An outbreak of 49 cases of tinea corporis gladiatorum due to Trichophyton tonsurans infection occurred in a high level judo team of 131 members in Orléans, central France, between October 2004 and April 2005. The team was divided into 5 groups: cadet-junior boys (n=44), cadet-junior girls (n=33), male university students (n= 15), female university students (n=21), and a group called ‘pôle technique’ made up of high level judokas who have finished academic study (n=18). The outbreak involved 86% of the cadet-junior boys, but only 6 men in the ‘pôle technique’ (33%) and only 5 of the 69 other team members (7%) (cadet-junior girls and university students). We describe the outbreak and the results of a survey that found a known risk factor for the ‘pôle technique’: sharing an electric hair shaver. Personal hygiene practices were found to be very good among the cadet-junior boys. The high attack rate in this group may be linked to the poor shower facilities in the gymnasium where they practiced that led them to have their showers several hours after the end of daily practice.

Sepsis is still a major cause of mortality in the intensive critical care unit and results from an overwhelming immune response to the infection. TNF signaling pathway plays a central role in the activation of innate immunity in response to pathogens. Using a model of polymicrobial sepsis by i.p. injection of cecal microflora, we demonstrate a critical role of TNFR1 and R2 activation in the deregulated immune responses and death associated with sepsis. A large and persistent production of TNF was found in wild-type (B6) mice. TNFR1/R2-deficient mice, compared with B6 mice, survive lethal polymicrobial infection with enhanced neutrophil recruitment and bacterial clearance in the peritoneal cavity. Absence of TNFR signaling leads to a decreased local and systemic inflammatory response with diminished organ injury. Furthermore, using TNFR1/R2-deficient mice, TNF was found to be responsible for a decrease in CXCR2 expression, explaining reduced neutrophil extravasation and migration to the infectious site, and in neutrophil apoptosis. In line with the clinical experience, administration of Enbrel, a TNF-neutralizing protein, induced however only a partial protection in B6 mice, with no improvement of clinical settings, suggesting that future TNF immunomodulatory strategies should target TNFR1 and R2. In conclusion, the present data suggest that the endogenous TNFR1/R2 signaling pathway in polymicrobial sepsis reduces neutrophil recruitment contributing to mortality and as opposed to pan-TNF blockade is an important therapeutic target for the treatment of polymicrobial sepsis.

On 22 September 2005, the Institut de Veille Sanitaire was alerted by a biologist at a hospital in Orléans

WNA RT-qPCR WNA amplification was performed using the following conditions: 1 Â Invitrogen RT-qPCR buffer mix (Superscript III One step RT-PCR, Life Technologies Corporation, Carlsbad, California), 0.3 mM of each primer (Hc_24_55F: 5 0 -CGTACGACATCATATTAAAAATGA-3 0 and Hc_22_128R: 5 0 -CTTTCTTTAAGGTAGC-CAAAAT-3 0 ), 0.1 mM of probe (Hc_21_79P: 5 0 -FAM-Evaluation of a New RT-qPCR Histoplasma

We describe the third case of prosthetic infection due to Erysipelothrix rhusiopathiae. The patient, a 68-yearold woman, had had total knee arthroplasty 12 months before diagnosis. She had been in contact with swine at home. We review the seven previous reports of septic arthritis due to E. rhusiopathiae. CASE REPORTA 68-year-old woman was referred to the orthopedic ward for total replacement of the right knee due to severe internal condyle osteonecrosis. She had a medical history of gout, chronic eczema of the lower limbs, and alcoholism with consequent cognitive disorders. A tricompartmental posterior stabilized cemented knee artroplasty, containing gentamicin, was performed. The patient did not experience any problems during the first 6 months of follow-up. The international knee scoring (IKS) system score was 80/200 before surgery and increased to 163/200 6 months after surgery. Soon after, the patient complained of eczema-like skin lesions on the lower limb, involving the site of surgical incision. During this period, neighbors reported seeing the patient feeding her neighbor's swine through the wire enclosure. The patient's general practitioner prescribed an intramuscular corticosteroid because of intense itching. Within weeks of receiving this treatment, she complained of swelling and pain in the right knee and received amoxicillinclavulanate. A radiography of the knee was normal. One month later, seropurulent fistulization of the right knee was observed at the distal end of the surgical incision site, and the patient was referred to the hospital. On admission, flexion of the right knee was reduced to 90°. The patient was not febrile. No cardiac murmurs, skin rash, or lymph node enlargement was found. The peripheral white blood cell count was 6,100 cells/mm 3 , and the C-reactive protein concentration was 74 mg/liter. Radiography revealed advanced osteolysis of the tibia, femur, and patella. Blood cultures remained sterile. Twelve months after right knee arthroplasty, surgical arthrotomy was carried out, yielding a sanguinepurulent "chocolate-like" fluid. Synovial resection was performed, revealing large geodes resulting from osteolysis in the femur, tibia, and patella. The prosthesis was removed and replaced by a vancomycin-and gentamicin-impregnated spacer. Intravenous rifampin and vancomycin treatment was started. Eleven peroperative samples were sent to the laboratory. All Gram staining tests were negative. Cultures were grown on blood agar plates under aerobic and anaerobic conditions and on chocolate agar plates incubated under 5% CO 2 . Cultures were negative on day 2. On day 4, four samples yielded pinpoint colonies. Microscopic observations of these first cultures revealed thin, short, cylindrical Gram-positive rods. Subcultures were set up for potential confirmation of Lactobacillus or Corynebacterium. These subcultures yielded enterococcus-shaped colonies on day 2. Bacteria were confirmed to be rod shaped but were longer and thinner than those observed in the initial cultures. On the basis of t...