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Vieux N, Perrier Q, Bedouch P, Epaulard O. Much ado about nothing? Discrepancy between the available data on the antiviral effect of hydroxychloroquine in March 2020 and its inclusion in COVID-19 clinical trials and outpatient prescriptions. Public Health 2023; 225:35-44. [PMID: 37918175 DOI: 10.1016/j.puhe.2023.09.018] [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: 03/22/2023] [Revised: 07/10/2023] [Accepted: 09/24/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVES Many of the 2020 COVID-19 clinical trials included an (hydroxy)chloroquine ((H)CQ) arm. We aimed to juxtapose the state of science before April 2020 regarding the benefits of (H)CQ for viral infections with the number and size of the clinical trials studying (H)CQ and the volume of (H)CQ dispensed in France. STUDY DESIGN We identified and analysed published scientific material regarding the antiviral activity of (H)CQ and publicly available data regarding clinical trials and drug dispensation in France. METHODS We conducted a review of scientific publications available before April 2020 and a systematic analysis of COVID-19 clinical trials featuring (H)CQ registered on clinicaltrials.gov. RESULTS Before April 2020, 894 scientific publications mentioning (H)CQ for viruses other than coronaviruses were available, including 35 in vitro studies (reporting an inconstant inhibition of viral replication), 11 preclinical studies (reporting no or disputable positive effects), and 32 clinical trials (reporting no or disputable positive effects). Moreover, 67 publications on (H)CQ and coronavirus infections were available, including 12 in vitro studies (reporting an inconstant inhibition of viral replication), two preclinical studies (reporting contradictory results), and no clinical trials. Meanwhile, 253 therapeutic clinical trials featuring an HCQ arm were registered in 2020, intending to enrol 246,623 patients. CONCLUSIONS The number and size of (H)CQ clinical trials for COVID-19 launched in 2020 were not supported by the literature published before April 2020.
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Affiliation(s)
- N Vieux
- Pôle Pharmacie, Université Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France
| | - Q Perrier
- Pôle Pharmacie, Université Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, Laboratory of Fundamental and Applied Bioenergetic (LBFA), INSERM U1055, Grenoble, France
| | - P Bedouch
- Pôle Pharmacie, Université Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, CHU Grenoble Alpes, TIMC, 38000 Grenoble, France
| | - O Epaulard
- Infectious Disease Department, Université Grenoble Alpes, Centre Hospitalier Universitaire Grenoble Alpes, Grenoble, France; Groupe de Recherche en Infectiologie Clinique, CIC-1406, INSERM-UGA-CHUGA, France.
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2
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Mailles A, Argemi X, Biron C, Fillatre P, De Broucker T, Buzelé R, Gagneux-Brunon A, Gueit I, Henry C, Patrat-Delon S, Makinson A, Piet E, Wille H, Vareil MO, Epaulard O, Martinot M, Tattevin P, Stahl JP. Changing profile of encephalitis: Results of a 4-year study in France. Infect Dis Now 2021; 52:1-6. [PMID: 34896660 DOI: 10.1016/j.idnow.2021.11.007] [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: 06/19/2021] [Revised: 11/01/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022]
Abstract
CONTEXT In 2007, we performed a nationwide prospective study to assess the epidemiology of encephalitis in France. We aimed to evaluate epidemiological changes 10years later. METHODS We performed a 4-year prospective cohort study in France (ENCEIF) from 2016 to 2019. Medical history, comorbidities, as well as clinical, biological, imaging, and demographic data were collected. For the comparison analysis, we selected similar data from adult patients enrolled in the 2007 study. We used Stata statistical software, version 15 (Stata Corp). Indicative variable distributions were compared using Pearson's Chi2 test, and means were compared using Student's t-test for continuous variables. RESULTS We analyzed 494 cases from 62 hospitals. A causative agent was identified in 65.7% of cases. Viruses represented 81.8% of causative agents, Herpesviridae being the most frequent (63.6%). Arboviruses accounted for 10.8%. Bacteria and parasites were responsible for respectively 14.8% and 1.2% of documented cases. Zoonotic infections represented 21% of cases. When comparing ENCEIF with the 2007 cohort (222 adults patients from 59 hospitals), a higher proportion of etiologies were obtained in 2016-2019 (66% vs. 53%). Between 2007 and 2016-2019, the proportions of Herpes simplex virus and Listeria encephalitis cases remained similar, but the proportion of tuberculosis cases decreased (P=0.0001), while tick-borne encephalitis virus (P=0.01) and VZV cases (P=0.03) increased. In the 2016-2019 study, 32 causative agents were identified, whereas only 17 were identified in the 2007 study. CONCLUSION Our results emphasize the need to regularly perform such studies to monitor the evolution of infectious encephalitis and to adapt guidelines.
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Affiliation(s)
- A Mailles
- Santé Publique France, Saint-Maurice, France; ESCMID Study Group on the infections of the Brain (ESGIB), Basel, Switzerland.
| | - X Argemi
- Infectious diseases and internal medicine department, Axium clinic, Aix-en-Provence, France
| | - C Biron
- Infectious diseases department, CHU Hôtel-Dieu, INSERM UIC 1413, Nantes university, Nantes, France
| | - P Fillatre
- ESCMID Study Group on the infections of the Brain (ESGIB), Basel, Switzerland; Intensive care unit, hôpital Yves-le-Foll, Saint-Brieuc, France
| | | | - R Buzelé
- Infectious diseases unit, hôpital Yves-le-Foll, Saint-Brieuc, France
| | - A Gagneux-Brunon
- Infectious diseases department, hôpital Nord, CHU Saint-Étienne, Saint-Priest-en-Jarez, France
| | - I Gueit
- Department of infectious diseases, CHU Rouen, Rouen, France
| | - C Henry
- Neurology, CH Delafontaine, Saint-Denis, France
| | - S Patrat-Delon
- Infectious diseases department, CHU Ponchaillou, Rennes, France
| | - A Makinson
- Infectious diseases and intensive care unit, Pontchaillou university hospital, Rennes, France
| | - E Piet
- Infectious diseases department, CH Annecy-Genevois, Metz Tessy, France
| | - H Wille
- Infectious diseases department, CH Côte Basque, 64109 Bayonne, France
| | - M O Vareil
- Infectious diseases department, CH Côte Basque, 64109 Bayonne, France
| | - O Epaulard
- ESCMID Study Group on the infections of the Brain (ESGIB), Basel, Switzerland; Université Grenoble Alpes, CHUGA, infectious diseases department, Grenoble, France
| | - M Martinot
- Infectious diseases department CH Colmar, Colmar, France
| | - P Tattevin
- ESCMID Study Group on the infections of the Brain (ESGIB), Basel, Switzerland; Infectious diseases department, CHU Ponchaillou, Rennes, France
| | - J P Stahl
- ESCMID Study Group on the infections of the Brain (ESGIB), Basel, Switzerland; Université Grenoble Alpes, CHUGA, infectious diseases department, Grenoble, France
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Landoas A, Cazzorla F, Gallouche M, Larrat S, Nemoz B, Giner C, Le Maréchal M, Pavese P, Epaulard O, Morand P, Mallaret MR, Landelle C. SARS-CoV-2 nosocomial infection acquired in a French university hospital during the 1st wave of the Covid-19 pandemic, a prospective study. Antimicrob Resist Infect Control 2021; 10:114. [PMID: 34353356 PMCID: PMC8339707 DOI: 10.1186/s13756-021-00984-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/23/2020] [Accepted: 07/20/2021] [Indexed: 02/06/2023] Open
Abstract
Background In healthcare facilities, nosocomial transmissions of respiratory viruses are a major issue. SARS-CoV-2 is not exempt from nosocomial transmission. Our goals were to describe COVID-19 nosocomial cases during the first pandemic wave among patients in a French university hospital and compliance with hygiene measures.
Methods We conducted a prospective observational study in Grenoble Alpes University Hospital from 01/03/2020 to 11/05/2020. We included all hospitalised patients with a documented SARS-CoV-2 diagnosis. Nosocomial case was defined by a delay of 5 days between hospitalisation and first symptoms. Hygiene measures were evaluated between 11/05/2020 and 22/05/2020. Lockdown measures were effective in France on 17/03/2020 and ended on 11/05/2020. Systematic wearing of mask was mandatory for all healthcare workers (HCW) and visits were prohibited in our institution from 13/03/2021 and for the duration of the lockdown period. Results Among 259 patients included, 14 (5.4%) were considered as nosocomial COVID-19. Median time before symptom onset was 25 days (interquartile range: 12–42). Eleven patients (79%) had risk factors for severe COVID-19. Five died (36%) including 4 deaths attributable to COVID-19. Two clusters were identified. The first cluster had 5 cases including 3 nosocomial acquisitions and no tested HCWs were positive. The second cluster had 3 cases including 2 nosocomial cases and 4 HCWs were positive. Surgical mask wearing and hand hygiene compliance were adequate for 95% and 61% of HCWs, respectively. Conclusions The number of nosocomial COVID-19 cases in our hospital was low. Compliance regarding mask wearing, hand hygiene and lockdown measures drastically reduced transmission of the virus. Monitoring of nosocomial COVID-19 cases during the first wave enabled us to determine to what extent the hygiene measures taken were effective and patients protected. Trial registration Study ethics approval was obtained retrospectively on 30 September 2020 (CECIC Rhône-Alpes-Auvergne, Clermont-Ferrand, IRB 5891).
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Affiliation(s)
- A Landoas
- Infection Control Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - F Cazzorla
- Infection Control Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - M Gallouche
- Infection Control Unit, Grenoble Alpes University Hospital, Grenoble, France.,Grenoble Alpes University/CNRS, Grenoble INP, MESP TIM-C UMR 5525, Grenoble, France
| | - S Larrat
- Virology Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - B Nemoz
- Virology Laboratory, Grenoble Alpes University Hospital, Grenoble, France.,Grenoble Alpes University/CNRS/CEA, Institut de Biologie Structurale (IBS), HIV and persistent viral infections, Grenoble, France
| | - C Giner
- Infection Control Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - M Le Maréchal
- Infectious Diseases Department, Grenoble Alpes University Hospital, Grenoble, France
| | - P Pavese
- Infectious Diseases Department, Grenoble Alpes University Hospital, Grenoble, France
| | - O Epaulard
- Infectious Diseases Department, Grenoble Alpes University Hospital, Grenoble, France
| | - P Morand
- Virology Laboratory, Grenoble Alpes University Hospital, Grenoble, France.,Grenoble Alpes University/CNRS/CEA, Institut de Biologie Structurale (IBS), HIV and persistent viral infections, Grenoble, France
| | - M-R Mallaret
- Infection Control Unit, Grenoble Alpes University Hospital, Grenoble, France.,Grenoble Alpes University/CNRS, Grenoble INP, MESP TIM-C UMR 5525, Grenoble, France
| | - C Landelle
- Infection Control Unit, Grenoble Alpes University Hospital, Grenoble, France. .,Grenoble Alpes University/CNRS, Grenoble INP, MESP TIM-C UMR 5525, Grenoble, France. .,Hospital Hygiene Department, Pavilion E - Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France.
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4
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Louaisil E, Nacher M, Adoissi J, Samou Fantcho F, Epaulard O, Ouedraogo E. Facteurs de risque de dépistage tardif au sein d’une zone de forte prévalence du VIH : étude comparative sur 10 ans entre deux hôpitaux régionaux des DOM TOM situés dans des localités distinctes. Infect Dis Now 2021. [DOI: 10.1016/j.idnow.2021.06.281] [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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5
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Lefebvre M, Vignier N, Pitard B, Botelho-Nevers E, Wyplosz B, Cohen R, Epaulard O. COVID-19 vaccines: Frequently asked questions and updated answers. Infect Dis Now 2021; 51:319-333. [PMID: 33681861 PMCID: PMC7910656 DOI: 10.1016/j.idnow.2021.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 02/23/2021] [Indexed: 12/29/2022]
Abstract
At the end of December 2019, China notified the World Health Organization about a viral pneumonia epidemic soon to be named COVID-19, of which the infectious agent, SARS-CoV-2, was rapidly identified. Less than one year later, published phase 3 clinical trials underlined the effectiveness of vaccines utilizing hitherto unusual technology consisting in injection of the messenger RNA (m-RNA) of a viral protein. In the meantime, numerous clinical trials had failed to identify a maximally effective antiviral treatment, and mass vaccination came to be considered as the strategy most likely to put an end to the pandemic. The objective of this text is to address and hopefully answer the questions being put forward by healthcare professionals on the different anti-SARS-CoV-2 vaccines as regards their development, their modes of action, their effectiveness, their limits, and their utilization in different situations; we are proposing a report on both today's state of knowledge, and the 14 February 2021 recommendations of the French health authorities.
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Affiliation(s)
- M Lefebvre
- Service des maladies infectieuses et tropicales, centre de prévention des maladies infectieuses et transmissibles, centre hospitalo-universitaire Hôtel-Dieu, Inserm CIC1413, 1, place Alexis-Ricordeau, 44000 Nantes, France.
| | - N Vignier
- Centre d'investigation clinique Antilles Guyane, CIC Inserm 1424, DRISP, centre hospitalier Andrée-Rosemon, Cayenne, French Guyana; Inserm, Sorbonne université, institut Pierre-Louis d'épidémiologie et de santé publique, IPLESP, 75012 Paris, France; Department of infectious disease, Groupe hospitalier Sud Ile-de-France, 77000 Melun, France
| | - B Pitard
- Université de Nantes, CNRS ERL6001, Inserm 1232, CRCINA, Nantes, France
| | - E Botelho-Nevers
- Service d'infectiologie, centre hospitalo-universitaire de Saint-Étienne, CIC 1408 Inserm, 42055 Saint-Étienne, France; Centre international de recherche en infectiologie (CIRI), Team GIMAP, université Lyon, université Jean-Monnet, université Claude-Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, 42023 Saint-Étienne, France
| | - B Wyplosz
- Service des maladies infectieuses et tropicales, Assistance publique-hôpitaux de Paris, Centre hospitalier universitaire Bicêtre, Paris, France
| | - R Cohen
- InfoVac, centre hospitalier intercommunal de Créteil, service de pédiatrie, 40, avenue de Verdun, 94000 Créteil, France
| | - O Epaulard
- Service des maladies infectieuses, centre hospitalo-universitaire Grenoble Alpes, Grenoble, France, CIC 1406 Inserm, Grenoble, France
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6
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Le Maréchal M, Morand P, Epaulard O, Némoz B. COVID-19 in clinical practice: A narrative synthesis. Med Mal Infect 2020; 50:639-647. [PMID: 33007400 PMCID: PMC7524428 DOI: 10.1016/j.medmal.2020.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/27/2020] [Accepted: 09/24/2020] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) was first reported in the city of Wuhan, China. The disease rapidly spread to the rest of China, to Southern-East Asia, then to Europe, America, and on to the rest of the world. COVID-19 is associated with a betacoronavirus named SARS-CoV-2. The virus penetrates the organism through the respiratory tract, conveyed by contaminated droplets. The main cell receptor targeted is the surface-bound ACE-2. As of the 26th July 2020, 15,200,000 COVID-19 cases and 650,000 deaths were reported worldwide. The mortality rate is estimated between 1.3 and 18.3%. The reproductive rate without any public health intervention is estimated around 4-5.1 in France. Most hospitalized patients for COVID-19 present respiratory symptoms, which in some cases is associated with fever. Up to 86% of admissions to ICU are related to acute respiratory failure. To date, no anti-viral therapy has proven its efficacy considering randomized trials. Only immunomodulatory treatments such as corticosteroids have shown to cause significant improvement in patient outcome.
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Affiliation(s)
- M Le Maréchal
- Service de Maladies Infectieuses, CHU de Grenoble-Alpes, France.
| | - P Morand
- Laboratoire de Virologie, Institut de Biologie et de Pathologie, CHU de Grenoble-Alpes, France
| | - O Epaulard
- Service de Maladies Infectieuses, CHU de Grenoble-Alpes, France
| | - B Némoz
- Laboratoire de Virologie, Institut de Biologie et de Pathologie, CHU de Grenoble-Alpes, France
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7
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Landré S, Mailles A, Ader F, Epaulard O, Tattevin P, Stahl J. Encéphalites chez les patients immunodéprimés en France, 2016–2019. Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.306] [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: 10/23/2022]
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8
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Mignot A, Epaulard O, Gavard-Perret M, Valette A, Abord-de-Chatillon E, Wilhelm M. Vaccination antigrippale et intention vaccinale chez les infirmiers et aides-soignants en institution : impact de leurs perceptions des conditions de travail. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.334] [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: 11/26/2022]
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9
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Andry F, Pierre I, Recule C, Caspar Y, Landelle C, Epaulard O, Pavese P. Épidémiologie et devenir des patients avec des hémocultures rendues positives une fois sortis de l’hôpital : étude rétrospective sur une année. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.177] [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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10
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Degoué M, Epaulard O. Les médecins généralistes et le vaccin anti-papillomavirus : une adhésion forte à la vaccination des filles et des jeunes hommes ayant des rapports avec des hommes, mais des occasions manquées. Med Mal Infect 2019. [DOI: 10.1016/j.medmal.2019.04.328] [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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Peyre M, Gauchet A, Bissuel F, Blanc M, Boibieux A, Cotte L, Forestier E, Janssen C, Legout L, Epaulard O. Satisfaction with sexual life in people living with HIV/AIDS: the persistent weight of the fear of transmission. AIDS Care 2018; 31:681-686. [PMID: 30350713 DOI: 10.1080/09540121.2018.1537465] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Sexual life is an important dimension of quality of life, which may be affected by the fear of transmission in people living with HIV/AIDS (PLWHA), despite the fact that antiretroviral therapy prevents person-to-person transmission. We, therefore, aimed to explore the sexual life satisfaction of PLWHA and its correlation with their fear of HIV transmission and self-esteem. Consecutive adult PLWHA from seven HIV care facilities in the Rhone-Alpes region, France, were asked to complete a self-administered, anonymous questionnaire concerning sociological and medical data, satisfaction with sexual life (18 questions), and self-esteem (Rosenberg score). Overall, 690 PLWHA answered the questionnaire (mean age 49.2 ± 11 years); 74.9% were men, of which 75.1% had sex with men. Overall, 68.0% of respondents feared transmitting HIV (a lot/a bit). A lower satisfaction with sexual life was significantly associated with being female, not having a stable sexual partner, being unemployed, having a low income, experiencing a fear of HIV transmission, having lower self-esteem, and not reporting an excellent/very good health status. These results strongly suggest that the information concerning the antiretroviral-induced suppression of infectivity should be widely diffused, as this may enhance the quality of sexual life in PLWHA.
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Affiliation(s)
- M Peyre
- a Department of Infectious Diseases , Centre Hospitalier Universitaire Grenoble-Alpes , Grenoble , France.,b COREVIH Arc-Alpin , Grenoble , France.,c Fédération d'Infectiologie Multidisciplinaire de l'Arc Alpin , Université Grenoble Alpes , Grenoble , France
| | - A Gauchet
- d Laboratoire InterUniversitaire de Psychologie, Personnalité, Cognition, Changement Social (LIP/PC2S), EA 4145 , Université Grenoble Alpes , Grenoble , France
| | - F Bissuel
- b COREVIH Arc-Alpin , Grenoble , France.,c Fédération d'Infectiologie Multidisciplinaire de l'Arc Alpin , Université Grenoble Alpes , Grenoble , France.,e Department of Infectious Diseases , Centre Hospitalier de Thonon , Thonon-les-Bains , France
| | - M Blanc
- a Department of Infectious Diseases , Centre Hospitalier Universitaire Grenoble-Alpes , Grenoble , France.,b COREVIH Arc-Alpin , Grenoble , France.,c Fédération d'Infectiologie Multidisciplinaire de l'Arc Alpin , Université Grenoble Alpes , Grenoble , France
| | - A Boibieux
- f Department of Infectious Diseases, Hôpital de la Croix-Rousse , Hospices Civils de Lyon , Lyon , France
| | - L Cotte
- f Department of Infectious Diseases, Hôpital de la Croix-Rousse , Hospices Civils de Lyon , Lyon , France
| | - E Forestier
- b COREVIH Arc-Alpin , Grenoble , France.,c Fédération d'Infectiologie Multidisciplinaire de l'Arc Alpin , Université Grenoble Alpes , Grenoble , France.,g Department of Infectious Diseases , Centre Hospitalier Métropole-Savoie , Chambéry , France
| | - C Janssen
- b COREVIH Arc-Alpin , Grenoble , France.,c Fédération d'Infectiologie Multidisciplinaire de l'Arc Alpin , Université Grenoble Alpes , Grenoble , France.,h Department of Infectious Diseases , Centre Hospitalier d'Annecy-Genevois , Annecy , France
| | - L Legout
- b COREVIH Arc-Alpin , Grenoble , France.,c Fédération d'Infectiologie Multidisciplinaire de l'Arc Alpin , Université Grenoble Alpes , Grenoble , France.,i Department of Infectious Diseases , Centre Hospitalier Alpes-Léman , Contamines , France
| | - O Epaulard
- a Department of Infectious Diseases , Centre Hospitalier Universitaire Grenoble-Alpes , Grenoble , France.,b COREVIH Arc-Alpin , Grenoble , France.,c Fédération d'Infectiologie Multidisciplinaire de l'Arc Alpin , Université Grenoble Alpes , Grenoble , France
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Epaulard O, Chavanet P, Lanotte P, Launay O, Lévy-bruhl D, Mootien J, Ploy M, Strady C, Gaillat J, Varon E. La vaccination anti-pneumococcique est insuffisamment réalisée chez les patients à risque : à propos de 693 cas d’infections invasives à pneumocoque. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.084] [Citation(s) in RCA: 1] [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] [Indexed: 11/27/2022]
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13
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Massot E, Epaulard O. Position des Sages-femmes vis-à-vis des vaccins et de leur rôle dans la vaccination : des résultats encourageants. Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.073] [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: 10/14/2022]
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14
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Potherat G, Tassel J, Epaulard O. De la vaccination au dépistage : étude des liens entre les hommes ayant des rapports sexuels avec des hommes et leur généraliste (étude HomoGen). Med Mal Infect 2018. [DOI: 10.1016/j.medmal.2018.04.245] [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: 11/26/2022]
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15
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Amsilli M, Epaulard O. Spondylodiscites à staphylocoque : différences entre les infections à Staphylococcus aureus et Staphylococcus coagulase. Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.216] [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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16
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Amsilli M, Epaulard O. Comment est réalisé le diagnostic microbiologique des spondylodiscites en pratique. Med Mal Infect 2017. [DOI: 10.1016/j.medmal.2017.03.210] [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: 11/25/2022]
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17
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Epaulard O. [Reactivation of resolved hepatitis B in HBsAg negative patients receiving rituximab: A preemptive strategy]. Med Mal Infect 2016; 46:64-5. [PMID: 27299166 DOI: 10.1016/j.medmal.2015.10.013] [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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Gaillat J, Varon E, Lanotte P, Lepoutre A, Pelloux I, Epaulard O, Bernard L, Chavanet P, Mootien Y. COL 2-02 - Surveillance épidémiologique clinico-microbiologique des infections invasives à pneumocoque de l’adulte (IIP) (SIIPA). Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30262-1] [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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Gueneau R, Carré M, Cahn JY, Epaulard O. VAC-01 - Vaccination après allogreffe de cellules souches : une efficacité inconstante. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30527-3] [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: 11/27/2022]
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20
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Andry F, Boisset S, Epaulard O. ENDO-03 - Isolement de staphylocoque doré dans les urines : l’endocardite infectieuse doit être recherchée. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30372-9] [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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21
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Gennai S, Rallo A, Keil D, Seigneurin A, Germi R, Epaulard O. Elaboration of a clinical and paraclinical score to estimate the probability of herpes simplex virus encephalitis in patients with febrile, acute neurologic impairment. Eur J Clin Microbiol Infect Dis 2016; 35:935-9. [PMID: 26984250 DOI: 10.1007/s10096-016-2619-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/29/2016] [Indexed: 10/22/2022]
Abstract
Herpes simplex virus (HSV) encephalitis is associated with a high risk of mortality and sequelae, and early diagnosis and treatment in the emergency department are necessary. However, most patients present with non-specific febrile, acute neurologic impairment; this may lead clinicians to overlook the diagnosis of HSV encephalitis. We aimed to identify which data collected in the first hours in a medical setting were associated with the diagnosis of HSV encephalitis. We conducted a multicenter retrospective case-control study in four French public hospitals from 2007 to 2013. The cases were the adult patients who received a confirmed diagnosis of HSV encephalitis. The controls were all the patients who attended the emergency department of Grenoble hospital with a febrile acute neurologic impairment, without HSV detection by polymerase chain reaction (PCR) in the cerebrospinal fluid (CSF), in 2012 and 2013. A multivariable logistic model was elaborated to estimate factors significantly associated with HSV encephalitis. Finally, an HSV probability score was derived from the logistic model. We identified 36 cases and 103 controls. Factors independently associated with HSV encephalitis were the absence of past neurological history (odds ratio [OR] 6.25 [95 % confidence interval (CI): 2.22-16.7]), the occurrence of seizure (OR 8.09 [95 % CI: 2.73-23.94]), a systolic blood pressure ≥140 mmHg (OR 5.11 [95 % CI: 1.77-14.77]), and a C-reactive protein <10 mg/L (OR 9.27 [95 % CI: 2.98-28.88]). An HSV probability score was calculated summing the value attributed to each independent factor. HSV encephalitis diagnosis may benefit from the use of this score based upon some easily accessible data. However, diagnostic evocation and probabilistic treatment must remain the rule.
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Affiliation(s)
- S Gennai
- Emergency Department, Grenoble University Hospital, CS 10217, 38043, Grenoble cedex 09, France.
| | - A Rallo
- Emergency Department, Grenoble University Hospital, CS 10217, 38043, Grenoble cedex 09, France
| | - D Keil
- Emergency Department, Grenoble University Hospital, CS 10217, 38043, Grenoble cedex 09, France
| | - A Seigneurin
- Medical Evaluation Unit, Grenoble University Hospital, Grenoble, France
| | - R Germi
- Laboratory of Virology, Grenoble University Hospital, Grenoble, France.,Unit of Virus Host Cell Interactions (UVHCI), UMI 3265 UGA-EMBL-CNRS, Grenoble, France.,Grenoble Institute of Clinical, Biological and Epidemiological Infectiology, Faculty of Medicine, University Grenoble-Alpes, Grenoble, France
| | - O Epaulard
- Unit of Virus Host Cell Interactions (UVHCI), UMI 3265 UGA-EMBL-CNRS, Grenoble, France. .,Grenoble Institute of Clinical, Biological and Epidemiological Infectiology, Faculty of Medicine, University Grenoble-Alpes, Grenoble, France. .,Infectious Diseases Department, Grenoble University Hospital, CS 10217, 38043, Grenoble cedex 09, France.
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22
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Epaulard O. [Gene therapy in HIV infection: proof-of-concept in 12 patients]. Med Mal Infect 2015; 44:239-40. [PMID: 25035879 DOI: 10.1016/j.medmal.2014.03.011] [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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23
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Dentan C, Epaulard O, Seynaeve D, Genty C, Bosson J. Étude rétrospective de l’association entre tuberculose et maladie thromboembolique veineuse selon la classification internationale des maladies, neuvième révision. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.10.084] [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: 10/24/2022]
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24
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Germi R, Mariette C, Alain S, Lupo J, Thiebaut A, Brion JP, Epaulard O, Saint Raymond C, Malvezzi P, Morand P. Success and failure of artesunate treatment in five transplant recipients with disease caused by drug-resistant cytomegalovirus. Antiviral Res 2013; 101:57-61. [PMID: 24184983 DOI: 10.1016/j.antiviral.2013.10.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 10/16/2013] [Accepted: 10/24/2013] [Indexed: 11/16/2022]
Abstract
Cytomegalovirus (CMV) strains resistant to ganciclovir, cidofovir and/or foscarnet were genotypically and phenotypically characterised in two haematopoietic stem cell transplant recipients and three solid-organ transplant recipients with CMV disease. The anti-malaria drug artesunate led to a favourable virological and clinical response in three cases with mild CMV diseases (fever and neutropaenia) but was ineffective in two fatal CMV diseases with lung involvement in spite of a decrease in the CMV DNA load in blood and bronchoalveolar fluid.
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Affiliation(s)
- R Germi
- Department of Virology, University Hospital, Grenoble, France; Unit of Virus Host Cell Interactions UMI 3265 UJF-EMBL-CNRS, B.P. 181, 6, rue Jules Horowitz, 38042 Grenoble Cedex 9, France.
| | - C Mariette
- Department of Infectious diseases, University Hospital, Grenoble, France
| | - S Alain
- Department of Virology, French National Cytomegalovirus Reference Center, University Hospital, Limoges, France
| | - J Lupo
- Department of Virology, University Hospital, Grenoble, France; Unit of Virus Host Cell Interactions UMI 3265 UJF-EMBL-CNRS, B.P. 181, 6, rue Jules Horowitz, 38042 Grenoble Cedex 9, France
| | - A Thiebaut
- Department of Hematology, University Hospital, Grenoble, France
| | - J P Brion
- Department of Infectious diseases, University Hospital, Grenoble, France
| | - O Epaulard
- Department of Virology, University Hospital, Grenoble, France; Unit of Virus Host Cell Interactions UMI 3265 UJF-EMBL-CNRS, B.P. 181, 6, rue Jules Horowitz, 38042 Grenoble Cedex 9, France; Department of Infectious diseases, University Hospital, Grenoble, France
| | - C Saint Raymond
- Department of Pneumology, University Hospital, Grenoble, France
| | - P Malvezzi
- Department of Nephrology, University Hospital, Grenoble, France
| | - P Morand
- Department of Virology, University Hospital, Grenoble, France; Unit of Virus Host Cell Interactions UMI 3265 UJF-EMBL-CNRS, B.P. 181, 6, rue Jules Horowitz, 38042 Grenoble Cedex 9, France
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Epaulard O, Villier C, Ravaud P, Chosidow O, Blanche S, Mamzer-Bruneel MF, Thiebaut A, Leccia MT, Lortholary O. A Multistep Voriconazole-Related Phototoxic Pathway May Lead to Skin Carcinoma: Results From a French Nationwide Study. Clin Infect Dis 2013; 57:e182-8. [DOI: 10.1093/cid/cit600] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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26
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Maillet M, Maubon D, Brion JP, François P, Molina L, Stahl JP, Epaulard O, Bosseray A, Pavese P. Pneumocystis jirovecii (Pj) quantitative PCR to differentiate Pj pneumonia from Pj colonization in immunocompromised patients. Eur J Clin Microbiol Infect Dis 2013; 33:331-6. [PMID: 23990137 PMCID: PMC7101903 DOI: 10.1007/s10096-013-1960-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 08/12/2013] [Indexed: 12/12/2022]
Abstract
Conventional polymerase chain reaction (PCR) in respiratory samples does not differentiate between Pneumocystis pneumonia (PCP) and Pneumocystis jirovecii (Pj) colonization. We used Pj real-time quantitative PCR (qPCR) with the objective to discriminate PCP from Pj colonization in immunocompromised patients. All positive Pj qPCR [targeting the major surface glycoprotein (MSG) gene] obtained in respiratory samples from immunocompromised patients presenting pneumonia at the Grenoble University Hospital, France, were collected between August 2009 and April 2011. Diagnoses were retrospectively determined by a multidisciplinary group of experts blinded to the Pj qPCR results. Thirty-one bronchoalveolar lavages and four broncho aspirations positive for the Pj qPCR were obtained from 35 immunocompromised patients. Diagnoses of definite, probable, and possible PCP, and pneumonia from another etiology were retrospectively made for 7, 4, 5, and 19 patients, respectively. Copy numbers were significantly higher in the “definite group” (median 465,000 copies/ml) than in the “probable group” (median 38,600 copies/ml), the “possible group” (median 1,032 copies/ml), and the “other diagnosis group” (median 390 copies/ml). With the value of 3,160 copies/ml, the sensitivity and specificity of qPCR for the diagnosis of PCP were 100 % and 70 %, respectively. With the value of 31,600 copies/ml, the sensitivity and specificity were 80 % and 100 %, respectively. The positive predictive value was 100 % for results with more than 31,600 copies/ml and the negative predictive value was 100 % for results with fewer than 3,160 copies/ml. qPCR targeting the MSG gene can be helpful to discriminate PCP from Pj colonization in immunocompromised patients, using two cut-off values, with a gray zone between them.
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Affiliation(s)
- M. Maillet
- Infectious Diseases Department, CHU de Grenoble, BP 218, 38 043 Grenoble cedex 9, France
| | - D. Maubon
- Infectious Agents Department, Parasitology-Mycology Laboratory, CHU Grenoble, Grenoble, France
| | - J. P. Brion
- Infectious Diseases Department, CHU de Grenoble, BP 218, 38 043 Grenoble cedex 9, France
| | - P. François
- Public Health Department, CHU Grenoble, Grenoble, France
| | - L. Molina
- Hematology Department, CHU Grenoble, Grenoble, France
| | - J. P. Stahl
- Infectious Diseases Department, CHU de Grenoble, BP 218, 38 043 Grenoble cedex 9, France
| | - O. Epaulard
- Infectious Diseases Department, CHU de Grenoble, BP 218, 38 043 Grenoble cedex 9, France
| | - A. Bosseray
- Internal Medicine Department, CHU Grenoble, Grenoble, France
| | - P. Pavese
- Infectious Diseases Department, CHU de Grenoble, BP 218, 38 043 Grenoble cedex 9, France
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Epaulard O, Adam L, Le Grand R, Martinon F. TLR-3 and TLR-7/8 ligands indirectly activate Langerhans cells when intradermally injected by triggering the recruitment of inflammatory cells. Retrovirology 2012; 9. [PMCID: PMC3442072 DOI: 10.1186/1742-4690-9-s2-p7] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- O Epaulard
- CEA/Division of Immuno-Virology, Fontenay aux Roses, France
| | - L Adam
- CEA/Division of Immuno-Virology, Fontenay aux Roses, France
| | - R Le Grand
- CEA/Division of Immuno-Virology, Fontenay aux Roses, France
| | - F Martinon
- CEA/Division of Immuno-Virology, Fontenay aux Roses, France
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Epaulard O, Leccia MT, Blanche S, Chosidow O, Mamzer-Bruneel MF, Ravaud P, Thiebaut A, Villier C, Lortholary O. Phototoxicity and photocarcinogenesis associated with voriconazole. Med Mal Infect 2011; 41:639-45. [PMID: 22055586 DOI: 10.1016/j.medmal.2011.09.016] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 08/03/2011] [Accepted: 09/23/2011] [Indexed: 11/15/2022]
Abstract
The antifungal voriconazole was given its marketing authorization in 2002. Several kinds of adverse effects have been reported, including acute and chronic cutaneous adverse effects, mainly due to a phototoxicity mechanism. More recently, some authors have reported that voriconazole was involved in the occurrence of multiple and often-aggressive cutaneous squamous cell carcinomas if the treatment was maintained for a long time. According to safety data in studies assessing voriconazole effectiveness, 8% of outpatients may experience phototoxic events. An overview of the different types of phototoxicity and of the concerned population was given by the 61 published case reports of photo-induced voriconazole-related skin adverse events (including 18 cases of squamous cell carcinomas). The most likely mechanisms may be phototoxicity directly related to either voriconazole or to its N-oxide main metabolite, and an interaction with retinoid metabolism; moreover, immunodeficiency may enhance the risk of skin cancer. Several issues remain to be investigated, and studies are needed concerning the phototoxicity and photocarcinogenesis of voriconazole and the prognosis of chronic non-malignant skin lesions. Voriconazole prescription must be associated with strict photoprotection; in case of a phototoxic adverse event, another azole may be recommended.
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Affiliation(s)
- O Epaulard
- Service des maladies infectieuses et de médecine tropicale, CHU de Grenoble, France.
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Epaulard O, Saint-Raymond C, Villier C, Charles J, Roch N, Beani JC, Leccia MT. Multiple aggressive squamous cell carcinomas associated with prolonged voriconazole therapy in four immunocompromised patients. Clin Microbiol Infect 2010; 16:1362-4. [DOI: 10.1111/j.1469-0691.2009.03124.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Meneses A, Epaulard O, Maurin M, Gressin R, Pavese P, Brion JP, Garin-Bastuji B, Stahl JP. Réactivation bactériémique d’une brucellose 70ans après la primo-infection. Med Mal Infect 2010; 40:238-40. [DOI: 10.1016/j.medmal.2009.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Revised: 04/19/2009] [Accepted: 08/28/2009] [Indexed: 11/27/2022]
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31
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Maurin M, Hammer L, Gestin B, Timsit J, Rogeaux O, Delavena F, Tous J, Epaulard O, Brion J, Croizé J. Quantitative real-time PCR tests for diagnostic and prognostic purposes in cases of legionellosis. Clin Microbiol Infect 2010; 16:379-84. [DOI: 10.1111/j.1469-0691.2009.02812.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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32
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Quetant S, Saint-Raymond C, Hugon A, Bedouch P, Epaulard O, Pison C, Leccia MT. 400: Aggressive Skin Cancers Associated with Prolonged Voriconazole Therapy in 3 Lung Transplant Patients. J Heart Lung Transplant 2010. [DOI: 10.1016/j.healun.2009.11.414] [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] Open
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33
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Barbieux M, Tremel F, Epaulard O, Vitrat-Hincky V, Roch N, Bonadona A, Brion JP, Stahl JP, Pavese P. [Severe infection following arteriotomy with Angio-Seal]. Med Mal Infect 2009; 40:292-5. [PMID: 19616393 DOI: 10.1016/j.medmal.2009.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Revised: 03/07/2009] [Accepted: 06/04/2009] [Indexed: 11/25/2022]
Abstract
Diagnostic or interventional femoral artery catheterizations are more and more commonly practiced, so are haemostatic puncture closure devices, used to prevent bleeding complications and decrease hospital length of stay. Complications, such as infections, have been reported after using haemostatic puncture closure devices. We report the case of a female patient presenting with severe infection after Angio-Seal use: femoral artery infection with sepsis and multiple organ failure, septic embolism with embolic skin abscesses, bacterial arthritis and inferior limb necrosis. Studies comparing the infectious risk of manual compression versus haemostatic puncture closure devices are contradictory. Nevertheless, aseptic rules must be strictly observed. Indications for these devices concern only patients with high risk of hemorrhage and should be discussed for immunodepressed, diabetic, or obese patients.
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Affiliation(s)
- M Barbieux
- Service des maladies infectieuses, hôpital Michallon, CHU de Grenoble, 38043 Grenoble, France
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Epaulard O, Courby S, Pavese P, Grand S, Laramas M, Molina L, Brion JP, Colle PE, Sotto JJ. Paraneoplastic Acute Diffuse Encephalitis Revealing Hodgkin's Disease. Leuk Lymphoma 2009; 45:2509-12. [PMID: 15621769 DOI: 10.1080/10428190400005262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Paraneoplastic neurological syndromes are associated with various cancers. Cerebellar and limbic paraneoplastic manifestations are known to be associated with Hodgkin's disease (HD), but reports of diffuse encephalitis associated with HD are very rare. We report a case of acute severe diffuse encephalitis revealing a HD. Clinical presentation, cerebro-spinal fluid modifications and magnetic resonance imagery data are described. The treatment associated specific chemotherapy and plasma exchange. The neurological status improved dramatically within the first days of treatment, with parallel neoplasm regression. This case stresses the fact that encephalopathy can be the first sign of an undiagnosed extra-cerebral neoplasm.
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Affiliation(s)
- O Epaulard
- Service des Maladies Infectieuses et Tropicales DMAS, Centre Hospitalo-Universitaire de Grenoble BP 217, 38043, Grenoble Cedex 09 France.
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35
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Epaulard O, Derouazi M, Pelletier L, Polack B, Toussaint B. Immunothérapie par vecteur bactérien vivant : utilisation du système de sécrétion de type III de Pseudomonas aeruginosa. Med Mal Infect 2008; 38 Suppl 2:S87-9. [DOI: 10.1016/s0399-077x(08)73002-6] [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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36
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Roch N, Salameire D, Courby S, Orsini-Piocelle F, Pegourie-Bandelier B, Gressin R, Dumontet C, Sturm N, Berger F, Toffart A, Guellerin J, Gereige G, Hincky V, Epaulard O, Brion J, Pavese P, Larrat S, Morand P, Stahl J. P640 Fatal viral opportunistic infections and Epstein-Barr virus positive large B-cell lymphoma after alemtuzumab treatment for a refractory Sezary syndrome. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70482-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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37
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Roch N, Mondesert B, Bouafia S, Pelloux I, Epaulard O, Pavese P, Brion JP, Stahl JP, Maurin M. Rickettsiose africaine: huit cas parmi un groupe de touristes âgés de retour d'Afrique du Sud. Rev Med Interne 2006. [DOI: 10.1016/j.revmed.2006.10.241] [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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38
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Epaulard O, Brion JP, Stahl JP, Colombe B, Maurin M. The changing pattern of Fusobacterium infections in humans: recent experience with Fusobacterium bacteraemia. Clin Microbiol Infect 2006; 12:178-81. [PMID: 16441457 DOI: 10.1111/j.1469-0691.2005.01328.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A retrospective study was conducted of 26 adult cases of fusobacterium bacteraemia that occurred between 1998 and 2003 at Center Hospitalier Universitaire de Grenoble, France. Most patients presented with pre-existing adverse medical conditions, including evolving malignant diseases (eight patients), recent surgery (four patients), and chronic organ failure (six patients). Only one patient presented with a classic Lemierre's syndrome. These results suggest an opportunistic pattern of modern fusobacterium infections.
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Affiliation(s)
- O Epaulard
- Service des Maladies Infectieuses, Département de Médecine Aiguë Spécialisée, Center Hoispitalier Universitaire de Grenoble, Grenoble, France.
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Ader F, Le Berre R, Faure K, Gosset P, Epaulard O, Toussaint B, Polack B, Nowak E, Viget NB, Kipnis E, Guery BP. Alveolar response to Pseudomonas aeruginosa: role of the type III secretion system. Infect Immun 2005; 73:4263-71. [PMID: 15972518 PMCID: PMC1168600 DOI: 10.1128/iai.73.7.4263-4271.2005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The type III secretion system (TTSS) is a specialized cytotoxin-translocating apparatus of gram-negative bacteria which is involved in lung injury, septic shock, and a poor patient outcome. Recent studies have attributed these effects mainly to the ExoU effector protein. However, few studies have focused on the ExoU-independent pathogenicity of the TTSS. For the present study, we compared the pathogenicities of two strains of Pseudomonas aeruginosa in a murine model of acute lung injury. We compared the CHA strain, which has a functional TTSS producing ExoS and ExoT but not ExoU, to an isogenic mutant with an inactivated exsA gene, CHA-D1, which does not express the TTSS at all. Rats challenged with CHA had significantly increased lung injury, as assessed by the wet/dry weight ratio for the lungs and the protein level in bronchoalveolar lavage fluid (BALF) at 12 h, compared to those challenged with CHA-D1. Consistent with these findings, the CHA strain was associated with increased in vitro cytotoxicity on A549 cells, as assessed by the release of lactate dehydrogenase. CHA was also associated at 12 h with a major decrease in polymorphonuclear neutrophils in BALF, with a proinflammatory response, as assessed by the amounts of tumor necrosis factor alpha and interleukin-1beta, and with decreased bacterial clearance from the lungs, ultimately leading to an increased mortality rate. These results demonstrate that the TTSS has a major role in P. aeruginosa pathogenicity independent of the role of ExoU. This report underscores the crucial roles of ExoS and ExoT or other TTSS-related virulence factors in addition to ExoU.
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Affiliation(s)
- F Ader
- Laboratoire de Recherche en Pathologie Infectieuse, Faculté de Médecine de Lille, France
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Le Berre R, Ader F, Faure K, Robriquet L, Epaulard O, Gosset P, Toussaint B, Guery B. CL6-03 Le système de sécrétion de type III: Un facteur de virulence important dans la pneumonie à Pseudomonas aeruginosa (Pa). Med Mal Infect 2004. [DOI: 10.1016/s0399-077x(04)90062-5] [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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41
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Epaulard O, Brion JP, Morand P, Fafi-Kremer S, Peco'h M, Gressin R, Sotto JJ, Stahl JP. C-02 Lymphoproliférations malignes de l'immunodéprimé: Étude de l'intérêt de la mesure de la charge virale EBV tumorale. Med Mal Infect 2004. [DOI: 10.1016/s0399-077x(04)90147-3] [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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42
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Epaulard O, Brion JP, Croizé J, Colombe B, Stahl JP. CL5-03 Bactériemie à Fusobacterium: À propos de 22 cas. Med Mal Infect 2004. [DOI: 10.1016/s0399-077x(04)90055-8] [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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Stahl JP, Pavese P, Epaulard O, Blanc M, Brion JP. Le treaement empirique des bactériémies. Med Mal Infect 2004; 34 Suppl 1:S55-6. [PMID: 15676249 DOI: 10.1016/s0399-077x(04)90018-2] [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] [Indexed: 10/26/2022]
Affiliation(s)
- J-P Stahl
- Service d'infectiologie, CHU Grenoble, Grenoble, France
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Imbert B, Seinturier C, Epaulard O, Koenig M, Gressin R, Carpentier P. Syndrome primitif des aPL et thrombocytémie essentielledeux bonnes raisons de thromboser. Rev Med Interne 2002. [DOI: 10.1016/s0248-8663(02)80201-6] [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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Abstract
Copious bronchorrhea can be related to bronchioloalveolar carcinoma, but reports of bronchorrhea related to lung metastasis are rare. We report the case of a woman presenting lung metastases of a cervical adenocarcinoma revealed by bronchorrhea, eventually identified as ectopic cervical mucus. Treatment included anticancer drugs and erythromycin, the latter in order to reduce the bronchorrhea, with eventually poor efficacy. This observation illustrates the importance of respiratory signs in the post-therapeutic follow up of cancer, especially cough and bronchorrhea in adenocarcinoma.
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Affiliation(s)
- O Epaulard
- Department of Pneumology, Centre Hospitalier Universitaire de Grenoble, A.MICHALLON, BP 217, 38043 Grenoble, France
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Abstract
INTRODUCTION Inflammatory pseudo-tumors (IPT) are benign neoplasms associated with local or general manifestations. Renal localization seems exceptional, and no case of fever of unknown origin caused by renal inflammatory pseudo-tumors have been reported. EXEGESIS The authors report the case of a man presenting fever of unknown origin and inflammatory syndrome. Computerized tomography showed a renal mass. Nephrectomy was performed, and renal inflammatory pseudo-tumor was diagnosed. After surgical exeresis, the clinical and biological abnormalities vanished. CONCLUSION This rare diagnosis must be considered in these situations. The outcome is excellent.
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Affiliation(s)
- O Epaulard
- Service de médecine interne, pavillon D.-Villars, centre hospitalier universitaire de Grenoble, France
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