[Staphylococcus aureus meningitis with intermediate sensitivity to glycopeptides. Therapeutic indications]. / Méningite à Staphylococcus aureus de sensibilité intermédiaire aux glycopeptides. Implications thérapeutiques

INTRODUCTION: Since 1997, several observations of glycopeptide intermediate Staphylococcus aureus (GISA) infections have been described. We report the case of meningitis. OBSERVATION: A 46 year-old man was treated surgically on several occasions for a meningioma of the back cranial fossa. Intracranial hypertension required the placing of a cerebrospinal leading-catheter. He developed a GISA meningitis. Antibiotics and removal of the catheter cured the infection. DISCUSSION: To our knowledge, this is the first observation of GISA meningitis. Such infections are rare and are probably underestimated due to the lack of standardized detection methods. They occur in fragile, surgical, immunodeficient patients, often living with prostheses. Prior treatment with vancomycine is often reported. The emergence of these infections is a serious therapeutic problem, since vancomycine is a major antibiotic used in the treatment of meticillin-resistant S. aureus (MRSA) infections.

[Epidemiology of fungemia in a university hospital; therapeutic incidence]. / Epidémiologie des septicémies à levures dans un hôpital universitaire, incidence thérapeutique.

Twenty-two candidemia happened in our hospital from January 1997 to may 1998. We studied the clinical evolution of the patients and the sensitivity of the yeasts to antifungal therapy (Fungitest and E-Test method). We found 11 Candida albicans (CA), 10 Candida non albicans (CNA) (3 C. glabrata, 2 C. parapsilosis, 4 C. tropicalis, 1 C. krusei) and 1 Saccharomyces cerevisiae. The mean age of the patients was 56.4 years. There were 13 men and 9 women. We found one group of 8 (36.4%) oncohematological patients, one group of 8 (36.4%) patients with abdominal surgery, one group of 3 (13.6%) children and one group of 3 adults (13.6%) who spent more than 10 days in an intensive care unit. Ten times, these candidemia were associated with bacteriemia, 4 times with several bacteria. Three patients died because of the candidemia, 2 times with CNA and one time with CA. There wasn't any resistance to amphotericin B or ketoconazole. All the CA and 3 CNA (30%) remained sensitive to the four antifungal drugs we used (amphotericin B, ketoconazole, fluconazole, itraconazole). The 3 C. glabrata and the C. krusei were resistant or limit to fluconazole. Since the generalization of the use of fluconazole, the epidemiology is marked by the emergence of new strains of CA with high level of resistance to azols, and of CNA. In our hospital, the CA remain preponderant and only the CNA are resistant to fluconazole making difficult the choice of empiric treatment for serious fungemia.

Transmission and scanning electron-microscopic observations on tanycytes in the mediobasal hypothalamus and the median eminence of adrenalectomized rats.

Tanycytes in the median eminence (ME) of the rat exhibit morphological features suggesting their possible participation in transport phenomena. After adrenalectomy, which modifies the hypothalamo-hypophyseal axis, they undergo morphological changes characterized by an accumulation of lipid droplets, an increased number of bleb-like protrusions at their apex, as well as an increased pinocytosis of intraventricularly injected horseradish peroxidase (HRP). In addition, after adrenalectomy an increased number of vacuoles appears at the level of the tubero-infundibular sulci. Their intracellular location in the tanycytes is demonstrated by an intraventricular injection of HRP. The significance of these vacuoles is discussed in relation to the hydroelectrolytic modifications associated with the state of adrenalectomy.