Epidemic of venereal treponematosis in wild monkeys: a paradigm for syphilis origin.

Treponema pallidum infections have been primarily known as slightly contagious mucocutaneous infections called yaws (tropical Africa and America) and bejel (subtropical North Africa). T. pallidum emerged as a highly infectious venereal syphilis agent in South America, probably about 500 years ago, and because of its venereal transmission, it quickly caused a worldwide pandemic. The disease manifests as lesions, including a chancre; then antibodies become detectable when or slightly after the chancre appears, and before the development of a rash and other systemic manifestations. Venereal diseases are poorly known in monkeys. During fieldwork in Senegal, we discovered an epizootic outbreak of venereal disease that we explored. We detected a venereal form of T. pallidum subsp. pertenue infection in green monkeys (Chlorocebus sabaeus), then observed an epizootic outbreak in Senegal and its spread among baboons a year later. Comparative analysis of T. pallidum genomes from the monkeys' chancres and other Treponema genomes showed an acceleration of the number of single nucleotide polymorphisms, comparable to that observed in syphilis. Identified T. pallidum clones seem to be epizootic through the acceleration of their mutation rate, which is linked to their larger diffusion.

[Community-acquired urinary tract infections in 15 to 65 years old female patients in France. Susceptibility of E. coli according to history: AFORCOPI-BIO network 2003]. / Infections urinaires communautaires de la femme de 15 à 65 ans: sensibilité aux antibiotiques de E. coli en fonction des antécédents: étude AFORCOPI-BIO 2003.

OBJECTIVES: A multicenter study was implemented in order to determine the distribution and antibiotic susceptibility patterns of strains isolated from 15 to 65 year old female patients with community-acquired urinary tract infections. PATIENTS AND METHODS: From October to December 2003, 11 French private laboratories consecutively collected 420 clinical strains with medical data. Minimal inhibitory concentrations of antibiotics on E. coli were determined using the agar dilution method in a coordinating center and interpretation followed the recommendations of the Comité de l'antibiogramme de la Société française de microbiologie. RESULTS: Escherichia coli was the most prevalent pathogen (80%) followed by Proteus mirabilis (4%), Klebsiella spp (2%), other Enterobacteriaceae (4%), Enterococcus spp (3%), Staphylococcus aureus (2%), Staphylococcus saprophyticus (2%), and Streptococcus agalactiae (2%). The susceptibility of E. coli strains was 61% for amoxicillin (AMX), 93% for nalidixic acid (NAL), 97% for norfloxacin (NOR) and ciprofloxacin (CIP), 77% for cotrimoxazole (SXT), 99% for fosfomycin, gentamicin and cefotaxime. The susceptibility of E. coli was lower in case of previous treatment with beta-lactam antibiotics for AMX (84 vs 95% p=0.02) and SXT (62 vs 81% p=0.02). In the same way, previous treatment with quinolones was associated with decreased susceptibility for NAL (84 vs 95% p=0.02) and SXT (62 vs 81% p=0.02). CONCLUSIONS: In 2003, fluoroquinolones, third generation cephalosporins, aminoglycosides, and fosfomycin kept a good activity on E. coli collected from community-acquired urinary tract infections in 15 to 65 years old female patients in France.

[Research of Lyme's disease in facial paralysis. A French multicenter study]. / Recherche de maladie de Lyme dans les paralysies faciales. Une étude multicentrique Française.

OBJECTIVES: Apparent a frigore facial palsy could possibly mask manifestations of unrecognized Lyme's disease. Since commonly used corticosteroid treatment could be deleterious if Borrelia burgdorferi infection was indeed the cause, we conducted a prospective study to search for possible infections in cases of recently diagnosed a frigore facial palsy. METHODS: For 3 years, 1990-1992, 49 French centres diagnosed a facial palsy in 346 patients (310 adults, 36 children under 15 years of age; mean age 38; range 16 months to 83 years). The patients were divided into three groups: a) facial palsy alone, b) zoster origin recognized due to outer ear eruption and c) cases with meningoradiculitis or joint signs or cases with facial diplegia. A questionnaire was used to evaluate exposure to risk of tick bits. A control group was established with 246 serum samples from subjects matched with the patients for age, geographical origin and exposure to risk of tick bits. Laboratory tests (indirect immunofluorescence and Western blot) were performed to search for anti-Borrelia burgdorferi antibodies in serum samples, and cerebral spinal fluid when possible, collected at presentation, on day 30 and on day 90. RESULTS: Sixty percent of the patients were urban dwellers, 15% lived in rural and 25% in semi-rural areas. There were 294 patients with facial palsy alone and their serum results were compared with those of the matched controls. There was no significant difference in the positivity for Borrelia burgdorferi antibodies between these two groups. CONCLUSION: These findings indicate that, unless there are clinical signs suggestive of borreliosis, it would not be necessary to test for Lyme's disease in patients with apparent a frigore facial palsy.

[Urinary tract infection in an urban population: etiology and antibiotic sensitivity as a function of patient history]. / Infections urinaires en pratique de ville: étiologies et sensibilité aux antibiotiques en fonction des antécédents. l'AFORCOPI-BIO. Association pour la Formation Continue en Pathologie Infectieuse des Biologistes.

OBJECTIVE: The aim of this study was to explore the relationship between etiological factors, bacterial isolates and Escherichia coli susceptibility to antibiotics in ambulatory patients with urinary tract infection. PATIENTS AND METHODS: A prospective study was conducted in 13 private medical laboratories in France in March 1998. Data were collected on 658 cases involving 679 strains in ambulatory patients with urinary tract infections. Data on age, gender, catheter insertion within the 7 preceding days, and history of hospitalization, urinary infection and antibiotic treatment during the 6 preceding months were recorded. The distribution of the bacterial isolates and Eschericha coli sensitivity to ciprofloxacin, cotrimoxazole, and gentamycin were studied. RESULTS: E. coli was most frequently isolated in women, in patients with no catheter or without a history of antibiotic treatment, hospitalization or urinary infection. There was no difference in E. coli sensitivity according to sex and age in women. In patients with prior antibiotic treatment, all the tested antibiotics except gentamycin were significantly less active. In case of prior hospitalization, the E. coli isolates were more resistant to amoxicillin, quinolones, cotrimoxazole and gentamycin. The level of E. coli suceptibility rose as the delay since hospitalization or urinary infection increased. CONCLUSION: Ambulatory patients comprise a heterogeneous population requiring particular attention to correctly adapt therapeutic strategies.

[Genital infections in women, in community practice. Comparison of two studies, 1987 and 2002]. / Les infections génitales chez la femme en pratique de ville Enquêtes Aforcopi-BIO. Comparaison des résultats 1987 et 2002.

One thousand eight hundred and thirty-six clinical and biological cervico-vaginal flora samples from genital infections in women observed in community practice in 1987 were compared to 368 samples collected in 2001. The diagnosis of sexually transmitted infection (STI) was rarely made. Nonetheless, examining these samples made it possible either to prescribe a specific treatment for a confirmed infection (chlamydia, trichonomiasis, candidiasis, gonococci, vaginosis), or to modify a long-term treatment that was often ineffective and sometimes badly tolerated. Not all vulvar itching, associated or not with pelvic pain, is caused by mycosis. Treatment based on a syndromic approach was often ineffective, because clinical symptoms, whether isolated or associated, even when they were suggestive of an etiology, presented only a minor positive predictive value (the PPV for the association ichting + pelvic pain was only 10% for chlamydia, but 45% for candidiasis). The diagnosis of vaginosis, suggested for the past 10 years as an improvement in the diagnosis of vulvo-vaginitis, was made in only 13% of the cases. The only significant difference in our two studies was a lower number of cases of gonococci, chlamydiae, and ureaplasms in 2001, the settings having remained identical, except for a lower number of patients in 2001.

Western blot as a seroepidemiologic tool for detecting foci of Mediterranean spotted fever (MSF).

We conducted a serosurvey on Mediterranean spotted fever (MSF), in a nonendemic area using western blot and microimmunofluorescence. Among 262 tested sera, 53 were positive by micro-immunofluorescence at a titer of 50. When 48 positive sera were western blot tested, 15 did not exhibited any reaction, 17 reacted against the non-specific lipopolysaccharide, and only 16 reacted against the specific protein antigens. Fourteen of the sera with a specific reaction were sampled in a village with a unique submediterranean climate. Western blot may be a more specific tool to determine the real seroprevalence of MSF.

Comparison of western blot and microimmunofluorescence as tools for Lyme disease seroepidemiology.

Sera from a population of 212 farmers of the Puy de Dôme (Midlands of France) who are in close contact with Ixodes ricinus, the vector of Lyme disease in Europe, and sera from 100 urban blood donors from the nearly city of Clermont Ferrand were examined by microimmunofluorescence (MIF) for antibodies reacting with Borrelia burgdorferi. The results showed a higher seroprevalence of IgG > 1/100 in farmers (25%) than in blood donors (10%). Using western blot with antibody at a 1/200 dilution, and regarding sera as being positive if they contained IgG reactive with more than 5 bands, 93/212 farmers (44%) and 20% of blood donors were positive. Reactions with specific protein bands (94, 73, 30 and 21 KDa) by western blot were demonstrated in 83/212 sera from farmers (39%) and 16% of blood donors. Both methods showed a higher seroprevalence in the farmer population. Western blot is a sensitive and specific test for seroepidemiology but, in highly endemic areas, it is not diagnostic for active Lyme borrelliosis.