Catecholamine syndrome, carcinoid lung tumor and stroke.
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Adult↗
Biomedical subjects
L Perrin
Publications and source records attributed to L Perrin.
Chronic destructive lung disease associated with a novel mycobacterium.
A woman born in 1920 has suffered from a chronic destructive lung disease since 1972, with development of a severe combined restrictive and obstructive ventilatory defect. Large quantities of acid-fast microorganisms have been repeatedly observed in her sputum. Multiple courses of antimycobacterial treatment did not stop the progression of the disease. The mycobacterium involved was first identified as Mycobacterium gordonae, and later as Mycobacterium scrofulaceum. Analysis of part of the amplified gene of the 16S rRNA, however, revealed that its sequence differed from that of any established mycobacterial species, although it was observed once before in a German lymph node isolate, for which the name "Mycobacterium interjectum" has been proposed. Retrospective analysis confirmed the presence of this sequence in frozen samples which had been provided by the patient in 1983, 1985, 1989, 1990, and 1993. Our case confirms the value of amplification and sequencing of mycobacterial 16S rRNA for classifying mycobacteria, and suggests that "Mycobacterium interjectum" may be involved in cases of chronic destructive lung disease.
Aged↗
High levels of circulating RNA in patients with symptomatic HIV-1 infection.
OBJECTIVE: To evaluate the concentration of circulating RNA (viraemia) in patients with symptomatic primary HIV infection and relate it to sero-immunological parameters. METHODS: Semiquantitation of circulating HIV RNA and proviral HIV DNA was performed using the polymerase chain reaction. Circulating HIV RNA concentrations were expressed as virus equivalent (RNA copies/2) per ml serum. RESULTS: The mean CD4+ lymphocyte count for 19 patients with symptomatic primary HIV infection was 583 x 10(6)/l. Fifteen (79%) patients had detectable levels of p24 antigen (median 462 pg/ml). Circulating HIV RNA (median 2.3 x 10(7) virus equivalent/ml serum) and proviral HIV DNA (median 3630 copies/ml blood) were detected in all samples tested. Follow-up data for five patients (200-1600 days) showed a 1-3 log reduction in circulating RNA within 2 months. Later, circulating RNA concentrations were consistently greater than 10(3) virus equivalent/ml serum. Within 10 days no p24 antigen was detectable. Levels of CD4+ cells varied markedly from patient to patient during the follow-up and, in this small group, no evident correlation was observed between circulating RNA levels and CD4+ lymphocyte counts. CONCLUSIONS: High concentrations of circulating RNA (viraemia) were present in 19 patients with symptomatic primary HIV infection. Although a decrease in viraemia was observed during the following 2 months, viraemia persisted in all patients with long-term follow-up. This suggests that active viral replication is a continuous process in HIV-infected patients.
Adult↗
Specific tolerance to HIV-1 antigens in an infant with rapid progression to AIDS.
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Female↗
Epidemiology of vertically transmitted HIV-1 infection in Switzerland: results of a nationwide prospective study. Swiss Neonatal HIV Study Group.
A nationwide study involving 286 children of human immunodeficiency virus (HIV)-infected mothers living in Switzerland has been performed with the participation of all paediatricians interested in HIV infection in the country. Of these children 201 could be followed up prospectively from birth up to a median age of 22 months. Prevalence of HIV infection in Swiss parturients was estimated at 0.1% and apparently remained stable from 1986 to 1989. Vertical transmission rate was estimated at 14%-20%. Variables of maternal or perinatal history were not associated with transmission rate. Transmission to pairs of siblings of the same mothers was discordant in 33% (6 of 18), with always the elder sibling being infected. Postneonatal mortality in infants of HIV-infected mothers followed up from birth was increased 15-fold over the general population with a very high incidence (2 in 100) of sudden infant death apparently unrelated to HIV infection.
Child↗
Toxoplasma encephalitis in patients with the acquired immunodeficiency syndrome.
Among 504 cases of AIDS diagnosed between 1983 and 1990, there were 86 patients (17%) with toxoplasma encephalitis (TE). All were symptomatic at the time of diagnosis. General signs such as fever, neck stiffness, or headache were present in 87.2%, and 75.6% had focal signs. The primary means of diagnosis was computerized tomographic scanning, revealing 169 lesions of which 80% were immediately contrast-enhancing. All patients had IgG antibodies against Toxoplasma gondii either before (74 of 75 evaluable patients) or at the time of diagnosis of TE (73 of 75). Elevated antibody titers were present in 44% of evaluable patients, compared to 11% of patients with AIDS and other opportunistic infections. Initial treatment was pyrimethamine plus sulfonamides in 65 patients, and pyrimethamine plus clindamycin in 12 patients, with other combinations or no treatment accounting for the remainder. Life-table analysis of the time to discontinuation of treatment because of suspected side effects suggested that sulfadiazine was significantly more toxic, with 48% of patients experiencing an interruption in treatment after 30 days, than pyrimethamine (12%) or clindamycin (24%). The 30-day mortality rate was 12%, and median survival was 310 days after diagnosis, 530 in patients treated with zidovudine and 190 days in those not so treated. Of 82 evaluable patients, 16 relapsed once and 4 of these more than once. The risk of relapse was 27% 1 year after diagnosis of a first episode of TE.
Acquired Immunodeficiency Syndrome↗
Hepatitis C: a possible etiology for cryoglobulinaemia type II.
Out of 15 successive patients with mixed essential cryoglobulinaemia type II (monoclonal IgM kappa/IgG), 13 had serological evidence for hepatitis C infection as shown by specific enzyme immunoassays and immunoblot. RNA was purified from the serum of seven patients and hepatitis C sequences were identified in five following reverse transcription and DNA amplification. The liver histology showed chronic active hepatitis with or without cirrhosis in the 12 patients with hepatitis C who had a liver biopsy. The two patients without serological evidence of hepatitis C suffered from haematological malignancies. Hepatitis C may be a major etiological agent of cryoglobulinaemia type II.
Adult↗
[Initial and general orthodontic and surgical studies. Prerequisites of orthognathic surgery].
On the basis of 3 cases, we try to demonstrate the dominating role of model surgery in the patient's motivation, the surgical indication and the cooperation with orthodontists. This is achieved with a perfectly reproducible and didactic surgery. The use of color wax and of the TARG are the two deciding elements of this work.
Adolescent↗
[HTLV-I/II in Switzerland: apropos of 4 case reports].
HTLV-I/II (human T-cell lymphotropic virus type I and II) infection is endemic in South Japan, Subsaharan Africa, the Caribbean and in regions of South America and of the United States. The infection almost always remains asymptomatic but is also associated with two distinct diseases: tropical spastic paraparesis (TSP), and adult T-cell leukemia (ATL). Although very rare in Europe, HTLV-I/II infection may occur in patients originating from endemic areas. We report the cases of four patients seropositive for HTLV-I/II, all of them living in Switzerland. Three of them originate from Zaire; the fourth is a Swiss female married to a Taiwanese. One patient has TSP; one has pyramidal signs along with systemic vasculitis-associated neuropathy; the third is HIV-position with stage III B infection, without symptoms of TSP or ATL; the last is entirely asymptomatic.
Adult↗
Epidemiological basis for clinical diagnosis of childhood malaria in endemic zone in West Africa.
It is difficult to distinguish childhood malaria from other common febrile disorders by parasite count alone, because of the wide variation in tolerance of parasitaemia among individuals. We postulated that the proportion of febrile episodes among young children that can be attributed to parasitaemia varies according to simple clinical criteria. We studied 1114 children aged 2-9 years, who attended a dispensary in the Republic of Niger, with a case-control approach; each of 557 febrile children was matched with a non-febrile control by sex, age, ethnic group, and day of presentation. Febrile episodes were classified according to three clinical criteria: the presence of a likely non-malarial cause; the duration (less than 3 or more than 3 days before presentation); and the intensity (below 39 degrees C or 39 degrees C and above). There was no evidence for an association between febrile episodes and parasite count during the dry, low-transmission, season. During the rainy, high-transmission, season, by contrast, there was a highly significant relation (p less than 0.0001) between the likelihood of fever and the parasite count; each clinical criterion strengthened the association. There was no association between parasitaemia and low intensity fevers, with an obvious cause, that started 3 or more days before presentation, even in the rainy season; however, the relative risk of a fever that met all three criteria developing in those with vs those without parasitaemia was 27.5. The proportion of febrile cases attributable to detectable parasitaemia (population attributable risk) ranged from 0 to 0.92. Our results suggest that simple clinical criteria may be valuable in the selection of febrile patients for antimalarial treatment. In this geographic area, high fever of short duration and with no other obvious cause that occurs during the rainy season is most likely to be malaria.
Animals↗
Bullous pemphigoid autoantibodies, HIV-1 infection and pruritic papular eruption.
Bullous pemphigoid (BP)-type autoantibodies were found by Western blot (WB) analysis of epidermal extracts in the serum of 38% of HIV-seropositive patients compared with 21% of HIV-seronegative patients with chronic pruritus and 76% of patients with BP. They were further identified as BP autoantibodies (BPab) by immunoprecipitation and immunoelectron microscopy. Their incidence increased from 21% in HIV infection stage II to 37% and 43% in stages III and IV, respectively. Of the patients suffering from HIV-related chronic pruritic papulovesicular eruption. 75% showed circulating BPab as compared with 29% in those without skin problems (P = 0.0066) and, among them, 30% met the diagnostic criteria for BP when histology, WB, immunofluorescence and immunoelectron microscopy techniques were used. In conclusion, this study identifies an autoimmune skin reaction that may account for, or be related to, the distressing pruritic eruptions occurring in HIV-infected patients.
Adult↗
Human T cell activation. Synergy between CD73 (ecto-5'-nucleotidase) and signals delivered through CD3 and CD2 molecules.
Interaction of the glycosyl phosphatidylinositol-linked differentiation Ag CD73 (ecto-5'-nucleotidase) with the CD73-specific mAb 1E9 generates agonistic signals that strongly synergize with T cell activation induced by CD3 and CD2 mAb. This synergy is observed only when 1E9 is immobilized on plastic and occurs in the absence of accessory cells or exogenous lymphokines. 1E9 induces a rapid (though transient) increase in [Ca2+]i in a minor proportion (20 to 30%) of unfractionated T lymphocytes (presumably CD73+ cells). However, this [Ca2+]i mobilization is not sufficient to fully activate CD73+ T cells, as shown by the requirement of additional signals such as CD3 or CD2 stimulation to initiate T cell proliferation. These signals cannot be substituted by the exogenous lymphokines, rIL-1, rIL-2, or rIL-4, or PMA (when T cells are rigorously depleted of monocytes). These data indicate that CD73 may behave as an accessory molecule regulating interactions between T cells and antigens or APC. A comparison was carried out with mAb 9.3 to the differentiation Ag CD28, another agonistic molecule with activating properties similar to CD73. Despite their lower percentage, the ability of CD73+ T cells to amplify the proliferation induced by CD3 or CD2 mAb was equivalent or even greater than that of CD28+ T cells. Once activated, CD73+ cells may recruit the remaining (CD73-) cells primed by CD3 or CD2 stimulation. Based on these data, we suggest that CD73+ T lymphocytes may be a specialized subset to amplify immune responses originated by the CD3 and CD2 activation pathways. Finally, the functional association between CD73 and integral membrane molecules like CD3 and CD2 suggests that GPI-anchored molecules may play a role in transmembrane signaling mediated by conventional second messenger systems.
5'-Nucleotidase↗
Hepatitis C virus in patients with cryoglobulinemia type II.
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Adult↗
Loss of antibodies against hepatitis C virus in HIV-seropositive intravenous drug users.
A time-point survey of 262 ex-intravenous drug users (IVDUs) on methadone treatment showed serological evidence of hepatitis C virus (HCV) in 64%, hepatitis B virus in 74% and HIV in 36%. Analysis of previously collected frozen stored sera of the same patients showed that 31 further IVDUs had had anti-HCV antibodies in the past and had lost them in a time-dependent fashion. Most HCV seroreversion was detected in HIV-positive people: 20 out of 85 in the HIV-positive group versus 11 out of 18 in the HIV-negative group.
Adult↗
Behavioural changes in intravenous drug users in Geneva: rise and fall of HIV infection, 1980-1989.
In the early 1980s, more than 90% of intravenous drug users (IVDUs) shared needles and syringes in Geneva. The prevalence of antibodies to HIV in the sera of outpatient IVDUs increased from 6% in 1981 to 38% in 1983; it was, however, still only 37% in 1988. IVDUs starting methadone maintenance in 1987-1989 had a seroprevalence rate of 22%. In 1989 the percentage of IVDUs exchanging syringes and needles fell to only 5% of seropositive addicts. Only one seroconversion was observed in 1094 patient-months of observation in 1988-1989, which was probably due to sexual contact. The evidence suggests that, in the IDVUs studied, transmission of HIV has diminished since the early 1980s.
Adolescent↗
Hypohaptoglobinaemia as an epidemiological and clinical indicator for malaria. Results of two studies in a hyperendemic region in West Africa.
Hypohaptoglobinaemia is a common phenomenon in tropical countries, where it is probably due to malaria-induced haemolysis. Two studies were carried out in a hyperendemic zone of West Africa to test its specificity and usefulness as an epidemiological indicator for measuring malaria endemicity. The first study evaluated the prevalence of hypohaptoglobinaemia before and after courses of antimalarial chemotherapy of varying duration. The second monitored haptoglobin levels in an untreated population during a whole year to compare its seasonal variations with those of several classic indicators of malaria. These studies suggest that in regions where malaria is endemic the prevalence of hypohaptoglobinaemia could be as useful an indicator as the parasitic index but would be much easier to establish and to monitor.
Adolescent↗
[Polyclonal B cell activation in infection caused by human immunodeficiency virus (HIV)].
87 patients with anti-HIV antibodies were divided into three groups based on the classification of the Centers for Disease Control and the following parameters reflecting polyclonal B cell activation were evaluated in these patients: immunoglobulin levels, circulating immune complexes and occurrence of autoantibodies. The results reported here indicate that intense polyclonal B cell activation occurs in both asymptomatic (CDC 2) and symptomatic patients (CDC 3 and CDC 4). Moreover, serological abnormalities were detected with similar frequency in the three groups studied.
Acquired Immunodeficiency Syndrome↗
Malaria specific human T cell clones: crossreactivity with various plasmodia species.
Peripheral blood mononuclear cells (PBMC) from donors with or without previous exposure to malaria in vivo were cultivated for 4 to 7 days in the presence of different malaria antigen (M.Ag) preparations: Plasmodium falciparum (P.f.Ag), P. berghei (P.b.Ag) and P. gallinaceum (P.g.Ag). All preparations induced a proliferative response in PBMC from donors with or without previous exposure to malaria. PBMC from both groups of donors were then primed with each of the three M.Ag and cloned in presence of autologous irradiated PBMC and M.Ag. All 152 clones recovered had the T4+ phenotype and required autologous antigen presenting cells (APC) in addition to M.Ag for proliferation. Species specific and crossreactive T cell clones (T cell clones proliferating in the presence of the three M.Ag preparations) were recovered following priming with each of the three M.Ag. Species specific and crossreactive T cell clones were recovered in similar percentages (approximately 50%) using PBMC from donors with or without previous exposure to malaria. These data are discussed in the context of crossreactivity at the T cell level among various plasmodia species and in relation to epitope recognition of malaria native, synthetic and fusion polypeptides.
Adult↗