Measles immunity and measles vaccine acceptance among healthcare workers in Paris, France.

BACKGROUND: In Europe, including France, a measles outbreak has been ongoing since 2008. Unprotected healthcare workers (HCWs) may contract and spread the infection to patients. AIM: The objective of this study was to evaluate HCWs' measles immunity and vaccine acceptance in our setting. METHODS: In a survey-based study conducted in three university hospitals in Paris, 351 HCWs were included between April and June 2011. The following data were collected at enrolment: age, hospital unit, occupation, history of measles infection and vaccination, previous measles serology and acceptance of a measles vaccination in case of seronegativity. Sera were tested for the presence of specific anti-measles IgG antibodies using the CAPTIA(®) measles enzyme-linked immunosorbent assay. FINDINGS: The mean age of the participating HCWs was 36 years (range: 18-67) and 278 (79.2%) were female. In all, 104 four persons (29.6%) declared a history of measles, and 90 (25.6%) declared never having received a measles vaccination. Among the 351 HCWs included in the study, 322 (91.7%) were immunized against measles (IgG >90 mIU/mL). The risk factors for not being protected were age [18-29 years, adjusted odds ratio: 2.7 (95% confidence interval: 1.1-6.9) compared with ≥30 years], no history of measles infection or vaccination. The global acceptance rate for a measles vaccination, before knowing their results, was 78.6%. CONCLUSION: In this cohort of HCWs, 8.3% were susceptible to measles; the group most represented were aged <30 years. Acceptance of the measles vaccine was high. A vaccination campaign in healthcare settings should target specifically healthcare students and junior HCWs.

[Emergence of Candida parapsilosis candidemia at Cochin hospital. Characterization of isolates and search for risk factors]. / Émergence de candidémies à Candida parapsilosis à l'hôpital Cochin. Caractérisation des isolats et recherche de facteurs de risque.

Candida parapsilosis is a normal saprophyte of the skin, characterized by their affinity for catheters. This species has, in vitro, a level of sensitivity against the echinocandins, significantly lower than that observed with other Candida species. Recently, new species: Candida orthopsilosis and Candida metapsilosis, phenotypically identical to C. parapsilosis, have been identified by molecular biology. From 2003 to 2007, in the Cochin hospital, the proportion of C. parapsilosis among non-albicans species isolated from blood cultures increased from 17 (3/18) to 38% (5/13). To understand the reasons for this emergence, we retrospectively characterized isolates, conducted a case-control and researched a link between the emergence and introduction of caspofungin in our hospital. We analysed data from 26 patients who had candidemia with C. parapsilosis. Genotypic analysis of isolates has not identified the new species C. orthopsilosis and C. metapsilosis. The case-control study showed a broad-spectrum antibiotics was significantly more frequent for candidemia with C. parapsilosis compared to C. albicans (52 versus 26%, P=0.04) as a previous treatment with caspofungin (11 versus 0%, P=0.04). The introduction of caspofungin is contemporary with the emergence of candidemia with C. parapsilosis with a tendency to be related to its level of consumption in the ICU. Our results should encourage biologists to closely monitor the frequency and level of sensitivity of strains of C. parapsilosis isolated in hospital.

[Diagnosis of invasive pulmonary aspergillosis: value of bronchoalveolar lavage galactomannan for immunocompromised patients]. / Diagnostic de l'aspergillose bronchopulmonaire invasive: valeur du dosage du galactomannane dans le lavage bronchoalvéolaire de patients immunodéprimés.

Invasive pulmonary aspergillosis (IPA) is an emerging disease associated with high mortality. The diagnosis is difficult, based on a combination of elements that are clinical, radiological and biological. For early detection of cases of IPA, during 25 months, we have systematically carried out on the LBA (N=355) of immunocompromised patients (N=313) a determination of Aspergillus galactomannan (GM) by ELISA (PlateliaAspergillus, BioRad). We observed 14 cases of probable API. The sensitivity of GM compared to direct examination (DE) and culture is, respectively, 64% versus 29% and 57%. The determination of GM is definitely more sensitive than the ED. Excellent specificity (98%) allows its implementation as a screening test in patients at risk.

Effects of candidaemia on outcome of burns.

AIM: To evaluate the diversity and antifungal susceptibilities of Candida isolates from wounds and blood of burn victims, and the associated mortality rates compared with those of controls without candidaemia. METHODS: We performed a nested case-control study within a database of clinical data for all patients admitted to our burn unit from January 2001 to December 2005. Each candidaemic patient was compared with two matched controls. Bloodstream cultures were performed if the core temperature was >39 degrees C, and three sites were cultured weekly for fungal identification (burn wound, pharynx, urinary tract). RESULTS: At least one episode of candidaemia was diagnosed among 20 of 851 persons admitted during the study period. Isolates in bloodstream infection were Candida albicans (65%), C. parapsilosis (25%) and C. tropicalis (10%). The median time between admission and onset of candidaemia was greater with C. albicans infection (42.6+/-31 days) than with infection by other yeasts (18+/-12 days). Candidaemia was associated with more extensive burn and longer duration of hospital stay but with similar mortality, compared with controls. CONCLUSION: Candidaemia in burn cases is mostly due to fluconazole-susceptible C. albicans and is not associated with increased mortality.

[An update on Candida dubliniensis]. / Actualités sur Candida dubliniensis.

Eleven years ago, Irish authors, using molecular biology, demonstrated the existence of Candida dubliniensis, a new species of Candida close to Candida albicans. Initially isolated from AIDS patients with oral candidiasis, this species was detected, even in immunocompetent patients. Recently, with new, easy to implement identification tests (latex, immunochromatography), numerous epidemiological studies were undertaken. In most studies, C. dubliniensis was most often identified in the oral cavity. In the absence of HIV infection, the proportion C. dubliniensis/C. albicans ranged from 1 to 5% but it increased to 15-20% in case of HIV infection. It should be stressed that, from an experimental point of view, the acquisition of a secondary resistance to fluconazole is more quickly obtained with C. dubliniensis that with C. albicans, this resistance remains exceptionally observed in clinical observations.

Clinical and experimental evaluation of a new chromogenic medium (OCCA, Oxoid) for direct identification of Candida albicans, C. tropicalis and C. krusei.

Oxoid Chromogenic Candida Agar (OCCA) is a new commercial ready-to-use medium that contains chromogenic substrates for rapid detection and specific identification of Candida albicans, C. tropicalis and C. krusei. We evaluated the performance of this medium with 364 clinical specimens and 31 subcultures, and examined its ability to support the growth of small inocula of six reference strains. CHROMagar Candida was used as the reference medium. OCCA permitted the growth of most important yeasts, and readily discriminated among Candida spp. in clinical specimens, including mixed cultures.

[Delayed testing for the diagnosis of fungi in the urines. Evaluation of the BD Vacutainer C&S tubes for the storage of urine samples at room temperature]. / Recherche différée de levures dans les urines. Evaluation des tubes BD Vacutainer C&S pour la conservation des échantillons à température ambiante.

The study included 37 urine samples which have been artificially infected with low levels (10(3) CFU/mL) of various fungi strains. We compared the effects of sample storage, up to 48 hours, at room temperature, in a urine evacuated tube containing specific additives with storage at + 4 degrees C, for the same length of time, in a urine evacuated tube without any additives. There have been no differences of results (speed of growth and colony size) between the 2 modes of storage. However, the experience has shown that samples needed a careful mixing before seeding to avoid underdetection of the strains. Based on the study results, the BD Vacutainer C&S tubes are suitable for delayed testing for the diagnosis of urine fungal infection.

Mycetoma of the foot caused by Fusarium solani: identification of the etiologic agent by DNA sequencing.

We report a case of Fusarium solani mycetoma of the foot that could not be diagnosed by culture, but was correctly identified after amplification and sequence analysis of fungal internal transcribed spacers 1 and 2 and 5.8S ribosomal DNA regions.

Localized oral Fusarium infection in an AIDS patient with malignant lymphoma.

We report here a case of localized oral Fusarium infection in an AIDS patient who developed an ulceration in the soft palate. Fusarium solani was identified by histopathology and culture. We believe this to be the second reported case of oral Fusarium infection in a patient with haematological malignancy and the first reported association of oral Fusarium infection with AIDS.

[Two cases of inexplicable autochthonous malaria in Toulouse, France]. / Deux cas inexpliqués de paludisme autochtone a Toulouse, France.

Malaria involving both Plasmodium falciparum and vivax was observed in two patients hospitalized in the same room of the Cardiology Department of the Purpan University Hospital in Toulouse, France. One patient was in coma without fever by the time of diagnosis. None of the patients had traveled to malaria areas within the last 33 years. Epidemiological investigations failed to detect malaria in family members, hospital staff, or other patients. Transmission due to transfusion of infected blood, use of contaminated surgical instrumentation, or bite of an autochthonous anopheles mosquito was reasonable ruled out. Since Toulouse International Airport is located less than three kilometers from the Purpan University Hospital, the most likely explanation was airport-acquired malaria due to the bite of a mosquito imported by an aircraft coming from abroad. The hypothesis that an Anopheles mosquito survived the plane trip and then was blown into the patients' room was supported by temperature and wind conditions prevailing at the time of infection.

[Seroepidemiology of toxoplasmosis in Niamey, Niger]. / Séro-épidémiologie de la toxoplasmose à Niamey, Niger.

A seroepidemiological survey of toxoplasmosis was carried out in Niamey, Niger, in 1992. Three hundred and seventy-one sera from 200 females and 171 males were tested by indirect immunofluorescence assay for IgG. Using a cut-off value of 12 UI, 67 sera (18%) were positive. In this group detection of specific IgM by ELISA with immunocapture revealed 8 positive sera (11.9%). Seroprevalence of specific IgG was not correlated with ethnic origin or sex but did increase with age from 6.9% in subjects under 5 years to 34.9% in subjects 50 years and over. These findings are comparable with those from previous studies in similar climates and confirm that the prevalence of toxoplasmosis is higher in humid coastal regions than dry desert areas.

[Fusarium onychomycosis]. / Onychomycose à Fusarium.

INTRODUCTION: A 69-year-old man with an uneventful past history consulted for a proximal subungueal leukonychia and associated paronychia of the right greater toe. Macroscopic examination and culture lead to the diagnosis of Fusarium oxysporum. Local treatment with bifonazol and cyclopirox was effective. DISCUSSION: Fungal onychomycoses are uncommon and usually present as superficial leukonychia. The association of a proximal localization with paronychia would suggest possible Fusarium infection. Though no specific treatment protocol is well-established, this case emphasizes the importance of effective treatment since invasive fusariosis is described in immunosuppressed patients with ungueal localizations can be an important portal for infection.

[Seroepidemiology of toxoplasmosis on Mayotte (Comores Archipelago)]. / Séro-épidémiologie de la toxoplasmose à Mayotte (Archipel des Comores).

A seroepidemiological survey of toxoplasmosis was carried out on Mayotte Island. Detection of IgG was performed on 871 samples from 509 females and 362 males by indirect immunofluorescence assay. Using a cut-off value of 12 UI (1/16), 734 sera (84.3%) were found to be positive. Assays for specific IgM which were carried out only in positive subjects detected IgM in 13 people (1.5%). Comparison between different ethnic groups showed significantly higher rates of seroprevalence in villages with latrines. This finding is attributed to the use of fresh water for bathing and dish washing. It has been hypothesized that use of salt water for these purposes lessens the rate of contamination by destroying Toxoplasma gondii oocysts.