First case report of a human sepsis involving a recently identified anaerobic agent: Bacteroides faecis.

Up until now, Bacteroides faecis, a Gram-negative, anaerobic, non-motile, nonsporeforming rod has been principally described as a commensal microbe isolated from the feces of healthy adults. We report the first case of human Bacteroides faecis sepsis after removal of suspected post-colonic ischemia colonized epicardic electrodes. Electrodes and blood cultures both grew Gram-negative anaerobic rods but usual phenotypic methods and 16S rARN gene sequencing failed to ensure its species identification. B. faecis was finally identified using hsp60 gene sequencing. Because this species is not well-known and is difficult to identify, it may have been overlooked or misidentified in previous studies.

Efficacy of a tailored PCR-guided triple therapy in the treatment of Helicobacter pylori infection.

INTRODUCTION: Resistance to clarithromycin and fluoroquinolones is increasing in many countries. We aimed to assess the efficacy of a tailored PCR-guided triple therapy versus an empirical triple therapy in the treatment of H. pylori infection. PATIENTS AND METHODS: French multicenter prospective open-label randomized study to assess H. pylori and resistance to clarithromycin and levofloxacin with GenoType HelicoDR® test. Patients of the control group were treated with empirical therapy of proton pump inhibitor (PPI), amoxicillin, and clarithromycin for 7 days. Patients of the experimental group with clarithromycin-susceptible strains, clarithromycin-resistant/levofloxacin-susceptible strains, and with clarithromycin-resistant/levofloxacin-resistant strains received tailored therapy of PPI, amoxicillin, and clarithromycin for 7 days, PPI, amoxicillin, and levofloxacin for 10 days, and PPI, amoxicillin, and metronidazole for 14 days, respectively. H. pylori eradication was assessed by 13C urea breath test at least 28 days after the end of treatment. RESULTS: We included 526 patients: 260 (49.4%) were randomly assigned to empirical triple therapy and 266 (50.6%) to tailored therapy. Clarithromycin and levofloxacin resistances were 23.3% and 12.8%, respectively. Follow-up urea breath test was available for 415 (78.9%) patients. Tailored therapy was superior to empirical therapy in terms of eradication (85.5% vs. 73.1%, RR=1.85, 95%CI [1.25-2.78], p=0.003). Findings were consistent in the susceptibility analysis using multiple imputation (RR=1.61, 95%CI [1.14-2.27], P=0.003) and per-protocol analysis (RR=1.89, 95%CI [0.25-2.78], p=0.003). CONCLUSION: In a country with a high level of clarithromycin resistance, tailored PCR-guided therapy was superior to empirical triple therapy for H. pylori eradication (https://www.ClinicalTrials.gov: NCT01168063).

Treatment compliance with European guidelines and prognosis of Clostridium difficile infection according to age.

OBJECTIVE: Age>65 years is associated with the recurrence and poor prognosis of Clostridium difficile infection (CDI). Data on elderly patients (≥75 years) is scarce, and little is known about compliance with European guidelines in terms of specific treatment. We aimed to analyze the treatment and prognosis of CDI in two groups of patients aged

Assessment of the automated multiplex-PCR Unyvero i60 ITI® cartridge system to diagnose prosthetic joint infection: a multicentre study.

OBJECTIVES: Prosthetic joint infections (PJI) are responsible for significant morbidity and mortality and their number continues to rise. Their management remains complex, especially the microbiological diagnosis. Besides 'homemade' tests developed by several teams, new molecular biology methods are now available with different analytical performance and usability. METHODS: We studied the performances of one of these tests: ITI® multiplex PCR (mPCR) by the Curetis® company and compared it to either 'optimized' culture or 16S rRNA PCR. We performed a retrospective multicentre study to assess the contributions of mPCR in the diagnosis of PJI. We randomly selected 484 intraoperative specimens among 1252 of various types (biopsy, bone, tissue around the prosthesis, synovial fluid) from 251 patients in seven different hospitals. Each sample was treated according to the recommendations of the manufacturer. RESULTS: In all, 154 out of 164 (93.9%) samples negative in culture were negative with the mPCR. Among the 276 positive samples in culture, 251 (90.9%) were monomicrobial, of which 119 (47.4%) were positive with the mPCR, and 25 (9.1%) were polymicrobial, of which 12 (48%) were positive with the mPCR. The concordance rate of mPCR with culture was 58.1% (53.6%-62.7%) and the concordance rate with 16S rRNA PCR was 70.1% (65.5%-74.6%). CONCLUSION: This new standardized molecular test showed a lack of detection when the bacterial inoculum was low (number of positive media per sample and number of colonies per media) but can be useful when patients have received antibiotic therapy previously.

[Prevalence of Acinetobacter baumannii carriage in patients of 53 French intensive care units on a given day]. / Prévalence un jour donné du portage d'Acinetobacter baumannii chez les patients de 53 réanimations françaises.

OBJECTIVE: This study was made to evaluate multiresistant Acinetobacter baumannii colonization in French intensive care units. DESIGN: We conducted a prevalence study on the carriage of A. baumannii for a one-day period in various French ICUs. On December 10, 2003, one nasal and/or rectal swab sampling was performed in 506 patients of 53 ICUs. RESULTS: Sixteen patients (3.16%) from 7 centers (13%) were colonized by A. baumannii. None of the known risk factors for colonization by multiresistant A. baumannii were identified in these patients. CONCLUSIONS: Overall, A. baumannii colonization is limited except during epidemic situations. Our study reflects the carriage of A. baumannii in ICUs on a given day. This study showed that there was no multiresistant A. baumannii epidemic clone, potentially responsible for outbreaks, present in the tested French ICUs.

Nosocomial outbreak of Pseudomonas aeruginosa associated with a drinking water fountain.

Over a four-month period, ten patients were suspected of having acquired nosocomial infection to P. aeruginosa in the ear, nose, and throat department. Environmental and clinical isolates were compared. Only water from a drinking water fountain was contaminated by P. aeruginosa. This isolate and those of three patients had indistinguishable random amplified polymorphic DNA profiles. These patients had serious oncology diseases. The drinking water fountain was used for their alimentation by percutaneous endoscopic gastrostomy and was the origin of the outbreak. Another type of drinking fountain with a terminal ultraviolet treatment was installed, following which no new infections linked to drinking water were identified.

Four additional cases of trisomy 14 as the sole anomaly in various haematological malignancies.

We report on four cases of trisomy 14 as the sole anomaly. Three cases were myelodysplastic syndromes and one was a non-Hodgkin's lymphoma. This anomaly is mainly in myeloid disorders and still remains to be well documented. On the other hand, we show this anomaly to be also a non-random anomaly in lymphoproliferative disorders.

Correlation between IL-8 induction, cagA status and vacA genotypes in 153 French Helicobacter pylori isolates.

The polymorphism of clinical presentations associated with Helicobacter pylori infection is potentially due to differences in the virulence of individual strains. H. pylori virulence has been associated with the ability to induce secretion of interleukin-8 (IL-8), the vacA genotypes, and the cagA status. The aim of this study was to determine the virulence profiles of 153 French H. pylori isolates on the basis of vacA genotypes, cagA status, and IL-8 induction ability. A total of 153 H. pylori isolates from patients with chronic gastritis (n = 74) or gastro-duodenal ulcers (n = 79) was examined for vacA genotypes and cagA status by polymerase chain reaction (PCR) and dot blot, and for their ability to induce IL-8 secretion by HEp-2 cells. The prevalence of vacA genotypes was: s1/m1 44.3%, s1/m2 24.9%, and s2/m2 23.5%. The cagA gene was present in 64% of the strains. IL-8 secretion was induced by 58.7% of the isolates. The presence of the cagA gene was significantly correlated with the s1/m1 vacA genotype and with the induction of IL-8. Thirty-four strains were atypical (cagA-positive/IL-8 noninducer or cagA-negative/IL-8 inducer). vacA genotypes, cagA status, and IL-8 induction ability are not correlated with the presence or absence of ulcer. The cagA status is not sufficient to predict the proinflammatory ability of H. pylori.

Nucleotide sequence and characterization of peb4A encoding an antigenic protein in Campylobacter jejuni.

The 29-kDa protein PEB4, a major antigen of Campylobacter jejuni, is present in all C. jejuni strains tested and elicits an antibody response in infected patients. By screening a lambda gt11 library of chromosomal DNA fragments of C. jejuni strain 81-176 in Escherichia coli Y1090 cells with antibody raised against purified PEB4, a recombinant phage with a 2-kb insert expressing an immunoreactive protein of 29 kDa was isolated. DNA sequence analysis revealed that the insert contains two complete open reading frames ORF-A and ORF-B. ORF-A (peb4A) encodes a 273-residue protein with a calculated molecular mass of 30,460 daltons. The deduced amino acid sequence, composition and pl of the recombinant mature protein are similar to those determined for purified PEB4. The first 21 residues resemble a signal peptide. Gene bank searches indicated 33.7% identity with protein export protein PrsA of Bacillus subtilis and 23.8% identity with protease maturation protein precursor PrtM of Lactococcus lactis. PCR experiments indicate that peb4A is highly conserved among C. jejuni strains. ORF-B begins 2 bp after the last codon of peb4A and encodes a putative protein of 353 residues with 63.4% identity with E. coli fructose 1,6-biphosphate aldolase. The sequence arrangement suggests that these two genes form an operon.

Panmictic structure of Helicobacter pylori demonstrated by the comparative study of six genetic markers.

We compared the classifications of strains obtained by analysis of several genetic markers to demonstrate the panmictic structure of Helicobacter pylori, previously suggested by the study of multilocus enzyme electrophoresis. A series of 39 strains, including 37 clinical isolates from patients with gastritis or ulcers from two regions of France, reference strain CIP 101260 and the Sydney strain (strain SSI), were used. They were studied by restriction fragment length polymorphism analysis of ribosomal DNA (ribotyping) using HindIII and HaeIII, by polymorphism analysis of the ureA-ureB and flaA genes by PCR-RFLP using HaeIII and MboI, by vacA genotyping and by the presence or absence of the cagA gene and of the insertion sequence IS605 detected by PCR. There was a high level of genetic polymorphism over the studied strains, with 38 ribotypes, 38 restriction profiles for the ureA-ureB gene, 19 restriction profiles for the flaA gene and five combinations of the signal and mid-region sequences of the vacA gene. Factorial analysis of correspondence and hierarchical clustering performed using each marker revealed that the different classifications of the strains were not correlated. This suggests there is much genetic recombination between strains and supports the hypothesis of a panmictic structure for the H. pylori species.

Dengue 1 epidemic in French Polynesia, 1988-1989: surveillance and clinical, epidemiological, virological and serological findings in 1752 documented clinical cases.

An epidemic of dengue 1 occurred in French Polynesia in December 1988 and June 1989. This paper records (i) the trend of the outbreak and its surveillance and (ii) the clinical, epidemiological and virological data obtained from 1752 documented cases. The epidemic reached its peak in February in Tahiti Island, 7 weeks after its recognition. Among 6034 suspect cases reported by sentinel physicians, 60.3% were < 20 years old. The illness was classical dengue. No fatality or case of dengue haemorrhagic fever/dengue with shock syndrome was reported. Of 4792 patients subjected to laboratory testing, 41% were confirmed as positive. The serological attack rate was c. 40%. The estimated number of dengue infections in the Windward Islands was about 20,000. Transmission was associated with Aedes aegypti. Study of documented cases showed a higher confirmation rate in both the civilian population < 15 years old (46.5%) and the susceptible French military population (47.6%) than in older civilians (31.1%, P < 0.05). Furthermore, primary dengue infections were predominant in both of the first 2 groups. The diagnosis was mostly confirmed (i) by virus isolation on day < 5 of illness and (ii) by detection of immunoglobulin (Ig) M on day > or = 5 of illness. The study showed that adequate surveillance of an epidemic requires both clinically and laboratory-based systems.

Seroprevalences of Toxoplasma, malaria, rubella, cytomegalovirus, HIV and treponemal infections among pregnant women in Cotonou, Republic of Benin.

Seroprevalences for toxoplasmosis, malaria, rubella, cytomegalovirus, HIV and treponemal infections were evaluated among 211 pregnant women residing in the Cotonou area, Republic of Benin. One hundred and thirteen women (53.6%) had toxoplasma antibodies, 185 (87.7%) malaria antibodies and 181 (85.8%) rubella antibodies. Among the 205 (97.2%) women with cytomegalovirus antibodies, 6 presented recent or current infection. No HIV seropositivity was detected. Five (2.4%) of these women had a positive treponematosis serology corresponding to previous infection or reinfection. These results were compared with previous studies conducted in Africa. Routine serological screening should be recommended in young age and in pregnancy for rubella, only in pregnant women for HIV and toxoplasma infections, in order to control their possible consequences on women and newborns.

Presence of caprine arthritis-encephalitis virus (CAEV) infected cells in flushing media following oviductal-stage embryo collection.

To improve the knowledge on the risk of transmission of the caprine arthritis-encephalitis virus (CAEV) during embryo manipulations, we conducted a double-nested polymerase chain reaction (PCR) for CAEV proviral-DNA on flushing media recovered from the oviducts 48 h after the beginning of estrus and on blood from 89 donor does. Sixty-four does had negative blood and flushing media by PCR. Among the 25 CAEV infected goats (blood PCR positive), 11 were PCR flushing media positive (P < 0.01). Cell lysate from flushing media samples that were PCR positive were serially diluted 10 times at 1:100. Starting with the second 1:100 dilution all the cell lysate samples were PCR negative. The mean number of embryos recovered was not significantly different between goats with flushing media PCR positive and goats with flushing media PCR negative (6.0 +/- 5.4 versus 7.8 +/- 4.4, respectively; mean +/- S.D.) nor between goats with blood PCR positive and goats with blood PCR negative (7.0 +/- 5.0 versus 5.9 +/- 5.3; mean +/- S.D.). The presence of CAEV infected cells in oviductal flushing media from infected donor does was indicated for the first time during this study. The absence of flushing media PCR positive for goat blood PCR negative seemed to allow the use of the blood PCR test to confidently predict the absence of CAEV provirus in the oviductal fluid.

Presence of caprine arthritis-encephalitis virus (CAEV) proviral DNA in genital tract tissues of superovulated dairy goat does.

Transmission of caprine arthritis-encephalitis virus (CAEV) is not completely understood and the vertical route of infection from the goat to the embryo or to the fetus needs to be investigated. This route of infection involves the presence of CAEV in the genital tract tissues. Prior studies have detected CAEV-infected cells in genital secretions and in flushing media recovered during embryo collection from infected goats. To specify the origin of these cells, we conducted a double-nested polymerase chain reaction (PCR) test on embryo flushing media and on mammary gland, mammary lymph node, synovial membrane, pelvic lymph node, uterus and oviduct tissues from 25 CAEV-infected (blood PCR positive) embryo donor goats for the presence of CAEV proviral DNA. The presence of proviral DNA was found in 22 of 25 mammary gland samples, 14 of 25 uterus samples, and in 16 of 25 oviduct samples. Nineteen of 25 goats had at least one positive genital tract sample. Flushing media from 11 goats were PCR positive. All goats with positive-flushing media were oviduct positive. Of this group of does, except for 1 of the 11, infection of flushing media correlated with infection of almost all the other tissues examined. The frequency of positive tissues for flushing media-positive goats (61/66; 92%) was significantly higher than that for flushing media-negative goats (50/84; 60%) (P<0.01). This study demonstrated the presence of CAEV-infected cells in the goat genital tract. The presence of CAEV-infected cells in the uterus and oviducts suggests potential for vertical transmission of CAEV from doe to embryo or fetus.

A single diethylcarbamazine dose for treatment of Wuchereria bancrofti carriers in French Polynesia: efficacy and side effects.

In the fall of 1988, 14 Tahitian Wuchereria bancrofti carriers were treated by a single diethylcarbamazine (DEC) 3 mg/kg dose. Determination of blood microfilarial (mf) density was carried out on days 0, 7, 14, 30, 90 and 180 using the membrane filtration technique. Clinical signs and side effects were noted during the 3 days following treatment. Complete clearance of microfilaremia was observed in two carriers (negativation rate 14%). A decrease of mf density was noted in all of the 14 carriers, ranging from 35.2 to 99.2% (median 78.75%). The percentage decrease in mf density, determined for the whole group from the geometric mean of the 14 mf counts, was 86% by day 7 and reached 95% by day 180. Side effects were observed in 10 patients (71%) of whom 3 only were unable to perform usual activities for less than 24 hours. Though it induced an incomplete initial mf clearance, a single DEC 3 mg/kg dose was effective in reducing about 90% of the microfilaremia and in sustaining this reduction over a period of six months. Such long-term reduction (comparable to that observed in W. bancrofti carriers treated with a daily DEC 6 mg/kg dose during 12 days) is likely responsible for the consistent decrease of total mf counts observed in the Tahitian population which has been treated for years with single DEC doses given every six months.

Identification and susceptibility testing for obligate anaerobic bacteria using a semi-automated API ATB plus system.

We evaluated the reliability of the API systems, Rapid ID 32 A and ATB ANA, for the identification and susceptibility testing of obligate anaerobic bacteria in a clinical laboratory that does not possess either an anaerobic chamber or a chromatograph. Tested were 105 clinical isolates. Identifications were compared with those obtained according to the criteria of the Virginia Polytechnic Institute Manual using the API 20 A system with incubation in an anaerobic chamber and gas chromatography. Identifications were concordant in 86.3% of cases. The Rapid ID 32 A system was inaccurate in distinguishing Bacteroides of the fragilis group. Susceptibility to 10 antibiotics of the ATB ANA system was compared to that obtained by MIC determination on Wilkins Chalgren agar. Overall, concordance was 78.2%. Disagreements were mostly minor (16.4%): resistant strains classified as intermediate or intermediate classified as susceptible. When the ATB ANA strip cannot be inoculated in an anaerobic chamber, it is possible that a denser inoculum would decrease the percentage of minor disagreements.

[Disseminated Mycobacterium bovis tuberculosis in an aged female patient without HIV infection]. / Tuberculose généralisée à Mycobacterium bovis chez une malade âgée en dehors de l'infection à VIH.

The authors report the case of a woman affected by disseminated infection caused by Mycobacterium bovis, without risk exposure and immunodeficiency. There were chest and urinary localisations and bacteremia. Usually, M bovis is responsible of chest tuberculosis, in patients with professional exposure. Disseminated forms usually affect patients with immunodeficiency. Bacteria may be responsible of about 1% of tuberculosis, but real frequency is not known, because of its non specific report.

[Search for bacterial contamination of the aqueous humor during cataract surgery with and without local antibiotic prophylaxis]. / Recherche d'une contamination bactérienne du liquide intra-oculaire au cours de la chirurgie de la cataracte avec et sans antibioprophylaxie locale.

PURPOSE: Bacterial contamination of anterior chamber at the end of cataract surgery, was compared between two techniques: extracapsular extraction and phacoemulsification. The effectiveness of preoperative antibiotic eyedrops using Norfloxacine 0.3% (Chibroxine) was also evaluated. METHOD: The study focused on 101 patients grouped according to surgical technique and presence of preoperative antibiotic eyedrops. Conjunctival sampling was made the day prior the surgery, as well as in the operating room, after skin and conjunctival desinfection with povidone iodine in all the patients included in the study. Aqueous humour was collected at the end of surgery. RESULTS: Eight samples out of 101 were positive which represents 7.9% of the cases. In 75% of the cases, the anterior chamber aspirate showed a different germ or non-recurrent germ in the second conjunctival sample. None of the included patients developed endophthalmitis. The two most frequent pathogens were Propionibacterium acnes in 62.5% of the cases, and Staphylococcus epidermidis in 50%. Another pathogen was found in a culture environment: Micrococcus roseus. In two samples, two different bacteria grew: Propionibacterium acnes and Staphylococcus epidermidis. Whatever the surgical technique, no statistically significant bacterial contamination was found. There was no significant statistical difference between patients who had local antibiotic eyedrops and those who did not. CONCLUSION: This study confirms the poor reliability of local antibiotic eyedrops to prevent surgical contamination. Furthermore performing an anterior chamber aspirate at the end of the surgery for risk patients would help the physician identify the pathogens involved in endophthalmitis in order to begin antibiotic treatment as soon as possible.

[True or supposed bacterial endophthalmitis. Study of anatomo-functional outcome apropos of 32 cases]. / Endophtalmies bactériennes ou supposées telles. Etude du devenir anatomo-fonctionnel à propos de 32 cas.

PURPOSE: Vision prognostic study depending on the germs and the therapic performed in bacterial endophthalmitis. METHODS: In a retrospective study over a period of 3 years (1991-1993), 32 cases of post surgery bacterian endophthalmitis were detected: 30 cases after cataract surgery (29 cases after extra capsular surgery and one case after intra capsular), one case after trabeculectomy and one case after keratoplasty. RESULTS: A risk factor was evidenced in 15.6% of the cases. Endocular samples were done in 68.75% of the cases. The positive rate was 36.4% showing a Staphylococcus in 5 cases out of 8 (62,5%). In 37.5% of the cases an intraocular antibiotic injection was associated to the anterior chamber punction. 40% of the cases contaminated with Staphylococcus regained a visual acuity of more than 3/10. For the two cases where a Streptococcus was isolated an evisceration was necessary. Our results show that a higher visual acuity was obtained when a posterior vitrectomy was performed. When the posterior vitrectomy was associated with a corticoid therapy, the visual prognostic was better. Thus, 71% of these cases regained a visual acuity of more than 3/10. CONCLUSION: Our results show that performing a posterior vitrectomy associated to a general corticotherapy within 48 hours from the bacterian endophthalmitis diagnosis would allow best vision improvement.

[Q fever and fetal death in utero. Two cases]. / Fièvre Q et mort foetale in utero. Deux observations.

Some cases of late abortion occurring after a Coxiella burneti infection, more often with a chronic evolution, have already been mentioned in the literature. We reported here two cases of early abortion, contemporaneous of an acute infection due to C. burneti. Two patients, after a contact, before and at the beginning of the pregnancy, with an animal susceptible to contaminate human beings by C. burneti, presented no clinical symptom characteristic of Q fever. The fetal death for the two cases was found out at the 17th week of amenorrhoea. All the investigations in order to search for an abortion etiology remained negative. Only, the specific serologies showed an acute infection due to C. burneti.