La Revue du praticien最新文献

UTERINE FIBROIDS. Uterine fibroids are the most common tumors of the female genital tract. They can be asymptomatic or associated with various symptoms like abnormal uterine bleeding, pelvic pain, pelvic or extra pelvic compressive signs, or anaemia. They can also be associated with infertility. The main further examination for fibroids diagnosis is pelvic ultrasound. Pelvic MRI (Magnetic Resonance Imaging) is also useful before surgery or interventional radiology for fibroid mapping. All fibroids must be located according to the FIGO classification. No treatment is necessary in the absence of clinical symptoms. The management of uterine fibroids depends on the clinical signs, the mapping, and the preservation of the uterus as well as fertility. Medical treatment is the first-line option. In case of failure, therapeutic options include surgery or uterine artery embolization.

PREVENTION STRATEGY FOR INVASIVE MENINGOCOCCAL DISEASE. The prevention strategy for invasive meningococcal disease (IMD) includes vaccination and antibiotic prophylaxis in the vicinity of a case. IMD is unpredictable, difficult to recognize at an early stage, and very severe, with a mortality rate about 10 %, and 20 to 25 % of survivors suffering from permanent disabling sequelae that impact their quality of life. Meningococcal conjugate vaccines against A, C, ACWY provide both individual and collective protection due to their effect on meningococcal carriage. Protein-based vaccines against serogroup B have been developed. These vaccines demonstrate effectiveness in the field in children and adolescents with acceptable tolerance. Immunization programs have been adapted to recent epidemiologic modifications. Immunization with the ACWY meningococcal conjugate vaccine has replaced meningococcal C vaccination and is now mandatory for infants, along with the meningococcal B vaccine. The ACWY meningococcal vaccine is recommended for adolescents aged 11-14 years, with a catchup program for those aged 15 to 2 5 years.

DIAGNOSIS OF INVASIVE NEISSERIA MENINGITIDIS INFECTIONS. Invasive meningococcal infections are unpredictable, difficult to diagnose and extremely serious, with a high risk of death and sequelae in survivors. They primarily affect subjects with no underlying pathology, but risk factors have been identified. The most frequent clinical forms are meningitis, septicemia and meningococcal septic shock, including purpura fulminans. Atypical presentations, such as pneumonia, epiglottitis and digestive tract infections, are increasingly common, especially since the incidence of serogroups W and Y has risen. They can lead to misdiagnosis and are associated with higher case-fatality rates.

Phage therapy: WHERE DO WE STAND? Bacteriophages, discovered at the beginning of the 20th century by Félix d'Hérelle, are viruses that infect and destroy bacteria. Unlike antibiotics, phages are specific to a given bacterial species. After initial successes (shigellosis, cholera), the arrival of antibiotics overshadowed phage therapy. It was not until 2000, with the emergence of antibiotic resistance, that phages and phage therapy made a comeback. They have the status of medicines, but production remains limited. In France, treatments are carried out on a compassionate basis, with a number of isolated successes that need to be confirmed by clinical trials. Some trials are currently underway in France to assess the efficacy of phage therapy in combination with antibiotics. France, a pioneer in phage therapy in its early days and at the time of its comeback, seems to be slowing down in 2024 compared with its European neighbors. The adoption of phage therapy on a routine basis in France will still require time and significant progress.

ANTIBIOTIC TREATMENT OF INVASIVE MENINGOCOCCAL INFECTION. Invasive meningococcal infections (IMI) are extremely severe pathologies that justify very early antibiotic therapy to limit complications and death. Three different situations may arise: 1) clinical suspicion of purpura fulminans in the pre-hospital setting, 2 confirmed or strongly suspected IMI, 3) post-exposure chemoprophylaxis of a patient's contacts. In the first two situations, 3rd generation cephalosporins (C3G), cefotaxime or ceftriaxone are the reference antibiotics, and have the advantage of having an impact on nasopharyngeal carriage of meningococcus. Chemoprophylaxis of contact subjects is based on rifampicin, but ciprofloxacin (subject to retained sensitivity) and C3Gs are possible alternatives.