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Biomedical subjects

P Tattevin

Publications and source records attributed to P Tattevin.

At least 19 recordsLinked to original sources
PubMed2006

Comparison of epidemiological, clinical, and biological features of invasive aspergillosis in neutropenic and nonneutropenic patients: a 6-year survey.

BACKGROUND: Invasive aspergillosis is an opportunistic infection that occurs mainly among patients with prolonged neutropenia. Few data are available on invasive aspergillosis in nonneutropenic patients. METHODS: The aim of this survey was to compare neutropenic and nonneutropenic patients who had received a diagnosis of invasive aspergillosis at our institution during a 6-year period. RESULTS: Among the 88 cases of invasive aspergillosis analyzed here, 12 were histologically proven, 52 were probable, and 24 were possible. Forty-seven percent of cases were diagnosed in the intensive care unit, and 40% were diagnosed in hematology units. Neutropenia was a risk factor for 52 patients (59%), most of whom had hematological or solid malignancies. Among the 36 nonneutropenic patients (41%), the main underlying conditions were steroid-treated chronic obstructive pulmonary disease, asthma, rheumatoid arthritis, giant-cell arteritis, and microvascular disorders; 10 patients were recipients of solid-organ transplants, and 1 patient was seropositive for human immunodeficiency virus. The distribution of proven and probable invasive aspergillosis was similar for neutropenic and nonneutropenic patients. The mortality rate was 71.5% overall and was significantly higher among nonneutropenic patients than among neutropenic patients (89% vs. 60%; P<.05). Compared with neutropenic patients, nonneutropenic patients were significantly less likely to have symptoms of invasive aspergillosis and more likely to have frequent intercurrent pneumonia due to another microorganism. The sensitivity of mycological examination of bronchoalveolar lavage fluid specimens was higher for nonneutropenic patients than for neutropenic patients (85% vs. 58%; P<.05), whereas the sensitivity of antigenemia was the same for the 2 populations (65% vs. 64%). Findings on thoracic computed tomographs were similar, except that segmental areas of consolidation occurred more frequently among neutropenic patients. CONCLUSION: This survey at a whole institution underlines the high number of cases of invasive aspergillosis among nonneutropenic patients, with an overall mortality rate that was significantly higher than that for neutropenic patients.

Adolescent↗
PubMed2006

Tuberculosis treatment duration in France: From guidelines to daily practice.

BACKGROUND: Guidelines for tuberculosis (TB) recommend 6 months of treatment except for meningeal TB, where a 9- to 12-month course may be preferred. METHODS: In order to assess whether practices in France are in agreement with those guidelines, we performed an anonymous audit of the policy of French physicians, focusing on TB treatment duration and corticosteroid use according to the TB presentation. RESULTS: Sixty-six completed forms were analyzed. Reported treatment duration was usually 6 months for pulmonary TB (91% of physicians) and miliary TB (45%), 9 months for pulmonary TB in HIV-infected patients (42%) and for TB lymphadenitis (57%), and 12 months for TB meningitis (79%) and osteo-articular TB (65%). Corticosteroid use was systematic for meningitis (80%) and pericarditis (65%). CONCLUSION: This study reveals discrepancies between guidelines and daily practice for TB treatment duration in France: We observed a very high reported rate of unnecessary, prolonged treatment for most extrapulmonary TB.

Journal Article↗
PubMed2005

Use of high-performance liquid chromatography (HPLC) to monitor beta-lactam plasma concentrations during the treatment of endocarditis.

Guidelines recommend high doses of beta-lactams for the therapy of endocarditis. This report describes a retrospective study of 15 endocarditis patients (median age 64 years), treated according to guidelines, whose beta-lactam trough plasma concentrations were measured with high-performance liquid chromatography because of tolerance or efficacy concerns. For amoxycillin, the mean level was 86.8 mg/L (range: 30-212 mg/L); five (45%) patients had concentrations > 1000 x MIC. For cloxacillin, the mean level was 47.9 mg/L (range: 16.7-104 mg/L). The consequences of high and unpredicted beta-lactam trough plasma concentrations for a prolonged period have not yet been thoroughly evaluated.

Adult↗
PubMed2005

Clinical presentation of leptospirosis: a retrospective study of 34 patients admitted to a single institution in metropolitan France.

Leptospirosis has a highly variable clinical presentation, which may be related to different infecting serovars, host factors, or a combination of these. This study investigated retrospectively 34 consecutive patients with serologically confirmed leptospirosis admitted during the period 1992-2002. On admission, the most frequent symptoms were fever (100%), headache (75%), myalgia (55%), arthralgia (45%) and vomiting (39%). Pertinent laboratory findings included lymphopenia (85%), thrombocytopenia (75%), elevated liver enzymes (87%) and renal abnormalities (proteinuria, 77%; haematuria, 58%; elevated serum creatinine, 53%). The study confirmed the variable clinical and biological symptoms of leptospirosis, and indicated that lymphopenia is a common feature of leptospirosis cases.

Adolescent↗
PubMed2004

[Recurrent pericarditis during meningococcal meningitis. 2 case reports].

INTRODUCTION: There is little information on the frequency, physiopathology and management of extra-cerebral manifestations of N. meningitidis meningitis. Articular, pleural and pericardial involvement is occasionally reported with a symptomatology that can be delayed with regard to the initial diagnosis. OBSERVATIONS: In two patients in whom the diagnosis of meningococcal meningitis had been confirmed, the progression was towards a recurrent pericarditis up until the 4th month after the initial episode of infection in the first case and pericarditis with tamponade and surgical draining in the second. However, the final outcome was favourable for both patients following treatment with non-steroidal anti-inflammatories (NSAIs). COMMENTS: The incidence of pericardial involvement is unknown. The distinction has to be made between purulent pericarditis, more frequent in children, and the inflammatory pericarditis that is often of late onset. The indication for surgical draining must be dominated by the clinical hemodynamic impact. The indication for NSAIs and/or acetyl-salicylic acid is not codified (doses, duration), but in the two cases reported here we would privilege NSAIs.

Adolescent↗
PubMed2004

[Cerebral aspergillosis].

INTRODUCTION: The brain is almost always a localization of invasive aspergillosis, after hematogenous spread from pulmonary aspergillosis. Brain aspergilosis is not rare and is one of the worst prognosis factors of invasive aspergillosis. STATE OF ART: The incidence of this severe mycosis is currently on the rise due to the development of major immunosuppressive treatments. Brain aspergillosis is noteworthy for its vascular tropism, leading to infectious cerebral vasculitis, mainly involving thalamoperforating and lenticulostriate arteries, with a high frequency of thalamic or basal nuclei lesions. Extra-neurologic features that suggest this diagnosis are: i) risk factors for invasive aspergillosis (major or prolonged neutropenia, hematologic malignancies, prolonged corticosteroid treatment, bone marrow or solid organ transplant, AIDS); ii) persistent fever not responding to presumptive antibacterial treatment; iii) respiratory signs (brain aspergillosis is associated with pulmonary aspergillosis in 80 to 95 p. 100 of cases). Perspectives. Two recent major improvements in brain aspergillosis management must be outlined: i) for diagnostic purposes, the development of testing for Aspergillus antigenemia (a non-invasive procedure with good diagnostic value for invasive aspergillosis); ii) for therapeutic purposes, the demonstration that voriconazole is better than amphotericin B in terms of clinical response, tolerance and survival, for all types of invasive aspergillosis, the benefit being probably even greater in case of brain aspergillosis because of the good diffusion of voriconazole into the central nervous system. CONCLUSIONS: Brain aspergillosis is a severe emerging opportunistic infection for which diagnostic and therapeutic tools have recently improved. Thus, this diagnostic must be suspected early, especially in the immunocompromised patient, in the event of respiratory symptoms and when the brain lesions are localized in the central nuclei and the thalamus.

Antifungal Agents↗
PubMed2004

Successful treatment of brain aspergillosis with voriconazole.

Until recently, brain aspergillosis was almost always fatal, with a response rate to amphotericin B of < 10%. This study describes a retrospective analysis of eight consecutive cases of brain aspergillosis. All patients were immunosuppressed and five required mechanical ventilation. Antifungal treatment included amphotericin B (n = 7), itraconazole (n = 3), voriconazole (n = 2) and flucytosine (n = 1). Three (38%) patients survived following prolonged azole therapy after initial amphotericin B treatment, combined with a reduction in their immunosuppressive treatment. The prognosis of brain aspergillosis might be improved if immunosuppression could be reduced and prolonged oral azole therapy used.

Adult↗
PubMed2003

[Vibrio vulnificus septicemia transmitted through a wound caused by a crustacea].

INTRODUCTION: Vibrio vulnificus proliferates during the summer in salt water where it infects the crustaceans. Expression of its pathogenicity depends on the underlying condition and mode of contamination. OBSERVATION: A 65 year-old man presented with a Vibrio vulnificus septicaemia of cutaneous origin, transmitted when he cut himself with a crawfish. The severity of the infection was enhanced by severe immuno-depression and haemochromatosis. The infection regressed with appropriate antibiotherapy. COMMENTS: Severe V. vulnificus infections are rare. Depending on the underlying condition and mode of contamination, one can distinguish between benign gastro-enteritis, local occasionally devastating infections and usually fatal septicaemia. CONCLUSION: Even the most severe forms of V. vulnificus infections may be cured with early and well adapted anti-infectious treatment.

Aged↗
PubMed2003

[Cutaneous metastatic Crohn's disease].

INTRODUCTION: Cutaneous metastatic Crohn's disease is a granulomatous inflammation of the skin that is noncontiguous to the gastrointestinal tract. CASE REPORT: A 42-year-old man with Crohn's disease is admitted for antibiotic resistant erysipela-like dermo-hypodermitis. The presence of granulomatous lesions on skin biopsy, the absence of any infectious agent identified despite extensive investigations and the dramatic improvement observed with corticosteroid eventually lead to the diagnosis of cutaneous metastatic Crohn's disease. CONCLUSION: During Crohn's disease, biopsy should be considered for every undiagnosed skin lesion as the characteristics of cutaneous metastatic Crohn's disease are not specific. The presence of a non caseous granulomatous dermal infiltration suggests the diagnosis and should make consider the initiation of corticosteroid and the discontinuation of others inappropriate therapeutics (i.e. surgical treatment, antibiotics).

Adult↗
PubMed2001

[Fainting after drinking a glass of whiskey-soda...].

BACKGROUND: Alcohol intolerance is a rare syndrome that usually involves pain, pruritus, or vasomotor phenomena consecutive to moderate alcohol intake. This syndrome may unmask various malignancies, especially Hodgkin's disease or non-Hodgkin lymphoma, and carcinoma of the cervix. CASE REPORT: A patient who became unconscious after drinking a glass of whiskey-cola was explored for alcohol intolerance. High-level hypereosinophilia was discovered. The diagnosis of idiopathic hypereosinophilia was retained after extensive evaluation. DISCUSSION: Idiopathic hypereosinophilia may be a premalignancy expression of a lymphoproliferative disorder. In our patient, who also had alcohol intolerance known to be associated with later diagnosis of malignancy, lymphocyte phenotype studies revealed an abnormal population. However, rearrangement studies of T-cell and B-cell receptors, as well as bone marrow cytology and histology did not enable identification of a lymphoproliferative disorder. This patient will require close follow-up due to the risk of developing a lymphoproliferative disorder.

Abdominal Pain↗
PubMed2001

The adhesive property of the type IV pilus-associated component PilC1 of pathogenic Neisseria is supported by the conformational structure of the N-terminal part of the molecule.

Neisserial PilC proteins are key elements in type IV pili biogenesis and adhesion. Two pilC alleles are usually present in Neisseria meningitidis. At least one of the PilC proteins is required for pilus assembly and competence for transformation. In addition, meningococcal PilC1, but not PilC2, modulates adhesiveness, whereas, in N. gonorrhoeae, both alleles are adhesive. The meningococcal pilC genes are differently regulated, and it was shown that the expression of pilC1, but not that of pilC2, is transiently induced by bacteria-cell contact. The aim of this work was to determine whether, besides regulation, PilC1-mediated adhesion was conferred by some specific protein pattern not present in the meningococcal PilC2 protein. We demonstrate first that differences within the primary sequence of the meningococcal PilC1 and PilC2 are responsible for different adhesion phenotypes, thus eliminating the regulation of transcription being solely responsible for the adhesive phenotype of PilC1. To identify the regions of PilC1 responsible for adhesion, we engineered meningococcal strains expressing various PilC1-PilC2 hybrids at the pilC1 locus. Our data demonstrate that the specific PilC1 adhesion-promoting regions are located in the amino-terminal part of the molecule and that several domains within this region probably interact with each other to promote adhesion to human cells.

Amino Acid Sequence↗
PubMed2001

Varicella-zoster virus limbic encephalitis in an immunocompromised patient.

A case of limbic encephalitis in a patient who had undergone prolonged immunosuppressive treatment with i.v. cyclophosphamide and oral prednisolone for a microscopic polyangeitis is reported. A brain MRI scan revealed symmetric mesial temporal lobe lesions. Studies of cerebrospinal fluid (CSF) revealed a positive PCR for varicella-zoster virus (VZV) DNA in 2 separate samples. Owing to a delay in diagnosis, intravenous acyclovir was initiated only after 11 d of symptoms. PCR of CSF for VZV DNA became negative on day 14 of treatment while brain lesions had resolved on subsequent MRI scans. Limbic encephalitis is a novel form of VZV infection. When brain imaging is suggestive of limbic encephalitis in an immunocompromised patient, PCR of CSF for VZV DNA should be performed, as early antiviral treatment may improve the outcome.

Acyclovir↗
PubMed2000

[Development of a predictive model for respiratory isolation of patients suspected of having pulmonary tuberculosis].

INTRODUCTION: As numerous nosocomial outbreaks of pulmonary tuberculosis have been reported during the last two decades, prompt identification and effective isolation of contagious patients should be made a priority in tuberculosis control policies. There is a need to develop a predictive model which would allow prompt recognition and isolation of smear-positive patients. CURRENT KNOWLEDGE AND KEY POINTS: Various authors have attempted to improve the respiratory isolation policies for patients suspected of having pulmonary tuberculosis. A French multicenter prospective study of 211 patients suspected of having pulmonary tuberculosis established that: 1) the current respiratory isolation policy of suspected pulmonary tuberculosis needs improvement (sensitivity = 71.4%; i.e., 28.6% of smear-positive patients are admitted without isolation) and 2) better interpretation of clinical and radiological data available on patient admission could improve the adequacy of respiratory isolation. Univariate analysis showed that predictive factors of pulmonary tuberculosis were chest X-rays (P < 0.00001), symptoms (P = 0.0004), age (mean: 40.8 years for TB vs. 47.5 for non-TB, P = 0.04), HIV infection (10.6% vs. 28.7%, P = 0.01), immigrant (72% vs. 55%, P = 0.03) and BCG status (P = 0.025), while multivariate analysis demonstrated that chest X-ray pattern (P < 0.00001), HIV infection (P = 0.002) and symptoms (P = 0.009) were independent predictive factors. FUTURE PROSPECTS AND PROJECTS: From these data, a model was proposed and evaluated in the derivation cohort using the receiver operating characteristics (ROC) curve. We retrospectively studied the predictive model in two populations different from the one from which it was derived. The model would have improved sensitivity of the respiratory isolation policy from 71.4% (current respiratory isolation policy) to 82.4% and 91.1%, respectively. Prospective, multicenter studies are requested to establish the value of such a predictive model in improving the respiratory isolation policy for patients suspected of having pulmonary tuberculosis.

Cohort Studies↗
PubMed2000

[Partial tricuspid homograft: a new technique for tricuspid valve repair. Report of a case].

The authors report the case of a drug abuser treated successfully for fungal tricuspid endocarditis complicated by massive pulmonary embolism. Partial valvular replacement with a segment of a tricuspid homograft associated with disobliteration of a pulmonary artery was performed. Peroperative transoesophageal echocardiography showed satisfactory tricuspid valve function. The postoperative course was uneventful. After 5 months' follow-up, the patient was asymptomatic and in good general condition. Control echocardiography showed a stable operative result.

Adult↗