Impact of Vitamin D Supplementation on Influenza Vaccine Response and Immune Functions in Deficient Elderly Persons: A Randomized Placebo-Controlled Trial

Background: Immunosenescence contributes to reduced vaccine response in elderly persons, and is worsened by deficiencies in nutrients such as Vitamin (Vit-D). The immune system is a well-known target of Vit-D, which can both potentiate the innate immune response and inhibit the adaptive system, and so modulate vaccination response.Objective: This randomized placebo-controlled double-blind trial investigated whether Vit-D supplementation in deficient elderly persons could improve influenza seroprotection and immune response.Design: Deficient volunteers (Vit-D serum <30 ng/mL) were assigned (V1) to receive either 100,000 IU/15 days of cholecalciferol (D, n = 19), or a placebo (P, n = 19), over a 3 month period. Influenza vaccination was performed at the end of this period (V2), and the vaccine response was evaluated 28 days later (V3). At each visit, serum cathelicidin, immune response to vaccination, plasma cytokines, lymphocyte phenotyping, and phagocyte ROS production were assessed.Results: Levels of serum 25-(OH)D increased after supplementation (D group, V1 vs. V2: 20.7 ± 5.7 vs. 44.3 ± 8.6 ng/mL, p < 0.001). No difference was observed for serum cathelicidin levels, antibody titers, and ROS production in D vs. P groups at V3. Lower plasma levels of TNFα (p = 0.040) and IL-6 (p = 0.046), and higher ones for TFGβ (p = 0.0028) were observed at V3. The Th1/Th2 ratio was lower in the D group at V2 (D: 0.12 ± 0.05 vs. P: 0.18 ± 0.05, p = 0.039).Conclusions: Vit-D supplementation promotes a higher TGFβ plasma level in response to influenza vaccination without improving antibody production. This supplementation seems to direct the lymphocyte polarization toward a tolerogenic immune response. A deeper characterization of metabolic and molecular pathways of these observations will aid in the understanding of Vit-D's effects on cell-mediated immunity in aging. This clinical trial was registered at clinicaltrials.gov as NCT01893385

Methicillin-susceptible, Doxycycline-resistant Staphylococcus aureus, Côte d’Ivoire

This virulent clone has already spread to other continents

Lemierre's syndrome and genetic polymorphisms: a case report

BACKGROUND: Lemierre's syndrome presents a classic clinical picture, the pathophysiology of which remains obscure. Attempts have been made to trace genetic predispositions that modify the host detection of pathogen or the resultant systemic reaction. CASE PRESENTATION: A 17-year old female, with no previous medical history, was admitted to the intensive care unit for septic shock, acute respiratory distress syndrome and Lemierre's syndrome. Her DNA was assayed for single nucleotide polymorphisms previously incriminated in the detection of the pathogen, the inflammatory response and the coagulation cascade. We observed functional variations in her Toll like 5 receptor (TLR 5) gene and two coagulation variations (Tissue Factor (TF) 603 and Plasminogen-Activator-Inhibitor-1 (PAI-1) 4G-4G homozygosity) associated with thrombotic events. CONCLUSION: The innate immune response and the prothrombogenic mutations could explain, at least in part, the symptoms of Lemierre's syndrome. Genomic study of several patients with Lemierre's syndrome may reveal its pathophysiology

Health Care Support Issues for Internationally Adopted Children: A Qualitative Approach to the Needs and Expectations of Families

International audienceBACKGROUND: Families of internationally adopted children may face specific problems with which general practitioners (GPs) may not be familiar. The aim of the study was to explore problems faced by families before, during and after the arrival of their internationally adopted child and to assess the usefulness of a specific medical structure for internationally adopted children, which could be a resource for the GP. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a qualitative study using individual semistructured guided conversations and interviewed 21 families that had adopted a total of 26 children internationally in the Puy de Dome department, France, in 2003. Quantitative data were used to describe the pathologies diagnosed and the investigations performed.Our study showed that the history of these families, from the start of the adoption project to its achievement, is complex and warrants careful analysis. Health-care providers should not only consider the medical aspects of adoption, but should also be interested in the histories of these families, which may play a role in the forming of attachments between the adoptee and their adoptive parents and prevent further trouble during the development of the child. We also showed that adoptive parents have similar fears or transient difficulties that may be resolved quickly by listening and reassurance. Most such families would support the existence of a specific medical structure for internationally adopted children, which could be a resource for the general practitioner. However, the health-care providers interviewed were divided on the subject and expressed their fear that a special consultation could be stigmatizing to children and families. CONCLUSIONS/SIGNIFICANCE: A specific consultation with well-trained and experienced practitioners acting in close collaboration with GPs and paediatricians may be of help in better understanding and supporting adopted children and their families

Prévention vaccinale et risques professionnels liés aux hépatites A, B et C en milieu de soins

La pandémie VIH/SIDA a fortement contribué au renforcement de la veille sanitaire relative aux risques professionnels liés aux hépatites virales B et C en milieu de soins et dans une moindre mesure à l'hépatite virale A. Ce travail rapporte 2 types d'études portant sur l'épidémiologie des hépatites virales A, B et C chez le personnel de santé et sur les stratégies vaccinales anti-hépatite A en France et anti-hépatite B au Maroc à destination de ce personnel. En France, les résultats observés plaident pour le maintien de la politique vaccinale menée à ce jour contre l'hépatite B. Au Maroc, son renforcement paraît indispensable sous peine d'une recrudescence de la morbi-mortalité liée à l'hépatite B. de même, la tenue rigoureuse des registres vaccinaux est la base pour évaluer l'efficacité de cette politique vaccinale. En l'absence de traitement préventif post-exposition et de vaccin, la prévention du risque hépatite C est basée sur le respect des règles d'hygiène générale et des précautions universelles adoptées pour les AES en France. Au Maroc, l'importance du risque AES incite à la mise en œuvre urgente d'une véritable politique de santé, d'hygiène et de sécurité au travail dans les hôpitaux publics et dans les cliniques privées. La vaccination contre l'hépatite A a été instaurée au CHU de clermont-Ferrand dès 1994 à l'embauche pour le personnel des services de pédiatrie, de gastro-entérologie et de celui de la préparation des repas en cuisine centrale. La surveillance épidémiologique en santé au travail, couplée à un renforcement des mesures préventives déjà effectives (règles d'hygiène, vaccinations anti-VHA et anti-VHB) et aux innovations issues des biotechnologies, devrait permettre à terme un contrôle de ces infections virales dont 2 d'entre elles (VHB et VHC) restent à l'échelle mondiale des préoccupations de premier plan, notamment en milieu professionnel.CLERMONT FD-BCIU-Santé (631132104) / SudocPARIS-Académie Médecine (751065201) / SudocSudocFranceF

INFECTIONS A PNEUMOCOQUES ET PNEUMONIES AIGUES COMMUNAUTAIRES (IMPLICATIONS THERAPEUTIQUES ET VACCINALES (DOCTORAT : MALADIES INFECTIEUSES ET TROPICALES))

CLERMONT FD-BCIU-Santé (631132104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Enquête sur l'utilisation des tests de diagnostic rapide des angines aiguës en médecine générale

CLERMONT FD-BCIU-Santé (631132104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

LES MENINGITES A ENTEROVIRUS CHEZ L'ADULTE (A PROPOS DE 30 OBSERVATIONS EN REGION AUVERGNE DE 1998 A 2000)

CLERMONT FD-BCIU-Santé (631132104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Pre-AIDS mortality in HIV-infected individuals in England, Wales and Northern Ireland, 1982-1996

Objective: To assess pre-AIDS mortality in HIV-infected patients in England, Wales and Northern Ireland during the period 1982-1996. Design: Surveillance data on pre-AIDS and AIDS deaths reported to the PHLS-AIDS Centre were analysed. Methods: Pre-AIDS mortality was estimated as the proportion of pre-AIDS deaths among all deaths in HIV-infected people. Trends over time in the number of pre-AIDS and AIDS deaths were compared using Poisson regression with logarithmic link. Causes of pre-AIDS deaths were recorded. Comparisons were made between the pre-AIDS and the AIDS death groups by logistic regression for: age, location of residence at death, year of death and risk exposure. Results: Four-hundred and sixty-eight pre-AIDS deaths and 8574 AIDS deaths were identified. Pre-AIDS mortality accounted for 5.0% of HIV-related deaths. Trends over time in the number of pre-AIDS and AIDS deaths were not significantly different (P = 0.11). Reported causes of pre-AIDS death included pneumonia (92), liver disease (62), septicaemia (51), malignancies (49), suicide (45), cardiopulmonary causes (46), haemorrhage (42), overdose (24) and accidental causes (24). Factors positively associated with pre-AIDS death were injecting drug use, haemophilia and blood transfusion, residence outside the Thames regions, and death at an older age. Conclusions: Pre-AIDS mortality represents a substantial proportion of HIV mortality, particularly where injecting drug use is a frequent route of HIV transmission