Search

Résumé Introduction Les péricardites aiguës sont souvent accompagnées d’une atteinte myocardique. Quand le tableau clinique à l’avant-plan est une péricardite avec une atteinte limitée du myocarde, on parle de myopéricardite. Cette affection n’est que peu décrite dans la littérature médicale et les critères diagnostiques utilisés dans les études ne sont pas standardisés. Nous avons dès lors souhaité évaluer les caractéristiques démographiques et cliniques, ainsi que le pronostic des patients atteints de cette affection. Patients et méthodes Revue rétrospective des dossiers de tous les patients admis pour myopéricardite entre janvier 2002 et juin 2011, dont le diagnostic a été confirmé en imagerie par résonance magnétique cardiaque. Résultats Vingt-sept patients remplissant les critères d’inclusion ont été inclus. Quatre-vingt-un pour cent étaient des hommes et l’âge médian était de 32 ans. Un tableau infectieux a précédé l’hospitalisation dans 55 % des cas. La fraction d’éjection moyenne du ventricule gauche à l’admission était de 55 %, avec une atteinte segmentaire majoritairement latérale et inférieure. Une coronarographie a été réalisée dans 37 % des cas afin d’exclure une origine coronarienne. Nous avons identifié 5 cas (19 %) de myopéricardite survenues au décours d’une infection à streptocoques du groupe A. Toutes les sérologies virales réalisées sont revenues négatives. Une tachycardie ventriculaire non soutenue a été objectivée chez 15 % des patients. La mortalité à deux ans était nulle et le taux de récidive à deux ans a été de 15 % dans notre cohorte. Conclusions La myopéricardite est une pathologie affectant principalement des hommes jeunes et dont l’évolution est généralement bénigne. Notre série a mis en évidence une proportion importante de cas précédés d’une infection par streptocoque du groupe A. Introduction Pericarditis are frequently associated with some degree of concomitant myocardial involvement. Predominant pericarditis with limited myocardial involvement are named myopericarditis. Data regarding myopericarditis are scarce. Patients and methods Retrospective chart review of all patients admitted between 2002 and 2011 with magnetic resonance imaging confirmed myopericarditis. Results Twenty-seven patients were included. Eighty-one percent were men, with median age of 32 years. Infectious disease preceded hospitalization in 55% of cases. Mean left ventricle ejection fraction at admission was 55% with focal myocardial impairment mainly localized in lateral and inferior walls. Coronary angiogram was performed in 37% of cases to rule out an ischaemic aetiology. We identified 5 cases (19%) of myopericarditis preceded by an episode of streptococcus group A throat infection. Non-sustained ventricular tachycardia was observed in 15% of cases. After a 2-year follow-up period, mortality rate was zero and recurrence rate was 15%. Conclusions In our series, myopericarditis was a benign disease affecting mostly young men, and prognosis was good. A significant proportion of cases was preceded by group A streptococcus infection. [ABSTRACT FROM AUTHOR]

Abstract: An increased incidence and severity of invasive group A streptococcus (GAS) infections over the past decade have been reported by several authors, but GAS remains an uncommon cause of bacterial meningitis. The aim of this study was to describe and analyze the clinical and biological data of GAS meningitis by reporting 10 new cases of pediatric GAS meningitis and making a literature review. The mean age of patients, seven girls and three boys, was 3 years. There was a history of preexisting or concomitant community-acquired infection in five patients over 10. The outcome was fatal in two cases. All patients received an initial empirical antimicrobial therapy with a third generation cephalosporin switched in six cases to amoxicillin. The prognosis for this type of streptococcal meningitis is usually good, but death may occur even in children without any identified risk factor for severe infection. [Copyright &y& Elsevier]

Abstract: Objective: The authors studied the epidemiology of pharyngitis in children and evaluated the contribution of a rapid streptococcal test. Patients and methods: This prospective study was conducted from June 2007 to May 2008 in a primary health care institution (Policlinique de la Caisse Nationale de Sécurité Sociale) in Tunisia. Clinical findings were recorded; throat swabs were performed, and a rapid streptococcal test was made. Results: Five hundred and four children were included in this study. The mean age was 5 years and 8 months. Culture was positive for group A streptococcus in 166 cases (32.9 %). Group A streptococcus was more frequently isolated in children aged 5 to 8 years. There was no difference in clinical features between groups of streptococcal and non-streptococcal pharyngitis. The sensitivity and specificity of the rapid test were respectively 93.2 and 95.3 %. Conclusion: Pharyngitis was of bacterial origin in one third of cases; among these, group A streptococcus was the most frequent bacterium. The rapid test is a quick and reliable tool for the diagnosis of pharyngitis and hence an appropriate treatment. [Copyright &y& Elsevier]

Abstract: Scarlet fever is a rare disease in adult patients. We report a patient in whom scarlet fever was associated with hypertrophic gastritis and multiple organ failure. A 62-year-old woman presented with septic shock and multiple organ failure. Bacteriological survey was negative. Abdominal tomodensitometry showed an hypertrophic gastritis. Histological analysis demonstrated a non specific gastritis without any tumoral sign. Cefotaxime and amoxicillin led to improvement and hypertrophic gastritis progressively resolved. A sandpaper rash over the body with finger desquamation, elevation of antistreptolysin O and a recent contact with an infected grandson led to the diagnosis of scarlet fever. Due to antibiotic prescription, scarlet fever is now uncommon. Although classical, ENT or gastroenteritis presentations may be puzzling for the diagnosis of scarlet fever. As 150 years ago, diagnosis of scarlet fever is still a clinical challenge. [Copyright &y& Elsevier]

Abstract: Penicillin remains the drug of choice for the treatment of Group A Streptococci infections. However, for patients hypersensitive to β-lactam antibiotics and in whom therapy with these drugs fails, macrolides are often the recommended substitute. Over the past few years, increased rates of erythromycin resistance have been reported for Group A Streptococci worldwide. The known mechanisms of macrolide resistance in Streptococci are modification of the ribosomal target by a methylase encoded by erm genes and a macrolide-specific efflux mechanism encoded by the mef(A) gene. Mutation of the ribosomal target of macrolides is a rare resistance mechanism in streptococci. A total of 22.4% in France in 2003 of A Group Streptococcus were erythromycin resistant, and 69.4%, 4.2%, and 26.4% of these isolates harbored ermB, ermA, and mefA, respectively. Increasing resistance in France is mainly associated with a few emm type 28 clones. [Copyright &y& Elsevier]

Résumé: Nous rapportons un cas de méningite purulente à streptocoque A chez un patient porteur d’une brèche ostéoméningée. Ce cas permet de souligner plusieurs points intéressants : a) une cause rare de méningite bactérienne ; b) les diagnostics à évoquer dans la situation où l’examen direct du LCR est positif à cocci à Gram+ mais que l’antigène pneumocoque est négatif sur le LCR ; c) le pneumocoque n’est pas la seule bactérie responsable de méningite bactérienne associée à une brèche ostéoméningée. [ABSTRACT FROM AUTHOR]

Reporting of severe invasive group A streptococcal disease (IGAS) has increased in Canada over the past decade, highlighting the importance of optimal chemoprophylaxis and management strategies. Canadian guidelines have had variable uptake across Canada. This practice point updates relevant aspects of these guidelines, with a focus on chemoprophylaxis of contacts of IGAS cases and clinical management of IGAS. The importance of penicillin in treating group A streptococcal disease is reaffirmed, and the role of clindamycin is discussed. In situations in which chemoprophylaxis may be considered, preferred agents are summarized.

We reported a case of group A streptococcal meningitis in a patient with a CSF fluid leak. This case underlined several relevant points: (i) an unfrequent cause of bacterial meningitis; (ii) the main diagnosis to evoke when the direct examination of CSF shows Gram+ cocci with a negative pneumococcal antigen; (iii) that bacteria other than Streptococcus pneumoniae are possible in front of a meningitis associated with a CSF fluif leak., (Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.)

Given the potentially devastating consequences of severe invasive group A streptococcal disease, attention has been directed toward the role of chemoprophylaxis and the optimization of management strategies. In response to this issue, Canadian guidelines were previously developed. However, the uptake of these recommendations is variable across Canada. The present document summarizes key components of the recommendations for use by Canadian physicians. The importance of penicillin in the treatment of group A streptococcal disease is reaffirmed, and the role of clindamycin is discussed. In addition, in situations in which chemoprophylaxis may be considered, the preferred agents are summarized.