Background Mycobacterium marinum is a nontuberculous mycobacterium that causes skin and soft tissue infections. Treatment consists of multiple antibiotics, sometimes combined with surgical... Show moreBackground Mycobacterium marinum is a nontuberculous mycobacterium that causes skin and soft tissue infections. Treatment consists of multiple antibiotics, sometimes combined with surgical debridement. There is little evidence for the choice of antibiotics, the duration of treatment, and the role of susceptibility testing. Methods We performed a retrospective cohort study of culture-confirmed M. marinum infections in the Netherlands in the 2011-2018 period. Clinical characteristics, in vitro susceptibility, extent of disease, treatment regimens, and outcomes were analyzed. Incidence was assessed from laboratory databases. Results Forty cases of M. marinum infection could be studied. Antibiotic treatment cured 36/40 patients (90%) after a mean treatment duration of 25 weeks. Failure/relapse occurred in 3 patients, and 1 patient was lost to follow-up. Antibiotic treatment consisted of monotherapy in 35% and 2-drug therapy in 63%. Final treatment contained mostly ethambutol-macrolide combinations (35%). Eleven patients (28%) received additional surgery. We recorded high rates of in vitro resistance to tetracyclines (36% of isolates). Tetracycline resistance seemed correlated with poor response to tetracycline monotherapy. The annual incidence rate was 0.15/100( )000/year during the study period. Conclusions Prolonged and susceptibility-guided treatment results in a 90% cure rate in M. marinum disease. Two-drug regimens of ethambutol and a macrolide are effective for moderately severe infections. Tetracycline monotherapy in limited disease should be used vigilantly, preferably with proven in vitro susceptibility. Show less
Hart, J.W.H. 't; Leeman, M.; Mourik, B.C.; Pouw, N.; Biter, L.U.; Apers, J.A.; ... ; Dunkelgruen, M. 2021
Background: In metabolic-bariatric fast-track surgery, patients are scheduled for discharge on postoperative day 1. The neutrophil-to-lymphocyte ratio (NLR) could be an inexpensive and rapid way to... Show moreBackground: In metabolic-bariatric fast-track surgery, patients are scheduled for discharge on postoperative day 1. The neutrophil-to-lymphocyte ratio (NLR) could be an inexpensive and rapid way to identify patients at risk of early complications. This study aimed to determine the predictive value of the NLR on early complications.Methods: Prospective data were collected of all patients undergoing primary metabolic surgery in a single center, between April 2018 and April 2019. The association between NLR, leukocyte count, hemoglobin, and C-reactive protein (CRP) was compared with early complications.Results: In total, 829 patients underwent primary metabolic surgery: 336 (40.5%) Roux-en-Y gastric bypass, 410 (49.5%) sleeve gastrectomy, and 83 (10.0%) one anastomosis gastric bypass. Major complications occurred in 34 (4.1%) patients, who had significantly higher levels of postoperative NLR (p < 0.001), delta-NLR (p < 0.001), leukocyte count (p < 0.001), and CRP (p = 0.008). The ideal cutoff points to predict complications after metabolic surgery were 6.73 for postoperative NLR (sensitivity 74% and specificity 70%) and 4.68 for delta-NLR (sensitivity 77% and specificity 75%).Conclusion: Postoperative NLR and delta-NLR were independently associated with early major complications after metabolic surgery. These markers may be useful to help identify patients who are at risk for complications, and can aid in the decision making for safe postoperative discharge on day 1 or early intervention. Show less
At the time SARS-CoV-2 was identified as the cause of coronavirus disease 2019 (COVID-19) no in vitro diagnostic (IVD) tests were available since it was a new virus. Very shortly after the release... Show moreAt the time SARS-CoV-2 was identified as the cause of coronavirus disease 2019 (COVID-19) no in vitro diagnostic (IVD) tests were available since it was a new virus. Very shortly after the release of the genomic sequence of SARS-CoV-2, laboratory-developed tests (LDTs) were developed, made available and implemented in several laboratories in the Netherlands and globally. In this study, the performance of an E-gene Sarbeco specific realtime reverse-transcriptase PCR (RT-PCR) was verified on the open modus of the geneLEAD VIII sample-to-answer platform. The results obtained from 134 clinical samples, of which 63 had been tested positive, showed almost complete concordance compared to the same PCR on the routine diagnostic systems and that was validated according to the national reference standard. The only discordant sample tested positive using the routine diagnostic workflow with a cycle threshold (CT) value of 37.7, while the sample tested negative using the geneLEAD VIII workflow. In addition, good performance was achieved in analyzing a blinded SARS-CoV-2 external quality assurance (EQA) panel. Implementation of the geneLEAD VIII platform as routine diagnostic tool resulted in testing 871 clinical samples with 115 positive results. In conclusion, the geneLEAD VIII SARSCoV-2 workflow presented in this study showed excellent diagnostic performance and with a rapid turnaround time of approximately two hours it proved a valuable option for STAT SARS-CoV-2 testing in the absence of (rapid, CE-IVD) point-of-care testing platforms. Show less
Substantial differences exist in virulence among Mycobacterium tuberculosis strains in preclinical TB models. In this study we show how virulence affects host responses in mice during the first... Show moreSubstantial differences exist in virulence among Mycobacterium tuberculosis strains in preclinical TB models. In this study we show how virulence affects host responses in mice during the first four weeks of infection with a mycobacterial strain belonging to the Beijing, East-African-Indian or Euro-American lineage. BALB/c mice were infected with clinical isolates of the Beijing-1585 strain or the East-African Indian (EAI)-1627 strain and host responses were compared to mice infected with the non-clinical H37Rv strain of the Euro-American lineage. We found that H37Rv induced a 'classical' T-cell influx with high IFN-gamma levels, while Beijing-1585 and EAI-1627 induced an influx of B-cells into the lungs together with elevated pulmonary IL-4 protein levels. Myeloid cells in the lungs appeared functionally impaired upon infection with Beijing-1585 and EAI-1627 with reduced iNOS and IL-12 expression levels compared to H37Rv infection. This impairment might be related to significantly reduced expression in the bone marrow of IFN-gamma, TNF-alpha and IFN-beta in mice infected with Beijing-1585 and EAI-1627, which could be detected from the third day post infection onwards. Our findings suggest that increased virulence of two clinical isolates compared to H37Rv is associated with a fundamentally different systemic immune response, which already can be detected early during infection. Show less
