ABSTRACT
Herein, we present a case of extensive lymph node involvement by disseminated Cryptococcus infection developing in the immediate period after liver transplantation and initiation of immunosuppressive therapy. The patient, a 56 year old ethnicity unknown man, received a liver transplant for acute decompensated liver. Beginning 24 days after transplantation, he was found to have Cryptococcus neoformans infection, involving the pleural fluid, blood, cerebrospinal fluid (CSF), liver, and lymph nodes. He received treatment with amphotericin B and flucytosine; he was transitioned to fluconazole, and his response was good. This relatively rapid development of disease raises the possibility of donor-derived Cryptococcus infection.
Subject(s)
Cryptococcosis , Cryptococcus , Immunosuppressive Agents/adverse effects , Liver Transplantation/adverse effects , Lymph Nodes , Humans , Lymph Nodes/microbiology , Lymph Nodes/pathology , Male , Middle AgedABSTRACT
Strongyloides stercoralis has the potential to cause accelerated autoinfection in immunocompromised hosts. Screening tests for strongyloidiasis may be falsely negative in the setting of immunosuppression. We report a case of Strongyloides hyperinfection syndrome in a patient with human T-lymphotropic virus type 1-associated T-cell leukemia early after hematopoietic stem cell transplant. The diagnosis was made by stool ova and parasite examination, despite a negative screening enzyme-linked immunosorbent assay. Because of anticipated prolonged neutropenia, an extended course of treatment was utilized.
Subject(s)
HTLV-I Infections/complications , Hematopoietic Stem Cell Transplantation/adverse effects , Human T-lymphotropic virus 1/isolation & purification , Leukemia, T-Cell/complications , Lymphoma, T-Cell/complications , Strongyloides stercoralis/isolation & purification , Strongyloidiasis/diagnosis , Transplantation Conditioning/adverse effects , Adult , Animals , Antineoplastic Agents/therapeutic use , Antiprotozoal Agents/therapeutic use , Enzyme-Linked Immunosorbent Assay , Fatal Outcome , HTLV-I Infections/therapy , HTLV-I Infections/virology , Hepatitis B, Chronic/complications , Humans , Immunocompromised Host , Leukemia, T-Cell/therapy , Leukemia, T-Cell/virology , Lymphoma, T-Cell/therapy , Lymphoma, T-Cell/virology , Male , Respiratory Distress Syndrome/complications , Respiratory Insufficiency/etiology , Strongyloidiasis/drug therapy , Strongyloidiasis/parasitology , Transplantation Conditioning/methodsABSTRACT
To confirm a diagnosis of influenza at the point of care, healthcare professionals may rely on rapid influenza diagnostic tests (RIDTs). RIDTs have low to moderate sensitivity compared with viral culture or real-time reverse-transcription polymerase chain reaction (rRT-PCR). With the resurgence of the influenza A (Flu A; subtype H1N1) pandemic 2009 (pdm09) strain in the years 2013 and 2014, we evaluated the accuracy of the United State Food and Drug Administration (FDA)-approved Sofia Influenza A+B Fluorescent Immunoassay to detect epidemic Flu A(H1N1)pdm09 in specimens from the upper-respiratory tract. During a 3-month period, we collected 40 specimens that tested positive via PCR and/or culture for Flu A of the H1N1 pdm09 subtype. Of the 40 specimens, 27 tested positive (67.5%) via Sofia assay for Flu A. Of the 13 specimens with a negative result via Sofia testing, 4 had coinfection, as detected by the GenMark Diagnostics eSensor Respiratory Viral Panel. This sensitivity of the RIDT Sofia assay to detect Flu A(H1N1) pdm09 was comparable to previously reported sensitivities ranging from 10% to 75% for older RIDTs.
Subject(s)
Immunoassay/methods , Influenza A Virus, H1N1 Subtype/metabolism , Influenza, Human/diagnosis , Nucleic Acid Amplification Techniques/methods , Virus Cultivation/methods , Adolescent , Adult , Aged , Child , Female , Humans , Infant , Male , Middle Aged , Sensitivity and SpecificityABSTRACT
Methicillin-susceptible Staphylococcus aureus (MSSA) isolates lacking mecA yet testing positive on the Xpert MRSA assay were recovered from culture for 7.7% of 248 Xpert-positive nasal samples. These "false-positive" Xpert results may be attributed to staphylococcal cassette chromosome (SCC) elements without the mecA gene. Pulsed-field gel electrophoresis (PFGE) analysis revealed a diverse population of MSSA strains.
Subject(s)
Anti-Bacterial Agents/pharmacology , Bacteriological Techniques/methods , Diagnostic Errors , Methicillin/pharmacology , Molecular Diagnostic Techniques/methods , Staphylococcal Infections/microbiology , Staphylococcus aureus/drug effects , Bacterial Proteins/genetics , DNA, Bacterial/genetics , Humans , Penicillin-Binding Proteins , Staphylococcus aureus/isolation & purificationABSTRACT
The BD Phoenix AP instrument reduced the manual setup time for the Phoenix system by 50%. For batches of 14 organisms, the average manual manipulation time per isolate was 89.5 s for BD Phoenix by the use of the AP instrument and 101 s for Vitek 2 (P<0.001).
