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Abstract Objectives Nocardia , a Gram-positive bacterium, is responsible for rare and severe infections. Accurate microbiological data are essential to guide antibiotic treatment. Our primary objective was to describe species identification and results of antimicrobial susceptibility testing (AST) for Nocardia isolates analysed over a 6-year period. Secondary objectives were to study temporal trends in species distribution and AST results. Methods We retrospectively analysed results from Nocardia isolates sent between January 2010 and December 2015 to a French laboratory dedicated to Nocardia (Observatoire Français des Nocardioses). Species identification was obtained by amplification and sequencing of a 600-bp fragment of the 16S rRNA gene (for all isolates) and of hsp65 (when required). AST was performed using disk diffusion. Results We included 793 Nocardia isolates, mostly from the lungs (53.8%). The most frequent species were Nocardia farcinica (20.2%), Nocardia abscessus complex (19.9%) and Nocardia nova complex (19.5%). The proportion of N. farcinica increased significantly over time from 13% in 2010 to 27.6% in 2014. Linezolid, amikacin, trimethoprim-sulfamethoxazole, minocycline and imipenem were the most frequently identified active antibiotics with, respectively, 0% (0/734), 2.9% (21/730), 5.4% (40/734), 9.4% (69/734) and 19.5% (143/732) of isolates not susceptible. Nocardia farcinica was frequently not susceptible to cefotaxime (118/148, 79.7% of the isolates), but only about 5% of Nocardia cyriacigeorgica and N. abscessus complex isolates were not susceptible to cefotaxime. Conclusions In this first epidemiological study of Nocardia isolated from human samples in France, N. farcinica was the species most frequently identified and its prevalence increased over time. [ABSTRACT FROM AUTHOR]

Résumé L’abcès cérébral à Nocardia est plus fréquent chez les sujets immunodéprimés. Ici, nous rapportons le cas d’une nocardiose cérébrale et pulmonaire simulant une métastase tumorale survenue chez un patient algérien âgé de 40 ans apparemment immunocompétent. Le patient présentait des abcès intracérébraux révélés par l’imagerie par résonance magnétique suite à une crise d’épilepsie généralisée inaugurale. Il était apyrétique et a présenté une complication neurologique à type d’hémiparésie gauche. L’imagerie pulmonaire réalisée dans le cadre d’un bilan d’extension d’une néoplasie cérébrale a décelé la présence d’un nodule pulmonaire dans le segment apical du lobe inférieur droit. La craniotomie et la culture du pus cérébral extrait ont permis d’isoler et d’identifier Nocardia abscessus. Le patient a reçu initialement une bithérapie à base de cotrimoxazole et d’amikacine, puis un relais par cotrimoxazole seul. Après sept mois, l’évolution clinique était satisfaisante avec amélioration de l’hémiparésie. Les lésions intracrâniennes ont nettement régressé et le nodule pulmonaire a disparu. Le cotrimoxazole a été arrêté après douze mois de traitement. Après un recul de deux ans, l’état de santé de notre patient s’est nettement amélioré. Il est cependant suivi régulièrement en ambulatoire pour des examens de contrôle. Abstract Nocardial brain abscess is often occurring in immunocompromised patients. It is uncommon in immunocompetent individuals. Here, the authors describe a case of cerebral and pulmonary nocardiosis mimicking a metastatic tumor in an apparently health 40-year-old Algerian male. The patient presented multiple brain abscess revealed by inaugural epileptic seizure. He was afebrile and presented with left hemiparesis. Staging imaging showed a nodular lung lesion in the apical segment of the right lower lobe. The patient underwent double craniotomy for resection of the lesion. Culture of the resected specimen isolated Nocardia abscessus. The patient was initially started on intravenous trimethoprim-sulfamethoxazole and intravenous amikacine. He was switched to oral trimethoprim-sulfamethoxazole. He finished seven months of antibiotic therapy with a good clinical response. Imaging revealed reduction in the brain abscess and a complete resolution of the lung lesion. Cotrimoxazole was stopped after twelve months of therapy. After two years, the health status of our patient improves day after day. He is however regularly under medical supervision for control exams. [ABSTRACT FROM AUTHOR]

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Summary: Biofilms develop inside endoscope channels even when valid endoscope reprocessing protocols are applied. The use of an efficient biocide is not sufficient if the channels are not cleaned thoroughly prior to disinfection. This study compared new anti-biofilm combinations of detachment promoting agents with a cleaning product in current use. Tests were performed using Teflon tubing and a contamination device that reproduces conditions that are prevalent during endoscopy. Products were subjected to static+brushing or dynamic treatments, and their ability to remove a preformed biofilm was assessed. The residual biofilm after treatment was assessed and compared with untreated controls. The percentage of surface covered by biofilm was measured after staining with crystal violet. Culturable bacteria levels were determined by plating the bacteria scraped from the tubing surface and counting the colony-forming units (CFU). Further tests were performed on actual endoscopes that had been contaminated artificially. Biofilm removal was confirmed by scanning electron microscopy. This study showed that the new anti-biofilm products prevented the build-up of biofilm and removed a mature biofilm (approximately 108 CFU/cm2), whereas protocols based on detergent-disinfectants containing quaternary ammonium compounds showed low efficacy as these protocols and products fixed the biofilm on the endoscope surfaces. The new procedure and agents represent a new approach to biofilm control that may improve the efficacy of endoscope reprocessing, and reduce the risk of transmitting infections. [Copyright &y& Elsevier]

Introduction Les Nocardia sont des bactéries à Gram positif responsables de pathologies rares mais graves. Disposer de données microbiologiques précises (sensibilité aux antibiotiques et typage moléculaire d’espèce) sur un grand nombre de souches est indispensable afin de choisir le traitement probabiliste puis de l’adapter. Notre objectif principal était de décrire la sensibilité aux antibiotiques et l’épidémiologie moléculaire des Nocardia en France sur une large collection de souches. Notre objectif secondaire était d’étudier l’évolution au cours du temps de la résistance aux antibiotiques et de la proportion de chaque espèce et d’évaluer la répartition géographique des souches collectées. Matériels et méthodes Nous avons analysé rétrospectivement les données relatives aux souches de Nocardia isolées chez l’homme durant 6 ans (2010–2015). L’identification d’espèce était obtenue par amplification et séquençage d’un fragment de 600pb du gène codant pour l’ARNr 16S (pour toutes les souches) et le gène hsp65 (pour les complexes N . abscessus et N . transvalensis ). La sensibilité aux antibiotiques était évaluée par technique de diffusion des antibiotiques en disques sur gélose Mueller-Hinton ajustée en cations. Résultats Nous avons inclus 793 souches de Nocardia , principalement isolées au niveau pulmonaire (53,8 %) ou à partir de lésions cutanées ou sous-cutanées (19,7 %). Les principales espèces étaient N . farcinica (20,2 %), N . abscessus complexe (19,9 %), N . nova complexe (19,5 %) et N . cyriacigeorgica (12,9 %). La proportion de N . farcinica augmentait significativement au cours du temps. Le linézolid, l’amikacine, le triméthoprime-sulfaméthoxazole, la minocycline, et l’imipénem étaient les antibiotiques les plus souvent actifs in vitro avec respectivement 0 %, 2,9 %, 7 %, 9,4 %, 13,8 % et 19,5 % de souches non sensibles ; ces fréquences étaient stables au cours du temps. N . farcinica était souvent non sensible aux céphalosporines de 3 e génération (∼ 80 % des souches), mais seulement 5 % des N . cyriacigeorgica et des N . abscessus complexe n’étaient pas sensibles au céfotaxime et à la ceftriaxone. Une plus grande densité de souches était observée dans le Sud-Est de la France et dans les territoires d’Outre-Mer, par rapport au Nord de la France. Conclusion Dans cette première étude épidémiologique des souches de Nocardia isolées chez l’Homme en France, N . farcinica était la principale espèce identifiée et sa proportion augmentait au cours du temps. [ABSTRACT FROM AUTHOR]

Abstract: The bone morphogenetic proteins (BMPs) are cytokines of the transforming growth factor beta family. Some BMPs such as BMP-2 and BMP-7 play a major role in the development of the skeleton and the maintenance of homeostasis during bone remodelling. To date, only BMP-2 and BMP-7 have been approved by the Food and Drug Administration for specific orthopaedic applications. However, due to BMP cost, peptides derived from their knuckle epitope with osteogenic properties have been developed. BMPs are involved in many other biological events, including embryogenesis, angiogenesis and cancer. BMPs therefore have great biomedical potential as osteogenic factors and as anti-cancer agents. This review focuses on the use of BMPs and their derived peptides in biomedical delivery systems and gene therapy. [Copyright &y& Elsevier]

Currently for bacterial identification and classification the rrs gene encoding 16S rRNA is used as a reference method for the analysis of strains of the genus Nocardia. However, it does not have enough polymorphism to differentiate them at the species level. This fact makes it necessary to search for molecular targets that can provide better identification. The sod A gene (encoding the enzyme superoxide dismutase) has had good results in identifying species of other Actinomycetes. In this study the sod A gene is proposed for the identification and differentiation at the species level of the genus Nocardia. We used 41 type species of various collections; a 386 bp fragment of the sod A gene was amplified and sequenced, and a phylogenetic analysis was performed comparing the genes rrs (1171 bp), hsp 65 (401 bp), sec A1 (494 bp), gyr B (1195 bp) and rpo B (401 bp). The sequences were aligned using the Clustal X program. Evolutionary trees according to the neighbour-joining method were created with the programs Phylo_win and MEGA 6. The specific variability of the sod A genus of the genus Nocardia was analysed. A high phylogenetic resolution, significant genetic variability, and specificity and reliability were observed for the differentiation of the isolates at the species level. The polymorphism observed in the sod A gene sequence contains variable regions that allow the discrimination of closely related Nocardia species. The clear specificity, despite its small size, proves to be of great advantage for use in taxonomic studies and clinical diagnosis of the genus Nocardia. [ABSTRACT FROM AUTHOR]

Abstract: Introduction. – The purpose of this study was to identify, through recursive partitioning, clinically relevant criteria which predict the need for acute neurosurgical intervention in a group of patients with mild head injury. Materials and methods. – A retrospective cohort of all adult patients, from April 2000 to March 2001, who sustained a blunt trauma and underwent head CT scan, was reviewed. The following inclusion criteria for mild head injury were used: initial Glasgow Coma Scale (GCS) ranging from 13 to 15; no loss of consciousness lasting more than one hour; no obvious skull fracture; a cranial CT scan performed. We collected demographic and trauma related data, interventions and outcome. Univariate and multivariate analyses were undertaken. In parallel, recursive partitioning was carried out using all variables to elaborate a decision algorithm. Results. – There were 405 patients in the sample. CT identified lesions in 12% of patients. Twelve patients (3%) required acute neurosurgical intervention. The recursive partitioning analysis identified three significant sequential nodes: deterioration of the GCS; an initial GCS of 13 vs 14 or 15; and the presence of associated injuries or comorbid conditions. Conclusions. – A simple three step rule predicts the need for acute neurosurgical intervention based on clinical findings: a deteriorating GCS; an initial GCS of 13; and the presence of associated injuries or comorbid conditions. [Copyright &y& Elsevier]

Bacteria of the genus Gordonia are rarely involved in human infections. We report here the case of a 30-year-old man from Guinea Buissau with mycetoma of the foot. 16S DNA sequencing after surgical biopsy identified Gordonia westfalica. To our knowledge, this is the first report of human infection caused by G. westfalica. [ABSTRACT FROM AUTHOR]