Introduction: Ureaplasma species are common colonizers of the human genitourinary tract but can occasionally cause severe extragenital infections, particularly in immunocompromised individuals. Because of the rarity of these invasive infections, diagnosis can be challenging.Case report: A 67-year-old man with a history of central nervous system lymphoma treated with rituximab presented with hip pain, low-grade fever, and restricted mobility. His condition rapidly progressed to septic shock, requiring broad-spectrum antibiotics and surgical hip lavage. Conventional cultures of joint fluid and blood remained negative. Molecular testing eventually identified Ureaplasma urealyticum by PCR, leading to targeted antimicrobial therapy and subsequent clinical improvement.Conclusion: Although uncommon, Ureaplasma species should be considered in the differential diagnosis of bone and joint infections, particularly in immunocompromised patients with negative routine microbiological cultures. Molecular diagnostic methods, including 16S rRNA gene sequencing and species-specific PCR, play a pivotal role in establishing the diagnosis and guiding appropriate therapy.

INTRODUCTION:Post-neurosurgical brain abscesses are documented in approximately 9% of cases, with causative pathogens often linked to polymicrobial or nosocomial origins. CASE REPORT:We report the first case of post-neurosurgical Legionella pneumophila brain abscess in a 55-year-old woman with drug-resistant epilepsy. The abscess developed following stereo-electroencephalography and thermocoagulation procedures, manifesting as hemiparesis and vomiting. Diagnosis was confirmed via 16S rRNA PCR, antigen testing, and Buffered Charcoal Yeast Extract (BCYE) culture. Treatment with targeted antibiotics, including levofloxacin and rifampicin, led to a complete recovery without sequelae. Investigation identified the patient's home water system as the infection source. CONCLUSION:This case highlights the importance of molecular diagnostics and tailored therapy in managing rare brain abscesses.

Surgical site infections following spinal surgery (SSI-SS) are a major concern, leading to increased morbidity, prolonged hospital stays, and higher healthcare costs. This study aimed to analyze the epidemiology, microbiological characteristics, and treatment outcomes of SSI-SS at La Timone Hospital, Marseille, from 2016 to 2022. We conducted a retrospective cohort study of patients with microbiologically confirmed SSI-SS. Demographic data, bacterial pathogens, antimicrobial resistance profiles, and treatment outcomes were analyzed over a two-year follow-up period. Among 6,975 spinal surgery patients, 227 (3.3

Orthopedic prosthesis infection must be medically managed after appropriate microbiological documentation. While bacteria and fungi are acknowledged to be causative opportunistic pathogens in this situation, the potential role of methanogens in orthopedic prosthesis infections is still unknown. In a retrospective study, a total of 100 joint and bone samples collected from 25 patients were screened by specific PCR assays for the detection of methanogens. PCR-positive samples were observed by autofluorescence, electron microscopy and tentatively cultured under specific culture conditions. Methanogens were detected by quantitative PCR in 4/100 samples, in the presence of negative controls. Sequencing identified Methanobrevibacter oralis in two cases, Methanobrevibacter smithii in one case and Methanobrevibacter wolinii in one case. Microscopic methods confirmed molecular findings and bacterial culture yielded two strains of Staphylococcus aureus, one strain of Staphylococcus epidermidis and one strain of Proteus mirabilis. These unprecedented data highlight the presence of methanogens in joint and bone samples of patients also diagnosed with bacterial orthopedic prosthesis infection, questioning the role of methanogens as additional opportunistic co-pathogens in this situation.

Background Prognosis of herpetic encephalitis remains severe, with a high proportion of deaths and sequelae. Its treatment is based on acyclovir, but the precise and most effective modalities of this treatment are not established. The objective of this study was to determine them. Methods For this, we carried out a descriptive, retrospective, monocentric study, using the current coding database at Marseille University Hospitals. Cohort was intended to be exhaustive for the disease, from January 2000 to June 2019, including patients hospitalized in intensive care and conventional hospitalization sector. Patients (n = 76) included were at least 16 years of age and had a clinical presentation, cerebral Magnetic Resonance Imaging, and/or electroencephalogram abnormalities consistent with herpetic encephalitis confirmed by a positive HSV-PCR in the CSF. Clinical data and treatment, including the doses actually administered to the patient, were compared according to patient's outcome. Results The mortality rate was 12%, whereas 49% had complete recovery and 39% sequelae impeding independence. Poor outcome was statistically associated with persistence of confusion, aphasia, and impaired consciousness lasting more than 5 days, superinfection, status epilepticus, and length of stay in intensive care unit. A statistical decision tree, constructed using the Classification And Regression Tree model, to prioritize treatment management, showed two main factors that influence the outcome: the patient's weight, and the average daily acyclovir dose actually administered. Conclusion These results suggest to modify acyclovir management in herpetic encephalitis, for low-weight patients (< 79 kg) with a minimum dosage of 2550 mg/day (850 mg/ 8 h), when possible.

Pain sensitization leading to polyalgia can be observed during infectious diseases. The blood pressure cuff-evoked pain threshold (BPCEPT) has been used in previous studies as a screening tool for fibromyalgia. We aimed to use the BPCEPT as a screening test for detecting pain sensitization in patients suffering from infectious diseases. We also investigated whether specific factors were associated with pain sensitization. We performed a prospective comparative study including all patients of our infectious diseases center in a 1-year period. We created a positive control group of patients suffering from fibromyalgia and a negative control group of "apparently healthy" patients consulting for vaccination. The blood pressure (BP) cuff was inflated until the patient signaled that they experienced pain, and this pressure value was noted. A total of 2355 patients were included. The positive control group had significantly lower values of the BPCEPT than all other groups. Among hospitalized patients with infectious diseases, a low BPCEPT was significantly associated with high temperature (P < .0001), older age (P = .002), being a woman (P = .004), high serum glutamic-oxaloacetic transaminase (P = .007), and high C reactive protein levels (P = .02). Moreover, in multivariate analysis, respiratory infection, meningitis, urinary tract infection, febrile neutropenia, and Q fever were independently associated with a low BPCEPT. A significant negative dynamic correlation between the BPCEPT and temperature was also observed (P < .001). We demonstrated for the first time in a large sample of patients that the BPCEPT method can be used to detect pain susceptibility. We observed a significant dynamic correlation between pain sensitization and temperature. Additionally, pain sensitization was associated with some diseases, suggesting that they trigger pain sensitivity.

The etiological agent of COVID-19 SARS-CoV-2, is primarily a pulmonary-tropic coronavirus. Infection of alveolar pneumocytes by SARS-CoV-2 requires virus binding to the angiotensin I converting enzyme 2 (ACE2) monocarboxypeptidase. ACE2, present on the surface of many cell types, is known to be a regulator of blood pressure homeostasis through its ability to catalyze the proteolysis of Angiotensin II (Ang II) into Angiotensin-(1-7) [Ang-(1-7)]. We therefore hypothesized that SARS-CoV-2 could trigger variations of ACE2 expression and Ang II plasma concentration in SARS-CoV-2-infected patients. We report here, that circulating blood cells from COVID-19 patients express less ACE2 mRNA than cells from healthy volunteers. At the level of circulating cells, this ACE2 gene dysregulation mainly affects the monocytes, which also show a lower expression of membrane ACE2 protein. Moreover, soluble ACE2 (sACE2) plasma concentrations are lower in prolonged viral shedders than in healthy controls, while the concentration of sACE2 returns to normal levels in short viral shedders. In the plasma of prolonged viral shedders, we also found higher concentrations of Ang II and angiotensin I (Ang I). On the other hand, the plasma levels of Ang-(1-7) remains almost stable in prolonged viral shedders but seems insufficient to prevent the adverse effects of Ang II accumulation. Altogether, these data evidence that the SARS-CoV-2 may affect the expression of blood pressure regulators with possible harmful consequences on COVID-19 outcome.

BACKGROUND:We need an effective treatment to cure COVID-19 patients and to decrease virus carriage duration.METHODS:We conducted an uncontrolled, non-comparative, observational study in a cohort of 80 relatively mildly infected inpatients treated with a combination of hydroxychloroquine and azithromycin over a period of at least three days, with three main measurements: clinical outcome, contagiousness as assessed by PCR and culture, and length of stay in infectious disease unit (IDU).RESULTS:All patients improved clinically except one 86 year-old patient who died, and one 74 year-old patient still in intensive care. A rapid fall of nasopharyngeal viral load was noted, with 83% negative at Day7, and 93% at Day8. Virus cultures from patient respiratory samples were negative in 97.5% of patients at Day5. Consequently patients were able to be rapidly discharged from IDU with a mean length of stay of five days.CONCLUSION:We believe there is urgency to evaluate the effectiveness of this potentially-life saving therapeutic strategy at a larger scale, both to treat and cure patients at an early stage before irreversible severe respiratory complications take hold and to decrease duration of carriage and avoid the spread of the disease. Furthermore, the cost of treatment is negligible.

Background: In our institute in Marseille, France, we initiated early and massive screening for coronavirus disease 2019 (COVID-19). Hospitalization and early treatment with hydroxychloroquine and azithromycin (HCQ-AZ) was proposed for the positive cases. Methods: We retrospectively report the clinical management of 3,737 screened patients, including 3,119 (83.5%) treated with HCQ-AZ (200 mg of oral HCQ, three times daily for ten days and 500 mg of oral AZ on day 1 followed by 250 mg daily for the next four days, respectively) for at least three days and 618 (16.5%) patients treated with other regimen ("others"). Outcomes were death, transfer to the intensive care unit (ICU), >= 10 days of hospitalization and viral shedding. Results: The patients' mean age was 45 (sd 17) years, 45% were male, and the case fatality rate was 0.9%. We performed 2,065 low-dose computed tomography (CT) scans highlighting lung lesions in 592 of the 991 (59.7%) patients with minimal clinical symptoms (NEWS score = 0). A discrepancy between spontaneous dyspnoea, hypoxemia and lung lesions was observed. Clinical factors (age, comorbidities, NEWS-2 score), biological factors (lymphocytopenia; eosinopenia; decrease in blood zinc; and increase in D-dimers, lactate dehydrogenase, creatinine phosphokinase, troponin and C-reactive protein) and moderate and severe lesions detected in low-dose CT scans were associated with poor clinical outcome. Treatment with HCQ-AZ was associated with a decreased risk of transfer to ICU or death (Hazard ratio (HR) 0.18 0.11-0.27), decreased risk of hospitalization >= 10 days (odds ratios 95% CI 0.38 0.27-0.54) and shorter duration of viral shedding (time to negative PCR: HR 1.29 1.17-1.42). QTc prolongation (>60 ms) was observed in 25 patients (0.67%) leading to the cessation of treatment in 12 cases including 3 cases with QTc> 500 ms. No cases of torsade de pointe or sudden death were observed. Conclusion: Although this is a retrospective analysis, results suggest that early diagnosis, early isolation and early treatment of COVID-19 patients, with at least 3 days of HCQ-AZ lead to a significantly better clinical outcome and a faster viral load reduction than other treatments.

Background: In France, the combination hydroxychloroquine (HCQ) and azithromycin (AZ) is used in the treatment of COVID-19. Methods: We retrospectively report on 1061 SARS-CoV-2 positive tested patients treated for at least three days with the following regimen: HCQ (200 mg three times daily for ten days) + AZ (500 mg on day 1 followed by 250 mg daily for the next four days). Outcomes were death, clinical worsening (transfer to ICU, and 10 day hospitalization) and viral shedding persistence (> 10 days). Results: A total of 1061 patients were included in this analysis (46.4% male, mean age 43.6 years - range 14 -95 years). Good clinical outcome and virological cure were obtained in 973 patients within 10 days (91.7%). Prolonged viral carriage was observed in 47 patients (4.4%) and was associated to a higher viral load at diagnosis (p < .001) but viral culture was negative at day 10. All but one, were PCR-cleared at day 15. A poor clinical outcome (PClinO) was observed for 46 patients (4.3%) and 8 died (0.75%) (74 -95 years old). All deaths resulted from respiratory failure and not from cardiac toxicity. Five patients are still hospitalized (98.7% of patients cured so far). PClinO was associated with older age (OR 1.11), severity of illness at admission (OR 10.05) and low HCQ serum concentration. PClinO was independently associated with the use of selective beta - blocking agents and angiotensin II receptor blockers (p < .05). A total of 2.3% of patients reported mild adverse events (gastrointestinal or skin symptoms, headache, insomnia and transient blurred vision). Conclusion: Administration of the HCQ+AZ combination before COVID-19 complications occur is safe and associated with a very low fatality rate in patients.

BackgroundCervical osteomyelitis following the treatment of pharyngeal cancer with laryngectomy and chemoradiotherapy is poorly reported.MethodsSix cases of cervical osteomyelitis occurring over a 1-year period are described herein. These are reviewed alongside four cases reported previously in the literature.ResultsAmong the total 10 cases, the average age of the patients was 58.7 years. The period between laryngectomy and the diagnosis of cervical osteomyelitis was on average 3 years and 1 month and the male to female sex ratio was 9:1. Two patients had a history of cervical fistula with an esophageal prosthesis, one had a spontaneous cervical fistula, one had a pharyngeal cutaneous fistula, and one had an esophageal prosthesis without any fistula. At the time of diagnosis, seven had a history of cervical pain (70%) and nine had a neurological deficit (90%). Seven patients (70%) underwent surgery; one (10%) was contraindicated for a general anesthetic and two (20%) died before any intervention. The indication for surgery was a neurological deficit for six patients (60%) and the requirement for lavage and debridement for two patients (20%). The average length of antimicrobial treatment was 12.7 weeks. The outcome was favorable for six patients. Four patients died.ConclusionsCervical osteomyelitis is a serious but rarely reported complication following the treatment of pharyngeal cancer with chemoradiotherapy and laryngectomy. Cervical pain was the first sign to appear, sometimes 1year before any other sign. Physicians should be aware of this dreaded complication, which is probably underdiagnosed and is related to an increased mortality rate.

Les infections ostéo-articulaires (IOA) peuvent s'avérer complexes et nécessites souvent une antibiothérapie de longue durée. Récemment, il a été montré une non infériorité du traitement par voie orale par rapport à la voie injectable. De plus, le cotrimoxazole (trimethoprim-sulfamethoxazole) a montré une efficacité dans la prise en charge des infections staphylococciques sur matériel d'ostéosynthèse et prothèses articulaires. Compte tenu des caractéristiques microbiologiques des IOA, nous avons étudié l'efficacité du cotrimoxazole par voie orale dans le traitement de ces infections sur un spectre plus large de micro-organismes. L'étude monocentrique rétrospective a été réalisée dans un centre de référence des infections ostéo-articulaires. Tous les patients inclus ont eu un traitement par cotrimoxazole à forte dose (sulfamethoxazole 2400–4800 mg/jour/trimethoprim 480–960 mg/jour) par voie orale en monothérapie ou associée à un autre agent anti-infectieux pour toute IOA documentée avec ou sans matériel des membres ou du rachis. Nous avons évalué l'efficacité définie par l'absence de rechute à un an d'arrêt de l'antibiothérapie. La tolérance et les effets secondaires imputables au traitement ont également été évalués. Au total, 133 patients ont reçu un traitement par cotrimoxazole sur une période de 3 ans. Parmi eux 30,1 % (40 patients sur 133) ont présenté un effet indésirable au traitement ayant nécessité un arrêt précoce ou tardif. Le nombre de perdus de vue avant la fin des un an de suivi était de 30,8 % (41 patients sur 133). L'efficacité globale du traitement qui était associée dans 92,3 % des cas à au moins un autre agent anti-infectieux était de 63,5 % avec 33 patients guéris sur 52 à un an de l'arrêt des antibiotiques. La proportion de guérison pour les prothèses de hanche était de 66,6 % (4 sur 6 patients), de 100 % (1 patient) pour les prothèses de genou, de 57,9 % (11 sur 19 patients) pour les matériels d'ostéosynthèse des membres, de 66,6 % (4 sur 6 patients) pour les ostéites, de 100 % (2 patients) pour les arthrites, de 53,8 % (7 sur 13 patients) pour les arthrodèses rachidiennes et de 80 % (4 sur 5 patients) pour les spondylodiscites. Treize des vingt-quatre patients (54,2 %) qui n'ont pas bénéficié d'un retrait de matériel ont été guéris. Le taux d'infection polymicrobienne était de 59,6 % (31/52). Sur 103 microorganismes isolés sur les prélèvements des 52 patients, on retrouve 20,4 % (21) de Staphylococcus aureus, 14,6 % (15) de staphylocoques à coagulase négative, 39,8 % (41) d'entérobactéries, 1,9 % (2) de bacilles non fermentants, 5,8 % (6) d'entérocoques, 7,8 % (8) d'anaérobies et 9,7 % autres. Le cotrimoxazole administré à forte dose par voie orale en ambulatoire semble une alternative intéressante pour le traitement des IOA particulièrement dans les infections polymicrobiennes et/ou à entérobactéries. Son administration se complique fréquemment d'effets secondaires qui doivent conduire à une utilisation prudente et une surveillance attentive.

Les infections sont les complications connues des plaies par arme à feu, et participent à la morbi-mortalité de celui-ci. Les guerres d’Iraq et d’Afghanistan ont été pourvoyeuses de nombreuses études épidémiologiques militaires, mais les études civiles menées sur ce sujet sont plus rares. Nous avons étudié les patients civils ayant été admis pour plaie par arme à feu dans les hôpitaux de l’Assistance Publique–Hôpitaux de Marseille et de l’Hôpital d’Instruction des Armées Laveran. Nos objectifs principaux étaient de décrire rétrospectivement la prise en charge des plaies par arme à feu civiles, à Marseille, France, et d’étudier les différents types d’infection les compliquant. Notre objectif secondaire était d’en dégager des facteurs de risque d’infection. De 1995 à 2017, 265 patients civils atteints de plaie balistique ont été pris en charge par nos structures. 27 % d’entre eux ont présenté une infection dont la moitié étaient des ostéomyélites, avec un taux de récidive de 30 %. Les bactéries les plus fréquemment retrouvées étaient Staphylococcus aureus, Enterobacter cloacae, Pseudomonas aeruginosa ou Escherichia coli. En analyse univariée, la plaie reçue par accident, les projectiles de type plombs ou chevrotine, l’atteinte du bras ou de la cheville, l’importance du délabrement, les fractures Gustilo IIIB et IIIC, et la fermeture précoce de la plaie étaient des facteurs de risque d’infection. Un quart des plaies balistiques civiles étudiées ont développé une infection. Les plaies présentant les facteurs de risque d’infection devraient, en addition à une prise en charge chirurgicale initiale soigneuse, bénéficier d’une antibiothérapie probabiliste d’emblée, active contre les bactéries que nous avons les plus fréquemment retrouvées.

Research on the relationship between changes in the gut microbiota and human disease, including AIDS, is a growing field. However, studies on the eukaryotic component of the intestinal microbiota have just begun and have not yet been conducted in HIV-infected patients. Moreover, eukaryotic community profiling is influenced by the use of different methodologies at each step of culture-independent techniques. Herein, initially, four DNA extraction protocols were compared to test the efficiency of each method in recovering eukaryotic DNA from fecal samples. Our results revealed that recovering eukaryotic components from fecal samples differs significantly among DNA extraction methods. Subsequently, the composition of the intestinal eukaryotic microbiota was evaluated in HIV-infected patients and healthy volunteers through clone sequencing, high-throughput sequencing of nuclear ribosomal internal transcribed spacers 1 (ITS1) and 2 (ITS2) amplicons and real-time PCRs. Our results revealed that not only richness (Chao-1 index) and alpha diversity (Shannon diversity) differ between HIV-infected patients and healthy volunteers, depending on the molecular strategy used, but also the global eukaryotic community composition, with little overlapping taxa found between techniques. Moreover, our results based on cloning libraries and ITS1/ITS2 metabarcoding sequencing showed significant differences in fungal composition between HIV-infected patients and healthy volunteers, but without distinct clusters separating the two groups. Malassezia restricta was significantly more prevalent in fecal samples of HIV-infected patients, according to cloning libraries, whereas operational taxonomic units (OTUs) belonging to Candida albicans and Candida tropicalis were significantly more abundant in fecal samples of HIV-infected patients compared to healthy subjects in both ITS subregions. Finally, real-time PCR showed the presence of Microsporidia, Giardia lamblia, Blastocystis and Hymenolepis diminuta in different proportions in fecal samples from HIV patients as compared to healthy individuals. Our work revealed that the use of different sequencing approaches can impact the perceived eukaryotic diversity results of the human gut. We also provide a more comprehensive view of the eukaryotic community in the gut of HIV-infected patients through the complementarity of the different molecular techniques used. Combining these various methodologies may provide a gold standard for a more complete characterization of the eukaryotic microbiome in future studies.

Primary HIV‐1 infections (PHI) with non‐B subtypes are increasing in developed countries while transmission of HIV‐1 harboring antiretroviral resistance‐associated mutations (RAMs) remains a concern. This study assessed non‐B HIV‐1 subtypes and RAMs prevalence among patients with PHI in university hospitals of Marseille, Southeastern France, in 2005‐2015 (11 years). HIV‐1 sequences were obtained by in‐house protocols from 115 patients with PHI, including 38 for the 2013‐2015 period. On the basis of the phylogenetic analysis of the reverse transcriptase region, non‐B subtypes were identified in 31% of these patients. They included 3 different subtypes (3A, 1C, 4F), 23 circulating recombinant forms (CRFs) (CRF02_AG, best BLAST hits being CRF 36_cpx and CRF30 in 7 and 1 cases, respectively), and 5 unclassified sequences (U). Non‐B subtypes proportion increased significantly, particularly in 2011‐2013 vs in 2005‐2010 (P = .03). CRF02_AG viruses largely predominated in 2005‐2013 whereas atypical strains more difficult to classify and undetermined recombinants emerged recently (2014‐2015). The prevalence of protease, nucleos(t)ide reverse transcriptase, and first‐generation nonnucleoside reverse transcriptase inhibitors–associated RAMs were 1.7% (World Health Organization [WHO] list, 2009/2.6% International AIDS Society [IAS] list, 2017), 5.2%/4.3%, and 5.2%/5.2%, respectively. Etravirine/rilpivirine‐associated RAM (IAS) prevalence was 4.3%. Men who have sex with men (MSM) were more frequently infected with drug‐resistant viruses than other patients (26% vs 7%; P = .011). The recent increase of these rare HIV‐1 strains and the spread of drug‐resistant HIV‐1 among MSM in Southeastern France might be considered when implementing prevention strategies and starting therapies.

We recently analyzed, in our real-life cohort of 2260 HIV-infected patients, the reasons for discontinuation of dolutegravir-based combined antiretroviral therapies (cARTs) [1]. Of 517 patients, 55 (10.6%) discontinued this cART due to adverse effects. Unexpectedly, four (7%) of these adverse effects were abnormal weight gain, which ranged between 4 and 12 kg. This prompted us to assess, retrospectively, the evolution of weight and BMI (kg/m2) among the 462 patients who received this cART for more than 6 months. Mean age of these patients was 50.1 years, and 65% were men. At baseline, mean CD4+ lymphocyte cell count was 591 cells/μl (range 5–2010). Most patients (94%) were already receiving cART, and plasma HIV-1 RNA was suppressed for 92% of them. Dolutegravir was mostly associated with abacavir/lamivudine (48%) or tenofovir/emtricitabine (32%) [1]. Finally, BMI was less than 18 kg/m2 (class I) for 6% of the patients, ranging between 18 and 25 kg/m2 (II) in 59%, and between 25 and 30 kg/m2 (III) in 24%, and was more than 30 kg/m2 (IV), indicating obesity, in 6%. Mean time from baseline to weight/BMI assessments was 276 ± 79 days. At this time point, mean weight gain was 3 kg (P = 0.009) and mean BMI increase was 1 kg/m2 (P = 0.002) (Fig. 1). We observed, for 20% of the patients, a more than 10% weight increase compared with baseline, whereas a 4–10% weight increase was observed for 27% of the patients. In addition, during follow-up, in 13% of the patients, BMI increased from class II to class III, and, in 9% of the patients with class III, BMI increased toward class IV. We further found that mean increases in BMI and weight were significant for women, whereas they only showed a tendency toward significancy for men. Finally, these increases were particularly significant for women receiving abacavir/lamivudine and dolutegravir, in whom weight increased from 57 to 62 kg (P = 0.009) (Fig. 1a) and BMI increased from 22 to 24 kg/m2 (P = 0.01) (Fig. 1b).Fig. 1: Evolution of weight (kg) (a) and BMI (kg/m2) (b) after 1 year on a dolutegravir-based regimen.P = Anova. M/ABC+, men on dolutegravir + abacavir; W/ABC+, women on dolutegravir + abacavir.A recent study conducted in 41 149 HIV-infected patients from the D:A:D cohort showed that a high level of BMI may be associated with serious non-AIDS events [2]. In addition, body fat changes can be deleterious to self-perception and HAART adherence [3]. Gains in central fat in HIV-positive patients were strongly associated with protease inhibitors of earlier generation. However, McComsey et al.[4] showed recently, in a large randomized ART-initiation trial including 328 patients, that central and peripheral fat changes did not differ after 96 weeks of treatment containing either two boosted protease inhibitors (including darunavir and atazanavir) or the integrase strand transfer inhibitor (INSTI) raltegravir (+1 kg/m2 in 3.8–4.7% of the patients). There are, to our knowledge, no data on the effect of other INSTIs on body composition. Nevertheless, an in-vitro study showed that, in contrast with raltegravir, elvitegravir altered adipocytes differentiation and function, although less than efavirenz [5]. Hence, our preliminary finding incites the need to monitor, in other large cohorts, the effect of dolutegravir on body weight, BMI, and fat changes at various body sites. Pharmacological assessments may be helpful to explain the more significant rise observed for BMI and weight in women on dolutegravir/abacavir/lamivudine. Acknowledgements Conflicts of interest The authors have no conflicts of interest to declare. Funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Direct-acting agents (DAA) have proved dramatic efficiency to cure chronic hepatitis C.1 ,2 Extensive assessment of their real-life effectiveness is now required, including in cirrhotic and genotype 3 HCV-infected patients who are under-represented in real-world studies but are considered the still hard-to-cure population.1–5 We read therefore with interest the article by Welzel et al 1 about the achievement of sustained virological response (SVR) in 91% of cases in a real-world cohort treated with sofosbuvir plus daclatasvir with or without ribavirin for 12–24 weeks. Indeed, remarkably, SVR was 92% in patients infected with HCV-3 (n=102), 97% in cirrhotics (n=389), 98% in HIV-infected individuals (n=55) and 96% in case of prior HCV therapy (n=341). We analysed the efficacy and safety of DAA-based anti-HCV therapies administered during 2 years (May 2014–April 2016) to a real-world cohort of 170 HCV-HIV-coinfected …

Bone and joint infection involving Granulicatella adiacens is rare, and mainly involved in cases of bacteremia and infectious endocarditis. Here we report three cases of prosthetic joint infection involving G. adiacens that were successfully treated with surgery and prolonged antimicrobial treatment. We also review the two cases of prosthetic joint infection involving G. adiacens that are reported in the literature.