In 2007, we performed a nationwide prospective study to assess the epidemiology of encephalitis in France. We aimed to evaluate epidemiological changes 10years later.
We performed a 4-year ...prospective cohort study in France (ENCEIF) from 2016 to 2019. Medical history, comorbidities, as well as clinical, biological, imaging, and demographic data were collected. For the comparison analysis, we selected similar data from adult patients enrolled in the 2007 study. We used Stata statistical software, version 15 (Stata Corp). Indicative variable distributions were compared using Pearson's Chi
test, and means were compared using Student's t-test for continuous variables.
We analyzed 494 cases from 62 hospitals. A causative agent was identified in 65.7% of cases. Viruses represented 81.8% of causative agents, Herpesviridae being the most frequent (63.6%). Arboviruses accounted for 10.8%. Bacteria and parasites were responsible for respectively 14.8% and 1.2% of documented cases. Zoonotic infections represented 21% of cases. When comparing ENCEIF with the 2007 cohort (222 adults patients from 59 hospitals), a higher proportion of etiologies were obtained in 2016-2019 (66% vs. 53%). Between 2007 and 2016-2019, the proportions of Herpes simplex virus and Listeria encephalitis cases remained similar, but the proportion of tuberculosis cases decreased (P=0.0001), while tick-borne encephalitis virus (P=0.01) and VZV cases (P=0.03) increased. In the 2016-2019 study, 32 causative agents were identified, whereas only 17 were identified in the 2007 study.
Our results emphasize the need to regularly perform such studies to monitor the evolution of infectious encephalitis and to adapt guidelines.
To describe the main characteristics and the treatment of cryptococcosis in patients with sarcoidosis.
Multicenter study including all patients notified at the French National Reference Center for ...Invasive Mycoses and Antifungals.
Retrospective chart review. Each case was compared with two controls without opportunistic infections.
Eighteen cases of cryptococcosis complicating sarcoidosis were analyzed (13 men and 5 women). With 2749 cases of cryptococcosis registered in France during the inclusion period of this study, sarcoidosis accounted for 0.6% of all the cryptococcosis patients and for 2.9% of the cryptococcosis HIV-seronegative patients. Cryptococcosis and sarcoidosis were diagnosed concomitantly in four cases; while sarcoidosis was previously known in 14/18 patients, including 12 patients (67%) treated with steroids. The median rate of CD4 T cells was 145 per mm(3) (range: 55-1300) and not related to steroid treatment. Thirteen patients had cryptococcal meningitis (72%), three osteoarticular (17%) and four disseminated infections (22%). Sixteen patients (89%) presented a complete response to antifungal therapy. After a mean follow-up of 6 years, no death was attributable to cryptococcosis. Extra-thoracic sarcoidosis and steroids were independent risk factors of cryptococcosis in a logistic regression model adjusted with the sex of the patients.
Cryptococcosis is a significant opportunistic infection during extra-thoracic sarcoidosis, which occurs in one-third of the cases in patients without any treatment; it is not associated to severe CD4 lymphocytopenia and has a good prognosis.
Moxifloxacin is an antibiotic of the fluoroquinolone class, marketed in France since 2002. It is used primarily in the treatment of bacterial sinusitis and acute exacerbations of chronic bronchitis. ...The purpose of this study is to report a possible severe ocular side effect following the systemic use of moxifloxacin.
Case report of a patient who presented with the appearance of a severe acute uveitis after being treated with systemic moxifloxacin. Eleven days after initiation of moxifloxacin treatment, the patient developed simultaneous bilateral eye pain, pigment dispersion and diffuse iris transillumination. This case was further complicated by ocular hypertension. Etiologic investigations for other causes of the uveitis were negative. In particular, an anterior chamber tap was performed and PCR for herpes viruses (HSV, VZV, EBV, CMV) was negative.
Drug-induced uveitis is relatively rare. The relationship between systemic fluoroquinolone treatment and the occurrence of uveitis has been considered "possible", according to World Health Organization criteria, in a recent retrospective analysis of 40 case reports. Moxifloxacin was suspected in 25 of these cases. The presence of both iris transillumination and pigment dispersion appears specific to the uveitis in question.
It appears that practitioners prescribing moxifloxacin and ophthalmologists should be informed of this possible adverse effect, so that it may be quickly recognized, managed and reported.
Human trichinellosis is a potentially severe parasitic disease occurring after ingestion of undercooked meat infected with Trichinella sp. larvae. We report the case of a patient who ate an ...undercooked bear meat hunted in Canada; he presented with the usual symptoms of trichinellosis (i.e, facial oedema, myalgias and fever) complicated with an asymptomatic myocarditis. Myocarditis is a rare, but potentially lethal complication of trichinellosis. Myocarditis should be screened systematically even when specific symptoms are missing; dosage of troponin serum is a simple and reliable mean for such screening.
Objectives
The aim of this study was to describe the proportion of liver‐related diseases (LRDs) as a cause of death in HIV‐infected patients in France and to compare the results with data from our ...five previous surveys.
Methods
In 2010, 24 clinical wards prospectively recorded all deaths occurring in around 26 000 HIV‐infected patients who were regularly followed up. Results were compared with those of previous cross‐sectional surveys conducted since 1995 using the same design.
Results
Among 230 reported deaths, 46 (20%) were related to AIDS and 30 (13%) to chronic liver diseases. Eighty per cent of patients who died from LRDs had chronic hepatitis C, 16.7% of them being coinfected with hepatitis B virus (HBV). Among patients who died from an LRD, excessive alcohol consumption was reported in 41%. At death, 80% of patients had undetectable HIV viral load and the median CD4 cell count was 349 cells/μL. The proportion of deaths and the mortality rate attributable to LRDs significantly increased between 1995 and 2005 from 1.5% to 16.7% and from 1.2‰ to 2.0‰, respectively, whereas they tended to decrease in 2010 to 13% and 1.1‰, respectively. Among liver‐related causes of death, the proportion represented by hepatocellular carcinoma (HCC) dramatically increased from 5% in 1995 to 40% in 2010 (p = 0.019).
Conclusions
The proportion of LRDs among causes of death in HIV‐infected patients seems recently to have reached a plateau after a rapid increase during the decade 1995−2005. LRDs remain a leading cause of death in this population, mainly as a result of hepatitis C virus (HCV) coinfection, HCC representing almost half of liver‐related causes of death.
Background: Acute polyradiculoneuropathy or Guillain–Barre syndrome is a neurological disease which may present with severe forms which have a poor prognosis. The patient’s management requires ...multidisciplinary specialised care. Morbidity has been reported to be significantly improved with initial therapy using high-dose intravenous immunoglobulin (IVIG). However, this therapy represent an immunological risk which has remained overlooked by clinicians in the majority of cases and is not clearly stated by the pharmaceutical companies. Therefore, the use of IVIG in the intensive care unit can cause some problems.
Case report: A 32-year-old woman presented with clinical signs of Guillain–Barre syndrome. The patient received high-dose intravenous immunoglobulin (TEGELINE
®). Nine days after beginning therapy, she presented with severe immunological hemolytic anaemia; the IVIG was suspected as the cause. The blood cell count returned to normal approximately two months after the onset of the hemolytic syndrome.
Conclusion: Despite the effectiveness of IVIG therapy in the management of various diseases, intensive care clinicians should be aware of possible major adverse effects which make a careful assessment of the patient necessary before treatment. It may also be important to consider the patient’s ABO blood group before initiating IVIG treatment, particularly in patients bearing A and/or B blood group antigens.
Leukocytoclastic vasculitis has been described after immunization against influenza, hepatitis B, rubella, and smallpox. We describe what we believe is the first case of leukocytoclastic vasculitis ...associated with hepatitis A vaccination. HAV infection is rarely associated with extrahepatic manifestations. Some cases of cutaneous vasculitis, cholestatic hepatitis, and cryoglobulinemia that were associated with HAV infection have been reported. In one case, IgM antibodies to HAV as well as IgM cryoglobulins with activity against HAV antibodies were detected in a patient's serum. Havrix vaccine is an inactivated HAV vaccine formulated from HAV strain HM175. Since live HAV can provoke leukocyclastic vasculitis, inactivated HAV antigen could have similar immunogenicity and could thus induce the same pathogenic immune dysregulation.
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