Publications by authors named "Philippe Grange"

68 Publications

Intraoperative Measures to Reduce the Risk of COVID-19 Transmission During Minimally Invasive Procedures: A Systematic Review and Critical Appraisal of Societies' Recommendations.

Surg Laparosc Endosc Percutan Tech 2021 Jul 28. Epub 2021 Jul 28.

Medical Affairs, Ethicon Inc., Cincinnati, OH.

Background: The coronavirus 2019 pandemic and the hypothetical risk of virus transmission through aerosolized CO2 or surgical smoke produced during minimally invasive surgery (MIS) procedures have prompted societies to issue recommendations on measures to reduce this risk. The aim of this systematic review is to identify, summarize and critically appraise recommendations from surgical societies on intraoperative measures to reduce the risk of severe acute respiratory syndrome coronavirus 2 transmission to the operative room (OR) staff during MIS.

Methods: Medline, Embase, and Google Scholar databases were searched using a search strategy or free terms. The search was supplemented with searches of additional relevant records on coronavirus 2019 resource websites from Surgical Associations and Societies. Recommendations published by surgical societies that reported on the intraoperative methods to reduce the risk of severe acute respiratory syndrome coronavirus 2 transmission to the OR staff during MIS were also reviewed for inclusion. Expert opinion articles were excluded. A preliminary synthesis was performed of the extracted data to categorize and itemize the different types of recommendations. The results were then summarized in a narrative synthesis.

Results: Thirty-three recommendation were included in the study. Most recommendations were targeted to general surgery (13) and gynecology (8). Areas covered by the documents were recommendations on performance of laparoscopic/robotic surgery versus open approach (28 documents), selection of surgical staff (13), management of pneumoperitoneum (33), use of energy devices (20), and management of surgical smoke and pneumoperitoneum desufflation (33) with varying degree of consensus on the specific recommendations among the documents.

Conclusions: While some of the early recommendations advised against the use of MIS, they were not strictly based on the available scientific evidence. After further consideration of the literature and of the well-known benefits of laparoscopy to the patient, later recommendations shifted to encouraging the use of MIS as long as adequate precautions could be taken to protect the safety of the OR staff. The release and implementation of recommendations should be based on evidence-based practices that allows health care systems to provide safe surgical and medical assistance.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SLE.0000000000000972DOI Listing
July 2021

Trans-urethral bladder suture in female patients: Not a tour de force but a quick and realistic answer to complex situations.

Urologia 2021 Mar 16:3915603211001168. Epub 2021 Mar 16.

Urology Department, Kings College Hospital NHS Foundation Trust, London, UK.

Introduction: Trans-urethral bladder surgery has gained popularity in the fields of electro-resection and laser lithotripsy, with endoscopic suturing being overlooked. Bladder defect closure using a pure trans-urethral suturing technique can provide a quick and effective solution in situations where conventional management options are not feasible.

Methods: Here we describe this innovative novel technique developed by our group that was used to treat two different cases with bladder perforation at two different institutions. We used a 5 mm laparoscopic port with gas insufflation and a laparoscopic needle holder trans-urethrally to achieve defect closure with a monofilament 2/0 monocryl mattress suture on a small 22 mm needle.

Results: The defects were successfully closed without any intraoperative complications. Average operative time for the technique was 18 min with minimal blood loss. Bladder closure was sustained at a median follow-up of 2 years for one of these cases.

Conclusions: We claim that transurethral bladder suturing is quick, safe in expert hands and provides an effective option where the clinical condition/situation of the patient warrants a minimally invasive surgery approach.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/03915603211001168DOI Listing
March 2021

as an Opportunistic Pathogen: An Update of Its Virulence-Associated Factors.

Microorganisms 2021 Feb 2;9(2). Epub 2021 Feb 2.

NSERM Institut Cochin, INSERM U1016-CNRS UMR8104, Equipe de Biologie Cutanée, Université de Paris, 75014 Paris, France.

is a member of the skin microbiota found predominantly in regions rich in sebaceous glands. It is involved in maintaining healthy skin and has long been considered a commensal bacterium. Its involvement in various infections has led to its emergence as an opportunist pathogen. Interactions between and the human host, including the human skin microbiota, promote the selection of strains capable of producing several virulence factors that increase inflammatory capability. This pathogenic property may be related to many infectious mechanisms, such as an ability to form biofilms and the expression of putative virulence factors capable of triggering host immune responses or enabling to adapt to its environment. During the past decade, many studies have identified and characterized several putative virulence factors potentially involved in the pathogenicity of this bacterium. These virulence factors are involved in bacterial attachment to target cells, polysaccharide-based biofilm synthesis, molecular structures mediating inflammation, and the enzymatic degradation of host tissues. , like other skin-associated bacteria, can colonize various ecological niches other than skin. It produces several proteins or glycoproteins that could be considered to be active virulence factors, enabling the bacterium to adapt to the lipophilic environment of the pilosebaceous unit of the skin, but also to the various organs it colonizes. In this review, we summarize current knowledge concerning characterized virulence factors and their possible implication in the pathogenicity of .
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/microorganisms9020303DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7913060PMC
February 2021

α-Tocopherol Acetate Attenuates Mitochondrial Oxygen Consumption and Maintains Primitive Cells within Mesenchymal Stromal Cell Population.

Stem Cell Rev Rep 2021 08 28;17(4):1390-1405. Epub 2021 Jan 28.

Etablissement Français du Sang Nouvelle Aquitaine, Place Amélie Raba Léon, CS 21010 33075, Bordeaux Cedex, France.

We present here the data showing, in standard cultures exposed to atmospheric O concentration, that alpha-tocopherol acetate (α-TOA) has a positive impact on primitive cells inside mesenchymal stromal cell (MstroC) population, by maintaining their proliferative capacity. α-TOA decreases the O consumption rate of MStroC probably by impacting respiratory chain complex II activity. This action, however, is not associated with a compensatory increase in glycolysis activity, in spite of the fact that the degradation of HIF-1α was decreased in presence of α-TOA. This is in line with a moderate enhancement of mtROS upon α-TOA treatment. However, the absence of glycolysis stimulation implies the inactivity of HIF-1α which might - if it were active - be related to the maintenance of stemness. It should be stressed that α-TOA might act directly on the gene expression as well as the mtROS themselves, which remains to be elucidated. Alpha-tocopherol acetate (α-TOA), a synthetic vitamin E ester, attenuates electron flow through electron transport chain (ETC) which is probably associated with a moderate increase in mtROS in Mesenchymal Stromal Cells. α-TOA action results in enhancement of the proliferative capacity and maintenance of the differentiation potential of the mesenchymal stem and progenitor cells.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s12015-020-10111-9DOI Listing
August 2021

Long-Term Effects of Mental Training on Manual and Cognitive Skills in Surgical Education - A Prospective Study.

J Surg Educ 2021 Jul-Aug;78(4):1216-1226. Epub 2020 Nov 27.

Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Electronic address:

Objectives: Limited training opportunities and expanding requirements are challenging surgical education, calling for alternative training methods like simulation or mental training. The aim of this study is to evaluate short- and long-term effects of a structured mental training on surgical performance.

Design: Medical students without laparoscopic experience were randomly assigned to 3 groups: (1) control (2) video training, and (3) video plus mental training performing 2 E-BLUS (European Training in Basic Laparoscopic Urological Skills) exercises, "peg transfer" (PT) and "cutting a circle" (CC). Group 3 performed a structured mental training course (identification of procedural key steps, relaxation, mental vocalization, and imaging). Longitudinal assessment including binominal checklists, global rating scales (GRS), procedural times, and Test of Performance Strategies (TOPS) were performed at baseline, day 2, 14, and after 16 months. Statistical analysis included ANOVA and general linear models with repeated measures.

Setting: The study was conducted in "Olympus Training and Education Center Hamburg West" and "Endo Club Academy" at the University Medical Center Hamburg-Eppendorf.

Participants: Participants were eligible if they were medical students with no experience in laparoscopy. 24 participants were recruited and finished the study.

Results: The mental training group maintained significantly better GRS scores at 16 months for PT (mean score 24.6 [95% CI: 21-28.25]) and CC (mean score 22.5 [18.4-26.6]) (both p < 0.01) and performed faster in the latter (261 seconds [Std. Dev 116] vs. 427 seconds [SD 132] vs. 368 seconds [SD 78]) compared to the other groups (p = 0.004). Longitudinally, mental training had a significant effect on TOPS scores and procedural times (p < 0.001 and p = 0.005, respectively).

Conclusion: In addition to short time efficacy, our study is the first to ascertain a positive long-term effect of mental training on manual and cognitive skills and might be a useful and cost-effective tool in surgical education.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jsurg.2020.11.005DOI Listing
June 2021

Contribution of GATA6 to homeostasis of the human upper pilosebaceous unit and acne pathogenesis.

Nat Commun 2020 10 20;11(1):5067. Epub 2020 Oct 20.

Centre for Stem Cells and Regenerative Medicine, King's College London, Floor 28, Tower Wing, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK.

Although acne is the most common human inflammatory skin disease, its pathogenic mechanisms remain incompletely understood. Here we show that GATA6, which is expressed in the upper pilosebaceous unit of normal human skin, is down-regulated in acne. GATA6 controls keratinocyte proliferation and differentiation to prevent hyperkeratinisation of the infundibulum, which is the primary pathological event in acne. When overexpressed in immortalised human sebocytes, GATA6 triggers a junctional zone and sebaceous differentiation program whilst limiting lipid production and cell proliferation. It modulates the immunological repertoire of sebocytes, notably by upregulating PD-L1 and IL10. GATA6 expression contributes to the therapeutic effect of retinoic acid, the main treatment for acne. In a human sebaceous organoid model GATA6-mediated down-regulation of the infundibular differentiation program is mediated by induction of TGFβ signalling. We conclude that GATA6 is involved in regulation of the upper pilosebaceous unit and may be an actionable target in the treatment of acne.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41467-020-18784-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7575575PMC
October 2020

Surveillance of Antibiotic Resistance Genes in Treponema Pallidum Subspecies Pallidum from Patients with Early Syphilis in France.

Acta Derm Venereol 2020 Jul 28;100(14):adv00221. Epub 2020 Jul 28.

INSERM, Institut Cochin U1016-CNRS UMR8104, Université Sorbonne Paris Descartes, Groupe Hospitalier, Paris, France.

Benzathine penicillin G (BPG) is the reference treatment for early syphilis, but shortages have recently been reported, highlighting a need for the validation of alternative treatments. The aim of this study was to evaluate the genomic resistance of Treponema pallidum subspecies pallidum (TPA) to macrolides and doxycycline in France. Swabs from genital, anal, oral and cutaneous lesions were obtained from 146 patients with early syphilis in France. They were screened for mutations conferring resistance to macrolides and doxycycline by nested PCR and sequencing. Resistance to macrolides was detected in 85% of the isolates, but no point mutations conferring doxycycline resistance were detected. These findings confirm that, in France, resistance to macrolides is widespread. Moreover, we confirmed the absence of genomic resistance to doxycycline in the TPA strains. Therefore, doxycycline could be safely recommended as an alternative to BPG for the treatment of early syphilis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2340/00015555-3589DOI Listing
July 2020

Directly Sequenced Genomes of Contemporary Strains of Syphilis Reveal Recombination-Driven Diversity in Genes Encoding Predicted Surface-Exposed Antigens.

Front Microbiol 2019 31;10:1691. Epub 2019 Jul 31.

Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czechia.

Syphilis, caused by subsp. (TPA), remains an important public health problem with an increasing worldwide prevalence. Despite recent advances in cultivation, genetic variability of this pathogen during infection is poorly understood. Here, we present contemporary and geographically diverse complete treponemal genome sequences isolated directly from patients using a methyl-directed enrichment prior to sequencing. This approach reveals that approximately 50% of the genetic diversity found in TPA is driven by inter- and/or intra-strain recombination events, particularly in strains belonging to one of the defined genetic groups of syphilis treponemes: Nichols-like strains. Recombinant loci were found to encode putative outer-membrane proteins and the recombination variability was almost exclusively found in regions predicted to be at the host-pathogen interface. Genetic recombination has been considered to be a rare event in treponemes, yet our study unexpectedly showed that it occurs at a significant level and may have important impacts in the biology of this pathogen, especially as these events occur primarily in the outer membrane proteins. This study reveals the existence of strains with different repertoires of surface-exposed antigens circulating in the current human population, which should be taken into account during syphilis vaccine development.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fmicb.2019.01691DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6685089PMC
July 2019

Reduced α-2,6 sialylation regulates cell migration in endometriosis.

Hum Reprod 2019 03;34(3):479-490

Département 'Développement, Reproduction et Cancer', Institut Cochin, INSERM U1016 (Professeur Batteux), Université Paris Descartes, Sorbonne Paris Cité, 22 Rue Méchain, Paris, France.

Study Question: Is endometriosis associated with aberrant sialylation patterns and what is the potential impact of such anomalies on cell migratory properties?

Summary Answer: The reduced α-2,6 sialylation patterns in the peritoneal fluid of endometriosis-affected women and in stromal and epithelial cells from endometriotic lesions could be associated with enhanced cell migration.

What Is Known Already: Endometriosis is considered to be a benign disease although, like cancer, it has the characteristic of being an invasive disease with cells that have an enhanced capacity to migrate. Aberrant sialylation has been reported in various malignancies and it has been linked to tumour invasion and metastasis.

Study Design, Size, Duration: We conducted a prospective laboratory study in a tertiary-care university hospital. We investigated non-pregnant patients who were <42 years of age (n = 273) when they underwent surgery for a benign gynaecological condition.

Participants/materials, Setting, Methods: The study population consisted of 102 women with histologically proven endometriosis and 71 endometriosis-free controls, who underwent a complete surgical exploration of the abdominopelvic cavity. Peritoneal fluids were collected during the surgical procedures, and endometrial and endometriotic biopsies were performed on all of the patients to generate stromal and epithelial primary cell cultures. The expression of α-2,6-sialyltransferase (ST6GALNAC1) was studied in eutopic and ectopic endometria of endometriosis patients and in eutopic endometria of controls by reverse transcription followed by quantitative real-time polymerase chain reaction (RT-qPCR). The α-2,6 sialylation levels were measured by ELISA in the peritoneal fluids of patients and controls and by western-blot in primary endometrial and endometriotic cell cultures using Sambucus nigra agglutinin (SNA), an α-2,6 sialic acid-binding lectin. A transwell migration assay after incubation of the cells with neuraminidase was also performed to evaluate the impact of desialylation on eutopic endometrial stromal cell migration.

Main Results And The Role Of Chance: ST6GALNAC1 gene expression was significantly lower in endometriotic lesions compared to that in eutopic endometrium of endometriosis-affected patients and healthy endometrium (16-fold for both; P < 0.01). We observed a significant reduction in SNA levels in the peritoneal fluids of endometriosis-affected women compared to control women (median optic density (OD), 0.257; range, 0.215-0.279 versus median OD, 0.278; range 0.238-0.285; P < 0.01), as well as in stromal (mean OD, 705 907; standard error of the mean (SEM), 141 549 versus mean OD, 1.16 × 106; SEM, 107,271; P < 0.05) and epithelial (mean OD, 485 706; SEM, 179 681 versus mean OD, 1.25 × 106; SEM, 232 120; P < 0.05) ectopic endometriotic cells compared to control eutopic cells, indicating reduced α-2,6 sialylation. Finally, in the transwell migration assay, the eutopic endometrial cells of endometriosis patients migrated significantly more into the lower chamber after incubation with neuraminidase, indicating enhanced migration by these cells after desialylation.

Large Scale Data: N/A.

Limitations, Reasons For Caution: Our control group involved patients operated for benign gynaecological conditions (e.g. tubal infertility, uterine fibroids or ovarian cysts) which may also be associated with altered sialylation patterns.

Wider Implications Of The Findings: The hyposialylation pattern of endometriotic cells appeared to be associated with enhanced migratory abilities, which might contribute to the establishment of early endometriotic implants. Further research is needed to confirm these findings, as this could lead to new potential therapeutic targets for this complex disorder.

Study Funding And Competing Interest(s): No external funding was received and there are no conflicts of interest.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/humrep/dey391DOI Listing
March 2019

Multi-locus sequence typing of Treponema pallidum subsp. pallidum present in clinical samples from France: Infecting treponemes are genetically diverse and belong to 18 allelic profiles.

PLoS One 2018 19;13(7):e0201068. Epub 2018 Jul 19.

Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.

Treponema pallidum subsp. pallidum, the causative agent of sexually transmitted syphilis, detected in clinical samples from France, was subjected to molecular typing using the recently developed Multilocus Sequence Typing system. The samples (n = 133) used in this study were collected from 2010-2016 from patients with diagnosed primary or secondary syphilis attending outpatient centers or hospitals in several locations in France. Altogether, 18 different allelic profiles were found among the fully typed samples (n = 112). There were five allelic variants identified for TP0136, 12 for TP0548, and eight for TP0705. Out of the identified alleles, one, seven, and three novel alleles were identified in TP0136, TP0548, and TP0705, respectively. Partial allelic profiles were obtained from 6 samples. The majority of samples (n = 110) belonged to the SS14-like cluster of TPA isolates while 7 clustered with Nichols-like isolates. Patients infected with Nichols-like samples were more often older (p = 0.041) and more often diagnosed with secondary syphilis (p = 0.033) compared to patients infected with SS14-like samples. In addition, macrolide resistance caused by the A2058G mutation was found to be associated with allelic profile 1.3.1 or with strains belonging to the 1.3.1 lineage (p<0.001). The genetic diversity among TPA strains infecting the European population was surprisingly high, which suggests that additional studies are needed to reveal the full genetic diversity of TPA pathogens infecting humans.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0201068PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6053231PMC
January 2019

Laparoscopic mesh repair of a labial hernia.

Neurourol Urodyn 2018 03 13;37(3):1178-1179. Epub 2017 Nov 13.

King's College Hospital, London, England.

Aims: To present a narrated video designed to demonstrate the steps involved in a laparoscopic mesh repair of a labial hernia.

Methods: This was in a 76-year-old woman who presented with a small bowel hernia in to her left labium majus. In 2014 she had a robotically assisted radical cystectomy for bladder cancer with anterior exenteration. She developed the hernia in February 2015 and initially a vaginal approach was attempted to repair the hernia (with layered non-absorbable sutures to close the fascia over the defect) at her local hospital, although this was unsuccessful. A laparoscopic repair with mesh on the 10 May 2016 was undertaken at our unit.

Results: This was a complex case requiring a multi disciplinary approach and individualised care. The need for a mesh was obvious: however, the use of both synthetic and biological meshes to achieve an optimum result was unique and highly successful.

Conclusion: In this instance a minimally invasive laparoscopic approach where initial adhesiolysis was performed and then a synthetic mesh sandwiched in between two biological porcine meshes provided a unique management solution. The patient was seen 8 weeks post operatively and at 14 months after the procedure. She had complete resolution of her symptoms with no residual hernia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/nau.23440DOI Listing
March 2018

Characterization of a Propionibacterium acnes Surface Protein as a Fibrinogen-Binding Protein.

Sci Rep 2017 07 25;7(1):6428. Epub 2017 Jul 25.

Université Sorbonne Paris Descartes, Faculté de Médecine, INSERM CNRS UMR8104, Institut Cochin U1016, Laboratoire de Dermatologie-CNR Syphilis, Paris, France.

Propionibacterium acnes (P. acnes) is a major skin-associated bacterium that was long considered commensal, until several studies revealed it to be an opportunistic pathogen. We investigated the ability of P. acnes surface proteins to recognize ECM proteins and showed that a 58 kDa P. acnes surface protein was specifically recognized by human fibrinogen (hFg). The 58 kDa protein was further characterized by two-dimensional (2-D) electrophoresis and MALDI-ToF as a P. acnes host cell-surface attachment protein, PA25957, recognizing dermatan sulfate (DsA1). This protein sequence contains 432 amino acids with the presence of three structurally different domains: an N-terminal signal peptide, a C-terminal LPXTG motif, and a PT repeat region. DsA1 is mostly produced during stationary phase. It appears to be highly glycosylated, containing GalNAc residues. Purified DsA1 strongly recognizes the Aα and Bβ subunits of hFg, and specific enzymatic deglycosylation of hFg demonstrated the involvement of the protein backbone in the recognition process. The Bβ subunit of hFg was cloned in four peptide fractions (Fg1-Fg4). The N-terminal Fg1 peptide of hFg was recognized by DsA1, and priming DsA1 with Fg1 inhibited DsA1/hFg recognition. We describe here for the first time, the characterization of a P. acnes surface glycoprotein recognizing human fibrinogen.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41598-017-06940-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5527093PMC
July 2017

Genomic landscape of human diversity across Madagascar.

Proc Natl Acad Sci U S A 2017 08 17;114(32):E6498-E6506. Epub 2017 Jul 17.

L'Institut des Mondes Africains (IMAF)-CNRS, 94200 Ivry-sur-Seine, France.

Although situated ∼400 km from the east coast of Africa, Madagascar exhibits cultural, linguistic, and genetic traits from both Southeast Asia and Eastern Africa. The settlement history remains contentious; we therefore used a grid-based approach to sample at high resolution the genomic diversity (including maternal lineages, paternal lineages, and genome-wide data) across 257 villages and 2,704 Malagasy individuals. We find a common Bantu and Austronesian descent for all Malagasy individuals with a limited paternal contribution from Europe and the Middle East. Admixture and demographic growth happened recently, suggesting a rapid settlement of Madagascar during the last millennium. However, the distribution of African and Asian ancestry across the island reveals that the admixture was sex biased and happened heterogeneously across Madagascar, suggesting independent colonization of Madagascar from Africa and Asia rather than settlement by an already admixed population. In addition, there are geographic influences on the present genomic diversity, independent of the admixture, showing that a few centuries is sufficient to produce detectable genetic structure in human populations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1073/pnas.1704906114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5559028PMC
August 2017

Stones First! A Gas Pyelo-nephroscopy Strategy for Laparoscopic Pyeloplasty and Renal Stone Extraction.

Urology 2017 Nov 13;109:206-209. Epub 2017 Jun 13.

Urology Department, Kings College Hospital, London, UK.

Objective: To report our experience on gas endoscopy as the first step of pelvi-ureteric junction (PUJ) obstruction repair when complicated by nephrolithiasis.

Materials And Methods: Stone formation because of urine stasis is a known complication of PUJ obstruction and an indication for its surgical repair. The undisputed results of the Anderson-Hynes dismembered pyeloplasty make it a quasi-gold standard; however, the identification and extraction of calyceal stones through the laparoscopic route can be challenging. Between 2009 and 2016, 39 patients underwent laparoscopic pyeloplasty at Ygia Polyclinic, with a subgroup of 6 patients having concomitant calyceal stones. These 6 patients first underwent gas pyelo-nephroscopy before dismembering the PUJ. Demographic data, intraoperative technical details, outcomes, as well as postoperative outcomes, were collected and analyzed.

Results: We report a small series (n = 6) with 3 minor modifications of the laparoscopic repair of PUJ obstruction complicated by stones. One modification is to carry out a pyelo-nephroscopy for stone extraction before dismembering the junction. The second modification is the use of gas medium to distend the renal cavity, and the third is the use of a flexible cystoscope. Postoperative recovery was uncomplicated in all 6 patients, with successful relief of the PUJ obstruction and stable stone free results demonstrated on follow-up for all patients.

Conclusion: We claim that these modifications overcome the usual challenges related to working in a collapsed cavity and using fluid media, while achieving desirable outcomes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.urology.2017.06.003DOI Listing
November 2017

The last sea nomads of the Indonesian archipelago: genomic origins and dispersal.

Eur J Hum Genet 2017 08 17;25(8):1004-1010. Epub 2017 May 17.

Equipe de Médecine Evolutive, Laboratoire d'Anthropologie Moléculaire et Imagerie de Synthèse UMR-5288, Université de Toulouse, Toulouse, France.

The Bajo, the world's largest remaining sea nomad group, are scattered across hundreds of recently settled communities in Island Southeast Asia, along the coasts of Indonesia, Malaysia and the Philippines. With a significant role in historical trading, the Bajo lived until recently as nomads, spending their entire lives on houseboats while moving long distances to fish and trade. Along the routes they traveled, the Bajo settled and intermarried with local land-based groups, leading to 'maritime creolization', a process whereby Bajo communities retained their culture, but assimilated - and frequently married into - local groups. The origins of the Bajo have remained unclear despite several hypotheses from oral tradition, culture and language, all currently without supporting genetic evidence. Here, we report genome-wide SNP analyses on 73 Bajo individuals from three communities across Indonesia - the Derawan of Northeast Borneo, the Kotabaru of Southeast Borneo and the Kendari of Southeast Sulawesi, with 87 new samples from three populations surrounding the area where these Bajo peoples live. The Bajo likely share a common connection with Southern Sulawesi, but crucially, each Bajo community also exhibits unique genetic contributions from neighboring populations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/ejhg.2017.88DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5567155PMC
August 2017

Human Treponema pallidum 11q/j isolate belongs to subsp. endemicum but contains two loci with a sequence in TP0548 and TP0488 similar to subsp. pertenue and subsp. pallidum, respectively.

PLoS Negl Trop Dis 2017 03 6;11(3):e0005434. Epub 2017 Mar 6.

Department of Biology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.

Background: Treponema pallidum subsp. endemicum (TEN) is the causative agent of endemic syphilis (bejel). An unusual human TEN 11q/j isolate was obtained from a syphilis-like primary genital lesion from a patient that returned to France from Pakistan.

Methodology/principal Findings: The TEN 11q/j isolate was characterized using nested PCR followed by Sanger sequencing and/or direct Illumina sequencing. Altogether, 44 chromosomal regions were analyzed. Overall, the 11q/j isolate clustered with TEN strains Bosnia A and Iraq B as expected from previous TEN classification of the 11q/j isolate. However, the 11q/j sequence in a 505 bp-long region at the TP0488 locus was similar to Treponema pallidum subsp. pallidum (TPA) strains, but not to TEN Bosnia A and Iraq B sequences, suggesting a recombination event at this locus. Similarly, the 11q/j sequence in a 613 bp-long region at the TP0548 locus was similar to Treponema pallidum subsp. pertenue (TPE) strains, but not to TEN sequences.

Conclusions/significance: A detailed analysis of two recombinant loci found in the 11q/j clinical isolate revealed that the recombination event occurred just once, in the TP0488, with the donor sequence originating from a TPA strain. Since TEN Bosnia A and Iraq B were found to contain TPA-like sequences at the TP0548 locus, the recombination at TP0548 took place in a treponeme that was an ancestor to both TEN Bosnia A and Iraq B. The sequence of 11q/j isolate in TP0548 represents an ancestral TEN sequence that is similar to yaws-causing treponemes. In addition to the importance of the 11q/j isolate for reconstruction of the TEN phylogeny, this case emphasizes the possible role of TEN strains in development of syphilis-like lesions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1371/journal.pntd.0005434DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5354452PMC
March 2017

TLR-2 Recognizes Propionibacterium acnes CAMP Factor 1 from Highly Inflammatory Strains.

PLoS One 2016 30;11(11):e0167237. Epub 2016 Nov 30.

Université Sorbonne Paris Descartes, Faculté de Médecine, INSERM, Institut Cochin, Laboratoire de Dermatologie-CNR Syphilis, Paris, France.

Background: Propionibacterium acnes (P. acnes) is an anaerobic, Gram-positive bacteria encountered in inflammatory acne lesions, particularly in the pilosebaceous follicle. P. acnes triggers a strong immune response involving keratinocytes, sebocytes and monocytes, the target cells during acne development. Lipoteicoic acid and peptidoglycan induce the inflammatory reaction, but no P. acnes surface protein interacting with Toll-like receptors has been identified. P. acnes surface proteins have been extracted by lithium stripping and shown to induce CXCL8 production by keratinocytes.

Methodology And Principal Findings: Far-western blotting identified two surface proteins, of 24.5- and 27.5-kDa in size, specifically recognized by TLR2. These proteins were characterized, by LC-MS/MS, as CAMP factor 1 devoid of its signal peptide sequence, as shown by N-terminal sequencing. Purified CAMP factor 1 induces CXCL8 production by activating the CXCL8 gene promoter, triggering the synthesis of CXCL8 mRNA. Antibodies against TLR2 significantly decreased the CXCL8 response. For the 27 P. acnes strains used in this study, CAMP1-TLR2 binding intensity was modulated and appeared to be strong in type IB and II strains, which produced large amounts of CXCL8, whereas most of the type IA1 and IA2 strains presented little or no CAMP1-TLR2 binding and low levels of CXCL8 production. The nucleotide sequence of CAMP factor displays a major polymorphism, defining two distinct genetic groups corresponding to CAMP factor 1 with 14 amino-acid changes from strains phylotyped II with moderate and high levels of CAMP1-TLR2 binding activity, and CAMP factor 1 containing 0, 1 or 2 amino-acid changes from strains phylotyped IA1, IA2, or IB presenting no, weak or moderate CAMP1-TLR2 binding.

Conclusions: Our findings indicate that CAMP factor 1 may contribute to P. acnes virulence, by amplifying the inflammation reaction through direct interaction with TLR2.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0167237PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5130237PMC
July 2017

Eroded Tape: A Case of an Early Vesicoscopy Rather Than Laser Melting.

Urology 2017 04 18;102:247-251. Epub 2016 Nov 18.

King's College Hospital, London, United Kingdom.

Objective: To report our experience on vesicoscopic excision of eroded foreign material in the bladder.

Materials And Methods: The use of xenografts in female urology is becoming more prevalent and so are their complications. Erosion of foreign material into the bladder often goes unrecognized for a long time and patients are troubled by irritative urinary symptoms, recurrent infections, and stone formation. The treatment of such erosions is traditionally reported through the transurethral route using laser or electrocautery to cut the foreign material. Such methods have a high rate of incomplete material removal and as a result a high recurrence rate. Leaving a urothelial defect results in prolonged time to symptom resolution. Between 2012 and 2015, 5 patients with eroded tapes were referred for tertiary care to King's College Hospital and Ygia Polyclinic; all patients had undergone a variety of endoscopic, vaginal, and/or open attempts for mesh removal that failed. We offered vesicoscopic excision of the eroded portion of the tape.

Results: We here report 5 cases with tape erosions referred to our team that were treated with vesicoscopic excision of the material and primary closure of the urothelial defect. The foreign material was completely removed in all cases and there is no recurrence at a median follow-up of 30 months.

Conclusion: Vesicoscopic excision of bladder-eroded foreign material is feasible and efficient. We recommend this technique to be considered as a primary approach to tapes eroding into the bladder.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.urology.2016.09.068DOI Listing
April 2017

Clinical and Biological Characteristics of 40 Patients With Neurosyphilis and Evaluation of Treponema pallidum Nested Polymerase Chain Reaction in Cerebrospinal Fluid Samples.

Clin Infect Dis 2016 11 1;63(9):1180-1186. Epub 2016 Sep 1.

Laboratoire de Recherche en Dermatologie, Institut Cochin INSERM U1016, Centre National de Référence Syphilis, Faculté de Médecine, Université Paris Descartes.

Background: Syphilis remains a significant public health problem. We conducted a prospective study to define more precisely the clinical and biological characteristics of patients with neurosyphilis (NS), and we assessed the diagnostic value of nested polymerase chain reaction (PCR) testing for Treponema pallidum in cerebrospinal fluid (CSF) samples.

Methods: From 2001 to 2013, we included 40 patients (90% men; 45% infected with human immunodeficiency virus) with NS, defined as syphilis with neurological and/or ophthalmological symptoms and CSF abnormalities.

Results: Thirty patients (75%) had early, 5 (12.5%) had late, and 5 had meningovascular NS. Twenty-four patients (80%) with early NS had ophthalmological symptoms, 14 (47%) had neurological symptoms, and 8 (26%) had both. All patients with meningovascular NS had only neurological symptoms. All patients with late NS had neurological symptoms, and 2 (40%) also had ocular symptoms. Ophthalmological symptoms were present in 65% of all patients with NS, and neurological symptoms in 60%. Seventeen patients (42.5%) had CSF white blood cell counts >20/μL (mean, 57/μL), and 27 (67.5%) had high CSF protein levels (>0.5 g/L; mean value, 1 g/L). CSF PCR results were positive in 42%, and CSF VDRL results in 30%. The nested PCR assay had an overall sensitivity of 42.5%, a specificity of 97%, a positive predictive value of 77%, and a negative predictive value of 86%.

Conclusions: Early NS is the most frequent presentation, with an overrepresentation of polymorphous ophthalmological symptoms. PCR is highly specific and of potential value when used with other biological parameters.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/cid/ciw499DOI Listing
November 2016

When Physical Examination Signs Point to Sinister Causes.

Urology 2016 Nov 22;97:e23-e24. Epub 2016 Aug 22.

Department of Urology, Ygia Polyclinic Private Hospital, Limassol, Cyprus. Electronic address:

A 55-year-old male presented with mild abdominal discomfort. On physical examination, a right upper quadrant abdominal mass was palpable and an obstructed right varicocele was evident. Ultrasonography and computed tomography revealed a 15 cm right renal tumor with a 2 cm aortocaval lymph node. The patient underwent an uneventful laparoscopic transperitoneal radical nephrectomy and lymphadenectomy and was discharged after 2 days. No complications or recurrence were noted at 6 months follow-up. This report signifies the importance of physical examination and attention to cardinal clinical signs and also the feasibility of laparoscopy in large renal tumor in expert hands.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.urology.2016.08.018DOI Listing
November 2016

Isolation of Treponema DNA from Necrophagous Flies in a Natural Ecosystem.

EBioMedicine 2016 Sep 28;11:85-90. Epub 2016 Jul 28.

Department of Medicine, University of Washington, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104, USA.

Background: Recently, the World Health Organization launched a campaign to eradicate the tropical disease yaws, caused by the bacterium Treponema pallidum subsp. pertenue; however, for decades researchers have questioned whether flies act as a vector for the pathogen that could facilitate transmission.

Methods: A total of 207 fly specimens were trapped in areas of Africa in which T. pallidum-induced skin ulcerations are common in wild baboons; 88 flies from Tarangire National Park and 119 from Lake Manyara National Park in Tanzania were analyzed by PCR for the presence of T. pallidum DNA.

Findings: We report that in the two study areas, T. pallidum DNA was found in 17-24% of wild-caught flies of the order Diptera. Treponemal DNA sequences obtained from many of the flies match sequences derived from nearby baboon T. pallidum strains, and one of the fly species with an especially high prevalence of T. pallidum DNA, Musca sorbens, has previously been shown to transmit yaws in an experimental setting.

Interpretation: Our results raise the possibility that flies play a role in yaws transmission; further research is warranted, given how important understanding transmission is for the eradication of this disfiguring disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5049926PMC
http://dx.doi.org/10.1016/j.ebiom.2016.07.033DOI Listing
September 2016

Impact of Laparoscopic Lens Contamination in Operating Theaters: A Study on the Frequency and Duration of Lens Contamination and Commonly Utilized Techniques to Maintain Clear Vision.

Surg Laparosc Endosc Percutan Tech 2016 Aug;26(4):286-9

*King's College London School of Medicine †Honorary Urology Consultant at King's College Hospital NHS Foundation Trust, London, UK.

Introduction: In laparoscopy, contamination of the distal lens is problematic. Not only a cause of frustration, repeatedly cleaning the laparoscope takes up significant time and disrupts the operative flow. Our study aims to explore and describe quantitatively this particular issue within the operating theaters of a major teaching hospital.

Materials And Methods: We recorded data assessing the occurrence of impaired vision on the screen display and quantified the occurrence, duration, and modality of cleaning events. Data were recorded on a time-line sheet and collected for basic quantitative analysis as reported below. A brief interview with the surgeons was carried out at the end of each procedure.

Results: A total of 64 hours of laparoscopy covering 25 procedures in 4 surgical disciplines were observed. The study found that 56% of the operation was performed with a clear display, while 37% of the time was spent impaired vision. Seven percent of the operation was spent cleaning the distal lens. The interviews recorded a unison sense of frustration and safety concerns regarding lens contamination.

Conclusions: Our observational study demonstrates that one third of the duration of a laparoscopic procedure is performed without perfectly clear display. The suboptimal display during an operation is similar to that of driving with a dirty windshield and having to step out of the car to clean it before continuing with the journey. The disruption to operative flow is transcribed as frustration felt by surgeons when display is compromised and having to clean the lens. However, the economical impact of cleaning the lens during the operation remains to be demonstrated.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/SLE.0000000000000289DOI Listing
August 2016

Treponema pallidum 11qj Subtype May Correspond to a Treponema pallidum Subsp. Endemicum Strain.

Sex Transm Dis 2016 08;43(8):517-8

Institut Cochin U1016 Equipe Batteux Laboratoire de Dermatologie-CNR Syphilis Faculté de Médecine Université Sorbonne Paris Descartes Paris, FranceDepartment of Biology Faculty of Medicine Masaryk University Brno, Czech RepublicGenoscreen Lille, FranceDepartment of Biology Faculty of Medicine Masaryk University Brno, Czech RepublicCentre des MST Hôpital Saint-Louis AP-HP Paris, FranceInstitut Cochin U1016 Equipe Batteux Laboratoire de Dermatologie-CNR Syphilis Faculté de Médecine Université Sorbonne Paris Descartes Paris, FranceService de Bactériologie Groupe Hospitalier Paris Centre Cochin-Hôtel Dieu-Broca Paris, FranceDepartment of Biology Faculty of Medicine Masaryk University Brno, Czech RepublicInstitut Cochin U1016 Equipe Batteux Laboratoire de Dermatologie-CNR Syphilis Faculté de Médecine Université Sorbonne Paris Descartes Paris, France E-mail: de Dermatologie-Vénéréologie Hôpital Cochin Pavillon Tarnier AP-HP Paris, France.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/OLQ.0000000000000474DOI Listing
August 2016

Combined Laparoscopic, Vesicoscopic, and Vaginal Repair of a Vesicovaginal Fistula.

J Minim Invasive Gynecol 2016 Sep-Oct;23(6):859-60. Epub 2016 Mar 23.

Urogynaecology and Urology Departments, King's College Hospital, London, UK.

Study Objective: To demonstrate a combined laparoscopic, vesicoscopic, and vaginal approach to repair of a complex vesicovaginal fistula.

Design: Technical video demonstrating a combined laparoscopic, vesicoscopic, and vaginal approach for repairing a vesicovaginal fistula (Canadian Task Force classification level III).

Setting: Urogynecology and Urology Departments of a tertiary referral center for urogynecology.

Interventions: A 38-year-old woman presented with a vesicovaginal fistula secondary to a previous total abdominal hysterectomy. An initial attempt to repair the fistula vaginally was unsuccessful owing to infection and comorbidities. After counseling, the patient agreed to a combined laparoscopic, vesicoscopic, and vaginal repair of her vesicovaginal fistula.

Conclusion: The incidence of vesicovaginal fistula following a total abdominal hysterectomy for benign causes is 1 in 540 [1]. Management of this complication can be challenging, and success rates vary. Initially, laparoscopy was performed, which allowed mobilization of the omentum to provide an interposition patch between the bladder and vagina after repair of the fistula. The fistula tract was then identified vesicoscopically and excised. Once the tract was closed and the patch secured, a vaginal approach was adopted to excise the remaining fistula tract as well as scar tissue. Interrupted closure of the vagina was performed in multiple layers to reduce the risk of recurrence. We have used vesicoscopy since 2007 for a variety of female urogynecologic problems, including bladder diverticula, ureteric stenosis, vesicoureteric reflux, foreign body removal, and vesicovaginal fistula repair [2]. This combined multidisciplinary approach offers a minimally invasive option for the repair of complex vesicovaginal fistulae, and should be considered in selected complex cases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jmig.2016.03.013DOI Listing
July 2017

Technical Video: Vesicoscopic Excision of Eroded Tension-free Vaginal Tape.

J Minim Invasive Gynecol 2016 Jul-Aug;23(5):676. Epub 2016 Mar 19.

Urogynaecology Department, King's College Hospital, London, UK.

Study Objective: To show vesicoscopic excision of eroded tension-free vaginal tape (TVT).

Design: A technical video showing vesicoscopic excision of eroded TVT (Canadian Task Force Classification level III).

Setting: Urogynecology and Urology Departments, King's College Hospital, London, UK, a tertiary referral center for urogynecology.

Interventions: A 52-year-old woman presented with suprapubic pain, hematuria, and recurrent urinary tract infections 4 years after TVT insertion for stress urinary incontinence. Cystoscopy revealed exposed tape with calcifications on the right aspect of the bladder. Video urodynamics showed normal bladder function and no stress incontinence. After counseling, she opted to have the portion of tape excised via a vesicoscopic approach.

Conclusion: Exposed tape is found in up to 4% of women who have undergone TVT procedures because of primary unrecognized bladder injury or secondary erosion [1]. Management of this complication can result in a succession of invasive procedures. In this case, vesicoscopy allowed complete excision of the exposed portion of tape. After mobilization, the bladder wall was closed without tension using Mignot-Grange's extracorporeal knotting technique. The stumps of the tape were buried deeply to prevent recurrent erosion. We have used vesicoscopy since 2007 for a variety of female urogynecologic problems including bladder diverticula, ureteric stenosis, vesicoureteric reflux, foreign body, and vesicovaginal fistulae [2]. So far, we have undertaken 5 tape excisions in 4 patients (1 bilateral exposure). Incontinence has not recurred in any of the women. In conclusion, vesicoscopy can facilitate excision of exposed intravesical tape without risking urethral trauma for recurrent tape exposure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jmig.2016.03.010DOI Listing
June 2017

Pulmonary Consolidations due to Secondary Syphilis with Positive Bronchial Washing Immunohistochemistry.

Am J Respir Crit Care Med 2016 May;193(9):1061-2

1 Assistance Publique Hôpitaux de Paris, Service de Pneumologie, Hôpital Avicenne, Bobigny, France.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1164/rccm.201511-2296IMDOI Listing
May 2016

Superoxide anions produced by Streptococcus pyogenes group A-stimulated keratinocytes are responsible for cellular necrosis and bacterial growth inhibition.

Innate Immun 2016 Feb 29;22(2):113-23. Epub 2015 Nov 29.

Institut Cochin, INSERM U1016, Faculté de Médecine, Université Paris Descartes, Paris, France Service de Dermatologie-Vénéréologie, Hôpital Cochin-Pavillon Tarnier, Paris, France

Gram-positive Streptococcus pyogenes (group A Streptococcus or GAS) is a major skin pathogen and interacts with keratinocytes in cutaneous tissues. GAS can cause diverse suppurative and inflammatory infections, such as cellulitis, a common acute bacterial dermo-hypodermitis with a high morbidity. Bacterial isolation yields from the lesions are low despite the strong local inflammation observed, raising numerous questions about the pathogenesis of the infection. Using an in vitro model of GAS-infected keratinocytes, we show that the major ROS produced is the superoxide anion ([Formula: see text]), and that its production is time- and dose-dependent. Using specific modulators of ROS production, we show that [Formula: see text] is mainly synthesized by the cytoplasmic NADPH oxidase. Superoxide anion production leads to keratinocyte necrosis but incomplete inhibition of GAS growth, suggesting that GAS may be partially resistant to the oxidative burst. In conclusion, GAS-stimulated keratinocytes are able to develop an innate immune response based on the production of ROS. This local immune response limits GAS development and induces keratinocyte cell death, resulting in the skin lesions observed in patients with cellulitis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1753425915619476DOI Listing
February 2016

Inhibition of EGFR Tyrosine Kinase by Erlotinib Prevents Sclerodermatous Graft-Versus-Host Disease in a Mouse Model.

J Invest Dermatol 2015 Oct 4;135(10):2385-2393. Epub 2015 May 4.

INSERM U 1016, Institut Cochin, Université Paris Descartes Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Laboratoire d'Immunologie biologique, Hôpital Cochin, AP-HP, Paris, France. Electronic address:

Chronic graft-versus-host disease (GVHD) follows allogeneic hematopoietic stem cell transplantation. It results from alloreactive processes induced by minor histocompatibility antigen incompatibilities leading to the activation of CD4 T cells and the development of fibrosis and inflammation of the skin and visceral organs and autoimmunity that resemble systemic sclerosis. EGFR is a ubiquitous cell receptor deeply involved in cell proliferation, differentiation, and motility. EGFR has recently been implicated in autoimmune and fibrotic diseases. Therefore, we tested whether Erlotinib, an EGFR tyrosine kinase inhibitor, can prevent sclerodermatous GVHD (Scl-GVHD). Scl-GVHD was induced in BALB/c mice by B10.D2 bone marrow and spleen cell transplantation. Transplanted mice displayed severe clinical symptoms including alopecia, fibrosis of the skin and visceral organs, vasculitis, and diarrhea. The symptoms were reversed in mice treated with Erlotinib. These beneficial effects were mediated by the decreased production of activated/memory CD4(+) T cells and the reduction in T-cell infiltration of the skin and visceral organs along with a decrease in IFN-γ and IL-13 production and autoimmune B-cell activation. The improvement provided by Erlotinib in the mouse model of Scl-GVHD supplies a rationale for the evaluation of Erlotinib in the management of patients affected by chronic GVHD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/jid.2015.174DOI Listing
October 2015

Clinical Aspects of Syphilis Reinfection in HIV-Infected Patients.

Dermatology 2015 24;230(4):302-7. Epub 2015 Mar 24.

Unité de Maladies Infectieuses et Dermatologie, Hôpital Bonnet, Centre Hospitalier Intercommunal Fréjus Saint-Raphaël, Fréjus, France.

Background: The incidence of HIV-syphilis co-infection has risen since 2000, especially among men having sex with men (MSM). Syphilis reinfection can occur, but the clinical features of such events remain poorly characterized.

Objective: To compare the cutaneous lesions seen with syphilis reinfections with those of first episodes in HIV-infected patients.

Methods: In a cohort of HIV-infected patients, syphilis reinfection was established both clinically and biologically by evaluating changes in Venereal Disease Research Laboratory titers. Photographs and medical records were studied in order to determine the type of skin lesions and their quantification.

Results: Among 533 HIV-infected patients, 42 (8%) experienced a first syphilis infection. Thirteen episodes of reinfection occurred in 12/42 (28%) patients, all MSM. In 78% of cases, reinfections were less symptomatic than first episodes. All patients presented classical syphilis lesions.

Conclusions: We observed a high rate of reinfection, but with less severe skin manifestations during reinfection episodes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1159/000369617DOI Listing
February 2016
-->