The incidence of tuberculosis (TB) remains high in elderly adults in France. Immunosenescence and comorbidities challenge both diagnosis and treatment in this population. Recent data describing TB characteristics and outcomes in the elderlies are scarce. We aimed to describe clinical and microbiological features of TB in the elderly population and to identify factors associated with 2-year mortality. We conducted a retrospective multicenter study including patients aged≥75years who were diagnosed with TB between 2010 and 2020 across 18 centers. A multivariate analysis was used to identify factors independently associated with 2-year mortality. A total of 295 patients were included: mainly born in France (57%). Immunosuppression was rare (9.8%). Fever and cough were uncommon, while weight loss was the most frequent symptom (60.3%), significantly associated with diagnostic delays. Pulmonary TB was the predominant form (63.1%) with higher culture positivity observed in this group and in the oldest patients. Isoniazid resistance was rare (5.2%). Standard quadritherapy was the most common initial regimen and was not associated with higher rates of adverse events. At two-year follow-up, overall mortality was 31.3%. In multivariate analysis, mortality was significantly associated with severe renal failure, living in nursing home or long-term care facilities, and weight loss at presentation. This study highlights the atypical presentation of TB in elderly adults and the continued use of standard quadritherapy despite low drug resistance. Weight loss, though nonspecific, appears to be the most prognostic symptom and is associated with delayed diagnosis and higher mortality.

The aim of this study was to evaluate the performances of Anyplex® MTB/NTM Real-time Detection and Xpert MTB/RIF Ultra for tuberculosis (TB) disease in people living with Human Immunodeficiency Virus (PLHIV) with low CD4+T lymphocyte cell (CD4) count. A retrospective observational study included respiratory and non-respiratory specimens from PLHIV stratified based on their CD4 count (<200 vs.≥200 cells/µL) using Anyplex® MTB/NTM Real-time Detection or Xpert® MTB/RIF Ultra. In PLHIV with low CD4 count (<200 cells/µL), Anyplex demonstrated comparable sensitivity (81.4% vs. 81.8%) and specificity (78.7% vs. 78.5%) to Xpert for MTC detection in respiratory samples, but lower sensitivity (81.8% vs. 100%) and higher specificity (83.3% vs. 66.6%) than Xpert in non-respiratory samples. Whereas the two methodologies showed similar MTC diagnostic performance in respiratory samples from PLHIV with low CD4 levels, Anyplex showed higher specificity and lower sensitivity than Xpert in non-respiratory samples.

To estimate influenza and pneumococcal vaccination coverage in immunocompromised adults in France. We used the Echantillon Généraliste des Bénéficiaires database, a representative sample of 850,000 patients covered by health insurance, with prospective collection of data on health care. We included adult patients with at least one of the following conditions: people living with HIV (PLWH), solid organ transplant, cancer treated by chemotherapy, any patient under immunosuppressive/immunomodulating therapy. We enrolled 10,784 immunocompromised patients, with a median age of 49years [35-63]. During 2011-2017, complete seasonal influenza vaccine coverage (i.e., one shot each year) was 14.3% [13.6-15.0] and closely correlated with age: 1.2%, 2.8%, 10.9%, and 38.7%, in the age groups 18-34, 35-49, 50-65, and>65years, respectively (P<0.01). Pneumococcal vaccine coverage was complete (13-valent conjugated vaccine followed by 23-valent polysaccharide vaccine) in 6.9%, not correlated with age. Influenza and pneumococcal vaccine coverage in France during the study period, was very low, complete in<15% of immunocompromised adults.

The diagnosis of Lyme borreliosis (LB) relies primarily on clinical evaluation supported by appropriate serologic testing in selected cases. Serology is recommended only in suspected disseminated LB, characterized by compatible clinical signs and history of tick exposure. In early localized disease such as erythema migrans, laboratory testing is unnecessary due to low sensitivity and the reliability of clinical diagnosis. A two-tiered testing algorithm remains the standard: enzyme-linked immunosorbent assay (ELISA) followed by immunoblot confirmation when ELISA results are positive or equivocal. For patients with symptoms lasting less than six weeks and negative initial results, serology should be repeated after three weeks. Only IgG are considered to confirm LB diagnosis. Intrathecal antibody synthesis is critical for diagnosing Lyme neuroborreliosis (LNB), achieving>99% sensitivity after 6-8weeks, although isolated antibody index elevation without pleocytosis suggests alternative etiologies. Interpretation of serology must always consider clinical context: IgG may remain for years after recovery, and isolated IgM beyond six weeks typically represents a false positive. Serologic limitations include low sensitivity in early disease and cross-reactivity, particularly for IgM. PCR may aid diagnosis from synovial fluid or skin lesions but is rarely informative for cerebrospinal fluid. Emerging biomarkers such as CXCL13 and advanced molecular approaches remain experimental and require further validation.