Hepatitis C virus （HCV） is a global health concern, notably in Southeast Asia, and in Laos the presentation of the HCV- induced liver disease is poorly known. Our objective was thus to describe a comprehensive HCV i...Hepatitis C virus （HCV） is a global health concern, notably in Southeast Asia, and in Laos the presentation of the HCV- induced liver disease is poorly known. Our objective was thus to describe a comprehensive HCV infection pattern in order to guide national health policies. A study on a group of 1765 patients formerly diagnosed by rapid test in health centres was conducted at the Centre of Infectiology Lao Christophe Merieux in Vientiane. The demographic information of patients, their infection status （viral load： VL）, liver function （aminotransferases） and treatments were analysed. Results showed that gender distribution of infected people was balanced; with median ages of 53.8 for men and 51.6 years for women （13-86 years）. The majority of patients （72%） were confirmed positive （VL 〉 50 IU/mL） and 28% of them had high VL （〉 61oglo）. About 23% of patients had level of aminotransferases indicative of liver damage （〉 40 IU/mL）; but less than 20% of patients received treatment. Patients rarely received a second sampling or medical imaging. The survey also showed that cycloferon, pegylated interferon and ribavirin were the drugs prescribed preferentially by the medical staff, without following any international recommendations schemes. In conclusion, we recommend that a population screening policy and better management of patients should be urgently implemented in the country, respecting official guidelines. However, the cost of biological analysis and treatment are significant barriers that must be removed. Public health resolutions should be immediately enforced in the perspective of meeting the WHO HCV elimination deadline by 2030.展开更多
Background: Blood eosinophilia is a common laboratory abnormality, and its characterization frequently represents a quandary for primary care physicians. Consequently, in France, specialists and particularly hematolog...Background: Blood eosinophilia is a common laboratory abnormality, and its characterization frequently represents a quandary for primary care physicians. Consequently, in France, specialists and particularly hematologists, often must investigate patients who present with blood eosinophilia that often, but not always, occurs because of allergic causes. Both the Departments of Hematology and Parasitology at Toulouse University Hospitals established a collaboration to rule out allergic causes of eosinophilia, particularly helminthiases, prior to initiating more sophisticated investigations.Methods: Since 2004, the authors employed the same protocol to investigate eosinophilic outpatients who attended the clinic of Parasitology at Toulouse University Hospitals, and they reported the performance of this diagnostic procedure that was designed to be rapid(no hospitalization required) and only moderately expensive.Results: A total of 406 patients who presented with blood eosinophilia greater than 0.5(×10~9, giga cells per litter, G/L) had an allergic etiology in 350(86.2%) cases. Among the remaining 56 subjects, 17 did not undergo a follow-up and 39 were referred to another specialized department, mostly Hematology. However, only 21 patients attended then were subsequently investigated. Non-allergic causes of eosinophilia, including 3 cases of the lymphoid variant of hypereosinophilic syndrome and 2 cases of myeloproliferative disorder, were identified in 14 patients, whereas 7 remained diagnosed as having idiopathic eosinophilia.Conclusion: This study underlines the need to investigate patients presenting with even moderate blood eosinophilia. The work-up that was employed appears to be efficient and versatile and may be used by any medical specialist, such as in hematology, infectious disease, or internal medicine departments, who needs to investigate eosinophilic patients and should initially rule out any etiology of allergic eosinophilia.展开更多
Background Cerebral malaria(CM)is a neuropathology which remains one of the deadliest forms of malaria among African children.The kinetics of the pathophysiological mechanisms leading to neuroinflammation and the deat...Background Cerebral malaria(CM)is a neuropathology which remains one of the deadliest forms of malaria among African children.The kinetics of the pathophysiological mechanisms leading to neuroinflammation and the death or survival of patients during CM are still poorly understood.The increasing production of cytokines,chemokines and other actors of the inflammatory and oxidative response by various local actors in response to neuroinflammation plays a major role during CM,participating in both the amplification of the neuroinflammation phenomenon and its resolution.In this study,we aimed to identify risk factors for CM death among specific variables of inflammatory and oxidative responses to improve our understanding of CM pathogenesis.Methods Children presenting with CM(n=70)due to P.falciparum infection were included in southern Benin and divided according to the clinical outcome into 50 children who survived and 20 who died.Clinical examination was complemented by fundoscopic examination and extensive blood biochemical analysis associated with molecular diagnosis by multiplex PCR targeting 14 pathogens in the patients'cerebrospinal fluid to rule out coinfections.Luminex technology and enzyme immunoassay kits were used to measure 17 plasma and 7 urinary biomarker levels,respectively.Data were analysed by univariate analysis using the nonparametric Mann-Whitney U test and Pearson’s Chi2 test.Adjusted and multivariate analyses were conducted separately for plasma and urinary biomarkers to identify CM mortality risk factors.Results Univariate analysis revealed higher plasma levels of tumour necrosis factor(TNF),interleukin-1beta(IL-1β),IL-10,IL-8,C-X-C motif chemokine ligand 9(CXCL9),granzyme B,and angiopoietin-2 and lower urinary levels of prostanglandine E2 metabolite(PGEM)in children who died compared to those who survived CM(Mann-Whitney U-test,P-values between 0.03 and<0.0001).The multivariate logistic analysis highlighted elevated plasma levels of IL-8 as the main risk factor for death during CM(adjusted odd ratio=14.2,P-value=0.002).Values obtained during follow-up at D3 and D30 revealed immune factors associated with disease resolution,including plasma CXCL5,C-C motif chemokine ligand 17(CCL17),CCL22,and urinary 15-F2t-isoprostane.Conclusions The main risk factor of death during CM was thus elevated plasma levels of IL-8 at inclusion.Follow-up of patients until D30 revealed marker profiles of disease aggravation and resolution for markers implicated in neutrophil activation,endothelium activation and damage,inflammatory and oxidative response.These results provide important insight into our understanding of CM pathogenesis and clinical outcome and may have important therapeutic implications.展开更多
Background:While malaria morbidity and mortality have declined since 2000,viral central nervous system infections appear to be an important,underestimated cause of coma in malaria-endemic Eastern Africa.We aimed to de...Background:While malaria morbidity and mortality have declined since 2000,viral central nervous system infections appear to be an important,underestimated cause of coma in malaria-endemic Eastern Africa.We aimed to describe the etiology of non-traumatic comas in young children in Benin,as well as their management and early outcomes,and to identify factors associated with death.Methods:From March to November 2018,we enrolled all HIV-negative children aged between 2 and 6 years,with a Blantyre Coma Score≤2,in this prospective observational study.Children were screened for malaria severity signs and assessed using a systematic diagnostic protocol,including blood cultures,malaria diagnostics,and cerebrospinal fluid analysis using multiplex PCR.To determine factors associated with death,univariate and multivariate analyses were performed.Results:From 3244 admissions,84 children were included:malaria was diagnosed in 78,eight of whom had a viral or bacterial co-infection.Six children had a non-malarial infection or no identified cause.The mortality rate was 29.8%(25/84),with 20 children dying in the first 24 h.Co-infected children appeared to have a poorer prognosis.Of the 76 children who consulted a healthcare professional before admission,only 5 were prescribed adequate antimalarial oral therapy.Predictors of early death were jaundice or increased bilirubin[odd ratio(OR)=8.6;95% confidential interval(CI):2.03-36.1]and lactate>5 mmol/L(OR=5.1;95%CI:1.49-17.30).Antibiotic use before admission(OR=0.1;95%CI:0.02-0.85)and vaccination against yellow fever(OR=0.2,95%CI:0.05-0.79)protected against mortality.Conclusions:Infections were found in all children who died,and cerebral malaria was by far the most common cause of non-traumatic coma.Missed opportunities to receive early effective antimalarial treatment were common.Other central nervous system infections must be considered in their management.Some factors that proved to be protective against early death were unexpected.展开更多
基金supported by CILM, Institut de Recherche pour le Développement, Campus Francethe Fondation Mérieux
文摘Hepatitis C virus （HCV） is a global health concern, notably in Southeast Asia, and in Laos the presentation of the HCV- induced liver disease is poorly known. Our objective was thus to describe a comprehensive HCV infection pattern in order to guide national health policies. A study on a group of 1765 patients formerly diagnosed by rapid test in health centres was conducted at the Centre of Infectiology Lao Christophe Merieux in Vientiane. The demographic information of patients, their infection status （viral load： VL）, liver function （aminotransferases） and treatments were analysed. Results showed that gender distribution of infected people was balanced; with median ages of 53.8 for men and 51.6 years for women （13-86 years）. The majority of patients （72%） were confirmed positive （VL 〉 50 IU/mL） and 28% of them had high VL （〉 61oglo）. About 23% of patients had level of aminotransferases indicative of liver damage （〉 40 IU/mL）; but less than 20% of patients received treatment. Patients rarely received a second sampling or medical imaging. The survey also showed that cycloferon, pegylated interferon and ribavirin were the drugs prescribed preferentially by the medical staff, without following any international recommendations schemes. In conclusion, we recommend that a population screening policy and better management of patients should be urgently implemented in the country, respecting official guidelines. However, the cost of biological analysis and treatment are significant barriers that must be removed. Public health resolutions should be immediately enforced in the perspective of meeting the WHO HCV elimination deadline by 2030.
文摘Background: Blood eosinophilia is a common laboratory abnormality, and its characterization frequently represents a quandary for primary care physicians. Consequently, in France, specialists and particularly hematologists, often must investigate patients who present with blood eosinophilia that often, but not always, occurs because of allergic causes. Both the Departments of Hematology and Parasitology at Toulouse University Hospitals established a collaboration to rule out allergic causes of eosinophilia, particularly helminthiases, prior to initiating more sophisticated investigations.Methods: Since 2004, the authors employed the same protocol to investigate eosinophilic outpatients who attended the clinic of Parasitology at Toulouse University Hospitals, and they reported the performance of this diagnostic procedure that was designed to be rapid(no hospitalization required) and only moderately expensive.Results: A total of 406 patients who presented with blood eosinophilia greater than 0.5(×10~9, giga cells per litter, G/L) had an allergic etiology in 350(86.2%) cases. Among the remaining 56 subjects, 17 did not undergo a follow-up and 39 were referred to another specialized department, mostly Hematology. However, only 21 patients attended then were subsequently investigated. Non-allergic causes of eosinophilia, including 3 cases of the lymphoid variant of hypereosinophilic syndrome and 2 cases of myeloproliferative disorder, were identified in 14 patients, whereas 7 remained diagnosed as having idiopathic eosinophilia.Conclusion: This study underlines the need to investigate patients presenting with even moderate blood eosinophilia. The work-up that was employed appears to be efficient and versatile and may be used by any medical specialist, such as in hematology, infectious disease, or internal medicine departments, who needs to investigate eosinophilic patients and should initially rule out any etiology of allergic eosinophilia.
基金This work was supported by a grant from the French National Research Agency(ANR-17-CE17-0001),including a PhD grant for Jade Royo.Bertin Vianou received a PHD grant called Research grant for a thesis in the South(ARTS)from the Institut de Recherche pour le Développement France(IRD).
文摘Background Cerebral malaria(CM)is a neuropathology which remains one of the deadliest forms of malaria among African children.The kinetics of the pathophysiological mechanisms leading to neuroinflammation and the death or survival of patients during CM are still poorly understood.The increasing production of cytokines,chemokines and other actors of the inflammatory and oxidative response by various local actors in response to neuroinflammation plays a major role during CM,participating in both the amplification of the neuroinflammation phenomenon and its resolution.In this study,we aimed to identify risk factors for CM death among specific variables of inflammatory and oxidative responses to improve our understanding of CM pathogenesis.Methods Children presenting with CM(n=70)due to P.falciparum infection were included in southern Benin and divided according to the clinical outcome into 50 children who survived and 20 who died.Clinical examination was complemented by fundoscopic examination and extensive blood biochemical analysis associated with molecular diagnosis by multiplex PCR targeting 14 pathogens in the patients'cerebrospinal fluid to rule out coinfections.Luminex technology and enzyme immunoassay kits were used to measure 17 plasma and 7 urinary biomarker levels,respectively.Data were analysed by univariate analysis using the nonparametric Mann-Whitney U test and Pearson’s Chi2 test.Adjusted and multivariate analyses were conducted separately for plasma and urinary biomarkers to identify CM mortality risk factors.Results Univariate analysis revealed higher plasma levels of tumour necrosis factor(TNF),interleukin-1beta(IL-1β),IL-10,IL-8,C-X-C motif chemokine ligand 9(CXCL9),granzyme B,and angiopoietin-2 and lower urinary levels of prostanglandine E2 metabolite(PGEM)in children who died compared to those who survived CM(Mann-Whitney U-test,P-values between 0.03 and<0.0001).The multivariate logistic analysis highlighted elevated plasma levels of IL-8 as the main risk factor for death during CM(adjusted odd ratio=14.2,P-value=0.002).Values obtained during follow-up at D3 and D30 revealed immune factors associated with disease resolution,including plasma CXCL5,C-C motif chemokine ligand 17(CCL17),CCL22,and urinary 15-F2t-isoprostane.Conclusions The main risk factor of death during CM was thus elevated plasma levels of IL-8 at inclusion.Follow-up of patients until D30 revealed marker profiles of disease aggravation and resolution for markers implicated in neutrophil activation,endothelium activation and damage,inflammatory and oxidative response.These results provide important insight into our understanding of CM pathogenesis and clinical outcome and may have important therapeutic implications.
基金funded by the French National Research Agency(ANR-17-CE17-0001).
文摘Background:While malaria morbidity and mortality have declined since 2000,viral central nervous system infections appear to be an important,underestimated cause of coma in malaria-endemic Eastern Africa.We aimed to describe the etiology of non-traumatic comas in young children in Benin,as well as their management and early outcomes,and to identify factors associated with death.Methods:From March to November 2018,we enrolled all HIV-negative children aged between 2 and 6 years,with a Blantyre Coma Score≤2,in this prospective observational study.Children were screened for malaria severity signs and assessed using a systematic diagnostic protocol,including blood cultures,malaria diagnostics,and cerebrospinal fluid analysis using multiplex PCR.To determine factors associated with death,univariate and multivariate analyses were performed.Results:From 3244 admissions,84 children were included:malaria was diagnosed in 78,eight of whom had a viral or bacterial co-infection.Six children had a non-malarial infection or no identified cause.The mortality rate was 29.8%(25/84),with 20 children dying in the first 24 h.Co-infected children appeared to have a poorer prognosis.Of the 76 children who consulted a healthcare professional before admission,only 5 were prescribed adequate antimalarial oral therapy.Predictors of early death were jaundice or increased bilirubin[odd ratio(OR)=8.6;95% confidential interval(CI):2.03-36.1]and lactate>5 mmol/L(OR=5.1;95%CI:1.49-17.30).Antibiotic use before admission(OR=0.1;95%CI:0.02-0.85)and vaccination against yellow fever(OR=0.2,95%CI:0.05-0.79)protected against mortality.Conclusions:Infections were found in all children who died,and cerebral malaria was by far the most common cause of non-traumatic coma.Missed opportunities to receive early effective antimalarial treatment were common.Other central nervous system infections must be considered in their management.Some factors that proved to be protective against early death were unexpected.
