Impact of the COVID-19 outbreak on the reporting of adverse drug reactions associated with self-medication

Objectives

The primary objective of the present study was to describe the characteristics of adverse drug reactions (ADRs) linked to self-medication that were notified to the French Pharmacovigilance Database (FPVD) during the COVID-19 outbreak in 2020 first wave. The secondary objective was to compare the characteristics of these ADRs in 2020 with those notified during the same calendar period a year previously.

Material and methods

We analyzed ADRs recorded in the FPVD between March 15th and May 31st, 2020 vs. the same dates in 2019. Only ADRs linked to self-medication were analyzed. Descriptive statistics were used to obtain an overview of the types and characteristics of these ADRs.

Results

Of 3114 ADRs notified to the FPVD during the COVID-19 period in 2020, 114 (3.7%) were linked to self-medication. The equivalent proportion in 2019 was 1.6% (113 out of 7097). Half of the ADRs notified in 2020 were “serious”. The median age of affected patients was 30.5, and 22% of the ADRs concerned children. Of the 114 ADRs linked to self-medication, 107 (66%) were for prescription-only drugs. The three mostly frequently suspected ATC classes were analgesics, psycholeptics, and antibacterials for systemic use. The most frequent ADRs were general disorders, gastrointestinal disorders, and nervous system disorders. The main difference between the non-COVID-19 period and the COVID-19 period was the higher proportion of medication errors during the latter.

Conclusion

The present study is the first to have reported on ADRs linked to self-medication and notified during a COVID-19 outbreak. Further studies of self-medication patterns and their consequences in a pandemic context are mandatory and effective information on medication use (including self-medication and its dangers) during a pandemic is essential.

Neglected vector-borne bacterial diseases and arboviruses in the Mediterranean area

Arthropod vectors can transmit pathogenic microorganisms from one vertebrate to another during their blood meal. Although some vector-borne diseases have been eradicated in the Mediterranean area, such as malaria and dengue, recent endemic microorganisms (Toscana virus, Rickettsia spp.) remain neglected even though they cause many more cases. New diagnostic tools and innovative tools for the identification and characterization of vector species and microorganisms have been developed at IHU Méditerranée Infection, either internally or through collaborative and integrated projects. We have detected Rickettsia slovaca as a human pathogen and have described the disease; we have shown that Rickettsia felis can be transmitted by Anopheles mosquitoes; we have emphasized the increasing importance of bedbug (Cimex lectularius) as a potential vector of Bartonella quintana; and we have described the Toscana virus, a major agent of meningitis and meningoencephalitis which was disseminated in North Africa and Central and Eastern Europe, where it frequently cocirculates with a large number of newly described phleboviruses transmitted by sand flies.

Infestation by pyrethroids resistant bed bugs in the suburb of Paris, France

Bed bugs are hematophagous insects responsible for a re-emerging and challenging indoor pest in many countries. Bed bugs infestations may have health consequences including nuisance biting, cutaneous and systemic reactions. This resurgence can probably be attributed to factors such as increased international travel and development of resistance against insecticides. Resistance against pyrethroids has been reported several times from the USA and rarely in Europe. In France, very few data on bed bugs are available. The present study aimed to assess the infestation by bed bugs of a complex of two high-rise apartment buildings in the suburb of Paris and to evaluate their susceptibility to pyrethroid insecticides. We inspected for bed bugs 192 out of 198 apartments units (97%) and interviewed their residents. 76 (39.6%) apartments were infested. Among the 97 residents living in infested apartments, 53 (54.6%) reported bed bug bites. A total of 564 bed bugs were collected in the infested units. Bioassays showed that 54 out of 143 bed bugs were resistant to pyrethroids (37.8%; 95% confidence interval: 29.9-45.7%). DNA sequencing showed that all bed bugs tested (n = 124) had homozygous L925I kdr-like gene mutation. The level of pyrethroid resistance found indicates that this phenomenon was already established in the site and prompts the need to reevaluate the wide use of pyrethroids to control bed bugs.

A century of leishmaniasis in Alpes-Maritimes, France

A century of publications on leishmaniasis in Alpes-Maritimes, in southern France, is here reviewed. Autochtonous human and canine leishmaniasis were first recognised in this département, which lies by the Mediterranean Sea and near the Italian border, in 1918 and 1925, respectively. The parasite responsible for the leishmaniasis, Leishmania infantum, is transmitted by Phlebotomus perniciosus and P. ariasi. The human leishmaniasis is zoonotic, with domestic dogs acting as the main 'reservoir' hosts. In prospective surveys over the last two decades, a mean of 12% of the domestic dogs checked in Alpes-Maritimes have been found seropositive for L. infantum but only about 50% of the seropositive animals showed any clinical signs of infection at the time of the surveys. During the last 30 years, 178 cases of human visceral leishmaniasis have been recorded in the area. Such cases are sporadic and often opportunistic, occurring predominantly in children (29% of the 178 cases) or HIV-positive subjects (31%). Recently, it has been demonstrated that, in Alpes-Maritimes, approximately 20% of those found seropositive in leishmanin skin tests are asymptomatic carriers, with amastigotes in their peripheral blood.

[A case of feline leishmaniasis in the south of France]

Cet article rapporte un cas de leishmaniose féline disséminée chez un chat (Felis catus) de 14 ans, séropositif pour le FIV et vivant dans les Alpes-Maritimes (sud de la France). Le chat présente des papules érythémateuses ulcérées sur la face et l’encolure, et une lésion proliférative ulcérée sur l’oreille gauche. C’est l’examen histopathologique des lésions cutanées qui permet le diagnostic d’une leishmaniose disséminée, associée à un carcinome épidermoïde de l’oreille. 100 mg d’allopurinol administrés une fois par jour per os pendant quatre mois ont permis la rémission totale des lésions cutanées. Des prélèvements post mortem ont révélé la persistance du parasite dans l’organisme après six mois de traitement. Cet article discute de la sensibilité du chat à la leishmaniose et de son rôle potentiel de réservoir.

First two autochthonous dengue virus infections in metropolitan France, September 2010

In September 2010, two cases of autochthonous dengue fever were diagnosed in metropolitan France for the first time. The cases occurring in Nice, southeast France, where Aedes albopictus is established, are evidence of dengue virus circulation in this area. This local transmission of dengue calls for further enhanced surveillance, active case finding and vector control measures to reduce the spread of the virus and the risk of an epidemic.

First two autochthonous dengue virus infections in metropolitan France, September 2010

In September 2010, two cases of autochthonous dengue fever were diagnosed in metropolitan France for the first time. The cases occurring in Nice, south-east France, where Aedes albopictus is established, are evidence of dengue virus circulation in this area. This local transmission of dengue calls for further enhanced surveillance, active case finding and vector control measures to reduce the spread of the virus and the risk of an epidemic.

Resurgence of bedbugs in southern France: a local problem or the tip of the iceberg?

BACKGROUND

Bedbugs (Cimex lectularius) have been feeding on sleeping human beings since prehistory. In Europe, bed bugs were common and endemic until World War II when improved body and home hygiene, and widespread use of insecticides led to almost complete eradication. Current evidence indicates that bedbugs are making a comeback in Europe, USA, Canada and Australia. In our practice in Southern France, we observed several cases within a period of only 1 year.

OBJECTIVES

Based on this experience, we conducted an epidemiological study to evaluate the status of bedbugs in France.

METHODS

During summer 2009, we mailed a short questionnaire to all hospital professors in the CEDEF (Collège des Enseignants de Dermatologie de France) asking four questions: number of suspected diagnosis of bedbugs in the year 2009, and number of certain positive diagnosis, difficulties in treatment, use of a pest control professional for treatment, and finally personal opinion on actual incidence of bedbugs, compared with past years.

RESULTS

Of the 84 questionnaires sent, there were only 26 responses despite two reminders. The responses were predominantly southern France, probably as a result of intensive immigration and increased travel and trade. Difficulties encountered during diagnosis and treatment are also mentioned. Utilizing the services of entomological experts and pest control professionals is essential.

CONCLUSIONS

  France has the same experience regarding the resurgence of bedbugs as several European countries, USA, Canada and Australia, especially the southern regions. This emerging health problem has to be known by dermatologists. A national programme has been launched in France to assess actual incidence and study C. lectularius- related diseases.

[Leishmaniases in France: an update]

Leishmaniases are parasitic diseases due to a flagellate protozoan of the genus Leishmania. They are transmitted from mammal to mammal by the bite of an arthropod vector: a female sandfly. Among the different clinical presentations, the zoonotic visceral leishmaniasis (ZVL) is due to Leishmania infantum. Dogs are the reservoir and can develop a deadly disease. ZVL is described in China, Pakistan, Latin America and in the Mediterranean region, particularly in the South of France. In recent years, many asymptomatic carriers have been described. Despite the fact that cases in immunocompromised adults are the majority, the classic Mediterranean ZVL in young children is still observed. The classic triad of symptoms is: fever, pallor, splenomegaly and hepatomegaly in half of the cases. The biological orientation is a low blood count (anemia, leuconeutropenia, and thrombocytopenia) and an inflammatory syndrome. Serological tests are useful, but the diagnosis is made by the identification of the parasite in a bone marrow sample. Today, the treatment is done by the liposomal amphotericin B (AmBisome) and the total dose must to be 20 mg/kg.

[Multinodular hepatopathy with fever in a tropical climate: hepatic amebiasis with multiple abscesses]

Hepatic amebiasis is common in tropical zones. Solitary abscess is the classical form but multinodular presentation does not rule out amebiasis as the underlying cause. Definitive diagnosis cannot be based on clinical and radiologic findings alone. Serological testing for amebiasis is necessary. In zones where serology is unavailable, response to presumptive metronidazole treatment is still a useful for diagnosis.

[Liposomal amphotericin B as treatment for visceral leishmaniasis in Europe, 2009]

Visceral leishmaniasis (VL) causes an estimated 500,000 new cases of disease and more than 50,000 deaths a year. For more than 60 years, pentavalent antimonies were considered the standard therapy for VL. The emergence of Leishmania strains resistant to antimonials led to the evaluation of other treatments including amphotericin B and its lipidic derivatives. Clinical trials with liposomal amphotericin B demonstrated that total doses of 10 to 20mg/kg, administered according to various regimens, had a 90-98% efficacy in non-immunocompromised patients. Compared to antimonials, liposomal amphotericin B provides favorable efficacy/tolerance and cost efficacy ratios. The WHO recently produced consensus recommendations for the use of liposomal amphotericin B in VL. In Europe, liposomal amphotericin B has progressively become the reference treatment of VL in clinical practice, and it is recommended as the first line therapy.

[Bedbugs (Heteroptera, Cimicidae): biting again]

Bedbugs have been man's faithful companions from his cave days to the present time. After World War II, improvements in household and personal cleanliness and above all widespread use of insecticidal treatment led to a decline in the prevalence of bedbugs so that they became almost unknown to populations in industrialized countries. However in recent years a resurgence of bedbugs has been reported in North America as well as in most European countries. The purpose of this study is to provide an update on the comeback of bedbugs in France and the world, to discuss their impact on public health, and to consider possible causes for the current resurgence.

[Confirmed chikungunya in children in Mayotte. Description of 50 patients hospitalized from February to June 2006]

The French Indian Ocean island Mayotte was hit by an outbreak of chikungunya in January 2005. The purpose of this retrospective study is to report data recorded over a five-month period (February - June 2006) in the pediatric-neonatal department of the Hospital Center in Mayotte. The study cohort includes a total of 50 children in whom chikungunya was confirmed by molecular tools. Mean age was 9.3 years and the male-to-female sex ratio was 1:5. The main symptoms were intense pain (88%), high fever (82%), and skin rash (80%) that was less common in children under 2 years of age. Neurological complications were observed in 46% of patients including hypotonia (22%) that occurred mainly in newborns, meningitis syndrome (18%) and convulsions (16%) that occurred mainly in children over 2 years of age. Infectious complications included pneumonia (4%), pyelonephritis (2%), and possible nosocomial septicemia due to Pseudomonas (6%). The main hematological abnormalities were lymphopenia (27%) and thrombopenia (16%). Serum CRP values were moderately high (mean, 25 mg/l). Elevated AST (24%) and ALT (10%) values were observed. High CSF protein levels were noted in 30% of cases. A total of 25 children required hospitalization for more than 10 days. There were two deaths in newborns infected before the seventh day of life. The main risk factors for hospitalization longer than 10 days were premature birth and age at the time of chikungunya infection.

[Mediterranean leishmaniasis caused by Leishmania infantum. Update on the utility of the IT-Leish and ID-Pagia leishmaniasis tests]

The purpose of this article is to update information about Mediterranean leishmaniasis caused by Leishmania infantum in man and about the canine reservoir. Special emphasis is placed on laboratory diagnosis tests for Mediterranean visceral leishmaniasis (MVL) in humans. In addition two rapid diagnostic tests for human leishmaniasis are compared based on indirect immunofluorescence and Western blot. Findings show that the overall sensitivity of the two tests in immunocompetent and immunodepressed patients ranged from 54% to 97%, a specificity of 97%, with positive predictive value ranging from 75% to 97% and a negative predictive value of around 95%. For diagnosis of cutaneous leishmaniasis, positivity of these tests in one case out of 2 underscores the predictive value of a positive test.

[Relapse of Plasmodium falciparum malaria in a patient treated with artesunate]

Chemoprophylaxis and the curative treatment of malaria are well documented in France. Nevertheless this data is still not accounted for by healthcare professionals and in the global population, and no longer approved treatments may be prescribed. The authors report the case of a 24-year-old female traveler having stayed in Africa where she was used to treat fever with artesunate. Soon after her return, she presented with uncomplicated Plasmodium falciparum malaria once again treated with artesunate. The evolution was initially favorable but a relapse occurred 3 weeks later. A conventional mefloquine treatment lead to a final cure. This observation confirms that artesunate monotherapy in malaria exposes to a risk of relapse. Artesunate should not be used as monotherapy in P. falciparum malaria.

Human trichinellosis due to Trichinella britovi in southern France after consumption of frozen wild boar meat

Six patients were infected with Trichinella britovi in southern France following consumption of frozen wild boar meat, which had been frozen at -35 degrees C for 7 days. Microscopic examination of a sample of frozen wild boar muscle revealed the presence of rare encapsulated Trichinella larvae, identified as T. britovi. People eating wild boar must follow individual prophylactic rules such as efficient cooking of meat (at least 65 degrees C at the core for 1 minute) as recommended by the International Commission on Trichinellosis, or freezing exceeding four weeks at -20 degrees C.

Human trichinellosis due to Trichinella britovi in southern France after consumption of frozen wild boar meat

Six patients were infected with Trichinella britovi in southern France following consumption of frozen wild boar meat, which had been frozen at -35°C for 7 days. Microscopic examination of a sample of frozen wild boar muscle revealed the presence of rare encapsulated Trichinella larvae, identified as T. britovi. People eating wild boar must follow individual prophylactic rules such as efficient cooking of meat (at least 65°C at the core for 1 minute) as recommended by the International Commission on Trichinellosis, or freezing exceeding four weeks at -20°C.

Consensual treatment of plasmodium falciparum malaria does not lead to adequate quinine blood concentrations

Since 1996, we have a common protocol in the Infectious Diseases Department and the Intensive Care Unit for the administration of quinine in case of Plasmodium falciparum malaria. Patients were classified as uncomplicated form of malaria (UFM) or severe form of malaria (SFM) according to WHO criteria, adding parasitemia >5% as a criteria of SFM. Treatment of SFM should consist of a 4 h infusion of 16 mg/kg quinine-base loading dose, followed by 8 mg/kg every 8 h. Patients with UFM receive quinine-base, 8 mg/kg every 8 h. A therapeutic index of 10-15 mg/l was considered adequate. Hypoglycemia and cardiotoxicity were the two main adverse effects of quinine to be investigated. In order to verify that these modalities for quinine administration are associated with adequate quinine blood concentrations, we have reviewed the pharmacological data and the occurrence of adverse effects. Between April 1996 and December 2000, 95 patients were hospitalised: 25 with SFM and 70 with UFM: 78/95 patients (82%) received adequate treatment and 26/95 (28%) of the patients presented an overdosage of quinine. Six severe adverse effects were observed, even in case of adequate quinine administration. Consensual treatment of malaria does not confer adequate quinine blood concentrations, and toxic effects are still common.

[Myiasis caused by Dermatoba hominis after an organized tours in Amazonia]

BACKGROUND

Human cutaneous myiasis is a common disease in endemic tropical zones. The incidence of imported cases follows the development of organized tours in the tropics.

CASE REPORTS

We report 2 cases of Dermatobia hominis furonculoid myiasis in patients who took 2 different organized tours which both visited the same Amazonian site in Peru (Puerto Maldonado).

DISCUSSION

In Latin American countries, D. hominis myiasis is transmitted by Diptera (generally mosquitos, rarely flies) who carry eggs laid by an adult fly to man. This phenomena is called "phoresia" and explains the preferential localization of lesions in exposed areas unlike African myiasis caused by Cordylobia anthropophaga which contaminates clothing soiled when drying.