[Herpetic meningoencephalitis in the elderly. Apropos of 13 cases]. / Méningoencéphalite herpétique du sujet âgé. A propos de 13 observations.

In a retrospective analysis of 13 cases of Herpes simplex encephalitis (mean age: 67.2 +/- 6.4 years; ten women, three men), the authors conclude that this infection is more often due to Herpes simplex virus 1 in the elderly. Diagnosis is difficult at an early stage, and must be suspected in case of confusion (9/13), especially feverish (11/13), associated with neurological signs (10/13), and particularly epilepsy (5/13). It requires a lumbar puncture which collect a clear and lymphocytic fluid. Prognosis of this encephalitis depends on early diagnosis and an presumptive therapy with acyclovir. EEG is helpful showing periodic activity (10/13). CT scan and MRI can show unspecific abnormalities, but often too late. Laboratory findings will secondarily confirm the diagnosis quite frequently, using new Elisa methods. Polymerase chain reaction allows earlier diagnosis. Geriatric cases seem more often due to reinfection or to endogen virus reactivation rather than to primary infection.

[Value of the assay of 4 urinary enzyme activities in the diagnosis of the infectious or toxic (aminoglycosides) origin of a renal disease. Preliminary results]. / Etude de la valeur des dosages de quatre activités enzymatiques urinaires dans le diagnostic de l'origine infectieuse ou toxique (aminosides) d'une atteinte rénale. Résultats préliminaires.

Occurrence of a renal failure in an infected patient may be referred to various causes: infection, renal toxicity of drugs (for instance aminoglycosides), shock . . . Determination of some urinary enzymatic activities might be helpful in unravelling the mechanism involved in such cases. Therefore a prospective study of the specificity of some urinary enzymatic activities was performed. The whole LDH activity, the LDH isoenzyme 5 (LDH 5), and two lysosomal enzymes, N-acetyl-beta-D-glucosaminidase (NAG) and beta-glucuronidase (beta-GLU) were dosed systematically, in several groups of patients: I (n = 34): healthy control, with normal renal function; II (n = 24): renal impairment, without recent upper urinary-tract infection (UTI) or aminoglycoside treatment; III (n = 27): upper UTI without aminoglycoside treatment, IV (n = 22): patients treated with aminoglycosides (without upper UTI); V (n = 16): upper UTI treated with aminoglycosides. Results showed a rather good specificity of whole LDH and LDH 5 for infectious kidney damage, and of NAG for tubular injury due to aminoglycoside treatments. Values of urinary beta-glucuronidase varied over a wide range; they were little increased in group III, without a great discriminative value. No significant difference was noted between group I and group II, for any enzyme whatever.

[Endocarditis caused by heart valve prosthesis. Apropos of 35 cases]. / Endocardites sur prothèse valvulaire. A propos de 35 observations.

35 cases of prosthetic valve endocarditis are reported. The diagnostic is based on clinical, echocardiographic, bacteriological and anatomical aspects. Heart failure, neurologic complications, positive culture of prosthesis, Staphylococcus aureus infection and perivalvular abscess are factors of a bad prognosis. The current therapeutic trends associate antibiotic treatment and infected prosthetic valve replacement rather for hemodynamic indications than bacteriological factors. General prognosis has a mortality of 40 p. cent. Prophylaxis of infection, although simple is necessary.

[Value of corticosteroids in bacterial meningitis]. / Intérêt des corticoïdes dans les méningites bactériennes.

Bacterial meningitis mortality largely results from the intense host inflammation response to infection. Lysis of bacteria releases bacterial components that stimulate production of cytokines. Cerebrospinal fluid concentrations of these cytokines have been shown to correlate with the severity of the meningitis in both experimental and clinical situations. Dexamethasone has an antiinflammatory effect superior to methylprednisolone. It is the only agent with which significant clinical studies have yet been performed. A recent study recommends the routine use of dexamethasone with Haemophilus influenzae meningitis. The immediate and long-term clinical profiles indicate significantly better outcomes for the dexamethasone group. It is prudent to administer dexamethasone before the first parenteral dose of antibiotic to prevent the release of bacterial components induced by bacterial lysis. The search for agents that down modulate inflammation more strongly continues. Some monoclonal antibodies are superior to dexamethasone in experimental meningitis without modification of antibiotic pharmacokinetics.

[Hyponatremia in AIDS. Etiology and diagnosis]. / Hyponatrémie au cours du SIDA. Etiologie et diagnostic.

Hyponatremia is a common electrolyte abnormality in AIDS patients. In this study, hyponatremia was defined as natremia less than 130 mmol/l at two different samplings. Medical records of 160 hospitalized AIDS patients were exhaustively reviewed in search for hyponatremia and, if present, of its etiology. 45 cases of hyponatremia were identified in 43 AIDS patients. Two causes were predominant: hypovolemic hyponatremia, due to water and salt losses (11 cases) and the syndrome of inappropriate antidiuretic hormone secretion (10 cases). These results are consistent with those of the literature and were used to develop a simple diagnosis schedule based on the analysis of limited clinical and biological data: hydration status, serum and urinary osmolality, natriuria and creatininemia.

[Monotherapy of Pseudomonas aeruginosa septicemia with azlocillin]. / Monothérapie des septicémies à Pseudomonas aeruginosa par azlocilline.

Azlocillin was administered alone to seven patients without malignant or blood disease presenting with septicaemia caused by Pseudomonas aeruginosa. In 6 cases the infection developed after surgery and in 3 of these it was responsible for a state of shock, twice associated with acute anuric renal failure. The minimum inhibitory concentrations of azlocillin varied from 2 to 32 micrograms/ml; 5 strains were resistant to carbenicillin. The minimum inhibitory to minimum bactericidal concentrations ratio, measured on five occasions, was equal to 2. Bacterial eradication was obtained in 6 patients. One patient with multivisceral failure died during treatment and in this case the responsible organism had become resistant to azlocillin.

[Treatment of septicemia with latamoxef. Multicentric study of 60 cases]. / Traitement des septicémies par le latamoxef. Etude multicentrique de soixante cas.

Sixty patients including forty two males and eighteen females, age range: 18-87 years, received antibacterial single drug treatment with latamoxef for septicemia. Forty nine patients had underlying conditions including multiple trauma, neoplasm, cardiovascular, metabolic and respiratory tract diseases. Causative pathogens were isolated in all cases. The predominant isolates were E. coli (thirty), Klebsiella pneumoniae (tent) and Enterobacter (seven). A single organism was isolated in fifty seven cases; in the other three cases two organisms were isolated from blood cultures. Mean daily dosage was 46.6 +/- 6.1 mg . kg-1 (range: 14-113 mg . kg-1). In the majority of cases (fifty two) dosage was 3 g . d-1 or less; in thirty cases it was no higher than 2 g . d-1. Duration of therapy ranged from six to thirty eight days. Serum titer was measured in many cases and latamoxef blood levels were assayed in nine patients. A satisfactory clinical response was achieved in fifty eight cases and fifty eight bacteriological cures were also obtained. There was no statistically significant difference in therapeutic response between the 2 g and 3 g daily dosage groups. Tolerance was very good; untoward effects were few and required drug discontinuation in one case only.

[Lymphogranuloma venereum affecting simultaneously cervical and inguinal lymph nodes (author's transl)]. / Lymphogranulomatose vénérienne a double localisation cervicale et inguinale.

Nicolas-Favre's disease, also called lymphogranuloma venereum, a venereally transmitted disease caused by Chlamydia trachomatis, is usually presenting as an inguinal lymphadenopathy or an anorectal syndrome. Cervical lymph node involvement is uncommon, and in a review of the literature the authors found about fifteen such cases. The mode of transmission frequently consists of oral sexual contact. In this report, the authors describe a case of simultaneous cervical and inguinal lymph node involvement. The inguinal localization secondarily appeared, and allowed to suspect diagnosis.

[Cervical Pyoderma gangrenosum: treatment by plasma exchanges]. / Pyoderma gangrenosum cervical: traitement par échanges plasmatiques.

The authors report one case of Pyoderma gangrenosum whose unusual cervical localization was particularly bothering. Besides, the patient, an 18-year-old girl, had clinical symptoms of Crohn's disease confirmed by radiological investigations and bowel pathology. A benign monoclonal gammapathy and an auto-immune haemolytic anaemia were also found. After four plasma exchanges Pyoderma healed rapidly, Crohn's disease stabilized and biological abnormalities disappeared. Comments and review of the literature are reported. It appears that such a case is quite exceptional, as far as clinical, biological data and therapy (plasma exchange) are concerned.