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Biomedical subjects

E Caumes

Publications and source records attributed to E Caumes.

At least 55 records · Page 3Linked to original sources
PubMed2001

[Fainting after drinking a glass of whiskey-soda...].

BACKGROUND: Alcohol intolerance is a rare syndrome that usually involves pain, pruritus, or vasomotor phenomena consecutive to moderate alcohol intake. This syndrome may unmask various malignancies, especially Hodgkin's disease or non-Hodgkin lymphoma, and carcinoma of the cervix. CASE REPORT: A patient who became unconscious after drinking a glass of whiskey-cola was explored for alcohol intolerance. High-level hypereosinophilia was discovered. The diagnosis of idiopathic hypereosinophilia was retained after extensive evaluation. DISCUSSION: Idiopathic hypereosinophilia may be a premalignancy expression of a lymphoproliferative disorder. In our patient, who also had alcohol intolerance known to be associated with later diagnosis of malignancy, lymphocyte phenotype studies revealed an abnormal population. However, rearrangement studies of T-cell and B-cell receptors, as well as bone marrow cytology and histology did not enable identification of a lymphoproliferative disorder. This patient will require close follow-up due to the risk of developing a lymphoproliferative disorder.

Abdominal Pain↗
PubMed2001

[New indications of ivermectin].

INTRODUCTION: Ivermectin is a semi-synthetic derivative of a family of macrocyclic lactones. This drug has a broad-spectrum anti-parasitic effect against various nematodes and ectoparasites. CURRENT KNOWLEDGE AND KEY-POINTS: Onchocerciasis and lymphatic filariasis are common indications. More recently ivermectin has been recommended in the treatment of strongyloidiasis and scabies. FUTURE PROSPECTS AND PROJECTS: Promising results have been shown in the treatment of ascariasis, cutaneous larva migrans, loiasis and head lice.

Antiparasitic Agents↗
PubMed2001

[Epidemiological features and incidence trends of primary cerebral lymphomas observed in 80 HIV-infected patients from 1983 to 1999].

OBJECTIVE: To describe the epidemiological characteristics of primary central nervous system lymphoma (PCNSL) and the evolution of the incidence of this lymphoma in HIV-infected patients with a more than 17-year follow-up. RESULTS: Eighty cases of PCNSL were analyzed from a data base of 2,263 AIDS subjects followed from 1983 to 1999 (3.5% of the patients with AIDS). At the time of diagnosis, PCNSL was the first AIDS defining event in 36% of the cases, median CD4 count was 9/mm3 (0-134); 82% of the patients were given antiretroviral therapy (HAART = 0). Only eight cases of PCNSL were observed after 1996 (median HIV RNA level: 250,000 copies/mL (24,000-1,500,000)). The incidence was 39 per 100 patients-year in 1991 and decreased to 1.9 in 1999. At the end of the study, 78 patients had died (98%). The median survival was one month before 1996 ([0-27], n = 72), and was ten months after ([0-44], n = 8). Two patients were still alive 38 and 44 months after diagnosis. After 1996, survival was increased in patients with good response to antiretroviral treatment and in patients with high CD4 count at the moment of diagnosis. CONCLUSION: After the introduction of HAART (1996), the incidence of PCNSL has decreased drastically and survival was increased.

Adult↗
PubMed2001

Neurologic sequelae after severe falciparum malaria in adult travelers.

Severe falciparum malaria usually occurs in nonimmune patients, namely children in endemic areas or travelers returning from tropical areas. It generally has one of two outcomes: rapid death or cure without sequelae. Neurologic sequelae have been reported in children but have not been described in detail in adults. The purpose of this study was to determine the clinical spectrum, neuroimaging aspects and long-term outcome of these sequelae. We describe six imported cases of severe malaria with neurologic sequelae in adults, seen in a Parisian university hospital over a 10-year period. The most striking findings were neuropsychological disorders, in particular memory impairment and diffuse white matter damage on magnetic resonance imaging. Only three of the patients had made a full recovery after 6 months.

Adult↗
PubMed2001

[Metronidazole].

Metronidazole was first introduced for the treatment of trichomoniasis. Now, its therapeutics use has subsequently been expanded to include protozoal and anaerobic infections. Oral administration is recommended: rosacea, perioral dermatitis, Helicobacter pylori, Trichomonas vaginalis and Giardia lamblia infections and bacterial vaginosis. Metronidazole given orally is absorbed almost completely. Metronidazole has limited plasma protein binding but can reach very favourable tissue distribution, including central nervous system and placenta. This drug is extensively metabolised by the liver to form 5 oxydative metabolites. The majority of this drug and metabolites are excreted in urine and feces. The half-life is 6 to 10 hours. The recommended dose is 500 mg three time per day and an adaptation is necessary in renal insufficiency. Metronidazole is well tolerated when administered in dosages of less than 2 g per day. Some adverse reactions appear to be related to the high dosages and treatment duration. Drug interactions with alcohol, warfarin and phenytoin have been reported. Mutagenesis and cancerogenesis is only described in mouse. Resistance, both clinical and microbiological, has been described only rarely.

Anti-Infective Agents↗
PubMed2000

Impact of highly active antiretroviral therapy on onset of Mycobacterium avium complex infection and cytomegalovirus disease in patients with AIDS.

OBJECTIVES: To assess the impact of highly active antiretroviral therapy (HAART) on the onset of first disseminated Mycobacterium avium complex (MAC) infection and first cytomegalovirus (CMV) disease episode in HIV-infected at-risk patients. METHODS: The incidence of the two infections occurring in at-risk patients was calculated for two periods (January 1995-June 1996 and July 1996-December 1997) using the database of the HIV-infected patients followed in the Infectious Diseases Department at the Pitié-Salpêtrière Hospital in Paris. HAART was progressively introduced in late June 1996 in France. RESULTS: A total of 91 first disseminated MAC infections and 124 first CMV disease episodes were recorded. The incidence of first disseminated MAC infections fell from 13.4 per 100 person-years in the first 18-month period to 2.6 per 100 person-years in the second 18-month period. Similarly, the incidence of first CMV disease episodes fell from 20.9 to 3.5 per 100 person-years. Fourteen patients on HAART developed a first MAC infection, 12 (85.7%) within 2 months of starting HAART. Nineteen patients on HAART had a first CMV disease episode, 10 (52.6%) within 2 months of starting HAART. CONCLUSIONS: HAART led to a five-fold decrease in the incidence of first disseminated MAC infections and a six-fold decrease in first CMV disease episodes, although patients remain vulnerable to both diseases for approximately 2 months after starting HAART.

AIDS-Related Opportunistic Infections↗
PubMed2000

Herpes zoster.

Explore the source record for details and available documents.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Treatment of cutaneous larva migrans.

Cutaneous larva migrans caused by the larvae of animal hookworms is the most frequent skin disease among travelers returning from tropical countries. Complications (impetigo and allergic reactions), together with the intense pruritus and the significant duration of the disease, make treatment mandatory. Freezing the leading edge of the skin track rarely works. Topical treatment of the affected area with 10%-15% thiabendazole solution or ointment has limited value for multiple lesions and hookworm folliculitis, and requires applications 3 times a day for at least 15 days. Oral thiabendazole is poorly effective when given as a single dose (cure rate, 68%-84%) and is less well tolerated than either albendazole or ivermectin. Treatment with a single 400-mg oral dose of albendazole gives cure rates of 46%-100%; a single 12-mg oral dose of ivermectin gives cure rates of 81%-100%.

Antinematodal Agents↗
PubMed2000

Induction and maintenance therapy of cytomegalovirus central nervous system infection in HIV-infected patients.

OBJECTIVE: To evaluate the efficacy and safety of the foscarnet-ganciclovir combination in induction therapy (IT) and maintenance therapy (MT) for cytomegalovirus (CMV) central neurological disorders in HIV-infected patients. DESIGN: An open pilot non-comparative multicentre study. METHODS: Thirty-one patients with acute CMV encephalitis (CMVe) (n = 17) or CMV myelitis (CMVm) (n = 14) during the era before highly active antiretroviral therapy (HAART) received intravenous IT with foscarnet 90 mg/kg plus ganciclovir 5 mg/kg twice a day followed by MT. The primary endpoint was clinical efficacy, assessed at the end of the induction phase. RESULTS: The foscarnet-ganciclovir combination in IT resulted in a 74% (23 out of 31 patients) clinical improvement or stabilization. Eight patients did not respond clinically. Side-effects leading to drug discontinuation occurred in 10 patients during IT. Among the 23 patients who qualified for the maintenance phase, CMV disease progressed in 10, with a median time to the first relapse of 126 days (range 64-264 days). Overall, the median survival time was 3 months [95% confidence interval (CI), 2-4 months]. CONCLUSION: The combination of foscarnet and ganciclovir can safely be used for CMV central nervous system (CNS) infection, with an improvement or stabilization in 74% of patients. Life-long MT with this combination is recommended as long as the immune system is profoundly impaired.

AIDS-Related Opportunistic Infections↗
PubMed2000

[Emerging and re-emerging infectious diseases--a challenge for public health].

We have recently seen a worldwide explosion of infectious diseases: emerging diseases like the HIV/AIDS pandemic, or old diseases like cholera, tuberculosis, diphteria, plague, yellow fever, dengue, or malaria. These reemerging diseases are on the surge because of multiple factors: environmental changes, transformation of ecosystems, ongoing socioeconomic degradation and deterioration of public health systems in many countries. The increasing bacterial resistance to antibiotics or virologic resistance to antiviral drugs are becoming a serious problem today. This global danger needs a global response. There must be a cooperation between the different actors in the field of public health. The general practitioner should look for good therapeutic compliance, control vaccinations, and give his patients health education, including prevention of HIV and other sexually transmitted diseases.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Neurological complications of varicella-zoster virus infection in adults with human immunodeficiency virus infection.

This multicentre retrospective study describes the clinical features and prognostic significance of Varicella-zoster virus (VZV)-associated neurological complications. The study was performed in patients with human immunodeficiency virus (HIV) infection, hospitalized for VZV neurological complications, confirmed in every case by positive VZV polymerase chain reaction (PCR) in cerebrospinal fluid (CSF). Between 1990 and 1995, 34 HIV-infected patients were included in the study. At diagnosis, 59% had AIDS, with a median CD4 count of 11 x 10(9)/l. A past history of zoster was noted in 35% of cases. A concomitant herpes zoster rash and/or acute retinal necrosis were noted in 71% and 12% of patients, respectively. The predominant neurological manifestations were encephalitis (13), myelitis (8), radiculitis (7) and meningitis (6). The mean CSF white blood cell count was 126/mm3 and the mean CSF protein concentration was 2.3 g/l. Interferon-alpha level was increased in 36% of patients. VZV was isolated from CSF cultures in 2/6 cases. Magnetic resonance imaging was abnormal, demonstrating encephalitis lesions. After intravenous antiviral therapy, complete recovery was obtained in 18 cases (53%), serious sequelae were observed in 10 cases (29%) and 6 patients died (18%). Severe symptoms and a low CD4 cell count appeared to be associated with death or sequelae. In conclusion, VZV should be considered as a possible cause of encephalitis, myelitis, radiculitis or meningitis in HIV-infected patients, especially in patients with a history of or concomitant herpes zoster or acute retinal necrosis. VZV-PCR in the CSF may allow rapid diagnosis and early specific antiviral treatment.

Adult↗
PubMed2000

[Cutaneous vasculitis disclosing pulmonary tuberculosis].

We report the case of a patient with leukocytoclasic vasculitis that disclosed active pulmonary tuberculosis. This patient had no signs of systemic vasculitis. The clinical course was favorable with anti-tuberculosis drugs alone. There has been no recurrence at 8 months. Vasculitis associated with tuberculosis is uncommon. The pathophysiological mechanism remains uncertain. No immunosuppressor treatment is needed and the vasculitis generally regresses with treatment of the infection.

Humans↗
PubMed2000

[Coxiella burnetii pneumopathy on return from French Guiana].

Q fever is a worldwide zoonosis but is not often a common cause of fever among travellers returning from the tropics. We report a case of acute Q fever, revealed by a pneumonia and acquired by a traveller in French Guyana. The chest radiography showed alveolar opacities and pleural effusion. Biological abnormalities were elevated liver enzyme levels and thrombocytopenia. The patient improved or the third day of antibiotic treatment. She mentioned that 3 other people she lived with during her trip had been diagnosed with Q fever. A common source outbreak was then suspected. They all stayed in the same farm in French Guyana. Animal exposure occurred there, in particular with a goat and a dog (both were parturient). The disease was probably transmitted by airborne dust to our patient, as no other vectors of transmission were found. Since the clinical presentation of Q fever is not specific, in order for the physician to diagnose it, he must have an awareness of the disease. Our case emphasised that looking for risk factors of Coxiella burnetii exposures is particularly important. Amongst them, the most important seems to be contact with farm animals. The clinician should thus try to trace such a possible contact when treating a case of traveler's Q fever.

Adult↗