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Moraz M, Jacot D, Papadimitriou-Olivgeris M, Senn L, Greub G, Jaton K, Opota O. Universal admission screening strategy for COVID-19 highlighted the clinical importance of reporting SARS-CoV-2 viral loads. New Microbes New Infect 2020; 38:100820. [PMID: 33235799 PMCID: PMC7676852 DOI: 10.1016/j.nmni.2020.100820] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/03/2020] [Accepted: 11/13/2020] [Indexed: 12/26/2022] Open
Abstract
Previously limited to symptomatic patients, our hospital introduced a universal admission screening strategy for coronavirus disease 2019 on 25 April 2020. All patients were tested by RT-PCR. We observed decreased viral loads linked to increased screening of asymptomatic patients highlighting the fact that viral load values could guide infection control decisions.
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Affiliation(s)
- M. Moraz
- Institute of Microbiology, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
| | - D. Jacot
- Institute of Microbiology, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
| | - M. Papadimitriou-Olivgeris
- Infectious Diseases Service, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
- Service of Hospital Preventive Medicine, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
| | - L. Senn
- Service of Hospital Preventive Medicine, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
| | - G. Greub
- Institute of Microbiology, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
- Infectious Diseases Service, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
| | - K. Jaton
- Institute of Microbiology, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
| | - O. Opota
- Institute of Microbiology, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
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2
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Caruana G, Croxatto A, Coste AT, Opota O, Lamoth F, Jaton K, Greub G. Diagnostic strategies for SARS-CoV-2 infection and interpretation of microbiological results. Clin Microbiol Infect 2020; 26:1178-1182. [PMID: 32593741 PMCID: PMC7315992 DOI: 10.1016/j.cmi.2020.06.019] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/15/2020] [Accepted: 06/20/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND To face the current COVID-19 pandemic, diagnostic tools are essential. It is recommended to use real-time RT-PCR for RNA viruses in order (a) to perform a rapid and accurate diagnostic, (b) to guide patient care and management and (c) to guide epidemiological strategies. Further studies are warranted to define the role of serological diagnosis and a possible correlation between serological response and prognosis. OBJECTIVES The aim was to guide clinical microbiologists in the use of these diagnostic tests and clinicians in the interpretation of their results. SOURCES A search of literature was performed through PubMed and Google Scholar using the keywords SARS-CoV-2, SARS-CoV-2 molecular diagnosis, SARS-CoV-2 immune response, SARS-CoV-2 serology/antibody testing, coronavirus diagnosis. CONTENT The present review discusses performances, limitations and use of current and future diagnostic tests for SARS-CoV-2. IMPLICATIONS Real-time RT-PCR remains the reference method for diagnosis of SARS-CoV-2 infection. On the other hand, notwithstanding its varying sensitivity according to the time of infection, serology represents a valid asset (a) to try to solve possible discrepancies between a highly suggestive clinical and radiological presentation and negative RT-PCR, (b) to solve discrepancies between different PCR assays and (c) for epidemiological purposes.
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Affiliation(s)
- G Caruana
- Institut de Microbiologie, Département de médecine de laboratoire et pathologie (DMLP), Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Lausanne, Switzerland
| | - A Croxatto
- Institut de Microbiologie, Département de médecine de laboratoire et pathologie (DMLP), Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Lausanne, Switzerland
| | - A T Coste
- Institut de Microbiologie, Département de médecine de laboratoire et pathologie (DMLP), Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Lausanne, Switzerland
| | - O Opota
- Institut de Microbiologie, Département de médecine de laboratoire et pathologie (DMLP), Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Lausanne, Switzerland
| | - F Lamoth
- Institut de Microbiologie, Département de médecine de laboratoire et pathologie (DMLP), Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Lausanne, Switzerland; Service de Maladies Infectieuses, Département de médecine, Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Lausanne, Switzerland
| | - K Jaton
- Institut de Microbiologie, Département de médecine de laboratoire et pathologie (DMLP), Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Lausanne, Switzerland
| | - G Greub
- Institut de Microbiologie, Département de médecine de laboratoire et pathologie (DMLP), Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Lausanne, Switzerland; Service de Maladies Infectieuses, Département de médecine, Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Lausanne, Switzerland.
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Opota O, Mazza-Stalder J, Greub G, Jaton K. The rapid molecular test Xpert MTB/RIF ultra: towards improved tuberculosis diagnosis and rifampicin resistance detection. Clin Microbiol Infect 2019; 25:1370-1376. [PMID: 30928564 DOI: 10.1016/j.cmi.2019.03.021] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [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: 12/06/2018] [Revised: 03/14/2019] [Accepted: 03/16/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Tuberculosis diagnosis has dramatically improved since the introduction of the rapid molecular test Xpert MTB/RIF (Xpert) detecting M. tuberculosis and rifampicin resistance directly from clinical specimens, therefore shortening the turnaround time, reducing patient's isolation period and decreasing the time to start anti-TB drugs. The new version, Xpert MTB/RIF Ultra (Ultra), displays a higher sensitivity and an improved rifampicin resistance detection. Both tests have been endorsed by the World Health Organisation. AIMS Xpert and Ultra rapidly became widespread and paved the way for new approaches and new paradigms as well as for the development of molecular point-of-care tests (POCTs). In this narrative review, we aimed to address their performance in the diagnosis of tuberculosis and to discuss the expectations of these tests as well as their limits and the unmet needs. SOURCES Peer-reviewed publications addressing the diagnostic performance of Ultra and Xpert. CONTENT We focused on publications that evaluated the performance of Ultra and Xpert on the same group of patients or the same set of specimens in different tuberculosis-burden settings. IMPLICATIONS The studies published so far reported an increased sensitivity of Ultra when compared to Xpert, which represents a benefit for tuberculosis diagnosis. The fact that such a sensitive assay cannot distinguish between alive and dead bacilli emphasizes that caution should be exercised regarding indications and interpretation of results. Additional studies are needed to determine the true performance for the diagnosis of extrapulmonary tuberculosis because of the great diversity of the specimens.
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Affiliation(s)
- O Opota
- Institute of Microbiology, University of Lausanne, University Hospital of Lausanne, Lausanne, Switzerland.
| | - J Mazza-Stalder
- Pneumology Service, University Hospital of Lausanne, Lausanne, Switzerland
| | - G Greub
- Institute of Microbiology, University of Lausanne, University Hospital of Lausanne, Lausanne, Switzerland; Infectious Diseases Service, University Hospital of Lausanne, Lausanne, Switzerland
| | - K Jaton
- Institute of Microbiology, University of Lausanne, University Hospital of Lausanne, Lausanne, Switzerland
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Pilloux L, Baumgartner A, Jaton K, Lienhard R, Ackermann-Gäumann R, Beuret C, Greub G. Prevalence of Anaplasma phagocytophilum and Coxiella burnetii in Ixodes ricinus ticks in Switzerland: an underestimated epidemiologic risk. New Microbes New Infect 2018; 27:22-26. [PMID: 30534383 PMCID: PMC6278774 DOI: 10.1016/j.nmni.2018.08.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 08/27/2018] [Accepted: 08/29/2018] [Indexed: 11/25/2022] Open
Abstract
Ticks are vectors of several microorganisms responsible for infectious diseases in human and animals, such as Anaplasma phagocytophilum and Coxiella burnetii. In this study, we investigated the prevalence of these two bacteria in 62 889 Ixodes ricinus ticks in selected regions covering all Switzerland. A high prevalence of 11.9% of A. phagocytophilum DNA was observed by real-time PCR on 8534 pools of ticks. This pool prevalence corresponds to an estimated prevalence of 1.71% in individual tick. A total of 144 of the 171 collection sites (84.2%) were positive for the presence of A. phagocytophilum, and these sites were homogenously distributed throughout Switzerland. Such prevalence and geographical distribution underline the risk of human and animal exposure to A. phagocytophilum and highlight the need to assess the epidemiology and clinical diagnosis of human and animal anaplasmosis in Switzerland. However, DNA of C. burnetii was never found in any tick pool. This absence suggests a very low role of I. ricinus ticks as vector and reservoir of C. burnetii in Switzerland, and it supports previous reports demonstrating the role of sheep and goats in the epidemiology of Q fever. However, considering its pathogenic potential, it is necessary to keep monitoring for the possible reemergence of this bacterium in ticks in the future.
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Affiliation(s)
- L. Pilloux
- Institute of Microbiology of the Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - A. Baumgartner
- Federal Food Safety and Veterinary Office, Bern, Switzerland
| | - K. Jaton
- Institute of Microbiology of the Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - R. Lienhard
- ADMED Microbiologie, La Chaux-de-Fonds, Switzerland
- Spiez Laboratory, Federal Office for Civil Protection, Spiez, Switzerland
| | - R. Ackermann-Gäumann
- Swiss Reference Center for Tickborne Disease (NRZK/CNRT), Spiez, Switzerland
- Spiez Laboratory, Federal Office for Civil Protection, Spiez, Switzerland
| | - C. Beuret
- Spiez Laboratory, Federal Office for Civil Protection, Spiez, Switzerland
| | - G. Greub
- Institute of Microbiology of the Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Swiss Reference Center for Tickborne Disease (NRZK/CNRT), Spiez, Switzerland
- Corresponding author: G. Greub, Center for Research on Intracellular Bacteria, Institute of Microbiology, University Hospital Center and University of Lausanne, 1011 Lausanne, Switzerland
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5
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Bondolfi C, Vu F, Cavassini M, D'Acremont V, Greub G, Jaton K, Masserey E, Pongelli S, Bouche L, Ngarambe C, Bize R, Bodenmann P. 4.10-P4Epidemiology of sexually transmitted infections among female sex workers in Switzerland: a local exploratory cross-sectional study. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky048.143] [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: 11/12/2022] Open
Affiliation(s)
- C Bondolfi
- Department of Ambulatory Care and Community Medicine, Switzerland
| | - F Vu
- Department of Ambulatory Care and Community Medicine, Switzerland
| | - M Cavassini
- Department of Infectious Diseases, Switzerland
| | - V D'Acremont
- Department of Ambulatory Care and Community Medicine, Switzerland
| | - G Greub
- Institute of Microbiology, Switzerland
| | - K Jaton
- Institute of Microbiology, Switzerland
| | - E Masserey
- Department of Public Health in the canton of Vaud, Switzerland
| | | | - L Bouche
- Department of Ambulatory Care and Community Medicine, Switzerland
| | - C Ngarambe
- Department of Ambulatory Care and Community Medicine, Switzerland
| | - R Bize
- Centre for Public Health Practice and Evaluation, Switzerland
| | - P Bodenmann
- Department of Ambulatory Care and Community Medicine, Switzerland
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Mazza-Stalder J, Chevallier E, Opota O, Jaton K, Masserey E, Nicod L. P223 Tuberculosis. Medico-social approach in canton of Vaud, Switzerland. Chest 2017. [DOI: 10.1016/j.chest.2017.04.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Opota O, Balmpouzis Z, Berutto C, Kaiser-Guignard J, Greub G, Aubert JD, Prod'hom G, Manuel O, Jaton K. Visceral leishmaniasis in a lung transplant recipient: usefulness of highly sensitive real-time polymerase chain reaction for preemptive diagnosis. Transpl Infect Dis 2016; 18:801-804. [PMID: 27495987 DOI: 10.1111/tid.12585] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 02/10/2016] [Revised: 05/04/2016] [Accepted: 05/30/2016] [Indexed: 11/30/2022]
Abstract
We report the case of a lung transplant recipient in whom the diagnosis of visceral leishmaniasis (VL) was made by detection of parasites in a peripheral blood smear when the parasite load already reached 8.9 × 103 parasites/mL. We demonstrated that the VL diagnosis could have been done months before the development of symptoms by the use of Leishmania-specific real-time polymerase chain reaction (PCR), suggesting the role of preemptive PCR-based diagnosis in transplant recipients at risk for VL.
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Affiliation(s)
- O Opota
- Institute of Microbiology, University of Lausanne and University Hospital Center, Lausanne, Switzerland
| | - Z Balmpouzis
- Pneumology Service, University Hospital of Lausanne, Lausanne, Switzerland
| | - C Berutto
- Transplantation Center, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - J Kaiser-Guignard
- Hematology Service, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - G Greub
- Institute of Microbiology, University of Lausanne and University Hospital Center, Lausanne, Switzerland.,Infectious Diseases Service, University Hospital of Lausanne, Lausanne, Switzerland
| | - J-D Aubert
- Pneumology Service, University Hospital of Lausanne, Lausanne, Switzerland.,Transplantation Center, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - G Prod'hom
- Institute of Microbiology, University of Lausanne and University Hospital Center, Lausanne, Switzerland
| | - O Manuel
- Transplantation Center, University Hospital and University of Lausanne, Lausanne, Switzerland. .,Infectious Diseases Service, University Hospital of Lausanne, Lausanne, Switzerland.
| | - K Jaton
- Institute of Microbiology, University of Lausanne and University Hospital Center, Lausanne, Switzerland
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8
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Opota O, Senn L, Prod'hom G, Mazza-Stalder J, Tissot F, Greub G, Jaton K. Added value of molecular assay Xpert MTB/RIF compared to sputum smear microscopy to assess the risk of tuberculosis transmission in a low-prevalence country. Clin Microbiol Infect 2016; 22:613-9. [DOI: 10.1016/j.cmi.2016.04.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/30/2016] [Accepted: 04/08/2016] [Indexed: 10/21/2022]
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9
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Jaton L, Pillonel T, Jaton K, Dory E, Prod'hom G, Blanc DS, Tissot F, Bodenmann P, Greub G. Common skin infection due to Panton-Valentine leucocidin-producing Staphylococcus aureus strains in asylum seekers from Eritrea: a genome-based investigation of a suspected outbreak. Clin Microbiol Infect 2016; 22:739.e5-8. [PMID: 27283147 DOI: 10.1016/j.cmi.2016.05.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 03/17/2016] [Revised: 05/09/2016] [Accepted: 05/28/2016] [Indexed: 01/14/2023]
Abstract
Since late 2014, multiple cases of abscesses and boils due to methicillin-susceptible Staphylococcus aureus (MSSA) expressing the Panton-Valentine leucocidin (PVL) were observed in Eritrean asylum seekers in Lausanne, Switzerland. Strains isolated from infected Eritrean and non-Eritrean patients were compared by whole genome sequencing to determine whether these numerous cases result from an outbreak. The genome of S. aureus PVL-producing strains were sequenced and compared. Clinical and epidemiological characteristics of patients infected by PVL-producing strains were investigated. This work reports 15 cases of infections due to PVL-producing strains affecting mostly asylum seekers (n = 10), people working with refugees and/or exposed to Africans (n = 3). Most infections were due to closely related strains of CC152 (n = 8) and CC15 (n = 3), two distantly related (>34 000 core single nucleotide polymorphisms) clonal complexes. An epidemiological link between the 15 cases could be ruled out by whole genome sequencing (33 to 172 core single nucleotide polymorphisms between the different strains of a given complex). Altogether, these results reflect the probable high incidence of CC15 and CC152 PVL-producing strains in eastern Africa. Clinicians facing unusual skin infections in African refugees (or in any person returning from this region of high endemicity) should consider S. aureus PVL-producer before suspecting rare infections such as leishmaniasis or rickettsiosis. Clinicians should also remember that PVL are frequently expressed by MSSA in some regions of the world and that antibiotics that are efficient on toxin expression, such as clindamycin, represent the best therapeutic option.
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Affiliation(s)
- L Jaton
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - T Pillonel
- Institute of Microbiology, University of Lausanne and University Hospital of Lausanne, Lausanne, Switzerland
| | - K Jaton
- Institute of Microbiology, University of Lausanne and University Hospital of Lausanne, Lausanne, Switzerland
| | - E Dory
- Vulnerable Population Centre, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - G Prod'hom
- Institute of Microbiology, University of Lausanne and University Hospital of Lausanne, Lausanne, Switzerland
| | - D S Blanc
- Service of Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - F Tissot
- Infectious Diseases Service, University Hospital of Lausanne, Lausanne, Switzerland
| | - P Bodenmann
- Vulnerable Population Centre, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
| | - G Greub
- Institute of Microbiology, University of Lausanne and University Hospital of Lausanne, Lausanne, Switzerland.
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10
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Diene SM, Bertelli C, Pillonel T, Jacquier N, Croxatto A, Jaton K, Greub G. Comparative genomics of Neisseria meningitidis strains: new targets for molecular diagnostics. Clin Microbiol Infect 2016; 22:568.e1-7. [PMID: 27085725 DOI: 10.1016/j.cmi.2016.03.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 03/05/2016] [Accepted: 03/19/2016] [Indexed: 01/19/2023]
Abstract
In 2010, Jaton et al. (False-negative PCR result due to gene polymorphism: the example of Neisseria meningitidis. J Clin Microbiol 2010;48:4590-2) reported an isolate of Neisseria meningitidis serogroup B that was not detected by the ctrA quantitative real-time PCR (qRT-PCR) used in our diagnostic laboratory. Sequence analysis of ctrA revealed several single nucleotide polymorphisms responsible for the negative qRT-PCR. Therefore, we sequenced the genome of this isolate and performed comparative genomics to propose new gene targets for the specific detection of N. meningitidis from clinical specimens. We identified 11 genes as specific to N. meningitidis genomes and common to at least 177 (97%) of the 183 genomes available. Among them, three genes (metA, tauE and shlA) were selected to develop new qRT-PCRs for the detection of N. meningitidis DNA. The three qRT-PCRs were highly sensitive and specific, and they exhibited a good reproducibility when tested on plasmidic positive controls and genomic DNA extracted from strains of N. meningitidis and other relevant bacterial species. The clinical sensitivity and specificity of metA and tauE qRT-PCRs were both 100% based on a testing of cerebrospinal fluid samples positive for N. meningitidis or other clinically relevant bacteria. Despite a 100% specificity, the sensitivity of the shlA qRT-PCR was only 70%. We thus recommend using the metA and/or tauE qRT-PCRs developed here. To prevent PCR failure in the presence of new polymorphic strains, the detection of dual targets by duplex qRT-PCR would be more accurate and suitable for the diagnosis of N. meningitidis from clinical specimens.
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Affiliation(s)
- S M Diene
- Institute of Microbiology, University Hospital Center and University of Lausanne, Switzerland
| | - C Bertelli
- Institute of Microbiology, University Hospital Center and University of Lausanne, Switzerland
| | - T Pillonel
- Institute of Microbiology, University Hospital Center and University of Lausanne, Switzerland; SIB Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - N Jacquier
- Institute of Microbiology, University Hospital Center and University of Lausanne, Switzerland
| | - A Croxatto
- Institute of Microbiology, University Hospital Center and University of Lausanne, Switzerland
| | - K Jaton
- Institute of Microbiology, University Hospital Center and University of Lausanne, Switzerland
| | - G Greub
- Institute of Microbiology, University Hospital Center and University of Lausanne, Switzerland.
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Opota O, Prod'hom G, Andreutti-Zaugg C, Dessauges M, Merz L, Greub G, Chave JP, Jaton K. Diagnosis of Aerococcus urinae infections: Importance of matrix-assisted laser desorption ionization time-of-flight mass spectrometry and broad-range 16S rDNA PCR. Clin Microbiol Infect 2015; 22:e1-e2. [PMID: 26363405 DOI: 10.1016/j.cmi.2015.08.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 08/19/2015] [Accepted: 08/31/2015] [Indexed: 11/16/2022]
Affiliation(s)
- O Opota
- Institute of Microbiology, University of Lausanne and University Hospital Centre, University Hospital of Lausanne, Lausanne, Switzerland
| | - G Prod'hom
- Institute of Microbiology, University of Lausanne and University Hospital Centre, University Hospital of Lausanne, Lausanne, Switzerland
| | - C Andreutti-Zaugg
- La Source Hospital, University Hospital of Lausanne, Lausanne, Switzerland
| | - M Dessauges
- La Source Hospital, University Hospital of Lausanne, Lausanne, Switzerland
| | - L Merz
- Infectious Diseases Service, University of Lausanne and University Hospital Centre, Lausanne, Switzerland
| | - G Greub
- Institute of Microbiology, University of Lausanne and University Hospital Centre, University Hospital of Lausanne, Lausanne, Switzerland; Infectious Diseases Service, University of Lausanne and University Hospital Centre, Lausanne, Switzerland.
| | - J-P Chave
- La Source Hospital, University Hospital of Lausanne, Lausanne, Switzerland
| | - K Jaton
- Institute of Microbiology, University of Lausanne and University Hospital Centre, University Hospital of Lausanne, Lausanne, Switzerland
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12
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Giulieri S, Chapuis-Taillard C, Jaton K, Cometta A, Chuard C, Hugli O, Du Pasquier R, Bille J, Meylan P, Manuel O, Marchetti O. CSF lactate for accurate diagnosis of community-acquired bacterial meningitis. Eur J Clin Microbiol Infect Dis 2015; 34:2049-55. [PMID: 26282789 DOI: 10.1007/s10096-015-2450-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 07/02/2015] [Indexed: 11/25/2022]
Abstract
CSF lactate measurement is recommended when nosocomial meningitis is suspected, but its value in community-acquired bacterial meningitis is controversial. We evaluated the diagnostic performance of lactate and other CSF parameters in a prospective cohort of adult patients with acute meningitis. Diagnostic accuracy of lactate and other CSF parameters in patients with microbiologically documented episodes was assessed by receiver operating characteristic (ROC) curves. The cut-offs with the best diagnostic performance were determined. Forty-five of 61 patients (74%) had a documented bacterial (n = 18; S. pneumoniae, 11; N. meningitidis, 5; other, 2) or viral (n = 27 enterovirus, 21; VZV, 3; other, 3) etiology. CSF parameters were significantly different in bacterial vs. viral meningitis, respectively (p < 0.001 for all comparisons): white cell count (median 1333 vs. 143/mm(3)), proteins (median 4115 vs. 829 mg/l), CSF/blood glucose ratio (median 0.1 vs. 0.52), lactate (median 13 vs. 2.3 mmol/l). ROC curve analysis showed that CSF lactate had the highest accuracy for discriminating bacterial from viral meningitis, with a cutoff set at 3.5 mmol/l providing 100% sensitivity, specificity, PPV, NPV, and efficiency. CSF lactate had the best accuracy for discriminating bacterial from viral meningitis and should be included in the initial diagnostic workup of this condition.
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Affiliation(s)
- S Giulieri
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - C Chapuis-Taillard
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - K Jaton
- Institute of Microbiology, Department of Laboratories, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - A Cometta
- Internal Medicine Service, Regional Hospital, Yverdon, Switzerland
| | - C Chuard
- Internal Medicine Service, Cantonal Hospital, Fribourg, Switzerland
| | - O Hugli
- Emergency Medicine Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - R Du Pasquier
- Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - J Bille
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Institute of Microbiology, Department of Laboratories, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - P Meylan
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Institute of Microbiology, Department of Laboratories, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - O Manuel
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - O Marchetti
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
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Gallardo C, Williams-Smith J, Jaton K, Asner S, Cheseaux JJ, Troillet N, Manuel O, Berthod D. [Leptospirosis in a family after whitewater rafting in Thailand]. Rev Med Suisse 2015; 11:872-876. [PMID: 26050305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Leptospirosis is a zoonosis found worldwide, with an incidence that is approximately 10 times higher in the tropics than in temperate regions. The main reservoir of leptospirosis is the rat and human infection usually results from exposure to infected animal urine or tissues. Only 10% of cases are symptomatic. We present here two confirmed and two probable cases of leptospirosis in a family returning from whitewater rafting in Thailand, illustrating the wide variety of the clinical manifestations of this infection. Two of the patients were hospitalized and presented a probable Jarisch-Herxheimer reaction after initiation of beta-lactam therapy. The two others patients were treated empirically with doxycycline. We discuss here some relevant aspects of the epidemiology, clinical manifestations, therapy and the challenge of an early diagnosis of leptospirosis.
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Bally F, Quach A, Greub G, Jaton K, Petignat C, Ambord C, Fellay J, Masserey E, Spencer B. Opportunistic testing for urogenital infection with Chlamydia trachomatis in south-western Switzerland, 2012: a feasibility study. ACTA ACUST UNITED AC 2015; 20. [PMID: 25764187 DOI: 10.2807/1560-7917.es2015.20.9.21051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The feasibility of opportunistic screening of urogenital infections with Chlamydia trachomatis was assessed in a cross-sectional study in 2012, in two cantons of south-western Switzerland: Vaud and Valais. Sexually active persons younger than 30 years, not tested for C. trachomatis in the last three months, were invited for free C. trachomatis testing by PCR in urine or self-applied vaginal swabs. Of 2,461 consenting participants, 1,899 (77%) were women and all but six (0.3%) submitted a sample. Forty-seven per cent of female and 25% of male participants were younger than 20 years. Overall, 134 (5.5%) of 2,455 tested participants had a positive result and were followed up. Seven per cent of all candidates for screening were not invited, 10% of invited candidates were not eligible, 15% of the eligible candidates declined participation, 5% of tested participants testing positive were not treated, 29% of those treated were not retested after six months and 9% of those retested were positive for C. trachomatis. Opportunistic C. trachomatis testing proved technically feasible and acceptable, at least if free of charge. Men and peripheral rural regions were more difficult to reach. Efforts to increase testing and decrease dropout at all stages of the screening procedure are necessary.
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Affiliation(s)
- F Bally
- Institut Central (Hopital du Valais), Service des maladies infectieuses, Sion, Switzerland
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15
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Dormond L, Jaton K, de Vallière S, Genton B, Greub G. Malaria real-time PCR: correlation with clinical presentation. New Microbes New Infect 2015; 5:10-2. [PMID: 25905022 PMCID: PMC4404418 DOI: 10.1016/j.nmni.2015.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 12/31/2014] [Accepted: 02/18/2015] [Indexed: 11/25/2022] Open
Abstract
Among 112 patients infected only by Plasmodium falciparum, WHO criteria of severity were compared with parasite load assessed by microscopy and quantitative PCR. Clinical severity was significantly correlated with higher parasite load as determined by microscopy (p < 0.001) and by PCR (p < 0.001). Hence, quantitative PCR might be useful to predict outcome.
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Affiliation(s)
- L Dormond
- Institute of Microbiology, University Hospital Centre and University of Lausanne, Lausanne, Switzerland
| | - K Jaton
- Institute of Microbiology, University Hospital Centre and University of Lausanne, Lausanne, Switzerland
| | - S de Vallière
- Travel Clinic, Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland
| | - B Genton
- Travel Clinic, Department of Ambulatory Care and Community Medicine, University Hospital, Lausanne, Switzerland ; Service for Infectious Diseases, University Hospital Centre, Lausanne, Switzerland ; Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - G Greub
- Institute of Microbiology, University Hospital Centre and University of Lausanne, Lausanne, Switzerland ; Service for Infectious Diseases, University Hospital Centre, Lausanne, Switzerland
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16
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Opota O, Jaton K, Greub G. Microbial diagnosis of bloodstream infection: towards molecular diagnosis directly from blood. Clin Microbiol Infect 2015; 21:323-31. [PMID: 25686695 DOI: 10.1016/j.cmi.2015.02.005] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 02/01/2015] [Accepted: 02/04/2015] [Indexed: 11/19/2022]
Abstract
When a bloodstream infection (BSI) is suspected, most of the laboratory results-biochemical and haematologic-are available within the first hours after hospital admission of the patient. This is not the case for diagnostic microbiology, which generally takes a longer time because blood culture, which is to date the reference standard for the documentation of the BSI microbial agents, relies on bacterial or fungal growth. The microbial diagnosis of BSI directly from blood has been proposed to speed the determination of the etiological agent but was limited by the very low number of circulating microbes during these paucibacterial infections. Thanks to recent advances in molecular biology, including the improvement of nucleic acid extraction and amplification, several PCR-based methods for the diagnosis of BSI directly from whole blood have emerged. In the present review, we discuss the advantages and limitations of these new molecular approaches, which at best complement the culture-based diagnosis of BSI.
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Affiliation(s)
- O Opota
- Institute of Microbiology, University of Lausanne and University Hospital Center, Lausanne, Switzerland
| | - K Jaton
- Institute of Microbiology, University of Lausanne and University Hospital Center, Lausanne, Switzerland
| | - G Greub
- Institute of Microbiology, University of Lausanne and University Hospital Center, Lausanne, Switzerland; Infectious Diseases Service, University of Lausanne and University Hospital Center, Lausanne, Switzerland.
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Vogne C, Prod'hom G, Jaton K, Decosterd L, Greub G. A simple, robust and rapid approach to detect carbapenemases in Gram-negative isolates by MALDI-TOF mass spectrometry: validation with triple quadripole tandem mass spectrometry, microarray and PCR. Clin Microbiol Infect 2014; 20:O1106-12. [DOI: 10.1111/1469-0691.12715] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 06/05/2014] [Accepted: 06/08/2014] [Indexed: 11/30/2022]
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18
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Jaton K, Schrenzel J, Greub G. [Microbiological diagnosis of pneumonia]. Rev Med Suisse 2014; 10:2126-2129. [PMID: 25549372] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Pneumonia is an importance cause of mortality and morbidity in adults. Two types of pneumonia are defined: community-acquired and nosocomial pneumonia with their corresponding etiology such as pneumococci or Haemophilus influenzae and Pseudomonas or enterobacteriaceae, respectively. However, the reality is more complex with aspiration pneumonia, pneumonia in immunocompromised patient, and pneumonia in ventilated patients. Culture in the case of nosocomial pneumonia is especially important to obtain the antibiotic susceptibility of the infectious agent and to adjust therapy. Moreover for immunocompromised patients, the differential diagnosis is much wider looking for viruses, filamentous fungi and Pneumocystis can be very informative, using new molecular assays.
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Affiliation(s)
- K Jaton
- Institut de microbiologie, Université de Lausanne et CHUV, Lausanne
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19
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Palmiere C, Jaton K, Lobrinus A, Schrag B, Greub G. Post-mortem diagnosis of malaria. New Microbes New Infect 2014; 2:154-5. [PMID: 25356366 PMCID: PMC4184481 DOI: 10.1002/nmi2.52] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 04/25/2014] [Accepted: 05/12/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- C Palmiere
- University Centre of Legal Medicine, University Hospital Centre and University of Lausanne Lausanne, Switzerland ; Hospital Centre of Sion Sion, Switzerland
| | - K Jaton
- Institute of Microbiology, University Hospital Centre and University of Lausanne Lausanne, Switzerland
| | - A Lobrinus
- Division of Clinical Pathology, University Hospital Centre and University of Geneva Geneva, Switzerland
| | - B Schrag
- University Centre of Legal Medicine, University Hospital Centre and University of Lausanne Lausanne, Switzerland ; Hospital Centre of Sion Sion, Switzerland
| | - G Greub
- Institute of Microbiology, University Hospital Centre and University of Lausanne Lausanne, Switzerland ; Service of Infectious Diseases, University Hospital Centre Lausanne, Switzerland
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20
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21
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Gervais P, Manuel O, Jaton K, Giulieri S. [Skin infections due to rapid-growing mycobacteria]. Rev Med Suisse 2014; 10:931-934. [PMID: 24843991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Rapid-growing mycobacteria (e.g. M. abscessus and M. chelonae) are emerging pathogens with various clinical manifestations. Among immunocompetent individuals, rapid-growing mycobacteria may be responsible of pulmonary, cutaneous, osteoarticular and postoperative infections, as well as lymphadenitis and catheter-associated infections. Among immunocompromised patients, disseminated infections are also observed. Diagnosis relies on specific microbiological investigations to confirm etiology and guide antibiotic treatment. The treatment requires a multi-disciplinary approach that includes specific long-term antibiotic treatment, surgical debridement and reduction of immunosuppression whenever possible.
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22
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Jaton K, Peter O, Raoult D, Tissot JD, Greub G. Development of a high throughput PCR to detect Coxiella burnetii and its application in a diagnostic laboratory over a 7-year period. New Microbes New Infect 2013; 1:6-12. [PMID: 25356317 PMCID: PMC4184484 DOI: 10.1002/2052-2975.8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 07/22/2013] [Indexed: 01/20/2023] Open
Abstract
Q fever is a worldwide zoonotic infectious disease due to Coxiella burnetii. The clinical presentation may be acute (pneumonia and/or hepatitis) or chronic (most commonly endocarditis). Diagnosis mainly relies on serology and PCR. We therefore developed a quantitative real-time PCR. We first tested blindly its performance on various clinical samples and then, when thoroughly validated, we applied it during a 7-year period for the diagnosis of both acute and persistent C. burnetii infection. Analytical sensitivity (< 10 copies/PCR) was excellent. When tested blindly on 183 samples, the specificity of the PCR was 100% (142/142) and the sensitivity was 71% (29/41). The sensitivity was 88% (7/8) on valvular samples, 69% (20/29) on blood samples and 50% (2/4) on urine samples. This new quantitative PCR was then successfully applied for the diagnosis of acute Q fever and endovascular infection due to C. burnetii, allowing the diagnosis of Q fever in six patients over a 7-year period. During a local small cluster of cases, the PCR was also applied to blood from 1355 blood donors; all were negative confirming the high specificity of this test. In conclusion, we developed a highly specific method with excellent sensitivity, which may be used on sera for the diagnosis of acute Q fever and on various samples such as sera, valvular samples, aortic specimens, bone and liver, for the diagnosis of persistent C. burnetii infection.
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Affiliation(s)
- K Jaton
- Institute of Microbiology, University Hospital of Lausanne Lausanne, Switzerland
| | - O Peter
- Infectious Diseases and Immunology, Institut Central des Hôpitaux Valaisans Sion, Switzerland
| | - D Raoult
- Faculté de Médecine, Université de la Méditerranée Marseille, 13005, France
| | - J-D Tissot
- Service Régional Vaudois de Transfusion Sanguine Epalinges, Switzerland
| | - G Greub
- Institute of Microbiology, University Hospital of Lausanne Lausanne, Switzerland
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Clerc O, Prod'hom G, Senn L, Jaton K, Zanetti G, Calandra T, Greub G. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry and PCR-based rapid diagnosis of Staphylococcus aureus bacteraemia. Clin Microbiol Infect 2013; 20:355-60. [PMID: 23991748 DOI: 10.1111/1469-0691.12329] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [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: 02/06/2013] [Revised: 07/05/2013] [Accepted: 07/05/2013] [Indexed: 11/29/2022]
Abstract
Effective empirical treatment is of paramount importance to improve the outcome of patients with Staphylococcus aureus bacteraemia. We aimed to evaluate a PCR-based rapid diagnosis of methicillin resistance (GeneXpert MRSA) after early detection of S. aureus bacteraemia using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). Patients with a first episode of S. aureus bacteraemia identified using MALDI-TOF MS were randomized in a prospective interventional open study between October 2010 and August 2012. In the control group, antibiotic susceptibility testing was performed after MALDI-TOF MS identification on blood culture pellets. In the intervention group, a GeneXpert MRSA was performed after S. aureus identification. The primary outcome was the performance of GeneXpert MRSA directly on blood cultures. We then assessed the impact of early diagnosis of methicillin resistance on the empirical treatment. In all, 197 episodes of S. aureus bacteraemia were included in the study, of which 106 were included in the intervention group. Median time from MALDI-TOF MS identification to GeneXpert MRSA result was 97 min (range 25-250). Detection of methicillin resistance using GeneXpert MRSA had a sensitivity of 99% and a specificity of 100%. There was less unnecessary coverage of MRSA in the intervention group (17.1% versus 29.2%, p 0.09). GeneXpert MRSA was highly reliable in diagnosing methicillin resistance when performed directly on positive blood cultures. This could help to avoid unnecessary prescriptions of anti-MRSA agents and promote the introduction of earlier adequate coverage in unsuspected cases.
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Affiliation(s)
- O Clerc
- Infectious Diseases Service, University Hospital Centre and University of Lausanne, Lausanne, Switzerland
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Lovis A, Clerc O, Lazor R, Jaton K, Greub G. Isolated mediastinal necrotizing granulomatous lymphadenopathy due to cat-scratch disease. Infection 2013; 42:153-4. [DOI: 10.1007/s15010-013-0484-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 05/22/2013] [Indexed: 12/01/2022]
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Lamoth F, Jaton K, Vaudaux B, Greub G. Parachlamydia and Rhabdochlamydia: Emerging Agents of Community-Acquired Respiratory Infections in Children. Clin Infect Dis 2011; 53:500-1. [DOI: 10.1093/cid/cir420] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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27
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Giulieri S, Morisod B, Edney T, Odman M, Genne D, Malinverni R, Hammann C, Musumeci E, Voide C, Greub G, Masserey E, Bille J, Cavassini M, Jaton K. Outbreak of Mycobacterium haemophilum Infections after Permanent Makeup of the Eyebrows. Clin Infect Dis 2011; 52:488-91. [DOI: 10.1093/cid/ciq191] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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28
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Abstract
Actinobaculum schaalii is a new species that has so far been isolated from human blood, urine and pus. Its importance has probably been underestimated and other Actinobaculum spp. may also have been underdiagnosed. This retrospective study comprises all known cases of A. schaalii infections identified since 2004 in the canton of Neuchâtel (170,000 inhabitants), Switzerland. Strains were cultivated and isolated in the bacteriology laboratory using its routine procedure. Identification included a Rapid ID 32 A strip (bioMérieux) and 16S rRNA gene sequencing. Twenty-one positive samples were found in 19 patients (11 male, 8 female) of all ages (range 16-91 years): 10 from urine (50%), six from blood (30%), one from both blood and urine (5%), and three from pus (15%). Thirteen out of 17 (76%) cases with either blood or urine specimens had underlying genitourinary tract pathologies. When urine cultures were positive for A. schaalii, leucocytes were found in all samples (10/10, 100%) but all nitrite tests were negative (10/10, 100%). The onset of appropriate treatment was delayed due to the diminished sensitivity of A. schaalii to the antibiotics commonly used for UTIs (i.e. ciprofloxacin and trimethoprim/sulfamethoxazole) and to the delay in microbiological diagnosis. A. schaalii should specifically be searched in all cases of leukocyturia with a negative nitrite test but with Gram-positive rods in the Gram stain, in patients with underlying genitourinary tract pathology, instead of dismissing these findings as clinically irrelevant colonization by coryneform bacteria. This infection may be much more common than previously thought.
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Affiliation(s)
- C Beguelin
- Department of Internal Medicine, HNE Community Hospital, Lausanne, Switzerland
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29
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Jaton K, Greub G. [PCR in microbiology: from DNA amplification to results interpretation]. Rev Med Suisse 2007; 3:931-2, 934-8. [PMID: 17575968] [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] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Nucleic acid amplification (PCR) allows a relatively rapid and accurate diagnosis of infection caused by intracellular bacteria and other fastidious pathogens for which culture is difficult or impossible. Thus, Chalamydia trachomatis PCR largely improved our ability to diagnose chlamydial infection. PCR also exhibits a high sensitivity and a high reproductibility. However PCR has limitations that have to be taken into consideration to appropriately interpret the results. Such interpretation is difficult and should take into account the characteristics of the test, the microbial agent identified, the sample tested, and the clinical presentation. It is therefore essential that clinical microbiologists and clinicians share their knowledge and expertise to interpret PCR results at both clinical and analytical levels.
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Affiliation(s)
- K Jaton
- Institut de microbiologie Université de Lausanne CHUV, 1011 Lausanne.
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Abstract
We describe the case of a patient with a culture-proven infection of the ascending aorta caused by Legionella pneumophila 16 months after cardiac transplantation. Serology follow-up and surveillance culture of the hospital water supply suggested a nosocomial acquisition of the infection during the post-transplantation period. The diagnosis was made after 5 months of recurrent unexplained febrile episodes. A Teflon ring implanted around the aortic suture line during the intervention may have contributed to the unusual localization of the infection. The patient was successfully treated with antibiotics and aortic reconstruction.
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Affiliation(s)
- S Guyot
- Service of Infectious Diseases, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Altwegg M, Süess O, Jaton K, Greub G, Egli K. P919 Specimen pooling for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae in urogenital specimens. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70760-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Zufferey J, Togni G, Hohlfeld P, Bille J, Forestier F, Jaton K. [Diagnosis of materno-fetal toxoplasmosis]. Rev Med Suisse Romande 2000; 120:449-54. [PMID: 10911751] [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] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The antenatal diagnosis of congenital toxoplasmosis represents today an important application of molecular diagnostic methods such as PCR. Done directly in amniotic fluid, the PCR for T. gondii is able to detect in utero infected foetus with high probability. Doing so, it precludes to obtain foetal blood and to use more cumbersome and lengthy procedures such as inoculation to cell lines or to mice. Although it is use today in many centres, the molecular diagnosis of T. gondii by PCR is neither commercialized nor standardised. The objective of this report is to present the methodology used in our institution and to establish its degree of validation.
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Affiliation(s)
- J Zufferey
- Institut de microbiologie, CHUV, Lausanne
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Cavassini M, Wenger A, Jaton K, Blanc DS, Bille J. Evaluation of MRSA-Screen, a simple anti-PBP 2a slide latex agglutination kit, for rapid detection of methicillin resistance in Staphylococcus aureus. J Clin Microbiol 1999; 37:1591-4. [PMID: 10203531 PMCID: PMC84841 DOI: 10.1128/jcm.37.5.1591-1594.1999] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.6] [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
The MRSA-Screen test (Denka Seiken Co., Ltd., Tokyo, Japan), consisting of a slide latex agglutination kit that detects PBP 2a with a monoclonal antibody, was blindly compared to the oxacillin disk diffusion test, the oxacillin-salt agar screen, and PCR of the mecA gene for the detection of methicillin resistance in Staphylococcus aureus. A total of 120 methicillin-susceptible S. aureus (MSSA) and 80 methicillin-resistant S. aureus (MRSA) isolates, defined by the absence or presence of the mecA gene, respectively, were tested. The MRSA-Screen test, the oxacillin disk diffusion test, and the oxacillin-salt agar screening test showed sensitivities of 100, 61.3, and 82.5% and specificities of 99.2, 96.7, and 98.3%, respectively. We conclude that the MRSA-Screen is a very accurate, reliable, and fast test (15 min) for differentiation of MRSA from MSSA colonies on agar plates.
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Affiliation(s)
- M Cavassini
- Institut de Microbiologie, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
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Peters M, Pohlenz J, Jaton K, Ninet B, Bille J. Studies of the detection of Listeria monocytogenes by culture and PCR in cerebrospinal fluid samples from ruminants with listeric encephalitis. Zentralbl Veterinarmed B 1995; 42:84-8. [PMID: 7483908 DOI: 10.1111/j.1439-0450.1995.tb00686.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A total of 14 cerebrospinal fluid (CSF) samples from ruminants clinically suspected of suffering from listeric encephalitis were examined by polymerase chain reaction (PCR) for the detection of Listeria monocytogenes (L. m.). Of these samples, 11 were examined bacteriologically. Although the clinical diagnosis was confirmed in eight of 11 ruminants by histological and/or bacteriological examination of the brains, L. m. was only detected in one of the CSF samples using PCR, and in none by culture. The PCR-positive CSF sample was obtained from a sheep which had been treated with antibiotics prior to CSF sampling. From these findings, it was concluded that L. m. only occasionally gains access to the meningoventricular system in the course of listeric encephalitis of ruminants and that a reliable aetiological in vivo diagnosis of listeric encephalitis generally cannot be based on the detection of L. m. in the CSF of affected ruminants.
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Affiliation(s)
- M Peters
- Institute of Microbiology and Infectious Diseases of Animals, School of Veterinary Medicine, Hannover, Germany
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Jaton K, Sahli R, Bille J. Development of polymerase chain reaction assays for detection of Listeria monocytogenes in clinical cerebrospinal fluid samples. J Clin Microbiol 1992; 30:1931-6. [PMID: 1500495 PMCID: PMC265418 DOI: 10.1128/jcm.30.8.1931-1936.1992] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.5] [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: 12/27/2022] Open
Abstract
In order to improve the diagnosis of Listeria meningitis or meningoencephalitis, especially in patients who have received antibiotics before their cerebrospinal fluid (CSF) has been examined, two assays for the detection of Listeria monocytogenes based on the polymerase chain reaction (PCR) were evaluated. After a standard PCR, the amplified DNA was detected either by a second round of PCR with internal primers followed by gel electrophoresis and ethidium bromide staining (nested PCR) or by dot blot hybridization to an internal digoxigenin-labeled probe (PCR-dot blot). For PCR, two sets of primers within the invasion-associated protein gene (iap gene) were chosen. They allowed for the highly specific detection of all L. monocytogenes reference strains tested (serotypes 1/2a, 1/2b, 1/2c, 3a, 3b, 3c, 4a, 4b, 4c, 4d, and 7). These primers did not detect amplification products from various other gram-positive or gram-negative bacterial DNAs or human DNA. The sensitivities of both assays were assessed on sterile CSF samples that were artificially seeded with serial dilutions of L. monocytogenes serotype 4b cells. By both methods the limit of detection was less than 10 cells in the initial reaction. Since the nested PCR is more prone to contamination because of manipulation of the amplified products, a standard PCR assay followed by dot blot hybridization was applied to 52 CSF samples in a retrospective study. Of 28 CSF samples which were sterile or positive for bacteria other than Listeria species, 24 were PCR negative. In contrast, from 17 patients with culture-proven Listeria meningitis, 14 of 17 initial CSF samples were PCR positive, as were 3 of 7 culture-negative followup CSF samples taken after patients received antibiotics. These results support the usefulness of this approach in the diagnosis of Listeria meningitis, in particular, when antibiotic administration precedes culture of CSF.
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Affiliation(s)
- K Jaton
- Centre National des Listeria, University Hospital, Lausanne, Switzerland
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