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Monrad I, Sahlertz SR, Nielsen SSF, Pedersen LØ, Petersen MS, Kobel CM, Tarpgaard IH, Storgaard M, Mortensen KL, Schleimann MH, Tolstrup M, Vibholm LK. Persistent Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Immunocompromised Host Displaying Treatment Induced Viral Evolution. Open Forum Infect Dis 2021; 8:ofab295. [PMID: 34258320 PMCID: PMC8244814 DOI: 10.1093/ofid/ofab295] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 04/06/2021] [Accepted: 06/03/2021] [Indexed: 11/13/2022] Open
Abstract
We report a coronavirus disease 2019 case with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) persisting beyond 333 days in an immunocompromised patient with chronic lymphocytic leukemia, asymptomatically carrying infectious SARS-CoV-2 at day 197 postdiagnosis. In addition, viral sequencing indicates major changes in the spike protein over time, temporally associated with convalescent plasma treatment.
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Affiliation(s)
- Ida Monrad
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Stine Sofie Frank Nielsen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | | | - Carl Mathias Kobel
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Martin Tolstrup
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Line K Vibholm
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
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Sperling S, Mortensen KL, Gjørup P, Fløe A, Hilberg O. [Bacterial lung abscesses]. Ugeskr Laeger 2021; 183:V12200948. [PMID: 34060466] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
A lung abscess is a necrotising infection leading to loss of healthy lung tissue. It develops over several weeks, and the typical presentation includes cough, fever, and general deterioration. The clinical work-up includes contrast-enhanced CT-scans, and frequently flexible bronchoscopy with broncho-alveolar lavage as described in this review. The infection commonly represents aspiration of oral bacterial flora, including anaerobic microbes. Penicillin resistance is common. A lung abscess generally requires long-term, tailored antibiotic treatment. The patient should consult a dentist to identify possible dental foci.
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Lausch KR, Søgaard M, Rosenvinge FS, Johansen HK, Boysen T, Røder BL, Mortensen KL, Nielsen L, Lemming L, Olesen B, Leitz C, Kristensen L, Dzajic E, Østergaard LJ, Schønheyder HC, Arendrup MC. Treatment of candidemia in a nationwide setting: increased survival with primary echinocandin treatment. Infect Drug Resist 2018; 11:2449-2459. [PMID: 30538511 PMCID: PMC6260183 DOI: 10.2147/idr.s176384] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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] [Indexed: 01/05/2023] Open
Abstract
Background In accordance with international guidelines, primary antifungal treatment (AFT) of candidemia with echinocandins has been nationally recommended in Denmark since 2009. Our nationwide cohort study describes the management of candidemia treatment focusing on the impact of prophylactic AFT on species distribution, the rate of adherence to the recommended national guidelines for AFT, and the effect of AFT on patient outcomes. Materials and methods Incident candidemia cases from a 2-year period, 2010-2011, were included. Information on AFT was retrospectively collected from patient charts. Vital status was obtained from the Danish Civil Registration System. HRs of mortality were reported with 95% CIs using Cox regression. Results A total of 841 candidemia patients was identified. Prior to candidemia diagnosis, 19.3% of patients received AFT (162/841). The risk of non-albicans candidemia increased after prior AFT (59.3% vs 45.5% among nontreated). Echinocandins as primary AFT were given for 44.2% (302/683) of patients. Primary treatment with echinocandins resulted in adequate treatment in a higher proportion of patients (97.7% vs 72.1%) and was associated with lower 0- to 14-day mortality compared with azole treatment (adj. HR 0.76, 95% CI: 0.55-1.06). Significantly lower 0- to 14-day mortality was observed for patients with Candida glabrata and Candida krusei with echinocandin treatment compared with azole treatment (adj. HR 0.50, 95% CI: 0.28-0.89), but not for patients with Candida albicans or Candida tropicalis. Conclusion The association shown between prior AFT and non-albicans species underlines the importance of treatment history when selecting treatment for candidemia. Compliance with national recommendations was low, but similar to previously reported international rates. Primary treatment of candidemia with echinocandins compared with azoles yielded both a higher proportion of adequately treated patients and improved mortality rates. This real-life setting supports guidelines recommendation, and further focus on compliance with these seems warranted.
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Affiliation(s)
| | - Mette Søgaard
- Department of Cardiology, Aalborg University Hospital, 9000 Aalborg, Denmark.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, 9000 Aalborg, Denmark
| | - Flemming Schønning Rosenvinge
- Department of Clinical Microbiology, Odense University Hospital, 5000 Odence C, Denmark.,Department of Clinical Microbiology, Lillebaelt Hospital, 5500 Middelfart, Denmark
| | | | - Trine Boysen
- Department of Clinical Microbiology, Hvidovre Hospital, 2650 Hvidovre, Denmark
| | - Bent Løwe Røder
- Department of Clinical Microbiology, Hospital of Slagelse, Slagelse Sygehus, 4200 Slagelse, Denmark
| | - Klaus Leth Mortensen
- Department of Infectious Disease, Aarhus University Hospital, 8200 Aarhus, Denmark, .,Department of Clinical Microbiology, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Lene Nielsen
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark
| | - Lars Lemming
- Department of Clinical Microbiology, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Bente Olesen
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark
| | - Christine Leitz
- Department of Clinical Microbiology, Viborg Regionshospital, 8800 Viborg, Denmark
| | - Lise Kristensen
- Department of Clinical Microbiology, Aarhus University Hospital, 8200 Aarhus, Denmark.,Department of Clinical Microbiology, Herning Regionshospital, 7400 Herning, Denmark
| | - Esad Dzajic
- Department of Clinical Microbiology, Sydvestjysk Sygehus, 6700 Esbjerg, Denmark
| | | | - Henrik Carl Schønheyder
- Department of Clinical Microbiology, Aalborg University Hospital, 9000 Aalborg, Denmark.,Department of Clinical Medicine, University of Aalborg, 9000 Aalborg, Denmark
| | - Maiken Cavling Arendrup
- Department of Clinical Microbiology, Rigshospitalet, 2100 Copenhagen, Denmark.,Unit of Mycology, Statens Serum Institute, 2300 København, Denmark.,Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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Lausch KR, Søgaard M, Rosenvinge FS, Johansen HK, Boysen T, Røder B, Mortensen KL, Nielsen L, Lemming L, Olesen B, Leitz C, Kristensen L, Dzajic E, Østergaard L, Schønheyder HC, Arendrup MC. High incidence of candidaemia in a nationwide cohort: Underlying diseases, risk factors and mortality. Int J Infect Dis 2018; 76:58-63. [PMID: 30176293 DOI: 10.1016/j.ijid.2018.08.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 06/04/2018] [Revised: 08/14/2018] [Accepted: 08/19/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Denmark has a high incidence rate of candidaemia. A Nordic study suggested a higher Danish prevalence of haematological malignancies as an underlying reason. This nationwide study ascertained clinical characteristics of Danish candidaemia patients and investigated potential factors contributing to the high incidence and mortality. METHODS Microbiological and clinical data for candidaemia patients in 2010-2011 were retrieved. 30-day mortality was estimated by hazard ratios (HR) with 95% confidence intervals (CI, Cox regression). RESULTS Data were available for 912/973 candidaemia episodes (93.7%). Intensive care unit (ICU) held the largest share of patients (43.2%). Prevalent host factors were multi-morbidity (≥2 underlying diseases, 74.2%) and gastrointestinal disease (52.5%). Haematological disease was infrequent (7.8%). Risk factors included antibiotic exposure (90.5%), CVC (71.9%) and Candida colonisation (66.7%). 30-day mortality was 43.4%, and 53.6% in ICU. Mortality was lower for patients with recent abdominal surgery (HR 0.70, 95% CI: 0.54-0.92). CONCLUSION A substantial prevalence of multi-morbidity and a high 30-day mortality was found. We hypothesise, that an increasing population of severely ill patients with prolonged supportive treatment and microbiological testing may in part explain the high candidaemia incidence in Denmark. Nationwide studies are warranted to clarify this issue.
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Affiliation(s)
- K R Lausch
- Dpt. of Infectious Disease, Aarhus University Hospital, Aarhus, Denmark.
| | - M Søgaard
- Dpt. of Cardiology, Aalborg University Hospital, Denmark; Aalborg Thrombosis Research Unit, Dpt. of Clinical Medicine, Faculty of Health, Aalborg, Denmark
| | - F S Rosenvinge
- Dpt. of Clinical Microbiology, Odense University Hospital, Odense, Denmark; Dpt. of Clinical Microbiology, Lillebaelt Hospital, Denmark
| | - H K Johansen
- Dpt. of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark
| | - T Boysen
- Dpt. of Clinical Microbiology, Hvidovre Hospital, Hvidovre, Denmark
| | - B Røder
- Dpt. of Clinical Microbiology, Slagelse Sygehus, Slagelse, Denmark
| | - K L Mortensen
- Dpt. of Infectious Disease, Aarhus University Hospital, Aarhus, Denmark; Dpt. of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - L Nielsen
- Dpt. of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - L Lemming
- Dpt. of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - B Olesen
- Dpt. of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - C Leitz
- Dpt. of Clinical Microbiology, Viborg Regionshospital, Viborg, Denmark
| | - L Kristensen
- Dpt. of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark; Dpt. of Clinical Microbiology, Herning Regionshospital, Denmark
| | - E Dzajic
- Dpt. of Clinical Microbiology, Sydvestjysk Sygehus, Denmark
| | - L Østergaard
- Dpt. of Infectious Disease, Aarhus University Hospital, Aarhus, Denmark
| | - H C Schønheyder
- Dpt. of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark; Dpt. of Clinical Medicine, University of Aalborg, Aalborg, Denmark
| | - M C Arendrup
- Dpt. of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark; Unit of Mycology, Statens Serum Institute, Copenhagen, Denmark; Dpt. of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Mortensen KL, Krogh TP, Jensen-Fangel S, Hauge EM. Severe acute pancytopaenia in a patient with rheumatoid arthritis complicated by fatal invasive pulmonary aspergillosis. Scand J Rheumatol 2016; 46:249-250. [PMID: 27575284 DOI: 10.1080/03009742.2016.1209553] [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: 10/21/2022]
Affiliation(s)
- K L Mortensen
- a Department of Infectious Diseases , Aarhus University Hospital Skejby , Aarhus , Denmark.,b Department of Medicine , Randers Regional Hospital , Randers , Denmark
| | - T P Krogh
- c Department of Rheumatology , Aarhus University Hospital , Aarhus , Denmark
| | - S Jensen-Fangel
- a Department of Infectious Diseases , Aarhus University Hospital Skejby , Aarhus , Denmark
| | - E M Hauge
- c Department of Rheumatology , Aarhus University Hospital , Aarhus , Denmark.,d Department of Clinical Medicine , Aarhus University , Aarhus , Denmark
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Abstract
PURPOSE Introducing a simple image grading system to support the interpretation of in vivo confocal microscopy (IVCM) images in filamentous fungal keratitis. SETTING Clinical and confocal studies took place at the Department of Ophthalmology, Aarhus University Hospital, Denmark. Histopathological analysis was performed at the Eye Pathology Institute, Department of Neuroscience and Pharmacology, University of Copenhagen, Denmark. METHODS A recent series of consecutive patients with filamentous fungal keratitis is presented to demonstrate the results from in-house IVCM. Based upon our experience with IVCM and previously published images, we composed a grading system for interpreting IVCM images of filamentous fungal keratitis. RESULTS A recent case series of filamentous fungal keratitis from 2011 to 2012 was examined. There were 3 male and 3 female patients. Mean age was 44.5 years (range 12-69), 6 out of 17 (35%) cultures were positive and a total of 6/7 (86%) IVCM scans were positive. Three different categories of IVCM results for the grading of diagnostic certainty were formed. CONCLUSION IVCM is a valuable tool for diagnosing filamentous fungal keratitis. In order to improve the reliability of IVCM, we suggest implementing a simple and clinically applicable grading system for aiding the interpretation of IVCM images of filamentous fungal keratitis.
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Affiliation(s)
- E Nielsen
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Skejby, Denmark
| | - S Heegaard
- Eye Pathology Institute, Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Skejby, Denmark ; Department of Ophthalmology, Glostrup Hospital, Glostrup, Aarhus University Hospital, Skejby, Denmark
| | - J U Prause
- Eye Pathology Institute, Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Skejby, Denmark
| | - A Ivarsen
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Skejby, Denmark
| | - K L Mortensen
- Department of Clinical Microbiology and Infectious Diseases, Aarhus University Hospital, Skejby, Denmark
| | - J Hjortdal
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Skejby, Denmark
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Mortensen KL, Jensen RH, Johansen HK, Skov M, Pressler T, Howard SJ, Leatherbarrow H, Mellado E, Arendrup MC. Aspergillus species and other molds in respiratory samples from patients with cystic fibrosis: a laboratory-based study with focus on Aspergillus fumigatus azole resistance. J Clin Microbiol 2011; 49:2243-51. [PMID: 21508152 PMCID: PMC3122734 DOI: 10.1128/jcm.00213-11] [Citation(s) in RCA: 145] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 04/11/2011] [Indexed: 11/20/2022] Open
Abstract
Respiratory tract colonization by molds in patients with cystic fibrosis (CF) were analyzed, with particular focus on the frequency, genotype, and underlying mechanism of azole resistance among Aspergillus fumigatus isolates. Clinical and demographic data were also analyzed. A total of 3,336 respiratory samples from 287 CF patients were collected during two 6-month periods in 2007 and 2009. Azole resistance was detected using an itraconazole screening agar (4 mg/liter) and the EUCAST method. cyp51A gene sequencing and microsatellite genotyping were performed for isolates from patients harboring azole-resistant A. fumigatus. Aspergillus spp. were present in 145 patients (51%), of whom 63 (22%) were persistently colonized. Twelve patients (4%) harbored other molds. Persistently colonized patients were older, provided more samples, and more often had a chronic bacterial infection. Six of 133 patients (4.5%) harbored azole-nonsusceptible or -resistant A. fumigatus isolates, and five of those six patients had isolates with Cyp51A alterations (M220K, tandem repeat [TR]/L98H, TR/L98H-S297T-F495I, M220I-V101F, and Y431C). All six patients were previously exposed to azoles. Genotyping revealed (i) microevolution for A. fumigatus isolates received consecutively over the 2-year period, (ii) susceptible and resistant isolates (not involving TR/L98H isolates) with identical or very closely related genotypes (two patients), and (iii) two related susceptible isolates and a third unrelated resistant isolate with a unique genotype and the TR/L98H resistance combination (one patient). Aspergilli were frequently found in Danish CF patients, with 4.5% of the A. fumigatus isolates being azole nonsusceptible or resistant. Genotyping suggested selection of resistance in the patient as well as resistance being achieved in the environment.
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Affiliation(s)
- Klaus Leth Mortensen
- Mycology Unit, Department of Microbiological Surveillance and Research, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark.
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Mortensen KL, Johansen HK, Fuursted K, Knudsen JD, Gahrn-Hansen B, Jensen RH, Howard SJ, Arendrup MC. A prospective survey of Aspergillus spp. in respiratory tract samples: prevalence, clinical impact and antifungal susceptibility. Eur J Clin Microbiol Infect Dis 2011; 30:1355-63. [PMID: 21541671 DOI: 10.1007/s10096-011-1229-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 03/13/2011] [Indexed: 10/18/2022]
Abstract
A three-month laboratory-based prospective survey was conducted at four major university hospitals covering one-third of the Danish population in order to determine the prevalence, significance, and susceptibility pattern of aspergilli in airway samples. Samples received in January-March 2007 for routine microbiologic investigation were examined for Aspergillus following routine procedures and with extended incubation (5 days). Identification was done by morphologic criteria and susceptibility testing using EUCAST method for azoles and amphotericin B E-test. Invasive aspergillosis (IA) was evaluated using modified EORTC/MSG criteria. A total of 11,368 airway samples were received. Growth of Aspergillus spp. was found in 129 and 151 patients using routine and extended incubation, respectively. Three patients had proven IA (2%), 11 probable (7%), four had allergic bronchopulmonary aspergillosis (ABPA) (3%), but the majority was colonised (88%). Underlying conditions were cystic fibrosis in 82 patients (55%), chronic obstructive pulmonary disease in 19 (13%) and haematological disorder in 11 (7%). Twenty-six patients (18%) were at intensive care unit and 69 (47%) received steroid treatment. Azole MICs were elevated for five isolates as follows (itraconazole, posaconazole, voriconazole MICs [mg/L]): two A. fumigatus isolates (>4; >4; 2 and >4; 0.125; 1), one A. lentulus isolate (2; 2; 0.5) and two A. terreus isolates (2; 2; 2 and 2; 0.125; 1). For four isolates the amphotericin B MIC was >1 μg/ml (3/112 A. fumigatus, 1/2 A. terreus). In conclusion, Aspergillus appears to be an important pathogen in Denmark. Elevated itraconazole MICs were detected in 4% of the isolates including a multi-azole resistant isolate.
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Affiliation(s)
- K L Mortensen
- Mycology Unit, Department of Microbiological Surveillance and Research, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark.
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Arendrup MC, Mavridou E, Mortensen KL, Snelders E, Frimodt-Møller N, Khan H, Melchers WJG, Verweij PE. Development of azole resistance in Aspergillus fumigatus during azole therapy associated with change in virulence. PLoS One 2010; 5:e10080. [PMID: 20404915 PMCID: PMC2852403 DOI: 10.1371/journal.pone.0010080] [Citation(s) in RCA: 134] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Accepted: 03/09/2010] [Indexed: 11/18/2022] Open
Abstract
Four sequential Aspergillus fumigatus isolates from a patient with chronic granulomatous disease (CGD) eventually failing azole-echinocandin combination therapy were investigated. The first two isolates (1 and 2) were susceptible to antifungal azoles, but increased itraconazole, voriconazole and posaconazole MICs were found for the last two isolates (3 and 4). Microsatellite typing showed that the 4 isolates were isogenic, suggesting that resistance had been acquired during azole treatment of the patient. An immunocompromised mouse model confirmed that the in vitro resistance corresponded with treatment failure. Mice challenged with the resistant isolate 4 failed to respond to posaconazole therapy, while those infected by susceptible isolate 2 responded. Posaconazole-anidulafungin combination therapy was effective in mice challenged with isolate 4. No mutations were found in the Cyp51A gene of the four isolates. However, expression experiments of the Cyp51A showed that the expression was increased in the resistant isolates, compared to the azole-susceptible isolates. The microscopic morphology of the four isolates was similar, but a clear alteration in radial growth and a significantly reduced growth rate of the resistant isolates on solid and in broth medium was observed compared to isolates 1 and 2 and to unrelated wild-type controls. In the mouse model the virulence of isolates 3 and 4 was reduced compared to the susceptible ones and to wild-type controls. For the first time, the acquisition of azole resistance despite azole-echinocandin combination therapy is described in a CGD patient and the resistance demonstrated to be directly associated with significant change of virulence.
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Hornum M, Mortensen KL, Kamper AL, Andersen AB. Limitations of the QuantiFERON-TB Gold test in detecting Mycobacterium tuberculosis infection in immunocompromised patients. Eur J Intern Med 2008; 19:137-9. [PMID: 18249311 DOI: 10.1016/j.ejim.2007.03.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Accepted: 03/09/2007] [Indexed: 01/05/2023]
Abstract
Four cases are presented, immunosuppressed by at least three different mechanisms: one HIV-positive patient with a CD4 count of 0.29 x 10(6)/ml, one malnourished patient, and two kidney-transplanted patients. All patients had a negative interferon (IFN)-gamma test for suspected tuberculosis (TB), but a positive culture. We conclude that a negative IFN-gamma test does not exclude TB disease in immunosuppressed patients.
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Affiliation(s)
- Mads Hornum
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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