The French national prospective cohort of patients co-infected with HIV and HCV (ANRS CO13 HEPAVIH): Early findings, 2006-2010

<p>Abstract</p> <p>Background</p> <p>In France, it is estimated that 24% of HIV-infected patients are also infected with HCV. Longitudinal studies addressing clinical and public health questions related to HIV-HCV co-infection (HIV-HCV clinical progression and its determinants including genetic dimension, patients' experience with these two diseases and their treatments) are limited. The ANRS CO 13 HEPAVIH cohort was set up to explore these critical questions.</p> <p>To describe the cohort aims and organization, monitoring and data collection procedures, baseline characteristics, as well as follow-up findings to date.</p> <p>Methods</p> <p>Inclusion criteria in the cohort were: age > 18 years, HIV-1 infection, chronic hepatitis C virus (HCV) infection or sustained response to HCV treatment. A standardized medical questionnaire collecting socio-demographic, clinical, biological, therapeutic, histological, ultrasound and endoscopic data is administered at enrolment, then every six months for cirrhotic patients or yearly for non-cirrhotic patients. Also, a self-administered questionnaire documenting socio-behavioral data and adherence to HIV and/or HCV treatments is administered at enrolment and yearly thereafter.</p> <p>Results</p> <p>A total of 1,175 patients were included from January 2006 to December 2008. Their median age at enrolment was 45 years and 70.2% were male. The median CD4 cell count was 442 (IQR: 304-633) cells/μl and HIV RNA plasma viral load was undetectable in 68.8%. Most participants (71.6%) were on HAART. Among the 1,048 HIV-HCV chronically co-infected patients, HCV genotype 1 was predominant (56%) and cirrhosis was present in 25%. As of January, 2010, after a median follow-up of 16.7 months (IQR: 11.3-25.3), 13 new cases of decompensated cirrhosis, nine hepatocellular carcinomas and 20 HCV-related deaths were reported, resulting in a cumulative HCV-related severe event rate of 1.9/100 person-years (95% CI: 1.3-2.5). The rate of HCV-related severe events was higher in cirrhotic patients and those with a low CD4 cells count, but did not differ according to sex, age, alcohol consumption, CDC clinical stage or HCV status.</p> <p>Conclusion</p> <p>The ANRS CO 13 HEPAVIH is a nation-wide cohort using a large network of HIV treatment, infectious diseases and internal medicine clinics in France, and thus is highly representative of the French population living with these two viruses and in care.</p

Staphylococcus lugdunensis, a serious pathogen in periprosthetic joint infections: comparison to Staphylococcus aureus and Staphylococcus epidermidis

Objectives: The aim of this study was to assess the characteristics of periprosthetic joint infection (PJI) due to Staphylococcus lugdunensis and to compare these to the characteristics of PJI due to Staphylococcus aureus and Staphylococcus epidermidis. Methods: A retrospective multicentre study including all consecutive cases of S. lugdunensis PJI (2000–2014) was performed. Eighty-eight cases of staphylococcal PJI were recorded: 28 due to S. lugdunensis, 30 to S. aureus, and 30 to S. epidermidis, as identified by Vitek 2 or API Staph (bioMérieux). Results: Clinical symptoms were more often reported in the S. lugdunensis group, and the median delay between surgery and infection was shorter for the S. lugdunensis group than for the S. aureus and S. epidermidis groups. Regarding antibiotic susceptibility, the S. lugdunensis strains were susceptible to antibiotics and 61% of the patients could be treated with levofloxacin + rifampicin. The outcome of the PJI was favourable for 89% of patients with S. lugdunensis, 83% with S. aureus, and 97% with S. epidermidis. Conclusion: S. lugdunensis is an emerging pathogen with a pathogenicity quite similar to that of S. aureus. This coagulase-negative Staphylococcus must be identified precisely in PJI, in order to select the appropriate surgical treatment and antibiotics

Brucellose : revue de la littérature à propos d’un cas pédiatrique

International audienc

Rapid Isolation of Staphylococcus aureus Pathogens from Infected Clinical Samples Using Magnetic Beads Coated with Fc-Mannose Binding Lectin

Here we describe how Staphylococcus aureus bacteria can be rapidly isolated from clinical samples of articular fluid and synovial tissue using magnetic beads coated with the engineered chimeric human opsonin protein, Fc-mannose-binding lectin (FcMBL). The FcMBL-beads were used to capture and magnetically remove bacteria from purified cultures of 12 S. aureus strains, and from 8 articular fluid samples and 4 synovial tissue samples collected from patients with osteoarthritis or periprosthetic infections previously documented by positive S. aureus cultures. While the capture efficiency was high (85%) with purified S. aureus strains grown in vitro, direct FcMBL-bead capture from the clinical samples was initially disappointing (< 5% efficiency). Further analysis revealed that inhibition of FcMBL binding was due to coating of the bacteria by immunoglobulins and immune cells that masked FcMBL binding sites, and to the high viscosity of these complex biological samples. Importantly, capture of pathogens using the FcMBL-beads was increased to 76% efficiency by pretreating clinical specimens with hypotonic washes, hyaluronidase and a protease cocktail. Using this approach, S. aureus bacteria could be isolated from infected osteoarthritic tissues within 2 hours after sample collection. This FcMBL-enabled magnetic method for rapid capture and concentration of pathogens from clinical samples could be integrated upstream of current processes used in clinical microbiology laboratories to identify pathogens and perform antibiotic sensitivity testing when bacterial culture is not possible or before colonies can be detected

Clinical Tissue Samples Infected with <i>S</i>. <i>aureus</i>.

<p>Clinical Tissue Samples Infected with <i>S</i>. <i>aureus</i>.</p

Inhibition of <i>S</i>. <i>aureus</i> capture by human immunoglobulin (Ig).

<p>Capture of cultured <i>S</i>. <i>aureus</i> strains isolated from clinical samples using FcMBL-beads (Control) was inhibited by adding 1 mg/ml total human Ig (+ Ig, mean: 8%). Depleting Ig in the supernatant of centrifuged clinical samples infected with <i>S</i>. <i>aureus</i> with protein A-coated magnetic beads partially restored the capture (SNT-SA + ProA, man: 23%). ***: p-value < 0.0001.</p

Pathogen capture efficiencies using magnetic separations for 12 <i>S</i>. <i>aureus</i> clinical isolates grown <i>in vitro</i>.

<p>All cultured bacterial strains isolated isolated from infected tissues bound to FcMBL-beads (FcMBL) and produced capture efficiencies ranging from 30 to 100% (mean: 84%). Use of Fc-coated magnetic beads (Fc) or FcMBL-beads in the presence of EDTA to support only binding to surface protein A resulted in much more heterogeneous response, with capture frequencies from 0 to 80% (mean Fc: 21%, mean EDTA: 24%). Fc capture was totally abolished by treatment with proteases that can degrade surface protein A (Fc + proteases), while FcMBL capture was conserved (mean: 68%) under the same conditions (FcMBL + proteases). ***: p-value < 0.0001; *: p-value < 0.05; NS: not significant</p

Restoration of FcMBL-mediated capture of <i>S</i>. <i>aureus</i> from infected articular fluids and synovial tissues.

<p>The high level (mean: 85% +/- 5.9) of FcMBL-mediated capture of cultured <i>S</i>. <i>aureus</i> strains (Cultured) was greatly reduced (mean: 1.3% +/- 1.2) when similar studies were carried out by adding FcMBL-beads directly to complex tissue samples. Addition of an enzymatic cocktail of proteases and hyaluronidase (Enzymes) to remove endogenous Ig and other potential surface masking proteins, as well as decrease sample viscosity, resulted in restoration of FcMBL binding (mean: 76% +/- 5.7). ***: p-value < 0.0001.</p

PCR results with articular fluids infected with <i>S</i>. <i>aureus</i>.

<p>PCR results with articular fluids infected with <i>S</i>. <i>aureus</i>.</p