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Glucocorticoids may cause inflammatory lesions on the face and trunk, often referred as "steroid acne".1 Clinical presentation -similar to folliculitis- and limited efficacy of common anti-acne treatments have led us to consider the pathogenic responsibility of infectious agents such as Malassezia and/or Demodex.2-4.

Introduction Les glucocorticoides entrainent parfois des lesions inflammatoires du visage et du tronc, souvent appelees « acne » cortico-induite. Le caractere monomorphe, souvent en pelerine, et l’analogie semiologique, folliculite, avec des eruptions a Malassezia et a Demodex nous a fait evoquer leur responsabilite pathogenique. Materiel et methodes Etude monocentrique, prospective sur 6 mois (01/05 au 01/11/2019) ayant inclus tous les patients traites par glucocorticoides generaux ou locaux, consultant dans un hopital universitaire (tous services confondus) et necessitant une consultation dermatologique pour un diagnostic d’acne ou de folliculite cortico-induite. Une analyse mycologique et parasitologique a ete effectuee. Les donnees demographiques, cliniques et paracliniques ont ete collectees. Resultats Six sujets masculins, d’âge moyen 46 ans [24–61], ont ete inclus. Ils presentaient des maladies diverses justifiant une prise de glucocorticoides generaux (n = 5) et/ou locaux (n = 3) depuis une duree mediane de 2,5 ans (5 semaines–22 ans). Tous avaient recu differents traitements anterieurs, inefficaces (doxycycline, n = 2 ; erythromycine topique, n = 3 ; retinoides topiques, n = 1 ; peroxyde de benzoyle, n = 1 ; solution moussante antiseptique, n = 3). Cliniquement, les patients presentaient une eruption monomorphe (papuleuse, n = 5 et/ou pustuleuse, n = 4) avec une nette predominance au tronc ; le visage et le cou etaient impliques chez deux patients. L’analyse myco-parasitologique des lesions a trouve Malassezia spp. (n = 2), Demodex (n = 1) ou les deux (n = 3). Des traitements antifongiques ou acaricides ont ete instaures (ivermectine, n = 4 ; crotamiton, n = 2 ou ketoconazole en creme, n = 4). Cinq patients ont ete reevalues apres une duree moyenne de 6,4 semaines : 2 patients ont pu parallelement arreter leur corticotherapie, un etait gueri et un ameliore a 4 et 1 semaines de l’arret, respectivement ; concernant les autres patients, il existait une guerison, une amelioration et une recidive apres une regression des symptomes. Discussion L’analyse myco-parasitologique a mis en evidence Malassezia et/ou Demodex chez tous les patients traites par glucocorticoides. Le lien entre Malassezia et « acne » cortico-induite avait ete deja evoque dans quelques observations medicales isolees avec une amelioration potentielle par l’itraconazole (dont un cas pendant le QDN JDP 2019). En revanche, aucune observation prealable n’avait rapporte la presence de Demodex, surtout hors visage. En conclusion, le diagnostic clinique d’« acne » cortico-induite est celui d’une folliculite infectieuse possiblement liee a Malassezia et/ou Demodex. Le diagnostic myco-parasitologique est indispensable devant les formes difficiles a traiter, notamment en cas d’echec des traitements de premiere intention.

Pneumocystis jirovecii pneumonia (PCP) is a life-threatening disease in allogeneic hematopoietic cell transplantation (HCT) recipients. Trimethoprim-sulfamethoxazole (TMP-SMX) is the preferred prophylaxis but has significant toxicity. We assessed 139 consecutive HCT patients for PCP prophylaxis in our center. According to our procedures, TMP-SMX should be given as first-line prophylaxis from engraftment. In case of intolerance, atovaquone (ATO) or aerosolized pentamidine may be given. Thirteen (9.3%) patients did not receive prophylaxis because they early died. Of the 126 prophylaxed patients, 113 (90%) received TMP-SMX and 13 (10%) received ATO as first-line regimen. However, only 51/113 (45%) patients received TMP-SMX as the sole prophylaxis: 60 patients were switched to ATO because of side effect. There were 18 PCP cases: 3 occurred before engraftment, 7 occurred under ATO, 3 occurred while prophylaxis was pending the resolution of side effects, and 5 occurred after stopping prophylaxis. No cases occurred under TMP-SMX while 7 (9.6%) cases occurred under first-(n = 13) or second (n = 60)-line ATO. There are many concerns about PCP prophylaxis after HCT: patients may develop PCP before engraftment or several months after stopping immunosuppressors, and half of them do not receive TMP-SMX all along the at-risk periods. New prophylactic drugs and strategies should be evaluated.

Objectives: Several studies, especially in Europe, have recently reported the emerging phenomenon of azole resistance in Aspergillus fumigatus, but very few data are available in France. Our study aimed to determine the resistance prevalence in A. fumigatus isolates recovered from clinical samples over a 1-year period in two university hospital centers. Methods :A llA. fumigatus isolates were screened for azole resistance using RPMI agar plates supplemented with itraconazole and voriconazole. Resistance was then confirmed by the EUCAST method. A part of the beta-tubulin gene was amplified for resistant isolates to confirm the A. fumigatus species, and the Cyp51A gene and its promoter were afterward sequenced to detect mutations potentially responsible for this resistance. Results: One hundred sixty-five A. fumigatus isolates were recovered from 134 patients. Three isolates recovered from three patients were found resistant with MICs of >8 mg/l, 4 mg/l, and 1 mg/l for itraconazole, voriconazole, and posaconazole, respectively. The TR34/L98H mutation, previously and largely described in other countries, was detected in the three isolates. Conclusion: Our study demonstrated the occurrence of azole resistance among unselected A. fumigatus clinical isolates, with an overall prevalence of 1.8%.

Some cases of fungal infection remained undiagnosed, especially when the pathogens are uncommon, require specific conditions for in vitro growth, or when several microbial species are present in the specimen. Ultra-Deep Sequencing (UDS) could be considered as a precise tool in the identification of involved pathogens in order to upgrade patient treatment. In this study, we report the implementation of UDS technology in medical laboratory during the follow-up of an atypical fungal infection case. Thanks to UDS technology, we document the first case of gastro-intestinal basidiobolomycosis (GIB) due to Basidiobolus meristosporus. The diagnosis was suspected after histopathological examination but conventional microbiological methods failed to supply proof. The final diagnosis was made by means of an original approach based on UDS. DNA was extracted from the embedded colon biopsy obtained after hemicolectomy, and a fragment encompassing the internal transcribed spacer (ITS) rDNA region was PCR-amplified. An Amplicon library was then prepared using Genome Sequencer Junior Titanium Kits (Roche/454 Life Sciences) and the library was pyrosequenced on a GS Junior (Roche/454 Life Sciences). Using this method, 2,247 sequences with more than 100 bases were generated and used for UDS analysis. B. meristosporus represented 80% of the sequences, with an average homology of 98.8%. A phylogenetic tree with Basidiobolus reference sequences confirmed the presence of B. meristosporus (bootstrap value of 99%). Conclusion : UDS-based diagnostic approaches are ready to integrate conventional diagnostic testing to improve documentation of infectious disease and the therapeutic management of patients.

Resume La gale est une ectoparasitose frequente et ubiquitaire. Elle touche un grand nombre de personnes, en particulier les enfants, et representent une lourde charge en termes de sante publique. Elle est presente dans tous les milieux sociaux et entrainent des epidemies dans les institutions. Le diagnostic est avant tout clinique mais peut beneficier d’un prelevement parasitologique pour confirmer le diagnostic, notamment dans certaines situations cliniques. En France, avant 2001, les traitements de la gale etaient uniquement des traitements topiques, avec l’utilisation preponderante du benzoate de benzyle. Depuis ces 15 dernieres annees, des avancees significatives ont ete observees dans la prise en charge de cette pathologie, avec l’utilisation devenue importante de l’ivermectine par voie orale. Cet article propose de revoir les differentes possibilites therapeutiques en 2010 en fonction des differentes situations cliniques rencontrees.

Summary Contamination of preservation solution (PS) with yeasts during solid organ recovery can lead to life-threatening complications in the recipients. The prevalence of such a contamination needs to be established. From January 2004 to December 2008, we prospectively investigated the potential fungal contamination of all the PSs collected in our institution using a standardised procedure consisting in centrifugation of 10mL PS and incubation of the pellet seeded on fungal-specific medium for 15 days at 30°C. During the study period, 728 transplantations (397 kidneys, 262 livers and 69 hearts) were performed for which 659 PSs (90.5%) were available. The yeast contamination rate was 0% (0/62), 3.1% (11/356) and 4.1% (10/241) for heart, kidney and liver transplants, respectively. We identified 10 Candida albicans , five C. glabrata , two C. krusei , one C. tropicalis , one C. valida , one Pichia etchelsii and one Rhodorula sp. Routine bacterial analysis identified only five of these 21 fungal contaminations. Twenty recipients were alive after at least one year of follow-up and one died from meningeal carcinomatosis at seven months. Three patients were found to have the same species of Candida from their surgical drains but did not develop any infection or abnormalities upon ultrasound investigation. Fourteen patients received antifungal drugs. Yeast contamination occurred in 3.4% of all kidney and liver PSs tested. Its clinical consequences and therapeutic management remain to be defined. Our study also suggests that optimisation/standardisation of microbiological procedures is warranted, including analysis of large PS volume, seeding of fungal-specific medium and prolonged incubation.

Background Scabies, or mange as it is called in animals, is an ectoparasitic contagious infestation caused by the mite Sarcoptes scabiei. Sarcoptic mange is an important veterinary disease leading to significant morbidity and mortality in wild and domestic animals. A widely accepted hypothesis, though never substantiated by factual data, suggests that humans were the initial source of the animal contamination. In this study we performed phylogenetic analyses of populations of S. scabiei from humans and from canids to validate or not the hypothesis of a human origin of the mites infecting domestic dogs. Methods Mites from dogs and foxes were obtained from three French sites and from other countries. A part of cytochrome c oxidase subunit 1 (cox1) gene was amplified and directly sequenced. Other sequences corresponding to mites from humans, raccoon dogs, foxes, jackal and dogs from various geographical areas were retrieved from GenBank. Phylogenetic analyses were performed using the Otodectes cynotis cox1 sequence as outgroup. Maximum Likelihood and Bayesian Inference analysis approaches were used. To visualize the relationship between the haplotypes, a median joining haplotype network was constructed using Network v4.6 according to host. Results Twenty-one haplotypes were observed among mites collected from five different host species, including humans and canids from nine geographical areas. The phylogenetic trees based on Maximum Likelihood and Bayesian Inference analyses showed similar topologies with few differences in node support values. The results were not consistent with a human origin of S. scabiei mites in dogs and, on the contrary, did not exclude the opposite hypothesis of a host switch from dogs to humans. Conclusions Phylogenetic relatedness may have an impact in terms of epidemiological control strategy. Our results and other recent studies suggest to re-evaluate the level of transmission between domestic dogs and humans.

Several studies, especially in Europe, have recently reported the emerging phenomenon of azole resistance in Aspergillus fumigatus, but very few data are available in France. Our study aimed to determine the resistance prevalence in A. fumigatus isolates recovered from clinical samples over a 1-year period in two university hospital centers.All A. fumigatus isolates were screened for azole resistance using RPMI agar plates supplemented with itraconazole and voriconazole. Resistance was then confirmed by the EUCAST method. A part of the beta-tubulin gene was amplified for resistant isolates to confirm the A. fumigatus species, and the Cyp51A gene and its promoter were afterward sequenced to detect mutations potentially responsible for this resistance.One hundred sixty-five A. fumigatus isolates were recovered from 134 patients. Three isolates recovered from three patients were found resistant with MICs of8 mg/l, 4 mg/l, and 1 mg/l for itraconazole, voriconazole, and posaconazole, respectively. The TR34/L98H mutation, previously and largely described in other countries, was detected in the three isolates.Our study demonstrated the occurrence of azole resistance among unselected A. fumigatus clinical isolates, with an overall prevalence of 1.8%.

Introduction Les formes graves de gale –profuses et hyperkeratosiques– sont plus rares que la gale commune mais beaucoup plus contagieuses, posant parfois un probleme de sante publique lors d’epidemies en institutions. Les donnees de la litterature sont pauvres et viennent pour la plupart de populations specifiques. L’objectif de l’etude etait d’analyser retrospectivement les cas de gales graves en Ile-de-France. Materiel et methodes Etude multicentrique regionale retrospective realisee apres sollicitation des services de dermatologie et de maladies infectieuses et tropicales (SMIT) d’Ile-de-France sur leurs cas de gales graves diagnostiquees entre 2009 et 2014. L’identification des cas a ete faite sur le codage PMSI puis seuls les cas de gales graves ont ete inclus dans l’etude. Les criteres de selection etaient une clinique compatible, associee a une confirmation paraclinique (parasitologie, dermoscopie ou histologie). Les cas sans confirmation paraclinique etaient discutes entre les investigateurs pour inclusion. Les renseignements sur l’epidemiologie, le diagnostic, les facteurs favorisants, le traitement et l’evolution ont ete recueillis. Resultats Parmi les 38 centres sollicites, 22 ont accepte de participer a l’etude et 15 avaient hospitalise. Quatre-vingt-trois patients repondant aux criteres de selection : 72 (87 %) en dermatologie et 11 (13 %) en SMIT ; 55 (66 %) etaient de sexe masculin, d’âge median 64 ans (0,3–97), 20 (24 %) vivaient en institution et 5 (6 %) etaient SDF ; 53 (63 %) avaient une gale hyperkeratosique et 30 (37 %) une gale profuse. Une confirmation paraclinique a ete realisee dans 84 % des cas. Le delai entre le debut des symptomes et le diagnostic etait de 3 mois (1–6). Une erreur initiale de diagnostic etait documentee dans 42 % des cas (eczema le plus souvent). La plupart des patients avaient des comorbidites. Le benzoate de benzyle/sulfiram etait le topique le plus prescrit, le plus souvent associe a l’ivermectine (2 prises, separees de 7 jours). La duree d’hospitalisation etait de 15,3 ± 9,6 jours. Les complications etaient surtout septiques et 2 patients (2,4 %) sont decedes. Discussion Ces gales graves ont ete plus souvent observees chez des patients âges, vivant en collectivites, defavorises, immunodeprimes (acquis ou induits par des traitements, y compris dermocorticoides) ou ayant des comorbidites. Il n’y avait pas de standardisation du diagnostic, ni du traitement. La morbi-mortalite etait superieure a la gale commune. La principale limite de l’etude etait sur les modalites de recueil des cas, excluant les patients non hospitalises. Conclusion Il n’existe pas de consensus pour le diagnostic ou la prise en charge des gales graves. La mise en place de recommandations specifiques, de revues systematiques (Cochrane) ou d’essais randomises (« GALE CRUSTED », PHRC 2015) est indispensable.

Resume Introduction Les dermatophyties plantaires passent souvent inapercues et sont a l’origine de recidives ou de reinfestations des autres sites. L’objectif de l’etude etait d’evaluer la frequence des atteintes plantaires associees a des onyxis ou a des intertrigos a dermatophytes. Malades et methodes Il s’agissait d’une etude retrospective incluant les malades vus en consultation de mycologie entre janvier 2002 et decembre 2003, qui avaient un dermatophyte en culture sur les plantes, espaces inter-orteils, et/ou ongles des orteils. Le sexe, l’âge et les resultats du prelevement etaient releves a partir des cahiers de paillasse. Resultats Sept cent seize malades ont ete inclus correspondant a 1 291 prelevements. Le sex-ratio H/F etait de 1,5 et l’âge moyen de 48 ans. Les ongles des orteils ont ete preleves chez 591 malades, les plantes chez 433 malades et les intertrigos chez 267 malades. Une atteinte plantaire a ete trouvee dans 66,6 p. 100 en cas d’atteinte interdigitoplantaire, dans 75,1 p. 100 en cas d’atteinte ungueale, et dans 73,9 p. 100 en cas d’atteinte mixte. T. rubrum etait le dermatophyte le plus frequemment isole. Discussion Une atteinte conjointe de la plante, de l’ongle et/ou de l’espace inter-orteil a ete trouvee dans plus de deux tiers des cas. Malgre le caractere retrospectif de notre etude et ses biais evidents, nos resultats suggerent que l’atteinte plantaire a dermatophytes est frequente et doit etre depistee. La sensibilite et la specificite du depistage clinique meritent d’etre evaluees au cours d’une etude prospective.

Toxoplasmosis is a rare but life-threatening complication of allogeneic stem-cell transplantation. Polymerase chain reaction (PCR) offers the possibility to make the diagnosis earlier than conventional techniques, and is then expected to improve the prognosis. We undertook a prospective screening using a competitive PCR in blood in 32 stem-cell transplant recipients. The sampling covered the first 150 days post-transplant, at days 21, 30, 45, 60, 90, 120, and 150. Twenty-four patients had anti-toxoplasma antibodies before transplant. Three of them (12.5%) had transient PCR-positive samples at 21, 45, and 90 days post-transplant, respectively. The three PCR-positive patients were febrile but had no funduscopic examination or cerebral computerised tomography (CT) scan abnormalities. The PCR signal disappeared when the patients were given trimethoprim-sulfamethoxazole, and no full-blown toxoplasmosis was observed. Toxoplasma reactivation evidenced using PCR is frequent in seropositive patients not receiving trimethoprim-sulfamethoxazole during the 1-3 months post-transplant. Toxoplasma PCR should be included in the diagnostic strategy of fever of unexplained origin in allogeneic stem-cell transplant recipients. Then, prompt specific therapy can be initiated to avoid development of full-blown toxoplasmosis.

Introduction Les relations entre drepanocytose et paludisme restent obscures et la croyance selon laquelle les sujets drepanocytaires seraient proteges reste repandue. But de l’etude Colliger les cas de paludisme chez des patients drepanocytaires et en degager les particularites epidemiologiques, cliniques et biologiques. Materiel et methodes Une etude retrospective descriptive a ete realisee au CHU Henri Mondor a Creteil sur une periode de 7 ans (2000-2007). Elle concernait les cas de paludisme d’importation chez les patients drepanocytaires homozygotes. Resultats 17 patients ont ete inclus (18 acces palustres). Seuls 14 dossiers etaient exploitables. L’âge moyen etait de 33 ans (17-55 ans). Tous les patients avaient ete infectes en Afrique centrale ou de l’Ouest. 7 acces (50 %) etaient lies a Plasmodium falciparum, 5 a P. ovale et 2 a P. malariae. Le taux d’hemoglobine etait de 6 g/dl en moyenne (2,5-9). A l’exception d’un cas, la thrombopenie etait absente. Les patients ont tous ete hospitalises, dont 4 en reanimation, pour une duree moyenne de 8 jours (1-30). Les traitements utilises etaient la quinine (P. falciparum) ou la chloroquine (autres especes). Les acces etaient compliques dans tous les cas sauf un (hemolyse aigue, n = 9, crise vaso-occlusive, n = 7, complication neurologique avec insuffisance renale, n = 1, et defaillance multiviscerale avec deces du patient, n = 1). Conclusion Contrairement aux donnees de la litterature, notre etude montre que les patients porteurs de l’hemoglobinose SS font des acces palustres, frequemment compliques, quelle que soit l’espece en cause. Comparee aux cas de paludisme recenses dans le service, la proportion de Plasmodium autre que falciparum est elevee (p