Enteric multiplex PCR panels: A new diagnostic tool for amoebic liver abscess?

Invasive amoebiasis is a life-threatening infection requiring immediate detection and treatment. However, diagnosis is challenging because conventional methods such as light microscopy and serology are unreliable. Molecular techniques are therefore considered the new diagnostic reference standard, but most of the developed assays are research tools and not widely available. Recently commercial multiplex PCR panels have been introduced which permit the simultaneous detection of multiple enteric pathogens including Entamoeba histolytica in stool samples. Our report demonstrates for the first time that these new assays might also serve as a rapid tool to diagnose amoebic liver abscess in patients with cystic focal liver lesions.

Susceptibilidad antifúngica de Candida albicans recuperadas de pacientes con SIDA y candidiasis orofaríngea y esofágica. Experiencia con Etest / Antifungal susceptibility for Candida albicans isolated from AIDS patients with oropharyngeal and esophageal candidiasis: experience with Etest

BACKGROUND: Oropharyngeal candidiasis (OPC) and esophageal candidiasis (EPC) are frequent complications in AIDS patients. The use of Fluconazole, an effective and a low toxicity drug, has been associated to the emergency of secondary resistant strains. For this reason, in vitro antifungal susceptibility tests are necessary to predict a therapeutic failure. Etest is an easy to perform alternative test, that has showed a good agreement with the broth microdilution reference method (NCCLS, document M27-A). AIM: To measure the susceptibility of C. albicans isolates from AIDS patients complicated with OPC and EPC to Amphotericin B (AmB) and Fluconazole (Flu) using Etest. MATERIAL AND METHODS: Twenty strains from 20 AIDS patients were studied. AmB was tested in RPMI 1640 agar and Flu in Casitone agar. RESULTS: All studied strains showed minimal inhibitory concentrations (MICs) < 1 mg/mL for AmB. A highly resistant strain to Flu (> 256 mg/mL) was isolated from a patient previously treated with Flu. CONCLUSIONS: In AIDS patients with OPC and EPC, the susceptibility to Flu of the isolates should be screened, to detect resistant strains. Etest is a reliable alternative in these cases, for laboratories that cannot use the reference method.

[Polyradiculopathy caused by cytomegalovirus in AIDS patients: successful treatment with highly active antiretroviral therapy (HAART)]. / Polirradiculopatía por citomegalovirus en 2 pacientes con SIDA: tratamiento exitoso con terapia anti retroviral de alto grado de actividad (TAAGA).

We report two male patients with AIDS, aged 23 and 30 years old respectively. One was admitted due to a progressive weakness of the left leg and urinary and fecal incontinence. The other was admitted due to a progressive paraparesia without incontinence, but with a severe lumbar pain. In both patients polymerase chain reactions for cytomegalovirus in cerebrospinal fluid were positive. Treatment with ganciclovir, for 21 and 14 days respectively and highly active antiretroviral therapy was started. Both patients experienced recovery of their neurological deficits after 98 and 88 days of therapy, respectively.

Comparative studies of two-times-daily versus three-times-daily indinavir in combination with zidovudine and lamivudine.

OBJECTIVES: To compare the efficacy and safety of two-times-daily versus three-times-daily indinavir in combination with zidovudine and lamivudine. DESIGN: Two multicenter, open-label, randomized 24-week studies. METHODS: Adults HIV-1 infection, HIV-1 RNA greater than 10000 copies/ml, and no prior lamivudine or protease inhibitor therapy were eligible. In a pilot study (Study A), patients received indinavir at 800 mg every 8 h, 1000 mg every 12 h, or 1200 mg every 12 h. In a subsequent study (Study B), patients received indinavir at 800 mg every 8 h or 1200 mg every 12 h. All subjects received zidovudine (300 mg) and lamivudine (150 mg) every 12 h. An intent-to-treat analysis was used. RESULTS: In Study A, which enrolled 88 patients, neither HIV-1 RNA nor CD4 cell responses differed significantly between treatment groups at 24 weeks when corrected for multiple comparisons. Study B enrolled 433 patients, but was prematurely discontinued when interim analysis suggested greater efficacy of three-times-daily indinavir. Of the first 87 patients reaching week 24, HIV-1 RNA was less than 400 copies/ml in 91% receiving three-times-daily versus 64% receiving two-times-daily indinavir (P < 0.01). CONCLUSION: Three-times-daily indinavir appears more efficacious than two-times-daily dosing when administered with zidovudine and lamivudine. Two-times-daily indinavir dosing should only be considered in situations characterized by favorable pharmacokinetic drug-drug interactions.

[Fatal lactic acidosis in a patient with acquired immunodeficiency syndrome treated with highly active antiretroviral therapy. Report of a case]. / Acidosis láctica fatal en paciente con síndrome de inmunodeficiencia adquirido y tratamiento antiretroviral de alto grado de actividad: comunicación de un caso.

Type B lactic acidosis occurs without any evidence of cellular hypoxia and is associated with the use of drugs or toxins. We report a 36 years old woman with acquired immunodeficiency syndrome that was admitted to the hospital with a severe lactic acidosis. She had been treated with didanosine, stavudine and efavirenz for four months prior to admission. Despite the use of high bicarbonate doses and vasoactive drugs, the patient had a catastrophic evolution and died in shock and multiple organ failure, 68 hours after admission. (Rev Méd Chile 2000; 128: 1139-43).

Hantavirus pulmonary syndrome in a Chilean patient with recent travel in Bolivia.

A case of hantavirus pulmonary syndrome (HPS) was serologically confirmed in a critically ill patient in Santiago, Chile. The patient's clinical course had many similarities to that of other HPS patients in North and South America but was complicated by acute severe renal failure. The patient's history included self-reported urban and probable rural rodent exposure during travel in Bolivia. Comparison of a viral sequence from an acute-phase serum sample with other known hantaviruses showed that the hantavirus nucleic acid sequence from the patient was very similar to a virus recently isolated from rodents associated with HPS cases in Paraguay.

[Unusual presentation of urinary tract infection in 6 cases]. / Presentaciones inhabituales de infecciones del tracto urinário en 6 casos.

Urinary tract infections may have different clinical presentations that may range from asymptomatic bacteriuria to purulent collections and severe sepsis. We report 6 diabetic patients, 3 presenting with a renal carbuncle and 3 with an emphysematous pyelonephritis. All required medical and surgical treatment and had a good evolution. Two carbuncles were caused by beta- hemolytic type B streptococcus. This is the second notification of this agent as causative of renal abscesses, probably reaching the kidney through hematogenous dissemination from cutaneous foci.

[Streptococcus pneumoniae septicemia. Analysis of 40 cases]. / Septicemia por Streptococcus pneumoniae. Analisis de 40 casos.

Sepsis due to Streptococcus pneumoniae has a high mortality. We report a retrospective review of 40 episodes of S pneumonia sepsis in adult patients during a two year period in a general hospital, that represented 11.3% of all sepsis observed in such hospital. Ninety two percent of infections were community acquired and in 95%, the portal of entry was the respiratory tract. Eighty five percent of patients had at least one risk factor such as alcohol abuse, unconsciousness or chronic pulmonary disease. Nine patients had suppurative complications (empyema in 4 cases, spontaneous bacterial peritonitis in 2, septic arthritis in 2 and meningitis in 1 case) and 12 (30%) died. The potential benefit of antipneumococcal vaccine as prevention should be considered in high risk subjects.

Salmonella infections in a cancer center.

Data concerning 40 patients hospitalized in a cancer center and Salmonella infection were analyzed. Hematological malignancy was present in 24 patients (60%) and solid tumor in 14 patients (35%). Among the predisposing factors, antineoplastic chemotherapy was the most frequent (60%) followed by antacid use (47.5%), corticosteroids (37.5%), granulocytopenia below 500 neutrophils/microliters (15%), surgery (10%) and splenectomy (2.5%). Bacteremia was the most frequent clinical syndrome accounting for 42.5% of the patients. Focal infection, enteritis and carrier state accounted for the remaining 30%, 20% and 7.5% respectively. Salmonella typhimurium and S. dublin represented 65% of the isolates, with clear association between serotype dublin and bacteremia. All S. dublin isolates were resistant to chloramphenicol. Among dublin and typhimurium serotypes, 20% the isolates were resistant to the traditional antibiotics used in salmonellosis (ampicillin, chloramphenicol, cotrimoxazole). All strains were susceptible in vitro to cephalosporins. The frequency of relapse was 15% and the overall mortality (within 30 days) attributed to Salmonella infection was 15%.

Anaerobic bacteremia in a cancer center.

Seventy-five episodes of clinically relevant anaerobic bacterial bacteremia observed in cancer patients were reviewed. Gastrointestinal (22.7%), hematological (22.7%) and female genital tract (18.6%) cancers were the most common underlying malignant diseases. Among 84 strains of strict anaerobic bacteria recovered in the 75 patients, gram-negative rods were isolated in 49 patients (58.3%), gram-positive rods in 29 patients (34.5%) and gram-positive cocci in 6 patients (8%). Bacteroides spp. and Clostridium spp. were the most frequent pathogens (85.7%). Twenty-one episodes of bacteremia were polymicrobial, aerobic gram-positive cocci being the most frequently associated pathogens. When identified, the primary sites were the gastrointestinal tract (40%), the female genital tract (17.3%), skin and soft tissue (14.6%), the oropharynx (12%) and the lower respiratory tract (6.7%). The source remained unknown in 7 cases (9.3%). The overall survival (evaluated 10 days after the occurrence of bacteremia) was 82.5%. There was no difference in mortality between patients with monomicrobial and polymicrobial bacteremia. Pulmonary complications were more frequent in patients with fatal outcome in comparison to patients who survived. The mortality rate of the patients adequately treated was 10.3% compared to 41% for the patients not treated or treated inadequately (P = 0.016, chi 2).