Éditeur(s) : HAL CCSD Elsevier Masson
Résumé : International audience
The Société de pneumologie de langue française defines acute exacerbation of chronic obstructive pulmonary disease (AE COPD) as an increase in daily respiratory symptoms, basically duration ≥ 48h or need for treatment adjustment. Etiology of EA COPD are mainly infectious, viral (rhinovirus, influenzae or parainfluenzae virus, coronavirus, adenovirus and respiratory syncytial virus) or bacterial (Haemophilus influenzae, Streptococcus pneumoniae, or Moraxella catarrhalis). Pollutant exposure can also lead to AE COPD, such as NO2, SO2, ozone or particulates (PM10 and PM2.5). In 30% the etiology remains unknown. Differential diagnoses of AE COPD include infectious pneumonia, pneumothorax, acute heart failure and pulmonary embolism. Presences of signs of severity impose hospitalization: signs of respiratory distress, shock, acute confusion but also fragile patients, insufficient home support or absence of response to initial treatment. AE COPD treatments consist on increase in bronchodilators, chest physiotherapy, and antibiotics if sputum is frankly purulent. Systemic corticosteroids should not be systematic.Recommended dose is 0.5 mg/kg on short course (7 days). During hospitalization, oxygen supplementation and thromboprophylaxis could be prescribed. The main interest in noninvasive ventilation is persistent hypercapnia despite optimal medical management. During ambulatory management or hospitalization, clinical assessment at 48-72h is mandatory. L’exacerbation aiguë de bronchopneumopathie chronique obstructive (EA BPCO) représente un événement important dans l’histoire naturelle de la BPCO, notamment en cas d’hospitalisation. Les EA BPCO interviennent dans la gravité et l’évolution de la BPCO ; et leur prévention est un des objectifs principal des traitements de fond.
La Société de pneumologie de langue française définie l’exacerbation aiguë de bronchopneumopathie chronique obstructive (EA BPCO) comme une majoration des symptômes respiratoires au-delà des variations quotidiennes, en pratique, d’une durée ≥ 48h ou justifiant une modification thérapeutique. L’étiologie de ces EA BPCO est principalement infectieuse, virale (rhinovirus, virus influenzae et parainfluenzae, coronavirus, adénovirus et virus respiratoire syncytial) ou bactérienne (principalement Haemophilus influenzae, Streptococcus pneumoniae et Moraxella catarrhalis). Elles peuvent également résulter de l’exposition à certains polluants comme le NO2, le SO2, l’ozone et la pollution particulaire (PM10 et PM2,5). L’étiologie reste indéterminée dans près de 30 % des cas. Les diagnostics différentiels des EA BPCO incluent les pneumopathies infectieuses, les pneumothorax, les poussées d’insuffisance cardiaque et les embolies pulmonaires. La présence de signes de gravité conditionnent l’hospitalisation : signes d’insuffisance respiratoire aiguë, de choc ou de défaillance neurologique, mais aussi en cas de patient fragile, d’absence de soutien familial à domicile ou d’absence de réponse au traitement initial. Le traitement d’une EA BPCO consiste en une majoration des bronchodilatateurs, une kinésithérapie respiratoire, une antibiothérapie en cas d’expectoration franchement purulente.La prescription de corticoïdes systémiques ne doit pas être systématique. La dose recommandée est de 0,5 mg/kg sur une courte période (7 jours). Lors d’une hospitalisation, une oxygénothérapie et une thromboprophylaxie peuvent être prescrite. La ventilation noninvasiveest principalement indiquée en cas de persistance d’une hypercapnie malgré un traitement médical optimal. Que le patient soit pris en charge en ambulatoire ou en hospitalisation, une réévaluation clinique à 48-72h est indispensable.
ISSN: 0755-4982

hal-01117949
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01117949
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01117949/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01117949/file/Prise%20en%20charge%20des%20exacerbations_accepted.pdf
DOI : 10.1016/j.jeurea.2015.02.002

Éditeur(s) : HAL CCSD
Résumé : National audience
Nocardiosis is an infectious disease with wide range of clinical features, which can eventually lead to death. The agent responsible belongs to the genus Nocardia that includes about fifty different species. Nocardiosis occurs mainly in immunocompromised hosts. We report here three cases of disseminated nocardiosis misdiagnosed initially as cerebral metastatic lung cancer. These patients, including two immunocompetent hosts, presented with both pulmonary and cerebral lesions. In all three patients, the diagnosis was based on magnetic resonance imaging with diffusion sequence, apparent diffusion coefficient reconstruction and neurosurgical cerebral biopsies. Treatment with an appropriate antibiotic regimen was prolonged for several months. Progress was favorable with full resolution of the neurological symptoms and the radiological abnormalities. These three cases emphasize the diagnostic challenge of nocardiosis, especially in disseminated disease.
Revue Des Maladies Respiratoires

hal-01659440
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01659440
DOI : 10.1016/j.rmr.2017.08.002
PUBMED : 28918971

Éditeur(s) : Wiley-blackwell Publishing, Inc
Résumé : Aims: A description of bacterial pathogens in shrimp ponds is necessary to understand their pathogenesis. Vibrio nigripulchritudo was shown to contain saprophytic and pathogenic strains among New Caledonian isolates. We established a method to map the development of V. nigripulchritudo in pond sediments at three different genetic levels: the species level, then at the pathogenic cluster level and finally at the plasmid level, present only in all highly pathogenic isolates. Methods and Results: PCR methods were applied to shrimp pond sediments both before and after a mortality outbreak. Using crude samples, the species V. nigripulchritudo is not detected at first (0/42 samples at day 56 post stocking) but appears frequently in the sediments after the mortality event (30/42 at day 107). The distribution of strains from the pathogenic cluster of V. nigripulchritudo also follows this pattern. In contrast, the pSFn1 virulence-associated plasmid was detected in one sample at day 56 and none at day 107. An enrichment method was developed to lower the detection limits of our assays. After enrichment, the species V. nigripulchritudo was detected in all samples at both dates. The number of samples positive for pSFn1 was 42/42 samples at day 56 and 29/42 at day 107. Conclusions: These results show that the sediments contain V. nigripulchritudo, notably pathogenic strains. Surprisingly, the virulence-associated plasmid pSFn1 found in all V. nigripulchritudo isolated from moribund shrimp appears less frequently in sediments, possibly being useless or even detrimental to its recipient bacteria in this environment. Significance and Impact of the Study: This study confirms the presence of pathogenic V. nigripulchritudo strains in shrimp pond sediment before a mortality outbreak complying with a previous hypothesis that sediments could be the infecting reservoir. After the outbreak, both total V. nigripulchritudo and pathogenic strains populations have largely increased, possibly contributing to the recurrent mortality observed in this shrimp vibriosis.
Journal Of Applied Microbiology (1364-5072) (Wiley-blackwell Publishing, Inc), 2010-06 , Vol. 108 , N. 6 , P. 2003-2011

Droits : 2010 The Society for Applied Microbiology - Wiley-Blackwell
http://archimer.ifremer.fr/doc/00004/11484/8177.pdf
DOI:10.1111/j.1365-2672.2009.04601.x
http://archimer.ifremer.fr/doc/00004/11484/

Éditeur(s) : HAL CCSD Oxford University Press
Résumé : International audience
Chronic rhinosinusitis (CRS) rank second at chronic inflammatory diseases in industrialized countries and are an important public health concern. Diagnosis relies on a set of arguments including clinical signs, imaging, histopathologic and mycological analyses of sinus specimens, collected during nasal endoscopy. The sensitivity of fungal cultures is reported to be poor, even when direct examination is positive, thus the epidemiology of fungal chronic sinusitis is ill-known. This study evaluated the sensitivity of molecular diagnosis in 70 consecutive samples (61 patients with CRS) analysed at the University Hospital of Rennes during a 3-year period. DNA detection was performed using a conventional PCR method targeting the ITS1/ITS2 sequence and the resulting amplification products were sequenced. Fungal CRS was proven in 42 patients (69%), of which only 20 (48%) had a positive culture. 37/42 (88%) patients were diagnosed with a fungus ball, 3 with allergic fungal CRS and 2 with undetermined fungal CRS. PCR was positive in all 42 cases and direct sequencing allowed to identify fungi in all cases but one, and detected multiple infection in 3. Aspergillus fumigatus was present in 69% of patients; Cladosporium cladosporoides in 9.5%, Scedosporium sp., A. nidulans and A. flavus in 7% each. In 2/19 patients with negative direct examination, sequencing analysis revealed the presence of Capnobotryella sp. and C. cladosporoides, in clinical settings compatible with fungal sinusitis. In conclusion, ITS1/ITS2 PCR had a twice better sensitivity than culture, and combined sequencing provides accurate epidemiological data on fungal CRS.
ISSN: 1369-3786

hal-01383632
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01383632
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01383632/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01383632/file/Contribution%20of%20molecular%20tools%20for%20the%20diagnosis.pdf
DOI : 10.1093/mmy/myw041

Éditeur(s) : HAL CCSD Elsevier Masson
Résumé : International audience
This observation perfectly illustrates the main epidemiological, clinical and biological peculiarities of this parasitic disease. Particularly, as it concerns a tourist who travelled across Africa for a short period of time it is possible to assess the time of exposure to infecting mosquito bites, the maturation period of time as well as the time of clinical incubation. On the other hand the value of the immunological techniques to make the diagnosis of loaiasis as well as the difficulties to treat this affection are stressed upon.
ISSN: 0181-5512

hal-00715439
https://hal.univ-antilles.fr/hal-00715439
PUBMED : 6939746

Éditeur(s) : HAL CCSD IGI Global
Résumé : International audience
The social behavior of individuals is an important factor of the transmission and the evolution of many diseases. As such, epidemic studies have attempted to integrate social aspects in dissemination modeling. Since the pioneering works of Klovdahl on AIDS in 1985, epidemiological investigations and interventions increasingly focus on social networks. Significant factors of the transmission and outbreak of many infectious diseases are the structure and nature of human interactions. Network-based modeling approaches have found various applications in epidemiology as a simple yet efficient way to represent the complexity of human relationships implicated in dissemination processes. However, most results have been obtained by considering social networks as steady stage structures. Evolving networks have not been explored. The objective is first to give an overview of network-based modeling attempts in epidemiology to analyze and understand the dissemination processes with an emphasis on dynamic networks. The authors approach is designed to understand the impact of social links dynamics on epidemic spread. The authors present the results obtained by combining network evolution patterns (link creation and deletion) and a typical epidemic model. The speed of link dynamics and the infection time strongly influence the occurrence and value of the epidemic peak.
ISSN: 1947-8186

hal-00700105
https://hal.archives-ouvertes.fr/hal-00700105
DOI : 10.4018/jismd.2012070103

Éditeur(s) : HAL CCSD Public Library of Science
Résumé : International audience
BACKGROUND: Dengue and malaria are two major public health concerns in tropical settings. Although the pathogeneses of these two arthropod-borne diseases differ, their clinical and biological presentations are unspecific. During dengue epidemics, several hundred patients with fever and diffuse pain are weekly admitted at the emergency room. It is difficult to discriminate them from patients presenting malaria attacks. Furthermore, it may be impossible to provide a parasitological microscopic examination for all patients. This study aimed to establish a diagnostic algorithm for communities where dengue fever and malaria occur at some frequency in adults. METHODOLOGY/PRINCIPAL FINDINGS: A sub-study using the control groups of a case-control study in French Guiana - originally designed to compare dengue and malaria co-infected cases to single infected cases - was performed between 2004 and 2010. In brief, 208 patients with malaria matched to 208 patients with dengue fever were compared in the present study. A predictive score of malaria versus dengue was established using .632 bootstrap procedures. Multivariate analysis showed that male gender, age, tachycardia, anemia, thrombocytopenia, and CRP>5 mg/l were independently associated with malaria. The predictive score using those variables had an AUC of 0.86 (95%CI: 0.82-0.89), and the CRP was the preponderant predictive factor. The sensitivity and specificity of CRP>5 mg/L to discriminate malaria from dengue were of 0.995 (95%CI: 0.991-1) and 0.35 (95%CI 0.32-0.39), respectively. CONCLUSIONS/SIGNIFICANCE: The clinical and biological score performed relatively well for discriminating cases of dengue versus malaria. Moreover, using only the CRP level turned to be a useful biomarker to discriminate feverish patients at low risk of malaria in an area where both infections exist. It would avoid more than 33% of unnecessary parasitological examinations with a very low risk of missing a malaria attack.
ISSN: 1935-2727

inserm-00872353
http://www.hal.inserm.fr/inserm-00872353
http://www.hal.inserm.fr/inserm-00872353/document
http://www.hal.inserm.fr/inserm-00872353/file/journal.pntd.0002420.pdf
DOI : 10.1371/journal.pntd.0002420

Éditeur(s) : HAL CCSD Elsevier Masson
Résumé : International audience
Four lyophilizated liver flüke antigens and one of hydatid fluid were examined for the presence of blood group like antigens P1, A, B, M and N by an hemagglutination inhibition test with hyperimmune and natural hemagglutinating sera. P1 or P1-like substance was found in the extracts of "Fasciola hepatica" and "F. gigantica" in a lower concentration than in echinoccocal fluid. This presence may explain the occurrence of anti-P1 antibodies in patients infected with liver flüke and belonging to the P2 blood group. However biochemical studies will be necessary to determine if the P1 activity is due to the blood group P1 substance of the red cell itself or due to a P1 like substance.
ISSN: 0369-8114

hal-00715431
https://hal.univ-antilles.fr/hal-00715431
PUBMED : 392420

Résumé : Les études écologiques sont maintenant considérées comme prometteuses en raison de leur capacité à intégrer dans un même modèle autant des facteurs individuels que populationnels. Le mouvement récent de l’open data pourrait jouer un rôle important dans la pérennisation des démarches multidisciplinaires. Cette thèse montre que l’association des méthodes écologiques aux données publiques permet d’éclairer sous un angle nouveau des problématiques des maladies infectieuses.En Guyane Française, des méthodes écologiques dites de séries temporelles couplées aux données climatiques libres ont contribué à une meilleure compréhension du rôle du climat sur la dynamique de la transmission du paludisme, de la leishmaniose cutanée ainsi que de l’histoplasmose disséminée. L’utilisation de méthodes écologiques sur des données libres de la littérature scientifique concernant la séroprévalence toxoplasmose dans les populations humaines a permis d’identifier les principaux facteurs influençant le niveau de séroprévalence globale et indirectement du risque de toxoplasmose congénital associé. L’association de données onusiennes à des méthodes écologiques a permis de montrer qu’une prévalence importante d’ascaridiose est associée à une réduction par 10 de l’incidence du paludisme et l’impact significatif de la corruption sur la mortalité juvéno-infantile et sur les résistances aux anti-tuberculeux. Ces études montrent que l’association des méthodes écologiques aux données publiques permet d’éclairer sous un angle nouveau des problématiques des maladies infectieuses. Ce type d‘étude fournit la flexibilité nécessaire à l’étude des interactions complexes des nombreux déterminants de la santé.
Ecological studies are now considered promising because of their ability to integrate as well as individual factors than populational ones in the same model. The recent open data movement could play an important role in the sustainability of multidisciplinary approaches. The studies developed in this thesis show that the combination of ecological methods with open data could give original results in the issues of infectious diseases.In French Guiana, ecological methods called time series, coupled with open climate data, have contributed to a better understanding of the role of climate on the dynamics of malaria, cutaneous leishmaniasis and disseminated histoplasmosis. The use of ecological methods with open data from the scientific literature concerning toxoplasmosis seroprevalence in human populations has permitted to identify the main factors influencing the level of overall seroprevalence and indirectly to estimate the associated risk of congenital toxoplasmosis.The combination of UN data to ecological methods has shown that a high prevalence of ascariasis is associated with a reduction from 10 in the incidence of malaria and that corruption has a significant impact on child mortality and resistance to TB.The various studies developed in this thesis show that the combination of ecological methods to public data sheds a new light on the issues of infectious diseases. This type of study provides the flexibility to study the complex interactions of many determinants of health.

http://www.theses.fr/2011AGUY0482/document

Éditeur(s) : HAL CCSD MDPI
Résumé : International audience
Hand disinfection with alcohols-based hand rubs (ABHRs) are known to be the most effective measure to prevent nosocomial infections in healthcare. ABHRs contain on average 70% by weight of one or more alcohols. During the hand rubbing procedure, users are exposed to these alcohols not only through dermal contact, but also via inhalation, due to the physical and chemical properties of alcohols volatilizing from alcoholic solutions or gels into the air. Ethanol ingestion is well known to increase risks of several diseases (affecting the pancreas, liver, cardiovascular system…), but there is a lack of knowledge about the effects of exposure to other alcohols (including n- or isopropanol) via inhalation and dermal contact, despite the worldwide use of ABHRs. This work aims at discussing possible health effects related to unintentional alcoholization (via inhalation and dermal contact) from professional ABHR usage to suggest the need for more research in this area (but not to question the value of ABHRs). Based upon an average of 30 hand rubbings per healthcare professional per day, it can be assumed that a healthcare worker may be exposed to a maximum 5,500 mg/m(3) per work shift, five times above the recommended occupational time weighted average limit. Thus, in order to answer the question posed in the title, studies on spatial and temporal variability of alcohol emission from ABHRs in real world situations and studies on certain high risk individuals are needed.
ISSN: 1660-4601

hal-01122305
https://hal.archives-ouvertes.fr/hal-01122305
PUBMED : 20948945
DOI : 10.3390/ijerph7083038
PUBMEDCENTRAL : PMC2954566

Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
The nine countries sharing the Amazon forest accounted for 89% of all malaria cases reported in the Americas in 2008. Remote sensing can help identify the environmental determinants of malaria transmission and their temporo-spatial evolution. Seventeen studies characterizing land cover or land use features, and relating them to malaria in the Amazon subregion, were identified. These were reviewed in order to improve the understanding of the land cover/use class roles in malaria transmission. The indicators affecting the transmission risk were summarized in terms of temporal components, landscape fragmentation and anthropic pressure. This review helps to define a framework for future studies aiming to characterize and monitor malaria.
ISSN: 1475-2875

inserm-00834790
http://www.hal.inserm.fr/inserm-00834790
http://www.hal.inserm.fr/inserm-00834790/document
http://www.hal.inserm.fr/inserm-00834790/file/1475-2875-12-192.pdf
DOI : 10.1186/1475-2875-12-192

Éditeur(s) : HAL CCSD Wiley-Blackwell
Résumé : International audience
Seven patients from a group of 16 travelers were diagnosed at our institution with one or more sand fleas on their toes, 1 day to 3 weeks after returning from Madagascar. A questionnaire was sent to the whole group to collect clinical and epidemiological information, which showed that 9 of 13 (69%) had received pre-travel medical advice, but none were aware of sand flea; thus prevention measures were rarely applied. Five of seven (71%) patients wore open sandals throughout the trip. Overall, 10 sand fleas were extracted
ISSN: 1195-1982

hal-01162380
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01162380
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01162380/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01162380/file/Tungiasis%20outbreak%20in%20Madagascar-1.pdf
DOI : 10.1111/jtm.12217

Éditeur(s) : HAL CCSD Oxford University Press (OUP)
Résumé : International audience
BACKGROUND: HIV cohort collaborations, which pool data from diverse patient cohorts, have provided key insights into outcomes of antiretroviral therapy (ART). However, the extent of, and reasons for, between-cohort heterogeneity in rates of AIDS and mortality are unclear. METHODS: We obtained data on adult HIV-positive patients who started ART from 1998 without a previous AIDS diagnosis from 17 cohorts in North America and Europe. Patients were followed up from 1 month to 2 years after starting ART. We examined between-cohort heterogeneity in crude and adjusted (age, sex, HIV transmission risk, year, CD4 count and HIV-1 RNA at start of ART) rates of AIDS and mortality using random-effects meta-analysis and meta-regression. RESULTS: During 61 520 person-years, 754/38 706 (1.9%) patients died and 1890 (4.9%) progressed to AIDS. Between-cohort variance in mortality rates was reduced from 0.84 to 0.24 (0.73 to 0.28 for AIDS rates) after adjustment for patient characteristics. Adjusted mortality rates were inversely associated with cohorts' estimated completeness of death ascertainment [excellent: 96-100%, good: 90-95%, average: 75-89%; mortality rate ratio 0.66 (95% confidence interval 0.46-0.94) per category]. Mortality rate ratios comparing Europe with North America were 0.42 (0.31-0.57) before and 0.47 (0.30-0.73) after adjusting for completeness of ascertainment. CONCLUSIONS: Heterogeneity between settings in outcomes of HIV treatment has implications for collaborative analyses, policy and clinical care. Estimated mortality rates may require adjustment for completeness of ascertainment. Higher mortality rate in North American, compared with European, cohorts was not fully explained by completeness of ascertainment and may be because of the inclusion of more socially marginalized patients with higher mortality risk.
ISSN: 0300-5771

hal-00875138
https://hal.archives-ouvertes.fr/hal-00875138
DOI : 10.1093/ije/dys164
PUBMED : 23148105

Éditeur(s) : HAL CCSD Instituto Oswaldo Cruz, Ministério da Saúde
Résumé : International audience
A cross section of a human population (501 individuals) selected at random, and living in a Bolivian community, highly endemic for Chagas disease, was investigated combining together clinical, parasitological and molecular approaches. Conventional serology and polymerase chain reaction (PCR) indicated an active transmission of the infection, a high seroprevalence (43.3%) ranging from around 12% in < 5 years to 94.7% in > 45 years, and a high sensitivity (83.8%) and specificity of PCR. Abnormal ECG tracing was predominant in chagasic patients and was already present among individuals younger than 13 years. SAPA (shed acute phase antigen) recombinant protein and the synthetic peptide R-13 were used as antigens in ELISA tests. The reactivity of SAPA was strongly associated to Trypanosoma cruzi infection and independent of the age of the patients but was not suitable neither for universal serodiagnosis nor for discrimination of specific phases of Chagas infection. Anti-R-13 response was observed in 27.5% only in chagasic patients. Moreover, anti-R13 reactivity was associated with early infection and not to cardiac pathology. This result questioned previous studies, which considered the anti-R-13 response as a marker of chronic Chagas heart disease. The major clonets 20 and 39 (belonging to Trypanosoma cruzi I and T. cruzi II respectively) which circulate in equal proportions in vectors of the studied area, were identified in patients' blood by PCR. Clonet 39 was selected over clonet 20 in the circulation whatever the age of the patient. The only factor related to strain detected in patients' blood, was the anti-R-13 reactivity: 37% of the patients infected by clonet 39 (94 cases) had anti-R13 antibodies contrasting with only 6% of the patients without clonet 39 (16 cases).
ISSN: 0074-0276

hal-01256421
https://hal.archives-ouvertes.fr/hal-01256421
DOI : 10.1590/S0074-02762002000300002
IRD : fdi:010029219
PUBMED : 12048553

Éditeur(s) : HAL CCSD
Résumé : International audience
Nouv Presse Med

hal-00715425
https://hal.univ-antilles.fr/hal-00715425
PUBMED : 745979

Éditeur(s) : HAL CCSD Springer Verlag
Résumé : International audience
We carried out a soil sampling survey in September 2008 in central Cayenne, French Guiana, using molecular methods to assess the presence of the dimorphic fungus Histoplasma capsulatum. Four of the 31 samples collected (12.9 %) tested positive by PCR, with confirmation of the result by DNA sequencing. H. capsulatum is therefore present in urban environments in French Guiana. These results provide additional support for the primary prophylaxis of AIDS-related histoplasmosis in French Guiana
ISSN: 0301-486X

hal-01349668
https://hal.archives-ouvertes.fr/hal-01349668
https://hal.archives-ouvertes.fr/hal-01349668/file/Article%20Histo%20Cayenne%20R2.pdf
DOI : 10.1007/s11046-012-9550-y

Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
IntroductionFever is associated with a poor outcome in severely brain-injured patients, and its control is one of the therapies used in this condition. But, fever suppression may promote infection, and severely brain-injured patients are frequently exposed to infectious diseases, particularly ventilator-associated pneumonia (VAP). Therefore, we designed a study to explore the role of a fever control protocol in VAP development during neuro-intensive care.MethodsAn observational study was performed on severely brain-injured patients hospitalized in a university ICU. The primary goal was to assess whether fever control was a risk factor for VAP in a prospective cohort in which a fever control protocol was applied and in a historical control group. Moreover, the density of VAP incidence was compared between the two groups. The statistical analysis was based on a competing risk model multivariate analysis.ResultsThe study included 189 brain-injured patients (intervention group, n¿=¿98, and historical control group, n¿=¿91). The use of a fever control protocol was an independent risk factor for VAP (hazard ratio 2.73, 95% confidence interval [1.38, 5.38; P¿=¿0.005]). There was a significant increase in the incidence of VAP in patients treated with a fever control protocol (26.1 versus 12.5 VAP cases per 1000 days of mechanical ventilation). In cases in which a fever control protocol was applied for >3 days, we observed a higher rate of VAP in comparison with the rate among patients treated for ¿3 days.ConclusionFever control in brain-injured patients was a major risk factor for VAP occurrence, particularly when applied for >3 days.
ISSN: 1364-8535

hal-01118640
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01118640
PUBMED : 25498970
DOI : 10.1186/s13054-014-0689-4
PUBMEDCENTRAL : PMC4279880

Éditeur(s) : HAL CCSD Lippincott, Williams & Wilkins
Résumé : PURPOSE OF REVIEW: Malaria represents one of the most important selective factors affecting human populations. Several inherited diseases of red blood cells lead to resistance at the erythrocytic stage. Among patients who experience hereditary elliptocytosis related to mutations of erythrocyte membrane proteins, molecular studies have shown the prevalence of particular spectrin mutations in patients from black ethnic extraction, leading one to question the selection of new malaria-resistant genes. RECENT FINDINGS: Prospective epidemiological and molecular studies in West Africa have confirmed the prevalence (between 0.6 and 1.6%) of particular spectrin mutations related to hereditary elliptocytosis. These studies have also revealed the frequency of alpha-spectrin chain polymorphisms, associated in cis with elliptocytogenic spectrin mutations and defining particular spectrin allele haplotypes. Culture studies of Plasmodium falciparum in elliptocytes bearing such elliptocytogenic alleles of spectrin showed that these alleles are supplementary genetic factors of malaria resistance in vitro. SUMMARY: Certain instances of spectrin mutations or polymorphisms have not yet been shown to constitute new factors of innate resistance to malaria in vivo. Epidemiological surveys of hereditary elliptocytosis and parasite culture studies, however, have argued that the relationships between parasite and spectrin-based skeleton should be examined more closely and the molecular interactions between parasite ligands and particular spectrin chain domains should be characterized.
ISSN: 1065-6251

inserm-00128119
http://www.hal.inserm.fr/inserm-00128119
http://www.hal.inserm.fr/inserm-00128119/document
http://www.hal.inserm.fr/inserm-00128119/file/Dhermy_et_al_figures.pdf
DOI : 10.1097/MOH.0b013e3280d21afd

Résumé : Aujourd’hui, il est indispensable de découvrir de nouveaux agents thérapeutiques pour faire face à l’expansion des infections fongiques humaines. D’un autre côté, certains arbres amazoniens ont acquis des moyens pour se protéger contre la dégradation fongique. Ces composés d’origine végétale pourraient donc être des candidats potentiels au développement de composés antifongiques. Il est ainsi exposé dans ce travail la sélection bio-inspirée et la récolte d’espèces d’arbres amazoniens résistants à la dégradation fongique ; à partir desquelles il est proposé d’isoler, d’identifier et de valoriser les métabolites responsables de la durabilité naturelle et d’étudier leurs propriétés sur des champignons pathogènes humains. Cette étude a conduit à l’isolement de molécules inédites apportant un complément d’information chimiotaxonomique pour les espèces étudiées. De plus, il a pu être mis en avant deux molécules pouvant devenir des composés pertinents pour le développement de traitements antimycotiques.
It is now essential to discover new therapeutic agents against the increase of human fungal infections. On the other hand, some Amazonian trees have succeeded to develop a chemical defense arsenal to protect themselves against fungal degradation. These compounds of plant origin could become potential candidates for the development of antifungal compounds for the treatment of human fungal diseases. Therefore, this manuscript describes the bio-inspired selection and collection of Amazonian tree species capable of specializing a highly fungiresistant wood; from which it is proposed to isolate, identify and valorize the secondary metabolites responsible for the natural durability, and study their properties on human pathogenic fungi. Ultimately, this study led to the isolation of new compounds and providing additional important chemotaxonomic information for the species studied. In addition, it as been established that two compounds could be relevant for the development of antimitotic therapies.

http://www.theses.fr/2011AGUY0467/document

Éditeur(s) : HAL CCSD
Résumé : International audience
Direct examinations of blood and serologic tests were used to assess the intensity of the filarial endemicity in Gabon. Both methods revealed that the prevalence of filariasis with microfilaremia (Loa loa and Dipetalonema perstans) is presently very elevated. The areas that are more involved are the forest regions as well as the highest ones (ogoue, Lolo, Ngounie). Women appeared to be suffering from loasis to a lesser extent than men. On the other hand, the prevalence was identical for Dipetalonema perstans. For the gabonese population one can approximately say that 3 out of 5 adults patients have filariasis, two being D. perstans and one L. loa. Consequently these affections represent a major public health problem. Finally one must note that no case of lymphatic filariasis has been identified.
Bull Soc Pathol Exot Filiales

hal-00717069
https://hal.univ-antilles.fr/hal-00717069
PUBMED : 6936082