[Retrospective study of 106 cases of varicella in immunocompetent adults. Parameters associated with varicella pneumonia]. / Etude rétrospective de 106 cas de varicelle chez l'adulte immunocompétent. Paramètres associés à la pneumonie varicelleuse.

INTRODUCTION: Varicella occurring in healthy adults may extend to the lungs. Diagnosing this complication is sometimes difficult because of the discrepancy between imaging and clinical presentation usually reported in this affection. METHOD: The authors report the result of a retrospective study on 106 immunocompetent patients including 48 cases of varicella pneumonia. This condition is defined as the presence of clinical signs of pneumonia and radiological and biological abnormalities consistent with viral pneumonitis. RESULTS: Comparison of the patients with or without varicella pneumonia (VP) showed that smoking was a risk factor for VP. Other parameters seem to be more associated with VP, such as fever greater than 38.3 degrees C, enanthem in the mouth, and biological hepatitis. In this study, 29.2% of the patients had received nonjustified acyclovir treatment because of missing specific criteria for the diagnosis of VP. CONCLUSION: An exact definition of VP and using parameters associated to VP would help to specify indication for hospitalization and acyclovir treatment. Careful monitoring of healthy patients with varicella is essential for an early detection of clinical signs requiring hospitalization.

Safety of prolonged high-dose levofloxacin therapy for bone infections.

The records of 84 patients with bone infections treated with high-dose levofloxacin (i.e. 0.75-1g daily) for more than 4 weeks were reviewed. Patients were given either 500 mg b.i.d. throughout the treatment period [Group 1 (n=41)], 500 mg b.i.d. for 3 weeks and then 750 mg q.d. [Group 2 (n=21)] or 750 mg q.d. for the whole treatment period [Group 3 (n=22)]. All patients had combined therapy, including levofloxacin-rifampin in 62 cases (73.8%), for an average duration of 13.7 weeks. Muscular pain and/or tendonitis were reported in 19 patients (22.6%) which affected more patients in Groups 1 and 2 than in Group 3 (14/41 and 5/21 vs. 0/22; p=0.01 and 0.001, respectively). A dosage of 750 mg q.d. may be warranted for prolonged high-dose levofloxacin treatment in patients with bone infections rather than 500 mg b.i.d. for the entire duration of treatment, or for the first 3 weeks.