Compassionate use of amphotericin B lipid complex (Abelcet) in life-threatening fungal infections: report of 30 courses.

OBJECTIVE: To report a single-center experience of compassionate use of amphotericin B lipid complex (ABLC) in patients with proven or suspected fungal infection who were or would have been unable to tolerate conventional amphotericin B. METHODS: Twenty-eight patients receiving 30 courses of ABLC for 22 proven invasive mycosis episodes (11 aspergillosis, seven candidosis, four miscellaneous) and eight suspected episodes are described. Seven patients were given ABLC first-line therapy because of conditions precluding the use of amphotericin B deoxycholate (Am B).

Detection of rifampicin and isoniazid resistances of Mycobacterium tuberculosis strains by particle counting immunoassay (PACIA).

The particle agglutinated counting immunoassay (PACIA) was used to determine the susceptibility of Mycobacterium tuberculosis strains to the two major antimycobacterial drugs, isoniazid and rifampicin. On evaluating 12 M. tuberculosis strains with different sensitivities, our results were in complete accordance with those obtained using the well-known BACTEC system.

A fatal case of Mycoplasma hominis meningoencephalitis in a full-term newborn.

We report the case of a 20-day-old full-term baby, born to a mother who had had an uncomplicated pregnancy and delivery, who died 13 days after the onset of meningitis. Mycoplasma hominis was the sole agent repeatedly recovered from cerebrospinal fluid and from postmortem brain tissue.

[Infectious endocarditis: old myths and current concepts].

Updating of several main themes concerning the infectious endocarditis with the aim to denounce various old myths and to precise different actual concepts. The authors consider principally the echocardiographic revolution and the new diagnostic criteria, the bacteriologic pitfalls and the preventive strategies.

[Cardiovascular diseases: toward an optimal use of clinical biological laboratories].

Cardiovascular diseases are a frequent cause of morbidity and mortality in our country. The early detection of risk factors by laboratory tests and the subsequent preventive treatment may have a substantial beneficial effect on public health. However, since these tests are performed on large populations, they must be chosen with caution, in order to optimise their cost/ effectiveness ratio.

Evaluation of the Gen-Probe amplified Mycobacterium tuberculosis direct test for the routine diagnosis of pulmonary tuberculosis.

A total of 624 respiratory specimens from 543 patients (418 Belgian, 110 Rwandan, and 15 Colombian patients) were tested for the presence of Mycobacterium tuberculosis by the Mycobacterium Tuberculosis Direct Test (MTDT, Gen-Probe). Compared to culture, the MTDT on 497 samples of sputum or broncho-alveolar lavage from Belgium had a sensitivity, specificity and positive and negative predictive value of 86.4%, 96.

[Pharyngo-tonsillitis: Current clinical, bacteriological, serological and therapeutic aspects].

The authors present the pharyngo-tonsillitis in four fields: clinical, bacteriology, serology and treatment. They insist on the danger of the beta-hemolytic Strep A, the failures of the ASLO detection and stress the execution of the rapid antigenic test at the office. They suggest the limitation of the administration of antibiotics and the prescription of a penicillin which is much better than macrolides or cephalosporins of second or third generation.

Evaluation of Rapid ATB Staph for 5-hour antimicrobial susceptibility testing of Staphylococcus aureus. Groupement pour le Dépistage, L'Etude et la Prévention des Infections Hospitalières-Groep ter Opsporing, Studie en Preventie van Infecties in de Ziekenhuizen.

The accuracy of Rapid ATB Staph (bioMérieux, La Balme-Les Grottes, France) for detection of oxacillin resistance and for detection susceptibility to 11 other antimicrobial agents in 553 and 519 Staphylococcus aureus isolates, respectively, was evaluated by comparing results with those produced by oxacillin agar screen and agar dilution methods, respectively. Further characterization of isolates with discrepant results for oxacillin testing was done by PCR detection of the nuc and mecA genes. By oxacillin agar screening, there were 307 oxacillin-resistant and 246 oxacillin-susceptible isolates.

Candida albicans septic thrombosis of the right atrium is associated with a central venous catheter.

Right atrial thrombus formation is a rare complication of central venous catheterization in adults. Infection of this thrombus is exceptional. A case of a right atrial thrombus associated with Candida albicans infection is described.

Rapid identification of Mycobacterium xenopi from bacterial colonies or "Bactec" culture by the polymerase chain reaction and a luminescent sandwich hybridization assay.

Oligonucleotide primers were used in the polymerase chain reaction (PCR) to amplify a specific 584-bp DNA fragment, located in the 16S RNA gene of Mycobacterium xenopi. This set of primers, X222 and X224, was able to discriminate between the pathogen and other mycobacterial species as well as non-mycobacterial strains; it detected down to 3 fg of M. xenopi DNA, i.

Rapid simple and nested polymerase chain reaction for the diagnosis of Pneumocystis carinii pneumonia.

We have developed a rapid and easy extraction procedure for polymerase chain reaction (PCR) protocols. Using this simplified step, we evaluated the sensitivity and the specificity of a simple PCR using the primers of Wakefield et al, and of a nested PCR, using new internal primers selected by us, in a total of 89 bronochoalveolar lavage (BAL) fluid samples from 43 immunosuppressed patients. In 13 patients, Pneumocystis carinii pneumonia (PCP) was diagnosed by immunofluorescent antibody (IFA) staining performed on BAL cells cytospun on microscope slides.

Evaluation of gas-liquid chromatography (GLC) for rapid detection of Clostridium difficile in fecal specimens.

Clostridium difficile intestinal infection is a major nosocomial hazard in patients receiving antimicrobial therapy. Rationale for rapid diagnosis include lifesaving antimicrobial therapy in patients with severe colitis and early isolation measures for transmission control. We have therefore analysed the sensitivity, specificity and predictive value of GLC identification of isocaproic acid in diarrheic stools from adult hospitalized patients in comparison with selective fecal culture on Cycloserine Cefoxitin Fructose Agar.

Rapid biochemical screening for Salmonella, Shigella, Yersinia, and Aeromonas isolates from stool specimens.

Four screens for the rapid (4 to 6 h) biochemical detection of pathogens from enteric isolation media are described. The Salmonella screen consisted of Kligler iron agar (KIA), motility-indole-urea-tryptophan-deamination semisolid medium (MIU-TDA), and the o-nitrophenyl-beta-D-galactopyranoside (ONPG) test; the Shigella screen consisted of KIA, MIU-TDA, the ONPG test, and the lysine decarboxylation-indole test; the Yersinia screen consisted of a rhamnose broth; the Aeromonas screen consisted of a xylose agar plate. When tested on 2,102 fresh isolates and 71 stock strains, the screens correctly detected 212 enteric pathogens (sensitivity, 100%), with a specificity of 98.

Usefulness of gram staining of blood collected from total parenteral nutrition catheter for rapid diagnosis of catheter-related sepsis.

The accuracy of Gram staining of blood drawn from catheters used to administer total parenteral nutrition was compared with paired quantitative blood cultures for the diagnosis of catheter-related sepsis. Gram staining was positive in 11 of 18 episodes of catheter-related sepsis documented by quantitative culture (sensitivity, 61%) but in none of the 5 episodes of fever unrelated to catheter infection. Thus, this procedure enabled the rapid presumptive diagnosis and guidance of antimicrobial therapy for total parenteral nutrition catheter sepsis, with a positive predictive value of 100% and a negative predictive value of 42%.

Prevotella bivia as an unusual cause of endocarditis.

A case of monomicrobial endocarditis due to Prevotella bivia in a 60-year-old man without previous cardiac lesions is reported. The extremely indolent course with multiple systemic emboli as the only clinical manifestation occurring at least seven months before diagnosis and the persistently negative blood cultures were remarkable features of this case. The incidence, clinical characteristics, treatment and outcome of published cases of infective endocarditis due to anaerobic bacteria are briefly reviewed.

Human milk banking: influence of storage processes and of bacterial contamination on some milk constituents.

This paper reviews the effects of storage and bacterial content contaminating human milk on some milk constituents. Moreover, it reviews the inhibitory effect of refrigeration and freezing on bacterial growth. Our results suggest that the type and length of storage have an effect on some milk constituents, that this effect is modulated by the bacterial contamination of the milk and that refrigeration has a significant inhibitory effect on bacterial growth which is not observed after freezing.

Nosocomial colonization and infection with multiresistant Acinetobacter baumannii: outbreak delineation using DNA macrorestriction analysis and PCR-fingerprinting.

The prevalence of nosocomial acinetobacter colonization and infection in a university hospital was reviewed and multiresistant Acinetobacter baumannii infections in an intensive care unit (ICU) were investigated using epidemiological typing and a case-control study. Acinetobacter colonization at various body sites was found in 3.2 to 10.

Detection of mycobacterial antigens present in short-term culture media using particle counting immunoassay.

Particle counting immunoassay (PACIA) was compared with the BACTEC system for detecting mycobacterial growth after short-term culture and was used to identify M. tuberculosis. The latex particles were coated with polyclonal anti-BCG or with specific 2A1-2 monoclonal antibodies.

[Prevention of bacterial endocarditis: current recommendations].

International consensus has been reached on the guidelines of prevention programmes of bacterial endocarditis in patients bearing a valvulopathy and submitted to various diagnostic or surgical procedures. They are presently characterised by: 1) targeting of indications: less procedures have to be covered by an appropriate antibiotic and owing to progresses made in ultrasonography, less patients with mitral valve prolapse have to be protected; 2) simplification of the administration of the antibiotics: priority is given to the oral route and two doses are sufficient, one before, and one after the procedure; 3) the dropping of penicillin V and the questioning of erythromycin: amoxicillin becomes the first-choice drug, more often administered orally than parenterally; in case of allergy to beta-lactams, clindamycin takes precedence over macrolides. Those new strategies for antibiotic prophylaxis should reveal themselves better followed, more performant and less expensive.

Mediastinitis caused by Aspergillus fumigatus with ruptured aortic pseudoaneurysm in a heart transplant recipient: case study.

The case of a heart transplant recipient with a ruptured aortic pseudoaneurysm caused by an Aspergillus fumigatus mediastinitis is reported. Contamination of surgical fields occurring by air seeding during surgery appears to be the most probable source of infection. Subtle infectious signs of the wound and subacute course are remarkable features of this case.

Vascular graft infection caused by Aspergillus species: case report and review of the literature.

We report an unusual case of vascular graft infection caused by Aspergillus fumigatus that began with a false aneurysm, major arterial emboli, and septic arthritis. Successful treatment included resection of the infected graft, restoration of circulation by extraanatomic bypass, and administration of amphotericin B and itraconazole, a new antifungal agent. Graft infection in the case reported herein most likely occurred during surgery and took place during an insidious outbreak of postoperative infection.

[Fulminant erysipelas].

An apparent resurgence of invasive and life-threatening group A streptococcal infections in young and previously healthy hosts is reported in several countries. We report a case of fatal necrotizing fasciitis and review the spectrum of these clinical syndromes, including the invasive soft tissue infections. This changing pattern of infection could be explained by an increased incidence of some serotypes of group A Streptococcus carrying specific virulence factors, such as pyrogenic exotoxins.