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OBJECTIVES To compare two learning methods for Lyme disease (e-learning versus face-to-face training) to assess knowledge and know-how. METHODS The study population was volunteer general medicine residents and family physicians (FP). Face-to-face training on Lyme disease was offered to each group. E-learning training was then offered to those who had not attended the face-to-face training. Theoretical knowledge was assessed by an identical pre- and post-test questionnaire and know-how by a script concordance test. RESULTS Seventy learners (47 FPs and 23 general medicine residents) were included in the face-to-face training group and 61 (33 FPs and 28 general medicine residents) in the e-learning group. The pre- and post-test scores were significantly improved in the FP group (difference of 29.3±1.9 [P

Introduction La recherche d’IgM anti-Borrelia burgdorferi sl (Bbsl) seriques est tres largement prescrite malgre : – le manque de sensibilite et de specificite de cette technique ; – leur persistance pendant plusieurs mois a annees chez certains patients y compris apres traitement antibiotique ; – les recommandations 2018 de l’ESCMID Study Group for Lyme Borreliosis (ESGBOR) de ne les rechercher qu’en cas de signes cardiaques ou de lymphocytome. Materiels et methodes Afin d’evaluer l’apport en pratique clinique de cette recherche en complement de celle des IgG anti-Bbsl, nous avons conduit une etude observationnelle retrospective portant sur 2035 serologies effectuees du 01/01 au 30/06/21 par Elisa (EIA) puis en cas de positivite par un seul Western-blot (WB). Resultats Un EIA IgM anti-Bbsl positif ou douteux etait retrouve pour 252/2035 serums (resp. 152 et 100) puis un WB IgM non negatif (positif, douteux ou non realise) n’etait retrouve que pour 128/252 serums (resp. 22, 24 et 82) et ce sans WB IgG positif pour 80/128 d’entre eux. Pour 23/80 l’absence de donnees cliniques ne permettait pas de conclure sur la pertinence de la prescription. Parmi les 57/80 patients pour lesquels les donnees cliniques etaient accessibles, pour 51/57 (90%) patients les symptomes etaient apparus depuis plus 6 semaines avant le prelevement du serum (31/49 pour lesquels la date de debut des symptomes etait connue) et/ou n’etaient pas conformes aux criteres de ESGBOR (35/57) et/ou un diagnostic differentiel avait ete pose (33/57). Parmi les 6 patients restants, 5/6 presentaient des signes neurologiques : – avec pour les 4/5 patients pour lesquels l’index de synthese intrathecale d’IgG anti-Bbsl avait pu etre calcule, 4/4 presentant un index > 1,5 en faveur d’une neuroborreliose; pour 1/5 cet index n’avait pas pu etre calcule mais le titre en IgG anti-Bbsl dans le LCR etait > a 500 UI/mL ; – et avec pour 5/5 patients un EIA IgG anti-Bbsl positif et pour 4/5 un WB IgG douteux; pour 1/5 patient dont le serum avait ete preleve seulement 9 jours apres le debut des symptomes le WB IgG etait negatif. Au final seule 1/2035 recherche d’IgM anti-Bbsl serique par EIA pour un patient presentant depuis 2 semaines une uveite posterieure associee a une vascularite retinienne, des cephalees, une asthenie et un syndrome algique apportait une information supplementaire a la recherche d’IgG anti-Bbsl sl. Par ailleurs, on constate que pour les 10/57 patients presentant des signes neurologiques depuis 6 semaines ou moins avant le prelevement du serum et un WB IgG negatif ou douteux et pour lesquels la recherche d’IgM anti-Bbsl seriques par EIA etait positive ou douteuse le WB IgM n’avait pas ete realise dans 8/10 cas. A posteriori 5/10 WB IgM sont negatifs et la positivite du WB IgM n’est correlee ni a la synthese intrathecale d’IgG anti-Bbsl ni a la pleiocytose ni a la mise en place d’un traitement. Conclusion En conclusion la recherche d’IgM anti-Bbsl seriques ne semble d’aucune utilite en supplement de la recherche d’IgG en dehors des recommandations de l’ESGBOR si ce n’est pour le diagnostic des formes oculaires de borreliose de Lyme.

Resume Objectifs Vitek-2™ AIX et PC n’ont pas les memes regles d’interpretation phenotypique. Nous avons verifie que les CMI brutes determinees par ces deux versions du Vitek-2™ permettent au biologiste de conclure au meme phenotype de resistance, puis nous avons compare les interpretations phenotypiques du biologiste avec celles des deux systemes. Materiel et methodes Un total de 251 souches d’enterobacteries de differents groupes et phenotypes a ete teste. Chaque souche a ete etudiee simultanement sur les deux types de Vitek-2™, a partir du meme inoculum calibre. Nous avons ensuite compare leur phenotype de resistance aux beta-lactamines. Resultats Pour les souches ne produisant ni β-lactamases a spectre etendu (BLSE) ni cephalosporinase a haut niveau (CHN), le biologiste conclut dans 99,3 % des cas au meme phenotype de resistance par l’interpretation des resultats bruts du Vitek-2™ AIX versus PC. L’interpretation phenotypique du biologiste est differente de celle du Vitek-2™ dans respectivement 40 % versus 43 % des cas pour les versions AIX et PC. Pour les souches multiresistantes, le biologiste conclut dans 100 % des cas au meme phenotype de resistance par l’interpretation des resultats bruts du Vitek-2™ AIX versus PC. Dans 51,5 % des cas, le biologiste estime devoir recourir a l’epreuve de synergie par diffusion (SD). Les resultats de cette technique mettent en avant 29 % de discordance avec les deux types de Vitek-2™. Enfin, lorsque les Vitek-2™ concluent a la presence d’une BLSE seule, ce resultat est systematiquement confirme par SD. Conclusion Le passage du Vitek-2™ AIX au Vitek-2™ PC ne modifie en rien les resultats de l’interpretation phenotypique du biologiste.

Resume Introduction La maladie de Lyme est une zoonose transmise par une morsure de tique relativement frequente dans l’hemisphere Nord. Notre etude rappelle que les manifestations ophtalmologiques au cours de la maladie de Lyme sont multiples et variees, y compris dans l’enfance. Patients et methodes Six enfants presentant des manifestations oculaires au cours d’une maladie de Lyme ont ete suivis au centre hospitalier universitaire de Strasbourg (zone d’endemie) entre 2000 et 2010. L’histoire de la maladie, les manifestations oculaires et systemiques, la presence d’une serologie positive contre Borrelia et l’exclusion d’autres causes inflammatoires ou infectieuses ont ete utilisees comme criteres diagnostiques. Resultats Parmi les six enfants suivis, deux d’entre eux presentaient une uveite, deux une paralysie oculomotrice, un une neuropathie optique et un une myosite orbitaire survenues dans un contexte de maladie de Lyme. Des manifestations systemiques suivant la morsure de tique, comme un erytheme migrant ou un syndrome pseudo-grippal, ont ete retrouvees chez tous les enfants. Deux enfants ont aussi souffert d’une arthrite du genou. La serologie de la maladie de Lyme, obtenue avant de debuter une antibiotherapie, etait positive pour chacun des enfants. Tous les enfants ont ete traites par une antibiotherapie adaptee a l’âge. Trois enfants (deux uveites, une neuropathie optique) ont aussi beneficie d’une corticotherapie locale ou systemique. La guerison a ete obtenue en deux a douze semaines sans aucune rechute a ce jour pour l’ensemble des patients. Conclusion Chez l’enfant comme l’adulte, la maladie de Lyme doit etre evoquee devant toute manifestation ophtalmologique inexpliquee, notamment en zone d’endemie. Une confirmation microbiologique doit etre obtenue precedant la mise en route d’un traitement par antibiotherapie. Une prise en charge correcte permet une evolution sans sequelle et l’absence de rechute ulterieure, y compris lorsque les symptomes sont observes dans la petite enfance.

Resume But de l’etude Suivre l’evolution de l’incidence et des principales caracteristiques des bacteriemies et fongemies enregistrees entre 2005 et 2007. Patients et methode La methodologie d’enquete etablie par le centre de coordination de la lutte contre les infections nosocomiales de l’Est inclut tous les patients hospitalises sur une periode de trois mois. Des donnees microbiologiques et cliniques sont collectees pour toute hemoculture positive. Resultats Les bacteriemies nosocomiales acquises en hospitalisation complete sont majoritaires avec un taux d’incidence variant de 0,996 a 1,31 ‰ journees d’hospitalisation. Les populations les plus touchees sont celles de plus de 50 ans. Les portes d’entree predominantes sont les catheters centraux, les origines digestives et urinaires. Les micro-organismes les plus frequemment isoles sont les staphylocoques a coagulase negative, Staphylococcus aureus et Escherichia coli. La frequence des deces survenus au cours des sept jours suivant le debut des episodes varie de 16 % en 2005 a 8 % en 2007. Les bacteriemies communautaires representent 28 % des episodes et touchent majoritairement les populations de plus de 70 ans. Les portes d’entrees predominantes sont urinaires, digestives et pulmonaires. Escherichia coli, Staphylococcus aureus et Streptococcus pneumoniae sont les micro-organismes les plus frequemment retrouves. La frequence des deces survenus au cours de la premiere semaine varie de 3,7 a 9,8 % selon l’annee d’etude. Conclusion Cette enquete annuelle permet de mesurer le niveau de risque infectieux dans un etablissement, d’identifier les portes d’entree les plus frequemment en cause et surtout de cibler les actions de prevention a mettre en œuvre.

Resume Materiel et methodes Les concentrations minimales inhibitrices de nine antibiotiques ont ete determinees par une methode de reference (norme M11-A5 du National Committee for Clinical and Laboratory Standards) sur 376 souches de bacteries anaerobies strictes. Les souches se repartissaient ainsi : 254 Bacteroides du groupe fragilis (dont 143 B. fragilis ), 122 autres bacteries a Gram negatif ( Bacteroides spp. , Prevotella, Fusobacterium, Porphyromonas, Suterella, Desulfomonas, Veillonella ). Resultats Chez B. fragilis (groupe) les taux de resistance sont les suivants : amoxicilline–acide clavulanique 2,8 %, ticarcilline 27,5 %, ticarcilline–acide clavulanique 1,9 %, piperacilline–tazobactam 1,9 %, cefoxitine 6,2 %, imipeneme 0,8 %, clindamycine 28,3 %. Considerant les etudes multicentriques anterieures, la resistance a l’imipeneme reste faible en 2003 et n’est observee que chez B. fragilis . La resistance a la clindamycine se maintient et avoisine les 25 %. Aucune resistance au metronidazole n’est constatee, mais une sensibilite diminuee est observee chez B. fragilis , B. merdae et Prevotella , soit chez 4,3 % des anaerobies a Gram negatif. Discussion Cette etude confirme la forte resistance des anaerobies a Gram negatif a la clindamycine, les bonnes activites de l’imipeneme, des associations β-lactamines–inhibiteur de β-lactamase et du metronidazole. Cependant, la sensibilite diminuee au metronidazole semble augmenter.

Las espondiloartropatias (EPA) agrupan distintas enfermedades cuya lesion elemental es una lesion inflamatoria de las entesis axiales y/o perifericas. Se trata de la espondiloartritis anquilosante (EA), las artritis reactivas (AR), la artritis psoriasica (RP) y las manifestaciones articulares de las enterocolopatias inflamatorias cronicas (enfermedad de Crohn y rectocolitis ulcerohemorragica). Su prevalencia se aproxima a la de la poliartritis reumatoide, y es del orden del 0,2-0,5% en la poblacion general. Estas enfermedades reumaticas tienen caracteristicas comunes: casi siempre comienzan en el adulto joven con una base genetica predisponente (antigeno leucocitico humano [HLA] B27) y tienen una evolucion marcada por frecuentes remisiones espontaneas, aunque tambien hacia una forma cronica invalidante y discapacitante. Todas las entesis pueden estar afectadas. Las localizaciones mas caracteristicas son las sacroiliacas y la columna vertebral, responsables de la afectacion axial, y tambien el calcaneo, las articulaciones claviculares, la sinfisis pubica y las interfalangicas distales en las afecciones perifericas. Algunas artritis perifericas asimetricas pueden completar el cuadro clinico. Cuando en un adulto joven existe un cuadro de raquialgias inflamatorias o de inflamacion de las entesis o articulaciones perifericas, habra que buscar mediante el interrogatorio y la exploracion clinica antecedentes personales o familiares de EPA, asi como de psoriasis, acne, pustulosis, enteropatia, trastorno urogenital o digestivo y oftalmopatia. En la exploracion fisica hay que descartar un cuadro pelvirraquideo, entesitico, articular periferico o extraarticular. Las pruebas de laboratorio sirven sobre todo para descartar los diagnosticos diferenciales. Asi, el sindrome inflamatorio puede ser muy leve o estar ausente, sobre todo en las formas axiales. La busqueda del HLA B27 solo esta justificada en las formas iniciales y/o atipicas de EPA, y debe ser interpretada con prudencia, ya que un 7-10% de la poblacion caucasica es portadora de al menos un alelo HLA B27. Las lesiones radiologicas caracteristicas aparecen casi siempre en la fase tardia, pero cuando lo hacen permiten confirmar el diagnostico. La piedra angular del tratamiento de las EPA es la asociacion de antiinflamatorios no esteroideos (AINE), cuya eficacia es un criterio diagnostico clave, y de reeducacion funcional. Los analgesicos son eficaces como tratamiento complementario de los AINE. Si los AINE resultan insuficientes, se puede plantear la introduccion de un tratamiento de fondo. En las formas perifericas, ciertos tratamientos como la sulfasalazina, el metotrexato, la leflunomida y los antifactores de necrosis tumoral (TNF)-α han mostrado su eficacia clinica, sobre todo en las RP. En cambio, solo el anti-TNF-α ha demostrado eficacia clinica en las formas axiales. Estos tratamientos solo se pueden utilizar en las EPA despues del fracaso de un tratamiento convencional dirigido de forma optima y de acuerdo con la opinion de un reumatologo que tenga una gran experiencia en las EPA y en las bioterapias.

Resume Les spondylarthropathies (SP) regroupent des pathologies dont la lesion elementaire est une atteinte inflammatoire des entheses axiales et/ou peripheriques. Il s'agit de la spondylarthrite ankylosante (SPA), des arthrites reactionnelles (AR), du rhumatisme psoriasique (RP) et des manifestations articulaires des enterocolopathies inflammatoires chroniques (maladie de Crohn et rectocolite ulcerohemorragique). Leur prevalence est proche de celle de la polyarthrite rhumatoide, de l'ordre de 0,2 a 0,5 % dans la population generale. Ces rhumatismes ont des caracteristiques communes : Ils debutent le plus souvent chez l'adulte jeune avec un terrain genetique predisposant ( human leukocyte antigen [HLA] B27) et ont une evolution marquee par de frequentes remissions spontanees mais aussi vers une forme chronique, invalidante et handicapante. Toutes les entheses peuvent etre touchees. Les localisations les plus caracteristiques sont les sacro-iliaques et le rachis, responsables de l'atteinte axiale, mais aussi le calcaneus, les articulations claviculaires, la symphyse pubienne et les interphalangiennes distales pour ce qui est des atteintes peripheriques. Des arthrites peripheriques, asymetriques, peuvent completer le tableau clinique. Face a un tableau de rachialgies inflammatoires de l'adulte jeune, ou d'atteinte inflammatoire des entheses ou articulations peripheriques, il faudra a l'interrogatoire et a l'examen clinique des antecedents personnels ou familiaux de SP, mais aussi de psoriasis, acne, pustulose, enteropathie, affection genito-urinaire ou digestive, atteinte oculaire. L'examen clinique recherche les syndromes pelvirachidien, enthesitique, articulaire peripherique et extra-articulaire. Le bilan biologique sert surtout a eliminer les diagnostics differentiels. En effet, le syndrome inflammatoire peut etre absent ou discret, surtout dans les formes axiales. La recherche de HLA B27 ne se justifie que dans les formes debutantes et/ou atypiques de SP et doit etre interpretee avec prudence car 7 a 10 % de la population caucasoide porte au moins un allele HLA B27. Les lesions radiologiques caracteristiques apparaissent le plus souvent tardivement, mais permettent alors de confirmer le diagnostic. La pierre angulaire de la prise en charge des SP est l'association des anti-inflammatoires non steroidiens (AINS), dont l'efficacite est un critere diagnostique important, et de la reeducation fonctionnelle. Les antalgiques sont interessants en traitement d'appoint des AINS. En cas d'insuffisance des AINS, on pourra envisager l'introduction d'un traitement de fond. Pour les formes peripheriques, certains traitements comme la Salazopyrine ® , le methotrexate, le leflunomide et les anti- tumor necrosis factors (TNF)-α ont fait la preuve de leur efficacite clinique, en particulier dans le RP. En revanche, seuls les anti-TNF-α ont demontre une efficacite clinique sur les formes axiales. Ces traitements ne peuvent etre utilises dans les SP qu'apres l'echec d'un traitement conventionnel conduit de facon optimale et sur avis d'un rhumatologue ayant une grande experience des SP et des biotherapies.

We report three cases of delivery and postpartum bacteremia due to unusual anaerobic bacteria in healthy young women. Leptotrichia amnionii bacteremia occurred during delivery in two mothers and was associated with fetal distress during labor. Conversely, Sneathia sanguinegens bacteremia occurred postpartum, 2 days after delivery, without consequence for the neonate.

Resume Le diagnostic d'infection neonatale est difficile: l'hemoculture apporte une aide indeniable si son resultat est fiable. Parmi les 880 hemocultures prelevees pendant l'annee 1996, 55 se sont revelees positives, soit un taux de positivite global de 6,25%. Quinze hemocultures etaient considerees comme contaminees et 36 correspondaient a des bacteriemies vraies: soit un taux global de contamination de 1,7% et un taux de bacteriemies vraies de 4,1%. Le taux de contamination des hemocultures peut etre diminue par une asepsie rigoureuse lors du prelevement. La sensibilite de detection des bacteriemies neonatales peut etre accrue en prelevant un volume de sang de 1 a 2 ml, determine en fonction du contexte clinique.

We describe an outbreak of pneumonia due to Streptococcus pneumoniae in a French retirement home. Eleven residents developed pneumonia. Eight patients had positive results of urinary antigen tests. There were no further cases after the implementation of control measures, which involved isolation of and receipt of antibiotic therapy by symptomatic residents. No risk factors for transmission of S. pneumoniae were identified in this population.

SUMMARY This study investigates the seroreactivity to Borrelia burgdorferi antigens of patients suAering from rheumatoid arthritis (RA) for

Purpose Lyme borreliosis (LB) is the most common human tick-borne disease in the Northern hemisphere. The various ophthalmologic manifestations of Lyme borreliosis (LB) during childhood period are discussed in this study. Methods Six children with LB-associated ocular manifestations were treated between 2000 and 2010 in the ophthalmology department of Strasbourg University Hospital (an endemic area). Medical history, ocular and systemic clinical findings, determinations of antibodies related to Borrelia as well as exclusion of other causes were diagnosis criteria. Results Two uveitis, Two abducens palsies, one optical neuropathy and one orbital myositis associated with LB were diagnosed. Systemic findings, such as arthritis, rash, or erythema migrans were mentioned in all cases. Two children also complained about severe knee arthritis. Determination of antibodies was positive in all patients. All patients were treated by antibiotics adjusted to individual circumstances and some of them (two uveitis and one optic neuropathy) also had anti-inflammatory treatment. Resolution of ocular signs, without any relapse, was observed in all patients within two to twelve weeks. Conclusion For any unexplained ocular symptom, even for children, LB should be taken into account especially in endemic areas. Such patients should undergo serological testing. If the clinical presentation is suggestive of LB, a course of oral antibiotics should be used. All in all, permanent defects are extremely rare during childhood period, even following long-term manifestation at an early age.

Resume L'effet benefique de la decontamination digestive sur la reduction de l'incidence de la maladie du greffon contre l'hote (GvHD) est generalement admis. Nous rapportons ici notre experience portant sur 40 greffes allogeniques successives realisees a partir de donneurs apparentes HLA identiques. La decontamination totale a ete effectuee avec isolement en isolateur plastique ou en chambre a flux laminaire, alimentation sterilisee et antibiotiques oraux non-absorbables. Trente-huit patients sont evaluables (2 deces precoces). Seuls 4 d'entre eux restaient porteurs de bacteries au niveau intestinal alors que 24 etaient porteurs de levures. La plupart des patients etaient porteurs de germes au niveau nasal ou oropharynge (staphylocoques : 20 patients, bacilles a Gram negatif : 4 patients, levures : 16 patients). Vingt-huit patients (74 %) ont presente une GvHD aigue. Une relation significative a ete etablie entre colonisation bacterienne nasale ou oropharyngee et GvHD (p

Lyme borreliosis (LB) is the most common human tick-borne disease in the Northern hemisphere. The various ophthalmologic manifestations of Lyme borreliosis (LB) during childhood are discussed in this paper.Six children with LB-associated ocular manifestations were treated between 2000 and 2010 in the ophthalmology department of Strasbourg University Hospital (an endemic area). Medical history, ocular and systemic clinical findings, determinations of antibodies related to Borrelia, as well as exclusion of other causes were the diagnosis criteria.Two cases of uveitis, two cases of abducens palsies, one case of optical neuropathy, and one case of orbital myositis associated with LB were diagnosed. Systemic findings, such as arthritis, rash, or erythema migrans were mentioned in all cases. Two children also complained of severe knee arthritis. Determination of antibodies was positive in all patients. They were all treated with antibiotics adjusted to individual circumstances and some of them (two cases of uveitis and one of optic neuropathy) also had anti-inflammatory treatment. Resolution of ocular signs, with no relapse, was observed in all patients within two to 12 weeks.For any unexplained ocular symptom, even in children, LB should be taken into account, especially in endemic areas. Such patients should undergo serological testing. If the clinical presentation is suggestive of LB, a course of oral antibiotics should be used. All in all, permanent defects are extremely rare during the childhood period, even following long-term manifestation at an early age.

Vitek-2™ AIX versus Vitek-2™ PC have different rules for phenotypic interpretation. The aim of this study is to ensure that the raw results determined by these two versions of Vitek-2™ allow biologists to conclude to the same resistance phenotype, but also to evaluate their own phenotypic interpretation system (advanced expert system).A total of 251 strains of Enterobacteriaceae of different groups and phenotypes was tested. Each strain was studied simultaneously on both types of Vitek-2™ from the same calibrated inoculum. We then compared their resistance phenotype to beta-lactams.For strains not producing ESBL or CHN, the biologist concluded in 99.3% of cases to the same resistance phenotype by interpreting the raw results of Vitek-2™ AIX versus PC. The phenotypic interpretation of biologist is different from the Vitek-2™ in respectively 40% versus 43% of cases for AIX and PC versions. For multi-resistant strains, the biologist concluded in 100% of cases to the same resistance phenotype by interpreting the raw results of Vitek-2™ AIX versus PC. In 51.5% of cases the biologist use the disk diffusion method (DD). The results of this technique put forward 29% discrepancy with the two types of Vitek-2™. Finally, when Vitek-2™ claims the presence of an ESBL alone, this result is routinely confirmed by DD.The switch from Vitek-2™ AIX to Vitek-2™ PC does not alter the results of the phenotypic interpretation of biologist.

B. JAULHAC, M. BES, N. BORNSTEIN, Y. PIEMONTY. BRUN AND J. FLEURETTE. 1992. A dot blot hybridization technique with oligonucleotide probes was developed for the specific detection of the TSST-1 gene and the staphylococcal enterotoxin (SE) genes A, B, C, D and E. For each toxin gene a probe sequence was chosen from the previously determined sequence. A total of 145 staphylococcal strains (133 Staphylococcus aureus and 12 coagulase-negative staphylococci (CNS)) were studied by this genotypic method and by two phenotypic assays (gel immunodiffusion and ELISA). An excellent correlation (96%) was observed between the genotypic and phenotypic assays. DNA from two CNS strains hybridized with a probe without detection of the corresponding toxin (SEB for one strain and SEC for the other strain). One Staph. aureus strain was shown to be an SEC producer, but was not detected by the corresponding probe. Gene probe and immunological assays seem to be complementary methods for studies of staphylococcal strains producing (or potentially producing) TSST-1 or enterotoxins.

To follow the evolution of incidence of the main feature of bloodstream infections identified in a french hospital between 2005 and 2007.We included all the patients hospitalised during three times three-month periods, according to the protocol given by the coordination center against nosocomial infections. For every positive blood culture, we collected clinical and microbiological datas.Hospital-acquired bacteremias are the most frequent with an incidence rate between 0.996 to 1.31 per thousand days of hospitalisation. The population is mainly over 50 years old. The main sources of infection are central catheter, digestive and urinary tracts. Organisms causing the majority of nosocomial bloodstream infections are coagulase-negative staphylococci, Staphylococcus aureus and Escherichia coli. The mortality rate during the first week varies from 16% in 2005 to 8% in 2007. Community-acquired bloodstream infections represent 28% of all episodes, and affect people who are over 70 years old. The main sources of infection are urinary, digestive and pulmonary. Escherichia coli, Staphylococcus aureus and Streptococcus pneumoniae are most frequently isolated. The mortality rate during the first week varies from 3.7 to 9.8% according to the year of study.This annual investigation enables us to measure the infection risk level in our hospital, to identify the main sources implied and to create targeted actions to prevent nosocomial bloodstream infections.

A rapid and specific assay for toxic shock syndrome toxin-1 gene (tst gene) detection in Staphylococcus aureus was developed using the polymerase chain reaction. A two-primer set and an oligonucleotide detection probe were synthesized. After 40 cycles of amplification, detection of a 160-bp amplified DNA fragment was carried out by agarose gel electrophoresis and Southern blot hybridization. This assay was sensitive since it was able to detect 1-10 bacteria. It was also specific since no amplification was documented with DNAs from enterotoxigenic S. aureus or Gram-negative bacteria devoid of the tst gene.

The seabird tick Ixodes uriae (White) is common in subantarctic areas and is likely to be a vector of pathogenic agents. This paper reports on the prevalence of tick-infested adult king penguins (Aptenodytes patagonicus) and on antibodies to the Lyme disease agent (Borrelia burgdorferi sensu lato) in adult and chick penguins. Fifteen percent of the adults of the colony studied were tick infested. B. burgdorferi antibodies were detected in 14% of tick-infested adults' and in 6% of chicks' sera. The percentage of tick-infested adults differed significantly according to location in the colony, the highest density occurring on the upper slopes of the colony. The potential role of king penguins as B. burgdorferi reservoirs and the effect of this agent on king penguin populations remain unknown. The consequences for human health are discussed.

Acute myelitis accounts for 4 to 5 percent of all cases of neuroborreliosis. In the literature, simultaneous spinal MRI and cerebrospinal fluid (CSF) investigations are presented for only 8 cases. We describe here 3 cases of acute Lyme myelitis.In a cohort of 45 patients with neuroborreliosis, diagnosed between January 1998 and January 2005, 3 had acute myelitis. Clinical, biological and radiological data were studied.The three patients had motor, sensorial and sphincter involvement. Extra-spinal involvement, such as fever and headache for one, facial nerve palsy for the second and subarachnoid hemorrhage for the third, was also noted. Pleocytosis varied from 10 to 520 white cells per mm3. Lyme serology was positive in CSF for all. Intrathecal anti-Borrelia antibody index was positive or intermediate for all three patients. Spinal cord MRI revealed a large hyperintense zone involving more than 3 vertebral segments. Myelitis was central, posterior or transverse in the axial plane. The clinical course was favorable after a three-week course of appropriate antibiotics.These 3 cases and the others from the literature show the diversity of the clinical and radiological features of acute myelitis: transverse, central or posterior myelitis. Thus, Lyme serology in CSF in indicated for patients presenting acute myelitis, particularly in endemic areas.

Using an agar reference method (Norma M11-A5, National Committee for Clinical and Laboratory Standards) the minimal inhibitory concentrations of nine antibiotics were determined for 376 anaerobic strains. The following strains were investigated: 254 Bacteroides fragilis group (including 143 B. fragilis), 122 other gram-negative anaerobes (Bacteroides spp., Prevotella, Fusobacterium, Porphyromonas, Suterella, Desulfomonas, Veillonella).In the B. fragilis group resistance rates were: coamoxyclav 2.8%, ticarcillin 27.5%, ticarcillin-clavulanic acid 1.9%, piperacillin-tazobactam 1.9%, cefoxitin 6.2%, imipenem 0.8%, clindamycin 28.3%, respectively. Based on previous studies, resistance to imipenem remained low in 2003 and was only observed for B. fragilis. Resistance to clindamycin was maintained around 25%. No metronidazole resistance was observed, but decreased susceptibility was found for B. fragilis, B. merdae and Prevotella, as in 4.3% of gram-negative anaerobes.This study confirms the high resistance rate of gram-negative anaerobes to clindamycin, the efficient activity of imipenem, beta-lactam/beta-lactamase inhibitor combinations and metronidazole. However, reduced metronidazole susceptibility seems to be increasing.

European borreliosis, known to the general public as 'Lyme disease' in analogy with the American form, which it differs from in many points, is endemic in the area of Alsace and is a public health problem. The level of knowledge and prevention of the population with regard to the disease has never been assessed in France.A survey was conducted in all the national health examination centers in Alsace using a self-applied questionnaire. The data collected concerned the socio-demographical characteristics, knowledge on the disease, history of tick bites, fear the disease creates, frequency of visits to the forest, prevention habits when visiting the forest and the attitude adopted in the case of a tick bite.Out of the 600 persons included, 99 (16.5 p.cent) had been bitten by ticks once or more over the past year. The existence of Lyme's disease was known to 74 p.cent of the consultants, 63 p.cent claimed they were worried by the disease and 43 p.cent knew that the first manifestation is redness spreading over the skin. Twenty-seven percent wore trousers and long sleeves when visiting the forest and 19 p.cent inspected their body carefully on their return. The persons least well informed were also those who did little to protect themselves against tick bites. They often were under 30 years old, lived in urban settings and had few diplomas. Those who had frequent spare time in forest and those who had a history of tick bites were the best informed and protected themselves better. The fear of the disease was associated with better knowledge and more appropriate behaviour.This study shows that a large percent of the population in Alsace is exposed to tick bites. Tick bite borreliosis is relatively well known, but protection remains insufficient. Better knowledge of the disease is related to better prevention. Information and teaching campaigns for the general public could specifically target the young people, urban dwellers and those with few diplomas. Specific messages of prevention could be delivered to the most exposed at-risk subjects (i.e. those bitten by ticks or having leisure in forest) at the places of their leisure or medical consultations.

Temporal changes of antibiotic susceptibilities among anaerobes in France are followed in our laboratory since 1992. For Bacteroides strains, resistance increased from 1992 to 1998 for amoxicillin-clavulanic acid, cefotetan and clindamycin. The present study evaluates the situation in 2000 for 434 Gram-negative anaerobic clinical isolates (obtained from 9 large university hospitals) by testing amoxicillin and ticarcillin alone or combined with clavulanic acid, cefoxitin, cefotetan, imipenem, clindamycin and metronidazole (using the NCCLS-approved method for MIC determination. The main genera tested included Bacteroides (359 strains of the fragilis group), Prevotella (40 strains), Fusobacterium (23 strains) and miscellaneous species (8 strains). Resistance rates within the B. fragilis group were: amoxicillin-clavulanic acid 5.6%, ticarcillin 33%, ticarcillin-clavulanic acid 2%, cefoxitin 13%, cefotetan 44%, clindamycin 33%, imipenem 1% and metronidazole

Lyme borreliosis is a multisystemic infection caused by the spirochaete Borrelia burgdorferi. In European endemic areas like northeast France, articular manifestations are, after neuroborreliosis, the most frequent extra-cutaneous features observed. Among the pathogenic species of Borrelia, Borrelia burgdorferi sensu stricto is the most frequently identified during Lyme arthritis, but others species also seem to be involved.The diagnosis of Lyme arthritis is usually based on combined clinical data and serological laboratory tests. In atypical forms, detection of bacterial DNA could be useful. While mechanisms involved in acute Lyme arthritis are beginning to be better understood, the pathogenesis of chronic arthritis, which concerns about 10% of the patients, remains unknown. Two hypotheses are proposed to explain the prolonged evolution of the articular disease: a chronic persistence of Borrelia burgdorferi, which evades the host immune system within the joint and/or an autoimmune mechanism by molecular mimicry. The antibiotic therapy is codified in acute arthritis, but is not really adapted in chronic Lyme arthritis or post-Lyme syndrome.To prevent the disease, the vaccine available in the United States does not offer complete protection and is not useful in Europe since the species heterogeneity is important for the outer surface protein A. A better understanding of Lyme disease pathogenesis can subsequently lead to new therapeutic or preventive approaches.

In Europe, Borrelia burgdorferi sensu stricto, Borrelia afzelii and Borrelia garinii are known as pathogens among the Borrelia burgdorferi sensu lato group. Since it is not yet known which Borrelia are responsible for Lyme borreliosis in France, the objective of this study was to identify the species of Borrelia responsible for erythema migrans in the region of Alsace, France.Eighteen patients with erythema migrans (EM) of more than 5 cm of diameter were included in this prospective study. All patients were investigated at the Strasbourg University Hospital. Patients were biopsied on the active border of their lesion. Cutaneous biopsies of the active border of the lesion were cultivated in BSK-H medium (Sigma) and analysed in vitro by PCR after 8 weeks of culture, using flagellin consensus sequences which are present in all species of Borrelia burgdorferi sensu lato group as primers. Species-specific oligotyping was used for species identification.Among the 18 patients biopsied, 7 had evidence of borrelia infection revealed by culture and/or PCR. Borrelia afzelii was detected in 4 patients and Borrelia garinii in three.These preliminary results appear to confirm that Borrelia afzelii and Borrelia garinii are the predominant borrelial species in EM lesions in our geographic area, as in other European countries.

A 37-year-old man living in eastern France seroconverted to Rickettsia helvetica in August 1997, 4 weeks after the onset of an unexplained febrile illness. Results of a serosurvey of forest workers from the area where the patient lived showed a 9.2% seroprevalence against R. helvetica. This organism may pose a threat for populations exposed to Ixodes ricinus ticks.

Articular manifestations of Lyme disease may be less common in Europe than in the United States, perhaps because European strains of Borrelia burgdorferi are characterized by greater genetic diversity and different organotropisms as compared with American strains. The diagnosis rests on clinical symptoms. A history of erythema migrans is pathognomonic. Isolated articular manifestations with no history of erythema migrans raise difficult diagnostic problems. Monoarthritis and asymmetric oligoarthritis is the most characteristic pattern; enthesitis can occur, a clinical feature shared with spondylarthropathy. Serologic tests (indirect immunofluorescence, Western blotting) have not been standardized and should be used only to confirm the diagnosis in patients with suggestive clinical manifestations. The interpretation of serologic test results is made difficult by the high seroprevalence rates seen among the general population in endemic areas, where subclinical Borrelia burgdorferi infection probably occurs. Detection of Borrelia burgdorferi DNA using polymerase chain reaction amplification is a potent tool both for diagnosis and for gaining insight into the pathophysiology of Lyme disease. However, difficulties subsist (risk of contamination of the specimens, inhibitory effects). Continued work is needed to determine which targets (chromosomal DNA, plasmidic DNA) and specimens (joint fluid and/or synovial membrane) provide optimal results.

The efficacy of gastrointestinal decontamination in reducing the incidence of severe bacterial or fungal infections and of moderate to severe acute graft-versus-host disease (GVHD) has been suggested. We report here a retrospective study of 71 patients grafted consecutively in our institution with bone marrow from HLA genotypically identical siblings. Complete decontamination (plastic isolator or laminar airflow room, sterile nursing and oral antimicrobial drugs) was carried out in all patients. Sixty eight patients were evaluable. Only six patients had aerobic Gram negative rods or anaerobic bacteria in their faeces and 44 of 68 (65%) had yeasts in their faeces. Most patients had oropharyngeal and/or nasal colonisation with bacteria (Gram positive cocci: 39 patients (57%); Gram negative rods: 13 patients (19%)) or yeasts (29 patients (43%)). Thirty nine patients (57%) experienced severe gradeor = II acute GVHD (grade II-IV). A significant relation was found between bacterial oropharyngeal or nasal colonisation and GVHD (P0.01) but not between gastrointestinal microflora and GVHD, whatever microorganisms were considered (bacteria, yeasts).

Progress in molecular biology has led to the development of new tools for bacteriological diagnosis. Sporadic genes coding for virulence factors can be detected with highly specific genetic probes applied to cultured bacteria. Such genetic probes can also be used to specifically identified cultured bacteria whose general taxonomic classification is known. Another advantage of molecular genetics is the possibility that the cell culture step may not be needed, bacteria being identified directly in the sample specimen. Such techniques are particularly interesting to identify bacteria which are difficult to culture (for example: Borrelia burgdorferi, Chlamydia trachomatis) or which grow slowly (mycobacteria). The bacterial DNA must be isolated and amplified with an enzyme reaction. This is a critical step in the method: several positive and negative controls are required. When performed under optimal conditions, amplification techniques are excellent methods which can offer results similar to culture methods in culturable bacteria. Finally, molecular biology can be used to identify previously cultured bacteria for which there is no taxonomic orientation. Here the ribosome 165 DNA must be amplified and sequenced. The sequence is then compared with a data bank allowing classification. One could image future techniques applied to certain pathology samples for the detection and identification of bacteria without need for a culture step. However, direct microscope examination and bacterial culture remain the basic methods for bacteriologic diagnosis, the advantages and disadvantages of molecular biology leading to its use a complementary method for improving the quality of the diagnosis.

Situation La maladie de Lyme est une affection systemique due a Borrelia burdorgferi sensu lato. Elle sevit essentiellement aux Etats-Unis et en Europe avec une incidence allant de 86 cas /100 000 hab. en France a 134 cas/100 000 hab. aux Etats-Unis. Elle a ete decrite ces dernieres annees en Tunisie, en Afrique du Sud, en Afrique centrale et en Cote d’Ivoire. En Algerie, en dehors de quelques observations non publiees, aucun travail n’a ete rapporte. Cependant la tique vectrice a ete identifiee recemment par I. BITAM (article sous presse), elle heberge Borrelia garinii et Borrelia lusataniae . A partir de ces donnees nous avons realise cette premiere etude grâce a l’appui financier de l’Agence Nationale de Developpement de la Recherche en Sante, Algerie ANDRS et du Groupe d’Etude Epidemiologique et de Prevention CHU Villeneuve-Saint-Georges. Objectif Etude transversale pour estimer la seroprevalence de la maladie de Lyme dans la Wilaya (departement) de Setif entre 2004 et 2006. Patients 874 sujets appartenant a 3 groupes de population : 574 eleveurs, 100 forestiers et 200 donneurs de sang, moyenne d’âge 38 ans (8 a 85 ans), sex-ratio 2,5. Resultats Les 20 serums testes positifs en IgG au test ELISA au laboratoire Central de Setif ont ete testes par Western Blot au Laboratoire de reference des Borrelia de Strasbourg. 10 serums etaient positifs en Western blot donnant une seroprevalence globale de 1,1 % (IC = 0,45-1,94). Cette seroprevalence etait respectivement de 2 % chez les donneurs de sang, de 1 % chez les forestiers et de 0,87 % chez les eleveurs. Conclusion Il est imperatif de completer ce premier travail par une etude clinique avec isolement de la bacterie par culture ou par biologie moleculaire pour pouvoir affirmer l’existence et l’incidence de cette zoonose emergente dans notre pays.