Emergence of Clostridium difficile tcdC variant 078 in Marseille, France.

The purpose of this investigation was to evaluate the epidemiology of hypervirulent Clostridium difficile ribotypes from January 2013 to February 2017 in the Marseille area of southern France. By using the Xpert Clostridium difficile Epi polymerase chain reaction (PCR) assay and sequencing the tcdC gene, we characterised C. difficile isolates from symptomatic patients diagnosed with C. difficile infection (CDI) in Marseille university hospitals. We first tested retrospectively 278 C. difficile samples isolated from January 2013 to December 2014 and observed a high prevalence of isolates with tcdC mutations and deletions previously described in both hypervirulent ribotypes RT027 and RT078 (16.4% and 10.7%, respectively). We highlighted the co-circulation of these two hypervirulent C. difficile tcdC variants (tV) with distinct epidemiological characteristics. While an RT027 outbreak occurred mainly as healthcare-associated infection in the elderly, CDI caused by tV078 occurred mainly in a younger population as community-associated infection. From January 2016, a systematic survey of these two hypervirulent C. difficile ribotypes revealed the emergence of CDI caused by tV078, currently being more prevalent than RT027 in the Marseille area. The present study is the first report of the emergence of CDI caused by tV078 in southern France. We showed the simultaneous circulation and sequential spread of hypervirulent ribotypes, such as RT027 and tV078. This emphasises the need for an efficient surveillance system for CDI with ribotyping and an optimised management of CDI caused by hypervirulent strains.

Primary subacute epiphyseal osteomyelitis caused by Mycobacterium species in young children: a modern diagnostic approach.

Primary epiphyseal subacute osteomyelitis (PESAO) caused by Mycobacterium species in young children is poorly recognized. We aimed to define the spectrum of this uncommon condition and to propose a novel diagnostic approach. We performed a systematic review of the literature on the PubMed website by selecting all reports of isolated infantile PESAO caused by Mycobacterium species since 1975. We identified 350 citations, of which 174 were assessed for eligibility based on title and abstract. The full text of 81 eligible citations was screened, and relevant data of 15 children under 4 years of age with mycobacterial PESAO were extracted. These data were pooled with those from our Institution. Data from 16 children were reviewed. The median age was 16 ± 7 months and the male:female ratio 1.7. The knee was the most common infection site (94%). The diagnosis of mycobacterial disease was delayed in all cases (range, 2 weeks to 6 months), and initially presumed by histology in 15 children (94%). Microbiologically proven diagnosis was confirmed by bone cultures in 8 of the 15 children (53%), and by specific PCR in 2 of the 3 culture-negative bone specimens (67%). Three children experienced long-term orthopedic complications despite surgical drainage and prolonged antimycobacterial regimens. All recently reported cases came from high-burden tuberculosis areas. Mycobacterium species contribute to the burden of infantile PESAO in endemic tuberculosis areas and may cause growth disturbances. We argue in favor of the early recognition of mycobacterial disease by specific molecular assays in children with infantile PESAO living in high-burden areas.

Bartonella henselae is usually not viable in lymph nodes of patients with cat scratch disease.

Bartonella henselae, the agent of cat scratch disease (CSD), appears to be a common organism responsible for lymphadenitis in both adults and children. There is a very low isolation rate for B. henselae from lymph nodes of patients with CSD. Our objective was to evaluate B. henselae viability in a large series of lymph nodes from patients with CSD. From January to November 2016, we analyzed lymph node biopsy samples from patients diagnosed with CSD. We used reverse transcription-quantitative polymerase chain reaction (RT-qPCR) to detect B. henselae RNA, as well as cultures, histological analyses, and fluorescence in situ hybridization (FISH). We tested 87 lymph nodes positive for B. henselae DNA but only 8 (9%) presented with B. henselae RNA. We did not find a significant difference for the pap threshold cycle (CT) values between RNA-positive and RNA-negative lymph nodes (p = 0.5). Cultures, histological analyses, and FISH were negative for all the tested samples. We provide evidence that B. henselae are not or are rarely viable in most cases in the lymph nodes of patients with CSD.

Insights into bacterial colonization of intensive care patients' skin: the effect of chlorhexidine daily bathing.

Skin is a major reservoir of bacterial pathogens in intensive care unit (ICU) patients. The aim of this study was to assess the skin bacterial richness and diversity in ICU patients and the effect of CHG daily bathing on skin microbiota. Twenty ICU patients were included during an interventional period with CHG daily bathing (n = 10) and a control period (n = 10). At day seven of hospitalization, eight skin swab samples (nares, axillary vaults, inguinal creases, manubrium and back) were taken from each patient. The bacterial identification was performed by microbial culturomics. We used the Shannon index to compare the diversity. We obtained 5,000 colonies that yielded 61 bacterial species (9.15 ± 3.7 per patient), including 15 (24.5 %) that had never been cultured from non-pathological human skin before, and three (4.9 %) that had never been cultured from human samples before. Notably, Gram-negative bacteria were isolated from all sites. In the water-and-soap group, there was a higher risk of colonization with Gram-negative bacteria (OR = 6.05, 95 % CI [1.67-21.90]; P = 0.006). In the CHG group, we observed more patients colonized by sporulating bacteria (9/10 vs. 3/10; P = 0.019) with a reduced skin bacterial richness (P = 0.004) and lower diversity (0.37, 95 % CI [0.33; 0.42] vs. 0.50, 95 % CI [0.48; 0.52]). Gram-negative bacteria are frequent and disseminated components of the transient skin flora in ICU patients. CHG daily bathing is associated with a reduction in Gram-negative bacteria colonization together with substantial skin microbiota shifts.

Complementarity between targeted real-time specific PCR and conventional broad-range 16S rDNA PCR in the syndrome-driven diagnosis of infectious diseases.

Molecular tools have shown an added value in the diagnosis of infectious diseases, in particular for those caused by fastidious intracellular microorganisms, or in patients receiving antibiotics before sampling. If 16S rDNA amplification had been gradually implemented in microbiology laboratories, specific real-time polymerase chain reaction (PCR) would have permitted an increase in the sensitivity of molecular methods and a reduction of contamination. Herein, we report our experience in the diagnosis of infectious diseases over two years, during which 32,948 clinical samples from 18,056 patients were received from France and abroad. Among these samples, 81,476 PCRs were performed, of which 1,192 were positive. Molecular techniques detected intracellular microorganisms in 31.3 % of respiratory samples, 27.8 % of endocarditis samples and 51.9 % of adenitis samples. Excluding intracellular bacteria, 25 % of the positive samples in this series were sterile in culture. Conventional broad-range PCR permitted the identification of fastidious and anaerobic microorganisms, but specific real-time PCR showed a significant superiority in the diagnosis of osteoarticular infections, in particular for those caused by Kingella kingae and Staphylococcus aureus, and for endocarditis diagnosis, specifically when Streptococcus gallolyticus and Staphylococcus aureus were involved. The sensitivity of conventional broad-range PCR was 62.9 % concerning overall diagnoses for which both techniques had been performed. These findings should lead microbiologists to focus on targeted specific real-time PCR regarding the clinical syndrome. Finally, syndrome-driven diagnosis, which consists of testing a panel of microorganisms commonly involved for each syndrome, permitted the establishment of 31 incidental diagnoses.

Scalp eschar and neck lymphadenopathy after tick bite: an emerging syndrome with multiple causes.

The clinical and epidemiological features of 56 patients with scalp eschar associated with neck lymphadenopathy after a tick bite (SENLAT) syndrome were evaluated at the National French Rickettsial Center. Eschar swabs, crusts, and biopsies as well as ticks and blood samples were acquired for molecular and serological assays. SENLAT predominantly affects children (p < 0.05), followed by 40- to 70-year-olds, and it is found mostly in women (p < 0.05). The seasonal distribution has two peaks: one in the spring (55%) and one in the autumn (30%). The etiological agent was identified in 18 cases, which include Rickettsia slovaca in 13 cases with incidences of two co-infections with Rickettsia raoultii and one case caused by Rickettsia sibirica mongolitimonae. Other possible agents that were found in attached ticks were Candidatus R. rioja, Coxiella burnetii, and Borrelia burgdorferi. The tick vector was Dermacentor marginatus in almost all cases, with the exception of one case, in which Ixodes ricinus was identified as the vector. Our findings show that SENLAT is a clinical entity characterized as a local infection controlled by the immune system and is neither pathogen- nor vector-specific.

Molecular revolution in the diagnosis of microbial brain abscesses.

A brain abscess is a life-threatening infection, frequently with serious sequelae. Culture-based methods present many limitations and do not enable an exhaustive documentation of the bacterial flora. 16S rRNA-based amplification, cloning, and high-throughput sequencing have dramatically increased the number of identified agents of brain abscesses, showing that the causative flora is polymicrobial in up to 40 % of cases, with the presence of at least one anaerobic bacterium. In contrast, real-time polymerase chain reaction (PCR) technology is an appealing alternative to culture-based methods for diagnosing brain abscesses due to its speed, sensitivity, and specificity. Molecular typing is available for several bacterial and fungal genera, and this user-friendly tool is accessible for the clinical microbiology laboratory to diagnose microbes involved in a brain abscess. This article reviews the applications of the currently available tools for the etiological diagnosis of a brain abscess.

Outbreak of adenovirus type 1 severe pneumonia in a French intensive care unit, September-October 2012.

We herein describe and analyse the first outbreak of severe pneumonia caused by human adenovirus type1 (HAdV C type 1), which included immunocompetent patients in an intensive care unit (ICU) of Marseille, France, and occurred between September and October 2012. Seven successive patients were diagnosed by HAdV specific real-time polymerase chain reaction with a positive bronchoalveolar lavage. After the collection of nasopharyngeal swabs from healthcare workers, three nurses working night shifts tested positive for HAdV C including one that had exhibited respiratory signs while working one week before the outbreak. She was the most likely source of the outbreak. Our findings suggest that HAdV-1 could be considered as a possible cause of severe pneumonia even in immunocompetent patients with a potential to cause outbreaks in ICUs. HAdV rapid identification and typing is needed to curtail the spread of this pathogen. Reinforcing hand hygiene with antiseptics with demonstrated activity against non-enveloped viruses and ensuring that HCWs with febrile respiratory symptoms avoid direct patient contact are critical measures to prevent transmission of HAdV in healthcare settings.

[Concussion and sport: too often underdiagnosed]. / Commotions cérébrales et sport: trop souvent méconnues.

Concussions are frequent in contact sports. Clinical symptoms, cognitive impairment, neurobehavioral features can be present. Loss of consciousness is rare. If suspicion, the player must be removed from the game. Return to play is gradual; it may be possible only if the sportsman is asymptomatic. Strict application of the rules of the game, fair play can decrease the incidence of concussion. SCAT (pocket, SCAT 3, SCAT Child) should be used as a help to diagnosis and follow up.

Molecular detection and MST genotyping of Coxiella burnetii in ruminants and stray dogs and cats in Northern Algeria.

Aiming at identifying the reservoir and contamination sources of Coxiella burnetii in Northern Algeria, we investigated the molecular presence of the bacterium in 599 samples (blood, placenta, liver, spleen, and uterus) collected from cattle, sheep, dogs and cats. Our qPCR results showed that 15/344 (4.36%) blood samples and six/255 (2.35%) organ specimens were positive for C. burnetii. In cattle, three (4%) blood and liver samples were positive. In sheep, one blood (1.19%) and 3 (8.57%) placenta samples were positive. At the Algiers dog pound, 8 (10%) and 3 (5%) blood samples were qPCR positivein dogs and cats, respectively. In addition, MST genotyping showed that MST 33 was present in cattle and sheep, MST 20 in cattle,andMST 21 in dogs and cats.

The role of Streptococcus intermedius in brain abscess.

Brain abscess represents a significant medical problem, despite recent advances made in detection and therapy. Streptococcus intermedius, a commensal organism, has the potential to cause significant morbidity. S. intermedius expresses one or more members of a family of structurally and antigenically related surface proteins termed antigen I/II, which plays a potential role in its pathogenesis. It is involved in binding to human fibronectin and laminin and in inducing IL-8 release from monocytes, which promotes neutrophil chemotaxis and activation. There are few published data on the role of this organism in brain abscess. This review focuses on the clinical evidence, pathogenic role, mechanism of predisposition, and currently employed strategies to fight against S. intermedius associated to brain abscess.

Lactobacillus rhamnosus bacteremia: an emerging clinical entity.

Lactobacillus spp. are ubiquitous commensals of the normal human flora that are only occasionally found in clinical infections. Their role in human disease is established for infectious endocarditis but is controversial for other infections. We sought to characterize clinically associated Lactobacillus spp. We conducted a retrospective study, which consisted of the screening of Lactobacillus isolates obtained in our laboratory from January 2004 to December 2009. The polymerase chain reaction (PCR) assay was selected as the gold standard method. The isolates were first identified using API Coryne strips, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), and 16S rRNA gene sequencing. Lactobacillus tuf gene-based identification was used when the 16S rRNA results were inconclusive. Among the 60 strains of Lactobacillus spp. obtained in our laboratory, L. rhamnosus was the most commonly isolated species and was found in blood cultures from 16 patients. Combined with 45 patients reported in the literature, we found that patients presenting with L. rhamnosus bacteremia experienced nosocomial infections associated with both immunosuppression (66 %) and catheters (83 %).

[Elite senior athletes. Physiological modifications related to performance decrease in elderly]. / Seniors et records: compatibles? modifications physiologiques liées à la baisse des performances des sujets âgés.

Results of masters athletes are more and more impressive. With age, VO2max, strength, speed, coordination, recovery decrease. Regular training with enough intensity is the most appropriate, the less expensive measure to prevent morbidity and dependence. It's efficacy in patients is regularly demonstrated.

A case of multifocal chronic Q fever osteomyelitis.

Chronic Q fever can be difficult to diagnose because of a variety of non-specific clinical presentations. Chronic Q fever osteoarticular infections have rarely been reported in the literature. We describe here an unusual multifocal osteomyelitis due to Coxiella burnetii in an adult.

[Musculoskeletal adverse drug reactions]. / Médicaments et effets indésirables musculosquelettiques.

Musculoskeletal complaints are frequent. Numerous rheumatologic but also endocrine diseases should be considered. The locomotor system, and more specifically muscles and bones, may also be the target organ for adverse drug reactions. They are generally temporarily disabling, disappearing with drug discontinuation. Medical history, locomotor and neurologic exam, blood analysis help to find the diagnosis and to choose the management.

Draft genome of Metabacillus niabensis strain 4T19T isolated from cotton-waste composts for mushroom cultivation.

In this article, we present the draft genome sequence of Metabacillus niabensis strain 4T19T (= CSUR Q2603 T = DSM 17723 = JCM 16399 = KACC 11279), that is a new Metabacillus species isolated from cotton-waste composts. The genome sequence from Metabacillus niabensis strain 4T19T was assembled into 462 contigs for a total size of 4,987,608 bp with a G + C content of 35.5%.

Dialister massiliensis sp. nov., a new bacterium isolated from the human gut.

Dialister massiliensis strain Marseille-P5638T (= CSUR P5638) is a new species from the genus Dialister and family Veillonellaceae which was isolated from the gut microbiota of a healthy individual.

Pseudoruminococcus massiliensis gen. nov., sp. nov., a new bacterium isolated from the human gut microbiota.

Pseudoruminococcus massiliensis strain Marseille-P3876T (= CSUR P3876) is a new genus from the family Ruminococcaceae that was isolated from the gut microbiota of a healthy Senegalese man.

Description of Prevotella rectalis sp. nov., a new bacterium isolated from human rectum.

Using a taxonogenomics method, we describe here a Gram-negative bacterium named Prevotella rectalis sp. nov., strain Marseille-P4334T (= CSUR P4334) isolated from the rectum. Strain Marseille-P4334T has a genome that measure 3.03 Mbp with 43.3 mol% G + C content.

Massilistercora timonensis gen. nov., sp. nov., a new bacterium isolated from the human microbiota.

Massilistercora timonensis gen. nov., sp. nov. strain Marseille-P3756T is a new species of the phylum Firmicutes; it was isolated from the human gut microbiota and has a genome of 2 769 591 bp (51.2% G + C). The closest species based on 16S rRNA sequence was Merdimonas faecis strain BR31 with 95.2 % sequence similarity. Considering phenotypic features and comparative genome studies, we proposed the strain Marseille-P3756T as the type strain of Massilistercora timonensis sp. nov., a new species within the genus Massilistercora.