Causes of mortality of kiwi (Apteryx spp.) in New Zealand: a retrospective analysis of post-mortem records, 2010-2020.

AIMS: To examine and assess causes of mortality of kiwi (Apteryx spp.) submitted to Massey University between 2010 and 2020 across the five recognised species according to location, age group and captivity status in New Zealand. METHODS: Post-mortem reports were obtained from the Massey University/Te Kunenga ki Purehuroa School of Veterinary Science/Wildbase Pathology Register. Inclusion criteria were all species of kiwi with a date of post-mortem examination between August 2010 and August 2020. Data from each report was exported, categorised and compared using Microsoft Excel. RESULTS: Of a total of 1,005 post-mortem reports, there were 766 North Island brown kiwi (NIBK; A. mantelli), 83 tokoeka (A. australis), 73 rowi (A. rowi), 49 great spotted kiwi (A. haastii), and 34 little spotted kiwi (A. owenii). This comprised 19 eggs/embryos, 125 neonatal, 473 juvenile, 153 subadult, and 235 adult kiwi. There were 615 kiwi from wild populations, 148 from sanctuary populations, 238 from captivity, and four from unspecified locations. The leading cause of death was trauma, affecting 322 (32.0 (95% CI = 29.2-35.0)%) kiwi including 289 (37.3 (95% CI = 26.0-31.7)%) NIBK. Nearly half of these died from predation by mustelids, with losses recorded from neonates to adults and clustered in the central to southern North Island. Predation by dogs was the second most common cause of death, killing 84 (8.4 (95% CI = 6.7-10.2)%) kiwi, of which 65.5% came from the northern districts of the North Island. Non-infectious disease killed 214 (21 (95% CI = 18.8-24.0)%) kiwi, and included developmental deformities, gastrointestinal foreign bodies and predator trap injuries. Infectious disease killed 181 (18.0 (95% CI = 15.7-20.5)%) kiwi and the proportion decreased with age, with common diagnoses including coccidiosis, bacterial septicaemia, avian malaria, and fungal respiratory disease. Starvation affected 42 (4.2 (95% CI = 3.0-5.6)%) kiwi, comprised of mainly neonatal or juvenile individuals from wild or sanctuary populations, with a higher percentage seen in tokoeka (11/83; 13.3%) compared to other species (min 0%, max 5.9%). The cause of death was undetermined in 246 (24.5 (95% CI = 21.8-27.3)%) cases, which was most often due to poor preservation of remains. This included 33/73 (46%) rowi and 32/83 (39%) tokoeka, and affected mainly birds from sanctuary and wild populations. CONCLUSIONS: This study enhances our understanding of causes of mortality in captive, wild and sanctuary populations of all kiwi species and age groups within contemporary New Zealand.

Vaccination practices for Leptospira spp. on New Zealand dairy farms.

AIMS: To describe leptospiral vaccination practices in dairy herds in New Zealand and evaluate conformity with best practice guidelines issued by the New Zealand Veterinary Association using data from a questionnaire administered by participating veterinary practices. METHODS: A cross-sectional study of 200 randomly selected dairy farms stratified by herd size and region throughout New Zealand was conducted from January to April 2016 to investigate leptospiral vaccination practices in dairy herds in New Zealand. Using a pre-tested questionnaire administered during a face-to-face interview, vaccination practice details such as vaccine types, time, and age of vaccination and whether vaccines were administered by veterinary or farm staff, were collected. RESULTS: Leptospiral vaccination programmes had been implemented on 199/200 (99.5 (95% CI = 97.2-99.9)%) farms, and on 178 (89.4%) of those, programmes had been running for ≥5 years. Most farmers used bivalent vaccines containing antigens for leptospiral serovars Pomona and Hardjo (144/179 (80.4%) in calves, 112/167 (60.7%) in heifers, and 112/163 (68.7%) in cows), rather than trivalent vaccines which also include antigens for L. interrogans serovar Copenhageni. In total, 123/200 (61.5%) of farmers purchased only vaccinated animals but 51/199 (25.6%) were unsure of the vaccination status of purchased cattle. Sixty-one percent (105/172) of farmers had other livestock on their farms and of them, 78/186 (42%) vaccinated some or all for Leptospira spp. Leptospiral vaccines were administered always or sometimes with other animal remedies on 30/190 (15.8%) and 91/190 (47.9%) of farms, respectively. Most farmers had not made changes to their vaccination programme in the previous 5 years. Timing of first vaccination of calves ranged from 2 weeks to 10 months of age, with 112/189 (59.3%) vaccinating by 4 months of age. Approximately half of the farms followed the best practice guideline for the timing of vaccinations for calves (high-risk farms; 67/162; 41.4%) heifers (72/165, 43.6%), and cows (171/184; 92.9%). CONCLUSIONS: The results of this survey suggest that there is almost universal adoption of leptospiral vaccination for dairy cattle in New Zealand. However, there remain areas for improvement regarding the proportion of farmers following best practice guidelines and refinement of vaccination programmes, particularly with respect to timing of vaccination in calves.

On-farm risk factors associated with Leptospira shedding in New Zealand dairy cattle.

This study aimed to evaluate risk factors associated with shedding of pathogenic Leptospira species in urine at animal and herd levels. In total, 200 dairy farms were randomly selected from the DairyNZ database. Urine samples were taken from 20 lactating, clinically normal cows in each herd between January and April 2016 and tested by real-time polymerase chain reaction (PCR) using gyrB as the target gene. Overall, 26.5% of 200 farms had at least one PCR positive cow and 2.4% of 4000 cows were shedding Leptospira in the urine. Using a questionnaire, information about risk factors at cow and farm level was collected via face-to-face interviews with farm owners and managers. Animals on all but one farm had been vaccinated against Hardjo and Pomona and cows on 54 of 200 (27%) farms had also been vaccinated against Copenhageni in at least one age group (calves, heifers and cows). Associations found to be statistically significant in univariate analysis (at P < 0.2) were assessed by multivariable logistic regression. Factors associated with shedding included cattle age (Odds ratio (OR) 0.82, 95% CI 0.71-0.95), keeping sheep (OR 5.57, 95% confidence interval (CI) 1.46-21.25) or dogs (OR 1.45, 95% CI 1.07-1.97) and managing milking cows in a single as opposed to multiple groups (OR 0.45, 95% CI 0.20-0.99). We conclude that younger cattle were more likely to be shedding Leptospira than older cattle and that the presence of sheep and dogs was associated with an increased risk of shedding in cows. Larger herds were at higher risk of having Leptospira shedders. However, none of the environmental risk factors that were assessed (e.g. access to standing water, drinking-water source), or wildlife abundance on-farm, or pasture were associated with shedding, possibly due to low statistical power, given the low overall shedding rate.

[Community- and non-community-acquired bacteremia: correlation between empiric antimicrobial therapy and susceptibility of micro-organisms isolated during 2007 in the Ile-de-France microbiologists network]. / Anti-infectieux empiriques dans les 24-48 premières heures des bactériémies des patients hospitalisés dans les hôpitaux du groupe des microbiologistes d'Ile-de-France en 2007.

AIM OF THE STUDY: To estimate the percentage of empirical treatments adapted in the bloodstream infections of community and not community origin and to determine the main circumstances in which this initial treatment is not adapted. PATIENTS AND METHODS: Surveillance of bloodstream infections from the laboratories of microbiology of the eight hospitals of the Ile-de-France network, during year 2007. The study concerned the patients hospitalised in medicine, surgery, obstetrics, intensive care, following care and rehabilitation, day hospitalisation, hospitalisation at home, who presented one or several episodes of bloodstream infections. RESULTS: During year 2007, 2013 bloodstream infections were analysed. Only 63.9% of bloodstream infections had an adapted initial antibiotic treatment. Among this proportion of bloodstream infections, an adapted empirical treatment concerned mainly the community episodes, the urinary tract, the pulmonary tract, or maternal-foetal episodes and the maternity ward and pediatrics. The percentage of adapted treatments was superior in the bloodstream infections where were isolated an Enterobacteriaceae, Streptococcus pneumoniae or other streptococci. On the contrary, only a quarter of bloodstream infections due to an Enterobacteriaceae producing BLSE or to a MRSA had received an adapted empirical treatment. CONCLUSION: Only two-thirds of the patients developing a bloodstream infection received an adapted initial antibiotic treatment. This proportion was even lower when it was not about a community origin, in spite of the frequent administration of several anti-infectious molecules or with wide spectrum.

Emerging Leptospira strain poses public health risk for dairy farmers in New Zealand.

Leptospira infection in dairy cattle and leptospirosis in dairy farm workers were common in New Zealand prior to the introduction of dairy cattle vaccination in the 1980s. Despite widespread vaccination within the dairy industry, the long-term effectiveness of vaccination and current Leptospira exposure status remained unknown. A cross-sectional study was conducted from January-April 2016 to investigate the prevalence of pathogenic Leptospira spp. DNA in urine at cow and herd level, and its relationship to five Leptospira serovars known to be endemic. Two hundred dairy farms were randomly selected from the national database. Twenty paired blood and urine samples were collected on each farm from adult cows (n = 4000). Sera were tested using the Microscopic Agglutination Test against serovars Hardjobovis (termed Hardjo), Pomona, Copenhageni, Ballum and Tarassovi with titres ≥48 being considered positive. Urine was tested using quantitative real-time PCR (qPCR) that amplifies the gryB gene. All but one herd had been vaccinated with a bivalent Hardjo/Pomona or trivalent vaccine incorporating Copenhageni. In total, 2.4% of cows were urine qPCR positive and 27% of farms had at least one urine qPCR positive cow. Overall 63% of cows were seropositive to one or more serovars: 44% for Hardjo, 28% for Pomona, 15% for Copenhageni (in vaccinated herds), and for unvaccinated cows: 1% for Copenhageni, and 3% for Ballum and 17% for Tarassovi. Of the 94 qPCR urine-positive cows, 51 were seropositive to Tarassovi, 3 to Ballum, 3 to Copenhageni, 24 to Hardjo, and 17 to Pomona, the latter two presumably reflecting vaccination titres. A strong association was found between shedding and serology for Tarassovi. While there was no evidence that current vaccination programmes were ineffective in protecting against their target serovars, serovar Tarassovi has apparently emerged in NZ dairy cattle. As Tarassovi is currently not included in vaccines and is prevalent in notified leptospirosis cases in dairy workers, we concluded that this serovar poses a public health risk.

Thyroid incidentalomas on 18FDG-PET/CT: a metabolico-pathological correlation.

BACKGROUND: Thyroid incidentaloma is defined as an unsuspected thyroid lesion found on imaging study or while performing a surgery non-related to the thyroid gland. Most recent scientific literature tends to demonstrate a detection rate of 0.1-4.3% for incidental findings of thyroid focal uptake identified by 18F-fluorodeoxyglugose Positron Emission Tomography with computed tomography (18FDG-PET/CT) initially prescribed for nonthyroid disease. From 10.3 to 80.0% of patients who underwent further evaluation are diagnosed with malignant lesions. Our first objective is to determine the risk of malignancy confined in thyroid incidentalomas(IT) detected on 18FDG-PET/CT in patients treated in a tertiary care center (Centre Hospitalier Universitaire de Sherbrooke). Second, we want to identify a cut-off value for SUVmax in order to distinguish benign from malignant IT. Third, we look for predictive criterion that can be outlined to help in their management. METHODS: We retrospectively reviewed 40 914 charts of patients who had a 18FDG-PET/CT done in a tertiary center from 2004 to 2014. For each patient where a thyroid incidentaloma has been identified, Maximum Standardized Uptake Value (SUVmax), ultrasound report, cytology and histopathological results as well as oncologic outcomes were compiled and analyzed. RESULTS: In this study, the incidence for thyroid incidentaloma detected with 18FDG-PET/CT is 0.74%. The rate of malignancy present in IT is 8.2% based on histopathological results. Of the patients who underwent surgery, thyroid malignancy was identified in 54.3% of them. Cytoponction showed a strong correlation with final histopathological results (p = 0.009). CONCLUSION: Thyroid incidentalomas detected with 18FDG-PET/CT are relatively infrequent, but the potential risk of malignancy remains elevated. Fine needle aspiration biopsy is the investigation of choice to rule out a malignant incidentaloma when there is no other element in the clinical portrait to preclude such additional work up.

Serological patterns, antibody half-life and shedding in urine of Leptospira spp. in naturally exposed sheep.

AIMS: To determine within-farm prevalence, longitudinal pattern of exposure measured by serology, antibody titre longevity and point prevalence of shedding in urine of Leptospira borgpetersenii serovar Hardjo and L. interrogans serovar Pomona in naturally infected sheep on a sample of commercial farms in New Zealand. METHODS: On eight commercial sheep farms, between September 2011 and January 2014, blood samples were collected from 115-217 ewe lambs on each farm, at intervals of 2-11 months. They were analysed by microscopic agglutination test (MAT) for antibodies to L. borgpetersenii serovar Hardjo and L. interrogans serovar Pomona, using a titre cut-point of 48. Urine from 98 animals was tested by quantitative PCR (qPCR). The half-life of antibodies was estimated in 185 sheep for serovar Hardjo and 21 for Pomona, and the seroprevalence and mean titre of animals lost to follow-up was compared with those remaining in the study. RESULTS: Within-flock seroprevalence for serovar Hardjo reached a maximum at 17-22 months of age, ranging from 79 to 100%. Seroprevalence for serovar Pomona rose above 10% on three farms and increased to 21-54% by 4-14 months. Seroconversions occurred mainly from late autumn to early summer at 7-15 months of age. Seroprevalences ranging from 3 to 76% for serovar Hardjo and 0.5 to 15% for serovar Pomona were observed up to 3 months of age, likely due to maternally derived immunity. The half-life of antibody in response to infection was estimated to be 6.7 (95% CI=5.8-7.9) months for serovar Hardjo and 6.3 (95% CI=4.8-9.0) months for Pomona. The prevalence of sheep with urine positive for leptospires on qPCR on each farm ranged from 11 to 88%. All but one of the qPCR-positive animals were seropositive for serovar Hardjo. On two farms where Pomona exposure was observed, animals that were lost to follow-up had a higher geometric mean titre for serovar Pomona than those remaining in the study. CONCLUSIONS: This study demonstrated seasonal exposure from autumn to early summer in young sheep, a wide range of within-flock serological and shedding prevalence, and gives an estimation of the half-life of MAT titres in sheep. More extensive data are needed to fully understand the epidemiology of leptospirosis in sheep flocks across New Zealand and, along with economic analysis, to justify and design cost-effective and efficient control measures to protect human and animal health.

Factors associated with fetal losses in ewe lambs on a New Zealand sheep farm.

CASE HISTORY: As part of a production study of ewe lambs on a large farm in the Waikato region of New Zealand in 2011, pregnancy diagnosis was undertaken twice by trans-abdominal ultrasonography at 68-103 and 97-132 days of gestation. At the second pregnancy diagnosis 257/3,790 (6.8%) ewe lambs had evidence of non-viable fetuses or absence of a pregnancy that was present at the previous pregnancy diagnosis (fetal loss). LABORATORY FINDINGS: Serum antibody titres for Leptospira interrogans serovar Pomona appeared generally higher in 10 ewe lambs with fetal loss compared with 10 that were still pregnant. Histopathological investigation was not able to confirm that fetal loss was associated with leptospial infection. EPIDEMIOLOGICAL INVESTIGATION: In the 2012-born cohort of ewe lambs 443 were vaccinated with a bivalent leptospirosis vaccine and 882 unvaccinated. Serum was collected from 124 non-vaccinated ewe lambs between January and December 2013 for measurement of antibodies to Leptospira serovar Pomona and L. borgpetersenii serovar Hardjo-bovis using a microscopic agglutination test (MAT). Less than 5% of these ewe lambs were seropositive until May, but by August 85% and 48% of animals were seropositive to Leptospira serovars Hardjo-bovis and Pomona, respectively. Fetal loss in non-vaccinated ewe lambs was 78/882 (9%) compared with 23/443 (5%) in vaccinated ewe lambs. Combined data from the 2011- and 2012-born ewe lambs (n=5,115) were analysed using a logistic regression model and fetal loss as the dependent variable. In the final model fetal loss was associated with pre-mating bodyweight (p=0.003), weight change from pre-mating to initial pregnancy diagnosis (p<0.001), year born and leptospirosis vaccination status (p=0.013). Amongst the serologically monitored ewe lambs, there were associations between fetal loss and being seropositive to Leptospira serovar Pomona using titre cut-points of 1:48 and 1:768 (p<0.001). CLINICAL RELEVANCE: Low pre-mating weight and/or low weight gain from mating to pregnancy diagnosis was associated with increased fetal loss, emphasising the importance of ewe lambs achieving target pre-mating weights and liveweight gains during pregnancy. Infection with Leptospira serovar Pomona was associated with fetal loss in the 2012-born cohort and the possibility of infection with this serovar should be considered when investigating cases of fetal loss.

A nosocomial outbreak of multidrug-resistant Mycobacterium bovis among HIV-infected patients. A case-control study.

OBJECTIVE: To identify risk factors in a nosocomial outbreak of multidrug-resistant Mycobacterium bovis (MDRMB) tuberculosis (TB) among HIV-infected patients. DESIGN: We evaluated the study period (from the first to the last MDRMB smear-positive patients hospitalized in the unit) using a case-control study with three control groups. Since MDRMB is extremely rare, we assumed that a single strain was responsible for all six cases. SETTING: A 19-bed infectious diseases unit in Paris, France. PATIENTS: The index case was an AIDS patient who was hospitalized in September 1989 because of MDRMB TB. The cases were five HIV-infected patients who developed MDRMB TB between January 1990 and October 1991. Controls were randomly selected from HIV-infected patients in our unit during the study period (case-control study 1, 15 patients), during the contact period (at least one MDRMB smear-positive patient hospitalized in the unit; case-control study 2,20 patients), and patients matched according to the length of contact (case-control study 3, 24 patients). INTERVENTIONS: After detecting the nosocomial outbreak, we took respiratory isolation precautions for all patients suspected of having active TB. MAIN OUTCOME MEASURES: Risk factors for MDRMB nosocomial transmission, and the occurrence of new cases of MDRMB infection in HIV-infected patients and health-care workers after the introduction of isolation precautions. RESULTS: The most important predictor of nosocomial transmission of MDRMB to HIV-infected patients was the (mean +/- s.d.) length of contact in days [cases, 22 +/- 15.8; study 1 controls, 11.2 +/- 18.9 (P = 0.07); study 2 controls, 14.6 +/- 8.5 (P = 0.043)]. Only one case of MDRMB TB resulted from exposure to MDRMB-smear-positive patient after the introduction of respiratory isolation measures. The incubation period in the single health-care worker who developed MDRMB TB was longer than in the cases. CONCLUSION: In a nosocomial outbreak of MDRMB TB, the contact time was the main risk factor of transmission to HIV-infected patients. Respiratory isolation measures appear to be effective.

Antithrombotic effect of ticlopidine in a platelet-independent model of venous thrombosis.

The antithrombotic activity of ticlopidine demonstrated in a variety of experimental models of thrombosis has been explained by its antiaggregating properties. This study describes the antithrombotic effect of ticlopidine in a platelet independent model of venous thrombosis. In the rat, ligature of the inferior vena cava induces thrombosis. Antiaggregating drugs (acetylsalicylic acid, dipyridamole, sulfinpyrazone) are inactive while anticoagulants (heparin, acenocoumarol) are highly antithrombotic. Ticlopidine reduces thrombus weight significantly and dose-dependently (ED 50 = 150 mg/kg/day X 3 days). Thrombocytopenia induced by injection of anti-platelet anti-serum was found not to modify thrombus formation. Yet, even in these conditions, ticlopidine remains active. Acetylsalicylic acid treatment does not prevent the antithrombotic effect of ticlopidine, indicating that its action is independent of PGI2 synthesis. These results demonstrate that ticlopidine acts as an antithrombotic agent in a venous thrombosis model in which platelets play a minor role.

Broad spectrum anti-platelet activity of ticlopidine and PCR 4099 involves the suppression of the effects of released ADP.

Aggregation and serotonin secretion were studied in washed rat platelets after oral administration of ticlopidine or its more potent analog PCR 4099. Besides a complete suppression of the ADP-induced aggregation, the two drugs significantly inhibited aggregation and secretion induced by three protein kinase C activators (1-oleoyl-2-acetyl-sn-glycerol, OAG; 12-0-tetradecanoyl phorbol-13-acetate, TPA; phospholipase C), by the calcium ionophore A 23187 and by thrombin. The highest inhibition was observed at low stimuli concentrations but could be partly or almost completely overcome by increasing their concentrations. The combination of aspirin (ASA) with the ADP scavenging system, creatine phosphate/creatine phosphokinase (CP/CPK) in vitro resulted in an inhibition similar to that observed ex vivo after ticlopidine or PCR 4099 treatment. Moreover, these in vitro and ex vivo treatments were not additive. As identical results were obtained with CP/CPK alone but not with ASA, it is concluded that ticlopidine and PCR 4099 do not interfere with protein kinase C or calcium movements but specifically inhibit the effects of released ADP, which might explain the broad spectrum anti-platelet activity of these drugs.

Anti-inflammatory and platelet anti-aggregant activity of phospholipase-A2 inhibitors.

Mepacrine, papaverine, p-bromophenacyl bromide and 2,3-dibromo(4'-cyclohexyl-3'-chloro)-phenyl-4-oxo-butyric acid (CB 874) inhibit the hydrolysis of phospholipids induced by thrombin in dog platelets. They also exhibit anti-inflammatory and anti-aggregant properties. These biological activities may be explained by a direct or indirect inhibitory action on phospholipase A2. Phospholipase A2 inhibitors may block not only the release of arachidonic acid and its subsequent conversion into prostaglandins but also the formation of lysophospholipids involved in inflammation and/or platelet aggregation.

[Role of cefuroxime-axetil in the treatment of respiratory tract infections. Bacteriological and pharmacological data]. / Place du céfuroxime-axetil dans le traitement des infections respiratoires. Bases bactérologiques et pharmacologiques.

Cefuroxime-axetil, the 1-acetoxyethyl ester of cefuroxime, is a prodrug for oral administration. The indication of this new formulation in the treatment of community acquired RTI required an updating of its activity against respiratory pathogens. A total of 260 isolates were included in a study using MIC determination (agar dilution technique): the mode MICs for Haemophilus spp., Branhamella catarrhalis, streptococci, S. pneumoniae ranged from 0.016 to 0.5 mg/l; no difference was noted between beta-lactamase producers and non producers in Haemophilus and B. catarrhalis; coagulase positive staphylococci, E. coli, K. pneumoniae isolated from RTI exhibited mode MICs not exceeding 4 mg/l (except for methicillin-R staphylococci mode MIC greater than 128 mg/l). Simultaneously the pharmacokinetic parameters were determined in healthy volunteers after a loading dose (500 mg) of the drug: 7 consecutive samples collected after a light meal provided the following data: Cmax = 7.77 +/- 2.2 mg/l; Tmax = 2.33 +/- 0.23 hrs; t1/2 beta = 1.18 +/- 0.19 hrs; AUC = 22.17 +/- 6.4 h.mg/l. Cmax and AUC were half of these values after administration of 250 mg. These results, together with the known intrinsic beta-lactamase stability of cefuroxime, should ensure sufficient in vivo concentrations and effective in vivo antibacterial activity against most respiratory pathogens after oral administration of cefuroxime-axetil.

[Comparative activity of imipenem, ceftazidime and cefotaxime against Acinetobacter calcoaceticus]. / Activité comparative de l'imipénème, du céfotaxime et de la ceftazidime vis-à-vis d'Acinetobacter calcoaceticus.

The authors compared the in vitro activity of imipenem, ceftazidime and cefotaxime against 100 strains of Acinetobacter calcoaceticus isolated in 1986 and 1987. The minimal inhibitory and bactericidal concentrations (MICs and MBCs) were determined by the agar dilution and broth microdilution methods respectively, with and without 50 per cent of human serum in the medium to evaluate the possible influence of protein binding. Imipenem was the most active of the three drugs against Acinetobacter, including beta-lactamase producing strains. The MICs 50 and 90 of imipenem were 0.18 micrograms/ml and 0.48 micrograms/ml respectively, as opposed to 5.16 and 14.61 micrograms/ml for ceftazidime, 16 and 75.6 micrograms/ml for cefotaxime. No change was noted in the susceptibility of Acinetobacter to imipenem from 1981 to 1987. The geometric mean MIC of imipenem was 0.25 micrograms/ml. Susceptibility remained unchanged for ceftazidime and cefotaxime but the geometric mean MICs were higher, being 7.29 and 22.8 micrograms/ml respectively. Imipenem had the highest bactericidal activity, with a mean MBC/MIC ratio of 1.16. The presence of human serum did not influence the results, due to the low protein binding of all three antibiotics. It is concluded that imipenem is one of the major antibiotics available for the treatment of nosocomial Acinetobacter infections. However, a few resistant strains have recently been isolated, confirming the need for epidemiological surveillance of bacterial resistance to this antibiotic.

[Mycobacterium gordonae infections in human immunodeficiency virus infection]. / Infections à Mycobacterium gordonae au cours de l'infection par le virus de l'immunodéficience humaine.

OBJECTIVES: Non-tuberculous mycobacteria infections are frequent in patients infected with the human immunodeficiency virus (HIV). Mycobacterium avium intracellulare is the most frequent organism isolated but several other mycobacteria are also seen. Mycobacterium gordonae is a saprophytic mycobacteria which is rarely pathogenic. It was observed in 9% (7 patients) of the mycobacterial infections observed in our unit over a period of 3 years. METHODS: In order to determine whether M. gordonae plays a pathogenic role in HIV-infected patients, we re-evaluated the 7 clinical files of patients with M. gordonae infection. The findings were compared with data in the literature. RESULTS: All seven of our patients had a poor general health status with fever and pulmonary infection. The chest X-ray was abnormal in 5 patients. M. gordonae was isolated from blood cultures in 2 patients and from sputum or gastric contents in 5. Outcome was favourable using anti-tuberculosis combinations. CONCLUSION: A pathogenic role for M. gordonae cannot be excluded in HIV-infected patients. However, since this mycobacterium is an ubiquitous organism, diagnosis should be based on a typical clinical presentation and certain laboratory identification from appropriate samples.

[Tuberculosis in Africans hospitalized in Paris. Impact of infection by the human immunodeficiency virus]. / Tuberculose chez des Africains hospitalisés à Paris. Impact de l'infection par le virus de l'immunodéficience humaine.

OBJECTIVES: Human immunodeficiency virus (HIV) infection has greatly modified the epidemiology and clinical course of tuberculosis. The aim of this study was to analyze the characteristics of tuberculosis in African patients hospitalized in Paris by comparing clinical features in patients with and without HIV infection. METHODS: Hospital records of 71 patients from Africa hospitalized between 1989 and 1992 in Paris with a certain or probable diagnosis of tuberculosis were studied retrospectively. RESULTS: There were 30 patients (42%) with HIV infection. In 12 of them (40%) HIV positivity was discovered at diagnosis of tuberculosis. Age, sex, and duration of residence in France before diagnosis were similar between HIV+ and HIV- patients. Pulmonary tuberculosis was found in 23 patients and extrapulmonary forms (mainly lymph node involvement) were seen in 34; both in 14 patients. There was no difference in localization between HIV+ and HIV- patients except for disseminated tuberculosis which was more frequent in HIV+ patients. Skin reactions to tuberculin were positive in 76% and 97% of the HIV- and HIV+ patients respectively (p < 0.02). Drug resistance was observed in 8 patients (6 HIV+): streptomycin (n = 6), pyrazinamide (n = 2), isoniazide (n = 2), ethambutol (n = 1) and rifampicin (n = 1). Drug therapy was successful in controlling the initial manifestations of tuberculosis in both HIV+ and HIV- patients. CONCLUSION: Extrapulmonary forms of tuberculosis, especially lymph node infection was more frequent in Africans hospitalized in Paris, whether the patients were HIV positive or negative. HIV infection was associated with disseminated tuberculosis, non-excavated pulmonary tuberculosis and undesirable side effects of antituberculosis drugs.

[Vancomycin in meningitis caused by penicillin G resistant Streptococcus pneumoniae]. / Vancomycine dans les méningites à Streptococcus pneumoniae résistant à la pénicilline G.

We report two cases of penicillin G-resistant pneumococcal meningitis in adults, with clinical and bacteriological failure of amoxicillin and negative or incomplete response to third generation cephalosporins. Meningitis occurred in a man treated for myeloma and in an elderly woman under prolonged intermittent amoxicillin therapy for chronic otitis. Such situations are known as exposing to pneumococcal meningitis and to resistance of the strain involved to penicillin G. Both patients were cured by vancomycin in continuous infusion associated with rifampicin or fosfomycin. Contrary to third generation cephalosporins, which have higher minimal inhibitory concentrations, vancomycin and rifampicin are still fully active against penicillin G-resistant pneumococcal strains. Thus, vancomycin administered in continuous infusion and associated with rifampicin and fosfomycin deserves to be tried as first-line treatment of pneumococcal meningitis in patients at risk of resistance to penicillin G.

[Models of experimental Haemophilus influenzae and Streptococcus pneumoniae pneumonia in mice]. / Modèles de pneumopathies expérimentales chez la souris à Haemophilus influenzae et Streptococcus pneumoniae.

Streptococcus pneumoniae and Haemophilus influenzae are the bacteria most frequently involved in bronchopulmonary and E.N.T. diseases. Experimental models are useful to analyse in vivo the physiopathological interactions between bacteria and lung tissue and to study the activity of various antibiotics in the focus of infection. Models for pneumococci are devised according to the virulence of the strain, the inoculation technique and the type of animal used. When strains of different virulence and hosts of different lineage are combined, several experimental models with different natural histories are obtained. These experimental models make it possible to study therapeutic measures at different stages, comparing the relative activities of fluoroquinolones, ampicillin and macrolides. For fluoroquinolones, no correlation has been found between in vivo and in vitro data in these models, but the effectiveness of new compounds has been studied. As regard Haemophilus influenzae, lung infection models are rare, either because their septicaemic component is too important or because they do not enable this organism to multiply. Moreover, the models obtained do not lend themselves easily to therapeutic trials and favour those antibiotics that have high serum concentrations. Developing a better model would enable us to improve our knowledge of the pathogenicity of this micro-organism.