Search

Resume Contexte Le rotavirus est le principal agent infectieux des gastroenterites aigues severes (GEA) chez le nourrisson et l’enfant de moins de cinq ans. Compte tenu de la disponibilite recente de nouveaux vaccins, il est important d’evaluer precisement le taux d’incidence des gastroenterites a rotavirus (GERV) communautaires et leurs consequences medico-epidemiologiques. Methodes Ce travail est le versant francais du programme d’etudes SPRIK. Il s’agit d’etude multicentrique, prospective, observationnelle realisee entre octobre 2005 et mai 2007, destinee a estimer chez les enfants de moins de cinq ans l’incidence annuelle des GERV qui ont conduit a une consultation chez un medecin generaliste ou un pediatre. Il presente les donnees collectees par 41 medecins generalistes et 36 pediatres repartis sur l’ensemble du territoire francais metropolitain. Un echantillon de selles a ete preleve pour chaque enfant. La presence de rotavirus a ete recherchee par le medecin a l’aide d’un test immunochromatographique rapide. Resultats Un total de 1648 episodes de GEA correspondant a 1463 patients eligibles a ete inclus dans l’etude, essentiellement de decembre a mai (pic en fevrier–mars). Le taux d’incidence des GERV donnant lieu a une consultation en medecine de ville a ete de 1357 cas pour 100 000 sujets-annees (1,36 %), avec un intervalle de confiance a 95 % de [1345–1368]. Le pic d’incidence a ete observe avant l’âge de deux ans. Les GERV ont represente 21 % de l’ensemble des GEA. Les patients ayant une GERV etaient plus jeunes (14,1 ± 10,8 mois versus 18,4 ± 13,9 mois pour les autres GEA, p p p p Conclusion Le taux d’incidence rapporte dans cette etude est proche de ceux de precedents travaux realises en Europe. La frequence et la gravite relative des GERV communautaires plaident en faveur d’une vaccination chez les tres jeunes enfants pour reduire le fardeau lie a cette pathologie.

Resume Contexte En France, les infections a Rotavirus sont responsables chaque annee d’environ 300 000 episodes de gastroenterite aigue (GEA) chez les enfants de moins de cinq ans. Elles sont egalement a l’origine de 138 000 consultations en ville et de 18 000 hospitalisations. L’etude Surveillance for Hospitalized Rotavirus Infections in Kids (SHRIK) est une etude prospective observationnelle europeenne realisee afin d’evaluer le fardeau des gastroenterites a Rotavirus (GERV) chez ces enfants. Methode L’etude SHRIK se deroulait sur une periode d’un an et s’adressait aux patients de moins de cinq ans ayant consulte le service des urgences pour une gastroenterite aigue (GE-U), ayant ete hospitalises pour une gastroenterite aigue (GE-H) ou ayant developpe une GERV 48 heures apres leur hospitalisation (GE-N). Un echantillon de selles etait preleve pour chacun des enfants inclus et analyse par methode Elisa. Resultats Les resultats presentes concernent les patients inclus en France. Un total de 755 patients atteints de GEA et âges de moins de cinq ans a ete inclus (357 pour une GE-U, 372 pour une GE-H et 26 pour une GE-N). Parmi ces patients, la proportion de GERV etait de 49,1 % pour les GE-U (n = 114) et de 64,4 % pour les GE-H (n = 186). La majorite (89 %) des GERV concernait des enfants de moins de deux ans. Selon l’echelle de Vesikari, la GEA des patients GERV etait plus frequemment qualifiee de « severe » que celle des patients atteints de gastroenterite non a Rotavirus (GENRV) (68,4 % contre 41,9 %, p Conclusion L’etude SHRIK montre que le fardeau des infections a Rotavirus est eleve ; elles representent plus de 70 % des GEA traitees a l’hopital au cours du pic hivernal.

Objective. – Most of coxsackieviruses A (CV-A) are difficult to isolate in cell culture and are responsible for flask paralysis in suckling mice. The aim of the present work was to analyze the ability of immune and RT-PCR techniques to detect viral components of three different serotypes, CV-A6, CV-A13, and CV-A14, in skeletal muscles of experimentally infected suckling mice. Material and methods. – The antigen detection was done by immunofluorescence technique on trypsinized muscular cells and by immunoperoxidase assay on frozen sections of skeletal muscle, using a monoclonal antibody directed towards a conserved epitope of the VP1 capsid protein among enteroviruses. The nested RT-PCR technique used primers located in the 5′ non coding region of viral RNA. Results. – The group antigen was present in muscle cells of suckling mice infected by the three serotypes of CV-A which were assayed. Similarly, the muscle specimens were positive by nested RT-PCR. A kinetic study performed with CV-A13 and CV-A14 showed that the RT-PCR assay was positive as soon as 24 h after infection whereas the detection of VP1 antigen and symptoms of flask paralysis were observed only 48 and 72 h after infection, respectively. Conclusion. – These results show that the tested serotypes of CV-A can be easily detected in muscle specimens of suckling mice by using antigenic and molecular techniques currently available for the diagnosis of enterovirus infections.

Non-fermentative Gram negative rods are opportunistic pathogens responsible for nosocomial infections. Using phenotypic markers (serotypes for Pseudomonas aeruginosa and antibiotic susceptibility) allows a preliminary screening of epidemiologically-related strains. However, genotypic markers are necessary to better characterize nosocomial strains for the investigation of outbreaks or cross-transmissions in the hospital setting. Infections due to P. aeruginosa, Burkholderia. cepacia or Stenotrophomonas. maltophilia are usually hospital-acquired and responsible for a high mortality rate as illustrated by the lethality of nosocomial pneumonia due to P. aeruginosa. The severity of these infections is due to the virulence factors of the bacteria and to their occurrence in debilitated patients in whom invasives devices are used. The hospital environment can act as a reservoir with a rate of exogeneous transmission of these bacteria as high as 50% in some studies. To better prevent nosocomial infections related to Gram negative non fermentative rods, the control of the aqueous hospital environment, the strict application of hand disinfection and the investigation of potential cross-transmission in the hospital setting are needed.

Hemodialysed patients are recognised as a group at increased risk of infection with hepatitis C virus (HCV). The aim of this study was to determine the prevalence and incidence of HCV infection among dialysis patients of the east-centre part of Tunisia. Two hundred and seventy-six patients dialysed until 2001 were recruited within seven hemodialysis units located in the cities of Sousse, Monastir and Mahdia. The serum markers of HCV infection were tested over the period of March 2000–December 2002, by a 3rd generation ELISA test for antibodies and by qualitative RT-PCR technique for viral RNA. The prevalence of anti-HCV antibodies and of HCV RNA was 32.6% (90 patients) and 25.7% (71 patients), respectively. Between 1998 and 2002, 20 new infections were documented in five of the seven dialysis units corresponding to an incidence of 2.34% per year, with an average time of contamination after the beginning of dialysis of 4.6 years. If all the infections are assessed to have occurred during dialysis, the density of incidence of HCV contamination was 4.4% per year of dialysis. A high correlation was noticed between the presence of HCV markers in serum and the duration of dialysis (F = 34.15, P < 0.0001). In the absence of other risk factors (transfusion, drug-addiction), these results plead for the nosocomial transmission of the observed HCV infections. A phylogenetic analysis of the E2 hypervariable region of the viral genome is in progress to confirm this assumption.

The aim of this study was to evaluate the risk of hospital-acquired diarrhoea during an epidemic period through a prospective multicentre observational study. A systemic investigation of the hospital-acquired diarrhoea (occurring at least 48 h after hospital admission) was conducted through a standardised questionnaire from January to March 1999 in patients of 5 years old or less hospitalised in 28 wards (620 beds) belonging to 20 hospitals located in the south-east part of France. Overall, 241 cases of hospital-acquired diarrhoea were collected, corresponding to a prevalence of 3.3% (3.6% after exclusion of patients admitted for diarrhoea) and a density of incidence of 0.81 per 100 days of hospitalisation. The mean stay duration of hospital-infected patients was greater than 10 days, versus 3.9 days for the other children (P < 0.001). A readmission was required in 27% of the infected children. Rotavirus was involved in 97.8% of microbiologically documented cases (88%). In 50% of the cases, the hospital-acquired diarrhoea was seen in patients with bronchiolitis. Contact isolation measures were prescribed in 88.4% of the cases. These results stress that hospital-acquired diarrhoea represent an important medical and economic load for paediatric units and could be used as reference data to evaluate the impact of preventive measures, especially to reduce readmission and mean stay duration.

We report an outbreak of infections due to methicillin-resistant Staphylococcus aureus (MRSA) in a medical unit and the possible implication of student nurses in the dissemination of the epidemic strain. A retrospective epidemiological study looking for hospitalised patients colonised or infected with MRSA from the 1st of June to the 30th of September 2001 in the unit was conducted. An audit of delivered cares and a nasal screening of health care workers (HCW) was performed. Six patients were colonised or infected with a MRSA strain, four of them exhibiting a bacteremia. Six HCW had a nasal carriage of MRSA. Typing of the MRSA strains by pulsed field gel electrophoresis demonstrated an epidemic clone isolated from five of six patients, two student nurses and one HCW not implicated in nursing cares. This report illustrates the risk of nosocomial outbreak linked to cares delivered by student nurses.

Resume Ce travail decrit deux phenomenes epidemiques a Staphylococcus aureus de sensibilite diminuee aux glycopeptides, l’un en 2000 avec huit patients concernes et l’autre en 2001–2002 avec 16 patients. Le depistage systematique de ces souches aux laboratoires de bacteriologie de notre hopital a permis de les detecter rapidement. Le caractere clonal de ces souches a ete confirme par electrophorese en champ pulse. La gestion de ces phenomenes epidemiques a confirme (i) la necessite de l’application systematique des precautions standards, (ii) l’importance de la transmission d’informations pour lutter contre les bacteries multiresistantes mais egalement la difficulte de transfert dans un autre service des patients colonises et (iii) le caractere intermittent du portage de S. aureus, ce qui necessite une surveillance prolongee des patients colonises et/ou infectes. De plus cette etude souligne l’interet d’une prise en charge multidisciplinaire de la diffusion des bacteries multiresistantes.