Pulmonary eosinophilia associated with dapsone.
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Biomedical subjects
Publications and source records attributed to G Badillet.
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Mycotic infections are a frequent and often severe complication in the immunosuppressed patient. A review of autopsy findings in 54 cases with gross, histologic and mycologic studies was undertaken among immunocompromised patients after chemotherapy or allogenic bone marrow transplantation: fungal infections were either localized especially in lungs and gastrointestinal tract, or disseminated. Fungi were various: principally Candida and Aspergillus, but also Fusarium, Torulopsis and Trichosporon. In acquired immunodeficiency syndrome (11 autopsy cases), mycotic infections appeared different. Oral and esophageal candidiasis could be found, but cryptococcosis and histoplasmosis were the major generalized mycosis. This study suggests that fungal infections are not the same in patients treated by chemotherapy or bone marrow transplantation, and in acquired immunodeficiency syndrome.
Prophylactic treatment of mice with interferon (IFN) or polyinosinic-polycytidylic acid [poly(I:C)], an IFN inducer, provided significant protection against an extracellular infection by Aspergillus fumigatus in both Swiss and Swiss athymic nude mice. Tunicamycin (TM) treatment inhibits the antifungal activity of IFN and poly(I:C) in these mice. Anti-asialo GM1 or TM [both inhibitors of natural killer (NK) cell function] treatment enhance the severity of A. fumigatus infection. These results suggest that NK cells may play a role in A. fumigatus infection and in the antifungal activity of IFN.
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An epidemiological study of dermatophytes was achieved during the years 1983-1984 in the Mycology Laboratory of Saint-Louis' Hospital. Immigrants represent an important part of the people who came to consult us: 28 per cent in 1983. The two most important immigrant peoples show different features: Black African people, who were mass contaminated by tinea agents (Trichophyton soudanense and Microsporum langeronii), were not much contaminated by epidermophytic agents (Trichophyton rubrum, Trichophyton interdigitale, Epidermophyton floccosum). Conversely, in people from the Maghreb, if tinea (Trichophyton violaceum) were not numerous, epidermophyties were found in the same proportion than in native people. The transmission of various dermatophytes from one population to another seems quite easy to detect for tinea agents: Trichophyton soudanense, Microsporum langeronii and Trichophyton violaceum can contaminate native people. Microsporum canis often contaminates the children from the Maghreb, and rarely Black African children. But the transmission of epidermophytes is much more difficult to study, due to a lack of documents in the African countries involved. The Scytalidium and Hendersonula pathology recently discovered in France is almost exclusively restricted to Black immigrants from the West Indies and Africa.
A widespread maculo-papular cutaneous rash appeared on a HIV-positive young bisexual Cambodian man. He was treated for Mycobacterium tuberculosis and Pneumocystis carinii infections. He had been residing in France for seven years. Histology showed, within the dermis, abundant extracellular and intramacrophagic yeast-like organisms suggestive of histoplasmosis. Cultured specimens produced a growth of colonies after three weeks on Sabouraud 4 p. 100 dextrose agar at 25 degrees C. Numerous macroconidia were found which made the species diagnosis of Histoplasma capsulatum possible. Despite initiation of therapy with amphotericin B the patient died. Cutaneous involvement with or without specific features is uncommon in disseminated histoplasmosis. The specific cutaneous lesions are protean. They rarely are the presenting sign of initial infection. Disseminated histoplasmosis has a poor prognosis in acquired immunodeficiency syndrome: amphotericin B is not curative. Maintenance suppressive therapy with ketoconazole has been recommended following amphotericin B completion, although break-through has been reported.
The frequency, mode of occurrence, diagnostic criteria and main features of systemic and visceral candidiasis have been evaluated in a retrospective study of all cases managed in St Louis Hospital, Paris, during the [June 1, 1985-May 31, 1986] period. During this one year period 23 patients suffered from systemic or visceral candidiasis and Candida spp. accounted for 9.6% of all positive blood cultures, fourth in number after Enterobacteriaceae, Staphylococcus and Pseudomonas. Abnormal underlying condition was present in all patients, mainly haematologic malignancies, serious abdominal surgery and AIDS. In patients with haematologic malignancies C. tropicalis was the main species involved in contrast with surgical patients in whom the dominant responsible species was C. albicans. No Candida oesophagus was common. Therapeutic regimens included amphotericin B in all patients with systemic disease. We conclude that in an institution mainly oriented toward management of cancer and surgical patients, systemic and visceral candidiasis are common and represent a serious problem.
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Several strains of Microsporum audouini, M. langeroni and M. rivalieri were observed by light and scanning electron microscopies. The macroaleuriospore shape and ornamentation were illustrated and compared for the 3 species as the pectinate hyphae for M. langeroni and M. rivalieri and the chlamydospores and particular hyphae for M. audouini and M. langeroni. The 3 species are morphologically very close but they are distinguishable from each other on the basis of morphology, geographic distribution and pathogenicity.
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Seven cases of severe candida infection in heroin addicts are reported. The principal features of this condition which arose in 1980, apparently due to a particular quality of heroin, are described, Candida albicans was the only pathogenic agent isolated from mainly scalp nodular and pustular lesions. These cutaneous lesions were associated in half the cases with ocular lesions, which sometimes had a poor prognosis despite active therapy. Osteo-articular complications were less common. Ketoconazole therapy alone gave good results in this series. The precise reasons for this dissemination of Candida albicans and for these localisations are still not clearly understood.
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We have reviewed the clinical and microbiological features of 113 cases of idiopathic onycholysis primarily affecting the great toenails. It is suggested that the majority of these cases were traumatic in origin. Although dermatophytes and potentially pathogenic bacteria were frequently found in the lesions, they were thought to be commensal in most cases. This is of considerable significance with regard to the selection of appropriate therapy.
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