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Highlights • This original article is the first report of isolate and culture of a bacterium from ancient human samples and dental pulp in particular. • The dental pulp is a mirror of the individual's infectious state at the time of death. • Ancient dental pulp culture yielded to the identification and isolation of the bacterium Clostridium tertium responsible for septicaemia during World War I,., Background Dental pulp, encapsulating a blood drop, could be used to diagnose pathogen bacteraemia in archaeological materials using DNA-based techniques. We questioned the viability of such ancient pathogens preserved in ancient dental pulp. Methods After meticulous decontamination of 32 teeth collected from 31 World War I soldiers exhumed in Spincourt, France, dental pulps were extracted and cultured under strict anaerobiosis. Colonies were identified by mass spectrometry and whole genome sequencing. Fluorescent in situ hybridisation (FISH) was used for the direct microscopic detection of pathogens of interest in the dental pulp. All the experimental procedures included negative controls, notably sediments in contact with individual SQ517 to ensure that results did not arise from contamination. Findings Clostridium tertium was detected by FISH in two dental pulp specimens taken from a 1914 soldier. After a two-day incubation period, both dental pulp samples grew colonies identified by mass spectrometry and genome sequencing as C. tertium; whereas negative controls remained free of C. tertium in all the observations, and no C. tertium was founded in sediments. Skeletal remains of this soldier exhibited two notches in the left tibia evocative of a cold steel wound, and a probably fatal unhealed bullet impact in the hip bone. Interpretation Data indicated the presence of C. tertium in the dental pulp at the time of the death of one World War I soldier, in 1914. This observation diagnosed C. tertium bacteraemia, with war wounds as the probable portal of entry for C. tertium. Our C. tertium strains ante-dated by three years, the princeps description of this deadly opportunistic pathogen.

The aetiology of appendicular abscess is predominantly microbial with aerobic and anaerobic bacteria from gut flora. In this study, by using specific laboratory tools, we co-detected Methanobrevibacter oralis and Methanobrevibacter smithii among a mixture of enterobacteria including Escherichia coli, Enterococcus faecium and Enterococcus avium in four unrelated cases of postoperative appendiceal abscesses. These unprecedented observations raise a question on the role of methanogens in peri-appendicular abscesses, supporting antibiotics as an alternative therapeutic option for appendicitis, including antibiotics active against methanogens such as metronidazole or fusidic acid.

We retrospectively investigated cases of false-positive diagnoses using the BIOFIRE (R) FilmArray (R) meningitis/encephalitis (ME) panel to measure the impact of using a dedicated biosafety cabinet combined with preventive measures to reduce the prevalence of false-positive diagnoses due to pre-analytical in-laboratory contamination. False-positive results were identified by reviewing clinical data, biological parameters and cytology results of cerebrospinal fluid (CSF) samples showing discrepant results between the FilmArray ME panel and routine PCR assays. A total of 327 CSF were analysed over 16 weeks in point-of-care (POC) A and B, over two 8-week periods, periods 1 and 2. The analysis yielded 30 (9 center dot 17%) detection of at least one pathogen including 21/30 (70%) viruses and 9/30 (30%) bacteria. During period 1, POC-A and POC-B manipulated CSF under a non-dedicated hood featuring laminar flow, whereas during period 2, CSFs were manipulated under a dedicated biosafety cabinet without any airflow in POC-A. During period 1, false positives were detected in 3/114 CSF (2 center dot 63%) in POC-A and 1/36 (2 center dot 77%) in POC-B (P = 0 center dot 97); during period 2, false positives were detected in 0/139 CSF (0%) in POC-A and 1/38 (2 center dot 63%) in POC-B (P = 0 center dot 23). All false positives were bacterial. The use of a dedicated cabinet without ventilation along with preventive measures during period 2 in POC-A significantly reduced the number of false-positive results (P = 0 center dot 05). Preventive measures described in this study can mitigate false positives when using PCR-based multiplex assays such as the BIOFIRE FilmArray ME Panel for the diagnosis of meningitis and other infectious diseases.

Background 18F-Fluorodeoxyglucose Positron Emission Tomography (18F-FDG PET) has been shown to be useful for the diagnosis of infective endocarditis (IE), but its prognostic value remains unknown. Objectives This study sought to assess the prognostic value of 18F-FDG PET/CT in prosthetic (PVE) and native valve endocarditis (NVE). Methods We prospectively studied 173 consecutive patients (109 PVE and 64 NVE) with definite IE who underwent an 18F-FDG PET/CT study and were follow-up for one year. Primary end-point was a composite of major cardiac events i.e. death, recurrence of IE, acute cardiac failure, non-scheduled hospitalization for cardiovascular reason, and new embolic event. Results 18F-FDG PET/CT was positive in 100 (58%) patients, 83% (n = 90/109) in the PVE and 16% (n = 10/64) in the NVE group. At a mean follow of 225 days (199 to 251 days), the primary end-point occurred in 94 (54%) patients, 63 (58%) in the PVE group and 31 (48%) in the NVE group. In the PVE group, positive 18F-FDG PET/CT was significantly associated with higher rate of primary end-point (OR = 2.6, IC95% = 1.04 to 6.6; P = 0.04). Moderate to intense 18F-FDG valvular uptake was also associated with worse outcome (OR = 2.1; IC95% = 1.1 to 4.0; P = 0.03) and to new embolic events, (OR = 7.5; IC95% = 1.24 to 45.2) P = 0.03). In the NVE group, 18F-FDG PET/CT was not associated with occurrence of the primary end-point. Conclusion In addition to be an accurate diagnostic tool, 18F-FDG PET/CT is predictive of major cardiac events in PVE and of embolic events during the first year following IE episode.

In Senegal, we have developed technology-driven research based on observation and technology transfer especially in molecular biology, genomics, culturomics, and proteomics with the use of the first Maldi-TOF mass spectrometer in clinical microbiology in Africa. This strategy is associated with a policy of training students from the South and helping them to return back. This technology transfer and expertise has enabled us to explore the causes of non-malarial fevers of unknown causes, with the study of the repertoire of infectious pathogens in humans and arthropod vectors, to diagnose infectious diseases in rural areas with Point of Care laboratories, to isolate new bacteria, and to study pathologies linked to mass gatherings. They have also allowed us to develop transdisciplinary research including the study of the microbiota in malnourished children. We wish to continue this technological development, which provides the foundation for high-level research in Senegal.

Background Infective endocarditis (IE) is a severe disease requiring early diagnosis and treatment. Although echocardiography (ECHO) is the key diagnostic method, CT-scan (CT) has recently been added as a new ESC diagnostic criterion. However, published data are scarce and included few patients Purpose To assess the additional value of CT over ECHO for the diagnosis of IE Methods Between 2014 and 2017, 246 pts with suspected IE underwent both ECHO and CT. Using the expert consensus of the Endocarditis Team after a 3-month follow-up as gold standard, 222 IE were confirmed (112 native [NVE] and 110 prosthetic [PVE]) and 24 were rejected. The primary end-point was the comparison between ECHO and cardiac CT (CCT) findings. The secondary end-point was the change in diagnostic criteria sensitivity and specificity associated with the addition of CT results. Results 1. Among the 110 cases of definite PVE, – Vegetations were found in 49 (44%) pts by ECHO and 45 (40%) by CCT (agreement in 71 [64%] pts). – Periannular lesions were found in 33 (30%) pts by ECHO and 46 (41%) by CCT (agreement in 86 [77%] pts). – CCT found a new cardiac lesion missed by ECHO in 10 (9%) pts. 2. Among the 112 cases of definite NVE, – Vegetations were found in 84 (76%) pts by ECHO and 90 (81%) by CCT (agreement in 84 [76%] pts). – Periannular lesions were found in 34 (30%) pts by ECHO and 29 (26%) by CCT (agreement in 58 [52%] pts). – CCT found a new cardiac lesion missed by ECHO in 3 (3%) pts. 3. Including CT findings as major and minor criteria increased the sensitivity of Duke criteria from 60 to 70% in 124 suspected PVE, and from 73 to 80% in 122 suspected NVE, without significant decrease in specificity. Conclusions 1. This study is the largest prospective study assessing the value of CT in the diagnosis of IE. 2. Adding CT findings significantly increases the sensitivity of Duke criteria, both in NVE and PVE. 3. Our results support the use of ESC criteria including CT rather than Duke criteria.

Background and objectives 18F-FDG PET/CT has recently been added as a major criterion in the ESC 2015 infective endocarditis (IE) guidelines, but the value of this new diagnostic algorithm has never been prospectively assessed. Purposes 1. Primary objective: to assess the value of the new ESC criteria including 18F-FDG PET/CT in prosthetic valve infective endocarditis (PVIE). 2. Secondary objectives: to determine the reproducibility of 18F-FDG PET/CT; to assess its ability to predict embolic events. Methods Between 2014 and 2017, 175 patients with suspected PVIE were prospectively included in 3 French centers. After exclusion of patients with uninterpretable or not feasible PET/CT,115 patients were finally included in the analysis, including 91 definite IE and 24 rejected IE, as defined by an expert Consensus of Endocarditis Team after 3-month follow-up as Gold Standard Nuclear data were blindly analyzed by two independent nuclear medicine physicians. Patients follow-up was scheduled at one and three months after hospitalization Results Significant cardiac uptake by PET/CT (major criterion) was observed in 67 among 91 patients with definite PVIE and 6 patients with rejected IE (sensitivity 73.6%, specificity 75%, positive predictive value 91%, negative predictive value 42%). Considering cardiac uptake as a major criterion, the ESC 2015 classification increased the sensitivity of Duke criteria from 57 to 84% (p Intraobserver reproducibility of cardiac uptake evaluation was good (kappa = 0.84) but inter observer reproductibility was less satisfactory (kappa = 0.63). Embolic events occurred in 31 patients (27%) and were correlated with vegetation size by ECHO (p Conclusion 1. the value of PET CT and ESC criteria is confirmed and may allow earlier diagnosis of PVIE 2. PET CT is associated with an increased risk of false positive results probably related to the technical improvements 3. Reproducibility of nuclear measurements seems unsatisfactory, justifying efforts to standardize PET studies interpretation 4. Our study describes for the first time a positive correlation between a positive PET/Ct and occurrence of embolic events, warranting additional studies.

Background 18-Fluorodeoxyglucose Positron emission tomography (18F-FDG PET/CT) has been shown to be useful for the diagnosis of IE, but its prognostic value is unknown. Objectives This study sought to assess the prognostic value of 18F-FDG PET/CT in prosthetic (PVE) and native valve endocarditis (NVE). Methods We prospectively studied 173 consecutive patients (109 PVE and 64 NVE) with definite IE who underwent a 18F-FDG PET/CT study and were follow-up for one year. Primary end-point was a composite of major cardiac events i.e. death, recurrence of IE, acute cardiac failure, non-scheduled hospitalization for cardiovascular reason, and new embolic event Results 18F-FDG PET/CT was positive in 98 (57%) patients, 82% (n=88/109) in the PVE and 16% (n=10/64) in the NVE group. At a mean follow of 225±18 days, the primary end-point occurred in 94 (55%) patients, 63 (58%) in the PVE group and 31 (48%) in the NVE group. In the PVE group, positive 18F-FDG PET/CT was significantly associated with higher rate of primary end-point (OR=2.6, IC95%=1.04 to 6.6; p=0.04). Moderate to intense 18F-FDG valvular uptake was also associated with worse outcome (OR=2.1; IC95%=1.1 to 4.0; p=0.03) and to new embolic events, (OR: 8.8; IC95%= 1.1 to 69.5; p=0.02). In the NVE group, 18F-FDG PET/CT was not associated with occurrence of the primary end-point. Conclusion In addition to be an accurate diagnostic tool, 18F-FDG PET/CT is predictive of major cardiac events in PVE and to embolic events during the first year following IE episode

Resume Contexte La resistance aux antibiotiques est une question actuelle de sante publique que les etudes de paleomicrobiologie eclairent de donnees contributives. Methodes Les analyses recentes d’echantillons d’environnement et d’echantillons humains anciens, particulierement par les methodes de sequencage massif de l’ADN ont montre la presence dans ces echantillons de genes codant la resistance aux β-lactamines et aux glycopeptides ainsi qu’aux tetracyclines et aux macrolides. Conclusions Ces donnees indiquent que sans surprise, les mecanismes de resistance aux antibiotiques sont presents dans l’environnement des populations humaines anciennes auxquelles elles ont ete transmises notamment dans les microbiotes digestifs etudies au travers de l’analyse d’echantillons anciens de plaque dentaire et de microbiote digestif. Sur ces bases, les travaux en cours concernent la reconstitution de ces enzymes anciens et de leurs ancetres communs pour en tester le spectre d’activite et en comprendre les mecanismes d’evolution.

Background Embolic events (EE) are major complications of infective endocarditis (IE). Animal models have demonstrated the benefit of aspirin (ASP) and statins (ST) in their prevention, but clinical studies have given conflicting results. Purpose To evaluate the benefit of prior ASP or ST therapy on embolic risk in patients with IE. Methods In a retrospective study from 2010 to 2016, the impact of daily ASP or ST therapy on admission on the risk of EE in patients with IE was assessed. The primary end point was EE occurring before or during hospitalization. Results Among 529 pts with IE, 135 (25%) were treated by ASP, 130 (24%) were treated by ST at the time of diagnosis. EE occurred in 264 (50%) pts including 242 (46%) before and 61 (11%) after initiation of antibiotics. As compared with the 394 pts without prior ASP therapy, the 135 ASP pts were older (67.8 ± 11 vs. 64.4 ± 16 P = 0.02), had more frequent history of renal failure (P = 0.0008) and presented with less frequent EE [53 (39%) vs. 211 (53%) P = 0.01] and similar hemorrhagic complications (8 (5.9%) vs. 45 (11%) P = NS). As compared with the 399 patients without previous ST therapy, the 130 ST patients were older (63.6 ± 16 vs. 70.2 ± 9 P Conclusions Prior aspirin and statin therapy reduces EE in patients with IE without increasing hemorrhagic risk. Additional prospective studies are warranted to assess the benefit of both therapies in reducing morbidity and mortality in IE.

This review will focus on infectious diseases. A large series reviewing in-flight emergencies indicated that infectious diseases accounted for 2.8 percent of emergencies and no death. In this situation, physicians present aboard provided almost half of the initial in-flight medical care.In order to anticipate how modern technologies for medical laboratory and internet transmission of data may help reducing the medical deserts during travel, it is useful to briefly review the medical syndromes and situations most frequently encountered during travel, and then review how point-of-care (POC) laboratories may help resolving this issue. Indeed, POCs have been invented to provide patients and doctors with near-to patient, rapid diagnosis of some urgent diseases requiring some rapid medical decisions regarding the necessity for hospitalization, the necessity for isolating a contagious patient and the necessity to start a specific medical treatment such as an appropriate antimicrobial in the case of diagnosed infectious disease.

Resume Introduction Malgre de nombreux travaux consacres a la prevention, au diagnostic et au traitement des infections peri-prothetiques (IPP), les pratiques chirurgicales reposent parfois dans ce domaine sur des bases scientifiques limitees. Une large conference de consensus regroupant 50 pays, denommee International Consensus Meeting on Periprosthetic Joint Infection (ICMPJI) a produit en 2013 des recommandations robustes. Hypothese Les conferences de consensus francaises ne comportent pas de divergence majeure avec l’ICMPJI. Materiel et methodes Une traduction du consensus ICMPJI qui regroupait 300 experts et aboutissant a 207 recommandations a ete effectuee par quatre lecteurs dont 2 avait participe a la conference afin de rechercher d’eventuelles divergences avec les pratiques et recommandations francaises. Resultats Nous avons identifie 23 divergences majeures ou innovations par rapport aux recommandations et pratiques usuelles francaises. Parmi celles-ci, la non-recherche systematique du portage nasal ou urinaire d’agents infectieux avant la pose d’une prothese, ce depistage devant etre reserve aux patients symptomatiques et/ou a risque d’infection. La conference rappelle que l’environnement operatoire est un vecteur d’infection : poignee de scialytique et canule d’aspiration doivent faire l’objet d’une attention particuliere. Un ecoulement de plaie de plus de 5–7 jours doit conduire a un lavage-debridement (L-D). Cette procedure n’est efficace que dans les trois premiers mois postoperatoires et/ou dans les trois premieres semaines apres le debut des symptomes, elle doit comporter un changement des tous les implants modulaires. La conference contre indique le L-D dans un contexte fongique (suggerant une revision en deux temps) et le changement en un temps en cas de fistule. L’utilisation d’entretoises (articulees au genou) est recommandee en cas de changement en deux temps. Discussion De nombreux points de divergences sont apparus avec les recommandations et pratiques francaises. Cette conference doit amener les pratiques francaises a evoluer en retenant qu’une seule recommandation sur les 207 a obtenu un agrement de 100 % (limitation au strict minimum de la circulation du personnel dans les salles operatoires).

Background Infective endocarditis (IE) is a severe disease requiring early diagnosis and treatment. Although echocardiography (ECHO) is the key diagnostic method, CT-scan (CT) has recently been added as a new ESC diagnostic criterion. However, published data are scarce and included few patients. Purpose To assess the additional value of CT over ECHO for the diagnosis of IE. Methods Between 2014 and 2017, 246 pts with suspected IE underwent both ECHO and CT. Using the expert consensus of the Endocarditis Team after a 3-month follow-up as gold standard, 222 IE were confirmed (112 native [NVE] and 110 prosthetic [PVE]) and 24 were rejected. The primary end-point was the comparison between ECHO and cardiac CT (CCT) findings. The secondary end-point was the change in diagnostic criteria sensitivity and specificity associated with the addition of CT results. Results Among the 110 cases of definite PVE, Vegetations were found in 49 (44%) pts by ECHO and 45 (40%) by CCT (agreement in 71 [64%] pts). Periannular lesions were found in 33 (30%) pts by ECHO and 46 (41%) by CCT (agreement in 86 [77%] pts). CCT found a new cardiac lesion missed by ECHO in 10 (9%) pts. Among the 112 cases of definite NVE, Vegetations were found in 84 (76%) pts by ECHO and 90 (81%) by CCT (agreement in 84 [76%] pts). Periannular lesions were found in 34 (30%) pts by ECHO and 29 (26%) by CCT (agreement in 58 [52%] pts). CCT found a new cardiac lesion missed by ECHO in 3 (3%) pts. Including CT findings as major and minor criteria increased the sensitivity of Duke criteria from 60 to 70% in 124 suspected PVE, and from 73 to 80% in 122 suspected NVE, without significant decrease in specificity. Conclusions This study is the largest prospective study assessing the value of CT in the diagnosis of IE. Adding CT findings significantly increases the sensitivity of Duke criteria, both in NVE and PVE. Our results support the use of ESC criteria including CT rather than Duke criteria.

Background and Objectives In native mitral valve infective endocarditis (NMVIE), the respective values of mitral valve repair (MVR) and mitral valve replacement (MVRP) are still debated. We compared MVR and MVRP in a large prospective series of pts operated on for NMVIE in La Timone Hospital, Marseille. Methods Between 2010 and 2017, 151 pts with NMVIE underwent early ( Results As compared with MVR, MVRP pts had more associated aortic abscess (15 vs 4%, P = 0.03), and more restrictive lesions (28 vs 3%, P Conclusion Early MVR for NMVIE is associated with better outcome than MVRP, without excess reoperation rate, residual mitral regurgitation, or recurrence. In experienced hands, early MVR is technically feasible in 76% of NMVIE and should be the preferred option in these pts.

Resume Staphylococcus aureus est l’agent pathogene le plus frequemment rencontre dans les infections sur materiel orthopedique et diverses strategies sont employees pour limiter le risque de transmission et donc d’infection lors des gestes chirurgicaux. Objectifs A partir de la realisation de meta-analyses, l’objectif de ce travail etait d’etudier, d’une part, la relation entre portage nasal de S . aureus et developpement d’infections osteo-articulaires et, d’autre part, d’evaluer les methodes actuelles de decolonisation. Resultats Concernant la relation entre portage nasal de S . aureus et infection du site operatoire, les resultats de la meta-analyse montrait une relation en faveur d’une augmentation du risque d’infection en cas de portage : OR = 5,92 ; 95 % IC 95 [1,15–30,39] ; p = 0,033. Concernant la prevention de la transmission croisee, il existe une preuve scientifique etablie montrant une reduction significative du site operatoire a S . aureus par l’association mupirocine et solution antiseptique de chlorhexidine 2 %, chez les sujets dont le depistage nasal est positif, toute chirurgie confondue ; mais la difference n’est pas significative dans le sous-groupe de chirurgie orthopedique. Les resultats de la meta-analyse confirme cette tendance : OR = 0,60 ; IC 95 [0,34–1,06] ; p = 0,08. Conclusion Cette revue de la litterature confirme que le portage nasal de S . aureus est un facteur de risque majeur des infections du site operatoire (ISO). L’efficacite de l’eradication de ce portage n’est pas clairement demontree en chirurgie orthopedique, a cause d’echantillons trop faibles. La tendance positive doit cependant inciter a favoriser les etudes de taille suffisante et dans l’attente, d’evaluer au cas par cas, le benefice risque. Niveau de preuve Niveau 2. Meta-analyse.

Postmeningitis subdural empyema is rare in infants. It can have a severe clinical course with possible serious long-term consequences and 10% mortality. Diagnosis is often difficult. Postmeningitis subdural empyema must be discussed in cases of atypical progression of well-treated meningitis. We report the case of an 18-month-old infant presenting subdural empyema with an insidious course following Neisseria meningitidis group C meningitis.

Résumé Le diagnostic des infections bactériennes repose sur l’isolement du pathogène, qui ne peut pas être réalisé dans le temps du soin. Egalement, la culture est mal adaptée au diagnostic des infections polymicrobiennes. Une alternative est la détection de séquences ADN spécifiques dans l’échantillon clinique par les puces à ADN. La première utilisation des puces à ADN en tant qu’outil diagnostic date de 1995. Cette revue porte sur la mise au point de différentes puces à ADN pour la détection des bactéries pathogènes au cours des infections respiratoires, digestives et systémiques. Ces études ont permis de montrer que les puces à ADN sont un outil fiable, rapide et reproductible pour le diagnostic des maladies infectieuses d’origine bactérienne. Le coût et la technicité demeurent deux freins au déploiement en routine de cette technologie pour le diagnostic des infections bactériennes.

Resume Objectifs L’implantation de protheses articulaires est devenue un geste frequemment realise, mais le risque d’infection persiste entre 0,5 et 2 %. Le traitement necessite une prise en charge medicochirurgicale de longue duree. Le traitement antibiotique prepare le geste operatoire en reduisant l’inoculum bacterien. Le plus souvent, l’ablation chirurgicale des tissus infectes et de la prothese s’impose, mais n’est pas parfaitement codifiee. Le traitement ambulatoire de longue duree Il permet, dans de nombreux cas, de proteger le materiel implante et facilite la prise en charge therapeutique en diminuant le nombre de jours d’hospitalisation et le nombre de gestes chirurgicaux. L’antibiotherapie doit etre adaptee aux bacteries isolees et necessite souvent des associations d’antibiotiques. Les patients doivent etre traites au moins six mois et etre suivis regulierement pendant plusieurs annees apres l’arret du traitement pour detecter les recidives. Algorithmes decisionnels Le traitement ambulatoire de longue duree peut etre propose d’emblee en cas de prothese de hanche ou d’epaule non descellee, infectee a staphylocoques, Pseudomonas ou enterobacteries. Le nettoyage chirurgical avec conservation de la prothese est propose lors d’infections postoperatoires precoces diagnostiquees rapidement et avec un bon etat cutane. Le changement de prothese doit etre propose en cas de prothese descellee et systematiquement en cas de prothese de genou. Le choix d’un changement en un temps ou deux temps depend de l’efficacite initiale du traitement antibiotique, de l’etat cutane local et de l’etat general.

Resume Objectifs Les mycobacteries a croissance rapide sont des pathogenes emergents d’isolement facile, mais d’identification laborieuse. L’objectif de ce travail est de preciser le role de ces especes en pathologie humaine. Materiels et methodes Nous avons revu l’ensemble des articles de langue anglaise publies en 1999–2007 utilisant les mots cles : rapidly growing mycobacteria. Resultats Vingt-sept nouvelles especes de mycobacteries a croissance rapide ont ete decrites en dix ans. Les mycobacteries a croissance rapide produisent des colonies visibles sur gelose en moins d’une semaine, la plupart des milieux non selectifs permettant la croissance en particulier la gelose au sang. Leur identification precise ne peut se faire actuellement qu’a l’aide du sequencage de genes cibles, en particulier du gene rpoB. Discussion Si l’interpretation d’une mycobacterie a croissance rapide dans un prelevement clinique n’est pas univoque, ces especes sont responsables d’infections pulmonaires chroniques resistantes aux traitements antibiotiques, en particulier chez les patients presentant une mucoviscidose ; elles sont egalement responsables d’infections d’inoculation de la peau et des tissus mous, de septicemies avec une porte d’entree vasculaire, ainsi que d’osteites. La prochaine mise a disposition du genome de Mycobacterium abscessus et de Mycobacterium chelonae permettra certainement la mise en place de nouveaux outils moleculaires de detection et d’identification, tandis que des systemes phenotypiques multiparametriques devraient permettre l’identification phenotypique fonctionnelle pour l’ensemble des laboratoires de microbiologie.

Resume Objectif Evaluer l’interet du scanner dans l’exploration des infections de protheses totales de hanches. Patients et methodes Un scanner a ete realise sur dix sept hanches de quatorze patients presentant une suspicion d’infection de prothese totale de hanche. Nous recherchons dans les parties molles peri-prothetiques la presence d’abces, d’epanchements articulaires et de fistules cutanees et au niveau de l’interface os-materiel prothetique, la presence de liseres radio-clairs ou d’erosions osseuses. Nous etudions la faisabilite du scanner malgre les artefacts metalliques generes par les protheses. Resultats Dix hanches sont septiques. Nous retrouvons un abces dans les parties molles chez huit patients sur dix, associe dans sept cas a un epanchement articulaire suspect de surinfection. Un trajet fistuleux inflammatoire est retrouve dans huit cas. L’analyse de l’interface osseuse revele la presence de liseres chez dix patients, dont sept sont septiques et d’erosions chez quatre patients dont deux sont septiques. Les artefacts metalliques ne sont pas un obstacle dans la visualisation des abces des parties molles. Conclusions Le scanner permet le diagnostic d’abces des parties molles au cours des infections de protheses de hanches. Cet examen permet d’orienter l’intervention chirurgicale ou une surveillance si un traitement medical seul est envisage.

Resume Introduction. – La leptospirose icterohemorragique est une anthropozoonose endemique en France. La forme clinique la plus connue est la forme de Weil's. La fievre de Fort Bragg comporte une lesion cutanee papuleuse pretibiale caracteristique. Decrite initialement aux Etats-unis, elle constitue une forme souvent benigne et habituellement non icterique de leptospirose. Nous rapportons le premier cas francais empruntant des signes cliniques a ces deux formes. Exegese. – Un homme, âge de 52 ans vivant dans le Var, developpait un syndrome pseudogrippal severe associe a une lesion papuleuse erythemateuse pretibiale. L'evolution etait marquee par l'apparition d'un ictere severe dont l'exploration concluait a une leptospirose. Conclusion. – Le cas de notre patient rappelle la forme clinique particuliere de leptospirose qu'est la fievre de Fort Bragg. Cette derniere doit etre reconnue devant une lesion inflammatoire pretibiale febrile avec ou sans evolution icterique.

Influenza is the most important cause of acute respiratory illness leading to hospitalization among children during community epidemics. This illness can cause extensive nosocomial outbreaks with serious morbidity and mortality among specific groups of children. Paediatric patients with community-acquired influenza and healthcare workers are the main reservoir for the nosocomial spread of the virus. During epidemics in the community, testing for influenza should be requested in all children with compatible symptoms admitted in the hospital, and measures should be introduced for the prevention or early control of an outbreak. Recent advances in the management of influenza include rapid diagnoses based on antigen detection and the identification of the new neuraminidase inhibitors zanamivir and oseltamivir. Annual vaccination against influenza of children with high-risk conditions, their family members and healthcare workers is the principle measure for the prevention of nosocomial outbreaks. Although vaccination against influenza appears to be cost-effective at all ages in terms of prevention of illness, related hospitalizations, deaths, reduction of healthcare costs and productivity loss, vaccination coverage among target groups is limited.

Europa and Juan-de-Nova are two little coral islands in the Mozambique Channel. They are only occupied by a troop detachment of 15 men, who exercise the French sovereignty and maintain the island. During these activities, the men work in dampness and they can encounter rats. The aim of this survey is to show presence of leptospirosis in these islands by testing rat kidney by specific PCR. The results found a positive specimen on each island (2/52) indicating a previously unknown presence of Leptospira organisms in these islands.

A chlorine preparation was tested against 34 strains of Aeromonas hydrophila isolated from a hospital water facility and patients with nosocomial infections in a French medical school hospital. In-vitro bactericidal activity was determined by a macro- and micromethod, using specific interfering substances over a range of dilutions and temperatures, after 1 and 5 minute exposure times. A 10 5 -fold reduction in the challenge inoculum was taken as the criterion of efficacy. Results obtained by both methods agreed and indicated a median minimal bacterial concentration of chlorine of from 0·95 ppm without interfering substances to 297 ppm in the presence of interfering substances. These data indicate that Aeromonas hydrophila isolates are relatively resistant to chlorine, thus precluding the use of chlorine alone as a disinfectant for water supplies contaminated with Aeromonas spp.

Introduction: Because of the increased use of im plantable access systems, the incidence of blood stream and catheter infections associated with these systems has concomitantly increased. Classically, he parin-lock flush solutions were used to prevent thrombosis; more recently, vancomycin was added to the solution to prevent infections caused by Gram- positive bacteria, particularly coagulase-negative Staphylococci. Disorders due to Gram-negative organ isms have now appeared in oncologic patients. We therefore tested the addition of colistin to heparin- vancomycin solutions. Colistin was chosen for its good activity against Gram-negative bacteria (98% susceptibility in our hospital), its good tolerance due to low systemic passage, and its low cost. Methods: We developed formulations contain ing heparin (100 IU/mL) and various concentrations of vancomycin (10-500 μg/mL) and colistin (10-100 μg/mL) in 0.9% NaCl. Each sterile solution was tested for physical and chemical compatibility (spectropho tometry, nuclear magnetic resonance, and pH mea surements) and its antibacterial activity (against ox acillin-resistant Staphylococcus aureus, Enterococcus faecium, Klebsiella pneumoniae exhibiting broad- spectrum betalactamase (BSBL), imipenem-resistant Pseudomonas aeruginosa) for 2 months at 4°C and at room temperature. Results: The most suitable combination of drugs is heparin (100 IU/mL), vancomycin (100 μg/mL), and colistin (100 μg/mL). This flush solution main tains activity when stored at 4°C for up to 1 month. Conclusions: We feel that the combination of heparin, vancomycin, and colistin can be used as a flush solution for indwelling catheters.

Purpose Microbial keratitis is an infection of the cornea that can be severe since it leads, in some cases, to blindness. One of the most important prognostic factors is the microbiological diagnosis which determines the rapid use of the appropriate treatment. Therefore we sought a faster and more efficient diagnosis method by using mass spectrometry. Methods This study is the analysis of corneal samples with MALDI-TOF MS as a new approach, undeveloped in the literature, without preparation nor culture of infected epithelia. All together 18 human corneal epithelia were studied to characterize the healthy human corneal spectra. An animal experimentation was also conducted on 45 Balb/c mice for comparison of their left healthy corneas and their right infected corneas by two difficult diagnosis seeds: Mycobacterium chelonae or Acanthamoeba polyphaga. Results Corneal protein spectra can be obtained quickly, in less than ten minutes, and easily by simple deposit on a mass-spectrometry target. The study of healthy corneas gives reproducible and specific spectra compared to other human tissues available in our database. In animal model, the MALDI-TOF MS detects an inflammatory response secondary to wound healing corneal and an infectious response to Mycobacterium chelonae. Conclusion This original work consists in using MALDI-TOF MS for a microbial keratitis analyze directly on infected epithelium. This technique permits, to differentiate easily and quickly, a healthy cornea from an ulcerated or infected one in mice. After the development of microbiologic recognition algorithms, mass-spectrometry could be used, in the future, for a “minute” diagnosis of infectious keratitis.Diagnosis of infectious keratitis by mass spectrometry.

Postmeningitis subdural empyema is rare in infants. It can have a severe clinical course with possible serious long-term consequences and 10% mortality. Diagnosis is often difficult. Postmeningitis subdural empyema must be discussed in cases of atypical progression of well-treated meningitis. We report the case of an 18-month-old infant presenting subdural empyema with an insidious course following Neisseria meningitidis group C meningitis.

Purpose The etiologic evaluation of uveitis is frequently unsuccessful if only noninvasive methods are used. We conducted a prospective study to evaluate systematic screening for pathogens of uveitis. Methods All patients with uveitis referred to the participating tertiary ophthalmology departments from January 2001 to September 2007 underwent intraocular and serum specimen collection. The standardized protocol for laboratory investigations included universal polymerase chain reaction (PCR)-based detection of any bacteria and mycoses, specific PCR-based detection of fastidious (difficult-to-grow) bacteria and herpes viruses, and culture of vitreous fluid. Sera were tested for fastidious bacteria. Results Among the 1321 included patients, infection was diagnosed in 147 (11.1%) patients: 78 (53%) were caused by fastidious bacteria that included spirochetes, Bartonella species, intracellular bacteria (Chlamydia species, Rickettsia species, Coxiella burnetii), and Tropheryma whipplei; 18 by herpes viruses; and 9 by fungi. Bartonella quintana, Coxiella burnetii, Paracoccus yeei, Aspergillus oryzae, and Cryptococcus albidus were found to be associated with uveitis for the first time, to our knowledge. Conclusion We recommend applying a 1-step diagnostic procedure that incorporates intraocular, specific microbial PCR with serum analyses in tertiary centers to determine the etiology of uveitis.

Europa and Juan-de-Nova are two little coral islands in the Mozambique Channel. They are only occupied by a troop detachment of 15 men, who exercise the French sovereignty and maintain the island. During these activities, the men work in dampness and they can encounter rats. The aim of this survey is to show presence of leptospirosis in these islands by testing rat kidney by specific PCR. The results found a positive specimen on each island (2/52) indicating a previously unknown presence of Leptospira organisms in these islands.

Coxiella burnetii is a strictly intracellular bacterium. Bacteriostatic effects have been described previously on a few isolates in embryonated eggs (A. J. Spicer, M. G. Peacock, and J. C. Williams, p. 375-383, in W. Burgdorfer and R. L. Anacker, ed., Rickettsiae and rickettsial diseases, 1981). We used the shell-vial technique (D. Raoult, G. Vestris, and M. Enea, J. Clin. Microbiol. 28:2482-2484, 1990) to determine the susceptibility of C. burnetii to amoxicillin, amikacin, erythromycin, co-trimoxazole, pefloxacin, ofloxacin, ciprofloxacin, chloramphenicol, tetracycline, doxycycline, minocycline, and rifampin antibiotics at a single dilution. Human embryonic lung fibroblast monolayers in shell vials were seeded with 13 different C. burnetii isolates, including 3 reference strains (Nine Mile, Q212, and Priscilla) and 10 new isolates, in order to obtain 30% infected cells 6 days later. After inoculation, antibiotics were added, shell vials were incubated for 7 days, and immunofluorescence was revealed and compared with that of the positive controls. Strain Nine Mile was more susceptible than strains Q212 and Priscilla were. The heterogeneity of susceptibility to fluoroquinolones, chloramphenicol, and erythromycin was noted among the strains; all were resistant to amoxicillin and amikacin, and all were susceptible to rifampin, co-trimoxazole, tetracycline, and tetracycline analogs.