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Djibouti is an East African country with a high tuberculosis incidence. This study was conducted over a 2-month period in Djibouti, during which 62 consecutive patients with pulmonary tuberculosis (TB) were included. Genetic characterization of Mycobacterium tuberculosis, using mycobacterial interspersed repetitive-unit variable-number tandem-repeat typing and spoligotyping, was performed. The genetic and phylogenetic analysis revealed only three major families (Central Asian, East African Indian and T). The high diversity and linkage disequilibrium within each family suggest a long period of clonal evolution. A Bayesian approach shows that the phylogenetic structure observed in our sample of 62 isolates is very likely to be representative of the phylogenetic structure of the M. tuberculosis population in the total number of TB cases.

Resume La maladie du charbon est une zoo-anthroponose touchant les troupeaux et parfois l’homme en contact avec les produits animaux dans un contexte de maladies professionnelles, industrielles ou de toxi-infections alimentaires. Elle se presente sous formes cutanee, digestive et respiratoire. Bacillus anthracis est l’agent responsable de la maladie du charbon. C’est un bacille a Gram positif, immobile, capsule, non hemolytique formant des spores. Alors qu’il est facile de traiter le charbon cutane par les antibiotiques, le charbon digestif, le charbon meninge et le charbon pulmonaire (ou d’inhalation) sont redoutables. Le cycle du charbon met en jeu une forme sporulee tellurique et une forme vegetative capsulee produisant les toxines charbonneuses chez l’hote. Toujours presente dans l’environnement hydrotellurique des zones d’enzootie, la maladie reemerge periodiquement en fonction des evolutions climatiques et ecologiques ou des activites humaines. La grande resistance des spores dans l’environnement et la virulence du bacille du charbon en font un agent potentiel de guerre bacteriologique et de bioterrorisme de premier plan. Il est donc important de savoir faire le diagnostic biologique de cette maladie qui s’appuie sur des techniques de bacteriologie classique, de biologie moleculaire et d’immunologie.

Resume Le diagnostic au laboratoire des parasitoses oculaires est un sujet peu aborde dans la litterature. Le fait est qu’un grand nombre de parasites est susceptible d’atteindre cet organe en mettant en jeu a chaque fois le pronostic fonctionnel visuel. C’est pourquoi cet article propose une revue de la litterature des moyens disponibles au laboratoire pour le diagnostic des plus frequentes de ces affections. Les strategies a mettre en œuvre sont variees. Elles doivent tenir compte d’un certain nombre de contraintes dont les principales sont : la difficulte et la dangerosite des prelevements et le rendement des techniques diagnostiques utilisees.

Resume La recherche de porteurs asymptomatiques de Salmonella spp. parmi le personnel de la restauration est une pratique ancienne et bien connue des professionnels qui en ont la charge. La responsabilite de ces porteurs dans la survenue de toxi-infections alimentaires collectives n'est cependant pas bien etablie pour les salmonelles non typhiques. L'analyse de la litterature scientifique montre qu'il s'agit la plupart du temps de patients malades ou convalescents qui auraient pu etre identifies avec un bon interrogatoire et un bon signalement. Il apparait de plus en plus que le depistage systematique a l'embauche est une mesure couteuse et inutile. Ces considerations meriteraient d'etre prises en compte pour actualiser la reglementation.

The need for diagnosis of imported malaria is frequent in France. Diagnosis biological tools are different, according methods, sensitivity, interpretation and costs. Strategies for their use could be stratified according locally available methods, and experience of the practician.

Resume Les medecins exercant en pays tropical sont frequemment places dans des situations ou une formation minimale aux techniques de laboratoire s'avere tres utile. Cette formation courte doit etre adaptee a la fois aux besoins et aux techniques realisables sur place. Elle doit contenir des techniques hematologiques de base, les examens directs en bacteriologie et parasitologie en insistant particulierement sur le diagnostic du paludisme. Le conditionnement et l'expedition des echantillons dans de bonnes conditions de securite vers un laboratoire de reference font aussi partie des objectifs pedagogiques. Selon les besoins, les stagiaires pourront aussi etre formes a la detection des premiers cas dans le contexte d'epidemies de meningites a meningocoque ou de cholera. Cette formation courte doit enfin etre prolongee par des documents pedagogiques et les CD Rom apparaissent comme les supports les mieux adaptes.

This study allowed evaluation and comparison of the precision (20 samples) and agreement (200 samples) of the relative and absolute values of the monocyte count using three methods: microscopic, flow cytometry and the automated ABX Vega hematology analyzer. Flow cytometry is the most precise method, even if the coefficient of variation of the automated analyzer is very similar. The coefficient of correlation between the ABX Vega and the flow cytometer is very satisfactory (r = 0.8042). This study of the agreement also made it possible to confirm the difficulty that automated hematology analyzers have in differentiating between some granulocytes and monocytes and their propensity to overstimate the latter when the sample includes immature forms of granulocytes. This fact stresses the importance of the microscopic method, despite its lack of precision. The observed discrepancies did not lead to any difficulties in clinical interpretation; however, this finding should be taken into consideration, particularly in myleoproliferative syndromes and the laboratory monitoring of chemotherapy.

We present laboratory measurements of the absorption cross sections of the ν5 band (540–580 cm−1) of chlorine nitrate made under stratospheric conditions of temperature and pressure. We use the measured cross sections and observed mid-infrared stratospheric emission spectra to retrieve mid-latitude vertical mixing ratio profiles for both day and night in the altitude range 20–34 km, and compare the results with a sunset profile obtained simultaneously from solar absorption measurements of the ν4 Q branch at 780 cm−1. The profiles obtained using these two methods are shown to be in excellent agreement, validating retrievals using the ν4 band. We also find good agreement in this altitude range between the observed day/night ratio and the results of a 1-D photochemical model

Resume Les accidents d'ordre immunologique sont parmi les causes les plus frequentes d'incidents transfusionnels. Les controles de concordance ultime pre-transfusionnels constituent la derniere etape avant transfusion. L'evaluation de leur qualite de realisation n'est pas effectuee en pratique. Nous avons donc mis en place a l'HIA Laveran une evaluation de la qualite de realisation de ces tests. Pendant une periode de 13 mois de novembre 2001 a decembre 2002 les cartes de concordance ultime pre-transfusionnel ont ete retournees systematiquement au depot de sang medicalise pour analyse (taux de retour 91 %). Trois types d'erreurs ont ete releves : erreurs techniques, erreurs de comprehension et erreurs mixtes. Le taux global de non conformite etait de 10,4 % (sur un total de 1632 cartes). Pour chaque erreur, l'utilisateur de la carte a beneficie d'une formation complementaire tandis que l'evaluation de la qualite de la realisation de ces tests etait poursuivie parallelement. Cet enseignement s'est accompagne d'une baisse significative du taux de non conformite global (22,8 % en novembre 2001 contre 10,7 % en decembre 2002). Cette etude a permis de mettre en evidence l'importance d'une evaluation de la qualite de realisation de ces tests de concordance ultime et l'efficacite de mesures correctrices simples.

Using Fourier-transform spectra, absolute line position measurements were performed in the 1 ← 0 allowed subbands of 14 N 16 O for transitions characterized by high J values ( J ≤ 41.5). A global analysis of these new data along with previously published infrared, far-infrared, and microwave data involving the ν = 0, 1, and 2 vibrational states was carried out and yielded improved rovibrational, Λ-doubling, and hyperfine coupling spectroscopic constants. Absolute intensities have also been obtained and the vibrational dipole moment of the 1 ← O subbands, as well as the Herman-Wallis coefficients, were determined through an analysis of these new intensities and of those reported by M. N. Spencer, C. Chakerian, Jr., L. P. Giver, and L. R. Brown ( J. Mol. Spectrosc. 165, 506-524, 1994). These constants and the ones reported for the 2 ← 1 allowed subbands and the 1 ← 0 forbidden subbands were used to compute a complete synthetic spectrum in which line positions were calculated, using the spectroscopic constants obtained in this work and accounting for the hyperfine structure.

Resume Haemophilus aphrophilus est un commensal des voies aeriennes superieures des vertebres rarement pathogene pour l'homme. Il est responsable d'endocardites et d'abces cerebraux dont il peut representer 16 % des etiologies. Les facteurs favorisants sont des facteurs lies au germe (tropisme cerebral et coinfection bacterienne), lies a l'hote (metastase d'origine valvulaire, infection loco-regionale, immunodepression) et rarement lies a l'environnement (contact avec les animaux domestiques). Le diagnostic differentiel peut se poser avec H. paraphrophilus, H. actinomycetemcomitans, Eikenella corrodens et Cardiobacterium hominis. H. aphrophilus a en general une sensibilite conservee aux antibiotiques. Deux nouveaux cas d'abces cerebral a H. aphrophilus sont rapportes. L'evolution de ces cas recents est favorable. Les progres des moyens diagnostiques facilitent l'isolement de ce germe qui doit etre systematiquement recherche dans les abces cerebraux communautaires.

Using Fourier transform spectra, absolute line positions and intensities have been measured in the 2 Π 1/2 - 2 Π 3/2 and 2 Π 3/2 - 2 Π 1/2 forbidden subbands of the vibrational 1 ← 0 fundamental band of nitric oxide. To retrieve accurate results from the spectra, the hyperfine structure was carefully taken into account. From the measured line intensities, the vibrational transition dipole moment, as well as the Herman-Wallis coefficients, has been determined for the studied subbands.

The ν1 and 2ν6 infrared bands of 35CINO2 around 7.7 μm have studied for the first time by high-resolution Fourier-transform spectroscopy. Assignments have been made for 2109 a-type P-, Q-, and R-branch transitions of the ν1 band (with K′a up to 30 and J′ up to 80) and 2139 a-type P-, Q-, and R-branch transitions of the 2ν6 band (with K′a up to 26 and J′ up to 78). The rotational constants in the v1 = 1 and v6 = 2 vibrational states of 35CINO2 were determined by least-squares calculations. The strength of the first-order Fermi resonance between the v1 = 1 and v6 = 2 vibrational states and its influence on the rotational constants are discussed.

Nitryl chloride (ClNO[sub 2]) is involved in heterogeneous stratospheric chemistry by the reaction of HCl with N[sub 2]O[sub 5] on polar stratospheric cloud particles. The present work reports the first high-resolution infrared absorption spectra of nitryl chloride. The authors have recorded two infrared absorption spectra of ClNO[sub 2] at room temperature between 450 and 2,450 cm[sup [minus]1] with a stepping-mode Fourier transform spectrometer at 0.0028 cm[sup [minus]1] nonapodized resolution. The spectrum shows rich, well-resolved rotational structure in the [nu][sub 6] (652 cm[sup [minus]1]), [nu][sub 2] (792 cm[sup [minus]1]), [nu][sub 1] (1,268 cm[sup [minus]1]), 2[nu][sub 6] (1,318 cm[sup [minus]1]), and [nu][sub 4] (1,684 cm[sup [minus]1]) bands. They have carried out a rotational analysis of the [nu][sub 4] band of [sup 35]ClNO[sub 2] around 1,684 cm[sup [minus]1], leading to the assignment of 1,691 b-type transitions. The authors have determined new rotational constants for the ground state, and the rotational constants for the [nu][sub 4] = 1 vibrational state.

Seventy-six individual line intensities of the {ν 5 , 2ν 9 } and {ν 3 , ν 4 } bands of HNO 3 have been measured using high-resolution Fourier transform spectra recorded in the 450-1640 cm −1 spectral range. These intensities were then accurately reproduced using a model which takes explicitly into account both Fermi- and Coriolis-type resonances affecting the { v 5 = 1, v 9 = 2} and { v 3 = 1, v 4 = 1} interacting upper levels of HNO 3 . Finally, synthetic spectra (line positions and intensities) of the {ν 5 , 2ν 9 } (11 μm) and {ν 3 , ν 4 } (7.6 μm) bands of HNO 3 have been generated.

The investigation of the rotational structure of the 2ν3(A1), ν1(A1), 2ν9(A1), and ν3 + ν4(A1) bands of CH2D2 is carried out. The band centers and rotational, centrifugal, and resonance parameters are obtained.

The investigation of the rotational structure of ν 4 + ν 9 ( B 2 ), 2 ν 9 ( A 1 ), and ν 3 + ν 4 ( A 1 ) bands of CH 2 D 2 is carried out. The band centers (2285.97695, 2458.79616, and 2469.20351 cm −1 , respectively) and rotation-vibration energy levels are obtained.

Here we present the first line‐by‐line measurements of interference parameters Y0k describing line‐mixing effects in the weak overlapping regime for He‐broadened CO lines in the 0–1 and 0–2 bands at 296 K. A detailed analysis of the line shape at intermediate perturber pressures (up to about 10 atm) has been performed, starting from previous theoretical calculations, which has demonstrated the possibility of an individual measurement of Yk parameters. The method is based on the existence of a component of the line shift, quadratic with the perturber pressure (density) and proportional to Y0k. Comparison of our measurements with results predicted from coupled‐states calculations shows good overall agreement. Linear pressure shifts have also been simultaneously measured. The uncertainty on the data is important since linear shifts are very small; however, some features can be considered as significant although we have no clear understanding of them. Possible explanations are discussed.

High-resolution infrared spectra of CH2D2 have been recorded with a Fourier transform interferometer. The rotational structures of the vibrational bands 2ν5(A1), ν3 + ν9(B2), ν5 + ν9(B1), and ν3 + ν7(B1) have been analyzed. The band centers, rotational, centrifugal, and resonance parameters obtained reproduce the experimental data within about 0.001 cm−1.

The intensities of 13 C 16 O 2 lines have been measured in the three bands centered at 883.145, 913.425, and 1017.659 cm − , using Fourier transform spectra. The square of the transition dipole moment and the Herman-Wallis coefficients have been determined; the band intensities deduced from these results are in good agreement with the ones obtained by calculations employing the Direct Numerical Diagonalization method. In addition, the self-broadening coefficients of 75 lines have been measured in the two strongest bands.

Background Chikungunya virus (CHIKV), an arbovirus, is responsible for a two-stage disabling disease, consisting of an acute febrile polyarthritis for the first 10 days, frequently followed by chronic rheumatisms, sometimes lasting for years. Up to now, the pathophysiology of the chronic stage has been elusive. Considering the existence of occasional peripheral vascular disorders and some unexpected seronegativity during the chronic stage of the disease, we hypothesized the role of cryoglobulins. Methods From April 2005 to May 2007, all travelers with suspected CHIKV infection were prospectively recorded in our hospital department. Demographic, clinical and laboratory findings (anti-CHIKV IgM and IgG, cryoglobulin) were registered at the first consultation or hospitalization and during follow-up. Results Among the 66 travelers with clinical suspicion of CHIKV infection, 51 presented anti-CHIKV IgM. There were 45 positive with the serological assay tested at room temperature, and six more, which first tested negative when sera were kept at 4°C until analysis, became positive after a 2-hour incubation of the sera at 37°C. Forty-eight of the 51 CHIKV-seropositive patients were screened for cryoglobulinemia; 94% were positive at least once during their follow-up. Over 90% of the CHIKV-infected patients had concomitant arthralgias and cryoglobulinemia. Cryoglobulin prevalence and level drop with time as patients recover, spontaneously or after short-term corticotherapy. In some patients cryoglobulins remained positive after 1 year. Conclusion Prevalence of mixed cryoglobulinemia was high in CHIKV-infected travelers with long-lasting symptoms. No significant association between cryoglobulinemia and clinical manifestations could be evidenced. The exact prognostic value of cryoglobulin levels has yet to be determined. Responsibility of cryoglobulinemia was suspected in unexpected false negativity of serological assays at room temperature, leading us to recommend performing serology on pre-warmed sera., Author Summary Chikungunya virus is present in tropical Africa and Asia and is transmitted by mosquito bites. The disease is characterized by fever, headache, severe joint pain and transient skin rash for about a week. Most patients experience persisting joint pain and/or stiffness for months to years. In routine practice, diagnosis is based upon serology. Since 2004 there has been an ongoing giant outbreak of Chikungunya fever in East Africa, the Indian Ocean Islands, India and East Asia. In parallel, more than 1,000 travelers were diagnosed with imported Chikungunya infection in most developed countries. Considering the clinical features of our patients (joint pain), we hypothesized that cryoglobulins could be involved in the pathophysiology of the disease as observed in chronic hepatitis C infection. Cryoglobulins, which are immunoglobulins that precipitate when temperature is below 37°C, can induce rheumatic and vascular disorders. From April 2005 through May 2007, we screened all patients with possible imported Chikungunya infection for cryoglobulins. They were present in over 90% of patients, and possibly responsible for the unexpected false negativity of serological assays. Cryoglobulin frequency and levels decreased with time in recovering patients.

The investigation of the rotational structure of ν 4 + ν 9 ( B 2 ), 2 ν 9 ( A 1 ), and ν 3 + ν 4 ( A 1 ) bands of CH 2 D 2 is carried out. The band centers (2285.97695, 2458.79616, and 2469.20351 cm −1 , respectively) and rotation-vibration energy levels are obtained.

Resume En 1994, la Bioforce intervenait a Djibouti pour une epidemie de cholera. La necessite d'installer un centre de traitement en milieu urbain a amene a adopter des solutions originales: hopital sous tente a cote de l'hopital general et epandage des excreta. Cette action ponctuelle, qui fut tres efficace dans la lutte contre la letalite, ne pouvait pas regler les problemes de fond: acces de la population a l'eau potable et assainissement. Ces carences deviennent encore plus criantes au moment des inondations qui sont devenues frequentes depuis quelques annees aux mois de novembre et decembre.

Visceral leishmaniasis is present in 61 countries but 90% of the 500,000 new cases that arise annually occur in five countries, i.e., India, Bangladesh, Nepal, Sudan, and Brazil. Annual mortality is approximately 59000 cases. Agents based on pentavalent antimony have been the mainstay of treatment for the last 60 years. In recent years, however, clinical resistance to these agents has been reported especially in the state of Bihar in India. Pentamidine and amphotericin B were introduced in the 1950s and 1960s. More recent additions to the therapeutic arsenal include liposomal amphotericin B, miltefosine, and paromomycin. Among these recent molecules, miltefosine, i.e., the only oral agent, appears most vulnerable because it involves long-term treatment and has a long half-life. The main therapeutic problems now being encountered are the emergence of acquired resistance to antimonials, the high cost of treatment, and failure of therapy in immunocompromised patients mainly due to concurrent human immunodeficiency virus (HIV) infection. For eradication initiatives such as the one aimed at eliminating leishmaniasis on the Indian subcontinent, the appearance of drug resistance increases the risk associated to parasite infection and, as for malaria, tuberculosis and HIV infection, raises fears that the problems in the implementation of public health policies will lead to highly refractory forms.

The need for diagnosis of imported malaria is frequent in France. Diagnosis biological tools are different, according methods, sensitivity, interpretation and costs. Strategies for their use could be stratified according locally available methods, and experience of the practician.

Zoonosis is the cause of the vast majority of emerging diseases. Bats that occupy the second place in the mammal class play an important role. Whether they belong to the microchiroptera suborder or to the megachiroptera suborder, bats on all five continents have been implicated in transmission of numerous pathogens including not only viruses such as Lyssavirus (e.g. rabies), Hepanivirus (e.g. Hendra and Nipah virus) and recently coronavirus (e.g. SARS-like coronavirus and Ebola virus) but also fungus such as histoplasmosis. By modifying environmental conditions and encroaching on their biotope, human intervention has probably contributed to the introduction of chiropteras into an epidemiologic chain in which they previously had no place, thus promoting the emergence of new pathogens.

Malaria is a parasitological emergency requiring safe quick accurate diagnosis so that appropriate therapy can be implemented. A number of rapid diagnostic tests based on detection of HRP2 Ag, enzymes, LDH or aldolase are now available. However the use of these tests is restricted to trained, experienced staff in special situations. The purpose of this report is to describe the different tests on the market and clarify the limitations for their use.

In 2001, an outbreak of typhoid fever occurred among the members of the French Armed Forces. All had received a typhoid vaccination as per the immunization schedule practiced in the Armed Forces (every 5 years). A retrospective cohort study was conducted in 94 personnel. The objectives were to confirm the diagnosis, determine the source of contamination and identify the factors associated with defective vaccinal efficacy. Twenty-four cases were clinically identified. A cucumber salad was identified as the contaminating dish (Risk Ratio = 3.6; 95%CI 1.5-8.9). Only one factor was related to defective vaccinal efficacy; the risk of typhoid fever was two-fold higher in people vaccinated more than 3 years previously (Risk Ratio = 2.2; 95%CI, 1.1-4.2). Compliance with food hygiene rules could have prevented 24 cases of typhoid fever. Nevertheless, repeat vaccination against typhoid fever is now conducted every 3 years in the French Forces, in compliance with the manufacturers' recommendations.

As far as transfusions accidents are concerned, immunological causes are frequent. Pretransfusion Bedside Compatibility Tests (PBCT) are the last chance to avoid them. However low data are disponible on the quality their realisation is achieved. The aim of the study is to evaluate the quality level of achievement of these tests, in HIA Laveran Hospital (Marseille Armees, France). During 13 months, from november 2001 to december 2002, we systematically analysed PBCT after use (analysis rate 91%). Three kinds of errors have been noticed: Technical errors, understanding errors and both. Overall mistake rate was 10.4% (1632 tests analysed). In the same time, a complementary formation was dispensed to users responsible of misfits. This formation was successful, decreasing the overall mistake rate from 22.8% (november 2001) to 10.7% (december 2002). This study is an evidence of the importance to evaluate achievement quality of PBCT and shows how efficient can be simple correction methods.

Most outbreaks of noscomial infection are detected by means of molecular biological testing. However Euclidian distance is a rapid, reliable alternative if facilities for molecular biological testing are unavailable, as at the Principal Hospital in Dakar, Senegal. Over the 7 month period from 01/10/98 to 31/04/99, 110 of the 1033 blood cultures specimens collected in a group of 2360 children hospitalized in pediatric departments A and B of the Principal Hospital were found to be positive for Burkholderia cepacia. This high incidence suggested the possibility of an epidemic. This likelihood was further increased by evidence showing that all strains exhibited the same biotype and by results of pulsed-field electrophoresis (CHEF Mapper, Spel digestion) indicating that bacteria was of clonal origin. These findings were entirely consistent with those obtained by Euclidian distance but excessive mortality was not observed in the children involved. Testing of environmental specimens demonstrated the presence of the same strains in respirators and catheters. The most feasible hypothesis to account for these findings is environmental contamination resulting in mucocutaneous contamination of patients. Hemoculture containers were probably contaminated during handling.

This report describes the results of epidemiological surveillance of cutaneous leishmaniasis in French military personnel in French Guiana. Data was collected regarding microscopic diagnosis, clinical manifestations, and lesion location as well as compliance with vector control measures. Year-to-year variations in the incidence in the general population have been attributed to changes in climatic conditions. Monitoring incidence and density curves, correlation of findings with local epidemiological data, and analysis of the most recent epidemic in 1998/99 (326 cases, attack rate 3.2% men years) highlight the importance of behavioral factors. The proportion of total cases involving military personnel varied widely from 20 to 85%. Investigation consistently showed that failure to apply elementary protective measures against sandfly bites was the most determinant factor in this proportion. Strict compliance with these measures appears to reduce the risk of infection considerably.

Monitor the evolution in France of antibiotic sensitivity of non-typhoid salmonella isolated in fecal cultures conducted in army hospital laboratories.A prospective study was performed from January 1998 to December 1999 in all the biology departments of the 11 army hospitals in France. All the non-repetitive strains were sent to an official center for serotyping and determination of the minimum inhibiting concentrations, by dilution in Mueller Hinton's gelose. The antibiotics currently used in treatment were tested and interpretation endpoints followed the recent recommendations of the Antibiogram committee of the French society of microbiology. Identification of beta-lactamase was conducted by iso-electric focalization and polymerization by chain reaction (PCR). For Salmonella Typhimurium, research for the specific resistance locus of the DT104 clone was made using PCR.Two hundred and twenty-two non-repetitive salmonella strains were isolated. The principle serotypes found were: Salmonella Enterididis (23.9%), S. Typhimurium (21.2%) and S. Hadar (10.8%). All the strains were sensitive to ciprofloxacin and cefotaxim, whereas one third exhibited reduced sensitivity to aminopenicillin. Depending on the serotype, Typhimurium and Hadar serotypes exhibited significantly lesser sensitivity to aminopenicillin, nalidixic acid and tetracycline. For S. Typhimurium, resistance is related to the diffusion of the multiresistant DT104 clone, which involves half of the strains of this serotype. For S. Hadar, 18 out of 24 strains (75%) were resistance to nalidixic acid, and 5 of them exhibited reduced resistance to ciprofloxacin. There was no difference in sensitivity to antibiotics between the strains responsible for diarrhea and those isolated in systematic examinations for capacity to work in the food trade (respectively 54 and 46% of strains).Non-typhoid salmonella are frequently isolated in diarrhea of infectious origin. The increasing resistance to antibiotics is primarily related to the diffusion of the DT104 clone, regarding S. Typhimurium and to the increase in resistance to quinolone, regarding S. Hadar.

Summary The authors report four cases of infections related to Corynebacterium diphtheriae seen during less than two years in New Caledonia : two cases of endocarditis, one angina and one vulvovaginitis. These cases confirm the spread of this bacteria in the area and underline the importance of a high level of immunization of the population.

The aim of this study, conducted in the French Military hospitals, was to monitor the course of the antimicrobial sensibility of bacteria isolated from nosocomial infection in intensive care units.A prospective study has been conducted from January to December 1998 in all the intensive care units of the French Army. All the non-repetitive strains isolated from nosocomial infection were collected and sent to a reference centre. Antimicrobial susceptibility was determined by the agar dilution method. Beta-lactamase were identified by iso-electro-focalisation. Antibiotics choice and interpretative criteria were those of the "Comité Français de l'Antibiogramme de la Société Française de Microbiologie".A total of 849 strains are included in this study. Pseudomonas aeruginosa was the most frequently isolated bacterium (20%) followed by Escherichia coli (19%) Staphylococcus aureus (15%), coagulase-negative Staphylococci (CoNS) (11%) and Enterococci (7%). Imipenem was the most effective antibiotic against enterobacteriaceae (336 isolates; 100% susceptibility). Gentamicin (92%), amikacin (92%) third generation cephalosporins (83%), aztreonam (83%) and ciprofloxacin (78%) were also very effective. Resistance to III generation cephalosporins was correlated with an extended spectrum beta-lactamase (BLSE) in 36% of cases. This BLSE could be associated with an over production of the constitutive cephalosporinase. The most frequent species producing BLSE were Enterobacter aerogenes (75% of BLSE) and Klebsiella pneumoniae (17%). Among the 172 P. aeruginosa isolated, antimicrobial susceptibility were respectively: 71% for imipenem, 62%: tobramycin, 60%: amikacin 59%: ciprofloxacin 59% piperacillin + tazobactam, 55% piperacillin, 53%: ceftazidime and 44% for ticarcillin. Seventy per cent of the 96 CoNS and 50.2% of the 126 S. aureus isolated were resistant to methicillin. A strain of S. aureus and 2 CoNS strains had intermediate resistance to teicoplanin. Twenty per cent of the 59 Enterococci strains isolated were resistant to aminopenicillins (10/11 strains of E. faecium), and 9% presented a high level of resistance to gentamicine. One strain of E. faecium was resistant to vancomycin.The evolution of the susceptibility to antibiotics in intensive care units reflects the antibiotic pressure and level of cross-transmission. High rates of meticillin-resistance among staphylococci, of resistance to beta-lactams antibiotics among P. aeruginosa and of ciprofloxacin among Enterobacteriaceae are shown in this study. The implementation of appropriate strategies for surveillance and prevention is necessary.

Since the first outbreak in 1970, cholera epidemics have occurred regularly in Guinea. Until 1994, epidemics recurred every 8 years and were confined to the capital and coastal areas. The first cases in every epidemic were observed in coastal lagoons near the Sierra Leone border. In 1994, the disease demonstrated its migratory ability as the first cases were reported in towns located in far eastern inland areas. Spread of the disease from war-torn Sierra Leone and Liberia where epidemics have also been reported cannot be ruled out. Control measures have gradually been implemented to deal with these outbreaks and a treatment facility was built at the University of Conakry in 1994. Bacteriological studies including antibiotic susceptibility tests carried out at this center showed that the offending bacteria was Vibrio cholerae El Tor of the Ogawa group. Although this strain is relatively sensitive to all antibiotics, analysis of epidemiological data revealed high mortality rates at the beginning of every outbreak probably due to delays in organizing appropriate care. A major effort is now being made to improve the response time particularly in remote inland areas.

The increasing hospital-to-hospital transmission of multiple drug-resistant bacteria is a major concern for bacteriology laboratories involved in nosocomial infection control. The interlaboratory reproducibility of pulsed-field gel electrophoresis (PFGE) for Pseudomonas aeruginosa typing was evaluated by asking four hospital laboratories (two in Lyon, one in Brest, and one in Marseille) to study 11 P. aeruginosa isolates, some of which were epidemiologically related, and the reference strain ATCC 27853. Two laboratories used the Genepath system, one the Chef DR II, system, and one the Chef Mapper system, Bio-Rad, restriction/Spe I. Profiles were read visually and by computerized comparison of restriction band molecular weights (Taxotron, software, PAD Grimont, Pasteur Institute, Paris, France). These two methods led to similar epidemiological conclusions. However, centralization of the data showed poor center-to-center reproducibility due to inadequate standardization of the procedure.