A 58-year-old man presented with retrosternal pain 30 months after a surgical operation for reflux esophagitis in relation to Barrett's esophagus. Gastroscopy revealed an ulcer of the inferior part of the esophagus, which on biopsy proved to be an adenocarcinoma. Additional surgery was performed through the abdomen and through the thorax via the sixth intercostal space. Resection of the lower part of the esophagus and high anastomosis were performed because of nondilatable peptic stenosis. Two chest tubes were put in place: one draining the right pleura and the other in contact with the anastomosis. On the second postoperative day, a sepsis-like syndrome including bronchospasm developed with increasing ventilation requirements. A chest radiograph revealed no abnormalities, and a perfusion computed tomography (CT) scan did not show pulmonary thromboembolism. Amoxicillin-clavulanic acid and gentamicin were given for 8 days despite various bacteriological analyses that were all sterile, including 10 blood samples, 3 pleural fluid samples, 1 bronchoalveolar lavage, 1 bronchial aspiration, and 1 urine sample. The patient improved partially, and the pleural tube was removed. On the 13th postoperative day, the patient was still ventilator dependent. Fever recurred, and biological investigations showed a leukocyte count of 11,700/mm 3 and a C-reactive protein level of 128 mg/liter. A chest CT scan revealed a small collection of 1 cm in diameter in contact with the posterior part of the anastomosis and a new infiltrate of the left lung parenchyma located in the apical segment of the lower lobe. Analysis of the fluids from both bronchoalveolar lavage and chest tube showed a large number of neutrophils and numerous flagellated, motile organisms with the typical appearance of trichomonads, visible on wet preparations and Giemsa staining. Culture of bronchoalveolar fluid yielded Neisseria lactamica, while culture of tube fluid yielded alpha-and beta-hemolytic streptococci and Haemophilus parainfluenzae. Treatment with metronidazole, piperacillintazobactam, and gentamicin was started. Trichomonads were not found in the drained fluid, and a chest CT scan showed the resolution of the collection and no change in pulmonary parenchyma 3 and 5 days after the initiation of metronidazole therapy, respectively. The CT scan failed to show passage of contrast material from the esophageal suture line into the mediastinum. Antibiotics, including metronidazole, were continued for 10 days, and the tube was removed later. However, the patient had remained ventilator dependent since the operation. Ischemic brain damage of unknown origin was revealed by cerebral magnetic resonance imaging, and the patient remained in a deep coma for 1 week and then died.In order to identify the species of Trichomonas, we amplified directly from the bronchoalveolar fluid and sequenced the 5.8S rRNA gene and the internal transcribed spacer flanking regions (ITS1 and ITS2) with the forward and reverse primers TRICHO-F and TRICHO-R (5Ј-CGGTAGGTGAACCTGC CGTT-3Ј and...

Two cases of invasive aspergillosis (IA) in immunocompetent patients with a fulminant fatal outcome are reported. Both patients were elderly and had a history of chronic lung disease treated with prolonged inhaled corticosteroids and a short course of systemic corticosteroids. They presented with dyspnea and fever, their respiratory function deteriorated rapidly, and they died 7 days after admission. Aspergillus fumigatus was cultured from respiratory samples. IA was confirmed in one case by necropsy that showed diffuse bilateral necrotizing pneumonitis and myocarditis. In the other case, IA diagnosis was established by thoracic CT scan plus detection of Aspergillus antigen in two blood samples. These two cases demonstrate that short-term corticosteroid therapy in immunocompetent patients with underlying chronic lung conditions is a risk factor for IA, and that its evolution can be fulminant.

RÉSUMÉ Entre le premier décembre 2007 et la fin mai 2008, nous avons analysé 120 prélèvements nasopharyngés effectués chez 120 enfants âgés de 15 jours à 6 ans, hospitalisés dans deux hôpitaux au Nord du Liban pour la recherche d'une infection par le virus respiratoire syncytial (VRS). Sur les 120 prélèvements, 32 étaient positifs pour le VRS (26,7 %). Il y avait un pic en janvier qui disparaissait progressivement de février à mai. La positivité au VRS était significativement associée à la présence de rhinorrhée et de dyspnée comme symptômes cliniques et à l'absence de signes de pneumonie à la radiographie thoracique aussi bien qu'au diagnostic de bronchites ou de bronchiolites. La recherche de VRS lors des infections respiratoires chez l'enfant est importante car elle pourrait limiter des prescriptions inutiles d'antibiotique.

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