A case of tricuspid valve endocarditis due to Cardiobacterium hominis which emphasizes the shift between the poverty of clinical symptoms and the severity of cardiac damages.

Infectious endocarditis due to Cardiobacterium hominis is an uncommon event, accounting for less than 2% of all cases of infectious endocarditis. The infection of the tricuspid valve as it is reported here is extremely rare. We report the case of a tricuspid endocarditis due to Cardiobacterium hominis in a 56 year-old man who was admitted to hospital with pelvic and scapular pain. The diagnosis was established through positive blood cultures and echographic detection of a large tricuspid vegetation. Despite efficient antibiotic therapy, valve replacement was required. The clinical course of Cardiobacterium endocarditis is usually subacute, and the diagnosis may therefore be delayed. This case emphasizes the shift between the poverty of clinical symptoms and severity of cardiac damages, what we could call the Cardiobacterium paradox.

Complete Genome Sequence of Noninvasive Streptococcus pyogenes M/emm28 Strain STAB10015, Isolated from a Child with Perianal Dermatitis in French Brittany.

We report here the complete genome sequence of a noninvasive strain of Streptococcus pyogenes M/emm28, isolated from perianal dermatitis in a child. The genome is composed of 1,950,454 bp, with a G+C content of 38.2%, and it has 1,925 identified coding sequences and harbors two intact prophages and a new integrating conjugative element (ICE).

Association of Anti-Porphyromonas gingivalis Antibody Titers With Nonsmoking Status in Early Rheumatoid Arthritis: Results From the Prospective French Cohort of Patients With Early Rheumatoid Arthritis.

OBJECTIVE: To investigate the possible link between Porphyromonas gingivalis infection and rheumatoid arthritis (RA), according to antibody profile, genetic and environmental factors, and RA severity. METHODS: For assessing P gingivalis infection, serum levels of antibodies directed against P gingivalis lipopolysaccharide were measured in 694 patients with early RA who were not exposed to steroids or disease-modifying antirheumatic drugs. Anti-P gingivalis antibody titers were compared between patients with early RA and various control groups, and according to various patient characteristics. RESULTS: Anti-P gingivalis antibody titers did not significantly differ between patients with RA and controls and did not significantly differ with anti-citrullinated protein antibody (ACPA), rheumatoid factor (RF), or HLA shared epitope status. Anti-P gingivalis antibody titers were significantly higher among patients who had never smoked compared to patients who had ever smoked (P = 0.0049). Among nonsmokers, high anti-P gingivalis antibody levels were associated with a higher prevalence of erosive change (47.5% versus 33.3% with modified Sharp/van der Heijde score erosion subscale ≥1; P = 0.0135). CONCLUSION: In this large early RA cohort, we did not detect any association of anti-P gingivalis antibodies with RA or with ACPA status. These results suggest that the association of periodontitis and RA could be linked to bacterial species other than P gingivalis or to a mechanism other than citrullination. Nevertheless, we found higher anti-P gingivalis antibody titers in nonsmokers. In addition, in this population of nonsmokers, high anti-P gingivalis antibody titers were associated with more severe disease. We hypothesize that the role of tobacco in RA pathogenesis is so high that the effect of P gingivalis could be revealed only in a population not exposed to tobacco.

Scoring system avoids Chlamydia trachomatis overscreening in women seeking surgical abortions.

OBJECTIVE: To develop and validate a predictive score to avoid unnecessary screening and prophylactic antibiotic use in abortion clinics by identifying a group of women who are at very low risk for Chlamydia trachomatis (CT) infection. METHODS: This population-based retrospective study includes 1000 women who underwent surgical abortion between January and September 2010. The main outcome measure was the rate of CT infection among women seeking an induced abortion according to sociodemographic and clinical data. The score was developed by using two-thirds of the data set as the derivation sample to identify the strongest predictors of CT. A receiver operating characteristic curve established cutoffs and applied the score to the remaining one-third (validation sample). RESULTS: The rate of CT infection was 6.7%. Three criteria were independently associated with CT: gestation more than 10 weeks (adjusted odds ratio [aOR], 1.96; 95% confidence interval [95% CI], 1.06-3.64), not using contraception (aOR, 2.70; 95% CI, 1.41-5.16), and having 0 or 1 child (aOR, 3.46; 95% CI, 1.34-8.93). The CT score was based on these 3 criteria. The low-risk group was derived from values of the score (probability of CT, 1.3% [95% CI, 0-3.0]). Application of these criteria to the validation data set confirmed the diagnostic accuracy of the score (probability of CT, 0%). Sensitivity was 100% and specificity was 26.9% for the score in the validation data set. When applied to the validation data set, the score avoided 25.4% of CT tests and screened 100% of CT-infected women before surgical abortion. CONCLUSIONS: This easy-to-calculate score may prove useful for avoiding CT test in 25% of patients seeking surgical abortion.

Screening for Chlamydia trachomatis using self-collected vaginal swabs at a public pregnancy termination clinic in France: results of a screen-and-treat policy.

OBJECTIVE: To assess the prevalence of Chlamydia trachomatis (CT) infection and the risk factors for CT infection among women presenting for abortion at a clinic in France. METHODS: Women seeking surgically induced abortions were systematically screened by PCR on self-collected vaginal swabs between January 1, 2010, and September 30, 2010. CT-positive women were treated with oral azithromycin (1 g) before the surgical procedure. RESULTS: Of the 978 women included in the study, 66 were CT positive. The prevalence was 6.7% (95% confidence intervals [CI] 5.1%-8.3%). The risk factors for CT infection were the following: age <30 years (Odds ratio [OR]: 2.0 [95% CI: 1.2-3.5]), a relationship status of single (OR: 2.2 [95% CI: 1.2-4.0]), having 0 or 1 child (OR: 5.2 [95% CI: 2.0-13.0]), not using contraception (OR: 2.4 [95% CI: 1.4-4.1]), and completing 11 weeks or more of gestation (OR: 2.1 [95% CI: 1.3-3.6]). Multiple logistic regression indicated that 4 factors--having 0 or 1 child, a single relationship status, no contraceptive use, and a gestation of 11 weeks or more--were independently associated with CT infection. The rate of postabortion infection among all patients was 0.4% (4/978). CONCLUSIONS: These results reveal a high prevalence (6.7%) of CT-positive patients among French women seeking induced abortions. Because it is not common practice to screen the general population for CT, screening before induced abortions seems relevant. A cost-effectiveness study is required to evaluate this screen-and-treat policy.

Proficiency of PCR in hospital settings for nonculture diagnosis of invasive meningococcal infections.

BACKGROUND: Meningococcal meningitis requires rapid diagnosis and immediate management which is enhanced by the use of PCR for the ascertainment of these infections. However, its use is still restricted to reference laboratories. METHODS: We conducted an inter-laboratory study to assess the implementation and the performance of PCR in ten French hospital settings in 2010. RESULTS: Our data are in favour of this implementation. Although good performance was obtained in identifying Neisseria meningitidis positive samples, the main issue was reported in identifying other species (Streptococcus pneumoniae and Haemophilus influenzae) which are also involved in bacterial meningitis cases. CONCLUSIONS: Several recommendations are required and, mainly, PCR should target the major etiological agents (N. meningitidis, S. pneumonia, and H. influenzae) of acute bacterial meningitis. Moreover, PCR should predict the most frequent serogroups of Neisseria meningitidis according to local epidemiology.

Heterotrophic bacterial growth on hoses in a neonatal water distribution system.

After preliminary tests indicated an increased number of heterotrophic bacteria, we investigated possible sources of contamination in a neonatal intensive care unit (NICU) water distribution system. Scanning electron microscopic examination of flexible metallic hoses associated with the system revealed the presence of a biofilm; partial 16S rDNA sequencing revealed that the biofilm contained Blastomonas natatoria. Purgation of the water system three times a day, reinforced faucet cleaning, decreasing the cold water temperature to 12 degrees , and six repeated chlorinations at concentrations as high as 2 mg/L were not sufficient to eradicate the bacterial contamination. Replacing all of the rubber-interior flexible metallic hoses with teflon-lined hoses followed by heating the water to 70 degrees successfully controlled the bacteria.

[Sacroiliitis due to Kingella kingae in an adult: updates on this pathogen]. / Kingella kingae, agent de sacro-iliite de l'adulte: données récentes à propos de ce pathogène.

We report here the case of a sacro-iliitis due to Kingella kingae in a 35 year-old patient. This case report points out the pathogenic potency in adults of this organism which is known as a cause of invasive infections in young children. Inoculation of blood culture vials with clinical specimens and the use of nucleic acid amplification have recently improved the sensitivity to identify Kingella kingae and to diagnose infections which need an efficient antimicrobial therapy.