Bacterial infection profiles in lung cancer patients with febrile neutropenia

<p>Abstract</p> <p>Background</p> <p>The chemotherapy used to treat lung cancer causes febrile neutropenia in 10 to 40% of patients. Although most episodes are of undetermined origin, an infectious etiology can be suspected in 30% of cases. In view of the scarcity of data on lung cancer patients with febrile neutropenia, we performed a retrospective study of the microbiological characteristics of cases recorded in three medical centers in the Picardy region of northern France.</p> <p>Methods</p> <p>We analyzed the medical records of lung cancer patients with neutropenia (neutrophil count < 500/mm³) and fever (temperature > 38.3°C).</p> <p>Results</p> <p>The study included 87 lung cancer patients with febrile neutropenia (mean age: 64.2). Two thirds of the patients had metastases and half had poor performance status. Thirty-three of the 87 cases were microbiologically documented. Gram-negative bacteria (mainly enterobacteriaceae from the urinary and digestive tracts) were identified in 59% of these cases. <it>Staphylococcus </it>species (mainly <it>S. aureus</it>) accounted for a high proportion of the identified Gram-positive bacteria. Bacteremia accounted for 60% of the microbiologically documented cases of fever. 23% of the blood cultures were positive. 14% of the infections were probably hospital-acquired and 14% were caused by multidrug-resistant strains. The overall mortality rate at day 30 was 33% and the infection-related mortality rate was 16.1%. Treatment with antibiotics was successful in 82.8% of cases. In a multivariate analysis, predictive factors for treatment failure were age >60 and thrombocytopenia < 20000/mm³.</p> <p>Conclusion</p> <p>Gram-negative species were the most frequently identified bacteria in lung cancer patients with febrile neutropenia. Despite the success of antibiotic treatment and a low-risk neutropenic patient group, mortality is high in this particular population.</p

Prevalence of Drug-Resistant HIV-1 Variants in Untreated Individuals in Europe: Implications for Clinical Management

BackgroundInfection with drug-resistant human immunodeficiency virus type 1 (HIV-1) can impair the response to combination therapy. Widespread transmission of drug-resistant variants has the disturbing potential of limiting future therapy options and affecting the efficacy of postexposure prophylaxis penta increase-spacing 1>MethodsWe determined the baseline rate of drug resistance in 2208 therapy-naive patients recently and chronically infected with HIV-1 from 19 European countries during 1996-2002 ResultsIn Europe, 1 of 10 antiretroviral-naive patients carried viruses with ⩾1 drug-resistance mutation. Recently infected patients harbored resistant variants more often than did chronically infected patients (13.5% vs. 8.7%; P=.006). Non-B viruses (30%) less frequently carried resistance mutations than did subtype B viruses (4.8% vs. 12.9%; P<.01). Baseline resistance increased over time in newly diagnosed cases of non-B infection: from 2.0% (1/49) in 1996-1998 to 8.2% (16/194) in 2000-2001 ConclusionsDrug-resistant variants are frequently present in both recently and chronically infected therapy-naive patients. Drug-resistant variants are most commonly seen in patients infected with subtype B virus, probably because of longer exposure of these viruses to drugs. However, an increase in baseline resistance in non-B viruses is observed. These data argue for testing all drug-naive patients and are of relevance when guidelines for management of postexposure prophylaxis and first-line therapy are update

Tracing the HIV-1 subtype B mobility in Europe: a phylogeographic approach

<p>Abstract</p> <p>Background</p> <p>The prevalence and the origin of HIV-1 subtype B, the most prevalent circulating clade among the long-term residents in Europe, have been studied extensively. However the spatial diffusion of the epidemic from the perspective of the virus has not previously been traced.</p> <p>Results</p> <p>In the current study we inferred the migration history of HIV-1 subtype B by way of a phylogeography of viral sequences sampled from 16 European countries and Israel. Migration events were inferred from viral phylogenies by character reconstruction using parsimony. With regard to the spatial dispersal of the HIV subtype B sequences across viral phylogenies, in most of the countries in Europe the epidemic was introduced by multiple sources and subsequently spread within local networks. Poland provides an exception where most of the infections were the result of a single point introduction. According to the significant migratory pathways, we show that there are considerable differences across Europe. Specifically, Greece, Portugal, Serbia and Spain, provide sources shedding HIV-1; Austria, Belgium and Luxembourg, on the other hand, are migratory targets, while for Denmark, Germany, Italy, Israel, Norway, the Netherlands, Sweden, Switzerland and the UK we inferred significant bidirectional migration. For Poland no significant migratory pathways were inferred.</p> <p>Conclusion</p> <p>Subtype B phylogeographies provide a new insight about the geographical distribution of viral lineages, as well as the significant pathways of virus dispersal across Europe, suggesting that intervention strategies should also address tourists, travellers and migrants.</p

Le syndrome de Lemierre (une complication rare des infections oropharyngées)

Décrit en 1936 par Lemierre, le syndrome de Lemierre était alors une complication rare, mais pas exceptionnelle des infections oro-pharyngées. Il associe une thrombose septique de la veine jugulaire interne et des emboles septiques, le plus souvent pulmonaires. Il est du à un germe anaérobie, le plus souvent il s'agit de F. necrophorum. Bien que présentant des signes caractéristiques, il reste encore sous diagnostiqué. Il est cependant très important de faire un diagnostic rapide afin de diminuer la morbi/mortalité de ce syndrome en instaurant rapidement le traitement. Ce dernier étant basé sur une antibiothérapie associée à une anticoagulation. Avec l'apparition des antibiotiques il est devenu une "maladie oubliée". Ces dernières années son incidence tend à augmenter. Cette augmentation est liée aussi bien à la restriction des prescriptions antibiotiques qu'a une meilleure connaissance de la maladie par les praticiens.AMIENS-BU Santé (800212102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Evaluation de la procédure de prise en charge des accidents d'exposition au VIH au CHU d'Amiens (à propos de 628 dossiers sur deux années (2001-2002))

Un Accident d'Exposition au Sang ou aux Sécrétions (AES) est défini par un contact avec du sang ou un liquide contenant du sang possiblement infecté par le virus de l'immunodéficience humaine (VIH), mais aussi par les virus des hépatites (VHB ou VHC). Lors de ces accidents, qu'ils soient professionnels en milieu de soins ou qu'ils surviennent lors de rapports sexuels à risque, ou chez les usagers de drogue par voie intraveineuse, il existe un risque quantifiable de contamination virale. Nous avons voulu étudier, à la manière d'un audit, l'ensemble des moyens mis en œuvre au CHU d'Amiens pour la prise en charge de ces accidents très spécifiques. Nous avons repris pour cela les dossiers des 628 consultants pour AES au CHU d'Amiens sur 2001 et 2002. Il s'agit là d'une prise en charge complexe et pluridisciplinaire qui nécessite la mise au point de procédures de travail et de protocoles accessibles à tous. Une évaluation régulière des pratiques reste nécessaire au sein du CHUAMIENS-BU Santé (800212102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Les infections invasives à méningocoque, à propos de la campagne de vaccination par le MenBvac® contre la souche B:14:P1-7, 16 dans la Somme

Malgré les avancées thérapeutiques et vaccinales, les infections invasives à méningocoques persistent, notamment localement, en France et dans la Monde. Bien que leur incidence soit proche d un cas pour 100 000 habitants, la sévérité des cas fait que cette incidence bénéficie d une surveillance renforcée. La prise en charge d un cas se fait selon des procédures spécifiées par des recommandations régulièrement publiées. Depuis 2003 en Seine Maritime et depuis 2008 dans la Somme, ces départements ont dû faire face à une augmentation importante de cas d Infections Invasives à Méningocoque B, notamment de la souche B:14:P1-7,16. Débutée en Seine-Maritime en 2006, une campagne de vaccination par le vaccin norvégien MenBvac® a été étendue en 2009 à quatre cantons de la Somme afin d éradiquer cette hyper-endémie inquiétante. Ainsi, la Direction Départementale des Affaires Sanitaires et Sociales de la Somme, relayée par l Agence Régionale de Santé de Picardie, et le Centre Hospitalier Universitaire d Amiens ont dû, dans un délai relativement court et avec toutes les difficultés que cela comporte, penser et organiser cette vaccination qui concernait plus de 13 000 jeunes âgés de 2 mois à 24 ans. Après un schéma vaccinal à trois injections jusqu en 2011 et devant, certes une diminution de l incidence mais associée à la circulation persistante de cette souche B14, les autorités sanitaires ont choisi d instaurer désormais un schéma à quatre doses et de proposer une dose de rattrapage à tous les jeunes vaccinés par trois injections. La persistance de cette souche particulièrement virulente, l impression qu une nouvelle zone d endémie peut apparaître à chaque instant et les progrès sur l élaboration d un vaccin universel contre le méningocoque B font perdurer l espoir tout en reposant le problème de la délimitation des zones vaccinales.In spite of the therapeutic and vaccinal advances, invasive meningococcal diseases remain, especially in some regions of France but also in the world. Although their incidence is about one case for 100 000 inhabitants, these cases are more and more serious and are consequently strictly controlled. The treatment of a case is dictated by special procedures specified by recommendations which get regularly published. Present since 2003 in Seine Maritime and since 2008 in Somme, those departments have faced an important increase of invasive B-meningococcal diseases, especially the strain Neisseria Meningitidis B : 14: P1.7,16. In 2006 began in Seine Maritime a broad vaccination drive by the Norwegian vaccine MenBvac®, and this one has been broaden in 2009 to 4 zones of the department in order to eradicate this worrying hyper-endemic. The Departmental Direction of Health and Social Affairs in Somme, relieved by the Regional Agency of Health in Picardie and the Hospital of Amiens have also had to think about and organize, in a very short time and with all the difficulties linked to it, this vaccination drive which concerned more than 14 000 young people from 2 months to 24 years old. After a vaccinal pattern of three injections until 2011, even if we notice a diminution of the incidence, a persistent circulation of this strain B14 remains, sanitary authorities have also chosen to establish a pattern of 4 doses and propose a fourth dose to young people who had been only vaccined by three injections. The persistence of this very strong strain, the feeling that a new zone of endemic can appear at every moment and the progress on the development of a universal vaccine against the B-meningococcal are hopeful, but the problem of demarcation of vaccination zones remains.AMIENS-BU Santé (800212102) / SudocSudocFranceF

Coloscopie sans sédation : à partir de quarante observations

REIMS-BU Santé (514542104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

MODELE EXPERIMENTAL D'EPIDIDYMITE A CHLAMYDIA TRACHOMATIS CHEZ LA SOURIS MALE (ETUDE DU RETENTISSEMENT SUR LA FERTILITE)

AMIENS-BU Santé (800212102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

APPORT DU GENOTYPAGE DANS L'INTERPRETATION DE L'EFFET DES ANTIRETROVIRAUX CHEZ LES PATIENTS INFECTES PAR LE VIH (ETUDE PILOTE AU CHU D'AMIENS)

AMIENS-BU Santé (800212102) / SudocSudocFranceF