D. Bitar

Increasing Incidence of Zygomycosis (Mucormycosis), France, 1997–2006

Results were derived from a population-based study using hospital discharge data.

A Global Analysis of Mucormycosis in France: The RetroZygo Study (2005–2007)

BACKGROUND Mucormycosis is a deadly invasive fungal infection whose characteristics are only partially understood. METHODS Data on mucormycosis obtained in France between 2005 and 2007 from 2 notification systems were merged. The 2008 European Organisation for Research and Treatment of Cancer/Mycoses Study Group definition criteria were applied and risk factors for death were analyzed by hazard ratios (HRs) calculated from the Cox proportional hazards regression model. RESULTS A total of 101 cases (60 proven, 41 probable), mostly in men (58%) >50 years (mean age, 50.7 ± 19.9) were recorded. Hematological malignancies represented 50% (median time for occurrence, 8.8 months after disease onset), diabetes 23%, and trauma 18% of cases. Sites of infection were lungs (28%; 79% in hematology patients), rhinocerebral (25%; 64% in diabetic patients), skin (20%), and disseminated (18%). Median time between first symptoms and diagnosis was 2 weeks. The main fungal species were Rhizopus oryzae (32%) and Lichtheimia species (29%). In cases where the causative species was identified, R. oryzae was present in 85% of rhinocerebral forms compared with only 17% of nonrhinocerebral forms (P < .001). Treatment consisted of surgery in 59% and antifungals in 87% of cases (liposomal amphotericin B in 61%). Ninety-day survival was 56%; it was reduced in cases of dissemination compared with rhinocerebral (HR, 5.38 [2.0-14.1]; P < .001), pulmonary (HR, 2.2 [1.0-4.7]; P = .04), or skin localization (HR, 5.73 [1.9-17.5]; P = .002); survival was reduced in cases of hematological malignancies compared with diabetes mellitus (HR, 2.3 [1.0-5.2]; P < .05) or trauma (HR, 6.9 [1.6-28.6], P = .008) and if ≥2 underlying conditions (HR, 5.9 [1.8-19.0]; P = .004). Mucormycosis localization remained the only independent factor associated with survival. CONCLUSIONS This 3-year study performed in one country shows the diverse clinical presentation of mucormycosis with a high prevalence of primary skin infection following trauma and a prognosis significantly influenced by localization.

Population-Based Analysis of Invasive Fungal Infections, France, 2001–2010

These infections are underrecognized as a cause of death in the general population and high-risk groups.

Introduction of SARS in France, March–April, 2003

We describe severe acute respiratory syndrome (SARS) in France. Patients meeting the World Health Organization definition of a suspected case underwent a clinical, radiologic, and biologic assessment at the closest university-affiliated infectious disease ward. Suspected cases were immediately reported to the Institut de Veille Sanitaire. Probable case-patients were isolated, their contacts quarantined at home, and were followed for 10 days after exposure. Five probable cases occurred from March through April 2003; four were confirmed as SARS coronavirus by reverse transcription–polymerase chain reaction, serologic testing, or both. The index case-patient (patient A), who had worked in the French hospital of Hanoi, Vietnam, was the most probable source of transmission for the three other confirmed cases; two had been exposed to patient A while on the Hanoi-Paris flight of March 22–23. Timely detection, isolation of probable cases, and quarantine of their contacts appear to have been effective in preventing the secondary spread of SARS in France.

Estimating the burden of mucormycosis infections in France (2005–2007) through a capture-recapture method on laboratory and administrative data

BACKGROUND Mucormycoses are rare but severe fungal infections whose incidence is increasing, particularly in immunosuppressed and diabetic patients. Following a retrospective study on the characteristics and outcomes of cases who were identified through two sources of information, we carried out a capture-recapture method to estimate the actual burden of the disease in France, 2005-2007. METHODS An administrative dataset from the national hospital discharge system and a laboratory dataset from the National Reference Centre for Mycoses and Antifungals were combined to identify patients from 2005 to 2007. We applied capture-recapture equations to estimate the number of cases missed by both sources and to assess the advantages of each dataset, especially in terms of sensitivity. RESULTS There were 94 mucormycosis cases included in the study: 30 and 31 in each respective source and 33 common to both. Capture-recapture showed that 28 cases were missed (expected total: 122 cases, CI95: 102-142). Each dataset had a sensitivity value below 53%. The merged set yielded a 77% sensitivity (66%-92%). CONCLUSION This study highlights the importance of combining available sources when analysing rare infectious diseases. The proportion of 23% missed cases might seem acceptable given the scarcity of the disease, for which further knowledge is needed. However this proportion could decrease in the future, through the sensitization of clinicians, pathologists and mycologists together with the improving quality of discharge datasets.

Prevalences of scabies and pediculosis corporis among homeless people in the Paris region: results from two randomized cross-sectional surveys (HYTPEAC study).

Dermatological infections constitute the most common health problem in the homeless population.

Épidémiologie de la tuberculose en France

Tuberculosis causes an ever-increasing public health burden throughout the world and is one of the World Health Organizations top priorities. In France, the incidence of tuberculosis has been stable at around 10 cases per 100 000 inhabitants per year since 1997. In 2004, the incidence rate in 2004 was 9.2 per 100 000, with substantial geographic disparities: the Ile-de-France region (including Paris and its suburbs) accounted for more than 40% of all reported cases (20.8 per 100 000). Incidence rates of tuberculosis vary according to the geographic origin: in France, this rate is highest among people from sub-Saharan Africa (incidence rate: 166.7 per 100.000 compared with 5.0 per 100.000 for those born in France). Pulmonary tuberculosis is the disease form most commonly observed (71.5% of cases). Among those cases, 76.9% were laboratory-confirmed in 2004. National guidelines to improve case management and disease control were updated in 2003 and 2005. Funding must be made available to reinforce tuberculosis surveillance and to conduct public health initiatives targeted at the populations most at risk.

COL6-01 Thème : Infections nosocomiales et fongiques Augmentation de l’incidence des zygomycoses en France métropolitaine, 1997 - 2006

Introduction La frequence des zygomycoses semble augmenter, notamment parmi les personnes immunodeprimees. Nous voulions estimer l’incidence des zygomycoses dans la population francaise en decrivant les caracteristiques cliniques et epidemiologiques de cette infection fongique grave. Methodes Les nouvelles admissions liees a une zygomycose en France metropolitaine entre 1997 et 2006, extraites de la base de donnees anonymisee du PMSI, ont ete analysees selon l’annee d’hospitalisation, l’âge, le sexe, le departement de residence des patients, les formes cliniques de la maladie et les pathologies associees. Resultats 547 cas de zygomycoses (289 hommes et 258 femmes) etaient identifies. L’âge moyen etait de 54,8 ans (0 a 96 ans). Le taux d’incidence annuel moyen atteignait 0,9 cas par million de personnes et augmentait avec l’âge : 0,2/10 6 chez les moins de 15 ans vs 2,5/10 6 chez les 65 ans et plus. L’incidence annuelle augmentait au cours du temps : de 0,7 cas/10 6 en 1997 a 1,2 cas/10 6 en 2006. Les formes invasives (pulmonaires, rhinocerebrales ou disseminees) etaient les plus frequemment rapportees (37 %), suivies des formes cutanees ou gastro-intestinales (34 %). La localisation n’etait pas precisee pour 29 % des cas. Les pathologies associees incluaient notamment une immunosuppression (20 %) ou un diabete (19 %). Conclusion Les donnees de surveillance passive a travers le PMSI permettent de mieux documenter les tendances. Elles montrent une augmentation reguliere de l’incidence des zygomycoses en France. Toutefois les caracteristiques clinico-epidemiologiques, mycologiques et therapeutiques de la maladie necessitent des analyses complementaires. Une etude retrospective plus approfondie va etre menee dans ce but, a partir des dossiers medicaux des patients identifies par le PMSI et le CNRMA.