIVO: En esta revisión se pretende actualizar los nuevos procedimientos aplicables en el diagnóstico microbiológico de las bacteriemias y fungemias. MÉTODO: Revisión de la literatura científica. RESULTADOS Y CONCLUSIONES: Tras definir el proceso e indicar sus principios fundamentales, se revisan los principales biomarcadores utilizados en la práctica clínica. Posteriormente, se resaltan las particularidades de la fase preanalítica (recogida y transporte de las muestras) y se detallan los pasos a seguir para la identificación microbiológica por métodos clásicos, basados en el cultivo de las muestras de sangre. En el siguiente apartado, se revisan los métodos diagnósticos no basados en el cultivo, incluyendo los que detectan la presencia del genoma del microorganismo y los basados en el estudio del proteoma mediante espectrometría de masas. En el último apartado se describen los procedimientos a seguir para el estudio de la sensibilidad antibiótica, tanto por métodos fenotípicos como genotípicos


OBJETIVE: In this review we try to update the new procedures applicable in the microbiological diagnosis of bacteriemia and fungemias. METHOD: Review of scientific literature. RESULTS AND CONCLUSIONS: After defining the process and indicating its fundamental principles, the main biomarkers used in clinical practice are reviewed. Subsequently, the particularities of the pre-analytical phase (collection and transport of samples) are highlighted and the steps to follow for the microbiological identification by classical methods are detailed, based on the culture of the blood samples. In the following section, we review the diagnostic methods not culture based, including those that detect the presence of the genome of the microorganism and those based on the study of proteome by mass spectrometry. The last section describes the procedures more frecuently used for the study of antibiotic susceptibility, both by phenotypic and genotypic methods


Assuntos
Humanos , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Fungemia/diagnóstico , Fungemia/microbiologia , Hemocultura/métodos , Técnicas Microbiológicas/métodos , Biomarcadores , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz
10.
Intern Med ; 58(15): 2219-2224, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30996161

RESUMO

Infectious diseases, including those caused by fungi, remain important issues in patients receiving malignant lymphoma chemotherapy. We herein report a rare case of Exophiala dermatitidis fungemia during chemotherapy in a 67-year-old woman admitted to our hospital. She had a fever that could not be resolved despite antifungal therapy. Yeast-like fungi were detected in blood culture samples, but biochemical identification was difficult. E. dermatitidis, a black mold, was identified using time-of-flight mass spectrometry. The patient finally improved after her treatment was switched to voriconazole. Fungal infection is difficult to diagnose and treat, but this novel approach can improve patients' outcomes.


Assuntos
Antifúngicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Exophiala , Fungemia/tratamento farmacológico , Linfoma/tratamento farmacológico , Voriconazol/uso terapêutico , Idoso , Feminino , Fungemia/complicações , Fungemia/diagnóstico , Humanos , Linfoma/complicações , Espectrometria de Massas
11.
Diagn Microbiol Infect Dis ; 95(1): 77-79, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31005402

RESUMO

Eremothecium coryli is a dimorphic fungus of the Saccharomycetes class. While species within this class are known to cause human infection, Eremothecium species have previously only been known as phytopathogens and never been isolated from a human sample. Here, we report the first known case of human E. coryli infection.


Assuntos
Eremothecium/fisiologia , Fungemia/diagnóstico , Fungemia/tratamento farmacológico , Leucemia Mieloide Aguda/complicações , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Hemocultura , DNA Fúngico/genética , Eremothecium/citologia , Eremothecium/efeitos dos fármacos , Eremothecium/genética , Feminino , Fungemia/microbiologia , Fungemia/patologia , Humanos , Testes de Sensibilidade Microbiana , RNA Ribossômico 28S/genética , Análise de Sequência de DNA , Falha de Tratamento
12.
BMC Pulm Med ; 19(1): 46, 2019 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-30791902

RESUMO

BACKGROUND: Opportunistic infections, while well studied in the AIDS population, continue to have variable and surprising presentations. Here, we present a case of disseminated histoplasmosis with disseminated nontuberculous mycobacterial infection in a 50 year old man with long standing AIDS living in a non-endemic area. CASE PRESENTATION: Patient presented with a constellation of symptoms, and imaging of the chest showed a pulmonary mass with cavitation, multiple nodules, and ground glass opacities. Further investigations revealed granulomatous lung nodules and fungemia consistent with Histoplasma capsulatum, and coinfection with disseminated nontuberculous mycobateria in a nonendemic area. CONCLUSIONS: Immunocompromised patients risk co-inhabitation by multiple infectious organisms. Some of these organisms may preside in the host for years prior to reactivation. Clinicians in non endemic areas should therefore be careful to not overlook specific organisms based on a lack of a recent travel history. Physicians in nonendemic areas should become more familiar with the clinical findings and diagnostic approach of infectious such as Histoplasmosis, to ensure earlier recognition and treatment in immunocompromised individuals.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Síndrome de Imunodeficiência Adquirida/complicações , Bacteriemia/complicações , Fungemia/complicações , Histoplasmose/complicações , Infecções por Mycobacterium não Tuberculosas/complicações , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/patologia , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Anfotericina B/uso terapêutico , Antibacterianos/uso terapêutico , Fármacos Anti-HIV/uso terapêutico , Antifúngicos/uso terapêutico , Antituberculosos/uso terapêutico , Azitromicina/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , California , Emtricitabina/uso terapêutico , Etambutol/uso terapêutico , Fungemia/diagnóstico , Fungemia/tratamento farmacológico , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Histoplasmose/diagnóstico , Histoplasmose/tratamento farmacológico , Histoplasmose/patologia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/patologia , Rifabutina/uso terapêutico , Tenofovir/uso terapêutico , Tomografia Computadorizada por Raios X
13.
Clin Microbiol Infect ; 25(4): 469-473, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29964233

RESUMO

OBJECTIVES: The question of whether to obtain two or three sets of blood cultures to assess the aetiology of bloodstream infections (BSIs) remains open to debate. Few studies have assessed the proportion of BSIs missed without the third blood culture set (BCS). The aim of our study was to determine the proportion of BSIs that would be missed without the third BCS in a hospital where obtaining three BCSs is the standard of care. METHODS: We performed a descriptive retrospective study in Hospital Gregorio Marañón (Madrid) from 2010 to 2013. We included all episodes of BSI in which three BCSs were systematically obtained. RESULTS: We included 4000 episodes of BSI between 2010 and 2013. Without the third BCS, we would have missed 298 (7.5%) episodes of BSI: 141 (47.3%) by gram-positive microorganisms, 147 (49.3%) by gram-negative microorganisms, and 10 (3.4%) by yeasts. In 132/298 (44.3%) of the episodes another clinical sample was obtained within a week of the BCS extraction; in 101/298 (33.9%), the same microorganism was present in a significant clinical sample other than blood. CONCLUSIONS: Our data suggest that performing a third BCS is useful, as not doing this could result in an unacceptable number of BSIs going undetected.


Assuntos
Bacteriemia/diagnóstico , Hemocultura/métodos , Erros de Diagnóstico/estatística & dados numéricos , Fungemia/diagnóstico , Bacteriemia/microbiologia , Feminino , Fungemia/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha , Centros de Atenção Terciária/estatística & dados numéricos
14.
J Clin Microbiol ; 57(2)2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30487304

RESUMO

Rapid identification and susceptibility testing results are of importance for the early appropriate therapy of bloodstream infections. The ePlex (GenMark Diagnostics) blood culture identification (BCID) panels are fully automated PCR-based assays designed to identify Gram-positive and Gram-negative bacteria, fungi, and bacterial resistance genes within 1.5 h from positive blood culture. Consecutive non-duplicate positive blood culture episodes were tested by the ePlex system prospectively. The choice of panel(s) (Gram-positive, Gram-negative, and/or fungal pathogens) was defined by Gram-stained microscopy of blood culture-positive bottles (BacT/Alert; bioMérieux). Results with the ePlex panels were compared to the identification results obtained by standard culture-based workflow. In total, 216 positive blood culture episodes were evaluable, yielding 263 identification results. The sensitivity/positive predictive value for detection by the ePlex panels of targeted cultured isolates were 97% and 99% for the Gram-positive panel and 99% and 96% for the Gram-negative panel, resulting in overall agreement rates of 96% and 94% for the Gram-positive and Gram-negative panel, respectively. All 26 samples with targeted resistance results were correctly detected by the ePlex panels. The ePlex panels provided highly accurate results and proved to be an excellent diagnostic tool for the rapid identification of pathogens causing bloodstream infections. The short time to results may be of added value for optimizing the clinical management of patients with sepsis.


Assuntos
Bacteriemia/diagnóstico , Bactérias/isolamento & purificação , Hemocultura/métodos , Fungemia/diagnóstico , Fungos/isolamento & purificação , Técnicas de Diagnóstico Molecular/métodos , Reação em Cadeia da Polimerase/métodos , Automação Laboratorial/métodos , Bactérias/classificação , Bactérias/genética , Fungos/classificação , Fungos/genética , Humanos , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade
16.
BMC Infect Dis ; 18(1): 693, 2018 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-30587143

RESUMO

BACKGROUND: Highly active antiretroviral therapy has significantly changed the natural history of HIV infection, leading to a dramatic reduction of HIV-related morbidity and mortality. Late Presenters, Very Late Presenters and AIDS presenters still represent, also in Europe, including Italy, a huge challenge in terms of diagnostic and therapeutic management. CASE PRESENTATION: A 35-year-old male with a history of fever and back pain. HIV test resulted positive with a high HIV Viral Load and a very low T-CD4 number of cells (5 cells/mm3). Imaging investigations revealed multiple vertebral and pulmonary lesions together with abdominal and thoracic lymphadenopathy. Blood cultures were positive for Cryptococcus neoformans and for Staphylococcus haemolyticus. Lymphnode biopsy resulted positive in PCR for Non-Tuberculosis Mycobacteria (Mycobacterium chelonae). A gastric biopsy also revealed a GIST. The patient also had CMV DNA positive. Although we performed antiretroviral therapy and specific-therapies for each disease, he was transferred to intensive care unit where he died due to an Acute Respiratory Distress Syndrome. CONCLUSION: The reported case is unusual due to the relevant number of opportunistic diseases (both infectious and tumoral) emerging not long after the HIV infection had been diagnosed. Late presenters HIV patients and AIDS presenters still represent a challenge, which is often too complex for clinicians to deal with. In spite of proper management, the risk of suboptimal results cannot be excluded.


Assuntos
Criptococose/complicações , Neoplasias Gastrointestinais/complicações , Tumores do Estroma Gastrointestinal/complicações , Infecções por HIV/diagnóstico , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Osteomielite/complicações , Doenças da Coluna Vertebral/complicações , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Adulto , Criptococose/diagnóstico , Criptococose/microbiologia , Criptococose/virologia , Cryptococcus neoformans/isolamento & purificação , Diagnóstico Tardio , Evolução Fatal , Fungemia/complicações , Fungemia/diagnóstico , Fungemia/microbiologia , Neoplasias Gastrointestinais/microbiologia , Neoplasias Gastrointestinais/virologia , Tumores do Estroma Gastrointestinal/microbiologia , Tumores do Estroma Gastrointestinal/virologia , HIV , Infecções por HIV/complicações , Infecções por HIV/microbiologia , Humanos , Masculino , Infecções por Mycobacterium não Tuberculosas/complicações , Mycobacterium chelonae/isolamento & purificação , Osteomielite/diagnóstico , Osteomielite/microbiologia , Osteomielite/virologia , Doenças da Coluna Vertebral/microbiologia , Doenças da Coluna Vertebral/virologia
17.
J Med Microbiol ; 67(11): 1589-1595, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30311873

RESUMO

PURPOSE: Bloodstream infections are major causes of morbidity and mortality that lead to prolonged hospital stays and higher medical costs. In this study, we aimed to evaluate the MinION nanopore sequencer for the identification of the most dominant pathogens in positive blood culture bottles. METHODOLOGY: 16S and ITS1-5.8S-ITS2 rRNA genes were amplified by PCR reactions with barcoded primers using nine clinical isolates obtained from positive blood bottles and 11 type strains, including five types of Candida species. Barcoded amplicons were mixed, and multiplex sequencing with the MinION sequencer was performed. In addition, barcoded PCR amplicons were sequenced by Sanger sequencing to validate the performance of the MinION. RESULTS: The bacterial and Candida spp. identified by MinION sequencing, based on the highest homology of reference sequences from the NCBI gene databases, agreed with the matrix-assisted laser desorption ionization time of flight mass spectrometry results, excepting the closely related species Streptococcusand Escherichia coli. The 'pass' reads obtained within about 10 min of sequencing were sufficient to identify the pathogens. The average values of sequence identities with 1D2 chemistry and the R9.5 flow cell were around 99 %; thus, frequent sequence errors did not affect species identification based on amplicon sequencing. CONCLUSION: We have established a rapid, portable and economical technique for the identification of pathogens in positive blood culture bottles through a novel MinION nanopore sequencer amplicon sequencing scheme, which replaces traditional Sanger sequencing.


Assuntos
Hemocultura/instrumentação , Hemocultura/métodos , Nanoporos , Análise de Sequência de DNA/instrumentação , Análise de Sequência de DNA/métodos , Bacteriemia/sangue , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Bactérias/classificação , Bactérias/genética , Bactérias/isolamento & purificação , Bactérias/patogenicidade , Candida/genética , Candida/isolamento & purificação , Candida/patogenicidade , DNA Bacteriano/genética , DNA Bacteriano/isolamento & purificação , DNA Fúngico/genética , DNA Fúngico/isolamento & purificação , Escherichia coli/genética , Escherichia coli/isolamento & purificação , Fungemia/sangue , Fungemia/diagnóstico , Fungemia/microbiologia , Fungos/genética , Fungos/isolamento & purificação , Fungos/patogenicidade , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Reação em Cadeia da Polimerase/métodos , Análise de Sequência de DNA/economia , Análise de Sequência de DNA/estatística & dados numéricos
18.
Otolaryngol Head Neck Surg ; 159(3): 576-580, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29870310

RESUMO

Objective Identify methods to improve the frozen-section diagnosis of acute invasive fungal rhinosinusitis. Study Design Biopsies with frozen section for suspected acute invasive fungal rhinosinusitis were reviewed to identify causes for missed diagnoses and evaluate methods for potential improvement. Setting All aspects of the study were performed at the Penn State Milton S. Hershey Medical Center. Subjects and Methods All frozen sections performed for suspected acute invasive fungal rhinosinusitis between 2006 through 2017 were reviewed with their diagnoses compared to the final diagnoses. Sensitivity and specificity were determined for each biopsy specimen to evaluate the diagnostic method and for each patient for its effectiveness on outcome. Causes for frozen-section failures in diagnosis were identified. A periodic acid-Schiff stain for fungus (PASF) was modified for use on frozen tissue (PASF-fs) and applied both retrospectively and prospectively to frozen sections to determine its ability to identify undetected fungus and improve diagnostic sensitivity. Results Of 63 biopsies positive for acute invasive fungal rhinosinusitis, 51 were diagnosed on frozen section, while 61 were identified by including the novel PASF-fs stain, reducing the failure rate from 19% to 3%. Of 41 cases that were positive, 34 were diagnosed on frozen section. Of the 7 that were not, 5 were identified by including the PASF-fs, reducing the failure rate from 17% to 5%. Conclusions Frozen section interpretation of biopsies for suspected acute invasive fungal rhinosinusitis using a PASF-fs stain should enable a rapid and accurate diagnosis with improved outcomes by shortening the time to surgery.


Assuntos
Secções Congeladas/métodos , Fungemia/diagnóstico , Fungemia/imunologia , Rinite/diagnóstico , Sinusite/diagnóstico , Doença Aguda , Biópsia por Agulha , Estudos de Coortes , Corantes/farmacologia , Reações Falso-Negativas , Feminino , Fungemia/microbiologia , Humanos , Hospedeiro Imunocomprometido , Imuno-Histoquímica , Masculino , Estudos Retrospectivos , Rinite/microbiologia , Sensibilidade e Especificidade , Sinusite/microbiologia
19.
Ann Saudi Med ; 38(3): 194-199, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29848937

RESUMO

BACKGROUND: Bloodstream infections are associated with high rates of morbidity and mortality. Rapid detection of bloodstream infections is important in achieving better patient outcomes. OBJECTIVE: Compare the time-to-detection (TTD) of the new BacT/Alert Virtuo and the BACTEC FX automated blood culture systems. DESIGN: Prospective simulated comparison of two instruments using seeded samples. SETTING: Medical microbiology laboratory. METHODS: Blood culture bottles were seeded in triplicate with each of the standard ATCC strains of aerobes, anaerobes and yeast. TTD was calculated as the length of time from the beginning of culture incubation to the detection of bacterial growth. MAIN OUTCOME MEASURES: TTD for the various tested organisms on the two microbial detection systems. RESULTS: The 99 bottles of seeded blood cultures incubated in each of the blood culture systems included 21 anaerobic, 39 aerobic and 39 pediatric bottles. The BacT/Alert Virtuo system exhibited significantly shorter TTD for 72.7 % of the tested organisms compared to BACTEC FX system with a median difference in mean TTD of 2.1 hours (interquartile range: 1.5-3.5 hours). The BACTEC FX system was faster in 15.2% (5/33) of microorganisms, with a median difference in mean TTD of 25.9 hours (IQR: 9.1-29.2 hours). CONCLUSION: TTD was significantly shorter for most of the microorganisms tested on the new BacT/Alert Virtuo system compared to the BACTEC FX system. LIMITATIONS: Use of simulated cultures to assess TTD may not precisely represent clinical blood cultures. CONFLICT OF INTEREST: None.


Assuntos
Bacteriemia/diagnóstico , Bactérias/isolamento & purificação , Fungemia/diagnóstico , Leveduras/isolamento & purificação , Bacteriemia/microbiologia , Hemocultura/métodos , Fungemia/microbiologia , Humanos , Técnicas Microbiológicas/métodos , Estudos Prospectivos , Fatores de Tempo
20.
Eur J Clin Microbiol Infect Dis ; 37(9): 1621-1626, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29882176

RESUMO

Collecting adequate volumes of blood in blood culture bottles is crucial for sensitive detection of bacteremia and fungemia. Tools enabling easy collection of data on the degree of blood culture bottle filling at different hospital departments are an important step toward quality measurement and improvement. In this study, we verified the accuracy of a software tool for the monitoring of blood culture bottle filling developed by Becton Dickinson, BD blood volume monitoring system (BVMS) that was adjusted for use on plastic BACTEC bottles, and evaluated its ease of use in routine practice. In total, 538 negative plastic BD BACTEC Plus Aerobic/F blood culture bottles collected in two secondary care hospitals in Belgium were included in the study. The BVMS software demonstrated good performance, with an acceptable mean difference of - 0.3 mL or - 4.0% between the mean volume estimated by BVMS and the mean weight-based volume. Data (mean blood volume and standard deviation) and figures (box-and-whisker and histogram plots) on blood culture bottle filling are easily acquired. They provide information on the current situation in a hospital (department) and can be used as a tool for quality improvement measurements and follow-up. Caution is required when interpreting BVMS results for hospital wards where a substantial amount of the bottles collected come from patients with hematocrit values < 30%. This study demonstrated that BVMS is a reliable and easy to use tool which facilitates monitoring and coordination of optimization of blood culture bottles filling by the clinical laboratory.


Assuntos
Hemocultura/instrumentação , Hemocultura/normas , Software , Bacteriemia/diagnóstico , Bélgica , Sangue/microbiologia , Fungemia/diagnóstico , Hematócrito/estatística & dados numéricos , Humanos , Controle de Qualidade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA