Antibiotic susceptibility of cultivable microbiota from the oral cavity of captive Bothrops atrox and Bothrops lanceolatus: Implications for the treatment of snakebite-associated infections in the French departments of America.

INTRODUCTION: Secondary infection is a frequent complication after bites by Bothrops atroxin French Guiana or B. lanceolatus in Martinique. Knowledge of the bacteria present in snake mouths is a valuable aid for determining probabilistic antibiotherapy after Bothrops bite. The objectives of this study were to describe the cultivable bacteria of the oral microbiota of the specimens of B. atrox and B. lanceolatus kept in captivity, and to study their susceptibility to antibiotics. METHODS: Fifteen B. atrox and 15 B. lanceolatus were sampled. Bacterial cultures were performed and each morphotype on plates was identified using MALDI-TOF mass spectrometry. Antibiotic susceptibility was studied using the agar disk diffusion method, with possible determination of the MICs. RESULTS: One hundred and twenty-two isolates were identified: 52 isolates and 13 species in B. atrox, 70 isolates and 23 species in B. lanceolatus. The main species were Providencia rettgeri, Morganella morganii, Pseudomonas aeruginosa, Staphylococcus xylosus, and Paeniclostridium sordellii (only in B. lanceolatus mouths). For B. atrox, 96% of isolates were susceptible to piperacillin/tazobactam, cefepime, imipenem and meropenem, 94% to ciprofloxacin and 76% to cefotaxime and ceftriaxone. For B. lanceolatus, 97% of isolates were susceptible to meropenem, 96% to cefepime, 93% to imipenem and piperacillin/tazobactam, 80% to ciprofloxacin, and 75% to cefotaxime and ceftriaxone. Many isolates were resistant towards amoxicillin/clavulanate. CONCLUSION: Among currently recommended antibiotics, cefepime and piperacillin/tazobactam seem more suitable than cefotaxime or ceftriaxone in the event of a Bothrops bite. Ciprofloxacin may also be considered for B. atrox.

[Severe cytomegalovirus-associated protein losing gastropathy in an immunocompetent adult]. / Entéropathie exsudative sévère compliquant une primo-infection à cytomégalovirus chez un adulte immunocompétent.

INTRODUCTION: Clinical expression of cytomegalovirus (CMV) infection is numerous and depends on the immune status of the host. In immunocompromised patients, CMV disease corresponds to reactivation of the virus with tissue damage responsible for significant morbidity and mortality. In immunocompetent adults, primary CMV infection is usually asymptomatic but may rarely result in severe organ damage. OBSERVATION: We report the case of a 28-year-old man, considered immunocompetent and without medical history, presenting with a primary CMV infection revealed by a severe protein-losing gastroenteropathy (serum albumin level: 18.9g/L). The CT scan showed a gastro-duodeno-jejuno-ileitis pattern. Upper intestinal endoscopy revealed diffuse ulcerated and congestive gastritis predominantly in the fundus. Histological analysis of the biopsies showed no viral inclusion and no immunohistochemical staining reaction, but a high viral load (5.61 log). Treatment was symptomatic associated with anticoagulation due to the major hypoalbuminemia. The patient slowly recovered, and normal clinical examination and blood tests were observed two months after the onset of symptoms. CONCLUSION: Severe CMV organ involvement in the immunocompetent patient is very rare but potentially serious. Digestive involvement complicated by exudative enteropathy is possible. Evolution is usually favorable without the need for antiviral treatment.

Microbiology of French military casualties repatriated from overseas for an open traumatic injury.

BACKGROUND: This study aimed to describe the microbiological epidemiology of repatriated French soldiers with an open traumatic injury, and to measure the proportion of multidrug-resistant bacteria (MDRB). METHODS: Retrospective study including all French soldiers repatriated in 2011 and 2012 in Parisian military hospitals for open traumatic injury. Results of clinical samples and MDRB screening were collected. The antibiotic susceptibility was assessed using the agar disk diffusion method. Characterization of resistance mechanisms was performed using PCR. Genotyping of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) isolates was performed using rep-PCR. RESULTS: A total of 139 patients were included; 70% of them were repatriated from Afghanistan. At admission, 24/88 were positive for MDRB (28%), mainly ESBL-E but no carbapenemase-producing Enterobacteriaceae and vancomycin-resistant Enterococcus faecium were identified. Forty-five patients had lesion sample collection, and 28/45 had a positive culture. The most frequently isolated pathogens were Enterobacter cloacae, Pseudomonas aeruginosa, and Escherichia coli. For eight patients, a MDRB was isolated from the wound, mainly ESBL-E (7/8) but also one methicillin-resistant Staphylococcus aureus and one imipenem-resistant Acinetobacter baumannii. Among ESBL-E, the PCR evidenced the high prevalence of CTX-M15 enzymes. Rep-PCR performed on the 23 ESBL-producing E. coli isolates highlighted numerous profiles. CONCLUSIONS: Controlling the spread of ESBL-E is currently challenging for French Armed Forces. Despite any evidence of an epidemic clone, a high-level compliance with hygiene precautions is required throughout the chain of care to avoid cross contamination.

Outbreak of CTX-M-15-producing Enterobacter cloacae associated with therapeutic beds and syphons in an intensive care unit.

An outbreak of extended-spectrum ß-lactamase-producing Enterobacter cloacae (ESBL-ECL) occurred in our intensive care unit (ICU) and involved 18 patients (8 infected and 10 colonized). The mean age of patients was 69 years, and all infected patients had underlying medical conditions. Within hours' recognition of the spread of ESBL-ECL, the infection control team requested for staff education, reinforcement of infection control measures, and environmental screening. New transmissions were observed in the institution after weeks of enhanced infection control measures. Microbial swabbing revealed bacterial contamination of some mattresses and syphons with epidemiologic links between environmental, screening, and clinical isolates. This outbreak resulted in the temporary closure of the ICU for complete biocleaning.

Paenibacillus larvae Phage Tripp Genome Has 378-Base-Pair Terminal Repeats.

Paenibacillus larvae bacteriophage Tripp was isolated from an American foulbrood diseased honey bee hive in North Carolina, USA. The 54,439-bp genome is 48.3% G+C, encodes 92 proteins, no tRNAs, and has 378-bp direct terminal repeats. It is currently unique in Genbank.

Nanoindentation of Isometric Viruses on Deterministically Corrugated Substrates.

It has been just over 100 years since inventor Joseph Coyle perfected the egg carton-a package format that has known very little changes since its first appearance ( Dhillon , S. B. C. Inventor Created Better Way to Carry Eggs. In The Globe and Mail Vancouver , 2013 ). In this article, we extend Coyle's old idea to the study of mechanical properties of viruses. Virus stiffness, strength, and breaking force obtained by force spectroscopy atomic force microscopy (AFM) provide the knowledge required for designing nanocontainers for applications in biotechnology and medicine, and for understanding the fundamentals of virus-host interaction such as virus translocation from one cellular compartment to another. In previous studies, virus particles adsorbed on flat surfaces from a physiological buffer were subjected to directional deformation by a known force exerted via a microscopic probe. The affinity between the virus shell and surface is required to be strong enough to anchor particles on the substrate while they are indented or imaged, yet sufficiently weak to preserve the native structure and interactions prior deformation. The specific question addressed here is whether an experimental scheme characterized by increased contact area and stable mechanical equilibrium under directional compression would provide a more reliable characterization than the traditional flat substrate approach.

Partition locus-based classification of selected plasmids in Klebsiella pneumoniae, Escherichia coli and Salmonella enterica spp.: an additional tool.

The dissemination of antimicrobial resistance genes in Enterobacteriaceae has been largely attributed to plasmids, circular DNA molecules capable of autonomous replication. Whereas high-copy-number plasmids primarily rely on passive diffusion for plasmid maintenance, low-copy-number plasmids utilize so-called partition (par) systems. Plasmid partition relies on three structures, i.e. a centromere like DNA site, a centromere-binding protein and an ATPase or a GTPase motor protein for plasmid positioning. Identification and classification of plasmids is essential for tracing plasmids conferring drug resistance. PCR-based replicon typing is currently the standard method for plasmid identification but there are new classification schemes, especially the relaxase gene typing (PRaseT). Here we developed a multiplex PCR set targeting par loci found on the plasmids most frequently encountered in Enterobacteriaceae. This method, called "plasmid partition gene typing" (PAR-T), was validated with 136 transconjugants or transformants harboring various replicon types. The method was tested with 30 multidrug-resistant clinical isolates including Escherichia coli, Klebsiella pneumoniae and Salmonella enterica subsp. enterica carrying 1-4 replicons; all replicons were tested in parallel with PRaseT for comparison. Six multiplex PCRs and one simplex PCR including 18 pairs of primers recognized plasmids of groups IncA/C, FIA, FIB, FIC, FIIk, FII, HI1, HI2, I1, L/M, N, X. Our set of multiplex PCRs showed high specificity for the classification of resistance plasmids except for IncX replicons.

[What is your diagnosis? A "fat arm". Onchocerciasis]. / Une histoire de "gros bras".

We report a case of edema of the right forearm with pruriginous papules and eosinophilia in the blood. The patient had lived in a forested area of Cameroon. The clinical, laboratory, and geographical findings led to a diagnosis of onchocerciasis, despite the absence of microfilaments on skin biopsy samples. The patient was successfully treated with ivermectin and doxycycline.

An 8-year survey of strains identified in blood cultures in a clinical haematology unit.

The aim of our study was to determine the epidemiological profile and the antibiotic susceptibility of bacteria and fungi identified from blood cultures in the patients of the clinical haematology unit. A retrospective study was carried out over an 8-year period (2003-2010) in the clinical haematology unit of the Percy Military Medical Center. During this period, we collected 723 isolates: Gram-negative bacilli (70.8%) and Gram-positive cocci (18.7%). The four most commonly isolated species were Escherichia coli (18.5%), Pseudomonas aeruginosa (14.8%), Stenotrophomonas maltophilia (6.2%) and Staphylococcus epidermidis (5.4%). The rate of methicillin-resistant Staphylococcus aureus was 6.45% and that of coagulase-negative staphylococci 61.2%. No resistance to glycopeptides was observed. In E. coli, as in the Klebsiella-Enterobacter-Serratia group, a 27% resistance to fluoroquinolones was observed. Concerning P. aeruginosa, the phenotypes were distributed over penicillinase (23.4%) and cephalosporinase (13.1% were resistant to ceftazidime). The impermeability rate of imipenem was 9.3%. The aggressiveness and duration of haematological treatments explains why infections remain one of the main complications of neutropenia. The emergence of new or unusual bacteria is highly likely. Antibiotic selective pressure and long periods of hospitalization could explain the emergence of multiresistant bacteria. As a consequence, epidemiological surveillance is indispensable.

Fabrication and superhydrophobic behavior of fluorinated microspheres.

We describe the preparation of fluorinated microspheres by precipitation polymerization and their use to fabricate superhydrophobic surfaces. For that purpose, two different approaches have been employed. In the first approach, a fluorinated monomer (either 4-fluorostyrene or 2,3,4,5,6-pentafluorostyrene) was added to the initial mixture of monomers constituted by styrene (S) and divinylbenzene (DVB). The second approach is based on the encapsulation of a block copolymer, polystyrene-b-poly(2,3,4,5,6-pentafluorostyrene), during the polymerization of the monomers (S and DVB), thus enabling the formation of particles with perfluorinated chains instead of single functional groups at the interface. Both approaches led to narrow polydisperse particles with fluoro-functional groups at the interface as demonstrated by scanning electron microscopy (SEM), infrared (IR) spectroscopy, and X-ray photoelectron spectroscopy (XPS). Surface array of particles obtained by simple solvent casting presented superhydrophobic behavior with contact angles of water droplets of ca. 160-165°.

[Multidrug intoxication]. / Intoxication polymédicamenteuse.

The authors report an suicide attempt by a 43 years old woman treated by Previscan, Effexor, Rivotril, and Stilnox for phlebitis anteriority and anxious-depressive disorders. On arrival to the emergency unit, the medical status and the patient history required a cardiovascular reanimation and gastric washing. The haemostasis analysis demonstrates an anticoagulant overdose and the prescription of vitamine K1 and PPSB was necessary. Later, the multidrug poisoning was demonstrated thanks to blood, urinary and gastric fluid high performance liquid chromatography toxicological analyses. This case report points out that biological and toxicological analyses are complementary. The first ones are useful to determine the emergency symptomatic cares, and to check the drugs' efficiency. The second ones, although longer, are necessary to identify with certainty incriminated drugs.

Design of polypeptide-functionalized polystyrene microspheres.

In this contribution, the principle of spontaneous surface segregation has been applied for the preparation of polypeptide-functionalized polystyrene microspheres. For that purpose, an amphiphilic diblock copolymer was introduced in the mixture styrene/divinylbenzene and polymerized using AIBN as initiator. During the polymerization, cross-linked particles were obtained in which the diblock copolymer was encapsulated. The amphiphilic diblock copolymers used throughout this study contain a hydrophilic polypeptide segment, either poly(L-lysine) or poly(L-glutamic acid) and a hydrophobic polystyrene block. After 4 h of polymerization, rather monodisperse particles with sizes of approximately 3-4 microm were obtained. Upon annealing in hot water, the hydrophilic polypeptides migrate to the interface, hence, either positively charged or neutral particles were obtained when poly(L-lysine) is revealed at the surface and exposed to acidic or basic pH, respectively. On the opposite, negatively charged particles were achieved in basic pH water by using poly(L-glutamic acid) as additive. The surface chemical composition was modified by changing the environment of the particles. Thus, exposure in toluene provoked a surface rearrangement, and due to its affinity, the polystyrene block reorients toward the interface.

[Imported mycosis: a review of paracoccidioidomycosis]. / Mycoses d'importation: le point sur la paracoccidioïdomycose.

Population migration is increasing the number of systemic mycosis cases, a condition little or not present in Metropolitan France, thus often weakly documented for medical teams. Paracoccidioidomycosis is a systemic mycosis geographically confined to Latin America. The causative agent is Paracoccidioides brasiliensis, a dimorphic fungus present at ground level. Discovering that the armadillo was a new host allowed documenting the ideal conditions for this fungus development. The mortality rate is currently 1.45 for one million people and the disease affects mainly farmers. The mode of infection is respiratory and all organs and mucous membranes can be affected by lymphatic dissemination. The chronic form with pulmonary, cutaneous and oral lesions is the most important. The diagnosis can be carried out by direct examination of samples revealing the presence of budding yeasts, as well as culture at 25 and 37 degrees C. Antifungals like the sulfamethoxazole-trimethoprime combination, amphotericin B, but especially azole derivatives are use in the therapeutic management of patients. Detection and gp 43 antigen assay is useful for the patient's follow-up.