Biomedical subjects
L de Gentile
Publications and source records attributed to L de Gentile.
Pneumocystis carinii pneumonia in patients with hematologic malignancies: a descriptive study.
Objectives. A retrospective multicentric study was conducted over a five-year period to evaluate the clinical and laboratory characteristics and outcome of patients with proven Pneumocystis carinii pneumonia (PCP) complicating hematologic malignancies.Results. The study included 60 HIV-negative patients with 18 non-Hodgkin's malignant lymphoma (30%), 13 chronic lymphocytic leukaemia (21.7%), 10 acute leukemia (16.6%), 5 multiple myeloma (8.3%), 4 Waldenström's diseases (6.6%), 4 chronic myeloid leukemia (6.6%), 3 myelodysplasia (5%), 2 Hodgkin's diseases (3.3%) and 1 thrombopenia. Bronchoalveolar lavage was diagnostic in all patients. Forty-nine patients received cytotoxic drugs (81.7%), 25 (41.7%) a long-term corticotherapy and 15 (25%) underwent bone marrow transplantation. Twenty-seven patients (45%) required admission in the intensive care unit, 35 (58.3%) received an adjunctive corticotherapy and 18 mechanical ventilation (30%). Twenty patients (33.3%) died of PCP. A previous long-term corticotherapy (p=0.04), high respiratory (p=0.05) and pulse rates (p=0.02), elevated C reactive protein (p=0.01) and mechanical ventilation (OR=13.37; IC: 1.9-50) were associated with a poor prognosis. Adjunctive corticotherapy did not modify the prognosis.Conclusions. These results suggest that PCP can occur during the course of various hematologic malignancies, not only lymphoproliferative disorders. Prognosis remains poor. The diagnosis should be advocated more frequently and earlier to improve the prognosis.
[Loffler's fibroblastic endocarditis. A report of a case complicating toxocarosis].
The authors report a case of Löffler's fibroblastic endocarditis complicating a toxocarosis infection. Parasitic infestation with toxocara canis is usually asymptomatic, but this was a very rare observation of cerebral involvement associated with symptomatic Löffler's endocarditis. This is an unusual form of restrictive cardiac disease constantly accompanied by prolonged hypereosinophilia. In addition to the classical signs of cardiac failure, an acute febrile illness imitating a connective tissue disease may be observed. Echocardiography helps diagnosis by showing endomyocardial fibrosis and adherent thrombosis at one or both ventricular apices. The management of cardiac failure should include, whenever possible, radical treatment of the hypereosinophilia. At an advanced stage, surgical endocardial decortication is the only means of improving symptoms and the prognosis of these patients.
[Urticaria and parasites].
Urticaria has many etiology and during its exploration, it's important to mind about parasitic disease. The authors present briefly ten of them potentially associated with this eruption. For each disease (ascaridiosis, trichinellosis, fasciolosis, giardiosis, toxocarosis, anisakidosis, cercarial dermatitis, schistosomiasis, strongyloidosis, hydatidosis), they precise epidemiological situation for contamination and simple diagnosis approach.
[Individual prevention of malaria caused by Plasmodium falciparum].
Individual protection against Plasmodium falciparum malaria is based on a simultaneous observance of a preservation from mosquitos bites during the night and an adapted chemioprophylaxis. It is suitable to personalize chemioprophylaxis advices according to the ground (intolerance to anti paludic drugs, drugs interactions, pregnancy...) to the context of the transmission (visited countries, seasons, resistance level of malaria strains) and at last the local way of the medical assistance under taken against this disease. Nevertheless, it is good to remind that there is no preventive mean which gives full protection by itself. All fever that happens after a trip in an endemic zone for malaria has to be considered firstly as due to malaria and investigations have to be made under this condition.
First report of Cryptococcus albidus septicaemia in an HIV patient.
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Pleural effusion and toxocariasis.
The case history is described of a woman who presented with bilateral pleural effusions caused by Toxocara canis infestation. The condition responded rapidly to treatment.
[Cercarial dermatitis in Europe: a new public health problem?].
Cercarial dermatitis is a parasitic impasse that has worldwide distribution. The condition manifests itself as a highly pruriginous skin rash and is due to penetration of the dermis by larval stages (furcocercariae) of avian trematodes. Many species may be responsible for this disease. In Europe the genus Trichobilharzia is widely represented, in particular by the species T. ocellata; the definitive host is the duck (Anas platyrhinchos); the intermediate hosts are snails of the genus Lymnea (L. ovata or L. stagnalis). In France, cases of cercarial dermatitis were reported in June and July 1994 to the health authorities of three départements in the Pays de la Loire Region (western France). The epidemiological situation, common to the three maintained ponds that were concerned, is as follows: high level of eutrophication of the sites, colonization of the ponds by L. ovata, and settlement by many duck colonies. The simultaneous occurrence of these three phenomena, combined with long hours of sunshine in the summer, is responsible for most of the foci of cercarial dermatitis recently described in Europe. Control of this condition is difficult, requiring strict maintenance of bodies of water and if necessary the use of molluscicides such as niclosamide. The use of praziquantel in baits for treating the definitive hosts appears to interrupt the natural cycle of the avian Schistosomatidae. In the light of the observations reported here and the analysis of recent publications, cercarial dermatitis may be regarded as an emerging disease. Its public health impact needs to be evaluated at the global level.
Pulmonary toxoplasmosis after allogeneic bone marrow transplantation: case report and review.
We report an isolated case of toxoplasma pneumonitis in a 27-year-old man. This acute infection occurred after induction chemotherapy for AMLo relapsing 3 years post-allogeneic BMT. The detection of Toxoplasma gondii in the bronchoalvolar lavage (BAL), by culture in fibroblast cell line MRC5 enabled us to make the diagnosis. Pyrimethamine and sulfadiazine were effective.
Prevalence of Candida ciferrii in elderly patients with trophic disorders of the legs.
In order to define the prevalence of Candida ciferrii in onychomycosis, the fungal biota associated with toe nail onyxis was examined in 50 elderly patients with trophic disorders of the legs and in 220 patients without clinical evidence of trophic disorders. Candida ciferrii was more frequent in the first group of patients since it was recovered from 24% of these patients, whereas its prevalence was only 1.4% in the control group. Moreover, the positivity of the direct examination of toe nail scrapings, the absence of any other associated pathogens, and the repeated isolation of this yeast species for some of the patients confirmed its pathogenicity.
Epidemiologic approach to human toxocariasis in western France.
Toxocara canis is a common parasite in puppies. The danger to human health has not been properly established. We estimated the current incidence of this pathogen in two western districts of France, Loire-Atlantique and Maine et Loire. Blood samples from 1836 eosino-philic patients were collected and tested by an enzyme-linked immunosorbent assay (ELISA) excretory-secretory Toxocara antigen test. We obtained positive results in 22% of the cases and highly positive results in 7%. The ELISA data seemed to be age-dependent, with older patients having more positive results (P < 0.0001). The interlaboratory distribution of positive test results was statistically significantly different (P < 0.0001), suggesting regional sources. The main clinical expressions of toxocariasis were: asthenia, gastric pain, and pulmonary disease. Individual and collective surveys of this zoonotic disease need to be carried out.
[A cyst may be hidden by another. Cutaneous cysticercosis].
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Gelatinous transformation of the bone marrow: manifestation of an acute leukemia?
Gelatinous transformation of the bone marrow in a 79-year-old patient was observed. It was associated with acute leukemia diagnosed on the biopsy of a vertebral body, indicated by previous Indium-transferrin scintigraphy. Though the lesion is usually associated with severe weight loss and cachexia, the rare cases of gelatinous transformation reported among patients with malignant disease are summarized. It is suggested that metastatic changes by blast cells in acute leukemia may lead to gelatinous transformation of bone marrow but this remains to be investigated.
[Malaria and pregnancy. Report of a case of congenital Plasmodium falciparum malaria].
We report a case of congenital malaria due to a chloroquine-resistant strain of Plasmodium falciparum acquired in Mali. Ours is the first report of chloroquine-resistant congenital malaria in this part of Africa. We recall the various pathophysiologic, diagnostic and therapeutic features of this disease that should be considered in every neonate born to a mother who may have malaria. Although such cases are infrequent, we also discuss the very serious problems, mainly therapeutic, that they raise in several countries where they are endemic (South-East Asia and Africa particularly).
[Candida albicans chlamydospores observed in vivo in a patient with AIDS].
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[Erratic localization and uncommon longevity of Schistosoma haematobium. Apropos of a case].
A case of Schistosoma hematobium epididymal bilharzia is reported. This case is remarkable on the one hand because of the extreme longevity of the trematodes (30 years), illustrated by the presence of viable eggs in the epididymis, and secondly by the isolated epididymal localization of the parasite.
[Generalized mucormycosis. Apropos of a case caused by Absidia corymbifera].
This is the case of a woman, 49 year old, suffering from acute lymphoblastic common leukemia, who died from respiratory and cardiac insufficiency 47 days after the onset of aplasia. Autopsy revealed cardiac and cerebral dissemination of pulmonary mycosis. Absidia corymbifera (Mucoraceae, Phycomycete) was shown by culture to be the pathogen involved.
[Human gnathostomiasis manifested by cutaneous larva migrans syndrome. Apropos of a case].
The authors report a case of cutaneous Larva migrans attributed to a gnathostomiasis in a Laotian man living in France since 3 years. The diagnosis was suggested on the basis of epidemiological and clinical context (he often ate raw fresh fish in Thailand) and blood eosinophilia. It was confirmed by ELISA method which showed a very high antibody titer to Gnathostoma spinigerum. The patient was treated with cortisone and diethylcarbamazine and he has remained asymptomatic since.