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RESUME La formation et l’information representent deux exemples des differentes facettes qui font partie du systeme de soins. Elles s’adressent, l’une aux professionnels de sante, l’autre au grand public et sont d’autant plus importantes qu’elles concernent des sujets sensibles, souvent mal compris ou qui font malheureusement l’objet d’informations incompletes ou erronees. Parmi les exemples les plus recents, il faut rappeler la vaccination ou la borreliose de Lyme. Afin d’illustrer l’importance de la diffusion de messages scientifiquement valides et medicalement clairs, nous proposons de developper les points essentiels et sensibles accompagnant la borreliose de Lyme.

Resume Objectif La syphilis est en pleine recrudescence depuis les annees 2000 et la neurosyphilis constitue une manifestation rare de cette infection sexuellement transmissible dont nous avons voulu evaluer les caracteristiques. Materiels et methodes Etude retrospective de 2004 a 2014 de tous les cas de neurosyphilis codes dans le PMSI des hopitaux universitaires de Strasbourg. Nous avons inclus et analyse le cas de 13 patients hospitalises pendant cette periode et repondant aux criteres diagnostiques de la neurosyphilis. Resultats Neuf patients sur 13 presentaient une atteinte ophtalmologique isolee, 3 (23,1 %) avaient une uveite posterieure, 2 (15,4 %) une panuveite et 4, une papillite (30,8 %). Cinq sur 13 (38,5 %) etaient seropositifs pour le VIH et 3/5 (60 %) avaient plus de 400 lymphocytes T CD4 + /mm 3 au moment du diagnostic de neurosyphilis. Enfin, tous les patients ont beneficie d’un traitement par penicilline ou cephalosporine par voie parenterale et 5/13 (38,5 %) d’une corticotherapie systemique. Conclusion Cette etude revele l’importance des manifestations ophtalmologiques dans la neurosyphilis dont elle constitue la principale manifestation au sein de cette cohorte de patients.

RESUME Infection due a des bacteries appartenant au complexe Borrelia burgdorferi sensu lato, transmises par piqures de tiques du genre Ixodes, la borreliose de Lyme est une infection qui peut etre polysystemique. Ses manifestations cliniques, pour certaines anciennement decrites, sont mieux connues depuis l’identification des germes et la mise au point des techniques diagnostiques. A l’exception de quelques aspects tres specifiques, la symptomatologie clinique ou dominent les atteintes neurologiques et articulaires, est tres proteiforme pouvant etre partagee avec d’autres pathologies. Sur la base des donnees anamnestiques et des tests serologiques, le diagnostic sera en general facile a etablir, conforte par une antibiotherapie adaptee efficace.

Lyme borreliosis (LB) is certainly the most common infection transmitted through the bite of Ixodes in Northern Hemisphere. These ticks are also able to transmit other microorganisms such as the bacteria Anaplasma phagocytophilum (Ap) and Bartonella henselae (Bh), with the latter discovered fairly recently, leading to diferent clinical presentations often close to those of LB. The aim of this study was to evaluate the frequency of co-infection by either of these bacteria in patients with LB, particularly when a treatment with beta-lactam antibiotic was only partially effective. Of these patients, on the basis of serological data, 8.07% were simultaneously contaminated by Bh, 6.83% by Ap and 4.96% were co-infected by Bh and Ap. Since the choice of an antibiotic should take into account the specificities of these germs and especially their intracellular proliferation, these results should be considered in selecting treatment.

La maladie de Lyme fait l’objet d’une mediatisation importante. De nombreux articles et emissions de radio et de television ont contribue a renforcer un sentiment d’etat d’alerte concernant cette maladie. L’une des demandes principales des patients est de beneficier d’une reconnaissance et d’une prise en charge adaptee de leur infection...

Introduction Few studies have evaluated the promising role of 18 F–fluoro-2-deoxy-D-glucose positron emission tomography (PET) and PET/computed tomography FDG PET/CT in evaluating and monitoring treatment response in patients with lymph node tuberculosis (LNTB). The aim of this clinical investigation was to assess the clinical usefulness of FDG PET/CT for initial tuberculosis staging and to determine the prognostic value of the decrease of 18 F–FDG uptake during antibiotic treatment in LNTB patients. Methods We retrospectively reviewed 18 cases of LNTB admitted at a single center from 2004 to 2014. Medical records of patients who underwent two FDG PET/CT (>6 months interval), at initial staging and at the end of therapy were reviewed to determine the impact of FDG PET/CT on initial management of LNTB and response to therapy. Statistical analysis was performed using linear mixed-effects model. Results Thirteen cases of disseminated LNTB and five cases of localized LNTB were included in the study. Initial FDG PET/CT allowed guided biopsy for initial diagnosis in 5 patients and identified unknown extra-LN TB sites in 9 patients. Visual analysis follow-up of FDG PET/CT showed a complete metabolic response in 9/18 patients (all of whom were cured), a partial response in 7/18 (5 of whom were cured) and no response in 2/18 (all of whom were not cured). The semi-quantitative evaluation of 18F–FDG intensity decrease based on the maximum standardized uptake value (SUVmax), compared to targeted estimated decrease allowed to predict correctly a complete response to treatment in 14/18 cases. Conclusion FDG PET/CT allows an accurate pre-therapeutic mapping of LNTB and helps for early TB confirmation. The SUVmax follow up is a potential tool for monitoring the treatment response.

Few studies have evaluated the promising role ofWe retrospectively reviewed 18 cases of LNTB admitted at a single center from 2004 to 2014. Medical records of patients who underwent two FDG PET/CT (6 months interval), at initial staging and at the end of therapy were reviewed to determine the impact of FDG PET/CT on initial management of LNTB and response to therapy. Statistical analysis was performed using linear mixed-effects model.Thirteen cases of disseminated LNTB and five cases of localized LNTB were included in the study. Initial FDG PET/CT allowed guided biopsy for initial diagnosis in 5 patients and identified unknown extra-LN TB sites in 9 patients. Visual analysis follow-up of FDG PET/CT showed a complete metabolic response in 9/18 patients (all of whom were cured), a partial response in 7/18 (5 of whom were cured) and no response in 2/18 (all of whom were not cured). The semi-quantitative evaluation of 18F-FDG intensity decrease based on the maximum standardized uptake value (SUVmax), compared to targeted estimated decrease allowed to predict correctly a complete response to treatment in 14/18 cases.FDG PET/CT allows an accurate pre-therapeutic mapping of LNTB and helps for early TB confirmation. The SUVmax follow up is a potential tool for monitoring the treatment response.

Objective Staphylococcus lugdunensis is a coagulase-negative staphylococcus that displays an unusually high virulence rate close to that of Staphylococcus aureus . It also shares phenotypic properties with S. aureus and several studies found putative virulence factors. The objective of the study was to describe the clinical manifestations of S. lugdunensis infections and investigate putative virulence factors. Method We conducted a prospective study from November 2013 to March 2016 at the University Hospital of Strasbourg. Putative virulence factors were investigated by clumping factor detection, screening for proteolytic activity, and sequence analysis using tandem nano-liquid chromatography-mass spectrometry. Results In total, 347 positive samples for S. lugdunensis were collected, of which 129 (37.2%) were from confirmed cases of S. lugdunensis infection. Eighty-one of these 129 patients were included in the study. Bone and prosthetic joints (PJI) were the most frequent sites of infection ( n =28; 34.6%) followed by skin and soft tissues ( n =23; 28.4%). We identified and purified a novel protease secreted by 50 samples (61.7%), most frequently associated with samples from deep infections and PJI ( pr 0.97 and pr 0.91, respectively). Protease peptide sequencing by nano-liquid chromatography-mass spectrometry revealed a novel protease bearing 62.42% identity with ShpI, a metalloprotease secreted by Staphylococcus hyicus . Conclusion This study confirms the pathogenicity of S. lugdunensis , particularly in bone and PJI. We also identified a novel metalloprotease called lugdulysin that may contribute to virulence.

Skin disorders are the third most common reason for consultation on return from travelling.1 Myiasis is the fourth most common condition diagnosed.2 The two species most often responsible for myiasis are Dermatobia hominis in Latin America and Cordylobia anthropophaga in Africa.3 C . anthropophaga or Tumbu fly is a sub-Saharian African peri-domestic fly.2 Its larvae, also called Cayor Worm is responsible for the furuncular-like lesions seen in animals and accidentally in humans, as well, more frequently in infants. Soils, sheets or wet clothes are usually contaminated by droppings on which female flies lay their eggs. After prolonged contact, larvae actively penetrate the skin, where they grow in about 10 days, causing multiple injuries.4 The need for prolonged contact explains the characteristic location of lesions on covered areas, in particular areas such as the buttocks.4 Progression of the condition is marked by the …

Introduction L’activite de conseil en antibiotherapie est une composante importante de l’activite des services d’infectiologie. Si plusieurs etudes demontrent l’impact favorable du conseil en antibiotherapie dans certaines situations cliniques ciblees (ex. bacteriemie a Staphylococcus aureus ), peu d’etudes se sont attache a l’identification des risques d’echec une fois l’avis donne. L’objectif de notre travail etait d’identifier ces facteurs, afin d’ameliorer nos pratiques. Materiels et methodes Les patients hospitalises, en secteurs de medecine ou de chirurgie, ayant beneficie d’un « avis infectieux » dans les 14 jours apres leur admission dans une UF a dossier informatise (DX-care) ont ete inclus. L’echec de prise en charge etait definit par un deces intra-hospitalier ou un transfert en reanimation. Resultats Au total, 112 patients etaient hospitalises en secteur de medecine, 128 en secteur chirurgical. Sans difference selon les secteurs, l’âge moyen etait de 62,5 ans (±18,3), 161 patients (67,1 %) etaient des hommes. Le motif d’hospitalisation etait une infection pour 130 (54,2 %), communautaire dans 49,8 % des cas. Le score moyen de comorbidite de Charlson etait de 4,4 (±3). Sur 240 avis, 167 (69,7 %) etaient telephoniques, 181 (75,4 %) pour un probleme therapeutique, 118 donnes (49,2 %) dans les 3 jours. Les principaux diagnostics etaient : infections intra-abdominales 42 (17,5 %), pulmonaires 30 (12,5 %), sur KT 20 (8,3 %), osteoarticulaires 19 (7,9 %), vasculaires 19 (7,9 %). Apres l’avis, le diagnostic etait modifie pour 64 patients (26,7 %). Parmi, 50 patients etaient en echec (dont 27 deces). Le score de Charlson a l’admission (OR = 1,24 IC95 % [1,03–1,50]), une infection a BMR (OR = 8,27 IC95 % [1,37–49,80]), le respect des modifications therapeutiques proposees (OR = 0,09 IC95 % [0,01–0,67]) et la degradation de l’etat clinique au 3 e jour apres l’avis (OR = 12,50 IC95 % [3,16–49,46]) etaient independamment associes a l’echec (analyse multivariee). Conclusion Notre etude montre que des elements simples a recueillir au moment de l’avis (score de Charlson, infection a BMR) associes a des elements simples de suivi (etat clinique au 3 e jour, non respect de l’avis donne) sont associes au risque d’echec de prise en charge. Dans une perspective d’amelioration de nos pratiques, la reevaluation de nos conseils pourrait etre envisagee pour des patients cibles, a l’image d’une reevaluation d’antibiotherapie. Toutefois, elle genererait un surplus d’activite difficile a absorber par les equipes d’infectiologie aux effectifs souvent tres limites et sur-sollicitees. Un travail complementaire devrait etre entrepris pour identifier precisement les patients qui doivent en beneficier.

Resume Contexte Une epidemie de gale s’est declaree dans les services de geriatrie des Hopitaux universitaires de Strasbourg en septembre 2005. Le cas index souffrait d’une gale hyperkeratosique, forme extremement contagieuse. L’epidemie s’est propagee hors du service initialement atteint, s’etendant a plusieurs unites fonctionnelles et pavillons ainsi qu’aux familles des personnels et patients touches. Objectif Nous avons decris cette epidemie, son evolution et l’ensemble des mesures mises en place pour l’enrayer. Methodologie Une enquete retrospective a permis de recenser l’ensemble du personnel, des patients et des familles impliques. Nous avons a cette fin utilise les prescriptions medicales enregistrees par la pharmacie, les listings etablis par le service de medecine du travail et les dossiers medicaux. Resultats Du 31 aout au 16 decembre 2005, deux vagues epidemiques ont ete enregistrees impliquant 51 patients et personnels du pole de geriatrie, avec au total 58 episodes de gale, dont sept recidives. Les mesures mises en œuvre pour enrayer l’epidemie se sont declinees selon trois grands axes : la mise en place des precautions complementaires de type contact, l’information des personnes impliquees et le traitement des cas de gale associe au traitement de masse des cas contacts. Ce traitement a ete de grande ampleur et a concerne 490 malades et 592 soignants. L’ensemble de ces mesures a permis de maitriser l’epidemie en trois mois. Conclusion Il est essentiel d’agir rapidement et de mettre en œuvre des actions radicales avant que la gale ne soit bien installee au sein d’une collectivite.

Resume Introduction Les patients seropositifs VIH ont un risque eleve de complications infectieuses. La vaccination est un moyen de prevenir certaines de ces infections. Depuis 2006, de nouvelles recommandations d’experts ont elargi en France les indications vaccinales. Nous avons etudie le statut vaccinal de la cohorte alsacienne des patients seropositifs VIH, pour la grippe, le pneumocoque (PNC), les hepatites A (VHA) et B (VHB) et le tetanos. Patients et methode Du 20 aout 2007 au 15 septembre 2007, les patients seropositifs VIH de la COREVIH Alsace ont ete inclus dans une etude prospective de recueil de donnees demographiques, medicales, immunovirologiques et vaccinales. Resultats Trois cent trente et un patients ont ete inclus, 49 % asymptomatiques, 29 % symptomatiques non sida, 18 % sida, chez 4 % l’information n’etant pas renseignee. Soixante et onze patients (21,4 %) etaient vaccines pour la grippe, 11 patients (3,3 %) contre le PNC, 34 patients contre l’hepatite A, soit 16,3 % des sujets non immuns, 120 patients contre l’hepatite B, soit 60 % des sujets sans marqueurs seriques et 126 (56,2 %) contre le tetanos. Les principaux motifs de non-vaccination etaient l’absence de proposition par le praticien, le manque d’efficacite attendue et la crainte d’un effet immunovirologique deletere. Conclusion Les taux de couverture vaccinale pour les vaccins recommandes chez les sujets vivants avec le VIH restent tres insuffisants et parfois inferieurs a ceux de la population generale francaise. Il parait donc necessaire de sensibiliser prescripteurs et malades sur l’interet de ces vaccinations.

Resume Objectif Streptococcus agalactiae (streptocoque du groupe B) est une cause importante d'infection invasive chez les adultes en dehors de la grossesse, touchant plus particulierement les personnes âgees ayant des facteurs favorisants sous-jacents. Nous avons cherche a decrire ces facteurs favorisants et les caracteristiques cliniques de ces infections dans notre hopital. Methode Soixante-quatre dossiers d'infections invasives a S. agalactiae de patients hospitalises entre janvier 1997 et janvier 2006 ont ete analyses retrospectivement. Resultats La moyenne d'âge des patients etait de 59 ± 17 ans. Le sex-ratio etait de 1,06. Au moins un antecedent etait trouve pour 90,6 % des patients. Le diabete (43,7 %), une arterite des membres inferieurs (34,4 %), une cardiopathie ischemique (20,3 %), une neoplasie (20,3 %), representaient les principaux antecedents. L'index moyen de comorbidite de Charlson etait de 2,5 ± 2. Les manifestations cliniques comprenaient : les infections urinaires hautes (32,8 %), les infections de la peau et des tissus mous (25 %), les osteoarthrites (21,9 %). Une bacteriemie survenait dans 31,2 % des cas, sans point de depart pour deux patients. Nous rapportons deux cas d'endocardite, un cas de meningite et quatre deces survenus dans le premier mois. Conclusion Malgre le caractere retrospectif de notre etude, nous avons pu decrire avec precision l'ensemble du spectre clinique des infections invasives a S. agalactiae. Nous confirmons l'importance du role du terrain sous-jacent dans l'emergence de cette pathologie et la gravite des infections.

Resume Propos Staphylococcus aureus est le premier agent responsable de bacteriemies nosocomiales en France. Pres de 40 % des souches sont resistantes a la meticilline (SAMR). Depuis 15 ans, on assiste a une modification de l'epidemiologie de ces infections alors que leur strategie therapeutique a peu evolue. Actualites et points forts La frequence des bacteriemies a SAMR a nettement augmente en milieu hospitalier et elles sont recemment apparues en milieu communautaire. Les nombreuses etudes cliniques ont permis d'identifier d'une part les facteurs influencant leur emergence, et d'autre part les groupes de patients a risque de developper ces infections et leurs complications. Parallelement, la sensibilite des SAMR aux antibiotiques a evolue avec l'apparition de souches de sensibilite diminuee et resistantes aux glycopeptides. A l'inverse, les modalites therapeutiques se sont peu modifiees. La strategie antibiotique optimale reste mal definie par defaut d'etudes cliniques valables. La place des associations d'antibiotiques et l'interet du suivi des taux seriques de glycopeptides restent discutes. Enfin, le nombre de nouvelles molecules antibiotiques actives sur ces germes est limite. Perspectives La frequence et la severite des bacteriemies a SAMR restent preoccupantes dans notre pays. La prevention de ces infections doit etre un souci permanent pour tout clinicien. Elle passe par une bonne connaissance de leur epidemiologie. Une meilleure definition des strategies therapeutiques et la mise au point de nouveaux agents anti-infectieux sont par ailleurs indispensables.

Resume Propos Ce travail a pour objectif de decrire les aspects cliniques et les facteurs favorisant la forme muqueuse de la leishmaniose tegumentaire, dans une population amazonienne de 30 000 habitants, sur une periode de quatre ans. Materiel et Methodes Etude descriptive de 16 patients. Les 16 patients ont ete inclus parmi 170 cas de leishmaniose tegumentaire vus entre janvier 2000 et decembre 2003 sur les criteres d'atteinte muqueuse et la presence du parasite a l'examen direct du frottis muqueux. Resultats La population touchee est une population jeune, a predominance masculine. L'absence de traitement precoce et le nombre de lesions cutanees interviennent dans le developpement de la forme muqueuse, ainsi que la reponse immunitaire de l'hote au parasite et possiblement l'espece parasitaire ainsi que le vecteur. Conclusion La leishmaniose muqueuse doit etre recherchee et traitee le plus rapidement possible pour eviter l'evolution vers des lesions plus delabrantes.

Resume Preambule – La diarrhee nosocomiale a Clostridium difficile represente 25 % des diarrhees en milieu hospitalier. Les services de maladies infectieuses sont consideres comme exposant volontiers au risque de DNCD du fait de l’utilisation importante d’antibiotiques. Objectifs et methode – Afin d’identifier les principaux facteurs de risque de DNCD, nous avons realise, au cours du premier semestre 2001, une etude prospective : 152 patients hospitalises pendant au moins six jours ont ete inclus dans cette etude. Les facteurs d’exposition etudies ont ete les suivants : l’âge, la duree moyenne d’hospitalisation, la prise d’antibiotique au cours de l’hospitalisation, la mobilite reduite etablie d’apres les criteres standardises de l’Organisation mondiale de la sante (OMS) et la notion d’hospitalisation recente. Resultats – Une duree moyenne de sejour prolongee (36 jours ; IC 95 % : 23–48) et une antibiotherapie realisee notamment avec des β-lactamines apparaissent comme des facteurs de risque significatifs ce qui confirme les donnees de la litterature. En revanche, nous n’avons pas observe de liaison entre l’âge, l’hospitalisation recente et l’apparition de DNCD. Enfin, cette etude a permis de mettre en evidence que la mobilite reduite des patients est un facteur favorisant l’apparition de DNCD.

Background: Staphylococcus aureus bacteremia (SAB) may be complicated by endocarditis or metastatic infection without evidence of endocarditis (MIWE). The aim of this study was to identify risk factors for MIWE and endocarditis in patients with SAB. Methods: We performed a retrospective chart review to compare characteristics of patients with uncomplicated SAB and patients whose SAB course was complicated by MIWE or endocarditis. We reviewed the charts of patients with SAB diagnosed in our department from 1992 to 1999 for S. aureus portal of entry, secondary foci of infection, underlying conditions, previous valvular defects, and foreign material. Endocarditis was defined according to the Duke criteria. Patients were classified as having MIWE when the diagnosis of endocarditis was not definite according to the Duke criteria and when there was evidence of at least one secondary metastatic infection other than endocarditis. Results: Some 109 patients had 111 episodes of SAB. Sixty-three patients had no evidence of metastatic infection and constituted the control group. Twenty-seven patients developed at least one episode of MIWE. A community-acquired SAB (CI 95% OR: 1.4–12.3, P

Introduction Le conseil en antibiotherapie est une composante essentielle de l’activite des services d’infectiologie dont la valorisation aupres de l’administration est difficile. Cette valorisation est d’autant plus complexe que le nombre d’avis donne est important et que l’effectif de l’equipe est reduit. Nous presentons comment nous avons pu quantifier et valoriser notre activite en utilisant un « questionnaire » incorpore dans un tableur Excel®. Materiels et methodes En quelques heures, nous avons developpe un « questionnaire » tres simple de recueil de donnees en utilisant le langage VBA dans Excel®. Ce questionnaire a ensuite ete utilise par les infectiologues de notre service, pour permettre de decrire precisement tous les avis donnes par telephone ou au sein des unites cliniques. Resultats Le questionnaire, comportant 24 items renseignes en 20 a 30 secondes (cases a cocher) a ete utilise sur une periode de 4 mois (fevrier–mai). Sur 1495 avis donnes, 364 (24,3 %) etaient un probleme d’echec therapeutique, 545 (36,5 %) une infection nosocomiale, 416 (27,8 %) une infection a BMR, 266 (17,8 %) une infection sur materiel, 47 (3,1 %) un probleme allergique. Le type d’infections etait tres varie : 225 (15,4 %) intra-abdominale, 171 (11,7 %) pulmonaire, 162 (11,1 %) osteoarticulaire, 140 (9,6 %) urogenitale. La prise en charge en cours, ne suivant pas les recommandations, etait identifiee comme engageant le pronostic vital pour 46 patients (3,1 %), surtout en cas de bacteriemie. Pour 142 (9,5 %), l’avis etait considere comme trop tardif. Seuls 158 avis (13,6 %) etaient traces dans DX-care. L’exhaustivite du recueil par les cliniciens a ete de 80 % permettant d’evaluer a 6000 le nombre d’avis donnes chaque annee (20 a 30/jours). Conclusion Grace a un formulaire dans un tableur Excel® nous avons pu preciser et quantifier rapidement le volume important de notre activite. Nous avons ainsi identifie que 20 a 30 % de nos interventions portaient sur des problematiques a fort risque medicolegal (infections sur materiel, infections a BMR ou nosocomiales) ou que l’avis etait clairement sollicite trop tardivement. Malgre cela, la tracabilite de nos avis dans le dossier du patient reste faible, en raison d’un sous-effectif tres net de notre equipe par rapport a la taille de notre etablissement. Ces donnees sont desormais utilisees pour soutenir nos demandes de prets ou de creation de postes.

International audience; Objectives. - We had for objectives: i) to evaluate the accuracy of serologic testing for Lyme borreliosis performed in a private medical laboratory (PML); to evaluate the impact of these tests on the practices of infectious diseases specialists (IDS).Patients and method. - This study was performed in two steps: i) retrospective study of patients followed in a university hospital infectious diseases outpatient clinic for suspected Lyme borreliosis, tested (ELISA and Western blot) by both the PML and the National Reference Center (NRC); ii) national survey on IDS practices concerning patients consulting for suspected Lyme borreliosis.Results. - Between July 2008 and July 2011, 128 patients consulting for suspected Lyme borreliosis were tested by both laboratories. Serological tests came back positive in 91% of cases from the PML versus 8% of cases from the NRC. Lyme borreliosis was the IDS's final diagnosis for 3.6% of patients. The survey on practices revealed that: i) the modal duration of consultation for suspected Lyme borreliosis was 30-60 minutes; ii) for 33% of patients, serologic test results performed at the PML were the only reason to suspect Lyme borreliosis; iii) 60% of patients had no indication for antibiotics.Conclusion. - The serological test performed in the PML were positive most of the time, but were not confirmed by tests performed at the NRC. This discrepancy lead to multiple and prolonged consultations in infectious diseases clinics, and discordance in the indications for antibiotics.; ObjectifsLes objectifs sont : i) évaluer la pertinence des diagnostics de maladie de Lyme établis à l’aide de tests réalisés par un laboratoire d’analyses médicales privé (AMP) ; ii) évaluer l’impact des diagnostics établis par ce laboratoire sur la pratique des infectiologues.Patients et méthodeDeux étapes : i) étude rétrospective des patients consultants dans un service d’infectiologie de CHU pour suspicion de maladie de Lyme avec tests (ELISA, Western blot) par le laboratoire AMP et le Centre national de référence (CNR) ; ii) enquête de pratique auprès de médecins infectiologues à l’aide de questionnaires portant sur les patients vus pour suspicion de borréliose.RésultatsEntre juillet 2008 et juillet 2011, 128 patients ayant consulté pour suspicion de maladie de Lyme ont fait réaliser une sérologie Lyme dans les 2 laboratoires. La sérologie était positive dans 91 % des cas pour le laboratoire AMP versus 8 % pour le CNR. Le diagnostic a été finalement retenu par l’infectiologue chez 3,6 % des patients. L’enquête de pratique a montré que i) la durée moyenne de consultation pour suspicion de maladie de Lyme était de 30 à 60 minutes ; ii) 33 % des patients avaient pour seule documentation la sérologie réalisée au laboratoire AMP ; iii) 60 % des patients n’avaient pas d’indication d’antibiotique.ConclusionLes sérologies de borréliose réalisées au laboratoire AMP un taux de séropositivité élevé, le plus souvent en désaccord avec les tests réalisés au CNR. Ces différences sont à l’origine de consultations spécialisées prolongées et de discordances dans les indications d’antibiothérapie.

We report the case of a 27-year-old man presenting with a hepatic abscess and hereditary hemorrhagic telangiectasia (HHT). The association between HHT and an infectious disease seemed to be induced by arteriovenous malformations and maybe also by a deficit of polymorphonuclear cells, a monocyte oxidative burst and phagocytosis. This diagnosis should be suggested in case of serious infections in young patients. Prevention is based on screening for and destroying infection, antibioprophylaxis and embolization of arteriovenous malformations.

A 31-year-old woman from Cameroon was admitted to the University of Strasbourg Hospital in December 2007 with pelvic pain and fever that developed over three days. Her condition rapidly worsened and she underwent emergency exploratory celioscopy. Surgeons found peritoneal and retrouterine abscesses. The high rectum had a 4-cm perforation with infiltrated, friable, and irregular edges. A biopsy specimen of this pseudotumoral specimen showed many Schistosoma haematobium eggs with an inflammatory reaction surrounding the eggs. The patient was treated with praziquantel (40 mg/kg/day) for 5 days and a 4-week course of antibiotic therapy. Her progress was good and digestive continuity surgery was performed four months later. Schistosomiasis frequently involves rectal mucosa, but perforation is unusual. Our review of the literature found only two cases of colon perforation associated with S. mansoni infection. To our knowledge, this is the first case of rectal perforation caused by S. haematobium described in the literature.

Because of its high diagnostic sensitivity in detection of unknown primary tumors, F-18 FDG PET/CT was used in the exploration of a 51-year-old woman presenting with multiple lymphadenopathy of the hepatic hilum and several hepatic and splenic hypodensities on radiologic examinations for which malignancy was suspected. Despite the morphofunctional malignant appearance, both histologic examination and PCR analysis revealed Bartonella henselae infection. Moreover, repeat F-18 FDG PET showed disease regression during focused antibiotic therapy.

Resume Une etude retrospective de 277 cas de borreliose de Lyme, diagnostiques sur des criteres cliniques, epidemiologiques et serologiques, a permis de colliger 147 observations de patients presentant des manifestations neurologiques. Ces complications survenaient dans 65,5 % des cas au cours de la phase secondaire de la maladie (131 cas). Les atteintes concernaient surtout le systeme nerveux peripherique : meningoradiculites (51 cas), neuropathies peripheriques sans atteinte meningee (50 cas), paralysies de nerfs crâniens (40 cas). Les manifestations centrales sont plus rares (24 cas). La meningite a ete notee chez 63 patients, souvent associee a un des tableaux precedents. Les complications neurologiques au cours de la phase tertiaire de la maladie ont ete notees dans 47 % des cas (16 cas) parmi lesquels les manifestations centrales sont les plus frequentes. L’evolution sous traitement antibiotique est en general favorable en phase secondaire. En phase tardive, le pronostic est moins satisfaisant, des sequelles etant possibles malgre une antibiotherapie potentiellement efficace.

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.

In a retrospective study, we registered 210 patients hospitalized in Strasbourg for malaria from 1984 to 1995. The diagnosis was always confirmed by presence of the parasite on blood smears. We analysed the epidemiological, clinical, biological and therapeutic data. The number of cases rose each year, with a maximum in 1995. The majority of cases occurred in January and from August to October, these periods corresponding with the return of travelers. In most cases, infection took place in Africa. In this region, Plasmodium falciparum is the most frequent species of the parasite. The mean age of the patients was 33 years. The clinical manifestations were polymorphic: fever, chills, sweating, and headache were very frequent. We noted 15 serious infections (with the WHO's definition) and two cases of cerebral malaria. All cases had a favorable outcome. Five cases occurred in pregnant women; two of them had a severe form of malaria. Among the biological abnormalities, we found thrombopenia, haemolysis, hypocholesterolaemia and hypertriglyceridaemia. The significance of disturbance of the lipid metabolism is not known. Hypocholesterolaemia is very frequent, and hypertriglyceridaemia seems to be associated with severe malaria. Most malaria attacks occurred in patients without adequate chemoprophylaxis. This confirms the importance of prophylactic information given to patients by their physicians. Resistance develops against each new medication that is available; among these quinine remains the drug of choice to cure severe malaria.

Resume Comme au cours des precedentes annees, les maladies infectieuses communautaires restent d'actualite pour de nombreuses raisons. La diminution de la sensibilite de la plupart des germes aux antibiotiques se developpe et touche notamment les bacteries les plus courantes comme le pneumocoque et Escherichia coli . Dans d'autres cas, il s'agit pour certains germes comme Chlamydia pneumoniae, Helicobacter pylori ou Campylobacter jejuni d'une meilleure definition de leur role pathogene ou de leur responsabilite dans certaines situations cliniques specifiques. Les progres des techniques de biologie moleculaire permettent de reconnaitre ou de preciser la place de certains “nouveaux” germes comme les Ehrlichia ou les bartonelles. Un certain nombre d'infections restent mal maitrisees ainsi que l'illustre de facon remarquable la tuberculose. Les methodes de prevention et en particulier les vaccinations sont souvent determinantes dans le controle de ces infections a travers de nouveaux schemas de vaccination et surtout le developpement de nouveaux vaccins.

Reported here is a case of mediastinitis caused by Aspergillus fumigatus and Staphylococcus epidermidis following a heart transplantation that was successfully treated with amphotericin B in combination with new antifungal drugs (caspofungin and voriconazole), antibiotics and superficial wound drainage. A review of the literature revealed that Aspergillus as a cause of mediastinitis has been rarely described. In the few existing reports, evolution was generally fatal, especially in immunocompromised patients, despite treatment with antifungal drugs and surgery.

Study design This case report illustrates a patient presenting with sciatica and diagnosed with epithelioid sarcoma involving the spine. Objectives The treatment of this patient involved multiple mass resections and decompressions of the spinal canal. Radio- and chemotherapy were applied once a clear diagnosis was obtained. Summary of background data Epithelioid sarcoma is a rare tumor mainly arising in the extremities. Confusion with a benign inflammatory process are possible. Treatment after histologic diagnosis involves wide resection. To our knowledge, this report represents the first case of epithelioid sarcoma involving the spine. Methods After initial discectomy, recurrent scarring and mass formation required multiple decompression procedures and fusion. The initial pathology revealed inflammatory reaction on fibrosis. In a later procedure, the histologic diagnosis of epithelioid sarcoma was made. Radiotherapy and chemotherapy were begun immediately. Results Despite aggressive resections, radiotherapy, and chemotherapy, the patient died 3 months after the last surgical procedure. Conclusion Spinal epithelioid sarcoma can be mistaken for a benign inflammatory process. After a histologic diagnosis, aggressive wide resection is necessary. Multiple recurrences are documented with this tumor in other sites. Prognosis in trunk involvement is less favorable than involvement of the extremities. The role of adjuvant radio- and chemotherapy is unclear for spinal involvement.

Resume La meningo-encephalite a tique due au virus TBE (Tick-Borne Encephalitis) est surtout repandue en Asie et en Europe Centrale. Le premier cas observe en France l'a ete en 1968. Depuis 21 observations ont pu etre reunies jusqu'en 1994. Le tableau clinique realise etait une meningite isolee (6 cas), une meningo-encephalite (13 cas), une meningo-radiculite (1 cas) et une phase primaire d'infection (1 cas). Tous les patients se sont contamines en Alsace ou il existe vraisemblablement plusieurs foyers, deux etant predominants. Cette pathologie est probablement sous-estimee et une surveillance plus etroite s'avere necessaire.

The objective of this study was to investigate the presence of stereoselective processes in the pharmacokinetics and metabolism of tertatolol in humans, using urinary excretion data. Six healthy male volunteers were given single 5mg oral doses of (+,−)-tertatolol; the stereoisomers of tertatolol and its hydroxylated and glucuronidated metabolites in urine were determined by high-pressure liquid chromatography (HPLC). (−)-Tertatolol was found in higher amounts in urine compared with the other enantiomer, with a (−)/(+) ratio of 1.45. The (−)/(+) ratio of 0.39 for the glucuronic acid conjugates of tertatolol enantiomers suggested a high stereoselectivity in glucuronidation. However, the glucuronidation of 4-hydroxytertatolol did not exhibit any stereoselectivity. A high product stereoselectivity in the formation of 4-hydroxytertatolol was found for (+)-tertatolol but not for (−)-tertatolol. The ratio of the two stereoisomers originating from (+)-tertatolol being equal to 2.2. These observations, based solely on urine data, strongly suggest the presence of stereoselectivity in tertatolol pharmacokinetics and metabolism in humans. However, more specific studies are necessary to determine which are the stereoselective processes and to evaluate the clinical implications of these observations.

Enterococcus faecalis (E. faecalis) has become a major leading cause of nosocomial endocarditis. Treatment of such infections remains problematic and new therapeutic options are needed. Nine E. faecalis strains were tested: six obtained from patients presenting endocarditis, one with isolated bacteremia, and two reference strains. Antibiotics included daptomycin, alone or in combination, linezolid, tigecycline, rifampicin, gentamicin, teicoplanin, ceftriaxone and amoxicillin. Time-kill studies included colony counts at 1, 4 and 24 h of incubation. Significant bactericidal activity was defined as a decrease of ≥3log10CFU/ml after 24 h of incubation. Antibiotics were tested at a low (10(6) CFU/ml) and high (10(9) CFU/ml) inoculum, against exponential- and stationary-phase bacteria. We also performed time kill studies of chemically growth arrested E. faecalis. Various pH conditions were used during the tests. In exponential growth phase and with a low inoculum, daptomycin alone at 60 µg/ml and the combination amoxicillin-gentamicin both achieved a 4-log10 reduction in one hour on all strains. In exponential growth phase with a high inoculum, daptomycin alone was bactericidal at a concentration of 120 µg/ml. All the combinations tested with this drug were indifferent. In stationary phase with a high inoculum daptomycin remained bactericidal but exhibited a pH dependent activity and slower kill rates. All combinations that did not include daptomycin were not bactericidal in conditions of high inoculum, whatever the growth phase. The results indicate that daptomycin is the only antibiotic that may be able of overcoming the effects of growth phase and high inoculum.

Background Cerebral involvement in schistosomiasis is not rare, but it is underdiagnosed because of the lack of clinical suspicion and the frequency of asymptomatic forms. Neurologic complications are generally supported by granuloma formation around ectopic eggs which have migrated to the brain. Moreover, vascular lesions and cerebral arteritis have been well documented in histopathological studies. Nevertheless, cerebral vasculitis in later stages of the Schistosoma mansoni infection have not yet been described in living subjects. Case presentation A 28-year-old french woman had a stroke linked with cerebral vasculitis, 6 monthes after returning from Burkina-Faso. At the same time, a S. mansoni disseminated infection was diagnosed. She suffered from a new stroke after undertaking praziquantel therapy, which lead us to associate the S. mansoni infection and cerebral vasculitis. Conclusion This is the first report of such association, since cerebral vasculitis has never been described in later stages of the S. mansoni infection. Although the causal link between the two pathologies could not be proved, we suggest that S. mansoni is able to cause severe vascular damage in cerebral vessels. Schistosomiasis must be investigated in the event of a brain infarct in young people, particularly in patients originating or returning from an endemic area.

A 31-year-old woman from Cameroon was admitted to the University of Strasbourg Hospital in December 2007 with pelvic pain and fever that developed over three days. Her condition rapidly worsened and she underwent emergency exploratory celioscopy. Surgeons found peritoneal and retrouterine abscesses. The high rectum had a 4-cm perforation with infiltrated, friable, and irregular edges. A biopsy specimen of this pseudotumoral specimen showed many Schistosoma haematobium eggs with an inflammatory reaction surrounding the eggs. The patient was treated with praziquantel (40 mg/kg/day) for 5 days and a 4-week course of antibiotic therapy. Her progress was good and digestive continuity surgery was performed four months later. Schistosomiasis frequently involves rectal mucosa, but perforation is unusual. Our review of the literature found only two cases of colon perforation associated with S. mansoni infection. To our knowledge, this is the first case of rectal perforation caused by S. haematobium described in the literature.

The human immunodeficiency virus 1 envelope glycoprotein is synthesized as a precursor, gp160, which is subsequently cleaved to generate the external gp120 and the transmembrane gp41. Both of these cleavage products are known to mediate critical functions of the virus. In order to define the best strategy for the development of a vaccine against human immunodeficiency virus 1, it could be important to map the crucial epitopes on gp160. This entire gp160 is uneasy to purify because it is readily subjected to proteolytic cleavage. Furthermore, it is anchored on the cell membrane and needs detergent treatment for purification. We thus used a recombinant gp160 which was engineered to remove the cleavage sites between gp120 and gp41 and the hydrophobic transmembrane in order to investigate the murine immune response. We selected a panel of 8 monoclonal antibodies which recognize different epitopes on the immunizing recombinant soluble gp160. The reactivity of the monoclonal antibodies was checked on virus-derived gp160, gp120, and gp41. Three antibodies reacted only with gp120 but the others were shown to react with gp41 epitopes or with discontinuous epitopes bridging gp120 and gp41. One subregion of these epitopes was located using a synthetic peptide corresponding to the sequence of gp41. This epitope is apparently part of an immunodominant site since it is recognized by three different monoclonal antibodies. We used competitive inhibition experiments to map the epitopes on recombinant gp160; therefore, the results are probably indicative of the folding of the recombinant soluble gp160 used for immunization.