Volatile Organic Compounds of Malignant Breast Cancer Wounds: Identification and Odors.

INTRODUCTION: During the metabolic processes of malignant wounds, bacteria produce a large amount of volatile organic compounds (VOCs) that are responsible for malodors and may have a major impact on the patient's quality of life with a risk of isolation. OBJECTIVE: A translational study was conducted on 32 malignant breast wounds by combining the identification of bacterial strains present on wounds, the identification of VOCs produced by these bacterial strains, and sensory evaluation to assess odor intensity and quality of odorous bacteria. MATERIALS AND METHODS: Thirty-two patients with malignant breast cancer wounds > 10 cm2 at various stages of the disease (curative or palliative) were included in the protocol. Volatile organic compounds were collected from primary dressings by headspace solid-phase microextraction and then analyzed by gas chromatography separation coupled with a mass spectrometer detector analysis. Microbiological samplings were taken and analyzed on agar plates. The odors of selected bacteria were assessed by a panel of staff members. RESULTS: Proteus mirabilis and Fusobacterium necrophorum seem to produce the strongest and most typical malignant wound odor. The VOCs were analyzed and dimethyl disulfide, dimethyl trisulfide, phenol, indole, and 3-methylbutanal were found to be produced by bacteria generating the most typical wound odor. CONCLUSIONS: This study suggests the bacteria present in wounds may be responsible for odors. In addition, these findings could pave the way to engineer new types of dressings and to develop an evaluation method to assess their efficiency both quantitatively and qualitatively as well as improve quality of palliative care and comfort for women with malignant wounds.

Comparative Analysis of Bacterial Community Composition and Structure in Clinically Symptomatic and Asymptomatic Central Venous Catheters.

Totally implanted venous access ports (TIVAPs) are commonly used catheters for the management of acute or chronic pathologies. Although these devices improve health care, repeated use of this type of device for venous access over long periods of time is also associated with risk of colonization and infection by pathogenic bacteria, often originating from skin. However, although the skin microbiota is composed of both pathogenic and nonpathogenic bacteria, the extent and the consequences of TIVAP colonization by nonpathogenic bacteria have rarely been studied. Here, we used culture-dependent and 16S rRNA gene-based culture-independent approaches to identify differences in bacterial colonization of TIVAPs obtained from two French hospitals. To explore the relationships between nonpathogenic organisms colonizing TIVAPs and the potential risk of infection, we analyzed the bacterial community parameters between TIVAPs suspected (symptomatic) or not (asymptomatic) of infection. Although we did not find a particular species assemblage or community marker to distinguish infection risk on an individual sample level, we identified differences in bacterial community composition, diversity, and structure between clinically symptomatic and asymptomatic TIVAPs that could be explored further. This study therefore provides a new view of bacterial communities and colonization patterns in intravascular TIVAPs and suggests that microbial ecology approaches could improve our understanding of device-associated infections and could be a prognostic tool to monitor the evolution of bacterial communities in implants and their potential susceptibility to infections. IMPORTANCE Totally implanted venous access ports (TIVAPs) are commonly used implants for the management of acute or chronic pathologies. Although their use improves the patient's health care and quality of life, they are associated with a risk of infection and subsequent clinical complications, often leading to implant removal. While all TIVAPs appear to be colonized, only a fraction become infected, and the relationship between nonpathogenic organisms colonizing TIVAPs and the potential risk of infection is unknown. We explored bacteria present on TIVAPs implanted in patients with or without signs of TIVAP infection and identified differences in phylum composition and community structure. Our data suggest that the microbial ecology of intravascular devices could be predictive of TIVAP infection status and that ultimately a microbial ecological signature could be identified as a tool to predict TIVAP infection susceptibility and improve clinical management.

Bacterial floras and biofilms of malignant wounds associated with breast cancers.

The risk of infections and the appearance of symptoms (e.g., odors) represent the main troubles resulting from malignant wounds. The aim of this study was to characterize the balance of bacterial floras and the relationships between biofilms and bacteria and the emergence of symptoms. Experimental research was carried out for 42 days on malignant wounds associated with breast cancer. Investigations of bacterial floras (aerobes, aero-anaerobes, and anaerobes), detection of the presence of biofilms by microscopic epifluorescence, and clinical assessment were performed. We characterized biofilms in 32 malignant wounds associated with breast cancer and bacterial floras in 25 such wounds. A mixed group of floras, composed of 54 different bacterial types, was identified, with an average number per patient of 3.6 aerobic species and 1.7 anaerobic species; the presence of strict anaerobic bacterial strains was evidenced in 70% of the wounds; biofilm was observed in 35% of the cases. Odor was a reliable indicator of colonization by anaerobes, even when this symptom was not directly linked to any of the identified anaerobic bacteria. Bacteria are more likely to be present during myelosuppression and significantly increase the emergence of odors and pain when present at amounts of >10(5) · g(-1). The presence of biofilms was not associated with clinical signs or with precise types of bacteria. No infections occurred during the 42-day evaluation period. This study provides a dynamic description of the bacterial floras of tumoral wounds. The study results highlight the absolute need for new therapeutic options that are effective for use on circulating bacteria as well as on bacteria organized in biofilm.

A rat model of central venous catheter to study establishment of long-term bacterial biofilm and related acute and chronic infections.

Formation of resilient biofilms on medical devices colonized by pathogenic microorganisms is a major cause of health-care associated infection. While in vitro biofilm analyses led to promising anti-biofilm approaches, little is known about their translation to in vivo situations and on host contribution to the in vivo dynamics of infections on medical devices. Here we have developed an in vivo model of long-term bacterial biofilm infections in a pediatric totally implantable venous access port (TIVAP) surgically placed in adult rats. Using non-invasive and quantitative bioluminescence, we studied TIVAP contamination by clinically relevant pathogens, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus and Staphylococcus epidermidis, and we demonstrated that TIVAP bacterial populations display typical biofilm phenotypes. In our study, we showed that immunocompetent rats were able to control the colonization and clear the bloodstream infection except for up to 30% that suffered systemic infection and death whereas none of the immunosuppressed rats survived the infection. Besides, we mimicked some clinically relevant TIVAP associated complications such as port-pocket infection and hematogenous route of colonization. Finally, by assessing an optimized antibiotic lock therapy, we established that our in vivo model enables to assess innovative therapeutic strategies against bacterial biofilm infections.

Variable association between Chlamydophila psittaci infection and ocular adnexal lymphomas: methodological biases or true geographical variations?

Since the first publication in 2004, a large number of reports have raised the question of an association between ocular adnexal lymphoma and Chlamydia psittaci. The results of this scientific debate, however, remain controversial. The primary objective of this paper was therefore to raise important questions concerning the interpretation of the different and heterogeneous data on the association between Chlamydophila psittaci and ocular adnexal lymphoma, namely the impact of the methodology used and the epidemiological variability of seroprevalence of C. psittaci antibodies. This paper also provides some methodological suggestions for future studies in the field of chlamydia-lymphoma associations.

Enterovirus 71 meningoencephalitis during chemotherapy in a child with metastatic osteosarcoma.

Enterovirus meningoencephalitis is rare but can be severe. Very few cases of these infections have been reported in pediatric oncology. We report the case of a 10-year-old boy with tibial osteosarcoma and lung metastases who developed enterovirus 71 meningoencephalitis during aplasia. Clinical features comprised fever, hypotension, vesicular rash, generalized seizures, and altered consciousness. Diagnosis was confirmed by polymerase chain reaction on samples of cerebrospinal fluid and skin vesicles. The patient received treatment with intravenous immunoglobulins with an excellent outcome with no cutaneous or neurologic sequelae. Immunoglobulin therapy could be considered in cases of invasive enteroviral infection with such severity in pediatric oncology.