Minocycline-induced hypersensitivity syndrome presenting with meningitis and brain edema: a case report

<p/> <p>Background</p> <p>Hypersentivity Syndrome (HS) may be a life-threatening condition. It frequently presents with fever, rash, eosinophilia and systemic manifestations. Mortality can be as high as 10% and is primarily due to hepatic failure. We describe what we believe to be the first case of minocycline-induced HS with accompanying lymphocytic meningitis and cerebral edema reported in the literature.</p> <p>Case presentation</p> <p>A 31-year-old HIV-positive female of African origin presented with acute fever, lymphocytic meningitis, brain edema, rash, eosinophilia, and cytolytic hepatitis. She had been started on minocycline for inflammatory acne 21 days prior to the onset of symptoms. HS was diagnosed clinically and after exclusion of infectious causes. Minocycline was withdrawn and steroids were administered from the second day after presentation because of the severity of the symptoms. All signs resolved by the seventh day and steroids were tailed off over a period of 8 months.</p> <p>Conclusion</p> <p>Clinicians should maintain a high index of suspicion for serious adverse reactions to minocycline including lymphocytic meningitis and cerebral edema among HIV-positive patients, especially if they are of African origin. Safer alternatives should be considered for treatment of acne vulgaris. Early recognition of the symptoms and prompt withdrawal of the drug are important to improve the outcome.</p

Keep an ear out for Francisella tularensis: otomastoiditis Cases after Canyoneering

We report here three unusual cases of otomastoiditis due to Francisella tularensis, complicated by cervical abscesses and persistent hearing loss, plus facial paralysis for one patient. Intriguingly, the three patients had practiced canyoneering independently in the same French river, between 2009 and 2014, several days before clinical symptoms onset. The results point out that fresh water exposure may be a potential contamination route for tularemia. Besides, due to the frequent complications and sequelae, we believe that F. tularensis should be considered as a possible etiology in case of otitis media, failure of the conventional antibiotic treatment, and suspicious exposure of the bacteria

Étude des pratiques des médecins généralistes dans la prise en charge des infections urinaires à entérobactéries sécrétrices de bêta-lactamase à spectre étendu

Les infections urinaires à entérobactéries sécrétrices de bêta-lactamase à spectre étendu (EBLSE) sont un problème largement méconnu en médecine générale. L objectif de cette étude a été d étudier les pratiques des médecins généralistes lors de la découverte d EBLSE sur un résultat d'examen cytobactériologique des urines (ECBU). Cette étude épidémiologique descriptive rétrospective multicentrique a été réalisée du 1er janvier au 31 décembre 2012 dans 5 laboratoires de Savoie et d Isère. Ont été recueillis les ECBU positifs à EBLSE prescrits par des médecins généralistes. Les données anonymes, recueillies par questionnaire, ont porté sur la conformité de l antibiothérapie et la mise en place de mesures d hygiène spécifiques. Ont été également étudiés : la prévalence des EBLSE, les caractéristiques de l infection (communautaire, associé aux soins ou nosocomial), les facteurs de risque d infection à EBLSE, les mesures associées (avis spécialisé, hospitalisation, ECBU de contrôle). Sur 19494 ECBU, 103 ont été inclus, et 56 questionnaires recueillis. La prévalence des ECBU positifs à EBLSE a été de 0,60%. L antibiothérapie a été conforme pour 35 patients (62,5%). Des mesures spécifiques d hygiène ont été prises pour 22 patients (32,3%). Treize patients (23,2%) ont reçu à la fois une antibiothérapie conforme et des mesures d hygiène spécifiques. Vingt-sept patients (48,2%) ont été informés de la présence d une EBLSE dans les urines. La mise en place concomitante d une antibiothérapie conforme et de mesures d hygiène spécifiques est insuffisante. Les infections urinaires à EBLSE sont un problème de médecine générale dont la prise en charge en termes d antibiothérapie et de mesures associées peut être optimisée.Urinary tract infection (UTI) caused by Enterobacteriaceae extended-spectrum-beta-lactamase (EESBL) is an unknown issue for most of the general practitioner (GP). The aim of this study was to evaluate their practice in case of EESBL discovered on a urine culture. This epidemiological, retrospective, multicenter and descriptive study was undertaken from the 1st of January to the 31st of December 2012, in 5 laboratories in Savoie and Isere. Urine cultures prescribed by GP and positive for EESBL were collected. Anonymous data, undertaken by questionnaires, were about antibiotic treatment conformity and specific hygiene measures settings. Also under consideration: EESBL prevalence, characteristics of the infections (community-associated, health-care associated or hospital-acquired), risk factors for EESBL colonization and related measures (specialist opinion, hospitalization, urine cultures screening). One hundred and three urine cultures out of 19 494 were considered, and 56 questionnaires included. Prevalence of EEBLS positive results was 0,6%. Antibiotic treatment was relevant for 35 patients (62,5%), specific hygiene measures were set up for 22 patients (32,3%). Thirteen patients (23,2%) received both antibiotic treatment and specific hygiene measures. Twenty seven patients (48,2%) were informed of the presence of a multi-drug resistant bacteria in their urine. In GP practice, concomitant settings of both antibiotic treatment and specific hygiene measures in case of urine culture positive for EESBL are an insufficient process and should be improved.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Intérêt d un questionnaire simplifié pour l évaluation des patients se déclarant allergiques à la pénicilline

Introduction : Le diagnostic d allergie à la pénicilline est fréquemment porté par excès. Les tests allergiques cutanés éliminent 80% des allergies autodéclarées. L objectif de l étude est d évaluer si des médecins non allergologues peuvent exclure le diagnostic d allergie aux pénicillines grâce à un questionnaire portant sur des données cliniques simples. Méthodes : L étude se déroulait de novembre 2009 à mai 2010 dans 7 cabinets de médecine générale d Isère et de Savoie et dans le service des maladies infectieuses du centre hospitalier de Chambéry. Les médecins incluaient les patients se déclarant allergiques à la pénicilline quelque soit le motif de consultation. Ils évaluaient la probabilité de l allergie à l aide d un questionnaire simple conçu pour l étude. La proportion de patients dont l allergie était exclue à l issue du questionnaire était analysée. Les médecins adressaient les patients non exclus à un allergologue. Un rappel téléphonique des patients évaluait le nombre réellement envoyé chez l allergologue. Résultats : L étude comptait 105 patients. Les médecins excluaient l allergie chez 15,2% des patients (IC 95% : 0,09-0,22). Une pénicilline avait été réintroduite chez 13,3% des patients sans provoquer de réactions allergiques. Parmi les patients non exclus, 41,5% étaient envoyés chez l allergologue et 8,6% avaient consulté. Conclusion : Notre questionnaire permettait d exclure 15,2% des patients se déclarant allergiques à la pénicilline. Il pourrait dépister en pratique courante ambulatoire et hospitalière les faux allergiques à la pénicilline. Les médecins et les patients doivent être sensibilisés à l intérêt de la consultation allergologique.Introduction: Many patients have been incorrectly given the label allergic to penicillin. Among patients with a reported history of penicillin allergy, 80% have no evidence of penicillin allergy on skin testing. The purpose is to evaluate if non allergists can exclude penicillin allergy with a simple questionnaire. Methods: Patients were enrolled from November 2009 to may 2010 in seven general practitioner offices and in infectious diseases department of Chambery s Hospital. Patients reporting penicillin allergy were included, whatever purposes of consultation. Physicians evaluated the probability of allergy with a simple questionnaire designed for the study. We analysed the ratio of patients with an allergy excluded. Physicians should offer patients to consult an allergist. We phoned patients to know if they had undergone investigations. Results: The study cohort consisted of 105 patients. Physicians excluded 15.2% of patients who reported penicillin allergy (CI 95% : 0.09-0.22). Fourteen patients (13.3%) were reexposed to penicillin without further reaction. Among patients with non-excluded allergy, 41.5% were referred to allergist and 8.5% had undergone investigations. Conclusion: We could exclude 15.2% of patients reporting penicillin allergy with our questionnaire. This questionnaire could be practically useful to detect false allergies. Physicians and patients need further education focusing on the benefit of investigations of penicillin allergy.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Bactériémie à Staphylococcus aureus résistant à la Méticilline (Etude Prospective des Facteurs de Risque de Mortalité à 30 Jours.)

STRASBOURG-Medecine (674822101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Can information and communication technologies be pro-poor?

There is over 20 years of accumulated cross-country evidence on the link between telecommunications provision and economic growth. Looking at micro-studies from a range of countries including Bangladesh, Botswana and Zimbabwe, there is also some evidence that provision of telephony has a dramatic effect on the income and quality of life of the rural poor. This paper examines cross-country evidence to discover if teledensity (the number of telephones per capita) has a pro-poor growth impact--fostering increased average incomes while reducing inequality. It also examines the impact of telecommunications rollout on quality of life variables including infant mortality and literacy. It finds that, historically, telecommunications rollout has had a positive and significant impact on increasing inequality and little impact on quality of life variables. A reason for this is tested and preliminarily confirmed that rollout has (historically) only benefited the wealthy. The paper will then turn to emerging evidence on the role of the Internet in poverty relief and statistics on the access gap in provision between rich and poor, suggesting that this new ICT will also be a force for income divergence. Using the results of the cross-country analysis on telecommunications, the paper will conclude with a discussion of potential policy responses (such as sector reform and universal access programs) to turn telecommunications from a source of growth that also increases inequality to a source of growth that diminishes it.Telecommunications Poverty Inequality Economic growth

Evaporation under cavity flow: laser speckle correlation of the wind velocity above the liquid surface

International audienc

Structure and Dynamics of Nonionic Surfactant Aggregates in Layered Materials

International audienceAggregation of surfactants on solid surfaces as they are adsorbed from solution is the basis of numerous technological applications such as colloidal stabilization, ore flotation, or cleaning floors. The understanding of both the structure and the dynamics of surfactant aggregates for the development of alternative way of preparation of hybrid layered materials. For this purpose, we study the adsorption of the tri-ethylene glycol mono n-decyl ether (C10E3) nonionic surfactant onto a synthetic montmorillonite (Mt), an aluminosilicate clay mineral for organoclay preparation with important applications in materials sciences, catalysis, wastewater treatment, or as drug delivery. The aggregation mechanisms follow those observed in an analogous natural Mt, with the condensation of C10E3 in a bilayer arrangement once the surfactant self-assembles in a lamellar phase beyond the critical micelle concentration, underlining the importance of the surfactant state in solution. Solid-state 1 H nuclear magnetic resonance (NMR) at fast magic-angle spinning (MAS) and high magnetic field, combined with 1 H-13 C correlation experiments and different types of 13 C NMR experiments selectively probe mobile or rigid moieties of C10E3 in three different aggregate organizations: (i) lateral monolayer, (ii) lateral bilayer, and (iii) normal bilayer. High-resolution 1 H{ 27 Al} CP-1 H-1 H spin diffusion experiments shed light on proximities and dynamics of the dynamics of different fragments and fractions of the intercalated surfactant molecules with respect to the Mt surface. 23 Na and 1 H NMR measurements combined with complementary NMR data, at both molecular and nanometer scales, precisely pointed out the location C10E3 ethylene oxide hydrophilic group in close contact with Mt surface interacting through ion-dipole or Van der Waals interactions