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In the last decade, the epidemiology of meningococcal infections in Switzerland and Europe has changed. The prevalence of Y and W serogroups augmented, with more atypical clinical manifestations such as pharyngitis, pneumonia and arthritis. A hypervirulent clonal serogroup W strain of Neisseria meningitidis has emerged in Europe and Switzerland, with a noticeable potential for epidemics as evidenced by its clonality. In this context, vaccinal recommendations for risk groups have and will continue to evolve towards the use of novel conjugated vaccines.

Primary Immunodeficiency Diseases (PID) comprise inborn defects of the immune system which are and therefore difficult to study For this reason, the European Society for ImmunoDeficiencies (ESID) has set up an internet-based international patient and research database which integrates research data with more detailed clinical information. These disorders are not only found in children, but also in adults resulting in a wide range of clinical manifestations. Primary immunodeficiency adults are much less known and may remain undiagnosed.

Autoimmune pancreatitis (ALP) represents a distinct form of chronic pancreatitis initially described in Japan but now reported worldwide. AIP often presents with obstructive jaundice/pancreatic mass as well as pancreatic exocrine and endocrine insufficiency. Histologically, it is characterised by a lymphoplasmacytic infiltrate with fibrosis. The disease responds readily to steroids in 70-80% of cases. Given the absence of unified diagnostic criteria, the diagnosis of AIP proves difficult. In particular, distinguishing ALP from pancreatic or biliary cancer remains a challenging task. In order to avoid unnecessary resections for an otherwise benign and easily treatable condition, it is urgent to refine diagnostic criteria and to reach an international consensus.

Continuous surveillance of acute diarrhea in France has been conducted by Inserm's sentinel network of general practitioners (GP) since 1991. Similar GP-based studies have been performed in the Netherlands, Austria and the UK. The causes of most cases of acute diarrhea are unclear. In case-controlstudies designed to identify viruses in stools, 35 to 40% of cases and virtually none of the controls were positive for one of 4 major viruses (rotavirus, calicivirus, astrovirus and adenovirus). Thus, no viral cause was identified in more than 60% of patients with acute diarrhea. The causative role of viruses such as torovirus, picobirnavirus, picornavirus and enterovirus 22 has rarely been investigated. Further investigations are needed to identify other viral, bacterial fungal or parasitic causes of acute diarrhea. In France, on average, more than 3 million people (predominantly children) visit a GP for acute diarrhea each year. Most of these patients recover spontaneously within a few days, but the medical, social and economic costs of acute diarrhea are sufficiently high to justify a more aggressive public policy to prevent and control epidemics in Europe., COMMUNICATION SCIENTIFIQUESéance du 9 novembre 2010Malgré une surveillance permanente et continue des diarrhées aiguës sur le territoire français assurée par les médecins généralistes du réseau Sentinelles de l’Inserm depuis 1991, et la mise en place de systèmes de surveillance similaires ou des études en médecine générale dans d’autres pays d’Europe, notamment aux Pays-Bas, en Autriche et au Royaume-Uni, force est de constater que leur étiologie reste encore largement méconnue. Si des études cas-témoins conduites avec une recherche de virus dans les selles ont permis d’identifier un virus dans 35 à 40 % des cas et chez un faible nombre de témoins, en faveur d’un rôle causal probable de quatre virus principalement retrouvés lors des épidémies (rotavirus, calicivirus, astrovirus et adénovirus), dans plus de 60 % des cas la cause de ces diarrhées aigües hivernales ou estivales reste inconnue. Le rôle de virus actuellement peu ou pas recherchés comme les torovirus, picobirnavirus, picornavirus ou entérovirus 22 mériterait d’être précisé. Des recherches restent donc à conduire, notamment visant à l’identification plus étendue d’agents pathogènes potentiellement responsables, qu’ils soient viraux, bactériens, fongiques ou parasitaires, avant de pouvoir espérer prévenir et contrôler de manière efficace ces épidémies récurrentes en Europe, qui concernent de larges segments de la population. En France environ trois millions de personnes consultent en moyenne chaque année leur médecin généraliste pour un épisode de diarrhée aiguë (ce sont des patients de tous âges, bien que plus souvent des enfants). Si pour l’immense majorité des cas leur évolution favorable est spontanée en quelques jours, le coût sanitaire, social et économique de ces épidémies d’ampleur nationale est très élevé et justifierait une politique de prévention et de lutte plus ambitieuse à l’échelle de l’Europe,.

DISTURBING EPIDEMIOLOGICAL DATA: Over the past decade there has been a continuous progression in the percentage of Staphylococcus aureus strains resistant to methicillin (MRSA), a slight progression in coagulase-negative staphylococci strains resistant to methicillin and a spectacular progression of enterococci resistant to glycopeptides, not only in hospitals but also in intensive care settings. The increase in nosocomial septicemia is currently a major patient safety issue. HIGHER MORTALITY IN BACTEREMIC PATIENTS: The excess mortality globally observed in cases of bacteremia (compared with patients without bacteremia) is markedly enhanced with regard to secondary bacteremia. Bacteremia is responsible for a significant increase in the overall duration of hospitalization. PROGNOSTIC FACTORS OF STAPHYLOCOCCI BACTEREMIA: The mortality rate is significantly higher in patients in whom initial therapy was inappropriate compared with those in whom it was adequate. The isolation of MRSA strains is a negative prognostic factor. PATIENTS AT RISK OF MRSA BACTEREMIA: Independent risk factors for MRSA bacteremia include prior exposure to antibiotics, a nosocomial origin, a history of hospitalization within the 6 preceding months, and the presence of a decubitus ulcer. To avoid MRSA bacteremias related to catheters, alternatives should be found to their use, all hygiene rules should be carefully respected, the insertion point should be carefully disinfected and protected, and the catheter should be removed as rapidly as possible.