Biomedical subjects
Publications and source records attributed to P Léonard.
Most of the echinococcosis cases treated in Belgium are contracted in African and Mediterranean countries. In this paper the authors describe the case of a Mediterranean patient suffering from a hepatic hydatid cyst treated by oral albendazole and laparoscopic liver resection.
Alveolar echinococcosis is a serious parasitic disease, leading to large hepatic lesions. It must be distinguished from cystic echinococcosis, or hydatic cyst, caused by Echinococcus granulosus. Early diagnosis may allow surgical removal of the lesions by segmental hepatectomy, the only curative treatment. Parasitostatic medical treatment with albendazole may promote stabilization of the disease. Until recently, Belgium was considered a country at very low risk for alveolar echinococcosis, as no human case was reported, despite up to 51% of fox infection in southern Belgium autopsy series. Recently four patients presented with alveolar echinococcosis at the University Hospital Center of Liege, leading to the fear of a possible alveolar echinococcosis endemy in southern Belgium. Two of these patients underwent curative hepatectomy, but the other two had already pulmonary metastases at diagnosis and received palliative albendazole therapy. This article presents these cases, and reviews the clinical features of this parasitic disease.
OBJECTIVE: The authors had an aim to define the ideal patient profile by determining the factors responsible for an initial variation of CD4 lymphocytes and viral load, and the effect of these factors on the therapeutic response after 12 months of treatment in HIV infected patients. PATIENTS AND METHOD: A retrospective study was made on data concerning the clinical stage, the HIV phenotype strain, the therapeutic status, and the type of treatment. This data was compared to the CD4 count and the viral load before and after 12 months of treatment. RESULTS: Initially, CD4 lymphocytes values were low in case of: phenotype SI (p = 0.012), patient in clinical stage C (p < 0.0001), or treated with protease inhibitor (p < 0.0002). The viral loads were high for patients in stage C (p < 0.0002) and treated with protease inhibitor (p < 0.0001). After 12 months of treatment, the increase of CD4 count was lower in patients with phenotype SI (p = 0.05). Furthermore, the viral load was statistically more important in naive patient (p < 0.0001). CONCLUSION: According to our study, the ideal patient is naive and presents with phenotype NSI.
Ebola hemorrhagic fever appears after an incubation of 3 days to 3 weeks. The first symptoms are fever accompanied by general and hemorrhagic signs leading to death in 50 to 90% of cases. During epidemics definition of cases permits prompt diagnosis. Due to the high risk of person-to-person and nosocomial transmission associated with Ebola hemorrhagic fever, management is based on isolation of patients and institution of protected care. Hands and soiled material are often decontaminated using sodium hypochlorite. Patient waste is decontaminated and incinerated. Treatment is essentially supportive. There is currently no vaccine available. Persons having been in close contact with patient should be kept under medical surveillance for 21 days. Recovering patients should use condoms for three months. Bodies of deceased patients should be handled by trained teams and buried quickly.
Great scourge of poor countries, malaria is the most important tropical parasitic disease. It is responsible for a large number of deaths in concerned countries and represents a real danger for travellers going to endemic regions. So, prophylactic measures are essential. On the one hand protective measures against mosquito bites, by wearing covering clothes, by using repellents and bed net (eventually impregnated with insecticide) will be useful. On the other hand, chemoprophylaxis is most often necessary, adapted to the possibility of chloroquine resistant P. falciparum, to the length or conditions of travel, and to the traveller's antecedents and age. Special concern about pregnant woman is necessary, due to potential severity of malaria. Chemoprophylaxis needs to be continued after coming back, for a duration depending on the drug used. Unfortunately, no prophylaxis is 100% effective, and the appearance of fever during the travel or two to three months after return requires medical advice. In some circumstances, it is necessary to prescribe a stand-by emergency treatment, if no quick medical advice is possible.
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We present data from 112 patients followed in the Infectious Diseases Unit of the Liege University Hospital (CHU Sart-Tilman). The primary goal of this study was to evaluate the efficiency of highly active antiretroviral therapy (HAART) on surrogate immunological and virological parameters. The study also aimed at determining the prevalence of opportunistic infections and iatrogenic metabolical abnormalities in the era of HAART. Data from HIV infected patients under combined treatment were collected from March 1996 till July 1999. The follow-up focused on the variation of the CD4 cell counts and viral load, and the occurrence of opportunistic infections. The average age was 39 +/- 10 years and the sex ratio (M/F) was 2.3. At baseline, the CD4 count was 352 +/- 244/mm3 and the viral load was 4.1 +/- 1.2 log. After 12 months, the CD4 cells were at 540 +/- 374 and the viral load at 2.5 +/- 1.5 log. This favourable outcome was observed in 70% of patients (naive and experienced). Clinically, patients in therapeutic success presented few opportunistic infections, but many drugs related toxicity. Our data demonstrate the efficiency of combined treatment in the management of HIV infected patients. However, the apparition of toxicity problems could limit the benefit brought by these drugs.
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BACKGROUND: Mycobacterium xenopi spinal infections were diagnosed in 1993 in patients who had undergone surgical microdiscectomy for disc hernia, by nucleotomy or microsurgery, in a private hospital. Contaminated tap water, used for rinsing surgical devices after disinfection, was identified as the source of the outbreak. Several cases were recorded in the 4 years after implementation of effective control measures because of the long time between discectomy and case detection. The national health authorities decided to launch a retrospective investigation in patients who were exposed to M xenopi contamination in that hospital. METHODS: Mailing and media campaigns were undertaken concurrently to trace exposed patients for spinal infections. Patients were screened by magnetic resonance imaging (MRI), and the scans were reviewed by a radiologist who was unaware of the diagnosis. Suspected cases had discovertebral biopsy for histopathological and bacteriological examination. FINDINGS: Of 3244 exposed patients, 2971 (92%) were informed about the risk of infection and 2454 (76%) had MRI. Overall, 58 cases of M xenopi spinal infection were identified (overall cumulative frequency 1.8%), including 26 by the campaign (mean delay in detection 5.2 years, SD 2.4, range 1-10 years). Multivariate analysis showed that the risk of M xenopi spinal infection was related to nucleotomy and high number of patients per operating session. INTERPRETATION: Failures in hygiene practices could result in an uncontrolled outbreak of nosocomial infection. Patients who have been exposed to an iatrogenic infectious hazard should be screened promptly and receive effective information.
Protease inhibitors constitute the last class of antiretroviral drugs appeared on the market. They raised an enormous enthusiasm, reinforced by recent studies results. These molecules prevent the formation of infectious viral particles, while inhibiting a viral enzyme that plays a key role in the cycle of replication of the HIV. Their efficiency, especially in association, is recognized for all stages of the infection and the intervening of a resistance often requires many mutations. However, the unexpected adverse events such as lipodystrophy and some interactions can limit their utilization in first intention.
Hydroxyurea is an anticancerous product, used recently in the treatment of HIV-1 infection thanks to its inhibitory action in viral replication, potentialization of the nucleosides activity (particularly ddI or didanosine) and its cytostatic properties on CD4 and CD8 lymphocytes. Many studies showed its efficiency, as further drug, in initial regimen of a tritherapy (containing ddI) and salvage therapy. The dosage of 500 mg bid seems tolerated well by adults, and 20 mg/kg by children. Long-term tolerance remains unknown. With ddI, it could be proposed in developing countries.
Non nucleoside reverse transcriptase inhibitors (NNRTI) are a new arm in the treatment of the HIV infection. They inhibit the replication by direct non competitive binding to the enzyme, and do not require phosphorylation. The fast emergence of resistance in monotherapy obliges to use them in a triple association. The 103 mutation confers a cross-resistance. The most common adverse event is rash. Association with nucleoside analogues is additive or even synergistic. They are metabolized by the cytochrome P450. Within a combined therapy, their efficiency is comparable to protease inhibitors, notably in patients with low viral load.
Nevirapine is the first non nucleoside reverse transcriptase inhibitor registered in Belgium and indicated in the treatment of HIV-1 infection. In association with 2 nucleoside analogues, its efficiency is similar to a tritherapy with protease inhibitor, particularly in naive patients with low viral load. It has a good tolerance profile and is easy to take. Studies in progress should permit to widen its indications.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.