RESUMEN
BACKGROUND: The incidence of chronic kidney disease (CKD) is 10 times higher in human immunodeficiency virus (HIV)-infected patients than in the general population. We explored the prevalence and determinants of proximal tubular dysfunction (PTD) in HIV-infected individuals, and assessed the impact of the tubulopathy on the estimated glomerular filtration rate (eGFR) outcome. METHODS: A cohort study was performed on 694 outpatients followed in a French centre to analyse the prevalence of PTD, the diagnosis performance of screening tools and the associated factors. eGFR was prospectively evaluated to analyse the predictive value of the tubulopathy on eGFR decrease. RESULTS: At inclusion, 14% of the patients presented with PTD and 5% with CKD. No individual tubular marker, including non-glomerular proteinuria, glycosuria dipstick or hypophosphataemia, registered sufficient performance to identify PTD. We found a significant interaction between tenofovir disoproxil fumarate exposure and ethnicity (P = 0.03) for tubulopathy risk. Tenofovir disoproxil fumarate exposure was associated with PTD in non-Africans [adjusted odds ratio (aOR) = 4.71, P < 10-3], but not in patients of sub-Saharan African origin (aOR = 1.17, P = 0.73). Among the 601 patients followed during a median of 4.3 years, 13% experienced an accelerated eGFR decline. Unlike microalbuminuria and glomerular proteinuria, tubulopathy was not associated with accelerated eGFR decline. CONCLUSION: PTD is not rare in HIV-infected individuals but is less frequent in sub-Saharan African patients and is associated with tenofovir disoproxil fumarate exposure only in non-Africans. Its diagnosis requires multiple biochemical testing and it is not associated with an accelerated eGFR decline.
Asunto(s)
Fármacos Anti-VIH/efectos adversos , Etnicidad/estadística & datos numéricos , Tasa de Filtración Glomerular , Infecciones por VIH/tratamiento farmacológico , VIH/efectos de los fármacos , Insuficiencia Renal Crónica/epidemiología , Tenofovir/efectos adversos , Adulto , Biomarcadores/análisis , Femenino , Francia/epidemiología , Infecciones por VIH/virología , Humanos , Túbulos Renales/efectos de los fármacos , Túbulos Renales/patología , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Insuficiencia Renal Crónica/inducido químicamente , Insuficiencia Renal Crónica/patología , Insuficiencia Renal Crónica/virologíaRESUMEN
Typhoid fever is a bacterial infection caused by Salmonella typhi or S. paratyphi, recognized as a classical cause of fever in returning travellers. However, neuropsychiatric presentations are rarely reported in travellers diagnosed in western countries, whereas they are more commonly described in patients treated in endemic areas. We describe such a case and discuss the pathophysiologic mechanisms of this complication.
Asunto(s)
Encefalitis/diagnóstico , Glucocorticoides/uso terapéutico , Prednisona/uso terapéutico , Salmonella paratyphi A/aislamiento & purificación , Viaje , Fiebre Tifoidea/diagnóstico , Diagnóstico Diferencial , Electroencefalografía , Encefalitis/sangre , Encefalitis/tratamiento farmacológico , Encefalitis/fisiopatología , Glucocorticoides/administración & dosificación , Humanos , Masculino , Prednisona/administración & dosificación , Fiebre Tifoidea/sangre , Fiebre Tifoidea/tratamiento farmacológico , Adulto JovenRESUMEN
A 65 year-old woman was admitted for acute heart failure and severe sepsis revealing definite mitral infective endocarditis with severe regurgitation, complicated by multiple embolisms. Three blood cultures yielded a group G Streptococcus canis strain. Urgent surgery was performed with bioprosthetic valve replacement. Polymerase chain reaction analysis of the valve found S canis DNA. Amoxicillin and gentamicin were given for 2 weeks followed by 4 weeks of amoxicillin alone. She reported contact with a dog without bite. S canis has been reported to cause zoonotic septicemia but to our knowledge, this is the first human case of native valve infective endocarditis.