Characteristics and clinical relevance of the quantitative touch-down major surface glycoprotein polymerase chain reaction in the diagnosis of Pneumocystis pneumonia.

The evaluation of quantitative polymerase chain reaction (PCR) characteristics can increase the accuracy of the laboratory diagnosis of Pneumocystis pneumonia (PCP). Between July 2008 and September 2009, 66 non-sequential prospective bronchoalveolar lavage (BAL) samples, obtained from five HIV-infected and 49 non HIV-infected patients were investigated, using a quantitative-touch-down-PCR to determine the number of copies of major surface glycoprotein (MSG) genes of Pneumocystis jirovecii (q-TD-MSG-PCR). PCP was confirmed by microscopic observation of Pneumocystis, radio-clinical and therapeutic data in 18/54 patients. For PCP, the cut-off was 54.3 MSG copies per ml of BAL fluid. The PCR was positive in these same 18 cases and it was the only positive assay in two cases and the earliest diagnosis test in one case of PCP relapse. The likelihood positive ratio, sensitivity and specificity of the q-TD-MSG-PCR were 44, 100% and 97.7%, respectively. The Predictive Negative Value was 100% and the Predictive Positive Value of 95.5%, the intra- and inter-assay variability values were 2.7% (at more than 30 MSG copies) and 11.7% (at 10,000 MSG copies), respectively. Quantitative PCR can help diagnose PCP even in cases of low Pneumocystis load and might decrease morbidity in association with very early specific treatments.

Outbreak of Tinea capitis and corporis in a primary school in Antananarivo, Madagascar.

INTRODUCTION: Tinea capitis is common among schoolchildren in developing countries but underreported in Madagascar. We report the occurrence of an outbreak of gray patch tinea capitis due to Microsporum langeronii in a public primary school of Antananarivo, the capital city of Madagascar. METHODOLOGY: Forty-two children were included, 27 (64%) of them presenting with tinea capitis and 32 (76%) with Tinea corporis. Patients were treated with griseofulvin 500 mg and Povidone-iodine 4% and followed up for four weeks. RESULTS: Twenty-five (93%) of the 27 children with tinea capitis presented a gray patch as the main clinical feature. All these cases were fluorescent under Wood's UV light and positive in cultures for M. langeronii. All 27 children reported a contact with infected classmates, and 19 (70%) reported to have infected brothers and sisters at home. After four weeks of treatment, all patients recovered. CONCLUSION: Appropriate treatment and improved hygienic practices reduced the occurrence of tinea in the studied school and no more cases of tinea capitis or corporis occurred after the outbreak.