[Atypical hand, foot and mouth disease in adults: A note on 6 cases]. / Syndrome main-pied-bouche atypique de l'adulte : à propos de 6 observations.

INTRODUCTION: Hand, foot and mouth disease (HFMD) is form of viral dermatosis well known among the pediatric population, in whom it has a typical presentation. However, it is less common in adults, with a more heterogeneous presentation, potentially making diagnosis extremely challenging for the clinician. PATIENTS AND METHODS: This was a retrospective case series from 2013 to 2018 of HFMD in adults, with all cases being confirmed by cutaneous polymerase chain reaction (PCR). We studied the clinical, epidemiological and viral characteristics of each patient. RESULTS: This series of 6 cases comprised 4 men and 2 women, with a mean age of 42.5 years. Five patients presented extended purpuric lesions, four had bullous lesions, and three showed cutaneous signs without any mucosal lesions. Extended lesions on the trunk were found in four patients. One patient presented rosette-shaped pustular lesions on the limbs, one had eczema-like lesions on the scalp, and one presented extended purpuric lesions on the soles. DISCUSSION: These different cases of adult HFMD raise questions about differential diagnosis in relation to other acute cutaneous and mucous diseases. It is essential to be aware of these different types of presentation of the disease in order to determine the diagnosis and discuss preventive measures.

Pneumococcal cellulitis in an immunocompetent adult.

Streptococcus pneumoniae is a rare cause of cellulitis that develops mainly in patients with underlying chronic disease or those immunocompromised by drug or alcohol abuse. We report here a case of pneumococcal cellulitis in an immunocompetent patient.

[Methicillin resistant Staphylococcus aureus bacteremia seven years of survey in a French hospital]. / Sept années de surveillance des bactériémies à "Staphylococcus aureus résistant à la méthicilline" au centre hospitalier René Dubos (Pontoise).

In our French general hospital with 1000 hospitalization beds, a specific isolation for multiresistant bacteria colonized or infected patients was set up since 1998. To assess the impact of these recommendations, the rate of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia was calculated for each year since 1998. From 1998 to 2004, 493 cases of Staphylococcus aureus (SA) bacteremia occurred in our hospital: 319 strains were susceptible to methicillin and 174 were MRSA. During the 7 years period of our study, we observed a significant tendency for reduction in the number of bacteremia with MRSA strains (p=0.016). The significant decrease of the MRSA bacteremia between 1998 and 2004 was obtained through the cooperation between staff members, bacteriologists and hospital nosocomial infection committee members.

[Significant decrease of rate and incidence of methicillin resistant Staphylococcus aureus in a French general hospital between 1999 and 2001]. / Surveillance des bactéries multirésistantes: diminution significative du taux et de l'incidence de Staphylococcus aureus résistant à la méticilline (SARM) dans un centre hospitalier général entre 1999 et 2001.

In our French general hospital of 1000 hospitalization beds, a specific isolation for multiresistant bacteria (MRB) colonized or infected patients was set up since 1998. To assess the impact of these recommendations, the rate and incidence of methicillin resistant Staphylococcus aureus (MRSA), the most important MRB recovered in French hospitals, were calculated for each year since 1999. All the strains isolated from clinical samples, except duplicates (same bacteria in the same patient), were included. The results were compared with the chi(2)-test. Between 1999 and 2001, 644 strains were isolated. MRSA rate went from 46% in 1999 to 41% in 2000, and to 37% in 2001 (P = 0.007). In the study proposed by the CCLIN Paris-Nord, in April, May and June of each year, the rate of SARM was 52% in 1999, 43% in 2000 then 36% in 2001. The incidence per 100 admissions was 0.73 in 1999, 0.59 in 2000 and 0.54 in 2001 (P = 0.002) and the incidence per 1000 hospitalization days was, respectively, 0.92, 0.74, 0.67 in 1999, 2000 and 2001 (P < 0.001). The significant decrease of the rate and incidence of SARM proved that the isolation policy was effective in our hospital. This decrease was obtained through cooperation between staff members, bacteriologists and hospital nosocomial infection committee members. We know that measures to prevent MRSA cross transmission are very difficult to maintain over a long time and we hope that indicators would not increase next year. The use of alcohol based hand-rub since May 2002 should contribute to maintain this decrease.

Hepatitis C virus infection in pediatric liver transplantation.

To determine the prevalence of antibodies to hepatitis C virus (HCV) and the short-term evolution of HCV infection in children undergoing orthotopic liver transplantation, we retrospectively studied the sera and medical records of 149 children surviving from 9 months to 5 years after OLT. Fourteen children (9.4%) were found to be positive for anti-HCV with second-generation ELISA and RIBA tests. They were individualized in 2 distinctive groups. In 5 children, anti-HCV was present before OLT, and in 1 patient only HCV RNA was detected at that time. All 6 patients were positive for anti-HCV after OLT. In the other 8 children, anti-HCV and HCV RNA were only detected after OLT and likely reflect infection during or shortly after OLT. The antibody reactivities against the 3 antigens included in the second-generation RIBA test varied in a given patient throughout follow-up and between these 2 groups of children. In all patients, serum transaminase (ALT) activities returned to normal levels when prednisone therapy was lowered and given every other day. These results indicate that the search for HCV infection in these children is necessary in the differential diagnosis of other liver complications in order to avoid excessive immunosuppressive treatment.