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Biomedical subjects

C Leport

Publications and source records attributed to C Leport.

At least 91 records · Page 5Linked to original sources
PubMed1996

Comparison of infective endocarditis in patients with and without previously recognized heart disease.

In a consecutive series of patients with infective endocarditis, we compared the charts of 123 nonaddicted patients without previously known heart disease with those of 174 patients with native valve disease. The 2 groups were similar in age, sex, clinical findings, and mortality rates, but infective endocarditis was more often located on the aortic valve, more often due to Streptococcus bovis and enterococci in patients without previously known heart disease.

Aged↗
PubMed1996

Pulmonary toxoplasmosis in patients infected with human immunodeficiency virus: a French National Survey.

We reviewed all cases of pulmonary toxoplasmosis (PT) that were documented by detection of Toxoplasma gondii in bronchoalveolar lavage fluid specimens during a French nationwide review of extracerebral toxoplasmosis in patients infected with human immunodeficiency virus (HIV). Only 64 cases of proven PT were recorded during the 33-month survey. The patients were similar to other patients with AIDS in terms of age, sex, and risk factors for HIV infection. PT occurred mainly in patients with advanced immunodeficiency (mean [+/- SD] CD4+ lymphocyte count, 40 +/- 75/mm3). Clinical features of PT usually include fever, cough and dyspnea; the associated radiological findings were mainly diffuse interstitial infiltrates. Serological data were uninformative. The treatment for PT was the same as that for cerebral toxoplasmosis. A clinical response was observed for 47% of patients, 23% of whom relapsed. Twenty-four patients (37%) died of toxoplasmosis, and 17 (27%) died of other causes. The median survival time was 150 days. We conclude that PT is an infrequent but severe infection in HIV-patients in France.

AIDS-Related Opportunistic Infections↗
PubMed1996

Pyrimethamine for primary prophylaxis of toxoplasmic encephalitis in patients with human immunodeficiency virus infection: a double-blind, randomized trial. ANRS 005-ACTG 154 Group Members. Agence Nationale de Recherche sur le SIDA. AIDS Clinical Trial Group.

Pyrimethamine (50 mg) with folinic acid (15 mg) given three times weekly was assessed as primary prophylaxis for toxoplasmic encephalitis (TE) in 554 human immunodeficiency virus-infected patients seropositive for Toxoplasma gondii and with < 200 CD4 cells/mm3. At 1 year, the incidence of TE was similar in pyrimethamine, 12%, and placebo, 13%, groups (relative risk [RR], 0.9; 95% confidence interval [CI], 0.6-1.4), and the survival rate was also similar, 85% and 80%, respectively (RR, 0.9; 95% CI, 0.7-1.2). Rash was the only adverse event that appeared significantly more frequently in the pyrimethamine arm (7% vs. 1%). In the on-treatment analysis, the incidence of TE was lower in the pyrimethamine arm, 4%, than in the placebo arm, 12% (P < .006). Thus, pyrimethamine cannot be recommended as a first-line regimen for primary prophylaxis of TE if the patient can take cotrimoxazole. However, it should be considered for patients who are intolerant to cotrimoxazole, especially in high-risk patients with < 100 CD4 cells/mm3.

AIDS-Related Opportunistic Infections↗
PubMed1996

Predictive value of Toxoplasma gondii antibody titres on the occurrence of toxoplasmic encephalitis in HIV-infected patients. ANRS 005/ACTG 154 Trial Group.

OBJECTIVE: To study the predictive value of anti-Toxoplasma gondii antibody titres for the occurrence of toxoplasmic encephalitis (TE) in HIV-infected patients. METHODS: Data from the placebo arm of a trial of primary prophylaxis for TE (ANRS 005/ACTG 154) were analysed. Patients included had CD4+ cell counts < 200 x 10(6)/l and a positive Toxoplasma serology. Immunoglobulin (Ig) G and IgM Toxoplasma antibody titres at entry were retrospectively determined by enzyme-linked immunosorbent assay and agglutination on serum samples in a single laboratory. Incidence of TE was estimated by Kaplan-Meier method and a Cox model was used to study the predictive value of antibody titres, adjusted for other covariates. RESULTS: All 164 patients studied were positive for IgG antibodies and one had IgM antibodies. After a mean follow-up of 16 months, 31 cases of TE were documented. One-year incidence of TE was significantly higher in patients with IgG titres > or = 150 IU/ml (23.7%) than in patients with titres < 150 IU/ml (7.7%; relative risk, 3.1; P < 0.003). IgG titres remained significantly associated with the occurrence of TE (relative risk, 3.3; P < 0.005) in the Cox model. Predictive value of IgG titres did not differ according to baseline CD4+ cell counts. CONCLUSIONS: In patients with CD4+ cell counts < 200 x 10(6)/l, IgG anti-Toxoplasma antibody titre is a prognostic factor of occurrence of TE, with a higher risk for titres > or = 150 IU/ml. This finding should reinforce the recommendation of specific prophylaxis in these patients.

AIDS-Related Opportunistic Infections↗
PubMed1996

Response to fluconazole by 23 patients with human immunodeficiency virus infection and oral candidiasis: pharmacological and mycological factors.

The MICs of fluconazole for strains of Candida species and the levels of fluconazole in serum were determined at day 0 and day 14 for 23 human immunodeficiency virus-infected patients with oral candidiasis who were treated orally with 100 mg of fluconazole per day for 14 days. Among the 23 patients, 11 (48%) were not clinically cured and had persistent isolation of Candidiasis albicans (n = 10) and/or presence of non-C. albicans (n = 6). Clinical response could be predicted by the susceptibility of the strain to fluconazole determined at day 0. All 12 patients who were cured were infected with a strain for which the MIC was < 0.78 mg/liter. All four patients who were infected with a strain for which the MIC was > 3.12 mg/liter experienced clinical failure. These data suggest that a C. albicans strain could be defined as being susceptible when the MIC of fluconazole is < 0.78 mg/liter and as being resistant when the MIC is > 3.12 mg/liter.

AIDS-Related Opportunistic Infections↗
PubMed1996

Life expectancy in hospitalized patients with AIDS: prognostic factors on admission.

In the course of the inevitable hospitalizations of AIDS patients, many difficult questions concerning curative and palliative approaches to care have to be answered. In order to guide these strategies, we conducted a prospective study to identify those variables which can be easily quantified on admission which might be predictive of patient outcomes. Between 1 June 1990 and 25 April 1991, 140 consecutive hospitalizations of 83 AIDS patients were recorded. Demographic, clinical, and biological data were collected within 48 hours of admission. Probable (p <0.10) or definite (p <0.05) factors contributing to a higher mortality included type of opportunistic infections, serum albumin level, total lymphocyte count, weight, CD4 cell count, and neurological manifestations. In the multivariate proportional hazards model, two factors were significantly and independently predictive of lower survival: body weight less than 90% of ideal body weight and neurologic manifestations. The probability of survival was significantly affected by the number of predictive factors present on admission, and patients were significantly more likely to die when these latter two factors were present concomitantly. These factors might be useful to define the optimal mode of care for hospitalized AIDS patients, considering both patients' wishes and an objective assessment of the prognosis.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Infective endocarditis in patients with negative blood cultures: analysis of 88 cases from a one-year nationwide survey in France.

Blood cultures were negative in 88 (14%) of 620 cases of infective endocarditis (IE) documented in France during a 1-year nationwide survey. In 15 of these 88 cases, the causative microorganism was identified: seven cases of Q fever endocarditis and two cases of chlamydial endocarditis were diagnosed by serological and/or immunohistologic techniques, and a pathogen was cultured from five surgically removed valves and one arterial septic embolus. Forty-two (48%) of the 88 cases involved patients who had received antibiotics before the first blood sample was taken for culture. Mortality was lower in this group than among patients who had not previously received antibiotics (7% vs. 22%, P = .05). Comparison of blood culture-negative cases of IE with blood culture-positive cases revealed that the former tended to occur more often on prosthetic valves (32% vs. 22%, P = .16), were more often left-sided (97% vs. 83%, P = .0009), less often included extracardiac symptoms at presentation (52% vs. 63%, P = .06), and were more often surgically treated (53% vs. 34%, P = .001). Mortality was similar regardless of the results of blood culture (15% vs. 21%, P = .18). This study showed that more than 10% of all cases of IE in France are still associated with negative blood cultures and confirmed that a search for pathogens such as Coxiella burnetii and Chlamydia species is worthwhile in this situation.

Adolescent↗
PubMed1995

Antibiotic prophylaxis for infective endocarditis from an international group of experts towards a European consensus. Group of Experts of the International Society for Chemotherapy.

Antibiotic prophylaxis for infective endocarditis is recommended for cardiac patients at risk who undergo an at-risk procedure. Efforts should focus on patients with the highest risk, i.e., those with a prosthetic valve undergoing a dental procedure. Amoxicillin is the main recommendation in patients who are not allergic to penicillin. In patients allergic to penicillin clindamycin orally or vancomycin intravenously are proposed. Aminoglycosides are added for gastrointestinal or urological procedures.

Anti-Bacterial Agents↗
PubMed1995

Procedures associated with infective endocarditis in adults. A case control study.

OBJECT: To assess the relative risk of infective endocarditis associated with various procedures and the protective efficacy of antibiotic prophylaxis by a case-control study. BACKGROUND: Recommendations for the prevention of infective endocarditis are based on the hypothesis of a relationship between procedures and infective endocarditis which is supported by anecdotal reports and data from experimental models. METHODS: Cases met the Von Reyn's diagnostic criteria modified with echocardiographic and macroscopic findings Controls were recruited from cardiology or medicinal wards. Cases (n = 171) and controls were matched as regards sex, age and underlying cardiac condition. They were requested to indicate all the medical, surgical or dental procedures within the previous 3 months. Among potential confounding factors, infectious episodes and skin wounds in the previous 3 months were reported. Antibiotic prophylaxis administration was documented for type, dosage, duration and administration schedule. RESULTS: Cases significantly more frequently than controls had undergone at least one procedure (matched odds ratio, 1.6; 95% confidence interval, 1.01 to 2.53). Dental procedures considered as a whole were not associated with an increased risk, although scaling and root canal treatment showed a trend towards a higher risk of infective endocarditis (P = 0.065). Among non-dental procedures, only surgery appeared to be at risk (matched odds ratio, 4.7; 95% confidence interval, 1.02 to 22). Considering all procedures, the risk of infective endocarditis increased significantly with the number of procedures. While general co-morbid conditions did not differ between the two groups, cases significantly more frequently than controls had experienced an infectious episode or a skin wound. In multivariate analysis, only infectious episodes and skin wounds significantly increased the risk of infective endocarditis. Scaling was the only independent risk factor for viridans streptococcal infective endocarditis. The 46% protective efficacy of antibiotic prophylaxis was not significant. CONCLUSIONS: Procedures do increase the risk of infective endocarditis. The interpretation of the apparent low risk associated with dental procedures may be as a result of the current practice of antibiotic prophylaxis. Our data suggest that surgery should be more clearly mentioned in future guidelines, and reemphasize that a rigorous treatment of any focal infection in cardiac patients is mandatory. From the efficacy rate of antibiotic prophylaxis,it can be estimated that the overall incidence of infective endocarditis might be reduced by 5 to 10% in France by appropriate use of antibiotic prophylaxis in cardiac patients.

Adult↗
PubMed1995

Characteristics of infective endocarditis in France in 1991. A 1-year survey.

OBJECTIVE: To update data on incidence and characteristics of infective endocarditis in France. BACKGROUND: Numerous studies have shown that the incidence and course of infective endocarditis remain stable in spite of advances in treatment and of prophylactic recommendations. METHODS: A survey of all consecutive cases of infective endocarditis was conducted over 12 months in all the institutions of three French regions. RESULTS: Data were collected from 415 cases of definite (32%), probable (53%), and possible (15%) infective endocarditis. The adjusted annual incidence was 24.3 cases per million inhabitants. Thirty-four percent of the patients had no previously known heart disease, 33% had native valve disease, 22% had a prosthetic valve, and 11% had miscellaneous underlying conditions. Infective endocarditis was located solely on the mitral valve in 39%, solely on the aortic valve in 36%, and on the tricuspid valve in 6%. Echocardiography showed a vegetation on the mitral valve in 39%, on the aortic valve in 29%, and on the tricuspid valve in 8%. The causal microorganism was identified in 92%; it was a Streptococcus in 58%, and a Staphylococcus in 23%. Twenty patients were intravenous drug users, and 45 had had a medical or a surgical procedure, which might be associated with the occurrence of infective endocarditis. During the first 2 months after admission, 24% of the patients underwent surgery, and 17% of all patients died. CONCLUSIONS: Despite medical and surgical advances, infective endocarditis remains frequent and severe in France.

Adolescent↗
PubMed1995

RP 59500 prophylaxis of experimental endocarditis due to erythromycin-susceptible and -resistant isogenic pairs of viridans group streptococci.

RP 59500 is a new injectable streptogramin composed of two synergistic components (quinupristin and dalfopristin) which are active against a number of erythromycin-susceptible and -resistant gram-positive bacteria. The following experiments investigate the ability of RP 59500 to prevent experimental endocarditis due to either of two erythromycin-susceptible streptococcal isolates or their constitutively erythromycin-resistant Tn916 delta E transconjugants. RP 59500 had low MICs (0.125 to 0.5 mg/liter) for all four test organisms and was substantially bactericidal in vitro. Rats with catheter-induced aortic vegetations were given single-dose antibiotic prophylaxis 30 to 60 min before bacterial inoculation through a computerized pump system which permitted the simulation of drug kinetics for humans produced by either 7 mg of RP 59500 per kg of body weight or 1 g of vancomycin. Single-dose RP 59500 prophylaxis successfully prevented endocarditis due to both the erythromycin-susceptible parent strains and their erythromycin-resistant derivatives in rats challenged with the minimal inoculum infecting 90% of controls. In addition, RP 59500 also prevented infection in animals challenged with fivefold-larger inocula of the erythromycin-susceptible parent strains. Vancomycin successfully prevented endocarditis due to any of the four test organisms. These results underline the in vivo efficacy of RP 59500 against both erythromycin-susceptible and -resistant streptococci. Such good results against the resistant strains would not be expected with erythromycin or clindamycin, which are the standard macrolidelincosamide-streptogramin antibiotics used for endocarditis prophylaxis in humans. An oral form of RP 59500 which might advantageously replace some of the older prophylactic regimens is currently being developed.

Animals↗
PubMed1994

Empiric antituberculosis treatment: benefits for earlier diagnosis and treatment of tuberculosis.

SETTING: Tuberculosis may be diagnosed too late, especially in HIV-infected patients, with consequences on bacillus transmission and survival. Empiric antibuberculosis treatment (EATT) may be started before diagnosis of tuberculosis is confirmed. As rifampicin is a broad spectrum antibiotic, EATT including rifampicin may be effective in infections other than tuberculosis, leading to misdiagnosis. OBJECTIVE: To define the efficiency criteria of EATT with or without rifampicin. DESIGN: Between 1988 and 1991, 20 febrile patients with suspected tuberculosis (including 15 who were HIV-positive) were started on EATT in the absence of bacteriological or histological proof of tuberculosis. 10 patients (50%) received a 4-drug non-specific EATT including rifampicin, isoniazid, pyrazinamide and ethambutol, and 10 (50%), received a 3-drug specific EATT without rifampicin. RESULTS: In 10 patients (50%), the diagnosis of tuberculosis was confirmed by positive cultures within a mean of 32 days (15-57 days) after the beginning of EATT (group TB 1). Of the 10 patients whose cultures remained negative, 4 (20%) became afebrile and showed improvement under EATT (group TB 2), and 6 (30%) remained febrile and did not improve (group No TB). Patients from groups TB 1 and TB 2 became afebrile within a mean of 11 days (1-54 days). This delay was not different between patients receiving specific or non-specific EATT. In patients receiving specific EATT, rifampicin was added to the initial 3-drug treatment after resolution of fever. CONCLUSION: EATT appears to be a useful method for rapid presumptive diagnosis and treatment of tuberculosis.

AIDS-Related Opportunistic Infections↗