Shift of the 2009-2011 measles outbreak from children to adults: an observational review at the University Hospital of Clermont-Ferrand, France.

In 2009-2011, 113 adult in- and outpatients with measles were referred to the University Hospital of Clermont-Ferrand (centre of France): 71 (62.8 %) needed hospitalisation, 31 had pneumonia, 29 diarrhoea, 47 liver enzymes elevation, 38 thrombopaenia, one encephalitis and there were no deaths. Nineteen cases occurred among healthcare workers and five of them were hospital-acquired. There were 92 unvaccinated patients. The 2011 peak of that measles re-emerging epidemic occurred when non-immunised adults were affected.

Impact of rapid enterovirus molecular diagnosis on the management of infants, children, and adults with aseptic meningitis.

Enteroviruses (EV) are the main etiological agents of aseptic meningitis. Diagnosis is made by detecting the genome using RT-PCR. The aim of the study was to evaluate the impact of a positive diagnosis on the management of infants, children, and adults. During 2005, 442 patients were admitted to hospital with suspected meningitis. Clinical and laboratory data and initial treatment were recorded for all patients with enteroviral meningitis. The turnaround time of tests and the length of hospital stay were analyzed. The results showed that EV-PCR detected EV in 69 patients (16%), 23% (16/69) were adults. About 18% of CSF samples had no pleocytosis. After positive PCR results, 63% of children were discharged immediately (mean 2 hr 30 min) and 95% within 24 hr. Infants and adults were discharged later (after 1.8 and 2 days, respectively). The use of antibiotics was significantly lower in children than in infants and adults. The PCR results allowed discontinuation of antibiotics in 50-60% of all patients treated. Patients received acyclovir in 16% of cases (7% children vs. 50% adults) and 23% (11% vs. 69%) underwent a CT scan. Clinical data were compared between patients whose positive EV-PCR results were available within 24 hr (n = 32) and those whose results were available > 24 hr after collection of CSF (n = 14). Duration of antibiotic treatment (difference: 2.3 days; P = 0.05) was reduced between the two groups. No statistical difference in the length of stay was observed. The EV-PCR assay should be performed daily in hospital laboratory practice and considered as part of the initial management of meningitis.

Phosphorylation, glycosylation, and proteolytic activity of the 52-kD estrogen-induced protein secreted by MCF7 cells.

We have studied the posttranslational modifications of the 52-kD protein, an estrogen-regulated autocrine mitogen secreted by several human breast cancer cells in culture (Westley, B., and H. Rochefort, 1980, Cell, 20:353-362). The secreted 52-kD protein was found to be phosphorylated mostly (94%) on high-mannose N-linked oligosaccharide chains, and mannose-6-phosphate signals were identified. The phosphate signal was totally removed by alkaline phosphatase hydrolysis. The secreted 52-kD protein was partly taken up by MCF7 cells via mannose-6-phosphate receptors and processed into 48- and 34-kD protein moieties as with lysosomal hydrolases. By electron microscopy, immunoperoxidase staining revealed most of the reactive proteins in lysosomes. After complete purification by immunoaffinity chromatography, we identified both the secreted 52-kD protein and its processed cellular forms as aspartic and acidic proteinases specifically inhibited by pepstatin. The 52-kD protease is secreted in breast cancer cells under its inactive proenzyme form, which can be autoactivated at acidic pH with a slight decrease of molecular mass. The enzyme of breast cancer cells, when compared with cathepsin D(s) of normal tissue, was found to be similar in molecular weight, enzymatic activities (inhibitors, substrates, specific activities), and immunoreactivity. However, the 52-kD protein and its cellular processed forms of breast cancer cells were totally sensitive to endo-beta-N-acetylglucosaminidase H (Endo H), whereas several cellular cathepsin D(s) of normal tissue were partially Endo H-resistant. This difference, in addition to others concerning tissue distribution, mitogenic activity and hormonal regulation, strongly suggests that the 52-kD cathepsin D-like enzyme of breast cancer cells is different from previously described cathepsin D(s). The 52-kD estrogen-induced lysosomal proteinase may have important functions in facilitating the mammary cancer cells to proliferate, migrate, and metastasize.

[Genotyping and molecular epidemiology of non polyomyelitic enteroviruses]. / Génotypage et épidémiologie moléculaire des entérovirus non poliomyélitiques.

Nonpolio enteroviruses can be reliably identified with molecular and computer tools for taxonomic, diagnostic and epidemiologic purposes. Seroneutralization tests can efficiently be replaced by genotyping assays using the VP1 capsid protein encoding gene to identify enterovirus strains isolated in cell cultures. Genotyping showed the close genetic relatedness between human enterovirus serotypes and animal enteroviruses and also rhinoviruses currently classified in a separate genus within the Picornaviridae family. Enterovirus genotyping can be done prospectively within 2 to 5 days in a greater number of meningitis patients, using cerebrospinal fluid specimens and hence can help in providing a prompt response to health alert. In the molecular epidemiology of human enteroviruses, recent advances were made by investigating genetic diversity within individual serotypes (genotypes, lineages) and the patterns of circulation and transmission of virus variants involved in epidemics (echovirus 30, enterovirus 71). The observation of epidemiologic features such as the frequent viral immigration of strains from different geographical origins speaks in favour of developing molecular identification of enteroviruses. Recombinant enterovirus strains can also be identified by genotyping. Homologous recombination is a major contributor to the genetic diversity in enteroviruses. Molecular signatures of recombination events are observed in circulating strains, suggesting the occurrence of frequent co-infections during their circulation within the general population. The role of genetic recombination in the emergence of virus variants and its involvement in the epidemiology of human enteroviruses should be investigated.

[Video: An innovation for developmental care in the neonatal intensive care unit]. / La surveillance vidéo : une innovation au service des soins de développement en unité de soins intensifs de néonatologie.

INTRODUCTION: Our neonatal intensive care unit (NICU) was designed with a web-camera system in eight private rooms and four open wards. This equipment was installed to both guarantee children's safety in the NICU and promote the bond between the child and his/her family through a viewing service permitted by an Internet access. METHOD: We evaluated the web-camera system in its 5th year with two types of users. The nursing staff was asked about use of the video and its impact on their management of NICU patients. Questionnaires for parents sought to determine how they used the system and their feelings about it. RESULTS: Ninety-three percent of the nursing staff used the web-camera system to provide medical supervision or to comply with developmental care, mainly to respect the baby's natural rhythm by initiating care only when the baby showed signs of awakening. The web-camera system allowed them to observe the baby, verify his/her good body position, and spot discomfort situations. It helped provide a faster and personalized answer that was adjusted to the baby's needs. Sixty-one percent of the parents used the remote connection, half of them to present the child to the family. Only 17% of parents were embarrassed by the cameras; 88% of parents thought that the video was an additional safety device in NICU management. CONCLUSION: The web-camera system appeared to be an interesting technology in the NICU to support developmental care when children could be put in private rooms. It helped staff react faster to situations that created an inappropriate stimulation for the baby. It also allowed to them to respect the baby's natural rhythm. It reassured nursing staff and parents and it facilitated the baby's integration into the family.

[From prospective molecular diagnosis of enterovirus meningitis...to the prevention of antibiotic resistance]. / Du diagnostic moléculaire initial prospectif des méningites à entérovirus...à la lutte contre l'antibiorésistance.

Meningitis initially presents with intense manifestations that are not generally specific to a given etiology. The first major question for the physician is to decide whether to initiate a probabilistic treatment. Enteroviruses are a major cause of aseptic meningitis, which is benign in immunocompetent patients. Molecular diagnosis is now becoming the gold standard and its prospective use at the time of patient admission, on the sole basis of clinical suspicion of meningitis, has yielded more reliable data. Cytological and biochemical data from CSF analyses are of low predictive value to influence the initial decision to treat with antibiotics. In addition, cases of meningitis during winter are not uncommon. Adults are concerned in about 25% of cases. Thus, if molecular diagnostic tools are not rapidly available, patient management may be inconsistent, leading to unnecessary scans, laboratory investigations and treatment (including overconsumption of antibiotics). Current progress in the automation and practicability of viral genomic detection yields the result within a few hours after admission. Rapid molecular viral diagnosis of a benign disease that does not require treatment but which is initially worrying is of unquestionable advantage. It is of benefit to both the patient and the community because of its input on health economics, the needless consumption of drugs and, as a result, resistance to antibiotics. The diagnosis of meningitis can no longer remain a retrospective diagnosis after elimination of all the possible causes, since not prescribing unnecessary laboratory tests and not treating are true therapeutic decisions.

Effect of estradiol on nonmalignant human mammary cells in primary culture.

We have studied effects of estradiol on primary cultures of nonmalignant human mammary tissue collected surgically from fibroadenomas or during reduction mammoplasties. After enzymatic digestion, "organoids" made of epithelial cells organized in ductal or alveolar structure were grown in primary cultures (up to 12 days) on different substrata (glass, plastic, collagen-coated plastic, and floating collagen membranes). Transmission and scanning electron microscopy showed that these organoids were responsive to physiological concentrations of estradiol. Condensed chromatin of epithelial cells became dispersed following estrogen treatment. The plasma membrane of epithelial cells at the surface of the organoids was dramatically modified by estradiol, which increased the number and the length of the microvilli, as observed previously in the MCF7 breast cancer cell line (Vic et al., Cancer Res., 42: 667-673, 1982). This effect was not observed with the same concentrations of progesterone, dexamethasone, dihydrotestosterone, or 1 microM tamoxifen or in fibroblasts of the same tissue, demonstrating that epithelial mammary cells are specifically responsive to estradiol. By contrast, no effect of estradiol could be evidenced on the [35S]methionine-labeled proteins released into the medium by the organoids. The estrogen-regulated protein of Mr 52,000 was not found in the medium after purification by concanavalin A-sepharose or immunoprecipitation with specific antibodies to the Mr 52,000 protein from MCF7 cells. We conclude that nonmalignant mammary cells are responsive to estrogens in primary culture.

Autocrine growth stimulation of the MCF 7 breast cancer cells by the estrogen-regulated 52 K protein.

The growth of MCF 7 human breast cancer cells is stimulated in vitro by estradiol (E2) and we have previously shown that estrogen-regulated glycoproteins released into the culture medium can partly mimic this effect. In this paper, we evaluate the mitogenic activity of the 52 K glycoprotein, which is a major E2-stimulated protein released by MCF 7 cells. The 52 K protein was purified 600-fold by affinity chromatography on Concanavalin A and an anti-52 K monoclonal antibody Sepharose columns. The 99% purified 52 K protein fraction stimulated the growth of estrogen-deprived MCF 7 cells. A mean 1.7-fold increase was obtained with nanomolar concentrations of seven different preparations of 52 K protein. This stimulation represented 40% of the mitogenic effect of E2. Both the 52 K protein and E2 induced microvilli at the cell surface but the effect of the 52 K protein occurred earlier. Other putative growth factors which are also stimulated by E2 and observed by [35S]cysteine labeling did not comigrate with the purified 52 K protein. Finally, the labeled 52 K protein was found to enter MCF 7 cells and to be processed into an immunoreactive 34 K protein. These data indicate that the E2-regulated 52 K glycoprotein is an autocrine mitogen on MCF 7 cells in culture and support the hypothesis that estrogens stimulate the growth of mammary cancer via this (and possibly other) secreted protein(s) acting as autocrine (and paracrine?) growth factors.

Prospective analysis of 61 cases of enteroviral meningitis: interest of systematic genome detection in cerebrospinal fluid irrespective of cytologic examination results.

BACKGROUND: Enteroviruses are the most commonly identified cause of viral meningitis. Detection of the enterovirus genome in cerebrospinal fluid (CSF) using reverse-transcription polymerase chain reaction (PCR) has proved to be useful in diagnosis and is more rapid and sensitive than viral cultures. In routine practice, cytologic examination results of CSF are obtained swiftly and PCR indication is performed as a second step. OBJECTIVES: The aim of this study was to determine, by analysis of complete data from CSF results for 61 cases of proven enteroviral meningitis, whether cytologic CSF findings can be used to establish viral etiology and to indicate if PCR assay should be performed. STUDY DESIGN: From a prospective study of children admitted during 1997 for suspected enterovirus meningitis in which PCR and viral cultures of CSF were systematically performed, we selected 61 patients with proven enterovirus meningitis. We compared global white cell count (WCC), relative percentage of lymphocytes/neutrophils, PCR and culture for enterovirus, patient age, and clinical data. RESULTS: 92% of patients (56/61) had positive PCR in CSF and in 48% (29/61) enterovirus was isolated in CSF. Nine patients (14.75%) had WCC<10/mm(3); eight of them had positive PCR and two had positive culture. There were comparable numbers of CSF with a predominance of lymphocytes (n=25) and CSF with a predominance of neutrophils (n=22), and of positive PCR and positive cultures of CSF in the two groups. Results were not influenced by the age of the patients. CONCLUSION: Irrespective of other CSF parameters, it seems difficult to dispense with PCR assay for enterovirus genome detection. It should be introduced as a true rapid routine test. Early reporting of a positive PCR result could result in a considerable saving in health resources.

Nosocomial rotavirus infections in adult renal transplant recipients.

We conducted a 24-month survey of hospital-acquired rotavirus infections in 20 renal transplant recipients who received their graft during 1988. Four cases of nosocomial rotavirus infection were diagnosed (20% of patients), 3-34 days after graft. Two patients presented with severe diarrhoea and two with fever alone. The cases occurred mainly during the winter months and remained sporadic. None of our patients was found to have chronic excretion of rotaviruses. Contacts from paediatric cases can be ruled out. We concluded that rotavirus nosocomial infections were frequent in adult renal transplant recipients and suggest that screening for rotavirus is regularly performed in these immunodeficient patients who are very susceptible to hypovolaemia.

An outbreak due to echovirus type 30 in a neonatal unit in France in 1997: usefulness of PCR diagnosis.

Between February and August 1997, 53 patients with enterovirus meningitis were hospitalized in Clermont-Ferrand, France. All but one were children. Echovirus type 30 was involved in 70% of cases with identified serotype. The outbreak ceased on August 8. Two months later, a neonate was admitted to the neonatal unit with an echovirus type 30 meningitis thought to be acquired at delivery. Twenty days later a nosocomial outbreak of echovirus type 30 involving five neonates occurred. Two of them presented with meningitis and two with febrile seizure; One was asymptomatic. The retrospective examination of the maternal sera in a neutralization test, using the index case strain as a source of antigen, showed that none of the neonates was passively immunized before hospitalization. The use of genome detection in cerebrospinal fluid allowed rapid diagnosis and infection was contained by re-inforcing hygiene measures. Prospective examination of stools in the neonatal and paediatric units showed no further occurrences of the disease. No sporadic case was observed in the general population. Hence, nosocomial infections can occur a long time after an outbreak in the general population; rapid diagnosis with molecular tools is useful both for a definite diagnosis in patients already hospitalized, and to act as a rapid alert, even in intervals between seasonal outbreaks.

[Evaluation of 4 years of surveillance of enteroviruses in sewage. Correlation with human pathology]. / Bilan de quatre années de dépistage des entérovirus dans les eaux usées. Corrélations avec la pathologie humaine.

This survey is concerned with isolations of enteroviruses from sewage and stools of children admitted to pediatric wards of the Clermont-Ferrand hospital during 4 years (from january 1, 1980, to december 31, 1983). Some epidemics of different serotypes (Coxsackies B1, B4, B5, Echovirus 33) occurred, mainly between june and october. In some instances, virus isolation in sewage occurred a few weeks before epidemic of the same virus, giving some predictive value to pediatric pathology. This survey allowed us to adapt immunologic diagnosis of enteroviruses in children and limit the use of expensive reagents.

Mineral balance and whole body bone mineral content in very low-birth-weight infants.

Fat and mineral metabolic balance studies were performed in 25 normal very low-birth-weight infants (< or = 1500 g at birth) fed either pooled pasteurized human milk supplemented with calcium, phosphorus and magnesium, or a preterm formula. Calcium, phosphorus and magnesium intake were similar in both groups and averaged 100 mg/kg/day, 72 mg/kg/day and 8 mg/kg/day, respectively. Calcium and phosphorus retention was higher in the subjects fed fortified human milk than in those receiving a preterm formula (65 +/- 14 and 62 +/- 9 mg/kg/day versus 55 +/- 12 and 47 +/- 7 mg/kg/day respectively). The difference was only significant for phosphorus. Magnesium retention was similar in the two groups and averaged 3 mg/kg/day. Fat intake and absorption was significantly higher in the preterm formula fed group than in the one fed fortified human milk (5.5 +/- 0.4 g/kg/day and 88 +/- 4% versus 4.2 +/- 1 g/kg/day, 79 +/- 6% respectively). Assessment of the whole body bone mineral content by dual energy X-ray absorptiometry was performed at 3 and 6 months of age in another group of 25 low-birth-weight infants fed either fortified human milk or a preterm formula. Whole body bone mineral content (BMCt) was low (43.3 +/- 30.8 g of hydroxyapatite) at 3 months of age (theoretical term) compared to normal full-term newborns at birth. There was no significant influence of the diet. At 6 months of age, BMCt reached 168.6 +/- 36.6 g, a value similar to that of full-term newborns, with no significant difference between the two regimen groups.(ABSTRACT TRUNCATED AT 250 WORDS)

[Lipid pneumonia and superinfection by Mycobacterium fortuitum. Apropos of a case]. / Pneumonie lipidique et surinfection par Mycobacterium fortuitum. A propos d'un cas.

We report a case of lipoid pneumonia complicated by supra-infection with Mycobacterium fortuitum. The diagnosis of a lipoid pneumonia was suggested by the CT Scanner which showed a negative density in the pneumonic tissue. The supra-infection by the mycobacterium dit not change the radiological opacities which stayed the same following a cure of the mycobacterial infection. A histo-pathological study showed evidence of macrophages with voluminous lipid inclusions but equally the atypical mycobacteria were associated with a giant cell-epithelioid reaction. In patients with a lipoid pneumonia the possibility of an infection should be considered and a supra-infection with an atypical mycobacterium should be looked for. At the same time, when a bacteriological study of sputum or fibreoptic aspiration of a rapidly growing mycobacterium is obtained this should raise the possibility of oil inhalations. Alveolar lavage seems to be a technique which seems to be entirely appropriate to obtain the diagnosis of the two concomitant disorders.

[A simple and rapid method to test the permeability of condoms to viruses]. / Une méthode simple et rapide de contrôle de l'imperméabilité aux virus des préservatifs.

phi x 174 and T7 coliphages can be used to find out if condoms are virus-proof. Protection against hepatitis B virus or papillomavirus contamination is not assured when T7, a 65 nm broad virus, leaks through the condom. The simple test can be used to establish a quality control norm for condoms.

[The re-emergence in 1997 of rubella infections during pregnancy. 11 cases in Clermont-Ferrand]. / Recrudescence en 1997 des infections rubéoliques pendant la grossesse. 11 cas à Clermont-Ferrand.

OBJECTIVE: Describe the clinical and laboratory features of rubella observed during the first semester of pregnancy in 11 patients in 1997. PATIENTS AND METHODS: Eleven pregnant women, aged 15-30 years, were referred to the Clermont-Ferrand University Hospital for suspected rubella. Four had had at least 1 prior pregnancy, none had been vaccinated. Rubella serology was obtained for all 11 patients and polymerase chain reaction viral amplification was performed on amniotic fluid in 9 cases. RESULTS: The virology laboratory identified 8 cases of primary rubella (2 prior to 12 weeks gestation) and 3 reinfections (1 prior to 12 weeks gestation). Fetal infection was evidenced in I gravida II patient at 17-18 weeks gestation. All pregnancies were continued to term and no case of congenital rubella malformation was observed. However specific IgM assays were performed at birth in 6 of the 11 infants and revealed infection in 3. CONCLUSION: These observations indicate that a local epidemic of rubella occurred in the general population. They illustrate the risk of a rubella epidemic in France and the lack of sufficient vaccination of the young adult population, finally they emphasize that current anti-rubella vaccination programs should be promoted.

[Waldman's disease. Primary intestinal lymphangiectasis]. / Maladie de Waldman. Lymphangiectasies intestinales primitives.

INTRODUCTION: Primary intestinal lymphangiectasias are often associated with lymphoedema. OBSERVATION: The diagnosis was performed at 4 months when Maxime presented with lymphoedema, diarrhea, hypoprotidemia and hypolipemia. Duodenum biopsies revealed intestinal lymphangiectasias. An hyperprotidic and low fat diet, medium chain triglyceride-supplemented and an elastic contention allowed a decline of the oedemas. DISCUSSION: We report one case of Waldman's disease. It shows very well the typical circumstances of diagnosis in this disease and the two types of oedema (lymphoedema and hypoprotidic oedema).

Repeated genomic transfers from echovirus 30 to echovirus 6 lineages indicate co-divergence between co-circulating populations of the two human enterovirus serotypes.

Human echovirus types 6 (E-6) and 30 (E-30) cause seasonal epidemics of aseptic meningitis. These two enteroviruses are frequently observed in co-circulation, an epidemiological pattern that is prerequisite for the occurrence of dual infections, which can lead to recombination between co-infecting virus strains. Viral sequences were determined at loci 1D (VP1 capsid protein) and 3CD (non structural proteins) in 49 E-6 strains recovered in a single geographical region in France from 1999 to 2007, during the epidemiological survey of enterovirus infections. They were compared with previously recorded sequences of E-30 strains to investigate their evolutionary histories and possible recombination patterns. Phylogenetic analyses identified two distinct E-6 populations and different subpopulations. Assuming a relaxed molecular clock model and a Bayesian skyline demographic model in coalescent analyses with the BEAST program, the substitution rate in E-6 was estimated at 8.597×10(-3) and 6.252×10(-3) substitution/site/year for loci 1D and 3CD respectively. Consistent estimates of divergence times (t(MRCA)) were obtained for loci 1D and 3CD indicating that two distinct E-6 populations originated in 1997 and 1999. Incongruent phylogenetic patterns inferred for the two loci were indicative of recombination events between the two populations. Phylogenies including the E-30 3CD sequences showed close genetic relationships between E-6 and discrete E-30 subpopulations. Recombination breakpoints were located with statistical significance in E-6 and E-30 genomes. Estimates of t(MRCA) of phylogenetic recombinant clades indicated directional genetic transfers from E-30 to E-6 populations and their co-divergence over the time period studied.

Heat shock cognate 70 protein secretion as a new growth arrest signal for cancer cells.

Earlier studies indicated that density-arrested cancer cells released an unidentified growth inhibitor whose secretion was prevented by overexpression of the lysosomal protease cathepsin D (cath D). In this study, this growth inhibitor was purified by affinity chromatography and identified as the heat shock cognate 70 protein (hsc70) based on its peptide microsequencing and specific antibody recognition. Among intracellular proteins, including other heat shock proteins, only constitutive hsc70 was secreted in response to the high-cell density. Moreover, hsc70 secretion from cancer cells was generated by serum deprivation, whereas its cellular concentration did not change. Prevention of Hsc70 secretion by cath D overexpression was associated with the formation of multilayer cell cultures, thus indicating a loss of contact inhibition. In addition, we showed that supplementing the culture medium with purified hsc70 inhibited cell proliferation in the nanomolar range. Conversely, removal of this extracellular hsc70 from the medium by either retention on ADP-agarose or competition at the Hsc70 binding site restored cell proliferation. Hsc70 appears active in human breast cancer cells and hypersecreted by direct cath D inhibition. These results suggest a new role of this secreted hsc70 chaperone in cell proliferation that might account for the higher tumor growth of cancer cells overexpressing cath D.