Streptococcus bovis/Streptococcus equinus complex fecal carriage, colorectal carcinoma, and infective endocarditis: a new appraisal of a complex connection.

The proportion of group D streptococcal infective endocarditis (IE) (predominantly due to Streptococcus gallolyticus) and the incidence of colorectal cancer are higher in France than in most European countries. We assumed that this could be explained by a high group D streptococci (GDS) fecal carriage rate. The aims of this study were to re-assess the GDS fecal carriage rate in France and its relationship with colorectal cancer. Consecutive adult subjects who were to undergo a complete colonoscopy were invited to participate. GDS were searched in subjects' stools before their colonoscopy using biomolecular techniques. Colonoscopic findings were sorted into four subgroups: normal colonoscopy, non-tumoral lesions, benign tumors, and premalignant/malignant tumors. GDS fecal carriages were calculated overall and in each subgroup and compared. The data from 259 subjects were analyzed. GDS were identified in the feces of 12 subjects, with the following distribution: S. lutetiensis (n = 9), S. pasteurianus (n = 2), and S. gallolyticus (n = 1). This accounted for an overall GDS fecal carriage rate of 4.6 %. The GDS fecal carriage rate was 6 % in case of normal colonoscopy, 1.3 % in case of non-tumoral lesions, 3.2 % in case of benign tumors, and 11 % in case of premalignant/malignant tumors. These four percentages were not statistically different. The GDS fecal carriage rate was lower than expected, which did not confirm our working hypothesis. Most strains belonged to S. bovis biotype II, while S. gallolyticus was found only once. These findings suggest that different GDS play different roles in the etiopathogenesis of IE and colorectal cancer.

Leptospirosis in Franche-Comté (FRANCE): clinical, biological, and therapeutic data.

OBJECTIVES AND METHOD: We report the patient data in 77 cases of leptospirosis confirmed by PCR and/or serology (micro-agglutination), observed between 1994 and 2008 at the Besançon teaching hospital. Our aim was to compare the epidemiological, clinical, biological, and therapeutic characteristics of leptospirosis in the Franche-Comté region, to those reported in other regions. RESULTS: The median age was 42years and 95% were male patients. Leptospirosis acquisition was likely related to aquatic leisure activities (50.6%), professional exposure (28.6%), building maintenance works (11.7%), or unknown (9.1%). Forty-eight cases were uncomplicated and 29 were severe presentations of leptospirosis. Among severe cases, eight patients had to be managed in an intensive care unit, and one patient died. L. grippotyphosa and L. icterohaemorrhagiae were the main serogroups involved. Age above 50years and serogroup L. icterohaemorrhagiae were positively associated with clinical severity. The outcome was favorable for 15 patients treated with ceftriaxone for less than 7days. CONCLUSIONS: We recommended conducting clinical trials aiming at validating short courses of ceftriaxone to treat leptospirosis.

[Transformation of Escherichia coli and different species of Pseudomonas by a plasmid DNA isolated from Pseudomonas testosteroni]. / Transformation d'Escherichia coli et de différentes espèces de Pseudomonas par un ADN plasmidique isolé de Pseudomonas testosteroni.

Pseudomonas testosteroni uses testosterone as sole source of carbon. We were able to isolate an extrachromosomal DNA from a strain of Pseudomonas testosteroni and to obtain Pseudomonas putida and aeruginosa and Escherichia coli transformants catabolizing testosterone.

[Elimination of various virulence plasmids by antibiotics]. / Elimination de différents plasmides de virulence par les antibiotiques.

The pathogenicity of some enterobacteria is due to a plasmid encoding for outer membrane proteins or for toxins. The elimination of the plasmid gives a non-virulent strain. We have tried to eliminate plasmids encoding for the thermostable toxin of Escherichia coli (plasmid pCSltl) or for the enteroinvasive property of Shigella (plasmids pWR24, pHW401, pWR110), of Salmonella (plasmid pSD6) and of Yersinia (plasmids pYL4 and P4). The loss of plasmid was confirmed by agarose gel electrophoresis of a crude lysate. Fourteen antibiotics belonging to different chemical families were used at subinhibitory concentration. A control experiment without antibiotic was carried out to detect spontaneous loss of plasmids. No antibiotic was able to eliminate plasmids pCSltl, pHW401, pSD6, pYL4. Novobiocin eliminated pWR24 and pWR110, rifampicin eliminated pWR110 and P4. Three other antibiotics gave a cure of bacteria harbouring plasmids pWR110 and P4 but the percentage of cure was too low for a therapeutical interest.

Development of plasmid-mediated resistance in Vibrio cholerae during treatment with trimethoprim-sulfamethoxazole.

The persistence of Vibrio cholerae, biotype el tor, in a patient treated with trimethoprim-sulfamethoxazole was due to the acquisition of a conjugative resistance plasmid. The plasmid, with a molecular size of 72 megadaltons, belonged to incompatibility group 6-C and conferred resistance to ampicillin, chloramphenicol, sulfonamide, and trimethoprim.

[Demonstration of lipoprotein anomalies in leptospirosis. Prospective study in 10 patients]. / Mise en évidence d'anomalies des lipoprotéines au cours des leptospiroses. Etude prospective chez dix malades.

Abnormalities of lipid metabolism have never been shown in human leptospirosis. A prospective study of plasma lipids was performed in 10 consecutive patients with leptospirosis. Significant increase of triglycerides with low levels of the high-density lipoproteins and cholesterol fraction was observed in 8 patients. Electrophoresis of lipoproteins showed a fusion of beta and pre-beta lipoproteins and a marked decrease of alpha lipoproteins. The respective role of bacteria, liver and kidney could be suggested to explain these abnormalities of lipoproteins in leptospirosis.

Elimination of a virulence plasmid from Shigella sonnei and Escherichia coli by antibiotics.

Plasmid pWR105 is a non-self-conjugative plasmid conferring enteroinvasive properties on Shigella sonnei. Loss of this plasmid is accompanied by loss of the invasive phenotype as well as of the form I antigen expression. Thirteen antibiotics belonging to different chemical families were used at subinhibitory concentrations to eliminate pWR105 from S. sonnei and Escherichia coli K12. Rifampicin, novobiocin, chloramphenicol, cotrimoxazole and erythromycin eliminated the plasmid from both strains. Clindamycin eliminated pWR105 from E. coli only. Several other antibiotics gave a low rate of cure (ciprofloxacin, nalidixic acid, oxolinic acid, nifurzide, tilbroquinol, minocycline). We may expect that these antibiotics would destabilize plasmids from other Shigella species and enteroinvasive E. coli, as these extrachromosomal DNA molecules share a high degree of homology.

Mechanisms of beta-lactam resistance in Pseudomonas aeruginosa: prevalence of OprM-overproducing strains in a French multicentre study (1997).

One hundred and forty-three non-repetitive strains of Pseudomonas aeruginosa were collected in 13 French hospitals in 1997. A decreased susceptibility or resistance to ticarcillin (MIC > 16 mg/L) was found in 61 isolates (43%) and this was attributed to three major mechanisms: (i) overexpression of OprM and hence related efflux components such as MexAB or MexXY (42.6%), (ii) production of acquired beta-lactamase (29.5%) and (iii) overexpression of chromosomally encoded AmpC cephalosporinase (21.3%). Four of seven 'intrinsically' resistant strains (11.5%) with normal amounts of OprM were shown to produce low levels of AmpC, whereas in three isolates no resistance mechanism to beta-lactams could be identified. Overproduction of OprM thus appears as an important mechanism of ticarcillin resistance in French isolates of P. aeruginosa.

In vivo selection of a target/efflux double mutant of Pseudomonas aeruginosa by ciprofloxacin therapy.

We report the emergence after 4 days of ciprofloxacin monotherapy of a double mutant of Pseudomonas aeruginosa overexpressing the multidrug efflux system MexAB-OprM and harbouring a mutation in the gyrB gene. Compared with its initial susceptible counterpart, this mutant exhibited a significant increase in resistance to most of the beta-lactam antibiotics tested (16 x MIC of ticarcillin) and to ciprofloxacin (128 x MIC). Combined ceftazidime and amikacin therapy finally eradicated the resistant isolate and cured the patient of his infection. This case illustrates how strains of P. aeruginosa may develop high levels of fluoroquinolone resistance by combining efflux mechanisms and target alterations.

[Immunity in tetanus]. / Etude de l'immunité au cours du tétanos.

Among twenty six patients who have got tetanus the movement of the IgG, IgA, IgM, the serum complement, the number of B end T lymphocytes do not change in a significant way during the illness. There is no abnormally that could be considered as a consequence or a favorable factor of tetanus. In a group of patients being vaccinated against tetanus it has been given evidence that the specific antibodies develop much later than in a group of non vaccinated blood givers. Such an abnormal response can be found also in a third group of individuals without tetanus but whose ages in the average are comparable to these of the patients (69 years old). Thus, it seems not to be connected with tetanus itself but with the old ages of the patients.

[Influence of Chlamydiae serology and the presence of a pelvic inflammatory state on the results of in-vitro fertilization]. / Influence de la sérologie Chlamydiae et de l'existence d'un status inflammatoire pelvien sur les résultats de la fécondation in vitro.

The authors investigated the influence of Chlamydiae serology and the presence of a pelvic inflammatory state on the outcome of in-vitro fertilization on the basis of an analysis of 116 stimulation cycles. The study included 71 female patients suffering from infectious sterility of tubular origin with distal lesions. Chlamydiae trachomatis serology was considered to be positive at IgG titers in excess of 1/64. When the serum test was positive, there was a significant reduction in the number of clinical pregnancies and the cleavage rate. The percentage of ectopic pregnancies (6 ectopic pregnancies out of 29 clinical pregnancies) was very high, particularly if the serum test was positive and a pelvic inflammatory state persisting after antibiotic treatment contraindicated microsurgery. Surgery was performed only in favorable cases and did not appear to have any negative impact on the outcome. The presence of a non-stabilized pelvic infectious state was correlated with a significant increase in the drop-out rate and the number of post-menopausal gonadotropin required to achieve stimulation. The fact that unexpected spontaneous pregnancies may occur after an unsuccessful attempt must be taken into account when sterilization or salpingectomy are envisaged in an attempt to improve the outcome.

Epidemiology of Staphylococcus aureus in patients with cystic fibrosis.

Seven hundred and thirty-four isolates of Staphylococcus aureus, recovered from the sputum of 238 cystic fibrosis patients in six French hospitals, were characterized by esterase electrophoretic typing, capsular polysaccharide serotyping and phage typing and tested against 14 antibiotics for sensitivity. Thirty-four esterase electrophoretic types were found with a genotypic diversity coefficient of 0.91. Five hundred and forty-eight (78.7%) isolates produced capsular polysaccharide and 350 (50.3%) were type 8. Four hundred and sixty isolates (66.6%) were phage typable and 202 (28.2%) were lysed by group III bacteriophages. No esterase electrophoretic type, capsular type or phage type was specific to cystic fibrosis. Isolates belonged to a wide range of types, similar to strains acquired outside hospitals. Eighty-five patients had three or more consecutive isolates over at least 6 months. The ability of S. aureus to persist for long periods of time has been demonstrated in 73% of them. Methicillin-resistance was encountered among 73 strains (9.8%) which were also multiresistant. Two hundred and eighty-nine (39.9%) strains were sensitive to all antibiotics tested except to penicillin. Pristinamycin and co-trimoxazole were the most effective antibiotics. These results could contribute to the elaboration of a rational approach to the prophylaxis and therapy of respiratory staphylococcal infections in cystic fibrosis patients.

Cytomegalovirus, Chlamydia pneumoniae, and Helicobacter pylori IgG antibodies and restenosis after stent implantation: an angiographic and intravascular ultrasound study.

OBJECTIVE: To determine the impact of previous infection with cytomegalovirus, Chlamydia pneumoniae, and Helicobacter pylori on neointimal proliferation after coronary angioplasty with stent implantation. DESIGN: The study population was made up of 180 patients who had stent implantation in a native coronary artery with systematic angiographic and intravascular ultrasound (IVUS) follow up at six months. Quantitative coronary angiography was used to assess the late lumen loss. The mean area of neointimal tissue within the stent and the ratio of neointimal tissue to stent area were assessed from IVUS images. Previous cytomegalovirus, C pneumoniae, and H pylori infection was identified by IgG antibody determination. RESULTS: Previous cytomegalovirus infection was detected in 50% of the population, previous C pneumoniae in 18%, and previous H pylori in 33%. Mean (SD) reference diameter was 2.94 (0.48) mm and mean minimum lumen diameter after stent implantation was 2.45 (0.42) mm. At six months, the mean late loss was 0.74 (0.50) mm, the mean neointimal tissue area was 3.8 (1.7) mm(2), and the average ratio of neointimal tissue area to stent area was 45 (18)%. None of these variables of restenosis was linked to any of the three infectious agents. By multivariate analysis, lesion length was the variable best correlated with mean neointimal tissue area, the ratio of neointimal tissue to stent area, and late loss, explaining respectively 31%, 39%, and 8% of their variability. CONCLUSIONS: Previous infection with cytomegalovirus, C pneumoniae, or H pylori was not a contributing factor in the process of restenosis after stent implantation.

Genotypic analysis of Burkholderia cepacia isolates from 13 French cystic fibrosis centers.

Burkholderia cepacia has been involved in outbreaks of pulmonary infection among patients with cystic fibrosis (CF), and the spread of a highly transmissible clone has been reported throughout the United Kingdom and Canada. These data prompted a DNA-based typing study of the strains recovered in French CF centers. Ninety-five isolates recovered from 71 patients attending 13 CF centers in 9 regions of France were characterized by randomly amplified polymorphic DNA (RAPD) analysis and pulsed-field gel electrophoresis (PFGE). Twenty-one genotypes were identified among the 95 isolates, and the results of RAPD and PFGE were concordant for 89 isolates (94%). Cross-colonization was demonstrated in 7 of the 13 CF centers. The investigation of serial isolates showed that most chronically colonized patients harbored a single B. cepacia strain. A geographically clustered distribution of B. cepacia genotypes was observed, except for one genotype, which was detected in four regions but was proven to be different from the genotype of the British-Canadian highly transmissible strain. The present study confirms the ability of B. cepacia to spread among CF communities in France and the importance of epidemiological surveys in the institution of prevention policies.