Reactivation of Plasmodium infection during a treatment with infliximab: A case report.

We describe a symptomatic Plasmodium falciparum infection in a 29-year-old Guinean man receiving Infliximab for one year and without recent travel. The reactivation of submicroscopic malaria following the inhibition of TNF-alpha by infliximab is suspected.

Epidemiology and outcome of invasive pneumococcal disease among adults in Belgium, 2009-2011.

This epidemiological study examined morbidity and case fatality of invasive pneumococcal disease (IPD) in adults in Belgium as well as distribution and antibiotic susceptibility of Streptococcus pneumoniae serotypes.Adults hospitalised with microbiologically proven IPD were prospectively enrolled. The study started in 2009 with patients aged ≥50 years, whereas in 2010 and 2011, patients aged ≥18 years were included. The clinical presentation, patient profile, treatment, outcome, and mortality were recorded during hospitalisation.Outcome was also assessed one month afterdischarge. Of the 1,875 patients with IPD identified, 1,332 were included in the analysis. Bacteraemic pneumonia, affecting 1,049 of the patients, was the most frequent IPD type (79%), and chronic obstructive pulmonary disease and cancer were the main comorbidities.One-third of patients required admission to intensive care unit. A total of 208 (16%) patients died during hospitalisation and an additional 21 (2%) within one month after discharge. Case fatality rates of ≥20%were observed in patients with chronic heart failure, hepatic disease, and renal insufficiency. Serotypes 7F, 1, 19A, and 3 were the most prevalent and together accounted for 47% (569/1,214) of all IPD cases and 42% (80/189) of mortality. Of the patient isolates, 21% (255/1,204) were resistant to erythromycin and 22% (264/1,204) to tetracycline. Penicillin non-susceptibility was mostly found in serotype 19A isolates. These baseline data are essential when assessing the impact of pneumococcal conjugate vaccination in adults in the future.

A rare case of hematemesis following gastro-duodenal strongyloides infection.

We report the case of a 30-year old Black African man with a two-year history of nausea, abdominal discomfort and pruritus due to infection with Strongyloides stercoralis, which was successfully treated, but then complicated by the development of a bleeding pseudo-tumor in the duodenum. A review of the literature was performed.

Clinical use of the meropenem-clavulanate combination for extensively drug-resistant tuberculosis.

Mycobacterium tuberculosis strains resistant to almost all available anti-tuberculosis drugs are an increasing threat to public health worldwide. Among existing drugs with potential antimycobacterial effects, the combination of meropenem with clavulanate has been shown to have potent in vitro bactericidal activity against extensively drug-resistant tuberculosis (XDR-TB). To explore its potential clinical efficacy, a meropenem-clavulanate-containing salvage regimen was started in six patients with severe pulmonary XDR-TB, in association with the only one or two remaining active second-line drugs. Encouraging preliminary data are detailed and discussed.

[Meningitis and renal cancer]. / Méningite et néoplasie rénale.

A 51 year-old man with a renal cancer (pT3N0M0) consulted at the emergency department for persistent headache initiated a week before and recent vomiting. Physical examination and blood analyses were not remarkable. Cerebral magnetic resonance imaging demonstrated radiological signs of meningitis. The differential diagnosis of meningitis is discussed.

Multidrug-resistant tuberculosis: a review of the 23 cases treated by the Saint-Pierre University Hospital (Brussels).

For about fifteen years, Belgium, as other developed countries, has been confronted with multidrug-resistant tuberculosis (MDR-TB). The treatment of MDR-TB is complex, associating several antibiotics and causing multiple adverse effects. The aim of this study is to report our experience with MDR-TB at the Saint-Pierre University Hospital in Brussels.

Pseudomonas aeruginosa: resistance and therapeutic options at the turn of the new millennium.

Pseudomonas aeruginosa is a major cause of nosocomial infections. This organism shows a remarkable capacity to resist antibiotics, either intrinsically (because of constitutive expression of beta-lactamases and efflux pumps, combined with low permeability of the outer-membrane) or following acquisition of resistance genes (e.g., genes for beta-lactamases, or enzymes inactivating aminoglycosides or modifying their target), over-expression of efflux pumps, decreased expression of porins, or mutations in quinolone targets. Worryingly, these mechanisms are often present simultaneously, thereby conferring multiresistant phenotypes. Susceptibility testing is therefore crucial in clinical practice. Empirical treatment usually involves combination therapy, selected on the basis of known local epidemiology (usually a beta-lactam plus an aminoglycoside or a fluoroquinolone). However, therapy should be simplified as soon as possible, based on susceptibility data and the patient's clinical evolution. Alternative drugs (e.g., colistin) have proven useful against multiresistant strains, but innovative therapeutic options for the future remain scarce, while attempts to develop vaccines have been unsuccessful to date. Among broad-spectrum antibiotics in development, ceftobiprole, sitafloxacin and doripenem show interesting in-vitro activity, although the first two molecules have been evaluated in clinics only against Gram-positive organisms. Doripenem has received a fast track designation from the US Food and Drug Administration for the treatment of nosocomial pneumonia. Pump inhibitors are undergoing phase I trials in cystic fibrosis patients. Therefore, selecting appropriate antibiotics and optimising their use on the basis of pharmacodynamic concepts currently remains the best way of coping with pseudomonal infections.

Recommendations for the use of the 23-valent polysaccharide pneumococcal vaccine in adults: a Belgian consensus report.

A multidisciplinary expert panel, appointed by the High Council for Public Health, evaluated the scientific evidence on which the recommendations for the appropriate use of the pneumococcal vaccine was based and reviewed the studies that became available since previous reports. The conclusions of the working group, presented in this manuscript, resulted in an update of the Belgian recommendations for pneumococcal vaccination.

[Pertussis vaccine in adolescents and adults]. / La vaccination de l'adolescent et de l'adulte contre la coqueluche.

Despite high immunisation rates in infancy, Bordetella pertussis is still circulating in industrialised countries, causing severe infections in infants too young to be vaccinated, as well as an important number of long lasting cough episodes in older children, adolescents and young adults. The limited duration of the protection resulting from vaccination in the 2 first years of life is probably responsible for the insufficient control of the disease. The development of acellular pertussis vaccines has allowed immunisation of school age children, and an adult formulation is now available. The indications of this vaccine will be discussed.

[Vaccination of general practitioners]. / La vaccination des médecins généralistes.

The vaccination of general practitioners represents significant problems for two reasons: they can be a reservoir of infectious diseases for the patients they are in contact with and their attitudes towards vaccination can influence their preventative acts and consequently the vaccination coverage of the population. The anti-influenza vaccination of the care providers is associated with a decrease of mortality amongst patients. Hepatitis B is one of the most frequent professional occupational infectious diseases and vaccination is necessary for all the professionals at risk. Concerning the whooping-cough we can observe at the present time an increase in the number of cases. The "Conseil Supérieur d'Hygiène" advises to propose vaccination of the people in contact with infants and people who have not HAD vaccination supplements in childhood. The rubella vaccination for unprotected women is also recommended for the care providers, to avoid the risk of infection and the possible implications for the foetus. The existing data in Belgium on the vaccination coverage of general practitioners is poor, but leads us to believe there is an insufficient vaccination coverage against these diseases. A study will shortly be undertaken to analyze the vaccination status of the Belgian French-speaking doctors and to further analyse their reasoning for any possible non-vaccination.

[Linezolid (Zyvoxid)]. / Le linézolide (Zyvoxid).

Linezolid is a novel antibiotic administrable by the intravenous as well as the oral route. It is aimed by its re-imbursement conditions at treating proven beta-lactam- or glycopeptide-resistant staphylococcal and enterococcal infections in the hospital and post-discharge outpatient. It has various indications: pulmonary infections, complicated skin and soft tissue infections, infections in the febrile neutropenic patient, urinary tract infections, intra-abdominal infections, chronic osteitis. Bacteriologic documentation of the infection is required to avoid overconsumption and development of resistance. The oral forms exhibit complete bio-availability. Caution is recommended with regard to linezolid's MAO inhibitory effect and the risk of thrombocytopenia requiring weekly hematologic monitoring.

[Telithromycin, first ketolide]. / La télithromycine, premier kétolide.

Telithromycine is the first ketolide on the market. Its characteristics are the two sites fixation on the bacterial ribosomia and and as a consequence a good activity on the majority of penicillin and macrolides resistant bacteria, included S. pneumonia and S. pyogenes. Telithromycine represents an alternative to beta-lactames and moxifloxacine to treat communautary pneumonia, bacterial pharyngoamygdalitis, suppurative sinusitis and bronchitis. There are nevertheless problems with drugs interactions and risk of resistance development.

[Vaccinations for the traveller]. / Les vaccinations du voyageur.

Long distance journeys are more and more frequent. Beside malaria prophylaxis, the general practitioner shall consider several points. Vaccinations against tetanus, diphtheria and (for a few years at least) polio should be done every ten years. Hepatitis A vaccine shall often be done (with > 20 years protection) but typhoid fever vaccine shall be limited to adventurous and/or long stays. Yellow fever vaccine (10 years validity) is only administrated in specialised centers; this is the only mandatory vaccine for certain african or south american countries. In certain instances, one shall consider vaccination against hepatitis B, meningococcal meningitis or, less often, against rabies, central european or japanese encephalitis. The vaccine against cholera (numerous side effects and poor efficacy) is no more available.

[Vaccinations for the traveler]. / Les vaccinations du voyageur.

Long distance journeys are more and more frequent. Beside malaria prophylaxis, the general practitioner shall consider several points. Vaccinations against tetanus, diphtheria and (for a few years at least) polio should be done every ten years. Hepatitis A vaccine shall often be done (with > 20 years protection) but typhoid fever vaccine shall be limited to advanturous and/or long stays. Yellow fever vaccine (10 years validity) is only administrated in specialised centers; this is the only mandatory vaccine for certain african or south american countries. In certains instances, one shall consider vaccination against hepatitis B, meningococcal meningitis or, less often, against rabies, central european or japanese encephalitis. The vaccine against cholera (numerous side effects and poor efficacy) is no more available.