[Epidemiological aspects of human Q fever in Indre-et-Loire between 2003 and 2005 and comparison with caprine Q fever]. / Aspects épidémiologiques de la fièvre Q humaine en Indre-et-Loire entre 2003 et 2005 et confrontation à la fièvre Q caprine.

OBJECTIVE: Chronic infection is the major risk of Q fever. C. burnetii infections result from the inhalation of contaminated aerosols. Indre-et-Loire is a rural French area with numerous goat farms. We evaluated human Q fever epidemiology and compared it with Q fever in goats. DESIGN: This retrospective study was made between 2003 and 2005. The diagnosis of C. burnetii infection was based on serologic findings from all the subdivision laboratories. Antibodies were detected by using indirect immunofluorescence. Farm animal data was processed by ELISA on blood samples from goats and cattle after Q fever related abortion in 2006 and results of PCR-processed milk samples from 156 goat farms. RESULTS: Forty human cases were studied: 38 acute Q fever (11 pneumonia, 10 hepatitis, 10 pneumonia with hepatitis, two isolated fever) and six chronic Q fever (four endocarditis). Sixteen patients (40%) had been professionally exposed, 10 (25%) of whom were goat farmers. Eight (20%) had been in contact with placenta. All the human cases were located in the south of Indre-et-Loire. Twenty percent of the volunteer goat farms had at least one milk sample positive for Q fever by PCR. Forty-nine of the 75 goat abortion samples were positive in ELISA. Ninety-two of the goat farms with positive samples were located in the south of Indre-et-Loire. CONCLUSION: This study revealed similar location of human and caprine Q fever. Identifying such geographical correlation may lead to improving prevention and detection.

Optimal duration of antibiotic therapy in vertebral osteomyelitis.

OBJECTIVES: To compare the risk of relapse of vertebral osteomyelitis (VO), according to the duration of antibiotic therapy (< or =6 weeks versus >6 weeks). METHODS: We performed a 10-year retrospective study to assess the risk of VO relapse and to verify that this risk was not enhanced in patients who received 6 weeks of antibiotic therapy (Group 1) as compared with those who received a longer treatment (Group 2). VO was diagnosed based on clinical manifestations, magnetic resonance imaging and/or computed tomography findings, and isolation of a pyogenic organism in blood cultures and/or a discovertebral biopsy. Relapse was diagnosed based on isolation of the same organism in blood cultures and/or a discovertebral biopsy. Outcome was evaluated 6 months post-treatment and in December 2004. RESULTS: Group 1 included 36 patients (mean age, 58 +/- 15 years) and Group 2 included 84 patients (mean age, 67 +/- 15 years) (P = 0.003). Clinical data and microorganisms were comparable in the 2 groups. In the first 6 months, 6 (5%) patients died (Group 1, n = 2; Group 2, n = 4), and 5 (4%) in Group 2 relapsed, 2 with recurrent VO and 3 with recurrent bacteremia. In 2004, 91 patients were evaluated (mean follow-up, 40.6 +/- 31 months): 77 (85%) were cured, 13 (14%) died (Group 1, n = 3; Group 2, n = 10), 1 had VO due to a different microorganism (Group 2), and no long-term relapses occurred. CONCLUSION: Our results suggest that antibiotic therapy of VO could be safely shortened to 6 weeks without enhancing the risk of relapse.

Prevalence and persistence of antibody titers to recombinant HIV-1 core and matrix proteins in HIV-1 infection.

Numerous studies have established the correlation between antibodies to the core protein p24 of HIV-1 and the progression of the acquired immunodeficiency syndrome. In this study, we analyzed the immune response to two recombinant gag proteins, p24 and p17, in order to evaluate their diagnostic or prognostic significance. Immune response to the immunodominant domain of the transmembrane glycoprotein gp41 was used as a reference. Sera collected from individuals from France and Burundi (Central Africa) at various CDC stages of HIV-1 infection were tested using three sandwich enzyme-linked immunoassays developed with a synthetic peptide corresponding to the immunodominant domain of gp41, SP gp41, or recombinant p24 and p17 cloned and expressed in Escherichia coli. These assays allowed detection of titer antibodies to the three cited antigens. Antibodies to SP gp41 were detected in every HIV-1-positive patient from France and Burundi, generally at a high and stable level. Results obtained with p24 confirmed the value of antibodies to p24 as a prognostic marker only in European and North American populations, since the African population had very high levels of these antibodies even at an advanced stage of the disease. They also confirmed that initial antibody response to p24 is more predictive of outcome than antibody titer change over time. Although antibodies to p17 decline during progression to AIDS, they are frequently absent in French patients at early, asymptomatic stages and therefore could not be used as a prognostic marker. In contrast, antibodies to p17 are significantly less common in African patients with AIDS when compared with symptomless HIV-1-infected African individuals.(ABSTRACT TRUNCATED AT 250 WORDS)

Isolated motor control dysfunction related to progressive multifocal leukoencephalopathy during AIDS with normal MRI.

We describe the case of a human immunodeficiency virus-infected 34-year-old man with progressive multifocal leukoencephalopathy (PML). His case displayed unusual features, including a bizarre movement disorder, predominant involvement of the subcortical U fibers on neuropathologic examination, and the absence of MRI abnormalities suggestive of PML. Anatomic-clinical correlations are discussed.

Protein-energy malnutrition in elderly medical patients.

STUDY OBJECTIVE: To evaluate (1) the prevalence of protein-energy malnutrition in elderly patients; (2) the changes in nutritional status during the hospital stay; and (3) (main objective) the relationship between simple nutritional parameters and short-term in-hospital mortality. DESIGN: Prospective time series at admission and on the 15th day of hospitalization. SETTING: Medical care unit in a teaching hospital. PARTICIPANTS: Consecutive sample of 324 hospitalized patients greater than or equal to 70 years (86.4% of eligible patients). Norms of measurements were obtained from a referred sample of healthy control subjects (26 males and 36 females). MAIN OUTCOME MEASURES: Mid-arm circumference, triceps skinfold thickness, serum albumin, prealbumin, and retinol-binding protein levels were measured in patients at admission and on the 15th day. RESULTS: (1) Prevalence of PEM was 30% in male and 41% in female patients. (2) Both mid-arm circumference and serum albumin level decreased over the first 15 days of hospital stay (53 patients, paired t test, P less than 0.05). Triceps skinfold thickness did not change. (3) A step-wise discriminant-function analysis determined the utility of the parameters at admission as predictors of in-hospital mortality before the 15th day. Mid-arm circumference, triceps skinfold thickness, albumin, and prealbumin levels, as well as age, are predictors of in-hospital mortality, with 73% sensitivity, 69% specificity, and 70% of correctly classified patients of both sexes. CONCLUSIONS: Parameters used are predictors for short-term in-hospital mortality of elderly patients hospitalized in an acute medical unit. The lean body mass is preferentially mobilized for energy during hospitalization.

[Situations and procedures with risk of bacterial endocarditis (intracardiac surgery excluded)]. / Situations et gestes à risque d'endocardite infectieuse (en dehors des interventions intracardiaques).

Situations which can be considered at risk for infective endocarditis are those causing a bacteremia, which is necessary for the development of an endocarditis. Such situations can be identified by clinical studies evaluating the rate at which a bacteremia occurs after some procedures or because of lesions, then the risk of endocarditis after such a bacteremia. Without considering preexisting cardiac lesion and age, some situations seem to be at risk of subsequent endocarditis: acute bacterial infection for which antibiotherapy is necessary; procedures involving the mouth with the exception of superficial caries and bloodless supragingival prosthetic preparations; oesophageal dilatation, laser endo-oesophageal procedures, sclerosis of oesophageal varices; colonoscopy and sigmoidoscopy for cancer lesions, gastrointestinal procedures on a potentially infected gastrointestinal tract (cholecystectomy, colectomy...); tonsillectomy and adenoidectomy; naso-tracheal intubation; instrumental procedures involving the ureter or kidney, and prostatic or urinary tract biopsies and surgery; procedures performed on infected skin. In cardiac patients at high risk, in addition to the above retrograde cholangiography, colonoscopy and rectosigmoidoscopy, lithotripsy. In these situations the risk of endocarditis is probably linked to the rate of bacteremia, the size of inoculum, and the bacteria, compared with spontaneous bacteremia without any procedure, where the inoculum is low and bacteria is considered as non pathogenic. A prophylaxis has to be discussed in such situations, which are probably involved in less than 10% of endocarditis.

[Serologic diagnosis and epidemiology of acute delta hepatitis in Indre-et-Loire]. / Diagnostic sérologique et épidémiologique des hépatites aiguës delta en Indre-et-Loire.

A 6 years retrospective study (1981-1986) of 153 consecutive cases of HBsAg positive acute hepatitis was carried out to assess the prevalence of delta virus infections in the Indre-et-Loire a district of the Loire Valley in France. Diagnostic value of the various serum markers of delta infection, i. e. HDAg, anti-HD and anti-HD IgM, were evaluated using immunoenzyme assays. During the survey, 22 cases of delta hepatitis were diagnosed (12 co-infections, 10 superinfections). They all involved young adults, 21 of them were drug-addicts, and one young woman was the consort of a drug-addict. In Indre-et-Loire, delta virus infection was responsible for half of acute HBsAg positive hepatitis among drug-users in the last 3 years of our study. Clinical and biological features of acute delta hepatitis were compared to those of the other HBsAg positive hepatitis: two cases of fulminant hepatitis occurred among the 12 co-infections; 4 of 6 superinfection that could be followed up to 6 months developed biopsy-proven chronic active hepatitis. Delta Ag was found constantly during the first week of the disease, its disappearance was always followed by a seroconversion to anti-HD after four weeks. Anti-delta IgM was an inconstant and late marker: it was detected within the first 4 weeks in only one case (a co-infection); it persisted only in superinfections. Our study shows that delta Ag is an efficient serum marker for the early diagnosis of acute delta hepatitis.

[Impact of Opposable Medical References (RMO) prescription guidelines for antibiotic prescriptions in ambulatory medicine]. / Impact des Références Médicales Opposables (RMO) sur la prescription antibiotique en médecine ambulatoire.

The French RMO (Références Médicales Opposables) are prescription guidelines based on a critical assessment of antibiotic drug prescription. The RMO 2, which concerns the prescription of commonly used antibiotics for otorhinolaryngological/respiratory infections, provides an example of the advantages and drawbacks of such an approach. Its effect on prescription behaviour is probably significant. The economic impact in terms of health cost has remained within acceptable limits.

[Toxoplasmic pleuro-pericarditis associated with Hodgkin's disease]. / Pleuro-péricardite toxoplasmique associée à une maladie de Hodgkin.

Pericarditis caused by toxoplasma infection is exceptional: 16 cases only have been published since 1943. The authors report a case of Hodgkin's disease associated with, and revealed by, toxoplasmic pleuro-pericarditis, and they review the literature on this complication of toxoplasmosis. Since the infection can be cured and since pericarditis may become chronic and constrictive if untreated, toxoplasmosis should be envisaged and confirmed or infirmed by serological tests in all patients presenting with pericarditis of uncertain origin. Provided it has not reached the chronic stage, toxoplasmic pericarditis responds well to the conventional treatment with pyrimethamine and sulfonamides.

[Anthropometric and biological evaluation of 44 patients with protein-calorie malnutrition]. / Evaluation anthropométrique et biologique de 44 patients présentant une malnutrition protéino-énergétique.

In industrial countries protein-calorie malnutrition (PCM) is a frequent cause of hospital morbidity and mortality. In this study, 88 hospital patients were evaluated: 44 (25 men and 19 women) aged from 20 to 80 years) with PCM, and 44 without malnutrition; the two groups were matched with regard to sex, age and height. The following parameters were determined: arm muscle surface, whole-body muscle mass, proportion of body fat, serum albumin (Alb), prealbumin (PA), retinol-binding protein (RBP), transferrin, thyroxine-binding protein, thyroxine, triiodothyronine, reverse triiodothyronine and total complement. Anthropometric measurements were validated by planimetry of a computerized tomographic section of the arm in 60 patients. There were significant differences between the two sexes in anthropometric values. Alb, PA and RBP values were different in men and RBP only in women; all other biochemical parameters were the same in both sexes. Thus, the group with PCM could be distinguished from the control group by anthropometric values and RBP values. Anthropometric parameters have been reported as being more specific of PCM than biochemical parameters, but since the latter are considered more sensitive, both complement each other and must be taken into account.

[Treatment of acute group A beta-hemolytic streptococcal tonsillitis in children with a 5-day course of josamycin]. / Traitement des angines aiguës à streptocoque beta-hémolytique du groupe A chez l'enfant par la josamycine pendant cinq jours.

MATERIAL AND METHODS: In this randomized open study, 325 children aged two to 15 years with acute tonsillitis and a positive test of GA beta H streptococcal antigen were treated with josamycin 50 mg.kg-1.day-1 b.i.d for 5 days, or penicillin 50,000 to 100,000 IU/day t.i.d for 10 days. Clinical assessments and throat cultures for GA beta HS isolation were performed at the inclusion visit (V1), at the end of treatment visit (V2: day 12 for all patients) and at the follow-up visit (V3: day 30). In case of positive GA beta HS culture, the bacterial DNA by RFLP was performed to differentiate between the persistence (presence of original strain at V2), relapse (eradication at V2 and acquisition of same strain at V3) and reinfection (eradication at V2 and acquisition of different strain at V3). RESULTS: Two hundred and twenty-three patients were included in the bacteriological and clinical criteria per protocol analysis. At V2, eradication rates were comparable: 82% in josamycin and 80% in penicillin patients; clinical cure rates were 90% and 89%. At V3, relapse of GAS assessed only on clinically and bacteriologically cured patients at V2 occurred in 12% of josamycin patients and 12.8% of penicillin patients. Tolerance was good; 14% and 10% of josamycin and penicillin patients respectively experienced an adverse event. CONCLUSION: In this non-inferiority study, the efficacy of a 5-day course of josamycin is comparable to reference treatment in GA beta HS tonsillitis in children.

[Acute fatty liver of pregnancy]. / La stéatose hépatique aiguë gravidique.

The authors analyse 115 cases of acute fatty liver of pregnancy, proven histologically. Characteristics of the condition is the finding of central nuclei in the hepatocytes containing microvesicular droplets. The disease occurs more frequently in primiparous women (54 per cent) and usually occurs in the third trimester of the pregnancy. A pre-icteric phase usually precedes the jaundice and during that time there is usually vomiting and/or nausa with abdominal pain or anarexia. In 92 per cent of case there is transient loss of consciousness with hepatic encephalopathy. Further tests show that there is more defective liver function than would be expected from the extent of cell lysis; and there is defective renal function. The worst complications are intestinal haemorrhages (48 per cent of cases)--genital bleeding (43 per cent of cases)--shock--diffuse intravascular coagulation and complications associated with coma. Maternal mortality at present runs at 25 per cent and fetal mortality at 60 per cent. The condition does not recur. Early evacuation of the uterus is recommended by most authors and does probably improve the outlook. The various hypotheses concerning the aetiology are discussed.

[Malaria, pregnancy and prophylaxis]. / Paludisme, grossesse et prophylaxie.

We present two case histories. The first is a case of congenital malaria in a newborn whose Laotian mother immigrated into France 2 years ago. The other is a case of very severe malaria with fetal death in a 28 year old woman who was 8 months pregnant and who had come back to France from Gabon where she had lived for 2 years. The authors wish to draw attention to malaria brought into the country and how serious it can be, and suggest prophylactic measures to be applied for pregnant women and their newborn babies.

[Prescription of beta-lactams for community-acquired broncho-pulmonary infections in adults. Observations in the hospital environment]. / Prescription des bêta-lactamines pour infections broncho-pulmonaires communautaires de l'adulte. Observatoire en milieu hospitalier.

OBJECTIVE: Analyze beta-lactam prescription patterns used in hospitals for the treatment of community-acquired lower respiratory tract infections in adults. PATIENTS AND METHODS: A prospective study was carried out over 4 months (October 1997 to January 1998) in 54 medical units caring for lung disease, internal medicine/infectious disease, geriatric and general medicine patients in 27 hospitals representative of the public facilities in France. Data were collected on the medical unit, the patients, and the antibiotic prescriptions, including discharge prescriptions. The cost analysis of antibiotic therapy took into account all antibiotics given to the patients during their hospital stay. RESULTS: One thousand eighteen patients were included in the study: 266 were treated for acute bronchitis, 405 for bronchitis infection with underlying chronic respiratory disease, and 347 for pneumonia. Noteworthy findings included: low percentage of protocols within the medical units (25.3%), an unexpected frequency of hospitalization for acute bronchitis generally among elderly women, and prolonged intravenous antibiotic therapy and hospitalization (5 to 6 days and 9 to 12.5 days respectively). CONCLUSION: This study confirms the need to reinforce measures aimed at optimizing antibiotic prescriptions in hospitals.

[Pulmonary malacoplakia and Rhodococcus equi pneumonia in a patient infected with the human immunodeficiency virus. A case report with review of the literature]. / Malacoplasie pulmonaire et pneumonie à Rhodococcus equi chez un patient infecté par le virus de l'immunodépression humaine. A propos d'un cas avec revue de la littérature.

We report a case of pulmonary malakoplakia in a patient suffering from AIDS secondary to a Rhodococcus equi pneumonia. The association between these two pathologies only occurring in the immunodepressed does not seen fortuitous. Deficiency in cellular immunity and macrophage cellular activity as well as failure of intracellular bactericidal and phagolysosomal function are very probably the links. The treatment of this opportunistic germ rests on prolonged poly-antibiotic therapy or indeed surgical excision.

[Primary staphylococcal septicemia in adults. A retrospective study]. / Septicémies primitives à staphylocoques de l'adulte. Etude rétrospective.

In this retrospective study, 100 cases of primary staphylococcal septicaemia collected in 5 hospitals over a 2-year period were reviewed. Out of 91 strains of Staphylococcus aureus isolated, 6 were methicillin-resistant, but all 6 came from the same hospital. The mortality rate was 36 per cent. The only prognostic factors elicited were chronic renal failure and septic shock. The 64 patients who survived stayed in hospital for a mean period of 42 days, and 42 recovered without sequelae. Staphylococcal infections remain serious and are not all hospital-acquired.

[Neuromeningeal listeriosis in adults, excluding pregnancy. Prognosis and development of neurologic manifestations. Retrospective study of 63 cases]. / Listériose neuro-méningée de l'adulte, en dehors de la grossesse. Pronostic et évolution des manifestations neurologiques. Etude rétrospective de 63 observations.

Patients' constitutional background, treatment and neurological manifestations were analyzed in a retrospective study of 63 cases of neuromeningeal listeriosis in adults. Age over 60 and coma at the onset were of poor prognosis, but immunodepression (present in only 38% of the cases) did not seem to affect the outcome. The ampicillin-aminoglycoside combination did not appear to improve the vital and functional prognoses more than ampicillin alone. The neurological manifestations observed at the end of hospitalization in 16 of the 42 patients who were cured were not necessarily permanent: among the 13 patients who could be followed up for a mean period of 6.5 years, 5 recovered completely, 5 recovered partially and 3 remained unchanged at neurological examination.

[Mycoplasma pneumoniae infections. A multicenter retrospective study of 182 cases]. / Les aspects des infections à Mycoplasma pneumoniae. Etude multicentrique rétrospective de 182 cas.

The spectrum of 182 hospital Mycoplasma pneumoniae infections, collected over a five-year period, is reviewed. The diagnosis was based on complement fixation test. Mycoplasma infection was encountered mainly in young people, mean age 29 years. Eighty-four per cent presented with an atypical pneumonia, 33 per cent had extrapulmonary manifestations mainly neurological and cutaneous. Acute respiratory failure occurred in 32 cases. Only 5 patients died. Macrolides or tetracyclines remain the most effective antibiotics but spontaneous recovery is usual.

[Scintigraphic assessment of pulmonary deposition of pentamidine administered by aerosol]. / Evaluation scintigraphique de la déposition pulmonaire de la pentamidine administrée en aérosol.

Isotopic techniques enable to determine the best conditions to aerosolize pentamidine as a preventive treatment of pneumocystis. An original labelling technique of pentamidine isethionate has led into a feasibility study of pentamidine scintigraphy in the monkey, and then to a clinical study. A tracer dose of 2 mg of pentamidine isethionate was diluted into 200 mg of pentamidine mesylate. An ultrasonic nebulizer (TV 6000) and a jet nebulizer (Venticis II) were first compared in four baboons. With the two nebulisers the curves of pulmonary kinetic activity showed a peak 10-15 minutes after the beginning of inhalation and then a plateau. With the ultrasonic TV6000 the pulmonary dose was on average 0.8 mg or 0.4% of the pentamidine aerosolized and the gastric contamination 3.1%. With the Venticis II compressed air apparatus the amount of pentamidine delivered to the deep lung was a mean of 4.2 mg or 2.1% of the aerosolized dose whereas the gastric contamination was only 0.5%. The delivery of the aerosol by the ultrasonic inhaler TV 6000 was then compared with two compressed air inhalers Venticis II and Respirgard II in four patients infected with HIV virus who were submitted to a preventative therapy against pneumocystis. With the ultrasonic TV 6000 the pulmonary dose was 0.8 mg or 0.3%-0.5% of the dose of pentamidine aerosolized and the digestive contamination was 3.1%. The performance of the two compressed air nebulizers Venticis II and Respirgard II were similar. The amount of pentamidine delivered to the deep lung was respectively 12 and 14 mg or 6 and 8% of the dose of pentamidine aerosolized and the digestive activity was 0.2%.(ABSTRACT TRUNCATED AT 250 WORDS)

[Efficacy and tolerance of cefotiam hexetil in the super-infected chronic sinusitis. A randomized, double-blind study in comparison with cefixime]. / Efficacité et tolérance du céfotiam hexétil dans le traitement de surinfection de la sinusite chronique. Etude randomisée, en double aveugle, comparison au céfixime.

Efficacy and safety of a new oral third generation Cephalosporin, Cefotiam Hexetil (CTM) 200 mg bid were compared with those of Cefixime (CX) 200 mg bid over 10 day duration of treatment. One hundred and twenty two ambulatory adults suffering from chronic sinusitis were randomized by ENT specialists in this multicentre prospective double blind, doubled dummy study. Sinusitis diagnosis evocated in front of fascial pain, purulent nasal discharge and/or obstruction was confirmed with sinus X-ray. Use of antibiotics or corticosteroids concomitantly or 15 days prior inclusion represented one of the major exclusion criterion. One hundred and seventy one patients were evaluated for efficacy analysis (62 and 59 respectively in CTM and CX groups). Regarding demographic data, clinical and radiological signs, the two populations were comparable at inclusion excepted for sex and weight (female: 73% in CTM group versus 47% in CX group). The overall clinical success rate at the end of treatment (cure+improvement) was not significantly different between the two groups (CTM: 82% versus CX: 80%). The incidence of adverse events was less frequent in the CTM group (14.5% versus 19%). In conclusion, CTM 200 mg bid is as efficacious and as well tolerated as CX 200 mg bid in the treatment of chronic sinusitis in adults.