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Resume Introduction Capnocytophaga canimorsus est un bacille Gram negatif commensal de la cavite buccale des chiens et des chats, pathogene pour l’homme, dont les manifestations cliniques les plus frequentes sont des septicemies, meningites et endocardites. Nous rapportons le cas d’une bacteriemie a C. canimorsus se manifestant par un erytheme annulaire centrifuge multiple associe a une monoarthrite du genou. Observation Un homme de 66 ans consultait pour une eruption cutanee et une monoarthrite du genou droit febrile, secondaires a une piqure d’insecte sur l’hallux droit. L’examen dermatologique montrait de multiples plaques erythemateuses annulaires d’extension centrifuge du tronc et des membres. L’analyse du liquide articulaire du genou droit montrait un liquide inflammatoire avec culture bacteriologique sterile et une PCR Borrelia negative. Les hemocultures permettaient d’isoler la bacterie C. canimorsus. La PCR de l’ARN 16S dans le liquide articulaire etait positive au meme germe. La reprise de l’anamnese permettait de decouvrir que le chien du patient avait leche la plaie de l’hallux. Discussion C. canimorsus affecte plus frequemment les sujets immunodeprimes. L’atteinte cutanee est presente dans la moitie des cas. Il s’agit le plus frequemment d’une dermo-hypodermite, d’un livedo pathologique ou d’un purpura thrombotique. Nous rapportons ici le cas d’une bacteriemie a C. canimorsus chez un patient immunocompetent se manifestant par un erytheme annulaire centrifuge multiple et une monoarthrite du genou.

Background This study aimed to describe the microbiological epidemiology of repatriated French soldiers with an open traumatic injury, and to measure the proportion of multidrug-resistant bacteria (MDRB). Methods Retrospective study including all French soldiers repatriated in 2011 and 2012 in Parisian military hospitals for open traumatic injury. Results of clinical samples and MDRB screening were collected. The antibiotic susceptibility was assessed using the agar disk diffusion method. Characterization of resistance mechanisms was performed using PCR. Genotyping of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) isolates was performed using rep-PCR. Results A total of 139 patients were included; 70% of them were repatriated from Afghanistan. At admission, 24/88 were positive for MDRB (28%), mainly ESBL-E but no carbapenemase-producing Enterobacteriaceae and vancomycin-resistant Enterococcus faecium were identified. Forty-five patients had lesion sample collection, and 28/45 had a positive culture. The most frequently isolated pathogens were Enterobacter cloacae, Pseudomonas aeruginosa, and Escherichia coli. For eight patients, a MDRB was isolated from the wound, mainly ESBL-E (7/8) but also one methicillin-resistant Staphylococcus aureus and one imipenem-resistant Acinetobacter baumannii. Among ESBL-E, the PCR evidenced the high prevalence of CTX-M15 enzymes. Rep-PCR performed on the 23 ESBL-producing E. coli isolates highlighted numerous profiles. Conclusions Controlling the spread of ESBL-E is currently challenging for French Armed Forces. Despite any evidence of an epidemic clone, a high-level compliance with hygiene precautions is required throughout the chain of care to avoid cross contamination.

Objective Cerebrospinal fluid (CSF) leukocytes analysis is commonly used to diagnose meningitis and to differentiate bacterial from viral meningitis. Interpreting CSF monocytes can be difficult for physicians, especially in France where lymphocytes and monocytes results are sometimes pooled. Patients and methods We assessed SF monocytes in patients presenting with microbiologically confirmed meningitis (CSF leukocyte count > 10/mm3 for adults or > 30/mm3 for children Results Two-hundred patients (82 BM, 86 VM, and 32 NB) were included. The proportions of monocytes were higher in VM (median 8%; range 0–57%) than in BM (median 5%; range 0–60%, P = 0.03) or NB (median 5%; range 0–53%, P = 0.46), with a high value overlap between conditions. Conclusion CSF monocytes should not be used to discriminate BM from VM and NB because of value overlaps.

Capnocytophagacanimorsus (C. canimorsus), a commensal Gram-negative bacillus found in the oral cavity of dogs and cats, is pathogenic for humans, with the most common clinical manifestations being septicemia, meningitis and endocarditis. Herein we report a case of CC bacteremia manifesting as multiple plaques of erythema annulare centrifugum associated with monoarthritis of the knee.A 66-year-old man consulted for a skin rash and monoarthritis of the right knee with fever following an insect bite on his right hallux. Cutaneous examination revealed numerous erythematous annular plaques on the trunk and limbs with centrifugal extension. Analysis of synovial fluid from the right knee showed an inflammatory liquid with a sterile bacteriological culture and PCR was negative for Borrelia. C. canimorsus bacteria were isolated from blood cultures. 16S RNA PCR performed on the synovial fluid was positive for the same organism. The patient's history revealed that his hallux wound had been licked by his dog.C. canimorsus most frequently affects immunosuppressed subjects. Cutaneous signs are seen in half of all cases, most frequently presenting as cellulitis, pathological livedo or thrombotic purpura. We report herein a case of CC bacteremia in an immunocompetent patient manifesting as multiple plaques of erythema annulare centrifugum, an unusual sign, and monoarthritis of one knee.

Introduction Capnocytophaga canimorsus (CC) est un bacille Gram negatif commensal de la cavite buccale des chiens et des chats, pathogene pour l’homme, dont les manifestations cliniques les plus frequentes sont des septicemies, meningites et endocardites. L’atteinte cutanee est presente dans 50 % des cas. Nous rapportons le cas d’un erytheme annulaire centrifuge multiple (EACM) associe a une monoarthrite du genou secondaire a une infection a CC. Observation Un homme de 66 ans consultait pour une eruption cutanee et une monoarthrite du genou droit en contexte febrile dans les suites d’une piqure d’insecte sur l’hallux droit. L’examen dermatologique montrait sur le tronc et les membres de multiples plaques erythemateuses annulaires sans alteration de la surface cutanee, a bordure palpable et guerison centrale, d’extension centrifuge objectivee a 2 jours d’intervalle. L’histologie cutanee montrait un infiltrat inflammatoire mononuclee dermique aspecifique. L’analyse du liquide articulaire du genou droit montrait un liquide inflammatoire avec culture bacteriologique sterile. La PCR Borrelia dans le liquide articulaire etait negative. Apres 3 jours de culture, les hemocultures permettaient d’isoler la bacterie CC. La PCR de l’ARN 16S dans le liquide articulaire etait positive au meme germe. La reprise de l’anamnese permettait de decouvrir que le chien du patient avait leche la plaie de l’hallux. La recherche d’une immunodepression sous-jacente etait negative. L’evolution etait favorable apres antibiotherapie d’une duree de 6 semaines par cephalosporine de 3e generation (C3G), puis rifampicine et levofloxacine, associees a un lavage articulaire. Discussion CC est un germe pathogene pour l’homme, pourvoyeur de septicemies, meningites et endocardites avec un taux de mortalite de 26 %. Son identification en milieu de culture standard est difficile. L’infection touche preferentiellement des patients splenectomises, ayant une asplenie fonctionnelle ou ethyliques chroniques. L’atteinte cutanee est presente dans 50 % des cas, le plus frequemment sous la forme d’une dermo-hypodermite, d’un livedo pathologique ou d’un purpura thrombotique. Nous rapportons ici le cas d’une bacteriemie a CC chez un patient immunocompetent se manifestant par un EACM, manifestation plus inhabituelle, et une monoarthrite du genou. Deux autres cas d’EACM secondaire a une bacteriemie a CC ont ete decrits dans la litterature. Conclusion Nous rapportons une cause rare d’EACM dans le cadre d’une bacteriemie a CC chez un adulte immunocompetent apres lechage d’une porte d’entree infectieuse par un chien. L’erytheme annulaire centrifuge est un syndrome revelant des causes variees pour lequel l’etendue des investigations doit etre appreciee au cas par cas en fonction du contexte et des symptomes associes. Sa survenue en contexte febrile, surtout si une atteinte articulaire est associee, doit faire evoquer une infection a CC.

Introduction La babesiose est une parasitose transmise par les tiques due a differents especes au sein desquelles predominent Babesia divergens, Babesia microti. Aux USA B. microti est l’espece la plus commune responsable de plus mille cas par an chez l’immunocompetent (IC) et l’immunodeprime (ID). A l’inverse en Europe seule une cinquantaine de cas est rapportee avec une tres forte predominance de cas severes dus a B. divergens principalement chez des patients splenectomises. Cette description correspond de fait a la definition classique de la babesiose europeenne. Plusieurs donnees recentes semblent toutefois plaider vers la survenue de tableaux cliniques plus moderes de babesiose chez l’IC et une presence importante de B. microti notamment en France. Materiels et methodes Une analyse retrospective de cas diagnostiques en Alsace associee a une analyse d’une etude recente de seroprevalence en France chez des travailleurs forestiers du Nord-Est de la France a ete realisee afin definir les caracteristiques de la babesiose en France. Resultats Depuis 2009 on note en Alsace la survenue de 6 cas averes (patient avec frottis positif et/ou PCR positive et/ou seroconversion) chez des patients tous IC et de 12 cas possibles (serologie positive isolee avec tableau compatible) avec 11/12 patients IC. Tous les cas ont evolue favorablement. Une etude de seroprevalence recherchant a la fois B. microtii et B. divergens realisee entre 2002 et 2003 chez 627 travailleurs forestiers du Grand-Est a trouve une seroprevalence de 0,1 % pour B. divergens et 2,5 % pour B. microti soulignant la preponderance de cette espece. Conclusion La babesiose en France et par-la en Europe semble concerner essentiellement les IC et l’espece B. microti est frequente. La babesiose europeenne est sous-estimee. Plusieurs mecanisme concourent a ce sous diagnostic. – Une meconnaissance de la pathologie. – Une definition inadaptee restreinte aux tableaux severes chez les patients splenectomises. – Des moyens diagnostiques biologiques limites a un petit nombre de laboratoire et d’interpretation delicate (frottis sanguin pauci-parasitaire chez l’IC, PCR et serologie Babesia en immunofluorescence « faites maison » sans kit commercialise). Il apparait necessaire de realiser des etudes prospectives afin de mieux connaitre la babesiose en France et en Europe et d’ameliorer les examens diagnostiques disponibles.

Objectives Patients hospitalized for influenza should receive early treatment with a neuraminidase inhibitor. Patients and methods We conducted a retrospective study of the prescription of oseltamivir during the 2016–2017 influenza epidemic among patients hospitalized for influenza confirmed by RT-PCR in the infectious disease department. Results Treatment with oseltamivir was initiated as recommended in 96% of hospitalized patients presenting with influenza. However, a delay in prescription was observed with only 18% of prescriptions made on the first day. The prescriptions were exclusively initiated in the infectious disease department. Conclusion To improve the early prescription of oseltamivir during the influenza season, two recommendations are essential: oseltamivir availability in the emergency department pharmacy, awareness of physicians of the need to prescribe to any patient hospitalized for a lower respiratory tract infection treatment with a neuraminidase inhibitor upon admission to the emergency department.

Objective We assessed the systematic RT-PCR screening of patients admitted to an infectious diseases department (IDD), during the 2012–2013 influenza outbreak. Methodology Patients admitted with cough and fever underwent a nasopharyngeal smear for RT-PCR screening. Results Ninety-eight patients were admitted in the IDD, from January 1st to February 22nd, 46 were screened; 11 male and 6 female patients (17.3%, mean age of 68 years) were positive. The diagnoses made in the emergency department, before RT-PCR screening, were most frequently lung infection and sepsis, but influenza in only 4 cases. The diagnosis of influenza led to stopping antibiotics (n = 4), initiating curative (n = 4) and preventive (n = 4) treatments with oseltamivir, and isolating patients to prevent a hospital outbreak. Conclusion Systematic RT-PCR screening allows a rapid therapeutic management and the prevention of hospital epidemic through appropriate isolation measures.

Introduction Le virus TBE (Tick-Borne Encephalitis) est responsable de l’encephalite a tique. Cette zoonose est transmise a l’homme surtout par piqure de tiques du genre Ixodes. Elle est endemique en Europe Centrale et de l’Est ou une augmentation du nombre de cas a ete rapportee ces 30 dernieres annees. L’infection symptomatique dans 30 % des cas, peut se compliquer de signes neurologiques. Le diagnostic repose selon la definition de l’ECDC sur des criteres biologiques et cliniques. En France, environ 10 cas par an sont rapportes, en 2016, une recrudescence des cas TBE a ete observee avec 29 cas confirmes. Materiels et methodes En 2017, des echantillons seriques ou de LCR (n = 688) issus de la France entiere ont ete testes (Serion Classic TBE Virus Kit). Les donnees cliniques ont ete recueillies pour classer les cas confirmes. Les donnees epidemiologiques ont ete comparees aux donnees anterieures. Pour 3 patients, l’ARN viral a ete recherche par RT-PCR (region E-NS1) sur du serum et du LCR. Les profils serologiques correspondant a une infection ancienne ou une immunite vaccinale ont ete etudies. Resultats Dix-sept cas confirmes ont ete diagnostiques entre avril et octobre 2017 dont 8 (47 %) cas importes (Allemagne, Siberie, Roumanie) contre 1 seul l’an passe. La majorite des cas autochtones etaient situes en Alsace, mais un cas a ete confirme en Auvergne. Les cas sont survenus entre avril et octobre avec un pic d’incidence en juillet. Douze sur 17 (70 %) patients ont rapporte une piqure de tiques (65 % en 2016). Onze patients ont presente des tableaux de meningo-encephalite (65 %) et 6 patients (35 %) des tableaux de meningites. La duree moyenne d’hospitalisation etait de 14 jours (3 a 60 jours) et la serologie TBE prescrite en moyenne 2,5 jours apres l’hospitalisation. Seul 0,6 % des echantillons testes au laboratoire correspondait a des controles d’immunite vaccinale. Conclusion En 2017, nous avons diagnostique 17 cas confirmes de TBE. L’Alsace reste la zone de plus forte prevalence en France avec une repartition ubiquitaire. La TBE est une pathologie peu connue en France et probablement insuffisamment diagnostiquee. D’autres zones geographiques pourraient etre concernees comme le montre le premier cas autochtone identifie en 2017 en Auvergne. La vaccination pourtant efficace est rarement prescrite en cas de voyage dans les pays a risque comme le montre la proportion elevee de cas importes en 2017.

Resume But de l'etude Entre le 1er janvier et le 31 decembre 2005, les participants a l'Observatoire regional du pneumocoque (ORP) Alsace (un centre hospitalier universitaire, sept centres hospitaliers non universitaires et 12 laboratoires prives) ont collecte 232 souches supposees pathogenes et non redondantes de Streptococcus pneumoniae pour etudier leur sensibilite vis-a-vis des betalactamines. Methode Les concentrations minimales inhibitrices (CMI) de la penicilline G, de l'amoxicilline et du cefotaxime ont ete determinees par la methode E-test et par la methode de dilution en milieu gelose (Steers). Les resultats ont ete interpretes selon les recommandations du CA-SFM. Les sensibilites a d'autres molecules ont ete etudiees. Resultats Les souches ont ete isolees de 151 hemocultures, de 11 liquides cephalorachidiens, de 38 pus d'otites moyennes aigues, de huit liquides pleuraux et un quota de 24 prelevements pulmonaires. Le pourcentage de pneumocoques de sensibilite diminuee a la penicilline G (PSDP) [hors prelevements pulmonaires] est de 35,1 versus 44,0 % en 2003. Le pourcentage de PSDP diminue pour les differents sites de prelevements par rapport aux autres annees de surveillance. Les PSDP restent plus frequemment isoles chez les enfants que chez les adultes (43,8 versus 32,5 %). Les souches resistantes aux betalactamines sont rares. Les souches sont dans l'ensemble plus sensibles a l'erythromycine, aux tetracyclines, a la fosfomycine par rapport aux annees anterieures. Conclusion On observe une diminution des PSDP, les souches de haut niveau de resistance sont rares. Les pourcentages de PSDP observes en Alsace demeurent parmi les plus bas au niveau national.

Resume Objectifs De juillet 1997 a juin 1998, 15 laboratoires de microbiologie, organises en observatoire regional et repartis sur l'ensemble de l'Alsace, ont participe a un recrutement exhaustif des pneumocoques isoles en situation d'infection dans le but d'etudier leur sensibilite aux antibiotiques. Methode Les souches ont ete isolees de prelevements diagnostiques (prelevements pulmonaires, hemocultures, liquides cephalorachidiens, prelevements ORL). Resultats L'observatoire a recrute 599 souches dont 32,9 % sont des pneumocoques de sensibilite diminuee a la penicilline G (PSDP: concentrations minimales inhibitrices CMI > 0,06 mg/L). Parmi ces PSDP, dix souches presentent une resistance de haut niveau (CMI > 1 mg/L), trois sont resistantes a l'amoxicilline (CMI > 2 mg/L) et aucune au cefotaxime. La prevalence des PSDP est plus elevee chez l'enfant que chez l'adulte (45,3 % contre 28,2 %) et dans les pus d'oreille (59,4 %). Les PSDP sont frequemment resistants a l'erythromycine (76,6 %), au cotrimoxazole (65,2 %) et a la fosfomycine (18,4 %). Les serotypes 23, 14 et 9 sont les plus frequents: 29,1 %, 26,1 % et 17,9 % des souches respectivement. Conclusion Cette enquete a permis de preciser, pour la premiere fois, l'impact exact de la resistance de Streptococcus pneumoniae a la penicilline G et aux antibiotiques dans la region Alsace. La prevalence des PSDP est l'une des plus faibles observees en France la meme annee avec une proportion tres restreinte de souches resistantes a la penicilline G et aux autres β-lactamines, γ compris dans les pus d'oreille de l'enfant.

The 16S rRNA genes (rDNA) of 50 strains belonging to 26 different coryneform bacterial species and genomospecies and of the type strain of Rhodococcus equi were enzymatically amplified. Amplified rDNA restriction analysis (ARDRA) with the enzymes Alu l, Cfo l and Rsa l was carried out. The combination of the ARDRA patterns obtained after restriction with these three different enzymes enabled the differentiation between the following species: Corynebacterium accolens (number of strains = 2), C. afermentans subsp. afermentans (2), C. afermentans subsp. lipophilum (2), C. amycolatum (3), CDC coryneform group ANF-1-like (1), CDC coryneform group ANF-3-like (1), C. cystitidis (1), C. diphtheriae (4), C. jeikeium (3), C. macginleyi (2), C. minutissimum (1), C. pilosum (1), C. pseudotuberculosis (2), C. renale (2), C. striatum (2), C. urealyticum (3), C. xerosis (1), CDC coryneform groups B-1 (2), B-3 (2), F-1, genomospecies 1 and 2 (6), G, genomospecies 1 (1) and G, genomospecies 2 (2). The following strains or species could not be differentiated from each other; C. pseudodiphtheriticum (2) from C. propinquum (former CDC coryneform group ANF-3) (2), CDC coryneform group F-1, genomospecies 1 (4) from genomospecies 2 (2) and C. jeikeium genomospecies A (1) from genomospecies C (2). ARDRA may represent a possible alternative for identification of coryneforms, since this technique enabled the identification of most coryneforms tested and since DNA extraction ( i.e. cell lysis by boiling), amplification, restriction and electrophoresis can be carried out within 8 hours. This might allow quick identification of C. diphtheriae and other possible pathogens of the genus Corynebacterium .

We studied 12 coryneform isolates having similar biochemical profiles which did not permit their assignment to any recognized taxa. Human semen was the source for seven of these strains, whereas the other strains were isolated from urethra, urine, and blood specimens of adult male patients. These bacteria were found in significant quantities (10(4) to 10(5) CFU/ml) in semen specimens from infertile male patients with the diagnosis of prostatitis. These strains had characteristics of the genus Corynebacterium, such as 60 mol% G + C in the DNA and corynemycolic acids, meso-diaminopimelic acid, arabinose, and galactose in the cell wall. Quantitative DNA-DNA hybridizations (S1 nuclease procedure) and phylogenies based on comparisons of almost-complete small-subunit ribosomal DNA sequences confirmed that these strains constitute a single new species within the genus Corynebacterium. All 12 strains showed similar phenotypic features, i.e., good growth on sheep blood agar in contrast with poor growth on the same medium supplemented with 1% Tween 80, a positive CAMP test in the presence of Staphylococcus aureus, glucose and sucrose fermentation, and the presence of beta-glucuronidase. Some strains reduced nitrate and hydrolyzed urea or esculin. These features allowed us to distinguish these strains from members of any other coryneform taxon, and the proposed name is Corynebacterium seminale with strain IBS B12915 (CIP 104297) as the type strain. The description and delineation of these strains as a new species should be useful for further studies, including evaluations of their prevalence among the normal flora and their clinical implications.

The genus Gordona was proposed by Tsukamura in 1971 (M. Tsukamura, J. Gen. Microbiol. 68:15-24,1971) and was revived in 1988 by Stackebrandt et al. (E. Stackebrandt, J. Smida, and M. D. Collins, J. Gen. Appl. Microbiol. 34:341-348, 1988) to accommodate Rhodococcus species containing mycolic acids with 48 to 66 carbon atoms and MK-9(H2) as the predominant menaquinone type. On the basis of mycolic acid composition as determined by high-performance liquid chromatography, DNA-DNA similarity data (S1 nuclease procedure), and the rRNA gene restriction patterns of the type strains, we propose that Rhodococcus chubuensis Tsukamura 1982 is a subjective synonym of Gordona sputi (Tsukamura 1978) Stackebrandt 1989 comb. nov. We found that R. chubuensis type strain ATCC 33609, and G. sputi type strain ATCC 29627 exhibit identical mycolic acid profiles, 97% DNA relatedness (difference in thermal denaturation midpoints, 1.0°C), and similar ribotypes after PvuII endonuclease digestion. Thus, as defined by the type strains and considering the priority of the name G. sputi, these two species should be regarded as a single species named Gordona sputi; an emended description of this taxon is given.

Chemotaxonomic and genomic studies were performed on seven Corynebacterium group ANF-3 strains isolated from human sources. All these strains possess cell wall component type IV (meso-diaminopimelic acid, arabinose and galactose), corynemycolic acids and a G+C content of DNA of 57 to 59 mol%. These results confirm that they can be placed in the genus Corynebacterium. Six of these strains were found to constitute a tight hybridization group distinct from named Corynebacterium species or related organisms. This genomic group constitutes a new species which can be identified within the genus Corynebacterium by ribotyping or phenotypic tests and for which the name Corynebacterium propinquum is proposed. The type strain is strain B 77159 (= Collection of the Institut Pasteur CIP 103792).

A high-performance liquid chromatography (HPLC) study of 307 strains of Corynebacterium species and related taxa revealed that strains classified as "Corynebacterium aquaticum"; "Corynebacterium asperum"; and Centers for Disease Control (CDC) groups 1, 2, A-3, A-4, A-5, B-1, B-3, E, F-2, and I-2 as well as some unidentified coryneforms do not contain any corynomycolic acids; therefore, they should not be included in the genus Corynebacterium. Such an HPLC method of identification permitted the correct assignment to the genus Rhodococcus of two unpigmented strains of coryneform bacteria whose mycolic acid profiles were comparable to those of Rhodococcus equi. Bacteria belonging to CDC groups ANF-1, ANF-3, F-1, G-1, G-2, and I-1, as well as some other Corynebacterium sp. strains, yielded corynomycolic acid HPLC patterns related to those of Corynebacterium species. Either similarities or differences were observed in the corynomycolic acid profiles of Corynebacterium species tested after culture on sheep blood agar and/or sheep blood agar supplemented with Tween 80, which demonstrated that identification at the species or group level is possible. However, Corynebacterium striatum and CDC group I-1 bacteria as well as CDC group G-1 and group G-2 bacteria had indistinguishable HPLC patterns. Conversely, some variations were observed within some species as Corynebacterium xerosis, C. striatum, and Corynebacterium minutissimum. The evaluation procedure of this HPLC method by mass spectrometry analysis of isolated eluted peaks revealed that analytical reverse-phase HPLC alone does not provide any structural information, since isomers with identical polarities coeluted as a single peak. Nevertheless, HPLC is a rapid and reliable method for identification of corynomycolic acid-containing bacteria in the clinical microbiological laboratory.

Twenty-one Corynebacterium group D2 (“C. urealyticum” strains were found to constitute a tight DNA hybridization group distinct from named Corynebacterium species. The strains of Corynebacterium group D2 had cell wall component type IV, short chain mycolic acids and G+C content of DNA of 65–66 mol %. Corynebacterium group D2 constitutes a genomic species which can be identified by phenotypic tests.

During an 11-month prospective study, urine cultures were performed on 5685 samples obtained in three hospital units. The use of a selective medium improved the recovery of antibiotic-multiresistant corynebacteria (AMC): 703 isolates (12.4%) compared with 88 isolates (1.6%) on sheep blood agar. Corynebacterium group D2 (CGD2) was isolated in 80.5% of urines yielding greater than or equal to 10(5) AMC ml-1 whereas Corynebacterium jeikeium represented 80.2% of isolates with less than 10(5) AMC ml-1. Among 16 patients with greater than or equal to 10(5) ml-1 C. jeikeium none had signs of urinary tract infection. In contrast, among 56 patients with greater than or equal to 10(5) CGD2, 40 (71%) had abnormal urinary sediment (mainly apatite or struvite crystals) and 29 (52%) had clinical signs of urinary tract infections sometimes complicated by lithiasis (seven cases) and alkaline-encrusted cystitis (two cases).

Between 1st January 2005 and 31st December 2005, 232 strains of Streptococcus pneumoniae were collected in the Alsace county from participating laboratories (one from university hospital, 7 from general hospitals and 12 private laboratories) to assess their susceptibility to penicillin and evaluated serogroups of strains.The coordinating centre performed MICs by the reference agar dilution test, interpreted according to CA-SFM breakpoints. Others antibiotics (erythromycin, cotrimoxazole, tetracycline...) were tested by agar diffusion, ATB-PNEUMO gallery or VITEK gallery (BioMérieux, France) by each participating laboratory. Data were processed, using 4th dimension software.Strains were collected from 151 blood samples, 38 ear pus, 11 cerebrospinal fluids, 8 pleural liquids and 24 representative pulmonary samples. The prevalence of pneumococci with decreased susceptibility to penicillin G (PDSP) is 35.1% (pulmonary samples excluded). The rate of PNSP decreases for all types of samples compared with other years of surveillance 2003 (44.0%). The rate of blood samples decreases for first time between the creation of Pneumococcal Observatory. The high-level resistance tend to decrease and began low. The PDSP are rather resistant to erythromycin, cotrimoxazole and fosfomycin. Among the PDSP, the most prevalent serotypes were 14, 19, 6 and 9.Among pneumococcal strains, the rate of PDSP tend however to decrease in 2005 compared with 2003. The rate stays inferior to the observed rates in other French counties where the same decreasing is described.

Introduction Nous rapportons le cas d’une toxocarose revelee par des nodules pulmonaires excaves au scanner. Observation Une femme de 27 ans, d’origine caucasienne, se presentait a la consultation de medecine interne pour decouverte de micronodules pulmonaires dissemines, dont certains excaves, mis en evidence sur un examen scannographique. Elle avait en effet remarque une lesion nodulaire au niveau de son sein gauche depuis environ 4 ans, avec quelques fois un aspect inflammatoire de la peau et une exteriorisation purulente. Son medecin traitant avait demande une mammographie, interpretee comme normale, un bilan biologique qui retrouvait une hypereosinophilie a 1500/mm3 et une radiographie thoracique qui mettait en evidence un syndrome interstitiel micronodulaire bilateral. L’interrogatoire retrouvait un amaigrissement involontaire de 20 kg en deux ans, des episodes febriles intermittents depuis 6 mois, avec des pics jusqu’a 39 °C, des sueurs nocturnes, avec un etat general conserve. Une toux ancienne semblait par ailleurs persister. Il n’y avait pas de notion de voyage en zone tropicale. Elle avait travaille un an dans la marine, ou elle avait voyage en Ecosse uniquement. La patiente possedait en revanche un chat et un chien depuis plusieurs annees. Ses principaux antecedents comprenaient un tabagisme recemment sevre a 12 paquets-annees et une allergie aux acariens, phaneres d’animaux et pollens de gramines. L’examen clinique etait normal en dehors une lesion pigmentee centimetrique d’allure ancienne au niveau du sein gauche. Le bilan biologique etait marque par une hypereosinophilie (1,5 G/L), une elevation des IgE totales a 460 kUI/L. On ne notait pas de syndrome inflammatoire et l’electrophorese des proteines plasmatiques etait normale. Fonction renale et bilan hepatique etaient sans particularites. Le bilan auto-immun en particulier etait negatif, le dosage de l’enzyme de conversion de l’angiotensine normal. Les coprocultures bacteriennes et parasitaires (en particulier la recherche d’anguillules) etaient negatives. Les serologies parasitaires Toxocarose larva migrans (IFI A. Suum a 1/60, Western Blot T. canis positif), Trichinellose (IFI T. Spiralis a 1/60) et Ascaridose se revelaient positives (IFI sur A. suum a 1/60, Western Blot sur T. canis positif). Les serologies hydatidose, echinococcose alveolaire, Taenia saginata et T. anguillulose etaient negatives. L’echographie abdomino-pelvienne etait sans particularite. L’echographie des seins concluait a une mastodystrophie d’origine fonctionnelle. La biopsie cutanee de l’areole mammaire retrouvait un infiltrat inflammatoire non specifique sans arguments pour une lesion maligne. Le scanner thoracique sans injection mettait en evidence des micronodules dissemines intra-pulmonaires, predominant en peripherie, avec pour certains un aspect d’excavation, de l’ordre de 8 mm. Il n’y avait pas de lesions kystiques a paroi fine. Le lavage broncho-alveolaire retrouvait une flore normale, pas de bacilles acido-alcoolo-resistants ni d’histiocytes, et la culture (en particulier de mycobacteries, notamment atypiques) etait negative. Un traitement par albendazole per os administre empiriquement avant l’ensemble des resultats biologiques permettait tres rapidement une amelioration clinique, biologique et radiologique : dix jours plus tard, la patiente ne presentait plus aucun symptome. L’hypereosinophilie se normalisait et le scanner thoracique de controle a 3 mois etait strictement normal. Discussion Devant le tableau de granulomatose avec excavations pulmonaires, il n’etait aucunement evident d’evoquer le diagnostic de toxocarose. Il etait d’abord legitime d’eliminer une infection, et en particulier une mycobacteriose. Une histiocytose langerhansienne pulmonaire etait peu probable en l’absence d’images kystiques, et en presence de l’hypereosinophilie. Une maladie de Wegener etait peu probable en l’absence de signes extra-pulmonaires. Les metastases ne pouvaient etre exclues sans documentation histologique. Ici, le diagnostic de toxocarose a ete pose a posteriori sur la base de l’hypereosinophilie biologique, des lesions pulmonaires scannographiques (bien qu’atypiques), des serologies positives, de l’amelioration spectaculaire de la symptomatologie sous traitement anti-parasitaire, et de l’absence d’arguments pour un autre diagnostic. Conclusion La toxocarose peut etre revelee chez le sujet caucasien par un tableau pulmonaire avec des nodules excaves. Il est important de connaitre ce diagnostic peu frequent, car il est accessible a un traitement curatif rapidement efficace.

Introduction – objectifs Depuis l’an 2000, on note une resurgence de la syphilis qui pose des problemes diagnostiques et de sante publique. Nous avons etudie l’epidemiologie et le parcours de soins des patients atteints d’un hopital general dans le but d’une eventuelle optimisation. Materiels et methodes Etude retrospective de l’epidemiologie et du parcours de soins de soins des cas de syphilis adultes du 1 er janvier 2003 au 31 decembre 2012 d’un centre hospitalier regional alsacien identifies a partir des serologies syphilitiques positives, des donnees du PMSI et des dossiers medicaux hospitaliers. Resultats Sur 10 ans, on denombre 59 cas, 51 hommes pour 8 femmes, moyenne d’âge 45,4 ans. On assiste a une augmentation des cas a partir de 2006 jusqu’en 2010 (de 4 a 14) suivie d’une baisse (9 en 2012). Trente-deux patients etaient seropositifs VIH (54,2 %). Trente patients etaient homosexuels (50,9 %), 7 bisexuels (11,9 %) et 12 heterosexuels (20,3 %). On tend vers une diffusion aux personnes heterosexuelles (22,2 % en 2009–2012, 8,3 % en 2006–2008) et seronegatives VIH (44,4 % en 2009–2012, 16,7 % en 2006–2008). La syphilis etait primaire dans 8 cas (13,6 %), primo-secondaire dans 3 cas (5,1 %), secondaire dans 24 cas (40,7 %), latente precoce dans 6 cas (10,2 %), latente tardive dans 11 cas (18,6 %) et une neurosyphilis dans 7 cas (11,9 %). Une consultation a frequemment eu lieu en medecine generale, 30 cas sur 45 entre 2009 et 2012 (66,7 %), dont la majorite n’a pas abouti au diagnostic (23 soit 76,7 %). Conclusion La resurgence locale de la syphilis est confirmee avec une atteinte preferentielle de patients seropositifs VIH et/ou homo-bisexuels avec une preponderance de stades secondaires et latents. Il existe un manque de sensibilisation a cette pathologie en medecine generale qui peut s’expliquer par l’epidemiologie nouvelle, sa presentation et une meconnaissance de sa resurgence. Une optimisation de la prise en charge en ville est souhaitable.

The aim of the present work was to determine by blood culture the prevalence of blood infection with Bartonella species in a well-defined, European, urban stray cat population. Therefore, 94 stray cats were trapped from 10 cat colonies. Blood samples of these cats were cultured on both blood agar and liquid medium in order to raise the likelihood of bacterial detection. Fifty blood samples (53%) gave a positive culture result for Bartonella species. Isolate identification was performed by sequencing the first 430 bases of the 16S ribosomal DNA. Three types of sequences were thus obtained. The first type (17 isolates; 34%) was identical to that of B. henselae Houston-1 and the corresponding strains were referred as B. henselae type I. The second sequence type (18 isolates; 36%) was identical to that initially described as "BA-TF," and the corresponding strains were referred to as B. henselae type II. The third sequence type (15 isolates; 30%) was identical to that of the Bartonella clarridgeiae type strain (ATCC 51734). Our study points out the major role of stray cats as a reservoir of Bartonella spp. which can be transmitted to pet cats and, consequently, to humans. The study also highlights the high prevalence of B. clarridgeiae (16%) in the blood of stray cats.

We report a case of bacteremia due to a strain identified as Gordona sputi in a patient with metastatic melanoma. The origin of infection remains unknown, but extensive cutaneous lesions due to interleukin-2 treatment may have been the portal of entry. The isolate was related to G. sputi on the basis of its biochemical and genomic properties but exhibited some differences from the type strain.

Serum samples from 35 cat scratch disease (CSD) patients, 180 control patients (123 without lymph node enlargement and 57 with lymph node enlargement not evoking CSD), and 102 nonpatient subjects (35 with cat contact and 67 without cat contact) were tested by semiquantitative indirect immunofluorescence assay for the presence of antibodies directed to Afipia felis (ATCC 53690T) or Bartonella henselae (ATCC 49882T). The CSD group had statistically higher antibody titers against B. henselae than the control groups (P < 10(-5)), whereas no difference in A. felis antibody titers was evidenced among all groups tested. Among the 317 serum samples studied, the three with high A. felis antibody titers ( > or = 64) also had high antibody titers against other alpha-2 proteobacteria. The value of the indirect immunofluorescence assay with B. henselae antigen for the diagnosis of CSD was as follows: for a cutoff of 32, sensitivity was 0.80, specificity was 0.85, and the likelihood ratio was 5.1; for a cutoff of 64, the likelihood ratio was 12.1. In summary, in France, CSD is associated with high antibody titers against B. henselae, as previously described in the United States. However, the causes for B. henselae seronegativity in CSD patients and those for high antibody titers outside the typical nosological frame of CSD still have to be identified.

A new, well-documented case of Mycobacterium shimoidei infection is reported. This bacterium was isolated from a patient with preexisting pulmonary lesions who developed a tuberculosis-like cavity in the lung. Isolation of fewer than ten strains, not epidemiologically related, has been reported worldwide; all originated from human pulmonary samples. Identification of the strain described here was first accomplished by 16S rDNA direct sequencing after in vitro amplification. This method allows rapid identification of unusual bacteria. The identification was confirmed by specific phenotypical tests and by chromatographic methods.

Levels of genomic DNA relatedness were determined using a S1 nuclease procedure for reference bacteria identified as biotypes of Corynebacterium diphtheriae, biovars of Corynebacterium pseudotuberculosis, and 'Corynebacterium ulcerans'. These results showed that the three species are separate taxa at the genomospecies level whereas biotypes and biovars are closely related genomically within each species. Phylogenetic analyses of small-subunit rDNA sequences revealed that 'Corynebacterium ulcerans' forms a tight cluster with Corynebacterium pseudotuberculosis within the robust branch that groups all Corynebacterium sequenced to date. Therefore, we propose that the species incertae sedis 'C. ulcerans' should be conclusively recognized as a distinct species within the genus Corynebacterium with strain CCUG 2708 = NCTC 7910 as type strain. This species is characterized by urease production and fermentation of glycogen.

DNA relatedness experiments were performed with 38 clinical isolates and 13 reference strains of coryneform taxa exhibiting a lipid requirement for optimal growth. Forty-five of these strains split into five genomic groups at the species level, whereas six other strains remained unclustered. Genomospecies II fits Corynebacterium accolens, but the other genomospecies were not genetically related to any of the defined Corynebacterium species. Phylogenetic analyses of genes coding for small-subunit rRNA sequences revealed that two genomospecies (I and III) and C. accolens form a tight cluster within the robust branch that groups all Corynebacterium species presently sequenced. Reference strains of biotypes C-1, C-2, and C-3 of “Corynebacterium pseudogenitalium” were found to fall into genomospecies I, as well as “Corynebacterium tuberculostearicum,” Centers for Disease Control and Prevention (CDC) coryneform group G-1, and CDC coryneform group G-2 reference strains. Biochemical tests allowed differentiation between genomospecies except between genomospecies IV and V and between six unclustered strains and genomospecies I. We propose a new classification for these lipid-requiring diphtheroids within the genus Corynebacterium with the delineation of some CDC coryneform group G-1 strains (genomospecies III) as a new species for which the name Corynebacterium macginleyi is proposed. The type strain is strain JCL-2 (CIP 104099), isolated from a human corneal ulcer.

Levels of DNA relatedness were determined by performing DNA-DNA hybridization experiments (S1 nuclease procedure) with 13 human isolates exhibiting various antimicrobial susceptibility patterns which had been identified as Corynebacterium jeikeium by classical tests and the API Coryne system and with reference strains of C. jeikeium and related taxa. Twelve of 13 isolates which formed three genomic groups showed between 22 and 75% relatedness with the type strain of C. jeikeium. One of these genomic groups included all the strains resistant to penicillin and gentamicin and is genomically related to the C. jeikeium type strain at the species level. In addition, the reference strain of "Corynebacterium genitalium" biotype II was found to belong to this genospecies and therefore can be considered as a synonym of C. jeikeium. In contrast, one isolate and the reference strains of "Corynebacterium pseudogenitalium" biotypes C-3 and C-4 which were assigned to C. jeikeium by the API Coryne system were less than 10% related to the C. jeikeium type strain. These nongenomically related strains can be differentiated from the jeikeium-related strains on the basis of positive acidification from fructose and growth under anaerobic conditions. Furthermore, these strains exhibited full susceptibility to penicillin whereas the strains related to the C. jeikeium type strain are resistant to or only moderately susceptible to penicillin. No genomic relationship was found between C. jeikeium-related strains and other lipophilic coryneforms, identified as Corynebacterium accolens or Corynebacterium group G or F. Our study demonstrates the necessity to perform the fructose fermentation test or respiratory-type test for the correct identification of lipophilic coryneforms as C. jeikeium. Although these strains show genomic diversity at the species level, in a practical aspect, biochemical properties as well as antimicrobial susceptibility may allow the classification of such isolates in this single taxon.

Nineteen strains of facultatively anaerobic gram-positive rods isolated in pure culture from middle ear fluids were identified. All effusions were collected by tympanocentesis in children with acute otitis media. Identification of microorganisms to the genus level was done by studying the cell wall composition. Sixteen strains contain meso-diaminopimelic acid and arabinogalactan polymer but lack mycolic acids; therefore, these strains do not belong to a previously described taxon. Because of similarities with Corynebacterium afermentans (Centers for Disease Control group ANF-1), we temporarily classified these mycolateless strains ANF-1 like. Isolation of these microorganisms in pure culture from middle ear fluids collected by tympanocentesis is a strong argument for their involvement in acute otitis media.

We have determined the cell wall composition, guanine-plus-cytosine (G+C) contents of the DNA, rRNA gene restriction patterns, and the levels of DNA-DNA relatedness of 11 strains identified biochemically as Centers for Disease Control (CDC) Corynebacterium group absolute nonfermenter 1 (Corynebacterium group ANF-1). For seven of these strains, growth is abundant on 5% sheep blood agar, which differentiates them from the four other strains, whose growth requires a lipid supplement such as Tween 80. Two of the lipid-requiring strains produced mucoid colonies on 1% Tween 80-supplemented sheep blood agar. All strains possess cell wall component type IV, short-chain mycolic acids, and G+C contents of DNA of 66 to 68 mol% as determined by reverse-phase high-performance liquid chromatography. DNA-relatedness experiments by an S1 nuclease procedure showed that nine of these strains, including two of the lipid-requiring strains, constitute a new genomic species less than 40% related to Corynebacterium species and other coryneform groups. The lipid-requiring strain T18502 exhibited 98% DNA relatedness with another lipid-requiring strain, T88593 (difference in thermal denaturation midpoint [delta Tm] = 2 degrees C) and 71 to 77% similarity with the nonlipophilic strains (delta Tm range of from to 5 degrees C). Conversely, the DNA relatedness between strain LCDC 88199 and the six other nonlipophilic strains ranged from 86 to 100% (delta Tm range of from 1 to 3 degrees C) and was only 73 and 76% with the lipophilic strains T18502 and T88593, respectively (delta Tm, 3 and 4 degrees C). These results indicated that these two cultural types of bacteria constitute two subspecies within the new genomic species.(ABSTRACT TRUNCATED AT 250 WORDS)

Reverse-phase high-performance liquid chromatography of corynomycolic acids provided a specific pattern for each Corynebacterium species studied. These data suggest that a fast and reproducible procedure is now available for bacteriological identification at the genus and at the species level of corynomycolic-acid-containing bacteria. Mass spectrometry analysis of post-column collected fractions provided the order of elution of some corynomycolic acids and isomers and showed the high specificity of the chromatographic assay which could be used for the routine bacteriological identification of some species belonging to the genus Corynebacterium.

Rhodococcus equi is a pathogen for some animal species. It can cause opportunistic pulmonary infections in immunocompromised people. The authors describe such an infection that causes malacoplakia in a patient with acquired immunodeficiency syndrome. The likeness between lesions due to Rhodococcus equi and those due to other opportunistic germs as Mycobacterium avium-intracellulare is emphasized.

Introduction et objectifs Determiner la prevalence d’un deficit quantitatif en Ig lors d’infections invasives a germes encapsules. Materiels et methodes Etude prospective de janvier 2008 a janvier 2009 a l’hopital de Colmar. Critere d’inclusion – Toute infection invasive a pneumocoque ou HI (meningite, septicemie, pleuresie ou infection de liquide peritoneal). Critere d’exclusion : absence de determination du taux d’Ig serique. Resultats Entre janvier 2008 et janvier 2009, 43 patients ont presente une infection invasive a pneumocoque (40 cas) ou HI (3 cas). L’âge moyen etait de 58 ans (E 1 et 95 ans). Les infections incluaient 4 meningites, 2 endocardites, 2 infections de liquide peritoneal, 35 septicemies d’origine pulmonaire. Quinze patients ont ete exclus du fait de la non-determination du taux d’Ig. Parmi les 28 patients restants, 6 etaient des enfants. Aucun deficit en Ig n’a ete note chez eux. Chez les 22 adultes, le taux moyen d’IgG etait de 9,97 g/l [E 1,31-40,4], celui d’IgA de 2,62 g/l [E Conclusion Dans notre etude, une prevalence elevee de deficit en Ig est observee. Au cours d’infections invasives a pneumocoque ou HI, le dosage des Ig devrait etre systematiquement propose, particulierement chez l’adulte, attitude qui permettrait une prise en charge etiologique et preventive precoce.

Corynebacterium group D2 (CGD2) are lipophilic antibiotic-multiresistant bacteria involved in some infections of immunocompromised patients. The fatty acid composition and structure of different strains was established by several mass spectrometric methods, particularly negative ion tandem mass spectrometry coupled with capillary gas chromatography. Non-hydroxylated fatty acid profiles of three strains of CGD2 (ATCC 43042, ATCC 43043, ATCC 43044) were almost identical and revealed the presence of several straight chain unsaturated fatty acids from the omega-9 series, with even carbon numbers ranging from 14 to 24. Branched saturated fatty acids were mainly anteiso-heptadecanoic acid and tuberculostearic acid. Surprisingly, a relatively large quantity of 10-methylene octadecanoic acid was found. The non-hydroxylated fatty acid profile of one rare beta-lactam susceptible strain (SC1) was different; 10-methylene octadecanoic acid was lacking whereas tuberculostearic acid was much more abundant. In contrast, the four CGD2 strains displayed highly similar mycolic acid patterns. The major mycolic acid species corresponded to C32, C30 and C28 bis-unsaturated with a double bond on each branch at the omega-9 position. The comparison of the mycolic acid composition and structure with those of other medically important corynebacteria strains, revealed a characteristic pattern for CGD2 strains, and CGD2 strains were easily distinguished from Corynebacterium jeikeium (CIP 82.51).

Resume Les corynebacteries du groupe D2, caracterisees par une multi-resistance aux antibiotiques, ont ete recemment impliquees dans des infections urinaires en milieu hospitalier. Nous decrivons ici le premier cas d'endocardite survenu chez un sujet âge et immunodeprime dont la porte d'entree est vraisemblablement une cystite incrustante compliquee d'une pyelonephrite.

A new Corynebacterium species, Corynebacterium argentoratense was isolated from the throats of four human patients. It is characterized by the presence of chemotype IV, a cell wall, corynomycolic acids, and a G+C content ranging from 60 to 61 mol%. Strains belonging to this species exhibit high levels of DNA relatedness as determined by DNA-DNA hybridization experiments (S1 nuclease procedure) but no close DNA relatedness with related Corynebacterium species. Phylogenies based on comparative analyses of nearly complete small-subunit rDNA sequences confirmed the inclusion of this new species within the genus Corynebacterium and grouped it in a cluster with C. diphtheriae, C. ulcerans, C. pseudotuberculosis, and C. kutscheri. PCR experiments revealed an absence of the gene coding for diphtheria toxin. This new species can be identified by its mycolic acid pattern, fermentation of sugars, and enzymatic activities. Strain IBS B10697 (CIP 104296) is the type strain of C. argentoratense.