[Thinking differently about health care after COVID-19]. / Repenser les soins de santé post-COVID-19.

The health crisis linked to the coronavirus pandemic (COVID-19) has forced society and hospitals in particular to adapt and reform. Teamwork between hospitals, even beyond the networks, helped them to deal with the crisis. The medical and nursing staff had to learn to work differently and differentiate urgent from non-urgent care. But the patient also had to change his/her behaviour. Access to hospitals has been divided between a separate COVID and non-COVID route in order to avoid contamination. Telemedicine has become a daily way of communicating between doctors and patients. Telephone consultations have been set up with reimbursement by social security. However, these actions and innovations should not end with the crisis but, on the contrary, be a lever to rethink the role of hospitals, and our health care system more generally.

La crise sanitaire liée à la pandémie du coronavirus (COVID-19) a obligé la société, et les hôpitaux en particulier, à s'adapter et se réformer. Le travail en équipe entre hôpitaux, même au-delà des réseaux, a permis de faire face à la crise. Le corps médical et infirmier a dû apprendre à travailler différemment et faire la distinction entre les soins urgents et non urgents. Mais le patient aussi a dû changer ses comportements. L'accès aux hôpitaux s'est vu diviser entre un trajet COVID et non-COVID, bien distincts, afin d'éviter des contaminations. La télémédecine est devenue un moyen quotidien de communiquer entre le monde médical et les patients. Des consultations téléphoniques ont été instaurées avec, à la clef, un remboursement par l'INAMI. Cependant, ces actions et innovations ne devraient pas se terminer avec la crise liée à la COVID-19, mais, au contraire, être un levier pour repenser le rôle des hôpitaux, et notre système de soins de santé plus globalement.

Fasciola hepatica: an assessment on the vectorial capacity of Radix labiata and R. balthica commonly found in Belgium.

A previous study conducted in Belgium revealed that genetic material of Fasciola sp. was present in snail species belonging to the genus Radix. Here, these snails were collected and identified by DNA-based techniques as Radix labiata and Radix balthica. These two species and Galba truncatula (the major intermediate host in Europe) were experimentally infected with Fasciola hepatica. The resulting metacercariae were fed to rats and the infection was monitored using several techniques. Microscopy revealed the presence of larval stages in 78.3, 45, and 6.25% of G. truncatula, R. labiata, and R. balthica snails, respectively. These results were confirmed by a PCR that amplifies a Fasciola sp. specific sequence. Furthermore, this PCR was found to be more sensitive than microscopic examination. R. labiata shed fewer metacercariae than G. truncatula but these were as infective to rats as those shed by G. truncatula. This study demonstrates that R. labiata may act as an incidental intermediate host for F. hepatica in Belgium.

Comparison of three techniques for the serological diagnosis of Neospora caninum in the dog and their use for epidemiological studies.

An enzyme-linked immunosorbent assay (ELISA) was developed in our laboratory and used to determine the seroprevalence of Neospora caninum in three different dog populations in Belgium: healthy dogs from cattle farms and urban dogs with or without various neurological disorders. The test was validated and compared with two other tests: an indirect fluorescent antibody test (IFAT) and a commercially available competitive enzyme-linked immunosorbent assay (C-ELISA). The study showed a good correlation between the IFAT and the ELISA developed. When the two tests were compared with the C-ELISA, moderate positive and negative agreement indices were observed. Using our ELISA and the IFAT techniques, a high prevalence was found in farm dogs. This result showed that the neurological symptoms are not usually associated with the Neospora infection. In conclusion, the ELISA developed in our laboratory could replace the IFAT for the screening of a large number of dogs' sera.

Validation of a competitive enzyme-linked immunosorbent assay for diagnosing Babesia equi infections of Moroccan origin and its use in determining the seroprevalence of B. equi in Morocco.

A highly specific and sensitive competitive enzyme-linked immunosorbent assay for detection of specific antibody to Babesia equi in serum from equids was validated for use in Morocco. The assay is based on the specific inhibition of binding of a monoclonal antibody to a conserved epitope within a recombinant parasite peptide by serum from infected animals. The assay was compared to an established indirect immunofluorescence assay, with a concordance of 91%. The assay was used to determine seroprevalence for B. equi infections in donkeys and horses throughout Morocco. A total of 578 sera (163 horses and 415 donkeys) from 6 locations representing different bioclimatic regions were assayed. An analysis of variance, indicated no significant effect of location; however, donkeys were significantly more likely than horses to be seropositive. Management conditions contribute to greater tick infestations and thus Babesia exposure in donkeys than in horses.

Serological, clinical and histopathological changes in naturally infected dogs with Leishmania infantum in the Khemisset province, Morocco.

Canine leishmaniasis (canL) is widespread in the north of Morocco and the Leishmania infantum local strains are highly virulent. An epidemiological survey was carried out in 1993-1995 in the Khemisset province. In this region, the severity of the disease was assessed during regular visits to the identified foci by clinical examination of 323 dogs. Clinical signs were protean and occurred in various combinations. Biopsies were made on available sick dogs; the main histological changes were severe infiltration of the spleen, lymph nodes and bone marrow by mononuclear cells and hyperplasia of macrophage cells with amastigotes in their cytoplasm. The seroprevalence among 323 dog sera tested by ELISA showed a rate of 16.71%. The highest prevalence of the disease was 23.6% in the Sid El Ghandour hamlet. A comparison of the results of this study with those from the year following the first examination on the same site (Sid El Ghandour) of 67 dogs showed that the disease prevalence had not increased significantly (23.6% to 25.33%).

Analysis of immune responses in dogs with canine visceral leishmaniasis before, and after, drug treatment.

The incidence of canine visceral leishmaniasis (CVL) is increasing in the Mediterranean region. Many drugs have been tested for treatment of CVL, but little is known regarding their effect on test immune responses. In our study, three dogs naturally infected with Leishmania infantum and five dogs experimentally infected with the same strain, were treated with dimethasulfonate pentamidine (Lomidine) and the immune response evaluated before, and after, treatment. After the last injection, animals began to gain weight and the major clinical signs disappeared. Antibody titers gradually decreased to low levels, six months after treatment. At the same time, antigen specific lymphoproliferation reappeared in the sampled animals. This study shows that, after treatment, immune cellular responses to leishmanial antigens, involved in protection against Leishmania infection, were established.

Immune responses in vaccinated dogs with autoclaved Leishmania major promastigotes.

A comparative study was undertaken on the immunogen power of autoclaved Leishmania major promastigotes (ALM) vaccines given simultaneously with either BCG or saponin against canine leishmaniasis. The humoral immune response was assessed by ELISA and western blotting. The cellular immune response was evaluated by the lymphocyte transformation test. Dogs vaccinated simultaneously with ALM and saponin showed high antibody titres to crude L. infantum antigens after the first vaccine booster and reacted with several antigens, with molecular weights from 26 to 108 kDa by western blotting. However, the lymphocyte proliferation of these dogs to the crude L. infantum antigen was not significantly different from the control group. In contrast, in dogs vaccinated simultaneously with ALM and BCG, the antibody titres to crude antigen were low. Their sera reacted with the same proteins recognised by sera from dogs vaccinated simultaneously with ALM and saponin by western blotting. However, the 85-kDa protein was only identified by sera taken from dogs vaccinated simultaneously with ALM and BCG. These latter exhibited specific lymphocyte proliferation to the L. infantum antigen. This cell proliferation was observed for approximately 9 months after the first dose of the vaccine. This study indicates that a combination of ALM as the vaccine and BCG as the adjuvant, in the dog model, was successful in inducing a cell immune response, which is implicated in protection of dogs against a Leishmania infection.

Immune response against Leishmania antigens in dogs naturally and experimentally infected with Leishmania infantum.

Cell-mediated and humoral immune response in naturally and experimentally infected dogs was studied using crude and pure antigens. Both types of infections induced severe signs of visceral disease, but the symptoms observed in natural infections were more pronounced than in experimental infections. In addition, asymptomatic infections were not observed in experimentally infected animals. Disease evolution in laboratory infections was rapid and an increase in antibody titer to crude parasite antigen was correlated with the appearance and aggravation of clinical symptoms. Peripheral blood lymphocyte proliferation to crude antigen and pure gp63 was observed early following experimental infection, but was abolished once the infected dogs began to exhibit clinical signs. A similar pattern was observed in naturally infected dogs. Serum from all patent dogs showed high antibody titers to rK39 in enzyme-linked immunosorbent assays (ELISA), and reacted by western blotting with several antigens, 12 to 120 KDa, including gp63 and gp70. In the case of asymptomatic dogs. antibody titers to crude antigen were low and only a few antigens were identified by western blotting. None of the pure proteins examined, gp63, gp70, and rK39 were recognized by western blotting or ELISA. However, asymptomatic dogs exhibited specific lymphocyte proliferation to both crude antigen and the potential vaccine candidate gp63.