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Le Touquet – Paris-Plage, France

Leroy O.,Coty | Mira J.P.,Service de Reanimation medicale | Mira J.P.,University of Paris Descartes | Montravers P.,Center Hospitalier University Bichat Claude Bernard | And 6 more authors.
Critical Care | Year: 2010

Introduction: Candidemia raises numerous therapeutic issues for intensive care physicians. Epidemiological data that could guide the choice of initial therapy are still required. This analysis sought to compare the characteristics of intensive care unit (ICU) patients with candidemia due to non-albicans Candida species with those of ICU patients with candidemia due to Candida albicans.Methods: A prospective, observational, multicenter, French study was conducted from October 2005 to May 2006. Patients exhibiting candidemia developed during ICU stay and exclusively due either to one or more non-albicans Candida species or to C. albicans were selected. The data collected included patient characteristics on ICU admission and at the onset of candidemia.Results: Among the 136 patients analyzed, 78 (57.4%) had candidemia caused by C. albicans. These patients had earlier onset of infection (11.1 ± 14.2 days after ICU admission vs. 17.4 ± 17.7, p = 0.02), higher severity scores on ICU admission (SOFA: 10.4 ± 4.7 vs. 8.6 ± 4.6, p = 0.03; SAPS II: 57.4 ± 22.8 vs. 48.7 ± 15.5, P = 0.015), and were less often neutropenic (2.6% vs. 12%, p = 0.04) than patients with candidemia due to non-albicans Candida species.Conclusions: Although patients infected with Candida albicans differed from patients infected with non-albicans Candida species for a few characteristics, no clinical factor appeared pertinent enough to guide the choice of empirical antifungal therapy in ICU. © 2010 Leroy et al.; licensee BioMed Central Ltd.

Epaulard O.,Grenoble University Hospital Center | Leccia M.-T.,Grenoble University Hospital Center | Chosidow O.,University Paris Est Creteil | Thiebaut A.,Grenoble University Hospital Center | And 3 more authors.
Medecine et Maladies Infectieuses | Year: 2011

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. © 2011 Elsevier Masson SAS.

Richaud C.,University of Paris Descartes | Lebeaux D.,University of Paris Descartes | Lebeaux D.,Center dInfectiologie Necker Pasteur | Lortholary O.,University of Paris Descartes | Lortholary O.,Institute Pasteur Paris
Current Fungal Infection Reports | Year: 2013

International travel is increasing. As fungal infections associated with travel are rare diseases, they are often underestimated and misdiagnosed. Thus, updated knowledge in this area is of key importance for physicians not only for pretravel counselling but also for the management of patients upon their return. We present an update of data published in 2012 and 2013. We present an overview of epidemiological changes, especially new endemic areas, and the implications of climate and natural disasters. Through experimental and clinical data, new insights into the pathophysiology of fungal infections associated with travel have been obtained, especially for Cryptococcus spp. Recently published diagnostic tools could lead to faster and more accurate diagnosis. Lastly, recent prognostic and therapeutic data are emphasized. © 2013 Springer Science+Business Media New York.

Theodoropoulos N.,Northwestern University | Lanternier F.,Center dInfectiologie Necker Pasteur | Rassiwala J.,Northwestern University | Mcnatt G.,Northwestern Memorial Hospital | And 4 more authors.
Transplant Infectious Disease | Year: 2012

Background. Tuberculosis (TB) reactivation is a rare but significant complication of organ transplantation, and screening of all transplant candidates for latent infection is recommended with either an interferon-γ release assay (IGRA) or tuberculin skin test (TST). Methods. After institutional review board approval, we retrospectively collected data to describe the yield of transplant candidate screening using the QuantiFERON-TB Gold (QFT) and QuantiFERON-TB Gold In-Tube (QFT-IT) assays since the institution of TB screening in 2008 and the epidemiology of all cases of post-transplant TB in our institution since 2004. Results. A total of 2392 patients were screened with either the QFT or QFT-IT assay through October 2009; 245 (10.2%) tested positive and 206 (8.6%) were indeterminate. Of those with positive results, 107 (43.7%) were foreign born and most of the remainder had prior TB exposures. Of the tests performed at a reference lab, 29% were indeterminate, whereas 14% were indeterminate using our in-house lab. The majority of indeterminate results were seen in liver transplant candidates (40.6% vs. 11.8% in non-liver candidates). Three of 694 (0.43%) screened patients who underwent transplantation developed TB post transplant. Conclusions. Post-transplant TB occurs at a low rate with universal IGRA-based candidate screening, which is comparable to studies using TST screening. © 2011 John Wiley & Sons A/S.

Lambert-Niclot S.,French Institute of Health and Medical Research | Peytavin G.,AP HP | Duvivier C.,Center dInfectiologie Necker Pasteur | Duvivier C.,Institute Pasteur Paris | And 10 more authors.
Antimicrobial Agents and Chemotherapy | Year: 2010

HIV-1 RNA level and darunavir concentration in the genital tract were measured in 45 men receiving darunavir-ritonavir mono- or tritherapy. At week 48, a low frequency (3/45) of HIV-1 RNA shedding was observed in patients (1 on monotherapy and 2 on triple therapy), although they had undetectable HIV-1 RNA in plasma. The median darunavir seminal plasma concentration was close to the blood plasma free fraction, demonstrating a good penetration of darunavir into the male genital tract. Copyright © 2010, American Society for Microbiology. All Rights Reserved.

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