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The demand for rapid molecular diagnostics for respiratory viruses has increased substantially. Several point-of-care PCR platforms have become available, yet comparative performance data remain limited. To evaluate the diagnostic accuracy and operational reliability of four rapid PCR platforms for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza A and B viruses (IAV, IBV), and respiratory syncytial virus (RSV), in comparison with the GeneXpert (Cepheid, USA) platform. Nasopharyngeal swabs from patients with respiratory symptoms were tested using the GeneXpert, positive samples were subsequently analysed on four alternative systems: the 30-minute and 1-hour M10 (SD Biosensor, South Korea) assays, FlashDetect™ Flash10 (Coyote Bioscience, China), Vivalytic (Bosch Healthcare Solutions, Germany), and Galaxy Lite (Igenesis, China). Additional lower viral load samples and cultured IAV/ IBV strains were included. A total of 223 GeneXpert positive samples were prospectively analysed. Flash10 showed 94.6% overall agreement, missing SARS-CoV-2 (n = 4, GeneXpert Cycle threshold (Ct) min-max; 37.7-42.2), IAV (n = 5, 32.8-37.7), and IBV (n = 3, 26.5-36.7). Vivalytic showed 83.0% overall agreement, missing SARS-CoV-2 (n = 16, 30.4-42.2), IAV (n = 9, 26.8-37.7), IBV (n = 9, 27.2-36.7), and RSV (n = 4, 31.5-37.0). Galaxy Lite achieved 88.2% overall agreement but failed in 27.2% of test runs. With a smaller sample size the M10 (30-minute) assay showed 98.6% overall agreement with GeneXpert, missing one SARS-CoV-2 case (Ct 39.7). Among four platforms, the M10 (30-min version) and Flash10 platforms demonstrated the highest agreement rates with the GeneXpert. The variability in performance highlights the importance of independent platform evaluation.

Background: Infections are a common and serious threat to patients with acute ischemic stroke. The aim of this study was to assess the effect of infection on mortality and functional outcome at discharge and at 1 year. Methods: From a consecutive cohort study in 11 centers, the Netherlands Stroke Survey, we selected 521 patients with ischemic stroke admitted to hospital within 48 h of onset. Stroke-associated infection was defined as infection occurring within 7 days after admission. Poor outcome (modified Rankin score >2) was recorded at discharge and at 1 year. Results: Stroke-associated infection occurred in 78 patients (15%); 39 of these (7.5%) had pneumonia and 23 (4.4%) had urinary tract infection. Overall, 276 patients (53%) had a poor outcome at 1 year. Poor outcome was recorded in 69 patients with stroke-associated infection (88%), and 37 of the 78 patients with stroke-associated infection (47%) had died at 1 year. After adjustment for confounders, stroke-associated infection was associated with poor outcome at discharge [odds ratio (OR) 2.6, 95% confidence interval (CI) 1.0–6.7] and at 1 year (OR 3.8, 95% CI 1.8–8.9). Pneumonia had a stronger association with poor outcome at 1 year (OR 10, 95% CI 2.2–46). Conclusions: This study suggests that stroke-associated infection, in particular pneumonia, is independently associated with poor functional outcome after ischemic stroke.

We studied nosocomial infections due to Mycobacterium bovis bacille Calmette-Guérin (BCG) Onco-TICE bacteria, transmitted by contamination of medication prepared in BCG Onco-TICE–contaminated hoods in the pharmacy, in 5 immunocompromised patients at 3 hospitals. The BCG strains cultured from the patients had the same DNA profile as the BCG Onco-TICE strain used for bladder instillation. To prevent these infections, a change from open to closed preparation was made; strictly separated preparation in time of BCG Onco-TICE instillation and chemotherapy was enforced, the biological safety cabinet was disinfected between preparations, and gloves were changed between preparations

BackgroundThe demand for rapid molecular diagnostics for respiratory viruses has increased substantially. Several point-of-care PCR platforms have become available, yet comparative performance data remain limited.ObjectivesTo evaluate the diagnostic accuracy and operational reliability of four rapid PCR platforms for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza A and B viruses (IAV, IBV), and respiratory syncytial virus (RSV), in comparison with the GeneXpert (Cepheid, USA) platform.MethodsNasopharyngeal swabs from patients with respiratory symptoms were tested using the GeneXpert, positive samples were subsequently analysed on four alternative systems: the 30-minute and 1-hour M10 (SD Biosensor, South Korea) assays, FlashDetect™ Flash10 (Coyote Bioscience, China), Vivalytic (Bosch Healthcare Solutions, Germany), and Galaxy Lite (Igenesis, China). Additional lower viral load samples and cultured IAV/ IBV strains were included.ResultsA total of 223 GeneXpert positive samples were prospectively analysed. Flash10 showed 94.6% overall agreement, missing SARS-CoV-2 (n = 4, GeneXpert Cycle threshold (Ct) min-max; 37.7-42.2), IAV (n = 5, 32.8-37.7), and IBV (n = 3, 26.5-36.7). Vivalytic showed 83.0% overall agreement, missing SARS-CoV-2 (n = 16, 30.4-42.2), IAV (n = 9, 26.8-37.7), IBV (n = 9, 27.2-36.7), and RSV (n = 4, 31.5-37.0). Galaxy Lite achieved 88.2% overall agreement but failed in 27.2% of test runs. With a smaller sample size the M10 (30-minute) assay showed 98.6% overall agreement with GeneXpert, missing one SARS-CoV-2 case (Ct 39.7).ConclusionAmong four platforms, the M10 (30-min version) and Flash10 platforms demonstrated the highest agreement rates with the GeneXpert. The variability in performance highlights the importance of independent platform evaluation.

In this clinical pearl an ectopic human Dioctophyma renale infection in the abdominal cavity is reported for the first time. The patient presented with a gastric perforation and the release of an adult Dioctophyma renale through an abdominal drain and three co-infections (Plasmodium malariae, Strongyloides stercoralis and Mansonella perstans).

Enterobacter species were studied longitudinally in a children’s hospital. In total, 287 Enterobacter isolates were obtained from 171 children in 15 different wards (from March 1995 through April 1997). Strains were typed by random amplified polymorphic DNA and pulsed-field gel electrophoresis, which were concordant in outcome. In total, 97 DNA types and 199 colonization events were identified. A predominant clone was isolated 111 times from 62 children; another clone was isolated 19 times from 10 patients. These clones caused 36% of all colonizations. In 34% of the children, Enterobacter clones were found in 2–4 patients. The remaining colonizations were due to unique Enterobacter isolates. A large proportion of the Enterobacter strains was acquired through cross-transmission. This finding contrasts with the prevailing opinion that resistant Enterobacter strains are selected primarily from the patient’s own gut flora

Melioidosis, caused by the Gram-negative bacterium Burkholderia pseudomallei, is an opportunistic infection across the tropics. Here, we provide a systematic overview of imported human cases in a non-endemic country over a 25-year period. All 55 Dutch microbiology laboratories were contacted in order to identify all B. pseudomallei positive cultures from 1990 to 2018. A response rate of 100% was achieved. Additionally, a systematic literature search was performed, medical-charts reviewed, and tissue/autopsy specimens were re-assessed. Thirty-three travelers with melioidosis were identified: 70% male with a median-age of 54 years. Risk factors were present in most patients (n = 23, 70%), most notably diabetes (n = 8, 24%) and cystic fibrosis (n = 3, 9%). Countries of acquisition included Thailand, Brazil, Indonesia, Panama, and The Gambia. Disease manifestations included pneumonia, intra-abdominal abscesses, otitis externa, genitourinary, skin-, CNS-, and thyroid gland infections. Twelve (36%) patients developed sepsis and/or septic shock. Repeat episodes of active infection were observed in five (15%) and mortality in four (12%) patients. Post-mortem analysis showed extensive metastatic (micro)abscesses amongst other sites in the adrenal gland and bone marrow. The number of imported melioidosis is likely to increase, given rising numbers of (immunocompromised) travelers, and increased vigilance of the condition. This first systematic retrospective surveillance study in a non-endemic melioidosis country shows that imported cases can serve as sentinels to provide information about disease activity in areas visited and inform pre-travel advice and post-travel clinical management.

The host-response parameters fever, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) are activated in concert by cytokines such as interleukin-6 (11-6). 11-6 is secreted in response to Escherichia coli infection of the urinary tract. This study tested the hypothesis that the level of fever, CRP, and ESR is coregulated in individual patients. Body temperature, CRP, ESR, pyuria, and renal concentrating capacity were analyzed in 692 children with first-time urinary tract infections. The association of the parameters was evaluated by correlation and multiple regression analysis. The body temperature, CRP, and ESR were significantly correlated (r = .54, .58, and .58; P < .001), and variation in CRP and ESR explained rv4O% of the variation in fever. In contrast, the renal concentrating capacity and pyuria were weakly or not at all correlated with the febrile response (r = −.22; P < .001),and <10% ofthe variation in renal concentrating capacity was explained by the other parameters. The results suggest that fever, CRP, and ESR describe the same aspect of the host response to UTI.

Bacterial factors associated with long-term persistence in the colon have not been defined. Individual Escherichia coli strains in the colonic flora of 13 schoolgirls with asymptomatic bacteriuria were identified by electromorphic typing of chromosomally encoded enzymes and defined as resident or transient. The strains were characterized as to serotype, receptor specificity, and adherence to the human colonic epithelial cell line HT-29. Colonic resident strains expressed P fimbriae, adhered to colonic epithelial cells via a mannose-resistant mechanism, and expressed the uropathogenic serotypes O1, O2, O6, O7, O18, O25, or O75 more often than did the transient strains, which were often nontypeable. The serotype and hemagglutination pattern were generally retained during intestinal carriage, in contrast to the loss of such properties upon prolonged colonization of the urinary tract. P fimbriae with Galα1→4Galβ-specific adherence may, in fact, have evolved to increase persistence in the colon.

The mechanism whereby attachment enhances Escherichia coli virulence in the urinary tract was studied by a detailed analysis of the host response to bacteriuria. Episodes of bacteriuria in 1473 children were followed prospectively from 1970 to 1984. To study the inflammatory response to the bacteriuric epidoses, were corded body temperature, C-reactive protein, micro sedimentation rate, urinary leukocyte count, and renal concentrating capacity. Bacterial isolates from each episode were identified and saved, and the adhesive capacity of 2669 E. coli strains was defined by their binding to galactoseαl→4galactoseβ-containing receptors. Inflammatory response was significantly higher and renal concentrating capacity significantly lower during episodes caused by attaching strains. There was a linear relation between the number of indicators of inflammation and the proportion of galactoseαl→4galactoseβbinding strains present. Vesicoureteric reflux potentiated the inflammatory response. Attaching strains of E. coli thus appeared to be more capable of causing inflammation than were other bacteria. The potentiating effect of attachment on inflammation explains the over-representation of galactoseαl→4galactoseβ-recognizing bacteria in patients with acute pyelonephritis.