Coccidioidomycosis: an unexpected diagnosis in a patient with persistent cough.

Coccidioidomycosis is an endemic fungal infection of the new world caused by Coccidioides immitis. Because of its low incidence in the European continent, the disease is not well known in Belgium. A 34-year-old male was referred by his general physician with a chronic cough and a nodular infiltrate on chest X-ray. Because a malignant tumour was suspected, a diagnostic work-up was performed and, finally, a broad excision of the pulmonary lesion was carried out. The unsuspected diagnosis of chronic coccidioidomycosis was eventually made based on identification of the filamentous fungus in mycological culture of the lung tissue, and the presence of the typical spherules with endospores upon histopathologic examination. The patient later admitted to have been travelling to Arizona frequently in the past year for professional reasons. Coccidioides spp. should always be considered as a possible aetiologic agent of pulmonary infection in former residents and recent travellers to regions where the fungus is endemic.

Clinical predictive value of real-time PCR quantification of human cytomegalovirus DNA in amniotic fluid samples.

The aim of this study was to evaluate the diagnostic reliability and prognostic significance of the quantification of cytomegalovirus (CMV) DNA in amniotic fluid (AF). We retrospectively reviewed the results for 282 amniotic fluid samples that had been tested for CMV by a quantitative real-time PCR. We observed three cases in which no CMV genomes were detected in the AF but in which the children were nevertheless congenitally infected. Hence, we conclude that a negative result by PCR for CMV in AF cannot rule out the possibility of congenital infection. No false-positive PCR results were observed. A correlation between the CMV viral load in AF and the fetal and neonatal outcomes could not be demonstrated in our study. Instead, a correlation was found between the CMV viral load and the gestational age at the time of amniocentesis.

Infection of the thyroid gland caused by Campylobacter fetus subsp. fetus.

We report what we consider to be the first case of an abscess of the thyroid gland due to Campylobacter fetus subsp. fetus (C. fetus) in a patient suffering from hyperthyroidism. C. fetus is known as a rare and opportunistic pathogen in humans, causing a broad variety of systemic infections. Acquisition by humans is thought to occur through contact with animals or animal products and to start as a gastro-intestinal colonization. The detection of C. fetus in stool is challenging, since culture efforts are generally directed in order to fulfil growth requirements of C.jejuni, a much more common enteric pathogen. Detection of C. fetus in non-stool samples is even more challenging since routine culture doesn't imply prolonged incubation (>72h), selective media and microaerophilic conditions. It is therefore not unlikely that human infections caused by C. fetus occur more often than generally assumed.

Patient dosimetry measurements in 50 radiology departments in Belgium.

Since July 2001, the Belgian law requires a yearly quality control measurement on all medical radiological equipment. The medical physicists of the AV Controlatom are certified experts in Belgium and perform these quality control measurements, including a patient dosimetry study. In this study, patient dosimetry results since January 2002 are presented for the following examinations: chest PA and LAT, abdomen and pelvis. Since conventional film-based imaging is currently being replaced by phosphorplate technology, a comparison between both technologies is made. In some radiology departments, digital imaging is already in use. These dosimetry results are also analysed. Dose reductions of >70% can be achieved. For the chest examinations, several departments still use fluoroscopy for positioning the patient. Results show that about half of the patient dose is due to the fluoroscopy. A comparison between the dose results and the European Diagnostic Reference Levels (EDRL) is made.

[Severe diarrhea due to rotavirus infection in a Belgian hospital 1981-2002]. / Seizoensgebonden diarree door rotavirussen in België gedurende 1981-2002.

Rotavirus infections are a major cause of severe diarrhea in children younger than 2 years. In Belgium they cause many hospitalizations because of dehydration. A study of the laboratory diagnosis of rotavirus infections in 28.251 stool samples at a university teaching hospital in Belgium during a twenty-year period (1981-2002) showed a marked seasonality. The virus was most often diagnosed during the winter months: 54% of the rotavirus isolates were found in the first three months of the year, with 21% of the positive samples occurring in February. Recently, rotaviruses can be genotyped based on differences in the viral outer capsid protein VP7. Vaccines are currently being developed against the four most prevalent genotypes G1, G2, G3 and G4. During the last three epidemic seasons (1999-2002) in Belgium, G1 was the most prevalent genotype and accounted for 62% of the rotavirus isolates recovered. G2, G3 and G4 were also isolated, and other emerging types need to be carefully monitored too, since G9 (45%) was co-dominant with G1 (42%) in the 2000-2001 rotavirus season in Belgium. The future development of an efficient rotavirus vaccine will need to take the diversity of the rotavirus genotypes into account.