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1. mBio

Author

Bretagne, S. (Stéphane), Sitbon, K. (Karine), Desnos-Ollivier, M. (Marie), Garcia-Hermoso, D. (Dea), Letscher-Bru, V. (Valerie), Cassaing, S. (Sophie), Millon, L. (Laurence), Morio, F. (Florent), Gangneux, J. (Jean-Pierre), Hasseine, L. (Lilia), Favennec, L. (Loïc), Cateau, E. (Estelle), Bailly, E. (Eric), Moniot, M. (Maxime), Bonhomme, J. (Julie), Desbois-Nogard, N. (Nicole), Chouaki, T. (Taieb), Paugam, A. (André), Bouteille, B. (Bernard), Pihet, M. (Marc), Dalle, F. (Frédéric), Eloy, O. (Odile), Sasso, M. (Milène), Demar, M. (Magalie), Mariani-Kurkdjian, P. (Patricia), Robert, V. (Vincent), Lortholary, O. (Olivier), Dromer, F. (Françoise), Denis, J. (Julie), Herbrecht, R. (Raoul), Mertes, P. (Paul-Michel), Meziani, F. (Ferhat), Sabou, M. (Marcela), and Schneider, F. (Francis)

Subjects
Aucun
Abstract

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

Published
2022

2. Coronavirus Disease 2019: Associated Multiple Organ Damage: Associated Multiple Organ Damage

Author

Collange, O. (Olivier), Tacquard, C. (Charles), Delabranche, X. (Xavier), Leonard-Lorant, I. (Ian), Ohana, M. (Mickaël), Onea, M. (Mihaela), Anheim, M. (Mathieu), Solis, M. (Morgane), Sauer, A. (Arnaud), Baloglu, S. (Seyyid), Pessaux, P. (Patrick), Ohlmann, P. (Patrick), Kaeuffer, C. (Charlotte), Oulehri, W. (Walid), Kremer, S. (Stephane), and Mertes, P. (Paul-michel)

Subjects
Sciences du Vivant [q-bio]/Médecine humaine et pathologie
Abstract

A 56-year-old man presented a particularly severe and multisystemic case of coronavirus disease 2019 (COVID-19). In addition to the common lung and quite common pulmonary embolism and kidney injuries, he presented ocular and intestinal injuries that, to our knowledge, have not been described in COVID-19 patients. Although it is difficult to make pathophysiological hypotheses about a single case, the multiplicity of injured organs argues for a systemic response to pulmonary infection. A better understanding of physiopathology should feed the discussion about therapeutic options in this type of multifocal damage related to severe acute respiratory syndrome coronavirus 2.

Published
2020

3. Brain MRI Findings in Severe COVID-19: A Retrospective Observational Study

Author

Kremer, S. (Stéphane), Boulay, C. (Clotilde), de Sèze, J. (Jérome), Ferré, J. (Jean-Christophe), Maamar, A. (Adel), Carsin-Nicol, B. (Béatrice), Collange, O. (Olivier), Bonneville, F. (Fabrice), Adam, G. (Gilles), Martin-Blondel, G. (Guillaume), Rafiq, M. (Marie), Geeraerts, T. (Thomas), Delamarre, L. (Louis), Grand, S. (Sylvie), Krainik, A. (Alexandre), Kremer, S. (Stephane), Alleg, M. (Manel), Anheim, M. (Mathieu), Anxionnat, R. (René), Ardellier, F. (François-Daniel), Baloglu, S. (Seyyid), Bapst, B. (Blanche), Benzakoun, J. (Joseph), Berge, J. (Jérome), Bolognini, F. (Federico), Bornet, G. (Grégoire), Boulouis, G. (Grégoire), Boutet, C. (Claire), Brisset, J. (Jean Christophe), Caillard-ohlmann, S. (Sophie), Carré, S. (Sophie), Comby, P. (Pierre-Olivier), Constans, J. (Jean Marc), David, J. (Jean-Stéphane), de Beaurepaire, I. (Isaure), De Seze, J. (Jerome), Desal, H. (Hubert), Edjlali-Goujon, M. (Myriam), Fabre, X. (Xavier), Fafi-Kremer, S. (Samira), Feuerstein, P. (Philippe), Henry Feugeas, M. (Marie-Cécile), Forestier, G. (Géraud), Gaudemer, A. (Augustin), Hansmann, Y. (Yves), Heintz, A. (Adrien), Boisrame, J. (Julie), Hemmert, C. (Céline), Hmeydia, G. (Ghazi), Jager, L. (Lavinia), Kazémi, A. (Apolline), Kerleroux, B. (Basile), Khalil, A. (Antoine), Lacalm, A. (Audrey), Lecler, A. (Augustin), Lecocq, C. (Claire), Lefebvre, N. (Nicolas), Lersy, F. (François), Matthieu, M. (Muriel), Megdiche, I. (Imen), Mertes, P. (Paul-michel), Messié, J. (Julien), Metanbou, S. (Serge), Meyer, N. (Nicolas), Meziani, F. (Ferhat), Mutschler, V. (Veronique), Nesser, P. (Patrick), Oesterlé, H. (Hélène), Ohana, M. (Mickaël), Oppenheim, C. (Catherine), Pyatigorskaya, N. (Nadya), Ricolfi, F. (Frédéric), Saleme, S. (Suzana), Schenck, M. (Maleka), Schmitt, E. (Emmanuelle), Schneider, F. (Francis), Sebag, N. (Nathan), Talla Mba, Y. (Yannick), Thouant, P. (Pierre), Willaume, T. (Thibault), Zhu, F. (François), Zorn, P. (Pierre-Emmanuel), Cotton, F. (François), Les Hôpitaux Universitaires de Strasbourg (HUS), Laboratoire des sciences de l'ingénieur, de l'informatique et de l'imagerie (ICube), Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS)-École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Réseau nanophotonique et optique, Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Matériaux et nanosciences d'Alsace (FMNGE), Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut de Chimie du CNRS (INC)-Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Département de Radiologie [CHU de Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES), Service des maladies infectieuses et réanimation médicale [Rennes] = Infectious Disease and Intensive Care [Rennes], CHU Pontchaillou [Rennes], CHU Toulouse [Toulouse], CHU Grenoble, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Centre hospitalier de Haguenau, Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Universitaire de Nancy (CHU Nancy), CHU Henri Mondor, Institut de psychiatrie et neurosciences de Paris (IPNP - U1266 Inserm), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), CHU Bordeaux [Bordeaux], Hôpitaux Civils de Colmar, Hôpital Privé d'Antony, Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Observatoire Français de la Sclérose En Plaques [Lyon] (OFSEP), Immuno-Rhumatologie Moléculaire, Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Dijon, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), CHU Amiens-Picardie, Hospices Civils de Lyon (HCL), Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier de Roanne (CH Roanne), CH de Roanne, Groupe hospitalier de la région de Mulhouse Sud-Alsace (GHRMSA), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Limoges, CHU Strasbourg, Nouvel Hôpital Civil de Strasbourg, Université de Strasbourg (UNISTRA), Hôpital Marie-Madeleine [Forbach], CHU Lille, Hôpital de la Fondation Ophtalmologique Adolphe de Rothschild [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Les Hôptaux universitaires de Strasbourg (HUS), Nanomédecine Régénérative (NanoRegMed), Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute (ICM), Institut National de la Santé et de la Recherche Médicale (INSERM)-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)-Centre National de la Recherche Scientifique (CNRS), Centre de Recherche en Acquisition et Traitement de l'Image pour la Santé (CREATIS), Université Jean Monnet [Saint-Étienne] (UJM)-Hospices Civils de Lyon (HCL)-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université de Lyon-Institut National des Sciences Appliquées (INSA)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM), École Nationale du Génie de l'Eau et de l'Environnement de Strasbourg (ENGEES)-Université de Strasbourg (UNISTRA)-Institut National des Sciences Appliquées - Strasbourg (INSA Strasbourg), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Institut National de Recherche en Informatique et en Automatique (Inria)-Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de la Recherche Scientifique (CNRS)-Matériaux et Nanosciences Grand-Est (MNGE), Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS)-Réseau nanophotonique et optique, Université de Strasbourg (UNISTRA)-Université de Haute-Alsace (UHA) Mulhouse - Colmar (Université de Haute-Alsace (UHA))-Centre National de la Recherche Scientifique (CNRS)-Université de Strasbourg (UNISTRA)-Centre National de la Recherche Scientifique (CNRS), Université de Rennes (UR), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), CHU Henri Mondor [Créteil], Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E), Institut du Cerveau = Paris Brain Institute (ICM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National des Sciences Appliquées de Lyon (INSA Lyon), Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Ferré, Jean-Christophe, and Université de Lyon-Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA)-Hospices Civils de Lyon (HCL)-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Adult, Male, medicine.medical_specialty, Sciences du Vivant [q-bio]/Neurosciences [q-bio.NC], Adolescent, Pneumonia, Viral, Gastroenterology, 030218 nuclear medicine & medical imaging, Temporal lobe, White matter, Cohort Studies, 03 medical and health sciences, symbols.namesake, Betacoronavirus, Young Adult, 0302 clinical medicine, Cerebrospinal fluid, Internal medicine, Intensive care, medicine, Humans, Radiology, Nuclear Medicine and imaging, 10. No inequality, Child, Pandemics, Fisher's exact test, Aged, Retrospective Studies, medicine.diagnostic_test, business.industry, SARS-CoV-2, [SCCO.NEUR]Cognitive science/Neuroscience, [SCCO.NEUR] Cognitive science/Neuroscience, Brain, COVID-19, Retrospective cohort study, Magnetic resonance imaging, Middle Aged, medicine.disease, Magnetic Resonance Imaging, 3. Good health, Venous thrombosis, medicine.anatomical_structure, Neuroradiology, 030220 oncology & carcinogenesis, symbols, Female, business, Coronavirus Infections
Abstract

International audience; BackgroundBrain MRI parenchymal signal abnormalities have been associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).PurposeTo describe the neuroimaging findings (excluding ischemic infarcts) in patients with severe coronavirus disease 2019 (COVID-19) infection.Materials and MethodsThis was a retrospective study of patients evaluated from March 23, 2020, to April 27, 2020, at 16 hospitals. Inclusion criteria were (a) positive nasopharyngeal or lower respiratory tract reverse transcriptase polymerase chain reaction assays, (b) severe COVID-19 infection defined as a requirement for hospitalization and oxygen therapy, (c) neurologic manifestations, and (d) abnormal brain MRI findings. Exclusion criteria were patients with missing or noncontributory data regarding brain MRI or brain MRI showing ischemic infarcts, cerebral venous thrombosis, or chronic lesions unrelated to the current event. Categorical data were compared using the Fisher exact test. Quantitative data were compared using the Student t test or Wilcoxon test. P < .05 represented a significant difference.ResultsThirty men (81%) and seven women (19%) met the inclusion criteria, with a mean age of 61 years ± 12 (standard deviation) (age range, 8–78 years). The most common neurologic manifestations were alteration of consciousness (27 of 37, 73%), abnormal wakefulness when sedation was stopped (15 of 37, 41%), confusion (12 of 37, 32%), and agitation (seven of 37, 19%). The most frequent MRI findings were signal abnormalities located in the medial temporal lobe in 16 of 37 patients (43%; 95% confidence interval [CI]: 27%, 59%), nonconfluent multifocal white matter hyperintense lesions seen with fluid-attenuated inversion recovery and diffusion-weighted sequences with variable enhancement, with associated hemorrhagic lesions in 11 of 37 patients (30%; 95% CI: 15%, 45%), and extensive and isolated white matter microhemorrhages in nine of 37 patients (24%; 95% CI: 10%, 38%). A majority of patients (20 of 37, 54%) had intracerebral hemorrhagic lesions with a more severe clinical presentation and a higher admission rate in intensive care units (20 of 20 patients [100%] vs 12 of 17 patients without hemorrhage [71%], P = .01) and development of the acute respiratory distress syndrome (20 of 20 patients [100%] vs 11 of 17 patients [65%], P = .005). Only one patient had SARS-CoV-2 RNA in the cerebrospinal fluid.ConclusionPatients with severe coronavirus disease 2019 and without ischemic infarcts had a wide range of neurologic manifestations that were associated with abnormal brain MRI scans. Eight distinctive neuroradiologic patterns were described.

Published
2020
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