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Resume But de l'etude. – Notre objectif etait d'etudier la prevalence et les caracteristiques des syndromes de Guillain-Barre (SGB) associes a Campylobacter jejuni et au cytomegalovirus (CMV) dans un centre de prise en charge francais. Patients et methodes. – L'etude a porte sur 264 patients atteints de SGB hospitalises a l'hopital Raymond-Poincare (Garches) entre 1996 et 2001. Les donnees cliniques ont ete recueillies prospectivement. Les serums preleves a l'admission ont ete analyses retrospectivement pour la recherche des anticorps anti-C. jejuni, anti-CMV et antigangliosides GM1 et GM2. Resultats. – Les SGB associes a un profil serologique d'infection recente a C. jejuni etaient les plus frequents (58/264, 22 %) ; ils survenaient majoritairement chez des hommes d'âge mur (âge moyen : 51,3 ans ; sex-ratio H/F : 1,76), generalement apres des troubles gastro-intestinaux (52 %) ; ils etaient souvent purement moteurs (57 %), severes (ventilation artificielle : 40 %) et associes a une reponse IgG et/ou IgM anti-GM1 (44 %). Les SGB associes a une primo-infection par le CMV etaient moins frequents (40/264, 15 %), mais de gravite comparable (ventilation artificielle : 37,5 %) ; ils survenaient principalement chez des femmes jeunes (âge moyen : 35,9 ans ; sex-ratio H/F : 0,82), souvent apres une infection du tractus respiratoire (28 %) ou un syndrome pseudogrippal (15 %), et etaient frequemment associes a des troubles sensitifs (73 %) et a une reponse IgM anti-GM2 (47 %). Conclusion. – C. jejuni et le CMV sont deux causes majeures de SGB en France et sont associes a des tableaux distincts mais de severite comparable.

A case of disseminated infection due to Nocardia nova with subcutaneous popliteal and retrosternal abscesses and lung involvement in an immunocompromised patient is reported. The patient did not respond to sulfonamide therapy. Clinical recovery was obtained upon treatment with imipenem then clarithromycin. Western blot studies revealed an antibody response to a known Nocardia-specific 55-kDa antigen in four successive sera samples collected in the period from the time of admission to seven months later. The resolution of the disseminated nocardiosis and efficacy of the clarithromycin treatment were assessed on the basis of disappearance of the antibodies to the 55-kDa antigen, without invasive sampling.

The role of anaerobic bacteria in ventilator-associated pneumonia (VAP) has been little investigated. In this study we analyzed the incidence of anaerobes in patients with a first episode of bacteriologically documented VAP (10(3)CFU/ml), using protected specimen brushes (PSB). We particularly took care to preserve anaerobic conditions during transport and the microbiological procedure. Two groups were considered: group A with anaerobic bacteria recovered from PSB, with or without anaerobes, and group B with aerobic bacteria only. One hundred and thirty patients were included, 30 (23%) in group A, and 100 (77%) in group B. The main anaerobic strains isolated were Prevotella melaninogenica (36%), Fusobacterium nucleatum (17%), and Veillonella parvula (12%). Univariate analysis demonstrated that patients in group A were younger than those in group B (p0.05) and their simplified acute physiologic score was higher (p0.02). The percentage of patients receiving antibiotics before PSB did not differ significantly between group A (57%) and group B (35%). VAP with anaerobes occurred more often in patients orotracheally intubated than nasotracheally intubated (p0.02). Episodes of VAP involving anaerobic bacteria occurred more often in the first five days (early VAP) than after the fifth day (late VAP) (p0.05). The 3-mo mortality rate was similar in the two groups, but death occurred earlier in group B (p0.01). Multivariate analysis demonstrated that presence of altered level of consciousness (p = 0.0002), higher simplified acute physiologic score (p = 0.003), and admission to the medical ICU (p = 0.02) were the factors independently predisposing to the development of VAP with anaerobes.

Summary The authors report a case of brucellosis occuring in a technician involved in the isolation of Brucella melitensis from blood cultures of a patient who has contracted brucellosis in Spain.

A Campylobacter fetus strain was isolated from an abdominal aortic aneurysm in a 56-year-old man who had no significant chronic illness except arteriosclerosis. The strain was identified on the basis of the usual taxonomic markers and fatty acid profiles. The patient's immunological status regarding Campylobacter fetus was studied by Western blot. The strong immune response observed against the 99 kDa protein of the strain confirms that the S-layer protein is the immunodominant antigen of Campylobacter fetus.

A case of pneumonia caused by Streptococcus pneumoniae occurring in a patient receiving pristinamycin is reported. Despite empirical treatment with pristinamycin, 2 g/day for five days, the patient's condition worsened. Protected brush specimen and blood cultures permitted isolation of Streptococcus pneumoniae. MIC testing indicated that the strain was susceptible to pristinamycin and resistant to erythromycin and penicillin. Streptococcus pneumoniae was eradicated by cefotaxime, and pneumonia resolved. This case underlines the fact that pristinamycin may not be suitable for the treatment of multiresistant pneumococcal infections.

Botulism, a food-borne toxin-mediated disease caused by Clostridium botulinum is still a common disease, which is most frequent in the rural environment; 108 cases, 66 males and 42 females, average age 32 years, were recorded from 1965 to 1990 in the infectious disease department of the University Hospital of Poitiers (France). In 83% of patients, the food responsible was home-cured ham. Mean incubation time was 3.4 days; digestive symptoms were observed in 93% of cases, ocular symptoms in 92% and urinary tract dysfunction in 22%. A scale of severity was used to classify the patients into those suffering from severe (6), intermediate (50) and mild (52) forms of the disease. Botulinum toxin type B was found in 36 (52%) of 69 blood samples and in 41 (51%) of 81 samples of the suspected food. From 1965 to 1976, 44 patients were treated with both toxoid and heterologous equine serotherapy. Since 1976, 29 patients have been treated with guanidine hydrochloride (35 mg/kg daily) and 35 patients with guanidine hydrochloride plus heterologous serotherapy. All 108 patients recovered without any sequelae.

The presence of Helicobacter pylori on gastric mucosa has been associated with type B gastritis and peptic ulcer disease. Despite its uncertain role in pathogenesis, gastric mucosa colonization by H. pylori is at least a good indicator for gastroduodenal inflammatory diseases [1,14,19].

Summary A case of Listeria monocytogenes ocurring in an ICU patient is reported. L. monocytogenes was isolated in blood cultures after 23 days of hospitalization in a 61-year-old patient, initially admitted for decompensed chronic insufficiency due to corticodependent asthma. She had fever and chills but no neurologic or digestive disorder. The nosocomial origin was strongly suspected but could not proved because bacteriologic food control was negative.

Summary The authors report the case of a community respiratory tract infection by penicillin resistant pneumococcus in patient with AIDS. This infection was controled by antibiotic therapy with amoxicillin.

Adult spontaneously hypertensive rats (SHR) were daily treated for 2 weeks with perindopril [an angiotensin-converting enzyme (ACE) inhibitor] and nitrendipine (a calcium antagonist) alone or in combination. Blood pressure (BP), heart rate (HR), and diuresis were assessed weekly in conscious rats, and systemic and regional hemodynamics were investigated by the microsphere technique at the end of the treatment in anesthetized rats. Both perindopril (2 mg.kg-1.d-1) and nitrendipine (10 mg.kg-1.d-1) decreased BP to the same extent, but perindopril exerted a longer action. The hemodynamic profile of each drug was respectively consistent with the classic ones of ACE inhibitors and calcium antagonists already described in the literature. With combination of the two treatments, effects were at least additive, except that the nitrendipine-induced tachycardia was partially reduced by perindopril. BP reduction was additive, and significant potentiation was shown at the systemic [cardiac index (CI) increase, total peripheral resistance (TPR) decrease] and some regional (hepatic, muscular, and cutaneous vasodilations) levels. These results, which are in agreement with the different mechanisms of action of the two drugs, emphasize the advantage of combining perindopril with nitrendipine for treatment of hypertension.