[Psoas abscesses reviewed]. / Les abces du psoas a pyogenes.

Psoas abscesses are rare. In the absence of specific symptoms and signs, their diagnosis was usually difficult. Medical imaging advances have helped in their diagnosis and treatment. Eleven cases of psoas abscess were reviewed retrospectively. We tried to determine epidemiologic and clinical features and therapeutic alternatives for this entity. Mean aged 27 years. Three of the 11 cases occurred in females. An underlying disease was observed in three cases. Associated clinical features were fever (n = 11), lumbar pain (n = 10), and psoOtis (n = 5). Diagnosis was confirmed by ultrasonography (n = 10) and computed tomography (n = 1). Blood culture was positive in 6 out of 11 cases: Staphylococcus aureus (n = 5) and Klebsiella pneumonia (n = 1) Staphylococcceus aureus was isolated in 6 abscess pus. Antibiotics were prescribed in all cases for a mean length of 61 days, in association with percutaneous drainage in 5 cases, surgical drainage in one case and abscess puncture in one case. Outcome was favourable in all cases.

[Infectious urgencies in an emergency medical service]. / Les urgences infectieuses dans un service d'urgences medicales.

The aim of this study is to evaluate the frequency of infectious urgencies and the quality of their management in an emergency medical service. During the period of study, 21737 consultants are recorded, from which 2011 for an infectious urgency (9,25%), pharyngitis with rhinitis excluded. 692 patients are hospitalized and 1074 receive ambulatory antibiotics. Therapeutic urgencies are the most frequent infectious urgencies (48,4%), followed by protection urgencies (46,3%), urgencies due to antibiotics (5,2%) and prevention urgencies (0,1%). The conduct is considered correct for 1379 cases (68,5%) and incorrect for 500 cases (25%). Main incorrect conducts are the absence of follow-up (81,6%) and the maladjusted antibiotherapy (11,8%). These results incite, mainly, to the improvement of the professional training of emergency physicians and their communication with their colleagues of the other sanitary structures.

Posterior segment manifestations of Rickettsia conorii infection.

PURPOSE: To characterize and analyze the posterior segment manifestations of Mediterranean spotted fever (MSF), an infectious disease caused by Rickettsia conorii. DESIGN: Prospective, noncomparative case series. PARTICIPANTS: Thirty patients (60 eyes) with serologically proven MSF at the acute stage. METHODS: Patients underwent complete ophthalmic examination, including dilated biomicroscopic fundus examination, fundus photography, and fluorescein angiography. Sequential follow-up examinations were performed in patients with evidence of posterior segment involvement. RESULTS: Of 30 patients, 25 (83.3%) had unilateral (n = 5) or bilateral (n = 20) posterior segment involvement related to MSF. Of those 25 patients, 16 (64%) had no ocular symptoms, and 9 (36%) had ocular complaints. Findings included mild vitreous inflammation (45 eyes [75%]), white retinal lesions (18 eyes [30%]), focal vascular sheathing (5 eyes [8.3%]), multiple arterial plaques (1 eye [1.7%]), intraretinal hemorrhages (14 eyes [23.3%]), white-centered retinal hemorrhages (2 eyes [3.3%]), subretinal hemorrhages (2 eyes [3.3%]), serous retinal detachment (3 eyes [5%]), macular star (2 eyes [3.3%]), cystoid macular edema (1 eye [1.7%]), optic disc edema (1 eye [1.7%]), branch retinal artery occlusion (1 eye [1.7%]), optic disc staining (30 eyes [50%]), retinal vascular leakage (27 eyes [45%]), delayed filling in a branch retinal vein (1 eye [1.7%]), and multiple hypofluorescent choroidal dots (10 eyes [16.7%]). One eye (1.7%) had retinal neovascularization at the 6-month follow-up examination. All posterior segment findings at the acute stage resolved in 3 to 10 weeks, and the final visual acuity was 20/20 in 42 of 45 affected eyes (93.3%). Retinal pigment epithelium changes developed in 9 eyes (15%), with resolved full-thickness white retinal lesions. No other abnormalities were noted in the eye with retinal neovascularization over a further follow-up of 6 months. CONCLUSION: Posterior segment involvement, frequently asymptomatic, is common in patients with acute MSF. Because the diagnosis can be easily overlooked, a careful dilated funduscopic examination, complemented by fluorescein angiography in selected cases, is recommended. Mild vitritis, retinal vasculitis, optic disc staining, white retinal lesions, retinal hemorrhages, and multiple hypofluorescent choroidal dots are the most common manifestations of MSF. Posterior segment changes in a patient with fever and/or skin rash living in or returning from a specific endemic area, especially during the spring or summer, strongly suggest R. conorii infection.