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Objective: Anaerobic deep abscesses are rare and may have unusual location leading to severe outcome due to delayed diagnosis and treatment. In order to improve their diagnosis, we report and analyse 5 new cases., Methods: Patients were seen from 1999 to 2003 in a single department of internal medicine of the university hospital of Marseille., Results: Five new cases were diagnosed consisting in 3 females and 2 males with a medium age of 56,8 years, with unusual location in 4 cases: epidural (2), psoas (1) and sub-diaphragmatic (1) or circumstances in one case of pulmonary abscess unrelated to inhalation. Predisposing conditions thought to compromise resistance to infection were found in all cases: social poverty (4/5), alcoholism (3/5), smoking (4/5), teeth and periodontal disease (4/5), neoplasia (2/5), iatrogenic disease (2/5). Symptoms were insidious (5/5) and unspecific but were always related to the abscess location. Abscesses were frequently found distant from the initial focus of infection because of frequent hematogenous spread (4/5). Drainage of the collection led to bacterial identification in all cases (4/4), although blood cultures could be positive (3/5) and helpful in one case in which drainage was not possible (1/5). The isolated organisms always corresponded to the suspected initial focus (oropharynx 4/5 and digestive 1/5). Finally, combination of surgical drainage and double prolonged antibiotherapy (penicillin+metronidazole) was the elected treatment., Conclusion: Since hematogenous diffusion is frequent, anaerobic infection should be suspected in any case of deep abscess affecting patients with predisposing conditions such as poverty, severe teeth disease or iatrogenic procedure.

Purpose: To describe clinical, biological characteristics and associated diseases of cold agglutinins in adults., Methods: Retrospective study in a single department of internal medicine from 1997 to 2002. The inclusion criteria were a positive direct Coombs test and a positive research for cold-reactive autoantibodies. We recorded for each patient: clinical presentation at onset and during follow-up, biological parameters of haemolysis, biological characteristics of the cold agglutinin and associated diseases., Results: Fifty-eight patients (34 females, 24 males), with medium age of 58.8 were included in the study. Clinical presentation was highly variable between acute life-threatening haemolysis and absence of symptoms. Results of direct antiglobulin test were C3 (74%), IgG + C3 (22.4%), IgG (3.4%). Titer, thermal amplitude, strength and specificity of Coombs test were correlated, in all cases except 6, with cold agglutinin haemolytic activity. In 77.6% of cases cold agglutinin was secondary; related to: autoimmune disorders (n = 19), lymphoproliferative disorders (n = 11) and infections (n = 10)., Conclusion: Clinical presentation of cold agglutinin is highly variable and not always related to the biological characteristics of the bound antibody (titer, thermal amplitude, specificity). In our single center study, diseases associated with cold agglutinin were various with the highest frequency of auto-immune disorders. Our study underlined also the high frequency of lymphoproliferative disorders and justifies a close follow-up of these patients. Finally, we reported a high frequency of hepatitis C virus infection among the infectious aetiologies.

Background: Enteroviruses (EV) circulate worldwide and are a major cause for annual epidemics of meningitis in humans. During the last two decades, echovirus type 30 (E-30) has revealed to be one of the most prevalent enteroviruses at the origin of epidemics of EV meningitis., Objectives: To design an approach to timely investigate epidemics due to EV. To apply this strategy to the outbreak of meningitis due to E-30 that occurred at the end of year 2000 in Marseilles, France., Study Design: The approach consisted to (i) determine whether the epidemic was caused by a dominant strain; (ii) identify the dominant strain by sequencing the first isolates during the outbreak; (iii) identify a restriction enzyme, capable to produce an Restriction fragment length polymorphism (RFLP) profile characteristic for the dominant strain, for rapid identification based on RFLP analysis of PCR products., Results and Conclusions: A total of 394 samples were tested; 258 (corresponding to 177 patients) were positive for the presence of EV by cell culture and/or RT-PCR. Sequence analysis of a 785-bp PCR product (including the 5' end of the VP1 gene) performed for the 30 first isolates permitted to identify a RFLP profile that was specific of the dominant strain after enzymatic cleavage by Bst X1. This RFLP profile was observed in 246 out of 258 PCR products. This method of typing is rapid, simple and inexpensive, and may be applied for the epidemiological typing of EV in epidemic situations.

Objective: Heyde's syndrome associates aortic stenosis and digestive hemorrhage secondary to intestinal angiodysplasia., Observation: A 61 year-old man presented with anemia due to martial deficiency and melena, the endoscopic examination of which was negative. The existence of a tight aortic stenosis, suspected on auscultation, suggested the diagnosis of Heyde's syndrome. Angiodysplasia is revealed during oriented enteroscopy. Following valve replacement, the need for transfusion disappeared, together with the anemia., Discussion: Although some epidemiological studies deny the existence of this syndrome, the observation of authentic cases of resolution of digestive bleeding following surgical replacement of an aortic valve, such as ours, is an argument in favor of the reality of Heyde's syndrome.

Background: Q fever is characterized by its clinical polymorphism; neurological involvement has occasionally been described. In the course of acute Q fever, neurological manifestations may include aseptic meningitis, encephalitis or encephalomyelitis, and peripheral neuropathy., Objective: To review and evaluate cases of acute Q fever with neurological symptoms diagnosed in our laboratory., Methods: A total of 1269 acute Q fever cases were recorded from January 1985 to January 2000 in our laboratory and were reviewed for neurological complications. Patients were considered to have acute Q fever when serological procedures showed Coxiella burnetii phase II titers of 1:200 or higher for IgG and 1:50 or higher for IgM. Those patients who underwent a lumbar puncture for cerebrospinal fluid analysis or who had abnormal neurological symptoms were selected for this study. We describe the clinical, epidemiological, and biological features of these cases. We also review the literature and compare our cases with those previously reported., Results: Among the 45 patients selected, 14 were excluded because they had normal cerebrospinal fluid and no neurological symptoms. Two were excluded because there were no clinical or epidemiological data. Three major clinical syndromes were observed: meningoencephalitis or encephalitis in 17 cases; meningitis in 8; and myelitis and peripheral neuropathy in 4. Encephalitic signs were not specific, but behavior or psychiatric disturbances were common., Conclusions: Q fever should be included in the differential diagnosis of acute neurological disease in a patient with a fever. Serological testing should be performed in cases of meningoencephalitis, lymphocytic meningitis, and peripheral neuropathy, including Guillain-Barré syndrome and myelitis.

Human herpes virus type 8 (HHV-8) is predominantly associated with Kaposi's sarcoma. Nothing is known about its manifestation in primary infection. We report an HIV-negative patient with chronic polyadenitis and lymphocytosis that may have been related to a primary HHV-8 infection.

Introduction: Acute parvovirus B19 infection induces a transient inhibition of erythroid cell formation, which may induce an erythroblastopenia crisis in patients suffering from chronic hemolytic anemia., Exegesis: We report here an exceptional observation of acute erythroblastopenia crisis with good outcome, occurring at the same time in a mother and her son, both suffering from hereditary spherocytosis. Diagnosis of parvovirus infection is based on detection of serum parvovirus B19-specific immunoglobulin M antibodies in the mother and her son and by the positivity of parvovirus B19 DNA detected by PCR in serum in the mother. Outcome was good, with the end of the erythroblastopenia crisis obtained 7 to 10 days later, but requiring blood transfusion in the mother., Conclusion: Our observation is a reminder that the contagiosity of parvovirus B19 is high in household contacts and that protection of family members should rapidly be considered in hereditary spherocytosis.

Epidemiology: African rickettsiasis is transmitted by Rickettsia africae, a cattle tick. Amblyomma spp. is an emerging rickettsiasis in sub-sehalian Afric described in 1992. Seroepidemiology studies conducted in Africa show that it is probably the most widespread rickettsiasis in the sorld. In addition, the development of tourist activities in southern African countries has led to an increase in the number of reported cases in subjects returning from endemic areas. A high serprevalence of anti R. africae anticodies has been recently reported in the guadeloupe (French East Indies) population as well as one documented infection., Clinic: The clinical expression of African tick rickettsiasis includes fevder, headache, inoculation scar, locoredgional node enlargement, and an inconsistent sometimes vesicular rash. The diagnosis is made on the basis of serological findings and cross absorption of anti R. africae and R. conorii antibodies and/or isolation or gene amplification of R. africae from inoculation scar biopsies.