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AbstractPurpose:We aimed to determine whether serum procalcitonin (PCT) values could help in identifying flu in patient admitted to the emergency department (ED) with influenza-like illness (ILI) during influenza A(H1N1)2009 pandemic.Methods:An observational retrospective cohort study was performed in a referral ED for emerging infectious diseases. All patients tested for influenza A(H1N1)2009 by Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) and procalcitonin between June 2009 and January 2010 were analyzed. PCT was studied for its negative predictive value of bacterial infection. Patients PCT−/RT-PCR + were considered as true positive.Results:On the 80 patients included, 16 were positive for influenza A(H1N1)2009 RT-PCR, all but one of them had low PCT concentrations. Conversely, 19 (30%) of the 64 patients with negative RT-PCR had elevated PCT concentrations. For a PCT threshold <0.25 μg/L, sensitivity was 0.94, specificity 0.30, positive predictive value 0.25 and negative predictive value 0.95 for the diagnosis of flu.Conclusion:In the context of an influenza pandemic, serum PCT measurement may be useful for clinical decisions in the ED as most of RT-PCR confirmed patients have low PCT values. Patients with PCT above 0.25 μg/L are unlikely to have a unique diagnosis of flu.

Los antivirales son en la actualidad un sector esencial de la farmacopea antiinfecciosa. Incluso si no se tienen en cuenta los antirretrovirales y los antivirales dirigidos contra los virus de la hepatitis B y C, que constituyen una parte muy importante, existen varias moléculas que se utilizan en la práctica clínica que permiten luchar eficazmente contra las infecciones por virus herpes, adenovirus, poxvirus, virus del papiloma y virus de la gripe. La mayoría de estas moléculas se dirigen contra las enzimas virales implicadas en la replicación de los genomas virales. La mayoría de los análogos nucleosídicos (de los que el arquetipo es el aciclovir) y los análogos nucleotídicos (cuyo arquetipo es el cidofovir) requieren una fosforilación previa para inhibir, por un mecanismo de competición y, en ocasiones de terminación, la actividad de una polimerasa de ADN (ácido desoxirribonucleico). El foscarnet, análogo de pirofosfato, ejerce esta inhibición directamente sin modificación. En la actualidad, se dispone de menos antivirales para los virus ARN (ácido ribonucleico) que para los de ADN, aunque los inhibidores de la neuraminidasa han demostrado su eficacia contra los virus de la gripe. La especificidad de los antivirales suele ser estrecha, limitada por lo general para cada molécula a unos pocos virus relacionados. Las otras limitaciones del uso actual de los antivirales son la imposibilidad de erradicar las infecciones virales latentes, la aparición de resistencia, los efectos indeseables relacionados en gran parte con la toxicidad celular relativa de las moléculas y su coste. Se esperan avances tanto en la eficacia de los antivirales como en su tolerabilidad clínica y el número de las enfermedades virales tratadas. Es esencial que las exigencias económicas no restrinjan la dinámica de uno de los ámbitos más innovadores de la medicina contemporánea.

Les infections à cytomégalovirus (CMV) constituent une cause majeure de morbidité et de mortalité chez les patients recevant une greffe d’organe solide ou de cellules souches hématopoïétiques (CSH), et ce en dépit de l’existence d’outils diagnostiques très performants (quantification de l’ADN viral par PCR en temps réel), de protocoles d’immunodépression optimisés et de molécules antivirales efficaces. De plus, l’instauration de traitements antiviraux préventifs ou curatifs, souvent durant des périodes prolongées, chez des patients dont l’immunité cellulaire est altérée, peut conduire à l’émergence de résistance du CMV aux antiviraux. Le traitement antiviral des infections à CMV ne fait pas l’objet d’un réel consensus, bien qu’il existe différentes recommandations. L’évaluation du risque réel d’infection à CMV post-greffe nécessite, en plus des marqueurs virologiques habituels, la surveillance de la réponse immunitaire T spécifique anti-CMV. Une meilleure connaissance des mutations de résistance du CMV aux antiviraux et l’utilisation de nouvelles molécules antivirales sont nécessaires pour une meilleure prise en charge thérapeutique des patients greffés.

The herpes simplex virus type 1 (HSV-1) genome is a linear double-stranded DNA of 152 kpb. It is divided into long and short regions of unique sequences termed ULand US, respectively, and these are flanked by regions of inverted internal and terminal repeats. Microsatellites are short tandem repeats of 1- to 6-nucleotide motifs; they are often highly variable and polymorphic within the genome, which raises the question of whether they may be used as molecular markers for the precise differentiation of HSV-1 strains. In this study, 79 different microsatellites (mono-, di-, and trinucleotide repeats) in the HSV-1 complete genome were identified by in silico analysis. Among those microsatellites, 45 were found to be distributed in intergenic or noncoding inverted repeat regions, while 34 were in open reading frames. Length polymorphism analysis of the PCR products was used to investigate a set of 12 distinct HSV-1 strains and allowed the identification of 23 polymorphic and 6 monomorphic microsatellites, including two polymorphic trinucleotide repeats (CGT and GGA) within the UL46 and US4 genes, respectively. A multiplex PCR method that amplified 10 polymorphic microsatellites was then developed for the rapid and accurate genetic characterization of HSV-1 strains. Each HSV-1 strain was characterized by its own microsatellite haplotype, which proved to be stable over time in cell culture. This relevant innovative tool was successfully applied both to confirm the close relationship between sequential HSV-1 isolates collected from patients with multiple recurrent infections and to investigate putative nosocomial infections.

We evaluated the utility of the commercial Allplex genital ulcer real-time PCR multiplex assay for detecting Treponema pallidum(TPA), herpes simplex virus 1 (HSV-1) and 2 (HSV-2), and Chlamydia trachomatisserovar L (lymphogranuloma venereum [LGV]) DNA in mucosal and genital ulcers in the context of suspected syphilis. In total, 374 documented genital and mucosal ulcers from patients with and without syphilis presenting at several sexually transmitted infection (STI) centers in France from October 2010 to December 2016 were analyzed at the National Reference Center (CNR) for Bacterial STIs at Cochin Hospital in Paris. TPA detection results were compared with the final diagnosis based on a combination of clinical examination, serological results, and in-house nested PCR (nPCR).