Frequent carriage of Panton-Valentine leucocidin genes by Staphylococcus aureus isolates from surgically drained abscesses

Between 1 February and 15 April 2002, 95 patients were admitted to Gaston Bourret Territorial Hospital (New Caledonia, France) for drainage of community-acquired soft tissue abscesses. Staphylococcus aureus was detected in 68 cases (72%). Two-thirds of the patients with S. aureus infection had furuncles, which were located on the limbs in 82% of cases. The median interval between symptom onset and hospital admission was 5.7 days. Three-quarters of the patients were Melanesians living in tribes. Fifty-four S. aureus isolates were screened for toxin genes. Panton-Valentine leucocidin (PVL) genes were detected in 48 isolates (89%), the exfoliative toxin A gene was detected in 1 isolate, and no toxin genes were detected in 4 isolates. S. aureus nasal carriage was detected in 39.7% of patients with S. aureus infections. Two infecting S. aureus strains and two nasal carriage strains were resistant to methicillin. Comparative pulsed-field gel electrophoresis, performed in 16 cases, showed that five of six patients with PVL-positive nasal carriage strains were infected by the same strains. In contrast, 8 of 10 patients with PVL-negative nasal carriage strains were infected by PVL-positive strains. PVL genes thus appear to be a major virulence factor in both primary and secondary S. aureus skin infections.     

Placental pathologic changes in malaria. A histologic and ultrastructural study.

Placenta malarial changes (PMCs) related to maternal plasmodium infection were present in 33% (247 cases) of a series of 741 placentas collected from an unselected population living in an area of high malarial endemicity (Haut-Ogooué, Gabon, Africa). Plasmodia were found on material thick blood films taken at the time of delivery in 42% of the women with and 24% of women without associated PMCs. Plasmodium falciparum was the most frequent infecting organism. PMCs were more frequent and, in general, more marked in primiparas. The primiparas were significantly (P less than 0.001) more numerous in the group with PMCs than in the control group without such changes. The mean weight of term placentas with malarial changes was significantly (46 g; P less than 0.001) less than that of placentas without such changes. The morphologic changes were a combination of the following features: 1) presence of parasites in the intervillous spaces; 2) macrophage concentration in the intervillous spaces; 3) malarial pigment deposits; 4) excess of perivillous fibrinoid deposits; 5) syncytiotrophoblastic damage; and 6) trophoblastic basal lamina thickening. Plasmodia were found in placental intervillous spaces in 42% (105/247). Local parasitemia varied in magnitude; in a few cases, 30% or more of the maternal erythrocytes were infected. Macrophage concentration in the intervillous spaces was present in 29% (72/247) and was always associated with local parasitemia. Macrophages phagocytized red blood cells and malarial pigment, and their number varied inversely with that of the local parasites. It seems, therefore, that macrophages play an important role in local parasite clearance. Malarial brown pigment was observed in all cases from the series. It had characteristic ultrastructural features and occurred in perivillous deposits of fibrinoid, in macrophages, or free in intervillous spaces. Excessive perivillous fibrinoid deposits were a constant histologic finding and were usually associated with syncytiotrophoblastic necrosis or ultrastructural damage such as partial microvilli loss, filamentous material accumulation in intracytoplasmic vacuoles, and "podocytelike" cytoplasmic projections on the basal surface. At these sites the trophoblastic basal lamina was usually thickened. Previously reported morphologic data and our own findings suggest that the peculiar placental changes in malaria, restricted to intervillous spaces and to villous surfaces, may be related to an immunopathologic process.     

Comparative study of tissue culture and mouse inoculation methods for demonstration of Toxoplasma gondii.

Two methods for the isolation of Toxoplasma gondii were analyzed and compared. Bradyzoites or tachyzoites of three strains of T. gondii were injected into mice and introduced in parallel onto MRC5 fibroblasts cultured on cover slips. In the cultures, the parasites were more readily identified by an indirect immunofluorescence assay than by examination of unstained or Giemsa-stained cultures. With the RH strain, the tachyzoites replicated actively, and large foci of parasites were observed in 24 h. The bradyzoites or tachyzoites of the other strains could also be cultivated, but grew rather slowly; 2 days after inoculation, early stages of multiplication could be observed: from day +4, Toxoplasma clusters or foci were easily identified at a x100 magnification. The course of infection in mice was greatly dependent on the virulence of the strain and on the parasitic stage inoculated. In the chronically infected mice, evidence of Toxoplasma infection was only detected 45 days after inoculation through the demonstration of cysts in the brain or the presence of specific antibodies in the serum. The mean ratio of infected mice and positive cultures was compared in relation to the inoculum size. The tissue culture method was found to be at least as sensitive as mouse inoculation. Since Toxoplasma organisms may be isolated within a few days in tissue culture, it is proposed that this method should be used when early isolation of the parasite is crucial for the diagnosis of toxoplasmosis.     

Leishmania braziliensis Vianna, 1911 in French Guiana

A new case of cutaneous Leishmaniasis to L. braziliensis Vianna, 1911, contracted in French Guyana is reported. The parasite, isolated in culture, is identified by enzymatic typing (13 zymoden). The identified zymodem is zymodem MON-43. It is the same of the WHO reference strain L. braziliensis s. st.     

A 3 year retrospective review of intrauterine insemination, using cryopreserved donor spermatozoa and cycle monitoring by urinary or serum luteinizing hormone measurements

Insemination with donor spermatozoa is an integral part of infertility treatment. For the last 3 years in our unit, intrauterine insemination with donor spermatozoa (IUID) has been used in preference to vaginal insemination. In this retrospective study, patients were offered an initial course of five single intrauterine inseminations with cryopreserved donor spermatozoa and treatment was then reviewed. A total of 389 patients received 1465 inseminations. In all, 1119 cycles were monitored using luteinizing hormone serum analyses and 346 cycles using the urine home test kits. The clinical pregnancy rate per insemination for the cycles monitored by the serum assay was 18.0% (202/1119) compared with the urine cycles (13.7%, 46/346) (P <05). The pregnancy loss rate was not significantly different (14.4%, 29/202 and 21.7%, 10/46) (serum and urine cycles respectively). The viable clinical pregnancy rate was significantly higher (P <03) for the serum cycles than for the cycles using the urinary monitoring (15.5%, 173/1119 and 10.4%, 36/346 respectively). The cycles monitored by serum assay had a significantly higher cumulative viable clinical pregnancy rate (P <0001) of 70.2% after nine inseminations compared with the urine monitored cycles of 54.8%. The majority of patients opted for the serum cycles, with a minority self-selecting the urine cycles mainly for travelling convenience. The explanation for the significant differences between the viable clinical pregnancy rates per insemination and the cumulative viable clinical pregnancy rates may be due to the sensitivity of the urine home test kit or the patients' interpretation of the result.      

脾内血管的应用解剖学研究盐酸喹那普利治疗原发性高血压的临床应用观察

目的　探讨盐酸喹那普利 (QuinaprilHydrochloride)治疗轻、中度原发性高血压的有效性和安全性。方法　全国 6家医院参加的一项多中心、随机、双盲、平行组间对照研究。结果　 113例原发性高血压病人治疗 8周后 ,总有效率达 85 84% ,统计学有显著性差异。盐酸喹那普利副反应较轻 ,对肾脏、肝脏、造血系统和心脏未见有害作用。结论　盐酸喹那普利是一种安全、疗效好、副反应小的治疗轻、中度原发性高血压的有效药物。     

Prevalence and factors associated with uveitis in spondylarthritis patients in France: Results from an observational survey

Objective

To accurately estimate the prevalence of and the factors associated with uveitis in spondylarthritis (SpA) patients in France.

Methods

In an observational survey of SpA patients (diagnosis confirmed by the European Spondylarthropathy Study Group and/or Amor's criteria) consulting their rheumatologist for routine followup, we collected information regarding present/past history of uveitis, as well as detailed characteristics of the disease. Factors independently associated with uveitis were determined.

Results

From September 2008 to January 2009, 202 rheumatologists participated in the survey and recruited 902 patients (61% men) with a mean ± SD age of 45.3 ± 13.4 years and a mean ± SD disease duration of 10.4 ± 9.6 years. The SpA diagnoses were ankylosing spondylitis (71%), psoriatic arthritis (18%), or other SpA (11%). The HLA–B27 positivity rate was 76%. Uveitis prevalence was 32.2% (95% confidence interval [95% CI] 29.1–35.3%) since psoriasis and inflammatory bowel disease were 22.3% (95% CI 19.5–25.0%) and 8.6% (95% CI 6.7–10.5%), respectively. Recurrence of uveitis occurred in 52.3% and complications occurred in 11.7% of patients. Factors independently associated with uveitis were HLA–B27 positivity (adjusted odds ratio [OR_adj] 2.97 [95% CI 1.83–4.81], P < 0.0001) and disease duration (OR_adj 1.28 [95% CI 1.16–1.41], P < 0.0001 for ≥10 years).

Conclusion

Results indicate that uveitis is the most common extraarticular feature of SpA, occurring preferentially in HLA–B27–positive patients over the entire course of the disease.