Annales de biologie clinique最新文献

Bacterial vaginosis, one of the most common pathologies in adult women, is defined as a chronic polymicrobial condition resulting from dysbiosis of the vaginal microbiota. Despite 70 % of patients being asymptomatic, diagnosis of this condition relies on clinico-microbiological tools. Despite being considered a gold standard technique, the Nugent score, established during microscopic examination of vaginal smears, has shown a lack of standardization and reproducibility. The discovery of new bacteria not included in the microscopic Nugent score, such as BVAB1,2,3, Atopobium sp., and Megaspheara sp., undetectable by conventional techniques, has highlighted a lack of specificity and sensitivity of the score currently provided to clinicians. This has spurred the development of new PCR kits to perform Nugent scores via molecular biology and address the shortcomings of microscopic techniques. This study has shed light on the contribution of molecular biology to the diagnosis of bacterial vaginosis, as well as the performance and limitations of the Allplex™ Bacterial Vaginosis kit marketed by Seegen® compared to microscopic examination.

Clostridioides difficile is a Gram-positive, spore-forming anaerobic enteropathogen responsible for a wide spectrum of clinical diseases ranging from mild diarrhoea to pseudomembranous colitis. It is the first cause of healthcare-associated diarrhoeas, but community-associated Clostridioides difficile infections (CDI) are increasingly reported in patients without the common risk factors (age > 65 years, previous antibiotic treatment). The main C. difficile virulence factors are toxins A (TcdA) and B (TcdB), and in some cases the binary toxin. The CDI incidence has increased in Europe since the early 2000s, then decreased to reach approximately 4 cases/10,000 patients/days. C. difficile should be tested only in diarrheal stools. Children less than 3 years old are frequently colonized, therefore CDI diagnosis should be carried out only in specific cases (outbreak, Hirschsprung disease). No stand-alone method can be used for the CDI diagnosis. The European Society for Clinical Microbiology and Infectious Diseases (ESCMID) recommends a two-step algorithm with a sensitive screening test (molecular assay or glutamate dehydrogenase immunochromatographic assay). If the screening test is negative, the CDI diagnosis can be ruled out. If the screening test is positive, a second highly specific test should be used, such as toxin A/B immunochromatographic assay.

This observation reports the case of an occupational allergic asthma in a laboratory technician, caused by exposure to formaldehyde. She experienced feelings of discomfort during low exposure, below the regulatory exposure thresholds. Sent to occupational medicine, signs of an asthma attack were noted by the doctor. Respiratory function tests showed bronchial hyperactivity. The diagnosis of formaldehyde asthma was made due to the recurrence of signs during exposure and the absence of other allergies. This type of occupational asthma is rare nowly and this case is an opportunity to recall what the different occupational asthmas are and which are the most common among laboratory technicians.

The Working Group Preanalytical Phase of the European Federation of Clinical Chemistry and Laboratory Medicine advises suppressing haemolysis-sensitive tests when haemolysis is clinically significant, as improper specimen handling can rupture red blood cells, increasing potassium levels. Thus, a correctly repeated blood sample should show lower potassium levels than a haemolysed one. This study aimed to determine the prevalence of haemolysed samples with potassium levels below the reference range and whether this predicts hypokalemia in repeated collections. From March 2022 to March 2024, 396,640 non-haemolysed samples (H-index < 2 UA) were analyzed. Samples with an H-index ≥ 2 AU were classified as haemolysed, and potassium values were suppressed. Warnings were issued for haemolysed samples with potassium below the reference range (3.4-4.5 mmol/L), advising new sample collection. Twenty-five (0.01%) repeat samples were taken within 24 hours of a previously haemolysed sample with low potassium. Severe and moderate hypokalemia were more common in these repeats, with severe hypokalemia (≤2.5 mmol/L) found in 48% of repeat tests, compared to 0.3% in all samples. Though rare, a decrease in potassium in haemolysed samples often precedes hypokalemia diagnosis. Implementing a simple and cost-effective LIS algorithm to alert clinicians could potentially reduce diagnosis and treatment time.

The obstetrical follow-up of patients with a severe hypofibrinogenemia requires a multidisciplinary collaboration because of potential maternal-fetal complications (recurrent miscarriages, intrauterine fetal demise, post-partum hemorrhage, thrombosis). We report the obstetrical management of a multiparous patient with a severe congenital hypofibrinogenemia associated with a platelet disorder (abnormal phospholipid externalization). A therapeutic strategy based on a biweekly administration of fibrinogen concentrates associated with enoxaparin and aspirin allowed the maintenance of pregnancy. But this last one got complicated by a placenta percreta requiring a salvage hysterectomy with an appropriate hemorrhage prophylaxis.