ABSTRACT
Chronic granulomatous disease (CGD) is characterized by frequent infections, most of which are curable. Granulibacter bethesdensis is an emerging pathogen in patients with CGD that causes fever and necrotizing lymphadenitis. However, unlike typical CGD organisms, this organism can cause relapse after clinical quiescence. To better define whether infections were newly acquired or recrudesced, we use comparative bacterial genomic hybridization to characterize 11 isolates obtained from 5 patients with CGD from North and Central America. Genomic typing showed that 3 patients had recurrent infection months to years after apparent clinical cure. Two patients were infected with the same strain as previously isolated, and 1 was infected with a genetically distinct strain. This organism is multidrug resistant, and therapy required surgery and combination antimicrobial drugs, including long-term ceftriaxone. G. bethesdensis causes necrotizing lymphadenitis in CGD, which may recur or relapse.
Subject(s)
Acetobacteraceae , Communicable Diseases, Emerging/complications , Communicable Diseases, Emerging/microbiology , Gram-Negative Bacterial Infections/complications , Gram-Negative Bacterial Infections/microbiology , Granulomatous Disease, Chronic/complications , Granulomatous Disease, Chronic/microbiology , Acetobacteraceae/classification , Acetobacteraceae/drug effects , Acetobacteraceae/genetics , Acetobacteraceae/isolation & purification , Adolescent , Adult , Base Sequence , Communicable Diseases, Emerging/diagnosis , Communicable Diseases, Emerging/drug therapy , DNA Primers/genetics , Genome, Bacterial , Genomic Instability , Gram-Negative Bacterial Infections/diagnosis , Gram-Negative Bacterial Infections/drug therapy , Humans , Male , RNA, Bacterial/genetics , RNA, Ribosomal, 16S/genetics , RecurrenceABSTRACT
Rapid antigen testing using immunochromatographic devices has become a diagnostic mainstay for detection of influenza virus and respiratory syncytial virus, the two major viruses infecting the respiratory tract. Recent studies have indicated that poor performance in the detection of the novel influenza A virus 2009 H1N1 should preclude their use. A survey of influenza diagnostic methods available on ClinMicroNet and Division C, the two ASM list servers, revealed that, despite this reported poor performance, a majority of the laboratories surveyed intend to continue to offer this testing during the current influenza season. Our two experts have been asked to consider the following question: what is the role of rapid immunochromatographic antigen testing in the laboratory diagnosis of influenza A virus infection during the current 2009 H1N1 pandemic?
