Active pulmonary tuberculosis: Role for amikacin in early treatment

OBJECTIVE

To evaluate the efficacy of amikacin on sputum conversion during initial sputum smear positive tuberculosis treatment.

MATERIAL AND METHODS

Single-center observational cohort study (2012-2013) evaluating time to sputum smear conversion with standard treatment (ST) versus standard treatment+amikacin (IV 15mg/kg/day) for seven days (STamK).

RESULTS

Forty-five patients were included. Median time to smear negative samples was 26.5 days (14-56) for the 30 (66.7%) patients included in the ST group and 48 days (19.5-69.5) for the 15 patients (33.3%) included in the STamK group (P=0.76). Time to negative culture was only known for 27 patients (61.4%): 47.5 days (26-58) for 18 patients in the ST group and 40 days (14-77) for nine patients in the STamK group.

CONCLUSION

Despite our small sample size, the addition of amikacin in active tuberculosis treatment did not seem to impact time to smear conversion or period of contagiousness.

MALDI-TOF MS contribution to diagnosis of melioidosis in a nonendemic country in three French travellers

Melioidosis is an endemic disease in Southeast Asia and northern Australia. An increasing number of cases are being reported in nonendemic countries, making the diagnosis less obvious. We discuss the identification of Burkholderia pseudomallei using matrix-assisted desorption ionization–time of flight mass spectrometry on the occasion of recent cases of imported melioidosis in French travellers.

Vascular graft infection due to Pasteurella multocida

Background

Vascular graft infections are infrequent complications with important morbidity and mortality rates. Pasteurella multocida, a Gram negative bacillus, is a normal oral commensal of many animals. For mankind, it is a pathogenous bacillus which is rarely implicated in vascular grafts.

Case report

We report hereafter the fourth case introduced in the international literature about vascular graft infections caused by P. multocida. The patient was successfully treated with a combination of a surgical graft change and a 6 weeks bi-antibiotic therapy.

Discussion

There is fours case reported in litterature with quite different antibiotic drugs and duration.

Conclusion

P. multicoda graft infection should be long with initial intravenous drug and mainteance traitement should not be required.

Survey of French physician practices in treatment and control of transmission of smear-positive tuberculosis

OBJECTIVES

To evaluate isolation practices and management of sputum smear-positive tuberculosis (TB) in France.

METHODS

A survey was conducted using a questionnaire e-mailed in 2011 and 2012 to physicians of the French Society of Infectious Diseases, the French Respiratory Society and the French National Society of Internal Medicine.

RESULTS

Of 311 responders, a quarter stated they treated more than 25 TB cases per year. A total of 87.8% declared they routinely used a four-drug regimen in the initial intensive phase. Of the 311 physicians who responded, 31.9% removed isolation precautions after three negative acid-fast bacilli (AFB) sputum results, 19.0% after 15 days of treatment and 34.1% only in case of clinical improvement. According to 71% of the responders, discharge from hospital despite positive AFB sputum smear results was 'possible'. A routine AFB sputum smear was performed after 2 months of treatment by only 21% of the responders.

CONCLUSION

Despite recent national guidelines, the management of isolation precautions for sputum smear-positive TB remains heterogeneous, and a significant proportion of physicians use a three-drug regimen. Further efforts should be made to implement TB guidelines, mainly by raising awareness through national scientific institutions, but also by obtaining better evidence.

Acquisition of carbapenemase-producing Enterobacteriaceae by healthy travellers to India, France, February 2012 to March 2013

Healthy travellers to countries where carbapenemases-producing Enterobacteriaceae (CPE) are endemic might be at risk for their acquisition, even without contact with the local healthcare system. Here, we report the acquisition of CPE (two OXA-181, one New Delhi metallo-beta-lactamase 1 (NDM-1)) in three healthy travellers returning from India. The duration of CPE intestinal carriage was less than one month. The results indicate that healthy travellers recently returning from India might be considered as at risk for CPE carriage.

Management of mycetomas in France

OBJECTIVE OF THE STUDY

Mycetomas are chronic sub-cutaneous tropical infections in which exogenous causative agents, fungal (eumycetes) or bacterial (actinomycetes), generate grains. The typical presentation is multi-fistulized pseudotumors. This disease, particularly eumycetoma, is difficult to treat. It is a major health problem in tropical and subtropical countries. In France, the disease is rare, but patients have access to a broader range of treatments. The authors had for objective to present the cases of mycetomas diagnosed in developed country and their management.

PATIENTS AND METHODS

A retrospective study was made on the clinical presentation and management of mycetomas from 1995 to 2011, in the Bobigny Avicenne teaching hospital.

RESULTS

Six patient files were studied. The patients were men with a median age of 31 years (16-70). Five patients were from Sub Saharan Africa, one from Sri Lanka. The etiologies were one actinomycetoma and five eumycetomas. There was bone involvement in five cases. There was one atypical presentation: a primary intra-osseous mycetoma. Three patients were cured including two by surgical management and one by medical treatment (actinomycetoma). Antifungal therapy failed (four patients) in every case (voriconazole, itraconazole, ketoconazole, terbinafine, caspofungin).

CONCLUSION

The results of this study made in a non-epidemic zone revealed that despite a typical clinical presentation, the diagnosis and management were delayed because this imported disease is rare in France. The patients received new broad-spectrum triazole and caspofungin, but none were cured with antifungal therapy alone.

[Assessment of vaccination coverage among travelers to areas where yellow fever is endemic (Senegal)]

This prospective survey, conducted at the Dakar airport from August 18, 2011, to May 8, 2012, asked a sample of travelers living in France and returning there after a stay in Senegal to complete a questionnaire. The aim of the study was to assess the determinants of vaccination coverage against yellow fever. The study included 10 298 travelers, with a median age of 48 years (interquartile range: 27-58); 52% were tourists, and 22% were traveling for business purposes. The measured level of anti-yellow fever vaccination coverage was 39.3%. Vaccination coverage was influenced by the travelers' level of knowledge and their perception of the risk.