[Acute Gemella haemolysans spondylodiscitis in an immunocompetent patient]. / Spondylodiscite aiguë à Gemella haemolysans chez une patiente immunocompétente.

INTRODUCTION: Gemella is a commensal bacterium of the upper respiratory tract responsible for rare infections such as acute endocarditis and meningitis. We report the case of an acute Gemella haemolysans spondylodiscitis. OBSERVATION: A 72 year-old woman was hospitalised for an etiological control and treatment of acute L4-L5 spondylodiscitis with epiduritis, confirmed on MRI. The clinical picture was composed of backache with shivering and alteration in general status of health. The peripheral bacteriological samples, intra-dermal reaction and brucella serology were all negative. The surgical L5 biopsy, following bacteriological enrichment, isolated Gram-positive cocci, later identified as Gemella haemolysans. The antibiogram showed good sensitivity to amoxicillin, dalacin and erythromycin, and strong resistance to aminosides. The search for a contamination point was negative. The patient rapidly improved with antibiotics combining 6 g/d of amoxicillin and 1200 mg/d of clindamycin, and the biological and clinical signs regressed. The antibiotic bi-therapy was continued for two and a half months and then relayed to amoxicillin alone for two further weeks. COMMENTS: The first descriptions of Gemella haemolysans infection were made in the seventies. Cases of infectious endocarditis were succeeded by septicaemia on cirrhosis and later a few cases of acute post-neurosurgical meningitis. In the majority of cases, a dental contamination point was found. The difficulties in its etiological diagnosis, related to the problems in identifying this germ that has similar characteristics to Streptococcus viridans, suggests that the prevalence of Gemella haemolysans infections is greatly underrated. The sensitivity profile generally observed is sensitivity to penicillins and aminosides--the association of which is synergic--, to cyclines and glycopeptides, and resistance to trimethoprime-sulfamethoxazole.

Response to anti-HCV therapy in HIV-HCV-coinfected patients: does the lipid profile really have an effect?

BACKGROUND: Because high serum low-density lipoprotein (LDL) and total cholesterol concentrations before treatment have been found to be significant positive prognostic factors for a sustained virological response to HCV therapy in monoinfected patients, the aim of this study was to assess this relationship in HIV-HCV-coinfected patients. METHODS: Pretreatment fasting lipid parameters (in particular total cholesterol, LDL, high-density lipoprotein [HDL], apolipoprotein B [apoB] and triglycerides [TG]) were assessed in 315 patients from the French National Agency for Research on AIDS and Viral Hepatitis (ANRS) HC02-Ribavic therapeutic trial. RESULTS: There was a significant correlation between pretreatment lipid parameters and steatosis (total cholesterol r=-0.23, P<0.0001; LDL r=-0.23, P<0.0001; HDL r=-0.28, P<0.0001; and TG r=0.18, P=0.002), but not with fibrosis. None of these lipid parameters were significant predictors of a sustained virological response to HCV therapy, even after adjustment for the type of interferon treatment and for the main known prognostic factors for a response to HCV therapy. CONCLUSIONS: The possible effect of lipid metabolism on virological response is outweighed by other prognostic factors that affect response to HCV therapy in the ANRS HC02-Ribavic study.