Background SARS-CoV-2 is the cause of a current pandemic worldwide. This virus can reach all organs, and disturbs the immune system leading to a cytokine storm in severe forms. We aimed to report cutaneous features among COVID-19 hospitalized patients. Methods We performed a cross-sectional study on one given day among all patients hospitalized in acute care for COVID-19 and included all patients with cutaneous features. Follow-up 48 hours later was obtained. Results Among 59 adult patients hospitalized on the day of the study, in an infectious diseases ward for SARS-CoV-2 infection, confirmed by molecular assay and/or radiological findings (CT scan), 40 were included. Several cutaneous manifestations were found: macular exanthema (80%), face edema (32%), livedo (13%), urticarial rash (8%), purpura (5%), oral lichenoid lesions (33%) and conjunctivitis (18%). Cutaneous biopsy was performed in 17 patients. Histological findings showed mast cell hyperplasia (100%), superficial perivascular infiltrate of lymphocytes (94%) and superficial edema (47%) consistent with capillary leak. Conclusions Various dermatological signs can be encountered during COVID-19. A macular rash was the most frequent. All cutaneous features could be related to a vascular leak process.

Highlights: COVID toes can be encountered in young individuals during acute COVID-19 infection while it results from the direct action of Spike protein on vessels. We report the case of COVID toes during the French campaign of vaccination that occurred 4 days after the vaccination with the Pfizer-BioNTech mRNA vaccine against COVID-19.

Introduction Keratoacanthomas (KA) are common cutaneous skin tumors originating from the hair follicles. Unlike squamous cell carcinoma, KA can regress spontaneously and have a benign evolution. Solitary KA is the most common form but familial multiple KA (Ferguson–Smith type), genetically predisposed KA (such as in xeroderma pigmentosum, or Muir–Torre syndrome), or sporadic multiple eruptive KA (Grzybowski type) have been described. Generalized eruptive KA of Grzybowski (GEKA) is a rare condition (around 40 reported cases). The pathophysiology is still unclear. Human papillomavirus (HPV) has been detected in sporadic KA but the presence of HPV39 has never been reported, to our knowledge, in GEKA. Case Report GEKA in an 80-year-old woman was successfully treated with acitretin (0.5 mg/kg/day) combined with surgical removal of the largest lesions. Treatment was well tolerated and led to decreased pruritus and tumor regression within 6 months. The presence of HPV39 was detected in a lesion by polymerase chain reaction and Sanger sequencing. No genetic alteration was found, in particular in the genes usually altered in squamous cell carcinoma (including NOTCH1 , NOTCH2 , CDKN2A , TP53 ). Conclusion We report a case of GEKA associated with the presence of HPV39 and the successful use of acitretin combined with surgical removal of the larger lesions.

Introduction Better understanding how hospital staff members (HSMs), including HCWs, were contaminated by SARS-CoV-2 during the first wave can help refining the control measures, in the context of the current second wave in Europe. Methods From March 5 th to May 10 th 2020, the infectious diseases unit at Raymond-Poincaré teaching Hospital opened a weekday consultation dedicated to HSMs for a PCR testing. While in the waiting room, HSMs were offered to complete a questionnaire on their potential risk exposure to SARS-CoV-2. Results Of the 200 HSMs screened, 70 were positive. Ninety-nine HSMs (including 86 HCWs) completed the questionnaire of whom 28 cases positive. In the multivariable analysis among healthcare workers, age ≥ 44 years-old (aOR = 5.2, 95%CI [1.4-22.5]), not using a facemask systematically when caring for a patient (aOR = 13.9, 95%CI [1.8-293.0]), were significantly associated with SARS-CoV-2 infection. Conversely, working in a ward dedicated to COVID-19 patients (aOR = 0.7, 95%CI [0.2-3.2]) was not significantly associated with SARS-CoV-2 infection. Regarding community related exposures occurring in and outside the hospital among the HSMs, participation to meetings inside the hospital without wearing a facemask (aOR = 21.3, 95%CI [4.5-143.9]) and participation to private gathering (aOR = 10, 95%CI [1.3-91.0]) were significantly associated with SARS-CoV-2 infection. Conclusions Our results support the effectiveness of barrier precautions, underline that in-hospital contaminations not related to patient care may occur, and that part of the contaminations may be related to exposures in the community. Better protecting HCWs against COVID-19 and thereby ensuring workforces is crucial to fight the current second wave of the epidemic.

BackgroundInfections caused by multidrug-resistant organisms (MDRO) are emerging worldwide. Physicians are increasingly faced with the question of whether patients need empiric antibiotic treatment covering these pathogens. This question is especially essential among MDRO carriers. We aim to determine the occurrence of MDRO bacteraemia among bacteraemic patients colonized with MDRO, and the associated factors with MDRO bacteraemia among this population.MethodsWe performed a retrospective monocentric study among MDRO carriers hospitalized with bacteraemia between January 2013 and August 2016 in a French hospital. We compared characteristics of patients with MDRO and non-MDRO bacteraemia.ResultsOverall, 368 episodes of bacteraemia were reviewed; 98/368 (26.6%) occurred among MDRO carriers.Main colonizing bacteria were extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (40/98; 40.8%), ESBL-producing Klebsiella pneumoniae (35/98; 35.7%); methicillin-resistant Staphylococcus aureus (26/98; 26.5%) and multidrug-resistant Pseudomonas aeruginosa (PA) (12/98; 12.2%).There was no significant difference considering population with MDRO bacteraemia vs. non-MDRO bacteraemia, except for immunosuppression [OR 2.86; p = 0.0207], severity of the episode [OR 3.13; p = 0.0232], carriage of PA [OR 5.24; p = 0.0395], and hospital-acquired infection [OR 2.49; p = 0.034].In the multivariate analysis, factors significantly associated with MDRO bacteraemia among colonized patient were only immunosuppression [OR = 2.96; p = 0.0354] and the hospital-acquired origin of bacteraemia [OR = 2.62; p = 0.0427].ConclusionsAccording to our study, occurrence of bacteraemia due to MDRO among MDRO carriers was high. Factors associated with MDRO bacteraemia were severity of the episode and hospital-acquired origin of the bacteraemia. Thus, during bacteraemia among patients colonized with MDRO, if such characteristics are present, broad-spectrum antimicrobial treatment is recommended.

Introduction Peu de cas de COVID-19 chez des patients infectés par le VIH ont été rapportés dans la littérature. Nous décrivons les caractéristiques clinicobiologiques et l’évolution de la COVID-19 chez 10 patients infectés par le VIH. Matériels et méthodes 10 patients (1,8 %) de notre file active de 560 patients ont eu la COVID-19 entre le 9 mars et le 30 avril 2020. Le diagnostic d’infection à Coronavirus SARS-CoV-2 a été fait par amplification par PCR en temps réel du gène E du betacoronavirus sur écouvillon nasopharyngé. Résultats Dix patients infectés par le VIH-1, 6 hommes et 4 femmes, d’âge moyen 56 ans ont présenté la COVID-19. L’infection par le VIH avait été diagnostiquée depuis 19 ans environ (min : 6 mois, max : 32 ans). Sept patients sur 10 étaient classés stade C. Tous les patients avaient un traitement antirétroviral : trithérapie (9/10) ou bithérapie (1/10), une charge virale VIH indétectable et des LT CD4 > 200/mm 3 (min : 295, max : 1350/mm 3 ). Quatre patients ont été hospitalisés pour une pneumonie, 1 patiente avec antécédent de cancer du poumon a présenté une pneumonie nosocomiale à SARS-CoV-2. Quatre patients ambulatoires avaient une infection respiratoire haute et 1 un tableau digestif isolé. Les patients hospitalisés pour pneumonie communautaire avaient des comorbidités : hypertension artérielle (4/4), diabète de type 2 (4/4), obésité (2/4), maladie respiratoire chronique (1/4). La présentation clinique comprenait : fièvre (7/10), toux (7/10), anosmie et agueusie (3 des 5 patients ambulatoires) et troubles digestifs (3/10). La guérison survenait en 7 à 14 jours sous traitement symptomatique (formes ambulatoires). L’hospitalisation survenait entre 7 et 12 jours après le début des symptômes avec une durée d’hospitalisation de 8 à plus de 45 jours. Deux patients ont présenté un SDRA : une décédée à 12 jours en médecine ; l’autre admis en réanimation avec ventilation mécanique pendant 2 mois. La patiente décédée a eu du ritonavir/lopinavir, une corticothérapie et un antagoniste du récepteur IL1. Les autres patients hospitalisés ont reçu : antibiotiques (4/5), hydroxychloroquine (2/5), antagoniste du récepteur C5 (1/5). Conclusion Les patients infectés par le VIH ont les mêmes présentations cliniques que ceux non infectés par le VIH avec des formes sévères de COVID-19 survenant chez des patients ayant les facteurs de risque décrits dans la littérature (âge, comorbidités tels l’hypertension artérielle, le diabète, l’obésité ou une pathologie respiratoire chronique). Une infection par le VIH bien contrôlée sur le plan immunovirologique ne semble pas être un facteur de risque de COVID-19. Par ailleurs, le traitement antirétroviral en cours ne semble pas être un facteur protecteur contre l’infection à SARS-CoV-2. Une étude étiologique est nécessaire pour confirmer ces hypothèses.

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In a large regional observational cohort study of adult (≥ 18 years), outpatients with COVID-19, prevalence, characteristics, and outcome of patients with rash and/or chilblain-like lesions (CLL), compared with population without cutaneous features, were studied. In total, 28,957 outpatients were included; the prevalence of rash and CCL were 9.5% and 3.7%, respectively. Presence of rash was significantly associated with presence of asthenia, shivers or myalgia, respiratory and gastro-intestinal symptoms, and anosmia/ageusia. The presence of CCL was associated with chest pain, chest oppression, nausea/vomiting, and anosmia/ageusia. Patients with CCL were significantly less prone to an unfavourable outcome (hospitalization or death).