[Liver abscess : case report and literature review]. / Abcès hépatique : rapport de cas et revue de la littérature.

Liver abscess is a rare condition. There are multiple etiologies and mortality linked to the infections or local complications is high. The rapid diagnosis and the implementation of an adequate and effective treatment are essential to allow healing without sequels. We report the case of a monofocal bacterial hepatic abscess in a 61-year-old patient with an iatrogenic origin. A review of the literature is proposed in order to address the incidence, the different microorganisms, the different etiologies and the different possibilities of treatment. It should be noted that mycotic abscess, which is extremely rare outside the immunocompromised patient, will not be discussed in this article.

L'abcès hépatique est une pathologie rare. Les étiologies sont multiples et la mortalité, liée au phénomène infectieux ou aux complications locales, est élevée. La rapidité diagnostique et la mise en place d'un traitement adéquat et efficace sont indispensables pour permettre la guérison sans séquelle. Nous rapportons le cas d'un abcès hépatique bactérien monofocal d'origine iatrogène à la prise en charge compliquée chez une patiente de 61 ans. Une revue de la littérature est ensuite proposée afin d'aborder l'incidence, les différents micro-organismes, les différentes étiologies et les différentes possibilités de prise en charge. A noter que l'abcès mycotique, rarissime en dehors du patient immunodéprimé, ne sera pas discuté dans cet article.

[Emergency department utilization by HIV-positive adults in a Belgian setting]. / Etude des motifs d'admission au service des Urgences d'une cohorte de patients infectés par le VIH suivis au CHU de Liège.

The use of the emergency department (ED) by human immunodeficiency virus (HIV)-infected adults undergoes an evolution following the introduction of antiretroviral therapy (ART). Improving our knowledge about ED use characteristics will contribute to a correct diagnosis and therapeutic approach in this patient group, at the moment they are discharged from the ED. We conducted a one-year retrospective study on characteristics of ED use involving 1026 patients living with HIV. The majority of them was treated with antiretroviral therapy (95 %) and had a viral load lower than 50 copies (73.6 %). Among them, 117 patients (11.8 %) were admitted at least once to the ED. The most common ED discharge diagnoses were related to trauma (30 %). This study shows that the great majority of diagnoses were not related to infectious diseases (6.3 %, of which half were HIV-related). One hypothesis to explain these results would be that HIV-positive adults in this study had excellent antiretroviral coverage and were well controlled in terms of HIV.

L'utilisation du département des urgences (DU) par les adultes infectés par le virus de l'immunodéficience humaine (VIH) évolue suite à l'instauration des traitements antirétroviraux (TAR). Nous avons besoin d'améliorer nos connaissances à ce sujet et d'en savoir plus sur le diagnostic de ces patients lorsqu'ils quittent le service d'urgence. Nous avons réalisé une étude rétrospective sur une durée d'un an et qui s'intéresse aux caractéristiques de l'utilisation du DU par 1.026 patients vivant avec le VIH. La majorité d'entre eux était sous traitement anti-rétroviral (95 %) et avait une charge virale inférieure à 50 copies (73,6 %). Parmi eux, 117 (11,8 %) se sont présentés au moins une fois au DU. Les principaux motifs d'admission étaient d'ordre traumatologique (30 %). Cette étude montre que la grande majorité des motifs d'admission au DU des patients vivant avec le VIH n'était pas en rapport avec des pathologies infectieuses (seulement 6,3 %, dont la moitié directement liées au VIH). Une hypothèse pour expliquer ces résultats serait que les patients étudiés bénéficiaient d'une excellente couverture anti-rétrovirale et étaient bien contrôlés en termes de VIH.

[Lyme disease or not ?] / Maladie de Lyme ou pas ?

Lyme disease is a complex pathology due to an infection by a spirochaete from the genus Borrelia. This infection results from a tick bite lasting more than 24 hours. Signs and symptoms are numerous and are usually classified in three stages: early localized disease, early disseminated disease and late disease. The skin, the heart, the nervous system and the joints are mostly concerned. It is important to distinguish the clinical manifestations of the disease from those that are sometimes associated with it but with no scientific evidence. The purpose of this article is to insist on which signs and symptoms can be related to the disease and on those that usually are not. Diagnostic methods and treatments are also discussed.

La maladie de Lyme est une pathologie complexe, qui résulte d'une infection par un spirochète du genre Borrelia. Cette infection est transmise par une morsure de tique, devant perdurer plus de 24 heures. Les manifestations cliniques de la maladie de Lyme sont nombreuses et classiquement divisées en 3 phases : primaire, secondaire et tertiaire. Elle touche principalement les systèmes cutané, cardiaque, neurologique et articulaire. Il est important de distinguer les manifestations cliniques pouvant être rapportées à cette maladie et celles pour lesquelles aucune évidence scientifique n'a pu être apportée. En effet, il est de plus en plus fréquent que certaines pathologies, dont l'étiologie est incertaine à l'heure actuelle, soient considérées comme provoquées ou secondaires à la borréliose. Cet article vise à faire la lumière sur les symptômes et signes pouvant être attribués à cette affection et ceux qui ne le sont pas. Les méthodes diagnostiques et thérapeutiques seront aussi discutées.

[Osteoarticular tuberculosis nosology and diagnostic pitfalls]. / Tuberculose ostéoarticulaire : nosologie et pièges diagnostiques.

Osteoarticular or skeletal tuberculosis is a clinical manifestation of extrapulmonary tuberculosis, occurring during the lympho-hematogenous spread of Mycobacterium tuberculosis from a pulmonary primary infection or reactivation of latent infection, years or even decades after the initial infection. Bone and joint tuberculosis is a rare disease with non-specific symptoms and radiological characteristics, often delaying diagnosis for more than a year after clinical onset. First-line hospital departments should develop a clinical suspicion when confronted with a subacute inflammatory bone or joint pathology in patients with underlying comorbidities, especially when coming from tuberculosis-endemic countries. We report a clinical case characterized by lumbar and pelvic abscesses, before addressing in detail the different types of skeletal involvement related to tuberculosis, through a review of the literature.

La tuberculose ostéoarticulaire ou osseuse est une manifestation clinique de la tuberculose extra-pulmonaire, apparaissant lors de la dissémination lympho-hématogène de Mycobacterium tuberculosis à la suite d'une infection pulmonaire primaire ou la réactivation d'une infection latente, des années, voire des décennies après une primo-infection. Il s'agit d'une maladie rare dont les symptômes ainsi que les signes radiologiques sont non spécifiques, ce qui retarde souvent le diagnostic de plus d'un an après les premiers signes cliniques. Les services hospitaliers de première ligne doivent suspecter le diagnostic en cas de pathologie inflammatoire subaiguë des os ou des articulations chez des patients avec comorbidités, surtout s'ils sont originaires de régions endémiques pour la tuberculose. Nous rapporterons un cas clinique caractérisé par des abcès lombaires et pelviens avant d'aborder en détail les différents types d'atteintes squelettiques de la tuberculose au travers d'une revue de la littérature.

[Acute cytomegalovirus proctitis in a immunocompetent patient]. / Rectite aiguë à cytomégalovirus chez un patient immunocompétent.

Cases of CMV proctitis are frequently reported in immunocompromised patients. However, some cases of CMV proctitis are linked to a CMV primary infection and to unprotected anal intercourse in immunocompetent patients. The most common symptom is bloody diarrhea (hemorrhagic colitis). The endoscopic exam can present in distincts forms. The diagnostic is based on a set of clinical, biological, endoscopic and histological arguments. The prognosis of the disease is favorable. The treatment is supportive. A research on other sexually transmitted diseases must be conducted.

Des cas de rectite à cytomégalovirus (CMV) sont fréquemment rapportés chez des patients immunodéprimés. Cependant, certains cas de rectite à CMV sont associés à une primo-infection à CMV et des rapports anaux non protégés chez une personne immunocompétente. La diarrhée hémorragique est le symptôme le plus fréquent. La présentation endoscopique est variée. Le diagnostic repose sur un faisceau d'arguments cliniques, biologiques, endoscopiques et histologiques. Le pronostic de l'affection est favorable. Le traitement est simplement supportif. Une recherche d'autres maladies sexuellement transmissibles doit être réalisée.

A frontal mucocele caused by an immune reconstitution inflammatory syndrome in a patient with HIV infection.

We describe a 55-year-old bisexual Belgian man with a multi-drug resistant HIV infection who developed an Immune Reconstitution Inflammatory Syndrome (IRIS) presenting as a mucocele of the frontal sinus, one year after starting a new effective darunavir containing antiretroviral treatment regimen. His CD4+ lymphocyte count had increased from 3 cells/mm3 prior to the start of the latter treatment to 196 cells/mm3 just before he developed the IRIS phenomenon. IRIS is a paradoxical clinical deterioration during highly active antiretroviral treatment (HAART), due to an exaggerated immune-inflammatory reaction. With the increasing numbers of persons living with HIV infection and the increased use of HAART it is expected that in the future more otolaryngological manifestations of IRIS will be detected.

High hydrostatic pressure inactivation of vegetative microorganisms, aerobic and anaerobic spores in pork Marengo, a low acidic particulate food product.

To prolong the shelf-life of particulate food products, high pressure processing is one of the emerging technologies to be studied as an alternative to classical pasteurization and sterilization by heat. Pork Marengo (a low acidic, partially prepared stew of pieces pork, carrots and peas) was inoculated with several strains of sporulating and vegetative microorganisms. The microbial spoilage of the product was evaluated after a high pressure treatment of 400 MPa during 30 min at, respectively, 20 and 50 °C. Several Clostridium spp. and Bacillus spp. survived the treatment, and the Gram-positive cocci Enterococcus faecalis and Staphylococcus aureus were revealed to be more pressure resistant than Saccharomyces cerevisiae and the Gram-negative bacteria Pseudomonas fluorescens and Escherichia coli. The high pressure treatment at 20 °C demonstrated that high pressure processing (HPP) of neutral-pH foods cannot rely on pressure alone as a pasteurization/sterilization process. Another physical agent like heat is needed. High pressure treatment at 50 °C demonstrated that heat transfer limitations in particulate food products still can trouble their successful pasteurization/sterilization.

The contribution of health-care services to a sound and sustainable malaria-control policy.

HIV and AIDS, tuberculosis, and malaria, besides presenting a large mortality and morbidity burden in developing countries, are also responsible for poor economic development. In the past international agencies devoted resources and efforts to control malaria and other diseases without taking into account health-system performance and sustainability. Even assuming that the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM)--a recent international initiative--would provide the necessary funds, a poorly performing health-care system will not be able to use these funds optimally. Moreover, even if all interventions are cost-effective, their impact on mortality and morbidity will only be marginal if access to proper care is not guaranteed. It is the responsibility of scientists and health managers to highlight to donor agencies the importance of an accessible and well functioning health-care system at all levels for the control of specific diseases.

Ultrasound of the normal kidney: a sonographic, anatomic and histologic correlation.

Technical progress in sonographic equipment providing routinely high resolution images makes it appropriate that some criteria of normality have to be reviewed. In this paper normal sonographic images of the kidney are correlated with anatomy and histology. The effect of aging upon normal anatomical relations and histologic findings is analysed. Special attention is focussed on particular anatomical details as far as they can explain the particular topography or sonographic appearance of some pathologies.

Reduction of Bacillus subtilis, Bacillus stearothermophilus and Streptococcus faecalis in meat batters by temperature-high hydrostatic pressure pasteurization.

People have a growing preference for fresh, healthy, palatable and nutritious meals and drinks. However, as food deterioration is a constant threat along the entire food chain, food preservation remains as necessary now as in the past. High pressure processing is one of the emerging technologies being studied as an alternative to the classical pasteurization and sterilization treatments of food. Samples of fried minced pork meat were inoculated with strains of Streptococcus faecalis and with sporulating microorganisms like Bacillus subtilis and stearothermophilus. The samples were subjected to several combined temperature-high pressure treatments predicted by the mathematical model applied in Response Surface Methodology. Using the "Box-Behnken" concept, the number of tests for a whole area of pressure-temperature-time-combinations (pressure variation: 50-400 MPa, temperature variation 20-80°C, time variation 1-60 min) could be limited to 15. In the center point of the model, the experimental combination was performed in triple to estimate the experimental variance. All the tests were executed in a randomized order to exclude the disturbing effect of environmental factors. Microbial analysis revealed for each microorganism an important reduction in total plate count, demonstrating a superior pressure resistance of the sporulating microorganisms in comparison with the most pressure resistant vegetative species Streptococcus faecalis. The effect of the medium composition could be neglected, showing little protective effect of, e.g. the fat fraction as seen in heat preservation techniques.

A nephrotic syndrome of tropical origin: case report and short review of the aetiology.

We present a case of nephrotic syndrome in a 38-year-old man of Ivorian origin. In the search of the cause of his illness an infection with Plasmodium malariae (P. malariae) was diagnosed by serology and by microscopy of a Giemsa thin blood smear which revealed rare gametocytes of P. malariae. Proteinuria significantly diminished within three months after antimalarial treatment. Antibodies against Schistosoma were detected as well. Examination of kidney biopsy revealed a discrete mesangioproliferative glomerulonephritis. This case highlights that a thorough history-taking may be essential and that infectious diseases should be included in the differential diagnostic thinking process when a nephrotic syndrome is diagnosed.

Cutaneous metastatic tuberculous abcess in a patient with cervico-mediastinal lymphatic tuberculosis.

Metastatic tuberculous abcess or tuberculous gumma is a rare form of cutaneous tuberculosis resulting from haematogenous spread from a non-cutaneous tuberculous focus. A 26-year old patient of Pakistani origin presented at our clinic with an abcess on his right thigh that had slowly grown over a period of two months to a total size of 30 cm. Based on clinical findings, microbiology, CT thigh and CT chest, our patient was diagnosed with a tuberculous abcess and cervico-mediastinal tuberculous lymphadenitis. Antituberculosis drugs were initiated. Cutaneous tuberculosis should be included in the differential diagnosis of chronic cutaneous abcesses, especially in patients from tuberculosis endemic nations.

Inhaled corticosteroids in persons with HIV infection: not that harmless.

There is a growing group of HIV-seropositive patients at risk for chronic lung disease due to their life style and age. The interaction between certain antiretroviral drugs and corticosteroid inhalation therapy is potentially dangerous but often unrecognised. We present three cases from our HIV-clinic of whom two developed full blown Cushing's syndrome over a short period of time and one presented with asymptomatic hypocortisolaemia due to serious drug interactions between HIV-drugs and inhaled corticosteroids. General practitioners, HIV and chest physicians should all be aware of this potentially life-threatening interaction and the combination of those products should be avoided where possible.

Anaphylactic shock as a single presentation of Echinococcus cyst.

We describe the case of a 14-year-old boy of Turkish origin, presenting with anaphylactic shock after a minor abdominal trauma. Further investigations revealed a hepatic Echinococcal cyst without evidence of rupture. Anti-helminthic therapy was administered. Because of aggravating symptoms and recurrent anaphylaxis, surgical excision was performed. Intra-operative, a rupture into the biliary tree was seen. After surgery, the anaphylactic symptoms disappeared and the patient recovered. This case-report supports the fact that anaphylactic shock can be the only presentation of a hydatid cyst. Microscopic spillage can possibly be sufficient to cause major anaphylaxis.

Tetraploidy with hydrops fetalis, cystic nuchal hygroma and 90, XX karyotype.

In the present report we describe a mid-trimester Turner fetus with cystic nuchal hygroma, hydrops fetalis and 90, XX karyotype. This observation suggests that the development of a typical Turner syndrome in humans is apparently caused by a specific autosome/X chromosome ratio (44:1 in 45, X patients or 88:2 in the present fetus) rather than by an X-chromosome monosomy.

The tetraphocomelia-cleft palate syndrome in identical twins.

An identical pair of twins with the tetraphocomelia-cleft palate syndrome is presented. It is hypothesized that Roberts' syndrome and the pseudothalidomide syndrome, previously reported as separate entities, represent different manifestations of the same autosomal, recessively inherited malformation pattern.

A new lethal syndrome with cloudy corneae, diaphragmatic defects and distal limb deformities.

Two female sibs are reported with a possibly new lethal malformation pattern, the major anomalies of which are: coarse face with small eyes and cloudy corneae, cleft soft palate, hypoplasia and absence of lobulation of both lungs, diaphragmatic defects, digitalisation of thumbs and distal limb deformities.