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1.
Sante Publique ; 36(3): 39-48, 2024.
Artigo em Francês | MEDLINE | ID: mdl-38906813

RESUMO

INTRODUCTION: Pakistan has the second highest prevalence of hepatitis C globally. The Musafir study, set up in 2018 in a Parisian suburb to understand the representations of hepatitis and HIV within the Urdu-speaking, male, migrant community living there, provided an opportunity to think about culturally acceptable health promotion interventions. These included awareness campaigns on hepatitis—which did not cover the question of HIV, considered taboo—, held in a mosque. PURPOSE OF THE RESEARCH: The aim of this article is to describe the implementation of awareness and testing campaigns within a Pakistani religious and cultural association. METHOD: A partnership with a Pakistani association that runs a place of worship enabled awareness and testing campaigns for hepatitis and HIV to be carried out, thanks to the involvement of the association’s managers and the imam. RESULTS: Between February and June 2023, 113 people were tested during the five campaigns that were carried out. The population screened consisted almost exclusively of Urdu-speaking men. Anti-HCV antibodies were found in six people, three of whom had already recovered, and two people tested positive for HBV. No cases of HIV were detected. CONCLUSIONS: The prevalence of hepatitis C found was 5.3 percent, in line with the prevalence in Pakistan. This experiment highlighted the feasibility conditions of a partnership with a faith-based organization and offers ideas for developing this type of initiative in France.


Assuntos
Hepatite C , Programas de Rastreamento , Humanos , Paquistão/etnologia , Masculino , Adulto , Hepatite C/epidemiologia , Hepatite C/diagnóstico , Pessoa de Meia-Idade , Adulto Jovem , Feminino , Prevalência , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Promoção da Saúde , Adolescente
2.
BMC Infect Dis ; 22(1): 540, 2022 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-35698029

RESUMO

BACKGROUND: The impact of the variant of concern (VOC) Alpha on the severity of COVID-19 has been debated. We report our analysis in France. METHODS: We conducted an exposed/unexposed cohort study with retrospective data collection, comparing patients infected by VOC Alpha to contemporaneous patients infected by historical lineages. Participants were matched on age (± 2.5 years), sex and region of hospitalization. The primary endpoint was the proportion of hospitalized participants with severe COVID-19, defined as a WHO-scale > 5 or by the need of a non-rebreather mask, occurring up to day 29 after admission. We used a logistic regression model stratified on each matched pair and accounting for factors known to be associated with the severity of the disease. RESULTS: We included 650 pairs of patients hospitalized between Jan 1, 2021, and Feb 28, 2021, in 47 hospitals. Median age was 70 years and 61.3% of participants were male. The proportion of participants with comorbidities was high in both groups (85.0% vs 90%, p = 0.004). Infection by VOC Alpha was associated with a higher odds of severe COVID-19 (41.7% vs 38.5%-aOR = 1.33 95% CI [1.03-1.72]). CONCLUSION: Infection by the VOC Alpha was associated with a higher odds of severe COVID-19.


Assuntos
COVID-19 , SARS-CoV-2 , Idoso , Estudos de Coortes , Feminino , Hospitalização , Humanos , Masculino , Estudos Retrospectivos
3.
Urol Int ; 96(2): 241-3, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-25115408

RESUMO

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.


Assuntos
Pielonefrite/microbiologia , Pionefrose/microbiologia , Salmonella typhi/isolamento & purificação , Febre Tifoide/microbiologia , Infecções Urinárias/microbiologia , Urolitíase/microbiologia , Antibacterianos , Drenagem/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Nefrectomia , Pielonefrite/diagnóstico , Pielonefrite/terapia , Pionefrose/diagnóstico , Pionefrose/terapia , Stents , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Febre Tifoide/diagnóstico , Febre Tifoide/terapia , Infecções Urinárias/diagnóstico , Infecções Urinárias/terapia , Urina/microbiologia , Urolitíase/diagnóstico , Urolitíase/terapia
4.
Diabetes Metab ; 50(3): 101525, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38442769

RESUMO

OBJECTIVE: We aimed to assess the feasibility and diagnostic performance of ultrasound-guided bone biopsies at the bedside of diabetic patients admitted for suspected foot osteitis not requiring surgery. RESEARCH DESIGN AND METHODS: In this retrospective monocentric study, we compared the performance of ultrasound-guided (n = 29 consecutive patients, Dec.2020-Oct.2022) versus surgical (n = 24 consecutive patients, Jan.2018-Nov.2020) bone biopsies at confirming or ruling out diabetic foot osteitis (primary outcome). RESULTS: Patient characteristics were similar in the two intervention groups, including arteritis prevalence (62.3 %), SINBAD score, and wound location (phalanges 36 %, metatarsus 43 %, and calcaneus 21 %). However, the ultrasound-guided group was older (67 ± 11 versus 60 ± 13 years respectively, P = 0.047) and had more type 2 diabetes (97 % versus 75 %, P = 0.038). Diagnostic performance (i.e., capacity to confirm or rule out suspected osteitis) was similar for ultrasound-guided (28/29 cases: 25 confirmations, 3 invalidations) and surgical (24 confirmations/24) biopsies, P = 0.358. No biopsy-related side effect or complication was observed for either intervention, even for patients on antiaggregation and/or anticoagulation therapy. The mean (± standard deviation) time necessary to perform the biopsy was shorter in the ultrasound-guided group (2.6 ± 3.0 versus 7.2 ± 5.8 days, respectively, P < 0.001) and wound evolution at three months was more favorable (83.3 versus 41.2 %, P = 0.005) (94.4 % versus 66.7 %, respectively, patients with new surgical procedure within six months excluded; P = 0.055). Even though not statistically significant, healing rates in terms of wound and osteitis at six months were also better in the ultrasound-guided group (wound: 40.9 % versus 36.8 %; P = 0.790, and osteitis: 81.8 vs 55.6 % P = 0.071). CONCLUSION: In diabetic patients with suspected foot osteitis not requiring surgery, bedside ultrasound-guided bone biopsies may constitute a promising alternative to surgical biopsies. This intervention provided excellent tolerance and microbiological documentation, short lead-times, and more favorable wound prognosis.


Assuntos
Pé Diabético , Biópsia Guiada por Imagem , Humanos , Pé Diabético/diagnóstico por imagem , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Estudos Retrospectivos , Biópsia Guiada por Imagem/métodos , Osteíte , Ultrassonografia de Intervenção/métodos , Osso e Ossos/patologia , Osso e Ossos/diagnóstico por imagem
5.
Sci Rep ; 14(1): 3702, 2024 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-38355640

RESUMO

The transmission risk of SARS-CoV-2 within hospitals can exceed that in the general community because of more frequent close proximity interactions (CPIs). However, epidemic risk across wards is still poorly described. We measured CPIs directly using wearable sensors given to all present in a clinical ward over a 36-h period, across 15 wards in three hospitals in April-June 2020. Data were collected from 2114 participants and combined with a simple transmission model describing the arrival of a single index case to the ward to estimate the risk of an outbreak. Estimated epidemic risk ranged four-fold, from 0.12 secondary infections per day in an adult emergency to 0.49 per day in general paediatrics. The risk presented by an index case in a patient varied 20-fold across wards. Using simulation, we assessed the potential impact on outbreak risk of targeting the most connected individuals for prevention. We found that targeting those with the highest cumulative contact hours was most impactful (20% reduction for 5% of the population targeted), and on average resources were better spent targeting patients. This study reveals patterns of interactions between individuals in hospital during a pandemic and opens new routes for research into airborne nosocomial risk.


Assuntos
Hospitais , SARS-CoV-2 , Adulto , Humanos , Criança , Surtos de Doenças , Pandemias/prevenção & controle
6.
Malar J ; 12: 399, 2013 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-24200190

RESUMO

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.


Assuntos
Antimaláricos/uso terapêutico , Atovaquona/uso terapêutico , Malária Falciparum/tratamento farmacológico , Proguanil/uso terapêutico , Viagem , Adolescente , Adulto , África , Idoso , Ásia , Criança , Combinação de Medicamentos , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Migrantes , Resultado do Tratamento , Adulto Jovem
7.
PLoS One ; 18(10): e0276038, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37862300

RESUMO

The burden of the first year of the coronavirus disease 2019 (COVID-19) pandemic was greater for vulnerable populations, such as immigrants, people living in disadvantaged urban areas, and people with chronic illnesses whose usual follow-up may have been disrupted. Immigrants receiving care for HIV in Seine-Saint-Denis' hospitals have a combination of such vulnerabilities, while nonimmigrant people living with HIV (PLWHIV) have more heterogeneous vulnerability profiles. The ICOVIH study aimed to compare the socioeconomic effects of the COVID-19 crisis as well as attitudes toward COVID-19 vaccination among immigrant and nonimmigrant PLWHIV. A questionnaire assessed vulnerabilities prior to the COVID-19 epidemic and the impact of the early epidemic on administrative, residential, professional, and financial fields. We surveyed 296 adults living with HIV at four hospitals in Seine-Saint-Denis, the poorest metropolitan French department, between January and May 2021. Administrative barriers affected 9% of French-born versus 26.3% of immigrant participants. Immigrants experienced financial insecurity and hunger more often than nonimmigrant participants (21.8% versus 7.1% and 6.6% versus 3%, respectively). Spontaneous acceptance of vaccination was higher among nonimmigrant than among immigrant participants (56.7% versus 32.1%), while immigrants were more likely to wait for their doctor's recommendation or for their doctor to convince them than their French-born counterparts (34.2% versus 19.6%). The trust-based doctor‒patient relationship established through HIV follow-up appeared to be a determining factor in the high acceptance of the COVID-19 vaccine among immigrant participants.


Assuntos
COVID-19 , Emigrantes e Imigrantes , Infecções por HIV , Adulto , Humanos , Vacinas contra COVID-19 , Relações Médico-Paciente , COVID-19/epidemiologia , COVID-19/prevenção & controle , Infecções por HIV/epidemiologia , Hospitais Públicos , Fatores Socioeconômicos , França/epidemiologia
8.
AIDS ; 36(4): F1-F5, 2022 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-35013085

RESUMO

OBJECTIVES: Coronavirus disease 2019 (COVID-19) vaccination is reportedly efficient in people with HIV (PWH) but vaccine trials included participants with normal CD4+ T-cell counts. We analyzed seroconversion rates and antibody titers following two-dose vaccination in PWH with impaired CD4+ T-cell counts. METHODS: We collected retrospective postvaccination SARS-COV-2 serology results available in a university hospital for PWH vaccinated between March and September, 2021 who were tested for antispike antibodies from 8 to 150 days following dose 2. Antibody titers were compared in PWH with CD4+ T-cell count less than 200 cells/µl, 200 < CD4+ T-cell counts < 500 cells/µl and CD4+ T-cell count greater than 500 cells/µl at vaccination. RESULTS: One hundred and five PWH were included: n = 54 in the CD4+ T-cell count less than 500 cells/µl group (n = 18 with CD4+ <200 cells/µl, n = 36 with 200 < CD4+ < 500 cells/µl) and 51 in the CD4+ T-cell count greater than 500 cells/µl group. They received two doses of BNT162b2 (75%), mRNA-1273 (8.5%), or ChAdOx1 nCoV-19 (16.5%). The median time from vaccine dose 2 to serology was consistent across all groups (73 days, interquartile range [29-97], P = 0.14). Seroconversion rates were 100% in the CD4+ T-cell count greater than 500 cells/µl group but 89% in participants with CD4+ T-cell counts less than 500 cells/µl (22 and 5.5% seronegative in the CD4+ T-cell counts <200 cells/µl and 200 < CD4+ < 500 cells/µl groups, respectively). Median antibody titers were 623.8 BAU/ml [262.2-2288] in the CD4+ greater than 500 cells/µl group versus 334.3 BAU/ml [69.9-933.9] in the CD4+ less than 500 cells/µl group (P = 0.003). They were lowest in the CD4+ less than 200 cells/µl group: 247.9 BAU/ml [5.88-434.9] (P = 0.0017) with only 44% achieving antibody titers above the putative protection threshold of 260 BAU/ml. CONCLUSION: PWH with CD4+ T-cell counts less than 500 cells/µl and notably less than 200 cells/µl had significantly lower seroconversion rates and antispike antibody titers compared with PWH with CD4+ T-cell counts greater than 500 cells/µl, warranting the consideration of targeted vaccine strategies in this fragile population.


Assuntos
COVID-19 , Infecções por HIV , Formação de Anticorpos , Vacina BNT162 , Vacinas contra COVID-19 , ChAdOx1 nCoV-19 , Infecções por HIV/epidemiologia , Humanos , Estudos Retrospectivos , SARS-CoV-2 , Vacinação
9.
Infect Dis Now ; 52(2): 61-67, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35085862

RESUMO

Sexual health is an integral part of overall health and should be discussed with all people who seek help. The Vaccination and Prevention working group of the French Infectious Diseases Society (SPILF) and the Migrant Commission of the French AIDS Society (SFLS) developed recommendations to address this issue with migrants presenting vulnerability factors. After defining sexual health and target migrants, practical recommendations were issued. Sexual health can be discussed simply with migrants or people with an immigrant background. Some migrants are exposed to sexual vulnerability due to their migration route, social isolation, administrative and housing insecurity, gender inequalities, and discrimination. Situations of sexual vulnerability, sexual violence, and female genital mutilation should be systematically identified and followed by appropriate care that respects the migrant's needs. Extended screening for HIV and sexually transmitted infections (STI) should be systematically offered as part of a "migrant health checkup" and completed, if necessary, with information on preventing tools for HIV, STIs, unwanted pregnancies, and sexual violence. In this population, it is important to check if vaccinations are up to date. Sexology and addiction counselling is sometimes useful. The specific needs of LGBTQIA+ people with an immigrant background should be taken into account.


Assuntos
Infecções por HIV , Saúde Sexual , Migrantes , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Gravidez , Comportamento Sexual , Sexualidade
10.
Front Public Health ; 8: 443, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33014963

RESUMO

Objectives: To evaluate and compare practices regarding the diagnosis, isolation measures, and treatment of tuberculosis (TB) in high-income countries and mainly in Europe. Materials and Methods: A survey was conducted from November 2018 to April 2019 within the European Society of Clinical Microbiology and Infectious Diseases Study Group for Mycobacterial Infections (ESGMYC). The practices observed were compared to the main international guidelines. Results: Among 136 ESGMYC members, 64 (17 countries) responded to the questionnaire. In their practice, two (20.7%) or three sputum samples (79.3%) were collected for the diagnosis of pulmonary TB, alternatively induced sputum (n = 37, 67.2%), bronchoscopy (34, 58.6%), and gastric aspirates (15, 25.9%). Nucleic acid amplification tests (NAATs) were performed by 41 (64%) respondents whatever the smear result and by 47 (73%) in case of smear-positive specimens. NAAT and adenosine deaminase measurement were used for extrapulmonary TB diagnosis in 83.6 and 40.4% of cases, respectively. For isolation duration, 21 respondents (42.9%) were keeping isolation until smear negativity. An initial treatment without ethambutol was offered by 14% (n = 9) of respondents. Corticosteroid therapy, cerebrospinal fluid opening pressure testing, and repeated lumbar puncture were carried out for central nervous system TB by 79.6, 51.9, and 46.3% of the respondents, respectively. For patients with human immunodeficiency virus-TB coinfection, the preferred antiretroviral therapy included dolutegravir 50 mg twice a day (56.8%). Comparing with the recommendations of the main guidelines, the practices are not totally consistent. Conclusion: This study shows heterogeneous practices, particularly for diagnosis, and isolation, although rapid molecular testing is implemented in most centers. More standardization might be needed.


Assuntos
Tuberculose Pulmonar , Tuberculose , Países Desenvolvidos , Europa (Continente) , Humanos , Escarro , Tuberculose/diagnóstico
11.
ERJ Open Res ; 6(4)2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33257911

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak is a primary global concern, and data are lacking concerning risk of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) environmental contamination. OBJECTIVE: To identify risk factors for SARS-CoV-2 environmental contamination in COVID-19 patients admitted to the intensive care unit (ICU). METHODS: A prospective single centre 1-day study was carried out in an ICU. Four surfaces (the ventilator control screen, the control buttons of the syringe pump, the bed rails and the computer table located >1 m away from the patient) were systematically swabbed at least 8 h after any cleaning process. We analysed clinical, microbiological and radiological data to identify risk factors for SARS-CoV-2 environmental contamination. RESULTS: 40% of ICU patients were found to contaminate their environment. No particular trend emerged regarding the type of surface contaminated. Modality of oxygen support (high-flow nasal cannula oxygenation, invasive mechanical ventilation, standard oxygen mask) was not associated with the risk of environmental contamination. Univariate analysis showed that lymphopenia <0.7×109·L-1 was associated with environmental contamination. CONCLUSION: Despite small sample size, our study generated surprising results. Modality of oxygen support is not associated with risk of environmental contamination. Further studies are needed.

12.
Rev Prat ; 69(6): 676-678, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31626433

RESUMO

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.


VIOLENCES FAITES AUX FEMMES MIGRANTES: MIEUX LES REPÉRER. Aujourd'hui, dans le monde entier, les personnes se déplacent. Les femmes et les filles représentent près de la moitié des 244 millions de migrants. Elles sont parfois amenées à quitter leur pays d'origine pour fuir des violences physiques, psychologiques ou sexuelles et des discriminations liées au genre. Puis la route migratoire et la nouvelle vie en pays d'asile les exposent à des situations de vulnérabilité et elles sont donc à risque d'abus physique, psychologique ou sexuel. Le risque de contamination par le virus de l'immuno déficience humaine est important. Dans les pays d'accueil, les praticiens reçoivent ces femmes pour des motifs de consultation divers. Connaître leur parcours permet de les accompagner et de leur proposer une prise en charge adaptée à leurs besoins et à leurs demandes. La première étape est le dépistage systématique par les professionnels. Ensuite, la prise en charge pluridisciplinaire est essentielle : acteurs sociaux, psychologues, sexologues, infectiologues, gynécologues, médecins spécialistes de la douleur… Cela implique une formation spécifique des professionnels confrontés à ces populations.


Assuntos
Violência Doméstica , Refugiados , Delitos Sexuais , Migrantes , Feminino , Infecções por HIV , Humanos , Refugiados/psicologia , Migrantes/psicologia , Violência
13.
Arch Dis Child ; 104(7): 629-635, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30127061

RESUMO

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.


Assuntos
Mycobacterium tuberculosis/isolamento & purificação , Manejo de Espécimes/métodos , Escarro/microbiologia , Tuberculose Pulmonar/diagnóstico , Criança , Serviços de Saúde da Criança , Humanos , Tuberculose Pulmonar/microbiologia , Tuberculose Pulmonar/patologia
14.
Travel Med Infect Dis ; 29: 40-47, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30951905

RESUMO

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.


Assuntos
Infecções por HIV/tratamento farmacológico , Migrantes/estatística & dados numéricos , Doença Relacionada a Viagens , África Subsaariana/etnologia , Antirretrovirais/uso terapêutico , Febre/epidemiologia , França/epidemiologia , Gastroenteropatias/epidemiologia , Infecções por HIV/virologia , Humanos , Malária/epidemiologia , Malária/mortalidade , Doenças Respiratórias/epidemiologia , Fatores de Risco , Carga Viral
17.
Int J Antimicrob Agents ; 52(3): 385-389, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29906564

RESUMO

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.


Assuntos
Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Doenças Transmissíveis Importadas/epidemiologia , Doenças Transmissíveis Importadas/transmissão , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/transmissão , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Bactérias Gram-Positivas/transmissão , Enterococos Resistentes à Vancomicina/isolamento & purificação , Enterobacteriáceas Resistentes a Carbapenêmicos/efeitos dos fármacos , Estudos de Casos e Controles , Doenças Transmissíveis Importadas/terapia , Farmacorresistência Bacteriana Múltipla , Infecções por Enterobacteriaceae/microbiologia , Infecções por Enterobacteriaceae/terapia , Escherichia coli/efeitos dos fármacos , Escherichia coli/genética , Proteínas de Escherichia coli/genética , Feminino , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/terapia , Hospitalização/estatística & dados numéricos , Humanos , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/genética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Viagem , Enterococos Resistentes à Vancomicina/efeitos dos fármacos , beta-Lactamases/genética
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