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Téllez A, Ambrosioni J, Hernández-Meneses M, Llopis J, Ripa M, Chambers ST, Holland D, Almela M, Fernández-Hidalgo N, Almirante B, Bouza E, Strahilevitz J, Hannan MM, Harkness J, Kanafani ZA, Lalani T, Lang S, Raymond N, Read K, Vinogradova T, Woods CW, Wray D, Moreno A, Chu VH, Miro JM. Clinical characteristics and outcome of infective endocarditis due to Abiotrophia and Granulicatella compared to Viridans group streptococci. J Infect 2022; 85:137-146. [PMID: 35618152 DOI: 10.1016/j.jinf.2022.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 12/06/2021] [Accepted: 05/19/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the clinical characteristics and outcome of Abiotrophia and Granulicatella infective endocarditis and compare them with Viridans group streptococci infective endocarditis. METHODS All patients in the International Collaboration on Endocarditis (ICE) - prospective cohort study (PCS) and the ICE-PLUS cohort were included (n=8112). Data from patients with definitive or possible IE due to Abiotrophia species, Granulicatella species and Viridans group streptococci was analyzed. A propensity score (PS) analysis comparing the ABI/GRA-IE and VGS-IE groups according to a 1:2 ratio was performed. RESULTS Forty-eight (0.64%) cases of ABI/GRA-IE and 1,292 (17.2%) VGS-IE were included in the analysis. The median age of patients with ABI/GRA-IE was lower than VGS-IE (48.1 years vs. 57.9 years; p=0.001). Clinical features and the rate of in-hospital surgery was similar between ABI/GRA-IE and VGS-IE (52.1% vs. 45.4%; p=0.366). Unadjusted in-hospital death was lower in ABI/GRA-IE than VGS-IE (2.1% vs. 8.8%; p=0.003), and cumulative six-month mortality was lower in ABI/GRA-IE than VGS-IE (2.1% vs. 11.9%; p<0.001). After PS analysis, in-hospital mortality was similar in both groups, but six-month mortality was lower in the ABI/GRA IE group (2.1% vs. 10.4%; p=0.029). CONCLUSIONS Patients with ABI/GRA-IE were younger, had similar clinical features and rates of surgery and better prognosis than VGS-IE.
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Affiliation(s)
- Adrián Téllez
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Juan Ambrosioni
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Jaume Llopis
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain; Department of Genetics, Microbiology and Statistics. Faculty of Biology, University of Barcelona, Barcelona, Spain
| | - Marco Ripa
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain; Unit of Infectious and Tropical Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stephen T Chambers
- Department of Pathology, University of Otago, Christchurch and Christchurch Hospital, Christchurch, New Zealand
| | - David Holland
- Infectious Diseases Unit, Middlemore Hospital, Auckland, New Zealand
| | - Manel Almela
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Núria Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Benito Almirante
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Emilio Bouza
- Clinical Microbiology and Infectious Diseases Service, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Jacob Strahilevitz
- Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University, Jerusalem, Israel
| | - Margaret M Hannan
- Department of Medical Microbiology, Mater Hospitals, Dublin, Ireland
| | - John Harkness
- Department of Microbiology, St. Vincent's, Sydney, New South Wales, Australia
| | - Zeina A Kanafani
- Division of Infectious Diseases, American University of Beirut, Beirut, Lebanon
| | - Tahaniyat Lalani
- Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, Maryland, United States of America
| | - Selwyn Lang
- Department of Microbiology, Middlemore Hospital, Auckland, New Zealand
| | - Nigel Raymond
- Department of Infectious Diseases, Wellington Hospital, Wellington, New Zealand
| | - Kerry Read
- Department of Infectious Diseases, North Shore Hospital, Auckland, New Zealand
| | - Tatiana Vinogradova
- Institute of Experimental Cardiology, Russian Medical State University, Moscow, Russia
| | - Christopher W Woods
- Department of Medicine, VA Medical Centre, Durham, North Carolina, United States of America
| | - Dannah Wray
- Infectious Disease Division, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Asuncion Moreno
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Vivian H Chu
- Infectious Diseases, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Jose M Miro
- Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
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Sorg B, Harkness J, Gonzalez A, Bushana P, Jorgensen E, Hegarty D, Nardo AD, Prochiantz A, Wisor J, Aicher S, Brown T. 014 Diurnal changes in perineuronal nets and parvalbumin neurons in the rat medial prefrontal cortex. Sleep 2021. [DOI: 10.1093/sleep/zsab072.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Perineuronal nets (PNNs) surrounding fast-spiking, parvalbumin (PV) interneurons provide excitatory:inhibitory balance within cortical circuits. This balance is impaired in several disorders that are also associated with altered diurnal rhythms, yet few studies examined diurnal rhythms of PNNs or PV cells.
Methods
We measured the intensity and number of PV cells and PNNs labeled with Wisteria floribunda agglutinin (WFA) and also the oxidative stress marker 8-oxo-deoxyguanosine (8-oxo-dG) in rat prelimbic medial prefrontal cortex (mPFC) at Zeitgeber times (ZT) ZT0, 6, 12, and 18. To examine changes in inhibitory and excitatory inputs to PV cells, we measured GAD 65/67 and vGLUT1 puncta apposed to PV cells with and without PNNs. Whole-cell slice recordings in fast-spiking (PV) cells with PNNs was conducted to determine the ratio of alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor:N-methyl-D-aspartate receptor (AMPA:NMDA) at ZT18 vs. ZT6. Finally, the number of PV cells and PV/PNN cells containing orthodenticle homeobox 2 (OTX2), which maintains PNNs, was also assessed.
Results
Relative to ZT0, the intensities of PNN and PV labeling were increased in the dark compared with the light phase. The intensity of 8-oxo-dG was decreased from ZT0 at all times. There were more excitatory puncta on PV cells with PNNs at ZT18 vs. ZT6, but no changes in PV cells without PNNs and no changes in inhibitory puncta. There was an increased AMPA:NMDA ratio at ZT18 vs. ZT6. The number of PV cells and PV/PNN cells containing OTX2 showed a strong trend toward an increase from ZT6 to ZT18, with no differences in non-PV-containing cells.
Conclusion
Diurnal fluctuations in PNNs and PV cells alter cortical excitatory:inhibitory balance. Detailed understanding of how these fluctuations are regulated should provide new insights into treatments for diseases impacted by disturbances in sleep and circadian rhythms. Ongoing studies are examining diurnal fluctuations in downstream signaling after PNN removal.
Support (if any)
Washington State University Alcohol and Drug Abuse Research Program, NIH GM134789 (JHH); NIH DA033404 (BAS), DA040965 (BAS, TEB, SAA); NIH NS078498 (JPW); NIH P30 NS061800 (SAA); and Agence Nationale de la Recherche ANR-18-CE16-0013-01 (AP and AAD).
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Affiliation(s)
| | | | | | - Priyanka Bushana
- Elson S. Floyd College of Medicine, Washington State University Spokane
| | | | | | - Ariel Di Nardo
- Centre for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, PSL Research University, Labex MemoLife
| | - Alain Prochiantz
- Centre for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, PSL Research University, Labex MemoLife
| | - Jonathan Wisor
- Elson S. Floyd College of Medicine, Washington State University Spokane
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Page B, Guo Y, Han P, Cheng Z, Harkness J, Shen C, Choflet A, Hu C, Cecil E, Schmitt N, Shpitser I, Kiess A, McNutt T, Quon H. Quality of Life differences in Male and Female Patients with Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Affiliation(s)
- J. Harkness
- Dept. of Clinical Pathology, Musgrove Park Hospital, Taunton, England
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5
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Page B, Han P, Peng L, Cheng Z, Harkness J, Shen C, Choflet A, Cecil E, Hui X, Schmitt N, Shpitser I, McNutt T, Quon H. Gender Differences in Radiation Therapy Effects in Male and Female Patients With Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2017.12.240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Nicol C, Harkness J. Viscosimetric monitoring of plasmapheresis. Clin Hemorheol Microcirc 2016. [DOI: 10.3233/ch-1985-5107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- C.G. Nicol
- Winthrop Laboratories, Surbiton, KT6 4PH, England
| | - J. Harkness
- Musgrove Park Hospital, Taunton, TA1 5DA, England
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Chan D, Barratt J, Roberts T, Phillips O, Šlapeta J, Ryan U, Marriott D, Harkness J, Ellis J, Stark D. Detection of Dientamoeba fragilis in animal faeces using species specific real time PCR assay. Vet Parasitol 2016; 227:42-7. [PMID: 27523936 DOI: 10.1016/j.vetpar.2016.07.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/18/2016] [Accepted: 07/19/2016] [Indexed: 11/26/2022]
Abstract
Dientamoeba fragilis is a potentially pathogenic, enteric, protozoan parasite with a worldwide distribution. While clinical case reports and prevalence studies appear regularly in the scientific literature, little attention has been paid to this parasite's biology, life cycle, host range, and possible transmission routes. Overall, these aspects of Dientamoeba biology remain poorly understood at best. In this study, a total of 420 animal samples, collected from Australia, were surveyed for the presence of Dientamoeba fragilis using PCR. Several PCR assays were evaluated for sensitivity and specificity. Two previously published PCR methods demonstrated cross reactivity with other trichomonads commonly found in animal samples. Only one assay exhibited excellent specificity. Using this assay D. fragilis was detected from one dog and one cat sample. This is the first report of D. fragilis from these animals and highlights the role companion animals may play in D. fragilis transmission. This study demonstrated that some published D. fragilis molecular assays cross react with other closely related trichomonads and consequently are not suitable for animal prevalence studies.
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Affiliation(s)
- Douglas Chan
- Department of Microbiology, SydPath, St. Vincent's Hospital, Victoria St, Darlinghurst, N.S.W, Australia; i3 Institute, University of Technology, Sydney, Ultimo, N.S.W, Australia; School of Life Sciences, University of Technology, Sydney, Ultimo, N.S.W, Australia
| | - Joel Barratt
- i3 Institute, University of Technology, Sydney, Ultimo, N.S.W, Australia; School of Life Sciences, University of Technology, Sydney, Ultimo, N.S.W, Australia
| | - Tamalee Roberts
- Department of Microbiology, SydPath, St. Vincent's Hospital, Victoria St, Darlinghurst, N.S.W, Australia
| | - Owen Phillips
- Department of Microbiology, SydPath, St. Vincent's Hospital, Victoria St, Darlinghurst, N.S.W, Australia
| | - Jan Šlapeta
- School of Life and Environmental Sciences, Faculty of Veterinary Science, The University of Sydney, N.S.W., Australia
| | - Una Ryan
- School of Veterinary and Life Sciences, Murdoch University, Western Australia, Australia
| | - Deborah Marriott
- Department of Microbiology, SydPath, St. Vincent's Hospital, Victoria St, Darlinghurst, N.S.W, Australia
| | - John Harkness
- Department of Microbiology, SydPath, St. Vincent's Hospital, Victoria St, Darlinghurst, N.S.W, Australia
| | - John Ellis
- School of Life Sciences, University of Technology, Sydney, Ultimo, N.S.W, Australia
| | - Damien Stark
- Department of Microbiology, SydPath, St. Vincent's Hospital, Victoria St, Darlinghurst, N.S.W, Australia; School of Life Sciences, University of Technology, Sydney, Ultimo, N.S.W, Australia.
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Mubarak N, Sandaradura I, Isaia L, O'Sullivan M, Zhou F, Marriott D, Iredell JR, Harkness J, Andresen D. Non-susceptibility to ceftaroline in healthcare-associated multiresistant MRSA in Eastern Australia. J Antimicrob Chemother 2015; 70:2413-4. [PMID: 25977400 DOI: 10.1093/jac/dkv124] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023] Open
Affiliation(s)
- Nasmiya Mubarak
- Department of Microbiology, St Vincent's Hospital, Darlinghurst, Sydney, Australia
| | - Indy Sandaradura
- Department of Microbiology, St Vincent's Hospital, Darlinghurst, Sydney, Australia School of Biological Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Lupeoletalalelei Isaia
- Centre for Infectious Diseases and Microbiology, Institute for Clinical Pathology and Medical Research, Westmead, Sydney, Australia Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
| | - Matthew O'Sullivan
- Centre for Infectious Diseases and Microbiology, Institute for Clinical Pathology and Medical Research, Westmead, Sydney, Australia Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
| | - Fei Zhou
- Centre for Infectious Diseases and Microbiology, Institute for Clinical Pathology and Medical Research, Westmead, Sydney, Australia
| | - Deborah Marriott
- Department of Microbiology, St Vincent's Hospital, Darlinghurst, Sydney, Australia School of Biological Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia Department of HIV, Immunology and Infectious Diseases, St Vincent's Hospital, Darlinghurst, Sydney, Australia
| | - Jon R Iredell
- Centre for Infectious Diseases and Microbiology, Institute for Clinical Pathology and Medical Research, Westmead, Sydney, Australia Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia Sydney Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - John Harkness
- Department of Microbiology, St Vincent's Hospital, Darlinghurst, Sydney, Australia School of Biological Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - David Andresen
- Department of HIV, Immunology and Infectious Diseases, St Vincent's Hospital, Darlinghurst, Sydney, Australia Sydney Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia
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9
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Chan D, Barratt J, Roberts T, Lee R, Shea M, Marriott D, Harkness J, Malik R, Jones M, Aghazadeh M, Ellis J, Stark D. The Prevalence of Angiostrongylus cantonensis/mackerrasae Complex in Molluscs from the Sydney Region. PLoS One 2015; 10:e0128128. [PMID: 26000568 PMCID: PMC4441457 DOI: 10.1371/journal.pone.0128128] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/22/2015] [Indexed: 11/18/2022] Open
Abstract
Angiostrongylus cantonensis and Angiostrongylus mackerrasae are metastrongyloid nematodes that infect various rat species. Terrestrial and aquatic molluscs are intermediate hosts of these worms while humans and dogs are accidental hosts. Angiostrongylus cantonensis is the major cause of angiostrongyliasis, a disease characterised by eosinophilic meningitis. Although both A. cantonensis and A. mackerrasae are found in Australia, A. cantonensis appears to account for most infections in humans and animals. Due to the occurrence of several severe clinical cases in Sydney and Brisbane, the need for epidemiological studies on angiostrongyliasis in this region has become apparent. In the present study, a conventional PCR and a TaqMan assay were compared for their ability to amplify Angiostrongylus DNA from DNA extracted from molluscs. The TaqMan assay was more sensitive, capable of detecting the DNA equivalent to one hundredth of a nematode larva. Therefore, the TaqMan assay was used to screen molluscs (n=500) of 14 species collected from the Sydney region. Angiostrongylus DNA was detected in 2 of the 14 mollusc species; Cornu aspersum [14/312 (4.5%)], and Bradybaenia similaris [1/10 (10%)], which are non-native terrestrial snails commonly found in urban habitats. The prevalence of Angiostrongylus spp. was 3.0% ± 0.8% (CI 95%). Additionally, experimentally infected Austropeplea lessoni snails shed A. cantonensis larvae in their mucus, implicating mucus as a source of infection. This is the first Australian study to survey molluscs using real-time PCR and confirms that the garden snail, C. aspersum, is a common intermediate host for Angiostrongylus spp. in Sydney.
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Affiliation(s)
- Douglas Chan
- Department of Microbiology, SydPath, St. Vincent’s Hospital, Victoria St, Darlinghurst, NSW, Australia
- i3 Institute, University of Technology, Sydney, Ultimo, NSW, Australia
- * E-mail:
| | - Joel Barratt
- i3 Institute, University of Technology, Sydney, Ultimo, NSW, Australia
- School of Medical and Molecular Sciences, University of Technology, Sydney, Ultimo, NSW, Australia
| | - Tamalee Roberts
- Department of Microbiology, SydPath, St. Vincent’s Hospital, Victoria St, Darlinghurst, NSW, Australia
| | - Rogan Lee
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Westmead, NSW, Australia
| | - Michael Shea
- Malacology Department, Australian Museum, Sydney, NSW, Australia
| | - Deborah Marriott
- Department of Microbiology, SydPath, St. Vincent’s Hospital, Victoria St, Darlinghurst, NSW, Australia
| | - John Harkness
- Department of Microbiology, SydPath, St. Vincent’s Hospital, Victoria St, Darlinghurst, NSW, Australia
| | - Richard Malik
- Centre for Veterinary Education, University of Sydney, Camperdown, NSW, Australia
| | - Malcolm Jones
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - Mahdis Aghazadeh
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - John Ellis
- School of Medical and Molecular Sciences, University of Technology, Sydney, Ultimo, NSW, Australia
| | - Damien Stark
- Department of Microbiology, SydPath, St. Vincent’s Hospital, Victoria St, Darlinghurst, NSW, Australia
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Brett J, Lam V, Baysari MT, Milder T, Killen L, Chau AMT, McMullan B, Harkness J, Marriott D, Day RO. Pneumonia Severity Scores and Prescribing Antibiotics for Community-Acquired Pneumonia at an Australian Hospital. Journal of Pharmacy Practice and Research 2015. [DOI: 10.1002/j.2055-2335.2013.tb00228.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jonathan Brett
- Department of Clinical Pharmacology and Toxicology; St Vincent's Hospital
| | - Vincent Lam
- Faculty of Medicine, University of NSW; Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital
| | - Melissa T Baysari
- Australian Institute of Health Innovation, Faculty of Medicine, University of NSW; Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital
| | | | | | - Anthony MT Chau
- Australian Institute of Health Innovation, Faculty of Medicine, University of NSW; Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital
| | | | | | | | - Richard O Day
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital; Faculty of Medicine, University of NSW; Sydney New South Wales
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Abstract
Although Blastocystis is one of the most common enteric parasites, there is still much controversy surrounding the pathogenicity and potential treatment options for this parasite. In this review we look at the evidence supporting Blastocystis as an intestinal pathogen as shown by numerous case studies and several in vivo studies and the evidence against. We describe the chronic nature of some infections and show the role of Blastocystis in immunocompromised patients and the relationship between irritable bowel syndrome and Blastocystis infection. There have been several studies that have suggested that pathogenicity may be subtype related. Metronidazole is the most widely accepted treatment for Blastocystis but several cases of treatment failure and resistance have been described. Other treatment options which have been suggested include paromomycin and trimethroprim- sulfamethoxazole.
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Affiliation(s)
- Tamalee Roberts
- Department of Microbiology, St. Vincent's Hospital, Victoria St, Darlinghurst 2010, NSW, Australia ; School of Medical and Molecular Biosciences, University of Technology, Sydney, Ultimo, NSW 2007, Australia
| | - Damien Stark
- Department of Microbiology, St. Vincent's Hospital, Victoria St, Darlinghurst 2010, NSW, Australia
| | - John Harkness
- Department of Microbiology, St. Vincent's Hospital, Victoria St, Darlinghurst 2010, NSW, Australia
| | - John Ellis
- School of Medical and Molecular Biosciences, University of Technology, Sydney, Ultimo, NSW 2007, Australia
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Tyner CL, Harkness J, Hoblet K, Zumwalt L, Templeton K, McLaughlin R. University teaching hospital and private clinic collaboration to enhance veterinary educational opportunities at Mississippi State University. J Vet Med Educ 2014; 41:90-95. [PMID: 24384387 DOI: 10.3138/jvme.0713-098r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The College of Veterinary Medicine at Mississippi State University established a not-for-profit corporation (MSU-CVM-COS) to develop and manage private specialty clinics that would enhance teaching and student learning, increase caseload, and generate revenue. The corporation currently operates the Animal Emergency and Referral Center (AERC) and the Veterinary Specialty Center (VSC) as affiliates of Mississippi State University. These privately managed facilities provide access to advanced medical equipment, enhance clinical service and teaching, and promote the College's One Health initiative.
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Abstract
This article reports long-term infection and treatment failure in 18 symptomatic individuals infected with Blastocystis spp. Patients were initially treated with either metronidazole, iodoquinol or triple combination therapy consisting of nitazoxanide, furazolidone and secnidazole. Following treatment, resolution of clinical symptoms did not occur and follow-up testing revealed ongoing infection with the same subtype. Patients then underwent secondary treatment with a variety of antimicrobial agents but remained symptomatic with Blastocystis spp. still present in faeces. Sequencing of the SSU rDNA was completed on all isolates and four subtypes were identified in this group: ST1, ST3, ST4 and ST5. This study highlights the lack of efficacy of several commonly used antimicrobial regimens in the treatment of Blastocystis and the chronic nature of some infections. It also demonstrates the need for further research into treatment options for Blastocystis infection.
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Affiliation(s)
- Tamalee Roberts
- i3 Institute, School of Medical and Molecular Sciences, University of Technology, Sydney, Ultimo, NSW, Australia.,Department of Microbiology, SydPath, St Vincent's Hospital, Victoria St., Darlinghurst, NSW, Australia
| | - John Ellis
- i3 Institute, School of Medical and Molecular Sciences, University of Technology, Sydney, Ultimo, NSW, Australia
| | - John Harkness
- Department of Microbiology, SydPath, St Vincent's Hospital, Victoria St., Darlinghurst, NSW, Australia
| | - Deborah Marriott
- Department of Microbiology, SydPath, St Vincent's Hospital, Victoria St., Darlinghurst, NSW, Australia
| | - Damien Stark
- Department of Microbiology, SydPath, St Vincent's Hospital, Victoria St., Darlinghurst, NSW, Australia
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Fletcher S, Van Hal S, Andresen D, McLaws ML, Stark D, Harkness J, Ellis J. Gastrointestinal pathogen distribution in symptomatic children in Sydney, Australia. J Epidemiol Glob Health 2013; 3:11-21. [PMID: 23856534 PMCID: PMC7320378 DOI: 10.1016/j.jegh.2012.11.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Revised: 11/28/2012] [Accepted: 11/30/2012] [Indexed: 12/14/2022] Open
Abstract
There is limited information on the causes of paediatric diarrhoea in Sydney. This cross-sectional study used clinical and microbiological data to describe the clinical features and pathogens associated with gastrointestinal illnesses for children presenting to two major public hospitals in Sydney with diarrhoea, for the period January 2007-December 2010. Of 825 children who tested positive for an enteric pathogen, 430 medical records were reviewed. Adenovirus, norovirus and rotavirus were identified in 20.8%, 20.3% and 21.6% of reviewed cases, respectively. Younger children were more likely to have adenovirus and norovirus compared with rotavirus (P=0.001). More viruses were detected in winter than in the other three seasons (P=0.001). Rotavirus presented a distinct seasonal pattern with the lowest rates occurring in the warm months and peaking in the cooler months. Adenovirus showed a less consistent monthly trend, and norovirus detection increased in the cooler months (P=0.008). A decline in the number of rotavirus cases was observed after mid-2008. The majority of childhood diarrhoeal illnesses leading to hospital presentations in Sydney are caused by enteric viruses with most infections following clear seasonal patterns. However, a sustained decrease in the incidence of rotavirus infections has been observed over the study period.
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Affiliation(s)
- Stephanie Fletcher
- The iThree Institute and School of Medical and Molecular Biosciences, University of Technology, Sydney, P.O. Box 123, Broadway, NSW, Australia
| | - Sebastian Van Hal
- The iThree Institute and School of Medical and Molecular Biosciences, University of Technology, Sydney, P.O. Box 123, Broadway, NSW, Australia
- Department of Microbiology, Liverpool Hospital, Locked Bag 7103, Liverpool NSW 1871, Australia
| | - David Andresen
- Department of Microbiology, Children’s Hospital at Westmead, NSW, University of Sydney, Australia
| | - Mary-Louise McLaws
- School of Public Health and Community Medicine, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Damien Stark
- The iThree Institute and School of Medical and Molecular Biosciences, University of Technology, Sydney, P.O. Box 123, Broadway, NSW, Australia
- Division of Microbiology, SydPath, St. Vincent’s Hospital, Sydney, NSW, Australia
| | - John Harkness
- The iThree Institute and School of Medical and Molecular Biosciences, University of Technology, Sydney, P.O. Box 123, Broadway, NSW, Australia
- Division of Microbiology, SydPath, St. Vincent’s Hospital, Sydney, NSW, Australia
| | - John Ellis
- The iThree Institute and School of Medical and Molecular Biosciences, University of Technology, Sydney, P.O. Box 123, Broadway, NSW, Australia
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Roberts T, Stark D, Harkness J, Ellis J. Subtype distribution of Blastocystis isolates identified in a Sydney population and pathogenic potential of Blastocystis. Eur J Clin Microbiol Infect Dis 2012; 32:335-43. [PMID: 22996007 DOI: 10.1007/s10096-012-1746-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 08/31/2012] [Indexed: 12/01/2022]
Abstract
Blastocystis is one of the most common enteric parasites present in humans. There is still much uncertainty about the pathogenic potential of this parasite, and it was suggested that its pathogenicity could be subtype-related. This report aimed to study 98 Blastocystis isolates found in human stool specimens to identify the subtypes present and carry out phylogenetic analysis on these isolates. This study also aimed to show the relationship between subtype and symptoms. Five-hundred and thirteen stool samples were submitted to five different diagnostic techniques for the detection of Blastocystis. Polymerase chain reaction (PCR)-positive samples were then sequenced and the small subunit (SSU) rDNA sequences were aligned and submitted to phylogenetic analysis. Ninety-eight samples were positive by any of the diagnostic methods for Blastocystis and 96 were positive by PCR. There were seven different subtypes (1, 2, 3, 4, 6, 7 and 8) identified by PCR and sequencing. This is the first large-scale study to examine the occurrence of Blastocystis in Australia. This study reports the high incidence of subtype 3 (44 %) in this population and discusses the emerging idea of subtype-dependent pathogenicity.
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Affiliation(s)
- T Roberts
- Department of Microbiology, SydPath, St. Vincent's Hospital, Victoria St., Darlinghurst, 2010 NSW, Australia.
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16
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Nagata N, Marriott D, Harkness J, Ellis JT, Stark D. Current treatment options for Dientamoeba fragilis infections. Int J Parasitol Drugs Drug Resist 2012; 2:204-15. [PMID: 24533282 DOI: 10.1016/j.ijpddr.2012.08.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 08/06/2012] [Accepted: 08/07/2012] [Indexed: 12/20/2022]
Abstract
Dientamoeba fragilis belongs to the trichomonad group of protozoan parasites and it has been implicated as a cause of gastrointestinal disease with world-wide prevalences ranging from 0.5% to 16%. The majority of patients with dientamoebiasis present with gastrointestinal complaints. Chronic symptoms are common with up to a third of patients exhibiting persistent diarrhoea. Numerous studies have successfully demonstrated parasite clearance, coupled with complete resolution of clinical symptoms following treatment with various antiparasitic compounds. Treatments reported to be successful for dientamoebiasis include carbarsone, diphetarsone, tetracyclines, paromomycin, erythromycin, hydroxyquinolines and the 5-nitroimidazoles, including metronidazole, secnidazole, tinidazole and ornidazole. It is of note that most current treatment data is based only on small number of case reports. No large scale double blind randomised placebo controlled trials testing the efficacy of antimicrobial agents against D. fragilis has been undertaken highlighting the need for further study. In addition there is very little in vitro susceptibility data available for the organism making some current treatment options questionable. The aim of this review is to critically discuss all treatment options currently available for dientamoebiasis.
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Affiliation(s)
- Noriyuki Nagata
- Division of Microbiology, SydPath, St. Vincent's Hospital, Darlinghurst, Australia ; University of Technology Sydney, School of Medical and Molecular Biosciences, Broadway, Australia
| | - Deborah Marriott
- Division of Microbiology, SydPath, St. Vincent's Hospital, Darlinghurst, Australia ; University of Technology Sydney, School of Medical and Molecular Biosciences, Broadway, Australia
| | - John Harkness
- Division of Microbiology, SydPath, St. Vincent's Hospital, Darlinghurst, Australia ; University of Technology Sydney, School of Medical and Molecular Biosciences, Broadway, Australia
| | - John T Ellis
- University of Technology Sydney, School of Medical and Molecular Biosciences, Broadway, Australia ; University of Technology Sydney, iThree Institute, Broadway, Australia
| | - Damien Stark
- Division of Microbiology, SydPath, St. Vincent's Hospital, Darlinghurst, Australia ; University of Technology Sydney, School of Medical and Molecular Biosciences, Broadway, Australia
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17
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Abstract
Several enteric protozoa cause severe morbidity and mortality in both humans and animals worldwide. In developed settings, enteric protozoa are often ignored as a cause of diarrheal illness due to better hygiene conditions, and as such, very little effort is used toward laboratory diagnosis. Although these protozoa contribute to the high burden of infectious diseases, estimates of their true prevalence are sometimes affected by the lack of sensitive diagnostic techniques to detect them in clinical and environmental specimens. Despite recent advances in the epidemiology, molecular biology, and treatment of protozoan illnesses, gaps in knowledge still exist, requiring further research. There is evidence that climate-related changes will contribute to their burden due to displacement of ecosystems and human and animal populations, increases in atmospheric temperature, flooding and other environmental conditions suitable for transmission, and the need for the reuse of alternative water sources to meet growing population needs. This review discusses the common enteric protozoa from a public health perspective, highlighting their epidemiology, modes of transmission, prevention, and control. It also discusses the potential impact of climate changes on their epidemiology and the issues surrounding waterborne transmission and suggests a multidisciplinary approach to their prevention and control.
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Affiliation(s)
| | - Damien Stark
- School of Medical and Molecular Biosciences, University of Technology Sydney, Sydney, NSW, Australia
- St. Vincent's Hospital, Sydney, Division of Microbiology, SydPath, Darlinghurst, NSW, Australia
| | - John Harkness
- School of Medical and Molecular Biosciences, University of Technology Sydney, Sydney, NSW, Australia
- St. Vincent's Hospital, Sydney, Division of Microbiology, SydPath, Darlinghurst, NSW, Australia
| | - John Ellis
- The ithree Institute, University of Technology Sydney, Sydney, NSW, Australia
- School of Medical and Molecular Biosciences, University of Technology Sydney, Sydney, NSW, Australia
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18
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Stark D, Roberts T, Marriott D, Harkness J, Ellis JT. Detection and transmission of Dientamoeba fragilis from environmental and household samples. Am J Trop Med Hyg 2012; 86:233-6. [PMID: 22302854 DOI: 10.4269/ajtmh.2012.11-0526] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Dientamoeba fragilis is a commonly occurring pathogenic protozoan often detected at higher rates in stool samples than Giardia intestinalis. However, little is known about its life cycle and mode of transmission. A total of 210 environmental and household samples were examined for the presence of D. fragilis by culture and polymerase chain reaction. Of 100 environmental samples, D. fragilis was detected only in untreated sewage. In the household samples D. fragilis was detected in 30% of household contacts tested and was not detected in any domestic pets. This study provides evidence that environmental transmission of D. fragilis is unlikely and that pets played no role in transmission of the disease in this study. Direct transmission from infected persons is the most likely mode of transmission for D. fragilis. The study also highlights the need for household contacts to be screened, given the propensity of close contacts to become infected with the organism.
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Affiliation(s)
- Damien Stark
- Division of Microbiology, SydPath, St. Vincent's Hospital, Sydney, New South Wales, Australia.
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19
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Barratt JLN, Harkness J, Marriott D, Ellis JT, Stark D. A review of Dientamoeba fragilis carriage in humans: several reasons why this organism should be considered in the diagnosis of gastrointestinal illness. Gut Microbes 2011; 2:3-12. [PMID: 21637013 DOI: 10.4161/gmic.2.1.14755] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Dientamoeba fragilis is a protozoan that inhabits the human gut. It is approximately 100 years since Dientamoeba's discovery and first description when it was described as a rare and harmless commensal. Since then it has struggled to gain recognition as a pathogen despite the evidence supporting its pathogenicity. Dientamoeba remains neglected, probably due to the misconceptions that it is uncommon and non-pathogenic. Usually, carriage of Dientamoeba is associated with symptoms such as abdominal pain and diarrhea. Moreover, antimicrobial therapy followed by resolution of symptoms coincides with the eradication of Dientamoeba. This manuscript reviews the scientific literature relating to Dientamoeba's prevalence and pathogenicity. While much of the evidence supporting its pathogenicity is only circumstantial, it is apparent that most researchers agree that Dientamoeba is pathogenic. Therefore, in symptomatic patients who harbor Dientamoeba and no other pathogen, Dientamoeba should be considered as the etiological agent and treated as such.
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Affiliation(s)
- Joel L N Barratt
- Division of Microbiology, SydPath, St. Vincent's Hospital, Darlinghurst, Australia
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20
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Roberts T, Barratt J, Harkness J, Ellis J, Stark D. Comparison of microscopy, culture, and conventional polymerase chain reaction for detection of blastocystis sp. in clinical stool samples. Am J Trop Med Hyg 2011; 84:308-12. [PMID: 21292905 DOI: 10.4269/ajtmh.2011.10-0447] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We tested 513 stool samples from patients in Sydney, Australia for Blastocystis by using five diagnostic techniques: microscopy of a permanently stained smear using a modified iron-hematoxylin stain, two xenic culture systems (a modified Boeck and Drbohlav's medium and tryptone, yeast extract, glucose, methionine-9 medium), and two published conventional polymerase chain reaction methods specific for the small subunit ribosomal DNA. Ninety-eight (19%) samples were positive for Blastocystis in one or more of the diagnostic techniques. The PCR 2 method was the most sensitive at detecting Blastocystis with a sensitivity of 94%, and the least sensitive was microscopy of the permanent stain (48%). Subtype 3 was the most predominant subtype (present in 43% of samples assigned to this group). This study highlights the low sensitivity of microscopy when used as the sole diagnostic modality for detection of Blastocystis sp.
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Affiliation(s)
- Tamalee Roberts
- Department of Microbiology, SydPath, St. Vincent's Hospital, Sydney, Australia.
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21
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James R, Barratt J, Marriott D, Harkness J, Stark D. Seroprevalence of Entamoeba histolytica infection among men who have sex with men in Sydney, Australia. Am J Trop Med Hyg 2010; 83:914-6. [PMID: 20889891 DOI: 10.4269/ajtmh.2010.10-0231] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A retrospective analysis was undertaken to determine the seroprevalence of Entamoeba histolytica infection in Sydney, Australia. Using an enzyme-linked immunosorbent assay, 429 high risk human immunodeficiency virus (HIV)-infected men who have sex with men (MSM), 446 low risk HIV-uninfected MSM, and 456 HIV-uninfected controls were assessed. Seroprevalence rates were 5.13% for the high risk HIV-infected MSM group, 0.22% for the low risk HIV-uninfected MSM group, and 0.44% for the control group. We found that high risk HIV-infected MSM have a significantly greater seroprevalence of E. histolytica with a relative risk of 22.87, when compared with low risk HIV-uninfected MSM and 11.69 when compared with controls. These findings show that in Sydney, sexually active HIV-infected MSM are at greater risk of developing amoebic disease caused by E. histolytica than HIV-uninfected MSM and the general population.
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Affiliation(s)
- Rodney James
- Department of Microbiology, St. Vincent's Hospital, Darlinghurst, New South Wales, Australia.
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22
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Abstract
There are many neglected nonenteric protozoa able to cause serious morbidity and mortality in humans, particularly in the developing world. Diseases caused by certain protozoa are often more severe in the presence of HIV. While information regarding neglected tropical diseases caused by trypanosomatids and Plasmodium is abundant, these protozoa are often not a first consideration in Western countries where they are not endemic. As such, diagnostics may not be available in these regions. Due to global travel and immigration, this has become an increasing problem. Inversely, in certain parts of the world (particularly sub-Saharan Africa), the HIV problem is so severe that diseases like microsporidiosis and toxoplasmosis are common. In Western countries, due to the availability of highly active antiretroviral therapy (HAART), these diseases are infrequently encountered. While free-living amoebae are rarely encountered in a clinical setting, when infections do occur, they are often fatal. Rapid diagnosis and treatment are essential to the survival of patients infected with these organisms. This paper reviews information on the diagnosis and treatment of nonenteric protozoal diseases in immunocompromised people, with a focus on patients infected with HIV. The nonenteric microsporidia, some trypanosomatids, Toxoplasma spp., Neospora spp., some free-living amoebae, Plasmodium spp., and Babesia spp. are discussed.
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Affiliation(s)
- J L N Barratt
- Department of Microbiology, St. Vincent's Hospital, Darlinghurst 2010, NSW, Australia.
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23
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Abstract
Among 750 symptomatic and asymptomatic patients, Dientamoeba fragilis was detected at a prevalence of 5.2% and more common than Giardia intestinalis. Most infected patients presented with diarrhea and abdominal pain with symptoms greater than 2 weeks duration being common. Bacterial and viral causes of infection were excluded by routine microbiological techniques. Treatment of D. fragilis infection with either iodoquinol, paromomycin, or combination therapy resulted in the eradication of the parasite and complete resolution of symptoms. Treatment failure/relapses were associated only with the use of metronidazole. Nineteen patients were examined for pin worm, no Enterobius vermicularis, a proposed vector of transmission, were detected. Intermittent shedding of D. fragilis was found to be highly variable. These studies confirm the pathogenic nature of D. fragilis and we recommend laboratories routinely test for the organism.
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Affiliation(s)
- Damien Stark
- Department of Microbiology, St. Vincent's Hospital, Darlinghurst 2010, NSW, Australia.
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24
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Stark D, Barratt J, Ellis J, Harkness J, Marriott D. Repeated Dientamoeba fragilis infections: a case report of two families from Sydney, Australia. Infect Dis Rep 2009. [DOI: 10.4081/idr.2009.1280] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We report cases of two unrelated families who both presented with recurrent Dienta-moeba fragilis infections. Subsequent antimicrobial therapy resulted in the clearance of D. fragilis and total resolution of gastrointestinal symptoms in both families. This report highlights the potentially recurrent nature of D. fragilis infections and the need for laboratories to routinely test for this organism.
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25
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Stark D, Barratt JLN, van Hal S, Marriott D, Harkness J, Ellis JT. Clinical significance of enteric protozoa in the immunosuppressed human population. Clin Microbiol Rev 2009; 22:634-50. [PMID: 19822892 PMCID: PMC2772358 DOI: 10.1128/cmr.00017-09] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Globally, the number of immunosuppressed people increases each year, with the human immunodeficiency virus (HIV) pandemic continuing to spread unabated in many parts of the world. Immunosuppression may also occur in malnourished persons, patients undergoing chemotherapy for malignancy, and those receiving immunosuppressive therapy. Components of the immune system can be functionally or genetically abnormal as a result of acquired (e.g., caused by HIV infection, lymphoma, or high-dose steroids or other immunosuppressive medications) or congenital illnesses, with more than 120 congenital immunodeficiencies described to date that either affect humoral immunity or compromise T-cell function. All individuals affected by immunosuppression are at risk of infection by opportunistic parasites (such as the microsporidia) as well as those more commonly associated with gastrointestinal disease (such as Giardia). The outcome of infection by enteric protozoan parasites is dependent on absolute CD4(+) cell counts, with lower counts being associated with more severe disease, more atypical disease, and a greater risk of disseminated disease. This review summarizes our current state of knowledge on the significance of enteric parasitic protozoa as a cause of disease in immunosuppressed persons and also provides guidance on recent advances in diagnosis and therapy for the control of these important parasites.
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Affiliation(s)
- D Stark
- Department of Microbiology, St. Vincent's Hospital, Darlinghurst 2010, NSW, Australia.
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26
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Stark D, Barratt J, Ellis J, Harkness J, Marriott D. Repeated Dientamoeba fragilis infections: a case report of two families from Sydney, Australia. Infect Dis Rep 2009; 1:e4. [PMID: 24470882 PMCID: PMC3892568 DOI: 10.4081/idr.2009.e4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 10/26/2009] [Accepted: 10/28/2009] [Indexed: 11/23/2022] Open
Abstract
We report cases of two unrelated families who both presented with recurrent Dientamoeba fragilis infections. Subsequent antimicrobial therapy resulted in the clearance of D. fragilis and total resolution of gastrointestinal symptoms in both families. This report highlights the potentially recurrent nature of D. fragilis infections and the need for laboratories to routinely test for this organism.
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Affiliation(s)
- Damien Stark
- Division of Microbiology, SydPath, St. Vincent’s Hospital, Sydney, Australia
- Department of Medical and Molecular Biosciences, University of Technology Sydney, Broadway, Australia
| | - Joel Barratt
- Division of Microbiology, SydPath, St. Vincent’s Hospital, Sydney, Australia
- Department of Medical and Molecular Biosciences, University of Technology Sydney, Broadway, Australia
| | - John Ellis
- Department of Medical and Molecular Biosciences, University of Technology Sydney, Broadway, Australia
| | - John Harkness
- Division of Microbiology, SydPath, St. Vincent’s Hospital, Sydney, Australia
- Department of Medical and Molecular Biosciences, University of Technology Sydney, Broadway, Australia
| | - Deborah Marriott
- Division of Microbiology, SydPath, St. Vincent’s Hospital, Sydney, Australia
- Department of Medical and Molecular Biosciences, University of Technology Sydney, Broadway, Australia
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27
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Stark D, van Hal S, Barratt J, Ellis J, Marriott D, Harkness J. Limited genetic diversity among genotypes of Enterocytozoon bieneusi strains isolated from HIV-infected patients from Sydney, Australia. J Med Microbiol 2009; 58:355-357. [PMID: 19208886 DOI: 10.1099/jmm.0.006445-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Microsporidia are intracellular parasites, with over 1200 species belonging to 143 genera described to date. They are opportunistic pathogens in humans and can cause chronic diarrhoea in immunosuppressed patients. Both Enterocytozoon bieneusi and Encephalitozoon intestinalis cause intestinal disease, with Enterocytozoon bieneusi more commonly identified in patients with human immunodeficiency virus (HIV) infection. In this study, intestinal microsporidial clinical isolates from patients in Sydney, Australia, were genotyped. All specimens were from HIV-infected men with low CD4(+) T-cell counts (<100 cells mm(-3)). Genotyping of the internal transcribed spacer regions of the rRNA gene showed the presence of only one genotype, the anthroponotic Enterocytozoon bieneusi genotype B strain. This study thus highlighted the limited genetic diversity among Australian Enterocytozoon bieneusi isolates, and it is hypothesized that, due to the reduced incidence of microsporidia and the subsequent reduction in the human reservoir of the anthroponotic genotype B, locally acquired intestinal microsporidiosis will rarely be seen in HIV-infected persons undergoing highly active antiretroviral therapy in the future in Australia.
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Affiliation(s)
- D Stark
- University of Technology Sydney, Department of Medical and Molecular Biosciences, Broadway, Australia.,St Vincents Hospital, Department of Microbiology, Sydney, Australia
| | - S van Hal
- St Vincents Hospital, Department of Microbiology, Sydney, Australia
| | - J Barratt
- University of Technology Sydney, Department of Medical and Molecular Biosciences, Broadway, Australia.,St Vincents Hospital, Department of Microbiology, Sydney, Australia
| | - J Ellis
- University of Technology Sydney, Department of Medical and Molecular Biosciences, Broadway, Australia
| | - D Marriott
- St Vincents Hospital, Department of Microbiology, Sydney, Australia
| | - J Harkness
- St Vincents Hospital, Department of Microbiology, Sydney, Australia
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28
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Abstract
Entamoeba histolytica is a pathogenic ameba that has recently been recognized as an emerging pathogen in men who have sex with men (MSM) in Asia-Pacific countries where it is not endemic, i.e., Japan, Taiwan, and Republic of Korea. We report locally acquired invasive amebiasis in Sydney, Australia, exclusively in MSM.
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Affiliation(s)
- Damien Stark
- St. Vincent's Hospital, Darlinghurst, New South Wales, Australia
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29
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Abstract
Leishmaniasis is a protozoan infection rarely reported in Australia. However, with the advent of increased international tourism and migration of refugees from endemic regions, leishmaniasis has emerged as an increasingly imported infection. We report 20 cases (17 cutaneous, 2 visceral, and 1 post-kala-azar dermal leishmaniasis). These data highlight the range of species causing leishmaniasis imported in Australia and demonstrate the importance of species identification in determining proper treatment.
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Affiliation(s)
- Damien Stark
- Division of Microbiology, SydPath, St. Vincent's Hospital, Darlinghurst, Australia.
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30
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van Hal S, Stark D, Marriott D, Harkness J. Achromobacter xylosoxidans subsp. xylosoxidans prosthetic aortic valve infective endocarditis and aortic root abscesses. J Med Microbiol 2008; 57:525-527. [PMID: 18349376 DOI: 10.1099/jmm.0.47496-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We report a case of prosthetic valve infective endocarditis and aortic root abscesses caused by Achromobacter xylosoxidans subsp. xylosoxidans. The patient was an intravenous drug user and had injected amphetamines using 'duck pond water' as a diluent. After surgical intervention and 6 weeks of intravenous meropenem therapy, the patient made an uneventful recovery.
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Affiliation(s)
- S van Hal
- Department of Microbiology, St Vincent's Hospital, Darlinghurst 2010, NSW Sydney, Australia
| | - D Stark
- Department of Microbiology, St Vincent's Hospital, Darlinghurst 2010, NSW Sydney, Australia
| | - D Marriott
- Department of Microbiology, St Vincent's Hospital, Darlinghurst 2010, NSW Sydney, Australia
| | - J Harkness
- Department of Microbiology, St Vincent's Hospital, Darlinghurst 2010, NSW Sydney, Australia
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31
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Stark D, van Hal S, Fotedar R, Butcher A, Marriott D, Ellis J, Harkness J. Comparison of stool antigen detection kits to PCR for diagnosis of amebiasis. J Clin Microbiol 2008; 46:1678-81. [PMID: 18367563 PMCID: PMC2395085 DOI: 10.1128/jcm.02261-07] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Revised: 01/16/2008] [Accepted: 03/18/2008] [Indexed: 11/20/2022] Open
Abstract
The present study was conducted to compare two stool antigen detection kits with PCR for the diagnosis of Entamoeba histolytica infections by using fecal specimens submitted to the Department of Microbiology at St. Vincent's Hospital, Sydney, and the Institute of Medical and Veterinary Science, Adelaide, Australia. A total of 279 stool samples containing the E complex (E. histolytica, Entamoeba dispar, and Entamoeba moshkovskii) were included in this study. The stool specimens were tested by using two commercially produced enzyme immunoassays (the Entamoeba CELISA PATH and TechLab E. histolytica II kits) to detect antigens of E. histolytica. DNA was extracted from all of the samples with a Qiagen DNA stool mini kit (Qiagen, Hilden, Germany), and a PCR targeting the small-subunit ribosomal DNA was performed on all of the samples. When PCR was used as a reference standard, the CELISA PATH kit showed 28% sensitivity and 100% specificity. The TechLab ELISA (enzyme-linked immunosorbent assay) kit did not prove to be useful in detecting E. histolytica, as it failed to identify any of the E. histolytica samples which were positive by PCR. With the TechLab kit, cross-reactivity was observed for three specimens, one of which was positive for both E. dispar and E. moshkovskii while the other two samples contained E. moshkovskii. Quantitative assessment of the PCR and ELISA results obtained showed that the ELISA kits were 1,000 to 10,000 times less sensitive, and our results show that the CELISA PATH kit and the TechLab ELISA are not useful for the detection of E. histolytica in stool samples from patients in geographical regions where this parasite is not endemic.
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Affiliation(s)
- D Stark
- St. Vincent's Hospital, Department of Microbiology, Sydney, Australia.
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32
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Abstract
We present a case of Candida dubliniensis meningitis that developed 2 months after apparently successful treatment of an episode of C. dubliniensis candidemia in a heart-lung transplant recipient in Australia. This case highlights the importance of follow-up in patients with candidemia or disseminated infection, especially in immunosuppressed patients.
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Stark D, Phillips O, Peckett D, Munro U, Marriott D, Harkness J, Ellis J. Gorillas are a host for Dientamoeba fragilis: an update on the life cycle and host distribution. Vet Parasitol 2007; 151:21-6. [PMID: 18022187 DOI: 10.1016/j.vetpar.2007.10.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Revised: 10/02/2007] [Accepted: 10/03/2007] [Indexed: 11/17/2022]
Abstract
Dientamoeba fragilis is a gastrointestinal protozoan that has a worldwide distribution and is emergeing as a common cause of diarrhea. As D. fragilis has a propensity to cause chronic illness with symptoms similar to irritable bowel syndrome (IBS) it is not surprising that some patients with D. fragilis are misdiagnosed as having IBS. In contrast to most other pathogenic protozoa very little is known about its life cycle, epidemiology and mode of transmission. What role animal reservoirs play in the transmission of this parasite is unknown. Consequently we undertook a prospective study to determine the host distribution of D. fragilis. Over a 2-year-period, 608 faecal samples from a wide range of animal and bird species, including pigs and other food species, were screened using permanent stained smears for the presence of D. fragilis. Trophozoites of D. fragilis were only detected in Western lowland gorillas (3/10) (Gorilla g. gorilla) and confirmed by PCR targeting the SSU rRNA gene. The limited host range detected suggests human infection may not involve transmission from other animal species. In addition, we provide an update on the limited knowledge about the life cycle of this parasite and its host distribution.
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Affiliation(s)
- Damien Stark
- St Vincent's Hospital, Division of Microbiology, SydPath, Darlinghurst, NSW, Australia.
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34
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van Hal SJ, Stark D, Lockwood B, Marriott D, Harkness J. Methicillin-resistant Staphylococcus aureus (MRSA) detection: comparison of two molecular methods (IDI-MRSA PCR assay and GenoType MRSA Direct PCR assay) with three selective MRSA agars (MRSA ID, MRSASelect, and CHROMagar MRSA) for use with infection-control swabs. J Clin Microbiol 2007; 45:2486-90. [PMID: 17537949 PMCID: PMC1951204 DOI: 10.1128/jcm.00139-07] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2007] [Revised: 03/15/2007] [Accepted: 05/17/2007] [Indexed: 11/20/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is an increasing problem. Rapid detection of MRSA-colonized patients has the potential to limit spread of the organism. We evaluated the sensitivities and specificities of MRSA detection by two molecular methods (IDI-MRSA PCR assay and GenoType MRSA Direct PCR assay) and three selective MRSA agars (MRSA ID, MRSASelect, and CHROMagar MRSA), using 205 (101 nasal, 52 groin, and 52 axillary samples) samples from consecutive known MRSA-infected and/or -colonized patients. All detection methods had higher MRSA detection rates for nasal swabs than for axillary and groin swabs. Detection of MRSA by IDI-MRSA was the most sensitive method, independent of the site (94% for nasal samples, 80% for nonnasal samples, and 90% overall). The sensitivities of the GenoType MRSA Direct assay and the MRSA ID, MRSASelect, and CHROMagar MRSA agars with nasal swabs were 70%, 72%, 68%, and 75%, respectively. All detection methods had high specificities (95 to 99%), independent of the swab site. Extended incubation for a further 24 h with selective MRSA agars increased the detection of MRSA, with a corresponding decline in specificity secondary to a significant increase in false-positive results. There was a noticeable difference in test performance of the GenoType MRSA Direct assay in detection of MRSA (28/38 samples [74%]) compared with detection of nonmultiresistant MRSA (17/31 samples [55%]) (susceptible to two or more non-beta-lactam antibiotics). This was not observed with selective MRSA agar plates or IDI-MRSA. Although it is more expensive, in addition to rapid turnaround times of 2 to 4 h, IDI-MRSA offers greater detection of MRSA colonization, independent of the swab site, than do conventional selective agars and GenoType MRSA Direct.
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Affiliation(s)
- S J van Hal
- Department of Microbiology, St. Vincent's Hospital, Darlinghurst 2010 NSW, Australia.
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van Hal SJ, Muthiah K, Matthews G, Harkness J, Stark D, Cooper D, Marriott D. Declining incidence of intestinal microsporidiosis and reduction in AIDS-related mortality following introduction of HAART in Sydney, Australia. Trans R Soc Trop Med Hyg 2007; 101:1096-100. [PMID: 17662322 DOI: 10.1016/j.trstmh.2007.06.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2007] [Revised: 06/01/2007] [Accepted: 06/01/2007] [Indexed: 11/29/2022] Open
Abstract
Limited data exist regarding the incidence of intestinal microsporidiosis following the introduction of highly active antiretroviral therapy (HAART) in Australia. At St Vincent's Hospital, Sydney, all faecal samples submitted for diarrhoea from HIV-infected patients between 1995 and 2006 underwent screening for microsporidiosis. A total of 3564 patients (7366 faecal specimens) was examined, resulting in 159 patients identified with microsporidiosis. The incidence of microsporidiosis declined from 11% in 1995 to 0% from 2004 onwards. At presentation the majority of patients were severely immunocompromised (median CD4 105 cells/mm(3)), with only 16% of patients on effective HAART. Twenty-four patients (24/76, 32%) died within a median of 22 months following microsporidiosis diagnosis. Significant predictors of AIDS-related mortality at presentation included the level of immunodeficiency and receiving no or ineffective HAART (P<0.05). Patients presenting after 1998 had a significant reduction in the risk of AIDS-related mortality compared with patients presenting before 1998 (hazard ratio 0.27, 95% CI 0.79-0.92). All 52 (68%) surviving patients were on effective HAART, with a median CD4 count 382 cells/mm(3) and HIV RNA of < 50 copies/ml at follow-up (median 4 years). The dramatic decline of intestinal microsporidiosis in our study reconfirms the importance of effective HAART in preventing advanced immunodeficiency, opportunistic infections and associated AIDS-related deaths.
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Affiliation(s)
- S J van Hal
- Department of Clinical Microbiology and Infectious Diseases, St Vincent's Hospital, Victoria Street, Darlinghurst, NSW 2010, Sydney, Australia.
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Abstract
The genus Entamoeba contains many species, six of which (Entamoeba histolytica, Entamoeba dispar, Entamoeba moshkovskii, Entamoeba polecki, Entamoeba coli, and Entamoeba hartmanni) reside in the human intestinal lumen. Entamoeba histolytica is the causative agent of amebiasis and is considered a leading parasitic cause of death worldwide in humans. Although recent studies highlight the recovery of E. dispar and E. moshkovskii from patients with gastrointestinal symptoms, there is still no convincing evidence of a causal link between the presence of these two species and the symptoms of the host. New approaches to the identification of E. histolytica are based on detection of E. histolytica-specific antigen and DNA in stool and other clinical samples. Several molecular diagnostic tests, including conventional and real-time PCR, have been developed for the detection and differentiation of E. histolytica, E. dispar, and E. moshkovskii in clinical samples. The purpose of this review is to discuss different methods that exist for the identification of E. histolytica, E. dispar, and E. moshkovskii which are available to the clinical diagnostic laboratory. To address the need for a specific diagnostic test for amebiasis, a substantial amount of work has been carried out over the last decade in different parts of the world. The molecular diagnostic tests are increasingly being used for both clinical and research purposes. In order to minimize undue treatment of individuals infected with other species of Entamoeba such as E. dispar and E. moshkovskii, efforts have been made for specific diagnosis of E. histolytica infection and not to treat based simply on the microscopic examination of Entamoeba species in the stool. The incorporation of many new technologies into the diagnostic laboratory will lead to a better understanding of the public health problem and measures to control the disease.
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Affiliation(s)
- R Fotedar
- St. Vincent's Hospital, Department of Microbiology, Sydney, Darlinghurst, NSW 2010, Australia
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Stark D, Milliken S, Marriott D, Harkness J. Rhizopus microsporus var. rhizopodiformis sinus-orbital zygomycosis in an immunosuppressed patient: successful treatment with posaconazole after a complicated clinical course. J Med Microbiol 2007; 56:699-701. [PMID: 17446298 DOI: 10.1099/jmm.0.47069-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
A case of sinus-orbital Rhizopus microsporus var. rhizopodiformis infection in a patient with graft versus host disease following allogeneic blood stem cell transplantation is reported. Commercially available pea straw compost used for gardening was suspected to be the source of the infection. After an initial relapse, treatment with surgical debridement, liposomal amphotericin B and posaconazole was successful.
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Affiliation(s)
- D Stark
- Department of Microbiology, St Vincent's Hospital, Sydney, Australia
| | - S Milliken
- Department of Haematology, St Vincent's Hospital, Sydney, Australia
| | - D Marriott
- Department of Microbiology, St Vincent's Hospital, Sydney, Australia
| | - J Harkness
- Department of Microbiology, St Vincent's Hospital, Sydney, Australia
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Stark D, Riley LA, Harkness J, Marriott D. Bordetella petrii from a clinical sample in Australia: isolation and molecular identification. J Med Microbiol 2007; 56:435-437. [PMID: 17314377 DOI: 10.1099/jmm.0.46976-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The first isolation of Bordetella petrii from a patient with chronic suppurative mastoiditis is reported. Molecular characterization of the isolate was performed by sequencing the small-subunit rRNA gene, the Bordetella outer-membrane protein A gene (ompA) and the RisA response regulator gene (risA). This is the first reported case of B. petrii causing suppurative mastoiditis and only the second documented case of a clinically significant B. petrii isolate.
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MESH Headings
- Adult
- Anti-Bacterial Agents/pharmacology
- Australia
- Bacterial Outer Membrane Proteins/genetics
- Bacterial Proteins/genetics
- Bordetella/classification
- Bordetella/drug effects
- Bordetella/genetics
- Bordetella/isolation & purification
- Bordetella Infections/microbiology
- DNA, Bacterial/chemistry
- DNA, Bacterial/genetics
- DNA, Ribosomal/chemistry
- DNA, Ribosomal/genetics
- Genes, rRNA
- Humans
- Male
- Mastoiditis/microbiology
- Microbial Sensitivity Tests
- Molecular Sequence Data
- Phylogeny
- RNA, Bacterial/genetics
- RNA, Ribosomal, 16S/genetics
- Receptors, Cell Surface/genetics
- Sequence Analysis, DNA
- Sequence Homology, Nucleic Acid
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Affiliation(s)
- D Stark
- Department of Microbiology, St Vincent's Hospital, Darlinghurst 2010, NSW, Australia
| | - L A Riley
- Department of Microbiology, St Vincent's Hospital, Darlinghurst 2010, NSW, Australia
| | - J Harkness
- Department of Microbiology, St Vincent's Hospital, Darlinghurst 2010, NSW, Australia
| | - D Marriott
- Department of Microbiology, St Vincent's Hospital, Darlinghurst 2010, NSW, Australia
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Stark D, Fotedar R, van Hal S, Beebe N, Marriott D, Ellis JT, Harkness J. Prevalence of enteric protozoa in human immunodeficiency virus (HIV)-positive and HIV-negative men who have sex with men from Sydney, Australia. Am J Trop Med Hyg 2007; 76:549-52. [PMID: 17360882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
A prospective, comparative study of the prevalence of enteric protozoa was determined among human immunodeficiency virus (HIV)- positive and HIV-negative men who have sex with men (MSM) in Sydney, Australia. A total of 1,868 patients submitted stool specimens; 1,246 were from MSM (628 HIV positive and 618 HIV positive) and 622 from non-MSM were examined over a 36-month period. A total of 651 (52.2%) stool specimens from MSM were positive for protozoa compared with 85 (13%) from non-MSM. There was a significant difference in the prevalence of Blastocystis hominis, Endolimax nana, Entamoeba histolytica/dispar complex, Entamoeba hartmanni, Iodamoeba butschlii, and Enteromonas hominis detected between MSM and non-MSM (P<0.001). The only notable difference between HIV-negative and HIV-positive MSM was that HIV-infected MSM were found to more likely have a Cryptosporidium parvum infection. Entamoeba histolytica was found in 3 patients, E. dispar in 25, and E. moshkovskii in 17, all of whom were MSM. When compared with a control group, MSM were significantly more likely to harbor intestinal protozoa and have multiple parasites present. The results of this study show high rates of enteric parasites persist in MSM and highlight the importance of testing for intestinal parasites in MSM. This is the first report of E. moshkovskii from MSM.
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Affiliation(s)
- Damien Stark
- Department of Microbiology, St. Vincent's Hospital, Darlinghurst, and Department of Medical and Molecular Biosciences, University of Technology, Sydney, New South Wales, Australia.
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40
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Stark D, van Hal S, Hillman R, Harkness J, Marriott D. Lymphogranuloma venereum in Australia: anorectal Chlamydia trachomatis serovar L2b in men who have sex with men. J Clin Microbiol 2007; 45:1029-31. [PMID: 17251405 PMCID: PMC1829134 DOI: 10.1128/jcm.02389-06] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Lymphogranuloma venereum (LGV) is a sexually transmitted infection that is causing an ongoing epidemic in men who have sex with men (MSM) in Europe, the United Kingdom, and North America. Twenty-nine rectal swabs positive for Chlamydia trachomatis were analyzed by real-time PCR for the presence of LGV serovars. Genotyping revealed an identical L2b serovar from four specimens. All patients were MSM and human immunodeficiency virus infected. Three of the four presented with severe ulcerative proctitis. We report a cluster of rectal LGV serovar L2b infections in Sydney, Australia.
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Affiliation(s)
- D Stark
- Department of Microbiology, St. Vincent's Hospital, Sydney, Australia.
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Fotedar R, Stark D, Beebe N, Marriott D, Ellis J, Harkness J. PCR detection of Entamoeba histolytica, Entamoeba dispar, and Entamoeba moshkovskii in stool samples from Sydney, Australia. J Clin Microbiol 2007; 45:1035-7. [PMID: 17229864 PMCID: PMC1829108 DOI: 10.1128/jcm.02144-06] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This study investigated the presence of Entamoeba histolytica, Entamoeba dispar, and Entamoeba moshkovskii in stool samples from a patient population in Sydney, Australia. Stool samples were tested by microscopy and PCR. Five patients were found with E. histolytica infections, while E. dispar and E. moshkovskii were observed in 63 (70.8%) and 55 (61.8%) patients, respectively, by PCR. This is the first study in Australia using molecular techniques to determine the presence of E. histolytica, E. dispar, and E. moshkovskii.
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Affiliation(s)
- R Fotedar
- Department of Microbiology, St. Vincent's Hospital, Sydney, Australia
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Abstract
Dientamoeba fragilis is a pathogenic trichomonad parasite that causes gastrointestinal disease in humans. We report seven cases of travelers' diarrhea caused by D fragilis in patients who had traveled to overseas destinations within Asia or the Pacific which occurred over an 8-month period. Patients presented with diarrhea lasting from 5 days to over 4 weeks. Dientamoeba fragilis should be considered as a cause of diarrhea in returning travelers.
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Affiliation(s)
- Damien Stark
- Department of Microbiology, St Vincent's Hospital, Sydney, NSW, Australia.
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Marriott D, Stark D, Harkness J. Veillonella parvula discitis and secondary bacteremia: a rare infection complicating endoscopy and colonoscopy? J Clin Microbiol 2006; 45:672-4. [PMID: 17108070 PMCID: PMC1829049 DOI: 10.1128/jcm.01633-06] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report a case of Veillonella parvula lumbar discitis and secondary bacteremia confirmed by molecular characterization of the 16S rRNA genes. Identification of the organism was essential for an appropriate choice of antimicrobial therapy following the failure of empirical flucloxacillin. Veillonella spp. are normal flora of the gastrointestinal tract, raising the possibility that an endoscopy and colonoscopy performed 8 weeks prior to presentation, during which small intestinal and rectal biopsies were obtained, was the portal of entry. This case highlights the importance of obtaining a microbiologic diagnosis, particularly in patients who previously have had procedures involving instrumentation.
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Affiliation(s)
- D Marriott
- Department of Microbiology, St.Vincent's Hospital, Darlinghurst, Sydney, NSW 2010, Australia.
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Stark D, van Hal S, Marriott D, Ellis J, Harkness J. Irritable bowel syndrome: a review on the role of intestinal protozoa and the importance of their detection and diagnosis. Int J Parasitol 2006; 37:11-20. [PMID: 17070814 DOI: 10.1016/j.ijpara.2006.09.009] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Revised: 09/06/2006] [Accepted: 09/19/2006] [Indexed: 12/19/2022]
Abstract
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder in which abdominal pain is associated with a defect or a change in bowel habits. Gut inflammation is one of the proposed mechanisms of pathogenesis. Recent studies have described a possible role for protozoan parasites, such as Blastocystis hominis and Dientamoeba fragilis, in the etiology of IBS. Dientamoeba fragilis is known to cause IBS-like symptoms and has a propensity to cause chronic infections but its diagnosis relies on microscopy of stained smears, which many laboratories do not perform, thereby leading to the misdiagnosis of dientamoebiasis as IBS. The role of B. hominis as an etiological agent of IBS is inconclusive, due to contradictory reports and the controversial nature of B. hominis as a human pathogen. Although Entamoeba histolytica infections occur predominately in developing regions of the world, clinical diagnosis of amebiasis is often difficult because symptoms of patients with IBS may closely mimic those patients with non-dysenteric amoebic colitis. Clinical manifestations of Giardia intestinalis infection also vary from asymptomatic carriage to acute and chronic diarrhoea with abdominal pain. These IBS-like symptoms can be continuous, intermittent, sporadic or recurrent, sometimes lasting years without correct diagnosis. It is essential that all patients with IBS undergo routine parasitological investigations in order to rule out the presence of protozoan parasites as the causative agents of the clinical signs.
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Affiliation(s)
- D Stark
- St. Vincent's Hospital, Department of Microbiology, Victoria St., Darlinghurst, NSW2010, Sydney, Australia.
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45
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Stark D, Pett S, Marriott D, Harkness J. Post-kala-azar dermal leishmaniasis due to Leishmania infantum in a human immunodeficiency virus type 1-infected patient. J Clin Microbiol 2006; 44:1178-80. [PMID: 16517925 PMCID: PMC1393159 DOI: 10.1128/jcm.44.3.1178-1180.2006] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report the first case of post-kala-azar dermal leishmaniasis due to Leishmania infantum in a human immunodeficiency virus type 1-infected patient in Australia. Molecular characterization of the isolate was performed using PCR restriction fragment length polymorphism targeting both repetitive sequences from Leishmania nuclear DNA and repetitive kinetoplast DNA minicircles for species differentiation.
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Affiliation(s)
- D Stark
- Department of Microbiology, St. Vincent's Hospital, Darlinghurst 2010 NSW, Sydney, Australia.
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46
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Affiliation(s)
- J Houston
- Crossley Sanatorium, Frodsham, England
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47
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48
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Stark D, Beebe N, Marriott D, Ellis J, Harkness J. Evaluation of three diagnostic methods, including real-time PCR, for detection of Dientamoeba fragilis in stool specimens. J Clin Microbiol 2006; 44:232-5. [PMID: 16390978 PMCID: PMC1351980 DOI: 10.1128/jcm.44.1.232-235.2006] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Dientamoeba fragilis is a protozoan parasite of humans that infects the mucosa of the large intestine and is associated with gastrointestinal disease. We developed a 5' nuclease (TaqMan)-based real-time PCR assay, targeting the small subunit rRNA gene, for the detection of D. fragilis in human stool specimens and compared its sensitivity and specificity to conventional PCR and microscopic examination by a traditional modified iron-hematoxylin staining procedure. Real-time PCR exhibited 100% sensitivity and specificity.
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Affiliation(s)
- D Stark
- Department of Microbiology, St. Vincent's Hospital, Sydney, Australia.
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Stark DJ, Beebe N, Marriott D, Ellis JT, Harkness J. Dientamoebiasis: clinical importance and recent advances. Trends Parasitol 2005; 22:92-6. [PMID: 16380293 DOI: 10.1016/j.pt.2005.12.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Revised: 11/02/2005] [Accepted: 12/09/2005] [Indexed: 11/24/2022]
Abstract
Dientamoeba fragilis, an unusual single-celled parasite that was described first in 1918, is found worldwide in the gastrointestinal tract of humans. D. fragilis has emerged from obscurity recently because it is now recognized as a common cause of chronic diarrhoea and is treatable with drugs. Recent molecular studies have described D. fragilis as having two genotypes. Diagnostic tests, based on conventional and real-time PCR, have been developed that will provide a rapid, sensitive and specific diagnosis of D. fragilis. These tests will also aid the elucidation of the host distribution and the life cycle of this pathogen.
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Affiliation(s)
- Damien J Stark
- St Vincent's Hospital, Department of Microbiology, Sydney, New South Wales 2010, Australia.
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Stark D, Beebe N, Marriott D, Ellis J, Harkness J. Prospective study of the prevalence, genotyping, and clinical relevance of Dientamoeba fragilis infections in an Australian population. J Clin Microbiol 2005; 43:2718-23. [PMID: 15956388 PMCID: PMC1151954 DOI: 10.1128/jcm.43.6.2718-2723.2005] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A prospective study was conducted over a 30-month period, in which fecal specimens from 6,750 patients were submitted to the Department of Microbiology at St. Vincent's Hospital, Sydney, Australia. Trophozoites of Dientamoeba fragilis were detected in 60 (0.9%) patients by permanent staining, and confirmation was performed by PCR. Gastrointestinal symptoms were present in all patients, with diarrhea and abdominal pain the most common symptoms. Thirty-two percent of patients presented with chronic symptoms. The average age of infected patients was 39.8 years. No correlation was found between D. fragilis and Enterobius vermicularis, a proposed vector of transmission for D. fragilis. The genetic diversity of 50 D. fragilis isolates was examined by PCR, and the PCR products were analyzed for the presence of restriction fragment length polymorphisms. These results showed no variation in the small-subunit rRNA gene and demonstrated a single genotype for all Australian isolates. This study shows the potential pathogenic properties of D. fragilis and the need for all laboratories to routinely test for this organism.
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Affiliation(s)
- D Stark
- Department of Microbiology, St. Vincent's Hospital, Sydney, Australia.
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