Publications by authors named "Eric Caumes"

205 Publications

Intravenous artesunate for the treatment of severe imported malaria: implementation, efficacy and safety in 1391 patients.

Clin Infect Dis 2021 Feb 13. Epub 2021 Feb 13.

Biologie Intégrée du Globule Rouge, INSERM, Université de Paris, Université des Antilles, Paris, France.

Background: Intravenous artesunate is the WHO-recommended first-line treatment for severe malaria worldwide, but it is still not fully licensed in Europe. Observational studies documenting its safety and efficacy in imported malaria are thus essential.

Methods: We prospectively collected clinical and epidemiological features of 1391 artesunate-treated patients among 110 participant centers during the first seven years (2011-2017) of a national program implemented by the French Drug Agency.

Results: Artesunate became the most frequent treatment for severe malaria in France rising from 9.9% in 2011 to 71.4% in 2017. Mortality was estimated at 4.1%. Treatment failure was recorded in 27 patients but mutations in the Kelch-13 gene were not observed. Main reported adverse events (AE) were anemia (136 cases), cardiac events (24, including 20 episodes of conduction disorders and/or arrhythmia) and liver enzyme elevation (23). Mortality and AE were similar in the general population and in HIV-infected, overweight or pregnant patients, but the only pregnant woman treated in the first trimester experimented a hemorrhagic miscarriage. The incidence of post-artesunate delayed hemolysis (PADH) was 42.8% when specifically assessed in a 98-patient subgroup but was not associated with fatal outcomes or sequelae. PADH was twice as frequent in patients of European compared to African origin.

Conclusion: Artesunate was rapidly deployed and displayed a robust clinical benefit in patients with severe imported malaria, despite a high frequency of mild to moderate PADH. Further explorations in the context of importation should assess outcomes during the first-trimester of pregnancy and collect rare but potentially severe cardiac AE.
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http://dx.doi.org/10.1093/cid/ciab133DOI Listing
February 2021

Why Methodology Is Important: Coffee as a Candidate Treatment for COVID-19?

J Clin Med 2020 Nov 17;9(11). Epub 2020 Nov 17.

Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Infectious Diseases Department, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'hôpital, 75013 Paris, France.

Background: During this pandemic situation, some studies have led to hasty conclusions about Corona Virus Disease-19 (COVID-19) treatment, due to a lack of methodology. This pedagogic study aimed to highlight potential biases in research on COVID-19 treatment.

Methods: We evaluate the effect of coffee's active part, 1,3,7-trimethylxanthine (TMX) on patients with COVID-19. A cohort of 93 patients, with a diagnosis of COVID-19 is analyzed.

Results: TMX group and control group included, respectively, 26 and 67 patients. In the TMX group, patients had a median length of stay in hospital of 5.5 days shorter than in the control group (9.5 vs. 15 days, < 0.05). Patients in the control group were more severe than patients in the TMX group with a significantly higher National Early Warning Score 2 (NEWS-2 score) (8 vs. 6, = 0.002).

Conclusions: Multiple biases prevents us from concluding to an effect of coffee on COVID-19. Despite an important social pressure during this crisis, methodology and conscientiousness are the best way to avoid hasty conclusions that can be deleterious for patients. Identifier: NCT04395742.
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http://dx.doi.org/10.3390/jcm9113691DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7698499PMC
November 2020

Abdominal Tuberculosis: Experience from Two Tertiary-Care Hospitals in the Paris Region.

Am J Trop Med Hyg 2021 01;104(1):223-228

1Service de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France.

Abdominal tuberculosis (ATB) is uncommon and not very well known by clinicians. We describe the characteristics, evolution, and treatment of patients with ATB in two large hospitals in the Paris region. We reviewed all records of patients treated for ATB, from January 01, 2010 to December 01, 2016, diagnosed by bacteriological and/or histological methods or highly suspected because of clinical/radiological features. We included 80 patients, with a median (IQR) age of 39 (29-50) years, with 56.2% being males. Among them, 63.7% had African origins, 15% Asian, and 11.2% European. Twenty-nine had a cause of immunosuppression ( = 21 HIV infection). The main abdominal localizations were lymph nodes (72.5%), peritoneum (62.5%), and solid organs (25%). Extra-abdominal localizations were recorded in 65 (81.2%) patients. Tuberculosis was proven bacteriologically in 71%, histologically in 50%, and solely clinical/radiological in 10% of cases. Patients received standard therapy for a median duration of 9 months, with a favorable outcome. Corticosteroid therapy was used in 15 cases, either for paradoxical reaction or to prevent complications. Abdominal TB was mainly represented by lymphatic and peritoneal localizations, proven bacteriologically, and associated with extra-abdominal localizations in most cases. The use of steroids remains controversial, but it does not seem systematically needed in case of abdominal involvement.
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http://dx.doi.org/10.4269/ajtmh.20-0023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7790114PMC
January 2021

Prevalence of hyposmia and hypogeusia in 390 COVID-19 hospitalized patients and outpatients: a cross-sectional study.

Eur J Clin Microbiol Infect Dis 2020 Oct 8. Epub 2020 Oct 8.

Groupe Hospitalier Universitaire APHP, Sorbonne Université, site Pitié-Salpêtrière, Paris, France.

Anecdotal evidence rapidly accumulated during March 2020 from sites around the world that sudden hyposmia and hypogeusia are significant symptoms associated with the SARS-CoV-2 pandemic. Our objective was to describe the prevalence of hyposmia and hypogeusia and compare it in hospitalized and non-hospitalized COVID-19 patients to evaluate an association of these symptoms with disease severity. We performed a cross-sectional survey during 5 consecutive days in March 2020, within a tertiary referral center, associated outpatient clinic, and two primary care outpatient facilities in Paris. All SARS-CoV-2-positive patients hospitalized during the study period and able to be interviewed (n = 198), hospital outpatients seen during the previous month (n = 129), and all COVID-19-highly suspect patients in two primary health centers (n = 63) were included. Hospitalized patients were significantly more often male (64 vs 40%) and older (66 vs 43 years old in median) and had significantly more comorbidities than outpatients. Hyposmia and hypogeusia were reported by 33% of patients and occurred significantly less frequently in hospitalized patients (12% and 13%, respectively) than in the health centers' outpatients (33% and 43%, respectively) and in the hospital outpatients (65% and 60%, respectively). Hyposmia and hypogeusia appeared more frequently after other COVID-19 symptoms. Patients with hyposmia and/or hypogeusia were significantly younger and had significantly less respiratory severity criteria than patients without these symptoms. Olfactory and gustatory dysfunction occurs frequently in COVID-19, especially in young, non-severe patients. These symptoms might be a useful tool for initial diagnostic work-up in patients with suspected COVID-19.
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http://dx.doi.org/10.1007/s10096-020-04056-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7543958PMC
October 2020

Mortality from malaria in France, 2005 to 2014.

Euro Surveill 2020 09;25(36)

The members of the French imported malaria Study group are acknowledged at the end of this article.

IntroductionMalaria is a notifiable disease in all European Union and European Economic Area countries except Belgium and France, where only autochthonous malaria is notifiable. Although morbidity caused by malaria has been assessed, little is known about mortality incidence.ObjectiveOur aim was to estimate the number of imported malaria-related deaths in hospital in metropolitan France.MethodsWe matched individual deaths reported between 1 January 2005 and 31 December 2014 to the French National Reference Centre for malaria (FNRCm) with malaria-related deaths from two other sources: the French National Registry on medical causes of death and the French national hospital discharge database. A capture-recapture method with log-linear modelling was used. Age, sex and place of death stratification were applied to remove heterogeneity.ResultsThe estimated malaria-related deaths in metropolitan France during the study period were 205 (95% confidence interval (CI): 191-219). The annual mean number of malaria-related deaths was estimated at 21 (95% CI: 19-22). The FNRCm malaria-related deaths surveillance had a 38% sensitivity (95% CI: 32-44). Among 161 in-hospital individual malaria-related deaths reported from three data sources, the sex ratio (male to female) was 2.6. Median age of the patients was 57 years, ranging from 1 to 89 years.ConclusionThe pertinent finding of this report is that malaria-related death records were significantly less complete [corrected] than case records. Therefore, data comparison of imported malaria morbidity and mortality between countries should imperatively be assessed using standard indicators weighted according to the completeness of health surveillance systems.
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http://dx.doi.org/10.2807/1560-7917.ES.2020.25.36.1900579DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7502900PMC
September 2020

[Does an injection of yellow fever vaccine really provide protection for life?]

Rev Prat 2020 03;70(3):317

Service de maladies infectieuses et tropicales, groupe hospitalier Pitié-Salpêtrière, Paris, France.

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March 2020

[Yellow fever is still a current threat ?]

Rev Prat 2020 Mar;70(3):312-316

Service de maladies infectieuses et tropicales, groupe hospitalier Pitié-Salpêtrière, Paris, France.

Yellow fever is still a current threat? Yellow fever is a mosquito-borne disease. Africa is the major endemic zone, although there have been epidemics of concern in South America in the last 3 years, especially in Brazil. The virus causes a febrile hepatitis, which can lead to hemorrhagic complications and death. Diagnosis is based on non-specific serological tests. There is no curative treatment. Prevention relies on protection against mosquito bites and on vaccination with a live attenuated vaccine. WHO recommends only one dose of vaccine but data from the literature about life-long protection are divergent on that point, and travel medicine French authorities still recommend a second dose in most at-risk situations.
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March 2020

Epidemiological and Clinical Characteristics of International Travelers with Enteric Fever and Antibiotic Resistance Profiles of Their Isolates: a GeoSentinel Analysis.

Antimicrob Agents Chemother 2020 10 20;64(11). Epub 2020 Oct 20.

Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA.

Enteric fever, caused by serovar Typhi ( Typhi) and serovar Paratyphi ( Paratyphi), is a common travel-related illness. Limited data are available on the antimicrobial resistance (AMR) patterns of these serovars among travelers. Records of travelers with a culture-confirmed diagnosis seen during or after travel from January 2007 to December 2018 were obtained from GeoSentinel. Traveler demographics and antimicrobial susceptibility data were analyzed. Isolates were classified as nonsusceptible if intermediate or resistant or as susceptible in accordance with the participating site's national guidelines. A total of 889 travelers ( Typhi infections,  = 474; Paratyphi infections,  = 414; coinfection,  = 1) were included; 114 (13%) were children of <18 years old. Most individuals (41%) traveled to visit friends and relatives (VFRs) and acquired the infection in South Asia (71%). Child travelers with Typhi infection were most frequently VFRs (77%). The median trip duration was 31 days (interquartile range, 18 to 61 days), and 448 of 691 travelers (65%) had no pretravel consultation. Of 143 Typhi and 75 Paratyphi isolates for which there were susceptibility data, nonsusceptibility to antibiotics varied (fluoroquinolones, 65% and 56%, respectively; co-trimoxazole, 13% and 0%; macrolides, 8% and 16%). Two Typhi isolates (1.5%) from India were nonsusceptible to third-generation cephalosporins. Typhi fluoroquinolone nonsusceptibility was highest when infection was acquired in South Asia (70 of 90 isolates; 78%) and sub-Saharan Africa (6 of 10 isolates; 60%). Enteric fever is an important travel-associated illness complicated by AMR. Our data contribute to a better understanding of region-specific AMR, helping to inform empirical treatment options. Prevention measures need to focus on high-risk travelers including VFRs and children.
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http://dx.doi.org/10.1128/AAC.01084-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7577154PMC
October 2020

Reply to Million et al.

Clin Infect Dis 2020 Aug 6. Epub 2020 Aug 6.

Sorbonne Université, INSERM UMR 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Département de Santé Publique, Unité de Recherche Clinique Pitié Salpêtrière - Charles Foix, Centre de Pharmaco-épidémiologie de l'AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, 75013, Paris, France.

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http://dx.doi.org/10.1093/cid/ciaa1122DOI Listing
August 2020

Evolution of viral quasispecies during SARS-CoV-2 infection.

Clin Microbiol Infect 2020 Nov 24;26(11):1560.e1-1560.e4. Epub 2020 Jul 24.

Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié Salpêtrière, Service de Virologie, Paris, France.

Objectives: Studies are needed to better understand the genomic evolution of the recently emerged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aimed to describe genomic diversity of SARS-CoV-2 by next-generation sequencing (NGS) in a patient with longitudinal follow-up for SARS-CoV-2 infection.

Methods: Sequential samples collected between January 29th and February 4th, 2020, from a patient infected by SARS-CoV-2 were used to perform amplification of two genome fragments-including genes encoding spike, envelope, membrane and nucleocapsid proteins-and NGS was carried out with Illumina® technology. Phylogenetic analysis was performed with PhyML and viral variant identification with VarScan.

Results: Majority consensus sequences were identical in most of the samples (5/7) and differed in one synonymous mutation from the Wuhan reference sequence. We identified 233 variants; each sample harboured in median 38 different minority variants, and only four were shared by different samples. The frequency of mutation was similar between genes and correlated with the length of the gene (r = 0.93, p = 0.0002). Most of mutations were substitution variations (n = 217, 93.1%) and about 50% had moderate or high impact on gene expression. Viral variants also differed between lower and upper respiratory tract samples collected on the same day, suggesting independent sites of replication of SARS-CoV-2.

Conclusions: We report for the first time minority viral populations representing up to 1% during the course of SARS-CoV-2 infection. Quasispecies were different from one day to the next, as well as between anatomical sites, suggesting that in vivo this new coronavirus appears as a complex and dynamic distributions of variants.
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http://dx.doi.org/10.1016/j.cmi.2020.07.032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7378485PMC
November 2020

Linezolid-Associated Neurologic Adverse Events in Patients with Multidrug-Resistant Tuberculosis, France.

Emerg Infect Dis 2020 08;26(8):1792-1800

Linezolid is one of the most effective drugs for treating multidrug-resistant tuberculosis (MDR TB), but adverse effects remain problematic. We evaluated 57 MDR TB patients who had received >1 dose of linezolid during 2011-2016. Overall, patients received 600 mg/day of linezolid for a median of 13 months. In 33 (58%) patients, neurologic or ophthalmologic signs developed, and 18 (32%) had confirmed peripheral neuropathy, which for 78% was irreversible at 12 months after the end of TB treatment despite linezolid withdrawal. Among the 19 patients who underwent ophthalmologic evaluation, 14 patients had optic neuropathy that fully reversed for 2. A total of 16 (33%) of 49 patients had a linezolid trough concentration >2 mg/L, and among these, 14 (88%) experienced adverse effects. No significant association was found between trough concentration and neurologic toxicity. These findings suggest the need to closely monitor patients for neurologic signs and discuss optimal duration of linezolid treatment.
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http://dx.doi.org/10.3201/eid2608.191499DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7392460PMC
August 2020

Compassionate use of hydroxychloroquine in clinical practice for patients with mild to severe Covid-19 in a French university hospital.

Clin Infect Dis 2020 Jun 18. Epub 2020 Jun 18.

Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies infectieuses et Tropicales, 75013, Paris, France.

Background: Data from non-randomized studies have suggested that hydroxychloroquine could be an effective therapeutic agent against Covid-19.

Methods: We conducted an observational, retrospective cohort study involving hospitalized adult patients with confirmed, mild to severe Covid-19 in a French university hospital. Patients who received hydroxychloroquine (200mg tid dosage for 10 days) on a compassionate basis in addition to SOCwere compared to patients without contraindications to hydroxychloroquine who received SOCalone. A propensity score-weighted analysis was performed to control for confounders: age, sex, time between symptom onset and admission ≤ 7 days, Charlson comorbidity index, medical history of arterial hypertension, and obesity, NEWS2 score at admission, and pneumonia severity. The primary endpoint was time to unfavorable outcome, defined as: death, admission to an intensive care unit, or decision to withdraw or withhold life-sustaining treatments, whichever came first.

Results: Data from 89 patients with laboratory-confirmed Covid-19 were analyzed, 84 of whom were considered in the primary analysis; 38 patients treated with hydroxychloroquine and 46 patients treated with SOCalone. At admission, the mean age of patients was 66 years, the median Charlson comorbidity index was 3, and the median NEWS2 severity score was 3. After propensity score weighting, treatment with hydroxycholoroquine was not associated with a significantly reduced risk of unfavorable outcome (HR 0.90 [0.38; 2.1], p = 0.81). Overall survival was not significantly different between the two groups (HR 0.89 [0.23; 3.47], p = 1).

Conclusion: In hospitalized adults with Covid-19, no significant reduction of the risk of unfavorable outcomes was observed with hydroxychloroquine in comparison to standard of care. Unmeasured confounders may however have persisted despite careful propensity-weighted analysis and the study might be underpowered. Ongoing controlled trials in patients with varying degrees of initial severity on a larger scale will help determine whether there is a place for hydroxychloroquine in the treatment of Covid-19.
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http://dx.doi.org/10.1093/cid/ciaa791DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7337663PMC
June 2020

Early administration of ritonavir-boosted lopinavir could prevent severe COVID-19.

J Infect 2021 01 27;82(1):159-198. Epub 2020 May 27.

Sorbonne Université, INSERM 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, and Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Service de Virologie, Paris, France. Electronic address:

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http://dx.doi.org/10.1016/j.jinf.2020.05.039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7251410PMC
January 2021

Unusual subdural empyema in a homeless patient diagnosed by molecular approach: a case report.

BMC Infect Dis 2020 May 19;20(1):357. Epub 2020 May 19.

Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre-Louis d'Epidémiologie et de Santé Publique, Paris, France.

Background: We report a case of subdural empyema in a homeless patient caused by Bartonella quintana. B. quintana is a facultative intracellular bacteria for which bacterial growth is fastidious. The molecular biology approach has been a real help in establishing the diagnosis.

Case Report: A 59-years old homeless patient, with a history of chronic alcohol abuse, was brought to the emergency department with a massive subdural empyema. Extensive microbiological evaluation didn't reveal any pathogen in the pus collected before antibiotic treatment. B. quintana was detected in the pus from the empyema using a 16S rRNA-based PCR. Histology of intraoperative samples was consistent with the diagnosis and a serological assay was positive. The patient responded well to a treatment that included craniectomy with drainage of the loculated pus, total removal of the infected capsule and a combination of antibiotics.

Conclusion: This unique case of B. quintana-related empyema illustrates the risk of secondary infection of subdural hematoma with B. quintana since such infections have recently reemerged, predominantly among the homeless populations. Patients with subdural empyema in at-risk populations should be systematically evaluated for B. quintana with an appropriate diagnostic approach involving molecular biology.
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http://dx.doi.org/10.1186/s12879-020-05088-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7236200PMC
May 2020

Zika among international travellers presenting to GeoSentinel sites, 2012-2019: implications for clinical practice.

J Travel Med 2020 Jul;27(4)

Department of Epidemiology and Global Health, University of Umea, Petrus Laestadius Väg, 901 87, Umeå, Sweden.

Introduction: International travellers contribute to the rapid spread of Zika virus (ZIKV) and its sentinel identification globally. We describe ZIKV infections among international travellers seen at GeoSentinel sites with a focus on ZIKV acquired in the Americas and the Caribbean, describe countries of exposure and traveller characteristics, and assess ZIKV diagnostic testing by site.

Methods: Records with an international travel-related diagnosis of confirmed or probable ZIKV from January 2012 through December 2019 reported to GeoSentinel with a recorded illness onset date were included to show reported cases over time. Records from March 2016 through December 2019 with an exposure region of the Americas or the Caribbean were included in the descriptive analysis. A survey was conducted to assess the availability, accessibility and utilization of ZIKV diagnostic tests at GeoSentinel sites.

Results: GeoSentinel sites reported 525 ZIKV cases from 2012 through 2019. Between 2012 and 2014, eight cases were reported, and all were acquired in Asia or Oceania. After 2014, most cases were acquired in the Americas or the Caribbean, a large decline in ZIKV cases occurred in 2018-19.Between March 2016 and December 2019, 423 patients acquired ZIKV in the Americas or the Caribbean, peak reporting to these regions occurred in 2016 [330 cases (78%)]. The median age was 36 years (range: 3-92); 63% were female. The most frequent region of exposure was the Caribbean (60%). Thirteen travellers were pregnant during or after travel; one had a sexually acquired ZIKV infection. There was one case of fetal anomaly and two travellers with Guillain-Barré syndrome. GeoSentinel sites reported various challenges to diagnose ZIKV effectively.

Conclusion: ZIKV should remain a consideration for travellers returning from areas with risk of ZIKV transmission. Travellers should discuss their travel plans with their healthcare providers to ensure ZIKV prevention measures are taken.
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http://dx.doi.org/10.1093/jtm/taaa061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7604850PMC
July 2020

Oral migration of Dirofilaria repens after creeping dermatitis.

Parasite 2020 18;27:16. Epub 2020 Mar 18.

Assistance Publique - Hôpitaux de Paris, Service des Maladies Infectieuses et Tropicales, Hôpital Universitaire Pitié-Salpêtrière, Sorbonne Université, 75013 Paris, France.

We report an autochthonous case of oral dirofilariasis in a 46-year-old female patient exposed in South-Eastern France. The patient first presented eyelid creeping dermatitis of one-week duration, then a sub-mucosal nodule appeared in the cheek. The entire nodule was removed surgically. Histologically, the nodule appeared as inflammatory tissue in which a worm was seen. The molecular analysis, based on cox1 and 12S sequences, identified Dirofilaria repens. Ivermectin treatment was given prior to diagnosis, while taking into consideration the most common causes of creeping dermatitis, but treatment was ineffective. The oral form of dirofilariasis is uncommon and could lead to diagnostic wandering.
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http://dx.doi.org/10.1051/parasite/2020015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7079549PMC
November 2020

Combining bacteriophages and dalbavancin for salvage therapy of complex Staphylococcus aureus extradural empyema.

Med Mal Infect 2020 Aug 6;50(5):458-459. Epub 2020 Mar 6.

Department of Neurosurgery, groupe hospitalier Pitié-Salpêtrière, AP-HP, Paris, France; Sorbonne université, Experimental Neuro-Oncology Unit, CRICM INSERM U1127 CNRS UMR 7225, ICM, 75013 Paris, France.

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http://dx.doi.org/10.1016/j.medmal.2020.02.004DOI Listing
August 2020

Imported loiasis in France: a retrospective analysis of 167 cases with comparison between sub-Saharan and non sub-Saharan African patients.

BMC Infect Dis 2020 Jan 20;20(1):63. Epub 2020 Jan 20.

Infectious Diseases and Tropical Medicine Department, Pitié Salpétrière Hospital and University Pierre et Marie Curie, 75013, Paris, France.

Background: Imported loiasis is a rare cause of consultation at the return of stay in central Africa, which often poses difficult diagnostic and therapeutic questions to practitioners especially those who are unaccustomed to tropical medicine. These difficulties can lead to risks for the patients especially if inappropriate treatment is given. Large series of imported loiasis are scarce.

Methods: We retrospectively studied the data including outcome in patients diagnosed with imported loiasis between 1993 and 2013 in the Paris area on the basis of a parasitological diagnosis (microfilaremia > 1/ml and/or serologic tests). We compared sub-Saharan and non sub-Saharan African patients.

Results: Of the 177 identified cases, 167 could be analysed. Sex ratio was 1, mean age 41 years and 83% were sub-Saharan Africans. Cameroon was the main country of exposure (62%). Incubation time may be long (up to 18 months). Of the 167 cases, 57% presented with characteristic symptoms (Calabar swellings, creeping dermatitis, eyeworm) whereas 43% were diagnosed fortuitously. Microfilaremia was evidenced in 105 patients (63%), and specific antibodies in 53%. Compared to sub-Saharan Africans, other patients were presenting less frequently with eyeworm migration and microfilaremia whereas they had higher eosinophilia and positive serology. Prevalence of Calabar swellings was not significantly different between the two groups. Cure rates were 52% with ivermectin alone, and 77% with ivermectin followed by diethylcarbamazine. No severe adverse event was reported.

Conclusions: Presentation of imported loiasis varies according to ethnicity. A systematic screening should be recommended in patients with potential exposure in endemic country. Treatment with ivermectin followed by diethylcarbamazine could be a valuable option.
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http://dx.doi.org/10.1186/s12879-019-4740-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6971866PMC
January 2020

Cutaneous and mucocutaneous leishmaniasis in travellers and migrants: a 20-year GeoSentinel Surveillance Network analysis.

J Travel Med 2019 Dec;26(8)

Tropical Disease Unit, Division of Infectious Diseases, University Health Network-Toronto General Hospital, Toronto, Canada.

Background: Cutaneous leishmaniasis (CL) may be emerging among international travellers and migrants. Limited data exist on mucocutaneous leishmaniasis (MCL) in travellers. We describe the epidemiology of travel-associated CL and MCL among international travellers and immigrants over a 20-year period through descriptive analysis of GeoSentinel data.

Methods: Demographic and travel-related data on returned international travellers diagnosed with CL or MCL at a GeoSentinel Surveillance Network site between 1 September 1997 and 31 August 2017 were analysed.

Results: A total of 955 returned travellers or migrants were diagnosed with travel-acquired CL (n = 916) or MCL during the study period, of whom 10% (n = 97) were migrants. For the 858 non-migrant travellers, common source countries were Bolivia (n = 156, 18.2%) and Costa Rica (n = 97, 11.3%), while for migrants, they were Syria (n = 34, 35%) and Afghanistan (n = 22, 22.7%). A total of 99 travellers (10%) acquired their disease on trips of ≤ 2 weeks. Of 274 cases for which species identification was available, Leishmania Viannia braziliensis was the most well-represented strain (n = 117, 42.7%), followed by L. major (n = 40, 14.6%) and L. V. panamensis (n = 38, 13.9%). Forty cases of MCL occurred, most commonly in tourists (n = 29, 72.5%) and from Bolivia (n = 18, 45%). A total of 10% of MCL cases were acquired in the Old World.

Conclusions: Among GeoSentinel reporting sites, CL is predominantly a disease of tourists travelling mostly to countries in Central and South America such as Bolivia where risk of acquiring L. V. braziliensis and subsequent MCL is high. The finding that some travellers acquired leishmaniasis on trips of short duration challenges the common notion that CL is a disease of prolonged travel. Migrants from areas of conflict and political instability, such as Afghanistan and Syria, were well represented, suggesting that as mass migration of refugees continues, CL will be increasingly encountered in intake countries.
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http://dx.doi.org/10.1093/jtm/taz055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7353840PMC
December 2019

A patient from Mali with Actinomadura bangladeshensis-induced foot mycetoma: A diagnostic challenge.

Travel Med Infect Dis 2019 Sep - Oct;31:101452. Epub 2019 Aug 1.

Infectious and Tropical Diseases Department, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France; Faculty of Medicine, Sorbonne-Université, Paris, France.

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http://dx.doi.org/10.1016/j.tmaid.2019.07.008DOI Listing
February 2020

Comment on "Effect of Artemisia annua and Artemisia afra tea infusions on schistosomiasis in a large clinical trial".

Phytomedicine 2019 09 25;62:152804. Epub 2018 Dec 25.

GMRC, Service de Santé Publique, Université de Strasbourg, CHU de Strasbourg. iCUBE, UMR7357, 67000 Strasbourg, France.

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http://dx.doi.org/10.1016/j.phymed.2018.12.027DOI Listing
September 2019

"No glove, no love": Time to get priorities right again to prevent sexually transmitted infections?

Authors:
Eric Caumes

Med Mal Infect 2019 Aug 20;49(5):293-295. Epub 2019 Apr 20.

Service de maladies infectieuses et tropicales, Sorbonne Université, hôpitaux universitaires Pitié-Salpêtrière Charles Foix, AP-HP, 75013 Paris, France; Inserm, Sorbonne Université, institut Pierre-Louis d'épidémiologie et de santé publique, 75013 Paris, France. Electronic address:

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http://dx.doi.org/10.1016/j.medmal.2019.03.016DOI Listing
August 2019

Outcomes of Bedaquiline Treatment in Patients with Multidrug-Resistant Tuberculosis.

Emerg Infect Dis 2019 05;25(5):936-943

Bedaquiline is recommended by the World Health Organization for the treatment of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB). We pooled data from 5 cohorts of patients treated with bedaquiline in France, Georgia, Armenia, and South Africa and in a multicountry study. The rate of culture conversion to negative at 6 months (by the end of 6 months of treatment) was 78% (95% CI 73.5%-81.9%), and the treatment success rate was 65.8% (95% CI 59.9%-71.3%). Death rate was 11.7% (95% CI 7.0%-19.1%). Up to 91.1% (95% CI 82.2%-95.8%) of the patients experienced >1 adverse event, and 11.2% (95% CI 5.0%-23.2%) experienced a serious adverse event. Lung cavitations were consistently associated with unfavorable outcomes. The use of bedaquiline in MDR and XDR TB treatment regimens appears to be effective and safe across different settings, although the certainty of evidence was assessed as very low.
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http://dx.doi.org/10.3201/eid2505.181823DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6478224PMC
May 2019

Letter to the editor: Prevention of bacterial sexually transmitted infections (STI) in France: why not recommend using condoms and safer sex?

Authors:
Eric Caumes

Euro Surveill 2019 03;24(12)

Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, Paris, France.

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http://dx.doi.org/10.2807/1560-7917.ES.2019.24.12.1900171DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6440582PMC
March 2019

Propensity Score Analysis of Artesunate Versus Quinine for Severe Imported Plasmodium falciparum Malaria in France.

Clin Infect Dis 2020 01;70(2):280-287

Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre-Louis d'Epidémiologie et de Santé Publique, France.

Background: Little is known on the use of artesunate compared with quinine for the treatment of imported malaria cases in nonendemic countries with a high level of care. Therefore, we compared the 2 treatments in terms of mortality and hospital and intensive care unit (ICU) discharge rates.

Methods: We analyzed the cohort of all severe imported malaria patients reported to the French National Reference Center from 2011 to 2017. After controlling for differences between quinine- and artesunate-treated individuals using the inverse probability of treatment weighting method, 28-day mortality rate was compared between the groups as well as hospital and ICU discharge rates using Kaplan-Meier estimation and weighted Cox proportional hazard models.

Results: Overall, 1544 patients were enrolled. Fifty patients died, 18 in the quinine group (n = 460) and 32 in the artesunate group (n = 1084), corresponding to death rates of 3.9% and 2.9%, respectively. No difference was evident between quinine and artesunate either in mortality or in hospital discharge rate, with hazard ratios (HRs) of 1.03 (95% confidence interval [CI], 0.47-2.25) and 1.12 (95% CI, 0.94-1.34), respectively. Artesunate was associated with a faster ICU discharge rate (HR, 1.18. 95% CI, 1.02-1.36).

Conclusions: In a country with a high level of care, artesunate was associated with a shorter length of stay in the ICU, which supports the actual therapeutic transition; however, no difference was found in terms of mortality or in hospital discharge rates between artesunate- and quinine-treated patients.
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http://dx.doi.org/10.1093/cid/ciz206DOI Listing
January 2020

[Syphilis: what's new?]

Rev Prat 2018 Oct;68(8):881-885

Département des maladies infectieuses et tropicales, groupe hospitalier La Pitié-Salpêtrière, Paris, France.

Syphilis : what's new ? Syphilis is a sexually transmitted disease caused by Treponema pallidum. It is strongly resurgent since the end of the 1990s especially in the MSM community. The diagnosis is serological, sometimes confirmed by the direct examination of a mucocutaneous lesion. Neurological and ophthalmological localizations may be early and involve functional prognosis. Treatment normally relies on intramuscular benzathine penicillin or oral doxycycline. The effectiveness of the treatment is judged on the decrease of the quantitative VDRL.
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October 2018

Reply to Bouiller et al and Lacout et al.

Clin Infect Dis 2019 05;68(11):1975-1976

Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Pitié-Salpêtrière Charles Foix, Service de Maladies Infectieuses et Tropicales.

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http://dx.doi.org/10.1093/cid/ciy1013DOI Listing
May 2019