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Patients lost to follow-up and treatment failure in tuberculosis disease (TB) are major public health issues. In the absence of appropriate treatment, approximately 70 % of smear-positive patients will die within 10 years of disease progression. This study, conducted in the French region with the highest incidence, aimed to assess tuberculosis treatment outcomes and its determinants.A prospective, multicenter cohort study (CO1TB) of adults and children treated for TB was conducted in four hospitals in the North of Paris. Treatment outcome at 1 year and associated socioeconomic and clinical factors were studied by multivariate logistic regression.Among 145 TB cases included from May 2018 to January 2020, patients were mainly born abroad and most lived in difficult socioeconomic conditions. During treatment, 25/145 (17 %) patients experienced adverse effects, which were not significantly associated with discontinuation of treatment (p = 0.99). At 1 year, 114 (78 %) had completed treatments, 26 (19 %) were lost to follow-up, three (2.1 %) were still being treated and two (1.4 %) had died. In the multivariate analysis, a history of TB was significantly associated with unfavorable treatment outcome (aOR = 5.3, 95 %CI (1.5;18.6) and a trend towards significance (p 0.2) was observed among patients aged under 24 years (aOR = 2.9, 95 %-CI 0.95;8.5).In this precarious population, socioeconomic conditions were not found to be associated with unfavorable treatment outcome, whereas history of tuberculosis and young age played a role. Increased monitoring is thus required for these patients.

SETTING: Migrants to Europe face a disproportionate burden of infections, including TB, yet little is known about the approach taken by primary and secondary care providers to screening and treatment. We therefore explored policy and practice relating to screening of active TB and latent TB infection (LTBI) in France.METHODS: We conducted an online national survey of French primary and secondary care physicians regarding their practices in relation to TB/LTBI screening among migrants.RESULTS: 367 physicians responded to the questionnaire among which 195 (53.1%) were primary care physicians, 126 (34.3%) were TB specialists in secondary care, and 46 (12.5%) other physicians; 303 (85.5%) were involved daily in the care of migrants. Most respondents recommended systematic TB screening with chest X-ray for migrants from medium and high-incidence countries (71.9%). Primary care physicians were less likely to offer screening than physicians in other settings (aOR 0.21, 95% CI 0.09–0.48). 220 (61.8%) offered LTBI screening for children (CONCLUSION: Improving awareness on TB screening is a critical next step to improve health outcomes in migrant groups and meet regional targets for tackling TB.

Data on the microbiological epidemiology of Intra-Abdominal Abscesses (IAAs) are very scarce. We aimed to study the microbiological epidemiology of these infections in order to optimize empirical antibiotic therapy.Between January 2015 and December 2020, we retrospectively analyzed all IAAs files in our hospital. Clinical and microbiological data such as antibiotic susceptibilities were collected.We studied 243 IAA cases. All in all, 139 (57.2%) IAAs were healthcare-associated and 201 (82.7%) were drained. The highest risk situations for IAAs were appendicitis (n = 69) and diverticulitis (n = 37). Out of the 163 microbiologically documented infections, 136 (81.9%) were polymicrobial. Enterobacterales (n = 192, 36.1%), Enterococcus sp. (n = 84, 17.6%) and anaerobes (n = 66, 16.1%) were the most frequently identified bacteria. Gram-negative bacteria were susceptible to amoxicillin-acid clavulanic, piperacillin-tazobactam, cefotaxime, meropenem in 55.2%, 84.9%, 77.6% and 99.5% of cases, respectively. Concerning Gram-positive bacteria, the susceptibility rate was 81.8% for amoxicillin-clavulanic acid, piperacillin-tazobactam and meropenem, and decreased to 63.4% for cefotaxime.This study highlights the polymicrobial profile of IAAs and their low susceptibility to amoxicillin and clavulanic acid. The piperacillin-tazobactam association remained the most appropriate empirical antibiotic therapy.

Background Screening of active and latent tuberculosis among migrants is a public health concern but physicians’ practices are poorly known. The study aimed to evaluate physicians’ practices in France. Methods A national survey of physicians’ practices about infectious diseases prevention among migrants was conducted in 2017-2018 and broadcasted by several scientific societies. Results In total, 367 physicians answered; 53.1% were primary care physicians, 34.3% “TB involved physicians”, and 85.5% were involved daily with migrants. Screening by chest X ray is recommended by 84.8%, 71.9% and 38.4% of participants for migrants from high- (>100 cases/100,000 p.a.), medium- (> 50/100,000), and low-incidence countries respectively. One physician in two declares considering migration conditions in his/her decision of screening migrants from low incidence countries. Primary care physicians are less likely to offer screening (aOR= 0.21[0.09-0.48], p < 0.001). About screening prescription, only 55.6% consider it their responsibility. TB control centres are designated by 56.7% of respondents. Concerning screening for latent tuberculosis infection (LTBI), 61.8% and 34.0% offered screening for children under the age of 15 and for all migrants (adults and children) from high incidence countries respectively; physicians working in Paris and its region being less likely to offer it (aOR=0.45 [0.28-0.71], p = 0.001 and aOR=0.43 [0.27-0.69] p = 0.001 respectively). Among those screening children, 88.1% recommend treatment if facing a positive result, most often with a 3-month isoniazid rifampicin double therapy, and 11.4% offer follow up alone. Conclusions Physicians’ practices in France regarding screening of tuberculosis among migrants are heterogeneous. Which population should be targeted for LTBI screening remains unclear in the context of contradictory national and international recommendations. The results of our study raise the issue of knowledge, and adherence to these guidelines. Key messages Physicians’ practices in France concerning active and latent tuberculosis screening among newly arrived migrants are heterogeneous. Many physicians involved in migrants’ care ignore or do not adhere to current national guidelines, especially concerning LTBI screening among newly arrived migrants.

To identify tools that will result in faster diagnosis, making the current pulmonary tuberculosis strategy more efficient.A 4-year (2015-2018) retrospective study. The gold standard for diagnosis was a positive culture from a respiratory specimen. All sputum, fibroscopy and post-fibroscopy specimens (for smear negative patients) were collected. Each specimen was analyzed through smear examination and culture. All nucleic acid amplification testing results were included. Analyses looked at the incremental yield of positive cases of each successive specimen collection, and time to diagnosis.A total of 354 patients had at least one positive culture. Sputum allowed a diagnosis in 92% of cases (including a gain in sensitivity of around 7% for the third sputum specimen), with 160 smear-positive patients (45%). Among smear-negative patients, 109 underwent a fibroscopy procedure (culture sensitivity of 75%), and 59 had a post-fibroscopy specimen collected, which together identified the rest of the patients (8%). Molecular testing was used in 237 specimens. Median time to diagnosis was 11 days, which was significantly reduced among smear-negative patients when molecular testing was used (P0.001). Shortening the delay between sputum specimen collections did not alter procedure sensitivity.We identified several aspects of the French tuberculosis diagnosis algorithm that could be improved, and posed the basis for a prospective study. Centers in higher incidence areas could benefit from a dedicated, predefined procedure exploring suspicions of tuberculosis. A high suspicion score of tuberculosis could drive the reasoned use of molecular testing in such settings.

International audience; The diagnosis of malaria should always be considered in travelers returning from an endemic area and presenting with fever or a history of fever, either isolated or combined with other general, digestive, and/or respiratory symptoms, even if appropriate chemoprophylaxis was used.• Outpatient management of uncomplicated Plasmodium falciparum malaria may be implemented if precise clinical and biological criteria are met and if medical follow-up is possible.• Admission to hospital is recommended for individuals at risk of complications (young children and elderly, comorbidity, pregnancy, splenectomy, etc.).• The first-line treatment of uncomplicated P. falciparum malaria in adults is an artemisinin-derivative combination therapy (ACT): artemether-lumefantrine or artenimol-piperaquine. When such treatment is unavailable, not tolerated, or contraindicated, if interactions with concomitant medication are possible, or if ACT fails, then treatment with atovaquone-proguanil is an alternative option. Pregnant women (1st trimester) presenting with uncomplicated P. falciparum malaria should be hospitalized and treated with atovaquone-proguanil, or quinine if vomiting occurs. From the 2nd trimester on, priority should be given to artemether-lumefantrine or artenimol-piperaquine.• Uncomplicated malaria caused by species other than P. falciparum (i.e., P. vivax, P. ovale, P. malariae, or P. knowlesi) is treated with chloroquine or ACT. The latter is preferable in cases of co-infection or P. vivax malaria in travelers returning from a region known for resistance to chloroquine.• To prevent relapses in individuals infected with P. vivax or P. ovale, the dormant liver forms must be eliminated using primaquine, for which temporary use authorization (TUA) may be obtained once possible contraindications have been ruled out (glucose-6-phosphate dehydrogenase [G6PD] deficiency, pregnancy, breastfeeding).

Tuberculous meningitis (TBM) is the most lethal and disabling form of tuberculosis. In 2017, approximately 10 million people developed TB worldwide, of whom more than 100,000 new cases of TBM are estimated to occur per year. In patients who are co-infected with HIV-1, TBM has a mortality approaching 50%. Diagnosis of TBM is often delayed by the insensitive and lengthy culture technique required for disease confirmation. GeneXpert represents the most significant advance in TBM diagnostics over the past decade, but it lacks sensitivity and cannot be used to rule out the diagnosis. Higher volume of cerebrospinal fluid (CSF) seems to be interesting to improve the diagnosis performances. New rapid and accurate diagnostic tools are necessary. Better advances have been made concerning the anti-tuberculosis chemotherapy of TBM, with the publication of clinical trials and pharmacokinetic studies exploring the use of higher rifampicin doses and fluoroquinolones. The rise of drug-resistant TBM is another challenge for management because TBM caused by multidrug resistant organisms results in death or severe disability in almost all sufferers.

Resume Objectifs Decrire les lesions broncho-pulmonaires residuelles et evaluer l’interet de la tomodensitometrie (TDM) en fin de traitement d’une tuberculose pulmonaire. Materiels et methodes Analyse des TDM thoraciques initiales et de fin de traitement de 56 patients avec tuberculose pulmonaire selon une grille de lecture incluant les lesions parenchymateuses et des voies aeriennes. Les donnees TDM de fin de traitement ont ete analysees en fonction des donnees cliniques, mycobacteriologiques et du TDM initial. Resultats Des lesions actives (cavite a paroi epaisse et/ou micronodules centrolobulaires) persistaient chez 24 patients (43 %) apres un traitement moyen de 7 mois. La persistance de ces signes d’activite etait correlee initialement a la presence d’un syndrome cavitaire (p = 0,027), a une atteinte bronchique predominant en sous-segmentaire, a une extension plus importante des micronodules (p = 0,024) et a des bronchectasies (p = 0,04). Ces lesions residuelles n’etaient pas associees a un risque plus eleve de rechute. Conclusion La persistance de signes d’activite sur la TDM de fin de traitement d’une tuberculose ne correspond pas obligatoirement a une absence de guerison mais a un retard radiologique. Cette imagerie est neanmoins utile pour faire le bilan des sequelles de l’arbre bronchique, voire estimer le risque de complications ulterieures.

OBJECTIVES To evaluate isolation practices and management of sputum smear-positive tuberculosis (TB) in France. METHODS A survey was conducted using a questionnaire e-mailed in 2011 and 2012 to physicians of the French Society of Infectious Diseases, the French Respiratory Society and the French National Society of Internal Medicine. RESULTS Of 311 responders, a quarter stated they treated more than 25 TB cases per year. A total of 87.8% declared they routinely used a four-drug regimen in the initial intensive phase. Of the 311 physicians who responded, 31.9% removed isolation precautions after three negative acid-fast bacilli (AFB) sputum results, 19.0% after 15 days of treatment and 34.1% only in case of clinical improvement. According to 71% of the responders, discharge from hospital despite positive AFB sputum smear results was 'possible'. A routine AFB sputum smear was performed after 2 months of treatment by only 21% of the responders. CONCLUSION Despite recent national guidelines, the management of isolation precautions for sputum smear-positive TB remains heterogeneous, and a significant proportion of physicians use a three-drug regimen. Further efforts should be made to implement TB guidelines, mainly by raising awareness through national scientific institutions, but also by obtaining better evidence.

To describe the residual broncho-pulmonary lesions and evaluate the role of CT scanning at the end of treatment of pulmonary tuberculosis.Analysis of the initial and end of treatment CT scans of 56 patients with pulmonary tuberculosis according to a reading grid including parenchymatous and airways lesions. The CT data at the end of treatment were analysed in relation to the clinical and microbiological data, and the original CT scan.Active lesions (thick walled cavities and/or centrilobular micronodules) persisted in 24 patients (43%) after a mean treatment period of 7 months. The persistence of these signs of activity was correlated with the initial presence of a cavitary syndrome (p=0.027), with predominant sub-segmentary bronchial involvement, with extensive micronodular spread (p=0.024) and with bronchiectasis (p=0.04). These residual lesions were not associated with an increased risk of relapse.The persistence of signs of activity on the CT scan at the end of treatment of tuberculosis do not necessarily correspond to an absence of cure but to a radiological delay. This imaging is nevertheless useful to make an assessment of any subsequent changes in the bronchial tree and to estimate the risk of later complications.

Background Vascular graft infections are infrequent complications with important morbidity and mortality rates. Pasteurella multocida, a Gram negative bacillus, is a normal oral commensal of many animals. For mankind, it is a pathogenous bacillus which is rarely implicated in vascular grafts. Case report We report hereafter the fourth case introduced in the international literature about vascular graft infections caused by P. multocida. The patient was successfully treated with a combination of a surgical graft change and a 6 weeks bi-antibiotic therapy. Discussion There is fours case reported in litterature with quite different antibiotic drugs and duration. Conclusion P. multicoda graft infection should be long with initial intravenous drug and mainteance traitement should not be required.

Introduction Evaluer l’efficience du laboratoire pour le diagnostic bacteriologique de la tuberculose en croisant les cas cliniquement repertories a ceux bacteriologiquement documentes au cours de l’annee 2015. Materiels et methodes Interrogation des donnees patients a partir du logiciel d’aide a la prescription, du logiciel de production de resultats de laboratoire et du logiciel de gestion du dossier patient. Inclusion des patients repertories en 2015. Cent soixante-cinq cas repartis en 4 groupes selon la presence d’une prescription d’isoniazide (INH+ ou −) et les resultats d’investigations microbiologiques (BAC+ ou BAC−) : groupe A (INH+, BAC− [ n = 10]) ; groupe B (INH+, BAC+ et culture positive a Mycobacterium tuberculosis complex [Mtb cx] [C+] [ n = 71]) ; groupe C (INH+, BAC+ mais culture negative a Mtb cx [C−] [ n = 54]) et groupe D (INH−, BAC+, C+ [ n = 30]). Pour l’objectif poursuivi, seuls les groupes B, C et D ayant fait l’objet d’investigations bacteriologiques, ont ete retenus ( n = 155). Pour chaque patient, les donnees cliniques ont ete analysees. Resultats L’analyse des donnees cliniques a permis d’obtenir les resultats suivants. Pour les 71 patients du groupe B (45 %), il existait une parfaite coherence clinique, biologique et therapeutique avec 40 tuberculoses pulmonaires (TP) 13 tuberculoses mixtes (TM) et 18 tuberculoses extrapulmonaires (TXP). Pour les 54 patients du groupe C (35 %), 4 cas etaient inexploitables car sans information clinique. Sur les 50 cas restants, nous avons repertorie 10 infections tuberculeuses latentes (ITL), 6 mycobacterioses, 11 traitements d’epreuves, 8 TP, TM ou TXP deja sous traitement lors des investigations bacteriologiques pouvant expliquer les resultats de culture negatifs. En revanche, pour 15 cas (2 TP, 4 TM et 9 TXP) une C+ n’a pas ete obtenue. Pour les 30 patients du groupe D (19 %), nous avons repertorie 19 TP, 2 TM et 9 TXP. L’efficience globale de laboratoire etait de 96 % pour les TP, meilleure que pour les TM (79 %) et TEX (75 %). Une analyse du nombre des investigations pratiquees pour les C− indique qu’un nombre insuffisant d’investigations est a mettre en avant. Conclusion A partir de l’ensemble des cas de TB repertories, le laboratoire a apporte un diagnostic positif pour 96 % des cas de TP. Il apparait que l’efficience du laboratoire est satisfaisante pour le diagnostic des TP et la principale cause de deficit de diagnostic bacteriologique repose sur un defaut d’investigations. Pour les TXP, l’analyse est plus complexe ; neanmoins le laboratoire a apporte sa contribution au diagnostic dans 3 cas sur 4.

Introduction Identifier rapidement les cas de tuberculose en milieu hospitalier est un objectif prioritaire pour prevenir les cas secondaires chez les patients et les soignants. Multiplier les sources d’informations permettant une alerte rapide est primordiale. Nous avons evalue sur une periode d’un an la place du logiciel d’aide a la prescription medicamenteuse dans la detection des patients suivis pour tuberculose pulmonaire au sein d’un groupe hospitalier universitaire confronte a une des incidences de tuberculose pulmonaire les plus elevees de France. Materiels et methodes Tous les cas de tuberculose ont ete repertories du 01/01/2015 au 31/12/2015 en utilisant le logiciel d’aide a la prescription medicamenteuse et le logiciel de gestion de resultats de laboratoire. Toutes les prescriptions incluant de l’isoniazide (INH) en complement des donnees du laboratoire de microbiologie ont ete prises en compte. Resultats Pendant la periode d’etude, 165 cas ont ete identifies. Parmi ceux-ci, 30 (18 %) patients l’etaient uniquement par culture positive (absence de prescription informatisee d’INH). Cent trente-cinq patients (82 %) avaient une prescription d’INH dont 71 (52 %) avec une culture positive a Mycobacterium tuberculosis complex , 10 (8 %) sans aucune investigation bacteriologique (8 diagnostics faits l’annee precedente et 2 infections tuberculeuses latentes [ITL]) et 54 (40 %) sans aucun prelevement positif malgre des investigations bacteriologiques. Il s’agissait pour ce groupe de 10 ITL, 6 mycobacterioses (MA) et 38 cas cliniquement suspects de tuberculose maladie. En excluant les ITL, les MA et les cas diagnostiques l’annee precedente, 38 (28 %) des 135 cas retenus l’etaient grâce au logiciel d’aide a la prescription des medicaments. Conclusion En pratique le logiciel d’aide a la prescription a permis dans notre travail d’identifier 38 cas supplementaires de tuberculose maladie soit 23 % des cas de l’annee etudiee. L’alerte a partir du logiciel d’aide a la prescription nous parait etre un complement a ne pas negliger en complement de l’alerte microbiologique afin d’elargir la population des cas autour desquels une enquete doit etre menee dont la recherche de cas secondaires eventuels afin de maitriser au mieux le risque de diffusion intra-hospitalier.

Mycobacterium bovis is responsible for a zoonosis originating in cattle. This disease has rarely affected man in industrialised countries since the establishment of veterinary surveillance in cattle. We report the case of a young female patient who developed a Mycobacterium bovis primary infection revealed by erythema nodosum. Infection was probably due to the consumption of non-pasteurised milk in Morocco. This clinical manifestation is rare and physicians ought to be aware of this imported pathology.

Giant hydatid cyst located in the retroperitoneal space is rare. The purpose of this report is to present a case cured by surgery in an adult traveller.In August 2009, a 67-year-old female who traveled frequently to Lebanon was admitted for assessment of a giant retroperitoneal hydatid cyst discovered coincidentally following palpation of an abdominal mass in 1997. From 1966 to 1975, the patient had undergone several surgical procedures for pulmonary and hepatic hydatidosis, complicated by vomica and anaphylactic shock. In 1997, computed tomography showed that the retroperitoneal cyst measured 100 mm at the widest point. At that time, the patient refused to undergo further surgery and was treated medically using albendazole initially in association with praziquantel. In 2009, the cyst had expanded to 180 mm at the widest point and the patient finally consented to perikystectomy. Excision was total and recovery was uneventful. Histology examination confirmed the viability of the cyst. Follow-up examination at 12 months indicated no relapse.The retroperitoneal space is a rare location for hydatidosis. Occurrence in this location is generally primary. In case of discovery of a liquid-filled retroperitoneal mass, a history of travel to an endemic area for hydatid disease should be elicited. Diagnosis relies on radiological findings and positive serology. Since retroperitoneal cysts are often giant, they respond poorly to medical treatment. Similarly radiological treatment is difficult due to retroperitoneal location. Surgery, preferably perikystectomy, is the treatment of choice.

Chloroquine-proguanil association is recommended for prophylaxis against falciparum malaria in countries with a low prevalence of chloroquine resistance. It is usually well tolerated with mild side effects consisting mainly of transient digestive discomfort and buccal manifestations (mouth sores or ulcers). The purpose of this report is to describe a case of duodenal ulcers presenting as epigastric pain with 10-kg weight-loss in a 32-year-old man taking chloroquine-proguanil for malaria prophylaxis during a stay in Haiti. No other causes of duodenal ulcers or weight-loss were found. Chloroquine-proguanil prophylaxis was discontinued and replaced by omeprazole for four weeks. Symptoms improved quickly and full recovery was observed within one month. To our knowledge, the occurrence of duodenal ulcers under chloroquine-proguanil association is quite rare, but possibly severe. Upper digestive endoscopy should be performed if a patient under chloroquine-proguanil develops abdominal pain especially in association with weight-loss. If endoscopy reveals duodenal ulcers, chloroquine-proguanil should be discontinued and replaced by another prophylactic regimen.

Candida species is the fourth most common cause of bloodstream infection and is the leading cause of invasive fungal infection among hospitalized patients. Acute disseminated candidiasis remains a life-threatening disease that now occurs mainly in intensive care units hospitalized patients. Delay in treatment of Candida bloodstream infections could be minimized by the development of more rapid and sensitive diagnostic techniques for the identification of Candida bloodstream infections. Current guidelines for the management of invasive candidiasis recommend fluconazole or an echinocandin as the primary therapeutic option. The optimal choice of the antifungal agent should depend on local epidemiology, prior antifungal therapy and patient's characteristics.

To describe the epidemiological and clinical features of enteroviral meningitis as well as the biological profile of the cerebrospinal fluid (CSF).A retrospective study conducted in a single centre between 2004 and 2008. All aseptic meningitis due to Enterovirus were included.Fifty-nine patients were included. The triad including fever, headache and neck stiffness was reported in 62% of patients. Twelve patients (20%) had a neutrophilic leukocytosis and 23 (39%) an elevated CRP level. Twenty-eight patients (47%) had a prominent neutrophilic reaction in the CSF and nine (15.2%) had a low glucose concentration. A presumptive anti-bacterial treatment was initiated in 47 patients (80%) for an average of 3.2 days.Due to the lack of specificity of clinical features and biological manifestations of Enterovirus meningitis, the widespread use of real-time Enterovirus PCR is a priority for reducing the number of unnecessary anti-bacterial treatment. Guidelines based on clinical and biological features may be associated to help physicians in the differential diagnosis between bacterial and viral meningitides.

Mycoplasma hominis has been associated with pelvic inflammatory illness, postpartum and neonatal infections and respiratory tract diseases. It is rarely isolated from patients with other infections. Reported here is a case of tibial osteitis that occurred in a 16-year-old immunocompetent man. Clinical and laboratory findings improved under treatment with clindamycin and fluoroquinolones.

Introduction – objectifs Evaluer la conformite aux recommandations de bonnes pratiques de la gestion des catheters veineux peripheriques en hospitalisation de maladies infectieuses. Materiels et methodes Etude observationnelle prospective dans le secteur d’hospitalisation classique de 22 lits de maladies infectieuses du CHU Avicenne. Recueil hebdomadaire pendant 2 mois de donnees cliniques relatives a la perfusion peripherique de tous les malades hospitalises : justification et duree de maintien de la voie d’abord, nombre et type de complications associees. Resultats Sur 2 mois, 174 patients hospitalises ont ete evalues et 96 (55,2 %) avaient une perfusion peripherique. Six (6,25 %) de ces perfusions n’etaient pas justifiees, dont 2 etaient associees a une complication mineure malgre une duree de perfusion correcte La date de pose du catheter n’etait notee par les infirmieres que dans 43 % des cas, dont 1 seul cas avec maintien > 96 heures (5 jours), sans complication associee. Conclusion Les recommandations de bonne pratique concernant l’indication, le maintien et la prevention des complications des perfusions peripheriques etaient plutot bien respectees dans notre service, en dehors de la tracabilite de la date de pose de la perfusion. Les complications observees n’etaient pas liees a une duree de maintien excessive.

Introduction – objectifs Evaluer le benefice de l’amikacine (AmK) en debut de traitement d’une tuberculose bacillifere (TTB) sur le delai de negativation de l’examen des crachats. Materiel et methodes Etude pilote prospective non randomisee monocentrique au CHU d’Avicenne sur la periode 2010-2013. Evaluation comparative sequentielle du delai de negativation de l’examen microscopique (EM) et de la culture des crachats/tubages entre TTB classique (TTBc) et TTB associe a AmK (TTB-AmK) IV 15 mg/kg/j pendant 7 jours adapte aux dosages. Les patients avec souche resistante, infection VIH ou insuffisance renale etaient exclus. Resultats L’etude a porte sur 45 patients : 30 (66,6 %) dans le groupe TTBc, 15 (33,3 %) dans le groupe TTB-AmK. Le sex ratio H/F etait de 4,6. La toux et les expectorations etaient retrouvees chez respectivement 41 (91,1 %) et 32 (71,1 %) des patients. Une majorite des patients (42 soit 93,3 %) avaient une caverne pulmonaire. Les medianes du delai de negativation de l’EM etaient respectivement de 26,5 [14-56] et 48 [19,5-69,5] jours dans les groupes TTBc et TTB-Amk avec une difference non significative (p = 0,52). Le delai de negativation de la culture n’etait connu que pour 26 patients (57,7 %) : 42,2 jours [14-90] en moyenne pour les 18 patients du groupe TTBc et 63,2 jours [14-77] pour les 8 patients du groupe TTB-AmK. Les 19 (42,2 %) autres patients avaient une culture encore positive au premier EM negatif. Aucun effet secondaire lie a l’AmK n’a ete rapporte. Conclusion La tuberculose pulmonaire bacillifere necessite un isolement prolonge couteux et contraignant pour le patient. L’ajout d’AmK au TTB initial ne semble pas avoir d’impact sur le delai de negativation de l’examen microscopique, critere de non-contagiosite le plus souvent retenu. Une etude randomisee avec des effectifs plus importants serait necessaire pour confirmer ces resultats.

Introduction – objectifs Evaluer l’apport d’un scanner thoracique en fin de traitement antituberculeux. Etudier les facteurs predictifs de persistance de signes d’activite (cavites a parois epaisses +/- nodules centrolobulaires) et de lesions sequellaires bronchiques en fin de traitement. Materiels et methodes Etude comparative retrospective au CHU Avicenne d’octobre 2006 a mars 2012 par trois radiologues des scanners thoraciques pour tuberculose pulmonaire realises au debut et a la fin du traitement. Resultats L’etude a porte sur 56 patients dont 43 (77 %) hommes. Six patients etaient VIH+ (11 %). La persistance de signes d’activite radiologique residuelle (ARR) en fin de traitement etait retrouvee chez 24 patients asymptomatiques sur 56 (43 %) et etait associee significativement a la presence initiale de cavites (p = 0,03), de micronodules (p = 0,022) et d’une atteinte bronchique sous segmentaire. Les symptomes cliniques et l’immunodepression n’etaient pas associes significativement a une ARR. Des sequelles bronchiques, retrouvees chez 36 patients sur 56 (64 %), avaient pour facteurs predictifs initiaux les cavites (p = 0,003), les condensations (p = 0,004), les micronodules (p = 0,03) et une atteinte bronchique initiale a type de DDB (p Conclusion La presence isolee de signes d’ARR en fin de traitement temoigne probablement le plus souvent d’un retard radioclinique et ne doit pas faire prolonger le traitement par le clinicien. Le scanner thoracique peut neanmoins servir d’imagerie de reference en situation de rechute tuberculeuse, d’hemoptysie, de surinfection bacterienne ou de greffe aspergillaire.

Objectifs Decrire l’aspect en imagerie de l’atteinte osseuse dans le cadre de mycoses invasives. Materiels et methodes Analyse retrospective en radiographie standard, scanner et IRM de 6 cas de mycoses invasives chez des patients, pour la majorite immunodeprimes, avec atteinte osseuse. Le diagnostic a ete confirme dans ces 6 cas par des prelevements avec etude anatomo-pathologique ou mycologique. Resultats Nous illustrons differentes atteintes osseuses fongiques interessant les parois des sinus de la face, le rachis, la scapula et les os longs dont le point de depart est pulmonaire, cardiaque, cutane ou sinusal. Le mode d’extension se fait par contiguite ou par voie hematogene. Les lesions des sinus sont lytiques avec extension aux structures adjacentes (sinus caverneux, carotides, meninges et parenchyme cerebral). L’extension au rachis se caracterise par une osteite focale ou etagee ou par une spondylodiscite. Enfin l’atteinte des os longs se manifeste par des images d’osteolyse multifocales avec importante extension musculo-aponevrotique. Conclusion L’extension vertebrale ou aux os longs de la mycose invasive est moins connue et doit etre evoquee chez un patient immunodeprime presentant une atteinte viscerale. Le diagnostic radiologique reste cependant aspecifique et doit etre confirme par une biopsie.