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Biomedical subjects

C Leport

Publications and source records attributed to C Leport.

At least 199 records · Page 11Linked to original sources
PubMed1986

Comparative trial of acyclovir and vidarabine in disseminated varicella-zoster virus infections in immunocompromised patients.

A comparative assessment of vidarabine and acyclovir in the treatment of varicella and disseminated zoster in immunosuppressed patients was undertaken. Thirty-eight immunosuppressed patients with varicella (N = 18) or disseminated zoster (N = 20) were treated intravenously with 10 mg/kg/day of vidarabine or 30 mg/kg/day of acyclovir for 5 days according to a preestablished code within each diagnosis group--varicella and disseminated zoster. Two deaths, although not directly related to VZV infection, were observed in the vidarabine-treated varicella group. The times to cessation of formation of new lesions and to the disappearance of fever were similar for vidarabine and acyclovir in each group. In the varicella group, VZV was isolated on day 5 in four out of five vidarabine patients versus one out of five acyclovir patients. No severe adverse effects were observed with either drug. Neutropenia present in patients of both drug groups was transitory and most often related to previous cytolytic chemotherapy. These data suggest that either vidarabine or acyclovir could be used in the treatment of severe VZV infections in immunosuppressed patients, although a larger number of patients would be required for definitive conclusion. Because of the large amount of solute required for vidarabine administration, acyclovir may be preferred when the risk of cardiorespiratory failure is high.

Acyclovir↗
PubMed1986

[Association of bacterial endocarditis and alcoholic cirrhosis in 9 patients].

Ten cases of bacterial endocarditis were observed in cirrhotic patients. In 7 cases, endocarditis was due to group D Streptococcus, 5 of which were Streptococcus D. bovis. Special features were the involvement of tricuspid valve and the involvement of two or more valves in 4 cases. Surgery was necessary in the acute phase in 5 patients: cure was definitely obtained in 8 cases after a particularly long interval. A colonic lesion could have been the portal of entry in some cases. Liver cirrhosis was considered as a predisposing factor for bacterial endocarditis, especially due to group D Streptococcus or to other bacteria of intestinal origin. This is probably related to the frequency of the colonic origin of group D Streptococcus endocarditis. Loss of filter function of the liver may partly explain the features of these forms of endocarditis.

Adult↗
PubMed1986

[Ultrastructural markers in LAV-HTLV III virus infection: study of the rectal mucosa in 16 patients].

Ultrastructural study of rectal mucosa was performed in 6 patients with AIDS related complex (ARC) and in 10 patients with AIDS. There were 16 men (mean age: 39.1 years): 8 homosexuals, 3 Haitians, 2 Africans and 3 IV drug abusers, all having significant titers of LAV antibodies. Two types of ultrastructural markers were observed: tubuloreticular structures (TRS) were found in endothelial cells, lymphocytes and macrophages in 1/6 ARC patients and 10/10 AIDS patients. TRS have already been described in various pathological situations and seem to be related to alpha-interferon, test tube and ring shaped forms (TRF) were observed in lymphocytes and macrophages in 0/6 ARC patients and 6/10 AIDS patients. TRF have been rarely reported previously. The 6 AIDS patients with TRF were 4 homosexuals and 2 Haitians. In two of three of these patients in whom repeated ultrastructural studies were performed, the same markers were found. All AIDS patients with TRF died within a mean time of ten months after the diagnosis had been established, whereas 1/4 AIDS patients without TRF died within seven months and the three others survived for more than 14 months. These data suggest that the association of TRS and TRF in the rectal mucosa could be specific of AIDS. In LAV/HTLV III retro-virus infection, this association is an aggravating factor.

Acquired Immunodeficiency Syndrome↗
PubMed1985

[Treatment of severe staphylococcal infections. Failure of rifampicin in combination therapy. 4 cases].

Seven patients with severe methicillin-resistant Staphylococcus aureus infections (5 with bacterial endocarditis, 1 with mediastinitis and 1 with meningitis and septicaemia) were treated with rifampicin combined with vancomycin in 6 cases and with gentamicin in 1 case. The 7 strains initially isolated from haemocultures were resistant to methicillin and sensitive to rifampicin. In 4 of these patients (3 of whom received vancomycin and 1 gentamicin) clinical and bacteriological failure was observed, with selection of rifampicin-resistant mutants. Bactericidal activity was always mediocre in both serum and cerebrospinal fluid, with insufficient vancomycin and gentamicin concentrations in 3 patients. An in vitro study of the combined antibiotics by the chequer-board method suggested antagonism in 3 of these 4 cases. Thus, in spite of its excellent activity and unquestionable effectiveness, rifampicin should be used with caution in severe staphylococcal infections.

Anti-Bacterial Agents↗
PubMed1984

Late prosthetic valve endocarditis. Bacteriological findings and prognosis in 29 cases.

Of 296 incidences of infectious endocarditis seen between 1971 and 1980, 29 cases of late prosthetic valve endocarditis (10%) occurred in 26 patients who had undergone valve replacement more than two months previously. The prosthesis was mitral in 8 cases, aortic in 9 cases, and multiple in 12 cases. The clinical picture consistently associated fever together with a regurgitation murmur in 12 cases (41%), a splenomegaly in 7 cases, a neurologic accident in 13 cases and other signs of endocarditis in 10 cases. Blood cultures were positive in 28 cases. The diagnosis was confirmed anatomically in 11 cases. Thirty-one causative agents were identified: 15 streptococci (48%), most of them were group D (11/15), 11 staphylococci (35%) 6 Staphylococcus aureus, 5 Staphylococcus coagulase negative and 5 other species. Two relapses and 3 recurrent infections were noted. The death rate was 58% with some factors being associated with a higher death rate: non-streptococcal micro-organism (87%) regurgitation murmur (83%) cardiac failure with dysfunction of the prosthesis (89%) neurologic complication (91%). Eight valve replacements were performed within a mean period of 32 days after the onset of the antibiotherapy with a death rate of 75%. It decreased to 50% for patients treated with antibiotic alone, and as low as 23% for Streptococcal endocarditis. These results suggest that earlier and more frequent indications for cardiac valve replacement could be an alternative to improve the prognosis.

Endocarditis, Bacterial↗
PubMed1984

[West Nile virus meningomyeloencephalitis--value of interferon assays in primary encephalitis].

A 68 year-old woman contracted West Nile fever after a stay of one month in Israel. Mild encephalitis and severe myelitis, resembling the "polio syndrome", developed, with important sequelae. Specific antibodies against West Nile fever virus progressively increased in the patient's serum. Epidemiological and clinical data about neurologic aspects of this infection are reviewed. Meningoencephalitis is not unusual, but only one previous case of acute anterior myelitis has been described in humans although this pathology is well known in experimental and veterinary diseases. Very few studies concern interferon and arbovirus infections in humans. Interferon assays in our patient's serum and cerebrospinal fluid showed its presence and persistence: this is in relation with the replication of the virus in the central nervous system, as it has been demonstrated in other primary viral encephalitis.

Aged↗
PubMed1982

[Adenine arabinoside treatment of varicella and generalized herpes zoster in 43 immunosuppressed patients].

Forty-three immunosuppressed patients presenting with varicella or generalized herpes zoster were treated with adenine arabinoside (as monophosphate in 10 patients). All those who received the recommended 5-day course were rapidly cured without relapse; the skin lesions were virus-free after the 5th days of treatment. Five patients with malignant varicella involving several organs and who had only been treated for a few hours died. It is concluded that adenine arabinoside is a useful drug in VZ virus infections, although it has no immediate action. The monophosphate presentation, more soluble and requiring lesser amounts of solvent, is easier to administer and as effective as the ordinary presentation.

Adolescent↗
PubMedDate not supplied

Progression to AIDS or death as endpoints in HIV clinical trials.

PURPOSE: To assess progression to AIDS or death from month 4 after a protease inhibitor-containing regimen is initiated in a cohort of 1,281 patients. METHOD: We used Kaplan-Meier estimates of probability of clinical progression. RESULT: At month 4, most patients had an HIV-1 RNA plasma value below 500 copies/mL (78%) and a CD4 cell count above 300 cells/mm(3) (62%). Starting from month 4, clinical progression at 1 and 2 years of follow-up was low (<3% at 1 year) in patients with HIV RNA <500 copies/mL or 500-10,000 copies/mL and in patients with CD4 between 50 and 300 cells/mm(3) or >300 cells/mm(3). A higher risk of clinical progression (> or =10% at 1 year) was evidenced only in patients with poor response to antiretroviral therapy, that is, with CD4 <50 cells/mm(3) or CD4 between 50-300 cells/mm(3) together with an HIV RNA >10,000 copies/mL. CONCLUSION: In patients currently on antiretroviral therapy, clinical trials with clinical progression as endpoint are almost not feasible, except in patients with a poor immunovirological response to first- or second-line HAART.

Anti-HIV Agents↗
PubMedDate not supplied

Self-reported symptoms after initiation of a protease inhibitor in HIV-infected patients and their impact on adherence to HAART.

PURPOSE: The purpose of our study was to assess short-term self-reported symptoms in patients who were started on two nucleoside reverse transcriptase inhibitors and one protease inhibitor (PI) in the multicenter APROCO cohort (N = 336) and to assess the influence of these symptoms on adherence. METHOD: Adherence and patient's reported symptoms were measured at 1 and 4 months (M) after initiation of highly active antiretroviral therapy (HAART) through self-administered questionnaires. RESULTS: Most patients reported at least one symptom (94.0% at M1; 88.0% at M4); fatigue and diarrhea were the most often reported symptoms. Respectively, 81.3% and 75.0% of patients were strictly adherent to HAART during the 4 days prior to M1 and M4 visits. After adjustment for younger age, history of antiretroviral treatment, unstable housing, poor social support, and alcohol consumption, patients who reported a high number of symptoms at M1 were more likely to be nonadherent at M4 (odds ratio per symptom = 1.13; 95% CI = 1.03-1.24). CONCLUSION: Patients reporting a high number of symptoms soon after HAART initiation are at higher risk of future nonadherence and could be targeted for interventions to achieve good levels of adherence and to improve treatment outcome.

Adult↗