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IntroductionOur purpose was to describe the course of Long COVID symptoms after 12-month follow-up, their impact on daily life and the factors associated with the relief of symptoms.MethodsA cross-sectional survey was conducted within an out-patient clinic for Long COVID patients. Participants, who had experienced their initial COVID-19 episode between January, 15 2020 and May 21, 2021, were contacted 12-months post onset. Their characteristics, symptom course at initial COVID-19 episode, Long COVID phase and one year follow-up along with remission status were collected through a questionnaire and a specific post COVID remission scale from complete remission to persistence of symptoms and dependence in daily life activities.ResultsAmong the 231 long COVID participants who answered the 12-month follow-up questionnaire, 63.2% had developed SARS-CoV-2 antibodies before COVID-19 vaccination. At 12-month follow-up, only 8.7% of the participants felt in complete remission while 28.6% noted a significant improvement of their symptoms. The prevalence rate of most symptoms remained high at 12 months: asthenia 83.1%, neurocognitive and neurological symptoms 91.8%, cardiothoracic symptoms 77.9%, musculoskeletal 78.8%. During Long COVID phase, 62.2% had to stop working at least once and only 32.5% resumed professional activities full time at one year follow-up. The presence of SARS-CoV-2 antibodies before COVID-19 vaccination was associated with an increased probability of significant improvement at one year (aPRR: 1.60, p=0.028) while ageusia at initial Long COVID phase was associated with a lower probability of improvement (aPRR: 0.38, p=0.007).ConclusionWhile observing a trend towards some improvement in a majority of long COVID patients at a 12-month follow-up, fatigue, musculoskeletal pain, cardiothoracic symptoms and neurocognitive impairment persisted in most of them. Having developed SARS-CoV-2 antibodies was associated with a better prognosis while persistent ageusia at long COVID phase seems to be associated with the persistence of symptoms.

Fungal eye damages are rare but severe diseases that cause corneal opacity and blindness. The most common pathogens of such damages are Fusarium and Aspergillus. Fusarium is ubiquitous mold found commonly in soil and organic debris. The risk factors for fungal eye damages are trauma (plants, soil, metallic or foreign bodies), corneal surgery (keratoplasty), disruption of corneal epithelium, contact lens wear, and immunosuppressed patients. Clinical suspicion of fungal keratitis is helpful because the diagnosis is difficult to reach based on a laboratory verification, with corneal scraping in adequate culture medium and PCR. Fusarium sp are generally resistant to most antifungal drugs. Despite medical therapy with topical natamycin and voriconazole, surgery is often required with antifungal intracorneal injection, corneal transplantation, and enucleation. A 37-year-old patient presented with a trauma of cornea with a metallic piece was examined in this study. Nine months after local treatment, he complained of painful ocular lesion with a hypopyon. He was treated by intravitreal injection of vancomycin. A corneal scrapping showed hyphae of Fusarium proliferatum. He was treated with amphotericin B and voriconazole; however, no convincing efficacy was achieved and the unbearable eye pain persisted and, unfortunately, he was diagnosed with hepatic cytolysis. Due to the treatment failure, therefore, the enucleation was required and the pathological examination of the eye was found negative.

Introduction: Cerebral malaria which occurs during the active infection is the most common neurological complication of malaria. Other complications including post-malaria neurological syndrome (PMNS) can rarely occur following complete recovery from the disease. We report a case of post-malaria neurological syndrome in a Tunisian patient. Case presentation: A 26-year-old Tunisian man with no past medical history was admitted in 2016 for a muscle weakness of the 4 limbs, seizures, tetraparesis and myoclonus which appeared after he returned from Côte d’Ivoire where he had been treated three weeks ago for Plasmodium falciparum malaria with favorable outcome. Blood smears for malaria were negative. Brain MRI showed multiple hypersignal cerebral lesions. Investigations didn’t show any infectious, metabolic, toxic, vascular or tumoral etiology. Thus, the diagnosis of PMNS was considered. The patient was treated with methylprednisolone with favorable outcome. Two years later, he was completely asymptomatic. Conclusion: PMNS should be considered in patients with neurological symptoms occurring within two months of cured acute disease in which blood smears for malaria are negative and other etiologies have been ruled out. In most cases, the disease is self-limited while in severe cases corticosteroid therapy should be prescribed with favorable outcome. Keywords: Post-malaria neurological syndrome; immunologic; corticosteroid.

Some parasites, such as Trichomonas vaginalis or Sarcoptes scabiei, are sexually transmitted. However, sexual transmission of most intestinal parasites is very rare. The present study reports a case of homosexual man infected with HIV who was found to be a carrier of Strongyloides stercoralis, even though he had never traveled to the tropics. However, he had repeated sexual relations with many partners, some of whom were from endemic areas. Sexual transmission of Strongyloides stercoralis and amoebiasis due to Entamoeba histolytica is rare but has already been found in the population at risk. Therefore, this parasitosis should be sought in HIV patients complaining of digestive disorders.

Objectives: Dogs can be trained to identify several substances not detected by humans, corresponding to specific volatile organic compounds (VOCs). The presence of VOCs, triggered by SARS-CoV-2 infection, was tested in sweat from Long COVID patients. Patients and methods: An axillary sweat sample of Long COVID patients and of COVID-19 negative, asymptomatic individuals was taken at home to avoid any hospital contact. Swabs were randomly placed in olfaction detection cones, and the material sniffed by at least 2 trained dogs. Results: Forty-five Long COVID patients, mean age 45 (6-71), 73.3% female, with prolonged symptoms evolving for a mean of 15.2 months (5-22) were tested. Dogs discriminated in a positive way 23/45 (51.1%) Long COVID patients versus 0/188 (0%) control individuals (p

Background Cutibacterium species are common pathogens in periprosthetic joint infections (PJI). These infections are often treated with β-lactams or clindamycin as monotherapy, or in combination with rifampin. Clinical evidence supporting the value of adding rifampin for treatment of Cutibacterium PJI is lacking. Methods In this multicenter retrospective study, we evaluated patients with Cutibacterium PJI and a minimal follow-up of 12 months. The primary endpoint was clinical success, defined by the absence of infection relapse or new infection. We used Fisher’s exact tests and Cox proportional hazards models to analyze the effect of rifampin and other factors on clinical success after PJI. Results We included 187 patients (72.2% male, median age 67 years) with a median follow-up of 36 months. The surgical intervention was a 2-stage exchange in 95 (50.8%), 1-stage exchange in 51 (27.3%), debridement and implant retention (DAIR) in 34 (18.2%), and explantation without reimplantation in 7 (3.7%) patients. Rifampin was included in the antibiotic regimen in 81 (43.3%) cases. Infection relapse occurred in 28 (15.0%), and new infection in 13 (7.0%) cases. In the time-to-event analysis, DAIR (adjusted hazard ratio [HR] = 2.15, P = .03) and antibiotic treatment over 6 weeks (adjusted HR = 0.29, P = .0002) significantly influenced treatment failure. We observed a tentative evidence for a beneficial effect of adding rifampin to the antibiotic treatment—though not statistically significant for treatment failure (adjusted HR = 0.5, P = .07) and not for relapses (adjusted HR = 0.5, P = .10). Conclusions We conclude that a rifampin combination is not markedly superior in Cutibacterium PJI, but a dedicated prospective multicenter study is needed.

International audience; For the first 3 months of COVID-19 pandemic, COVID-19 was expected to be an immunizing non-relapsing disease. We report a national case series of 11 virologically-confirmed COVID-19 patients having experienced a second clinically- and virologically-confirmed acute COVID-19 episode. According to the clinical history, we discuss either re-infection or reactivation hypothesis. Larger studies including further virological, immunological and epidemiologic data are needed to understand the mechanisms of these recurrences.

Supplemental Digital Content is available in the text, We performed an observational prospective monocentric study in patients living with HIV (PLWH) diagnosed with COVID-19. Fifty-four PLWH developed COVID-19 with 14 severe (25.9%) and five critical cases (9.3%), respectively. By multivariate analysis, age, male sex, ethnic origin from sub-Saharan Africa and metabolic disorder were associated with severe or critical forms of COVID-19. Prior CD4+ T cell counts did not differ between groups. No protective effect of a particular antiretroviral class was observed.

Highlights • We report a screening campaign of asymptomatic staff workers in elderly nursing homes in Paris. • Before the campaign, 12.1% of the employees had developed symptomatic COVID-19. • Among screened employees not known to have the virus, 32/241 (13.3%) tested positive for SARS-CoV2. • Staff carrying SARS-CoV2 were asymptomatic in 75% of cases. • All in all, 66 out of 281 (23.5%) of the home employees had been carriers for COVID-19., Objectives To show that circulation of SARS-COV-2 in nursing homes in France can come from staff as well as residents’ families, whether they are known or not to have had COVID-19. Methods This study reports a screening campaign of asymptomatic staff working in elderly nursing homes in Paris where the virus had been circulating actively in March and April 2020. Results Before the screening campaign, the rate of symptomatic COVID-19 was 23.3% among the residents and 12.1% among their home employees. Within a 72 h screening period, all employees not known to have the virus were screened by RT-PCR in nasopharyngeal swabs. Among the 241 screened employees, 32 (13.3%) tested positive for SARS-CoV-2 on RT-PCR. SARS-CoV-2 carriers and non-carriers did not differ in term of gender, age or type of staff. Staff carrying SARS-CoV-2 were strictly asymptomatic in 75% of cases while during the days following or before the test, 25% presented mild symptoms of COVID-19. Considering both symptomatic and asymptomatic cases, 66 out of 281 (23.5%) of the home employees had been carriers for COVID-19. Conclusion Screening for viral carriage of asymptomatic staff in nursing homes can avoid contact and transmission to frequently severely vulnerable residents.

Objectives To assess the efficacy of local intranasal treatment with budesonide (nasal irrigation), in addition to olfactory rehabilitation, in the management of loss of smell in COVID-19 patients without signs of severity and with persistent hyposmia 30 days after the onset of symptoms. To search for an association between the presence of an obstruction on MRI and the severity of olfactory loss, at inclusion and after 30 days of treatment. Trial design Two center, open-label, 2-arm (1:1 ratio) parallel group randomized controlled superiority trial. Participants Inclusion criteria - Patient over 18 years of age; - Patient with a suspected SARS-CoV-2 infection, whether or not confirmed by PCR, or close contact with a PCR-confirmed case, typical chest CT scan (unsystematic frosted glass patches with predominantly sub-pleural appearance, and at a later stage, alveolar condensation without excavation or nodules or masses) or positive serology ; - Patient with isolated sudden onset hyposmia persisting 30 days after the onset of symptoms of CoV-2 SARS infection; - Affiliate or beneficiary of a social security scheme; - Written consent to participate in the study. Non-inclusion criteria - Known hypersensitivity to budesonide or any of the excipients; - Hemostasis disorder or epistaxis; - Oral-nasal and ophthalmic herpes virus infection; - Long-term corticosteroid treatment; - Treatment with potent CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, voriconazole, posaconazole, clarithromycin, telithromycin, nefazodone and HIV protease inhibitors); - Severe forms of SARS-CoV-2 with respiratory or other signs; - Hyposmia persisting for more than 90 days after the onset of symptoms - Other causes of hyposmia found on interrogation or MRI; - Patient benefiting from a legal protection measure; - Pregnant or breastfeeding women. The participants will be recruited from: Hôpital Fondation Adolphe de Rothschild and Hôpital Lariboisière in Paris, France Intervention and comparator Intervention: Experimental group: Nasal irrigation with budesonide and physiological saline (Budesonide 1mg/2mL diluted in 250mL of physiological saline 9°/00): 3 syringes of 20mL in each nasal cavity, morning and evening, for 30 days, in addition to olfactory rehabilitation twice a day. Control group: Nasal irrigation with physiological saline 9°/00 only: 3 syringes of 20cc in each nasal cavity, morning and evening, for 30 days, in addition to olfactory rehabilitation twice a day. Main outcomes Percentage of patients with an improvement of more than 2 points on the ODORATEST score after 30 days of treatment. Randomisation Patients will be randomized (1:1) between the experimental and control groups, using the e-CRF. The randomization list will be stratified by centre. Blinding (masking) Participants and caregivers are aware of the group assignment. People assessing the outcomes are blinded to the group assignment Numbers to be randomised (sample size) 120 patients are planned to be randomized into two groups of 60 patients. Trial Status MDL_2020_10. Version number 2, May 22, 2020. Recruitment started on May 22, 2020. The trial will finish recruiting by August 2020. Trial registration EUDRACT number: 2020-001667-85; date of trial registration: 15 May 2020 Protocol registered on ClinicalTrial.gov, registration number: NCT04361474 ; date of trial registration: 24 April 2020. Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.

HIGHLIGHTS • Isolated loss of smell without nasal obstruction is an early red-flag of COVID-19 • These patients should adopt all the preventive measures and a lockdown • Olfactory/gustative dysfunction had high predictive value to identify COVID-19 • Olfactory/gustative dysfunction had high specificity to identify COVID-19 • Self-reported loss of smell, among other symptoms, could help to screen COVID-19, Objectives To determine the frequency of SARS-CoV-2 positive samples in a subset of patients consulting for primarily isolated acute (

Introduction Une proportion importante de patients présentant des symptômes persistants après un épisode suspecté de COVID-19 n’ont pas d’infection documentée. Il s’agit de patients n’ayant pu faire une PCR lors de l’épisode aigu et/ou n’ayant pas développé ou ayant perdu les anticorps contre le SRAS-CoV-2 ou n’ayant pas fait d’infection par le SARS-CoV-2. Ces patients sont souvent discrédités lorsqu’ils parlent de leurs symptômes. L’objectif était de comparer le profil clinique de patients consultant pour des symptômes persistants attribués au COVID-19 en fonction de l’existence ou non d’une infection documentée. Matériels et méthodes Il s’agissait d’une cohorte prospective monocentrique, de patients ambulatoires ayant consulté pour des symptômes persistants ou résurgents après un 1er épisode symptomatique de COVID-19, entre le 25 mai 2020 et le 25 janvier 2021. Tous les patients ont eu au moins une sérologie SARS-CoV-2 réalisée lors du suivi. Une infection documentée (DOC+) était définie par une RT-PCR et/ou une sérologie positive pour le SARS-CoV-2. Résultats Parmi 204 patients évalués de façon consécutive, 130 (63,7 %) était DOC+ et 74 (36,3 %) DOC−. Le pourcentage de femmes était similaire dans les deux groupes (78,4 DOC+ vs 76,9 % DOC−) et les patients DOC+ étaient plus âgés (47,6 vs 42,4 ans, p = 0,001). Les symptômes persistants étaient pour les DOC+ et DOC− respectivement: (1) une fatigue majeure (pour 76,2 % vs 71,6 %, NS) ; (2) des symptômes neurologiques (69,2 % vs 85,1 %, p = 0,019) ; (3) des symptômes cardiothoraciques (73,1 % vs 83,8 %, NS) ; (4) des myalgies (22,3 % vs 25,7%, NS); (5) des dysosmies (30,8 % vs 16,2 %, p = 0,033) ; (6) des symptômes digestifs (37,1 % vs 68,6 %, p = 0,034) (7) des symptômes cutanés (19,2 % vs 31,1 %, NS) ; (7) une fièvre (9,3 % vs 24,4 %, p = 0,007). Conclusion Le profil clinique des patients DOC+ et DOC−, bien que très similaire présentent des différences portant sur les symptômes neurologiques et généraux. Ceci peut suggérer des mécanismes physiopathologiques différents. Quoiqu’il en soit, leurs plaintes nécessitent une prise en charge holistique et orientée sur les symptômes.

Introduction Les manifestations persistantes ou resurgentes de COVID-19 survenant plus de 2 a 3 semaines apres un premier episode sont extremement diverses et encore mal connues. Materiels et methodes Une consultation post-COVID a ete ouverte a l’Hotel-Dieu depuis mai 2020 pour les patients (pts) souffrant de symptomes prolonges ou resurgents de COVID. Un recueil etait fait selon un questionnaire preetabli, apres obtention de l’accord oral des pts. Ils etaient inclus en cas de diagnostic d’infection confirmee a SARS-COV-2 et apres exclusion d’un diagnostic differentiel. Le diagnostic de COVID etait retenu devant : RT-PCR et/ou une serologie positive et/ou scanner thoracique initial typique de COVID et/ou contact avec un cas confirme par PCR associe a 2 signes majeurs (anosmie, toux, fievre, dyspnee). Resultats Parmi les 58 pts vus en consultation entre le 20 mai et le 12 juin 2020, 26 avaient un diagnostic de COVID confirme par RT-PCR (n = 15), serologie (n = 8), scanner thoracique typique (n = 1) et/ou presence de deux signes majeurs avec contage (n = 2). Il s’agissait de 19 (73,1 %) femmes et 7 (26,9 %) hommes, d’âge moyen 46 ans (22–75). Quatre sur 23 (15,4 %) pts avaient un antecedent de pathologie auto-immune et 11 (42,3 %) un terrain d’allergie. Les symptomes initiaux les plus frequemment retrouves etaient : fievre (n = 19, 73,1 %), toux (n = 18, 69,2 %), anosmie (n = 17, 65,4 %) et cephalees (n = 16, 61,5 %). Seuls 4/23 (17,4 %) pts ont ete hospitalises. Un intervalle libre entre le 1er episode et les episodes suivants a ete note dans 11 cas avec une duree de 13 ± 10 jours, en moyenne. Lors du 2e episode une persistance des symptomes du premier episode etait notee dans 11 cas, une reapparition de ces memes symptomes dans 16 cas et l’apparition de symptomes differents dans 18 cas. Lors des episodes tardifs, les symptomes etaient intermittents dans 35 % des cas (n = 7/20). 22 patients (84,6 %) etaient apyretiques. Les symptomes les plus frequents rapportes etaient : – au moins 1 symptome neurologique (21 pts, 80,7 %) : psychocognitifs a type de troubles de la memoire, de la concentration, de l’humeur, somnolence (n = 17) ; sensoriels a type de cephalees, trouble de l’equilibre, fourmillements, brulure et douleur neurogene (n = 35) ; trouble de la deglutition et de l’elocution (n = 2) et dysregulation thermique (n = 2) dont 4 ont eu une IRM cerebrale qui est redevenue normale ; – des symptomes cardiovasculaires, pour 20 pts (76,9 %), a type d’oppression et douleurs thoraciques, palpitations, dyspnee d’effort et toux ayant conduit au diagnostic de pericardite et/ou myocardite (n = 5 cas) ; – et une asthenie souvent majeure (16 cas, 61,5 %). La PCR SARS-COV-2 etait souvent negative (n = 14/21, 66,7 %) lors que la serologie SARS-COV-2 etait le plus souvent positive (15/23, 65,2 %). Conclusion Les myopericardites evoquent un syndrome post infectieux de nature dysimmunitaire, tandis que des recherches approfondies doivent etre menees sur les atteintes neurologiques pour lesquelles une atteinte virale directe ne peut etre exclue.

We report an observation of facial and upper limb demodicosis, revealing a human immunodeficiency virus infection. After an initial improvement with metronidazole, worsening of skin lesions related to immune reconstitution inflammatory syndrome was observed, requiring the use of steroids. Keywords: Demodex, demodicosis, human immunodeficiency virus, immune reconstitution inflammatory syndrome, metronidazole

Introduction Cerebral vasculitis is an uncommon life-threatening complication of community-acquired bacterial meningitis. Patient and methods We report the case of a 64-year-old woman with pneumococcal meningitis who developed parainfectious vasculitis causing ischaemic brain damage. Cerebral magnetic resonance imaging (MRI) confirmed the diagnosis. Clinical and radiological recovery after delayed addition of corticosteroid was achieved. Discussion This report shows that the onset of neurological deficits following pneumococcal meningitis can be caused by cerebral vasculitis. Underdosing with antibiotics and delayed adjunctive dexamethasone seem to favour this complication. There are no guidelines for treatment but high doses of steroids led to resolution in this case. Learning points Pneumococcal meningitis complicated by cerebral vasculitis can be treated with high-dose steroids.A repeat lumbar puncture is recommended to rule out relapsing or persistent infection in patients who deteriorate after 48 h of adequate antibiotic therapy.The cerebral vasculitis in our patient may have been caused by antibiotic underdosing and by delayed dexamethasone administration.