Lyme disease in man: quid in 2018?

La maladie de Lyme connue depuis déjà longtemps, a pris récemment un regain d’intérêt dans les pays développés où au-delà de la forme classique de la maladie est venue s’adjoindre la notion de « Lyme chronique », entité non scientifiquement démontrée, mais revendiquée par des groupes et associations de malades, relayée par des forums de discussion, persuadés que leurs maux multiples et parfaitement subjectifs peuvent être expliqués par cette infection. Or la maladie de Lyme est une infection bien définie, épidémiologiquement, microbiologiquement et cliniquement. Les règles de diagnostic y compris biologique et de traitement sont scientifiquement établies comme pour toute pathologie infectieuse. Vouloir l’élargir à tous les troubles inexpliqués pour aboutir à des prises en charges non validées tient de l’empirisme pour ne pas dire de l’escroquerie.Lyme disease, already known for a long time, took recently a renewed interest in developed countries where, beyond the classic form of the disease, emerged the chronic Lyme disease entity, not scientifically proven, but claimed by groups and associations of sick people, relieved by web pages, convinced that their multiple and perfectly subjective symptoms could be explained by this infection. Yet, Lyme disease is a very precise infection, epidemiologically, microbiologically and clinically. As for any other infectious diseases, the diagnosis (clinical and biological) and treatment are scientifically defined. Widening this diagnosis to all unexplained disorders to end in not validated managements is mere empiricism, and not to say fraud or charlatanism

Human animal exchanges « good and less good ». The physician’s opinion

La relation entre l’Homme et l’animal est une constante, un élément essentiel puisque nous vivons en permanence l’un avec l’autre. Cette relation plus ou moins proche s’exprime par de nombreux aspects, dont une grande partie se rattache directement ou indirectement à la Santé. Toute relation comporte des aspects positifs mais aussi des points négatifs. Sont donc abordés ici, ces différents points, le bon pour l’Homme et pour l’animal, le moins bon également pour les deux protagonistes.The relationship between man and animal is a constant, an essential element since we live constantly with each other. This more or less close relationship is expressed by many elements, much of which relates directly or indirectly to Health. Every relationship has positive aspects, but also negative elements. These points are thus discussed here, the good for man and the animal, the less good also for the two protagonists

Distinct Time Effects of Vaccination on Long-Term Proliferative and IFN-γ–producing T Cell Memory to Smallpox in Humans

Residual immunity to the smallpox virus raises key questions about the persistence of long-term immune memory in the absence of antigen, since vaccination ended in 1980. IFN-γ–producing effector–memory and proliferative memory T cells were compared in 79 vaccinees 13–25 yr after their last immunization and in unvaccinated individuals. Only 20% of the vaccinees displayed both immediate IFN-γ–producing effector–memory responses and proliferative memory responses at 6 d; 52.5% showed only proliferative responses; and 27.5% had no detectable vaccinia-specific responses at all. Both responses were mediated by CD4 and CD8 T cells. The vaccinia-specific IFN-γ–producing cells were composed mainly of CD4Pos CD45RANeg CD11aHi CD27Pos and CCR7Neg T cells. Their frequency was low but could be expanded in vitro within 7 d. Time since first immunization affected their persistence: they vanished 45 yr after priming, but proliferative responses remained detectable. The number of recalls did not affect the persistence of residual effector–memory T cells. Programmed revaccination boosted both IFN-γ and proliferative responses within 2 mo of recall, even in vaccinees with previously undetectable residual effector–memory cells. Such long-term maintenance of vaccinia-specific immune memory in the absence of smallpox virus modifies our understanding of the mechanism of persistence of long-term memory to poxviruses and challenges vaccination strategies

Delayed-Onset Hemolytic Anemia in Patients with Travel-Associated Severe Malaria Treated with Artesunate, France, 2011–2013

French Artesunate Working GroupInternational audienceArtesunate is the most effective treatment for severe malaria. However, delayed-onset hemolytic anemia has been observed in ≈20% of travelers who receive artesunate, ≈60% of whom require transfusion. This finding could discourage physicians from using artesunate. We prospectively evaluated a cohort of 123 patients in France who had severe imported malaria that was treated with artesunate; our evaluation focused on outcome, adverse events, and postartesunate delayed-onset hemolysis (PADH). Of the 123 patients, 6 (5%) died. Overall, 97 adverse events occurred. Among the 78 patients who received follow-up for >8 days after treatment initiation, 76 (97%) had anemia, and 21 (27%) of the 78 cases were recorded as PADH. The median drop in hemoglobin levels was 1.3 g/dL; 15% of patients with PADH had hemoglobin levels of <7 g/dL, and 1 required transfusion. Despite the high incidence of PADH, the resulting anemia remained mild in 85% of cases. This reassuring result confirms the safety and therapeutic benefit of artesunate

Communication of pharmacogenetic research results to HIV-infected treated patients: standpoints of professionals and patients.

International audienceThe aim of pharmacogenetic studies is to adapt therapeutic strategies to individual genetic profiles, thus maximising their efficacy and minimising the likelihood of adverse side effects. Since the advent of personalised medicine, the issue of communicating research results to participants has become increasingly important. We addressed this question in the context of HIV infection, as patients and associations are particularly concerned by research and therapeutic advances. We explored the standpoints of both research professionals and participants involved in a pharmacogenetic study conducted in a cohort of HIV-infected patients. The setting of the research protocol was followed over a 2-year period. Participants' standpoints were collected through a questionnaire and interviews were conducted with research professionals. Of 125 participants, 76% wished to receive individual results and 71% wished to receive collective results; 39% did not know when results might be expected. Communication of global research results is a principle that is generally accepted by professionals. Concerning individual feedback, the professionals felt that it was necessary if it could be of direct benefit to the participant, but they expressed doubts for situations with no recognised benefit. Our results highlight the necessity to consider this issue in greater detail. We suggest the need to anticipate the debates concerning individual feedback, to differentiate between situations and the importance of further investigations on the opportunities and modalities of communication. Finally, our work emphasised the opposite pressures between the pursuit of scientific knowledge and the therapeutic orientation of clinical trials

T-cell and serological responses to Erp, an exported Mycobacterium tuberculosis protein, in tuberculosis patients and healthy individuals

<p>Abstract</p> <p>Background</p> <p>The identification of antigens able to differentiate tuberculosis (TB) disease from TB infection would be valuable. Cellular and humoral immune responses to Erp (Exported repetitive protein) – a recently identified <it>M. tuberculosis </it>protein – have not yet been investigated in humans and may contribute to this aim.</p> <p>Methods</p> <p>We analyzed the cellular and humoral immune responses to Erp, ESAT-6, Ag85B and PPD in TB patients, in BCG⁺individuals without infection, BCG⁺individuals with latent TB infection (LTBI) and BCG^-controls. We used lymphoproliferation, ELISpot IFN-γ, cytokine production assays and detection of specific human antibodies against recombinant <it>M. tuberculosis </it>proteins.</p> <p>Results</p> <p>We included 22 TB patients, 9 BCG⁺individuals without TB infection, 7 LTBI and 7 BCG^-controls. Erp-specific T cell counts were higher in LTBI than in the other groups. Erp-specific T cell counts were higher in LTBI subjects than TB patients (median positive frequency of 211 SFC/10⁶PBMC (range 118–2000) for LTBI subjects compared to 80 SFC/10⁶PBMC (range 50–191), p = 0.019); responses to PPD and ESAT-6 antigens did not differ between these groups. IFN-γ secretion after Erp stimulation differed between TB patients and LTBI subjects (p = 0.02). Moreover, LTBI subjects but not TB patients or healthy subjects produced IgG3 against Erp.</p> <p>Conclusion</p> <p>The frequencies of IFN-γ-producing specific T cells, the IFN-γ secretion and the production of IgG3 after Erp stimulation are higher in LTBI subjects than in TB patients, whereas PPD and ESAT-6 are not.</p

Covid 19 :chloroquine & hydoxychloroquine, a dilemma !

Bricaire François. Covid-19 : Chloroquine et hydroxychloroquine, un dilemme!. In: Bulletin de l'Académie Vétérinaire de France tome 173 n°1, 2020. pp. 83-84