Publications by authors named "Steven De Keukeleire"

16 Publications

  • Page 1 of 1

Atypical manifestation of Vibrio cholerae: fear the water!

Acta Clin Belg 2018 Dec 19;73(6):462-464. Epub 2018 Jun 19.

a Department of Laboratory Medicine , AZ Alma , Eeklo , Belgium.

Background: In recent years, there has been an universal increase in number of reports of infections involving non-O1, non-O139 V. cholerae (NOVC). NOVC infection is only rarely complicated by septicaemia or invasive extra-intestinal infection.

Case Summary: We report the first documented case of NOVC bacteraemia in a Belgian immunocompetent male after ingestion of water when paddling in a creek.

Conclusion: Clinicians should include V. cholerae in their differential diagnosis in patients presenting with a self-limiting gastroenteritis after ingestion of raw and undercooked seafood or bathing in potentially contaminated recreational waters during warm summers.
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http://dx.doi.org/10.1080/17843286.2018.1483563DOI Listing
December 2018

Keratinous matrices for the assessment of drugs of abuse consumption: A correlation study between hair and nails.

Drug Test Anal 2018 Jan 5. Epub 2018 Jan 5.

Toxicological Centre, University of Antwerp, Belgium.

Keratinous matrices - hair and nails - accumulate substances over time and allow retrospective investigation of past consumption. Analysis of these matrices can provide information complementary to blood and urine analysis or can be used as standalone. So far, research has primarily focused on the detection of substances in hair, while studies in nails are scarce. In this study, we assessed concentrations of drugs of abuse and their metabolites in hair, fingernails, and toenails collected from the same individuals to evaluate differences and correlations between matrices. A total of 26 hair, 24 fingernail, and 18 toenail samples were collected. Samples were analysed by a validated liquid chromatography-tandem mass spectrometry method able to simultaneously detect the following compounds: amphetamine (AMP), methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA), 3,4-methylenedioxyethylamphetamine, morphine (MOR), codeine (COD), 6-monoacetylmorphine (6-MAM), methadone (MTD), 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), cocaine (COC), benzoylecgonine (BE), and ecgonine methyl ester (EME). Strong positive correlations between hair, fingernails, and toenails were present for COC, BE, EME, AMP and MDMA. MOR, COD, 6-MAM, MTD and EDDP showed positive trends. Concentrations were generally higher in nails compared to hair. Ratios between parent compounds and their metabolites were assessed for 6-MAM/MOR, EDDP/MTD, BE/COC and EME/COC. Preliminary cut-off concentrations for COC, BE, EME and AMP in fingernails and toenails were proposed. In light of these results, nails can be considered as a useful alternative to hair for monitoring of long-term drug consumption. However, care should be taken regarding the variability in the accumulation of compounds between the matrices.
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http://dx.doi.org/10.1002/dta.2356DOI Listing
January 2018

Ethyl glucuronide in keratinous matrices as biomarker of alcohol use: A correlation study between hair and nails.

Forensic Sci Int 2017 Oct 26;279:187-191. Epub 2017 Aug 26.

Toxicological Center, University of Antwerp, Universiteitsplein 1, B2610 Antwerp, Belgium. Electronic address:

To quantify alcohol use, objective, specific and sensitive long-term alcohol markers are necessary. Ethyl glucuronide (EtG), a direct metabolite of alcohol, accumulates in keratinous matrices such as hair and nails, and is a specific and sensitive long-term biomarker for the detection of chronic alcohol consumption. So far, research has primarily focused on the detection of EtG in hair, and studies on its measurement in nails are scarce. In this article, we assessed EtG concentrations in hair, finger- and toenails from the same individuals in order to evaluate the direct correlation between the matrices. To this end, a total amount of 45 hair, 41 fingernail, and 13 toenail samples were collected from patients treated for alcohol use disorders at two psychiatric centers in Belgium. Samples were analyzed by gas chromatography-tandem mass spectrometry. Hair EtG concentrations ranged from 123pg/mg for chronic excessive alcohol consumption, 59-123pg/mg for moderate alcohol consumption, and <59pg/mg for alcohol abstinence. In light of these results, nails may be a useful alternative to hair samples for monitoring of long-term alcohol consumption, e.g., in cases where hair is not available. Further studies are needed to establish cut-off values for EtG levels in nails.
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http://dx.doi.org/10.1016/j.forsciint.2017.08.022DOI Listing
October 2017

Primary hyperparathyroidism associated to thrombocytopenia: an issue to consider?

Clin Cases Miner Bone Metab 2017 Jan-Apr;14(1):97-100. Epub 2017 May 30.

Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium.

Primary hyperparathyroidism (PHPT) is probably the most common endocrine disorder of the parathyroid glands, causing hypercalcemia. It is diagnosed often in persons with elevated serum calcium levels. However, hematological manifestations, such as thrombocytopenia are less known. In this case we describe the possible association of PHPT with reversible thrombocytopenia after parathyroidectomy. This hematological abnormality can be included in the spectrum of possible causes, including seemingly non-specific symptoms, in the decision tree towards surgical assessment.
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http://dx.doi.org/10.11138/ccmbm/2017.14.1.097DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5505723PMC
May 2017

A straightforward, validated liquid chromatography coupled to tandem mass spectrometry method for the simultaneous detection of nine drugs of abuse and their metabolites in hair and nails.

Anal Chim Acta 2017 Apr 25;960:101-109. Epub 2017 Jan 25.

Toxicological Centre, University of Antwerp, Universiteitsplein 1, B2610 Antwerp, Belgium; Toxicology and TDM Laboratory, ZNA Stuivenberg Hospital, Lange Beeldekenstraat 267, B2060 Antwerp, Belgium.

Hair and nails allow for a stable accumulation of compounds over time and retrospective investigation of past exposure and/or consumption. Owing to their long window of detection (weeks to months), analysis of these matrices can provide information complementary to blood and urine analysis or can be used in standalone when e.g. elimination from the body has already occurred. Drugs of abuse are often used together and, therefore, multi-analyte methods capable of detecting several substances and their metabolites in a single run are of importance. This paper presents the development and validation of a method based on liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) for the simultaneous detection of nine drugs of abuse and their metabolites in hair and nails. We focused on a simple and straightforward sample preparation to reduce costs, and allow application in routine laboratory practice. Chromatographic and mass spectrometric parameters, such as column type, mobile phase, and multiple reaction monitoring transitions were optimized. The method was validated according to the European Medicine Agency guidelines with an assessment of specificity, limit of quantification (LOQ), linearity, accuracy, precision, carry-over, matrix effects, recovery, and process efficiency. Linearity ranged from 25 to 20 000 pg mg hair and from 50 to 20 000 pg mg nails, and the lowest calibration point achieved the requirements for the LOQ (25 pg mg for hair and 50 pg mg for nails). Although it was not the main focus of the article, the reliability of the method was proven through successful participation in a proficiency test, and by investigation of authentic hair and nail samples from self-reported drug users. In the future, the method should allow comparison between the two matrices to acquire an in-depth knowledge of nail analysis and to define cutoff levels for nail analysis, as they exist for hair.
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http://dx.doi.org/10.1016/j.aca.2017.01.022DOI Listing
April 2017

Analytical and clinical comparison of Elecsys syphilis (Roche) - Architect syphilis TP and reformulated Architect syphilis TP (Abbott) assay.

Diagn Microbiol Infect Dis 2017 Mar 9;87(3):210-212. Epub 2016 Dec 9.

Department of Laboratory Medicine, AZ St Jan Bruges, Bruges, Belgium. Electronic address:

The performance of Elecsys Syphilis was compared to Architect Syphilis TP and Reformulated Architect Syphilis TP. The overall sensitivity and specificity were 98.4% and 99.5%, 97.7% and 97.1%, and 99.2% and 99.7% respectively. The assays are comparable and considered adequate for syphilis screening.
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http://dx.doi.org/10.1016/j.diagmicrobio.2016.12.003DOI Listing
March 2017

Influence of Body Mass Index on Hair Ethyl Glucuronide Concentrations.

Alcohol Alcohol 2017 Jan 20;52(1):19-23. Epub 2016 Oct 20.

Laboratoire National de Santé, Service de Toxicologie, Dudelange, Luxembourg.

Aim: Analysis of ethyl glucuronide (EtG) concentrations in hair is increasingly used to estimate the consumption of alcohol of the prior months. Linear correlations between the amount of alcohol consumed and the concentration of EtG in hair have been reported, and several variables that may influence this correlation have been investigated: e.g. cosmetic hair treatments, gender influences or hair color. Here, we investigate the influence of body mass index (BMI) on this correlation.

Methods: A post hoc analysis on the influence of BMI on the relation between amounts of alcohol consumed and the measured EtG concentrations in hair in 199 participants.

Results: Our data show higher EtG concentrations in participants with high BMI (≥25) compared to participants with low BMI (<25) (P = 0.001) across a wide range of amounts of alcohol consumed.

Conclusions: We conclude that BMI should be taken into account when interpreting hair EtG concentrations.

Short Summary: Ethyl glucuronide concentrations in hair (hEtG) can be used to estimate the consumption of alcohol of the prior months. Body mass index (BMI) influences this relation and BMI should be taken into account when interpreting hEtG concentrations in participants with high BMI (≥25) compared to participants with low BMI (<25).
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http://dx.doi.org/10.1093/alcalc/agw079DOI Listing
January 2017

Therapeutic Drug Monitoring of Meropenem in Neonate with Necrotizing Enterocolitis: A Challenge.

Case Rep Infect Dis 2016 15;2016:6207487. Epub 2016 Sep 15.

Department of Laboratory Medicine, AZ Sint-Jan Bruges, Bruges, Belgium.

Necrotizing enterocolitis (NEC) continues to be a major cause of neonatal morbidity and mortality. We describe the added value of therapeutic drug monitoring by presenting the case of a preterm infant with severe NEC treated with meropenem. Dosing strategy will achieve adequate patient outcome when treating pathogens with elevated MIC. As safe as meropenem is, there are not enough data for 40 mg/kg, every 8 h infused over 4 h; accordingly, strict monitoring of blood levels is mandatory. Based on our findings, a 4 h prolonged infusion of 40 mg/kg meropenem, every 8 h, will achieve an adequate patient outcome.
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http://dx.doi.org/10.1155/2016/6207487DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5040777PMC
September 2016

Nontuberculous mycobacteria among pulmonary tuberculosis patients: a retrospective Belgian multicenter study.

Acta Clin Belg 2017 Feb 24;72(1):45-48. Epub 2016 Jun 24.

i Department of Laboratory Medicine , UZ Leuven , Leuven , Belgium.

Objectives: Currently, there are no European data about the frequency and clinical significance of nontuberculous mycobacteria (NTM) grown from respiratory samples during the treatment of tuberculosis (TB). We determined the frequency and clinical significance of NTM isolated before or during pulmonary tuberculosis treatment in Belgian laboratories.

Methods: We conducted a nationwide retrospective multicenter cohort study on the co-isolation of TB and NTM in Belgium. Starting from laboratory data between 2006 and 2013, possible TB-NTM co-isolations were searched for.

Results: A total of 2569 unique culture-positive pulmonary tuberculosis cases were included in the study. Only 35 (1.4%) of these TB cases had an NTM co-isolated, and two of these 35 fulfilled the ATS criteria for NTM lung disease.

Conclusion: A very low prevalence of 1.4% NTM co-isolations was found in Belgian patients with culture-proven pulmonary TB.
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http://dx.doi.org/10.1080/17843286.2016.1200823DOI Listing
February 2017

Anaerobic bacteraemia: a 10-year retrospective epidemiological survey.

Anaerobe 2016 Jun 23;39:54-9. Epub 2016 Feb 23.

Department of Microbiology and Infection Control, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium.

In order to identify current trends in anaerobic bacteraemia, a 10-year retrospective study was performed in the University Hospital Brussel, Belgium. All clinically relevant bacteraemia detected from 2004 until 2013 were included. Medical records were reviewed in an attempt to define clinical parameters that might be associated with the occurrence of anaerobic bacteraemia. 437 of the isolated organisms causing anaerobic bacteraemia were thawed, subcultured and reanalyzed using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF). There were an average of 33 cases of anaerobic bacteraemia per year during 2004-2008 compared to an average of 27 cases per year during 2009-2013 (P = 0.017), corresponding to a decrease by 19% between the first and the latter period. Also, the total number of cases of anaerobic bacteraemia per 100,000 patient days decreased from 17.3 in the period from 2004 to 2008 to 13.7 in the period 2009 to 2013 (P = 0.023). Additionally, the mean incidence of anaerobic bacteraemia decreased during the study period (1.27/1000 patients in 2004 vs. 0.94/1000 patients in 2013; P = 0.008). In contrast, the proportion of isolated anaerobic bacteraemia compared to the number of all bacteraemia remained stable at 5%. Bacteroides spp. and Parabacteroides spp. accounted for 47.1% of the anaerobes, followed by 14.4% Clostridium spp., 12.6% non-spore-forming Gram-positive rods, 10.5% anaerobic cocci, 8.2% Prevotella spp. and other Gram-negative rods and 7.1% Fusobacterium spp. The lower gastrointestinal tract (47%) and wound infections (10%) were the two most frequent sources for bacteraemia, with the origin remaining unknown in 62 cases (21%). The overall mortality rate was 14%. Further studies focusing on the antimicrobial susceptibility and demographic background of patients are needed to further objectify the currently observed trends.
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http://dx.doi.org/10.1016/j.anaerobe.2016.02.009DOI Listing
June 2016

Hepatitis E: An Underdiagnosed, Emerging Infection in Nonendemic Regions.

J Clin Transl Hepatol 2015 Dec 15;3(4):288-91. Epub 2015 Dec 15.

Department of Laboratory Medicine, AZ St-Jan Bruges, Bruges, Belgium.

Although hepatitis E virus (HEV) is the primary cause of enterically transmitted acute hepatitis and jaundice in developing countries, locally acquired HEV infections are increasing in nonendemic countries. As such, HEV is emerging as an underdiagnosed cause of infection. This report describes three clinically variable cases of HEV infection with unusual clinical presentations. These cases highlight the fact that HEV should be considered in the differential diagnosis of patients with unexplained hepatitis (acute or chronic) with or without extrahepatic manifestations. HEV should also be considered in patients with persistently elevated liver enzymes who have not travelled to known HEV-endemic regions. Lack of knowledge among physicians and an absence of standardized diagnostic tests may result in increased morbidity and mortality from HEV infection.
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http://dx.doi.org/10.14218/JCTH.2015.00039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4721898PMC
December 2015

Diagnosis of hepatitis C virus genotype 2k/1b needs NS5B sequencing.

Int J Infect Dis 2015 Dec 17;41:1-2. Epub 2015 Oct 17.

Department of Laboratory Medicine, Clinical Microbiology, AZ St-Jan Bruges-Ostend, Ruddershove 10, 8000 Bruges, Belgium. Electronic address:

Hepatitis C virus (HCV) is probably the most common cause of liver cirrhosis and hepatocellular carcinoma worldwide. The correct identification of HCV genotype has important clinical implications as a marker of responsiveness to antiviral therapy and serves as a guideline for the duration of treatment. The VERSANT HCV Genotype 2.0 Assay failed to detect HCV genotype 2k/1b. HCV genotype 2k/1b detection requires NS5B sequencing.
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http://dx.doi.org/10.1016/j.ijid.2015.10.010DOI Listing
December 2015

Performance of BacT/Alert resin-based FN plus bottles compared with BacT/Alert charcoal-based FN bottles for the detection of anaerobes in experimentally seeded blood cultures.

Anaerobe 2015 Oct 5;35(Pt B):92-5. Epub 2015 Aug 5.

Department of Microbiology and Infection Control, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium.

Recently new resin-based BacT/Alert FAN Plus bottles containing antibiotic-binding polymeric beads, were introduced as an improvement of the charcoal-based FAN bottles for the recovery of bacteria and fungi. To assess the performance of the novel anaerobic FN plus bottles in the detection of anaerobic organisms, we compared the detection rate and the time to detection (TTD) in spiked resin-based FN Plus bottles and charcoal-based FN bottles. The bottles were experimentally seeded with reference strains or clinical strains collected from positive blood cultures. Five reference strains and fifty-five clinically significant anaerobic isolates were investigated, of which 91% (61/67) showed growth in both types of bottles within an incubation time of 5 days. A significant prolonged median TTD of 45 h for anaerobic microorganisms was observed in the resin-based bottles versus 29 h in the charcoal-based bottles (P < 0.0001). Bacteroides spp., associated with higher virulence and higher mortality rates in bloodstream infections, were detected faster in the charcoal-based bottles as compared to the resin-based bottles. In conclusion recently improved resin FN bottles showed a significantly increased median TTD for the recovery of anaerobic isolates.
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http://dx.doi.org/10.1016/j.anaerobe.2015.07.010DOI Listing
October 2015

Stability of vitamin B12 - A preanalytical view.

Clin Chim Acta 2015 Aug 25;448:58-9. Epub 2015 Jun 25.

Department of Laboratory Medicine, AZ St-Jan Bruges, Bruges, Belgium.

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http://dx.doi.org/10.1016/j.cca.2015.06.015DOI Listing
August 2015

Potential risk of misclassification HCV 2k/1b strains as HCV 2a/2c using VERSANT HCV Genotype 2.0 assay.

Diagn Microbiol Infect Dis 2015 Jul 7;82(3):201-2. Epub 2015 Apr 7.

Department of Laboratory Medicine, AZ St-Jan Bruges, Bruges, Belgium.

The performance of a hepatitis C virus (HCV) NS5B sequencing method described by Murphy et al. (Use of sequence analysis of the NS5B region for routine genotyping of hepatitis C virus with reference to C/E1 and 5' untranslated region sequences. J Clin Microbiol 2007;45(4):1102-12.) was compared with the VERSANT HCV Genotype 2.0 assay. The sequencing strategy led to detection of HCV recombinant genotype 2k/1b, previously identified as genotype 2a/2c, which reveals the importance of exact HCV genotyping and subtyping.
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http://dx.doi.org/10.1016/j.diagmicrobio.2015.04.001DOI Listing
July 2015

Analytical performance of the VITROS® Immunodiagnostic Products total PSA II and free PSA assays.

Clin Biochem 2014 Sep 15;47(13-14):1323-5. Epub 2014 Jun 15.

Department Clinical Chemistry, ZNA Hospitals, Antwerp, Belgium.

Objectives: To assess the precision and the performance of the VITROS(®) total PSA II (tPSA) and free PSA (fPSA) assays on the VITROS(®) ECi/ECiQ Immunodiagnostic system.

Design And Methods: The precision of the tPSA and fPSA assays was evaluated following the Clinical and Laboratory Standards Institute (CLSI)-guideline EP5-A2. During a 20-day period, 2 runs of 5 quality control (QC) samples were performed daily. Results of tPSA (n=292) and fPSA (n=289) were compared between VITROS(®) ECi/ECiQ Immunodiagnostic system and Roche Cobas 8000 e602 system (Cobas tPSA and fPSA assays). A modified CLSI-guideline EP9-A2 was used to correlate the results based on a Deming regression correlation study.

Results: A within-run and within-calibration imprecision of ≤2% was obtained for all 5 QC concentration levels for both tPSA and fPSA. Method comparison revealed a constant bias of 17% for tPSA and 6% for fPSA. These values are within the desirable bias of 18.7% suggested by the Westgard Biological Variation Database Specifications. A high agreement was found between the two methods, with correlation coefficients of 0.997 and 0.993 for tPSA and fPSA respectively.

Conclusion: The VITROS(®) tPSA and fPSA assays showed an excellent precision and bias and a good correlation with the Roche method.
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http://dx.doi.org/10.1016/j.clinbiochem.2014.06.006DOI Listing
September 2014
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