Philippe Cruaud

Integron-Associated Antibiotic Resistance in Salmonella enterica Serovar Typhi from Asia

ABSTRACT Eighteen of 25 isolates of Salmonella enterica serovar Typhi were multidrug resistant and contained class 1 integrons with a single cassette, dfrVII or aadA1. The dfrVII-containing integron was likely borne on an IncHI1 plasmid. Salmonella serovar Typhi could become resistant to broad-spectrum cephalosporins by integrating cassettes, such as veb-1, a common cassette in Asia.

Tuberculosis in adolescents: A French retrospective study of 52 cases.

Background: The only available data about tuberculosis (TB) among adolescents date back to the 1980s, although the incidence of tuberculosis has been increasing in this age group. Methods: Medical records were reviewed for all adolescents aged 12 to 18 years hospitalized with the diagnosis of TB in Avicenne/Jean Verdier Teaching hospital (Seine-Saint-Denis, suburb of Paris) between September 2000 and December 2004. Results: Of the 52 patients identified, 52% were female. Median age at diagnosis was 15 years (range, 12–18 years). The proportion of adolescents known to be born abroad was 90%. Diagnoses resulted from the examination of a sick child in 79% of cases, a case contact investigation of an adult suspected of having TB in 19% and routine tuberculin skin test in 2%. Twenty-seven of 52 patients (52%) had isolated pulmonary disease. Sixteen patients (31%) had pulmonary and extrapulmonary TB and 8 cases (17%) had exclusively extrapulmonary disease. The site of extrapulmonary TB included pleural (n = 8), meningitis (n = 4), lymph node (n = 4), peritoneal (n = 5), osteoarticular (n = 3) and genitourinary (n = 1). TB was confirmed by the isolation of Mycobacterium tuberculosis from sputum (n = 21), gastric aspirate (n = 8), bone (n = 1) or cerebrospinal fluid (n = 2). No case had a relapse or recurrence of disease in median 3.2 years of follow up. Conclusions: Our results indicate that demographic and clinical characteristics of adolescents with TB differed from adults and children. A specific approach to the prevention and treatment of TB in adolescents is absolutely necessary.

Gastrointestinal tuberculosis: 17 cases collected in 4 hospitals in the northeastern suburb of Paris

UNLABELLED Gastrointestinal tuberculosis is a rare form of extrapulmonary tuberculosis and its diagnosis can be difficult. AIMS To analyze the diagnostic and therapeutic characteristics of gastrointestinal tuberculosis. METHODS Retrospective study from 17 cases collected in 4 hospitals in Seine Saint-Denis between 1987 and 2002. RESULTS Seventeen cases and 19 localizations were collected: small intestine (N = 7), ileocecum (N = 6), colon (N = 4) and gastroduodenum (N = 2). Two patients had two localizations. Mean age was 43.9 years. Subjects from immigrant populations (76.5%) were preferentially affected. Twenty-three percent of patients (13 tested) were infected by human immunodeficiency virus. Weight-loss and general weakness (88%), abdominal pain (88%), fever (59%), nausea/vomiting (53%) were the predominant symptoms. The delay in diagnosis was 82 days (range: 7-180) and time before specific treatment 31.6 days (range: 7-90). Histological evidence of caseating granuloma was found in six patients. Mycobacterium tuberculosis was detected in six. Digestive imaging was abnormal in 15 patients. Mesenteric lymph nodes were the most common associated site of tuberculosis (N = 8, 47%). Mean duration of treatment was 8.2 months (range: 6-12). Thirteen patients were cured, three died and one was lost to follow up. CONCLUSION Gastrointestinal tuberculosis is not an uncommon diagnosis in the north-eastern Parisian area, especially among immigrant populations and immunodeficient patients. The most frequent localizations are the small intestine and ileocecum. Diagnosis can be made by pathology and/or bacteriology on endoscopic and/or surgical biopsy samples.

Utilization of 16S ribosomal DNA sequencing for diagnosis of septicemia due to Neisseria elongata subsp. glycolytica in a neutropenic patient.

ABSTRACT Septicemia due to Neisseria elongata subsp. glycolytica occurs infrequently. We report a case of septicemia in a patient undergoing antimitotic chemotherapy. Gram-negative coccobacilli were isolated from blood cultures. The identity of the isolate by phenotypic methods was uncertain. In contrast, identity was confirmed by 16S ribosomal DNA sequencing, which appeared to be very useful for correct identification.

Prolonged paradoxical response to anti-tuberculous treatment after infliximab

A 56-year-old woman with ankylosing spondylitis, treated for 3 months with infliximab, developed miliary tuberculosis with mediastinal lymphadenopathies and brain and splenic lesions. After initial improvement under anti-tuberculous therapy, she suffered an unexpectedly prolonged paradoxical worsening with several episodes of lymphadenopathy, including life-threatening ones, over a period of more than 14 months of follow-up. The outcome was favorable as a result of corticosteroid and surgical treatments. This phenomenon reflects a paradoxical reaction precipitated by infliximab withdrawal.

SFP-P018 – Pathologie infectieuse – Tuberculose de l’adolescent : étude rétrospective de 52 cas

Objectifs Aucune serie de tuberculose (TB) chez l’adolescent n’a ete rapportee jusqu’a maintenant alors que cette tranche d’âge est fortement touchee. Materiels et Methodes Nous avons analyse les donnees medicales de tous cas adolescents âges de 12 a 18 ans, hospitalises pour tuberculose dans le CHU Avicenne/Jean Verdier (Seine-Saint-Denis) entre 2000 et 2004. Resultats 52 cas ont ete inclus dans cette etude. Le sexe ratio est equilibre et la mediane d’âge au diagnostic etait de 15,2 ans. La proportion d’adolescents nes a l’etranger etait de 90 %. Le diagnostic de tuberculose a ete evoque sur la presence de signes cliniques dans 79 % des cas, suite a une enquete autour d’un cas dans 19 % des cas et 19 % et apres un test tuberculinique systematique dans 2 % des cas. Vingt cinq adolescents (48 %) presentent des signes extra-pulmonaires : pleuresie (n = 8), meningite (n = 4), adenopathie (n = 4), atteinte peritoneale (n = 5), atteinte osteo-articulaire (n = 3) et atteinte genito-urinaire (n = 1). M. Tuberculosis a ete isole des aspirations gastriques pour 54 % des adolescents. Aucun cas de rechute n’a ete signale avec un recul moyen de quatre ans. Conclusions Nos resultats montrent que les caracteristiques cliniques et demographiques des adolescents sont differentes de celles des adultes et des enfants. Aussi bien dans la prevention que pour le traitement, les infections a M. Tuberculosis, doivent etre adaptees a cette tranche d’âge.