Bacteremia and adrenal gland abscess due to Nocardia cyriacigeorgica: a case report and review.

BACKGROUND: Nocardia cyriacigeorgica is one of the most common Nocardia species found in human infections, recently reclassified. Even though Nocardia may affect all organs by hematogenous dissemination, bacteremia are uncommon. Among all possible dissemination sites, the involvement of the adrenal glands is particularly rare. CASE PRESENTATION: We report here a rare case of Nocardia disseminated infection with notably bacteremia and adrenal gland abscess, in a 77-years-old immunocompetent man. Adrenal gland abscess diagnosis was made by imaging (computerized tomography, magnetic resonance and positron emission tomography scan). A complete regression of all lesions including the left adrenal gland was obtained after 6 months of antibiotics. A review of literature was also performed. CONCLUSION: Nocardia bacteremia is a rare event but blood cultures may help to improve detection of Nocardia spp. in a non-invasive way. Adrenal abscess due to Nocardia spp. is very rare with only fourteen cases reported in the literature, but it is a true cause of adrenal masses. Our report suggests that clinician should be aware of this rare location and prioritize a non-invasive diagnosis strategy.

Low rate of oseltamivir prescription among adults and children with confirmed influenza illness in France during the 2018-19 influenza season.

BACKGROUND: Oseltamivir shows effectiveness in reducing influenza-related symptoms, morbidity and mortality. Its prescription remains suboptimal. OBJECTIVES: We aim to describe oseltamivir prescription in confirmed cases of influenza and to identify associated factors. METHODS: A prospective monocentric observational study was conducted between 1 December 2018 and 30 April 2019. All patients with a virologically confirmed influenza diagnosis were included. Factors associated with oseltamivir prescription were studied. RESULTS: Influenza was confirmed in 755 patients (483 children and 272 adults), of which 188 (25.1%) were hospitalized and 86 (11.4%) had signs of severity. Oseltamivir was prescribed for 452 patients (59.9%), more frequently in children than in adults [329/483 (68.1%) versus 123/272 (45.2%), P < 0.001]. Factors associated with oseltamivir prescription were evaluated in 729 patients (246 adults and 483 children). Patients with at least one risk factor for severe influenza received oseltamivir less frequently (50%, 137/274) than those without risk factors (70%, 315/452) (P < 0.001). Pregnant women received oseltamivir in 81% of cases (17/21). Severe influenza cases were treated with oseltamivir in only 45.3% (39/86). The median duration of symptoms was 24 h (IQR 12-48) in treated patients versus 72 h (IQR 48-120) in untreated patients (P < 0.01). CONCLUSIONS: Oseltamivir should be administered as early as possible, preferably within 24-48 h after illness onset, for the best benefits. It is, however, very important to promote the use of neuraminidase inhibitor ('NAI') treatment beyond 48 h in some specific patient populations.

Methodological Quality Assessment with the AGREE II Scale and a Comparison of European and American Guidelines for the Treatment of Lyme Borreliosis: A Systematic Review.

BACKGROUND: Most European and American countries recently updated their guidelines on Lyme borreliosis (LB). The aim of this study was to provide a comparative overview of existing guidelines on the treatment of LB in Europe and America and to assess the methodological quality of their elaboration. METHODS: A systematic search was carried out in MEDLINE, Google Scholar, and the national databases of scientific societies from 2014 to 2020. Quality was assessed by two independent reviewers using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. RESULTS: Twelve guidelines were included. The scores for the AGREE II domains (median ± IQR) were: overall assessment 100 ± 22, scope and purpose 85 ± 46, stakeholder involvement 88 ± 48, rigour of development 67 ± 35, clarity of presentation 81 ± 36, applicability 73 ± 52 and editorial independence 79% ± 54%. Cohen's weighted kappa showed a high agreement (K = 0.90, 95%CI 0.84-0.96). Guidelines were quite homogeneous regarding the recommended molecules (mostly doxycycline in the first intention and ceftriaxone in the second intention), their duration (10 to 28 days), and their dosage. The differences were due to the lack of well-conducted comparative trials. The International Lyme and Associated Diseases Society (ILADS) guidelines were the only ones to suggest longer antibiotics based on an expert consensus. CONCLUSION: European and American guidelines for the treatment of LB were quite homogeneous but based on moderate- to low-evidence studies. Well-conducted comparative trials are needed to assess the best molecules, the optimal duration and the most effective doses.

Evaluation of in vitro activity of copper gluconate against SARS-CoV-2 using confocal microscopy-based high content screening.

CONTEXT: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) that emerged late in 2019 is the etiologic agent of coronavirus disease 2019 (Covid-19). There is an urgent need to develop curative and preventive therapeutics to limit the current pandemic and to prevent the re-emergence of Covid-19. This study aimed to assess the in vitro activity of copper gluconate against SARS-CoV-2. METHODS: Vero E6 cells were cultured with or without copper gluconate 18-24 hours before infection. Cells were infected with a recombinant GFP expressing SARS-CoV-2. Cells were infected with a recombinant GFP expressing SARS-CoV-2. Infected cells were incubated in fresh medium containing varying concentration of copper gluconate (supplemented with bovine serum albumin or not) for an additional 48 -h period. The infection level was measured by the confocal microscopy-based high content screening method. The cell viability in presence of copper gluconate was assessed by XTT and propidium iodide assays. RESULTS: The viability of Vero E6 cells exposed to copper gluconate up to 200 µM was found to be similar to that of unexposed cells, but it dropped below 70 % with 400 µM of this agent after 72 h of continuous exposure. The infection rate was 23.8 %, 18.9 %, 20.6 %, 6.9 %, 5.3 % and 5.2 % in cells treated prior infection with 0, 2, 10, 25, 50 and 100 µM of copper gluconate respectively. As compared to untreated cells, the number of infected cells was reduced by 71 %, 77 %, and 78 % with 25, 50, and 100 µM of copper gluconate respectively (p < 0.05). In cells treated only post-infection, the rate of infection dropped by 73 % with 100 µM of copper gluconate (p < 0.05). However, the antiviral activity of copper gluconate was abolished by the addition of bovine serum albumin. CONCLUSION: Copper gluconate was found to mitigate SARS-CoV-2 infection in Vero E6 cells but this effect was abolished by albumin, which suggests that copper will not retain its activity in serum. Furthers studies are needed to investigate whether copper gluconate could be of benefit in mucosal administration such as mouthwash, nasal spray or aerosols.

Impact of a decision-aid tool on influenza vaccine coverage among HCW in two French hospitals: A cluster-randomized trial.

INTRODUCTION: Nosocomial outbreaks of seasonal influenza are frequent, and vaccination is largely recommended for healthcare workers (HCWs). Vaccine coverage in French HCWs does not exceed 20%. Decision-aids (DA) are potential useful interventions to increase vaccine coverage (VC). Our aim was to evaluate the impact of a DA on HCWs influenza vaccine coverage. MATERIAL AND METHODS: Prospective cluster-randomized trial conducted in 83 departments in two public hospitals (a teaching and a non-teaching hospital) during the 2018-2019 flu season. Distribution of the DA and of questionnaire about decisional conflict and knowledge in the departments randomized in the intervention group. RESULTS: A total number of 3 547 HCWs were concerned by the study (1 953 in the intervention group, 1 594 in the control group). Global VC was 35.6% during the 2018-2019 season, instead of 23.6% in the 2017-2018 season (p < 0.005). During the 2018-2019 season, VC was 31% (95% CI 28.7-33.3) in the control group and 38.7% (95% CI 36.5-40.9) in the intervention group (p < 0.005). Among the 158 HCWs exposed to the DA who answered the survey, 51.3% had no decisional conflict. HCWs without decisional conflict were more prone to get vaccinated before flu season. CONCLUSION: The use of the DA was associated with a 25% relative increase in VC among HCWs against seasonal influenza. This modest increase remained far from the WHO 75% target, but may have reduced the number of nosocomial. Multi-component interventions are needed to increase VC in HCWs.