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Competing Interests: Intérêts concurrents: Aucun déclaré.

Psoas abscess is a rare infection, difficult to diagnose, which can be primary or secondary, it is often caused by a bacterial micro-organism (Staphylococcus aureus, Escherichia coli), and in rare cases by a fungal micro-organism (Candida). We report an exceptional case of Candida tropicalis psoas abscess in a 52-year-old man with no history of pathology who had inflammatory lower back pain with fever and general deterioration. The biological assessment showed a renal insufficiency and a biological inflammatory syndrome, a computed tomography made in urgency was in favor of a psoas abscess. The bacteriological study of percutaneous drainage product allowed to isolate Candida tropicalis.

COPD is a respiratory disease associated with multiple extrapulmonary comorbidities: cardiovascular diseases, osteoporosis, depression and psychological disorders are the most prevalent. Comorbidities, especially ischemic heart disease, represent a major cause of morbidity and mortality in COPD patients. The putative link between COPD and comorbidities could be the low-grade systemic inflammation, which is common in COPD. The presence of multiple comorbidities has a strong impact on the management of COPD patients., (Copyright © 2014. Published by Elsevier Masson SAS.)

Cardiac surgery with cardiopulmonary bypass (CPB) can cause a systemic inflammatory response (SIRS) making difficult the interpretation of inflammatory markers. Procalcitonin (PCT) is a marker of inflammation that appears to be a good early marker of infection after cardiac surgery. To study the kinetics of PCT after cardiac surgery with CPB and to determine its diagnostic and prognostic value. This is a prospective observational study including 40 adult patients consecutively operated for a coronary or valve surgery with CPB, so programmed or semi-urgent. The anesthetic protocol was standardized for all patients. A determination of PCT and CRP was performed before the CEC, at the decision of the CEC (H0), 4 hours after (H4), then H24, H48, H72 and H96. The rate of PCT and CRP increased significantly from the H4 until 4(th) day compared to baseline. (p<0.05). The concentration of PCT increased at the end of CPB, reaching its peak on 1(st) day (0.96±1.00 ng/mL) and then declined rapidly to J2, J3 and J4. CRP showed a slower kinetics with a peak on day 2 (204±81 mg/L) and decreased more slowly. PCT levels showed no significant variation depending on the type of surgery and they were significantly increased in cases of severe SIRS, late postoperative infection and postoperative renal dysfunction (PORD). However, the rates of CRP were not correlated with these complications. According to ROC curve analysis, a threshold value of 0.958 ng/mL PCT measured on the 1(st) day after surgery had a sensitivity of 85% and a specificity of 95% for the prediction of severe SIRS with organ dysfunction. For a threshold of 1.2 ng/mL measured at day 1 postoperatively, the PCT has a sensitivity of 100% and a specificity of 96% for predicting late infection. For a threshold value of 0.475 ng/mL measured at the decision of the CPB, the PCT has a sensitivity of 80% and a specificity of 69% for predicting PORD. PCT levels were correlated with severity scores. They were also correlated with length of stayin ICU. According to ROC curve analysis, a cutoff of 0.737 ng/mL measured at 1(st )postoperative day, the PCT has a sensitivity of 76% and a specificity of 91% for the prediction of an ICU stay of more 3 days with AUC=0.818. The PCT is a marker that has a fast kinetics and can early predict severe SIRS, and late postoperative infection as well as PORD.

Intrauterine infection could be responsible for 25% up to 40% of preterm births. This relationship was initially demonstrated using animal models, inducing their abortion by injecting bacteria or endotoxins. In human research, examination of amniocentesis fluid showed the anteriority of infection over labor induction, and the existence of a subclinical latency phase between these two phenomena. The ascending route is preponderant, and four stages can be distinguished: cervical and vaginal infection, chorio-decidual infection, intra-amniotic infection, fetal infection. The intrauterine infection is very frequent in case of early preterm birth (<30 WG). It is associated with an increase of neurological and pulmonary morbidity. Most commonly found bacterial species are mycoplasma species, but also Escherichia coli, Gardnerella vaginalis and streptococcus B. Several markers of the infection have been studied: a maternal leukocytosis>15,000/mm(3) or a C-Reactive Protein (CRP)>20mg/l, an increase of fibronectin and/or IL-6 cervical, a short cervical length especially before 32 WG, a leukocytosis of the amniotic fluid, and/or high interleukin concentrations. The main marker used for the newborn is the CRP, but other markers can also be used for an early diagnosis of an infection, especially interleukin 6., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Procalcitonine (PCT) is recognized as a major and specific biomarker in diagnosis of bacterial infection. Used early in sepsis, it allows immediate administration of antibiotics and monitoring its effectiveness. Confronted on systemic inflammation response syndrom (SIRS), physicians must react quickly and effectively to evaluate bacterial infection and sepsis. The objective of this study was to compare analytical and clinical performances of semi-quantitative PCT-Q assay (Brahms) with quantitative and automated assay such on Kryptor (Brahms). Fifty blood samples of intensive care patients were compared. The analytical performance observed with PCT-Q assay is accurate: linear ratio kappa of 0.912 (95% CI 0.61, 0.97) and a good correlation between these techniques (p < 0.0001) (MedCalc software) were observed. Three discordances were observed and confirm the difficulties of reading for values close to 0.5 ng/mL. For these patients, PCT result showed its interest to discriminate local infection of a sepsis, to stop antibiotherapy with broad spectrum and to consolidate a therapeutic effectiveness in multi-visceral failure context. The semi-quantitative assay seems adapted for a fast and reliable evaluation of PCT in a general-purpose laboratory, not requiring neither dedicated analyzer, nor complex technicality but a control of the visual evaluation of results. It could be used for diagnosis of sepsis without monitoring precisely therapeutic follow-up.

Acute sinusitis in children is a controversial issue in terms of its diagnostic criteria, classification and therapeutic management. A therapeutic delay can lead to complications if the cause is bacterial. Guidelines have been set, but they are not consensual in pediatrics. Complications of acute bacterial sinusitis are uncommon in children, but they can be extremely severe and cause high morbidity and mortality. Because of their rarity, they often are not identified early, exposing the patient to an unfavorable outcome. We report on a case of acute bacterial pan-sinusitis complicated with thrombophlebitis of the cavernous sinuses and meningitis in a 9-year-old child, in spite of early and adapted antibiotic therapy. The bacterial agent was Staphylococcus aureus, which had no resistance or toxin profile. The progression was favorable under intravenous antibiotic therapy and after bilateral sphenoidectomy. This case raises the question of the best therapy for acute bacterial sinusitis in pediatrics and the management of complications., (Copyright 2010. Published by Elsevier SAS.)

We report on a 12-year-old patient from Congo who presented acute chorea following cardiac surgery for poststreptococcal mitral valvulopathy. She showed severe and asymmetrical chorea, associated with motor impersistence and agitation. Biological investigations disclosed inflammatory signs and brain MRI was normal. Due to the negative results of the biological and morphological investigations, the diagnosis of Sydenham chorea was suspected. High doses of oral steroids resulted in a dramatic improvement of the chorea as well as the behavior disturbance within 1 month. Sydenham chorea is not an unusual complication of rheumatic fever. Usually, patients develop chorea a few weeks after beta-hemolytic streptococcal pharyngitis. Details on its pathophysiology remain to be determined. Our case highlights its possible onset in the postoperative period if alternative etiologies of infantile chorea have been excluded.

Despite recent medical progresses in patient support, the mortality of sepsis remains high. Recently, new supporting strategies were proposed to improve outcome. Whereas such strategies are currently considered as standard of care, their real impact on mortality, morbidity, length of stay, and hence, health care resources utilization has been only weakly evaluated so far. Obviously, there is a critical need for epidemiologic surveys of sepsis to better address these major issues. The Lausanne Cohort of septic patients aims at building a large clinical, biological and microbiological database that will be used as a multidisciplinary research platform to study the various pathogenic mechanisms of sepsis in collaboration with the various specialists. This could be an opportunity to strengthen the collaboration within the Swiss Latin network of Intensive Care Medicine.

Consensual and precise definitions. Sepsis is composed of a suspected or documented infection associated with at least 2 SIRS criteria (systemic inflammatory response syndrome). Severe sepsis is sepsis with arterial hypotension and failure of one or several organs following the reduction in tIssue perfusion. Septic shock is a severe sepsis, the hypotension of which is refractory to volemic expansion. From an epidemiological point of view. Over the past two decades, its incidence is on the increase. Mortality varies from 25 to 80% of cases and sepsis remains the first cause of death in intensive care. The elements of diagnosis. The initial clinical signs are those of an infection and the port of entry and microbiological proof must be systematically researched before the appearance of a drop in blood pressure with hemodynamic impact on the various organs and hence their possible failure. The biological abnormalities observed depend on the deficient organ(s); hyperlactatemia is a good marker of visceral hypoperfusion. The sepsis risk factors. Any situation enhancing immunodepression is a risk factor for sepsis. Factors of virulence of the micro-organisms also intervene and, in cases of fungal infection, inherent risk factors. Genetic susceptibility probably intervenes, genetic variability playing either a protective or a deleterious role (the interest of Toll-like receptors).

Meningo-radiculitis is the most common peripheral nerve system involvement of Lyme disease. We report the observation of a 73 year-old woman presenting a subacute multiple mononeuropathy and a severe inflammatory syndrome. Diagnosis of Lyme disease was confirmed by a lymphocytic meningitis with positive serologic results in the cerebrospinal fluid. Nerve biopsy showed inflammatory cells spreading along the endoneurium. This case report emphasizes that Lyme disease may present as a multiple mononeuropathy mimicking a vasculitic neuropathy.

Nocardiasis is an uncommon bacterial disease often observed in immunodepressed patients. Its interactions with the immune system remain poorly known. We report a case of Nocardia asteroides thoracic nocaridiasis in an African subject who also had macrophage activation syndrome. We recall the classic data on nocardiasis in Africa and emphasize the importance of emergence in HIV-infected subjects. The association between nocardiasis and macrophage activation syndrome suggest a possible pathogenic mechanism involving the immune system (lymphocytes and macrophages) and Nocardia asteroides.

Excepting emergency and aplasia: two to three blood samples should be draw for culture an hour apart within a 24 period (standard). For emergency or aplasia: two to three blood samples should be drawn for culture before initiating early antibiotic therapy. The delay between samples drawn from different sites should be less than one hour (standard). For patients on antibiotics: four to six blood samples should be drawn for culture within 48 hours, outside ongoing antibiotic administration. If the patient is given corticosteroids, it is recommended to draw two or three blood samples in case of deterioration (agreement of the experts). Rigorous aseptic techniques must be used (standard). Culture media are chosen according to the institution's microbial ecology (standard). The volume of blood drawn should be adapted to the system used (standard). Culture positivity is determined at 24 to 48 hours.