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1. Epidemiological, Clinical and Laboratory Features of Strongyloidiasis in 69 Attendees at a French Outpatient Clinic

Author

Jean-François Magnaval, Judith Fillaux, Richard Fabre, Sophie Cassaing, Alexis Valentin, Xavier Iriart, and Antoine Berry

Subjects
strongyloidiasis, southwestern France, epidemiology, clinical picture, eosinophilia, Strongyloides ratti, Medicine
Abstract

The present retrospective study analyzed the characteristics of strongyloidiasis in patients who were diagnosed at the Outpatient Clinic of the Department of Parasitology-Mycology, Toulouse, France. Sixty-nine file records were included in the study on the basis of a positive stool examination that used Baermann’s method. The prominent epidemiological findings were the presence of former immigrants from Italy or Portugal, veterans from the 1st Indochina war, and autochthonous cases. Almost 1/4 of the patients were asymptomatic. Manifestations of skin allergy were the main clinical feature. Blood eosinophilia was present in 76.8% of the patients, and serum total IgE was ≥150 kIU/L in 79.7%. Immunodiagnosis was achieved from 1990 to 2001 by indirect immunofluorescence (IFAT) that was then replaced with ELISA, both methods using Strongyloides ratti filariform larvae. ELISA was found to be similar to IFAT in terms of specificity but exhibited a greater sensitivity. Patients were primarily treated with albendazole or ivermectin beginning in 1993. Forty-eight patients attended the follow-up consultation. Kinetics of the clinical picture and blood eosinophilia were found to be the most convenient parameters to assess the efficacy of anthelmintic therapy. In conclusion, strongyloidiasis remains a neglected disease in Southwestern France. The resolution of clinical features along with the kinetics of eosinophilia appeared to be the most appropriate parameters to check during the posttreatment follow-up.

Published
2023
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2. Evaluation of the Performance of the Novodiag® Stool Parasites Assay for the Detection of Intestinal Protozoa and Microsporidia

Author

Pamela Chauvin, Florie Barba, Emilie Guemas, Eléna Charpentier, Claire Cottrel, Judith Fillaux, Alexis Valentin, Sarah Baklouti, Sophie Cassaing, Sandie Ménard, Antoine Berry, and Xavier Iriart

Subjects
stool, protozoa, microsporidia, diagnosis, microscopy, qPCR, Medicine
Abstract

Objectives: We aimed to assess the performance of the Novodiag® Stool Parasites (NSP) assay in the diagnosis of the most common intestinal protozoan and microsporidia infections. Methods: A panel of 167 selected stool samples was retrospectively analysed with the NSP assay and compared to routine microscopy and qPCR methods for the detection of pathogenic protozoa and microsporidia. Results: Whereas specificity was high for all protozoa and microsporidia, NSP sensitivity was strongly dependent on the comparative method used as reference. When compared to microscopic methods, NSP sensitivity was high (96.7 to 100%) for Blastocystis hominis, Entamoeba histolytica and Cyclospora cayetanensis but was lower for Giardia intestinalis (85.2%) and ≤50% for Cystoisospora belli and Dientamoeba fragilis. In comparison to conventional qPCR, the NSP assay demonstrated lower sensitivity characteristics dependent on parasite loads, reaching 60 to 70% for G. intestinalis, D. fragilis, Cryptosporidium spp. and E. histolytica. Sensitivity was 100% for Enterocytozoon bieneusi, but none of the five samples containing Encephalitozoon spp. were detected. Conclusions: The overall performance of the NSP assay in the diagnosis of gastrointestinal protozoa and microsporidia seems to be better than or equivalent to that observed with microscopic methods but inferior to that obtainable with classical targeted qPCR.

Published
2023
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3. Evaluation of Three Quantitative Anti-SARS-CoV-2 Antibody Immunoassays

Author

Sabine Chapuy-Regaud, Marcel Miédougé, Florence Abravanel, Isabelle Da Silva, Marion Porcheron, Judith Fillaux, Chloé Diméglio, and Jacques Izopet

Subjects
SARS-CoV-2, immunoassay, binding antibodies, neutralizing antibodies, COVID, Microbiology, QR1-502
Abstract

ABSTRACT The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in December 2019 and caused a dramatic pandemic. Serological assays are used to check for immunization and assess herd immunity. We evaluated commercially available assays designed to quantify antibodies directed to the SARS-CoV-2 Spike (S) antigen, either total (Wantaï SARS-CoV-2 Ab ELISA) or IgG (SARS-CoV-2 IgG II Quant on Alinity, Abbott, and Liaison SARS-CoV-2 TrimericS IgG, Diasorin). The specificities of the Wantaï, Alinity, and Liaison assays were evaluated using 100 prepandemic sera and were 98, 99, and 97%, respectively. The sensitivities of all three were around 100% when tested on 35 samples taken 15 to 35 days postinfection. They were less sensitive for 150 sera from late infections (>180 days). Using the first WHO international standard (NIBSC), we showed that the Wantai results were concordant with the NIBSC values, while Liaison and Alinity showed a proportional bias of 1.3 and 7, respectively. The results of the 3 immunoassays were significantly globally pairwise correlated and for late infection sera (P < 0.001). They were correlated for recent infection sera measured with Alinity and Liaison (P < 0.001). However, the Wantai results of recent infections were not correlated with those from Alinity or Liaison. All the immunoassay results were significantly correlated with the neutralizing antibody titers obtained using a live virus neutralization assay with the B1.160 SARS-CoV-2 strain. These assays will be useful once the protective anti-SARS-CoV-2 antibody titer has been determined. IMPORTANCE Standardization and correlation with virus neutralization assays are critical points to compare the performance of serological assays designed to quantify anti-SARS-CoV-2 antibodies in order to identify their optimal use. We have evaluated three serological immunoassays based on the virus spike antigen that detect anti-SARS-CoV-2 antibodies: a microplate assay and two chemiluminescent assays performed with Alinity (Abbott) and Liaison (Diasorin) analysers. We used an in-house live virus neutralization assay and the first WHO international standard to assess the comparison. This study could be useful to determine guidelines on the use of serological results to manage vaccination and treatment with convalescent plasma or monoclonal antibodies.

Published
2021
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4. A Retrospective Study of the Efficacy of Albendazole and Diethylcarbamazine for the Treatment of Human Toxocariasis

Author

Jean-François Magnaval, Judith Fillaux, and Antoine Berry

Subjects
toxocariasis, treatment, observational study, retrospective study, albendazole, diethylcarbamazine, Medicine
Abstract

In the Department of Parasitology and Mycology of Toulouse University Hospitals, patients presenting with common/covert toxocariasis were treated either with albendazole (39 cases) or with diethylcarbamazine (32 cases). Albendazole (ABZ) was given at 10 mg/kg b/w daily for 14 days, and diethylcarbamazine (DEC) was given at 4 mg/kg b/w daily for 21 days. In both groups, follow-up consultations occurred approximately 48 days after the end of the anthelmintic therapy. ABZ and DEC displayed a similar efficacy on the kinetics of the clinical picture (−64.5% of reduction vs. −72.7%, respectively) and on the levels of blood eosinophilia, serum eosinophil cationic protein and serum total IgE. However, the effect of the medication on the laboratory parameters was moderate. The rate of adverse reactions was similar in both groups (38% for ABZ vs. 31% for DEC), but DEC-treated patients complained of more intense and long-lasting side effects. The DEC group had more major adverse reactions, resulting in the termination of the anthelmintic treatment. The results from this retrospective study bring further arguments for considering ABZ, given at 10 mg/kg daily for 2 weeks, as the drug of choice in the treatment of human toxocariasis.

Published
2022
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5. Evaluation of six commercial kits for the serological diagnosis of Mediterranean visceral leishmaniasis.

Author

Maude F Lévêque, Emilie Battery, Pascal Delaunay, Badre Eddine Lmimouni, Karim Aoun, Coralie L'Ollivier, Patrick Bastien, Charles Mary, Christelle Pomares, Judith Fillaux, and Laurence Lachaud

Subjects
Arctic medicine. Tropical medicine, RC955-962, Public aspects of medicine, RA1-1270
Abstract

BackgroundZoonotic visceral leishmaniasis (VL) is endemic in the Mediterranean basin. However, large-scale comparative analyses of the commercial kits for the serological diagnosis of this neglected disease are lacking. This study compared the performances of four enzyme-linked immunosorbent assays (ELISA) and two immunochromatographic tests (ICT) as screening tests for the serodiagnosis of human VL in the Mediterranean region.Methodology/principal findingsSerum samples from 319 patients living in France, Tunisia or Morocco were tested using two ICT (IT LEISH and TruQuick LEISH IgG/IgM Meridian) and four ELISA reagents (NovaLisa Leishmania infantum IgG, Bordier Leishmania infantum, Ridascreen Leishmania IgG, and Vircell Leishmania). The population with proven VL (n = 181) included 65 immunocompromised patients. Significantly higher percentages of false-negative results were obtained with all assays in immunocompromised patients, compared with the immunocompetent population. In the whole population, sensitivity and specificity ranged from 80.7% to 93.9% and from 95.7% to 100%, respectively. The maximum accuracy was observed with the Bordier and Vircell ELISA kits (96.2%), and the lowest accuracy with Ridascreen reagent (88.7%). New thresholds of positivity are proposed for the Bordier, Vircell and NovaLisa ELISA kits to achieve 95% sensitivity with the highest possible specificity. Western blot (WB), used as a confirmation method, showed 100% sensitivity and identified 10.1% of asymptomatic carriers among the control population from the South of France.Conclusions/significanceThis is the first study that compared commercially available kits for VL serodiagnosis in the endemic region of the Mediterranean basin. It provides specific information about the tests' performance to help clinicians and biologists to select the right assay for VL screening.

Published
2020
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6. A Clustered Case Series of Mucorales Detection in Respiratory Samples from COVID-19 Patients in Intensive Care, France, August to September 2021

Author

Emilie Guemas, Sophie Cassaing, Sandra Malavaud, Judith Fillaux, Pamela Chauvin, Lucie Lelièvre, Stéphanie Ruiz, Béatrice Riu, Antoine Berry, and Xavier Iriart

Subjects
fungal infection, COVID-19, mucormycosis, aspergillosis, Aspergillus, Mucorales, Biology (General), QH301-705.5
Abstract

While COVID-19-associated pulmonary aspergillosis is now well described in developed countries, COVID-19-associated mucormycosis (CAM) has seemed to remain quite rare in Europe. A retrospective study was performed between March 2020 to September 2021 among COVID-19 adult patients in the intensive care unit (ICU) at Toulouse Hospital (Southern France). PCR screening on respiratory samples, which target Aspergillus or Mucorales DNA, were performed, and the number of fungal detections was evaluated monthly during the study period. During the 19 months of the study, 44 (20.3%) COVID-19 ICU patients had a positive PCR for Aspergillus, an overall rate in keeping with the incidence of ICU COVID-19 patients. Ten patients (7.1%) had a positive Mucorales PCR over the same period. Surprisingly, 9/10 had a positive Mucor/Rhizopus PCR in August-September 2021, during the fourth Delta SARS-CoV-2 variant wave. Epidemic investigations have identified a probable environmental cause linked to construction works in the vicinity of the ICU (high levels of airborne spores due to the mistaken interruption of preventive humidification and summer temperature). Even if CAM are apparently rare in Europe, a cluster can also develop in industrialised countries when environmental conditions (especially during construction work) are associated with a high number of COVID-19 patients in the ICU.

Published
2022
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7. Therapy and Prevention for Human Toxocariasis

Author

Jean-François Magnaval, Emilie Bouhsira, and Judith Fillaux

Subjects
toxocariasis, treatment, benzimidazoles, albendazole, mebendazole, thiabendazole, Biology (General), QH301-705.5
Abstract

For the last four decades, knowledge about human toxocariasis with regard to its epidemiology, pathophysiology, clinical spectrum, and imaging or laboratory diagnosis has substantially progressed. Knowledge about specific therapy with anthelmintics has lagged behind. To date, only four drugs are registered for human use, and their efficacy has rarely been assessed in prospective controlled trials. It is likely that the repurposing of potent anthelmintics from veterinary medicine will improve this situation. Due to its wide availability and a lack of major side effects during short regimens, albendazole has become the drug of choice. However, its efficacy should be more precisely assessed. The role of anthelmintics in the treatment of neurological or ocular toxocariasis remains to be clarified. Prophylactic measures in humans or companion animals are efficient and represent first-line treatments for the control of this zoonosis. Unfortunately, their implementation in areas or countries where toxocariasis epidemiology is driven by poverty is quite difficult or unrealistic.

Published
2022
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8. New Insights into Blood Circulating Lymphocytes in Human Pneumocystis Pneumonia

Author

Eléna Charpentier, Catherine Marques, Sandie Ménard, Pamela Chauvin, Emilie Guemas, Claire Cottrel, Sophie Cassaing, Judith Fillaux, Alexis Valentin, Nicolas Blanchard, Antoine Berry, and Xavier Iriart

Subjects
Pneumocystis jirovecii, pneumocystosis, immunophenotyping, lymphocyte, T helper, B lymphocytes, Biology (General), QH301-705.5
Abstract

The host lymphocyte response is decisive in Pneumocystis pneumonia (PCP) pathophysiology but little is known of the specific roles of lymphocyte subpopulations in this fungal infection. Peripheral NK, NKT, B, TCD4+ and TCD8+ subpopulations were compared by immunophenotyping between 20 patients diagnosed with PCP (PCP(+)] and 20 uninfected immunosuppressed patients (PCP(−)). Among PCP(+) subjects, the lymphocyte populations were also compared between surviving and deceased patients. Low B cell count (p = 0.03), while there was no difference for the TCD4 count. Among the PCP(+) group, the 7 deceased patients had lower Th1 (p = 0.02) and Tc1 (p = 0.03) populations, higher Th2 response (p = 0.03), higher effector TCD8 (p < 0.01), lower central memory TCD8 (p = 0.04) and reduced NK cells (p = 0.02) compared with the 13 survivors. Th1/Th2 ratio < 17, CD8 Tc1 < 44%, effector TCD8 < 25%, central memory TCD8 < 4%, NK cells < 50 cells/µL and total lymphocytes < 0.75 G/L were associated with a higher risk of mortality (p = 0.003, p = 0.007, p = 0.0007, p = 0.004, p = 0.02 and p = 0.019, respectively). The traditional analysis of TCD4 and TCD8 populations may be insufficient in the context of PCP. It could be completed by using B cells to predict the risk of PCP, and by using lymphocyte subpopulations or total lymphocyte count, which are easy to obtain in all health care facilities, to evaluate PCP prognosis.

Published
2021
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9. A diagnostic protocol designed for determining allergic causes in patients with blood eosinophilia

Author

Jean-François Magnaval, Guy Laurent, Noémie Gaudré, Judith Fillaux, and Antoine Berry

Subjects
Blood eosinophilia, Diagnostic protocol, Classification, Secondary eosinophilias, Allergy, Helminthiases, Medicine (General), R5-920, Military Science
Abstract

Abstract Background Blood eosinophilia is a common laboratory abnormality, and its characterization frequently represents a quandary for primary care physicians. Consequently, in France, specialists and particularly hematologists, often must investigate patients who present with blood eosinophilia that often, but not always, occurs because of allergic causes. Both the Departments of Hematology and Parasitology at Toulouse University Hospitals established a collaboration to rule out allergic causes of eosinophilia, particularly helminthiases, prior to initiating more sophisticated investigations. Methods Since 2004, the authors employed the same protocol to investigate eosinophilic outpatients who attended the clinic of Parasitology at Toulouse University Hospitals, and they reported the performance of this diagnostic procedure that was designed to be rapid (no hospitalization required) and only moderately expensive. Results A total of 406 patients who presented with blood eosinophilia greater than 0.5 (×109, giga cells per litter, G/L) had an allergic etiology in 350 (86.2%) cases. Among the remaining 56 subjects, 17 did not undergo a follow-up and 39 were referred to another specialized department, mostly Hematology. However, only 21 patients attended then were subsequently investigated. Non-allergic causes of eosinophilia, including 3 cases of the lymphoid variant of hypereosinophilic syndrome and 2 cases of myeloproliferative disorder, were identified in 14 patients, whereas 7 remained diagnosed as having idiopathic eosinophilia. Conclusion This study underlines the need to investigate patients presenting with even moderate blood eosinophilia. The work-up that was employed appears to be efficient and versatile and may be used by any medical specialist, such as in hematology, infectious disease, or internal medicine departments, who needs to investigate eosinophilic patients and should initially rule out any etiology of allergic eosinophilia.

Published
2017
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10. Real-time PCR for diagnosis of imported schistosomiasis.

Author

Hélène Guegan, Judith Fillaux, Eléna Charpentier, Florence Robert-Gangneux, Pamela Chauvin, Emilie Guemas, Jérôme Boissier, Alexis Valentin, Sophie Cassaing, Jean-Pierre Gangneux, Antoine Berry, and Xavier Iriart

Subjects
Arctic medicine. Tropical medicine, RC955-962, Public aspects of medicine, RA1-1270
Abstract

BackgroundThe diagnosis of schistosomiasis currently relies on microscopic detection of schistosome eggs in stool or urine samples and serological assays. The poor sensitivity of standard microscopic procedures performed in routine laboratories, makes molecular detection methods of increasing interest. The aim of the study was to evaluate two in-house real-time Schistosoma PCRs, targeting respectively S. mansoni [Sm] and S. haematobium [Sh] in excreta, biopsies and sera as potential tools to diagnose active infections and to monitor treatment efficacy.MethodsSchistosoma PCRs were performed on 412 samples (124 urine, 86 stools, 8 biopsies, 194 sera) from patients with suspected schistosomiasis, before anti-parasitic treatment. Results were compared to microscopic examination and serological assays (enzyme-linked immunosorbent assay (ELISA), indirect haemagglutination (HA) and Western Blot (WB) assay).ResultsCompared to microscopy, PCRs significantly increased the sensitivity of diagnosis, from 4% to 10.5% and from 33.7% to 48.8%, for Sh in urine and Sm in stools, respectively. The overall sensitivity of PCR on serum samples was 72.7% and reached 94.1% in patients with positive excreta (microscopy). The specificity of serum PCR was 98.9%. After treatment, serum PCR positivity rates slowly declined from 93.8% at day 30 to 8.3% at day 360, whereas antibody detection remained positive after 1 year.ConclusionSchistosoma PCRs clearly outperform standard microscopy on stools and urine and could be part of reference methods combined with WB-based serology, which remains a gold standard for initial diagnosis. When serological assays are positive and microscopy is negative, serum PCRs provide species information to guide further clinical exploration. Biomarkers such as DNA and antibodies are of limited relevance for early treatment monitoring but serum PCR could be useful when performed at least 1 year after treatment to help confirm a cured infection.

Published
2019
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11. Multicenter Evaluation of a Novel Immunochromatographic Test for Anti-aspergillus IgG Detection

Author

Raphaël P. Piarroux, Thomas Romain, Aurélie Martin, Damien Vainqueur, Joana Vitte, Laurence Lachaud, Jean-Pierre Gangneux, Frédéric Gabriel, Judith Fillaux, and Stéphane Ranque

Subjects
immunochromatography, Aspergillus serology, point-of-care, chronic pulmonary aspergillosis, allergic broncho-pulmonary aspergillosis, sensitivity, Microbiology, QR1-502
Abstract

Aspergillus sp. fungi cause various diseases in both immunocompetent and immunocompromised patients. The most frequent Aspergillus disorders include chronic pulmonary aspergillosis (CPA), a life-threatening disease that affects at least 3 million people worldwide, and allergic bronchopulmonary aspergillosis (ABPA), which affects approximately 4.8 million severe asthmatic patients globally. Diagnosis of such diseases involves IgG serological testing; however, the currently available anti-Aspergillus IgG detection assays are inappropriate for resource-poor laboratory settings, as they are expensive, rely on automated procedures, and require stable electrical power. Therefore, accurate CPA or ABPA diagnosis facilities are lacking in most low- and middle-income countries. We evaluated a novel anti-Aspergillus antibody immunochromatographic test (ICT) that requires minimal laboratory equipment. Two evaluations were performed: a single-center 4-month prospective study in a French reference laboratory (44 cases/257 patients) and a retrospective study in five French reference laboratories (262 cases and 188 controls). We estimated the ICT indices for the diagnosis of chronic aspergillosis, and the test results were compared to those of anti-Aspergillus IgG immunoblot (IB) assay. Of the 713 patients included in the study, 306 had chronic aspergillosis. Test sensitivity and specificity were 88.9% (95%CI[85–92]) and 96.3% (95%CI[94–98]) for the ICT and 93.1% (95%CI[90–96]) and 94.3% (95%CI[92–96]) for the IB, respectively. Agreement between the two assays was almost perfect (kappa = 0.86). As this ICT displays good diagnostic performance and complies with the ASSURED (Affordable, Sensitive, Specific, User-friendly, Equipment-free, and Delivered) criteria, we concluded that this anti-Aspergillus antibody ICT can be used to diagnose Aspergillus diseases in resource-poor settings.

Published
2019
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12. Schistosomiasis Haematobium, Corsica, France

Author

Antoine Berry, Hélène Moné, Xavier Iriart, Gabriel Mouahid, Olivier Aboo, Jérôme Boissier, Judith Fillaux, Sophie Cassaing, Cécile Debuisson, Alexis Valentin, Guillaume Mitta, André Théron, and Jean-François Magnaval

Subjects
Schistosoma haematobium, schistosomiasis haematobium, schistosomiasis autochthonous transmission, Bulinus truncatus, snails, reemergence, Medicine, Infectious and parasitic diseases, RC109-216
Published
2014
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13. Evaluation of the Performance of the Novodiag® Stool Parasites Assay for the Detection of Intestinal Protozoa and Microsporidia

Author

Iriart, Pamela Chauvin, Florie Barba, Emilie Guemas, Eléna Charpentier, Claire Cottrel, Judith Fillaux, Alexis Valentin, Sarah Baklouti, Sophie Cassaing, Sandie Ménard, Antoine Berry, and Xavier

Subjects
stool, protozoa, microsporidia, diagnosis, microscopy, qPCR, Novodiag Stool Parasites, performance
Abstract

Objectives: We aimed to assess the performance of the Novodiag® Stool Parasites (NSP) assay in the diagnosis of the most common intestinal protozoan and microsporidia infections. Methods: A panel of 167 selected stool samples was retrospectively analysed with the NSP assay and compared to routine microscopy and qPCR methods for the detection of pathogenic protozoa and microsporidia. Results: Whereas specificity was high for all protozoa and microsporidia, NSP sensitivity was strongly dependent on the comparative method used as reference. When compared to microscopic methods, NSP sensitivity was high (96.7 to 100%) for Blastocystis hominis, Entamoeba histolytica and Cyclospora cayetanensis but was lower for Giardia intestinalis (85.2%) and ≤50% for Cystoisospora belli and Dientamoeba fragilis. In comparison to conventional qPCR, the NSP assay demonstrated lower sensitivity characteristics dependent on parasite loads, reaching 60 to 70% for G. intestinalis, D. fragilis, Cryptosporidium spp. and E. histolytica. Sensitivity was 100% for Enterocytozoon bieneusi, but none of the five samples containing Encephalitozoon spp. were detected. Conclusions: The overall performance of the NSP assay in the diagnosis of gastrointestinal protozoa and microsporidia seems to be better than or equivalent to that observed with microscopic methods but inferior to that obtainable with classical targeted qPCR.

Published
2023
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14. A Retrospective Study of the Efficacy of Albendazole and Diethylcarbamazine for the Treatment of Human Toxocariasis

Author

Antoine Berry, Judith Fillaux, and Jean-francois Magnaval

Subjects
Microbiology (medical), Infectious Diseases, toxocariasis, treatment, observational study, retrospective study, albendazole, diethylcarbamazine, General Immunology and Microbiology, Immunology and Allergy, Molecular Biology
Abstract

In the Department of Parasitology and Mycology of Toulouse University Hospitals, patients presenting with common/covert toxocariasis were treated either with albendazole (39 cases) or with diethylcarbamazine (32 cases). Albendazole (ABZ) was given at 10 mg/kg b/w daily for 14 days, and diethylcarbamazine (DEC) was given at 4 mg/kg b/w daily for 21 days. In both groups, follow-up consultations occurred approximately 48 days after the end of the anthelmintic therapy. ABZ and DEC displayed a similar efficacy on the kinetics of the clinical picture (−64.5% of reduction vs. −72.7%, respectively) and on the levels of blood eosinophilia, serum eosinophil cationic protein and serum total IgE. However, the effect of the medication on the laboratory parameters was moderate. The rate of adverse reactions was similar in both groups (38% for ABZ vs. 31% for DEC), but DEC-treated patients complained of more intense and long-lasting side effects. The DEC group had more major adverse reactions, resulting in the termination of the anthelmintic treatment. The results from this retrospective study bring further arguments for considering ABZ, given at 10 mg/kg daily for 2 weeks, as the drug of choice in the treatment of human toxocariasis.

Published
2022
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15. Diagnosis of Congenital Toxoplasmosis: Performance of Four IgG and IgM Automated Assays at Birth in a Tricentric Evaluation

Author

Marine Avignon, Maude F. Lévêque, Emilie Guemas, Milène Sasso, Sahar Albaba, Laurence Lachaud, and Judith Fillaux

Subjects
Microbiology (medical), Immunoglobulin M, Pregnancy, Immunoglobulin G, Pregnancy Complications, Parasitic, Infant, Newborn, Antibodies, Protozoan, Humans, Female, Immunoassays, Toxoplasma, Toxoplasmosis, Toxoplasmosis, Congenital
Abstract

For postnatal diagnosis of congenital toxoplasmosis (CT), the gold standard for the detection of anti-Toxoplasma IgM in newborns relies on the immunosorbent agglutination assay (ISAGA), which is manufactured from whole Toxoplasma parasites that become difficult to maintain. For IgG, only the Platelia assay provides a validated assay for cord blood according to the manufacturer, allowing its use in this context. We compared the analytical performance of four commercialized automated assays, Platelia, Abbott, Vidas, and Liaison, for the detection of IgG and IgM in the cord blood or peripheral blood of newborns from women infected during pregnancy. The assays were performed on samples from 509 newborns, collected from the university hospitals of Montpellier, Nîmes, and Toulouse. For IgM, the four assays appeared to be sufficiently informative to be used for congenital toxoplasmosis diagnosis (area under the curve [AUC] > 0.8, receiver operating characteristic [ROC] analysis), with Platelia showing the best performance, similar to ISAGA with regard to accuracy (83%). For the Vidas (76%), Abbott (75%), and Liaison (74%) assays, the accuracy was significantly lower. Maternal treatment significantly decreased the sensitivity of all the assays. For IgG, the four evaluated assays showed a sensitivity of over 90%, with Abbott (95%) and Liaison (94%), exhibiting a significantly higher sensitivity than Platelia (90%). Furthermore, Abbott showed its superiority in the cases of maternal infection during the third trimester. In the context of the newborns of mothers infected by Toxoplasma gondii during pregnancy, to ensure efficient care, Platelia and Abbott seemed to be the most suitable reference tests for the detection of IgM for the former and IgG for the latter.

Published
2022
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17. New Insights into Blood Circulating Lymphocytes in Human Pneumocystis Pneumonia

Author

Claire Cottrel, Nicolas Blanchard, Xavier Iriart, Emilie Guemas, Pamela Chauvin, Sophie Cassaing, Alexis Valentin, Judith Fillaux, Antoine Berry, Catherine Marques, Eléna Charpentier, Sandie Menard, Benson-Rumiz, Alicia, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), Université Toulouse III - Paul Sabatier (UT3), and Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Microbiology (medical), QH301-705.5, Lymphocyte, Context (language use), Plant Science, lymphocyte, Pneumocystis pneumonia, Article, Pneumocystis jirovecii, pneumocystosis, Immunophenotyping, immunophenotyping, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, T helper, medicine, Pneumocystosis, Biology (General), Ecology, Evolution, Behavior and Systematics, B cell, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, biology, business.industry, biology.organism_classification, medicine.disease, respiratory tract diseases, medicine.anatomical_structure, Immunology, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, business, CD8, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, B lymphocytes
Abstract

The host lymphocyte response is decisive in Pneumocystis pneumonia (PCP) pathophysiology but little is known of the specific roles of lymphocyte subpopulations in this fungal infection. Peripheral NK, NKT, B, TCD4+ and TCD8+ subpopulations were compared by immunophenotyping between 20 patients diagnosed with PCP (PCP(+)] and 20 uninfected immunosuppressed patients (PCP(−)). Among PCP(+) subjects, the lymphocyte populations were also compared between surviving and deceased patients. Low B cell count (&lt, 40 cells/µL) was more frequent in PCP(+) than in PCP(−) patients (p = 0.03), while there was no difference for the TCD4 count. Among the PCP(+) group, the 7 deceased patients had lower Th1 (p = 0.02) and Tc1 (p = 0.03) populations, higher Th2 response (p = 0.03), higher effector TCD8 (p &lt, 0.01), lower central memory TCD8 (p = 0.04) and reduced NK cells (p = 0.02) compared with the 13 survivors. Th1/Th2 ratio &lt, 17, CD8 Tc1 &lt, 44%, effector TCD8 &lt, 25%, central memory TCD8 &lt, 4%, NK cells &lt, 50 cells/µL and total lymphocytes &lt, 0.75 G/L were associated with a higher risk of mortality (p = 0.003, p = 0.007, p = 0.0007, p = 0.004, p = 0.02 and p = 0.019, respectively). The traditional analysis of TCD4 and TCD8 populations may be insufficient in the context of PCP. It could be completed by using B cells to predict the risk of PCP, and by using lymphocyte subpopulations or total lymphocyte count, which are easy to obtain in all health care facilities, to evaluate PCP prognosis.

Published
2021
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18. Evaluation of six commercial kits for the serological diagnosis of Mediterranean visceral leishmaniasis

Author

Coralie L'Ollivier, Emilie Battery, Laurence Lachaud, Karim Aoun, Pascal Delaunay, Badre Eddine Lmimouni, Judith Fillaux, Christelle Pomares, Patrick Bastien, Charles Mary, Maude F. Lévêque, Biologie, Génétique et Pathologie des Pathogènes Eucaryotes (MIVEGEC-BioGEPPE), Pathogènes, Environnement, Santé Humaine (EPATH), Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle (MIVEGEC), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud])-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud])-Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle (MIVEGEC), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud])-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud]), Centre National de Référence des Leishmanioses [CHRU Montpellier] (CNR-L), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université de Montpellier (UM), Université de Montpellier (UM), Laboratoire de Parasitologie-Mycologie, Nice, Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre Hospitalier Universitaire de Nice (CHU Nice)-Université Côte d'Azur (UCA), Centre méditerranéen de médecine moléculaire (C3M), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Côte d'Azur (UCA), Université Mohammed V de Rabat [Agdal] (UM5), Laboratoire de Parasitologie Médicale, Biotechnologies et Biomolécules (LR11IPT06), Institut Pasteur de Tunis, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP), Université de Tunis El Manar (UTM), Vecteurs - Infections tropicales et méditerranéennes (VITROME), Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut de Recherche Biomédicale des Armées [Brétigny-sur-Orge] (IRBA), Institut Hospitalier Universitaire Méditerranée Infection (IHU Marseille), Pharmacochimie et Biologie pour le Développement (PHARMA-DEV), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT), Service de Parasitologie et Mycologie [CHU Toulouse], Institut Fédératif de Biologie (IFB), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Pôle Biologie [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud]), Centre National de Référence des Leishmanioses (LL & PB) received financial support from Santé Publique France (ministry of Health)., We are grateful to Patricia Gasq, Patrick Lami, Marie-Line Loiry for technical assistance and Nicolas Molinari for help in conception of the study., Université de Montpellier (UM)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Université Nice Sophia Antipolis (... - 2019) (UNS), University of Mohammed V, Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Institut de Recherche Biomédicale des Armées (IRBA), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie de Toulouse (ICT-FR 2599), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Institut de Chimie du CNRS (INC)-Institut de Recherche pour le Développement (IRD), Service de Parasitologie et Mycologie, CHU Toulouse [Toulouse]-Institut Fédératif de Biologie (IFB) - Hôpital Purpan, Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], and CHU Toulouse [Toulouse]

Subjects
0301 basic medicine, Male, Kala-azar, Leishmania IgG, RC955-962, Pathology and Laboratory Medicine, Serology, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Arctic medicine. Tropical medicine, Zoonoses, Medicine and Health Sciences, Mass Screening, Enzyme assays, Enzyme-linked immunoassays, Leishmania infantum, Child, Leishmaniasis, Protozoans, Aged, 80 and over, Immunoassay, Leishmania, education.field_of_study, Serodiagnosis, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, biology, Mediterranean Region, Eukaryota, Middle Aged, 3. Good health, Morocco, Infectious Diseases, Bioassays and Physiological Analysis, Child, Preschool, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Leishmaniasis, Visceral, Female, France, Public aspects of medicine, RA1-1270, Research Article, Neglected Tropical Diseases, Adult, Tunisia, Adolescent, 030231 tropical medicine, Population, Enzyme-Linked Immunosorbent Assay, Research and Analysis Methods, Sensitivity and Specificity, 03 medical and health sciences, Young Adult, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, Diagnostic Medicine, parasitic diseases, medicine, Parasitic Diseases, Humans, Serologic Tests, [SDV.MP.PAR]Life Sciences [q-bio]/Microbiology and Parasitology/Parasitology, education, Immunoassays, Aged, Protozoan Infections, business.industry, Public Health, Environmental and Occupational Health, Organisms, Biology and Life Sciences, Infant, medicine.disease, biology.organism_classification, Serum samples, Tropical Diseases, Virology, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Parasitic Protozoans, 030104 developmental biology, Visceral leishmaniasis, Immunologic Techniques, Reagent Kits, Diagnostic, business, Biochemical Analysis, Asymptomatic carrier
Abstract

Background Zoonotic visceral leishmaniasis (VL) is endemic in the Mediterranean basin. However, large-scale comparative analyses of the commercial kits for the serological diagnosis of this neglected disease are lacking. This study compared the performances of four enzyme-linked immunosorbent assays (ELISA) and two immunochromatographic tests (ICT) as screening tests for the serodiagnosis of human VL in the Mediterranean region. Methodology/Principal findings Serum samples from 319 patients living in France, Tunisia or Morocco were tested using two ICT (IT LEISH and TruQuick LEISH IgG/IgM Meridian) and four ELISA reagents (NovaLisa Leishmania infantum IgG, Bordier Leishmania infantum, Ridascreen Leishmania IgG, and Vircell Leishmania). The population with proven VL (n = 181) included 65 immunocompromised patients. Significantly higher percentages of false-negative results were obtained with all assays in immunocompromised patients, compared with the immunocompetent population. In the whole population, sensitivity and specificity ranged from 80.7% to 93.9% and from 95.7% to 100%, respectively. The maximum accuracy was observed with the Bordier and Vircell ELISA kits (96.2%), and the lowest accuracy with Ridascreen reagent (88.7%). New thresholds of positivity are proposed for the Bordier, Vircell and NovaLisa ELISA kits to achieve 95% sensitivity with the highest possible specificity. Western blot (WB), used as a confirmation method, showed 100% sensitivity and identified 10.1% of asymptomatic carriers among the control population from the South of France. Conclusions/Significance This is the first study that compared commercially available kits for VL serodiagnosis in the endemic region of the Mediterranean basin. It provides specific information about the tests’ performance to help clinicians and biologists to select the right assay for VL screening., Author summary Human visceral leishmaniasis (VL) is a neglected disease endemic in the Mediterranean region, caused by Leishmania infantum. Accurate VL diagnosis is critical for rapid and correct patient management. Various serological tests are used, including commercial kits that require qualifications with specific information about their performance. In this study, we compared the performance of six commercial kits, two immunochromatographic tests (ICT; IT LEISH and TruQuick LEISH IgG/IgM Meridian) and four enzyme-linked immunosorbent assays (ELISA; NovaLisa Leishmania infantum IgG, Bordier Leishmania infantum, Ridascreen Leishmania IgG, and Vircell Leishmania), available in France and used as screening tests. The Bordier and Vircell ELISA reagents displayed the highest analytic performance compared with all the other kits. However, no test displayed 95% sensitivity at the thresholds recommended by the manufacturers. To reach this sensitivity value with the highest possible specificity, new thresholds are proposed for the Bordier, Vircell and NovaLisa ELISA reagents. Positive and negative results obtained with the six screening tests were confirmed by Western blot (100% sensitivity). Overall, this study presents a comparative analysis of commercially available kits for the serodiagnosis of human VL and provides additional information on the prevalence of asymptomatic carriers in the Mediterranean basin.

Published
2020
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19. Performance evaluation of different strategies based on microscopy techniques, rapid diagnostic test and molecular loop-mediated isothermal amplification assay for the diagnosis of imported malaria

Author

Catherine Armengol, Sandie Menard, Antoine Berry, Xavier Iriart, Judith Fillaux, A.-S. Salabert, Arnaud Pagès, H. Guegan, Emilie Guemas, Pamela Chauvin, Eléna Charpentier, E. Benichou, Alexis Valentin, Sophie Cassaing, CHU Toulouse [Toulouse], Centre de Physiopathologie Toulouse Purpan (CPTP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps (LEASP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Toulouse Neuro Imaging Center (ToNIC), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Service de Parasitologie et Mycologie, CHU Toulouse [Toulouse]-Institut Fédératif de Biologie (IFB) - Hôpital Purpan, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées, Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Toulouse [Toulouse], Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Toulouse Mind & Brain Institut (TMBI), Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, CCSD, Accord Elsevier, and Institut Fédératif de Biologie (IFB) - Hôpital Purpan

Subjects
0301 basic medicine, Plasmodium, Alethia, [SDV]Life Sciences [q-bio], Buffy coat, Rapid diagnostic test, MESH: Africa, MESH: Malaria / diagnosis, Gastroenterology, MESH: Communicable Diseases, Imported / diagnosis, MESH: Nucleic Acid Amplification Techniques / standards, 0302 clinical medicine, Communicable Diseases, Imported, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Diagnosis, MESH: Communicable Diseases, Imported / parasitology, Prospective Studies, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, Imported malaria, MESH: Molecular Diagnostic Techniques / methods, Microscopy, Temperature, General Medicine, MESH: Temperature, 3. Good health, [SDV] Life Sciences [q-bio], Infectious Diseases, Real-time polymerase chain reaction, Molecular Diagnostic Techniques, MESH: Microscopy / methods, France, Nucleic Acid Amplification Techniques, Microbiology (medical), medicine.medical_specialty, 030106 microbiology, Loop-mediated isothermal amplification, Real-Time Polymerase Chain Reaction, Sensitivity and Specificity, QBC, 03 medical and health sciences, Thin smear, LAMP, Internal medicine, parasitic diseases, medicine, Humans, MESH: Molecular Diagnostic Techniques / standards, MESH: Malaria / parasitology, RDT, MESH: Microscopy / standards, Plasmodium species identification, MESH: Humans, business.industry, MESH: Plasmodium, Thick smear, medicine.disease, MESH: Nucleic Acid Amplification Techniques / methods, MESH: Prospective Studies, MESH: Sensitivity and Specificity, Malaria, MESH: France, MESH: Real-Time Polymerase Chain Reaction / standards, Blood smear, Africa, business
Abstract

Objectives Malaria is one of most common tropical diseases encountered in travellers and migrants. It requires an urgent and reliable diagnosis considering its potential severity. In this study, performance of five diagnostic assays were evaluated in a nonendemic region and compared prospectively to quantitative PCR (qPCR). Methods A prospective study was conducted at Toulouse Hospital from August 2017 to January 2018 and included all patients with initial Plasmodium screening. Thin and thick blood smears (TnS, TkS), quantitative buffy coat (QBC), rapid diagnostic tests (RDTs) and commercial loop-mediated isothermal amplification (LAMP) were independently performed on each blood sample and compared to our qPCR reference standard. Results The study encompassed 331 patients, mainly returning from Africa. qPCR detected 73 Plasmodium-positive samples (including 58 falciparum). Individually, LAMP had a 97.3% (71/73) sensitivity, far ahead of TnS (84.9%, 62/73), TkS (86.3%, 63/73), QBC (86.3%, 63/73) and RDT (86.3%, 63/73). RDT demonstrated a high sensitivity for falciparum (98.3%, 57/58) but missed all ovale, malariae and knowlesi infections. Specificity was excellent for all techniques (99.6–100%). The most sensitive diagnosis strategies were TnS + RDT (95.9%, 70/73), TnS + LAMP (97.3%, 71/73) and TnS + RDT + LAMP (100%, 73/73), about 10% higher than strategies using exclusively microscopy, TkS + TnS (87.7%, 64/73) or QBC + TnS (87.7%, 64/73). TnS remains necessary for Plasmodium species identification and quantification. Adding sequentially TnS only on LAMP-positive samples did not decrease TnS + LAMP strategy sensitivity. Conclusions In nonendemic countries, the currently recommended microscopy-based strategies seem unsatisfactory for malaria diagnosis considering RDT and LAMP performance, two rapid and sensitive assays that require limited training.

Published
2020
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20. Schistosomose urogénitale et cancer

Author

Jean-François Magnaval, Judith Fillaux, Xavier Iriart, and Antoine Berry

Subjects
0301 basic medicine, Gynecology, 03 medical and health sciences, medicine.medical_specialty, 030104 developmental biology, Schistosomiasis haematobium, Urinary Schistosomiasis, Philosophy, Tropical medicine, medicine, Pathology and Forensic Medicine
Abstract

L’association entre la schistosomose urogenitale (SU) et le cancer de la vessie a ete evoquee pour la premiere fois par C. Goebel en 1905 avant d’etre mieux precisee en 1911 par A.R Ferguson. Ulterieurement, la publication de plusieurs travaux dont les resultats etaient concordants avec ceux de Ferguson renforca cette l’hypothese. Le lien de causalite a ete etabli plus tardivement apres la publication d’etudes cas temoins confirmant S. haematobium comme un facteur de risque de cancer de la vessie independant. Dans le cadre de la SU, les mecanismes aboutissant au carcinome vesical restent encore mal connus. Deux processus non exclusifs sont classiquement evoques: 1) une reaction inflammatoire chronique intra-vesicale causee par les granulomes bilharziens centres sur les oeufs; 2) un role cocarcinogene des schistosomoses, avec a la fois une reponse immunitaire de type Th2 intra-vesicale, une alteration de la dynamique vesicale evoluant vers la stase urinaire, le tout favorisant les infections chroniques connues pour etre cancerigenes. En dehors du plus jeune âge des patients au moment du diagnostic et de la frequence elevee des formes epidermoides, l’histoire naturelle des cancers lies a S. haematobium ne differe guere de celles des tumeurs malignes non liees aux schistosomoses. En depit de la frequence elevee des atteintes genitales, S. haematobium ne semble pas implique dans la genese des cancers de cette sphere. Pour S. mansoni et S. japonicum les elements de preuve restent, a ce jour, insuffisants pour les impliquer dans la genese des hepatocarcinomes ou des cancers colorectaux. Le sequencage complet du genome de S. haematobium et l’existence d’un nouveau modele souris de l’atteinte vesicale devraient permettre une meilleure comprehension de la genese des carcinomes vesicaux. Cependant, seul un meilleur controle, sur le terrain, de cette helminthiase assurera une reduction de la morbidite et mortalite liees a ce cancer induit, comme cela a ete observe ces dernieres annees en Egypte.

Published
2017
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21. Time before anti-Toxoplasma IgG seroconversion detection by 7 commercial assays in French pregnant women

Author

Xavier Iriart, Catherine Armengol, Judith Fillaux, Antoine Berry, Pamela Chauvin, Christine Roques-Malecaze, Sophie Cassaing, Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], Pharmacochimie et Biologie pour le Développement (PHARMA-DEV), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT-FR 2599), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie de Toulouse (ICT-FR 2599), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Institut de Chimie du CNRS (INC)-Institut de Recherche pour le Développement (IRD), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), and Université de Toulouse (UT)

Subjects
Adult, 0301 basic medicine, Microbiology (medical), Time Factors, [SDV]Life Sciences [q-bio], 030106 microbiology, Antibodies, Protozoan, Toxoplasma gondii, Immunoblot, 03 medical and health sciences, Pregnancy, medicine, Humans, Pregnancy Complications, Infectious, Immunodiagnosis, Seroconversion, Automation, Laboratory, biology, Diagnostic Tests, Routine, business.industry, General Medicine, medicine.disease, biology.organism_classification, Virology, 3. Good health, Infectious Diseases, Immunoglobulin G, Immunology, Female, France, Reagent Kits, Diagnostic, Automated tests, business, Toxoplasma, Toxoplasmosis
Abstract

International audience; We assessed the ability to early detect a toxoplasmic seroconversion between 1 immunoblot (LDBIO II®) and 6 automated assays (TGS TA®, Architect®, Vidas II®, Liaison II®, Platelia®, and Elecsys®), comparing the time before anti-Toxoplasma gondii IgG detection during infection in pregnant women. From 2007 to 2015, 620 sera of 269 women were included. The median durations before positive IgG detection with Vidas II®, Liaison II®, Platelia®, and Elecsys® were significantly longer than Architect® with differential times from 11 to 28days (P

Published
2017
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22. Serological diagnosis of Toxoplasma gondii

Author

Pierre Marty, Isabelle Villena, Judith Fillaux, Aurélie Guigon, Loïc Simon, Christelle Pomares, Rose-Anne Lavergne, Odile Villard, Inserm U1065, Centre Méditerranéen de Médecine Moléculaire, Pharmacochimie et Biologie pour le Développement (PHARMA-DEV), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie de Toulouse (ICT-FR 2599), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Institut de Chimie du CNRS (INC)-Institut de Recherche pour le Développement (IRD), Service de Parasitologie et Mycologie, CHU Toulouse [Toulouse]-Institut Fédératif de Biologie (IFB) - Hôpital Purpan, Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], Département de Radiologie [HCL, Lyon], Hospices civils de Lyon (HCL), Institut de Parasitologie et de Pathologie Tropicale (IPPTS), Université de Strasbourg (UNISTRA), Laboratoire de Parasitologie-Mycologie (LPM), IFR 53, Université de Reims Champagne-Ardenne (URCA)-Université de Reims Champagne-Ardenne (URCA)-CHU Maison Blanche-UPRES EA 2070, Laboratoire de recherche en Hydrodynamique, Énergétique et Environnement Atmosphérique (LHEEA), École Centrale de Nantes (ECN)-Centre National de la Recherche Scientifique (CNRS), Infections Parasitaires : Transmission, Physiopathologie et Thérapeutiques (IP-TPT), Service de Santé des Armées-Assistance Publique - Hôpitaux de Marseille (APHM)-Aix Marseille Université (AMU)-Institut de Recherche pour le Développement (IRD), Toxoplasma p35 Study Group, Centre Hospitalier Universitaire de Nice (CHU Nice), Université Côte d'Azur (UCA), Centre méditerranéen de médecine moléculaire (C3M), Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Côte d'Azur (UCA), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT), Service de Parasitologie et Mycologie [CHU Toulouse], Institut Fédératif de Biologie (IFB), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Pôle Biologie [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre Hospitalier Régional d'Orléans (CHRO), Centre hospitalier universitaire de Nantes (CHU Nantes), Université de Nantes (UN), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT-FR 2599), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, and Institut de Recherche pour le Développement (IRD)-Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Service de Santé des Armées

Subjects
Male, [SDV]Life Sciences [q-bio], ved/biology.organism_classification_rank.species, Antibodies, Protozoan, Serology, Hammondia hammondi, 0302 clinical medicine, Child, Aged, 80 and over, 0303 health sciences, biology, Middle Aged, Neospora caninum, 3. Good health, Infectious Diseases, Child, Preschool, Female, Toxoplasma, Toxoplasmosis, Research Article, Adult, Adolescent, IgG, Veterinary (miscellaneous), 030231 tropical medicine, Toxoplasma gondii, Cross Reactions, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, Young Adult, False-positive, Antigen, parasitic diseases, medicine, Humans, lcsh:RC109-216, False Positive Reactions, Serologic Tests, Aged, Pregnancy, Fetus, 030306 microbiology, ved/biology, Infant, medicine.disease, biology.organism_classification, Architect, Insect Science, Immunoglobulin G, Immunology, Animal Science and Zoology, Parasitology, Reagent Kits, Diagnostic
Abstract

Background: Primary infection byToxoplasma gondiiin pregnant women can result in serious outcomes for the foetus. A false-positive IgG result during pregnancy can lead to a misdiagnosis of past infection and to stopping preventive measures. We collected 189 sera with positive Architect®Toxo IgG assay (Abbott Laboratories) and negative IgG results with at least two other serological tests, in order to find an explanation for the suspected false-positive IgG results. We used therecomLine Toxoplasma IgG®immunoblot (Mikrogen Diagnostik) to search for specific antigenic reactivities of the sera, and the LDBio Toxo II IgG®immunoblot (LDBio Diagnostics) as a confirmatory test.Results: The bands GRA8 and/or GRA7 were positive for 148 samples (78.3%). GRA8 was the most frequent band, appearing in 133 patterns (70.4%), whereas GRA7 was present for 49 samples (25.9%). Of the 81 samples tested with LDBio®, 23 (28.4%) turned out to be positive. Of the 58 negative LDBio®tests (71.6%) (real false-positive Architect®IgG), 23 samples (39.6%) did not show either a GRA8 or p30 band byrecomLine®. Their false positivity with Architect®remains unexplained since Abbott uses these two recombinant antigens for their assay.Conclusions: The Architect®IgG false positivity forT. gondiiseems to be due to reactivity against GRA8 for the majority of the sera and GRA7 to a lesser extent. The hypothesis of past contact with parasites genetically close toT. gondiisuch asHammondia hammondiorNeospora caninumseems promising and should be assessed further.

Published
2019
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23. Real-time PCR for diagnosis of imported schistosomiasis

Author

Sophie Cassaing, Jérôme Boissier, Hélène Guegan, Antoine Berry, Alexis Valentin, Judith Fillaux, Florence Robert-Gangneux, Eléna Charpentier, Jean-Pierre Gangneux, Emilie Guemas, Pamela Chauvin, Xavier Iriart, Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service de Parasitologie et Mycologie, CHU Toulouse [Toulouse]-Institut Fédératif de Biologie (IFB) - Hôpital Purpan, Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], Centre de Physiopathologie Toulouse Purpan (CPTP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Interactions Hôtes-Pathogènes-Environnements (IHPE), Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM)-Institut Français de Recherche pour l'Exploitation de la Mer (IFREMER)-Université de Perpignan Via Domitia (UPVD), ANR 18 CE35 0001 03, U.S. Department of Defense, Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service de Parasitologie et Mycologie [CHU Toulouse], Institut Fédératif de Biologie (IFB), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Pôle Biologie [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Université de Perpignan Via Domitia (UPVD)-Institut Français de Recherche pour l'Exploitation de la Mer (IFREMER)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), Université de Perpignan Via Domitia (UPVD), Institut Français de Recherche pour l'Exploitation de la Mer (IFREMER), Centre National de la Recherche Scientifique (CNRS), Université de Montpellier (UM), ANR-18-CE35-0001,HySWARM,Hybrid Swarm: rôle de l'hybridation dans les capacités invasives, l'épidémiologie et le diagnostic de la schistosomiase(2018), and Modat, Anne

Subjects
0301 basic medicine, Schistosoma Mansoni, Physiology, Biopsy, RC955-962, Artificial Gene Amplification and Extension, Urine, Pathology and Laboratory Medicine, Gastroenterology, Polymerase Chain Reaction, Serology, MESH: DNA, Helminth / analysis, Feces, Schistosomiasis haematobia, MESH: Biopsy, 0302 clinical medicine, Arctic medicine. Tropical medicine, Medicine and Health Sciences, Schistosomiasis, MESH: Animals, MESH: Schistosomiasis haematobia / blood, MESH: Travel, ComputingMilieux_MISCELLANEOUS, Schistosoma haematobium, Travel, biology, [SDV.BID.EVO]Life Sciences [q-bio]/Biodiversity/Populations and Evolution [q-bio.PE], Eukaryota, DNA, Helminth, 6. Clean water, 3. Good health, Body Fluids, Infectious Diseases, Real-time polymerase chain reaction, Helminth Infections, Schistosoma, Schistosoma mansoni, Anatomy, Public aspects of medicine, RA1-1270, MESH: Schistosomiasis mansoni / urine, Research Article, Neglected Tropical Diseases, medicine.medical_specialty, 030231 tropical medicine, Surgical and Invasive Medical Procedures, MESH: Schistosomiasis mansoni / diagnosis, MESH: Schistosoma haematobium / isolation & purification, Real-Time Polymerase Chain Reaction, Research and Analysis Methods, Sensitivity and Specificity, 03 medical and health sciences, Internal medicine, Helminths, parasitic diseases, medicine, Parasitic Diseases, [SDV.BID.EVO] Life Sciences [q-bio]/Biodiversity/Populations and Evolution [q-bio.PE], Animals, Humans, Molecular Biology Techniques, MESH: Real-Time Polymerase Chain Reaction / methods, Molecular Biology, MESH: Humans, MESH: Schistosomiasis haematobia / urine, business.industry, Public Health, Environmental and Occupational Health, Organisms, Biology and Life Sciences, Gold standard (test), biology.organism_classification, medicine.disease, Tropical Diseases, Invertebrates, Schistosoma Haematobium, MESH: Schistosomiasis haematobia / diagnosis, Schistosomiasis mansoni, MESH: Sensitivity and Specificity, 030104 developmental biology, MESH: Feces / parasitology, MESH: Schistosomiasis mansoni / blood, business
Abstract

Background The diagnosis of schistosomiasis currently relies on microscopic detection of schistosome eggs in stool or urine samples and serological assays. The poor sensitivity of standard microscopic procedures performed in routine laboratories, makes molecular detection methods of increasing interest. The aim of the study was to evaluate two in-house real-time Schistosoma PCRs, targeting respectively S. mansoni [Sm] and S. haematobium [Sh] in excreta, biopsies and sera as potential tools to diagnose active infections and to monitor treatment efficacy. Methods Schistosoma PCRs were performed on 412 samples (124 urine, 86 stools, 8 biopsies, 194 sera) from patients with suspected schistosomiasis, before anti-parasitic treatment. Results were compared to microscopic examination and serological assays (enzyme-linked immunosorbent assay (ELISA), indirect haemagglutination (HA) and Western Blot (WB) assay). Results Compared to microscopy, PCRs significantly increased the sensitivity of diagnosis, from 4% to 10.5% and from 33.7% to 48.8%, for Sh in urine and Sm in stools, respectively. The overall sensitivity of PCR on serum samples was 72.7% and reached 94.1% in patients with positive excreta (microscopy). The specificity of serum PCR was 98.9%. After treatment, serum PCR positivity rates slowly declined from 93.8% at day 30 to 8.3% at day 360, whereas antibody detection remained positive after 1 year. Conclusion Schistosoma PCRs clearly outperform standard microscopy on stools and urine and could be part of reference methods combined with WB-based serology, which remains a gold standard for initial diagnosis. When serological assays are positive and microscopy is negative, serum PCRs provide species information to guide further clinical exploration. Biomarkers such as DNA and antibodies are of limited relevance for early treatment monitoring but serum PCR could be useful when performed at least 1 year after treatment to help confirm a cured infection., Author summary Schistosomiasis is one of the most important human parasitic neglected tropical diseases. It is a major source of morbidity and mortality in Africa but also in South America, the Caribbean, the Middle East, and Asia. It is transmitted by skin penetration of schistosome cercariae via contact with freshwater. Schistosoma mansoni and S. haematobium are the most common species and are frequent causes of infection in travelers and migrants returning from endemic areas. Chronic infections with these two species can cause irreversible damage to the liver or genitourinary tract. Diagnosis mainly relies on serological screening and microscopic procedures from urine and stool specimens that can, however, fail to detect low parasite burden and depend on operator competence. So there is a need to improve the detection of this disease. With this retrospective study, we evaluate the accuracy of a specific Schistosoma PCR assay for the diagnosis of schistosomiasis on a large cohort of migrants and travelers returning from endemic areas. Our study showed that PCR, a technique allowing Schistosoma DNA amplification and detection, greatly improved the diagnosis of both parasite species in urine, feces and biopsies. We also demonstrate that the detection of circulating Schistosoma DNA in blood by PCR is useful to confirm schistosomiasis diagnosis, to provide a species identification when the microscopy research is negative and to monitor the treatment efficacy.

Published
2019
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24. Performance of seven commercial automated assays for the detection of low levels of anti-Toxoplasma IgG in French immunocompromised patients

Author

Tiphaine Douet, Catherine Armengol, Pamela Chauvin, Judith Fillaux, Antoine Berry, Xavier Iriart, Sophie Cassaing, Eléna Charpentier, Service de Parasitologie et Mycologie [CHU Toulouse], Institut Fédératif de Biologie (IFB), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Pôle Biologie [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre Hospitalier Comminges Pyrénées (CHCP), Pharmacochimie et Biologie pour le Développement (PHARMA-DEV), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT), Service de Parasitologie et Mycologie, CHU Toulouse [Toulouse]-Institut Fédératif de Biologie (IFB) - Hôpital Purpan, Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie de Toulouse (ICT-FR 2599), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Institut de Chimie du CNRS (INC)-Institut de Recherche pour le Développement (IRD), ESIM - Déterminants Sociaux de la Santé et du Recours aux Soins (DS3), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), Service de Parasitologie-Mycologie [Toulouse], Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], CHU Bordeaux [Bordeaux], Unité de Nutrition Humaine (UNH), Institut National de la Recherche Agronomique (INRA)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT-FR 2599), Centre National de la Recherche Scientifique (CNRS)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut de Recherche pour le Développement (IRD)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Université Toulouse III - Paul Sabatier (UT3), and Université Fédérale Toulouse Midi-Pyrénées

Subjects
Adult, Male, Veterinary (miscellaneous), [SDV]Life Sciences [q-bio], Toxoplasma gondii, Antibodies, Protozoan, Biology, IgG low level, Sensitivity and Specificity, lcsh:Infectious and parasitic diseases, Serology, 03 medical and health sciences, Immunocompromised Host, Young Adult, medicine, Humans, Mass Screening, lcsh:RC109-216, In patient, Serologic Tests, Immunodiagnosis, Mass screening, 030304 developmental biology, Automation, Laboratory, 0303 health sciences, 030306 microbiology, Middle Aged, medicine.disease, biology.organism_classification, Toxoplasmosis, 3. Good health, Titer, Infectious Diseases, Insect Science, Immunoglobulin G, Immunology, biology.protein, Animal Science and Zoology, Parasitology, Female, Enzyme immunoassays, Automated tests, Reagent Kits, Diagnostic, Antibody, Toxoplasma, Research Article
Abstract

International audience; Background: Immunocompromised patients are at high risk for the development of severe toxoplasmosis from tissue cyst reactivation, the most frequently, or from recently acquired acute infections. Knowledge of serologic status is therefore crucial. Screening for toxoplasmosis is sometimes performed while patients are already immunocompromised and have a low or even undetectable IgG titer by routine automated enzyme immunoassays. The aim of this study was to assess the sensitivity and specificity of seven reagents for the detection of low levels of IgG. Sera from 354 patients were collected and analysed. Results: Elecsys® offered the best analytic performances, superior to those of Architect® and Platelia®, which were superior to those of Access II® and TGS TA®. Vidas II® and Liaison II® reagents exhibited poor analytical performances in this cohort. For Elecsys®, Platelia® and Architect®, new thresholds for the grey zone and positive zone have been defined to improve the sensitivity of these reagents while maintaining excellent specificity. Conclusions: Commercialized assays for toxoplasmosis screening are not suitable for IgG low-level detection in patients without adapting the supplier thresholds to avoid false negative results and risk generalized toxoplasmosis.; Contexte : Les patients immunodéprimés courent un risque élevé de développer une toxoplasmose grave résultant de la réactivation de kystes tissulaires, le plus souvent, ou d’infections aiguës récemment contractées. La connaissance du statut sérologique est donc cruciale. Le dépistage de la toxoplasmose est parfois effectué chez des patients déjà immunodéprimés et dont le titre en IgG est faible, voire indétectable, par les immunoessais enzymatiques automatisés de routine. Le but de cette étude était d’évaluer la sensibilité et la spécificité de sept réactifs pour la détection de faibles taux d’IgG. Les sérums de 354 patients ont été recueillis et analysés. Résultats : Elecsys® offre les meilleures performances analytiques, supérieures à celles d’Architect® et de Platelia®, supérieures à celles d’Access II® et de TGS TA®. Les réactifs Vidas II® et Liaison II® ont présenté des performances analytiques médiocres dans cette cohorte. Pour Elecsys®, Platelia® et Architect®, de nouveaux seuils pour la zone grise et la zone positive ont été définis pour améliorer la sensibilité de ces réactifs tout en maintenant une excellente spécificité. Conclusions : Les tests commercialisés pour le dépistage de la toxoplasmose ne conviennent pas à la détection de faibles taux d’IgG chez les patients sans adaptation des seuils des fournisseurs pour éviter les résultats faux négatifs et le risque de toxoplasmose généralisée.

Published
2019
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25. Human toxocariasis and atopy

Author

Xavier Iriart, Alexis Valentin, Sophie Cassaing, Jean-François Magnaval, Judith Fillaux, Antoine Berry, Laboratoire d'Anthropobiologie (LA), École des hautes études en sciences sociales (EHESS)-Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS), Pharmacochimie et Biologie pour le Développement (PHARMA-DEV), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie de Toulouse (ICT-FR 2599), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Institut de Chimie du CNRS (INC)-Institut de Recherche pour le Développement (IRD), Service de Parasitologie et Mycologie, CHU Toulouse [Toulouse]-Institut Fédératif de Biologie (IFB) - Hôpital Purpan, Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], Université Fédérale Toulouse Midi-Pyrénées, CHU Bordeaux [Bordeaux], Université de Toulouse (UT), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Service de Parasitologie et Mycologie [CHU Toulouse], Institut Fédératif de Biologie (IFB), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Pôle Biologie [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre de Physiopathologie Toulouse Purpan (CPTP), and Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
MESH: Toxocara, Hypersensitivity, Immediate, Male, [SDV]Life Sciences [q-bio], MESH: Hypersensitivity, Immediate / parasitology, Disease, Immunoglobulin E, Atopy, Leukocyte Count, 0302 clinical medicine, MESH: Eosinophil Cationic Protein / blood, Clinical picture, Outpatients, Eosinophilia, Outpatient clinic, MESH: Animals, Outcome, 0303 health sciences, MESH: Middle Aged, biology, MESH: Immunoglobulin E / blood, Middle Aged, 3. Good health, Infectious Diseases, Female, France, IgE, medicine.symptom, Research Article, Adult, medicine.medical_specialty, Veterinary (miscellaneous), Antibodies, Helminth, MESH: Eosinophils / cytology, MESH: Antibodies, Helminth / blood, lcsh:Infectious and parasitic diseases, MESH: Hypersensitivity, Immediate / immunology, 03 medical and health sciences, MESH: Toxocariasis / immunology, Internal medicine, medicine, Animals, Humans, lcsh:RC109-216, Retrospective Studies, Toxocara, 030304 developmental biology, MESH: Humans, Toxocariasis, Eosinophil Cationic Protein, MESH: Adult, MESH: Retrospective Studies, Retrospective cohort study, medicine.disease, MESH: Male, MESH: Outpatients, MESH: France, Eosinophils, 030228 respiratory system, Parasitology, MESH: Leukocyte Count, Insect Science, biology.protein, Animal Science and Zoology, MESH: Female, Human toxocariasis
Abstract

To assess the possible influence of atopy on the clinical picture of human toxocariasis, a retrospective study was carried out using file records for patients who attended the Outpatient Clinic of Parasitology in Toulouse University Hospitals. A total of 106 file records for patients who had been diagnosed with common/covert toxocariasis were extracted from the database. Forty-nine patients (20 females and 29 males) were considered atopic since they exhibited a long (≥ 1 year) history of various allergic issues along with a titer ≥ 0.7 kIU/L for specific IgE against at least two out of nine mixes of common inhalant allergens. Fifty-seven patients (42 females and 15 males) were designated nonatopic on the basis of a negative result (0.35 kIU/L) of the test for specific IgE. Demographic (age and sex), clinical (20 signs or symptoms) and laboratory (blood eosinophil count, eosinophil cationic protein, serum total IgE, and specific anti-Toxocara IgE) variables were investigated by bivariate analysis followed by multivariate regression analysis using "atopy" as the outcome variable. On the basis of our results, the clinical or laboratory picture of toxocaral disease was not affected by the presence of an atopic status.Toxocarose humaine et atopie.Pour évaluer la possible influence de l’atopie sur la présentation clinico-biologique de la toxocarose humaine, une étude rétrospective a été réalisée à partir des dossiers de patients vus à la Consultation du Service de Parasitologie-Mycologie du CHU de Toulouse. Cent-six dossiers de patients diagnostiqués comme ayant la forme commune de la toxocarose ont été extraits de la base de données. Quarante-neuf patients (20 femmes et 29 hommes) ont été considérés comme atopiques, eu égard à une longue (≥ 1 an) histoire de manifestations allergiques couplée à une recherche positive (≥ 0.7 kUI/L) des IgE spécifiques contre au moins deux parmi 9 mélanges de pneumallergènes communs. Cinquante-sept patients (42 femmes et 15 hommes) ont été classés non atopiques sur la base d’un résultat négatif ( 0.35 kUI/L) de la recherche d’IgE spécifiques. Les variables démographiques (âge et sexe), cliniques (20 signes ou symptômes) et biologiques (numération des éosinophiles sanguins, dosage des protéines cationiques des éosinophiles, des IgE totales et des IgE spécifiques anti-Toxocara) ont été l’objet d’une analyse statistique bivariée suivie par une régression logistique multivariée, en utilisant “atopie” comme variable à expliquer. Selon nos résultats, le tableau clinique et biologique de la toxocarose n’est pas modifié par la présence d’un état atopique.

Published
2020
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26. Prenatal therapy with pyrimethamine + sulfadiazine vs spiramycin to reduce placental transmission of toxoplasmosis: a multicenter, randomized trial

Author

Laurent Mandelbrot, François Kieffer, Rémi Sitta, Hélène Laurichesse-Delmas, Norbert Winer, Louis Mesnard, Alain Berrebi, Gwenaëlle Le Bouar, Jean-Paul Bory, Anne-Gaëlle Cordier, Yves Ville, Franck Perrotin, Jean-Marie Jouannic, Florence Biquard, Claude d’Ercole, Véronique Houfflin-Debarge, Isabelle Villena, Rodolphe Thiébaut, Denis Pons, C. Nourrisson, Rose-Anne Lavergne, Judith Fillaux, Corinne Assouline, Florence Robert-Gangneux, Coralie L’Ollivier, Florence Bretelle, Béatrice Guidicelli, Patricia Garcia, Anne-Gaelle Cordier, Alexandra Benachi, Christelle Vauloup-Fellous, Emmanuelle Letamendia, Marie-Elisabeth Bougnoux, Nathalie Van Langendonck, Jérôme Potin, Pierre Marty, Christelle Pomarès, Cynthia Trastour, Anne Sophie Deleplancque, Jean-Marc Costa, Marie-Thérèse Chève, Jean-Yves Col, Bernard Cimon, Y. Sterkers, Laurence Lachaud, Gilles Burlet, Martine Maréchaud, Estelle Perraud, Anne-Gaelle Grébille, Morgane Valentin, Sandrine Houzé, Sophie Omnès, Yvon Chitrit, Christine Boissinot, Hélène Yéra, Olivia Anselem, Vassilis Tsatsaris, Marie-Victoire Sénat, Florent Fuchs, Adela Angoulvant, Charles Muszynski, Anne Totet, Catherine Noël, Laurent Bidat, Tiphaine Barjat, Pierre Flori, Hervé Pelloux, Marie-Pierre Brenier-Pinchart, Catherine Thong-Vanh, Corinne Floch, Lionel Carbillon, Eric Lachassine, Aude Ricbourg, Luc Paris, Marc Dommergues, Thierry Rousseau, Frederic Dalle, Marie Laure Dardé, Véronique Aubard, Camille Olivier, Eric Verspyk, Loic Favennec, Service de gynécologie obstétrique, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Nord Val de Seine, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut de Puériculture et de Périnatalogie, Santé publique et épidémiologie des déterminants professionnels et sociaux de la santé, Epidémiologie, sciences sociales, santé publique (IFR 69), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Gynécologie [CHU Clermont-Ferrand], CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Physiopathologie des Adaptations Nutritionnelles (PhAN), Institut National de la Recherche Agronomique (INRA)-Université de Nantes (UN), Gynécologie‑Obstétrique, Service de Gynécologie et Obstétrique [Rennes] = Gynaecology [Rennes], CHU Pontchaillou [Rennes], Université Paris Descartes - Paris 5 (UPD5), CHU Necker - Enfants Malades [AP-HP], Centre Hospitalier Universitaire de Reims (CHU Reims), CHRU Tours, Hôpital Bretonneau, Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Gynécologie-Obstétrique [CHU Trousseau], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Trousseau [APHP], Service de gynécologie-obstétrique, Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Epidémiosurveillance de protozooses à transmission alimentaire et vectorielle (ESCAPE), Université de Reims Champagne-Ardenne (URCA)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Agence nationale de sécurité sanitaire de l'alimentation, de l'environnement et du travail (ANSES), Université de Bordeaux (UB), Centre de recherche sur la Paléobiodiversité et les Paléoenvironnements (CR2P), Muséum national d'Histoire naturelle (MNHN)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS), Laboratoire Microorganismes : Génome et Environnement (LMGE), Université Blaise Pascal - Clermont-Ferrand 2 (UBP)-Université d'Auvergne - Clermont-Ferrand I (UdA)-Centre National de la Recherche Scientifique (CNRS), Centre de Physiopathologie Toulouse Purpan (CPTP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de Parasitologie et Mycologie, CHU Toulouse [Toulouse]-Institut Fédératif de Biologie (IFB) - Hôpital Purpan, Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Assistance Publique - Hôpitaux de Marseille (APHM), Gynépole, Aix Marseille Université (AMU)- Hôpital Nord [CHU - APHM], Service de gynécologie-obstétrique, médecine de la reproduction [Béclère], Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Antoine Béclère [Clamart], Division of Pediatrics and Neonatal Critical Care, FAME Department, South Paris, University Hospitals, 'A.Beclere' Medical Center-APHP, Service de Parasitologie-Mycologie-Médecine Tropicale, CHRU Bretonneau, Centre méditerranéen de médecine moléculaire (C3M), Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Côte d'Azur (UCA), Anofel Cryptosporidium National Network, Institut de signalisation, biologie du développement et cancer (ISBDC), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Centre National de la Recherche Scientifique (CNRS)-Université Côte d'Azur (UCA), Laboratoire de Biologie Moléculaire, Hôpital américain, Groupe d'Étude des Interactions Hôte-Pathogène (GEIHP), Université d'Angers (UA), Biologie, Génétique et Pathologie des Pathogènes Eucaryotes (MIVEGEC-BioGEPPE), Pathogènes, Environnement, Santé Humaine (EPATH), Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle (MIVEGEC), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud])-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud])-Maladies infectieuses et vecteurs : écologie, génétique, évolution et contrôle (MIVEGEC), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud])-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD [France-Sud]), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), laboratoire parasitologie, CHU Bichat Paris, Ministère de la santé, Hôpital Louis Mourier - AP-HP [Colombes], Service de parasitologie-mycologie [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Service de Gynécologie et Obstétrique [Cochin], Hôpital Cochin [AP-HP], Physiopathologie et Pharmacotoxicologie Placentaire Humaine (U1139), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Gynécologie-Obstétrique [Bicêtre], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, Service de gynécologie-obstétrique et médecine de la reproduction, Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Arnaud de Villeneuve, Biomécanique et Bioingénierie (BMBI), Université de Technologie de Compiègne (UTC)-Centre National de la Recherche Scientifique (CNRS), Departments of Medical Parasitology and Mycology, Centre Hospitalier René Dubos [Pontoise], Groupe Immunité des Muqueuses et Agents Pathogènes (GIMAP), Université Jean Monnet [Saint-Étienne] (UJM), Laboratoire de parasitologie-mycologie, CHU Grenoble, Epigenetique, Pathologie et Developpement (UMR_S_741), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de gynécologie-obstétrique [Hôpital Jean Verdier], Université Paris 13 (UP13)-Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Parasitologie - Mycologie [CHU Pitié-Salpétrière], CHU Pitié-Salpêtrière [AP-HP], Service de Gynécologie-Obstétrique, Maternité, Chirurgie Gynécologique [CHU Pitié-Salpêtrière], Centre Max Weber (CMW), École normale supérieure - Lyon (ENS Lyon)-Université Lumière - Lyon 2 (UL2)-Université Jean Monnet [Saint-Étienne] (UJM)-Centre National de la Recherche Scientifique (CNRS), Laboratoire Interactions Muqueuses Agents Transmissibles (LIMA), Université de Bourgogne (UB), Service de Gynécologie-Obstétrique [CHU Limoges], CHU Limoges, CHU Tenon [AP-HP], Appareil Digestif Environnement Nutrition (ADEN ), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU), Statistics In System biology and Translational Medicine (SISTM), Inria Bordeaux - Sud-Ouest, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)-Epidémiologie et Biostatistique [Bordeaux], Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Bordeaux Segalen - Bordeaux 2-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Bordeaux [Bordeaux], CHU Clermont-Ferrand, Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Régional d'Orléans (CHRO), AP-HP - Hôpital Antoine Béclère [Clamart], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), PRES Université Nantes Angers Le Mans (UNAM), CHU Lille, Université de Reims Champagne-Ardenne (URCA), Hôpital Maison Blanche, Institut National de Recherche en Informatique et en Automatique (Inria)-Institut National de Recherche en Informatique et en Automatique (Inria)- Bordeaux population health (BPH), Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris 1 Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université de Nantes (UN)-Institut National de la Recherche Agronomique (INRA), Hôpital Paule de Viguier, CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU), Agence nationale de sécurité sanitaire de l'alimentation, de l'environnement et du travail (ANSES)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Université de Reims Champagne-Ardenne (URCA), Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Institut National de la Santé et de la Recherche Médicale (INSERM)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Université d'Angers (UA), Université Nice Sophia Antipolis (... - 2019) (UNS), Centre National de la Recherche Scientifique (CNRS)-Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Diderot - Paris 7 (UPD7), Hôpital Jean Verdier [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris 13 (UP13), Service de parasitologie - mycologie [CHU Pitié-Salpétrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service Gynécologie [CHU Toulouse], Pôle Femme-Mère-Couple [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de Parasitologie et Mycologie [CHU Toulouse], Institut Fédératif de Biologie (IFB), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Pôle Biologie [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université Jean Monnet - Saint-Étienne (UJM), École normale supérieure de Lyon (ENS de Lyon)-Université Lumière - Lyon 2 (UL2)-Université Jean Monnet - Saint-Étienne (UJM)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hopital Louis Mourier - AP-HP [Colombes]-Hôpitaux Universitaires Paris Nord Val de Seine, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Université Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Panthéon-Sorbonne (UP1)-Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM), Pôle de Gynécologie-Obstétrique et Reproduction Humaine, CHU Clermont-Ferrand-Université de Clermont-Ferrand, Physiologie des Adaptations Nutritionnelles [UMR_A1280] (PhAN), Centre de Physiopathologie Toulouse Purpan ex IFR 30 et IFR 150 (CPTP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS), Centre de recherche Médecine, Science, Santé et Société (CERMES), Université Paris-Sud - Paris 11 (UP11)-École des hautes études en sciences sociales (EHESS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de Gynécologie et Obstétrique [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-CHU Pontchaillou [Rennes]-Hôpital Sud, Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Antoine Béclère, Université Côte d'Azur (UCA)-Université Côte d'Azur (UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Côte d'Azur (UCA)-Université Côte d'Azur (UCA)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Trousseau [APHP], Groupe d'Etude des Interactions Hôte-Parasite (GEIHP), Institut de Recherche pour le Développement (IRD [France-Sud])-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), Hopital Louis Mourier - AP-HP [Colombes], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP], CHU Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Bicêtre, Université Paris 13 (UP13)-Hôpital Jean Verdier [Bondy], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], Service de Gynécologie et Obstétrique [Groupe Hospitalier Pitié-Salpêtrière], CHU Pitié-Salpêtrière [APHP], and CHU Tenon [APHP]

Subjects
0301 basic medicine, Adult, medicine.medical_specialty, 030106 microbiology, Antiprotozoal Agents, Sulfadiazine, [SDV.MP.PRO]Life Sciences [q-bio]/Microbiology and Parasitology/Protistology, Toxoplasmosis, Congenital, law.invention, 03 medical and health sciences, Folinic acid, pyrimethamine-sulfadiazine, 0302 clinical medicine, Randomized controlled trial, law, Internal medicine, medicine, Humans, 030212 general & internal medicine, Seroconversion, Pregnancy Complications, Infectious, ComputingMilieux_MISCELLANEOUS, spiramycin, prenatal diagnosis, tolerance, business.industry, Spiramycin, Obstetrics and Gynecology, Prenatal Care, medicine.disease, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Toxoplasmosis, Infectious Disease Transmission, Vertical, 3. Good health, SISTM, Pyrimethamine, Treatment Outcome, Chemoprophylaxis, Drug Therapy, Combination, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, pregnancy, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, medicine.drug, toxoplasmosis
Abstract

International audience; Background - The efficacy of prophylaxis to prevent prenatal toxoplasmosis transmission is controversial, without any previous randomized clinical trial. In France, spiramycin is usually prescribed for maternal seroconversions. A more potent pyrimethamine + sulfadiazine regimen is used to treat congenital toxoplasmosis and is offered in some countries as prophylaxis. Objective - We sought to compare the efficacy and tolerance of pyrimethamine + sulfadiazine vs spiramycin to reduce placental transmission. Study design - This was a randomized, open-label trial in 36 French centers, comparing pyrimethamine (50 mg qd) + sulfadiazine (1 g tid) with folinic acid vs spiramycin (1 g tid) following toxoplasmosis seroconversion. Results - In all, 143 women were randomized from November 2010 through January 2014. An amniocentesis was later performed in 131 cases, with a positive Toxoplasma gondii polymerase chain reaction in 7/67 (10.4%) in the pyrimethamine + sulfadiazine group vs 13/64 (20.3%) in the spiramycin group. Cerebral ultrasound anomalies appeared in 0/73 fetuses in the pyrimethamine + sulfadiazine group, vs 6/70 in the spiramycin group (P = .01). Two of these pregnancies were terminated. Transmission rates, excluding 18 children with undefined status, were 12/65 in the pyrimethamine + sulfadiazine group (18.5%), vs 18/60 in the spiramycin group (30%, P = .147), equivalent to an odds ratio of 0.53 (95% confidence interval, 0.23-1.22) and which after adjustment tended to be stronger (P = .03 for interaction) when treatment started within 3 weeks of seroconversion (95% confidence interval, 0.00-1.63). Two women had severe rashes, both with pyrimethamine + sulfadiazine. Conclusion - There was a trend toward lower transmission with pyrimethamine + sulfadiazine, but it did not reach statistical significance, possibly for lack of statistical power because enrollment was discontinued. There were also no fetal cerebral toxoplasmosis lesions in the pyrimethamine + sulfadiazine group. These promising results encourage further research on chemoprophylaxis to prevent congenital toxoplasmosis.

Published
2018
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27. Persistence of schistosomal transmission linked to the Cavu river in southern Corsica since 2013

Author

Jérôme Boissier, Florian Busato, L. Ramalli, P. Malfait, Stephen Mulero, Antoine Berry, Guillaume Normand, Harold Noel, Vincent Gendrin, Jean-François Allienne, Josselin Vincent, Hélène Barré-Cardi, Judith Fillaux, Jean-Dominique Chiappini, Santé publique France - French National Public Health Agency [Saint-Maurice, France], Interactions Hôtes-Pathogènes-Environnements (IHPE), Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM)-Institut Français de Recherche pour l'Exploitation de la Mer (IFREMER)-Université de Perpignan Via Domitia (UPVD), Office de l'environnement de la Corse, Polyclinique de l'Ormeau, Centre Hospitalier de Bigorre (Tarbes), Hôpital Nord Franche-Comté [Hôpital de Trévenans] (HNFC), Service de Parasitologie et Mycologie, CHU Toulouse [Toulouse]-Institut Fédératif de Biologie (IFB) - Hôpital Purpan, Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], Centre de Physiopathologie Toulouse Purpan (CPTP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Modat, Anne, Université de Perpignan Via Domitia (UPVD)-Institut Français de Recherche pour l'Exploitation de la Mer (IFREMER)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), Centre Hospitalier de Bigorre [Tarbes], Service de Parasitologie et Mycologie [CHU Toulouse], Institut Fédératif de Biologie (IFB), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Pôle Biologie [CHU Toulouse], and Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)

Subjects
0301 basic medicine, Bulinus, Epidemiology, Snails, 030231 tropical medicine, 030106 microbiology, Corsica, Zoology, Fresh Water, parasitic diseases, Schistosomiasis, law.invention, Persistence (computer science), Schistosomiasis haematobia, 03 medical and health sciences, 0302 clinical medicine, law, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Virology, medicine, Animals, Humans, Parasite hosting, Urogenital Schistosomiasis, Helminths, Disease Notification, biology, Public Health, Environmental and Occupational Health, Outbreak, medicine.disease, biology.organism_classification, 3. Good health, Transmission (mechanics), [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, outbreaks, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Schistosoma haematobium, Schistosoma, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, Rapid Communication, Environmental Monitoring
Abstract

Seven cases of urogenital schistosomiasis occurred in Corsica in 2015 and 2016. The episodes were related to exposure to the same river and involved the same parasite strain as an outbreak with 106 cases in summer 2013. The connection calls for further investigations on the presence of an animal reservoir and the survival of infested snails during winter. However, recontamination of the river from previously infected bathers remains the most likely hypothesis. Since 2015, seven cases of urogenital schistosomiasis reported exposure to the Cavu river in southern Corsica. They had no history of contact to fresh water in endemic areas. Here, we describe the cases indicating persistent schistosomal transmission linked to this river since 2013. To date, no contamination has been related to an exposure in 2017, but cases might arise in the coming months considering the long parasitic cycle in humans. Therefore, physicians in France and elsewhere should test possible clinical cases, regardless of the year of exposure to the Cavu river.

Published
2018
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28. Risk Factors of Pneumocystis Pneumonia in Solid Organ Recipients in the Era of the Common Use of Posttransplantation Prophylaxis

Author

Laurence Lavayssière, O. Roques, Jean-François Magnaval, Sandie Menard, Lionel Rostaing, A. Del Bello, Sophie Cassaing, Olivier Cointault, Antoine Berry, Judith Fillaux, Rose-Anne Lavergne, Isabelle Cardeau-Desangles, Pamela Chauvin, Nassim Kamar, Xavier Iriart, L. Esposito, T. Challan Belval, CHU Toulouse [Toulouse], Pharmacochimie et Biologie pour le Développement (PHARMA-DEV), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT-FR 2599), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC), Centre de Physiopathologie Toulouse Purpan (CPTP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT), and Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Graft Rejection, Male, Antifungal Agents, [SDV]Life Sciences [q-bio], Cytomegalovirus, Pneumocystis carinii, Pneumocystis pneumonia, Clinical research, Postoperative Complications, Risk Factors, Immunology and Allergy, Pharmacology (medical), Univariate analysis, risk stratification, Pneumonia, Pneumocystis, Graft Survival, risk assessment, Middle Aged, complication: infectious, practice, Tissue Donors, 3. Good health, fungal, Cytomegalovirus Infections, Female, Risk assessment, infection and infectious agents, medicine.medical_specialty, infectious disease, lung, disease: infectious, Immunocompromised Host, Internal medicine, Trimethoprim, Sulfamethoxazole Drug Combination, medicine, Humans, Retrospective Studies, Transplantation, business.industry, Organ Transplantation, Odds ratio, Antibiotic Prophylaxis, medicine.disease, Transplant Recipients, Tacrolimus, Confidence interval, Surgery, Case-Control Studies, business, Follow-Up Studies
Abstract

International audience; Pneumocystis pneumonia (PCP) in solid organ transplant (SOT) recipients becomes rare in the immediate posttransplantation period thanks to generalized prophylaxis. We aimed to identify the predictive factors for PCP in the era of universal prophylaxis and to propose a strategy for preventing PCP beyond the first year after transplantation. In a retrospective case-control study, 33 SOT cases with PCP diagnosed between 2004 and 2010 were matched with two controls each to identify risk factors for PCP by uni- and multivariate analysis. All the patients benefited from 6 months of posttransplantation trimethoprim-sulfamethoxazole prophylaxis. Most PCP in SOT patients occurred during the second year posttransplantation (33%). By univariate analysis, age, nonuse of tacrolimus, total and CD4 lymphocyte counts, gamma-globulin concentration and cytomegalovirus (CMV) infection appeared to be PCP risk factors. In the final multivariate analysis, age (adjusted odds ratio [OR] 3.7, 95% confidence interval [CI]: 1.3-10.4), CMV infection (OR: 5.2, 95% CI: 1.8-14.7) and total lymphocyte count (OR: 3.9, 95% CI: 1.4-10.7) were found to be independently associated with PCP. The second year posttransplantation appeared to be the new period of highest risk of PCP. Age, CMV viremia and lymphocytes were the most pertinent predictive criteria to evaluate the risk of PCP in clinical practice.

Published
2015
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29. Large outbreak of urogenital schistosomiasis acquired in Southern Corsica, France: monitoring early signs of endemicization?

Author

H. Noël, J.-L. Termignon, M. Ruello, H. Barré-Cardi, J. Durand, Antoine Berry, Camille Pelat, M. Debruyne, Judith Fillaux, L. Ramalli, A. Maccary, P. Malfait, J.-D. Chiappini, C. Sommen, Jérôme Boissier, G. Chyderiotis, Institut des Sciences Chimiques de Rennes (ISCR), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées - Rennes (INSA Rennes), Institut National des Sciences Appliquées (INSA)-Université de Rennes (UNIV-RENNES)-Institut National des Sciences Appliquées (INSA)-Ecole Nationale Supérieure de Chimie de Rennes-Centre National de la Recherche Scientifique (CNRS), Interactions Hôtes-Pathogènes-Environnements (IHPE), Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM)-Institut Français de Recherche pour l'Exploitation de la Mer (IFREMER)-Université de Perpignan Via Domitia (UPVD), Institut Européen des membranes (IEM), Université de Montpellier (UM)-Université Montpellier 2 - Sciences et Techniques (UM2)-Ecole Nationale Supérieure de Chimie de Montpellier (ENSCM)-Centre National de la Recherche Scientifique (CNRS), Cellule Interrégionale d'Epidémiologie, Santé publique France, French Ministry of Health, Santé publique France - French National Public Health Agency [Saint-Maurice, France], Office de l'environnement de la Corse, CHU Toulouse [Toulouse], Centre de Physiopathologie Toulouse Purpan (CPTP), Université Toulouse III - Paul Sabatier (UT3), and Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Microbiology (medical), Adult, Male, medicine.medical_specialty, Adolescent, Early signs, 030231 tropical medicine, Early detection, Corsica, Schistosomiasis, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Serology, Disease Outbreaks, 03 medical and health sciences, Schistosomiasis haematobia, Young Adult, 0302 clinical medicine, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Urogenital schistosomiasis, Environmental health, Medicine, Urogenital Schistosomiasis, Humans, 030212 general & internal medicine, Child, ComputingMilieux_MISCELLANEOUS, Aged, [SDV.MHEP.ME]Life Sciences [q-bio]/Human health and pathology/Emerging diseases, business.industry, Transmission (medicine), [SDV.BID.EVO]Life Sciences [q-bio]/Biodiversity/Populations and Evolution [q-bio.PE], Outbreak, General Medicine, Environmental Exposure, Middle Aged, medicine.disease, 3. Good health, Surgery, Infectious Diseases, Epidemiologic surveillance, Parasitic, Child, Preschool, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Female, France, business
Abstract

International audience; Objectives: Clustered cases of urogenital schistosomiasis were reported in April 2014 among French and German tourists linked to exposure in the Cavu River, Southern Corsica, France, between 2011 and 2013. We set up national surveillance for autochthonous urogenital schistosomiasis to document the largest possible number of cases in order to identify potential sites of transmission and to determine the extent of the outbreak in France and Corsica.Methods:The early response consisted mostly of prohibiting swimming in the river, performing a nationwide serologic screening of all persons exposed to the river between 2011 and 2013 and treating confirmed cases. Physicians were asked to report all patients with one or more positive antischistosome serologic test. Cases were defined as occurring in a resident of France with serologic evidence of schistosomiasis or schistosome eggs in urine and no history of contact with freshwater in known endemic areas. We documented symptoms as well as place and time of exposure to freshwater for all subjects. To estimate the outbreak size, we modelled the effect of the 2014 nationwide screening on the 2011–2015 time series of serodiagnosed schistosomiasis cases using log-linear autoregression.Results: In 2014, a total of 106 autochthonous cases were reported, including 35 symptomatic infections. All patients had swum in the Cavu during summer 2013. Over 30 000 persons were likely screened for autochthonous schistosomiasis. The model-estimated outbreak size was 338 cases, including 36 serodiagnosed in 2015.Conclusions: Besides the 2013 outbreak, there is evidence of small-scale transmission in 2015 in Corsica. Early detection and control of recurrences requires raising community and medical awareness.

Published
2017
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30. Diagnostic biologique de la toxocarose humaine

Author

Richard Fabre, Jean-François Magnaval, and Judith Fillaux

Subjects
Medical Laboratory Technology, Biochemistry (medical), Analytical Chemistry
Abstract

Resume La toxocarose est une helminthozoonose due a la presence dans l’organisme humain de larves de Toxocara sp., vers ronds de la famille des Ascarides. A ce jour, deux especes seulement, Toxocara canis et Toxocara cati , parasites respectifs du chien et du chat, ont ete reconnues comme agents causatifs de la maladie humaine. Le diagnostic biologique des formes generalisees, larva migrans viscerale et toxocarose commune, est essentiellement serologique, et repose sur la methode ELISA utilisant des antigenes larvaires d’excretion-secretion. Tout resultat positif ou douteux doit etre ensuite verifie par une technique de western-blot. La toxocarose commune est une parasitose frequente, mais la plupart du temps benigne. Une grande majorite des sujets atteints est asymptomatique ou n’a que quelques signes cliniques, et reste donc sans diagnostic. Cette forme de toxocarose se resout generalement spontanement, et les patients gueris conservent un residu d’anticorps specifiques (« cicatrice serologique »), de sorte qu’une seropositivite residuelle peut etre associee a n’importe quelle pathologie, infectieuse ou non. Separee du contexte clinico-biologique, une serologie positive n’a a priori aucune valeur diagnostique, et ne peut etre prise en consideration qu’une fois eliminees les autres etiologies possibles du syndrome presente par le patient. A l’inverse de ce qui peut etre realise dans d’autres infections, l’anciennete de la presence des IgG specifiques ne peut etre evaluee en dosant les IgM specifiques. Le dosage des autres classes – notamment IgE – ou sous-classes – IgG3/IgG4 – d’anticorps specifiques, ou la detection des complexes immuns circulants se sont averes inaptes a differencier une parasitose active de la presence d’anticorps residuels. A l’heure actuelle, la presence d’une toxocarose commune active est affirmee par des arguments indirects, comme l’existence de signes cliniques qui ne peuvent etre rattaches a une autre pathologie, associes a une eosinophilie sanguine et/ou a un taux eleve de proteine cationique des eosinophiles. Une telle situation est loin d’etre ideale.

Published
2014
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31. A persistent risk of urogenital schistosomiasis transmission linked to the Cavu River in Southern Corsica since 2013

Author

Stephen Mulero, Josselin Vincent, Antoine Berry, J.-D. Chiappini, Jean-François Allienne, Jérôme Boissier, P. Malfait, Hélène Barré-Cardi, Judith Fillaux, Harold Noel, Guillaume Normand, Florian Busato, V. Gendrin, and L. Ramalli

Subjects
Epidemiology, business.industry, Bulinus truncatus, Notifiable disease, Public Health, Environmental and Occupational Health, Outbreak, Zoology, Schistosomiasis, Biology, medicine.disease, biology.organism_classification, law.invention, Transmission (mechanics), law, medicine, Seroprevalence, Livestock, business, Schistosoma
Abstract

Introduction Urogenital schistosomiasis, a tropical snail-borne disease, re-emerged in Europe in 2013, with 106 cases linked to exposure to the Cavu River in Southern Corsica. The implicated parasite strain was a hybrid of a human-bovine Schistosoma parasite (S. haematobium–S. bovis) of Senegalese origin. The parasite's introduction to the river was presumed to have occurred via an infected individual. Subsequent to this outbreak, we developed a human and snail surveillance system to detect and control schistosomal transmission. Environmental research and phylogenetic analysis were performed to understand the continuing transmission of schistosomiasis in the river. Methods Autochthonous urogenital schistosomiasis became a notifiable disease in France from 2016. A case was defined as a person with serological or parasitological evidence of schistosomiasis, with no history of travel outside of Corsica in a known endemic area. Patient specimens were genotyped, and compared with the 2013 outbreak strain. Seasonal molecular surveillance of snails in the Cavu River was established for rapid detection of schistosomes. Bulinus truncatus snails, intermediates host of S. haematobium, are collected weekly from the Cavu River when conditions are optimal for schistosomal transmission (June–September). Seroprevalence studies in livestock in Southern Corsica and in wild rodents captured along the Cavu River, were conducted. Results Following the 2013 outbreak, seven new cases were identified: one in 2015, four in 2016 and two in 2017. Three cases reported exposure to the Cavu River in summer 2015, two cases in both summer 2015 and 2016 and two other cases in 2016 and 2017. For the last cases, the period between the 2017 exposure and the diagnosis of the symptomatic case is of four weeks whereas the average time for onset of symptoms after exposure is of 30 weeks. Therefore, this suggests that the infection occurred in 2016. Although no specimen was isolated from patients exposed only in 2015, specimens from a patient exposed in 2015/2016 and from another patient exposed in 2016/2017 were closely related to the 2013 strain. With between 1965 and 5364 snails analyzed each year, the surveillance did not detect any Schistosoma-infested snails in the river from 2015 to 2017. Twenty-one rodents were captured for testing along the river and 3,479 cows and goats in Southern Corsica. All seroprevalence tests were negative. Discussion/Conclusion Corsica possesses all the necessary conditions for permanent transmission of urogenital schistosomiasis. Further research on the survival of infested snails over the winter period, and on the presence of a rodent reservoir in the river area are fundamental to evaluate the risk of ongoing transmission of urogenital schistosomiasis in the Cavu River. The persistence of a human reservoir in vicinity of the Cavu River would increase this risk. Therefore, tourists and locals exposed to the river must be advised of the risk of recreational water use in the Cavu. Public health authorities must reinforce physicians’ awareness of screening recommendations, to promptly detect and treat new cases and to prevent further transmission in Corsica. The maintenance of schistosomes in Corsica serves as a warning to other regions in Europe with environmental conditions favorable to urogenital schistosomiasis transmission.

Published
2018
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32. A case report of isolated lymphadenopathy revealing localized leishmanial lymphadenopathy in an asthenic 25-year-old man

Author

Pierre Delobel, Guillaume Martin-Blondel, Camille Laurent, Bruno Marchou, Judith Fillaux, Pierre Brousset, Paul Hofman, Antoine Berry, Quentin Hurlot, Pagès, Nathalie, Institut Universitaire du Cancer de Toulouse - Oncopole (IUCT Oncopole - UMR 1037), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM), Pharmacochimie et Biologie pour le Développement (PHARMA-DEV), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT-FR 2599), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, Service de Parasitologie et Mycologie [CHU Toulouse], Institut Fédératif de Biologie (IFB), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Pôle Biologie [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre de Physiopathologie de Toulouse Purpan, Institut National de la Recherche Agronomique (INRA), Centre Hospitalier Universitaire de Nice (CHU Nice), Service Maladies infectieuses et tropicales [CHU Toulouse], Pôle Inflammation, infection, immunologie et loco-moteur [CHU Toulouse] (Pôle I3LM Toulouse), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre de Physiopathologie Toulouse Purpan (CPTP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre de Recherches en Cancérologie de Toulouse (CRCT), Université de Toulouse (UT)-Université de Toulouse (UT)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), CHU Toulouse [Toulouse]-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC), Service de Parasitologie et Mycologie, CHU Toulouse [Toulouse]-Institut Fédératif de Biologie (IFB) - Hôpital Purpan, Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], Service des maladies infectieuses et tropicales [Toulouse], Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], and Centre National de la Recherche Scientifique (CNRS)-Université Toulouse III - Paul Sabatier (UT3)

Subjects
0301 basic medicine, Adult, Lymphadenopathy / parasitology, Male, Pathology, medicine.medical_specialty, diagnosis, Biopsy, [SDV]Life Sciences [q-bio], Biopsy, Fine-Needle, 030231 tropical medicine, 030106 microbiology, Diagnosis Differential, Antiprotozoal Agents, Leishmania donovani, Polymerase Chain Reaction, Lymphoid hyperplasia, Diagnosis, Differential, Amphotericin B / therapeutic use, 03 medical and health sciences, 0302 clinical medicine, Cervical lymphadenopathy, lymphadenopathy, medicine, Antiprotozoal Agents / therapeutic use, Humans, Clinical Case Report, Leishmania infantum, Leishmaniasis, biology, business.industry, General Medicine, medicine.disease, biology.organism_classification, amphotericin B, 3. Good health, [SDV] Life Sciences [q-bio], Visceral leishmaniasis, Fine-Needle, Leishmaniasis, Visceral, medicine.symptom, Differential diagnosis, Visceral / diagnosis, business, Epithelioid cell, Research Article
Abstract

International audience; Background: Visceral leishmaniasis (VL) is endemic in large areas of the tropics, the subtropics, and the Mediterranean basin. Besides classical VL presentation, exceptional cases of a limited form of VL have been reported. Here we describe the challenges of diagnosis and management of this intriguing entity.Case summary: A 25-year-old French Caucasian man presented with marked asthenia that had lasted 6 months and was strictly isolated except for a 2-cm left cervical lymphadenopathy. The rest of the clinical examination and extensive biological exploration were unremarkable.Histological examination of the cervical lymphadenopathy showed a reactive lymphoid hyperplasia with granulomatous organization associated with small particles in the cytoplasm of epithelioid histiocytes and giant cells evocative of Leishman-Donovan bodies. Polymerase chain reaction (PCR) performed on the tissue confirmed the presence of Leishmania donovani/infantum DNA. Direct examination of a bone marrow aspiration, together with blood and bone marrow PCR, did not find other evidence for VL. Serology for leishmaniasis was unreactive. Extensive work-up for other causes of granulomatous lymphadenitis was negative. A diagnosis of localized leishmanial lymphadenopathy was made. Intravenous liposomal amphotericin B (20 mg/kg in five infusions) was initiated and well tolerated. Asthenia disappeared promptly and the patient fully recovered.Conclusion: Localized lymph node enlargement because of leishmanial infection should be included in the differential diagnosis of lymphadenopathy of unknown origin in patients who stayed or visited, even a long time ago and for a short period, endemic areas for leishmaniasis such as the Mediterranean basin. Fine-needle aspiration cytology and/or PCR for Leishmania sp of the lymphadenopathy might contribute to the diagnosis. A low-dose liposomal amphotericin B treatment might be effective, and deserves further study.

Published
2016
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33. Assessment of Aspergillus sensitization or persistent carriage as a factor in lung function impairment in cystic fibrosis patients

Author

Michel Abbal, Judith Fillaux, J.-L. Rittié, M. Murris, Bernard Pipy, Antoine Berry, F. Brémont, Sophie Cassaing, Jean-François Magnaval, Christine Segonds, Eric Bieth, and Laurent Tétu

Subjects
Male, Microbiology (medical), Adolescent, Cystic Fibrosis, Cystic fibrosis, Body Mass Index, Aspergillus fumigatus, Pulmonary function testing, Young Adult, Forced Expiratory Volume, Odds Ratio, medicine, Humans, Child, Sensitization, General Immunology and Microbiology, biology, business.industry, Aspergillosis, Allergic Bronchopulmonary, General Medicine, biology.organism_classification, medicine.disease, Precipitin, Cystic fibrosis transmembrane conductance regulator, Infectious Diseases, medicine.anatomical_structure, Carrier State, Multivariate Analysis, Immunology, Disease Progression, biology.protein, Sputum, Female, France, Allergic bronchopulmonary aspergillosis, medicine.symptom, business
Abstract

Cystic fibrosis (CF) patients presenting with persistent carriage of, or sensitization to, Aspergillus fumigatus are often treated with antifungal therapies because the presence of the fungus is commonly thought to impede lung function, even in the absence of allergic bronchopulmonary aspergillosis (ABPA). The aim of this study was to assess Aspergillus-related status modulating the forced expiratory volume in 1 s (FEV₁) of CF patients.From 1995 to 2007, 251 patients were evaluated. Demographic data, cystic fibrosis transmembrane conductance regulator gene (CFTR) mutations, body mass index, and FEV(1) were recorded. The presence of A. fumigatus and Pseudomonas aeruginosa in sputum and the levels of A. fumigatus precipitin, total IgE (t-IgE), and specific anti-A. fumigatus IgE (Af-IgE) were determined. Patients were divided into 3 groups: (1) ABPA: A. fumigatus precipitin ≥3 lines, Af-IgE 0.35 IU/ml, and t-IgE ≥500 IU/ml; (2) sensitization: Af-IgE 0.35 IU/ml but t-IgE 500 IU/ml; and (3) persistent carriage: Af-IgE ≤ 0.35 IU/ml with either an A. fumigatus persistent positive culture or an A. fumigatus precipitin ≥3 lines, provided this serological finding had been found associated with at least 1 A. fumigatus-positive culture. The remaining patients represented the control group. A multivariate analysis was carried out with FEV(1) as the outcome variable.ABPA, sensitization, and persistent carriage were significantly associated with a larger decline in FEV₁ compared with the control group, with odds ratios of 15.9, 14.9, and 10.7, respectively. This association was independent of other associated factors (P. aeruginosa transient detection, age, being underweight, and low FEV₁ at baseline).In addition to ABPA, sensitization and persistent carriage appear to have an impact on pulmonary function in CF patients.

Published
2012
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34. Routine Identification of Medical Fungi by the New Vitek MS Matrix-Assisted Laser Desorption Ionization–Time of Flight System with a New Time-Effective Strategy

Author

Judith Fillaux, Rose-Anne Lavergne, Jean-François Magnaval, Sophie Cassaing, Alexis Valentin, Antoine Berry, and Xavier Iriart

Subjects
Microbiological Techniques, Microbiology (medical), Time Factors, Chromatography, Computer science, Fungi, Routine laboratory, Matrix assisted laser desorption ionization time of flight, Mycology, bacterial infections and mycoses, equipment and supplies, Mass spectrometry, University hospital, Microbiology, Identification (information), Mycoses, Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization, Humans, Clinical evaluation
Abstract

We report here a clinical evaluation of the Vitek MS system for rapid fungal identification. A strategy that uses a single deposit without prior protein extraction was utilized to save time and money. Clinical isolates from the Toulouse University hospital were used to evaluate the performance of the Vitek MS compared to that of both routine laboratory techniques and Vitek2. The Vitek MS performed well in the identification of yeasts and Aspergillus fungi (93.2% of correct identifications).

Published
2012
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35. Contribution of molecular diagnosis to the management of cutaneous leishmaniasis in travellers

Author

Sandie Menard, Jean-François Magnaval, Sophie Cassaing, Guillaume Martin-Blondel, Alexis Valentin, Judith Fillaux, Rose-Anne Lavergne, Pamela Chauvin, S. Arnaud, Christine Roques-Malecaze, Xavier Iriart, Antoine Berry, Bruno Marchou, Centre de Physiopathologie Toulouse Purpan (CPTP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de Parasitologie et Mycologie, CHU Toulouse [Toulouse]-Institut Fédératif de Biologie (IFB) - Hôpital Purpan, Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], Service des maladies infectieuses et tropicales [Toulouse], Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], Pharmacochimie et Biologie pour le Développement (PHARMA-DEV), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT-FR 2599), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC), Laboratoire d'Anthropobiologie (LA), École des hautes études en sciences sociales (EHESS)-Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS), Service de Parasitologie et Mycologie [CHU Toulouse], Institut Fédératif de Biologie (IFB), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Pôle Biologie [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Service Maladies infectieuses et tropicales [CHU Toulouse], Pôle Inflammation, infection, immunologie et loco-moteur [CHU Toulouse] (Pôle I3LM Toulouse), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, Pagès, Nathalie, Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT), École des hautes études en sciences sociales (EHESS)-Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), and Université de Toulouse (UT)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Adult, Male, Microbiology (medical), Adolescent, diagnosis, [SDV]Life Sciences [q-bio], 030231 tropical medicine, Direct examination, Leishmaniasis, Cutaneous, Polymerase Chain Reaction, Sensitivity and Specificity, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Cutaneous leishmaniasis, medicine, Humans, Child, leishmaniasis, Aged, Aged, 80 and over, Leishmania, Travel, 0303 health sciences, biology, cutaneous, 030306 microbiology, business.industry, Leishmaniasis, Sequence Analysis, DNA, sequencing, General Medicine, Middle Aged, medicine.disease, biology.organism_classification, Optimal management, 3. Good health, [SDV] Life Sciences [q-bio], PCR, Infectious Diseases, Molecular Diagnostic Techniques, Child, Preschool, Immunology, Female, Identification (biology), business
Abstract

International audience; Cutaneous leishmaniasis is one of the most frequent skin diseases occurring after travelling in endemic areas. Optimal management requires identification of the species of Leishmania involved. In this study we aimed to evaluate the use of molecular diagnosis as routine, in comparison with direct examination and culture. Thirty positive diagnoses were carried out between 2007 and 2013. Classical PCR enabled 11 positive cases to be identified that were found to be negative by conventional methods. Sequencing led to the identification of eight different species. Routine use of PCR and sequencing appears very efficient in the management of cutaneous leishmaniasis.

Published
2014
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36. Cellular and cytokine changes in the alveolar environment among immunocompromised patients duringPneumocystis jiroveciiinfection

Author

Jean-Fran Ç Ois Magnaval, Sophie Cassaing, Antoine Blancher, Sarah Abbes, Jean Tkaczuk, Judith Fillaux, Caroline Courtais, Monique Courtade, Bernard Pipy, Antoine Berry, Benoit Witkowski, and Xavier Iriart

Subjects
CD4-Positive T-Lymphocytes, Male, medicine.medical_treatment, Lymphocyte, CD8-Positive T-Lymphocytes, Pneumocystis carinii, Immunocompromised Host, Macrophages, Alveolar, parasitic diseases, medicine, Humans, Pneumocystis jirovecii, Interleukin 6, Immunity, Cellular, Lung, biology, medicine.diagnostic_test, Pneumonia, Pneumocystis, General Medicine, Middle Aged, respiratory system, biology.organism_classification, CD4 Lymphocyte Count, Pulmonary Alveoli, Interleukin 10, Infectious Diseases, Cytokine, Bronchoalveolar lavage, medicine.anatomical_structure, Immunology, biology.protein, Cytokines, Female, Bronchoalveolar Lavage Fluid, CD8
Abstract

Limited data exist on the cytokine and cellular changes in the alveolar environment in immunocompromised patients during Pneumocystis jirovecii infection. A cellular and a cytokine analysis were performed on bronchoalveolar lavage (BAL) samples from three groups of patients, i.e., an initial study group of 64 immunocompromised P. jirovecii positive individuals and two control groups of P. jirovecii -negative patients who had been or not immunosuppressed (65 patients). The results were related to alveolar dilution as determined by urea measurement. Compared with non-infected groups, P. jirovecii infected patients had a lower level of alveolar macrophages (AM), particularly those with high burdens of P. jirovecii . Alveolar macrophages over-expressed the Dectin-1 receptor, which was largely implicated in P. jirovecii clearance. The alveolar CD8 � T and CD4 � T lymphocyte counts were increased and an inverse correlation was observed between the alveolar CD4 � cell count and the P. jirovecii burden. Although the alveolar IL-6 level was considerably increased, alveolar IL-17, IL-10, TNF- α , TGF- β concentrations of P. jirovecii patients were not different from the control groups. Changes in the pulmonary environment were also highlighted during P. jirovecii colonization. Our study suggests that there is a correlation between the P. jirovecii burden in the alveolus (from colonization to a high P. jirovecii burden), and the degree of impairment of the alveolar immune response.

Published
2010
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37. Persistance de la transmission de la bilharziose urogénitale en Corse du Sud depuis 2013

Author

Harold Noel, Judith Fillaux, Jérôme Boissier, P. Malfait, Josselin Vincent, Antoine Berry, Jean-François Allienne, L. Ramalli, and Stephen Mulero

Subjects
Infectious Diseases
Abstract

Introduction La bilharziose urogenitale a re-emerge en Europe en 2013 avec la detection de 106 cas contractes lors de baignades dans la riviere Cavu en Corse du Sud. Afin de detecter et controler la transmission de la bilharziose en Corse, un systeme de surveillance a ete mis en place chez les humains et l’hote intermediaire Bulinus truncatus, un mollusque d’eau douce. Depuis, deux episodes de transmissions en 2015 et 2016 ont ete detectes, toujours en lien avec la riviere du Cavu. Materiels et methodes Depuis 2016, la bilharziose urogenitale autochtone est une maladie a declaration obligatoire en France. Un cas correspond a un individu presentant une serologie ou des examens parasitologiques en faveur d’une bilharziose et ne rapportant pas de baignades dans une zone d’endemie. Les œufs de parasite isoles chez les patients ont ete genotypes et compares a ceux identifies en 2013. A chaque saison estivale, une collecte hebdomadaire de bulins s’est tenue dans le Cavu pour detecter par PCR l’eventuelle presence du parasite dans l’environnement. Des etudes de seroprevalence chez les ovins et bovins en Corse du Sud et parmi les rongeurs captures aux abords du Cavu ont ete menees. Resultats Sept cas de bilharziose autochtone ont ete identifies depuis l’epidemie de 2013 : 5 rapportes a une contamination en ete 2015 et 2 en ete 2016. Les souches isolees chez ces individus presentaient toutes le meme genotype que l’hybride S. haematobium/S. bovis identifie en 2013. De 2015 et 2017, 1965 a 5364 bulins ont ete collectes chaque annee dans la riviere. Aucun n’a presente de traces d’infestation par le schistosome. Les serologies realisees chez 3479 ovins et bovins et 21 rongeurs etaient toutes negatives. Conclusion Avec l’identification d’une transmission en 2015 et 2016 se pose la question d’une installation d’un foyer de transmission permanent de la bilharziose urogenitale en Corse. Des recherches additionnelles sur la survie du bulin infeste durant la periode hivernale ainsi que sur la presence d’un reservoir chez les rongeurs sont fondamentales pour evaluer le risque de transmission perenne de la bilharziose dans la riviere du Cavu. En parallele, le depistage des personnes exposees doit etre renforce pour limiter l’etablissement d’un reservoir humain. Par ailleurs, la persistance de la bilharziose en Corse doit alerter sur ce risque les autres regions europeennes presentant des conditions environnementales similaires.

Published
2018
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38. Diagnosis of congenital toxoplasmosis: prenatal and neonatal evaluation of methods used in Toulouse University Hospital and incidence of congenital toxoplasmosis

Author

Judith Fillaux, Antoine Berry, Jean-François Magnaval, Sophie Cassaing, Corinne Assouline, Jean-Marc Ayoubi, Marie-Hélène Bessières, Alain Berrebi, and JP Cambus

Subjects
Amniotic fluid, diagnosis, lcsh:QR1-502, Antibodies, Protozoan, Polymerase Chain Reaction, Toxoplasmosis, Congenital, lcsh:Microbiology, Hospitals, University, Pregnancy, Prenatal Diagnosis, Spiramycin, medicine.diagnostic_test, Obstetrics, Incidence, Incidence (epidemiology), Drug Combinations, Pyrimethamine, PCR, congenital toxoplasmosis, Predictive value of tests, Amniocentesis, Female, France, Toxoplasma, medicine.drug, Microbiology (medical), medicine.medical_specialty, prenatal, lcsh:Arctic medicine. Tropical medicine, lcsh:RC955-962, Enzyme-Linked Immunosorbent Assay, Prenatal diagnosis, Sensitivity and Specificity, neonatal, Predictive Value of Tests, Sulfadoxine, medicine, Animals, Humans, business.industry, Infant, Newborn, DNA, Protozoan, medicine.disease, Toxoplasmosis, Immunoglobulin A, Surgery, Immunoglobulin G, Pregnancy Complications, Parasitic, business
Abstract

The aim of this study was to determine the incidence of congenital toxoplasmosis (CT) and to assess the performances of prenatal and neonatal diagnoses. From 1994-2005, in Toulouse University Hospital, France, amniocentesis was performed on 352 pregnant women who were infected during pregnancy. All women were treated with spiramycin and pyrimethamine-sulfadoxine when prenatal diagnosis was positive. Among the 275 foetuses with follow-up, 66 (24%) were infected. The transmission rates of Toxoplasma gondii were 7%, 24% and 59% in the first, second and third trimesters, respectively. The sensitivity and specificity of PCR on amniotic fluid (AF) were 91% and 99.5%, respectively. One case was diagnosed by mouse inoculation with AF and six cases were diagnosed by neonatal or postnatal screening. The sensitivity and specificity of PCR on placentas were 52% and 99%, respectively. The sensitivity of tests for the detection of specific IgA and IgM in cord blood was 53% and 64%, respectively, and specificity values were 91% and 92%. In conclusion, PCR performed on AF had the highest levels of sensitivity and specificity for the diagnosis of CT. This permits an early diagnosis of most cases and should be recommended.

Published
2009

39. Accuracy of a routine real-time PCR assay for the diagnosis of Pneumocystis jirovecii pneumonia

Author

Sophie Cassaing, Richard Fabre, M. Alvarez, Marie-Denise Linas, Antoine Berry, Judith Fillaux, Sonia Malvy, and Bruno Marchou

Subjects
DNA, Bacterial, Male, Microbiology (medical), medicine.medical_specialty, Pneumocystis carinii, Polymerase Chain Reaction, Sensitivity and Specificity, Microbiology, Gastroenterology, Internal medicine, parasitic diseases, Humans, Medicine, Pneumocystis jirovecii, Molecular Biology, Direct fluorescent antibody, Aged, DNA Primers, medicine.diagnostic_test, biology, business.industry, Pneumonia, Pneumocystis, Respiratory disease, Gold standard (test), Middle Aged, medicine.disease, biology.organism_classification, Reverse transcription polymerase chain reaction, Pneumonia, Bronchoalveolar lavage, Real-time polymerase chain reaction, Fluorescent Antibody Technique, Direct, Immunology, Female, business, Bronchoalveolar Lavage Fluid
Abstract

Pneumocystis jirovecii is a common cause of life-threatening pneumonia among immunocompromised patients. Using 400 fresh bronchoalveolar lavage samples, we compared prospectively routine direct immunofluorescence assay (DFA) and a real-time PCR assay, performed on a LightCycler system, for the detection of P. jirovecii. Among the 66 PCR positive samples, 31 were positive by DFA. No patient was found as having the pattern "PCR--ve/DFA+ve". The semi-quantification of the P. jirovecii DNA was represented by the cycle threshold (Ct). Using DFA as the gold standard, the sensitivity of the PCR was 100% for Ctor = 28 and the specificity was 100% for Ct22. Between these two points, the results could be discrepant. The patients of the "22or = Ct28" group presented more frequently with a radiological interstitial syndrome than the "Ctor = 28" group, and presented less frequently with HIV-infection and elevated lactate dehydrogenase (LDH) assay than in the "Ct22" group. A negative PCR allowed us to exclude the P. jirovecii pneumonia. The real-time PCR assay seems to be an accurate diagnosis method and could replace the DFA. The semi-quantitative results should be helpful to distinguish colonized, subclinically infected and P. jirovecii pneumonia patients.

Published
2008
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40. EPIDEMIOLOGY OF TOXOCARIASIS IN A STEPPE ENVIRONMENT: THE PATAGONIA STUDY

Author

Jean-François Magnaval, Judith Fillaux, Claudia Daniela Sobrino-Becaria, Graciela Santillán, Edmundo Larrieu, and Oscar Jensen

Subjects
Adult, Male, Rural Population, Veterinary medicine, medicine.medical_specialty, Multivariate analysis, Adolescent, Steppe, Climate, Blotting, Western, Antibodies, Helminth, Argentina, Soil, Seroepidemiologic Studies, Environmental protection, Virology, parasitic diseases, Epidemiology, medicine, Animals, Humans, Seroprevalence, Child, Ecosystem, Toxocara, geography, Toxocariasis, geography.geographical_feature_category, Age Factors, Middle Aged, Field survey, medicine.disease, humanities, Contamination rate, Infectious Diseases, Multivariate Analysis, Female, Parasitology, Rural population
Abstract

To investigate the epidemiology of human toxocariasis in a steppe environment, a field survey was carried out in three provinces of Argentina's Patagonia (Chubut, Neuquen, and Rio Negro) among 114 rural subjects residing in estancias (cattle- or sheep-breeding ranches). Overall seroprevalence was 31.6%, and the contamination rate of soil by Toxocara eggs was 35.1%. Bivariate and multivariate analyses were performed for various exposure variables and also for the De Martonne aridity-humidity index. Multivariate analysis revealed that the seroprevalence rate was found to be inversely correlated with age but was positively linked to De Martonne index. These findings suggest that the harsh climatic conditions existing in Argentina's Patagonia would inhibit embryonation of eggs in the soil, thus lowering the transmission of human toxocariasis.

Published
2007
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41. Evidence for a permanent presence of schistosomiasis in Corsica, France, 2015

Author

Pierre Delobel, Bruno Marchou, Antoine Berry, Jérôme Boissier, Judith Fillaux, Jean François Magnaval, Guillaume Martin-Blondel, Xavier Iriart, Centre de Physiopathologie Toulouse Purpan (CPTP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de Parasitologie et Mycologie, CHU Toulouse [Toulouse]-Institut Fédératif de Biologie (IFB) - Hôpital Purpan, Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], Pharmacochimie et Biologie pour le Développement (PHARMA-DEV), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT-FR 2599), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC), Service des maladies infectieuses et tropicales [Toulouse], Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], Interactions Hôtes-Pathogènes-Environnements (IHPE), Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM)-Institut Français de Recherche pour l'Exploitation de la Mer (IFREMER)-Université de Perpignan Via Domitia (UPVD), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de Parasitologie et Mycologie [CHU Toulouse], Institut Fédératif de Biologie (IFB), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Pôle Biologie [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT), Service Maladies infectieuses et tropicales [CHU Toulouse], Pôle Inflammation, infection, immunologie et loco-moteur [CHU Toulouse] (Pôle I3LM Toulouse), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université de Perpignan Via Domitia (UPVD), and Université de Perpignan Via Domitia (UPVD)-Institut Français de Recherche pour l'Exploitation de la Mer (IFREMER)-Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM)

Subjects
0301 basic medicine, Adult, Male, medicine.medical_specialty, Epidemiology, Bulinus, diagnosis, 030106 microbiology, 030231 tropical medicine, Blotting, Western, Corsica, serology, Schistosomiasis, Enzyme-Linked Immunosorbent Assay, Praziquantel, 03 medical and health sciences, Schistosomiasis haematobia, 0302 clinical medicine, Virology, Environmental health, schistosomiasis, medicine, Urogenital Schistosomiasis, Animals, Humans, Acute schistosomiasis, transmission, Schistosoma haematobium, Anthelmintics, biology, Transmission (medicine), [SDV.BID.EVO]Life Sciences [q-bio]/Biodiversity/Populations and Evolution [q-bio.PE], Public Health, Environmental and Occupational Health, Outbreak, medicine.disease, biology.organism_classification, 3. Good health, Geography, Treatment Outcome, Immunology, France
Abstract

International audience; We present a case of acute schistosomiasis acquired in Corsica after bathing in the Cavu River during the summer of 2015. The diagnosis was made following epidemiological, laboratory and serological assessments. After a previous outbreak of urogenital schistosomiasis during the summer of 2013, when more than 120 infections were diagnosed, this further case indicates transmission was still effective in 2015, thus suggesting a permanent presence of schistosomiasis in Corsica.

Published
2015
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42. Changements globaux et infections parasitaires à mollusques vecteurs. Un schistosome hybride atteint l’Europe

Author

Eve Toulza, Julien Kincaid-Smith, Judith Fillaux, Jérôme Boissier, Antoine Berry, Jean-François Allienne, Interactions Hôtes-Pathogènes-Environnements (IHPE), Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM)-Institut Français de Recherche pour l'Exploitation de la Mer (IFREMER)-Université de Perpignan Via Domitia (UPVD), Service de Parasitologie et Mycologie, CHU Toulouse [Toulouse]-Institut Fédératif de Biologie (IFB) - Hôpital Purpan, Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], and CHU Toulouse [Toulouse]

Subjects
[SDV.BID.EVO]Life Sciences [q-bio]/Biodiversity/Populations and Evolution [q-bio.PE], General Medicine, General Biochemistry, Genetics and Molecular Biology, 3. Good health
Abstract

International audience; La schistosomiase, ou bilharziose, est une maladie parasitaire tropicale et subtropicale causée par des parasites qui habitent les vaisseaux sanguins humains et sont transmis par des mollusques d’eau douce spécifiques. L’infection humaine se produit par la pénétration transcutanée du stade larvaire infectieux du parasite émis par le mollusque vecteur, dans l’eau de baignade.

Published
2015
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43. A systematic review of computer-based patient record systems and quality of care: more randomized clinical trials or a broader approach?

Author

Cyrille Delpierre, Judith Fillaux, Patrice Massip, M. Alvarez, Lise Cuzin, and Thierry Lang

Subjects
medicine.medical_specialty, Medical Records Systems, Computerized, Quality Assurance, Health Care, MEDLINE, Clinical decision support system, Simulated patient, law.invention, Patient satisfaction, Randomized controlled trial, law, Outcome Assessment, Health Care, Health care, Humans, Medicine, Medical history, Qualitative Research, Randomized Controlled Trials as Topic, business.industry, Health Policy, Public Health, Environmental and Occupational Health, General Medicine, Consumer Behavior, Cross-Sectional Studies, Data extraction, Research Design, Family medicine, business
Abstract

Purpose. To analyse the impact of computer-based patient record systems (CBPRS) on medical practice, quality of care, and user and patient satisfaction. Data sources. Manual and electronic search of the Medline, Cochrane, and Embase databases. Study selection. Selected articles were published from 2000 to March 2003. CBPRS was defined as computer software designed to be used by clinicians as a direct aid in clinical decision making. To be included, the systems should have recorded patient characteristics and offered online advice, or information or reminders specific to clinicians during the consultation. Data extraction. Keywords used for the search were: electronic record, informatic record, electronic medical record, electronic patient record, patient order entry, computer-based patient system, clinical decision support systems, and evaluation. Results. Twenty-six articles were selected. Use of a CBPRS was perceived favourably by physicians, with studies of satisfaction being mainly positive. A positive impact of CBPRS on preventive care was observed in all three studies where this criterion was examined. The 12 studies evaluating the impact on medical practice and guidelines compliance showed that positive experiences were as frequent as experiences showing no benefit. None of the six studies analysing the impact of CBPRS on patient outcomes reported any benefit. Conclusions. CBPRS increased user and patient satisfaction, which might lead to significant improvements in medical care practices. However, the studies on the impact of CBPRS on patient outcomes and quality of care were not conclusive. Alternative approaches considering social, cultural, and organizational factors may be needed to evaluate the usefulness of CBPRS.

Published
2004
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44. Speech perception and speech intelligibility in children after cochlear implantation

Author

Nadine Cochard, Judith Fillaux, Olivier Deguine, Bernard Fraysse, Georges Wanna, Marie-Noëlle Calmels, and Issam Saliba

Subjects
Male, Longitudinal study, medicine.medical_specialty, Time Factors, Speech perception, genetic structures, medicine.medical_treatment, media_common.quotation_subject, Deafness, Intelligibility (communication), Audiology, Language Development, Speech Production Measurement, Cochlear implant, Perception, otorhinolaryngologic diseases, medicine, Humans, Longitudinal Studies, Child, media_common, medicine.diagnostic_test, business.industry, Speech Intelligibility, Infant, General Medicine, Cochlear Implantation, Language development, Treatment Outcome, Otorhinolaryngology, Child, Preschool, Pediatrics, Perinatology and Child Health, Speech Perception, Female, sense organs, Audiometry, Audiometry, Speech, business, psychological phenomena and processes
Abstract

Objective: This study aimed to evaluate the long-term speech perception and speech intelligibility of congenitally and prelingually deaf children after cochlear implantation. It was a longitudinal study following 63 congenitally or prelingually deaf children up to 5 years after implantation. They each received a nucleus multichannel cochlear implant before they were 10 years old. Methods: Perception is evaluated using the Test for the Evaluation of Voice Perception and Production (TEPP) and concerns closed- and open-set word and sentence perception without lip-reading. The intelligibility is classified according to the Speech Intelligibility Rating (SIR). The evaluations have been made every 3 months for 1 year, then at 18 months, 2 years, 3 years and 5 years after the cochlear implantation. Results: After 5 years of implantation, the median percentage of closed-words speech perception (CSW) is 95.5%—93.67% for closed-sentence speech perception (CSS) and 76.3% for open-sentence speech perception (OSS); the median Speech Intelligibility Rating is 3.83. Conclusions: Congenitally and prelingually deaf children who receive cochlear implant before the age of 10 years develop speech perception and speech intelligibility abilities. The closed-set perception progresses quickly and seems to reaching a plateau at 5 years post implantation. The improvement of open-sentence perception is not significant until the first year post implantation. The speech intelligibility improves regularly the five first year post implantation.

Published
2004
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45. Recherche de seuils d’interprétation de la PCR Pneumocystis sur LBA chez les patients VIH(−), basée sur la mise en évidence de facteurs de risque discriminant la pneumocystose classique des formes pauci ou asymptomatiques

Author

A. Berry, Judith Fillaux, Alexis Valentin, M. Le Bouar, S. Menard, Sophie Cassaing, B. Dubouil, X. Iriart, and Pamela Chauvin

Subjects
0301 basic medicine, 03 medical and health sciences, Infectious Diseases, 030106 microbiology
Abstract

Pneumocystis jirovecii (Pj) est un champignon responsable de la pneumocystose pulmonaire (PCP), pneumopathie interstitielle touchant frequemment les patients immunodeprimes. La PCR specifique de Pj a permis une augmentation considerable de la sensibilite diagnostique en comparaison avec les techniques de microscopie mais a aussi fait emerger le concept de colonisation ou de formes pauci-symptomatiques. La distinction entre ces differentes formes d’infection a Pj est difficile, et influence de maniere importante la mise sous traitement. La PCR quantitative peut permettre d’orienter vers l’une de ces entites en se basant sur la charge fongique mais il est necessaire de valider precisement des seuils quantitatifs discriminants. Dans cette demarche, le principal ecueil est de constituer les 2 groupes de reference « PCP » et « pauci ou asymptomatique ». Si l’on se base sur la methode microscopique de reference (immunofluorescence) pour definir ces groupes, on se heurte au manque de sensibilite de cette technique par rapport a la PCR, qui entraine le classement inadequat des patients atteints de pneumocystose mais presentant une faible charge fongique. D’autre part, lorsque l’on se base sur les criteres cliniques classiquement presents au cours de la PCP pour constituer les groupes « PCP » et « pauci ou asymptomatique », on peut observer des biais de selection, la clinique et le contexte evocateurs etant eux-memes des motivations a la recherche de Pj. A la difference des deux approches precedentes, la methodologie developpee ici est basee sur une etude de facteurs de risque sans a priori, et permet donc de lever ces ecueils. 322 immunodeprimes VIH(−), avec un LBA positif en PCR Pj [1] ont ete inclus. Ils presentaient une distribution homogene des charges fongiques, quel que soit le type d’immunosuppression identifie, permettant une analyse commune de ces patients. Afin de constituer 2 groupes de comparaison dont le statut « PCP » ou « pauci ou asymptomatique » etait tres probable, les patients presentant des charges fongiques extremes (Ct 75eme percentile), ont ete selectionnes puis compares sans a priori sur 85 criteres differents. 9 facteurs de risque cliniques (dyspnee, LLC ou LNH, greffe cardiaque), therapeutiques (corticoides, ciclosporine, rituximab), biologiques (LDH, lymphocytes totaux) et radiologiques (syndrome interstitiel bilateral), ont ete identifies, permettant de differencier les patients pauci ou asymptomatiques des patients atteints de PCP. Un score prenant en compte le poids relatif de chacun de ces facteurs de risque a ete calcule, permettant de classer dans des groupes definitifs « pauci ou asymptomatique » ou « PCP », des patients dont le statut n’avait pu etre determine precedemment. A partir de ces groupes definitifs, un seuil de Ct de PCR a 27,5 a ete etabli (specificite : 98 % ; VPP : 97 %), permettant de classer les patients en « PCP probable » ou « PCP possible », uniquement grâce au resultat de la PCR diagnostique. En conclusion, il est possible d’etablir des seuils de PCR en limitant les biais lies a l’etablissement des groupes « PCP » et « pauci ou asymptomatique », grâce a une demarche basee sur la recherche de facteurs de risque sans a priori pour discriminer les 2 entites.

Published
2016
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46. Mucormycose pulmonaire chez un enfant diabétique

Author

Claire Fougère, Sylvain Blanchon, Sophie Cassaing, Marcel Dahan, Pamela Chauvin, Fabien Gayda, Fanny Lanternier, Isabelle Serres, J Berjaud, Antoine Berry, Olivier Lortholary, Maeva Da Costa, F. Brémont, Judith Fillaux, Audrey Martin-Blondel, Xavier Iriart, and Guillaume Martin-Blondel

Subjects
Infectious Diseases
Abstract

Plusieurs etudes ont mis en evidence que les mucormycoses connaissent une incidence croissante. Leur morbi-mortalite significative est connue chez les adultes mais il existe a ce jour peu de donnees en pediatrie. Ces infections, causees par les champignons filamenteux de l’ordre des mucorales, sont caracterisees par leur tendance a une invasion vasculaire rapide. Des atteintes localisees peuvent rapidement progresser vers les tissus mous, rhinocerebraux, orbitaires, gastro-intestinaux ou pulmonaires. Nous rapportons un cas de mucormycose invasive survenu chez une adolescente de 15 ans atteinte d’un diabete insulinodependant admise aux urgences pediatriques du CHU de Toulouse pour une decompensation acidocetosique accompagnee d’une pneumopathie bilaterale evoquant une infection virale surinfectee. Au 10 e jour, apres une phase d’amelioration et de sortie de reanimation, une infection fongique est evoquee devant une condensation lobaire inferieure gauche, une re-ascension de son syndrome inflammatoire et une aggravation de son etat general en depit d’une antibiotherapie probabiliste menee de facon optimale. L’expectoration induite, au 12 e jour d’hospitalisation, permet de mettre en evidence a l’examen direct des filaments de mucorales, confirmes a j14 sur le LBA et les biopsies bronchiques. Le traitement antifongique par Ambisome ® 7,5 mg/kg est immediatement debute. Les cultures fongiques sont restees steriles. Une PCR ciblant les mucorales (realisee sur les prelevements pulmonaires et le serum) et le sequencage nucleotidique ont permis de confirmer l’espece Rhizopus arrhizus . Compte tenu de la persistance de la positivite de la PCR serique et de l’aggravation endoscopique et tomodensitometrique, il est associe au 11eme jour de traitement du posaconazole et de la Caspofungine. Au 17 e jour une pneumonectomie gauche de sauvegarde est realisee dans des conditions difficiles. Depuis, l’etat de la patiente est en constante amelioration. Les PCRs fongiques se sont negativees tres rapidement apres l’intervention chirurgicale. En conclusion, les techniques moleculaires permettent une amelioration considerable du diagnostic biologique des mucormycoses. Devant la severite de ces infections, bien que rares, elles devraient etre recherchees de facon systematique chez d’adolescent diabetique se presentant pour une symptomatologie infectieuse pulmonaire lors d’une acidocetose afin d’instaurer un traitement optimal precocement.

Published
2017
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47. High negative predictive value diagnostic strategies for the reevaluation of early antifungal treatment: A multicenter prospective trial in patients at risk for invasive fungal infections

Author

Sophie Cassaing, Olivier Cointault, Bernard Georges, V. Mondain, Eric Rosenthal, Florence Robert-Gangneux, Stanislas Nimubona, Pierre Tattevin, Pierre Marty, Hervé Hyvernat, Laurence Lavayssière, Anne Sirvent, Jean-Pierre Gangneux, Sophie de Guibert, Antoine Berry, Lilia Hasseine, Matthieu Revest, Judith Fillaux, Service de Parasitologie et Mycologie, CHU Toulouse [Toulouse]-Institut Fédératif de Biologie (IFB) - Hôpital Purpan, Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], Service de Parasitologie-Mycologie [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Institut de recherche en santé, environnement et travail (Irset), Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )-Institut National de la Santé et de la Recherche Médicale (INSERM)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Université d'Angers (UA), Centre méditerranéen de médecine moléculaire (C3M), Université Nice Sophia Antipolis (... - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Université Côte d'Azur (UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Parasitologie-Mycologie, Centre Hospitalier Universitaire de Nice, Centre Hospitalier Universitaire de Nice (CHU Nice)-Centre Hospitalier Universitaire de Nice (CHU Nice), Service de Parasitologie et Mycologie [CHU Toulouse], Institut Fédératif de Biologie (IFB), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Pôle Biologie [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université de Rennes (UR)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Université Nice Sophia Antipolis (1965 - 2019) (UNS), COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-COMUE Université Côte d'Azur (2015-2019) (COMUE UCA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Côte d'Azur (UCA), and Centre Hospitalier Universitaire de Nice (CHU Nice)

Subjects
Male, [SDV]Life Sciences [q-bio], Aspergillosis, chemistry.chemical_compound, Invasive fungal infection, 0302 clinical medicine, Secondary Prevention, Aspergillus galactomannan, 030212 general & internal medicine, Prospective Studies, Antifungal stewardship program, Prospective cohort study, DNA, Fungal, 0303 health sciences, education.field_of_study, Middle Aged, 3. Good health, PCR, Infectious Diseases, Blood, Treatment Outcome, Molecular Diagnostic Techniques, Female, Drug Monitoring, Fungemia, Microbiology (medical), Fusariosis, Adult, medicine.medical_specialty, Population, Context (language use), Biology, Real-Time Polymerase Chain Reaction, 03 medical and health sciences, Galactomannan, Young Adult, Predictive Value of Tests, Internal medicine, DNA, Ribosomal Spacer, medicine, Humans, Empirical treatment, education, Panfungal PCR, Antifungals, 030306 microbiology, medicine.disease, Disseminated Candidiasis, Surgery, chemistry, Cryptococcosis, Invasive aspergillosis, Reevaluation
Abstract

International audience; Early antifungal therapeutic strategies are proposed during invasive fungal infection (IFI), but antifungal stewardship programs should institute a systematic reevaluation of prescriptions, particularly in the context of empirical treatment. Here, we aimed to evaluate the performances and particularly the negative predictive value (NPV) of diagnostic strategies, including a whole blood panfungal quantitative PCR assay (PF-qPCR) in a high risk population for IFI. The first step was to standardize and optimize a new PF- rtPCR targeting ITS2 region. Then, this method was evaluated in a multicenter prospective study including 313 patients with suspected IFI for whom an early antifungal treatment was prescribed. All patients enrolled at day 0 of their treatment benefited from serum Aspergillus galactomannan (GM) antigen detection twice a week, weekly PF-qPCR assay, and when indicated and feasible, CT-scan and mycological sampling. In total, 125 of 313 patients were diagnosed with IFI: 68 invasive aspergillosis (eight proven, 48 probable and 12 possible), one fusariosis, 47 candidemia, three disseminated candidiasis and six cryptococcosis. Globally, the sensitivity of the PF-qPCR assay was only 40%, but the specificity, PPV and NPV were 96%, 88% and 69%, respectively. In the population of patients at high risk for invasive aspergillosis who also benefited from Aspergillus GM detection, the sensitivity and the NPV of the combined detection reached to 78% and 84%, respectively. Even higher NPV were obtained when combining negative PF-qPCR and CT scan (95%) as well as negative GM and CT scan (93%), thus allowing to rationalize and re-evaluate the prescription of empirical treatment in such highly selected population.

Published
2014
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48. Schistosomiasis Haematobium, Corsica, France

Author

Guillaume Mitta, Xavier Iriart, Jean-François Magnaval, Cécile Debuisson, Sophie Cassaing, Olivier Aboo, Jérôme Boissier, André Théron, Hélène Moné, Judith Fillaux, Alexis Valentin, Antoine Berry, Gabriel Mouahid, Centre de Physiopathologie Toulouse Purpan (CPTP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Ecologie et évolution des interactions [2011-2014] (2EI), Université de Perpignan Via Domitia (UPVD)-Centre National de la Recherche Scientifique (CNRS), CHU Toulouse [Toulouse], Centre National de la Recherche Scientifique (CNRS), Service de Parasitologie et Mycologie, CHU Toulouse [Toulouse]-Institut Fédératif de Biologie (IFB) - Hôpital Purpan, Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], Pharmacochimie et Biologie pour le Développement (PHARMA-DEV), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie de Toulouse (ICT-FR 2599), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Institut de Chimie du CNRS (INC)-Institut de Recherche pour le Développement (IRD), Laboratoire d'Anthropobiologie (LA), École des hautes études en sciences sociales (EHESS)-Université Toulouse - Jean Jaurès (UT2J)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Service de Parasitologie et Mycologie [CHU Toulouse], Institut Fédératif de Biologie (IFB), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Pôle Biologie [CHU Toulouse], Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT), École des hautes études en sciences sociales (EHESS)-Université Toulouse - Jean Jaurès (UT2J), Université de Toulouse (UT)-Université de Toulouse (UT)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Centre National de la Recherche Scientifique (CNRS), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT-FR 2599), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées, and Modat, Anne

Subjects
Letter, Epidemiology, Range (biology), Bulinus truncatus, Expedited, Schistosomiasis haematobia / transmission, MESH: Schistosomiasis haematobia / parasitology, Corsica, lcsh:Medicine, Snail, MESH: Schistosoma haematobium / genetics, 0302 clinical medicine, MESH: Schistosoma haematobium / classification, MESH: Animals, schistosomiasis haematobium, Schistosoma haematobium, Geography Medica, 0303 health sciences, MESH: France / epidemiology, MESH: Schistosomiasis haematobia / transmission, biology, Ecology, Intermediate host, MESH: Child Preschool, 6. Clean water, 3. Good health, Europe, Infectious Diseases, Female, France, MESH: Schistosomiasis haematobia / epidemiology, l Humans, Microbiology (medical), medicine.medical_specialty, snails, 030231 tropical medicine, Zoology, Schistosomiasis, Schistosoma haematobium / classification, lcsh:Infectious and parasitic diseases, 03 medical and health sciences, France / epidemiology, biology.animal, parasitic diseases, Schistosoma haematobium / genetics, medicine, Animals, Bulinus, lcsh:RC109-216, Schistosomiasis haematobia / diagnosis, Letters to the Editor, Schistosomiasis haematobia / parasitology, 030304 developmental biology, reemergence, MESH: Humans, Child Preschool, lcsh:R, medicine.disease, biology.organism_classification, schistosomiasis autochthonous transmission, MESH: Schistosomiasis haematobia / diagnosis, [SDE.BE] Environmental Sciences/Biodiversity and Ecology, Tropical medicine, [SDE.BE]Environmental Sciences/Biodiversity and Ecology, MESH: Geography Medical, MESH: Female, Schistosomiasis haematobia / epidemiology
Abstract

To the Editor: In Europe, urinary schistosomiasis (1) has previously been detected only in Portugal, where this focus disappeared during the 1950s (2). However, freshwater snails of the species Bulinus contortus, B. truncatus, and Planorbarius metidjensis, which are recognized intermediate hosts for Schistosoma haematobium trematodes, have been found in Portugal (3), Spain (4), and Corsica (5,6). This finding suggested that autochthonous schistosomiasis could re-emerge in southern Europe if these mollusks become infected. We report a probable focus for transmission of schistosomiasis haematobium in Corsica, France. In March 2014, a 4-year-old girl (index case-patient) from France was referred to the Toulouse University Hospital (Toulouse, France), with gross hematuria. Ultrasonography and cystoscopic examination of the bladder detected a polyp. Examination of the polyp for parasites identified bodies that were consistent with schistosome eggs. Parasitologic examination of urine confirmed schistosomiasis by detecting viable S. haematobium eggs. The parents of the girl (family A) did not report any stay or travel in an area to which urinary schistosomiasis was endemic; they reported summer holidays only in Mallorca in the Balearic Islands (Spain) and Corsica. However, her father reported that since 2012, he had experienced gross hematuria that had been evaluated by standard urologic investigations but not by cystoscopy; no etiology was determined. Parasitologic urinalysis in our hospital department showed numerous viable S. haematobium eggs in the father’s urine. The parents of the index case-patient also reported that an 8-year-old boy in a friend’s family (family B), who shared summer vacations with them had exhibited gross hematuria since February 2013. A third family (family C) was also investigated because they also spent holidays in Corsica with families A and B. Families B and C had also spent a summer in Mallorca, but they denied any contact with freshwater. Of 11 French native-born members of the 3 families, 6 had positive results for S. haematobium by urine examination. All case-patients had specific positive immunodiagnostic results by an ELISA that used S. mansoni extracts and by indirect hemagglutination. In addition, 2 family members who had a negative result by urine examination had a positive serologic result. Spending summer vacations in the same village in Corsica (Sainte-Lucie de Porto-Vecchio), where members of the 3 families had bathed at least once per holiday period in the Cavu River, was the epidemiologically prominent feature that linked these persons. Families A and C were in Sainte-Lucie de Porto-Vecchio in August 2011, and families A, B, and C were in the same location in August 2013. During these investigations, we were contacted by the Department of Tropical Medicine, Dusseldorf University Hospital (Dusseldorf, Germany), because a 10-year-old boy and his father had been given diagnoses of schistosomiasis haematobium on the basis of positive urinalysis results for S. haematobium eggs. Two other members of this family (5 persons) had a positive immunodiagnostic result. Locations of previous vacations for this family outside Germany included Spain (not the Balearic Islands) and Corsica, where they bathed frequently in the Cavu River. These epidemiologic findings provide strong circumstantial evidence supporting the presence of a previously unrecognized focus of urinary schistosomiasis in Corsica. We performed molecular analysis of schistosomal miracidia DNA. The second internal transcribed spacer region of the ribosomal gene complex (7,8) was amplified and sequenced. Viable eggs obtained from the patients in France were those of S. haematobium. Additional molecular investigations are being conducted to assess genetic diversity of this isolate from Corsica and the geographic origin of the introduced parasite. The malacologic situation in Sainte Lucie de Porto-Vecchio was investigated during May 12–19, 2014; three rivers (Figure) were included in the survey. Four sites were sampled in the Cavu River, and B. truncatus snails were found in 3 sites that corresponded to bathing areas (site 1: 41°43′53.57″N, 9°17′36.70″E; site 2: 41°43′22.13″N, 9°17′59.87″E; site 3: 41°42′8.40″N, 9°21′5.82″E). Snails were also found in the nearby Tarcu River (site 5) and Osu River (site 6). These findings confirmed previous data for the presence of B. truncatus snails in Corsica (5,6). Water temperature was recorded at 11:00 am at these 3 sites (range 15°C–16°C). This temperature range is not optimal for the snail intermediate host stage of the parasite life cycle (9,10). Of 148 live snails that were obtained in the Cavu River, none were infected with schistosome cercariae. Figure Corsica, France, showing malacologic survey sampling sites (oval) in 3 rivers (Tarcu, Cavu, and Osu). Bulinus truncatus snails were found at sites 1, 2, 3, 5, and 6. Data from the field survey and epidemiologic information for the cases in France and Germany, indicated transmission of schistosomiasis haematobium in the Cavu River in southeastern Corsica in 2011 and 2013. Additional supportive evidence is the fact that the father of the index case-patient had gross hematuria in 2012 and 2013. Two hypotheses are proposed to account for this situation. The first hypothesis is that the parasite (i.e., schistosome eggs) was transmitted by an infected person into the Cavu River in June or July 2011, when environmental conditions were favorable for snail infection. However, questions arise about survival of infected snails during the winter and their ability to reinfect the area during the following summers in 2012 and 2013. The second hypothesis is that schistosome eggs were spread by infected persons at the beginning of summer and caused a permanent transmission cycle in this focus. This situation would be difficult to control. Additional information should be obtained by a long-term malacologic survey to detect infected mollusks in this region.

Published
2014
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49. Aspergillus Sensitization or Carriage in Cystic Fibrosis Patients

Author

Jean-François Magnaval, Christine Segonds, M. Murris, Sophie Cassaing, F. Brémont, Laurent Tétu, Bernard Pipy, Judith Fillaux, Pharmacochimie et Biologie pour le Développement (PHARMA-DEV), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT-FR 2599), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Institut de Chimie du CNRS (INC), Institut de Recherche pour le Développement (IRD)-Institut de Chimie de Toulouse (ICT), Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Institut National Polytechnique (Toulouse) (Toulouse INP), Université de Toulouse (UT)-Institut de Recherche pour le Développement (IRD)-Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT), and Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)

Subjects
Male, predictive factors, MESH: Aspergillus fumigatus / immunology, Cystic Fibrosis, [SDV]Life Sciences [q-bio], Immunoglobulin E / blood, Azithromycin, Aspergillosis, Cystic fibrosis, Gastroenterology, sensitization, 0302 clinical medicine, MESH: Antibodies, Fungal / blood, Child, Sensitization, 2. Zero hunger, MESH: Aspergillus fumigatus / isolation & purification, 0303 health sciences, MESH: Carrier State / epidemiology, Hazard ratio, MESH: Immunoglobulin E / blood, 3. Good health, Infectious Diseases, medicine.anatomical_structure, Child, Preschool, Carrier State, Female, Allergic bronchopulmonary aspergillosis, medicine.symptom, Aspergillosis Allergic, medicine.drug, Microbiology (medical), medicine.medical_specialty, Adolescent, Aspergillus fumigatus / immunology, Cystic Fibrosis / complications, 03 medical and health sciences, Internal medicine, medicine, Humans, Aspergillus fumigatus / isolation & purification, Antibodies, Fungal, Survival analysis, MESH: Aspergillosis, Allergic Bronchopulmonary / epidemiology, MESH: Adolescent, Child Preschool, 030306 microbiology, business.industry, fungal infection, Aspergillus fumigatus, Aspergillosis, Allergic Bronchopulmonary, Carrier State / epidemiology, Infant, MESH: Cystic Fibrosis / complications, Immunoglobulin E, medicine.disease, Bronchopulmonary / epidemiology, 030228 respiratory system, Pediatrics, Perinatology and Child Health, Sputum, Antibodies Fungal / blood, business
Abstract

International audience; Background: Aspergillus fumigatus (Af) sensitization and persistent carriage are deleterious to lung function, but no consensus has been reached defining these medical entities. This work aimed to identify possible predictive factors for patients who become sensitized to Af, compared with a control group of non-sensitized Af carriers.Methods: Between 1995 and 2007, 117 pediatric patients were evaluated. Demographic data, CFTR gene mutations, body mass index and FEV1 were recorded. The presence of Af in sputum, the levels of Af-precipitin, total IgE (t-IgE) and specific IgE to Af (Af-IgE) were determined. Patients were divided into 2 groups: (1) "sensitization": level of Af-IgE > 0.35 IU/mL with t-IgE level < 500 IU/mL and (2) "persistent or transient carriage": Af-IgE level ≤ 0.35 IU/mL with either an Af transient or persistent positive culture. A survival analysis was performed with the appearance of Af-IgE in serum as an outcome variable.Results: Severe mutation (hazard ratio = 3.2), FEV1 baseline over 70% of theoretical value (hazard ratio = 4.9), absence of Pa colonization, catalase activity and previous azithromycin administration (hazard ratio = 9.8, 4.1 and 1.9, respectively) were predictive factors for sensitization. We propose a timeline of the biological events and a tree diagram for risk calculation.Conclusions: Two profiles of cystic fibrosis patients can be envisaged: (1) patients with nonsevere mutation but low FEV1 baselines are becoming colonized with Af or (2) patients with high FEV1 baselines who present with severe mutation are more susceptible to the Af sensitization and then to the presentation of an allergic bronchopulmonary aspergillosis event.

Published
2014
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50. Toxoplasmic encephalitis IRIS in HIV-infected patients: a case series and review of the literature

Author

Judith Fillaux, Emmanuelle Uro-Coste, Pierre Delobel, Guillaume Martin-Blondel, Bruno Marchou, V. Cuvinciuc, M. Alvarez, Patrice Massip, Lise Cuzin, Centre de Physiopathologie Toulouse Purpan (CPTP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service Maladies infectieuses et tropicales [CHU Toulouse], Pôle Inflammation, infection, immunologie et loco-moteur [CHU Toulouse] (Pôle I3LM Toulouse), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Service d'anatomie pathologique et histologie-cytologie [Rangueil], Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Service Neuroradiologie Diagnostique et Thérapeutique [CHU Toulouse], Pôle imagerie médicale [CHU Toulouse], Service de Parasitologie et Mycologie [CHU Toulouse], Institut Fédératif de Biologie (IFB), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Pôle Biologie [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Peer, Hal, Service des maladies infectieuses et tropicales [Toulouse], Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse]-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées, Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Neuroradiologie Diagnostique et Thérapeutique [Toulouse], Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse], Service de Parasitologie et Mycologie, CHU Toulouse [Toulouse]-Institut Fédératif de Biologie (IFB) - Hôpital Purpan, and CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse]-Hôpital Purpan [Toulouse]

Subjects
Adult, Male, medicine.medical_specialty, HIV Infections, 03 medical and health sciences, toxoplasmic encephalitis, 0302 clinical medicine, Immune reconstitution inflammatory syndrome, Immunopathology, medicine, Humans, 030212 general & internal medicine, Sida, AIDS-Related Opportunistic Infections, medicine.diagnostic_test, biology, business.industry, Brain biopsy, chemoprophylaxis, HIV, Retrospective cohort study, Middle Aged, medicine.disease, biology.organism_classification, immune reconstitution inflammatory syndrome, Dermatology, Toxoplasmosis, 3. Good health, Psychiatry and Mental health, Toxoplasmosis, Cerebral, Chemoprophylaxis, Immunology, Female, Surgery, Neurology (clinical), business, 030217 neurology & neurosurgery, Encephalitis
Abstract

Toxoplasmic encephalitis associated with immune reconstitution inflammatory syndrome (TE-IRIS) is rarely described.To identify TE-IRIS cases, the authors performed a retrospective study of all HIV-infected patients diagnosed as having TE in our unit between January 2000 and June 2009, and a review of published cases.Three patients out of 65 toxoplasmic encephalitis (TE) cases, together with six from the literature, fulfilled the unmasking TE-IRIS definition. None fulfilled the paradoxical TE-IRIS definition. TE occurred within a median time of 48.5 days (IQ(25-75) 21-56) after starting antiretroviral therapy. Cases did not have distinctive clinical or neuroimaging features from TE occurring without immune reconstitution. However: (1) cases occurred at a median CD4 lymphocytes count of 222/μl (IQ(25-75) 160-280); (2) TE occurred in five patients who were supposed to take an effective chemoprophylaxis; (3) two patients had a brain biopsy showing an intense angiocentric inflammatory infiltrating with predominantly CD8 lymphocytes; (4) in one patient, the abnormal length of evolution under treatment might be due to the heightened immune response.Although rare, unmasking TE-IRIS exists and might occur despite effective prophylaxis and an unusually high CD4 lymphocyte count. Immune reconstitution inflammatory syndrome does not modify TE diagnosis and treatment but might extend its clinical course.

Published
2010
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