[Toxic shock syndrome consecutive to the presence of vaginal tampon for menstruation regressive after early haemodynamic optimization and activated protein C infusion]. / Choc toxique staphylococcique dans un contexte menstruel de port de tampons vaginaux d'évolution favorable après optimisation hémodynamique précoce et administration de protéine C activée.

A 19-year-old woman was admitted in the intensive care unit for a septic shock recognized as a menstrual toxic shock syndrome with a Staphylococcus aureus. An early goal oriented therapy was started in order to correct in particular the venous central O(2) saturation (ScvO(2)) associated to an early empiric anti-infectious treatment. A multi-organ failure appeared in a second time, so that we began a protein C activated infusion. The outcome was also auspicious. Bacteriologic samples and specific samples for the research of Staphylococci toxins confirmed the diagnosis of toxic shock syndrome with Staphylococcus aureus. A genotypic study allowed us to identify many anomalies which could be involved in the incompletely understood physiopathology of this disease.

[Pneumococcal antibiotic resistance. Data from 6 regional registries for 1999]. / Résistance du pneumocoque aux antibiotiques. Données de 6 observatoires régionaux pour l'année 1999.

RESISTANCE BY REGION: Resistance varied greatly by region, ranging from 34.2% resistant strains in Alsace to 63.1% in Brittany. The incidence of resistant strains was always higher in children (especially in children aged 1 to 5 years) and in ENT samples. The time course of resistance has varied between regions, as has that of serotypes. CRUCIAL FINDING: In these 6 regions, and despite a high incidence (that varied from one region to another) of reduced susceptibility strains for penicillin G, amoxicillin (19-32%) and cefotaxime (6.5-18.5%), amoxicillin-cefotaxime resistant strains remained very rare (0.2-3.5%).

[Cutaneous mycobacteriosis]. / Mycobactérioses cutanées.

Tuberculosis is reappearing, due to diminished surveillance, illegal immigration, the HIV epidemic and certainly also due to emerging resistance. The clinical expression of cutaneous tuberculosis depends on the stage of development, the clinical background and the virulence of the germ. Diagnosis is predominantly clinical, but laboratory results also play a role. Treatment involves the quadruple antibiotic treatment prescribed for any tubercular infection. Atypical mycobacteria are widespread throughout the environment and are pathogenic, but also saprophytic, comensal and opportunistic, figure a favourable setting in the immunodeficient individual. Following entry by penetrance, the early lesion is papulonodulary, nodulary, keratoid, crusted, ulcerated, sporotrichoid, generally without peripheral adenopathy. Histological examination discloses a granulomatous reaction limiting the development of the infection; such development is absent in the immunodeficient patient, thus explaining the spread. The most common mycobacterial infection in France, generally in the immunocompetent individual, is "aquarium disease" which follows a benign course; the most common in tropical areas is Mycobacterium ulcerans; whereas Mycobacterium avium intracellulare, fortuitum and chelonae cause, in the immunodeficient patient, severe and extensive infection. Treatment should start as soon as diagnosis is made and the germ identified.

[Use of the Bactec TB 460 method for the bacteriological diagnosis of tuberculosis. Results of a multicenter study]. / Utilisation de la méthode Bactec TB460 pour le diagnostic bactériologique de la tuberculose. Résultats d'une étude multicentrique.

Isolation of Mycobacteria on Loewenstein-Jensen medium lasts many weeks. The use of Radiometric method (Bactec TB 460) reduces the delays. Results of 79,064 cultures are reported from a multicentric study associating 16 laboratories. The average was 4.8% of positivity and 2.51% of contamination. The comparison of the results with conventional method previously obtained shows that radiometric method is more sensitive and contaminations are less numerous. Concerning hemocultures the Bactec method is very usefull. Among 11,277 tests performed 907 were positive (8.04%). Mycobacterium avium was identified in 89% of the cases. Identification test utilizes Biochemical and NAP tests, but also more and more Nucleic probes. The antibiotic sensitivity is performed in five days. The mean delay of analysis is about 25 days, lessening by half the conventional method delays. Nevertheless, Bactec method has the following inconveniences: syringe inoculation, use of radiolabelled products, expensive cost.

French multicenter study involving eight test sites for radiometric determination of activities of 10 antimicrobial agents against Mycobacterium avium complex.

The radiometric BACTEC 460-TB methodology has filled an increased need in the screening of a wide range of antimicrobial agents against Mycobacterium avium (MAC) isolates on a patient-to-patient basis. In this context, a multicenter study involving eight test sites across France was performed to determine the MICs of 10 antimicrobial agents for MAC organisms. The aim of the investigation was to compare the in vitro activities of D-cycloserine, ethambutol, ethionamide, rifampin, amikacin, streptomycin, ciprofloxacin, sparfloxacin, clofazimine, and clarithromycin against MAC isolates. All of the test sites received the same clinical isolates of MAC, and the MICs were determined by a common protocol. The overall interlaboratory reproducibility of the MICs within +/- 1 dilution of the modal MICs varied from 79.70 to 100% (mean, 95.2% +/- 2.1%), whereas overall agreement of the MICs among the test sites varied from a mean of 91% +/- 4.1% to a mean of 98 +/- 1.3%. We confirmed that the proposed methodology is easy, accurate, and sufficiently reproducible to be used routinely in a clinical laboratory. Despite variations in the MICs of the same drug among strains, no link between the origin of MAC isolates (from human immunodeficiency virus-positive or -negative patients) and their drug susceptibilities was established. On the basis of the MICs that inhibited 50 and 90% of isolates tested for the drugs used, clarithromycin, clofazimine, ethambutol, and streptomycin were the most uniformly active against MAC; this was followed by amikacin, rifampin, and sparfloxacin. On the other hand, ciprofloxacin, D-cycloserine, and ethionamide showed only marginal in vitro activities.

[In vitro sensitivity to antibiotics of genital mycoplasmas isolated in Toulouse. Study of new molecules (macrolides and quinolones)]. / Sensibilité in vitro aux antibiotiques des mycoplasmes génitaux isolés à Toulouse. Etude de nouvelles molécules (macrolides et quinolones).

The minimal metabolism-inhibiting concentrations (MMC) of 11 antibiotics were determined for 40 strains each of M. hominis and U. urealyticum using a terminal color change broth method. All strains were recovered in 1990. Resistance to tetracycline (MMC greater than 8 mg/l) was found for 12.5% of strains of M. hominis and U. urealyticum, as compared with 5% in 1985. Rokitamycin was the most active macrolide against M. hominis (MMC 90: 0.06 mg/l). U. urealyticum strains were susceptible to all the macrolides tested, with the greatest activities being seen for rokitamycin and clarithromycin (MMC 90: 0.06 mg/l and 0.12 mg/l respectively). Sparfloxacin was the most active quinolone against both species. Human clinical trials designed to evaluate these new molecules for the treatment of mycoplasmal and ureaplasmal genital infections are warranted.

[Atypical cutaneous mycobacterium diseases. Results of a national survey]. / Les mycobactérioses cutanées atypiques. Résultats d'une enquête nationale.

We report the results of a retrospective inquiry concerning atypical cutaneous mycobacterioses in France over the last 5 years. Ninety-two cases were observed, contracted from aquariums (50 p. 100), in swimming pools (4.4 p. 100) and as a result of mesotherapy (15.2 p. 100); 66.3 p. 100 of the patients had no other pathology; 17.4 p. 100 were immunodepressed. Bacteriological examination was positive in 44.7 p. 100 of the cases; swabbing, scratching and punturing were better than biopsy to obtain a bacteriological culture. Mycobacteria were identified in 59.8 p. 100 of the cultures. In order of frequency, the pathogens were Mycobacterium marinum (from aquariums), M. chelonae (from iatrogenic lesions) and M. avium-intracellulare (in immunodepression). M. fortuitum, M. ulcerans, M. flavescens, M. haemophilum and M. kansasii were rare. The formation of epithelial giant-cell granulomas was observed in patients without any other pathology. Non-specific infiltration was found in patients with immunodepression and bacteriological examination was often positive in those with non-specific infiltrates. The treatment of atypical cutaneous mycobacterioses is always difficult; third generation tetracyclines and antibacterial combinations are often prescribed, but the results of in vitro tests are not reproducible in vivo. New antibiotics, such as clarithromycin, quinolones, ansamycin and clofazimine, are currently being tested.

In vitro activity of sparfloxacin and other antimicrobial agents against genital pathogens.

The in vitro activity of sparfloxacin was determined for 60 strains of Neisseria gonorrhoeae, 15 strains of Chlamydia trachomatis and 40 strains each of Gardnerella vaginalis, Mycoplasma hominis, and Ureaplasma urealyticum and compared with those of ampicillin, azithromycin, clarithromycin, erythromycin, ofloxacin, temafloxacin and tetracycline. Sparfloxacin was active against all the strains studied and appeared to be the most potent quinolone tested. Sparfloxacin had the lowest MICs against N. gonorrhoeae (MICs 0.002-0.06 micrograms/ml). Its MICs against C. trachomatis (0.03-0.06 micrograms/ml) were higher than those of clarithromycin but lower than those of the other antimicrobial agents. Sparfloxacin was particularly active against tetracycline-susceptible as well as resistant strains of M. hominis (MICs, 0.06 micrograms/ml) and U. urealyticum (MICs 0.125-1 micrograms/ml). Because of this in vitro activity and its tissue distribution, sparfloxacin might be a valuable therapeutic agent for treating major bacterial sexually transmitted diseases.

Clinical and microbiologic features of urethritis in men in Toulouse, France.

On hundred twenty-six men who attended a hospital microbiology laboratory and 99 men who attended a private laboratory in Toulouse, France, for symptoms of urethritis were examined during 1988, for evidence of urethral pathogens. The following incidences were found: Neisseria gonorrhoeae: 24 (10.7%); Chlamydia trachomatis: 58 (25.8%); Ureaplasma urealyticum: 46 (20.4%); Gardnerella vaginalis: 21 (9.3%); Haemophilus parainfluenzae: 21 (9.3%); Streptococcus agalactiae: 15 (6.7%); Candida albicans: 10 (4.4%); and Trichomonas vaginalis: 4 (1.8%). The prevalence of these microorganisms was similar in the two groups of patients. No pathogen was isolated from 71 patients (31.6%). Mixed infections with at least two pathogens were found in 49 men (21.8%). Another goal of this study was to determine the relative prevalence of urethral pathogens in relation to clinical findings. N. gonorrhoeae was isolated significantly more often in patients who had a urethral discharge (P less than .05) that contained five or more polymorphonuclear cells per high-power field (PMN/HPF) (P less than .001). G. vaginalis was isolated significantly more often in patients who did not have an urethral discharge (P less than .05) and in men with less than five PMN/HPF (P less than .05). Isolation of C. albicans was significantly associated with pruritus (P less than .05) and balanitis (P less than .001). Like the clinical features, the gram-stained urethral smear was of limited value in diagnosis and therapeutic decision-making regarding non-gonococcal urethritis. In contrast, this study underlines the importance of full identification of urethral isolates in the management of urethritis in men.

Evaluation of the Captia enzyme immunoassays for detection of immunoglobulins G and M to Treponema pallidum in syphilis.

Two new enzyme-linked immunosorbent assays (ELISA), one for the measurement of immunoglobulin G (IgG) (Captia Syphilis-G) and one for the measurement of IgM (Captia Syphilis-M), were evaluated for detecting antibodies to Treponema pallidum. Serum samples from 169 patients, 96 with various stages of untreated syphilis, 63 with treated syphilis, and 10 who were noninfected, were investigated. All sera were also examined by traditional treponemal and cardiolipin tests and by the fluorescent treponemal antibody absorption (FTA-ABS) test for 19S(IgM). The overall sensitivity of Captia Syphilis-G was 98.3%. The IgG ELISA was very sensitive (100%) in all stages of untreated syphilis, except in primary syphilis (82%). In all diagnostic groups of syphilis, the reactivity of Captia Syphilis-M was similar to that of the 19S(IgM) FTA-ABS test, except in reinfections, in which the IgM capture ELISA was less sensitive. False-positive IgM capture ELISA results were not found in the 10 neonates born to mothers adequately treated for syphilis. However, of six serum samples containing rheumatoid factor, two were reactive in the Captia Syphilis-M test but not in the 19S(IgM) FTA-ABS test. This indicated that the specificity of the IgM capture ELISA was not absolute. All serum samples from treated patients were reactive in the IgG ELISA, but only 15 samples were reactive in the IgM capture ELISA, which appeared to be as effective as the 19S(IgM) FTA-ABS test in monitoring the effect of treatment. Simultaneous measurement of IgG and IgM antibodies for T. pallidum by the Captia immunoassays appears to be an efficient and simple method for confirming the diagnosis of syphilis as well as for indicating whether active disease is present.

Comparative in vitro activities of pristinamycin and other antimicrobial agents against genital pathogens.

The MICs of pristinamycin for genital pathogens were compared with those of ampicillin, tetracycline, erythromycin, and ciprofloxacin. Pristinamycin was active against all the strains studied. Because of this activity and its lack of toxicity, pristinamycin might be a valuable therapeutic agent for treating major sexually transmitted diseases.

Lower genital tract infections in women: comparison of clinical and epidemiologic findings with microbiology.

We screened 392 women attending the Laboratory of Microbiology of Toulouse Purpan Hospital for symptoms of lower genital tract infection for six microorganisms. Rates of isolation of Neisseria gonorrhoeae, Chlamydia trachomatis, Candida albicans, Mycoplasma hominis, and Gardnerella vaginalis were 1%, 7.7%, 29.8%, 23.8%, and 37.5%, respectively. Trichomonas vaginalis was detected by direct examination in specimens from 3.1% of patients. Another goal of this study was to determine the relative prevalence of these microorganisms in relation to clinical and epidemiologic findings. C. trachomatis was isolated significantly more often from patients under 25 year old (P less than 0.001), from those who use oral contraceptives (P less than 0.01), from those who have a male sexual partner with symptoms of sexually transmitted disease (P less than 0.001), and from those who present signs of cervicitis (P less than 0.05). Isolation of C. albicans was significantly associated with vulvar pruritus (P less than 0.01), vulvitis (P less than 0.01), and vaginitis (P less than 0.001). G. vaginalis and M. hominis are significantly associated with bacterial vaginosis (P less than 0.001). This syndrome was diagnosed clinically in 27.2% of our study population and was highly correlated with use of an intrauterine device (P less than 0.05).

[Etiology of bacterial vaginosis (non-specific vaginitis)]. / Etiologie de la vaginose bactérienne (vaginite non spécifique).

56 women who were diagnosed bioclinically as having a bacterial vaginal infection were studied, as were 35 women as a control group. The study was a semi-quantitative analysis of the vaginal bacterial flora, both aerobic and anaerobic. It shows that Gardnerella vaginalis and anaerobic bacteria such as Peptococcus, Peptostreptococcus, Bacteroïdes, Veillonella and Mobiluncus were associated in a statistically significant way with bacterial vaginitis. On the other hand Lactobacilli were less frequently found (p less than 0.001) than in the control group of women. The way in which the microbial flora is changed has been observed during attacks of vaginitis and is discussed, as is the importance of making the diagnosis and of treating this syndrome.

[Comparative activity of tetracycline, doxycycline and minocycline against Haemophilus]. / Activé comparée de tétracycline, doxycycline et minocycline sur Haemophilus.

A total of 90 isolates of Haemophilus were studied for susceptibility to tetracycline, doxycycline and minocycline. In vitro activity was determined by agar dilution method (MIC) and disk diffusion test. Disk diffusion tests were done on chocolate agar and on supplemented Mueller-Hinton agar. MICs rang from greater than or equal to 128 to 0,25, 32 to 0,5 and 32 to 0,25 micrograms/ml for tetracycline, doxycycline and minocycline respectively. Strains can be divided into tetracycline-sensitive strains which are inhibited by concentration less than or equal to 2 micrograms/ml and tetracycline-resistant strains inhibited by greater than or equal to 16 micrograms/ml. Sensitive strains are inhibited by 0,5-1 microgram/ml of doxycycline and 0,25-2 micrograms/ml of minocycline. Resistant strains are inhibited by concentrations from 2 to 32 micrograms/ml of doxycycline and from 0,5 to 32 micrograms/ml of minocycline. All but one resistant strains were inhibited by a concentration of less than or equal to 4 micrograms/ml of minocycline; all but two resistants strains were inhibited by doxycycline at a concentration greater than or equal to 4 micrograms/ml. The correlation coefficients are the following: for tetracycline, r = -0,95; for doxycycline r = -0,83 when disk diffusion test is done on supplemented Mueller-Hinton and r = -0,94 on chocolate agar; for minocycline r = -0,62 on supplemented Muller-Hinton and r = -0,75 on chocolate agar.

[Haemophilus colonization in children: serotypes, biotypes and antibiotic sensitivity]. / Colonisation de l'enfant par Haemophilus; sérotypes, biotypes et sensibilité aux antibiotiques.

The occurrence of Haemophilus in throat swabs from 273 hospitalized children aged 0-15 years has been investigated. Haemophilus was detected in 124 children. H. influenzae was observed in 15.7% of the children and 37.6% of the carriers. H. parainfluenzae was observed in 31.8% of the children and 70% of the carriers. The carriage rate of Haemophilus influenzae type b occurred in 6.6% of the children and was not observed in children aged less than six months. One nontypable, biotype II strain of H. influenzae (2.2%) was resistant to ampicillin and tetracycline; one biotype I, type b strain was resistant to tetracycline. Among 90 strains of H. parainfluenzae, 20 were beta-lactamase-producing strains; 80% of these strains were isolated in children aged more than two years. Beta-lactamase-producing Haemophilus was detected in 7.7% of children but only 0.36% of children were carrier of ampicillin-resistant H. influenzae. No chloramphenicol-resistant strain was isolated during this study.

[Gardnerella vaginalis. Frequency of its isolation from women complaining of leukorrhea]. / Gardnerella vaginalis. Fréquence de son isolement chez la femme se plaignant de leucorrhées.

A study was carried out on 131 vaginal swabs that were taken from 98 women who had a discharge and 33 women who were asymptomatic to determine the frequency in which Gardnerella vaginalis was discovered. This study shows that this bacteria is the only micro-organism that is found in a significantly higher number of women with nonspecific discharges (37%) than in those who have no discharge (9.1%). These results, while they do not show that Gardnerella vaginalis is the only aetiological factor in nonspecific vaginitis, do underline that it is a factor in thinking about such a syndrome and therefore it should be looked for by the laboratory and by the doctor treating patients.

Occurrence of viruses in human stools in the Ahaggar (Alberia).

From October 1977 to May 1980, 243 stools collected in sedentary and semi-nomadic populations of the Ahaggar (Algerian Sahara) were examined using immunoelectronmicroscopy and tissue culture inoculation. Immunoelectronmicroscopy revealed the presence of rotaviruses in 8, coronaviruses in 26, adenoviruses in 5 and small round viruses in 4. Enteroviruses were isolated in tissue culture from 24 stools. Rotaviruses were present in the Ahaggar but were associated with little acute enteric disease. The high frequency of coronaviruses both in gastroenteritis patients and in patients without disease was surprising. The prevalence of enteroviruses in this hyperarid zone was similar to or higher than that found in noticeably more human countries. Further systematic bacterial, viral and parasitic examinations are required to clarify the role of the above viruses in the aetiology of gastroenteritis in this region.

Immune complex glomerulonephritis in mice infected with Escherichia coli.

C57Bl/6 mice were injected intraperitoneally with 10(8) to 2 x 10(8) living K 38 Escherichia coli (E. coli) and serological changes and kidney involvement were studied. E. coli were found in the blood 45 min to 24 hr after injection. In serum, large amounts of deoxyribonucleic acid (DNA) were present 24 hr after E. coli injection, and thereafter disappeared. Seven days after infection, antibodies directed against E. coli, anti-DNA antibodies and C1q-binding substances were found in serum and the kinetics of the variations of these parameters were studied until day 35. Kidney lesions were evaluated immunochemically and by optical and electron microscopy. In the glomeruli, heavy granular deposits of IgG and IgM were constantly found in mesangium and along capillary walls. In most kidneys slight granular deposits of IgG and IgM were also found in the tubules. Histological studies revealed in the glomeruli mild endocapillary cell proliferation, focal thickening of glomerular basement membrane and dense deposits in mesangial and subendothelial areas and inside the glomerular basement membrane; in the tubules dense deposits were focally observed inside the tubular basement membrane.