Brain 18F-FDG PET imaging in outpatients with post-COVID-19 conditions: findings and associations with clinical characteristics.

BACKGROUND: Brain 18F-FDG PET imaging has the potential to provide an objective assessment of brain involvement in post-COVID-19 conditions but previous studies of heterogeneous patient series yield inconsistent results. The current study aimed to investigate brain 18F-FDG PET findings in a homogeneous series of outpatients with post-COVID-19 conditions and to identify associations with clinical patient characteristics. METHODS: We retrospectively included 28 consecutive outpatients who presented with post-COVID-19 conditions between September 2020 and May 2022 and who satisfied the WHO definition, and had a brain 18F-FDG PET for suspected brain involvement but had not been hospitalized for COVID-19. A voxel-based group comparison with 28 age- and sex-matched healthy controls was performed (p-voxel at 0.005 uncorrected, p-cluster at 0.05 FWE corrected) and identified clusters were correlated with clinical characteristics. RESULTS: Outpatients with post-COVID-19 conditions exhibited diffuse hypometabolism predominantly involving right frontal and temporal lobes including the orbito-frontal cortex and internal temporal areas. Metabolism in these clusters was inversely correlated with the number of symptoms during the initial infection (r = - 0.44, p = 0.02) and with the duration of symptoms (r = - 0.39, p = 0.04). Asthenia and cardiovascular, digestive, and neurological disorders during the acute phase and asthenia and language disorders during the chronic phase (p ≤ 0.04) were associated with these hypometabolic clusters. CONCLUSION: Outpatients with post-COVID-19 conditions exhibited extensive hypometabolic right fronto-temporal clusters. Patients with more numerous symptoms during the initial phase and with a longer duration of symptoms were at higher risk of persistent brain involvement.

Evolution of Olfactory Disorders in COVID-19 Patients.

OBJECTIVES: A high frequency and a strong association of olfactory/gustatory impairment with COVID-19 were reported. Its spontaneous evolution remains unknown. The aim of this study was to investigate the spontaneous evolution of olfactory disorders in COVID-19 patients. STUDY DESIGN: Cross-sectional study. METHODS: A total of 229 patients with laboratory-confirmed COVID-19 from March 1 through 31, 2020 in our institution were included. Among them, 140 patients (mean age, 38.5 years, 89 women) reported sudden olfactory/gustatory disorders during COVID-19. All patients were interviewed by phone based on a questionnaire with 16 questions at time of survey. The primary end point was olfactory recovery rate at time of survey. RESULTS: The frequency of patients with olfactory disorders was higher before March 20, 2020 than since (70.3% vs. 53.9%, respectively) (P = .016). At time of survey (26 days of the mean time from anosmia onset), 95.71% reported to start an olfactory recovery. The mean time from olfactory loss onset to recovery onset was 11.6 days. Recovery started between the fourth and the fifteenth day after olfactory loss onset in 78.4% of patients. Complete olfactory recovery happened for 51.43% of patients. There was a significant relationship between the complete olfactory recovery and a short time from olfactory loss onset to recovery onset (P = .0004), absence of nasal obstruction (P = .023) and absence of sore/dry/tingling feeling in the nose (P = .007) in COVID-19 patients. CONCLUSION: Knowledge of spontaneous evolution of olfactory disorders allows reassuring patients and planning therapeutic strategies for persistent olfactory dysfunction after having definitely recovered from COVID-19. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:2667-2673, 2020.

Evaluation of effects of an operational multidisciplinary team on antibiotic use in the medium to long term at a French university hospital.

Background Antibiotic-resistant bacteria are a major public health problem throughout the world. In 2006, in accordance with the national guidelines for antibiotic use, the CHRU of Nancy created an operational multidisciplinary antibiotic team at one of its sites. In 2011, a cluster-controlled trial showed that the operational multidisciplinary antibiotic team (the intervention) had a favourable short-term effect on antibiotic use and costs. Objective Our objective was to determine whether these effects continued over the medium to long term (that is, 2-7 years after creation of the operational multidisciplinary antibiotic team, 2009-2014). Setting The 1800-bed University Hospital of Nancy (France). Method The effect in the medium to long term is measured according to the same criteria and assessed by the same methods as the first study. A cluster controlled trial was performed on the period 2009-2014. The intervention group comprised 11 medical and surgical wards in settings where the operational multidisciplinary antibiotic team was implemented and the control group comprised 6 wards without this operational team. Main outcome measure Consumption of antibiotics overall and by therapeutic class (in defined daily doses per 1000 patient-days) and costs savings (in €). Results The reduction in antibiotic use and costs continued, but at a lower rate than in the short term (11% between 2009 and 2014 compared with 33% between 2007 and 2009) at the site of the intervention. The principal decreases concerned fluoroquinolones and glycopeptides. At the site without an operational multidisciplinary antibiotic team (the control group), total antibiotic use remained stable. Between 2009 and 2014, costs fell 10.5% in the intervention group and 5.7% in the control group. Conclusion This study shows that it is possible to maintain the effectiveness over time of such an intervention and demonstrates its role in defining a hospital's antibiotic policy.

Varicella arthritis in childhood: a case report and review of the literature.

Nonbacterial arthritis is a rare but well-recognized complication of acute varicella in children. Reported cases usually described monoarthritis of the knee that occurs at the onset of the rash or shortly after. Herein, we describe a case of arthritis of the hip that occurred in a 4-year-old girl 6 days before the onset of rash. The presence of varicella-zoster virus DNA in synovial fluid was confirmed by real-time polymerase chain reaction. A review of the literature reported 26 previous cases of aseptic arthritis due to varicella infection among children.

Effects of an operational multidisciplinary team on hospital antibiotic use and cost in France: a cluster controlled trial.

OBJECTIVE: The study objective was to evaluate the effectiveness of an operational multidisciplinary antibiotic team, including an infectious disease physician and a clinical pharmacist, in reducing the hospital antimicrobial consumption and costs. SETTING: The 1800-bed University Hospitals of Nancy (France). METHOD: A cluster controlled 'before-after' study was performed. The intervention group comprised 11 medical and surgical wards in settings where the operational antibiotic team was implemented, and the control group comprised 6 wards without this operational team. The 'before' period (2005) preceded the implementation of the operational team in the intervention group and 'after' (July 2007 to June 2008) followed its full implementation. MAIN OUTCOME MEASURE: We compared consumption of antibiotics overall and by therapeutic class (in defined daily doses per 1,000 patient days) and cost savings (in ) between 'before' and 'after' in both groups (control and intervention), using a mixed effect linear model. RESULTS: The overall consumption of antibiotics decreased after implementation of the operational team by 33.6% in the intervention group and by 3.3% in the control group (P = 0.003). Compared with the control group, the decrease in antibiotic use in the intervention group was significantly higher for various therapeutic classes (broad-spectrum penicillins, injectable fluoroquinolones, glycopeptides) and specific drugs (imipenem, ciprofloxacin, teicoplanin). For the same activity, the total cost savings were 14-fold higher in the intervention group. CONCLUSION: Establishment of an operational multidisciplinary team may be an effective way to reduce hospital antibiotic use and cost, with a good acceptance rate among prescribers.

Opportunistic infections as causes of death in HIV-infected patients in the HAART era in France.

The objective of the study was to describe the underlying causes of death of HIV-infected patients in the HAART era and to focus on those related to opportunistic infection (OI), in a national multicentre study ('Mortalité 2000'). A total of 964 deaths were recorded and 924 cases were available for analysis. Underlying cause of death were AIDS-related (47%), viral hepatitis (11%), non-AIDS cancers (11%), cardiovascular diseases (7%) and others (11%). Among patients who died of AIDS events, 262 (27%) died of at least one OI. OIs reported at the time of death were Cytomegalovirus infection 67 times, Pneumocystis jiroveci pneumonia 56, disseminated Mycobacterium avium intracellulare infection 53 and cerebral toxoplasmosis 48. Compared to patients who died of other causes, patients who died of OIs were younger and more likely to be infected through heterosexual contact, in poor socioeconomic conditions, migrants, more recently diagnosed for HIV infection, and naive of antiretroviral therapy and OI prophylaxis. OIs are still a major cause of death in HIV-infected patient in the HAART era, especially among patients recently diagnosed for HIV infection and who do not have access to care, as well as in long term infected patients where prophylaxis should be revisited.

Liver disease as a major cause of death among HIV infected patients: role of hepatitis C and B viruses and alcohol.

BACKGROUND/AIMS: We analyzed the characteristics of HIV infected patients who died from liver disease, focusing on hepatitis virus co-infection. METHODS: One-hundred and eighty-five French hospital departments involved in HIV/AIDS management prospectively notified all deaths occurring in 2000. Patients whose hepatitis C (HCV) and hepatitis B (HBV) serostatus was known were classified as being infected by HCV alone, HBV alone (HBsAg positive), both HCV and HBV, or neither HCB nor HBV. RESULTS: Among 822 HIV infected patients, 29% were infected by HCV alone, 8% by HBV alone, and 4% by both HCV and HBV. The most frequent causes of death were liver disease (31% of cases) and AIDS (29%) among HIV-HCV co-infected patients, and AIDS (38%) and liver disease (22%) among HIV-HBV co-infected patients. Liver disease was a more frequent cause of death among patients co-infected by both HCV and HBV (44% of cases). Hepatocellular carcinoma was present in 15% of patients who died from liver disease, and was associated with HBV co-infection. Nearly half the patients who died from liver disease had more than 200 CD4/mm3. CONCLUSIONS: Liver disease is now a leading cause of death among HIV-HCV co-infected patients and is becoming an important cause of death among HIV-HBV co-infected patients. The risk of death from liver disease is highest in patients co-infected by both HCV and HBV.

Causes of death among human immunodeficiency virus (HIV)-infected adults in the era of potent antiretroviral therapy: emerging role of hepatitis and cancers, persistent role of AIDS.

BACKGROUND: In the era of highly active antiretroviral therapy (HAART) mortality has decreased substantially among human immunodeficiency virus (HIV)-infected people with access to HAART, but there are concerns regarding co-morbidities and adverse effects of HAART, which may impair vital prognosis. The Mortality 2000 study examined the causes of death in HIV-infected adults at a national level in France in the year 2000. METHODS: All French hospital wards known to be involved in the management of HIV infection were asked to notify prospectively the deaths that occurred in 2000 among HIV-infected adults. The causes of death were documented using a standardized questionnaire. RESULTS: The 185 participating wards notified 964 deaths. The main underlying causes of death were AIDS-related (47%, non-Hodgkin's lymphoma: 23%), viral hepatitis (11%, hepatitis C: 9%, hepatitis B: 2%), cancer not related to AIDS or hepatitis (11%), cardiovascular disease (7%), bacterial infections (6%), suicide (4%), and adverse effect of antiretroviral treatments (1%). Among AIDS-related deaths, HIV infection had been diagnosed recently in 20%. Smoking was recorded in 72% of cancer-related deaths and alcohol consumption in 54% of hepatitis-related deaths. Among non-HIV related deaths between 25 and 64 years, the proportion of infectious diseases (including HCV and HBV-related deaths) was higher in HIV-infected adults than in the general population. CONCLUSIONS: Improved strategies for detecting HIV infection before AIDS-defining complications occur are needed in the era of HAART. The prevention of non-AIDS related cancers, especially lung cancer, the management of non-Hodgkin's lymphoma, and of viral hepatitis are also important priorities.

Malignancy-related causes of death in human immunodeficiency virus-infected patients in the era of highly active antiretroviral therapy.

BACKGROUND: Before the introduction of highly active antiretroviral therapy (HAART), malignancies accounted for less than 10% of all deaths among human immunodeficiency virus (HIV)-infected patients. This figure may have increased, and the observed types of malignant disease may have been modified, as a result of decreased occurrence of opportunistic infections, the chronicity of HIV infection, the possible oncogenic role of HIV itself, and the aging of the HIV-infected population. METHODS: All French hospital wards involved in the management of HIV infection were asked to prospectively document the deaths of HIV-infected patients in the year 2000. Underlying causes of death were defined using a standardized questionnaire. RESULTS: Of a total of 964 deaths, 269 (28%) were attributable to malignancies. Acquired immunodeficiency virus (AIDS)-related malignancies were the underlying cause of 149 deaths (15%); among these malignancies were non-Hodgkin lymphoma (n = 105 [11%]), noncerebral lymphoma (n = 78 [median CD4 count, 86 x 10(6) per liter; interquartile range [IQR], 35-231 x 10(6) per liter), and primary cerebral lymphoma (n = 27 [median CD4 count, 20 x 10(6) per liter; IQR, 4-109 x 10(6) per liter). Kaposi sarcoma was associated with 40 deaths (4%), and cervical carcinoma was associated with 5 (0.5%). Non-AIDS-related malignancies were the underlying cause of 120 deaths (13%); these non-AIDS-related malignancies included 103 solid tumors (50 respiratory tumors, 19 hepatocarcinomas, 9 digestive tumors, and 6 anal tumors; median CD4 count, 218 x 10(6) per liter; IQR, 108-380 x 10(6) per liter) and 17 hemopathies (12 Hodgkin lymphomas, 4 myeloid leukemias, and 1 myeloma; median CD4 count, 113 x 10(6) per liter; IQR, 56-286 x 10(6) per liter). Compared with patients who died of other causes, patients who died of solid tumors were more likely to be male, to smoke, to be older, and to have higher CD4 counts. CONCLUSIONS: Malignant disease has been a major cause of death among HIV-infected patients in industrialized nations since the introduction of HAART. Whereas lethal hemopathies and Kaposi sarcoma are associated with advanced immunosuppression, lethal solid tumors can occur in patients with controlled HIV infection.

[HIV-tuberculosis coinfection]. / Co-infection tuberculose-VIH.

Coinfection with the human immunodeficiency virus (HIV) and tuberculosis is a major public health problem throughout the world. In subsaharan Africa and Southeast Asia, as many as one third of all patients with tuberculosis also have HIV infection. These two infection interact on each other, worsening the prognosis and increasing mortality. The diagnosis of tuberculosis is sometimes difficult to establish since the clinical presentation may be incomplete, but must always be evoked and sought whenever there is the slightest doubt. These patients should be given conventional anti-tuberculosis treatment using three or four anti-tuberculosis drugs for a duration of 9 months. Overall outcome is favorable. Drug interactions between antiretroviral drugs and anti-tuberculosis drugs is a real problem, limiting the use of certain agents. The restored immunization achieved with HAART protocols involve "paradoxical" reactions which complicate patient adherence to therapy. It would be reasonable to treat tuberculosis first, then, in 6 weeks, introduce an adapted antiretroviral regimen. Prevention of tuberculosis for patients at risk should be based on rifampicin and pyrazinamid for 2 months.

[Causes of death in HIV-infected French drug users, 1995-2000]. / Causes de décès chez les usagers de drogues français infectés par le VIH, 1995-2000.

Since the decline in mortality among HIV-infected persons after introduction of highly active antiretroviral therapy, concerns related to co-morbidities have increased as they may impair vital prognosis, particularly in intravenous (IV) drug users. We describe firstly the changes in the distribution of the causes of death between 1995 and 2000 among IV drug users in the "Aquitaine Cohort" based on hospital information system, and secondly the distribution of the causes of death among IV drug users in the French national survey "Mortalité 2000" specifically set up in 2000 for optimal exhaustiveness. The total number of deaths declined between 1995 and 2000 and 1/3 were IV drug users. Deceased IV drug users were younger than other deceased patients, had longer median time from diagnosis of HIV infection and higher median CD4 cell count. Poor socio-economic conditions were notified in 55%. Among IV drug users, the proportion of AIDS-related deaths was above 75% in 1995 and below 30% in 2000. In 2000, 25% of deaths were HCV-related, 12% of deaths were due to accident, overdose or suicide, and 8% were due to non-AIDS non-HCV related cancer. Among IV drug users, improvement in vital prognosis requires to improve management of HCV infection and to take into account socio-economic conditions and other addictive behaviours like alcohol consumption and smoking.