Le carcinome à cellules de Merkel revisité : un nouvel exemple de tumeur humaine viro-induite

Merkel cell carcinoma (MCC) is a neuroendocrine carcinoma of the skin of poor outcome. A new type of virus, isolated in 2008, was found to be strongly associated with CCM. This virus, belonging to the family of polyomavirus, was called MCPyV for Merkel Carcinoma Polyomavirus. Recent data favour a causative role of MCPyV in oncogenesis. MCC represents thus a new model for the understanding of the mechanisms of oncogenesis. The distinct molecular viral signature in every case of MCC represents an original tool for the follow-up of the disease. New therapeutic perspectives are to be drawn using this model.     

Conduite à tenir devant un problème du donneur de cellules souches hématopoïétiques : test de grossesse positif et gammapathie monoclonale

In the attempt to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapy (SFGM-TC) set up the third annual series of workshops which brought together practitioners from all member centers and took place in October 2012 in Lille. Here we report our results and recommendations regarding the management of common issues related to the donor: pre-transplant pregnancy and monoclonal gammopathy.     

Méningo-encéphalite à Bartonella quintana chez un sujet immunocompétent : une observation rare

Introduction

Bartonella quintana (Bq) is responsible of various clinical pictures. Neuromeningeal complications are rarely reported.

Case

A 20-year-old woman was admitted for fever, headache lasting for 5 days. On admission, she was febrile at 39.3 °C and had a stiff neck. Symptoms, contact with animals, biological tests and lumbar puncture (PL) rendered viral meningitis a likely diagnosis. She had received symptomatic treatment and the outcome was favorable. Three days later, the patient had headache, agitation and confusion with fever. The PL noted 130/mm³ whites, 90% lymphocytes. The albuminorachie was 0.98 g/L, glucorachie was normal. The patient was treated with 400 mg of ofloxacine/day, seven days. Serologic tests for B. quintana were reactive. The outcome was favorable.

Conclusion

B. quintana infection should be considered in neurological symptoms of unknown etiology.     

Prise en charge d’une réactivation/infection à CMV chez l’allogreffé et prise en charge de la réactivation EBV/syndrome lymphoproflifératif à EBV chez l’allogreffé de cellules souches hématopoïétiques

In the attempt to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapy (SFGM-TC) set up the third annual series of workshops which brought together practitioners from all member centers and took place in October 2012 in Lille. Here the SFGM-TC addressed the issue of post-transplant CMV and EBV reactivation, and EBV-related Lymphoproliferative Disorders.     

Greffes de cellules souches hématopoïétiques à partir d’un donneur haplo-identique : recommandations de la SFGM-TC (première partie)

Haploidentical allogeneic stem cell transplantation (CST) has globally taken off in the past decade. It appears to be a valid alternative to other sources of stem cells; however, further research is necessary to validate the use of this approach in standard patient care. In the attempt to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapies (SFGM-TC) set up its fourth annual series of workshops which brought together practitioners from all of its member centers. These workshops took place in September 2013 in Lille. This is part one of the recommendations regarding allogeneic stem cell transplantation from an HLA-haploidentical related donor.     

Greffes de cellules souches hématopoïétiques à partir d’un donneur haploidentique : recommandations de la SFGM-TC (deuxième partie)

Haploidentical allogeneic stem cell transplantation (CST) has globally taken off in the past decade. It appears to be a valid alternative to other sources of stem cells; however, further research is necessary to validate the use of this approach in standard patient care. In the attempt to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapies (SFGM-TC) set up its fourth annual series of workshops which brought together practitioners from all of its member centers. These workshops took place in September 2013 in Lille. This is part two of the recommendations regarding allogeneic stem cell transplantation from an HLA-haploidentical related donor.     

Reconstruction du cartilage nasal par ingénierie tissulaire à base de polyéthylène de haute densité et d’un hydrogel

Aim of the study

Nasal reconstruction remains a challenge for any surgeon. The surgical indications for nasal reconstruction after oncologic resection, trauma or as part of cosmetic rhinoplasty, are steadily increasing. The current attitude for reconstruction is the use of autologous cartilage grafts of various origins (septal, ear or rib) trying to restore a physiological anatomy but their quantity is limited. Thus, in order to produce an implantable cartilaginous model, we developed a study protocol involving human nasal chondrocytes, growth factors and a composite biomaterial and studied at the molecular, cellular and tissue level the phenotype of the chondrocytes cultured in this model.

Materials and methods

After extraction of chondrocytes and their amplification on plastic, the cells were cultured for 15 days either in monolayer or within an agarose hydrogel or a composite biomaterial (agarose/high density polyethylene: Medpor^®) in the presence or not of a cocktail of soluble factors (BIT): bone morphogenetic protein-2 (BMP-2), insulin and triiodothyronine (T3). The quality of the chondrocyte phenotype was analyzed by PCR, western blotting and immunohistochemistry.

Results

During their amplification in monolayer, chondrocytes dedifferentiate. However, our results show that the BIT cocktail induces redifferentiation of chondrocytes cultured in agarose/Medpor with synthesis of mature chondrogenic markers. Thereby, chondrocytes associated with the agarose hydrogel will colonize Medpor and synthesize an extracellular matrix characteristic of nasal cartilage.

Conclusion

This nasal cartilage tissue engineering protocol provides the first interesting results for nasal reconstruction.     

Impact de l’augmentation de l’incidence des entérobactéries productrices de bêta-lactamases à spectre étendu (EBLSE) sur l’application des précautions complémentaires dans un centre hospitalier universitaire

Aim of the study

The French national surveillance program of multidrug-resistant bacteria (MDR) shows an increase of enterobacteriaceae-producing extended-spectrum beta-lactamases (ESBLE) incidence. The objectives of this study were to assess: the incidence of EBLSE in a large French university hospital between 2005 and 2010, and the difference of barrier precautions implementation between ESBL and other MDR.

Methods

The ESBLE incidence measure used data from the laboratory of bacteriology. The application of isolation and barrier precautions was analyzed from the MRB national surveillance data over a 3-year period from 2006 to 2008. Data were entered and analyzed using Epi Info software. The Chi² test was used for the comparison of proportions.

Results

The overall incidence of ESBLE was significantly higher in 2010 than in 2005 (0.20/1000 patients-days vs 0.03/1000 patients-days, respectively) (P < 0.001). The same was observed for Escherichia coli incidence with rates ranging from 0.02/1000 patients-days in 2005 to 0.15/1000 patients-days in 2010. Isolation precautions for patients with EBLSE were applied in relation for most patients with MRB (ESBLE vs others), without significant difference.

Conclusion

The surveillance programme of MRB showed a significant increase of ESBLE, especially for E. coli. Isolation and barrier precautions were used for most patients with MRB, including ESBLE.     

Évolution du nombre d’infections à Rotavirus et à virus respiratoire syncytial chez les enfants hospitalisés au CHU de Dijon entre 1998 et 2005

Aim

Respiratory syncytial virus (RSV) and Rotavirus infections represent up to 30% of cross infections in pediatric units. As they are a major public health problem, we studied their evolution and distribution at the Dijon University Hospital.

Population and methods

This exhaustive retrospective study included children under 15 with a new Rotavirus or RSV infection who were hospitalised at the Dijon University Hospital between 1998 and 2005. The general trend was determined by using moving averages, and the Spearman correlation coefficient r_s was calculated.

Results

From 1998 to 2005, 1886 new RSV (n = 981) or Rotavirus (n = 905) infections were identified in hospitalised children. The number of the infections decreased significantly, both for RSV (r_s = −0.71 ; p < 0.0001) and for Rotavirus (r_s = −0.77 ; p < 0.0001). Almost half of Rotavirus infections were nosocomial (46.3%) vs 5.3% of RSV infections, p < 0.0001. There was no significant difference in the proportion of RSV nosocomial infections between the epidemic and non-epidemic period (4.9% of nosocomial infections vs 7.1% respectively, p = 0.25). Rotavirus nosocomial infections were less frequent in epidemic period (41.6%) than in non-epidemic period (54.6%); p = 0.0002.

Conclusion

RSV and Rotavirus infections significantly decreased between 1998 and 2005. Proportion of RSV or Rotavirus infections didn’t increase in epidemic period, which could be explained both by an increased attention from healthcare professionals and by the effectiveness of hygiene measures taken.     

Conduite à tenir devant une anomalie biologique découverte lors du bilan pré-don cellules souches hématopoïétiques : sérologie IgM positive pour le cytomégalovirus,le virus d’Epstein-Barr,la toxoplasmose,ou la syphilis

In the attempt to harmonize clinical practices between different French transplantation centers, the French Society of Bone Marrow Transplantation and Cell Therapy (SFGM-TC) set up the third annual series of workshops which brought together practitioners from all member centers and took place in October 2012 in Lille. Here we report our results and recommendations regarding the management of pre-transplant donor's cytomegalovirus, Epstein-Barr virus, Toxoplasma gondii, or syphilis IgM positive serology test.     

Coinfection à Mycoplasma pneumoniae et Chlamydophila pneumoniae chez un enfant hospitalisé pour une pneumonie sévère avec détresse respiratoire : choix des outils diagnostiques pour une prise en charge optimale

The role for Mycoplasma pneumoniae and Chlamydophila pneumoniae in lower and upper respiratory tract infections in childhood increased by use of specialised diagnostic techniques, more and more performant for the early diagnosis of these infections. However, the prevalence of M. pneumoniae and C. pneumoniae as a cause of severe pneumoniae among hospitalized children has been rarely described. We report a case of M. pneumoniae et C. pneumoniae coinfection in a 10-year-old child hospitalized with a respiratory distress.