Archive for January, 2010

Clinical Value of Treponema pallidum Real-Time PCR for Diagnosis of Syphilis

Journal of Clinical Microbiology  1 Feb 2010 V.48 N.2 p.497-502

R. Heymans,1, J. J. van der Helm,3,4, H. J. C. de Vries,2,3,6 H. S. A. Fennema,2,4 R. A. Coutinho,6,7 and S. M. Bruisten1,5*

Public Health Laboratory,1 STI Outpatient Clinic,3 Department of Research, Cluster of Infectious Diseases, Amsterdam Public Health Service, Amsterdam, The Netherlands,4 Department of Dermatology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands,2 Department of Experimental Virology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands,5 Department of Internal Medicine, CINIMA, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands,6 National Institute for Public Health and Environment (RIVM), Bilthoven, The Netherlands7

The diagnosis of syphilis can be complicated when it is based on diverse clinical manifestations, dark-field microscopy, and serology. In the present study, therefore, we examined the additional clinical value of a Treponema pallidum real-time TaqMan PCR for the detection of primary and secondary syphilis. The additional value of the T. pallidum real-time PCR for the diagnosis of primary syphilis was evaluated by the use of three different algorithms: (i) a head-to-head comparison of the dark-field microscopy result and the T. pallidum real-time PCR result, (ii) comparison of the clinical diagnosis made in a sexually transmitted infection clinic (STI) (including by dark-field microscopy) and the T. pallidum real-time PCR result, and (iii) comparison of the clinical diagnosis made in a general practitioner’s office (without dark-field microscopy) and the T. pallidum real-time PCR result. A fourth algorithm was used to determine the performance of the T. pallidum real-time PCR regarding the detection of secondary syphilis. From December 2006 to April 2008, 716 patients with suspected cases of primary syphilis and 133 patients with suspected cases of secondary syphilis were included in the study. A kappa value of 0.601 was found for the agreement between dark-field microscopy and the T. pallidum real-time PCR. Good agreement was found between the T. pallidum real-time PCR and both the diagnosis of the general practitioner (kappa = 0.745) and the diagnosis of the STI clinic (kappa = 0.769). The sensitivity with respect to the STI clinic diagnosis was 72.8%, the specificity was 95.5%, the positive predictive value was 89.2%, and the negative predictive value was 95.0%. The T. pallidum real-time PCR is a fast, efficient, and reliable test for the diagnosis of primary syphilis in an STI outpatient clinic and a general practitioner setting, but it has no added diagnostic value for the diagnosis of secondary syphilis.

abstract

http://jcm.asm.org/cgi/content/abstract/48/2/497

January 30, 2010 at 7:59 pm Leave a comment

Evaluation of Diagnostic Tests for Clostridium difficile Infection

Journal of Clinical Microbiology  1 Feb 2010 V.48 N.2 p.606-608

Jonathan Swindells, Nigel Brenwald, Nathan Reading, and Beryl Oppenheim*

Department of Medical Microbiology, City Hospital, Birmingham, United Kingdom

We evaluated toxigenic Clostridium difficile detection by a lateral flow assay for antigen and toxin, an enzyme immunoassay, and two commercial PCR methods. Compared to the cell cytotoxicity neutralization assay and toxigenic culture, both toxin detection methods lacked sensitivity. PCR following combined antigen and toxin detection provided the most useful diagnostic information.

abstract

http://jcm.asm.org/cgi/content/abstract/48/2/606

January 30, 2010 at 7:56 pm Leave a comment

Outbreak of Skin Infections in College Football Team Members Due to an Unusual Strain of Community-Acquired Methicillin-Susceptible Staphylococcus aureus

Journal of Clinical Microbiology  1 Feb 2010 V.48 N.2 p.609-611

Jose-Mario Fontanilla,1* Kathryn B. Kirkland,1 Elizabeth A. Talbot,1 Kenton E. Powell,1 Joseph D. Schwartzman,1 Richard V. Goering,2 and Jeffrey Parsonnet1

Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire,1 Creighton University Medical Center, Omaha, Nebraska2

We report a skin and soft-tissue infection outbreak among football team members due to a USA300 methicillin-susceptible Staphylococcus aureus (MRSA) strain with genes coding for Panton-Valentine leukocidin and the arginine catabolic mobile element. We postulate that the strain is a community-associated USA300 MRSA strain that lost methicillin resistance but retained important virulence factors.

abstract

http://jcm.asm.org/cgi/content/abstract/48/2/609

January 30, 2010 at 7:53 pm Leave a comment

Evaluation of Risk Factors for Coinfection or Cocolonization with Vancomycin-Resistant Enterococcus and Methicillin-Resistant Staphylococcus aureus

Journal of Clinical Microbiology  1 Feb 2010 V.48 N.2 p.628-630

Katherine Reyes,1 Rushdah Malik,3 Carol Moore,1 Susan Donabedian,1 Mary Perri,1 Laura Johnson,1 and Marcus Zervos1,2*

Division of Infectious Diseases, Henry Ford Health System, Detroit, Michigan,1 Wayne State University, School of Medicine, Detroit, Michigan,2 St. Joseph’s Mercy Oakland Hospital, Pontiac, Michigan3

We retrospectively evaluated 410 patients with coinfection or cocolonization due to vancomycin-resistant (VR) enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA). The prevalence rate was 19.8%. Risk factors included isolation of VR Enterococcus faecalis and use of linezolid or clindamycin. Inc18-like vanA plasmids were found in 7% of VR E. faecalis isolates and none of the VR E. faecium isolates.

abstract

http://jcm.asm.org/cgi/content/abstract/48/2/628

January 30, 2010 at 7:52 pm Leave a comment

Corynebacterium accolens-Associated Pelvic Osteomyelitis

Journal of Clinical Microbiology  1 Feb 2010 V.48 N.2 p.654-655

CASE REPORT

Jenny S. J. Wong,1 Lois M. Seaward,1 Carmen P. Ho,1 Trevor P. Anderson,1 Esther O. C. Lau,1 Matthew R. Amodeo,1,2 Sarah C. L. Metcalf,2 Alan D. Pithie,2 and David R. Murdoch1,3*

Department of Microbiology, Canterbury Health Laboratories,1 Department of Infectious Diseases, Christchurch Hospital,2 University of Otago, Christchurch, New Zealand3

Corynebacterium accolens is a rare human pathogen. We encountered a case of C. accolens isolated from a thigh collection in a man with osteomyelitis of the adjacent pubic symphysis.

abstract

http://jcm.asm.org/cgi/content/abstract/48/2/654

January 30, 2010 at 7:50 pm Leave a comment

Severe Leptospirosis in Hospitalized Patients, Guadeloupe

Emerging Infectious Diseases Feb 2010 V.16 N.2

Cécile Herrmann-Storck,  Magalie Saint Louis, Tania Foucand, Isabelle Lamaury, Jacqueline Deloumeaux, Guy Baranton, Maurice Simonetti, Natacha Sertour, Muriel Nicolas, Jacques Salin, and Muriel Cornet

Guyane University, Guadeloupe, French West Indies (C. Herrman-Storck, M. Saint Louis, T. Foucand, I. Lamaury, J. Deloumeaux, M. Simonetti, M. Nicholas, J. Salin); Institut Pasteur, Paris, France (G. Baranton, N. Serour, M. Cornet); and Paris Descartes University, Paris (M. Cornet)

Abstract

We evaluated prognostic factors for leptospirosis in 168 consecutive hospitalized patients in Guadeloupe. Factors independently associated with severity included chronic hypertension or chronic alcoholism, late initiation of antibacterial therapy, abnormal chest auscultation results, icterus, oligoanuria, disorders of consciousness, elevated aspartate aminotransferase levels, hyperamylasemia, and Leptospira interrogans serovar Icterohemorrhagiae.

Full Text

http://www.cdc.gov/eid/content/16/2/331.htm

PDF

http://www.cdc.gov/eid/content/16/2/pdfs/331.pdf

January 30, 2010 at 12:35 pm Leave a comment

Community-associated Methicillin-Resistant Staphylococcus aureus in Outpatients, United States, 1999–2006

Emerging Infectious Diseases  Dec. 2009  V.15  N.12

Eili Klein, David L. Smith, and Ramanan Laxminarayan

Princeton University, Princeton, New Jersey, USA (E. Klein, R. Laxminarayan); University of Florida, Gainesville, Florida, USA (D.L. Smith); and Resources for the Future, Washington, DC, USA (E. Klein, D.L. Smith, R. Laxminarayan)

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has become a major problem in US hospitals already dealing with high levels of hospital-associated MRSA (HA-MRSA). Using antimicrobial drug susceptibility data for 1999–2006 from The Surveillance Network, we characterized the relationship between outpatient and inpatient levels of CA-MRSA nationally. In outpatients, the frequency of CA-MRSA isolates has increased >7× during 1999–2006, which suggests that outpatients have become a major reservoir for CA-MRSA. However, contrary to results in other reports, although CA-MRSA increases are associated with decreases in the frequency of HA-MRSA in hospitals, the decreases are only modest. This finding suggests that instead of replacing HA-MRSA in the hospital, CA-MRSA is adding to the overall presence of MRSA already found within the hospital population.

abstract

http://www.cdc.gov/eid/content/15/12/1925.htm

PDF

http://www.cdc.gov/eid/content/15/12/pdfs/1925.pdf

January 30, 2010 at 12:30 pm Leave a comment

Cutaneous Larva Migrans

N Engl J of Med   January 28, 2010  V.362  N.4

Images in Clinical Medicine

A 42-year-old man presented with a 1-week history of intensely pruritic eruption on the dorsum of his right foot. He had gone for a barefoot stroll on the beach a few days before the onset of the rash. The lesion progressed daily, despite the application of antibacterial lotion to the eruption. The physical examination revealed serpiginous, erythematous raised tracts with bulla formation, findings that are clinically diagnostic of cutaneous larva migrans (Panel A). Cutaneous larva migrans is caused by the migration of hookworm larvae in human skin. It is most commonly caused by the hookworm that infects dogs and cats…

abstract

http://content.nejm.org/cgi/content/full/362/4/e10?query=TOC

PDF

http://content.nejm.org/cgi/reprint/362/4/e10.pdf

January 28, 2010 at 7:08 pm Leave a comment

Bacterial Meningitis After Intrapartum Spinal Anesthesia — New York and Ohio, 2008–2009

MMWR Weekly January 29, 2010 V.59  N.3  p.65-69

In June 2007, the Healthcare Infection Control Practices Advisory Committee (HICPAC) recommended for the first time that surgical masks be worn by spinal procedure operators to prevent infections associated with these procedures (1). HICPAC made the recommendation in response to several reports of meningitis following myelography procedures. In September 2008, three bacterial meningitis cases in postpartum women were reported to the New York State Department of Health (NYSDOH); in May 2009, two similar cases were reported to the Ohio Department of Health…

Full Text

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5903a1.htm?s_cid=mm5903a1_e

PDF

http://www.cdc.gov/mmwr/pdf/wk/mm5903.pdf

January 28, 2010 at 6:19 pm Leave a comment

Pandemic (H1N1) 2009 Cases, Buenos Aires, Argentina

Emerging Infectious Diseases Feb 2010 V.16 N.2

Marcela Echavarría,  Marcia Querci, Débora Marcone, Cristina Videla, Alfredo Martínez, Pablo Bonvehi, and Guadalupe Carballal

Centro de Educación Médica e Investigaciones Clínicas (CEMIC) University Hospital, Buenos Aires, Argentina

Abstract

To determine clinical and virologic characteristics of pandemic (H1N1) 2009 in Buenos Aires, Argentina, we conducted real-time reverse transcription–PCR on samples from patients with influenza-like illness, June 11–30, 2009. Of 513 patients tested, 54% were positive for influenza virus subtype H1N1. Infection rate was lowest for patients >60 years of age.

Full Text

http://www.cdc.gov/eid/content/16/2/311.htm

PDF

http://www.cdc.gov/eid/content/16/2/pdfs/311.pdf

January 27, 2010 at 10:31 pm Leave a comment

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