We report a multidrug-resistant Neisseria gonorrhoeae urogenital and pharyngeal infection with ceftriaxone resistance and intermediate resistance to azithromycin in a heterosexual woman in her 20s in France. Treatment with ceftriaxone plus doxycycline failed for the pharyngeal localisation. Whole-genome sequencing of isolate F90 identified MLST1903, NG-MAST ST3435, NG-STAR233, and relevant resistance determinants. F90 showed phenotypic and genotypic similarities to an internationally spreading multidrug-resistant and ceftriaxone-resistant clone detected in Japan and subsequently in Australia, Canada and Denmark.

BackgroundThe microbiological diagnosis of bone and joint infections (BJI) currently relies on cultures, and the relevance of molecular methods is still debated. The aim of this study was to determine whether polymerase chain reaction (PCR) could improve the etiological diagnosis of BJI.MethodsA prospective study was conducted during a 4-year period at Lariboisiere University Hospital (Paris, France), including patients with suspicion of infectious spondylodiscitis, septic arthritis, prosthetic joint infections, and respective noninfected groups. Clinical and radiological data were collected at inclusion and during follow-up. All samples were analyzed by conventional cultures and 16S ribosomal deoxyribonucleic acid (rDNA) gene (16S-PCR). Specific cultures and PCR targeting Mycobacterium tuberculosis were also performed for spondylodiscitis samples. Case records were subsequently analyzed by an independent expert committee to confirm or invalidate the suspicion of infection and definitively classify the patients in a case or control group. The sensitivity of the combination of culture and PCR was compared with culture alone.ResultsAfter expert committee analysis, 105 cases of BJI cases and 111 control patients were analyzed. The most common pathogens of BJI were staphylococci (30%), M tuberculosis (19%), and streptococci (14%). Adding PCR enhanced the sensitivity compared with culture alone (1) for the diagnosis of M tuberculosis spondylodiscitis (64.4% vs 42.2%; P < .01) and (2) for nonstaphylococci BJI (81.6% vs 71.3%; P < .01). It is interesting to note that 16S-PCR could detect BJI due to uncommon bacteria such as Mycoplasma and fastidious bacteria.ConclusionsOur study showed the benefit of 16S-PCR and PCR targeting M tuberculosis as add-on tests in cases of suspected BJI.

Observation:Discussion:SIADH is characterized by a hypovolemic hyponatraemia, and must be evoked if the following criteria are present : plasmatic osmolarity <280 mOsm/kg or natraemia<134 mmol/L, urinary osmolality>100 mOsm/kg, clinical normal volemia, sodium urine concentration>40 mmol/L with normal fluid and sodium intake, exclusion of hypothyroidism, adrenal insufficency or diuretics intake. Additional criteria are low uricemia, low uremia, and normal creatinine, potassium and alkali reserve (1). In the face of a SIADH, the clinician can use few therapeutic strategies. Aetiological treatment and fluid limitation constitute the first line treatment. However, there are some situations where fluid limitation is not effective, and a pharmacological agent has to be introduced.A 78 year-old woman was referred for cough, chest pain, shortness of breath and tiredness. Her past medical history was composed of high blood pressure and dyslipidemia. Blood tests revealed hyponatraemia, and computed tomography analysis led to the diagnosis of a right lung adenocarcinoma with T2N1bM1 staging , that could not be surgically removed, as metastases were present ( fig.1).As dyspnea and tiredness increased, a chimiotherapy with pemetrexed was initiated. However hyponatraemia was still observed.