[Cerebral toxoplasmosis concomitant with primary toxoplasma infection in AIDS].
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Biomedical subjects
Publications and source records attributed to F Raffi.
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Fibronectin, a non-specific opsonin involved in the clearance of microorganisms, is thought to play a role in various infectious disease processes. Its diagnostic value as a biological marker of infection and/or prognosis in human immunodeficiency virus (HIV) patients is questionable. We conducted a prospective study to evaluate plasma fibronectin levels in patients with HIV infection at different stages of the disease. Eighty-one consecutive HIV-infected patients seen in our department were evaluated clinically and biologically. Classifications according to the Centers for Disease Control (CDC) stages were: Group II (n = 22), Group III (n = 17), acquired immunodeficiency syndrome (AIDS) (n = 17) and AIDS related complex (n = 25). Plasma fibronectin levels were measured by a radial immunodiffusion assay. Plasma fibronectin levels were not different between HIV-infected patients (344 +/- 128 mg/L) and controls (n = 20, 335 +/- 45 mg/L). Among the 81 patients, plasma fibronectin levels were within normal value in 79%, with no significant difference of mean plasma fibronectin between the different CDC groups. No correlation was found between plasma fibronectin and other biological parameters including CD4+ cells, p24 antigen, beta-2-microglobulin. Furthermore, no correlation was noted between fibronectin and complement levels or presence of circulating immune complexes. These results suggest that plasma fibronectin is not a useful marker in patients with HIV infection.
During a gestation with oligoamnios and growth retardation noticed at 25th week an amniocentesis allowed us to discover the 14th case of complete trisomy 9, the third detected in utero. It is also the first without heart malformation, otherwise phenotype was usual. The liver had small areas of necrosis with calcifications and slight fibrosis which may be in relation with two cordocentesis made before expulsion. The important phenotype alterations and poor outcome of fetuses with trisomy 9 justify elective abortion.
Mycotic aneurysms, a quite rare syndrome, are classified into three groups: primary (the most frequent one), secondary to bacterial endocarditis, and secondary to direct inoculation (infections focus or trauma). Primary aneurysms are related to bacteremia with bacterial setting of an atheromatous lesion, most often. Clinical presentation is often misleading or delayed from infectious process. However, presence of clinical aneurysm, pain, and infectious syndrome should suggest diagnosis and lead to immediate antibiotic therapy and rapid surgical management, as rupture of the aneurysm is a frequent, serious and ineluctable complication. Importance of microbiologic search is to be emphasized as the diversity of the responsible microorganisms is very high; waiting for bacteriological results, a bactericidal double antibiotherapy should be instituted.
Secretion of N-acetyl-beta-D-glucosaminidase (NAG) isoenzymes by human blood monocyte-derived macrophages in response to zymosan and human recombinant interferon-gamma was studied. Macrophages were found to release NAG in response to zymosan, but interferon-gamma has no effect on secretion. Isoenzyme separation by isoelectric focusing demonstrates that non stimulated and zymosan or interferon-gamma treated macrophages release predominantly NAG B and, to a lesser extent, NAG A isoenzymes. In all these conditions, the intracellular intermediate form NAG I could not be detected in the media. Thus, activated macrophages may not be the source of NAG intermediate forms I and P in pathological or maternal serum. In contrast, macrophages could contribute to a significant elevation of urinary activity and NAG B excretion in response to inflammatory conditions.
Endocrine function was prospectively evaluated in 98 patients (73 men and 25 women) infected by HIV in various stages of illness: Centers for Disease Control groups II (19), III (20), IVA and IVC2 (27), IVC1 and IVD (32). Testing included baseline and post-stimulation evaluation of gonadal, thyroidal, and adrenal axes. Although adrenal function was within normal values in most cases, with no differences between patient groups, nine out of 98 patients had either a low baseline or post-stimulation serum cortisol, cytomegalovirus adrenalitis being suspected in two cases. Mineralocorticoid response was normal in all individuals. The main abnormalities were sick euthyroid syndrome with low tri-idothyronine and/or thyroxine in 16% of patients and hypotestosteronemia in 29% of men with AIDS. These abnormalities, related to a functional deficiency of the hypothalamic-pituitary axis, were highly correlated with the degree of illness, i.e. weight loss and low CD4+ cell count. It was concluded that endocrine dysfunction in HIV-infected patients is rarely of clinical significance, that it is related more to cachexia and advanced disease than to HIV or opportunistic infections, and that it could serve as a prognostic marker.
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We evaluated the efficacy and toxicity of piperacillin-ofloxacin as an empiric treatment of fever in patients with neutropenia. 24 febrile episodes occurring in 21 patients (mean neutropenia: 204/mm3) were treated. The neutropenia was due to an hematologic malignancy in 6 cases and to chemotherapy in 15 cases. Fever was related to septicemia in 4 cases, urinary tract infection in 1 case, other infectious sites without microbiological documentation in 11 cases, and was of unknown origin in 8 cases. Empirical therapy was started within 24 hours of the occurrence of fever greater than 38.5 degrees C with the combination of intravenous piperacillin (12 g/day in 3 divided doses) and oral ofloxacin (400 mg/day in 2 doses). The overall response rate was 86% (19/22) of evaluable cases, with an immediate success rate (apyrexia within 48 hours) of 46%. Of the 3 failures, one was bacteriologically documented and was due to a multiply resistant strain of Staphylococcus haemolyticus (to which both piperacillin and ofloxacin were resistant). The therapy was clinically well tolerated in all except 3 patients, in whom intolerance to intravenous piperacillin was observed, leading to discontinuation of the drug in 2 cases. More extensive and comparative trials should better determine the place of this piperacillin-ofloxacin combination as first-line treatment of febrile episodes in patients with neutropenia.
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