Polyoxygenated Stigmastane-Type Steroids from Vernonia kotschyana Sch. Bip. ex Walp. and Their Chemophenetic Significance.

Four polyoxygenated stigmastanes (1-4) alongside known analogues (7-8) and flavonoids (5-6) were isolated from a dichloromethane/methanol (1:1, v/v) extract of the whole plant of Vernonia kotschyana Sch. Bip. ex Walp. (Asteraceae). Their structures were determined by means of spectroscopic and spectrometric analysis. The relative stereochemistry of the new compounds was established and confirmed via biosynthesis evidence and cyclization of 1 under acidic conditions. A plausible biosynthetic pathway to the new compounds and the chemophenetic significance of the isolated constituents were also discussed. The crude extract, fractions, and compounds (1-3) were assessed for their antibacterial activity against five highly prevalent bacterial strains. The fractions and compounds showed low to moderate activity with minimal inhibitory concentrations (MICs) > 125 µg/mL.

[Nocardia farcinica brain abscess associated with a pulmonary embolism in an immunocompetent patient]. / Abcès cérébral à Nocardia farcinica associé à une embolie pulmonaire chez une patiente immunocompétente.

INTRODUCTION: Nocardiosis is a rare, generally systemic infection that occurs in immunocompromised patients. We report a case of Nocardia farcinica primary brain abscess in an immunocompetent patient, unusually associated with a pulmonary embolism. OBSERVATION: A 62 year-old woman without medical past was hospitalised because of a Bravais-Jacksonian type of seizure. The clinical and radiological profile was unspecific. The diagnosis was made on identification of the microorganism. The patient improved after craniotomy with excision of the abscess and appropriate antibiotic therapy for four months. DISCUSSION: The N. farcinica species is distinct from others by its high degree of antibiotic resistance its virulence. We insist on the need to identify not only the microorganism but also the species concerned because this may influence the treatment strategy.

[Audit on antibiotic prescriptions in a department of infectious diseases]. / Audit des prescriptions antibiotiques dans un service de maladies infectieuses. A prospective and observational survey.

OBJECTIVES: France is one of the countries that prescribe the most antibiotics. The inappropriate use of antibiotics participates in the emergence of multi-resistant bacteria. This study was aimed at assessing the adequation of antibiotic prescriptions in a hospital department of internal medicine-infectious diseases. METHODS: Over a two-month period, all the antibiotics treatments were analysed prospectively. The adequation of the treatments was analysed at first with regard to the various consensus conferences of the French-speaking Society of infectious diseases (Société de pathologie infectieuse de langue française (Spilf)) and then with regard to the bacteriological results. RESULTS: One hundred and five prescriptions were analysed during the study period. Thirty-five percent of prescriptions were inadequate with regard to the criteria used. In 22 cases the prescription was excessive, in 8 cases it was unjustified and in 5 cases it was inappropriate. Moreover, in univariate analysis, 3 factors were correlated with inadequation: prescriptions drawn-up by a non-infectious disease practitioner (OR =3.45, IC 95% 1.34-9.09, p=0.008), prescriptions drawn-up by junior in the department (OR =4.10, IC 95% 1.54-11.08, p=0.003) and prescriptions pour respiratory infections (OR=2.58, IC 95% 1.03-6.48, p =0.04). CONCLUSION: This study conducted in a department of infectious diseases reveals the persisting high rate of inappropriate prescriptions, confirming the need to develop control and retro-control strategies regarding the prescription of antibiotics in order to control the diffusion of multi-resistant bacteria.

Type I interferon production is profoundly and transiently impaired in primary HIV-1 infection.

BACKGROUND: Successful immunological control of human immunodeficiency virus (HIV) infection is achieved only in rare individuals. Plasmacytoid dendritic cells (DCs) are mostly responsible for the production of strong antiviral factors--that is, type I interferons (IFNs)--in response to viruses. Their natural IFN production is impaired in chronic HIV infection, in correlation with viral load and disease progression, but it has not been tested during the critical stage of primary infection, when a balance is set between host immune responses and viral replication. METHODS: We longitudinally studied 26 patients during the primary stage of HIV infection. Fifteen patients received highly active antiretroviral therapy (HAART) for 12 months. RESULTS: At the time of inclusion into the cohort, median type I IFN production in response to herpes simplex virus type 1 stimulation was dramatically impaired in peripheral blood mononuclear cells (PBMCs) from HIV-infected patients, compared with that in PBMCs from 31 uninfected donors (180 vs. 800 IU/mL; P<.0001). Median circulating plasmacytoid DC counts were also significantly decreased (7300 vs. 13,500 cells/mL; P=.001). Twelve months later, IFN production returned to normal, and the data suggest that HAART may help in the recovery of IFN production by plasmacytoid DCs. CONCLUSIONS: These data underline the potential for early antiretroviral treatment and IFN- alpha treatment to enhance viral control in a larger proportion of patients during the critical stage of primary infection.

Early plasmacytoid dendritic cell changes predict plasma HIV load rebound during primary infection.

During human immunodeficiency virus (HIV) infection, interruption of highly active antiretroviral therapy (HAART) is usually followed by virus load rebound. Previous data have suggested a role for plasmacytoid dendritic cells (pDCs) in anti-HIV innate immunity. Here, the number of pDCs was measured by flow cytometry before, during, and after receipt of HAART in 7 patients with documented primary HIV-1 infection. A negative correlation was evidenced between pDC counts after 1 month of HAART and mean plasma virus load after interruption of HAART (r2=0.85; Spearman's partial rho =-0.92; P=.03). pDC counts during treatment might help predict immune replication control after interruption of HAART.