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Biomedical subjects

B Byl

Publications and source records attributed to B Byl.

At least 19 recordsLinked to original sources
PubMed2001

Fatal primary infection due to human herpesvirus 6 variant A in a renal transplant recipient.

We describe a fatal primary human herpesvirus 6 (HHV-6) variant A infection in a kidney transplanted adult woman. On day 20 post transplantation (TX), after rejection therapy, the patient presented an acute hemophagocytic syndrome with hepatitis and central nervous system involvement. HHV-6 IgG and IgM antibodies seroconversion was demonstrated. HHV-6 variant A was the sole pathogen detected by nested PCR and/or culture in blood, bone marrow aspiration, liver biopsy, cerebrospinal fluid and bronchoalveolar lavage. The graft was HHV-6 seropositive and the patient was not transfused before day 28 post TX, suggesting that the virus was transmitted by the graft. Despite immunoglobulins, ganciclovir and foscarnet therapy, the HHV-6 infection progressed and led to severe aplasia. The patient developed Aspergillus fumigatus pneumonia and died from fulminant candidemia. This case demonstrated for the first time that HHV-6 variant A primary infection can cause life-threatening disseminated infection in immunosuppressed patients.

Adult↗
PubMed2000

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Journal Article↗
PubMed1999

Single cell analysis of antigen-specific T cell responses in HIV-infected individuals.

Antigen-specific and polyclonally induced T cell responses were analyzed in 10 HIV-infected individuals and in 14 controls by enumerating the numbers of tetanus toxoid (TT)-specific and phytohemagglutinin (PHA)-induced IFN-gamma-secreting cells (SC) and IL-4-SC using an enzyme-linked immunospot assay. Whereas the numbers of IFN-gamma-SC in HIV-infected patients were not different from those of the controls in response to an in vitro stimulation with PHA, they were significantly decreased in response to an in vitro stimulation with TT, both before and after a TT booster. Cell depletion experiments indicated that this difference was related to an impairment of CD4(+) T-cell-mediated TT-specific IFN-gamma secretion. Concerning IL-4, the numbers of both polyclonally induced IL-4-SC and TT-specific IL-4-SC were significantly lower in HIV-infected patients than in the controls. It is concluded that secretion of antigen-specific cytokines of both Th1 and Th2 types is depressed in HIV-infected patients.

Adult↗
PubMed1999

Impact of infectious diseases specialists and microbiological data on the appropriateness of antimicrobial therapy for bacteremia.

Antimicrobial therapy for 428 episodes of bacteremia in an 850-bed university hospital was prospectively evaluated for 1 year to measure the impact of two factors--blood culture results and the therapy chosen by infectious diseases specialists (IDSs)--on quality of treatment and outcome. Initial shock, a simplified acute physiology score of >15, and inappropriateness of the empirical treatment were independently associated with increased mortality. Empirical treatment was appropriate in 63% of the episodes. This proportion reached 78% for the episodes treated by IDSs, compared with 54% for the others (P < .001). After availability of blood culture results, the proportion of appropriate treatments increased to 94%, with 97% for IDS-treated patients and 89% for other patients (P = .008). IDSs more frequently shifted to oral antibiotics and used fewer broad-spectrum drugs. This study underlines the impact of blood culture results and of IDSs on the prescription of appropriate treatment for bacteremia and on the better use of antimicrobial drugs.

Administration, Oral↗
PubMed1999

Penetration of meropenem in lung, bronchial mucosa, and pleural tissues.

Lung, bronchial mucosa, and pleural tissue samples were obtained from 14 patients undergoing lung surgery 1 to 5 h after administration of 1 g of meropenem. The mean (range) peak concentrations of meropenem were 3.9 (0.2 to 8.2), 6.6 (3.0 to 13.3), and 2.8 (0.6 to 7.8) mg/kg of tissue, respectively, exceeding the MICs at which 90% of isolates are inhibited for most respiratory pathogens.

Adult↗
PubMed1998

Bacterial extract OM85-BV induces interleukin-12-dependent IFN-gamma production by human CD4+ T cells.

To obtain insight into the possible mode of action of bacterial extracts used as immunostimulants in Europe, we used the ELISPOT technique to investigate the effects of one of them (OM85-BV, Broncho-Vaxom) on interferon-y (IFN-gamma) production by peripheral blood mononuclear cells (PBMC). We found that (1) OM85-BV stimulates IFN-gamma secretion by PBMC from normal individuals and human immunodeficiency virus (HIV)-infected patients, (2) CD4+ cells represent the major source of IFN-gamma produced in response to OM85-BV, and (3) this effect of OM85-BV involves the induction of interleukin-12 (IL-12) secretion by accessory cells. We conclude that bacterial extracts might enhance antimicrobial defenses by eliciting IL-12-dependent IFN-gamma synthesis by CD4+ T cells.

Acquired Immunodeficiency Syndrome↗
PubMed1998

The patient with intravascular lines.

Vascular catheters are the most frequently used indwelling devices. Infections are potentially life-threatening complications of their use, and account for an important proportion of nosocomial infections. Diagnostic methods include essentially semi-quantitative culture of catheter tip and blood culture. For treatment of most catheter-related infections, the catheter should be removed, and antibiotics should be associated in case of systemic infection. Surgically inserted central venous catheter may be maintained in some conditions depending both from the nature of the pathogen and the severity of the infection. These different aspects of catheter infections are reviewed.

Anti-Bacterial Agents↗
PubMed1995

Antibiotic prophylaxis for infectious complications after therapeutic endoscopic retrograde cholangiopancreatography: a randomized, double-blind, placebo-controlled study.

We performed a randomized, double-blind, placebo-controlled trial of antibiotic prophylaxis before diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in 82 uninfected patients with cholestasis due to biliary tree obstruction of single or multiple causes. The patients were assigned to receive piperacillin (4 g) or placebo three times daily; prophylaxis was started just before initial ERCP and was continued until biliary drainage was completely unobstructed (by one or more ERCP procedures); the maximal duration of prophylaxis was 7 days. Nine patients were withdrawn from the study, and five others could not be assessed because of protocol violations. The 68 clinically evaluable patients underwent 81 therapeutic ERCP procedures. Clinical success (defined as an absence of fever, cholangitis, and clinical signs of sepsis during the 48 hours after the last dose of piperacillin or placebo) was documented for 32 (94%) of the 34 patients given piperacillin and for 24 (71%) of the 34 patients given placebo (odds ratio, 6.66; P = .01). Complete biliary drainage influenced clinical outcome favorably (odds ratio, 5.0; P = .02). All seven instances of bacteriologic failure (bacteremia) involved patients in the placebo group (P < .01). We concluded that antimicrobial prophylaxis significantly reduces the incidence of septic complications after therapeutic ERCP among patients presenting with cholestasis.

Adult↗
PubMed1994

Interleukin-10 production during septicaemia.

Interleukin-10 is produced during incubation of human whole blood with bacterial lipopolysaccharide (LPS) and down-regulates tumour necrosis factor-alpha production in this in-vitro model of endotoxaemia. 39 out of 69 (57%) patients with gram-negative (n = 25) or gram-positive septicaemia (n = 44) had increased plasma interleukin-10 (range 12-2740 pg/mL), whereas interleukin-10 was undetectable in 29 out of 33 control patients without infection and in 20 healthy volunteers. Patients with septic shock (n = 21) had higher interleukin-10 (main 58 pg/mL) than septicaemic patients without shock (11 pg/mL, p < 0.001). We conclude that interleukin-10 is produced during sepsis and might be involved in the control of the inflammatory response induced by bacterial products.

Adult↗
PubMed1994

Microbiological specimen collection in the emergency room.

The first step in the accurate diagnosis of infectious diseases is to provide the laboratory with adequate specimens for microbiological examination. The sample must be representative of the disease process: samples collected on body surfaces, harbouring saprophytic germ are less reliable than aspiration of closed body areas. A sufficient quantity of infectious material, preferably sampled with a syringe aspiration than with a swab, must be transported rapidly to the laboratory. Finally, close collaboration between the clinician and the microbiologist is essential for appropriate collection of selected specimens and corrected interpretation of the bacteriological results. Gram-stained smear examination of the samples is extremely useful and can provide immediate information for initiation of rational empiric antibiotic treatment. The indications for blood cultures sampling are reviewed. Number of blood cultures and volume of blood per culture are important. Screening of the sputum to discard samples too contaminated by the saliva is mandatory: if only screened samples are considered, a sputum Gram stain is a reliable guide to empiric therapy. Gram stain is also essential in the examination of the cerebrospinal fluid as well as is the detection of bacterial antigens. Cytological and chemical characteristics of this exudate are useful in differentiating bacterial meningitis from other diseases but there is considerable overlap between the laboratory parameters of bacterial meningitis and infections of other etiologies.

Blood↗
PubMed1993

Tumor necrosis factor alpha and interleukin 6 plasma levels in infected cirrhotic patients.

BACKGROUND: Patients with liver cirrhosis disclose both increased production and decreased metabolism of tumor necrosis factor alpha (TNF-alpha) and interleukin 6 (IL-6). The present study analyzes the characteristic pattern of these cytokines during sepsis in cirrhotics. METHODS: TNF-alpha and IL-6 plasma levels, measured during 15 days from the onset of cirrhotic decompensation or of the septic event, were compared between 14 infected patients with liver cirrhosis, 18 uninfected decompensated cirrhotic patients, and 35 septicemic patients devoid of liver disease. Cytokines were measured using immunoassays. RESULTS: In infected cirrhotics, initial levels of both TNF-alpha and IL-6 were significantly higher than in noninfected cirrhotic patients (P < 0.0001) or in septicemic patients devoid of cirrhosis (P < 0.001). Initial IL-6 plasma levels (threshold, 200 pg/mL) showed 89% specificity and 100% sensitivity in discriminating cirrhotic decompensation due to infection from that caused by other factors. TNF-alpha and IL-6 plasma levels remained significantly higher for many days in infected cirrhotic patients compared with the other two groups. CONCLUSIONS: Both the profoundly increased initial levels of TNF-alpha and IL-6 and their persistence over days after sepsis onset seem characteristic of the cirrhotic patients. The exact relationship between prolonged exposure to TNF-alpha and poor prognosis in these patients is unknown, but it might represent a unique opportunity for the use of anti-TNF-alpha antibodies during sepsis.

Aged↗
PubMed1991

Role of quinolones in the treatment of bronchopulmonary infections, particularly pneumococcal and community-acquired pneumonia.

In view of their antimicrobial activity and pharmacological properties, fluoroquinolones should be suitable for the treatment of lower respiratory tract infections. The overall clinical success rate using enoxacin, ofloxacin, pefloxacin, and ciprofloxacin ranges from 81% to 89%. Despite relatively high MICs of the fluoroquinolones for Streptococcus pneumoniae, the clinical success rate of these drugs in pneumococcal infections is 91%, but the eradication rate of this pathogen is lower (73%). In addition, fluoroquinolones appeared to be as effective as standard antibiotic regimens for treatment of bronchopulmonary infections in most of the comparative trials reported. The new quinolones could be a good alternative for treatment of acute exacerbations of chronic bronchitis, especially if examination of the sputum reveals gram-negative pathogens. In community-acquired pneumonia, drugs other than quinolones seem indicated because of the limited efficacy of the new quinolones in the treatment of severe pneumococcal infections and the poor activity of these drugs against the anaerobic flora causing aspiration pneumonia. In contrast, new quinolones should be very suitable for treatment of nosocomial pulmonary infections due to gram-negative pathogens. Quinolones used with or without erythromycin and rifampin, might be useful in the treatment of Legionnaires' disease. The role of these drugs in treatment of Chlamydia and Rickettsiae infections remains to be defined.

Anti-Infective Agents↗
PubMedDate not supplied

Trichoderma viride infection in a liver transplant recipient.

A liver transplant recipient developed infection of a perihepatic haematoma due to Trichoderma viride. Before the infection was diagnosed, the patient received intense immuno-suppressive and prolonged antibacterial and anti-fungal therapies. Although the death of the patient was not directly related to the fungal infection, abundant quantities of this pathogen were recovered in the haematoma at post-mortem examination, despite previous surgical removal and treatment with amphotericin B and fluconazole.

Adult↗