Diagnostic des fièvres et syndromes inflammatoires biologiques d’origine indéterminée : étude prospective sur 39 patients au centre hospitalier universitaire de Grenoble Alpes

Introduction: Our aim was to study prevalence of FUO, IUO and their etiologies, and evaluate diagnosis contribution of complementary examinations, mainly (18F)FDG-PET. Methods: We conducted a monocentric prospective study at Grenoble Alpes University Hospital between December 2015 and November 2017. Fever > 38,3°C or C-reactive Protein level > 5mg/L for more than a week, without diagnosis after minimal investigations defined FUO/IUO. The different causes were listed as infectious diseases, noninfectious inflammatory diseases (NIID), neoplasms, miscellaneous diseases and undiagnosed. Diagnostic features of (18F)FDG- PET were studied. Results: Thirty-nine patients were included, respectively 32 FUO and 7 IUO. A diagnosis was made possible in 67% cases, mainly NIID (50%) and neoplasms (31%), then infectious diseases (15%) and miscellaneous diseases (4%). Most exams, such as laboratory tests or imaging technics were mildly helpful for diagnosis. (18F)FDG- PET was performed in 82% of patients, and helpful for final diagnosis in 47% of cases. Diagnostic performances of (18F)FDG- PET were excellent in case there was no clinical clue (sensitivity 86% and negative predictive value 90%). Thirty-two patients received a treatment, linked with the causal disease in 64% of cases. Six patients (15%) died during follow up. Death was always related to the causal disease. None of the undiagnosed patients died. Conclusion: Complete and repeated physical examination helps guide diagnostic approach of FUO and IUO. Without these clinical clues, (18F)FDG- PET has a major place to help with final diagnosis and to exclude a potential severe disease if normal.Introduction : Les fièvres et syndromes inflammatoires d’origine indéterminée (FUO/IUO) sont des entités nosologiques qui évoluent au cours du temps, des techniques diagnostiques et selon la zone géographique concernée. Le but de cette étude est d’étudier la prévalence les étiologies et l’apport diagnostique, de la TEP-[18F] au FDG. Méthodes : Nous avons mené une étude prospective monocentrique entre décembre 2015 et novembre 2017. Une fièvre ou un taux de CRP > 5mg/L sans fièvre depuis une semaine, sans diagnostic après un bilan minimal définissaient les FUO/IUO. Les étiologies étaient classées en infections, maladies inflammatoires non infectieuses (MINI), néoplasies, autres causes et étiologies non retrouvées. Les performances diagnostiques de la TEP-[18F]FDG étaient évaluées. Résultats : Trente-neuf patients ont été inclus, 32 FUO et 7 IUO. Le taux de diagnostic était de 67% : les MINI représentaient 50%, les néoplasies 31%, les infections 15% et les causes « autres » 4%. La TEP-[18F]FDG était réalisée chez 82% des patients et aidait au diagnostic dans 47% des cas. En l’absence d’orientation clinique se sensibilité était de 86% et la valeur prédictive négative de 90%. Six patients (15%) sont décédés au cours du suivi et 4 patients (10%) ont été perdus de vue. Aucun patient sans diagnostic final n’est décédé. Conclusion : Un examen clinique rigoureux et répétés permet de guider la démarche diagnostique des FUO et IUO. La TEP-[18F]FDG semble tenir une place importante en l’absence d’orientation en aidant au diagnostic et en éliminant une pathologie grave en cas de normalité

Prévalence et caractéristiques de l’auto-immunité sérique chez les patientes suivies pour infertilité au CHU de Grenoble

International audienceFertility disorders in autoimmune diseases are well described. However, little is known about the presence of a humoral serum autoimmunity in case of infertility (antinuclear antibodies, ACAN or antiphospholipid, APL) without criteria of autoimmune disease

Effect of Professional and Extra-Professional Exposure on Seroprevalence of SARS-CoV-2 Infection among Healthcare Workers of the French Alps: A Multicentric Cross-Sectional Study

We aimed to report SARS-CoV-2 seroprevalence after the first wave of the pandemic among healthcare workers, and to explore factors associated with an increased infection rate. We conducted a multicentric cross-sectional survey from 27 June to 31 September 2020. For this survey, we enrolled 3454 voluntary healthcare workers across four participating hospitals, of which 83.4% were female, with a median age of 40.6 years old (31.8–50.3). We serologically screened the employees for SARS-CoV-2, estimated the prevalence of infection, and conducted binomial logistic regression with random effect on participating hospitals to investigate associations. We estimated the prevalence of SARS-CoV-2 infection at 5.0% (95 CI, 4.3%–5.8%). We found the lowest prevalence in health professional management support (4.3%) staff. Infections were more frequent in young professionals below 30 years old (aOR = 1.59, (95 CI, 1.06–2.37)), including paramedical students and residents (aOR = 3.38, (95 CI, 1.62–7.05)). In this group, SARS-CoV-2 prevalence was up 16.9%. The location of work and patient-facing role were not associated with increased infections. Employees reporting contacts with COVID-19 patients without adequate protective equipment had a higher rate of infection (aOR = 1.66, (95 CI, 1.12–2.44)). Aerosol-generating tasks were associated with a ~1.7-fold rate of infection, regardless of the uptake of FFP2. Those exposed to clusters of infected colleagues (aOR = 1.77, (95 CI, 1.24–2.53)) or intra-familial COVID-19 relatives (aOR = 2.09, (95 CI, 1.15–3.80)) also had a higher likelihood of infection. This report highlights that a sustained availability of personal protective equipment limits the SARS-CoV-2 infection rate to what is measured in the general population. It also pinpoints the need for dedicated hygiene training among young professionals, justifies the systematic eviction of infected personnel, and stresses the need for interventions to increase vaccination coverage among any healthcare workers

Increased risk of severe COVID-19 in hospitalized patients with SARS-CoV-2 Alpha variant infection: a multicentre matched cohort study

International audienceBackground: The impact of the variant of concern (VOC) Alpha on the severity of COVID-19 has been debated. We report our analysis in France.Methods: We conducted an exposed/unexposed cohort study with retrospective data collection, comparing patients infected by VOC Alpha to contemporaneous patients infected by historical lineages. Participants were matched on age (± 2.5 years), sex and region of hospitalization. The primary endpoint was the proportion of hospitalized participants with severe COVID-19, defined as a WHO-scale > 5 or by the need of a non-rebreather mask, occurring up to day 29 after admission. We used a logistic regression model stratified on each matched pair and accounting for factors known to be associated with the severity of the disease.Results: We included 650 pairs of patients hospitalized between Jan 1, 2021, and Feb 28, 2021, in 47 hospitals. Median age was 70 years and 61.3% of participants were male. The proportion of participants with comorbidities was high in both groups (85.0% vs 90%, p = 0.004). Infection by VOC Alpha was associated with a higher odds of severe COVID-19 (41.7% vs 38.5%-aOR = 1.33 95% CI [1.03-1.72]).Conclusion: Infection by the VOC Alpha was associated with a higher odds of severe COVID-19