Utility of anaerobic bottles for the diagnosis of bloodstream infections.

BACKGROUND: Obligate anaerobes usually account for less than 10% of bacteria recovered from blood cultures (BC). The relevance of routine use of the anaerobic bottle is under debate. The aim of this study was to evaluate the utility of anaerobic bottles for the diagnosis of bloodstream infections (BSI). METHODS: We conducted a 6-month, retrospective, monocentric study in a tertiary hospital. All positive BC were grouped into a single episode of bacteremia when drawn within 7 consecutive days. Bacteremia were classified into contaminants and BSI. Charts of patients with BSI due to obligate anaerobes were studied. RESULTS: A total of 19,739 blood cultures were collected, 2341 of which (11.9%) were positive. Anaerobic bottles were positive in 1528 (65.3%) of all positive BC but were positive alone (aerobic bottles negative) in 369 (15.8%). Overall 1081 episodes of bacteremia were identified, of which 209 (19.3%) had positive anaerobic bottles alone. The majority 126/209 (60.3%) were contaminants and 83 (39.7%) were BSI. BSI due to facultative anaerobes, obligate aerobes and obligate anaerobes were identified in 67 (80.7%), 3 (3.6%) and 13 (15.7%) of these 83 episodes, respectively. BSI due to obligate anaerobic bacteria were reported in 9 patients with gastro-intestinal disease, in 3 with febrile neutropenia and in 1 burned patient. CONCLUSIONS: Anaerobic bottles contributed to the diagnosis of a significant number of episodes of bacteremia. Isolated bacteria were mostly contaminants and non-obligate anaerobic pathogens. Rare BSI due to obligate anaerobes were reported mainly in patients with gastro-intestinal disorders and during febrile neutropenia.

Prognosis of autoimmune hemolytic anemia in critically ill patients.

Patients with autoimmune hemolytic anemia (AIHA) may require intensive care unit (ICU) admission. In order to describe the characteristics of AIHA patients in ICU and identify prognosis factors, clinical and biological data from 44 patients admitted in one ICU between 2002 and 2015 were retrospectively analyzed. The main reasons for ICU admission were profound anemia without any organ failure in 19 patients (either for safer transfusion or continuous monitoring only). Twenty-five (57%) patients had a past history of hemopathy. Twenty patients presented with a direct anti-globulin test (DAT) positive for immunoglobulin G (DAT-IgG) only (46%), 8 with a DAT positive for both IgG and complement (DAT-IgG+C) (36%), and 16 with a DAT positive for complement only (DAT-IgG+C) (18%). Corticosteroids and rituximab were administered to respectively 44 (100%) and 12 (25%) patients. Red blood cell transfusion was required in 28 (64%) patients. Ten (23%) patients received vasopressors. Renal replacement therapy was necessary in 14 (31.8%) patients. Thirteen (30%) patients died in the ICU. There was no difference between survivors and non-survivors regarding associated comorbidities like hemopathy (18/31 [58%] vs. 7/13 [54%], p = 0.80). In decedents, age was higher (72 years [57.8-76.3] vs. 50 years [34.3-64], p < 0.01) and organ dysfunctions were more severe at day 1 (SOFA 8 [7-11] vs. 5.5 [3-7], p < 0.01). Patients with a DAT-IgG displayed poorer outcome in comparison with patients with DAT-IgG+C/C (hospital mortality 69% vs. 36%, p = 0.04). Mortality rate of AIHA patients requiring ICU admission is consequential and appears to be impacted by age, organ failures, and DAT-IgG.

Scientific response to the 2021 eruption of Nyiragongo based on the implementation of a participatory monitoring system.

The development of a resilient society is a major challenge for growing human population faced with abundant natural hazards. During and after the May 22, 2021 eruption of Nyiragongo, the local population was surprised and scared by the subsequent seismicity and associated surface fracturing, coupled with the alert of a possible new eruptive vent opening in Goma (Democratic Republic of Congo) and/or Gisenyi (Rwanda). The creation of a toll-free phone number enabled the population to record fractures and gas/thermal anomalies affecting the area. Such work was fundamental in enabling scientists and authorities to assess the associated risks. Crucially, gas data showed that the degassing through fractures did not represent direct transfer of magmatic volatiles but was more likely of superficial origin. Surprisingly, this participatory work revealed that the first fractures appeared several weeks before the eruption and their opening was not detected by the monitoring system. This firmly underlines the need for scientists to anchor citizen science in monitoring strategies.

Magma pressure discharge induces very long period seismicity.

Volcano seismicity is one of the key parameters to understand magma dynamics of erupting volcanoes. However, the physical process at the origin of the resulting complex and broadband seismic signals remains unclear. Syn-eruptive very long period (VLP) seismic signals have been explained in terms of the sudden expansion of gas pockets rising in the liquid melt. Their origin is linked to a magma dynamics which triggers the explosive process occurring before the explosive onset. We provide evidence based on acoustic, thermal, and ground deformation data to demonstrate that VLP signals at Stromboli are generated at the top of the magma column mainly after the explosion onset. We show that VLP amplitude and duration scale with the eruptive flux which induces a decompression of 103-104 Pa involving the uppermost ~ 250 m of the feeding conduit. The seismic VLP source represents the final stage of a ~ 200 s long charge and discharge mechanism the magma column has to release excess gas accumulated at the base of a denser and degassed magma mush. The position of the VLP seismic source coincides with the centroid of the shallow mush plug and tracks elevation changes of the magma free surface.

[DRESS syndrome caused by phenylbutazone]. / DRESS syndrome à la phénylbutazone.

The drug rash with hypereosinophilia and systemic symptoms (DRESS) syndrome is a severe drug-induced hypersensitivity syndrome. We report a 57-year-old woman suffering from a DRESS syndrome 15 days after phenylbutazone exposure. She had a skin eruption, liver involvement and hypereosinophilia. She fully recovered after drug withdrawal.

Severe atypical pneumonia in critically ill patients: a retrospective multicenter study.

BACKGROUND: Chlamydophila pneumoniae (CP) and Mycoplasma pneumoniae (MP) patients could require intensive care unit (ICU) admission for acute respiratory failure. METHODS: Adults admitted between 2000 and 2015 to 20 French ICUs with proven atypical pneumonia were retrospectively described. Patients with MP were compared to Streptococcus pneumoniae (SP) pneumonia patients admitted to ICUs. RESULTS: A total of 104 patients were included, 71 men and 33 women, with a median age of 56 [44-67] years. MP was the causative agent for 76 (73%) patients and CP for 28 (27%) patients. Co-infection was documented for 18 patients (viruses for 8 [47%] patients). Median number of involved quadrants on chest X-ray was 2 [1-4], with alveolar opacities (n = 61, 75%), interstitial opacities (n = 32, 40%). Extra-pulmonary manifestations were present in 34 (33%) patients. Mechanical ventilation was required for 75 (72%) patients and vasopressors for 41 (39%) patients. ICU length of stay was 16.5 [9.5-30.5] days, and 11 (11%) patients died in the ICU. Compared with SP patients, MP patients had more extensive interstitial pneumonia, fewer pleural effusion, and a lower mortality rate [6 (8%) vs. 17 (22%), p = 0.013]. According MCA analysis, some characteristics at admission could discriminate MP and SP. MP was more often associated with hemolytic anemia, abdominal manifestations, and extensive chest radiograph abnormalities. SP-P was associated with shock, confusion, focal crackles, and focal consolidation. CONCLUSION: In this descriptive study of atypical bacterial pneumonia requiring ICU admission, mortality was 11%. The comparison with SP pneumonia identified clinical, laboratory, and radiographic features that may suggest MP or CP pneumonia.

Life-threatening complications and outcomes in patients with malignancies and severe pulmonary embolism.

BACKGROUND: Data are scarce about ICU patients with malignancy and severe pulmonary embolism. Here, our main objective was to identify risk factors for life-threatening complications, organ failures, and death in ICU patients with severe pulmonary embolism, with special attention to the impact of malignancy. We also described the clinical features of PE in patients with and without malignancies. METHODS: Data from consecutive adults admitted to our ICU in 2002-2011 with severe pulmonary embolism were collected retrospectively. Multivariate analysis was performed to look for factors associated with death, organ failures, or life-threatening complications (major bleeding, recurrent PE, and cardiac arrest). RESULTS: Of 119 included patients (42 [35%] with bilateral pulmonary embolism), 41 had solid malignancies, 27 hematological malignancies, and 51 no malignancies. The most common symptoms were syncope (40%) and hemoptysis (18%) in patients with solid and hematological malignancies, respectively. Life-threatening complications occurred in 23 (19%) patients; risk factors were obesity (OR, 13.22; 1.93-90.70), disseminated intravascular coagulation/ischemic hepatitis (OR, 27.06; 5.14-142.46), fluid load ≥1000 mL/24 h (OR, 6.42; 1.60-25.76), and solid malignancy (OR, 5.45; 1.15-25.89). Inhospital mortality was 27/119 (23%) and respiratory or circulatory failure developed in 36 (30%) patients. Risk factors for these adverse outcomes were older age (OR, 1.04/year; 1.01-1.07), higher oxygen flow rate (OR, 1.28/L; 1.13-1.45); and renal failure (OR, 8.08; 2.50-26.11); whereas chest pain was protective (OR, 0.13; 0.04-0.48). CONCLUSION: In this study, solid malignancy was a risk factor for life-threatening complications but not for death.

[So-called small cell anaplastic carcinoma of the bronchi: optic and ultrastructure microscopy]. / Le carcinome anaplasique dit "a petites cellules" des bronches: microscopie optique et ultrastructure.

The bronchogenic small cell carcinoma has histological characteristics. They concern the nucleus, the cytoplasm and the cytoplasmic membrane. An ultrastructural study reveals a great diversity in aspect and cellular components.

[Pulmonary lesions following bone marrow graft. Study of 35 cases]. / Lésions pulmonaires après greffe de moelle osseuse. Etude de 35 cas.

Lung biopsy of 35 patients with interstitial pneumonitis following bone marrow transplantation (BMT) have been studied histologically, ultrastructurally and by immunofluorescence. Among infectious diseases, cytomegaloviruses (CMV) are the more frequently found, whereas Pneumocystis carinii infections are more frequently found in immunocompromised hosts without BMT. CMV infections are related to severe chronic graft-versus-host disease in allogenic or mismatched BMT. Hemorrhagic pulmonary oedema and vascular damage might be the consequence of high doses of cyclosporin A or of disseminated intravascular coagulation. Granulomatous and fibrosing lesions corresponded in 2 cases to an eosinophilic pneumonitis and in 11 cases to an "idiopathic" diffuse interstitial pneumonitis. 2 patients had concomitant diffuse lung fibrosis, sclerotic plaques of the skin and Sjögren-like syndrome. The pulmonary and cutaneous scleroses had common features in the types of collagen and in the composition of the infiltrate. Both fibroses might result from a common pathogenic mechanism related to an immunologic conflict between the lymphocytes of the graft and the cells from the host tissues.

[Radiologic aspects of acute invasive pulmonary aspergillosis in 18 immunodepressed patients]. / Aspects radiologiques de l'aspergillose pulmonaire aiguë invasive chez 18 malades immuno-déprimés.

A retrospective study of 18 immunodepressed patients with acute invasive pulmonary aspergillosis enabled the radiologic picture of this increasingly frequent opportunist affection to be described, and different manifestations of the disease as a function of underlying conditions to be determined. Two groups could be distinguished: the first of patients with malignant blood diseases (n = 10) when the "aplasia" factor was dominant; the second of patients without blood diseases (n = 8) when the immunodepression was usually induced by a recent increase in corticoid therapy. Neutropenia was not a finding in any of these patients. The most frequent radiologic finding was single or multiple round excavating foci, these corresponding to zones of bronchopneumonia containing aspergillus filaments with central tissue necrosis forming the "target" lesion. The aplasia was distinguished by the multiplicity of lesions and their excavation following aplasia in the shape of a crescent due to sequestrum formation. Prognosis was related to severity of subjacent lesions. In the 2nd group, lesions could be single and nodular; prognosis was improved by the possibility of reducing immunodepression factors.

[Distal lesions of the Fallopian tubes. Prognostic values of peroperative tubal biopsy]. / Lésions tubaires distales. Intérêt pronostique de la biopsie tubaire per-opératoire.

78 biopsies were carried out during 63 distal tubal microsurgical operations, followed up for two years at least. The clinical outcome was studied according to the pathological state of the better tube: Viable pregnancies become more frequent with subnormal tubes (40%) and with tubes with moderate chronic salpingitis (65%). The risk of extra-uterine pregnancy is at a maximum with chronic cicatricial salpingitis (29.4%). Progressive chronic salpingitis results in only 6.6% viable pregnancies and will definitely constitute an indication for in vitro fertilization rather than microsurgery.

[Ciliated epithelium of the Fallopian tube in women. An ultrastructural study (author's transl)]. / Epithélium cilié de la trompe de Fallope chez la femme. Etude ultrastructurale.

The steps in the ultrastructural changes that occur in new cilia formation in tubal epithelium have been well demonstrated in animals. In women, it is difficult to show cilia growing again and some authors deny that new growth occurs. Transmission electron microscopy studies on 32 specimens have shown that human new growth of cilia does occur. It arises in the midst of a cellular population which has as its characteristic a cytoplasm that is more clear than those of the neighbouring cells. Different ultrastructural aspects can be described. They resemble those that have been demonstrated in different animal species. On the other hand no mitoses have been shown. We will study the correlations between plasma hormone levels, the numbers of tissue receptors and the appearance of these clear cells in another article.

[Late bone metastases of a pheochromocytoma]. / Métastases osseuses tardives d'un phéochromocytome.

Pheochromocytoma is a usually benign tumor of chromaffin tissue (90% of cases). We report a 77-year-old patient with a past medical history of surgically removed pheochromocytoma that was considered to be "benign", who presented with secondary bone metastases 5 years later. A treatment combining radiation and interferon allowed to control the metastatic lesions. The possibility of late metastatic extension in patients with pheochromocytoma should be kept in mind.

[Intra-alveolar hemorrhage in immunodeficient patients]. / Les hémorragies intra-alvéolaires chez les immuno-déprimés.

Occurrence of intra-alveolar hemorrhage (whose theoretical causes are briefly reviewed) in an immunocompromised host raises a number of practical problems, mainly related to the interpretation of bronchoalveolar lavage (BAL) studies undertaken to identify one or more etiologies. An open lung biopsy is often needed in addition to the BAL. Three main nosological groups may be proposed: the acquired immunodeficiency syndrome, in which alveolar hemorrhage is more often caused by a Kaposi sarcoma than by a viral infection often combined with opportunistic diseases; aplasias, in which intra-alveolar hemorrhage may be caused not only by the thrombocytopenia but also by infectious or mycotic diseases; connective tissue diseases and vasculites, mainly systemic lupus erythematosus, that may cause vascular lesions of the lungs. Pathogenesis is still unelucidated, but a combination of alveolocapillary basement membrane lesions and diffuse alveolar damage may be involved.

[Carcinoid tumors of the rectum. Apropos of 2 cases with metastases]. / Tumeurs carcinoïdes du rectum. A propos de deux cas avec métastases.

We are reporting two cases of carcinoid tumors of the rectum treated surgically. In both cases, there were nodes metastases and in one case liver metastases without carcinoid syndrome. Carcinoid tumors of the rectum are rare and usually asymptomatic; metastases are essentially located in the lymph nodes and the liver.

[Pulmonary emphysema, hepatic lesions, and insulin-dependent diabetes in a patient with alpha-1-antitrypsin (Pi ZZ) deficiency (author's transl)]. / Emphysème pulmonaire, atteinte hépatique, diabète insulinodépendant chez un sujet déficitaire en alpha-1-antitrypsine (Pi ZZ).

A 47-year-old patient with panlobular emphysema and insulin-dependent diabetes had an alpha-1-antitrypsin phenotype Pi ZZ deficiency. Liver function tests were abnormal, and postmortem examination of the liver demonstrated abnormal intrahepatocytic globules of A1AT (a typical finding when the allele Z is present), but also fibrosis with steatosis. The patient's sister, Pi ZZ, had neither diabetes nor bronchopneumopathy, and no anomalies in liver function. Needle puncture biopsy of the liver had not been conducted. The phenotype Pi ZZ is typically associated with panlobular emphysema in adults, and cholestatic hepatitis in children. From reports in the published literature, it appears that isolated hepatic lesions or those associated with emphysema are rare. The fortuitous association of diabetes and hepatic lesions in this typical case of pulmonary affection in an adult is discussed.

Immunohistological localization of immunoglobulins in pneumocystosis of adults.

We examined by direct immunofluorescence open lung biopsies from seven adult patients with Pneumocystis carinii pneumonia. In all of them, immunoglobulin deposits (especially IgA) were found in alveoli that exhibited by light microscopy the classical foamy exudate infested by Pneumocystis. These immunoglobulins were eluted at an acid pH and were able to fix complement fractions in vitro. Moreover, we could reproduce this fixation by incubating previously eluted tissue sections with concentrated immunoglobulins isolated from a bronchopulmonary lavage performed in another case of pneumocystis. This immunohistological pattern suggests the presence of a humoral response in pulmonary parenchyma of patients infected with Pneumocystis carinii, despite the consistent underlying immunocompromised status. Considering these results, we conclude that humoral immune mechanisms do not constitute the main barrier against the development of Pneumocystis carinii in human lungs.