Microorganisms

The indoor microbial community is a mixture of microorganisms resulting from outdoor ecosystems that seed the built environment. However, the biogeography of the indoor microbial community is still inadequately studied. Dust from more than 3000 dwellings across France was analyzed by qPCR using 17 targets: 10 molds, 3 bacteria groups, and 4 mites. Thus, the first spatial description of the main indoor microbial allergens on the French territory, in relation with biogeographical factors influencing the distribution of microorganisms, was realized in this study. Ten microorganisms out of 17 exhibited increasing abundance profiles across the country: Five microorganisms (Dermatophagoïdes pteronyssinus, Dermatophagoïdes spp., Streptomyces spp., Cladosporium sphaerospermum, Epicoccum nigrum) from northeast to southwest, two (Cryptococcus spp., Alternaria alternata) from northwest to southeast, Mycobacteria from east to west, Aspergillus fumigatus from south to north, and Penicillium chrysogenum from south to northeast. These geographical patterns were partly linked to climate and land cover. Multivariate analysis showed that composition of communities seemed to depend on landscapes, with species related to closed and rather cold and humid landscapes (forests, located in the northeast) and others to more open, hot, and dry landscapes (herbaceous and coastal regions, located in the west). This study highlights the importance of geographical location and outdoor factors that shape communities. In order to study the effect of microorganisms on human health (allergic diseases in particular), it is important to identify biogeographic factors that structure microbial communities on large spatial scales and to quantify the exposure with quantitative tools, such as the multi-qPCR approach

Une paralysie diaphragmatique bilaterale revelant une neuroborreliose de Lyme

INTRODUCTION: Lyme disease is not uncommon and can sometimes progress to neurological complications. We report here an unusual case of bilateral diaphragmatic paralysis secondary to Lyme neuroborreliosis. CASE REPORT: A 79-year-old man was admitted to the intensive care unit for acute respiratory distress requiring intubation and the long-term use of nocturnal non-invasive ventilation. Three months beforehand he had been bitten by a tick and developed erythema migrans which was treated with Doxycycline for 10 days. This clinical presentation became complicated a few days later by the progressive onset of severe dyspnoea. At admission, chest radiography revealed bilateral elevation of the diaphragm. Pulmonary function tests revealed a severe restrictive disorder aggravated by decubitus. A diaphragmatic electromyogram showed bilateral axonal polyneuropathy of the phrenic nerves. IgG and IgM antibodies to Borrelia burgdorferi were detectable in serum and cerebrospinal fluid, leading to the diagnosis of Lyme disease. He was treated with intravenous ceftriaxone 2g per day for 21 days, leading to a substantial improvement in symptoms. CONCLUSION: In the presence of unilateral or bilateral diaphragmatic paralysis of undetermined aetiology, it seems relevant to perform Lyme serology in the blood and, in positive cases, to follow up with a lumbar puncture in order to detect intrathecal IgG synthesis

Environ Res

RATIONALE: Asthma, frequently associated with rhinitis, is the most common chronic disease in children, and a significant role is played by a range of environmental exposures. Among them, air pollution is of foremost concern. However, little is known about the impact of airborne pesticide exposure on children's respiratory health in rural areas. The objective of this study was to analyze the association between airborne pesticide exposure and asthma and rhinitis in children. METHODS: In a French vineyard rural area, children (3-10 years old) from 4 selected schools were invited to participate in this study over two periods: winter, with no or low air pesticide levels, and summer when fields are frequently treated with pesticides. Two health outcomes were considered: asthma and rhinitis symptoms (ISAAC questionnaire), and peak expiratory flow (PEF). A quantitative score of symptoms was built. Exposure to pesticides was evaluated 1) by measuring 56 pesticides in the ambient outdoor air around schools in the two periods and building a cumulative exposure index, and 2) by measuring ethylenethiourea (ETU) concentrations in urine in a subsample of children (n=96), ETU being a urine biomarker of exposure to dithiocarbamates fungicides. Next, the association between pesticide exposure and respiratory health was studied using a logistic regression model, adjusted for confounders and respiratory status at baseline. RESULTS: 281 children participated in the study (47% girls, mean age: 7.5yrs). 25% of the children were living on a farm. 22% had experienced wheezing at least once. 15.8% had asthma diagnosed by a doctor, 12% had current asthma and 35% had allergic rhinitis. The main pesticides detected in the ambient outdoor air around schools were fungicides (89,3%; mainly folpet and dithiocarbamates) and insecticides (10.6%). No association was found between the symptom score and pesticides in the outdoor air around schools during summer, when pesticides were applied to vineyards. However, an association was found between ETU urinary concentration (>0.974mug/g creatinine) and asthma and rhinitis symptoms (OR=3.56; IC 95% 1.04-12.12). This result could be explained by extracurricular exposure, which was not considered in our air measurements in the schools. No association was found between peak expiratory flow and exposure to pesticides in the air. CONCLUSIONS: Children living in vineyard rural areas are at a higher risk of airborne dithiocarbamates exposure during the summer period. Despite the limited size of our sample, our results suggest possible links between some pesticide measurements and respiratory and allergic symptoms such as rhinitis

Pharmacoepidemiol Drug Saf

PURPOSE: Sophia Asthme (SA) is a chronic disease management program of the French national health insurance for adult patients with asthma. We evaluated the early impact of this intervention. METHODS: We conducted a matched controlled, before-and-after quasi-experimental study within the French Health Insurance Database (Systeme National Des Donnees de Sante [SNDS]). The SA program was implemented in a set of 18 Departements in France and targeted 18- to 44-year-old subjects, with at least two reimbursement dates for asthma drug therapy during the 12-month period prior to program targeting. Change in outcomes was assessed from the "before program" period (January-December 2014) to the "after program implementation" period (March 2015-February 2016) in the program group (eligible to SA program in the 18 Departements) and in the matched controlled group. The main outcome measure was the before-after change in proportion of subjects with a controllers/(controllers+relievers) ratio greater than 50%. RESULTS: Of the 99 578 subjects of the program group, 9225 (9.3%) actually participated in SA program. The program had no significant impact on the proportion of subjects with a ratio greater than 50%. However, subjects exposed to SA program were significantly more likely to be dispensed controller medications (OR = 1.04; 95% CI, 1.01-1.07) and to sustain their use of these medications (OR = 1.08; 95% CI, 1.05-1.12). CONCLUSION: We did not demonstrate any significant impact of the program on the primary outcome. The modest yet encouraging findings of this early evaluation suggest the need for reformulation of the program and its evaluation

Archives des Maladies Professionnelles et de l'Environnement

Résumé Objectif Le devenir professionnel des asthmatiques est souvent défavorable avec des conséquences fréquentes de l’asthme sur le statut socioéconomique (diminution de revenus et/ou perte de l’emploi). L’objectif de ce travail était d’étudier l’itinéraire socioprofessionnel des asthmatiques à partir des données de l’enquête Santé et itinéraire professionnel. Méthodes En 2006, 13 648 individus de 20 à 74 ans vivant en France métropolitaine en ménage ordinaire ont participé à l’enquête. En 2010, ils ont été recontactés et 11 220 individus ont été réinterrogés. La présente analyse a porté sur les 11 068 individus ayant participé aux deux vagues de l’enquête et ayant un itinéraire professionnel. L’asthme aux différents moments de la vie a été repéré par les déclarations des individus. Les antécédents professionnels et médicaux ont été recueillis. Résultats Chez les femmes, après ajustement sur l’âge, la probabilité d’être asthmatique était plus élevée chez celles ayant eu au moins une période de chômage au cours de leur itinéraire professionnel, une durée de périodes de chômage de plus d’un an et une durée d’emploi plus courte, et était plus faible chez celles ayant les revenus les plus élevés. Entre 2006 et 2010, les femmes asthmatiques ont connu plus fréquemment des périodes de chômage et des arrêts maladie que les non-asthmatiques. Aucune différence statistiquement significative n’était observée chez les hommes. Conclusions Ces résultats suggèrent que les femmes asthmatiques comparées au non-asthmatiques, connaissent des parcours professionnels plus instables et ont des revenus inférieurs, ce qui n’est pas observé chez les hommes. Les cohortes Coset et Constances devraient permettre d’étudier plus en détail l’impact de l’asthme sur la carrière professionnelle des travailleurs. Summary Purpose of the study The working life of people with asthma and the consequences of asthma on their socio-economic status are often unfavorable (decreased income and/or loss of employment). The objective of our analysis was to study the socio-professional itinerary of asthmatic people using data from Santé et Itinéraire Professionnel survey. Methods In 2006, 13,648 individuals aged 20 to 74 years living in France participated in the survey, among whom 11,220 individuals were re-interviewed in 2010. Our study population included 11,068 persons who participated in both phases of the survey and had a occupational itinerary. Asthma at different times of life was identified through individuals’ reporting. Data on occupational and medical history were collected. Results In women, the age-adjusted probability of having asthma was higher in those with at least one period of unemployment during their working life, a period of unemployment of more than one year, and a shorter duration of employment. It was lower in those with the highest incomes. Between 2006 and 2010, women with asthma experienced more often periods of unemployment and sick leave than non-asthmatics. In men, no significant difference was observed. Conclusion These results suggest that asthmatic women experience a more unstable working life and have lower incomes as compared to non-asthmatics, which is not observed in men. The ongoing Coset and Constances cohorts would allow to assess more deeply the impact of asthma on the working life