BACKGROUND:Despite vaccination, patients receiving anti-CD20 monoclonal antibodies (mAbs) for multiple sclerosis (MS) or neuromyelitis optica spectrum disorders (NMOSD) have an increased risk of developing severe or protracted COVID-19. The aim of this study was to describe the effect of COVID-19 convalescent plasma (CCP) in patients with MS or NMOSD exposed to anti-CD20 and infected by SARS-CoV-2. METHODS:This French national, retrospective cohort study was conducted between November 2020 and June 2023. Patients with MS or NMOSD, under anti-CD20 mAbs, with symptomatic COVID-19 and treated by CCP were screened. Protracted COVID-19 was defined by a duration of symptoms >21 days. The primary endpoint was the overall survival 30 days after CCP administration. RESULTS:Ninety-two patients from 34 hospitals were included, 84 (91%) with MS and 8 (9%) with NMOSD. Overall, 30-day survival was 97% (IC95%: 91-99). SARS-CoV-2 viremia was positive in 47/75 (61%) patients before CCP versus 9/59 (15%) seven days post-CCP. In the 52 patients (57%) with protracted COVID-19, the duration of symptoms before CCP was 51 [28-69] days, including fever in 75% of cases, which disappeared in 100% of patients 7 days post-CCP. CONCLUSIONS:CCP could be a therapeutic option in patients exposed to anti-CD20 mAbs for inflammatory demyelinating disease, particularly in those with protracted COVID-19.
BACKGROUND:Refractory acute respiratory distress syndrome (ARDS) is the leading cause of death in patients with Covid-19. Large studies of lung pathology in patients who died of Covid-19-ARDS may help to understand the mechanisms of death and to guide further research. METHODS:This prospective multicentre cohort study included 338 post-mortem, percutaneous, lung biopsies from 169 patients who died of Covid-19-ARDS between 22/04/2020 and 08/03/2021 in 26 intensive care units in France. The biopsies were done at the bedside by the intensivist immediately after death, using a 14G needle and following anatomical landmarks. A pathologist examined all biopsies, describing all elementary lesions and establishing a final histopathological diagnosis. RESULTS:Lung parenchyma was evaluable in 155/169 (92%) patients. Early, proliferative-phase diffuse alveolar damage (DAD) was the most common finding (39%), followed by late proliferative-phase DAD (32%) and exudative-phase DAD (18%); fibrotic-phase DAD was present in three (2%) patients. Organising pneumonia (OP) and acute fibrinous and organising pneumonia (AFOP) were evidenced in 21 (13%) and 16 (9%) patients, respectively. Unclassified interstitial lesions were seen in 33 (21%) patients. Microthrombi were uncommon (6%). CONCLUSIONS:DAD was the most common pathological pattern, whereas collagen fibrosis and microthrombi were rare. A quarter of patients had evidence of OP or AFOP. This substantial prevalence of corticosteroid-sensitive patterns suggests that selected patients with refractory Covid-19-ARDS might benefit from higher doses or longer courses of corticosteroids. TRIAL REGISTRATION: CLINICALTRIALS:gov NCT04675281. Registered 19 December 2020.
We report a rare case of cervical lymphadenopathy tularemia from North Africa in a French immunocompromised traveler returning from Egypt after participating in an outdoor travel involving dromedary camels. The timeline and clinical course support tularemia as a cause of infection in this patient. The diagnosis was confirmed by serology and polymerase chain reaction methods. A concurrent Epstein-Barr virus-infectious mononucleosis complicated the diagnosis of tularemia. Treatment was successful after surgical procedures in addition to two different antimicrobial regimens: doxycycline followed by fluoroquinolones.
Severe forms of Guillain–Barré syndrome (GBS) and myasthenia gravis (MG) may result in prolonged mechanical ventilation in ICUs. Data on weaning from mechanical ventilation are scarce, and our objective was to assess ventilator weaning characteristics in a large-scale multicenter study. Multicenter retrospective cohort study including all patients intubated for at least 48 h for GBS or MG over a 10-year period (from January 2014 to December 2023). The primary outcome was the proportion of patients having experienced prolonged weaning (at least 7 days). Some 886 patients admitted to 47 ICUs in France were retained in the analysis, including 513 (58
Giant Cell Arteritis (GCA) incidence is influenced by various unexplained factors. Multiple studies have investigated seasonal influence on GCA incidence, yielding contradictory results. This meta-analysis aims to determine the pooled seasonal influence on GCA incidence and if it is modulated by latitude. MEDLINE and Scopus databases were searched for articles reporting on incidence and describing seasonal or monthly proportions of GCA. The primary outcome measured was the Seasonal Incidence Risk Ratio (SIRR) defined as the incidence of GCA in warm seasons (Spring and Summer) over GCA incidence in cold seasons (Autumn and Winter). Meta-analysis of GCA incidence variations with season was performed on the pooled SIRR. Nineteen articles describing GCA incidence and seasonal variations in 39,829 patients were included, 10 studies reported a significant seasonal pattern in the incidence of GCA with seven studies reporting a warm seasonal pattern and three studies reporting a cold seasonal while 9 studies did not report a significant seasonal pattern. The pooled SIRR estimate in this meta-analysis was 1.08 [0.99–1.17]. We observed a significant reverse correlation between SIRR and the studies’ location latitude r= – 0.595(p = 0.015), additionally, we observed an inflexion latitude line in Lyon, France (45.8), all studies performed southern to that line reported higher proportion of warm seasons cases. The pooled SIRR of studies performed southern to the inflexion line was 1.18 [1.09–1.28]. Overall, there was no significant pooled seasonal pattern; however, a warm-season pattern was driven by studies from southern locations, linking latitude and seasonal influence as environmental factors in GCA.
