[Usefulness of panfungal PCR for the diagnosis of fungal infection in immunocompromised patients]

Indigenous case of disseminated histoplasmosis from the Penicillium marneffei endemic area of China

This is the first indigenous case of disseminated histoplasmosis reported from the Penicillium marneffei endemic area in southern China. It was diagnosed by histopathology of tissue, gross and microscopic morphology of the culture and PCR assay of the isolated fungus. Successful antifungal treatment was with itraconazole 400 mg/day for 5 months. This case suggests that histoplasmosis should be an important differential diagnosis in immunocompromised patients in southern China and South East Asia (the only endemic area for P. marneffei).

Les spondylodiscites à Candida; à propos de deux cas

In recent years, the incidence of systemic infections due to Candida increased, but the incidence of spondylodiscitis remained low, and epidural involvement during such infection was seldom reported. The purpose of this study was to report the cases of 2 young male heroin addicts who developed spondylodiscitis due to Candida sp., with epidural involvement. In one case, a microbiological diagnosis was obtained after biopsy. In the other case, the diagnosis was based on serological data and Candida antigenemia. In both cases, an oral fluconazole based therapy was administered at first (because of a poor peripheral venous system), but proved to be inefficient. A secondary therapy by liposomal amphotericin B proved efficient allowing a favourable evolution. This pathology raised a number of problems concerning diagnosis and treatment. The clinical data was non-specific the paraclinical diagnosis required MRI, and biopsy. When microbiological assessment is negative, serology and the antigenemia can be useful. The treatment pattern suggested for the management of bone and joint infections is: intravenous amphotericine B for 2-3 weeks, followed by oral administration of fluconazole or voriconazole for 6-12 month. Surgical treatment is recommended only to patients ay risk of neurological disorders or severe epidural abscess.