Temporal trends of cutaneo-mucous histoplasmosis in persons living with HIV in French Guiana: Early diagnosis defuses South American strain dermotropism.

Histoplasmosis is the most frequent opportunistic infection and the first cause of mortality in HIV-infected patients in French Guiana and presumably in much of Latin America. Mucocutaneous lesions of histoplasmosis are considered as rare and late manifestations of the disease. It has been debated whether the greater proportion of cutaneo-mucous presentations in South America relative to the USA was the reflection of Histoplasma strains with increased dermotropism or simply delayed diagnosis and advanced immunosuppression. The objective of this study was to describe the clinical presentation, frequency, prognosis and temporal trends of cutaneomucous histoplasmosis in French Guiana. A retrospective study of patients with AIDS-related disseminated histoplasmosis followed in the three hospitals of French Guiana was performed between 1981 and 2014. Incident cases of histoplasmosis, proved by pathology and/or mycological examinations, were studied. Mucocutaneous histoplasmosis was confirmed by a positive cutaneous or mucosal biopsy. Mucocutaneous lesions were polymorphic. Ninety percent of patients were profoundly immunocompromised patients (CD4<50/mm3) and over 80% were not on antiretroviral treatment. The frequency of mucocutaneous forms and case fatality of disseminated histoplasmosis within one month of antifungal treatment significantly decreased over time (p<0,001). In this South American territory, diagnostic and therapeutic improvements have led to the quasi disappearance of cutaneous manifestations. There may be South American dermotropism in the laboratory but at the bedside early diagnosis seems to be the main parameter explaining the proportion of cutaneomucous presentations in South America relative to the USA

Le langage manipulateur

L’argumentation est au cœur des préoccupations de ceux qui ont pour vocation de « manipuler » la langue, que ce soit pour transmettre des informations et des savoirs, pour agir sur autrui et communiquer ou pour étudier la langue dans ses dimensions interlocutive, dialogique et pragmatique. À la croisée de différentes disciplines scientifiques ayant la langue comme composante transversale – l’analyse de discours, la linguistique textuelle, la didactique des langues, la communication, la pragmatique – l’argumentation est également soumise à une évolution exponentielle des outils et techniques de diffusion et de traitement des données qui rapprochent les locuteurs dans le temps et l’espace. Ce contexte de mondialisation et d’évolution technologique influe considérablement sur la forme, le contenu, la structure, l’impact et l’enjeu des discours argumentatifs. Cet ouvrage collectif réunit les contributions de chercheurs en linguistique, analyse de discours et didactique du français sur objectif spécifique et universitaire autour de la notion de manipulation, au sens premier et au sens dérivé du terme, que l’argumentation peut produire sur le langage. Il propose un double regard franco-espagnol en croisant les articles de collègues français et espagnols afin d’enrichir l’analyse de cette notion très actuelle

Intestinal hypoxia and hypoxia-induced signalling as therapeutic targets for IBD

Tissue hypoxia occurs when local oxygen demand exceeds oxygen supply. In chronic inflammatory conditions such as IBD, the increased oxygen demand by resident and gut-infiltrating immune cells coupled with vascular dysfunction brings about a marked reduction in mucosal oxygen concentrations. To counter the hypoxic challenge and ensure their survival, mucosal cells induce adaptive responses, including the activation of hypoxia-inducible factors (HIFs) and modulation of nuclear factor-kappa B (NF-kappa B). Both pathways are tightly regulated by oxygen-sensitive prolyl hydroxylases (PHDs), which therefore represent promising therapeutic targets for IBD. In this Review, we discuss the involvement of mucosal hypoxia and hypoxia-induced signalling in the pathogenesis of IBD and elaborate in detail on the role of HIFs, NF-kappa B and PHDs in different cell types during intestinal inflammation. We also provide an update on the development of PHD inhibitors and discuss their therapeutic potential in IBD