Etude de la colonisation bronchique par scedosporium apiospermum dans une cohorte de patients atteints de mucoviscidose

LYON1-BU Santé (693882101) / SudocSudocFranceF

The shift in rabies epidemiology in France: time to adjust rabies post-exposure risk assessment

International audienceThe epidemiology of rabies in France and western Europe has changed during the past 22 years. In France, rabies in non-flying terrestrial mammals was declared to be eliminated in 2001, and the risk of rabies is now limited to contact with bats, rabid animals illegally imported from rabies-enzootic countries and traveller exposure in enzootic areas. We analysed the epidemiology of rabies in France from 1995 to 2016, describing and analysing data on human rabies surveillance as well as data on post-exposure prophy-laxis (PEP) collected from the network of French antira-bies clinics. Over the study period, seven individuals were diagnosed with rabies in France, all of whom were infected outside mainland France. PEP data analysis revealed an expected overall decrease in PEP administration for individuals exposed in mainland France, but there was still overuse of anti-rabies drugs, given the very low epidemiological risk. On the other hand, a significant increase in PEP delivered to individuals exposed abroad was evidenced. These epidemiological trends indicate that clear guidelines should be provided to support physicians' efforts to adjust rabies risk assessment to the evolution of the epidemiological situation

Évaluation des connaissances, attitudes et pratiques sur le risque d'infection à lyssavirus chez les chiroptérologues français

Journées Nationales de l'Infectiologie et Journées Nationale de Formation des ParamédicauxNational audienc

Two-year immunogenicity of a pre-exposure rabies vaccination administered as a two-dose schedule

International audienceIn a young and healthy population, immunogenicity at 2 years of a rabies pre-exposure prophylaxis in a two-dose intramuscular schedule is satisfying. This regimen may be appropriate in people occupationally exposed to RABV, or travelling to highly endemic countries, provided they receive two booster doses in case of exposure

Infections of the Central Nervous System - Chapter 13: Rabies

International audienceRabies is a preventable zoonotic disease caused by a neurotropic virus of the Lyssavirus genus. The virus is transmitted from animal to human by bites, scratches, or direct exposure of mucosal surfaces to infectious saliva. All mammals are susceptible to rabies, but only a few species (e.g. dogs and bats) are important reservoirs for the disease. The virus reaches the brain mainly by centripetal propagation mediated by retrograde transneuronal transfer. Once clinical signs appear, the disease almost invariably progresses to fatal encephalitis

COVID-19-related travel restrictions temporarily reduced the demand for rabies post-exposure prophylaxis in France

International audienceDue to travel restrictions, a dramatic decrease of rabies post-exposure demand was observed in 2020 in the Ile-de-France region. The recovery of international travels may lead to a rebound in rabies exposures. This risk need to be anticipated and prevention messages delivered to people travelling to rabies-enzootic countries

Circumstances of Human–Bat interactions and risk of lyssavirus transmission in metropolitan France

International audienceSince the elimination of dog and terrestrial wild animal rabies, bat exposures remain the only source of autochthonous lyssavirus transmission to humans in Western Europe. European bats have already been found infected with several lyssaviruses, and human-bat interactions represent a risk of viral transmission and fatal encephalitis for humans. In this study, we aim to better characterize exposures to bats in metropolitan France from 2003 to 2016 and to identify circumstances associated with exposures to lyssavirus-positive bats. Two complementary sources of data were analysed: 1/ data associated with bats responsible for human exposure received for Lyssavirus testing by the French National Reference Centre for Rabies (NRCR); and 2/ data pertaining to individuals seeking medical care through the French Anti-Rabies Clinics network after contact with a bat. From 2003 to 2016, 425 bats originating from metropolitan France were submitted to the NRCR and 16 (4%) were found positive with a lyssavirus (EBLV-1b was diagnosed in 9 bats, EBLV-1a in 6 and BBLV in one specimen). The two factors associated with bat positivity in our study were the female sex and the bat belonging to the E. serotinus species. During the same study period, 1718 individuals sought care at an Anti-Rabies Clinic after exposure to a bat resulting in an estimated incidence of human-bat interactions of 1.96 per 106 person-years. The two most frequent circumstances of exposure were handling or bites. Interactions mostly involved one adult human being and one live and non-sick-looking bat. Our study provides new insights about circumstances of human-bat interactions and may be helpful to target prevention interventions to improve the awareness of the population of the risk of lyssavirus transmission

The Scedosporium apiospermum species complex: seroprevalence in patients with cystic fibrosis and clinical relevance

International audienceSpecies of the Scedosporium apiospermum complex are emerging fungal pathogens widely recognized now as causing chronic colonization of the airways in patients with cystic fibrosis (CF). Some recent studies performed in Canada 1 and France 2 suggested that the chronic colonization of the airways by another fungal pathogen, Aspergillus fumigatus, may contribute to the progressive deterioration of the lung function observed in some patients. We studied retrospectively the seroprevalence of the S. apiospermum species complex, as a marker of close contact between patient and the fungi, in a large monocentric cohort of CF patients attended in the reference centre in Lyon, France, and evaluated the clinical parameters associated with seropositivity.RESULTS:Serum samples from 373 CF patients were analysed. Serum antibodies against the S. apiospermum species complex were detected in 35 patients (9.4% of studied population). In multivariate analysis, seropositivity to the S. apiospermum species complex was associated only with seropositivity to A. fumigatus.CONCLUSIONS:This study does not suggest an association between sensitization against the S. apiospermum species complex and poorer lung function in patients with CF. Nevertheless, prospective studies are needed to evaluate more precisely the impact of both seropositivity to this species complex and its impact on the airway colonization by these fungi and on evolution of the lung function in patients with CF and the course of the disease.</p

Case Report: Cerebrovascular Events Associated With Bacterial and SARS-CoV-2 Infections in an Adolescent

International audienceNeurologic manifestations associated with Covid-19 are increasingly reported, especially stroke and acute cerebrovascular events. Beyond cardiovascular risk factors associated with age, some young adults without medical or cardiovascular history had stroke as a presenting feature of Covid-19. Suggested stroke mechanisms in this setting are inflammatory storm, subsequent hypercoagulability, and vasculitis. To date, a handful of pediatric stroke cases associated with Covid-19 have been reported, either with a cardioembolic mechanism or a focal cerebral arteriopathy. We report the case of an adolescent who presented with febrile meningism and stupor. Clinical, biological, and radiological features favored the diagnosis of Lemierre syndrome (LS), with Fusobacterium necrophorum infection (sphenoid sinusitis and meningitis) and intracranial vasculitis. The patient had concurrent SARS-CoV-2 infection. Despite medical and surgical antimicrobial treatment, stroke prevention, and venous thrombosis prevention, he presented with severe cerebrovascular complications. Venous thrombosis and stroke were observed, with an extension of intracranial vasculitis, and lead to death. As both F. necrophorum and SARS-CoV-2 enhance inflammation, coagulation, and activate endothelial cells, we discuss how this coinfection may have potentiated and aggravated the usual course of LS. The potentiation by SARS-CoV-2 of vascular and thrombotic effects of a bacterial infection may represent an underreported cerebrovascular injury mechanism in Covid-19 patients. These findings emphasize the variety of mechanisms underlying stroke in this disease. Moreover, in the setting of SARS-CoV-2 pandemic, we discuss in what extent sanitary measures, namely, lockdown and fear to attend medical facilities, may have delayed diagnosis and influenced outcomes. This case also emphasizes the role of clinical assessment and the limits of telemedicine for acute neurological condition diagnosis

Successful Treatment of Saksenaea sp. Osteomyelitis by Conservative Surgery and Intradiaphyseal Incorporation of Amphotericin B Cement Beads

International audienceOsteoarticular mucormycosis cases are quite rare and challenging infections that are mostly due to direct inoculation during traumatic injury among immu-nocompetent patients. Classic management includes a combination of aggressive surgical debridement, which may lead to amputation, and long-term systemic lipo-somal amphotericin B therapy. This article describes the successful treatment of Sak-senaea sp. osteomyelitis in a patient with diabetes mellitus, using a combination of systemic antifungal therapy and conservative surgery with insertion of amphotericin-impregnated cement beads. KEYWORDS Mucorales, amphotericin B, antifungal agents, osteomyelitis M ucorales osteomyelitis still presents diagnostic and therapeutic challenges and is associated with high mortality rates despite a combined therapeutic strategy involving antifungal treatment and surgery (1). Members of the order Mucorales are present in soil and plant debris and could be responsible for osteoarticular mucormy-cosis as a consequence of contamination through disrupted cutaneous barriers after traumatic injury (2). Surgical management is classically aggressive and complicated, with poor functional outcomes or even amputation. We report the first successful conservative orthopedic treatment of Saksenaea sp. osteomyelitis in a patient with diabetes mellitus, using in situ amphotericin-impregnated cement beads in combination with systemic posaconazole therapy. A 63-year-old man was admitted for a painful and swollen right ankle. He had well-controlled diabetes mellitus, hypertension, and degenerative arthritis. He lived in France and had never travelled overseas. Seven years earlier, he had suffered ankle trauma due to a rockfall and developed a necrotic subcutaneous abscess and a diaphyseal periosteal reaction seen on X-ray films. He underwent surgical drainage of the abscess; the sample cultures remained sterile and the surgical wound outcome was marked by a purple painless cutaneous infiltration. Seven years after the first operation, the patient's ankle became painful again and a bone biopsy was performed, which revealed no microorganisms in cultures. Empirical broad-spectrum antibiotherapy was initiated, without efficacy. Lower leg pain, erythema, and edema worsened and a satellite, 4-cm, right inguinal area of lymphadenopathy appeared. The patient was afebrile and had moderate biological inflammatory syndrome (C-reactive protein level, 50 mg/liter). Magnetic resonance imaging (MRI) showed decreased signal intensity on Citation Parize P, Mamez A-C, Garcia-Hermoso D, Dumaine V, Poirée S, Kauffmann-Lacroix C, Jullien V, Lortholary O, Lanternier F. 2019. Successful treatment of Saksenaea sp. osteomyelitis by conservative surgery and intradiaphyseal incorporation of amphotericin B cement beads