High mortality in peritonitis due to Mycobacterium avium complex: retrospective study and systematic literature review

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Thoracic splenosis mimicking a pleuropneumonia

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Isolated Cerebral Alveolar Echinococcosis

International audienceCerebral alveolar echinococcosis (AE) is rare and mostly associated with liver involvement. We report an exceptional case of a 62-year-old man with a hereditary hemorrhagic telangiectasia harboring a primary cerebral AE mimicking neurocysticercosis with >100 cerebral lesions and without liver involvement. Human alveolar echinococcosis (AE) is a rare zoonotic infection caused by the metacestode of the fox tapeworm, Echinococcus multilocularis. Endemic regions of AE are mainly limited to the Northern Hemisphere, especially to western China, Central Europe, Alaska, Russia, and Japan [1]. The main risk factors associated with human AE are rural settings, living near a forest, mountain climate, being a farmer, and being a dog owner. Humans become accidentally infected through the ingestion of eggs shed in the feces of definite hosts (eg, foxes, dogs) [1]. Primary extrahepatic involvement of AE is rare, and cerebral involvement is unusual [1]. We report an exceptional case of primary cerebral AE in which imaging showed multiple small round contrast-enhancing lesions. We will discuss the general diagnostic approach of brain abscesses, including the differential diagnosis of multiple abscesses and the physiopathology of isolated brain involvement in this case of AE. CASE REPORT We report the case of a 62-year-old pig breeder who lived in Normandy (France) and never traveled abroad. He used to eat fruits and vegetables from his own garden. His medical history was marked by a definite diagnosis of hereditary hemorrhagic telangiectasia (HHT) visceral arteriovenous malformations (AVMs). In December 2016, he was admitted to a general hospital because of an acute headache, confusion, and gait disorders. Physical examination revealed left ptosis, ataxia, dysarthria, and mucocutaneous telangiectasia. A brain magnetic resonance image (MRI) showed multiple parenchymal small gadolini-um-enhancing lesions with hypointense signals in T1-weighted sequences, associated with a large perilesional edema in fluid attenuated inversion recovery (FLAIR) sequences (Figure 1A and E). Cerebrospinal fluid (CSF) withdrawn on day 2 revealed a lymphocytic meningitis with 230 white cells/mm 3 , a protein content of 1g/L, and normal glycorrhachia. Suspected pyogenic brain abscesses were treated by cefotaxime and metronidazole. Blood and CSF cultures were sterile, and C-reactive protein was normal. Blood samples obtained for serological testing to detect Coxiella burnetii, Rickettsia spp., Bartonella henselae, Bartonella quintana, Brucella spp., Treponema pallidum, and HIV were negative. A second-step CSF analysis was negative for mycobacteria (polymerase chain reaction [PCR] and culture), Toxoplasma gondii (PCR), Cryptococcus spp., and Nocardia spp. At day 5, the patient's neurological status deteriorated, resulting in aphasia and right hemiplegia. Thoracic and abdominal CT and abdominal ultrasound (US) were normal. Albendazole and corticosteroid were added to the treatment because of a suspected neurocysticercosis (due to both his occupation and a consistent brain imaging presentation, although this condition is extremely rare in metropolitan France) or necrotic cerebral metastasis. The patient was referred to the Infectious Diseases Unit of the University Hospital of Caen, Normandy, on day 11. As serum and CSF serology for cysticercosis were negative, cor-ticosteroid and albendazole were stopped. A first brain biopsy (day 18) only showed inflammation consistent with an extra-abscess biopsy, leading to a second brain biopsy (day 30), which showed necrotic tissue with eosinophilic material composed of fragments of a laminated layer, intensely colored by the periodic acid-Schiff (PAS) stain and Grocott's methenamine silver stain (Figure 2). No germinative layer was noted. A tapeworm was suspected, but its genus could not be identified. The results of the bacteriological analyses of the brain tissue performed by direct examination, standard culture, universal bacterial PCR targeting the 16S rRNA gene, specific culture, fungal and myco-bacterial culture, and PCR of Mycobacterium spp. were negative. An exceptional case of autochthonous neurocysticercosi

Measles inclusion-body encephalitis (MIBE) in a immunocompromised patient

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Impact of aging on phenotype and prognosis in IgA vasculitis

International audienceObjectives Immunoglobulin A vasculitis (IgAV) is a small-vessel vasculitis most frequently benign in children while more severe in adults. We aimed to study the impact of age on presentation and outcome of adult IgAV. Methods We conducted a nationwide retrospective study including 260 IgAV patients. Patients were divided into four quartiles according to the age at IgAV diagnosis: <36, 36 ≤ age < 52; 52 ≤ age < 63 and ≥63 years. Comparison of presentation and outcome were performed according to age of disease onset. Results Mean age at diagnosis was 50.1 (18) years and 63% were male. IgAV diagnosed in the lowest quartile of age was associated with more frequent joint (P < 0.0001) and gastrointestinal involvement (P = 0.001). In contrast, the oldest patients had more severe purpura with necrotic lesions (P = 0.001) and more frequent renal involvement (P < 0.0001), with more frequent haematuria, renal failure, higher urine protein excretion and more frequent tubulointerstitial lesions. Patients were treated similarly in all groups of age, and clinical response and relapse rates were similar between groups. In the 127 treated patients with follow-up data for >6 months, clinical response and relapse rates were similar between the four groups. Median follow-up was of 17.2 months (9.1–38.3 months). Renal failure at the end of follow-up was significantly more frequent in the highest quartile of age (P = 0.02), but the occurrence of end-stage renal disease was similar in all groups. Last, overall and IgAV-related deaths were associated with increase in age. Conclusion Aging negatively impacts the severity and outcome of IgAV in adults. Younger patients have more frequent joint and gastrointestinal involvement, while old patients display more frequent severe purpura and glomerulonephritis

Impact of vaccination on the presence and severity of symptoms in hospitalized patients with an infection of the Omicron variant (B.1.1.529) of the SARS-CoV-2 (subvariant BA.1)

International audienceObjectives: The emergence of SARS-CoV-2 variants raised questions about the extent to which vaccines designed in 2020 have remained effective. We aimed to assess whether vaccine status was associated with the severity of Omicron SARS-CoV-2 infection in hospitalized patients. Methods: We conducted an international, multi-centric, retrospective study in 14 centres (Bulgaria, Croatia, France, and Turkey). We collected data on patients hospitalized for ≥24 hours between 1 December 2021 and 3 March 2022 with PCR-confirmed infection at a time of exclusive Omicron circulation and hospitalization related or not related to the infection. Patients who had received prophylaxis by monoclonal antibodies were excluded. Patients were considered fully vaccinated if they had received at least two injections of either mRNA and/or ChAdOx1-S or one injection of Ad26.CoV2-S vaccines. Results: Among 1215 patients (median age, 73.0 years; interquartile range, 57.0–84.0; 51.3% men), 746 (61.4%) were fully vaccinated. In multivariate analysis, being vaccinated was associated with lower 28-day mortality (Odds Ratio [95% Confidence Interval] (OR [95CI]) = 0.50 [0.32–0.77]), intensive care unit admission (OR [95CI] = 0.40 [0.26–0.62]), and oxygen requirement (OR [95CI] = 0.34 [0.25–0.46]), independent of age and comorbidities. When co-analysing these patients with Omicron infection with 948 patients with Delta infection from a study we recently conducted, Omicron infection was associated with lower 28-day mortality (OR [95CI] = 0.53 [0.37–0.76]), intensive care unit admission (OR [95CI] = 0.19 [0.12–0.28]), and oxygen requirements (OR [95CI] = 0.50 [0.38–0.67]), independent of age, comorbidities, and vaccination status. Discussion: Originally designed vaccines have remained effective on the severity of Omicron SARS-CoV-2 infection. Omicron is associated with a lower risk of severe forms, independent of vaccination and patient characteristics

Characteristics and Management of IgA Vasculitis (Henoch-Schonlein) in Adults Data From 260 Patients Included in a French Multicenter Retrospective Survey

International audienceMethods: Data on clinical characteristics, histologic features, and treatment response from 260 patients with IgAV included in a French multicenter retrospective survey were analyzed. Efficacy data were compared using different statistical models.Results: The mean ± SD age of the patients with IgAV at diagnosis was 50.1 ± 18 years, and 63% of patients were male. Baseline manifestations included purpura (100%), arthralgias/arthritis/myalgia (61%), glomerulonephritis (70%), and/or gastrointestinal involvement (53%). Thirty percent of patients showed renal failure at baseline. In univariate analysis, the response to therapy was 80% (64 of 80) in patients treated with corticosteroids (CS) alone, compared to 77% (23 of 30) in patients treated with CS plus cyclophosphamide (CYC) and 59% (10 of 17) in patients treated with colchicine (P = 0.17). Multivariable analysis showed that treatment with CS or CS plus CYC was more effective than colchicine in achieving a response. Efficacy differences were demonstrated using different statistical models: in the multivariable logistic regression model, odds ratio (OR) 3.68, 95% confidence interval (95% CI) 1.10–12.33 (P = 0.03); in the inverse probability weighting on propensity score model, OR 3.75, 95% CI 1.28–10.99 (P = 0.02). The efficacy of CS plus CYC as compared to CS alone was discordant according to the analytic method used. Analysis with the multivariable logistic regression model did not demonstrate a difference between CS plus CYC and CS alone (OR 0.88, 95% CI 0.29–2.67; P = 0.82). In contrast, inverse probability weighting on propensity score showed that CS plus CYC was more effective than CS alone (OR 1.79, 95% CI 1.00–3.20; P = 0.049).Conclusion: This series constitutes the largest series of adults with IgAV reported in the literature so far. It provides data on clinical and histologic presentation and therapeutic efficacy, suggesting that CS alone appears to be a reasonable first‐line therapy in patients with IgAV, while the benefit of adding CYC to CS remains uncertain

Empirical antibiotic therapy modalities for Enterobacteriaceae bloodstream infections in older patients and their impact on mortality: a multicentre retrospective study

International audiencePurpose: Enterobacteriaceae (EB) bloodstream infections (BSI) are frequent and serious in older patients. Physicians are faced with the dilemma of prescribing early appropriate empirical antibiotics to limit the risk of death, and sparing broad-spectrum antibiotic prescription. The aim of the study was to assess the rate of appropriate empirical antibiotics prescription to treat EB BSI in older patients and its impact on survival.Methods: This study conducted in 49 centres enrolled retrospectively up to the 10 last consecutive patients aged 75 years and over and treated for EB BSI. Factors related to in-hospital death were investigated using logistic regression.Results: Among the 487 enrolled patients (mean age 86 ± 5.9 years), 70% had at least one risk factor of being infected by third-generation cephalosporins (3GC)-resistant strain; however, only 13.8% of EB strains were resistant to 3GC. An empirical antimicrobial treatment was initiated for 418 patients (85.8%), and for 86% (n = 360/418) of them, it was considered appropriate. In-hospital mortality was 12.7% (n = 62) and was related to the severity of infection (OR 3.17, CI 95% 1.75-5.75), while a urinary portal of entry was protective (OR 0.34, CI 95% 0.19-0.60). Neither the absence of nor inappropriate empirical antibiotics prescription was associated with increased mortality.Conclusion: While patients enrolled in this study were at risk of being infected by multidrug-resistant bacteria, yet mainly treated with 3GC, empirical antibiotics prescription was appropriate in most cases and did not influence mortality

The risk of COVID-19 death is much greater and age dependent with type I IFN autoantibodies

International audienceSignificance There is growing evidence that preexisting autoantibodies neutralizing type I interferons (IFNs) are strong determinants of life-threatening COVID-19 pneumonia. It is important to estimate their quantitative impact on COVID-19 mortality upon SARS-CoV-2 infection, by age and sex, as both the prevalence of these autoantibodies and the risk of COVID-19 death increase with age and are higher in men. Using an unvaccinated sample of 1,261 deceased patients and 34,159 individuals from the general population, we found that autoantibodies against type I IFNs strongly increased the SARS-CoV-2 infection fatality rate at all ages, in both men and women. Autoantibodies against type I IFNs are strong and common predictors of life-threatening COVID-19. Testing for these autoantibodies should be considered in the general population