RESUMO
BACKGROUND: Reliable species identification of cultured isolates is essential in clinical bacteriology. We established a new study algorithm named NOVA - Novel Organism Verification and Analysis to systematically analyze bacterial isolates that cannot be characterized by conventional identification procedures MALDI-TOF MS and partial 16 S rRNA gene sequencing using Whole Genome Sequencing (WGS). RESULTS: We identified a total of 35 bacterial strains that represent potentially novel species. Corynebacterium sp. (n = 6) and Schaalia sp. (n = 5) were the predominant genera. Two strains each were identified within the genera Anaerococcus, Clostridium, Desulfovibrio, and Peptoniphilus, and one new species was detected within Citrobacter, Dermabacter, Helcococcus, Lancefieldella, Neisseria, Ochrobactrum (Brucella), Paenibacillus, Pantoea, Porphyromonas, Pseudoclavibacter, Pseudomonas, Psychrobacter, Pusillimonas, Rothia, Sneathia, and Tessaracoccus. Twenty-seven of 35 strains were isolated from deep tissue specimens or blood cultures. Seven out of 35 isolated strains identified were clinically relevant. In addition, 26 bacterial strains that could only be identified at the species level using WGS analysis, were mainly organisms that have been identified/classified very recently. CONCLUSION: Our new algorithm proved to be a powerful tool for detection and identification of novel bacterial organisms. Publicly available clinical and genomic data may help to better understand their clinical and ecological role. Our identification of 35 novel strains, 7 of which appear to be clinically relevant, shows the wide range of undescribed pathogens yet to define.
Assuntos
Bactérias , Corynebacterium , Bactérias/genética , Sequenciamento Completo do Genoma , Corynebacterium/genética , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , RNA Ribossômico 16S/genética , Técnicas de Tipagem Bacteriana/métodosRESUMO
BACKGROUND AND OBJECTIVES: Anogenital warts (AGWs) are most commonly caused by low-risk human papillomavirus (HPV) types, and although they are the most frequent viral sexually transmitted infections (STIs), little is known about STI coinfections in affected patients. We therefore sought to assess STI coinfection rates in patients with AGW, specify STI coinfections and calculate the number needed to screen (NNS) for each STI. METHODS: A retrospective cross-sectional study analyzing data sets from AGW patients treated in our clinic between 2008-2016. RESULTS: 142/196 (72 %) patients had been variably screened for infections with HIV, HBV and HCV, Treponema pallidum, Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium and HSV. The STI coinfection rate in all tested patients was 24.6 %, yielding an NNS of 4.1 to detect any STI. Of note, the coinfection rate did not differ significantly between heterosexual men, homosexual men and women, respectively. The NNS for syphilis was 8.4, for HIV 14.0, for HCV 28.5 and for HBV 39.0. The NNS for asymptomatic patients tested for HSV, Chlamydia trachomatis and Mycoplasma genitalium were 1.4, 5.3 and 12.0, respectively. CONCLUSION: Due to the high prevalence of STI coinfections, AGW patients should be screened for other STIs.
Assuntos
Coinfecção/epidemiologia , Condiloma Acuminado/epidemiologia , Infecções Sexualmente Transmissíveis/epidemiologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos RetrospectivosRESUMO
Legionella spp. are an important cause of pulmonary and rarely extrapulmonary infections. L. cincinnatiensis has only been implicated in five cases to date. We herein report the first case of L. cincinnatiensis septic arthritis in a 90-year old lady with a past medical history of chronic kidney disease. She developed septic arthritis of her left wrist after having received intraarticular corticosteroid injections and oral corticosteroids administered for presumed chondrocalcinosis. Appropriate antimicrobial treatment of L. cincinnatiensis septic arthritis was delayed until identification of this organism in joint biopsies by broad-range bacterial PCR targeting the 16S rRNA gene with subsequent rDNA sequence analysis and by culture on special media. Reviewing all reported cases of septic arthritis caused by Legionella spp. other than L. cincinnatiensis it is notable that diagnosis was established by PCR in the majority of cases and only subsequently confirmed by special culture. Although most patients were immunosuppressed, outcome was favourable. Treatment consisted of a fluoroquinolone alone or in combination with rifampicin or a macrolide. Our case highlights the need for a high index of suspicion for infections with unusual/fastidious organisms when symptoms are suggestive of septic arthritis but conventional methods fail to identify a causative organism.
Assuntos
Anti-Infecciosos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Legionella/fisiologia , Legionelose/tratamento farmacológico , Idoso de 80 Anos ou mais , Artrite Infecciosa/microbiologia , Feminino , Fluoroquinolonas/uso terapêutico , Humanos , Hospedeiro Imunocomprometido , Legionella/efeitos dos fármacos , Legionella/genética , Legionelose/diagnóstico , Legionelose/microbiologia , Macrolídeos/uso terapêutico , RNA Bacteriano/análise , RNA Ribossômico 16S/análise , Rifampina/uso terapêutico , Suíça , Resultado do TratamentoRESUMO
BACKGROUND: Fresh-frozen plasma (FFP) may contain antibodies to hepatitis B surface antigen (HBsAg, anti-HBs). These anti-HBs may lead to a misinterpretation of the actual hepatitis B immune status. Furthermore, they may not only confer protection against hepatitis B virus (HBV), but may also favor the selection of HBsAg mutants. CASE REPORT: We report a case of de novo HBV infection in a HBV-naïve recipient with alcoholic liver disease, who received a liver from a donor with antibodies to hepatitis B core antigen (HBcAg, anti-HBc) and anti-HBs. RESULTS: A lookback investigation revealed the following: 1) Due to anti-HBs passively acquired through FFP, the recipient was considered immune to HBV and did not receive anti-HBV prophylaxis. 2) Within 1 year after transplantation he developed hepatitis B in absence of any elevated liver enzymes after the anti-HBs by FFP declined. 3) Despite an infection with HBV-containing wild-type HBcAg, the patient did not seroconvert to anti-HBc positivity. 4) The replicating HBV encoded two HBsAg mutations, first sQ129R and 4 months later sP127S. They map to the highly conserved "α" determinant of the HBsAg loop. CONCLUSION: 1) Passive transfer of anti-HBs from FFP led to an erroneous pretransplant diagnosis of HBV immunity when the patient was in fact HBV-naïve. 2) HBsAg mutations might have been selected in escape from donor's actively produced anti-HBs and the recipient's anti-HBs by FFP might have favored this selection. 3) It is doubtful whether hepatitis B immunoglobulin could have prevented the reactivation. 4) Antiviral prophylaxis would have been crucial.
Assuntos
Anticorpos Anti-Hepatite B/sangue , Antígenos de Superfície da Hepatite B/genética , Vírus da Hepatite B/fisiologia , Hepatite B/transmissão , Transplante de Fígado/efeitos adversos , Ativação Viral/fisiologia , Hepatite B/sangue , Hepatite B/etiologia , Hepatite B/virologia , Antígenos do Núcleo do Vírus da Hepatite B/imunologia , Antígenos de Superfície da Hepatite B/imunologia , Vírus da Hepatite B/genética , Vírus da Hepatite B/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Mutação/fisiologia , Doadores de TecidosAssuntos
Sangue/parasitologia , Malária/diagnóstico , Malária/patologia , Plasmodium/citologia , Adolescente , África , Feminino , Humanos , Malária/parasitologia , MicroscopiaRESUMO
A novel immunoassay for Clostridium difficile glutamate dehydrogenase (GDH) and toxin A&B (LIAISON, DiaSorin) was compared to another GDH assay (Alere), PCR and toxigenic culture. The GDH-DiaSorin is slightly more sensitive than the GDH-Alere. Sensitivity of the Toxin-Diasorin test is in accordance to the sensitivity of other immunoassays in literature.
Assuntos
Proteínas de Bactérias/isolamento & purificação , Toxinas Bacterianas/isolamento & purificação , Clostridioides difficile/enzimologia , Clostridioides difficile/genética , Enterotoxinas/isolamento & purificação , Glutamato Desidrogenase/isolamento & purificação , Técnicas Imunoenzimáticas/métodos , Luminescência , Proteínas de Bactérias/análise , Proteínas de Bactérias/genética , Toxinas Bacterianas/genética , Técnicas Bacteriológicas/métodos , Enterotoxinas/genética , Fezes/química , Fezes/microbiologia , Glutamato Desidrogenase/genética , Humanos , Técnicas Imunoenzimáticas/instrumentação , Reação em Cadeia da Polimerase/métodos , Valor Preditivo dos Testes , Sensibilidade e EspecificidadeRESUMO
This study aimed at assessing the specificity of the Elecsys® HIV combi PT in comparison to the ARCHITECT® HIV Ag/Ab Combo. With both of these assays, 3997 unselected sera from patients of a tertiary health care centre in Basel, Switzerland, were screened for HIV. Reactive sera were reanalysed on the VIDAS® HIV Duo Ultra to identify false-reactive specimens prior to confirmation by quantitative PCR and line immunoassay. The Elecsys® compared to the ARCHITECT® shows a similar specificity (99.7% versus 99.8%) but a slightly lower positive predictive value (71.8% versus 80%). Samples tested with a cut-off index (COI) between 0.91 and 4.85 (cut-off <0.9) with the Elecsys® and with a signal to cut-off index (S/CO) between 1.09 and 12.49 (cut-off <1.0) with the ARCHITECT® were false-reactive. There was no false-reactive result with the VIDAS®. Of the false-reactive samples, 66.7% could be related to patient-specific underlying conditions. The HIV two-tiered diagnostic algorithm proposed in this work improved the positive predictive values of the Elecsys® or ARCHITECT® to 100% when the results of the VIDAS® were included. Values just above the cut-off are highly suspicious to be false-reactive and high COI or S/CO ratios are associated with true positivity.
Assuntos
Sorodiagnóstico da AIDS/métodos , Anticorpos Anti-HIV/sangue , Proteína do Núcleo p24 do HIV/sangue , Infecções por HIV/diagnóstico , HIV-1/imunologia , HIV-2/imunologia , Imunoensaio/métodos , Adulto , Reações Falso-Positivas , Feminino , Proteína do Núcleo p24 do HIV/imunologia , Infecções por HIV/imunologia , Humanos , Masculino , Valor Preditivo dos Testes , RNA Viral , Kit de Reagentes para Diagnóstico , Sensibilidade e EspecificidadeRESUMO
AIMS OF THE STUDY: Fetal abnormalities found on ultrasonography lead to a variety of diagnostic procedures, including a panel of serologies to detect possible maternal STORCH infections encompassing syphilis, Toxoplasma gondii, rubella, cytomegalovirus, herpes simplex, and others (human immunodeficiency virus, hepatitis B and C, parvovirus B19, enterovirus, varicella zoster, and Leptospira interrogans). The value of indiscriminate testing for infections upon the detection of fetal ultrasound abnormalities has been questioned. The aim of this study was to review the ultrasonographic abnormalities leading to maternal STORCH panels at the obstetrics department of a university hospital. METHODS: Laboratory results of all maternal STORCH tests requested after the detection of ultrasonographic abnormalities during a 5-year period (2008-2012) were analysed. The main ultrasound findings possibly caused by congenital infection were noted, and the outcomes of confirmed maternal and fetal infections were studied. RESULTS: In our study period, 392 maternal STORCH tests were performed because of fetal ultrasound abnormalities. The most common findings leading to STORCH testing were intrauterine growth restriction (30.4%) including microcephaly (1.5%), polyhydramnios (14.8%), and intrauterine fetal demise (13.3%). Maternal STORCH infections were found in 3.4% of growth-restricted fetuses, 5.2% of polyhydramnios, and 1.9% of intrauterine fetal demise. The leading aetiologies were cytomegalovirus and parvovirus B19. All seven congenital infections displayed multiple ultrasonographic abnormalities. CONCLUSION: Ultrasonographic findings associated with fetal infection are neither sensitive nor specific. Testing for STORCH infections should take into account exposure history, clinical signs and symptoms, obstetric history, and fetal ultrasound findings, but with special attention paid to cytomegalovirus and parvovirus B19.