Rickettsia mongolitimonae Encephalitis, Southern France, 2018

The COVID-19 pandemic and associated lockdown measures have been associated with substantial disruptions to health care services, including screening for human immunodeficiency virus (HIV) and management of people living with HIV (PLWH). Data from 3265 patients were examined in a retrospective cohort study. We compared outpatient follow-up for PLWH, the number of new patients, treatment adherence, hospitalizations, and deaths during the “pandemic period” (March 2020 to February 2021), the “pre-pandemic period” (the equivalent time frame in 2019), and the “post-pandemic period” (March to September 2021). During the pandemic period, the number of new patients seen at the HIV clinic (116) as well as the requested viral load tests (2414) decreased significantly compared to the pre-pandemic (204 and 2831, respectively) and post-pandemic periods (146 and 2640, respectively) (p < 0.01 for all the comparisons). However, across the three study periods, the number of drug refills (1385, 1330, and 1411, respectively), the number of patients with undetectable viral loads (85%, 90%, and 93%, respectively), and the number of hospital admissions among PLWH remained constant. Despite the COVID-19 pandemic’s impact, our findings show stability in the retention of clinical care, adherence to treatment, and viral suppression of PLWH, with no significant impact on hospitalization rates or all-cause mortality.

Background: In non-endemic countries, malaria can be transmitted through blood donations from imported cases. To ensure standards of quality and safety of human blood, the European Union and Spanish national law, requires a deferral period, or a screening by immunological or genomic test among those donors with potential risk of malaria. Scientific societies, European Committee on Blood Transfusion, and Spanish Society of Haematology and Haemotherapy, refer only to the result of the immunological test. Methods: An observational retrospective study was performed in potential donors with a positive immunological test for malaria done in the Regional Transfusion Center in Madrid and referred to the National Reference Unit for Tropical Diseases in Madrid between 2015–2020. At consultation a Polymerase Chain Reaction (PCR) for malaria was performed. Results: During the study period, 121 possible donors attended for consultation at NRU-Trop. Median age: 38.5 (IQR:33–48); median time to consultation was 32 months (IQR:12.5–110). Eighty-two (67.8%) donors were migrants and thirty-nine were travellers (32.2%). ELISA values were available for 109 subjects (90.1%), 56 individual left malaria endemic area > 3 years before. All donors tested negative for Plasmodium spp PCR test (n = 121, 100%). Conclusions: None of the subjects with a positive immunologic test deferred as blood donors had a positive genomic test. The presence of Plasmodium spp in collected blood was not detected by molecular techniques. To avoid the loss of potential blood donors, especially those with low incidence red blood cell antigens, as more precise microbiology techniques become available, updating the existing legislation becomes necessary to increase the availability of donated blood.

Altered lipid profiles have been observed in acute malaria, though mechanisms remain unclear. The impact of asymptomatic submicroscopic malaria infection (AMI) on lipids is unexploredAn observational, comparative, retrospective study was conducted of 1278 asymptomatic Sub-Saharan African migrants (ASSAMs) screened for malaria and lipid profiles during health exams (2010–2022). A systematic screening protocol for infectious disease was performed, including screening for Plasmodium spp. infection by polymerase chain reaction (PCR).Among 800 ASSAMs screened for malaria, 104 (13%) were PCR-positive: P. falciparum (68.72%), P. malariae (18.27%), P. ovale (9.62%), and mixed infections (3.8%). Participants with AMIs exhibited lower baseline lipid levels: total cholesterol (146 vs. 163 mg/dL; p < 0.001), HDL (43 vs. 47 mg/dL; p < 0.001), and LDL (87.5 vs. 98 mg/dL; p < 0.001), with no differences in triglycerides. After treatment, lipid levels partially equalized: total cholesterol (156 vs. 166; p = 0.01), HDL (44 vs. 47.5; p = 0.05), LDL (102 vs. 108.5; p = 0.31), with no changes in triglycerides. Patients with AMI showed higher rates of co-infections (Strongyloides 20.61% vs. 14.35%; p < 0.001; filariae 7.69% vs. 1.91%; p = 0.02) and lower mean corpuscular volume (87.2 vs. 85; p < 0.001). Conclusions: These findings suggest that cholesterol reductions in AMI are not solely due to acute inflammation but may reflect chronic inflammatory processes triggered by asymptomatic malaria. This supports a potential link between AMI and lipid profile changes, underscoring its role in subclinical chronic inflammation.

Clostridioides difficile infection (CDI) occurs in various contexts and care settings and is managed by multiple specialists who are not experts in its management. While there are many initiatives to improve the diagnosis and avoid overdiagnosis, there is less focus on the overall management of the infection. We studied a cohort of patients with a positive test result for toxigenic C difficile in 2 hospitals. Hospital A has a program that provides advice from an infectious disease specialist (IDS) and promotes continuity of care by providing a phone number to contact the IDS. Hospital B does not have any specific CDI program. The evaluation assessed the proportion of patients not treated (carriers or self-limited disease), adherence to Infectious Diseases Society of America guidelines, access to novel therapies, recurrence and mortality rates, and readmission and emergency department visits due to CDI. We assessed the program's effectiveness through a logistic regression model adjusted for covariates chosen by clinical criteria. Hospital A avoided more unnecessary treatments (19.3% vs 11.5%), provided access to novel therapies more frequently (35.3% vs 13%), and adhered more closely to current guidelines (95.8% vs 71.3%). Although the mortality and recurrence rates did not differ, the absence of an intervention program was associated with greater odds of admission due to recurrence (odds ratio, 4.19; P = .037) and more visits to the emergency department due to CDI (odds ratio, 8.74; P = .001). Implementation of a CDI intervention program based on recommendations from IDSs and improved access to specialized care during the follow-up is associated with enhanced quality of CDI management and potential reductions in hospital resource utilization.