Search

Background Stenosis is the most common complication of Crohn's disease (CD). Imaging of the ileo-caecal junction is mainly based on endoscopy, ultrasound, CT-enteroclysis or entero-MRI. The aim was to evaluate the performance of digestive ultrasound in the monitoring of Crohn's disease.The purpose of this work is to show the performance of digestive ultrasound and fecal calprotectin in the monitoring of CD. We compared the results of digestive ultrasound, enteroscan or enteroIRM with endoscopy and biology Methods This is a prospective study including 42 patients, spanning between July 2021 and July 2022. Clinical, biological, radiological and endoscopic data were studied. Khi-2 test was used with a value of p Results We included 42 patients in our study, divided into 18 men 24 women (sex ratio M/F is 0.75), mean age was 43.2 years, with a CD of L1 or L3 location, according to the Montreal classification were prospectively included. The main risk factor found was smoking in 61.9% of patients. The majority of patients (80.95%, n = 34) had koenig syndrome. All patients underwent digestive ultrasound, CT-enteroclysis and colonoscopy with an average delay of 15 days between the examinations. Digestive ultrasound showed intestinal thickening in 85.71% (n=36), of the small intestines in 57.14% of patients and localized at the terminal ileum (21.42%). Loss of stratification was found in 40.47% of patients, ileo-caecal stenosis in 57.14%, a directed fistula in 23.80% of patients, a deep collection in 28.57% (n=10). The CT-enteroclysis showed stenosing thickening of the ileo-caecal junction in 66.67% (n=28), a deep collection in 38.09%, a combed aspect of the mesentery in 33.33% and intestinal thickening associated with a fistulous path in 35.71%. Colonoscopy was performed with catheterisation of the last ileal loop in the majority of patients (73.80%, n=31). It showed ulcerations in 88.09% (70.5% deep and 17.6% superficial) and a stenosis that could not be crossed by the colonoscope in 40.47% (n=17). The mean level of faecal calprotectin was 532.5 with a standard deviation of 265.1 reflecting moderate to severe disease activity. There was a correlation between ultrasound and endoscopy in 71.4% of cases (n=30). There was significant correlation between endoscopic and ultrasound inflammatory activity (p=0.01) and between the location of intestinal thickening and ulcerations on endoscopy (p=0.01). Conclusion Ultrasound is non-radiating, reproducible and available, coupled with fecal calprotectin constitutes an accessible and easy monitoring tool. Our preliminary results are satisfactory and the study is still in progress to confirm the interest of ultrasound in the follow-up of patients with CD.

Background Toxoplasmosis is a zoonosis caused by the protozoan Toxoplasma gondii. In immunocompetent patients the infection is usually benign. However, cases of severe and even lethal primo-infections are regularly reported in South America. In contrast, data from tropical Africa are fragmentary. Methods Data for French cases of severe toxoplasmosis acquired between 2013 and 2018, in tropical Africa and among immunocompetent patients were collected retrospectively in 2018. Results Four male patients with a mean age of 34-years were identified. All infections originated in West or Central Africa. The clinical presentations were heterogeneous: two patients had severe disseminated toxoplasmosis, of which one presented with chorioretinitis associated with myositis and the other with febrile pneumopathy; one patient presented with post-infectious acute cerebellar ataxia and the final case had general symptoms and skin manifestations. The diagnosis of acute toxoplasmosis was confirmed by serology in four patients. Molecular diagnosis confirmed T. gondii infection in three patients with Africa 1 as the dominant genotype. The infection was cured with anti-infective treatment in all four patients. Ocular sequelae were reported in the two patients with chorioretinitis. Conclusions Imported cases of severe toxoplasmosis in immunocompetent patients are rare in France. However, this aetiology should be evoked rapidly in a patient with a severe infectious syndrome who has recently visited or originated from tropical Africa.

In France, international adoption includes around to 90,000 children since 1980 and near 300,000 immigrant children were counted in 2008. This population is heterogeneous, according to age and country of origin, and its large number. It is not easy to completely and surely assess the vaccine status of the child. Due to a great variability of individual situations, it is not possible to have systematic and unchangeable rules. This article aims to give an update of catch-up vaccination of internationally adopted or refugee or migrant children in France. The vaccination status of a child who recently arrived in France is complex and has to be adapted to his country of origin. Some of them were never vaccinated whereas the vaccine status of others is uncertain or unknown. Three parameters have to be considered: the age of the child, the country of origin, and sometimes serology in the case of doubts of his vaccine status. Catch-up vaccination of foreign children has to be adapted to French vaccine recommendations, as a reference, and to vaccines already administered to the child.

Resume Introduction La cryptococcose est une infection fongique grave dont le facteur favorisant est l’immunodepression a mediation cellulaire. L’osteite a Cryptococcus neoformans est une infection rare qui survient dans la plupart des cas dans les formes disseminees. Observation Une patiente de 72 ans diabetique, traitee par fludarabine-cyclophosphamide-rituximab (depuis dix mois) pour une leucemie lymphocytique, presente une lesion lytique de la tete du quatrieme metacarpien de la main gauche dont l’examen anatomopathologique met en evidence C. neoformans . Cette atteinte osseuse est associee a une atteinte costale et a une cryptococcose pulmonaire, sans atteinte meningee. Un traitement est instaure par fluconazole par voie intraveineuse pendant 15 jours relaye par fluconazole per os pendant six mois avec une evolution clinique favorable. Ce cas decrit une presentation clinique inhabituelle de forme disseminee sans atteinte neuromeningee avec localisations osseuses multiples. Une revue de la litterature des cas de cryptococcose osseuse chez les sujets adultes de 2000 a 2011 est egalement realisee. Conclusion La cryptococcose osseuse est une infection rare dont les modalites therapeutiques ne font pas l’objet de recommandations. Elle doit apparaitre comme diagnostic differentiel dans le cadre de lesions osteolytiques atypiques.

International audience; Direct-Acting Antivirals (DAAs) opened a new era in HCV treatment. We report the impact of HCV treatment in French HIV-HCV coinfected patients. METHODS: All HIV-HCV patients from the Dat'AIDS cohort followed between 2012 and 2015 were included. HCV status was defined yearly as naive, spontaneous cure, sustained virological response (SVR12), failure or reinfection. RESULTS: Among 32,945 HIV-infected patients, 15.2% were positive for anti-HCV antibodies. From 2012 to 2015, HCV incidence rate increased from 0.35%PY to 0.69%PY in MSM, while median incidence was 0.08%PY in other patients. Median reinfection rate was 2.56%PY in MSM and 0.22%PY in other patients. HCV treatment initiation rate rose from 8.2% in 2012 to 29.6% (48.0% in pre-treated patients vs 22.6% in naïve patients). SVR12 rate increased from 68.7% to 95.2%. By the end of 2015, 62.7% of the patients were cured either spontaneously or following SVR. CONCLUSIONS: HCV treatment dramatically increased in HIV-HCV patients in France from 2012 to 2015 resulting in HCV cure in nearly two-thirds of the patients in this cohort. Combined with a declining HCV prevalence, the prevalence of active HCV infection among HIV patients will drastically decrease in the forthcoming years.

Resume L’infection a VIH est une maladie a declaration obligatoire depuis 2003 et les donnees epidemiologiques ainsi recueillies ne sont pas exhaustives et ne concernent pas la mise sous traitement antiretroviral. Objectif et methode L’objectif de cette etude observationnelle retrospective declarative etait d’etudier l’evolution epidemiologique des nouvelles seropositivites diagnostiquees entre le 1er javvier 2000 et le 31 decembre 2007 dans les centres hospitaliers volontaires du Nord et l’Est de la France, la comparer aux donnees regionales et nationales, de completer les donnees de la declaration obligatoire notamment en ce qui concerne le traitement antiretroviral. Resultats Au total, 3030 questionnaires ont ete exploites. Entre 2000 et 2007, les principales tendances sont comparables a celles observees au niveau national : diminution du nombre de femmes, de personnes d’origine etrangere et de la proportion de patients decouverts avec un retard au diagnostic, augmentation du nombre de patients diagnostiques au stade de primo-infection et taux de CD4 plus eleves a la mise sous traitement antiretroviral. Cependant, des specificites locales apparaissent : proportion plus importante de patients contamines par voie homo/bisexuelle, proportion de patients co-infectes par les virus des hepatites moins importantes qu’au niveau national. Les prises en charge therapeutiques respectent les recommandations des experts, avec cependant un « effet centre » marque concernant les habitudes de prescription. Discussion Une telle etude epidemiologique locale, meme si elle confirme les principales tendances observees aux niveaux national et regional, devra permettre de les affiner, et proposer des mesures de prevention et de depistage plus specifiquement adaptees aux realites locales.

Introduction There are insufficient data regarding the efficacy and safety of vaccination in patients with auto-immune disease (AID) and/or drug-related immune deficiency (DRID). The objective of this study was to obtain professional agreement on vaccine practices in these patients. Methods A Delphi survey was carried out with physicians recognised for their expertise in vaccinology and/or the caring for adult patients with AID and/or DRID. For each proposed vaccination practice, the experts’ opinion and level of agreement were evaluated. Results The proposals relating to patients with AID specified: the absence of risk of AID relapse following vaccination; the possibility of administering live virus vaccines (LVV) to patients not receiving immunosuppressants; the pertinence of determining protective antibody titre before vaccination; the absence of need for specific monitoring following the vaccination. The proposals relating to patients with DRID specified that a 3–6 month delay is needed between the end of these treatments and the vaccination with LVV. There is no contraindication to administering LVV in patients receiving systemic corticosteroids prescribed for less than two weeks, regardless of their dose, or at a daily dose not exceeding 10 mg of prednisone, if this involves prolonged treatment. Out of 14 proposals, the level of agreement between the experts was “very good” for eleven, and “good” for the remaining three. Conclusion Proposals for vaccine practices in patients with AID and/or DRID should aid with decision-making in daily medical practice and provide better vaccine coverage for these patients.

Resume Objectif Une revue de la litterature a ete realisee, afin de repondre a la question suivante : existe-t-il des differences d’immunogenicite et de tolerance des vaccins en fonction de leur voie d’administration (intramusculaire ou sous-cutanee) et de la longueur de l’aiguille utilisee pour l’injection ? Methodes La strategie de recherche des articles comprenait une recherche electronique (base de donnees Medline via PubMed) et une recherche des references croisees. La selection des articles etait basee sur la lecture des resumes. Au total, 18 articles ont ete retenus et analyses ; 13 repondaient a la question posee. Resultats Neuf articles comparaient l’immunogenicite et/ou la tolerance d’un meme vaccin administre par voies intramusculaire et sous-cutanee. Tous les resultats montraient que l’immunogenicite et la tolerance systemique vaccinale etaient au moins aussi bonnes apres administration par voie intramusculaire que sous-cutanee. La tolerance locale etait meilleure par voie intramusculaire (risque moindre de developper un erytheme ou un œdeme). Quatre articles comparaient l’immunogenicite et la tolerance de vaccins administres par voie intramusculaire avec des aiguilles courtes (16 mm) ou longues (25 mm) chez les enfants. Les aiguilles longues induisaient moins de reactions locales, probablement parce qu’elles permettent d’atteindre le muscle plus vascularise, notamment chez les individus en surpoids ou obeses. Conclusions Les resultats d’immunogenicite et de tolerance sont en faveur de la vaccination par voie intramusculaire. La longueur de l’aiguille est a adapter a la morphologie (profondeur de la couche musculaire) de l’individu.

Hepatitis B is the most known viral hepatitis, and often turns into a media event in France. Its prevalence and incidence depend on countries, regions, and their inhabitants. The virus is highly infectious with a high genomic variability. Its immune reaction and pathology seem complex, but the latest consensus conferences gave a practical management. If Papillomavirus vaccine is ready and coming soon as the second STD vaccine, hepatitis B vaccine is available since 1982, and used with a real success. Fighting hepatitis B is to continue all together to immunize children and babies born from infected mothers, to adopt universal health workers precautions, to educate and modify high risk behaviours, to treat and prevent hepatitis B complications and superinfections, and finally to monitor and detect any resistant hepatitis B strain.

Resume La variabilite genomique du virus de l'hepatite B (VHB) est un mecanisme complexe qui assure le maintien de la stabilite de l'information genetique. Le genome du VHB est un ADN utilisant un ARN comme intermediaire. Au cours de sa replication, il se trouve ainsi, comme les virus a ARN, soumis a de nombreuses erreurs de copies ; cela fait du VHB le plus mutable des virus avec une exposition particuliere a differentes pressions selectives. Les consequences virologiques communes de la variabilite genomique sont connues. Ainsi, des virus distincts par 5 a 10 % de variation sont definis par des genotypes (A a H, etc.), et des mutants pre-C sont induits par mutation du codon stop. Le retentissement epidemioclinique de ce processus dynamique requiert une surveillance temporelle et geographique constante. Les consequences cliniques sur la variabilite genomique ont alerte le monde medical et de la recherche depuis le traitement des VHB chroniques par la lamivudine (1er anti-VHB), et la detection rapide de mutants dans le gene Pol. Cette pression de selection therapeutique preoccupe toujours et s'etend aux plus recentes molecules, imposant des strategies d'epargne ou d'association d'emblee des antiviraux. Par ailleurs, des mutants d'enveloppe ou de surface sont de plus en plus decrits chez les patients transplantes hepatiques et les nouveau-nes de meres VHB positives et, plus particulierement, ceux ayant recu une prophylaxie post-exposition VHB par immunoglobulines et vaccin anti-VHB. Ces mutants echappant a la vaccination actuelle incitent a la vigilance dans les pays de haute prevalence. Sans mettre en cause l'efficacite indeniable du vaccin VHB actuel, les reflexions sont orientees sur un vaccin plus adapte pour la post-exposition VHB.

Resume La caspofungine est un antifongique systemique, disponible uniquement par voie IV, appartenant a une nouvelle famille d’antifongiques, les echinocandines. Son spectre d’efficacite comprend la plupart des Candida spp. (y compris ceux ayant une resistance acquise ou intrinseque aux azoles) et la plupart des Aspergillus spp. Actuellement, en France, ses indications « officielles » sont limitees au traitement des candidoses invasives de l’adulte non neutropenique et a celui de l’aspergillose invasive des adultes, refractaires ou intolerants a l’amphotericine B, a ses formulations lipidiques ou a l’itraconazole. Au vu des donnees cliniques recentes, il est vraisemblable que cet antifongique devienne l’un des traitements de reference des candidemies, notamment chez les patients pour lesquels la souche de Candida spp. presente une resistance potentielle au fluconazole, voire des aspergilloses invasives extensives ou bilaterales des neutropeniques, en association avec le voriconazole ou les formulations lipidiques d’amphotericine B. Enfin, son interet pour le traitement antifongique empirique des neutropenies febriles vient d’etre souligne. La caspofungine pourrait ainsi devenir une alternative aux formulations lipidiques d’amphotericine B dans cette indication.

Resumen Toxoplasma gondii fue descubierto en 1908 simultaneamente por Nicolle y Manceaux, en Tunez, en Ctenodactylus gondii, y por Splendore en el conejo en Brasil. En 7923 janku encontro Toxoplasma gondii en los quistes retinionos de un nino hidrocefalico. En 1937, Wolf y Gowen comunicaron el primer caso de toxoplasmosis congenita humana y posteriormente Sabin describio los signos de la primoinfeccion humana. Los primeros estudios inmunoepidemiologicos comenzaron con la prueba de la lisis de Sabin y Feldman. La presentacion de la inmunofluorescencia indirecta en 1957 por Goldman y Kelen ha facilitado la cuantificacion de los anticuerpos especificos. Desmonts confirmo en 1965 el papel de la carne en la transmision humana. En 1970 Hutchison demostro la importancia epidemiologica del gato y la reproduccion sexual de T. gondii en el intestino delgado de este animal. Desde entonces, los enormes avances en el diagnostico inmunologico y parasitologico han permitido precisar la epidemiologia y la evolucion clinica segun el terreno. Las dos ultimas decadas se han distinguido por la preocupacion por controlar la transmision maternofetal. Ademas, la frecuencia de las inmunodepresiones ha obligado a mejorar el diagnostico precoz, el tratamiento curativo y la prevencion primaria y secundaria de la toxoplasmosis de reactivacion.

BACKGROUND Prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV) is usually based on zidovudine-containing regimens, despite potential toxicities. This multicenter trial evaluated whether lopinavir/ritonavir (LPV/r) monotherapy in HIV type 1-infected women not requiring antiretrovirals for themselves could control maternal viral load (VL). METHODS Overall, 105 pregnant women with baseline VL

In France, international adoption includes around to 90,000 children since 1980 and near 300,000 immigrant children were counted in 2008. This population is heterogeneous, according to age and country of origin, and its large number. It is not easy to completely and surely assess the vaccine status of the child. Due to a great variability of individual situations, it is not possible to have systematic and unchangeable rules. This article aims to give an update of catch-up vaccination of internationally adopted or refugee or migrant children in France. The vaccination status of a child who recently arrived in France is complex and has to be adapted to his country of origin. Some of them were never vaccinated whereas the vaccine status of others is uncertain or unknown. Three parameters have to be considered: the age of the child, the country of origin, and sometimes serology in the case of doubts of his vaccine status. Catch-up vaccination of foreign children has to be adapted to French vaccine recommendations, as a reference, and to vaccines already administered to the child.

Cryptococcosis is a serious invasive fungal infection mostly described in patients with cell-mediated immunosuppression. Cryptococcus neoformans osteomyelitis is a rare infection that occurs mainly during disseminated forms.A 72-year-old diabetic patient, treated with fludarabine-cyclophosphamide-rituximab (since 10 months) for lymphocytic leukemia presented with osteolysis of the fourth left hand metacarpien the histological examination of which revealed C. neoformans. This bone involvement was associated with costal osteolytis and pulmonary cryptococcosis but central nervous system (CNS) was spared. Fluconazole was administered intravenously for 15 days, then switched to oral route for 6 months with favorable clinical course. This case describes an unusual clinical presentation of disseminated cryptococcosis without CNS involvement with multiple osseous metastases. A review of cryptococcal osteomyelitis cases reported in adult from 2000 to 2011 is also discussed.Cryptococcosis is a rare infection that should be discussed in seriously immunocompromized patients presenting with osteomyelitis even in the absence of CNS involvement.

Resume Afin de documenter la frequence, la presentation et le devenir des infections bacteriennes chez les patients infectes par le VIH, une analyse retrospective des dossiers de 882 patients hospitalises de janvier 1985 a decembre 1992 a ete realisee. Cent quatre-vingt (21,4 %) patients ont presente 203 episodes. Les principales infections etaient : voies respiratoires inferieures (74), septicemies (31), sinusites (28), mycobacteries (21), meningites (7), abces et cellulite (7), genito-urinaires (7), angines et otites (6), diverses (15). Cent-cinquante-trois pathogenes ont ete isoles : S. pneumoniae (40), S. aureus (22), Mycobacterium Sp. (21), P. aeruginosa (15), E. coli (13), H. influenzae (11), Salmonella Sp. (7), Streptococcus Sp. (7), KES (6), S. epidermidis (3), Acinetobacter Sp. (3), divers (5). S. pneumoniae et H. influenzae etaient les germes le plus souvent isoles des infections pulmonaires. Soixante-treize pour cent des infections etaient communautaires. 68,4 % des patients avaient des CD4

To study the polymerase chain reaction (PCR) performance in detecting human immunodeficiency virus (HIV) infections, we tested 53 HIV-1 seropositive patients and 29 HIV-1 seronegative subjects for four different HIV-1 DNA regions. Fifty-one seropositive patients were found positive by PCR with at least one primer pair, but two were repeatedly negative for all primers. Weekly blood samples from 12 seropositive subjects all detected positive for at least one primer pair, but for three patients an irregular primer detection pattern was found. One additional HIV-1 seropositive sample, found negative for HIV DNA, was also negative for the beta-globin PCR control. The 29 seronegative specimens were HIV-1 DNA negative, as was a HIV-2 seropositive patient. This study demonstrates that PCR is almost as good as serological tests for detecting HIV infections, with a specificity of 100% and a sensitivity of 96% and that resampling the patients may improve detection performance.

Resume Les progres diagnostiques de la toxoplasmose evolutive au cours de la grossesse et de la toxoplasmose congenitale permettent, ces dernieres annees, la mise en route d'un traitement precoce, avec des protocoles adaptes et une surveillance constante et prolongee. Les techniques sont fiables et assurent actuellement, d'une part, la detection precoce d'une synthese foetale d'immunoglobulines specifiques de Toxoplasma gondii et, d'autre part, la mise en evidence du parasite par culture in vitro et par amplification enzymatique. La therapeutique classique par spiramycine peut prevenir l'atteinte congenitale, mais doit faire place aux medications plus efficaces des la suspicion de foetopathie. Les travaux experimentaux et les constatations cliniques ont contribue a une meilleure connaissance des proprietes pharmacocinetiques, de l'activite et des interactions des molecules antitoxoplasmiques. Les auteurs rappellent l'importance du depistage de la toxoplasmose materno-foetale et proposent une mise au point sur l'indication des molecules, classiques et recentes.

Resume Les germes a developpement intra-cellulaire responsables de pneumonies sont inhibes, in vitro, a des degres variables, en fonction des souches et des antibiotiques testes. Les macrolides, la rifampicine, les quinolones atteignent des taux eleves au niveau des voies respiratoires inferieures, qui peuvent egaler ou depasser les concentrations seriques et ont une excellente penetration intra-cellulaire. L'efficacite des macrolides, des cyclines, de la rifampicine et des quinolones dans le traitement de ce type de pneumonie a ete demontree in vitro, par les modeles d'infection intra-cellulaire, et/ou in vivo, par les modeles animaux. Macrolides et cyclines constituent les molecules de reference de ce type d'infection pour la majorite des auteurs. Mais l'efficacite et la securite d'emploi des quinolones font de ces dernieres une alternative therapeutique particulierement interessante.

In France, since 2003, all new HIV infection must be reported. Data collected with the declaration system is not exhaustive and only concerns epidemiological data.The authors' aim was to study the epidemiologic evolution of new HIV cases between January 1, 2000 and December 31, 2007 in North and East of France, to compare them with national and local data, to complete them, and to identify local specificities.A retrospective observational study was made, with a standardized questionnaire completed by any volunteer HIV care center in the North and the East of France.Three thousand and thirty questionnaires were analyzed. The main trends over these eight years were similar to those observed in the rest of France: a decreasing number of women and patients of foreign origin, a decreasing number of patients with a late diagnosis, an increasing number of primary infections, and a higher CD4 count on initiation of antiretroviral treatment. However, local specificities appeared, such as: increasing proportion of men having sex with men and a less important proportion of co-infected patients with hepatitis B and/or C than on the national level. The therapeutic regimen is adequate according to expert recommendations, with, however, a marked "center effect" concerning prescription habits.Such a local epidemiological study, even if it confirms observed trends in the rest of France, allows detailing them and suggesting prevention measures more specifically adapted to local settings.

Resume La signification clinique de l'infection par le complexe Mycobacterium avium intracellulare chez les patients atteints de SIDA n'est pas claire. Cette infection survient tardivement dans l'evolution de l'infection a VIH et les symptomes qui lui sont attribues sont nombreux et peu specifiques. Les prelevements biopsiques revelent une reaction inflammatoire moderee, un grand nombre de germes et des granulomes quand ils existent, sont incompletement formes.

A literature review was made to answer the following question: are there differences in immunogenicity and safety of vaccines according to the administration route (intramuscular or subcutaneous) and the length of needles used for injection?The search strategy included electronic searching (Medline database via PubMed) and cross-references. Articles were selected by reading abstracts, guided by the clinical question. A total of 18 articles were selected and analyzed; 13 answered the question.Nine articles compared the immunogenicity and/or the safety of a given vaccine administered via both intramuscular and subcutaneous routes. All the results showed that immunogenicity and systemic safety of the intramuscular route was at least as good as that of the subcutaneous route. Local tolerance was usually better via intramuscular route (lower risk of developing erythema or edema). Four articles compared the immunogenicity and the safety of vaccines administered with short (16mm) and long (25mm) needles in children. Long needles induced fewer local reactions, probably because they can reach more vascularized muscle, especially in overweight and obese patients.Immunogenicity and safety results are in favor of intramuscular vaccination. The appropriate needle length must to be adapted according to the morphological aspects (subcutaneous tissue and muscle thickness).

Resume L'incidence de la toxoplasmose animale sur la prevalence toxoplasmique humaine est peu connue au Portugal. Les auteurs ont etudie des animaux (bovides et porcs) destines a la consommation dans la region de Porto. Les prelevements, effectues aux abattoirs, ont permis de rechercher une reponse humorale et de mettre en evidence le parasite par immunofluorescence directe et inoculation a la souris. Les resultats notent une prevalence bovine de 43 % et porcine de 4 %. L'analyse de la contamination des animaux retient l'absence d'isolement de toxoplasme chez les bovides et la presence de kystes infestants dans les fragments de visceres et de muscles des porcs. La viande de porc, riche en toxoplasmes, expose au risque d'infestation du consommateur. La viande bovine n'aurait pas d'incidence sur la toxoplasmose humaine.

Resume Une dizaine d'observations d'anevrysmes arteriels cerebraux a Aspergillus fumigatus figurent dans la litterature. Nous rapportons ici le cas d'un patient immunodeprime presentant un anevrysme aspergillaire de l'artere sylvienne au cours d'une aspergillose pulmonaire.

The usual presentation of secondary syphilis is with cutaneous and mucosal symptoms. However, systematic symptoms can also occur. The purpose of this study was to describe non-mucocutaneous manifestations of secondary syphilis.Patients from the Infectious Diseases Department of Tourcoing Hospital in whom secondary syphilis was diagnosed between January 2000 and December 2006 were enrolled in this study. Patients with secondary syphilis had the typical cutaneous and mucosal symptoms and a VDRLgreater than or equal to one quarter (or a fourfold increase in the VDRL if previously positive).Seventy-seven patients presenting a total of 80 cases of secondary syphilis were enrolled, 50 of whom were HIV-positive. Of these patients, 21 (26.3 p. 100) had neurological symptoms with three cases (3.8 p. 100) of uveitis, four (5 p. 100) of papillitis, two (2.5 p. 100) of retinitis and one (1.25 p. 100) of otosyphilis. In 14 of these 21 patients (67 p. 100), lumbar puncture was performed, confirming the diagnosis of neurosyphilis in six cases. Three patients (3.8 p. 100) had diarrhoea, four (5 p. 100) had abdominal pain and six (7.5 p. 100) had hepatomegaly. Seven (11.5 p. 100) patients had alanine aminotransferase levels above twice the normal upper limit and two above 10 times the normal upper limit. Three patients had bone pain and in one patient, osteitis was confirmed by technetium and gallium scintigraphy (osteolysis).In patients with secondary syphilis, clinicians should search for non-mucocutaneous symptoms. In the presence of these symptoms, appropriate syphilis treatment should be initiated.

We developed and evaluated a PCR-based assay to detect four Plasmodium species in 79 blood samples from 56 travelers returning from areas where malaria is endemic. DNA amplification targeting a small region of the 18S rRNA gene was performed with Plasmodium genus-specific primers. The biotinylated PCR products were then identified by PCR-colorimetric Covalink NH microwell plate hybridization (CMPH) using species-specific phosphorylated probes covalently bound to a pretreated polystyrene surface. The results from PCR-CMPH showed high specificity, and for 47 of the 56 patients (84%), microscopy and PCR-CMPH results were in agreement. Discordant results were reevaluated with microscopy examination, other molecular methods, and DNA sequencing. Except for one patient, discrepancies were resolved in favor of PCR-CMPH: three mixed infections were detected, four species identification errors were corrected, and two negative results were shown to be positive. Our results indicate that PCR-CMPH is a simple, rapid, and specific method for malaria diagnosis. It employs stable reagents and inexpensive equipment, making it suitable for routine epidemiological use.

Hepatitis B is the most known viral hepatitis, and often turns into a media event in France. Its prevalence and incidence depend on countries, regions, and their inhabitants. The virus is highly infectious with a high genomic variability. Its immune reaction and pathology seem complex, but the latest consensus conferences gave a practical management. If Papillomavirus vaccine is ready and coming soon as the second STD vaccine, hepatitis B vaccine is available since 1982, and used with a real success. Fighting hepatitis B is to continue all together to immunize children and babies born from infected mothers, to adopt universal health workers precautions, to educate and modify high risk behaviours, to treat and prevent hepatitis B complications and superinfections, and finally to monitor and detect any resistant hepatitis B strain.

In April 2002, five cases of fascioliasis were diagnosed in Tourcoing. A case-finding and a case-control study were carried out to identify the source of the outbreak and take appropriate control measures. Eighteen cases were identified through the medical laboratories carrying out serology for fascioliasis. Fourteen cases and 23 controls, identified by the physicians of the cases, were interviewed on symptoms of the disease and their consumption of uncooked plants. Cases were more likely than controls to have eaten commercialized raw watercress (OR 86·7, PLymnaea truncatula. This outbreak of fascioliasis due to commercialized watercress indicates that actual sanitary regulations do not allow for the efficient prevention of infestation of watercress production in France.

Propionibacterium acnes is a common skin colonizer. Its involvement in brain abscesses is generally described as a complication of neurosurgical intervention. Propionibacterium acnes is susceptible to antibiotics used as treatment of anaerobic infections, except for the 5-nitroimidazoles. Surgical excision or drainage of a simple abscess combined with a long course of antibiotics is considered the treatment of choice. A case of a patient with multiple brain abscesses located in the right temporal lobe that occurred after the manipulation of an abscess of the right upper maxillary is reported. The patient did not improve despite a prolonged course of high-dose intravenous penicillin plus thiamphenicol, and cure was finally obtained after the excision of the right temporal lobe. Culture of the purulent material and the shell of the abscesses yielded P. acnes which was sensitive to all the antibiotics administered to the patient up to the intervention. The temporal lobectomy was followed by a 6-month course of ofloxacin. One year after the intervention, the patient remained apyretic without any other abscess on cranial computed tomography scan.

Manifestations similar to DRESS syndrome (drug rash with eosinophilia and systemic symptoms) may be induced by nevirapine.Three patients developed skin rash and general signs of liver dysfunction during the first 5 weeks after starting nevirapine. Laboratory tests showed elevated eosinophil counts and signs of inflammation simulating severe infection.The incidence of DRESS syndrome is probably underestimated. No standard treatment has been proposed. In our 3 patients, parenteral corticosteroid therapy was successful, leading to a rapidly favorable clinical course although liver tests took longer to return to normal.

Twenty nine cases of central nervous system infection due to Monosporium apiospermum have been reported. Six of them occurred after an aspiration pneumonia following a near drowning. The case of a 53 year old man is reported: M apiospermum was isolated from cerebrospinal fluid, sputum, urine and from the mud of the ditch where the patient had fallen. Though the treatment used recommended doses of intravenous, intrathecal and intraventricular amphotericin B, it was ineffective and the patient died 97 days after the near drowning. Necropsy showed that the ventricular infectious process was more prominent distant from the antifungal ventricular source.

The ParaSight F is a new diagnostic test for Plasmodium falciparum infections and is based on the detection of a trophozoite-derived antigen, the histidine rich protein II (HRP-II). To assess the usefulness of this test, we conducted a prospective study and analyzed 62 blood specimens from 38 patients, using thin blood films, thick blood films and the ParaSight F test. Compared to thick blood film, on samples taken before and during treatment, the ParaSight F test had 86.4% sensitivity and 100% specificity. In 31.5% of P. falciparum infected patients, parasitemia was lower than 1 parasite/1000 red blood cells, with all specimens being positive by the ParaSight F test. In 15 cases, specimens were negative by thin blood film, but were positive by thick blood film and by the ParaSight F test. Two patients had, after their treatment was started, positive results by ParaSight F and negative results by thick blood film. Cross-reactivity occurred neither with other Plasmodium species, nor in cases of severe inflammatory syndrome. Persistence of antigenemia was monitored in 14 patients receiving quinine. At day five of treatment, antigenemia persisted in seven patients. In conclusion, the ParaSight F test does not allow following up the efficacy of treatment, identifying other Plasmodium species, or assessing parasitemia. However, because this test is easy to perform and has good sensitivity and specificity, it is a useful tool in emergent context, in cases of parasitemia lower than the thin blood film threshold, and in cases morphologically difficult to decipher.

The pharmacokinetics of itraconazole formulated in a hydroxypropyl-beta-cyclodextrin oral solution was determined for two groups of human immunodeficiency virus (HIV)-infected adults with oral candidiasis (group A, 12 patients with CD4+ T-cell count of >200/mm3 and no AIDS, and group B, 11 patients with CD4+ T-cell count of 250 ng/ml) was reached at day 4. At day 14, Cmin values of itraconazole were 643 +/- 304 and 592 +/- 401 ng/ml for groups A and B, respectively, and Cmin values of hydroxyitraconazole were 1,411 +/- 594 and 1,389 +/- 804 ng/ml for groups A and B, respectively. In saliva, only unchanged itraconazole was detected, and mean concentrations were still high (>250 ng/ml) 4 h after the intake, which may contribute to the fast clinical response. In conclusion, the oral solution of itraconazole generates effective levels in plasma and saliva in HIV-infected patients; its relative bioavailability is not modified by the stage of HIV infection.

Procalcitonin (ProCT) is a recently described marker of severe sepsis. It was decided to assess the value of proCT as a marker of secondary infection in patients infected with HIV-1. ProCT plasma levels were measured by immunoluminometric assay in a prospective study in 155 HIV-infected individuals: 102 asymptomatic and 53 with fever or suspected secondary infections. The baseline plasma level of ProCT was low (0.5 ng/ml ± 0.37), even in the latest stages of the disease, and did not differ from the values of healthy subjects (0.54 ng/ml ± 0.08). EDTA-treated whole blood was collected from patients before starting specific antimicrobial therapy. No elevation of ProCT level was detected in HIV-infected patients with evolving secondary infections including PCP ( n = 4), cerebral toxoplasmosis ( n = 4), viral infections ( n = 9), mycobacterial infections ( n = 5), localized bacterial ( n = 12) and fungal infections ( n = 4), malignancies ( n = 3), and in various associated infectious and non-infectious febrile events ( n = 13). All these plasma values were lower than 2.1 ng/ml. In contrast, high ProCT plasma levels were detected in one HIV-infected patient with a septicaemic Haemophilus influenzae infection (16.5 ng/ml) and another one with a septicaemic Pseudomonas aeruginosa infection (44.1 ng/ml). ProCT values decreased rapidly under appropriate therapy. ProCT seems to be a specific marker of bacterial sepsis in HIV-infected patients, as no increase in other secondary infections could be detected in those patients. A rapid determination of ProCT level could be useful to confirm or refute bacterial sepsis for a better management of febrile HIV-infected patients.