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Biomedical subjects

O Rogeaux

Publications and source records attributed to O Rogeaux.

At least 19 recordsLinked to original sources
PubMed1995

Adverse cutaneous reactions to pyrimethamine/sulfadiazine and pyrimethamine/clindamycin in patients with AIDS and toxoplasmic encephalitis.

We assessed the value of clinical and laboratory parameters for predicting the occurrence of skin reactions induced by pyrimethamine/sulfadiazine and pyrimethamine/clindamycin and the effects of continued therapy for patients with these reactions. We retrospectively studied all episodes of toxoplasmic encephalitis in patients with AIDS who were treated with pyrimethamine/sulfadiazine or pyrimethamine/clindamycin. Eighteen (75%) of 24 patients treated with pyrimethamine/sulfadiazine had cutaneous reactions after a mean of 11 days, whereas 15 (58%) of 26 patients treated with pyrimethamine/clindamycin had cutaneous reactions after a mean of 13 days (P = .56). Nine (50%) of the 18 patients continued to be treated with pyrimethamine/sulfadiazine throughout the duration of hypersensitivity, compared with all 15 patients who were treated with pyrimethamine/clindamycin (P = .002). Nine patients had to stop therapy with pyrimethamine/sulfadiazine (two had Stevens-Johnson syndrome and one had Lyell's syndrome). Thus, treatment throughout the duration of hypersensitivity is more likely to succeed for patients receiving pyrimethamine/clindamycin, whereas therapy with pyrimethamine/sulfadiazine is associated with a high risk of Lyell's syndrome and Stevens-Johnson syndrome.

AIDS-Related Opportunistic Infections↗
PubMed1994

[Intracerebral tuberculoma in HIV infection. Epidemiology and contribution of magnetic resonance imaging].

Intracerebral tuberculomas, observed in two HIV-infected patients, illustrated the diagnostic and therapeutic problems involved when an intracranial formation is discovered in this clinical situation. Both patients had a history of pulmonary tuberculosis. No preventive treatment had been given and disseminated tuberculosis occurred within a short delay (less than 2 years). A neurological deficiency led to the discovery of intracranial formations. The lack of effect of anti-toxoplasmosis therapy and the simultaneous discovery of tuberculous lesions strongly suggested intracerebral tuberculoma. With antituberculosis treatment, the general signs disappeared rapidly. Magnetic resonance imaging was particularly useful for following the course of the intracerebral lesions with a stereotype structure (confluent polylobular abscesses), for eliminating rapid evolution which would suggest lymphoma, the main differential diagnosis and to indicate corticosteroid treatment due to persistent oedema. Outcome was favourable with anti-tuberculosis therapy and corticosteroids. Intracerebral tuberculomas are rare and should be entertained in patients with tuberculosis when intracerebral abscesses do not respond to antitoxoplasmosis therapy. Magnetic resonance imaging is the most adapted imaging technique for diagnosis and follow-up.

AIDS-Related Opportunistic Infections↗
PubMed1994

Effect of corticosteroids on the incidence of adverse cutaneous reactions to trimethoprim-sulfamethoxazole during treatment of AIDS-associated Pneumocystis carinii pneumonia.

We retrospectively studied all courses of treatment with trimethoprim-sulfamethoxazole (TMP-SMZ) alone and with adjuvant corticosteroids for AIDS-associated Pneumocystis carinii pneumonia. The corticosteroids were administered for 8-21 days (mean, 14 days) because of hypoxemia. We evaluated the influence of corticosteroids on the incidence of cutaneous adverse reactions to TMP-SMZ and on the course of AIDS during 3 months of follow-up. Of 38 patients treated with TMP-SMZ alone, 18 (47%) developed cutaneous side effects, whereas three (13%) of the 23 patients who received adjuvant corticosteroid therapy experienced such effects (P = .014). Of the 21 reactive patients, 14 were treated throughout the duration of hypersensitivity. Therapy was interrupted for seven patients (18%) treated with TMP-SMZ alone and for none of those who were given adjuvant corticosteroid therapy (P = .23). During follow-up, the incidence of mucocutaneous herpes simplex virus infection was higher among patients who received adjuvant corticosteroids than among those treated with TMP-SMZ alone (P = .005). Adjuvant corticosteroids thus reduce the incidence of adverse cutaneous reactions to TMP-SMZ in patients with AIDS who are treated for hypoxemic P. carinii pneumonia.

AIDS-Related Opportunistic Infections↗
PubMed1994

[Cholestatic viral hepatitis A in adults. Clinical, biological and histopathological study of 9 cases].

OBJECTIVES: We report here 9 cases of acute viral hepatitis A leading to hospitalization between June 1989 and October 1992. The main feature was a marked and protracted cholestasis. RESULTS: Jaundice lasted an average of 77 +/- 39 days (range: 30-120) and total serum bilirubin concentrations were 265 +/- 184 mumol/L (range: 51-560). IgM anti-HAV was present in the serum for 6.3 +/- 5.5 months (median: 4, range: 2-19). Histopathological examination of the liver was performed in 6 patients and most showed intralobular cholestasis and portal tract inflammation associated with dystrophy and paucity of bile ducts. Acute renal failure was noted in one patient. In three patients, whose pruritus was not relieved by cholestyramine, plasma exchange was an effective therapy. CONCLUSION: These case reports confirm the severity of viral hepatitis A in adults and emphasize the importance of vaccination.

Acute Kidney Injury↗
PubMed1994

Adverse cutaneous reactions to trimethoprim-sulfamethoxazole in patients with the acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia.

BACKGROUND AND DESIGN: Patients with the acquired immunodeficiency syndrome are predisposed to cutaneous drug reactions. The reasons are poorly understood and the circumstances in which such patients can be treated through hypersensitivity are a matter of discussion. We assessed the value of clinical and laboratory parameters for predicting trimethoprim-sulfamethoxazole-induced skin reactions and the effects of continued trimethoprim-sulfamethoxazole therapy in such patients. We retrospectively studied all episodes of nonhypoxemic Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome who were treated with trimethoprim-sulfamethoxazole. RESULTS: No clinical or laboratory parameters were found to be predictive of trimethoprim-sulfamethoxazole-induced cutaneous reactions. Of 38 patients treated with trimethoprim-sulfamethoxazole, 18 (47%) developed cutaneous reactions; these occurred within a median of 11 days (range, 7 to 20 days). Of these 18 patients, 12 (67%) continued to be treated with trimethoprim-sulfamethoxazole through hypersensitivity. Trimethoprim-sulfamethoxazole treatment was continued in 19 (95%) of the 20 patients who did not develop cutaneous reactions (P = .067). The mean duration of trimethoprim-sulfamethoxazole therapy was shorter (18 days) in patients who developed skin reactions than in those who did not (20 days) (P = .016). Noncutaneous side effects accounted for all but one interruption of therapy. CONCLUSION: No clinical or laboratory parameters were found to be predictive of cutaneous reactions. By treating through hypersensitivity, 67% of our patients, who otherwise might have had to stop taking trimethoprim-sulfamethoxazole, were able to continue this essential drug therapy.

AIDS-Related Opportunistic Infections↗
PubMed1993

[Tuberculosis and HIV].

With the increased number of HIV infected patients, tuberculosis has become more frequent in Europe, USA and particularly in Africa. Impaired immunity, poor life conditions and high prevalence of tuberculosis in the general population facilitate the transmission of the disease. Tuberculosis is often seen early in the course of HIV infection and sometimes reveals the underlying immunodeficiency. Most of these cases are due to reactivation of earlier primo-infection when tuberculosis occurs later in the HIV disease, it may be secondary to a recent contagion. The infection may be localized in the lungs or in extrathoracic sites such as lymph nodes, liver, spleen, blood or meninges. The diagnosis is based on direct visualization of acid fast bacilli in gastric aspirate or BAL, on positive blood cultures or in histological findings which often show atypical granulomatous reaction without marked caseation. The role of the intracutaneous tuberculin test remain questionable as it often proves negative. A positive skin reaction can be useful for the diagnosis of tuberculosis, however, this is rarely observed. An early diagnosis is important in order to improve the prognosis and this justifies the frequent instauration of empiric treatment. The usual quadritherapy is efficacious and when started early permits in most cases a favorable outcome. The duration of treatment is poorly standardized but approaches 9-12 months in most instances. The drugs are not always well tolerated. A life-long maintenance therapy seems to have become necessary and primary prophylaxis might be of interest. The increased occurrence of drug resistant stains adds to the interest of preventing transmission, particularly in the hospital.

AIDS-Related Opportunistic Infections↗
PubMed1993

[Prevalence of rheumatic manifestations in human immunodeficiency virus infection].

UNLABELLED: Various rheumatic manifestations have been reported in HIV infected patients, but the prevalence of these manifestations is not well known. Therefore, we have designed a prospective study to define the rheumatic manifestations in those patients. METHODS: 121 patients (stage IV of CDC classification) were assessed by physical examination and biological tests. RESULTS: arthralgia was found in 12.4%; painful articular syndrome occurred in 4.1%; arthritis was present in 6.6%; out of 8 cases of arthritis, only 2 had spondylarthropathy. The articular manifestations were mostly oligo- or polyarticular, rarely invalidating, sometimes recurrent. No septic arthritis, no myositis and only 1 case of vasculitis was found. Raynaud's phenomenon prevalence was 17.4%, 43% of which appeared after HIV seropositivity was known. Lacrymal hyposecretion assessed by Schirmer's test was found in 49.6%. However, this did not prove the existence of a Sjogren's syndrome as no histological examination was performed. Back pain reached 38.6%. Sciatic neuralgias were noted in 17.6%. Biological and immunological results were unspecific. Low levels of antinuclear antibodies were found in 11.1% cases. They were more frequently found when articular manifestations existed. A higher level of CD8 lymphocytes was also noted when articular manifestations were present. No statistical link existed between the different rheumatic manifestations. CONCLUSION: our results show that the prevalence of rheumatic manifestations in HIV infection is slightly increased (24.7%). This study is the first to emphasize the frequency of Raynaud's phenomenon and lacrymal hyposecretion in HIV patients.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Disseminated Penicillium marneffei infection associated with human immunodeficiency virus: a report of two cases and a review of 35 published cases.

Penicillium marneffei, a dimorphic fungus that is endemic in southeast Asia, causes deep-seated infection in humans and rodents. About 20 cases have been reported among the local populations of China, Thailand, and Hong Kong, and 35 cases have now been described in patients infected with the human immunodeficiency virus (HIV). We present a review of the literature and report two additional cases. Both immunocompromised and apparently immunocompetent hosts tend to develop disseminated, symptomatic infection. HIV-infected patients having travelled to southeast Asia and presenting with fever, skin lesions, hepatomegaly, adenopathies, or lung disease should be investigated for Penicillium marneffei infection. The diagnosis is based on the demonstration of the organism in clinical specimens. Treatment with amphotericin B or itraconazole is generally successful, but maintenance therapy is warranted for patients with an underlying immunodeficiency.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Foscarnet induction therapy for cytomegalovirus retinitis in AIDS: comparison of twice-daily and three-times-daily regimens.

We have evaluated the effects of induction therapy with foscarnet 100 mg/kg b.i.d. via i.v. infusion in 60 AIDS patients with cytomegalovirus (CMV) retinitis and compared the findings with those in 37 such patients receiving a foscarnet induction regimen of 60 mg/kg t.i.d. via i.v. infusion. Induction therapy was given for at least 3 weeks, with the treatment period being extended in cases of slow resolution of retinitis. There was no significant difference between response rates in the two groups, with ophthalmologic response being observed in 52 (96%) of 54 evaluable b.i.d. patients and 33 (97%) of 34 evaluable t.i.d. patients over mean durations of therapy of 26 and 27 days, respectively; complete and partial responses were observed in 91 and 6%, respectively, of b.i.d. patients and 85 and 12%, respectively, of t.i.d. patients. Foscarnet was discontinued because of adverse events in 3 (3%) of 97 patients, with treatment being stopped in 2 patients because of renal insufficiency and in 1 patient because of an acute neurologic disorder. Serum creatinine concentrations increased significantly in both the b.i.d. group (from 82 to 98 mumol/L, p less than 0.01) and the t.i.d. group (from 73 to 122 mumol/L, p less than 0.001), with the difference between increases not being statistically significant. Serum creatinine concentrations greater than 200 mumol/L were observed in two b.i.d. patients and four t.i.d. patients; in four cases, concomitant medications or conditions contributed to renal impairment. Hypocalcemia of less than 1.75 mmol/L occurred in 18% of b.i.d. patients and 28% of t.i.d. patients during treatment (p = 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗