ABSTRACT
Idiopathic multicentric Castleman disease (iMCD) is a lymphoproliferative disease of unknown etiology. Deciphering mechanisms involved in CD pathogenesis may help improving patients' care. Six cases of stereotyped sub-diaphragmatic iMCD affecting lower limb-draining areas and associated with severe and often ulcerative lower extremity chronic dermatological condition were identified in our cohort. Pathological examination revealed mixed or plasma-cell type MCD. In three patients, shotgun metagenomics failed to identify any pathogen in involved lymph nodes. Antibiotics had a suspensive effect while rituximab and tocilizumab failed to improve the condition. This novel entity requires a specific approach and exclusion of potentially harmful immunomodulation.
Subject(s)
Campylobacter Infections/epidemiology , Primary Immunodeficiency Diseases/epidemiology , Adult , Antibodies/blood , Campylobacter Infections/complications , Female , France/epidemiology , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/etiology , Humans , Liver Diseases/epidemiology , Liver Diseases/etiology , Male , Middle Aged , Prevalence , Primary Immunodeficiency Diseases/complicationsABSTRACT
OBJECTIVES: The Enterobacter cloacae complex (Ecc), routinely referred to as "E. cloacae" in clinical microbiology, encompasses several species with 12 genetic clusters and one sequence crowd that can be identified based on hsp60 sequencing. Little is known about the pathogenicity and distribution of resistance to antibiotics among the Ecc. METHODS AND RESULTS: In this prospective multicentre study, a total of 193 Ecc clinical isolates were collected from 10 academic hospitals distributed nationally across France and identified at the genetic cluster level on the basis of hsp60 sequencing. E. hormaechei isolates, which belong to clusters VI-VIII, were the largest group (53%), followed by cluster III that accounted for 28% of clinical isolates. All other Ecc clusters were present except cluster VII (E. hormaechei subsp. hormaechei). Cephalosporinase overproduction and ESBL were significantly more present in E. hormaechei (33% and 20%) than in other clusters (19% and 3%, respectively). CONCLUSIONS: These results suggest that rapid identification of "E. cloacae" at the genetic cluster level could improve adequacy of empirical antibiotic treatment and reduce the unnecessary use of broad spectrum antibiotics.
Subject(s)
Anti-Bacterial Agents/pharmacology , Enterobacter cloacae/classification , Enterobacter cloacae/drug effects , Enterobacteriaceae Infections/epidemiology , Enterobacteriaceae Infections/microbiology , beta-Lactam Resistance , beta-Lactams/pharmacology , Adolescent , Adult , Aged , Aged, 80 and over , Cephalosporinase/analysis , Chaperonin 60/genetics , Child , Child, Preschool , Enterobacter cloacae/genetics , Enterobacter cloacae/isolation & purification , Female , France/epidemiology , Genotype , Hospitals, University , Humans , Infant , Infant, Newborn , Male , Middle Aged , Prospective Studies , Sequence Analysis, DNA , Young AdultABSTRACT
We report a case of polyarthritis with axial involvement in a young female patient treated for acute lymphoblastic leukemia. Detection in the hip fluid of Ureaplasma urealyticum by broad-range PCR followed by electrospray ionization mass spectrometry allowed the diagnosis of septic arthritis and ad integrum recovery upon adapted antibiotic therapy.
