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Resume Introduction Parmi les especes de Campylobacter , Campylobacter fetus subspecies fetus est caracterise par la frequence de ses manifestations extra-digestives, notamment cardiovasculaires, survenant preferentiellement dans un contexte d’immunodepression. Les localisations cutanees sont plus rarement decrites. Observations Nous rapportons 3 observations d’infections cutanees bacteriemiques a C. fetus subspecies fetus survenus chez deux femmes âgees respectivement de 72 et 85 ans, et un homme âge de 79 ans. La recherche d’une complication ou d’une porte d’entree a type d’endocardite ou d’infection endovasculaire etait negative. L’evolution etait favorable sous traitement par amoxicilline-acide clavulanique dans les 3 cas, sans rechute observee. Conclusion C. fetus subspecies fetus est rarement associe a une atteinte cutanee et une atteinte cardiovasculaire doit systematiquement etre recherchee.

International audience; Objective: The aim was to create and validate a community-acquired pneumonia (CAP) diagnostic algorithm to facilitate diagnosis and guide chest computed tomography (CT) scan indication in patients with CAP suspicion in Emergency Departments (ED).Methods: We performed an analysis of CAP suspected patients enrolled in the ESCAPED study who had undergone chest CT scan and detection of respiratory pathogens through nasopharyngeal PCRs. An adjudication committee assigned the final CAP probability (reference standard). Variables associated with confirmed CAP were used to create weighted CAP diagnostic scores. We estimated the score values for which CT scans helped correctly identify CAP, therefore creating a CAP diagnosis algorithm. Algorithms were externally validated in an independent cohort of 200 patients consecutively admitted in a Swiss hospital for CAP suspicion.Results: Among the 319 patients included, 51% (163/319) were classified as confirmed CAP and 49% (156/319) as excluded CAP. Cough (weight = 1), chest pain (1), fever (1), positive PCR (except for rhinovirus) (1), C-reactive protein ≥50 mg/L (2) and chest X-ray parenchymal infiltrate (2) were associated with CAP. Patients with a score below 3 had a low probability of CAP (17%, 14/84), whereas those above 5 had a high probability (88%, 51/58). The algorithm (score calculation + CT scan in patients with score between 3 and 5) showed sensitivity 73% (95% CI 66-80), specificity 89% (95% CI 83-94), positive predictive value (PPV) 88% (95% CI 81-93), negative predictive value (NPV) 76% (95% CI 69-82) and area under the curve (AUC) 0.81 (95% CI 0.77-0.85). The algorithm displayed similar performance in the validation cohort (sensitivity 88% (95% CI 81-92), specificity 72% (95% CI 60-81), PPV 86% (95% CI 79-91), NPV 75% (95% CI 63-84) and AUC 0.80 (95% CI 0.73-0.87).Conclusion: Our CAP diagnostic algorithm may help reduce CAP misdiagnosis and optimize the use of chest CT scan.

Resume Dans les zones de haute prevalence tuberculeuse, les pleuresies tuberculeuses constituent la premiere etiologie des pleuresies sero-fibrineuses. De nombreux biomarqueurs, dont la determination de l’activite adenosine desaminase pleurale, ont ete propose pour aider au diagnostic de cette entite clinique et palier les limites des outils diagnostics classiques (examen direct, culture…). Bien que de nombreuses etudes aient demontre l’interet de la determination de l’activite adenosine desaminase pleurale, ce marqueur reste assez meconnu. L’objectif de cet article est de rappeler son interet en axant notre propos sur les pays a forte prevalence tuberculeuse.

Summary Objective Since the start of 2010 there has been a flare-up of measles in France, following on the resurgence observed in 2008. The aim of this study was to present results of the epidemiological surveillance of measles in the French armed forces in metropolitan France and to describe the outbreak that occurred in 2010 and 2011. Methods Criteria for report were those used for French national compulsory notification. The data, concerning active military personnel, were derived from epidemiological surveillance from 1992 to 2011 for the incidence rates and from notification forms completed in 2010 and 2011 by the military practitioners for the description of characteristics of cases. Results Between January 1992 and July 2010, 833 cases of measles were reported. Since 2002, the mean incidence rate had been 1 case p.100,000. A significant increase in incidence was observed in 2010 (10.1 p.100,000) and in 2011 (41.4 p.100,000). Clusters of cases accounted for 72.3% of cases. Rates were much higher among subjects under 30. Only 68.6% of cases had been previously vaccinated with at least one dose of MMR vaccine. The mean vaccine coverage among contacts of cases was approximated to 54.3%. Conclusions The outbreak of measles observed in 2010 and 2011 in the French armed forces followed the same pattern as that observed nationally and at European level, and can be seen as the likely consequence of inadequate vaccination coverage.

Resume Les manifestations pleuropulmonaires des vascularites necrosantes sont frequentes, polymorphes. Si l’existence de signes extrapulmonaires et la presence d’anticorps anticytoplasme des polynucleaires neutrophiles sont une aide utile pour le diagnostic d’une poussee de la vascularite, l’existence de symptomes pleuropulmonaires peut aussi faire debattre d’infections ou d’effets iatrogenes induits par les traitements immunosuppresseurs.

Resume Propos Cette etude avait pour objectif de decrire les aspects epidemiologiques, cliniques et biologiques du liquide cephalorachidien (LCR) dans les meningites a Enterovirus . Methodes Il s’agissait d’une etude retrospective monocentrique conduite sur la periode 2004 a 2008, de toutes les meningites aseptiques dues a une infection a Enterovirus . Resultats Cinquante-neuf patients, d’âge moyen de 31,4 ans, ont ete inclus. La triade, fievre, cephalees, raideur de nuque etait presente chez 62 % des patients. Une hyperleucocytose sanguine a polynucleaires neutrophiles (PNN) etait presente chez 12 patients (20 %), la C-reactive proteine etait elevee dans 23 cas (39 %). Vingt-huit patients (47 %) avaient une predominance de PNN dans le LCR et neuf (15,2 %) presentaient une hypoglycorachie. Un traitement probabiliste anti-infectieux a ete initie chez 47 patients (80 %) pendant 3,2 jours en moyenne. Conclusion L’absence de specificite des signes cliniques et biologiques des meningites a Enterovirus rend necessaire la generalisation de la PCR a Enterovirus en temps reel pour limiter les hospitalisations et les traitements anti-infectieux inutiles. Les regles de decision aident a distinguer les meningites bacteriennes des meningites virales.

Resume Introduction. – Le syndrome de Willi-Prader fait partie des obesites genetiques et une observation caricaturale est rapportee. Exegese. – Le tableau debute initialement par une hypotonie neonatale severe avec difficultes alimentaires, a laquelle succede une boulimie intense responsable d’une obesite morbide, associee a un retard statural, un syndrome dysmorphique avec acromicrie et des troubles du comportement. Le diagnostic est avant tout clinique et sera confirme par la mise en evidence de l’anomalie genetique, sur le chromosome 15, qui caracterise le syndrome de Willi-Prader, premiere affection pour laquelle a ete mise en evidence chez l’homme le mecanisme d’empreinte genomique. Conclusion. – Tout l’interet de la connaissance de ce syndrome repose aujourd’hui sur la necessite d’une prise en charge precoce et avec alors des possibilites therapeutiques par hormone de croissance.

In stays in tropical countries, the French military, and travelers in general, are exposed to diseases transmitted by the fecal-oral route, some of which are vaccine-preventable. Here we report a 42-yer-old soldier with hepatitis A, which first appeared on his return from a military operation in the Central African Republic. Despite its excellent immunogenicity and a duration of seroprotection extending beyond 20 years in the vast majority of cases, the hepatitis A vaccine can fail. This reminds us of the importance of combining vaccine and non-vaccine prevention in tropical countries, especially in precarious living conditions.

Les complications hematologiques associees a Mycoplasma pneumoniae sont variees, le plus souvent satellites du tableau de pneumonie. Le diagnostic d’infection a M. pneumoniae devant une fievre isolee, avec anomalies de l’hemogramme, est rare. Nous rapportons ici l’observation d’un homme de 25 ans, sans antecedent, hospitalise pour une fievre aigue associee a une hemolyse au retour d’un sejour a Djibouti. Le diagnostic d’infection a M. pneumoniae etait confirme par les donnees serologiques (profil de primo-infection). L’evolution etait favorable sous macrolides.

The authors report the results of a retrospective study of patients hospitalized for serologically- confirmed hepatic amebiasis confirmed by serology in four French military hospitals from January 1, 2002, through December 31, 2012. The study included 58 patients (53 men, 5 women) with a median age of 41 years (range: 25-80). Among them, 34 (59%) were in the military, 10 (17%) were tourists, 10 migrants (15%), and 4 expatriates (5%). For 75%, contamination occurred in sub-Saharan Africa. The qualitative latex test was simple to use and reliable, even in the emergency department. Medical treatment by metronidazole alone was efficacious in 75% of the patients. Indications for drainage must be discussed according to the clinical and laboratory evidence.

La tuberculose est une maladie pleiomorphe, dont la presentation clinique, meme chez un patient a risque, peut etre particulierement trompeuse. Nous rapportons un cas de rhumatisme de Poncet (RP), revelateur d'une recidive de tuberculose-maladie (avec atteinte pulmonaire et rachidienne) chez un senegalais de 61 ans, 12 ans apres l'infection initiale. La mise en place d'un traitement antituberculeux permettait la guerison du rhumatisme, devenu corticoresistant. La maladie de Poncet est une polyarthrite reactionnelle au BK, peu destructrice, d'evolution chronique. Bien que rare, cette entite ne doit pas etre meconnue des cliniciens: une infection a Mycobacterium tuberculosis doit etre recherchee en cas de rhumatisme chronique ne faisant pas sa preuve, a fortiori chez les patients a risque ou aux antecedents de tuberculose.

We describe the first isolation in France of a New-Delhi metallo-beta-lactamase-1 (NDM-1) producing Pseudomonas aeruginosa. In March 2012, a patient with history of prior hospitalisation in Serbia was diagnosed in France with acute pyelonephritis due to NDM-1 producing P. aeruginosa. Clinical and microbiological cure was obtained under appropriate antibiotic treatment. Two months later, she presented with a recurrence due to the same bacteria, with a favourable evolution. During both hospitalisations, contact isolation precautions were implemented and no cross-transmission was observed.

International audience; Background:To obtain reliable clinical data of human immunodeficiency virus type 1 group O (HIV-1/O) infection, and immunovirological responses to combination antiretroviral therapy (cART), in a large series of 101 patients.Methods:Piecewise linear models were used to estimate CD4 count before and after cART initiation. Kaplan-Meier survival curves were used to estimate time to reach clinical stage C before antiretroviral therapy (ART) and to analyze time to achieve a plasma viral load (pVL)