Emergence of Ceftriaxone Resistance during a Case of Pneumococcal Meningitis with Fatal Evolution.

We report a case of a 62-year-old man treated for Streptococcus pneumoniae meningitis by ceftriaxone and dexamethasone. After neurological improvement, neurological degradation by vasculitis occurred, despite effective concentrations of ceftriaxone in the serum and cerebrospinal fluid (CSF). S. pneumoniae with increased MICs to third-generation-cephalosporins (3GC) was isolated from the ventricular fluid 10 days after the isolation of the first strain. Isolate analysis showed that a mutation in the penicillin-binding protein 2X (PBP2X) has occurred under treatment.

Clinical diagnostic and therapeutic aspects of 221 consecutive anorectal Chlamydia trachomatis and Neisseria gonorrhoeae sexually transmitted infections among men who have sex with men.

OBJECTIVES: Proctitis caused by Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are known as sexually transmitted infections (STI). This study describes their clinical, diagnostic and therapeutic aspects. METHODS: Between 01/2013-03/2015, all MSM consulting for proctitis at proctology Institute-Saint-Joseph's Hospital, Paris, were included. Demographic, past-medical history, STI status and medical treatment were collected. Detection of CT/NG was performed by Transcription-Mediated Amplification (TMA) and antimicrobial susceptibilities for Ng by agar diffusion method. RESULTS: On 441 rectal samples collected, 221 (50.1%) were positive: 109 Ct (49.3%), 70 Ng (31.7%), 42 positive for both etiologies (19%). Among Ng infections, no resistance was detected to azithromycin and ceftriaxone. However, 84 strains (43.2%) were resistant to fluoroquinolones. More than one episode was diagnosed for 10 (5.1%) and 12 (6.2%) patients with CT and NG infections respectively. Anal abscesses were found for 27 (13.9%) patients, and 14 (7.2%) of them underwent surgery for anal fistula. CONCLUSIONS: The prevalence of CT/NG anorectal infections described is high on symptomatic patients, and a significant level of abscess was reported. These results confirm the interest of the association of recommended antibiotics excluding quinolones. Prospective studies would be relevant on complicated forms of anorectal infections.

Long-term maintenance of channel distribution in a central pattern generator neuron by neuromodulatory inputs revealed by decentralization in organ culture.

Organotypic cultures of the lobster (Homarus gammarus) stomatogastric nervous system (STNS) were used to assess changes in membrane properties of neurons of the pyloric motor pattern-generating network in the long-term absence of neuromodulatory inputs to the stomatogastric ganglion (STG). Specifically, we investigated decentralization-induced changes in the distribution and density of the transient outward current, I(A), which is encoded within the STG by the shal gene and plays an important role in shaping rhythmic bursting of pyloric neurons. Using an antibody against lobster shal K(+) channels, we found shal immunoreactivity in the membranes of neuritic processes, but not somata, of STG neurons in 5 d cultured STNS with intact modulatory inputs. However, in 5 d decentralized STG, shal immunoreactivity was still seen in primary neurites but was likewise present in a subset of STG somata. Among the neurons displaying this altered shal localization was the pyloric dilator (PD) neuron, which remained rhythmically active in 5 d decentralized STG. Two-electrode voltage clamp was used to compare I(A) in synaptically isolated PD neurons in long-term decentralized STG and nondecentralized controls. Although the voltage dependence and kinetics of I(A) changed little with decentralization, the maximal conductance of I(A) in PD neurons increased by 43.4%. This increase was consistent with the decentralization-induced increase in shal protein expression, indicating an alteration in the density and distribution of functional A-channels. Our results suggest that, in addition to the short-term regulation of network function, modulatory inputs may also play a role, either directly or indirectly, in controlling channel number and distribution, thereby maintaining the biophysical character of neuronal targets on a long-term basis.

Combining laser scanning confocal microscopy and electron microscopy to determine sites of synaptic contact between two identified neurons.

Here we report a double labelling method for correlative confocal and electron microscopy (EM) which allows selective characterisation of structural relationships between two single identified neurons in the same preparation. Using the lobster stomatogastric nervous system, we labelled pairs of identified, synaptically-connected neurons by intracellular injection of Lucifer Yellow (LY) in one neuron and a mixture of Rhodamine (Rdh) and Horseradish Peroxidase (HRP) in its partner. First, whole-mounts of LY- and Rdh-stained neurons were visualized using laser scanning confocal microscopy (LSCM) in order to isolate neuropilar regions of possible synaptic contact. Second, after conventional treatment for electron microscopy (LY was revealed with immunogold and HRP with DAB), areas of close appositions were viewed in EM. This technique allowed us to determine all the regions of close contact between two cells, and then to use electron microscopy to determine the presence or absence of synaptic contact within each of these restricted areas. These techniques enabled us to show that there were few areas of apposition and that only an extremely small proportion of these areas was in fact regions of synaptic contact between the two labelled neurons.

Ambulatory care: France, Federal Republic of Germany, and United States.

This study describes the results of a comparison of ambulatory medical care data for France, the Federal Republic of Germany (FRG), and the United States of America (U.S.). Data for this comparison were derived from independent national sample surveys in ambulatory care systems of the three countries in 1981-83. The French data set resulted from a sample of physicians who had been asked to document all patient-physician contacts for a specified 3-day period during 1982-83. The FRG survey of patient-physician contacts was performed in the fourth quarter of 1981 and the first quarter of 1982. Sample physicians reported for a sample of patient-physician contacts during two consecutive weekdays, the reporting periods being spread across the two calendar quarters in a balanced fashion. Survey physicians had been drawn at random from almost all ambulatory care specialties. U.S. survey data were obtained through a random sample of physicians reporting for a sample of their patient-physician contacts for a whole week, with the reporting weeks being spread across the whole year of 1981. Because regular office hours generally do not take place on weekends, Sundays were excluded in the French survey; in the FRG survey Saturdays and Sundays were excluded as reporting days. Although the French and the U.S. study universes consisted of almost all physicians practicing ambulatory medical care in the respective countries, the FRG physicians were drawn from five regions of the country systematically selected to represent the Federal Republic of Germany with respect to demographic population characteristics and physician specialty distribution. The universes of physicians and patient-physician encounters of the three national studies varied according to the ambulatory medical care systems of the respective countries. Data sets for this international comparison were derived from the respective national studies by selecting personal patient-physician contacts (in the physician's office or in the patient's home--referred to as "encounters") with eight physician specialties (general practitioners, pediatricians, obstetricians/gynecologists, internists, psychiatrists/neurologists, dermatologists, ophthalmologists, and otorhinolaryngologists). Patient variables used in the international comparison are patient age, sex, visit status, reason for encounter, and disposition. Yearly rates of personal patient-physician encounters in ambulatory medical care were estimated. Crude and age-sex standardized rates were computed for selected patient and physician characteristics.