Molecular Identification of Cutaneous Alternariosis in a Renal Transplant Patient.

Cutaneous alternariosis is a rare condition, caused by an uncommon opportunistic pathogen. The most frequently affected individuals are immunosuppressed patients, e.g., organ transplant patients on immunosuppressive therapy. Clinical manifestations range from local skin lesions to disseminated disease. We present a case report of cutaneous alternariosis in a renal transplant recipient, confirmed by histological examination and molecular means. In addition, a review of the literature was performed.

A hospital-level cost-effectiveness analysis model for toxigenic Clostridium difficile detection algorithms.

BACKGROUND: Despite thorough analyses of the analytical performance of Clostridium difficile tests and test algorithms, the financial impact at hospital level has not been well described. Such a model should take institution-specific variables into account, such as incidence, request behaviour and infection control policies. AIM: To calculate the total hospital costs of different test algorithms, accounting for days on which infected patients with toxigenic strains were not isolated and therefore posed an infectious risk for new/secondary nosocomial infections. METHODS: A mathematical algorithm was developed to gather the above parameters using data from seven Flemish hospital laboratories (Bilulu Microbiology Study Group) (number of tests, local prevalence and hospital hygiene measures). Measures of sensitivity and specificity for the evaluated tests were taken from the literature. List prices and costs of assays were provided by the manufacturer or the institutions. The calculated cost included reagent costs, personnel costs and the financial burden following due and undue isolations and antibiotic therapies. Five different test algorithms were compared. FINDINGS AND CONCLUSION: A dynamic calculation model was constructed to evaluate the cost:benefit ratio of each algorithm for a set of institution- and time-dependent inputted variables (prevalence, cost fluctuations and test performances), making it possible to choose the most advantageous algorithm for its setting. A two-step test algorithm with concomitant glutamate dehydrogenase and toxin testing, followed by a rapid molecular assay was found to be the most cost-effective algorithm. This enabled resolution of almost all cases on the day of arrival, minimizing the number of unnecessary or missing isolations.

Establishing quality control ranges for temocillin following CLSI-M23-A3 guideline.

OBJECTIVES: This study aimed to establish acceptable quality control ranges for temocillin disk diffusion tests and Etest(®) minimal inhibitory concentrations. METHODS: According to Clinical and Laboratory Standards Institute (CLSI) guideline, a Tier 2 quality control study was performed and involves seven laboratories. Each of them tested 10 replicates of two quality control strains (Escherichia coli ATCC 25922 and E. coli ATCC 35218) on three different media lots and, for disk diffusion, two disk lots. RESULTS: Proposed zone diameter quality control ranges were 12-25 mm for E. coli ATCC 25922 and 19-28 mm for E. coli ATCC 35218. Proposed Etest quality control ranges were 3-24 mg/l for E. coli ATCC 25922 and 2-6 mg/l E. coli ATCC 35218. CONCLUSION: Based on our results, we would advise the use of E. coli ATCC 35218 as QC strain for temocillin susceptibility testing and Etest because ranges obtained are narrower than with E. coli ATCC 25922 and do not overlap temocillin breakpoint.

Late onset of Strongyloides stercoralis meningitis in a retired Belgian miner.

We report a rare case of Strongyloides stercoralis meningitis in an immunocompromised patient treated for a lung carcinoma. Despite his Belgian origin, he was infected with S. stercoralis due to his former work as a miner. Although mostly prevalent in (sub)tropical areas, there are temperate regions where this nematode can occur.

Polypoidal choroidal vasculopathy, diagnosis and management.

Polypoidal Choroidal Vasculopathy (PCV) was first identified in 1985. Initially considered to be rare, PCV is currently frequently diagnosed in patients of African and Asian descent. In Caucasians, PCV counts for 10% of cases of AMD, and for up to 85% of patients with hemorrhagic or exudative retinal pigment epithelial detachment. Although the clinical presentation can be suggestive, extensive investigation with the indispensable indocyanine green angiography, is required for confirmation of PCV. Treatment has to be considered in active disease threatening the macula. Photodynamic therapy with Verteporfin is required for closure of PCV complexes. Anti-VEGF treatment reduces associated macular edema.

Intravitreal bevacizumab for myopic choroidal neovascularization: 1-year and 2-year results.

METHODS: A retrospective interventional case series of 29 patients with mCNV was conducted. Charts were reviewed of all patients who received IVB for active mCNV and who had a follow-up of at least 12 months after the first injection. Patients were divided into three groups based on length of followup: patients in Group 1 had a follow-up of > or =12 months, in Group 2 of > or =18 months and in Group 3 of > or =24 months. Changes in visual acuity (VA) and CMT were analyzed, as were safety considerations such as intraocular inflammation and endophthalmitis. RESULTS: Twenty women and nine men with a mean age of 62.2 years (range 31-85) were included. No peri- or post-injection ocular or systemic side effects were noted in either group. Mean logMAR best-corrected visual acuity (BCVA) at baseline for all patients (n=29) was 0.71. Mean visual acuity for all 29 patients had improved significantly at 3 months (p = 0.0035) and one year (p = 0.0042) after baseline. Although visual acuity gains were maintained at 18 and 24 months, these were not statistically significant (p = 0.11 and p = 0.19, respectively). The mean CMT decreased significantly at one year after baseline. CONCLUSION: This study confirms that administration of intravitreal bevacizumab is a safe and effective treatment modality for mCNV. Statistically significant visual improvement can be obtained.

Corneal complications of intraoperative Mitomycin C in glaucoma surgery.

PURPOSE: To report corneal toxicity of Mitomycin C application during filtering glaucoma surgery in two patients. CASE REPORTS: An elderly woman, 81 years of age, developed diffuse corneal epitheliopathy with subepithelial stromal oedema seven weeks after a trabeculectomy with Mitomycin C application. Another patient, a 76-year-old man, first developed a central epithelium defect and stromal oedema in the second postoperative week after a similar procedure. Later the corneal stroma melted, what resulted in perforation in the second postoperative month. RESULTS: Intraoperative Mitomycin C application during trabeculectomy induced serious corneal complications several weeks after the surgery. CONCLUSIONS: Although infrequent, serious corneal complications may arise following the intraoperative use of Mitomycin C in filtering surgery for glaucoma. The possible contributing factors to the development of the corneal toxicity will be discussed.

Glaucoma medication during pregnancy and nursing.

Risks that glaucoma medications pose to the fetus and neonate must be balanced against the risk of vision loss in the mother. There is no high level evidence for harmful effects on the fetus and neonate of medications used to treat glaucoma. All topical and systemic glaucoma medication should be avoided during the first trimester of pregnancy. Systemic carbonic anhydrase inhibitors, topical prostaglandin analogues and antimetabolites during surgery should be avoided absolutely. Some topical medications are deemed compatible with lactation by the American Academy of Pediatrics, however, caution should still be practiced.

Recurrence of blackwater fever: triggering of relapses by different antimalarials.

Five cases of blackwater fever (BWF) are described, all of whom had a history of recent quinine therapy. In two cases a second haemolytic crisis was induced by halofantrine, in one case also a third. Increasing frequency of this syndrome with its dramatic clinical presentation is to be expected as imported P. falciparum infection, parasite resistance to chloroquine and the use of quinine and other related antimalarials become more frequent.

Is the apparent outbreak of hepatitis A in Belgian hemophiliacs due to a loss of previous passive immunity?

Several reports describing outbreaks of hepatitis A in hemophilia A patients transfused with solvent/detergent-treated factor VIII concentrates have raised concern about possible transmission of hepatitis A by these concentrates. We recently witnessed such an outbreak of hepatitis A in 6 hemophilia A patients; review of the clinical data did not disclose any increased risk factor for community-acquired hepatitis A. A case-control study comparing the prevalence of anti-hepatitis A IgG antibodies in hemophiliacs and age-matched controls showed a lower seroprevalence in hemophiliacs. This might be due to passive protection acquired through transfusion of the previously used immunoglobulin-containing cryoprecipitate. The outbreak of hepatitis A could be explained as a catch-up phenomenon linked to the loss of passive protection with the use of purer factor VIII concentrates.

[Dental occlusion and orthodontics in children]. / Occlusion et orthodontie chez les enfants.

Patients with malocclusions frequently function normally and retain their dentition without problems. Strong correlations between occlusal factors and mandibular dysfunction are still controversial. However, signs and symptoms of craniomandibular disorders appear to be prevalent in children as well as in adults. Almost no symptoms of dysfunction have been seen in children aged 3-6 year. Work in the developmental aspects of these disorders has to be done. Orthodontic therapy seems unable to prevent CMD or resolve these problems. Generally, it does not cause or predispose people to develop CMD. If painful symptoms arise during treatment, it may be necessary to modify active treatment. Occlusal equilibration must be carried out with very much caution.