Biomedical subjects
Publications and source records attributed to J Frottier.
The first case of sparganosis is reported from France. The patient, a 21-year-old man, presented with a subcutaneous lump on the chest, and the diagnosis was made on histological examination after needle biopsy. He achieved a complete recovery.
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OBJECTIVES: The incidence of atypical mycobacterial infections has increased with the AIDS epidemic. To present, microscopic examinations of airway specimens positive for acid-fast bacteria were highly suggestive of tuberculosis. However, since the AIDS epidemic, certain authors have reported an increase in Mycobacterium avium intracellulare found in respiratory specimens. The aim of this work was to determine what factors might distinguish between these two infections revealed discovery of an acid-fact bacilli. METHODS: Hospital files of all HIV seropositive patients seen between November 1992 and March 1995 and with at least one airway specimen positive for acid-fast bacilli were studied retrospectively. RESULTS: Mycobacterium tuberculosis was isolated in 19 patients, Mycobacterium avium intracellulare in 8 and culosis and M. avium intracellulare. There was no difference for age, sex, geographical origin, transmission mode, antigen positivity, radiologic findings or clinical signs between patients with the different types of mycobacterium. The CD4 count was however significantly lower in patients with an atypical mycobacteriosis (14.5/mm3) than in patients with tuberculosis (91.7 +/- 83.7) (p = 0.004). CONCLUSION: These findings show that in HIV-infected patients with a CD4 count under 100/mm3, the presence of acid-fact bacilli can indicate either M. tuberculosis or M. avium intracellulare. Combined anti-tuberculosis and antimycobacteriosis therapy thus would appear to be justified until the germ can be identified.
Amphotericin B, alone or combined with flucytosine, is the reference curative treatment for neuromeningeal cryptococcosis associated with the acquired immune deficiency syndrome (AIDS). Treatment of non-meningeal forms is less well standardized. Out of 75 human immunodeficiency virus (HIV)-infected patients with cryptococcosis, 16 had no meningeal involvement. One died before receiving any treatment, another received amphotericine B and recovered, and the remaining 14 received curative therapy with fluconazole (200-400 mg/day); 11 of the latter entered complete remission, while three deteriorated during the first week of treatment but recovered on amphotericin B combined, in two cases, with fluconazole. Only one relapse occurred during maintenance treatment with low-dose fluconazole (100 mg/day). No adverse effects of fluconazole treatment were observed. One of the patients on amphotericin B developed acute renal impairment requiring drug withdrawal. These results suggest that first-line fluconazole therapy is effective and well tolerated in patients with AIDS-associated non meningeal cryptococcosis.
We conducted a retrospective study of all hospitalized human immunodeficiency virus (HIV)-infected patients from whom a strain of Streptococcus pneumoniae was isolated (n = 45) between January 1992 and September 1994, in order to determine the clinical manifestations and outcome of and risk factors for infection by S. pneumoniae with decreased susceptibility to penicillin G. Such strains were isolated from 14 patients (31%), of whom 8 had pneumonia, 2 had bronchial superinfection, 2 had sinusitis, and 2 were colonized. All infected patients made a clinical recovery regardless of the MIC of the isolate. Indexes of HIV disease stage (CD4+ cell count and p24 antigenemia), antiretroviral treatment, and hospital admission in the previous 3 months did not influence the susceptibility of the isolates. For HIV-infected patients, treatment with antibacterial agents--particularly trimethoprim-sulfamethoxazole--in the previous 3 months is associated with an increased risk for isolation of S. pneumoniae with decreased susceptibility to penicillin G (relative risk, 5.0; 95% confidence interval, 1.9-13.3).
The presence of human herpesvirus 8 (HHV-8) DNA sequences was sought by polymerase chain reaction (PCR) in peripheral blood mononuclear cells of 4 groups: 6 human immunodeficiency virus (HIV)-infected persons with well-defined dates of seroconversion, during the period between the diagnosis of HIV infection and the appearance of Kaposi's sarcoma (KS); 45 HIV-positive persons with no symptoms of HIV infection; 11 AIDS patients with KS; and 14 AIDS patients without KS. HHV-8 DNA PCR was positive in 3 of the 6 patients during HIV infection preceding the appearance of KS and in all but 1 of 11 AIDS patients with KS. HHV-8 DNA PCR was negative in all but 1 of the 45 HIV-positive persons with no symptoms of infection and in all but 1 AIDS patient without KS. These results indicate that HHV-8 DNA may be detected several years before the occurrence of KS in HIV-infected subjects.
The aim of this study was to investigate the possibility of vertical Epstein-Barr virus (EBV) transmission. We developed two nested-PCR methods for amplifying distinct regions of EBV DNA (BNRF1 and BamHI W) in circulating lymphocytes. Nested PCR was applied to samples obtained from 67 mother-infant pairs within 1 week of birth. We also tested samples from 16 neonates born to human immunodeficiency virus (HIV)-infected mothers to determine whether HIV increases the potential risk of vertical EBV transmission. About half of the 67 women in the first population were positive by nested PCR. Two neonates born to EBV PCR-positive women were also PCR positive. One of the 16 neonates born to HIV-infected women was PCR positive for EBV. These results strongly support the possibility of EBV transmission in utero or during delivery but do not suggest that HIV infection increases this risk. Further studies are required to confirm these findings, to identify the precise mode of vertical EBV transmission, and to determine the outcome for infants who are positive at birth for EBV DNA by nested PCR.
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We reviewed the records of 85 patients infected with both human immunodeficiency virus and Cryptococcus neoformans. Twenty-seven patients (32%) had pulmonary cryptococcosis. C. neoformans was cultured from bronchoalveolar lavage (BAL) or pleural fluid in 25 cases; the remaining two patients had cryptococcal antigen (CA) detected in BAL fluid and C. neoformans cultured from other sites. All but one of the 27 patients had detectable CA in serum. The CD4+ lymphocyte count was low in all cases (median, 24/mm3). Clinical manifestations of pulmonary cryptococcosis included fever (94%), cough (71%), dyspnea (7%), expectoration (4%), chest pain (2%), and hemoptysis (1%). Diffuse interstitial opacities (70.5%), focal interstitial abnormalities, alveolar opacities, adenopathies, cavitary lesions, and pleural effusions were evident. Outcome was poor (mean survival time, 23 weeks) despite treatment. Patients with localized pulmonary cryptococcosis appeared to have a higher CD4+ lymphocyte count, an earlier diagnosis, lower serum CA titers, fewer previous or concomitant infections, and a better prognosis than patients with disseminated cryptococcosis.
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Clostridium difficile is now well-established as the main cause of antibiotic-associated diarrhoea or colitis. Nosocomial acquisition of C. difficile has been described among various immunocompromised patient populations. From January to December 1992, 19 cases of antibiotic-associated diarrhoea occurred among AIDS patients in the same ward of a hospital. They all harboured C. difficile in their stools. All the strains were retrospectively typed by the random amplified polymorphic DNA (RAPD) method using two different 10-mer oligonucleotides. Twenty-five C. difficile strains (isolated from 15 patients) yielded the same RAPD pattern, suggesting they were identical. The timing and location of infections indicated that transmission of this highly resistant spore-forming bacterium can occur not only by direct patient-patient contact but also at a distance in time and space. This is the first report of an outbreak of C. difficile-associated diarrhoea in AIDS patients. Epidemiological markers are needed to recognize and control common-source outbreaks; RAPD assay is a simple, rapid and effective way of distinguishing isolates of C. difficile.
To evaluate the prognostic value of provirus copy number through quantitative DNA polymerase chain reaction (PCR) in early stages of human immunodeficiency virus type 1 (HIV-1) infection, 42 untreated and asymptomatic HIV-1-seropositive subjects with baseline CD4+ cell counts > 200 x 10(6)/L were included in a prospective study and followed over a median of 27 months. Disease progression was defined as decrease in CD4+ cells to < 200 (14 events). At enrollment, provirus copy number was associated with CD4+ cell count and percentage, serum IgA, and p24 antigenemia. Elevated provirus copy number above 20 allowed identification of patients at high risk of a subsequently decreasing CD4+ cell count, even after adjusting for baseline CD4+ cell count (P = .003). Measuring provirus copy number by PCR at early stages of HIV-1 infection could offer a useful early means to predict progression to AIDS.
From 1983 to 1991 only isolated cases of aspergillosis in AIDS patients were reported; since 1991, an increasing number of cases have been reported suggesting a recent emergence of this fungal infection. Aspergillosis occurs about 10 to 25 months after AIDS diagnosis in patients with CD4 below 50/mm3. Neutropenia and/or steroid therapy, which are known as predisposing factors in aspergillosis, are noticed in about one half of the patients. Previous pulmonary infection, especially pneumocystosis, are very common. Clinical signs are typical of an invasive pulmonary aspergillosis: constant fever, cough, dyspnea, frequent thoracic pains and haemoptysis. Radiologic signs frequently indicate an interstitial infiltration. Nodular and cavitating lesions, pleural effusions, thoracic lymph node enlargement are often present. Diagnosis procedures are realised on bronchoalveolar lavage by direct examination, culture and antigen detection. Aspergillus fumigatus is the most usually species detected. Post-mortem diagnosis is frequent. Invasive bronchial aspergillosis, localised infections (aspergilloma, otitis, sinusitis) or disseminated infections (nervous system, heart, kidney, lymph nodes, thyroid) are also described. Prognosis is poor even with treatment (amphotericin B or itraconazole). An earlier diagnosis and treatment of the bronchial colonization could probably improve this prognosis.
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Explore the source record for details and available documents.