[Septicemia, bilateral community acquired pneumonia and empyema due to Burkholderia pseudomallei (mellioidosis) with a favorable outcome following prolonged specific antibiotic therapy]. / Septicémie, pneumopathie bilatérale et pleurésie purulente à Burkholderia pseudomallei (mélioïdose) d'évolution favorable sous antibiothérapie adaptée, prolongée.

INTRODUCTION: Melioidosis is an infectious disease due to Burkholderia pseudomallei (Bp). It is regarded as endemic in southeast Asia and northern Australia. The septicaemic form is a severe illness with a high mortality. The tsunami in 2004 has renewed its current importance. CASE REPORT: A 57 year old man was admitted to hospital with a 2 week history of fever, productive cough and progressive weight loss. On admission he was in septic shock and respiratory failures secondary to a left lower lobe community acquired pneumonia. This progressed to a left sided empyema. Bp was isolated from blood cultures and the pleural pus. Initial intensive therapy with ceftazidime and cotrimoxazole for 4 weeks, followed by cotrimoxazole alone for 20 weeks, led to complete recovery with little residual radiological abnormality. Follow up gave no evidence of relapse but revealed an operable, squamous cell, bronchial carcinoma. CONCLUSION: Melliodosis seems to be an emerging disease in New Caledonia with 10 cases identified since 1999. A favourable climate and possibly an animal reservoir might explain sporadic cases in this region. It is important for the medical profession to be aware of this disease in order to ensure the rapid and correct management of patients whose life is at risk.

[Necrotizing pneumonia due to Gemella morbillorum in an immunocompetent patient]. / Pneumopathie nécrosante à Gemella morbillorum chez un patient immunocompétent.

BACKGROUND: Gemella morbillorum is an anaerobic to aerotolerant Gram positive coccus. It is considered a member of the normal upper respiratory tract flora including the oropharynx and also the gastro-intestinal and female genital tract. However severe infections are reported like endocarditis, septic shock and septic arthritis, more often in immunocompromised hosts. It is an infrequently isolated organism and a rare cause of pulmonary or pleural infections. CASE REPORT: We report a case of necrotizing pneumonia due to Gemella morbillorum in a 45-years-old Melanesian, smoker patient. The presentation was subacute with a four month history of loss of appetite, progressive weight loss and cough without fever. Initial presentation seems to be a malignant disease. The positive diagnosis has been established on the results of BAL fluid and the protected specimen brush samples. It was an immunocompetent patient presenting dental inflammation but not oral infection. Further management included intravenous administration of amoxicillin during two weeks. We recommended oral antibiotic treatment for another six weeks. After two months the patient was reevaluated. The CT scan showed no evidence of persistent infection. The HR CT scan will reveal multiple kystic bronchiectasies not seen on the first CT scan. CONCLUSION: Gm can be found endoscopic samples. Gemella morbillorum can be responsible of community-acquired pneumonia in immunocompetent host.

The prevalence of Mycobacterium tuberculosis drug resistance in New Caledonia, 1995-1996.

SETTING: Study of the susceptibility to anti-tuberculosis drugs of Mycobacterium tuberculosis strains isolated in New Caledonia, a French South Pacific Territory, where tuberculosis continues to be a public health problem. OBJECTIVE: To assess the stability of this susceptibility in order to justify both non-systematic susceptibility testing and the implementation of simplified chemotherapy regimens. METHODS: Over a period of nearly 2 years (1995-1996), every new case of tuberculosis confirmed by the laboratory was included in the study. A total of 105 strains were tested against five anti-tuberculosis drugs: isoniazid, rifampicin, ethambutol, pyrazinamide and streptomycin. RESULTS: No primary drug resistance was detected for the main drugs. One strain with acquired resistance to isoniazid and streptomycin was isolated from one of the 12 patients suffering a relapse of the disease. CONCLUSIONS: The results of this exhaustive study justify the non-systematic approach to susceptibility testing for new patients. However, for strains isolated from patients suffering from relapse or therapeutic failure, or who belong to a high risk population, drug susceptibility testing should be performed. This kind of management will aid in the detection of possible isoniazid and streptomycin resistance, thus avoiding the selection and possible emergence of strains resistant to rifampicin. The results of the study argue for the use of a fixed dose regimen using triple combination tablets of isoniazid, rifampicin and pyrazinamide (HRZ) for 2 months, followed by dual drug therapy (HR) for 4 months.

[29 cases of malaria introduced into New Caledonia from 1992 to 1995]. / A propos de 29 cas de paludisme importé en Nouvelle-Calédonie de 1992 à 1995.

Although located in a tropical zone of the South Pacific, the island of New Caledonia is malaria-free. This retrospective study of imported malaria was conducted jointly by the Pasteur Institute of New Caledonia and the Gaston Bourret Territorial Hospital between January 1, 1992 and December 31, 1995. A total of 29 patients were hospitalized for malaria. Most contracted the disease in Vanuatu. Plasmodium vivax was involved more often than Plasmodium falciparum (22 vs. 11). No case was severe, complicated, or fatal. In most cases treatment consisted of quinine followed by mefloquine. The median duration of hospitalization was 5.7 days. Since the annual incidence of imported malaria is significantly higher in New Caledonia than in France, the authors propose that a Travelers Information Center should be set up in New Caledonia to improve prophylaxis against malaria.

[X-ray computed tomographic and radiographic aspects of thoracic actinomycosis]. / Aspects radiographiques et tomodensitométriques de l'actinomycose thoracique.

UNLABELLED: The aim of this study was to evaluate chest radiographs and computed tomography (CT) in patients with thoracic actinomycosis. MATERIAL AND METHOD: Chest radiographs and CT scans of 9 patients with proved thoracic actinomycosis were reviewed. CT scans were performed after intravenous contrast administration. RESULTS: Airspace consolidation was present in the upper lobes in 6 patients and in the lower lobes in 3. Cavitations not apparent on the radiographs were seen on CT s in 2 cases. Mediastinal lymphadenopathies were seen on CT s in 2 cases, in one the infection extended through the mediastinal pleura into the mediastinum. Pleural thickening adjacent to the airspace consolidation was identified in 6 cases. Chest wall invasion occurred in 4 cases with a wavy periostal reaction involving ribs adjacent to the site of parenchymal involvement in 3 cases. Extension into the abdomen through the diaphragm was seen in one case. DISCUSSION: In humans, actinomycosis involves the thorax in 15% of the cases. Thoracic and pulmonary parenchymal involvement is usually secondary to aspiration of colonized material from the oropharynx in patients with poor oral hygiene. There is a basilar predominance of the disease, but some studies have reported apical predominance. The pulmonary infection leads to an airspace consolidation mainly in the lung periphery. The infection may extend across fissures and through the pleura. Chest wall and bone invasion are not uncommon. A wavy periosteal reaction involving ribs is said to be highly suggestive of pulmonary actinomycosis. CONCLUSION: Thoracic actinomycosis is characterized by airspace consolidation with adjacent pleural thickening. Chest wall invasion with a wavy periosteal reaction is highly suggestive.

[The double band sign: pleural tuberculosis in x-ray computed tomography]. / Signe de la double bande: tuberculose pleurale en tomodensitométrie.

We described on computed tomography, two cases of pleural tuberculosis with parietal pleural enhancement and thickening associated with another external high density line. We called this parietal pleural and extra pleural change, the "double band sign". After study of the regional anatomy, we think that this external line is the endothoracic fascia.

[Epidemic of pulmonary histoplasmosis after visiting a cave in New Caledonia]. / Epidémie d'histoplasmose pulmonaire après visite d'une grotte en Nouvelle-Calédonie.

We report an epidemic of acute pulmonary histoplasmosis which occurred in February 1994 among a group of 24 persons after they had once or twice visited a cave in New Caledonia. This study describes the physical and laboratory findings, which lead to the diagnosis of histoplasmosis. Each test was evaluated. All members of the group had a physical examination, early and late serological tests, pulmonary X-rays (including CT) and some had mycological examination of bronchoalveolar washes. Mycological investigations were made on samples collected from the cave. Histoplasmic skin testing was not possible. We defined a case as a person who visited the cave in January 1994, had evocative radiological features and at least four symptoms among the following: weakness, fever, headache, arthralgia, thoracic pains, dyspnea, cough and nausea. Of the 24 exposed persons, 7 cases were considered as severe, 8 cases as moderate, and 6 cases as mild, for a total of 21 cases and an attack rate of 87.5%. There was no progression towards disseminated histoplasmosis and no recorded death. The incubation period lasted from 5 to 17 days. The symptoms were divided into three groups. In the first group, the symptoms of fever, headache and arthralgia were common and nonspecific. In the second group, the symptoms of chest pain, cough, and dyspnea which often occurred later, were less common and more specific. In the third group, the symptoms of vomiting, diarrhea and dizziness were less common. The chest X-ray showed abnormalities in 100% of the cases, and in 11 of the 21 cases the characteristic finding was a miliary.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pulmonary dirofilariasis]. / Dirofilariose pulmonaire.

Dirofilariosis usually concerns dogs among which it is transmitted by mosquito bites. Human infection is rare and we describe here a case observed in a 75 years old woman in New Caledonia. A systematic pulmonary radiograph showed suspicious pulmonary nodules. At microscopic examination one can see pulmonary infarctus with thrombosis and Dirofilaria immitis inside a vessel. Diagnosis is usually made by histologic examination because biological investigations are of a little interest. Surgical treatment is enough. Chemioprophylaxia for dogs can reduce the risks of man infection.

[Alveolar opacities and busulfan pneumonia]. / Opacités alvéolaires et pneumopathie au busulfan.

A case of toxic pneumonia due to busulfan is reported in a man aged 65 treated for three years with busulfan for chronic myeloid leukaemia. He was admitted to hospital for dyspnoea, cough, fever and presented with crepitations, dense alveolar opacities, and a restrictive ventilatory defect. Trans-bronchial biopsy showed a filling of the alveoli by fibroblastic tissue, as well as voluminous dystrophic pneumocytes. Four months later in spite of steroid therapy the clinical state and respiratory function were worse. The alveolar opacities have regressed but some diffuse interstitial opacities had appeared. This new case is a reminder that the appearance of alveolar opacities in a patient treated with busulfan should raise the possibility of a toxic pneumonitis to busulfan in the differential diagnosis. This observation also underlines the role of the initial endo-alveolar fibrosis in the ultimate development of interstitial fibrosis.

Peripheral intramonocytic leishmanias in an AIDS patient.

Intramonocytic leishmanias were unexpectedly observed in blood smears of a Spanish AIDS patient. In immunodepressed patients from exposed countries, careful microscopic examination of blood smears should be requested by the clinician in cases of prolonged fever, and biologists must be informed that leishmanias may be fortuitously observed in the peripheral blood.

[Tumoral markers and monoclonal antibodies]. / Marqueurs tumoraux et anticorps monoclonaux.

The frequency of malignant pleuritis in general practice and its often difficult diagnosis have led to the ever increasing use of tumoral markers (TMs) which may overcome these difficulties and of immunocytochemical methods which may improve the results obtained by routine cytology. TMs are used in the diagnosis: a) to detect false-negative results and sometimes exclude false-positive results of cytology ("reactive" mesothelial cells); b) to distinguish reliably between malignant mesothelioma and metastatic pleuritis from an undetected adenocarcinoma, and c) to provide additional information, if needed, on the nature and origin of a malignant pleuritis. In pleural carcinology, TMs can be used as part of various methods which may be biochemical (assays of the marker in serum and, more important, in pleural fluid), cytochemical or immunocytochemical, histochemical or immunohistochemical, cytogenetic and cytofluorimetric. TMs can be defined and classified as follows: 1) intrinsic tumoral cell abnormalities; 2) substances associated with tumours which either induce them in the body without any specificity or secrete first generation TMs such as CEA, hyaluronic acid, NSE, ect.; 3) tumour-related antigens recognized by monoclonal antibodies or second generation markers. These markers, extremely varied, are directed against cell and often cell membrane antigens. They are not always very specific. When assayed separately their diagnostic sensitivity is low, but when used in batteries and combined with routine cytology they may fulfill the objectives listed above and fairly significantly improve the results of cytology. As last resort, they can be used in immunomorphology on cytology or biopsy specimens and provide a decisive answer.