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Objectives Brain abscess is one of the most serious diseases of the CNS and is associated with high morbidity and mortality. With regard to the lack of data supporting an optimal therapeutic strategy, this study aimed to explore the prognostic factors of brain abscess, putting emphasis on the impact of therapeutic decisions. Methods We retrospectively included patients hospitalized for brain abscess during a period of 13 years. Comorbidities (Charlson scale), clinical presentation, microbiology culture, radiological features and therapeutic management were collected. Glasgow Outcome Scale (GOS) at 3 months and length of hospital stay were, respectively, the main and the secondary outcomes. Logistic regression was used to determine factors associated with outcome independently. Results Initial Glasgow Coma Scale (GCS) ≤14 and comorbidities (Charlson scale ≥2) were associated with poor neurological outcome while oral antibiotic switch was associated with better neurological outcome. Oral switch did not appear to be associated with an unfavourable evolution in the subset of patients without initial neurological severity (GCS >14) on admission. Duration of IV regimen and time to oral switch were associated with the length of inpatient stay. Conclusions This study confirms the role of GCS and comorbidities as prognostic factors and presents reassuring data regarding the safety of oral switch for the antibiotic treatment of brain abscesses. Oral switch could prevent catheter-induced iatrogenic complications and allow a higher quality of life for patients.

Background New diagnostic tools have been developed to improve the diagnosis of infectious encephalitis. Using a prospective cohort of encephalitis patients, our objective was to identify possible clusters of patients with similar patterns among encephalitis of unknown cause (EUC) and to describe to what extent a patient’s initial presentation may be predictive of encephalitis etiology, particularly herpes simplex virus (HSV) and varicella-zoster virus (VZV). Methods The National Cohort of Infectious Encephalitis in France is an ongoing prospective cohort study implemented in France in 2016. Patients who present with documented or suspected acute infectious encephalitis were included. Focusing on the variables that describe the initial presentation, we performed a factor analysis of mixed data (FAMD) to investigate a pattern of association between the initial presentation of a patient and the etiologic pathogen. Results As of 1 August 2018, data from 349 patients were analyzed. The most frequent pathogens were HSV (25%), VZV (11%), tick-borne encephalitis virus (6%), Listeria (5%), influenza virus (3%), and EUC (34%). Using the FAMD, it was not possible to identify a specific pattern related to the group of EUC. Age, temporal or hemorrhagic lesions, and cerebral spinal fluid lymphocytosis were significantly associated with HSV/VZV encephalitis. Conclusions No initial clinical/imaging/biology pattern was identified at admission among EUC, despite the improvement in diagnostic tools. In this context, the recommendation for a universal, early, probabilistic, initial treatment against HSV and VZV is still relevant, regardless of the initial clinical presentation of the encephalitis.

Dalbavancin is a glycopeptide antibiotic with a long half-life, recently marketed in Europe for skin and soft-tissue infections (SSTIs), but its real-life use is not well known. The aim of this study was to describe all first prescriptions in France over an 16-month period. A retrospective study on all adult patients receiving at least one dose of dalbavancin from 1 June 2017 to 31 September 2018 was performed (75 patients from 29 French hospitals). Data were collected via a standard questionnaire. Failure was defined as persistence or reappearance of signs of infection, and/or switch to suppressive antibiotic treatment, and/or death from infection. The main indications were bone and joint infection (BJI) (64.0%), endocarditis (25.3%), and SSTI (17.3%). The main bacteria involved were Staphylococcus aureus (51.4%), including methicillin-resistant S. aureus (MRSA) (19.4%), and coagulase-negative staphylococci (44.4%). Median minimum inhibitory concentrations (MICs) for staphylococci to vancomycin and dalbavancin ranged from 0.875-2.0 mg/L and 0.032-0.064 mg/L, respectively. Dalbavancin was used after a mean of 2.3 ± 1.2 lines of antimicrobial treatment. The main treatment regimens for dalbavancin were a two-dose regimen (1500 mg each) in 38 cases (50.7%) and a single-dose regimen (1500 mg) in 13 cases (17.3%). Overall, at the patient's last visit, clinical cure was observed in 54/68 patients, whilst failure was observed in 14/68 patients. First use of dalbavancin in France was mostly off-label. Most were due to BJI, often as rescue therapy for severe infections. Even in off-label situations, dalbavancin appears safe and effective.

The aim of our study was to describe spine immobilization in a multicentric cohort of vertebral osteomyelitis (VO), and evaluate its association with neurological complications during follow-up.We prospectively included patients from 2016 to 2019 in 11 centers. Immobilization, imaging, and neurological findings were specifically analyzed during a 6-month follow-up period.250 patients were included, mostly men (67.2%, n=168). Mean age was 66.7±15 years. Diagnosis delay was 25 days. The lumbo-sacral spine was most frequently involved (56.4%). At diagnosis, 25.6% patients (n=64) had minor neurological signs and 9.2% (n=23) had major ones. Rigid bracing was prescribed for 63.5% (n=162) of patients, for a median of 6 weeks, with variability between centers (P0.001). The presence of epidural inflammation and abscess on imaging was associated with higher rates of rigid bracing prescription (OR 2.33, P=0.01). Frailness and endocarditis were negatively associated with rigid bracing prescription (OR 0.65, P0.01, and OR 0.42, P0.05, respectively). During follow up, new minor or major neurological complications occurred in respectively 9.2% (n=23) and 6.8% (n=17) of patients, with similar distribution between immobilized and non-immobilized patients.Spine immobilization prescription during VO remains heterogeneous and seems associated inflammatory lesions on imaging but negatively associated with frailness and presence of endocarditis. Neurological complications can occur despite rigid bracing. Our data suggest that in absence of any factor associated with neurological complication spine bracing might not be systematically indicated. We suggest that spine immobilization should be discussed for each patient after carefully evaluating their clinical signs and imaging findings.

Objectives Pulmonary tularemia is a rare and little-known disease, whose clinical and radiological presentation can be confused with those of much more frequent pathologies, such as lung cancer or B-cell lymphoma (46,000 and 5,000 new cases respectively per year in France). Furthermore, PET/CT is a powerful tool for the diagnosis of malignancies or the exploration of fever of unknown origin. The objective of this study was to describe the characteristics of pulmonary tularemia and to determine whether its PET/CT aspect could help distinguish it from neoplasia. Methods Retrospective observational study collecting all pulmonary tularemia cases for which a PET/CT was performed between 2016 and 2020. Results Twenty-seven cases of pulmonary tularemia were analyzed. The sex ratio was 4.4, and the median age was 60 years. Clinical manifestations were mainly represented by fever (n = 23), arthralgia (n = 7) and cough (n = 6). PET/CT revealed intensely hypermetabolic mediastinal adenopathies in all cases, associated with parenchymal (n = 20) or pleural (n = 6) lesions, suggesting neoplastic pathology in 15 patients. Cytopuncture or lymph node biopsy was performed in 16 patients, revealing non-specific adenitis (n = 8), necrotic epithelio-gigantocellular granuloma (n = 3), or were non-contributory (n = 5). All patients reported significant environmental exposure. The outcome was favorable for all patients, spontaneously for 8 of them and after antibiotic therapy with either doxycycline or ciprofloxacin for the other 19. Conclusions Depending on the epidemiological setting, pulmonary tularemia may be considered an alternative diagnosis to lung cancer, lymphoma, or tuberculosis, in the presence of infectious symptoms and hypermetabolic pulmonary lesions and mediastinal lymphadenopathies on PET/CT.

International audience; OBJECTIVES: Dalbavancin is a long-lasting lipoglycopeptide active against Gram-positive bacteria, especially methicillin-resistant staphylococci. Few data are available on dalbavancin use for treatment of prosthetic joint infections (PJIs). We describe a cohort of patients treated for PJI with dalbavancin and review the literature regarding this condition. METHODS: All adult patients with PJI from the French dalbavancin national cohort from 1 June 2017 to 1 January 2019 were included. We collected clinical and microbiological characteristics and outcome through a standardised questionnaire. Clinical cure was defined as absence of clinical signs of infection at last visit. Failure was a composite criterion defined by persistence or reappearance of signs of infection, and/or switch to suppressive antibiotic treatment and/or death from infection. The literature review was performed using PubMed. RESULTS: Seventeen patients were included. Bacteria were identified in 16 cases: Staphylococcus aureus (n = 10), including methicillin-resistant S. aureus (n = 1); and coagulase-negative staphylococci (n = 10), including methicillin-resistant Staphylococcus epidermidis (n = 4). Sixteen patients (94.1%) had received antibiotic therapy prior to dalbavancin use (mean of 2.2 ± 1.3 lines). Clinical cure was achieved in 8/17 patients after a median follow-up of 299.0 (IQR 97.0-476.0) days. We reviewed all cases of PJI treated with dalbavancin available in the literature and the overall clinical cure was estimated at 73.1%. CONCLUSION: Our study and literature data suggest that use of dalbavancin in PJI could be considered, even as salvage therapy. Dalbavancin appears to be a safe and easy treatment for patients with staphylococcal PJIs.

International audience; A 60-year-old non-smoker white woman presented with a new episode of hemoptysis. She reported recurrent hemoptoic sputum in the past month. She had no relevant medical history, except presumed resolved bacterial pneumonia 1 year ago. She denied taking immunosuppressive treatment and was not exposed to lung irritants. She had not traveled recently. General health status was good. She denied fever, dyspnea, chest pain, and extra-pulmonary symptoms.

Annals of Physical and Rehabilitation Medicine - In Press. Accepted Manuscript Available online since vendredi 8 septembre 2017

Introduction Le diagnostic d’infection tuberculeuse latente (ITL) repose sur des tests immunologiques detectant la reponse T memoire dirigee contre Mycobacterium tuberculosis. Parmi eux, les tests de relargage de l’interferon gamma presentent des sensibilite et specificite superieures a l’intradermoreaction a la tuberculine (IDRT). Depuis 2019, la societe Diasorin commercialise un kit de dosage d’interferon gamma circulant, technique sur automate Liaison XL, compatible avec le kit de prelevement QuantiFERON-TB Gold Plus. Le laboratoire de notre Centre Hospitalier a ete l’un des premiers a le deployer. Nous presentons un retour d’experience de la technique Diasorin. Materiels et methodes Analyse retrospective comparant les resultats des tests QuantiFERON realises par technique QuantiFERON-TB Gold Plus Elisa (Qiagen), sur automate Evolis (Biorad, mars–decembre 2018) et sur automate Liaison XL (Diasorin, mars–decembre 2019). Le seuil de positivite etait de 0,35 UI/mL, celui de la zone grise entre 0,30 et 0,70 UI/ml. Les doublons ont ete exclus. Les taux de resultats indetermines etaient compares par test exact de Fisher. Resultats En 2018, 1040 tests ont ete realises sur Evolis, contre 976 tests en 2019 sur Liaison XL. Le taux de tests positifs etait de 18,8 % (N = 196) et 14,2 % (N = 139) respectivement. Le dosage repose en effet sur le meme kit de prelevement Qiagen, et les conditions pre-analytiques conditionnant la correcte realisation du dosage restent inchangees. Le taux de tests indetermines etait multiplie par 3 avec la technique Liaison XL : 0,6 % (n = 6) en 2018 vs 2 % (n = 20) en 2019. Parmi eux, quelle que soit la technique employee, la majorite concerne des tubes NIL ayant depasse le seuil de 8 UI/mL (n = 4 en 2018, n = 15 en 2019), temoignant d’un taux d’interferon gamma circulant de base plus eleve chez ces patients que dans la population generale. Une IDRT realisee chez 12 de ces 19 patients a confirme l’ITL, et conduit a leur traitement. Fait notable, tous ces patients, a l’exception d’un, etaient originaires d’Afrique et d’Europe de l’Est. Par son implication dans les enquetes autour des cas de tuberculose et dans le depistage des migrants, le centre de lutte antituberculeuse (CLAT) est le principal prescripteur de QuantiFERON avec 652 (62,7 %) demandes en 2018 et 406 (41,6 %) en 2019 : il concentre la majorite des diagnostics d’ITL, avec respectivement 136 (69,4 %) et 81 (58,3 %) tests positifs. Le taux des tests indetermines etait significativement augmente avec la technique Diasorin dans la population de patients suivis au CLAT (0,6 % en 2018 vs 3,2 % en 2019, p = 0,0017), au contraire du reste de la population suivie dans notre centre hospitalier (0,5 % en 2018 vs 1,2 % en 2019, p = 0,3253). Conclusion Le nombre de tests indetermines est majore depuis l’utilisation du test Diasorin, ce phenomene survenant principalement chez les patients migrants, et semblant correle a la presence d’une ITL. Si la comprehension des mecanismes expliquant le taux eleve d’interferon gamma circulant chez ces patients reste a approfondir, un resultat indetermine devrait inciter a completer les explorations par la realisation d’une IDRT.

Objective The loosening of total joint replacement is a frequent complication after total hip arthroplasty (THA). Septic osteolysis should always be feared. We report here a rare case of hip arthroplasty infection due to Mycobacterium bovis after Bacillus Calmette-Guerin (BCG) therapy in a context of bladder cancer. Observations A 70-year-old man was referred to the department of rheumatology in September 2015, because of a total functional disability of the left lower limb. He underwent an un-cemented left total hip arthroplasty in 2003 for the treatment of osteoarthritis. We noted a bladder carcinoma treated by BCG instillation in 2013. Concerning his lower-limb, the activity-related pain has progressively intensified. No fever, weight loss, night sweat or other constitutional symptoms had been noticed. The medical examination showed an isolated painless mass in the inguinal fold. Initial x-ray showed a large trochanteric bone defect and a medial femoral cortex osteolysis. A CT-scan revealed a mass located between the acetabulum and the femoral vasculo-nervous package. A puncture of the mass yielded a hematic and purulent material. On day 14 of incubation, a BCG Mycobacterium bovis strain developed on a specific mycobacterial culture. Discussion–conclusion Tuberculosis vaccine is an effective intravesical immunotherapy for superficial urothelial bladder carcinoma. Most patients experience irritative voiding. Flu-like symptoms may occur and are resolved with symptomatic treatment. Osteoarticular complications are rare. Only 8 cases of prosthetic infections due to Mycobacterium bovis are reported. There is no predictive factor that could help identify patients at risk for developing BCG infection. Most of patients present sub-acute or chronic joint pain, with a great difficulty and a long delay for clinicians to make the diagnosis. In our case, the pseudo-tumoral aspect associated with the loosening of the THA showed many similarities with polyethylene wear induced osteolysis with a classic inflammatory granuloma. A regimen of antituberculous drugs was essential alongside with the removal of the mass. Peri-prosthetic infection due to Mycobacterium bovis is a very rare complication of BCG therapy but clinicians should be able to evocate this diagnosis.