Nocardiose : révision clinique et expérience dans un centre universitaire

La nocardiose est une maladie opportuniste rare qui se manifeste principalement chez les patients avec une immunodéficience cellulaire. La présentation clinique la plus fréquente chez les patients immunosupprimés est la maladie pulmonaire; un tiers développe aussi une forme disséminée. La nocardiose cutanée primitive est, au contraire, plus fréquente chez les patients immunocompétents avec inoculation directe cutanée. Le diagnostic clinique de la maladie est difficile car les signes et symptômes sont aspécifiques. La nocardiose a été reportée comme maladie émergente liée principalement à une augmentation du nombre de patients immunossupprimés. Aux Hôpitaux Universitaires de Genève, 28 cas de nocardiose ont été diagnostiqués entre 1989 et avril 2009, dont 7 entre 2008 et 2009. Nous avons analysé les caractéristiques épidémiologiques de cette maladie dans notre institution, et avons fait une recherche exhaustive de la littérature focalisée sur les facteurs de risque, les présentations cliniques, le diagnostic et le traitement de la nocardiose

Défis de la co-infection par le virus de l'hépatite C et le VIH

HIV and HCV share transmission routes and, for this reason, 25% of HIV patients are also infected by HCV, and up to 80% of HIV-positive iv drug users. AIDS incidence and mortality are not higher in HCV positive patients, but liver morbidity and mortality are increased. Spontaneous clearance of HCV after infection is less frequent among HIV positive patients. Liver fibrosis progresses faster in HIV-HCV co-infected patients compared to HCV mono-infected, but this can be partially slowed down with effective antiretroviral therapy and immune restoration. Response to HCV treatment is also weaker among co-infected patients. Pharmacological interactions and increased toxicity of antiretroviral drugs and anti-HCV drugs are challenging for clinicians, especially if the recently approved anti-HCV proteases are used

VIH/sida : une sélection des nouveautés les plus prometteuses en 2012

News related to HIV/AIDS was marked in 2012 both by emerging therapies, as well as by the changes management strategies. Therefore, we will discuss the crucial issue of when to start antiretroviral therapy, which appears to be more and more early. Furthermore, after the U.S. validation of the pre-exposure prophylaxis for individuals at high risk of HIV acquisition, prevention of HIV transmission has returned to the spotlight. Finally, we will review some promising novel molecules whose mechanisms of action, half-life or low dosage open the door to new treatment strategies

Epidemiology of viral respiratory infections in a tertiary care centre in the era of molecular diagnosis, Geneva, Switzerland, 2011-2012

Few studies have examined the epidemiology of respiratory viral infections in large tertiary centres over more than one season in the era of molecular diagnosis. Respiratory clinical specimens received between 1 January 2011 and 31 December 2012 were analysed. Respiratory virus testing was performed using a large panel of real-time PCR or RT-PCR. Results were analysed according to sample type (upper versus lower respiratory tract) and age group. In all, 2996 (2469 (82.4%) upper; 527 (17.6%) lower) specimens were analysed. Overall positivity rate was 47.4% and 23.7% for upper and lower respiratory samples, respectively. The highest positivity rate was observed in patients under 18 years old (p <0.001); picornaviruses were the most frequent viruses detected over the year. Influenza virus, respiratory syncytial virus, human metapneumovirus and coronaviruses showed a seasonal peak during the winter season, while picornaviruses and adenoviruses were less frequently detected in these periods. Multiple viral infections were identified in 12% of positive cases and were significantly more frequent in children (p <0.001). In conclusion, we observed significant differences in viral infection rates and virus types among age groups, clinical sample types and seasons. Follow-up of viral detection over several seasons allows a better understanding of respiratory viral epidemiology

Long-term hepatitis E viral load kinetics in an immunocompromised patient treated with ribavirin

Hepatitis E virus (HEV) can cause chronic infections in immunocompromised hosts. Viral kinetics in plasma and stools are poorly understood, particularly during antiviral treatment. Prolonged faecal shedding may be a concern for transmission. We describe HEV kinetics in an immunocompromised patient with prolonged faecal shedding despite undetectable viraemia on ribavirin treatment

Impact of highly active antiretroviral therapy on the molecular epidemiology of newly diagnosed HIV infections

To evaluate HIV-1 transmission trends and the impact of highly active antiretroviral therapy (HAART) on newly diagnosed HIV infections in Geneva, Switzerland

Corrigendum to "Dolutegravir-based antiretroviral therapy in a severely overweight child with a multi-drug resistant human immunodeficiency virus infection. A case report and review" [New Microbes New Infect] 6 (2015) 1-4]

[This corrects the article DOI: 10.1016/j.nmni.2015.02.003.]

Comparative analysis of viral shedding in pediatric and adult subjects with central nervous system-associated enterovirus infections from 2013 to 2015 in Switzerland

Several enterovirus (EV) genotypes can result in aseptic meningitis, but their routes of access to the central nervous system remain to be elucidated and may differ between the pediatric and adult populations