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ABSTRACT: Vulvovaginitis is the most frequent gynecologic pathology among prepubertal females. An infectious cause is found in 30% of cases and is highly associated with the presence of vaginal discharge upon examination. Neisseria gonorrhoeae may be one of the causative agents. Since N. gonorrhoeae is a common sexually transmitted disease, sexual abuse should be considered in the pediatric setting. We report the case of a 5-year-old girl with N. gonorrhoeae vulvovaginitis. Her previous history, multiple interviews with the patient and her parents, and clinical examination showed no evidence or signs of sexual abuse. Both parents presented gonorrhea, urethritis for the father and vaginitis for the mother. The discrepancy between pediatric evaluation and the presence of a bacterium associated with sexually transmitted disease led us to consider other means of contamination. Previous studies have shown that other routes of transmission are possible but are often neglected. Hence, contamination can be transmitted by the hands or mostly through passive means (towels, rectal thermometer, etc.). Many epidemics have been noted in group settings with young girls with no evidence of sexual transmission. Therefore, we concluded that this patient's infection was likely an accidental transmission within her family. The acknowledgement of these transmission routes is very important in order to avoid misguided suspicion of sexual abuse and the possible traumatic family and psychosocial consequences.
Archives de Pédiatrie 12/2012; · 0.30 Impact Factor
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V Lamand,
O Dauwalder,
A Tristan,
J S Casalegno,
H Meugnier,
M Bes,
O Dumitrescu,
M Croze, F Vandenesch,
J Etienne,
G Lina
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ABSTRACT: Clin Microbiol Infect ABSTRACT: Epidemiological data on staphylococcal scalded skin syndromes (SSSS), including bullous impetigo (BI) and generalized exfoliative syndrome (GES), are scarce. To better characterize SSSS and associated Staphylococcus aureus strains, we conducted a retrospective study of 349 cases collected in France between 1997 and 2007 by the National Reference Centre of Staphylococci. Our results showed a stationary evolution of SSSS cases, with a heterogeneous distribution of cases in France. Although notification was not exhaustive, we estimated an incidence of 0.56 cases/year/million inhabitants, in accordance with previous studies conducted in France and Europe, with a median age of 2 years old and sex ratios of 1. A seasonal effect was observed, with a higher GES/BI ratio in autumn compared with other seasons, which could be explained by the impact of viral co-infection. Genetic analysis of S. aureus strains showed that accessory gene regulator (agr) 4, exfoliative toxin A (eta) and B (etb) genes, staphylococcal and enterotoxin-like O (selo) gene and agr4 etb selo profiles were predominantly associated with GES, whereas agr2 eta and agr4 eta selo were more frequently observed with BI. Only one methicillin-resistant strain was found. Protein A (spa) typing identified two main genotypes: spa clonal complex (CC) 159/sequence-type (ST) 121 (75%) and spaCC346/ST15 (18%). spaCC159 was mainly associated with agr4 eta etb selo, agr4 eta selo and agr4 etb selo, and spaCC346 was mainly associated with agr2 eta, suggesting that French SSSS cases are caused by these two main lineages. However, in a multivariate analysis, only etb was independently associated with GES.
Clinical Microbiology and Infection 09/2012; · 4.54 Impact Factor
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N Sicot,
N Khanafer,
V Meyssonnier,
O Dumitrescu,
A Tristan,
M Bes,
G Lina, F Vandenesch,
P Vanhems,
J Etienne,
Y Gillet
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ABSTRACT: Clin Microbiol Infect ABSTRACT: Staphylococcal necrotizing pneumonia (NP) is a severe disease associated with Panton-Valentine leucocidin (PVL). NP was initially described for methicillin-susceptible Staphylococcus aureus (MSSA) infection, but cases associated with methicillin-resistant S. aureus (MRSA) infection have increased concomitantly with the incidence of community-acquired MRSA worldwide. The role of methicillin resistance in the severity of NP remains controversial. The characteristics and outcomes of 133 patients with PVL-positive S. aureus community-acquired pneumonia (CAP) were compared according to methicillin resistance. Data from patients hospitalized for PVL-positive S. aureus CAP in France from 1986 to 2010 were reported to the National Reference Centre for Staphylococci and were included in the study. The primary end point was mortality. Multivariate logistic modelling and the Cox regression were used for subsequent analyses. We analysed 29 cases of PVL-MRSA and 104 cases of PVL-MSSA pneumonia. Airway haemorrhages were more frequently associated with PVL-MSSA pneumonia. However, no differences in the initial severity or the management were found between these two types of pneumonia. The rate of lethality was 39% regardless of methicillin resistance. By Cox regression analysis, methicillin resistance was not found to be a significant independent predictor of mortality at 7 or 30 days (p 0.65 and p 0.71, respectively). Our study demonstrates that methicillin resistance is not associated with the severity of staphylococcal necrotizing pneumonia.
Clinical Microbiology and Infection 09/2012; · 4.54 Impact Factor
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O. Dauwalder,
A. -M. Freydière,
H. Meugnier,
Y. Benito,
M. Chomarat,
C. Ginevra,
P. Girardo,
M. -E. Reverdy,
J. Etienne,
G. Lina, F. Vandenesch
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ABSTRACT: La spectrométrie MALDI TOF [SM] a été récemment utilisée pour l’identification bactérienne. L’objectif de notre étude était
d’évaluer les performances analytiques du système associant spectromètre de masse Axima®, base de données Saramis® et logiciel
SIRWEB®. Une identification bactérienne cohérente avec l’identification biochimique fut obtenue dans 94,4 % des cas soit pour
305 sur 323 souches testées. Quatre souches se révélèrent impossibles à identifier par SM et 14 souches présentèrent des identifications
discordantes nécessitant le recours aux méthodes moléculaires.
The MALDI TOF [MS] has recently been introduced for bacterial identification. The aim of our study was to evaluate the analytical
performances of the system involving AXIMA®mass spectrometer [MS], SARAMIS database and SirWeb MALDI TOF® software. Congruent
bacterial identifications with biochemical test were obtained in 94.4 % of cases for 305 of 323 strains tested. For four strains,
MS bacterial identification was not obtained and 14 strains showed conflicting identifications between biochemical and MS
identifications requiring the use of molecular tools.
Mots clésIdentification bactérienne–spectrométrie de masse–MALDI TOF–SARAMIS®–SIRWEB®–Phoenix®–galeries API®
KeywordsBacterial identification–mass spectrometry–MALDI TOF–SARAMIS®–SIRWEB–Phoenix identification system–API® strips–comparison
Bio Tribune Magazine 04/2012; 37(1):6-11.
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Tx Nhan,
M Bes,
H Meugnier,
L Toko,
G Julienne,
Jm Thiolet,
C Tillier,
S Tessier,
J Baverel,
B Conscience,
Jp Lavigne,
F Laurent,
J Etienne, F Vandenesch,
A Tristan
Euro surveillance: bulletin europeen sur les maladies transmissibles = European communicable disease bulletin 01/2012; 17(44). · 6.15 Impact Factor
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ABSTRACT: Panton-Valentine leukocidin (PVL)-producing Staphylococcus aureus is associated with a broad spectrum of diseases, ranging from common uncomplicated soft tissue infections to severe diseases such as complicated soft tissue infections, extensive bone and joint infections, and necrotising pneumonia. Specialised management of infection based on the presence of PVL may not be required for mild infections, whereas it could be lifesaving in other settings. Moreover, most severe PVL diseases are recently identified entities and a 'gold standard' treatment from comparatives studies of different therapeutic options is lacking. Thus, recommendations are based on expert opinions, which are elaborated based on theory, in vitro data and analogies with other toxin-mediated diseases. In this review, we consider the potential need for specialised PVL-based management and, if required, which tools should be used to achieve optimal management.
International journal of antimicrobial agents 07/2011; 38(6):457-64. · 3.03 Impact Factor
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ABSTRACT: USA300 is an epidemic community-acquired methicillin-resistant Staphylococcus aureus (C-MRSA) clone in the USA, whereas the European C-MRSA clone ST80-IV has mainly a sporadic diffusion in Europe. The prevalence of European clone ST80-IV in Algeria is poorly documented. We prospectively studied S. aureus infections at Mustapha Bacha hospital in Algiers over a 20-month period. S. aureus nasal colonization was studied during a further 6-month period. The European clone ST80-IV was responsible for more than one-third of both community infections (35.7%) and hospital infections (35.8%). Panton-Valentine leukocidin (PVL)-positive MRSA isolated from hospital inpatients were resistant to multiple antibiotics, including fluoroquinolones in 44.9% of cases. The PVL-positive MRSA nasal carriage rate was high among patients and staff in the dermatology unit (8.7% and 18.5%, respectively), but low (2.7%) among patients attending the outpatient clinic. The European PVL-positive C-MRSA clone ST80-IV is widespread in the Algiers hospital and community settings.
Clinical Microbiology and Infection 04/2011; 17(4):526-32. · 4.54 Impact Factor
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ABSTRACT: The study objectives were to describe an outbreak of skin infections in school settings, caused by Staphylococcus aureus carrying Panton-Valentine leukocidin genes (Sa PVL(+)), over a 2-year period. Nasal colonization prevalence was assessed in families where new skin infections occurred, despite a prevention and control strategy.
A retrospective investigation of skin infections likely to be related to Sa and prospective monitoring and treatment of new infections occurring in pupils and their family members were implemented in October 2006, following the reporting of Sa PVL(+) abscesses and furuncles in a primary school. Additional nasal screening was performed in families where new skin infections occurred, after an initial systematic screening of Sa PVL(+) nasal carriers.
On October 31, 2008, 53 patients, accounting for 30 households, had developed 69 skin infections, in four decreasing outbreaks. The cumulative incidence of a first skin infection was 34.6% in primary classes, 21.3% in nursery schools, and 6.5% in the pupils' family households. Several skin infections were reported in 13 households, and in one of them, all of the seven family members had developed at least one skin infection during follow-up. The estimated frequency of nasal colonization ranged from 14.1% to 19.5% according to successive nasal screenings.
Early reporting of skin infection clusters is necessary to reinforce the effectiveness of hygiene and prevention measures, and thus limit the risk of a long-lasting outbreak.
Médecine et Maladies Infectieuses 03/2011; 41(7):364-71. · 0.72 Impact Factor
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ABSTRACT: Several Panton-Valentin leukocidin-positive clones of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) are spreading worldwide. The European clone ST80-IV is the main CA-MRSA clone in Europe. There is no reported study of the specific clinical manifestations and outcome of skin infections caused by the clone ST80-IV, using strict definitions of skin diseases.
Single-centre observational prospective cohort of S. aureus skin infections caused by the clone ST80-IV.
From November 1999 to October 2009, we diagnosed skin infections due to the clone ST80-IV in 20 patients (median age 28 years, median 27; range 1-66). All the isolates had all the following characteristics: lukPV, etd and edin gene-positive, agr 3 allele, spa-type t044 and ST80. All the isolates were resistant to beta-lactam agents, kanamycin, tetracycline and fusidic acid. During the study period, the 20 patients had the following manifestations: 19 primary abscesses (18 single abscess and one patient with two), eight furuncles, four folliculitis, one case of cellulitis, one wound infection and one felon. Surgical treatment and drainage was required for all the primary abscesses. The infections occurred mainly in the perineal area (50%). No secondary infections occurred in family members. Despite strict hygiene measures, systemic antibiotics and nasal mupirocine, four patients (20%) had recurrent skin infections over a period of a few months to 6 years.
The CA-MRSA clone ST80-IV is responsible for suppurative skin infections such as furuncles and abscesses, which can recur over a period of several years.
Journal of the European Academy of Dermatology and Venereology 02/2011; 25(2):164-9. · 2.98 Impact Factor
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M Bergeron,
O Dauwalder,
M Gouy,
A-M Freydiere,
M Bes,
H Meugnier,
Y Benito,
J Etienne,
G Lina, F Vandenesch,
S Boisset
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ABSTRACT: Staphylococcal species, notably, coagulase-negative staphylococci (CoNS), are frequently misidentified using phenotypic methods. The partial nucleotide sequences of the tuf and gap genes were determined in 47 reference strains to assess their suitability, practicability, and discriminatory power as target molecules for staphylococcal identification. The partial tuf gene sequence was selected and further assessed with a collection of 186 strains, including 35 species and subspecies. Then, to evaluate the efficacy of this genotyping method versus the technology of matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS), the 186 strains were identified using MALDI-TOF-MS (Axima® Shimadzu) coupled to the SARAMIS® database (AnagnosTec). The French National Reference Center for Staphylococci identification method was used as a reference. One hundred and eighty-four strains (98.9%) were correctly identified by tuf gene sequencing. Only one strain was misidentified and one was unidentified. MALDI-TOF-MS identified correctly 138 isolates (74.2%). Four strains were misidentified, 39 were unidentified, five were identified at the group (hominis/warneri) level, and one strain was identified at the genus level. These results confirm the value of MALDI-TOF-MS identification for common species in clinical laboratory practice and the value of the partial tuf gene sequence for the identification of all staphylococcal species as required in a reference laboratory.
European Journal of Clinical Microbiology 10/2010; 30(3):343-54. · 2.86 Impact Factor
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ABSTRACT: To report a case of unilateral acute endophthalmitis due to Staphylococcus epidermidis after simultaneous bilateral intravitreal injection using the same ranibizumab vial.
A 68-year-old phakic man had uneventful bilateral sequential ranibizumab intravitreal injection for bilateral neovascular age-related macular degeneration using the same vial. All of the vial contents (0.3 mL) were withdrawn through the filter needle attached to a 1-cc tuberculin syringe. Using the same syringe but separate injection needles, 0.05 mL was administrated to the right eye before 0.05 mL was injected into the left eye. Sterile gloves, drape, and eyelid speculum were used for each eye. Early Staphylococcus epidermidis postoperative endophthalmitis developed 3 days later in the right eye (injected first) with intense vitreous inflammation, limiting visual acuity to light perception. Management included intravitreal antibiotic agents and pars plana vitrectomy. The patient achieved an excellent visual outcome.
This case report demonstrates that bacterial endophthalmitis is a rare but potential complication of intravitreal anti-VEGF injection, that infection generally results from self-contamination of the patient from his or her own bacterial flora, and that simultaneous bilateral intravitreal injection should be avoided.
Journal francais d'ophtalmologie 01/2010; 33(1):31-5. · 0.51 Impact Factor
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T Ferry,
I Uçkay,
P Vaudaux,
P François,
J Schrenzel,
S Harbarth,
F Laurent,
L Bernard, F Vandenesch,
J Etienne,
P Hoffmeyer,
D Lew
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ABSTRACT: The purpose of this study was to determine the clinical and microbiological risk factors for treatment failure of methicillin-resistant Staphylococcus aureus (MRSA) orthopedic device-related infection (ODRI). A retrospective cohort study of patients with MRSA ODRI who were treated at Geneva University Hospitals between 2000 and 2008 was undertaken. Stored MRSA isolates were retrieved for genetic characterization and determination of the vancomycin minimum inhibitory concentration (MIC). Fifty-two patients were included, of whom 23 (44%) had joint arthroplasty and 29 (56%) had osteosynthesis. All 41 of the retrieved MRSA isolates were susceptible to vancomycin (MIC <or= 2 mg/L) and 35 (85%) shared genetic characteristics of the South German clone (ST228). During a median follow-up of 391 days (range, 4-2,922 days), 18 patients (35%) experienced treatment failure involving MRSA persistence or recurrence. Microbiological factors such as infection with the predominant clone and a vancomycin MIC of 2 mg/L were not associated with treatment failure. Using a Cox proportional hazards model, implant retention (hazard ratio [HR], 4.9; 95% confidence interval [CI], 1.3-18.2; P = 0.017) and single-agent antimicrobial therapy (HR, 4.4; 95% CI, 1.2-16.3; P = 0.025) were independent predictors of treatment failure after debridement. Therapy using a combination of antimicrobials should be considered for patients with MRSA ODRI, especially when implant removal is not feasible.
European Journal of Clinical Microbiology 11/2009; 29(2):171-80. · 2.86 Impact Factor
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ABSTRACT: The aim of this study was to estimate the frequency of methicillin-resistant Staphylococcus aureus (MRSA) strains in the French community and the proportion of Panton-Valentine (PVL)-MRSA.
A cross-sectional study was made during a 3-month period in 2003 through a network of private-sector, community-based medical laboratories selected throughout France: the Labville network. Each MRSA isolate was included and characterized by French National Reference Center for Staphylococci. The total number of S. aureus isolates was also collected.
Among the 283 patients infected or colonized by MRSA, 166 (59%) were considered as healthcare-associated, 14 (5%) as nursing-associated and 39 (14%) as community-acquired. The proportion of methicillin resistance among S. aureus was 14%. Taking into account the sampling design, the incidence of MRSA cases in French outpatients was estimated to be 0.50 [CI95%: 0.41-0.60] per 10,000 inhabitants. The molecular analysis confirmed that 80.6% belong to the Lyon clone, the most prevalent hospital MRSA clone spreading in France and 10.6% to a closely related clone. An emerging MRSA clone containing the tst1 gene was detected in six patients and the PVL-positive ST80 clone only in one, 22-year-old, patient.
Most of MRSA cases diagnosed in the community in France, in 2003, were elderly with specific risk factors and harbored hospital strains. The prevalence of PVL-MRSA remained low.
Médecine et Maladies Infectieuses 05/2009; 39(5):311-8. · 0.72 Impact Factor
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ABSTRACT: To determine whether Staphylococcus aureus Panton-Valentine leukocidin (PVL) is expressed during human infection, anti-PVL antibody titres were compared in patients with PVL-positive and PVL-negative staphylococcal infections, and in patients with no evidence of S. aureus infection. Patients with PVL-positive strains had higher levels of anti-PVL antibodies than individuals of both control groups. The median anti-PVL titre increased 8.6-fold during the course of PVL-positive infection and 1.4-fold during PVL-negative infection. These results indicate that only PVL-positive S. aureus strains elicit significant anti-PVL antibody production in humans, and demonstrate the production of PVL during PVL-positive S. aureus infection. The protective role of this immune response remains to be established.
Clinical Microbiology and Infection 02/2009; 15(2):144-8. · 4.54 Impact Factor
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E L Brown,
O Dumitrescu,
D Thomas,
C Badiou,
E M Koers,
P Choudhury,
V Vazquez,
J Etienne,
G Lina, F Vandenesch,
M G Bowden
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ABSTRACT: Methicillin-resistant Staphylococcus aureus is increasingly responsible for staphylococcal infections in the community. A large percentage of the community-acquired methicillin-resistant (CA-MRSA) strains in the USA produce Panton-Valentine leukocidin (PVL), which is associated with severe infections. The virulence of the clinical CA-MRSA strain USA300 was compared to that of its isogenic pvl-deleted mutant, and it was shown that PVL contributes to lung and muscle tissue destruction, respectively, in murine necrotizing pneumonia and skin infection models. Mice infected with the USA300 strain developed a dominant anti-PVL response. The PVL subunits were therefore tested as vaccinogens against this isolate, and their vaccine efficacy correlated with both the route of vaccination and infection. These data suggest that PVL is a virulence factor in murine CA-MRSA infections.
Clinical Microbiology and Infection 01/2009; 15(2):156-64. · 4.54 Impact Factor
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D Thomas,
T Perpoint,
O Dauwalder,
G Lina,
B Floccard,
J-C Richard,
A Bouvet,
D Peyramond,
B Allaouchiche,
C Chidiac, F Vandenesch,
J Etienne,
T Ferry
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ABSTRACT: The aim of this study was to examine the production of superantigenic toxins in vivo and in vitro in two patients with streptococcal toxic shock syndrome (TSS). In the first patient, a woman with puerperal fever and Streptococcus pyogenes peritonitis, flow cytometry of blood cells and in vitro studies of the isolate showed massive expansion of Vbeta 2-positive T cells corresponding to SpeC production. In the second case, involving a patient with streptococcal TSS and purpura fulminans following non-steroidal anti-inflammatory drug (NSAID) therapy, no Vbeta expansion of T cells was observed in vivo, but the SpeC Vbeta signature was also detected in vitro. In this latter patient, NSAID administration and/or severe disseminated infection might partly explain the absence of Vbeta T cell expansion in vivo. Combined in vivo and in vitro detection of a superantigenic toxin Vbeta signature may be useful to determine which superantigenic toxin is involved in individual cases of streptococcal TSS.
European Journal of Clinical Microbiology 12/2008; 28(6):671-6. · 2.86 Impact Factor
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ABSTRACT: Pus samples were prospectively collected from patients with Staphylococcus aureus skin infections and tested for Panton-Valentine leukocidin (PVL). PVL was detected at concentrations that were toxic for rabbit skin in all specimens from patients infected with strains harbouring PVL genes.
Clinical Microbiology and Infection 12/2008; 14(12):1180-3. · 4.54 Impact Factor
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Journal of Antimicrobial Chemotherapy 12/2008; 63(2):420-1; author reply 421. · 5.07 Impact Factor
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ABSTRACT: An outbreak of Staphylococcus aureus (SA) carrying the gene coding for Panton-Valentine leukocidin (PVL) skin infections in a primary school was investigated and monitored in the Val-d'Oise region (Greater Paris) in 2006.
Skin infections reported after the beginning of the school year in primary-school teachers, students and their relatives were diagnosed and treated at the local hospital and screening for nasal colonization was implemented. A patient presenting with folliculitis, an abscess or furuncle with a positive-skin test or nasal swab for SA-PV was considered to be a case of infection. Colonization was defined as identification of SA-PVL in a nasal swab in the absence of skin lesions. In addition to recommended control measures, treatment by topical intranasal mupirocin was prescribed to all colonized patients and relatives of infected patients.
Over five months, 22 cases of PVL-positive SA skin infections, including a case of simple folliculitis, were confirmed in 15 primary-school students (attack rate=18.5%) and seven relatives. The occurrence of nasal colonization in relatives not attending the same school ranged from 0 to 30% according to the number of cases of skin infection in the family (p<0,01). Two-thirds of patients treated with mupirocin were decolonized.
Transmission of this SA strain in school and family environments confirms the epidemic potential of PVL-positive isolates; however, screening for nasal colonization should be restricted to cases of skin infection and people in their immediate environment.
Médecine et Maladies Infectieuses 08/2008; 38(9):483-8. · 0.72 Impact Factor
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ABSTRACT: Most clinical isolates of Staphylococcus aureus harbour genes encoding superantigenic toxins that bind the Vbeta domain of T-cells, but little information is available concerning superantigenic toxin production during staphylococcal toxic shock syndrome (TSS) and septic shock. This prospective study investigated 14 patients with staphylococcal TSS or septic shock; the toxin gene profile of each isolate was determined and flow-cytometry was used to identify the discriminant Vbeta signature (DVbetaS) of each superantigenic toxin in vitro. Attempts were also made to identify in-vivo production of superantigenic toxin DVbetaS in patients' blood. The DVbetaS identified in vitro were: toxic shock syndrome toxin (TSST)-1, Vbeta 2; staphylococcal enterotoxin (SE), Vbeta 9, Vbeta 22; SEB, Vbeta 3, Vbeta 14, Vbeta 17; SED, Vbeta 1, Vbeta 8; egc, Vbeta 5.3, Vbeta 7.1, Vbeta 9, Vbeta 23; and SElK, Vbeta 5.1. The DVbetaS of TSST-1 and SEB were detected in patients with menstrual and non-menstrual TSS, respectively, whereas no Vbeta signature was detected during septic shock. All patients with septic shock (but only one patient with TSS) had lymphopenia and/or impaired cellular immunity. Detection of a superantigenic toxin DVbetaS may help to show which toxin is produced during staphylococcal TSS, thus confirming the diagnosis and hastening the administration of anti-toxin therapy. In contrast, this approach failed to demonstrate superantigenic toxin involvement in cases of septic shock. In this latter condition, a superantigenic toxin may not be produced by S. aureus, or its production may occur without expansion of targeted T-cells because of T-cell apoptosis and/or anergy.
Clinical Microbiology and Infection 07/2008; 14(6):546-54. · 4.54 Impact Factor
