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BackgroundCOVID-19 severity is mainly related to lung impairment. However, preexisting patient characteristics and biomarkers at admission associated with this event are not precisely known.MethodsWe report 205 patients admitted for a proven COVID-19 in our institution between March 7 and April 22, 2020, particularly their comorbidities, respiratory severity, immune profile, and metabolic profile.FindingsMedian age was 70 years [interquartile range (IQR) 25-75: 60;79]; 115 (56·1%) patients were men. Oxygen supplementation of >2L/min was required in 107 patients (52·2%) after a median time of 8 days [IQR: 6;10] after the first symptoms; 67 (32·7%) patients were admitted to the intensive care unit (ICU), almost exclusively due to severe hypoxia. Patients requiring >2L/min oxygen therapy and/or ICU admission were older and more frequently males, with a significantly higher body mass index (BMI), a significantly higher total cholesterol (TC) / HDL cholesterol ratio, and higher triglycerides. They also had higher plasma levels of C-reactive protein (CRP) and interleukin 6 (IL-6); IL-6 >20 ng/L and CRP >70 mg/L were significantly associated with ICU admission and/or (for patients with a decision of limitation of life-support therapy) death. Higher BMI and TC/HDL-c ratio were associated with higher CRP and IL-6 levels. Steroid therapy was performed in 61 patients; while its clinical impact was inconclusive due to heterogeneous situations, IL-6 levels decreased significantly more in these patients.InterpretationSevere COVID-19 mostly relates to late-onset pneumonia associated with preexisting metabolic syndrome markers and a surge in inflammatory markers, allowing the early identification of at-risk patients.FundingThis work was supported by Foundation University of Grenoble Alpes.

Schistosomiasis is a neglected tropical disease classically responsible for intestinal or urogenital forms. We report the incidental diagnosis of ectopic mammary schistosomiasis involving Schistosoma haematobium following a breast cancer screening mammogram in a European patient with a distant history of travel.

International audience; Recently, multidrug-resistant tuberculosis (MDR-TB) has become a therapeutic challenge. In addition to drug resistance, drug adverse events, intravenous delivery, cost and availability of some antibiotics in low-income countries have led to a look back to old drugs, especially those efficient against closely related organisms such as Mycobacterium leprae. Here we review the available drugs that respect the conditions above and could be upgraded to first-line therapy for treating MDR-TB and extensively drug-resistant tuberculosis (XDR-TB). (C) 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

Background Bone and joint infection involving Granulicatella adiacens is rare, and mainly involved in cases of bacteremia and infectious endocarditis. Here we report three cases of prosthetic joint infection involving G. adiacens that were successfully treated with surgery and prolonged antimicrobial treatment. We also review the two cases of prosthetic joint infection involving G. adiacens that are reported in the literature. Case presentation Not all five cases of prosthetic joint infection caused by G. adiacens were associated with bacteremia or infectious endocarditis. Dental care before the onset of infection was observed in two cases. The median time delay between arthroplasty implantation and the onset of infection was of 4 years (ranging between 2 and 10 years). One of our cases was identified with 16srRNA gene sequencing, one case with MALDI-TOF mass spectrometry, and one case with both techniques. Two literature cases were diagnosed by 16srRNA gene sequencing. All five cases were cured after surgery including a two-stage prosthesis exchange in three cases, a one-stage prosthesis exchange in one case, and debridement, antibiotics, irrigation, and retention of the prosthesis in one case, and prolonged antimicrobial treatment. Conclusion Prosthetic joint infection involving G. adiacens is probably often dismissed due to difficult culture or misdiagnosis, in particular in the cases of polymicrobial infection. Debridement, antibiotics, irrigation, and retention of the prosthesis associated with prolonged antimicrobial treatment (≥ 8 weeks) should be considered as a treatment strategy for prosthetic joint infection involving G. adiacens .

International audience; Second-line injectable antituberculosis drugs (aminoglycosides and capreomycin) are the main drugs used in the management of resistant tuberculosis. Their preserved efficacy in the case of multi-drug-resistant bacillus is counterbalanced by frequent adverse events. Adverse events are linked to the drugs themselves and to the recommended 8-month period of parenteral administration. In numerous countries facing a high incidence of multi-drug-resistant tuberculosis, treatment is administered by intramuscular injection. This procedure is painful and restrictive, and therefore treatment adherence is limited. This study reports the follow-up of 11 patients diagnosed with multi-drug-and extensively-resistant tuberculosis and treated with parenteral amikacin, and discusses the role of amikacin in the treatment of resistant tuberculosis. (C) 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

As a consequence of the Covid-19 pandemic, international and French health organisations are calling for large-scale screening of contacts people and symptomatic people in spring 2020, in order to diagnose positive people early, isolate !hem, and break the transmission chains of the Sars-Cov-2 virus. ln this context, a "Drive & Walk" screening centre was set up at the Centre Hospitalier Universitaire Grenoble Alpes (CHUGA) from 11 May to 18 June 2020. Il allowed the entire screening process to be carried out without users getting out of their vehicles; a section was also provided for pedestrians. The aim of our study was to assess the perception of the users of this centre at the CHUGA. lt was based on a questionnaire collecting users' characteristics and their perception of this large-scale screening centre. During the 6 weeks of opening, the Drive & Walk screened 690 people, ofwhom 578 agreed to participate. Participants had a median age of 35 years and a sex ratio of 0.87. 70% of users were symptomatic with an average duration of symptoms of 3 days. Their perception of the centre is strongly positive, with 95.4% of users considering the opening of a centre like the "Drive & Walk" to be a good thing. We find that 18.4% of users would not have done the test in a more classic laboratory. Furthermore, 83.7% of users agree with large-scale testing. We did not observe a significant association between users' perceptions and their age, gender or symptoms. Our study shows that this exceptional system was well received by its users, despite ils unprecedented nature, and in a global crisis situation. ln the event of a future need, il will therefore be possible to have again to implement "Drive & Walk" systems.; Du fait de la pandémie de Covid-19, les organisations de santé internationales et françaises appellent au printemps 2020 à un dépistage à grande échelle des personnes contacts et des personnes symptomatiques, afin de diagnostiquer précocement les personnes positives, les isoler, et casser les chaines de transmission du virus Sars-Cov-2. Un centre de test « Drive & Walk » a dans ce contexte été mis en place au Centre Hospitalier Universitaire Grenoble Alpes (CHUGA) du 11 mai au 18 juin 2020. Il permettait de réaliser tout le processus de dépistage sans que les usagers ne sortent de leur véhicule ; une partie était aussi prévue pour les piétons. Notre étude avait pour but d'évaluer la perception des usagers de ce centre, du CHUGA. Elle était basée sur un questionnaire de recueil des caractéristiques des usagers et de la perception qu'ils avaient de ce centre de dépistage à grande échelle. Durant les 6 semaines d' ouverture, le « Drive & Walk » a permis de dépister 690 personnes, dont 578 ont accepté de participer. Les participants avaient un âge médian à 35 ans et un sex ratio de 0,87. 70% des utilisateurs étaient symptomatiques avec une durée moyenne des symptômes de 3 jours. Leur perception est fortement positive quant au centre, avec 95,4% des usagers qui pensent que I'ouverture d'un centre comme le« Drive & Walk » est une bonne chose. On retrouve que 18,4% des usagers n'auraient pas fait le test dans un laboratoire plus classique. De plus, 83,7% des utilisateurs sont favorables au dépistage à grande échelle. Nous n'avons pas observé de lien significatif entre la perception des utilisateurs et leur âge, leur sexe ou leur symptômes. Notre étude montre que ce dispositif exceptionnel a été bien perçu par ses usagers, malgré son caractère inédit, et dans une situation de crise globale. En cas de nouvelle nécessité, il sera donc possible d'avoir à nouveau recours à des dispositifs de type « Drive & Walk ».