[Hemorrhagic fever with renal syndrome in Picardy].
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Biomedical subjects
Publications and source records attributed to E Dournon.
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The incidence of Legionnaire's disease is probably underestimated in France. Its clinical presentation is very suggestive, especially after the failure of a 48 hour therapeutic trial of beta-lactams, when a pneumococcal infection is initially suspected. This one sign is sufficient to orient the diagnostic survey and constitutes an indication for a therapeutic trial of macrolides for at least 72 hours. In fact, the delay in the diagnosis appears to be the determinant factor in the fatal outcome of the disease.
Two new cases of Lyme disease are reported. Both were contracted in western France. In the first case, a tick bite was followed by a typical erythema chronicum migrans and then a subacute arthritis. High levels of specific antibodies were demonstrated. In the second case, only erythema chronicum migrans developed and serology remained negative. At least, 16 typical cases of Lyme disease have now been reported in France from several geographical areas.
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A qualitative and quantitative survey of environmental Legionella in the Paris area was undertaken because of its epidemiological implications. Over a 2-year period, 322 water samples from the Paris area (unrelated to a legionnaires' disease outbreak) were examined for the presence of Legionella. No Legionella strain was isolated from the main water supplies of the municipality or from the distribution entry points of 36 buildings. Inside buildings, however, 84/190 (44.2%) tap water samples yielded one or several strains of Legionella (10(2) to 10(6) CFU/l). Contamination was significantly more frequent in hot tap water than in cold tap water. Legionella was isolated from 11 out of 14 air-conditioning systems investigated. Sixty-four of the 132 strains isolated were L. pneumophila serogroup 1. Other strains were L. pneumophila serogroups 2 to 6 (including a serogroup 4-5 variant), L. longbeachae serogroup 2 and 6 atypical Legionella.
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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.
Four cases of legionnaires' disease were diagnosed by specific serologic tests in a group of 33 immunocompromised patients admitted to the same hematologic department for acute febrile pneumonitis. The underlying disease of these four patients was hairy-cell leukemia (HCL) in three cases and allogeneic bone marrow transplantation in the other. This article stresses the enhanced susceptibility of patients with HCL to Legionella pneumophila and discusses its possible causes, especially monocyte deficiency. We propose the use of erythromycin as part of the initial empiric antibiotic therapy in immunocompromised hosts with acute pneumonitis until the results of specific serologic tests or isolation of L pneumophila is obtained.
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