Management of tuberculosis: are the practices homogeneous in high-income countries?

Objectives: to evaluate and compare practices regarding the diagnosis, isolation measures, and treatment of tuberculosis (TB) in high-income countries and mainly in Europe. Materials and Methods: a survey was conducted from November 2018 to April 2019 within the European Society of Clinical Microbiology and Infectious Diseases Study Group for Mycobacterial Infections (ESGMYC). The practices observed were compared to the main international guidelines. Results: among 136 ESGMYC members, 64 (17 countries) responded to the questionnaire. In their practice, two (20.7%) or three sputum samples (79.3%) were collected for the diagnosis of pulmonary TB, alternatively induced sputum (n = 37, 67.2%), bronchoscopy (34, 58.6%), and gastric aspirates (15, 25.9%). Nucleic acid amplification tests (NAATs) were performed by 41 (64%) respondents whatever the smear result and by 47 (73%) in case of smear-positive specimens. NAAT and adenosine deaminase measurement were used for extrapulmonary TB diagnosis in 83.6 and 40.4% of cases, respectively. For isolation duration, 21 respondents (42.9%) were keeping isolation until smear negativity. An initial treatment without ethambutol was offered by 14% (n = 9) of respondents. Corticosteroid therapy, cerebrospinal fluid opening pressure testing, and repeated lumbar puncture were carried out for central nervous system TB by 79.6, 51.9, and 46.3% of the respondents, respectively. For patients with human immunodeficiency virus-TB coinfection, the preferred antiretroviral therapy included dolutegravir 50 mg twice a day (56.8%). Comparing with the recommendations of the main guidelines, the practices are not totally consistent. Conclusion: this study shows heterogeneous practices, particularly for diagnosis, and isolation, although rapid molecular testing is implemented in most centers. More standardization might be needed

Vaccine breakthrough hypoxemic COVID-19 pneumonia in patients with auto-Abs neutralizing type I IFNs

Life-threatening `breakthrough' cases of critical COVID-19 are attributed to poor or waning antibody response to the SARS- CoV-2 vaccine in individuals already at risk. Pre-existing autoantibodies (auto-Abs) neutralizing type I IFNs underlie at least 15% of critical COVID-19 pneumonia cases in unvaccinated individuals; however, their contribution to hypoxemic breakthrough cases in vaccinated people remains unknown. Here, we studied a cohort of 48 individuals ( age 20-86 years) who received 2 doses of an mRNA vaccine and developed a breakthrough infection with hypoxemic COVID-19 pneumonia 2 weeks to 4 months later. Antibody levels to the vaccine, neutralization of the virus, and auto- Abs to type I IFNs were measured in the plasma. Forty-two individuals had no known deficiency of B cell immunity and a normal antibody response to the vaccine. Among them, ten (24%) had auto-Abs neutralizing type I IFNs (aged 43-86 years). Eight of these ten patients had auto-Abs neutralizing both IFN-a2 and IFN-., while two neutralized IFN-omega only. No patient neutralized IFN-ss. Seven neutralized 10 ng/mL of type I IFNs, and three 100 pg/mL only. Seven patients neutralized SARS-CoV-2 D614G and the Delta variant (B.1.617.2) efficiently, while one patient neutralized Delta slightly less efficiently. Two of the three patients neutralizing only 100 pg/mL of type I IFNs neutralized both D61G and Delta less efficiently. Despite two mRNA vaccine inoculations and the presence of circulating antibodies capable of neutralizing SARS-CoV-2, auto-Abs neutralizing type I IFNs may underlie a significant proportion of hypoxemic COVID-19 pneumonia cases, highlighting the importance of this particularly vulnerable population

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Prévalence des génotypes des papillomavirus humains chez des patients séropositifs pour le VIH (argumentaire pour une vaccination universelle anti-HPV)

L incidence des carcinomes anaux HPV-induits ne diminue pas chez les hommes VIH+ ayant des rapports sexuels avec les hommes (HSH) malgré l ère des trithérapies. L objectif de cette étude est de déterminer la prévalence des HPV chez des patients VIH dans un centre parisien et d en analyser les facteurs de risque. METHODELes hommes et femmes VIH+ du service de maladies infectieuses de l hôpital Tenon ayant eu un frottis à la recherche d HPV étaient inclus rétrospectivement. RESULTATS 93 HSH et 15 femmes âgés de 27 à 73 ans étaient analysés. Parmi les 33% des hommes qui avaient un examen clinique anormal, 70% de condylomes et 6,7% de dysplasies de bas grade étaient trouvés, alors que chez les femmes, les dysplasies de bas grade (60%) étaient plus fréquentes que les condylomes (30%).Les HPV 16 et 52 étaient majoritairement représentés avec des prévalences de 28% et 30% respectivement. Un portage asymptomatique était retrouvé chez 71,6% des patients avec une prévalence de 60% des HPV à haut risque (HR) et de 60,1% d'infection par plus d'un HPV. Cette étude n'a pas mis en évidence de facteur de risque d'infection par HPV. DISCUSSIONIl existe une forte prévalence d infection anale par HPV chez les HSH VIH+. La vaccination anti-HPV des patients HSH a montré son efficacité dans d'autres pays. Parallèlement, un dépistage précoce des néoplasies intraépithéliales anales et leur traitement permettraient de diminuer l incidence des carcinomes invasifs. CONCLUSION Les maladies HPV induites sont un enjeu de santé publique avec plus de 5% des cancers dans le monde attribuables aux HPV à HR. La vaccination, actuellement débattue, pourrait prévenir ce risque chez les HSHPARIS12-CRETEIL BU Médecine (940282101) / SudocSudocFranceF

Abcès amibiens hépatiques en Ile-de-France (à propos de 90 cas)

Les abcès amibiens hépatiques sont la principale manifestation extra intestinale de l amoebose invasive. Ils ont été largement décrits en zone d endémie. En zone non endémique on les décrit classiquement chez les touristes et immigrés. Nous avons voulu étudier les abcès amibiens hépatiques en Ile-de-France, région avec près de 2 millions d immigrés et une part non négligeable des 4.5 millions de touristes français se rendant chaque année en zone tropicale. Nous avons étudié 90 dossiers de patients présentant un abcès amibien hépatique dans 13 hôpitaux différents. Nous avons décrit ces dossiers, puis, à l aide d un modèle de régression logistique nous avons d une part, étudié les facteurs associés à la ponction hépatique, et d autre part, les facteurs associés à des abcès de grosse taille. Enfin nous avons analysé la guérison de ces abcès dans un modèle de Cox. La présentation des abcès en zone non endémique est celle classiquement décrite dans la littérature avec une part importante de touristes (40%). La prise en charge ne suit pas de logique particulière quant à la ponction hépatique. Les patients pris en charge dans un service chirurgical sont plus à risque de se faire ponctionner (OR=10.0, IC 95%, p=0.001), même si ces derniers n accueillent pas plus d abcès de grosse taille que les autres services. Les hommes (OR=6.07, Ic 95%, p=0.02) ainsi que les migrants n étant pas retournés en zone d endémie (OR 6.94, IC 95%, p=0.03) sont plus à risque de développer un abcès de grosse taille. Seule la taille influence la guérison : les abcès de grande taille ont tendance à guérir plus lentement (RR .40, IC 95 %, p=0.06).PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Socioeconomic impact of the COVID-19 crisis and early perceptions of COVID-19 vaccines among immigrant and nonimmigrant people living with HIV followed up in public hospitals in Seine-Saint-Denis, France.

The burden of the first year of the coronavirus disease 2019 (COVID-19) pandemic was greater for vulnerable populations, such as immigrants, people living in disadvantaged urban areas, and people with chronic illnesses whose usual follow-up may have been disrupted. Immigrants receiving care for HIV in Seine-Saint-Denis' hospitals have a combination of such vulnerabilities, while nonimmigrant people living with HIV (PLWHIV) have more heterogeneous vulnerability profiles. The ICOVIH study aimed to compare the socioeconomic effects of the COVID-19 crisis as well as attitudes toward COVID-19 vaccination among immigrant and nonimmigrant PLWHIV. A questionnaire assessed vulnerabilities prior to the COVID-19 epidemic and the impact of the early epidemic on administrative, residential, professional, and financial fields. We surveyed 296 adults living with HIV at four hospitals in Seine-Saint-Denis, the poorest metropolitan French department, between January and May 2021. Administrative barriers affected 9% of French-born versus 26.3% of immigrant participants. Immigrants experienced financial insecurity and hunger more often than nonimmigrant participants (21.8% versus 7.1% and 6.6% versus 3%, respectively). Spontaneous acceptance of vaccination was higher among nonimmigrant than among immigrant participants (56.7% versus 32.1%), while immigrants were more likely to wait for their doctor's recommendation or for their doctor to convince them than their French-born counterparts (34.2% versus 19.6%). The trust-based doctor‒patient relationship established through HIV follow-up appeared to be a determining factor in the high acceptance of the COVID-19 vaccine among immigrant participants

Atovaquone-proguanil in the treatment of imported uncomplicated Plasmodium falciparum malaria: a prospective observational study of 553 cases.

International audienceBACKGROUND: Each year, thousands of cases of uncomplicated malaria are imported into Europe by travellers. Atovaquone-proguanil (AP) has been one of the first-line regimens used in France for uncomplicated malaria for almost ten years. While AP's efficacy and tolerance were evaluated in several trials, its use in "real life" conditions has never been described. This study aimed to describe outcome and tolerance after AP treatment in a large cohort of travellers returning from endemic areas. METHODS: Between September 2002 and January 2007, uncomplicated malaria treated in nine French travel clinics with AP were followed for 30 days after AP initiation. Clinical and biological data were collected at admission and during the follow-up. RESULTS: A total of 553 patients were included. Eighty-eight percent of them were born in Africa, and 61.8 % were infected in West Africa, whereas 0.5 % were infected in Asia. Migrants visiting friends and relatives (VFR) constituted 77.9 % of the patients, the remainder (32.1 %) were backpackers. Three-hundred and sixty-four patients (66 %) fulfilled follow-up at day 7 and 265 (48 %) completed the study at day 30. Three patients had treatment failure. One-hundred and seventy-seven adverse drug reactions (ADR) were reported during the follow-up; 115 (77 %) of them were digestive ADR. Backpackers were more likely to experiment digestive ADR compared to VFR (OR = 3.8; CI 95 % [1.8-8.2]). Twenty patients had to be switched to another regimen due to ADR. CONCLUSION: This study seems to be the largest in terms of number of imported uncomplicated malaria cases treated by AP. The high rate of reported digestive ADR is striking and should be taken into account in the follow-up of patients since it could affect their adherence to the treatment. Beside AP, artemisinin combination therapy (ACT) is now recommended as first-line regimen. A comparison of AP and ACT, in terms of efficacy and tolerance, would be useful

Main characteristics for 90 patients with amoebic liver abscess.

<p>° : patients born and living in France who travelled to tropical areas °° : patients born in France living in an endemic region °°° : patients born in an endemic region and living in France who traveled back to their country to visit friends and relatives °°°° : patients born in an endemic region and living in France who did not return to their country since they immigrated * : White Blood Cells, ** C-Reactive Protein.</p

Flow chart.

<p>Flow chart.</p