Listeria monocytogenes infectious periaortitis: a case report from the infectious disease standpoint.

BACKGROUND: Endograft infection is a rare but extremely dangerous complication of aortic repair (25-100% of mortality). We describe here the first case of Listeria monocytogenes abdominal periaortitis associated with a vascular graft. We also discuss the differential diagnosis of periaortitis and provide a literature review of L. monocytogenes infectious aortitis. CASE PRESENTATION: Nine months after endovascular treatment of an abdominal aortic aneurysm (abdominal stent graft), a 76-year-old man was admitted for severe abdominal pain radiating to the back. Laboratory tests were normal apart from elevated C-reactive protein (CRP). Injected abdominal computed tomography (CT) showed infiltration of the fat tissues around the aortic endoprosthesis and aneurysmal sac expansion; positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro- D-glucose integrated with computed tomography (18F-FDG PET/CT) showed a hypermetabolic mass in contact with the endoprosthesis. Blood cultures were negative. At surgical revision, an infra-renal peri-aortic abscess was evident; post-operative antibiotic therapy with ciprofloxacin and doxycycline was started. Cultures of intraoperative samples were positive for L. monocytogenes. Results were further confirmed by a broad-range polymerase chain reaction (PCR) and next-generation sequencing. Antibiotic treatment was switched to intravenous amoxicillin for 6 weeks. Evolution was uneventful with decrease of inflammatory parameters and regression of the abscess. CONCLUSION: An etiologic bacterial diagnosis before starting antibiotic therapy is paramount; nevertheless, culture-independent methods may provide a microbiological diagnosis in those cases where antimicrobials are empirically used and when cultures remain negative.

[New medical demography : challenges for international medical graduates]. / Nouvelle démographie médicale : quels défis pour les médecins formés à l'étranger ?

« International Medical Graduates ¼ (IMGs) are medical doctors practicing abroad, in a country where they have not studied. Their number is increasing at the global level as well as in Switzerland. In this article we describe the challenges faced by IMGs : difficulties related to issues in communication, differences in medical education, variations in clinical practice and difficulties in dealing with specific categories of patients because of local societal values. These challenges demand a process of professional and cultural transition from these foreign medical doctors who constitute a real asset for the host countries. Indeed, they participate in solving the problem of medical shortage and bring to their host country their rich professional experience and recognized clinical skills.

Les « Diplômés Internationaux en Médecine ¼ (DIM), médecins pratiquant leur métier dans un pays dans lequel ils n'ont pas étudié, sont en augmentation à l'échelle globale comme à l'échelle suisse. Dans cet article, nous décrivons les défis rencontrés par les DIM : aspects liés à la communication, différences dans la formation médicale, variations dans la pratique clinique et difficultés de prise en charge de catégories spécifiques de patients en lien avec certaines valeurs sociétales. Ces défis rendent nécessaire un processus de transition professionnelle et culturelle de ces médecins étrangers, qui représentent un réel atout pour les pays d'accueil. En effet, ils participent à résoudre les problèmes de pénurie et de déserts médicaux en apportant leur riche expérience professionnelle et des compétences cliniques reconnues.