Leaf concentrate compared with skimmed milk as nutritional supplementation for HIV-infected children:a randomized controlled trial in Burundi

AbstractObjectiveThe effectiveness of leaf concentrate powder (LCP) as a nutritional supplement was established in trials conducted among adolescent girls and pregnant women in India. Here we evaluate LCP, compared with skimmed milk powder (SMP), as a supplement for antiretroviral-naïve children living with HIV in a sub-Saharan African country.DesignRandomized controlled, two-arm, 6-month trial comparing effects of isoproteic (5 g) LCP (10 g daily) and SMP (15 g daily) on HIV-1 viral load, CD4+cell count/percentage, weight/height-for-age, general blood parameters, diarrhoea, respiratory and HIV-related opportunistic infections.SettingBujumbura and Kirundo, Burundi.SubjectsEighty-three HIV-positive, antiretroviral-naïve children aged 5–14 years: median (range) CD4+count, 716 (361–1690) cells/mm3; log10HIV-1 viral load, 4·39 (1·79–6·00).ResultsLCP was equivalent to SMP in relation to HIV-specific blood parameters and did not demonstrate superiority over SMP in relation to Hb. Three children in each arm (LCP, 7·1 % (3/42); SMP, 7·3 % (3/41)) proceeded to antiretroviral therapy because their CD4+counts fell below 350 cells/mm3. Children in the LCP group reported higher levels of appetite and overall health at 6 months. There were no differences in clinical events or any other outcome measures. LCP was less palatable than SMP to the children in this population, but there were few negative perceptions of appearance, texture and taste.ConclusionsLCP appears to be equivalent to SMP as a nutritional supplement in this population, despite slightly lower palatability. In relation to viral load and CD4+count, equivalence may indicate no effect in either group. Effectiveness relative to no supplementation remains to be determined.</jats:sec

Surgical Mask to Prevent Influenza Transmission in Households: A Cluster Randomized Trial

Facemasks and respirators have been stockpiled during pandemic preparedness. However, data on their effectiveness for limiting transmission are scarce. We evaluated the effectiveness of facemask use by index cases for limiting influenza transmission by large droplets produced during coughing in households.A cluster randomized intervention trial was conducted in France during the 2008-2009 influenza season. Households were recruited during a medical visit of a household member with a positive rapid influenza A test and symptoms lasting less than 48 hours. Households were randomized either to the mask or control group for 7 days. In the intervention arm, the index case had to wear a surgical mask from the medical visit and for a period of 5 days. The trial was initially intended to include 372 households but was prematurely interrupted after the inclusion of 105 households (306 contacts) following the advice of an independent steering committee. We used generalized estimating equations to test the association between the intervention and the proportion of household contacts who developed an influenza-like illness during the 7 days following the inclusion. Influenza-like illness was reported in 24/148 (16.2%) of the contacts in the intervention arm and in 25/158 (15.8%) of the contacts in the control arm and the difference between arms was 0.40% (95%CI: -10% to 11%, P = 1.00). We observed a good adherence to the intervention. In various sensitivity analyses, we did not identify any trend in the results suggesting effectiveness of facemasks.This study should be interpreted with caution since the lack of statistical power prevents us to draw formal conclusion regarding effectiveness of facemasks in the context of a seasonal epidemic.clinicaltrials.gov NCT00774774

Entérovirus non poliomyélitiques et pathologies respiratoires

Les entérovirus (Picornaviridae) sont des agents infectieux communs divisés en 4 espèces (entérovirus humains, espèces A à D) qui regroupent actuellement 108 sérotypes. Ces virus non enveloppés à ARN simple brin de polarité positive, très résistants dans le milieu extérieur, se transmettent principalement par voie fécale-orale mais également par voie aérienne. Même si la grande majorité des infections à entérovirus est asymptomatique, ces pathogènes ubiquitaires sont responsables de syndromes infectieux incluant des infections des voies respiratoires hautes (sinusites, pharyngites, otites) ou basses (pneumonies, bronchiolites ou exacerbation de l’asthme infantile). Des travaux récents indiquent que les entérovirus seraient la troisième cause virale de bronchiolite chez les enfants âgés de 1 à 12 mois. Par ailleurs, des cas sporadiques et parfois mortels de pneumonies dues au virus coxsackie A16 (CV-A16), à l’entérovirus 71 (EV-71) et à un nouveau génotype d’entérovirus (EV-104) ont été décrits et montrent la capacité des entérovirus humains des espèces A à C à induire des infections respiratoires basses sévères. Les données épidémiologiques actuelles ainsi que la capacité d’évolution génétique rapide des souches d’entérovirus montrent que ces virus ont un fort potentiel d’émergence en tant que pathogènes humains. Elles soulignent la nécessité de développer de nouvelles stratégies préventives, diagnostiques et thérapeutiques pour lutter contre les infections pédiatriques respiratoires par le

Fatal Echovirus 18 Leukoencephalitis in a Child▿

Rare cases of leukoencephalitis have been reported in infants with documented enterovirus (EV) central nervous system (CNS) infections. A case of fatal encephalitis with white matter lesions caused by echovirus 18 is described, and it highlights the role of EV CNS infection as a potential cause of leukoencephalitis in infants

Comparison of Washing and Swabbing Procedures for Collecting Genital Fluids To Assess Shedding of Human Immunodeficiency Virus Type 1 (HIV-1) RNA in Asymptomatic HIV-1-Infected Women

Human immunodeficiency virus type 1 (HIV-1) RNA was detected by means of ultrasensitive reverse transcription-PCR assay of 19 cervicovaginal lavage, 21 cervical mucus, 18 vaginal wall, and 17 vaginal fornix paired samples from 25 asymptomatic HIV-1-infected women (76, 84, 72, and 68%, respectively; P > 0.5). Levels of HIV-1 RNA in cervicovaginal wash samples were highly correlated with those in paired endocervical mucus samples (r = 0.71; P = 0.0006), indicating that cervicovaginal washing and endocervical swabbing are equivalent collection procedures

Correction to: Cellular mechanisms responsible for cell-to-cell spreading of prions.

International audienceIn the original publication, part of acknowledgement text was missing. The complete acknowledgement section should read as follows

New Commercially Available PCR and Microplate Hybridization Assay for Detection and Differentiation of Human Polyomaviruses JC and BK in Cerebrospinal Fluid, Serum, and Urine Samples

JC and BK human polyomaviruses (family Polyomaviridae) may cause severe neurological or urinary tract pathologies in immunocompromised hosts. In the present study, we evaluated a new commercially available PCR and microplate colorimetric hybridization assay for the standardized differential detection of JC virus (JCV) and BK virus (BKV) genomes in clinical samples. This JC/BK Consensus test was first evaluated by testing serial dilutions of JCV or BKV plasmid DNA standards and was then compared with an in-house reference PCR assay for the detection of JC and BK virus genomes in 70 cerebrospinal fluid (CSF) samples of patients with neurological disorders and in 75 serum or plasma samples and 125 urine samples of renal graft recipients. This new test allowed a limit of detection of 10 copies and 1 copy of JC and BK virus genomes, respectively, and was able to differentiate various levels of JCV, BKV, and mixed JCV and BKV DNA genomes in a single reaction tube. Our results showed 100% specificity and sensitivity for the JC/BK Consensus test with CSF samples. With serum or plasma samples, this test had a sensitivity and a specificity of 100% for both JCV and mixed JCV and BKV DNA detection and a sensitivity and a specificity of 100 and 97.8% for BKV DNA detection, respectively. With urine samples, the sensitivity and specificity were 100 and 96.6%, respectively, for JCV DNA detection; 100 and 89.4%, respectively, for BKV DNA detection; and 44.4 and 100%, respectively, for mixed JCV and BKV DNA detection. In conclusion, our data indicate that this new test, the JC/BK Consensus test, is valuable for the sensitive and specific differential detection of single JCV and BKV infections in CSF, serum or plasma, and urine samples. The use of this reliable PCR assay would improve the routine virological diagnosis as well as the clinical care of immunocompromised patients with polyomavirus-related pathologies

Detection of Human Metapneumovirus RNA Sequences in Nasopharyngeal Aspirates of Young French Children with Acute Bronchiolitis by Real-Time Reverse Transcriptase PCR and Phylogenetic Analysis

Human metapneumovirus (HMPV) was the unique viral pathogen detected by a real-time reverse transcriptase PCR (RT-PCR) assay in 6 (6.4%) of 94 consecutive French children hospitalized for acute bronchiolitis from September 2001 to June 2002. This virus was identified as the third etiological cause of bronchiolitis, after respiratory syncytial virus and rhinovirus (35 [37%] and 21 [22%] of 94 cases, respectively). Phylogenetic analysis of F-gene sequences demonstrated the cocirculation of distinct HMPV genotypes during this study. These findings highlight the need to implement a rapid HMPV RT-PCR detection assay for the clinical diagnosis of respiratory infections in pediatric patients with bronchiolitis