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Biomedical subjects

R Laroche

Publications and source records attributed to R Laroche.

At least 37 records · Page 2Linked to original sources
PubMed1992

Cryptococcal meningitis associated with acquired immunodeficiency syndrome (AIDS) in African patients: treatment with fluconazole.

Cryptococcal meningitis associated with acquired immunodeficiency syndrome (AIDS) is particularly common in tropical Africa. This could be explained by the dramatic increase in the number of human immunodeficiency virus (HIV) infections and the high prevalence of Cryptococcus neoformans var. neoformans in the domestic and general environment of HIV-positive and AIDS patients Meningoencephalitis is the usual and dominant clinical feature of cryptococcal infection in AIDS patients and 'slim disease', tuberculosis and candidiasis are the most common opportunistic infections associated with cryptococcal meningitis. In a group of 64 African patients with AIDS and cryptococcosis treatment with a daily dose of 400 mg fluconazole (FCA) during the acute phase showed a clinical cure in 63% of the evaluable patients. Mycological response to treatment with negative culture was found in 76% of our patients (at day 60-90). The overall tolerance of FCA was excellent. This treatment was also used successfully for relapse of cryptococcal meningitis.

Acquired Immunodeficiency Syndrome↗
PubMed1992

[Value and limits of tomodensitometry applied to the diagnosis of sacroiliitis in young adults: study of 200 cases].

Diagnosis of sacroiliitis may be difficult to establish in patients under 25 years of age since growth is not yet completed and joint damage is often still minor. A prospective study of 200 subjects with a median age of 22 years was carried out to compare the value of CT scan and conventional radiology. The study population included 32 healthy subjects and 168 consecutive patients with presumptive spondylarthropathy including 36 with bilateral sacroiliitis and 8 with unilateral sacroiliitis. Conventional roentgenograms and CT scans were performed in every patient. Blind reading of roentgenograms and CT scans was carried out by two pairs of observers with differing experience. CT scan provided no additional information when reading was done by experienced observers: rates of mistaken and doubtful results were similar with both investigations (10%); specificity of both tests was comparable (90%) but sensitivity was significantly greater for CT scan (91.2%) than for conventional roentgenograms (71.6%), reflecting improved detection of roentgenographically occult sacroiliitis. Less experienced observers obtained better results with CT scans, illustrating the ease of interpretation of CT scan images. Analysis of false-positive CT scans revealed that normal variations and, above all, features due to as yet uncompleted growth were the main sources of mistakes. These mistakes cancelled the advantage of increased sensitivity of CT scan studies and explained why CT scan failed to improve diagnosis.

Adult↗
PubMed1992

[Falciparum malaria in French residents in Yaounde].

In South Cameroon, malaria is a disquieting problem. It represented 2.6% of consultants and concerned each year 10% among French residents. We have included 310 cases of Falciparum malaria between January 1, 1990 and December 31, 1990. There were 207 adults and 103 children with a mean age of 26 years. The duration of the stay was over one year in 137 cases and lower than 1 year in 183 patients. The chemoprophylaxis was correct in 194 patients according to the dose and duration. Forty-nine patients followed a combination of chloroquine and proguanil. Malaria attack was observed in 272 patients. Among them, there were 95 children. A severe malaria occurred in 38 cases. Mean parasitemia was of 0.24% (range: 0.002-7.5%). Therapy regimen was quinine: 36 cases, halofantrine: 266 cases, amodiaquine: 7 cases and association MFP (Fansimef) in 12 patients. The study shows the importance of malaria in an endemic area among expatriates despite the observance of chemoprophylactics regimens including proguanil.

Adolescent↗
PubMed1991

AIDS-associated cryptococcosis in Bujumbura, Burundi: an epidemiological study.

Cryptococcus neoformans var. neoformans was isolated from domestic dust in 54% of houses occupied or recently occupied by AIDS+ cryptococcosis patients and in 20% of control houses randomly chosen in Bujumbura, Burundi. It was not isolated from wards of similar patients in the University Hospital. This seems to prove that patients could not contaminate their own environment and that the presence of C. neoformans var. neoformans had another origin. In 40% of the cases, patients admitted contact with pigeons in the city and pigeon coops are frequently positive. We are convinced that the pigeon coops of the city play a part in the contamination of HIV+/AIDS patients; however, some patients denied any contact with pigeons and in these cases, the only possible source of contamination identified thus far is domestic dust, although the origin of the yeast remains unknown.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Pharmacokinetics of quinine and doxycycline in patients with acute falciparum malaria: a study in Africa.

The pharmacokinetics of quinine was investigated in patients with acute falciparum malaria treated with quinine alone or in the presence of doxycycline. Twenty-six patients divided into two groups of equal number were enrolled in the study. In the absence of doxycycline, the volume of distribution of quinine (mean +/- SD) was estimated to be 1.32 +/- 0.32 L/kg, and its clearance was 0.125 +/- 0.47 L/h/kg, which was only in partial agreement with previously published data. No effect of doxycycline on the pharmacokinetics of quinine was observed.

Adolescent↗
PubMed1990

[Rheumatological aspects of infection with human immunodeficiency virus (HIV)].

Since 1987, some works have been devoted to rheumatological manifestations appearing during the course of the HIV infection. If neurotropism of this retrovirus explains some misleading pseudo radicular aspects of the disease, sometimes revealing, inflammatory neuro-arthropathies are still under discussion. In Tropical Africa, increase of reactive arthritis of REITER's type seems to be correlated with the present epidemic outbreak. It is also admitted that HIV has a direct arthritic effect. These two facts lead to elaborate several pathogenic hypothesis concerning rheumatoid arthritis and spondylarthritis. On the other side, some systemic diseases may appear or be simulated at the occasion of the HIV infection, in particular, some lupoid manifestations. During AIDS, lymphocytic depletion may be at the origin of series of biological abnormalities that have to be known in order to mislead diagnosis.

Acquired Immunodeficiency Syndrome↗
PubMed1990

[Cryptococcosis in Bujumbura, Burundi. Apropos of 80 observed cases in 42 months].

Cryptococcosis is a systemic fungal disease and meningeal or meningoencephalitis involvement is the most serious complication. This is a retrospective analysis of 80 patients admitted from December 1983 to October 1985 (30 cases) and June 1987 to December 1988 (50 cases) in hospital of Bujumbura, Burundi, Central Africa. All patients have an AIDS. Clinically, the meningeal and meningoencephalitis attack prevails in 87% cases. The diagnosis in our study is essentially based on the examination of the CRL. Before the new antifungals, the treatment involved the association of amphotericin B and 5-fluorocytosine, during 6 to 8 weeks. This treatment was badly tolerated and the second falls, when the therapy was stopped, were frequent. Presently, the fluconazole is the best treatment of this affection (ailment?): it enables maintenance therapy for a disease in which the risks of recurrence and reinfection by the environment are not negligible in Africa.

Acquired Immunodeficiency Syndrome↗
PubMed1990

[Platelet antibody activity in malaria thrombocytopenia].

To assess immune responses to malaria-induced thrombocytopenia, an haematologic and immunologic study was performed on 25 patients with imported malaria upon admission and 8 days after treatment. Thrombocytopenia (150 x 10(9)/litre) was detected in 19 cases (P. falciparum: 11 cases, P. ovale: 6 cases, P. vivax: 2 cases). No laboratory evidence of disseminated intravascular coagulation impairment was found in any of the patients. Bone marrow examination performed in 9 cases showed no abnormality in the megakaryocyte series. Platelet count was independent of circulating parasite levels (r = 0.27) and inversely related to the number of antibody binding sites (ABS) on platelets (r = -0.6, p. less than 0.01). The indirect Coombs test (r = -0.54; p less than 0.01) and IgG and IgE levels (p less than 0.02) gave similar findings. A statistical correlation was observed between the level of circulating immune complex and the number of ABS (r = 0.525, p less than 0.01). Thus malaria-induced thrombocytopenia seems to mainly involve IgG type antiplatelet antibody activity. Although they may be implicated in the binding of antibodies to platelets, circulating immune complexes do not appear to mediate thrombocytopenia.

Adolescent↗
PubMed1990

[Pulmonary manifestations of malaria].

Pulmonary edema is a classic and severe manifestation of falciparum malaria. To evaluate the predictive factors of this severe complication, we studied epidemiological, clinical and biological data of 136 patients with acute malaria. Two groups were individualized according to the presence (group I = 53 patients) or the absence (group II = 83 patients) of pulmonary manifestations. Pulmonary signs incidence was not correlated with impairement consciousness, creatinemia, hypoglycemia, and coagulation abnormalities. However, age, tobacco abused, delay in starting treatment, oliguria, decreased protidemia were significantly increased. These factors, associated with severe malaria, expose to a more important risk of pulmonary edema, often induced by reanimation management.

Adolescent↗
PubMed1989

Isolation of Cryptococcus neoformans from houses of AIDS-associated cryptococcosis patients in Bujumbura (Burundi).

Cryptococcus neoformans var. neoformans, which is responsible for AIDS-associated cryptococcosis in Bujumbura, was isolated in the domestic environment of seven out of 20 patients with AIDS-associated cryptococcosis. The findings prove that in his own domestic environment, the HIV-positive patient in central Africa is frequently exposed to the yeast and these observations lead us to insist on the suitability of carrying out a systematic survey by means of soluble antigens-sensitized latex in every HIV-positive patient. This also proves the importance of a follow-up of the 'cured' patients who easily can be recontaminated after their return home.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[A sero-epidemiologic survey of HIV infection in Burundi between 1980 and 1981].

A retrospective investigation permitted us to show presence of HIV infection in Burundi between 1980 and 1981. 658 sera collected in healthy population of Burundi during this period have been tested for HIV1 and HIV2 with ELISA screening and western-blot analysis. Results completed with HIV1 antigen research show 29 patients infected with HIV1 (27 antibodies to HIV1 carriers, and 2 with HIV1 antigen). The epidemiological situation before finding HIV show high prevalence (4.4%) of HIV1 infection. No HIV2 was found. The epidemiology of HIV infection was dominated by high prevalence in urban areas (8.08%) but 2.82% of country people were infected, by frequence in man (5.94%) but 3.08% of women were carriers, and by heterosexual transmission. After this study HIV infection was more frequent and we have observed epidemiological modification (importance of vertical transmission). Frequent antigenic cross-reaction between HIV1 and HIV2 core proteins has been observed. Cross-reaction with other retrovirus is possible.

AIDS Serodiagnosis↗
PubMed1989

[Parasites, etiologic agents of diarrhea in AIDS. Significance of duodenal aspiration fluid test].

A research was made on one hundred cases of diarrhoeas in Aids-patients by stool examination including examination of duodenal aspirated liquid. Concerning the examination of duodenal fluid, we founded the parasites in almost one hundred patients of the cases. Among parasites observed, Isospora belli was the most frequent (20% of cases), followed by Cryptosporidium (15%). Strongyloides stercoralis represented 10% of the cases. The majority of other parasites was miscellaneous protozoa and some helminths.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Epidemiologic aspects of gastroduodenal ulcer in Burundi. Apropos of 1,476 new cases seen in 3 years].

The objective of this study is to evaluate the main epidemiological characteristics of gastroduodenal ulcer in Burundi, from 3,282 high gastrointestinal endoscopies, performed over a 3-year period, permitting the diagnosis of 1,476 ulcers (45%): the duodenal ulcer is predominant, almost 93 p. cent. The sex-ratio is 2.75/1. There is a peak of maximum frequency between the ages of 20 and 29 years for duodenal ulcer. The results of this study are consistent with the series published in Africa regarding the location of the ulcer, sex and age. The frequency is high in relation with the series coming from West Africa. Two provinces in the 15 which form Burundi, share between them 50% of ulcer patients. These are the highest regions of the country (average attitude = 1,800 meters), but where the socio-cultural and dietary customs are the same as in the other provinces.

Adolescent↗
PubMed1988

Acquired immunodeficiency syndrome and human immunodeficiency virus infection in Bujumbura, Burundi.

In the first seroepidemiological survey in Burundi in 1984, only 59 acquired immunodeficiency syndrome (AIDS) cases were recognized. We report here clinical surveillance of AIDS cases in the 4 hospitals in Bujumbura during a 4-month period in 1986. The project was combined with a seroprevalence study of pregnant women in the 6 dispensaries in Bujumbura. 258 AIDS patients were recorded. 16% of the 925 pregnant women were seropositive for human immunodeficiency virus (HIV). The clinical characteristics of 120 adult AIDS patients were similar to those reported in Kinshasa or Kigali. From demographic findings we presume that the major mode of HIV transmission in Bujumbura is by sexual contact. The results of this study formed the starting point of prevention activities against AIDS in Burundi.

Acquired Immunodeficiency Syndrome↗
PubMed1987

[Human arbovirus infections in Burundi: results of a seroepidemiologic survey, 1980-1982].

A serological survey on 623 human sera was conducted in Burundi in 1980-1982, in order to evaluate the frequency of arboviral antibodies in the inhabitants of the three main areas: lowlands, central plateau and mountainous ridge. The results show a rather high activity of arboviruses, mainly in the lowlands (34.2% of inhabitants with antibodies). Chikungunya virus seems to be the most active arbovirus; the activity of Flavivirus is moderate; no trace of activity of yellow fever or West Nile viruses was found; Bunyavirus antibodies (particularly against Ilesha virus) were also detected.

Alphavirus↗