Management of the blood supply for a Jk(a-b-) patient with an anti-Jk3 in preparation for an urgent heart transplant: An illustrative example of a successful international cooperation.

The Kidd blood group system currently comprises two polymorphic and antithetical antigens, Jka and Jkb, and one high-prevalence antigen, Jk3. Jknull individuals do not express any of the Kidd antigens, and are at risk of developing an anti-Jk3 which is known to be dangerous and responsible for acute or delayed hemolytic transfusion reaction. We report a case of an immunized Jknull patient, who was scheduled to undergo a heart transplant. In order to organize his blood provision management, two conference calls were held between the clinical team and the different staff involved in this challenging blood supply. In light of the blood needs, the available resources, and the constraints, a mix of fresh and frozen units were used. As the supply from France was not sufficient, Finland and New Zealand provided the majority of the fresh units. We report here how this international supply chain was organized, including the difficulties that we encountered. Anticipation, communication and flexibility were essential in making this heart transplant possible without needing to transfuse incompatible units.

Diversity of Mycobacterium avium subsp. hominissuis mycobacteria causing lymphadenitis, France.

The knowledge of Mycobacterium avium complex (MAC) genotypes responsible for lymphadenitis is limited. We retrospectively characterized all of the MAC isolates made in our laboratory in the last 18 years by sequence-based identification and genotyping, and compared the clinical and laboratory data for lymphadenitis-associated and non-lymphadenitis-associated MAC isolates. Of 67 MAC-infected patients, 25 lymphadenitis patients were significantly younger than 42 non-lymphadenitis patients, while the male/female ratio did not significantly differ between the two groups. Cervical topography found in 76.5% of lymphadenitis patients was significantly more frequent in non-immunocompromised patients (p=0.04). M. avium subsp. hominissuis was identified in 53 patients (24 lymphadenitis, 29 non-lymphadenitis), M. colombiense in six patients (five non-lymphadenitis, one lymphadenitis), M. intracellulare in four non-lymphadenitis patients, and M. chimaera in three non-lymphadenitis patients, while negative controls remained negative. M. hominissuis was significantly associated with lymphadenitis (p=0.03). M. hominissuis isolates yielded 15 genotypes in 29 non-lymphadenitis isolates (molecular diversity, 0.622) versus 11 genotypes in 24 lymphadenitis isolates (molecular diversity, 0.578), demonstrating a non-significant lower diversity of M. hominissuis isolates cultured from lymphadenitis. The genotypes did not correlate with the clinical features. These data suggest the presence of several environmental reservoirs for M. hominissuis causing lymphadenitis in France.

Molecular characterisation of isoniazid- and rifampicin-resistant Mycobacterium tuberculosis in Central Tunisia.

The aim of our study was to genotypically characterise isoniazid (INH) and rifampicin (RMP) resistant Mycobacterium tuberculosis isolates in Sousse, Central Tunisia, using DNA sequencing and multispacer sequence typing (MST). The results show that 27/28 (96.4%) and 1/28 (3.6%) INH-resistant isolates yielded respectively the kat G S315T and the inh A - 15C → T mutations. Two-thirds of RMP-resistant isolates yielded the rpo B D516V mutation and one sixth yielded either H526D or S531L mutations. Genotyping analysis revealed the multiclonal spread of drug-resistant isolates in Central Tunisia. Data presented here complete the previously published map of resistant M. tuberculosis isolates and highlight their regional disparity in Tunisia.

Imported extensively drug-resistant Mycobacterium tuberculosis Beijing genotype, Marseilles, France, 2011.

Multidrug- (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) are reported to gradually spread across European countries with low TB prevalence including France. Some isolates may even accumulate traits of resistance in addition to the XDR profile, as a result of therapeutic mismanagement. We report here the first case of XDR TB in Marseilles and discuss the potential effectiveness of sulfamide treatment in such cases.

Rapid molecular genetic assay for direct identification of Bordetella from patients specimens.

Biological diagnosis of whooping cough is increasingly necessary to confirm respiratory tract infection. Indeed, clinical symptoms are variable especially in adolescents and adults who contaminate newborns too young to be vaccinated. The PCR assay was proven highly sensitive for the diagnosis of pertussis. In this study, we reported the use of a new test (GenoQuick Bordetella [GQB], Hain Life Science, Germany) which permits the fast molecular genetic identification of Bordetella pertussis and parapertussis directly from patients specimens, i.e. swabs from nose or throat. The test was performed over a three months period on 40 specimens from patients (1 month to 65 years old), most of them were young children admitted in paediatric emergency with paroxysmal cough or prolonged cough.

Genotype MRSA, a new genetic test for the rapid identification of staphylococci and detection of mecA gene.

Early detection of Staphylococcus methicillin resistance (MR) is essential. However MR determination may be difficult because it is necessary to perform investigation of heterogeneous resistance and low level of resistance and to discriminate between oxacillin resistance and borderline resistance. Several phenotypic methods are recommended but they fail to detect low level of production de PBP2a, the modified Penicillin Binding Protein responsible for MR. Detection of mecA gene, the gene encoding PBP2a, using PCR is considered to be the reference method. We evaluated Genotype MRSA, a new rapid system based on DNA multiplex amplification and further hybridisation, for the identification of staphylococci and detection of the mecA gene. The study was performed on a collection of various Staphylococcus strains (N=30) from clinical human isolates including S. aureus MR and methicillin susceptible (MS), S. epidermidis MR and MS, and other species of coagulase negative Staphylococcus (CNS) MR and MS. For all the strains, the hybridization banding pattern obtained using Genotype MRSA correlated with their expected phenotypic and genotypic characteristics. Genotype MRSA allows the identification of the mecA gene as well as S. aureus and S. epidermidis specific genes. This DNA strip technology based assay can easily be incorporated into routine diagnostics. In addition, the short testing time (less than 2 hours) optimises treatment orientation. Genotype MRSA completely complies with all requirements for a fast, safe, valid and cost-effective MR diagnosis in staphylococci.