Résumés des articles parus dans Médecine et Maladies Infectieuses - Mars 2012 Volume 42,Issue 3, Pages 93-138.
Ce numéro de MMI dans EM-Consulte ou dans Science Direct
Revue générale
Epidemiology of chikungunya infection on Reunion Island, Mayotte, and neighboring countries
P. Renault, E. Balleydier, E. D’Ortenzio, M. Bâville, L. Filleul
Article EM-consulte - article Science Direct
Since 2004, the frequency of chikungunya virus infections has been increasing in Africa, Indian Ocean islands, and Asia. The epidemic began on the Kenyan coast, and reached the Comoros at the end of 2004 before spreading to the South-western Indian Ocean islands (SWIOI) in 2005 and especially in 2006. The epidemic then spread to Asia where epidemic foci are still active today. This increase also affected temperate zone countries where imported cases were reported, and indigenous transmission was reported in Italy in 2007, and in France (Var) in 2010. This review provides an update on the knowledge gained from monitoring chikungunya infections in SWIOI. Despite significant differences in design and performance, the implementation of surveillance systems has allowed describing the evolution of epidemic waves in the affected areas. Synchronous epidemic waves were observed in SWIOI, despite the differences between the preventive measures locally implemented. Between 2005 and 2007, all SWIOI were in inter-epidemic situation, except for Madagascar where a persistent virus circulation in an endemic-epidemic pattern was observed. In 2009, and in 2010, two moderate indigenous outbreaks were identified on the Reunion Island by the inter-epidemic surveillance system. Strains analyses demonstrated a reintroduction of the virus from Madagascar. These limited outbreaks should be a reminder of the vulnerability of SWIOI to arbovirosis, since the entomological indexes for competent vectors are high and the virus keeps on circulating more or less actively in the area.
Diagnosis and management of prosthetic vascular graft infections
L. Legout, P.V. D’Elia, B. Sarraz-Bournet, S. Haulon, A. Meybeck, E. Senneville, O. Leroy
Article EM-consulte - article Science Direct
Prosthetic vascular graft infection is a rare but very severe complication with a high death rate. Its optimal management requires appropriate surgical procedures combined with adequate antimicrobial treatment in reference center. The authors wanted to focus on the management of prosthetic vascular graft infection and define the clinical, microbiological, biological, and radiological criteria of vascular graft infection. Complementary investigations, although these are small series, include CT scan, the gold standard for the diagnosis of acute infection with a sensitivity and specificity reaching 100%, but decreased to 55% in case of chronic infection. More recently, PET-scanning was studied and yielded good results in chronic infections (sensitivity 98%, specificity 75.6%, positive predictive value 88.5%, and negative predictive value 84.4%). Managing prosthetic vascular graft infection, as with the orthopedic and vascular infections, requires replacing the vascular prosthesis. There is no correlation between the microbiological data and the location or type of vascular infection. Thus, the postoperative intravenous antibiotherapy should be bactericidal with a broad-spectrum. After obtaining intra-operative microbiological results, de-escalation therapy must include at least one anti-adherence agent, such as rifampicin in staphylococcal infections.
Articles originaux
Impact of early chest radiography and empirical antibiotherapy on delay in the diagnosis of pulmonary tuberculosis
C. Gatey, P. Tattevin, C. Rioux, B. Ducot, L. Meyer, E. Bouvet
Article EM-consulte - article Science Direct
Objective
The treatment of community-acquired pneumonia relies on empirical antibacterial treatment, guided by chest X-ray. We evaluated the impact of this practice on delay in the diagnosis of pulmonary tuberculosis.
Patients and methods
We performed a retrospective monocentric study on 64 documented cases of pulmonary tuberculosis.
Results
Empirical antibacterial treatment was prescribed between the first symptoms and pulmonary tuberculosis diagnosis in 42.2% of cases. The median delay between first contact with a healthcare provider and pulmonary tuberculosis treatment initiation (medical delay) was 13.5 days. The factors associated with medical delay above 30 days were alcohol abuse (OR 7.62; P = 0.02), and late chest X-ray (OR 9.33; P = 0.01). Empirical antibacterial treatment was more frequent in case of late chest X-ray (P = 0.02) and increased the risk of medical delay above 7 days (OR 6.3;P = 0.05).
Conclusion
When lower respiratory tract infection is suspected, early chest X-ray reduces the empirical use of antibacterial agents and decreases delay in the diagnosis of pulmonary tuberculosis.
Assessment of microbial larvicide spraying with Bacillus thuringiensis israelensis, for the prevention of malaria
D. Kinde-Gazard, T. Baglo
Article EM-consulte - article Science Direct
Objectives
The aim of this study was to assess the contribution of microbial larvicide spraying, Bacillus thuringiensis israelensis, as prevention strategy against malaria.
Methods
An experimental study consisted in spraying B. thuringiensis israelensis in a district during 1 year has been conducted. Another district (control) was not sprayed. Eight hundred and two children were evaluated, thick drop and swab examination was performed for those presenting with fever. The larval density was calculated in their habitats as well as larvicide remanence. Capture of mosquitoes with human bait allowed determining human exposure to bites at night, and identifying anopheles after dissection.
Results
The incidence of pediatric malaria was 13.8% in the sprayed district and 31.4% in the control district. The parasitic load ranged from 2000 to 42,000 parasites/μL in the sprayed district and 2000 to 576,000 parasites/μL in the control district. Plasmodium falciparum was the most frequent (97.8%) plasmodial species. In the control district, at least 20 larvae by liter of water were counted; anopheles larvae were found in 11 larval habitats out of 15 (73.33%). The human exposure to anopheles bites at night was 14.25 in the sprayed district and 33.13 in the control district. The remanence of B. thuringiensis israelensis was estimated at 9 days in the sprayed district.
Conclusion
The larvicide B. thuringiensis israelensis may be used in vector control strategy for the prevention of malaria.
Communication brève
Étude de 71 cas de leishmaniose viscérale diagnostiqués au CHU Mustapha d’Alger entre 1998 et 2009
H. Zait, Y. Ferhani, I. Achir, B. Hamrioui
Article EM-consulte - article Science Direct
Objectifs
Étudier rétrospectivement les aspects épidémiologiques, cliniques, diagnostiques et thérapeutiques de 71 cas de leishmaniose viscérale, de 1998 à 2009.
Patients et méthodes
Le diagnostic a été apporté par la présence des amastigotes de Leishmania dans les frottis de moelle osseuse et/ou par la sérologie.
Résultats
Une prédominance des cas en hiver (35,2 %) et au printemps (36,6 %) est constatée. Les régions de provenances sont celles endémiques du Nord de l’Algérie (74,6 %) et plus rarement des zones steppiques (8,4 %). Avec 88,7 %, l’écrasante majorité est infantile. Le sex-ratio est de 1,53. Les caractéristiques cliniques sont : fièvre (77,4 %), pâleur (43,6 %), splénomégalie (83 %), hépatomégalie (57,7 %). Les anomalies biologiques sont : anémie (56,3 %), thrombocytopénie (33,8 %) et leucopénie (28,1 %). Le N-méthylglucamine (Glucantime®) a été le plus souvent prescrit (70,4 %). Quatre décès (5,6 %) ont été enregistrés.
Conclusion
La leishmaniose viscérale reste une affection de l’enfant mais n’épargne pas l’adulte.
Cas cliniques
Céfoxitine et BLSE
M. Boyer, A. Bignon, R. Dessein, K. Faure, B. Guery, E. Kipnis
Article EM-consulte - article Science Direct
Staphylococcus pseudintermedius et Pasteurella dagmatis associés dans un cas de pneumonie communautaire
C. Laurens, N. Marouzé, H. Jean-Pierre
Article EM-consulte - article Science Direct
Lettres à la rédaction
Trompeuse amélioration d’une tuberculose abdominale en 72 heures sous amikacine
F. Suy, P. Berthelot, A. Carricajo, F. Lucht
Article EM-consulte - article Science Direct
Portage digestif asymptomatique et simultané de deux souches d’Escherichia coli exprimant des bêtalactamases à spectre étendu de type CTX-M-1 et CTX-M-14
S. Rachid, C. Harchay, A. Ben Othman, M. Zribi, A. Masmoudi, C. Fendri
Article EM-consulte - article Science Direct
Analyses de la littérature
Faut-il surveiller la CRP dans le traitement des infections de prothèses articulaires ?
Article EM-consulte - article Science Direct
Rendre obligatoire la vaccination anti-grippale pour les professionnels de santé : est-ce possible ?
Article EM-consulte - article Science Direct
