Highlights from the 2016 International Symposium on HIV & Emerging Infectious Diseases (ISHEID): 25-27 May, Marseille, France.

International audienceFor three days in May 2016, the International Symposium on HIV & Emerging Infectious Diseases gathered participants from all over the world around the theme 'Fighting deadly viruses'. HIV infection remained the main topic of the meeting but hepatitis, Ebola and Zika viruses as well as other emergent pathogens were also extensively covered. In this article we have tried to summarise what was presented during the plenary lectures, the two keynote lectures, and some of the work accepted for oral presentation. However, all abstracts can be found on the Journal of Virus Eradication website ( viruseradication.com/abstract.php)

Spontaneous clearance of chronic hepatitis C virus infection in HIV positive patients, southeastern France

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Risk factors for acquisition of CTX-M genes in pilgrims during Hajj 2013 and 2014

International audienceBackground: Mass gatherings, especially the Hajj pilgrimage, provide favourable conditions for bacterial transmission among participants, which might contribute to the international spread of ESBL-producing Enterobacteriaceae (ESBL-E). Objectives: Weconducted an analysis aimed at investigating risk factors for CTX-M gene (bla(CTX-M)) rectal carriage in 2013 and 2014 Hajj pilgrims. Methods: A total of 218 pilgrims provided paired pre- and post-Hajj rectal samples (2013, 129 pilgrims; 2014, 89 pilgrims). CTX-M genes in rectal samples were identified by PCR and confirmed by sequencing. Pilgrims' characteristics, including possible factors relating to ESBL acquisition, were collected and analysed using XLSTAT version 2016.05.34687 (Addinsoft). For the univariate analysis, the frequencies of nominal data were compared using Pearson's chi(2) test and Fisher's exact test, and the means of quantitative data were compared using Student's t-test. A difference was considered significant when P<0.05. For multivariate analysis, a logistic regression was carried out, considering all the significant data in univariate analysis. Results: The acquisition rates of CTX-M genes among pilgrims during the 2013 and 2014 Hajj were similar, at 31.0% and 34.83%, respectively. Being of Moroccan origin, having chronic conditions, shortness of breath or diarrhoea, and using beta-lactams were associated with higher CTX-M gene acquisition, while being of Algerian origin and using macrolides were associated with lower CTX-M acquisition in univariate analysis. Shortness of breath and diarrhoea remained associated with increased CTX-M gene acquisition and consumption of macrolides with lower CTX-M gene acquisition in multivariate analysis. Conclusions: The possible gut colonization by CTX-M-type ESBL bacteria should be taken into account when prescribing empirical antibiotic treatments for infections that occur in returning Hajj pilgrims

Mycoplasma genitalium, an agent of reemerging sexually transmitted infections

International audienceM. genitalium is a reemerging microorganism, responsible for sexually transmissible infections (STIs), with prevalence which varies depending on the country and population group studied. We report here M. genitalium prevalence among the specimens received for STI diagnosis in our routine microbiological laboratory in the university hospital in Marseille, France. We tested 4 624 samples from 3 793 patients using qPCR for M. genitalium, C. trachomatis, N. gonorrheae, T. pallidum. Of these samples, 528 (13.6%) patients were tested positive for at least one pathogen and 126 (3.3%) were positive for M. genitalium. M. genitalium is the second most prevalent micro-organism detected in women after C. trachomatis (10.4%) and the third most prevalent in men after C. trachomatis (5.1%) and N. gonorrhoeae (4.4%). We observed no significant differences between the prevalence of M. genitalium in vaginal, urethral and urine specimens (p = 0.9). Prevalence of M. genitalium is significantly higher in patients aged between 10-30 years (4.1%) compared to those aged between 30 and 50 years (2.7%) (p = 0.02, RR = 1.54 [1.06-2.24]) and patients over 50 years of age (1.1%) (p = 0.003, RR= 3.98 [1.47-10.8]). M. genitalium is a common agent of STI, therefore we suggest that this micro-organism should be systematically tested during chronic, recurrent, or antibiotic resistant genital infections and in populations at high-risk of STIs

From Expert Protocols to Standardized Management of Infectious Diseases

International audienceWe report here 4 examples of management of infectious diseases (IDs) at the University Hospital Institute Mediterranee Infection in Marseille, France, to illustrate the value of expert protocols feeding standardized management of IDs. First, we describe our experience on Q fever and Tropheryma whipplei infection management based on in vitro data and clinical outcome. Second, we describe our management-based approach for the treatment of infective endocarditis, leading to a strong reduction of mortality rate. Third, we report our use of fecal microbiota transplantation to face severe Clostridium difficile infections and to perform decolonization of patients colonized by emerging highly resistant bacteria. Finally, we present the standardized management of the main acute infections in patients admitted in the emergency department, promoting antibiotics by oral route, checking compliance with the protocol, and avoiding the unnecessary use of intravenous and urinary tract catheters. Overall, the standardization of the management is the keystone to reduce both mortality and morbidity related to IDs

Contribution of VitaPCR SARS-CoV-2 to the emergency diagnosis of COVID-19

Background: With the persistent COVID-19 pandemic, there is an urgent need to use rapid and reliable diagnostic tools for highly urgent cases. Antigen tests are disappointing with their lack of sensitivity. Among molecular tools allowing a diagnosis in less than an hour, only one, the Cepheid Xpert Xpress SARS-CoV-2 assay, has exhibited a good sensitivity. However, we are also facing a global shortage of reagents and kits. Thus, it is imperative to evaluate other point-of-care molecular tests. Methods: We evaluated the VitaPCR (TM) RT-PCR assay, whose sample analysis time is of approximately 20 min, in nasopharyngeal secretions from 534 patients presenting to our Institute, for the diagnosis of COVID-19, and compared it to our routine RT-PCR assay. We also compared the two assays with tenfold dilutions of a SARS-CoV2 strain. Results: Compared to our routine RT-PCR and the previous diagnosis of COVID-19, the sensitivity, specificity, positive and negative predictive values of VitaPCRTM can be evaluated to be 99.3 % (155/156), 94.7 % (358/378), 88.6 % (155/175) and 99.7 % (358/359), respectively. Tenfold dilutions of a SARS-CoV-2 strain show that the VitaPCR (TM) was more sensitive that our routine RT-PCR assay. Conclusion: The VitaPCR (TM) SARS-CoV-2 is an accurate rapid test, suitable for clinical practice that can be performed as part of a point-of-care testing, for the rapid diagnosis of COVID-19

FDG-PET/CT Incidental Detection of Cancer in Patients Investigated for Infective Endocarditis

International audienceBackground:Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) is an imaging technique largely used in the management of infective endocarditis and in the detection and staging of cancer. We evaluate our experience of incidental cancer detection by PET/CT during IE investigations and follow-up. Methods and Findings:Between 2009 and 2018, our center, which includes an ``endocarditis team,'' managed 750 patients with IE in a prospective cohort. PET/CT became available in 2011 and was performed in 451 patients. Incidental diagnosis of cancer by PET/CT was observed in 36 patients and confirmed in 34 of them (7.5%) (colorectaln= 17; lungn= 7; lymphoman= 2; melanoman= 2; ovariann= 2; prostaten= 1; bladdern= 1; ear, nose, and throatn= 1; brainn= 1). A significant association has been found between colorectal cancer andStreptococcus gallolyticusand/orEnterococcus faecalis[12/26 vs. 6/33 for other cancers,p= 0.025, odds ratio = 3.86 (1.19-12.47)]. Two patients had a negative PET/CT (a colon cancer and a bladder cancer), and two patients, with positive PET/CT, had a benign colorectal tumor. PET/CT had a sensitivity of 94-100% for the diagnosis of cancer in this patient. Conclusions:Whole-body PET/CT confirmed the high incidence of cancer in patients with IE and could now be proposed in these cases