Evaluation of the tuberculin skin test and the interferon-γ release assay for TB screening in French healthcare workers

<p>Abstract</p> <p>Introduction</p> <p>Using French cut-offs for the Tuberculin Skin Test (TST), results of the TST were compared with the results of an Interferon-γ Release Assay (IGRA) in Healthcare Workers (HCW) after contact to AFB-positive TB patients.</p> <p>Methods</p> <p>Between May 2006 and May 2007, a total of 148 HCWs of the University Hospital in Nantes, France were tested simultaneously with IGRA und TST. A TST was considered to indicate recent latent TB infection (LTBI) if an increase of >10 mm or if TST ≥ 15 mm for those with no previous TST result was observed. For those with a positive TST, chest X-ray was performed and preventive chemotherapy was offered.</p> <p>Results</p> <p>All HCWs were BCG-vaccinated. The IGRA was positive in 18.9% and TST ≥ 10 mm was observed in 65.5%. A recent LTBI was believed to be highly probable in 30.4% following TST. Agreement between IGRA and TST was low (kappa 0.041). In 10 (16.7%) out of 60 HCWs who needed chest X-ray following TST the IGRA was positive. In 9 (20%) out of 45 HCWs to whom preventive chemotherapy was offered following TST the IGRA was positive. Of those considered TST-negative following the French guidelines, 20.5% were IGRA-positive. In a two-step strategy - positive TST verified by IGRA - 18 out of 28 (64.3%) IGRA-positive HCWs would not have been detected using French guidelines for TST interpretation.</p> <p>Conclusion</p> <p>The introduction of IGRA in contact tracings of BCG-vaccinated HCWs reduces X-rays and preventive chemotherapies. Increasing the cut-off for a positive TST does not seem to be helpful to overcome the effect of BCG vaccination on TST.</p

Decreased Numbers of Blood Dendritic Cells and Defective Function of Regulatory T Cells in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

BACKGROUND: Dendritic cells (DC) and regulatory cells (Treg) play pivotal roles in controlling both normal and autoimmune adaptive immune responses. DC are the main antigen-presenting cells to T cells, and they also control Treg functions. In this study, we examined the frequency and phenotype of DC subsets, and the frequency and function of Treg from patients with ANCA-associated vasculitis (AAV). METHODOLOGY/PRINCIPAL FINDINGS: Blood samples from 19 untreated patients with AAV during flares and before any immunosuppressive treatment were analyzed, along with 15 AAV patients in remission and 18 age-matched healthy controls. DC and Treg numbers, and phenotypes were assessed by flow cytometry, and in vitro suppressive function of Treg was determined by co-culture assay. When compared to healthy volunteers, absolute numbers of conventional and plasmacytoid DC were decreased in AAV patients. During the acute phase this decrease was significantly more pronounced and was associated with an increased DC expression of CD62L. Absolute numbers of Treg (CD4(+)CD25(high)CD127(low/-) Tcells) were moderately decreased in patients. FOXP3 and CD39 were expressed at similar levels on Treg from patients as compared to controls. The suppressive function of Treg from AAV patients was dramatically decreased as compared to controls, and this defect was more pronounced during flares than remission. This Treg functional deficiency occurred in the absence of obvious Th17 deviation. CONCLUSION: In conclusion, these data show that AAV flares are associated with both a decrease number and altered phenotype of circulating DC and point to a role for Treg functional deficiency in the pathogenesis of AAV

Low Cognitive Awareness, but Not Complaint, is a Good Marker of Preclinical Alzheimer's Disease

Subjective cognitive decline (SCD) may result from many conditions, including Alzheimer's disease (AD)

Neonatal Screening for SCID: The French Experience

After it was demonstrated in 2005 that T cell receptor excision circle (TREC) quantification for dried blood spot (DBS) samples on Guthrie cards is an effective means of SCID screening and following several pilot studies, the practice was formally recommended in the US in 2010. More and more countries have adopted it since then. In France, before the health authorities could recommend adding SCID to the list of five diseases that were routinely screened for, feasibility and cost-effectiveness studies had to be conducted with a sufficiently large cohort of neonates. We carried out three such studies: The first sought to verify the effectiveness of the assay. The second, DEPISTREC, evaluated the feasibility of universal SCID screening in France and assessed the clinical benefit and economic advantage it would provide. Through the third study, NeoSKID, still under way and to continue until recommendations are issued, we have been offering SCID screening in the Pays de la Loire region of France. This review briefly describes routine newborn screening (NBS) and management of primary immunodeficiency diseases (PIDs) in France, and then considers the lessons from our studies and the status of SCID screening implementation within the country

Utilisation du QuantiFERON®-TB Gold in-tube au Centre Hospitalier Universitaire de Nantes (étude rétrospective des résultats indéterminés de janvier 2007 à août 2008)

Mycobacterium tuberculosis, bactérie responsable de la tuberculose, infecte environ un tiers de la population mondiale, selon les estimations de l'Organisation Mondiale de la Santé. Le diagnostic de la tuberculose-infection, forme latente et asymptomatique, est nécessaire dans certaines situations, en particulier en cas de contage avec un sujet contagieux, pour la surveillance du personnel de santé exposé et avant mise en place d'un traitement de type anti-TNF-a. Dans ce but, l'IntraDermo-Réaction, technique à la spécificité limitée, a longtemps été l unique moyen à disposition. Pour la remplacer, des tests in vitro ont été développés, utilisant des antigènes plus spécifiques. Parmi eux, le QuantiFERON®-TB Gold In Tube a été mis en place au laboratoire d'Immunologie du C.H.U. de Nantes en 2007, mais notre attention a rapidement été attirée par l obtention d'un pourcentage de résultats indéterminés non négligeable. Nous avons donc voulu rechercher parmi 477 patients issus des services les plus fréquemment impliqués dans cette situation, des facteurs susceptibles d être à l'origine de la survenue de cet évènement. Une analyse univariée a mis en évidence qu une numération lymphocytaire basse, l'hospitalisation en Néphrologie, la prise d un traitement immunosuppresseur de type anti-TNF-a, anti-rejet de greffe ou chimiothérapie anti-cancéreuse et un âge avancé étaient associés à l'obtention d un résultat indéterminé. Seule l'influence de la numération lymphocytaire persistait avec l'analyse multivariée. Cette donnée pourrait amener les cliniciens à discuter, pour les patients lymphopéniques, la prescription d'un autre I.G.R.A., le T-SPOT.TB®, dont une récente étude à montrer la survenue moindre de résultats indéterminés par rapport au QFT-IT, chez les patients infectés par le VIH.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF

Host and non-host interaction of Venturia inaequalis and Venturia pirina on Pyrus communis and Malus x domestica

National audienc

Pathogenicity of virulent Venturia inaequalis strain on four apple clones (Malus sp.)

National audienc

Ecologie territoriale et indicateurs pour un développement durable de la métropole parisienne

This article treats the environmental dimension of the Greater Paris system.It shows how a territorial ecology approach permits the cogent investigation of governance principles and policy options for the Greater Paris region.First we present estimates of synthetic indicators such as the ecological footprint and the environmental footprint that allow us to quantify the scale of environmental impact of the mega-city.Then we consider, with an integrated modeling and scenario analysis, the "metabolism" of Greater Paris as illustrated by the impacts of economic activity in the Seine River catchment on the Seine Estuary downstream. This example highlights the important scope for territorial policies based on ecosystem quality considerations and, more widely, the need to accord a central place to the environmental dimension for strategic visions of possible futures of the Paris mega-city.Cet article traite de la dimension environnementale de la dynamique du " Grand Paris ". Il explique comment une approche d'écologie territoriale permet d'aborder les questions degouvernance pour la métropole Parisienne. Nous présentons, dans un premier temps, des indicateurs synthétiques comme l'" empreinte écologique " et l'" empreinte environnementale ", permettant d'appréhender l'ampleur de l'impact environnemental de la métropole. Ensuite, nous mettons en évidence, à partir d'une modélisation intégrée originale couplée à une analyse de scénario quantitative, le " métabolisme " du Grand Paris et, plus particulièrement, les impacts de l'activité économique du bassin de la Seine en amont surl'écologie de l'estuaire de la Seine en aval. Les opportunités de politique territoriales suscitées par l'observation de la dégradation de l'estuaire sont démontrées. La nécessitéd'accorder une place centrale à l'environnementdans toute vision stratégique des avenirs possibles de la mégapole parisienne devient alors explicite