Mucormycose parotidienne : une nouvelle observation et revue de la littérature

Introduction

Mucormycosis is a rare, devastating, fungal infection, which disproportionately affects non-controlled diabetic patients, notably during ketoacidosis. The authors report the case of cervical mucormycoses with a particularly favorable evolution in diabetic woman.

Report

A 54-year-old woman, type 2 diabetic, had presented a left lateral cervical mass. The diagnosis was confirmed by histological examination. She was treated with Amphotericin B with favorable evolution.

Conclusion

The mucormycose is a rare infection. The treatment is medical and surgical. The prognosis is severe with an overall mortality rate of 40%.     

Lupus et grossesse : expérience d’un service de médecine interne à propos de 26 cas et revue de la littérature

Objective

To study the maternal and fetal outcomes in women with systemic lupus erythematosus.

Patients and methods

A retrospective study of 26 pregnancies in 15 systemic erythematosus patients diagnosed before or during pregnancy regarding to American College of Rheumatology criteria in a single reference center.

Results

The mean patient age was 31.52 years (24–39 years). The mean interval from the diagnosis of the systemic lupus erythematosus to pregnancy was 4.2 years. Eight pregnancies were planned. The flare rate of lupus during pregnancy was 31%, life birth rate was 65% and fetal loss rate was 35%.

Discussion and conclusion

As an increase in disease activity can occur during pregnancy and because of a higher rate of obstetrical complications in patients with lupus, it is important to carefully plan pregnancy. Pregnancy in lupus patients must be closely monitored by a multispeciality care of the patients.     

Étude parasitologique de 78 cas d’échinococcose kystique humaine colligés entre 2005 et 2012 au CHU Mustapha d’Alger

Aim

The aim of this work is to know the fertility rate of the metacestodes resulting from patients suffering from hydatidosis, the one of protoscoleces's viability and by comparing the results obtained with those found elsewhere. It reports, also, the epidemiological, clinical and diagnostically aspects of the studied patients.

Materials and methods

This study has carried on 78 hydatics samples resulting from 78 patients collected between 2005 and 2012 at the laboratory of parasitology of the Mustapha hospital center of Algiers. A questionnaire on the epidemiological context (contact with an animal-host of the cycle, place of residence, presence of family cases reached of hydatidosis and knowledge on the hydatic disease) concerned 69 patients. For each sample, a direct microscopic examination is made with or without vital staining. The presence of protoscoleces made qualified the fertile cyst. Those visualized moving or resistant to eosin at 0.2% are considered viables. Indirect diagnosis is based on the techniques: passive hemagglutination, electrophoresis, Elisa IgG Echinococcus granulosus and immunoblotting IgG “Echinococcus”. Molecular analysis is based on PCR and sequencing the partials fragments of two mitochondrial genes with the primers COX1 and ND1.

Results

The results obtained show that the surgical frequency of hydatidosis is significant at the young adult and at the child. The epidemiological context associated at the disease is the conjointly presence of a dog and herbivores. The fertility rate of human hydatid cysts is 88.4% and the ones of viability of the protoscoleces is 74.5%. In this series, the serology shows global positivity at 70%. The molecular characterization of five samples identify the species: E. granulosus ss.

Conclusion

Finally, the viability and fertility rates found here are raised. Sometimes viables protoscoleses are found after use of scolicidal solution. In front of these results, the parasitical treatment is more than necessary in order to minimize the risk of occurred of secondary echinococcosis or the relapses postoperatives.     

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.     

Pneumocystose à Pneumocystis jiroveci : étude comparée de la PCR et des techniques de coloration

Diagnosis of pneumocystis pneumonia is usually based on clinical features and X-rays photography and confirmed in the laboratory by visualisation of Pneumocystis organisms in stained preparations of respiratory specimens using several techniques (Gomori-Grocott, May-Grünwald Giemsa, bleu de toluidine O). Actually, PCR has considerably increased sensitivity of detection of Pneumocystis. The aim of this study is to compare conventional PCR results to those of staining techniques (Gomori-Grocott, May-Grünwald Giemsa) in addition to the X-ray and clinical findings in order to evaluate the contribution of each method. Sixty-four respiratory specimens were collected from 54 immuno-compromised patients with clinical symptoms of pulmonary infection. We diagnosed pneumocystis pneumonia in 16 patients according to staining techniques and/or typical clinical and radiological findings and/or response to treatment. Of the 15 patients, 14 were positive by PCR and only five were positive by direct examination, yielding a sensitivity and specificity of 93,3 and 87,1% for PCR and 33,3 and 100% for staining techniques. Conventional PCR provides a sensitive and objective method for the detection Pneumocystis jiroveci from less invasive sample.     

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.     

Impact de la composition du greffon sur le devenir des patients après une allogreffe de cellules souches hématopoïétiques : corrélation entre proportion des lymphocytes T CD4 du greffon exprimant le CCR7 et la survenue d’une GVH aiguë

In a previous prospective study on 62 patients who underwent an HLA-matched allogeneic stem cell transplantation, we have observed that proportion of donor-derived CCR7⁺/CD4⁺ T cells in the graft provided a predictive indicator of acute GVHD without interfering on chronic GVHD and relapse rate. Here we present our results on a confirmatory cohort of 137 consecutive patients. Indeed patients who received more than 76% of CCR7⁺/CD4⁺ T cells in the graft developed more often acute GVHD be it of low or high grade than those who did not. Determination of the CCR7⁺/CCR7^neg ratio of CD4⁺ T cells in the graft provides a predictive indicator of acute GVHD and could help to define strategies of partial selective T cell depleted transplantation.     

Co-infection par le VHB de génotype G : développement, validation et application d’une technique de quantification spécifique du VHB de génotype G

Goal of the study

A detection and quantification method specific of genotype G hepatitis B virus (G-HBV) was developed and used to study the epidemiology and evolution of G-HBV co-infection during antiviral therapy.

Patients and methods

A multiplex real time PCR was developed and validated on A-HBV and G-HBV plasmid mixes. G-HBV infection was sought for on chronic hepatitis B carriers followed in our institution.

Results

Two primers, flanking the specific G-HBV 36 nucleotide insertion and two probes, including one specific for the insertion, were validated for a multiplex real time PCR. This new tool was well correlated to commercially available quantification systems within a 2 to 7 log₁₀ IU/mL range. On A- and G-HBV clonal mixes, G-HBV was quantified with a precision between 5 to 10%. On HBV-HIV infected patients, a 25% G-HBV prevalence was found, while it was below 1% in HBV mono-infected patients. Longitudinal G-HBV quantifications on five treated patients indicate that G-HBV is not selected by antiviral treatment.

Conclusion

A specific method for G-HBV quantification within multi-genotype mixes was set up. The important G-HBV prevalence in HIV patients was unexpected. Our data are not in favour of an intrinsic resistance of G-HBV to current antivirals.     

Résultats de trois méthodes pour la détection de la mutation précore G1896A du virus de l’hépatite B chez les donneurs de sang français : PCR temps réel, séquençage et test Inno-LIPA

Aim

To screen hepatitis B virus (HBV) genotypes and associated basal core promoter (BCP; T1762A/A1764) and precore (PC; A1896) mutations among the 100 HBV surface antigen (HBsAg) positive voluntary blood donors in France.

Methods

HBV genotypes were determined by using direct sequence analysis. Three methods were used to detect G1896A mutation: non-commercial real-time PCR (PCRTR°, line probe assay (InnoLiPA HBV PreCore, INNOGENETICS^®) and direct sequencing of precore gene. HBV viral load was quantified with two commercial real-time PCR (COBAS^® AmpliPrep/COBAS^® TaqMan^® HBV Test/Roche and Real Time HBV/M2000/Abbott).

Results

The mean age of donors was 30 (18-64). Patients were from Africa (42%), Europa (50%), and Asia (8%). HBV/D was the most predominant (37%) genotype followed by HBV/A (31%) and HBV/E (22%). PC and BCP mutants were found in 57% with Inno-LIPA HBV test and 59% with both PCRTR and sequencing methods. A significant difference in the viral load of blood donors with wild and PC mutants was observed with the Taqman Cobas real time PCR (3,19 Log₁₀ UI/ml versus 4,93 Log₁₀ UI/ml, p < 0.05). Precore phenotype determination was in agreement with the three PC mutation detection methods in 56% of cases.

Conclusions

Non-Caucasian genotype E was present in the French blood donors. PC mutation was more common than BCP mutations in this study. As HBV infected blood donors were more often asymptomatic carriers, we could speculate that the G1896A mutation may favour the asymptomatic state, supporting previous observations.     

Recommandations de la SFGM-TC concernant l’injection prophylactique,préemptive et curative des lymphocytes du donneur (DLI) après allogreffe 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 fourth annual series of workshops which brought together practitioners from all member centers and took place in September 2013 in Lille. Here, we report our recommendations regarding the use of donor lymphocyte injection (DLI) in the prophylactic, pre-emptive and curative settings. This work has been limited to allogeneic stem cell transplantations from an HLA-matched (10/10) or -one antigen-mismatched (9/10) donor.     

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.     

Prévalence de Candida parapsilosis, C. orthopsilosis et de C. metapsilosis au sein des candidémies au CHU de Nantes et profil de sensibilité aux échinocandines par la méthode E-test : étude rétrospective de cinq ans (2004-2009)

Aim of the study

To determine the prevalence of C. parapsilosis sensu stricto, C. orthopsilosis and C. metapsilosis among candidemia at Nantes University Hospital and to evaluate the in vitro susceptibility of the isolates against three echinocandin drugs (caspofungin, micafungin and anidulafungin).

Material and methods

Retrospective study (march 2004 to july 2009) of 178 cases of candidemia corresponding to 183 Candida spp. strains identified by means of routine phenotypical methods. Re-identification of C. parapsilosis sensu lato isolates was performed by ITS rDNA sequencing analysis. Minimal inhibitory concentrations (MIC) were determined by E-test^®. All echinocandin non-susceptible isolates (MIC > 2 μg/mL) were analyzed for the presence/absence of FKS1 mutations associated with resistance.

Results

During this period, C. parapsilosis sensu lato was responsible for 27 candidemia, ranging at the second most common Candida species after C. albicans (n = 99, 54.1%). Neither isolates belong to C. orthopsilosis nor C. metapsilosis. According to the literature, all the isolates displayed high MICs against the three echinocandin drugs. All the isolates displayed both susceptibility (MIC ≤ 2 μg/mL) and a good agreement between MICs read at 24 h and 48 h for caspofungin and micafungin (MIC₅₀ = 0.75 μg/mL, MIC₉₀ = 1.5 μg/mL). Surprisingly, whereas most of the strains were susceptible to anidulafungin at 24 h (MIC₅₀ = 1 μg/mL, MIC₉₀ = 1.5 μg/mL), 14 (52 %) displayed non-susceptibility, despite the lack of mutation associated with resistance on FKS1, when reading was performed at 48 h (MIC₅₀ = 3 μg/mL, MIC₉₀ = 12 μg/mL).

Conclusion

Prevalence of C. orthopsilosis and C. metapsilosis in patients with candidemia is low at Nantes University Hospital. The difficulty encountered with MIC reading by E-test^® are discussed.     

Organisation, caractérisation et analyse multidimensionnelle des données de la marche : application à la marche du pied bot varus équinOrganisation, characterisation and multidimensional analysis of gait data: application with talipses equinovarus

This second paper is an application of our statistical approach to the clubfoot gait. Thirty-seven measurement variables are considered for each leg and come from EMG data, kinetic and kinematic data using a 3D-video system and force-plates. The patient sample contains 12 persons with a clubfoot on the left and/or the right side. This paper shows didactically how an approach based on a space-time characterization first, a multiple correspondence analysis second, allows to underscore the interindividual differences and for each individual, the difference between the two legs. A discussion about aspects related to measurement imperfection, to statistics and biomedicine is proposed.