Interest and reliability of a polymerase chain reaction on bone-marrow samples in the diagnosis of visceral leishmaniasis in AIDS.
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Biomedical subjects
Publications and source records attributed to B Toga.
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A PCR assay amplifying a repeated sequence from the Leishmania infantum genome was compared with direct examination of bone marrow aspirate, myeloculture, and serology for the diagnosis of visceral leishmaniasis in immunocompromised patients. Of 73 patients living in an area endemic for leishmaniasis and where visceral leishmaniasis was suspected by physicians, only 10 had an indisputable diagnosis of visceral leishmaniasis. None of the diagnostic tests performed in the study achieved 100% sensitivity for diagnosing visceral leishmaniasis. PCR exhibited superior sensitivity (82%) in comparison with bone marrow aspirate examination (55%) and myeloculture (55%). Our PCR assay also showed good specificity (97%), negative predictive value (97%), and positive predictive value (82%) even when all unconfirmed PCR results were scored as false positives. Serology exhibited good sensitivity (80%) and excellent specificity (100%), negative predictive value (98%), and positive predictive value (100%) in diagnosing new cases of visceral leishmaniasis but failed to diagnose relapses. We also observed consistent negative serological results using several different immunological detection methods for 2 of the 10 patients with confirmed cases of visceral leishmaniasis. This lack of serological reactivity persisted throughout the course of their infections. These results demonstrate the importance of using PCR as an aid in the diagnosis of visceral leishmaniasis in immunocompromised patients.
Three hundred and twenty-five sera from blood donors in the south of France were examined by means of the indirect fluorescent antibody test. 18% of the sera had antibodies to Rickettsia conorii, with a significantly higher prevalence (26%) in urban and suburban areas than in semi-rural areas (13 to 16%). This supports the view that in the south of France the highest prevalence of Mediterranean Spotted Fever is suburban. 5% of the sera had antibodies to Coxiella burnetti in this area, in which Q fever is endemic.
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The authors tested 481 dog sera from the South of France for Rickettsia conorii antibodies using an Indirect Immunofluorescent Antibody Technique. Eighty percent of the sera were positive at a dilution of 1:32 and 45% at a dilution of 1:128. The authors conclude that this provides evidence of the endemic situation of Mediterranean Spotted Fever in the South of France.
The antibacterial activity of moxalactam-penicillin combinations was studied against clinical isolates of Enterococci (20 strains), group B Streptococci (10), Listeria (3) and Enterobacteriaceae (10), using a microtiter checkerboard (FIC index, FBC index). Combinations of moxalactam (MX) with penicillin G, ampicillin or amoxicillin were usually synergistic against Enterococci and Listeria but with high MX concentrations. Against group B Streptococci, penicillin-MX combinations were synergistic (40%) or additive (60%) with MX concentrations easily achievable in the CSF.
Mediterranean spotted fever is a rickettsiosis due to R. conori. The authors have tested 2 serological reactions available in this disease: Weil-Felix (WF) and indirect immunofluorescent antibody test IF. IF, tested on 184 sera is sensitive (100% of positivity 30 days after the onset of the disease) and specific if a four fold in two sera is obtained at a level upper than: 80. The WF tested on 112 sera is not specific and its sensitivity is poor.
In vitro antibacterial activity of cefamandole-fosfomycin (CFM-FOS) combination was studied on 50 methicillin-resistant staphylococci strains. Anti-bacterial effects were evaluated with a bactericidal microtiter checkerboard method. CFM-FOS was compared with other combinations known to be potent against staphylococci. Synergy was consistently recorded with CFM-FOS. Mean MBC of CFM combined with FOS was 1 microgram/ml. Vancomycin-fosfomycin combination was infrequently synergistic (20%). Rifampin-fosfomycin, cefamandole-fusidic acid, and cloxacillin-fusidic acid combinations were usually antagonistic at bactericidal levels. Rifampicin-fusidic acid combination usually yielded additive effects. CFM-FOS killed most methicillin-resistant staphylococci studied at therapeutic concentrations.
We are presenting a new case of meningitis due to the Micrococcus luteus species. This germ was isolated twice in eight days from the CSF of a 57-year old woman. The patient had a ventriculoperitoneal shunt implanted for hydrocephalus following a meningeal haemorrhage. Antibiotic therapy was efficient but the patient died of a recurrent haemorrhage.