La tuberculose est une maladie infectieuse le plus souvent liée au Mycobacterium tuberculosis. Elle est fréquente dans les pays en voie de développement et son incidence est en hausse dans les pays développés. L’atteinte pulmonaire est la plus fréquente mais d’autres structures thoraciques peuvent être touchées. La confrontation radioclinique reste la démarche diagnostique habituelle, mais sa confirmation ne peut être que bactériologique et/ou histologique. Le rôle de l’imagerie dans la prise en charge de la maladie est fondamental. Ses manifestations radiologiques varient en fonction de l’âge du patient, de son statut immunitaire et de ses antécédents de tuberculose. La radiographie standard reste l’examen de première intention malgré ses insuffisances. Elle permet d’évoquer le diagnostic sur l’aspect et le siège des lésions. La tomodensitométrie s’avère d’un grand intérêt pour le diagnostic positif en cas de discordance radioclinique grâce à une sémiologie bien codifiée. Elle est fondamentale pour le diagnostic des complications parenchymateuses, vasculaires, ganglionnaires, pleurales, pariétales ou médiastinales. Elle permet également de faire un bilan des séquelles. L’IRM et le PET-scanner ont des indications limitées. Nous nous proposons à travers cet article d’illustrer les différentes formes radiocliniques, les formes particulières et séquellaires de la tuberculose thoracique ainsi que ses complications en situant la place des différents moyens d’exploration par l’imagerie.Tuberculosis is an infectious disease mostly due to Mycobacterium tuberculosis. It is frequent in developing countries and its incidence is rising in developed countries. Lungs are the most involved organs of the chest but other structures can be affected. Imaging is fundamental in the management of the disease. Confirmation of diagnosis can be made only by bacteriologic and/or histologic exams. The first approach of diagnosis is based on clinical symptoms and chest X-ray signs. Radiologic signs depend on patient's age, his immune status and his previous contact with M. tuberculosis. Conventional chest X-ray remains the first-line exam to realize. It can suggest the diagnosis on the appearance and location of the lesions. CT scan is recommended for the positive diagnosis in case of discrepancy between clinical and radiographic signs, as for the diagnosis of parenchymal, vascular, lymph nodes, pleural, parietal or mediastinal complications. It is also essential for the evaluation of parenchyma sequelae. MRI and PET-scan have limited indications. The purpose of this article is to illustrate different radiological forms of chest tuberculosis, its sequelae and complications and to highlight the role of each imaging technique in the patient's management.

Les patients en insuffisance rénale chronique terminale sont particulièrement à risque de tuberculose, en particulier péritonéale. Le diagnostic microbiologique est difficile dans bon nombre de cas. Les analyses biochimiques, en particulier le dosage de l'activité de l'adénosine déaminase dans l'ascite peuvent aider au diagnostic.Nous rapportons le cas d'une tuberculose péritonéale chez un patient dialysé, chez qui le traitement a été instauré sur la base d'un dosage d'adénosine déaminase élevé dans le liquide péritonéal. L'évolution a été très favorable, avec un recul de trois ans.À notre connaissance, il existe très peu de données concernant l'utilité du dosage d'adénosine déaminase dans l'ascite chez le patient en insuffisance rénale chronique terminale. Notre observation plaide en faveur de l'utilité de ce dosage dans l'ascite, chez le patient dialysé, pour aider au diagnostic de tuberculose péritonéale.End-stage renal failure patients are particularly at risk for tuberculosis, especially for peritoneal tuberculosis. Microbiological diagnosis remains hazardous in many cases.We report on a case of peritoneal tuberculosis in an end-stage renal failure patient. The diagnosis was suspected on the basis of adenosine deaminase dosage in peritoneal fluid, allowing an early presumptive treatment and a favourable outcome with a 3 years follow-up.The measurement of adenosine deaminase activity in ascites represents a diagnostic advance in tuberculous peritonitis among end-stage renal failure patients.

Since human papillomavirus (HPV) is the central causal factor in cervical cancer, understanding the epidemiology of this infection constitutes an important step towards development of strategies for prevention. Six hundred and fifty seven cervical samples were tested for HPV using PCR with consensus primers (MY09/MY11), by geno-typing (restriction and sequencing analyses) and by cervical cytology, from women who attended a Health Examination Center of the French social security. Women with no cervical smear as well as women with cytological abnormalities within the last 3 years were recruited. HPV DNA was detected in 7.3% of the women (5.3% for high-risk, 2.4% for low-risk, and 0.5% for unknown risk types) including 6 (0.9%) mixed infections. Fifteen different genotypes were detected, of which genotypes 16 (22.2%), 58 (13.0%), 18 (11.1%), 30 (9.2%), and 33 (9.2%) were the most prevalent. In age group 17-25 years, we found the highest frequencies for both any (22.1%) and high-risk (14.7%) HPV, and prevalences gradually decreased with age. 5.2% of low-grade squamous intraepithelial lesion, 0.3% of high-grade squamous intraepithelial lesion, and 1.2% of atypical squamous cells of undetermined significance were found. The frequencies of high risk and all HPV types were significantly higher in squamous intraepithelial lesions than in those with normal and reactive/reparative changes (P < 0.0001). The prevalence of high-risk HPV in the atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion group (28.6%) was significantly higher than in the normal and reactive/reparative changes groups (3.4%) (P < 0.0001). HPV detection was associated with younger age, single marital and non-pregnant status (P < 0.0001), premenopausal status (P = 0.0004), and contraception (P = 0.0008). Marital status (OR 4.5; 95% CI = 2.3-9.0) and tobacco consumption (OR 3.0; 95% CI = 1.6-5.7) were predictive independent factors of HPV infection. The French system of Health Examination Centers might be of interest for following women regularly, especially those with a low socioeconomic status.

The effect on germination of soaking duration, moist-chilling time, and temperature was evaluated using five seed lots of Acer pensylvanicum L. Seeds were soaked for 0, 48, 72, or 96 h, then moist chilled at 4 °C for 16, 24, or 32 weeks. Two temperature regimes were used for germination: (i) 16 h dark at 5 °C : 8 h light at 15 °C (5:15 °C) and (ii) 16 h dark at 20 °C : 8 h light at 30 °C (20:30 °C). Soaking and chilling seeds significantly increased germination. Germination was highest at 5:15 °C, but the germination speed was slow. Germination at 20:30 °C was lower, but 94%–98% of ungerminated seeds appeared to be viable, suggesting that they were dormant. Overall results showed that soaking seeds for 48 h, moist chilling for 16 weeks, and germinating at 5:15 °C produced an average germination of 92%.

Rotavirus and respiratory syncytial virus (RSV) infections represent up to 30% of the totality of nosocomial infections in paediatric wards. We studied the importance of these infections in the paediatric wards of the University Hospital Center of Poitiers, France, from October 1996 to September 1998. We defined as nosocomial an infection acquired after 3 days of hospitalization for rotavirus and after 7 days for RSV. The 274 cases of children presenting rotavirus gastroenteritis or RSV infection within this period were studied. Rotavirus was detected in stools by using an agglutination test and RSV was diagnosed in nasopharyngeal aspirations by direct examination with an immunofluorescence assay (IFA), cell culture and serotyping with IFA. We noted 50 rotavirus and 224 RSV infections, with a first epidemic of RSV subgroup B (49.5%) and a second epidemic of subgroup A (44.9%). 19 (38%) were rotavirus nosocomial infections and 5 (2.2%) were RSV nosocomial infections. The majority of the nosocomial infections occurred before the age of one year and particularly before the age of 6 months (42.2% for rotavirus, 60% for RSV). In comparison to community-acquired infections, children with rotavirus nosocomial infections were younger (9 months versus 12.5 months) which was the opposite for RSV nosocomial infections (10.8 months versus 6.5 months). The sex-ratio of children with community-acquired infections was 2.1 that was not reported in nosocomial infections. The length of stay in hospital was always longer in nosocomial infections (11.7 days versus 3.6 days for rotavirus; 38.8 days versus 4.8 days for RSV). Diarrhea (p = 0.007) and vomiting (p = 0.013) for enteric infections and wheezing (p = 0.02) for respiratory infections were more often observed in community-acquired infections. This study emphasizes the frequency and the consequences of rotavirus and RSV nosocomial infections in paediatric wards and the importance of the hygienic rules to prevent these infections.

Rotavirus and respiratory syncytial virus (RSV) infections represent up to 30% of the totality of nosocomial infections in paediatric wards. We studied the importance of these infections in the paediatric wards of the University Hospital Center of Poitiers, France, from October 1996 to September 1998. We defined as nosocomial an infection acquired after 3 days of hospitalization for rotavirus and after 7 days for RSV. The 274 cases of children presenting rotavirus gastroenteritis or RSV infection within this period were studied. Rotavirus was detected in stools by using an agglutination test and RSV was diagnosed in nasopharyngeal aspirations by direct examination with an immunofluorescence assay (IFA), cell culture and serotyping with IFA. We noted 50 rotavirus and 224 RSV infections, with a first epidemic of RSV subgroup B (49.5%) and a second epidemic of subgroup A ( 44.9%). 19 (38%) were rotavirus nosocomial infections and 5 (2.2%) were RSV nosocomial infections. The majority of the nosocomial infections occurred before the age of one year and particularly before the age of 4 months (42.2% for rotavirus, 60% for RSV). In comparison to community-acquired infections, children with rotavirus nosocomial infections were younger (9 months versus 12.5 months) which was the opposite for RSV nosocomial infections (10.8 months versus 6.5 months). The sex-ratio of children with community acquired infections was 2.1 that was not reported in nosocomial infections. The length of stay in hospital was always longer in nosocomial infections (11.7 days versus 3.6 days for rotavirus, 38.8 days versus 4.8 days for RSV, Diarrhea (p = 0.007) and vomiting (p = 0.013) for enteric infections and wheezing (p = 0.02) for respiratory infections were more often observed in community-acquired infections. This study emphasizes the frequency and the consequences of rotavirus and RSV nosocomial infections in paediatric wards and the importance of the hygienic rules to prevent these infections.

Rotavirus and respiratory syncytial virus (RSV) infections represent up to 30% of the totality of nosocomial infections in paediatric wards. We studied the importance of these infections in the paediatric wards of the University Hospital Center of Poitiers, France, from October 1996 to September 1998. We defined as nosocomial an infection acquired after 3 days of hospitalization for rotavirus and after 7 days for RSV. The 274 cases of children presenting rotavirus gastroenteritis or RSV infection within this period were studied. Rotavirus was detected in stools by using an agglutination test and RSV was diagnosed in nasopharyngeal aspirations by direct examination with an immunofluorescence assay (IFA), cell culture and serotyping with IFA. We noted 50 rotavirus and 224 RSV infections, with a first epidemic of RSV subgroup B (49.5%) and a second epidemic of subgroup A (44.9%). 19 (38%) were rotavirus nosocomial infections and 5 (2.2%) were RSV nosocomial infections. The majority of the nosocomial infections occurred before the age of one year and particularly before the age of 6 months (42.2% for rotavirus, 60% for RSV). In comparison to community-acquired infections, children with rotavirus nosocomial infections were younger (9 months versus 12.5 months) which was the opposite for RSV nosocomial infections (10.8 months versus 6.5 months). The sex-ratio of children with community-acquired infections was 2.1 that was not reported in nosocomial infections. The length of stay in hospital was always longer in nosocomial infections (11.7 days versus 3.6 days for rotavirus; 38.8 days versus 4.8 days for RSV). Diarrhea (p = 0.007) and vomiting (p = 0.013) for enteric infections and wheezing (p = 0.02) for respiratory infections were more often observed in community-acquired infections. This study emphasizes the frequency and the consequences of rotavirus and RSV nosocomial infections in paediatric wards and the importance of the hygienic rules to prevent these infections.

Human T-cell lymphotropic virus type I (HTLV-I) is associated with adult T-cell leukemia (ATL) and tropical spastic paraparesis/HTLV-I-associated myelopathy (TSP/HAM). Other inflammatory disorders may occur in HTLV-I-infected patients, such as sicca syndrome resembling Sjogren's syndrome. The sicca syndrome may be the unique clinical manifestation of HTLV-I infection, but is associated frequently with TSP/HAM, which could suggest that sicca syndrome might be an early event in disease progression to TSP/HAM in some cases. We investigated whether peculiar pX and LTR mutations could be related to sicca syndrome, or might argue the existence of clinical progression to TSP/HAM. pX, especially pX(I), pX(II), and pX(IV) ORFs corresponding to Tax cytotoxic T-lymphocyte epitopes, and LTR regions from Caribbean patients who have sicca syndrome with or without TSP/HAM, ATL patients, and healthy carriers were sequenced. The sequences were aligned and compared with ATK-1 prototype and published sequences. LTR sequences exhibited 1.5-2.4% of divergence with ATK-1. pX-sequenced regions showed a lower homology within p12(I) encoding sequences. Only few mutations were found within functionally important regions, but were not associated specifically with the clinical status. Finally, no mutations that could be related to sicca syndrome or argue the existence of clinical progression to TSP/HAM were found. It would be of interest to study the clinical evolution of HTLV-l-sicca syndrome in patients and to determine HTLV-I sequences from peripheral blood and salivary glands at different stages. (C) 1999 Wiley-Liss, Inc.

Herpes simplex virus type 2 (HSV-2) is more often sexually transmitted and associated with genital recurrent infection, However HSV-2 neurological manifestations such as meningitis were already reported, We describe a case of meningitis due to HSV-2, preceded by signs suggesting a common cystitis, in a woman with no history of primary or recurrent genital infection, Six months later genital herpetic lesions occurred. One HSV-2 strain was obtained from cerebrospinal fluid (CSF) and another from genital lesions, The molecular comparative analysis using restriction endonuclease digestion patterns showed the similarity of the two strains, Our report illustrates that HSV-2 infections are underdiagnosed and that molecular techniques can be of value in clarifying the physiopathology off HSV diseases.

RH have a limited pathogenicity but can be associated with serious illnesses among infants and children.

Herpes simplex virus type 2 (HSV-2) is more often sexually transmitted and associated with genital recurrent infection. However, HSV-2 neurological manifestations such as meningitis were already reported. We describe a case of meningitis due to HSV-2, preceded by signs suggesting a common cystitis, in a woman with no history of primary or recurrent genital infection. Six months later genital herpetic lesions occurred. One HSV-2 strain was obtained from cerebrospinal fluid (CSF) and another from genital lesions. The molecular comparative analysis using restriction endonuclease digestion patterns showed the similarity of the two strains. Our report illustrates that HSV-2 infections are underdiagnosed and that molecular techniques can be of value in clarifying the physiopathology of HSV diseases.

Les rhinovirus sont responsables d'infections respiratoires aiguës atteignant principalement le tractus respiratoire supérieur.

The aim of this study is to compare an ELISA (SeroELISA(R), Chlamydia, BMD/SAVYON(R) Diagnostics) with the micro-immunofluorescence (MIF) reference test, for IgG, and IgA anti-Chlamydia trachomatis titration. A group of 50 patients hospitalized or consulting at the University Hospital Center of Poitiers, France for genital tract infection or sterility, and 30 asymptomatic controls. Seroprevalence of C. trachomatis infection were evaluated. Satisfactory correlation (r = 0.61 for IgG, r = 0.71 for IgA) and sensitivity (94.3 % for IgG, 100 % for IgA) were found between the two techniques. A lack in sensitivity of the :MIF test might explain the poor specificity (80 %) and positive predictive value (52 %) observed for the detection of ELISA-IgA. C. trachomatis seroprevalence obtained by ELISA-IgG (77.1 %) and those obtained by MIF (70.8 %) vl ere quite close, whereas for IgA, the rates varied from 28.3 % by MIF to 58.7 % by ELISA, Among females, MIF-IgG greater than or equal to 256 or MIF-IgA greater than or equal to 10 were correlated with Chlamydia detection in the genital tract (p = 0.039), Whereas no relationship could be noticed between the seroprevalence of MIF-IgG greater than or equal to 256 or MIF-IgA greater than or equal to 10, and upper or lower genital tract infection. Our results emphasize the high sensitivity of ELISA especially for anti-C. trachomatis IgA detection. Nevertheless, additional testing is required to assess the specificity of this marker among Chlamydia genus.

The authors report a case of hemorrhagic dengue fever in France, a reminder that travellers to tropical areas are at major risk for this disease. The 4 dengue viruses have spread to nearly all tropical countries. Clinical manifestations range from asymptomatic to fatal forms. Among these, hemorrhagic dengue fever and dengue shock syndrome require emergency treatment. Physicians should keep in mind that dengue is to be considered as a diagnosis for acutely pyretic patients having travellers to tropical countries.

SETTING:Nine French laboratories routinely involved in mycobacterial work.OBJECTIVE:To assess the detection of Mycobacterium tuberculosis in experimental samples by polymerase chain reaction (PCR) using the insertion sequence IS6110 as a target for deoxyribonucleic acid (DNA) amplification.DESIGN:Nine laboratories participated in a blind study of the detection of M. tuberculosis by PCR in 20 coded samples containing either a definite number of M. tuberculosis complex (positive samples) or environmental mycobacteria (four samples) or no mycobacteria (five samples).RESULTS:Five laboratories reported false-positive PCR results, with an average rate of 7%. All laboratories except one reported positive PCR results for samples containing 10(5) cfu/ml or more. M. tuberculosis DNA was detected in two thirds of samples containing 10(4) and 10(3) cfu/ml, and in one third of the samples containing 10(2) cfu/ml.CONCLUSION:The results of the study suggest that PCR using IS6110 as a target for DNA amplication is neither very sensitive nor really specific for the detection of M. tuberculosis.

The radiometric BACTEC 460-TB methodology has filled an increased need in the screening of a wide range of antimicrobial agents against Mycobacterium avium (MAC) isolates on a patient-to-patient basis. In this context, a multicenter study involving eight test sites across France was performed to determine the MICs of 10 antimicrobial agents for MAC organisms. The aim of the investigation was to compare the in vitro activities of D-cycloserine, ethambutol, ethionamide, rifampin, amikacin, streptomycin, ciprofloxacin, sparfloxacin, clofazimine, and clarithromycin against MAC isolates. All of the test sites received the same clinical isolates of MAC, and the MICs were determined by a common protocol. The overall interlaboratory reproducibility of the MICs within +/- 1 dilution of the modal MICs varied from 79.70 to 100% (mean, 95.2% +/- 2.1%), whereas overall agreement of the MICs among the test sites varied from a mean of 91% +/- 4.1% to a mean of 98 +/- 1.3%. We confirmed that the proposed methodology is easy, accurate, and sufficiently reproducible to be used routinely in a clinical laboratory. Despite variations in the MICs of the same drug among strains, no link between the origin of MAC isolates (from human immunodeficiency virus-positive or -negative patients) and their drug susceptibilities was established. On the basis of the MICs that inhibited 50 and 90% of isolates tested for the drugs used, clarithromycin, clofazimine, ethambutol, and streptomycin were the most uniformly active against MAC; this was followed by amikacin, rifampin, and sparfloxacin. On the other hand, ciprofloxacin, D-cycloserine, and ethionamide showed only marginal in vitro activities.

L'identification classique des mycobactéries est habituellement basée sur l'étude des caractères culturaux, des caractères biochimiques et de la sensibilité aux agents anti-bactériens. Le délai de croissance, la température optimale de croissance, les aspects macroscopique et microscopique orientent le diagnostic vers le groupe des mycobactéries de la tuberculose ou vers celui des mycobactéries “atypiques”. Après réalisation de subcultures, l'étude des propriétés biochimiques, éventuellement complétée par celle de la sensibilité aux anti-bactériens conduit à l'identification de l'espèce. L'obtention d'un tel résultat requiert en général plusieurs semaines.