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The recent increase of migration to Europe represents a risk of increased the prevalence of multidrug-resistant (MDR) bacteria. We conducted a cross-sectional study among asylum seekers admitted at two hospitals in Switzerland. Of the 59 patients included, 9 (14%) were colonised by a MDR bacteria, including 5 (8.5%) methicilin-resistant Staphylococcus aureus (MRSA) and 4 (6.8%) extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. No patient carried both ESBL-producing bacteria and MRSA. None of the patients carried a vancomycin-resistant Enterococcus (VRE) or a carbapenem-resistant Enterobacteriaceae (CRE). Colonisation with MDR bacteria was not associated with hospitalisation abroad or recent arrival in Switzerland. Whole genome sequencing analysis allowed us to exclude transmission between patients. The prevalence of MDR bacteria carriage is moderate among asylum seekers in western Switzerland. Further surveillance studies are necessary to determine if there is a risk of dissemination of pathogens into the local population.

Background: Viral myocarditis is a leading cause of mortality and cardiovascular morbidity. Its clinical manifestation is heterogeneous varying from asymptomatic courses to presentations with ventricular arrhythmias, heart failure and cardiogenic shock. Right ventricular endomyocardial biopsy is the gold standard in confirming the diagnosis; however, this may not be readily available in some clinical settings. For identification of the viral causative agent, the expanded use of polymerase chain reaction (PCR) techniques may facilitate precise viral genomic diagnosis and improve outcomes. Case presentation: We report a case of a 56 -year-old female patient who presented to the hospital with chest pain mimicking an acute coronary syndrome and stable monomorphic ventricular tachycardia. She had a medical history notable for permanent pacemaker placement due to high-degree atrioventricular block, Brugada-like syndrome and venous thromboembolic disease. Her high-sensitivity troponin was elevated, evidence of myocardial injury, and an echocardiogram showed an ejection fraction of 55% with no wall motion abnormalities. She was managed with IV Amiodarone with subsequent cardioversion. Coronary angiography performed after cardioversion ruled out ischemia as the cause of her ventricular tachycardia. Examination of the nasopharyngal swap by PCR showed a Human Parainfluenza Virus type 3 (HPIV-3), the most likely culprit for her myocardial injury. The presumptive diagnosis of myocarditis complicated with ventricular tachycardia was made after ruling out other common etiologies. Conclusion: This case illustrates a mild presentation of myocarditis and the diagnostic challenge that may ensue due to the lack of specificity of their clinical presentation and the limitation to perform biopsies or cardiac magnetic resonance imaging.

Background: Despite an abundance of studies and landmark clinical trials conducted in Africa, no systematic analysis of published data has been done to ascertain the true burden of cryptococcal meningitis (CM) in different regions and its aetiologies. We aimed to establish the prevalence, incidence and mortality associated with CM and its aetiological causes in Africa. Methods: We searched PubMed, Embase, ISI Web of Science, Africa Index Medicus, and CINAHL for studies involving adults and/or children published between 1st January 1950 and 31st December 2017 and reporting data on prevalence, incidence, mortality, and aetiology of CM in Africa, with no language restriction. Random-effect meta-analysis was used to derive pooled prevalence, mortality and incidence. Findings: In 111 studies included, 53 reported on prevalence, 63 on mortality, 5 on incidence and 14 on molecular data. The prevalence and mortality of CM in Africa were 10.3% (95%CI 7.7 - 13.2) in 37,072 participants and 47.7% (95%CI 41.0 - 54.5) in 6,011 cases respectively between 1990 and 2017. The incidence of CM was 4.8 per 100,000 person-years at risk. The recurrence rate of CM was 1.2% (95%CI 0.0 - 3.8). Prevalence and mortality were higher in individuals with mean age Interpretation: The prevalence and mortality of CM remain unacceptably high in Africa, stressing the need for stronger actions to improve access to diagnosis and treatment both for CM and HIV on the continent. Funding Statement: The authors state: "None." Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This study is registered with PROSPERO, number CRD42017081312.

IntroductionCryptococcal meningitis is a neglected disease and an AIDS-defining illness, responsible for 15% of all AIDS-related deaths globally. In 2014, the estimated number of incident cryptococcal meningitis cases was 223 100, with 73% of them occurring in Africa. Currently available data on the prevalence, incidence, aetiologies and mortality of cryptococcal meningitis across Africa are sparse and of limited quality. We propose to conduct the first systematic review to summarise the epidemiological data available on cryptococcal meningitis and its aetiological causes in Africa.Methods and analysisWe will search PubMed, MEDLINE, Excerpta Medica Database, ISI Web of Science, Africa Index Medicus, Cumulative Index to Nursing and Allied Health for studies on cryptococcal meningitis published between 1st January 1950 and 31st December 2017, involving adults and/or children residing in Africa. After study selection, full text paper acquisition and data extraction, we will use validated tools and checklists to assess the quality of reporting and risk of bias for each study. Heterogeneity across studies will be assessed using the χ2test on Cochrane’s Q statistic and a random effect meta-analysis will be used to estimate the overall prevalence, incidence density and mortality of cryptococcal meningitis across studies with similar characteristics. This protocol is prepared and presented in accordance with the 2015 Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. Reporting of the results will be compliant with the Meta-Analysis Of Observational Studies in Epidemiology (MOOSE) guidelines.Ethics and disseminationThere is no requirement for ethical approval since we will be using data from published studies. The final report will be published in a peer-reviewed journal and further presented at conferences. This study is expected to provide useful contextual estimates needed to inform treatment policies on the African continent and assess the impact of diagnostic and prevention strategies on the burden of cryptococcal meningitis in the post antiretroviral therapy era.PROSPERO registration numberCRD42017081312.

Despite improvement of infection control measures during the last 20 years, incidence of health care associated infections (HAI) remains high. HAI, also known as nosocomial infections, are mainly due to susceptible bacteria. However, resistant bacteria are responsible for some of them. In Switzerland, methicillin resistant Staphylococcus aureus incidence is decreasing but enterobacteriaceae producing extended spectrum beta-lactamase are increasing. In addition, emerging resistance challenges such as vancomycin-resistant enterococci or carbapenemase-producing bacteria were observed occasionally during recent years. Physicians in charge of hospitalized patients should know and apply good practice measures to prevent HAI and reduce the emergence and spread of multidrug resistant bacteria.Malgré l’amélioration des mesures de contrôle de l’infection ces vingt dernières années, l’incidence des infections associées aux soins (IAS) reste importante. Les IAS, aussi appelées infections nosocomiales, sont en majorité dues à des germes sensibles aux antibiotiques, mais parfois des germes résistants sont en cause. Si, en Suisse, les staphylocoques dorés résistant à la méticilline sont en baisse, les entérobactéries productrices de bêtalactamases à spectre étendu sont à la hausse. De plus, des problématiques émergentes telles que les entérocoques résistant à la vancomycine ou les bactéries productrices de carbapénémases ont été notées sporadiquement ces dernières années. Les médecins doivent connaître et appliquer les mesures de prévention des IAS, et celles visant à limiter l’émergence et la dissémination des résistances bactériennes.

BackgroundThe benefit of using serological assays based on HEV genotype 3 in industrialised settings is unclear. We compared the performance of serological kits based on antigens from different HEV genotypes.MethodsTaking 20 serum samples from patients in southwest France with acute HEV infection (positive PCR for HEV genotype 3) and 550 anonymised samples from blood donors in southwest Switzerland, we tested for anti-HEV IgG using three enzyme immunoassays (EIAs) (MP Diagnostics, Dia.Pro and Fortress) based on genotype 1 and 2 antigens, and one immunodot assay (Mikrogen Diagnostik recomLine HEV IgG/IgM) based on genotype 1 and 3 antigens.ResultsAll acute HEV samples and 124/550 blood donor samples were positive with ≥1 assay. Of PCR-confirmed patient samples, 45%, 65%, 95% and 55% were positive with MP Diagnostics, Dia.Pro, Fortress and recomLine, respectively. Of blood donor samples positive with ≥1 assay, 120/124 (97%), were positive with Fortress, 19/124 (15%) were positive with all EIAs and 51/124 (41%) were positive with recomLine. Of 11/20 patient samples positive with recomLine, stronger reactivity for HEV genotype 3 was observed in 1/11(9%), and equal reactivity for both genotypes in 5/11 (45.5%).ConclusionsAlthough recomLine contains HEV genotype 3, it has lower sensitivity than Fortress in acute HEV infection and fails to identify infection as being due to this genotype in approximately 45% of patients. In our single blood donor population, we observe wide variations in measured seroprevalence, from 4.2% to 21.8%, depending on the assay used.

AimThe aim of this study was to determine the seroprevalence of Hepatitis E virus (HEV) among blood donors in southwest Switzerland.BackgroundHEV is recognized as a food-borne disease in industrialized countries, transmitted mainly through pork meat. Cases of transmission through blood transfusion have also been reported. Recent studies have revealed seroprevalence rates of 13.5%, 16.6% and 20.6% among blood donors in England, France and Denmark, respectively.MethodsWe analyzed 550 consecutive blood donor samples collected in the region of Lausanne, canton of Vaud, Switzerland, for the presence of anti-HEV IgG, using the MP Diagnostics HEV ELISA kit. For each donor, we documented age, sex and alanine aminotransferase (ALT) value.ResultsThe study panel was composed of 332 men (60.4%) and 218 women (39.6%). Overall, anti-HEV IgG was found in 27 of 550 samples (4.9%). The seroprevalence was 5.4% (18/332) in men and 4.1% (9/218) in women. The presence of anti-HEV IgG was not correlated with age, gender or ALT values. However, we observed a peak in seroprevalence of 5.3% in individuals aged 51 to 70 years old.ConclusionsCompared with other European countries, HEV seroprevalence among blood donors in southwest Switzerland is low. The low seroprevalence may be explained by the sensitivity of commercial tests used and/or the strict regulation of animal and meat imports. Data regarding HEV prevalence in Swiss livestock are lacking and merit exploration.

Periurethral abscess formation secondary to urethritis has become an atypical and rare urological complication. We report here a case of penile gonococcal periurethral abscess and review the literature. Chart review and writing of the manuscript have been approved by the Ethical Committee of the Faculty of Biology and Medicine of Lausanne University, Switzerland. In February 2007, a 46-year-old HIV-positive homosexual man was admitted to the Urology Clinic of the University Hospital of Lausanne for a painful cherry-sized mass of the distal penis. One week before the admission, he had consulted the outpatient emergency unit with a history of urethral discharge which was diagnosed clinically as gonococcal urethritis and treated with 400 mg of ofloxacin, single dose. On physical examination, the patient presented a good general status and was afebrile. Examination of the external genitalia revealed a tender mass 2 cm in diameter affecting the ventral aspect of the penis, close to the balano-preputial separation (Fig. 1a). The overlying skin was intact. There was no discharge, no ulceration, and no palpable lymphadenopathy. The C-reactive protein value and blood leucocytes count were within normal limits. Syphilis serology was positive with a VDRL titer of 2 and a TPHA titer of 1,280. Blood and urine cultures were negative. Penile ultrasound scan showed a hypo-echogenic collection adjacent to the distal penile urethra and spongy urethra measuring 20 9 15 9 10 mm (Fig. 1b). Retrograde urography and urethroscopy demonstrated normal urethral mucosa. The urethral lumen was narrowed by a bulging mass originating from outside the urinary tract. There was no communication between the mass and the urinary tract. Regarding the HIV infection, the CD4 lymphocyte count was 91 cells/mm (18%) and the HIV viral load was 2,300 copies/ml. (The patient had recently stopped his antiretroviral treatment.) A combined medical and surgical approach was required. Following a 5-day course of ceftriaxone 2 g once daily intravenously, the abscess did not decrease in size. The abscess was, thus, incised and drained completely by performing a transurethral endoscopic incision of the abscess using the Collins loop of a 24 French resectoscope. A urethral Foley catheter was then inserted and kept in place for 3 days. Gram stain and culture of the pus failed to identify any germ. A real-time in-house polymerase chain P. Jichlinski and M. Cavassini contributed equally to this work.

BACKGROUND: Chronic liver disease in human immunodeficiency virus (HIV)-infected patients is mostly caused by hepatitis virus co-infection. Other reasons for chronic alanine aminotransferase (ALT) elevation are more difficult to diagnose. METHODS: We studied the incidence of and risk factors for chronic elevation of ALT levels (greater than the upper limit of normal at 2 consecutive semi-annual visits) in participants of the Swiss HIV Cohort Study without hepatitis B virus (HBV) or hepatitis C virus (HCV) infection who were seen during the period 2002-2008. Poisson regression analysis was used. RESULTS: A total of 2365 participants were followed up for 9972 person-years (median age, 38 years; male sex, 66%; median CD4+ cell count, 426/microL; receipt of antiretroviral therapy [ART], 56%). A total of 385 participants (16%) developed chronic elevated ALT levels, with an incidence of 3.9 cases per 100 person-years (95% confidence interval [CI], 3.5-4.3 cases per 100 person-years). In multivariable analysis, chronic elevated ALT levels were associated with HIV RNA level >100,000 copies/mL (incidence rate ratio [IRR], 2.23; 95% CI, 1.45-3.43), increased body mass index (BMI, defined as weight in kilograms divided by the square of height in meters) (BMI of 25-29.9 was associated with an IRR of 1.56 [95% CI, 1.24-1.96]; a BMI 30 was associated with an IRR of 1.70 [95% CI, 1.16-2.51]), severe alcohol use (1.83 [1.19-2.80]), exposure to stavudine (IRR per year exposure, 1.12 [95% CI, 1.07-1.17]) and zidovudine (IRR per years of exposure, 1.04 [95% CI, 1.00-1.08]). Associations with cumulative exposure to combination ART, nucleoside reverse-transcriptase inhibitors, and unboosted protease inhibitors did not remain statistically significant after adjustment for exposure to stavudine. Black ethnicity was inversely correlated (IRR, 0.52 [95% CI, 0.33-0.82]). Treatment outcome and mortality did not differ between groups with and groups without elevated ALT levels. CONCLUSIONS: Among patients without hepatitis virus co-infection, the incidence of chronic elevated ALT levels was 3.9 cases per 100 person-years, which was associated with high HIV RNA levels, increased BMI, severe alcohol use, and prolonged stavudine and zidovudine exposure. Long-term follow-up is needed to assess whether chronic elevation of ALT levels will result in increased morbidity or mortality.