Invasive bone and joint infections from the French Scedosporiosis/lomentosporiosis Observational Study (SOS) cohort: no mortality with long-term antifungal treatment and surgery.

Little is known about localized osteoarticular Scedosporiosis (LOS). Most data come from case reports and small case series. Here we present an ancillary study of the nationwide French Scedosporiosis Observational Study (SOS), describing 15 consecutive cases of LOS diagnosed between January 2005 and March 2017. Adult patients diagnosed with LOS defined by osteoarticular involvement without distant foci reported in SOS were included. Fifteen LOS were analyzed. Seven patients had underlying disease. Fourteen patients had prior trauma as potential inoculation. Clinical presentation was arthritis (n = 8), osteitis (n = 5), and thoracic wall infection (n = 2). The most common clinical manifestation was pain (n = 9), followed by localized swelling (n = 7), cutaneous fistulization (n = 7), and fever (n = 5). The species involved were Scedosporium apiospermum (n = 8), S. boydii (n = 3), S. dehoogii (n = 1), and Lomentospora prolificans (n = 3). The species distribution was unremarkable except for S. boydii, which was associated with healthcare-related inoculations. Management was based on medical and surgical treatment for 13 patients. Fourteen patients received antifungal treatment for a median duration of 7 months. No patients died during follow-up. LOS exclusively occurred in the context of inoculation or systemic predisposing factors. It has a non-specific clinical presentation and is associated with an overall good clinical outcome, provided there is a prolonged course of antifungal therapy and adequate surgical management.

Localized osteoarticular scedosporiosis mostly occurs following direct inoculation. Management was most often based on voriconazole therapy and concomitant surgery. Unlike other invasive scedosporiosis, no patient died during follow-up.

[Care, a place of affectivity and emotions]. / Le soin, lieu d'affectivité et d'émotions.

Joy, fear, disgust, anger, sadness, surprise, emotions are fleeting and natural affects that catch us off guard. Care, as a face-to-face encounter with others, in a sometimes difficult context of serious or chronic pathologies, can become a place of affectivity, all the more so as care crosses the barriers of bodily intimacy. What to do with one's emotions in care?

[Alcohol consumption by health students: Ifsi protected?] / Consommation d'alcool des étudiants en santé : Ifsi protégé ?

A study of health students at the Université de Bretagne Occidentale showed that nursing students smoked more than those in other fields. The present study of health students in the same city shows that, conversely, students in nursing training institutes (Ifsi) consumed less alcohol.

[A little background on the history of AIDS and HIV]. / Principaux rappels à propos de l'histoire du sida et du VIH.

As we have just commemorated the 40th anniversary of the discovery of AIDS, which was described in 1981 and declared a pandemic 20 years ago, in 2002, we are tracing the history of the disease in order to promote awareness of the imaginary nature of the disease. A useful approach to the care of the HIV-positive person.

[Covid-19, or the highlighting of a "gift of self-care"]. / La crise de la Covid-19, ou la mise en lumière d'un don de son "soi-soignant".

The pandemic has highlighted the self-sacrifice of caregivers, who are ready to give themselves for their patients. But what does it mean? The caregiver gives himself; but, by putting on a good face, he gives a distorted image of himself. This gift of a "non-self" is a gift of his "caregiver-self". Awareness of this aspect can help to better listen to oneself and provide some lines of thought for society.

[Continued breastfeeding upon return to work: a qualitative study at the Brest University Hospital]. / Poursuite de l'allaitement à la reprise du travail : étude qualitative au CHRU de Brest.

The objective of this qualitative study was to highlight the facilitating measures and difficulties encountered in continuing breastfeeding when returning to work at the Brest Regional University Hospital. The eleven mothers interviewed were able to take advantage of the solidarity in the care services to carry out their project, but simple institutional measures are still possible to facilitate this conciliation.

[Microbial ecology, the understanding of the invisible living]. / L'écologie microbienne, pour une appréhension du vivant invisible.

Microorganisms are invisible to the naked eye. Hospital hygiene practices are therefore based on the representation that caregivers have of them. This difficulty can generate irrational behavior and fear of blame. Conversely, a better knowledge of the specificities of this invisible living world favors a rationalization of care practices. To do this, caregivers will be able to appropriate the major concepts of microbiology, particularly microbial ecology.

[What the invisible microbiota shows about the care giving system]. / Ce que l'invisible microbiote donne à voir du soin.

When we talk about micro-organisms, the notion of hygiene prevails. However, this invisible ecosystem, which permeates us and connects us to patients, should make us aware of the intimate relationship among human beings.

[Supporting students to take care of their health]. / Permettre aux étudiants d'être acteurs de leur santé.

The current health crisis is impacting the vision of the present and the future. It is not a matter of feeling "sacrificed", but rather of discovering a new way of approaching the world around us. This is the case for our representations of health and the interdependence of people and generations.

[Smell and care: from professionalism to emotions]. / Odeurs et soins, du professionnalisme aux émotions.

The sense of smell presents itself to us as a means of forging an opinion of a situation, sending us back to our memories and giving us a form of knowledge of the patient. In addition, besides the obvious repulsion that certain wounds can engender, the sense of smell can also, conversely, lead us into an eroticization of care.

[COVID-19, student aid, public health and solicitude]. / Covid-19, aide aux étudiants, santé publique et sollicitude.

Student aid policies are broad organizational lines. They must not be confused, despite the obvious solicitude of public actors, with the caregiver's posture. It is then necessary to reinterrogate solicitude to defend a form of prevention by the mobilization of the actors, namely the students themselves.

[Impact of the pandemic on students]. / Impact de la pandémie sur les étudiants.

French society has become aware of the distress of students, to the point of setting up systems dedicated to their mental health. To avoid confusion, it is important to qualify the mental health of students and to suggest ways to understand why this is a vulnerable population facing the health crisis.

[The balance of healthcare students in jeopardy]. / Les étudiants en santé, leur équilibre en péril.

Healthcare students have experienced this first year of the COVID-19 pandemic differently. Some have volunteered to support services in tension. They were concerned about whether their training would be provided, especially for technical skills.

[Hygiene resource practitioners' experience, at a time of health challenges]. / Le vécu des correspondants en hygiène à l'heure des grands enjeux sanitaires.

In the current context of the health crisis brought about by the Covid-19 epidemic, the implementation of good practices in terms of preventing contagion and the respect of good hygiene practices is vital. The hospital hygiene teams must be involved in raising awareness of these good practices. They rely notably on hygiene resource paramedical practitioners to share these practices with the nursing teams, notably in the area of the prevention of care-related infections and the spread of emerging highly drug-resistant bacteria. A focus group study conducted in 2019 in a military health facility in Brittany provides interesting insight into their practice.

[COVID-19: what protection for hospital staff?] / Covid-19 : quelles protections pour les personnels hospitaliers ?

In France, several caregivers have died of COVID-19. Certain pathologies or treatments were correlated with more severe forms. What measures have been put in place to protect the health of hospital caregivers who are particularly exposed?

Pneumocystis jirovecii and Cystic Fibrosis in Brittany, France.

Pneumocystis jirovecii is a transmissible fungus with a high pulmonary tropism. The prevalence of P. jirovecii in patients with cystic fibrosis (CF) has been estimated in Germany at 7.4%, in Spain at 21.5% and in Brazil at 38.2%. Data on the prevalence of P. jirovecii in CF patients in France remain scarce, particularly in Brittany, where the prevalence of CF is high (from 1/1600 to 1/4500). Our objectives were to determine the prevalence of colonization of the airways by P. jirovecii in Brittany in CF patients monitored at the "Centre de Ressources et de Compétences de la Mucoviscidose (CRCM)" of Rennes compared to that previously observed at the CRCM of Roscoff-Brest. Sputa from 86 patients (178 specimens) followed in Rennes were analyzed retrospectively. The detection of P. jirovecii was performed using real-time PCR targeting the gene encoding the mitochondrial large subunit of ribosomal RNA. Pneumocystis jirovecii DNA was detected in 3/86 patients (3.5%) monitored at Rennes, whereas it had previously been detected in 1/76 patients (1.3%) monitored at Roscoff-Brest, thus showing an overall prevalence of 2.5% in Brittany. These results obtained from two Breton centers taken together show that P. jirovecii prevalence in patients with CF in Brittany is lower than those observed in Germany, Spain, Brazil or in other regions of France. This study is a preliminary step in determining the risk factors for P. jirovecii acquisition, its epidemiological and clinical significance in CF patients through a prospective multicenter study.

A misleading false-negative result of Pneumocystis real-time PCR assay due to a rare punctual mutation: A French multicenter study.

This article describes a previously unreported mutation at position 210 (C210T) of the mitochondrial large subunit ribosomal RNA (mtLSUrRNA) gene of Pneumocystis jirovecii, which led to a false-negative result of a real-time polymerase chain reaction (PCR) assay. Since the aforementioned real-time PCR assay is widely used in France, a French multicenter study was conducted to estimate the mutation frequency and its potential impact on the routine diagnosis of Pneumocystis pneumonia (PCP). Through analysis of data obtained from eight centers, the mutation frequency was estimated at 0.28%. This low frequency should not call into question the routine use of this PCR assay. Nonetheless, the occurrence of the false-negative PCR result provides arguments for maintaining microscopic techniques combined to PCR assays to achieve PCP diagnosis.

Occupational accidents among attendants inside hyperbaric chambers in France.

INTRODUCTION: The purpose of the study was to assess the number of accidents among staff employed in the operation of hyperbaric chambers in France. MATERIALS AND METHODS: A retrospective study using a questionnaire was carried out on occupational accidents in France between 2005 and 2011. RESULTS: 12 (46%) centres participated in the study, representing 73 subjects. The mean age was 43.5 years (SD=9.73). They had worked in hyperbaric chambers for 9.8 years on average (SD=7.7). The average number of hyperbaric sessions was 198.3 per subject (SD=174.25), for a total of 8.072 hyperbaric sessions; 27% of the subjects reported that they had at least one accident during the study period. In all, 30 accidents were reported: 3 blood exposures, 4 accidents related to patient handling, 20 hyperbaric accidents; 3 other accidents. Of the hyperbaric accidents, 2 (10%) involved decompression sicknesses with cutaneous symptoms, 3 (15%) decompression illness (DCI), 14 (70%) ear traumatisms, 1 (5%) dental accident. The incidences were 372 per 100,000 sessions in hyperbaric chambers (SHC) for all accidents, 248 per 100,000 SHC for hyperbaric accidents and 173 per 100,000 SHC for ENT barotraumas. CONCLUSION: The accidents involving staff operating hyperbaric chambers were mainly ear traumatisms..

First human case of Fastidiosipila sanguinis infection.

Fastidiosipila sanguinis is a Gram-positive anaerobic coccus. We report the first case of osteitis implicating this species. The strain was accurately identified by 16S rRNA sequence analysis, matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) identification having failed. The reservoir remained unclear; an endogenous origin is suspected.