Parasitoses et mycoses des régions tempérées et tropicales

En parfaite cohérence avec le programme du deuxième cycle des études de médecine et les Épreuves Classantes Nationales, cet Abrégé \u27 Connaissances et pratique \u27 aborde les connaissances fondamentales en parasitologie et mycologie. - La partie \u27 Connaissances \u27 est divisée en trois sections : parasitoses, ectoparasitoses et mycoses. Les items du programme de DCEM2-DCEM4 sont clairement identifiés au début de chaque chapitre et dans un tableau récapitulatif inséré en début d\u27ouvrage. Le contenu, clair et didactique, est étayé par une très riche iconographie (avec plus de 200 illustrations en noir et en couleur) : cycles, cartes, schémas, photographies de pathologies et imageries. Enfin, chaque chapitre se conclut par un encadré Points clés résumant les éléments indispensables à connaître pour réussir les ECN. - La partie \u27 Pratique \u27, composée d\u27une trentaine de dossiers cliniques avec des corrections commentées, offre un véritable outil d\u27auto-évaluation et d\u27entraînement. - Pour cette deuxième édition, les membres de l\u27ANOFEL ont participé à la mise à jour de l\u27ensemble des items. Le nombre des illustrations a été augmenté, des tableaux récapitulatifs des traitements et des étiologies parasitaires ou fongiques par grands symptômes ont été ajoutés et les dossiers cliniques ont été renouvelés

What can be learned from phenotyping and genotyping analyses of Scedosporium prolificans isolates from diverse origins?

Introduction: Scedosporium prolificans is a filamentous fungus considered as an emerging opportunistic member of the order Microascaceae. This fungus has a broad clinical spectrum and can cause different types of infections: localized colonization in immunocompetent hosts or disseminated mycosis in immunocompromised patients. Moreover, S. prolificans resistance to most antifungal agents has been reported. Compared to the well characterized Scedosporium / Pseudallescheria complex, little is known about the fundamental aspects of S. prolificans biology, pathogenicity and epidemiology. Aim of the study: Our goal was to characterize a large population of S. prolificans strains, isolated from animals, human, or environment samples in different countries (European, USA and Australia). Results & methods: All strains were prospectively collected, and grown at 30# C on Sabouraud’s agar medium with kanamycin for 1 week. DNA was extracted from subcultures using UltraClean Fecal# DNA kit (MoBio, France). To improve the knowledge of this species at the phylogenetic level, we combined phenotypic criteria such as macroscopic and microscopic morphology features, antifungal susceptibilities based on E-test# method, and genotypic characterization using multi-loci approaches (superoxide dismutase, beta-tubulin and internal transcript spacer genes). Phylogenetic trees were constructed with unambiguously CLUSTALW aligned sequences using the neighbour-joining method with Kimura-2 parameter as substitution model and maximum parsimony analysis, using the BioEdit version 7.0.0 and Phylip version 2.0 softwares. Discussion: Among our collection composed of 59 isolates, we identified three macroscopically different morphotypes of S. prolificans and some genetic polymorphisms (1.8–2.2% difference between the analyzed sequences). These low sequence polymorphisms reflected intra-specific genetic variations. Therefore, we hypothesized that S. prolificans might be stable in space, and apparently insensitive to xenical or environmental factors. No correlation between clinical-biological characteristics and genotypic or phenotypic criteria of S. prolificans strains was found. In conclusion, our results supported the current perception of S. prolificans as a unique species and an emerging opportunistic pathogen

Micafungin susceptibility of the most common<em> Candida</em> species in 16 French university hospitals : comparison between the Etest® and the EUCAST methods (MICACAND study)

International audienceObjectives : Micafungin is currently used in France. The aim of this study is to determine its activity against a recent (2014) French collection of Candida isolates. Although EUCAST is the reference method for in vitro antifungal susceptibility testing, it is not commonly used in routine clinical microbiology laboratories. Thus, it is important to evaluate alternative methods. We compared EUCAST and Etest for micafungin susceptibility testing of Candida spp. and we monitored the emergence of resistance. Methods: Sixteen centers (6 in Paris area and 10 across France) participated in a two-months prospective study. Clinical isolates of various Candida species (mainly C. albicans, C. glabrata, C. tropicalis, C. parapsilosis, C. kefyr and C. krusei, about 10 isolates of each species per center) were tested by Etest, according to manufacturer’s instructions. All isolates were subsequently centralized in one center for MIC determination by EUCAST method. For comparison purposes, Etest MICs were raised to the next higher EUCAST concentration. Resistance was defined based on EUCAST clinical breakpoints or on epidemiological cut-off values when clinical breakpoints were not available. Results : A total number of 933 Candida isolates were tested. The overall agreement (+/- 2 log2 dilutions) between EUCAST and Etest was 97.9%. Species n E-Test EUCAST MIC range MIC range % agreement with Etest % resistance C. albicans 159 ≤ 0.015 - 0.06 ≤ 0.015 - 0.06 100 1.3 C. tropicalis 152 ≤ 0.015 - 0.5 ≤ 0.015 - 1 98.7 0.7 C. parapsilosis 152 ≤ 0.015 - 4 ≤ 0.125 - 4 96.1 1.3 C. glabrata 152 ≤ 0.015 - 0.125 ≤ 0.015 - 1 98.7 3.9 C. kefyr 136 ≤ 0.015 - 0.25 ≤ 0.015 - 0.125 97.8 ND C. krusei 127 ≤ 0.015 - 1 ≤ 0.015 - 0.25 96.9 0 Other Candida species* 55 ≤ 0.015 - 1 ≤ 0.015 - 1 94.5 ND Total 933 ≤ 0.015 - 4 ≤ 0.015 - 4 97.9 ND *: C. lusitaniae, C. guilliermondii, C. norvegensis, C. inconspicua, C. famata, C. pelliculosa, C. lambica, C. sphaerica, C. ciferii, C. catenulata, C. utilis, C. colliculosa, C. nivariensis Conclusions : This study demonstrated a very good agreement between Etest, performed on a routine basis, and EUCAST for micafungin MIC determination. Micafungin resistance among the main Candida species was uncommon

Evaluation of the risk of fungal colonization/infection in patients with cystic fibrosis : an international prospective study comparing the performance of media for mycological culturing MucoFong International Project (MFIP)

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Spectrum of Pulmonary Aspergillosis in Hyper-IgE Syndrome with Autosomal-Dominant STAT3 Deficiency

International audienceBackground: Autosomal-dominant signal transducer and activator of transcription 3 (STAT3) deficiency predisposes to recurrent bacterial pneumonia, complicated by bronchiectasis and cavitations. Aspergillosis is a major cause of morbidity in these patients. However, its diagnosis, classification, and treatment are challenging.Objective: We aimed to assess the prevalence and describe the clinical, mycological, and radiological presentation and related therapy and outcome of Aspergillus infections of the respiratory tract in the STAT3-deficient patients of the National French cohort.Methods: We performed a retrospective study of all pulmonary aspergillosis cases in STAT3-deficient patients (n = 74). Clinical and mycological data were collected up to October 2015 and imaging was centralized.Results: Twenty-one episodes of pulmonary aspergillosis in 13 (17.5%) STAT3-deficient patients were identified. The median age at first episode was 13 years (interquartile range, 10-26 years). Ninety percent of patients had previous bronchiectasis or cavitations. Infections were classified as follows: 5 single aspergilloma, 9 chronic cavity pulmonary aspergillosis, 5 allergic bronchopulmonary aspergillosis-like disease, and 2 mixed forms of concomitant allergic bronchopulmonary aspergillosis-like disease and chronic cavity pulmonary aspergillosis. No invasive aspergillosis cases were identified. Aspergillus species were isolated in 71% of episodes and anti-Aspergillus antibodies in 93%. Eleven episodes were breakthrough infections. Antifungal treatment was prolonged, with a median of 13 months, and 6 patients (7 episodes) required surgery, with a high rate of postsurgical complications. One patient died and 6 had a relapse.Conclusions: Chronic and allergic forms of aspergillosis occurred in 17.5% of STAT3-deficient patients, mostly in lung cavities. Almost half had recurrences, despite prolonged antifungal treatment and/or surgery