Genne D.,Center Hospitalier Of Bienne |
Chuard C.,Service des maladies infectieuses
Revue Medicale Suisse | Year: 2017
Several outbreaks have made the news in 2016 : Ebola has come at an end, Zika is booming and a resurgence of yellow fever takes place in Africa. In Switzerland, two hospital outbreaks have been reported, caused by Mycobacterium chimerae and Burkholderia cepacia. A major new article has consolidated the notion that prolonged antibiotic therapy is unnecessary in Lyme disease. As multiresistant bacteria are increasing in frequency, innovative therapeutic approaches are under development. For lung infections, sensitive and specific methods are in need to refine their etiological diagnosis. In pneumonia, therapy can be shortened without risk compared with usual practice. Finally, the epidemiology of bacterial meningitis has changed in the last 10 years, with a decrease of incidence.
Faye O.,Institute Pasteur Of Dakar |
Boelle P.-Y.,French Institute of Health and Medical Research |
Boelle P.-Y.,University Pierre and Marie Curie |
Heleze E.,Ministry of Health |
And 9 more authors.
The Lancet Infectious Diseases | Year: 2015
Background: An epidemic of Ebola virus disease of unprecedented size continues in parts of west Africa. For the first time, large urban centres such as Conakry, the capital of Guinea, are affected. We did an observational study of patients with Ebola virus disease in three regions of Guinea, including Conakry, aiming to map the routes of transmission and assess the effect of interventions. Methods: Between Feb 10, 2014, and Aug 25, 2014, we obtained data from the linelist of all confirmed and probable cases in Guinea (as of Sept 16, 2014), a laboratory database of information about patients, and interviews with patients and their families and neighbours. With this information, we mapped chains of transmission, identified which setting infections most probably originated from (community, hospitals, or funerals), and computed the context-specific and overall reproduction numbers. Findings: Of 193 confirmed and probable cases of Ebola virus disease reported in Conakry, Boffa, and Télimélé, 152 (79%) were positioned in chains of transmission. Health-care workers contributed little to transmission. In March, 2014, individuals with Ebola virus disease who were not health-care workers infected a mean of 2·3 people (95% CI 1·6-3·2): 1·4 (0·9-2·2) in the community, 0·4 (0·1-0·9) in hospitals, and 0·5 (0·2-1·0) at funerals. After the implementation of infection control in April, the reproduction number in hospitals and at funerals reduced to lower than 0·1. In the community, the reproduction number dropped by 50% for patients that were admitted to hospital, but remained unchanged for those that were not. In March, hospital transmissions constituted 35% (seven of 20) of all transmissions and funeral transmissions constituted 15% (three); but from April to the end of the study period, they constituted only 9% (11 of 128) and 4% (five), respectively. 82% (119 of 145) of transmission occurred in the community and 72% (105) between family members. Our simulations show that a 10% increase in hospital admissions could have reduced the length of chains by 26% (95% CI 4-45). Interpretation: In Conakry, interventions had the potential to stop the epidemic, but reintroductions of the disease and poor cooperation of a few families led to prolonged low-level spread, showing the challenges of Ebola virus disease control in large urban centres. Monitoring of chains of transmission is crucial to assess and optimise local control strategies for Ebola virus disease. Funding: Labex IBEID, Reacting, PREDEMICS, NIGMS MIDAS initiative, Institut Pasteur de Dakar. © 2015 Elsevier Ltd.
Sulkowski M.S.,Johns Hopkins University |
Sherman K.E.,University of Cincinnati |
Dieterich D.T.,Mount Sinai School of Medicine |
Bsharat M.,Vertex Pharmaceuticals |
And 11 more authors.
Annals of Internal Medicine | Year: 2013
Background: Telaprevir (TVR) plus peginterferon-o2a (PEG-IFN- o2a) and ribavirin substantially increases treatment efficacy for genotype 1 chronic hepatitis C virus (HCV) infection versus PEG-IFN- a2a-ribavirin alone. Its safety and efficacy in patients with HCV and HIV-1 are unknown. Objective: To assess the safety and efficacy of TVR plus PEG-IFN- a2a-ribavirin in patients with genotype 1 HCV and HIV-1 and to evaluate pharmacokinetics of TVR and antiretrovirals during coadministration. Design: Phase 2a, randomized, double-blind, placebo-controlled study. (ClinicalTrials.gov: NCT00983853) Setting: 16 international multicenter sites. Patients: 62 patients with HCV genotype 1 and HIV-1 who were HCV treatment-naive and receiving 0 or 1 of 2 antiretroviral regimens were randomly assigned to TVR plus PEG-IFN-a2a-ribavirin or placebo plus PEG-IFN-a2a-ribavirin for 12 weeks, plus 36 weeks of PEG-IFN-a2a-ribavirin. Measurements: HCV RNA concentrations. Results: Pruritus, headache, nausea, rash, and dizziness were higher with TVR plus PEG-IFN-a2a-ribavirin during the first 12 weeks. During this period, serious adverse events occurred in 5% (2 in 38) of those receiving TVR plus PEG-IFN-a2a-ribavirin and 0% (0 in 22) of those receiving placebo plus PEG-IFN-α2a-ribavirin; the same number in both groups discontinued treatment due to adverse events. Sustained virologic response occurred in 74% (28 in 38) of patients receiving TVR plus PEG-IFN-α2a-ribavirin and 45% (10 in 22) of patients receiving placebo plus PEG-IFN-α2a-ribavirin. Rapid HCV suppression was seen with TVR plus PEG-IFN-α2a- ribavirin (68% [26 in 38 patients] vs. 0% [0 in 22 patients] undetectable HCV RNA levels by week 4). Two patients had ontreatment HCV breakthrough with TVR-resistant variants. Patients treated with antiretroviral drugs had no HIV breakthroughs; antiretroviral exposure was not substantially modified by TVR. Limitation: Small sample size and appreciable dropout rate. Conclusion: In patients with HCV and HIV-1, more adverse events occurred with TVR versus placebo plus PEG-IFN-α2a-ribavirin; these were similar in nature and severity to those in patients with HCV treated with TVR. With or without concomitant antiretrovirals, sustained virologic response rates were higher in patients treated with TVR versus placebo plus PEG-IFN-α2a-ribavirin. © 2013 American College of Physicians.
Tissot F.,Service des Maladies Infectieuses |
Maillard M.H.,Service de Gastro enterologie et dHepatologie
Revue Medicale Suisse | Year: 2014
While metronidazole and vancomycin have been the only drug options to date for the treatment of C. difficile infection, new therapeutic approaches with promising results have recently emerged for the treatment of the first episode and relapses. Fidaxomicin is a new macrocyclic antibiotic more active against C. difficile and with a narrow spectrum allowing preservation of the intestinal microbiota. While having the same efficacy as vancomycin for the treatment of the first episode, this agent is associated with a lower rate of relapse. The highest relapse-free cure rate is achieved through fecal microbiota transplantation, which should be considered for patients with multiple relapses.
Minta D.K.,Service des maladies infectieuses
Médecine tropicale : revue du Corps de santé colonial | Year: 2011
Cryptococcal meningitis is the most common fatal central nervous system infection in AIDS patients in Sub-Saharan Africa. The purpose of this prospective study conducted from March 2003 to February 2004 in the internal medicine and infectious diseases departments of the Point G University Hospital Center was to investigate the clinical, prognostic and epidemiological profile of Cryptococcus neoformans infection in patients hospitalized for brain and meningeale infection (BMI). Diagnosis of neuromeningeal cryptococcosis (NMC) was based on positive identification of Cryptococcus by direct exam of the cebrospinal fluid (CSF) after India ink staining and/or culture on Sabouraud medium without actidione. During the study period, a total of 569 patients were hospitalized including 235 (41.3%) with HIV infection. Overall C. neoformans was identified in 14 patients. Median patient age was 39 +/- 8 years. There was a male preponderance with a sex ratio of 1.8 (9 men/5 women). Patients with BMI were HIV-positive in 85.7% of cases (n=12) and HIV-negative in 14.3% (n=2). The overall and HIV-specific prevalence of BMI was 2.5% and 5.1% respectively. The CD4 lymphocyte count was between I and 49 cells/mm3 in 64.3% of cases. The main clinical symptoms were cephalea in 85.7% of cases, altered consciousness in 50% and nausea/vomiting in 35.7%. Neurological manifestations (hemiparesis and cranial nerve deficit) were noted in 14.3%. HIV infection is the main purveyor of NMC in Mali. The actual incidence of cryptococcosis is unclear due to the poor sensitivity of diagnostic techniques. This study highlights diagnostic difficulties related to clinical polymorphism and poor technical facilities. Agglutination testing of blood and CSF is recommended, but mortality remains.
Yeni P.,Service des Maladies Infectieuses
Current HIV research | Year: 2010
Current HIV treatment guidelines emphasize the importance of using an active antiretroviral therapy regimen that produces full virologic suppression and immunologic competence, while at the same time providing patients with a favorable safety profile and limited risk for development of drug resistance. Etravirine (TMC125), a recently approved, non-nucleoside reverse transcriptase inhibitor (NNRTI), has shown durable, superior virologic efficacy over placebo in the Phase III, randomized, double-blind DUET trials in 1,203 treatment-experienced, NNRTI-resistant, HIV-1-infected patients. Statistical significance of responses with etravirine over placebo was maintained through Week 24, 48 and 96, regardless of baseline demographics, baseline disease characteristics or the background regimen used. Etravirine has demonstrated a favorable safety and tolerability profile; the incidence of treatment-emergent adverse events was comparable with placebo in the DUET trials, with the exception of rash. The tolerability profile of etravirine also appears to be favorable in terms of neuropsychiatric and hepatic side effects. The pharmacokinetic profile of twice-daily etravirine minimizes the potential for clinically relevant drug-drug interactions and allows for its use in combination with a wide range of other agents. In addition, etravirine has a high genetic barrier to the development of resistance, further enhancing potential benefit in patients infected with NNRTI-resistant virus. The clinical efficacy and favorable safety profile of etravirine, together with its pharmacokinetic profile and high genetic barrier to resistance, make it a valuable treatment option for a wide range of treatment-experienced HIV-1-infected patients.
Merz L.,Service des Maladies Infectieuses
Revue Medicale Suisse | Year: 2015
Strongyloïdes stercoralis hyperinfection syndrome, which carries a high mortality (60%), occurs usually after immunosuppressive therapy. Cellular immunosuppression allows the parasite to reactivate and stimulate its cycle of autoinfection. It is therefore important to prevent this syndrome by screening at risk patients at risk for chronic strongyloidiasis before starting immunosuppressive treatment and especially before treatment with corticosteroids, even that of short duration. Ivermectine is the treatment of choice.
Afiri M.,Service des maladies infectieuses
Médecine et santé tropicales | Year: 2013
This prospective study analyzes 173 patients, hospitalized between January 1, 2005, and December 31, 2008, for serologically confirmed leptospirosis. It describes the renal, clinical and laboratory manifestations in 88 (50.8%) of these cases. Acute kidney failure was frequent in this group (68 cases = 77.3%). Kidney damage was one of the multiple organs affected, with infection and hepatic and hemorrhagic signs predominant.
Gardiol C.,Service des maladies infectieuses |
Cavassini M.,Service des maladies infectieuses
Revue Medicale Suisse | Year: 2013
The risk of contracting a sexually transmitted infection while traveling abroad is increased in certain populations. Pre-travel consultation should include the education of travelers on the prevalence of HIV in the countries visited and on appropriate prevention measures. In patients infected with HIV (PHIV), combined antiretroviral therapy (cART) improves immunity, enabling them to travel with less risk for their health. Pre-travel consultation of PVIH has the following objectives : to determine immune status, to update immunization and to decide on anti-malaria drug prophylaxis, taking into account potential drug interactions with antiretroviral therapy. Vaccine response and duration of protection is shorter-lived in PVIH, especially if the CD4 count is below 200 cells/mm3 and the HIV viral load is detectable. Therefore cART is a cornerstone for disease prevention among patients infected with HIV who travel. © Médecine et Hygiène 2010.
Afiri M.,Service des maladies infectieuses
Médecine et santé tropicales | Year: 2013
The epidemic reported here took place from November 30, 2006, through January 3, 2007, in a rural area of Tala-Athmane and led to the hospitalization of 48 patients with leptospirosis. It was due to the proximity of homes to two uncontrolled garbage dumps invaded by rodents. All 48 hospitalized cases were confirmed serologically, and more than 60% were serogroup icterohaemorrhagiae. More than 14.5% of the patients were contaminated during occupational exposure. The authors describe the clinical polymorphism of these cases and the severity of this infection when not treated early. Outcome was favorable in nearly 98% of the patients receiving antibiotic therapy.