OBJECTIVES: Intradermal skin test (IDT) with mRNA vaccines may represent a simple, reliable, and affordable tool to measure T cell response in immunocompromised patients who failed to mount serological responses following vaccination with mRNA covid-19 vaccines. METHODS: We compared anti-SARS-CoV-2 antibodies and cellular responses in vaccinated immunocompromised patients (n = 58), healthy seronegative naive controls (NC, n = 8), and healthy seropositive vaccinated controls (VC, n = 32) by Luminex, spike-induced IFN-γ Elispot and an IDT. A skin biopsy 24 h after IDT and single-cell RNAseq was performed in three vaccinated volunteers. RESULTS: Twenty-five percent of seronegative NC had a positive Elispot (2/8) and IDT (1/4), compared to 95% (20/21) and 93% (28/30) in seropositive VC, respectively. Single-cell RNAseq data in the skin of VC showed a predominant mixed population of effector helper and cytotoxic T cells. The TCR repertoire revealed 18/1064 clonotypes with known specificities against SARS-CoV-2, among which six were spike-specific. Seronegative immunocompromised patients with positive Elispot and IDT were in 83% (5/6) treated with B cell-depleting reagents, while those with negative IDT were all transplant recipients. CONCLUSIONS: Our results indicate that delayed local reaction to IDT reflects vaccine-induced T-cell immunity opening new perspectives to monitor seronegative patients and elderly populations with waning immunity.
COVID-19 , T-Lymphocytes , Aged , Humans , COVID-19 Vaccines , COVID-19/diagnosis , COVID-19/prevention & control , SARS-CoV-2 , Biomarkers , mRNA Vaccines , Antibodies, Viral , Immunocompromised Host , Skin Tests , Vaccination
Work-related contact dermatitis is frequent and might reduce the professional activity. Through the presentation of a clinical situation and its handling, this article shows the added value of an occupational medicine intervention. This procedure integrating a field observation has shown useful solutions after the medical handling and the maintenance of employment, although they were not always where we expected them.
Les eczémas professionnels sont fréquents et peuvent parfois limiter l'exercice de l'activité professionnelle. Au travers de la présentation d'une situation clinique et de sa prise en charge, cet article montre la plus-value d'une intervention de médecine du travail. Cette démarche intégrant une approche de terrain a révélé des leviers utiles à la suite de la prise en charge et au maintien en emploi, même s'ils n'étaient pas toujours là où on les attendait.
Dermatitis, Contact , Occupational Medicine , Humans , Critical Pathways , Dermatitis, Contact/etiology , Dermatitis, Contact/therapy , Employment
Dermatoses are among the most frequent diseases related to working conditions. Nevertheless, there is an under-reporting of occupational diseases and the management of patients with either a possible occupational dermatosis or a condition aggravated by work which could be improved. The aim of this article is to present the most common occupational dermatoses, a multidisciplinary diagnostic approach to them and to propose a screening tool for occupational exposures.
Les dermatoses sont parmi les maladies les plus fréquentes en lien avec les conditions de travail. Néanmoins, il existe une sous-déclaration en maladie professionnelle et la prise en charge des patients atteints, soit d'une possible dermatose professionnelle, soit d'une condition aggravée par le travail, qui pourrait être améliorée. L'objectif de cet article est de présenter les dermatoses professionnelles les plus communes et une démarche diagnostique pluridisciplinaire et de proposer un outil de dépistage des expositions professionnelles à risque.
General Practitioners , Occupational Diseases , Occupational Exposure , Skin Diseases , Humans , Occupational Diseases/diagnosis , Occupational Diseases/epidemiology , Occupational Diseases/etiology , Skin Diseases/diagnosis , Skin Diseases/epidemiology , Skin Diseases/etiology
