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Resume Les infections rachidiennes a Candida albicans demeurent rares malgre l'incidence croissante des candidemies. Leur therapeutique est mal definie, dans la mesure ou elle n'a pas fait l'objet d'essais controles. Nous rapportons deux nouvelles observations, dont une sacro-iliite. Leur traitement a comporte l'association amphotericine B-flucytosine, seule dans un cas (doses totales de 2,3 g et 900 g) sur une duree de 3 mois. Dans l'autre observation, l'association amphotericine B-flucytosine (doses totales de 5,4 g et 3 780 g) est associee a l'itraconazole (dose totale de 12 g), avec un relais par le fluconazole (dose totale de 216 g); la duree du traitement est de 14 mois. Le traitement des infections rachidiennes a Candida albicans peut faire appel a l'amphotericine B, a la flucytosine et aux derives azoles. Les donnees pharmacocinetiques dans l'os sont precisees pour la flucytosine et le fluconazole. Pour ce dernier, une posologie de 600 a 800 mg/j est preferable chez l'adulte. L'analyse des cas rapportes, confrontee aux donnees pharmacocinetiques, permet de discerner deux modalites therapeutiques. L'une utilise l'amphotericine B (dose totale minimale de 1,5 g), seule ou en association avec la flucytosine; cette derniere ne doit pas etre utilisee en monotherapie. L'autre utilise un azole, principalement le fluconazole pour une duree arbitraire de 3 mois au moins. Le clinicien doit se montrer vigilant vis-a-vis des complications osteo-articulaires, parfois tardives, des candidemies. L'une de nos observations illustre combien la sterilisation d'une metastase septique osteo-articulaire est problematique lors d'une candidemie. Une forte posologie (600 a 800 mg/j chez l'adulte) du fluconazole est a proposer dans les essais therapeutiques ulterieurs concernant les candidemies.

Resume Vingt-deux cas de malades, adultes, admis pour une listeriose neuromeningee sur une periode de 11 ans, sont rapportes. Une immunodepression a ete retrouvee dans cinq cas. Dix patients sur 22 ont eu une atteinte des nerfs crâniens et neuf ont presente d'autres signes neurologiques de localisation. L'etude du LCR a montre une proteinorachie moyenne a 1,92 g/l avec 455 elements blancs par ml dont 50 ± 25 p. cent de lymphocyte. L. monocytogenes a ete isolee dans le sang et le LCR dans 12 cas, seulement dans le LCR dans neuf cas et exclusivement dans le sang dans un cas. La mise en route d'un traitement adapte est effectuee 4,4 ± 3,8 jours apres le debut de la symptomatologie. Les patients ont ete traites par une aminopenicilline dans 18 cas, en monotherapie trois fois, associe a la rifampicine sept fois, aux tetracyclines sept fois et aux aminosides une fois. L'association trimethoprime-sulfamethoxazole a ete utilisee dans quatre cas, une fois en monotherapie et trois fois associee a la rifampicine. Deux patients sur vingt-deux sont decedes et cinq ont garde des sequelles neurologiques. La faible mortalite relevee dans cette serie pourrait etre en relation avec la strategie therapeutique qui privilegie la diffusion des antibiotiques plutot que les donnees bacteriologiques classiques.

Resume En France, l'incidence de la brucellose humaine a considerablement diminue (800 cas declares en 1976, 104 en 1992). Ceci est le resultat indirect de la lutte veterinaire qui est en voie d'obtenir l'eradication de la maladie bovine dans nombre de departements a l'exception du Massif Central et des regions pyreneennes et alpines ou persiste une endemie brucellique chez les ovins et les caprins (role de la transhumance). Brucella melitensis Biovar 3 est aujourd'hui l'espece bacterienne dominante. Les aspects cliniques de la maladie humaine n'ont pas change mais les formes focalisees, squelettiques ou viscerales, ont proportionnellement plus diminue que le nombre total des cas. Aux moyens diagnostiques classiques — hemocultures trop souvent negligees, sero-agglutination de Wright — sont venues s'adjoindre l'IFI et l'ELISA qui reperent les IgM et les IgA temoins d'une infection recente et/ou evolutive. La methode IVAP (In Vitro Antibody Production) plus sophistiquee, possede les memes avantages mais demande a etre validee. L'antibiotherapie des formes aigues ou subaigues repose avant tout sur l'association de tetracycliques (tetracycline 2 g/j ou mieux doxycycline 200 mg/j durant 45 jours) soit avec la streptomycine (1 g/j durant 21 jours) soit avec la rifampicine (900 mg/j durant 45 jours). Chez la femme enceinte (les tetracycliques et les aminosides etant contre-indiques) ou l'enfant de moins de 8 ans (tetracycliques recuses), d'autres protocoles sont proposes avec cotrimoxazole et rifapicine (experience des pays de forte endemie). La prophylaxie repose avant tout sur la lutte veterinaire mais les precautions individuelles restent indispensables; la vaccination specifique (vaccin Merieux) devrait dans certaines conditions etre pratiquee de maniere plus systematique.

We developed an assay to detect antibodies spontaneously secreted in vitro by peripheral blood mononuclear cells (PBMC) against Brucella spp. High levels of anti-Brucella immunoglobulin G (IgG) and/or IgM and/or IgA antibodies were detected in the cell supernatant solution of PBMC cultures for 12 patients suffering from acute or focalized brucellosis and for 5 patients recently vaccinated against brucellosis. This spontaneous in vitro antibody production disappeared 5 to 20 months after onset of clinical signs and 20 to 27 days after vaccination. The transient character of this anti-Brucella antibody production by PBMC is consistent with a temporary in vivo stimulation of the immune system by Brucella antigens. Detection of this secretion could improve the diagnosis of evolutive brucellosis.

Resume Vingt trois patients atteints de Fievre Boutonneuse Mediterraneenne (22 formes communes, 1 forme grave) ont ete traites par la ciprofloxacine (C.); chez 21 patients l'antibiotique a ete administre par la voie veineuse relayee des l'apyrexie par la voie orale; chez deux sujets, la C. a ete donnee uniquement per os. Tous les patients ont gueri sans contre partie notable (une phlebite de perfusion) et l'apyrexie stricte a ete obtenue dans un delai moyen de 3,8 jours, delai superposable a celui observe lors de l'usage de la pefloxacine et de l'ofloxacine dans le traitement de cette rickettsiose.

Resume Chez cinq malades atteints du syndrome d'immuno-deficience acquise (sida) et indemnes de neuropathie peripherique, des symptomes musculaires (faiblesse, amyotrophie, douleurs et crampes) ou une elevation isolee des enzymes seriques ont ete constates. L'examen electromyographique (EMG) a permis de retrouver chez tous les malades des activites spontanees de fibrillations (f) et de potentiels lents (pl) et chez deux, des traces a signification myogene. La biopsie musculaire etait normale dans trois cas; l'aspect etait celui d'une myopathie dans un cas et d'une polymyosite dans l'autre. Dans un cas, les reactions immunocytochimiques ont mis en evidence des alterations de la dystrophine et de la laminine. La signification de ces alterations est discutee ainsi qu'une possible relation entre les activites spontanees et les modifications des proteines membranaires.

Background Q fever is a worldwide zoonosis caused by Coxiella burnetii, which can be isolated from ticks. Reports of people with both Q fever and other tickborne diseases are rare. In this study, we describe 6 patients with Q fever who were infected with 1 of the following tickborne pathogens: Rickettsia conorii (2 patients), Rickettsia slovaca (2), Rickettsia africae (1), and Francisella tularensis (1). Methods Diagnoses were made on the basis of results of microimmunofluorescence assays for detection of C. burnetii, R. conorii, R. slovaca, R. africae, and F. tularensis antigens. Cross-adsorption studies and Western blots were used to confirm dual infections. Results Among the 6 cases presented, 3 were probably due to a concomitant infection after a tick bite, whereas the remaining 3 were more likely consecutive infections. Conclusions Because acute Q fever is often asymptomatic, we recommend that patients infected with the tickborne pathogens mentioned above also undergo routine testing for concurrent infections with C. burnetii.

We report the first three documented cases of murine typhus imported into Europe from Indonesia, discuss clues for the diagnosis of the disease, and urge that murine fever be considered in the diagnosis of febrile disease in travelers.

25 HIV-infected antiretroviral-naive adults were included in a 24-week study to evaluate the efficacy and the tolerability of a zidovudine/didanosine combination therapy in which didanosine was administered once daily (200 mg if weight60 kg, 300 mg if weight60 kg) and zidovudine twice daily (500 mg/day if weight90 kg, 600 mg/day if weight90 kg). 5 patients discontinued their treatment early: 3 had poor compliance and 2 presented adverse events. Evaluation of treatment efficacy was based on CD4+ T cell enumeration and HIV RNA level quantitation in plasma (NASBA). Baseline values were 278 CD4+/mm3 and 5.42 log RNA copies/ml. Mean changes from baseline were +102 CD4+/mm3 and -2.14 log RNA copies/ml at week 8 and +156 CD4+/mm3 and -2.07 log RNA copies/ml at week 24. HIV RNA in plasma was lower than the detection limit (2.60 log RNA copies/ml) in 55% of patients at week 8 and in 30% at week 24. No major adverse events such as neuropathy or pancreatitis were observed. Once-daily administration of didanosine in combination with twice-daily administration of zidovudine is a well tolerated regimen that appears to be as effective ad the conventional zidovudine/didanosine combination regimen.

Multilocus enzyme electrophoresis and in vitro susceptibility testing with a broth microdilution method were used to analyze Candida albicans strain diversity in four AIDS patients with recurrent oropharyngeal candidiasis who successively developed clinical resistance to fluconazole (FCZ) and itraconazole (ITZ). One to ten colonies per sample were randomly chosen from oral washings collected before the initial FCZ treatment and just before every other antifungal treatment; a total of 98 isolates were analyzed. Multilocus enzyme electrophoresis analysis revealed 14 different electrophoretic types (ETs). Statistical analysis of genetic distances showed that C. albicans isolates clustered into five subpopulations (I to V). In each subpopulation, isolates are closely related, and genetic distances between subpopulations I to IV are short. In contrast, subpopulation V, which contained isolates typed as ET8 and ET14, is strongly divergent from the others; these isolates may represent atypical C. albicans isolates. Only one patient was infected with a single strain during the course of azole therapy; for the three remaining patients, variants of the same strain and different strains were concurrently isolated. Clinical FCZ resistance was clearly correlated with in vitro data for three patients. Moreover, MICs of ITZ increased during FCZ therapy, and MICs of ITZ which were > or = 1.56 micrograms/ml were found when clinical ITZ resistance occurred; isolates from subpopulation V showed the highest MICs of ITZ. Because of the emergence of clinical ITZ resistance after clinical FCZ resistance, the feasibility of long-term azole therapy for mucosal candidiasis in AIDS patients is questioned.

A French multicentre study was conducted in 15 Infectious Diseases departments; 347 cases of severe staphylococcal infections were collected during one year (October 1989 to October 1990): Two-hundred and fifty-eight strains were analysed with complementary bacteriological studies, including 62 strains of methicillin-resistant Staphylococcus aureus. Epidemiological, clinical and therapeutic aspects were investigated. Nosocomial infection was responsible for 90 percent of the cases, and previous antibiotic therapy was reported in 74 percent. An invasive procedure was incriminated in 43 patients (69 percent); intravenous catheter (38 percent), mechanical ventilation (31 percent), surgery (22 percent), prosthetic device (20 percent). Thirty-nine patients were treated with glycopeptides either alone or in combination with beta-lactams, aminoglycosides, fucidic acid, fosfomycin, rifampicin, quinolones or synergistines, showing the great diversity in the choice of antibiotics in methicillin-resistant S. aureus infections. More than 90 percent of these strains were resistant to gentamicin and quinolones, 80 percent of clindamycin and 70 percent to rifampicin. No resistance to glycopeptides (vancomycin or teicoplanin) was observed. Prognosis was severe, with a mortality rate of 35 percent, justifying educational and prophylactic measures in at risk medical departments.

In France, human brucellosis decreased significantly between the 70's (800 annual cases) and 1992 (102 cases), the result of the veterinary fight against animal disease. Bovin brucellosis is almost eradicated except into Massif Central, Pyrénées and Alpes, where goats and sheep are always responsible for the contamination of cows. B. melitensis 9/11 biovar 3 is the more frequent contaminant. Clinical features of human disease are unchanged but skeletal and visceral focalisations become less frequent than previously--Blood cultures--too often left--and seroagglutination remain classical means of diagnosis. I.I.F. and ELISA are more precise because recognition of specific IgM and IgA which are good evidence of recent or persistent infection. In vitro antibody production--assay (IVAP) is more sophistical; its value should be assessed. Today antibiotherapy for acute or subacute forms is based on associations: Tetracycline (2 g/d) or better Doxycycline (200 mg once daily for 45 d) are always associated with either Streptomycin (1 g daily for 21 days) or Rifampicin (900 mg once daily for 45 d). The first regimen is probably more efficient than the second one because relapses occur more often (5-10%) with Doxycycline-Rifampicin than with Doxycycline-Streptomycin (relapses: 4-5%). In pregnant women Cotrimoxazole-Rifampin is efficient enough and atoxic if the treatment is stopped 7 days before delivery. The same regimen is recommended in children less 8 years of age. Veterinary action should be going on in spite of its cost. Individual measures (gloves, antiseptic solution for shoes, boiled milk...) are always necessary. Specific immunization (vaccin Mérieux, France) often seems efficient despite a few light adverse effects; its use is recommended in farmers, veterinary and bacteriologic workers.

This prospective study evaluated the in vitro susceptibility of Candida albicans isolates recovered from the oral cavity of AIDS/ARC patients before and during long-term therapy with fluconazole. Thirty adults (15 with ARC and 15 with AIDS) with a first episode of thrush candidiasis were given oral fluconazole (Triflucan 50 mg; one capsule daily) for at least three months. Fungal susceptibility testing was performed before treatment, after one month, and at last follow-up (range 3.5-12 months; mean 5.7 months). MICs were determined using the agar dilution method with casitone (Difco 259-01) as the test medium at pH 7.2-7.4. There were two initial clinical failures (one with high MICs before and under treatment and one with an intermediate MIC initially and a rise in MIC under fluconazole). Four patients developed a clinical relapse with no change in MICs (which were low or intermediate). In six patients, clinical symptoms resolved but carriage of C. albicans persisted (low MICs). In 18 patients, clinical resolution with eradication of C. albicans was achieved. These data suggest that (1) clinical failures may be associated with in vitro resistance; (2) relapses under fluconazole maintenance therapy may develop in patients with advanced HIV disease despite the lack of change in the susceptibility of strains.

In 5 acquired-immunodeficiency syndrome (AIDS) cases without peripheral neuropathy, we observed myogen clinical signs (diffuse amyotrophy of lower limbs or cramps) or an isolated increase in seric enzyme (LDH, CK). EMG abnormalities were observed in all cases: spontaneous activities (fibrillations and positive sharp waves) in 5 cases, myogenic signs in 2 case. Muscular biopsies were normal in 3 cases and showed myopathic changes in 1 case and polymyositis in another case. Antidystrophin and antilaminin antibodies reactions were altered in 1 case. The spontaneous activities together with these modifications could be in favour of a lesion at the membrane level.

Authors report a case of infection of aortic aneurysm with Coxiella burnetii occuring eight years after an acute Q fever. The serology was compatible with a chronic Q fever. They discuss the role of different strains of Coxiella burnetii and the participation of host factors in the physiopathology of this case.

Resume Les auteurs analysent 55 cas de septicemies a bacille pyocyanique observes en 12 ans ; 40 patients etaient âges de plus de 50 ans, la plupart etaient hospitalises depuis plusieurs jours et pres de la moitie venaient de subir une intervention chirurgicale. Le role favorisant d'une antibiotherapie prealable et d'un terrain debilite est souligne. Les portes d'entree respiratoires, peritoneales et urinaires sont les plus frequentes, le role des catheters est plus modeste. Vingt-sept patients ont presente un choc toxi-infectieux inaugural et mortel dans 15 cas. La mortalite globale atteint 68 %. Une etude statistique confirme le role pejoratif de l'âge, de la chirurgie, des neoplasies et des defaillances viscerales prealables ; de meme, l'origine pulmonaire ou peritoneale du germe comporte un pronostic plus grave. Employes isolement, les polypeptidiques semblent plus efficaces que les aminosides ; les betalactamines isolees ou mieux, associees, demontrent leur superiorite et peuvent laisser esperer une amelioration du pronostic.

Resume Les salmonelloses de l'adulte ne donnent que rarement lieu a hospitalisation. Parmi les 53 cas recueillis a la Clinique des Maladies Infectieuses il y a eu 28 gastro-enterites aigues ; toutefois l'eventualite d'une diarrhee chronique n'est pas exceptionnelle (8 cas). Par ailleurs, la symptomatologie, l'evolution et les constatations biologiques conduisent a differencier des formes typhoidiques (8 cas) et des septicemies veritables (5 cas). Metastases ou foyers apparemment primitifs (2 cas), tant osseux que vasculaires, compliquent ces salmonelloses plus souvent que ne le font les fievres typhoides vraies. Souvent inutile dans les gastro-enterites, et peu efficaces sur le portage digestif, l'antibiotherapie n'a d'interet veritable que dans les formes typhiques, septicemiques et localisees.

Resume La comparaison des resultats obtenus avec la sero-agglutination de Wright, la reaction de fixation du complement, la reaction d'immunofluorescence indirecte, le test de transformation lymphoblastique en presence d'antigene brucellien et l'intradermo-reaction a la melitine est realisee dans 3 groupes de malades. Au cours de la brucellose aigue (44 cas) la sero-reaction de Wright reste une epreuve diagnostique de grande valeur. Elle est cependant egalee dans son interet par le test d'immunofluorescence indirecte qui permet par ailleurs une etude qualitative des diverses immunoglobulines. Le test de transformation lymphoblastique en presence d'antigene brucellien comme l'intradermo-reaction a la melitine dont la positivite est tardive n'ont, le plus souvent, qu'un interet diagnostique et pronostique limite. Durant la brucellose chronique afocale (34 cas) on constate l'absence ou le faible taux des anticorps seriques lorsqu'on utilise le test de Wright ou, a un moindre degre, la reaction de fixation du complement. Une positivite nette du test d'immunofluorescence indirecte n'est pas exceptionnelle. L'intradermo-reaction a la melitine est habituellement nettement ou fortement positive. Le test de transformation lymphoblastique en presence d'antigene brucellien donne dans 50 % des cas un index de stimulation eleve. Au cours des brucelloses focalisees (16 cas) le tableau immunologique est dans certains cas proche de celui des brucelloses aigues, et dans d'autres voisin de celui des brucelloses chroniques afocales. Toutefois un groupe, reduit en nombre mais tout a fait particulier, peut etre isole : celui de brucelloses focalisees d'evolution prolongee (endocardites, hepatosplenite…) ou existe une forte positivite des reactions serologiques et une defaillance de l'immunite cellulaire.

Resume L'antigenotherapie specifique a ete employee chez 44 malades atteints de brucellose chronique afocale. Elle a ete realisee avec des substances diverses (melitine buvable, vaccin antimelitensique et, plus souvent, fraction phenol-insoluble injectable). Les trois-quarts des patients ont ete notablement ou remarquablement ameliores. Ni la methode therapeutique utilisee, ni l'anciennete de l'infection brucellienne, ni la persistance d'un contact avec Brucella ne semblent influer sur les resultats ; en revanche les succes sont d'autant plus nombreux et complets que les sujets presentent une plus forte sensibilite retardee aux antigenes brucelliens.

Resume A partir de l'analyse d'une serie personnelle de 108 pneumopathies aigues non nosocomiales chez des patients de 60 ans ou plus, les auteurs ont recherche les particularites propres a ce terrain. Sont souvent retrouvees des pathologies prealables : bronchopathies chroniques (n : 27), cardio-vasculaires (n : 16), neuro-psychiatriques (n : 13) et neoplasiques extra-pulmonaires (n : 9). Le pneumocoque reste la cause la plus frequente (26 % des cas). Les pneumopathies atypiques ont egalement une place importante excepte les pneumopathies a mycoplasme. Ma mortalite (15 % des cas) survient chez les malades ayant presente des pneumopathies de deglutition ou ayant au prealable une insuffisance cardiaque. Elle semble donc liee le plus souvent a une cause extra-respiratoire plus qu'a la pneumopathie elle-meme.

Thirty-two patients were treated by ofloxacin on bacteriological documented infections. They were Enterobacterias: n = 15 (MIC less than or equal to 0.06 to 0.5 microgram/ml); Pseudomonas aeruginosa and Acinetobacter: n = 1 (MIC 0.5 and 4 micrograms/ml); Staphylococcus: n = 6 (MIC less than or equal to 0.06 to 4 micrograms/ml); Pneumococcus: n = 1; Mycoplasma: n = 1; Chlamydia psittaci: n = 2; Legionella pneumophila: n = 1; Rickettsias: n = 4 (three mediterranean fevers one query fever). Ofloxacin was given orally from 400 to 800 mg per day (5 to 15 mg/kg/day). It was used alone 26 times and on 6 occasions it was associated with rifampin on 6 staphylococcal infections. On 19 cases it was used after failure or intolerance of initial therapy. Thirty times it was the first antibiotic substance used. Results were good mainly: 1) on nine pneumonitis (enterobacterias: 4; Pneumococcus: 1; Mycoplasma: 1; Chlamydia: 2; Legionella: 1) during a mean duration of twenty days; 2) urinary infections (n:7) provoked by E. coli and Enterobacter cloacae (mean duration: 20 days); 3) 4 osteo-articular-infections (mean duration: 77 days); 4) Rickettsial infections (n:4) during a mean duration of 11 days. Results are particularly noteworthy because patients treated had severe infections: 12 bacteremias, 1 endocarditis and 1 purulent meningitis. None severe adverse effect was observed.

Pefloxacin was given as the single drug (except in one case) to twenty-seven patients with a variety of infections (bone and/or joint: 8; respiratory tract: 6; urinary tract: 5; bacteremia: 4; meninges: 3; other: 1). The following bacteria were isolated: P. aeruginosa: 11; Enterobacteriaceae: 10; Acinetobacter: 3; Staphylococci: 3 (including 2 methicillin-resistant strains), and Streptococcus faecalis: 2. Pefloxacin was given in a daily dosage of 800 mg in 20 patients and 1 200 to 1 600 mg in 7. All pathogens proved susceptible, in varying degrees. 21 patients recovered. Three incomplete results and three failures were observed. No significant side effects were recorded except for development of three mucosal candidiasis and two transient rashes. The authors put special emphasis on the value of pefloxacin in bone and meningeal infections.

One hundred one nosocomial septicemias (NS) were studied among 461 cases of septicemias (22%) collected by French Septicemia Expert System Group during 1985. The mean-age of the patients was 58 +/- 23 years while it was 56 +/- 23 years in the 360 community acquired septicemias (CAS). The source of septicemia was found more frequently in NS than in CAS (79/101 versus 223/360; p less than 0.002): mainly urinary tract and intravenous therapy in NS, urinary tract, gastrointestinal and biliary origin in CAS. Invasive procedures (except surgical procedures) were more frequent in NS than in CAS (13/101 vs 14/360; p less than 0.0001). Underlying diseases were more often associated with NS than with CAS (96/101 vs 276/360; p less than 0.0001). Many pathogens were involved in these NS but the frequency of S. aureus meti-S and meti-R, S. epidermidis, Enterobacter, Klebsiella, Serratia, Proteus indol + and Pseudomonas carbeni-R was significantly greater in NS than in CAS. There was no significant difference between NS and CAS for septic localizations, respiratory distress syndrome and septic shock. Two antibiotics (and possibly 3 antibiotics for polymicrobial septicemias) were more often used in NS than in CAS (61/101 vs 135/360; p = 0.002). If the duration of hospitalization was not significantly greater in NS than in CAS (26 +/- 29 days vs 23 +/- 33 days), the overall mortality was significantly more important (25.6% vs 14.9%; p less than 0.05).

Twenty nine patients with Rickettsiosis (Tick born fever, n: 22, Q fever, n: 7) has been treated with fluoroquinolones. These compounds was used alone n: 25 (Pefloxacin, n: 15; Ofloxacin, n: 10) or associated n: 4 (Pefloxacin + Rifampin). The general efficacy was excellent. Common Tick born fever and pulmonary forms of Q fever was fast cured. Severe Tick born fever (neurologic or polyvisceral forms, n: 5) and Q fever with long term hyperthermia, n: 4 cas always cured without complications but the time necessary to obtain apyrexia was often longer (6 cases).

Five cases of Brucella melitensis endocarditis are reported. Common features included subacute course, enhanced humoral immunity, and deficient cellular immunity. Appropriate antibiotic therapy led to recovery in all cases. In two patients, valvular replacement was necessary.

The authors discuss the present value of rifampicin in the treatment of human brucellosis on the basis of: 1) a bacteriological study of 42 strains of Brucella spp. (MIC's of rifampicin, tetracyclin, doxycyclin, minocyclin and streptomycin; results of doxycyclin-rifampicin and doxycyclin-streptomycin combinations), and 2) a clinical study of 38 cases of brucellosis treated with rifampicin, including 25 acute septicemias and 13 osteo-arthritis. Satisfactory results were observed in 92% of the cases with rifampicin alone, but one cannot state that the benefits are significant.

Cefotiam (SCE 963), a new, broad-spectrum, third generation cephalosporin was used in the treatment of 136 patients suffering from respiratory tract infections, urinary tract infections, septicemia, meningitis, biliary tract infections and osteoarthritis infections. Cefotiam was administered in monotherapy to 98 patients at the mean posology of two grams per day (extreme doses: 1 to 6 g). The following clinical effectiveness was noted: 83 successes and 18 failures on 101 available clinical reports. The general, biological tolerance and renal tolerance was good in all patients.

Fifty one cases of Pseudomonas aeruginosa bacteriaemia observed during the last 12 years are reported. Thirty five patients were over fifty years old; 92 p. cent were admitted for several days and about 50 p. cent were in post-operative period. A previous antibiotherapy and an impaired status are promotive factors. The respiratory or peritoneal origins are the most frequent. All patients were feverish; 24 have had an infectious shock which was inaugural in 12 cases. Seven pneumonitis, 3 endocarditis, one pericarditis and 2 osteitis were observed. An ecthyma gangrenosum was noted in three patients. Mortality was 70 p. cent. Comparison between recovered and died patients improved bad prognosis of old age, post operative period, neoplasic, previous organica weakness and pulmonary or peritoneal origins. Used alone, colimycin has seemed to be more effective than aminosid antibiotics; but their association with betalactamins was better. An in vitro study of the susceptibility of 100 Pseudomonas aeruginosa strains has proved the interest of piperacillin and cefsulodin; azlocillin, cefoperazone and ceftriaxone are just less effective.