Parasite

A 72-year-old man consulted in November 2012 for abdominal pain in the right upper quadrant. The patient had a history of suspected hepatic amebiasis treated in Senegal in 1985 and has not traveled to endemic areas since 1990. Abdominal CT scan revealed a liver abscess. At first, no parasitological tests were performed and the patient was treated with broad-spectrum antibiotics. Only after failure of this therapy, serology and PCR performed after liver abscess puncture established the diagnosis of hepatic amebiasis. The patient was treated with metronidazole and tiliquinol-tilbroquinol. Amebic liver abscess is the most frequent extra-intestinal manifestation. Hepatic amebiasis 22 years after the last visit to an endemic area is exceptional and raises questions on the mechanisms of latency and recurrence of these intestinal protozoan parasites. Un homme de 72 ans consulte en novembre 2012 pour des douleurs abdominales dans le quadrant supérieur droit. Le patient présente un antécédent probable d’abcès amibien du foie traité en 1985 au Sénégal et n’a pas voyagé en région d’endémie depuis 1990. Le scanner abdominal réalisé met en évidence un abcès hépatique. Dans un premier temps, aucun examen parasitologique n’est effectué et le patient est traité par des antibiotiques à large spectre. Suite à l’échec de ce traitement, la sérologie et la PCR réalisées après ponction de l’abcès hépatique, établissent le diagnostic d’amibiase hépatique. Le patient est traité par métronidazole et tiliquinol-tilbroquinol. L’abcès amibien du foie est la manifestation extra-intestinale de l’amibiase la plus fréquente. L’amibiase hépatique 22 ans après le dernier voyage en zone d’endémie est exceptionnelle et soulève des questions concernant les mécanismes de latence et de récurrence des protozoaires intestinaux

Progressive skin fibrosis is associated with a decline in lung function and worse survival in patients with diffuse cutaneous systemic sclerosis in the European Scleroderma Trials and Research (EUSTAR) cohort.

Objectives To determine whether progressive skin fibrosis is associated with visceral organ progression and mortality during follow-up in patients with diffuse cutaneous systemic sclerosis (dcSSc). Methods We evaluated patients from the European Scleroderma Trials and Research database with dcSSc, baseline modified Rodnan skin score (mRSS) ≥7, valid mRSS at 12±3 months after baseline and ≥1 annual follow-up visit. Progressive skin fibrosis was defined as an increase in mRSS >5 and ≥25% from baseline to 12±3 months. Outcomes were pulmonary, cardiovascular and renal progression, and all-cause death. Associations between skin progression and outcomes were evaluated by Kaplan-Meier survival analysis and multivariable Cox regression. Results Of 1021 included patients, 78 (7.6%) had progressive skin fibrosis (skin progressors). Median follow-up was 3.4 years. Survival analyses indicated that skin progressors had a significantly higher probability of FVC decline ≥10% (53.6% vs 34.4%; p<0.001) and all-cause death (15.4% vs 7.3%; p=0.003) than non-progressors. These significant associations were also found in subgroup analyses of patients with either low baseline mRSS (≤22/51) or short disease duration (≤15 months). In multivariable analyses, skin progression within 1 year was independently associated with FVC decline ≥10% (HR 1.79, 95% CI 1.20 to 2.65) and all-cause death (HR 2.58, 95% CI 1.31 to 5.09). Conclusions Progressive skin fibrosis within 1 year is associated with decline in lung function and worse survival in dcSSc during follow-up. These results confirm mRSS as a surrogate marker in dcSSc, which will be helpful for cohort enrichment in future trials and risk stratification in clinical practice

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

Effet de la supplémentation en vitamine D native sur la rigidité artérielle des patients hémodialysés.

STRASBOURG-Medecine (674822101) / SudocSudocFranceF

Etude immunohistochimique de la PTHrP et du récepteur RPTH1 dans le rein humain et diabétique

STRASBOURG-Medecine (674822101) / SudocSudocFranceF

Hémodialyse chez le patient traité par antivitamine K (faut-il hépariniser ?)

STRASBOURG-Medecine (674822101) / SudocSudocFranceF

Epidémiologie des microangiopathies thrombotiques traitées dans le service de néphrologie du CHU de Strasbourg entre 2002 et 2012

STRASBOURG-Medecine (674822101) / SudocSudocFranceF

Vascularites associées aux ANCA (pronostic rénal et général en cas de glomérulonéphrite rapidement progressive depuis le recours aux échanges plasmatiques)

STRASBOURG-Medecine (674822101) / SudocSudocFranceF

Epidémiologie de l'insuffisance rénale aiguë aux soins intensifs de néphrologie

STRASBOURG-Medecine (674822101) / SudocSudocFranceF