[Virological diagnosis of lower respiratory tract infections]. / Diagnostic virologique des infections respiratoires basses.

INTRODUCTION: The etiological diagnosis of bronchopulmonary infections cannot be assessed with clinical, radiological and epidemiological data alone. Viruses have been demonstrated to cause a large proportion of these infections, both in children and adults. BACKGROUND: The diagnosis of viral bronchopulmonary infections is based on the analysis of secretions, collected from the lower respiratory tract when possible, by techniques that detect either influenza and respiratory syncytial viruses, or a large panel of viruses that can be responsible for respiratory disease. The latter, called multiplex PCR assays, allow a syndromic approach to respiratory infection. Their high cost for the laboratory raises the question of their place in the management of patients in terms of antibiotic economy and isolation. In the absence of clear recommendations, the strategy and equipment are very unevenly distributed in France. OUTLOOK: Medico-economic analyses need to be performed in France to evaluate the place of these tests in the management of patients. The evaluation of the role of the different viruses often detected in co-infection, especially in children, also deserves the attention of virologists and clinicians. CONCLUSIONS: The availability of new diagnostic technologies, the recent emergence of SARS-CoV-2, together with the availability of new antiviral drugs are likely to impact future recommendations for the management of viral bronchopulmonary infections.

COVID-19 outpatient management: Shorter time to recovery in Healthcare workers according to an electronic daily symptoms assessment.

OBJECTIVES: Our aim is to compare the course of the disease between healthcare workers (HCWs) and non-HCWs suffering from covid-19 and eligible for outpatient management. METHODS: Single-center prospective cohort of outpatients with covid-19, diagnosed between the 10th March and the 2nd April, 2020 with a daily collection of symptoms by an on-line auto-questionnaire. RESULTS: A total of 186 patients were included (median age, 41 years [interquartile range, 19-78 years]; 74.2% female), of whom 132 (71%) were HCWs. The median follow-up after symptom onset was 14 (min 4-max 24) days. HCWs were significantly younger than non-HCWs (median age 40.3 years vs. 47.2 years [P<0.005]), and 81.8% were women. Four patients (2.2%) were hospitalized including one HCW. The median time to recovery was 9 days after symptom onset (95% CI 8-11) in the global population and respectively 8 (95% CI 8-9) and 13 (95% CI 11-15) days in HCWs and in non-HCWs (P<0.005). After adjusting for age, co-morbidities, and gender, the instantaneous risk ratio for symptom absence in HCWs was 1.76 compared with non-HCWs (95% CI [1.16-2.67], P=0.037). CONCLUSION: HCWs suffering from covid-19 had favorable outcomes and had a shorter time to recovery than non HCWs.

COVID-19 : les soignants sont-ils de véritables super-héros ?

Introduction Une grande partie des connaissances en cours concernant la COVID-19 est basée sur les données des patients hospitalisés. Notre objectif est de décrire l’évolution au jour le jour de la COVID-19 dans les cas admissibles à une prise en charge ambulatoire. Matériels et méthodes Cohorte prospective monocentrique de patients présentant une infection par le SARS-CoV-2 confirmée virologiquement et présentant des symptômes modérés, admissibles à une prise en charge ambulatoire, entre le 10 mars et le 2 avril 2020. Les symptômes quotidiens ont été recueillis au moyen d’un auto-questionnaire en ligne. Nous avons considéré qu’un patient était guéri lorsqu’aucun des trois symptômes principaux (fièvre, dyspnée et douleur thoracique) n’était signalé après les derniers symptômes connus via l’application en ligne. Résultats Un total de 186 patients ont été inclus (âge médian, 41 ans [intervalle interquartile, 19–78 ans] ;74,2 % de femmes), dont 132 (71 %) étaient des professionnels de santé. Treize patients (7 %) souffraient d’hypertension artérielle (la comorbidité la plus courante) et le suivi médian après l’apparition des symptômes était de 14jours (min 4–max 24). Les professionnels de santé étaient significativement plus jeunes que les autres (âge médian de 40,3 ans contre 47,2 ans [p<0,005]), et 81,8 % étaient des femmes. Quatre patients (2,2 %) ont été hospitalisés, dont un professionnel de santé. Le délai médian de guérison était de 9jours après l’apparition des symptômes (IC95 % : 8–11) dans notre population globale et de 8jours (IC95 % : 8–9) et 13jours (IC95 % : 11–15) chez les professionnels de santé et les non-professionnels de santé (p<0,005), respectivement. Après ajustement sur l’âge, le sexe, les comorbidités et le seuil de détection de la PCR SARS-CoV-2, le rapport de risque instantané pour l’absence de symptômes chez les professionnels de santé était de 1,76 par rapport aux non-professionnels de santé (IC95 % [1,16–2,67], p=0,037). Conclusion La grande majorité de cette cohorte de personnes atteintes d’une infection par la COVID-19 a guéri spontanément. Les professionnels de santé souffrant de la COVID-19 ont eu des résultats favorables et ont eu un temps de récupération plus court que les non-professionnels de santé. Des études supplémentaires sont nécessaires pour mieux comprendre ces différences.

SARS-CoV-2 infection: advocacy for training and social distancing in healthcare settings.

This article reports the observed rate of infection with severe acute respiratory syndrome coronavirus-2 in healthcare workers (HCWs) who worked on wards dedicated to care of patients with coronavirus disease 2019 (COVID-19) compared with HCWs who worked on non-COVID-19 wards. The infection rate was significantly higher among HCWs who worked on non-COVID-19 wards (odds ratio 2.3, P=0.005), illustrating the need to strengthen social distancing measures and training.