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International audience; Objective: To report the nature, diagnosis and therapeutic strategy of infectious emergencies in urology.Material and methods: Bibliographic research from Pubmed, Embase, and Google scholar in July 2021. A synthesis of the guidelines of national infectious diseases societies.Results: Urosepsis and complicated urinary tract infection have a standardized definition. Diagnosis and therapeutic strategy are presented for upper tract urinary infection, male urinary infection, healthcare associated urinary infection, symptomatic canduria and urinary infections of the elderly. Appropriate antibiotherapy should be tailored to the degree of severity, bacterial ecosystem, patient characteristics et localization of the infection.Conclusion: Urinary infections can be critical and require immediate care. Knowledge of the guidelines and of appropriate diagnosis and therapeutics strategy improve care which should be rapidly applied, and collegial.; ObjectifRapporter la nature, les stratégies diagnostiques et thérapeutiques des urgences infectieuses en urologie.Matériel et méthodeRecherche bibliographique à partir de Pubmed, Embase et Google Scholar en juillet 2021. Synthèse des recommandations nationales du comité d’infectiologie de l’AFU (CIAFU) et de la Société de Pathologies Infectieuses de Langue Française (SPILF).RésultatsL’urosepsis et sepsis urinaire grave répondent à des critères diagnostiques stricts. La prise en charge infectieuse diagnostique et thérapeutique des pyélonéphrites graves, infections urinaires masculines graves, infections urinaires associées aux soins, candiduries symptomatiques et infections urinaires chez la personne âgée sont décrites. L’antibiothérapie doit être adaptée à la gravité, l’écologie bactérienne, aux particularités du patient et au site d’infection.ConclusionLes infections urinaires peuvent être graves et nécessitent une prise en charge en urgence. La connaissance des recommandations et des stratégies diagnostiques et thérapeutiques adaptées aux diverses présentations permet une optimisation de la prise en charge qui doit être la plus rapide possible, et collégiale.

Incidence of obesity is constantly rising all over the world; obesity has developed into an important problem of public health. Clinical experience, supported by many clinical trials, shows that obesity constitutes a risk factor for numerous cardiovascular, metabolic, cancer and even infectious diseases. In this revue we summarize the present knowledge on immunological properties and functions of adipose tissue and their modifications in obese subjects, with a bending to a potentially deleterious chronic inflammatory state. We will discuss the negative impact of this chronic inflammation on physiological acute inflammatory reaction during infectious episodes. However, the modifications of anti-infectious immune response in obese subjects are not well known at present and need further investigations.

The diagnosis of histoplasmosis due to Histoplasma capsulatum var capsulatum is based on a direct examination identifying encapsulated yeast with narrow-based budding. Galactomannan antigenemia facilitates diagnosis, as well as the monitoring of patients receiving treatment. The case of a HIV-positive patient from Congo-Brazzaville with a disseminated form of African histoplasmosis highlighted the positive galactomannan antigen in this disease due to Histoplasma capsulatum var duboisii. Galactomannan antigenemia remained high with a very slow decrease during antifungal therapy and slow regression of clinical lesions. African histoplasmosis is a rare disease that is difficult to diagnose and rarely described in immunocompromised patients, in whom differential diagnosis can be common. This observation underlines the importance of the galactomannan antigen assay in patients who have travelled to endemic areas. As in the case of Histoplasma capsulatum var capsulatum, the positivity of the Aspergillus galactomannan antigen is very useful in the diagnosis and monitoring of African histoplasmosis.

To evaluate auto-questionnaire use for psychosocial vulnerability and substance use (smoking, alcohol consumption, depression, intimate violence) screening during pregnancy versus usual medical report.An auto-questionnaire based on validated tests (Fagerström/HSI, T-ACE, EPDS, SSQ6) was proposed to 1977 pregnant patients at their first obstetrical consultation. We compared results of auto-questionnaire and usual medical questioning.The auto-questionnaire was filled by 1676 pregnant patients (89.4 %). The two Fagerström/HIS questions showed that 20.7 % smoked during pregnancy. T-ACE score was better than usual medical questioning to detect excessive alcohol consumption (4.0 % vs 0.1 %, P0.05). Drug use before pregnancy was reported by 9.8 % patients in auto-questionnaire, but was only found in 4.9 % of medical files (P0.001). Seven percent patients reported at least 3 depressive symptoms on 4 purposed in auto-questionnaire. Intimate violence, physical or psychological, was reported in 9.4 %. All of these vulnerability factors were linked together, in auto-questionnaire or in usual medical reports.Using auto-questionnaire based on standardized screening tests could help medical practioneers to detect psychosocial vulnerability and/or substance use during pregnancy.

Diagnosing the presence of cytomegalovirus (CMV) in the blood of immunodepressed patients is often done by quantitative polymerase chain reaction (Q-PCR) even though the reference method remains the antigenemia pp65 (Ag-pp65) test.To define the predictive value of the Q-PCR in the diagnosis of CMV disease and assess treatment efficacy using the CMV R-gene test. To compare the Q-PCR results and feasibility with those of the Ag-pp65 test.The Q-PCR was performed in 34 whole blood samples (frozen at -80 degrees C until use) from five patients diagnosed with CMV disease, defined as the presence of clinical signs and Ag-pp65 in the nuclei of more than two cells. After extraction, viral DNA was quantified in each sample using the Q-PCR CMV R-gene kit according to the manufacturer's instructions. Immediately after blood was drawn, the Ag-pp65 test had been performed in 32 samples using CINAkit (Argene).The 16 samples positive by the Ag-pp65 test were also positive by PCR; six samples negative by the Ag-pp65 test were positive by PCR; and the remaining 10 samples were negative by both techniques. During treatment, the two markers' kinetics were similar.The CMV R-gene test has a predictive value as good as that of the Ag-pp65 test but is fast and easier to use. A prospective study with a greater number of patients is needed to define the prediction threshold for CMV disease.

Bordetella holmesii is a rare cause of bacteremia. It occurs mainly in hyposplenic patients, such as those affected by sickle cell anemia. The most frequent clinical signs are not very specific: fever, cephalalgia, cough, dyspnea, vomiting, etc. B. holmesii is frequently isolated from blood cultures. We describe the case of a 26-year-old sickle cell patient, presenting with dry cough and fever caused by a B. holmesii blood stream infection, identified by 16S rRNA gene sequencing. The outcome was favorable with amoxicillin. It is useful to know about B. holmesii, especially for physicians managing sickle cell or hyposplenic patients, because of its variable susceptibility to beta-lactams.

We report a 30-year-old woman who presented with a hypokaliemia-related subacute quadriparesis. The various causes of hypokalemia induced paresis were discussed but the association of hypokalemia with metabolic acidosis and normal anion gap was diagnostic of distal renal tubular acidosis. The renal tubulopathy was the presenting manifestation of a primary Sjogren's syndrome. Distal renal tubular acidosis concerns a third of the patients affected by this auto-immune disease.

Bicornuate uterus with rudimentary horn is a rare disability. Pregnancy can accidentally settle inside the rudimentary horn; in this case, it becomes apparent by uterine rupture generally in the second trimester. Bicornuate uterus should be diagnosed early, before pregnancy if possible. Abdominal pain of unknown origin occurring during the second trimester of pregnancy is the most frequent sign.

Actinomycosis is a rare disease. It has a highly varied clinical picture and may simulate genital or gastrointestinal neoplasms.This 45-year-old woman was referred for suspected ovarian cancer, with secondary lesions of the liver and pelvic wall. Pelvic actinomycosis was first suggested by the presence of an intrauterine device (IUD), which had been in place for several years without any follow-up. The final diagnosis was based upon histological examination of a biopsy sample of the parietal mass.The association of apparent pelvic tumors with infection and inflammation together with the presence of an IUD must suggest genital actinomycosis and lead to the rejection of any immediate surgical resection. The diagnosis is usually histological, with samples obtained either surgically or by percutaneous stereotactic biopsy. The treatment is essentially medical and consists of long-term antibiotics (penicillin). The prognosis is usually good.

Castleman's disease (CD) is a polyclonal lymphoplasmacytic and vascular proliferation prominent in lymphoid tissues, associated to Human Herpesvirus 8 (HHV-8) in Human Immunodeficiency Virus (HIV)-infected patients. The presence of autoimmune stigmates is frequent.We report two cases of neutropenia secondary to IgG neutrophil autoantibodies, indeterminate specificity, occurring in two HIV-infected patients with CD HHV-8+, treated by vinblastine since several years. The neutropenia was associated to other biologic stigmates of autoimmunity and the evolution has been complicated by several infections. Granulocyte-colony stimulating factor (G-CSF) and polyvalent immunoglobulin permitted a transient and low increase of neutrophila in one case.Auto-immune neutropenia in CD is rare and difficult to treat in our cases. This evolution is independent of relapse of CD. The immunoglobulin and G-CSF may be transitory effective.

The authors are dealing with a case of a pelvic fracture (right superior pubic ramus) after a road traffic accident to a patient who arise a pregnancy with twins at twenty five weeks pregnant. Seven per cent of a road traffic accident affect pregnancy with a maternal death rate from eight to sixteen per cent and a fetal death rate up to fifty seven per cent. Pelvic trauma are more deleterious during the pregnancy because of the gravide uterus, of the abdominal injuries binding more often, and of pregnancy secondary maternal physiology which lead to delay diagnosis and therapeutics. Blunt fetomaternal consequences are ruled by pelvic haematomas, uterine rupture, prematurity, acute fetal distress, fetal injuries and in utero death. At mid and long range arise the problem of child birth way and the risk of mechanical dystocy. Cesarean is store in case of vesical and urethral injuries, or perineal injury, several pelvic fractures or in case of the pelvic belt fracture moved and not reduced, bringing to a surgical unsymmetrical pelvis. In the other cases, the obstetrical prognoses will be done after a dialogue with all medical staff and a full synthesis of the file based on the fetopelvic comparisons (obstetrics previous, clinic, fetal biometry, pelvimetry X ray).

To evaluate the predictive value of postoperative urodynamic assessment on the apparition or the resurgence of genuine stress incontinence after a surgical procedure for genitourinary prolapse.103 patients operated on for prolapse, with or without an associated surgical procedure for genuine stress incontinence. A review of the results of the urodynamic assessment carried out during the early post operative period was effected.77.7% of the patients had an associated procedure for stress incontinence during surgery for prolapse. An urodynamic abnormality such as intrinsic sphincter deficiency and/or transmission ratio default was noted in 83.3% of the women who demonstrated incontinency during postoperative assessment, and in 76.7% of the patients without any problem of continence. During long term follow up, only 41.7% of the women who were incontinent shared intrinsic sphincter deficiency, and an abnormal cytometric parameter was noted in 74.4% of continent patients. 86% of the patients who were incontinent in the early postoperative period will remain so, whatever the result of the cystometric evaluation.Our results show that there is no correlation between the various cystometric parameters evaluated during the postoperative period, and the symptoms described by the patients. The absence of abnormal urodynamic assessment cannot consistently predict normal bladder function. Only postoperative symptoms can be considered to be predictive of a satisfactory surgical cure.

We report a case of acute toxoplasmosis during the first trimester of pregnancy in which antenatal diagnosis was negative. Except for non-specific signs of liver failure, assessment by repeated ultrasound scans, testing of fetal blood for toxoplasmic specific antibodies and competitive PCR to isolate the parasite, had ruled out fetal infection. In spite of early treatment with spiramycin, and although the infant was assumed to be non-contaminated, severe hydrocephalus was noted at 3 and half months of life, arising soon after therapy had been stopped. This case focuses attention on the problem of the shortcomings of the diagnostic techniques currently used, and leads us to question our practical course of action. Several questions are thus raised: how reliable are indirect signs of fetal compromise, what is the real sensitivity of the PCR test and how useful are repeated amniocentesis and inoculation of the amniotic fluid to mice.

Gamstorp's disease or hyperkaliemic periodic paralysis is a rare pathology leading to spells of generalized hypotonia due to hyperkaliema. It is hard to say how far pregnancy affects the course of the disease and what is the impact of the disease on pregnancy. We report a case of Gamstorp's disease during pregnancy and we insist on the fact that because it can be crippling during its acute phases, close surveillance is needed during pregnancy. Screening for malignant hyperthermia should be carried out. During labour, kaliemia level should be monitored repeatedly and the expulsion phase kept as short as possible if necessary by forceps delivery.