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We report 2 cases of human fascioliasis (HF) in Belgium, likely caused by consumption of vegetables from a garden that was flooded by pasture runoff. Because autochthonous HF is rare and the route of transmission was unusual, HF was not diagnosed until 6 months after symptom onset in both cases.

Objectives: To characterise the factors, outcomes and infections associated with antibiotic use in COVID-19 patients.Methods: Records of patients with RT-PCR-confirmed COVID-19, hospitalized at the CHU Charleroi (Belgium) between 11 March and 3 May 3 2020, were retrospectively reviewed. Factors associated with antibiotic treatment, outcomes and bacterial infections were analysed.Results: Among the 164 hospitalized COVID-19 patients (median age 60.5 years [IQR] 46-79), twenty-five (15.2%) were admitted to the ICU. Twenty-six (15.9%) died in the hospital. One hundred (61%) received antibiotic treatment. Combination therapies with macrolides were more common in the early part of the study period (26/67, 38.8%). Twenty-eight patients (17.1%) had a confirmed infection, mostly of the urinary tract (18/28, 64.3%). Only 2 (1.2%) had a documented respiratory coinfection. Six of the 7 ICU infections (85.7%) were superinfections. Gram-negative bacteria were most frequently isolated. In multivariate analysis, six factors were associated with antibiotic use: being hospitalized in the ICU (OR: 4.59; 95% CI 1.07-19.71), age > 65 years (OR: 4.16; 95% CI 1.72-10.05), arrival from a nursing home (OR: 4.59; 95% CI 1.11-19.71), diabetes (OR: 4.35; 95% CI 1.26-14.93), bilateral consolidation on chest CT (OR: 9.92; 95% CI 2.40-41.06) and a C-reactive protein level > 60 mg/L (OR:2.46; 95% CI 1.13-5.37). Antibiotic treatment did not reduce the length of stay or the mortality rate.Conclusion: Antibiotics have been overused during the COVID-19 pandemic, despite a low rate of coinfections . Integrating the antimicrobial stewardship (AMS) programme into the COVID-19 response is essential.

Introduction La meningite a HSV-2 chez l’adulte immunocompetent est benigne et souvent recidivante. Les recommandations belges pour son traitement ne precisent ni indication, duree ou posologie de l’acyclovir ou du valacyclovir. Objectifs Analyser les caracteristiques cliniques et cytobiochimiques des meningites a HSV-2 ainsi que leur bilan et traitement pour etablir un algorithme de prise en charge conforme aux donnees de la litterature. Patients et methodes Les dossiers des patients adultes avec un liquide cephalo-rachidien (LCR) positif par PCR pour HSV-2 hospitalises durant la periode de juin 2006–novembre 2018 au CHU de Tivoli (hopital secondaire belge de 518 lits) ont ete revus. Les donnees cliniques des patients, les analyses cytobacteriologiques et biochimiques du LCR, l’imagerie cerebrale, les modalites de traitement et l’evolution clinique ont ete analysees. Une revue de la litterature a ete effectuee. Resultats Dix patients ont presente une meningite a HSV-2 (dont une recidive) et 2 cas etaient associes a une encephalite. Tous etaient immunocompetents. L’âge median etait de 47,5 ans. La proteinorachie et la leucocytorachie mediane etait de 117,7 mg/dl et de 281,6 cellules/mm3. La duree mediane de l’acyclovir intraveineux (iv) etait de 14 jours et la posologie variait de 5 a 10 mg/kg/8 h. L’evolution fut favorable dans les 10 cas. Trois prophylaxies par valacyclovir furent instaurees. Discussion HSV-2 est le second agent des meningites virales chez l’adulte immunocompetent. Pour ce groupe, il n’existe pas de recommandation nationale claire de traitement occasionnant une prescription prolongee d’acyclovir iv, associee a un risque de toxicite et a un surcout des soins. La litterature montre une evolution generalement favorable pour ce groupe traite par de courte duree d’acyclovir iv. Conclusion L’elaboration d’un algorithme de prise en charge des meningites a HSV-2 non associees a une encephalite distinguant le patient immunocompetent de l’immunodeprime semble pertinente.