{"id":1808,"date":"2005-10-01T01:00:00","date_gmt":"2005-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/diarrhee-aigue-febrile-et-septicemie-a-vibrio-cholerae-non-cholerique-revelant-une-cholangite-sclerosante-primitive\/"},"modified":"2018-10-20T18:39:40","modified_gmt":"2018-10-20T16:39:40","slug":"diarrhee-aigue-febrile-et-septicemie-a-vibrio-cholerae-non-cholerique-revelant-une-cholangite-sclerosante-primitive","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/diarrhee-aigue-febrile-et-septicemie-a-vibrio-cholerae-non-cholerique-revelant-une-cholangite-sclerosante-primitive\/","title":{"rendered":"DIARRHEE AIGU\u00cb FEBRILE ET SEPTICEMIE A VIBRIO CHOLERAE NON CHOLERIQUE REVELANT UNE CHOLANGITE SCLEROSANTE PRIMITIVE"},"content":{"rendered":"

2005<\/strong><\/p>\n

Guy BELLA\u00cfCHE (1), S\u00e9verine BERDAH (1), Caroline GARANDEAU (2), Lydia MAISONNEUVE (2), Jeanne BELLOC (1), Jean-Luc SLAMA (1).
\nService d\u2019H\u00e9pato-Gastroent\u00e9rologie (1) et de Microbiologie (2). H\u00f4pital Robert Ballanger. 93600 Aulnay-sous-Bois.<\/em><\/p>\n

Gastroent\u00e9rologie <\/strong>– \u00a02005-08-26 –\u00a0PW –<\/p>\n

________________________________<\/p>\n

Les vibrions sont des bact\u00e9ries \u00e0 Gram n\u00e9gatif qui sont des h\u00f4tes naturels du milieu marin. Parmi ces vibrions, on distingue deux populations pathog\u00e8nes pour l\u2019homme, la premi\u00e8re constitu\u00e9e du vibrion chol\u00e9rique, appartenant aux s\u00e9rogroupes O1 et 0139 de l\u2019esp\u00e8ce Vibrio cholerae et \u00e0 l\u2019origine du chol\u00e9ra et d\u2019une seconde population comprenant les vibrions non chol\u00e9riques de l\u2019esp\u00e8ce Vibrio cholerae et 11 autres esp\u00e8ces du genre Vibrio, responsables habituellement d\u2019infections sporadiques rarement graves ou de toxi-infections alimentaires (1). Nous rapportons le cas d\u2019une diarrh\u00e9e aigu\u00eb f\u00e9brile r\u00e9solutive avec septic\u00e9mie \u00e0 Vibrio cholerae non-01\/non-0139 r\u00e9v\u00e9lant une cholangite scl\u00e9rosante primitive.
\nUne femme de 72 ans \u00e9tait hospitalis\u00e9e en r\u00e9animation en d\u00e9cembre 2004 pour un \u00e9tat de mal \u00e9pileptique avec fi\u00e8vre \u00e0 39\u00b0C. Elle avait comme principal ant\u00e9c\u00e9dent une \u00e9pilepsie trait\u00e9e par D\u00e9pakine chrono 500 2 comprim\u00e9s par jour depuis novembre 2003, une angiocholite sur lithiase de la voie biliaire principale trait\u00e9e par sphinct\u00e9rotomie endoscopique en septembre 2004. Elle revenait d\u2019Alger o\u00f9 elle avait s\u00e9journ\u00e9 pendant 2 mois, 10 jours avant son hospitalisation en r\u00e9animation. On notait \u00e0 l\u2019interrogatoire une diarrh\u00e9e faite de 4 \u00e0 6 selles par jour liquides, non glairo-sanglante ayant dur\u00e9 4 semaines et ayant c\u00e9d\u00e9 5 jours avant son hospitalisation. L\u2019examen clinique montrait une fi\u00e8vre isol\u00e9e et en plateau \u00e0 39\u00b0 C. Les examens biologiques montraient l\u2019absence d\u2019hyperleucocytose et une C-R\u00e9active Prot\u00e9ine \u00e0 102 UI\/L. Le bilan h\u00e9patique montrait une cholestase avec GGT \u00e0 50N et PAL \u00e0 4N, sans cytolyse associ\u00e9e ni augmentation de la bilirubin\u00e9mie. L\u2019\u00e9chographie h\u00e9pato-biliaire montrait une lithiase v\u00e9siculaire non compliqu\u00e9e et l\u2019\u00e9choendoscopie ne montrait pas de lithiase r\u00e9siduelle du chol\u00e9doque. L\u2019ECBU \u00e9tait st\u00e9rile et la radiographie de thorax \u00e9tait normale. Trois h\u00e9mocultures revenaient positives \u00e0 Vibrio cholerae non-01\/non-0139. La coproculture n\u2019\u00e9tait pas r\u00e9alis\u00e9e, la diarrh\u00e9e \u00e9tant r\u00e9solutive au cours de l\u2019hospitalisation. L\u2019apyrexie \u00e9tait rapidement obtenue sous Cefotaxime 3 grammes par jour en IV pendant 14 jours, permettant le retour \u00e0 domicile de la malade. Les s\u00e9rologies virales B, C et HIV \u00e9taient n\u00e9gatives. Les anticorps anti-nucl\u00e9aires anti-mitochondries, anti-muscles lisses et anti-r\u00e9ticulum endoplasmiques \u00e9taient n\u00e9gatifs. Devant la persistance de la cholestase avec PAL \u00e0 5 fois le taux normal et GGT \u00e0 40N en f\u00e9vrier 2005, un cath\u00e9t\u00e9risme r\u00e9trograde endoscopique \u00e9tait r\u00e9alis\u00e9 et montrait un aspect caract\u00e9ristique en arbre mort de l\u2019arbre biliaire posant le diagnostic de cholangite scl\u00e9rosante primitive. La ponction biopsie h\u00e9patique n\u2019\u00e9tait pas r\u00e9alis\u00e9e. Un traitement par ursolvan \u00e0 la dose de 25 mg\/Kg\/J permettait la quasi normalisation du bilan biologique h\u00e9patique avec PAL \u00e0 1,2 N et GGT \u00e0 8N en mai 2005.
\nIl s\u2019agit d\u2019un cas exceptionnel de septic\u00e9mie \u00e0 Vibrio cholerae non-01\/non-0139 au retour d\u2019Alg\u00e9rie r\u00e9v\u00e9lant une cholangite scl\u00e9rosante primitive. Ces souches de vibrions non-chol\u00e9riques sont rarement isol\u00e9es chez l\u2019homme en France mais peuvent, comme chez notre patiente, \u00eatre \u00e0 l\u2019origine de pathologies s\u00e9v\u00e8res. A la diff\u00e9rence de Vibrio cholerae o\u00f9 la contamination interhumaine est la plus fr\u00e9quente, l\u2019homme se contamine exclusivement par la consommation ou la manipulation de produits de la mer, en particulier les coquillages, en France m\u00e9tropolitaine ou apr\u00e8s un s\u00e9jour \u00e0 l\u2019\u00e9tranger. Ceci explique l\u2019absence d\u2019\u00e9pid\u00e9mie \u00e0 Vibrio cholerae non-01\/non-0139 qui se manifeste le plus souvent sous la forme d\u2019une diarrh\u00e9e aigu\u00eb f\u00e9brile rarement sanglante et rapidement r\u00e9solutive, les infections plus s\u00e9v\u00e8res avec septic\u00e9mies et choc septique parfois l\u00e9tal survenant chez le patient immunod\u00e9prim\u00e9. Toutes les causes d\u2019immunod\u00e9pression doivent \u00eatre recherch\u00e9es avec attention, en particulier les pathologies h\u00e9matologiques malignes et le SIDA ou comme chez notre patiente, une h\u00e9patopathie chronique. La pr\u00e9vention de ces infections passe donc par une sensibilisation des m\u00e9decins afin qu\u2019ils informent leurs patients pr\u00e9sentant une pathologie pr\u00e9disposante, en particulier h\u00e9patique, du risque repr\u00e9sent\u00e9 par un contact ou la consommation des produits de la mer, en particulier les coquillages.<\/p>\n","protected":false},"excerpt":{"rendered":"

2005 Guy BELLA\u00cfCHE (1), S\u00e9verine BERDAH (1), Caroline GARANDEAU (2), Lydia MAISONNEUVE (2), Jeanne BELLOC (1), Jean-Luc SLAMA (1). Service d\u2019H\u00e9pato-Gastroent\u00e9rologie (1) et de Microbiologie (2). H\u00f4pital Robert Ballanger. 93600 Aulnay-sous-Bois. Gastroent\u00e9rologie – \u00a02005-08-26 –\u00a0PW – ________________________________ Les vibrions sont des bact\u00e9ries \u00e0 Gram n\u00e9gatif qui sont des h\u00f4tes naturels du milieu marin. Parmi ces […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[4],"tags":[16],"class_list":["post-1808","post","type-post","status-publish","format-standard","hentry","category-gastroenterologie","tag-16"],"yoast_head":"\nDIARRHEE AIGU\u00cb FEBRILE ET SEPTICEMIE A VIBRIO CHOLERAE NON CHOLERIQUE REVELANT UNE CHOLANGITE SCLEROSANTE PRIMITIVE - Abstracts des congr\u00e8s de l'ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/diarrhee-aigue-febrile-et-septicemie-a-vibrio-cholerae-non-cholerique-revelant-une-cholangite-sclerosante-primitive\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"DIARRHEE AIGU\u00cb FEBRILE ET SEPTICEMIE A VIBRIO CHOLERAE NON CHOLERIQUE REVELANT UNE CHOLANGITE SCLEROSANTE PRIMITIVE - 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