Design of an integrated piggery system with recycled water, biomass production and water purification by vermiculture, macrophyte ponds and constructed wetlands

Since 2001 the swine experimental station of Guernévez has studied biological treatment plants for nutrient recovery and water recycling, suited to the fresh liquid manure coming out of flushing systems. An integrated system with continuous recycling was set up in 2007, associated with a piggery of 30 pregnant sows. It includes a screen, a vermifilter, and macrophyte ponds alternating with constructed wetlands. The screen and the vermifilter had a lower removal efficiency than in previous studies on finishing pigs. A settling tank was then added between the vermifilter and the first lagoon to collect the worm casts. A second vermifilter was added to recover this particulate organic matter. A storage lagoon was added to compensate for evaporative losses and complete pollution abatement, with goldfish as a bioindicator of water quality. The removal efficiency of the whole system was over 90% for COD and nitrogen, over 70% for phosphorus and potassium, and more than 4 logarithmic units for pathogens (E. coli, enterococci, C perfringens). Plant production was about 20 T DM ha(-1) y(-1). Floating macrophytes (Azolla caroliniana, Eichhornia crassipes, Hydrocotyle vulgaris) were more concentrated in nutrients than helophytes (Phragmites australis, Glyceria aquatica,…). Azolla caroliniana was successfully added to feed finishing pigs.

Preserving middle lobe to improve lung function in non-small-cell lung cancer

When a lung tumor arises in segment 6, the close anatomical relationship to the middle lobe bronchus may make a lower bilobectomy necessary. Sleeve lobectomy may be an alternative. These procedures were compared retrospectively in 36 patients operated on between January 2005 and December 2006 with non-small-cell lung cancer (stage I-IIIB) of the right lower lobe. Sleeve lobectomy was performed in 21 patients and bilobectomy in 15 (41%). Preoperative lung function was comparable in both groups. Radical resection was achieved in 34/36 patients. Operation time was 121 min for sleeve lobectomy and 144 min for bilobectomy. Chest tubes were removed after 5 days in both groups. Postoperative lung function was better after sleeve lobectomy than bilobectomy (forced expiratory volume in 1st sec: 78% vs. 69%). Preservation of the middle lobe by sleeve lobectomy is feasible. There was no evidence that this resection was less radical, and complication rates were similar in both groups.

Meningococcal interactions with the host

Neisseria meningitidis interacts with host tissues through hierarchical, concerted and co-ordinated actions of a number of adhesins; many of which undergo antigenic and phase variation, a strategy that helps immune evasion. Three major structures, pili, Opa and Opc predominantly influence bacterial adhesion to host cells. Pili and Opa proteins also determine host and tissue specificity while Opa and Opc facilitate efficient cellular invasion. Recent studies have also implied a role of certain adhesin-receptor pairs in determining increased host susceptibility to infection. This chapter examines our current knowledge of meningococcal adhesion and invasion mechanisms particularly related to human epithelial and endothelial cells which are of primary importance in the disease process.

Extracellular bacterial pathogen induces host cell surface reorganization to resist shear stress

Bacterial infections targeting the bloodstream lead to a wide array of devastating diseases such as septic shock and meningitis. To study this crucial type of infection, its specific environment needs to be taken into account, in particular the mechanical forces generated by the blood flow. In a previous study using Neisseria meningitidis as a model, we observed that bacterial microcolonies forming on the endothelial cell surface in the vessel lumen are remarkably resistant to mechanical stress. The present study aims to identify the molecular basis of this resistance. N. meningitidis forms aggregates independently of host cells, yet we demonstrate here that cohesive forces involved in these bacterial aggregates are not sufficient to explain the stability of colonies on cell surfaces. Results imply that host cell attributes enhance microcolony cohesion. Microcolonies on the cell surface induce a cellular response consisting of numerous cellular protrusions similar to filopodia that come in close contact with all the bacteria in the microcolony. Consistent with a role of this cellular response, host cell lipid microdomain disruption simultaneously inhibited this response and rendered microcolonies sensitive to blood flow–generated drag forces. We then identified, by a genetic approach, the type IV pili component PilV as a triggering factor of plasma membrane reorganization, and consistently found that microcolonies formed by a pilV mutant are highly sensitive to shear stress. Our study shows that bacteria manipulate host cell functions to reorganize the host cell surface to form filopodia-like structures that enhance the cohesion of the microcolonies and therefore blood vessel colonization under the harsh conditions of the bloodstream.

Certain infectious agents reach the bloodstream and succeed in surviving and multiplying at this site. This stage of the infection is associated with a life-threatening condition. The Gram-negative bacterium meningococcus, responsible for septicemia and meningitis, stands out as a paradigm of such a pathogen. Despite the characteristic flow-generated hydrodynamic forces of the bloodstream, meningococci have the striking ability to bind to the endothelium and to multiply in bacterial aggregates called microcolonies. Meningococci form aggregates in absence of eukaryotic cells, but we show that such aggregates are sensitive to mechanical stress, indicating that the presence of host cells enhances microcolony cohesion. Consistently, analysis of meningococcal microcolonies growing on the host cellular surface reveals that these structures are dense with cellular material in the form of cellular protrusions. Blocking this bacteria-induced cellular response renders microcolonies sensitive to blood flow. We then identify a bacterial component located on the outside of the bacteria and in direct contact with host cells as a key factor in the induction of this cellular response. This bacteria-induced cellular response is therefore a striking example of how pathogens exploit cellular functions as a survival strategy, in this case in the particular context of the bloodstream.

Safety and immunogenicity of SC599, an oral live attenuated Shigella dysenteriae type-1 vaccine in healthy volunteers: results of a Phase 2, randomized, double-blind placebo-controlled trial

SC599 vaccine is a live Shigella dysenteriae 1 strain attenuated by deletion of invasion [icsA], iron chelation [ent, fep] and shiga toxin A subunit [stxA] genes. In a preliminary Phase 1 single dose prospective study, we showed that SC599 vaccine was well tolerated, and the maximum tolerable dose was greater than 10(8) CFU [Sadorge C, Ndiaye A, Beveridge N, Frazer S, Giemza R, Jolly N, et al. Phase 1 clinical trial of live attenuated Shigella dysenteriae type-1 DeltaicsA Deltaent Deltafep DeltastxA:HgR oral vaccine SC599 in healthy human adult volunteers. Vaccine 2008; 26(7):978-8]. In this Phase 2 trial, three groups of volunteers ingested a single dose of SC599 [10(5) CFU, n=38; 10(7) CFU, n=36] or placebo [n=37]. Both 10(5) and 10(7) CFU doses were immunogenic, inducing significant IgA and IgG LPS-specific ASCs and antibody responses, comparable in magnitude to those of other strains that prevented illness following experimental challenge. In the intention to treat analysis, 34.2% and 44.4% IgA ASC responders were detected in the 10(5) and 10(7) CFU groups respectively (p<0001 vs placebo for both groups), as well as 31.6% and 33.3% serum IgA responders (p<001 and p<0.001 vs placebo for 10(5) and 10(7) CFU groups, respectively). No difference between the two vaccine groups was observed. No stxB-specific antibody response was detected in the vaccines. SC599 excretion occurred in 23.7 and 30.6% of subjects in the 10(5) and 10(7) CFU groups, respectively. SC599 vaccine was well tolerated, and the reported adverse events were mainly digestive. These results indicate that a single oral immunization of SC599 vaccine elicits a significant circulating IgA ASC and serum antibody response that may confer protection against the most severe symptoms of Shigellosis in responders to the vaccine.

Neisseria gonorrhoeae antibiotic resistance in Paris, 2005 to 2007: implications for treatment guidelines

Quinolone-resistant Neisseria gonorrhoeae rates have increased worldwide since 1994. The objective of this study was to appraise: (i) the antimicrobial susceptibility of Neisseria gonorrhoeae in a venereology clinic in Paris, between 2005 and 2007; and (ii) the factors associated with quinolone-resistant N. gonorrhoeae. A prospective study of consecutive cases was performed for the period 2005 to 2007. Susceptibility of N. gonorrhoeae to five antibiotics (ciprofloxacin, ceftriaxone, spectinomycin, penicillin G and tetracycline) was tested systematically. Clinical and epidemiological data were collected using a standardized form. Male-to-female sex ratio was 22.0. Median age was 30.0 years. Of 115 cases, 84 occurred in men having sex with men (72.6%) and 22 involved the anorectal area (19.1%). The rate of quinolone-resistant N. gonorrhoeae was 37.4% (43/115), without significant association with gender, age, sexual behaviour, past history of sexually transmitted diseases and susceptibility to other antibiotics. All N. gonorrhoeae were susceptible to ceftriaxone and spectinomycin. The rate of quinolone-resistant N. gonorrhoeae in Paris has been increasing since 2004. Ceftriaxone remains the gold standard treatment.

Acute pancreatitis related to tigecycline: case report and review of the literature

Tigecycline is a new broad-spectrum antibiotic. Nausea and vomiting are its most common side-effects. We describe here a case of severe acute pancreatitis related to tigecycline in order to highlight the possible occurrence of this adverse event and to remind clinicians to measure the lipase rate if in any doubt.

Evolution of non-dissolved particulate organic matter during composting of sludge with straw

Long term composting induces loss of C and organic matter stabilisation. These two processes may have opposite effects on long term carbon storage in soils. To check whether raw materials should be composted or not before being spread on the soil, changes in particle size fractions were quantified during composting of 9 tons of sewage sludge and straw. Both the mass of the fine fraction (<2 microm) and the amount of carbon contained in it increased after seven months, respectively, +37% and +43%. The fine fraction contributes to carbon sequestration. A literature review supported the assumption that composting should increase long term C storage. Nevertheless, soil texture or agricultural practices modify the behaviour of this fraction. Thus, the fractionation method used for soils is relevant to predict the effect of composting as a mitigation option in greenhouse gas reduction strategies, but is not sufficient in itself.

In situ growth potential of the subtidal part of green tide forming Ulva spp. stocks

Ulva spp., the algae most responsible for green tides in Brittany (France), are found on the foreshore and in the most beachward wave area (MBWA) of many bays during green tide phenomena. These algae have recently been seen drifting at greater depths (reaching - 20 m). In view of the significant quantities of algae found at these depths, and the less favorable conditions for algal growth than in the intertidal zone, we attempted to determine if they could grow there. For that, during their maximum growth period (from May to July), algae were picked up at three stations located on the foreshore, in the MBWA and in the subtidal (deep) zones of the Bay of Douarnenez, and their nitrogen, carbon and chlorophyll a + b contents were determined, and their photosynthetic activity was compared in the laboratory. The intracellular concentrations did not differ much from one station to another, although in the subtidal zone, the irradiance and the nitrogen concentration in the ambient water were much lower than those measured on the foreshore and in the MBWA. Photosynthetic activity characterized by maximum amounts of oxygen produced at different irradiances and by saturating and compensating irradiance levels, was also quite similar at the three stations. The irradiance, temperature and salinity of the subtidal environment, together with the chemical and photosynthetic characteristics of the algae found in that area, are consistent with the hypothesis that they grow there, and that their nitrogen supply comes from nitrogen releases from sediments. Nevertheless, their growth rate is probably less than that of algae in the MBWA.

[New lights on infectious mononucleosis]

This review focuses on recent studies that shed new lights on infectious mononucleosis (IM). The major transmission of Epstein-Barr virus (EBV) via saliva is opposed to the possibility of sexual transmission of EBV in developed countries. Multiple infections with different LMP-1 EBV genotypes are frequently observed during IM but with unclear significance. The strict lymphotropism of the virus during primary EBV infection is questioned. Prolonged high EBV-load in saliva is clearly demonstrated during IM and could be explained by a different immune response in tonsil versus blood. Benign and severe IM are also explained by the variability of the immune response. Correlations between severity of IM and high viral load in blood are controversial. A relationship between IM and Hodgkin's disease is suggested by several epidemiological studies. Despite potential new antiviral targets and preliminary human vaccine trials, the lack of curative or preventive treatment against IM is pointed out.

Fulminant Epstein-Barr virus (EBV) hepatitis in a young immunocompetent subject

We report a case of fulminant hepatitis related to a primary Epstein-Barr virus (EBV) infection in an immunocompetent 15-year-old male patient. The main causes of fulminant hepatitis are viral infections, drugs, and autoimmune diseases. Primary Epstein-Barr virus infection is usually a benign, self-limited disease in pediatrics but can exceptionally be fatal.

Comparison of serum hepatitis C virus (HCV) RNA and core antigen levels in patients coinfected with human immunodeficiency virus and HCV and treated with interferon plus ribavirin

Trak-C (Ortho-Clinical Diagnostics) is an enzyme-linked immunosorbent assay-based method capable of quantifying hepatitis C virus (HCV) core antigen (CA) in serum and could be an alternative to molecular detection and quantification of HCV RNA. We have evaluated the Trak-C assay in comparison with an HCV RNA quantitative assay (Versant HCV v3.0; Bayer Diagnostics) in the follow-up of 348 treated, human immunodeficiency virus (HIV)/HCV-coinfected patients included in the ANRS HC02 RIBAVIC trial. ANRS HC02 RIBAVIC is a therapeutic, multicenter, randomized protocol comparing the efficacy of alpha interferon 2b (IFN-alpha2b) (3 million units three times a week)-ribavirin (800 mg/day) to that of pegylated IFN-alpha2b (1.5 mug/kg of body weight/week)-ribavirin (800 mg/day) during 48 weeks of treatment of HIV/HCV-coinfected patients naïve to HCV treatment. Patients were assessed for virological analysis at day 0 and weeks 4, 12, 24, 48, and 72. Correlation of HCV RNA and HCV CA at the initiation of treatment was excellent (r = 0.92). HCV RNA and CA kinetics were similar during follow-up of HCV treatment from day 0 to week 72 whatever the group of response and genotype. The positive and negative predictive values of response to the treatment at week 4 were 59 and 94%, respectively, for HCV RNA load reduction of >2 log and 54 and 94%, respectively, for HCV CA below the threshold value (4.18 log(10) pg/ml . 10(4)). Trak-C, a new assay able to quantify CA in HIV/HCV-coinfected patients, correlates well with quantitative HCV RNA assays and is cheaper and easier to perform than molecular technology. HCV CA could be a valuable alternative test for therapeutic follow-up of coinfected patients treated with IFN plus ribavirin in developing countries.

Decrease of enteric micro-organisms from rural sewage sludge during their composting in straw mixture

AIMS

To study the decrease of enteric micro-organisms including viable nematode eggs, enteroviruses, faecal indicators (Escherichia coli and enterococci) and pathogenic bacteria (Listeria monocytogenes, Salmonella sp. and Clostridium perfringens) of a rural sewage sludge when it is composted for 7 months in mixture with straw.

METHODS AND RESULTS

Numbers of the test organisms and the physico-chemical parameters were measured on a monthly basis on the mixture, on the compost after being turned, and on the pile in three positions representing the part by which air is incoming, the bottom of the pile and the part through which air is outgoing. The lowest temperature in the pile was observed at the bottom, where it did not exceed 50 degrees C against 66 degrees C in the two other areas. There were no significant differences between the three areas in terms of micro-organism survival. Infectious enteroviruses were inactivated rapidly and were not found after the first turning whereas some genomes were detected until after the third turning. Escherichia coli and enterococci presented a similar survival rate and their number decreased by 4 log(10) whereas Salmonella decayed at a greater rate than L. monocytogenes. The numbers of C. perfringens decreased gradually to reach a final concentration in the mature compost of about 10(2) CFU g(-1) dry matter (d.m.), which was similar to that of the faecal indicators.

CONCLUSIONS

The hygienic effect of sludge composting in mixture with straw results in a significant reduction of enteric micro-organisms, the concentration of the faecal indicators in the final product being < 64 most probable number g(-1) d.m. The concentrations of Salmonella, enteroviruses and viable nematode eggs in the final product were not detectable which is in accordance with the French legislation.

SIGNIFICANCE AND IMPACT OF THE STUDY

The results which pointed out the different behaviour of the test micro-organisms reflect the difficulty to propose a relevant indicator of hygienization. Otherwise, they show that composting is an efficient means for hygienization of sludge of rural wastewater treatment, where the straw is available close to their place of production.

A case of arthritis caused by cytomegalovirus after kidney transplantation

Cytomegalovirus (CMV) is the leading cause of infectious complications after organ transplantation. We report the case of a 55-year-old renal transplant recipient who presented with CMV infection 2 months after transplantation. During oral ganciclovir treatment (5 weeks after interruption of intravenous ganciclovir), he experienced a sharp pain in the right shoulder. Examination was normal, but CMV antigenemia remained positive with 30 cells/300,000. He underwent a shoulder puncture, which confirmed the presence of CMV in the articular fluid after evaluation by polymerase chain reaction gene amplification. The patient recovered from his arthritis of the shoulder, and antigenemia became negative after 3 weeks of parenteral ganciclovir. We describe a CMV arthritis that occurred despite a curative treatment for CMV disease, and comment on the pathogenesis of this infection, the pharmalogical failure, and dosing or treatment duration.

[Etiology of bacterial infections in febrile neutropenic patients: the role of the laboratory in the diagnosis]

EPIDEMIOLOGICAL EVOLUTION: Until the mid-eighties, infectious complications (pneumonia, septicemia) observed in neutropenic patients were, in 70% of cases, of bacterial origin with Gram negative bacillae (Escherichia coli, Klebsiella sp, Pseudomonas aeruginosa) isolated 8 times out of 10. Among the Gram positive bacteria, Staphylococcus aureus predominated. The etiological profile of bacterial infections has since evolved with a predominance (60 to 70%) of Gram positive bacteria (coagulase-negative staphylococci, viridans streptococci) and a change in the epidemiology of the Gram positive bacteria notably with a lesser frequency of P. aeruginosa infections. THE GRAM POSITIVE BACTERIA: Coagulase-negative staphylococci are among the first germs responsible for nosocomial bacteremia (central venous catheters) and they are usually multiresistant. Viridans streptococci are a frequent cause of bacteremia; they are generally sensitive to antibiotics active on Gram positive bacteria, but the incidence of resistant strains is increasing. Enterococci are in majority responsible for colonisation in neutropenic patients and less frequently for infections; they raise the problem of resistance to antibiotics, notably to glycopeptides. Other Gram positive bacteria can be responsible for infections in neutropenic patients; it is crucial that they be identified because they require treatment with an appropriate antibiotic. GRAM NEGATIVE BACTERIA: Among the enterobacteria, Escherichia coli is predominantly isolated and raises the problem of the increasing incidence of resistance to fluoroquinolone. Pseudomonas aeruginosa, less frequently responsible today, remains associated with a far greater rate of mortality than that observed with the other microorganisms. Other Gram negative bacteria can be identified; they require an adapted antibiotherapy because they are often naturally multiresistant to antibiotics. THE ROLE OF THE LABORATORY: For the diagnosis of infections in neutropenic patients, the microbiology laboratory has a determinating role. The laboratory ensures the analysis of various biological examinations: blood cultures, methods permitting the diagnosis of an infection on a permanent catheter, copro-cultures (research for common enteropathogens, quantification in the case of digestive decontamination, screening for multiresistant bacteria), cytobacteriological examination of urine, samples of respiratory origin, cytobacteriological examination of cerebro-spinal fluid...).