[2023 update on alveolar echinococcosis]. / Échinococcose alvéolaire : prise en charge en 2023.

Alveolar echinococcosis is a rare but severe parasitic disease and is now in Europe the parasitic infection associated with the most morbidity and mortality. Its prevalence is increasing in Switzerland in both urban and rural areas. Echinococcosis is a differential diagnosis that should be considered when facing a cystic hepatic lesion. Moreover, this parasitic infection is increasing amongst immunocompromised patients, making the diagnosis more complex, because of atypic lesions and a more rapid evolution. At the current time, several treatment options, both surgical and medical, can offer patients a good prognosis and maintain a good quality of life.

L'échinococcose alvéolaire est une parasitose rare mais sévère. En Europe, il s'agit de l'infection parasitaire causant le plus de morbimortalité. Son incidence est en augmentation en Suisse dans les zones urbaines et rurales. L'échinococcose est donc un diagnostic différentiel à évoquer face à une lésion kystique hépatique. En outre, cette infection parasitaire est en augmentation chez les patients immunosupprimés, chez qui le diagnostic est plus complexe en raison de lésions atypiques et d'une évolution plus rapide. À l'heure actuelle, plusieurs modalités de traitements chirurgicaux et médicamenteux permettent d'offrir un bon pronostic aux patients tout en maintenant une bonne qualité de vie.

Post­COVID­19 Syndrome in Outpatients: a Cohort Study.

BACKGROUND: After mild COVID-19, some outpatients experience persistent symptoms. However, data are scarce and prospective studies are urgently needed. OBJECTIVES: To characterize the post-COVID-19 syndrome after mild COVID-19 and identify predictors. PARTICIPANTS: Outpatients with symptoms suggestive of COVID-19 with (1) PCR-confirmed COVID-19 (COVID-positive) or (2) SARS-CoV-2 negative PCR (COVID-negative). DESIGN: Monocentric cohort study with prospective phone interview between more than 3 months to 10 months after initial visit to the emergency department and outpatient clinics. MAIN MEASURES: Data of the initial visits were extracted from the electronic medical file. Predefined persistent symptoms were assessed through a structured phone interview. Associations between long-term symptoms and PCR results, as well as predictors of persistent symptoms among COVID-positive, were evaluated by multivariate logistic regression adjusted for age, gender, smoking, comorbidities, and timing of the survey. KEY RESULTS: The study population consisted of 418 COVID-positive and 89 COVID-negative patients, mostly young adults (median age of 41 versus 36 years in COVID-positive and COVID-negative, respectively; p = 0.020) and healthcare workers (67% versus 82%; p = 0.006). Median time between the initial visit and the phone survey was 150 days in COVID-positive and 242 days in COVID-negative patients. Persistent symptoms were reported by 223 (53%) COVID-positive and 33 (37%) COVID-negative patients (p = 0.006) and proportions were stable among the periods of the phone interviews. Overall, 21% COVID-positive and 15% COVID-negative patients (p = 0.182) attended care for this purpose. Four surveyed symptoms were independently associated with COVID-19: fatigue (adjusted odds ratio 2.14, 95% CI 1.04-4.41), smell/taste disorder (26.5, 3.46-202), dyspnea (2.81, 1.10-7.16), and memory impairment (5.71, 1.53-21.3). Among COVID-positive, female gender (1.67, 1.09-2.56) and overweight/obesity (1.67, 1.10-2.56) were predictors of persistent symptoms. CONCLUSIONS: More than half of COVID-positive outpatients report persistent symptoms up to 10 months after a mild disease. Only 4 of 14 symptoms were associated with COVID-19 status. The symptoms and predictors of the post-COVID-19 syndrome need further characterization as this condition places a significant burden on society.

Aseptic lung and liver abscesses: a diagnostic challenge.

A 67-year-old man known with systemic sarcoidosis was admitted to the department of internal medicine because of cough and chest pain for several weeks. Thoracic tomodensitometry demonstrated multiple pulmonary nodules. Biopsies revealed features compatible with abscesses. Cultures and serologic tests were negative and the patient was successfully treated with prednisone. Three years later, a thoraco-abdominal tomodensitometry showed a relapse in the lung and also the apparition of similar lesions in the liver. Blood test revealed elevated CRP level at 40 mg/L and mild cholestasis. Biopsies of the liver excluded neoplastic or infectious diseases and showed inflammatory granulation tissue with abscess formation. A diagnosis of sarcoidosis-associated aseptic abscesses syndrome was then made, which was successfully treated with corticosteroids.