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Backgrounds: High flow nasal cannula (HFNC) is an alternative therapy for acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). This study aimed first to describe outcomes of patients suffering from COVID-19-related ARDS treated with HFNC; secondly to evaluate safety of HFNC (patients and healthcare workers) and compare patients according to respiratory outcome. Methods: A retrospective cohort was conducted in French general hospital intensive care unit (ICU). Patients were included if receiving HFNC for hypoxemia (saturation pulse oxygen (SpO2) <92% under oxygen ⩾6 L/min) associated with ARDS and positive SARS-CoV-2 polymerase chain reaction (PCR). Main clinical characteristics and outcomes are described in patients: (a) with do not intubate order (HFNC-DNIO); (b) who did not need intubation (HFNC-only); and (c) eventually intubated (HFNC-intubation). Medians are presented with (1st–3rd) interquartile range. Results: From 26 February to 30 June 2020, 46 patients of median age 75 (70–79) years were included. In the HFNC-DNIO group (n = 11), partial arterial oxygen pressure (PaO2)/inhaled fraction of oxygen (FiO2) ratio median worst PaO2/FiO2 ratio was 109 (102–172) and hospital mortality was 54.5%. Except the HFNC-DNIO patients (n = 35), 20 patients (57%) were eventually intubated (HFNC-intubation group) and 15 were only treated by HFNC (HFNC-only). HFNC-intubation patients presented higher worst respiratory rates per minute in ICU [37 (34–41) versus 33 (24–34) min, p < 0.05] and worsened ICU admission PaO2/FiO2 ratios [121 (103–169) versus 191 (162–219), p < 0.001] compared with HFNC-only patients. Hospital mortality was 35% (n = 7/20) in HFNC-intubation group, 0% in HFNC-only group with a global mortality of these two groups of 20% (n = 7/35). Among tests performed in healthcare workers, 1/12 PCR in symptomatic healthcare workers and 1.8% serologies in asymptomatic healthcare workers were positive. After review of each case, COVID-19 was likely to be acquired outside hospital. Conclusions: HFNC seems to be useful for COVID-19-related ARDS and safe for healthcare workers. ARDS severity with PaO2/FiO2 <150 associated with respiratory rate >35/min could be regarded as a predictor of intubation. The reviews of this paper are available via the supplemental material section.

Acute diarrhea is a major cause of childhood morbidity and mortality worldwide. Its microbiological causes and clinico-epidemiological aspects were examined during the rainy seasons from 2008 to 2009 in 14 districts in Madagascar. Stool specimens of 2196 children with acute diarrhea and 496 healthy children were collected in a community setting. Intestinal parasites were diagnosed by microscopy and bacteria by culturing methods. Rota-, astro and adenoviruses were identified using commercially available ELISA kits and rotaviruses were confirmed using reverse transcriptase polymerase chain reaction (RT-PCR). Intestinal microorganisms were isolated from 54.6% of diarrheal patients and 45.9% of healthy subjects (p = <0.01). The most common pathogens in diarrheic patients were intestinal parasites (36.5%). Campylobacter spp. and Rotavirus were detected in 9.7% and 6.7% of diarrheic patients. The detection rates of Entamoeba histolytica, Trichomonas intestinalis and Giardia lamblia were much greater in diarrheal patients than in non diarrheal subjects (odds ratios of 5.1, 3.2, 1.7 respectively). The abundance of other enteropathogens among the non diarrheal group may indicate prolonged excretion or limited pathogenicity. In developing countries, where the lack of laboratory capacities is great, cross sectional studies of enteropathogens and their spatial distribution, including diarrheal and non diarrheal subjects, are interesting tools in order to advise regional policies on treatment and diarrheic patient management.

Background. An epidemic of Mycoplasma pneumoniae infection has been observed in France since the fall of 2023. We aimed to: i) describe the characteristics of adults hospitalized for M. pneumoniae infection and ii) identify factors associated with severe outcomes of infection (i.e., intensive care unit [ICU)] admission or in-hospital death). Methods. MYCADO is a retrospective observational study including adults hospitalized for ≥24 hours in 76 French hospitals for a M. pneumoniae infection between 1 September 2023 and 29 February 2024. Clinical, laboratory and imaging data were collected from medical records.We identified factors associated with severe outcomes of infection, defined as need for ICU or in-hospital death, using multivariable logistic regression.Findings. Overall, 1309 patients with M. pneumoniae infection were included: 718 (54.9%) males; median age 43 years (IQR 31-63); 288 (22.0%) with chronic respiratory failure; 423 (32.3%) with cardiovascular comorbidities; 95 (7.3%) with immunosuppression. The most common symptoms were: cough (n=1098, 83.9%), fever (n=1023, 78.2%), dyspnoea (n=948, 72.4%), fatigue (n=550, 42.0%), headache (n=211, 16.1%), arthromyalgia (n=253, 19.3%), vomiting (n=132, 10.1%); 156 (11.9%) patients had extra-respiratory manifestations, including 36 (2.8%) erythema multiforme, 19 (1.5%) meningoencephalitis, 44 (3.4%) autoimmune haemolytic anaemia and 17 (1.3%) myocarditis. The median hospital stay duration was 8 days (IQR 6-11); 415 (31.7%) patients were admitted to ICU and 28 (2.1%) died at hospital. Men, patients with hypertension, obesity, respiratory or liver chronic failure, extra-respiratory manifestations, bilateral lung damage or consolidation on computed tomography scan, elevated inflammatory syndrome, lymphopenia, and those who did not receive any active antibiotic against M. pneumoniae prior to admission, were more likely to present with severe outcomes of infection.Interpretation. This national, observational study highlights unexpected, atypical radiologic presentations, a high proportion of transfers to ICU, and an association between severity and delayed administration of effective antibiotics.

Background Pulmonary infections, ranging from mild respiratory issues to severe multiorgan failure, pose a major global health threat. The immune response in community-acquired pneumonia (CAP) and COVID-19 influences disease severity and outcomes, but molecular pathogenesis differs across pathogens. Comparisons of plasma cytokine profiles between CAP and COVID-19 are limited. Analyzing these profiles with machine learning and bioinformatics could reveal subtle patterns and improve our understanding of immune responses in both conditions. Methods We conducted a novel case–control study to profile cytokine levels in patients with CAP and COVID-19. Age- and sex-matched cohorts included 39 patients with CAP, 39 with COVID-19, and 20 healthy controls. We measured 384 plasma cytokine levels using proximity extension assays and analyzed differences between cohorts with conventional statistical methods, bioinformatics and machine learning. Results Median ages of the cohorts were comparable ( P  = 0.797). COVID-19 patients exhibited a higher prevalence of hematologic disease ( P  = 0.047), increased corticosteroid use ( P  = 0.040), and reduced antibiotic use ( P  = 0.012). Clinical outcomes, including mortality, ICU admission, invasive mechanical ventilation, renal replacement therapy, acute respiratory distress syndrome, and acute kidney injury, were similar between groups. Both cohorts showed comparable absolute circulating cytokine profiles but distinct profiles relative to healthy controls. Machine learning identified a model of twelve cytokines that distinguished CAP from COVID-19 with a classification accuracy of 0.71 (SD 0.20). Gene ontology and enrichment analysis revealed differences in cytosolic and nuclear functions, intracellular signaling, stress responses, and cell cycle processes between patient cohorts and healthy controls. Enriched GO pathways showed that CAP pathways were positively associated with leukocyte counts and ARDS development, while COVID-19 pathways were negatively associated with ARDS and positively with platelet counts. Conclusions This case–control study provides insights into cytokine profiles related to CAP and COVID-19 pathogenesis. Although absolute circulating cytokine levels showed no significant differences between the groups, machine learning identified a model of twelve proteins that effectively distinguished the cohorts. Gene ontology and enrichment analyses also revealed distinct dysregulated pathways with differing associations with clinical variables in each cohort. These findings underscore the complexity and variability of cytokine responses in pulmonary infections.

Multiple mononeuropathy (MM) occurs rarely during systemic lupus erythematosus (SLE) but may lead to major disability. The aim of this study was to investigate the clinic-pathological presentations of MM during SLE, as well as long-term outcomes. We conducted a multicentric retrospective study that included patients receiving a diagnosis of MM during SLE. Ten patients were included (8 women and 2 men, median age at MM diagnosis: 40.4 years). SLE was diagnosed before MM in 9/10 patients (median time 8.2 years). When MM occurred, the SLEDAI score was ≥6 for 6/9 patients. Presenting symptoms consisted of sensory deficits ( n  = 10), neuropathic pain ( n  = 9), and/or motor deficits ( n  = 9), sometimes symmetrical, affecting the lower limbs (10/10) and occasionally the upper limbs (5/10). All patients presented with uni- or bilateral damage of the common fibular nerve, with less frequent involvement of the tibial nerve. Serum cryoglobulinemia was positive in 5/9 patients. Electrophysiological studies confirmed the non-symmetrical involvement of multiple nerve trunks in all patients. Neuromuscular biopsy (performed in five patients) showed histological signs of vasculitis in two patients and perivascular lymphocytic inflammatory infiltrates in two others. All patients were treated with glucocorticosteroids combined with cyclophosphamide ( n  = 6), rituximab ( n  = 3), or mycophénolate-mofétil ( n  = 1). The median follow-up was 5 years. Two patients relapsed during follow-up. All patients had motor and/or sensory sequelae upon follow-up. MM associated with SLE is frequently caused by a vasculitis mechanism. Patients improve with steroids and immunosuppressive drugs. Long-term outcomes include frequent clinical sequelae and possible relapses.

Background Pneumocystis jirovecii pneumonia (PjP) is a rising cause of acute respiratory failure in immunocompromised patients, often requiring Intensive Care Unit (ICU) admission. However, optimal ventilatory strategies remain unclear. Methods For the present study, we conducted an ancillary analysis of the PRONOCYSTIS study, a large multicenter cohort of PjP patients. Patients admitted to the ICUs were compared according to initial respiratory management (High-Flow Nasal Cannula (HFNC), standard Oxygen (SO) or Non-Invasive Ventilation (NIV). A propensity score adjustment [inverse probability of treatment weighting (IPTW) analysis] was implemented to account for potential confounders. The primary outcome was intubation rate. Univariable and multivariable Cox regressions were also used to assess variables associated with survival. Results Over the study period, 248 patients with PjP were included in the present analysis. Of those, 70 were treated by HFNC while 118 and 60 received SO and NIV, respectively. HFNC patients had a decreased intubation rate (28.6% versus 45.0% in NIV and 55.4% in SO patients; p = 0.003). When assessing the impact of respiratory management on intubation by IPTW, HFNC remained an independent protective factor (weighted Hazard Ratio (HR) 0.41 (95% CI 0.24–0.69); p < 0.001). While, NIV was not associated with intubation (HR 0.62 (95% CI 0.37–1.02); p = 0.056). Through adjusted survival analysis, long-term corticosteroids treatment (aHR 4.03 (95% CI 2.01–8.08); p < 0.001), Solid tumor (aHR 3.37 (95% CI 1.45–7.86); p = 0.005) and the Sequential Organ Failure Assessment score (aHR 1.24 (95% CI 1.15–1.35); p < 0.001) were found to be independent predictor for death. Initial respiratory support was not associated with survival either in the Cox multivariable analysis or in the IPTW analysis. Conclusion Through this multicenter observational study of severe PjP patients, although oxygenation strategy was not associated with D90 survival, HFNC support appeared to be associated with a lower intubation rate. Further prospective studies are warranted to refine respiratory management in critically ill PjP patients.

Background Monoclonal gammopathy-associated capillary leak syndrome (MG-CLS) is a rare condition characterized by recurrent episodes of hypovolemic shock caused by a sudden increase in capillary permeability. The COVID-19 pandemic has been associated with a rise in MG-CLS episodes and increased mortality. We aimed to explore the association between MG-CLS and SARS-CoV-2 infection. We conducted a multicenter retrospective observational study involving MG-CLS patients who were admitted to the intensive care unit (ICU). The primary endpoint was 28-day mortality according to whether SARS-CoV-2 was identified as a trigger. Results The study included 84 patients (44% women) with a median age of 55 years [IQR 46–62], accounting for 127 ICU admissions. Most patients (88%) had monoclonal gammopathy, predominantly with an IgG heavy chain (98%). A trigger was identified in 63% of cases, primarily suspected or confirmed viral infections, including 26 episodes of SARS-CoV-2 infection. Within 28 days of ICU admission, 32% of patients died. Episodes triggered by SARS-CoV-2 were associated with a higher need for mechanical ventilation (69% vs. 38%, p = 0.004), renal replacement therapy (54% vs. 31%, p = 0.03), and increased 28-day mortality (42% vs. 17%, p = 0.005). Multivariable analysis revealed that SARS-CoV-2 infection was independently associated with 28-day mortality (OR 4.67 [1.08–20.1], p = 0.04). The use of intravenous immunoglobulins did not improve 28-day survival. Conclusion In this large cohort of MG-CLS episodes requiring ICU admission, SARS-CoV-2as a trigger was associated with significantly higher 28-day mortality compared to other triggers. Further research is essential to elucidate the specific mechanisms by which SARS-CoV-2 impacts MG-CLS patients. Graphical abstract