Characteristics and costs of carbapenemase-producing enterobacteria carriers (2012/2013).

OBJECTIVES: We had for aim to determine the characteristics of carbapenemase-producing enterobacteria (CPE) carriers and to assess the economic impact of isolation measures leading to loss of activity (closed beds, prolonged hospital stays) and additional personnel hours. PATIENTS AND METHODS: We conducted a retrospective study for 2years (2012/2013), in a French general hospital, focusing on CPE carriers with clinical case description. The costs were estimated by comparing the activity of concerned units (excluding the ICU) during periods with CPE carriers or contacts, during the same periods of the year (n-1), plus additional hours and rectal swabs. RESULTS: Sixteen EPC carriers were identified: 10 men and 6 women, 65±10years of age. Seven patients acquired EPC in hospital during 2 outbreaks in 2012. Four patients presented with an infection (peritonitis, catheter infection, and 2 cases of obstructive pyelonephritis) with a favorable outcome. The median length of stay was 21days [4,150]. Six patients died, 1 death was indirectly due to CPE because of inappropriate empiric antibiotic therapy. A decrease in activity was observed compared to the previous year with an estimated 547,303€ loss. The 1779 additional hours cost 63,870€, and 716 screening samples cost 30,931€. The total additional cost was estimated at 642,104€ for the institution. CONCLUSIONS: Specialized teams for CPE carriers and isolation of contact patients, required to avoid/control epidemics, have an important additional cost. An appreciation of their support is needed, as well as participation of rehabilitation units.

[Comparison of two ELISA tests to study the seroprevalence of herpes simplex 1 et 2 infection in a maternity near Paris]. / Comparaison de deux techniques Elisa pour l'étude de la séroprévalence de l'infection à herpes simplex 1 et 2 dans une maternité de la région parisienne.

UNLABELLED: The diagnosis of herpes simplex virus (HSV) genital infection is primarily clinical. The primary indication for serodiagnosis is to detect seronegativity in pregnant women at risk of acquiring the HSV virus during the course of their pregnancy. In this study, two ELISA tests were compared for the detection of HSV infection among a population of 307 pregnant women followed at the maternity of a community-based hospital in France (Robert Ballanger hospital in the Seine-Saint-Denis department). The two tests compared were: Test Captia anti-HSV-1 and anti-HSV-2 specifics IgG of Trinity Biotech and the ELISA IgG HerpesSelect 1 and 2 of FOCUS Diagnostics distributed by Eurobio Courtaboeuf, France. RESULTS: Both tests results were similar in terms of population prevalence for HSV-1 and HSV-2 infections (respectively 86.64% and 85.99% for HSV-1; 17.59% and 15.31% for HSV-2). Whereas the prevalence of the HSV-1 virus was described in the literature as being superior to our current results, the prevalence of HSV-2 according to the results of both ELISA tests studied was similar to the one described in previous cohort studies.

[Detection of HBV DNA by sensitive techniques and definition of chronic VHB infection by pre-C-C mutants]. / Détection de l'ADN du VHB par des techniques sensibles et définition de l'infection VHB chronique à mutants pré-C-C.

Our purpose is to assess the question of the definition of hepatitis B virus pre-C-C mutant-chronic infection, according to the level of the viral load at the era of very sensitive techniques of quantification of HBV DNA.

[Bilateral acute retinal necrosis syndrome associated with meningoencephalitis caused by herpes simplex virus 2. A case report]. / Nécrose rétinienne aiguë bilatérale associée à une méningo-encéphalite à herpes simplex virus 2.

INTRODUCTION: Acute retinal necrosis syndrome (ARN syndrome) is a rare viral disease with a poor prognosis in most cases. It is characterized by substantial ocular inflammation with progressive retinal necrosis, occlusive vasculitis and sometimes extraocular features. CASE REPORT: We report the case of a 62-year-old woman who was referred for a suspicion of a stroke. Ophthalmological examination revealed a profound bilateral visual loss due to extensive retinal necrosis. The patient was immediately treated with antiherpetic drugs. ARN syndrome with meningoencephalitis caused by herpes simplex virus type 2 was confirmed by PCR studies performed on aqueous humor and cerebrospinal fluid. Herpes simplex virus 2 (IgG+ , IgM-) was probably reactivated after intrathecal injection of steroids because of pain associated with narrowing of the lumbar vertebral canal. The patient was treated with intravenous Acyclovir for 3 weeks. After 4 months, both retinas were detached. DISCUSSION AND CONCLUSION: ARN syndrome caused by herpes simplex virus 2 most often occurs after reactivation of the latent virus in patients with a neurological medical history or congenital infection. Antiviral treatment must begin early to decrease risks of bilateralization and complications.

[RT-PCR in clinical diagnosis]. / La RT-PCR en diagnostic clinique.

Application fields of RT-PCR (reverse transcription-polymerase chain reaction) in clinical diagnosis comprises the assessment of viral load for RNA viruses and the analysis of gene transcription products. RT-PCR is also helpful when large genes have to be sequenced. Developments of quantitative approaches using real-time PCR recently led to a major widening of RT-PCR applications in clinical diagnosis. However, RT reaction is delicate due to its lack of reproducibility and to RNA lability and frequent contamination by DNA. In some cases additional difficulties come from the need to obtain a specific amplification in the presence of homologous sequences which might be present in higher amounts than the sequence of interest. These caveats have to be taken into account, when designing the RT protocol, and when choosing PCR primers and internal and/or external references. This review is aimed at helping the experimental setup of a RT-PCR based assay according to the objectives.

Sepsis due to Clostridium perfringens after pregnancy termination with feticide by cordocentesis: a case report.

We report a case of sepsis due to Clostridium perfringens after termination of pregnancy at 22 weeks with feticide by cordocentesis. Three weeks earlier, the 41-year-old patient had undergone an amniocentesis and a full trisomy 13 karyotype had been discovered. Feticide was performed by injection of thiopental and potassium chloride after percutaneous umbilical foetal blood sampling through the same needle. The patient delivered vaginally with signs of chorioamnionitis and septicaemia. She recovered under broad-spectrum antibiotherapy. C. perfringens was present in maternal blood cultures, placental smears and foetal organs. We discuss the possible mechanisms of infection by C. perfringens, including inoculation of intestinal germs.

[Pleural trichomoniasis due to trichomonas tenax]. / Trichomonase pleurale à Trichomonas tenax.

Thoracic infections due to Trichomonas species often go unrecognised as they are seldom described in the literature. We describe a case that, to our knowledge, is the first reported case of empyema caused by this organism. A 59 year old man with metastatic adenocarcinoma of the lung developed a right pyopneumothorax following treatment with corticosteroids and radiotherapy. The pleural fluid was purulent and fetid, and contained large numbers of Trichomonas tenax amongst a mixed bacterial flora. Pleural drainage and antibiotic therapy with metronidazole, ciprofloxacin and gentalline were instituted immediately, but the patient died 4 days later. Trichomonas tenax is part of the normal oral floral and may on occasions colonize the airways. It can thus become involved during aspiration pneumonia or cause pleural infection following the rupture of a pulmonary abscess. Such infection tends to be associated with concurrent respiratory pathology or with immunodepression. The significance Trichomonas tenax when found in the airways is unclear and their pathogenic role is discussed.

Effect of individual plasma lipoprotein(a) variations in vivo on its competition with plasminogen for fibrin and cell binding: An in vitro study using plasma from children with idiopathic nephrotic syndrome.

Simultaneous natural changes in lipoprotein(a) [Lp(a)] and plasminogen occur in the nephrotic syndrome and offer a unique opportunity to investigate their effects on plasminogen activation under conditions fashioned in vivo. Plasminogen, Lp(a), and apolipoprotein(a) in plasma were characterized, and their competitive binding to carboxy-terminal lysine residues of fibrin and cell membrane proteins was determined in nephrotic children during a flare-up of the disease (61 cases) and after 6 weeks (33 cases) and 6 months (42 cases) of remission. Low plasminogen concentrations (median 1.34 micromol/L, range 0.39 to 1.96 micromol/L) and high Lp(a) levels (median 0.27 g/L, range 0.07 to 2. 57 g/L) were detected at flare-up. These changes were associated with an increased Lp(a) binding ratio onto fibrin (3.13+/-0.48) and cells (1.53+/-0.24) compared with binding ratios of control children (1.31+/-0.19 and 1.05+/-0.07, respectively) with normal plasminogen and low Lp(a) (median 0.071 g/L). After 6 weeks and 6 months of remission, the values for net decrease in Lp(a) binding to fibrin were 1.7+/-0.22 (after 6 weeks) and 1.88+/-0.38 (after 6 months) and were correlated with low Lp(a) concentrations (median 0.2 g/L, range 0.07 to 0.8 g/L; and median 0.12 g/L, range 0.07 to 1.34 g/L) and inversely associated with increased plasminogen levels (median 1.82 micromol/L, range 1.4 to 2.1 micromol/L; and median 1.58 micromol/L, range 1.1 to 2.1 micromol/L). These studies provide the first quantitative evidence that binding of Lp(a) to lysine residues of fibrin and cell surfaces is directly related to circulating levels of both plasminogen and Lp(a) and that these glycoproteins may interact as competitive ligands for these biological surfaces in vivo. This mechanism may be of relevance to the atherothrombotic role of Lp(a), particularly in nephrotic patients.

[PCR SSCP study of an echovirus 30 meningitis outbreak]. / Etude par PCR SSCP d'une épidémie de méningite à échovirus 30.

Between April and October 1997, 21 children of 4 days to 13 years old were admitted to the Pedatric Unit of Aulnay Sous Bois's Hospital for viral meningitidis. The number of white blood cells in the cerebrospinal fluid (CSF) was between 1 and 612 cells/mm3, with, on an average, 56% of segmented cells, 34% lymphocytes and 34% monocytes. Proteins and glucose of CSF were standard. One CSF was normal. Viral meningitidis was confirmed by viral culture of CSF onto MRC5. Enterovirus were identified by direct immunofluorescence (Monoclonal Mouse Anti-Enterovirus, Dako). Serotyping (Enterovirus antisera, Eurobio, Trousses 4) identified an echovirus 30 in all cases. A highly conserved 154 bp sequence at the 5'non-coding region was studied by reverse transcription-polymerase chain reaction (RT-PCR) followed by single-strand conformation polymorphism (SSCP) (GenPhor, Pharmacia) analysis. Two dominant SSCP patterns were observed: the first contained 4/21 strains and the other 10/21 strains. The SSCP patterns of the 7 other strains were different. These results show that 2 echovirus 30 dominant clones were responsible of viral meningitidis admitted to the Pediatric Unit of Aulnay Sous Bois's hospital, between april and october 1997. The PCR-SSCP of the 5'non-coding region of echovirus 30 is a convenient, simple, reproducible epidemiologic method and it's easily applicable in a general hospital.

Coexpression of anionic glutathione-S-transferase (GST pi) and multidrug resistance (mdr1) genes in acute myeloid and lymphoid leukemias.

By using RNA slot-blot technique the frequency and degree of GST pi and mdr1 gene coexpression was investigated in 23 patients with acute myeloid leukemia (AML), and nine patients with acute lymphoid leukemia (ALL). With respect to the negative controls, MCF7 and HL-60 cell lines, increased GST pi and mdr1 mRNA levels, expressed as arbitrary units (U), were respectively detected both in AML and in ALL patients. A positive and significant correlation between GST pi and mdr1 gene expression was found in the group of AML patients, while in the smaller group of ALL patients only a trend could be shown. These data show that two different mechanisms of drug resistance can be coexpressed at the same time in patients with acute myeloid and lymphoid leukemia. From this evidence many important clinical and therapeutic questions arise.