Autochthonous Cutaneous Larva Migrans in France and Europe.

Cutaneous larva migrans is a dermatitis, typically acquired in warm tropical or sub-tropical countries, caused by migration of the larvae of nematodes (hookworm; mainly Ancylostoma braziliense and, occasionally, Ancylostoma caninum or Uncinaria stenocephala), which are parasitic on animals such as cats and dogs, into the patient's skin. The larvae penetrate the skin after contact with infected soil and cause a typical creeping eruption. Patients with cutaneous larva migrans seen in Europe have usually acquired the disease following a stay in a tropical or sub-tropical area. How-ever, some cases of cutaneous larval migrans are acquired in Europe. We report here 5 autochthonous cases in France and give an overview of European autochthonous cases.

[The presence of mycobacteria in bronchoalveolar lavage fluid from an immunocompetent patient does not necessarily imply tuberculosis]. / La présence de mycobactéries dans un LBA de sujet immunocompétent n'est pas synonyme de tuberculose.

Mycobacterium tuberculosis is the most frequently identified mycobacterium in the bronchoalveolar lavage fluid (BALF) of immunocompetent patients. Lung infections due to non-tuberculous mycobacteria (NTM) are rare in such patients and then often occur in the context of pre-existing chronic lung disease. We report the case of an immunocompetent 85-year-old woman without pre-existing lung disease in whom M. abscessus was recovered from BALF. Cytological examination of the BALF revealed an increased number of neutrophils and some acid-fast bacilli, all located within neutrophil cytoplasm. This case report contributes a cytological description of BALF in the context of M. abscessus infection, which is poorly detailed in the literature.

[BNP tests in the emergency department to diagnose congestive heart failure]. / Dosage du BNP pour le diagnostic d'insuffisance cardiaque congestive. Utilisation dans le service d'accueil des urgences.

OBJECTIVES: B-type natriuretic peptide (BNP) testing is a useful tool for diagnosis of congestive heart failure (CHF). In our institution only physicians in the lung disease, cardiology, and intensive care departments were authorized to order BNP testing. Our study sought to determine the validity of this strategy. METHODS: In this one-year prospective study, BNP testing was performed only in the lung disease and cardiology departments. The following details were recorded for each patient with a BNP assay: demographic information, clinical symptoms, physical examination, laboratory reports, chest radiography and ECG findings, and initial diagnosis (including in particular suspicion of CHF). The criterion for inclusion in this study was acute dyspnea on admission from the emergency department (ED), and the exclusion criterion was chest pain. We collected information about each patient's final diagnosis and outcome from the medical file. RESULTS: Overall, the study included 236 patients (100 admitted into the pneumology department and 136 into cardiology). Their mean age was 77.3+/-12.4 years and the sex ratio 1.29 (133 M/103 F). CHR was the final diagnosis for 170 patients (72%: 56% in pneumology and 84% in cardiology). Initial misdiagnosis led to erroneous orientation of 66 patients, 13 (5.5%) of whom were among the 39 (17%) patients who died. The diagnostic accuracy of the specialists' clinical judgment was 74%, compared with 87% and 91% for BNP cut-off levels of 100 and 250 pg/mL, respectively. COMMENT: Without BNP testing in the ED, more than a quarter of the patients with acute dyspnea were incorrectly oriented. Our study found BNP testing to be more effective than clinical judgment. In this series of patients, the cut-off value providing the best sensitivity and specificity was 250 pg/mL.

Fatal varicella hepatitis in an asthmatic adult after short-term corticosteroid treatment.

A 28-year-old male patient, treated with prednisone for bronchitis with sibilant rales, developed fever with abdominal pain and generalized vesicular rash after coming in contact with varicella-infected children. He was hospitalized after having a seizure. Laboratory values revealed hepatitis and rapidly fulminant hepatic insufficiency with disseminated intravascular coagulation. Despite acyclovir treatment, the patient died 4 days after admission. Clinical presentation could evoke a Reye's syndrome, but liver biopsy showed massive coagulative necrosis. This report demonstrates the increased risk of complicated varicella associated with the use of corticosteroids, even for a short period of time.

[Escherichia coli bacteremic urinary tract infections. Clinical aspects and pronostic factors]. / Bactériémies à Escherichia coli d'origine urinaire. Caractéristiques cliniques et facteurs pronostiques.

OBJECTIVE: To describe patients with bacteremia from urinary tract infection caused by Escherichia coli and investigate risk factors for mortality. METHOD: Retrospectively study of the files of patients with bacteremic urinary tract infection caused by E. coli and admitted via the Emergency Department of the University Hospital in Nice between 01/01/1997 and 12/31/2000. Inclusion criteria included at least one blood and urine culture positive for E. coli during the first 48 hours and age above 15 years. RESULTS: There were 118 patients in the population (71% female). Mean age was 73 years and median age 79 years. The majority of patients (90%) were hospitalized in a medical department. Initially the clinical picture was sepsis in 80% of patients, severe sepsis in 15% and septic shock in 5%. Lethality was 16%. In 40% of cases death occurred within the first 48 hours. Risk factors for mortality in multivariate analysis were initially severe clinical status and male sex. CONCLUSION: The population was aged and mortality was high for an infection presumed to be relatively benign. Age was not a risk factor for mortality, contrary to male gender.

A prospective multicenter study evaluating skin tolerance to standard hand hygiene techniques.

We performed a prospective multicenter study to assess the dryness and irritation of the hands in health care facilities, and to evaluate whether that disinfection with an alcohol-based hand rub (ABHR) is better tolerated than classic handwashing with mild soap and water. Our study was conducted in 9 sites in the summer and winter. A team of investigators evaluated dryness and irritation. This study takes into account most of the individual and environmental risk factors (age, sex, use of a protective agent, constitutional factors, personal factors, external factors, institution, function, and number of consecutive working days). The results from the 1932 assessments collected show that traditional handwashing is a risk factor for dryness and irritation, whereas the use of ABHR causes no skin deterioration and might have a protective effect, particularly in intensive use. These results provide a strong argument to counter the rear-guard resistance to the use of ABHRs.