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1.
Ticks Tick Borne Dis ; 11(1): 101301, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31653585

RESUMO

The incidence of Lyme borreliosis remains a matter of debate, but it can be estimated using the incidence of erythema migrans (EM), which is pathognomonic of the first phase. The aim of this prospective pilot study was to assess the feasibility of the on-line declaration of EM in rural areas where the incidence of Lyme borreliosis was previously estimated at 85 per 100,000 inhabitants per year. The study was limited to a rural area (Les Combrailles, Auvergne) of approximately 52,800 inhabitants and was preceded by an information campaign for the inhabitants and the healthcare professionals. Patients who sent a photo of the suspected EM by email or MMS message between April 2017 and April 2018 and who accepted to answer a questionnaire were included in the study. Two physicians then evaluated the quality of the photographs and the probability of EM. In parallel, the number of EM seen by physicians and pharmacists in the area over the given period was recorded. Out of the 113 emails and MMS messages received, 73 people were outside of the trial area or period and 9 did not complete the questionnaire. The photos of the remaining 31 people were analysed. The median age was 51.5 years old ([38-58] IQR) and 18 (58%) were women. Seven people (25%) stated that they did not have a smartphone and in 9 cases (29%) the photo was sent by a third party. The quality of the photos was considered very good in 22 (71%) cases, good in 7 (23%) cases, and average in 2 (6%) cases. The probability of EM was determined to be strong or possible in 12 (38%) cases, i.e. an estimated incidence of 22.7 per 100,000 inhabitants. Over the study period, 40 physicians and 20 pharmacists were contacted on a monthly basis. A median of 5 physicians [3;7] and 4 pharmacists [3 ;7] answered each month for a total of 18 and 36 declared EM respectively. The EM (strong probability/possible) collected by on-line declaration and those declared by healthcare professionals were all sent between April and October 2017. The total time spent on the information campaign and collection has been estimated at 265 h (divided between 10 people) for an overall cost of 10,669 Euros. The incidence of EM recorded by on-line self-declaration in our study seems to be lower than in previous studies, the under-reporting was probably linked to the low use of new technologies in the rural areas. Increasing the human resources and finances appears difficult to achieve in practice over a longer time period but the development of an application for the automatic recognition of EM could be one method for a more exhaustive collection in the long term and at lower cost.


Assuntos
Eritema Migrans Crônico/epidemiologia , Doença de Lyme/epidemiologia , Sistemas On-Line/instrumentação , População Rural/estatística & dados numéricos , Adulto , Estudos de Viabilidade , Feminino , França/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos
2.
J Travel Med ; 23(5)2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27378366

RESUMO

We describe an outbreak of varicella in 31 Sudanese refugees (all except one were male, mean age: 26 ± 1), from the Calais migrant camp and sheltered in a French transit area. The attack rate was 39%. Adults are scantly immunized against varicella zoster virus in East Africa and may be exposed to epidemics once in France.


Assuntos
Varicela/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Refugiados , Adulto , Varicela/diagnóstico , Varicela/prevenção & controle , Vacina contra Varicela , Feminino , França , Humanos , Masculino , Sudão , Adulto Jovem
3.
Euro Surveill ; 20(18)2015 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-25990231

RESUMO

Human alveolar echinococcosis (AE) is a severe hepatic disease caused by Echinococcus multilocularis. In France, the definitive and intermediate hosts of E. multilocularis (foxes and rodents, respectively) have a broader geographical distribution than that of human AE. In this two-part study, we describe the link between AE incidence in France between 1982 and 2007 and climatic and landscape characteristics. National-level analysis demonstrated a dramatic increase in AE risk in areas with very cold winters and high annual rainfall levels. Notably, 52% (207/401) of cases resided in French communes (smallest French administrative level) with a mountain climate. The mountain climate communes displayed a 133-fold (95% CI: 95-191) increase in AE risk compared with communes in which the majority of the population resides. A case-control study performed in the most affected areas confirmed the link between AE risk and climatic factors. This arm of the study also revealed that populations residing in forest or pasture areas were at high risk of developing AE. We therefore hypothesised that snow-covered ground may facilitate predators to track their prey, thus increasing E. multilocularis biomass in foxes. Such climatic and landscape conditions could lead to an increased risk of developing AE among humans residing in nearby areas.


Assuntos
Clima , Equinococose Hepática/diagnóstico , Echinococcus multilocularis/isolamento & purificação , Geografia , Animais , Estudos de Casos e Controles , Surtos de Doenças , Equinococose , Equinococose Hepática/epidemiologia , Raposas , França/epidemiologia , Humanos , Incidência , Análise Multivariada , Densidade Demográfica , Características de Residência , Fatores de Risco , Estações do Ano
4.
Clin Microbiol Infect ; 20(8): 746-51, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24261464

RESUMO

Internationally adopted children may suffer from different pathologies, including infectious diseases contracted in the country of origin. We evaluated the frequency of infectious diseases that may disseminate from adoptees to adoptive families on their arrival in France. All children who attended the clinic for international adoption in Clermont-Ferrand from January 2009 through to December 2011 were eligible for inclusion in the study. Standardized medical records dedicated to international adoption were retrospectively reviewed for demographic data, clinical diagnosis, and biological and radiological results. Data were completed by phone interviews with adoptive families after informed consent. One hundred and forty-two medical records were retrospectively reviewed and 86% of families agreed to be interviewed. One hundred and seventy-one potentially transmissible infections were diagnosed in 142 children, 12% (n = 20) of which were transmitted to adoptive families. Most of these infections were benign and transmission was restricted to the close family. Tinea was diagnosed in 44 adoptees and transmitted in 15 cases. Panton Valentine leukocidin producing methicillin-sensitive S. aureus (MSSA) was transmitted to an adoptive father who required hospitalization for bursitis. Transmission also occurred for CMV (n = 1), hepatitis A (n = 1), giardiasis (n = 1), scabies (n = 1), Moluscum (n = 2) and pediculosis (n = 2). Two cases of chronic hepatitis B and latent tuberculosis were diagnosed without subsequent transmission. In conclusion, infectious diseases are common in internationally adopted children and should be detected shortly after arrival to avoid transmission.


Assuntos
Adoção , Doenças Transmissíveis/epidemiologia , Transmissão de Doença Infecciosa , Saúde da Família , Criança , Pré-Escolar , Feminino , França/epidemiologia , Humanos , Lactente , Recém-Nascido , Entrevistas como Assunto , Masculino , Prevalência , Estudos Retrospectivos
5.
Rev Med Interne ; 35(6): 399-402, 2014 Jun.
Artigo em Francês | MEDLINE | ID: mdl-23890484

RESUMO

INTRODUCTION: Osteolytic lesions are not always related to malignancies. CASE REPORT: We report an 82-year-old woman suffering from subcostal pain. The patient underwent a splenectomy 40 years previously. CT-scan and MRI highlighted a calcified hepatic lesion associated with an osteolytic lesion of the L5 vertebra. Osteolytic and hepatic lesions were attributed to an alveolar echinococcosis based on positive serological assays. CONCLUSION: To our knowledge, this is the first report of an alveolar echinococcosis in a patient with splenectomy and secondary lesions. We suggest that the splenectomy could have promoted the parasite spreading to vertebra.


Assuntos
Equinococose/diagnóstico , Doenças da Coluna Vertebral/parasitologia , Esplenectomia , Idoso de 80 Anos ou mais , Feminino , Humanos , Imageamento por Ressonância Magnética
7.
Infection ; 41(6): 1157-61, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23765511

RESUMO

In 2009-2011, 113 adult in- and outpatients with measles were referred to the University Hospital of Clermont-Ferrand (centre of France): 71 (62.8 %) needed hospitalisation, 31 had pneumonia, 29 diarrhoea, 47 liver enzymes elevation, 38 thrombopaenia, one encephalitis and there were no deaths. Nineteen cases occurred among healthcare workers and five of them were hospital-acquired. There were 92 unvaccinated patients. The 2011 peak of that measles re-emerging epidemic occurred when non-immunised adults were affected.


Assuntos
Surtos de Doenças , Sarampo/epidemiologia , Adolescente , Adulto , Criança , Feminino , França/epidemiologia , Hospitais Universitários , Humanos , Masculino , Sarampo/prevenção & controle , Vacina contra Sarampo/administração & dosagem , Pessoa de Meia-Idade , Adulto Jovem
8.
Arch Pediatr ; 20(4): 449-58, 2013 Apr.
Artigo em Francês | MEDLINE | ID: mdl-23394726

RESUMO

Every year, the National Foundation for Infectious Diseases brings together more than 300 participants to review progress in vaccine research and development and identify the most promising avenues of research. These conferences are among the most important scientific meetings entirely dedicated to vaccine research for both humans and animals, and provide a mix of plenary sessions with invited presentations by acknowledged international experts, parallel sessions, poster sessions, and informal exchanges between experts and young researchers. During the Fifteenth Conference that took place in Baltimore in May 2012, various topics were addressed, including the scientific basis for vaccinology; exploration of the immune response; novel vaccine design; new adjuvants; evaluation of the impact of newly introduced vaccines (such as rotavirus, HPV vaccines); vaccine safety; and immunization strategies. The new techniques of systems biology allow for a more comprehensive approach to the study of immune responses in order to identify correlates of protection and to design novel vaccines against chronic diseases such as AIDS or malaria, against which natural immunity is incomplete.


Assuntos
Vacinas , Pesquisa Biomédica , Criança , Humanos , Vacinas contra Influenza
9.
Arch Pediatr ; 18(11): 1234-46, 2011 Nov.
Artigo em Francês | MEDLINE | ID: mdl-22019286

RESUMO

The annual meeting of the Infectious Disease Society of America (IDSA) ; which brought together nearly 5000 participants from over 80 countries in Vancouver, Canada, October 21 to 24, 2010 ; provided a review of the influenza (H1N1) 2009 pandemic, evaluated vaccination programmes and presented new vaccines under development. With 12,500 deaths in the United States in 2009-2010, the influenza (H1N1) 2009 pandemic was actually less deadly than the seasonal flu. But it essentially hit the young, and the toll calculated in years of life lost is high. The monovalent vaccines, whether live attenuated or inactivated with or without adjuvants, were well tolerated in toddlers, children, adults and pregnant women. In order to protect infants against pertussis, family members are urged to get their booster shots. The introduction of the 13-valent Pneumococcal conjugated vaccine in the beginning of 2010 may solve - but for how long ? - the problem of serotype replacement, responsible for the re-increasing incidence of invasive Pneumococcal infections observed in countries that had introduced the 7-valent vaccine. The efficacy of a rotavirus vaccine has been confirmed, with a reduction in hospitalization in the United States and a reduction in gastroenteritis-related deaths in Mexico. In the United States, vaccination of pre-adolescents against human papillomavirus (HPV) has not resulted in any specific undesirable effects. Routine vaccination against chicken pox, recommended since 1995, has not had an impact on the evolution of the incidence of shingles. Vaccination against shingles, recommended in the United States for subjects 60 years and over, shows an effectiveness of 55 %, according to a cohort study (Kaiser Permanente, Southern California). Although some propose the development of personalized vaccines according to individual genetic characteristics, the priority remains with increasing vaccine coverage, not only in infants but also in adults and the elderly. Vaccine calendars that cover a whole lifetime should be promoted, since the vaccination of adults and seniors is a determining factor of good health at all ages.


Assuntos
Influenza Humana/prevenção & controle , Vacinação/estatística & dados numéricos , Vacinação/normas , Vacinas , Adolescente , Criança , Pré-Escolar , Humanos , Esquemas de Imunização , Lactente , Recém-Nascido , Vacinas contra Influenza/imunologia , Influenza Humana/epidemiologia , Pandemias , Estados Unidos , Vacinas Virais
10.
Med Mal Infect ; 41(5): 278-90, 2011 May.
Artigo em Francês | MEDLINE | ID: mdl-21489733

RESUMO

The annual meeting of the Infectious Disease Society of America (IDSA); which brought together nearly 5000 participants from over 80 countries in Vancouver, Canada, October 21 to 24, 2010; provided a review of the influenza (H1N1) 2009 pandemic, evaluated vaccination programmes and presented new vaccines under development. With 12,500 deaths in the United States in 2009-2010, the influenza (H1N1) 2009 pandemic was actually less deadly than the seasonal flu. But it essentially hit the young, and the toll calculated in years of life lost is high. The monovalent vaccines, whether live attenuated or inactivated with or without adjuvants, were well tolerated in toddlers, children, adults and pregnant women. In order to protect infants against pertussis, family members are urged to get their booster shots. The introduction of the 13-valent Pneumococcal conjugated vaccine in the beginning of 2010 may solve--but for how long?--the problem of serotype replacement, responsible for the re-increasing incidence of invasive Pneumococcal infections observed in countries that had introduced the 7-valent vaccine. The efficacy of a rotavirus vaccine has been confirmed, with a reduction in hospitalization in the United States and a reduction in gastroenteritis-related deaths in Mexico. In the United States, vaccination of pre-adolescents against human papillomavirus (HPV) has not resulted in any specific undesirable effects. Routine vaccination against chicken pox, recommended since 1995, has not had an impact on the evolution of the incidence of shingles. Vaccination against shingles, recommended in the United States for subjects 60 years and over, shows an effectiveness of 55%, according to a cohort study (Kaiser Permanente, Southern California). Although some propose the development of personalized vaccines according to individual genetic characteristics, the priority remains with increasing vaccine coverage, not only in infants but also in adults and the elderly. Vaccine calendars that cover a whole lifetime should be promoted, since the vaccination of adults and seniors is a determining factor of good health at all ages.


Assuntos
Vacinação , Congressos como Assunto , Humanos
11.
Clin Microbiol Infect ; 17(2): 285-91, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20156216

RESUMO

Surgical percutaneous bone biopsy specimen after a 14-day antibiotic-free period represents the gold standard of care for diabetic foot osteomyelitis but may be difficult to implement in many institutions. We evaluate a simplified strategy based on the results of per-wound bone specimen culture. For that purpose, we retrospectively reviewed the charts of 80 consecutive patients with diabetic osteomyelitis and bone sample obtained via the wound after a careful debridement. The outcome was defined as favourable if there was a complete healing of the wound with no sign of infection and stable or improved bone X-ray 6 months after antibiotic therapy completion. Culture of bone specimens was positive in 96% of patients, although half of the patients did receive a course of antimicrobials within 14 days of the bone specimen being obtained. A total of 129 bacterial isolates were obtained from bone cultures with a mean of 1.6 ± 1 isolates per patient (Staphylococcus aureus: 33%; central nervous system: 14%; streptococci: 9%; enterococci: 12%; corynebacteria: 4%; Gram-negative bacilli: 20%; anaerobes: 4%). Forty-six percent of cultures were monomicrobial. The mean duration of follow-up from diagnosis was 17 ± 1 months. Six months after discontinuation of antibiotic, six patients (7.5%) had died, nine were considered as therapeutic failures and 65 were considered as cured. Fifty-four of these 65 patients had follow-up data available at 1 year and remained in remission. In conclusion, a simplified procedure based on the culture of bone sample obtained via the ulcer after a careful debridement of the wound is effective in the medical management of diabetic foot osteomyelitis.


Assuntos
Bactérias/isolamento & purificação , Infecções Bacterianas/microbiologia , Biópsia/métodos , Pé Diabético/microbiologia , Osteomielite/microbiologia , Manejo de Espécimes/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Bactérias/classificação , Infecções Bacterianas/tratamento farmacológico , Técnicas Bacteriológicas/métodos , Pé Diabético/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/tratamento farmacológico , Estudos Retrospectivos , Resultado do Tratamento
12.
Ann Dermatol Venereol ; 137(1): 5-11, 2010 Jan.
Artigo em Francês | MEDLINE | ID: mdl-20110062

RESUMO

BACKGROUND: The LRINEC score was developed in a retrospective study in order to distinguish necrotizing fasciitis from severe soft tissue infections using laboratory data. AIM: To evaluate the prognostic value of the LRINEC score in infectious cellulitis. PATIENTS AND METHODS: A prospective study was performed at the departments of infectious diseases and dermatology of the Clermont-Ferrand University Hospital. The three evaluation criteria were: time from initiation of antibiotics to regression of erythema, duration of fever and occurrence of complications (abscess, surgery, septic shock, necrotizing fasciitis, death, transfer to intensive care). Potential predictive variables were: LRINEC score>6 at admission, comorbidities, local appearance, clinical presentation and soft tissue ultrasound results. RESULTS: Fifty patients were included. The rate of complications was higher for patients with a LRINEC score>6 (54%) than for patients with a score<6 (12%, P=0.008). However, a LRINEC score>6 on admission was not significantly associated with increased duration of erythema or of fever. Prior lymphoedema was associated with a better prognosis. DISCUSSION: The LRINEC score may be a useful tool for the detection of complicated forms of soft tissue infections. Patients with a LRINEC score>6 on admission should be carefully evaluated (hospitalization, surgical assessment, close monitoring).


Assuntos
Fasciite Necrosante/epidemiologia , Índice de Gravidade de Doença , Infecções dos Tecidos Moles/complicações , Abscesso/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriemia/complicações , Desbridamento , Diagnóstico Precoce , Fasciite Necrosante/sangue , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/tratamento farmacológico , Fasciite Necrosante/etiologia , Fasciite Necrosante/cirurgia , Feminino , Febre/etiologia , França/epidemiologia , Hospitais Universitários/estatística & dados numéricos , Humanos , Linfedema/complicações , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Choque Séptico/epidemiologia , Choque Séptico/etiologia , Infecções dos Tecidos Moles/sangue , Infecções dos Tecidos Moles/tratamento farmacológico , Infecções dos Tecidos Moles/cirurgia , Adulto Jovem
13.
Vaccine ; 27(10): 1523-9, 2009 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-19168104

RESUMO

INTRODUCTION: There are insufficient data regarding the efficacy and safety of vaccination in patients with auto-immune disease (AID) and/or drug-related immune deficiency (DRID). The objective of this study was to obtain professional agreement on vaccine practices in these patients. METHODS: A Delphi survey was carried out with physicians recognised for their expertise in vaccinology and/or the caring for adult patients with AID and/or DRID. For each proposed vaccination practice, the experts' opinion and level of agreement were evaluated. RESULTS: The proposals relating to patients with AID specified: the absence of risk of AID relapse following vaccination; the possibility of administering live virus vaccines (LVV) to patients not receiving immunosuppressants; the pertinence of determining protective antibody titre before vaccination; the absence of need for specific monitoring following the vaccination. The proposals relating to patients with DRID specified that a 3-6 month delay is needed between the end of these treatments and the vaccination with LVV. There is no contraindication to administering LVV in patients receiving systemic corticosteroids prescribed for less than two weeks, regardless of their dose, or at a daily dose not exceeding 10mg of prednisone, if this involves prolonged treatment. Out of 14 proposals, the level of agreement between the experts was "very good" for eleven, and "good" for the remaining three. CONCLUSION: Proposals for vaccine practices in patients with AID and/or DRID should aid with decision-making in daily medical practice and provide better vaccine coverage for these patients.


Assuntos
Doenças Autoimunes/imunologia , Doenças Autoimunes/terapia , Síndromes de Imunodeficiência/imunologia , Síndromes de Imunodeficiência/terapia , Vacinação/efeitos adversos , Vacinação/métodos , Corticosteroides/efeitos adversos , Adulto , Antineoplásicos/efeitos adversos , Prova Pericial , Humanos , Síndromes de Imunodeficiência/induzido quimicamente , Terapia de Imunossupressão/efeitos adversos , Imunossupressores/efeitos adversos , Inquéritos e Questionários , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Vacinação/estatística & dados numéricos
14.
J Med Virol ; 81(1): 42-8, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19031461

RESUMO

Enteroviruses (EV) are the main etiological agents of aseptic meningitis. Diagnosis is made by detecting the genome using RT-PCR. The aim of the study was to evaluate the impact of a positive diagnosis on the management of infants, children, and adults. During 2005, 442 patients were admitted to hospital with suspected meningitis. Clinical and laboratory data and initial treatment were recorded for all patients with enteroviral meningitis. The turnaround time of tests and the length of hospital stay were analyzed. The results showed that EV-PCR detected EV in 69 patients (16%), 23% (16/69) were adults. About 18% of CSF samples had no pleocytosis. After positive PCR results, 63% of children were discharged immediately (mean 2 hr 30 min) and 95% within 24 hr. Infants and adults were discharged later (after 1.8 and 2 days, respectively). The use of antibiotics was significantly lower in children than in infants and adults. The PCR results allowed discontinuation of antibiotics in 50-60% of all patients treated. Patients received acyclovir in 16% of cases (7% children vs. 50% adults) and 23% (11% vs. 69%) underwent a CT scan. Clinical data were compared between patients whose positive EV-PCR results were available within 24 hr (n = 32) and those whose results were available > 24 hr after collection of CSF (n = 14). Duration of antibiotic treatment (difference: 2.3 days; P = 0.05) was reduced between the two groups. No statistical difference in the length of stay was observed. The EV-PCR assay should be performed daily in hospital laboratory practice and considered as part of the initial management of meningitis.


Assuntos
Infecções por Enterovirus/diagnóstico , Infecções por Enterovirus/terapia , Enterovirus/isolamento & purificação , Meningite Asséptica/terapia , Meningite Asséptica/virologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Administração de Caso , Criança , Pré-Escolar , Enterovirus/genética , Feminino , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Tomografia Computadorizada por Raios X
16.
Occup Med (Lond) ; 58(6): 419-24, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18562546

RESUMO

AIM: To evaluate knowledge and perception of hepatitis B, including prevention, among Moroccan health care workers (HCWs) and to estimate seroprevalence of hepatitis B and vaccine coverage (VC). METHODS: Four hundred and twenty HCWs were randomly selected and stratified by site: 120 in Rabat, 140 in Taza and 160 in Témara-Skhirat. The study included an anonymous questionnaire about knowledge of hepatitis B and its prevention and a serological survey. Oral statements and vaccine registers were used to analyse the VC of the HCWs. Serological testing and VC were analysed according to the occupational exposure. RESULTS: Participation rates in the questionnaire and serological tests were 68% (285/420) and 66% (276/420), respectively. Fifteen (5%) HCWs had a history of hepatitis B. All HCWs considered that hepatitis B virus (HBV) infection may be acquired through blood exposure. Vaccination was acknowledged as a necessary means against HBV transmission by 276 (98%) HCWs. Forty-two per cent HCWs had no HBV serological markers. The prevalence of hepatitis B surface antigen was 1%. The mean prevalence of hepatitis B core antibody (anti-HBc) was 28% and was significantly higher (P < 0.05) among nursing auxiliaries (57%), nurses (30%), medical physicians (31%) and midwives (25%) than among laboratory technicians (13%). According to the vaccination registers (available in two sites), VC (> or =3 doses) was 55%. VC was 75% among midwives, 61% among nurses, 53% among nursing auxiliaries and 38% among medical staff. Of the fully vaccinated HCWs without anti-HBc, 51% had serological evidence of protection. CONCLUSION: HBV vaccines should be more readily available for Moroccan HCWs by reinforcing current vaccination programmes.


Assuntos
Acidentes de Trabalho/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Vacinas contra Hepatite B/administração & dosagem , Hepatite B , Programas de Imunização/organização & administração , Acidentes de Trabalho/prevenção & controle , Adulto , Métodos Epidemiológicos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hepatite B/epidemiologia , Hepatite B/imunologia , Hepatite B/prevenção & controle , Anticorpos Anti-Hepatite B/sangue , Anticorpos Anti-Hepatite B/imunologia , Antígenos de Superfície da Hepatite B/sangue , Antígenos de Superfície da Hepatite B/imunologia , Humanos , Masculino , Marrocos , Estudos Soroepidemiológicos
17.
Rev Med Interne ; 29(12): 1034-7, 2008 Dec.
Artigo em Francês | MEDLINE | ID: mdl-18395304
18.
Rev Med Interne ; 29(2): 100-4, 2008 Feb.
Artigo em Francês | MEDLINE | ID: mdl-18164785

RESUMO

PURPOSE: Vein thrombosis risk and pulmonary embolism seem to be more important among human immunodeficiency virus (HIV) infected patients. METHOD: We performed a retrospective study including 780 HIV positive patients followed-up between January 2000 and June 2005 at the University Hospital of Clermont-Ferrand. RESULTS: Among the 780 HIV-infected patients, six cases of thromboembolic events were identified including, four with pulmonary embolism. All the patients were receiving lopinavir/ritonavir combination. CONCLUSION: Although uncommon, pulmonary embolism occurs more frequently among HIV positive patients than in general population. Clinicians must remain aware about the possibility of the occurrence of a thromboembolic event especially during the first few months after introduction of the antiretroviral therapy.


Assuntos
Terapia Antirretroviral de Alta Atividade/estatística & dados numéricos , Embolia Pulmonar/epidemiologia , Trombose Venosa/epidemiologia , Adulto , Fármacos Anti-HIV/uso terapêutico , Estudos de Coortes , Feminino , Seguimentos , França/epidemiologia , Inibidores da Protease de HIV/uso terapêutico , Soropositividade para HIV/epidemiologia , Humanos , Lopinavir , Masculino , Pessoa de Meia-Idade , Pirimidinonas/uso terapêutico , Estudos Retrospectivos , Ritonavir/uso terapêutico
19.
Vector Borne Zoonotic Dis ; 7(4): 507-17, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17979533

RESUMO

We conducted a prospective study to estimate the Lyme borreliosis incidence in two rural French departments, Meuse and Puy-de-Dôme. Concurrently, we investigated the prevalence of ticks infected with Borrelia burgdorferi sensu lato (sl) and Anaplasma phagocytophilum. The incidence of Lyme borreliosis decreased from 156 to 109/100,000 inhabitants in Meuse and from 117 to 76/100,000 inhabitants in Puy-de-Dôme in 2004 and 2005, respectively, corresponding to a decrease in the density of Ixodes ricinus nymphs infected with B. burgdorferi sl. During the same period, the density of adult ticks increased. Interestingly, B. valaisiana, a nonpathogenic species, infected adult ticks more often than nymphs. These results confirmed the correlation between the Lyme borreliosis incidence and the density of infected nymphs, a stage preferentially infected with B. afzelii. In contrast, we found a low rate of infection by A. phagocytophilum, ranging from 0% to 0.4% in Puy-de-Dôme and from 0.8% to 1.4% in Meuse, suggesting a low risk for humans.


Assuntos
Borrelia burgdorferi/fisiologia , Ixodes/microbiologia , Doença de Lyme/epidemiologia , Doença de Lyme/microbiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Anaplasma phagocytophilum/isolamento & purificação , Anaplasma phagocytophilum/fisiologia , Animais , Borrelia burgdorferi/isolamento & purificação , Feminino , França/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Ninfa/microbiologia , Densidade Demográfica , Estudos Prospectivos , Distribuição por Sexo
20.
Arch Mal Coeur Vaiss ; 100(5): 439-47, 2007 May.
Artigo em Francês | MEDLINE | ID: mdl-17646771

RESUMO

Kawasaki disease is an inflammatory arterial disease of unknown cause usually affecting young children, the principal complication of which is coronary artery aneurysm. Early treatment with immunoglobulins and aspirin prevents this complication. The diagnosis requires expert clinical criteria and, in atypical forms, a more recent decisional diagnostic tree has to be used. The authors report 6 cases of adult Kawasaki disease. As in the other sixty or so cases in the literature, hepatic forms were the commonest (5/6). Only three of the six cases met the classical clinical criteria and the diagnosis was made by the decisional tree or after coronary complications in the oldest subject. The five treated patients progressed favourably after a course of immunoglobulins. Echocardiography detected 100% of children with coronary disease but it was more difficult in adults in whom new non-invasive methods of coronary imaging (fast CT and MRI) and stress testing should complete the investigations. The association of prolonged pyrexia, clinical criteria and a biological inflammatory syndrome should, after exclusion of the differential diagnoses, suggest a diagnosis of Kawasaki disease in the adult as in the child. The possibility of coronary disease, even though extremely rare, should be recognised by the cardiologist and lead to diagnostic and therapeutic managements as aggressive as in children.


Assuntos
Síndrome de Linfonodos Mucocutâneos/diagnóstico , Adulto , Aneurisma Coronário/diagnóstico , Angiografia Coronária , Árvores de Decisões , Diagnóstico Diferencial , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Imunoglobulinas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Masculino , Pessoa de Meia-Idade , Miocardite/diagnóstico , Derrame Pericárdico/diagnóstico , Pericardite/diagnóstico
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