Chagas Disease, France

Chagas Disease, Franc

Infectious complications following heart transplantation in the era of high-priority allocation and extracorporeal membrane oxygenation

Abstract Background Infectious complications are a major cause of morbidity and mortality after heart transplantation (HT). However, the epidemiology and outcomes of these infections in the recent population of adult heart transplant recipients have not been investigated. Methods We conducted a single-center retrospective study on infectious complications occurring within 180 days following HT on consecutive heart transplant recipients, from January 2011 to June 2015 at Bichat University Hospital in Paris, France. Risk factors for non-viral infections occurring within 8, 30 and 180 days after HT were investigated using competing risk analysis. Results Overall, 113 patients were included. Fifty-eight (51%) HTs were high-priority allocations. Twenty-eight (25%) patients had an extracorporeal membrane oxygenation (ECMO) support at the time of transplantation. Ninety-two (81%) patients developed at least one infection within 180 days after HT. Bacterial and fungal infections (n = 181 episodes) occurred in 80 (71%) patients. The most common bacterial and fungal infections were pneumonia (n = 95/181 episodes, 52%), followed by skin and soft tissue infections (n = 26/181, 14%). Multi-drug-resistant bacteria were responsible for infections in 21 (19%) patients. Viral infections were diagnosed in 44 (34%) patients, mostly Cytomegalovirus infection (n = 39, 34%). In multivariate subdistribution hazard model, prior cardiac surgery (subdistribution hazard ratio sHR = 2.7 [95% CI 1.5–4.6] p < 0.01) and epinephrine or norepinephrine at the time of HT (sHR = 2.3 [95% CI 1.1–5.2] p  = 0.04) were significantly associated with non-viral infections within 8 days after HT. Prior cardiac surgery (sHR = 2.5 [95% CI 1.4–4.4] p < 0.01), recipient age over 60 years (sHR = 2.0 [95% CI 1.2–3.3] p < 0.01) and ECMO following HT (sHR = 1.7 [95% CI 1.0–2.8] p = 0.04) were significantly associated with non-viral infection within 30 days after HT, as well as within 180 days after HT. Conclusion This study confirmed the high rate of infections following HT. Recipient age, prior cardiac surgery and ECMO following HT were independent risk factors for early and late bacterial and fungal infections

Metagenomic Analysis of Microdissected Valvular Tissue for Etiologic Diagnosis of Blood Culture Negative Endocarditis

International audienceBackgroundEtiological diagnosis is a key to therapeutic adaptation and improved prognosis, particularly for infections such as endocarditis. In blood culture–negative endocarditis (BCNE), 22% of cases remain undiagnosed despite an updated comprehensive syndromic approach. This prompted us to develop a new diagnostic approach.MethodsEleven valves from 10 BCNE patients were analyzed using a method that combines human RNA bait-depletion with phi29 DNA polymerase-based multiple displacement amplification and shotgun DNA sequencing. An additional case in which a microbe was serendipitously visualized by immunofluorescence was analyzed using the same method, but after laser capture microdissection.ResultsBackground DNA prevented any diagnosis in cases analyzed without microdissection because the majority of sequences were contaminants. Moraxella sequences were dramatically enriched in the stained microdissected region of the additional case. A consensus genome sequence of 2.4 Mbp covering more than 94% of the Moraxella osloensis KSH reference genome was reconstructed with 234X average coverage. Several antibiotic-resistance genes were observed. Etiological diagnosis was confirmed using Western blot and specific polymerase chain reaction with sequencing on a different valve sample.ConclusionsMicrodissection could be a key to the metagenomic diagnosis of infectious diseases when a microbe is visualized but remains unidentified despite an updated optimal approach. Moraxella osloensis should be tested in blood culture–negative endocarditi

First results of tests on the WEAVE fibres

WEAVE is a new wide-field spectroscopy facility proposed for the prime focus of the 4.2m William Herschel Telescope. The facility comprises a new 2-degree field of view prime focus corrector with a 1000-multiplex fibre positioner, a small number of individually deployable integral field units, and a large single integral field unit. The IFUs (Integral Field Units) and the MOS (Multi Object Spectrograph) fibres can be used to feed a dual-beam spectrograph that will provide full coverage of the majority of the visible spectrum in a single exposure at a spectral resolution of 5000 or modest wavelength coverage in both arms at a resolution 20000. The instrument is expected to be on-sky by the first quarter of 2018 to provide spectroscopic sampling of the fainter end of the Gaia astrometric catalogue, chemical labeling of stars to V 17, and dedicated follow up of substantial numbers of sources from the medium deep LOFAR surveys. After a brief description of the Fibre System, we describe the fibre test bench, its calibration, and some test results. We have to verify 1920 fibres from the MOS bundles and 740 fibres from the mini-IFU bundles with the test bench. In particular, we present the Focal Ratio Degradation of a cable

Fibre links for the WEAVE instrument: the making of

International audienceThe WEAVE instrument nearing completion for the William Herschel Telescope is a fiber-fed spectrograph operating in three different modes. Two comprise deployable fibers at the prime focus for point-like objects and small integral field units (IFU), the third is a large IFU placed at the center of the field. Three distinct fiber systems support these modes and route the photons to the spectrograph located on the Nasmyth platform 33m away: the first features 960+940 fibers and is duplicated to allow configuring the fibers on one plate while observation is carried out on the other, the second has 20 hexagonal IFUs featuring 37 fibers each, the third is a large array of 609 fibers with twice the former's diameter. The large number of fibers and the diversity of their instantiation have made procurement of the parts and assembly of the custom cables a challenge. They involve project partners in France, the UK and the Netherlands and industrial partners in France, Canada, the USA and China to combine know-how and compress the schedule by parallelizing assembly of the cables. Besides the complex management that this induces, it has called for revising the fibers' handling to relax tolerances and for a rigorous assessment of the conformity of the products. This paper tells the story of the making of the fiber links, presents the overall organization of the procurement and assembly chains together with the inspection and testing allowing for assessing the conformance of the hardware delivered