[Resistance to first-line drugs and major genotypic lineages of Mycobacterium tuberculosis in the 3 French Department of the Americas: Profiles, evolution, and trends (1995-2011)]. / Résistance aux antituberculeux de première ligne et principales familles génotypiques de Mycobacterium tuberculosis en région Antilles-Guyane : profils, évolution et tendances de 1995 à 2011.

This is the first overview on resistant and multidrug resistant isolates of Mycobacterium tuberculosis circulating in the French Department of the Americas (Guadeloupe, Martinique, and French Guiana) over 17 years (January 1995-December 2011). A total of 1,239 cases were studied: 1,199 new cases (primary and multidrug resistance of 11.8 and 1.6% respectively), and 40 persistent (defined as cases with a previous history of positive culture over 6 months interval and whose spoligotypes remain unchanged), in which significantly higher proportions of resistance to at least isoniazid (22.5%, P = 0.002), rifampicin (20.0%, P < 0.001), and multidrug resistance (17.5%, P < 0.001) were observed as compared to new cases. The 281 spoligotypes obtained showed the presence of five major lineages, T (29.9%), LAM (23.9%), Haarlem (22.1%), EAI (7.1%), and X (6.7%). Two of these lineages, X and LAM, predominate among resistant and multidrug resistant isolates respectively (X: 10.5% of resistant isolates, P = 0.04; LAM: 42.3% of multidrug resistant isolates, P = 0.02). Four of the 19 major spoligo-profiles, corresponding to SIT 20, 64, 45, and 46, were significantly associated with drug resistance. Among them, genotype SIT 20, associated with monoresistance to isoniazid and multidrug resistance, would be actively and persistently in circulation, since 1999, in French Guiana, department in which one may also observe the presence of strains of M. tuberculosis phylogeographically associated to Guiana and Suriname (SIT 131 and SIT 1340).

[65-year-old man with yellow-orange papules on both forearms. Eruptive xanthomas]. / 65-jähriger Patient mit gelb-orange farbenen Papeln an beiden Unterarmen. Eruptive Xanthome.

A 65-year-old man presented with disseminated yellow-orange soft painless papules on both forearms. They had developed over the past five weeks. Clinical and laboratory investigations revealed secondary hyperlipidemia and diabetes mellitus Type 2a. Histology revealed dermal xanthomas consisting of foam cells, giant cells, and a sparse lymphocytic infiltrate. The patient was treated with a low fat, sugar free diet, as well as bezafibrate and metformin. The xanthomas resolved over six months.

Serving women in need: nurse-midwifery practice in the United States.

OBJECTIVE: Nurse-midwifery practices in the United States were examined to study the relationship between certified nurse-midwives' (CNMs) demographic, work setting, and practice characteristics in terms of clientele, practice size, and practice type. Factors that might influence the ability of CNMs to serve populations at risk for poor outcomes were given particular attention. METHODOLOGY: A total of 2,405 responses to a 1998 mailed survey of 6,365 nurse-midwives ever-certified by the American College of Nurse-Midwives were analyzed. RESULTS: Study results indicated that CNMs continue to serve a population who are, based on a social risk profile, disproportionately at risk for poor pregnancy outcomes, including women who are uninsured (16%), immigrant (27%), adolescent (29%), and women of color (50%). It was also found that clientele varied according to practice settings: CNMs working in non-hospital, nonprofit settings served a clientele that was 65% nonwhite, 44% immigrant, 40% adolescent, and 29% uninsured; these CNMs received 61% of their client payments from Medicaid. CNMs working in private offices or for managed care organizations were less likely to serve women with these characteristics. CONCLUSION: Study results, taken in conjunction with research that documents the safety of nurse-midwifery practice, reinforce policy recommendations that support expanded access to nurse-midwifery services. Findings also indicate a need for further research in the areas of CNM workload and productivity in managed care settings and the association between CNM race and ethnicity and the race and ethnicity of their clients.

[Exacerbation of pseudoparalytic myasthenia gravis following azithromycin (Zithromax)]. / Exazerbation einer Myasthenia gravis pseudoparalytica nach Azithromycin (Zithromax).

We report the case of a 25-year-old female patient with severe aggravation of myasthenia gravis due to azithromycin which was prescribed for an influenza syndrome. One hour after the intake of 500 mg azithromycin the patient developed weakness of the legs and respiratory distress due to respiratory muscle failure. She was hospitalized in a comatose state and required intubation and mechanical ventilation for six days. Acute worsening of myasthenia gravis was observed in this patient in 1986 after parenteral administration of erythromycin. Erythromycin causing aggravation of myasthenia gravis by interfering with neuromuscular transmission is reported in the literature. The close temporal relationship between the intake of azithromycin and severe worsening of myasthenia gravis in our patient suggests that azithromycin, a new azalid-antibiotic of the macrolid group, can exacerbate myasthenia gravis. We conclude that azithromycin should be added to the list of drugs to be used with caution in patients with myasthenia gravis.

[Haemophilus aphrophilus as a rare cause of bacterial spondylitis]. / Haemophilus aphrophilus als seltene Ursache einer bakteriellen Spondylitis.

We report a case of lumbar spondylitis due to Haemophilus aphrophilus in a 36-year-old man with monoclonal gammopathy of undetermined significance. Haemophilus aphrophilus is a gram-negative capnophilic, slow growing coccobacillus, a component of the normal human flora of the oropharynx. This organism is considered an uncommon human pathogen and has been reported in the literature in only 10 cases of bacterial spondylitis. We review the bacteriological and clinical findings, predisposing conditions and the previously reported infections caused by Haemophilus aphrophilus. The patient responded well to antibiotic treatment with ciprofloxacin.

[Cervical abscess caused by Capnocytophaga ochracea]. / Zervikalabszess durch Capnocytophaga ochracea.

Capnocytophaga is a gram-negative capnophilic bacterium which is part of the normal oral flora of humans (C. ochracea, C. gingivalis, C. sputigena) and mammals such as canines, cats, and rodents (C. animorsus and C. cynodegmi). Its role in the pathogenesis of periodontal disease is not well defined, and normally it represents an opportunistic germ of low pathogenicity. Threatening and fulminant infections have been observed in immunodeficient patients, and lately in immunocompetent hosts. We describe an otherwise healthy woman who developed a cervical abscess due to C. ochracea. Recurrent aphthous lesions are suspected to be the port of entrance for the germs. Bacteriological, clinical, epidemiological, and therapeutic aspects of Capnocytophaga infection are discussed.

[Swelling of the knee, fatigue]. / Knieschwellung, Müdigkeit.

A 43 year old man was admitted because of fatigue and swelling of the knees. Swelling of both knees, acropachy and turtle-back nails were registered during clinical investigation and laboratory tests showed leucocytosis, increased blood-sedimentation rate and alkaline phosphatase. Leucine aminopeptidase was normal. X-ray showed symmetric metaphyseal periosteal reactions on femora and tibiae of both sides compatible with hypertrophic osteoarthropathy. A parahilar round tumor measuring 5 x 7 cm infiltrating the right upper lobe was detected on chest x-ray suggestive of lung cancer. Pierre-Marie-Bamberger syndrome was diagnosed (hypertrophic osteoarthropathy associated with cancer of the lung). Under radiotherapy to the tumor the osteoarthropathy subsided and alkaline phosphatase returned to normal.

Sodium thiophene carboxylate does not facilitate expectoration.

A randomised double-blind crossover study compared the clinical effectiveness of a 21-day treatment with 600 mg per day of sodium thiophene carboxylate and placebo in 33 patients with stable chronic bronchial disease. During the seven week trial, subjective symptoms and findings were recorded, pulmonary function tests performed and sputum physical characteristics determined. Side-effects were closely monitored. Both subjective assessment of overall clinical efficacy and statistical analysis of the above mentioned factors failed to show any significant advantage of sodium thiophene carboxylate to placebo. Sodium thiophene carboxylate appears to be an expectorant and mucoregulatory drug, lacking evidence of clinical effectiveness in the treatment of patients with stable chronic bronchitis.