Florence Gourdon

Lemierre's syndrome and genetic polymorphisms: a case report

BackgroundLemierres syndrome presents a classic clinical picture, the pathophysiology of which remains obscure. Attempts have been made to trace genetic predispositions that modify the host detection of pathogen or the resultant systemic reaction.Case presentationA 17-year old female, with no previous medical history, was admitted to the intensive care unit for septic shock, acute respiratory distress syndrome and Lemierres syndrome. Her DNA was assayed for single nucleotide polymorphisms previously incriminated in the detection of the pathogen, the inflammatory response and the coagulation cascade. We observed functional variations in her Toll like 5 receptor (TLR 5) gene and two coagulation variations (Tissue Factor (TF) 603 and Plasminogen-Activator-Inhibitor-1 (PAI-1) 4G-4G homozygosity) associated with thrombotic events.ConclusionThe innate immune response and the prothrombogenic mutations could explain, at least in part, the symptoms of Lemierres syndrome. Genomic study of several patients with Lemierres syndrome may reveal its pathophysiology.

Entérocoques résistant aux glycopeptides dans un contexte endémo-épidémique: Stratégie d’isolement à l’admission des patients à risque

Resume Objectif Evaluer une strategie d’isolement et de depistage a l’admission dans un service de maladies infectieuses en periode endemo-epidemique pour l’enterocoque resistant aux aux glycopeptides (ERG) au CHU de Clermont-Ferrand. Methodes Depuis le 15/11/2004, des l’admission en maladies infectieuses, un depistage systematique de l’ERG a ete realise par ecouvillonnage rectal avec isolement du patient en cas d’antecedent (a) d’hospitalisation > 24 h dans un service a risque du CHU et/ou (b) d’antibiotherapie a large spectre d’une duree superieure a 48 h Un depistage hebdomadaire a ete pratique pour les patients hospitalises plus d’une semaine avec une antibiotherapie a large spectre ou ayant une sonde urinaire depuis plus d’une semaine ou neutropeniques durant l’hospitalisation. Resultats Jusqu’au 15/5/2005, sur 341 ecouvillonnages rectaux, 12 (3,5%) etaient positifs pour l’ERG: 8 a l’admission et 4 en cours d’hospitalisation. Quatre-vingt-un patients ont ete isoles des l’admission. Une etude cas temoin a confirme la pertinence des criteres d’isolement. Les mesures d’isolement ont ete acceptees par les patients a partir du moment ou elles etaient bien expliquees. Aucun nouveau cas n’a ete observe de mai a juillet 2005. Conclusion Une strategie d’isolement basee sur des facteurs de risque avec un depistage systematique a l’admission parait etre un moyen efficace pour controler une epidemie a ERG, tant parce qu’elle permet d’isoler des patients que parce qu’elle oblige l’equipe medicale et paramedicale a rester mobilisee.OBJECTIVES To evaluate a strategy based on screening and isolation at admission to a department of infectious diseases during an epidemic of vancomycin-resistant Enterococcus (VRE) at the University Hospital of Clermont-Ferrand. METHODS Systematic screening for VRE by anal swabs began on November 15, 2004. Patients were isolated on admission if (a) they had been hospitalized more than 24 h in an at-risk department of our hospital or (b) they had received a course of wide-spectrum antimicrobial therapy for longer than 48 h in the three months preceding admission. Patients hospitalized in our department were screened weekly if they were treated with wide-spectrum antibiotics, had a urinary catheter left in place for one week, or were neutropenic. RESULTS Through May 15, 2005, 12 (3.5%) of 341 swabs were found to be positive for VRE: eight were detected on admission and four during hospitalization. In all, 81 patients were isolated on admission. A case-control study confirmed that the criteria for patient isolation were indeed risk factors for VRE. Isolation was well accepted when it was clearly explained. No new case has been detected since March 2005. CONCLUSION An isolation strategy based on known risk factors for VRE with systematic screening on admission appears to be an effective way to control an outbreak of VRE, perhaps in part because it helps to keep the medical staff alert to this problem. Isolation is well tolerated as long as it is explained clearly.