Fungal rhinosinusitis are frequently described in humans and its prevalence appears to be increasing. They mainly involve species of the genus Aspergillus. To date, conventional mycological diagnosis remains challenging, as only 30% and 50% of cultures are positive in cases of fungal balls and invasive rhinosinusitis respectively. Over the past decade, human infections due to the Rasamsonia argillacea species complex are increasingly frequent and mainly concern patients with cystic fibrosis or chronic granulomatous disease. We report here the first case of pseudotumoral R. aegroticola sinusitis in a 66-year-old man with Meniere’s disease requiring repeated corticosteroid cures. The CT scan revealed areas of condensation and thinning of the straight sphenoidal bone walls, whose bone lysis could be confirmed during surgical excision. Direct microscopic examination of samples from different culture media revealed sterile mycelium without fruiting bodies, and was therefore not contributive. However, the sequencing of ITS and β-tubulin regions, performed from mucosal fragments and sterile mycelium, allowed the identification of R. aegroticola.

Torque teno virus (TTV) replication is tightly modulated by the host immune response. As such, TTV viremia has been investigated as a biomarker of immune competence for monitoring the risks of allograft rejection and opportunistic infections in solid organ transplant recipients. We aimed to investigate the associations between TTV levels in bronchoalveolar lavage fluid samples (BALF) and pathogen detection in patients with hematological diseases with suspicion of lower respiratory tract infection (LRTI). TTV DNA was quantified in BALF using qPCR. Linear and logistic regressions were used to study associations between TTV levels in BALF and patients' characteristics, cytological patterns and pathogen detection. A total of 330 BALF from 272 patients with hematological malignancies were included. TTV DNA was detected in 44.5% of samples. The median TTV viral load (VL) in positive samples was 6.24 log copies/mL (IQR: 4.68-7.66). Strong positive associations were found between TTV levels in BALF and a diagnosis of lymphoma, a neutrophil fraction > 3% of BALF cells, and the detection of at least one respiratory virus. To a lesser extent, allogeneic hematopoietic stem cell transplantation, significant bacterial growth in BALF culture, and cytomegalovirus detection in BALF were also associated with TTV levels. We identified in this study multiple associations with TTV VL in BALF. These findings suggest that high TTV levels in BALF could reflect an impaired local immune status, and correlate with the risk of viral LRTI in immunocompromised patients.

Background Fluconazole-resistant isolates of Candida parapsilosis have emerged worldwide in recent years. Objective Our objectives were to get an overview of the French epidemiology, to determine the incidence of azole resistance and to assess the genetic relationship between isolates. Methods We initiated a prospective national multicenter study (ReCap - Resistance of Candida parapsilosis to azole drugs). All C. parapsilosis isolates routinely identified in 15 French hospital mycology laboratories were included over a period of 6 to 20 months (depending on the center), regardless of the type of specimen and hospitalization unit. Isolates were tested for fluconazole susceptibility using a gradient diffusion method. Non-susceptible isolates (MIC ≥4 mg/L) and a random selection of susceptible isolates were subjected to further analysis (MICs determination by EUCAST method and microsatellite genotyping). Results Between May 2022 and February 2024, a total of 2,602 isolates were collected from 1,830 patients. Among these, 392 isolates (15.1%) from 184 patients (10%) were found to be resistant (MIC >4 mg/L). Percentage of patients colonized or infected by a resistant isolate ranged from 0 to 54.4% across centers. Genotyping analysis performed on 1,320 isolates showed high diversity among susceptible isolates and indicated that two fluconazole-resistant clusters are circulating in different hospitals of the Paris area. Cross-resistance occurred frequently with voriconazole resistance observed in 62.9% (73/116) of fluconazole-resistant isolates. Conclusion In France, the frequency of resistance to fluconazole reaches 10% of patients harboring C. parapsilosis, with very significant differences between regions. The Paris area is affected by two epidemic clusters involving many patients.

Anorexia nervosa (AN) is an eating disorder that mainly affects adolescents and young women. The disorder is characterised by dietary restriction or purges leading to malnutrition with subsequent metabolic anomalies, changes in immune function and increased mortality for the most severe forms of the disease. The changes in immune function may lead to increased susceptibility to bacterial infections or, more rarely, fungal infections, where only seven cases of chronic pulmonary aspergillosis (CPA) and one case of invasive pulmonary aspergillosis (IPA) have been described in the literature. Two cases of CPA (one male and one female) occurring in the context of extreme AN according to the DSM5 classification are described. These two cases are compared to eight cases (all females) described in the literature. Clinical, biological and radiological data were collected. The majority of the patients (9/10) were female. AN was considered to be extreme in seven patients, severe in one patient and undetermined in 2 patients (BMI missing). Preexisting lesions were mentioned in four patients and in our two cases. Computed tomography scans demonstrated the presence of endocavitary material in two cases in the literature. The presence of anti-Aspergillus antibodies (IgG and IgE) was reported in 6/10 patients. Galactomannan was detected in serum and bronchoalveolar lavage fluid in respectively 1 and 3 patients. An Aspergillus spp. was recovered from fungal culture in seven cases including: Aspergillus niger (n = 1), Aspergillus fumigatus (n = 5). Four patients underwent surgical removal of the mass and two of these were also treated with voriconazole (VCZ). Four patients received antifungal treatment alone, including VCZ monotherapy (n = 1), or a combination of antibiotic and antifungal with either VCZ (n = 2) or amphotericin B (n = 1). One patient received liposomal amphotericin B then oral voriconazole and another one received voriconazole before micafungin due to panazole-resistant Aspergillus strain associated with treatment for nontuberculous mycobacteria. Regression of the lesions was confirmed radiologically in two patients. The evolution was favourable for 8/10 cases. One death occurred in the context of IPA and the second after the patient left hospital against medical advice. These observations illustrate the possibility of CPA, or more rarely IPA, in patients with extreme AN. Evolution is usually favourable and rarely fatal. This complication should be considered in a patient with extreme AN in the presence of a preexisting cavity. Management should be multidisciplinary, involving personalised refeeding, medical treatment of aspergillosis associated with surgical treatment depending on the clinical context.

Fungi in the family Trichosporonaceae are rarely involved in invasive disease but are frequently associated with colonization or respiratory allergic infection. Trichosporonaceae exhibit intrinsic resistance to echinocandin antimicrobial drugs, posing challenges for treatment and contributing to high mortality rates. We complied a nationwide analysis of 112 cases of invasive disease caused by Trichosporon spp. and related fungi, diagnosed in France over 20 years, that combined clinical data, susceptibility profiles, and molecular identification. We identified 12 species; T. asahii was the most common species recovered, and the new species T. austroamericanum was next. Comparison of clinical data highlighted species and genotypic differences, such as a much higher proportion of children infected by T. asahii and major differences in antimicrobial drug susceptibility. Correct identification is not only of epidemiologic interest but also necessary for patient management because of the varying clinical and microbiological characteristics found in different species.

Background and objectives Antifungal treatment (AFT) for proven or probable invasive candidiasis (IC) is common in critically ill, immunocompromised patients. Early AFT de-escalation appears safe in unselected ICU patients, but has not been studied specifically amongst immunocompromised hosts. Methods This retrospective study was conducted in 19 ICUs in France between January 2019 and December 2024. All immunocompromised patients hospitalized in ICU for ≥5 days and treated with antifungals for a first proven or probable episode of IC were included. Early AFT de-escalation was defined as either spectrum reduction, i.e., a switch from an initial echinocandin or liposomal amphotericin B to fluconazole, or complete discontinuation of the initial antifungal, occurring within 5 days (day 1-5) of treatment initiation. The primary objective was to determine the incidence of early AFT de-escalation (censored at day 28 after initiation of AFT). Results 242 patients were analysed (median age 64 years, 64% males). Most patients (n=175, 72.3%) were treated empirically or pre-emptively for probable IC. Early AFT de-escalation occurred in 92 patients (38%, 95% confidence interval [CI] 31.9%-44.2%). AFT de-escalation consisted in spectrum reduction in 35.9%, and AFT discontinuation in 64.1% of cases. There was no difference in ICU mortality, ICU length-of-stay and the number of ventilator-free days between patients with and without AFT de-escalation. AFT was re-initiated within 7 days of de-escalation in 6 over 92 patients (6.5%) who had undergone AFT de-escalation. Conclusions Early AFT de-escalation occurred in 38% of critically ill immunocompromised patients, and was not associated with adverse prognostic outcomes.(240 words).

Molds are ubiquitous environmental microorganisms with major implications for human health, ranging from allergic reactions to invasive infections. Although the environmental seasonality of several fungal spores has long been recognized, its reflection in clinical isolates remains poorly explored. A total of 218 682 fungal spectra generated by 97 medical microbiology laboratories across France between 2020 and 2024 were analyzed, based on identifications performed using the MSI-2 Matrix Assisted Laser Desorption Ionization - Time of Flight Mass Spectrometry (MALDI-TOF MS) web platform. Seasonal patterns were assessed through additive decomposition, autocorrelation, and formal statistical testing. Distinct seasonal variation patterns were identified across taxa. Significant seasonality was detected for multiple taxa, including Alternaria, Cladosporium, Aspergillus sections Nigri and Flavi, Talaromyces, several taxa of Basidiomycota, and Rhizopus arrhizus. Positive or negative correlations between fungal identification counts and national mean temperature values were observed depending on the taxon. This study highlights the importance of considering seasonality in understanding the epidemiology of fungal diseases and demonstrates the value of multicenter MALDI-TOF MS data as a tool for epidemiological surveillance.

COVID-19-associated pulmonary aspergillosis (CAPA) is a recognized fungal superinfection, but diagnosis remains difficult due to non-specific clinical and radiological findings. While anti-Aspergillus spp. IgG antibodies (AspAb) are used for chronic aspergillosis diagnosis, their role in this context is unclear. We described AspAb kinetics in CAPA patients hospitalized in intensive care unit (ICU). We performed a retrospective study at Lille University Hospital from February 2020 to December 2021, enrolling ICU SARS-CoV-2 patients. Patients were included if they had at least one positive mycological marker - direct examination, culture, galactomannan antigen (GM) or Aspergillus fumigatus qPCR in bronchoalveolar lavage and/or serum - along with clinical and radiological findings consistent with CAPA, as defined by the 2020 ECMM/ISHAM consensus criteria. Among 898 patients, 95 (10.6%) had at least one positive mycological marker; 47 fulfilled CAPA criteria (5.2%), and 43 had at least one AspAb measurement. One-quarter of CAPA patients (23.3%, 10 patients) had at least one positive AspAb measurement (one of whom had only one measurement). Among AspAb-positive patients, 7 (70.0%) seroconverted a mean of 8.3 days (SD, 8.5) after CAPA diagnosis; one had documented positivity prior to hospitalization. Seven patients (70.0%) reached AspAb rate ≥ 80 AU/mL. These results are the first observed in CAPA patients and need to be confirmed in a larger cohort of non-neutropenic patients hospitalized in ICU with viral pneumonia.

Exopolysaccharides (EPS) are carbohydrate polymers produced by various bacteria, including species of the genus Lactobacillus. Until now, the link between the functional properties of these bacteria and their EPS remains poorly understood. Lactobacilli are used in a wide range of applications due to their protective effects against inflammation and their role in maintaining intestinal homeostasis. However, the functional properties of their EPS remain weakly characterized. This study investigated the EPS produced by Lactobacillus gasseri (Lg-EPS), a human-derived probiotic, focusing on their immunomodulatory activity and inhibitory effects on the growth and virulence of Candida albicans, an opportunistic fungal pathogen associated with dysbiosis and immune dysfunction. The results show that Lg-EPS are composed of 59.1% glucose, 26.0% galactose, 14.6% rhamnose, and 0.3% N-acetyl-glucosamine. Functionally, Lg-EPS reduced the expression of pro-inflammatory cytokines (IL-6, IL-8, CCL-2) and IL-6 protein levels, while increasing IL-10 expression and secretion. These effects were associated with downregulation of TLRs, MyD88 and NF-κB, alongside upregulation of the aryl hydrocarbon receptor (AhR), an intracellular transcription factor involved in immune modulation. Additionally, Lg-EPS increase induction of AhR activity in HT29-Lucia™ AhR cells. Furthermore, Lg-EPS inhibited C. albicans biofilm formation and fungal growth. These findings suggest that Lg-EPS contribute to immune regulation and antifungal defense via AhR activation. This receptor, known for sensing microbial metabolites, mediates anti-inflammatory effects by suppressing NF-κB signaling, enhancing IL-10 production, and reinforcing epithelial barrier function. This is the first report to demonstrate the AhR-dependent anti-inflammatory effect of bacterial EPS.

(1→3)-ß-d-glucans (BDG), major cell wall components of most pathogenic fungi, are useful for the diagnosis of invasive fungal diseases (IFD) due to their high negative predictive value. For several years, a number of BDG detection tests are commercially available, including Fungitell Assay (FA) and Wako assay, and more recently Fungitell STAT (STAT) unit test. Our aim was to compare the performance of the two Fungitell assays for IFD diagnosis. Sera from 90 patients with Pneumocystis jirovecii pneumonia (PJP, n = 30), candidemia (n = 30), and invasive pulmonary aspergillosis (IPA, n = 30), 30 patients colonized by P. jirovecii, and 70 healthy controls (women followed-up during pregnancy) were analyzed retrospectively. STAT and FA assays were performed according to manufacturer's instructions. The overall level of agreement between two Fungitell assays was excellent (weighted Cohen's kappa = 0.87 [95% CI: 0.80–0.94]). BDG rates were significantly higher in candidemia, IPA and PJP than in healthy controls (P < .0001). BDG rates were also significantly higher in PJP than for P. jirovecii colonization (P < .0001). Area Under the Curve (AUC) of STAT (0.92) was higher than FA (0.86) for IFD diagnosis. Using optimized positivity thresholds for IFD diagnosis (94 pg/ml and 0.86 for FA and STAT, respectively), sensitivities and specificities were 78.9% and 90% for FA and 85.6% and 88.6% for STAT, respectively. AUC of FA and STAT were higher for PJP diagnosis than for candidemia and IPA diagnosis. Compared to FA, STAT assay represents an interesting option for emergency IFD diagnosis and for small care centers.

Mothers experiencing depressive symptoms or gestational stress are at risk of developing maternal distress, which, in its most severe form, can progress to postpartum depression, profoundly affecting maternal well-being and infant care. Using a late-gestation restraint stress model, we investigated whether postpartum treatment of lactating dams with probiotic Limosilactobacillus reuteri (L. reuteri) could reverse stress-induced disruptions in maternal behavior and neurobiology. L. reuteri effectively improved maternal care, and restored reactivity to pup separation in stressed dams. Postpartum L. reuteri also corrected corticosterone-oxytocin imbalances in plasma, normalized hypothalamic oxytocin levels, the unglycosylated and glycosylated oxytocin receptor isoforms and it regulated the ratio of precursor to mature brain-derived neurotrophic factor (BDNF). Additionally, L. reuteri restored gut microbiota balance, increasing Lactobacillus spp. while reducing pathogenic strains in fecal pellets of stressed dams during lactation and post-weaning, correlating with both maternal oxytocin and corticosterone plasma levels. This study is the first to demonstrate the therapeutic efficacy of a probiotic and its molecular support in counteracting the adverse effects of gestational stress on maternal care through brain-gut axis mechanisms. These findings support probiotic-based interventions as safe, complementary preventive strategy for improving maternal health in conditions involving impaired maternal care and microbiota dysbiosis.

Nocardiosis is a serious infection in immunosuppressed patients, especially transplant recipients. The slow-growing phenotype of the bacterium and the variety of symptoms complicate diagnosis and delay antimicrobial therapy, resulting in high mortality rates despite effective treatments. A further complication is that some nocardiosis patients test positive in fungal diagnostics that detect (1,3)-β-D-glucan (the Fungitell assay), but the basis for this cross-reactivity remains unknown. We demonstrate that nocardial cell wall arabinogalactan is a cryptic antigen responsible for cross-reactivity in the Fungitell assay and that this antigen is revealed in vivo following bacterial cell lysis. We further show that the reactivity results from a β-glucose substitution of the galactan domain, a modification specific to nocardia, and identify the optimal antigen as a tetramer of the trisaccharide repeating unit. By providing structural evidence for Fungitell cross-reactivity during nocardiosis, this work paves the way for developing specific diagnostic tools that are currently lacking.

Background This systematic review and meta-analysis aimed to examine the performance of polymerase chain reaction (PCR) assays for diagnosing mucormycosis. Methods A standardised search was conducted from conception to December 3rd 2024 using PubMed, Embase, Global Health, and Cochrane library. Original studies that used PCR-based methods on any human specimen to diagnose mucormycosis were analysed for eligibility. Using a bivariate meta-analysis, the diagnostic performance of PCR was examined against the European Organisation for Research and Treatment of Cancer-Mycoses Study Group Education and Research Consortium 2020 (EORTC-MSGERC) definitions of proven and probable invasive mould disease, which was modified to include all patients at risk of mucormycosis. The study protocol was registered on the PROSPERO database (CRD42023478667). Findings Of 4855 articles, a total of 30 met inclusion criteria, including 5920 PCR reactions on 5147 non-duplicate specimens from 819 cases of proven/probable mucormycosis and 4266 patients who did not meet the EORTCMSGERC 2020 criteria. According to specimen type, sensitivity of PCR varied (p < 0.001) whereas specificity was similar (p = 0.662). Bronchoalveolar lavage fluid offered the highest sensitivity of 97.5% (95% CI 83.7-99.7%), specificity of 95.8% (95% CI 89.6-98.4%), positive likelihood ratio (LR+) of 23.5, and negative likelihood ratio (LR-) of 0.03. Tissue provided sensitivity of 86.4% (95% CI 78.9-91.5%), specificity of 90.6% (95% CI 78.1-96.3%), LR+ of 9.2, and LR- of 0.15. Blood provided reduced sensitivity of 81.6% (95% CI 70.1-89.4%), specificity of 95.5% (95% CI 87.4-98.5%), DOR of 95, LR+ of 18.3, and LR- of 0.19. Formalin-fixed paraffin- embedded specimens yielded the lowest sensitivity of 73.0% (95% CI 61.0-82.3%), highest specificity of 96.4% (CI 95% 87.5-99.0%), LR+ of 20.2, and LR- of 0.28. The covariates best explaining heterogeneity of the overall analysis were specimen type, study design (cohort versus case-control) and disease prevalence while patient population (COVID-19 versus other) and PCR (conventional versus quantitative) had less impact on heterogeneity. Interpretation This meta-analysis confirms the high performance of PCR for diagnosing mucormycosis and supports the instatement of PCR detection of free-DNA in blood, BALF and tissue into future updated definitions and diagnostic guidelines for mucormycosis. Copyright Crown Copyright (c) 2025 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

This study explores the adaptation of organic acid-based deep eutectic solvents (OA-DESs) as effective antimicrobial agents. Having already demonstrated their efficacy against planktonic bacteria in our previous research, herein we investigate their impact on more complex microbial forms, including biofilms, persister cells, and fungi (both human pathogenic and phytopathogenic). Our experiments revealed that OA-DESs effectively eradicated methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli in the biofilms, inducing significant morphological changes. A three-log-unit reduction was observed for most OA-DESs at concentrations below 1% (v/v), a remarkable achievement for this class of materials. Additionally, with only one exception, OA-DESs did not promote persister cells formation, underscoring their potential for complete eradication of biofilm-enveloped bacteria. In another part of our study, OA-DESs were compared to conventional DESs against Candida albicans, Candida auris, and Aspergillus fumigatus. Results showed that while individual DES components exhibited minimal activity, their combination effectively inhibited fungal growth and induced substantial morphological changes. Lastly, OA-DESs were tested against the phytopathogens Zymoseptoria tritici and Venturia inaequalis. Though their activity was less pronounced compared to pathogenic strains, most OA-DESs inhibited the growth of both fungi at the highest tested concentrations. Despite the broad scope of this investigation, we believe this work provides valuable insights into the potential of DESs as antimicrobial agents, offering a strong foundation for future research and innovation in this field.

OBJECTIVES:Intestinal colonization with multidrug-resistant Enterobacterales (MDRE-IC) increases the risk of MDRE bloodstream infection (BSI). However, its impact on the overall risk of nosocomial Enterobacterales bloodstream infections (nE-BSIs) remains unclear. This study aimed to determine this risk and identify associated factors in hospitalized patients. DESIGN:This retrospective cohort study at a 3200-bed tertiary institution including patients hospitalized in 2019 who underwent MDRE rectal swab (RS) screening. Inclusion criteria were age ≥18 years, first RS in 2019, follow-up ≥7 days, and Enterobacterales BSIs >48 hours after RS. The primary outcome was the first nE-BSI during the follow-up period, analyzed using a Cox model. RESULTS:Among 7006 patients, 817 (11.9%) had MDRE-IC. Most were male and primarily hospitalized in acute wards. nE-BSIs occurred in 433 (6.1%) patients and were more frequent in patients with MDRE-IC than the non-colonized group (adjusted hazard ratio [aHR] = 1.78, 95% confidence interval [CI]: 1.40-2.26). Intestinal colonization with extended-spectrum β-lactamase-producing and carbapenemase-resistant Enterobacterales showed similar risks for Enterobacterales BSI onset: aHR = 1.73 (95% CI: 1.33-2.24) and aHR = 2.02 (95% CI: 1.27-3.22), respectively. CONCLUSIONS:In hospitalized patients, MDRE-IC is associated with a higher rate of nE-BSI than those without MDRE-IC, underscoring the urgent need for improved infection prevention and control measures, as well as optimized antibiotic use to mitigate this risk.

BACKGROUND:Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy syndrome is a rare disease caused by biallelic mutations of the AIRE gene, usually presenting with the triad hypoparathyroidism-adrenal failure-chronic mucocutaneous candidiasis (CMC) and nonendocrine manifestations. The aim of this study was to determine the molecular profile of the AIRE gene, the prevalence of rare manifestations, and to characterize immunological disturbances in a French cohort. PATIENTS AND METHODS:A national, multicenter prospective observational study to collect genetic, clinical, biological, and immunological data (NCT03751683). RESULTS:Twenty-five patients (23 families) were enrolled. Eleven distinct AIRE variants were identified, 2 of which were not previously reported: an intronic variant, c.653-70G > A, and a c.1066del (p.Arg356GlyfsX22) variant (exon 9). The most common was the Finnish variant c.769C > T (16 alleles), followed by the variant c.967_979del13 (15 alleles), which seemed associated with a less severe phenotype. Seventeen out of 25 patients were homozygote. The median number of clinical manifestations was 7; 19/25 patients presented with the hypoparathyroidism-adrenal failure-CMC triad, 8/13 showed pulmonary involvement, 20/25 had ectodermal dystrophy, 8/25 had malabsorption, and 6/23 had asplenia. Fifteen out of 19 patients had natural killer cell lymphopenia with an increase in CD4+ and CD8+ T lymphocytes and an age-dependent alteration of B lymphocyte homeostasis compared with matched controls (P < .001), related to the severity of the disease. All tested sera (n = 18) were positive for anti-interferon-α, 15/18 for anti-IL-22 antibodies, and 13/18 for anti-IL-17F antibodies, without clear phenotypic correlation other than with CMC. CONCLUSION:This first prospective cohort showed a high AIRE genotype variability, with 2 new gene variants. The prevalence of potentially life-threatening nonendocrine manifestations was higher with systematic screening. These manifestations could, along with age-dependent B-cell lymphopenia, contribute to disease severity. Systematic screening for all the manifestations of the syndrome would allow earlier diagnosis, supporting vaccination and targeted therapeutic approaches.

Candida albicans is an immunogen for anti-Saccharomyces cerevisiae antibodies (ASCA), a serological marker of Crohn's disease. ASCA has also been reported in other autoimmune diseases, including coeliac disease (CeD). A strong antibody response against Hwp1, a protein associated with invasive hyphal form of C. albicans which presents peptide sequence homologies with gliadin, has also been described in CeD. This observation supports the hypothesis that C. albicans hyphal transition in C. albicans may trigger CeD onset through a mechanism of molecular/antigenic mimicry. In this study, we assessed whether the anti-C. albicans oligomannose and anti-Hwp1 protein responses may be linked despite their different pathophysiological significance. The measurement of ASCA levels in a cohort of patients involved in our previous Hwp1 study showed a significant correlation between the two biomarkers. This new observation further reinforces the link between C. albicans and CeD.

Introduction: In France, both students from medicine and pharmacy background can have access to the residency in laboratory medicine (LM). The current curriculum of LM residency includes an early choice of option after the first two years of residency, which subsequently guides the rest of the training. This study aimed to analyze these choice and motivational factors, since its implementation in 2017. Materials and methods: A national survey was conducted among LM residents and former residents who underwent the early option choice process. A questionnaire was developed and sent to residents via Google Forms. Several groups of items corresponding to potential motivational factors were included and rated on a 5 -point Likert scale. A psychometric analysis allowed to identify the main motivational factors. Results: A total of 178 responses from 24 residency regions were recorded. The median age was 28 years, with a slight female predominance (52%), and three-quarters of the participants had a pharmacy training background. The "hematology and immunology" option was the most chosen (35%). The psychometric analysis enabled to identify 7 motivational factors, and the most important is the training during the residency, which weights approximately 21 % in the choice. Several associations have been observed between the motivational factors and the background training, origin, the chosen option and the planned career. Conclusion: Several factors influence the choice of early option among LM residents, and some of these factors are associated with the background training, origin, chosen option and planned career.

IntroductionEn 2022 l'Organisation Mondiale de la Santé a mis à jour ses recommandations concernant le traitement de masse ou ciblé de la schistosomose en région de haute endémicité. Dans notre PASS, de 2014 à 2022, le diagnostic était exclusivement orienté par la clinique (DOC) notamment en présence de diarrhées ou d'une hématurie à l'anamnèse chez le migrant primo-arrivant (MPA) d'Afrique Sub-Saharienne (ASS). Cependant, les formes asymptomatiques sont fréquentes exposant aux complications potentielles d'une schistosomose chronique. Aussi, depuis début 2023, nous avons modifié nos pratiques en optant pour une stratégie de dépistage systématique du MPA d'ASS. L'objectif du projet est d'évaluer rétrospectivement ces deux stratégies.Matériels et méthodesUne analyse rétrospective des cas de schistosomose en contexte de DOC a été réalisée sur la période de 2014 à 2022. Le DOC était complété par une recherche parasitologique d'oeufs dans les selles (EPS) ou les urines (EPU). Depuis 2023, indépendamment des données cliniques ou de l'anamnèse, un dépistage sérologique systématique associant l'ELISA et l'Immunoblot chez le patient MPA d'ASS a été réalisé. En cas de sérologie positive, un examen microscopique, pour identification des oeufs de Schistosoma sp, dans les EPU et/ou EPS était réalisé et un traitement par praziquentel (40mg/kg) était initié suivi d'un contrôle parasitologique post thérapeutique.RésultatsDurant la période 2014 à 2022, le DOC a permis de déceler 10/78 cas de Schistosoma haematobium (Sh) dans les EPU et 1/78 cas à S. mansoni (Sm) dans l'EPS. L'âge moyen était de 26 ans et le sex-ratio de 5.5/1. Depuis 2023, le dépistage systématique sérologique a été réalisé chez 83 patients dont 25 était positif. Parmi ces 25 patients, les EPU et EPS ont permis de confirmer 4 cas à S. h dans les EPU et 2 cas de S. m dont 1 cas à l'EPS et 1 cas EPU. Ce dernier cas, présentant une espèce hybride S. haematobium/S. mansoni confirmée par séquençage. Les 83 patients étaient tous originaires d'Afrique de l'Ouest avec un âge médian de 25 ans et un sexe ratio de 2.19/1. Le traitement antibilharzien a pu être prescrit chez la majorité des patients. Nous détaillerons ultérieurement les modalités de confirmation du diagnostic et du maintien dans le circuit de soins dans une PASS.ConclusionLe nombre de cas de schistosomose par dépistage systématique en 2023 est supérieur à celui de la stratégie DOC. Ce résultat conforte l'importance du « test & treat » dès l'arrivée du MPA d'ASS dans le pays hôte. Notre étude montre qu'un dépistage sérologique couplé à une documentation parasitologique systématique sont essentiels chez les MPA d'ASS. De nouvelles techniques de dépistage, plus sensibles et rapides, telle que la PCR serait une bonne alternative aux techniques sérologiques notamment pour réduire les délais de rendu des résultats. Notre objectif à court terme est d'implémenter cette stratégie de dépistage systématique.Aucun lien d'intérêt