Activité in vitro de la daptomycine vis-à-vis de souches cliniques isolées de plaies du pied chez des diabétiques

Purpose of the study

The aim of this study was to evaluate the in vitro activity of daptomycin and other comparator agents against bacterial strains isolated from diabetic foot infections (DFI).

Patients and methods

All diabetic patients hospitalized for a first episode of DFI (stage 2 to 4, according to the International Working Group of Diabetic Foot classification) were selected in Nîmes University hospital between June 2006 to August 2007. MIC were determined using E-test strip (AB Biodisk^®) and custom broth microdilution panels against bacterial strains isolated from foot samples.

Results

Two hundred strains were studied. Daptomycin was active against 99.5% of all the strains especially Streptococcus sp. (100%), Enterococcus sp. (100%), coagulase-negative Staphylococcus (100%) and methicillin-susceptible Staphylococcus aureus (100%). Exclusively, one methicillin-resistant S. aureus strain was not covered by this antibiotic.

Conclusions

Daptomycin, a new broad spectrum antimicrobial agent against Gram-positive cocci, is qualified to belong to the therapeutic arsenal package of complicated skin and soft tissue infections in diabetic patients after microbial documentation.     

Mise au point d’une technique de PCR en temps réel pour la détection rapide des gènes qnr chez des entérobactéries productrices de bêta-lactamases à spectre étendu

Aim of the study

To develop a fast and reliable real time PCR technique for detecting plasmid-mediated quinolone resistance genes qnrA, qnrB and qnrS.

Methods

A real-time PCR assay using SYBR Green I and Roche LightCycler^® was developed to detect qnr genes. Detection of qnr genes was based on comparison of melting temperature differences with a positive control of each qnr genes. This assay was performed to study 138 isolates collected from diagnostic and screening samples in the Champagne-Ardenne region in 2004 (France).

Results

In optimized conditions, the three positive controls tested alone and with isolates confirmed the specificity of the PCR primers. Each PCR assay was able to test 30 strains in 60 min for 1 qnr gene. Out of 138 isolates screened, 3.6 % isolates were positive for a qnrA1, 1.5 % for qnrS1 and no qnrB-like gene. Prevalence of qnr determinants was 5 % and reached 9.5 % in clinical isolates.

Conclusion

Real-time PCR is a fast and reliable technique for screening of qnr-positive strains. This study shows a relatively high prevalence of qnr determinants (5 %) among ESBL-producing Enterobacteriaceae.     

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.     

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.     

Circulating estradiol defines the tumor phenotype in menopausal breast cancer patients

Objective

To correlate circulating hormone levels with the clinical and biological features of the tumors in menopausal breast cancer patients.

Design

Circulating hormone levels were measured in 161 previously untreated menopausal breast cancer patients within 72 h of their planned surgery. The obtained hormone levels were correlated with tumor size, histological and nuclear grade, histological score, axillary nodal status, DNA-ploidy and Ki67-, c-erb-B2-, p53, Bax-, VEGF- and Nup88-expression.

Results

The only statistically significant correlations found between circulating hormone levels and all tested variables were an inverse one between estradiol and the expression of the apoptosis-associated Bax gene (p = 0.009), and again an inverse correlation between estradiol and the expression of c-erb-B2 (p = 0.04). When comparing hormone levels with each other, a significant correlation between estradiol and progesterone (p < 0.0001), an inverse one between estradiol and FSH (p = 0.04) and a direct one between LH and prolactin (p = 0.001) were found.

Conclusion

Higher circulating estradiol levels in postmenopausal breast cancer patients are associated with molecular features usually defining a biologically less aggressive tumor phenotype.     

Association of BRCA1/2 mutations with FMR1 genotypes: Effects on menarcheal and menopausal age

Objective

Female BRCA (breast cancer gene)-1 and BRCA-2 mutations are significantly associated with risk of developing breast and ovarian cancers, in turn, associated with female infertility. BRCA-1 mutations have also been associated with occult primary ovarian insufficiency (OPOI), as have different mutations of the FMR1 gene. We, therefore, hypothesized that FMR1 genotypes may be associated with menarcheal and menopausal ages of BRCA mutation carriers.

Patients

We compared the FMR1 genotype and sub-genotype distribution in 99 BRCA1/2 positive women and in 182 healthy women without a known history of familial breast and ovarian cancer and searched for associations with age at menarche and menopause. T-test was used to assess differences in menarcheal and menopause ages, with times of menarche and menopause as continuous variables.

Results

Women with BRCA1/2 mutations showed significantly different FMR1 genotype and sub-genotype distributions when compared with the control group (p < 0.001). This result remained stable in a sub-group analysis of Caucasian BRCA1/2 carriers and healthy controls (p < 0.001). In addition, BRCA1/2 carriers indicated a trend toward shorter reproductive lifespan (p = 0.18).

Conclusions

Our data confirm the previously reported highly skewed distribution of FMR1 genotypes and sub-genotypes toward a high preponderance of low FMR1 alleles in BRCA1/2 carriers. We could demonstrate that BRCA-1 mutations are associated with an earlier onset of menopause compared to BRCA-2 carriers, although the distribution of the het-norm/low genotype is similar in both groups. Our findings suggest that there may be other factors beside the genotype that has an influence on menarche and especially menopause age in BRCA mutation carriers.     

Incidence des bactériémies et fongémies aux hôpitaux universitaires de Strasbourg de 2005 à 2007

Objective

To follow the evolution of incidence of the main feature of bloodstream infections identified in a french hospital between 2005 and 2007.

Methods

We included all the patients hospitalised during three times three-month periods, according to the protocol given by the coordination center against nosocomial infections. For every positive blood culture, we collected clinical and microbiological datas.

Results

Hospital-acquired bacteremias are the most frequent with an incidence rate between 0.996 to 1.31‰ days of hospitalisation. The population is mainly over 50 years old. The main sources of infection are central catheter, digestive and urinary tracts. Organisms causing the majority of nosocomial bloodstream infections are coagulase-negative staphylococci, Staphylococcus aureus and Escherichia coli. The mortality rate during the first week varies from 16% in 2005 to 8% in 2007. Community-acquired bloodstream infections represent 28% of all episodes, and affect people who are over 70 years old. The main sources of infection are urinary, digestive and pulmonary. Escherichia coli, Staphylococcus aureus and Streptococcus pneumoniae are most frequently isolated. The mortality rate during the first week varies from 3.7 to 9.8% according to the year of study.

Conclusion

This annual investigation enables us to mesure the infection risk level in our hospital, to identify the main sources implied and to create targeted actions to prevent nosocomial bloodstream infections.     

Forte prévalence des infections communautaires et nosocomiales à Staphylococus aureus résistant à la méticilline et portant le gène de la leucocidine de Panton-Valentine dans l’Algérois

Objectives

To determine the prevalence of community acquired and hospital methicillin-resistant Staphylococcus aureus (S. aureus) infections and the Panton-Valentine leukocidin.

Patients and methods

Seven hundred S. aureus strains were collected during 21 months period in Mustapha Bacha hospital. Bacterial identification was based on standard methods and susceptibilities were tested by disk diffusion method. Molecular study (toxins, mecA gene and agr alleles) were determined for 221 S. aureus isolates by multiplex PCR.

Results

The global MRSA prevalence was 42 %, 35 % in the community and 49 % in hospital setting. The frequency of strains containing PVL genes (PVL+) was 36 %, their molecular profile was: agr3, mecA+, etd, edin, which correspond to the C-MRSA major ST80 clone in Europe and the Maghreb. The H-MRSA-PVL+ were multidrug resistant. Among the MSSA, 13 strains contained the tst gene and five contained the exfoliatine genes ETA and ETB.

Conclusion

Our results show a high rate of MRSA-PVL+ in the community and the hospital setting. The H-MRSA-PVL+ were multidrug resistant complicating their antibiotic treatment options.     

Recombinaison génétique chez le poliovirus vaccinal : étude comparative chez les souches excrétées en cours de vaccination par le vaccin poliomyélitique oral et les souches circulantes

Aim of study

Recombination is one of the major mechanisms of evolution in poliovirus. In this work, recombination was assessed in children during vaccination with OPV and among circulating vaccine strains isolated in Tunisia during the last 15 years in order to identify a possible role of recombination in the response to the vaccine or the acquisition of an increased transmissibility.

Material and methods

This study included 250 poliovirus isolates: 137 vaccine isolates, excreted by children during primary vaccination with OPV and 113 isolates obtained from acute flaccid paralytic (AFP) cases and healthy contacts. Recombination was first assessed using a double PCR-RFLP, and sequencing.

Results

Nineteen per cent of recombinant strains were identified: 20% of strains excreted by vaccinees among 18% of circulating strains. The proportion of recombinant in isolates of serotype1 was very low in the two groups while the proportions of recombinants in serotypes 2 and 3 were different. In vaccinees, the frequency of recombinants in serotype3 decreased during the course of vaccination: 54% after the first dose, 32% after the second and 14% after the third dose.

Conclusion

These results suggest that recombination enhances the ability of serotype3 vaccine strains to induce an immune response. Apart from recent vaccination, it may contribute to a more effective transmissibility of vaccine strains among human population.     

Caractérisation phénotypique et génotypique (randomly amplified polymorphic DNA analysis et multiple-locus variable-number tandem-repeat analysis) de 96 isolats cliniques de Pseudomonas aeruginosa à l’hôpital F. Bourguiba (Monastir,Tunisie)

Aim of the study

Phenotypic and genotypic characterization of 96 clinical isolates of Pseudomonas aeruginosa recovered in a Tunisian teaching hospital during a 16-month period.

Materials and methods

All the isolates were characterized by serotyping, antimicrobial susceptibility typing and genotyping with randomly amplified polymorphic DNA (RAPD) analysis and multiple-locus variable-number tandem-repeat analysis (MLVA).

Results

Forty-one isolates out of 96 (43%) were recovered from two intensive care units (medical and chirurgical). Most of the isolates (48%) belonged to serotype O:11. Among the 13 antibiotypes, three multidrug resistant ones were mostly observed within the two intensive care units. Genotyping showed 83 RAPD types and 52 MLVA types. Isolates showing the same serotype could show different genotypes. A limited number of clusters was highlighted with MLVA typing, of which an outbreak of nine cases within the surgical intensive care unit.

Conclusion

Except this outbreak of nine cases, the heterogeneity observed for most of the P. aeruginosa isolates showed that outbreak situations were rare in the F. Bourguiba hospital during the study period. MLVA genotyping is a good tool for genotyping P. aeruginosa clinical isolates.     

Épidémie à Enterococcus faecium résistant à la vancomycine de type Van B au centre hospitalier de Béthune (Pas-de-Calais). Réalisation de deux enquêtes de prévalence en mai 2008 et en janvier 2009

Objective

An outbreak of vancomycin-resistant Enterococcus faecium (E. faecium) occurred in the Bethune Hospital since March 2008 (two consecutive waves). To control this outbreak, two-point prevalence surveys were conducted in May 2008 and January 2009 in inpatients hospitalised more than 24 hours on previously non-affected wards.

Methods

In each ward, information was given to inpatients, administrative and medical data were collected, rectal swabs or stool samples were performed and cultured on chromogenic media. Data were anonymised, and Epidata software was used for the analysis.

Results

In May 2008, nine patients were found to be colonized with vancomycin-resistant E. faecium among the 239 patients evaluated (prevalence : 3,76%), and three new wards were affected: neurology ward, general surgical ward, and emergency department observation unit. In January 2009, only one patient, hospitalised in cardiac intensive care unit, was colonised among the 157 patients evaluated (prevalence 0,63%).

Conclusions

These two-point prevalence surveys identified the reservoir of vancomycin-resistant E. faecium carriage, and were thus helpful to contain the two epidemic waves at the Bethune Hospital. A cohorting of the colonised inpatients was performed. Five secondary colonisation cases were detected among the 181 contact patients in May 2008, and no secondary case among 32 contact patients in January 2009.     

Dépistage de la Leptospirose : performance de la trousse Sérion Elisa classic Leptospira IgM

Aim of the study

Evaluate the sensitivity and the specificity of anti-Leptospira IgM detection with the Serion Elisa classic kit in comparison to the Panbio Elisa kit.

Methods

Twenty-three sera of patients whom Taqman probe real time PCR is positive and 19 sera positive by the microscopic agglutination test (MAT) are studied for sensitivity. Specificity is evaluated with 49 pairs of sera negative by MAT and with sera positive in IgM to EBV, to syphilis, to Borrelia and positive to influenza virus antibodies.

Results

14/23 (61%) of the sera positive by PCR and 27/30 (90%) of the sera positive at significant level by MAT are positive by Serion IgM Elisa. Serogroups Icterohaemorrhagiae, Grippotyphosa, Australis, Tarassovi, Canicola, Sejroe, Patoc and Cynopteri are detected. 40/49 sera (82%) negative by MAT are negative by Serion IgM Elisa. Agreement with the Panbio kit is 61% (30/49). Results are discrepant in 19/49 cases corresponding to a positive result by Panbio IgM and to a negative result by Serion IgM. Serological cross-reactions are more frequent with IgM to syphilis and to Borrelia than with IgM to EBV and to influenza virus antibodies.

Conclusion

A similar sensitivity is observed between the two kits but specificity is higher with Serion. Positivity in IgM is 61% in cases of leptospirosis diagnosed by PCR.     

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.     

Novel nonsense mutation of BRCA2 gene in a Moroccan man with familial breast cancer

Background

Breast cancer is the most common cancer in women worldwide. About 5 to 10% of cases are due to an inherited predisposition in two major genes, BRCA1 and BRCA2, transmitted as an autosomal dominant form. Male breast cancer is rare and is mainly due to BRCA2 than BRCA1 germline mutations.

Objective

Molecular study of BRCA2 gene in man with familial breast cancer.

Methods

PCR and direct sequencing of BRCA2 gene.

Results

Identification of novel heterozygous germline mutation c.6428C>A ; p.Ser2143Stop of BRCA2 gene.     

Meta-analysis of differentially expressed genes in primary Sjogren’s syndrome by using microarray

Introduction

The purpose of this study was to identify differentially expressed (DE) genes and biological processes associated with changes in gene expression in primary Sjogren’s syndrome (pSS).

Methods

We performed a meta-analysis using the INMEX program (integrative meta-analysis of expression data) of publicly available microarray GEO datasets of pSS. We performed Gene Ontology (GO) enrichment analyses and pathway analysis using Kyoto Encyclopedia of Genes and Genomes (KEGG).

Results

Three GEO datasets including 37 cases and 33 controls were available for the meta-analysis. We identified 179 genes across the studies which were consistently DE in pSS (146 up-regulated and 33 down-regulated). The up-regulated gene with the largest effect size (ES) (ES = −2.4228) was SELL (selectin L), whose product is required for the binding and subsequent rolling of leucocytes on endothelial cells to facilitate their migration into secondary lymphoid organs and inflammation sites. The most significant enrichment was in the immune response GO category (P = 2.52 × 10⁻²⁵). The most significant pathway in our KEGG analysis was Epstein–Barr virus infection (P = 9.91 × 10⁻⁰⁶).

Conclusions

Our meta-analysis demonstrated genes that were consistently DE and biological pathways associated with gene expression changes with pSS.     

Residents’ and standardized patients’ perspectives on empathy: Issues of agreement

Objective

We investigated correlations between residents’ scores on the Jefferson Scale of Empathy (JSE), residents’ perceptions of their empathy during standardized-patient encounters, and the perceptions of standardized patients.

Methods

Participants were 214 first-year residents in internal medicine or family medicine from 13 residency programs taking standardized patient-based clinical skills assessment in 2011. We analyzed correlations between residents’ JSE scores; standardized patients’ perspectives on residents’ empathy during OSCE encounters, using the Jefferson Scale of Patient Perceptions of Physician Empathy; and residents’ perspectives on their own empathy, using a modified version of this scale.

Results

Residents’ JSE scores correlated with their perceptions of their own empathy during encounters but correlated poorly with patients’ assessments of resident empathy.

Conclusion

The poor correlation between residents’ and standardized patients’ assessments of residents’ empathy raises questions about residents’ abilities to gauge the effectiveness of their empathic communications. The study also points to a lack of congruence between the assessment of empathy by standardized patients and residents as receivers and conveyors of empathy, respectively.

Practice implications

This study adds to the literature on empathy as a teachable skill set and raises questions about use of OSCEs to assess trainee empathy.     

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.     

Profil épidémiologique de 290 cas d’échinococcose kystique humaine diagnostiqués au CHU Mustapha d’Alger (2006 à 2011)

The aim of the study

This study reports a series of 290 cases of hydatidosis confirmed by the surgery and/or the imagery with a positive immuno-diagnosis collected between 1st January 2006 and 31 March 2011 at parasitology-mycology laboratory of hospital university center of Mustapha of Algiers. Our aim is to specify, through the listed cases, the epidemiological aspects of this affection and compared with those obtained in two previous Algerian epidemiological investigations carried out, between 1963–1964 and 1966–1975.

Patients and methods

It is a retrospective (2006–2008) and prospective (2008–2011) study. The parasitological diagnosis was carried out by the direct macroscopic and/or microscopic identification of the parasite and indirect diagnosis based on four techniques: passive hemagglutination, Elisa IgG “Echinococcus granulosus”, Western Blot IgG “Echinococcus” and electrophoresis.

Results

The study shows that this affection is still prerogative of the young adult. It bring out also in this study that the child of school age (ten years), in particular the boy, pays a heavy tribute. At the child, the preferential pulmonary seat of the hydatic disease is not devoid of risk. At adult, this parasitic disease mainly affect the active woman.

Conclusion

Generally, the epidemiological and clinical characteristics join the endemic countries data and confirmed the row of our country among them. The transmission seems as strong as in the past, in spite of a much better social educational level.