[Coronavirus and COVID-19 : focus on a galopping pandemic]. / Coronavirus et COVID-19 : le point sur une pandémie galopante.

The international community is currently facing a pandemic of acute respiratory syndrome caused by a new coronavirus, SARS-CoV-2. This syndrome has been named COVID-19 for CoronaVIrus Disease 2019 by the World Health Organization. The starting point of the epidemic is the city of Wuhan (China), where the virus is said to have been transmitted from animals to humans before inter-human transmission. This is the third epidemic caused by a coronavirus after those of severe acute respiratory syndrome (SARS) in 2003 and Middle East respiratory syndrome (MERS) started in 2012. COVID-19 has rapidly spread to China and is currently spreading all over the world. The infection mainly affects patients over 40 years of age and mortality is increased in the presence of comorbidities. Children are pauci- or asymptomatic. The diagnosis is most often based on the detection of the viral genome in the nasopharynx by molecular biology methods. In the absence of specific anti-viral molecules, treatment is currently mainly symptomatic. It is clear that the COVID-19 pandemic is more difficult to control than what the first data suggested. The key strategy to SARS-CoV-2 is to limit its transmission. Preventive measures are mainly based on the application of adequate hand hygiene measures and disinfection of the environment, as well as measures of social distance aimed at limiting contacts in the population and protecting populations at risk.

La communauté internationale fait actuellement face à une pandémie de syndrome respiratoire aigu due à un nouveau coronavirus, le SARS-CoV-2. Ce syndrome a été nommé COVID-19 pour COronaVIrus Disease 2019 par l'Organisation Mondiale de la Santé. Le point de départ de l'épidémie est la ville de Wuhan (Chine), où le virus aurait été transmis de l'animal à l'homme préalablement à la transmission inter-humaine. Il s'agit de la 3ème épidé¬mie causée par un coronavirus après celles du syndrome respiratoire aigu sévère (SARS) en 2003 et du syndrome respiratoire du Moyen-Orient (MERS) débutée en 2012. Le COVID-19 s'est rapidement propagé en Chine et se répand actuellement à travers le monde entier. L'infection touche surtout les patients de plus de 40 ans et la mortalité est accrue en présence de comorbidités. Les enfants sont, quant à eux, pauci- ou asymptomatiques. Le diagnostic repose, le plus souvent, sur la détection du génome viral au niveau du nasopharynx par des méthodes de biologie moléculaire. En l'absence de molécules anti-virales spéci¬fiques, le traitement reste, à l'heure actuelle, principalement symptomatique. Force est de constater que la pandémie de COVID-19 est plus difficile à contrôler que ce que les premières données ne laissaient présager. L'élément clé face au SARS-CoV-2 est de limiter sa transmission. Les mesures de prévention reposent, principalement, sur l'application de mesures d'hygiène des mains adéquates et la désinfection de l'environnement, ainsi que sur des mesures de distance sociale visant à limiter les contacts dans la population et à protéger les populations à risque.

[Norovirus nosocomial outbreak : an hospital experience]. / Epidémie nosocomiale à norovirus : à propos d'une expérience hospitalière.

Human noroviruses (NoV) are the main pathogenic agents worldwide responsible for viral sporadic and epidemic gastroenteritis worldwide. A gastroenteritis outbreak broke out in patients hospitalized in several wards located in two different floors of a hospital in Liege, Belgium. The objective was to determine whether a same NoV strain would be involved in the two different floors, and to explore how this outbreak would have spread from a floor to the other. Stool samples from patients and healthcare workers were collected, as well as data from medical files. NoV detection, quantification and characterization were performed using molecular biology methods. A same NoV strain, from genotype GII.4, was detected in two patients hospitalized on the two different floors. This finding allowed to conclude that a same outbreak spread in the two floors, probably due to movements of common healthcare workers. A rapid NoV detection during outbreak is important in the aim to rapidly implement hygiene measures to limit the size of the outbreak.

Les norovirus humains (NoV) sont reconnus mondialement comme les principaux agents étiologiques de gastro-entérites virales sporadiques et épidémiques au niveau mondial. Une épidémie de gastro-entérites s'est déclarée chez des patients hospitalisés dans plusieurs salles d'un hôpital de la région liégeoise, situées à deux étages différents. L'objectif était de déterminer si une même souche de NoV était impliquée aux deux étages, et d'investiguer la manière dont l'épidémie se serait propagée d'un étage à l'autre. Des prélèvements ont été collectés chez les patients et le personnel soignant. Les dossiers médicaux ont été examinés. La détection, la quantification et la caractérisation des souches de NoV ont été réalisées par des méthodes de biologie moléculaire. Une même souche de NoV, du génotype GII.4, a été mise en évidence chez deux patients hospitalisés aux deux étages différents. Ce résultat indique qu'il s'agit de la même épidémie qui s'est étendue à deux étages, probablement transmise par l'intermédiaire du personnel soignant commun. L'identification précoce des NoV lors des épidémies est primordiale afin de mettre en place rapidement les mesures d'hygiène permettant de limiter leur propagation.

[Noroviruses, these unknown worldwide epidemic enteropathogens]. / Les norovirus, ces entéro-pathogènes épidémiques mondiaux méconnus.

Discovered in the 1970s, human noroviruses (NoV) are the leading cause of foodborne disease and gastroenteritis outbreaks worldwide. NoV affect people of all ages. In children less than 5 years old, despite rotavirus remains the main enteropathogen responsible for viral gastroenteritis, NoV become the first etiological virus in countries where the rotavirus vaccine was introduced. Treatment of viral gastroenteritis is symptomatic. The key element in front of NoV infection is limiting their transmission. A rapid NoV detection during outbreak is important in the aim to rapidly implement hygiene measures to limit the size of the outbreak. Prevention of NoV infections relies on the use of adequate hand hygiene measures and disinfection of contaminated environmental surfaces. In face of an acute gastroenteritis outbreak, the early NoV identification with rapid laboratory tests or molecular biology methods is needed in the aim to implement as soon as possible hygiene measures to limit the size of the NoV outbreak. Due to antigenically diverse NoV strains and the lack of long term immunity, the development of an effective vaccine is difficult.

Découverts dans les années 1970, les norovirus humains (NoV) sont reconnus comme les principaux agents pathogènes responsables de toxi-infections d'origine alimentaire et d'épidémies de gastro-entérites au niveau mondial. Ils infectent toutes les tranches d'âge. Chez les enfants de moins de 5 ans, bien que le rotavirus reste actuellement la première cause de gastro-entérites virales, force est de constater que les NoV sont en passe d'en devenir la première cause dans les pays où la vaccination contre le rotavirus a été introduite. Le traitement des gastro-entérites virales est symptomatique. L'élément clé face aux infections à NoV est de limiter leur transmission. La prévention des infections à NoV repose principalement sur l'application de mesures d'hygiène des mains adéquates et la désinfection de l'environnement contaminé. Lors des épidémies de gastro-entérites aiguës, l'identification précoce des NoV par des méthodes de laboratoire rapides ou de biologie moléculaire est primordiale afin de mettre en place rapidement les mesures d'hygiène permettant de limiter leur propagation. La diversité antigénique des NoV et le manque d'immunité protectrice à long terme rendent la mise au point de vaccins difficile.

A case of giant cell arteritis associated with culture-proven Coxiella burnetii aortitis.

A case of proven Coxiella burnetii aortitis, possibly associated with giant cell arteritis (GCA), is reported. A 72-year-old man, who is a hunter, presented with weight loss, fever, jaw claudication, and hardened temporal arteries associated with a persistent inflammatory syndrome and arteritis of the whole aorta, including the brachiocephalic arteries, as seen on 18F-fluorodeoxyglucose positron emission tomography/computed tomography. The diagnosis of GCA was retained, and treatment with prednisolone was started. Given the aneurysm of the abdominal aorta, the patient underwent replacement of the abdominal aorta with an allograft. Histology showed intense chronic arteritis attributed to atherosclerosis with dissection. However, Coxiella burnetii infection was confirmed by serology and then by culture and molecular biology on the surgical specimen. A combination of hydroxychloroquine and doxycycline was added to tapered prednisolone and the outcome was favourable.

[Hepatosplenic lesions due to a systemic bartonellosis in an immunocompetent patient]. / Atteinte hépato-splénique et bartonellose systémique chez une patiente immunocompétente.

We describe a case of a young healthy patient who presents a lot of hepato-splenic lesions caused by a systemic cat scratch disease. This case allows us to discuss the uncommon manifestations of the cat scratch disease and to describe the two types of hepatic lesions caused by a systemic bartonella infection : the granulomatosis and peliosis.

Nous rapportons le cas d'une jeune patiente immunocompétente présentant de multiples lésions hépato-spléniques secondaires à une infection systémique à bartonella. L'opportunité nous est ainsi donnée de discuter des manifestations rares de la maladie des griffes du chat ainsi que de décrire les deux types d'atteintes hépatiques causées par cette infection : la granulomatose et la péliose.

A one-year survey of Microsporum audouinii infections in Belgium: epidemiological and genotypic characterization.

During recent years the proportion of tinea capitis infections due to Microsporum audouinii has increased in both Belgium and other European countries. To better understand the emergence of this species, the Belgian National Reference Centre for dermatophytes launched an epidemiological survey on the main anthropophilic dermatophytes causing tinea capitis in Belgium and included the genomic characterization of M. audouinii isolates. In total, 116 strains of M. audouinii were confirmed and characterized by the DiversiLab(®) system (bioMérieux). Six genotypic variants were identified, among which one major group included 90 isolates and the reference strain. Another variant group (11 strains) was exclusively confined to a geographical region in south Belgium. Analysis of epidemiological characteristics of the infected population showed that the main age category was 5- to 9-year-old children with a sex ratio (male/female) of 1.97. Data concerning the geographic origin of the family revealed a majority of Belgian nationality (44.7%), suggesting that the infection originated in Belgium. Other nationalities were primarily African. At this time, no clear correlation has been established between one particular strain and a specific country of origin.

Acute cholecystitis with Listeria monocytogenes.

Listeriosis, an opportunistic food-borne disease caused by Listeria monocytogenes, is infrequent and occurs preferentially in patients at the extremes of age, during pregnancy or in immunocompromised hosts. Most common manifestations are maternofoetal and neonatal infections, severe invasive presentations such as bacteraemia with or without central nervous system symptoms occuring preferentially in immunosuppressed patients and self-limited gastro-enteritis affecting healthy individuals. Exceptionally, focal infections such as cholecystitis are described. We report here a case of acute cholecystitis caused by Listeria monocytogenes in an 82-year-old woman. Thanks to a successful treatment: cholecystectomy and antimicrobial therapy (amoxicillin plus clavulanic acid), the patient soon recovered. This case-report provides an opportunity to review the current literature concerning the association of Listeria monocytogenes and cholecystitis.

[MALDI-TOF mass spectrometry in clinical bacteriology or how to identify a bacteria within one minute]. / Spectrométrie de masse MALDI-TOF en bactériologie clinique ou comment identifier une bactérie en une minute.

The major application of MALDI-TOF mass spectrometry in clinical microbiology is the bacterial identification based on the analysis of all their proteins (ribosomal and membrane-associated proteins). This technology allows the identification of most of bacteria within a few minutes. The method is fast, accurate, reliable and cost-effective by comparison to conventional phenotypic techniques. Other applications of MALDI-TOF mass spectrometry are still under development, as the detection of bacterial toxins or resistance mechanisms to antimicrobial agents.

Comparison of the value of measurement of serum galactomannan and Aspergillus-specific antibodies in the diagnosis of canine sino-nasal aspergillosis.

Serology is currently used for the diagnosis of canine sino-nasal aspergillosis (SNA). However, the accuracy of serological testing using commercially available, standardized purified antigen preparations of Aspergillus (CAPurAspAg) has only been poorly documented. The aim of the present study was to assess the diagnostic value of an agar-gel double immunodiffusion (AGDD) test and an anti-Aspergillus IgG ELISA, using CAPurAspAg and the commercially available Platelia test for the detection of serum galactomannan. Sera from 17 dogs with SNA, 18 dogs with a nasal tumour (NT), 11 dogs with lymphoplasmacytic rhinitis (LPR) and 33 control dogs were tested with the 3 methods. AGDD result was positive in 76.5% of dogs with SNA, whereas all sera from dogs with non-fungal nasal disease and control dogs were negative. A positive IgG ELISA result was obtained in 88% of dogs with SNA and in 18% of dogs with LPR. All patients with NT and control dogs had a negative IgG ELISA result. The Platelia test was positive in 24% of dogs with SNA, 11% of dogs with NT, 9% of dogs with LPR and 24% of control dogs. The results of this study suggest that (1) the detection of serum Aspergillus-specific antibodies with AGDD or ELISA, using CAPurAspAg, provides excellent specificity and good sensitivity, (2) the specificity is higher for AGDD (100%) than for ELISA (96.8%) while sensitivity is higher for ELISA (88.2%) than for AGDD (76.5%) and (3) serum galactomannan quantification with the Plateliat test is unreliable for the diagnosis of canine SNA.

[Infectious serology: interpretation of the results and traps to avoid]. / Sérologie infectieuse: interprétation des résultats et pièges a eviter.

In Medical Microbiology, in addition to the direct methods of indentification of infectious agentss, the serologic indirect techniques by quantification of antibodies have extremely useful in infectiology, for the diagnosis and the therapeutic or vaccination follow-up as well as for epidemiologic enquiries, serodiagnosis methods have significantly improved. Meanwhile, results may reveal hard to interpret, especially when are tries to specify the time of the beginning of an infection. The results require in the majority of the cases to be compared on two subsequent serum samples, to observe a possible increase in antibodies level. In addition, the infectious serology results may not be considered as the only element of final diagnosis. In all cases, they have to be interpreted and challenged against the clinical context.

Susceptibility testing of Pseudomonas aeruginosa by the Vitek 2 system: a comparison with Etest results.

P. aeruginona infections need accurate antimicrobial susceptibility data, as treatment mainly relies on antibiotic efficiency in debilitated patients. Vitek 2, a popular automated susceptibility testing method, was compared with Etest to assess its reliability on 150 Belgian P. aeruginonas isolates. Vitek 2 and Etest exhibited a high degree of concordance, but some discrepancies in clinical category were evident for cefepime (high minor and borderline very major error rate) and for piperacillin/tazobactam (high very major error rate). Vitek 2 appears to yield valuable information to the clinician concerning the antimicrobials amikacin, ceftazidime, ciprofloxacin and meropenem, in the setting of pseudomonas infection. For cefepime and piperacillin/tazobactam, a confirmatory testing by means of disk diffusion is worth considering.

Knowledge of HIV/AIDS modes of transmission and means of protection in different European countries.

This study was undertaken to assess the state of the european population's knowledge on HIV transmission and means of protection. Data were delivered from different national surveys based on questionnaires administered to general population samples. The results showed that the population's knowledge on HIV/AIDS are insufficient or even incorrect.

Efficacy and Tolerability of Fosinopril 10mg and Hydrochlorothiazide 12.5mg Combination in Elderly Patients with Mild to Moderate Hypertension : A French Multicentre Study.

The objective of the study was to evaluate the efficacy and tolerability of the combination of fosinopril l0mg (FOS) and hydrochlorothiazide (HCTZ) 12.5mg versus placebo in the treatment of elderly patients with mild to moderate hypertension. The study included two distinct phases: Phase I was a short-term phase consisting of a 4-week single-blind, placebo lead-in period followed by a randomised, double-blind, parallel group where patients were treated with either a combination tablet of FOS 10mg with HCTZ 12.5mg or placebo given once daily for 8 weeks. A total of 150 patients, ranging from 60 to 91 years of age, were included in this study. Phase II was a long-term extension of phase I and was a 12-month open-label follow-up in which all patients started therapy with FOS l0mg/HCTZ 12.5mg. After 4 weeks of initial therapy, escalation to FOS 20mg/HCTZ 12.5mg was allowed for seated diastolic blood pressure (SeDBP) > 90mm Hg. Clinic visits were scheduled at months 1, 3, 6, 9 and 12. Data from 118 patients were analysed. The mean SeDBP decreased from baseline more in the FOS/HCTZ group (-12.2mm Hg) than in the placebo group (-6.4mm Hg). Similar results were observed for supine diastolic and systolic blood pressure. After 8 weeks of treatment, 58.2% of patients showed normalised (≤ 90mm Hg) SeDBP with Fos/HCTZ vs 30.3% in the placebo group (p < 0.001). The mean decrease from baseline in SeDBP was -14.3mm Hg and -18.4mm Hg at 1 month and 12 months, respectively, demonstrating efficacy of the lower dose combination (10/12.5mg). The mean seated systolic blood pressure (SeSBP) also decreased from baseline and was -24.5mm Hg and -28.5mm Hg at months 1 and 12, respectively. The results for supine blood pressure corroborated the findings for seated blood pressure. Four patients died either during (2) or shortly after (2) long-term therapy, 5 patients discontinued long-term therapy because of adverse events, 14 patients experienced 16 serious adverse events. Cough was the most common adverse effect reported in 10.4% of patients. No symptomatic orthostatic hypotension was reported.Fosinopril 10 or 20mg when administered in combination with hydrochlorothiazide 12.5mg once daily for 12 months was found to be an effective antihypertensive treatment in elderly patients with mild to moderate hypertension.