[Streptococcus pyogenes: a rare etiology of non-gonococcal urethritis and balanitis in the adult]. / Streptococcus pyogenes: une cause exceptionnelle d'urétrite et de balanite non gonococcique de l'adulte.

Urethritis and balanitis due to S. pyogenes are very uncommon. The authors report the case of a 22 year-old male patient, presenting with this association, the first case reported in France. There was no associated STD.

[Antibiotic sensitivity of Salmonella isolated in army hospitals between 1998-1999]. / Sensibilité aux antibiotiques des salmonelles isolées dans les hôpitaux des armées en 1998-1999.

OBJECTIVES: Monitor the evolution in France of antibiotic sensitivity of non-typhoid salmonella isolated in fecal cultures conducted in army hospital laboratories. METHODS: A prospective study was performed from January 1998 to December 1999 in all the biology departments of the 11 army hospitals in France. All the non-repetitive strains were sent to an official center for serotyping and determination of the minimum inhibiting concentrations, by dilution in Mueller Hinton's gelose. The antibiotics currently used in treatment were tested and interpretation endpoints followed the recent recommendations of the Antibiogram committee of the French society of microbiology. Identification of beta-lactamase was conducted by iso-electric focalization and polymerization by chain reaction (PCR). For Salmonella Typhimurium, research for the specific resistance locus of the DT104 clone was made using PCR. RESULTS: Two hundred and twenty-two non-repetitive salmonella strains were isolated. The principle serotypes found were: Salmonella Enterididis (23.9%), S. Typhimurium (21.2%) and S. Hadar (10.8%). All the strains were sensitive to ciprofloxacin and cefotaxim, whereas one third exhibited reduced sensitivity to aminopenicillin. Depending on the serotype, Typhimurium and Hadar serotypes exhibited significantly lesser sensitivity to aminopenicillin, nalidixic acid and tetracycline. For S. Typhimurium, resistance is related to the diffusion of the multiresistant DT104 clone, which involves half of the strains of this serotype. For S. Hadar, 18 out of 24 strains (75%) were resistance to nalidixic acid, and 5 of them exhibited reduced resistance to ciprofloxacin. There was no difference in sensitivity to antibiotics between the strains responsible for diarrhea and those isolated in systematic examinations for capacity to work in the food trade (respectively 54 and 46% of strains). CONCLUSION: Non-typhoid salmonella are frequently isolated in diarrhea of infectious origin. The increasing resistance to antibiotics is primarily related to the diffusion of the DT104 clone, regarding S. Typhimurium and to the increase in resistance to quinolone, regarding S. Hadar.

[Suspected epidemic at a hospital in Senegal]. / Suspicion d'épidémie dans un hopital Sénégalais.

Most outbreaks of noscomial infection are detected by means of molecular biological testing. However Euclidian distance is a rapid, reliable alternative if facilities for molecular biological testing are unavailable, as at the Principal Hospital in Dakar, Senegal. Over the 7 month period from 01/10/98 to 31/04/99, 110 of the 1033 blood cultures specimens collected in a group of 2360 children hospitalized in pediatric departments A and B of the Principal Hospital were found to be positive for Burkholderia cepacia. This high incidence suggested the possibility of an epidemic. This likelihood was further increased by evidence showing that all strains exhibited the same biotype and by results of pulsed-field electrophoresis (CHEF Mapper, Spel digestion) indicating that bacteria was of clonal origin. These findings were entirely consistent with those obtained by Euclidian distance but excessive mortality was not observed in the children involved. Testing of environmental specimens demonstrated the presence of the same strains in respirators and catheters. The most feasible hypothesis to account for these findings is environmental contamination resulting in mucocutaneous contamination of patients. Hemoculture containers were probably contaminated during handling.

[Sensitivity to antibiotics of bacteria from nosocomial infections. Evolution in resuscitation services of military hospitals]. / Sensibilité aux antibiotiques des bactéries d'infections nosocomiales. Evolution dans les services de réanimation des hôpitaux des armées.

OBJECTIVE: The aim of this study, conducted in the French Military hospitals, was to monitor the course of the antimicrobial sensibility of bacteria isolated from nosocomial infection in intensive care units. PATIENTS AND METHODS: A prospective study has been conducted from January to December 1998 in all the intensive care units of the French Army. All the non-repetitive strains isolated from nosocomial infection were collected and sent to a reference centre. Antimicrobial susceptibility was determined by the agar dilution method. Beta-lactamase were identified by iso-electro-focalisation. Antibiotics choice and interpretative criteria were those of the "Comité Français de l'Antibiogramme de la Société Française de Microbiologie". RESULTS: A total of 849 strains are included in this study. Pseudomonas aeruginosa was the most frequently isolated bacterium (20%) followed by Escherichia coli (19%) Staphylococcus aureus (15%), coagulase-negative Staphylococci (CoNS) (11%) and Enterococci (7%). Imipenem was the most effective antibiotic against enterobacteriaceae (336 isolates; 100% susceptibility). Gentamicin (92%), amikacin (92%) third generation cephalosporins (83%), aztreonam (83%) and ciprofloxacin (78%) were also very effective. Resistance to III generation cephalosporins was correlated with an extended spectrum beta-lactamase (BLSE) in 36% of cases. This BLSE could be associated with an over production of the constitutive cephalosporinase. The most frequent species producing BLSE were Enterobacter aerogenes (75% of BLSE) and Klebsiella pneumoniae (17%). Among the 172 P. aeruginosa isolated, antimicrobial susceptibility were respectively: 71% for imipenem, 62%: tobramycin, 60%: amikacin 59%: ciprofloxacin 59% piperacillin + tazobactam, 55% piperacillin, 53%: ceftazidime and 44% for ticarcillin. Seventy per cent of the 96 CoNS and 50.2% of the 126 S. aureus isolated were resistant to methicillin. A strain of S. aureus and 2 CoNS strains had intermediate resistance to teicoplanin. Twenty per cent of the 59 Enterococci strains isolated were resistant to aminopenicillins (10/11 strains of E. faecium), and 9% presented a high level of resistance to gentamicine. One strain of E. faecium was resistant to vancomycin. CONCLUSION: The evolution of the susceptibility to antibiotics in intensive care units reflects the antibiotic pressure and level of cross-transmission. High rates of meticillin-resistance among staphylococci, of resistance to beta-lactams antibiotics among P. aeruginosa and of ciprofloxacin among Enterobacteriaceae are shown in this study. The implementation of appropriate strategies for surveillance and prevention is necessary.

[Inter-laboratory reproducibility of pulsed-field electrophoresis for the study of 12 types of Pseudomonas aeruginosa]. / Reproductibilité inter-laboratoire de l'électrophorèse en champ pulsé dans l'étude de 12 souches de Pseudomonas aeruginosa.

The increasing hospital-to-hospital transmission of multiple drug-resistant bacteria is a major concern for bacteriology laboratories involved in nosocomial infection control. The interlaboratory reproducibility of pulsed-field gel electrophoresis (PFGE) for Pseudomonas aeruginosa typing was evaluated by asking four hospital laboratories (two in Lyon, one in Brest, and one in Marseille) to study 11 P. aeruginosa isolates, some of which were epidemiologically related, and the reference strain ATCC 27853. Two laboratories used the Genepath system, one the Chef DR II, system, and one the Chef Mapper system, Bio-Rad, restriction/Spe I. Profiles were read visually and by computerized comparison of restriction band molecular weights (Taxotron, software, PAD Grimont, Pasteur Institute, Paris, France). These two methods led to similar epidemiological conclusions. However, centralization of the data showed poor center-to-center reproducibility due to inadequate standardization of the procedure.

[Histamine food poisoning]. / Les intoxications alimentaires histaminiques.

The authors describe a collective histamine related food-poisoning epidemic that occurred in the Navy due to the consumption of imported smoked swordfish (Xyphias gladius). Twenty cases were detected. The relative risk among consumers of swordfish is at 7.44 (C.I. of 95%: 2.57-21.59) and the doses of histamine were from 2.030 to 4.750 ppm in 9 samples of tested fish (N < 200 ppm). The interest in using a high-resolution chromatographic liquid to ensure a diagnosis, and in using the community norms in force are shown. A recent review of the literature serves to show the variety of fish responsible for this type of accident, to insist on the mildness, elusiveness, variability, and lack of specificity of clinical signs and therefore risks error in diagnoses, treatment and under-reporting of this type of collective food-poisoning.

Exposure to enteroviruses and hepatitis A virus among divers in environmental waters in France, first biological and serological survey of a controlled cohort.

An epidemiological study of hepatitis A and enteroviruses was conducted in a military diving training school, by evaluating the viral contamination of water using an ultrafiltration concentration technique, and assessing seroconversion and the presence of virus in stool specimens obtained from 109 divers and 48 controls. Three of 29 water specimens were positive for enterovirus by cell culture and 9 by molecular hybridization. There was little or no risk of virus infection during the training course (49 h exposure) because there was no significant difference between divers and controls for both viral isolation and seroconversion. However, a higher percentage of coxsackievirus B4 and B5 seropositive divers suggests that these were more exposed during previous water training. No hepatitis A virus (HAV) detection and no seroconversion to HAV was observed. The rate of HAV seropositive subjects was 17% in this 24.5-year-old population.

[Value of the E-test for the determination of the susceptibility to antibiotics of Neisseria meningitidis]. / Intérêt de l'E-test dans la détermination de la sensibilité aux antibiotiques de Neisseria meningitidis.

The E-test was evaluated by comparison with the reference agar dilution method on 50 N. meningitidis strains belonging to serotypes A [13], B [17] and C [12] or not agglutinated, isolated in France and Djibouti from cerebrospinal fluid. All strains were sensible by the reference method to penicillin G, cefotaxime, chloramphenicol, ciprofloxacin, doxycyclin, rifampicin. For erythromycin, some strains were intermediate (7/50). N. meningitidis serogroup A ATCC 13077 was used as control. The E-test quantitative accuracy compared with agar dilution results was 80% (+/- 1 log2) or 97% (+/- 2 log2). The E-test generally showed lower inhibitory concentration values than the agar dilution method. Some technical problems appear in our experience: agar plates must be well dried; on 85 mm diameter agar plates only one strip can be tested. The E-test for determination of antibiotic resistance of N. meningitidis is an easy but expensive method, which give reliable results with agar dilution.

[Evaluation of a micromethod for the bactericidal activity of five disinfectants on 108 hospital strains]. / Evaluation par une microméthode de l'activité bactéricide de cinq désinfectants sur 108 souches hospitalières.

The authors studied 5 disinfectants containing aldehyde and quaternary ammonium against 108 hospital strains. The minimal bactericidal activities (MBC) were determined with a microdilution method and the dilution-neutralization method (AFNOR T 72-150). The microdilution method results were validated using the MBCs of four reference strains tested with the dilution-neutralization method (AFNOR T 72-150). 3 disinfectants proved to be valuable. 1 disinfectant was valuable but with a MBC toward all bacteria only a dilution away from the dilution of use. 1 disinfectant was determined as unsatisfactory as 9.5 p. cent of all strains proved resistant toward it. All disinfectants matched AFNOR standards; but those specifications did not match toward hospital strains. Such an evaluation using a simple and reliable method should be of use.

[Schnitzler's syndrome. A new case]. / Syndrome de Schnitzler. Une nouvelle observation.

A new case of Schnitzler's syndrome is reported in a 72-year old man hospitalized for severe deterioration of his general condition associated with recurrent ancient urticaria. Paraclinical examinations, which showed inflammatory syndrome, bone condensation and IgM monoclonal gammapathy, led to the diagnosis of Schnitzler's syndrome, first described in 1972. Twenty-two cases have now been published, characterized by vasculitic urticaria, osteosclerosis and IgM macroglobulinaemia. There is also severe inflammatory syndrome and the other immunological examinations are normal. Recent studies suggest the possibility of uncontrolled activity of interleukin-1 alpha. The condition is chronic and usually benign, but the fear of malignant transformation in the long term makes the therapeutic choice difficult.

[Incidence of nosocomial infections in a military hospital]. / Incidence des infections nosocomiales dans un hôpital des armées.

Over a 2-year period, 479 cases of nosocomial infections were identified in our hospital by a surveillance method based on the bacteriological laboratory results. The monthly incidence rate ranged from 1.8 to 4 percent of all in-patients. With this method, a 2 percent background noise and a 4 percent alarm threshold could be defined. The most frequent nosocomial infections were urinary tract infections (77 percent), purulent skin infections (12 percent) and septicaemias (10 percent). Compared during 15 days with the most sensitive surveillance method of the National Nosocomial Infections Surveillance System, our method proved insufficient to detect nosocomial lung infections and superficial surgical wound infections. On the other hand, it was highly satisfactory to watch for urinary tract infections and septicaemias. Improvements that would not put a heavy burden on the work of clinical departments are suggested.

The chemoprophylaxis of cerebrospinal meningitis using rifampin in a military population.

Since February 5th 1990, the prevention of secondary cases of cerebrospinal meningitis (CSM) in France has been obtained by the use of rifampin. Following the detection of a case of N. meningitidis of antigenic formula B:NT:P1.15,16 in a military population, 89 contacts subjects received 600 mg rifampin twice a day during 2 days. Meningococcal carriage rate was investigated by nasopharyngeal swab sampling of the 89 subjects and 62 non-contact controls from the same community. Twenty-three days after the initial case of meningitis, carriage rate was 5.6% for treated subjects and 37.1 for controls. Sero-grouping, serotyping and subtyping failed to detect the initial virulent strain; it demonstrated the heterogeneity of circulating strains. Since rifampin-resistant mutants may occur, two strains in the treated group, it is essential that chemoprophylaxis in a community be limited strictly to the contact subjects.

[Malaria: chloroquine resistance]. / Paludisme: la résistance a la chloroquine.

Chloroquine remains the most commonly antimalaric drug utilized all around the world (340 t in 1988). Its efficiency is linked to its action on the digestive vacuole of plasmodium. Since 1957, the areas of resistance are spreading over of an alarming way, striking all continents. 3,000 cases of malaria are imported in France each year, and 90% of the strains tested in vitro by incorporating tritium hypoxanthine are resistant to chloroquine. The resistant parasites are able to exclude chloroquine from their cytoplasm and produce in great number two genes to synthetize a glycoprotein, probable agent of cellular exclusion of the antimalaric drug. Despite of it, to prescribe chloroquine in prophylaxis remains indispensable, because the risk of severe malaria due to some sensitive strains of Plasmodium falciparum.

[Focus on Schistosoma intercalatum]. / Le point sur Schistosoma intercalatum.

Area of frequent occurrence of Schistosoma intercalatum is limited to few countries along the Guinea Gulf although the main intervening agents, Bulinus globosus, Bulinus forskalii are dispersed all over Africa. Reservoir of Schistosoma intercalatum is only human and its cycle is difficult to keep up in test animals. Clinical manifestations are, the most often, a simultaneous inflammation of the rectum and sigmoid. Diagnosis is based on the presence of ova with terminal spine in feces or in biopsies of rectal mucosae. Serology, not specific of this species, eases finding of low infestations. Treatment is based on Praziquantel.