High clustering of acute HCV infections and high rate of associated STIs among Parisian HIV-positive male patients.

BACKGROUND: Increasing incidence of hepatitis C virus (HCV) infection in human immunodeficiency virus (HIV)-positive men having sex with men (MSM) has been described in recent years. Phylogenetic analyses of acute HCV infections were undertaken to characterize the dynamics during the epidemic in Paris, and associated sexually transmitted infections (STIs) were evaluated. METHODS: Sanger sequencing of polymerase gene was performed. Maximum likelihood phylogenies were reconstructed using FastTree 2.1 under a GTR+CAT model. Transmission chains were defined as clades with a branch probability ≥0.80 and intraclade genetic distances <0.02 nucleotide substitutions per sites. STIs detected ≤1 month before HCV diagnosis were considered. RESULTS: Among the 85 studied patients, at least 81.2% were MSM. Respectively, 47.6%, 39.0%, 11.0% and 2.4% were infected with genotypes 1a, 4d, 3a and 2k. At least 91.8% were co-infected with HIV. HCV re-infection was evidenced for 24.7% of patients and STIs for 20.0% of patients. Twenty-two transmission chains were identified, including 52 acute hepatitis C (11 pairs and 11 clusters from three to seven patients). CONCLUSIONS: These results revealed strong clustering of acute HCV infections. Thus, rapid treatment of both chronic and acute infections is needed among this population to decrease the prevalence of HCV, in combination with preventive behavioural interventions

Clinical and microbiological epidemiolgy of ESBL producing strains of Escherichia coli and Klebsiella pneumoniae

Les entérobactéries productrices de BLSE (EBLSE) ont émergé au début des années 80 puis ont largement diffusé. Elles sont actuellement responsables d’une pandémie mondiale qui représente un problème majeur de santé publique. D’une part, la diffusion des EBLSE expose à un risque de prescriptions antibiotiques empiriques inadaptées. Or, il est clairement établi qu’une antibiothérapie initiale inadaptée est responsable d’une augmentation de morbidité et de mortalité, mais également d’un surcoût de prise en charge. D’autre part, la dissémination des EBLSE a pour conséquence une prescription accrue de carbapénèmes, classe d’antibiotiques de référence sur les EBLSE. Cela expose au risque de sélection et de diffusion de bactéries productrices d’enzymes capables d’hydrolyser les carbapénèmes (carbapénémases) qui peut conduire à des situations d’impasses thérapeutiques. La diffusion des EBLSE est la conséquence d’une transmission croisée, favorisée par différents phénomènes, en particulier la pression de sélection par antibiothérapie. Après une revue de la littérature sur les EBLSE, nous présenterons les résultats du travail de recherche centré sur E. coli et K. pneumoniae. La large dissémination des EBLSE et en particulier des enzymes de type CTX-M est-elle due à des caractéristiques de l’hôte bactérien, de la bactérie ou du plasmide porteur des gènes de résistance ? Nous nous sommes attachés : (i) à décrire la population, la prise en charge et l’évolution de patients colonisés ou infectés par des EBLSE, (ii) croiser ces résultats avec les facteurs de virulence des souches et leur capacité à former du biofilm et, (ii) à caractériser les plasmides porteurs de la résistance.Enterobacteria producing extended spectrum β-lactamases (E-ESBL) emerged in the 80’s and then spread widely. They are currently responsible for a global pandemic that represents a major public health problem. On the one hand, the diffusion of E-ESBL exposes to a risk of inadequate empirical antibiotic prescriptions. It is clearly established that inadequate initial antibiotic therapy is responsible for increase morbidity and mortality, but also an additional cost. On the other hand, the spread of E-ESBL results in an increased prescription of carbapenems, a class of reference antibiotics on E-ESBL. This exposes the risk of selection and diffusion of enzyme-producing bacteria capable of hydrolysis of carbapenems (carbapenemases) which can lead to situations of untreatable infections. The diffusion of E-ESBL is the consequence of cross-transmission, favoured by different phenomena, in particular the selection pressure by antibiotic therapy. After a review of the literature on E-ESBL, we will present the results of of our research centered on Escherichia coli and Klebsiella Pneumoniae. Is the widespread release of E-ESBL and in particular of CTX-M-type enzymes due to characteristics of the bacterial host, bacterium, or plasmid carrying resistance genes? We have attached ourselves: (i) to describe the population, management and evolution of patients colonized or infected with E-ESBL, (ii) to cross these results with the virulence factors of the strains and their ability to form biofilm and, (ii) to characterize the plasmids carrying the resistance

Infection par le virus de l'hépatite B : histoire naturelle, manifestations cliniques et principes thérapeutiques

International audienceChronic hepatitis B infection remains a major public-health problem, with approximately 260 million world-wide cases of infection. Recent advances in the understanding of the natural history of chronic hepatitis B infection have led to progress in the care of infected patients. Sustained viral suppression is now possible for a majority of treated patients and is associated with a decrease in the morbidity and mortality attributable to cirrhosis and hepatocellular carcinoma. Complete cure is however not yet possible, due to the long-term persistence of viral DNA in hepatocytes of treated patients. Assessing the risk of viral reactivation in patients receiving immunosuppressive therapy is an increasingly frequent situation in clinical practice and its management is guided by both the patient's serological status and the potency of the immunosuppressive regimen. This review aims to present the clinical and biological presentations of chronic hepatitis B infection, the modalities of antiviral treatment, and how to assess the risk of viral reactivation in patients receiving immunosuppressive therapy.Avec près de 260 millions de cas dans le monde, l’hépatite B chronique est la première cause de mortalité par maladie du foie et dépasse actuellement l’infection par le VIH, la tuberculose ou le paludisme en termes de morbi-mortalité. D’importants progrès dans la compréhension de l’histoire naturelle de l’infection chronique ont conduit à une optimisation des modalités de suivi et des thérapeutiques proposées aux patients infectés. L’arsenal thérapeutique actuellement disponible permet d’obtenir dans la majorité des cas une suppression virale suffisante pour réduire le risque de complications hépatiques liées à l’infection chronique. La guérison complète n’est cependant pas encore possible, du fait de la persistance d’ADN viral dans les hépatocytes du sujet infecté, qui expose au risque de réactivation à l’arrêt du traitement. La gestion de ce risque sous traitement immunosuppresseur, qui dépend à la fois du statut sérologique et du traitement utilisé, est une situation fréquente et importante en pratique clinique, qui a fait l’objet de recommandations récentes.Cette revue générale propose de décrire les manifestations cliniques et biologiques de l’infection par le virus de l’hépatite B, les indications et modalités du traitement antiviral, et de résumer les principes de prise en charge du risque de réactivation virale sous traitement immunosuppresseur

Chlamydia trachomatis screening in urine among asymptomatic men attending an STI clinic in Paris: a cross-sectional study

Abstract Background The incidence of Chlamydia trachomatis (Ct) urethritis has been increasing for the past 10 years. There is little data regarding the screening of Ct infection in asymptomatic men in France, despite the national recommendation to screen at-risk asymptomatic men under 30 attending Sexually Transmitted Infections (STI) clinics. Recent data from the French surveillance network Rénachla show indeed that systematic screening is still focused on women. The objective of our study was to determine the prevalence and risk factors for Ct infection in asymptomatic men under 30 attending an STI clinic located in Paris, France. Methods We performed a cross-sectional study between April 4, and December 31, 2016 in the database of the software DIAMM Client V8 used in our STI clinic. We extracted the demographic characteristics, sexual behavior and result of STI screening of all asymptomatic men who had consulted and given their consent for the use of their personal data. Those data were collected in usual care through a standardized questionnaire filled in during an appointment with a trained physician. STI screening was performed using PCR kit CT/NG Abbott Realtime® on first void urines. For MSM, a rectal swab was also collected. Risk factors for Ct infection were analyzed by univariate and multivariate modeling using STATA software 8.2. Results Among 872 men who had attended the clinic, 647 were included and 37 (5.7, 95% CI 4.2 to 7.8) were positive for Ct in urine. In univariate analysis, men who had unprotected sex in the last 6 weeks (OR 2.40 (95%CI 1.16 to 4.94), p = 0.02), and those who had an infected partner (OR 7.6 (95%CI 3.03 to 20), p = 0.0001) were more likely to be infected. In the multivariate analysis having an infected partner was the only risk factor (OR 11.1(95% CI 3.7 to 33.3), p = 0.0001) that remained significant. Conclusion Prevalence of Ct infection is high among asymptomatic men of 30 years or less attending our urban STI clinic especially among those with an infected partner. The Ct screening among this population associated with partner notification, as recommended by the French national guidelines, should be more widely implemented

Clostridium difficile associated reactive arthritis: Case report and literature review

International audienceIntroduction : Extra-gastro-intestinal tract manifestations associated with Clostridium difficile infection (CDI), including reactive arthritis (ReA), are uncommon.Method : We report a case of ReA associated with a relapse of CDI in a 46-year-old woman. A toxigenic C. difficile strain was isolated from stools and characterized as PCR-ribotype 014/020/077. We conducted a comprehensive literature review of ReA associated with CDI (ReA-CDI). Diagnostic criteria for ReA-CDI were: (i) evidence of aseptic synovitis (confirmed by culture) developing during or immediately after colitis, (ii) presence of a toxigenic C. difficile strain in stool samples, and (iii) absence of other causes of colitis and arthritis.Results : Forty-nine cases of ReA-CDI (excluding the present report) have already been described since 1976. Of these reports, Mean age of patients was 38 years (SD: 18.5), 46% were male, and 68% had HLA B27 genotype. Sixty-nine percent of patients received a β-lactamin treatment before CDI. ReA-CDI occurred a median 10 days (range 0–55 days) after CDI. Outcome was favorable in 90% of patients and oral non anti-inflammatory drugs were required for 55%.Conclusion : ReA-CDI remains uncommon. Compared to the general population, it is more likely observed in younger patients with HLA B27-positive genotype

[Letter] Cutaneous diphtheria: 3 case-reports to discuss determinants of re-emergence in resource-rich settings

International audienceDiphtheria is a re-emerging disease in resource-rich settings. We here report three cases of cutaneous diphtheria diagnosed and managed in our infectious disease department and discuss the determinants of its re-emergence. Migration, travel and vaccine skepticism are key factors not only for diphtheria re-emergence, but for the future of most preventable diseases

Impact and Tolerance of Immunosuppressive Treatments in Patients Living with HIV with Inflammatory or Autoimmune Diseases

Background: Patients living with HIV (PLWHIV) can develop autoimmune diseases (AD) needing immunosuppressive treatments (IST). This study aims to describe the impact of IST in PLWHIV. Methods: This was a multicentric retrospective observational study in six HIV referral centers on PLWHIV under IST for AD. Demographic factors, viral co-infections, immunovirological status before and under IST, infectious events, and their descriptions were collected and described focusing on infectious events, immunovirological variations, and IST effectiveness. Results: 9480 PLWHIV were screened for inclusion. Among them, 138 (1.5%) had a history of auto-immune disease, among which 32 (23%) received IST. There was mainly spondyloarthropathy (28%) and the most commonly used IST was methotrexate. The median follow-up under IST was 3.8 years (2.7; 5.9). There were 15 infectious events (0.5 events/individuals) concerning nine patients. At the last medical follow-up, 81% of these were in remission of their AD. Under IST, there was an increase in CD4 during follow-up (629 vs. 827 CD4/mm3, p = 0.04). No HIV virological failure was noted. Conclusions: This study supports a growing evidence base that IST can be used safely and effectively in PLWHIV with careful monitoring

Comparing Inpatient Satisfaction Collected via a Web-Based Questionnaire Self-Completion and Through a Telephone Interview: An Ancillary Study of the SENTIPAT Randomized Controlled Trial

International audienceBackground: Assessing the satisfaction of patients about the health care they have received is relatively common nowadays. In France, the satisfaction questionnaire, I-Satis, is deployed in each institution admitting inpatients. Internet self-completion and telephone interview are the two modes of administration for collecting inpatient satisfaction that have never been compared in a multicenter randomized experiment involving a substantial number of patients.Objective: The objective of this study was to compare two modes of survey administration for collecting inpatient satisfaction: Internet self-completion and telephone interview.Methods: In the multicenter SENTIPAT (acronym for the concept of sentinel patients, ie, patients who would voluntarily report their health evolution on a dedicated website) randomized controlled trial, patients who were discharged from the hospital to home and had an Internet connection at home were enrolled between February 2013 and September 2014. They were randomized to either self-complete a set of questionnaires using a dedicated website or to provide answers to the same questionnaires administered during a telephone interview. As recommended by French authorities, the analysis of I-Satis satisfaction questionnaire involved all inpatients with a length of stay (LOS), including at least two nights. Participation rates, questionnaire consistency (measured using Cronbach alpha coefficient), and satisfaction scores were compared in the two groups.Results: A total of 1680 eligible patients were randomized to the Internet group (n=840) or the telephone group (n=840). The analysis of I-Satis concerned 392 and 389 patients fulfilling the minimum LOS required in the Internet and telephone group, respectively. There were 39.3% (154/392) and 88.4% (344/389) responders in the Internet and telephone group, respectively (P<.001), with similar baseline variables. Internal consistency of the global satisfaction score was higher (P=.03) in the Internet group (Cronbach alpha estimate=.89; 95% CI 0.86-0.91) than in the telephone group (Cronbach alpha estimate=.84; 95% CI 0.79-0.87). The mean global satisfaction score was lower (P=.03) in the Internet group (68.9; 95% CI 66.4-71.4) than in the telephone group (72.1; 95% CI 70.4-74.6), with a corresponding effect size of the difference at −0.253.Conclusions: The lower response rate issued from Internet administration should be balanced with a likely improved quality in satisfaction estimates, when compared with telephone administration, for which an interviewer effect cannot be excluded