The Department of Internal Medicine and Infectious Diseases at Cliniques universitaires Saint-Luc deals with pathologies that affect the whole body system, one of its priorities being to raise awareness and promote disease prevention. In this issue, we have tackled two very different themes, both of which having been the focus of ongoing innovation and discovery in recent years. These topics include on one hand the diagnosis of inborn errors of immunity in adults, which is a scarcely-known clinical entity within the medical world, though less rare than we would think. On the other hand figures the prevention of sexually transmitted infections, which is both a medical and societal concern
Belgium is facing an outbreak of Monkeypox virus. This illness was until now only endemic in West and Central Africa. Since May 2022, an exponential growth of new cases has been recorded in Europe. The clinical presentation is an influenza-like illness followed by a varioliform rash. Most patients will have mild to moderate symptoms but immunocompromised people, children and pregnant women can develop a severe illness. Mortality is low (3-10%) depending on the viral strain. The virus is transmitted mainly by prolonged skin contact and to a lesser extent by air (droplets). It is essential to implement preventive measures now (rapid screening, isolation of confirmed cases and high-risk contacts, public awareness) in order to contain this outbreak. A live attenuated vaccine (Imvanex®), currently not very available, could be used for post-exposure prophylaxis of contact cases and to a greater extent, for pre-exposure prevention. Antiviral treatments (Brincidofovir and Tecorivimat) will also be available in the near future.
Antibiotic resistance (ABR) is a phenomenon described since the discovery of the first antibiotics. In the euphoria of the golden age of antibiotics, this central problem remained hidden for a long time. Today, ABR is one of the central public health issues of the 21st century. Indeed, available projections estimate that by 2050, overall 10 million people could die each year from the consequences of ABR. In light of these figures, understanding the complexity of its determinants, as well as the delay in the fight against RBA appears crucial. ABR is a global problem, and it is intrinsically a geopolitical issue at the heart of the major challenges of our time. Understanding it from this perspective would enable us to better control this phenomenon. Antibiotics occupy a unique place among anti-infectives. They are indeed societal drugs that play a very special role in our therapeutic arsenal. Along with vaccination and the development of hygiene, antibiotics constitute one of the cornerstones of modern medicine. Without antibiotics, complex surgery is impossible, as are solid organ transplants, resuscitation, and treatment of oncological patients. What is more, prescribing antibiotics is the responsibility of all doctors, whatever their field of practice, and it may at times be the responsibility of non-physicians. Owing to its ubiquitous nature, the treatment of ABR should be a central concern. This article sought to cover ABR by analyzing both its determinants and the response lines that are emerging.
Halil Yildiz, Lucie Pothen, Chantal Lefebvre, Julien De Greef, Leila Belkhir, Anne Vincent, Fabien Roodhans, Jean-Luc Balligand, Jean Cyr Yombi, Philippe HainautPublished in the journal : February 2022Category : Médecine interne et maladies infectieuses
The so-called “general” internal medicine is a specialty that takes care of patients with multiple diseases or complex pathologies. The internist is therefore an unavoidable actor in management of hospitalized patients, while being a privileged contact for general practitioners.
In general, internists are in charge of treating various pathologies, including inflammatory diseases, auto-immunes diseases, or vascular diseases. They are also major actors in polyadenopathy diagnosis, treatment of thromboembolic diseases, diagnosis of neoplasias of undetermined origin, diagnosis and treatment of sarcoidosis or vasculitis, as well as diagnosis of fever and inflammatory syndromes of unknown origin. Their expertise is primarily based on diagnosis (with eventually referring the patients to other specialties, such as oncologist, inflammatory bowel disease specialist, or hematologist) and treatment of various affections. Another aspect of this specialty consists of diagnosis and management of infectious diseases, including acquired immuno-deficiency syndrome, tuberculosis, tropical fever, as well as COVID-19.
We wish to share this multifaceted aspect of our specialty means of presenting several 2021 therapeutic innovations.
J. De Greef, L. Pothen, H. Yildiz,W. Poncin, G. Reychler, S. Brilot, S. Demartin, E. Lagneaux, R. Lattenist, J. Lux,G. Pierman, G. Vandercam, S. Wallemacq, A. Scohy , A. Verroken, B. Mwenge, G. Liistro, A. Froidure, C. Pilette, L. Belkhir, J-C. YombiPublished in the journal : May 2020Category : Médecine interne et maladies infectieuses
The world is facing a serious pandemic. The disease called COVID-19 is caused by a new coronavirus, SARS-CoV-2, which started to spread in China in December 2019. COVID-19 is a condition that may be particularly serious and even fatal in elderly people, as well as in patients with comorbidities such as high blood pressure, cardiovascular diseases, chronic obstructive pulmonary disease, diabetes, chronic kidney disease, and cancer. The clinical presentation is mild in approximately 80% of cases, moderate to severe in 15% of cases, and critical in 5% of cases. The most common symptoms of COVID-19 are fever, fatigue, muscle aches, and dry cough. Some patients may exhibit nasal congestion, chills, sore throat, or diarrhea. Severely ill patients can develop an acute respiratory distress syndrome (ARDS), shock, thrombosis, and multiple organ failure, and they are at risk of death. COVID-19 patients with ARDS have a poor prognosis, with an estimated mortality rate of more than 10%. SARS-CoV-2 is primarily transmitted through respiratory droplets. Airway and hand hygiene is therefore essential. The diagnosis is made by reverse transcription-polymerase chain reaction on a nasopharyngeal or oropharyngeal swab and, in suggestive cases, by chest computed tomography, which has a high sensitivity. There is currently no effective specific treatment for COVID-19. Many molecules have been tried or are under investigation. The treatment currently remains supportive.
