First evidence of bacterial biofilms in the anaerobe part of scalp hair follicles: a pilot comparative study in folliculitis decalvans.

BACKGROUND: The cause of folliculitis decalvans (FD) remains unknown. We hypothesized that a bacterial biofilm could be involved in its pathogenesis. OBJECTIVE: To assess the presence or not of a bacterial biofilm in the hair roots of the scalp in FD. PATIENTS AND METHODS: Hairs plucked from four patients and three controls were examined by field emission scanning electron microscopy (FESEM) and confocal laser scanning microscopy (CLSM). RESULTS: Bacterial communities organized as biofilms were observed both by FESEM and CLSM in the under infundibular part of hair follicles in all patients and in two of the three controls. In patients and controls, these biofilms were formed exclusively of bacilli of comparable shapes. CONCLUSION: This pilot study provides the first evidence of the presence of bacterial biofilms in the infra infundibular part of human scalp hair follicles. These biofilms were detected both in FD patients and controls, suggesting their ubiquity as a commensal biofilm with a possible pathogenic shift in FD.

[Systematic screening for methicillin-resistant Staphylococcus aureus (MRSA) in the nasal cavities of patients hospitalized in the dermatology departments of the Saint-Louis Hospital]. / Dépistage systématique du portage nasal du Staphyloccocus aureus résistant à la méticilline (SARM) chez les patients hospitalisés en dermatologie : expérience de l'hôpital Saint-Louis.

OBJECTIVES: In a bid to combat methicillin-resistant Staphylococcus aureus (MRSA) more efficiently in our department, we performed a study to 1) clarify the MRSA carriage rate in patients hospitalized in the department; 2) evaluate the rate of MRSA acquisition during hospitalization; 3) describe the MRSA carrier profile; 4) study the morbidity and mortality associated with MRSA. PATIENTS AND METHODS: We conducted a three-month prospective study in all patients hospitalized for more than 24hours in the dermatology department of the Saint-Louis Hospital. Nasal swab cultures were performed on the day of admission, once a week thereafter and on the day of discharge. Clinical and epidemiological data were individually reviewed by means of a standardized questionnaire. RESULTS: In 310 patients, the prevalence of nasal MRSA carriage at admission was 6.5%. During hospitalization, 1.9% of our patients became colonized with MRSA. MRSA carriers were significantly older than non-carriers and had been hospitalized more frequently over the previous 12 months, principally in intensive care or in intermediate or long-term care facilities, and erosive and/or ulcerated dermatitis was more common in this population. Of the 27 patients colonized with MRSA, only three had MRSA infections, and these were successfully treated with antibiotics. DISCUSSION: The observed rate of MRSA carriage was close to that seen in intensive care units (7%). While systematic screening for MRSA in patients with erosive and/or ulcerated dermatitis would allow detection of twice as many cases of MRSA than the usual screening recommendations, this would be associated with little tangible benefit and high costs, and we therefore decided not to change the usual MRSA screening politic in our dermatology department.

Campylobacter infections in HIV-infected patients: clinical and bacteriological features.

OBJECTIVE: To study the clinical and bacteriological features of Campylobacter infections in HIV-infected patients. DESIGN: A retrospective analysis (1989-1992), followed by a prospective analysis (1992-1994). SETTING: Hospital HIV inpatient unit. PATIENTS AND METHODS: All patients with Campylobacter spp. identified by the laboratory of microbiology at Saint-Louis Hospital, Paris were studied, and their clinical features as well as their response to therapy recorded. RESULTS: During the study period, Campylobacter infection was documented in 38 HIV-infected patients, 76% of whom had AIDS. Campylobacter spp. was isolated from stools in 36 cases and from blood cultures in four cases. Species identification yielded C. jejuni (84%) and C. coli (16%). High-level resistance to quinolones was frequently observed (21%), but resistance to erythromycin (3%) and tetracycline (5%) was rare. Diarrhoea, fever and abdominal pain were the main clinical features of infection. Other intestinal pathogens were found in 42% of patients. Most patients had an acute illness with rapid resolution under appropriate antimicrobial therapy. However, eight patients (21%), experienced chronic diarrhoea with persistent isolation of Campylobacter and in vivo selection of resistant strains, requiring multiple courses of antibiotics. CONCLUSIONS: Campylobacter usually cause acute diarrhoea in patients with HIV infection. Antimicrobial therapy should be guided on in vitro susceptibility testing because of the prevalence of antibiotic resistance. Despite appropriate therapy, some patients will present with prolonged diarrhoea and in vivo selection of multiresistant isolates.

Risk factors for Clostridium difficile-associated diarrhoea in HIV-infected patients.

OBJECTIVE: To identify risk factors associated with a first episode of Clostridium difficile-associated diarrhoea (CDAD) in patients with HIV infection. DESIGN: A case-control study. SETTING: University teaching hospital HIV inpatient unit. PATIENTS AND METHODS: Nineteen HIV-infected patients with CDAD, defined as diarrhoea with positive stool culture for Clostridium difficile (CD) and positive stool cytotoxin B assay, were compared with 38 randomly selected controls (HIV-infected patients hospitalized on the ward on the day the matched case was diagnosed). CD isolates were phenotyped by electrophoretic protein patterns. RESULTS: The incidence of CDAD among HIV-infected patients was 4.1/100 of patient-admissions. On univariate analysis, cases were more likely to have used clindamycin [11 out of 19 compared with four out of 38; odds ratio (OR) 19; 95% confidence interval (CI), 2-160; P = 0.0007], and pyrimethamine (14 out of 19 compared with 13 out of 38; OR, 4.8; 95% CI, 1.4-16, P = 0.02) in the month before diagnosis, and to have had cerebral toxoplasmosis (12 out of 19 compared with 13 out of 38; OR, 2.8; 95% CI, 0.9-8.6; P = 0.09). There was also a significant increase of the risk of CDAD as duration of hospitalization in the ward increased (chi 2 for trend, P = 0.007). Multivariate models associated two risk factors with CDAD: clindamycin use (OR, 42; 95% CI, 2-813; P = 0.01), and prolonged hospitalization in the ward (OR, 3.6 per week in the ward; 95% CI, 1-13, P = 0.048). Of 18 available CD isolates, 15 (83%) had identical electrophoretic protein pattern. CONCLUSIONS: Clindamycin use and prolonged hospitalization in the ward were the main risk factors associated with CDAD in this study. These observations, together with the occurrence of one major phenotype of CD, suggest nosocomial transmission of CD in the ward.

[Re-evaluation of single-dose treatment with thiamphenicol and spectinomycin of uncomplicated male gonococcal urethritis]. / Réévaluation du traitement minute par le thiamphénicol et la spectinomycine des uréthrites gonococciques masculines non compliquées.

Gonococcal urethritis being highly contagious, the ideal treatment should be effective, well tolerated and relatively cheap. Among antibiotics fulfilling these conditions, thiamphenicol and spectinomycin are widely used throughout the world and particularly in France. However, the ever increasing incidence of infections caused by penicillinase-producing Neisseria gonorrhoeae (PPNG) strains, the growing number of strains with low sensitivity to penicillin and/or other antibiotics and the recent emergence of strains that are highly resistant to penicillin make it necessary from time to time to re-evaluate the main therapeutic approaches to gonococcal urethritis. In this study thiamphenicol and spectinomycin were compared for effectiveness as single-dose treatments of uncomplicated gonococcal urethritis in 207 male patients who consulted at the Clinical and Biological Centre for Sexually Transmitted Diseases, Saint-Louis Hospital, Paris, during April and May, 1985. Prior to the trial the patients had not received antibiotics for at least 2 weeks. They were allocated at random to two therapeutic groups: 89 patients received a single 2.5 g dose of thiamphenicol orally, and 84 patients received a single 2 g dose of spectinomycin by intramuscular injection. In every case the gonococcal origin of the urethritis had been confirmed by culture. The patients were examined 3 to 7 days after treatment for clinical and bacteriological evaluation. Specimens were cultivated on agar-blood medium, and N. gonorrhoeae was also identified by biochemical and antigenic reactions. The minimum inhibitory concentrations (MIC) of the two antibiotics were determined by the agar plate dilution method, using an agar nutrient medium. The possible production of beta-lactamase and the auxotypic and plasmidic profiles of the PPNG strains were investigated.(ABSTRACT TRUNCATED AT 250 WORDS)

[Balanitis and infectious agents. A prospective study of 100 cases]. / Balanites et agents infectieux. Etude prospective de 100 cas.

INTRODUCTION: The aim of this study was: 1) to evaluate the rate of micro-organism isolation in 100 patients consulting for balanitis at the Centre of sexually transmitted diseases at the St. Louis Hospital in Paris in comparison with that of micro-organisms isolated in 60 men without balanitis; 2) to search for a possible correlation between the clinical aspect of the disease and the nature of the infectious agent identified. METHODS: One hundred consecutive patients were included in the study. All underwent a clinical examination and samples were taken for bacteriology, mycology and virology examinations. Sixty healthy volunteers served as controls. Two samples were taken from the balanopreputial groove in search for fungi and bacteria. RESULTS: Candida albicans (CA) was isolated in 33 p. 100 of the patients. A pathogenic bacteria (beta-haemolytic streptococci, Staphylococcus aureus, Klebsiella), or a potentially pathogenic germ (Haemophilus parainfluenzae, anaerobic bacteria, Gardnerella vaginalis, Streptococcus milleri, group HB5) was found without CA in 28 p. 100 of the cases, a commensal flora (enterobacteria, group D streptococci) was found without CA in 8 p. 100 and in 31 p. 100 of the cases non causal agent could be identified. DISCUSSION: This series confirms the non-pathogenic nature of commensal bacteria: the number of isolations was similar in the subjects with and without balanitis (p < 0.9). The role played by the other bacteria in the development of balanitis is discussed: saprophytic association or direct pathogenesis? The significant difference in the rate of bacteria isolations in patients with balanitis compared with controls (p < 0.001) is in favour of a pathogenic role. The clinical presentation was not predictive of the presence of any particular micro-organism excepting the presence of pustules which were highly suggestive of candidiasis.

[Resistance phenotypes and genotypes of 182 ampicillin-resistant Salmonella Typhymurium strains of human and animal origin.]. / Phénotypes et génotypes de résistance de 182 souches de Salmonella sérotype Typhimurium résistantes à l'ampicilline d'origine humaine et animale.

Among the Salmonellae, an increase in the frequency of antibiotic resistance is mainly observed for S. Typhimurium, one of the most common serotypes encountered in human and animal diseases. One hundred and eighty-two ampicillin-resistant strains of S. Typhimurium, including 82 of human and 100 of animal origin, have been compared. The frequency of tetracycline, sulfonamide, streptomycin and chloramphenicol resistance was high (> 84 %) in both groups, the most common resistance pattern including these four antibiotics. By dot-blotting and hybridization with DNA probes, the genes encoding three types of beta-lactamase were detected. The TEM-type was found in 20 % and 22 % of human and animal strains, the CARB-type in 73 % and 77 %, respectively. The TEM- and CARB-types were found associated in five strains (four from humans an one from animal), and the OXA-2-type in only one human strain. The presence of the CARB-type genes was strongly correlated with that of the integrase (TnpI), independently of the origin of the strains, while the integrase gene in animal strains was also found in ca. 50 % of the strains carrying only TEM-type genes. These results suggest the acquisition and concommittant diffusion, in S. Typhimurium of human and animal origin, of integrons carrying multiple resistance genes including blacarb.

[Sexually transmitted diseases in men]. / Les maladies sexuellement transmissibles chez l'homme.

Sexually transmitted diseases (STD) constitute a frequent presenting complaint. The epidemiology of human immunodeficiency virus (HIV) infection is identical to that of STD and must therefore be systematically investigated in the presence of any STD. Chlamydia trachomatis (CT) is involved in the majority of cases of urethritis and epididymitis in young subjects and is present in the urethra of 10% of subjects with a genital ulcer. Genital ulcers are due to either Treponema Pallidum, Haemophilus ducreyi, or Herpes simplex virus: there is little clinicobacteriological correlation and it is therefore essential to perform laboratory examinations in order to establish the diagnosis. The prevalence of venereal vegetations due to HPV viruses has increased markedly over recent years and require effective treatment and surveillance because of the risk of carcinoma induced by viral oncogenesis. Other viral diseases such as hepatitis B are also classified as STD. The main diagnostic techniques used at the present time for each STD are reviewed and the consensually accepted therapeutic protocols are also proposed.

rRNA gene restriction patterns of Haemophilus influenzae biogroup aegyptius strains associated with Brazilian purpuric fever.

The rRNA gene restriction patterns of 92 isolates of Haemophilus influenzae biogroup aegyptius, associated with conjunctivitis or Brazilian purpuric fever in the State of São Paulo, Brazil, were studied with 16 + 23S rRNA from Escherichia coli as a probe. All strains were classified into 15 patterns. Isolates from Brazilian purpuric fever cases were seen only in patterns 3 (most frequently) and 4 (rarely), whereas isolates from conjunctivitis were found in all 15 patterns. The study demonstrated that rRNA from E. coli can serve as a probe for molecular epidemiology.

Novel OXA-10-derived extended-spectrum beta-lactamases selected in vivo or in vitro.

A clinical isolate of Pseudomonas aeruginosa, PAe191, was found to be highly resistant to all anti-Pseudomonas beta-lactam antibiotics (except imipenem) and resistant also to aminoglycosides. It produced a beta-lactamase (with an apparent pI of 7.6) which was not inhibited by clavulanic acid. Cloning and characterization of the beta-lactamase gene showed that it coded for a novel extended-spectrum OXA-10 variant, called OXA-19, which differed from OXA-10 by nine amino acids and from OXA-13 by two, i.e., Asn in position 73 (Asn73) instead of Ser and Asp157 instead of Gly. Asparagine in position 157 is implicated in resistance to ceftazidime, while the amino acid in position 73, in this variant, seems to condition the level of resistance to penicillins. The oxa19 gene was found to be inserted, in a typical integron structure, immediately downstream from an aac(6')-Ib gene coding for an aminoglycoside acetyltransferase variant, which was called AAC(6')-Ib9.

Deoxyribonucleic acid relatedness between Haemophilus aegyptius and Haemophilus influenzae.

Haemophilus aegyptius should be considered a junior subjective synonym of Haemophilus influenzae. Both nomenspecies are indistinguishable by DNA/DNA hybridization (S1 nuclease method). No single phenotypic test can unambigously separate H. aegyptius from the other biotypes of H. influenzae.