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Background Lumbar canal stenosis (LCS) is a clinicopathological and radiological disease first described in 1949, causing a neurovascular compression leading to back pain, radicular, sensory or motor deficit which treatment is difficult. Objectives The objectives of our study were appraisal of a protocolized treatment for 3 months and identification of predictive factors for failure of medical treatment. This is a prospective nonrandomized study with no control group. All patients satisfying inclusion criteria were included after clinical and radiological evaluation. Methods Clinical inclusion criteria were neurogenic claudication, radiculopathy at rest with or without back pain, mono or multirooted sensory, motor or reflex abnormalities of the lower limbs. Radiological inclusion criteria were: anteroposterior dural sac diameter 2 , reduction in the anteroposterior diameter of the spinal canal >25% on myelography in supine extended position. Results Included patients had at least one clinical and one radiological criteria. Treatment was 2 epidural injections of 125 mg hydrocortancyl 15 days apart, combined with NSAIDs or analgesic, associated with physiotherapy sessions over 2 months. 147 patients were included. Mean age was 62±13 years. F/M sex ratio is 1.3. Mean BMI was 27.5±4.3, overweight was present in 72.1%. At baseline, mean duration for back pain and radicular pain were 9.3±10.5 and 4.4±5.7years. Primary objective was evolution of the Oswestry [1] score (a low back pain disability questionnaire) at 3 months as compared to baseline. Secondary objective was the evolution of pain. At the end of treatment, the mean value for the Oswestry score decreased from 41.2 to 39.7 (p=0.17). Mean VAS for lumbar pain decreased from 53.6 to 42.1 (p BMI, duration of back and radicular pain, mean lumbar radicular VAS and mean Oswestry score at inclusion were not significantly different in improved and non improved patients. Predictors of good response to treatment were the initial presence of impulsivity cough and nocturnal pain. Conclusions In conclusion with this approach there was no significant decrease in Oswestry score, however there was a significant decrease in mean VAS lumbar and radicular pain. No predictor of poor response has been highlighted. Predictors of good response were the initial presence of impulsivity at cough and nocturnal pain. These results show the limits of medical treatment in the management of SCL. References Niskanen RO, The Oswestry Low Back Pain Disability Questionnaire. a two-year follow-up of spine surgery patients. Scand J Surg, 2002 91 (2):. P. 208-11. Disclosure of Interest None declared

Facial nerve palsy is a frequent situation of varying etiology and the former concept of frozen facial nerves is progressively being abandoned. The HTLV-1 virus, endemic to some tropical areas, is one of the most recent causes discovered.We present two HTLV-1 seropositive patients of Caribbean origin who developed facial palsy and several complications related to this retrovirus.When confronted with facial palsy, the presence of risk factors for HTLV-1 infection (particularly when native in high seroprevalence areas) must lead to serological examinations in the search for this retrovirus.

Introduction La maladie de Kikuchi Fujimoto (MKF) est une lymphadenite necrosante d’evolution benigne decrite initialement dans les populations asiatiques. Il n’y a aucune description des caracteristiques de cette maladie dans les populations originaires d’Afrique noire alors qu’elle est liee au lupus systemique (LS) dont on connait la frequence et la gravite dans les populations d’ascendance africaine. Il n’y a pas non de donnees epidemiologiques. L’objectif de cette etude est de (1) caracteriser la MKF dans les departements francais d’Amerique (DFA) ou la population est majoritairement d’origine africaine, (2) presenter une incidence en Martinique. Patients et methodes Etude retrospective multicentrique descriptive des patients porteurs d’une MKF suivis dans 7 hopitaux des 3 DFA. Etude epidemiologique par recoupement de sources sur la Martinique (2 seuls laboratoires d’anatomo-pathologie de l’ile, departement d’informatique du CHU de Martinique, services de medecine interne, ORL, rhumatologie, pediatrie). Les criteres d’inclusion etaient : patients d’origine martiniquaise, guadeloupeenne ou guyanaise au moment d’une biopsie compatible avec une MKF (habitant en Martinique pour l’etude epidemiologique) Resultats Il s’agissait de 27 femmes et 9 hommes d’âge moyen au diagnostic de 30,5 ans (5–59 ans) dont 9 presentaient au moins 2 episodes. Le delai moyen de diagnostic etait de 12,8 semaines (1–49). La localisation des adenopathies etait cervicale dans 88.8 %, axillaires dans 53.3 %. Les adenopathies etaient douloureuses dans 61.8 %. La fievre etait presente dans 83.3 %. Des manifestations extra-ganglionnaires etaient presentes : cutanees (37.9 %), organomegalie (17.8 %). Trois patients (8.33 %), tous lupiques, presentaient une forme severe : syndrome d’activation macrophagique (n = 2), neuropathie peripherique (n = 1). Sur l’ensemble de la cohorte, une maladie auto-immune associee etait presente dans 14 cas (38.8 %) : LS (n = 9 ; 25 %), lupus cutane chronique (n = 2 ; 5.6 %), Sjogren primaire probable (n = 2 ; 5.6 %), arthrite chronique juvenile (n = 1 ; 2.8 %). En Martinique a base de population, on retrouvait un lupus chez 27.3 % des MKF. Cette maladie etait decouverte concomitamment dans 8 cas, apparaissait apres la MKF dans 1 cas et etait deja presente dans 5 cas. La seule infection concomitante a une MKF est liee a un coxsackie avec syndrome pieds-mains-bouche, apparue chez la patiente ayant une arthrite chronique juvenile et dont la mere a un lupus. Un amaigrissement important, des lesions cutanees, une lymphopenie, et la presence d’anticorps antinucleaires chez une femme suggeraient l’existence d’un lupus sous jacent. Entre 1990 et 2013, 22 patients presentaient une MKF en Martinique, amenant a une incidence annuelle moyenne brute de 2.23 cas/1 000 000 habitants. Conclusion Les caracteristiques de la MKF dans notre population par rapport aux autres populations decrites dans la litterature sont une grande frequence de l’association avec le lupus. Il s’agit des premieres donnees sur l’epidemiologie de la MKF, qui semble peu frequente. Il reste difficile de dire si ces chiffres peuvent etre extrapoles a des populations d’autre origine ethnique.

Introduction L’atteinte ORL des myopathies inflammatoires est peu decrite dans la litterature. Elle est pourtant grave, associee a d’autres atteintes severes comme la myocardite et frequemment meconnue lorsque prise en charge par un non specialiste de ces pathologies. Patients et methodes Etude retrospective monocentrique d’un centre de competence referent pour les petites Antilles des maladies auto-immunes systemiques. Les criteres d’inclusion comprenaient : – atteinte ORL : manifestations cliniques (modification de la voix et/ou fausses routes) et consultation ORL ou orthophoniste ; – diagnostic de myosite : deficit rhizomelique et soit autoanticorps specifique des myosites avec des CPK > 3 fois la norme, soit biopsie et/ou IRM musculaires evocateurs ; – criteres internationaux des autres maladies autoimmunes. L’objectif de cette etude est de decrire les caracteristiques et l’evolution de cette atteinte dans une population d’origine Africaine. Resultats Il s’agissait de 12 femmes et 3 hommes d’âge moyen au diagnostic de 43,5 ans (18-78 ans) dont 4 sur 15 (26,7 %) presentaient au moins 2 episodes, dans un delai moyen de 35 mois (21–72 mois). Tous etaient originaires de Martinique sauf 3 (Dominique, Guyane, Saint-Martin). Le delai moyen entre le debut de la myosite et l’atteinte ORL etait de 3,2 mois. La duree moyenne de suivi etait de 4,05 annees (0–15 ans). La frequence des differentes maladies en cause etait : 2 dermatomyosites (13 %), 5 polymyosites (33 %), 2 syndromes des antisynthetases (13 %), 4 lupus (27 %), 2 connectivites mixtes (13 %). Les CPK etaient eleves dans 14 cas. Les anticorps antinucleaires etaient presents dans 13 cas (> 1/160). Les autoanticorps specifiques des myosites etaient retrouves chez 7 patients : SRP (n = 3), PmScl (n = 2), PL12 (n = 1), Jo1 (n = 1). Les manifestations etaient : voix modifiee (n = 4), fausses routes (n = 3), dysphagie (n = 7), vomissements (n = 1), hypersialorrhee (n = 1), dyspnee (n = 8), myocardite (n = 5), arret respiratoire (n = 1). Six (40 %) patients etaient admis en reanimation, 6 (40 %) presentaient une infection pulmonaire. Quatre patients (27 %) necessitaient une intubation orotracheale et 1 une tracheotomie. Dix (67 %) ont eu au moins un bolus de solumedrol avec un relai a fortes doses, 11 patients (73,3 %) ont beneficie d’immunoglobulines polyvalentes intra-veineuses a 2 g/kg (min. 1–max. 11 cures). Les immunosuppresseurs utilises etaient : endoxan (n = 6), azathioprine (n = 4), mycophenolate mofetil (n = 2). La recuperation etait constatee chez 6 patients avant 1 mois (dont 3 patients dans les 3 premiers jours de traitement), 3 patients entre 1 et 6 mois, et 3 patients en plus de 6 mois, avec un delai moyen de 4 mois (3 jours a 1 an). Le deces concernait une patiente (hypertension pulmonaire et myocardite). Deux patients (13,3 %) gardaient des sequelles permanentes a type de dysphagie non severe et une de dysphonie. Conclusion Dans notre population, cette atteinte severe se rencontre dans de nombreuses pathologies auto-immunes systemiques autres que dermatomyosites et polymyosites. Sa gravite reste elevee, doit etre connue, systematiquement recherchee et traitee au plus vite. Quelques patients presentent des sequelles ORL de cette atteinte. L’atteinte specifique myocardique est frequemment retrouvee chaez nos patients.

We report the onset of an urban epidemic of human myiasis caused by Dermatobia hominis. To our knowledge, this is the first urban epidemic described for D. hominis. The epidemic was most likely related to exceptional weather conditions and notably high rainfall in January 2000, which may have facilitated the maturation of the pupae.

Background No study describes the frequency of Behcet’s disease (BD) in the populations of African origin and its characteristics. Objectives To retrospectively assess by retrieval of multiple sources, the epidemiology and characteristics of BD in the mainly African descent population of Martinique, a French Island in the Caribbean. Methods In 2011 we consulted 5 different sources. Patients were included if they lived in Martinique, were classified as certain if they fulfilled the international criteria for BD. The diagnosis was considered only as probable if they had recurrent oral ulcers with at least one other international criteria but no other possible diagnosis. The incidence during the 1997-2011 interval and prevalence at December 31, 2010 were calculated. Basic and BD-related characteristics were recorded. Results 48 patients were indicated as BD. Only 36 (female, n=22; male, n=14) fulfilled the criteria. Mean age at diagnosis was 38.5 years old (range: 8-64), 36.6 for women and 41.6 for men. Disease onset was over 50 years old for 7 patients. Mean time between first signs and diagnosis was 4.2 years (range: 0-22). Twenty eight began their disease between 1997 and 2011 allowing a total crude mean annual incidence estimation of 0.72 new cases/10 5 inhabitants (0.79/10 5 for female and 0.59/10 5 for males, 0.37/10 5 for certain cases and 0.35/10 5 for probable). In December 2010, 28 patients were alive, 5 lost to follow up and 3 deceased: the crude prevalence was estimated as 7.04/10 5 inhabitants (Female: 7.49; male: 6.51). Genital ulcers were found in 75.6%. Dermatological manifestations were: pseudofolliculitis (52%), erythema nodosum (13.5%). Pathergy test was done for 6 patients and positive for 4. Nine patients had ophthalmologic involvement: anterior uveitis (55.5%, n=5), panuveitis and posterior uveitis (11.1%, n=1 each), conjunctival ulceration (22.2%, n=2). Parenchymal brain involvement was more frequent than non-parenchymal (7 versus 3 patients) without any cerebral venous thrombosis. Rheumatic manifestations were occurred in 20 patients (55.6%) mainly females (60%): polyarthritis (38.9%), monoarthritis and spondylarthropathy (11.1% each). Deep vein thromboses were seen in 2 cases and superficial in 1, central retinal artery occlusion in 1 patient. The colon was involved in 6 cases and the ileo-cecal region in one. Conclusions In Martinique, BD seems to be a rare disease compared to Mediterranean and most Asian countries. The incidence is comparable to Spain and Switzerland. The prevalence is higher than in most European countries and USA. Black population seems to have particular manifestations of BD: older age at onset and rare uveitis. Disclosure of Interest None Declared

Abstract 964 Background: High dose immunosuppressive therapy and hematopoietic stem cell transplantation (HSCT) has shown efficacy in severe or rapidly progressive systemic sclerosis (SSc) in phase 1 and 2 trials with durable responses in two thirds of patients (pts), while a recent phase 2 randomised trial in 19 SSc pts showed superior benefit of HSCT over iv pulse cyclophosphamide (Cy) on skin score and lung function. Methods: The ASTIS-trial (Autologous Stem cell Transplantation International Scleroderma trial) is a multinational prospective randomized controlled phase 3 trial, comparing safety and efficacy of HSCT versus Cy in early progressive dcSSc pts with disease duration of a) 4 years or less and evidence of organ involvement or b) of 2 years or less and evidence of systemic inflammation with or without major organ involvement. Major exclusion criteria were: concomitant severe SSc disease (mean PAP > 50 mmHg, DLCO < 40% predicted, creatinine clearance (CCl) 5gr iv or >3months oral) treatment), liver failure. Pts randomized to the transplant arm underwent mobilization with Cy 2×2 g/m2 + G-CSF 10mcg/kg/d, conditioning with Cy 200 mg/kg, rbATG 7.5 mg/kg, followed by reinfusion of CD34+ autologous HSCT. Controls were treated with 12× monthly iv pulse Cy 750 mg/m2. Crossing over was allowed after 2 years. The primary endpoint was event-free survival (EFS), defined as survival until death or development of major organ failure at 2 yrs. Toxicity according to WHO criteria and progression free survival (defined as worsening of modified Rodnan skin score, functional ability, major organ function) were the main secondary endpoints. The effects of treatment were analyzed on an ITT basis and by comparing EFS using the KM survival curves (using log-rank test) and Cox models. Results: 156 pts (female 59%), from 27 centers were enrolled in 10 countries from March 2001 until October 2009 and randomized to HSCT (n=79) or iv pulse Cy (n=77). Seventy-five pts in each arm started treatment, 70 pts in HSCT and 58 pts in control groups completed treatment. The median time (Interquartile Range (IR)) from randomization to completion of treatment was 93 (43.0) days in the HSCT and 338 (41.75) days in the control groups respectively. Baseline characteristics (mean (SD)) of the pts were: age 44 (11.2) yrs, SSc duration 1.4 (1.3) yrs, BMI 24 (14.4), Rodnan skin score 25 (8), HAQ 1.35 (0.8), prior Cy therapy 22%, creat cl 116 (39.5) ml/min, LVEF 65% (8.5), DLCO 59% (14), with no significant differences between the 2 arms. With data cut at 1 May 2012, median follow-up (IR) are 33 (42.0) and 27 (34.0) months in the HSCT and control groups respectively. Forty two events occurred : 18 in the HSCT group (16 deaths and 2 irreversible renal failures) and 24 in the control group (24 deaths). Event-free survival was time-dependent with a hazard ratio at 84 months of 0.22 (95% CI 0.08–0.58, P= 0.002). Eight deaths (including 1 during mobilization and 1 after conditioning) in the HSCT group were deemed treatment-related by the independent data monitoring committee with heart failure (3), ARDS (2), multiple organ failure (2) and pulmonary oedema (1) as the causes of death. In the control group, none died from treatment causes and most deaths were due to progressive disease. Eight pts in the control arm received rescue HSCT treatment, one of whom later died from secondary acute myeloid leukaemia. Two HSCT pts received rescue iv Cy therapy. Conclusions: The ASTIS-trial is the first international, investigator-initiated, phase 3 HSCT trial in early diffuse cutaneous systemic sclerosis. The data show that despite 10% treatment-related mortality, long term event-free survival and overall survival were better in the HSCT group than in the group treated with iv pulse cyclophosphamide. (Funded by the European Group for Blood and Marrow Transplantation, European League Against Rheumatism, AP-HP, NIHR, DIGR, Imtix-Sangstat, Miltenyi-Biotec, Amgen Europe; Current Controlled Trials number, ISRCTN 54371254). Disclosures: No relevant conflicts of interest to declare.

A healthy 32-year-old Afro-Caribbean man was referred to our hospital with suspected systemic vasculitis and chondritis because of symmetrical polyarthritis, recurrent erythematous lesions of the trunk and the face previously considered to be urticarian, and extremities swelling with distal symmetrical glove and stock sensory loss over a two-year period. He did not receive any antibiotics and corticosteroids. We observed bilateral ear pseudochondritis (Figure 1) with skin involvement of the lobule and limited tenderness, which excluded true chondritis that involved only cartilaginous areas, as seen in relapsing polychondritis, Wegener's granulomatosis, or mouth and genital ulcers with inflamed cartilage (MAGIC) syndrome. Figure 1. Pseudochondritis in an Afro-Carribean man with leprosy. This figure appears in color at www.ajtmh.org. True chondritis usually shows tenderness. Differential diagnosis of unilateral or bilateral pseudochondritis included infections, trauma, insect bite, tophaceous gout, radiotherapy, allergy, burn, or chilblain. Slight maculopapular lesions on the face compatible with leonine facies, papular erythematous geographic plaque-like lesions with two punch-out areas, presence of acid-fast bacilli in skin biospy specimens, and mucosal excretions enable diagnosis of lepromatous leprosy. Pseudochondritis is rarely reported in leprosy, and today is seen only in the lepromatous type.1 Ulceration, megalobule, and nodulation over the pinna may be seen.2 The patient was treated with rifampin, ofloxacine, and disulone. He showed rapid improvement at a one-year follow-up, but disease recurrence occurred one year later.

Service de Medecine Interne, Hopital Claude-Huriez, Universite Lille 2; CHRU, Lille, France; 2 Service d’Hematologie, Hopital Hotel-Dieu, Assistance Publique-Hopitaux de Paris, Paris, France; 3 Service de Radiologie, Hopital Saint-Louis, Assistance Publique-Hopitaux de Paris, Paris, France; 4 Service de Medecine Interne et Pathologie Vasculaire, Hopital Saint-Louis, Assistance Publique-Hopitaux de Paris, Paris, France; 5 Departement de Biostatistique et Infomatique Medicale, Hopital Saint-Louis, Assistance Publique-Hopitaux de Paris, Paris, France; 6 Service de Medecine Interne, CHU, Fort-de-France, France ; 7 Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK; 8 Unite INSERM U 697 France , Hopital Saint-Louis, Paris, France

Introduction Autologous Hematopoietic Stem Cell transplantation (AHSCT) is used since 1994 worldwide to treat severe autoimmune disease (AD) refractory to standard therapy. Despite early release and regular update of the European Society for Blood and Marrow Transplantation (EBMT) practice guidelines (Snowden JA et al BMT 2012, Alexander T et al BMT 2014) along with 3 randomised Clinical trials (CTs) for Systemic Sclerosis (SSc) ASTIS, Crohn's Disease (CD) ASTIC and Multiple sclerosis (MS) ASTIMS, the uptake of this approach varies according to each ADs and between countries. We therefore design this retrospective study to evaluate patients (pts) outcomes as reported to the French Bone Marrow Transplantation Society registry (SFGMT-TC) in light of the other States activity published or reported to the EBMTregistry. Materials and methods All AHSCT for adult AD pts (> 18 years (yrs)) reported in France from 1997 to 2013 with at least one yr follow-up after AHSCT were included in the study. Primary data were derived from the EBMT registry (MED-A/B forms) with additional data obtained through a specific questionnaire (MED-C) for the study. Primary end point is overall survival (OS), defined as time since the day of transplant to death, irrespective of the cause. Secondary end points are Progression Free Survival (PFS), 100 day treatment related mortality (100-day TRM) and non-relapse related mortality (NRM). The probabilities were estimated using the Kaplan-Meier estimator for OS and PFS, cumulative incidence for NRM, relapse/progression being the competing event. All tests were two-sided. Statistical analyses were performed with IBM SPSS Statistics 22.0 and R version 3.1.2 (R Development Core Team, Vienna, Austria) software packages. Results 96 adult pts (55% Female), median age 45 yrs [20-71], underwent a first AHSCT for ADs in 19 HSCT Units. Most of the ADs were rheumatological(72%) with 55 SSc, 7 polymyositis-dermatomyositis, 3 polychondritis, 2 Lupus Erythematosus, 1 Rheumatoid Arthritis (RA), 1 Ankylosing Spondylitis, or neurological (15%) with 14 MS, whereas the others were 5 CDs, 5 immune thrombocytopenic purpura, 1 hemolytic autoimmune anemia, 1 IgM neuropathy and 1 POEMS syndrome. Two pts had 2 simultaneous ADs (1 SSc and RA, 1 CD and RA). Median duration between AD diagnosis and AHSCT was 3.5 yrs [1-33]. With a median follow-up of 7 yrs [ Conclusion AHSCT for severe ADs, has progressively developed in France, allowing 5y OS equal to 79.4%, similar to UK (Snowden JA et al, BJH 2012) and EBMT data. In rapidly progressive severe SSc, where the proof of efficacy of AHSCT was obtained (Van Laar J and Farge D et al, JAMA 2014) and in MS (Pasquini MC et al BBMT 2010) where long-term responses are confirmed worldwide, the French and the EBMT registry activities have increased over the past 14 years, with sustained positive clinical results despite non negligible NMR, which remains lower than spontaneous AD evolution. Meanwhile, AHSCT activity has become exceptional in RA due to the availability of safe and effective biological therapies, and other indications remain rare, such as for CD or SLE where the risk of AHSCT in highly immunosuppressed patients has to be balanced with ADs severity. More than half of French pts were treated on an individual basis, outside CTs, underlying the need to evaluate national activity and to promote education of HSCT Unit members. At each French or other European state levels, like in the US, the indications for AHSCT in ADs remain low due to other competing therapies. Combined study using European and American data registry will allow analysis of a larger number of AD pts treated by AHSCT and would offer more clues to better understand the determinants of the response and to refine indications for each AD type. Disclosures Leblond: Gilead: Consultancy, Honoraria, Speakers Bureau; Janssen: Consultancy, Honoraria, Speakers Bureau; Roche: Consultancy, Honoraria, Other: Travel, Accommodations, Expenses, Speakers Bureau; GSK: Consultancy, Honoraria, Speakers Bureau; Mundipharma: Honoraria. Snowden:MSD: Consultancy, Other: Educational support, Speakers Bureau; Janssen: Other: Educational support, Speakers Bureau; Celgene: Other: Educational support, Speakers Bureau; Sanofi: Consultancy.

International audience; The French National Reference Center for Invasive Mycoses and Antifungals leads an active and sustained nationwide surveillance program on probable and proven invasive fungal diseases (IFDs) to determine their epidemiology in France. Between 2012 and 2018, a total of 10,886 IFDs were recorded. The incidence increased slightly over time (2.16 to 2.36/10,000 hospitalization days, P = 0.0562) in relation with an increase of fungemia incidence (1.03 to 1.19/10,000, P = 0.0023), while that of other IFDs remained stable. The proportion of ≥65-year-old patients increased from 38.4% to 45.3% (P < 0.0001). Yeast fungemia (n = 5,444) was due mainly to Candida albicans (55.6%) with stable proportions of species over time. Echinocandins became the main drug prescribed (46.7% to 61.8%), but global mortality rate remained unchanged (36.3% at 1 month). Pneumocystis jirovecii pneumonia (n = 2,106) was diagnosed mostly in HIV-negative patients (80.7%) with a significantly higher mortality than in HIV-positive patients (21.9% versus 5.4% at 1 month, P < 0.0001). Invasive aspergillosis (n = 1,661) and mucormycosis (n = 314) were diagnosed mostly in hematology (>60% of the cases) with a global mortality rate of 42.5% and 59.3%, respectively, at 3 months and significant changes in diagnosis procedure over time. More concurrent infections were also diagnosed over time (from 5.4% to 9.4% for mold IFDs, P = 0.0115). In conclusion, we observed an aging of patients with IFD with a significant increase in incidence only for yeast fungemia, a trend toward more concurrent infections, which raises diagnostic and therapeutic issues. Overall, global survival associated with IFDs has not improved despite updated guidelines and new diagnostic tools.IMPORTANCE The epidemiology of invasive fungal diseases (IFDs) is hard to delineate given the difficulties in ascertaining the diagnosis that is often based on the confrontation of clinical and microbiological criteria. The present report underlines the interest of active surveillance involving mycologists and clinicians to describe the global incidence and that of the main IFDs. Globally, although the incidence of Pneumocystis pneumonia, invasive aspergillosis, and mucormycosis remained stable over the study period (2012 to 2018), that of yeast fungemia increased slightly. We also show here that IFDs seem to affect older people more frequently. The most worrisome observation is the lack of improvement in the global survival rate associated with IFDs despite the increasing use of more sensitive diagnostic tools, the availability of new antifungal drugs very active in clinical trials, and a still low/marginal rate of acquired in vitro resistance in France. Therefore, other tracks of improvement should be investigated actively.

International audience; Background: Guillain-Barré syndrome (GBS) has been reported to be associated with Zika virus (ZIKV) infection in case reports and retrospective studies, mostly on the basis of serological tests, with the problematic cross-reacting antibodies of the Flavivirus genus. Some GBS cases do not exhibit a high level of diagnostic certainty. This prospective study aimed to describe the clinical profiles and the frequency of GBS associated with ZIKV during the ZIKV outbreak in Martinique in 2016.Methods: We recorded prospective data from GBS meeting levels 1 or 2 of diagnostic certainty for the Brighton Collaboration, with proof of recent ZIKV infection and negative screening for etiologies of GBS.Results: Of the sample of 34 patients with suspected GBS during the outbreak, 30 had a proven presence of GBS, and 23 had a recent ZIKV infection. The estimated GBS incidence rate ratio (2016 vs 2006-2015) was 4.52 (95% confidence interval, 2.80-7.64; P = .0001). Recent ZIKV infection was confirmed by urine reverse-transcription polymerase chain reaction (RT-PCR) analysis in 17 cases and by serology in 6 cases. Patients, 65% of whom were male, had a median age of 61 years (interquartile range, 56-71 years) and experienced severe GBS. Electrophysiological tests were consistent with the primary demyelinating form of the disease.Conclusions: ZIKV infection is usually benign, when symptomatic, but in countries at risk of ZIKV epidemics, adequate intensive care bed capacity is required for management of severe GBS cases. Arbovirus RNA detection by RT-PCR should be part of the management of GBS cases.