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L’infection tuberculeuse latente (ITL) récente chez les sujets contact

Le dépistage de l’infection tuberculeuse latente (ITL) chez les sujets contact de cas de tuberculose maladie devrait se faire dans l’intention de traiter. Or seules les ITL récentes, c’est-à-dire attribuables au contage, nécessitent un traitement préventif chez les adultes immunocompétents ; or aucun test actuel ne permet de dater une ITL. L’objectif de cette étude rétrospective avec utilisation du test QuantiFERON®-TB-Gold In-Tube (QFT) est d’évaluer la probabilité d’une ITL récente chez les sujets contact familiaux et professionnels, après comparaison des taux spécifiques d’ITL en fonction du type de contact. Parmi les 2424 sujets inclus, 407 (17 %) tests étaient positifs ; 129 (28 %) au sein du milieu familial, 69 (19 %) au sein du milieu amical, 153 (14 %) dans l’entourage professionnel et 56 (10 %) au sein du milieu scolaire (respectivement, OR=0,69 et p =0,04, OR=0,49 et p <0,001 et OR=0,51 et p <0,001). Après comparaison avec un taux basal d’ITL, pour les sujets contact professionnels et familiaux âgés de moins de 40ans nés dans un pays d’incidence inférieure à 20, le taux d’ITL récente est respectivement compris entre 15 et 40 % et entre 68 et 80 %. Pour ceux nés dans un pays d’incidence supérieure à 20, nous évaluons le pourcentage d’ITL récente entre 6 et 18 % pour les sujets contact professionnels et entre 43 à 50 % pour les familiaux. Ces résultats, bien qu’approximatifs et spécifiques de Paris, revêtent une importance tant pour le clinicien qui doit décider de la mise en route d’un traitement préventif que pour le médecin de santé publique qui doit définir un groupe de sujets contact. Enfin, pour limiter les différences de proportion d’ITL récente, il faudrait probablement préciser des seuils de temps de contact cumulé en fonction du type de contact avant qu’un individu soit considéré comme sujet contact.

Screening for latent tuberculous infection (LTBI) in contacts of identified cases of tuberculosis should be based on intention to treat. We know that only LTBI that is attributable to a recent transmission requires preventive treatment in immunocompetent adults. There is no current test that allows accurate dating of LTBI. The objective of this retrospective study with QuantiFERON-TB-Gold In-Tube (QFT) is to estimate the probability of recent LTBI in various groups of contacts. Among 2424 subjects included, 407 (17%) tests were positive; 129 (28%) within the family circle, 69 (19%) within the social environment, 153 (14%) among professional acquaintances and 56 (10%) within the school environment (respectively: OR=0.69 and P =0.04; OR=0.49 and P <0.001; OR=0.51 and P <0.001). After comparison with a basal rate of LTBI, professional and family contacts less than 40 years old, born in a country of incidence lower than 20, had a rate of recent LTBI between 15 and 40% and between 68 and 80%, respectively. For those born in a country of incidence greater than 20, we estimate the rate of recent LTBI between 6 and 18% for professional contacts and between 43 and 50% for family contacts. These results, although approximate and specific to Paris, are important for the clinician who has to decide on preventive treatment and for the public health specialist who has to identify groups of contacts. Finally, to limit the differences in rates of recent LTBI, it would probably be necessary to specify thresholds of accumulated contact time, according to the type of contact, before considering an individual as a contact.

Bronchopulmonary dysplasia: then and now.

When bronchopulmonary dysplasia (BPD) was first described in 1967, the use of assisted ventilation in neonates was in its infancy. High concentrations of oxygen were implicated, and BPD was equated with 'pulmonary oxygen toxicity'.

The etiologic role of not only oxygen but also peak inspiratory pressures and the duration of exposure to both was emphasized in the 1970s, but BPD remained a dreaded complication of managing respiratory distress syndrome in the 1980s. It was only after exogenous surfactant became commercially available for endotracheal administration that 'classical' BPD began to disappear and was replaced by the 'new' BPD. 'Classical' BPD was seen in more mature preterm infants (>28 weeks' gestational age) and in its severe form was chara...

Vibration response imaging: a novel noninvasive tool for evaluating the initial therapeutic effect of noninvasive positive pressure ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease

Conclusions VRI is a promising noninvasive tool for evaluating the initial therapeutic effects of NPPV in AECOPD patients and predicting the success of NPPV in the early stage.

Rapid Detection and Monitoring Therapeutic Efficacy of Mycobacterium tuberculosis Complex Using a Novel Real-Time Assay.

We combined real-time RT-PCR and real-time PCR (R/P) assays using a hydrolysis probe to detect Mycobacterium tuberculosis complex (MTBC)-specific 16S rRNA and its rRNA gene (rDNA).

The assay was applied to 28 nonrespiratory and 207 respiratory specimens from 218 patients. Total nucleic acids (including RNA and DNA) were extracted from samples, and results were considered positive if the repeat RT-PCR threshold cycle was < or =35 and the ratio of real-time RT-PCR and real-time PCR load was > or =1.51. The results were compared with those from existing methods, including smear, culture, and real-time PCR. Following resolution of the discrepant results between R/P assay and culture...

Inhalation Therapy in Patients Receiving Mechanical Ventilation: An Update

Journal of Aerosol Medicine and Pulmonary Drug Delivery

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