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Severe asthma in South Africa (SA) is underappreciated, especially in the primary care setting. This study highlights the epidemiological context of severe asthma as a phenotypic variant. Primary care practitioners, as first-contact medical providers, need grounding in the management of severe asthma based on the precision of diagnosis and negotiated along the 10-point strategy. The underdiagnosis and undertreatment of asthma ought to inform educational programmes and research in this country.

Background: South Africa (SA) has a large human immunodeficiency virus (HIV) epidemic but little is known of its effect on those ≥ 60 years of age viz. ‘older-persons’ living with HIV (OPLWH). Numbers in this age group are increasing and are expected to place a greater strain on existing resources. Objectives: To describe the demographic features and the co-morbidities of OPLWH in Tlokwe. This included an assessment of viral load (VL) suppression and the identification of associations between patient characteristics and clinical outcomes. Methods: A retrospective file review was undertaken to cover the period 01 May 2017 to 30 April 2018. Descriptive statistics were applied to demographic and clinical data and to treatment outcomes. Statistically significant associations were subjected to logistic regression analysis. Results: Of the 191 participants, 111/191 (58.1%) were female and 167/191 (87.4%) were 60 70 years of age. Of the participants, 154/191 (81.9%) were virally suppressed (< 400 copies/mL). Hypertension ( n = 106/191, 55.5%) was the most frequently identified co-morbidity. A CD4 cell count of ≥ 350 cells/mm 3 at last assessment correlated positively with VL suppression (odds ratio 2.3, confidence interval 1.05–5.02, p = 0.037). Conclusion: Although the level of VL suppression in this cohort was high, greater effort is required to bring this in line with the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommendations viz. 90% viral suppression in PLWH by 2030. Further research is needed to define the evolving long-term needs of OPLWH and to facilitate entry into care of those currently not in care.

International audience; This study was carried out under the aegis of the program Surface Water and Ocean Topography (SWOT) associated with the National Center of Space Studies (CNES). The future SWOT mission will offer new opportunities to survey the hydrodynamic in the rivers because it will provide data on the water level/ discharges with a high spatial resolution (oceans: 1 km, rivers: 100 m of width) and with a global cover. However, it is important to estimate the capacity of SWOT to reproduce the hydrodynamic phenomena in the estuaries and the temporal and the spatial variability of this dynamic. The aim of this paper is 1) to estimate the capacity of SWOT to reproduce the hydrological variability of watersheds, and 2) to validate the use of these data for other zone without hy-drometric station. Based on discharge measurements and simulated Surface Water and Ocean Topography (SWOT) data, we have investigated the hydrological variability of the main French rivers (Seine, Loire, Garonne and Rhône) by applying a series of statistical analyses to the time series of the discharge. A frequency analysis has been also used using a technique of wavelet. Results have shown a similar hydrological variability of the four watersheds. Three different periods of hydrologic variability has been identified: before 1970, between 1970 and 1990, and after 1990. Using these analyses, simulated SWOT samples and discharges were compared during the three studied periods. Simulated SWOT data, obtained by a synthetic sampling of river discharges basing on the number of measurements per repeat orbit, reproduce the hydrological variability of rivers. Such reproduction seems to be independent in the number of SWOT passages (from two to four), except for the minimum and maximum annual discharges where number of overpass seems to have an influence. These results were validated by coherence wavelet which underlines coherence higher than 90% How to cite this paper: Chevalier between simulated SWOT data and in-situ discharges. Nevertheless, good correlation was not observed for the minimum and the maximum annual discharge with an underestimation for SWOT maximum annual and an overestimation of the minimum annual SWOT ones. Moreover, best identification of minimum, mean and maximum annual discharge depends on SWOT overpasses.

International audience; Staphylococcus aureus induces severe infective endocarditis (IE) where embolic complications are a major cause of death. Risk factors for embolism have been reported such as a younger age or larger IE vegetations, while methicillin resistance conferred by the mecA gene appeared as a protective factor. It is unclear, however, whether embolism is influenced by other S. aureus characteristics such as clonal complex (CC) or virulence pattern. We examined clinical and microbiological predictors of embolism in a prospective multicentric cohort of 98 French patients with monomicrobial S. aureus IE. The genomic contents of causative isolates were characterized using DNA array. To preserve statistical power, genotypic predictors were restricted to CC, secreted virulence factors and virulence regulators. Multivariate regularized logistic regression identified three independent predictors of embolism. Patients at higher risk were younger than the cohort median age of 62.5 y (adjusted odds ratio [OR] 0.14; 95% confidence interval [CI] 0.05-0.36). S. aureus characteristics predicting embolism were a CC30 genetic background (adjusted OR 9.734; 95% CI 1.53-192.8) and the absence of pIB485-like plasmid-borne enterotoxin-encoding genes sed, sej, and ser (sedjr; adjusted OR 0.07; 95% CI 0.004-0.457). CC30 S. aureus has been repeatedly reported to exhibit enhanced fitness in bloodstream infections, which might impact its ability to cause embolism. sedjr-encoded enterotoxins, whose superantigenic activity is unlikely to protect against embolism, possibly acted as a proxy to others genes of the pIB485-like plasmid found in genetically unrelated isolates from mostly embolism-free patients. mecA did not independently predict embolism but was strongly associated with sedjr. This mecA-sedjr association might have driven previous reports of a negative association of mecA and embolism. Collectively, our results suggest that the influence of S. aureus genotypic features on the risk of embolism may be stronger than previously suspected and independent of clinical risk factors.

Nicaragua has one of the highest adolescent fertility rates in the world, but little is known about why approximately half of Nicaraguan women give birth before age 20.Data from the 2001 Nicaragua Demographic and Health Survey were used to examine the sexual and reproductive behavior of 3,142 females aged 15-19. Age at sexual debut and age at first birth were assessed using life table analysis, and the impacts of various factors on these measures were then examined in Cox proportional hazard models. Among sexually active females, current use of modern contraceptives was examined using logistic regression analysis.In Cox models, rural residence, rising levels of education and greater wealth were associated with older age at sexual debut (hazard ratios, 0.8, 0.5 and 0.9, respectively). When these factors were accounted for in multivariate analysis, age at first birth was positively associated with age at first sex: Having had first sex before age 15 was associated with an increased risk of having an earlier first birth (1.7-2.4), whereas having first had sex at age 16 or later was associated with a decreased risk (0.2-0.7). Among sexually active females, current use of a modern method was positively associated with being married or in a stable union and with having given birth (5.8 and 4.5, respectively), and negatively associated with lacking health care autonomy and wanting a baby within two years (0.4 and 0.6, respectively).Interventions that improve young women's education and economic opportunities might help them delay both sexual debut and childbearing, and efforts are also needed to facilitate their access to contraceptives, particularly for unmarried women.

RESUMO A necessidade de se atuar em um cenario de baixa disponibilidade de agua doce e de elevacao de custos com tratamento de agua e efluentes industriais incentiva a aplicacao de tecnicas sistematicas para conservacao e uso racional da agua em processos. Um importante metodo e o Diagrama de Fontes de Efluentes (DFE), cuja proposta e gerar redes de tratamento final do tipo centralizada e distribuida, a fim de reduzir a vazao de efluente a ser tratado e, por conseguinte, os custos a ele relacionados. Este trabalho teve como objetivo aplicar o metodo DFE, e propor sua utilizacao no contexto de um modelo de gerenciamento do uso da agua na industria. Um estudo de caso foi realizado utilizando cenarios de reuso obtidos a partir de um conjunto de dados representativos de uma refinaria de petroleo. Os resultados apontam a vantagem do tratamento distribuido em relacao ao centralizado. Enquanto este ultimo gerou cerca de 940 t/h de vazao tratada, o tratamento distribuido necessitou de somente 440 t/h do efluente, apresentando um custo em torno de metade daquele alcancado pela configuracao centralizada. Neste caso, o metodo sugere a importância da sintese de sistemas de tratamento visando a reducao do consumo de agua, da geracao e de impactos de efluentes sobre o corpo hidrico, destacando-se como um suporte ao processo de gerenciamento de recursos hidricos na industria.

The in vitro susceptibilities of 192 consecutive clinical strains of Pasteurella spp. isolated between 1996 and 2003 from soft tissue pus (n = 146), respiratory tract specimens (n = 38) and blood (n = 8) were studied by an agar dilution method. All isolates were susceptible to minocycline, cefotaxime, ofloxacin, ciprofloxacin and levofloxacin. Most strains were susceptible to moxifloxacin, amoxicillin, azithromycin and clarithromycin, whereas lower susceptibility rates to telithromycin (89.4%) were observed among respiratory tract isolates.

Resume Materiels et methodes. – Etude epidemiologique, clinique, biologique, radiologique et therapeutique des legionelloses de l'epidemie lorraine de juillet–aout 2004. Resultats. – Douze cas recenses dont 11 hommes. L'âge moyen est de 68,5 ans [min = 48 ; max = 96]. Six patients etaient fumeurs dont quatre alcoolotabagiques, trois diabetiques, trois porteurs d'hemopathie, un sous corticotherapie. Pour un patient, aucun facteur de risque n'a ete reconnu. Dans neuf cas, le debut a ete brutal. Neuf patients avaient une fievre superieure ou egale a 40 °C, neuf une dyspnee, sept une toux seche, sept une bradycardie relative, trois une diarrhee, trois un malaise, trois un syndrome confusionnel. Atteintes radiologiques unilaterales, unilobaires dans dix cas. Biologie : hyponatremie dans dix cas, cytolyse hepatique dans huit cas, rhabdomyolyse dans quatre cas, CRP > 300 mg/l dans huit cas. Le diagnostic a ete confirme par recherche d'antigenurie chez les 12 patients. Deux antigenuries se sont averees negatives rapidement apres l'initiation du traitement alors qu'une recherche prealable avait ete positive. Dans tous les cas, la premiere serologie realisee dans les premiers jours suivant l'apparition de la symptomatologie s'est averee negative. Deux serologies de controle se sont averees positives (sur quatre). Un seul prelevement d'expectoration sur sept realises s'est avere positif (tous ces prelevements ont ete realises apres la mise sous traitement). Dans sept cas, une bitherapie a ete instauree avec l'association preferentielle : fluoroquinolone–rifampicine. Deux deces ont ete recenses. La source de contamination n'a pu etre precisee. Conclusion. – La culture de Legionella pneumophila reste indispensable en contexte epidemique pour confronter des souches cliniques et environnementales afin de localiser la source de l'infection.

Resume Objectifs. – Analyse des caracteristiques cliniques et biologiques de cas de leptospirose diagnostiques en Lorraine entre 1996 et 2002 et des modalites de leur diagnostic microbiologique. Patients et methode. – Etude retrospective ; critere d’inclusion : confirmation serologique du diagnostic de leptospirose. Resultats. – Onze cas ont ete recenses dont la contamination etait le plus souvent due aux loisirs aquatiques pendant les mois d’ete. Sur le plan clinique, la fievre est apparue comme un symptome constant, tout comme l’etait la cytolyse hepatique sur le plan biologique. Leptospira interrogans serovar icterohaemorragiae a ete le serovar le plus frequemment identifie. Un patient de 17 ans, contamine lors de loisirs aquatiques est decede. Conclusion. – Au vu de ces resultats, l’interet de la vaccination des personnes ayant des loisirs aquatiques doit etre discute.

Resume Objectif – Cette etude retrospective avait pour but de decrire les caracteristiques epidemiologiques, cliniques et evolutifs des bacteriemies a streptocoque du groupe B chez l'adulte. Materiel et methodes – Les dossiers des malades hospitalises au CHU de Nancy de janvier 1996 a decembre 1999 et ayant eu une ou plusieurs hemocultures positives a SGB ont ete etudies. Resultats – Quarante et une bacteriemies a SGB chez l'adulte ont ete recensees sur une periode de 4 ans. La moyenne d'âge est de 61 ans avec un sex ratio en faveur des hommes. 85 % des patients etaient porteurs de pathologies sous jacentes (neoplasies, diabete, insuffisance cardiaque). Les presentations cliniques les plus frequentes etaient les suivantes : bacteriemie isolee (34 %), infection cutanee (22 %), infection pulmonaire (12 %). Le taux de mortalite globale etait de 22 % et 12 % des deces etaient en lien avec l'infection. Conclusion – L'incidence des infections a streptocoque du groupe B semble en voie d'augmentation chez les patients portuers de pathologies chroniques. La mortalite est elevee chez les patients les plus fragiles. Une meilleure connaissance des serotypes de SGB en cause et de la population exposee pourrait justifier le developpement et la mise en place d'une vaccination ciblee.

The present review describes the work carried out during the last 20 years in the field of the radioprotective activity and toxicity of several classes of organosilicon and organogermanium compounds (i.e. metallathiazolidines, metalladithioacetals, metallatranes and germathianes).

Dipyrrolyl monomers with more or less flexible and bulky spacers have been synthesized. The electrochemical behaviour of these monomers and their corresponding polymers has been investigated. Convergent results, obtained by cyclic voltammetry of the monomers and the polymers, ESCA analysis and mass measurements, demonstrate that from an early stage of polymerization, the monomers are oxidized at both pyrrolyl units, leading to different polymer structures, depending on the spacers used.

L'etude du mode de polymerisation de monomeres constitues de deux entites electropolymerisables espacees par des liens de taille et de rigidite differentes a ete realisee. Nous montrons que les deux entites polymerisables sont impliqL'etude du mode de polymerisation de monomeres constitues de deux entites electropolymerisables espacees par des liens de taille et de rigidite differentes a ete realisee. Nous montrons que les deux entites polymerisables sont impliquees dans le processus de formation de films organiques. L'utilisation de tels monomeres peut donc etre proposee pour l'obtention de polymeres bidimensionnels a interactions interchaines controlees. Par ailleurs la formation de complexes d'inclusion entre de tels monomeres et la cyclodextrine permet de realiser l'electrosynthese de ces materiaux, en milieu aqueux. uees dans le processus de formation de films organiques. L'utilisation de tels monomeres peut donc etre proposee pour l'obtention de polymeres bidimensionnels a interactions interchaines controlees. Par ailleurs la formation de complexes d'inclusion entre de tels monomeres et la cyclodextrine permet de realiser l'electrosynthese de ces materiaux, en milieu aqueux.

Summary A descriptive and retrospective study of all cases of osteoarticular infection due to Enterobacter sp. (n = 25) which occured between 1990 to 1994 at the Nancy University Hospital was carried out. Minimal inhibitory concentrations of the following antibiotics: cefotaxime, ceftriaxone, ceftazidime, cefepime, aztreonam, imipenem, gentamicin, tobramycin, amikacin, cotrimoxazole, pefloxacin, ofloxacin, ciprofloxacin, rifampin, and fosfomycin, were determined for all Enterobacter sp. strains responsible for these infections (E. cloacae: n = 22; E. aerogenes: n = 2 and E. sakazakii: n = 1). Among patients studied, 20 presented osteitis, 4 prosthetic joint infection, and 1 spondylodiscitis. The infection was post-operative, post-traumatic, or of another origin (urinary tract infection, perforating ulcer of the foot) in respectively 72 % (18/25), 16 % (4/25) and 12 % (3/25) of the cases. Underlying diseases were observed in 36 % (9/25) of the cases with a predominance of diabetes (5/9). Most of the strains studied (92 %) were susceptible to all β-lactam antibiotics tested. Only 2 strains presented a derepressed cephalosporinase phenotype and were only susceptible to imipenem and cefepime. All strains were resistant to fosfomycin and rifampin, and susceptible to all the other antibiotics tested. Adapted antibiotherapy combined with complementary medical and/or surgical treatment permitted to obtain recovery in 91.3 % of the assessable cases (21/23).

The laser Megajoule (LMJ), developed by the French Commissariat a l'Energie Atomique et aux Energies Alternatives (CEA), will be a cornerstone of the French Simulation Program, which combines improvement of physics models, high performance numerical simulation, and experimental validation. The LMJ facility is under construction at CEA CESTA near Bordeaux and will provide the experimental capabilities to study High-Energy Density Physics (HEDP). One of its goals is to obtain ignition and burn of DT-filled capsules imploded, through indirect drive scheme, inside rugby-shape hohlraum. The PETAL project consists in the addition of one short-pulse (ps) ultra-high-power, high-energy beam (kJ) to the LMJ facility. PETAL will offer a combination of a very high intensity multi-petawatt beam, synchronized with the nanosecond beams of the LMJ. This combination will expand the LMJ experimental field on HEDP. This paper presents an update of LMJ & PETAL status, together with the development of the overall program including targets, plasma diagnostics and simulation tools.

ISI Document Delivery No.: 034YW Times Cited: 5 Cited Reference Count: 12 Cited References: Alsdorf DE, 2007, REV GEOPHYS, V45, DOI 10.1029/2006RG000197 Andreadis KM, 2007, GEOPHYS RES LETT, V34, DOI 10.1029/2007GL029721 Biancamaria S, 2010, IEEE J-STARS, V3, P6, DOI 10.1109/JSTARS.2009.2034614 Biancamaria S, 2011, REMOTE SENS ENVIRON, V115, P373, DOI 10.1016/j.rse.2010.09.008 Cretaux JF, 2005, J GREAT LAKES RES, V31, P520 Durand M, 2010, IEEE J-STARS, V3, P20, DOI 10.1109/JSTARS.2009.2033453 Frappart F, 2008, J GEOPHYS RES-ATMOS, V113, DOI 10.1029/2007JD009438 Kouraev AV, 2004, REMOTE SENS ENVIRON, V93, P238, DOI 10.1016/j.rse.2004.07.007 Papa F, 2007, J GEOPHYS RES-ATMOS, V112, DOI 10.1029/2007JD008451 Papa F, 2010, J GEOPHYS RES-ATMOS, V115, DOI 10.1029/2009JD012674 Papa F, 2008, SURV GEOPHYS, V29, P297, DOI 10.1007/s10712-008-9036-0 Papa F, 2010, J GEOPHYS RES-OCEANS, V115, DOI 10.1029/2009JC006075 Papa, F. Biancamaria, S. Lion, C. Rossow, W. B. Papa, Fabrice/D-3695-2009 Papa, Fabrice/0000-0001-6305-6253 5 IEEE-INST ELECTRICAL ELECTRONICS ENGINEERS INC PISCATAWAY IEEE GEOSCI REMOTE S; International audience; In the context of the Surface Water and Ocean Topography (SWOT) mission, investigations are needed to refine the error budget for discharge estimations. This letter proposes to evaluate the uncertainties in the estimation of mean river discharge around the seasonal peak flow due to the satellite temporal sampling intervals. The daily time series of in situ river discharge measurements for 11 large rivers are used to analyze the uncertainties associated with the sampling of four altimeter repeat cycles: the 35-, 22-, and 10-day repeat cycles in the nadir-looking configuration of current altimeters and the 22-day repeat cycle in the SWOT wide-swath configuration, where a given location is observed every cycle twice at the equator and six times in higher latitudes. Results show that, for boreal rivers, a sampling of 35 or 22 days from current nadir altimeters is too coarse to give an accurate estimate of the average discharge around the seasonal peak flow, whereas for all watersheds, the uncertainties associated with a 10-day repeat cycle or the 22-day repeat cycle in the SWOT wide-swath configuration are within the range of acceptable uncertainties (15%-20%). In addition, the absolute maximum mean discharge uncertainties associated with the SWOT time sampling have a strong relationship with the variance of the river discharge. This suggests that, rather than the commonly used basin area, the magnitude of the short-time-scale variance of the discharge could be used as a predictor of the uncertainties associated with temporal sampling intervals when estimating average discharge around the seasonal peak flow.

Summary In vitro activity of 21 antibiotics has been studied against 90 Streptococcus pneumoniae strains isolated from adults with respiratory tract infection, from december 1990 to october 1991 in the University Hospital of Nancy. Only 5 strains presented penicillin G intermediate resistance whereas all other strains were susceptible to this antibiotic. Susceptibility to β-lactam antibiotics was decreased for penicillin-intermediate resistant strains. Imipenem, amoxicillin and cefotaxime remained the most active injectable β-lactam antibiotics tested according bacteriological and pharmacological data. Among oral β-lactam antibiotics amoxicillin showed the best activity against penicillin-intermediate resistant strains. Prevalence of resistance to macrolides and chloramphenicol was higher for penicillin intermediate-resistant strains. All strains were susceptible to glycopeptides and pristinamycin, but the MICs of this latter were 2 times higher for macrolides resistant strains. 7 strains were resistant to cotrimoxazole in vitro activity of which was sometimes due to only trimethoprim without any synergism between this drug and sulfamethoxazole.

New potential DNA radioprotective agents were obtained by coupling an oxazolopyridocarbazole nucleus (NMHE) to simple aminothiol molecules such as cystine, cysteamine and WR2721. The ability of the new adducts to compete with ethidium bromide DNA binding was determined through their IC 50 values which ranged between 1.4 and 2.75 × 10 −6 mol·dm −3 , whereas for aminothiols IC 50 ranged between 3 and 6 × 10 −3 mol·dm −3 . Similarly, the apparent DNA-binding constants for aminothiol-OPCs were found to be 200–1000 fold higher than for parent molecules. The apparent DNA binding constants of the adducts was strongly influenced by the medium ionic strength, which suggests that ionic interactions occur in the overall binding process. Microspectrofluorometric analysis of drug intracellular localization in SC 10 living cells revealed that aminothiol-OPCs were specifically accumulated in the cell nucleus.

Resume Une etude epidemiologique sur les infections a Pasteurella et bacteries apparentees, realisee sur une periode de 8 ans (1985–1992) entre le Centre National de Reference des Pasteurella et le CHU de Nancy, concerne 1153 patients. Les pasteurelloses d'inoculation representent les principales formes cliniques (66,5 %) et surviennent principalement chez des sujets jeunes; la contamination est consecutive dans la plupart des cas a des blessures animales, en particulier les morsures. Les formes systemiques (33,5 %) en majorite representees par des infections respiratoires et septicemiques, sont surtout retrouvees chez les sujets âges qui vivent en milieu rural ou ont un contact avec un animal. P. multocida est l'espece predominante (57,6 %) quelle que soit la forme clinique observee. Apres antibiotherapie adaptee (principalement par les β-lactamines et les cyclines), l'evolution est favorable dans les formes d'inoculation. En revanche, le taux de mortalite (7 % pour l'ensemble des formes systemiques) est relativement eleve parmi les infections septicemiques (14 %).

Chemical decontamination of toxic compounds (chemical warfare agents and/or insecticides) is of increasing importance. In this study, we report the use of ω-phthalimidoperoxyalkanoic acids 2 in the destruction of paraoxon (O,O-diethyl-O-para-nitrophenylphosphate), a well-known insecticide, and 2-chloro-2′-phenyldiethyl sulfide (a half mustard). We show that while all the peroxyacids used in this series allow the destruction of toxic compounds, the length n of the alkanoic side chain is important to the choice of the optimal industrial compound, which is 2d (n = 5). Synthese et reactivite d'une nouvelle serie d'ω-phtalimidoperacides. Application a la destruction de polluants organophosphores et organosoufres. La decontamination chimique de composes toxiques dans les series des organophosphores et organosoufres est d'une grande importance. Nous decrivons ici nos resultats sur la recherche de reactifs susceptibles de detruire des composes dans ces familles de toxiques; il s'agit d'une serie d'acides ω-phtalimidoperalcanoiques 2. Nous rationalisons, optimisons et justifions le choix du meilleur candidat en fonction de la longueur de la chaine alkyle du peracide 2d (n = 5).

New organophosphorus compounds utilized as haptens in immunology against organophosphorus compounds, inhibitors of acetylcholinesterase, have been synthesized. These compounds have structures similar to that of the organophosphorus nerve agent VX : [O-ethyl S-(2-(diisopropylamino)ethyl)methylphosphonothioate] by substitution of the S-atom by an O-atom or CH2 group, and by introduction of aryl, alkyl or alkylaryl groups instead of an ethyl group.

Francisella tularensis subsp. holarctica is widely disseminated in North America and the boreal and temperate regions of the Eurasian continent. Comparative genomic analyses identified a 1.59-kb genomic deletion specific to F. tularensis subsp. holarctica isolates from Spain and France. Phylogenetic analysis of strains carrying this deletion by multiple-locus variable-number tandem repeat analysis showed that the strains comprise a highly related set of genotypes, implying that these strains were recently introduced or recently emerged by clonal expansion in France and the Iberian Peninsula.

In hospital, false ceilings are a source of Aspergillus. A huge amount of spores may be suspended specially during their demolition near immunocompromised patients who are at risk to develop severe invasive aspergillosis (IA). Airway disinfection allows the no directed spraying of a disinfectant on surfaces contained into a determined volume.

To describe epidemiological, clinical, biological, radiological data and therapeutic features of legionnaire's disease during an outbreak occurring in Meurthe-et-Moselle between July-August 2004.12 cases were recorded including 11 men, 6 smokers, 4 alcoholo-nicotinic, 3 diabetics, 3 with hemopathy, 1 with corticotherapy; in one case no risks factors were found; mean age was 68.5 years [minimum=48; maximum=96]. Nine cases had sudden symptoms. Nine cases had a fever up to 40 degrees C, 9 with dyspnoea, 7 with cough, 7 with a relative bradycardia, 3 with diarrhoea, 3 felt faint, 3 with confusion. Radiology: unilateral unilobe localisation in 10 cases. Biological data: cytolysis in 8 cases, CRP300 mg/l in 8. The diagnosis confirmed with urinary antigen of Legionella pneumophila serogroup 1 (UrAgLp1) in 12 cases. In 2 cases, UrAgLp1 appeared negative between 3rd and 10th day after the beginning of a treatment although UrAgLp1 was positive before the treatment. In all cases, the first serology realised during first days following occurrence the first symptoms remained negative. Two serology of control in four were positive. One search of L. pneumophila serogroup 1 in sputum was positive in 7. Bitherapy was used in 7 cases with preferential association: fluoroquinolone+rifampicin. Two patients died. Origin of the contamination remains unknown.Culture of Legionella is essential, in epidemic context, to compare clinical and environmental Legionella and to locate the origin of contamination.

The authors had for aim, to describe clinical and biological features of 11 cases of leptospirosis observed in Lorraine between 1996 and 2002, and to assess the interest of diagnostic methods.A retrospective study was performed. The inclusion criteria was positive serological test for Leptospira.The contamination was mainly linked to water sports, during the summer holidays. The main symptom was fever, associated with moderate increase of aminotransferase serum level. Leptospira icterohaemorragiae was the most frequently identified serogroup. One 17-year-old male patient died after infection during water sports practice.Preventive measures should be considered for people exposed to Leptospira when practicing water sports.

Bacteremia caused by Francisella tularensis is rare and has been reported mainly in the United States and infrequently in Europe. We report herein the first case of bacteremic F. tularensis pneumonia in an immunocompetent individual in southern Europe.

The in vitro activity of quinupristin/dalfopristin, a new injectable streptogramin, and pristinamycin was evaluated against 200 recently isolated clinical Streptococcus pneumoniae strains expressing various degrees of susceptibility to penicillin G and erythromycin. MICs were determined by the agar dilution method. All strains were susceptible to pristinamycin irrespective of their susceptibility to penicillin G or erythromycin (MIC90: 0.25 mg/L for each phenotype). The activity of quinupristin/dalfopristin was slightly lower than that of pristinamycin against 42 penicillin G-susceptible/erythromycin-susceptible strains (MIC90: 0.5 mg/L), 13 penicillin G-susceptible/erythromycin-resistant strains (MIC90: 1 mg/L), 25 penicillin G-intermediate or -resistant/erythromycin-susceptible strains (MIC90: 0.5 mg/L) and 120 penicillin G-intermediate or -resistant/erythromycin-resistant strains (MIC90: 0.5 mg/L). The activity of both streptogramins was not significantly altered in case of erythromycin resistance. Thus, both streptogramins might be useful for the treatment of penumococcal infections, especially in cases of multiresistant strains.

Several fractions of the methanolic extract of the rhizome or the leaves of Aristolochia paucinervis Pomel were screened for antibacterial activity using the agar dilution method against fourteen reference bacterial strains. Only three fractions (defatted chloroformic rhizome fraction: APRC, rhizome ethyl acetate fraction: APRE and leaf chloroform fraction: APLC) showed an activity against at least one of the microorganisms tested. The minimum inhibitory concentration (MIC) determination showed that APRC was the most active against Clostridium perfringens, Clostridium difficile, Enterococcus faecalis, Micrococcus luteus and Bacillus subtilis. The high bacteriostatic activity of APRC was confirmed by its MIC determination against clinical strains of C. perfringens (n = 32), C. difficile (n = 31), and E. faecalis (n = 22). Results of this study suggest the potential interest of this highly active fraction and support the use of A. paucinervis Pomel in Moroccan traditional medicine to treat skin and soft-tissue infections, especially gas gangrene and intestinal diseases.

Capnocytophaga canimorsus, formerly designated Dysgonic fermenter 2 (DF-2) was first described in 1976; it is a commensal bacterium of dogs and cats saliva, which can be transmitted to man by bite (54% of cases), scratch (8.5%), or mere exposure to animals (27%). We present a review of the clinical and microbiological characteristics of the Capnocytophaga canimorsus infections and 12 cases of infection in France. Over 100 cases of human infections have been reported, mainly septicemia in patients with diminished defences, due to splenectomy (33%), alcohol abuse (24%), immunosuppression (5%). However 40% of septicemia occur in patients with no predisposing conditions. Other infections are less frequent: meningitis, endocarditis, arthritis, pleural and localized eye infections. These infections range from mild to fulminating disease, with shock, respiratory distress, disseminated intravascular coagulation. Dermatological lesions (macular or maculopapular rash, purpura) or gangrene are common. This fastidious Gram-negative bacterium grows slowly on chocolate agar or on heart infusion agar with 5% rabbit blood incubated in 5% CO2. In spite of a great susceptibility of bacteria to antibiotics, the mortality is of 30%. Because of the severity of these infections, taking into account this organism in the management of bites is necessary, especially in patients with predisposing factors.

Tetracyclines and beta-lactam antibiotics are usually recommended for the treatment of pasteurellosis following bite wounds. However other oral antimicrobial agents could be proposed. In vitro susceptibility of 94 Pasteurella strains [P. multocida (79), P. stomatis (11), P. dagmatis (2), P. canis (1), P. "SP" (1)], 20 group EF-4 strains and 28 Neisseria weaveri strains (formerly group M-5), that are bacteria often isolated after animal-inflicted wounds, was studied towards five antibiotics: clarithromycin, azithromycin, pristinamycin, trimethoprim-sulfamethoxazole and ciprofloxacin. MICs were determined by the agar dilution method using HTM medium (Oxoïd), and for pristinamycin using both HTM and Mueller-Hinton agar supplemented with 5% horse blood (BMH). Most of Pasteurella isolates showed intermediate susceptibility to clarithromycin (63%) and to azithromycin (90.5%) with lower MICs for azithromycin. Fourty-two and thirty-two percent of Pasteurella strains were susceptible to pristinamycin respectively on HTM and on BMH. EF-4 and N. weaveri were more sensitive than Pasteurella to macrolides and to pristinamycin. Trimethoprim-sulfamethoxazole was active against all isolates, with higher MICs for EF-4 and N. weaveri. On all strains tested, the lowest MICs were observed for ciprofloxacin. Trimethoprim-sulfamethoxazole and ciprofloxacin could be proposed as a therapeutic alternative in case of pasteurellosis following animal bites.

The first case of early-onset postsplenectomy arthritis due to intermediately penicillin-resistant Streptococcus pneumoniae is reported. After initial parenteral vancomycin and rifampin followed by oral prystinamycin-rifampin, the patient recovered without any sequelae. This case should increase awareness of the risk of invasive disease caused by penicillin-resistant Streptococcus pneumoniae in the early postoperative period after splenectomy.