Medicolegal Implications of Nosocomial Infections: A Case Report of Aspergillus Contamination during Cardiac Surgery.

Nosocomial infections have become a major issue of public health and lead to an increasing number of suits for damages. We present a rare case of Aspergillus contamination during cardiac surgery, describe the medicolegal investigation, and present the new system for compensation of bodily injury after nosocomial infection in France, based on the law of March 4, 2002 on patient rights and quality in the health system. This case demonstrates the limits of compensation for nosocomial infections on the grounds of national solidarity. The expert report requested by the regional commission for conciliation and compensation is of fundamental importance in enabling the commission to decide between fault and inherent risk of treatment.

Prospective pilot study to detect dogs with non food-induced canine atopic dermatitis using Fourier transform infrared spectroscopy.

BACKGROUND: The diagnosis of canine atopic dermatitis (CAD) remains challenging due to the lack of a simple biomarker or metabolic profile. In human medicine, Fourier transform infrared spectroscopy (FTIR) is an analytical technique used for several diseases. It requires a small amount of sample and allows the identification of structural moieties of biomolecules on the basis of their infrared absorption, with limited sample pretreatment. HYPOTHESIS/OBJECTIVES: The aim of the study was to evaluate the diagnostic value of FTIR. ANIMALS: Three groups were tested: 21 dogs with non food-induced CAD (NFICAD), 16 dogs with inflammatory conditions of various origins but without allergic dermatoses (OD) and 10 healthy dogs (H). METHODS: Peripheral blood was collected and spectra were acquired with a FTIR spectrophotometer. A principal component analysis (PCA) was performed on the full wavenumber spectra (4000-600/cm), followed by a Fisher discriminant analysis (DA) to assess the differences between the three groups. RESULTS: The PCA followed by the DA of whole spectra showed significant differences between the three groups. These results suggest that by using the FTIR method, dogs with NFICAD can be differentiated from healthy dogs and dogs with nonallergic inflammation. There was no overlap between the spectral data of the three groups indicating that NFICAD dogs were correctly segregated from the H and OD groups. CONCLUSIONS: A study on a larger cohort including common pruritic skin diseases is necessary to confirm these initial results and the relevance of this diagnostic technique.

Acute hormonal response to glucose, lipids and arginine infusion in overweight cats.

In cats, the incidence of obesity and diabetes is increasing, and little is known about specific aspects of the endocrine control of food intake in this species. Recent data suggest that ghrelin has an important role in the control of insulin secretion and vice versa, but this role has never been demonstrated in cats. Here we aimed to improve our understanding about the relationship between insulin, amylin and ghrelin secretion in response to a nutrient load in overweight cats. After a 16 h fast, weekly, six overweight male cats underwent randomly one of the four testing sessions: saline, glucose, arginine and TAG. All solutions were isoenergetic and isovolumic, and were injected intravenously as a bolus. Glucose, insulin, acylated ghrelin (AG), amylin and prolactin were assayed in plasma before and 10, 20, 40, 60, 80 and 100 min after the nutrient load. A linear mixed-effects model was used to assess the effect of bolus and time on the parameters. A parenteral bolus of glucose or arginine increased insulin and ghrelin concentrations in cats. Except for with the TAG bolus, no suppression of ghrelin was observed. The absence of AG suppression after the intravenous load of arginine and glucose may suggest: (1) that some nutrients do not promote satiation in overweight cats; or that (2) AG may be involved in non-homeostatic consumption mechanisms. However, the role of ghrelin in food reward remains to be assessed in cats.

Evaluation of eight commercial dog diets.

Estimation of the quality of commercial diets is a topic of interest for the majority of dog owners. Recently, in a French consumer association magazine, an evaluation of eight dog commercial dry diets (from super-premium, basic-nutrition, private-label and economy brands) according to several nutritional criteria was published. The aims of the study were: (1) to evaluate the apparent digestibility of these diets; (2) to score these diets according to digestibility results; and (3) to compare these data with the scoring of the magazine. Six adult Beagle dogs were enrolled for the digestibility trials. Diets were scored according to energy, crude protein and crude fat (CF) apparent digestibility coefficients, digestible protein-to-energy ratios and ash content. Each of the five criteria was scored from 4 to 20 points. The ranges of crude protein, CF, crude fibre and ash content were 20·9-30·6 %, 6·8-19·7 %, 2·2-3·3 % and 4·6-9·7 % on a DM basis, respectively. The ranges of energy, crude protein and CF apparent digestibility coefficients were 72·6-87·7 %, 70·4-82·5 % and 76·1-95·4 %, respectively. The range of the protein-to-energy ratio was 10-14 digestible crude protein per MJ metabolisable energy. Little overlap in the scoring systems was found, but the private-label brand and economy brand diets presented the lowest scores in the two systems. These results showed that the evaluation of commercial diets should take into account multiple nutritional aspects. In particular, analytical and biological (digestibility) criteria should be considered as complementary in the evaluation of dry dog commercial diets.

Late post-operative Aspergillus flavus endocarditis: Demonstration of a six years incubation period using microsatellite typing.

Late post-operative Aspergillus endocarditis is an under recognized life-threatening complication of heart valvular surgery. Optimal prevention and treatment need enhanced awareness. We report three cases of post-operative Aspergillus flavus endocarditis, including one with a 6-year long incubation period. Microsatellite typing incriminated a recurrent contamination of hospital environment.

Comparison of PCR-ELISA and Real-Time PCR for invasive aspergillosis diagnosis in patients with hematological malignancies.

This study aimed at comparing a real-time PCR assay and a PCR-ELISA assay of both serum and bronchoalveolar lavage (BAL) samples for the diagnosis of invasive aspergillosis (IA) in patients with hematological malignancies. Using a nested case-control design, 163 patients at risk were prospectively monitored and PCR assays were performed on frozen aliquots of 459 sera which were prospectively sampled twice weekly and 42 BAL specimens sampled from 43 probable and one proven IA cases and 47 matched controls. The data from three patients classified as possible IA were excluded from the nested case-control study. The sensitivity of real-time PCR and PCR-ELISA assays in serum was 73% and 86%, respectively and specificity was 100% for both. In BAL, sensitivity was 64% for real-time PCR, 71% for PCR-ELISA and 86% for Galactomannan antigen (GMA) assays with specificities of 96%, 96%, and 93%, respectively. While slightly less sensitive, the real time-PCR assay was highly specific and considerably faster and more workable than PCR-ELISA. Combining real-time PCR and GMA detection for both serum and BAL samples enhances routine laboratory IA diagnosis.

Postprandial response of plasma insulin, amylin and acylated ghrelin to various test meals in lean and obese cats.

The propensity of diets of different composition to promote obesity is a current topic in feline medicine. The effects of three meals with different protein:fat ratios on hormones (insulin, acylated ghrelin and amylin) involved in the control of food intake and glucose metabolism were compared. Five lean (two females and three males, 28.6 (sd 3.4) % body fat mass (BFM), mean body weight (BW) 4590 g) and five obese (two females and three males, 37.1 (sd 4.1) % BFM, mean BW 4670 g) adult cats were studied. Only BFM differed significantly between obese and lean cats. The cats were fed a high-protein (HP), a high-fat and a high-carbohydrate diet in a randomised cross-over design. Food intake did not differ between cats fed on the different diets, but obese cats consumed significantly more energy, expressed as per kg fat-free mass, than lean cats. After a 6-week adaptation period, a test meal was given and blood samples were collected before and 0, 30, 60 and 100 min after the meal. Baseline concentrations of glucose, amylin and acylated ghrelin were higher in obese cats than in lean cats, and obese cats showed the highest postprandial responses of glucose and amylin. The HP diet led to higher postprandial amylin concentrations than the other diets, indicating a possible effect of amino acids on beta-cell secretion. Postprandial ghrelin concentrations were unaffected by diet composition. The relationship between insulin, amylin and ghrelin secretion and their relevant roles in food intake and glucose metabolism in cats require further study.

[Management of congenital toxoplasmosis in France: current data]. / Prise en charge de la toxoplasmose congénitale en France : données actuelles.

Congenital toxoplasmosis is caused by transplacental contamination of the fetus withToxoplasma gondiifollowing maternal primary infection. The risk of mother-to-child transmission depends on the term of pregnancy at the time of maternal infection. The risk is lower than 5% in the first trimester but can reach 90% in the last days of pregnancy. Inversely, however, fetal disease is more severe when contamination occurs early in pregnancy. The French prevention program officially recommends monthly serological screening of susceptible women during pregnancy and information about hygiene and dietary rules. Prenatal diagnosis of congenital toxoplasmosis is based on a combination of examinations: PCR testing for the parasite in amniotic fluid, mouse inoculation, fetal ultrasonography, and magnetic resonance imaging. Neonatal screening consists of PCR of the placenta, mouse inoculation, detection of specific IgM and IgA in the newborn, ocular fundus examinations by indirect ophthalmoscopy, and transfontanellar ultrasonography. As soon as maternal infection is suspected, preventive treatment with spiramycin begins; the treatment is changed to a combination of pyrimethamine-sulfonamide if fetal infection is proved. Some teams are using this combination as first-line treatment after 30 weeks of gestation, without performing amniocentesis. Recent European multicenter studies raise questions about the effectiveness of prenatal treatment on mother-to-child transmission and on the reduction in the number and severity of fetal sequelae. A randomized controlled trial is required to prove the efficacy of prenatal treatment in general and of specific drugs, in particular. As soon as infection is confirmed, infected children are treated with the pyrimethamine-sulfonamide combination for 12 to 24 months. Recent multicenter studies show that postnatal treatment does not prevent ocular lesions: 5% of treated children had choroiditis lesions at birth, 20% at 5 years, and 30% at 8 years of age. Furthermore no consensus exists about the duration of postnatal treatment (3 months in Denmark versus 12 months in France). A multicenter randomized controlled trial is necessary to assess the efficacy of postnatal treatment and determine its duration. A surveillance system was set up in 2007 by the National Reference Center for Toxoplasmosis to determine the perinatal burden of this infection and to assess the national policy.

First detection of Wolbachia spp., including a new genotype, in sand flies collected in Marseille, France.

Pooled sand fly samples collected in Marseille, France, in July 2005 were examined by polymerase chain reaction amplification and sequencing of the 16S rRNA gene of the Anaplasmataceae. Two different sequences of the 16S rRNA gene were obtained that are similar to bacteria belonging to the genus Wolbachia. These findings were confirmed by amplification, sequencing, and phylogenetic analysis of the wsp gene of the genus Wolbachia. The Wolbachia species from Sergentomyia minuta has been named "Wolbachia sp. detected in Se. minuta".

LDBio-Toxo II immunoglobulin G Western blot confirmatory test for anti-toxoplasma antibody detection.

Tests commonly used for routine determination of anti-Toxoplasma gondii immunoglobulin G (IgG) antibodies show a high level of consistency. However, considerable variations between commercial screening tests are still observed in detecting antibodies present at low concentrations, leading to a number of discrepant and/or equivocal results. It is therefore important to use a reference test to confirm borderline results. In this study, we evaluated the use of a new qualitative test based on Western blot analysis--the LDBio-Toxo II IgG test--as a confirmatory test for at-risk patients. The study was performed retrospectively, using 569 serum samples with "low-positive" (2 to 32 international units) anti-Toxoplasma IgG levels from 375 patients. These samples were either sera collected during the routine screening of pregnant women, from patients with unrelated infections, or from immunocompromised patients or sequential sera taken from pregnant women with acquired Toxoplasma infection or from their newborns during follow-up. The LDBio-Toxo II IgG test was compared to several commercial tests commonly used for anti-Toxoplasma IgG screening. The Sabin-Feldman dye test was used as a reference test. In this study, the results of the LDBio-Toxo II IgG test appeared to be consistent with those of the dye test; the LDBio-Toxo II IgG test had a specificity of 100% and a sensitivity of 99.2%. Our findings suggest that the LDBio-Toxo II IgG test is a useful serological tool in cases in which the presence or absence of Toxoplasma antibodies needs to be reliably determined, for example, for the follow-up of pregnant women and their newborns or for subjects with immune deficiencies following human immunodeficiency virus infection, hematological malignancies, or transplantation.

Cocirculation of 2 genotypes of Toscana virus, southeastern France.

Toscana virus (TOSV), an arthropodborne phlebovirus transmitted by sandflies, can cause febrile illness and meningitis. The vector of TOSV in France was unknown. We detected TOSV RNA in 2 (female Phlebotomus perniciosus) of 61 pools of sandflies captured in southeastern France. Two genotypes of TOSV were identified.

[Unhealthy homes: possible interventions and their efficacy]. / Risques liés à l'habitat: les interventions possibles et leur efficacité.

Numerous health risks have been identified in dwellings and are a public health priority. Homes most often accumulate several different risks. Intervention programs must take this reality into account. Identification of a source of chemical pollution in the home makes it possible to correct indoor air quality quickly and inexpensively and provides immediate health benefits. Extermination of mites requires implementation of a group of complementary techniques in all contaminated areas, with help, when possible, from an indoor environment counselor. A team of multidisciplinary indoor habitat and health advisors must assess the health risks of the home. This inexpensive strategy reduces risks, although its effectiveness still requires confirmation. When the building has structural defects or abnormalities, more complex methods of renovation, or even moving, are necessary. There again, a complete assessment of their benefits to occupants' health is necessary.

Effect of glutamine on glutathione kinetics in vivo in dogs.

To determine whether glutamine affects glutathione (GSH, gamma-glutamyl-cysteinyl-glycine) metabolism, seven healthy beagle dogs received 6-h infusions of [(15)N]glutamate and [(13)C]leucine after a 3-day fast. Isotope infusions were performed during oral feeding with an elemental regimen, supplemented with either l-glutamine or an isonitrogenous amino acid mixture, on two separate days and in randomized order. Timed blood samples were obtained, and a surgical duodenal biopsy was performed after 6 h of isotope infusion. GSH fractional synthesis rate (FSR) was assessed from [(15)N]glutamate incorporation into blood and gut GSH, and duodenal protein synthesis from [(13)C]leucine incorporation into gut protein. Glutamine supplementation failed to alter erythrocyte GSH concentration (2189+/-86 vs. 1994+/-102 micromol L(-1) for glutamine vs. control; ns) or FSR (64+/-17% vs. 74+/-20% day(-1); ns). In the duodenum, glutamine supplementation was associated with a 92% rise in reduced/oxidized GSH ratio (P=.024) and with a 44% decline in GSH FSR (96+/-15% day(-1) vs. 170+/-18% day(-1); P=.005), whereas total GSH concentration remained unchanged (808+/-154 vs. 740+/-127 micromol kg(-1); P=.779). We conclude that, in dogs receiving enteral nutrition after a 3-day fast: (1) glutamine availability does not affect blood GSH, and, (2) in contrast, in the duodenum, the preserved GSH pool, along with a decreased synthesis rate, suggests that glutamine may maintain GSH pool and intestinal redox status by acutely decreasing GSH utilization.

Housing and health counselling: preliminary results of a new medical referral system in France.

STUDY OBJECTIVES: Since 2002, a new unique service is available to physicians in southeast France. They may ask for a housing environmental inspection for their patients when they feel that the indoor environment has a negative influence on health status. This telephone survey was designed to evaluate the efficacy of this service. DESIGN: During this time period, 328 such housing environmental inspections have been performed. The protocol of these inspections included a detailed questionnaire and environmental sampling for mold identification, mite-allergen evaluation and, in selected cases, measurement of volatile organic compounds (VOC). Inspections were performed by trained technicians. From April to September 2005, we performed a telephone interview survey, using a structured questionnaire, to evaluate the reported outcome. RESULTS: Main defects identified in houses were mold infestation (44%), mite contamination (32%), and VOC exposure (9%) from new furniture, repairs performed and hobbies. Substantial repairs, including carpentry, wall floors and ceilings repairs, mold decontamination, and plumbing, had been performed in 59.4% of those houses. Full compliance, partial compliance, and no compliance by the occupant with the recommendations provided by the housing environmental inspectors were 50%, 20%, and 30%, respectively. Reasons for non-compliance included moving, time, and money constraints. When rating the efficacy of the service, total, almost total, and partial effectiveness was reported by the families to be 3%, 31%, and 56%, respectively. CONCLUSION: This type of service holds great promise for patients as well as for physicians and should be investigated further by measuring physician-diagnosed health outcome and using cost-benefit analysis.

Reference values for Leishmania infantum parasitemia in different clinical presentations: quantitative polymerase chain reaction for therapeutic monitoring and patient follow-up.

Quantification of Leishmania infantum DNA in blood samples by an ultrasensitive quantitative polymerase chain reaction (QPCR) detected parasitemias in different clinical presentations. We observed a large range of parasitemias, more than 9 log values, and could determine the threshold between asymptomatic carriage and disease in the Mediterranean area (approximately one parasite/mL of blood). Based on kinetoplast DNA amplification, this assay had a sensitivity of 0.001 parasite DNA equivalents/mL and detected asymptomatic carriage of Leishmania. It detected parasite DNA in 58% of healthy subjects, while an immunoblot detected specific antibodies in only 16%. For initial diagnosis of disease, this quantitative PCR with blood samples constitutes a non-invasive alternative to bone marrow aspiration. Its main applications are monitoring of drug therapy and follow-up of immunodeficient patients for biologic confirmation of relapses.

Mycotoxin identification in moldy dwellings.

The objective of this study was to assess the level of macrocyclic trichothecenes (MCT), one of the most potent mycotoxins, on wall surfaces, floor dust and air samples from moldy dwellings. The study was based on an index group comprising 15 flooded dwellings contaminated by Stachybotrys chartarum or Chaetomium and a control group comprising nine dwellings without molds on visual inspection and mold sampling. Three samples were collected from each dwelling: a sample from the moldy wall, using a swab, a floor dust sample on a 0.5 m(2) surface with a cloth and an air sample using a pump comprising a 1 microm Teflon filter. The MCT level was measured using a monoclonal, antibody-based ELISA test. Compared with measurements performed in index dwellings, higher MCT values were measured on floor dust samples from moldy dwellings (P = 0.02). Samples from wall surfaces demonstrated nearly significant differences (P = 0.06). No significant differences were observed for air samples (P = 0.15), but some samples showed increased MCT levels. Significant correlations were observed between the levels measured on wall surfaces, floor dust and air samples (P = 0.02 to 0.05). In contrast, no correlation was observed between moldy surface and MCT levels. In conclusion, this paper reports for the first time direct evidence for the presence of MCT in moldy dwellings.

Spontaneous hormonal variations in male cats following gonadectomy.

The increased prevalence of obesity after neutering in cats is problematic in veterinary practice. Although many factors seem to be involved, the role of prolactin (PRL) and insulin-like growth factor-I (IGF-I), both implicated in adipose tissue development and glucose intolerance, should be considered. Seven male cats were castrated when 11 months old. Body weight was then recorded for 56 weeks and PRL, IGF-I and leptin assayed for 44 weeks. Body weight increased steadily but only significantly after 36 weeks. It stabilised after 44 weeks, and the cats then gained about 20% of their initial body weight. IGF-I increased rapidly and was significantly higher by week 3. PRL and leptin increased with initial peaks during the eighth and eleventh weeks, respectively. This study confirms that castration rapidly modifies the hormonal balance, partly explaining the body weight increase, and that hormonal changes precede this body weight increase. Hyperleptinaemia is apparently a consequence of excess weight.