Décès d’un nourrisson dans un contexte de syndrome pieds-mains-bouche associé à l’entérovirus A71

International audienceHand, foot, and mouth disease associated with enterovirus (EV) infections is a common pediatric pathology that is usually considered as benign. However, neurological complications of varying severity, sometimes fatal, are possible, particularly when EV-A71 is involved. Several Asian countries are regularly affected by large-scale epidemics of EV infections with substantial morbidity and mortality, where early screening and appropriate therapeutic management are a public health challenge. In 2016, Europe experienced an epidemic of unusual magnitude, associated with increasing cases of severe neurological complications in Spain and France, mainly affecting children. Virological diagnosis is based on EV genome detection in peripheral clinical specimens (vesicles or oral ulcerations, throat, nasopharyngeal aspirate, stool) in addition to cerebrospinal fluid and blood. EV-A71 is rarely detected in cerebrospinal fluid, which renders the diagnosis of EV-A71-associated encephalitis challenging. We report the case of a 27-month-old child with hand, foot, and mouth disease turning into rapidly progressive and fatal cardiopul-monary failure associated with EV-A71 infection, in France in 2016Le syndrome pieds-mains-bouche associé à une infection à entérovirus (EV) est une affection fréquente chez l’enfant, habituellement considérée comme bénigne. Des complications neurologiques de sévérité variable sont cependant possibles, en particulier dans les infections à EV-A71, pouvant conduire au décès. Plusieurs pays de la région asiatique sont régulièrement confrontés à des épidémies d’infections à EV de grande ampleur et à forte morbi-mortalité. En 2016, l’Europe a connu une épidémie d’une ampleur inhabituelle, associée à une recrudescence d’atteintes neurologiques sévères en Espagne et en France, touchant essentiellement des enfants. Le dépistage précoce et la prise en charge adaptée de ces formes sévères représentent un véritable enjeu. Le diagnostic virologique repose sur la recherche du virus dans les prélèvements périphériques (gorge, aspiration nasopharyngée, selles, lésions cutanéomuqueuses) en plus du sang et du liquide céphalorachidien, l’EV-A71 étant rarement retrouvé dans ce dernier. Nous rapportons le cas d’une enfant de 27 mois ayant présenté un syndrome pieds-mains-bouche d’allure initialement bénigne, secondairement compliqué d’une défaillance cardiorespiratoire aiguë fatale et associée à l’EV-A71. Les infections à EV associées au syndrome pieds-mains-bouche nécessitent aussi une surveillance épidémiologique particulière en dehors de l’Asie

Chronic use of inhaled corticosteroids in patients admitted for respiratory virus infections: a 6-year prospective multicenter study

International audienceInhaled corticosteroids (ICS) have been associated with increased risk of pneumonia. Their impact on respiratory virus infections is unclear. We performed a post-hoc analysis of the FLUVAC cohort, a multicenter prospective cohort study of adults hospitalized with influenza-like illness (ILI) during six consecutive influenza seasons (2012–2018). All patients were tested for respiratory virus infection by multiplex PCR on nasopharyngeal swabs and/or bronchoalveolar lavage. Risk factors were identified by logistic regression analysis. Among the 2658 patients included, 537 (20.2%) were treated with ICS before admission, of whom 282 (52.5%, 282/537) tested positive for at least one respiratory virus. Patients on ICS were more likely to test positive for non-influenza respiratory viruses (25.1% vs. 19.5%, P = 0.004), especially for adenovirus (aOR 2.36, 95% CI 1.18–4.58), and respiratory syncytial virus (aOR 2.08, 95% CI 1.39–3.09). Complications were reported in 55.9% of patients on ICS (300/537), primarily pneumonia (171/535, 32%). Among patients on chronic ICS who tested positive for respiratory virus, 14.2% (40/282) were admitted to intensive care unit, and in-hospital mortality rate was 2.8% (8/282). Chronic use of ICS is associated with an increased risk of adenovirus or RSV infections in patients admitted for ILI

Interim 2017/18 influenza seasonal vaccine effectiveness:Combined results from five European studies

Between September 2017 and February 2018, influenza A(H1N1)pdm09, A(H3N2) and B viruses (mainly B/Yamagata, not included in 2017/18 trivalent vaccines) co-circulated in Europe. Interim results from five European studies indicate that, in all age groups, 2017/18 influenza vaccine effectiveness was 25 to 52% against any influenza, 55 to 68% against influenza A(H1N1)pdm09, -42 to 7% against influenza A(H3N2) and 36 to 54% against influenza B. 2017/18 influenza vaccine should be promoted where influenza still circulates

Human IRF1 governs macrophagic IFN-γ immunity to mycobacteria

International audienceHighlights d Inherited complete human IRF1 deficiency underlies severe mycobacterial disease d Human IRF1 is essential for IFN-g-dependent macrophagic immunity to mycobacteria d Human IRF1 is essential for IFN-g-and STAT1-dependent immunity to mycobacteria d Human IRF1 is largely redundant for IFN-a/b-dependent antiviral intrinsic immunity Authors Je ´re ´mie Rosain