Description of an outbreak of hemorrhagic fever with renal syndrome in the southern Jura Mountains, France, in 2021

OBJECTIVE

The aim of our study was to describe the 2021 Hemorrhagic Fever with Renal Syndrome (HFRS) outbreak in the southern Jura Mountains.

PATIENTS AND METHODS

We included all laboratory-confirmed cases of HFRS reported between April and September 2021 in the three local hospitals.

RESULTS

A total of 90 patients were enrolled in the study: 73 hospitalized and 17 non-hospitalized patients. Transient myopia was only reported in non-hospitalized patients. Forty (44.4 %) patients underwent medical imaging before hantavirus diagnosis. Twenty-one patients (28.8 %) had a plasma creatinine level > 353.6 µmol/L, no patient developed severe metabolic disorder. Only one patient was dialyzed. A pacemaker was implanted before diagnosis of HFRS due to severe bradycardia in one patient. Sudden death was reported in one patient.

CONCLUSION

This hantavirus epidemic led to numerous hospitalizations, one dialysis treatment, and one death. Early diagnosis by rapid test could avoid unnecessary investigations.

Comparaison des scores de sévérité dans les pneumonies à SARS-CoV-2

Introduction

Le SARS-CoV-2 est responsable dans sa forme la plus grave d’une pneumonie avec une mortalité importante. Chen et al. ont proposé un score pronostique incluant des données cliniques et biologiques permettant d’identifier les personnes à risque d’évolution péjorative (Chen et al. Chest 2020).

L’objectif était de comparer le score de Chen aux scores pronostiques utilisés dans les pneumonies aiguës communautaires.

Matériels et méthodes

Ont été inclus tous les patients hospitalisés dans les unités médicales hors réanimation COVID avec un diagnostic de pneumonie à SARS-CoV-2 porté sur une PCR sur frottis nasopharyngé positive et/ou des images scanographiques typiques de COVID-19. Le diagnostic de pneumonie était défini par l’apparition d’une anomalie radiologique ou d’une auscultation anormale associée à des signes cliniques respiratoires. Les variables ont été recueillies de façon prospective et standardisées pour tous les patients avec un suivi clinique ou téléphonique systématique à j28 avec recueil du statut vital. Nous avons comparé le groupe des patients décédés au groupe des patients en vie à j28. Les scores comparés étaient le CURB-65, le CRB-65, le score de Fine et le score de Chen pour lesquels nous avons calculé l’aire sous la courbe pour prédire la mortalité à j28.

Résultats

Du 3 mars au 25 avril 2020, 436 patients ont été hospitalisés pour une infection à SARS-CoV-2, dont 304 (69,7 %) patients avec un diagnostic de pneumonie. Sur les 304 patients, 26 (11 %) patients ont été transférés en réanimation et 60 (20 %) sont décédés à j28.

Les patients décédés avaient plus souvent un âge supérieur à 65 ans (90 % vs 65 %, p < 0,01), était plus souvent de sexe masculin (66 % vs 11 %, p < 0,01), avaient plus souvent des antécédents d’AVC (22 % vs 6,6 %, p < 0,001), de coronaropathie (37 % vs 18 %, p < 0,01) et d’insuffisance rénale chronique (18 % vs 6,6 % p < 0,01).

À l’admission, ils présentaient plus fréquemment une fréquence respiratoire supérieure à 30 cycles/min (38 % vs 19 %, p < 0,01), une confusion (23 % vs 11 %, p < 0,01) mais ne présentaient pas plus d’hypotension artérielle. Il n’y avait pas de différence entre les 2 groupes pour les variables biologiques entrant dans le calcul des scores (CRP, ASAT, hématocrite, PaO₂, pH, glycémie et natrémie) excepté pour l’urée supérieure à 7 mmol/L (57 % vs 32 %, p < 0,001) et la PCT supérieure à 0,5 ng/mL (30 % vs 17 %, p = 0,021).

Les patients décédés avaient plus fréquemment un score CURB-65³2 et CRB-65³2 (82 % vs 50 %, p < 0,01 dans les 2 cas), un score de Fine³71 (98 % vs 80 %, p < 0,001), et avaient une moyenne du score de Chen plus élevée (247 ± 81 vs 168 ± 85, p < 0,01).

Les aires sous la courbe des scores CRB-65, CURB-65, de Fine et de Chen étaient respectivement de 68 % (IC95 % : 61–76), 71 % (IC95 % : 64–79), 74 % (IC95 % : 68–81) et 75 % (IC95 % : 68–81).

Conclusion

Le score de FINE pour prédire la mortalité à j28 est aussi performant que le score de Chen, créé spécifiquement pour l’infection à SARS-CoV-2. Ces deux scores sont cependant difficiles à utiliser en pratique courante contrairement au CURB-65 qui est rapide et facile d’utilisation.

[Eosinopenia in 2018]

Since 1893, eosinopenia is a biological test to help a diagnosis of bacterial infection. Several publications have confirmed this hypothesis, particularly in the intensive care, pneumology and pediatric units. The value of this marker has been identified in vascular cerebral diseases and coronary bypass. Its contribution seems as relevant as procalcitonin, without extra cost. The diagnostic performance of this test was reinforced by a composite score (CIBLE score) that may improve its value in daily routine. Finally, monitoring eosinopenia appears to be a reliable mortality marker.

Targeting human respiratory syncytial virus transcription anti-termination factor M2-1 to inhibit in vivo viral replication

Human respiratory syncytial virus (hRSV) is a leading cause of acute lower respiratory tract infection in infants, elderly and immunocompromised individuals. To date, no specific antiviral drug is available to treat or prevent this disease. Here, we report that the Smoothened receptor (Smo) antagonist cyclopamine acts as a potent and selective inhibitor of in vitro and in vivo hRSV replication. Cyclopamine inhibits hRSV through a novel, Smo-independent mechanism. It specifically impairs the function of the hRSV RNA-dependent RNA polymerase complex notably by reducing expression levels of the viral anti-termination factor M2-1. The relevance of these findings is corroborated by the demonstration that a single R151K mutation in M2-1 is sufficient to confer virus resistance to cyclopamine in vitro and that cyclopamine is able to reduce virus titers in a mouse model of hRSV infection. The results of our study open a novel avenue for the development of future therapies against hRSV infection.

[Hemolytic anemia and dysenteric syndrome: a case of ulcerative colitis]

A 53-years-old man has a dysentery since two weeks. The blood test shows Coombs-positive hemolytic anemia and inflammation. Autoimmune hemolytic anemia (AIHA) is treated with corticosteroid. A colonoscopy reveals an ulcerative colitis. The evolution of the patient is complicated by a spontaneous digestive perforation treated by total proctocolectomy. After this intervention, there is a resolution of the AIHA and the patient is gradually weaned from corticosteroids. AIHA is a rare extra-intestinal manifestation of inflammatory bowel disease essentially ulcerative colitis. Identification of this cause of secondary AIHA is important for the therapeutic strategy. However treatment is nonspecific and based on low levels of evidence.

When you can't see the wood for the trees. Mucor circinelloides: A rare case of primary cutaneous zygomycosis

A patient with refractory diffuse lymphoma treated for pulmonary invasive aspergillosis developed a concomitant primary cutaneous mucormycosis. The mucormycete was identified by sequencing as Mucor circinelloides. This case confirms the importance of a rapid pathogen diagnosis in immunocompromised patients and the usefulness of molecular methods for identification of rare fungal species.

Cadmium induces apoptosis and genotoxicity in rainbow trout hepatocytes through generation of reactive oxygene species

Cadmium poses a serious environmental threat in aquatic ecosystems but the mechanisms of its toxicity remain unclear. The purpose of this work was first to determine whether cadmium induced apoptosis in trout hepatocytes, second to determine whether or not reactive oxygen species (ROS) were involved in cadmium-induced apoptosis and genotoxicity. Hepatocytes exposed to increasing cadmium concentrations (in the range of 1-10 microM) showed a molecular hallmark of apoptosis which is the fragmentation of the nuclear DNA into oligonucleosomal-length fragments, resulting from an activation of endogenous endonucleases and recognized as a 'DNA ladder' on conventional agarose gel electrophoresis. Exposure of hepatocytes to cadmium led clearly to the DEVD-dependent protease activation, acting upstream from the endonucleases and considered as central mediators of apoptosis. DNA strand breaks in cadmium-treated trout hepatocytes was assessed using the comet assay, a rapid and sensitive single-cell gel electrophoresis technique used to detect DNA primary damage in individual cells. Simultaneous treatment of trout hepatocytes with cadmium and the nitroxide radical TEMPO used as a ROS scavenger, reduced significantly DNA fragmentation, DEVD-related protease activity and DNA strand breaks formation. These results lead to a working hypothesis that cadmium-induced apoptosis and DNA strand breaks in trout hepatocytes are partially triggered by the generation of ROS. Additional studies are required for proposing a mechanistic model of cadmium-induced apoptosis and genotoxicity in trout liver cells, in underlying the balance between DNA damage and cellular defence systems in fish.