Pharyngeal abscess complicated by Lemierre's syndrome: Identification of an atypical germ

INTRODUCTION

Lemierre's syndrome is a rare but serious complication of an oral infection mostly related to Fusobacterium necrophorum. This condition combines jugular vein thrombosis and septic emboli to the lungs or other organs.

CASE PRESENTATION

We report here an original case of a pharyngeal abscess complicated by Lemierre's syndrome in a young healthy male patient. Samples taken from the pus of the pharyngeal abscess showed the presence of Gardnerella vaginalis associated with Fusobacterium necrophorum. The patient was treated by draining the abscess, antibiotic therapy and preventive anticoagulation for 1 month. The evolution was good with a resolution of the thrombosis.

CONCLUSIONS

This case highlights the need for bacterial identification to adapt antibiotic therapy in Lemierre's syndrome. It also shows the possibility of extragenital localization of Gardnerella vaginalis in a male patient having oral sex with women. In contrast to sexually transmitted infections such as syphilis and pharyngeal gonococcus, this oral localization of Gardnerella vaginalis has not been described previously in the literature.

Capybara and Brush Cutter Involvement in Q Fever Outbreak in Remote Area of Amazon Rain Forest, French Guiana, 2014

We investigated a Q fever outbreak that occurred in an isolated area of the Amazon Rain Forest in French Guiana in 2014. Capybara fecal samples were positive for Coxiella burnetii DNA. Being near brush cutters in use was associated with disease development. Capybaras are a putative reservoir for C. burnetii.

Incidence of leptospirosis in the French armed forces from 2004 to 2018: Retrospective analysis

BACKGROUND

The French military personnel may be exposed to leptospirosis during their training or on duty on the field in continental France, and most of all, in intertropical areas in the French departments and in Africa. The aim of this study was to assess the incidence of leptospirosis from epidemiological surveillance and cases data from 2004 to 2018, and to propose tools to assess leptospirosis risk prior to any mission or leisure activity.

METHOD

A retrospective epidemiological study on leptospirosis cases among French Armed Forces was conducted. More data were collected for 2 clusters in Martinique, as most of leptospirosis cases among French military personnel were identified in Martinique.

RESULTS

Eighty-eight cases of leptospirosis were reported, 15 cases in continental France and 73 cases in overseas (including 42 cases in the French West Indies). The global leptospirosis incidence rate in continental France was 0.3/100,000 person-years and in overseas 24/100,000 person-years with the higher incidence rate in Martinique (99/100,000 person-years) and in Mayotte (36.9/100,000 person-years). For the clusters in Martinique, between January and June 2009, 7 cases were declared; between 2016 and 2018, 16 cases were reported, high proportions of severe cardiac, renal and neurological forms (6/16) and hospitalizations (9/16).

CONCLUSION

The occupational risk is real in French Armed Forces, particularly in malaria-free intertropical areas where chemoprophylaxis by doxycycline is not applied. Prevention can be optimized by the use of practical tools such as tables and cartographies, leading to a better leptospirosis risk assessment and application of preventive recommendations.

Use of Direct Oral Anticoagulants in Patients with Sickle Cell Disease and Venous Thromboembolism: A Prospective Cohort Study of 12 Patients

Patients with sickle cell disease have an increased risk of venous thromboembolism (VTE) and with a mortality 2-fold higher. The anticoagulation of VTE in a young population is an important question. Indeed, hemorrhagic complications of anticoagulation may occur more frequently than in the general population. The use of a direct oral anticoagulant (DOAC) is not recommended for VTE in patients with sickle cell disease because those patients were not included in the clinical studies. We aimed to study the safety of using DOACs in a prospective cohort of patients with sickle cell disease and VTE. We prospectively followed the cohort of all sickle cell disease patients undergoing recent DOAC treatment for VTE at a sickle cell disease reference center. Twelve patients received rivaroxaban for VTE (eight women and four men). The median age was 27 years (20-45). The sickle cell disease variants included homozygous Hb SS (HBB: c.20A>T) in eight patients, Hb S-β⁺-thalassemia (Hb S-β⁺-thal) in two, Hb S-β⁰-thal in one and Hb S-Hb C (HBB: c.19G>A) in one. The cumulative duration of follow-up was 3134 days under rivaroxaban treatment. There were two thrombotic events, including a patient with a double positivity of antiphospholipid antibodies. No major bleeding was observed, and 6/12 patients presented minor bleeding (epistaxis: n = 4; anal fissure bleeding: n = 1; menorrhagia n = 4). Of these, 3/6 required their treatment to be switched to apixaban, which stopped the bleeding. Direct oral anticoagulants may be an alternative treatment for VTE in patients with sickle cell disease, except for an associated antiphospholipid syndrome.

Methods for detecting Gemmata spp. bacteremia in the microbiology laboratory

OBJECTIVE

Gemmata bacteria are fastidious, Gram-negative and aerobic. The only representatives are Gemmata obscuriglobus and Gemmata massiliana. These Planctomycetes appear to be a part of human digestive tract microbiome, and G. massiliana has been isolated from water. Further specific detection in the blood of two patients with febrile neutropenia suggests that Gemmata bacteremia may remain under-documented. The objective of this study was to develop an effective protocol to document Gemmata spp. bacteremia in the laboratory. Using mock-infected and control blood specimens, three methods for detecting Gemmata bacteremia, namely, automated microbial detection, culture on solid medium, and quantitative polymerase chain reaction (PCR), have been developed and studied.

RESULTS

Gemmata spp. were undetected by automated blood culture system but culturing mock-infected blood on Caulobacter agar detected ≥ 10² G. obscuriglobus bacteria/mL and ≥ 10⁴ G. massiliana bacteria/mL. Specific real-time PCR detected 10² Gemmata bacteria/mL. These protocols may be used to investigate the epidemiology of Gemmata spp. bacteremia.

Evolution of the prevalence of intestinal parasitic infections among the French armed forces in French Guiana

Two cross-sectional studies were performed 2 years apart in French military personnel deployed from France to French Guiana. In 2011, military medical centres in French Guiana reported 40 cases of intestinal parasitism in service members returning from illegal gold mining sites in the rainforest. In 2013, 48 out of 132 service members returning from French Guiana after a 4-month mission had eosinophilia and seven were infected with hookworm. A presumptive first-line treatment with albendazole could be the most pragmatic strategy.

Two Cases of Leptospirosis in French Travelers Returning From Koh Samui, Thailand

We report the first two cases of leptospirosis in French travelers returning from Koh Samui, a famous tourist island in Thailand, in September 2014 and March 2015. The first patient developed a severe form of the disease including hemodynamic instability, interstitial pneumonia, rhabdomyolysis with renal impairment, and deep thrombocytopenia. The second patient had a milder disease, with severe muscle pain, jaundice, and renal impairment. The two patients reported bathing in fresh water in Namuang waterfall.

The airplane

As a rural private practice in occupational therapy expanded to meet the service requests in a large, sparsely populated area, the need for fast, efficient transportation became obvious. A private pilot's license was acquired and then an airplane was purchased to meet that transportation need. The private practice, geographical area and the intervention methods are reviewed. The efficiency, cost, safety and practicality of flying, and its effect on the success of the private practice are then described.