Quizz en Infectiologie

National audienc

Buruli ulcer acquired in Mali: A rare and atypical situation

International audienc

Facteurs de variation de la composition du lait à la Réunion

National audienceIn order to characterise the incidence of livestock farming practices and rations distributed to the animals on milk quality, surveys and feeding controls were carried out quarterly on twenty-nine dairy farms during 14 months (2002-2003). Herds milk samples were collected and analysed for chemical composition (fat, protein, urea, lactose, and mineral contents) and for hygienic quality (total bacteria, butyric spore and somatic cell counts). The 116 milk sample data were analysed to build a five-class milk quality typology. This typology was then confronted to the management practices. The main factors influencing the variability of herd milk were the season, and the level and nature of feeding. The milks highest in fat and proteins contents were produced in the winter, particularly when the animals were fed temperate forages. Regarding hygienic quality, the best results were obtained in the winter and spring, in areas with low rainfall. None of the five milk classes combined on a same period high fat and protein contents, and low levels of butyric spore and somatic cell counts. An important margin of progress in mastering these main quality parameters appeared. This could be realised by adapting feeding practices and/or herd management techniques that were identified in the study.Vingt-neuf élevages laitiers de la Réunion ont été suivis pendant 14 mois au cours des années 2002 et 2003. Des enquêtes et des contrôles d’alimentation ont été réalisés tous les trimestres pour caractériser les pratiques d’élevage et les rations distribuées. Sur des prélèvements de lait de troupeaux effectués tous les mois, des analyses de composition chimique (matières grasses, protéines, urée, lactose, minéraux,…) et de qualité hygiénique (germes totaux, cellules, spores butyriques) ont été réalisées. Au total 116 échantillons de lait correspondants à 4 passages ont été retenus pour construire une typologie des laits en 5 classes. Cette typologie a ensuite été analysée en fonction des pratiques d’élevage correspondantes. Les principaux facteurs de variation des caractéristiques des laits de troupeaux sont la saison, le niveau et la nature des apports alimentaires. Les laits les plus riches en matières utiles sont produits en hiver, essentiellement avec des rations à base de fourrages tempérés. Pour la qualité hygiénique, les meilleurs résultats sont obtenus en hiver et au printemps, dans les zones à faible pluviométrie. Aucune classe ne combine à la fois des laits riches en matières utiles, à faibles contaminations en spores butyriques et à faible numération cellulaire. Il existe donc une marge de progrès importante dans ces trois domaines, via des pratiques d’alimentation et/ou de conduite des animaux qui ont été identifiées dans cette étude

Current profile and management of gonococcal infections: A population-based study in Western France

International audienceObjective: To characterize the current profile of gonococcal infections in France, and to describe their management. Patients and method: A population-based retrospective study of all gonococcal infections documented by PCR in two French departments (Île-et-Vilaine, Morbihan), in 2014–2016. Cases were identified through hospital databases and the Rénago sentinel network. Results: We enrolled 245 patients (96 females, 149 males), with a median age of 25 years [interquartile range, 21–33]. The incidence rate was estimated at 4.54 per 100,000 inhabitants-year. Cases were diagnosed mostly by a general practitioner (n = 122, 49.8%) or a gynecologist (n = 45, 18.4%). The main clinical presentations included urethritis (n = 59), pelvic inflammatory disease (n = 40), cervicitis (n = 12), and anorectitis (n = 11). The main coinfections were Chlamydia trachomatis (n = 40) and HIV (n = 8). Ceftriaxone MIC was ≤ 0.12 mg/L in 146/147 patients with positive culture. Treatment was appropriate in 52/74 (70.2%) patients with available data. Conclusions: In France, general practitioners are at the front line in management of gonococcal infections. © 2020 Elsevier Masson SA

Non-HACEK gram-negative bacilli endocarditis: a multicentre retrospective case-control study

International audienceBACKGROUND: Infective endocarditis (IE) caused by non-HACEK gram-negative bacilli (GNB) is poorly characterised and may be emerging as a consequence of medical progress. METHODS: We performed an observational retrospective case-control study. Cases were non-HACEK GNB IE, definite or possible (modified Duke criteria), diagnosed in adults between 2007 and 2020 in six French referral hospitals. Two controls were included for each case (IE due to other bacteria, matched by sites and diagnosis date). RESULTS: Non-HACEK GNB were identified in 2.4% (77/3230) of all IE during the study period, with a mean age of 69.2 ± 14.6 years, and a large male predominance (53/77, 69%). Primary pathogens were Escherichia coli (n = 33), Klebsiella sp. (n = 12) and Serratia marcescens (n = 9), including eight (10%) multidrug-resistant GNB. Compared to controls (n = 154: 43% Streptococcus sp., 41% Staphylococcus sp. and 12% Enterococcus sp.), non-HACEK GNB IE were independently associated with intravenous drug use (IVDU, 8% vs. 2%, p = .003), active neoplasia (15% vs. 6%, p = .009), haemodialysis (9% vs. 3%, p = .007) and healthcare-associated IE (36% vs. 18%, p = .002). Urinary tract was the main source of infection (n = 25, 33%) and recent invasive procedures were reported in 29% of cases. Non-HACEK GNB IE were at lower risk of embolism (31% vs. 47%, p = .002). One-year mortality was high (n = 28, 36%). Comorbidities, particularly malignant hemopathy and cirrhosis, were associated with increased risk of death. CONCLUSIONS: Non-HACEK GNB are rarely responsible for IE, mostly as healthcare-associated IE in patients with complex comorbidities (end-stage renal disease, neoplasia), or in IVDUs