High performance of a novel antigen detection test on nasopharyngeal specimens for diagnosing SARS-CoV-2 infection.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has become a major public health issue worldwide. Developing and evaluating rapid and easy-to-perform diagnostic tests is a high priority. The current study was designed to assess the diagnostic performance of an antigen-based rapid detection test (COVID-VIRO®) in a real-life setting. Two nasopharyngeal specimens of symptomatic or asymptomatic adult patients hospitalized in the Infectious Diseases Department or voluntarily accessing the COVID-19 Screening Department of the Regional Hospital of Orléans, France, were concurrently collected. The diagnostic specificity and sensitivity of COVID VIRO® results were compared to those of real-time reverse-transcriptase quantitative polymerase chain reaction (RT-qPCR) results. A subset of patients underwent an additional oropharyngeal and/or saliva swab for rapid testing. A total of 121 patients confirmed to be infected and 127 patients having no evidence of recent or ongoing infection were enrolled for a total of 248 nasopharyngeal swab specimens. Overall, the COVID-VIRO® sensitivity was 96.7% (CI, 93.5%-99.9%). In asymptomatic patients, symptomatic patients having symptoms for more than 4 days and those with an RT-qPCR cycle threshold value ≥ 32, the sensitivities were 100%, 95.8%, and 91.9%, respectively. The concordance between RT-qPCR and COVID VIRO® rapid test results was 100% for the 127 patients with no SARS-CoV-2 infection. The COVID-VIRO® test had 100% specificity and sensitivity greater than 95%, which are better than the recommendations set forth by the WHO (specificity ≥ 97%-100%, sensitivity ≥ 80%). These rapid tests may be particularly useful for large-scale screening in emergency departments, low-resource settings, and airports.

Management of work-related common mental disorders in general practice: a cross-sectional study.

BACKGROUND: General practitioners (GPs) often manage individuals with work-related common mental disorders (CMD: depressive disorders, anxiety and alcohol abuse). However, little is known about the ways in which they proceed. The aim of this study is to analyze GPs' management and patterns of referral to other health professionals of patients with work-related CMD and associated factors. METHOD: We used data from a cross-sectional study of 2027 working patients of 121 GPs in the Nord - Pas-de-Calais region in France (April - August 2014). Statistical analyses focused on patients with work-related CMD detected by the GP and examined the ways in which GPs managed these patients' symptoms. Associations between patient, work, GP and contextual characteristics and GPs' management were explored using modified Poisson regression models with robust variance. RESULTS: Among the 533 patients with work-related CMD in the study, GPs provided psychosocial support to 88.0%, prescribed psychotropic treatment to 82.4% and put 50.7% on sick leave. Referral rates to mental health specialists and occupational physicians were respectively 39.8 and 26.1%. Several factors including patients' characteristics (occupational and sociodemographic), GPs' characteristics and environmental data were associated with the type of management used by the GP. CONCLUSION: Our study emphasizes the major and often lonesome role of the GP in the management of patients with work-related CMDs. Better knowledge of the way GPs manage those patients could help GPs in their practice, improve patients care and be a starting point to implement a more collaborative care approach.

Prevalence of work-related common psychiatric disorders in primary care: The French Héraclès study.

General practitioners (GP), on the frontline for individuals with mental health problems, often deal with work-related common psychiatric disorders. We aimed to determine the prevalence of work-related common psychiatric disorders in general practice and associated patients' and GPs' characteristics. HERACLES, a cross-sectional study among 2019 working patients of 121 GPs in the Nord - Pas-de-Calais region in France. Common psychiatric disorders were assessed using the MINI International Neuropsychiatric Interview, patient-perceived psychological distress and GP-diagnosed psychiatric disorders. The work-relatedness of common psychiatric disorders was ascertained by the GP and/or the patient. Prevalence rates adjusted on age were calculated by sex and associated characteristics were ascertained using multilevel Poisson regression models. The prevalence of work-related common psychiatric disorders ascertained using the MINI was estimated at 25.6% [23.7-27.5], 24.5% [22.6-26.4] for self-reported psychological distress and 25.8% [23.9-27.7] for GP-diagnosed psychiatric disorders. Age, history of psychiatric disorders, consultation for psychological purpose and GP's characteristics were associated with MINI-identified psychiatric disorders. The prevalence of work-related common psychiatric disorders among working adults seen in general practice is high but further studies are needed to support this results.

Week 96 results of the randomized, multicentre Maraviroc Switch (MARCH) study.

OBJECTIVES: The Maraviroc Switch (MARCH) study week 48 data demonstrated that maraviroc, a chemokine receptor-5 (CCR5) inhibitor, was a safe and effective switch for the ritonavir-boosted protease inhibitor (PI/r) component of a two nucleos(t)ide reverse transcriptase inhibitor [N(t)RTI] plus PI/r-based antiretroviral regimen in patients with R5-tropic virus. Here we report the durability of this finding. METHODS: MARCH, an international, multicentre, randomized, 96-week open-label switch study, enrolled HIV-1-infected adults with R5-tropic virus who were stable (> 24 weeks) and virologically suppressed [plasma viral load (pVL) < 50 HIV-1 RNA copies/mL]. Participants were randomized to continue their current PI/r-based regimen (PI/r) or to switch to MVC plus two N(t)RTIs (MVC) (1:2 randomization). The primary endpoint was the difference in the proportion with pVL < 200 copies/mL at 96 weeks. The switch arm was defined as noninferior if the lower limit of the 95% confidence interval (CI) for the difference was < -12% in the intention-to-treat (ITT) population. Safety endpoints (the difference in the mean change from baseline or a comparison of proportions) were analysed as key secondary endpoints. RESULTS: Eighty-two (PI/r) and 156 (MVC) participants were randomized and included in the ITT analysis; 71 (87%) and 130 (83%) were in follow-up and on therapy at week 96. At week 96, 89.0% and 90.4% in the PI/r and MVC arms, respectively, had pVL < 50 copies/mL (95% CI -6.6, 10.2). Moreover, in those switching away from PI/r, there were significant reductions in mean total cholesterol (differences 0.31 mmol/L; P = 0.02) and triglycerides (difference 0.44 mmol/L; P < 0.001). Changes in CD4 T-cell count, renal function, and serious and nonserious adverse events were similar in the two arms. CONCLUSIONS: MVC as a switch for a PI/r is safe and effective at maintaining virological suppression while having significant lipid benefits over 96 weeks.

Cervical cancer in sub-Saharan Africa: an emerging and preventable disease associated with oncogenic human papillomavirus.

Highly oncogenic human papillomavirus (HPV) infections are responsible for 7.7 % of cancers in developing countries, mainly cervical cancer. The incidence of this emerging cancer is steadily increasing in sub-Saharan Africa, with more than 75,000 new cases and close to 50,000 deaths a year, a toll further increased by HIV infection. According to the World Health Organization, cervical cancer will kill more than 443,000 women per year worldwide by 2030, nearly 90 % of them in sub-Saharan Africa. This increase in cervical cancer incidence in Africa is now counteracting the progress made by African women in reducing maternal mortality and increasing longevity. Nevertheless, cervical cancer is a potentially preventable noncommunicable disease that can be averted or halted by primary (vaccination), secondary (early diagnosis of situations at risk), and tertiary (early diagnosis of proven cases of cervical neoplasia) prevention. The close links between HIV and HPV justify linking cervical cancer prevention, screening, and management programs with AIDS programs as part of the "90-90-90" initiative of the UNAIDS, both nationally and regionally. Innovative strategies based on effective, rapid, inexpensive, and mobile screening tools, including at best molecular biology as well as vaccination and awareness programs, should be rapidly implemented and evaluated in sub-Saharan Africa.

The high burden of hospitalizations for primary EBV infection: a 6-year prospective survey in a French hospital.

Primary Epstein-Barr virus infection (PEI) is acquired increasingly later in life in developed countries, involving a growing number of adults. No studies have examined the effect of age on PEI. We conducted a prospective, single-centre, noninterventional survey to assess the clinical and economic effects of PEI care according to age. We included all serology-confirmed cases observed in all departments of a large regional hospital. Clinical and biologic data, therapeutics and costs of care were examined. Over a 6-year period, we included 292 subjects (148 children and 144 adults) with a median age of 15.4 years (range 9 months to 79 years). Adults were hospitalized more often (83% vs. 60%) and for longer periods of time (median 4 days vs. 2 days) than children (p ≤ 0.0001 for both). Two adults required a secondary transfer into the intensive care unit, although no children did. Typically, adults showed higher levels of activated lymphocytes and liver abnormalities. They also required the use of systemic corticosteroids more often (45% vs. 23%, p < 0.0001) and for longer periods of time (median 7 days vs. 3 days, p 0.02) than children. Overall, the costs were significantly higher for adults than for children (median, €1940 vs. €1130, p < 0.0001), mainly because of the frequency and duration of hospitalizations. Age increases the immune response and clinical severity of PEI, resulting in substantial additional costs for the community. Better recognition of the disease in adults could shorten the average length of hospital stay.

Early initiation of combined antiretroviral therapy preserves immune function in the gut of HIV-infected patients.

Massive loss of lamina propria CD4(+) T cells, changes in the lymphatic architecture, and altered intestinal epithelial barrier leading to microbial translocation are the common features of HIV-1 infection and are not fully restored under combined antiretroviral therapy (cART). To better understand determinants of gut mucosal restoration, we have performed phenotypic and gene expression analyses of the gut from HIV-infected patients, naive or treated with cART initiated either at the early phase of the primary infection or later during the chronic phase. We found a depletion of T helper type 22 (Th22) and interleukin-17-producing cells in naive patients. These populations, except Th22 cells, were not restored under cART. Regulatory T cells/Th17 ratio was significantly increased in HIV-infected patients and was inversely correlated to the restoration of CD4(+) T cells but not to gut HIV DNA levels. Gene profile analysis of gut mucosal distinguished two groups of patients, which fitted with the timing of cART initiation. In their majority early, but not later treated patients, exhibited conserved intestinal lymphoid structure, epithelial barrier integrity and dendritic cell maturation pathways. Our data demonstrate that early initiation of cART helps to preserve and/or restore lymphoid gut mucosal homeostasis and provide a rationale for initiating cART during the acute phase of HIV infection.

[PCR rDNA 16S used for the etiological diagnosis of blood culture negative endocarditis]. / PCR rDNA 16S dans le diagnostic étiologique des endocardites infectieuses à hémocultures négatives.

We report the case of a 55 year-old man presenting with a double aortic and mitral endocarditis for which resected valve culture was repeatedly negative. Specific PCR made on valves because of highly positive blood tests for Bartonella henselae remained negative. A molecular approach was made with 16S rDNA PCR, followed by sequencing. Bartonella quintana was identified as the etiology of endocarditis. B. quintana, "fastidious" bacteria, even if hard to identify in a laboratory, is often reported as a blood culture negative endocarditis (BCNE) agent. Molecular biology methods have strongly improved the diagnosis of BCNE. We propose a review of the literature focusing on the interest of broad-spectrum PCR on valve for the etiological diagnosis of BCNE.

A "true" polymicrobial endocarditis: Candida tropicalis and Staphylococcus aureus--to a drug user. Case presentation and literature review.

Polymicrobial endocarditis is more frequent in intravenous drug user (IVDU). Combined therapy--medical and surgical--represents the standard of care, but long-term suppressive therapy duration in fungal endocarditis is still debated. The polymicrobial endocarditis is rare: 1-3%. It is being observed with increasing frequency among drug users; a predominance of tricuspid valve involvement exists. We report a case of dual etiology infective endocarditis (IE) - Candida tropicalis and Staphylococcus aureus - in a IVDU; the treatment was combined, medical and surgical, and was followed by a suppressive antifungal therapy. We review the other published Candida tropicalis endocarditis cases and discuss their optimal management.

Treatment difficulties of a listerial rhombencephalitis in an adult patient allergic to penicillins.

Rhombencephalitis is not a rare presentation of listerial central nervous system infections in healthy adults. This report describes a case with several management difficulties linked to antibiotic related adverse events, pointing to alternative solutions to aminopenicillins. In addition, the role of dexamethasone in the management of inflammation and neurological symptoms is discussed.

Pneumocystis carinii pneumonia in patients with hematologic malignancies: a descriptive study.

Objectives. A retrospective multicentric study was conducted over a five-year period to evaluate the clinical and laboratory characteristics and outcome of patients with proven Pneumocystis carinii pneumonia (PCP) complicating hematologic malignancies.Results. The study included 60 HIV-negative patients with 18 non-Hodgkin's malignant lymphoma (30%), 13 chronic lymphocytic leukaemia (21.7%), 10 acute leukemia (16.6%), 5 multiple myeloma (8.3%), 4 Waldenström's diseases (6.6%), 4 chronic myeloid leukemia (6.6%), 3 myelodysplasia (5%), 2 Hodgkin's diseases (3.3%) and 1 thrombopenia. Bronchoalveolar lavage was diagnostic in all patients. Forty-nine patients received cytotoxic drugs (81.7%), 25 (41.7%) a long-term corticotherapy and 15 (25%) underwent bone marrow transplantation. Twenty-seven patients (45%) required admission in the intensive care unit, 35 (58.3%) received an adjunctive corticotherapy and 18 mechanical ventilation (30%). Twenty patients (33.3%) died of PCP. A previous long-term corticotherapy (p=0.04), high respiratory (p=0.05) and pulse rates (p=0.02), elevated C reactive protein (p=0.01) and mechanical ventilation (OR=13.37; IC: 1.9-50) were associated with a poor prognosis. Adjunctive corticotherapy did not modify the prognosis.Conclusions. These results suggest that PCP can occur during the course of various hematologic malignancies, not only lymphoproliferative disorders. Prognosis remains poor. The diagnosis should be advocated more frequently and earlier to improve the prognosis.

Selection of drug-resistant variants in the female genital tract of human immunodeficiency virus type 1-infected women receiving antiretroviral therapy.

We investigated human immunodeficiency virus (HIV) type 1 RNA, proviral DNA, and antiretroviral drug-resistant variants in cervicovaginal secretions of HIV-1-infected women receiving antiretroviral therapy. The prevalence of detectable HIV-1 RNA in genital secretions was inversely related to the number of antiretroviral drugs taken by the patients. Proviral DNA was detected in approximately half of all samples of cervicovaginal secretions from HIV-1-infected women, regardless of the presence or absence of HIV-1 RNA in cervicovaginal secretions and of the antiretroviral regimen. In cervicovaginal secretions of most women with persisting genital viral replication, HIV variants exhibiting mutations associated with drug resistance against protease and reverse-transcriptase pol genes were found. Our observations indicate that antiretroviral therapy is not effective in purging the female genital tract of cell-associated provirus and that antiretroviral drugs that penetrate the female genital tract at suboptimal concentrations exert a potent selective pressure on genital HIV variants when local replication of free HIV-1 RNA persists.

Malaria chemoprophylaxis of 3,446 French travelers departing from Paris to eight tropical countries.

BACKGROUND: Each year more and more French travelers are visiting areas where malaria is endemic. The aim of this study was to assess prophylactic regimens used by French travelers and to determine whether they meet current published recommendations. METHODS: This 12 month transversal study (May 1, 1995 to April 31, 1996) was conducted in embarkment lounges of Roissy Charles de Gaulle Airport to eight "tropical" destinations. RESULTS: 3,446 French travelers were enrolled. Twenty two and three-fifths percent of travelers had not sought any advice. The percentages of travelers staying less than 3 months (n = 2899) at risk of malaria (i.e., using none or inadequate chemoprophylaxis) were, according to the destination: Brazil (20%), Gabon (83%), Ivory Coast (26%), Kenya (43%), Madagascar (39%), Thailand (22%), Venezuela (41%) and Vietnam (8%). The suitability of the prophylaxis according to the information source for travelers staying less than 3 months varied as follows: specialist physician (OR = 1), travel agent (OR = 1.01, CI = 0.9 - 1. 1), occupational physician (OR = 1.13, CI = 0.6 - 2.1), GP (OR = 1. 58, CI = 1.1 - 2.3), none (OR = 1.95, CI = 1.3 - 2.9), friends (OR = 3, CI = 1.8 - 5) and pharmacist (OR = 3.94, CI = 2.1 - 7.5). Suitability of prophylaxis also varied according to the type of trip: organized tour (OR = 1), business trip (OR = 1.04, CI = 0.8 - 1.4), adventure tourism (OR = 2.1, CI = 1.6 - 2.9) and visit to family or friends (OR = 2.3, CI = 1.7 - 3.1). CONCLUSIONS: This study shows that the quality of advice on antimalarial chemoprophylaxis varies markedly according to the source, and that nearly one in three French travelers (29.3 %, 850/2899) to tropical areas is at risk of malaria.

'Brown sugar' heroin intoxication and improvement of surrogate immunologic markers in HIV infection.

OBJECTIVE: To report on the unexpected improvement in major biological surrogate markers (CD4 T-cell count, HIV RNA viral load, and apoptosis level) during the periods of 'brown sugar' heroin intoxication (BSI) in 12 HIV-1-infected intravenous drug users, independently of their antiretroviral therapy, compared to the period of 'brown sugar' heroin withdrawal (BSW). METHODS: The patients were followed prospectively for a total of 417 months over 4 years. Twenty-four episodes of BSI and 24 periods of BSW were analyzed. RESULTS: (1) BSI: the mean (+/-SE) duration was 9+/-1.8 months; at onset, the mean +/-SE CD4 T-cell count was 401+/-88/mm3; at the end, an absolute increase of 346 CD4 T-cells/mm3 and a CD4 T-cell count relative variation of +131% was observed. Half of the patients showed an increase of CD4 T-cell count of more than 90% during their follow-up. The mean+/-SE of CD8 T-cell count increased significantly by 108%. (2) BSW: the mean +/- SE duration was 8.4+/-1.3 months; at onset, the mean +/-SE CD4 T-cell count was 695+/-78/mm3; at the end, an absolute decrease of 342 CD4 T-cells/mm3 and a CD4 T-cell count relative variation of -52% was observed. Half of the patients showed a decrease of CD4 T-cell count of more than 51%. (3) Circulating viral load appeared to be significantly higher during BSW (median: 452 000 Eq RNA/mL) than during BSI (median: 52 000 Eq RNA/mL); p<0.01. (4) Similarly, the apoptotic process affecting circulating lymphocytes was significantly lower during BSI than during BSW episodes. (5) The 4-year mortality rate was 7%, compared with 36% in HIV-positive former drug users (p<0.001). CONCLUSIONS: Taken together, these features suggest that 'brown sugar' heroin could have either immunomodulatory or antiretroviral properties. Confirmation of these findings and investigation of the role of the many substances in 'brown sugar' heroin are indicated.

Health hazards in international tourists visiting Paris in August: a five-year retrospective epidemiologic survey.

BACKGROUND: Travel-related illnesses have been studied in visitors to developing countries, but no studies have examined the incidence of health problems in visitors to developed countries. METHODS: 4, 093 foreign tourists visiting Paris in August and attending to emergency medical care for acute health problems were included in an epidemiological survey conducted over 5 consecutive years. The objective was to determine what types of acute health problems occur in a foreign tourist population and to estimate the incidence of the main health hazards. RESULTS: Gastroenteritis represented the main cause of medical care in that population (from 14.5-21.9%) followed by traumatology, ENT problem, viral syndrome and dermatology which represented altogether 60-64% of all medical problems. Two factors were related to the distribution of diseases observed: age and nationality. The monthly incidence of gastroenteritis was estimated to be between 1.33 to 2.92 per 10,000 visitors, and the overall incidence of health problems between 8 to 10 per 10,000. CONCLUSIONS: Even if the incidence rate of gastroenteritis is low compared with developing countries, further studies are needed to support the hypothesis that gastroenteritis could be attributed to sanitary conditions in some restaurants of the French capital.

[Emergency consultations of foreign tourists in Paris in the month of August. 5 years of prospective surveillance (1992-1996)]. / Consultations d'urgence des touristes étrangers à Paris au mois d'août. Cinq années de surveillance prospective (1992-1996).

For five consecutive years, five major Parisian institutions in charge of emergencies have participated in a prospective collection of medical data for foreign patients visiting Paris in August; 4093 subjects have been studied. Gastroenteritis represented the main cause in calling on emergency medical care (14.5 to 21.9%), followed by traumatology, ear-nose-throat problems, syndromes labelled as viral, skin problems: these five categories represented 60 to 64% of all the serious problems encountered by tourists. The statistical frequency of different causes in calling on emergency care varied significantly according to two variables: the tourists' age and nationality. The incidence of gastroenteritis is estimated at between 13 and 30 per 100,000 visitors and the incidence of pathological problems taken all together--at 80 to 100 per 100,000.