Human babesiosis in Alsace.

OBJECTIVES: Human babesiosis is a rare parasitic anthropozoonosis transmitted to humans by tick bites. Fifty-six cases of human babesiosis have been recorded in Europe. Two cases of babesiosis were reported in Alsace, France, in 2009. We performed a retrospective observational descriptive study to assess the epidemiology of the disease in Alsace. METHODS: Patients were included if they had a positive serology result for Babesia and/or a positive blood smear and/or a positive PCR result. The tests were performed in the microbiology laboratories of the university hospitals of Strasbourg, the civil hospitals of Colmar, and the hospital of Mulhouse between January 1, 2005 and December 31, 2015. Included patients were divided into three groups: definite case group (positive PCR or positive blood smear or seroconversion), possible case group (positive serology results without seroconversion with a compatible clinical picture and without other confirmed diagnoses), and incompatible case group (positive serology results without seroconversion, without compatible clinical picture and/or with other confirmed diagnoses). The compatible clinical picture was defined by the presence of flu-like symptoms and fever (≥38°C). RESULTS: Fifty-one patients had at least one positive result. Three cases were excluded (missing files). There were six definite cases, 12 possible cases, and 30 incompatible cases. All patients in the definite case group were immunocompetent. No deaths occurred. CONCLUSIONS: Human babesiosis is probably underdiagnosed due to its non-specific symptoms, lack of awareness about the disease, and the difficulty in making a diagnosis.

Cerebrospinal fluid monocytes in bacterial meningitis, viral meningitis, and neuroborreliosis.

OBJECTIVE: Cerebrospinal fluid (CSF) leukocytes analysis is commonly used to diagnose meningitis and to differentiate bacterial from viral meningitis. Interpreting CSF monocytes can be difficult for physicians, especially in France where lymphocytes and monocytes results are sometimes pooled. PATIENTS AND METHODS: We assessed SF monocytes in patients presenting with microbiologically confirmed meningitis (CSF leukocyte count>10/mm3 for adults or >30/mm3 for children<2 months), i.e. bacterial meningitis (BM), viral meningitis (VM), and neuroborreliosis (NB). RESULTS: Two-hundred patients (82 BM, 86 VM, and 32 NB) were included. The proportions of monocytes were higher in VM (median 8%; range 0-57%) than in BM (median 5%; range 0-60%, P=0.03) or NB (median 5%; range 0-53%, P=0.46), with a high value overlap between conditions. CONCLUSION: CSF monocytes should not be used to discriminate BM from VM and NB because of value overlaps.

Risk factors for invasive pasteurellosis: a retrospective case study.

Pasteurellosis is a frequent zoonosis mainly transmitted by cats and dogs. Invasive forms of pasteurellosis are associated with significant morbidity and mortality. This retrospective study aimed to highlight risk factors (RFs) for invasive pasteurellosis. We included patients with positive Pasteurella samples. The clinical forms were classified as invasive or local pasteurellosis. We evaluated 13 RFs: age, sex, alcohol use, tobacco use, chronic liver disease, chronic renal failure, diabetes, chronic cardiovascular disease, chronic pulmonary disease, chronic inflammatory disease, chronic osteoarticular disease, immunosuppression, and progressive cancers. One hundred and two patients were enrolled; 28 and 74 had invasive and local forms respectively. Invasive forms included eight isolated bacteraemia, one septic shock, seven large-joint arthritis, two neurological infections, two abdominal infections, and eight pulmonary pasteurellosis. The mortality rate was 4 %, including 11 % and 1.4 % of patients with invasive or localized disease respectively. RFs statistically associated with the invasive group vs the local group were as follows: (1) average age, 63 years (22-93 years) vs 51 years (2-89 years) (p = 0.03), (2) alcohol consumption, 77.8 % vs 25 % (p = 0.03), (3) tobacco use, 64 % vs 25 % (p = 0.006), and (4) chronic liver disease, 21 % vs 1.5 % (p = 0.002). Age was the only significant RF identified using multivariate analysis. Overall, 27 % of patients had an invasive pasteurellosis and experienced significant mortality (11 %). Advanced age, chronic liver disease were the main RFs associated with invasive pasteurellosis. Healthcare providers should be aware of these RFs when patients are exposed to cats or dogs.

Contribution of systematic RT-PCR screening for influenza during the epidemic season.

OBJECTIVE: We assessed the systematic RT-PCR screening of patients admitted to an infectious diseases department (IDD), during the 2012-2013 influenza outbreak. METHODOLOGY: Patients admitted with cough and fever underwent a nasopharyngeal smear for RT-PCR screening. RESULTS: Ninety-eight patients were admitted in the IDD, from January 1st to February 22nd, 46 were screened; 11 male and 6 female patients (17.3%, mean age of 68 years) were positive. The diagnoses made in the emergency department, before RT-PCR screening, were most frequently lung infection and sepsis, but influenza in only 4 cases. The diagnosis of influenza led to stopping antibiotics (n=4), initiating curative (n=4) and preventive (n=4) treatments with oseltamivir, and isolating patients to prevent a hospital outbreak. CONCLUSION: Systematic RT-PCR screening allows a rapid therapeutic management and the prevention of hospital epidemic through appropriate isolation measures.