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H Félix

Publications and source records attributed to H Félix.

At least 19 recordsLinked to original sources

[Cutaneous signs of dengue. Apropos of 3 cases].

We report three cases of dengue with cutaneous signs that were observed in three women returning from Asia (and that were confirmed by serology). The exanthem has common characteristics: progressive appearance beginning on thewer limbs, macula-type elementary lesion associated with purpura, evolution in one single upward spread, confluent lesions with intervals of healthy skin, palmoplantar affection, disappearance of the eruption in an average of ten days, association with conjunctivitis in three cases, pharyngitis in two, epistaxis in two and haematuria in one. The lesions spread to the trunk in one patient only and another patient had pruritus. None of the patients showed signs of a state of shock. According to WHO and, despite the existence of haemorrhages and of a purpura, the three cases reported here cannot be considered as being dengue haemorrhagic fever due to the absence of hemoconcentration. The two types of cutaneous signs observed during the fever are described and their physiopathology is discussed.

Adult↗

[Failure of prevention of malaria by mefloquine in West Africa].

Mefloquine (Lariam) is extensively prescribed for the prevention of malaria in chloroquine-resistant areas. However, in west Africa, most of the strains of Plasmodium falciparum are still sensitive to chloroquine. In addition, a few of these strains are inherently resistant to mefloquine. Under these conditions, we must expect to see the failure of mefloquine prophylaxis in travellers returning from west Africa. We report here 5 such failures. The in vitro susceptibility of Plasmodium falciparum isolates from 4 of these patients was evaluated and showed that all 4 had normal sensitivity to chloroquine and quinine, 3 were resistant to mefloquine and one had reduced susceptibility to mefloquine. Mefloquine blood levels (measured 3 times) were within the normal protective range. These case reports indicate that mefloquine should be used cautiously for malaria prevention in west Africa. They also point out that, regardless of the prophylactic method used, fever in a traveller returning from endemic malaria regions always dictates the analysis of a thick blood smear to rule out the diagnosis of malaria.

Adult↗

[Malaria prevention today and tomorrow].

Individual chemoprophylaxis against malaria remains mandatory for all trips of brief or intermediate duration in endemic areas. The selected anti-malarial drug must be taken regularly from the beginning of the stay, during the stay and for the 30 days after return (The 30 days following the departure from regions at risk). Presently the following drugs are available: amino-4-quinolines, quinine, antifolinic agents, the association antifolinic-antifolic agents and mefloquine. Specific advantages, side-effects and adverse reactions, as well as dosage used for prophylaxis are given for each drug. The risk of agranulocytosis and severe hepatitis related to amodiaquine forbids its use until more information has become available. The association sulfadoxine + pyrimethamine is no longer recommended for prophylaxis by the French authorities and recently by the W.H.O., because of its potential, although seldom, risk of severe muco-cutaneous disorders. Detailed schemes of prophylaxis are given; they rely on sensitivity or resistance of Plasmodia strains, the length of the stay in at risk areas, and the local situation concerning the hazard of infection and drug resistance of Plasmodia. Chloroquine must be used in priority in areas characterized by sensitivity or low grade resistance to chloroquine. In order to avoid resistance to mefloquine, its administration has to be limited to prophylaxis for short stays and to the treatment of attacks resulting from infections acquired in areas known for resistance against the other drugs. Today, indeed, mefloquine is the single agent efficient in case of multiresistance to Plasmodium falciparum. The treatment of suspected or proved cases of malaria attacks occurring in temporary or permanent expatriates or in local, semi-immune residents, has become strongly advisable. In areas of resistance to chloroquine, either quinine (repeated injections), sulfadoxine-pyrimethamine (per os or unique parenteral injection) or if possible, mefloquine (full dose during 1 day) are to be used for the therapy of acute attacks. Continuous chemoprophylaxis is no longer encouraged for populations living in holoendemic areas. Treatment of suspected or overt malaria crises is, however, mandatory. The limitation to curative therapy is opening the way to more specific prophylaxis: pregnancy, delivery, intercurrent pathological events, such as surgery, trauma, infection... It is hoped that, until the forthcoming of anti-malaria immunoprophylaxis, these newly adjusted designs for chemotherapy will help to keep the progress of malaria and the development of plasmodial resistance under control.

Animals↗

[Value of cytapheresis in the treatment of loaiasis with high blood microfilaria levels. Results in 7 cases].

Seven patients infected with the filarial worm Loa loa received a treatment by cytapheresis in an attempt to lower the microfilaraemia. Microfilarial levels of between 6,000 and 38,500 ml, before extraction, were reduced, according to the case, by between 47 and 97% (mean 76%). The diethylcarbamazine chemotherapy which followed in 6 of 7 patients showed no sign of any of the serious side-effects which often occur in these type of cases. Due to its practicality and the fact that it is well tolerated, both clinically and biologically, cytapheresis would seem to represent the best method for initially treating loaiasis with high microfilaremia.

Adult↗

[Problems raised by the treatment of Kaposi's sarcoma in subjects with AIDS].

Kaposi's Syndrome (K. S.) was defined as a virus induced immunogenic tumour responding to interferon. It can be used as a guideline for therapeutical trials in A. I. D. S. K. S. mortality is 13%. K. S. + O. I. (opportunistic infections) mortality reaches 70% and O. I. mortality is approximately 50%. Therefore treating O. I. is a must but it is not mentioned in the paper. Attempts made to modify immunodepression, usual K. S. treatments, experimental treatments based upon similar pathogenicity (like systemic lupus erythematosus, Hansen's disease, preneoplasia dyskeratosis) were unsuccessful. Trials with alpha recombinant interferon realised at the Sloan Kettering Memorial for Cancer in New York are summarized for 74 patients and are in preliminary interpretation. Our study is based upon 13 cases studied for 14 to 4 months and comes up to the same conclusions using 18 to 36 million units/day for 6 months (6 cases) and 3 to 4 months (7 cases). For 6 full treatments the results are: 2 K. S. were cleaned up after 8 and 3 months follow up, 4 K. S. with O. I.: 3 remissions and then relapses and 1 stabilization, for 7 current treatments: 2 had to be discontinued because of bad tolerance, 1 stabilization and 4 remissions. For all treatments a decrease and a lesser gravity of O. I. can be noted during treatment. Besides flu-like syndromes, main clinical side effects, are: asthenia, general condition impairment, 2 fits were observed for which I.N.F. cannot be clearly incriminated. Daily treatment compelling and surveillance are real drawbacks. Different types of better used interferon will probably yield interesting results (40% regression or improvement).

Acquired Immunodeficiency Syndrome↗

[Ceftriaxone (Rocéphine) in major African infectious pathology. Results at the Niamey Hospital (Niger) ].

Ceftriaxone is a wide-spectrum-third generation cephalosporin characterized by outstandingly high efficacy as well as pharmokinetic properties making it suitable for administration in a single daily injection. Ceftriaxone has been found to be useful for treatment of the very severe infectious pathology in countries where hygiene and medical superstructures are still rudimentary. Eighteen of 20 patients with purulent meningitis (13 to Neisseria meningitidis A, 3 to Streptoc. pneumoniae, 1 to Listeria and 3 aseptic) recovered (there being 2 deaths at the 36th hour) after a mean 6 days of hospitalization. Despite the very delicate patient condition, recovery was seen in all 11 cases of very grave bronchopneumopathy, generally due to Streptoc, pneumonia. A dose of 2 g/day in 1 or 2 IV injections is sufficient in the adult, 0.50 g in a single dose being injected to infants weighing less than 10 kg, Meningitis required 4 to 7 days treatment (9 days in a case of Listeria) while the treatment period was longer for respiratory infections. Seven patients had been refractory to treatment with beta-lactamines and/or aminosides, and no adverse drug reactions were noted.

Adolescent↗

Treatment of purulent meningitis with a new cephalosporin-Rocephin (Ro 13-9904). Clinical, bacteriological and pharmacological observations in 24 cases.

In 21 of the 24 cases the diagnosis of purulent meningitis was confirmed by culturing the causal agent and/or by immunological diagnosis. The daily dosage of Rocephin ranged between 15 and 200 mg/kg administered in 2 i.m. injections. A cure was achieved in cases of meningococcal meningitis (1 case with sequelae: blindness in one eye), in 5 out of 6 cases of Haemophilus influenzae meningitis (1 case with severe neuropsychiatric sequelae), in 3 out of 9 cases of pneumococcal meningitis and in 2 out of 4 cases of enterobacterial meningitis. The tolerance was generally excellent. Sterilisation of the cerebrospinal fluid (CSF) was achieved in all 20 cases of meningitis confirmed by culture. The MIC levels are lower than the lowest CSF peak for Rocephin found in this study. The unusual pharmacological behavior of Rocephin makes it possible to achieve and to maintain for a long time highly satisfactory concentration levels in the CSF. These properties of Rocephin should lift the long-standing objections to the use of cephalosporins for the treatment of purulent meningitis.

Adolescent↗