A patient presenting with severe malaria, with hyperparasitaemia, received 7-day artesunate monotherapy. A severe recrudescence was detected and attributed to hyperparasitaemia, monotherapy and a polyclonal infection without Kelch 13 gene mutation. A second treatment with artesunate, then quinine, followed by artemether-lumefantrine, was successful.
Qualitative SARS-CoV-2 antigen assays based on immunochromatography are useful for mass diagnosis of COVID-19, even though their sensitivity is poor in comparison with RT-PCR assays. In addition, quantitative assays could improve antigenic test performance and allow testing with different specimens. Using quantitative assays, we tested 26 patients for viral RNA and N-antigen in respiratory samples, plasma and urine. This allowed us to compare the kinetics between the three compartments and to compare RNA and antigen concentrations in each. Our results showed the presence of N-antigen in respiratory (15/15, 100%), plasma (26/59, 44%) and urine (14/54, 28.9%) samples, whereas RNA was only detected in respiratory (15/15, 100%) and plasma (12/60, 20%) samples. We detected N-antigen in urine and plasma samples until the day 9 and day 13 post-inclusion, respectively. The antigen concentration was found to correlate with RNA levels in respiratory (p < 0.001) and plasma samples (p < 0.001). Finally, urinary antigen levels correlated with plasma levels (p < 0.001). Urine N-antigen detection could be part of the strategy for the late diagnosis and prognostic evaluation of COVID-19, given the ease and painlessness of sampling and the duration of antigen excretion in this biological compartment.
Significance A detailed characterization of viral load kinetics and its association with disease evolution is key to understand the virus pathogenesis, identify high-risk patients, and design better treatment strategies. We here analyze the mortality and the virological information collected in 655 hospitalized patients, including 284 with longitudinal measurements, and we build a mathematical model of virus dynamics and survival. We predict that peak viral load occurs 1 d before symptom onset, on average, and that dynamics of decline after peak is slower in older patients. Viral load dynamics after hospital admission is an independent predictor of the risk of death, suggesting that prolonged viral shedding of high quantities of virus is associated with poor outcome in this population.
Coronavirus SARS-CoV-2 : mesures dans les salles de cinema et les espaces culturels clos recevant du public en position assise, en phase 3 du deconfinement
Date du document : 18/06/2020
Date de mise en ligne : 24/06/2020
En prevision de leur reouverture, s’est posee la question des mesures sanitaires (gestes barrieres, distanciation physique) a mettre en œuvre dans les salles de cinema et les espaces culturels clos recevant du public en position assise.
Le Haut Conseil de la sante publique avait emis des recommandations a ce sujet dans son avis du 27 mai 2020. Dans ce nouvel avis, le HCSP a reexamine ses recommandations en prenant en compte la situation epidemiologique actuelle ainsi que les mesures prises a l’etranger dans le cadre de la reouverture de ces etablissements.
Le HCSP recommande toujours dans ce nouvel avis que chaque responsable de ces etablissements designe un referent Covid-19. Les responsables de ces etablissements doivent formaliser des regles de prevention adaptees en prenant en consideration la notion de groupe social. Ces regles doivent respecter les mesures rappelees par le HCSP dans cet avis. Ainsi notamment, le HCSP recommande pour ces etablissements qu’une distance de 1 metre soit respectee entre les differents groupes de spectateurs ne faisant pas partie d’un meme groupe de reservation. Une revision de la disposition des salles ainsi qu’une reorganisation des espaces sont necessaires afin de laisser un fauteuil vide entre les groupes de spectateurs jusqu’a un maximum de 10 personnes (groupe de personnes venant ensemble ou ayant reserve ensemble). Cette recommandation est assortie du port de masque grand public obligatoire pour les spectateurs a l’exception des enfants pour lesquels le port du masque ne peut etre impose compte tenu de leur acceptabilite et tolerance. Les salaries en contact avec le public doivent porter un masque grand public. L’hygiene des mains demeure une des cles de la prevention. Les spectateurs doivent realiser une hygiene des mains, en entrant et en sortant des salles. Pour cela les organisateurs doivent mettre a disposition des distributeurs de produits hydro-alcooliques dans des endroits facilement accessibles et au minimum a l’entree et a la sortie.
Le HCSP a emis egalement d’autres recommandations concernant la communication et information du public, l’accueil et la circulation des spectateurs et la gestion de l’environnement.
Abstract We previously reported the safety and immunogenicity data from a randomized trial comparing the monovalent (MV) recombinant protein Beta-variant (MVB.1.351) and MV ancestral protein (MVD614) booster vaccines with AS03 adjuvant (Sanofi/GSK) to mRNA BNT162b2 vaccine (Pfizer-BioNTech). First booster of the vaccines was administered in adult participants previously primed with 2 doses of BNT162b2. A subset of these participants with available blood samples collected at Day 0 (D0), at 28 days (D28), and 3 months (M3) post-booster were contacted for additional testing (195/208 participants). The persistence of cross-neutralizing antibodies, including against Omicron BA.1 and BA.4/5, up to 3 months after boosting was evaluated using a validated pseudovirus neutralization assay. The data showed that the MVB.1.351 vaccine induced higher and durable cross-neutralizing antibodies against Omicron subvariants up to 3 months after boosting compared to a MV ancestral and the mRNA BNT162b2 booster vaccine.
The clinical characteristics, outcome and treatment of non-tuberculous mycobacterial tenosynovitis are reviewed. From lesions localized in the hand, 10 different species of non-tuberculous mycobacteria have been reported. The most common are Mycobacterium marinum and Mycobacterium kansasii. Other less frequent organisms are Mycobacterium avium complex, Mycobacterium szulgai, Mycobacterium terrae, Mycobacterium fortuitum, Mycobacterium chelonae, Mycobacterium abscessus, Mycobacterium malmoense and Mycobacterium xenopi. The infections appear to be the result of previous trauma, surgical procedure, corticosteroid injection or non-apparent inoculation (water contamination). Immunosuppression is sometimes associated with the infections and can be considered as a risk factor. Surgical debridement and appropriate mycobacterial cultures are critical to enable diagnosis and appropriate management. Specimens should be inoculated on a range of media and incubated at a range of temperatures in order to isolate mycobacteria with different growth characteristics (with prolonged incubation). The optimal treatment of these infections is discussed.
