Pneumocystis jiroveci is the major cause of pneumonia in immunocompromised patients. To evaluate the performance of single and nested-polymerase chain reaction (PCR) methods compared with immunofluorescent assay (IFA) and cytological staining for diagnosis of P. jiroveci infection, the bronchoalveolar lavage (BAL) and sputum samples from 60 immunocompromised patients were studied. Between January 2005 and March 2008, 75 respiratory specimens (41 BAL and 34 sputum samples) were examined for P. jiroveci identification. We used the clinical classification as our diagnostic standard and we considered true positive the definite or probable Pneumocystis pneumonia. Fourteen patients (23.3%) developed Pneumocystis pneumonia. Eleven patients had a positive IFA but only nine were positive by cytological staining. Sixteen patients had a positive detection of P. jiroveci by PCR and nested-PCR. Thirteen of these patients were considered as having a definite Pneumocystis pneumonia and one patient with a probable Pneumocystis pneumonia. Five other patients had a positive detection only by nested-PCR. These patients were classified as no Pneumocystis pneumonia. PCR detection of P. jiroveci is a very sensitive test and will offer a powerful technique in clinical laboratories for the routine diagnosis of Pneumocystis pneumonia. Using the nested-PCR, additional clinical cases can be diagnosed, but there is then an obvious risk of detecting subclinical colonisation by P. jiroveci.

Background Serologic diagnosis of Chlamydophila pneumoniae (Cpn) infection routinely involves assays for the presence of IgG and IgM antibodies to Cpn. Although IgA antibodies to Cpn have been found to be of interest in the diagnosis of chronic infections, their significance in serological diagnosis remains unclear. The microimmunofluorescence (MIF) test is the current method for the measurement of Cpn antibodies. While commercial enzyme linked immunosorbent assays (ELISA) have been developed, they have not been fully validated. We therefore evaluated and optimized a commercial ELISA kit, the SeroCP IgA test, for the detection of Cpn IgA antibodies. Methods Serum samples from 94 patients with anti-Cpn IgG titers ≥ 256 (study group) and from 100 healthy blood donors (control group) were tested for the presence of IgA antibodies to Cpn, using our in-house MIF test and the SeroCP IgA test. Two graph receiver operating characteristic (TG-ROC) curves were created to optimize the cut off given by the manufacturer. Results The MIF and SeroCP IgA tests detected Cpn IgA antibodies in 72% and 89%, respectively, of sera from the study group, and in 9% and 35%, respectively, of sera from the control group. Using the MIF test as the reference method and the cut-off value of the ELISA test specified by the manufacturer for seropositivity and negativity, the two tests correlated in 76% of the samples, with an agreement of Ƙ = 0.54. When we applied the optimized cut-off value using TG-ROC analysis, 1.65, we observed better concordance (86%) and agreement (0.72) between the MIF and SeroCP IgA tests. Conclusion Use of TG-ROC analysis may help standardize and optimize ELISAs, which are simpler, more objective and less time consuming than the MIF test. Standardization and optimization of commercial ELISA kits may result in better performance.

La fièvre Q est une anthropozoonose de répartition mondiale due à Coxiella burnetii. Cette maladie, le plus souvent bénigne, voire asymptomatique, peut parfois se présenter sous forme d’infections sévères aigues ou chroniques.

Les atteintes tuberculeuses multifocales ou disséminées sont rares, représentant 9 à 10 % des atteintes extra-pulmonaires.

Chlamydia trachomatis (Ct) and Chlamydophila pneumoniae (Cpn) are obligate intracellular bacteria causing genital tract infections (GTI) and respiratory tract infections (RTI), respectively. Antigenic cross-reactivity between the two species may complicate serologic diagnosis. In this study, we compared the performance of two ELISA tests in relation to microimmunofluorescence (MIF) for the detection of Ct and Cpn IgG antibodies. We also explored the degree of cross-reactivity by ELISA and MIF. Among 278 positive sera for Cpn and/or Ct IgG antibodies in the MIF, 153 were from patients with GTI and 125 were from patients with RTI. These sera were tested by our in house MIF test and by two commercial ELISA: SeroCP and SeroCT for the detection of anti-Cpn IgG antibodies and anti-Ct IgG antibodies, respectively. In sera from patients with RTI, correlation between MIF and SeroCP was 92%. The specificity of this test was 38.5%. In fact, among the 140 sera from patients with GTI and that cross-reacted in MIF, only six were confirmed by the two ELISA tests as having IgG antibodies to Ct. The correlation between MIF and SeroCT was 80%. The specificity of this test was 100%. Indeed, among the 65 sera from patients with RTI with cross-reactions in MIF, 30 sera showed a negative SeroCT test. SeroCT was highly specific and could diminish considerably the extent of cross-reactions. Whilst, SeroCP test was not specific enough to distinguish between the presence of IgG antibodies and Cpn or Ct.

OBJECTIVE:Our aim is to report the clinical aspects, the etiologies, the treatment and the evolution of the psoas abscess in the adult.METHODS:Our retrospective study concerns 38 cases of psoas abscesses collected in the Department of Infectious Diseases of Sfax (Tunisia), over a period of 16 years (January 1990 - December 2005).RESULTS:The average age is 44 years (extremes: 16-76 years). The sex-ratio is 1.4. Six patients were diabetics and one had a chronic renal injury at the stage of hemodialysis. The clinical manifestations were: a fever (76.4%), an abdomino-pelvic ache (84.2%) and a psoitis (34.2%). All patients had a biologic inflammatory syndrome with a hyperleucocytosis in 28 cases. The abscess was one-sided in 29 cases and bilateral in 9 cases. After microbiological study and/or histological study, pathogens were identified in 31 patients, they were Staphylococcus aureus (10 cases), Staphylococcus lugdunensis (1 case), Streptococci (3 cases), Escherichia coli (2 cases), Bacteroides fragilis (1 case), Actinomyces (2 cases), Brucella (3 cases), Mycobacterium tuberculosis (8 cases) and Candida glabrata (1 case). The psoas abscess was primary in 10 cases and secondary in 28 cases. All the patients received an antibiotherapy or an antifungal therapy adapted to the micro-organism in cause, with a drainage of the abscess in 25 cases (surgical in 9 cases and percutaneous in 16 cases). The evolution was favourable in 36 cases. One patient presented recurrences and one patient died.CONCLUSION:The psoas abscess of the adult is characterized by a polymorphe clinical presentation. Germs in cause are very variable.

Objective: Surgery remains the ideal treatment for hydatid cysts. However, medical treatment with albendazole can be eficient and can, in some circumstances, replace surgery.Patients and methods: We report three cases of multiple hydatid cysts considered inoperable and treated by albendazole. The evaluation of results was based on computerized tomography. Cure was defined as disappearance of the cyst and improvement was defined as a clear decrease (at least 25%) of its size or a clear increase of the cystic density.Results: Cure was obtained in 41% and improvement in 50% of 22 cysts.Comments: The efficiency of chemotherapy in hydatidosis is well proved. Medical treatment is indicated when surgery is not possible and to reduce post surgical dissemination and relapse. Indications, optimal protocols, and criteria of good response should be standardized and evaluated in large series so as to optimize medical treatment. (C) 2002 Editions scientifiques et medicales Elsevier SAS. All rights reserved.

We report a case of Candida glabrata perinephric abscess in a patient with diabetes mellitus who recently underwent ureteropelvic surgery for lithiasic urinary tract obstruction. Surgical drainage and amphotericin B treatment led to resolution of the infection. C. glabrata urinary infection has become more prevalent over the last decade in immunocompromised patients. Drainage is indicated for development of a fungal abscess in the perinephric area. Most authors recommend administration of an antifungal adjuvant treatment.