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Biomedical subjects

Philippe Bossi

Publications and source records attributed to Philippe Bossi.

14 recordsLinked to original sources
PubMed2003

Atypical toxoplasmic manifestation after discontinuation of maintenance therapy in a human immunodeficiency virus type 1-infected patient with immune recovery.

We describe an HIV-infected man with recurrence of a toxoplasmic manifestation, despite immune reconstitution during highly active antiretroviral therapy. This atypical recurrence was more likely to be a reinfection than a reactivation, as attested by the genotypic analysis of the Toxoplasma gondii strain recovered from the patient.

AIDS-Related Opportunistic Infections↗
PubMed2003

[Tularemia, a potential bioterrorism weapon].

A POTENTIAL WEAPON: Because of its highly contagious nature with a low inoculum, principally with the biovar A, F. tularensis is considered as an agent that could be used by terrorists, notably when sprayed. Any epidemic of tularemia, essentially in its respiratory form, particularly in areas of low incidence of this infection, should be suspected to be a biowarfare attack. The voluntary contamination of water with this bacteria could also be used as a biological weapon. THE DIFFERENT FORMS OF THE DISEASE: Depend on the mode of contamination, the dose of inoculum and the virulence of the strains. The forms are pulmonary, ulcerous-glandular, typhoid, glandular, ocular-glandular, oropharyngeal and septicemic. IN GENERAL PRACTICE: Tularemia is a disease that requires official notification. Many guidelines exist for the treatment and prophylaxis of patients having been exposed to F. tularensis.

Adult↗
PubMed2003

[The plague, possible bioterrorist act].

PLAGUE AND BIOWARFARE: Plague is an infection caused by Yersinia pestis. This is a major agent that might be used as a biological weapon. If the bacteria is sprayed, the most frequent clinical form would be pneumonia. If contaminated fleas were used, the bubonic and septicaemic forms would be those observed. Suspicious context A biowarfare act by spraying Y pestis must be suspected when a patient without any risk factors presents with a primary pulmonary form of the disease in a non endemic area. PRACTICAL MANAGEMENT: All the patients presenting with a pulmonary form of plague must be hospitalised and isolated in de-pressurised room, at least for the first three days of antibiotherapy. For the other clinical forms, patients must isolated during the first 48 hours of treatment. Treatment must be initiated as rapidly as possible. Strains of Y. pestis are usually sensitive to many antibiotics (streptomycin, gentamicin, doxycycline, ciprofloxacin, chloramphenicol, sulfadiazin, trimethoprime-sulfamethoxazole...). PREVENTION: In the case of contact with a spray suspected of containing the plague bacilla, doxycycline or ciprofloxacin can be prescribed. A dead cell vaccine exists, but its efficacy in terms of protection from primary pneumonia appears inadequate.

Anti-Bacterial Agents↗
PubMed2003

[Botulism toxin, bioterrorist weapon].

BOTULISM AND BIOWARFARE: Botulism is a severe neuro-paralysing infection due to a toxin produced by Clostridium botulinum. The use of the botulinum toxin for terrorist aims in the form of aerosols is a perfectly credible eventuality. The botulinum toxin is the most potent toxin known; it is easy to produce and can lead to massive destruction. DEPENDING ON THE CONTAMINATION: The clinical forms of botulism depend on the mode of contamination. Botulism through inhalation can only be the result of a deliberate act using an aerosol. The clinical symptomatology is identical to that of the other forms. PREVENTION: In the case of a bio-terrorist attack with an aerosol of botulinum toxin, the subjects exposed should be vaccinated as a prophylactic measure with trivalent antitoxin vaccine (types A, B and E). This vaccine must be administered as rapidly as possible in symptomatic patients. A single case of botulism acquired by inhalation corresponds to an act of terrorism.

Administration, Oral↗
PubMed2003

[Anthrax in the era of biowarfare].

UNLABELLED: THE CONDITIONS OF INFECTION: Anthrax is a zoonosis due to Bacillus anthracis. Human contamination usually results from contact with an infected animal or product, or direct exposure to the bacteria. The latter represents one of the principle agents that can be used in biowarfare by spraying the spores. VARIOUS POSSIBILITIES: The inhaled form of the disease, characterised by hemorrhagic necrosis of the mediastinum adenopathies and septic shock, is the form that would probably be observed during a terrorist attack. The cutaneous and digestive forms are also possible. EVOLUTION: The clinical diagnosis, easy in the cutaneous form, is difficult in the other, rapidly progressive forms. Many guidelines have been published with recommendations for the treatment and prophylaxis of anthrax. Prognosis remains poor in the systemic form of the disease.

Adult↗
PubMed2003

Genotypic inhibitory quotient as predictor of virological response to ritonavir-amprenavir in human immunodeficiency virus type 1 protease inhibitor-experienced patients.

Forty-nine protease inhibitor (PI)-experienced but amprenavir (APV)-naïve patients experiencing virological failure were treated with ritonavir (RTV) (100 mg twice a day [b.i.d.]) plus APV (600 mg b.i.d.). Patients responded to therapy with a median viral load decrease of -1.32 log(10) by week 12. The addition of low-dose RTV enhanced the minimal APV concentration in plasma (APV C(min)) up to 10-fold compared with that obtained with APV (1,200 mg b.i.d.) without RTV. Baseline PI resistance mutations (L10F/I/V, K20M/R, E35D, R41K, I54V, L63P, V82A/F/T/S, I84V) identified by univariate analysis and included in a genotypic score and APV C(min) at week 8 were predictive of the virological response at week 12. The response to APV plus RTV was significantly reduced in patients with six or more of the resistance mutations among the ones defined above. The genotypic inhibitory quotient, calculated as the ratio of the APV C(min) to the number of human immunodeficiency virus type 1 protease mutations, was a better predictor than the virological or pharmacological variables used alone. This genotypic inhibitory quotient could be used in therapeutic drug monitoring to define the concentrations in plasma needed to control replication of viruses with different levels of PI resistance, as measured by the number of PI resistance mutations.

Adult↗
PubMed2003

[HAART and changes of epidemiology, treatment and prognosis of HIV-positive patients with Kaposi's sarcoma and lymphoma].

Highly active antiretroviral therapy (HAART) has changed the epidemiology of Kaposi's sarcoma (KS) and lymphoma occurring in people living with HIV. The KS's decrease was observed early after HAART availability: although delayed, the decrease of non Hodgkin lymphoma has been sign. The improvement of immune status due to HAART has decreased the occurrence of chemotherapy triggered opportunistic infections, and survival rates have been improved. The administration of chemotherapy with HAART does not seem to increase toxicity.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2002

[Smallpox, bioterrorism agent].

A CONSIDERABLE RISK: Among the infectious agents that might be used as terrorist weapons, the smallpox virus represents a sufficiently high risk, which is difficult to manage and must be seriously taken into account. FROM A MICROBIOLOGICAL POINT OF VIEW: Two viral strains of the smallpox virus, which belong to the Poxviridae and orthopoxvirus-type families, are known. They are associated with various clinical presentations of smallpox, i.e., variola major and variola minor or "alastrim". VARIOLA MAJOR: Five clinical forms of varying prognosis are described. Common smallpox, haemorrhagic smallpox (the most severe form of the disease), mild smallpox (predominantly observed in vaccinated patients), flat-type smallpox (defined by coalescent and slowly progressive lesions) and so-called "sine eruptione" smallpox. VARIOLA MINOR: This form is not as severe as variola major and the mortality rate is lesser. DIAGNOSIS: Smallpox must be systematically evoked on clinical elements and confirmed by electronic microscopy of a sample of liquid from a vesicle or pustule or a scab. The strains can be characterised by PCR (Polymerase Chain Reaction). TREATMENT: It is symptomatic. Early vaccination, within 4 days following exposure to the virus, permits the reduction in mortality by 50%. The only efficient prevention is vaccination prior to any exposure to the virus. In the case of a bioterrorist attack, the United States and most of the EC countries propose to vaccinate only the health professionnals most exposed to the virus and those having contacted identified cases.

Bioterrorism↗
PubMed2002

Discontinuation of secondary prophylaxis against disseminated Mycobacterium avium complex infection and toxoplasmic encephalitis.

We retrospectively studied outcomes for patients infected with human immunodeficiency virus who received highly active antiretroviral therapy (HAART) and had stopped receiving secondary prophylaxis against toxoplasmic encephalitis (TE) or disseminated Mycobacterium avium complex (MAC) infection. Nineteen patients had a history of TE, and 26 had a history of disseminated MAC infection. The median duration of secondary prophylaxis was 27 months, and the median duration of HAART before discontinuation of secondary prophylaxis was 22 months. Median CD4(+) cell counts at the time of cessation of secondary prophylaxis against TE or disseminated MAC infection were 404 and 105 cells/mm(3), respectively. Plasma virus load was undetectable in 68% of the patients who had a history of TE and in 31% of patients who had a history of disseminated MAC infection. Patients were followed up for a median of 29 months after discontinuation of secondary prophylaxis; no relapses occurred in patients with a history of TE, and 3 relapses occurred in patients with a history of disseminated MAC infection (incidence, 4 relapses per 100 person-years).

AIDS-Related Opportunistic Infections↗