Mortality from bloodstream infections (BSIs) correlates with diagnostic delay and the use of inappropriate empirical treatment. Early PCR-based diagnosis could decrease inappropriate treatment, improving patient outcome. The aim of the present study was to assess the clinical utility of this molecular technology to diagnose BSIs. We assessed a new dual-priming oligonucleotide-based multiplex PCR assay, the Magicplex Sepsis Test (MST) (Seegene), along with blood culture (BC). A total of 267 patients from the intensive care unit and haematology and emergency departments were enrolled. Clinical data were also used by physicians to determine the likelihood of infection. Ninety-eight (37 %) specimens were positive: 29 (11 %) by both the MST and BC, 29 (11 %) by the MST only, and 40 (15 %) by BC only. The proportion of agreement between the two methods was 73 % (Cohen's k: 0.45; 0.28-0.6; indicating fair to moderate agreement). According to clinical assessment, 63 (64 %) positive specimens were considered BSIs: 23 (36 %) were positive by both the MST and BC, 22 (35 %) were positive only by BC, and 18 (29 %) were positive only by the MST. Thirty-eight (14 %) positive specimens by the MST and/ or BC were considered as contaminants. Of 101 specimens collected from patients receiving antibiotics, 20 (20 %) were positive by the MST and 32 (32 %) by BC. Sensitivity and specificity were 65 % and 92 %, respectively, for the MST and 71 % and 88 %, respectively for BC. We concluded that the MST shows a high specificity but changes in design are needed to increase bacteraemia detection. For viability in clinical laboratories, technical improvements are also required to further automate the process.

Summary:In recent years, it has been recognised that the community respiratory viruses are a frequent cause of upper and lower respiratory tract infections in immunocompromised hosts such as bone marrow transplant recipients. By contrast, infections by non-polio enteroviruses have rarely been reported after stem cell transplantation. We present four cases of acute respiratory illness with enterovirus isolated as the sole pathogen from bronchoalveolar lavage. All four patients developed pneumonia and three died of progressive pneumonia, which reflects the severity of this complication. We conclude that enteroviral pulmonary infections may be a cause of severe pneumonia in immunocompromised hosts. Keywords: enterovirus; pulmonary infection; immunocompromised host Pneumonia is a frequent infectious complication in patients with hematologic malignancies, particularly following stem cell transplantation (SCT). Most viral pneumonias in these patients have been traditionally associated with herpes viruses. In recent years, however, an increasing number of reports have shown the importance of upper and lower respiratory tract infections in SCT recipients and other immunocompromised hosts caused by community respiratory viruses, mainly respiratory syncytial virus, influenza A and B, parainfluenza, adenovirus and picornaviruses. [1][2][3][4][5][6] The human picornaviruses (family Picornaviridae) which cause respiratory infections include rhinoviruses and enteroviruses, which in turn are classified into polioviruses, coxsackieviruses A and B, echoviruses and enterovirus 68-71. Infections by non-polio enteroviruses have rarely been reported in SCT recipients. Herein, we describe the presentation and clinical course of four highly immunocompromised SCT recipients with an acute respiratory illness who had enterovirus isolated from the bronchoalveolar lavage (BAL). Case reportsOne hundred and forty-four patients with hematologic malignancies received an allogeneic SCT and 414 patients received an autologous SCT between January 1990 and November 1997 at our institution. During this period, 190 BAL were performed in SCT recipients with an acute lower respiratory illness. All specimens were submitted for virological studies including antigen detection of respiratory viruses and tissue culture inoculation for cytomegalovirus, herpes simplex virus, enteroviruses and conventional respiratory viruses. An enterovirus was isolated as the sole pathogen in the BAL from four patients, whose characteristics are summarized in Table 1. UPN 463A 6-year-old male underwent an autologous bone marrow transplant (ABMT) for acute lymphocytic leukemia (ALL) in second complete remission (CR). The leukemia relapsed 9 months post-ABMT, and he received salvage chemotherapy with ICE (idarubicin, standard-dose cytarabine and etoposide). On day 20 of chemotherapy, neutropenic fever developed and empiric treatment with ceftazidime and amikacin was begun. Fever persisted and on day 24 he developed a nonproductive cough with a normal chest Xray, and on subse...

Molecular-based techniques reduce the delay in diagnosing infectious diseases and therefore contribute to better patient outcomes. We assessed the FilmArray blood culture identification (BCID) panel (Biofire Diagnostics/bioMé rieux) directly on clinical specimens other than blood: cerebrospinal, joint, pleural and ascitic fluids, bronchoscopy samples and abscesses. We compared the results from 88 samples obtained by culture-based techniques. The percentage of agreement between the two methods was 75 % with a Cohen k value of 0.51. Global sensitivity and specificity using the FilmArray BCID panel were 71 and 97 %, respectively. Sensitivity was poorer in samples with a low bacterial load, such as ascitic and pleural fluids (25 %), whereas the sensitivity for abscess samples was high (89 %). These findings suggest that the FilmArray BCID panel could be useful to perform microbiological diagnosis directly from samples other than positive blood cultures, as it offers acceptable sensitivity and moderate agreement with conventional microbiological methods. Nevertheless, cost-benefit studies should be performed before introducing this method into algorithms for microbiological diagnostics.

We report a case of simultaneous diagnosis of chronic lymphocytic leukemia (CLL) and acute myeloid leukemia (AML), in which the use of flow cytometry analysis allowed the demonstration of two different cell populations and the study of both immunophenotyp-ing patterns with a large panel of monoclonal antibodies (MoAbs). CLL cells showed a typical immunophenotype with coexpression of B cell markers with CD5, CD23, CD43, and weak surface immunoglobulin light chain restriction expression, whereas the AML population had a very uncommon phenotype with expression of myeloid markers and CD56 and lack of expression of other natural killer (NK) antigens, CD34 and HLA-DR. After chemotherapeutic treatment of AML with two induction courses, the patient achieved complete remission of the AML with persistence of a CD19/CD5 positive population. After consolidation chemotherapy, this latter population was no longer detectable despite the presence of lymphoid nodules in a bone marrow biopsy. Six months after diagnosis, the patient relapsed with AML and died shortly afterwards. Am.

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