Epidemic typhus imported from Algeria.

We report epidemic typhus in a French patient returning from Algeria. The diagnosis was confirmed by serologic testing and the isolation of Rickettsia prowazekii in blood. Initially the patient was thought to have typhoid fever. Because body lice are prevalent in industrialized regions, the introduction of typhus to pediculosis-endemic areas poses a serious public health risk

Bartonella quintana Characteristics and Clinical Management

The pathogen is reemerging in the United States and Europe and is responsible for a number of clinical conditions

Questions on Mediterranean Spotted Fever a Century after Its Discovery

New findings in MSF epidemiology, clinical features, and severe forms have changed the general perception of MSF

Triangular test applied to the clinical trial of azithromycin against relapses in Plasmodium vivax infections

BACKGROUND: Sequential analysis enables repeated statistical analyses to be performed throughout a trial recruitment period, while maintaining a pre-specified power and type I error. Thus the trial can be stopped as soon as the information accumulated is considered sufficient to reach a conclusion. Sequential tests are easy to use and their statistical properties are especially suitable to trials with very straightforward objectives such as non-comparative phase II trials. We report on a phase II study based on the triangular test (TT) aiming at assessing the effectiveness of azithromycin in preventing Plasmodium vivax relapses. METHODS: To test whether the P. vivax relapse rate was either <12% or ≥ 45% in patients treated with azithromycin, a sequential analysis based on the TT was as used. Patients infected with P. vivax were treated with azithromycin, 1.2 g daily, for 7 days. The onset of a relapse infection was monitored. RESULTS: Five patients presenting with an acute P. vivax infection were included in the study. All the patients were initially cured. Three patients reported mild gastrointestinal adverse effects. When the third patient relapsed, the sample path crossed the upper boundary of the TT, and the trial was stopped. CONCLUSIONS: Using the triangular test, with only a small number of patients, we concluded that azithromycin was not effective enough in preventing P. vivax relapses to warrant further evaluation in phase III. It is suggested that a wider use of sequential analysis in phase II anti-infective drugs trials may have financial and ethical benefits

Enhancing the evaluation of pathogen transmission risk in a hospital by merging hand-hygiene compliance and contact data: a proof-of-concept study

BACKGROUND:Hand-hygiene compliance and contacts of health-care workers largely determine the potential paths of pathogen transmission in hospital wards. We explored how the combination of data collected by two automated infrastructures based on wearable sensors and recording (1) use of hydro-alcoholic solution and (2) contacts of health-care workers provide an enhanced view of the risk of transmission events in the ward. METHODS:We perform a proof-of-concept observational study. Detailed data on contact patterns and hand-hygiene compliance of health-care workers were collected by wearable sensors over 12days in an infectious disease unit of a hospital in Marseilles, France.RESULTS:10,837 contact events among 10 doctors, 4 nurses, 4 nurses' aids and 4 housekeeping staff were recorded during the study. Most contacts took place among medical doctors. Aggregate contact durations were highly heterogeneous and the resulting contact network was highly structured. 510 visits of health-care workers to patients' rooms were recorded, with a low rate of hand-hygiene compliance. Both data sets were used to construct histories and statistics of contacts informed by the use of hydro-alcoholic solution, or lack thereof, of the involved health-care workers. CONCLUSIONS:Hand-hygiene compliance data strongly enrich the information concerning contacts among health-care workers, by assigning a 'safe' or 'at-risk' value to each contact. The global contact network can thus be divided into 'at-risk' and 'safe' contact networks. The combined data could be of high relevance for outbreak investigation and to inform data-driven models of nosocomial disease spread

Q Fever Outbreak in Homeless Shelter

Urban outbreaks of Q fever have occurred after exposure to slaughterhouses or parturient cats. We detected an outbreak of Q fever in a homeless shelter in Marseilles. Investigations showed that the main factors exposing persons to Coxiella burnetii were an abandoned slaughterhouse, used for an annual Muslim sheep feast, and wind

Acute cytomegalovirus infection complicated by venous thrombosis: a case report

BACKGROUND: CMV-induced vasculopathy and thrombosis have been reported, but they are rare conditions usually encountered in immunocompromised patients. However more and more complications of CMV infections are recognized in immunocompetent patients. CASE PRESENTATION: We present a case report of a previously healthy adult with cytomegalovirus infection that was complicated by tibiopopliteal deep venous thrombosis and in whom Factor V Leiden heterozygous mutation was found. CONCLUSION: This new case report emphasizes the involvement of cytomegalovirus in induction of vascular thrombosis in patients with predisposing risk factors for thrombosis. It is necessary to screen for CMV infection in patients with spontaneous thrombosis and an history of fever

Letter to the editor : management of patients with Ebola virus disease in Europe : high-level isolation units should have a key role

In the past, the rare imported cases of Ebola and Marburg in western European countries and the United States were managed in high-level isolation units (HLIUs). Subsequently, reported experiences indicate that strict contact-droplet isolation is enough for preventing transmission. From this hypothesis, the idea may derive that HLIUs are not strictly necessary for the management of EVD patients, who may be safely managed in non-specialised hospitals, as suggested by some international recommendations elaborated during the current Ebola outbreak in West Africa. Even if we concur that strict contact-droplet isolation is enough to prevent transmission during routine care, we believe that HLIUs should have a key role in EVD containment in countries where such facilities are available. An HLIU is a healthcare facility specifically designed to provide safe, secure, high-quality, and appropriate care, with optimal infection containment and infection prevention and control procedures, for a single patient or a small number of patients who have, or who may have, a highly infectious disease.peer-reviewe