The antibody index has a very good specificity but only moderate sensitivity. Given the lack of consensual criteria for neuroborreliosis and the absence of a "gold standard" diagnostic test, we propose pragmatic diagnostic criteria for neuroborreliosis, namely the presence of four of the following five items: no past history of neuroborreliosis, positive CSF ELISA serology, positive anti-Borrelia antibody index, favorable outcome after specific antibiotic treatment, and no differential diagnosis. These new criteria will need to be tested in a larger, prospective cohort.

We report three cases of delivery and postpartum bacteremia due to unusual anaerobic bacteria in healthy young women. Leptotrichia amnionii bacteremia occurred during delivery in two mothers and was associated with fetal distress during labor. Conversely, Sneathia sanguinegens bacteremia occurred postpartum, 2 days after delivery, without consequence for the neonate. CASE REPORTS Case 1.A 36-year-old woman from North Africa who was living in France had a pregnancy without complications. Vaginal delivery was associated with fetal distress during labor (acidosis, abnormal cardiac rhythm, and colored amniotic liquid), and a maternal postpartum fever up to 39°C occurred rapidly 1 h after delivery. Three blood cultures from peripheral veins were obtained after delivery but before any antibiotic administration. Each blood culture consisted of a pair of BACTEC PLUS Aerobic/F and Anaerobic/F culture vials (BD, Meylan, France). After blood cultures were obtained, the patient was treated with intravenous antibiotic therapy. One gram of intravenous amoxicillin was administered three times per day. Within 10 days of antibiotic therapy, the patient had recovered completely. The newborn did not develop postnatal clinical or laboratory evidence of infection despite initial fetal distress during labor.Case 2. A 32-year-old woman from Turkey who was living in France had a pregnancy without complications. Vaginal delivery was as described above for case 1, and a maternal postpartum fever up to 39°C occurred rapidly 1 h after delivery. Three blood cultures from peripheral veins were obtained after delivery but before any antibiotic administration. Each blood culture consisted of a pair of BACTEC PLUS Aerobic/F and Anaerobic/F culture vials. After blood cultures were obtained, the patient was treated with intravenous antibiotic therapy. One gram of intravenous amoxicillin was administered three times per day. However, because of fever relapse, clavulanic acid was added on the third day. On day 6, this patient developed another febrile episode, while her white blood cell count and C-reactive protein levels were normal and additional blood cultures remained negative. Within 10 days of antibiotic therapy, the patient had recovered completely. The newborn did not develop postnatal clinical or laboratory evidence of infection despite initial fetal distress during labor.Case 3. A 21-year-old woman from Turkey who was living in France had a pregnancy without complications. Vaginal delivery was without fetal distress, but the patient presented with fever up to 39°C 2 days after delivery. Three blood cultures from peripheral veins were obtained after delivery but before any antibiotic administration. Each blood culture consisted of a pair of BACTEC PLUS Aerobic/F and Anaerobic/F culture vials. After blood cultures were obtained, the patient was treated intravenously with 1 g of amoxicillin-clavulanic acid three times per day, 500 mg of metronidazole two times per day, and 100 mg of netilmicin two times per day for 4 days, which was then sw...

The aim of the present study was to investigate the use of the SNaPshot minisequencing method for the identification of Mycobacterium tuberculosis complex (MTBC) isolates to the species level and for further genotyping of M. tuberculosis isolates. We developed an innovative strategy based on two multiplex allelespecific minisequencing assays that allowed detection of eight species-specific and eight lineage-specific single nucleotide polymorphisms (SNPs). Each assay consisted of an eightplex PCR amplification, followed by an eightplex minisequencing reaction with the SNaPshot multiplex kit (Applied Biosystems) and, finally, analysis of the extension products by capillary electrophoresis. The whole strategy was developed with a panel of 56 MTBC strains and 15 negative controls. All MTBC strains tested except one M. africanum clinical isolate were accurately identified to the species level, and all M. tuberculosis isolates were successfully further genotyped. This two-step strategy based on SNaPshot minisequencing allows the simultaneous differentiation of closely related members of the MTBC, the distinction between principal genetic groups, and the characterization of M. tuberculosis isolates into one of the seven prominent SNP cluster groups (SCGs) and could be a useful tool for diagnostic and epidemiological purposes.Although tuberculosis (TB) is an age-old disease, it still represents a major health problem worldwide, accounting for nearly 2 million deaths annually (World Health Organization, Tuberculosis Facts 2009 [http://www.who.int/tb/publications /factsheets/en/]). Besides the need for an improved therapy and for new vaccines, effective TB control requires the initiation of appropriate therapy as well as an increased understanding of its epidemiology.The causative agents of TB in humans and animals, including Mycobacterium tuberculosis, M. africanum, M. bovis, M. canettii, M. microti, M. caprae, and M. pinnipedii, form the Mycobacterium tuberculosis complex (MTBC). Although they differ widely in terms of their host tropisms, phenotypes, and pathogenicities, all members of the MTBC are closely related genetically (51). M. tuberculosis species, the most common pathogen in humans, can be further divided into genetic groups that also show differences in their levels of virulence, immunogenicities, and geographical distributions (21). On the one hand, it is important to differentiate MTBC species to distinguish between strict human and zoonotic TB and to initiate an appropriate therapy (15). In particular, the distinction between M. tuberculosis and M. bovis is necessary, as the latter species is naturally resistant to the antituberculous drug pyrazinamide (48). On the other hand, genotyping of M. tuberculosis isolates is useful as a means of addressing evolutionary questions but also as a means of surveying the transmission dynamics of this pathogen and identifying new outbreaks.Identification of MTBC isolates to the species level is so far routinely performed by analysis of the phenotypic and biochemical ch...

In Lyme borreliosis, the skin is the key site for bacterial inoculation by the infected tick and for cutaneous manifestations. We previously showed that different strains of Borrelia burgdorferi sensu stricto isolated from tick and from different clinical stages of the Lyme borreliosis (erythema migrans, and acrodermatitis chronica atrophicans) elicited a very similar transcriptional response in normal human dermal fibroblasts. In this study, using whole transcriptome microarray chips, we aimed to compare the transcriptional response of normal human dermal fibroblasts stimulated by 3 Borrelia burgdorferi sensu lato strains belonging to 3 main pathogenic species (B. afzelii, B. garinii and B. burgdorferi sensu stricto) in order to determine whether “species-related” inflammatory pathways could be identified. The three Borrelia strains tested exhibited similar transcriptional profiles, and no species-specific fingerprint of transcriptional changes in fibroblasts was observed. Conversely, a common core of chemokines/cytokines (CCL2, CXCL1, CXCL2, CXCL6, CXCL10, IL-6, IL-8) and interferon-related genes was stimulated by all the 3 strains. Dermal fibroblasts appear to play a key role in the cutaneous infection with Borrelia, inducing a homogeneous inflammatory response, whichever Borrelia species was involved.

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