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Use of the “FilmArray® blood culture identification 2” panel in a case of endophthalmitis due to Candida parapsilosis
Uso del panel «FilmArray® blood culture identification 2» en un caso de endoftalmitis causado por Candida parapsilosis
Domingo Fernández-Vecilla
Corresponding author
domingofvec@gmail.com

Corresponding author.
, Iris Sharon Pérez-Ramos, Cristina Aspichueta-Vivanco, Miren Josebe Unzaga Barañano
Hospital Universitario de Basurto, Bilbao (Vizcaya), Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The FilmArray&#174; &#40;BioFire Diagnostics&#44; Salt Lake City&#44; UT&#44; USA&#41; system is a multiplex PCR that integrates sample preparation&#44; amplification&#44; detection and analysis&#46; One of the available panels is the &#34;Blood Culture Identification 2 &#40;BCID2&#41;&#34;&#44; which allows for searching for up to 43 different targets associated with bacteraemia&#44; including five antimicrobial resistance genes&#44; directly from positive blood cultures&#46; The objective of this text is to present our experience about the use of this PCR technique to help in the aetiological and therapeutic orientation in a case of endophthalmitis caused by <span class="elsevierStyleItalic">Candida parapsilosis &#40;C&#46; parapsilosis&#41;</span>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 79-year-old man on anticoagulation and antiplatelet therapy with diabetes mellitus and hypertension&#44; who underwent cataract surgery by phacoemulsification and intraocular lens implant without incident&#46; Six months later&#44; the patient has onset of pain&#44; photophobia&#44; and a slight decrease in visual acuity in that same eye&#46; Upon examination&#44; positive Tyndall effect&#44; mild capsular phimosis and fibrosis&#44; and whitish deposits are described&#46; An ocular ultrasound is performed revealing data regarding complete retinal detachment and linear floaters similarly fixed to the optic disc suggestive of membranes residual to endophthalmitis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; A sample of vitreous humor &#40;not diluted&#41; is taken prior to infusion of saline solution&#44; and subsequently a pars plana vitrectomy is performed&#46; Samples are sent to the microbiology laboratory&#58; vitreous and aqueous humor&#44; as well as vitrectomy <span class="elsevierStyleItalic">cassette</span> and intraocular lens capsular bag complex&#46; Intravitreal ceftazidime and vancomycin &#40;1&#44;000&#8239;mg and 500&#8239;mg diluted in 50&#8239;ml&#44; respectively&#41; are administered&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Upon arrival at the microbiology laboratory&#44; the diluted aqueous and vitreous humor samples are processed by centrifugation &#40;5&#8239;min at 3&#44;000&#8239;rpm&#41; and all but the last 0&#46;5&#8239;ml of the supernatant is transferred to another tube&#46; The sediment is resuspended in this 0&#46;5&#8239;ml for Gram staining and culture inoculation&#46; The samples are inoculated on chocolate agar &#40;Becton Dickinson&#44; Franklin Lakes&#44; NJ&#44; USA&#41;&#44; Trypticase Soy Agar with 5&#37; Sheep Blood &#40;Becton Dickinson&#44; Franklin Lakes&#44; NJ&#44; USA&#41; and Sabouraud agar with chloramphenicol &#40;Becton Dickinson&#44; Franklin Lakes&#44; NJ&#44; USA&#41;&#44; as well as in thioglycolate broth enrichment medium&#46; Yeasts are observed in the Gram stain&#46; At this point&#44; 200&#8239;&#181;l of the remaining supernatant is removed from the centrifuged vitreous humor for the performance of the FilmArray&#174;BCID2 Panel&#44; through which <span class="elsevierStyleItalic">C&#46; parapsilosis</span> identified&#46; After this result&#44; the patient is taken to the operating room that same day for intravitreal injection of voriconazole &#40;200&#8239;mg diluted in 20&#8239;ml&#41;&#46; At 24&#8239;h&#44; white colonies are observed in cultures of vitreous humor&#44; aqueous humor&#44; vitrectomy <span class="elsevierStyleItalic">cassette</span> and intraocular lens capsular bag complex&#44; later being identified as <span class="elsevierStyleItalic">C&#46; parapsilosis</span> by MALDI-TOF &#40;matrix-assisted laser desorption&#47;ionisation mass spectrometry&#44; Bruker&#8482;&#41;&#46; The patient is discharged from the hospital with oral fluconazole 100&#8239;mg&#47;24&#8239;h and corticosteroids 2&#46;5&#8239;mg&#47;48&#8239;h&#44; as well as tobramycin&#47;corticosteroid 1&#8239;mg&#47;mL and voriconazole 10&#8239;mg&#47;mL&#47;4&#8239;h eye drops&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The FilmArray&#174; BCID2 panel multiplex PCR system has been extensively tested&#44; with numerous studies demonstrating high sensitivity and specificity in positive blood culture samples&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Its applicability to sterile samples other than blood cultures has also been studied for therapeutic guidance in both the adult and paediatric population&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;6</span></a> Even in the context of septic arthritis or pleural empyema&#44; where the consistency of the sample and the high leukocyte concentration could inhibit this test&#44; this technique could be a helpful complementary diagnostic tool&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">It is rare that the FilmArray&#174; multiplex PCR system yields false negatives&#44; but Gonzalez-Donapetry et al&#46; presented a representative example&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Following their recommendations&#44; the <span class="elsevierStyleItalic">melting</span> curves and internal controls must be carefully reviewed because at times there may be alterations&#44; the meaning of which could differ depending on the clinical context&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The FilmArray&#174; BCID2 system has demonstrated some utility in sterile samples other than those indicated by the manufacturer&#44; and it is a tool to consider when it is necessary to establish early antibiotic treatment in patients and complex situations&#44; such as the case of endophthalmitis that we present&#46; Despite this&#44; the limitations of the technique in this type of sample must be taken into account&#44; carrying out a prior validation&#44; and further prospective studies that add more evidence to what has been observed up until now&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Author contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Domingo Fern&#225;ndez Vecilla&#58; drafted the scientific text&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Iris Sharon P&#233;rez Ramos&#58; helped draft the clinical case&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Cristina Aspichueta Vivanco&#58; reviewed the case and helped modify it&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Miren Josebe Unzaga Bara&#241;ano&#58; reviewed the case and helped modify it&#46;</p></li></ul></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0060" class="elsevierStylePara elsevierViewall">This text has not received funding&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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