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Abstract: The post therapeutic follow-up of Lyme borreliosis is managed according to clinical and serological data. The evolution of antibody rates is such that it doesn''t constitute the best element to rely on for follow-up. Indeed, after a sometimes transitory increase of this rate during or after antibiotherapy, the decrease is very slow, sometimes several months, and often incomplete. The follow-up should thus be made according to clinical symptoms and their resolution. Resolution of some but not all symptoms must lead to discussing two options. The first is that of administrating a complementary antibiotherapy with a different mode of action than the first antibiotic used. The second is that this may be due to recontamination, especially in highly endemic zones, given that antibodies present have no protecting effect. In this case, a new antibiotherapy must of course be initiated. [Copyright &y& Elsevier]

Introduction: Malgré un très large spectre de pathologies oculaires possibles, ces atteintes demeurent rares dans la borréliose de Lyme (1 % des maladies de Lyme avec manifestations systémiques). Sujets et méthods: Notre étude s’est intéressée aux patients consultant pour des manifestations oculaires compatibles avec une maladie de Lyme entre 2000 et 2007. Les critères diagnostiques retenus étaient les suivants : (i) morsure par une tique en zone d’endémie, (ii) manifestation oculaire compatible, (iii) diagnostic microbiologique ou sérologique, (iv) absence d’autres causes infectieuses ou inflammatoires. Résultats: Nous avons ainsi colligé les dossiers de 20 patients présentant des manifestations oculaires d’une maladie de Lyme : 8 uvéites antérieures, 3 choriorétinites, 5 paralysies oculomotrices, 2 neuropathies optiques et 2 myosites. Les atteintes oculaires étaient toutes révélatrices de la maladie en phase secondaire. Un traitement adapté, antibiothérapie (parfois associée à une corticothérapie), était efficace en quelques semaines. Aucune récidive n’est survenue après un recul variant de 6 mois à 7 ans. Discussion: La pathogénie des manifestations oculaires reste controversée. Les sérologies manquent de sensibilité et de spécificité, rendant l’imputabilité de Borrelia burgdorferi non certaine, notamment dans les cas de paralysies oculomotrices où l’analyse de l’humeur aqueuse et du vitré sont non contributifs. Le pronostic est favorable avec une antibiothérapie orale. Conclusion: Les manifestations oculaires demeurent rares dans la maladie de Lyme. Le diagnostic doit cependant être évoqué en zone d’endémie pour permettre la mise en route d’un traitement antibiotique afin d’éviter les manifestations sévère et tardive de la maladie. [Copyright &y& Elsevier]

Abstract: Context: An outbreak of scabies occurred in the geriatric department of the Strasbourg University Hospital in September 2005. The index case presented with hyperkeratosic scabies, an extremely contagious form. The epidemic spread to several wards and pavilions and also contaminated healthcare staff and patient''s families. Objective: Our objective was to describe the outbreak, its progression, and the measures taken to eradicate it. Methodology: All healthcare workers, patients, and families affected in the outbreak were retrospectively studied, using medical prescriptions recorded by the hospital pharmacy, listings established by the occupational health department, and patient files. Results: Two epidemic waves were recorded, between August 31 and December 16, 2005, affecting 51 patients and staff members in the geriatric department, with a total of 58 episodes of scabies, seven of which were recurrences. Three main measures were taken to eradicate the epidemic: setting up of “contact” isolation precautions, information for the affected individuals, and treatment of the infected patients associated to mass treatment of contact cases. The mass treatment was widely applied, involving 490 patients and 592 caregivers. All of these measures successfully curtailed the outbreak in 3 months. Conclusion: Rapid and radical action is essential to prevent extension of scabies within a community. [Copyright &y& Elsevier]

Abstract: Introduction: HIV patients have a high rate of infectious complications. Vaccination, though less efficient in case of severe immunosuppression, can prevent some of these infections. Since 2006, new vaccine recommendations have been elaborated in France. We studied the vaccine status of HIV+ patients for influenza, Streptococcus pneumoniae, tetanus, and hepatitis A and B among an alsatian HIV+ population. Patients and methods: From August 20, 2007 to September 15, 2007, HIV patients of the Alsace HIV center (COREVIH) were included in a prospective study, screening demographic, medical, immunovirologic, and vaccination data. Results: Three hundred and thirty-one patients were included, 49% of whom were asymptomatic, 29% symptomatic without AIDS, 18% at AIDS stage, and no documentation for 4%. Seventy-one patients (21.4%) were vaccinated against influenza, 11 (3.3%) against Streptococcus pneumoniae, 34 against HAV (only 16.3% of patients with a negative test before), 120 against HBV (60% of patients with no serological markers before), and 186 (56.2%) against tetanus. The most frequent reasons for non-vaccination were non-proposal by physicians, lack of expected effectiveness, and fear of an immunovirological adverse effect. Conclusion: Vaccination coverage for recommended vaccines of HIV infected people remains at a low level and appears sometimes inferior to the rates reached among the general French population. It is necessary to inform prescribers and HIV positive patients about the interest of vaccination. [Copyright &y& Elsevier]

Abstract: Objectives: Streptococcus agalactiae (Group B streptococcus) is a major cause of invasive diseases in non-pregnant adults, particularly in the elderly and those with underlying conditions. We describe these conditions and clinical characteristics of patients followed in our teaching hospital. Methods: We retrospectively reviewed clinical records of 64 patients with S. agalactiae-related invasive infection, hospitalized between January 1997 and January 2006. Results: The mean age of patients was 59 (±17 years). The H:F sex ratio was 1.06. At least one underlying condition was found in 90.6%. Diabetes mellitus (43.7%), peripheral vascular disease (34.4%), myocardial ischemia (20.3%) and malignant neoplasms (20.3%) were among the most frequent conditions. The mean index of comorbidity (Charlson) was 2.5 (±2). Common clinical manifestations included infection of the urinary tract (32.8%), skin and soft-tissue (25%), and osteoarthritis (21.9%). Bacteremia occurred in 31.2% with no identified source in 2 patients. During the first month, 2 cases of endocarditis, 1 case of meningitis, and 4 deaths occurred. Conclusion: We confirm the importance of underlying diseases in the emergence of S. agalactiae infections. [Copyright &y& Elsevier]

Abstract: Purpose: Staphylococcus aureus is the first agent responsible for nosocomial bacteremia in France. About 40% of the strains are resistant to methicillin (MRSA). The epidemiology of these infections has changed in the last fifteen years whereas therapeutics options have slightly progressed. Current knowledge and key points: Hospital-acquired MRSA bacteremia are more and more frequent while community-acquired strains recently appeared. Factors influencing the emergence of these infections were identified thanks to numerous clinical studies, as well as patients risk factors for developing these infections and their complications. At the same time, intermediate sensitive and resistant MRSA strains to glycopeptides appeared. Conversely, the best antibiotic strategy is still unclear in absence of good clinical studies. The interest of antibiotics combinations and of glycopeptides serum-concentrations control is still a matter of debate. Finally, the number of new active molecules remains limited. Perspectives: The frequency and severity of MRSA bacteremia are quite worrying in our country. The epidemiology of these infections must be known by every clinicians in order to prevent them. The therapeutic strategy has to be better define and need for new anti-infectious agents is critic. [Copyright &y& Elsevier]

Abstract: Background: This study had for aim to describe the clinical aspects and favoring factors of mucosal Leishmaniasis in an Amazonian population of 30,000 habitants in Guajara-Mirim (Rondonia-Brazil). Material and Method: A descriptive study was made of 16 patients with mucosal Leishmaniasis among 170 patients infected by Leishmania. Inclusion criteria were a mucosal lesion and positivity of direct microscopic examination. The patients were investigated retrospectively. Results: Patients with mucosal Leishmaniasis were young and mostly male The absence of treatment and the number of cutaneous lesions were probably responsible for the mucosal form, as well as the host immune response and maybe, the parasite species or vector characteristics. Conclusion: The mucosal form of leishmaniasis affects more often young male patients and this form must be detected early to avoid destructing lesions. [Copyright &y& Elsevier]

Foreword – Clostridium difficile associated diarrhea (CDAD) accounts for 25% of all cases of diarrhea occurring in hospital. Infectious diseases departments are considered as presenting with an important risk of CDAD because of the large quantity of antibiotics used.Objectives and method – The authors made a prospective study in the first 6 months of 2001, in order to identify the risk factors of CDAD in their department. One hundred and fifty-two patients hospitalized for at least 6 days were included in this study. The studied factors were: age, mean number of days of hospitalization (MDH), antibiotic therapy, WHO scale of reduced mobility of patients, recent hospitalization (less than 3 months before).Results – MDH was 36 (IC95%: 23–48). β-Lactam antibiotics were found as significant risk factors, as reported in the literature. However, age and a recent hospitalization were not related to the CDAD as described in the literature. A reduced mobility of patients was identified as a significant risk factor for developing a CDAD in our department. [Copyright &y& Elsevier]

In 1995, the emergence of extended-spectrum producing E. aerogenes was noted within various wards of the Strasbourg University Hospital.Objective – Extended-spectrum betalactamases-producing bacteria were then studied because of their therapeutical, ecological, and economical implications for hospitals.Patients and methods – In 1999, we undertook a prospective epidemiological study over a 6-month period, from November 1, 98 to May 31, 99, with bacteriologists, hygienists, clinicians, and pharmacists.Results – The study highlighted the persistant epidemic propagation of an E. aerogenes clone in the Strasbourg University Hospital and the emergence of 2 K. pneumoniae clones restricted to specific wards.Conclusions – Therapeutical implications and measures that need to be taken when faced with such resistance phenomena are discussed. [Copyright &y& Elsevier]