[Biological signifiance of 410 microcytosis]. / Signification biologique de 410 microcytoses de découverte fortuite chez des adultes jeunes.

We have detected 410 microcytosis among biological tests of military people. These microcytosis are principally coumpounded by haemoglobin's abnormalities (minor thalassemia, sickle cell diseases, E haemoglobin cases and cases of C haemoglobin) and cases of iron deficiency, usually among women.

[Streptococcus pyogenes: a rare etiology of non-gonococcal urethritis and balanitis in the adult]. / Streptococcus pyogenes: une cause exceptionnelle d'urétrite et de balanite non gonococcique de l'adulte.

Urethritis and balanitis due to S. pyogenes are very uncommon. The authors report the case of a 22 year-old male patient, presenting with this association, the first case reported in France. There was no associated STD.

A case of Aspergillus myocarditis associated with septic shock.

We report a case of isolated myocardial involvement due to Aspergillus sp., in a patient with multiple organ failure but no demonstrable immune deficiency apart from corticosteroid therapy given for the three weeks prior to hospitalization. This patient died of septic shock 7 days after hospitalization. Aspergillus was isolated only once from a sputum specimen obtained 24 h before death. At post-mortem examination there are emboli and myocardial lesions containing clusters of hyphae as Aspergillus confirmed by indirect immunofluorescence. The other organs were free of fungi. This observation is remarkable because the cardiac involvement was isolated and no immunodeficiency was present.

[Sensitivity to antibiotics of bacteria from nosocomial infections. Evolution in resuscitation services of military hospitals]. / Sensibilité aux antibiotiques des bactéries d'infections nosocomiales. Evolution dans les services de réanimation des hôpitaux des armées.

OBJECTIVE: The aim of this study, conducted in the French Military hospitals, was to monitor the course of the antimicrobial sensibility of bacteria isolated from nosocomial infection in intensive care units. PATIENTS AND METHODS: A prospective study has been conducted from January to December 1998 in all the intensive care units of the French Army. All the non-repetitive strains isolated from nosocomial infection were collected and sent to a reference centre. Antimicrobial susceptibility was determined by the agar dilution method. Beta-lactamase were identified by iso-electro-focalisation. Antibiotics choice and interpretative criteria were those of the "Comité Français de l'Antibiogramme de la Société Française de Microbiologie". RESULTS: A total of 849 strains are included in this study. Pseudomonas aeruginosa was the most frequently isolated bacterium (20%) followed by Escherichia coli (19%) Staphylococcus aureus (15%), coagulase-negative Staphylococci (CoNS) (11%) and Enterococci (7%). Imipenem was the most effective antibiotic against enterobacteriaceae (336 isolates; 100% susceptibility). Gentamicin (92%), amikacin (92%) third generation cephalosporins (83%), aztreonam (83%) and ciprofloxacin (78%) were also very effective. Resistance to III generation cephalosporins was correlated with an extended spectrum beta-lactamase (BLSE) in 36% of cases. This BLSE could be associated with an over production of the constitutive cephalosporinase. The most frequent species producing BLSE were Enterobacter aerogenes (75% of BLSE) and Klebsiella pneumoniae (17%). Among the 172 P. aeruginosa isolated, antimicrobial susceptibility were respectively: 71% for imipenem, 62%: tobramycin, 60%: amikacin 59%: ciprofloxacin 59% piperacillin + tazobactam, 55% piperacillin, 53%: ceftazidime and 44% for ticarcillin. Seventy per cent of the 96 CoNS and 50.2% of the 126 S. aureus isolated were resistant to methicillin. A strain of S. aureus and 2 CoNS strains had intermediate resistance to teicoplanin. Twenty per cent of the 59 Enterococci strains isolated were resistant to aminopenicillins (10/11 strains of E. faecium), and 9% presented a high level of resistance to gentamicine. One strain of E. faecium was resistant to vancomycin. CONCLUSION: The evolution of the susceptibility to antibiotics in intensive care units reflects the antibiotic pressure and level of cross-transmission. High rates of meticillin-resistance among staphylococci, of resistance to beta-lactams antibiotics among P. aeruginosa and of ciprofloxacin among Enterobacteriaceae are shown in this study. The implementation of appropriate strategies for surveillance and prevention is necessary.

[Antibiotic sensitivity of Salmonella isolated in army hospitals between 1998-1999]. / Sensibilité aux antibiotiques des salmonelles isolées dans les hôpitaux des armées en 1998-1999.

OBJECTIVES: Monitor the evolution in France of antibiotic sensitivity of non-typhoid salmonella isolated in fecal cultures conducted in army hospital laboratories. METHODS: A prospective study was performed from January 1998 to December 1999 in all the biology departments of the 11 army hospitals in France. All the non-repetitive strains were sent to an official center for serotyping and determination of the minimum inhibiting concentrations, by dilution in Mueller Hinton's gelose. The antibiotics currently used in treatment were tested and interpretation endpoints followed the recent recommendations of the Antibiogram committee of the French society of microbiology. Identification of beta-lactamase was conducted by iso-electric focalization and polymerization by chain reaction (PCR). For Salmonella Typhimurium, research for the specific resistance locus of the DT104 clone was made using PCR. RESULTS: Two hundred and twenty-two non-repetitive salmonella strains were isolated. The principle serotypes found were: Salmonella Enterididis (23.9%), S. Typhimurium (21.2%) and S. Hadar (10.8%). All the strains were sensitive to ciprofloxacin and cefotaxim, whereas one third exhibited reduced sensitivity to aminopenicillin. Depending on the serotype, Typhimurium and Hadar serotypes exhibited significantly lesser sensitivity to aminopenicillin, nalidixic acid and tetracycline. For S. Typhimurium, resistance is related to the diffusion of the multiresistant DT104 clone, which involves half of the strains of this serotype. For S. Hadar, 18 out of 24 strains (75%) were resistance to nalidixic acid, and 5 of them exhibited reduced resistance to ciprofloxacin. There was no difference in sensitivity to antibiotics between the strains responsible for diarrhea and those isolated in systematic examinations for capacity to work in the food trade (respectively 54 and 46% of strains). CONCLUSION: Non-typhoid salmonella are frequently isolated in diarrhea of infectious origin. The increasing resistance to antibiotics is primarily related to the diffusion of the DT104 clone, regarding S. Typhimurium and to the increase in resistance to quinolone, regarding S. Hadar.

[Analytical interference in determination of procalcitonin by PCT-Q (Brahms)]. / Interférence analytique dans le dosage semi-quantitatif de la procalcitonine (PCT-Q Brahms).

Procalcitonin (PCT) is a biological marker of infection. We present the cas of a patient who has presented a high concentration of PCT with PCT-Q test (Brahms). At the same time, the concentration of CRP is remained low, which is no physiological. Then, PCT concentration has been determinated with an automatic system (Kryptor-Brahms) and finded at low than 0.5 microg/l. Brahms company has searched an analytical interference: human anti-mouse antibodies (HAMA) were positive. If PCT concentration stay a marker of infection for the most part, this case show that biologists have to keep in mind that immunological assays remain submitted to interferences.

[Evaluation of a micromethod for the bactericidal activity of five disinfectants on 108 hospital strains]. / Evaluation par une microméthode de l'activité bactéricide de cinq désinfectants sur 108 souches hospitalières.

The authors studied 5 disinfectants containing aldehyde and quaternary ammonium against 108 hospital strains. The minimal bactericidal activities (MBC) were determined with a microdilution method and the dilution-neutralization method (AFNOR T 72-150). The microdilution method results were validated using the MBCs of four reference strains tested with the dilution-neutralization method (AFNOR T 72-150). 3 disinfectants proved to be valuable. 1 disinfectant was valuable but with a MBC toward all bacteria only a dilution away from the dilution of use. 1 disinfectant was determined as unsatisfactory as 9.5 p. cent of all strains proved resistant toward it. All disinfectants matched AFNOR standards; but those specifications did not match toward hospital strains. Such an evaluation using a simple and reliable method should be of use.

Comparative recoveries of Naegleria fowleri amoebae from seeded river water by filtration and centrifugation.

Detection of pathogenic Naegleria fowleri in environmental water samples, which is necessary for the prevention of primary amoebic meningoencephalitis, generally requires concentrating the samples. Two concentration techniques, filtration and centrifugation, were used to study the recovery of N. fowleri, in vegetative or cystic form, that had been mixed with the two other thermotolerant Naegleria species, N. lovaniensis and N. australiensis. Counting of amoebae was performed by the most probable number method on 10 water replicates of 100 ml and 10 ml each. With both concentration methods, recovery was better for cysts than for trophozoites (53% +/- 21% versus 5% +/- 5% by filtration and 57% +/- 25% versus 22% +/- 5% by centrifugation). The recovery of Naegleria trophozoites by filtration was very low, and centrifugation was significantly better than filtration in recovery of Naegleria trophozoites (22% +/- 5% versus 5% +/- 5%; P < 0.001). For cysts, however, filtration appeared as efficient as centrifugation, with equivalent values for recovery (53% +/- 21% versus 57% +/- 25%; P > 0.7). Although the recovery of cysts of N. fowleri obtained by filtration (51% +/- 24%) appeared higher than that by centrifugation (36% +/- 23%), the difference was not significant (P > 0.1). Both concentration methods have highly variable recovery rates, making accurate quantification of low concentrations (< 100/liter) of N. fowleri in the environment difficult.

[Is the quantitative antibiogram a reliable epidemiological marker for Pseudomonas aeruginosa infections? Comparison with pulsed field electrophoresis]. / L'antibiogramme quantitatif est-il un marqueur épidémiologique fiable des infections à Pseudomonas aeruginosa? Comparaison à l'électrophorèse en champ pulsé.

Epidemiologic supervision of P. aeruginosa infections is a daily care for microbiologists. The aim of this study is to evaluate quantitative antibiogram, which compare strains by calculation of euclidian distances from inhibition zone diameters on agar, compared with pulse field gel electrophoresis (PFGE) results. 53 isolates of P. aeruginosa obtained from bronchial secretions of 26 patients in intensive care unit are typed by conventional disk diffusion test on agar with 11 usual antibiotics. Dendrogram of euclidian distances is performed by Taxotron computer program (P.A.D. Grimont, Institute Pasteur, Paris); results are compared with 53 PFGE patterns after restriction with Spe I (Genepath system, BIO-RAD). Quantitative antibiogram has a high discriminatory power for beta-lactamin resistant strains: 27 isolates from 11 patients clustered in 5 types where PFGE discerned 5 patterns. The discriminatory power is low for beta-lactamin sensible strains: 26 isolates from 15 patients clustered in 8 types where PFGE discerned 19 patterns, but serotyping method combined with quantitative antibiogram restore a high disriminatory power for beta-lactamin sensible strains.

Exposure to enteroviruses and hepatitis A virus among divers in environmental waters in France, first biological and serological survey of a controlled cohort.

An epidemiological study of hepatitis A and enteroviruses was conducted in a military diving training school, by evaluating the viral contamination of water using an ultrafiltration concentration technique, and assessing seroconversion and the presence of virus in stool specimens obtained from 109 divers and 48 controls. Three of 29 water specimens were positive for enterovirus by cell culture and 9 by molecular hybridization. There was little or no risk of virus infection during the training course (49 h exposure) because there was no significant difference between divers and controls for both viral isolation and seroconversion. However, a higher percentage of coxsackievirus B4 and B5 seropositive divers suggests that these were more exposed during previous water training. No hepatitis A virus (HAV) detection and no seroconversion to HAV was observed. The rate of HAV seropositive subjects was 17% in this 24.5-year-old population.