Biomedical subjects
Publications and source records attributed to P Canton.
Legionella jordanis has seldom been reported as a cause of infection in humans. We describe a case of pneumonia due to L. jordanis that occurred in a non-immunocompromised 74-year-old patient and failed to respond to a combination of ceftriaxone and ofloxacin. Cure was achieved only after an erythromycin-rifampin combination was started.
Congestive cardiomyopathy is a highly unusual complication of Wegener's granulomatosis. In this report, we describe a 37-year-old man with histologically proven Wegener's granulomatosis who had two episodes of severe hypokinetic cardiomyopathy that responded well to cyclophosphamide. The theory that cardiomyopathy might be related to cardiac involvement in Wegener's granulomatosis and the beneficial effect of cyclophosphamide in this condition are discussed.
AIM: To identify factors predicting short-term mortality in patients with tuberculosis in the Lorraine region of France. METHOD: Retrospective survey in nine voluntarily participating hospitals between January 1990 and December 1994. RESULTS: In total 351 files were analyzed. The average age of patients was 49 +/- 19 years; 77% were of French origin, 60% were male; 35% were in paid employment at the time of the diagnosis, 42% were unemployed and 23% were retired. Twenty-three patients were infected by the human immunodeficiency virus (HIV), and 34 patients had a prior history of tuberculosis; 79% of all cases were exclusively pulmonary, 14% were exclusively extra-pulmonary (more frequent in women) and 7% were mixed. Extra-pulmonary sites of involvement were more frequent in HIV-infected patients. Chest X-ray was suggestive of tuberculosis in 158 patients with pulmonary involvement, and non-suggestive in 145 (more frequently in HIV-infected patients). In univariate analysis, HIV co-infection, increasing age and unemployment were linked to death during treatment. In multivariate analysis (logistic regression), HIV co-infection, old age, unemployment, pulmonary involvement and French origin were significantly linked to the risk of death during treatment.
Diagnosis of intraocular lymphoma is difficult and should be considered in middle-aged or older patients with a chronic uveitis. Many explorations (lumbar punctures, brain imaging and vitrectomies) may be needed before correct diagnosis is made. We report the case of a 50-year-old woman with an intraocular lymphoma for whom the diagnosis was confirmed by a vitrectomy.
Isolated aspergillosis of the sphenoid sinus is a difficult diagnosis because the often misleading clinical manifestations of this rare disease develop late. We report a case of invasive aspergillosis uniquely involving the sphenoid sinus revealed by clinical features suggesting pseudotumor of the pituitary in an immunocompetent man. A 71-year-old man presented sudden onset palsy of the abductor nerve of the left eye. Neuroimaging suggested a pseudotumor of the pituitary. Sphenoid sinusitis was discovered at surgery. The diagnosis of aspergillosis was provided by the histology examination of the sphenoid mucosa. Despite medical treatment with itraconazol alone then in combination with amphotericine B, the infectious process progressed to the pituitary, the cavernous sinus, the upper orbital fissue and the optic canal. Cure was finally achieved after a second surgical procedure to drain and aerate the sphenoid sinus. Aspergillosis of the sphenoid sinus is usually discovered due to neurological signs such as a cavernous sinus syndrome, pseudotumor of the pituitary or the orbit. Diagnosis is often made intraoperatively or at histology examination. Invasive forms almost always are seen in immunosuppressed subjects. In our case, the patient was immunocompetent and had no past history of sinusitis. The invasive sphenoid aspergillosis invaded bone tissue, the cavernous sinus and the meninges.
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OBJECTIVES: Identify prognosis factors in Pneumocystis carinii pneumonia at diagnosis and construct a model to predict mortality according to these prognosis factors. METHODS: Seventy-seven consecutive cases of proven AIDS-related Pneumocystis carinii pneumonia (67 men, 10 women, mean age 37.2 years) were reviewed to determine the most accurate initial prognostic factors and estimate an individual prediction of death. A stepwise logistic regression analysis was performed. Three kinds of data were entered into the logistic model: historical data, clinical and laboratory data obtained within the first 24 hours of diagnosis, and specific data related to chest X-ray and bronchoalveolar lavage results. RESULTS: The sum of arterial partial pressure of oxygen and carbon dioxide (PaO2 + PaCO2) and serum albumin level best predicted a fatal outcome in multivariate analysis. CONCLUSION: The logistic equation provided by the model might be used to accurately and quickly identify the patients with severe Pneumocystis carinii pneumonia who might benefit from supportive intensive care.
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The wasting syndrome is well known in HIV infected patients. Predominant free fatty mass deletion is achieved. The weight loss results from decrease of food intake, from gut disorders due to HIV or opportunistic infections. Metabolic disorders are reported too. Breakdown of carbohydrates and proteins presents energy source. Raised free fatty acid turn over and hypertriglyceridemia are reported. Polyunsatured fatty acid level is raised inducing free radicals increase. Free radicals delete immune functions (apoptosis). Vitamin and trace element decrease worsen negative effects of free radicals.
The recently proposed Duke criteria were confirmed to be more sensitive than the former Beth Israel criteria for the diagnosis of infective endocarditis (IE). To assess the specificity of the Duke criteria, we reviewed the records of 100 patients admitted to two internal medicine wards because of acute fever or fever of unknown origin (FUO). IE was considered a possible diagnosis for all patients who had had at least two blood cultures performed and one transthoracic echocardiogram obtained. The diagnosis of IE was rejected in all cases in accordance with the Duke criteria (i.e., a firm alternate diagnosis [n = 23], resolution of symptoms with no antibiotics [n = 39], or both reasons [n = 38]). To calculate the specificity of the Duke criteria, all 100 cases were then reclassified according to these criteria as if the diagnosis of IE had not been rejected. Only one patient, who probably did not have IE, was reclassified as having clinically definite IE. The specificity of the Duke criteria could therefore be calculated to 0.99 (95% confidence interval, 0.97-1). Although the design of the study may have resulted in a slight overestimation of the specificity rate, we conclude that the Duke criteria are highly specific for ruling out IE in patients with acute fever or FUO who are at low risk for IE.
We reviewed all cases of pulmonary toxoplasmosis (PT) that were documented by detection of Toxoplasma gondii in bronchoalveolar lavage fluid specimens during a French nationwide review of extracerebral toxoplasmosis in patients infected with human immunodeficiency virus (HIV). Only 64 cases of proven PT were recorded during the 33-month survey. The patients were similar to other patients with AIDS in terms of age, sex, and risk factors for HIV infection. PT occurred mainly in patients with advanced immunodeficiency (mean [+/- SD] CD4+ lymphocyte count, 40 +/- 75/mm3). Clinical features of PT usually include fever, cough and dyspnea; the associated radiological findings were mainly diffuse interstitial infiltrates. Serological data were uninformative. The treatment for PT was the same as that for cerebral toxoplasmosis. A clinical response was observed for 47% of patients, 23% of whom relapsed. Twenty-four patients (37%) died of toxoplasmosis, and 17 (27%) died of other causes. The median survival time was 150 days. We conclude that PT is an infrequent but severe infection in HIV-patients in France.
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A previously reported statistical model based on a combination of four parameters (total polymorphonuclear cell count in cerebrospinal fluid (CSF), CSF/blood glucose ratio, age and month of onset) appeared effective in differentiating acute viral meningitis (AVM) from acute bacterial meningitis (ABM). The objectives of this study were to validate this model on a large independent sample of patients with acute meningitis and to build and validate a new model based on this sample. Of 500 consecutive cases of community-acquired meningitis reviewed retrospectively, 115 were ABM, 283 were AVM and 102 were of uncertain etiology. For each of the ABM and AVM cases, the probability of ABM versus AVM (pABM) was calculated for both models. Sensitivity, specificity and predictive values as well as areas under the receiver operating characteristic (ROC) curves were calculated for both models. The original model proved an accurate and reliable diagnostic test. Its area under the ROC curve was 0.981. For pABM = 0.1, its negative and positive predictive values were 0.99 and 0.68, respectively. The new model retained four slightly different independent variables: CSF protein level, total CSF polymorphonuclear cell count, blood glucose level and leukocyte count. Its area under the ROC curve was 0.991 and, for pABM = 0.1, its negative and positive predictive values were 0.99 and 0.85, respectively. In conclusion, both models provide a valuable aid in differentiating AVM from ABM. They should be further evaluated in a prospective appraisal of their contribution to therapeutic decision making.
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Explore the source record for details and available documents.
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