Pub Date : 2025-10-29DOI: 10.1016/j.idnow.2025.105182
Philippe Lavrard-Meyer , Piseth Seng , Fabrice Bartolomei , Andreas Stein , Romain Carron
Introduction
Post-neurosurgical brain abscesses are documented in approximately 9% of cases, with causative pathogens often linked to polymicrobial or nosocomial origins.
Case report.
We report the first case of post-neurosurgical Legionella pneumophila brain abscess in a 55-year-old woman with drug-resistant epilepsy. The abscess developed following stereo-electroencephalography and thermocoagulation procedures, manifesting as hemiparesis and vomiting. Diagnosis was confirmed via 16S rRNA PCR, antigen testing, and Buffered Charcoal Yeast Extract (BCYE) culture. Treatment with targeted antibiotics, including levofloxacin and rifampicin, led to a complete recovery without sequelae. Investigation identified the patient’s home water system as the infection source.
Conclusion
This case highlights the importance of molecular diagnostics and tailored therapy in managing rare brain abscesses.
{"title":"Legionella in the brain: First culture-confirmed post-surgical abscess case and its successful management","authors":"Philippe Lavrard-Meyer , Piseth Seng , Fabrice Bartolomei , Andreas Stein , Romain Carron","doi":"10.1016/j.idnow.2025.105182","DOIUrl":"10.1016/j.idnow.2025.105182","url":null,"abstract":"<div><h3>Introduction</h3><div>Post-neurosurgical brain abscesses are documented in approximately 9% of cases, with causative pathogens often linked to polymicrobial or nosocomial origins.</div><div>Case report.</div><div>We report the first case of post-neurosurgical <em>Legionella pneumophila</em> brain abscess in a 55-year-old woman with drug-resistant epilepsy. The abscess developed following stereo-electroencephalography and thermocoagulation procedures, manifesting as hemiparesis and vomiting. Diagnosis was confirmed via 16S rRNA PCR, antigen testing, and Buffered Charcoal Yeast Extract (BCYE) culture. Treatment with targeted antibiotics, including levofloxacin and rifampicin, led to a complete recovery without sequelae. Investigation identified the patient’s home water system as the infection source.</div></div><div><h3>Conclusion</h3><div>This case highlights the importance of molecular diagnostics and tailored therapy in managing rare brain abscesses.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 8","pages":"Article 105182"},"PeriodicalIF":2.2,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145421569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-27DOI: 10.1016/j.idnow.2025.105179
Lonika Lodha , Akila Swaminathan , Abby John , Shalini Kunhikannan , Brindha Sundar , Sathishkumar A , Kalyani J. Nair , Amrita Pattanaik
Chandipura virus (CHPV) is an emerging zoonotic pathogen of significant public health concern, particularly in the Indian subcontinent. The virus was first identified in 1965 during a dengue-like febrile outbreak in the village of Chandipur, Maharashtra, India. CHPV is a bullet- shaped enveloped rhabdovirus with a single-stranded, negative-sense RNA genome. CHPV infections are characterised by fatal acute encephalitis, specifically in the paediatric population under the age of 15, with a case fatality rate (CFR) of 57%–70% observed during outbreaks. CHPV transmission is believed to occur via sandflies (Phlebotomus spp.), with additional roles for other arthropod vectors not yet fully ruled out. CHPV infection in humans is characterized by a sudden onset of fever, vomiting, and altered sensorium, progressing swiftly to coma and death in severe cases. Various diagnostic approaches, including serological assays, molecular techniques, animal inoculation, and virus isolation, have been employed for CHPV detection. The lack of specific antiviral treatment or a licensed vaccine compounds the threat posed by CHPV, particularly in resource-limited settings. In the absence of a licenced vaccine, prevention of CHPV infection relies on reducing vector-borne transmission of the virus. This review comprehensively investigates several key questions related to the CHPV, including its epidemiology, transmission mechanisms, clinical presentations, diagnostic techniques, and potential treatments.
{"title":"Chandipura virus: A comprehensive review","authors":"Lonika Lodha , Akila Swaminathan , Abby John , Shalini Kunhikannan , Brindha Sundar , Sathishkumar A , Kalyani J. Nair , Amrita Pattanaik","doi":"10.1016/j.idnow.2025.105179","DOIUrl":"10.1016/j.idnow.2025.105179","url":null,"abstract":"<div><div>Chandipura virus (CHPV) is an emerging zoonotic pathogen of significant public health concern, particularly in the Indian subcontinent. The virus was first identified in 1965 during a dengue-like febrile outbreak in the village of Chandipur, Maharashtra, India. CHPV is a bullet- shaped enveloped rhabdovirus with a single-stranded, negative-sense RNA genome. CHPV infections are characterised by fatal acute encephalitis, specifically in the paediatric population under the age of 15, with a case fatality rate (CFR) of 57%–70% observed during outbreaks. CHPV transmission is believed to occur via sandflies (<em>Phlebotomus</em> spp.), with additional roles for other arthropod vectors not yet fully ruled out. CHPV infection in humans is characterized by a sudden onset of fever, vomiting, and altered sensorium, progressing swiftly to coma and death in severe cases. Various diagnostic approaches, including serological assays, molecular techniques, animal inoculation, and virus isolation, have been employed for CHPV detection. The lack of specific antiviral treatment or a licensed vaccine compounds the threat posed by CHPV, particularly in resource-limited settings. In the absence of a licenced vaccine, prevention of CHPV infection relies on reducing vector-borne transmission of the virus. This review comprehensively investigates several key questions related to the CHPV, including its epidemiology, transmission mechanisms, clinical presentations, diagnostic techniques, and potential treatments.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 8","pages":"Article 105179"},"PeriodicalIF":2.2,"publicationDate":"2025-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145400679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-25DOI: 10.1016/j.idnow.2025.105181
Paul Petitgas , René Bun , Babacar Tounkara , Catherine Simac , Antoine Bertolotti , Patrice Poubeau , Yatrika Koumar , Rodolphe Manaquin , Kévin Diallo , Fanny Andry
Background
Peripherally inserted central catheters (PICCs) are associated with complications including deep vein thrombosis (DVT) and infections. However, the risk factors for developing DVT specifically during PICC-related infections remain poorly understood.
Methods
We conducted a retrospective observational study in a tertiary-care hospital in Reunion Island, examining adult patients with PICC-related infections between January 2021 and March 2022. Venous Doppler ultrasound results, microbiological data, and clinical variables were analyzed. Univariate analysis was performed to identify factors associated with PICC-related DVT.
Results
Among 63 patients with PICC-related infections, 40 underwent Doppler ultrasound examinations, with 12 (19 %) diagnosed with PICC-DVT. Infections with Staphylococcus aureus (P = 0.05) and local signs (P = 0.04) were significantly associated with PICC-DVT. Enterobacterales were the predominant pathogens (42.5 %). The incidence rate of PICC-DVT was 5.0/1000 catheter-days in patients with PICC-related infections.
Conclusions
Staphylococcus aureus infection and local signs are associated with PICC-DVT. Our findings suggest that these factors should be considered when managing patients with PICC-related infections. Prospective studies are needed to develop clinical prediction tools to identify which patients would benefit most from Doppler ultrasound.
{"title":"Risk factors for deep vein thrombosis during peripherally inserted central catheter-related infections: A retrospective study","authors":"Paul Petitgas , René Bun , Babacar Tounkara , Catherine Simac , Antoine Bertolotti , Patrice Poubeau , Yatrika Koumar , Rodolphe Manaquin , Kévin Diallo , Fanny Andry","doi":"10.1016/j.idnow.2025.105181","DOIUrl":"10.1016/j.idnow.2025.105181","url":null,"abstract":"<div><h3>Background</h3><div>Peripherally inserted central catheters (PICCs) are associated with complications including deep vein thrombosis (DVT) and infections. However, the risk factors for developing DVT specifically during PICC-related infections remain poorly understood.</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational study in a tertiary-care hospital in Reunion Island, examining adult patients with PICC-related infections between January 2021 and March 2022. Venous Doppler ultrasound results, microbiological data, and clinical variables were analyzed. Univariate analysis was performed to identify factors associated with PICC-related DVT.</div></div><div><h3>Results</h3><div>Among 63 patients with PICC-related infections, 40 underwent Doppler ultrasound examinations, with 12 (19 %) diagnosed with PICC-DVT. Infections with <em>Staphylococcus aureus</em> (<em>P</em> = 0.05) and local signs (<em>P</em> = 0.04) were significantly associated with PICC-DVT. <em>Enterobacterales</em> were the predominant pathogens (42.5 %). The incidence rate of PICC-DVT was 5.0/1000 catheter-days in patients with PICC-related infections.</div></div><div><h3>Conclusions</h3><div><em>Staphylococcus aureus</em> infection and local signs are associated with PICC-DVT. Our findings suggest that these factors should be considered when managing patients with PICC-related infections. Prospective studies are needed to develop clinical prediction tools to identify which patients would benefit most from Doppler ultrasound.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 8","pages":"Article 105181"},"PeriodicalIF":2.2,"publicationDate":"2025-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145525471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-24DOI: 10.1016/j.idnow.2025.105175
Jean-Philippe Lanoix
Introduction
Antibiotic misuse is a global threat and a public health priority. In 2002, France launched what has, up until now, been the best marketing campaign on antibiotics addressed to the general public.
Patients and method
To explore general public knowledge and possible regional factors contributing to antibiotic overuse, we performed a nation-wide quantitative survey (quota methods) of the general public (n = 1200) and general practitioners (n = 301) on their use (or prescription) and knowledge on antibiotics.
Results
Overall, general public knowledge on antibiotics remains low, while and demand is high, a finding confirmed by GPs who feel strongly impelled to prescribe antibiotics. The younger generation (<35-years-old) know less about antibiotics than the older generation (>60-years-old), and manifest greater demand for antibiotics. In our survey, only 49 % of the younger population seemed aware of the fact that antibiotics work on bacteria alone, as opposed to 64 % of the older population (p < 0.001). Another example: 59 % of the respondents thought that it was good to keep antibiotics at home or that taking antibiotics helps to heal faster, as opposed to 26 % of the older population (p < 0.0001). On the other hand, inhabitants of a high-prescribing region were neither worse nor better informed than the rest of the French population.
Conclusion
In conclusion, our study underscores limited knowledge of antibiotics of the younger population, raising questions on how to effectively reach them. As if the case with other public health messages; large-scale nationwide educational program is deeply needed to reach members of all generations: at school, at university, at work and on the social media.
{"title":"Knowledge of the French public on antibiotics: where do we stand, twenty years after the celebrated public health campaign “Antibiotics are not Automatic”?","authors":"Jean-Philippe Lanoix","doi":"10.1016/j.idnow.2025.105175","DOIUrl":"10.1016/j.idnow.2025.105175","url":null,"abstract":"<div><h3>Introduction</h3><div>Antibiotic misuse is a global threat and a public health priority. In 2002, France launched what has, up until now, been the best marketing campaign on antibiotics addressed to the general public.</div></div><div><h3>Patients and method</h3><div>To explore general public knowledge and possible regional factors contributing to antibiotic overuse, we performed a nation-wide quantitative survey (quota methods) of the general public (n = 1200) and general practitioners (n = 301) on their use (or prescription) and knowledge on antibiotics.</div></div><div><h3>Results</h3><div>Overall, general public knowledge on antibiotics remains low, while and demand is high, a finding confirmed by GPs who feel strongly impelled to prescribe antibiotics. The younger generation (<35-years-old) know less about antibiotics than the older generation (>60-years-old), and manifest greater demand for antibiotics. In our survey, only 49 % of the younger population seemed aware of the fact that antibiotics work on bacteria alone, as opposed to 64 % of the older population (p < 0.001). Another example: 59 % of the respondents thought that it was good to keep antibiotics at home or that taking antibiotics helps to heal faster, as opposed to 26 % of the older population (p < 0.0001). On the other hand, inhabitants of a high-prescribing region were neither worse nor better informed than the rest of the French population.</div></div><div><h3>Conclusion</h3><div>In conclusion, our study underscores limited knowledge of antibiotics of the younger population, raising questions on how to effectively reach them. As if the case with other public health messages; large-scale nationwide educational program is deeply needed to reach members of all generations: at school, at university, at work and on the social media.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 8","pages":"Article 105175"},"PeriodicalIF":2.2,"publicationDate":"2025-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145576311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-18DOI: 10.1016/j.idnow.2025.105167
Pierre Fillâtre , Rémy Gauzit
{"title":"Septic patients: time to do better!","authors":"Pierre Fillâtre , Rémy Gauzit","doi":"10.1016/j.idnow.2025.105167","DOIUrl":"10.1016/j.idnow.2025.105167","url":null,"abstract":"","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 8","pages":"Article 105167"},"PeriodicalIF":2.2,"publicationDate":"2025-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145336928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-14DOI: 10.1016/j.idnow.2025.105166
C. Ourghanlian , D. Kharchenko , V. Fihman , A. Galy , P-L. Woerther , R. Lepeule
Introduction
The European Committee on Antimicrobial Susceptibility Testing (EUCAST) changed the definition of the ‘intermediate’ (I) category in 2019, now defined as ‘susceptible, increased exposure’. We previously reported an increase in prescriptions for antibiotics still reported as ‘S’, compared with those now reported as ‘I’. This study aimed to evaluate the influence of a more explicit abbreviation (SFP or ‘Susceptible increased exposure’) than ‘I’ on the use of overly broad-spectrum antibiotics for the treatment of infections caused by wild-type (WT) Pseudomonas aeruginosa.
Methods
A retrospective observational multicenter study was conducted across five hospitals. Two study periods were defined, before and after the implementation of the new abbreviation (from September 2020 to February 2022, and from March 2022 to August 2023). All patients with an infection caused by WT P. aeruginosa treated with β-lactams were included. The main endpoint was the proportion of patients treated with an overly broad-spectrum antibiotic treatment by meropenem or ceftolozane/tazobactam.
Results
A total of 279 patients were included. No difference between groups was found, in terms of infection, microbiology, or demographic characteristics. Eight overly broad-spectrum antibiotic treatments by meropenem or ceftolozane/tazobactam were observed in Period 1 (5.6 %), versus one in Period 2 (0.7 %; p = 0.026). No overly broad-spectrum treatment was observed when the antimicrobial stewardship team had given advice.
Conclusions
The French recommendations derived from the EUCAST guidelines, with a new abbreviation, have contributed to a reduction in the prescription of broad-spectrum antibiotics and have helped mitigate clinicians’ misunderstanding of the previous guidelines.
{"title":"Evolution of the inappropriate use of broad-spectrum antibiotics for Pseudomonas aeruginosa infections following the 2022 CA-SFM guidelines","authors":"C. Ourghanlian , D. Kharchenko , V. Fihman , A. Galy , P-L. Woerther , R. Lepeule","doi":"10.1016/j.idnow.2025.105166","DOIUrl":"10.1016/j.idnow.2025.105166","url":null,"abstract":"<div><h3>Introduction</h3><div>The European Committee on Antimicrobial Susceptibility Testing (EUCAST) changed the definition of the ‘intermediate’ (I) category in 2019, now defined as ‘susceptible, increased exposure’. We previously reported an increase in prescriptions for antibiotics still reported as ‘S’, compared with those now reported as ‘I’. This study aimed to evaluate the influence of a more explicit abbreviation (SFP or ‘Susceptible increased exposure’) than ‘I’ on the use of overly broad-spectrum antibiotics for the treatment of infections caused by wild-type (WT) <em>Pseudomonas aeruginosa</em>.</div></div><div><h3>Methods</h3><div>A retrospective observational multicenter study was conducted across five hospitals. Two study periods were defined, before and after the implementation of the new abbreviation (from September 2020 to February 2022, and from March 2022 to August 2023). All patients with an infection caused by WT <em>P.<!--> <!-->aeruginosa</em> treated with β-lactams were included. The main endpoint was the proportion of patients treated with an overly broad-spectrum antibiotic treatment by meropenem or ceftolozane/tazobactam.</div></div><div><h3>Results</h3><div>A total of 279 patients were included. No difference between groups was found, in terms of infection, microbiology, or demographic characteristics. Eight overly broad-spectrum antibiotic treatments by meropenem or ceftolozane/tazobactam were observed in Period 1 (5.6 %), versus one in Period 2 (0.7 %; <em>p</em> = 0.026). No overly broad-spectrum treatment was observed when the antimicrobial stewardship team had given advice.</div></div><div><h3>Conclusions</h3><div>The French recommendations derived from the EUCAST guidelines, with a new abbreviation, have contributed to a reduction in the prescription of broad-spectrum antibiotics and have helped mitigate clinicians’ misunderstanding of the previous guidelines.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 8","pages":"Article 105166"},"PeriodicalIF":2.2,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145307465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-10DOI: 10.1016/j.idnow.2025.105165
Renan Le Cras , Patricia Vidal , Patricia Pavese , Patrice François , Anna Sette , Philippe Lesprit , on behalf of the CRAtb-AuRA
Objective
This study describes the implementation and short-term evolution of the antibiotherapy indicators selected by the Regional Antibiotherapy Center of Auvergne-Rhône-Alpes for utilization in primary care and nursing homes.
Material and Methods
This retrospective observational study was based on public reimbursement data between 2021 and 2023. Seven indicators were selected for the community and eight for nursing homes.
Results
We observed positive trends for first-line antibiotics for female urinary tract infections (community: + 28 %, nursing homes: +18 %), treatment duration > 7 days (community: −7,8%; −13,4% for amoxicillin-clavulanic acid; nursing homes: −20,5%), fluoroquinolones in nursing homes (−16 %) and combination of amoxicillin-clavulanic acid with metronidazole or amoxicillin in the community (–22 %). That said, total antibiotic consumption increased in the community (+16.5 %), while remaining stable in nursing homes.
Conclusion
This study identified areas for improvement in antibiotic therapy in our region. A longer follow-up will be necessary to assess the potential impact of initiatives such as ours on proper antibiotic use.
{"title":"Efficacy of antimicrobial stewardship indicators in assessing the impact of a regional antibiotic therapy center in primary care and nursing homes","authors":"Renan Le Cras , Patricia Vidal , Patricia Pavese , Patrice François , Anna Sette , Philippe Lesprit , on behalf of the CRAtb-AuRA","doi":"10.1016/j.idnow.2025.105165","DOIUrl":"10.1016/j.idnow.2025.105165","url":null,"abstract":"<div><h3>Objective</h3><div>This study describes the implementation and short-term evolution of the antibiotherapy indicators selected by the Regional Antibiotherapy Center of Auvergne-Rhône-Alpes for utilization in primary care and nursing homes.</div></div><div><h3>Material and Methods</h3><div>This retrospective observational study was based on public reimbursement data between 2021 and 2023. Seven indicators were selected for the community and eight for nursing homes.</div></div><div><h3>Results</h3><div>We observed positive trends for first-line antibiotics for female urinary tract infections (community: + 28 %, nursing homes: +18 %), treatment duration > 7 days (community: −7,8%; −13,4% for amoxicillin-clavulanic acid; nursing homes: −20,5%), fluoroquinolones in nursing homes (−16 %) and combination of amoxicillin-clavulanic acid with metronidazole or amoxicillin in the community (–22 %). That said, total antibiotic consumption increased in the community (+16.5 %), while remaining stable in nursing homes.</div></div><div><h3>Conclusion</h3><div>This study identified areas for improvement in antibiotic therapy in our region. A longer follow-up will be necessary to assess the potential impact of initiatives such as ours on proper antibiotic use.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 8","pages":"Article 105165"},"PeriodicalIF":2.2,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-04DOI: 10.1016/j.idnow.2025.105164
B HOELLINGER , D REY , P KLEE , C CHENEAU , C MENOULOU , T LEMMET , P GANTNER , A URSENBACH
Introduction
Intermittent antiretroviral therapy (ART) is commonly prescribed in France, but this strategy is not recommended internationally. The objective of this study was to evaluate real-life efficacy of intermittent ART in virologically suppressed individuals.
Methods
We conducted a retrospective non-comparative cohort study at Strasbourg University Hospital and included all people living with HIV (PLWH) on intermittent ART between 2017 and 2024. The primary outcome was virological success at W48 after initiation of intermittent ART.
Results
We included 160 PLWH. They were mainly males (80 %), with 59.4 % reporting sex with men and 75 % were born in France. Mean CD4 count was 672/mm3, and mean duration of viral suppression was 7.9 years. The third agent was a non-nucleoside reverse transcriptase inhibitor in 87/160 (54.3 %) participants, an integrase strand transfer inhibitor in 72/160 (45.0 %) participants, and one participant had a protease inhibitor. Three participants discontinued the intermittent ART strategy before W48, and five were lost to follow-up before W48, without virological failure at the time of the last update. We did not observe any virological failure at W48 for the remaining 152 participants, nor during longer follow-up (median 131 weeks). A blip occurred in five participants. Throughout the study period, 21/160 (13.1 %) PLWH discontinued intermittent ART strategy, mainly to switch for injectable ART (12/21, 57 %).
Conclusions
Our findings in real-life setting support intermittent triple ART as a safe, cost-effective, and well-tolerated maintenance option in selected compliant PLWH, including regimens with a lower genetic barrier to resistance.
{"title":"Real-life evaluation of intermittent triple antiretroviral therapy maintenance strategies","authors":"B HOELLINGER , D REY , P KLEE , C CHENEAU , C MENOULOU , T LEMMET , P GANTNER , A URSENBACH","doi":"10.1016/j.idnow.2025.105164","DOIUrl":"10.1016/j.idnow.2025.105164","url":null,"abstract":"<div><h3>Introduction</h3><div>Intermittent antiretroviral therapy (ART) is commonly prescribed in France, but this strategy is not recommended internationally. The objective of this study was to evaluate real-life efficacy of intermittent ART in virologically suppressed individuals.</div></div><div><h3>Methods</h3><div>We conducted a retrospective non-comparative cohort study at Strasbourg University Hospital and included all people living with HIV (PLWH) on intermittent ART between 2017 and 2024. The primary outcome was virological success at W48 after initiation of intermittent ART.</div></div><div><h3>Results</h3><div>We included 160 PLWH. They were mainly males (80 %), with 59.4 % reporting sex with men and 75 % were born in France. Mean CD4 count was 672/mm<sup>3</sup>, and mean duration of viral suppression was 7.9 years. The third agent was a non-nucleoside reverse transcriptase inhibitor in 87/160 (54.3 %) participants, an integrase strand transfer inhibitor in 72/160 (45.0 %) participants, and one participant had a protease inhibitor. Three participants discontinued the intermittent ART strategy before W48, and five were lost to follow-up before W48, without virological failure at the time of the last update. We did not observe any virological failure at W48 for the remaining 152 participants, nor during longer follow-up (median 131 weeks). A blip occurred in five participants. Throughout the study period, 21/160 (13.1 %) PLWH discontinued intermittent ART strategy, mainly to switch for injectable ART (12/21, 57 %).</div></div><div><h3>Conclusions</h3><div>Our findings in real-life setting support intermittent triple ART as a safe, cost-effective, and well-tolerated maintenance option in selected compliant PLWH, including regimens with a lower genetic barrier to resistance.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 8","pages":"Article 105164"},"PeriodicalIF":2.2,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-25DOI: 10.1016/j.idnow.2025.105163
Julien Carvelli , Coline Mortier , Mohamed Boucekine , Vincent Gilles , Yvonnick Boué , Guillaume Le Balle , Jeanne Broyon , Annabelle Lapostolle , Tanguy Cholin , Manon Dory , Chloé Andres , Renaud Piarroux , Louis Collet , Abdourahim Chamouine , Mohamadou Niang , for the CHOLEMAY Study Group
Objective
In 2024, the island of Mayotte (France) was affected by a cholera outbreak. The objective of this study was to identify clinical and laboratory criteria associated with severity (defined as hypovolemic shock and/or severe acidosis) in view of improving patient triage and therapeutic management in subsequent outbreaks.
Methods
From March 18 to July 12, 2024, we screened 215 patients with cholera (positive stool PCR). We excluded five patients who died outside hospital (no data, lethality = 2.3 %) and four patients for whom no data were available. We ultimately enrolled 206 patients. Severe forms of cholera were defined as the presence of at least one of the following three objective criteria: arterial hypotension; and/or neurological impairment (GCS < 14) (hypovolemic shock); and/or venous pH < 7.20 (severe acidosis) at first medical assessment.
Findings
Median patient age was 19 years (8–32 years), and 83 patients (40 %) presented with a severe form, which often consisted in fever (n = 13/83, 13 % vs. n = 6/123, 5 %, p = 0.04), vomiting (n = 71/83, 86 % vs. n = 79/123, 64 %, p < 0.001), a higher stool output (8 (4.5–10) vs. 4 (2–6) stools on day 1, p < 0.001) and severe hemoconcentration (Ht = 54 (47–60) vs. 43 (38–50), p < 0.001). In multivariate analysis, only hemoconcentration was associated with significantly greater severity (OR 95 % CI = 1.12 [1.04–1.21], p < 0.001).
Conclusion
Cholera is a toxin-mediated infection responsible for severe, occasionally fatal acute watery diarrhea. Severity is associated with neurological impairment, metabolic acidosis, and hemoconcentration. Triage and care of these patients are absolutely essential means of preventing death.
{"title":"The 2024 cholera outbreak in Mayotte. Clinical and biological factors associated with severe forms of the disease in an observational cohort of 206 patients","authors":"Julien Carvelli , Coline Mortier , Mohamed Boucekine , Vincent Gilles , Yvonnick Boué , Guillaume Le Balle , Jeanne Broyon , Annabelle Lapostolle , Tanguy Cholin , Manon Dory , Chloé Andres , Renaud Piarroux , Louis Collet , Abdourahim Chamouine , Mohamadou Niang , for the CHOLEMAY Study Group","doi":"10.1016/j.idnow.2025.105163","DOIUrl":"10.1016/j.idnow.2025.105163","url":null,"abstract":"<div><h3>Objective</h3><div>In 2024, the island of Mayotte (France) was affected by a cholera outbreak. The objective of this study was to identify clinical and laboratory criteria associated with severity (defined as hypovolemic shock and/or severe acidosis) in view of improving patient triage and therapeutic management in subsequent outbreaks.</div></div><div><h3>Methods</h3><div>From March 18 to July 12, 2024, we screened 215 patients with cholera (positive stool PCR). We excluded five patients who died outside hospital (no data, lethality = 2.3 %) and four patients for whom no data were available. We ultimately enrolled 206 patients. Severe forms of cholera were defined as the presence of at least one of the following three objective criteria: arterial hypotension; and/or neurological impairment (GCS < 14) (hypovolemic shock); and/or venous pH < 7.20 (severe acidosis) at first medical assessment.</div></div><div><h3>Findings</h3><div>Median patient age was 19 years (8–32 years), and 83 patients (40 %) presented with a severe form, which often consisted in fever (n = 13/83, 13 % vs. n = 6/123, 5 %, <em>p</em> = 0.04), vomiting (n = 71/83, 86 % vs. n = 79/123, 64 %, <em>p</em> < 0.001), a higher stool output (8 (4.5–10) vs. 4 (2–6) stools on day 1, <em>p</em> < 0.001) and severe hemoconcentration (Ht = 54 (47–60) vs. 43 (38–50), p < 0.001). In multivariate analysis, only hemoconcentration was associated with significantly greater severity (OR 95 % CI = 1.12 [1.04–1.21], <em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>Cholera is a toxin-mediated infection responsible for severe, occasionally fatal acute watery diarrhea. Severity is associated with neurological impairment, metabolic acidosis, and hemoconcentration. Triage and care of these patients are absolutely essential means of preventing death.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 8","pages":"Article 105163"},"PeriodicalIF":2.2,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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