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La maladie thromboembolique veineuse a une incidence de 1,57/1000. Chez les patients de moins de 50 ans, le bilan de thrombophilie est réalisé, dont les indications sont de plus en plus strictes. La place du dosage de l'homocystéine plasmatique est incertaine. Notre cas est un patient de 42 ans ayant une embolie pulmonaire, associée à une macrocytose, nous faisant découvrir une carence en B12 secondaire à une maladie de Biermer. Dans la littérature, les patients sont principalement des hommes, ayant un âge moyen limite à la réalisation du bilan de thrombophilie. Tous ces patients n'avaient pas d'autres étiologies que l'hyperhomocystéinémie secondaire à une maladie de Biermer. La prise en charge est peu détaillée. L'hyperhomocystéinémie n'est probablement pas le seul facteur thromboembolique. Le patient a bénéficié d'une anticoagulation et d'une supplémentation en cobalamine. Une bonne lecture de la NFS est un point essentiel. Venous thromboembolic diseases have an incidence of 1.57/1000. Among patients under 50 years old, thrombophilia is assessed, the indications for which are increasingly stringent. Today, the need of plasma homocysteine assay is uncertain. Our case is a 42 year-old man, in whom a pulmonary embolism associated with macrocytosis made us discover a B12 deficiency secondary to Biermer's disease. In the literature, patients are men with an average age limit to the realisation of the assessment of thrombophilia. Not all of these patients had any causal other than hyperhomocysteinemia secondary to Biermer's disease. The support is not detailed. Hyperhomocysteinemia is probably not the only thromboembolic factor. The patient received anticoagulation and vitamin B12 supplementation. A good reading of the complete blood count is essential. [ABSTRACT FROM AUTHOR]

Abstract: Sexual transmission is the most common pathway for HIV-1; nevertheless some individuals remain seronegative despite repeated high risk sexual exposure. These were grouped in cohorts of “highly exposed but persistently seronegative” individuals, mostly prostitutes and flailing couples. Three lines of defence were observed in these cohorts. The first one is the mucosal barrier, the determining factors of which are the type of epithelium (monolayer or multilayer), epithelial integrity, and the pre-existing microflora. The second one is linked to innate immunity directly related to the genetic and/or immune predispositions of the individual: mutations affecting the CCR5 chemokine receptor, secretion of protective soluble factors, and particular HLA alleles. The third one is acquired immunity via the mechanisms of humoral and/or specific cellular immunity. These studies suggest anti HIV-1 vaccinal strategies aiming at a local immunization combining the different types of responses observed in these individuals. [Copyright &y& Elsevier]

Actinomycosis is a rare chronic and multifaceted disease caused by Actinomyces species frequently mimicking malignancy or other chronic granulomatous lung diseases. We report 4 original presentations of actinomycosis arising under supposed penicillin prophylaxis in allogeneic stem cell transplantation recipients. [ABSTRACT FROM AUTHOR]

Abstract: The nasal septoplasty is a very current intervention in otorhinolaryngology surgery. The infectious complications of this intervention are rare and mostly mild. We report here the case of a patient hospitalized in ambulatory surgery within a fracture of the nose with luxation of the septum in the nasal fossa. This patient was operated for a reduction of this fracture with septoplasty. Twelve hours after the intervention the patient presented septic arthritis due to Streptococcus pyogenes. The tracks of prevention are presented. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: The aim of this study was to evaluate the vaccinal status among Croix-Rousse Hospital workers, attitude towards this vaccination, and the information delivered in order to promote this vaccination. Methods: Questionnaires were delivered by electronic mailing. Results: Six hundred (and) twenty-nine questionnaires were analyzed (26.7% of hospital workers); 30.7% of responders were vaccinated against influenza, 89.2% of responders were aware of influenza and vaccine. Vaccine coverage was lower in younger workers, non health-care workers, non physician health-care workers, and surgeons who responded. Motivation and reserve varied according to the status, position, and age, with some discrepancies. Conclusion: These results suggest implementing a better targeted vaccination campaign, according to the various categories of personnel. [Copyright &y& Elsevier]

Abstract: Objective. – The authors had for aim to evaluate the clinical and biological evolution in HIV-infected patients with viraemia lower than 30,000 copies/mL having decided to interrupt their treatment. Patients and méthods. – Patients with highly active antiretroviral therapy (HAART) for more than 3 months followed by treatment interruption longer than 1 month were included in a retrospective analysis. Results. – Forty-six patients having stopped treatment between November 1999 and July 2003 were included. The median duration of treatment interruption was 9.5 months. During the study, no clinical event occurred for 21 patients, and at least 1 clinical event occurred for the 25 others. The median CD4(+) cell counts (CD4) before and at the end of treatment interruption were 597/mm3 and 437/mm3, respectively (P <0.001). The median values of viral load before and at the end of treatment interruption were <50 and 23749 copies/mL, respectively (P <0.001). Among the 26 patients having started a new HAART, pre-treatment interruption and post-new HAART median CD4 (with a median delay after HAART of 9.7 months) were 548 and 432.5/mm3 (P =0.02). Pre-treatment interruption and post-new HAART median viral load were 131.5 and 94.5 copies/mL (NS). Conclusions. – Treatment interruption must be used with caution in spite of the absence of virological impact, because CD4 cell count after new HAART is lower than CD4 preceding treatment interruption. Treatment interruption is contraindicated for patients with AIDS. Physicians must carefully follow other patients who decide on a treatment interruption. [Copyright &y& Elsevier]

The article discusses liver and spleen abscesses without endocarditis due to bartonella quintana in an immunocompetent host. Year of discovery of bartonella quintana; Result of the physical examination of an 18 year old man; Causative role of B. quintana on the case report.