Impact of Home-Based Management of malaria combined with other community-based interventions: what do we learn from Rwanda?

Introduction: This study aimed to evaluate the impact of home-based management of malaria (HBM) strategy on time to treatment and reported presumed malaria morbidity in children aged less than 5 years in Rwanda. Methods: The study was carried out in two malaria-endemic rural districts, one where HBM was applied and the other serving as control. In each district, a sample of mothers was surveyed by questionnaire before (2004) and after (2007) implementation of HBM. Results: After implementation, we observed: i) an increase (P<0.001) in the number of febrile children treated within 24 hours of symptom onset in the experimental district (53.7% in 2007 vs 5% in 2004) compared with the control district (28% vs 7.7%); ii) a decrease in the reported number of febrile children in the experimental district (28.7% vs 44.9%, P<0.01) compared with the control district (45.7% vs 56.5%, P<0.05). Conclusion: HBM contributed to decrease time to treatment and reported presumed malaria morbidity.Pan African Medical Journal 2013; 14:5

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

CpG-ODN and MPLA Prevent Mortality in a Murine Model of Post-Hemorrhage-Staphyloccocus aureus Pneumonia

Infections are the most frequent cause of complications in trauma patients. Post-traumatic immune suppression (IS) exposes patients to pneumonia (PN). The main pathogen involved in PN is Methicillin Susceptible Staphylococcus aureus (MSSA). Dendritic cells () may be centrally involved in the IS. We assessed the consequences of hemorrhage on pneumonia outcomes and investigated its consequences on DCs functions. A murine model of hemorrhagic shock with a subsequent MSSA pneumonia was used. Hemorrhage decreased the survival rate of infected mice, increased systemic dissemination of sepsis and worsened inflammatory lung lesions. The mRNA expression of Tumor Necrosis Factor-alpha (TNF-α), Interferon-beta (IFN-β) and Interleukin (IL)-12p40 were mitigated for hemorrhaged-mice. The effects of hemorrhage on subsequent PN were apparent on the pDCs phenotype (reduced MHC class II, CD80, and CD86 molecule membrane expression). In addition, hemorrhage dramatically decreased CD8+ cDCs- and CD8- cDCs-induced allogeneic T-cell proliferation during PN compared with mice that did not undergo hemorrhage. In conclusion, hemorrhage increased morbidity and mortality associated with PN; induced severe phenotypic disturbances of the pDCs subset and functional alterations of the cDCs subset. After hemorrhage, a preventive treatment with CpG-ODN or Monophosphoryl Lipid A increased transcriptional activity in DCs (TNF-α, IFN-β and IL-12p40) and decreased mortality of post-hemorrhage MSSA pneumonia

Evaluation expérimentale des nouveaux antistaphylococciques (corrélation in vitro - in vivo)

Les bactéries à Gram positif sont au cœur des préoccupations actuelles en raison de leur multirésistance aux antibiotiques. La fréquence encore élevée des souches de Staphylococcus aureus résistantes à la méticilline (SARM) à l'hôpital, l'émergence de souches de sensibilité diminuée aux glycopeptides et la récente apparition de souches résistantes à la vancomycine (CMI >32mg/L) n'ont fait que renforcer le besoin de nouvelles molécules antistaphylococciques insensibles à ces mécanismes de résistance. Deux molécules récentes, le linézolide et la quinupristine-dalfopristine, sont actuellement disponibles sur le marché. A l'aide du modèle d'endocardite expérimentale du lapin, nous avons montré que l'administration en perfusion continue (à débit constant) du linézolide était supérieure au mode d'administration recommandé pour cette molécule (administration IV de 600 mg 2 fois par jour) sur trois souches de SARM. La quinupristine-dalfopristine a démontré une activité bactéricide sur deux souches de SARM (ermA- and ermA+) dans ce même modèle ; L'addition de gentamicine n'a pas permis d'augmenter l'efficacité antibactérienne, que ce soit en terme de réduction de la charge bactérienne dans la végétation ou de prévention de la sélection de mutants-résistants. L'étude in vitro des associations incluant le linézolide a permis de mettre en évidence un antagonisme avec la vancomycine et la gentamicine, essentiellement sur la phase de bactéricidie précoce de l'aminoside. Une indifférence a été observée avec le linézolide en association avec la rifampicine. Face à l'antagonisme observé in vitro pour la gentamicine, cette association a été étudiée in vivo sur deux souches de SARM sensibles à cet antibiotique. Contrairement aux résultats in vitro, l'association linézolide + gentamicine a démontré une activité bactéricide (>4 log10 UFC/g végétation) sur ces souches et apparaît capable de stériliser les végétations aortiques après trois jours de traitement.NANTES-BU Médecine pharmacie (441092101) / SudocSudocFranceF