High mortality in peritonitis due to Mycobacterium avium complex: retrospective study and systematic literature review

International audienc

Study on daptomycin use and implementation of an antimicrobial stewardship program

International audienceBackground Treatment of Gram-positive pathogens remains a major health issue due to the presence of methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococcus spp. Daptomycin offers an alternative after therapeutic failure using glycopeptides. Yet its use requires strict control given its financial impact and environmental risks. Since 2014, the use of daptomycin within our hospital has intensified, occasionally outside the scope of its approved indications. Objectives: The aim of this study is to analyze the appropriateness of daptomycin prescriptions. Setting This work was conducted in a 1500-bed University Hospital. Method A descriptive retrospective study was conducted from November 2013 to July 2014

Measles inclusion-body encephalitis (MIBE) in a immunocompromised patient

International audienc

A Pilot Study of Tobacco Screening and Referral for Smoking Cessation Program among HIV-Infected Patients in France

International audienceBackground: The prevalence of tobacco smoking is high among patients living with HIV, supporting the need for effectivetargeted interventions. Materials and Methods: All current smokers at our outpatient HIV clinic were invited to participate in asmoking cessation program. Results: Of the 716 patients living with HIV, 280 (39%) reported active smoking and were younger,more recently HIV infected and more frequently infected due to intravenous drug use (IDU). One hundred forty-seven (53%)smokers agreed to participate in the smoking cessation program and had a higher Fagerstro¨m score and were less likely IDU.During follow-up, 41 (28%) smokers withdrew from the program. After 6 months, 60 (57%) of the 106 smokers who completedthe intervention had stopped tobacco smoking and were more likely to use varenicline, adjusting for a history of depression.Conclusion: Our smoking cessation program was feasible. However, strategies to reach and retain in smoking cessationprogram specific groups such as IDU are needed to improve the smoking cessation cascade

Case Report: Leishmania and HIV Co-Diagnosis: How to Understand Medical History?

International audienceWe report a case of a severe visceral leishmaniasis revealing an HIV-1 infection presenting as an acute primary infection. A young French man living in Paris with history of unprotected sex with a recent male partner and recent travel in Greece was admitted in our Infectious Diseases Department, presenting with acute febrile psychotic disorder, and positive HIV-1 serology with high viral load, very low CD4 + T-cells count and a western blot pattern suggesting an acute infection. The psychotic disorder was finally related to hemophagocytic lymphohistiocytosis diagnosed on bone marrow aspiration, supposedly secondary to HIV acute primary infection. The progressive worsening of pancytopenia despite antiretroviral treatment and the persistence of fever, chills and sweat led to the diagnosis of visceral leishmaniasis through bone marrow biopsy and leishmanial serology. He was treated with intravenous liposomal amphotericin B with quick improvement. We discuss the way HIV infection and visceral leishmaniasis may have interact to lead to the clinical presentation of our patient

Immune Reconstitution Inflammatory Syndrome Unmasking or Worsening AIDS-Related Progressive Multifocal Leukoencephalopathy: A Literature Review

Incidence of progressive multifocal leukoencephalopathy (PML) in HIV-infected patients has declined in the combined antiretroviral therapy (cART) era although a growing number of acquired immunodeficiency syndrome (AIDS)-related PML-immune reconstitution inflammatory syndromes (PML-IRIS) have been published during the same period. Therapeutic management of PML-IRIS is not consensual and mainly relies on corticosteroids. Our main aim was, in addition to provide a thoughtful analysis of published PML-IRIS cases, to assess the benefit of corticosteroids in the management of PML-IRIS, focusing on confirmed cases. We performed a literature review of the 46 confirmed cases of PML-IRIS cases occurring in HIV-infected patients from 1998 to September 2016 (21 unmasking and 25 paradoxical PML-IRIS). AIDS-related PML-IRIS patients were mostly men (sex ratio 4/1) with a median age of 40.5 years (range 12–66). Median CD4 T cell count before cART and at PML-IRIS onset was 45/μl (0–301) and 101/μl (20–610), respectively. After cART initiation, PML-IRIS occurred within a median timescale of 38 days (18–120). Clinical signs were motor deficits (69%), speech disorders (36%), cognitive disorders (33%), cerebellar ataxia (28%), and visual disturbances (23%). Brain MRI revealed hyperintense areas on T2-weighted sequences and FLAIR images (76%) and suggestive contrast enhancement (87%). PCR for John Cunningham virus (JCV) in cerebrospinal fluid (CSF) was positive in only 84% of cases; however, when performed, brain biopsy confirmed diagnosis of PML in 90% of cases and demonstrated histological signs of IRIS in 95% of cases. Clinical worsening related to PML-IRIS and leading to death was observed in 28% of cases. Corticosteroids were prescribed in 63% of cases and maraviroc in one case. Statistical analysis failed to demonstrate significant benefit from steroid treatment, despite spectacular improvement in certain cases. Diagnosis of PML-IRIS should be considered in HIV-infected patients with worsening neurological symptoms after initiation or resumption of effective cART, independently of CD4 cell count prior to cART. If PCR for JCV is negative in CSF, brain biopsy should be discussed. Only large multicentric randomized trials could potentially demonstrate the possible efficacy of corticosteroids and/or CCR5 antagonists in the management of PML-IRIS

Draft Genome Sequence of Campylobacter coli Strain IPSID-1 Isolated from a Patient with Immunoproliferative Small Intestinal Disease

International audienceThe genome sequence and annotation of Campylobacter coli strain IPSID-1 are reported here. This bacterial isolate is the first to be cultured from a patient with immunoproliferative small intestinal disease (IPSID). The draft genome sequence is 1.683 Mb long, comprises 64 contigs, and has 31.26% G؉C content. Citation Criscuolo A, de la Blanchardière A, Coeuret S, Passet V, Saguet-Rysanek V, Vergnaud M, Verdon R, Leclercq A, Lecuit M, Brisse S. 2014. Draft genome sequence of Campylobacter coli strain IPSID-1 isolated from a patient with immunoproliferative small intestinal disease