1RXV Q¶DYRQV GpWHFWp DXFXQH LQIHFWLRQ jB. holmesii chez des individus suisses précédemment diagnostiqués comme ayant une infection à Bordetella par une PCR non discriminante. Il est alors peu probable que B. holmesii DLWFRQWULEXpjO¶DXJPHQWDWLRQrécente des cas de coqueluche rapportés en Suisse&HUWDLQHVpWXGHVVLPLODLUHVRQWpJDOHPHQWUpFROWpGHVUpVXOWDWVQpJDWLIVDORUVTXHG¶DXWUHV études ont estimé une SUpYDOHQFHG¶LQIHFWLRQà B. holmesii très variable entre 0-29% [2, 40, 49, 86-91]
.
Nos résultats nous ont surpris pour les raisons suivantes : premièrement, nous avons hospitalisé en 2011 aux Hôpitaux Universitaires de Genève deux patients avec une infection invasive à B.
holmesii et suspections sa présence « endémique » dans notre population [3]. Deuxièmement, B.
holmesii connait une haute prévalence chez nos voisins français [91]. Etant donné le caractère rétrospectif de notre étude, nous ignorons tout des patients testés -par exemple, leur présentation clinique, O¶anamnèse vaccinale ou les caractéristiques sociodémographiques. Il est dès lors impossible de savoir si et comment nos patients diffèrent des patients français. Nous pouvons FHSHQGDQWpFDUWHUOHSUREOqPHGHO¶kJHGHVSDWLHQWV, car la distribution est similaire dans les deux pWXGHVHWWRXWHVOHVFODVVHVG¶kJHVRQWUHSUpVHQWpHV/HVGHX[OLPLWHVPDMHXUHVGHQRWUHpWXGHVRQW donc liées à son caractère rétrospectif et au nombre relativement OLPLWpG¶pFKDQWLOORQVWHVWpV
Discussion
B. holmesii est une bactérie émergente (peu) FRQQXH GHSXLV XQH YLQJWDLQH G¶DQQpH GRQW O¶pWXGH V¶DYqUH intéressante pour plusieurs aspects. Du point de vue microbiologique, son origine est encore mal connue, de même que les raisons de son identification UpFHQWH,OVHSRXUUDLWTX¶LOV¶DJLVVHG¶XQH HVSqFH DYLDLUH j O¶RULJLQH TXL VH VHUDLW DGDSWpH j O¶KRPPH PDLV DXFXQH GRQQpH DQLPDOH Q¶HVW disponible à ce jour afin de pouvoir éventuellement soutenir cette hypothèse. Le transfert horizontal de matériel génétique entre B. holmesii HW G¶DXWUHV EDFWpULHVa probablement contribué à son émergence comme pathogène humain et pourrait possiblement augmenter son potentiel invasif dans le futur.
Comme illustré par la littérature, B. holmesii HVW XQHEDFWpULHXELTXLWDLUH FDSDEOHG¶LQGXLUHWRXWHs sortes G¶LQIHFWLRQV LQYDVLYHV DYHF SDUIRLV GHV SUpVHQWDWLRQV VpYqUHV FH TXL Q¶D pWp UHWURXYp FKH]
aucune autre espèce de Bordetella. Etant donné la difficulté à diagnostiquer cette bactérie, la prévalence des infections sévères est certainement sous-estimée. Le traitement est parfois difficile et prolongé, compliqué à la fois par le délai nécessaire avant de disposer du diagnostic et par la sensibilité moindre de la bactérie aux antibiotiques usuels, poussant les cliniciens à avoir recours aux antibiotiques à large spectre. $ILQG¶RSWLPLVHUjO¶DYHQLUO¶DSSURFKHG¶une infection invasive à B. holmesii et G¶améliorer son traitement, nous avons encouragé dans notre publication les cliniciens jUDSSRUWHUOHVLQIHFWLRQVDILQG¶DXJPHQWHUOHVFRQQDLVVDQFHVFOLQLTXHVODFRQFHUQDQW
Nous avons relevé dans les différents cas G¶LQIHFWLRQ LQYDVLYH jB. holmesii rapportés dans la
souches de B. holmesii G¶RULJLQHUHVSLUDWRLUHRXV\VWpPLTXH&HWWHREVHUYDWLRQSRVHODTXHVWLRQde la prévention par antibioprophylaxie des individus aspléniques -RXLPPXQRVXSSULPpVSRXUG¶DXWUHs raisons- HQFDVG¶LQIHFWLRQUHVSLUDWRLUHjB. holmesii ou de contact avéré avec un cas index. De plus, HOOH RXYUH XQH SRVVLELOLWp G¶DPpOLRUDWLRQ GH ODstratpJLH GLDJQRVWLTXH HQ FDV GH SUpVHQWDWLRQ G¶XQ patient avec une symptomatologie à la fois respiratoire et systémique.
De notre point de vue, la principale problématique inhérente aux infections respiratoires par B.
holmesii Q¶HVW ILQDOHPHQW pas tant le risTXH G¶LQIHFWLRQ LQYDVLYH VHFRQGDLUH, PDLV O¶LPSDFW GH VD mauvaise identification. En effet, une infection respiratoire à B. holmesii faussement diagnostiquée comme étant dû à B. pertussis secondairement au manque de spécificité de la PCR utilisée, porte prpMXGLFH j O¶pWXGH pSLGpPLRORJLTXH GH FHV GHX[ GHUQLqUHV. De plus, ceci perturbe O¶DQDO\VH GH O¶HIILFDFLWpGXYDFFLQFRQWUHODFRTXHOXFKH(QHIIHWXQFDVG¶LQIHFWLRQSDU B. holmesii faussement interprétée comme échec vaccinal a des conséquences individuelles -sur la perception du vaccin par le patient et ses médecins- et globales, ELDLVDQW OHV DQDO\VHV G¶HIILFDFLWp YDFFLQDOHUn nombre important de publications récentes rapportent les cas de coqueluche dans leur population et évaluent dans quelle mesure une vaccination récente est efficace, sans prendre en compte que certains de ces patients peuvent éventuellement avoir été infectés par B. holmesii et non par B. pertussis. La prise de conscience à grande échelle de cette problématique nous semble primordiale et nous espérons vivement que nos publications contribueront à sensibiliser les investigateurs de ces études.
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Annexes
Bordetella holmesii: an under-recognized Bordetella species The Lancet Infectious Diseases. 2014
Article principal ... 43 Annexe ... 53 Bordetella holmesii infection: what is the current knowledge?
Expert Review of Anti-infective Therapy. 2015 ... 69 Bordetella holmesii: still emerging and elusive 20 years on
Microbiology Spectrum. 2016 & Emerging infections. 2016 ... 77 Diagnosis of whooping cough in Switzerland: Differentiating Bordetella pertussis from Bordetella holmesii by polymerase chain reaction
PLoS One. 2014 ... 89 Bordetella holmesii is not detected in Swiss patients with pertussis-like symptoms
ESPID. 2013 ... 95 Bordetella holmesii bacteremia in a child with nephroblastoma
SSP. 2013 ... 97 Coqueluche
Planète Santé. 2013 ... 99