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Burton RJ, Raffray L, Moet LM, Cuff SM, White DA, Baker SE, Moser B, O'Donnell VB, Ghazal P, Morgan MP, Artemiou A, Eberl M. Conventional and unconventional T cell responses contribute to the prediction of clinical outcome and causative bacterial pathogen in sepsis patients. Clin Exp Immunol 2024:uxae019. [PMID: 38430552 DOI: 10.1093/cei/uxae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Indexed: 03/04/2024] Open
Abstract
Sepsis is characterised by a dysfunctional host response to infection culminating in life-threatening organ failure that requires complex patient management and rapid intervention. Timely diagnosis of the underlying cause of sepsis is crucial, and identifying those at risk of complications and death is imperative for triaging treatment and resource allocation. Here, we explored the potential of explainable machine learning models to predict mortality and causative pathogen in sepsis patients. By using a modelling pipeline employing multiple feature selection algorithms, we demonstrate the feasibility to identify integrative patterns from clinical parameters, plasma biomarkers and extensive phenotyping of blood immune cells. Whilst no single variable had sufficient predictive power, models that combined five and more features showed a macro area under the curve (AUC) of 0.85 to predict 90 day mortality after sepsis diagnosis, and a macro AUC of 0.86 to discriminate between Gram-positive and Gram-negative bacterial infections. Parameters associated with the cellular immune response contributed the most to models predictive of 90 day mortality, most notably, the proportion of T cells among PBMCs, together with expression of CXCR3 by CD4+ T cells and CD25 by mucosal-associated invariant T (MAIT) cells. Frequencies of Vδ2+ γδ T cells had the most profound impact on the prediction of Gram-negative infections, alongside other T cell-related variables and total neutrophil count. Overall, our findings highlight the added value of measuring the proportion and activation patterns of conventional and unconventional T cells in the blood of sepsis patients in combination with other immunological, biochemical and clinical parameters.
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Affiliation(s)
- Ross J Burton
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
- Adult Critical Care, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, United Kingdom
| | - Loïc Raffray
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
- Department of Internal Medicine, Félix Guyon University Hospital of La Réunion, Saint Denis, Réunion Island, France
| | - Linda M Moet
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Simone M Cuff
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Daniel A White
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Sarah E Baker
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Bernhard Moser
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
- Systems Immunity Research Institute, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Valerie B O'Donnell
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
- Systems Immunity Research Institute, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Peter Ghazal
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
- Systems Immunity Research Institute, Cardiff University, Cardiff CF14 4XN, United Kingdom
| | - Matt P Morgan
- Adult Critical Care, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff CF14 4XW, United Kingdom
| | - Andreas Artemiou
- School of Mathematics, Cardiff University, Cardiff CF24 4AG, United Kingdom
| | - Matthias Eberl
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff CF14 4XN, United Kingdom
- Systems Immunity Research Institute, Cardiff University, Cardiff CF14 4XN, United Kingdom
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Gérardin P, Issop A, Diarra YM, Cousty J, Jaffar-Bandjee MC, Maillard O, Raffray L, Nobécourt E, Bertolotti A. Harness risk stratification of diabetic patients with dengue in a cohort study. J Infect Public Health 2024; 17:535-541. [PMID: 38310745 DOI: 10.1016/j.jiph.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/13/2023] [Accepted: 01/18/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Identifying predictors of severe dengue (SD) is key for triage and management of patients as well as for advising travellers to countries where dengue is endemic. In this, meta-analyses have raised diabetes mellitus as a risk factor for SD and a prognostic factor for dengue-related mortality. The purpose of this study was to assess whether diabetic patients (DPs) are at increased risk for SD in comparison to non-diabetic patients (NDPs) in a setting of high prevalence of type 2 diabetes mellitus and increasing endemicity for dengue. METHODS In a cohort study conducted during the 2019 dengue epidemic on Reunion Island, we estimated the risk ratios (RR) of DPs for SD (WHO 2009 definition), hospitalisation, intensive care unit (ICU) admission, critical care need or death in the ICU, and scales rating severity or multiple organ dysfunction syndrome (MODS), among confirmed cases of dengue (positive RT-PCR or NS1 antigen). RESULTS In a Poisson regression model adjusted for age, gender and comorbidity, DPs were more likely to develop SD (adjusted RR: 1.46, 95%CI 1.10-1.95), to be hospitalised, admitted to the ICU, and need critical care or die in the ICU. Subgroup analyses identified female DPs, non-elderly DPs (< 65 years) and DPs with low Charlson score (< 3) to be at higher risk for SD, the two first subgroups trough more severe presentation (higher Simplified Acute Physiology Score-2 values; higher MODS scores, respectively). Male gender, age less than 65 years and mixed comorbidity were identified as prognostic factors for critical care need or death in the ICU, male and non-elderly DPs being more likely to develop MODS than their non-diabetic counterparts. CONCLUSIONS Together, these data highlight the role of diabetes mellitus in the progression from dengue to SD through higher severity per se or the event of MODS.
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Affiliation(s)
- Patrick Gérardin
- INSERM, CIC 1410, Centre Hospitalier Universitaire Réunion, Saint-Pierre, La Réunion, France; Plateforme de Recherche Clinique et Translationnelle, Centre Hospitalier Universitaire Réunion, Saint-Pierre, La Réunion, France.
| | - Azizah Issop
- Service d'Endocrinologie et de Diabétologie, Centre Hospitalier Universitaire Réunion, Saint Pierre, La Réunion, France
| | - Yves-Marie Diarra
- INSERM, CIC 1410, Centre Hospitalier Universitaire Réunion, Saint-Pierre, La Réunion, France; UMR PIMIT (CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion), Sainte Clotilde, La Réunion, France
| | - Julien Cousty
- Service de Réanimation Polyvalente et de Soins Continus, Centre Hospitalier Universitaire Réunion, Saint Pierre, La Réunion, France
| | - Marie-Christine Jaffar-Bandjee
- Centre National de Référence associé des arbovirus, Centre Hospitalier Universitaire Réunion, Pôle de Biologie, Saint Denis, La Réunion, France
| | - Olivier Maillard
- INSERM, CIC 1410, Centre Hospitalier Universitaire Réunion, Saint-Pierre, La Réunion, France
| | - Loïc Raffray
- UMR PIMIT (CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion), Sainte Clotilde, La Réunion, France; Service de Médecine Interne, Centre Hospitalier Universitaire Réunion, Saint Denis, La Réunion, France
| | - Estelle Nobécourt
- INSERM, CIC 1410, Centre Hospitalier Universitaire Réunion, Saint-Pierre, La Réunion, France; Service d'Endocrinologie et de Diabétologie, Centre Hospitalier Universitaire Réunion, Saint Pierre, La Réunion, France; UMR Diabète Athérothrombose Thérapies Réunion Océan Indien (DéTROI) (INSERM U1188), Plateforme CYROI, University of La Réunion, Sainte Clotilde, La Réunion, France
| | - Antoine Bertolotti
- INSERM, CIC 1410, Centre Hospitalier Universitaire Réunion, Saint-Pierre, La Réunion, France; Service des Maladies Infectieuses, Médecine Interne, Dermatologie, Centre Hospitalier Universitaire Réunion, Saint Pierre, La Réunion, France
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Rajaonarivelo JA, Desmoulin A, Maillard O, Collet L, Baudino F, Jaffar-Bandjee MC, Blondé R, Raffray L, Tortosa P. Clinical manifestations of human leptospirosis: bacteria matter. Front Cell Infect Microbiol 2023; 13:1259599. [PMID: 37953799 PMCID: PMC10635415 DOI: 10.3389/fcimb.2023.1259599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/06/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction A high incidence of human leptospirosis is recorded on Mayotte, an oceanic island located in southwestern Indian Ocean, but the severity of the disease appears relatively mild in terms of mortality rate and admission to the intensive care unit. It has been proposed that mild leptospirosis may result from a limited virulence of some of the occurring Leptospira species to which the population is exposed. Methods Clinical and biological data of patients admitted to the Centre Hospitalier de Mayotte were collected and the infecting Leptospira species were determined through molecular typing. Results Leptospira interrogans was detected in the minority of admitted patients but most of these patients suffered from severe forms, with 50% admitted to intensive care unit and suffering from organ failures. Nineteen percent of patients infected with Leptospira borgpetersenii were admitted to the intensive care, with 13% displaying organ failures, and one patient died. Leptospira mayottensis was found in 28% of the patients and not a single severe case was observed. Discussion The distribution of Leptospira species in patients was not different from that reported 10-15 years ago and bacterial genotypes were very closely related to those previously reported. These results highlight the importance of the diversity of pathogenic Leptospira circulating on Mayotte island and are in keeping with distinct outcome of the disease depending on the infecting Leptospira. Altogether, presented data support that the infecting Leptospira species is an important driver of disease severity in humans.
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Affiliation(s)
- Jeanne Arline Rajaonarivelo
- Unité Mixte de Recherche Processus Infectieux en Milieu Insulaire Tropical (UMR PIMIT), Université de La Réunion, CNRS 9192, INSERM 1187, IRD 249, La Réunion, France
| | - Anissa Desmoulin
- Service de Maladies Infectieuses, Centre Hospitalier Universitaire (CHU) de La Réunion Sites Sud, Réunion, France
- Service de Réanimation, Centre Hospitalier de Mayotte, Mayotte, France
| | - Olivier Maillard
- Department of Public Health and Research, Clinical Investigation Center (CIC), INSERM CIC 1410, CHU Réunion, Réunion, France
| | - Louis Collet
- Laboratoire de Microbiologie, Centre Hospitalier de Mayotte, Mayotte, France
| | - Fiona Baudino
- Unité Mixte de Recherche Processus Infectieux en Milieu Insulaire Tropical (UMR PIMIT), Université de La Réunion, CNRS 9192, INSERM 1187, IRD 249, La Réunion, France
| | | | - Renaud Blondé
- Service de Réanimation, Centre Hospitalier de Mayotte, Mayotte, France
| | - Loïc Raffray
- Unité Mixte de Recherche Processus Infectieux en Milieu Insulaire Tropical (UMR PIMIT), Université de La Réunion, CNRS 9192, INSERM 1187, IRD 249, La Réunion, France
- Service de Médecine Interne, Centre Hospitalier Universitaire Felix Guyon, Réunion, France
| | - Pablo Tortosa
- Unité Mixte de Recherche Processus Infectieux en Milieu Insulaire Tropical (UMR PIMIT), Université de La Réunion, CNRS 9192, INSERM 1187, IRD 249, La Réunion, France
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Richier Q, Dubernet A, Raffray L. Red eye and joint pain. Eur J Intern Med 2023; 114:120-121. [PMID: 37169633 DOI: 10.1016/j.ejim.2023.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/29/2023] [Indexed: 05/13/2023]
Affiliation(s)
- Quentin Richier
- Internal medicine department, Felix Guyon university hospital, Saint Denis, 97400 La Réunion, France.
| | - Arthur Dubernet
- Internal medicine department, Felix Guyon university hospital, Saint Denis, 97400 La Réunion, France
| | - Loïc Raffray
- Internal medicine department, Felix Guyon university hospital, Saint Denis, 97400 La Réunion, France; Unité Mixte Processus Infectieux en Milieu Insulaire Tropical (PIMIT), Université de La Réunion, CNRS 9192, INSERM U1187, IRD 249, Plateforme Technologique CYROI, 97490 Sainte-Clotilde, La Réunion, France
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de Frémont GM, Costedoat-Chalumeau N, Lazaro E, Belkhir R, Guettrot-Imbert G, Morel N, Nocturne G, Molto A, Goulenok T, Diot E, Perard L, Ferreira-Maldent N, Le Besnerais M, Limal N, Martis N, Abisror N, Debouverie O, Richez C, Sobanski V, Maurier F, Sauvetre G, Levesque H, Timsit MA, Tieulié N, Orquevaux P, Bienvenu B, Mahevas M, Papo T, Lartigau-Roussin C, Chauvet E, Berthoux E, Sarrot-Reynauld F, Raffray L, Couderc M, Silva NM, Jourde-Chiche N, Belhomme N, Thomas T, Poindron V, Queyrel-Moranne V, Delforge J, Le Ray C, Pannier E, Mariette X, Le Guern V, Seror R. Pregnancy outcomes in women with primary Sjögren's syndrome: an analysis of data from the multicentre, prospective, GR2 study. Lancet Rheumatol 2023; 5:e330-e340. [PMID: 38251600 DOI: 10.1016/s2665-9913(23)00099-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Adverse pregnancy outcomes in women with primary Sjögren's syndrome have only been evaluated retrospectively using heterogeneous methods and with contradictory results. We aimed to describe adverse pregnancy, delivery, and birth outcome risks in pregnant women with primary Sjögren's syndrome compared with those of a matched general population in France, and to identify factors predictive of disease flares or adverse pregnancy outcomes. METHODS We conducted a multicentre, prospective, cohort study in France using the GR2 (Groupe de Recherche sur la Grossesse et les Maladies Rares) registry. Women from the GR2 study were eligible if they had conceived before March, 2021, had primary Sjögren's syndrome according to the American College of Rheumatology and European Alliance of Associations for Rheumatology (EULAR) 2016 classification criteria, and had an ongoing pregnancy at 12 weeks of gestation. In women who entered in the registry with pregnancies before 18 weeks of gestation, we sought to identify factors associated with primary Sjögren's syndrome flare (≥3-point increase in EULAR Sjögren's Syndrome Disease Activity Index [ESSDAI] score) or adverse pregnancy outcomes (fetal or neonatal death, placental insufficiency leading to a preterm delivery [<37 weeks of gestation], or small-for-gestational-age birthweight). A matched controlled study compared adverse pregnancy, delivery, and birth outcome rates between pregnant women with primary Sjögren's syndrome from the GR2 registry and matched controls from the general population included in the last French perinatal survey (Enquête Nationale Périnatale 2016). FINDINGS 1944 pregnancies were identified in the GR2 cohort, of which 106 pregnancies in 96 women with primary Sjögren's syndrome were included in this analysis. The median age at pregnancy onset was 33 years (IQR 31-36). 87 (83%) of 105 pregnancies (with ethnicity data) were in White women, 18 (17%) were in Black women; 92 (90%) of 102 had previous systemic activity (ESSDAI score of ≥1; data missing in four pregnancies), and 48 (45%) of 106 had systemic activity at inclusion. Of 93 pregnancies included at week 18 of gestation or earlier, primary Sjögren's syndrome flares occurred in 12 (13%). No baseline parameters were associated with primary Sjögren's syndrome flare. Four twin pregnancies and one medical termination were excluded from the adverse pregnancy outcome analysis; of the remaining 88, adverse pregnancy outcomes occurred in six (7%). Among pregnancies in women with data for antiphospholipid antibodies (n=55), antiphospholipid antibody positivity was more frequent among pregnancies with adverse outcomes (two [50%] of four pregnancies) compared with those without adverse outcomes (two [4%] of 51 pregnancies; p=0·023). Anti-RNP antibody positivity was also more frequent among pregnancies with adverse outcomes than those without, although this was not statistically significant. In the matched controlled study, adverse pregnancy outcomes occurred in nine (9%) of 105 pregnancies in women with primary Sjögren's syndrome and 28 (7%) of the 420 matched control pregnancies; adverse pregnancy outcomes were not significantly associated with primary Sjögren's syndrome (odds ratio 1·31, 95% CI 0·53-2·98; p=0·52). INTERPRETATION Pregnancies in women with primary Sjögren's syndrome had very good prognoses for mothers and fetuses, with no overall increase in adverse pregnancy outcome risk compared with the general population. Women with antiphospholipid antibodies or anti-RNP antibodies require close monitoring, because these factors might be associated with a higher risk of adverse pregnancy outcomes. FUNDING Lupus France, Association des Sclérodermiques de France, Association Gougerot Sjögren, Association Francophone Contre la Polychondrite Chronique Atrophiante, AFM-Telethon, Société Nationale Française de Médecine Interne, Société Française de Rhumatologie, Cochin Hospital, French Health Ministry, Fondation for Research in Rheumatology, Association Prix Véronique Roualet, Union Chimique Belge.
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Affiliation(s)
- Grégoire Martin de Frémont
- APHP, Hôpital Bicêtre, Service de Rhumatologie, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Inserm UMR 1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Nathalie Costedoat-Chalumeau
- APHP, Hôpital Cochin, Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Paris, France; Centre de Recherche Epidémiologie et Biostatistiques de Sorbonne Paris Cité, Université de Paris, Paris, France
| | - Estibaliz Lazaro
- CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Bordeaux, France
| | - Rakiba Belkhir
- APHP, Hôpital Bicêtre, Service de Rhumatologie, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Inserm UMR 1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Gaëlle Guettrot-Imbert
- APHP, Hôpital Cochin, Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Paris, France
| | - Nathalie Morel
- APHP, Hôpital Cochin, Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Paris, France
| | - Gaétane Nocturne
- APHP, Hôpital Bicêtre, Service de Rhumatologie, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Inserm UMR 1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Anna Molto
- Centre de Recherche Epidémiologie et Biostatistiques de Sorbonne Paris Cité, Université de Paris, Paris, France; APHP, Hôpital Cochin, Service de Rhumatologie, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Paris, France
| | | | - Elisabeth Diot
- CHU de Tours, Service de Médecine Interne, Tours, France
| | - Laurent Perard
- Hôpital Saint-Joseph, Service de Médecine Interne, Lyon, France
| | | | | | - Nicolas Limal
- APHP, Hôpital Henri-Mondor, Service de Médecine Interne, Créteil, France
| | - Nihal Martis
- CHU de Nice, Hôpital Archet, Service de Médecine Interne, Nice, France
| | - Noémie Abisror
- APHP, Hôpital Saint-Antoine, Service de Médecine Interne, Paris, France
| | | | | | - Vincent Sobanski
- CHU de Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Inserm U1286, Université de Lille, Lille, France
| | - François Maurier
- Hôpitaux Privés de Metz, Service de Médecine Interne, Metz, France
| | | | - Hervé Levesque
- CHU de Rouen, Service de Médecine Interne, Rouen, France
| | | | | | | | - Boris Bienvenu
- Hôpital Saint-Joseph, Service de Médecine Interne, Marseille, France
| | - Matthieu Mahevas
- APHP, Hôpital Henri-Mondor, Service de Médecine Interne, Créteil, France
| | - Thomas Papo
- APHP, Hôpital Bichat, Service de Médecine Interne, Paris, France
| | | | - Elodie Chauvet
- Polyclinique Médipôle Saint-Roch, Service de Médecine Interne, Cabestany, France
| | - Emilie Berthoux
- Hôpital Saint-Joseph, Service de Médecine Interne, Lyon, France
| | | | - Loïc Raffray
- CHU Félix-Guyon, Service de Médecine Interne, Saint-Denis de la Réunion, France
| | - Marion Couderc
- CHU de Clermont-Ferrand, Service de Rhumatologie, Clermont-Ferrand, France
| | | | - Noémie Jourde-Chiche
- APHM, CHU de la Conception, Centre de Néphrologie et Transplantation Rénale, C2VN, Inserm 1263, Institut National de la Recherche Agronomique (INRA) 1260, Faculté de Pharmacie, Marseille, France
| | | | - Thierry Thomas
- CHU de Saint-Etienne, Service de Médecine Interne, Saint-Etienne, France
| | - Vincent Poindron
- CHU de Strasbourg, Service de Médecine Interne, Strasbourg, France
| | | | - Juliette Delforge
- APHP, Hôpital Jean-Verdier, Service de Médecine Interne, Bobigny, France
| | - Camille Le Ray
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université Paris Cité, Paris, France
| | - Emmanuelle Pannier
- APHP, Hôpital Cochin Port Royal, Maternité Port Royal, Service d'Obstétrique, Université de Paris, Paris, France
| | - Xavier Mariette
- APHP, Hôpital Bicêtre, Service de Rhumatologie, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Inserm UMR 1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Véronique Le Guern
- APHP, Hôpital Cochin, Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Paris, France
| | - Raphaèle Seror
- APHP, Hôpital Bicêtre, Service de Rhumatologie, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Inserm UMR 1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
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Carras M, Maillard O, Cousty J, Gérardin P, Boukerrou M, Raffray L, Mavingui P, Poubeau P, Cabie A, Bertolotti A. Associated risk factors of severe dengue in Reunion Island: A prospective cohort study. PLoS Negl Trop Dis 2023; 17:e0011260. [PMID: 37068115 PMCID: PMC10138848 DOI: 10.1371/journal.pntd.0011260] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 04/27/2023] [Accepted: 03/21/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND Since 2018, a dengue epidemic has been raging annually in Reunion Island, which poses the major problem of its morbidity and mortality. However, there is no consensus in the literature on factors associated with severity of illness. The objective of this study was to identify the factors associated with the occurrence of severe dengue (SD) according to the criteria adopted in 2009 by the World Health Organization (WHO), during the 2019 epidemic. METHODOLOGY/PRINCIPAL FINDINGS A total of 163 patients with RT-PCR-confirmed dengue were included in a multicenter prospective cohort study in Reunion Island between January and June 2019. Of these, 37 (23%) were classified as SD, which involves presentation dominated by at least one organ failure, and 126 (77%) classified as non-SD (of which 90 (71%) had warning signs). Confusion, dehydration, and relative hypovolemia were significantly associated with SD in bivariate analysis (p < 0.05). The factors associated with SD in multivariate analysis were a time from first symptom to hospital consultation over 2 days (OR: 2.46, CI: 1.42-4.27), a history of cardiovascular disease (OR: 2.75, 95%CI: 1.57-4.80) and being of Western European origin (OR: 17.60, CI: 4.15-74). CONCLUSIONS/SIGNIFICANCE This study confirms that SD is a frequent cause of hospitalization during dengue epidemics in Reunion Island. It suggests that cardiovascular disease, Western European origin, and delay in diagnosis and management are risk factors associated with SD fever, and that restoration of blood volume and correction of dehydration must be performed early to be effective. TRIAL REGISTRATION NCT01099852; clinicaltrials.gov.
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Affiliation(s)
- Mathys Carras
- Intensive Care Unit, CHU Réunion, Saint Pierre, Reunion, France
| | - 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
| | - Julien Cousty
- Intensive Care Unit, CHU Réunion, Saint Pierre, 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
| | - Malik Boukerrou
- Department of Gynecology and Obstetrics, CHU Réunion, Saint Pierre, Reunion, France
| | - Loïc Raffray
- Department of Internal Medicine, CHU Réunion, Saint Denis, Reunion, France
- UMR Processus Infectieux en Milieu Insulaire Tropical (PIMIT), CNRS 9192, INSERM 1187, IRD 249, Université de La Réunion, Sainte-Clotilde, Reunion, France
| | - Patrick Mavingui
- UMR Processus Infectieux en Milieu Insulaire Tropical (PIMIT), CNRS 9192, INSERM 1187, IRD 249, Université de La Réunion, Sainte-Clotilde, Reunion, France
| | - Patrice Poubeau
- Department of Infectious Diseases, CHU Réunion, Saint-Pierre, Reunion, France
| | - André Cabie
- Department of Infectious and Tropical Diseases, CHU Martinique, Fort-de-France, Martinique, France
- Clinical Investigation Center, INSERM CIC1424, CHU Martinique, Fort-de-France, Martinique, France
| | - Antoine Bertolotti
- Clinical Investigation Center, INSERM CIC1410, CHU Réunion, Saint Pierre, Reunion, France
- Department of Infectious Diseases, CHU Réunion, Saint-Pierre, Reunion, France
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Bagny K, Osdoit S, Raffray L. Ulcères atypiques dans la zone Océan Indien. Rev Med Interne 2023; 44:203-204. [PMID: 36997274 DOI: 10.1016/j.revmed.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/07/2022] [Indexed: 03/30/2023]
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8
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Richier Q, Dalmas JB, Gaüzère L, Raffray L. A rare skin complication of COVID-19 pandemic. Rev Med Interne 2023; 44:201-202. [PMID: 36806478 PMCID: PMC9886658 DOI: 10.1016/j.revmed.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/29/2023] [Indexed: 02/03/2023]
Affiliation(s)
- Q. Richier
- Service de médecine interne, CHU de Felix-Guyon, Saint-Denis, France,Corresponding author
| | - J.-B. Dalmas
- Service de médecine interne, CHU de Felix-Guyon, Saint-Denis, France
| | - L. Gaüzère
- Service de médecine interne, CHU de Felix-Guyon, Saint-Denis, France
| | - L. Raffray
- Service de médecine interne, CHU de Felix-Guyon, Saint-Denis, France,Inserm U1187, unité mixte processus infectieux en milieu insulaire tropical (PIMIT), CNRS 9192, IRD 249, plateforme technologique CYROI, université de La Réunion, 97490 Sainte-Clotilde, France
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9
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Maillard O, Hirschinger D, Bénéteau S, Koumar Y, Vague A, Girerd R, DiAscia L, Jabot J, Cousty J, Randrianjohany A, Bertolotti A, Raffray L. C-reactive protein: An easy marker for early differentiation between leptospirosis and dengue fever in endemic area. PLoS One 2023; 18:e0285900. [PMID: 37195992 DOI: 10.1371/journal.pone.0285900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 05/04/2023] [Indexed: 05/19/2023] Open
Abstract
In tropical regions, leptospirosis and dengue fever (DF) are infectious diseases of epidemiological importance and have overlapping symptomatic features. The objective of this study was to identify the factors associated to diagnosing leptospirosis that differentiate it to DF at the initial hospital evaluation. A multicenter retrospective study was conducted comparing confirmed leptospirosis to DF cases. Clinical/laboratory findings were compiled at hospital admission on Reunion Island between 2018 and 2019. Multivariable logistic regression was used to identify the predictors of leptospirosis. In total, 98 leptospirosis and 673 DF patients were included with a mean age of 47.8 (±17.1) and 48.9 (±23.3) years, respectively. In the multivariate analyses, the main parameters associated with leptospirosis were: i) increased neutrophil counts, ii) C-reactive protein values, iii) the absence of prolonged partial thromboplastin time, and iv) a decrease of platelets. The most discriminating parameter was C-reactive protein (CRP). With a threshold of 50mg/L, CRP taken alone had a sensitivity of 94% and a specificity of 93.5%. The positive and negative likelihood ratios were 14.5 and 0.06, respectively. In the setting of an early presumptive diagnosis, we found that an increased CRP value (>50 mg/L) could help diagnose leptospirosis and aid the decision process for hospital surveillance and/or a potential antibiotic treatment regimen.
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Affiliation(s)
- Olivier Maillard
- Department of Public Health and Research, CHU Réunion, Saint-Pierre, Reunion, France
- Clinical Investigation Center, INSERM CIC 1410, CHU Réunion, Saint-Pierre, Reunion, France
| | - David Hirschinger
- Department of Emergency Medicine, CHU Réunion, Saint-Denis, Reunion, France
| | - Samuel Bénéteau
- Department of Public Health and Research, CHU Réunion, Saint-Pierre, Reunion, France
| | - Yatrika Koumar
- Department of Infectious Diseases, CHU Réunion, Saint-Pierre, Reunion, France
| | - Adrien Vague
- Department of Emergency Medicine, CHU Réunion, Saint-Pierre, Reunion, France
| | - Rémi Girerd
- Department of Emergency Medicine, CHU Réunion, Saint-Pierre, Reunion, France
| | - Laura DiAscia
- Department of Emergency Medicine, CHU Réunion, Saint-Denis, Reunion, France
| | - Julien Jabot
- Intensive Care Unit, CHU Réunion, Saint-Denis, Reunion, France
| | - Julien Cousty
- Intensive Care Unit, CHU Réunion, Saint-Pierre, Reunion, France
| | - Andry Randrianjohany
- Department of Internal Medicine, Groupe Hospitalier Est Réunion, Saint-Benoit, Reunion, France
| | - Antoine Bertolotti
- Clinical Investigation Center, INSERM CIC 1410, CHU Réunion, Saint-Pierre, Reunion, France
- Department of Infectious Diseases, CHU Réunion, Saint-Pierre, Reunion, France
| | - Loïc Raffray
- Department of Internal Medicine, CHU Réunion, Saint-Denis, Reunion, France
- UMR Processus Infectieux en Milieu Insulaire Tropical (PIMIT), CNRS 9192, INSERM U1187, IRD 249, Université de La Réunion, Sainte-Clotilde, Reunion, France
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10
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Desroche T, Chong-Si-Tsaon A, Raffray L. Hemophagocytic lymphohistiocytosis-like presentation of malignant melanoma. Int J Lab Hematol 2022; 44:1005-1006. [PMID: 35699107 DOI: 10.1111/ijlh.13909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/27/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Tannvir Desroche
- Department of Internal Medicine and Dermatology, CHU Réunion, Saint Denis, France
| | | | - Loïc Raffray
- Department of Internal Medicine and Dermatology, CHU Réunion, Saint Denis, France
- Unité Mixte Processus Infectieux en Milieu Insulaire Tropical (PIMIT), Plateforme Technologique CYROI, INSERM U1187, IRD 249, CNRS 9192, Université de La Réunion, Sainte Clotilde, La Réunion, France
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11
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Murarasu A, Guettrot-Imbert G, Le Guern V, Yelnik C, Queyrel V, Schleinitz N, Ferreira-Maldent N, Diot E, Urbanski G, Pannier E, Lazaro E, Souchaud-Debouverie O, Orquevaux P, Belhomme N, Morel N, Chauvet E, Maurier F, Le Besnerais M, Abisror N, Goulenok T, Sarrot-Reynauld F, Deroux A, Pasquier E, de Moreuil C, Bezanahary H, Pérard L, Limal N, Langlois V, Calas A, Godeau B, Lavigne C, Hachulla E, Cohen F, Benhamou Y, Raffray L, de Menthon M, Tieulié N, Poindron V, Mouthon L, Larosa M, Eléfant E, Sentilhes L, Molto A, Deneux-Tharaux C, Costedoat-Chalumeau N. Characterisation of a high-risk profile for maternal thrombotic and severe haemorrhagic complications in pregnant women with antiphospholipid syndrome in France (GR2): a multicentre, prospective, observational study. Lancet Rheumatol 2022; 4:e842-e852. [PMID: 38261392 DOI: 10.1016/s2665-9913(22)00308-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prospective data about the risks of thrombotic and severe haemorrhagic complications during pregnancy and post partum are unavailable for women with antiphospholipid syndrome. We aimed to assess thrombotic and haemorrhagic events in a prospective cohort of pregnant women with antiphospholipid syndrome. METHODS This multicentre, prospective, observational study was done at 76 centres in France. To be eligible for this study, women had to have diagnosis of antiphospholipid syndrome; have conceived before April 17, 2020; have an ongoing pregnancy that had reached 12 weeks of gestation; and be included in the study before 18 weeks of gestation. Exclusion criteria were active systemic lupus erythematosus nephropathy, or a multifetal pregnancy. Severe haemorrhage was defined as the need for red blood cell transfusion or maternal intensive care unit admission because of bleeding or invasive procedures, defined as interventional radiology or surgery, to control bleeding. The GR2 study is registered with ClinicalTrials.gov, NCT02450396. FINDINGS Between May 26, 2014, and April 17, 2020, 168 pregnancies in 27 centres met the inclusion criteria for the study. 89 (53%) of 168 women had a history of thrombosis. The median term at inclusion was 8 weeks gestation. 16 (10%) of 168 women (95%CI 5-15) had a thrombotic (six [4%] women; 95% CI 1-8) or severe haemorrhagic event (12 [7%] women; 95% CI 4-12). There were no deaths during the study. The main risk factors for thrombotic events were lupus anticoagulant positivity at inclusion (six [100%] of six women with thrombosis vs 78 [51%] of 152 of those with no thrombosis; p=0·030) and placental insufficiency (four [67%] of six women vs 28 [17%] of 162 women; p=0·013). The main risk factors for severe haemorrhagic events were pre-existing maternal hypertension (four [33%] of 12 women vs 11 [7%] of 156 women; p=0·014), lupus anticoagulant positivity at inclusion (12 [100%] of 12 women vs 72 [49%] of 146 women; p<0·0001) and during antiphospholipid history (12 [100%] of 12 women vs 104 [67%] of 156 women; p=0·019), triple antiphospholipid antibody positivity (eight [67%] of 12 women vs 36 [24%] of 147 women; p=0·0040), placental insufficiency (five [42%] of 12 women vs 27 [17%] of 156 women; p=0·038), and preterm delivery at 34 weeks or earlier (five [45%] of 11 women vs 12 [8%] of 145 women; p=0·0030). INTERPRETATION Despite treatment adhering to international recommendations, a proportion of women with antiphospholipid syndrome developed a thrombotic or severe haemorrhagic complication related to pregnancy, most frequently in the post-partum period. Lupus anticoagulant and placental insufficiency were risk factors for these life-threatening complications. These complications are difficult to prevent, but knowledge of the antenatal characteristics associated with them should increase awareness and help physicians manage these high-risk pregnancies. FUNDING Lupus France, association des Sclérodermiques de France, association Gougerot Sjögren, Association Francophone contre la Polychondrite chronique atrophiante, AFM-Telethon, the French Society of Internal Medicine and Rheumatology, Cochin Hospital, the French Health Ministry, FOREUM, the Association Prix Veronique Roualet, and UCB.
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Affiliation(s)
- Anne Murarasu
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne, Centre de Référence Maladies Auto-immunes et Systémiques Rares, Hôpital Cochin, Université de Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Centre for Clinical Epidemiology, Hôpital Hôtel-Dieu, Université de Paris, Centre of Research in Epidemiology and Statistics, Paris, France
| | - Gaëlle Guettrot-Imbert
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne, Centre de Référence Maladies Auto-immunes et Systémiques Rares, Hôpital Cochin, Université de Paris, Paris, France
| | - Véronique Le Guern
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne, Centre de Référence Maladies Auto-immunes et Systémiques Rares, Hôpital Cochin, Université de Paris, Paris, France
| | - Cécile Yelnik
- Univ Lille, Inserm, CHU Lille, Service de Médecine Interne, U1167 RID-AGE, Lille, France
| | | | - Nicolas Schleinitz
- Service de Médecine Interne, Aix Marseille Université, APHM, Hôpital La Timone, Marseille, France
| | | | | | | | - Emmanuelle Pannier
- Assistance Publique-Hôpitaux de Paris, Service de Maternité Gynécologie Obstétrique Port-Royal, Université de Paris, Hôpital Cochin, Paris, France
| | - Estibaliz Lazaro
- Service de Médecine Interne, Hôpital du Haut-Lévêque, Pessac, France
| | | | | | - Nicolas Belhomme
- Service de Médecine Interne et Immunologie Clinique, Hôpital Sud, Rennes; Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, Rennes, France
| | - Nathalie Morel
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne, Centre de Référence Maladies Auto-immunes et Systémiques Rares, Hôpital Cochin, Université de Paris, Paris, France
| | - Elodie Chauvet
- Service de Médecine Interne, Centre Hospitalier Saint Jean, Perpignan, France
| | - François Maurier
- Service de Médecine Interne et Immunologie Clinique Groupe Hospitalier UNEOS Site Hôpital Robert Schuman, Vantoux, France
| | - Maëlle Le Besnerais
- Service de Médecine Interne, CHU Rouen, Rouen, France; INSERM U 905, Université de Rouen IFRMP, Institute for Biochemical Research, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Noemie Abisror
- Sorbonne Université, Service de Médecine Interne, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Tiphaine Goulenok
- Service de Médecine Interne, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | | | - Alban Deroux
- Service de Médecine Interne, CHU Grenoble-Alpes, Grenoble, France
| | | | - Claire de Moreuil
- Service de Médecine Interne et Pneumologie, CHU de Brest, Brest, France
| | | | - Laurent Pérard
- Service de Médecine Interne, Centre Hospitalier Saint Joseph Saint Luc, Lyon, France
| | - Nicolas Limal
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne, CHU Henri Mondor, Université Paris-Est Créteil, Créteil, France
| | - Vincent Langlois
- Service de Médecine Interne et Maladies Infectieuses, Hôpital Le Havre, Le Havre, France
| | - Anne Calas
- Service de Médecine Interne, Polyclinique Saint Laurent, Rennes, Frances
| | - Bertrand Godeau
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne, CHU Henri Mondor, Université Paris-Est Créteil, Créteil, France
| | | | - Eric Hachulla
- Univ Lille, Inserm, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France
| | - Fleur Cohen
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Hôpital de la Pitié-Salpêtrière, Service de médecine interne 2, Centre national de référence maladies auto-immunes et systémiques rares, lupus et syndrome des anticorps antiphospholipides, Paris, France
| | - Ygal Benhamou
- Service de Médecine Interne, CHU Rouen, Rouen, France; INSERM U 905, Université de Rouen IFRMP, Institute for Biochemical Research, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Loïc Raffray
- Service Médecine Interne et Dermatologie, CHU Réunion-Hôpital Félix Guyon, Saint Denis, France
| | - Mathilde de Menthon
- Assistance Publique Hôpitaux de Paris, Service de Médecine Interne et Immunologie Clinique, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | | | - Vincent Poindron
- Service d'Immunologie Clinique, Nouvel Hôpital Civil, Strasbourg, France; Centre de référence maladies autoimmunes rares Est Sud Ouest RESO, Strasbourg, France
| | - Luc Mouthon
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne, Centre de Référence Maladies Auto-immunes et Systémiques Rares, Hôpital Cochin, Université de Paris, Paris, France
| | | | - Elisabeth Eléfant
- Centre de Reference sur les Agents Tératogènes (CRAT), Hôpital Armand-Trousseau, Paris, France
| | - Loic Sentilhes
- Service de Gynécologie Obstétrique, CHU de Bordeaux, Bordeaux, France
| | - Anna Molto
- Assistance Publique-Hôpitaux de Paris, Centre for Clinical Epidemiology, Hôpital Hôtel-Dieu, Université de Paris, Centre of Research in Epidemiology and Statistics, Paris, France; Assistance Publique-Hôpitaux de Paris, Service de Rhumatologie, Hôpital Cochin, Université de Paris, Paris, France
| | - Catherine Deneux-Tharaux
- Université de Paris, U1153 Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Nathalie Costedoat-Chalumeau
- Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne, Centre de Référence Maladies Auto-immunes et Systémiques Rares, Hôpital Cochin, Université de Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Centre for Clinical Epidemiology, Hôpital Hôtel-Dieu, Université de Paris, Centre of Research in Epidemiology and Statistics, Paris, France.
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12
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Richier Q, Travers JY, Raffray L. A « tipical » but rare cause of neck pain. Eur J Intern Med 2022; 106:122-123. [PMID: 35985951 DOI: 10.1016/j.ejim.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Quentin Richier
- Internal medicine department, Felix Guyon University hospital, Saint-Denis, La Réunion, France.
| | - Jean-Yves Travers
- Radiology department, Felix Guyon University hospital, Saint-Denis, La Réunion, France
| | - Loïc Raffray
- Internal medicine department, Felix Guyon University hospital, Saint-Denis, La Réunion, France; Université de La Réunion, CNRS 9192, INSERM U1187, IRD 249, Unité Mixte Processus Infectieux en Milieu Insulaire Tropical (PIMIT), Plateforme Technologique CYROI, Sainte-Clotilde, La Réunion, France
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13
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Richier Q, Bataille N, Gauzëre L, Safla I, Villeroy F, Raffray L. Dengue-related maculopathy. J Travel Med 2022; 30:6708358. [PMID: 36130206 DOI: 10.1093/jtm/taac106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/08/2022] [Accepted: 09/10/2022] [Indexed: 11/12/2022]
Abstract
Dengue related maculopathy is an underestimated ocular condition, which could seriously affect patients with long-term scotoma. Here, we report a pedagogical clinical case with optical coherence tomography patterns for clinicians to be aware of this ophthalmological complication. Finally, we discuss the place of this complication in the severity criteria.
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Affiliation(s)
- Quentin Richier
- Internal medicine department, Felix Guyon university hospital, Saint Denis, 97400, La Réunion, France
| | - Noémie Bataille
- Ophthalmology department, Felix Guyon university hospital, Saint Denis, 97400, La Réunion, France
| | - Loraine Gauzëre
- Internal medicine department, Felix Guyon university hospital, Saint Denis, 97400, La Réunion, France
| | - Irchad Safla
- Ophthalmology department, Felix Guyon university hospital, Saint Denis, 97400, La Réunion, France
| | - Fréderic Villeroy
- Ophthalmology department, Felix Guyon university hospital, Saint Denis, 97400, La Réunion, France
| | - Loïc Raffray
- Internal medicine department, Felix Guyon university hospital, Saint Denis, 97400, La Réunion, France.,Unité Mixte Processus Infectieux en Milieu Insulaire Tropical (PIMIT), Université de La Réunion, CNRS 9192, INSERM U1187, IRD 249, Plateforme Technologique CYROI, 97490 Sainte-Clotilde, La Réunion, France
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14
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Dobi A, Dubernet A, Rakoto ML, Seteyen ALS, Vagner D, Lebeau G, Raffray L, Gasque P. Low levels of the key B cell activation marker, HLA-DR, in COVID-19 hospitalized cases are associated with disease severity, dexamethasone treatment, and circulating IL-6 levels. Immunol Res 2022; 70:714-719. [PMID: 35679009 PMCID: PMC9178219 DOI: 10.1007/s12026-022-09269-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/03/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Anthony Dobi
- Unité de Recherche en Pharmaco-Immunologie (UR-EPI), Université et CHU de La Réunion (Site Félix Guyon), 97400, Saint-Denis, France. .,Centre Hospitalier Universitaire Félix Guyon, Allée Des Topazes CS 11021, 97400, St Denis, La Réunion, France.
| | - Arthur Dubernet
- Unité de Recherche en Pharmaco-Immunologie (UR-EPI), Université et CHU de La Réunion (Site Félix Guyon), 97400, Saint-Denis, France
| | - Mahary Lalarizo Rakoto
- Unité de Recherche en Pharmaco-Immunologie (UR-EPI), Université et CHU de La Réunion (Site Félix Guyon), 97400, Saint-Denis, France.,Faculté de Médecine, Campus universitaire Ambohitsaina, BP375, Université d'Antananarivo, Antananarivo, Madagascar
| | - Anne-Laure Sandenon Seteyen
- Unité de Recherche en Pharmaco-Immunologie (UR-EPI), Université et CHU de La Réunion (Site Félix Guyon), 97400, Saint-Denis, France
| | - Damien Vagner
- UMR PIMIT 'Processus Infectieux en Milieu Insulaire Tropical' CNRS 9192, Université de La Réunion, INSERM 1187, IRD 249, 97400, Saint-Denis, France
| | - Grégorie Lebeau
- UMR PIMIT 'Processus Infectieux en Milieu Insulaire Tropical' CNRS 9192, Université de La Réunion, INSERM 1187, IRD 249, 97400, Saint-Denis, France
| | - Loïc Raffray
- Unité de Recherche en Pharmaco-Immunologie (UR-EPI), Université et CHU de La Réunion (Site Félix Guyon), 97400, Saint-Denis, France.,UMR PIMIT 'Processus Infectieux en Milieu Insulaire Tropical' CNRS 9192, Université de La Réunion, INSERM 1187, IRD 249, 97400, Saint-Denis, France.,Service de Médecine Interne, CHU de La Réunion (Site Félix Guyon), 97400, Saint-Denis, France
| | - Philippe Gasque
- Unité de Recherche en Pharmaco-Immunologie (UR-EPI), Université et CHU de La Réunion (Site Félix Guyon), 97400, Saint-Denis, France.,Laboratoire d'Immunologie Clinique et Expérimentale de La Zone Océan Indien (LICE-OI), Pôle de Biologie, CHU de La Réunion (Site Félix Guyon), 97400, Saint-Denis, France
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15
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Maillet F, Abitbol V, Allain J, Pérard L, Espitia O, Riviere E, Durel C, Guilpain P, Mouthon L, Cohen P, Melki I, De Moreuil C, Limal N, Mekinian A, Costedoat-Chalumeau N, Morel N, Harlé J, Raffray L, Boutemy J, Terrier B. Association entre vascularites des gros vaisseaux et maladies inflammatoires chroniques de l’intestin : description d’une cohorte rétrospective multicentrique. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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16
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Bocquet V, Raffray L, Vanhecke C, Goossens J, Scalbert C, Sultan N, Lartigau-Roussin C. Étude de la pagophagie dans un échantillon de 495 adultes bénéficiant d’une perfusion de fer, et revue de la littérature. NUTR CLIN METAB 2022. [DOI: 10.1016/j.nupar.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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17
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Delapierre A, Terrier B, Pillebout E, Baudart P, Jourde-Chiche N, Lioger B, Martis N, Moulis G, Rivière E, Le Gouellec N, Raffray L, Urbanski G, Sanges S, Maurier F, Deroux A, Mekinian A, Monteiro R, Marcelli C, Guillevin L, Maillot F, Lucas B, Aouba A, Audemard-Verger A. Clinical phenotype and cytokine profile of adult IgA vasculitis with joint involvement. Clin Rheumatol 2022; 41:1483-1491. [PMID: 35041109 DOI: 10.1007/s10067-021-05937-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 09/01/2021] [Accepted: 09/21/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Joint involvement can be observed during the course of adult IgA vasculitis (IgAV). However, clinical picture, prognosis, or pathophysiological data associated with this condition have been overlooked. We aimed to describe the clinical characteristics and outcome of IgAV patients with joint involvement and look to a specific cytokine profile. METHODS We analyzed clinical and biological data from a nationwide study that included adult IgAV patients. Presentation and outcomes of patients with or without joint involvement were compared at baseline and during follow-up. Plasma cytokine measurements of IgAV patients included in a prospective study were also analyzed using multiplex assays. RESULTS Among 260 patients, 62% had joint involvement. Among them, rheumatological manifestations included arthralgia (100%) or arthritis (16%), mostly involving the knees and ankles. In multivariate analysis, patients with joint involvement, compared to those without, were younger (p = 0.002; OR 0.87; 95% CI 0.80-0.95) and showed more frequent gastrointestinal tract involvement (p = 0.012; OR = 2.08; 95% CI 1.18-3.67). However, no difference in terms of clinical response, relapse, end-stage renal disease, or death was observed between groups. Among 13 cytokines measured, plasma interleukin (IL)-1β level was higher in patients with joint involvement compared to those without (mean ± SEM IL-1β, 3.5 ± 1.2 vs. 0.47 ± 0.1 pg/ml; p = 0.024) or healthy controls (vs. 1.2 ± 0.5 pg/ml; p = 0.076). CONCLUSION Joint involvement is frequent in adult IgAV and is associated with more frequent gastrointestinal involvement. Increased plasma IL-1β levels raise the question of targeting this cytokine in patients with chronic and/or refractory joint involvement. Key Points • Joint involvement in adult IgAV is a frequent manifestation. • Joint involvement is associated with more frequent gastrointestinal manifestations. • Interleukin-1β (IL-1β) might orchestrate joint inflammation in adult IgAV. • IL-1β might be a therapeutic target in patients with chronic and/or refractory joint involvement.
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Affiliation(s)
- Alice Delapierre
- Department of Rheumatology, Normandie UNIV, UNICAEN, CHU de Caen Normandie, 14 000, Caen, France
| | - Benjamin Terrier
- Université Paris Descartes, Paris, France.,Department of Internal Medicine, Hôpital Cochin, Paris, France.,National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Evangéline Pillebout
- Department of Nephrology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Pauline Baudart
- Department of Rheumatology, Normandie UNIV, UNICAEN, CHU de Caen Normandie, 14 000, Caen, France
| | - Noémie Jourde-Chiche
- Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie Et Transplantation Rénale, CHU de La Conception, AP-HM, Marseille, France
| | - Bertrand Lioger
- Department of Internal Medicine, Hôpital Saint Louis, APHP, Paris, France
| | - Nihal Martis
- Department of Internal Medicine, CHU, Nice, France
| | | | | | - Noémie Le Gouellec
- Department of Internal Medicine and Nephrology, Valenciennes, CH, France
| | - Loïc Raffray
- Department of Internal Medicine, CHU, La Réunion, France
| | | | - Sébastien Sanges
- Département de Médecine Interne Et Immunologie Clinique, CHU Lille, 59000, Lille, France.,Univ. Lille, INSERM, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France
| | | | - Alban Deroux
- Department of Internal Medicine, CHU de Grenoble, Grenoble, France
| | - Arsène Mekinian
- Department of Internal Medicine, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Renato Monteiro
- Center of Research On Inflammation INSERM U1149, CNRS ERL8252, Paris Diderot University, Paris, France
| | - Christian Marcelli
- Department of Rheumatology, Normandie UNIV, UNICAEN, CHU de Caen Normandie, 14 000, Caen, France
| | - Loïc Guillevin
- Université Paris Descartes, Paris, France.,Department of Internal Medicine, Hôpital Cochin, Paris, France.,National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Francois Maillot
- Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France.,University of Tours, Tours, France
| | - Bruno Lucas
- Paris Descartes University, Cochin Institute, CNRS UMR8104, INSERM U1016, Paris, France
| | - Achille Aouba
- Department of Internal Medicine and Clinical Immunology, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Alexandra Audemard-Verger
- Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France. .,University of Tours, Tours, France.
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roussin C, Raffray L, Sultant-Bichat N, Christophe V, Goossens J, Bocquet V, Sadones-Scalbert C. Étude de la pagophagie dans un échantillon de 495 adultes bénéficiant d’une perfusion de fer. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Maillet M, Bagny K, Sultant-Bichat N, Renou F, Gerber A, Klisnick J, Gauzere L, Randrianjohany A, Roussin C, Osdoit S, Bertolotti A, Raffray L. Épidémiologie du Lupus Érythémateux Cutané dans la population multi-ethnique de la Réunion : une étude rétrospective multicentrique. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Frumence E, Lebeau G, Viranaicken W, Dobi A, Vagner D, Lalarizo Rakoto M, Sandenon Seteyen AL, Giry C, Septembre-Malaterre A, Raffray L, Gasque P. Robust and low-cost ELISA based on IgG-Fc tagged recombinant proteins to screen for anti-SARS-CoV-2 antibodies. J Immunol Methods 2021; 495:113082. [PMID: 34051226 PMCID: PMC8152238 DOI: 10.1016/j.jim.2021.113082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 11/06/2022]
Abstract
The development of new diagnostic assays become a priority for managing COVID-19. To this aim, we presented here an in-house ELISA based on the production of two major recombinant and high-quality antigens from SARS-CoV-2. Full-length N and S-RBD fragment proteins fused to mouse IgG2a-Fc were produced in the CHO cell line. Secreted recombinant proteins were easily purified with standard Protein A chromatography and were used in an in-house ELISA to detect anti-N and anti-RBD IgGs in the plasma of COVID-19 RTPCR-positive patients. High reactivity against recombinant antigens was readily detected in all positive plasma samples, whereas no recognition was observed with control healthy subject's plasmas. Remarkably, unpurified recombinant N protein obtained from cell culture supernatant was also suitable for the monitoring by ELISA of IgG levels in positive patients. This work provides an early prospection for low price but high-quality serological kit development.
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Affiliation(s)
- Etienne Frumence
- Unité de recherche en Pharmaco-Immunologie (UR-EPI), Université et CHU de La Réunion, Saint-Denis 97400, France; Laboratoire d'immunologie Clinique et expérimentale de la ZOI (LICE-OI), Pôle de Biologie, CHU de La Réunion, Saint-Denis 97400, France.
| | - Grégorie Lebeau
- Unité de recherche en Pharmaco-Immunologie (UR-EPI), Université et CHU de La Réunion, Saint-Denis 97400, France; Laboratoire d'immunologie Clinique et expérimentale de la ZOI (LICE-OI), Pôle de Biologie, CHU de La Réunion, Saint-Denis 97400, France
| | - Wildriss Viranaicken
- UMR PIMIT 'Processus Infectieux en Milieu Insulaire Tropical' CNRS 9192, INSERM1187, IRD 249, Université de La Réunion, Saint-Denis 97400, France
| | - Anthony Dobi
- Unité de recherche en Pharmaco-Immunologie (UR-EPI), Université et CHU de La Réunion, Saint-Denis 97400, France; Laboratoire d'immunologie Clinique et expérimentale de la ZOI (LICE-OI), Pôle de Biologie, CHU de La Réunion, Saint-Denis 97400, France
| | - Damien Vagner
- Laboratoire d'immunologie Clinique et expérimentale de la ZOI (LICE-OI), Pôle de Biologie, CHU de La Réunion, Saint-Denis 97400, France; UMR PIMIT 'Processus Infectieux en Milieu Insulaire Tropical' CNRS 9192, INSERM1187, IRD 249, Université de La Réunion, Saint-Denis 97400, France
| | - Mahary Lalarizo Rakoto
- Unité de recherche en Pharmaco-Immunologie (UR-EPI), Université et CHU de La Réunion, Saint-Denis 97400, France; Laboratoire d'immunologie Clinique et expérimentale de la ZOI (LICE-OI), Pôle de Biologie, CHU de La Réunion, Saint-Denis 97400, France; Faculté de Médecine, Campus universitaire Ambohitsaina, BP375, Université d'Antananarivo, Madagascar
| | - Anne-Laure Sandenon Seteyen
- Unité de recherche en Pharmaco-Immunologie (UR-EPI), Université et CHU de La Réunion, Saint-Denis 97400, France; Laboratoire d'immunologie Clinique et expérimentale de la ZOI (LICE-OI), Pôle de Biologie, CHU de La Réunion, Saint-Denis 97400, France
| | - Claude Giry
- CNR associé arbovirus, Laboratoire de Microbiologie, Pôle de Biologie, CHU de La Réunion, Saint-Denis 97440, France
| | - Axelle Septembre-Malaterre
- Unité de recherche en Pharmaco-Immunologie (UR-EPI), Université et CHU de La Réunion, Saint-Denis 97400, France; Laboratoire d'immunologie Clinique et expérimentale de la ZOI (LICE-OI), Pôle de Biologie, CHU de La Réunion, Saint-Denis 97400, France
| | - Loïc Raffray
- UMR PIMIT 'Processus Infectieux en Milieu Insulaire Tropical' CNRS 9192, INSERM1187, IRD 249, Université de La Réunion, Saint-Denis 97400, France; Service de Médecine Interne, Centre Hospitalier Universitaire La Réunion Site Félix Guyon, CS11021, 97400 Saint Denis de La Réunion, France
| | - Philippe Gasque
- Unité de recherche en Pharmaco-Immunologie (UR-EPI), Université et CHU de La Réunion, Saint-Denis 97400, France; Laboratoire d'immunologie Clinique et expérimentale de la ZOI (LICE-OI), Pôle de Biologie, CHU de La Réunion, Saint-Denis 97400, France
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21
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Audemard-Verger A, Pillebout E, Amoura Z, Cacoub P, Jourde-Chiche N, Lioger B, Martis N, Moulis G, Rivière E, Baldolli A, Girard C, Goutte J, Gouellec NL, Raffray L, Urbanski G, Sanges S, Maurier F, Thervet E, Aouba A, Guillevin L, Maillot F, Terrier B. Gastrointestinal involvement in adult IgA vasculitis (Henoch-Schönlein purpura): updated picture from a French multicentre and retrospective series of 260 cases. Rheumatology (Oxford) 2021; 59:3050-3057. [PMID: 32211770 DOI: 10.1093/rheumatology/keaa104] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/20/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To describe the clinical presentation, treatments and prognosis of gastrointestinal (GI) involvement in adult IgA vasculitis (IgAV). METHODS Data from 260 adults with IgAV included in a French multicentre retrospective survey were analysed. Presentation and outcomes of patients with (GI+) and without (GI-) GI involvement were compared. RESULTS One hundred and thirty-seven (53%) patients had GI involvement. Initial manifestations were abdominal pain in 99%, intestinal bleeding in 31%, diarrhoea in 26% and acute surgical abdomen in only 4%. Abdominal imaging revealed thickening of intestinal wall in 61%, and endoscopies revealed abnormalities in 87%, mostly mucosal ulcerations. GI+ vs GI- patients were younger (46 ± 18 vs 54 ± 18 years; P = 0.0004), had more constitutional symptoms (43% vs 23%; P = 0.0005) and joint involvement (72 vs 50%; P = 0.0002), and higher CRP levels (3.7 vs 1.9 mg/dl; P = 0.001). Clinical response and relapse rates were comparable between groups, and all causes mortality (2 vs 4%) and IgAV-related mortality (1% vs 2%) as well. GI-related deaths were due to intestinal perforation and mesenteric ischaemia. CONCLUSION GI involvement is frequent in adult IgAV. GI involvement is frequent in adult IgAV. Mortality is not uncommon but does not seem to be specifically related to GI. Immunosuppressants should not be preferred as first-line therapy for GI+ patients but may be required in case of acute surgical abdomen.
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Affiliation(s)
| | - Evangéline Pillebout
- Department of Nephrology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP)
| | | | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Hôpital Pitié-Salpétrière.,Inflammation-Immunopathology-Biotherapy Department (DHU i2B), UMR 7211, UPMC Université Paris 06, Sorbonne Universités, Paris
| | | | - Bertrand Lioger
- Department of Internal Medicine, Hopital Saint Louis, APHP, Paris
| | | | | | | | | | | | - Julie Goutte
- Department of Internal Medicine, CHU, Saint-Etienne
| | | | - Loïc Raffray
- Department of Internal Medicine, CHU, La Réunion
| | | | - Sébastien Sanges
- Département de Médecine Interne et Immunologie Clinique, CHU.,University Lille, INSERM, U995-LIRIC-Lille Inflammation Research International Centre, Lille
| | | | - Eric Thervet
- Department of Nephrology, Hôpital Européen Georges Pompidou, AP-HP.,Université Paris Descartes
| | | | - Loïc Guillevin
- Department of Internal Medicine.,Université Paris Descartes.,National Referral Centre for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Francois Maillot
- Department of Internal Medicine and Clinical Immunology, CHRU Tours, University of Tours, Tours
| | - Benjamin Terrier
- Department of Internal Medicine.,Université Paris Descartes.,National Referral Centre for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
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22
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Cosse C, Kernéis S, Lescoat A, Pugnet G, Truchetet ME, Priollet P, Diot E, Martin M, Maurier F, Viallard JF, Agard C, Granel B, Berthier S, Fagedet D, Watelet B, Toquet S, Luque Paz D, Giret C, Cerles O, Dion J, Nguyen C, Raffray L, Bertolino J, Jourde W, Le Jeunne C, Mouthon L, Chaigne B. Osteitis in Systemic Sclerosis: a nationwide case-control retrospective study (SCLEROS Study). Arthritis Care Res (Hoboken) 2020; 74:809-817. [PMID: 33278067 DOI: 10.1002/acr.24530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/05/2020] [Accepted: 12/01/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is an autoimmune (AI) connective tissue disorder characterized by skin fibrosis, vasculopathy and dysimmunity. Data regarding osteitis in SSc are scarce. METHOD We performed a nationwide multicentre retrospective case-control study including patients with SSc according to the 2013 ACR/EULAR classification, with a diagnosis of osteitis. The objectives of the study were to describe, to characterize, and to identify associated factors for osteitis in patients with SSc. RESULTS Forty-eight patients were included. Twenty-six patients (54.1%) had osteitis beneath digital tip ulcers. Physical symptoms included: pain (36/48, 75%), erythema (35/48, 73%), and local warmth (35/48, 73%). Thirty-one (65%) patients had C-reactive protein levels >2 mg/L (8 [2.7 - 44.3] mg/L). On X-ray, CT-scans or MRI, osteitis was characterized by swelling or abscess of soft tissues with acro-osteolysis or lysis in 28 patients (58%). Microbiological sampling was performed in 45 (94%) patients. Most pathogens were Staphylococcus aureus (43.8%); anaerobes and Enterobacteriaceae (29.1%) and Pseudomonas aeruginosa (10.4%). Management comprised antibiotics in 37 (77.1%) patients and/or surgery in 26 (54.2%). Fluoroquinolones were used in 22 (45.8%) patients and amoxicillin + beta-lactamase inhibitor in 7 (14.6%). Six (12.6%) patients relapsed, 6 (12.6%) patients had osteitis recurrence, 15 (32%) sequelae, and 2 patients had septic shock and died. CONCLUSION This study confirmed digital tip ulcers as an associated factor for osteitis, and revealed a high rate of functional sequelae. Antimicrobial therapy with oral fluoroquinolone or intravenous amoxicillin and beta-lactamase inhibitor are used as first-line antibiotherapy in SSc patients with osteitis.
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Affiliation(s)
- Cyril Cosse
- Service de Médecine Interne, Centre de Référence Maladies systémiques auto-immunes rares d'Ile de France, Hôpital Cochin, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Solen Kernéis
- Antimicrobial Stewardship Team, APHP, Cochin hospital, University of Paris, Paris, France
| | - Alain Lescoat
- Université Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France; Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, 35203, Rennes, France
| | - Gregory Pugnet
- Service de Médecine Interne, CHU Toulouse, Toulouse, France ; Centre d'Investigation Clinique 1436, CHU Toulouse, Toulouse, France
| | - Marie-Elise Truchetet
- Rheumatology department and national center of reference for rare autoimmune diseases, Bordeaux University Hospital, France
| | - Pascal Priollet
- Service de médecine vasculaire, Hôpital Saint Joseph, Paris, France
| | - Elisabeth Diot
- Service de médecine Interne, Hôpital Bretonneau, Tours Cedex, France
| | - Mickael Martin
- Service de Médecine Interne, Maladies Infectieuses et Tropicales, CHU de Poitiers, Poitiers, France
| | - François Maurier
- Centre de compétence des maladies rares, Hôpitaux privés de Metz, Metz, France
| | - Jean François Viallard
- Département de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire Haut Lévêque, Université de Bordeaux, Pessac, France
| | - Christian Agard
- Service de médecine interne, Hôtel-Dieu, CHU Nantes, Hôpital, Université de Nantes, France
| | - Brigitte Granel
- Service de Médecine Interne, Hôpital Nord, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Sabine Berthier
- Service de Médecine Interne et Immunologie Clinique, CHU F MITTERRAND, Dijon, France
| | - Dorothée Fagedet
- Service de Médecine Interne - CHICAS, hôpital de GAP, Paris, France
| | | | | | - David Luque Paz
- Service des Maladies Infectieuses et Réanimation Médicale, CHU Rennes, France, Rennes
| | - Cloé Giret
- Service de médecine Interne, Hôpital Bretonneau, Tours Cedex, France
| | - Olivier Cerles
- Service de Médecine Interne, Centre de Référence Maladies systémiques auto-immunes rares d'Ile de France, Hôpital Cochin, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jérémie Dion
- Service de Médecine Interne, Centre de Référence Maladies systémiques auto-immunes rares d'Ile de France, Hôpital Cochin, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Christelle Nguyen
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires Paris Centre-Groupe Hospitalier Cochin, Assistance Publique-Hôpitaux de Paris, 75014, Paris, France.,Université de Paris, Faculté de Santé, UFR Médecine Paris Descartes, Sorbonne Paris Cité, 75006, Paris, France.,INSERM UMRS 1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs, UFR Sciences Fondamentales et Biomédicales, Centre Universitaire des Saints-Pères, 75006, Paris, France
| | - Loïc Raffray
- Service Médecine Interne et Dermatologie, CHU Réunion- Hôpital Félix Guyon, Saint Denis, France
| | - Julien Bertolino
- Service de Médecine Interne, Hôpital Nord, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Wendy Jourde
- Département de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Universitaire Haut Lévêque, Université de Bordeaux, Pessac, France
| | - Claire Le Jeunne
- Service de Médecine Interne, Centre de Référence Maladies systémiques auto-immunes rares d'Ile de France, Hôpital Cochin, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies systémiques auto-immunes rares d'Ile de France, Hôpital Cochin, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Benjamin Chaigne
- Service de Médecine Interne, Centre de Référence Maladies systémiques auto-immunes rares d'Ile de France, Hôpital Cochin, Université Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
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Deltombe T, Richier Q, Foucher A, Roussin C, Randrianjohany A, Gerber A, Poubeau P, Raffray L. L’artérite à cellules géantes à La Réunion, un territoire cosmopolite de l’Hémisphère Sud. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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24
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Moussiegt A, Jaubert J, Traversier N, Bertolotti A, Degagne I, Poubeau P, Moiton M, Raffray L. Arthrites gonococciques : Série de 47 cas hospitaliers. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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Hirschinger D, Bertolotti A, Bénéteau S, Koumar Y, Randrianjohany A, Maillard O, Raffray L. Facteurs distinctifs entre leptospirose et dengue à la prise en charge initiale hospitalière en contexte endémo-épidémique. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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26
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Lebeau G, Vagner D, Frumence É, Ah-Pine F, Guillot X, Nobécourt E, Raffray L, Gasque P. Deciphering SARS-CoV-2 Virologic and Immunologic Features. Int J Mol Sci 2020; 21:E5932. [PMID: 32824753 PMCID: PMC7460647 DOI: 10.3390/ijms21165932] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 02/07/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus (SARS-CoV)-2 and its associated pathology, COVID-19, have been of particular concerns these last months due to the worldwide burden they represent. The number of cases requiring intensive care being the critical point in this epidemic, a better understanding of the pathophysiology leading to these severe cases is urgently needed. Tissue lesions can be caused by the pathogen or can be driven by an overwhelmed immune response. Focusing on SARS-CoV-2, we and others have observed that this virus can trigger indeed an immune response that can be dysregulated in severe patients and leading to further injury to multiple organs. The purpose of the review is to bring to light the current knowledge about SARS-CoV-2 virologic and immunologic features. Thus, we address virus biology, life cycle, tropism for many organs and how ultimately it will affect several host biological and physiological functions, notably the immune response. Given that therapeutic avenues are now highly warranted, we also discuss the immunotherapies available to manage the infection and the clinical outcomes.
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Affiliation(s)
- Grégorie Lebeau
- Unité de Recherche Études Pharmaco-Immunologiques, Centre Hospitalier Universitaire La Réunion Site Félix Guyon, CS11021, 97400 Saint Denis de La Réunion, France; (D.V.); (É.F.); (X.G.); (P.G.)
- Laboratoire de Biologie, Secteur Laboratoire d’immunologie Clinique et Expérimentale de la Zone de l’océan Indien (LICE-OI), Centre Hospitalier Universitaire La Réunion Site Félix Guyon, CS11021, 97400 Saint Denis de La Réunion, France
| | - Damien Vagner
- Unité de Recherche Études Pharmaco-Immunologiques, Centre Hospitalier Universitaire La Réunion Site Félix Guyon, CS11021, 97400 Saint Denis de La Réunion, France; (D.V.); (É.F.); (X.G.); (P.G.)
- Unité Mixte de Recherche Processus Infectieux en Milieu Insulaire Tropical (PIMIT), Université de La Réunion, INSERM UMR 1187, CNRS 9192, IRD 249, Platform CYROI, 2 rue Maxime Rivière, 97491 Sainte Clotilde, La Réunion, France
| | - Étienne Frumence
- Unité de Recherche Études Pharmaco-Immunologiques, Centre Hospitalier Universitaire La Réunion Site Félix Guyon, CS11021, 97400 Saint Denis de La Réunion, France; (D.V.); (É.F.); (X.G.); (P.G.)
- Laboratoire de Biologie, Secteur Laboratoire d’immunologie Clinique et Expérimentale de la Zone de l’océan Indien (LICE-OI), Centre Hospitalier Universitaire La Réunion Site Félix Guyon, CS11021, 97400 Saint Denis de La Réunion, France
| | - Franck Ah-Pine
- Service d’anatomo-Pathologie, Centre Hospitalier Universitaire Sud Réunion, 97410 Saint Pierre, France;
| | - Xavier Guillot
- Unité de Recherche Études Pharmaco-Immunologiques, Centre Hospitalier Universitaire La Réunion Site Félix Guyon, CS11021, 97400 Saint Denis de La Réunion, France; (D.V.); (É.F.); (X.G.); (P.G.)
- Service de Rhumatologie, Centre Hospitalier Universitaire La Réunion Site Félix Guyon, CS11021, 97400 Saint Denis de La Réunion, France
| | - Estelle Nobécourt
- Service d’endocrinologie Diabétologie, Centre Hospitalier Universitaire Sud Réunion, 97410 Saint Pierre, France;
- Université de Formation et de Recherche Santé, Université de la Réunion, 97400 Saint-Denis, France
| | - Loïc Raffray
- Service de Médecine Interne, Centre Hospitalier Universitaire La Réunion Site Félix Guyon, CS11021, 97400 Saint Denis de La Réunion, France;
| | - Philippe Gasque
- Unité de Recherche Études Pharmaco-Immunologiques, Centre Hospitalier Universitaire La Réunion Site Félix Guyon, CS11021, 97400 Saint Denis de La Réunion, France; (D.V.); (É.F.); (X.G.); (P.G.)
- Laboratoire de Biologie, Secteur Laboratoire d’immunologie Clinique et Expérimentale de la Zone de l’océan Indien (LICE-OI), Centre Hospitalier Universitaire La Réunion Site Félix Guyon, CS11021, 97400 Saint Denis de La Réunion, France
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Elhani I, Pillebout E, Terrier B, Hankard A, Vrtovsnik F, Jourde-Chiche N, Greillier S, Groh M, Belfeki N, Bigot A, de Boysson H, Pageaux GP, Raffray L, Urbanski G, Ollivier I, Maillot F, Aouba A, Audemard-Verger A. IgA Vasculitis With Underlying Liver Cirrhosis: A French Nationwide Case Series of 20 Patients. J Rheumatol 2020; 48:735-740. [PMID: 32801133 DOI: 10.3899/jrheum.200293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Immunoglobulin A vasculitis (IgAV) and nephropathy (IgAN) share common immunological mechanisms. Liver cirrhosis is well known to be associated with IgAN. Here, we aimed to describe the presentation and outcome of IgAV patients with underlying cirrhosis. METHODS We conducted a French nationwide retrospective study of adult patients presenting with both IgAV and cirrhosis. Baseline characteristics were compared to those of the 260 patients included in the French nationwide IgAV registry (IGAVAS). RESULTS Twenty patients were included, and 7 (35%) were female. The mean ± SD age was 62.7 ± 11 years. At baseline, compared with IGAVAS patients, patients with underlying cirrhosis were older (62.7 ± 11 vs 50.1 ± 18, P < 0.01) and displayed more constitutional symptoms (weight loss 25% vs 8%, P = 0.03). Patients with underlying cirrhosis were also more likely to exhibit elevated serum IgA levels (5.6 g/L vs 3.6 g/L, P = 0.02). Cirrhosis and IgAV were diagnosed simultaneously in 12 patients (60%). Cirrhosis was mainly related to alcohol intake (n = 15, 75%), followed by nonalcoholic steato-hepatitis (n = 2), chronic viral hepatitis (n = 1), hemochromatosis (n = 1), and autoimmune hepatitis (n = 1). During follow-up with a median of 17 months (IQR 12-84), 10/13 (77%) exhibited IgAV remission at Month 3. One patient presented a minor relapse. Six patients died, but no deaths were related to IgAV. CONCLUSION We report the first case series of IgAV patients with underlining cirrhosis, to our knowledge, which was mainly alcohol related. The liver disease did not seem to affect baseline vasculitis characteristics. Physicians should investigate the existence of liver cirrhosis at IgAV diagnosis, especially in the context of alcohol abuse.
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Affiliation(s)
- Ines Elhani
- I. Elhani, MD, A. Hankard, MD, H. de Boysson, MD, A. Aouba, MD, Department of Internal Medicine, Caen, Normandie Université, UNICAEN, CHU de Caen Normandie
| | | | - Benjamin Terrier
- B. Terrier, MD, Université Paris Descartes, and Department of Internal Medicine, Hôpital Cochin, and National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris
| | - Antoine Hankard
- I. Elhani, MD, A. Hankard, MD, H. de Boysson, MD, A. Aouba, MD, Department of Internal Medicine, Caen, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - François Vrtovsnik
- F. Vrtovsnik, MD, Department of Nephrology, Bichat-Claude Bernard Hospital, AP-HP, and Inserm U1149 - CRI, University of Paris, Paris
| | - Noémie Jourde-Chiche
- N. Jourde-Chiche, MD, S. Greillier, MD, Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie et Transplantation Rénale, CHU de la Conception, AP-HM, Marseille
| | - Sophie Greillier
- N. Jourde-Chiche, MD, S. Greillier, MD, Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie et Transplantation Rénale, CHU de la Conception, AP-HM, Marseille
| | - Matthieu Groh
- M. Groh, MD, Department of Internal Medicine, National Referral Center for Hypereosinophilic Syndrome (CEREO), Suresnes
| | - Nabil Belfeki
- N. Belfeki, MD, Department of Internal Medicine, Groupe Hospitalier Sud Ile de France, Melun
| | - Adrien Bigot
- A. Bigot, MD, F. Maillot, MD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, CHRU Tours, and University of Tours, Tours
| | - Hubert de Boysson
- I. Elhani, MD, A. Hankard, MD, H. de Boysson, MD, A. Aouba, MD, Department of Internal Medicine, Caen, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Georges-Philippe Pageaux
- G.P. Pageaux, MD, Liver Transplantation Unit, Digestive Department, Saint Eloi University Hospital, University of Montpellier, Montpellier
| | - Loïc Raffray
- L. Raffray, MD, Department of Internal Medicine, Centre Hospitalier Universitaire de la Réunion, Réunion
| | - Geoffrey Urbanski
- G. Urbanski, MD, Department of Internal Medicine, Centre Hospitalier Universitaire d'Angers, Angers
| | - Isabelle Ollivier
- I. Ollivier, MD, Department of Hepato-Gastroenterology and Nutrition, Caen University Hospital, Caen, France
| | - Francois Maillot
- A. Bigot, MD, F. Maillot, MD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, CHRU Tours, and University of Tours, Tours
| | - Achille Aouba
- I. Elhani, MD, A. Hankard, MD, H. de Boysson, MD, A. Aouba, MD, Department of Internal Medicine, Caen, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Alexandra Audemard-Verger
- A. Bigot, MD, F. Maillot, MD, A. Audemard-Verger, MD, PhD, Department of Internal Medicine and Clinical Immunology, CHRU Tours, and University of Tours, Tours;
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Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA, formerly Churg-Strauss syndrome) is the least frequent antineutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV). Major advances of our knowledge on its pathophysiology have revealed features of both AAV and eosinophilic disorders. The development of targeted biotherapies for both diseases opened new possibilities for EGPA management. In this review, we highlight the rationale underlying the routine treatment strategy, which relies mainly on corticosteroids, with immunosuppressant adjunction for severe disease. However, novel therapies are still needed for refractory/relapsing disease and to alleviate the corticosteroid-dependence of asthma and chronic rhinosinusitis. At present, the most promising biotherapies target either eosinophil biology, like mepolizumab, an anti-interleukin-5, or the B-cell compartment, with rituximab. Recent clinical data on new treatment options are discussed and therapeutic strategies are proposed.
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Affiliation(s)
- Loïc Raffray
- Department of Internal Medicine, Félix-Guyon University Hospital of La Réunion, CS11021, Saint Denis, Reunion
| | - Loïc Guillevin
- Referral Center for Rare Systemic and Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Université Paris Descartes, 27, rue du Faubourg-Saint-Jacques, 75679 Paris Cedex 14, France.
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Abstract
INTRODUCTION Rituximab, an anti-B-cell biological therapy, has been investigated in several clinical trials on antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAVs). AREAS COVERED In this paper, the clinical trials and open-label studies on rituximab efficacy and safety in treating AAVs are reviewed. EXPERT OPINION Rituximab achieved high remission-induction and sustained-maintenance rates for patients with these severe diseases, thereby challenging the cornerstone treatment of corticosteroids and cyclophosphamide followed by azathioprine. Rituximab should be used as first-line therapy with corticosteroids to induce remission of severe AAVs, especially in situations in which cyclophosphamide may be problematic (relapse after cyclophosphamide, women of childbearing age, risk of malignancy). Cyclophosphamide indications are likely to be restricted in the future. Whenever possible, rituximab should be preferred to azathioprine to maintain remission. The current maintenance regimen has been extended to at least 18 months but its optimal duration remains unknown and recent data suggest the possibility to extend treatment to 4 years. Future challenges include defining the best dose regimen: at present, different schedules are used as alternatives to those recognized as standards by health authorities. In addition, it remains to identify which patients will benefit the most from long-term retreatment: potentially those with relapsing disease or anti-proteinase-3 ANCA-positivity.
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Affiliation(s)
- Loïc Raffray
- Department of Internal Medicine, Félix-Guyon University Hospital of La Réunion , Saint-Denis, France
| | - Loïc Guillevin
- Referral Center for Rare Systemic and Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Université Paris Descartes , Paris, France
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Raffray L, Burton RJ, Baker SE, Morgan MP, Eberl M. Zoledronate rescues immunosuppressed monocytes in sepsis patients. Immunology 2019; 159:88-95. [PMID: 31606902 PMCID: PMC6904622 DOI: 10.1111/imm.13132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/04/2019] [Accepted: 10/07/2019] [Indexed: 12/29/2022] Open
Abstract
Severe sepsis is often accompanied by a transient immune paralysis, which is associated with enhanced susceptibility to secondary infections and poor clinical outcomes. The functional impairment of antigen‐presenting cells is considered to be a major hallmark of this septic immunosuppression, with reduced HLA‐DR expression on circulating monocytes serving as predictor of mortality. Unconventional lymphocytes like γδ T‐cells have the potential to restore immune defects in a variety of pathologies including cancer, but their use to rescue sepsis‐induced immunosuppression has not been investigated. Our own previous work showed that Vγ9/Vδ2+ γδ T‐cells are potent activators of monocytes from healthy volunteers in vitro, and in individuals with osteoporosis after first‐time administration of the anti‐bone resorption drug zoledronate in vivo. We show here that zoledronate readily induces upregulation of HLA‐DR, CD40 and CD64 on monocytes from both healthy controls and sepsis patients, which could be abrogated by neutralising the pro‐inflammatory cytokines interferon (IFN)‐γ and tumour necrosis factor (TNF)‐α in the cultures. In healthy controls, the upregulation of HLA‐DR on monocytes was proportional to the baseline percentage of Vγ9/Vδ2 T‐cells in the peripheral blood mononuclear cell population. Of note, a proportion of sepsis patients studied here did not show a demonstrable response to zoledronate, predominantly patients with microbiologically confirmed bloodstream infections, compared with sepsis patients with more localised infections marked by negative blood cultures. Taken together, our results suggest that zoledronate can, at least in some individuals, rescue immunosuppressed monocytes during acute sepsis and thus may help improve clinical outcomes during severe infection.
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Affiliation(s)
- Loïc Raffray
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK.,Department of Internal Medicine, Félix Guyon University Hospital of La Réunion, Saint Denis, France
| | - Ross J Burton
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Sarah E Baker
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Matt P Morgan
- Directorate of Critical Care, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Matthias Eberl
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK.,Systems Immunity Research Institute, Cardiff University, Cardiff, UK
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Lejri-El Euchi H, Chirpaz E, Foucher A, Sultan-Bichat N, Randrianjohany A, Poubeau P, Gamon E, Roussin C, Osdoit S, Raffray L. Vaccination against influenza and pneumococcal infections in patients with autoimmune disorders under biological therapy: Coverage and attitudes in patients and physicians. Eur J Intern Med 2019; 69:25-31. [PMID: 31445784 DOI: 10.1016/j.ejim.2019.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/21/2019] [Accepted: 08/13/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients under biological therapy for auto-immune disease are considered immunosuppressed and several recent recommendations highlight the need for vaccination against influenza and pneumococcal infections. The aims of this study were to evaluate influenza and pneumococcal vaccine coverage among patients receiving biological therapy and identify factors associated with vaccine uptake within this population. METHODS A retrospective cross-sectional study was performed in adult patients attending hospitals for an auto-immune/inflammatory disease and treated with biological therapy. Vaccine uptake was evidenced from patient's medical records or from their pharmacist's records. Questionnaires about attitudes and knowledge regarding vaccinations were administered to patients and their physicians. Multivariable logistic regression was used to determine factors significantly associated with influenza and pneumococcal vaccine receipt. RESULTS A total of 208 patients were included: 52% female and mean age 50.6 (± 14.7) years. Among them 173 completed the questionnaire while 72 physicians replied. Underlying inflammatory diseases were rheumatisms (46%), bowel diseases (31%) and skin diseases (23%). Vaccine uptake was 28% for influenza, 48% for pneumococcus and 22% received both vaccines. Main factors associated to positive uptake were receiving a prescription from a physician, as well as having a good knowledge of vaccines. Factors limiting vaccination were a negative attitude toward vaccines in general, and belonging to the group of inflammatory bowel diseases. CONCLUSIONS Vaccine coverage for influenza and pneumococcal infections are low in the patients under biologics for auto-immune/inflammatory disease. Health policies should reinforce information and promotion of these vaccines among these patients but also the prescribers.
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Affiliation(s)
- Hajer Lejri-El Euchi
- Internal Medicine and Dermatology Unit, Reunion University Hospital, Saint Denis, Reunion Island, France.
| | - Emmanuel Chirpaz
- Statistics and methodological Unit, INSERM CIC 1410, Reunion University Hospital, Saint Denis, Reunion Island, France.
| | - Aurélie Foucher
- Internal Medicine Unit, Reunion University Hospital, Saint Pierre, Reunion Island, France.
| | - Nathalie Sultan-Bichat
- Internal Medicine and Dermatology Unit, Gabriel Martin Hospital, Saint Paul, Reunion Island, France.
| | | | - Patrice Poubeau
- Internal Medicine Unit, Reunion University Hospital, Saint Pierre, Reunion Island, France.
| | - Etienne Gamon
- Rheumatology Unit, Reunion University Hospital, Saint Denis, Reunion Island, France
| | - Céline Roussin
- Internal Medicine and Dermatology Unit, Gabriel Martin Hospital, Saint Paul, Reunion Island, France.
| | - Sophie Osdoit
- Internal Medicine and Dermatology Unit, Reunion University Hospital, Saint Denis, Reunion Island, France.
| | - Loïc Raffray
- Internal Medicine and Dermatology Unit, Reunion University Hospital, Saint Denis, Reunion Island, France.
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Lebeau-Desmoulin L, Bruneau L, Commins J, Herbreteau V, Raffray L. Identifying factors associated with treatment delay in leptospirosis: A retrospective study of patients admitted to hospital in Reunion (Indian Ocean) between 2014 and 2015. Med Mal Infect 2019; 50:352-360. [PMID: 31582278 DOI: 10.1016/j.medmal.2019.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/14/2018] [Accepted: 09/03/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Leptospirosis is a life-threatening zoonotic disease for which delayed treatment onset has been associated to poor prognosis. The purpose of the study was to identify the determinants of therapeutic delay in hospitalized leptospirosis cases. PATIENTS AND METHODS We carried out a retrospective multicenter study in the 4 public hospitals of Reunion Island, South Western Indian Ocean. Medical records of confirmed leptospirosis cases occurring in 2014-2015 were reviewed for socio-economic, demographic, geographic and medical data. The primary outcome measure was the therapeutic delay, defined as the time elapsed between the onset of symptoms and initiation of antibiotics. RESULTS Of the 117 patients included, 107 were men, with an average age of 44.9±15years. The median therapeutic delay was 4 days (interquartile: 2-5 days) and this delay was not found to be associated with severity. The following were found to be at increased risk of having a longer therapeutic delay: cases occurring outside the epidemic period, or rainy season (OR 2.8 [1.08-7.3], P=0.04) and cases with first medical evaluation in primary health care (OR 4.63 [1.43-14.93]; P=0.01) instead of emergency unit. No socio-economic or geographic characteristics were found to be linked to a longer therapeutic delay. CONCLUSION Although delayed treatment was not associated to disease severity, our results indicate that leptospirosis awareness is needed all year in the subtropical area of Reunion Island and particularly in primary care.
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Affiliation(s)
- L Lebeau-Desmoulin
- Service d'accueil des urgences, CHU La Réunion, site Félix-Guyon, allée des Topazes, CS11021, 97400 Saint-Denis, Reunion
| | - L Bruneau
- Unité de soutien méthodologique, CHU La Réunion, site Félix-Guyon, allée des Topazes, CS11021, 97400 Saint-Denis, Reunion
| | - J Commins
- IRD, UMR 228 ESPACE-DEV (IRD/UM/UR/UG/UA), station SEAS-OI, Saint-Pierre, Reunion
| | - V Herbreteau
- IRD, UMR 228 ESPACE-DEV (IRD/UM/UR/UG/UA), station SEAS-OI, Saint-Pierre, Reunion
| | - L Raffray
- Service de médecine interne et dermatologie, CHU La Réunion, site Félix-Guyon, allée des Topazes, CS11021, 97400 Saint-Denis, Reunion.
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Abstract
Eosinophilic granulomatosis with polyangiitis (formerly Churg-Strauss syndrome) is a rare type of anti-neutrophil cytoplasm antibody-associated vasculitis. Nevertheless, eosinophilic granulomatosis with polyangiitis stands apart because it has features of vasculitis and eosinophilic disorders that require targeted therapies somewhat different from those used for other anti-neutrophil cytoplasm antibody-associated vasculitides. Considerable advances have been made in understanding the underlying pathophysiology of eosinophilic granulomatosis with polyangiitis that have highlighted the key role of eosinophils and opened new therapeutic opportunities. Its conventional treatment relies mainly on agents that decrease inflammation: corticosteroids and immunosuppressant adjunction for severe manifestations. New therapeutic approaches are needed for refractory disease, relapses and issues associated with corticosteroid dependence, especially for asthma manifestations. Drugs under evaluation mostly target eosinophils and B cells. Results of low-evidence-based trials suggested possible efficacies of biologicals: B-cell-blocking rituximab and anti-immunoglobulin E omalizumab. Recently, the first large-scale randomised controlled trial on eosinophilic granulomatosis with polyangiitis proved the efficacy of anti-interleukin-5 mepolizumab. That finding opens a new era in eosinophilic granulomatosis with polyangiitis management, with mepolizumab approval but also in future drug evaluations and trial designs for eosinophilic granulomatosis with polyangiitis. Additional studies are needed to determine which patients would benefit most from targeted therapies and achieve personalised treatment for patients with eosinophilic granulomatosis with polyangiitis. Herein, we review eosinophilic granulomatosis with polyangiitis characteristics and provide an overview of established and novel pharmacological agents.
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Affiliation(s)
- Loïc Raffray
- Department of Internal Medicine, Félix-Guyon University Hospital of La Réunion, Saint Denis, Réunion Island, France
| | - Loïc Guillevin
- Department of Internal Medicine, Referral Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Université Paris Descartes, Paris, France.
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Gaüzère L, Gerber A, Renou F, Ferrandiz D, Bagny K, Osdoit S, Yvin JL, Raffray L. [Epidemiology of systemic lupus erythematosus in Reunion Island, Indian Ocean: A case-series in adult patients from a University Hospital]. Rev Med Interne 2018; 40:214-219. [PMID: 30041816 DOI: 10.1016/j.revmed.2018.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/01/2018] [Accepted: 07/03/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The study aimed at assessing the epidemiology and clinical features of systemic lupus erythematosus (SLE) in Reunion Island, South West of Indian Ocean. PATIENTS AND METHODS A retrospective study was conducted at the University Hospital of La Reunion (Saint-Denis) by charts review from 2004 to 2015. Patients with a SLE diagnosed over 15 years according to SLICC 2012 criteria were included. Incidence and prevalence were inferred from national health insurance database and population census results. RESULTS In total, 123 patients met inclusion criteria: 116 were women (94%) and mean age at diagnosis was 34.7±13.4 years. Ten percent of all patients had a least one parent with autoimmune disease, and 4% with lupus. The main manifestations were musculoskeletal (89%) and mucocutaneous with acute or subacute lesions (76%), alopecia (25%), ulcers (15%) and discoid lupus (11%). Lupus nephropathy occurred in 39%, serositis in 31% and neurological features in 15%. Antinuclear antibodies were positive in 99% (threshold >1/80), and associated to anti-DNA (70%), anti-SSA (47%), anti-RNP (42%), and anti-Sm (37%). APL syndrome was diagnosed in 15%. The average annual standardized incidence between 2010 and 2016 was 6.3 cases per 100,000 inhabitants (95% confidence interval [CI]: 5.6-6.9). The prevalence was 76 cases per 100,000 inhabitants in 2016 (95% CI: 70-82). CONCLUSION Lupus in the multi-ethnic population of Reunion Island is characterized by high incidence and high rates of articular and renal manifestations, as well as anti-ENA antibodies.
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Affiliation(s)
- L Gaüzère
- Service de médecine interne, hôpital Félix-Guyon, CHU de La Réunion, allée des Topazes, CS 11021, 97400 Saint-Denis, Réunion
| | - A Gerber
- Service de médecine interne, hôpital Félix-Guyon, CHU de La Réunion, allée des Topazes, CS 11021, 97400 Saint-Denis, Réunion
| | - F Renou
- Service de médecine interne, hôpital Félix-Guyon, CHU de La Réunion, allée des Topazes, CS 11021, 97400 Saint-Denis, Réunion
| | - D Ferrandiz
- Service de médecine interne, hôpital Félix-Guyon, CHU de La Réunion, allée des Topazes, CS 11021, 97400 Saint-Denis, Réunion
| | - K Bagny
- Service de médecine interne, hôpital Félix-Guyon, CHU de La Réunion, allée des Topazes, CS 11021, 97400 Saint-Denis, Réunion
| | - S Osdoit
- Service de médecine interne, hôpital Félix-Guyon, CHU de La Réunion, allée des Topazes, CS 11021, 97400 Saint-Denis, Réunion
| | - J L Yvin
- Service de médecine interne, hôpital Félix-Guyon, CHU de La Réunion, allée des Topazes, CS 11021, 97400 Saint-Denis, Réunion
| | - L Raffray
- Service de médecine interne, hôpital Félix-Guyon, CHU de La Réunion, allée des Topazes, CS 11021, 97400 Saint-Denis, Réunion.
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Audemard A, Baldolli A, Le Gouellec N, Raffray L, Deroux A, Goutte J, Lioger B, Amoura Z, Cacoub P, Sanges S, Pillebout E, Terrier B. Impact de l’âge sur la présentation clinique et le pronostic au cours de la vascularite à IgA de l’adulte. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.03.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gauzere L, Gerber A, Yvin J, Ferrandiz D, Renou F, Chirpaz E, Bagny K, Osdoit S, Raffray L. Caractéristiques épidémiologiques, cliniques et biologiques du lupus érythémateux systémique au CHU de Saint-Denis (Réunion) : étude rétrospective de janvier 2004 à juillet 2015. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Audemard-Verger A, Dechartres A, Amoura Z, Le Gouellec N, Cacoub P, Urbanski G, Augusto J, Moulis G, Raffray L, Thervet E, Pillebout E, Terrier B. Caractéristiques et prise en charge des vascularites à IgA (purpura rhumatoïde) de l’adulte : résultats des 260 patients inclus dans l’enquête IGAVAS. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Raffray L, Renou F, Bourdier-de-Beauregard M, Lartigau-Roussin C, Mohamed S. [Vomiting and abdominal pain in a 29-year-old man]. Rev Med Interne 2016; 38:65-68. [PMID: 27745938 DOI: 10.1016/j.revmed.2016.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 07/26/2016] [Indexed: 11/17/2022]
Affiliation(s)
- L Raffray
- Service de médecine interne et dermatologie, CHU La Réunion, site Félix-Guyon, allée des Topazes, CS11021, 97400 Saint-Denis, Réunion.
| | - F Renou
- Service de médecine interne et dermatologie, CHU La Réunion, site Félix-Guyon, allée des Topazes, CS11021, 97400 Saint-Denis, Réunion
| | | | - C Lartigau-Roussin
- Service de médecine interne et gastro-entérologie, CH Gabriel-Martin, 97460 Saint-Paul, Réunion
| | - S Mohamed
- Service de médecine interne et d'immunologie clinique, CHRU de Brabois-Nancy, rue Morvan, 54500 Vandœuvre-lès-Nancy, France
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Lartigau-Roussin C, Paclet MH, Audin H, Toussaint B, Henni T, Raffray L. [Macro-AST and myeloma: An incidental association?]. Rev Med Interne 2016; 38:210-213. [PMID: 27745940 DOI: 10.1016/j.revmed.2016.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/29/2016] [Accepted: 05/28/2016] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Macro-AST is recognized as a classical aetiology of isolated and persistent increase of serum aspartate aminotransferase (AST) levels. Macro-AST are high molecular weight complexes associating AST and a macromolecule, often an immunoglobulin. Although those macroenzymes of unknown pathogenesis are usually non-pathogenic, association with several diseases, including autoimmune diseases and liver diseases has been described. CASE REPORT We report here the case of a 45-year-old patient with previously normal liver enzymes in whom an AST elevation and an IgA monoclonal gammopathy were discovered concomitantly. Following the diagnosis of multiple myeloma, we could evidence in the patient's serum a complex between AST and the monoclonal IgA. AST levels course followed closely the progression of monoclonal gammopathy. CONCLUSION This is the first report demonstrating a clear link between macro-AST and a monoclonal gammopathy.
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Affiliation(s)
- C Lartigau-Roussin
- Service de gastro-entérologie et de médecine interne, centre hospitalier Gabriel-Martin, 38, rue Labourdonnais, 97460 Saint-Paul, Réunion.
| | - M H Paclet
- Laboratoire de biochimie des enzymes et des protéines, DBTP, institut de biologie et pathologie, CHU Grenoble Alpes, 38043 Grenoble, France
| | - H Audin
- Service de gastro-entérologie et de médecine interne, centre hospitalier Gabriel-Martin, 38, rue Labourdonnais, 97460 Saint-Paul, Réunion
| | - B Toussaint
- Laboratoire de biochimie des enzymes et des protéines, DBTP, institut de biologie et pathologie, CHU Grenoble Alpes, 38043 Grenoble, France
| | - T Henni
- Service d'hématologie, CHU La Réunion site Félix-Guyon, allée des Topazes, CS11021, 97400 Saint-Denis, Réunion
| | - L Raffray
- Service de médecine interne, CHU La Réunion site Félix-Guyon, allée des Topazes, CS11021, 97400 Saint-Denis, Réunion
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Cohen Aubart F, Haroche J, Emile J, Fuzibet J, Granel B, Grosbois B, Ly K, Lazaro E, Saadoun D, Maurier F, Raffray L, Amoura Z. Les patients ayant une maladie d’Erdheim-Chester avec mutation BRAF V600E ont un profil cardiovasculaire plus marqué que ceux non mutés. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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41
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Mekinian A, Grignano E, Braun T, Decaux O, Liozon E, Costedoat-Chalumeau N, Kahn JE, Hamidou M, Park S, Puéchal X, Toussirot E, Falgarone G, Launay D, Morel N, Trouiller S, Mathian A, Gombert B, Schoindre Y, Lioger B, De Wazieres B, Amoura Z, Buchdaul AL, Georgin-Lavialle S, Dion J, Madaule S, Raffray L, Cathebras P, Piette JC, Rose C, Ziza JM, Lortholary O, Montestruc F, Omouri M, Denis G, Rossignol J, Nimubona S, Adès L, Gardin C, Fenaux P, Fain O. Systemic inflammatory and autoimmune manifestations associated with myelodysplastic syndromes and chronic myelomonocytic leukaemia: a French multicentre retrospective study. Rheumatology (Oxford) 2015; 55:291-300. [DOI: 10.1093/rheumatology/kev294] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Indexed: 01/02/2023] Open
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Raffray L, Rivière P, Bonnet H, Duffau P, Longy-Boursier M. Hépatite granulomateuse révélant une infection disséminée à Mycobacterium bovis après BCG-thérapie intravésicale. Rev Med Interne 2015; 36:626-30. [DOI: 10.1016/j.revmed.2014.10.361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 05/21/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
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Jacquemin C, Schmitt N, Contin-Bordes C, Liu Y, Narayanan P, Seneschal J, Maurouard T, Dougall D, Davizon ES, Dumortier H, Douchet I, Raffray L, Richez C, Lazaro E, Duffau P, Truchetet ME, Khoryati L, Mercié P, Couzi L, Merville P, Schaeverbeke T, Viallard JF, Pellegrin JL, Moreau JF, Muller S, Zurawski S, Coffman RL, Pascual V, Ueno H, Blanco P. OX40 Ligand Contributes to Human Lupus Pathogenesis by Promoting T Follicular Helper Response. Immunity 2015; 42:1159-70. [PMID: 26070486 DOI: 10.1016/j.immuni.2015.05.012] [Citation(s) in RCA: 159] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 01/29/2015] [Accepted: 03/23/2015] [Indexed: 01/29/2023]
Abstract
Increased activity of T follicular helper (Tfh) cells plays a major pathogenic role in systemic lupus erythematosus (SLE). However, the mechanisms that cause aberrant Tfh cell responses in SLE remain elusive. Here we showed the OX40 ligand (OX40L)-OX40 axis contributes to the aberrant Tfh response in SLE. OX40L was expressed by myeloid antigen-presenting cells (APCs), but not B cells, in blood and in inflamed tissues in adult and pediatric SLE patients. The frequency of circulating OX40L-expressing myeloid APCs positively correlated with disease activity and the frequency of ICOS(+) blood Tfh cells in SLE. OX40 signals promoted naive and memory CD4(+) T cells to express multiple Tfh cell molecules and were sufficient to induce them to become functional B cell helpers. Immune complexes containing RNA induced OX40L expression on myeloid APCs via TLR7 activation. Our study provides a rationale to target the OX40L-OX40 axis as a therapeutic modality for SLE.
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Affiliation(s)
- Clément Jacquemin
- University Bordeaux, CIRID, UMR/CNRS 5164, F-33000 Bordeaux, France; CNRS, CIRID, UMR 5164, F-33000 Bordeaux, France
| | | | - Cécile Contin-Bordes
- University Bordeaux, CIRID, UMR/CNRS 5164, F-33000 Bordeaux, France; CNRS, CIRID, UMR 5164, F-33000 Bordeaux, France; CHU de Bordeaux, F-33076 Bordeaux, France
| | - Yang Liu
- Baylor Institute for Immunology Research, Dallas, TX 75204, USA
| | - Priya Narayanan
- Baylor Institute for Immunology Research, Dallas, TX 75204, USA
| | - Julien Seneschal
- University Bordeaux, CIRID, UMR/CNRS 5164, F-33000 Bordeaux, France; CNRS, CIRID, UMR 5164, F-33000 Bordeaux, France; CHU de Bordeaux, F-33076 Bordeaux, France
| | | | - David Dougall
- Baylor Institute for Immunology Research, Dallas, TX 75204, USA
| | | | - Hélène Dumortier
- CNRS, Immunopathology and therapeutic chemistry/Laboratory of excellence MEDALIS, Institut de Biologie Moléculaire et Cellulaire;University of Strasbourg, F-67081 Strasbourg, France
| | | | | | - Christophe Richez
- University Bordeaux, CIRID, UMR/CNRS 5164, F-33000 Bordeaux, France; CNRS, CIRID, UMR 5164, F-33000 Bordeaux, France; CHU de Bordeaux, F-33076 Bordeaux, France
| | - Estibaliz Lazaro
- University Bordeaux, CIRID, UMR/CNRS 5164, F-33000 Bordeaux, France; CNRS, CIRID, UMR 5164, F-33000 Bordeaux, France; CHU de Bordeaux, F-33076 Bordeaux, France
| | - Pierre Duffau
- University Bordeaux, CIRID, UMR/CNRS 5164, F-33000 Bordeaux, France; CNRS, CIRID, UMR 5164, F-33000 Bordeaux, France; CHU de Bordeaux, F-33076 Bordeaux, France
| | - Marie-Elise Truchetet
- University Bordeaux, CIRID, UMR/CNRS 5164, F-33000 Bordeaux, France; CNRS, CIRID, UMR 5164, F-33000 Bordeaux, France; CHU de Bordeaux, F-33076 Bordeaux, France
| | - Liliane Khoryati
- University Bordeaux, CIRID, UMR/CNRS 5164, F-33000 Bordeaux, France; CNRS, CIRID, UMR 5164, F-33000 Bordeaux, France
| | - Patrick Mercié
- University Bordeaux, CIRID, UMR/CNRS 5164, F-33000 Bordeaux, France; CHU de Bordeaux, F-33076 Bordeaux, France
| | - Lionel Couzi
- University Bordeaux, CIRID, UMR/CNRS 5164, F-33000 Bordeaux, France; CHU de Bordeaux, F-33076 Bordeaux, France
| | - Pierre Merville
- University Bordeaux, CIRID, UMR/CNRS 5164, F-33000 Bordeaux, France; CNRS, CIRID, UMR 5164, F-33000 Bordeaux, France; CHU de Bordeaux, F-33076 Bordeaux, France
| | - Thierry Schaeverbeke
- University Bordeaux, CIRID, UMR/CNRS 5164, F-33000 Bordeaux, France; CHU de Bordeaux, F-33076 Bordeaux, France
| | - Jean-François Viallard
- University Bordeaux, CIRID, UMR/CNRS 5164, F-33000 Bordeaux, France; CHU de Bordeaux, F-33076 Bordeaux, France
| | - Jean-Luc Pellegrin
- University Bordeaux, CIRID, UMR/CNRS 5164, F-33000 Bordeaux, France; CHU de Bordeaux, F-33076 Bordeaux, France
| | - Jean-François Moreau
- University Bordeaux, CIRID, UMR/CNRS 5164, F-33000 Bordeaux, France; CNRS, CIRID, UMR 5164, F-33000 Bordeaux, France; CHU de Bordeaux, F-33076 Bordeaux, France
| | - Sylviane Muller
- CNRS, Immunopathology and therapeutic chemistry/Laboratory of excellence MEDALIS, Institut de Biologie Moléculaire et Cellulaire;University of Strasbourg, F-67081 Strasbourg, France; University of Strasbourg Institute for Advanced Study, F-67081 Strasbourg, France
| | - Sandy Zurawski
- Baylor Institute for Immunology Research, Dallas, TX 75204, USA
| | | | | | - Hideki Ueno
- Baylor Institute for Immunology Research, Dallas, TX 75204, USA.
| | - Patrick Blanco
- University Bordeaux, CIRID, UMR/CNRS 5164, F-33000 Bordeaux, France; CNRS, CIRID, UMR 5164, F-33000 Bordeaux, France; Baylor Institute for Immunology Research, Dallas, TX 75204, USA; CHU de Bordeaux, F-33076 Bordeaux, France.
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Raffray L, Karkowski L, Dupon M, Constans J, Pellegrin JL, Catroux M. Actinomycoses en service de médecine : série de 21 cas. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.03.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Raffray L, Assenjee L, Yvin JL, Gerber A, Bouquillard E, Renou F, Roussin C, Thirapathi-Appadu Y, Foucher A, Poubeau P, Ferrandiz D. Épidémiologie de la sclérodermie systémique à La Réunion. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.03.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bagny K, Osdoit S, Raffray L, Gerber A, Yvin J. Une poussée lupique atypique. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.03.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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47
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Bertolotti A, Raffray L, Liferman F, Doutre MS, Longy-Boursier M, Beylot-Barry M. Atteinte cutanée de la maladie d’Erdheim-Chester : 4 cas. Ann Dermatol Venereol 2013. [DOI: 10.1016/j.annder.2013.09.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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48
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Baulier G, Victor J, Raffray L, Mercié P, Duffau P. Une toux hypogammaglobulinémique. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.10.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Raffray L, Bertolotti A, Duffau P, Longueville E, Mercié P, Longy-Boursier M. [An exophtalmos]. Presse Med 2013; 42:1674-7. [PMID: 24144886 DOI: 10.1016/j.lpm.2013.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 02/10/2013] [Accepted: 03/18/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- Loïc Raffray
- Hôpital St André, service de médecine interne, CHU de Bordeaux, 33075 Bordeaux, France.
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50
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Raffray L, Longy-Boursier M, Bronnimann D, Duffau P, Constans J, Pellegrin JL. Actinomycoses : présentations en service de médecine interne. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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