Current knowledge and practice of Candida auris screening in France: A nationwide survey from the French Society of Medical Mycology (SFMM).

Due to large outbreaks observed worldwide, Candida auris has emerged as a major threat to healthcare facilities. To prevent these phenomena, a systematic screening should be performed in patients transferred from regions where the pathogen is highly endemic. In this study, we recorded and analyzed French mycologists' current knowledge and practice regarding C. auris screening and diagnosis. Thirty-six centers answered an online questionnaire. Only 11 (30.6 %) participants were aware of any systematic screening for C. auris for patients admitted to their hospital. In the case of post-admission screening, axillae/groins (n = 21), nares (n = 7), rectum (n = 9), and mouth (n = 6) alone or various combinations were the body sites the most frequently sampled. Only six centers (8.3 %) reported using a commercially available plate allowing the differentiation of C. auris colonies from that of other Candida species, while five laboratories (13.8 %) had implemented a C. auris-specific qPCR. Considering the potential impact on infected patients and the risk of disorganization in the care of patients, it is crucial to remember to biologists and clinicians the utmost importance of systematic screening on admission.

Antifungal susceptibility testing practices in mycology laboratories in France, 2018.

A survey of mycology laboratories for antifungal susceptibility testing (AFST) was undertaken in France in 2018, to better understand the difference in practices between the participating centers and to identify the difficulties they may encounter as well as eventual gaps with published standards and guidelines. The survey captured information from 45 mycology laboratories in France on how they perform AFST (number of strains tested, preferred method, technical and quality aspects, interpretation of the MIC values, reading and interpretation difficulties). Results indicated that 86% of respondents used Etest as AFST method, with a combination of one to seven antifungal agents tested. Most of the participating laboratories used similar technical parameters to perform their AFST method and a large majority used, as recommended, internal and external quality assessments. Almost all the participating mycology laboratories (98%) reported difficulties to interpret the MIC values, especially when no clinical breakpoints are available. The survey highlighted that the current AFST practices in France need homogenization, particularly for MIC reading and interpretation.

Investigation of nosocomial pneumocystis infections: usefulness of longitudinal screening of epidemic and post-epidemic pneumocystis genotypes.

BACKGROUND: Twenty-five patients, of whom 22 were renal transplant recipients, developed Pneumocystis jirovecii infections at the nephrology department of Reims University Hospital (France) from September 2008 to October 2009, whereas only four sporadic cases had been diagnosed in this department over the 14 previous years. AIM: This outbreak was investigated by analysing patient encounters and P. jirovecii types. METHODS: A transmission map was drawn up. P. jirovecii typing at DHPS, ITS and mtLSU rRNA sequences was performed in the patients of the cluster (18 patients with Pneumocystis pneumonia (PCP) and seven colonized patients), 10 unlinked control patients (six PCP patients and four colonized patients), as well as 23 other patients diagnosed with P. jirovecii (nine PCP patients and 14 colonized patients) in the same department over a three-year post-epidemic period. FINDINGS: Eleven encounters between patients harbouring the same types were observed. Three PCP patients and one colonized patient were considered as possible index cases. The most frequent types in the cluster group and the control group were identical. However, their frequency was significantly higher in the first than in the second group (P < 0.01). Identical types were also identified in the post-epidemic group, suggesting a second outbreak due to the same strain, contemporary to a disruption in prevention measures. CONCLUSIONS: These results provide additional data on the role of both PCP and colonized patients as infectious sources. Longitudinal screening of P. jirovecii types in infected patients, including colonized patients, is required in the investigation of the fungus's circulation within hospitals.

Detection of Loa loa Microfilariae in Follicular Fluid During Assisted Reproductive Technology: Case Report and Review of the Literature.

We report on a case of loiasis revealed during an assisted reproductive technology (ART) cycle. Loa loa could limit implantation outcome. We propose to focus on an ART strategy with frozen embryos to treat the patient before any transfer.

Scedosporium apiospermum Otitis Complicated by a Temporomandibular Arthritis: A Case Report and Mini-Review.

Scedosporium apiospermum is an ubiquitous fungus responsible for various infections in immunocompromised and immunocompetent patients. Ear infections are infrequent. We report an exceptional case of S. apiospermum external otitis complicated by temporomandibular joint arthritis. After 6 months of antibiotherapy, diagnosis was established by mycological analysis of external auditory canal and infratemporal fossae needle sampling. A satisfactory outcome was obtained after 2 months of voriconazole alone. We have reviewed 15 cases of S. apiospermum otitis. Seven of these patients were immunocompromised. Most common clinical presentation included a chronic external otitis lasting months or years before complication stage. Most common clinical features included recurrent unilateral otalgia (11/15) and purulent otorrhea (13/15). Diagnosis was often made at later stage (12/15) with local extension to bones and/or soft tissues (9/15) or cerebral lethal dissemination (3/15).The extremely low incidence of S. apiospermum otomycosis and its non-specific presentation results in a frequent diagnosis delay. A mycological investigation should be performed in case of persistent external otitis and/or osteolysis despite prolonged antibiotic treatment to prevent further extension of the disease.

[Post-traumatic mucormycosis due to Lichtheimia corymbifera: three case reports]. / Mucormycoses post-traumatiques à Lichtheimia corymbifera: à propos de 3 cas.

We report 3 cases of post-traumatic cutaneous mucormycosis caused by Lichtheimia corymbifera, two of them occurring after a farm working accident. Management of post-traumatic mucormycoses consists of a wide excision of the infected tissue, combined with immediate antifungal therapy. Liposomal amphotericin B is the recommended first line treatment. Few studies have evaluated the efficacy of posaconazole. All 3 patients received a surgical debridement and liposomal amphotericin B, which was followed by posaconazole in 2 cases. The duration of the antifungal treatment is not yet well defined. All three patients received a treatment of five weeks with a favorable outcome.

[Acquired jejunal and ileal diverticula (Meckel's excluded)]. / Les diverticules jéjuno-iléaux acquis (Meckel exclus).

Acquired jejuno-ileal diverticulosis are rare (0.1 to 1.4%) but their complications are non exceptional (6 to 13%) with a death rate which can reach 40% in older patients. From a histological view, acquired diverticulosis differ from congenital ones by an absent muscular tunic. Complications consist in, by descending order: diverticulitis, perforation (7%), acute bowel obstruction (3%), intestinal hemorrhage (2.7%) mostly massive, malabsorption of fat, protein, macrocytic anaemia, intestinal tumors same as found in small, bowel. The treatment of small bowel diverticulosis becomes surgical only when complicated. It consists in the strict resection of the complicated diverticulosis area, respecting the asymptomatic diverticulosis. Prophylaxis of the complications is based on healthy diet habits against stasis, bowel pressure using antispasmodics, intestinal disinfectants, residue free diet, and against infection (oral tetracyclines).

[Cancer of the cardia: value of total gastrectomy with partial esophagectomy by laparotomy-right thoracotomy approach]. / Cancer du cardia: intérêt de la gastrectomie totale avec oesophagectomie partielle par laparotomie-thoracotomie droite.

INTRODUCTION: Surgical resection of cardial and subcardial cancers is often associated with pathological involvement of esophageal section margin, resulting in early anastomotic recurrences. Total gastrectomy associated with partial esophagectomy through combined abdominal and right thoracic approach allows esophageal section under azygos vein. PATIENTS AND METHODS: We studied, in 17 patients operated on using this procedure, post-operative morbidity, mortality and anastomotic relapse. RESULTS: No post-operative death, fistula or anastomotic relapse have been observed. Two patients exhibited benign infectious post-operative complication. CONCLUSION: Total gastrectomy with partial esophagectomy through combined abdominal and right thoracic approach seems therefore to be considered as a good alternative in the surgical management of cardial and subcardial carcinomas.

[Severe chronic parenchymatous pancreatitis: surgical treatment by wirsungo-sphincteroclasia. Original technique: 92 cases]. / Pancréatite chronique parenchymateuse sévère: traitement chirurgical par wirsungo-sphinctéroclasie. Technique originale: 92 cas.

Since october 1986, we have performed 92 wirsungo-sphincteroclasias (W-SC) in patients with severe chronic pancreatitis who did not have dominant cavity formation (which can be managed by simple cyst-duodenostomy) and presented dilatation (even moderate) of the Wirsung's duct. This novel technique involves identification of the biliopancreatic outlet by biliary spincteroclasia followed by short cephalic wirsungotomy. This method allows desobstruction of the duct both upstream and downstream followed by drilling and calibration of the duct and the ampula to 9 to 11 mm. The wirsungotomy is then sutured and a temporary naso-wirsung drain is installed instead of a wirsungojejunal Y anastomosis. Biliodigestive anastomosis was also required in 64 cases using a Vankemmel cholecystoplasty in all cases except 2 (prior cholecystectomy). Duodenoplasty and gastrojejunostomy were also required in 4 and 3 cases respectively. There were no post-operative deaths and pancreatic fistulization was never observed. The mean hospital stay after surgery was 12.2 days. Long-term follow-up at 3 to 33 months showed 6 reoperations (W-SC) and 5 more cases of biliodigestive anastomosis. Actuarial survival at 5 years was 81.5% with 90.7% good and excellent results with weight gain in 50% of the cases. The rate of diabetes degradation was better than with other treatment modalities. These very encouraging results have led us to abandon the more classical techniques of exeresis or pancreatojejunal drainage into an excluded loop in favor of W-SC for chronic parenchymatous pancreatitis or cyst-duodenostomy for chronic cavitary pancreatitis. The procedure is associated with a biliodigestive anastomosis using the Vankemmel plasty in about two-thirds of the cases.

[Sarcoidosis with extensive ulcerating and atrophying cutaneous manifestations (of the Pick-Herxheimer type) and with cardiac and muscular involvement. About one case (author's transl)]. / Sarcoïdose a manifestations cutanées extensives ulcéreuses et atrophiantes (de type Pick-Herxheimer) avec complications cardiaques et musculaires. A propos d'un cas.

The authors report an unusual case of chronic sarcoidosis with skin ulcerations and atrophic lesions simulating Pick-Herxheimer's disease. Other severe manifestations are found: cardiac involvement with conduction disturbances and myocardial failure, and muscular involvement which responded well to corticosteroid therapy.

[Shulman's syndrome: fasciitis with eosinophilia, pseudoscleroderma with eosinophilia]. / Le syndrome de shulman: fasciite avec eosinophilie; pseudo-sclérodermie a éosinophiles. A propos de 2 cas.

The authors report two cases of the Shulman's syndrome. Twenty one cases of this new entity are found in the literature. The main signs are the acute painful onset after an unusual physical exertion, the development of fasciitis, and (or) myositis, and (or) scleroderma of limbs, the absence of Raynaud's phenomenon, visceral involvement, constant eosinophilia and hypergammaglobulinemia; the prognosis is good with an improvement sometimes spontaneous or coincident with prednisone therapy. One of the observations is interesting by the association with Gougerot-Sjogren's syndrome, and a familial case of morphea. The prognosis in this case is mediocre: failure of corticotherapy, and incomplete remission with cyclophosphamide.

[Changes in plasma level of corticotropin after intravenous injection of metyrapone. Value of this test in pituitary pathology]. / Variations du taux plasmatique d'hormone corticotrope après injection intraveineuse de métyrapone. Intérêt de ce test en pathologie hypophysaire

The Metyrapone was given, the morning, in perfusion intravenous of saline serum over 2 hours. A.C.T.H. levels were determined before and at 2, 4, 8 and 24 hours. Sixteen normal subjects adults served on controls with 1 g of Metyrapone. Sixteen other normal subjects with 2 g of Metyrapone are best responses. With this maximum dose 2 g were studied nine hypophysal adenomas with three low responses, three normal and three high responses; thirteen hypophysectomised subjects with very low peak value at 4 hours, and only two responses higher than the controls, five Cushing's syndromes with variable responses. The I.V. Metyrapone test seems to offer several advantages: it eliminates the questions about gastro-intestinal absorption of Metyrapone (oral) and the difficulties of urine collection. With the A.C.T.H. dosage on 4 hours, this is a rapid test able to put in combination other hypophysal tests.

[T.R.H. test in 93 cases of thyroid disease]. / Test à la t.r.h. dans 93 affections thyroïdiennes

The authors used the stimulation of TSH test by intravenous injection of TRH in 93 patients. They obtained a negative or weak response in thyrotoxicosis, toxic adenomas, and Means syndrome, and a normal response with non-extinctive hot nodules. The response was positive and high in primary hypothyroidism. The results are sometimes paradoxal in hypothalamo-pituitary pathology even after hypophysectomy: a delayed and elevated response is in favour of a pituitary reserve of non-utilised TSH. In non-functional goitres and thyroiditis, the sometimes positive responses obtained are an indication for substitutive and depressive therapy.