Vaccination against Streptococcus pneumoniae in high-risk patients is crucial and hospitalization is a valuable opportunity. Adult patients hospitalized (>48 hours) for various infectious conditions and eligible for 13-valent pneumococcal conjugate vaccination from April 2021 to 2023 were included. The primary endpoint was the vaccine response rate (VRR) at least one month after vaccination. Of the 725 potentially eligible patients, 143 were included in the study. The most common comorbidities were diabetes mellitus (47%) and chronic cardiovascular disease (42%). VRR was acceptable at 46%, with a lower geometric mean concentration (GMC) of IgG in non-responders than in responders (1.27 µg/mL vs. 9.49 µg/mL, p < 0.001). In the multivariate analysis, the strongest negative predictor of VRR was a Charlson score of >3 (OR: 0.23 [0.06-0.81], p = 0.022). Vaccination within 48 hours after apyrexia (OR: 6.25 [1.85-20], p = 0.004) and the presence of diabetes (OR: 2.70 [1.05-7.14], p = 0.039) were independently associated with a better VRR. Hospitalization for acute infection should not be viewed as a barrier to vaccination but as an opportunity for optimized pneumococcal prevention after a short delay of apyrexia and should not be routinely postponed.

Introduction. - Tuberculous otomastoiditis is a rare and serious infection that most often occurs in association with pulmonary involvement. It is easy to diagnose when the two pathologies are associated and isolated. We herein report the case of a patient initially hospitalized for Pseudomonas aeruginosa necrotising otitis externa (NOE), which delayed the diagnosis of tuberculous otomastoiditis. Observation. - The 50-year-old patient was hospitalized for NOE and concurrently presented with pulmonary tuberculosis. NOE was associated with temporal bone lysis with carotid canal involvement. Despite appropriate treatment, NOE evolution was unfavourable. Two months later, the patient underwent a mastoidectomy to evacuate a mastoid abscess. In a deep tissue sample, tuberculosis complex was detected by PCR assay. For 12 months, the patient underwent for pulmonary and osseous tuberculosis. While the clinical course was favourable but deafness occurred subsequently. Conclusion. - An association of P. aeruginosa NOE and tuberculous otomastoiditis is a highly exceptional event. (c) 2024 SPLF. Published by Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Introduction L’otomastoïdite tuberculeuse est une infection rare et grave survenant le plus souvent en association avec une atteinte pulmonaire. Le diagnostic est facile lorsque les deux atteintes sont associées et isolées. Nous rapportons le cas d’un patient initialement hospitalisé pour une authentique otite maligne externe (OME) à Pseudomonas aeruginosa ce qui a retardé le diagnostic d’otomastoïdite tuberculeuse. Observation Nous rapportons le cas d’un patient de 50 ans hospitalisé pour une OME et qui présentait concomitamment une tuberculose pulmonaire. L’OME était associée à une lyse de l’os temporal avec atteinte du canal carotidien. Malgré un traitement adapté, l’évolution de l’OME n’était pas favorable. Le patient bénéficiait deux mois plus tard d’une mastoïdectomie pour mise à plat d’une abcédation mastoïdienne. La PCR du complexe tuberculosis était positive au niveau du prélèvement profond. Le patient a été traité durant 12 mois pour cette tuberculose pulmonaire et osseuse. L’évolution était favorable mais au prix d’une surdité séquellaire. Conclusion L’association d’une OME à pyocyanique et d’une otomastoïdite tuberculeuse est exceptionnelle.

The data that support the findings of this study are available from the corresponding author upon reasonable request.

We describe a rare case of severe disseminated monkeypox (MPox) virus infection complicated by peritonitis in a 44-year-old man living with well-controlled HIV. The patient was successfully treated with tecovirimat without requiring surgery. MPox should be considered in the differential diagnosis of non-bacterial peritonitis in patients at risk of infection.

La pandémie Sars-Cov2 a impliqué en 1ère ligne les SMIT. L'oxygénothérapie à haut débit nasal humidifiée (OHDN) est apparue comme une alternative à la ventilation mécanique (VM). La saturation des capacités de réanimation a imposé des ressources hors réanimation pour des patients Covid-19 critiques mono-défaillants respiratoires ne relevant pas de la VM: les SI au sein des SMIT, existants ou créés, ont été une des réponses proposées. Enfin, le décret soins critiques de 2022 pose la question de la pérennité hors pandémie des SI-SMIT. Nous rapportons le retex de l'ouverture d'un SI-SMIT en étroite collaboration avec la réanimation pendant la pandémie et les perspectives en période post-pandémie Etudes en 3 temps: 1. Cohorte rétrospective sur 6 mois des patients hospitalisés dans un SI-SMIT, ouvert de novo pour prendre en charge des pneumonies COVID-19. Ont été évalués: nombre de jours.patients, sévérité et critères d'oxygénation. Un questionnaire a évalué la formation et le ressenti des soignants impliqués dans le SI-SMIT. 2. Enquête nationale par questionnaire électronique sur l'utilisation de l'OHD en SMIT et le recours au SI-SMIT. 3. Cohorte rétrospective sur 2 mois des patients en SI-SMIT en dehors de la période pandémique Etude 1: Huit lits SI Covid-19 ont été ouverts au sein du SMIT en lien avec la réanimation. Sur le 1er semestre 2021, 224 patients ont réalisé au moins un séjour, 32 deux séjours soit un total 938 jours.patient. Les admissions sont issues de médecine ou urgences (n=177, 79%) ou de réanimation (n=48, 21 %). Le score IGS2 médian était à 30 et PaO2/FiO2 à l'admission à 126, avec corticoïdes (99%), tocilizumab (59%), OHDN (97%) et décubitus ventral vigile (55%). La DMS était de 4,5 jours et le taux de létalité de 9% (n=16). Parmi les 54 questionnaires-soignants, 25 (46%) IDE, 12 (22%) AS, 17 (32%) interne ou médecin. Dix (19%) ont exprimé un manque de formation ou d'encadrement. Le délai de maitrise de l'OHDN et autres techniques de SI était ≤ 1 semaine. Quarante-trois (80%) soignants estimaient positive l'ouverture du SI-SMIT en terme de nouvelles compétences et de progression. Etude 2: Parmi les 64 services ayant répondu (soit 85% de réponses), 5 disposaient déjà de SI sous la responsabilité d'infectiologues avant la pandémie et 7 services ont ouvert une unité de SI-SMIT. Concernant l'utilisation de l'OHD, 34 (53%) des services y ont eu recours et 21 (33%) étaient favorables à la poursuite ou mise en place après la pandémie. Etude 3: le maintien de lits de SI-SMIT après la pandémie permet l'admission de patients pour 1/3 des urgences, 1/3 de médecine et 1/3 de réanimation, d'âge médian 67 ans, avec un IGS2 sans l'âge à 24 et un SOFA médian à 4. La DMS est de 4,5 jours et le taux d'occupation de 85% Notre travail démontre l'apport d'une structure de SI-SMIT lors de la pandémie Sars-Cov2, évalue la réponses des SMIT en France et l'intérêt du maintien de ce type de structure hors pandémie. Dans la perspective des futures pandémies que les évolutions climatiques rendent inéluctables, la pérennité de ces structures est un atout pour le système de santé Aucun lien d'intérêt

Abstract Objectives We aimed to evaluate the impact of an uninterrupted workflow regarding blood cultures on turnaround time and antibiotic prescription. Methods Monomicrobial episodes of bacteremia were retrospectively evaluated before and after a continuous 24/7 workflow was implemented in our clinical microbiology laboratory (pre- and post-intervention periods; PREIP and POSTIP). Primary outcome was the time from specimen collection to the first change in antibiotic therapy. Secondary outcomes included the time from specimen collection to effective antibiotic therapy and to antibiotic susceptibility testing results (or turnaround time), as well as hospital length of stay and all-cause mortality at 30 days. Results A total of 548 episodes of bacteremia were included in the final analysis. There was no difference in PREIP and POSTIP regarding patient characteristics and causative bacteria. In POSTIP, the mean time to the first change in antibiotic therapy was reduced by 10.4 h (p<0.001). The time to effective antibiotic therapy and the turnaround time were respectively reduced by 4.8 h (p<0.001) and 5.1 h (p=0.006) in POSTIP. There was no difference in mean hospital length of stay or mortality between the two groups. Conclusions Around the clock processing of blood cultures allows for a reduction in turnaround time, which in turn reduces the delay until effective antibiotic therapy prescription.

Background: One of the main symptoms of COVID-19 is hyposmia or even anosmia. Olfactory identification is most often affected. In addition, some cognitive disorders tend to appear following the infection, particularly regarding executive functions, attention, and memory. Olfaction, and especially olfactory identification, is related to semantic memory which manages general knowledge about the world. The main objective of this study was to determine whether semantic memory is impaired in case of persistent post COVID-19 olfactory disorders. Methods: 84 patients (average age of 42.8 ± 13.6 years) with post COVID-19 olfactory loss were included after consulting to the ENT department. The clinical evaluation was carried out with the Pyramid and Palm Tree Test, the word-retrieval task from the Grémots, the Sniffin’ Sticks Test and the Computerised Olfactory Test for the Diagnosis of Alzheimer’s Disease. Results: Semantic memory was impaired in 20% (n = 17) of patients, especially in the 19–39 age-group. The olfactory threshold was only significantly correlated with the semantic memory scores. Conclusions: Similar to all cognitive disorders, semantic disorders can have a negative impact on quality of life if left untreated. It is essential to carry out specific assessments of post COVID-19 patients to accurately determine their disorders and to put in place the best possible rehabilitation, such as speech and language therapy, to avoid quality-of-life impairment.

Kidney transplant (KT) recipients are at increased risk of developing severe forms of COVID-19. Little is known about the immunological mechanisms underlying disease severity in these patients receiving T-cell targeting immunosuppressive drugs. We investigated the relationship between T cell responsiveness at the beginning of the infection and the risk of subsequent progression to respiratory failure. We performed a multicentric prospective study in KT recipients with a positive RT-PCR COVID-19 test and only mild symptoms at inclusion. Blood samples were collected at baseline in a cell culture system containing T cell stimuli. We assessed T cell responsiveness by computing the ratio between the levels of Th1, Th2, Th17 and Treg cytokines produced after polyclonal stimulation and the number of blood lymphocytes. We then used an unsupervised classification approach to stratify patients into low and high T cell responders and a penalized logistic regression to evaluate the association between T cell responsiveness and progression to severe pneumonia. Forty-five patients were included. All patients who progressed to severe pneumonia (24.4%, n = 11) were low T cell responders at baseline (p = 0.01). In multivariate analysis, low T cell responsiveness at baseline was the main risk factor for subsequent progression to severe pneumonia. This study provides novel insights into the mechanisms underlying COVID-19 severity in organ transplant recipients and data of interest to clinicians managing immunosuppressive drugs in these patients.

(1) Background: Persistent post-viral olfactory disorders (PPVOD) are estimated at 30% of patients one year after COVID-19 infection. No treatment is, to date, significantly effective on PPVOD with the exception of olfactory training (OT). The main objective of this work was to evaluate OT efficiency on post-COVID-19 PPVOD. (2) Methods: Consecutive patients consulting to the ENT department with post-COVID-19 PPVOD were included after completing clinical examination, the complete Sniffin’ Stick Test (TDI), the short version of the Questionnaire of olfactory disorders and the SF-36. Patients were trained to practice a self-olfactory training with a dedicated olfactory training kit twice a day for 6 months before returning to undergo the same assessments. (3) Results: Forty-three patients were included and performed 3.5 months of OT in average. We observed a significant TDI score improvement, increasing from 24.7 (±8.9) before the OT to 30.9 (±9.8) (p < 0.001). Based on normative data, a significant increase in the number of normosmic participants was observed only for the threshold values (p < 0.001). Specific and general olfaction-related quality of life improved after the OT. (4) Conclusions: Olfactory function appeared to improve only in peripheral aspects of post-COVID-19 PPVOD after OT. Future controlled studies must be performed to confirm the OT role and justify new therapeutic strategies that may focus on the central aspects of post-COVID-19 PPVOD.

Malaria is still an endemic disease in Africa, with many imported cases in Europe. The standard treatment is intravenous artesunate for severe malaria and oral artemisinin-based combination therapy (ACT) for uncomplicated malaria. Delayed hemolytic anemia (DHA) after intravenous artesunate has been extensively described, and guidelines recommend biological monitoring until 1 month after the end of the treatment. A link with an autoimmune process is still unsure. Nevertheless, cases with positive direct antiglobulin test (DAT) have been reported. Conversely, DHA is not recognized as an adverse effect of oral ACT. Previously, only few cases of DHA occurring after oral ACT without intravenous artesunate administration have been reported. We report the case of a 42-year-old man returning from Togo. He was treated with dihydroartemisinin/piperaquine combination for uncomplicated Plasmodium falciparum malaria, with low parasitemia. Nine days after the end of the treatment, the patient developed hemolytic anemia with positive DAT. Eventually, the patient recovered after corticotherapy. After excluding common causes of autoimmune hemolytic anemia, we considered that dihydroartemisinin/piperaquine treatment was involved in this side effect.

ABSTRACTBackgroundPersistent post-viral olfactory disorders (PPVOD) are widely reported after a COVID-19 and estimate to 30% one year after infection. Parosmias are the main qualitative dysosmia associated with olfaction recovery. No treatment is, to date, significantly efficient on PPVOD except olfactory training (OT). The main objective of this work was to evaluate OT efficiency on post-COVID-19 PPVOD.MethodsConsecutive patients consulting to the ENT department with post-COVID-19 PPVOD were included after mainly clinical examination, the complete Sniffin’ Stick Test (TDI), the short version of the Questionnaire of olfactory disorders and the SF-36. Patients were trained to practice a self-olfactory training (professional manufactured olfactory training kit) twice a day for 6 months before coming back and undergo the same complete evaluation.ResultsForty-three patients were included and performed 3,5 months of OT in average. There was a significant improvement in the mean TDI score increasing from 24,7 (±8,9) before the OT to 30,9 (±9,8) (p<0,001). Parosmias increased significantly from 8 (18,6%) to 27 (62.8%) (p<0,001). Based on normative data divided by sex and age, a significant increase in the number of normosmic participants was only found for the Threshold values (p<0,001). Specific and general olfaction-related quality of life improved after the OT.ConclusionsOT seems to be efficient in post-COVID-19 PPVOD, probably on the peripheral regenerative part of the olfactory recovery. Future therapeutic strategies may focus on the central aspects of the post-COVID-19 PPVOD.

Recurrent cystitis (RC) has rarely been studied; its management varies and research on a holistic approach of these patients is scarce. We attempted to characterize patients suffering from RC and investigated their current care pathways, aiming to offer customized and autonomous management. In this paper, we present a descriptive, single-center, cross-sectional study of women presenting with RC at an infectious disease (ID) clinic. A questionnaire was developed and was completed by ID physicians during patient visits. From October 2016 to January 2019, 202 women were included (mean age 59 years). Sexual intercourse, stress and diarrhoea/digestive symptoms were reported as trigger factors by 35%, 34% and 19% of patients, respectively. A majority (54%) were at risk for complications and were those more exposed to inappropriate antibiotic prescriptions. In total, 56% of women suffered from more than 10 episodes/year and 48% suffered from relapses, mainly due to E. coli. Genitourinary syndrome of menopause (GSM) was a frequent complaint (74.5% of women). Fluoroquinolones and 3rd generation cephalosporins were prescribed in 38% and 30% of women, respectively. Most women wished for non-antimicrobial approaches and autonomy. Patients require comprehensive, tailored care in order to benefit from a broader range of treatment options in compliance with recommendations.

Background: Sudden olfactory loss is a major symptom of SARS-CoV-2 infection and has a negative impact on daily life quality. Almost 80% of disorders regress spontaneously. No precise characterization of the medium- and long-term olfactory symptoms has been carried out yet, apart from self-assessments. The main objective of this work was to characterize persistent smell disorders in this population. Methodology: Consecutive patients consulting to the ENT department with post-Covid19 olfactory loss were included. The clinical examination included an analog scale for the self-assessment of olfactory recovery), a nasofibroscopy, the Sniffin’ Stick Test and the short version of the Questionnaire of olfactory disorders. Results: Among the 34 patients included, based on the Sniffin’ Sticks Test, 29.4% (n=10) could be classified as normosmic, 55.9% (n=19) as hyposmic and 14.7% (n=5) as functional anosmic). Only olfactory identification impairment was significantly correlated with olfactory complaint and daily anxiety and annoyance related to lack of olfaction recovery. This identification disorder seemed to worsen over time. Conclusions: It is crucial to assess odor identification disorders in case of persistent olfactory complaints after COVID-19. It is fundamental to target this disorder, as it does not improve spontaneously and negatively impact quality of life.

Corynebacteria are rare causative agents of infective endocarditis. This is a reported case of a destructive aorto-mitral infective endocarditis caused by Arthrobacter woluwensis. Microbial identification was achieved by 16S rRNA polymerase chain reaction on valve tissue samples. Outcome was favorable after surgical valve replacement and 4-week antibiotic treatment.

La pneumonie est l'enjeu principal de l'infection à SARS-CoV-2. L'atteinte sévère concerne les patients oxygénoréquérants, et la forme sévère, les patients nécessitant un transfert en soins intensifs ou réanimation. De nombreuses études ont démontré l'efficacité de la corticothérapie chez les patients oxygénoréquérants, avec une diminution du taux de mortalité. On observe néanmoins des patients évoluant vers une atteinte critique, sans critère prédictif défini. La TDM thoracique joue désormais un rôle central dans le diagnostic et la prise en charge de la COVID-19, avec des atteintes spécifiques évoluant au cours de la maladie. L'objectif de cette étude était de définir l'utilité de la TDM thoracique au cours du traitement de la COVID-19, afin de rechercher un pattern radiologique prédictif de l'évolution clinique. Nous avons inclus les patients admis pour une pneumonie à SARS-CoV-2 sévère ou critique, traités par corticothérapie, ayant bénéficiés d'une TDM thoracique avant la corticothérapie (TDM pré-CTC) puis sous corticothérapie (TDM per-CTC), dans le centre hospitalier universitaire de Nice. Les données cliniques, biologiques et radiologiques des patients répondant aux critères d'inclusions étaient recueillis à partir des dossiers médicaux informatisés, du 26 mars au 30 décembre 2020. Le critère de jugement principal était l'analyse de l'évolution des atteintes parenchymateuses entre la TDM pré- et per-CTC, mise en relation avec l'évolution clinique. L'évolution clinique était définie par la cinétique des besoins en oxygène dans les 48 h suivant la TDM per-CTC. Les atteintes scanographiques étaient définies en pourcentage d'atteinte parenchymateuse de 4 patterns. L'analyse scanographique étaient réalisée de manière systématique en aveugle par deux radiologues. Au total, 29 patients répondaient à nos critères d'inclusion. La moyenne d'âge était de 65,5 ans, en majorité des hommes (83 %). Au total, 8 patients (28 %) s'aggravèrent sur le plan clinique avec une amélioration dans 75 % des cas des vaisseaux épaissis et du « crazy paving ». Parmi les 21 patients présentant une évolution clinique favorable, on constatait une aggravation dans 57 % des cas du verre dépoli et dans 52 % de la condensation. L'évolution de la pneumonie organisée (PO) était significativement corrélée à l'évolution clinique p = 0,0089 (odds ratio : 0,0882, intervalle de confiance à 95 % [0,0064 ; 0,7157]). En effet, 81 % des patients avec une évolution clinique favorable présentaient une diminution du pourcentage d'atteinte parenchymateuse de la PO. Tandis que 75 % des patients en aggravation clinique avaient, de manière concomitante, une aggravation du pourcentage d'atteinte parenchymateuse de la PO. Notre étude montre une cohérence entre l'évolution clinique et l'évolution de la PO pouvant faire de la TDM thoracique un outil de monitorage. La présence ou l'aggravation de la PO, après 4 jours de corticothérapie, serait prédictive d'une hypoxémie nécessitant une intensification ou une prolongation de la corticothérapie.

Abstract Objectives: The variant 20I/501Y.V1, associated to a higher risk of transmissibility, emerged in Nice city (South East of France, French Riviera) during January 2021. The pandemic has resumed late December 2020 in this aera. A high incidence rate together with a fast turn-over of the main circulating variants, provided us the opportunity to analyze modifications in clinical profile and outcome traits. Methods: Observational study in the University hospital of Nice from December 2020 to February 2021. We analyzed data of sequencing of SARS-CoV-2 from the sewage collector and PCR screening from all positive samples at the hospital. Then, we described the characteristics of all COVID-19 patients admitted in the emergency department (ED) (n=1247) and those hospitalized in the infectious diseases ward or ICU (n=232). Demographic data, clinical signs and severity were documented by the NEWS-2, SAPS-2 and SOFA scores were recorded and analyzed. Results: the UK-variant was absent in the area in December, then increasingly spread in January representing 59% of the PCR screening performed mid-February. The rate of patients over 65 years admitted to the ED decreased from 63% to 50% (p=0.001). The mean age of hospitalized patients in the infectious diseases ward decreased from 70.7 to 59.2 (p<0.001) while the proportion of patients without comorbidity increased from 16% to 42% (p=0.007). Neither the NEWS-2 score nor the main signs of clinical severity have changed over time. Conclusion: Spread of the UK-variant in the South East of France affects younger and healthier patients.

Background Post-COVID-19 Olfactory impairment has a negative impact on quality of life. The Sniffin Sticks test 12 items (SST-12) can be used in quick olfactory disorders screening. Its evaluation in a post-covid-19 situation was the main objective of this work. Methods All patient impaired with a post-COVID olfactory loss were included while consulting to the ENT department. The clinical examination included an olfaction recovery self-assessment (VAS), a nasofibroscopy, a quality of life (QoL) assessment, the complete Sniffin’ Sticks Test (SST), and the SST-12. Results Among the 54 patients included, 92% ( n = 50) were correctly screened as olfactory impaired by SST-12. We report excellent correlations between SST-12 and SST (rho (52) = 0.98, p < 0.001), QoL(rho (52) = 0.33 p = 0.016), or VAS (rho (52) = 0.49, p < 0.001) assessments. Conclusions SST-12 is a quick and reliable tool to screen large-scale population of post-COVID-19 olfactory impaired patients and could be used in a general daily clinical practice.

The variant 20I/501Y.V1, associated to a higher risk of transmissibility, emerged in Nice city (Southeast of France, French Riviera) during January 2021. The pandemic has resumed late December 2020 in this area. A high incidence rate together with a fast turn-over of the main circulating variants, provided us the opportunity to analyze modifications in clinical profile and outcome traits. We performed an observational study in the University hospital of Nice from December 2020 to February 2021. We analyzed data of sequencing of SARS-CoV-2 from the sewage collector and PCR screening from all positive samples at the hospital. Then, we described the characteristics of all COVID-19 patients admitted in the emergency department (ED) (n = 1247) and those hospitalized in the infectious diseases ward or ICU (n = 232). The UK-variant was absent in this area in December, then increasingly spread in January representing 59% of the PCR screening performed mid-February. The rate of patients over 65 years admitted to the ED decreased from 63 to 50% (p = 0.001). The mean age of hospitalized patients in the infectious diseases ward decreased from 70.7 to 59.2 (p < 0.001) while the proportion of patients without comorbidity increased from 16 to 42% (p = 0.007). Spread of the UK-variant in the Southeast of France affects younger and healthier patients.

Frontline health care workers (HCWs) have been particularly exposed to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) since the start of the pandemic but the clinical features and immune responses of those infected with SARS-CoV-2 have not been well described. In a prospective single center cohort study, we enrolled 196 frontline HCWs exposed to the SARS-Cov-2 and 60 patients with moderate and severe forms of the coronavirus disease 2019 (COVID-19). Serological tests and cytokines assay were performed to analyze SARS-CoV-2-specific humoral and cellular immunity. Of the 196 HCWs tested, 15% had specific antibodies against SARS-CoV-2 and 45% of seropositive HCWs were strictly asymptomatic. However, in comparison to moderate and severe forms, HCWs with mild or asymptomatic forms of COVID-19 showed lower specific IgA and IgG peaks, consistent with their mild symptoms, and a robust immune cellular response, illustrated by a high production of type I and II interferons. Further studies are needed to evaluate whether this interferon functional immune assay, routinely applicable, can be useful in predicting the risk of severe forms of COVID-19.