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Aoun J, Copin C, Portelette M, Orri M, Spodenkiewicz M. Suicidal thoughts and behavior of adolescents with depression in Reunion Island - evolution before and after the initial Covid-19 lockdown. L'ENCEPHALE 2024:S0013-7006(24)00094-0. [PMID: 38824046 DOI: 10.1016/j.encep.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND The number of patients consulting with suicidal thoughts and behavior in the health care centers have increased since the Covid-19 pandemic. This increase has been particularly important among adolescents. Most often these patients are diagnosed with anxiety or depressive symptoms. We only have a limited amount of information on depression and STB in adolescents since epidemiological monitoring in health care institutions is based on computerized coding derived from ICD-10. This coding system is very specific for the different forms of depression yet fails to provide accurate coding for suicidal thoughts and behavior. The objectives of this study were to compare the numbers of adolescents with depression who were admitted with suicidal thoughts and behavior before and after the initial Covid-19 lockdown and to highlight possible gender disparities. METHODS Patients' medical charts for this retrospective research were obtained from the Department of Adolescent Psychiatry at the University Hospital Centre of Reunion Island, manually screened, and then analyzed. We included all adolescents diagnosed with depression who had had their first consultation between January 1, 2019 and July 31, 2021. The number of patients presenting suicidal thoughts, self-harm and suicide attempts were compared before and after the initial Covid-19 lockdown. RESULTS Three hundred and sixty-one adolescents diagnosed with depression participated in the study (33.5% males, 66.5% females). Their average age was 16 (SD=1.7). The number of admitted patients increased from 9 to 16 new adolescents with depression and STB each month between the period before and after the first lockdown, with a large proportion of female patients (increase of 74.1%). CONCLUSION This study showed an increase in the number of adolescents consulting for suicidal thoughts or behavior in an adolescent psychiatry department in Reunion Island after the initial Covid-19 lockdown. They were mainly female. This increase has strained an already overburdened mental health system by doubling the number of adolescents that each health care provider has had to help which increases the risk of inadequate care by rapidly increasing the workload but with constant resources.
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Affiliation(s)
- Josee Aoun
- Pôle de santé mentale, CIC-EC 1410, Université & CHU de La Réunion, Saint-Pierre, La Réunion, France
| | - Coline Copin
- Pôle de santé mentale, CIC-EC 1410, Université & CHU de La Réunion, Saint-Pierre, La Réunion, France; Moods Team, Inserm UMR-1018, CESP, Le Kremlin-Bicêtre, France
| | - Miléna Portelette
- Pôle de santé mentale, CIC-EC 1410, Université & CHU de La Réunion, Saint-Pierre, La Réunion, France
| | - Massimiliano Orri
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montréal, Québec, Canada
| | - Michel Spodenkiewicz
- Pôle de santé mentale, CIC-EC 1410, Université & CHU de La Réunion, Saint-Pierre, La Réunion, France; Moods Team, Inserm UMR-1018, CESP, Le Kremlin-Bicêtre, France; McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montréal, Québec, Canada.
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Maillard O, Belot J, Adenis T, Rollot O, Adenis A, Guihard B, Gérardin P, Bertolotti A. Early diagnosis of dengue: Diagnostic utility of the SD BIOLINE Dengue Duo rapid test in Reunion Island. PLoS Negl Trop Dis 2023; 17:e0011253. [PMID: 36996260 PMCID: PMC10089357 DOI: 10.1371/journal.pntd.0011253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 04/11/2023] [Accepted: 03/20/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND In Reunion Island, dengue outbreaks have been occurring since 2018. The healthcare facilities are facing the problem of managing a massive influx of patients and a growing care burden. The aim of this study was to evaluate the performance of the SD Bioline Dengue Duo rapid diagnostic test in adults consulting at an emergency department during the 2019 epidemic. METHODOLOGY/PRINCIPAL FINDINGS This retrospective study of diagnostic accuracy included patients over 18 years old, suspected of dengue, who were admitted to emergency units of the University Hospital of Reunion between the 1st of January and 30th of June, 2019, and were tested for dengue fever with the SD Bioline Dengue Duo rapid diagnostic test and reverse transcriptase polymerase chain reaction. Over the study period, 2099 patients were screened retrospectively. Of them, 671 patients matched the inclusion criteria. The overall rapid diagnostic test performance was 42% for sensitivity and 15% for specificity. The non-structural 1 antigen component had a good specificity of 82% but a low sensitivity of 12%. The immunoglobulin M component had a sensitivity of 28% and a specificity of 33%. Sensitivities were slightly improved beyond the 5th day of illness compared to the early stage for all components, but only the non-structural 1 antigen component had a better specificity of 91%. Furthermore, predictive values were low and post-test probabilities never improved pre-test probabilities in our setting. CONCLUSIONS/SIGNIFICANCE These results suggest that the SD Bioline Dengue Duo RDT did not achieve sufficient performance levels to rule in, or discard, an early point of care dengue diagnosis in the emergency department during the 2019 epidemic in Reunion.
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Affiliation(s)
- Olivier Maillard
- Department of Public Health and Research, CHU Réunion, Saint-Pierre, Reunion, France
- Clinical Investigation Center, INSERM CIC1410, CHU Réunion, Saint Pierre, Reunion, France
| | - Jeanne Belot
- Department of Emergency Medicine, CHU Réunion, Saint-Pierre, Reunion, France
| | - Thibault Adenis
- Department of Emergency Medicine, CHU Réunion, Saint-Pierre, Reunion, France
| | - Olivier Rollot
- Department of Public Health and Research, CHU Réunion, Saint-Pierre, Reunion, France
- Clinical Investigation Center, INSERM CIC1410, CHU Réunion, Saint Pierre, Reunion, France
| | - Antoine Adenis
- Department of Public Health and Research, CH Andrée Rosemon, Cayenne, French Guiana, France
- Clinical Investigation Center, INSERM CIC1424, CH Andrée Rosemon, Cayenne, French Guiana, France
| | - Bertrand Guihard
- Department of Emergency Medicine, CHU Réunion, Saint Denis, Reunion, France
| | - Patrick Gérardin
- Department of Public Health and Research, CHU Réunion, Saint-Pierre, Reunion, France
- Clinical Investigation Center, INSERM CIC1410, CHU Réunion, Saint Pierre, Reunion, France
| | - Antoine Bertolotti
- Clinical Investigation Center, INSERM CIC1410, CHU Réunion, Saint Pierre, Reunion, France
- Department of Infectious Diseases and Dermatology, CHU Réunion, Saint-Pierre, Reunion, France
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Arman ME, Yavuz M, Cekic D, Issever K, Genc AC, Yaylacı S. Leptospirosis during the COVID-19 pandemic: a case report. Rev Inst Med Trop Sao Paulo 2023; 65:e18. [PMID: 36921206 PMCID: PMC10013484 DOI: 10.1590/s1678-9946202365018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/02/2023] [Indexed: 03/15/2023] Open
Abstract
Since SARS-CoV-2 disease (COVID-19) has been labeled as a pandemic, it took the spotlight in the differential diagnosis for patients presenting with acute respiratory and systemic symptoms. Leptospirosis is one of the most common zoonoses in the world, yet it is mainly a disease of differential diagnosis for places that do not have it as an endemic. Due to the high burden of COVID-19 on the healthcare field, patients suffering from other infections may have been inadvertently neglected. COVID-19 infection can mimic other infectious diseases and can confuse physicians in their search for a confirmatory diagnosis. Nonetheless, it is very crucial to broaden the differential diagnosis and keep diseases like leptospirosis within the differential diagnosis despite its rarity, especially in patients presenting with unexplained systemic infectious symptoms. This is a unique case of a patient who presented with dyspnea, jaundice and change in urine color who was suspected to be COVID-19 positive. After a detailed investigation, the patient was diagnosed with leptospirosis instead of COVID-19 and was treated with plasmapheresis and antibiotics accordingly.
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Affiliation(s)
- Mehmet Emir Arman
- Sakarya University, Training and Research Hospital, Department of Internal Medicine, Adapazari, Sakarya, Turkey
| | - Mustafa Yavuz
- Sakarya University, Training and Research Hospital, Department of Internal Medicine, Adapazari, Sakarya, Turkey
| | - Deniz Cekic
- Sakarya University, Training and Research Hospital, Department of Internal Medicine, Adapazari, Sakarya, Turkey
| | - Kubilay Issever
- Giresun University, Faculty of Medicine, Department of Internal Medicine, Giresun, Turkey
| | - Ahmed Cihad Genc
- Sakarya University, Training and Research Hospital, Department of Internal Medicine, Adapazari, Sakarya, Turkey
| | - Selcuk Yaylacı
- Sakarya University, Training and Research Hospital, Department of Internal Medicine, Adapazari, Sakarya, Turkey
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SARS-CoV-2 and Dengue Virus Coinfection in a Mexican Pediatric Patient: A Case Report from Early Molecular Diagnosis. Pathogens 2022; 11:pathogens11111360. [PMID: 36422612 PMCID: PMC9695305 DOI: 10.3390/pathogens11111360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 11/17/2022] Open
Abstract
Mexico is an endemic region for dengue virus (DENV). The increase in this disease coincides with outbreaks of COVID-19, both of which are single-stranded positive RNA viruses. These characteristics make it difficult to distinguish each disease because they share clinical and laboratory features, which can consequently result in misdiagnoses. This is why the use of precision confirmatory tests (qRT-PCR) are crucial for early diagnosis. We herein report a pediatric patient who presented a coinfection for DENV and COVID-19, “SARS-CoV-2/Dengue”. This patient initially presented a fever, cough, and headache and, three days later, developed generalized pain and epistaxis. Blood studies revealed thrombocytopenia and leukopenia, and the patient was admitted to the hospital for a probable DENV infection. Within 48 h, qRT-PCR tests specific for SARS-CoV-2 and DENV were performed and resulted as positive. The patient immediately received pharmacological treatment with azithromycin, oseltamivir, and metamizole. During hospitalization (9 days), the patient had no signs of respiratory distress and maintained normal body temperature and normal blood oxygen saturation. This case warns of the need for early diagnosis and adequate clinical and pharmacological management in the face of a “SARS-CoV-2/Dengue” coinfection. Early molecular detection of both viruses and timely treatment helped the patient to achieve a favorable recovery.
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Role of Diagnostics in Epidemiology, Management, Surveillance, and Control of Leptospirosis. Pathogens 2022; 11:pathogens11040395. [PMID: 35456070 PMCID: PMC9032781 DOI: 10.3390/pathogens11040395] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 12/12/2022] Open
Abstract
A One Health approach to the epidemiology, management, surveillance, and control of leptospirosis relies on accessible and accurate diagnostics that can be applied to humans and companion animals and livestock. Diagnosis should be multifaceted and take into account exposure risk, clinical presentation, and multiple direct and/or indirect diagnostic approaches. Methods of direct detection of Leptospira spp. include culture, histopathology and immunostaining of tissues or clinical specimens, and nucleic acid amplification tests (NAATs). Indirect serologic methods to detect leptospiral antibodies include the microscopic agglutination test (MAT), the enzyme-linked immunosorbent assay (ELISA), and lateral flow methods. Rapid diagnostics that can be applied at the point-of-care; NAAT and lateral flow serologic tests are essential for management of acute infection and control of outbreaks. Culture is essential to an understanding of regional knowledge of circulating strains, and we discuss recent improvements in methods for cultivation, genomic sequencing, and serotyping. We review the limitations of NAATs, MAT, and other diagnostic approaches in the context of our expanding understanding of the diversity of pathogenic Leptospira spp. Novel approaches are needed, such as loop mediated isothermal amplification (LAMP) and clustered regularly interspaced short palindromic repeats (CRISPR)-based approaches to leptospiral nucleic acid detection.
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Gérardin P, Maillard O, Bruneau L, Accot F, Legrand F, Poubeau P, Manaquin R, Andry F, Bertolotti A, Levin C. Differentiating COVID-19 and dengue from other febrile illnesses in co-epidemics: Development and internal validation of COVIDENGUE scores. Travel Med Infect Dis 2021; 45:102232. [PMID: 34896649 PMCID: PMC8656151 DOI: 10.1016/j.tmaid.2021.102232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/03/2021] [Accepted: 12/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this cohort study was to develop two scores able to differentiate coronavirus 2019 (COVID-19) from dengue and other febrile illnesses (OFIs). METHODS All subjects suspected of COVID-19 who attended the SARS-CoV-2 testing center of Saint-Pierre hospital, Reunion, between March 23 and May 10, 2020, were assessed for identifying predictors of both infectious diseases from a multinomial logistic regression model. Two scores were developed after weighting the odd ratios then validated by bootstrapping. RESULTS Over 49 days, 80 COVID-19, 60 non-severe dengue and 872 OFIs were diagnosed. The translation of the best fit model yielded two scores composed of 11 criteria: contact with a COVID-19 positive case (+3 points for COVID-19; 0 point for dengue), return from travel abroad within 15 days (+3/-1), previous individual episode of dengue (+1/+3), active smoking (-3/0), body ache (0/+5), cough (0/-2), upper respiratory tract infection symptoms (-1/-1), anosmia (+7/-1), headache (0/+5), retro-orbital pain (-1/+5), and delayed presentation (>3 days) to hospital (+1/0). The area under the receiver operating characteristic curve was 0.79 (95%CI 0.76-0.82) for COVID-19 score and 0.88 (95%CI 0.85-0.90) for dengue score. Calibration was satisfactory for COVID-19 score and excellent for dengue score. For predicting COVID-19, sensitivity was 97% at the 0-point cut-off and specificity 99% at the 10-point cut-off. For predicting dengue, sensitivity was 97% at the 3-point cut-off and specificity 98% at the 11-point cut-off. CONCLUSIONS COVIDENGUE scores proved discriminant to differentiate COVID-19 and dengue from OFIs in the context of SARS-CoV-2 testing center during a co-epidemic.
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Affiliation(s)
- Patrick Gérardin
- Centre for Clinical Investigation - Clinical Epidemiology (CIC 1410), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion.
| | - Olivier Maillard
- Centre for Clinical Investigation - Clinical Epidemiology (CIC 1410), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion
| | - Léa Bruneau
- Department of Public Health and Research Support, Centre Hospitalier Universitaire de La Réunion, Saint Denis, Reunion
| | - Frédéric Accot
- COVID-19 Testing Centre, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion
| | - Florian Legrand
- COVID-19 Testing Centre, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion; City to Hospital Outpatient Clinic for the Care of COVID-19, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion
| | - Patrice Poubeau
- COVID-19 Testing Centre, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion; Department of Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion; City to Hospital Outpatient Clinic for the Care of COVID-19, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion
| | - Rodolphe Manaquin
- COVID-19 Testing Centre, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion; Department of Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion; City to Hospital Outpatient Clinic for the Care of COVID-19, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion
| | - Fanny Andry
- COVID-19 Testing Centre, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion; Department of Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion; City to Hospital Outpatient Clinic for the Care of COVID-19, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion
| | - Antoine Bertolotti
- Centre for Clinical Investigation - Clinical Epidemiology (CIC 1410), Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion; COVID-19 Testing Centre, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion; Department of Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion
| | - Cécile Levin
- COVID-19 Testing Centre, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion; Department of Infectious Diseases and Tropical Medicine, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion; City to Hospital Outpatient Clinic for the Care of COVID-19, Centre Hospitalier Universitaire de La Réunion, Saint Pierre, Reunion
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