Endemicity, molecular diversity and colonisation routes of Pseudomonas aeruginosa in intensive care units.

OBJECTIVE: We carried out a prospective study to evaluate the endemicity of Pseudomonas aeruginosa in intensive care units (ICUs). Pulsed-field gel electrophoresis (PFGE) was used to determine the genotypes of P. aeruginosa isolates. This allowed us to determine the importance of cross-colonisation and the colonisation routes of P. aeruginosa. DESIGN: We screened epidemiological specimens (rectal swab, nose swab and tracheal aspiration) and routine clinical cultures from patients admitted to ICUs during a 2-year period, from 1st January, 1998, to 31st December, 1999. SETTING: The study was carried out in four separate adult ICUs located in the Franche-Comté region of France. These four units admitted a total of 1,500 patients per year. RESULTS: A total of 1686 specimens were collected from 473 patients; 122 of these patients were positive on admission, 351 became positive during hospitalisation. The overall incidence of P. aeruginosa was 15.7 cases per 100 patients and 15.1 cases per 1000 days of hospitalisation. Of 184 patients with at least one ICU-acquired positive clinical culture, 104 had been previously identified as carriers by a similar genotype. Typing of 208 non-replicate isolates revealed 101 major DNA patterns. Approximately 50% of P. aeruginosa carriage or colonisation/infection was acquired via cross-transmission; the other cases probably originated from endogenous sources. CONCLUSION: Cross-colonisation seems to play an important role in the general spread of P. aeruginosa in ICUs.

[Meningitis and interferon-alpha in the cereprospinal fluid. What diagnostic and therapeutic approach? A case report]. / Méningite et présence d'interféron alpha dans le liquide céphalorachidien. Quelle attitude diagnostique et thérapeutique? A propos d'un cas.

BACKGROUND: In meningitis without germs, the existence of an inflammatory syndrome leads toward a bacterial etiology while the detection of interferon-alpha (IFN-alpha) in the cerebrospinal fluid (CSF) argues for a viral meningitis. The coexistence of the inflammatory syndrome and the presence of IFN-alpha in the CSF makes this differentiation difficult. The reported case yields the picture and begs the question on the diagnostic approach and the required therapeutic attitude. CASE REPORT: A six-week-old infant, exclusively breast-fed, was hospitalized for fever. The examination showed an important inflammatory syndrome and meningeal attempt with a cellularity at 94/mm3 with 53% polymorphonuclear neutrophils, contrasting with normal proteinorrhachia and glycorrhachia. The IFN-alpha in the CSF was present at 4 UI/mL while the bacteriological culture and the viral search by PCR were negative. The clinical and biological worsening within the first 36 hours, in spite of the parenteral dispensation of a triple antibiotic therapy (amoxicillin, ceftriaxone, netilmicin), then a favorable clinical and biological response after adjunction of vancomycin, led toward a pneumococcal meningitis with reduced sensitivity to beta-lactams. The maternal antibiotic therapy by amoxicillin and its presence in the maternal milk favored the hypothesis of a decapitated bacterial meningitis. CONCLUSION: In the presence of a meningitis without germs, the coexistence of a sizable inflammatory syndrome and the detection of IFN-alpha in the CSF must be considered as an unusual phenomenon and motivate the pursuit of antibiotic therapy until viral identification.

[A Parisian case of congenital malaria]. / Un cas parisien de paludisme congénital.

A case of symptomatic congenital malaria (Plasmodium vivax) was diagnosed and treated in a 3 week-old girl in Paris. This led to discuss the characteristics of transplacental contamination and symptomatology of congenital malaria and the methods for diagnosis and treatment of this very rare disease.

[Pulmonary valve stenosis. The medical solution]. / Sténose valvulaire pulmonaire. La solution médicale.

Pulmonary valvular stenosis had been diagnosed since infancy in a 3 year-old girl. Cyanotic episodes occurring when the child cried led to the decision to remove the stenosis, whose gradient was 58 mmHg. Transluminal dilatation through the femoral vein, after premedication and local anesthesia induced a decrease of the gradient to 18 mmHg with a good angiographic result. This technique, which may be used in numerous types of pulmonary stenosis, allowed avoidance of the disadvantages of surgery under general anesthesia with median sternotomy and cardiopulmonary by-pass.

[The child's gastroduodenal ulcer (author's transl)]. / Les ulcères gastro-duodénaux de l'enfant.

The child's gastroduodenal ulcer is not uncommon. Its symptomatology is notably different from the adult's and gives it a rather original aspect. The pain is often atypical, almost permanent and its rythm is not necessarily related to the meals. The psychological context and the family background are almost always disclosed. The digestive hemorrhage is easily revealing. Radiological traps are to be known. The treatment is virtually always medical. Cimetidine has been used only in complications, in which it has appeared very useful. Surgery is not called for but in case of perforation or hemorrhage; then it is essentially preserving.