Coronavirus disease 2019 (COVID-19) pandemic is affecting millions of patients worldwide. The consequences of initial exposure to SARS-CoV-2 go beyond pulmonary damage, with a particular impact on lipid metabolism. Decreased levels in HDL-C were reported in COVID-19 patients. Since HDL particles display antioxidant, anti-inflammatory and potential anti-infectious properties, we aimed at characterizing HDL proteome and functionality during COVID-19 relative to healthy subjects. HDLs were isolated from plasma of 8 severe COVID-19 patients sampled at admission to intensive care unit (Day 1, D1) at D3 and D7, and from 16 sex- and age-matched healthy subjects. Proteomic analysis was performed by LC-MS/MS. The relative amounts of proteins identified in HDLs were compared between COVID-19 and controls. apolipoprotein A-I and paraoxonase 1 were confirmed by Western-blot analysis to be less abundant in COVID-19 versus controls, whereas serum amyloid A and alpha-1 antitrypsin were higher. HDLs from patients were less protective in endothelial cells stiumalted by TNFα (permeability, VE-cadherin disorganization and apoptosis). In these conditions, HDL inhibition of apoptosis was blunted in COVID-19 relative to controls. In conclusion, we show major changes in HDL proteome and decreased functionality in severe COVID-19 patients.

Dengue and coronavirus disease 2019 (COVID-19) may share clinical and laboratory features. Reunion Island is a French overseas department located in the Indian Ocean with a population of more than 850,000 inhabitants. Due to its tropical climate, Reunion Island is at risk of arbovirus outbreaks. An increase in the number of dengue cases has been reported on the island since the beginning of 2018, with 3 different serotypes circulating mostly in austral summer. According to the last epidemiological report of March 30, 2020 from Santé Publique France, 3,144 new cases of dengue have been diagnosed since the beginning of 2020 in Reunion Island [1]. On March 2020, the first COVID-19 cases were imported to the island from metropolitan France by airplane. We report the case of an 18-year-old male living in Reunion Island, with no relevant past medical history except occasional migraines. Our patient travelled back from Strasbourg (initial French epicenter of COVID-19) to Reunion Island on March 18, 2020. After his arrival, he returned to his parents' home, respected national confinement guidelines, and only went shopping once. The onset of symptoms occurred on April 3, with fever (39˚C), asthenia, anorexia, and headache. On April 4, he tested positive in the emergency department for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by reverse transcription (RT)-PCR (E gene, RdRP gene, and N gene positive), the causative virus of COVID-19. He was discharged from the emergency room after diagnosis. On April 5, an itchy erythema rash appeared. He came back to the hospital on April 7 for persistent fever (38.7˚C), arthromyalgia, dyspnea with polypnea (respiratory rate of 24 breaths per minute), and itchy maculopapular rash. The dengue rapid test was positive (NS1 antigen+) in the emergency department. Therefore, he was hospitalized the same day in the COVID-19 unit of St Denis University Hospital Center. The physical examination revealed a body temperature of 38˚C, blood pressure of 112/63 mmHg, pulse of 63 beats per minute, and oxygen saturation of 99% in ambient air. He had dry cough (since February) and no chest pain. Pulmonary auscultation was normal. He had no hematuria. He described retro-orbital eye pain and mild photophobia, with anorexia, nausea, and vomiting. He had infracentimetric cervical lymphadenopathies. Skin examination showed a roseoliform maculopapular exanthema of the trunk, limbs, and face, which rapidly evolved into a scarlatiniform-like rash. There were no real intervals of healthy skin but rounded islands of sparing ("white islands in a sea of red") (Figs 1 and 2). There was no mucosal involvement nor hand and feet affection involvement. The itching had stopped, and there was no scratching

Objectives: The aim of this study was to provide a systematic review of Epstein-Barr virus-associated smooth muscle tumors (EBV-SMT) in human immunodeficiency virus (HIV)-infected adults, focusing on clinical and histopathologic features and outcome. Methods: A literature search was performed using Medline, Embase and the Cochrane Library. Results: We reviewed 35 cases including our case of a patient with a progressive multifocal EBV-SMT. Patients were mainly men (n = 24) with a mean age of 35.5 years. Median CD4 count was 21/mm³. Main locations were brain (n = 12), liver (n = 8), spinal cord (n = 7) and adrenal gland (n = 6). The tumors were multifocal in 34% of cases, whereas analysis of clonality showed different clones in tumors from different sites. Treatment included removal surgery in 17 cases and/or radiotherapy in 9 and therapeutic abstention in 4. Mean follow-up after diagnosis was 12.3 months. Nine patients died during this period essentially from opportunistic infection and only 2 from the disease. Conclusion: EBV-SMT should be added to the list of virally induced tumors in severely immunocompromised HIV-infected adults. Multifocality of independent tumor clones, especially in liver, brain, spinal cord and adrenal gland, and a slow disease progression seem to be the key features of these tumors, the treatment of which remains poorly defined.

On Reunion Island, in response to the threat of emergence of the pandemic influenza A(H1N1)2009 virus, we implemented enhanced influenza surveillance from May 2009 onwards in order to detect the introduction of pandemic H1N1 influenza and to monitor its spread and impact on public health. The first 2009 pandemic influenza A(H1N1) virus was identified in Réunion on July 5, 2009, in a traveller returning from Australia; seasonal influenza B virus activity had already been detected. By the end of July, a sustained community pandemic virus transmission had been established. Pandemic H1N1 influenza activity peaked during week 35 (24-30 August 2009), 4 weeks after the beginning of the epidemic. The epidemic ended on week 38 and had lasted 9 weeks. During these 9 weeks, an estimated 66 915 persons who consulted a physician could have been infected by the influenza A(H1N1)2009 virus, giving a cumulative attack rate for consultants of 8.26%. Taking into account the people who did not consult, the total number of infected persons reached 104 067, giving a cumulative attack rate for symptomatics of 12.85%. The crude fatality rate (CFR) for influenza A(H1N1)2009 and the CFR for acute respiratory infection was 0.7/10 000 cases. Our data show that influenza pandemic did not have a health impact on overall mortality on Réunion Island. These findings demonstrate the value of an integrated epidemiological, virological and hospital surveillance programme to monitor the scope of an epidemic, identify circulating strains and provide some guidance to public health control measures.

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