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Introduction. - Group A -hemolytic streptococcus (GAS), streptococcus pyogenes is a human pathogen responsible for a wide range of clinical manifestations. Invasive GAS infections are rare, an increase has been described since the mid-1980s in developed countries and they cause high morbidity and mortality. Objective. To describe predisposing factors specific to each age group and clinical characteristics of patients with invasive GAS infection, as well as to analyze risk factors associated with bacteremia and mortality. Material and methods. Retrospective and descriptive study through systematic analysis of medical records of al1 hospitalized patients for an invasive GAS infection in the Cliniques Universitaires Saint-Luc (CUSL) between 2011 and 2016. We split the cohort into two groups to compare pediatric and adult populations. Results. Sixty-height patients were included (26 children and 60 adults). Children's' median age was 1, 6 years old and 66,l years old for adults. ln the adult population, 90% had 1 to 4 predisposing factors (median of 2 factors) in contrast 70% of children did not have any documented risk factor but 19% developed a GAS infection following chickenpox. The most common clinical manifestations were occult bacteremia (31%; n :; 31), bone and joint involvement (27%; 9 arthritis, 10 bursitis and 8 osteitis), necrotizing fasciitis(14%; n = 14), pneumonia 13%; (n = 13) and pleural empyema (9%; n = 9). Thirty cases of STSS were recorded (36%). Streptococcus pyogenes was isolated from blood cultures in 70% of case. The average length of stay in the hospital was 19, 4 days. Early fatality rate (< 10 weeks) was 18,4% (12% in pediatrics and 21% in > 18 years old). Thirty-six percent required a surgical treatment and 25% have benefited from dual therapy clindamycin-penicillin.Conclusions: Invasive GAS infections are rare however their progression is rapid and their mortality is significant. A risk factor is more common in adults but chickenpox is the main risk factor in children. Mortality and morbidity related to invasive GAS infections could be potentially prevented ln the future by a vaccine and current research in this field must be encouraged. Antimicrobial prophylaxis is indicated in persons in close contact with a patient infected with invasive SBHA. Introduction. Le streptocoque -hémolytique du groupe A (SBHA), streptococcus pyogene est un germe humain responsable d'un large éventail de manifestations cliniques. Les infections invasives à SBHA sont des affections rares, en recrudescence dans les pays industrialisés depuis le milieu des années 1980 et responsables d'une morbidité et d'une mortalité élevées. Objectif. Décrire l'incidence, les facteurs de risque spécifiques à chaque groupe d'âge et les caractéristiques cliniques des patients atteints d'une infection invasive à SBHA, ainsi que les facteurs associés à la bactériémie et à la mortalité. Matériel et méthode. Étude clinique descriptive et rétrospective via l'analyse systématique du dossier des patients hospitalisés aux Cliniques Universitaires Saint-Luc entre les années 2011 et 2016 pour une infection invasive à SBHA. La cohorte est scindée en deux groupes, permettant de comparer les populations pédiatriques et adultes. Les résultats évalués sont les suivants : âge, genre, facteurs prédisposant (chroniques ou aigus), traitement et évolution. Résultats. Les dossiers de 86 patients ont été analysés (26 enfants et 60 adultes). L'âge médian est, chez les enfants, de 1,6 an ; contre 66,1ans chez les adultes. Dans la population adulte, 90% ont de 1 à 4 facteurs prédisposant (médiane de 2 facteurs) contrairement aux enfants, chez qui, 70% n'ont pas de facteur de risque documenté et 19% ont développé une infection à SBHA dans le décours d'une varicelle. Les manifestations cliniques les plus fréquemment décrites sont la bactériémie occulte (31% ; n = 31), les affections ostéoarticulaires (27% ; 9 arthrites, 10 bursites et 8 ostéites), la fasciite nécrosante (14% ; n = 14), la pneumonie {13% ; n = 13) et la pleurésie {9% ; n = 9). 30 cas de STSS ont été comptabilisé (36%). Streptococcus pyogènes a été isolé à partir d'hémocultures dans 70% des cas. La durée moyenne d'hospitalisation est de 19 jours. Le taux de mortalité précoce (< 10 semaines) s'élève à 18,4% (12% en pédiatrie et 21% chez les > 18 ans). Trente-six pourcents des patients ont dû subir un traitement chirurgical et 25% ont bénéficié d'une bithérapie clindamycine-pénicilline. Conclusions. Les infections invasives à SBHA sont rares mais de progression rapide et de mortalité significative. Un facteur de risque est plus fréquemment retrouvé chez l'adulte mais la varicelle reste le facteur principal chez l'enfant. Le diagnostic précoce permet une antibiothérapie agressive efficace. L’intérêt d'une vaccination est manifeste et justifie les recherches actuelles en ce sens.

Streptococcus pyogenes --- Retrospective Studies

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Antibodies, Bacterial --- Exotoxins --- Streptococcal Infections --- Streptococcus pyogenes --- blood --- immunology --- immunology --- pathogenicity

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DIABETES MELLITUS, INSULIN-DEPENDENT --- DIABETES MELLITUS, INSULIN-DEPENDENT --- HYPERTENSION --- HYPERTENSION --- EPILEPSY --- STREPTOCOCCAL INFECTIONS --- STREPTOCOCCUS PYOGENES --- DRUG INTERACTIONS --- HUMAN --- CASE REPORT --- DRUG THERAPY --- PHYSIOPATHOLOGY --- PHYSIOPATHOLOGY --- DRUG THERAPY --- DRUG THERAPY --- DRUG THERAPY --- DIABETES MELLITUS, INSULIN-DEPENDENT --- DIABETES MELLITUS, INSULIN-DEPENDENT --- HYPERTENSION --- HYPERTENSION --- EPILEPSY --- STREPTOCOCCAL INFECTIONS --- STREPTOCOCCUS PYOGENES --- DRUG INTERACTIONS --- HUMAN --- CASE REPORT --- DRUG THERAPY --- PHYSIOPATHOLOGY --- PHYSIOPATHOLOGY --- DRUG THERAPY --- DRUG THERAPY --- DRUG THERAPY

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Major depression and obsessive–compulsive disorder (OCD) are now recognized among the most frequent psychiatric disorders, affecting 16–17% and 2–3% of the general population, respectively. They are commonly characterized by: i) a high level of psychiatric and somatic comorbidities; ii) a recurrence or chronic profile; and iii) a negative impact on daily functions, thereby leading to a profound impairment of quality of life. Despite significant advances in pharmacological and psychological therapies over the last decades, unsuccessful responses to standard treatment strategies are classically observed in approximately 20–30% of cases. Therefore, there is a significant need for improving the pathophysiological knowledge through a better identification of environmental, clinical, psychological, genetic, anatomical, and biological determinants, specifically implied in the development, the phenotypic expression, and the relapsing course and/or contributing to the therapeutic failure in major depression and OCD. We are convinced that this research approach is particularly relevant providing critical support for the promotion of innovative treatment alternatives potentially useful for the management of resistant forms of major depression and OCD.

n/a --- i-health --- olfaction --- psychiatry --- obsession --- obsessive–compulsive disorder --- transcranial direct current stimulation --- ecological momentary assessment --- Streptococcus pyogenes --- cytokines --- immunology --- compulsion --- cognition --- nosography --- pediatric autoimmune neuropsychological disorders associated with streptococcal infection (PANDAS) --- symptoms networks --- brain stimulation --- neuromodulation --- OCD --- m-health --- categorizations --- ecological momentary intervention --- fictional case study --- pediatric acute-onset neuropsychiatric syndrome (PANS) --- Toxoplasma gondii --- tDCS --- therapeutic tool --- depression --- markers --- quality of life --- Tourette syndrome --- Obsessive-compulsive disorder. --- Depression, Mental. --- Dejection --- Depression, Unipolar --- Depressive disorder --- Depressive psychoses --- Melancholia --- Mental depression --- Unipolar depression --- Affective disorders --- Neurasthenia --- Neuroses --- Manic-depressive illness --- Melancholy --- Sadness --- Compulsive disorder --- Fixed ideas --- Obsession (Psychology) --- Obsessive-compulsive neuroses --- Obsessive-compulsive neurosis --- OCD (Disease) --- Compulsive behavior --- Bipolar disorder --- obsessive-compulsive disorder