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Mucormycoses are rare but emerging diseases with poor prognosis caused by ubiquitous fungi from the environment. In November 2008, our teaching hospital experienced three cutaneous mucormycosis due to Lichtheimia spp. (ex Absidia/Mycocladus) in the intensive care and orthopaedic units. Environmental and epidemiological investigations suggested a possible cross-transmission of L. ramosa between two patients in intensive care. This is the first report of possible person-to-person transmission of mucormycosis species. These cases show the ineffectiveness of hydro-alcoholic solutions against spores and underline the need to respect standard precautions to prevent fungi dissemination.

International audience; In 2002, the French Food Safety Agency drew attention to the lack of information on the prevalence of human cryptosporidiosis in the country. Two years later, the ANOFEL Cryptosporidium National Network (ACNN) was set up to provide public health authorities with data on the incidence and epidemiology of human cryptosporidiosis in France. Constituted on a voluntary basis, ACNN includes 38 hospital parasitology laboratories (mainly in university hospitals). Each laboratory is engaged to notify new cases of confirmed human cryptosporidiosis, store specimens (e.g. stools, duodenal aspirates or biopsies) and related clinical and epidemiological data, using data sheet forms. From January 2006 to December 2009, 407 cryptosporidiosis cases were notified in France and 364 specimens were collected. Of the notified cases, 74 were children under four years of age, accounting for 18.2%. HIV-infected and immunocompetent patients represented 38.6% (n=157) and 28% (n=114) of cases, respectively. A marked seasonal pattern was observed each year, with increased number of cases in mid to late summer and the beginning of autumn. Genotyping of 345 isolates from 310 patients identified C. parvumin 168 (54.2%) cases, C. hominis in 113 (36.4%) and other species in 29 (9.4%), including C. felis (n=15), C. meleagridis (n=4), C. canis (n=4), Cryptosporidium chipmunk genotype (n=1), Cryptosporidium rabbit genotype (n=1) and new Cryptosporidium genotypes (n=4). These data represent the first multisite report of laboratory-confirmed cases of cryptosporidiosis in France.

A sensitive, rapid and specific diagnostic method is essential for the diagnosis of toxoplasmosis in immunocompromised hosts or in congenital infection. We report the development of a real-time PCR assay for quantitative diagnosis of toxoplasmosis with competitive internal amplification control. This PCR was applied after allogeneic stem cell transplantation to estimate the frequency of reactivation.Primers and Taqman probe (FAM-BHQ1) were designed to amplify the 529 bp element of T. gondii. The internal amplification control was developed by cloning a fragment of Arabidopsis thaliana DNA flanked by sequences specific for T. gondii 529 bp element. A Taqman probe specific for the competitive internal control was designed and tested (YY-BHQ1). We determined the repeatability and reproducibility of the method. A prospective study was performed on adults who received an allogeneic hematopoietic stem cell transplantation. After transplantation, patients were monitored once per week during the first 100 days; they were then monitored once every 2 weeks until day 180 after transplantation (i.e., day +180).A total of 451 samples from 40 patients were tested. Twenty-five patients had both positive toxoplasmosis serology and an adequate chemoprophylaxis. One sample from one patient was found positive. The rate of reactivation in the population of this study is 4%.A monitoring by T. gondii PCR should be realized weekly for patients receiving an allogeneic hematopoietic stem cell transplantation, without an adequate chemoprophylaxis.

Exogenous fungal endophthalmitis is a rare postoperative and posttraumatic complication with, often, a dreadful prognosis. We report one case of Absidia corymbifera endophthalmitis after penetrating injury with a retained intraocular vegetable foreign body. We focus on the risk factors for the development of fungal endophthalmitis (vegetable foreign body, corticotherapy) and the importance of ocular fluid samples for stain and appropriate culture. In this case, the treatment associating contaminated tissue extraction and systemic and intravitreal administration of antifungal agents was efficient.

Geotrichum capitatum sepsis are rare, occurring exclusively in immunocompromised patients.We report the case of a patient with acute leukemia, presenting with chemotherapy-induced neutropenia and hospitalized in an intensive care unit for a severe sepsis. In spite of an antibiotic and antifungal treatment, the patient died of cardiorespiratory failure. Later on, blood cultures proved to be positive for Geotrichum capitatum.If fungal infections are common in neutropenic patients, Geotrichum capitatum sepsis remain exceptional. The portal of entry is digestive or respiratory, and the invasion is favored by immunodepression and suppression of the normal microbial flora. Induced lesions can be multiorganic. The treatment is not well established, and the association of either amphotericine B and 5-fluorocytosine or amphotericine B and itraconazole would lead to better results. Nevertheless, the prognosis is still unfavorable, with a mortality rate of approximately 75%.

The investigation of a trichinosis outbreak in Auvergne, France identified 23 cases in 12 households living in two cities-Clermont-Ferrand and Montluçon-between 15 February and 7 March 1991. One patient required intensive care, 15 had major symptoms, and seven had minor or no symptoms. Two case control studies demonstrated a significant (p0.01) association between eating horse meat and acute trichinosis. Veterinary services found that three supermarkets where the patients had bought horse meat during the suspected period had been supplied by a single wholesaler. The analysis of the wholesaler's records revealed that the implicated horse meat had been imported from a slaughterhouse in the United States. This outbreak occurred despite a requirement in France for all meat from horses slaughtered in France and in countries exporting meat to France to be examined systematically for trichinella.

Systemic Malassezia furfur (Mf) infections are only seen in neonates and immunocompromised patients.A 2-year-8-month-old boy was given chemotherapy for mediastinal T cell lymphoma. Meningeal relapse supervened 10 months later, requiring polychemotherapy plus CNS irradiation followed by bone marrow transplantation. Three days after transplantation, fever associated with neutropenia required administration of ceftazidime, amikacin, vancomycin plus acyclovir followed by amphotericin B, cefotaxime plus erythromycin. Blood cultures were negative, but blood swears showed yeasts into polynuclear cells after cytocentrifugation; these yeasts were also present in the central catheter removed after a few days course of amphotericin B, flucytosine plus fluconazole. The patient was then given GM-CSF subcutaneously (5 micrograms/kg/day), followed by progressive correction of aplasia and cure of the Mf infection.This is a new case of systemic Mf infection seen in an immunocompromised child receiving parenteral nutrition with lipids.

Between August 1991 and August 1993, 75 patients (42 male) with Wolff Parkinson White syndrome (43 concealed) were subjected to radiofrequency ablation of accessory pathways at our institution. 55 had left, 8 postero septal, 2 anteroseptal and 10 right accessory pathways. A retrograde aortic technique with placement of the ablation catheter in close proximity to the mitral annulus was used for most of the patients with left accessory pathways and for some with posteroseptal pathways. The right, anteroseptal and some posteroseptal pathways were ablated using a right heart approach placing the ablation catheter in the tricuspid annulus. Ablation was successful in 61 patients (81%). One subject developed a fatal cardiac tamponade after a transeptal catheterization and was unrelated to the ablation per se. It is concluded that radiofrequency ablation of accessory pathways is a curative procedure for a great majority of patients with Wolf Parkinson White syndrome.

We report two cases of semi-invasive pulmonary aspergillosis with a thoracic wall extension in the first case and a parietal vasculitis without Aspergillus invasion in the second. Semi-invasive pulmonary aspergillosis is an identifiable entity. It is characterized by impairment of local pulmonary defense mechanisms and/or a mild systemic immunosuppression as well as a slowly progressive course. Pulmonary symptoms are not specific. The thoracic wall involvement subsequent to a contiguous pulmonary lesion occurs rarely and indicates poor prognosis. CT scan improves diagnosis significantly, confirmed by histology and/or by the biopsy growth of Aspergillus. Itraconazole, tolerated better than amphotericin B, is an efficient treatment though prognosis remains poor (28% of deaths). Detection of anti-neutrophil cytoplasmic antibodies (diffuse cytoplasmic staining) evolving conversely to this disease seems to be associated with infectious vasculitis. These antibodies are found in vasculitis and especially in Wegener's granulomatosis with a high specificity. They have also been described in a few patients with infectious diseases.

Apart from the rarity of the causal agent, this case is of interest because of the absence of cervico-facial involvement and the presence of multiple cutaneous nodules at a distance from the visceral localisation.

We observed a case of lung infection with Paragonimus for a 4 year old child in Gabon. The treatment with bithionol was partially uneffective. Indeed, after the end of this treatment we observed hypereosinophilia, hyper IgG and X Rays pulmonary opacities but without eggs in stools of sputum.

A study on the presence of oral Entamoeba gingivalis and Trichomonas tenax has been carried out on calculus or dental plaque from 117 diabetic subjects. Statistical analysis of results shows no correlation between diabetes and protozoa. The same frequency was found between diabetic and normal subjects. Nevertheless, a significant relation has been found between the diabetes and the yeasts.