Pierre Flori

Acquired resistance to voriconazole and itraconazole in a patient with pulmonary aspergilloma

We describe the development of resistance in an Aspergillus fumigatus strain, originally sensitive to itraconazole and voriconazole, recovered from a case of pulmonary aspergilloma treated with voriconazole. A G448S mutation on the cyp51A gene was detected by sequencing. Frequent culture and in vitro antifungal susceptibility testing is suggested for early detection of the development of multi-azole resistance in patients on long-term therapy for A. fumigatus infections.

Measure of viral load by using the abbott real-time HIV-1 assay on dried blood and plasma spot specimens collected in 2 rural dispensaries in Cameroon.

Background:This study aimed to evaluate the use of dried blood spots (DBSs) and dried plasma spots (DPSs) locally collected in 2 rural dispensaries in Cameroon for the quantification of HIV-1 RNA. Methods:Forty-one subjects were sampled and spots of whole blood and plasma were deposited onto Whatman 903 cards and dried at ambient temperature under local conditions. Two sets of DBS and DPS cards were done per patient. The rest of the liquid plasma (LP) was frozen until use. LPs were tested at the “Chantal Biya” International Reference Centre (Yaoundé, Cameroon) by the Abbott Real-Time HIV-1 assay (Abbott Molecular Diagnostics, Wiesbaden, Germany). One series of DBS and DPS was transported and tested between 2 and 6 weeks later at the Virology Laboratory of Saint-Etienne (France). The second series was routed by mail and tested after up to 3 months of storage at ambient temperature. Results:From the first series, the correlation rate between viral loads obtained from LP and DBS, and from LP and DPS, was 0.98 and 0.99, respectively; specificity of DBS and DPS results was 100%. The results obtained from the second series indicate a great stability of DBS after long-term storage. Conclusion:This study demonstrates that DBSs collected under local conditions in resource-limited settings are suitable for the differed quantification of HIV-1 RNA.

Reliability of Immunoglobulin G Antitoxoplasma Avidity Test and Effects of Treatment on Avidity Indexes of Infants and Pregnant Women

ABSTRACT The immunoglobulin G antitoxoplasma avidity test (Vidas; BioMérieux) is an immunoenzymatic test useful for excluding acute infection after the onset of pregnancy. The avidity index (AI) is the ratio of the signal in a test sample washed with urea, which disrupts low-avidity complexes, to that washed without urea. An AI of >0.3 is taken to mean that infection had occurred more than 4 months ago. The increase of the AI with time and the influence of the different treatments given to pregnant women and their newborns were evaluated. A total of 59 pregnant women (271 sera) and their 60 neonates (199 sera) were tested from 1998 to 2002. There were five groups of women based on the type and duration of treatment given. Thirteen pregnant women (group 1) did not receive any treatment, 15 (group 2), 11 (group 3), and 17 (group 4) women received treatment with spiramycin (9 MIU/day) for 0.5 to 2, 2.5 to 5, and 5.5 to 8 months, respectively, and the last 3 women (group 5) received tritherapy (pyrimethamine-sulfonamide and spiramycin alternatively) for 1.5 to 2.5 months. All of the maternal sera collected in the first 6 months had an AI of <0.30, with a mean of 0.07 (range, 0.01 to 0.21). The increase was slow (0.02/month), and there was no significant difference when comparisons were made between the treatment groups. Neonates with proven maternofetal transmission had an increasing AI, unlike those without transmission. However, long-term therapy with pyrimethamine-sulfonamide, as opposed to treatment with spiramycin alone, was found to slow down the progression of the AI. An AI of >0.2 is sufficient to exclude acute infection in pregnant women. In neonates, it is not of major use to diagnose congenital infection; however, it could be a good indicator of compliance and efficacy of treatment of infected infants.

Hair dermatophytosis diagnosed by reflectance confocal microscopy: six cases.

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Inefficacy of alcohol‐based hand rub on mites in a patient with hyperkeratotic scabies

The Wold Health Organization is strongly promoting alcohol‐based hand rubs to interrupt transmission of pathogens within the healthcare environment, and in some hospitals they are being recommended in cases of scabies. However, there are no studies that demonstrate the efficacy of such hand rubs against scabies.

Dermatophytose de la peau glabre diagnostiquée par microscopie confocale

n patient de 32 ans nous a été adressé pour une dermaose très prurigineuse, évoluant depuis environ un an. Le atient avait été traité sans bénéfice par acitrétine pour une ventuelle maladie de Darier suspectée en raison de lésions ératosiques sur le visage et le décolleté. À l’examen clinique, des macules érythématoquameuses aux bords bien limités, étendues étaient résentes sur le décolleté (Fig. 1), le cou, le visage, a zone pubienne, les fesses et la face antérieure des uisses (Fig. 2). Ces aspects étaient évocateurs d’une ermatophytose de la peau glabre.

Evaluation of a New Immunochromatography Technology Test (LDBio Diagnostics) To Detect Toxoplasma IgG and IgM: Comparison with the Routine Architect Technique

ABSTRACT A study comparing the ICT (immunochromatography technology) Toxoplasma IgG and IgM rapid diagnostic test (LDBio Diagnostics, France) with a fully automated system, Architect, was performed on samples from university hospitals of Marseille and Saint-Etienne. A total of 767 prospective sera and 235 selected sera were collected. The panels were selected to test various IgG and IgM parameters. The reference technique, Toxoplasma IgGII Western blot analysis (LDBio Diagnostics), was used to confirm the IgG results, and commercial kits Platelia Toxo IgM (Bio-Rad) and Toxo-ISAgA (bioMérieux) were used in Saint-Etienne and Marseille, respectively, as the IgM reference techniques. Sensitivity and specificity of the ICT and the Architect IgG assays were compared using a prospective panel. Sensitivity was 100% for the ICT test and 92.1% for Architect (cutoff at 1.6 IU/ml). The low-IgG-titer serum results confirmed that ICT sensitivity was superior to that of Architect. Specificity was 98.7% (ICT) and 99.8% (Architect IgG). The ICT test is also useful for detecting IgM without IgG and is both sensitive (100%) and specific (100%), as it can distinguish nonspecific IgM from specific Toxoplasma IgM. In comparison, IgM sensitivity and specificity on Architect are 96.1% and 99.6%, respectively (cutoff at 0.5 arbitrary units [AU]/ml). To conclude, this new test overcomes the limitations of automated screening techniques, which are not sensitive enough for IgG and lack specificity for IgM (rare IgM false-positive cases).

Unusual reflectance confocal microscopy findings during the examination of a perianal nevus: pinworms.

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Rapid characterization of human brain aspergillosis by confocal microscopy on a thick squash preparation

from those of other viral infections by characteristic enlarged nuclei with large basophilic inclusions, surrounded by a conspicuous halo. The recognition of the typical multinucleated epithelial cells with moulded ground-glass nuclei does not pose any diagnostic dilemma for herpes simplex virus infection. However, cells in urine with non-typical viral inclusions of these two viruses, which may be identified as decoy cells, can cause difficulty in the differentiation from cells with other viral inclusions. Thus, cytological features seen in decoy cells are not specific to BKPyV. Therefore, the use of the term ‘decoy cells’ should be extended to similar atypical cells in urine caused by viral infection other than BKPyV. Other investigations for the identification of viral infections, such as immunostaining, electron microscopy and molecular studies, are advised in conjunction with the detection of decoy cells in urine cytology.