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Biomedical subjects

B Hoen

Publications and source records attributed to B Hoen.

At least 73 records · Page 4Linked 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

Procedures associated with infective endocarditis in adults. A case control study.

OBJECT: To assess the relative risk of infective endocarditis associated with various procedures and the protective efficacy of antibiotic prophylaxis by a case-control study. BACKGROUND: Recommendations for the prevention of infective endocarditis are based on the hypothesis of a relationship between procedures and infective endocarditis which is supported by anecdotal reports and data from experimental models. METHODS: Cases met the Von Reyn's diagnostic criteria modified with echocardiographic and macroscopic findings Controls were recruited from cardiology or medicinal wards. Cases (n = 171) and controls were matched as regards sex, age and underlying cardiac condition. They were requested to indicate all the medical, surgical or dental procedures within the previous 3 months. Among potential confounding factors, infectious episodes and skin wounds in the previous 3 months were reported. Antibiotic prophylaxis administration was documented for type, dosage, duration and administration schedule. RESULTS: Cases significantly more frequently than controls had undergone at least one procedure (matched odds ratio, 1.6; 95% confidence interval, 1.01 to 2.53). Dental procedures considered as a whole were not associated with an increased risk, although scaling and root canal treatment showed a trend towards a higher risk of infective endocarditis (P = 0.065). Among non-dental procedures, only surgery appeared to be at risk (matched odds ratio, 4.7; 95% confidence interval, 1.02 to 22). Considering all procedures, the risk of infective endocarditis increased significantly with the number of procedures. While general co-morbid conditions did not differ between the two groups, cases significantly more frequently than controls had experienced an infectious episode or a skin wound. In multivariate analysis, only infectious episodes and skin wounds significantly increased the risk of infective endocarditis. Scaling was the only independent risk factor for viridans streptococcal infective endocarditis. The 46% protective efficacy of antibiotic prophylaxis was not significant. CONCLUSIONS: Procedures do increase the risk of infective endocarditis. The interpretation of the apparent low risk associated with dental procedures may be as a result of the current practice of antibiotic prophylaxis. Our data suggest that surgery should be more clearly mentioned in future guidelines, and reemphasize that a rigorous treatment of any focal infection in cardiac patients is mandatory. From the efficacy rate of antibiotic prophylaxis,it can be estimated that the overall incidence of infective endocarditis might be reduced by 5 to 10% in France by appropriate use of antibiotic prophylaxis in cardiac patients.

Adult↗
PubMed1995

Characteristics of infective endocarditis in France in 1991. A 1-year survey.

OBJECTIVE: To update data on incidence and characteristics of infective endocarditis in France. BACKGROUND: Numerous studies have shown that the incidence and course of infective endocarditis remain stable in spite of advances in treatment and of prophylactic recommendations. METHODS: A survey of all consecutive cases of infective endocarditis was conducted over 12 months in all the institutions of three French regions. RESULTS: Data were collected from 415 cases of definite (32%), probable (53%), and possible (15%) infective endocarditis. The adjusted annual incidence was 24.3 cases per million inhabitants. Thirty-four percent of the patients had no previously known heart disease, 33% had native valve disease, 22% had a prosthetic valve, and 11% had miscellaneous underlying conditions. Infective endocarditis was located solely on the mitral valve in 39%, solely on the aortic valve in 36%, and on the tricuspid valve in 6%. Echocardiography showed a vegetation on the mitral valve in 39%, on the aortic valve in 29%, and on the tricuspid valve in 8%. The causal microorganism was identified in 92%; it was a Streptococcus in 58%, and a Staphylococcus in 23%. Twenty patients were intravenous drug users, and 45 had had a medical or a surgical procedure, which might be associated with the occurrence of infective endocarditis. During the first 2 months after admission, 24% of the patients underwent surgery, and 17% of all patients died. CONCLUSIONS: Despite medical and surgical advances, infective endocarditis remains frequent and severe in France.

Adolescent↗
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

Risk factors for bacterial infections in chronic haemodialysis adult patients: a multicentre prospective survey.

All adult patients from 13 dialysis centres were prospectively followed up for 6 months in an attempt to appraise the current risk factors for bacterial infections in stable chronically haemodialysed patients. Parameters recorded as potential risk factors for BI were age, gender, cause of renal failure, time elapsed since the start of dialysis, history of transplantation, recent surgical procedure, previous bacterial infection, current immunosuppressive or erythropoietin therapy, type of angioaccess device, and serum ferritin level. Six hundred and seven patients (mean age 56.5 years, range 18-85) were enrolled in the study. Mean time elapsed since the start of dialysis was 4.7 years. One hundred and eighteen patients had developed at least one bacterial infection during the study period whereas 489 had remained free of bacterial infection at the end of the follow-up. In multivariate analysis three parameters were found to be significant and independent risk factors for bacterial infection: previous history of bacterial infection (at least one versus no previous episode), type of angioaccess device (catheter versus native fistula), and elevated serum ferritin level (greater versus lower than 500 micrograms/l). These results support the evidence that impaired host defences in chronic haemodialysis patients may be secondary to the dialysis procedure and suggest that the incidence of bacterial infection in these patients may be further reduced by appropriate supportive therapy.

Adolescent↗
PubMed1994

[Epidemiology of primary bacterial meningitis].

In industrialized countries, the incidence of community-acquired bacterial meningitis is between 5 and 10 cases/10(5) population/year. The highest age-specific attack rates are recorded between 0 and 2 years of age and can reach 100 cases/10(5) population/year or more in some countries. In this range of age, Streptococcus agalactiae, Listeria monocytogenes and Escherichia coli are responsible for meningitis in neonates whereas Haemophilus influenzae, Neisseria meningitidis and Streptococcus pneumoniae cause meningitis in children older than 1 month. H. influenzae was the leading cause of bacterial meningitis in children but its incidence has declined since the introduction of routine childhood immunization with conjugate vaccines. N. meningitidis is the leading cause of meningitis in teenagers and young adults, whereas S. pneumoniae is responsible for most of meningitis in the elderly. Prognosis of bacterial meningitis mainly depends on the type of causative organism and on the age of onset. Detailed epidemiologic features of Haemophilus, meningococcal and pneumococcal meningitis are provided.

Adolescent↗
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↗
PubMed1993

[Acquired data on the antibiotic treatment of bacterial endocarditis on native or prosthetic valves].

Antimicrobial therapy of infective endocarditis is based on periodically updated expert recommendations that derive from both clinical and experimental data. Streptococcal and enterococcal endocarditis should be treated intravenously with a combination of penicillin+aminoglycoside in the absence of allergy to penicillin. The choice of either penicillin or ampicillin, the dose and the length of treatment plainly depend on susceptibility of streptococcal strain to penicillin. In patients allergic to penicillin, vancomycin is the optimal choice. The treatment of native valve meticillin-susceptible staphylococcal endocarditis is based on a combination of oxacillin or cefamandole+aminoglycoside. Vancomycin is recommended in case of allergy to penicillin and in meticillin resistant staphylococcal endocarditis. Prosthetic valve staphylococcal endocarditis are often due to meticillin-resistant coagulase negative staphylococci. Therefore they should be treated with vancomycin in combination with rifampicin and an aminoglycoside unless the strain is resistant to either of these 2 antibiotics. For the treatment of culture-negative endocarditis, different situations should be considered: in native valve endocarditis, the possible responsibility of deficient streptococci justifies an ampicillin+aminoglycoside combination; in recently implanted (< 1 year) prosthetic valve endocarditis a combination of vancomycin+rifampicin+aminoglycoside should be used because of the high probability of meticillinresistant staphylococci: if prosthetic valve is implanted for more than a year endocarditis may be due to streptococci, staphylococci and fastidious gram-negative bacilli; a combination of vancomycin+aminoglycoside +/- third generation cephalosporin is therefore recommended.

Anti-Bacterial Agents↗