MANIFESTATIONS EXTRA-PULMONAIRES DES ASPERGILLOSES INVASIVES CHEZ L'ADULTE NON NEUTROPENIQUE (A PROPOS DE TROIS OBSERVATIONS)

TOURS-BU Médecine (372612103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Infection profonde de la peau et des tissus mous à Mycobacterium malmoense

International audienceNontuberculosis mycobacteria (NTM) are non-communicable opportunistic organisms that typically infect immunocompromised hosts such as in malignancy or HIV/AIDS. However, NTM infections are more frequently being reported in immunocompetent individuals with underlying chronic respiratory diseases, previous tuberculosis or condition including alcoholism, smoking and long term use of steroids. Mycobacterium malmoense is one of the NTM species most frequently isolated in Europe, and has been reported in nonspecific pulmonary infections in adults and sub acute/chronic cervical lymphadenitis in children. Cutaneous infections are rare and clinical presentations are nodula. Other uncommon presentations include, soft tissue, joint infections, urinary tract infection, tenosynovitis, and disseminated infection in patients with HIV

Infection à <em>Clostridium difficile</em> : performances du test combiné GDH-ToxA/B et analyse des facteurs de risque de récidive

National audienc

Tuberculosis -HIV, a common and sensitive care in connection with a case of pleural tuberculosis revealing AIDS

National audienceTuberculosis is the most common disease inaugural of AIDS in France and HIV serology should be offered routinely when a tuberculosis case is diagnosed. Similarly, tuberculosis should also be sought before starting antiretroviral treatment. The case of pleural tuberculosis revealing AIDS presented here illustrates the difficulties of management of this co-infection due to polychemotherapy used to treat each of these pathologies causing drug interactions requiring dose adjustments and changes in treatment protocol and an increase in side effects. This is especially true when combining rifampicin and protease inhibitors and non-nucleoside reverse transcriptase inhibitors. On the other hand, resistance of Mycobacterium tuberculosis is possible in these patients coinfected by HIV particularly among migrants and in the case history of tuberculosis treatment

Pneumocystis jirovecii pneumonia in HIV-negative patients: A prospective study with focus on immunosuppressive drugs and markers of immune impairment

International audienc

Revisiting HBV resistance to entecavir with a phenotypic approach

International audienceTreatment adaptation after hepatitis B virus (HBV) treatment failure relies on genotypic resistance testing. However, the results of such tests are not always consistent with treatment response. These discrepancies may be due to differences in resistance levels between isolates with the same genotypic resistance testing profiles. We explored this hypothesis by investigating six cases of entecavir treatment failure with an integrative strategy combining genotypic and phenotypic resistance testing, medical record review and therapeutic drug monitoring. Among isolates with genotypic reduced susceptibility to entecavir, one displayed a higher level of resistance to entecavir (mean fold change in entecavir IC50 of 1 508 ± 531 vs. 318 ± 53, p=0.008). This isolate harbored a substitution (rt250L) at a position reported to be associated with resistance (rt250V). Reversion to wild-type amino acid at this position partially restored susceptibility to entecavir, confirming that the rt250L mutation was responsible for the high level of resistance to entecavir. This is the first description of entecavir treatment failure associated with selection of the rt250L mutation without other entecavir resistance mutations. One isolate with genotypic resistance to entecavir, harboring the rt173L mutation, displayed a lower level of resistance than the other, harboring the rt202G mutation (mean fold change of 323 ± 124 vs. 6 036 ± 2 100, p=0.20). These results suggest that isolates harboring the rt250L mutations should be considered resistant to entecavir, whereas isolates harboring the rt173L mutations should be considered to display reduced susceptibility to entecavir. An integrative approach to antiviral drug resistance in HBV would provide a more accurate assessment of entecavir treatment failures and help to improve the accuracy of genotypic testing algorithms

Acute Tibial osteomyelitis caused by intraosseous access during initial resuscitation: a case report and literature review

International audienceBackground Intra-osseous (IO) access is recommended in cases of pre-hospital emergency or resuscitation when intravascular (IV) route is difficult or impossible. Despite recent improvement in IO devices and increasing indications, it remains rarely used in practice. Various complications have been reported but are uncommon. Case presentation We report a case of massive acute tibial osteomyelitis in an adult male three months after an IO catheter insertion for emergency drug infusion. We review the literature on association between IO access and acute osteomyelitis in children and adults. Conclusions Emergency-care givers and radiologists should be informed about this infrequent complication in order to make early diagnosis and initiate adequate antibiotic therapy

Prosthetic Valve Candida spp. Endocarditis: New Insights Into Long-term Prognosis—The ESCAPE Study

International audienceBackground: Prosthetic valve endocarditis caused by Candida spp. (PVE-C) is rare and devastating, with international guidelines based on expert recommendations supporting the combination of surgery and subsequent azole treatment.Methods: We retrospectively analyzed PVE-C cases collected in Spain and France between 2001 and 2015, with a focus on management and outcome.Results: Forty-six cases were followed up for a median of 9 months. Twenty-two patients (48%) had a history of endocarditis, 30 cases (65%) were nosocomial or healthcare related, and 9 (20%) patients were intravenous drug users. "Induction" therapy consisted mainly of liposomal amphotericin B (L-amB)-based (n = 21) or echinocandin-based therapy (n = 13). Overall, 19 patients (41%) were operated on. Patients <66 years old and without cardiac failure were more likely to undergo cardiac surgery (adjusted odds ratios [aORs], 6.80 [95% confidence interval [CI], 1.59-29.13] and 10.92 [1.15-104.06], respectively). Surgery was not associated with better survival rates at 6 months. Patients who received L-amB alone had a better 6-month survival rate than those who received an echinocandin alone (aOR, 13.52; 95% CI, 1.03-838.10). "Maintenance" fluconazole therapy, prescribed in 21 patients for a median duration of 13 months (range, 2-84 months), led to minor adverse effects.Conclusion: L-amB induction treatment improves survival in patients with PVE-C. Medical treatment followed by long-term maintenance fluconazole may be the best treatment option for frail patients