Effect of organic amendments on the mobility of trace elements in phytoremediated techno-soils: role of the humic substances.

The efficiency of aided phytostabilization using organic amendments such as ramial chipped wood (RCW) and composted sewage sludge (CSS) was studied on contaminated techno-soils, on nine experimental plots. The objective was to characterize the role of fulvic (FA) and humic acids (HA) on the mobilization of trace elements, specifically As, Cu, Mo, Pb and Zn. Results showed that the addition of CSS increased the total organic carbon and nitrogen content more than with RCW and as a result, the C/N ratio in the CSS soil was higher than in the RCW and non-amended (NE) soil, reflecting the high decomposition of soil organic matter in the CSS soil compared with the other soils. The RCW and CSS amendments increased the hydrogen index (HI) values and the oxygen index (OI) values compared with the NE soil, especially for the soil treated with CSS which contained more aliphatic than aromatic compounds. The addition of CSS to the techno-soil significantly increased the percentage of C org associated with the HA fractions compared with the RCW and NE soils. The soil amended with CSS showed the highest E 4/E 6 ratio and the lowest E 2/E 3 ratio of FA. Zn and As were more abundant in the FA fraction than in the HA fraction, whereas Pb, Cu and Mo were more associated to HA than to FA in the treated and untreated soils, which may explain the difference in their mobility and availability.

Are plants useful as accumulation indicators of metal bioavailability?

The use of accumulation bioindicator to assess metal bioavailability has mainly concerned individual species. This work addresses this issue at the plant community level. Metal content within different species from plant communities found at three contaminated and one uncontaminated site was compared. Results showed that for two contaminated sites, leaf metals concentrations were comparable to those in plants from control site, i.e. approx (mg/kg) 0.1 Cd, 0.2 Cr, 9.2 Cu, 1.8 Ni, 0.5 Pb and 42 Zn. Only plants from the third site showed higher metal contents, ranging from 1.5- to 8-fold those of the control community. This contrasted with ammonium acetate-EDTA extractions, which indicated a very high "availability" of metals at the three sites, as compared to the control site. Thus, metal content in plant communities provided accurate information on actual transfer toward the ensemble of vegetation, which could be used to establish site-specific "fingerprints" of metal bioavailability.

[Non-fatal disseminated mucormycosis in a solid organ transplant]. / Mucormycose disséminée d'évolution favorable chez une greffée pulmonaire.

BACKGROUND: Mucormycosis is a rare fungal infection occurring most frequently in immunocompromised patients. The pathogens are filamentous fungi, order of Mucorales. Disseminated mucormycosis is a severe, life treating disease. Early diagnosis is a major determinant for prognosis, however, it remains difficult. The management consists in an early antifungal therapy using lipid formulation of amphotericin B associated with an extensive surgical debridement. Despite this therapeutic of choice, the mortality of disseminated mucormycosis remains high. OBSERVATION: We report the case of disseminated mucormycosis in a 25 years old woman 9 months after a pulmonary transplantation. The clinical presentation included pulmonary and thyroid localization and the pathogen was Absidia corymbifera. The patient survived thanks to a large surgical debridement, and an early antifungal bitherapy by lipid formulation of amphotericin B and posaconazole. CONCLUSION: The re-emergence and the high mortality of mucormycosis in solid organ transplant receiver show the necessity to find new therapeutic approaches. Posaconazole associated with liposomal amphotericin B could be an interesting option to treat disseminated mucormycosis and improve their outcome.

[Dry sausage mould hypersensitivity pneumonitis: three cases]. / Pneumopathie à la fleur de saucisson: trois observations.

INTRODUCTION: Hypersensitivity pneumonitis (HP) can occur as a consequence of inhaling a wide range of different antigens. The clinical diagnosis is based on five main criteria as proposed by the GERM'O'P. CASE REPORTS: We present in this report three cases of occupational hypersenstitivity pneumonitis caused by inhalation of dry sausage mould. Lung infiltrates were observed in each case on CT scanning, with a lymphocytic or mixed inflammatory picture in bronchoalveolar lavage fluid, and specific antibodies (precipitins) against extract from dry sausage mould (which notably contains Penicillium). In all three cases, the condition improved after reducing exposure to the allergen and, in two cases, after the administration of corticosteroid therapy. CONCLUSION: Exposure to dry sausage mould occurs in work places where salami is made and should be considered as a possible cause of hypersenstitivity pneumonitis.

Multi-tolerance to heavy metals in Plantago arenaria Waldst. & Kit.: adaptative versus constitutive characters.

Tolerance to Cu, Cd, Ni and Zn was investigated in a population of the pioneer species Plantago arenaria growing in a metallurgical landfill. Tolerance levels were compared with those of two other pioneer species (Coniza sumatrensis and Verbascum densiflorum) growing in the same location, and with a control population taken from an uncontaminated site. Results showed that the metalliferous population of P. arenaria was more tolerant to metal toxicity than C. sumatrensis and V. densiflorum. Comparisons with literature data confirmed that the metalliferous population of P. arenaria was highly tolerant to Cu, moderately tolerant to Cd and Ni, but not particularly tolerant to Zn. The control population of P. arenaria responded the same as the metalliferous one excepted for Cu, for which it was much more sensitive. This suggested that multi-metal tolerances in the metalliferous population of P. arenaria resulted both from constitutive and adaptative traits, depending on the metal. To check whether P. arenaria was able to cope with high internal metal levels, accumulation patterns were evaluated in pot experiments. Results showed that metals accumulated in roots and leaves, at levels proportional to soil content. Metal content was much higher in roots than in leaves and the leaf:root concentration ratio was kept constant over a wide range of soil metal contents. This suggested that metal tolerance was related to the ability to retain metal ions in roots and to tightly control their translocation to leaves. Finally metal tolerance in P. arenaria is discussed in relation to its pioneer and xerophytic characteristics.

Multicenter evaluation of a commercial PCR-enzyme-linked immunosorbent assay diagnostic kit (Onychodiag) for diagnosis of dermatophytic onychomycosis.

We prospectively evaluated a new PCR-enzyme-linked immunosorbent assay kit (Onychodiag; BioAdvance, France) for the diagnosis of dermatophytic onychomycosis by testing nail samples from 438 patients with suspected onychomycosis and from 108 healthy controls in three independent laboratories. In two laboratories, samples were collected by trained mycologists as close as possible to the lesions (proximal samples). In one laboratory, samples were collected by other physicians. All samples were processed by conventional mycological techniques and by Onychodiag, blindly to the mycological results. An additional distal sample, collected by clipping the nail plate, was obtained from 75 patients and tested with Onychodiag alone. In patients with culture-proven dermatophytic onychomycosis, the sensitivity of Onychodiag was 83.6% (87.9% including the gray zone) and ranged from 75 to 100% according to the laboratory and the sampling conditions. The specificity was 100% when healthy subjects were considered true negative controls. Onychodiag was positive on 68 patient samples that were sterile or yielded nondermatophyte species in culture. Based on the results of Onychodiag for mycologically proven positive samples and true-negative samples, these results were considered true positives, and the poor performance of mycology on these samples was attributed to inconvenient sampling conditions or to contaminants. When tested on distal samples, Onychodiag was positive in 49/53 (92%) cases of proven dermatophytic onychomycosis. Finally, with either proximal or distal samples, Onychodiag provided a diagnosis of dermatophytic onychomycosis within 24 to 48 h after sampling, and its sensitivity was close to that of mycological techniques applied to proximal samples.

Ten-year surveillance of fungal contamination of food within a protected haematological unit.

Since 1992, we have established a protocol of food management (restrictive diet, food distribution protocol and fungal surveillance) for allogeneic stem-cell transplant (SCT) recipients hospitalised in protected ward. This study analyses the results of 10-year surveillance of fungal contamination of this diet. Among the 456 types of foods tested filamentous fungi were isolated in 37 of them (8.1%). Aspergillus fumigatus was isolated in one type of food only, while the majority of the food was contaminated to a lower extent.

Liposomal muramyl tripeptide phosphatidylethanolamine: Targeting and activating macrophages for adjuvant treatment of osteosarcoma.

About one third of osteosarcoma patients develop lung metastasis refractory to chemotherapy. Recent studies indicate that biological response modifiers activating the patient's immune system may help controlling minimal residual disease via pathways distinct from those used by cytotoxic drugs, and therefore prove effective against tumor resistance. Muramyl tripeptide phosphatidylethanolamine (MTP-PE) is a synthetic lipophilic glycopeptide capable of activating monocytes and macrophages to a tumoricidal state. When intercalated in multilamellar liposomes (L-MTP-PE) and injected intravenously, it targets lung, liver, and spleen macrophages. Therapeutic activity of L-MTP-PE was demonstrated in several preclinical models of experimental lung metastasis and in clinical trials in dogs with osteosarcoma. Although macrophage activation was shown to be directly involved in the in vivo anti-metastatic activity of this molecule, cytokine and chemokine secretion by activated macrophages could induce recruitment and stimulation of other immune cells, which may in turn indirectly contribute to the anti-tumor effect. L-MTP-PE has undergone clinical development in humans. In early trials, most side effects of L-MTP-PE were minimal. L-MTP-PE showed signs of efficacy in treatment of patients with recurrent osteosarcoma and the encouraging results from phase II studies led to a phase III trial conducted by the Children's Oncology Group in patients with newly diagnosed high-grade osteosarcoma. Patients were treated with or without L-MTP-PE in combination with multi-drug chemotherapy in adjuvant setting; significantly higher overall survival and disease-free survival were observed in the group receiving L-MTP-PE.

Syntheses, in vitro antibacterial and antifungal activities of a series of N-alkyl, 1,4-dithiines.

A series of dithiines were synthesized by cyclization of 4-(alkylamino)-4-oxobutanoic acids under the action of SOCl2. Their in vitro antibacterial and antifungal activities have been evaluated against reference strains and versus reference compounds. The so-called 'isoimides' 2a, 2b were totally inactive whereas some imides had low MICs for few bacteria and for few fungal microorganisms.

Soil characteristics, heavy metal availability and vegetation recovery at a former metallurgical landfill: Implications in risk assessment and site restoration.

Pedological and botanical characteristics of a former metallurgical landfill were examined to assess the risks of heavy metals mobility and to evaluate remediation feasibility. In addition to very high heavy metals levels (Cu, Cr, Mn, Ni, Pb, Zn), the soil was characterized by a lack of clear horizonation, a relatively high pH, a high mineral and organic carbon contents, a low nitrogen level and a high C/N ratio. A two step sequential extraction showed that heavy metals were poorly labile (i.e. not soluble in diluted CaCl2), indicating that their leaching under natural conditions was probably very low. However, extraction with DTPA generated significant amounts of metals (mainly Pb and Cu), suggesting they were potentially mobilizable. A botanical survey of the area showed a biodiverse plant community (28 species and 11 families), with no obvious toxicity symptoms. Measurements of metal contents in dominant species confirmed that they were closely similar to those reported for species growing in unpolluted environments. Consequently, for an effective site restoration, indigenous species could be well suited to cope with local conditions in a phytostabilization strategy.

Routine use of a commercial test, GLABRATA RTT, for rapid identification of Candida glabrata in six laboratories.

When evaluated in six clinical laboratories from six countries with 1,174 fresh isolates, including 715 Candida glabrata and 459 non-C. glabrata strains, GLABRATA RTT (Fumouze Diagnostics, Levallois Perret, France) yielded an overall sensitivity and an overall specificity of 95.8 and 98.9%, respectively. The results were consistent from one laboratory to another. The five false-positive results corresponded to C. parapsilosis (n = 2), C. tropicalis, C. guilliermondii, and C. lusitaniae. GLABRATA RTT allows a rapid, cost-effective, and reliable presumptive identification of C. glabrata.

Epidemiology of candidaemia in Europe: results of 28-month European Confederation of Medical Mycology (ECMM) hospital-based surveillance study.

In order to update the epidemiological and mycological profile of candidaemia in Europe, the European Confederation of Medical Mycology conducted a prospective, sequential, hospital population-based study from September 1997 to December 1999. A total of 2,089 cases were documented by 106 institutions in seven European countries. Rates of candidaemia ranging from 0.20 to 0.38 per 1,000 admissions were reported. Candida albicans was identified in 56% of cases. Non-albicans Candida species were most frequently isolated from patients with haematological malignancies (65%). With increasing age, an increasing incidence of Candida glabrata was seen. The 30-day mortality rate was 37.9%. The survey results underline the burden of candidaemia in a wide range of patient populations, confirm the importance of non- albicans species, and provide baseline data for future surveillance studies at a European level.

[Toxocariasis in adults]. / Toxocarose de l'adulte.

PURPOSE: Toxocariasis is a widespread zoonotic parasitosis that is frequent in France. It is due to the presence of larvae of roundworms belonging to the genus Toxocara in the human body. Clinical signs are often non-specific. The disease can be asymptomatic or can lead to death. Toxocariasis can be thought of because of clinical signs or presence of hypereosinophilia, but the diagnosis is made by specific serology. Since there is no consensus to date regarding treatment, prevention is of paramount importance. CURRENT KNOWLEDGE AND KEYPOINTS: Recent studies point out the frequency of this parasitic disease that is often asymptomatic. The serological diagnosis remains the main tool for the diagnosis of toxocariasis. FUTURE PROSPECTS AND PROJECTS: Further studies on toxocariasis should focus on the prevalence of this disease in French population regarding the probability of infection: living in the countryside, food habits, hygiene and presence of dogs in the neighborhood. Tools of the biological diagnosis (mainly serological techniques) should be improved, but, especially, studies should focus on the evaluation of specific treatment in order to give unquestionable guidelines on this point.

In vitro susceptibility of Aspergillus spp. clinical isolates to albendazole.

The in vitro antifungal activity of albendazole, a benzimidazole widely used as an antihelmintic drug in humans, was investigated and assessed for its activity against Aspergillus spp. Forty-eight isolates, representing the most frequent species found in human pathology [Aspergillus fumigatus (n = 27), Aspergillus flavus (n = 10), Aspergillus terreus (n = 7), Aspergillus nidulans (n = 3) and Aspergillus niger (n = 1)], and one quality control strain (A. niger ATCC 9804 83435) were tested according to the NCCLS M38-P methodology for moulds. All the strains were susceptible to albendazole, with homogeneous MICs for each species; three strains were resistant to itraconazole.

Eight-year surveillance of environmental fungal contamination in hospital operating rooms and haematological units.

An eight-year fungal environmental surveillance was carried out in 15 operating theatres and two haematological units. Sampling was performed twice a year in each room, using contact plates for plane surfaces and sterile swabs for grids. From 1992 to 1999, individual rooms in the 17 units were sampled on 1094 occasions and 3822 samples were collected. The percentage of rooms without fungus increased regularly between 1992 and 1999 (41.1% and 74.8%, respectively). The units were classified according to the fungal contamination during the eight years: the operating theatres which required the highest protection (cardiological, thoracic, vascular, hand, orthopaedic and neurosurgery) and the adult haematological unit showed least contamination (71.8% rooms were negative). The most frequent species isolated were Penicillium spp. (28.4%), Cladosporium spp. (15.6%) and Aspergillus spp. (7.6%). Aspergillus fumigatus was rarely isolated (3.7%), and was mainly isolated at the beginning of the study. This study demonstrates that environmental control programmes are effective in reducing environmental mould contamination and could be useful in establishing exposure guidelines, especially by defining an acceptable level of biocontamination in zones at risk.

[Severe hypoxemia with orthodeoxia due to right to left shunt in idiopathic bronchiolitis obliterans organizing pneumonia]. / Hypoxémie sévère avec orthodéoxie par shunt droit-gauche au cours d'une bronchiolite oblitérante avec organisation pneumonique idiopathique.

We report a case of BOOP with severe hypoxemia and orthodeoxia. Chest X-ray showed bilateral infiltrative pneumonia and computed tomography scan revealed consolidations on lower lobes. Diagnosis of right-to-left shunt was made on the increase of alveolar-arterial oxygen difference under FIO2 100%, accented in standing position. Contrast-enhanced echocardiography and technetium-99 macroaggregated albumin body scanning did not show anatomical right-to-left shunt and permitted the diagnosis of intrapulmonary shunt at the capillary level because of intra-alveolar organisation. Treatment with corticosteroids and cyclophosphamide led to clinical, and radiological improvement with correction of the hypoxemia and the shunt.

Diagnosis of malaria in non-endemic countries by the ParaSight-F test.

QBC, examination of thin blood smears, and Parasight-F were performed for every case of malaria suspected between May 1997 and December 1998. Data from 310 patients were reported. Fifty had malaria infection diagnosed by QBC and thin blood film, among whom 39 had Plasmodium falciparum infection. Three of these 39 were negative with the Parasight-F test. Eleven patients had a positive ParaSight-F test but microscopic diagnosis methods were negative. Interpretation of these 11 positive ParaSight-F results is proposed to depend on clinical criteria.

Prospective comparison of MR lung perfusion and lung scintigraphy.

This study attempted to assess the accuracy and potential of lung magnetic resonance (MR) perfusion imaging compared with perfusion scintigraphy in the evaluation of patients with suspected lung perfusion defects. The technique, which uses an inversion recovery turbo-FLASH sequence with ultra-short TE (1.4 msec), was tested in 24 patients suspected clinically of having acute pulmonary embolism (n = 19) and in patients with severe pulmonary emphysema (n = 5). Perfusion lung scintigraphy was performed within 48 hours prior to the MRI examination in both groups of patients. The dynamic study was acquired in the coronal plane and consisted of 10 images of 6 slices (a total of 60 images per series). Gadopentetate dimeglumine (0.1 mmol/kg) was manually injected as a compact bolus during the acquisition of the first image. Three senior radiologists reviewed all unprocessed two-dimensional coronal sections. They were blinded to clinical data and other imaging modalities. For the three observers, the average sensitivity and specificity of MR were 69% and 91%, respectively. The overall agreement between MR and scintigraphy appears to be good, with a good correlation between the two modalities (kappa = 0.63). However, the data showed variability depending on the location of the perfusion defect, with higher accuracy in the upper lobes. The agreement between MR perfusion and scintigraphy appears to be moderate in the left inferior lobe (kappa = 0.48). The data showed an overall good interobserver agreement (kappa = 0.66). MR perfusion of the lung is a promising technique in detecting lung perfusion defects.

A monoclonal antibody specific to surface antigen on Candida krusei.

A monoclonal antibody (MAb; MAb 6B3) which reacts specifically with a cell wall antigen found in all strains or isolates of Candida krusei was developed. MAb 6B3 was extensively tested by immunofluorescence assay for cross-reaction with many Candida, Cryptococcus, Saccharomyces, Trichosporon, and Rhodotorula species and was found to react only with the species C. krusei. The specific epitope is expressed on the surface of fungal cells and appears to reside on a protein moiety. Taking into account the increasing importance of fluconazole-resistant strains in nosocomial fungal infections, the very high degree of specificity of this MAb for C. krusei could be useful for the routine detection of C. krusei in culture or in tissue samples.