Relevance of eosinophilia and hyper-IgE in immigrant children.

Immigrants from undeveloped countries are a growing problem in Europe. Spain has become a frequent destination for immigrants (20% of whom are children) because of its geographic location and its historic and cultural links with Africa and Latin America. Eosinophilia is frequent in adult immigrants, travelers and expatriates coming from tropical areas. However, there are few studies that focus on the incidence and causes of tropical eosinophilia and hyper-IgE in immigrant children.We evaluated, prospectively, the prevalence and causes of eosinophilia and hyper-immunoglobulin E (IgE) in 362 immigrant children coming from Sub-Saharan Africa, Northern Africa and Latin America to Salamanca, Spain, between January 2007 and December 2011.Absolute eosinophilia and hyper-IgE were present in 22.9% and 56.8% of the analyzed children, respectively. The most frequent causes of absolute eosinophilia were filariasis (52.6%), strongyloidiasis (46.8%) and schistosomiasis (28.9%). Filariasis (41.9%), strongyloidiasis (29.6%) and schistosomiasis (22.2%) were the most frequent causes of increased levels of IgE. The area under the ROC curve showed similar values between eosinophil count and IgE levels in the diagnosis of helminthiasis (69% [95% confidence interval (CI) 63%-74%] vs 67% [95% CI 60%-72%], P = 0.24). Eosinophilia and hyper-IgE have a high value as biomarkers of helminthiasis in children coming from tropical and subtropical areas.

Diagnóstico microbiológico de las infecciones intraabdominales / Microbiological diagnosis of intra-abdominal infections

Las infecciones intraabdominales constituyen un amplio y diverso grupo de procesos intra y retroperitoneales que incluyen infecciones no complicadas, en las que el proceso infeccioso se limita al órgano o tejido de origen (apendicitis, diverticulitis, colecistitis…), y complicadas, cuando la infección se extiende y afecta al peritoneo desencadenando cuadros generales, como las peritonitis difusas, o localizados, como los abscesos intraabdominales. La mayoría se produce por perforación o inflamación de la pared intestinal, a partir de la flora gastrointestinal, y por tanto son infecciones polimicrobianas y mixtas, con predominio de bacterias anaerobias. El diagnóstico microbiológico es esencial para conocer la etiología y sobre todo la sensibilidad, en especial de las infecciones nosocomiales o comunitarias en pacientes de riesgo por el incremento de resistencia bacteriana, multirresistencia e implicación fúngica. A pesar de los avances en el diagnóstico microbiológico, en el caso de las infecciones intraabdominales sigue siendo directo, basándose en las tinciones y cultivos, y el progreso más notable es la introducción de la espectrometría de masas (MALDI-TOF) en la identificación de los patógenos implicados.De forma general se indican las recomendaciones sobre la recogida, transporte y procesamiento microbiológico de las muestras clínicas. Se comenta la etiopatogenia, la clínica y el diagnóstico microbiológico de las peritonitis primarias, secundarias y terciarias y de la peritonitis (y otras infecciones) asociada a diálisis peritoneal, de los abscesos intraabdominales (intraperitoneales, viscerales y retroperitoneales), infecciones de las vías biliares, apendicitis y diverticulitis (AU)

Intra-abdominal infections represent a large and wide group of diseases which include intra- and retro-peritoneal infections. Some of them could be defined as uncomplicated, where the infectious process is limited to the organ or tissue of origin (appendicitis, diverticulitis, cholecystitis…). Complications occur when the infection spreads to the peritoneum, triggering localised peritonitis and abdominal abscesses. Most intra-abdominal infections are due to perforation or inflammation of the intestinal wall. The microorganisms that cause these infections come from the gastrointestinal flora, and therefore produce polymicrobial infections mixed with a predominance of anaerobic bacteria. Microbiological diagnosis is essential to determine the aetiology and the susceptibility of antimicrobial agents of the microorganism involved, especially in nosocomial infections or in community infections in predisposed patients due to increasing bacterial resistance to antimicrobial agents, multidrug resistance and fungal involvement. Despite the advances in microbiological diagnosis, in the case of intra-abdominal infections it still remains direct, being based on stains and cultures, the most notable progress is the introduction of mass spectrometry (MALDI-TOF) for the rapid identification of the pathogens involved. This review will provide recommendations on the collection, transport and microbiological processing of clinical specimens. Comments on the pathogenesis, clinical and microbiological diagnosis of peritonitis primary, secondary, tertiary and peritonitis (and other infections) associated with peritoneal dialysis, intra-abdominal abscesses (intraperitoneal, retroperitoneal and visceral), biliary tract infections, appendicitis and diverticulitis are also presented (AU)

[Microbiological diagnosis of intra-abdominal infections]. / Diagnóstico microbiológico de las infecciones intraabdominales.

Intra-abdominal infections represent a large and wide group of diseases which include intra- and retro-peritoneal infections. Some of them could be defined as uncomplicated, where the infectious process is limited to the organ or tissue of origin (appendicitis, diverticulitis, cholecystitis…). Complications occur when the infection spreads to the peritoneum, triggering localised peritonitis and abdominal abscesses. Most intra-abdominal infections are due to perforation or inflammation of the intestinal wall. The microorganisms that cause these infections come from the gastrointestinal flora, and therefore produce polymicrobial infections mixed with a predominance of anaerobic bacteria. Microbiological diagnosis is essential to determine the aetiology and the susceptibility of antimicrobial agents of the microorganism involved, especially in nosocomial infections or in community infections in predisposed patients due to increasing bacterial resistance to antimicrobial agents, multidrug resistance and fungal involvement. Despite the advances in microbiological diagnosis, in the case of intra-abdominal infections it still remains direct, being based on stains and cultures, the most notable progress is the introduction of mass spectrometry (MALDI-TOF) for the rapid identification of the pathogens involved. This review will provide recommendations on the collection, transport and microbiological processing of clinical specimens. Comments on the pathogenesis, clinical and microbiological diagnosis of peritonitis primary, secondary, tertiary and peritonitis (and other infections) associated with peritoneal dialysis, intra-abdominal abscesses (intraperitoneal, retroperitoneal and visceral), biliary tract infections, appendicitis and diverticulitis are also presented.

Eficacia de la espectrometría de masas MALDI-TOF en la identificación de bacterias anaerobias / No disponible

Objetivo. La espectrometría de masas (EM) MALDI-TOF se ha convertido en un recurso de referencia para la identificación de microorganismos en los servicios de microbiología clínica. No obstante, los datos relativos a algunos grupos de microorganismos son todavía controvertidos. En el presente estudio se ha determinado la fiabilidad de la EM MALDI-TOF para la identificación de aislamientos clínicos de bacterias anaerobias, en comparación con técnicas bioquímicas convencionales, y usando como referencia en caso de discrepancias las secuenciación de ARNr 16S.Material y métodos Se analizaron 126 aislamientos clínicos de bacterias anaerobias mediante el sistema API 20A (bioMérieux, Marcy l’Étoile, Francia) y mediante EM MALDI-TOF (Autoflex II, Bruker Daltonics, Alemania), utilizando la base de datos BioTyper 2.0 (Bruker Daltonics, Alemania). Cuando se produjeron discrepancias, o la EM MALDI-TOF no fue capaz de identificar microorganismo alguno, se usó como método de identificación de referencia la secuenciación del ARNr 16S.ResultadosEl método bioquímico y la EM MALDI-TOF coincidieron, a nivel de especie, en el 60,9% de los casos, y solo a nivel de género en el 20,3%. De las 48 identificaciones discrepantes, la secuenciación respaldó la identificación por EM MALDI-TOF a nivel de especie en 32 casos (66,7%), y a nivel de género en 8 (16,7%). Dicha secuenciación apoyó la identificación bioquímica a nivel de especie solamente en 2 casos (..) (AU)

Aim of the study: MALDI-TOF mass spectrometry (MS) is becoming a major resource in the Clinical Microbiology laboratory. Results on some groups of microorganisms are still controversial. We have studied the reliability of MALDI-TOF MS for the identification of anaerobic clinical isolates was studied compared to conventional biochemical methods, with rRNA 16S sequencing being used as a reference when discrepancies arose. Material and methods: A total of 126 anaerobic bacteria clinical isolates were studied by using API20Akits (bioMérieux, Marcy l’Étoile, France) and MALDI-TOF MS (Autoflex II, Bruker Daltonics, Germany), and using the data library BioTyper 2.0 (Bruker Daltonics, Germany). When discrepancies arose, or MALDI-TOFMS was not able to identify any microorganism, rRNA 16S sequencing was used as the reference standard. Results: The biochemical method and MALDI-TOF MS agreed in identifying 60.9% of isolates at species level, and 20.3% of isolates at genus level. Among the 48 discrepancies observed, rRNA 16S sequencing (..) (AU)

[Reliability of MALDI-TOF mass spectrometry in the identification of anaerobic bacteria]. / Eficacia de la espectrometría de masas MALDI-TOF en la identificación de bacterias anaerobias.

AIM OF THE STUDY: MALDI-TOF mass spectrometry (MS) is becoming a major resource in the Clinical Microbiology laboratory. Results on some groups of microorganisms are still controversial. We have studied the reliability of MALDI-TOF MS for the identification of anaerobic clinical isolates was studied compared to conventional biochemical methods, with rRNA 16S sequencing being used as a reference when discrepancies arose. MATERIAL AND METHODS: A total of 126 anaerobic bacteria clinical isolates were studied by using API20A kits (bioMérieux, Marcy l'Étoile, France) and MALDI-TOF MS (Autoflex II, Bruker Daltonics, Germany), and using the data library BioTyper 2.0 (Bruker Daltonics, Germany). When discrepancies arose, or MALDI-TOF MS was not able to identify any microorganism, rRNA 16S sequencing was used as the reference standard. RESULTS: The biochemical method and MALDI-TOF MS agreed in identifying 60.9% of isolates at species level, and 20.3% of isolates at genus level. Among the 48 discrepancies observed, rRNA 16S sequencing supported MALDI-TOF MS identification, at species level, in 32 isolates (66.7%), and in 8 isolates (16.7%) at genus level. rRNA 16S sequencing supported biochemical identification in only two isolates (4.2%) at species level, and in 26 isolates (54.2%) at genus level. The eight isolates for which MALDI-TOF MS did not manage to identify, or the identification obtained was rejected by sequencing, belonged to species that are still not added to the BioTyper II data library. CONCLUSIONS: Results obtained in this study show that, overall, MALDI-TOF MS identification of anaerobic bacteria is more reliable than identification obtained by conventional biochemical methods (24% more correct identifications at species level). The number of major errors (incorrect identification at the genus level) is also 2.5-times lower. Moreover, all the major errors obtained by MALDI-TOF MS were due to the absence of some species in the data library. Thus, when data libraries are more complete, reliability differences between both methods will probably be even higher.