Patrick Choutet

First Isolation of Bartonella alsatica from a Valve of a Patient with Endocarditis

ABSTRACT We report the first documented case of endocarditis in a man infected with Bartonella alsatica, which causes bacteremia in healthy wild rabbits. B. alsatica was identified by serology and culture and by PCR of an aortic valve specimen. B. alsatica should be added to the list of zoonotic agents of blood culture-negative endocarditis.

Hepatitis E virus seroprevalence and risk factors for individuals in working contact with animals

BACKGROUND In industrial countries genotypes 3 and 4 of HEV are detected in swine, wild boar, deer and rabbits, and they are associated with autochthonous infections suggesting the existence of zoonotic HEV infections, compatible with the putative involvement of undercooked pork and big game products as a source of infection. OBJECTIVES To evaluate the prevalence of anti-HEV antibodies in different population groups in contact with animals and to investigate risk factors for HEV infection. STUDY DESIGN Serum samples were collected from 859 healthy French subjects, including pig farm workers, forestry workers and individuals without working contact with animals (control group). In addition, 58 swine veterinarians were included in the study. Subjects were interviewed using a structured questionnaire, and anti-HEV antibodies were investigated using a sensitive and specific sandwich ELISA. RESULTS Anti-Hepatitis E virus (HEV) antibodies were detected in 26% of control population, and in 36% and 44% of forestry and pig farm workers, respectively. In addition, an increase in seroprevalence from the north to the south of France was observed (30.2% versus 40.7%). Consumption of pork liver sausage (AOR 4.4, p < 10(-4)), occupational contact with animals (AOR 1.58, p = 0.038 for forestry workers and AOR 2.51, p < 10(-4) for pig farm workers), and living in southern France (AOR 1.47, p = 0.02), were independent risk factors. Wearing working gloves and boots might reduce HEV infection. CONCLUSIONS Occupational exposure to animals and consuming raw or undercooked pork liver sausage or pork liver play a significant role in HEV transmission in industrial countries.

High Hepatitis E Virus Seroprevalence in Forestry Workers and in Wild Boars in France

ABSTRACT Hepatitis E virus (HEV) is a fecally and orally transmitted human pathogen of worldwide distribution. In industrial countries, HEV is observed in an increasing number of autochthonous cases and is considered to be an emerging pathogen. A growing body of evidence suggests that HEV is a zoonotic disease, and pig handlers and pig veterinarians have been reported to be high-risk groups for HEV infection. The aims of the present study were to establish the prevalence of anti-HEV in wild boars in France and to identify whether forestry workers are at a higher risk of HEV infection. Three different anti-HEV tests were used to compare their effectiveness in detecting anti-HEV in the general population. The most sensitive test was then used to investigate HEV seroprevalence in 593 forestry workers and 421 wild boars. Anti-HEV was detected in 31% of the forestry workers and 14% of the wild boars. Detection of anti-HEV in humans was correlated with age, geographical location, and occupational activity and in wild boars was correlated with geographical location. HEV infection is frequent in woodcutters in France, and it varies geographically. Further studies are needed to confirm these findings and to elucidate the transmission route and the exact virus reservoirs.

Temporal development and prognostic value of antibody response to the major neutralizing epitopes of gp120 during HIV-1 infection.

Our objective was to analyse the humoral response to the major neutralizing epitopes of gp120. The kinetics of the appearance of antibodies directed to the V3 region (V3 Abs) and antibodies directed to the CD4 binding site (CD4BS Abs) were compared in sequential sera from 20 seroconverters. V3 Abs were titrated using 2 different indirect EIAs with synthetic oligopeptides coated on the solid phase. The sequences of the oligopeptides used were those of the MN isolate or a mixture of the consensus sequences of the 5 major HIV‐1 subtypes (A–E). CD4BS Abs titers were determined using an EIA in which serum antibodies compete with a labeled human monoclonal antibody, F105, whose corresponding epitope overlaps the conformation‐dependent CD4BS, for binding to purified recombinant gp120 coated on a solid phase. The prognostic value of both antibodies was analyzed in a longitudinal study of 60 HIV‐1 infected patients (17 nonprogressors and 43 progressors). Eighty‐five percent and 70% of HIV seroconverters were positive for V3 Abs and CD4BS Abs, respectively, during the observation period. V3 Abs were detected first in the majority of the patients (mean delay of appearance, 1.22 ± 0.96 months vs. 4.81 ± 2.05 months for CD4BS Abs). Both categories of antibodies appeared simultaneously in 4 patients (20%). No prognostic value could be attributed to these antibodies. Our data confirm that V3 Abs and CD4BS Abs appear with some delay after primary infection, suggesting that they do not play a large or early role in the rapid clearance of viremia in primary HIV‐1 infection. These antibodies were not associated with progression to symptomatic infection and are thus of no value for surveillance in HIV‐1 infected patients. J. Med. Virol. 52:309–315, 1997.

Chronic Q Fever: Relevance of Serology

To the Editor—We read with interest the recent paper on Q fever by Healy et al [1], which describes the results of initial and follow-up serologic analysis after an outbreak of Q fever, and the discrepancy in test results obtained from different reference laboratories. This article raises the problem of management of asymptomatic patients with a chronic serological profile (phase 1 serum level of immunoglobulin G [IgG],

Lack of association between rifampicin plasma concentration and treatment-related side effects in osteoarticular infections.

800 mg/dL). We conducted a retrospective analysis of 35 patients with chronic Q fever whose conditions were followed in our institution between 1996 and 2009, who had an initial (n 5 26) or secondary (postacute phase) (n 5 9) serological diagnosis of chronic Q fever. Of the 35 patients, 23 were asymptomatic, 9 had definite endocarditis (Duke criteria), 2 had hepatitis, and 1 had optical neuritis. The asymptomatic patients included 7 with possible cases of endocarditis, according to the Duke criteria (phase 1 IgG level,

Successful treatment of acute fascioliasis with bithionol

800 mg/dL and valvular disease). Of the 16 (n 5 23 minus 7) asymptomatic patients with a chronic serological profile, 9 received no treatment; all 9 were healthy. Clinical and serological controls were conducted in 2010 for 7 of these patients: 5 had a healing serological profile and 2 had serological controls (follow-up ,1 year) that showed a regression of the phase 1 IgG or IgA titers.

Prevalence and persistence of antibody titers to recombinant HIV−1 core and matrix proteins in HIV−1 infection

The aim of this study was to assess the frequency of gastrointestinal side effects (GSE) and hepatotoxicity in patients treated with rifampicin for an osteoarticular infection and to determine if there is an association between rifampicin plasma concentrations and side effects. Rifampicin plasma concentrations were prospectively measured before (trough concentration, C0) and 2 ± 0.5 h (peak concentration, C2) after drug intake. The presence of GSE, the alanine transferase (ALT) value, and concomitantly administered medications were recorded on the day rifampicin concentrations were measured. C0 and C2 were compared for differences regarding the presence or absence of side effects. Multivariate analysis was performed, with associated medications being taken into account. Seventy C0 and 57 C2 values were measured in 46 adults after a median treatment of 8 days (range, 1–179). Wide inter‐individual variability was observed for C0 and C2. Thirteen (28%) patients reported GSE at least once. When GSE occurred, C0 (median, 1 mg L−1; range, 0.1–9.9 mg L−1) and C2 (median, 10.3 mg L−1; range, 1.8–40.3 mg L−1) were similar to C0 (median, 0.6 mg L−1; range, 0.1–10.3 mg L−1) and C2 (median, 10.9 mg L−1; range, 2.9–29.0 mg L−1) without GSE. The ALT value was more than normal in only three patients (6.5%) after rifampicin treatment began. The patients received no different associated medications whether or not GSE were present. Multivariate analysis showed no association between rifampicin plasma concentrations and GSE. GSE occur frequently in patients receiving rifampicin for osteoarticular infection but without an association with rifampicin plasma concentrations. Thus, therapeutic drug monitoring of rifampicin is irrelevant in the management of GSE.