Usefulness of (1,3) ß-D-glucan detection in bronchoalveolar lavage samples in Pneumocystis pneumonia and Pneumocystis pulmonary colonization.

OBJECTIVE OF THE STUDY: Recent data demonstrate the usefulness of (1,3) ß-d-glucan (BG) detection in serum samples to distinguish patients developing Pneumocystis pneumonia and patients who are colonized by the fungus. In contrast, data of BG detection in bronchoalveolar lavage (BAL) samples from these patient populations are still rare. PATIENTS: In this context, we determined BG levels in BAL samples from 11 Pneumocystis pneumonia (PCP) patients, 10 colonized patients, and 24 Pneumocystis-uninfected patients. MATERIALS AND METHODS: BG levels were determined on each BAL sample using the Fungitell(®) kit (Associates of Cape Cod, Inc., Cape Cod, MA, USA) according to the manufacturer's instructions applied to serum sample examination. RESULTS: The BG levels in BAL samples from the PCP patient group (mean value 20 588 pg/mL) were significantly higher than those in the colonized patient group (mean value 105 pg/mL) (P=0.0001, Mann-Whitney test) and than those in the Pneumocystis-uninfected patient group (mean value 74 pg/mL) (P<0.0001, Mann-Whitney test). The BG levels in BAL samples from the colonized patient group did not differ significantly from those in the Pneumocystis-uninfected patients group (P=0.21). CONCLUSION: The results suggest that measurements of BAL BG levels may facilitate the differential diagnosis of PCP and pulmonary colonization with Pneumocystis.

Cross-sectional serological survey of human fascioliasis in haiti.

Fasciola hepatica, the aetiological agent of fascioliasis in the Caribbean region, occurs throughout the major islands of the Greater Antilles and in localised zones on two islands (Martinique and Saint Lucia) of the Lesser Antilles. However, apart from Puerto Rico, information regarding human fascioliasis in islands of the Caribbean is out of date or unavailable, or even nonexistent as in Haiti. The authors conducted a retrospective, cross-sectional serological survey in Port-au-Prince using a Western blotting test (LDBIO Diagnostics) on human fascioliasis in Haiti. A total of 216 serum samples obtained from apparently healthy adults were tested. The frequency of antibodies in serum samples of the study population was 6.5% (14/216). The immunodominant bands recognised in Western blots were 27-28 kDa (100%), 42 kDa (64%), 60 kDa, and 8-9 kDa (28%). This is the first survey to reveal a relatively low proportion of asymptomatic F. hepatica-infected humans in Haiti.

Childhood cryptosporidiosis: a case report.

Cryptosporidium has emerged as an important cause of diarrheal illness worldwide, especially amongst young children and patients with infectious or iatrogenic immune deficiencies. The authors describe a case of mild cryptosporidiosis in a well-nourished, immunocompetent, one-year-old child. Rapid clinical and parasitological improvement was observed after a 3-day course of nitazoxanide.

Seroprevalence of human Taenia solium cysticercosis in Haiti.

Human Taenia solium cysticercosis is common in developing countries due to poor sanitary conditions and economics based on breeding livestock, especially pigs, with low hygiene standards. Neurocysticercosis, caused by migration of the larvae of the tapeworm in the nervous system, is the leading cause of acquired epilepsy in adults in Central and South America, sub-Saharan Africa, and East and South Asia. This makes neurocysticercosis a large public health problem in developing countries. Two clinical cases of neurocysticercosis have been observed recently in Haiti. In order to evaluate the prevalence of human T. solium cysticercosis in this country, in 2007 we conducted a cross-sectional serological retrospective survey using a Western blotting test (LDBIO Diagnostics) in Port-au-Prince, where sewage systems are rare and swine usually roam freely throughout the area. A total of 216 serum samples, obtained from healthy adults seen in the work setting of periodical medical visits, were tested after storage at - 20 degrees C. The frequency of antibodies in serum samples of the study population was 2.8% (6/216). The immunodominant bands recognized in Western blots were 23-26 kDa (100%), 39 kDa (67%), 45 kDa and 6-8 kDa (50%), 50-55 kDa (33%). These results confirm for the first time an endemic situation of cysticercosis in humans in Haiti, with similar prevalence as that reported in other Latin American and African countries. It reinforces the urgent need for control and prevention measures to be taken by local public health services.

Nosocomial Pneumocystis jirovecii infections.

Airborne transmission of Pneumocystis sp. from host to host has been demonstrated in rodent models and several observations suggest that interindividual transmission occurs in humans. Moreover, it is accepted that the Pneumocystis organisms infecting each mammalian species are host specific and that the hypothesis of an animal reservoir for Pneumocystis jirovecii (P. jirovecii), the human-specific Pneumocystis species, can be excluded. An exosaprophytic form of the fungus cannot be strictly ruled out. However, these data point toward the potential for the specific host to serve as its own reservoir and for Pneumocystis infection in humans as an anthroponosis with humans as a reservoir for P. jirovecii. This review highlights the main data on host-to-host transmission of Pneumocystis in rodent models and in humans by the airborne route and provides a rationale for considering the occurrence of nosocomial infections and measures for their prevention

[Bilharziasis caused by Schistosoma mansoni in a traveler returning from Guinea: failure of serodiagnostic testing]. / Bilharziose à Schistosoma mansoniau retour de Guinée: défaillance du sérodiagnostic.

The purpose of this report is to describe a case of febrile hypereosinophilic syndrome in a traveler three weeks after returning from a sightseeing trip to Guinea. Laboratory testing demonstrated an inflammatory response syndrome and hepatic cytolysis. Parasite serology led to suspicion of toxocariasis that was treated using albendazole. Follow-up tests at two months showed the presence of Schistosoma mansoni eggs in stools despite negative standard serodiagnostic testing (hemagglutination). Secondarily Western blot testing of serum samples at one, two and 14 months after returning from Guinea continued to show only protein bands specific to toxocariasis with no bands specific to bilhariziasis. These findings provide further evidence of the limitations of serological testing for detection of bilharziasis in travelers and the difficulty of diagnosis. Guinea is a high-risk tourist destination. Intestinal and urinary bilharziasis are endemic over three-fourths of country. Travelers planning even short stays in areas where bilharziasis is endemic should be advised on preventive measures.

Pneumocystis jirovecii genotypes and granulomatous pneumocystosis.

This study describes the initial data concerning molecular typing of Pneumocystis jirovecii in a patient having developed granulomatous Pneumocystis pneumonia (PCP). Three types, B(1)a(3), B(1)a(4), B(1)b(2), were identified. All three had been described in reports concerning patients with common diffuse alveolar PCP. The present data show that identical microorganisms can be involved in both granulomatous PCP and diffuse alveolar PCP and that the pathogenesis of the granulomatous response to P. jirovecii may more likely be related to host factors.

[Enteric parasites and AIDS in Haiti: utility of detection and treatment of intestinal parasites in family members]. / Parasites intestinaux et sida en Haïti: faut-il déparasiter l'entourage familial?

Intestinal parasites and human immunodeficiency virus (HIV) are major health problems in Haiti. Both entities are known to interact strongly with cell-mediated immunity. The purpose of this study undertaken in Port-au-Prince, Haiti was to evaluate the risk of enteric parasite transmission between HIV-infected patients and family members. Routine examination of stool specimens for parasites was conducted in 90 HIV-infected undergoing treatment for intestinal disorders due mainly to Cryptosporidium sp. (62%) and 123 healthy family member volunteers. A stool sample preserved in 10% formalin solution was examined to detect protozoa (MIF, modified Ziehl-Neelsen stain, Uvibio fluorescence technique, Weber stain) and helminth ova (Bailenger technique). In addition to Cryptosporidium sp., 14 parasitic species were identified: 6 Rhizopoda, 3 Flagellata (including Giardia duodenalis), 1 Coccidia (Cyclospora cayetanensis), 3 Nematoda (mainly Ascaris lumbricoides) and 1 Cestoda (Hymenolepis nana). This is the first time that 5 protozoa, i.e., Blastocystis hominis, Entamoeba hartmanni, E. polecki, Chilomastix mesnili, and Enteromonas hominis, have been reported in Haiti. As expected, enteric parasites were less common in HIV-infected subjects undergoing medical treatment (11.1%) than in uninfected family members (41.5%) (p = 0.0000). Multiple intestinal parasitism (infection by 2 to 4 parasites) was observed in 19.5% of family members. The findings of this study indicate that detecting and treating intestinal parasites in subjects living in close contact with HIV-infected patients as well as informing family members of the importance of personal hygiene in Haiti are highly recommended measures to preserve the health of AIDS patients.

Development of an RT-PCR on the heat shock protein 70 gene for viability detection of Pneumocystis carinii f. sp. hominis in patients with pneumocystosis and in air sample.

To test the viability of Pneumocystis carinii f. sp. hominis, an RT-PCR assay that employs specific primers from the Heat Shock Protein 70 gene was developed. Using this method, the viability of P.c. hominis in bronchoalveolar lavage fluids from patients developing PCP and in the environment of PCP patients was established.