Infection by unusual microorganisms can be one of the clinical manifestations of primary immunodeficiency (PID). We report on a four-month-old child with pneumonia caused by the fungus Acremonium kiliense as the first clinical manifestation of chronic granulomatous disease. We emphasize the importance of an active search for unusual organisms in immunodeficient patients, and a precise diagnosis and early institution of specific treatment against such microorganisms for the reduction of the morbidity and mortality of these patients.
Objective: To evaluate the accuracy of an interferongamma release assay (QuantiFERON-TB Gold
in Tube) for diagnosing Mycobacterium tuberculosis infection in a young pediatric
population. Methods: 195 children previously vaccinated with BCG were evaluated, being 184 healthy
individuals with no clinical or epidemiological evidence of mycobacterial
infection, and 11 with Mycobacterium tuberculosis infection, according to
clinical, radiological, and laboratory parameters. A blood sample was obtained
from each child and processed according to the manufacturer's instructions. The
assay performance was evaluated by a Receiver Operating Characteristic (ROC)
curve. Results: In the group of 184 non-infected children, 130 (70.6%) were under the age of four
years (mean age of 35 months). In this group, 177 children (96.2%) had negative
test results, six (3.2%) had indeterminate results, and one (0.5%) had a positive
result. In the group of 11 infected children, the mean age was 58.5 months, and
two of them (18%) had negative results. The ROC curve had an area under the curve
of 0.88 (95%CI 0.82-0.92; p<0.001), disclosing a predictive positive value of
81.8% for the test (95%CI 46.3-97.4). The assay sensitivity was 81.8% (95%CI
48.2-97.2) and the specificity was 98.8% (95%CI 96-99.8). Conclusions: In the present study, the QuantiFERON-TB Gold in Tube performance for diagnosing
M. tuberculosis infection was appropriate in a young pediatric population.
Cryptosporidium sp., a coccidian parasite usually found in the faeces of cattle, has been recently implicated as an agent of human intestinal disease, mainly in immunocompromised patients. In the study realized, by an indirect immunofluorescence technique, specific immunoglobulins (IgG and IgM) have been demonstrated in human serum against Cryptosporidium oocysts. Purified oocysts were used as antigens in the indirect immunofluorecence assay. After analyzing this test in sera from selected groups of patients, the frequency of both specific IgG and IgM of immunocompetent children who were excreting oocysts in their faeces was 62% and in children with negative excretion of oocysts was 20% and 40%, respectively. In adults infected with the human immunodeficiency virus (HIV) and who were excreting Cryptosporidium in their stools, the frequency was 57% for IgG but only 2% for IgM. Twenty three percent of immunocompromised adults with not determined excretion of oocysts in their stools had anti-Cryptosporidium IgG in their sera. Children infected with human immunodeficiency virus had no IgM and only 14% had IgG detectable in their sera. The indirect immunoflorescence assay, when used with other parasitological techniques appears to be useful for retrospective population studies and for diagnosis of acute infection. The humoral immune response of HIV positive patients to this protozoan agent needs clarification.
Poliomyelitis associated with live strain vaccine is defined as the paralytic form of the acute anterior poliomyelitis related to the vaccine strain. Since these strains behave similarly to the wild-type virus, we can differentiate, epidemiologically, two types of vaccine-associated poliomyelitis: cases in which the patient was vaccinated and cases in which the patient had had contact with vaccinated individuals. We herein present the case of an unvaccinated child, with a clinical picture of an acute anterior poliomyelitis associated with the live strain vaccine, whose brother received the Sabin vaccine 20 days before the onset of the symptoms. Vaccine strain of the type 3 poliovirus was isolated in fecal culture and a presented mutation in nucleotide 472 (C-->U) in the 5' non-coding region, which is strongly related to the higher strain virulence.
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