Vaccination par le BCG : enquête auprès d'enfants de moins de 5 ans consultant dans un service d'urgences hospitalières

International audienceFrance is a country with a low incidence of tuberculosis. However, there are important local variations: some parts of the city of Marseilles (southern France) presented a yearly incidence greater than 30/100,000 in 2010. The main goal of this study was to evaluate the BCG vaccine coverage among at-risk children younger than 5 years consulting in one of the city's pediatric emergency departments. Material and methods. This descriptive study took place in February 2013 and used a semi-directive questionnaire distributed to parents. Results. One hundred and thirty-five children were included, 98 (72.6 %) were considered as being at risk of tuberculosis and among them 75 (76.5 %, 95 % CI [68.0–85.1]) were vaccinated with BCG. Parents' knowledge of tuberculosis was relevant in 48 % of the respondents. Only 19 % of the parents reported that BCG protects against tuberculosis, but 73 % were in favor of this vaccination. Two criteria significantly increased vaccine coverage among at-risk children: birth in Marseilles and age more than 6 months on the consultation day. The child living in a poor family and type of medical follow-up did not significantly influence BCG vaccine coverage. Conclusion. BCG coverage was high in at-risk children younger than 5 years born in Marseilles. Cooperation between private physicians , maternity hospitals and mothers, and children's public health services probably facilitates this high level of protection.Malgré une faible incidence de la tuberculose en France, il existe de grandes variations à l'échelle communale : certains quartiers de Marseille présentent ainsi une incidence annuelle supérieure à 30/ 100 000. Le but de notre étude etait d'évaluer la couverture vaccinale par le vaccin de Calmette et Guérin (BCG) des enfants à risque aâgés de moins de 5 ans consultant dans un service d'urgences pédiatriques. Matériel et méthodes : Cette étude descriptive a eété réalisée en février 2013 à l'aide d'un questionnaire semi-directif proposé aux parents. Résultats : Cent-trente-cinq enfants ont été inclus, 98 (72,6 %) étaient considérés àrisque de tuberculose et parmi ces derniers 75 (76,5 %, IC 95 % [68,0–85,1]) eétaient vaccinés par le BCG. Seuls 48 % des parents connaissaient la tuberculose et 19 % savaient que le BCG protégeait contre cette maladie, mais 73 % étaient favorables à ce vaccin. Deux paramètres étaient liés à la vaccination des enfants à risque : une naissance à Marseille et un âge supérieur à 6 mois le jour de la consultation. La précarité des conditions de vie et le type de suivi médical n' influençaient pas significativement la couverture vaccinale des enfants à risque. Conclusion : En 2013, la couverture vaccinale par le BCG des enfants de moins de 5 ans nés à Marseille et à risque de tuberculose était correcte mais perfectible. Une coopération entre médecins de ville, maternités et services de protection maternelle et infantile (PMI) permet probablement d'obtenir cette bonne couverture vaccinale

Influence of oxygen on asexual blood cycle and susceptibility of Plasmodium falciparum to chloroquine: requirement of a standardized in vitro assay

OBJECTIVE: The main objective of this study was to assess the influence of gas mixtures on in vitro Plasmodium falciparum growth and 50% inhibitory concentration (IC(50)) for chloroquine. METHODS: The study was performed between February 2004 and December 2005. 136 Plasmodium falciparum isolates were used to evaluate gas mixtures effect on IC(50 )for chloroquine by isotopic microtest. The oxygen effect on asexual blood cycle of 3D7 and W2 clones was determined by thin blood smears examination and tritiated hypoxanthine uptake. RESULTS: From 5% O(2 )to 21% O(2 )conditions, no parasiticide effect of O(2 )concentration was observed in vitro on the clones 3D7 and W2. A parasitostatic effect was observed during the exposure of mature trophozoïtes and schizonts at 21% O(2 )with an increase in the length of schizogony. The chloroquine IC(50 )at 10% O(2 )were significantly higher than those at 21% O(2), means of 173.5 nM and 121.5 nM respectively (p < 0.0001). In particular of interest, among the 63 isolates that were in vitro resistant to chloroquine (IC(50 )> 100 nM) at 10% O(2), 17 were sensitive to chloroquine (IC(50 )< 100 nM) at 21% O(2). CONCLUSION: Based on these results, laboratories should use the same gas mixture to realize isotopic microtest. Further studies on comparison of isotopic and non-isotopic assays are needed to establish a standardized in vitro assay protocol to survey malaria drug resistance

Leishmania infantum leishmaniasis in corticosteroid – treated patients

BACKGROUND: The number of leishmaniasis cases associated with immunosuppression has increased regularly over the past 20 years. Immunosuppression related to HIV infection, immunosuppressive treatment, organ transplantation, and neoplastic diseases increases the risk for Leishmania-infected people to develop visceral illness. CASE PRESENTATION: Three cases of Leishmania infantum leishmaniasis in corticosteroid (CS)-treated patients are reported: an isolated lingual leishmaniasis in a farmer treated with CS for asthma, a severe visceral leishmaniasis associated with cutaneous lesions in a woman with myasthenia gravis, and a visceral involvement after cutaneous leishmaniasis in a man receiving CS. CONCLUSION: Physicians should recognise CS-treated patients as a population likely to be immunesuppressed. In immunodeficiency conditions, unusual forms of leishmaniasis can develop and foster the risk of a diagnostic delay and of poor response to therapy

Utjecaj izloženosti 1,6-heksametilen diizocijanatu (HDI) na vršni ekspiratorni protok u autolakirera u Iranu

The aim of this study was to investigate the effects of occupational exposure to 1,6-hexamethylene diisocyanate (HDI) on peak flowmetry in automobile body paint shop workers in Iran. We studied a population of 43 car painters exposed to HDI at their workplaces. Peak expiratory fl ow was tested for one working week, from the start to the end of each shift. Air was sampled and HDI analysed in parallel, according to the OSHA 42 method. Daily and weekly HDI exposure averages were (0.42±0.1) mg m-3 and (0.13±0.05) mg m-3, respectively. On painting days, 72 % of workers showed more than a 10 % variation in peak expiratory fl ow. Inhalation exposure exceeded the threshold limit value (TLV) ten times over. This strongly suggests that HDI affected the peak fl owmetry in the studied workers.Cilj je ovog ispitivanja bio utvrditi vršni protok u 43 iranska autolakirera profesionalno izložena 1,6-heksametilen diizocijanatu (HDI). Vršni ekspiratorni protok testiran je tjedan dana na početku i kraju svake smjene. Uzorkovanje i mjerenje HDI-ja u zraku radilo se istodobno s testiranjem vršnoga protoka, prema metodi OSHA 42. Prosječna dnevna izloženost radnika HDI-ju iznosila je (0.42±0.1) mg m-3, a tjedna (0.13±0.05) mg m-3. U 72 % radnika vršni ekspiratorni protok tijekom dana varirao je više od 10 %. Radnici su udisali deset puta više razine HDI-ja od graničnih te je moguće da je HDI utjecao na mjerenja plućne funkcije

A gold-containing drug against parasitic polyamine metabolism: the X-ray structure of trypanothione reductase from Leishmania infantum in complex with auranofin reveals a dual mechanism of enzyme inhibition

Auranofin is a gold(I)-containing drug in clinical use as an antiarthritic agent. Recent studies showed that auranofin manifests interesting antiparasitic actions very likely arising from inhibition of parasitic enzymes involved in the control of the redox metabolism. Trypanothione reductase is a key enzyme of Leishmania infantum polyamine-dependent redox metabolism, and a validated target for antileishmanial drugs. As trypanothione reductase contains a dithiol motif at its active site and gold(I) compounds are known to be highly thiophilic, we explored whether auranofin might behave as an effective enzyme inhibitor and as a potential antileishmanial agent. Notably, enzymatic assays revealed that auranofin causes indeed a pronounced enzyme inhibition. To gain a deeper insight into the molecular basis of enzyme inhibition, crystals of the auranofin-bound enzyme, in the presence of NADPH, were prepared, and the X-ray crystal structure of the auranofin–trypanothione reductase–NADPH complex was solved at 3.5 Å resolution. In spite of the rather low resolution, these data were of sufficient quality as to identify the presence of the gold center and of the thiosugar of auranofin, and to locate them within the overall protein structure. Gold binds to the two active site cysteine residues of TR, i.e. Cys52 and Cys57, while the thiosugar moiety of auranofin binds to the trypanothione binding site; thus auranofin appears to inhibit TR through a dual mechanism. Auranofin kills the promastigote stage of L. infantum at micromolar concentration; these findings will contribute to the design of new drugs against leishmaniasis

Revolutionizing Clinical Microbiology Laboratory Organization in Hospitals with In Situ Point-of-Care

BACKGROUND: Clinical microbiology may direct decisions regarding hospitalization, isolation and anti-infective therapy, but it is not effective at the time of early care. Point-of-care (POC) tests have been developed for this purpose. METHODS AND FINDINGS: One pilot POC-lab was located close to the core laboratory and emergency ward to test the proof of concept. A second POC-lab was located inside the emergency ward of a distant hospital without a microbiology laboratory. Twenty-three molecular and immuno-detection tests, which were technically undemanding, were progressively implemented, with results obtained in less than four hours. From 2008 to 2010, 51,179 tests yielded 6,244 diagnoses. The second POC-lab detected contagious pathogens in 982 patients who benefited from targeted isolation measures, including those undertaken during the influenza outbreak. POC tests prevented unnecessary treatment of patients with non-streptococcal tonsillitis (n = 1,844) and pregnant women negative for Streptococcus agalactiae carriage (n = 763). The cerebrospinal fluid culture remained sterile in 50% of the 49 patients with bacterial meningitis, therefore antibiotic treatment was guided by the molecular tests performed in the POC-labs. With regard to enterovirus meningitis, the mean length-of-stay of infected patients over 15 years old significantly decreased from 2008 to 2010 compared with 2005 when the POC was not in place (1.43±1.09 versus 2.91±2.31 days; p = 0.0009). Altogether, patients who received POC tests were immediately discharged nearly thrice as often as patients who underwent a conventional diagnostic procedure. CONCLUSIONS: The on-site POC-lab met physicians' needs and influenced the management of 8% of the patients that presented to emergency wards. This strategy might represent a major evolution of decision-making regarding the management of infectious diseases and patient care

Kemijski sastav, antioksidativno djelovanje, inhibicija elastaze i protuupalno djelovanje eteričnog ulja biljke Illicium anisatum

The essential oil of air-dried Illicium anisatum obtained by hydrodistillation was analyzed by gas chromatography–mass spectrometry (GC–MS). Fifty-two components were identified in the essential oil and the main component was eucalyptol (21.8 %). The antioxidant and anti-elastase activities of the essential oil were also investigated; the essential oil exhibited moderate DPPH scavenging and anti-elastase activities. To clarify the mechanism of the anti-inflammatory activities of I. anisatum essential oil (IAE), we evaluated whether it could modulate the production of nitric oxide (NO) and prostaglandin E2 (PGE2) by activated macrophages. The results indicate that IAE is an effective inhibitor of LPS-induced NO and PGE2 production in RAW 264.7 cells. These inhibitory activities were accompanied by dose-dependent decreases in the expression of iNOS and COX-2 proteins and iNOS and COX-2 mRNA. In order to determine whether IAE can be safely applied to human skin, the cytotoxic effects of IAE were determined by colorimetric MTT assays in human dermal fibroblast and keratinocyte HaCaT cells. IAE exhibited low cytotoxicity at 100 μg mL1. Based on these results, we suggest that IAE may be considered an anti-aging and anti-inflammatory candidate for cosmetic materials, but additional in vitro and in vivo tests have to be performed to prove its safety and efficacy.Eterično ulje biljke Illicium anisatum dobiveno destilacijom vodenom parom analizirano je plinskom kromatografijom-spektrometrijom masa (GC-MS). Identificirane su pedeset i dvije komponente eteričnog ulja, a glavna komponenta je eukaliptol (21,8 %). Ispitivanje antioksidativnog djelovanja te djelovanja na elastazu ukazuju na umjerenu sposobnost hvatanja DPPH radikala i inhibicije elastaze. Kako bi se objasnio mehanizam protuupalnog djelovanja eteričnog ulja I. anisatum (IAE), ispitan je učinak na moduliranje produkcije dušikovog(II) oksida (NO) i prostaglandina E2 (PGE2) iz aktiviranih makrofaga. Rezultati ukazuju da je IAE učinkovit inhibitor LPS-inducirane produkcije NO i PGE2 u RAW 264.7 stanicama. Inhibitorno djelovanje popraćeno je smanjenjem ekspresije iNOS i COX-2 proteina i iNOS i COX-2 mRNA. Kako bi se odredilo može li se IAE sigurno primijeniti na ljudsku kožu, citotoksični učinci IAE određeni su kolorimetrijskim MTT testom u humanim dermalnim fibroblastima i keratinocitima HaCaT. IAE je pokazao nisku citotoksičnost pri koncentraciji 100 μg mL-1. Temeljem ovih rezultata IAE se može smatrati potencijalnim sredstvom protiv starenja i protuupalnim sredstvom u kozmetičkim pripravcima. Međutim, dodatni in vitro i in vivo testovi nužni su za potvrdu njegove sigurnosti i učinkovitosti