Mucosal leishmaniasis in a heart transplant recipient.
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Heart Transplantation↗
Biomedical subjects
F Bricaire
Publications and source records attributed to F Bricaire.
Pyogenic bacterial pneumonia in human immunodeficiency virus-infected inpatients: a clinical, radiological, microbiological, and epidemiological study.
We prospectively studied features of pyogenic bacterial pneumonia in 263 consecutive human immunodeficiency virus-infected inpatients over a 6-month study period. Risk factors for bacterial pneumonia were examined by a case-control study that included 33 cases who presented with at least one episode of bacterial pneumonia and 80 controls without bacterial pneumonia. The estimated cumulative incidence of bacterial pneumonia per year was 12.5 cases per 100 inpatients (95% confidence interval [CI], 8.8-17.2). The 38 episodes of bacterial pneumonia that occurred in the 33 inpatients were mainly unilateral, but 32 episodes were patchy lobar or diffuse infiltrates. Microbiological etiologies were obtained in 33 of the 38 episodes of bacterial pneumonia. Thirty-seven pathogens were identified, including Streptococcus pneumoniae (16, of which 12 had a decreased susceptibility to penicillin), Haemophilus influenzae (6), and Pseudomonas aeruginosa (6). The risk factors for bacterial pneumonia that were identified after logistic regression included prior sinusitis within 1 month before admission (odds ratio [OR], 3.2; 95% CI, 1.1-9.1) and prior bacterial infection of the lower respiratory tract within 6 months before admission (OR, 3.1; 95% CI, 1.1-8.3).
AIDS-Related Opportunistic Infections↗
Acyclovir-resistant herpes zoster in human immunodeficiency virus-infected patients: results of foscarnet therapy.
We retrospectively studied 18 consecutive cases of acyclovir-resistant zoster. All the patients had chronic skin lesions that failed to heal despite treatment with intravenous acyclovir (30 mg/[kg.d]) in 15 cases and oral acyclovir (4 g/d) in three cases for > 10 days. The mean CD4+ cell count was 20 x 10(6)/L. The mean number of previous zoster episodes was 1.53. Fifteen of the 16 patients evaluable for previous acyclovir treatment had received the drug. Thirteen patients were treated with intravenous foscarnet (200 mg/[kg.d]) for a mean of 17.8 days. Complete healing was observed in 10 (77%) of the 13 treated patients. Zoster relapsed after cessation of foscarnet therapy in five of the 10 responding patients. The median time to relapse was 110 days. Four patients died of varicella-zoster virus-associated visceral complications. These results show that acyclovir-resistant zoster has a poor prognosis but responds well to foscarnet therapy.
AIDS-Related Opportunistic Infections↗
Facial folliculitis due to Clostridium perfringens in a patient infected with human immunodeficiency virus.
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AIDS-Related Opportunistic Infections↗
The level of human immunodeficiency virus (HIV) type 1 RNA in cerebrospinal fluid as a marker of HIV encephalitis.
We prospectively evaluated the level of human immunodeficiency virus (HIV) type 1 RNA in cerebrospinal fluid (CSF) as a marker of HIV encephalitis. Fifty-two HIV-1-infected patients (41 males and 11 females; mean age, 39 years) were tested for the presence of HIV-1 RNA in plasma and CSF. Samples of CSF were obtained by lumbar puncture to evaluate cognitive deficits, seizures, or fever among these patients. HIV encephalitis was diagnosed in 11 patients (21%), other CNS diseases were diagnosed in 12 (23%), and fever without CNS disease was diagnosed in 29 (56%). HIV-1 RNA was detectable in 92% of the plasma specimens and 75% of the CSF specimens. No significant difference was observed in CSF levels of HIV-1 RNA between patients with or without HIV encephalitis. CSF levels of HIV-1 RNA correlated with plasma levels of HIV-1 RNA (Spearman's rank correlation, +0.31; P = .02) and CSF white blood cell counts (Spearman's rank correlation, +0.4; P < .01). The absence of any significant difference between patients with or without HIV encephalitis suggests that the CSF HIV-1 RNA level is not a good marker for the diagnosis of HIV encephalitis.
AIDS Dementia Complex↗
Mycobacterium avium complex common-source or cross-infection in AIDS patients attending the same day-care facility.
To delineate the epidemiology of Mycobacterium avium complex (MAC) infection in acquired immunodeficiency syndrome patients, we studied 32 case patients with disseminated MAC infection who attended the same daycare facility during a period of 13 months. Pulsed-field gel electrophoresis analysis showed very low similarity between MAC strains, suggesting that, despite close contacts between the patients, nosocomial cross-transmission or exposure to a common source of MAC did not occur.
AIDS-Related Opportunistic Infections↗
Toxoplasma gondii-associated Guillain-Barré syndrome in an immunocompetent patient.
We report a case of Guillain-Barré syndrome associated with an acute, disseminated toxoplasmosis due to a new and unknown zymodeme (zymodeme 12) in an immunocompetent patient. The patient's condition improved with pyrimethamine and sulfadiazine. Only the standard treatment for toxoplasmosis was effective, whereas intravenous immunoglobulins were ineffective.
Adult↗
[Hepatitis G virus: a new agent responsible for viral hepatitis].
Modern biology has allowed to detect a new hepatitis virus called G (HGV), joining an already important member of hepatitis viruses. Thus the share of viral hepatitis non A-non D decreases. The HGV belongs to the Flaviviridae and is similar to the HCV. Transmission occurs essentially by contaminated blood. There are still some open questions, particularly concerning the real pathogenic responsibility of the virus, which is far from clear considering latest publications. Further studies are necessary to precise epidemiologic data, ways of transmission, and pathogenic properties.
Flaviviridae↗
Use of DNA fingerprinting for primary surveillance of nosocomial tuberculosis in a large urban hospital: detection of outbreaks in homeless people and migrant workers.
SETTING: A large urban teaching hospital in the southeast of Paris. OBJECTIVE: Primary surveillance of nosocomial transmission of tuberculosis (TB) by systematic restriction fragment length polymorphism analysis (RFLP) of isolates (n = 161) recovered from smear-positive pulmonary TB patients identified from 1 March 1993 to 28 February 1994, and from all TB patients (with any form of tuberculous infection) identified from 1 March 1994 to 30 April 1995. RESULTS: Systematic RFLP analysis revealed 12 clusters of patients (n = 40) infected by strains of Mycobacterium tuberculosis showing matching RFLP patterns. None of the isolates were multidrug-resistant. Compared with non-clustered patients, clustered patients were more likely to be homeless (55% vs 19%, P < or = 0.001), or Africans living in hostels for migrant workers (20% vs 6%, P = 0.01), and had fewer previous admissions to hospital (12% vs 28%, P = 0.05). Further epidemiological investigations showed that the clustered TB cases actually resulted not from nosocomial transmission, but from transmission in the community, very likely in homeless shelters and hostels for migrant workers. CONCLUSION: No nosocomial transmission of TB was identified among the patients included during the study period. Systematic RFLP analysis using hospital-based sampling can detect the spread of TB in specific environments in the community where transmission is occurring.
Adult↗
Acyclovir-resistant varicella-zoster virus: phenotypic and genetic characterization.
A man with acquired immunodeficiency syndrome (AIDS) developed zoster of the right arm which was resistant clinically to acyclovir. Varicella-zoster virus (VZV) was cultured from a skin biopsy performed at the beginning of acyclovir therapy (isolate 1) and after its failure (isolate 2). The emergence of acyclovir resistance during treatment was investigated by developing a simple and rapid drug sensitivity assay based on the plaque reduction reference method. This late-antigen synthesis reduction assay involved serial dilutions of cell-associated virus. The 50% inhibitory concentration (IC50) of acyclovir was 16 +/- 7.5 microM for the susceptible reference strain OKA, in agreement with published data. The acyclovir IC50 increased from 6.5 microM for isolate 1 to 100 microM for isolate 2. In comparison with the sequence of isolate 1, isolate 2 had a single mutation consisting of a C to T change at position 907 of the thymidine kinase gene, which changed a glutamine codon into a stop codon at position 303 of the thymidine kinase protein. These results show the emergence of acyclovir resistance through a single previously undescribed mutation in the thymidine kinase gene, and confirm the heterogeneity of mutations inducing acyclovir resistance.
AIDS-Related Opportunistic Infections↗
[Apropos of 1 case of hepatogastric fascioliasis in Cape Verde].
The authors report a case of Fascioliasis sp. distomiasis with a double hepatic and gastric location primitively associated with a gastric cancer metastazed to the liver. The parasitic origin of the lesions suspected from the histological specimen of the gastric biopsy (the presence of eggs) was confirmed by serology with the presence of the arc 2 specific to immunoelectrophoretic analysis, while the parasitological examination of the stools was always negative. The patient grew well after a day's cure of triclabendazole (375 mg x 2). Although the ectopic locations of Fascioliasis are classic, they are usually in the abdominal wall, less frequently in the gastric or colic wall. The fact that the contamination originated on the Cape Verde is indiscutable, since the patient had never left the island. It is the 5th case described in medical literature, thus confirming the presence of Fasciola hepatica (or gigantica) on the islands of the Cape Verde, whose population is of both Portuguese and African origin and has kept the eating habits of the former colonial power (Portugal is a zone of high endemicity for human fascioliasis). It would be interesting to look for Limnaea and contaminated bovine on the Cape Verde islands.
Africa, Western↗
[Clinical importance of the quantification of HIV-1 RNA in cerebrospinal fluid for the diagnosis of HIV encephalitis].
We evaluated prospectively the HIV-1 RNA level in CSF as a marker of HIV encephalitis diagnosis. 110 HIV-1 infected patients (mean age: 39 years; sex-ratio M/F: 94/16) were tested for HIV-1 RNA in plasma and CSF. Lumbar punctures were performed to explore cognitive deficit, seizure or fever. HIV encephalitis was diagnosed in 15 patients (14%), other CNS disease in 34 (31%), and fever without CNS disease in 61 (55%). HIV-1 RNA was detectable in 93% of the plasma and in 62% of the CSF. No significant difference was observed in CSF HIV-1 RNA between patients with or without HIV encephalitis. CSF HIV-1 RNA was correlated with plasma HIV-1 RNA (p < 0.01), CSF protein (p < 0.01) and CSF white cell counts (p < 0.01). The absence of any significant difference between patients with or without HIV encephalitis, suggests that the CSF HIV-1 RNA level is not a good marker for its diagnosis.
AIDS Dementia Complex↗
[Liposomes: promising perspectives].
NEW THERAPEUTIC VECTORS: Liposomes are nontoxic biodegradable lipid particles which can vehicle drug compounds to the site of action, thus limiting the risk of general toxicity. WITH AMINOGLYCOSIDES: Liposome vectors for aminoglycosides, particularly amikacin, have been developed. Oto- and hepatic toxicity can be limited allowing the use of higher doses for longer periods. WITH AMPHOTERICIN B: Liposomal amphotericin B is now available and appears to give interesting results both in terms of efficacy and tolerance. OTHER APPLICATIONS: Capsular forms of other antibiotics such as ciprofloxacin are being studied. An encapsulated anticytomegalovirus agent, foscamet, is also be explored. In cancerology, liposomes could be developed to deliver toxic agents such as doxorubicin for example. The high cost of these therapeutic vectors does however limit their current use.
Amphotericin B↗
[Resistance to antiretroviral agents: mechanism and study methods].
FREQUENT MUTATIONS: Associated with the high turnover rate of the HIV, frequent inverse transcriptase errors lead to a wide range of possible mutations. Certain mutations can modify the response to antiretroviral agents. The development of resistant strains is mediated by the selection pressure of antiretroviral agents and occurs at a very variable rate depending on the antiretroviral agent used. TO LOWER THE RISK OF RESISTANCE: Persistent replication, whatever the cause, favors the emergence of resistant mutants. Thus the antiretroviral treatment must be initiated early and with the most powerful protocol possible in order to reduce viral replication as quickly as possible. CONTRIBUTION OF VIROLOGY TESTS: It is not always possible to predict the efficacy of antiviral agents from phenotyping and genotyping results. Their use is currently limited to cases of treatment failure. Their contribution in everyday clinical practice remains to be defined.
Anti-HIV Agents↗
[Influenza: new therapeutic perspectives].
TWO WELL-KNOWN AGENTS: Although the activity of amantadin and rimantadin against type A Myxovirus influenzae are well known, use is still limited. These agents only have a moderate curative effect and, though they are more effective for prophylaxis, can only be used in cases with a certain positive diagnosis, which is difficult to obtain. In addition, questions remain concerning tolerance which is not always excellent, particularly for amantadin. ZANAMIVIR: This compound belongs to a new class. It specifically inhibits the neuraminidase in type A and B Myxovirus influenzae. Given by the nasal route, zanamivir has been shown to be effective compared with placebo, reducing the duration and intensity of flu symptoms and with a very satisfactory tolerance profile. GS4104: Studies are in the preliminary phases for this agent which is a powerful inhibitor of the influenzae A and B virus neuraminidase. It has been found to be active in mouse and rodent models. IN CLINICAL PRACTICE: Vaccination remains the only effective tool today. These new compounds can only be seen as complementary agents to be used in combination with vaccination regimes.
Administration, Intranasal↗
[Cognitive disorders in AIDS: clinical, virological and neuroradiological features].
HIV-associated neurocognitive disorders are mainly reported during the late stages of the disease, in deeply immunosuppressed patients Clinically, they present as a subcortical cognitive impairment, dominated by reduced psychomotor speed and memory deficit. Encephalic magnetic resonance imaging shows in most cases a diffuse leucoencephalopathy, and there is often a poor correlation between clinical status and neuroradiological findings. The diagnostic and prognostic value of HIV load in blood and cerebrospinal fluid is currently under investigation. Finally, the efficacy of new antiretroviral drugs on HIV dementia remains uncertain.
Acquired Immunodeficiency Syndrome↗
[Urinary calculi and crystalluria in HIV+ patients treated with indinavir sulfate].
OBJECTIVES: Anti-proteases, a new class of anti-HIV drugs used in combination with reverse transcriptase inhibitors have led to spectacular improvement in the patients' clinical status. Since April 1996, indinavir is the most widely prescribed anti-protease in France. PATIENTS AND METHODS: From July 1996 to July 1997, we analyzed 46 spontaneously expulsed stones in 45 HIV+ patients (35 men and 10 women; age range 25 to 64 years) given indinavir in combination with other drugs since one week to ten months. Only six patients were known to have a past history of renal lithiasis. RESULTS: Forty-one calculi contained indinavir monohydrate (INDM) identified by mass spectrometry and infrared spectrophotometry. INDM was the only component excepting proteins in 39/45 calculi. In the 12 others, other compounds were also identified. Among the 114 urine samples collected 2 to 3 hours after an 800 mg dose of indinavir, 38 (33%) monohydrate indinavir crystals, identified by infrared microscopy. Mean urinary pH was significantly higher than in samples without INDM crystals (6.53 +/- 0.68 versus 5.96 +/- 0.71, p < 0.001). CONCLUSION: Two measures could possibly reduce the risk of crystalization: administration of urine acidifiers and increased fluid intake to raise diuresis. Alkalinisation is not indicated. Long-term increased fluid intake should be preferred over acidification which could be reserved solely for the treatment of drug-induced lithiasis.
Adult↗
[Tuberculous meningitis: clinical, biological and x-ray computed tomographic comparison between patients with or without HIV infection].
OBJECTIVES: Determine possible differences in clinical manifestations, laboratory findings and neuroimaging results in tuberculous meningitis patients with and without HIV infection. PATIENTS AND METHODS: We retrospectively reviewed data of 38 patients with positive cerebrospinal fluid cultures for Mycobacterium tuberculosis who were hospitalized in 3 university hospitals in Paris over the last 11 years. RESULTS: There were 24 HIV-infected patients and 14 without HIV infection. Mean CD4 lymphocyte count was 103 +/- 180/mm3 in the HIV group. Age (median age = 33 years for the HIV group vs. 53 for the non-HIV group), sex ratio (3 vs. 0.75), and prior history of tuberculosis (46% vs. 43%) were similar in both groups. Clinical presentation was similar for headache (83% in HIV group vs. 50% in non-HIV group; p = 0.02) and confusion (54% vs. 93% in non-HIV group p = 0.05). Serum natremia (mmol/l) (131 +/- 5 vs. 125 +/- 8; p = 0.024), white blood cell count (x 10(9)/l) (5.8 +/- 4.7 vs. 10.7 +/- 1.7; p = 0.37) and erythrocyte sedementation rate (mm/h) (68 +/- 34 vs. 31 +/- 35; p = 0.003) were significantly different in the 2 groups. Median cerebrospinal fluid findings were similar in the 2 groups: leukocytes (x 10(6)/l) (375 +/- 860 vs 218 +/- 250), glucose (mmol/l) (2.3 +/- 0.9 vs 2.7 +/- 1.9) and protein (g/l) (3.8 +/- 7.1 vs. 2.6 +/- 1.6). CT-scans of the brain were similar in the 2 groups. Mortality during hospitalization was similar (42% vs 36%; NS). CONCLUSION: HIV infection appears to have little impact on the presentation of tuberculous meningitis.
Adult↗