Biomedical subjects
Publications and source records attributed to D Raoult.
The authors tested 481 dog sera from the South of France for Rickettsia conorii antibodies using an Indirect Immunofluorescent Antibody Technique. Eighty percent of the sera were positive at a dilution of 1:32 and 45% at a dilution of 1:128. The authors conclude that this provides evidence of the endemic situation of Mediterranean Spotted Fever in the South of France.
In France, between 1974 and 1983, 1 194 diagnoses of L. icterohaemorrhagiae leptospirosis were confirmed serologically at Pasteur Institute (Paris), WHO Reference Center. The number of cases diagnosed each year rose from 74 in 1974 to 277 in 1983. The annual incidence in 1983 was 0.55 per 100 000. The temporal distribution shows that 25% of cases were in August and 63% between July and October. Two areas have a greater incidence: the South West and the East. The departments near the sea of the South East, the North and the West have the lowest incidence.
The damp environment and density of animal population in Camargue are good arguments for the study of leptospirosis. A serological and epidemiological survey on 642 blood samples revealed 36 (5.6%) with significant antibody titers. Icterohaemorrhagiae is followed by Canicola, Grippotyphosa, Australis and Ballum... The most endemic area is not Camargue but the area situated at the northeast (Basse-Durance). Women are twice more affected than men. These two results are not consistent with our initial hypothesis. It is always advisable to seek the etiology of fevers of unknown origin.
During Summer 1984 was conducted a prospective study concerning Mediterranean Spotted Fever (a rickettsiosis due to Rickettsia conorii) in the south of Corsica. The prevalence of symptomatic and typical cases was 48 per 100,000. A seroepidemiologic study made on blood donors of the same area shows a prevalence of antibody to R. conorii at 12% for a dilution of 1/32, 4.8% for 1/64 and 2.5% for 1/128. This study show that Corsica is, as well as south of France, Sicily and Spain an endemic country for Mediterranean Spotted Fever and that asymptomatic cases are mostly frequent.
The authors report 5 cases of leptospirosis with neurological symptoms. One case of polyradiculoneuritis, one case of meningoencephalitis, two of meningitis and a case a meningeal syndrome were observed. Three of these cases were contracted near Marseille, one in Singapour and one in Comores. The diagnosis was done by serology and the evolution was good.
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Leptospirosis in Tahiti was studied during 1981. 42 cases were detected by positive blood cultures grown in Stuart's medium. The present paper describes the isolation of leptospira from the blood of four cases 30 days after the date of onset.
A severe case of boutonneuse fever was reported which was only diagnosed after death. The infectious syndrome and cutaneous eruption were associated with meningitis, encephalitis, hypoxaemia and thrombocytopaenia. The absence of an initial lesion ("tache noire") and the notion of recent German measles contamination explained the late diagnosis. Serious cases of boutonneuse fever were usually rare; they were better known as Rocky Mountain spotted fever, a rickettsial infection of the same group, the clinical symptoms of which were very similar and which gave the same proteus agglutination reactions as with boutonneuse fever. An earlier diagnosis, now possible thanks to immunofluorescent techniques using skin biopsies, should enable earlier treatment.
A case of facial cellulitis of dental origin associating a retropterygoidal necrosis, a retro-orbital abscess and a cervicofacial cellulitis is reported. No related risk factors were found in this 28 year old man. Bacteriological analyses showed a mixed bacterial flora and the presence of candida. Direct examination favoured an anaerobic germ infection. However the culture and identification of theses germs were impossible. The clinical circumstances together with the results of facial computed tomography tended to make the diagnosis of an anaerobic cellulitis highly probable. The diagnostic and therapeutic managements are reviewed.
Indirect immunofluorescent staining was performed on cryostat sections of skin biopsy specimens from 21 patients. In six of the 11 cases finally diagnosed as Mediterranean spotted fever, coccobacillary forms of Rickettsia conorii were identified in these sections. A factor recognized as contributing to false-negative results was prior treatment with tetracycline. No false-positive results were obtained for 10 patients whose final diagnosis was not Mediterranean spotted fever. This laboratory test can aid in the early diagnosis of severe and atypical forms of Mediterranean spotted fever.
Mediterranean spotted fever is a rickettsiosis due to R. conori. The authors have tested 2 serological reactions available in this disease: Weil-Felix (WF) and indirect immunofluorescent antibody test IF. IF, tested on 184 sera is sensitive (100% of positivity 30 days after the onset of the disease) and specific if a four fold in two sera is obtained at a level upper than: 80. The WF tested on 112 sera is not specific and its sensitivity is poor.
Cefoperazone was given parenterally to 10 patients (9 woman and 1 man, aged 19 to 75 years) with positive blood cultures for Salmonella typhi (9 cases) or Salmonella paratyphi A (1 case). Daily dosage was 0.5 g on the first day, 1 g on the second and 2 g on the third. Five patients had 4 g on the fourth day. Average time to defervescence was five days. There were no relapses. Cefoperazone is therefore satisfactory for treating typhoid fever, especially caused by ampicillin- or chloramphenicol-resistant bacteria.
The authors report a case of neuro-endocrine sarcoidosis, associating panhypopituitarism , diabetes insipidus, and involvement of the optic chiasma with behavioural changes, chronic meningitis and a diffuse pyramidal syndrome. The diagnosis was suggested by the presence of mediastinal lymphadenopathy and confirmed during a surgical procedure to conserve the optic nerves. The clinical course on corticosteroids was unfavourable because of iatrogenic cushing' syndrome and steroid dependence . It was not possible to withdraw steroids, even with the use of immunosuppressors (Methotrexate).
The authors report two cases of bacteremia due to Campylobacter fetus fetus (also called C. fetus intestinalis). One was a 22-year-old female, under treatment for active systemic lupus erythematosus, who died. The other was a fifty-year-old male, in a poor general condition, who had a self-limited acute febrile dysentery. In this patient, C. fetus fetus was found in stools after apparent recovery, raising the problem of healthy carriers. A review of the literature shows 64 other such cases.
The authors report a case of atrophic rhinitis associated with Klebsiella ozaenae. The literature is reviewed. This pathogen could be involved in both respiratory tract infections and systemic diseases. The relationship between Klebsiella ozaenae and ozena is discussed.
Six cases of severe Mediterranean boutonneuse fever are reported. The clinical diagnosis, based on the presence of summer fever with an erythematous rash plus an escharr in three patients, was confirmed by serology (microagglutination in 1 case, indirect immunofluorescence in 4). The symptoms resembled those of Rocky Mountain spotted fever associating, as they did, a purpuric rash with neurological signs (impaired consciousness in all 6 cases, convulsion in 2), respiratory symptoms (5) and digestive signs (diarrhoea in 1 case, enlargement of the liver in 4). Laboratory examinations showed thrombopenia (6), rise in serum transaminases (5), LDH (5) and CPK (6), increased in blood urea and creatinine levels (6), hyponatraemia (6), hypokaliaemia (5) and hypocalcaemia (5). Two patients treated with doxycycline recovered and 4 died. Among these, 1 had received erythromycin, 1 a tetracycline and 1 doxycycline.
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