molecular typing of Legionella pneumophila strains isolated from environment in Morocco.

Legionella pneumophila is a common cause of hospital and community-acquired pneumonia, being transmitted by inhalation of aqueous aerosols. Most legionellosis outbreaks are linked to contaminated hot water systems or cooling towers. The aim of this study was to determine the genetic diversity of (n= 55) environmental strains of L. pneumophila recovered from the hot water distribution systems of 16 establishments in seven Moroccan towns during the period 2009-2011. Thirteen chromosomal restriction patterns determined by Pulsed field gel electrophoresis were detected. The strains of L. pneumophila serogroup1 exhibited in 6/13 different PFGE patterns, while the strains of L. pneumophila serogroups 2-14 showed 7/13 PFGE patterns. The PFGE showed the existence of various patterns in Morocco, The pattern -XI- have tree similar profiles with the endemic L. pneumophila Paris's strain. This technique also allowed to conclude that the same pulsotype was found for many strains isolated from different establishments. Moreover, different pulsolypes were found for strains isolated from the same establishment. These results showed that PFGE analysis is a powerful tool to reveal the clonal nature and genetic differences among L. pneumophila strains.

[Schistosoma haematobium among immigrants consulting in municipal free clinics in Paris in 2003]. / La schistosomose urinaire chez des migrants ayant consulté dans des centres médico-sociaux de Paris en 2003.

The "Consultations de Diagnostic et d'Orientation" (CDO) are free medical consultations for precarious populations, proposed by the Health Department of Paris. More than two-thirds of the CDO patients come from Sub-Saharan Africa. Schistosoma haematobium (SH) is one of the most frequent infectious diseases detected within CDO. More than a thousand people have consulted for the first time in CDO in 2003 in one of the municipal free Clinics which proposes this service. Parasitologic test of urine has been performed among 220 patients and found 24 positive results: viable eggs of SH (10.8%). All 24 patients are male, most of them are under 35 years-old and come from the region of the Senegal River that lies in the junction of Mali, Senegal and Mauritania. We want to remind physicians in non-tropical setting to think of SH when they see a patient originating from Africa. To ask him if he presents haematuria and if not, to prescribe a parasitologic test of urine. If all patients from endemic regions had undergone this screening in 2003, we would have detected about 20 more cases of SH. If treated early enough, it could avoid severe uronephrological complications, which are rare but represent a high health care cost (bladder tumor, renal failure).

[Pollen content of the Paris air: comparison of the results obtained by two samplers for the year 2003]. / Contenu pollinique de l'air a Paris: comparaison des résultats obtenus a partir de deux capteurs pour l'année 2003.

During the 2003 season, a second pollen collector has been established in Paris city (Audubon site) to study the representativeness of the initial collector situated on the roof of the Pasteur Institute. The Hygiene Laboratory of Paris followed the pollen counts from the two collectors, during the period going from May to September. Both the samplers are Lanzoni model with a flow rate of 10 l x min(-1). The quantitative results show that no statistical difference exists between the pollen counts obtained from the 2 sites (Mann-Withney test, p > .05). The dominant species are Urticaceae, Poacae and Castenea species for the 2 collectors. Their counts are similar except for Poacae whose results are higher at the Audubon site. The collection period do not take into account the pollen production period of many trees species because of the late installation of the collector on the Audubon site. The results show that the two sites chosen for the study of pollen distribution are comparable. Nevertheless, the comparative study should be maintained on the next year to get more details about the observed differences and to collect the early trees pollen.

Detection of Mycobacterium tuberculosis complex by PCR in hospital air samples.

Tuberculosis remains a health problem in many developed countries. After the development of a sedimentation method, a semi-quantitative approach for bioaerosol monitoring of Mycobacterium tuberculosis based on polymerase chain reaction (PCR) was adapted for direct detection in air. Bovine serum albumin was added to override airborne environmental particle PCR inhibitors. The method gave positive results in hospital rooms where tubercular pneumonia patients were hospitalized during the first days after their diagnosis.

[Environmental audits in Ile-de-France]. / Audits environnementaux en Ile-de-France.

Mould exposure in indoor environments can cause various health effects: infections, allergies, toxic effects and irritations. We have lead environmental audits (n = 32), at physician's request, in suspected mould allergic patient homes. A deep home visit allows the detection of potential indoor fungal and humidity sources, afterwards, a sample strategy is determinate. Results show that indoor airborne spores concentrations vary from some units (CFU) to more than thousands per m3. In dust samples, the number of spores per gram ranges from hundred to millions. A statistical analysis shows that "mouldy dwellings" are more contaminated than "non mouldy" ones and than outdoor air. Mould species relative presence is specific in each contaminated home, depending on various factors (mouldy support nature, competition between species...).

[Blind treatment or treatment oriented to intestinal parasitoses in a Parisian health center for refugees]. / Traitement à l'aveugle ou traitement orienté des parasitoses intestinales dans un centre parisien de soins pour exilés.

The Comede health care center for political refugees received 4,414 first arrivals from 70 African, Asian and South American countries in 1989. Many arrived from areas where intestinal parasitic infections are endemic, and where infections by nematodes (Ancyclostoma duodenale, Necator americanus, Ascaris lumbricoides, Trichuris trichiura, Strongyloides stercoralis), trematodes (Schistosoma hematobium, Schistosoma stercoralis) and protozoa (Entamoeba coli) cause significant morbidity. The question that arises is whether we should screen stools and urine only in the case of African refugees, or treat all refugees empirically (mass treatment program). We carried out a retrospective study of 1,425 patients seen for the first time in the Comede from August 1, 1989 to December 31, 1989. Three-quarters of the subjects were men and the mean age was 29 years. 63.2% of the subjects were from 28 African countries, 18.6% from 8 Asian countries, 10% from 5 South American countries and the West Indies, and 6.4% from 4 countries of the Mediterranean basin. 4 countries of the Mediterranean basin. All the subjects were asked to provide stool and urine specimens at the Paris City Laboratory, which were examined using the merthiolate iodo formol direct methods, two concentration methods (MIF and Kato) and Baermann's technique. Patients with infestations were prescribed appropriate treatment at a second visit, compliance with which was good (86%). The prevalence of intestinal parasite infections was 60%. Albendazole was given to 44% of patients, while 45% of African patients were given praziquantel and 2.7% tinidazole.(ABSTRACT TRUNCATED AT 250 WORDS)

Health effects of attending a public swimming pool: follow up of a cohort of pupils in Paris.

OBJECTIVES: This study aimed to determine the health effects of attending a well-kept school swimming pool maintained according to French public health regulations. METHODS: This prospective month long study was carried out on a randomised sample of pupils aged 5 to 18 years who attended a private French school with two swimming pools. The children surveyed, helped by their parents, had to fill in questionnaires about their bathing habits and symptoms during the survey period. Inspections of the pool complex were made and these included physicochemical and bacteriological analyses of the pools' water. PARTICIPATION: The response rates achieved were 70% at primary and middle school levels but only 25% in the high school pupils. Because of this older teenagers were excluded from the final analysis (of 246 children). RESULTS: Compared with non-bathers, bathers experienced fatigue and eye irritation significantly more often (p < 0.001). The eyes were red (38% of bathers) and/or watery (16%) after swimming but this resolved spontaneously within 24 hours. Bathing behaviour (bath duration, head immersion, wearing swimming goggles) did not affect these incidence rates noticeably. There were no differences between bathers and non-bathers with regard to other symptoms, especially otolaryngological ones. This survey does not allow definite conclusions to be made about verrucas because 22% of non-bathers were exempted from swimming because of verrucas that they might have caught previously in a pool. CONCLUSIONS: Except for verrucas, the methodology was adequate and daily self reporting of symptoms was feasible. This college largely recruits pupils from higher social classes and is not therefore representative of schools in Paris.

[Evaluation of the screening strategy for lead poisoning in 1-to-3-year-old children monitored in maternal-child welfare centers in Paris]. / Evaluation de la stratégie de dépistage du saturnisme chez les enfants âgés de 1 à 3 ans, suivis dans les centres de protection maternelle et infantile à Paris.

A procedure for screening for lead poisoning was implemented since 1987 in the maternal and child health centers of 6 Paris "arrondissements". It relies on a screening of the children through environmental and clinical information. Our study aimed at evaluating this procedure and at estimating the prevalence of lead poisoning in the children aged 1 to 3 years old attending free maternal and child health centers in Paris. We did a cross-sectional survey of a sample of 512 children. A questionnaire concerning each child's risk factors was answered by the paediatric nurses of the clinics. Potential lead poisoning cases were detected by capillary determining of free erythrocyte protoporphyrins (FEP). Blood lead level (PbB) was measured in children with FEP > or = 350 micrograms/l. The prevalence rate of lead poisoning was estimated at 1.9% +/- 1.7% for a PbB threshold > or = 250 micrograms/l and at 9.6% +/- 3.5% for a PbB threshold > or = 150 micrograms/l. The detection procedure identified 4 children out of 5 with a PbB > or = 250 micrograms/l and 2 children out of 3 with a PbB > or = 150 micrograms/l.

The intracellular multiplication of Legionella pneumophila in protozoa from hospital plumbing systems.

Between October 1987 and March 1989, we tested 144 water samples obtained from the plumbing and cooling tower systems of 5 Paris hospitals for the presence of legionellae and amoebae. Of the samples tested for Legionella, 67 out of 144 (46.5%) were positive, and 82 out of 116 tested for amoebae (70.7%) were positive. The ability of protozoa to support the multiplication of legionella was shown by incubating samples at 35.5 degrees C for 7-15 days. Prior to determining the presence of legionellae and amoebae, 51 of the 144 samples were incubated. After incubation, 22 out of 25 (88%) samples which were positive for the presence of both Legionella and amoebae showed multiplication of Legionella. In 3 out of the 25 (12%) samples containing Legionella and amoebae, Legionella failed to multiply. Six out of the 51 (11.8%) samples which were negative in direct culture for Legionella but positive for amoebae, became positive after incubation. Legionella did not multiply in samples negative for amoebae, nor was there proliferation in samples after filtration through a 1.2-microns membrane followed by incubation for the same period and temperature. Strains of Legionella pneumophila serogroup 1 and serogroup 6 (SG1 and SG6), including 3 patient isolates and 2 environmental isolates, were cocultured with 2 strains of amoebae and Tetrahymena pyriformis. Plate counts, Gimenez staining and electron microscopy demonstrated that intracellular legionellae proliferation occurred.

Pseudoepidemic of aspergillosis after development of pulmonary infiltrates in a group of bone marrow transplant patients.

During February and March 1985, seven patients in the pediatric bone marrow transplant unit (PBMTU) of a 350-bed cancer hospital developed pulmonary infiltrates. Five of the patients had Aspergillus spp. isolated from the respiratory tract, and two of these patients had histologic evidence of aspergillosis. Between 26 February and 22 April, Aspergillus spp. were isolated in a total of 70 cultures from 39 hospitalized patients. Of the 70 cultures, 14 (group 1) were from respiratory specimens of PBMTU patients with pulmonary infiltrates and were submitted to the laboratory intermittently over the 56-day period. However, of the other 56 Aspergillus-positive cultures (group 2), 41 (73%) were submitted on six days during this period (P less than 0.001, chi-square goodness of fit), including 8 blood cultures submitted on one day. When Aspergillus sp. was recovered from group 1 cultures early during this period, the isolates were stored in the culture-processing room. Aspergillus isolates were not handled in a biological safety cabinet, and blood cultures were done by using a system which requires opening of an evacuated bottle to room air. The presence of stored Aspergillus isolates was associated with a markedly elevated concentration of airborne fungi in the culture-processing room. After removal of the stored Aspergillus isolates from the culture-processing room, the concentration of airborne fungi returned to background level and there were no further Aspergillus-positive cultures. These findings suggested that group 2 cultures had been contaminated by stored Aspergillus isolates. No evidence for a common source of infection was found in the PBMTU patients with pulmonary infiltrates.

[Haemophilus influenzae infections in infants and macrolides. Importance of the choice of an effective antibiotic and compliance with its administration schedule]. / Infections à Haemophilus influenzae du nourrisson et macrolides. Importance du choix d'un antibiotique efficace et du respect de son rythme d'administration.

Five cases of meningitis due to Haemophilus influenzae type b are reported. In four, the same pathogen was recovered from blood. In every case, meningitis developed despite administration of macrolides for ENT infections (4 cases) or pneumonia (1 case). These five observations are conclusive evidence that macrolides failed to prevent meningeal diffusion of Haemophilus influenzae presumptively responsible for the initial focal infection. In vitro activity of macrolides against Haemophilus influenzae is poor. For the treatment of ENT infections in pediatric patients aged 2 months to 5 years, the age group most susceptible to infection by Haemophilus influenzae, we recommend amoxicillin which is more active and bactericidal. An adequate dosage should be used (50 to 100 mg/kg/24 h) divided into four oral doses given at six hour intervals. This therapeutic attitude may need to be revised if the prevalence of beta-lactamase-producing H. influenzae strains (5 to 10% as of now) were to increase. In this case, use of an amoxicillin-clavulanic acid combination under the same conditions as outlined above may prove satisfactory. Correct administration of judiciously chosen antibiotics in ENT infections in infants and children is the most effective means of preventing meningitis due to H. influenzae.