Biomedical subjects
E Senneville
Publications and source records attributed to E Senneville.
Failure of intravenous antibiotic therapy of multiple temporal brain abscesses due to Propionibacterium acnes requiring temporal lobectomy.
Propionibacterium acnes is a common skin colonizer. Its involvement in brain abscesses is generally described as a complication of neurosurgical intervention. Propionibacterium acnes is susceptible to antibiotics used as treatment of anaerobic infections, except for the 5-nitroimidazoles. Surgical excision or drainage of a simple abscess combined with a long course of antibiotics is considered the treatment of choice. A case of a patient with multiple brain abscesses located in the right temporal lobe that occurred after the manipulation of an abscess of the right upper maxillary is reported. The patient did not improve despite a prolonged course of high-dose intravenous penicillin plus thiamphenicol and cure was finally obtained after the excision of the right temporal lobe. Culture of the purulent material and the shell of the abscesses yielded P. acnes which was sensitive to all the antibiotics administered to the patient up to the intervention. The temporal lobectomy was followed by a 6-month course of ofloxacin. One year after the intervention, the patient remained apyretic without any other abscess on cranial computed tomography scan.
Isolated cutaneous Mycobacterium avium complex infection in AIDS.
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Pulmonary clofazimine crystals in two patients with the acquired immunodeficiency syndrome.
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Bilateral ureteral obstruction due to Saccharomyces cerevisiae fungus balls.
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[Hantavirus infection without renal involvement].
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Efficacy, safety and tolerance of parenteral piperacillin/tazobactam in the treatment of patients with lower respiratory tract infections.
An open, non-comparative multicentre study was conducted at 36 sites in six countries to test the efficacy and safety of piperacillin/tazobactam in the therapy of lower respiratory tract infections. Piperacillin 4 g and tazobactam 500 mg were administered intravenously every 8 h for a minimum of five days. Two hundred and thirty patients were enrolled: 133 were evaluable for clinical efficacy and 106 for bacteriological efficacy. The clinical response was favourable in 96% of evaluable patients and the bacterial eradication rate was 93%. Nine patients (4%) had severe adverse events related to piperacillin/tazobactam and requiring discontinuation of therapy. In this study piperacillin/tazobactam was an effective and safe drug in the treatment of hospitalized patients with lower respiratory tract infection caused by sensitive organisms.
[Bifocal spondylodiscitis simulating rhizomelic pseudo-polyarthritis].
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Broad- versus narrow-spectrum antibiotic use: the role of in vitro testing and its correlation with clinical efficacy.
The spectrum of activity of any antibiotic varies with time, the geographical locale and the site of isolation of the bacteria. This variability is related to the changing heterogeneity (specifically, the degree of resistance) of the bacterial population. In order to choose the most appropriate antimicrobial agent, it is necessary to know the infection site, the degree of diffusion of antibiotics at this site, and the pathogen responsible, and then to determine the sensitivity of the pathogen. If the pathogen is unknown, an assessment of the patient's clinical status should be made; generally, the weaker the patient, the broader the spectrum of antibiotics that should be used. If the pathogen and its in vitro susceptibility pattern are known, narrow-spectrum antibiotics are preferable. The carefully standardized conditions of in vitro testing do not correlate with the in vivo situation, in which the effectiveness of antibiotics is altered by diffusion and immune response. The in vitro tests available do not always correlate with the clinical situation; some bacteria showing resistance in the laboratory are actually susceptible in practice in some infection sites, and vice versa. In vitro tests are also affected by technical limitations. An in vitro test can aid the assessment of efficacy but cannot guarantee it.
[Value of quinolones in the treatment of lower respiratory tract infections caused by intracellular organisms, excluding mycobacteria].
In vitro studies of quinolones against intracellular pathogens responsible for lower respiratory tract infections have shown that growth inhibition varies with the strain and with the drug. Following administration of quinolones, drug levels in the lower respiratory tract are similar to or greater than serum levels. Quinolones penetrate readily into cells. The effectiveness of quinolones in lower respiratory tract infections has been demonstrated in both in vitro intracellular infection models and in vivo animal models. These data show that quinolones are a valid therapeutic alternative for lower respiratory tract infections due to intracellular organisms.
[Varicella in pregnancy after the 20th week of amenorrhea].
We report five cases of varicella pneumonia among ten otherwise healthy pregnant women who were admitted in our hospital between 1986 and 1991 with chickenpox. The precise frequency of this rare complication is not well known actually but analysis of the literature shows that the mortality rate is about 20%. Beside the problem of the fetal varicella syndrome, the other complication is the severe varicella of the neonate which can appear when varicella occurs in the mother within 5 days before, and 2 days after delivery. When primary varicella infection occurs during pregnancy clinical examination must be repeated for a week after occurring of the exanthema to find elements of severity significance. Acyclovir is the drug of choice (10 to 15 mg/kg every 8 hours) for 7 days when pneumonia is present. Varicella-zoster immunoglobulin is useful for prophylaxis and for neonates with high risk of severe varicella.
Co-trimoxazole for toxic epidermal necrolysis in AIDS.
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Rickettsia conorii isolated from ticks introduced to northern France by a dog.
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Deep venous thrombosis and antibodies to cyproterone acetate.
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Efficacy of intravenous ofloxacin: a French multicentre trial in 185 patients.
The efficacy of intravenous ofloxacin therapy (200 mg 12-hourly) followed, when appropriate, by oral administration of the same dose was evaluated in an open multicentre trial involving 185 patients in 31 French hospitals. Dosage adjustment was made for patients in renal failure. Infection was hospital-acquired in 35 cases, 53 patients required admission to an intensive care unit. The infections comprised septicaemia (n = 56), pneumonia (n = 18), bronchitis (n = 10), urinary tract (n = 78), female pelvis (n = 8), bone and joint (n = 5), skin and soft tissues (n = 10). The causative pathogens were: Staphylococcus spp. (n = 23), Streptococcus spp. (n = 11), Escherichia coli (n = 85), Haemophilus influenzae (n = 9), Klebsiella, Enterobacter or Serratia spp. (n = 21), Salmonella spp. (n = 22), Chlamydia spp. (n = 3), Legionella spp. (n = 1), Mycoplasma pneumoniae (n = 1) and miscellaneous Gram-negative bacilli (n = 17). All were ofloxacin-susceptible. Mean duration of therapy was 8.06 ( +/- 2.6) days for the i.v. and 14.8 ( +/- 14.39) days for the oral preparation. Clinical cure was achieved in 173 patients (93.5%). It is concluded that iv ofloxacin is an effective treatment for a range of infections due to susceptible organisms.
[Infectious endocarditis of the tricuspid valve in patients with endocardial pacemakers].
Right heart endocarditis in patients with permanent cardiac pacing catheters is uncommon but not an exceptionally rare complication. Two dimensional echocardiography provides diagnostic and prognostic information. The authors report two cases which illustrate the fact that many workers recommend explanation of the pacing catheter and that tricuspidectomy with or without valve replacement may sometimes be necessary.
[Acyclovir and specific anti-varicella-herpes zoster immunoglobulins in the treatment of varicella-zoster virus infection in 113 adults].
From January 1978 to December 1988, 54 males and 59 females were treated for varicella, zoster and disseminated zoster by varicella-zoster immunoglobulin (group I) or acyclovir (group II). 67 patients had immune deficiency disease. Treatment was successful for 92/100 patients in group I and for 100/100 patients in group II. Thrombophlebitis and renal failure were observed in group II and regressed when acyclovir was stopped. Varicella-zoster immunoglobulin and acyclovir are two effective therapeutics in the treatment of varicella and zoster in adults including immunocompromised patients. The use of acyclovir could not reduce the duration of hospitalization.
[Corticosteroids and non-steroidal anti-inflammatory agents in the treatment of acute respiratory distress syndrome and bacterial pneumonia].
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