Les personnes migrantes récemment arrivées en France peuvent être atteintes de différentes parasitoses dont la prévalence reste élevée parmi celles originaires des zones d’endémie, confortant l’intérêt d’un bilan systématique. La présente synthèse de la littérature confirme la fréquence de certaines parasitoses quand elles font l’objet d’un dépistage systématique. Parmi elles, la strongyloïdose, la schistosomose et la giardiose sont les plus fréquemment retrouvées. D’autres parasitoses plus rares présentent également un intérêt de santé publique particulier. La maladie de Chagas concerne spécifiquement les personnes originaires d’Amérique du Sud et présente un enjeu de transmission mère-enfant. La loaose quant à elle, est une parasitose rare d’Afrique centrale forestière susceptible d’entraîner des effets indésirables graves en cas de traitement systématique par ivermectine. Enfin, même si des modélisations médico-économiques concluent à l’intérêt d’une approche par traitement systématique par albendazole ou praziquantel, aucune étude clinique n’a encore évalué ces stratégies en vie réelle.

BACKGROUND:Post-Artesunate delayed hemolysis (PADH) occurs in approximately 15 % of treated patients 2-3 weeks after artesunate administration. Identifying risk markers for PADH would help predict which patients are at higher risk. METHODS:In this prospective national cohort study conducted in a non-malaria endemic area from 2011 to 2016, a Cox proportional hazards model was used to assess the association between clinical and biological data available at Day 0 and the occurrence of PADH within 30 days of artesunate administration. RESULTS:In the analyzed population (n = 327), 49 PADH events occurred after a median time of 14 days (IQR, 13-17) after artesunate initiation. Higher initial parasitemia was associated with an increased risk of PADH, with a significant interaction found with patient origin. The cumulative probability of PADH event at Day 30 post-artesunate was 65 % (95 % confidence interval [CI], 44-79) for European patients vs. 14 % (95 % CI, 0-26) for those with recent African ancestry [RAA] when the initial parasitemia was >10 %. After adjustment for weight, history of malaria, initial hemoglobin, very severe malaria and residence in an endemic area, compared to recent African ancestry with initial parasitemia <4 %, the adjusted hazard ratio for PADH occurrence was 18.8 (95 % CI, 4-89) for Europeans and 4.77 (95 % CI, 0.8-29.2) for recent African ancestry with initial parasitemia >10 %. CONCLUSIONS:This study showed that initial parasitemia and patient origin were the main predictors of developing PADH, with the highest risk observed in Europeans with an initial parasitemia >10 %.

BACKGROUND:Hyperparasitemia (HP), defined as a parasitemia > 4%, is the most frequent severity criterion considered in adults with imported malaria. Isolated hyperparasitemia (iHP), accounting for 10-40% of cases, has a controversial prognostic significance. METHODS:Multicenter retrospective study including all adult patients with imported Plasmodium falciparum malaria and HP admitted to 16 hospitals in the Greater Paris area between 2018 and 2022 and reported to the National Reference Center. Amongst HP patients, iHP at hospital admission was identified by retrospective analysis of medical records to minimize classification bias. The primary endpoint was a composite outcome using the Desirability of Outcome Ranking (DOOR) method with three levels of decreasing desirability: hospital survival, absence of organ support requirement, shortest length of stay. Association between HP, iHP and outcomes was evaluated by negative binomial regression models. RESULTS:Of 355 patients enrolled with HP, 135 (38%) had iHP. iHP patients were predominantly male (55.6%), aged 41 (32-52.3) years and born in an endemic country (86.4%). Compared with patients with HP and additional severity criteria, iHP was independently associated with a lower risk of worse DOOR [RR 0.56, 95%CI (0.48-0.65)]. No deaths were recorded in the iHP population, and 2/135 (1.5%) patients required organ support. In the iHP population, immunosuppression [RR 1.65, 95%CI (1.16-2.37)] and parasitemia>10% [RR 1.57, 95%CI (1.01-2.24)] were independently associated with worse DOOR. Only 47 (34.8%) iHP patients were admitted to an ICU at diagnosis, and 40 (29.6%) were treated with oral therapy alone. CONCLUSION:In imported malaria in France, iHP was associated with a low risk of serious adverse outcomes overall. In patients with iHP, immunosuppression and parasitemia >10% were associated with an increased risk of adverse outcome, highlighting the importance of a close hospital monitoring.

Conidiobolomycosis is a rare tropical mycosis that is often difficult to diagnose and treat. METHOD:We describe here an imported case that highlights these issues. RESULTS:A 24-year-old HIV positive patient was diagnosed and treated for a conidiobolomycosis due to Conidiobolus coronatus. Imaging showed extensive facial invasion. Biopsy and fungal culture confirmed conidiobolomycosis, resistant to standard antifungals. Initial therapy with liposomal amphotericin B and itraconazole failed due to drug interactions. After adjusting treatment and performing surgery, the patient's condition improved. Despite high MICs, clinical response was favorable. He completed 14 months of itraconazole without recurrence four months post-treatment. Serial beta-D-glucan assays showed promise as a reliable biomarker for therapeutic monitoring. CONCLUSION:This case highlights the complex medicosurgical management of a rare imported tropical mycosis, the diagnostic aspects of conidiobolomycosis, and the promising potential benefit of beta-D-glucan for the management and follow-up of this severe tropical deep-sited mycosis.

BACKGROUND:The diagnostic and treatment approaches for schistosomiasis in individual patients, outside endemic areas, are not standardised. This study aimed to appraise the reference documents that the experts from the TropNet and GeoSentinel networks use in practice as guidance for the clinical management of their patients with (suspect) schistosomiasis. METHODS:We systematically appraised the following data from the referenced guidance documents: i) document type, ii) case definitions, iii) diagnostic techniques envisaged; iv) treatment recommendations; v) follow-up recommendations; vi) screening recommendations, and vii) symptom-based diagnostic suspicion. RESULTS:Twenty-two of the 30 responders (73.3 %) indicated 19 reference documents, three of which were WHO material not intended for individual clinical management. Only 4/19 (21.1 %) documents were national recommendations; no international guideline was indicated. Case definitions were explicitly presented in only one document (1/19; 5.3 %). Diagnostic tools were detailed in 11/16 (68.8 %) and follow-up guidance in 8/16 (50 %) documents. Treatment guidance was provided in 14/16 (87.5 %) documents. CONCLUSIONS:Heterogeneity in clinical guidance was evident, although with noticeable overlap at least for chronic schistosomiasis. This confirms the need to formalise case definitions, which should be used to design trials to rigorously assess diagnostic tools and treatment schemes, and eventually come to harmonization of clinical management guidance.

The diagnosis and treatment of schistosomiasis among migrants in nonendemic countries are still challenging. An online questionnaire was sent to adult and pediatric infectious disease specialists through the French infectious disease societies' mailing lists to assess attitudes and practices toward the disease. We included all individuals who responded to the online questionnaire but excluded from analysis residents and doctors with dual practices (adults and children) from the analysis. The questionnaire consisted of 19 questions about professional status, screening practices, diagnostic methods, treatment protocols, and follow-up. The response rate was 10.5% (n = 102/970); four respondents were excluded, including two medical residents and two respondents with dual practices. Adult and pediatric infectious disease specialists participated in the study. Serology was the most frequently used diagnostic method among asymptomatic patients. The preferred imaging examination was ultrasound, especially among pediatricians. Praziquantel treatment dose schemes were heterogeneous; 55 of 98 respondents prescribed more than one dose. Serology was still used by 23% (n = 23/98) of the respondents as a follow-up tool despite its irrelevance. The management of chronic schistosomiasis in nonendemic countries is heterogeneous even among infectious disease specialists. New guidelines need to consider the diversity of nosological frameworks.

Intra-abdominal and gastrointestinal mucormycosis are less frequent than rhino-orbito-cerebral and pulmonary mucormycosis, but highly lethal. Their diagnosis remains challenging due to the non-specific clinical presentation. We collected English-language cases of intra-abdominal and gastrointestinal mucormycosis in non-haematological and non-neonatal patients published up to October 2024. This review analysed the epidemiological, clinical, and therapeutic charts of 290 cases. A proportion of 53.4% were reported from India and the USA. The main predisposing conditions were diabetes, solid organ transplant, ICU, and corticosteroid treatment. The most common site was the stomach (53.8%). Gastrointestinal perforation, skin breakdown, and abdominal wall infection were sources of intra-abdominal localisation. The most common symptoms were abdominal pain, vomiting, and gastrointestinal bleeding. The diagnosis relied on histology (93.8%), mycology with microscopy and culture (38.8%), and molecular methods (9.9%). Mortality (52.9%) was lower when treatment was intravenous amphotericin B, combined or not with surgery. Prompt treatment, essential for a favourable outcome, relies on early suspicion and diagnosis. Gastrointestinal and intra-abdominal mucormycosis should also be suspected in patients admitted in ICU with ventilation/nasogastric tube and corticosteroids and those with abdominal trauma or surgery, presenting abdominal distension, pain, and GI bleeding. Mycological diagnosis including direct examination, culture and Mucorales qPCR on tissue should assist with rapid diagnosis and thus treatment.

We investigated whether baseline levels of biomarkers related to endotheliopathy, thromboinflammation, and fibrosis were associated with clinical outcomes in hospitalized COVID-19 patients. We analyzed the associations between baseline levels of 21 biomarkers and time to hospital discharge and change in NEWS-2 score in patients from DisCoVeRy trial. We fitted multivariate models adjusted for baseline ISARIC 4C score, disease severity, D-dimer values, and treatment regimen. Between March 22 and June 29, 2020, 603 participants were randomized; 454 had a sample collected at baseline and analyzed. The backward selection of multivariate models showed that higher baseline levels of soluble suppressor of tumorigenicity 2 (sST2) and nucleosomes were statistically associated with a lower chance of hospital discharge before day 29 (sST2: aHR 0.24, 95% CI [0.15-0.38], p < 10-9; nucleosomes: aHR 0.62, 95% CI [0.48-0.81], p < 10-3). Likewise, higher levels of baseline sST2 were statistically associated with lower changes in the NEWS-2 score between baseline and day 15 (adjusted beta 4.47, 95% CI [2.65-6.28], p < 10-5). Moreover, we evaluated sST2 involvement in a confirmation cohort (SARCODO study, 103 patients) and found that elevated baseline sST2 levels were significantly associated with lower rates of hospital discharge before day 29 and a higher model performance (AUC at day 29 of 92%) compared to models without sST2. sST2 emerged as an independent predictor of clinical outcomes in two large cohort of hospitalized COVID-19 patients, warranting further investigation to elucidate its role in disease progression and potential as a therapeutic target.

Campylobacter sp. is widely considered a leading causative agent of bacterial food-borne gastrointestinal illness. Discitis and endocarditis caused by Campylobacter spp. are extremely rare. We describe the case of a 94-year-old man who was admitted for recent lumbar pain, diarrhea, and fever. C. fetus and C. coli were identified by MALDI-TOF from blood and stool samples respectively. MRI of the spine showed L5–S1 discitis. Patient was treated with 6 weeks of amoxicillin with clinical and microbiological response until cardiac implantable electronic device (CIED) related endocarditis occurred four weeks after the end of the antibiotic treatment. He was treated with another 6 weeks amoxicillin regimen, with a favorable outcome after a 6-month follow-up. Enteric infection with Campylobacter spp. in a debilitated patient should raise the possibility of a co-infection with another more invasive species such as C. fetus, leading to systemic invasion. In case of Campylobacter fetus bacteremia, a search for endocarditis and spondylodiscitis is recommended even in the absence of specific clinical signs.

IntroductionL'artésunate intraveineux est le traitement de première intention du paludisme grave en France. La molécule est disponible via une autorisation temporaire d'utilisation nominative depuis mai 2011. Son utilisation est passée rapidement de 10% en 2012 à 86% en 2023. Les dérivés de l'artémisinine tuent plus vite et plus massivement les parasites dans les globules rouges (GR) que la quinine. La molécule est responsable d'un effet indésirable grave fréquent : une anémie retardée survenant après le traitement, la PADH. La survenue de la PADH peut être prédite par la mesure, entre le J3 et le J7, du taux d'hématies pittées, débarrassées par la rate du parasite mort, et remises en circulation. Nous avons développé et adapté une méthode de diagnostic en cytométrie en flux (CF) pour un usage médical. La technique est disponible comme un examen spécialisé de recours pour toutes les structures de soins en charge des patients.Matériels et méthodesles informations épidémiologiques et cliniques des cas graves sont déclarées sur le site sécurisé Voozanoo par les correspondants du CNR du paludisme. Les effets indésirables sont recueillis auprès du Centre de pharmacovigilance qui gère les déclarations de l'ATU. Les échantillons du J0 et du suivi (J3, J7, J14, J21 et J28) sont adressés au CNR du paludisme qui réalise la technique et rend le résultat dans le temps clinique. Cette méthode repose sur la détection d'hématies pittées par CF en ciblant une protéine parasitaire Ring Erythrocyte Surface Antigen (RESA) persistant dans les hématies pittées.RésultatsDans une première étude réalisée de 2011 à 2017 sur 1370 patients de 76 établissements hospitaliers, la mortalité était de 4,1%. Des EI hématologiques ont été signalés dans 43,3 % cas. La nécessité de recours à la transfusion sanguine a été rapporté dans 9,3% des cas. Dans un sous-groupe de patients, l'incidence de la PADH était de 42,8 % (n = 42/98). Plus fréquente chez les patients d'origine européenne (57,9 %) par rapport à ceux d'origine africaine (29,2 %). Pour la période 2018-2023, 1709 nouveaux patients de 129 structures hospitalières ont reçu de l'artésunate intraveineux en première intention. La mortalité était de 2%. Les EI comparables à la période précédente en première analyse. L'analyse en sous-groupe de l'incidence de la PADH et de sa prédiction par notre technique de CF montre que cette prédiction permet de cibler efficacement les patients les plus à risque de PADH. Les résultats consolidés seront disponible dans quelques semaines. Entre 2011 et 2023, aucun décès n'a été attribué à la PADH.ConclusionDans notre large cohorte, la PADH n'a pas été associée à des issues fatales ou à des séquelles. Elle ne remet pas en cause l'utilisation de la molécule dans cette indication. La mesure précoce des hématies pittées J3-J7 est utile pour cibler les patients les plus à risque de PADH et prévenir les conséquences d'une hémolyse parfois brutale et massive.Aucun lien d'intérêt

BackgroundPersons living with HIV (PWH) harbor an altered gut microbiome (higher abundance of Prevotella and lower abundance of Bacillota and Ruminococcus lineages) compared to non-infected individuals. Some of these alterations are linked to sexual preference and others to the HIV infection. The relationship between these lineages and metabolic alterations, often present in aging PWH, has been poorly investigated.MethodsIn this study, we compared fecal metagenomes of 25 antiretroviral-treatment (ART)-controlled PWH to three independent control groups of 25 non-infected matched individuals by means of univariate analyses and machine learning methods. Moreover, we used two external datasets to validate predictive models of PWH classification. Next, we searched for associations between clinical and biological metabolic parameters with taxonomic and functional microbiome profiles. Finally, we compare the gut microbiome in 7 PWH after a 17-week ART switch to raltegravir/maraviroc.ResultsThree major enterotypes (Prevotella, Bacteroides and Ruminococcaceae) were present in all groups. The first Prevotella enterotype was enriched in PWH, with several of characteristic lineages associated with poor metabolic profiles (low HDL and adiponectin, high insulin resistance (HOMA-IR)). Conversely butyrate-producing lineages were markedly depleted in PWH independently of sexual preference and were associated with a better metabolic profile (higher HDL and adiponectin and lower HOMA-IR). Accordingly with the worst metabolic status of PWH, butyrate production and amino-acid degradation modules were associated with high HDL and adiponectin and low HOMA-IR. Random Forest models trained to classify PWH vs. control on taxonomic abundances displayed high generalization performance on two external holdout datasets (ROC AUC of 80-82%). Finally, no significant alterations in microbiome composition were observed after switching to raltegravir/maraviroc.ConclusionHigh resolution metagenomic analyses revealed major differences in the gut microbiome of ART-controlled PWH when compared with three independent matched cohorts of controls. The observed marked insulin resistance could result both from enrichment in Prevotella lineages, and from the depletion in species producing butyrate and involved into amino-acid degradation, which depletion is linked with the HIV infection.

Terminology in schistosomiasis is not harmonised, generating misunderstanding in data interpretation and clinical descriptions. This study aimed to achieve consensus on definitions of clinical aspects of schistosomiasis in migrants and returning travellers. We applied the Delphi method. Experts from institutions affiliated with GeoSentinel and TropNet, identified through clinical and scientific criteria, were invited to participate. Five external reviewers revised and pilot-tested the statements. Statements focusing on the definitions of acute or chronic; possible, probable, or confirmed; active; and complicated schistosomiasis were managed through REDCap and replies managed in a blinded manner. Round 1 mapped the definitions used by experts; subsequent rounds were done to reach consensus, or quantify disagreement, on the proposed statements. Data were analysed with percentages, medians, and IQRs of a 5-point Likert scale. The study was terminated on the basis of consensus or stability-related and time-related criteria. 28 clinicians and scientists met the criteria for experts. 25 (89%) of 28 experts replied to Round 1, 18 (64%) of 28 to Round 2, 19 (68%) of 28 to Round 3, and 21 (75%) of 28 to at least two rounds. High-level consensus (79–100% agreement and IQRs ≤1) was reached for all definitions. Consensus definitions will foster harmonised scientific and clinical communication and support future research and development of management guidelines for schistosomiasis.

The prevalence of anti-tuberculosis related adverse cutaneous reactions is around 1%. The most frequent reaction is exanthema, then urticaria and drug rash with eosinophilia and systemic symptoms (DRESS). Sequential drug reintroduction helped identifying rapidly the main culprit drug with good outcome. Rifampicin and pyrazinamide were the two most culprit drugs. DRESS was attributable to ethambutol and rifampicin.

La tuberculose, maladie infectieuse curable par un traitement antibiotique adéquat, demeure un enjeu majeur de Santé Publique. Estimée à moins de 5% des cas de tuberculose en France, la TB mono-résistante à l'isoniazide est associée à des risques d'échec thérapeutique et de récidive. L'apparition d'effets indésirables des antituberculeux majeurs nécessite parfois le recours aux fluoroquinolones. Les tests de sensibilité phénotypiques et génotypiques aux antituberculeux majeurs ne sont pas toujours contributifs ou retardent par leur délai de résultat la mise sous traitement adapté. Sur la plateforme de sécurité microbiologique de niveau 3, nous réalisons sur les prélèvements ou cultures un nouveau test rapide Xpert MTB/XDR® (Cepheid) qui recherche en 90 min la résistance à l'isoniazide et aux antituberculeux de 2nde ligne dont les fluoroquinolones. Dans notre algorithme, ce test succède au test Xpert MTB/RIF Ultra® si la quantité d'ADN est suffisante et est mené en parallèle de l'antibiogramme en milieu liquide. L'objectif cette étude rétrospective multicentrique est d'évaluer la place de cette nouvelle PCR dans la prise en charge du patient tuberculeux. D'octobre à décembre 2022, 18 patients ont été inclus (10 tuberculoses pulmonaires, 8 extra-pulmonaires). Le test XDR a été contributif pour 16 patients (7 prélèvements et 9 cultures). Pour la sensibilité à l'isoniazide, 100% de concordance ont été observés entre le test XDR et les antibiogrammes. Le test XDR a permis de rechercher des mutations associées avec des résistances à l'isoniazide pour 4 tuberculoses extra-pulmonaires avec antibiogramme non contributif. Deux cas de mono-résistance à l'isoniazide ont été retrouvés et ont conduit à un changement de thérapie antituberculeuse. Des effets indésirables ont été observés chez 3 patients qui ont en moins de 24 heures bénéficier d'un relais de l'antituberculeux en cause par des fluoroquinolones. Le test XDR a permis une facilité et un gain de temps à la détection de la résistance à l'isoniazide et aux fluoroquinolones. Il a permis d'ajuster le traitement plus rapidement que ce soit en terme de résistance ou de tolérance. Toutefois, la complémentarité entre les tests génotypiques et phénotypiques reste essentielle. Aucun lien d'intérêt

Le paludisme est une urgence médicale qui tue une vingtaine de personnes chaque année en France. Les services d’urgences adultes et pédiatriques sont en première ligne pour son diagnostic ainsi que pour l’évaluation de la gravité des cas dont dépendent le choix du traitement initial et la décision finale d’orientation (traitement ambulatoire, admission en médecine, admission en réanimation). Intégrer le patient à sa sortie des urgences dans une filière de soins adaptée à son état clinique et à son contexte personnel et social est essentiel à la qualité des soins et à la sécurité du patient. Mais l’organisation adéquate du parcours clinique du patient au sein du service d’urgences est également essentielle. Nous présentons ici un rappel des principales difficultés diagnostiques et thérapeutiques du paludisme, et des outils d’aide au diagnostic et à la décision thérapeutique à mettre en place dans les services d’urgences afin d’améliorer la qualité et la sécurité des soins des patients.

BACKGROUND:The optimal duration of antimicrobial therapy for urinary tract infections (UTIs) in men remains controversial. METHODS:To compare 7 days to 14 days of total antibiotic treatment for febrile UTIs in men, this multicenter randomized, double-blind. placebo-controlled noninferiority trial enrolled 282 men from 27 centers in France. Men were eligible if they had a febrile UTI and urine culture showing a single uropathogen. Participants were treated with ofloxacin or a third-generation cephalosporin at day 1, then randomized at day 3-4 to either continue ofloxacin for 14 days total treatment, or for 7 days followed by placebo until day 14. The primary endpoint was treatment success, defined as a negative urine culture and the absence of fever and of subsequent antibiotic treatment between the end of treatment and 6 weeks after day 1. Secondary endpoints included recurrent UTI within weeks 6 and 12 after day 1, rectal carriage of antimicrobial-resistant Enterobacterales, and drug-related events. RESULTS:Two hundred forty participants were randomly assigned to receive antibiotic therapy for 7 days (115 participants) or 14 days (125 participants). In the intention-to-treat analysis, treatment success occurred in 64 participants (55.7%) in the 7-day group and in 97 participants (77.6%) in the 14-day group (risk difference, -21.9 [95% confidence interval, -33.3 to -10.1]), demonstrating inferiority. Adverse events during antibiotic therapy were reported in 4 participants in the 7-day arm and 7 in the 14-day arm. Rectal carriage of resistant Enterobacterales did not differ between both groups. CONCLUSIONS:A treatment with ofloxacin for 7 days was inferior to 14 days for febrile UTI in men and should therefore not be recommended. CLINICAL TRIALS REGISTRATION:NCT02424461; Eudra-CT: 2013-001647-32.

Malaria is a medical emergency that kills about 20 people annually in France. Adult and pediatric emergency departments are on the front line for its diagnosis and for evaluating the severity of the cases, which depends on the choice of the initial treatment and the final decision of orientation (ambulatory treatment, admission, admission in intensive care). Integrating the patient upon discharge from the emergency department into a care pathway adapted to their clinical condition and personal and social context is essential to the quality of care and patient safety. But the proper organization of the clinical patient pathway within the emergency department is also crucial. We present here a reminder of the main diagnostic and therapeutic difficulties and the diagnostic and therapeutic decision support tools to be implemented in the emergency department to improve the quality and safety of patient care.