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Background: Malaria antibody detection is a valuable tool in the prevention of transfusion-transmitted malaria in countries with a high proportion of donors with travel exposure to malaria. The immunofluorescent antibody test (IFAT) is still the reference method, but it is not suitable for screening of blood donors. ELISA would be an interesting alternative to the IFAT, but it lacks sensitivity.Study Design and Methods: To evaluate the potential value of a combined screening strategy based on malaria antigen and antibody detection, plasma samples from 203 patients infected with Plasmodium falciparum were tested with an ELISA for the detection of malaria antibodies (Malaria IgG CELISA, Cellabs) and a P. falciparum histidine-rich protein-2 kit (Malaria P.f., ICT Diagnostics) for the detection of malaria antigens.Results: Among patients with positive IFAT results, CELISA had a sensitivity of 71 percent, whereas the combined screening tests (CELISA and Malaria P.f.) had a sensitivity of 88 percent (p < 0.001). Sequential samples from 50 patients were tested. The combined screening tests shortened the detection of seroconversion from 11.4 +/- 1.6 to 5.3 +/- 1.1 days (p < 0.001).Conclusion: Combined malaria antigen and antibody detection, with methods compatible with mass screening, may constitute an attractive alternative to the IFAT for blood donor screening. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To describe the evolving epidemiology, management, and risk factors for death of invasive Candida infections in intensive care units (ICUs). DESIGN: Prospective, observational, national, multicenter study. SETTING: One hundred eighty ICUs in France. PATIENTS: Between October 2005 and May 2006, 300 adult patients with proven invasive Candida infection who received systemic antifungal therapy were included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: One hundred seven patients (39.5%) with isolated candidemia, 87 (32.1%) with invasive candidiasis without documented candidemia, and 77 (28.4%) with invasive candidiasis and candidemia were eligible. In 37% of the cases, candidemia occurred within the first 5 days after ICU admission. C. albicans accounted for 57.0% of the isolates, followed by C. glabrata (16.7%), C. parapsilosis (7.5%), C. krusei (5.2%), and C. tropicalis (4.9%). In 17.1% of the isolates, the causative Candida was less susceptible or resistant to fluconazole. Fluconazole was the empirical treatment most commonly introduced (65.7%), followed by caspofungin (18.1%), voriconazole (5.5%), and amphotericin B (3.7%). After identification of the causative species and susceptibility testing results, treatment was modified in 86 patients (31.7%). The case fatality ratio in ICU was 45.9% and did not differ significantly according to the type of episode. Multivariate analysis showed that factors independently associated with death in ICU were type 1 diabetes mellitus (odds ratio [OR] 4.51; 95% confidence interval [CI] 1.72-11.79; p = 0.002), immunosuppression (OR 2.63; 95% CI 1.35-5.11; p = 0.0045), mechanical ventilation (OR 2.54; 95% CI 1.33-4.82; p = 0.0045), and body temperature >38.2 degrees C (reference, 36.5-38.2 degrees C; OR 0.36; 95% CI 0.17-0.77; p = 0.008). CONCLUSIONS: More than two thirds of patients with invasive candidiasis in ICU present with candidemia. Non-albicans Candida species reach almost half of the Candida isolates. Reduced susceptibility to fluconazole is observed in 17.1% of Candida isolates. Mortality of invasive candidiasis in ICU remains high. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Comparison of treatments initiated during invasive candidiasis in intensive care units with current French guidelines. Study design: Prospective, observational, French multicenter study (October 2005–May 2006). Patients and methods: Selection of patients with Candida species identification and in vitro antifungal susceptibility determination. The empiric treatments instituted before the microbiologic documentation of infection and the curative treatments instituted after identification of the causative Candida and determination of its susceptibility were collected and compared with treatments proposed by the French clinical practice guidelines (2004) for the management of patients with invasive candidiasis. Results: One hundred and eighty-six patients were studied. Invasive candidiasis was due to fluconazole-resistant or susceptible-dose dependent Candida in 18.3% of patients, without any significant influence of a previous treatment with azoles. Empiric and curative treatments were both in accordance with recommendations for 47% of patients. Recommendations were mainly not respected when proposed therapy was amphotericin B that disappeared from therapeutics used in ICU. Finally, 16.9% of episodes of invasive candidiasis, for which fluconazole was the recommended treatment, were due to fluconazole-resistant or susceptible-dose dependent Candida. Conclusion: The support of French ICU physicians to current French guidelines was observed in 47% of cases. The infrequent use of amphotericin B must be emphasized. The nonnegligible incidence of fluconazole-resistant or susceptible-dose dependent Candida sp., particularly in patients without any prior exposition to azole agents, and the inability to predict this resistance should lead to propose a revision of 2004 guidelines. [Copyright &y& Elsevier]

Most of the published works so far have aimed at finding genes associated with multiple sclerosis (MS) susceptibility. Very few studies have attempted to correlate disease features with DNA variants. In a well-characterized sample (651 patients) representative of multiple sclerosis natural history, we engaged a comprehensive study of the role of human leukocyte antigen (HLA) in the course of the disease. We investigated the role of HLA-DRB1*15 allele in samples stratified according to severity evaluated by the Multiple Sclerosis Severity Score (MSSS), time to reach EDSS 6.0 and disease type. We found that HLA-DRB1*15 genotype does not influence MS severity even among patients presenting with a given type of the disease. However, we show for the first time that HLA-DRB1*15 allele modulates the course of MS for relapsing–remitting (RR) onset patients likely by precipitating the secondary progressive (SP) phase.Genes and Immunity (2008) 9, 570–574; doi:10.1038/gene.2008.52; published online 10 July 2008 [ABSTRACT FROM AUTHOR]

The transmission of viral hepatitis from health care workers (HCW) to patients is of worldwide concern. Since the introduction of serologic testing in the 1970s there have been over 45 reports of hepatitis B virus (HBV) transmission from HCW to patients, which have resulted in more than 400 infected patients. In addition there are six published reports of transmissions of hepatitis C virus (HCV) from HCW to patients resulting in the infection of 14 patients. Additional HCV cases are known of in the US and UK, but unpublished. At present the guidelines for preventing HCW to patient transmission of viral hepatitis vary greatly between countries. It was our aim to reach a Europe-wide consensus on this issue. In order to do this, experts in blood-borne infection, from 16 countries, were questioned on their national protocols. The replies given by participating countries formed the basis of a discussion document. This paper was then discussed at a meeting with each of the participating countries in order to reach a Europe-wide consensus on the identification of infected HCWs, protection of susceptible HCWs, management and treatment options for the infected HCW. The results of that process are discussed and recommendations formed. The guidelines produced aim to reduce the risk of transmission from infected HCWs to patients. The document is designed to complement existing guidelines or form the basis for the development of new guidelines. This guidance is applicable to all HCWs who perform EPP, whether newly appointed or already in post. [Copyright &y& Elsevier]

To measure the prevalence and intensity of pain in hospitalized patients and to assess the quality of pain management, an exhaustive cross-sectional study was conducted in every department in a university hospital. Patients hospitalized for 24 hours or more completed an anonymous self-report questionnaire. Among the 1,475 inpatients, 998 completed the questionnaire. During the 24-hour period prior to our survey, 55% experienced pain. On 100 mm pain intensity measures, the median maximum pain experienced in the 24 preceding hours was 60 mm and the median pain intensity at the time of the survey was 30 mm. Although pain measured at the time of survey disappeared in only 16% of patients, 79% were satisfied with pain management. Despite a high satisfaction level, the prevalence and intensity of pain were very high. This study provided baseline data on pain in a French hospital and led to the implementation of a program for improving pain management. [ABSTRACT FROM AUTHOR]

We prospectively evaluated serum procalcitonin concentrations in patients who presented to an emergency department (ED) with suspected infectious or inflammatory disease. Of 195 study patients, 68 had final diagnosis of systemic infection, and 24 of those 68 had elevated serum procalcitonin levels (0.5 ng/mL). The procalcitonin level had a sensitivity of 0.35 and specificity of 0.99 for the diagnosis of systemic infection. In multivariate analysis, the procalcitonin level was the only independent variable associated with this diagnosis; in contrast, the C-reactive protein level was not. All patients with systemic infections who ultimately died had procalcitonin levels of 1 0.5 ng/mL at admission. Procalcitonin levels were significantly higher in patients who ultimately died of systemic infection than in patients who survived. The optimal procalcitonin threshold for the ED population may be lower than that proposed for critically ill patients. Determination of the procalcitonin level may be useful for screening and prognosis of more-severely ill ED patients. [ABSTRACT FROM AUTHOR]

Introduction La polémique née au début des années 90 de l’observation d’atteintes neurologiques démyélinisantes telles que la sclérose en plaques chez des sujets vaccinés quelques semaines auparavant contre l’hépatite B a laissé des traces dans l’esprit du public comme dans celui du corps médical, bien qu’aucune des études épidémiologiques menées ensuite sur ce sujet n’ait mis en évidence l’existence d’un lien de causalité entre ces événements et le vaccin de l’hépatite B. De ce fait, beaucoup de médecins encore maintenant sont réticents à vacciner un patient atteint de sclérose en plaques quel que soit le vaccin à administrer, mais surtout lorsqu’il s’agit d’un vaccin vivant tel que celui de la fièvre jaune, redoutant de provoquer une poussée évolutive ou une aggravation de la maladie en stimulant le système immunitaire. Pour d’autres praticiens au contraire, le rapport bénéfice/risque est en faveur de la vaccination chez ces patients. Matériels et méthodes Afin de mieux connaître les facteurs pouvant influer sur les attitudes et les pratiques dans cette situation, une enquête par questionnaire électronique a été réalisée au centre médical de l’institut Pasteur selon la méthode Delphi auprès de médecins de centres de conseils aux voyageurs (CCV), de neurologues et d’infectiologues. Résultats Des deux tours de questionnaire effectués, il ressort que les experts dans leur majorité pensent qu’il est possible de vacciner un patient atteint de SEP avec un vaccin inerte quel qu’il soit ; la majorité pense également qu’un vaccin vivant atténué peut être administré à un patient atteint de SEP ne recevant pas de traitement immunosuppresseur ou n’en recevant plus depuis au moins 3 mois. Si le déplacement est prévu dans une zone d’endémie amarile, la plupart des experts sont d’accord pour vacciner ce voyageur contre la fièvre jaune s’il n’est pas sous traitement immunosuppresseur ; seule une minorité lui conseille de renoncer à son voyage et aucun d’entre eux ne préfère lui proposer un certificat de contre-indication au vaccin amaril. Conclusion Les experts ayant répondu aux questions posées dans cette enquête, s’accordent sur le fait que la sclérose en plaques ne constitue pas en soi une contre-indication aux vaccinations en général ; une personne atteinte de SEP doit pouvoir bénéficier des vaccins dont elle a besoin, sous réserve d’une bonne évaluation du rapport bénéfice/risque. [ABSTRACT FROM AUTHOR]

Assesses the level of agreement between the terminal care support teams (TCST) and other hospital care providers in identifying terminal care inpatients. Overview on the cross-sectional descriptive study; Consensual answer of the care providers compared to the gold standard; Applicability of the definition of care providers.