Covichem: A biochemical severity risk score of COVID-19 upon hospital admission

Clinical and laboratory predictors of COVID-19 severity are now well described and combined to propose mortality or severity scores. However, they all necessitate saturable equipment such as scanners, or procedures difficult to implement such as blood gas measures. To provide an easy and fast COVID-19 severity risk score upon hospital admission, and keeping in mind the above limits, we sought for a scoring system needing limited invasive data such as a simple blood test and co-morbidity assessment by anamnesis. A retrospective study of 303 patients (203 from Bordeaux University hospital and an external independent cohort of 100 patients from Paris Pitié-Salpêtrière hospital) collected clinical and biochemical parameters at admission. Using stepwise model selection by Akaike Information Criterion (AIC), we built the severity score Covichem. Among 26 tested variables, 7: obesity, cardiovascular conditions, plasma sodium, albumin, ferritin, LDH and CK were the independent predictors of severity used in Covichem (accuracy 0.87, AUROC 0.91). Accuracy was 0.92 in the external validation cohort (89% sensitivity and 95% specificity). Covichem score could be useful as a rapid, costless and easy to implement severity assessment tool during acute COVID-19 pandemic waves

Aggravations paradoxales des tuberculoses acquises sous anti-TNFa (description et facteurs de risque)

Les aggravations paradoxales de tuberculose, connues sous le nom de syndrome de reconstitution immunitaire inflammatoire (IRIS), sont récemment rapportées à l arrêt de l anti-TNF chez des patients ayant développé une tuberculose sous biothérapie. Nous rapportons la première série d IRIS de tuberculoses à l arrêt des anti TNF.Les cas d IRIS ont été recueillis à partir du registre RATIO et d un appel national à observations et comparés à des tuberculoses sous anti-TNF sans IRIS. Entre 2001 et 2010, 14 cas d IRIS ont été recueillis. Les patients, âgés de 52 ans (IQR: 41-67), souffrent d arthrites inflammatoires (10), de vascularites (3) et de psoriasis (1) et sont traités par anticorps monoclonaux (13) et récepteurs solubles (1). Au diagnostic de tuberculose, le plus souvent disséminée (12), tous les anti-TNFa sont stoppés, les antibiotiques et une corticothérapie (8) sont introduits. L IRIS est diagnostiqué, 62 jours (IQR: 22.00-131.00) après le début des antituberculeux, devant la réapparition de fièvre, l apparition, l augmentation de taille ou la fistulisation d adénopathies, l apparition d abcès froids, de tuberculomes, de péricardite, pleurésie, de cavernes pulmonaires. Les IRIS ont été traités par corticoïdes (9), rituximab (1), reprise d une quadrithérapie (2) et chirurgie (4) avec une évolution toujours favorable. L étude cas-témoins a trouvé comme facteurs de risque : la dissémination initiale de la tuberculose, et la profondeur de l immunodépression induite par les anti-TNFa. L IRIS, de diagnostic difficile, est source d une morbidité importante : traitement significativement plus long, hospitalisations à répétitions, chirurgies et corticothérapie prolongée.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocSudocFranceF

Une progression tumorale fulgurante sous abatacept

INTRODUCTION: La molécule de co-stimulation Cytotoxic T-lymphocyte antigen-4 (CTLA-4) inhibe l’activation lymphocytaire T. En thérapeutique, elle est ciblée de deux manières opposées : son blocage permet de restaurer l’immunité anti-tumorale en oncologie, tandis que des agonistes de CTLA4 tels que l’abatacept sont utilisés dans le traitement de certaines maladies immuno-inflammatoires et notamment la polyarthrite rhumatoïde (PR). OBSERVATION: Nous rapportons le cas d’un patient de 69 ans suivi pour une PR sévère traitée efficacement par abatacept, ayant présenté une progression tumorale anormalement rapide d’un carcinome indifférencié multi-métastatique. DISCUSSION: Bien qu’aucun sur-risque de cancer n’ait été rapporté sous abatacept, plusieurs cas de possible association avec une évolution tumorale défavorable ont été décrits. Dans le cas rapporté ici, l’abatacept pourrait avoir inhibé l’immuno-surveillance, et permis l’échappement tumoral.INTRODUCTION: Co-stimulatory molecule cytotoxic T-lymphocyte antigen-4 (CTLA-4) inhibits T-cell activation. Clinically, CTLA-4 has been targeted in opposite ways: its blockade enhances antitumor immunity in the field of oncology, whereas CTLA-4 agonists such as abatacept are used for the treatment of immuno-inflammatory diseases as rheumatoid arthritis (RA). OBSERVATION: We herein report the case of a 69-year-old man with a history of severe RA successfully treated with abatacept, who showed unusually rapid progression of undifferentiated multi-metastatic carcinoma. DISCUSSION: Although no significant increase in malignancy has been reported in abatacept-treated patients, several case reports have documented the possible association with the acceleration of the progression of malignancy. Here, abatacept may have altered immune surveillance and hence allowed tumor growth

Circulation of Multiple Patterns of Unique Recombinant Forms B/CRF02_AG in France

International audienc

Prosthetic Valve Candida spp. Endocarditis: New Insights Into Long-term Prognosis-The ESCAPE Study

Background Prosthetic valve endocarditis caused by Candida spp. (PVE-C) is rare and devastating, with international guidelines based on expert recommendations supporting the combination of surgery and subsequent azole treatment. Methods We retrospectively analyzed PVE-C cases collected in Spain and France between 2001 and 2015, with a focus on management and outcome. Results Forty-six cases were followed up for a median of 9 months. Twenty-two patients (48%) had a history of endocarditis, 30 cases (65%) were nosocomial or healthcare related, and 9 (20%) patients were intravenous drug users. "Induction" therapy consisted mainly of liposomal amphotericin B (L-amB)-based (n = 21) or echinocandin-based therapy (n = 13). Overall, 19 patients (41%) were operated on. Patients <66 years old and without cardiac failure were more likely to undergo cardiac surgery (adjusted odds ratios [aORs], 6.80 [95% confidence interval [CI], 1.59-29.13] and 10.92 [1.15-104.06], respectively). Surgery was not associated with better survival rates at 6 months. Patients who received L-amB alone had a better 6-month survival rate than those who received an echinocandin alone (aOR, 13.52; 95% CI, 1.03-838.10). "Maintenance" fluconazole therapy, prescribed in 21 patients for a median duration of 13 months (range, 2-84 months), led to minor adverse effects. Conclusion L-amB induction treatment improves survival in patients with PVE-C. Medical treatment followed by long-term maintenance fluconazole may be the best treatment option for frail patients