Concomitant or consecutive infection with Coxiella burnetii and tickborne diseases.

BACKGROUND: Q fever is a worldwide zoonosis caused by Coxiella burnetii, which can be isolated from ticks. Reports of people with both Q fever and other tickborne diseases are rare. In this study, we describe 6 patients with Q fever who were infected with 1 of the following tickborne pathogens: Rickettsia conorii (2 patients), Rickettsia slovaca (2), Rickettsia africae (1), and Francisella tularensis (1). METHODS: Diagnoses were made on the basis of results of microimmunofluorescence assays for detection of C. burnetii, R. conorii, R. slovaca, R. africae, and F. tularensis antigens. Cross-adsorption studies and Western blots were used to confirm dual infections. RESULTS: Among the 6 cases presented, 3 were probably due to a concomitant infection after a tick bite, whereas the remaining 3 were more likely consecutive infections. CONCLUSIONS: Because acute Q fever is often asymptomatic, we recommend that patients infected with the tickborne pathogens mentioned above also undergo routine testing for concurrent infections with C. burnetii.

[Meningo encephalitis revealing Q fever: two cases and a review of the literature]. / Méningo-encéphalite au cours d'une fièvre Q aiguë

Q fever is a zoonosis caused by Coxiella burnetii. The acute Q fever is usually characterized by a self-limited flu-like syndrome, fever, pneumonia and hepatitis. Symptoms of the chronic Q fever (evolution>3 months) mainly consist of endocarditis with negative culture. Focal neurological symptoms are rarely observed. Neurological symptoms of acute Q fever consist of meningitis or meningo-encephalitis. Neurological symptoms of chronic Q fever are cerebral embolisms from Coxiella burnetii infected heart valves. We herein report two patients with meningoencephalitis revealing acute Q fever.

[Imported dengue: study of 44 cases observed from 1994 to 1997 in 9 university hospital centers. Infectio-Sud-France group]. / Dengue importée: étude de 44 cas observés de 1994 à 1997 dans 9 centres hospitaliers universitaires. Groupe Infectio-Sud-France.

Imported dengue is increasingly observed in non endemic countries. We report a retrospective study of 44 cases of dengue fever diagnosed in nine french university hospitals between 1994 and 1997. The patients were aged between 13 and 67 years. Most of them were tourists and had been traveling for a few weeks, in French West Indies and French Guyana (18), South-East Asia (10), India (7) or Polynesia (4). Only, two contracted the disease in Africa. The onset of symptoms preceded the return or followed it within 7 days. The most frequent clinical presentation was a febrile and painful syndrome. Cutaneous manifestations (rash or macular exanthem) were observed in 59% of cases, digestive symptoms in 50%, pharyngitis and/or cough in 25%, microadenopathy in 20%, moderate mucous haemorrhagic manifestations in 16% and neuropsychiatric manifestations in 14%. The common biological abnormalities were thrombocytopenia (84%), leukopenia (59%), and elevated transminases (57%). The diagnosis, orientated by negativity of malaria smears, the knowledge of an epidemic in the visited country, or occurrence of similar cases in the entourage, were argued by serological results: presence of anti-DEN IgM in 25 cases, serological conversion (anti- DEN IgG) in 7 cases or very high seropositivity (anti-DEN IgG > 1/1280) in 12 cases. No virus isolation was obtained.

[Acquired cytomegalovirus infections in immunocompetent adults: 116 cases]. / Cytomégalovirose acquise de l'adulte immunocompétent. 116 observations.

OBJECTIVE: To analyse retrospectively the clinical, biological and epidemiological features of cytomegalovirus (CMV) infection in the immunocompetent host. PATIENTS AND METHODS: A retrospective study was conducted in 116 cases of CMV infection (74 inpatients, 42 out-patients) collected from 1981 to 1997 in a university hospital. Diagnostic was established on serological criteria in all cases. RESULTS: Fever was observed in all cases but one (mean duration: 21 days). The most frequent symptoms were headache (51%) and myalgia (46%). Splenomegaly was the most frequent sign (36%). Pulmonary interstitial opacities on chest x-ray were found in 8.5% of patients. Pulmonary (1 case) and neurological (2 cases) complications occurred. Concomitant HIV primary infection was observed in 2 patients. Mononucleosis and ALAT and LDH elevations were observed in 95%, 85% and 95% of cases respectively. Viremia was positive in 79% (30/38). pp65 antigenemia was useful to establish the diagnosis in 9 patients. Antibiotics were prescribed in 46% before diagnosis was established. CONCLUSION: CMV infection in the immunocompetent host is a frequent and rarely complicated disease. pp65 antigenemia should be evaluated more in this setting. Most hospitalizations due to this affection could be avoided.

Murine typhus in travelers returning from Indonesia.

We report the first three documented cases of murine typhus imported into Europe from Indonesia, discuss clues for the diagnosis of the disease, and urge that murine fever be considered in the diagnosis of febrile disease in travelers.

[Once-daily administration of didanosine in combination with anti-retroviral zidovudine in previously untreated patients]. / Administration en prise unique quotidienne de la didanosine dans une association anti-rétrovirale avec la zidovudine chez des patients non préalablement traités.

25 HIV-infected antiretroviral-naive adults were included in a 24-week study to evaluate the efficacy and the tolerability of a zidovudine/didanosine combination therapy in which didanosine was administered once daily (200 mg if weight < 60 kg, 300 mg if weight > 60 kg) and zidovudine twice daily (500 mg/day if weight < 90 kg, 600 mg/day if weight > 90 kg). 5 patients discontinued their treatment early: 3 had poor compliance and 2 presented adverse events. Evaluation of treatment efficacy was based on CD4+ T cell enumeration and HIV RNA level quantitation in plasma (NASBA). Baseline values were 278 CD4+/mm3 and 5.42 log RNA copies/ml. Mean changes from baseline were +102 CD4+/mm3 and -2.14 log RNA copies/ml at week 8 and +156 CD4+/mm3 and -2.07 log RNA copies/ml at week 24. HIV RNA in plasma was lower than the detection limit (2.60 log RNA copies/ml) in 55% of patients at week 8 and in 30% at week 24. No major adverse events such as neuropathy or pancreatitis were observed. Once-daily administration of didanosine in combination with twice-daily administration of zidovudine is a well tolerated regimen that appears to be as effective ad the conventional zidovudine/didanosine combination regimen.

Simultaneous carriage of Candida albicans strains from HIV-infected patients with oral candidiasis: multilocus enzyme electrophoresis analysis.

Genetic diversity of 160 Candida albicans isolates from the oral cavity of 16 HIV-infected adults prior to antifungal treatment was assessed using multilocus enzyme electrophoresis (10 C. albicans colonies were randomly chosen from each specimen culture). 20 electrophoretic types were distinguished from the analysis of 21 enzyme loci (10 were polymorphic). Five patients (31%) were found to be colonized by 2 or 3 genetically distinct strains. Nevertheless, in these five cases, one strain predominated (from 7 to 9 of the 10 colonies). Some HIV + patients with oral candidiasis appear to be simultaneously infected with several genetically different C. albicans strains before antifungal treatment.

Fluconazole- and itraconazole-resistant Candida albicans strains from AIDS patients: multilocus enzyme electrophoresis analysis and antifungal susceptibilities.

Multilocus enzyme electrophoresis and in vitro susceptibility testing with a broth microdilution method were used to analyze Candida albicans strain diversity in four AIDS patients with recurrent oropharyngeal candidiasis who successively developed clinical resistance to fluconazole (FCZ) and itraconazole (ITZ). One to ten colonies per sample were randomly chosen from oral washings collected before the initial FCZ treatment and just before every other antifungal treatment; a total of 98 isolates were analyzed. Multilocus enzyme electrophoresis analysis revealed 14 different electrophoretic types (ETs). Statistical analysis of genetic distances showed that C. albicans isolates clustered into five subpopulations (I to V). In each subpopulation, isolates are closely related, and genetic distances between subpopulations I to IV are short. In contrast, subpopulation V, which contained isolates typed as ET8 and ET14, is strongly divergent from the others; these isolates may represent atypical C. albicans isolates. Only one patient was infected with a single strain during the course of azole therapy; for the three remaining patients, variants of the same strain and different strains were concurrently isolated. Clinical FCZ resistance was clearly correlated with in vitro data for three patients. Moreover, MICs of ITZ increased during FCZ therapy, and MICs of ITZ which were > or = 1.56 micrograms/ml were found when clinical ITZ resistance occurred; isolates from subpopulation V showed the highest MICs of ITZ. Because of the emergence of clinical ITZ resistance after clinical FCZ resistance, the feasibility of long-term azole therapy for mucosal candidiasis in AIDS patients is questioned.

Visceral leishmaniasis in HIV-infected patients in the south of France.

Between 1989 and 1993, investigations by classical parasitological procedures of 139 HIV-infected adults living in visceral leishmaniasis (VL) endemic areas showed that 10 of them (7.2%) were positive for Leishmania (by stained smears and culture). In the same period we identified 15 VL cases in patients not infected with HIV. Thus, 40% (10/25) of our VL cases were associated with HIV infection.

The yeast Candida albicans has a clonal mode of reproduction in a population of infected human immunodeficiency virus-positive patients.

To ascertain the population structure of Candida albicans, we have carried out a multilocus enzyme electrophoresis study based on the analysis of 21 gene loci. We have thus characterized 55 strains isolated one each from 55 human immunodeficiency virus-positive patients. There is considerable polymorphism among the strains. A population-genetic analysis indicates that the two fundamental consequences of sexual reproduction (i.e., segregation and recombination) are apparently absent in this population of C. albicans. The population structure of C. albicans appears to be clonal, a state of affairs that has important medical and biological consequences.

[Current aspects of brucellosis]. / Aspects actuels des brucelloses.

In France, human brucellosis decreased significantly between the 70's (800 annual cases) and 1992 (102 cases), the result of the veterinary fight against animal disease. Bovin brucellosis is almost eradicated except into Massif Central, Pyrénées and Alpes, where goats and sheep are always responsible for the contamination of cows. B. melitensis 9/11 biovar 3 is the more frequent contaminant. Clinical features of human disease are unchanged but skeletal and visceral focalisations become less frequent than previously--Blood cultures--too often left--and seroagglutination remain classical means of diagnosis. I.I.F. and ELISA are more precise because recognition of specific IgM and IgA which are good evidence of recent or persistent infection. In vitro antibody production--assay (IVAP) is more sophistical; its value should be assessed. Today antibiotherapy for acute or subacute forms is based on associations: Tetracycline (2 g/d) or better Doxycycline (200 mg once daily for 45 d) are always associated with either Streptomycin (1 g daily for 21 days) or Rifampicin (900 mg once daily for 45 d). The first regimen is probably more efficient than the second one because relapses occur more often (5-10%) with Doxycycline-Rifampicin than with Doxycycline-Streptomycin (relapses: 4-5%). In pregnant women Cotrimoxazole-Rifampin is efficient enough and atoxic if the treatment is stopped 7 days before delivery. The same regimen is recommended in children less 8 years of age. Veterinary action should be going on in spite of its cost. Individual measures (gloves, antiseptic solution for shoes, boiled milk...) are always necessary. Specific immunization (vaccin Mérieux, France) often seems efficient despite a few light adverse effects; its use is recommended in farmers, veterinary and bacteriologic workers.