An immunoglobulin-M immunosorbent agglutination assay (ISAGA) was introduced to detect toxoplasma specific IgM. This assay incorporates mu chain capture and use of entire toxoplasma trophozoites as an antigen source. The performance of the ISAGA was compared with that of a double sandwich enzyme linked immunosorbent assay (DS-ELISA) currently used in the Public Health Laboratory Service Toxoplasma Reference Laboratories. The ISAGA was found to be more sensitive than DS-ELISA but there was no demonstrable difference in the specificity or reproducibility between the two assays. The ISAGA is suitable for the diagnosis of acute toxoplasmosis in immunocompetent patients and as a screening test for recent infection in pregnant women. The persistence of ISAGA reactivity, however, is such that additional serological assessment is required to define the risk of congenital infection.

Cellulosimicrobium funkei is a rare, opportunistic pathogen. We describe a case of bacteremia and possibly prosthetic valve endocarditis by this organism in a nonimmunocompromised patient. Useful phenotypic tests for differentiating C. funkei from Cellulosimicrobium cellulans and Cellulosimicrobium terreum include motility, raffinose fermentation, glycogen, D-xylose, and methyl-␣-D-glucopyranoside assimilation, and growth at 35°C. CASE REPORTClinical aspects. An 81-year-old male presented to the Casualty Department with a 2-day history of back pain, acute confusion, and fever. He had undergone a Medtronic Mosaic tissue aortic valve replacement for aortic stenosis 7 months before. On examination, he had a temperature of 39°C and looked very unwell. He had no obvious focus of infection, and systemic examination was normal. The patient had two prior admissions to the hospital in the 7 months following his operation. The first was a month after his surgery, when he was admitted to the general intensive care unit with severe pneumonia and pseudomembranous colitis. All five sets of blood cultures taken during this admission were negative, and a transthoracic echocardiogram was reported as normal. Two months after this discharge, he was readmitted and treated for presumed Micrococcus luteus prosthetic valve endocarditis (PVE) with 6 weeks of intravenous flucloxacillin and 2 weeks of gentamicin. Though a transesophageal echocardiogram at the time did not show any vegetation, 2 of 3 blood culture sets grew Micrococcus luteus. During that admission, he also developed a peripherally inserted central catheter (PICC) line infection with Bacillus cereus, which was treated by line removal.One set of blood cultures was taken before patient therapy of intravenous amoxicillin-clavulanic acid at 1.2 g three times a day (TDS) commenced. After 24 h of incubation, the aerobic bottle in the blood culture set grew Gram-positive rods. Since the patient was improving clinically and a subsequent repeat blood culture was negative, it was presumed that the organism was a skin contaminant. No further identification was carried out, and the isolate was discarded. A transthoracic echocardiogram found no vegetations on the heart valves. No evidence of infection on a chest radiograph, abdominal ultrasound examination, computed tomography (CT) of the brain, magnetic resonance imaging (MRI) of the spine, or a bone scan was found. The patient received 10 days of antibiotics, during which time significant clinical improvement was noted, although his white cell count and C-reactive protein (CRP) level remained persistently elevated.Eighteen days later, the patient developed a fever with an increasing white cell count and CRP level. Three sets of blood cultures were taken. The next day, all six bottles were positive for a Gram-positive rod. Empirical treatment for presumed prosthetic valve endocarditis was started, with intravenous vancomycin at 1 g daily and gentamicin at 80 mg twice a day (BID). An urgent transesophageal echocardiogram confirmed the...

The limitations of serological assessment in toxoplasma infection of the eye are well recognised, but the predictive value of clinical examination is not defined. We undertook a prospective investigation into the role of clinical examination and of serological findings in cases of suspected toxoplasma infection of the eye by means of the dye test and multiple IgM assays. Seventy-four cases of retinal disease and 202 control patients were studied. Patients with retinal disease had a significantly higher incidence of toxoplasma seropositivity than the control group. This was because some patients with retinal disease had acquired the infection congenitally. Half the patients investigated for toxoplasmosis were seronegative. Possible explanations for these findings included misdiagnosis, clinical uncertainty, or, the use of serology testing in the confirmation of other diseases. An excess of IgM reactivity among the retinal disease group may indicate low level immunoglobulin-M production associated with an acute exacerbation of ocular toxoplasmosis. There is a need to consider invasive procedures in cases of ocular infection and for novel techniques to aid the diagnosis of toxoplasma retinochoroiditis.

Background: Markerless (ML) motion capture systems have recently become available for biomechanics applications. Evidence has indicated the potential feasibility of using an ML system to analyze lower extremity kinematics. However, no research has examined ML systems’ estimation of the lower extremity joint moments and powers. This study aimed to compare lower extremity joint moments and powers estimated by marker-based (MB) and ML motion capture systems. Methods: Sixteen volunteers ran on a treadmill for 120 s at 3.58 m/s. The kinematic data were simultaneously recorded by 8 infrared cameras and 8 high-resolution video cameras. The force data were recorded via an instrumented treadmill. Results: Greater peak magnitudes for hip extension and flexion moments, knee flexion moment, and ankle plantarflexion moment, along with their joint powers, were observed in the ML system compared to an MB system (p < 0.0001). For example, greater hip extension (MB: 1.42 ± 0.29 vs. ML: 2.27 ± 0.45) and knee flexion (MB: −0.74 vs. ML: −1.17 nm/kg) moments were observed in the late swing phase. Additionally, the ML system’s estimations resulted in significantly smaller peak magnitudes for knee extension moment, along with the knee production power (p < 0.0001). Conclusions: These observations indicate that inconsistent estimates of joint center position and segment center of mass between the two systems may cause differences in the lower extremity joint moments and powers. However, with the progression of pose estimation in the markerless system, future applications can be promising.

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