Cancers cutanés et bronchopulmonaire chez un viticulteur après expositions répétées à l’arsénite de soude

L’arsenic est un métalloïde dont les composés inorganiques solubles ont une toxicité élevée. L’arsénite de soude, composé arsenical inorganique à l’état trivalent, a été utilisé jusqu’en 2001 comme antifongique en viticulture française. Il a été classé dans le groupe des agents cancérogènes avérés par le Centre international de recherche sur le cancer (CIRC) dès 1979. Il n’existe aucune substitution efficiente actuellement.Le cas rapporté relate l’histoire d’un homme âgé de 62 ans, ouvrier viticole retraité, fumeur, exposé à l’arsénite de soude (dont le Pyralesca® identifié sur les factures du chef d’entreprise). Il a été atteint de kératoses actiniques profuses, et de plusieurs carcinomes épidermoïdes dès le début des années 80, puis opéré (pneumonectomie gauche) d’un carcinome bronchique épidermoïde lobaire inférieur gauche (pT4N1 Mx) en 2006. Ces deux localisations cancéreuses sont imputables à l’utilisation d’arsénite de soude par présomption d’origine. Elles ont été reconnues courant 2009, en maladies professionnelles indemnisables du régime agricole. En raison du long délai d’apparition des cancers après expositions arsenicales, des cas peuvent toujours apparaître, a posteriori, chez des salariés en activité, ou retraités. Bien qu’un risque d’intoxication aiguë subsiste du fait de restes de stock, la possibilité d’une exposition chronique à l’arsénite en viticulture est improbable en France depuis la campagne d’éradication de 2006–2007 où 97 % des stocks ont été traités. Une information reste néanmoins nécessaire auprès des médecins du travail, médecins généralistes, dermatologues et pneumologues afin de lutter contre la sous-déclaration de ce type de cancers professionnels. Enfin, un suivi post-professionnel pourrait être envisagé en régime agricole

The effect of introducing IGRA to screen French healthcare workers for tuberculosis and potential conclusions for the work organisation

INTRODUCTION: In France, pre-employment screening for tuberculosis (TB) is performed for healthcare workers (HCW). Screening is repeated when exposure to TB patients or infectious material occurs. The results of these TB screenings were analysed in a retrospective analysis. METHOD: Tuberculin skin tests (TST) and interferon-gamma release assays (QuantiFERON® Gold In-Tube - QFT) were used to perform the TB screenings. The screening results of 637 HCWs on whom QFT was performed were taken from the records of the University Hospital of Nantes. RESULTS: In three (0.5%) HCW, the QFT was indeterminate. In 22.2%, the QFT was positive. A second QFT was performed in 118 HCWs. The reversion rate was 42% (5 out of 17). The conversion rate was 6% (6 out of 98). A TST was performed on 466 (73.5%) of the HCWs. Results for TST > 10 mm were 77.4%. In those with a TST < 10 mm, QFT was positive in 14% and in those with a TST ≥ 10 mm, QFT was positive in 26.7%. Depending on the definition for conversion in the QFT, the annual attack rate was 4.1% or 7.3%. X-ray and pneumology consultation was based on positive QFT rather than TST alone (52 out of 56). No active TB was detected. CONCLUSION: The TST overestimated the prevalence of LTBI in this cohort. The decision about X-ray and consultation regarding preventive treatment should be based on the QFT rather than the TST results. The high reversion rate should be taken into consideration when consulting with HCWs regarding preventive treatment. The high conversion rate seems to indicate that preventive measures such as wearing masks should be improved

MS, souffrance au travail et discontinuité de l’encadrement de proximité

National audienc

T Cell Dysregulation in Non-silicotic Silica Exposed Workers: A Step Toward Immune Tolerance Breakdown

International audienceBackground: Chronic silica exposure can lead to silicosis, complicated or not by autoimmune diseases (AID). The pathophysiology of silica-induced AID remains not fully understood, especially immune mechanisms that may develop in patients without yet established silicosis. We conducted a prospective clinical study to analyze the impact of crystalline silica (CS) on T cell phenotype and regulatory T cells (Tregs) frequency, as well as on auto-antibodies development in non-silicotic workers exposed to CS.Methods: Workers with moderate to high exposure level to CS and aged between 30 and 60 years-old were considered for inclusion. Peripheral blood mononuclear cells were analyzed by flow cytometry. Auto-antibodies were screened in serum by immunofluorescence. Blood from 42 and 45 healthy subjects (HC) was used as control for T cell phenotype and serum analyses, respectively.Results: Among the 63 included workers exposed to CS, 55 had full data available and were analyzed. Ten were exposed to CS for <5 years, 18 for 5–10 years and 27 for more than 10 years. The frequency of Tregs (CD4+CD25+CD127−FoxP3+) was significantly lower in CS exposed workers as compared to HC. We found an increased expression of the activation marker HLA-DR on T cells (CD3+, CD4+, and CD8+) of CS exposed workers as compared to HC. Tregs to activated T cells ratio was also lower in exposed subjects. In the latter, HLA-DR expression level and Tregs frequency were significantly associated with CS exposure duration. Serum autoantibody detection was significantly higher in CS exposed workers as compared to HC. Especially, among workers exposed more than 10 years, antinuclear antibodies and ANCA were detected in 44 and 22% among them, as compared to 5 and 2.5% in HC, respectively.Conclusion: This work shows that CS exposure is associated with a decrease of Tregs frequency, an increase of T cell activation status, and a tolerance breakdown against auto-antigens. These results show that alterations of the T cell compartment can be detected early over the course of CS exposure, preceding silicosis development or AID onset

Management of low back pain in primary care prior to multidisciplinary functional restoration : a retrospective study of 72 patients

International audienc