[Streptococcus pneumoniae neonatal infection]. / Infection néonatale précoce à Streptococcus pneumoniae.

One case of early onset invasive pneumococcal disease in the newborn, acquired from the maternal vagina, is reported. Streptococcus pneumoniae has been estimated to be rarely responsible for neonatal sepsis (1-8%) together with maternal infection. Clinical features are similar to other neonatal infections, but outcome is particularly severe (mortality: 50%, neurological sequelae: 13%). Newborn are most often infected from the maternal vagina that has been colonized with S. pneumoniae, despite the rarity of vaginal carriage of S. pneumoniae (yield in genital swabs from 0.03 to 0.75%). Severe outcome should lead to presumptive treatment (amoxicillin +/- vancomycin) of babies colonized with pneumococcus or born to colonized mother, even if asymptomatic, and, when necessary, of the mother. The rarity of the genital carriage, together with the difficulty to isolate S. pneumoniae from vaginal swabs makes unrealistic to systematically search for this organism. However, given the high ratio infection: colonization, greater significance should be attached to the discovery of vaginal colonization with pneumococcus in the pregnant or in the newborn in order to improve treatment and outcome.

[Diagnosis by blood smear of a fulminant pneumococcemia complicating a myeloma]. / Diagnostic sur le frottis sanguin d'une pneumococcémie fulminante compliquant un myélome.

INTRODUCTION: During a pneumococcal septicemia, the direct revelation of bacteria on a blood smear is rare and has been mainly described in splenectomised patients. OBSERVATION: A 62 year-old non-splenectomised man suffering from myeloma died, a few hours after his admission to emergency department, from a fulminant pneumococcemia, the diagnosis of which had been rapidly evoked on the examination of a blood smear showing numerous Gram positive diplococci. COMMENTS: This observation highlights the potential severity of pneumococcal infections in patients suffering from altered humoral immunity and the diagnostic interest, in this case, of a systematic routine blood smear permitting rapid initiation of appropriate treatment.

Hepatic lipase induces the formation of pre-beta 1 high density lipoprotein (HDL) from triacylglycerol-rich HDL2. A study comparing liver perfusion to in vitro incubation with lipases.

High density lipoprotein subfractions with a pre-beta migration play a key role in the reverse cholesterol transport. The origin of these particles is not yet clearly defined. We propose to verify a possible origin of these particles during the catabolism of high density lipoprotein2 (HDL2) by hepatic lipase using two different models. A rat liver perfusion of native human HDL2 in the presence of heparin induced, after 30 min, the formation of the pre-beta 1 HDL subspecies. Human HDL2 enriched with triacylglycerols, perfused in the same conditions, led after 15 min to an enhanced production of this pre-beta 1 HDL population, as compared with the results obtained with native HDL2. A reduction of the alpha-HDL2 fraction was also evident. After perfusion, a similar formation of pre-beta 1 HDL from triacylglycerol-rich HDL2 was observed in absence of heparin. When these HDL2 were incubated in vitro for 120 min at 37 degrees C in the presence of partially purified rat hepatic lipase, the appearance of pre-beta 1 HDL was again found and associated with a decrease in size of the remaining alpha-HDL subfractions as compared with original HDL2. On the contrary, the incubation of the same HDL2 with snake venom phospholipase A2 produced no pre-beta HDL. These results evidence the role of the triacylglycerol lipase activity of hepatic lipase in the formation of pre-beta 1 HDL from triacylglycerol-rich HDL2.