Biomedical subjects
Publications and source records attributed to Eric Caumes.
The clinical spectrum of neurosyphilis is large. Serologic tests for syphilis are commonly indicated in diseases involving the central nervous system. The diagnosis of syphilis relies on epidemiological, clinical and biological grounds (cerebrospinal fluid abnormalities and RPR test). The treatment of neurosyphilis is still penicillin G.
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BACKGROUND: Localized cutaneous leishmaniasis (LCL) is a common cause of dermatosis in travelers returning from the tropics. We describe the epidemiological, clinical, and biological aspects and therapeutic outcome of imported LCL. METHODS: A retrospective study of all cases of LCL observed from 1992 to 2000 in our tropical disease unit. Diagnosis was based on direct examination of skin smear and/or culture with identification of subsequent subspecies. RESULTS: Thirty-nine cases (25 males, 14 females; median age: 38 years) were included: 35 French travelers and four foreign immigrants; 15 cases were acquired in the Old World and 24 cases in the New World. The patients presented to our department with a median of 60 days after return. Thirteen patients had already consulted general practitioners, and the diagnosis was missed in five cases (38%). Five clusters were identified. The median number of skin lesions was two per patient. Diagnosis was established by direct microscopic examination in 36 cases (92%). Thirty-five patients were assessable for first-line treatment with antimonials (intramuscularly in 18, intralesionally in nine), intramuscular pentamidine isethionate or oral ketoconazole (four patients each). Twenty-five patients (71.4%) were cured. The remaining 10 patients were cured after one to three courses of other treatments. Overall adverse events occurred in 60% of the patients treated with antimonials and 37% of those treated with pentamidine. CONCLUSION: Imported LCL is still unrecognized by Western physicians. Clusters may be observed in groups of travelers. The therapeutic outcome is impaired by numerous but minor side-effects.
CIRCUMSTANCES AND CHARACTERISTICS: The risk of toxiderma is greater in patients infected by the human immunodeficiency virus (HIV). The most common toxidermas are maculopapular exanthema and drug hypersensitivity reactions. These toxidermas are predominantly observed with non-nucleoside reverse transcriptase analogs (nevirapine, efavirenz) and abacavir. Toxiderma has also been observed with other nucleoside reverse transcriptase analogs (zalcitabine) and protease inhibitors. REGARDING SEVERITY: The toxidermas observed are usually benign (maculopapular exanthema) and do not always require suspension of the treatment. However, certain toxidermas (Stevens-Johnson syndrome, Lyell syndrome and drug hypersensitivity syndrome) may be life-threatening and therefore contraindicate the continuation of treatment and also its sudden reintroduction. PREVENTION AND PRACTICAL APPROACH: Several studies have assessed the risk factors for toxiderma induced by nevirapine and hypersensitivity reactions to abacavir. The practical approach varies depending on the drug responsible, the clinical form of the toxiderma and the possible alternatives.
The treatment of cutaneous larva migrans and Toxocara infection relies on antihelminthic agents such as thiabendazole, albendazole and ivermectin. The efficacy of these agents varies according to the helminthic disease.
Ivermectin, a broad-spectrum anti-parasitic agent first used in veterinary medicine, is active against numerous species of helminths and arthropods. For the past few years, world-wide reports on the use of ivermectin in various parasitic diseases with cutaneous tropism have led to its use in the field of skin parasitology. In this paper we review parasitoses which have been treated with ivermectin; mainly, filariasis, strongyloidiasis, cutaneous larva migrans, and scabies and head lice.
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ACTIVITY: Ivermectine, derived from beta avermectines, monocyclic lactones produced by Streptomyces avermitilis, is a potent oral microfilaricide used by veterinaries since 1981. The anti-filarial activity is two-fold: both microfilaricide and embryotoxic in female adults; it has no activity on the latter. INDICATIONS: Ivermectine is the treatment of choice in onchocercosis, induced by the nematode Onchocerca volvulus, and was included in the onchocercosis control program (programme de contrôle de l'onchocercose (OCP) in 1987. Ivermectine has also demonstrated efficacy on other filaries (Wuchereria bancrofti, Loa loa), in intestinal nematodes (Ascaris lumbricoïdes, Strongyloides stercoralis) and in parasite nematodes in man (larva migrans ankylosis). ACCORDING TO THE RESULTS OF RECENT STUDIES: Its activity has been recently extended to ectoparasitosis: sarcoptes and pediculosis of the scalp.
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).
Immortalization of B cells by Epstein-Barr virus (EBV) and their subsequent proliferation leads to B-cell non-Hodgkin's lymphoma in immunocompromised patients. The role of hepatitis C virus (HCV) in B-cell non-Hodgkin's lymphoma has recently been raised, and an interaction between HCV and EBV is supported by recent in vitro experiments. The aim of this study was to investigate in vivo interactions between HCV and EBV in patients with AIDS, i.e., patients exposed to the risk of EBV-related B-cell non-Hodgkin's lymphoma. A total of 135 patients were prospectively studied. Serological and molecular markers of HCV, EBV, and human immunodeficiency virus (HIV) infection were sought. All the patients harbored latent EBV infection, and 20% had detectable HCV RNA in serum. No significant relationship was found between HIV, HCV, and EBV viral load in peripheral blood mononuclear cells or plasma. There was no difference between anti-HCV-positive and -negative patients or between HCV RNA-positive and -negative patients with regard to the prevalence of EBV markers, especially EBV replication markers. The presence of EBV replication markers was not related to HCV RNA seropositivity or to HCV viral load. Five patients subsequently developed B-cell non-Hodgkin's lymphoma, none of whom had markers of EBV or HCV replication. These results argue against an in vivo interaction between HCV and EBV in patients with AIDS, and against a role of HCV infection in the occurrence of B-cell non-Hodgkin's lymphoma in these patients.
BACKGROUND: Persons with HIV infection have increased rates of drug eruptions. OBJECTIVE: Our aim was to evaluate the risk factors of drug eruptions in response to sulfonamides in patients with AIDS, using a case-control analysis. METHODS: One hundred thirty-six patients who were hospitalized for pneumocystosis or toxoplasmosis were evaluated at the onset of treatment for various risk factors, which were then compared among patients with (48, 36%) and without (88, 64%) a drug eruption. RESULTS: In multivariate analysis, high CD8(+) cell count and age less than 36 years indicated a risk of drug eruption (respective odds ratios: 3.5 [95% CI 1.6-7.8], P =.002, and 2.1 [95% CI 1-4.6], P =.06). Markers of viral replication for HIV, Epstein-Barr virus, cytomegalovirus, human herpesvirus 6, and parvovirus B19, slow acetylation phenotype or genotype, and glutathione level were not associated with a risk. Administration of corticosteroids had no preventive effect. CONCLUSIONS: Our results challenge several current concepts regarding drug eruptions by discarding a strong association with glutathione deficiency, slow acetylation, or active viral infections and by showing no preventive effect of corticosteroids.
Disseminated toxoplasmosis during acute infections has rarely been observed in immunocompetent patients. We report a case of severe acute disseminated toxoplasmosis acquired by an immunocompetent patient in French Guiana and review the literature.
BACKGROUND: Mycobacterium marinum is a nontuberculous mycobacterium responsible for skin infections. Although cases have been seldom reported, no series of M marinum infection has been recently reported and the treatment is not standardized. METHODS: A national survey was conducted on culture-confirmed M marinum infections that occurred in France from January 1, 1996, to December 31, 1998. Clinical characteristics and therapeutic data were analyzed, and the minimum inhibitory concentrations of 11 antibiotics were determined against the causative isolates. RESULTS: Sixty-three cases of M marinum infection were studied. In 53 (84%) of the patients, inoculation was related to fish tank exposure. The site of infection was mainly the upper limb (in 60 [95%] of the 63 patients), and infection was spread to deeper structures in 18 (29%) of the patients. All patients were treated with antibiotics (median time, 3(1/2) months), and 30 (48%) underwent surgery. Various antibiotic regimens were prescribed, and the initial regimen was modified in 22 (35%) of the patients. Clarithromycin, cyclines, and rifampin were the most commonly prescribed antibiotics. Cure was observed for 55 (87%) of the patients. Failure was related to deep structure involvement (3 of 45 vs 5 of 18 patients; P =.04) but not to any antibiotic regimen. All strains showed the same susceptibility pattern without acquired resistance. The 90% minimum inhibitory concentrations of rifampin and rifabutin were far lower (0.5 and 0.06 micro g/mL, respectively) than the 90% minimum inhibitory concentrations of clarithromycin (2 micro g/mL) and the cyclines (minocycline, 4 micro g/mL; and doxycycline, 8 micro g/mL). CONCLUSIONS: Mycobacterium marinum infections are emerging infections related to fish tank hobby. Because of the severity of the cases with spread of infection, clinical awareness of M marinum infection and its associated risk factors is important so that the diagnosis can be made and therapy can be initiated promptly.
Tropical sprue is a rare disease in travelers. Its etiology remains unclear. We report two cases of tropical sprue occurring in long-term residents in Nepal and Cameroon. In one case, Tropheryma whippelii, the agent of Whipple's disease, was identified. Many infectious agents have been suggested to be the etiological agent of tropical sprue, but no association with Whipple's disease has yet been reported.
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