[Incidental finding aortitis: how to handle it?] / Découverte fortuite d'une aortite : quelle prise en charge ?

Aortitis may be an incidental finding at imaging. It refers to inflammation of the aortic wall and sometimes may be hard to differentiate with the periaortitis, inflammation of tissues around the vessel. Their clinical presentation is as varied as their etiologies. Appropriate early management is essential for improving patient prognosis, as the diagnostic approach remains challenging.

Une aortite, inflammation de la paroi de l'aorte, est parfois décrite à l'imagerie. Elle peut être confondue avec une périaortite, l'inflammation des tissus autour du vaisseau. La présentation clinique de ces deux atteintes est aussi diverse que leurs causes. Comme la prise en charge thérapeutique adéquate dépend de la maladie sous-jacente, un choix réfléchi d'examens paracliniques est essentiel pour améliorer le pronostic du patient.

[Clostridioides difficile infection: various therapeutic approaches]. / Infection à Clostridioides difficile : approches thérapeutiques diverses.

In 2021, the European and American Infectious Diseases Societies published new guidelines for the treatment of Clostridiodes difficile colitis. They have opted for a change in practice with fidaxomicin being recommended as the first line of treatment, and vancomycin as a second choice. Metronidazole remains recommended only in cases where other treatments are not available. These choices have not been endorsed by the Swiss Infectious Diseases Society, which still proposes metronidazole as first-line treatment. As a matter of fact, this inexpensive treatment still presents a satisfactory efficacy on the strains of Clostridoides difficile found in Switzerland in the context of patients without risk factors and with low probability of relapse.

En 2021, les sociétés d'infectiologie européenne et américaine ont publié des guidelines relatives au traitement des colites à Clostridioides difficile. Elles ont opté pour un changement des pratiques avec la recommandation en première ligne de la fidaxomicine, la vancomycine devenant un deuxième choix. Le métronidazole est préconisé uniquement dans les cas où les autres traitements ne seraient pas disponibles. Ces choix n'ont pas été repris par la Société suisse d'infectiologie, qui propose toujours le métronidazole en première intention. En effet, ce traitement peu coûteux présente encore une efficacité satisfaisante sur les souches retrouvées en Suisse dans le cadre des colites à Clostridioides difficile sans facteurs de risque et à faible probabilité de rechute.

[Hantavirus infections]. / Infections à hantavirus.

Hantaviruses are enveloped zoonotic RNA viruses hosted by rodents and responsible in the Americas for hantavirus pulmonary syndrome. In Europe, they cause hemorrhagic fever with renal syndrome and its milder form, nephropathia epidemica. The disease begins abruptly with high fever, chills, headache, back pain and abdominal pain associated with nausea and vomiting. Diagnosis is primarily made by serology. There is currently no specific medication or preventive available in Europe. Treatment is symptomatic.

Les hantavirus sont des virus zoonotiques à ARN enveloppés hébergés principalement par des rongeurs et responsables, aux Amériques, du syndrome pulmonaire à hantavirus. En Europe, ils provoquent la fièvre hémorragique avec syndrome rénal et sa forme plus légère appelée néphropathie épidémique. La maladie se présente de manière aiguë avec une forte fièvre, des frissons, des céphalées, des dorsalgies ainsi que des douleurs abdominales associées à des nausées et vomissements. Le diagnostic se fait principalement par sérologie. Il n'existe actuellement pas de médication spécifique, ni de vaccination disponible en Europe. Le traitement repose sur un soutien symptomatique.

[Methicillin-resistant Staphylococcus aureus: 15 years of molecular epidemiology in Western Switzerland]. / Staphylococcus aureus résistant à la méticilline : 15 ans de surveillance moléculaire en Suisse romande.

Since the introduction of antibiotics, successive waves of Staphylococcus aureus clones occurred, each one having characteristic susceptibility pattern to antibiotics and virulence factors. We report here the results of a molecular epidemiological surveillance of methicillin-resistant S. aureus (MRSA) in French-speaking Switzerland between 2006 and 2020 showing the emergence and disappearance of clones known for their international dissemination, and the sporadic appearance of other international clones. Since 2012, a marked decrease in the incidence of cases attributable to the biology of the clones and to the control measures taken in the hospitals has been observed. These results highlight the importance of continuous surveillance in order to better assess the burden of this multi-resistant pathogen in our region.

Depuis l'introduction des antibiotiques, des vagues successives de clones de Staphylococcus aureus sont apparues, chacun avec un profil de susceptibilité aux antibiotiques et de virulence caractéristique. Nous rapportons ici les résultats d'une surveillance épidémiologique moléculaire de S. aureus résistant à la méticilline (MRSA) en Suisse romande entre 2006 et 2020 montrant l'émergence et la disparition de clones connus pour leur dissémination internationale, ainsi que l'apparition sporadique d'autres clones internationaux. Depuis 2012, une diminution marquée de l'incidence des cas attribuable à la biologie des clones et aux mesures de contrôle prises dans les hôpitaux est observée. Ces résultats nous montrent l'importance d'une surveillance continue afin de mieux évaluer le fardeau que représente ce germe multirésistant dans notre région.

[Actinomycosis]. / Actinomycose.

Actinomycosis is a chronic bacterial infection, caused by the genus Actinomyces, commensal of the digestive and genital tract. The most common presentation of the disease affects the cervicofacial region, but other anatomical sites in the abdomen, thorax and central nervous system may be involved. Differential diagnosis includes neoplasia. Prolonged culture of deep samples in an anaerobic environment is the gold standard of the diagnosis. The treatment of choice is intravenous penicillin G followed by oral amoxicillin for a total duration of 6 to 12 months. However, depending on the location and response to antibiotics, shorter therapy may be considered.

L'actinomycose est une infection bactérienne chronique, causée par le genre Actinomyces, commensal des tractus digestif et génital. La forme la plus fréquente de la maladie touche la région cervico-faciale, mais d'autres sites anatomiques dans l'abdomen, le thorax et le système nerveux central peuvent être concernés. Le diagnostic différentiel se fait souvent avec une néoplasie. La mise en culture prolongée de prélèvements profonds en milieu anaérobe est le gold standard du diagnostic. Le traitement de choix est la pénicilline G intraveineuse, suivi d'un relais per os par amoxicilline, pour une durée totale de 6 à 12 mois. Cependant, selon la localisation et la réponse aux antibiotiques, une thérapie plus courte peut être envisagée.

[Vertebral osteomyelitis in adults]. / Spondylodiscite chez l'adulte.

Back pain is a frequent reason for consultation. Although commonplace most of the time, back pain can sometimes be the only symptom of vertebral osteomyelitis, an infection that usually affects an intervertebral disc and the two adjacent vertebrae. Microbiology varies with the host's risk factors and local epidemiology. MRI is the preferred radiologic modality. Nevertheless, the definitive diagnosis is based on microbiological and histopathological elements. Antibiotic therapy alone may in some cases lead to cure, while in other cases the use of surgery is necessary. If it isn't diagnosed in time, vertebral osteomyelitis can have serious consequences. Thus, the physician must be familiar with the anamnestic, clinical and paraclinical elements that will bring him to actively look for this disease.

Les maux de dos sont un motif de consultation fréquent. Bien que souvent banals, ils peuvent parfois être le seul symptôme d'une spondylodiscite, une infection qui touche généralement un disque intervertébral et les deux vertèbres adjacentes. La microbiologie varie en fonction des facteurs de risque de l'hôte et de l'épidémiologie locale. L'IRM est la modalité radiologique de choix. Néanmoins, le diagnostic définitif repose sur des éléments microbiologiques et histopathologiques. Une antibiothérapie seule peut dans certains cas mener à la guérison, tandis que dans d'autres cas la chirurgie est nécessaire. Lorsqu'elle n'est pas diagnostiquée à temps, la spondylodiscite peut être lourde de conséquences. Le médecin doit ainsi connaître les éléments anamnestiques, cliniques et paracliniques devant le faire rechercher activement cette maladie.

[Legionellosis]. / Légionellose.

Legionellosis refers to the two clinical syndromes caused by Legionella : Pontiac fever, a benign febrile illness and Legionnaires'disease (or pneumonia). Clinically and radiologically, Legionnaires'disease presents itself as a « typical ¼ pneumonia caused by Streptococcus pneumonia. Diagnosis is usually made by using urinary antigen testing. Culture and PCR are also helpful. Legionella is resistant to betalactam antibiotics, and is treated by quinolones or macrolides.

La légionellose regroupe deux entités cliniques : la fièvre de Pontiac, une maladie fébrile bénigne, et la pneumonie à Legionella ou maladie du légionnaire. Sur les plans clinique et radiologique, la pneumonie à Legionella se présente le plus souvent comme une pneumonie « typique ¼ à pneumocoque. Son diagnostic repose généralement sur la mise en évidence d'un antigène de la bactérie dans les urines ; la culture et la PCR sont également des examens utiles. La légionelle est un germe résistant aux bêtalactamines et nécessite un traitement par quinolones ou macrolides.

[Listeria monocytogenes infections]. / Infections à Listeria monocytogenes.

Listeria monocytogenes infections are caused by food ingestion. They are not only transmitted by animal products, but also by secondarily contaminated fruits and vegetables. They preferentially affect pregnant women, patients of extreme ages and the immu-nocompromised, and manifest as a gastroenteritis, bacteremia, meningo-encephalitis or maternal-fetal infection. Diagnosis is achieved by culture of usually sterile sites. The preferred treatment is amoxicillin with or without gentamicin. For patients at risk, prevention is based on avoiding at-risk food or cooking it when possible.

Les infections à Listeria monocytogenes sont d'origine alimentaire, transmises non seulement par les produits animaux mais aussi par des fruits et légumes secondairement contaminés. Elles affectent préférentiellement les femmes enceintes, les patients d'âges extrêmes et les patients immunosupprimés et se manifestent généralement sous forme de gastroentérite, bactériémie, méningo-encéphalite ou infection materno-fœtale. Le diagnostic se pose par la culture de tissus normalement stériles. Le traitement de choix est l'amoxicilline complétée ou non de gentamicine. Chez les patients à risque, la prévention passe par l'éviction des aliments à risque ou la cuisson de ceux-ci lorsqu'elle est possible.

[One year of infectious diseases : a review]. / Une année d'infectiologie en revue.

Several outbreaks have made the news in 2016 : Ebola has come at an end, Zika is booming and a resurgence of yellow fever takes place in Africa. In Switzerland, two hospital outbreaks have been reported, caused by Mycobacterium chimerae and Burkholderia cepacia. A major new article has consolidated the notion that prolonged antibiotic therapy is unnecessary in Lyme disease. As multiresistant bacteria are increasing in frequency, innovative therapeutic approaches are under development. For lung infections, sensitive and specific methods are in need to refine their etiological diagnosis. In pneumonia, therapy can be shortened without risk compared with usual practice. Finally, the epidemiology of bacterial meningitis has changed in the last 10 years, with a decrease of incidence.

Plusieurs épidémies ont fait l'actualité en 2016 : celle d'Ebola qui est arrivée à son terme, celle de Zika qui est en pleine expansion et une résurgence de la fièvre jaune sur le continent africain. En Suisse, deux épidémies hospitalières ont été rapportées, dues aux bactéries Mycobacterium chimerae et Burkholderia cepacia. Un nouvel article majeur a consolidé la notion que l'antibiothérapie prolongée est inutile dans la maladie de Lyme. Les bactéries multirésistantes augmentent en fréquence ; des approches thérapeutiques innovatrices sont en développement. Pour les infections pulmonaires, on est toujours à la recherche de méthodes sensibles et spécifiques pour affiner le diagnostic étiologique. Dans la pneumonie, la durée du traitement peut être raccourcie sans risque par rapport à ce qui se fait usuellement. Enfin, l'épidémiologie des méningites bactériennes a beaucoup changé ces 10 dernières années, avec une diminution de l'incidence de cette maladie.

Optimal culture incubation time in orthopedic device-associated infections: a retrospective analysis of prolonged 14-day incubation.

Accurate diagnosis of orthopedic device-associated infections can be challenging. Culture of tissue biopsy specimens is often considered the gold standard; however, there is currently no consensus on the ideal incubation time for specimens. The aim of our study was to assess the yield of a 14-day incubation protocol for tissue biopsy specimens from revision surgery (joint replacements and internal fixation devices) in a general orthopedic and trauma surgery setting. Medical records were reviewed retrospectively in order to identify cases of infection according to predefined diagnostic criteria. From August 2009 to March 2012, 499 tissue biopsy specimens were sampled from 117 cases. In 70 cases (59.8%), at least one sample showed microbiological growth. Among them, 58 cases (82.9%) were considered infections and 12 cases (17.1%) were classified as contaminations. The median time to positivity in the cases of infection was 1 day (range, 1 to 10 days), compared to 6 days (range, 1 to 11 days) in the cases of contamination (P < 0.001). Fifty-six (96.6%) of the infection cases were diagnosed within 7 days of incubation. In conclusion, the results of our study show that the incubation of tissue biopsy specimens beyond 7 days is not productive in a general orthopedic and trauma surgery setting. Prolonged 14-day incubation might be of interest in particular situations, however, in which the prevalence of slow-growing microorganisms and anaerobes is higher.

Identification of Francisella tularensis in ascites in the context of typhoidal tularaemia.

Tularaemia is a highly infectious, zoonotic disease caused by Francisella tularensis, which has become increasingly prevalent over the past decade. Depending on the route of infection, different clinical manifestations can be observed. We report a case of typhoidal tularaemia presenting as a febrile illness with gastrointestinal symptoms in a patient in her mid-80s. During the acute illness phase and in the context of alcohol-related liver cirrhosis, the patient developed progressive ascites. During paracentesis, spontaneous bacterial peritonitis was consistently reported. Blood culture revealed Gram-negative bacilli identified as F. tularensis upon microscopic examination. Immediate clinical improvement was observed after adaptation to a pathogen-specific antibiotic regime. Typhoidal tularaemia presents general, non-specific symptoms without the local manifestations seen in other forms of the disease, thus representing a diagnostic challenge. In the case of protracted fever and if the epidemiological context as well as possible exposure are compatible, tularaemia should be considered in the differential diagnosis.

[Nontuberculous mycobacterial lung infections]. / Infections pulmonaires dues aux mycobactéries non tuberculeuses.

Diagnosis of nontuberculous mycobacterial infection, which most often cause pulmonary disease, are increasing. Only a few of the numerous mycobacteria species are clearly pathogenic. Patients, either immunocompetent or immunocompromised, with orwithout underlying disease, are contaminated from the environment. Diagnosis, according to standardized criteria, is based on clinical picture, radiological exams and positive microbiological samples, usually on more than one occasion (slow growing culture and PCR). There are several typical presentations, such as tuberculosis-like disease and lung nodules associated with bronchiectasis. Treatment combines several antimicrobials, is long (occasionally more than one year) and is not always successful.

[Infections related to water activities]. / Infections liées aux activités aquatiques.

Infections acquired by exposure to water are common. The evolution of these infections found in our region is benign. However, some acquired in our regions or during travel abroad, may have a severe clinical course that requires early diagnosis. This article proposes a non-exhaustive review of the most common infections encountered in our regions or acquired abroad. The review excludes gastrointestinal infections acquired after ingestion of contaminated water.

Characteristics, comorbidities, 30-day outcome and in-hospital mortality of patients hospitalised with COVID-19 in a Swiss area - a retrospective cohort study.

BACKGROUND: Since its first description in December 2019, coronavirus disease 19 (COVID-19) has spread worldwide. There is limited information about presenting characteristics and outcomes of Swiss patients requiring hospitalisation. Furthermore, outcomes 30 days after onset of symptoms and after hospital discharge have not been described. AIMS: To describe the clinical characteristics, outcomes 30 days after onset of symptoms and in-hospital mortality of a cohort of patients hospitalised for COVID-19 in a Swiss area. METHODS: In this retrospective cohort study, we included all inpatients hospitalised with microbiologically confirmed COVID-19 between 1 March and 12 April 2020 in the public hospital network of a Swiss area (Fribourg). Demographic data, comorbidities and outcomes were recorded. Rate of potential hospital-acquired infection, outcomes 30 days after onset of symptoms and in-hospital mortality are reported. RESULTS: One hundred ninety-six patients were included in the study. In our population, 119 (61%) were male and the median age was 70 years. Forty-nine patients (25%) were admitted to the intensive care unit (ICU). The rate of potential hospital-acquired infection was 7%. Overall, 30 days after onset of symptoms 117 patients (60%) had returned home, 23 patients (12%) were in a rehabilitation facility, 18 patients (9%) in a medical ward, 6 patients (3%) in ICU and 32 (16%) patients had died. Among patients who returned home within 30 days, 73 patients (63%) reported persistent symptoms. The overall in-hospital mortality was 17%. CONCLUSION: We report the first cohort of Swiss patients hospitalised with COVID-19. Thirty days after onset of the symptoms, 60% had returned home. Among them, 63% still presented symptoms. Studies with longer follow-up are needed to document long-term outcomes in patients hospitalised with COVID-19.

[Pediculosis]. / Les pédiculoses.

Head pediculosis is a benign and common disease, particularly in children. It is usually asymptomatic and a definite diagnosis is not always easy. When a case is discovered, overdiagnosis and unwarranted therapies may be a consequence of patient follow-up and contact investigation. As a general rule, topical pediculicides--mainly permethrin and malathion--give good results despite the emergence of resistance in some countries. Pediculosis of the body affects populations with very poor sanitation conditions; simple hygiene measures are the cornerstone of therapy. Phtirius pubis is sexually transmitted, easily diagnosed and treated with topical pediculicides.

[Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA)--a new challenge in the ambulatory setting?]. / Staphylocoques dorés résistant à la méthicilline acquis dans la communauté: un nouveau défi en médecine ambulatoire?

In the last decade, community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) have emerged in young, individuals without risk factors for MRSA acquisition. They mainly present with skin and soft tissue infections. CA-MRSA are genotypically and phenotypically differents from HA-MRSA. In case of recurrent or severe soft tissue infections, search for CA-MRSA should be performed. Treatment consists of incision and drainage of abscesses and furuncles. If antibiotics are needed, trimethoprim-sulfamethoxazole is the first choice. A specialist in infection control is advised for contact screening implementation of hygienic precautions and decolonization therapy.

[Quality in microbiology: contribution of the physician]. / Microbiologie de qualité: la contribution du médecin praticien.

It is not always easy to choose the right microbiology test to order. Which pathogens to look for? What is the best-fitted method: microscopy, culture, tests for antigens, antibodies, genes or toxins? How to sample and transport the specimen? This article brings some answers to the questions the physician often asks when prescribing microbiology exams on stools, deep respiratory tract secretions, blood and wounds. By selecting the appropriate tests and respecting the guidelines for sampling and transporting specimens, the physician greatly contributes to the quality of results.