White thrombus as a possible feature of atypical stroke etiology: Coxiella burnetii as the primary cause of acute ischemic stroke.

Acute ischemic stroke (AIS) is the most common neurologic complication of infective endocarditis. We describe a singular case report of a 62- year-old male with AIS related to the occlusion of the left middle cerebral artery. Thrombus-aspiration allowed retrieving a 6 millimeters white thrombus. The real-time polymerase chain reaction performed on the thrombus detected Coxiella Burnetii allowed the diagnosis of infective endocarditis (IE) and the identification of the specific pathogen. Coxiella Burnetii is an endemic, small, intracellular, gram-negative coccobacillus and it is a rare cause of IE. The management of AIS caused by IE remains controversial, although in the cases of major occlusion mechanical thrombectomy is associated with better clinical outcomes. IE patients could not present symptoms and signs related to the infection, therefore we underline the importance of the microbiological analysis of the retrieved thrombi especially when atypical etiology is suspected.

Identifying SARS-COV-2 infected patients through canine olfactive detection on axillary sweat samples; study of observed sensitivities and specificities within a group of trained dogs.

There is an increasing need for rapid, reliable, non-invasive, and inexpensive mass testing methods as the global COVID-19 pandemic continues. Detection dogs could be a possible solution to identify individuals infected with SARS-CoV-2. Previous studies have shown that dogs can detect SARS-CoV-2 on sweat samples. This study aims to establish the dogs' sensitivity (true positive rate) which measures the proportion of people with COVID-19 that are correctly identified, and specificity (true negative rate) which measures the proportion of people without COVID-19 that are correctly identified. Seven search and rescue dogs were tested using a total of 218 axillary sweat samples (62 positive and 156 negative) in olfaction cones following a randomised and double-blind protocol. Sensitivity ranged from 87% to 94%, and specificity ranged from 78% to 92%, with four dogs over 90%. These results were used to calculate the positive predictive value and negative predictive value for each dog for different infection probabilities (how likely it is for an individual to be SARS-CoV-2 positive), ranging from 10-50%. These results were compared with a reference diagnostic tool which has 95% specificity and sensitivity. Negative predictive values for six dogs ranged from ≥98% at 10% infection probability to ≥88% at 50% infection probability compared with the reference tool which ranged from 99% to 95%. Positive predictive values ranged from ≥40% at 10% infection probability to ≥80% at 50% infection probability compared with the reference tool which ranged from 68% to 95%. This study confirms previous results, suggesting that dogs could play an important role in mass-testing situations. Future challenges include optimal training methods and standardisation for large numbers of detection dogs and infrastructure supporting their deployment.

Can the detection dog alert on COVID-19 positive persons by sniffing axillary sweat samples? A proof-of-concept study.

The aim of this proof-of-concept study was to evaluate if trained dogs could discriminate between sweat samples from symptomatic COVID-19 positive individuals (SARS-CoV-2 PCR positive) and those from asymptomatic COVID-19 negative individuals. The study was conducted at 2 sites (Paris, France, and Beirut, Lebanon), followed the same training and testing protocols, and involved six detection dogs (three explosive detection dogs, one search and rescue dog, and two colon cancer detection dogs). A total of 177 individuals were recruited for the study (95 symptomatic COVID-19 positive and 82 asymptomatic COVID-19 negative individuals) from five hospitals, and one underarm sweat sample per individual was collected. The dog training sessions lasted between one and three weeks. Once trained, the dog had to mark the COVID-19 positive sample randomly placed behind one of three or four olfactory cones (the other cones contained at least one COVID-19 negative sample and between zero and two mocks). During the testing session, a COVID-19 positive sample could be used up to a maximum of three times for one dog. The dog and its handler were both blinded to the COVID-positive sample location. The success rate per dog (i.e., the number of correct indications divided by the number of trials) ranged from 76% to 100%. The lower bound of the 95% confidence interval of the estimated success rate was most of the time higher than the success rate obtained by chance after removing the number of mocks from calculations. These results provide some evidence that detection dogs may be able to discriminate between sweat samples from symptomatic COVID-19 individuals and those from asymptomatic COVID-19 negative individuals. However, due to the limitations of this proof-of-concept study (including using some COVID-19 samples more than once and potential confounding biases), these results must be confirmed in validation studies.

[Nocardia farcinica brain abscess associated with a pulmonary embolism in an immunocompetent patient]. / Abcès cérébral à Nocardia farcinica associé à une embolie pulmonaire chez une patiente immunocompétente.

INTRODUCTION: Nocardiosis is a rare, generally systemic infection that occurs in immunocompromised patients. We report a case of Nocardia farcinica primary brain abscess in an immunocompetent patient, unusually associated with a pulmonary embolism. OBSERVATION: A 62 year-old woman without medical past was hospitalised because of a Bravais-Jacksonian type of seizure. The clinical and radiological profile was unspecific. The diagnosis was made on identification of the microorganism. The patient improved after craniotomy with excision of the abscess and appropriate antibiotic therapy for four months. DISCUSSION: The N. farcinica species is distinct from others by its high degree of antibiotic resistance its virulence. We insist on the need to identify not only the microorganism but also the species concerned because this may influence the treatment strategy.

[Immunodeficiency and tuberculosis]. / Dépression immunitaire et tuberculose.

A number of medical conditions may alter immune responsiveness, and predispose to tuberculosis. Management of immunodeficiency-related tuberculosis treatment is complex, and the clinical and public health consequences associated with treatment failure are serious. Human immunodeficiency virus infection is a major cause of immunodeficiency increasing tuberculosis susceptibility. Whenever possible, the care for immunodeficiency-related tuberculosis should be provided by experts in the management of both diseases.

[Aging and HIV infection: 4 years follow-up of 149 HIV infected patients older than 60 years in West Paris agglomeration (COREVIH Île-de-France Ouest)]. / Vieillissement et infection par le VIH: suivi de 149 patients âgés de plus de 60ans infectés par le VIH (COREVIH Île-de-France Ouest).

UNLABELLED: In France, patients over 50 years represent more than 23.6% of all registered cases in the French Hospital Database for HIV (FHDH), and 18% of newly HIV-diagnosed patients. OBJECTIVE: To describe the long-term evolution after 4 years of a cohort of HIV infected patients older than 60 years recruited in COREVIH Île-de-France Ouest. RESULTS: One hundred and forty-nine participants, 115 men (77%) and 34 women (23%), were included in the cohort analysis in 2004, and baseline characteristics were: median age 65.4 years (60.3-86.3), CDC stage C: 36%, HBV and HCV co-infections: four (2.7%) and eight (5.4%) patients, median time from first HIV infection diagnosis: 8.5 years (0.25-19.5), ongoing HAART regimen: 88%, median duration of ARV treatment: 7.5 years (0.2-15.5), baseline CD4 cells count: 372/mm(3) (18-1860), HIV viral load less than 200 c/ml: 104 (70%). After a 4-year follow-up, 111 patients were alive, all but one treated with HAART, 17/149 (11.5%) were lost for follow-up, and 21/149 were deceased (14%). Causes of death were acute cardiovascular disease (4/21), neoplasia (11/21), neurological disease 1/21, end stage liver disease 3/21, unknown 2/21. The prevalence of co-morbidities after 4 years of follow-up were: arterial hypertension 40/111 (36%), hypercholesterolemia 48/111 (43%), diabetes 23/111 (21%), kidney disease with renal insufficiency (creatinine clairance<60 ml/min): 36/111 (32%). At the end of follow-up, median CD4 cells count was 494/mm(3), and viral load was undetectable less than 200 c/ml in 107/111 patients (96%). No new opportunistic infection occurred during the 4-year follow-up, but 24 patients had a new diagnosis of neoplasia (incidence 40/1000 person-year). Cancer was the cause of death in 11/24. CONCLUSION: Clinical and immunological improvement was continuous under HAART in these aged HIV infected patients, but co-morbidities are frequently observed in this population, with high incidence of cardiovascular disease and neoplasia, and related mortality. A multidisciplinary approach, with preventive consultations, oncology and cardiovascular screening, as done in geriatrics, is warranted in the aging HIV population.

Molecular identification of Tritrichomonas foetus-like organisms as coinfecting agents of human Pneumocystis pneumonia.

Trichomonads closely related to the bovid parasite Tritrichomonas foetus were identified in the bronchoalveolar lavage sample from a patient with AIDS in association with Pneumocystis pneumonia. This human case of T. foetus-like infection emphasizes the zoonotic potential of trichomonads, although the existence of a human-host-adapted T. foetus strain cannot be excluded.

[Treatment of tuberculosis infection]. / Traitement de la tuberculose sensible et résistante aux antituberculeux.

Tuberculosis is a chronic bacterial infection caused by Mycobacterium tuberculosis. It continues as an important cause of morbidity and mortality worldwide, especially in impoverished countries and where human immunodeficiency virus infection is endemic. The modern treatment of tuberculosis is based on the administration of effective drugs. Regimens do not differ for pulmonary and extra-pulmonary tuberculosis. In order to prevent the emergence of drug-resistant organisms, which is present initially in very small numbers, at least two effective drugs are always required. Short-course therapy has been developed to mitigate the consequences of patient default. It is best considered as consisting of two phases. An initial 2-month intensive phase of daily therapy should include isoniazid, rifampin, ethambutol and pyrazinamide. A consolidation phase of daily therapy with isoniazid and rifampin should be continued for an additional 4 months, preferably more for special clinical circumstances. This standardized drug strategy is successful only if the resources conserved by shortening treatment are used to maintain patient compliance. Completely supervised regimens have been also developed with success. Defaults lead not only to treatment failure but also the emergence and transmission of drug-resistant organisms. Treatment of confirmed or suspected drug-resistant tuberculosis is difficult and should only be made on experts consultation. More difficult to use and/or less effective than first line drugs, second line drugs could be chosen and associated. However drug toxicities should be monitored, with greatest concern to hepatitis. Follow-up of patients must be organised until 2 years after the completion of therapy to detect relapses. Treatment includes prophylactic measures which are a major modality for decreasing the spread of infection.