Cytomegalovirus (CMV) Shedding in French Day-Care Centers: A Nationwide Study of Epidemiology, Risk Factors, Centers' Practices, and Parents' Awareness of CMV.

BACKGROUND: Congenital cytomegalovirus (CMV) remains an important healthcare burden, resulting from primary or secondary infection in pregnant women. Exposure to young children's saliva is a major risk factor, as prevalence of CMV shedding can reach 34%. METHODS: This cross-sectional, multicenter, nationwide study was conducted in randomly selected day care centers (DCCs), and complemented with a survey among parents and DCCs. All children aged >3 months were eligible. The study measured the CMV shedding prevalence in children's saliva and described CMV genotypes epidemiology. The risk factors for CMV shedding and high viral load were evaluated using multivariable models. RESULTS: A total of 93 DCCs participated. Among the 1770 enrolled children with evaluable samples, the CMV shedding prevalence was 40% (713/1770, 95% confidence interval, 34.6-46.1), independently associated with children aged between 12 and 18 months, history of CMV infection in ≥1 parents, a mid-level income. Prevalence increased with DCC staff workload and attending children number. Viral load was ≥5 log-copies CMV/mL in 48% (342/713). Risk factors for higher viral load included children aged between 12 and 18 months, and still being breastfed. The most frequent genotype combinations were gB1-gN4c-gH2 (6.9%), gB1-gN2-gH2 (6.3%), gB4a-gN3a-gH1 (6.3%), and gB1-gN3b-gH2 (5,7%). CMV awareness was low in parents: their serological status was unknown by 72% of mothers and 82% of fathers. Only 41% knew something about CMV. CONCLUSIONS: CMV shedding was independently associated with risk factors related to the children, family and DCC. Some of these risk factors may influence prevention strategies, including through an improved information provided to parents. CLINICAL TRIALS REGISTRATION: NCT01704222.

Investigation of an outbreak of osteoarticular infections caused by Kingella kingae in a childcare center using molecular techniques.

We describe an outbreak of 5 osteoarticular infections among 24 daycare center attendees. Polymerase chain reaction revealed Kingella kingae in the joint fluid of 1 child and in 85% of throat samples from healthy contacts. Multilocus sequence typing performed on the joint fluid and carriage isolates identified an unique sequence type. Rifampin failed to eradicate K. kingae carriage.

Spinal tuberculosis: a longitudinal study with clinical, laboratory, and imaging outcomes.

OBJECTIVES: To study imaging changes associated with spinal tuberculosis (ST) over time and evaluate their association with clinical and laboratory data. METHODS: Between 1997 and 2004, patients with proven ST in our institution were prospectively enrolled and treated for 1 year. Clinical and laboratory data were collected at baseline and every 3 months. Computed tomography (CT) and magnetic resonance imaging (MRI) were performed at baseline. MRI was performed at least twice during treatment and at the end of treatment. RESULTS: Nineteen patients were enrolled; neurological signs were present at baseline in 14 patients (74%). Initial MRI/CT findings comprised (in percentages of patients) the following: paravertebral abscesses (100/100); intradiscal abscesses (47/0); and epidural abscesses (82/24) with spinal cord compression (64/18) or radicular compression (36/0). Edema of the vertebral body was observed on initial MRI in all the patients. Full follow-up data were available for 15 patients: all were cured with a mean follow-up of 25 months after the end of treatment. Weight gain was nearly maximal at 6 months, and pain relief was achieved within 9 months. C-reactive protein returned to normal after 3 months. On MRI, all epidural abscesses disappeared within 9 months; paravertebral abscesses disappeared after 3, 6, and 12 months in 45, 50, and 85% of patients, respectively. Vertebral body signal converted to a fatty signal in 75% of cases at 12 months. CONCLUSIONS: Significant imaging abnormalities can persist after successful treatment of ST. These findings suggest that MRI need not be repeated in patients with clinical and laboratory improvement.

Comparative study of postoperative and spontaneous pyogenic spondylodiscitis.

OBJECTIVES: Postoperative spondylodiscitis (POS) is poorly characterized, partly owing to its rarity. The aim of this prospective study was to compare the clinical, biological, bacteriological, and imaging features of postoperative and spontaneous spondylodiscitis (SS). METHODS: A multidisciplinary spondylodiscitis cohort follow-up study was conducted between February 1999 and June 2003 in a 500-bed teaching hospital. All patients hospitalized in internal medicine, orthopedic, and neurosurgery wards with a culture-proven diagnosis of pyogenic spondylodiscitis were included. Clinical and bacteriological data were collected. All patients underwent computed tomography and/or magnetic resonance imaging of the spine. RESULTS: Sixteen patients had SS and 7 patients had POS. Patients with POS tended to be younger (52 versus 69 years), with less frequent underlying diseases (29 versus 75%) and a more prolonged interval between symptom onset and diagnosis (16 versus 3.4 weeks) than patients with SS. Blood cultures were positive in 14 and 81% of cases in the POS and SS groups, respectively, and invasive diagnostic procedures were necessary in 86% of patients with POS and 19% of patients with SS ( P = 0.005). Staphylococci were the more frequent isolates in both groups but were more frequently coagulase-negative in POS patients than in patients with SS ( P = 0.01). Vertebral edema tended to be more frequent in POS and was located more posteriorly than in SS ( P = 0.023). CONCLUSIONS: POS is associated with specific clinical, microbiological, and imaging features possibly related to pathophysiologic characteristics. Knowledge of these characteristics should help reduce the current delay in the diagnosis of POS.

Acute pulmonary embolism: a rare complication of a large non-parasitic hepatic cyst.

A 56-year-old patient with a non-parasitic hepatic cyst developed acute dyspnoea. Pulmonary embolism was diagnosed. Bleeding into the hepatic cyst, leading to its enlargement and compression of the inferior vena cava, was the only likely cause of the pulmonary embolism. This complication of a non-parasitic liver cyst has not been reported previously. The patient was treated with heparin. Surgical evacuation of the cyst using the 'fenestration' technique was also performed. There was no recurrent pulmonary embolism or hepatic cyst during a 1-year follow-up period.

Changes in the pattern of respiratory diseases necessitating hospitalization of HIV-infected patients since the advent of highly active antiretroviral therapy.

The incidence rates of opportunistic diseases, hospital admission and death have fallen markedly since the advent of highly active antiretroviral therapy (HAART). We examined the impact of HAART on the pattern of HIV-related respiratory diseases necessitating hospitalization. We retrospectively compared the numbers and etiologies of respiratory diseases diagnosed in HIV-infected patients hospitalized in the chest department of a Paris university hospital during the three years preceding widespread prescription of HAART in France (era 1, starting in July 1993) and the first three years of widespread HAART prescription (era 2, starting in July 1996). Respectively, 207 and 119 HIV-infected patients were admitted for respiratory disease in era 1 and era 2. Only 31.1% of patients admitted during era 2 were receiving HAART. Pulmonary opportunistic infections other than Pneumocystis carinii pneumonia (PCP) (p = 0.0008) and exacerbations of chronic bronchial disease due to gram-negative bacilli (p = 0.04) virtually disappeared in era 2. In contrast, PCP, bacterial pneumonia, tuberculosis, pulmonary Kaposi's sarcoma and pulmonary non-Hodgkin lymphoma showed only a twofold decrease in era 2, while lung cancer was more frequent (p = 0.004). The frequency of severe respiratory diseases necessitating hospitalization of HIV-infected patients has fallen since the advent of HAART, and their etiologic distribution has changed.

Improvement of symptomatic human immunodeficiency virus-related lymphoid interstitial pneumonia in patients receiving highly active antiretroviral therapy.

To analyze the impact of highly active antiretroviral therapy on lymphoid interstitial pneumonia (LIP), we reviewed the medical files of 5 human immunodeficiency virus (HIV)-infected patients in whom LIP was diagnosed during 1996-2001 who had never previously received antiretroviral treatment. Patients were mildly immunosuppressed at the time of diagnosis of LIP but had high plasma HIV loads and marked circulating and pulmonary CD8 hyperlymphocytosis. All patients improved clinically, radiologically, and functionally; improvement was accompanied by a drastic reduction in the virus load and an increase in the CD4 lymphocyte count.