Étude rétrospective des cas de péritonites candidosiques développées dans le service de réanimation chirurgicale du CHU de Rouen sur une période de six ans (2006-2011)

Les informations concernant les espèces de Candida responsables de péritonite, les facteurs aggravant la mortalité ainsi que les stratégies thérapeutiques à mettre en oeuvre en probabiliste sont encore limitées. Cette étude prospective regroupe 86 patients adultes hospitalisés dans le service de réanimation chirurgicale du CHU de Rouen, qui ont développé une péritonite fongique entre 2006 et 2011. Les espèces de Candida retrouvées sont C. albicans (n = 68/103 isolats, 66%), C. glabrata (n = 11, 11%), C. tropicalis (n = 7), C. krusei (n = 5), C. parapsilosis (n = 4), C. inconspicua (n =2), C. lusitaniae (n = 2), C. intermedia (n = 1), C. kefyr (n = 1), C. norvegiensis (n = 1), C. utilis (n =1). Sur les isolats testés, 10% étaient résistants ou de sensibilité diminuée au fluconazole. Un traitement probabiliste a été mis en oeuvre dans 79% des cas avec un délai d'instauration moyen de deux jours après la réalisation du prélèvement. La mortalité de notre série est de 37% et apparaît moins importante lorsque l'espèce fongique retrouvé est C.glabrata. La réalisation d'une dialyse ou le recours à des amines vasopressives pour palier un choc hémodynamique durant le séjour hospitalier sont des facteurs accroissant la mortalité.ROUEN-BU Médecine-Pharmacie (765402102) / SudocSudocFranceF

Successful treatment of Trichosporon asahii fungemia with isavuconazole in a patient with hematologic malignancies

International audienceTrichosporon spp. are yeast-like microorganisms responsible for skin, urinary, pulmonary, or bloodstream infections. Due to intrinsic resistance to echinocandins, poor susceptibility to polyenes, and preferred occurrence in immunocompromised patients, such infections are often of poor prognosis. Yet no consensual therapeutic guidelines are presently available. Several clinical cases of Trichosporon infections have been successfully treated with azole therapy, including voriconazole which appeared frequently effective against Trichosporon both in vitro and in vivo. However, the low efficacy associated with some Trichosporon genotypes, complex pharmacokinetics, and the side effects of voriconazole represent limitations for its use and has prompted a search for other therapeutic options. Here, we report a case of T. asahii fungemia in a patient with B-cell acute lymphoblastic leukemia which was successfully treated with isavuconazole consecutive to stopping voriconazole therapy due to severe side effects. This observation suggests that isavuconazole with a similar spectrum to voriconazole, fewer pharmacology interactions, and side effects may be considered as a valuable therapeutic option against Trichosporon infections

Common occurrence of Cryptosporidium hominis in asymptomatic and symptomatic calves in France

International audienceSymptomatic infection by the Apicomplexan Cryptosporidium spp. is presently considered the most frequent parasitic cause of acute diarrhea in both humans (especially severe in immunocompromised individuals and infants in both developed and developing countries) and cattle (calves), while asymptomatic infections are less often documented. Cryptosporidium (C.) hominis once considered to be restricted to humans accounts for the majority of pediatric cases in several countries. C. parvum can also infect cattle as well as C. bovis, C. andersoni, and C. ryanae. Recently, cattle C. hominis cryptosporidiosis has been reported, suggesting that the presence of C. hominis in calves was previously underestimated. The aim of this work was to characterize Cryptosporidium spp. infection in both asymptomatic and symptomatic dairy and beef calves from Metropolitan France. From February to November 2015, C. parvum or C. hominis infected calves were detected in farms from 5 geographic regions of France. Surprisingly, C. hominis was present in about one fifth of Cryptosporidium spp. infected calves, and exhibited genotypes which were previously reported in human and nonhuman primate. Further investigations are aimed at documenting direct or indirect C. hominis transmissions between and among livestock and humans

Semi-automated repetitive sequence-based PCR amplification for species of the Scedosporium apiospermum complex

International audiencePurpose: The Scedosporium apiospermum species complex usually ranks second among the filamentous fungi colonizing the airways of patients with cystic fibrosis (CF), but little is known about the molecular epidemiology of the airway colonization.Methods: Polymerase chain reaction (PCR) amplification of repetitive sequences (rep-PCR) was applied to the retrospective analysis of a panel of isolates already studied by random amplification of polymorphic DNA (RAPD) and comprising 63 isolates recovered from sputa from 9 CF patients. Results were compared to those obtained previously by RAPD, and herein by beta-tubulin (TUB) gene sequencing and Multilocus Sequence Typing (MLST).Results: Within the panel of isolates studied, S. apiospermum sensu stricto and Sce-dosporium boydii, as expected, were the predominant species with 21 and 36 isolates, respectively. Four isolates from one patient were identified as Scedosporium auranti-acum, whereas two isolates belonged to the Pseudallescheria ellipsoidea subgroup of S. boydii. rep-PCR analysis of these isolates clearly differentiated the three species and P. ellipsoidea isolates, whatever the rep-PCR kit used, and also permitted strain differentiation. When using the mold primer kit, results from rep-PCR were in close agreement with those obtained by MLST. For both S. apiospermum and S. boydii, 8 genotypes were differentiated by rep-PCR and MLST compared to 10 by RAPD. All S. aurantiacum isolates shared the same RAPD genotype and exhibited the same rep-PCR profile and sequence type.Conclusions: These results illustrate the efficacy of rep-PCR for both species identification within the S. apiospermum complex and genotyping for the two major species of this comple

Evaluation of voriconazole anti-Acanthamoeba polyphaga in vitro activity, rat cornea penetration and efficacy against experimental rat Acanthamoeba keratitis

International audienceBackground: Acanthamoeba keratitis (AK) is a sight-threatening infectious disease. Its effective and safe medical therapy remains highly debated. Recently, voriconazole, a monotriazole with noted in vitro activity against a large variety of fungi, has been successfully used both topically and systemically to treat human AK cases.Objectives: To measure anti-Acanthamoeba polyphaga in vitro activity, anti-rat AK efficiency and rat cornea penetration of eye-drop and oral voriconazole.Methods: A. polyphaga was maintained in axenic cultures. In vitro, amoebicidal and cysticidal activities of voriconazole were measured using an XTT assay. AK lesions of Sprague Dawley rats were scored from grade 0 to grade 3. For 21 days, from day 7 post-infection, voriconazole (1% solution) eye drops were instilled or voriconazole was administered by gavage (60 mg/kg/day). After killing, superficial corneal epithelium scrapings were cultured and analysed by PCR, and eye-globe histology was performed. Cornea and plasma concentrations were determined using 2D HPLC separation and tandem MS.Results: In vitro, voriconazole inhibited trophozoite proliferation with an IC50 value of 0.02 mg/L and an IC90 value of 2.86 mg/L; no cysticidal effect was found. In AK rats, eye drops reduced clinical worsening from day 7 to day 14 post-infection and oral voriconazole was not effective. Voriconazole cornea concentrations were directly dependent on the frequency of eye-drop instillations, which resulted in lower plasma concentrations, whilst oral voriconazole resulted in lower cornea concentrations.Conclusions: Present data underline the need for high-frequency eye-drop instillation regimens for efficient AK therapy

Update on Cryptosporidium spp.: highlights from the Seventh International Giardia and Cryptosporidium Conference

While cryptosporidiosis is recognized as being among the most common causes of human parasitic diarrhea in the world, there is currently limited knowledge on Cryptosporidium infection mechanisms, incomplete codification of diagnostic methods, and a need for additional therapeutic options. In response, the Seventh International Giardia and Cryptosporidium Conference (IGCC 2019) was hosted from 23 to 26 June 2019, at the Rouen Normandy University, France. This trusted event brought together an international delegation of researchers to synthesize recent advances and identify key research questions and knowledge gaps. The program of the interdisciplinary conference included all aspects of host-parasite relationships from basic research to applications to human and veterinary medicine, and environmental issues associated with waterborne parasites and their epidemiological consequences. In relation to Cryptosporidium and cryptosporidiosis, the primary research areas for which novel findings and the most impressive communications were presented and discussed included: Cryptosporidium in environmental waters, seafood, and fresh produce; Animal epidemiology; Human cryptosporidiosis and epidemiology; Genomes and genomic evolution encompassing: Comparative genomics of Cryptosporidium spp., Genomic insights into biology, Acquiring and utilizing genome sequences, Genetic manipulation; Host-parasite interaction (immunology, microbiome); and Diagnosis and treatment. High quality presentations discussed at the conference reflected decisive progress and identified new opportunities that will engage investigators and funding agencies to spur future research in a “one health” approach to improve basic knowledge and the clinical and public health management of zoonotic cryptosporidiosis

Les cortinaires de la section orellani

Les intoxications fongiques induites par Cortinarius orellanus, C.speciosissinus, C.henrici et C.Orellaroides ont été répertoriées. Elles ont permis d'étudier le syndrome orellanien. Il se caractérise par une première phase gastro-intestinale, puis par I'apparition d'une insuffisance rénale aiguë. Ces intoxications sont induites par l'orellanine qui se dégrade en orellinine toxique puis en orelline non toxique.ROUEN-BU Médecine-Pharmacie (765402102) / SudocSudocFranceF

Giardia duodenalis chez les ruminants

International audienceGiardia duodenalis est un protozoaire flagellé ubiquiste et très commun infectant les mammifères dont l’Homme. Ce parasite est considéré comme un complexe d’espèces comprenant huit assemblages identifiés de A à H, certains assemblages étant plus spécifiques d’hôtes. Le cycle biologique est très simple et comprend un stade trophozoïte chez l’hôte et un stade kyste infectieux dans l’environnement. La période prépatente (période comprise entre l’ingestion de kystes par l’hôte et le début d’excrétion des kystes dans les fèces) est de l’ordre de 6 à 10 j. Giardia est retrouvé plus fréquemment chez les jeunes ruminants (ou pré-ruminants) avec un début d’excrétion autour de quelques jours d’âge, un pic de prévalence entre 2 et 6 mois et une fréquence d’excrétion plus faible et irrégulière au-delà de 6 mois. Les facteurs derisque d’infection sont le jeune âge, le contact avec la mère, des défauts dans le nettoyage et la désinfection des locaux, un déficit de transfert colostral et la saison. Cliniquement, la giardiose se manifeste par une diarrhée chronique, intermittente, accompagnée d’une excrétion de kystes irrégulière. Il faut cependant souligner que la majorité des études mettent en évidence l’importance des infections asymptomatiques chez les ruminants et ce, quel que soit le niveau d’excrétion de kystes. Le diagnostic de giardiose chez les veaux est complexe en raison d’une non simultanéité entre signes cliniques et excrétion de kystes (contrairement à Cryptosporidium par exemple). Parmi les nombreuses techniques diagnostiques existantes, on privilégiera la technique la plus sensible. En raison d’une recontamination fréquente des animaux après traitement, le contrôle de la giardiose s’appuie principalement sur des mesures hygiéniques (propreté des litières et désinfection)

Prévention de l'aspergillose invasive liée aux travaux (expérience du CHU de Rouen)

L'aspergillose invasive (AI) est une infection opportuniste grave chez les patients immunodéprimés notamment en onco-hématologie et chez les transplantés. L'inhalation de spores d'Aspergillus est a principale voie de contamination ce qui suggère le rôle déterminant de l'aérobiocontamination environnementale dans l'épidémiologie de l'AI. La présence de travaux hôpitaliers est un facteur de risque majeur et a été impliqué plusieurs fois dans la survenue d'épidémies. La prévision de nombreus travaux de restructuration sur le long terme au CHU de Rouen a conduit le laboratoire d'hygiène a élaborer un plan de prévention comprenant la mise en place de mesures spécifiques et une surveilance de l'aérobiocontamination. Pour cela, une collaboration étroite a été indispensable entre les intervenants sur le chantier, les hygiénistes, les personnels soignants et les personnels administratifs. L'application de ces mesures lors des chantiers qui se sont déroulés en pédiatrie entre décembre 2002 et septembre 2003 s'est révélé efficace. La continuité des soins a pu être assurée dans le service d'onco-hématologie pédiatrique pendant des travaux à haut risque. A ce jour, aucun cas d'AI n'est à déplorer.ROUEN-BU Médecine-Pharmacie (765402102) / SudocSudocFranceF