The genus Enterobacter is a member of the ESKAPE group, which contains the major resistant bacterial pathogens. First described in 1960, this group member has proven to be more complex as a result of the exponential evolution of phenotypic and genotypic methods. Today, 22 species belong to the Enterobacter genus. These species are described in the environment and have been reported as opportunistic pathogens in plants, animals, and humans. The pathogenicity/virulence of this bacterium remains rather unclear due to the limited amount of work performed to date in this field. In contrast, its resistance against antibacterial agents has been extensively studied. In the face of antibiotic treatment, it is able to manage different mechanisms of resistance via various local and global regulator genes and the modulation of the expression of different proteins, including enzymes (β-lactamases, etc.) or membrane transporters, such as porins and efflux pumps. During various hospital outbreaks, the Enterobacter aerogenes and E. cloacae complex exhibited a multidrug-resistant phenotype, which has stimulated questions about the role of cascade regulation in the emergence of these well-adapted clones.

https://hal-amu.archives-ouvertes.fr/hal-02735917/document

Enterobacter spp.: Update on Taxonomy, Clinical Aspects, and Emerging Antimicrobial Resistance

Danon disease, an X-linked dominant cardioskeletal myopathy, is caused by primary deficiency of lysosome-associated membrane protein-2 (LAMP-2). To clarify the clinicopathological features and management, we performed the first nationwide, questionnaire-based survey on Danon disease in Japan. A total of 39 patients (17 males, 22 females) from 20 families were identified in the analysis. All patients had cardiomyopathy. Of the 21 patients who died, 20 (95%) died of cardiac failure or sudden cardiac arrest. Most patients had hypertrophic cardiomyopathy. Wolf⁻Parkinson⁻White syndrome was present at a comparatively high incidence (54% in males, 22% in females). Only one female patient received a heart transplant, which is the most effective therapy. Histopathologically, all male patients showed autophagic vacuoles with sarcolemmal features in muscle. Half of the probands showed de novo mutations. Male patients showed completely absent LAMP-2 expression in muscle. In contrast, female patients showed decreased LAMP-2 expression, which is suggested to reflect LAMP-2 haploinsufficiency due to a heterozygous null mutation. In conclusion, Danon disease is an extremely rare muscular disorder in Japan. Cardiomyopathy is the most significant prognostic factor and the main cause of death. Our findings suggest that the present survey can extend our understanding of the clinical features of this rare disease.

https://www.mdpi.com/1422-0067/19/11/3507/pdf

A Nationwide Survey on Danon Disease in Japan.

Atypical cardiac myxomas: A clinicopathologic analysis and their comparison to 64 typical myxomas

Thromboembolic events commonly occur in critically ill patients, and although they do not consistently present with specific signs and symptoms, they are associated with high morbity and mortality Antithrombotic agents are the mainstay of the prevention and treatment of venous thromboembolism, and they are also used for stroke prevention in atrial fibrillation, embolism prevention in heart failure, and anticoagulation of prosthetic valves These drugs have been combined with antiplatelet therapy for the prevention of secondary acute coronary syndrome Antithrombotic agents such as Aspirin, clopidogrel, vitamin K antagonists and fondaparinux, an indirect Factor Xa inhibitor, are already incorporated into our clinical practice New small-molecule, selective Factor Xa and thrombin inhibitors that simultaneously inhibit free plasma and clot-associated factor activities have received considerable attention recently These new oral anticoagulants are in various phases of clinical development dabigatran, rivaroxaban and apixaban are in more advanced phases of clinical development and are already available in a number of countries This review article highlights the studies describing the use of these three anticoagulants in an intensive care setting

/pdf/novos-anticoagulantes-em-cuidados-intensivos-5eyismlcul.pdf

Novos anticoagulantes em cuidados intensivos

La manifestation la plus frequente de la maladie thromboembolique veineuse d'effort est la thrombose veineuse des membres superieurs survenant dans des conditions particulieres et stereotypees, et parfois compliquee d'embolies pulmonaires. Quelques cas de thromboses veineuses des membres inferieurs sont decrits chez des sportifs. Certains arguments physiopathologiques (modifications rheologiques, lesions parietales et anomalies de la coagulation) laissent suggerer qu'il existe une relation entre la maladie thromboembolique veineuse et l'effort physique, mais le lien de causalite est parfois difficile a etablir. Nous rapportons trois observations d'embolies pulmonaires apparues au decours d'un effort prolonge de course a pied chez des marathoniens entraines. A notre connaissance, tres peu de cas similaires ont ete decrits. La possible responsabilite de ce type d'effort physique est discutee, de meme que celle de differents autres cofacteurs tels que les anomalies de l'hemostase et la contraception estro-progestative.

Maladie thromboembolique veineuse d’effort : mythe ou réalité ? À propos de trois cas d’embolies pulmonaires chez des coureurs de fond.

Myxoma is the most common primary tumor of the heart. The rarity of infected cardiac myxomas leads to numerous diagnostic and therapeutic difficulties. We present a case of infected left atrial myxoma caused by methicillin-sensible Staphylococcus aureus in a 48-year-old woman complicated by systemic embolism and septic shock.

/pdf/systemic-embolism-and-septic-shock-complicated-left-atrial-22gqky4yd7.pdf

Systemic Embolism and Septic Shock Complicated Left Atrial Myxoma: Case Report

Endocardite infectieuse à Enterobacter aerogenes

[Double location of cardiac hydatid cyst: left ventricle and pulmonary artery].

Resume Introduction Les anti-vitamines K (AVK) sont efficaces dans la prevention des accidents vasculaires cerebraux chez les patients en fibrillation auriculaire (FA) non valvulaire. En depit de leur efficacite demontree, les AVK sont sous-utilises chez les patients a haut risque thromboembolique. L’objectif de ce travail est de decrire les particularites de l’utilisation du traitement AVK et les determinants de leur absence de prescription chez les patients en FA non valvulaire. Methodes Etude retrospective ayant inclus 233 patients qui ont ete hospitalises entre 2005 et 2007 pour une FA (paroxystique/chronique/recidivante, persistante ou permanente). Les patients ont ete classes en trois groupes (risque eleve, modere et faible) selon le niveau de risque thromboembolique en se referant aux recommandations internationales. Resultats L’âge moyen des malades etait de 64 ± 14 ans avec 35 % des patients dont l’âge etait superieur a 75 ans. L’hypertension arterielle etait le facteur de risque thromboembolique le plus frequemment retrouve (61 %), suivi du diabete (19 %) et de l’insuffisance cardiaque congestive (12 %). Cinq pour cent des patients eurent un evenement embolique. Parmi les patients a haut risque (n = 111), 75 % (84) etaient traites par AVK, 20 % (n = 22) du meme groupe par Aspirine® et 5 % (5) ne recevaient aucun antithrombotique. Parmi les 27 patients a haut risque non traites par AVK, les principales raisons a l’origine de cette absence de prescription etaient un rapport benefice/risque juge insuffisant (37 %), des antecedents hemorragiques sous AVK (6 %), les causes neurologiques (5 %). Mais, chez la moitie des sujets, aucune raison de non-prescription ne pouvait etre determinee. Conclusion Cette etude montre que 25 % des patients en FA non valvulaire a haut risque thromboembolique ne sont pas traites par AVK et ce sans raison apparente bien que les recommandations internationales dans cette indication soient claires.

Anticoagulation orale et fibrillation auriculaire

L'hydatidose cardiaque est une pathologie exceptionnelle. Les localisations cardiaques droites, surtout celles de l'oreillette droite, sont encore plus rares et de pronostic grave. Nous rapportons l'observation de trois cas de kyste hydatique de l'oreillette droite. La premiere patiente est decedee en post-operatoire immediat par defaillance cardiaque droite et saignement tracheal abondant. L'evolution post-operatoire immediate et a moyen terme a ete favorable dans les deux autres cas. Nous insistons sur l'interet de l'echographie cardiaque dans le diagnostic du kyste hydatique dont le contexte clinique est peu evocateur en raison d'une grande latence clinique. La chirurgie cardiaque est necessaire et doit etre precoce dans ce type de localisation vu le risque important d'embolie pulmonaire.

Hydatid cyst of the right atrium

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