[Community-acquired pneumonia of atypical presentation, role of macrolides].
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Adult↗
Biomedical subjects
B Becq-Giraudon
Publications and source records attributed to B Becq-Giraudon.
Lupus syndrome after parvovirus B19 infection.
Systemic lupus erythematosus is uncommon in elderly individuals. A 72-year-old woman developed parvovirus B19 infection followed by a systemic lupus erythematosus-like syndrome with persistent thrombocytopenia and Raynanud's phenomenon. Few cases of systemic lupus erythematosus after parvovirus B19 infection have been reported, and none had thrombocytopenia.
Aged↗
[Non-antibiotic effects of antibiotics: from side effects to therapeutic uses].
Sometimes therapeutic needs to tap drugs side effects of a treatment to show new indications for those drugs. Antibiotics, which are somewhat some often-used drugs, are frequently prescribed in non-infectious pathologies. Some indications are reported in the literature: immunosuppressive or antiinflammatory (disulone, salazopyrine, cotrimoxazole, clofazimine, fusidique acid), small bowel prokinetic action (macrolides), endocrine effects (déméclocycline, kétoconazole), enzymatic effects (rifampicine, cyclines), sclerotherapy (cyclines), pro- or anti-tumoral effects. This incomplete list is growing up every days.
Anti-Bacterial Agents↗
Western blot monitoring of disseminated Nocardia nova infection treated with clarithromycin, imipenem, and surgical drainage.
A case of disseminated infection due to Nocardia nova with subcutaneous popliteal and retrosternal abscesses and lung involvement in an immunocompromised patient is reported. The patient did not respond to sulfonamide therapy. Clinical recovery was obtained upon treatment with imipenem then clarithromycin. Western blot studies revealed an antibody response to a known Nocardia-specific 55-kDa antigen in four successive sera samples collected in the period from the time of admission to seven months later. The resolution of the disseminated nocardiosis and efficacy of the clarithromycin treatment were assessed on the basis of disappearance of the antibodies to the 55-kDa antigen, without invasive sampling.
Anti-Bacterial Agents↗
[Immunologic studies in the differential diagnosis of infectious endocarditis and septicemia without endocardiac lesion].
Differential diagnosis between infective endocarditis and septicemia without endocarditis remains a crucial clinical difficulty. Value of immunological data during those pathologies has been evaluated in a 2 year prospective study. Sixty-one patients, admitted in an internal medicine and infectious diseases unit for a documented infectious disease, were included. They were separated in three groups: group I (n = 21): demonstrated infective endocarditis; group II (n = 19): septicemia without endocarditis and group III (n = 21): non septicemic well-defined infectious disease. Following parameters were studied: immune circulating complexes, C reactive protein, erythrocyte sedimentation rate, fibrinogen, rheumatoid factor, antinuclear antibodies, Treponema pallidum serodiagnostic and cryoglobulinemia. There were no differences between the three studied groups. In particular, immune circulating complexes were present in respectively 67%, 58% and 62% of the patients of the three groups. So, presence or absence of immunologic abnormalities does not provide help for diagnosis of endocarditis in a febrile patient.
Adult↗
[Disseminated Mycobacterium bovis tuberculosis in an aged female patient without HIV infection].
The authors report the case of a woman affected by disseminated infection caused by Mycobacterium bovis, without risk exposure and immunodeficiency. There were chest and urinary localisations and bacteremia. Usually, M bovis is responsible of chest tuberculosis, in patients with professional exposure. Disseminated forms usually affect patients with immunodeficiency. Bacteria may be responsible of about 1% of tuberculosis, but real frequency is not known, because of its non specific report.
Aged↗
[Is the indomethacin test able to indicate the etiological diagnosis of isolated fever?].
The aim of this study was to determine if evolution of fever after administration of indomethacin to febrile patients could separate those with fever of infectious origin from those with non-infectious origin. All patients with a rectal body temperature superior than 38 degrees C for at last 5 days and without any antibiotic or antipyretic therapy for more than 48 hours, were included in a 1 year prospective study. Each patient received one time 50 mg of indomethacin and rectal body temperature was obtained every 3 hours for 12 hours. Forty-five patients were included, 20 in group I (fever of infectious origin) and 25 in group II (fever of non-infectious origin). The mean age and mean initial body temperature were similar in the two groups. After administration of indomethacin, mean duration and mean amplitude of abatement of fever were similar in the two groups. Hypothermia was observed more frequently in group II (28%) than in group I (10%) (p < 0,05) and was preferentially associated to a malignant lymphoma. Also, diagnostic procedure with indomethacin is of little interest to separate fever of infectious origin from other, but hypothermia would suggest a fever due to a malignant lymphoma.
Adult↗
[Neurologic complications of infectious endocarditis].
Ten patients with neurological complications (NC) among a retrospective series of 53 consecutive cases of infective endocarditis were studied: 6 males and 4 females, mean age 60 years. NC were present at admission in 6 cases: 2 generalized seizures, 4 strokes, associated with 2 meningeal syndromes. Four cases of NC occurred during hospitalization: 1 stroke with come, 1 transient ischaemic attack, 2 generalized seizures. Blood cultures were positive in 7 cases: 6 group D Streptococci, 1 Gram negative bacillus. Five digestive portal of entry were identified. Cerebrospinal fluid was purulent in 1 patient, aseptic in 1, haemorragic in 2, and normal in 1. Cranial computed tomography revealed: infarct in 4 cases, brain abscess in 1 case, absence of abnormality in 1 case. There was no angiographic documentation. Antimicrobial therapy was maintained 5 to 6 weeks. Two patients underwent cardiac surgery. Two patients died of subarachnoid haemorrage. Comparison of patients with NC, and the 43 without NC, revealed two different point: vegetations were more frequent in the NC (8 cases out of 10) than without NC (19 cases out of 43) (p = 0.04). Streptoccus was often more found in NC (6 cases out of 6) than without NC (6 cases out of 24) (p < 0.01). Compared with the previously reported studies, where Staphylococcus was usually described, our results showed a higher frequency of Streptococcus D bovis, an older age, a higher frequency of stroke and digestive portal of entry. Vegetations were more frequent with NC than without.
Adult↗
Rifampin-induced nonresponsiveness of giant cell arteritis to prednisone treatment.
Rifampin is an enzymatic inducer known to increase steroid metabolism. We studied two patients with giant cell arteritis in whom rifampin caused nonresponsiveness to prednisone treatment. A prednisone pharmacokinetics study was done. When rifampin-prednisone treatment must be used in giant cell arteritis, we propose increasing the prednisone dosage to 2 mg/kg per day.
Aged↗
["Primum non nocere". Prospective study of 115 cases of iatrogenic diseases collected over one year in 106 patients].
One hundred and fifteen cases of iatrogenic disorders were observed in 106 patients during a one-year prospective study. Each case was included after informed agreement of two investigators. Each case was classified into 4 groups, according to duration time between iatrogenic disorder and hospitalization, and into 3 sections according to responsibility of causative agent. A control group of 200 patients matched for age and sex was studied. Patients represented 8% of the hospitalisations. Mean age (69.2 years) was higher than other patients hospitalized during the same period (61.6 years). Principal causative agents were diuretics (30), physchotrops (13) and technic examinations (12). Main pathologies were electrolytes disorders (28), orthostatic hypotension (19), confusion and/or alteration of mental functions (13), and cutaneous or allergic disorders (12). Mean induced hospitalization duration time was of 8 days. Mean estimate cost was 18,808 francs per patient. Associated factors were elderly, and an elevated number of drugs. A negligency could participate to iatrogenic disorders in 50% of cases. Half part of iatrogenic disorders could be avoided by using simple precautions: respect of contra-indications, restriction on self-therapy and of number of associated drugs.
Adolescent↗
Retrospective study of 108 cases of botulism in Poitiers, France.
Botulism, a food-borne toxin-mediated disease caused by Clostridium botulinum is still a common disease, which is most frequent in the rural environment; 108 cases, 66 males and 42 females, average age 32 years, were recorded from 1965 to 1990 in the infectious disease department of the University Hospital of Poitiers (France). In 83% of patients, the food responsible was home-cured ham. Mean incubation time was 3.4 days; digestive symptoms were observed in 93% of cases, ocular symptoms in 92% and urinary tract dysfunction in 22%. A scale of severity was used to classify the patients into those suffering from severe (6), intermediate (50) and mild (52) forms of the disease. Botulinum toxin type B was found in 36 (52%) of 69 blood samples and in 41 (51%) of 81 samples of the suspected food. From 1965 to 1976, 44 patients were treated with both toxoid and heterologous equine serotherapy. Since 1976, 29 patients have been treated with guanidine hydrochloride (35 mg/kg daily) and 35 patients with guanidine hydrochloride plus heterologous serotherapy. All 108 patients recovered without any sequelae.
Adolescent↗
[Current aspects of infectious endocarditis. Apropos of 53 cases].
Fifty-three cases of infective endocarditis are reported: 10 definite, 33 probable, 10 possible. There were: 35 males, 18 females, mean age: 66 +/- 14 years. Twenty-three patients had a known valve involvement, 21 a recently diagnosed valve involvement, 9 a prosthetic valve. Fifty patients had fever, 43 had a regurgitating murmur, 28 weakness and weight-loss, 13 cutaneous lesions, 11 arthritis, 8 splenomegaly, 3 ocular lesions. The portal of entry was suspected or confirmed in 37 cases: intestinal in 12 cases, dental in 11 cases, cutaneous in 7 cases, urinary tract infection in 6 cases, upper respiratory tract infection in 1 case. The micro-organism was found in 45 cases: 10 oral streptococci, 12 D bovis streptococci, 6 enterococci, 5 aureus staphylococci, 3 coagulase-negative staphylococci, 2 Coxiella burnetii, 7 other bacterias. Blood-cultures were negative in 8 cases. Precordial echocardiography found vegetations in 27 native valves and 9 prosthetic alterations. Ten patients had neurologic complications, 27 cardiac complications, 8 acute renal failure. Nine patients needed cardiac surgery, 6 died. Our results, compared with those in the literature, showed older age, a higher frequency of digestive portal of entry and of D bovis streptococci, frequently associated with a colic tumour.
Aged↗
Septicemia due to Capnocytophaga canimorsus after a dog bite in a cirrhotic patient.
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Animals↗
Hepatic fibrin-ring granulomas in giant cell arteritis.
Hepatic fibrin-ring granulomas were found in a 70-year-old man with prolonged fever and inflammatory syndrome. Diagnosis of giant cell arteritis was confirmed by temporal artery biopsy. Other diseases usually associated with fibrin-ring granulomas in liver, such as Q fever, cytomegalovirus hepatitis, infectious mononucleosis, Hodgkin's disease, non-Hodgkin's lymphoma, allopurinol treatment, and visceral leishmaniasis, were ruled out. This report suggests that giant cell arteritis should be considered as an additional cause of hepatic fibrin-ring granulomas.
Aged↗
[Primum non nocere, a forgotten adage at times. Apropos of 106 cases of iatrogenic pathologies collected in a year].
Results of a prospective trial showed that 7.9% of patients in an internal medicine department were affected by a drug-induced pathology (DIP). Reasons for this include non respect of contra-indications or to non supervision of treatment such as anti-hypertensive drugs. DIP affected more often elderly patients, and reflected superconsummation of medication.
Adult↗
[Is the immunologic evaluation in endocarditis of value?].
Forty-seven patients were included in a prospective trial to define the interest for searching immunologic abnormalities during endocarditis. No specific abnormalities were found, aside some patients with endocarditis who have a high levels of immune complexes. These results suggest that the interesting immunologic abnormality is the presence of an high level of immune complexes could be of interest in endocarditis.
Adult↗
[Transient loss of consciousness in an internal medicine unit. Study of the initial evaluation and medium-term outcome].
The authors report the results of a study concerning 90 patients admitted to an Internal Medicine Unit for transient loss of consciousness. The cause of this event was found in 74 cases (82%), including 73 where the initial evaluation had been simple, consisting of physical examination, electrolytogram, blood glucose level, electrocardiogram and test for postural hypotension. Patients and physicians reported different frequencies of recurrence (17 and 51% respectively) and complications (27 and 96% respectively). Recurrences were usually multiple and appeared soon after the initial event. A 4% mortality rate was recorded over 21 months, but only one death was due to a cardiovascular cause. No death was observed in the group of patients without initial aetiological diagnosis. Apart from cardiac syncopes, the consequences of transient loss of consciousness seem to be psychological rather than physical. A simple initial evaluation is often sufficient.
Adolescent↗
[Idiopathic retroperitoneal fibrosis and ankylosing spondylitis].
A case of ankylosing spondylarthritis in which retroperitoneal fibrosis developed 16 years after onset is reported. The patient also had aortic incompetence and cardiac conduction disorders. Eight other cases of ankylosing spondylitis with retroperitoneal fibrosis have been published. Potential relationships between the two conditions--including the possible role of indomethacin used by the patient for 16 years--are discussed.
Aortic Valve Insufficiency↗