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Patients and Method: 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., Results: 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, CRP >300 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., Conclusion: Culture of Legionella is essential, in epidemic context, to compare clinical and environmental Legionella and to locate the origin of contamination.

Objective: 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., Patients and Methods: A retrospective study was performed. The inclusion criteria was positive serological test for Leptospira., Results: 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., Conclusion: Preventive measures should be considered for people exposed to Leptospira when practicing water sports.

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.

EF4 bacteria are found in animal saliva and may contaminate bite wounds. Minimum inhibitory concentrations of 36 antimicrobials against 44 EF4 strains were determined using dilution in Mueller-Hinton agar. EF4 bacteria were susceptible to aminopenicillins, carboxypenicillins, ureidopenicillins, third-generation cephalosporins, fluoroquinolones, rifampicin, and trimethoprime-sulfamethoxazole. Susceptibility was intermediate for penicillin G, low for macrolides and variable for aminoglycosides. EF4 bacteria were resistant to lincomycin and trimethoprime. Routine prophylactic treatment of bite-induced Pasteurella infections using an aminopenicillin or a cycline also protects against EF4 infection of the wound.

The authors present the main characteristics of respiratory pasteurellosis on the basis of 32 personal cases. The predominant background is chronic obstructive lung disease consecutive, in most cases, to chronic bronchitis. In patients without chronic lung disease the infection occurs when the terrain is deficient. The most common clinical form is bronchitis; pneumonia, pleurisy and lung abscess are rare. The existence of asymptomatic carriers has been recognized. Clinical manifestations are devoid of pathognomonic signs and symptoms. Diagnosis rests on isolation of the micro-organism and can be completed by serodiagnosis and intradermal reaction to pasteurelline. The severity of respiratory pasteurellosis depends on the clinical form and the background. The curative treatment is simple and effective as a rule, but prevention is possible and recommended since pasteurellosis is a potentially severe infection.

The most recent statistics in France underline a doubly increasing preoccupation: the alarming rise in the frequency of bites by dogs (watchdogs or lapdogs), and the great number of pathogenic bacteria isolated from the bite wounds. During the last three years (1985, 1986, 1987), the Bacteriological Laboratory of Nancy received 390 samples, and 56% of them contained one or more bacteria. These bacteria basically were Pasteurella (61%), but other different species were isolated and identified recently: for example, the bacterial groups EF4, M5, IIj and especially DF2. The clinical feature is usually a wound which, neglected, is suppurating. But the bacteria of the DF2 group lead to general complications, very serious: more than 50 cases of septicemia have been published. In such cases, the notion of underlying pathology is important: alcoholism, cancer, splenectomy. Therefore, this new threat calls for great vigilance: curative treatment with antibiotic therapy adjusted to the isolated and tested bacterium; but, after all bites by a dog, real prophylaxis is systematically essential, with classical actions and antibiotic therapy (betalactamine or cycline) if the organism of the patient is deficient.

Authors report a Pasteurella Multocida corneal abscess after a scratch from a cat. The evolution was torpid and needed a transfixiant keratoplasty. They recall bacterial tanks, infestation ways, clinical manifestations and bacteriological identification. They note the low occurrence of ophthalmological manifestations and the sensibility of Pasteurella to various antibiotics, especially Beta lactams, phenicol and cyclins.

We report the cases of two patients who developed legionnaires' disease during the course of hairy cell leukaemia. The clinical features are described with special emphasis on the severity of illness in one patient and marked jaundice in both. These cases demonstrate the enhanced susceptibility to Legionella pneumophila infections in patients with hairy cell leukaemia. We therefore suggest a reevaluation of empiric antimicrobial treatment of pneumonia in such patients.

We have been isolating Pasteurella multocida and similar germs increasingly during the last few years: due to the rabies coming back in Eastern France, more consultations have been held following animal bites; samples are then taken for a bacteriologic research. We have studied their sensitivity towards 30 antibiotics. The determination of the MIC was achieved through the agar dilution method on 34 Pasteurella multocida of human origin issued after bites and expectorations, 4 EF4 and 4 M5. The Pasteurella are very sensitive to: beta-lactam antibiotics (the lowest MIC were observed for ureido-penicillins, amino-benzylpenicillins and third generation cephalosporins), chloramphenicol, cyclines and quinolones. Fosfomycin colistin and aminoglycosides are also active but with higher MIC. The macrolides have got a slow or no activity at all. The M5 are susceptible to the same antibiotics as Pasteurella but with slightly higher concentrations. Regarding EF4, minor sensitivity or resistance to penicillin G, cephalothin and cefamandole can be pointed out.