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1.
Rev Prat ; 69(6): 676-678, 2019 Jun.
Artículo en Francés | MEDLINE | ID: mdl-31626433

RESUMEN

Today, people all over the world are on the move. Women and girls account for nearly half of the 244 million migrants. They are sometimes forced to leave their country of origin to flee physical, psychological or sexual violence and gender discrimination. Then the migratory route and the new life in the country of asylum expose them to situations of vulnerability and they are therefore at risk of physical, psychological or sexual abuse. The risk of HIV infection is high. Practitioners in host countries receive these women for various reasons in consultation. Knowing their background allows us to support them and offer them care adapted to their needs and requests. The first step is systematic screening by professionals. Secondly, multidisciplinary care is essential: social actors, psychologists, sexologists, infectiologists, gynaecologists, pain specialists, etc. This requires specific training for professionals confronted with these populations.


Asunto(s)
Violencia Doméstica , Refugiados , Delitos Sexuales , Migrantes , Femenino , Infecciones por VIH , Humanos , Refugiados/psicología , Migrantes/psicología , Violencia
3.
Travel Med Infect Dis ; 29: 40-47, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30951905

RESUMEN

BACKGROUND: Literature on health events in HIV-infected travellers is scarce, particularly in sub-Saharan African (SSA) migrants. METHODS: We investigated health events in HIV-infected SSA migrants living in France during and after travel to their native country. All had a pre-travel plasma viral load (pVL) below 200 copies/mL and were on stable combined antiretroviral therapy (cART). Logistic regression models were used to assess the risk factors for at least one adverse health event or febrile event. RESULTS: Among 264 HIV migrants, pre-travel median CD4 count was 439/mm3 and 27 migrants (6%) experienced a low-level viremia between 50 and 200 copies/mL. One hundred (38%) experienced at least one event (13 experienced two events). The most common events were gastrointestinal, including diarrhoea (n = 29, 26%), respiratory events (n = 20, 18%), and malaria (n = 17, 15%; 1 death). In multivariable analysis, a pre-travel low-level viremia and a lack of pre-travel medical advice significantly increased the risk for any event (OR 4.31, 95% CI, 1.41-13.1; and OR 3.62, 95% CI, 1.38-9.47; respectively). A lack of pre-travel advice significantly increased the risk for febrile event. CONCLUSIONS: Early and tailored counselling on pre-travel medical advice regarding diarrhoea and vector-borne diseases prophylactic measures in HIV-infected SSA migrants should be emphasised before travel to Africa.


Asunto(s)
Infecciones por VIH/tratamiento farmacológico , Migrantes/estadística & datos numéricos , Enfermedad Relacionada con los Viajes , África del Sur del Sahara/etnología , Antirretrovirales/uso terapéutico , Fiebre/epidemiología , Francia/epidemiología , Enfermedades Gastrointestinales/epidemiología , Infecciones por VIH/virología , Humanos , Malaria/epidemiología , Malaria/mortalidad , Enfermedades Respiratorias/epidemiología , Factores de Riesgo , Carga Viral
4.
Arch Dis Child ; 104(7): 629-635, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30127061

RESUMEN

BACKGROUND: Diagnosis of intrathoracic tuberculosis (ITB) is limited in children partly by their difficulty to produce sputum specimen. OBJECTIVE: To systematically review the detection yields of mycobacterial culture and Xpert MTB/RIF from induced sputum (IS), nasopharyngeal aspirate (NPA) and gastric aspirate (GA) in children with presumptive ITB. DESIGN: Pubmed, Embase and Biosis databases and grey literature were searched. Randomised controlled trials, cohort, cross-sectional or case control studies using IS, GA and NPA for diagnosis of ITB published between January 1990 and January 2018 were included. Data were extracted on study design, case definition of presumptive ITB, sample collection methods, outcome measures and results. RESULTS: 30 studies were selected, including 11 554 children. Detection yields for culture ranged between 1% and 30% for IS, 1% and 45% for GA and 4% and 24% for NPA. For Xpert MTB/RIF, it was between 2% and 17% for IS, 5% and 51% for GA and 3% and 8% for NPA. There was a tendency of better yields with IS when the pretest probability of ITB was low to moderate and with GA when it was high. Sampling a second specimen contributed for 6%-33% of the cumulative yield and combination of different methods significantly increase the detection yields. CONCLUSIONS: Despite the important study heterogeneity, any of the specimen collection methods offers good potential to confirm childhood ITB. However, their operational challenges were poorly evaluated. In the absence of a sensitive non-sputum based test, only a minority of children with ITB can be confirmed.

5.
Int J Antimicrob Agents ; 52(3): 385-389, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-29906564

RESUMEN

BACKGROUND: Extensively-drug-resistant bacteria (XDRB) have emerged as a major source of resistance. Hospitalization abroad seems to be the major risk factor associated with carriage, and numerous reports have warned about the risk of in-hospital transmission. However, little is known regarding possible community transmission. METHODS: A retrospective matched case-control study was conducted in a Parisian teaching hospital, which included patients admitted to hospital with a history of travel abroad over the preceding 12 months. Each XDRB carrier at admission (case) was matched with two non-carriers (controls) hospitalized in the same ward and admitted during the same month. AIM: To describe and identify risk factors associated with XDRB carriage at admission. FINDINGS: Forty-six cases and 92 controls were enrolled. The results of univariate and multi-variate analyses showed that health repatriation was the only factor associated with a higher risk of carrying XDRB (odds ratio 3.22, 95% confidence interval 1.23-7.84; P=0.01). Surprisingly, one-third of the study population had not been hospitalized abroad within the preceding 12 months. The most frequently identified XDRB species were Escherichia coli (36%), Enterococcus spp. (17%) and Klebsiella pneumoniae (9%), and the most frequently identified enzyme was OXA-48 (36%). CONCLUSION: In this retrospective study, health repatriation was the only risk factor for XDRB carriage identified at admission. Furthermore, the data suggest community-onset transmission. Therefore, there is an urgent need to conduct studies in high-risk countries to identify the risk factors associated with community carriage.


Asunto(s)
Enterobacteriaceae Resistentes a los Carbapenémicos/aislamiento & purificación , Enfermedades Transmisibles Importadas/epidemiología , Enfermedades Transmisibles Importadas/transmisión , Infecciones por Enterobacteriaceae/epidemiología , Infecciones por Enterobacteriaceae/transmisión , Infecciones por Bacterias Grampositivas/epidemiología , Infecciones por Bacterias Grampositivas/transmisión , Enterococos Resistentes a la Vancomicina/aislamiento & purificación , Enterobacteriaceae Resistentes a los Carbapenémicos/efectos de los fármacos , Estudios de Casos y Controles , Enfermedades Transmisibles Importadas/terapia , Farmacorresistencia Bacteriana Múltiple , Infecciones por Enterobacteriaceae/microbiología , Infecciones por Enterobacteriaceae/terapia , Escherichia coli/efectos de los fármacos , Escherichia coli/genética , Proteínas de Escherichia coli/genética , Femenino , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/terapia , Hospitalización/estadística & datos numéricos , Humanos , Klebsiella pneumoniae/efectos de los fármacos , Klebsiella pneumoniae/genética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Viaje , Enterococos Resistentes a la Vancomicina/efectos de los fármacos , beta-Lactamasas/genética
6.
Urol Int ; 96(2): 241-3, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-25115408

RESUMEN

INTRODUCTION: Salmonella is a rare cause of urinary tract infections. We report here a unique case of pyonephrosis due to Salmonella Typhi (S. Typhi) complication, a stone-related obstructive pyelonephritis. CASE REPORT: A 47-year-old man, without any history of typhoid fever or gastrointestinal symptoms, presented with a pyonephrosis and life-threatening bacteremia following an acute obstructive right pyelonephritis caused by S. Typhi. The patient was treated by urinary drainage (ureteral stent), antibiotics, and delayed right nephrectomy. We postulated that urolithiasis could explain asymptomatic chronic urinary carriage of S. Typhi. CONCLUSION: S. Typhi is one possible cause of life-threatening urinary tract infection, especially in the context of urolithiasis.


Asunto(s)
Pielonefritis/microbiología , Pionefrosis/microbiología , Salmonella typhi/aislamiento & purificación , Fiebre Tifoidea/microbiología , Infecciones Urinarias/microbiología , Urolitiasis/microbiología , Antibacterianos , Drenaje/instrumentación , Humanos , Masculino , Persona de Mediana Edad , Nefrectomía , Pielonefritis/diagnóstico , Pielonefritis/terapia , Pionefrosis/diagnóstico , Pionefrosis/terapia , Stents , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Fiebre Tifoidea/diagnóstico , Fiebre Tifoidea/terapia , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/terapia , Orina/microbiología , Urolitiasis/diagnóstico , Urolitiasis/terapia
7.
Malar J ; 12: 399, 2013 Nov 07.
Artículo en Inglés | MEDLINE | ID: mdl-24200190

RESUMEN

BACKGROUND: Each year, thousands of cases of uncomplicated malaria are imported into Europe by travellers. Atovaquone-proguanil (AP) has been one of the first-line regimens used in France for uncomplicated malaria for almost ten years. While AP's efficacy and tolerance were evaluated in several trials, its use in "real life" conditions has never been described. This study aimed to describe outcome and tolerance after AP treatment in a large cohort of travellers returning from endemic areas. METHODS: Between September 2002 and January 2007, uncomplicated malaria treated in nine French travel clinics with AP were followed for 30 days after AP initiation. Clinical and biological data were collected at admission and during the follow-up. RESULTS: A total of 553 patients were included. Eighty-eight percent of them were born in Africa, and 61.8% were infected in West Africa, whereas 0.5% were infected in Asia. Migrants visiting friends and relatives (VFR) constituted 77.9% of the patients, the remainder (32.1%) were backpackers. Three-hundred and sixty-four patients (66%) fulfilled follow-up at day 7 and 265 (48%) completed the study at day 30. Three patients had treatment failure. One-hundred and seventy-seven adverse drug reactions (ADR) were reported during the follow-up; 115 (77%) of them were digestive ADR. Backpackers were more likely to experiment digestive ADR compared to VFR (OR = 3.8; CI 95% [1.8-8.2]). Twenty patients had to be switched to another regimen due to ADR. CONCLUSION: This study seems to be the largest in terms of number of imported uncomplicated malaria cases treated by AP. The high rate of reported digestive ADR is striking and should be taken into account in the follow-up of patients since it could affect their adherence to the treatment. Beside AP, artemisinin combination therapy (ACT) is now recommended as first-line regimen. A comparison of AP and ACT, in terms of efficacy and tolerance, would be useful.


Asunto(s)
Antimaláricos/uso terapéutico , Atovacuona/uso terapéutico , Malaria Falciparum/tratamiento farmacológico , Proguanil/uso terapéutico , Viaje , Adolescente , Adulto , África , Anciano , Asia , Niño , Combinación de Medicamentos , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Migrantes , Resultado del Tratamiento , Adulto Joven
8.
PLoS Negl Trop Dis ; 7(8): e2333, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23951372

RESUMEN

BACKGROUND: Worldwide, amoebic liver abscess (ALA) can be found in individuals in non-endemic areas, especially in foreign-born travelers. METHODS: We performed a retrospective analysis of ALA in patients admitted to French hospitals between 2002 and 2006. We compared imported ALA cases in European and foreign-born patients and assessed the factors associated with abscess size using a logistic regression model. RESULTS: We investigated 90 ALA cases. Patient median age was 41. The male:female ratio was 3.5:1. We were able to determine the origin for 75 patients: 38 were European-born and 37 foreign-born. With respect to clinical characteristics, no significant difference was observed between European and foreign-born patients except a longer lag time between the return to France after traveling abroad and the onset of symptoms for foreign-born. Factors associated with an abscess size of more than 69 mm were being male (OR = 11.25, p<0.01), aged more than 41 years old (OR = 3.63, p = 0.02) and being an immigrant (OR = 11.56, p = 0.03). Percutaneous aspiration was not based on initial abscess size but was carried out significantly more often on patients who were admitted to surgical units (OR = 10, p<0.01). The median time to abscess disappearance for 24 ALA was 7.5 months. CONCLUSIONS/SIGNIFICANCE: In this study on imported ALA was one of the largest worldwide in terms of the number of cases included males, older patients and foreign-born patients presented with larger abscesses, suggesting that hormonal and immunological factors may be involved in ALA physiopathology. The long lag time before developing ALA after returning to a non-endemic area must be highlighted to clinicians so that they will consider Entamoeba histolytica as a possible pathogen of liver abscesses more often.


Asunto(s)
Entamoeba histolytica/aislamiento & purificación , Absceso Hepático Amebiano/epidemiología , Viaje , Adulto , Femenino , Francia/epidemiología , Humanos , Absceso Hepático Amebiano/diagnóstico , Absceso Hepático Amebiano/patología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
9.
J Infect Dis ; 200(6): 991-1001, 2009 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-19656069

RESUMEN

BACKGROUND: In the context of the increasing resistance to sulfadoxine-pyrimethamine (SP), we evaluated the efficacy of mefloquine (MQ) for intermittent preventive treatment during pregnancy (IPTp). METHODS: A multicenter, open-label equivalence trial was conducted in Benin from July 2005 through April 2008. Women of all gravidities were randomized to receive SP (1500 mg of sulfadoxine and 75 mg of pyrimethamine) or 15 mg/kg MQ in a single intake twice during pregnancy. The primary end point was the proportion of low-birth-weight (LBW) infants (body weight, <2500 g; equivalence margin, 5%). RESULTS: A total of 1601 women were randomized to receive MQ (n=802)or SP (n=799).In the modified intention-to-treat analysis, which assessed only live singleton births, 59 (8%) of 735 women who were given MQ and 72 (9.8%) of 730 women who were given SP gave birth to LBW infants (difference between low birth weights in treatment groups, -1.8%; 95% confidence interval [CI], -4.8% to 1.1%]), establishing equivalence between the drugs. The per-protocol analysis showed consistent results. MQ was more efficacious than SP in preventing placental malaria (prevalence, 1.7% vs 4.4% of women; P = .005),clinical malaria (incidence rate, 26 cases/10,000 person-months vs. 68 cases/10,000 person-months; P = .007) and maternal anemia at delivery (as defined by a hemoglobin level <10 g/dL) (prevalence, 16% vs 20%; marginally significant at P = .09). Adverse events (mainly vomiting, dizziness, tiredness, and nausea) were more commonly associated with the use of MQ (prevalence, 78% vs 32%; P < 10(-3)) One woman in the MQ group had severe neuropsychiatric symptoms. CONCLUSIONS: MQ proved to be highly efficacious--both clinically and parasitologically--for use as IPTp. However, its low tolerability might impair its effectiveness and requires further investigations.


Asunto(s)
Antimaláricos/uso terapéutico , Malaria/prevención & control , Mefloquina/uso terapéutico , Complicaciones Parasitarias del Embarazo/prevención & control , Pirimetamina/uso terapéutico , Sulfadoxina/uso terapéutico , Anomalías Inducidas por Medicamentos , Aborto Espontáneo/inducido químicamente , Adulto , Antimaláricos/efectos adversos , Combinación de Medicamentos , Femenino , Humanos , Lactante , Recién Nacido , Mefloquina/efectos adversos , Embarazo , Pirimetamina/efectos adversos , Método Simple Ciego , Mortinato , Sulfadoxina/efectos adversos , Adulto Joven
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