Biomedical subjects
Publications and source records attributed to L Geffray.
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Several studies have suggested that the progression of hepatitis C virus (HCV) infection is more severe in patients infected by the human immunodeficiency virus (HIV). Two national retrospective multicenter cohort surveys were performed in France that included 17,487 HIV-infected patients during 1995 and 26,497 during 1997. The following data was evaluated: total number of deaths; number of deaths linked to AIDS, cirrhosis, or hepatocellular carcinoma (HCC); and number of deaths related to other (non-HCV--linked) causes. In 1995, the causes of death were as follows: AIDS, 1307 (7.47%); cirrhosis or HCC, 21 (0.12%); and other (non-HCV--linked) causes, 99 (0.56%). In 1997, the causes of deaths were as follows: AIDS, 459 (1.73%); cirrhosis or HCC 36 (0.13%); and other (non-HCV--linked) causes, 48 (0.18%). Comparative results between the 1995 and 1997 surveys showed a dramatic decrease in AIDS-related mortality rates (7.47% vs. 1.73%; P<.001) but not in HCV-related mortality rates (0.06% vs. 0.07%; P=.79). In France, despite the high prevalence of HCV infection in HIV-positive patients, the mortality rate in 1995 and 1997 caused by HCV-related cirrhosis or HCC was low.
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INTRODUCTION: Domestic pets can transmit numerous infections, including bacterial, parasitic, fungal, and viral diseases. This paper reports the epidemiologic, clinical, therapeutic and prophylactic data of these zoonoses. CURRENT KNOWLEDGE AND KEY POINTS: The routes of transmission are various. Bites and scratches are the most common health hazards and result in localized infections. Pasteurellosis, various aerobic and anaerobic infections, and cat-scratch disease are predominant. Bites are treated by cleaning the wound, rabies and tetanus prophylaxis, and the appropriate use of antibiotics. Other infections are transmitted through cutaneous, mucous, digestive or respiratory routes, by direct contact with the pets, excreta, or by arthropods. The most common are gastrointestinal (campylobacter, salmonella, yersinia, parasites, etc), dermatologic (dermatophytoses, scabies, cutaneous larva migraines, etc.), respiratory (psittacosis, etc.), and multisystemic (toxoplasmosis, toxocariasis, leishmaniosis). Certain people are at high risk for diverse diseases: small children (toxocariasis, helminthiasis), pregnant women (toxoplasmosis), and immunodeficient patients (cryptosporidiosis, salmonellosis, systemic pasteurellosis). These infectious diseases can be partly prevented by avoiding contact with diseased animals, and by washing the hands following exposure to pets or pet-derived excreta. Specific vaccines for humans and pets, as well as worming pets regularly, form an important part of the prevention. Veterinarians must discourage the keeping of wild or exotic animals as pets. FUTURE PROSPECTS AND PROJECTS: National health survey institutions and new communication systems can improve our knowledge about the real epidemiology of pet-transmitted zoonoses.
PURPOSE: Hepatitis C (HCV) has a high prevalence (10-30%) among human immunodeficiency virus (HIV)-infected patients. However, little information is available regarding the impact of hepatitis C on survival. The objective of our study was to determine the incidence of hepatitis C-related deaths in HIV-HCV co-infected patients. METHODS: The study was a retrospective (1-year), multicenter cohort survey conducted in 63 departments of either internal medicine or infectious diseases in France. It included 26,497 HIV-infected patients, of whom 4,465 (16.8%) presented coinfection due to the hepatitis C virus. The following parameters were studied for the year 1997: total number of deaths, number of deaths related to either AIDS, cirrhosis, hepatocellular carcinoma, or other causes. RESULTS: Among the 26,497 patients, 543 deaths (incidence: 2%) were observed in 1997; 543 deaths were due to AIDS (incidence: 1.7%), 36 to cirrhosis and/or hepatocellular carcinoma (incidence: 0.13%), and 48 (incidence: 0.18%) to another cause. In the subgroup including 4,465 HIV-HCV-coinfected patients, 29 deaths (incidence: 0.64%) were due to either HCV-related cirrhosis or hepatocellular carcinoma. These results were compared with those of a previous similar survey conducted in 1995, before the era of highly active antiretroviral therapy. The only significant difference is the dramatic regression of deaths due to AIDS. CONCLUSION: The impact of hepatitis C virus on the mortality among HIV-infected patients whose follow-up took place in departments of either internal medicine or infectious diseases in France was very low in 1997. The expected increase in the life span in these patients could modify these results in the future, due to recent improvements in the HIV infection treatment.
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Cholera remains a great epidemic disease. The spread of the current pandemic due to Vibrio cholerae O1, the discovery of a permanent aquatic reservoir due to dormant state of vibrio, the occurrence in 1992 of the new pathogenic serotype O139 in India, and increasing antibiotic resistance are clear demonstration that this old disease is far from conquered. Clinical manifestations are due to the stimulation of enterocytic cAMP by vibrio's enterotoxin. Treatment by appropriate early rehydration is highly effective. During major outbreaks it requires "military logistics". Hygiene and chlorine remain the best prophylaxis; WHO's recommendations on the use of the new oral vaccines, effective against O1-strains, will probably evolve as the results of ongoing trials will become available.
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The authors report 4 cases of African histoplasmosis in Zaïrans. The diagnostic was based ou cutaneous (4 patients), bones (3), lymph-nodes (2), and bowel-localizations (1) and was confirmed by the presence of Histoplasma duboisiis yeasts in cutaneous biopsy (4 patients), in pus of abscess or cutaneous lesions (3) and in stools (1). Two HIV seronegatives patients had a good outcome with amphotericin B. One patient died without any treatment. One HIV-1 and HTLV-1 seropositive patient had successful short-term outcome with ketoconazole. Seven others cases of association between African histoplasmosis and AIDS are noted in the literature. They suggest the opportunistic nature of this deep mycosis.
We assessed the pancreatic beta cells function of HIV patients receiving either 300 mg per month of aerosolized pentamidine (n = 12) or oral trimethoprim-sulfamethoxazole (TMP-SMX), twice a day three times per week (TMP: 160 mg, SMX: 800 mg) (n = 10). Intravenous (i.v.) glucose tolerance tests were performed after i.v. injection of 0.5 glucose by kg of body weight in 30 seconds. Plasma insulin levels were assessed at baseline, 1, 2, 3 and 5 min. Moreover, in patients receiving inhaled pentamidine, plasma glucose amylase and insulin levels were measured every 30 min for 2 hours after the end of the aerosol. Plasma pentamidine levels were measured 30 min after the end of the aerosol. Those tests were performed every 2-3 months for one year. In most patients taking aerosol treatment, pentamidine levels were detectable, remaining under levels of 50 ng/ml. Pentamidine plasma levels increased in a time dependent manner. Baseline plasma glucose, amylase and insulin levels were in normal range and remained stable during the therapy. For 7 out of 12 patients, glucose tolerance tests showed an adequate insulin secretion: the addition of the two best insulin levels were higher than 70 IU/ml. When this criteria was not found (n = 5), a glucagon stimulation test allowed to exclude an endocrine pancreatic dysfunction. Due to its apparent short half-life, increased pentamidine levels could be related to an improvement of spray techniques as well as to a cumulative effect. Pancreatic function was preserved in pentamidine-treated patients compared to TMP-SMX-treated patients.
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The authors study the possible involvement of retrovirus in Sjögren's syndrome. They report a preliminary study of 20 French and 13 Ecuadorian patients with a primary Sjögren syndrome. A previous epidemiologic study showed a HTLV1 seroprevalence going from 0.04 to 6% on different regions of Ecuador. The results of this study show the presence of anti-HTLV1 antibodies only in 2 Ecuadorian patients and does not allow a final conclusion of the role of HTLV1 virus. Nevertheless other studies continue on the serie using minor salivary gland specimens obtained by biopsy. Recent publications and the notion of an "endogen" retrovirus will may be lighten a new day in this research.
59 cases of Plasmodium falciparum malaria fever occurring in non-immune Caucasian subjects having got a correct chemoprophylaxis by chloroquine were treated by halofantrine (HALFAN). They were given 1500 mg divided in 3 doses of 500 mg every 6 hours from D1 to D8. All them were back from a malarial highly endemic zone with chloroquine resistance. Analysis of the main biological and clinical efficiency parameters displayed very satisfactory results: disappearances of fever (mean 22 H) and parasitemia (mean 36 H) are short. After two months of monitoring, no malaria recrudescence was noted. With an efficacy of 10 p.c. associated to a noticeable clinical and biological tolerance Halofantrine is a first-class treatment of chloroquine resistant malaria fever.
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