Etude rétrospective des thrombopénies auto-immunes au cours du lupus érythémateux aigu disséminé (TIPUS)

Les cytopénies auto-immunes sont fréquentes au cours du LED et sont parfois révélatrices de la maladie. L'anémie hémolytique, la leucopénie (< 4000/mm3) la lymphopénie (< 1500/mm3) ou la thrombopénie (< 100 G/L) font partie des critères diagnostiques de l'AmericanCollege of Rheumatology (ACR). La thrombopénie auto-immune (ou PTI) survient chez 7 à 30 % des patients lupiques : son traitement est mal codifié et sa prise en charge est souvent calquée sur celle du PTI primaire. La littérature fait état de peu d'études dans ce domaine. Le but de notre étude est d'évaluer l'efficacité des traitements des thrombopénies auto-immunes au cours du PTI avec marqueurs lupiques ou lupus avéré et de décrire le profil clinico-biologique associé à cette pathologie. Il s'agit d'une étude rétrospective multicentrique réalisée au CHU de Bordeaux et dans 3 hôpitaux de l'APHP. Cinquante patients ont été inclus dans ce travail, principalement des femmes (88 %), jeunes (âgées en moyenne de 36 ans). Le LED et le PTI surviennent simultanément chez 72 % des patients. Notre étude confirme l'efficacité des corticoïdes, immunoglobulines ou association dans le traitement de 1ère ligne (réponse initiale de 86, 66 %, 80 % et 87,7 % respectivement). En revanche, la majorité des patients rechute en moins de 3 mois. En cas d'échec, l'hydroxychloroquine est remarquablement efficace dans le maintien de la réponse thérapeutique chez les patients ayant un PTI secondaire au LED : 74 % de réponse. Le rituximab semble aussi une alternative intéressante à la splénectomie dans les formes réfractaires mais ces données doivent être confirmées par de plus grandes études en raison du faible nombre de patients. La stratégie thérapeutique du PTI associée au LED semble différente du PTI primaire : l'hydroxychloroquine doit en être un des piliers en raison de son efficacité remarquable dans la réponse à long terme.BORDEAUX2-BU Santé (330632101) / SudocSudocFranceF

Interest of a Commercialized <i>Pneumocystis jirovecii</i> Quantitative PCR to Discriminate Colonization from <i>Pneumocystis</i> Pneumonia according to the Revised EORTC/MSGERC Criteria

Quantitative PCR (qPCR) is highly sensitive to diagnose Pneumocystis jirovecii (Pj) pneumonia (PCP). However, differentiating PCP and colonization remains difficult. This study aimed to establish the performances of the commercialized qPCR MycoGENIE® Pj kit (Ademtech) to distinguish PCP and Pj colonization. Patients with a positive Pj qPCR on bronchoalveolar lavage (BAL) or upper respiratory tract (URT) samples were prospectively included between May 2019 and December 2020 at Bordeaux University Hospital. They were classified in “PCP” or “Pj colonization” groups based on the revised EORTC/MSGERC criteria. The two groups’ results were compared; ROC curves were produced to determine the best thresholds. Excluding the low number of HIV-positive subjects, there were 100 PCP (32 BAL, 68 URT) and 70 Pj colonization (34 BAL, 36 URT). Pj loads were significantly higher in PCP compared to Pj colonization group (p ≤ 0.01). The best cut-offs for PCP diagnosis were 31.45 Cq/8275 copies/mL for BAL and 32.33 Cq/8130 copies/mL for URT (sensitivity = 59.4%, 63.3%, specificity = 82.4%, 88.9%, respectively). Fungal load quantification using MycoGENIE® Pj qPCR helps discriminating PCP from colonization, high fungal loads being indicative of probable PCP. Low load results should be interpreted with caution, in accordance with clinical and radiological signs

Identification of Streptococcus sinensis from a patient with endocarditis using MALDI-TOF mass spectrometry, 16S rDNA- and sodA-based phylogeny

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Characteristics and Prognosis Factors of Pneumocystis jirovecii Pneumonia According to Underlying Disease

International audienceBackground: Pnemocystis jirovecii pneumonia (PcP) remains associated with high rates of mortality, and the impact of immunocompromising underlying disease on the clinical presentation, severity, and mortality of PcP has not been adequately evaluated.Research question: Does the underlying disease and immunosuppression causing PcP impact the outcome and clinical presentation of the disease?Study design and methods: In this multicenter retrospective observational study, conducted from January 2011 to December 2021, all consecutive patients admitted with a proven or probable diagnosis of PcP according to The European Organisation for Research and Treatment of Cancer consensus definitions were included to assess the epidemiology and impact of underlying immunosuppressive diseases on overall and 90-day mortality.Results: Overall, 481 patients were included in the study; 180 (37.4%) were defined as proven PcP and 301 (62.6%) were defined as probable PcP. Patients with immune-mediated inflammatory diseases (IMIDs) or solid tumors had a statistically poorer prognosis than other patients with PcP at day 90. In multivariate analysis, among the HIV-negative population, solid tumor underlying disease (OR, 5.47; 95% CI, 2.16-14.1; P < .001), IMIDs (OR, 2.19; 95% CI, 1.05-4.60; P = .037), long-term corticosteroid exposure (OR, 2.07; 95% CI, 1.03-4.31; P = .045), cysts in sputum/BAL smears (OR, 1.92; 95% CI, 1.02-3.62; P = .043), and SOFA score at admission (OR, 1.58; 95% CI, 1.39-1.82; P < .001) were independently associated with 90-day mortality. Prior corticotherapy was the only immunosuppressant associated with 90-day mortality (OR, 1.67; 95% CI, 1.03-2.71; P = .035), especially for a prednisone daily dose ≥ 10 mg (OR, 1.80; 95% CI, 1.14-2.85; P = .010).Interpretation: Among patients who were HIV-negative, long-term corticosteroid prior to PcP diagnosis was independently associated with increased 90-day mortality, specifically in patients with IMIDs. These results highlight both the needs for PcP prophylaxis in patients with IMIDs and to early consider PcP curative treatment in severe pneumonia among patients with IMIDs

Long-term outcome of patients with non-operated prosthetic valve infective endocarditis is relapse the main issue?

International audienceIn non-operated prosthetic valve endocarditis (PVE), long term outcome is largely unknown. We report the follow-up of 129 non-operated patients with PVE alive at discharge. At one year, the mortality rate was 24%, relapses and reinfection were rare (5% each). Enterococcal PVE was associated with a higher risk of relapse

Multicenter Retrospective Study of Invasive Fusariosis in Intensive Care Units, France

Invasive fusariosis can be life-threatening, especially in immunocompromised patients who require intensive care unit (ICU) admission. We conducted a multicenter retrospective study to describe clinical and biologic characteristics, patient outcomes, and factors associated with death and response to antifungal therapy. We identified 55 patients with invasive fusariosis from 16 ICUs in France during 2002­–­­2020. The mortality rate was high (56%). Fusariosis-related pneumonia occurred in 76% of patients, often leading to acute respiratory failure. Factors associated with death included elevated sequential organ failure assessment score at ICU admission or history of allogeneic hematopoietic stem cell transplantation or hematologic malignancies. Neither voriconazole treatment nor disseminated fusariosis were strongly associated with response to therapy. Invasive fusariosis can lead to multiorgan failure and is associated with high mortality rates in ICUs. Clinicians should closely monitor ICU patients with a history of hematologic malignancies or stem cell transplantation because of higher risk for death

Prognosis of immune checkpoint inhibitors-induced myocarditis: a case series

Background Immune checkpoint inhibitors (ICI) have transformed cancer treatment over the last decade. Alongside this therapeutic improvement, a new variety of side effects has emerged, called immune-related adverse events (irAEs), potentially affecting any organ. Among these irAEs, myocarditis is rare but life-threatening.Methods We conducted a multicenter cross-sectional retrospective study with the aim of better characterizing ICI-related myocarditis. Myocarditis diagnosis was based on the recent consensus statement of the International Cardio-Oncology Society.Results Twenty-nine patients were identified, from six different referral centers. Most patients (55%) were treated using anti-programmed-death 1, rather than ICI combination (35%) or anti-programmed-death-ligand 1 (10%). Transthoracic echocardiography was abnormal in 52% of them, and cardiac magnetic resonance showed abnormal features in 14/24 patients (58%). Eleven patients (38%) were classified as severe. Compared with other patients, they had more frequently pre-existing systemic autoimmune disease (45% vs 6%, p=0.018), higher troponin level on admission (42-fold the upper limit vs 3.55-fold, p=0.001), and exhibited anti-acetylcholine receptor autoantibodies (p=0.001). Seven patients (24%) had myocarditis-related death, and eight more patients died from cancer progression during follow-up. Twenty-eight patients received glucocorticoids, 10 underwent plasma exchanges, 8 received intravenous immunoglobulins, and 5 other immunosuppressants. ICI rechallenge was performed in six patients, with only one myocarditis relapse.Discussion The management of ICI-related myocarditis may be challenging and requires a multidisciplinary approach. Prognostic features are herein described and may help to allow ICI rechallenge for some patients with smoldering presentation, after an accurate evaluation of benefit–risk balance

Necrotizing soft tissue infections in critically ill neutropenic patients: a French multicentre retrospective cohort study

Abstract Background Necrotizing soft tissue infections (NSTIs) are rare life-threatening bacterial infections. Few data are available regarding neutropenic patients with NSTIs. Our objectives were to describe the characteristics and management of neutropenic patients with NSTIs in intensive care units (ICUs). We conducted a retrospective multicentre cohort study in 18 ICUs between 2011 and 2021. Patients admitted with NSTIs and concomitant neutropenia at diagnosis were included and compared to non-neutropenic patients with NSTIs. The relationship between therapeutic interventions and outcomes was assessed using Cox regression and propensity score matching. Results 76 neutropenic patients were included and compared to 165 non-neutropenic patients. Neutropenic patients were younger (54 ± 14 vs 60 ± 13 years, p = 0.002) and had less lower limb (44.7% vs 70.9%, p < 0.001) and more abdomino-perineal NSTIs (43.4% vs 18.8%, p < 0.001). Enterobacterales and non-fermenting gram-negative bacteria were the most frequently isolated microorganisms in neutropenic patients. In-hospital mortality was significantly higher in neutropenic than in non-neutropenic patients (57.9% vs 28.5%, p < 0.001). Granulocyte colony-stimulating factor (G-CSF) administration was associated with a lower risk of in-hospital mortality in univariable Cox (hazard ratio (HR) = 0.43 95% confidence interval (CI) [0.23–0.82], p = 0.010) and multivariable Cox (adjusted HR = 0.46 95% CI [0.22–0.94], p = 0.033) analyses and after overlap propensity score weighting (odds ratio = 0.25 95% CI [0.09; 0.68], p = 0.006). Conclusions Critically ill neutropenic patients with NSTIs present different clinical and microbiological characteristics and are associated with a higher hospital mortality than non-neutropenic patients. G-CSF administration was associated with hospital survival