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Biomedical subjects

P Canton

Publications and source records attributed to P Canton.

At least 55 records · Page 3Linked to original sources
PubMed1995

Infective endocarditis in patients with negative blood cultures: analysis of 88 cases from a one-year nationwide survey in France.

Blood cultures were negative in 88 (14%) of 620 cases of infective endocarditis (IE) documented in France during a 1-year nationwide survey. In 15 of these 88 cases, the causative microorganism was identified: seven cases of Q fever endocarditis and two cases of chlamydial endocarditis were diagnosed by serological and/or immunohistologic techniques, and a pathogen was cultured from five surgically removed valves and one arterial septic embolus. Forty-two (48%) of the 88 cases involved patients who had received antibiotics before the first blood sample was taken for culture. Mortality was lower in this group than among patients who had not previously received antibiotics (7% vs. 22%, P = .05). Comparison of blood culture-negative cases of IE with blood culture-positive cases revealed that the former tended to occur more often on prosthetic valves (32% vs. 22%, P = .16), were more often left-sided (97% vs. 83%, P = .0009), less often included extracardiac symptoms at presentation (52% vs. 63%, P = .06), and were more often surgically treated (53% vs. 34%, P = .001). Mortality was similar regardless of the results of blood culture (15% vs. 21%, P = .18). This study showed that more than 10% of all cases of IE in France are still associated with negative blood cultures and confirmed that a search for pathogens such as Coxiella burnetii and Chlamydia species is worthwhile in this situation.

Adolescent↗
PubMed1995

Evaluation of the Duke criteria versus the Beth Israel criteria for the diagnosis of infective endocarditis.

New diagnostic criteria for infective endocarditis (IE) have been proposed by the Duke University Endocarditis Service (Durham, NC) to update the widely used Beth Israel (Boston) criteria. We compared the Duke criteria with the Beth Israel criteria in a series of 115 consecutive patients with suspected IE who were hospitalized in a referral center. The diagnosis of IE was histologically and/or bacteriologically confirmed for 27 operated patients. If surgery had not been performed on these 27 patients, 22 vs. 12 would have been classified as having ¿clinically definite¿ and ¿probable¿ IE by the Duke vs. the Beth Israel criteria, respectively, whereas 0 vs. 5 would have been ¿rejected¿ by the Duke vs. the Beth Israel criteria, respectively. The improvement in sensitivity of the criteria from 44% (Beth Israel) to 82% (Duke) was statistically significant (P < .01). We confirm that the Duke criteria improve the sensitivity of diagnosis of IE. The specificity of these criteria should be further evaluated.

Adult↗
PubMed1995

Schnitzler's syndrome: two case reports and review of the literature.

Schnitzler's syndrome is a combination of chronic urticaria, fever of unknown origin, disabling bone pain, hyperostosis, increased erythrocyte sedimentation rate, and macroglobulinemia. Since it was first described in 1974, only 26 cases have been published in the literature. In this report, we describe two additional cases and review the clinical features and pathogenesis of this uncommon syndrome.

Aged↗
PubMed1995

[Comparative outcome of aortic valve endocarditis with or without annular abscess].

Annular abscess is a not uncommon but serious complication of aortic valve endocarditis. The aim of this retrospective study was to evaluate the prognosis of aortic valve endocarditis with and without annular abscess. Between January 1981 and 1989, 122 consecutive cases of aortic endocarditis fulfilling the diagnostic criteria of Duke University were admitted to hospital. Group I included 40 cases with aortic ring abscess confirmed at surgery, in 35 patients; group II comprised 43 cases of operated aortic valve endocarditis without annular abscess in 41 patients and group III comprised 38 cases of aortic valve endocarditis treated medically without echocardiographic or angiographic signs of annular abscess in 36 patients. The patients in group III were significantly older than those in group I (57 +/- 14 years vs 44 +/- 17 years; p < 0.001). From the clinical point of view, endocarditis of prosthetic valves was slightly more common, but without reaching statistical significance, in group I, but the abscess was associated with more severe cardiac failure. Systemic embolism, atrioventricular block and pericardial effusion were equally common in the three groups. On the other hand, endocarditis with annular abscess was more often the result of infection with streptococci A, B, C or pneumoniae, than forms without abscess (22.5% vs 5% and 3% respectively in the 3 groups; p < 0.05). Of the patients treated surgically, destructive lesions of the valves were more common in cases of abscess (57.5% vs 35%; p < 0.05): the hospital mortality was higher in cases of abscess (17.5% vs 7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗
PubMed1995

[Isolation of an acid-alcohol resistant bacillus (BAAR) in the febrile HIV infected patients: Mycobacterium tuberculosis (MT) or Mycobacterium avium complex (MAC)?].

The detection of BAAR in HIV infected patients with CD4 < 100/mm3 and with an infectious syndrome urge on beginning an effective treatment against Mycobacterium tuberculosis and/or Mycobacterium avium Complex, before the results of the culture are known. Our purpose was to search clinical and biological features to angle directly the diagnosis towards a tuberculosis or not, and to start the most suitable treatment. This retrospective study, from 1986 to 1993, stated on 54 patients who had at least one sample with positive BAAR (blood, marrow, stools, sputum or urine cultures). From these cultures, MAC was isolated on 37 patients and BK on 17. The both groups were similar for age, sex, risk factor, number of opportunistic infections, delay between the date of AIDS and the discovery of a positive BAAR, and Ag p24. However, a significant difference in favor of a MAC disease exists regarding about: disseminated infections (92% vs 53%), digestive troubles (57% vs 23.5%), anterior or concomitant CMV infection (49% vs 9%), isolation of BAAR in blood culture (54% vs 20%) or in stools culture (76% vs 33%), leucopenia (2850/mm3 +/- 1520 vs 4124/mm3 +/- 2232), anémia (Hb 9.1 g/dl +/- 1.5 vs 10.1 g/dl +/- 1.6). The univariated analysis of results allowed us to conclude that the presence of one among those parameters must induce the prescription of a suitable treatment against MAC.

AIDS-Related Opportunistic Infections↗
PubMed1995

[Value of the stool bacteriological test in Mycobacterium avium complex infections in AIDS].

Incidence of Mycobacterium avium complex (MAC) infection has increased in HIV infected patients. We report a retrospective study of 25 cases of MAC infection occurring in HIV patients. Stools examination was performed in 5 (31%) of the patients without digestive symptoms and in the 9 (100%) patients presenting with diarrhoea. The stools culture are positive in 79% of cases (11/14). In all the patients with diarrhoea, direct examination of the stools gave the diagnosis of MAC infection. All the patients had profound immunodepression with CD4+ cell count < 5/mm3. The mean survival time from mycobacteriosis diagnosis was 122 +/- 90 days despite antimycobacteriosis therapy.

AIDS-Related Opportunistic Infections↗
PubMed1994

[Herpetic meningoencephalitis in the elderly. Apropos of 13 cases].

In a retrospective analysis of 13 cases of Herpes simplex encephalitis (mean age: 67.2 +/- 6.4 years; ten women, three men), the authors conclude that this infection is more often due to Herpes simplex virus 1 in the elderly. Diagnosis is difficult at an early stage, and must be suspected in case of confusion (9/13), especially feverish (11/13), associated with neurological signs (10/13), and particularly epilepsy (5/13). It requires a lumbar puncture which collect a clear and lymphocytic fluid. Prognosis of this encephalitis depends on early diagnosis and an presumptive therapy with acyclovir. EEG is helpful showing periodic activity (10/13). CT scan and MRI can show unspecific abnormalities, but often too late. Laboratory findings will secondarily confirm the diagnosis quite frequently, using new Elisa methods. Polymerase chain reaction allows earlier diagnosis. Geriatric cases seem more often due to reinfection or to endogen virus reactivation rather than to primary infection.

Aged↗
PubMed1994

Extracerebral toxoplasmosis in patients infected with HIV. A French National Survey.

A French nationwide survey of extracerebral toxoplasmosis (ECT) in HIV-infected patients was performed between January 1990 and September 1992. All French hospitals were surveyed, and all but a few responded. Data collected included epidemiologic, clinical, and biologic features; therapy; and outcome. During the 33-month survey, 199 cases were collected. The prevalence of ECT in patients with AIDS can be estimated at 1.5%-2%. Age, sex, and HIV risk factors were similar to those of the general AIDS population in France. Extracerebral toxoplasmosis appeared mainly in HIV-infected patients with advanced immunosuppression: the mean CD4+ lymphocyte count was 57/mm3(+/- 99). The localizations observed were: eyes (50% of patients); lung (26%); disseminated (at least 2 extracerebral visceral localizations) (11.5%); peripheral blood (acute febrile syndrome with isolated positive parasitemia) (3%); heart (3%); bone marrow (3%); bladder (1%); and isolated cases of rhinopharynx, skin, liver, lymph nodes, conus medullaris, and pericardium. In this survey, muscular and pancreatic localizations were always associated with other extracerebral localizations. A cerebral localization was diagnosed in 41% of cases. Serologic data provided little information. Ocular fundus examination, bronchoalveolar lavage, tissue biopsy, and search for parasitemia were the main diagnostic procedures. Treatment was the same as for cerebral toxoplasmosis. A clinical response was observed in 64% of cases; 19% relapsed. Death occurred in 106 (53%) cases and was related to ECT in 34% of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS-Related Opportunistic Infections↗
PubMed1994

Giant-cell arteritis of the female genital tract.

A 56-year-old woman with long-lasting fever of unknown origin was diagnosed as having a giant-cell arteritis of the genital tract with no evidence of temporal arteritis. Diagnosis relied on pathological examination, which showed a segmental panarteritis of ovaries, myometrium, endometrium and uterus cervix. Corticosteroid therapy led to clinical cure within a few weeks. Twenty-five cases of giant-cell arteritis of the female genital tract have been published of which only four were associated with temporal arteritis. We recommend that such a diagnosis should be considered in women presenting with long-lasting fever of unknown origin, even in the absence of temporal arteritis and the clinical evidence of genital abnormalities.

Diagnosis, Differential↗
PubMed1994

[Pulmonary involvement with a favorable course during Loa loa filariasis].

We report a case of pulmonary infiltrate in filariasis due to Loa loa in a 52 years old patient, living in Cameroon. Antifilarial treatment with ivermectin then diethylcarbamazine led to a rapid resoluting of the pulmonary abnormalities. It is the fifth case of lung disease during filariasis Loa loa.

Cameroon↗
PubMed1994

Trimethoprim-sulfamethoxazole versus aerosolized pentamidine for primary prophylaxis of Pneumocystis carinii pneumonia: a prospective, randomized, controlled clinical trial. LFPMI Study Group. Ligue Française de Prévention des Maladies Infectieuses.

The objective was to compare the efficacy and tolerance of monthly aerosolized pentamidine versus trimethoprim-sulfamethoxazole (TMP-SMX) to prevent the first episode of Pneumocystis carinii pneumonia (PCP) in human immunodeficiency virus (HIV)-infected patients. In an open, prospective, randomized multicentric clinical trial, HIV-infected patients (n = 214) with CD4 cell counts < 200/mm3 or 20% without a history of PCP or cerebral toxoplasmosis were randomized to receive for at least 2 years aerosolized pentamidine (300 mg monthly) or low-dose daily TMP-SMX (400-80 mg). The mean follow-up was 578 days. The two groups (except for gender) were homogeneous for age, risk group for HIV infection, initial CD4+ lymphocyte count, and mean follow-up. The PCP rate per year of observation using an intent-to-treat analysis was 3.1% and 1.3% in the groups treated with pentamidine and TMP-SMX, respectively (p > 0.05). Moderate or severe clinical and biological side effects were observed in five patients on pentamidine and 33 on TMP-SMX (p < 0.05). Nineteen episodes of cerebral toxoplasmosis were diagnosed during the study. The analysis showed no significant difference in time of development of toxoplasmosis, but only one patient was actually treated with TMP-SMX. Survival was not significantly different in the two groups. Low-dose daily TMP-SMX or monthly aerosolized pentamidine effectively prevented a first episode of PCP in HIV-infected patients, but aerosolized pentamidine was better tolerated. However, TMP-SMX is less costly and should have a preventive effect for toxoplasmosis.

AIDS-Related Opportunistic Infections↗