Multicentric evaluation of a specific intrathecal anti-Treponema pallidum IgG index as a diagnostic biomarker of neurosyphilis: results from a retro-prospective case-control study.

BACKGROUND AND OBJECTIVES: The diagnosis of neurosyphilis (NS) lacks a true 'gold standard', making the diagnosis challenging while consequences of a misdiagnosis are potentially severe. The aim of this study was to evaluate the diagnostic performance of measuring an antibody index (AI) for the intrathecal synthesis of specific anti-Treponema pallidum (T. pallidum) IgG for the diagnosis of NS. METHODS: Specific anti-T. pallidum IgG were measured simultaneously in paired cerebrospinal fluid (CSF)-serum samples collected retrospectively and prospectively between 2007 and 2022, from patients suspected of NS, in Switzerland. An AI was calculated to account for blood-brain barrier integrity. Area under the receiver operating characteristic curve, sensitivity/specificity and positive/negative predictive values of AI test were estimated. Two NS definitions were used: NS1 included patients with NS suspicion presenting with neurological symptoms and/or acute neurosensory signs, and positive T. Pallidum Hemagglutinations Assay (TPHA)/T. pallidum particle agglutination assay (TPPA) serology and CSF-TPHA/TPPA ≥320, and either CSF-leucocytes >5 cells/mm3 and/or CSF-protein >0.45 g/L and/or a reactive CSF-venereal disease research laboratory (VDRL)/rapid plasma reagin (RPR) test. NS2 included patients with suspected NS presenting with acute ocular and/or otologic symptoms, and positive TPHA/TPPA serology, and a favourable response to NS treatment. Controls were patients diagnosed with any other central nervous system (CNS) pathologies and with positive TPHA/TPPA serology. RESULTS: The study included 71 NS (43 NS1 and 28 NS2) and 110 controls. With a threshold of ≥1.7, sensitivity and specificity of the specific AI test were 90.7% (CI 77.7 to 97.4) and 100% (CI 96.7 to 100.0), respectively, for NS1 and 14.3% (CI 4 to 32.7) and 100% (CI 96.7 to 100.0) for NS2. In patients suspected of NS with a CNS involvement (NS1 group), NS could be confirmed by the positivity of this specific AI. CONCLUSIONS: Measurement of an intrathecal synthesis index of specific anti-T. pallidum IgG in patients with CSF inflammatory signs appears to be a valuable diagnostic test. However, in otic or ocular syphilis, presenting few CSF abnormalities, AI is not sufficient alone to confirm NS diagnosis. TRIAL REGISTRATION: Swiss Association of Research Ethics Committees number 2019-00232.

[Mpox (Monkeypox): from a dermatologist's point of view]. / Mpox (variole du singe) : l'œil du dermatologue.

Mpox (Monkeypox) was largely unknown in Switzerland before the outbreak that started in May 2022 and spread worldwide, including Europe and the Americas. This article reviews the clinical manifestations and treatment of this infection while emphasizing the importance of clinical observation. Rapid identification and diagnosis of cases allow a more efficient application of sanitary measures in order to prevent further spreading of the disease.

La mpox (variole du singe) était une maladie largement méconnue dans notre pays avant la poussée épidémique de mai 2022. Cette dernière a essaimé dans plusieurs pays, notamment en Europe et aux Amériques. Nous abordons ici les symptômes et signes cliniques ainsi que le traitement de cette maladie, tout en rappelant l'importance de l'observation clinique en médecine. Un diagnostic précoce des patients infectés permet une application plus efficace des mesures sanitaires afin de limiter la propagation.

[Urethritis in the context of risk of sexually transmitted infections : update!] / Urétrites en contexte de risque d'infections sexuellement transmises : actualités.

Urethritis of infectious origin are part of the sexually transmitted diseases (STD) that represent a major public health problem in terms of costs and morbidity. The incidence of urethritis has been increasing for several years and the diagnosis and management must be carried out as soon as possible to avoid complications that may arise and that are sometimes irreversible, but also to limit contamination chains. The difficulties of diagnosis lie in the numerous asymptomatic cases and the management of sexual partners who may be multiple and difficult to identify. The constantly changing epidemiology and resistance to antibiotics guide new developments in their management.

Les urétrites d'origine infectieuse font partie des IST et représentent un problème majeur de santé publique en termes de coûts et de morbidités. Depuis plusieurs années, leur incidence ne cesse d'augmenter et le diagnostic ainsi que la prise en charge doivent être réalisés dans les meilleurs délais afin d'éviter des complications parfois irréversibles, mais aussi de limiter la chaîne de contamination. Les difficultés du diagnostic résident dans les nombreux cas asymptomatiques et la prise en charge des partenaires sexuels qui peuvent être multiples et difficiles à identifier. L'épidémiologie et la résistance aux antibiotiques en constante évolution guident les nouveautés de leur prise en charge.

[SARS-COV-2 infection and skin manifestations]. / Infection par le SARS-CoV-2 et manifestations cutanées.

With the COVID-19 emergence, came the description of large cutaneous rash variety. Although nonspecific and rarer than respiratory symptoms, many case reports emerged on 2020 and can be classified into 3 categories. Histopathological analysis associated with microbiological samples can guide the diagnosis. Knowledge of these cutaneous rash can help diagnosis and allow precocious detection of COVID 19, especially with patients without other systemic symptoms.

Avec l'émergence du Covid-19 est apparue la description de différentes manifestations cutanées. Bien qu'aspécifiques et plus rares que les symptômes respiratoires, de nombreux rapports de cas ont été publiés durant l'année 2020, pouvant être classés en 3 catégories. L'analyse histopathologique associée aux prélèvements microbiologiques peut orienter le diagnostic. Les connaissances de ces manifestations cutanées peuvent parfois aider au diagnostic et permettre une détection plus précoce de l'infection par le SARS-CoV-2, notamment chez les patients ne présentant pas d'autres symptômes systémiques.

An Unusual Case of Cocaine-induced Neutrophilic Systemic Disease.

is missing (Short communication).

[Martorell hypertensive ischemic ulcer: an atypical wound to know]. / Angiodermite nécrotique†: un ulcère à connaître.

Martorell hypertensive ischemic ulcer is often an unrecognized cause of chronic leg ulcer and may result in a delayed management. We describe a typical case report with clinical key features for diagnosis and therapeutic management. Pathophysiology and main differential diagnosis are discussed. Skin biopsy can be used to rule out differential diagnosis. Management should be focused on pain control, evaluation and treatment of cardiovascular risks before performing a skin graft.

L'angiodermite nécrotique ou ulcère de Martorell est une cause souvent méconnue d'ulcère chronique des membres inférieurs, pouvant conduire à un retard de prise en charge. Au travers d'un cas clinique typique, nous discutons des hypothèses physiopathologiques et de la prise en charge diagnostique et thérapeutique. La biopsie cutanée permet d'éliminer les diagnostics différentiels. Le traitement est spécifique et repose sur un contrôle de la douleur, la recherche et le traitement des facteurs de risque cardiovasculaire avant d'entreprendre une greffe cutanée de peau mince.

[Lyme Borreliosis in 2020 practice, from a dermatological point of view]. / Borréliose de Lyme vue par le dermatologue, en pratique en 2020.

Lyme borreliosis is a frequent disease in Switzerland. Due to the increasing number of symptoms attributed to this infection, the diagnostic is often controversy between different specialists and is often a subject of discussion. The diagnostic of Lyme disease lays particularly on the knowledge of cutaneous signs which are the only specific. Despite recent scientific progress, microbiological diagnostic is still delicate and serological tests currently used do not differentiate between an active infection versus a serological marker. Here we describe the different clinical presentations of Lyme disease diagnosis and management procedures according to stages of evolution.

La borréliose de Lyme est une maladie fréquente en Suisse. Elle a beaucoup fait parler d'elle ces dernières années en raison d'un nombre croissant de symptômes qui lui ont été attribués, faisant polémique auprès des spécialistes. Le diagnostic de la maladie de Lyme repose en grande partie sur la reconnaissance des signes cutanés qui seuls sont spécifiques. Malgré les progrès scientifiques, le diagnostic microbiologique reste toujours délicat, et les tests sérologiques utilisés actuellement ne permettent pas de faire la distinction entre une infection active et une cicatrice sérologique. Dans cet article, nous décrivons les différentes manifestations cliniques et la prise en charge diagnostique et thérapeutique selon les stades d'évolution de la maladie.

[Rubor, calor, dolor, tumor†: skin and soft tissue infections]. / Rubor, calor, dolor, tumor†: infections de la peau et des tissus mous.

Skin infections are a frequent cause of consultation, yet the diagnosis can be challenging for physicians. Microbiological documentation is rare, and empiric antibiotic regimens should cover the most commonly identified bacteria, i.e. streptococci Staphylococcus aureus. Other pathogens should be considered in case of immunosuppression or certain exposures. Necrotizing fasciitis (NF) is a severe but rare infection. Early surgical management in parallel with antibiotics is the cornerstone of treatment. Despite the high incidence of these infections, little progress has been made in their management and some areas of uncertainty exist, especially regarding the optimal duration of treatment, the prevention of recurrences and the use of polyclonal immunoglobulins for NF. This article reviews the main aspects of diagnosis and treatment of these infections.

Les infections de la peau sont fréquentes mais leur diagnostic peut représenter un défi pour le clinicien. La documentation de l'étiologie microbiologique est rare et le traitement empirique doit couvrir les germes fréquents, notamment Streptococcus spp. et Staphylococcus aureus. Des bactéries inhabituelles peuvent être retrouvées lors d'immunosuppression ou exposition spéciale. La fasciite nécrosante (FN) est une infection sévère mais rare, dont le traitement repose sur la chirurgie rapide et l'antibiothérapie. Malgré leur fréquence, peu de progrès ont été réalisés dans la prise en charge de ces infections et des incertitudes persistent par rapport à la durée optimale de traitement, la prophylaxie pour les récurrences ou l'utilité des immunoglobulines polyclonales intraveineuses pour la FN. Cet article aborde les aspects diagnostiques et thérapeutiques de ces infections.

[A new life for old anatomical wakes]. / Nouvelle vie pour les moulages anatomiques anciens.

Wax mouldings exemplifying human body and cutaneous diseases were produced and used from the 18th to the 20th century. They were mainly used for teaching and also for exhibitions to prevent sexually transmitted diseases. Many medical mouldings are still shown in European museums. Their originality and their artistic value encourage us to preserve them and also benefit of them as a new old tool to teach. Thanks to modern applications of imagery we show here how such historical pieces find a new life.

Les moulages en cire étaient largement utilisés dans les facultés de médecine entre le XVIIIe et le début du XXe siècle pour l'enseignement de l'anatomie et des dermatoses. Mais on pouvait également les voir dans certaines expositions itinérantes, dont l'objectif était d'informer un public large sur les maladies sexuellement transmises. De nos jours, de nombreuses pièces sont exposées dans différents musées en Europe. La qualité technique et artistique et l'originalité des moulages en cire motivent non seulement leur conservation mais aussi la redécouverte de leur potentiel de nouveau-vieil outil d'enseignement. Grâce aux applications modernes de l'imagerie, nous montrons ici comment de telles pièces historiques trouvent une nouvelle vie.

[Update on Mycoplasma genitalium among women]. / Le point sur Mycoplasma genitalium chez la femme.

Mycoplasma genitalium (MG) is a sexually transmitted pathogen with a poorly understood natural history. Often asymptomatic, it has been associated with urogenital conditions. The implementation of NAAT (Nucleic Acide Amplification Test) has not only improved the detection of MG, but also brought to light the emergence of antibiotic resistances, hence challenging the proposed treatment strategies and questioning the indication for systematic screening. This article summarizes current knowledge on MG among women, over viewing incidence, prevalence and clinical implications. It resumes the last guidelines in terms of screening and treatment.

Mycoplasma genitalium (MG) est un pathogène sexuellement transmissible souvent asymptomatique, dont la pathogénicité est méconnue. Source croissante d'intérêt car mieux détecté depuis l'implémentation des NAAT (Nucleic Acide Amplification Test), MG serait incriminé dans diverses pathologies uro-génitales. L'émergence des résistances aux antibiotiques est un enjeu de taille dans le traitement de l'infection et soulève le débat sur l'utilité d'un dépistage systématique. Cet article résume l'état des connaissances actuelles au sujet de MG chez la femme : son incidence, sa prévalence ainsi que ses implications cliniques. Il fait la synthèse des dernières recommandations en termes de dépistage et de traitement.

[Infection of chronic wounds in elderly patients]. / Infection de plaies chroniques : particularités chez la personne âgée.

Chronic wounds infection in the elderly patients presents the risk of functional decompensation, or irreversible worsening of a wound. The diversity of clinical situations, the absence of data from clinical trials in the literature and a certain fatalism in view of the poor prognosis of these conditions should not be allowed to delay the early preparation of a patient-centred care plan (aiming at complete scarring, remission or symptomatic relief). Diagnostic and therapeutic strategies must be flexible, to take account not only of functional issues, constraints and special features relating to the patient but also of the resources and technical means available. Antibiotic therapy is widely used and must be reduced. It needs, however, to be considered for inclusion in a care plan that must be comprehensive and multidisciplinary.

L'infection de plaies chroniques chez le patient âgé fait peser le risque d'une décompensation fonctionnelle ou d'une aggravation irréversible de la plaie. L'hétérogénéité des situations cliniques, l'absence de données issues d'essais cliniques et un certain fatalisme devant le pronostic précaire de ces affections ne doivent pas retarder l'élaboration d'un projet de soins adapté au patient (traitement visant à une cicatrisation complète, une rémission ou alors purement symptomatique). La stratégie de prise en charge doit s'adapter de façon dynamique aux enjeux fonctionnels, aux contraintes et particularités liées au patient mais aussi aux ressources et moyens techniques à disposition. Par ailleurs, l'emploi de l'antibiothérapie doit être maîtrisé et ne doit pas éluder une prise en charge globale et pluridisciplinaire.

[Fever and rash in the adult patient]. / Exanthème fébrile chez l'adulte.

Fever with rash is a frequent reason for consultation. A detailed medical history and thorough physical examination are essential since laboratory tests often lack specificity. Certain infectious and non-infectious causes are considered medical emergencies and must always be investigated upon initial evaluation. In the case of a history of recent travel the differential diagnosis has to be broadened but it should not be forgotten that resurgent « childhood ¼ viral diseases like measles can be acquired while traveling.

L'exanthème fébrile est un motif fréquent de consultations. Une anamnèse détaillée et un status minutieux sont les clés pour poser le diagnostic car les examens de laboratoire sont souvent peu spécifiques. Certaines causes infectieuses et non infectieuses représentent des urgences et doivent toujours être évoquées et recherchées lors de l'évaluation initiale. L'élément « retour de voyage ¼ élargit le diagnostic différentiel, mais ne doit pas faire oublier que certains « exanthèmes infantiles ¼ comme la rougeole peuvent aussi être acquis en voyageant.

Use of Treponema pallidum PCR in testing of ulcers for diagnosis of primary syphilis.

Treponema pallidum PCR (Tp-PCR) has been noted as a valid method for diagnosing syphilis. We compared Tp-PCR to a combination of darkfield microscopy (DFM), the reference method, and serologic testing in a cohort of 273 patients from France and Switzerland and found the diagnostic accuracy of Tp-PCR was higher than that for DFM.

Performance of the 47-kilodalton membrane protein versus DNA polymerase I genes for detection of Treponema pallidum by PCR in ulcers.

Treponema pallidum PCR (Tp-PCR) is a direct diagnostic method for primary and secondary syphilis, but there is no recommendation regarding the best choice of target gene. In this study, we sequentially tested 272 specimens from patients with sexually transmitted ulcers using Tp-PCR targeting the tpp47 and then polA genes. The two methods showed similar accuracies and an almost-perfect agreement.

Hyaluronic Acid Filler in HIV-Associated Facial Lipoatrophy: Evaluation of Tissue Distribution and Morphology with MRI.

OBJECTIVE: This prospective observational study evaluated magnetic resonance imaging (MRI) findings of hyaluronic acid (HA) injections used for the correction of HIV-associated facial lipoatrophy. METHODS: Ten consecutive males underwent subdermal HA injection (mean 1.3 ± 0.6 ml per side) and MRI examinations prior to and then 1, 6 and 12 months after injection. Two radiologists blinded to the clinical data assessed morphologic and quantitative changes. RESULTS: MRI revealed HA deposition in the subdermal and deep fat compartments. A significant HA volume increase was observed 1 month after injection (mean increase 331%, p < 0.0001) as compared to the injected amount. No volume reduction occurred at 12 months (p = 0.9961). The measured bound water content did not change (p > 0.9991), whereas skin thickness and tissue vascularization increased during the first 6 months (p = 0.01). CONCLUSION: Our data show that the cosmetic results of HA injections are caused by water binding in the deep facial fat and by a transient increase in vascularization and skin thickness.

[Infections disease update: 2014 is viral]. / Infectiologie en 2014: une année virale.

Chikungunya's phenomenal dissemination imposes now infection suspicion when returning from endemic areas. Colorectal cancer screening may be dependent of the microbiome. Even a small amount of E. coli in catheter sampled urine is predictive for a urinary infection. Prevention of pharyngitis suppurated late complications doesn't justify systematic antimicrobial therapy. A bitherapy is probably better for severe community acquired pneumonias. Due to epidemiology and resistances, management of gonorrhoea has changed. Enterovirus 68 is particular because of its almost exclusive lung tropism in children. The question is no longer how to treat hepatitis C but which patients to treat and when. Pritelivir clearly improves herpes genitalis symptoms. The first confirmed case of Ebola has reach our contry.

Clinical features and management of a severe paradoxical reaction associated with combined treatment of Buruli ulcer and HIV co-infection.

BACKGROUND: In West and Central Africa Buruli ulcer (BU) and HIV co-infection is increasingly recognised and management of these two diseases combined is an emerging challenge for which there is little published information. In this case we present a severe paradoxical reaction occurring after commencing antibiotic treatment for BU combined with antiretroviral therapy for HIV, and describe its clinical features and management. This includes to our knowledge the first reported use of prednisolone in Africa to manage a severe paradoxical reaction related to BU treatment. CASE PRESENTATION: A 30 year old immunosuppressed HIV positive man from Cameroon developed a severe paradoxical reaction 24 days after commencing antibiotic treatment for BU and 14 days after commencing antiretroviral therapy for HIV. Oral prednisolone was successfully used to settle the reaction and prevent further tissue loss. The antiretroviral regimen was continued unchanged and the BU antibiotic treatment not prolonged beyond the recommended duration of 8 weeks. A second small local paradoxical lesion developed 8 months after starting antibiotics and settled with conservative treatment only. Complete healing of lesions occurred and there was no disease recurrence 12 months after commencement of treatment. CONCLUSIONS: Clinicians should be aware that severe paradoxical reactions can occur during the treatment of BU/HIV co-infected patients. Prednisolone was effectively and safely used to settle the reaction and minimize the secondary tissue damage.

Evaluation of whole-genome enrichment and sequencing of T. pallidum from FFPE samples after 75 years.

The recent developments in genomic sequencing have permitted the publication of many new complete genome sequences of Treponema pallidum pallidum, the bacterium responsible for syphilis, which has led to a new understanding of its phylogeny and diversity. However, few archived samples are available, because of the degradability of the bacterium and the difficulties in preservation. We present a complete genome obtained from a Formalin-Fixed Paraffin-Embedded (FFPE) organ sample from 1947, kept at the Strasbourg Faculty of Medicine. This is the preliminary, proof-of concept study of this collection/biobank of more than 1.5 million FFPE samples and the evaluation of the feasibility of genomic analyses. We demonstrate here that even degraded DNA from fragile bacteria can be recovered from 75-year-old FFPE samples and therefore propose that such collections as this one can function as sources of biological material for genetic studies of pathogens, cancer, or even the historical human population itself.

Towards an Early Clinical and Biological Resistance Detection in Dermatophytosis: About 2 Cases of Trichophyton indotineae.

Trichophyton indotineae causes resistant dermatophytosis to terbinafine. The global spread of terbinafine-resistant Trichophyton indotineae strains with mutations in the squalene epoxidase gene is a major issue. This emerging species is now more frequently isolated in Europe and we report here two cases of T. indotineae tinea corporis in Switzerland, one with in vitro resistance to terbinafine and a second with in vitro susceptibility but a clinical resistance. Mycology isolation from cultures and sequencing ITS gene were used to confirm T. indotineae infection. In vitro antifungal susceptibility was tested in a microplate with a colorimetric detection of fungal viability for the determination of the minimal inhibitory concentration (MIC). Facing these emerging resistances and since there are a limited number of antifungal agents available to treat dermatophytosis, the early detection of terbinafine resistance should be a prerequisite in the management of T. indotineae infections.

Congenital syphilis in Switzerland: a marker of inequality? A mini-review.

Syphilis remains a global public health problem, with growing incidence in most regions of the world, particularly among women of childbearing age. This alarming trend has led to an increase in cases of congenital syphilis, resulting in devastating consequences. While the implementation of measures by the World Health Organization (WHO) and various governments has contributed to a decline in the global incidence of congenital syphilis, many countries are facing an escalating crisis, as incidence continues to rise. This mini-review aims to provide an overview of the current state of this disease in different parts of the world, focusing on the most affected populations and highlighting congenital syphilis as a marker of vulnerability. It also focuses on Switzerland, a country with a robust economy, to identify shortcomings in the healthcare system that contribute to the persistence of congenital syphilis, even though the infection is easily detectable and treatable. In conclusion, this mini-review highlights the persistent risk of congenital syphilis worldwide, regardless of country prevalence or economic status, and underscores the need for sustained efforts to reach underserved women, emphasizing the vital role of comprehensive training for healthcare professionals.