Incidence d’une station d’épuration biologique sur le niveau de contamination en salmonelles des eaux et des boues résiduaires.

Foodborne pathogens occasionally harboured in the gastro-intestinal tract of some domestic animals may be retrieved in slaughterhouses waste water and in sludge of water purification units. Salmonella, athogen common to man and Animals, is often used as a biological risk indicator. The aim of the present study was to assess effectiveness of a recent water purification unit by rapid and semi-quantitative detection of this micro-organism. The water purification unit collects waste water of seven food-processing industries, including a pig slaughterhouse. This latest was the main source of Salmonella contamination with a level of more 103 colony forming unit (CFU) per ml, that was very close to the average level of contamination of total incoming waste water. The unit, whose principle of action is based on biological purification, has permitted a 4 log10 reduction of Salmonella contamination, with a final contamination level of less than 1 CFU/ml. It was observed only a little decrease of contamination levels during the biological treatment steps, in contrast with the one observed during the clarification step. This was due to adsorption of bacteria by material in suspension. Fresh sludge were harboured an average of 102 CFU of Salmonella per gram. In the beginning of December 1999, two sludge piles were let on the ground along a field and sampled microbiologically every month. Seven month later, no Salmonella were recovered from the piles. 309Des agents pathogènes, hébergés dans le tractus digestif de certains animaux domestiques, peuvent se retrouver dans les eaux usées des abattoirs et finalement dans les boues des stations d’épuration. Salmonella, agent pathogène pour l’homme et les animaux, est le plus souvent utilisé comme marqueur de risque biologique. La présente étude vise à déterminer l’efficacité d’une récente station d’épuration industrielle par la détermination rapide et semi-quantitative de la présence de ce micro-organisme. Parmi sept entreprises agro-alimentaires déversant leurs eaux usées dans cette station d’épuration industrielle, un abattoir porcin fut la principale source de contamination avec un niveau moyen de contamination de plus de 103 salmonelles/ml proche de celui du mélange des eaux en entrée d’épuration. La station, basée sur un procédé d’épuration biologique, a permis de réduire le niveau de contamination dans les eaux sortantes à moins de 1 salmonelle/ml, soit un taux de réduction de 4 logarithmes décimaux. Le niveau de contamination diminue peu dans les étapes biologiques de traitement. C’est principalement dans le clarificateur que s’opère la réduction par adsorption des bactéries sur les matières en suspension. Le niveau moyen des salmonelles dans les boues fraîches s’élève à 102 salmonelles/g. Lors du suivi microbiologique mensuel de deux tas de boues disposés en bordure de champs au début du mois de décembre 1999, sept mois ont été nécessaires avant de ne plus pouvoir isoler de salmonelles dans 25 g

Eating disorder or oesophageal achalasia during adolescence: diagnostic difficulties

International audienceMarine was a fourteen and a half-year-old adolescent female hospitalized for an eating disorder (ED) of the anorexic type with purging behaviors. She has had a complicated life course, made up of disruptions and discontinuities, both family and school. Since the age of five, Marine had been intermittently treated in psychiatry for a diagnosis of oppositional defiant disorder. The current illness started with spontaneous and induced vomiting associated with major weight loss (body mass index, 15.27 kg m−2). The diagnosis of anorexia nervosa was established after several opinions from professionals in five Parisian university pediatric departments, where additional investigations were carried out without any somatic cause being identified. In this context, Marine was transferred to a child psychiatry unit. There, she had acute dyspnea during the insertion of a nasogastric tube. As a result, a new specialized opinion was sought from a pediatric gastroenterologist and further explorations were performed (oeso-gastroduodenal transit and manometry), leading to the conclusion to an oesophageal achalasia requiring surgical treatment. This case report highlights that the exclusion of any organic disorder should be a priority in the diagnostic assessment of an ED. Oesophageal achalasia is a rare differential diagnosis and should be considered in case of swallowing difficulties or dysphagia. Health care professionals should take care to provide appropriate somatic follow-up for patients with psychiatric disorders

CD89 Is a Potent Innate Receptor for Bacteria and Mediates Host Protection from Sepsis

Summary: Direct bacterial recognition by innate receptors is crucial for bacterial clearance. Here, we show that the IgA receptor CD89 is a major innate receptor that directly binds bacteria independently of its cognate ligands IgA and c-reactive protein (CRP). This binding is only partially inhibited by serum IgA and induces bacterial phagocytosis by CD11c+ dendritic cells and monocytes and/or macrophages, suggesting a physiological role in innate host defense. Blood phagocytes from common variable immunodeficiency patients bind, internalize, and kill bacteria in a CD89-dependent manner, confirming the IgA independence of this mechanism. In vivo, CD89 transgenic mice are protected in two different models of sepsis: a model of pneumonia and the cecal ligation and puncture (CLP) polymicrobial model of infection. These data identify CD89 as a first-line innate receptor for bacterial clearance before adaptive responses can be mounted. Fc receptors may emerge as a class of innate receptors for various bacteria with pleiotropic roles. : de Tymowski et al. demonstrate that CD89 serves as an innate receptor during the early phase of infection. During the late phase, the receptor acts in both innate and adaptive immune responses through double interaction with IgA- or CRP-opsonized and non-opsonized bacteria. Keywords: Fc receptor, innate receptor, sepsis, ITAM, host defens

Rapid Improvement after Starting Elexacaftor–Tezacaftor–Ivacaftor in Patients with Cystic Fibrosis and Advanced Pulmonary Disease

International audienceRationale: Elexacaftor-tezacaftor-ivacaftor is a CFTR (cystic fibrosis [CF] transmembrane conductance regulator) modulator combination, developed for patients with CF with at least one Phe508del mutation. Objectives: To evaluate the effects of elexacaftor-tezacaftor- ivacaftor in patients with CF and advanced respiratory disease. Methods: A prospective observational study, including all patients aged ⩾12 years and with a percent-predicted FEV1 (ppFEV1) <40 who initiated elexacaftor-tezacaftor-ivacaftor from December 2019 to August 2020 in France was conducted. Clinical characteristics were collected at initiation and at 1 and 3 months. Safety and effectiveness were evaluated by September 2020. National-level transplantation and mortality figures for 2020 were obtained from the French CF and transplant centers and registries. Measurements and Main Results: Elexacaftor-tezacaftor- ivacaftor was initiated in 245 patients with a median (interquartile range) ppFEV1 = 29 (24-34). The mean (95% confidence interval) absolute increase in the ppFEV1 was +15.1 (+13.8 to +16.4; P < 0.0001), and the mean (95% confidence interval) in weight was +4.2 kg (+3.9 to +4.6; P < 0.0001). The number of patients requiring long-term oxygen, noninvasive ventilation, and/or enteral tube feeding decreased by 50%, 30%, and 50%, respectively (P < 0.01). Although 16 patients were on the transplant waiting list and 37 were undergoing transplantation evaluation at treatment initiation, only 2 received a transplant, and 1 died. By September 2020, only five patients were still on the transplantation path. Compared with the previous 2 years, a twofold decrease in the number of lung transplantations in patients with CF was observed in 2020, whereas the number of deaths without transplantation remained stable. Conclusions: In patients with advanced disease, elexacaftor-tezacaftor-ivacaftor is associated with rapid clinical improvement, often leading to the indication for lung transplantation being suspended

Long-term neurological symptoms after acute COVID-19 illness requiring hospitalization in adult patients: insights from the ISARIC-COVID-19 follow-up study

in this study we aimed to characterize the type and prevalence of neurological symptoms related to neurological long-COVID-19 from a large international multicenter cohort of adults after discharge from hospital for acute COVID-19

Paediatric COVID-19 mortality: a database analysis of the impact of health resource disparity

Background The impact of the COVID-19 pandemic on paediatric populations varied between high-income countries (HICs) versus low-income to middle-income countries (LMICs). We sought to investigate differences in paediatric clinical outcomes and identify factors contributing to disparity between countries.Methods The International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC) COVID-19 database was queried to include children under 19 years of age admitted to hospital from January 2020 to April 2021 with suspected or confirmed COVID-19 diagnosis. Univariate and multivariable analysis of contributing factors for mortality were assessed by country group (HICs vs LMICs) as defined by the World Bank criteria.Results A total of 12 860 children (3819 from 21 HICs and 9041 from 15 LMICs) participated in this study. Of these, 8961 were laboratory-confirmed and 3899 suspected COVID-19 cases. About 52% of LMICs children were black, and more than 40% were infants and adolescent. Overall in-hospital mortality rate (95% CI) was 3.3% [=(3.0% to 3.6%), higher in LMICs than HICs (4.0% (3.6% to 4.4%) and 1.7% (1.3% to 2.1%), respectively). There were significant differences between country income groups in intervention profile, with higher use of antibiotics, antivirals, corticosteroids, prone positioning, high flow nasal cannula, non-invasive and invasive mechanical ventilation in HICs. Out of the 439 mechanically ventilated children, mortality occurred in 106 (24.1%) subjects, which was higher in LMICs than HICs (89 (43.6%) vs 17 (7.2%) respectively). Pre-existing infectious comorbidities (tuberculosis and HIV) and some complications (bacterial pneumonia, acute respiratory distress syndrome and myocarditis) were significantly higher in LMICs compared with HICs. On multivariable analysis, LMIC as country income group was associated with increased risk of mortality (adjusted HR 4.73 (3.16 to 7.10)).Conclusion Mortality and morbidities were higher in LMICs than HICs, and it may be attributable to differences in patient demographics, complications and access to supportive and treatment modalities