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Roca A, Camara B, Tinto H. Intrapartum Azithromycin vs Placebo for Neonatal Sepsis-Reply. JAMA 2023; 330:188. [PMID: 37432434 DOI: 10.1001/jama.2023.8331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Affiliation(s)
- Anna Roca
- MRC Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Bully Camara
- MRC Unit The Gambia, London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Halidou Tinto
- Institut de Recherche en Sciences de la Santé-Clinical Research Unit of Nanoro, Nanoro, Burkina Faso
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Roca A, Camara B, Bognini JD, Nakakana UN, Somé AM, Beloum N, Rouamba T, Sillah F, Danso M, Jones JC, Graves S, Jagne I, Getanda P, Darboe S, Tahita MC, Ndure E, Franck HS, Edmond SY, Dondeh BL, Nassa WGJ, Garba Z, Bojang A, Njie Y, Bottomley C, Tinto H, D’Alessandro U. Effect of Intrapartum Azithromycin vs Placebo on Neonatal Sepsis and Death: A Randomized Clinical Trial. JAMA 2023; 329:716-724. [PMID: 36881034 PMCID: PMC9993186 DOI: 10.1001/jama.2022.24388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/25/2023] [Indexed: 03/08/2023]
Abstract
Importance Neonatal sepsis is a leading cause of neonatal mortality. New interventions are needed to decrease neonatal sepsis and mortality in regions with highest burden. Objective To evaluate the efficacy of intrapartum azithromycin to reduce neonatal sepsis or mortality, as well as neonatal and maternal infections. Design, Setting, and Participants This double-blind, placebo-controlled, randomized clinical trial enrolled and followed up birthing parents and their infants at 10 health facilities in The Gambia and Burkina Faso, West Africa, between October 2017 and May 2021. Interventions Participants were assigned at random to receive oral azithromycin (2 g) or placebo (ratio 1:1) during labor. Main Outcomes and Measures The primary outcome was a composite of neonatal sepsis or mortality, with the former defined based on microbiologic or clinical criteria. Secondary outcomes were neonatal infections (skin, umbilical, eye and ear infections), malaria, and fever; postpartum infections (puerperal sepsis, mastitis), fever, and malaria; and use of antibiotics during 4-week follow-up. Results The trial randomized 11 983 persons in labor (median age, 29.9 years). Overall, 225 newborns (1.9% of 11 783 live births) met the primary end point. The incidence of neonatal mortality or sepsis was similar in the azithromycin and placebo groups (2.0% [115/5889] vs 1.9% [110/5894]; risk difference [RD], 0.09 [95% CI, -0.39 to 0.57]), as was the incidence of neonatal mortality (0.8% vs 0.8%; RD, 0.04 [95% CI, -0.27 to 0.35]) and neonatal sepsis (1.3% vs 1.3%; RD, 0.02 [95% CI, -0.38 to 0.43]). Newborns in the azithromycin group compared with the placebo group had lower incidence of skin infections (0.8% vs 1.7%; RD, -0.90 [95% CI, -1.30 to -0.49]) and need for antibiotics (6.2% vs 7.8%; RD, -1.58 [95% CI, -2.49 to -0.67]). Postpartum parents in the azithromycin group had lower incidence of mastitis (0.3% vs 0.5%; RD, -0.24 [95% CI, -0.47 to -0.01]) and puerperal fever (0.1% vs 0.3%; RD, -0.19 [95% CI, -0.36 to -0.01]). Conclusions and Relevance Azithromycin administered orally during labor did not reduce neonatal sepsis or mortality. These results do not support routine introduction of oral intrapartum azithromycin for this purpose. Trial Registration ClinicalTrials.gov Identifier: NCT03199547.
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Affiliation(s)
- Anna Roca
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Bully Camara
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Joel D. Bognini
- Institut de Recherche en Sciences de la Santé–Clinical Research Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso
| | - Usman N. Nakakana
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Athasana M. Somé
- Institut de Recherche en Sciences de la Santé–Clinical Research Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso
| | - Nathalie Beloum
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Toussaint Rouamba
- Institut de Recherche en Sciences de la Santé–Clinical Research Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso
| | - Fatoumata Sillah
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Madikoi Danso
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Joquina C. Jones
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Shashu Graves
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Isatou Jagne
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Pauline Getanda
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Saffiatou Darboe
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Marc C. Tahita
- Institut de Recherche en Sciences de la Santé–Clinical Research Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso
| | - Ebrahim Ndure
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Hien S. Franck
- Institut de Recherche en Sciences de la Santé–Clinical Research Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso
| | - Sawadogo Y. Edmond
- Institut de Recherche en Sciences de la Santé–Clinical Research Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso
| | - Bai L. Dondeh
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Wilfried G. J. Nassa
- Institut de Recherche en Sciences de la Santé–Clinical Research Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso
| | - Zakaria Garba
- Institut de Recherche en Sciences de la Santé–Clinical Research Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso
| | - Abdoulie Bojang
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Yusupha Njie
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Halidou Tinto
- Institut de Recherche en Sciences de la Santé–Clinical Research Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso
| | - Umberto D’Alessandro
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
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Jagne I, Keeley AJ, Bojang A, Camara B, Jallow E, Senghore E, Oluwalana C, Bah SY, Turner CE, Sesay AK, D’Alessandro U, Bottomley C, de Silva TI, Roca A. Impact of intra-partum azithromycin on carriage of group A streptococcus in the Gambia: a posthoc analysis of a double-blind randomized placebo-controlled trial. BMC Infect Dis 2022; 22:103. [PMID: 35093029 PMCID: PMC8800276 DOI: 10.1186/s12879-022-07080-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/11/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Group A Streptococcus (GAS) is a major human pathogen and an important cause of maternal and neonatal sepsis. Asymptomatic bacterial colonization is considered a necessary step towards sepsis. Intra-partum azithromycin may reduce GAS carriage.
Methods
A posthoc analysis of a double-blind, placebo-controlled randomized-trial was performed to determine the impact of 2 g oral dose of intra-partum azithromycin on maternal and neonatal GAS carriage and antibiotic resistance. Following screening, 829 mothers were randomized who delivered 843 babies. GAS was determined by obtaining samples from the maternal and newborn nasopharynx, maternal vaginal tract and breastmilk. Whole Genome Sequencing (WGS) of GAS isolates was performed using the Illumina Miseq platform.
Results
GAS carriage was lower in the nasopharynx of both mothers and babies and breast milk among participants in the azithromycin arm. No differences in GAS carriage were found between groups in the vaginal tract. The occurrence of azithromycin-resistant GAS was similar in both arms, except for a higher prevalence in the vaginal tract among women in the azithromycin arm. WGS revealed all macrolide-resistant vaginal tract isolates from the azithromycin arm were Streptococcus dysgalactiae subspecies equisimilis expressing Lancefield group A carbohydrate (SDSE(A)) harbouring macrolide resistant genes msr(D) and mef(A). Ten of the 45 GAS isolates (22.2%) were SDSE(A).
Conclusions
Oral intra-partum azithromycin reduced GAS carriage among Gambian mothers and neonates however carriage in the maternal vaginal tract was not affected by the intervention due to azithromycin resistant SDSE(A). SDSE(A) resistance must be closely monitored to fully assess the public health impact of intrapartum azithromycin on GAS.
Trial registration ClinicalTrials.gov Identifier NCT01800942
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Bojang A, Baines SL, Camara B, Guerillot R, Donovan L, Marqués RS, Secka O, D'Alessandro U, Bottomley C, Howden BP, Roca A. Impact of Intrapartum Oral Azithromycin on the Acquired Macrolide Resistome of Infants' Nasopharynx: A Randomized Controlled Trial. Clin Infect Dis 2021; 71:3222-3225. [PMID: 32445474 PMCID: PMC7819521 DOI: 10.1093/cid/ciaa609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 05/19/2020] [Indexed: 11/14/2022] Open
Abstract
In a post hoc analysis of samples from an intrapartum azithromycin randomized clinical trial, we found that children whose mothers had been treated with the drug had higher prevalence of macrolide-resistance genes msr(A) and ermC at 28 days but not at 12 months. The 2 genes were positively associated in the nasopharynx. CLINICAL TRIALS REGISTRATION NCT1800942.
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Affiliation(s)
- Abdoulie Bojang
- Medical Research Council Unit, The Gambia, at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Sarah L Baines
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Bully Camara
- Medical Research Council Unit, The Gambia, at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Romain Guerillot
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Liam Donovan
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Raquel Sánchez Marqués
- Medical Research Council Unit, The Gambia, at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Ousman Secka
- Medical Research Council Unit, The Gambia, at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Umberto D'Alessandro
- Medical Research Council Unit, The Gambia, at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Christian Bottomley
- Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Benjamin P Howden
- Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.,Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Anna Roca
- Medical Research Council Unit, The Gambia, at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
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Getanda P, Bojang A, Camara B, Jagne-Cox I, Usuf E, Howden BP, D'Alessandro U, Bottomley C, Roca A. Short-term increase in the carriage of azithromycin-resistant Escherichia coli and Klebsiella pneumoniae in mothers and their newborns following intra-partum azithromycin: a post hoc analysis of a double-blind randomized trial. JAC Antimicrob Resist 2021; 3:dlaa128. [PMID: 34223077 PMCID: PMC8210243 DOI: 10.1093/jacamr/dlaa128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/17/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives To evaluate the impact of one oral dose of intrapartum azithromycin (2 g) on the carriage and antibiotic resistance of Escherichia coli and Klebsiella pneumoniae in the nasopharynx, breast milk and vaginal swabs of mothers and K. pneumoniae in the nasopharynx of their newborns. Methods We performed a post hoc analysis of a double-blind, placebo-controlled randomized-trial (ratio 1:1) conducted in The Gambia. Breast milk (BM) and vaginal swabs (VS) from mothers and nasopharyngeal swabs (NPS) from mother-newborn pairs were collected at different timepoints during the 4 week follow-up. Samples were processed using standard microbiological procedures. For BM and NPS post-intervention results were combined for analysis. Results In the original trial 829 mothers were randomized. In this analysis, complete sample sets were available for 630 mothers for E. coli analysis (76.0%) and 564 mother-newborn pairs for K. pneumoniae analysis (68.0%). For E. coli, carriage prevalence in BM and VS was similar in both arms but resistance was higher in the azithromycin arm in VS (2.6% versus 0%, P = 0.004). For K. pneumoniae, carriage prevalence was higher in the azithromycin arm for BM (13.8% versus 8.7%, P = 0.055) but not for VS or NPS. Prevalence of azithromycin resistant K. pneumoniae was higher in the azithromycin arm for BM (3.6% versus 1.0%, P = 0.050) and VS (1.5% versus 0% P = 0.057). Conclusions Oral intrapartum azithromycin did not reduce carriage of E. coli and K. pneumoniae and was associated with an increase in the prevalence of azithromycin-resistant E. coli and K. pneumoniae isolates in BM and VS.
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Affiliation(s)
- Pauline Getanda
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Abdoulie Bojang
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Bully Camara
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Isatou Jagne-Cox
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Effua Usuf
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, Doherty Institute for Infection and Immunity, Victoria, Australia
| | - Umberto D'Alessandro
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Christian Bottomley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Anna Roca
- Disease Control and Elimination Theme, Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
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Camara B, Oluwalana C, Miyahara R, Lush A, Kampmann B, Manneh K, Okomo U, D'Alessandro U, Roca A. Stillbirths, Neonatal Morbidity, and Mortality in Health-Facility Deliveries in Urban Gambia. Front Pediatr 2021; 9:579922. [PMID: 33659227 PMCID: PMC7917219 DOI: 10.3389/fped.2021.579922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 01/25/2021] [Indexed: 12/22/2022] Open
Abstract
Background: The Gambia Demographic and Health Survey 2013 data showed that up to 63% of deliveries in the country occur in health facilities. Despite such a high rate, there are few facility-based studies on delivery outcomes in the country. This analysis ancillary to a randomized control trial describes occurrence of poor pregnancy outcomes in a cohort of women and their infants delivering in a government health facility in urban Gambia. Methods: Using clinical information obtained during the trial, we calculated rates of poor pregnancy outcomes including stillbirths, hospitalization and neonatal deaths. Logistic regression was used to calculate odds ratio (OR) and 95% confidence interval (CI) in the risk factors analysis. Results: Between April 2013 and 2014, 829 mothers delivered 843 babies, including 13 stillbirths [15.4 (7.1-23.8)] per 1,000 births. Among 830 live born infants, 7.6% (n = 63) required hospitalization during the 8-week follow-up period. Most of these hospitalizations (74.6%) occurred during the early neonatal period (<7 days of life). Severe clinical infections (i.e., sepsis, meningitis and pneumonia) (n = 27) were the most common diagnoses, followed by birth asphyxia (n = 13), major congenital malformations (n = 10), jaundice (n = 6) and low birth weight (n = 5). There were sixteen neonatal deaths, most of which also occurred during the early neonatal period. Overall, neonatal mortality rate (NMR) and perinatal mortality rate (PMR) were 19.3 (CI: 9.9-28.7) per 1,000 live births and 26.1 (CI: 15.3-36.9) per 1,000 total births, respectively. Severe clinical infections and birth asphyxia accounted for 37 and 31% of neonatal deaths, respectively. The risk of hospitalization was higher among neonates with severe congenital malformations, low birth weight, twin deliveries, and those born by cesarean section. Risk of mortality was higher among neonates with severe congenital malformations and twin deliveries. Conclusion: Neonatal hospitalization and deaths in our cohort were high. Although vertical interventions may reduce specific causes of morbidity and mortality, data indicate the need for a holistic approach to significantly improve the rates of poor pregnancy outcomes. Critically, a focus on decreasing the high rate of stillbirths is warranted. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT01800942.
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Affiliation(s)
- Bully Camara
- Medical Research Council Unit the Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Claire Oluwalana
- Medical Research Council Unit the Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Reiko Miyahara
- Department of Clinical Tropical Medicine, Institute of Tropical Medicine, Graduate School of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Alyson Lush
- Medical Research Council Unit the Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Beate Kampmann
- Medical Research Council Unit the Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Kebba Manneh
- Bundung Maternal and Child Health Hospital, Banjul, Gambia
| | - Uduak Okomo
- Medical Research Council Unit the Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Umberto D'Alessandro
- Medical Research Council Unit the Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Anna Roca
- Medical Research Council Unit the Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
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Kone A, Zoumanigui N, Camara M, Onivogui Z, Camara B, Sylla S, Bangoura J. The varices of lower members: Epidemiological, clinical study and management in the medical and surgical cardiological service of the donka national hospital. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bojang A, Camara B, Jagne Cox I, Oluwalana C, Lette K, Usuf E, Bottomley C, Howden BP, D'Alessandro U, Roca A. Long-term Impact of Oral Azithromycin Taken by Gambian Women During Labor on Prevalence and Antibiotic Susceptibility of Streptococcus pneumoniae and Staphylococcus aureus in Their Infants: Follow-up of a Randomized Clinical Trial. Clin Infect Dis 2019; 67:1191-1197. [PMID: 29608659 PMCID: PMC6160601 DOI: 10.1093/cid/ciy254] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/27/2018] [Indexed: 11/14/2022] Open
Abstract
Background Oral azithromycin given to women in labor decreases maternal and neonatal bacterial carriage but increases azithromycin-resistant bacteria during at least 4 weeks following the intervention. We assessed the prevalence of bacterial carriage and azithromycin resistance 12 months after treatment among study infants. Methods Nasopharyngeal swabs (NPSs) were collected between November 2014 and May 2015 from children aged 11-13 months whose mothers had received azithromycin or placebo during labor. Streptococcus pneumoniae and Staphylococcus aureus were isolated using conventional microbiological methods. Antibiotic susceptibility was determined by disk diffusion and confirmed by Etest or VITEK-2. Results NPSs were collected from 461 children. The prevalence of S. pneumoniae and S. aureus was similar between children from the azithromycin and placebo arms (85.0% vs 82.1%; odds ratio [OR], 1.23 [95% confidence interval {CI}, .73-2.08] for S. pneumoniae and 21.7% vs 21.3%; OR, 1.02 [95% CI, .64-1.64] for S. aureus). Prevalence of azithromycin-resistant S. pneumoniae was similar in both arms (1.8% vs 0.9% in children from the azithromycin and placebo arms, respectively; OR, 2.10 [95% CI, .30-23.38]); resistance to other antibiotics was also similar between arms. For S. aureus, there was no difference in azithromycin resistance between children in the azithromycin (3.1%) and placebo (2.6%) arms (OR, 1.22 [95% CI, .35-4.47]) or resistance to any other antibiotics. Conclusions The higher prevalence of S. aureus azithromycin resistance observed among women treated during labor and their babies 4 weeks after treatment had waned 12 months after delivery. Azithromycin intervention did not induce other antibiotic resistance to S. pneumoniae or S. aureus. Clinical Trials Registration NCT01800942.
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Affiliation(s)
- Abdoulie Bojang
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara
| | - Bully Camara
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara
| | - Isatou Jagne Cox
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara
| | - Claire Oluwalana
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara
| | - Kodou Lette
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara
| | - Effua Usuf
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Christian Bottomley
- Medical Research Council Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, Doherty Institute for Infection and Immunity, Victoria, Australia
| | - Umberto D'Alessandro
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom.,Institute of Tropical Medicine, Antwerp, Belgium
| | - Anna Roca
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
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Brosseau C, Danger R, Durand M, Durand E, Foureau A, Lacoste P, Tissot A, Roux A, Reynaud-Gaubert M, Kessler R, Mussot S, Dromer C, Brugière O, Mornex JF, Guillemain R, Claustre J, Magnan A, Brouard S, Velly J, Rozé H, Blanchard E, Antoine M, Cappello M, Ruiz M, Sokolow Y, Vanden Eynden F, Van Nooten G, Barvais L, Berré J, Brimioulle S, De Backer D, Créteur J, Engelman E, Huybrechts I, Ickx B, Preiser T, Tuna T, Van Obberghe L, Vancutsem N, Vincent J, De Vuyst P, Etienne I, Féry F, Jacobs F, Knoop C, Vachiéry J, Van den Borne P, Wellemans I, Amand G, Collignon L, Giroux M, Angelescu D, Chavanon O, Hacini R, Martin C, Pirvu A, Porcu P, Albaladejo P, Allègre C, Bataillard A, Bedague D, Briot E, Casez‐Brasseur M, Colas D, Dessertaine G, Francony G, Hebrard A, Marino M, Protar D, Rehm D, Robin S, Rossi‐Blancher M, Augier C, Bedouch P, Boignard A, Bouvaist H, Briault A, Camara B, Chanoine S, Dubuc M, Quétant S, Maurizi J, Pavèse P, Pison C, Saint‐Raymond C, Wion N, Chérion C, Grima R, Jegaden O, Maury J, Tronc F, Flamens C, Paulus S, Philit F, Senechal A, Glérant J, Turquier S, Gamondes D, Chalabresse L, Thivolet‐Bejui F, Barnel C, Dubois C, Tiberghien A, Pimpec‐Barthes F, Bel A, Mordant P, Achouh P, Boussaud V, Méléard D, Bricourt M, Cholley B, Pezella V, Brioude G, D'Journo X, Doddoli C, Thomas P, Trousse D, Dizier S, Leone M, Papazian L, Bregeon F, Coltey B, Dufeu N, Dutau H, Garcia S, Gaubert J, Gomez C, Laroumagne S, Mouton G, Nieves A, Picard C, Rolain J, Sampol E, Secq V, Perigaud C, Roussel J, Senage T, Mugniot A, Danner I, Haloun A, Abbes S, Bry C, Blanc F, Lepoivre T, Botturi‐Cavaillès K, Loy J, Bernard M, Godard E, Royer P, Henrio K, Dartevelle P, Fabre D, Fadel E, Mercier O, Stephan F, Viard P, Cerrina J, Dorfmuller P, Feuillet S, Ghigna M, Hervén P, Le Roy Ladurie F, Le Pavec J, Thomas de Montpreville V, Lamrani L, Castier Y, Mordant P, Cerceau P, Augustin P, Jean‐Baptiste S, Boudinet S, Montravers P, Dauriat G, Jébrak G, Mal H, Marceau A, Métivier A, Thabut G, Lhuillier E, Dupin C, Bunel V, Falcoz P, Massard G, Santelmo N, Ajob G, Collange O, Helms O, Hentz J, Roche A, Bakouboula B, Degot T, Dory A, Hirschi S, Ohlmann‐Caillard S, Kessler L, Schuller A, Bennedif K, Vargas S, Bonnette P, Chapelier A, Puyo P, Sage E, Bresson J, Caille V, Cerf C, Devaquet J, Dumans‐Nizard V, Felten M, Fischler M, Si Larbi A, Leguen M, Ley L, Liu N, Trebbia G, De Miranda S, Douvry B, Gonin F, Grenet D, Hamid A, Neveu H, Parquin F, Picard C, Stern M, Bouillioud F, Cahen P, Colombat M, Dautricourt C, Delahousse M, D'Urso B, Gravisse J, Guth A, Hillaire S, Honderlick P, Lequintrec M, Longchampt E, Mellot F, Scherrer A, Temagoult L, Tricot L, Vasse M, Veyrie C, Zemoura L, Dahan M, Murris M, Benahoua H, Berjaud J, Le Borgne Krams A, Crognier L, Brouchet L, Mathe O, Didier A, Krueger T, Ris H, Gonzalez M, Aubert J, Nicod L, Marsland B, Berutto T, Rochat T, Soccal P, Jolliet P, Koutsokera A, Marcucci C, Manuel O, Bernasconi E, Chollet M, Gronchi F, Courbon C, Hillinger S, Inci I, Kestenholz P, Weder W, Schuepbach R, Zalunardo M, Benden C, Buergi U, Huber L, Isenring B, Schuurmans M, Gaspert A, Holzmann D, Müller N, Schmid C, Vrugt B, Rechsteiner T, Fritz A, Maier D, Deplanche K, Koubi D, Ernst F, Paprotka T, Schmitt M, Wahl B, Boissel J, Olivera‐Botello G, Trocmé C, Toussaint B, Bourgoin‐Voillard S, Séve M, Benmerad M, Siroux V, Slama R, Auffray C, Charron D, Lefaudeux D, Pellet J. Blood CD9 + B cell, a biomarker of bronchiolitis obliterans syndrome after lung transplantation. Am J Transplant 2019; 19:3162-3175. [PMID: 31305014 DOI: 10.1111/ajt.15532] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 06/12/2019] [Accepted: 07/07/2019] [Indexed: 01/25/2023]
Abstract
Bronchiolitis obliterans syndrome is the main limitation for long-term survival after lung transplantation. Some specific B cell populations are associated with long-term graft acceptance. We aimed to monitor the B cell profile during early development of bronchiolitis obliterans syndrome after lung transplantation. The B cell longitudinal profile was analyzed in peripheral blood mononuclear cells from patients with bronchiolitis obliterans syndrome and patients who remained stable over 3 years of follow-up. CD24hi CD38hi transitional B cells were increased in stable patients only, and reached a peak 24 months after transplantation, whereas they remained unchanged in patients who developed a bronchiolitis obliterans syndrome. These CD24hi CD38hi transitional B cells specifically secrete IL-10 and express CD9. Thus, patients with a total CD9+ B cell frequency below 6.6% displayed significantly higher incidence of bronchiolitis obliterans syndrome (AUC = 0.836, PPV = 0.75, NPV = 1). These data are the first to associate IL-10-secreting CD24hi CD38hi transitional B cells expressing CD9 with better allograft outcome in lung transplant recipients. CD9-expressing B cells appear as a contributor to a favorable environment essential for the maintenance of long-term stable graft function and as a new predictive biomarker of bronchiolitis obliterans syndrome-free survival.
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Affiliation(s)
- Carole Brosseau
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France.,Institut du thorax, Inserm UMR 1087, CNRS, UMR 6291, Université de Nantes, Nantes, France.,Institut du thorax, CHU de Nantes, Nantes, France
| | - Richard Danger
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Maxim Durand
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France.,Faculté de Médecine, Université de Nantes, Nantes, France
| | - Eugénie Durand
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France
| | - Aurore Foureau
- Institut du thorax, Inserm UMR 1087, CNRS, UMR 6291, Université de Nantes, Nantes, France.,Institut du thorax, CHU de Nantes, Nantes, France
| | - Philippe Lacoste
- Institut du thorax, Inserm UMR 1087, CNRS, UMR 6291, Université de Nantes, Nantes, France.,Institut du thorax, CHU de Nantes, Nantes, France
| | - Adrien Tissot
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France.,Institut du thorax, Inserm UMR 1087, CNRS, UMR 6291, Université de Nantes, Nantes, France.,Institut du thorax, CHU de Nantes, Nantes, France.,Faculté de Médecine, Université de Nantes, Nantes, France
| | - Antoine Roux
- Hôpital Foch, Suresnes, France.,Université Versailles Saint-Quentin-en-Yvelines, UPRES EA220, Versailles, France
| | | | | | - Sacha Mussot
- Centre Chirurgical Marie Lannelongue, Service de Chirurgie Thoracique, Vasculaire et Transplantation Cardiopulmonaire, Le Plessis Robinson, France
| | | | - Olivier Brugière
- Hôpital Bichat, Service de Pneumologie et Transplantation Pulmonaire, Paris, France
| | | | | | - Johanna Claustre
- Clinique Universitaire Pneumologie, Pôle Thorax et Vaisseaux, CHU Grenoble Alpes, Université Grenoble Alpes, Inserm U1055, Grenoble, France
| | - Antoine Magnan
- Institut du thorax, Inserm UMR 1087, CNRS, UMR 6291, Université de Nantes, Nantes, France.,Institut du thorax, CHU de Nantes, Nantes, France
| | - Sophie Brouard
- Centre de Recherche en Transplantation et Immunologie, UMR 1064, INSERM, Université de Nantes, Nantes, France.,Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Nantes, France.,Centre d'Investigation Clinique (CIC) Biothérapie, CHU Nantes, Nantes, France
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Patarin J, Ghiringhelli É, de Saint Vincent MR, Cracowski JL, Camara B, Quétant S, Bosc C, Quésada JL, Cracowski C. P215 Pathological markers in cystic fibrosis: comparing sputum rheology with spirometry. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30508-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Rouzé H, Viprey M, Allemann S, Dima A, Denis A, Poupon-Bourdy S, Reix P, Camara B, Pin I, Durieu I, Reynaud Q, Touzet S. P069 Adherence to long-term therapies in cystic fibrosis: a French cross-sectional study linking prescribing, dispensing and hospitalisation data. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30363-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Falque L, Gheerbrant H, Saint-Raymond C, Quétant S, Camara B, Briault A, Porcu P, Pirvu A, Durand M, Pison C, Claustre J. [Selection of lung transplant candidates in France in 2019]. Rev Mal Respir 2019; 36:508-518. [PMID: 31006579 DOI: 10.1016/j.rmr.2018.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 03/30/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION In 2015, the International Society for Heart and Lung Transplantation (ISHLT) published a consensus document for the selection of lung transplant candidates. In the absence of recent French recommendations, this guideline is useful in order to send lung transplant candidates to the transplantation centers and to list them for lung transplantation at the right time. BACKGROUND The main indications for lung transplantation in adults are COPD and emphysema, idiopathic pulmonary fibrosis and interstitial diseases, cystic fibrosis and pulmonary arterial hypertension (PAH). The specific indications for each underlying disease as well as the general contraindications have been reviewed in 2015 by the ISHLT. For cystic fibrosis, the main factors are forced expiratory volume in one second, 6-MWD, PAH and clinical deterioration characterized by increased frequency of exacerbations; for emphysema progressive disease, the BODE score, hypercapnia and FEV1; for PAH progressive disease or the need of specific intravenous therapy and NYHA classification. Finally, the diagnosis of fibrosing interstitial lung disease is usually a sufficient indication for lung transplantation assessment. OUTLOOK AND CONCLUSION These new recommendations, close to French practices, help clinicians to find the right time for referral of patients to transplantation centers. This is crucial for the prognosis of lung transplantation.
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Affiliation(s)
- L Falque
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble-Alpes, 38000 Grenoble, France; Université Grenoble-Alpes, 38000 Grenoble, France
| | - H Gheerbrant
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble-Alpes, 38000 Grenoble, France; Université Grenoble-Alpes, 38000 Grenoble, France
| | - C Saint-Raymond
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - S Quétant
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - B Camara
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - A Briault
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - P Porcu
- Service de chirurgie cardiaque, pôle thorax et vaisseaux, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - A Pirvu
- Service de chirurgie thoracique et vasculaire, pôle thorax et vaisseaux, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - M Durand
- Service de réanimation cardio-vasculaire et thoracique, pôle anesthésie-réanimation, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - C Pison
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble-Alpes, 38000 Grenoble, France; Université Grenoble-Alpes, 38000 Grenoble, France; Inserm1055, laboratoire de bioénergétique fondamentale et appliquée, 38000 Grenoble, France
| | - J Claustre
- Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble-Alpes, 38000 Grenoble, France; Université Grenoble-Alpes, 38000 Grenoble, France.
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Burgel P, Bergeron-Lafaurie A, Bassinet L, Chatte G, Camara B, Andrejak C, Leroy S, Roge C, Audoly C, Murris-Espin M. Registre EMBARC France de dilatations des bronches : données à l’inclusion. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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14
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Graziani M, Reynaud-Gaubert M, Gomez E, Traclet J, Ahmad K, Bergot E, Bertoletti L, Camara B, Israël-Biet D, Jaïs X, Kiakouama-Maleka L, Marchand-Adam S, Montani D, Nieves A, Nunes H, Piegay F, Wémeau-Stervinou L, Zarza V, Polazzi S, Schott A, Zeghmar S, Humbert M, Nasser M, Cottin V. Hypertension pulmonaire au cours des pneumopathies interstitielles diffuses : relation avec la fonction pulmonaire et effet du traitement de l’hypertension pulmonaire (étude HYPID). Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Roca A, Camara B, Oluwalana C, Lette K, Bottomley C, D’Alessandro U. Long-lasting effect of oral azithromycin taken by women during labour on infant nutrition: Follow-up cohort of a randomized clinical trial in western Gambia. PLoS One 2018; 13:e0206348. [PMID: 30359447 PMCID: PMC6201939 DOI: 10.1371/journal.pone.0206348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 10/11/2018] [Indexed: 11/20/2022] Open
Abstract
Objective To assess the effect of administering an oral dose of 2g of azithromycin in Gambian women during labour on infant growth. Methods Children whose mothers had been randomized to receive either an oral dose of 2g of azithromycin or placebo during labour were visited at home at the end of infancy by trained study nurses blind to the treatment allocation. The follow-up visit of these cohorts (exposed and non-exposed to azithromycin), which was not part of the original trial design, was conducted between November 2014 and May 2015 when the infants were 11 to 13 months of age. During visits, nurses recorded anthropometrical measurements and transcribed information from the infants’ welfare cards. Results Four-hundred and sixty-five (79.6%) of the 584 infants aged 11–13 months at the time of the survey were recruited. The proportion of children with an age-adjusted Z-score <-2SD for mid-upper-arm circumference (MUAC) was lower among those exposed to azithromycin [1.3% versus 6.3%, OR = 0.21 95%CI (0.06,0.72), p = 0.006] and there was weak evidence of a difference in the proportion of infants with weight-for-age (WAZ) Z-score <-2SD [7.1% versus 12.1%, OR = 0.58 95%CI (0.33,1.04), p = 0.065]. For all other malnutrition indicators the proportions were similar in the exposed and un-exposed cohort. Conclusions Our results show that azithromycin in labour may have a beneficial effect in MUAC among children who are below the curve. Larger studies with closer follow-up are warranted. Trial registration (main trial) ClinicalTrials.gov Identifier NCT01800942.
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Affiliation(s)
- Anna Roca
- MRC Unit at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- * E-mail:
| | - Bully Camara
- MRC Unit at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Claire Oluwalana
- MRC Unit at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Kodou Lette
- MRC Unit at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Umberto D’Alessandro
- MRC Unit at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
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Camara B, Fuchs A, Benitez JC, Quetant S, Chanoine S, Llerena C, Herbinet A, Wuyam B, Vion V, Pin I. WS08.6 Effects of home-based adapted physical activity in patients with cystic fibrosis: an interventional study. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30166-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Patarin J, Ghiringhelli E, Camara B, Benitez JC, Quétant S, Pison C. P111 Testing sputum in patients with cystic fibrosis using rheology: the ageing effect. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30407-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Andujar P, Kelkel E, Briault A, Jeanjean C, Pernot J, Bertrand D, Hérengt F, Guillaud-Ségard B, Pépin JL, Destors M, Leroy S, Ben-Saidane H, Gonzalez J, Camara B, Debabeche N, Ernesto S, Plaindoux A, Bosc C, Guerder A, Pontier-Marchandise S, Maurel F, Boyer L, Hess D, Burgel PR, Roche N, Aguilaniu B. Prise en charge des patients avec BPCO en consultation en CHU, CHG et en médecine libérale dans l’observatoire Colibri-BPCO. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Patarin J, Ghiringhelli E, Cracowski C, Camara B, Quétant S, Bosc C, Pison C, Cracowski JL. Évaluation des propriétés rhéologiques de sécrétions bronchiques issues de patients BPCO et asthmatiques. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Claustre J, Jouve T, Beaumier L, Camara B, Quétant S, Saint-Raymond C, Bedouch P, Chanoine S, Pison C. Efficacité de l’évérolimus sur les infections et maladies à cytomégalovirus en transplantation pulmonaire, une étude de cohorte. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Burr SE, Camara B, Oluwalana C, Bojang E, Bottomley C, Bojang A, Bailey RL, D'Alessandro U, Roca A. Does azithromycin given to women in labour decrease ocular bacterial infection in neonates? A double-blind, randomized trial. BMC Infect Dis 2017; 17:799. [PMID: 29282015 PMCID: PMC5746019 DOI: 10.1186/s12879-017-2909-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 12/12/2017] [Indexed: 11/22/2022] Open
Abstract
Background Vertical transmission can result in neonatal infection and disease. Reducing the transmission of bacterial pathogens from mother to infant may be an effective means of preventing neonatal infection, including bacterial conjunctivitis. Methods In a double-blind, randomized trial, we assessed the effect of administering a single dose of oral azithromycin to women in labour on bacterial colonization of the neonate. A reduction in purulent neonatal conjunctivitis was a secondary objective of the trial. Ocular samples were collected from the lower fornix of infants presenting with clinical signs of purulent conjunctivitis during the first eight weeks of life. Incidence of purulent conjunctivitis was compared between trial arms. Bacterial infection was assessed using PCR and incidence of purulent conjunctivitis due to bacteria was also compared between arms. Results Forty of 843 infants (4.7%) presented clinical signs of purulent conjunctivitis. No significant difference in incidence of purulent conjunctivitis was seen between azithromycin and placebo arms [4.3% (18/419) versus 5.2% (22/424), OR = 0.82, 95% CI (0.44,1.54), p = 0.628]. S. aureus was the most commonly identified pathogen, detected in 38% of cases. Incidence of purulent-conjunctivitis due to bacterial infection was lower in the azithromycin arm [1.2% (5/419) versus 3.8% (16/424), OR = 0.31, 95% CI (0.12–0.82), p = 0.025)]. The incidence of gram-positive bacteria was also lower in the azithromycin arm [1.0% (4/419) versus 3.3% (14/424), OR = 0.28, 95%CI (0.10–0.82), p = 0.029]. Conclusions Oral azithromycin given to women during labour may have the potential to reduce the incidence of bacterial neonatal conjunctivitis. Trial registration ClinicalTrials.gov, identifier NCT01800942, registration date 26 Feb 2013.
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Affiliation(s)
- Sarah E Burr
- London School of Hygiene and Tropical Medicine, London, UK
| | - Bully Camara
- Medical Research Council Unit, The Gambia, Fajara, Banjul, The Gambia
| | - Claire Oluwalana
- Medical Research Council Unit, The Gambia, Fajara, Banjul, The Gambia
| | - Ebrima Bojang
- Medical Research Council Unit, The Gambia, Fajara, Banjul, The Gambia
| | | | - Abdoulie Bojang
- Medical Research Council Unit, The Gambia, Fajara, Banjul, The Gambia
| | - Robin L Bailey
- London School of Hygiene and Tropical Medicine, London, UK
| | - Umberto D'Alessandro
- London School of Hygiene and Tropical Medicine, London, UK.,Medical Research Council Unit, The Gambia, Fajara, Banjul, The Gambia
| | - Anna Roca
- London School of Hygiene and Tropical Medicine, London, UK. .,Medical Research Council Unit, The Gambia, Fajara, Banjul, The Gambia.
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El-Zeenni N, Chanoine S, Recule C, Stahl JP, Maurin M, Camara B. Are guidelines on the management of non-tuberculous mycobacteria lung infections respected and what are the consequences for patients? A French retrospective study from 2007 to 2014. Eur J Clin Microbiol Infect Dis 2017; 37:233-240. [PMID: 29067624 DOI: 10.1007/s10096-017-3120-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 10/10/2017] [Indexed: 01/15/2023]
Abstract
Diagnosis and treatment of lung infections caused by non-tuberculous mycobacteria (NTM) remain challenging. Adherence of the clinicians to the American Thoracic Society (ATS) and the Infectious Diseases Society of America (IDSA) 2007 guidelines is often incomplete. Between 2007 and 2014, in Grenoble Alpes University Hospital, France, 132 patients had NTM-positive cultures from lower respiratory tract (LRT) samples. We retrospectively collected diagnosis, treatment, and outcome data of patients, and evaluated the adherence of clinicians to ATS/IDSA guidelines and the consequences of patients' prognoses. Using the ATS/IDSA definitions, 31 out of 132 patients (23.5%) were considered infected, 57 out of 132 patients (43.2%) were considered colonised, 33 out of 132 (25%) were contaminated and 11 (8.4%) had missing data. Among the 31 NTM-infected patients, M. avium (23 out of 31, 74.2%) was most frequently involved. The main risk factor for NTM lung infection was underlying lung disease (30 out of 31, 96.8%). Treatment was not appropriate according to current guidelines in 58.1% of infected patients (18 out of 31). Mainly, the antibiotic treatment was installed based on radiological signs (p = 0.0006), sputum results and bronchoalveolar lavage results (p < 0.0001 and p = 0.003 respectively). Most antibiotic regimens included a macrolide (83.4%). Patients receiving appropriate treatment had the same cure rates as those receiving inappropriate treatment (p = 0.22) and similar relapse rates (p = 0.92). Current medical practices for the treatment of NTM lung infections in our institution are not consistent with the ATS/IDSA guidelines. This could potentially affect the prognosis of these patients and favour the emergence of macrolide resistance in NTM species.
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Affiliation(s)
- N El-Zeenni
- Infectious Diseases Department, Grenoble Alpes University Hospital, 38000, Grenoble, France. .,Pneumology Department, Grenoble Alpes University Hospital, 38000, Grenoble, France. .,Infectious Diseases Department, Grenoble Alpes University Hospital, 38043, Grenoble, France.
| | - S Chanoine
- Pharmacy Department, Grenoble Alpes University Hospital, 38000, Grenoble, France.,Grenoble Alpes University, Grenoble, France
| | - C Recule
- Microbiology Department, Grenoble Alpes University Hospital, 38000, Grenoble, France
| | - J-P Stahl
- Infectious Diseases Department, Grenoble Alpes University Hospital, 38000, Grenoble, France.,Grenoble Alpes University, Grenoble, France
| | - M Maurin
- Grenoble Alpes University, Grenoble, France.,Microbiology Department, Grenoble Alpes University Hospital, 38000, Grenoble, France
| | - B Camara
- Pneumology Department, Grenoble Alpes University Hospital, 38000, Grenoble, France
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Ghiringhelli E, Pison C, Cracowski C, Patarin J, Camara B, Quetant S, Bosc C, Cracowski JL. EPS1.7 Rheology as a tool for treatment evaluation and monitoring in cystic fibrosis. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30280-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Roca A, Bojang A, Camara B, Oluwalana C, Lette K, West P, D'Alessandro U, Bottomley C. Maternal colonization with Staphylococcus aureus and Group B streptococcus is associated with colonization in newborns. Clin Microbiol Infect 2017; 23:974-979. [PMID: 28478240 PMCID: PMC5714057 DOI: 10.1016/j.cmi.2017.04.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/12/2017] [Accepted: 04/19/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Although Staphylococcus aureus and Group B streptococcus (GBS) are major causes of neonatal sepsis in sub-Saharan Africa, it is unclear how these bacteria are transmitted to the neonate. METHODS In a cohort of 377 Gambian women and their newborns, nasopharyngeal swabs were collected at delivery (day 0), and 3, 6, 14 and 28 days later. Breast milk samples and vaginal swabs were collected from the mother. Staphylococcus aureus and GBS were isolated using conventional microbiological methods. RESULTS Most women were carriers of S. aureus (264 out of 361 with all samples collected, 73.1%) at some point during follow up and many were carriers of GBS (114 out of 361, 31.6%). Carriage of S. aureus was common in all three maternal sites and GBS was common in the vaginal tract and breast milk. Among newborns, carriage of S. aureus peaked at day 6 (238 out of 377, 63.1%) and GBS at day 3 (39 out of 377, 10.3%). Neonatal carriage of S. aureus at day 6 was associated with maternal carriage in the breast milk adjusted OR 2.54; 95% CI 1.45-4.45, vaginal tract (aOR 2.55; 95% CI 1.32-4.92) and nasopharynx (aOR 2.49; 95% CI 1.56-3.97). Neonatal carriage of GBS at day 6 was associated with maternal carriage in the breast milk (aOR 3.75; 95% CI 1.32-10.65) and vaginal tract (aOR 3.42; 95% CI 1.27-9.22). CONCLUSIONS Maternal colonization with S. aureus or GBS is a risk factor for bacterial colonization in newborns.
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Affiliation(s)
- A Roca
- Medical Research Council Unit The Gambia, Banjul, Gambia; Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - A Bojang
- Medical Research Council Unit The Gambia, Banjul, Gambia
| | - B Camara
- Medical Research Council Unit The Gambia, Banjul, Gambia
| | - C Oluwalana
- Medical Research Council Unit The Gambia, Banjul, Gambia
| | - K Lette
- Medical Research Council Unit The Gambia, Banjul, Gambia
| | - P West
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - U D'Alessandro
- Medical Research Council Unit The Gambia, Banjul, Gambia; Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Institute of Tropical Medicine, Antwerp, Belgium
| | - C Bottomley
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Oluwalana C, Camara B, Bottomley C, Goodier S, Bojang A, Kampmann B, Ceesay S, D'Alessandro U, Roca A. Azithromycin in Labor Lowers Clinical Infections in Mothers and Newborns: A Double-Blind Trial. Pediatrics 2017; 139:peds.2016-2281. [PMID: 28130432 DOI: 10.1542/peds.2016-2281] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We have recently completed a proof-of-concept trial showing that bacterial colonization decreased in women and newborns after the administration of azithromycin during labor. Here, we aim to assess the effect of the intervention on maternal and neonatal clinical infections. METHODS This was a double-blind, placebo-controlled randomized trial. Gambian women in labor were given either an oral dose of azithromycin (2 g) or placebo. Follow-up was conducted for 8 weeks after delivery. RESULTS From April 2013 to April 2014, we recruited 829 mothers and their 830 newborns. Sixteen infants died during the follow-up period (8 per arm). No maternal deaths or serious adverse events related to the intervention were reported. Maternal infections were lower in the azithromycin group (3.6% vs 9.2%; relative risk [RR], 0.40; 95% confidence interval [CI], 0.22-0.71; P = .002), as was the prevalence of mastitis (1.4% vs 5.1%; RR, 0.29; 95% CI, 0.12-0.70; P = .005) and fever (1.9% vs 5.8%; RR, 0.33; 95% CI, 0.15-0.74; P = .006). Among newborns, the overall prevalence of infections was also lower in the azithromycin group (18.1% vs 23.8%; RR, 0.76; 95% CI, 0.58-0.99; P = .052) and there was a marked difference in prevalence of skin infections (3.1% vs 6.4%; RR, 0.49; 95% CI, 0.25-0.93; P = .034). CONCLUSIONS Azithromycin given to women in labor decreases infections in both women and newborns during the puerperal period. Larger studies designed to evaluate the effect of the intervention on severe morbidity and mortality are warranted.
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Affiliation(s)
| | - Bully Camara
- Medical Research Council Unit, Banjul, The Gambia
| | | | - Sean Goodier
- London School of Economics, London, United Kingdom
| | | | - Beate Kampmann
- Medical Research Council Unit, Banjul, The Gambia.,Imperial College, London, United Kingdom
| | - Samba Ceesay
- Ministry of Health and Social Welfare, Banjul, The Gambia; and
| | - Umberto D'Alessandro
- Medical Research Council Unit, Banjul, The Gambia.,London School of Hygiene and Tropical Medicine, London, United Kingdom.,Institute of Tropical Medicine, Antwerp, Belgium
| | - Anna Roca
- Medical Research Council Unit, Banjul, The Gambia; .,London School of Hygiene and Tropical Medicine, London, United Kingdom
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Benitez J, Falque L, Gheerbrant H, Sébastien Q, Camara B. Tolérance de la colistine en poudre sèche via un inhalateur portable : expérience du CRCM de Grenoble. Rev Mal Respir 2017. [DOI: 10.1016/j.rmr.2016.10.622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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27
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Herengt F, Pernot J, Camara B, Pison C, Hess D, Aguilaniu B. Le tabagisme actif des patients BPCO légers (VEMS>70 %) accentue-t-il les symptômes, la fréquence des exacerbations et l’engagement dans les activités physiques quotidiennes ? Rev Mal Respir 2017. [DOI: 10.1016/j.rmr.2016.10.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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28
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Dumollard C, Bailly S, Perriot S, Brenier-Pinchart M, Saint-Raymond C, Camara B, Gangneux J, Persat F, Valot S, Grenouillet F, Pelloux H, Pinel C, Cornet M. Évaluation prospective d’un nouveau kit ELISA pour la détection des IgG anti- Aspergillus dans le diagnostic des aspergilloses pulmonaires chroniques et allergiques. J Mycol Med 2016. [DOI: 10.1016/j.mycmed.2016.04.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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29
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Abstract
An outbreak of Shigella sonnei that occurred in the ultra-Orthodox Jewish community (UOJC) was the subject of an investigation and response by the Montréal Regional Public Health Department (DRSP), who collaborated with several health and community partners. A total of 27 confirmed cases were reported in this outbreak, which lasted from February to June 2015. The epidemic curve was compatible with a point source with secondary person-to-person transmission. In 11 of the 27 cases, pulsed-field gel electrophoresis (PFGE) analysis of strains found a single PFGE pattern newly identified in Quebec. Almost all strains tested showed resistance to ampicillin and trimethoprim-sulfamethoxazole (TMP/SMX). All the cases resided in Montréal Centre-West. Most of the cases were under 5 years old and attended a daycare centre, an environment recognized to be conducive to the transmission of enteric diseases. DRSP sent timely information to families, daycare and school stakeholders, community partners and synagogues in the UOJC, which helped reduce the transmission of shigellosis in the community.
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Affiliation(s)
- PA Pilon
- Infectious Disease and Prevention Control, Montréal Regional Public Health Department, Montréal, QC
- School of Public Health, Université de Montréal, Montréal, QC
| | - B Camara
- Infectious Disease and Prevention Control, Montréal Regional Public Health Department, Montréal, QC
| | - S Bekal
- Laboratoire de santé publique du Québec, Sainte-Anne-de-Bellevue, QC
- Department of Microbiology and Immunology, Université de Montréal, Montréal, QC
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30
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Abass Cisse F, Soumah E, Camara B, Lamine Toure M, Djigué Barry S, Cisse A. Délai de consultation après AVC et les facteurs associés au CHU Ignace Deen de Conakry. Rev Neurol (Paris) 2016. [DOI: 10.1016/j.neurol.2016.01.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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31
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Roca A, Oluwalana C, Bojang A, Camara B, Kampmann B, Bailey R, Demba A, Bottomley C, D'Alessandro U. Oral azithromycin given during labour decreases bacterial carriage in the mothers and their offspring: a double-blind randomized trial. Clin Microbiol Infect 2016; 22:565.e1-9. [PMID: 27026482 PMCID: PMC4936760 DOI: 10.1016/j.cmi.2016.03.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/22/2016] [Accepted: 03/13/2016] [Indexed: 11/30/2022]
Abstract
Bacterial sepsis remains a leading cause of death among neonates with Staphylococcus aureus, group B streptococcus (GBS) and Streptococcus pneumoniae identified as the most common causative pathogens in Africa. Asymptomatic bacterial colonization is an intermediate step towards sepsis. We conducted a phase III, double-blind, placebo-controlled randomized trial to determine the impact of giving one oral dose of azithromycin to Gambian women in labour on the nasopharyngeal carriage of S. aureus, GBS or S. pneumoniae in the newborn at day 6 postpartum. Study participants were recruited in a health facility in western Gambia. They were followed for 8 weeks and samples were collected during the first 4 weeks. Between April 2013 and April 2014 we recruited 829 women who delivered 843 babies, including 13 stillbirths. Sixteen babies died during the follow-up period. No maternal deaths were observed. No serious adverse events related to the intervention were reported. According to the intent-to-treat analysis, prevalence of nasopharyngeal carriage of the bacteria of interest in the newborns at day 6 was lower in the intervention arm (28.3% versus 65.1% prevalence ratio 0.43; 95% CI 0.36–0.52, p <0.001). At the same time-point, prevalence of any bacteria in the mother was also lower in the azithromycin group (nasopharynx, 9.3% versus 40.0%, p <0.001; breast milk, 7.9% versus 21.6%, p <0.001; and the vaginal tract, 13.2% versus 24.2%, p <0.001). Differences between arms lasted for at least 4 weeks. Oral azithromycin given to women in labour decreased the carriage of bacteria of interest in mothers and newborns and may lower the risk of neonatal sepsis. Trial registrationClinicalTrials.gov Identifier NCT01800942.
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Affiliation(s)
- A Roca
- Medical Research Council Unit The Gambia; London School of Hygiene and Tropical Medicine, London, UK.
| | | | - A Bojang
- Medical Research Council Unit The Gambia
| | - B Camara
- Medical Research Council Unit The Gambia
| | - B Kampmann
- Medical Research Council Unit The Gambia
| | - R Bailey
- London School of Hygiene and Tropical Medicine, London, UK
| | - A Demba
- Ministry of Health and Social Welfare, Gambia
| | - C Bottomley
- London School of Hygiene and Tropical Medicine, London, UK
| | - U D'Alessandro
- Medical Research Council Unit The Gambia; London School of Hygiene and Tropical Medicine, London, UK; Institute of Tropical Medicine, Antwerp, Belgium
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32
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Keïta M, Diallo BM, Samaké BM, Fomba S, Dicko H, Goïta D, Camara B, Sima M, Diallo D, Doumbia D, Coulibaly Y. [Epidemiology and maternal prognosis of eclampsia in the intensive care unit at the University Hospital of Point G, Bamako]. Mali Med 2016; 31:1-9. [PMID: 30079675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE This research aimed to analyze the epidemio- clinical characteristic and the prognosis of patients with eclampsia admitted to the intensive care unit at the University Hospital of Point G. MATERIALS AND METHODS The clinical records of all patients admitted to intensive care for eclampsia from September 2009 to February 2011 were retrospectively collected. We analyzed the following parameters: age, parity, gravidity, the admission deadline, the beginning of eclampsia compared to the term of pregnancy, the number of seizure, mode of delivery, score of Glasgow, blood pressure, proteinuria, complications and evolution. RESULTS Among 702 admissions, 158 patients, with a mean age of 20 ± 4 were hospitalized for eclampsia (22.5%). We recorded 106 cases of first pregnancies (67.1%) and 104 primiparous (65.8%). The admission period after the first seizure was over 6 hours for 90 patients (57%). The first seizure had occurred in ante-partum period for 69 patients, in per-partum period for 4 patients and in postpartum period for 85 patients. UNLABELLED Ninety-three patients (59%) had consciousness disorders at admission, 12 patients received oxygen treatment .Vaginal delivery was the mode of delivery for 93 patients and cesarean section for 65 patients.Eclampsia was associated with renal failure in 25 patients, HELLP syndrome for 15 patients, the stroke for 5 patients, acute pulmonary edema for 3 patients, the coagulation disorders for one patient; and the sepsis for 6 patients. Maternal and perinatal lethality was 9.5% and 10.8% respectively. CONCLUSION Eclampsia is a frequent medical and obstetric emergency in intensive care unit of the University Hospital of Point G and affects young patients during their first pregnancy and delivery. Maternal and perinatal lethality remains high, due to the delay in the cases management and the associated factors of gravity. Strong actions are needed to raise awareness for early medical visit and to prepare medical teams for better cases management.
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Affiliation(s)
- M Keïta
- Service d'Anesthésie réanimation et des Urgences: CHU du Point G
| | - B M Diallo
- Service d'Anesthésie réanimation et des Urgences: CHU du Point G
| | - B M Samaké
- Service d'Anesthésie réanimation et des Urgences: CHU Gabriel TOURE
| | - S Fomba
- Programme National de Lutte contre le Paludisme
| | - H Dicko
- Service d'Anesthésie réanimation et des Urgences: CHU du Point G
| | - D Goïta
- Service d'Anesthésie réanimation et des Urgences: CHU du Point G
| | - B Camara
- Service d'Anesthésie réanimation et des Urgences: CHU du Point G
| | - M Sima
- Service de Gynécologie - obstétrique
| | - D Diallo
- Service d'Anesthésie réanimation et des Urgences: CHU du Point G
| | - D Doumbia
- Service d'Anesthésie réanimation et des Urgences: CHU du Point G
| | - Y Coulibaly
- Service d'Anesthésie réanimation et des Urgences: CHU du Point G
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33
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Roca A, Oluwalana C, Camara B, Bojang A, Burr S, Davis TME, Bailey R, Kampmann B, Mueller J, Bottomley C, D'Alessandro U. Prevention of bacterial infections in the newborn by pre-delivery administration of azithromycin: Study protocol of a randomized efficacy trial. BMC Pregnancy Childbirth 2015; 15:302. [PMID: 26585192 PMCID: PMC4653934 DOI: 10.1186/s12884-015-0737-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 11/10/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Neonatal deaths, estimated at approximately 4 million annually, now account for almost 40% of global mortality in children aged under-five. Bacterial sepsis is a leading cause of neonatal mortality. Assuming the mother is the main source for bacterial transmission to newborns, the primary objective of the trial is to determine the impact of one oral dose of azithromycin, given to women in labour, on the newborn's bacterial carriage in the nasopharynx. Secondary objectives include the impact of the intervention on bacterial colonization in the baby and the mother during the first month of life. METHODS/DESIGN This is a Phase III, double -blind, placebo controlled randomized clinical trial in which 830 women in labour were randomized to either a single dose of 2 g oral azithromycin or placebo (ratio 1:1). The trial included pregnant women in labour aged 18 to 45 years attending study health centres in the Western Gambia. A post-natal check of the mother and baby was conducted at the health centre by study clinicians before discharge and 8-10 days after delivery. Home follow up visits were conducted daily during the first week and then weekly until week 8 after delivery. Vaginal swabs and breast milk samples were collected from the mothers, and the pathogens Streptococcus pneumoniae, Group B Streptococcus (GBS) and Staphylococcus aureus were isolated from the study samples. For bacterial isolates, susceptibility pattern to azithromycin was determined using disk diffusion and E-test. Eye swabs were collected from newborns with eye discharge during the follow up period, and Chlamydial infection was assessed using molecular methods. DISCUSSION This is a proof-of-concept study to assess the impact of antibiotic preventive treatment of women during labour on bacterial infections in the newborn. If the trial confirms this hypothesis, the next step will be to assess the impact of this intervention on neonatal sepsis. The proposed intervention should be easily implementable in developing countries. TRIAL REGISTRATION ClinicalTrials.gov Identifier--NCT01800942--First received: February 26, 2013.
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Affiliation(s)
- Anna Roca
- Medical Research Council Unit, Fajara, The Gambia.
- London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | | | - Bully Camara
- Medical Research Council Unit, Fajara, The Gambia.
| | | | - Sarah Burr
- London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Timothy M E Davis
- School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia.
| | - Robin Bailey
- London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | | | | | | | - Umberto D'Alessandro
- Medical Research Council Unit, Fajara, The Gambia.
- London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Bourdy S, Rabilloud M, Touzet S, Roche S, Drai J, Martin C, Nove-Josserand R, Reix P, Pin I, Camara B, Reynaud Q, Laville M, Durieu I. 178 Glucose tolerance in cystic fibrosis patients over a 3-year period (DIAMUCO study). J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30355-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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35
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Cottin V, Montani D, Reynaud-Gaubert M, Kiakouama L, Nunes H, Dromer C, Wallaert B, Gomez C, Quetant S, Launay D, Gomez E, Bertoletti L, Traclet J, Camara B, Israel-Biet D, Sanchez O, Polazzi S, Zeghmar S, Schott A, Humbert M, Cordier J. Traitement de l’hypertension pulmonaire sévère associée à une pneumopathie interstitielle diffuse : résultats de l’étude prospective HYPID chez 72 patients. Rev Mal Respir 2014. [DOI: 10.1016/j.rmr.2013.10.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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36
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Aguilaniu B, Kelkel E, Hess D, Herengt F, Ben Saidane H, Guillaud-Segard B, Gonzalez-Bermejo J, Bertrand D, Camara B, Pernot J, Pison C, Pépin JL. COLIBRI-BPCO : observatoire longitudinal basé sur une consultation-web pour les pneumologues hospitaliers (H) et libéraux (L). Rev Mal Respir 2014. [DOI: 10.1016/j.rmr.2013.10.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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37
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Bosc C, Clement M, Deroux A, Mammar A, Pison C, Camara B. [Severe pneumonia due to cytomegalovirus in chronic obstructive pulmonary disease]. Rev Mal Respir 2013; 31:435-8. [PMID: 24878160 DOI: 10.1016/j.rmr.2013.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 08/10/2013] [Indexed: 11/30/2022]
Abstract
UNLABELLED Severe pneumonia due to cytomegalovirus in chronic obstructive pulmonary disease. INTRODUCTION We describe two cases of immunocompetent patients with chronic obstructive pulmonary disease (COPD) who developed severe cytomegalovirus (CMV) pneumonia. The clinical and radiological context and CMV replication in broncho-alveolar lavage suggested a diagnosis of CMV pneumonia. CASE HISTORIES We report two cases in patients with moderate chronic obstructive pulmonary disease not treated with long-term steroid therapy who developed bilateral pneumonia with hypoxaemia. The only pathogen identified was CMV with replication of the virus in the broncho-alveolar lavage. Investigation failed to detect any associated immune deficiency. CONCLUSION Severe cytomegalovirus pneumonia could be encouraged by the existence of chronic obstructive pulmonary disease due to local inflammatory changes.
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Affiliation(s)
- C Bosc
- Clinique universitaire de pneumologie, hôpital Albert-Michallon, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France.
| | - M Clement
- Service de pneumologie et d'oncologie thoracique, centre hospitalier de Chambéry, 73000 Chambéry, France
| | - A Deroux
- Clinique universitaire de pneumologie, hôpital Albert-Michallon, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France; Service de pneumologie et d'oncologie thoracique, centre hospitalier de Chambéry, 73000 Chambéry, France
| | - A Mammar
- Clinique universitaire de pneumologie, hôpital Albert-Michallon, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France
| | - C Pison
- Clinique universitaire de pneumologie, hôpital Albert-Michallon, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France
| | - B Camara
- Clinique universitaire de pneumologie, hôpital Albert-Michallon, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France
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38
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Keita M, Samaké B, Goïta D, Traore D, Dicko H, Houndjé P, Camara B, Diallo BM, Diallo D, Koïta A, Doumbia D, Coulibaly Y. [Loco-regional anesthesia practices in 1261 cases]. Mali Med 2013; 28:25-31. [PMID: 30049151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
GOAL The aim of this study was to take stock of the practice of the loco-regional anesthesia (LRA) at the University Hospital Center of Point G from January 2004 to December 2008. MATERIALS AND METHOD This is a retrospective study, assessing the practice of LRA. The demographic data, the surgery, the technical characteristics of the procedure made, the type of local anesthetic used, adverse events were evaluated. RESULTS The LRA involved 1261 patients - 8.30% of the total number of surgical procedures occurring during the studied period. The American Society of Anesthesiology (ASA) classification was used for the evaluation of patients in scheduled surgery. The patients belonged to class 1 (50.40%) and Class 2 (49.60%). The main surgical procedures were: 26.20% surgical prostatic adenomectomy, 23.80% of caesarean section, and the fistulogram test for 19.04%. The LRA techniques performed were: spinal anesthesia, 87.60%, epidural anesthesia, 12%. Three hundred and three adverse events (24%) have been reported, three (1%) of them have resulted in the death of the patient. The incidence of arterial hypotension was 94.40%, and 4.6% for bradycardia. The three heart attacks were fatal (0.024 ‰). Patients operated under spinal anesthesia and patients aged 60 years and older had more adverse events with 20% and 10.38% for p <0.05 respectively. Sixty eight failures (5.4%) were observed. CONCLUSION The practice of LRA at the University Hospital of Point G is characterized by adverse events and a low number of deaths. Patients operated under spinal anesthesia and patients aged 60 years and older are at greatest risk of adverse events.
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Affiliation(s)
- M Keita
- Service d'Anesthésie-réanimation et des Urgences: CHU du Point G
| | - B Samaké
- Service d'Anesthésie-réanimation: CHU Gabriel TOURE
| | - D Goïta
- Service d'Anesthésie-réanimation et des Urgences: CHU du Point G
| | | | - H Dicko
- Service d'Anesthésie-réanimation et des Urgences: CHU du Point G
| | - P Houndjé
- Service d'Anesthésie-réanimation et des Urgences: CHU du Point G
| | - B Camara
- Service d'Anesthésie-réanimation et des Urgences: CHU du Point G
| | - B M Diallo
- Service d'Anesthésie-réanimation et des Urgences: CHU du Point G
| | - D Diallo
- Service d'Anesthésie-réanimation et des Urgences: CHU du Point G
| | - A Koïta
- Service de Chirurgie « A »: CHU du Point G
| | - D Doumbia
- Service d'Anesthésie-réanimation et des Urgences: CHU du Point G
| | - Y Coulibaly
- Service d'Anesthésie-réanimation et des Urgences: CHU du Point G
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Kaloga M, Sarah K, Sangare A, Camara B, Ecra E, Kouassi A, Kouame K, Gbery I, Yao Y, Djeha D, Kanga J. Efficacité et tolérance du céfixime dans le traitement ambulatoire de l’érysipèle de jambe. Ann Dermatol Venereol 2011. [DOI: 10.1016/j.annder.2011.10.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Faye P, Diagne-Gueye N, Diom E, Ndiaye M, Fall A, Gueye M, Camara B, Ba M. Un cas d’arthrite juvénile idiopathique compliquée d’une ankylose cricoarythénoidienne. Arch Pediatr 2011; 18:1230-1. [DOI: 10.1016/j.arcped.2011.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 07/06/2011] [Accepted: 08/22/2011] [Indexed: 10/17/2022]
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Diagne-Guèye N, Diack-Mbaye A, Dramé M, Diagne I, Fall A, Camara B, Faye P, Sylla A, Diouf S, Sy-Signaté H, Sarr M. Connaissances et pratiques de mères sénégalaises vivant en milieu rural ou suburbain sur l’alimentation de leurs enfants, de la naissance à l’âge de six mois. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.jpp.2010.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ndour CT, Manga NM, Dia M, Camara B, Cissé F. [Neisseria meningitidis serogroup W135 meningitis in Senegal from 2000 to 2009]. Med Mal Infect 2011; 41:495-7. [PMID: 21458934 DOI: 10.1016/j.medmal.2011.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 11/18/2010] [Accepted: 02/14/2011] [Indexed: 12/01/2022]
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Camara B, Faye PM, Fall AL, Diagne GNR, Sbaa HC, Ba M, Sow HD. [Prescription errors in a pediatric hospital department in Dakar, Senegal]. Med Trop (Mars) 2011; 71:33-36. [PMID: 21585087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Prescription is the main source of medication error in daily medical practice. The purpose of this study was to determine the distribution and cost of drugs used and causes of prescription errors in one department of the Albert Royer National Children's Hospital Center in Dakar, Senegal. Study was focused on patients admitted from December 1 to March 3, 2009. Based on 792 expected hospitalizations, 1 out of 2 patients was randomly selected to obtain a cohort of 400 patients for whom a total of 1267 prescriptions were written by pediatricians and interns on duty. Prescriptions were evaluated by pediatric professors to identify errors. The types of errors taken into account in this study involved indication, dosage schedule, and treatment duration. A total of 216 (17.0%) errors were identified including 121 cases (9.5%) involving indication mainly for antibiotics (30.5%) and antimalarial drugs (28.9%). Dosage schedule errors were observed in 58 cases (4.5%) involving antibiotics (24.1%) and antifungals (25.8%). These findings confirm the need for an intensive information campaign to prevent medication misuse in countries such as Senegal. Campaigns should be based on training of relevant therapeutic staff to optimize health care and improve availability for everyone.
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Affiliation(s)
- B Camara
- Service hospitalier Universitaire de Fann, Dakar, Sénégal.
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Camara B, Martin-Blondel G, Desloques L, Ould Mohamed A, Rouquette I, Hermant C, Rostaing L, Kamar N. [Pneumocystis jiroveci infection associated with organizing pneumonia in a kidney transplant patient]. Rev Pneumol Clin 2010; 66:347-350. [PMID: 21167442 DOI: 10.1016/j.pneumo.2009.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Revised: 09/03/2009] [Accepted: 09/04/2009] [Indexed: 05/30/2023]
Abstract
The authors report the association of organizing pneumonia (OP) and a Pneumocystis jiroveci infection in a woman who benefited from a kidney transplant 13 years before and was under corticoids, cyclosporine and mycophenolate mofetil. The diagnosis was based on progressive dyspnoea with fever with an alteration in the general state associated with diffuse micronodular pneumopathy suggesting bronchiolitis. The conformation was obtained by the analysis of the alveolar bronchial washings and the histological examination of the distal biopsies revealing endo-alveolar vegetant fibromas. Transbronchial biopsies may be used for the diagnosis and thereby, avoid an invasive surgical pulmonary biopsy. The aetiology of OP may be related to the immunosuppressant treatment or infection by Pneumocystis jiroveci. The evolution in this case was favourable with trimethoprime and sulfamethoxazole associated with a transient increase in the corticoid treatment. This association is rarely described in patients undergoing solid organ transplants.
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Affiliation(s)
- B Camara
- Service de pneumologie, clinique des voies respiratoires, CHU Rangueil-Larrey, 24, chemin-de-Pouvourville, 31059 Toulouse, France.
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Camara B, Diagne Gueye NR, Faye PM, Fall L, Niang D, Ba MM, Sow HD. [Frequency of signs of severity in childhood malaria in Dakar]. Arch Pediatr 2010; 17:1107-8. [PMID: 20635463 DOI: 10.1016/j.arcped.2010.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Diagne I, Diagne-Guèye N, Fall A, Déme I, Sylla A, Coly J, Camara B, Sow H. Aspects épidémiologiques et évolutifs de la splénomégalie chez les enfants et adolescents porteurs de syndromes drépanocytaires majeurs au Sénégal. Arch Pediatr 2010; 17:1017-25. [DOI: 10.1016/j.arcped.2010.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 02/20/2010] [Accepted: 04/15/2010] [Indexed: 10/19/2022]
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Dogbo O, Laferriére A, D'Harlingue A, Camara B. Carotenoid biosynthesis: Isolation and characterization of a bifunctional enzyme catalyzing the synthesis of phytoene. Proc Natl Acad Sci U S A 2010; 85:7054-8. [PMID: 16578835 PMCID: PMC282122 DOI: 10.1073/pnas.85.19.7054] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Phytoene is the first C(40) intermediate in the biogenesis of carotenoids. It is formed by two enzyme activities, catalyzing (i) the coupling of two molecules of geranylgeranyl diphosphate to yield prephytoene diphosphate and (ii) the conversion of prephytoene diphosphate into phytoene. We show now, with Capsicum chromoplast stroma, that the overall activity resides in a single protein, which has been purified to homogeneity by affinity chromatography. The monomeric structure and the molecular size (M(r) 47,500) were demonstrated by NaDodSO(4)/PAGE and glycerol gradient centrifugation. Further characterization was achieved by using specific antibodies which allowed immunofractionation and immunoprecipitation of the enzymatic activity from chromoplast stroma. The two reactions followed conventional Michaelis-Menten kinetics, with K(m) values of 0.30 muM and 0.27 muM, respectively, for geranylgeranyl diphosphate and prephytoene diphosphate. The activity of the enzyme depends strictly upon the presence of Mn(2+). This selectivity may be one of the factors regulating the competition with potentially rival enzymes converting geranylgeranyl diphosphate into other plastid terpenoids. The two enzymatic reactions were inhibited by inorganic pyrophosphate and by the arginine-specific reagent hydroxyphenylglyoxal. In no instance were the two reactions kinetically uncoupled. These properties strongly suggest that the same enzyme catalyzes the two consecutive reactions, and we propose to name it phytoene synthase.
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Affiliation(s)
- O Dogbo
- Laboratoire de Biochimie du Développement Végétal, Associé au Centre National de la Recherche Scientifique, Université Pierre et Marie Curie, 75252 Paris Cedex 05, France
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Camara B, Absa L, Faye P, Ndior Cabrale M, Fall M, Toure A, Ndiaye M, Sene Mbaye M, Diouf A. P165 - Récupération du plomb de batteries et saturnisme à Dakar, Sénégal. Arch Pediatr 2010. [DOI: 10.1016/s0929-693x(10)70565-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hervier B, Wallaert B, Hachulla E, Adoue D, Lauque D, Audrain M, Camara B, Fournie B, Couret B, Hatron PY, Dubucquoi S, Hamidou M. Clinical manifestations of anti-synthetase syndrome positive for anti-alanyl-tRNA synthetase (anti-PL12) antibodies: a retrospective study of 17 cases. Rheumatology (Oxford) 2010; 49:972-6. [DOI: 10.1093/rheumatology/kep455] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Martin-Blondel G, Camara B, Selves J, Robic MA, Thebault S, Bonnet D, Alric L. Étiologies et évolution des hépatites granulomateuses : étude rétrospective de 21 cas consécutifs. Rev Med Interne 2010; 31:97-106. [DOI: 10.1016/j.revmed.2009.10.430] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 09/19/2009] [Accepted: 10/12/2009] [Indexed: 11/24/2022]
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