La rage

International audienceRabies virus, a neurotropic lyssavirus responsible for unavoidable fatal encephalitis, is transmitted by saliva of infected animals through bite, scratch or licking of broken skin or a mucous membrane. Infection can be prevented by timely prevention (wash for several minutes, antisepsis and vaccination completed by antirabies immunoglobulins [Ig] according to the severity of exposure). The 55,000 human deaths estimated annually worldwide result mainly from uncontrolled canine rabies in enzootic countries (particularly in Africa and in Asia), attributable to a lack of resources or interest for this disease. Bat rabies, henceforth first cause of human's rabies in many countries in America, affects a very small number of individuals but seems more difficult to control. Shortened vaccine protocols, rationalized use of Ig and development of products of substitution should enhance access of exposed patients to prevention. Finally, research on the biological cycle, the pathogeny and on escape of virus-induced mechanisms from the immune system should continue to pave the way for presently unknown treatments of clinical rabies

L'immunothérapie antirabique passive d'hier et d'aujourd'hui.

International audienceRabies is a fatal disease transmitted by infected animals by bite, scratch, licking on broken skin or contamination of mucosis by saliva. The regimen of post-exposure prophylaxis for people not previously vaccinated, that is currently recommended by WHO, consists of a combination of wound cleaning, active immunization and passive immunization when the exposure is of category 3. Most of the products available on the market, in particular human rabies immunoglobulins, highly purified equine rabies immunoglobulins and the derived F(ab')(2) fragments, are now characterized by high potency and safety. Although the interest of passive anti-rabies immunization was first demonstrated in the first half of the 20th century, there is still an inadequate supply of these products to the target populations mostly in developing countries. Therefore, it is urgent to set-up training and information actions for healthcare personnel on the need to use passive immunotherapy and the lack of adverse effects of the related products. For the future, we hope that a scale up of production and a lower price will improve the accessibility to these products. The development of new products based on monoclonal antibodies and molecular biology, and which may be cheaper, is promising

MANAGEMENT OF RABIES Post-exposure prophylaxis against rabies is still needed after a bite from a vaccinated animal

International audienceno abstrac

Etude coût-bénéfice de l'accès aux thérapeutiques antirétrovirales dans le cadre d' un regroupement inter-entreprises au Cameroun

PARIS-BIUM (751062103) / SudocCentre Technique Livre Ens. Sup. (774682301) / SudocSudocFranceF

Risk for Rabies Importation from North Africa

International audienceA retrospective study conducted in France indicated that a large proportion of patients injured by potentially rabid animals while in North Africa did not seek pretravel advice, and some had not received proper rabies postexposure prophylaxis while in North Africa. As a result, imported human rabies cases are still being reported, and the need for postexposure prophylaxis after exposure in North Africa is not declining. Tourists are generally unaware of the danger of importing potentially rabid animals and of the rules governing the movement of pets. In France, for example, rabid dogs have frequently been imported from Morocco to France through Spain. This situation imposes heavy social and economic costs and impedes rabies control in Europe. Rabies surveillance and control should therefore be reinforced in North Africa, and travelers to North Africa should receive appropriate information about rabies risk and prevention

Travel-Associated Rabies in Pets and Residual Rabies Risk, Western Europe

In 2015, countries in western Europe were declared free of rabies in nonflying mammals. Surveillance data for 2001–2013 indicate that risk for residual rabies is not 0 because of pet importation from countries with enzootic rabies. However, the risk is so low (7.52 × 10−10) that it probably can be considered negligible

Émergence des levures de type

Candida sp. est le premier agent en cause dans les infections fongiques invasives. La prévalence des candidémies est en augmentation, représentant près de 0,3 ‰ des admissions hospitalières en Europe, ce qui est important pour une pathologie dont la mortalité à 30 jours avoisine les 40 %. Cette émergence est en lien avec une augmentation des situations à risque dont fait partie l'utilisation étendue des antibiotiques. Nous avons cherché au travers d'une revue de la littérature à préciser ce lien entre antibiothérapie et Candida. Les antibiotiques, en détruisant une partie de la flore commensale bactérienne (à prédominance anaérobie au niveau digestif), permettent aux Candida, qui font partie de la flore, d'adhérer à la muqueuse et de se développer. L'augmentation du nombre de sites colonisés et de la charge fongique favorise ensuite l'infection. Enfin, la colonisation et l'infection à Candida sont d'autant plus fréquentes que la durée et le nombre d'antibiotiques prescrits sont importants. Les antibiotiques présentant un large spectre ou une activité sur la flore commensale comme les β-lactamines associées à un inhibiteur des β-lactamases ainsi que les céphalosporines de 3e génération à bonne diffusion digestive, les fluoroquinolones les plus récentes ou l'ertapénème, mais aussi lavancomycine, sont particulièrement pourvoyeurs de candidoses. En revanche, les antibiotiques peu actifs sur les bactéries de la flore qui ont u n e activité inhibitrice vis-à-vis des Candida, ou à mauvaise diffusion digestive, comme la roxithromycine, le linézolide, le céfépime ou l'aztréonam sont peu pourvoyeurs de candidose invasive

Rabies Risk: Difficulties Encountered during Management of Grouped Cases of Bat Bites in 2 Isolated Villages in French Guiana

International audienceIn French Guiana, from 1984 to 2011, 14 animal rabies cases and 1 human rabies case (2008) were diagnosed. In January 2011, vampire-bat attacks occurred in 2 isolated villages. In mid-January, a medical team from the Cayenne Centre for Anti-Rabies Treatment visited the sites to manage individuals potentially exposed to rabies and, in April, an anti-rabies vaccination campaign for dogs was conducted. Twenty individuals were bitten by bats in 1 month, most frequently on the feet. The median time to start management was 15 days. The complete Zagreb vaccination protocol (2 doses on day 0 and 1 dose on days 7 and 21) was administered to 16 patients, 12 also received specific immunoglobulins. The antibody titration was obtained for 12 patients (different from those who received immunoglobulins). The antibody titers were $0.5 EU/mL for all of them. The serology has not been implemented for the 12 patients who received immunoglobulins. Accidental destruction of a vampire-bat colony could be responsible for the attacks. The isolation and absence of sensitization of the populations were the main explanations for the management difficulties encountered. Sensitization programs should be conducted regularly