Medical treatment of a pacemaker endocarditis due to Candida albicans and to Candida glabrata.

We describe a case of pacemaker infection due to two fungal species: Candida albicans and C. glabrata. Transthoracic echocardiography showed a large vegetation on the intraventricular wires. Because of severe underlying diseases, surgery was believed to be contraindicated. The patient was treated using high dose of fluconazole, resulting in clinical improvement and negative blood cultures. However, 2 months later, the patient underwent a fatal stroke. At autopsy, a large vegetation was found only all along the wires. Postmortem culture of the infected material was positive for both C. albicans and C. glabrata.

Intestinal and extraintestinal Isospora belli infection in an AIDS patient. A second case report.

A 30-year-old black female, from Burkina Faso, had AIDS in 1990. She died in March 1993 following a cachexia secondary to a chronic intestinal isosporiasis. The autopsy revealed a massive parasitic infection by I. belli of the small intestine mesenteric and mediastinal lymph nodes and liver and spleen. The parasite stage observed in extra intestinal sites corresponded to unizoite tissue cysts. This is the first report of I. belli infection in liver and spleen.

Histiocytoid cardiomyopathy: a cause of sudden death in infancy.

We report the case of an infant aged of 14 months deceased of sudden death. The diagnosis of histiocytoid cardiomyopathy was made on a necropsic basis. The pathologic examination showed a cardiac hypertrophy characterized by yellowish areas with irregular outlines, disseminated in the myocardium, and made of histiocyte-like cells with foamy or granular cytoplasm. These cells reacted positively with desmin and myoglobin labels, and had rare and disorganised myofibrils in electron microscopy, proving their muscular origin. The illness affects infants and usually causes severe cardiac troubles leading to death without treatment. This case is the fourteenth associated with sudden death.

[Confirmation of Leishmania infantum MON-24, agent of cutaneous leishmaniasis in southern France]. / Confirmation de Leishmania infantum MON-24, agent de leishmaniose cutanée dans le sud-est de la France.

Leishmania infantum MON-24, an agent causing cutaneous leishmaniasis, has only been reported once in Southern France. The authors report an additional case which confirms the presence of this zymodeme as agent of cutaneous leishmaniasis in this area. Treatment with a single course of liposomal amphotericine B did not show convincing efficacy.

[Adrenal medullary hyperplasia: a rare etiology of arterial hypertension--report of a case]. / L'hyperplasie médullosurrénalienne: une étiologie rare de l'hypertension artérielle--rapport d'un cas.

Adrenal medullary hyperplasia is often misdiagnosed. The clinical features may resemble those of pheochromocytoma, with paroxysmal hypertension and elevated urinary catecholamine and metanephrine levels. Pathologic study shows diffuse or nodular adrenal medullary hyperplasia, determined by morphometric analysis: increased adrenal gland weight, increased relative medullary volume, increased relative medullary weight, decreased cortico-medullary ratio. Adrenal medullary hyperplasia may be primary or sporadic, but is often associated with multiple endocrine neoplasia (MEN) type II.

[Rabies encephalomyelitis with myocarditis and pancreatitis. Report on a case recently imported into France]. / Encéphalomyélite rabique avec myocardite et pancréatite. Observation d'un cas récent importé en France.

We report the case of a 29 year-old man who died from rabies in France, following a dog-bite during a trip in Mexico. Although it was clinically suspected, the diagnosis was uncertain until he died because of digestive, cardiac and psychiatric misleading symptoms associated to the neurologic disorders. Post mortem diagnosis was based upon virological study in immunofluorescence on cerebral smears, viral isolation on cell-culture, and ELISA. It was confirmed by light microscopy examination which showed numerous Negri bodies, and ultrastructural study of the rhabdovirus in the central nervous system. Extranervous lesions, especially myocarditis and pancreatitis, were observed and their meaning is discussed. The physician is exceptionally confronted to the diagnosis of human rabies in France. Nevertheless, the lack of compulsory antirabic vaccination and the increase of touring in enzootic countries increase the risk of infection. As an intra vitam diagnosis in frequently lacking, the diagnosis of rabies infection needs a complete post mortem virological study as well as an histological and ultrastructural examination of the central nervous system.

[Disseminated infection due to Scedosporium apiospermum in liver transplantation. Differential diagnosis from invasive aspergillosis]. / Infection disséminée à scedosporium apiospermum chez un transplanté hépatique. Un diagnostic différentiel de l'aspergillose invasive.

A case of fatal disseminated infection due to Scedosporium apiospermum occurring after liver transplantation is reported. Diagnosis was made at autopsy, as numerous fungal colonies were found in the lungs, heart, brain, kidney, spleen and liver. Scedosporium apiospermum was identified in pulmonary, cerebral and myocardial specimens by Sabouraud's glucose agar cultures. Infections due to Scedosporium (S. apiospermum ou Pseudallescheria boydii) occur in immunocompromised hosts, particularly after organ transplantation, and realize severe invasive fungal infection. Scedosporiosis is much more rare than aspergillosis and can be only identified by mycological study. This diagnosis is rarely performed during life time and allows an effective treatment by imidazoles.

[Placental infection in Rwanda: comparison an HIV infected population and a control population]. / Infection placentaire au Rwanda: comparaison entre une population infectée par le VIH et une population contrôle.

We report an histological study from term placentas of 286 HIV positive women born in Rwanda. We observed chorioamnionitis without any pathogen in 15% of the cases, cocci Gram positive infection in 12 observations and malaria infection in 75% of placentas. We noted 71 cases of active malaria infection with Plasmodium falciparum trophozoites in the erythrocytes of the intervillous spaces, and 135 cases of chronic infection with malaria pigment without any parasite. An ultrastructural study performed in 8 cases of active malaria infection showed characteristic features of trophozoites and schizontes, and malaria pigment. No viral particle were seen. We did not observe any significative difference concerning the incidence of chorioamnionitis and of malaria infection in 275 HIV negative placentas. In the literature as well as in the present study, the main lesions observed in the placentas of AIDS patients were chorioamnionitis. Opportunistic infections and neoplasias of the placenta are exceptional. Detection of HIV proteins by immunochemistry or in situ hybridization is possible, but the HIV could not be identified in the trophoblast by electron microscopy. Mechanisms of the materno-fetal transmission for HIV are currently unknown.

[Persistent diarrhea in HIV infected patients: role of Enterocytozoon bieneusi]. / Diarrhée persistante chez les patients infectés par le VIH: place d'Enterocytozoon bieneusi.

OBJECTIVES: To determine the epidemiologic, clinical and aetiologic features of chronic diarrhoea in patients with human immunodeficiency virus (HIV) infection. METHODS: Between January 1992 and April 1993, all HIV positive patients with chronic diarrhoea were enrolled in a prospective study. There were 46 patients in the study group including 33 (22 homosexuals) in stage C according to the 1993 Centers for Disease Control classification. RESULTS: Thirty-four pathogenic agents were isolated in 26 of the patients (57%). Enterocytozoon bieneusi was the most frequently found pathogen (11 patients, 24%) followed by Cryptosporidium sp (8 patients). Enterocytozoon bieneusi was found in association with other pathogens in 7 patients. All patients with microsporidiosis were in stage C (p = 0.04) and had a longer duration of diarrhoea (19.6 vs 9.8 weeks, p = 0.03), greater weight loss (9.6 vs 2.1 kg, p = 0.0003) and a lower Karnofsky index (48% vs 67%, p = 0.01). Prophylaxy with dapsone or pyrimethamine during the 3 months prior to inclusion had been more frequent (p = 0.04 and p = 0.05 respectively) in patients without microsporidiosis. CONCLUSION: Microsporidiosis should be suspected as a probable cause of chronic diarrhoea in HIV positive patients with a CD4 count < 100/mm3. Multiple infections may be a factor leading to treatment failure. Microsporidiosis seems to be linked to homosexual intercourse.

[Familial hemophagocytic lymphohistiocytosis. Differential diagnosis with secondary hemophagocytic syndromes]. / La lymphohistiocytose hémophagocytaire familiale. Une affection à différencier des syndromes hémophagocytaires secondaires.

We report 2 cases of familial hemophagocytic lymphohistiocytosis in two children, hétérozygous twins, born from consanguine parents. This disease is characterised by disseminated lymphohistiocytic infiltrates with hemophagocytosis, that most commonly involves bone marrow, spleen, lymph nodes, liver and central nervous system. Differential diagnosis is difficult with infection-induced hemophagocytic syndromes. The only distinguishing feature in pathology is the expression of CD21, CD30 and CD35 antigens by histiocytes. Differenciation is made by an association of clinical and pathologic characteristics: a familial history, lack of infection or neoplasm, and immunohistochemical results. Diagnostic must be rapidly made, because this disease is always fatal without treatment.

Unusual cutaneous manifestations of miliary tuberculosis.

Cutaneous manifestations of miliary tuberculosis are extremely rare. We describe a 62-year-old woman with leukopenia who developed infiltrated dermal-hypodermal and ulcerative cutaneous lesions during the course of miliary tuberculosis. Miliary tuberculosis was diagnosed when Mycobacterium tuberculosis bacilli were isolated by cultures of the bronchoalveolar lavage fluid and blood and when acid-fast bacilli were detected on histopathologic examination of hepatic, pulmonary, and cutaneous biopsy specimens. With the increasing incidence of immunocompromised patients, unusual presentations of tuberculosis may be observed more often. Acute miliary tuberculosis of the skin is an exceptional manifestation that is due to acute hematogenous dissemination of M. tuberculosis to the skin. We describe a patient who had unusual cutaneous manifestations of miliary tuberculosis.

[Secretory carcinoma of the breast. Report of a case in a 9-year-old boy]. / Le carcinome sécrétoire du sein. A propos d'une observation chez un garçon de 9 ans.

The authors report a child male case of secretory carcinoma of the breast, associated with a abnormal tumoral karyotype (monosomy 22). The diagnosis was made by histopathological examination. This breast carcinoma is characterized by an abundant intra and extracellulary secretory material, which present a reactivity with antimilk proteins antibodies and includes spherical dense bodies, identified by ultrastructural study. The prognosis is not bad, whatever the age of the patient, particularly for the children and young women, displaying an locoregional aggressivity. The signification of a monosomy 22 in secretory carcinoma is unknown.