The aim of this study was to estimate the incidence of COVID-19 disease in the French national population of dialysis patients, their course of illness and to identify the risk factors associated with mortality. Our study included all patients on dialysis recorded in the French REIN Registry in April 2020. Clinical characteristics at last follow-up and the evolution of COVID-19 illness severity over time were recorded for diagnosed cases (either suspicious clinical symptoms, characteristic signs on the chest scan or a positive reverse transcription polymerase chain reaction) for SARS-CoV-2. A total of 1,621 infected patients were reported on the REIN registry from March 16th, 2020 to May 4th, 2020. Of these, 344 died. The prevalence of COVID-19 patients varied from less than 1% to 10% between regions. The probability of being a case was higher in males, patients with diabetes, those in need of assistance for transfer or treated at a self-care unit. Dialysis at home was associated with a lower probability of being infected as was being a smoker, a former smoker, having an active malignancy, or peripheral vascular disease. Mortality in diagnosed cases (21%) was associated with the same causes as in the general population. Higher age, hypoalbuminemia and the presence of an ischemic heart disease were statistically independently associated with a higher risk of death. Being treated at a selfcare unit was associated with a lower risk. Thus, our study showed a relatively low frequency of COVID-19 among dialysis patients contrary to what might have been assumed.

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This study is the first one that describes the situation of Legionnaires' disease (LD) in Tunisia, with its clinical and epidemiological characteristics and investigates the risk factors associated with Legionella infections in our country. We conducted a retrospective multicentric study during 5 years (2008-2012) concerning all confirmed LD cases in Tunisia and we investigated risk factors for infection. The total of confirmed LD cases was 14. Incidence was 0.03. Mean age: 53.1, sex ratio (M/F): 2.6. Summer-autumnal peak was noted. Risk factors for infection were: the great humidity at home (n=4), living in community (n=3) and practice ablutions (before prayer) in public places (n=4). Community acquired legionellosis (n=9) and nosocomial (n=2). Pulmonary symptoms (n=11)+/-gastrointestinal (n=6) and/or neurological signs (n=4). Beta lactams therapy failed (n=11). CXR showed bilateral lesions (n=6). Abnormalities in laboratory values were noted: hyponatremia (n=9), high CPK levels (n=9). Diagnosis was confirmed by positive urinary Legionella antigens test (n=10) and by direct immunofluorescence (n=1). Treatment was based on bitherapy (n=10). Five patients died. The incidence of LD appears lower than other countries. Some risk factors, as ablutions, are different from that reported in Western countries and seem to be specific to our society. Given the seriousness of its consequences, it is strongly recommended to improve the national surveillance system up and register LD as notifiable disease.

Introduction: Hemodialysis patients are at increased risk for COVID-19 (SARS-CoV2 infection) and to present severe cases due to their special clinic and epidemiological characteristics. The aim is to describe the experience of a hospital Hemodialysis Unit during the COVID 19 pandemic. Methods: We report the experience of a Hemodialysis Unit by a retrospective study, We analyzed 62 patients in a hemodialysis program, between March 13th, 2020 and May 7th, 2020. Infection was defined as the presence of viral RNA by RT-PCR testing on nasopharyngeal swabs or detection of specific antibodies for SARS CoV2 (Wondfo Biotech). Information about demographic data, epidemiological data, laboratory findings, treatments and complications was collected, and comparisons were made between those who required admission and outpatient treated patients. Results: 14 out of 62 (22.6%) patients reported positive test for SARS CoV2 and 35.7% of them were men. The median age was 68 years (IQR, 58.7-80 years). In 6 of the cases (42.9%) hospital transmission was suspected. The comorbidities, symptoms, analytical findings and treatments permorfed are shown in the table. All patients who required admission suffered from bilateral pneumonia and the median time of hospitalization was 10 days. 50% of patients precised high-flow oxygen therapy, 2 (14.2%) patients presented ARDS, for whom invasive ventilatory support was neglected due to comorbidities, resulting in death.

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