Biomedical subjects
M Armengaud
Publications and source records attributed to M Armengaud.
[Urinary tract infection in an urban population: etiology and antibiotic sensitivity as a function of patient history].
OBJECTIVE: The aim of this study was to explore the relationship between etiological factors, bacterial isolates and Escherichia coli susceptibility to antibiotics in ambulatory patients with urinary tract infection. PATIENTS AND METHODS: A prospective study was conducted in 13 private medical laboratories in France in March 1998. Data were collected on 658 cases involving 679 strains in ambulatory patients with urinary tract infections. Data on age, gender, catheter insertion within the 7 preceding days, and history of hospitalization, urinary infection and antibiotic treatment during the 6 preceding months were recorded. The distribution of the bacterial isolates and Eschericha coli sensitivity to ciprofloxacin, cotrimoxazole, and gentamycin were studied. RESULTS: E. coli was most frequently isolated in women, in patients with no catheter or without a history of antibiotic treatment, hospitalization or urinary infection. There was no difference in E. coli sensitivity according to sex and age in women. In patients with prior antibiotic treatment, all the tested antibiotics except gentamycin were significantly less active. In case of prior hospitalization, the E. coli isolates were more resistant to amoxicillin, quinolones, cotrimoxazole and gentamycin. The level of E. coli suceptibility rose as the delay since hospitalization or urinary infection increased. CONCLUSION: Ambulatory patients comprise a heterogeneous population requiring particular attention to correctly adapt therapeutic strategies.
[Historical observations on nosocomial infections].
Explore the source record for details and available documents.
[Importance of the "Personal Serologic Immunization Card" among travelers].
The "Personal Immunization Card" is entering more and more in practice, even though its existence is not yet acknowledged. One of his advantages is to consider the travel medicine counsellor on one hand and the travelling adult on the other hand, being able to take a licit decision in account to informative data. That means to give the two actors-guarantors of the compliance--the responsibility in Public Health, in a domain considered until now in the same way as that of vaccinations in Infancy. The obligations and recommendations may not be sufficient, it is necessary to be convincing at the adult age. Without a doubt, we should get ride of the a priori with the progress in biology. We shall update our behaviour.
[Information communication to travelers, the French and Belgian experiences].
Providing relevant and up-to-date information to professionals and the general public is possible through many existing as well as developing means of communication including telephone and faxing, databases, answering machines and internet. Professionals may use information networks in order to harmonize advice given to their patients or clients. An exchange may also be established among all types of travel medicine professionals for keeping up with the latest relevant news and information or for sharing new ideas. Because travellers are now more proactive on their health than ever before, basic information designed for the general public is also becoming necessary. Examples of the various uses of communications in France and in Belgium are considered below.
[Recent evolution of travel medicine in France and in the world].
The purpose of this study is to show the different steps which have to led to the individualization of this discipline. The necessity of Travel Medicine is a result of the rapid expansion in international and intercontinental travel, in the development of means of prevention of risks linked to this increased travel, in modification made in the doctor-traveler relationship, and in the updating of everchanging epidemiological data. A strategy was developed in France, taking into account all components involved, leading to the creation of the French Travel Medicine Society in 1993. This society can be as an example abroad. The International Society of Travel Medicine was founded in 1992, Atlanta. Travel Medicine has always existed, but the organisation of its structures and especially the training of specialists has to be reconsidered. The main goal of Travel Medicine is the prevention, through information, of medical risks while travelling. This discipline is first and foremost a matter of Public Health. Investigation of this domain is far from complete.
Arguments against Chemoprophylaxis in Areas at Low Risk for Chloroquine-Resistant Plasmodium falciparum.
Chemoprophylaxis of malaria prevents the disease not the infection (suppressive chemoprophylaxis) with "high levels of confusion and low levels of compliance." The magnitude of danger of contracting malaria for travelers varies in several endemic zones. In West Africa, without prophylaxis, malaria is estimated to have an incidence of 1.4% per person per month. In South and Central America, the incidence is 0.05 and 0.01% per month, respectively. In Asia, the transmission and percentage of infection due to Plasmodium falciparum is much lower. The dangers of chemoprophylaxis in an area at low risk for chloroquine resistant P. falciparum are a reality. Incompletely active drugs change clinical manifestations, and changes in clinical manifestations delay the establishment of a correct diagnosis. The rate of adverse events is 15-20%, and hospitalization due to side effects of prophylaxis occurs in one in 10,000 travelers. Neuropsychiatric side effects have been reported with both mefloquine and chloroquine. A false sense of security can hinder a physician practicing in a nonendemic area from thinking of malaria when a traveler returns with fever. To complicate the picture, in many countries, there is an emerging drug resistance in P. falciparum as well as an emerging chloroquine resistance in P. vivax strains (20% in New Guinea and Irian Jaya). In short, no available chemoprophylaxis is free from toxicity, and its efficacy is never 100%. Alternatives to conventional chemoprophylaxis are encouraged in areas of low morbidity of malaria. In areas where P. vivax occurs primarily, and when the risk of serious side effects from chemoprophylaxis outweighs the risk of life threatening P. falciparum infection, there are four alternative strategies.2,3 The first strategy is that the traveler avoid mosquito bites. With a compulsive attitude, a high degree of protection can be realized with the proper use of pyrethrum-impregnated mosquito netting, topical DEET-containing insect repellents and impregnated protective clothing. Secondly, when the stay in malaria-endemic areas is less than 1 week, the disease will appear after returning home. No chemoprophylaxis is needed during the journey. With the onset of fever, diagnosis and therapy are performed without delay at home. This strategy assumes the participation of an informed physician. A third strategy is standby treatment, which is defined by the World Health Organization (WHO) as the use of antimalarial drugs carried for self administration when fever occurs and prompt medical attention is not available. Standby treatment is a safe option for an informed tourist traveling to areas at low risk of malaria or in areas where chemoprophylaxis may not be effective. Likewise, self therapy might be preferred for travelers who make frequent journeys characterized by brief and successive visits to malarious and nonmalarious areas, and for long-term travelers, and expatriots. Standby treatment minimizes drug overuse, demands early investigation of any febrile illness, and insists that effective treatment is given rapidly for P. falciparum malaria that occurs in nonimmune persons. This strategy is the responsibility assumed by teaching physicians and appears to be more advantageous than classic long-term chemoprophylaxis. A fourth strategy is systematic curative treatment carried out under supervision upon a traveler's return home. The administration of halofantrine after departure from endemic areas was studied for the prevention of P. falciparum malaria after short-term exposure,4 but the adverse cardiac effects of this drug obviates the usefulness of this "radical cure". Possibly the administration of doxycycline or azithromycin after departure from malarious areas could prevent P. falciparum malaria after short-term exposure and with less deleterious side effects. This approach requires more research, and again this will be the responsibility of physicians.
[Infectious meningitis with clear fluid. Epidemiology, etiology, diagnosis, development, prognosis, treatment].
Explore the source record for details and available documents.
Three-week hepatitis B vaccination provides protective immunity.
To determine whether a 3-week hepatitis B (HB) vaccination could achieve protective immunity, 89 healthy non-immunized young adults received three doses of 20 micrograms each of HBs antigen (GenHevac B, Pasteur) and were randomly assigned to schedule A (n = 44): two doses at day 0, one dose at day 21; or schedule B (n = 45): one dose at days 0, 10 and 21. Seroprotection rates (anti-HBs > or = 10 mIU ml-1) for groups A and B respectively were: 23 and 40% at day 21; and 77 and 91% at day 82 (not significant). Anti-HBs geometric mean titres were higher in group B than in group A (p < 0.05) at days 21 (6.4 versus 3.8) and 82 (77.6 versus 33.5). One year after primary vaccination, the seroprotection rate remained as high as 90% in the vaccinees of group B; after boosting all vaccinees had protective levels of anti-HBs antibodies. Thus 3-week HB vaccination with GenHevac B allowed early and durable protective immunity.
[Travel medicine].
Travel Medicine was inherited from Tropical Medicine and was organised around the development of intercontinental travels. It concerns all types of travellers, especially tourists, migrants and expatriates. It must be universal, scientific, but first of all preventive. Its aims to the information of all professionals concerned by health and tourism. Its goal is also the training of physicians and the education of travellers regarding their own responsibilities.
[Infectious disease observed upon travel return. Retrospective and prospective investigation conducted in 1992 with 15 hospitals].
We report 1,302 cases of patients observed in the Department of Infectious Diseases in 15 French hospitals: 1,036 in a retrospective study in 1991; 266 in a prospective study in 1992. 48% of patients suffered from malaria, diarrhoea or hepatitis; 50% were admitted in the hospital. We have numbered 191 cases of non tropical diseases, 14 cases of HIV seropositivity and 14 cases of adverse events due to antimalarial chemoprophylaxis.
[Real information needs of the traveller before his departure. Results of a survey by questionnaire].
This study is based upon 727 questionnaires completed by French travellers 10 days after intercontinental travel. The response rate was 40%. Two out of 5 travellers had generally mild health problems: fever (12%), diarrhoea (36%). Forty-six of them took drugs, which they had brought with them during their travel. Ten per cent had a satisfactory visit to a local physician. Medical informations given before departure appears to be sufficient, useful and relevant in more than 90% of cases. The traveller would like to receive them from his own physician or from vaccination centers. Other informations as insurance, assistance, administration, finances, appeared to have been incorrectly perceived by 20% of the travellers. The travel agent is the one who should provide adequate information. The traveller, in general, plans to do more travelling for his own well being if not for his work. Would not the bigger risk for him be "not to travel at all".
[Development and trends from 1986 to 1993 of the attitude of intercontinental travellers on departure from France, with respect to malaria prophylaxis].
Simultaneously to information campaigns on malaria prevention in France, 5 successive surveys were performed from 1986 to 1993 on the knowledge and attitudes of travellers regarding malaria prevention. French travellers (principally towards Sub Saharan Africa) know the risk of malaria and the measures of prevention (96%). Chimioprophylaxis using chloroquine has been progressively replaced by mefloquine and then by the association mefloquine-proguanil; 25% of travellers know mosquito prevention measures (repellents and impregnated bed nets) and 27% know the stand-by treatment. Passive attitude of travellers has been modified (in part due to their education) and tend to emphasize today their own responsibility.
Trends in zidovudine prescription since 1987 in AIDS-free HIV-positive French patients attending university hospitals.
Explore the source record for details and available documents.
Malaria chemoprophylaxis with mefloquine.
Explore the source record for details and available documents.
HIV-associated non-Hodgkin's lymphomas: clinical characteristics and outcome. The experience of the French Registry of HIV-associated tumors.
From 1/87 to 12/89, the French Registry of HIV-associated tumors recorded 131 cases of intermediate- and high-grade non-Hodgkin's lymphomas (NHL). There were 47 small non-cleaved Burkitt-type lymphomas (SNCL), 32 immunoblastic lymphomas (IL) and 52 diffuse large-cell or predominantly large-cell lymphomas (LCL). There were differences in the clinical patterns of the histological subtypes. Isolated extranodal presentation was less frequent in SNCL (2/47) than in IL (13/32) and LCL (17/49) (p less than 0.0001). In the latter two groups, the central nervous system was the principal site of extranodal involvement (16/30), 87% of SNCL, patients had no previous manifestations of AIDS whereas 40% of IL and LCL patients presented full-blown AIDS (p less than 0.01). At the time of NHL diagnosis, the median blood CD4 lymphocyte count was higher in SNCL (266/microL) than in LCL (125/microL, p less than 0.05) and IL (80/microL, p less than 0.01), 69% of stages I/II patients, 31% of stages III/IV, and 33% of stage ie patients achieved complete remission (CR), p less than 0.05. Overall median survival time was 5 months. There was no statistical difference in CR and survival rates among histological types. The two-year actuarial survival rate was 25% (median 8 months) for initially asymptomatic patients or those with persistent generalized lymphadenopathy (PGL) and 9% (median 3 months) for those previously with AIDS-related complex (ARC) and AIDS patients (p less than 0.001). Response to treatment was the other predictor factor. The two-year survival rate was 42% (median 16 months) for patients who achieved CR, and 5% (median 3 months) for those who did not.(ABSTRACT TRUNCATED AT 250 WORDS)
[Acute fever. Diagnostic orientation and management].
Explore the source record for details and available documents.
[Imipenem-cilastatin in infections].
A multicentre open trial was conducted in 31 centres to evaluate the therapeutic and ecological impact of imipenem-cilastatin on patients admitted to infectious pathology departments. Two-hundred patients (mean age: 58 +/- 19.4 years) were included in the study. The predominant infections were septicaemia, severe urinary tract infections and lower respiratory tract infections. Most of the patients treated (188/200) had associated severity factors. The acute infectious episode had been present for 9.3 +/- 12.2 days before the drug was prescribed. In the majority of patients the infection was hospital-acquired. Two-hundred and fifteen out of the 298 initial bacterial isolates were Gram-negative bacilli. Imipenem-cilastatin was administered alone in 74.5 per cent of the patients during 14.1 days on average in doses of 30 mg/kg/day. The drug was given as first-choice treatment in 60 per cent of the cases and after failure of another antibiotic therapy in 40 per cent. Clinical cure was obtained in 180 of the 198 assessable patients. Among therapeutic failures, 4 were due to the emergence during treatment of an imipenem-resistant Pseudomonas aeruginosa, but 30 of the 42 strains of Pseudomonas isolated before treatment were eradicated. The therapeutic success rates were 100 per cent in intra-abdominal infections, 94 per cent in septicaemias, 97 per cent in urinary tract infections and 82 per cent in lower respiratory tract infections, this last figure being one of the highest recorded in clinical trials. Frequent colonization or superinfection were not encountered in this study. The incidence of phlebitis at the site of injection was 14 per cent.