Evaluation of the chagas western blot igg assay for the diagnosis of chagas disease

Chagas disease is a debilitating and often fatal pathology resulting from infection by the protozoan parasite Trypanosoma cruzi. In its recommendations, the World Health Organization states that the diagnosis of T. cruzi infection is usually based on the detection of antibodies against T. cruzi antigens and performed with two methodologically different assays. An inconclusive result can be resolved with a third “confirmatory” assay. The objective of this article is to evaluate the effectiveness of the Chagas Western Blot IgG assay (LDBio Diagnostics, Lyon, France) as a confirmatory serologic test. The Chagas Western Blot IgG assay was performed with native antigens derived from a T. cruzi strain of the TcVI genotype. Retrospective sera were provided by two parasitology laboratories (France and Argentina). The sensitivity, specificity, positive predictive value and negative predictive value of the Chagas blot were all 100% in our sera collection. The Chagas blot is an easy and qualitative method for the diagnosis of Chagas disease, with results in less than 2 h. This immunoblot has potential as a supplemental test for the confirmation of the presence of antibodies against T. cruzi in serum specimens. Nonetheless, the very good initial results presented here will need to be confirmed in larger studies.Fil: Brossas, Jean Yves. Sorbonne Université Hôpital Pitié-Salpêtrière; FranciaFil: Ballering, Griselda Edith. Gobierno de la Ciudad de Buenos Aires. Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas; ArgentinaFil: Bisio, Margarita María Catalina. Gobierno de la Ciudad de Buenos Aires. Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas; ArgentinaFil: Guihenneuc, Jeremy. Sorbonne Université Hôpital Pitié-Salpêtrière; FranciaFil: Gulin, Julián Ernesto Nicolás. Gobierno de la Ciudad de Buenos Aires. Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas; ArgentinaFil: Jauréguiberry, S.. Sorbonne Université Hôpital Pitié-Salpêtrière; FranciaFil: Lescure, François Xavier. Hôpitaux Universitaires Paris Nord val de Seine; FranciaFil: Fekkar, Arnaud. Sorbonne Université Hôpital Pitié-Salpêtrière; FranciaFil: Mazier, Dominique. Sorbonne University; FranciaFil: Altcheh, Jaime Marcelo. Gobierno de la Ciudad de Buenos Aires. Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto Multidisciplinario de Investigaciones en Patologías Pediátricas; ArgentinaFil: Paris, Luc. Sorbonne Université Hôpital Pitié-Salpêtrière; Franci

Chagas Disease, France

Chagas Disease, Franc

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

Étude des répercussions de l indigence sur le suivi des personnes vivant avec le VIH/SIDA sous traitement antirétroviral, au Centre de Traitement Agréé de l hôpital Laquintinie de Douala (Cameroun)

Introduction. Au Cameroun, où presque 40% de la population vit en dessous du seuil de pauvreté, la prévalence du VIH est estimée à 5,3%. Depuis 2007, l accès au traitement antirétroviral (TAR) est gratuit. Est-ce suffisant pour que toutes les Personnes Vivant avec le VIH/SIDA (PvVIH) soient bien prises en charge d un point de vue médical ? L objectif principal de cette étude était de déterminer si l indigence était un facteur prédictif de survenue d échec thérapeutique. Méthodes. L indigence était définie à l aide d une grille d évaluation spécifique. Le critère de jugement principal était la survenue d un échec immunologique. Les critères d inclusion étaient : âge supérieur à 18 ans et initiation du TAR en 2008. Les critères d exclusion étaient : prophylaxie post-exposition ou prévention de la transmission mère-enfant. Résultats. Cent trente-huit patients ont été inclus avec un sex-ratio (femme/homme) de 3,6. Quarante-deux pour cent des patients inclus étaient indigents. A l initiation du TAR, l âge était de 34 ans, le taux de CD4 était de 173 cellules/mm3 et 67% des patients étaient aux stades 3 ou 4 de l OMS. La durée de suivi sous TAR était de 32 mois. Treize patients (9,4%) étaient en échec thérapeutique. L indigence n avait pas d impact significatif sur le taux d échec (10,3% des patients indigents versus 8,8% des non indigents, p=0,75). Conclusion. Cette étude a permis de soulever les difficultés d un suivi médical sur le long cours pour les PvVIH les plus démunies. Un ciblage précoce des indigents permettrait la mise en place d un système d accompagnement individuel de ces patients à haut risque de rupture de suivi.Background. In Cameroon, where virtually 40% of the population lives below the poverty line, the prevalence of HIV is estimated at 5.3%. Since 2007, access to antiretroviral treatment (ART) is free. Is it enough so that people living with HIV (PLHIV) may medically be well managed? The aim of this study was to determine whether indigence was predictive of a therapeutic failure. Methods. Indigence was defined using a specific evaluation grid. The primary outcome was the occurrence of an immunologic failure. All patients who were over the age of 18 and who initiated their ART in 2008 were included in the study. But patients who had post-exposure prophylaxis or initiated their ART within the framework for prevention of mother-to-children transmission were excluded from this study. Results. One hundred and thirty eight patients were involved in the study, in a women to men ratio of 3.6. Forty-two percent of this group were indigent. At the start of the ART, the age was 34, the rate of CD4 was 173 cells/mm3, and 67% of the patients were at the WHO stage 3 or 4. The length of follow-up was 32 months. Indigence did not have a significant impact on the failure rate (10.3% of the indigent patients versus 8.8% of the non indigent, p-value=0.75). Conclusions. This study allowed to point out the difficulties of a medical follow-up care on the long run, for the most impoverished PLHIV. An early targeting of the indigent would enable an individual caring system to be put into place, for those patients who highly incur the risk of a breaking-off in their follow-up care.GRENOBLE1-BU Médecine pharm. (385162101) / SudocSudocFranceF

Paramètres de la prise en charge médicale Ville-Hôpital du patient séropositif et réponse virologique à six mois de l'instauration d'un traitement antirétroviral

PARIS7-Xavier Bichat (751182101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Infections communautaires graves à Staphylococcus aureus porteur de leucocidine de Panton-Valentine (détermination des caractéristiques épidémiologiques et cliniques pour améliorer la prise en charge en ville)

PARIS6-Bibl. St Antoine CHU (751122104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Prise en charge tardive de l'infection par le VIH

PARIS7-Xavier Bichat (751182101) / SudocSudocFranceF

De l'Equateur au Tropique du Capricorne (leçons et défis d'un pays tropical sur le VIH/SIDA)

La politique brésilienne de contrôle du VIH/SIDA s'est imposée comme un modèle pour les pays en développement, par l'association d'une politique de prévention et de dépistage de grande ampleur avec un traitement universel et gratuit du VIH/sida. S'appuyant sur les acquis de la sociologie politique et des organisations, notre recherche, qualitative, analyse les composantes fédérale et locale de la politique brésilienne. Cette recherche met ainsi en évidence deux phases de la politique de contrôle du VIH/Sida : -la première phase est celle d'un programme vertical efficace, construit à l'échelon national, en réponse à une épidémie concentrée géographiquement (dans le sud-est du pays), et socialement, (au sein de groupes à niveau d'éducation et de revenus moyen ou élevé). L'articulation entre les composantes de prévention et de traitement demeure limitée. -la seconde phase est celle d'un programme horizontal, intégré localement, où états, municipalités et structures de soins primaires ont un rôle majeur dans les stratégies de contrôle, en réponse à une épidémie diffusant vers les états et les populations les plus pauvres du pays. Notre recherche permet enfin de proposer, à partir de l'exemple de la politique brésilienne de lutte contre le sida, un modèle dynamique des relations entre populations pauvres et systèmes de santé, en particulier des modalités de participation et de prise en charge de ces populationsAMIENS-BU Santé (800212102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF