J. Raymond

Clarithromycin Resistance in Helicobacter pylori Strains Isolated from French Children: Prevalence of the Different Mutations and Coexistence of Clones Harboring Two Different Mutations in the Same Biopsy

Background:  The aim of our study was to assess the different mutations involved in clarithromycin‐resistant Helicobacter pylori strains isolated from French children and their temporal trends.

Pertussis in young infants: apnoea and intra-familial infection

This study investigated 41 infants, aged <4 months, who were hospitalised with symptoms compatible with pertussis. Of these, 16 had Bordetella pertussis infection confirmed by real-time PCR. For four of these 16 patients, the initial sample was PCR-negative, but samples collected 5-7 days after the onset of infection were PCR-positive. PCR was also positive with samples from 15/16 families and 20/41 household contacts. Nine of the 20 positive household contacts were asymptomatic. Among the 16 infants with proven pertussis, apnoea was more frequent than in a control group for whom PCR was negative with both children and household contacts (69% vs. 28%). It was concluded that real-time PCR performed with samples from household contacts facilitates the diagnosis of infants suspected clinically of having pertussis, thereby enabling earlier treatment.

Using macro-arrays to study routes of infection of Helicobacter pylori in three families.

Background Analysis of the evolutionary dynamics of Helicobacter pylori allowed tracing the spread of infection through populations on different continents but transmission pathways between individual humans have not been clearly described. Materials and Methods To investigate person-to-person transmission, we studied three families each including one child with persistence of symptoms after antibiotic treatment. Ten isolates from the antrum and corpus of stomach of each family member were analyzed both by sequencing of two housekeeping genes and macroarray tests. Results A total of 134 (8.4%) out of the 1590 coding sequences (CDSs) tested, including cag PAI and insertion sequences, were present in some but not all isolates (and are therefore defined as variable CDSs). Most of the variable CDSs encoded proteins of unknown function (76/134) or were selfish DNA including that encoding restriction/modification enzymes (13/134). Isolates colonizing the stomach of one individual can vary by point mutations, as seen in hspA, or by the gain or loss of one to five CDSs. They were considered as (genetic) variants. The phylogenetic clustering of gene profiles obtained on macro-arrays allowed identifying the different strains infecting families. Two to five strains circulated within a family. Identical strains were present in at least two members of all three families supporting the accepted model of intrafamilial transmission. Surprisingly, the mother was not implicated in the transmission of H. pylori in the two French families. Sibling-to-sibling transmission and acquisition of H. pylori from outside the family appeared to be probable in the transmission pathways. Conclusion Macroarray analysis based on previously selected CDSs gives a comprehensive view of the genome diversity of a pathogen. This approach combined with information on the origin of the hspA and glmM alleles revealed that Helicobacter pylori infection may be acquired by more diverse routes than previously expected.

Échees du traitement antibiotique des salmonelloses sévères de l'enfant et utilisation des quinolones

BACKGROUND: Quinolone antibiotics are effective in the treatment of Salmonella infections in adults. Their use in children is limited by their side-effects. POPULATION AND METHODS: Forty-two patients (21 girls and 21 boys), aged 1 month to 12 years (mean 3.3 yrs) were admitted from September 1991 to June 1993 for severe Salmonella infections. Criteria of severity were persistent diarrhea and fever for more than 3 days. Thirty-one of these patients were less than 5 years of age. Blood culture was positive in 7 out of 35 patients: culture of the stools was positive in all patients. Five of the 42 patients had presented an acute episode of Salmonella infection a few weeks earlier and had remained asymptomatic carriers until the new acute and severe episode of diarrhea. All patients were given usual antibiotics, mainly ampicillin, amoxicillin, trimethoprime-sulfamethoxazole. Twenty-five of these patients were then given pefloxacin, 12 mg/kg/day, since the 5th day, for 7 days, because persistence of diarrhea and fever. RESULTS: Diarrhea and fever disappeared within less than 2 days in the group of patients given pefloxacin, even though in 6 patients the infecting Salmonella was in vitro resistant to beta-lactamins. Twenty % of patients remained asymptomatic carriers of Salmonella in the group treated by pefloxacin vs 47% in the group without it. There was no difference in species of Salmonella between both groups. None of the patients treated by pefloxacin developed side-effects during the six months following its administration. CONCLUSIONS: Short treatment by pefloxacin may be an alternative choice for treating severe Salmonella infections in children.

Propositions thérapeutiques pour le traitement des infections cutanées bactériennes

Resume Les infections cutanees sont frequentes en pediatrie, allant du simple furoncle ou des lesions d’impetigo aux formes severes de dermohypodermite necrosante. Les traitements antibiotiques par voie generale ne sont pas toujours indiques mais quand ils le sont, ils doivent donc prendre en compte la resistance des deux principales especes bacteriennes ( Staphylococcus aureus et Streptococcus pyogenes ), les parametres pharmacocinetiques-pharmacodynamiques ainsi que la severite et le type d’infection. Deux situations relevent d’un traitement local seul : l’impetigo limite et les lesions purulentes localisees. Les deux antibiotiques a utiliser preferentiellement sont la mupirocine et l’acide fucidique. Prochainement, un troisieme antibiotique local, la reptamuline, viendra completer l’arsenal therapeutique. Pour les infections cutanees superficielles non compliquees justifiant une antibiotherapie par voie orale, l’association amoxicilline-acide clavulanique offre les meilleures garanties d’efficacite. Des criteres pharmacodynamiques-pharmacocinetiques mediocres doivent faire abandonner les penicillines M orales. En cas d’allergie, une cephalosporine de premiere generation, un macrolide (si la sensibilite de la souche a ete verifiee) ou la pristinamycine (apres l’âge de 6 ans) sont des solutions alternatives acceptables. Pour les dermohypodermites bacteriennes l’antibiotique de choix reste l’amoxicilline-acide clavulanique par voie voie intraveineuse, afin d’etre actif sur les streptocoques du groupe A mais aussi sur un eventuel S. aureus ou des anaerobies. Pour les syndromes toxiniques et la dermohypodermite necrosante, il convient d’adjoindre a une beta-lactamine, la clindamycine en raison de son action sur les syntheses proteiques permettant en particulier de diminuer la production des toxines.

Diagnosis of Helicobacter pylori recurrence: relapse or reinfection? Usefulness of molecular tools

ABSTRACT Background and aims Infection due to Helicobacter pylori causes many gastrointestinal diseases including peptic ulcers and gastric carcinoma. Their treatment and prevention depends on the successful eradication of H. pylori. However, even after a well-conducted treatment, H. pylori persists in about 10–30% of patients. Recurrent infections can correspond to relapse or to re-infection and require appropriate medical care. In this study, we explore retrospectively three clinical cases using molecular methods, and propose new guidelines for the diagnosis of recurrence. Material and methods Ten colonies of H. pylori were selected from the primary culture of biopsy samples taken from the antrum and fundus for each patient. The genotype of each isolated colony was determined by analyzing the polymorphism of two housekeeping genes, hspA and glmM. The genome-wide composition of H. pylori strains was studied using in house macro-arrays designed. Results Relapses were demonstrated by the stability of genotypes and the slight genetic variability of strains on macro-arrays. Two patients suffered from relapses, one and three years after H. pylori treatment. For the third patient, both the polymorphism of glmM and hspA genotypes and the diversity of CDSs identified on macro-arrays suggested that several episodes of re-infection occurred, 1–8 years after eradication. Conclusion For the three clinical cases, molecular methods allowed identifying the causes of recurrent infections. We suggest to study genotype to distinguish between relapse and re-infection in order to adapt the treatment and the follow-up of patients to the nature of recurrence.

Pneumonies à pneumocoque hautement probables chez les enfants vaccinés gardés en collectivité

Invasive pneumococcal diseases were reduced after introduction of pneumococcal conjugate vaccine, but infections due to non-vaccine serotypes persisted. The pneumococcal origin of community-acquired pneumonia remains difficult to affirm, but high procalcitonin and C-reactive protein blood levels and duration of fever 48 h or less after initial antibiotic treatment are excellent predictors of pneumococci. Among 259 patients under 7 years of age hospitalized from 2003 to 2008 for community-acquired pneumonia, 47 met these criteria, including 27 of 141 hospitalized between 2006 (date of vaccine generalization) and 2008. Of these 27, 21 had previously received pneumococcal conjugate vaccine and 19 of 21 were attendees of nursery school or day care centers versus only 2 in 2003-2006. These data show that pneumococcal pneumonias are possible in immunized children cared for in-group settings.

Position du Groupe de pathologie infectieuse pédiatrique sur la prise en charge des méningites à pneumocoque de l’enfant en 2014

a Service de néonatologie, unité court séjour, petits nourrissons, centre hospitalier inter-communal de Créteil, 40, avenue de Verdun, 94000 Créteil cedex, France b Association clinique et thérapeutique infantile du Val-de-Marne (ACTIV), 27, rue Inkermann, 94100 Saint-Maur-des-Fossés, France c Centre de recherche clinique, centre hospitalier inter-communal de Créteil, 40, avenue de Verdun, 91010 Créteil cedex, France d Service de microbiologie, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France e Faculté de médecine, université Paris-Descartes, Paris 5, 15, rue de l’École-de-Médecine, 75006 Paris, France f Urgences pédiatriques-infectiologie, hôpitaux pédiatriques, CHU Lenval, 57, avenue de La-Californie, 06200 Nice, France g Service de pédiatrie générale, hôpital Armand-Trousseau, 26, avenue Arnold-Netter, 75571 Paris cedex 12, France h Université Pierre-et-Marie-Curie, Paris 6, 4, place Jussieu, 75005 Paris, France i Groupe de pathologie infectieuse pédiatrique de la Société française de pédiatrie, 94100 Saint-Maur-des-Fossés, France Disponible en ligne sur

Contribution of genetic amplification by PCR for the diagnosis of Helicobacter pylori infection in patients receiving proton pump inhibitors

Background Helicobacter pylori detection by standard methods may be altered by proton pump inhibitor (PPI) use. However, some patients cannot or should not interrupt PPI use before undergoing testing for H. pylori. Polymerase chain reaction (PCR) could allow more reliable H. pylori detection even in patients taking PPIs. Objective The aim of our study is to compare the H. pylori infection diagnostic value of histological examination without and with immunohistochemical staining, bacterial culture and PCR, in PPI-treated vs untreated patients. Methods Patients undergoing a gastric endoscopy for upper digestive symptoms were included. Gastric biopsy samples were obtained. The impact of taking PPI on the diagnostic performance of the different methods was studied. PCR results were confirmed by sequencing the glmM gene. Results A total of 497 patients were included, of whom 192 were H. pylori positive. Fifty-two patients received PPIs during the 14 days preceding the endoscopy while 140 did not. All methods had lower sensitivity than PCR, in all cases (PPI treatment or not). PPI use did not change significantly the methods’ sensitivities. Conclusion The PCR method showed the best performance for the detection of H. pylori in gastric samples, whether or not patients received previous PPI treatment. This diagnosis test could become a new gold-standard test, especially in patients undergoing PPI treatment.

[Streptococcus pyogenes/group a streptococcus: an extra-cellular bacteria whose only known reservoir is man].

1Université Paris-Descartes, Service de bactériologie, hôpital Cochin, 2, rue du Faubourg-Saint-Jacques, 75014 Paris, France 2Service de pédiatrie, CHU Lenval, 57, avenue de la Californie, 06200 Nice, France 3Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France 4Service de pédiatrie, hôpital Armand-Trousseau, 26, avenue du Docteur Arnold-Netter, 75012 Paris, France 5ACTIV (Association clinique et thérapeutique infantile du Val-de-Marne), 27, rue Inkermann, 94100 Saint-Maur-des-Fossés, France 6Centre de recherche clinique (CRC) et Centre hospitalier intercommunal (CHI), 40, avenue de Verdun, 94010 Créteil, France 7AFPA (Association française de pédiatrie ambulatoire), 4 rue Parmentier, 54270 Essey-les-Nancy, France 8Unité court séjour, petits nourrissons, service de néonatologie, CHI de Créteil, 40, avenue de Verdun, 94010 Créteil, France