Pulmonary cryptosporidiosis in the acquired immunodeficiency syndrome.

Since the beginning of the AIDS epidemic, Cryptosporidium has emerged as a pathogen responsible for diarrhea in humans. Cryptosporidiosis confined to the respiratory tract has been documented only rarely in humans. An HIV-infected patient is described here, who developed pulmonary and intestinal cryptosporidiosis. Lung involvement was proven by biopsy, which also revealed bronchiolitis but no other pathogens. The patient died of respiratory failure 2 months after the onset of respiratory symptoms.

[Histoplasmosis, caused by Histoplasma capsulatum, and AIDS]. / Histoplasmose à Histoplasma capsulatum et SIDA.

Histoplasma capsulatum histoplasmosis occurs frequently in endemic areas and with the AIDS outbreak, it appears as an opportunistic fungus involved in disseminated disease. We report the clinical, biological and treatment features of seven cases diagnosed in the CISIH of the Eastern part of Paris. Clinically, four patients were suffering from pulmonary symptoms, in three cases digestive disorders and in three cutaneous lesions. In all cases, the mycologic diagnosis was necessary. Amphotericin B and itraconazole were used as treatment for five patients (two died before the diagnosis was completed). Among these five subjects, four died (death was attributed to histoplasmosis in only one case). These observations emphasize the importance of this infection in HIV-infected patients coming from endemic areas.

Investigation of a nosocomial outbreak of Clostridium difficile-associated diarrhoea among AIDS patients by random amplified polymorphic DNA (RAPD) assay.

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.

[Treatment with doxycycline and nifuroxazide of Isospora belli infection in AIDS]. / Traitement par doxycycline et nifuroxazide de l'infection à Isospora belli au cours du SIDA.

Isospora belli infection is the most frequent coccidiosis after cryptosporidiosis in AIDS patients. Chronic watery diarrhea is observed. Trimethoprim-sulfamethoxazole is the recommended treatment. Four AIDS patients were intolerant to this drug and were treated with doxycycline and nifuroxazide. Three patients were cured. Two patients died of other infections. The two last patients relapsed and were treated again with long term doxycycline. No relapse occurred during the following twelve months.

[Ophthalmological complications in ORL and maxillofacial surgery]. / Complications ophthalmologiques de la chirurgie ORL et maxillo-faciale.

E.N.T. and maxillo-facial surgery may sometimes cause dramatic eye damage. Following a brief summary of the eye's anatomy and its surrounding parts, the most frequent surgical acts which may cause orbital complications are described. Perfect knowledge of the eye and its surrounding parts enable us to offset the dramatic changes due to the pathology.

[Isolated fractures of the medial orbital wall, surgical indications in 5 cases]. / Fracture isolée de la paroi interne de l'orbite, indications chirurgicales à propos de cinq cas.

Isolated fractures of the medial orbital wall are always blowout fractures. They are usually diagnosed when horizontal diplopia occurs (lateral movements of the globe and Lancaster test). If the medial rectus muscle is encapsulated (forced ductions and CT-scan), the area of restriction has to be explored surgically.