Hepatitis E virus seroprevalence and risk factors for individuals in working contact with animals.

BACKGROUND: In industrial countries genotypes 3 and 4 of HEV are detected in swine, wild boar, deer and rabbits, and they are associated with autochthonous infections suggesting the existence of zoonotic HEV infections, compatible with the putative involvement of undercooked pork and big game products as a source of infection. OBJECTIVES: To evaluate the prevalence of anti-HEV antibodies in different population groups in contact with animals and to investigate risk factors for HEV infection. STUDY DESIGN: Serum samples were collected from 859 healthy French subjects, including pig farm workers, forestry workers and individuals without working contact with animals (control group). In addition, 58 swine veterinarians were included in the study. Subjects were interviewed using a structured questionnaire, and anti-HEV antibodies were investigated using a sensitive and specific sandwich ELISA. RESULTS: Anti-Hepatitis E virus (HEV) antibodies were detected in 26% of control population, and in 36% and 44% of forestry and pig farm workers, respectively. In addition, an increase in seroprevalence from the north to the south of France was observed (30.2% versus 40.7%). Consumption of pork liver sausage (AOR 4.4, p < 10(-4)), occupational contact with animals (AOR 1.58, p = 0.038 for forestry workers and AOR 2.51, p < 10(-4) for pig farm workers), and living in southern France (AOR 1.47, p = 0.02), were independent risk factors. Wearing working gloves and boots might reduce HEV infection. CONCLUSIONS: Occupational exposure to animals and consuming raw or undercooked pork liver sausage or pork liver play a significant role in HEV transmission in industrial countries.

High hepatitis E virus seroprevalence in forestry workers and in wild boars in France.

Hepatitis E virus (HEV) is a fecally and orally transmitted human pathogen of worldwide distribution. In industrial countries, HEV is observed in an increasing number of autochthonous cases and is considered to be an emerging pathogen. A growing body of evidence suggests that HEV is a zoonotic disease, and pig handlers and pig veterinarians have been reported to be high-risk groups for HEV infection. The aims of the present study were to establish the prevalence of anti-HEV in wild boars in France and to identify whether forestry workers are at a higher risk of HEV infection. Three different anti-HEV tests were used to compare their effectiveness in detecting anti-HEV in the general population. The most sensitive test was then used to investigate HEV seroprevalence in 593 forestry workers and 421 wild boars. Anti-HEV was detected in 31% of the forestry workers and 14% of the wild boars. Detection of anti-HEV in humans was correlated with age, geographical location, and occupational activity and in wild boars was correlated with geographical location. HEV infection is frequent in woodcutters in France, and it varies geographically. Further studies are needed to confirm these findings and to elucidate the transmission route and the exact virus reservoirs.

Peroxisome proliferator activating receptor alpha and gamma polymorphisms and metabolic abnormalities in HIV-infected patients receiving highly active antiretroviral therapy: the ANRS CO8 APROCO-COPILOTE study.

Highly active antiretroviral therapy (HAART) is associated with fat redistribution and metabolic disorders. The present study was undertaken to evaluate the association between peroxisome proliferator activated receptor (PPAR)α and PPARγ polymorphisms, two genes involved in lipid metabolism and adipocyte differentiation, and elements of the metabolic syndrome, lipodystrophy, or carbohydrate metabolism abnormalities in patients receiving HAART. The frequency distribution of rare alleles for PPARα (L162V) and PPARγ (P12A and H449H) was compared using the chi square test in 363 HIV-1-infected patients classified according to the presence or absence of the metabolic syndrome after 48 months of follow-up on their first PI-containing regimen. The P12A rare g allele was present in 12% patients with normal glucose metabolism, 11% patients with impaired glucose tolerance or impaired fasting glucose, and 35% patients with diabetes (p=0.014). The rare g allele for L162V was present in 14% of patients free of hypertriglyceridemia and in 7% patients with hypertriglyceridemia (p=0.04). The rare g allele for L162V was found in 15% of patients free of any sign of lipodystrophy and 8% with at least one sign of lipodystrophy (p=0.04) and the rare t allele for H449H was found in 14% of patients free of any sign of lipodystrophy and 23% of patients with at least one sign of lipodystrophy (p=0.05). There was no convincing association between any polymorphism of PPARα and PPARγ and each individual component of the metabolic syndrome, except for the relationship of the P12A polymorphism with diabetes. Confirmatory studies on a larger number of individuals are needed.

[Emerging multidrug-resistant microorganisms among travelers returning to France and persons repatriated from foreign hospitals]. / Risque d'introduction et voies d'importation par l'homme de maladies infectieuses exotiques: cas particulier de l'emergence de bactéries pathogènes multirésistantes aux antibiotiques, importées en France a l'occasion de voyages internationaux ou du rapatriement de patients hospitalisés a l'etranger.

The spread of multidrug-resistant bacteria has become a major problem in France in recent years, owing to increasing antibiotic exposure, growing international exchanges, repatriation of hospitalized French patients, and treatment of French and foreign travelers in French hospitals. This article examines how different pathogens may become endemic in France.

[The French National Institute for Agricultural Medicine (INMA)]. / Institut national de médecine agricole (INMA), Tours.

Since 1958, the French National institute for agricultural medicine (INMA) has been studying the determinant health factors (non-exclusively medical) in the agricultural and rural environment. To reach this objective, the INMA organizes various types of training (degree in agricultural medicine, training for the physicians from the Mutualité Sociale Agricole--a French social security agency--, continuing education, seminars and symposiums etc.) designed for various health and safety professionals (occupational physicians, consultant physicians, general practitioners, especially from rural areas, members of safety committees etc.). This agricultural and rural specificity of the INMA is also one of the characteristics of its oldest training (2,500 physicians trained to date): the degree in agricultural medicine, which, following one or two years of courses, allows trainees to carry on occupational medicine in the agricultural sector. Through its holdings, the INMA website (www.inma.fr) provides physicians with a lot of answers to their questions regarding the health issue in agriculture.

Lack of association between rifampicin plasma concentration and treatment-related side effects in osteoarticular infections.

The aim of this study was to assess the frequency of gastrointestinal side effects (GSE) and hepatotoxicity in patients treated with rifampicin for an osteoarticular infection and to determine if there is an association between rifampicin plasma concentrations and side effects. Rifampicin plasma concentrations were prospectively measured before (trough concentration, C(0)) and 2 +/- 0.5 h (peak concentration, C(2)) after drug intake. The presence of GSE, the alanine transferase (ALT) value, and concomitantly administered medications were recorded on the day rifampicin concentrations were measured. C(0) and C(2) were compared for differences regarding the presence or absence of side effects. Multivariate analysis was performed, with associated medications being taken into account. Seventy C(0) and 57 C(2) values were measured in 46 adults after a median treatment of 8 days (range, 1-179). Wide inter-individual variability was observed for C(0) and C(2). Thirteen (28%) patients reported GSE at least once. When GSE occurred, C(0) (median, 1 mg L(-1); range, 0.1-9.9 mg L(-1)) and C(2) (median, 10.3 mg L(-1); range, 1.8-40.3 mg L(-1)) were similar to C(0) (median, 0.6 mg L(-1); range, 0.1-10.3 mg L(-1)) and C(2) (median, 10.9 mg L(-1); range, 2.9-29.0 mg L(-1)) without GSE. The ALT value was more than normal in only three patients (6.5%) after rifampicin treatment began. The patients received no different associated medications whether or not GSE were present. Multivariate analysis showed no association between rifampicin plasma concentrations and GSE. GSE occur frequently in patients receiving rifampicin for osteoarticular infection but without an association with rifampicin plasma concentrations. Thus, therapeutic drug monitoring of rifampicin is irrelevant in the management of GSE.

First isolation of Bartonella alsatica from a valve of a patient with endocarditis.

We report the first documented case of endocarditis in a man infected with Bartonella alsatica, which causes bacteremia in healthy wild rabbits. B. alsatica was identified by serology and culture and by PCR of an aortic valve specimen. B. alsatica should be added to the list of zoonotic agents of blood culture-negative endocarditis.

[How to promote a strong antibiotic policy in France?]. / Comment développer une politique antibiotique rigoureuse en France?

Microbial resistance to anti-infective drugs is a major public health threat. The phenomenon of selection has been amplified both in hospitals and in the community by increased antibiotic use. Antibiotic use in France is excessive. Good routine antimicrobial practices are crucial to control the spread of bacterial resistance. Antibiotic prescriptions have fallen by 17% since the beginning of a national control program in 2001.

[Antibiotic use: excesses and consequences]. / Utilisation des antibiotiques: excès et conséquences.

Antibiotic use in France is excessive. This statement is regularly expressed. The comparison with usage in other European countries, the frequency of use in viral infections, the misuse, specifically in the duration of treatment is easy proof of this. However, does this excessive use really have negative consequences in terms of public health? Yes, through the development of antibiotic resistance in hospital bacteria and also in the community. The phenomenon of selection has been amplified as much in the hospital as in the community due to the increase in antibiotic use. It has been a problem that has been neglected for a long time due to the regular release of new antibiotics with better performance onto the market. More than ever, as with any side effect, it has to be taken into account with each prescription of an antibiotic. It encourages the development of a reservoir of resistant bacteria and creates a collective medical risk of the appearance of infections for which the choice of treatment is at best restricted and costly, and at worst inexistent.