Clinical Microbiology Newsletter最新文献

Naegleria fowleri, Balamuthia mandrillaris, and Acanthamoeba species are free-living amebae that are ubiquitously found in soil and water and can opportunistically cause invasive, deadly infections in humans. In this review, we present four patient cases due to free-living amebae and review the epidemiology and clinical significance of the diseases they cause. Specifically, primary amebic encephalitis due to N. fowleri, granulomatous amebic encephalitis due to B. mandrillaris and Acanthamoeba spp., keratitis due to Acanthamoeba spp., and non-central nervous system systemic infections (due to B. mandrillaris and Acanthamoeba spp.) are reviewed, and the clinical utility of microbiologic and histopathologic methods for diagnosing infections due to free-living amebae are compared.

The debate over federal regulation of diagnostic tests is not new, but scientific advances, societal developments, and global events over the past decade have accelerated efforts by the Food and Drug Administration (FDA) and members of Congress to revise the regulatory oversight of these devices, including laboratory-developed tests (LDTs). Despite years of congressional hearings and public meetings, legislation in the House and Senate, draft guidance from the FDA, and debate in the stakeholder community, LDT regulation remains unchanged, and the path forward remains unclear. LDTs play an essential role in infectious disease (ID) management and treatment, and changes in their regulation will have far-reaching implications for diagnostic laboratories. LDTs are widely used by clinical microbiology laboratories for the diagnosis and monitoring of a myriad infectious diseases, and until three years ago, such testing was conducted largely out of the spotlight. The COVID-19 pandemic changed this by bringing ID tests into the forefront. As the 118th Congress gets under way, the regulation and oversight of diagnostic tests, including LDTs, remains at the forefront of health care policy discussions on Capitol Hill and with the FDA. Change is coming, and it is important that clinical microbiologists, ID physicians, and other laboratorians have a seat at the table when such changes are being discussed.

Tickborne illnesses are constantly evolving, requiring proficiency to guide diagnostic and therapeutic measures. Diagnosing tickborne illnesses can be challenging due to the wide range of potential symptoms and their overlap with those of other conditions. Various diagnostic modalities can be used to identify the etiology of a tickborne illness accurately; however, not all tests have the same diagnostic value, particularly as a patient's disease progresses. This review investigates the diagnostic modalities for four tickborne illnesses to determine their clinical utility. These four illnesses (Lyme disease, anaplasmosis, spotted fever rickettsiosis, and ehrlichiosis) are the most reported tickborne illnesses nationwide. This article aims to provide an updated summative review to guide practitioners in diagnosing these infections.

The blood brain barrier (BBB) controls the passage of molecules between the circulatory system and the central nervous system. Despite this, some fungi find ways to bypass the BBB, resulting in infections of the central nervous system (CNS) including meningitis, meningoencephalitis, and abscesses. While these infections are rare, the resultant mortality rates range from 30 to 99%, in part due to the poor penetration of most commercially available antifungals. Additionally, laboratory diagnostics can lack sensitivity and/or specificity and may require specialized diagnostic testing facilities, also contributing to the high mortality rate seen in CNS mycoses. Despite the high risk of mortality, detailed understanding of how these infections occur is limited to only a few of the most common fungi, and there is a dearth of research examining novel therapies to aid in the treatment of these infections.

Cytomegalovirus (CMV) is the most common congenital infection worldwide. Twenty percent of congenital CMV (cCMV) infections result in permanent disability, including hearing loss, cognitive deficits, cerebral palsy, and vision impairment, and 4% of cases result in death. Early recognition and diagnosis are imperative, as both antiviral treatment and non-pharmaceutical interventions can improve patient outcomes by reducing hearing loss, other symptomology, and overall disease severity. Specifically, evidence of effective therapy for symptomatic infants and, more recently, reduced fetal transmission following treatment of maternal primary infection may support expanded screening activities. Here, we present an overview of the clinical presentation, treatment and prevention of maternal CMV and cCMV infection. We discuss in detail new diagnostic methods for early and retrospective detection of congenital and maternal primary infections. Finally, we review proposed neonatal and prenatal screening strategies. Clinical laboratories should be aware of the latest clinical studies, the changing diagnostic landscape, and laboratory practices for cCMV and maternal CMV infection.

Tetracycline class antibiotics have activity against a wide range of Gram-positive, Gram-negative, and atypical bacterial pathogens, and they have been used for treatment of various infections, including respiratory infections, skin and soft tissue infections, and sexually transmitted infections. Increases in morbidity and mortality associated with infections by multidrug-resistant organisms have highlighted the need for new antibiotics. In 2018, three novel tetracyclines were approved by the FDA: eravacycline, omadacycline, and sarecycline. This review discusses the pharmacological properties and microbiological and clinical aspects of these new tetracyclines.

Medical laboratory scientists (MLS) often begin their careers employed in a hospital or public health laboratory, where employment qualifications and standards are dictated by the accrediting body. MLS who specialize in clinical microbiology have multiple career paths that can lead to a very successful and satisfying career. This review covers some details of the educational requirements and certifications required for employment within various hospital laboratory work environments and opportunities for career advancement. Alternative career paths are also highlighted, opening first with hospital departments adjacent to the clinical microbiology laboratory, such as quality assurance and infection prevention and control. In addition, careers in public health laboratories, research laboratories, scientific communication, project management, government, and the food industry, as well as foundation and non-profit work, are highlighted. Various technical career pathways within the industry and biotechnology sectors are described. The review concludes by acknowledging that for some individuals, career goals may not be fully realized without the pursuit of higher education, and it provides some overarching career advice for taking the next step toward a new career pathway.