Vertebral osteomyelitis (VO) is a rare event. To estimate the incidence of VO in France for 2002-2003, national hospital-discharge data were used. Hospital stays were categorized as definite, probable or possible VO. Unique patient identification numbers allowed the investigators to link patients with multiple hospital stays and to analyse data for individual patients. A sample of medical records was reviewed to assess the specificity of the VO case definition. In 2002-2003, 1977 and 2036 hospital stays corresponding to 1422 and 1425 patients (median age 59 years, male:female ratio 1.5) were classified as definite (64%), probable (24%) and possible (12%) VO. The overall incidence of VO was 2.4/100,000. Incidence increased with age: 0.3/100,000 (70 years). The main infectious agents reported were Staphylococcus spp. (38%) and Mycobacterium tuberculosis (31%). The most frequent comorbidities were septicaemia (27%) and endocarditis (9%). Three percent of patients died. A review of 90 medical records confirmed the diagnosis of VO in 94% of cases. Using a hospital database and a specific case definition, nationwide surveillance of VO is possible.

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We report the first documented case of endocarditis in a man infected with Bartonella alsatica, which causes bacteremia in healthy wild rabbits. B. alsatica was identified by serology and culture and by PCR of an aortic valve specimen. B. alsatica should be added to the list of zoonotic agents of blood culture-negative endocarditis.

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Human-to-human transmission of Mycobacterium bovis in two immunocompetent patients from the same family was confirmed by spoligotyping (pattern F35, which was only observed in cattle from the same area in France). A single allelic difference between animal and human isolates was observed with mycobacterial interspersed repetitive units containing variable-number tandem repeats, suggesting a jump across the species barrier.CASE REPORTS Case 1. In April 2004, a 50-year-old man, born in France, was admitted to the Respiratory Disease Department of the Limoges Hospital for pulmonary tuberculosis. Since 1987, he had been working in a slaughterhouse and handled offal. Clinical manifestations were cough and asthenia. The chest radiograph showed a cavitation of the left upper lobe. The tuberculin skin test (TST) reaction was considered positive. Gastric aspirations were positive for acid-fast bacilli (AFB), and cultures were secondarily positive for M. bovis. M. bovis was identified by phenotyping methods, and identification was then confirmed by molecular analysis (9). The human immunodeficiency virus (HIV) antibody test was negative. Therapy consisted of an association of isoniazid (INH), rifampin (RMP), and ethambutol (EMB). Sample cultures became negative after 1 month of treatment. EMB was discontinued after 3 months; INH and RMP were continued for a total duration of 12 months. Contact tracing was performed. Only his daughter had a positive TST, but she refused any prophylactic treatment.Case 2. In May 2007, the daughter of case 1, a 20-year-old woman, born in France, was admitted to the Tours Hospital for suspicion of pulmonary tuberculosis. She had had productive cough with night sweats, thoracic pain, and asthenia for 1 month before hospitalization. The chest radiograph showed a cavitation of the left upper lobe with mediastinal adenopathy confirmed by computed tomography. Two sputum specimens and one gastric aspiration were positive for AFB. Cultures grew M. bovis. The HIV antibody test was negative. Therapy was initiated with an association of INH, RMP, and EMB and continued for 3 months. Sputum smears and culture were negative after 1 month of treatment. EMB was discontinued after 3 months of treatment, and INH and RMP were continued for a total duration of 9 months. Contact tracing was conducted and identified one contact, the patient's grandmother, whose TST reaction was positive at 20 mm. Thus, she received a regimen of INH and RMP for 3 months to treat her latent tuberculosis infection.Case 1 worked in the Limoges slaughterhouse from 1987 to 2004 and was certainly occupationally exposed during this period. On the other hand, case 2 was born after hygienic measures were applied and she had never traveled to countries where they were not applied. Moreover, she had no contact with cattle herds. Therefore, it is most likely that she was infected by her father.We compared the M. bovis strains from cases 1 and 2 using spoligotyping and mycobacterial interspersed repetitive units containing variable-number tand...

Intravenous ZDV remains an effective tool to reduce transmission in cases of virological failure, even in cART-treated women. However, for the vast majority of women with low viral loads at delivery, in the absence of obstetrical risk factors, systematic intravenous ZDV appears to be unnecessary.

Predictors of virologic (plasma HIV RNA viral load [VL] < 500 copies/ml) and immunologic (rise in CD4+ cell count > 50 cells/mm3) response after 4 months of therapy (M4) were studied in 750 HIV-1-infected patients prospectively enrolled at the initiation of a protease inhibitor (PI)-containing regimen. A virologic response was observed in 80% of patients, and an immunologic response was observed in 64%. Sixty-two percent of patients self-reported full adherence to therapy at 1 month of therapy (M1) and M4. In multivariate analysis, a virologic response was more frequent in fully adherent patients (odds ratio [OR] = 2.0; p =.001). An immunologic response was associated with age < 36 years (OR =1.4; p =.03), baseline VL (OR = 1.5 per 1 log10 copies/ml higher; p <.01), decrease in VL at M1 (OR = 1.5 per 1 log10 copies/ml decrease; p <.01), baseline total lymphocyte count (OR = 1.7 per 50% lower; p <.001), and baseline CD4+ cell percentage > or = 20% (OR =1.9; p <.001) but not with adherence to therapy. Full adherence seems to be a major predictor of a virologic response to PI-containing triple therapy. An immunologic response may be possible despite incomplete adherence, at least early in therapy.

Coagulase-negative staphylococci (CoNS) have evolved into important agents of foreign body-related infections. Adhesion of causative bacteria to biomaterials is considered to be an essential step in these infections. We and others have shown that adhesion of CoNS to biomaterials may be mediated by protease-sensitive surface constituents. In the present study we expanded on these investigations by characterizing a biomaterial adhesin of Staphylococcus epidermidis 354 by using a strain-specific monoclonal antibody (MAb 36.4). MAb 36.4 was strongly and exclusively reactive with strain 354 in an enzyme-linked immunosorbent assay in which whole bacteria were used as antigens. Immunoblotting of cell wall polypeptides of strain 354 revealed strong reactivity with a 200- to 220-kDa band and a weaker reaction in the 100- to 110-kDa range. Preincubation of strain 354 with MAb 36.4 resulted in a 54 to 91% (mean +/- standard deviation, 74% +/- 14%; n = 10) inhibition of adhesion to polystyrene spheres. Fab fragments prepared from MAb 36.4 also inhibited adhesion effectively, indicating specific blocking of an adhesion antigen rather than aspecific inhibition. Immunogold electron microscopy with MAb 36.4 revealed deposition of gold particles on the cell surface and possibly also on fimbrialike surface projections. It is concluded that a surface-located protein antigen of S. epidermidis 354 recognized by MAb 36.4 acts as an adhesin mediating attachment to uncoated foreign material. It is speculated that this type of adhesion to biomaterials may play an important role in the pathogenesis of foreign body-related infections caused by CoNS.