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Biomedical subjects

O Bouchaud

Publications and source records attributed to O Bouchaud.

53 records · Page 3Linked to original sources
PubMed1994

[Streptococcus pneumoniae bacteremia and HIV infection. Retrospective study of 41 episodes in 30 patients].

OBJECTIVES: Pulmonary infections and bacteraemia, essentially due to Streptococcus pneumoniae and Haemophilus influenzae, are frequently reported in patients infected with the human immunodeficiency virus (HIV). We retrospectively analyzed episodes of bacteraemia in HIV-infected patients to determine whether supplementary risk factors could be ascertained and whether it would be advisable to propose vaccination. METHODS: From June 1986 to February 1992, 41 episodes of bacteraemia in 30 HIV-infected patients were observed in 7 different wards. Data on age, sex, risk group, Centers for Disease Control classification, CD4 counts and clinical outcome were recorded. RESULTS: There were 18 males and 12 females, mean age 34 years (range 26-67 years) in CDC class II (n = 11), III (n = 5) and IV (n = 16). There were 17 intravenous drug users (56.6%). There were 8 heterosexuals (26%), 3 homosexuals or bisexuals (n = 3) and 2 patients infected after blood transfusions (6%). All the heterosexual patients were of black-African or Carabean ethnic origin. Mean CD4 count was 239 mm3 (range 2-1148) during the episode of bacteraemia which occurred during an upper respiratory tract infection in 96% of the patients. Recurrent episodes were observed in 7 patients. Outcome of the infectious episode was favourable in 35/41 cases after antibiotic therapy. Six patients (all CDC class IV) died during the episode of bacteraemia. CONCLUSIONS: These observations showed that intravenous drug use and black-African ethnic origin are supplementary risk factors for S. pneumoniae infection in HIV-infected patients. The frequency of upper respiratory tract infections in these patients suggests that anti-S. pneumoniae vaccination should be evaluated further.

AIDS-Related Opportunistic Infections↗
PubMed1994

Plasma concentrations of the enantiomers of halofantrine and its main metabolite in malaria patients.

The plasma concentrations of the enantiomers of halofantrine and its N-desbutyl metabolite in six patients with malaria were measured after oral administration of 3 x 750 mg doses of micronised, racemic halofantrine hydrochloride given at 6-hour intervals. Significant differences were observed between the plasma concentrations of the enantiomers both of halofantrine and its N-monodesbutyl metabolite. AUC(0)84h values were higher for (+)halofantrine (9917 micrograms.ml-1.h) than for (-)-halofantrine (6127 micrograms.ml-1.h). The clinical significance of these observations is not known. The isomers have equipotent activity in vitro but their relative toxicity has not yet been assessed.

Adult↗
PubMed1994

Quantification of T cells reactive to Pf155/RESA peptides in Plasmodium falciparum-exposed individuals.

This study was designed to estimate, among T lymphocytes circulating in the peripheral blood of donors exposed to malaria parasites, the frequencies of those responding to Plasmodium falciparum antigens, and more specifically to Pf155/RESA peptides. The values of peptide-reactive T-cell frequencies were dispersed and rather low, ranging from 1:24,000 to undetectable (superior to 1:300,000). Subjects presented with different past exposure to parasites: either they had been repetitively exposed to malaria parasite infestation or they were recovering from a recent treated malaria attack. However, they had similar frequencies of T cells reactive to Pf155/RESA peptides. With cells from a minority of patients, "saw-tooth curves" were obtained, suggesting the existence of suppressor mechanisms operating in vitro in our limiting dilution assay.

Adult↗
PubMed1994

Clinical efficacy and pharmacokinetics of micronized halofantrine for the treatment of acute uncomplicated falciparum malaria in nonimmune patients.

Twenty-eight nonimmune patients with acute uncomplicated falciparum malaria returning from subSaharan Africa were treated with a micronized formulation of halofantrine hydrochloride (three doses of 250 mg at 6-hr intervals) to investigate the drug's efficacy, tolerance, and pharmacokinetics. In vitro drug susceptibility patterns were determined by the isotopic semimicrotest. Twenty-four of 28 patients were cured. Two of the four patients experiencing recrudescence were associated with low absorption of the drug and parasites susceptible in vitro to halofantrine. The other two patients had adequate plasma concentrations of halofantrine and its main human metabolite, N-desbutylhalofantrine, but the isolates were also resistant in vitro to the drugs, suggesting drug resistance as the cause of treatment failure. Only mild, transitory side effects were noted. A wide interindividual variation in plasma concentrations of halofantrine and its metabolite was observed. Pharmacokinetic studies suggested that the micronized formulation of halofantrine hydrochloride may not increase drug absorption considerably. Further studies using higher doses or longer treatment periods are needed to ensure that adequate plasma concentrations of the drug are used.

Acute Disease↗
PubMed1993

[Renal parenchymatous involvements in African and Caribbean patients with human immunodeficiency virus infection. Apropos of 10 cases].

Between 1989 and 1990, 10 HIV-infected patients with renal involvement (proteinuria and/or renal failure) were followed. The 5 men and 5 women black (4 Haitians, 3 Zairians, 2 Congolese and 1 Angolan). Their mean age was 31.7 +/- 4 years. No known risk factor was identified and transmission was probably heterosexual. When renal disease was diagnosed, 4 patients had AIDS, 5 had ARC and 1 was asymptomatic. Kidney biopsies were performed in 7 patients: 4 HIV-associated nephropathies (HIV AN) with segmental and focal hyalinizations, 1 thrombotic angiopathy, and 2 interstitial nephropathies, 1 with proliferative glomerulonephritis. The clinical, biological and radiographic patterns of 2 of the remaining 3 patients were suggestive of HIV AN. Four of the 6 patients with HIV AN developed end-stage renal disease within 5 +/- 2.5 months; renal function in the other 2 remained stable for 25 and 41 months, respectively, while they were receiving zidovudine, but deteriorated rapidly within weeks of withdrawing this drug. Zidovudine may have delayed the evolution of the nephropathies in these patients.

Acquired Immunodeficiency Syndrome↗
PubMed1993

[Frequency of bronchopulmonary isolation of Aspergillus species in patients infected with human immunodeficiency virus: pathogenic role?].

Prevalence of aspergillosis in patients infected with the human immunodeficiency virus (HIV) is unknown. Mycologic findings in bronchopulmonary specimens from 614 HIV-positive patients sent to a parasitology laboratory between June 1, 1989 and May 31, 1991 were analyzed retrospectively; medical records of Aspergillus sp--positive patients were studied to evaluate the potential pathogenic role of this organism. Prevalence of Aspergillus sp. was 2.7% in bronchoalveolar lavage (BAL) specimens, (21/757), 15.1% in sputum specimens (3/53), 12.6% in bronchial aspirates (11/87), 7% in protected brush specimens (2/28), and 16.6% in lung biopsy specimens (4/24). A total of 20 patients (rate = 3.14%) had lung specimens positive for Aspergillus sp. (A. fumigatus 95% and A. niger 5%). Among them, 66% had a single positive specimen (14.3% with a positive smear) and 33% had several positive specimens (mean 4.9 +/- 3.3). Four patients (20%) with a more than 20-month history of AIDS and less than 36 CD4+ cells per microliter had documented pulmonary aspergillosis; three of these patients also had a current or past history of pulmonary mycobacterial infection. Rate of recovery of Aspergillus sp. in LAB specimens was low. The other specimens were harvested because of clinically suggestive manifestations. However, in 20% of patients with positive specimens. A. fumigatus was the cause of patent infection; these patients had severe AIDS-related immunodeficiency.

AIDS-Related Opportunistic Infections↗
PubMed1992

[Visceral leishmaniasis in HIV infection. A totally opportunistic infection].

Visceral leishmaniasis occurring in immunocompromised patients, and in particular during HIV infection, has been described in recent years and differs from the usual Mediterranean kala-azar as encountered in France. In order to define the clinical, diagnostic and therapeutic features of the HIV-Leishmania spp. co-infection, we report 8 new cases and compare them with data from the literature. The co-infection occurs at any stage of HIV infection, usually in drug addicts using intravenous injections. Clinical manifestations, such as fever, weight loss, liver and spleen enlargement and polyadenopathy, and laboratory findings (cytoponia, inflammatory syndrome) are generally present but not specific during the HIV infection course. Moreover, some gastrointestinal and pleuropulmonary forms of the co-infection are misleading. Leishmaniasis serology is negative in 50 percent of the patients. In most cases the diagnosis is provided by detection of the parasite in bone marrow samples. Culture must be systematic, and samplings must be repeated if they are negative. The first-line treatment consists of pentavalent antimony. Almost 80 percent of the patients respond to this treatment, but relapses occur in 50 percent of the cases. This high risk of relapse and the opportunistic behaviour of leishmaniasis justify a prophylaxis of relapses.

AIDS-Related Opportunistic Infections↗
PubMed1992

[Diarrhea in AIDS. Group AIDS GIT].

Gastrointestinal (GI) infections are frequent in AIDS patients. The frequency and type of opportunistic GI infections are exactly the same in homosexuals and heterosexuals. Diarrhoea is the usual sign of GI infection, and its mechanism seems to combine a secretory component and a malabsorption. Although a number of pathogens can be isolated, in many cases the diarrhoea cannot be explained by an infection or a lesion. The hypothesis of a primary HIV infection in the epithelium of the small bowel and colon has not been confirmed by immunofluorescence and molecular hybridization. The HIV virus has been found in the GI mucosa, but it was probably carried by the immune cells in general circulation (CD4 lymphocytes and macrophages) which subsequently colonize the chorion of the mucosa.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Type RI resistance to halofantrine in West Africa.

A case of recrudescent falciparum malaria after halofantrine treatment is described. The patient contracted Plasmodium falciparum in Ivory Coast and was treated with halofantrine. Plasma levels of halofantrine and its metabolite were adequate. Thirty-one days after treatment, the patient was rehospitalized with symptoms of malaria. Recrudescence was confirmed by microscopic examination, indicating a type RI resistance to halofantrine. Mefloquine was given to treat recrudescent malaria. The parasite was susceptible to chloroquine and quinine in vitro but displayed elevated values of 50% inhibitory concentration for mefloquine and halofantrine. The case reminds us that chloroquine still has an important therapeutic role against African strains of P. falciparum and that mefloquine and halofantrine should be reserved for multi drug-resistant P. falciparum.

Animals↗
PubMed1991

[Hemolytic anemia associated with minor salmonellosis in an HIV positive, G6PD deficient Congolese woman].

Haemolytic anaemia in G6PD-deficient patients with thyphoid fever is well known, but there is only one case-report associated with non-typhic salmonella fever. We report here a case observed in a black african young woman whose HIV infection has been discovered on this occasion. Because of the high prevalence of HIV infection, salmonellosis and G6PD deficiency in sub-saharian Africa, an increasing number of such haemolytic anaemias should be expected in this geographic area.

Adult↗
PubMedDate not supplied

A simple clinical and paraclinical score predictive of CD4 cells counts below 400/mm3 in HIV-infected adults in Dakar University Hospital, Senegal.

In industrialized countries the decision to start co-trimoxazole (CMX) prophylaxis of HIV-related opportunistic infections is based on the CD4+ cell count. The value of CMX prophylaxis has also been demonstrated in Africa, where CD4+ cell counts are rarely available. We therefore developed a simple score predictive of a threshold CD4+ cell count (400/mm3) below which CMX prophylaxis is indicated. In a retrospective cross-sectional study, we collected clinical and biological data on 211 HIV-infected patients recruited from January 1996 through January 1998 at Fann University Hospital in Dakar, Senegal. Several variables were identified as being predictive of a CD4+ cell count below 400/mm3 by stepwise logistic regression. Each variable was weighted according to its regression coefficient, as follows: male sex (+1), weight loss (+2), body mass index < 22 (+2), herpes zoster (+4), tuberculin induration < 5 mm (+3) and haemoglobin < or = 10 g/dL (+1). A score of > or = 4 (sum of weights) selected patients with CD4+ cell counts below 400/mm3 with a sensitivity of 98% and a negative predictive value of 83%. Such a score should be applicable in the African context and should facilitate the management of HIV-infected patients, especially the prescription of CMX prophylaxis.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Use of the Parasight-F diagnostic test for imported malaria in a travel clinic.

The Parasight-F test based on the detection of a soluble antigen specific for Plasmodium falciparum is designed for the immediate diagnosis of malaria infection. We evaluated its use by clinicians during consultations. This prospective study of its diagnostic utility in febrile patients consulting a travel clinic on their return from areas endemic for malaria was conducted between May 1996 and May 1997. The Parasight-F test was performed by the clinician with confirmation by means of standard microscopic examination of venous blood. One-hundred and forty patients were enrolled. Forty-three (31%) cases of malaria were identified by microscopic examination. Thirty-eight were due to P. falciparum. The Parasight-F tests yielded 6 false-positive and 3 false-negative results compared to the microscopic findings. The specificity and sensitivity for the diagnosis of P. falciparum malaria were 94% and 92%. These results show that the Parasight-F test alone cannot replace microscopic diagnosis of malaria in travel clinics.

Adolescent↗
PubMedDate not supplied

Atovaquone plus proguanil versus halofantrine for the treatment of imported acute uncomplicated Plasmodium falciparum malaria in non-immune adults: a randomized comparative trial.

In endemic zones, the atovaquone-proguanil (AP) combination is well tolerated and effective in treating acute, uncomplicated malaria. Trials involving non-immune patients are lacking, however. We conducted a randomized, multicenter open-label trial to determine the efficacy and tolerability of the AP combination (1,000 mg + 400 mg once daily for 3 days) in comparison with halofantrine (HF) (1,500 mg in 3 doses) in non-immune adults with imported uncomplicated Plasmodium falciparum malaria. Follow-up visits were programmed on Days 7, 14, 21, 28, and 35 after hospital discharge. Out of 48 patients enrolled in the study, 41 were assessable for the cure rate (21 in the AP group and 20 in the HF group). All the patients were cured. The mean parasite clearance time was longer (63+/-23 hours) in the AP group than in the HF group (48+/-15 hours) (P = 0.02). The frequency of gastrointestinal adverse events was higher in the AP group. No noteworthy electrocardiographic changes were observed, particularly in the QTc interval. The AP combination appears to be a valuable alternative treatment in non-immune adults.

Acute Disease↗