Influence of HCV genotype 1 subtypes on the virus response to PEG interferon alpha-2a plus ribavirin therapy.

New factors that influence the viral response in HCV non-genotype 2/3 patients must be identified in order to optimize anti-HCV treatment. This multicenter prospective study evaluates the influence of HCV variability and pharmacological parameters on the virological response of these patients to pegylated interferon α2a (peg-IFN-α2a: 180 µg/week) and ribavirin (RBV; 800-1,200 mg/day) for 48 weeks. HCV subtypes were identified by sequencing the NS5B region. Serum RBV and peg-IFN-α2a concentrations were measured at weeks 4 and 12. The 115 patients (67 men; median age = 49, range 31-76) included 64 who had never been treated and 27 co-infected with HIV. The mean baseline HCV RNA was 6.30 ± 0.06 log IU/ml and the HCV genotypes were: G1 (n = 93) with 1a (n = 37) and 1b (n = 50), G4 (n = 20) and G5 (n = 2). Most patients (79/108; 73%) had an early virological response. Independent predictors of an early virological response were interferon naive patients (OR= 2.98, 95% CI: 1.15-7.72) and RBV of >2,200 ng/ml at week 12 (OR = 3.41, 95% CI: 1.31-8.90). Forty of 104 patients (38%) had a sustained virological response. The only independent predictors of a sustained virological response were subtype 1b (OR = 6.82, 95% CI: 1.7-26.8), and HCV RNA <15 IU/ml at week 12 (OR = 25, 95% CI: 6.4-97.6). Thus a serum RBV concentration of >2,200 ng/ml was associated with an early virological response and patients infected with HCV subtype 1b had a better chance of a sustained virological response than did those infected with subtype 1a.

[Bone involvement in cat scratch disease]. / Atteinte osseuse dans la maladie des griffes du chat.

INTRODUCTION: Cat scratch disease caused by Bartonella henselae with bone involvement is a rare presentation. CASE REPORT: We report a case of disseminated bartonellosis with multifocal osteomyelitis and multiple visceral involvement in an immunocompetent adult. Diagnostic confirmation was obtained by PCR on lymphadenopathy. In addition to our observation, 31 cases of bartonellosis with bone involvement were reported in the literature. Diagnosis is based on a combination of history, serology and PCR performed on tissue. The antibiotic treatment allows recovery in all cases. CONCLUSION: Cat scratch disease in its systemic form with bone involvement is a rare and difficult diagnosis for the clinician and an invasive approach is often required to obtain the diagnosis.

Retrospective analysis of nocardiosis in a general hospital from 1998 to 2017.

OBJECTIVES: To describe the epidemiological, clinical, microbiological, and therapeutic characteristics of Nocardiosis patients treated in a general hospital. PATIENTS AND METHODS: Monocentric retrospective analysis of patients presenting with Nocardia-positive biological sample from January 1, 1998 to May 1, 2017. RESULTS: We identified nine cases of Nocardia infections. Risk factors were oral corticosteroid therapy (n=3), solid cancer (n=2), hematological cancer (n=1), COPD (n=1). No risk factor was identified in patients with isolated cutaneous presentation (n=2). Disseminated presentations (n=3) were observed in patients receiving corticosteroid therapy (n=2) and presenting with ENT cancer (n=1). Identified Nocardia species were Nocardia nova (n=4), Nocardia cyriacigeorgica (n=2), Nocardia abscessus (n=1), Nocardia brasiliensis (n=1), and Nocardia asteroides (n=1). The median diagnostic time was 17 days. Antibiotic therapy was prolonged and included trimethoprim-sulfamethoxazole in 6/9 cases. The overall one-year case fatality was high (3/8). No recurrence was observed. We identified two cases of respiratory colonization with N. abscessus and N. cyriacigeorgica in COPD patients. CONCLUSION: Nocardiosis can occur both in immunocompetent and immunocompromised patients. It is a severe infection, with a miscellaneous clinical spectrum and complex treatments. Greater knowledge of nocardiosis is required from physicians for optimal medical care.

Bordetella bronchiseptica infection.

OBJECTIVE: To collect data of all patients admitted to hospital with a positive test to Bordetella bronchiseptica between 2001 and 2015. METHODS: We performed a retrospective monocentric study of all hospitalized patients over the past 15 years with a positive test to B. bronchiseptica. RESULTS: Nine patients were included between 2001 and 2015; two presented with infectious relapses, i.e. a total of 14 positive test samples were observed. Age, induced immunodeficiency, and preexisting respiratory illnesses are risk factors. All patients showed symptoms at sample collection and the infection was exclusively respiratory. The diagnosis was obtained through a cytobacteriological test of sputum, bronchial aspiration, or bronchial fibroscopy with a bronchoalveolar lavage. The drug susceptibility test revealed a natural resistance to cephalosporins including ceftazidime, monobactam, and fosfomycin. There were cases of resistance to penicillin A and to the trimethoprim/sulfamethoxazole association. The classically used antibiotic treatment for community-acquired pneumonia is based on probability and may thus fail. Four patients died. The duration and nature of the antibiotics to use have not been codified. CONCLUSION: B. bronchiseptica infection mainly affects the elderly. All patients should be treated, regardless of the importance of the inoculum, and all infected animals should be treated.

[Primary localized amyloidosis of the urinary tract. A case series of five patients]. / Amylose primitive localisée à l'appareil urinaire. A propos de cinq cas.

PURPOSE: To describe the clinical and radiographic features of patients with primary localized amyloidosis of the urinary tract. METHODS: We report a case of localized amyloidosis of the ureters and bladder. The medical records of four other cases from the French Register of localized amyloidosis were reviewed. RESULTS: The mean age of three men and two women was 53 years. All patients presented with gross hematuria, four patients presented with renal colic, only one patient had irritative lower urinary tract symptoms. Ureter and bladder were involved in three patients, both ureters in two patients and the bladder only, in one patient. Clinical and radiographic presentations mimicked a neoplasia excluded by histologic analysis. Immunohistochemical study was performed in only two cases and revealed lambda light chain amyloidosis. The median follow-up was eight years. Various treatments were performed, and recurrences occurred in two cases. None of the five patients developed monoclonal gammapathy or systemic amyloidosis. CONCLUSION: Primary localized amyloidosis of the urinary tract is a rare disorder and can easily be confused with a neoplasm. The physiopathology is unknown, the prognosis is usually good. There is no specific treatment, and repeated work-up for systemic amyloidosis is unnecessary as local recurrences appear to be the main complication.

[Hematologic and immunologic manifestations of primary cytomegalovirus infections in non-immunocompromised hospitalized adults]. / Manifestations hématologiques et immunologiques de la primo-infection à cytomégalovirus chez l'adulte hospitalisé non immunodéprimé.

PURPOSE: Cytomegalovirus (CMV) infection in non-immunocompromised adults can sometimes induce hematological and immunological disorders that may mislead diagnosis. METHODS: Case reports of hospitalized non-immunocompromised adults with positive serology for CMV including the presence of immunoglobulin M or seroconversion were assessed in a retrospective study (1981-1998). We focused on clinical and biological abnormalities showing the role of CMV in disruption of functioning of hematological and immunological systems. RESULTS: Among 115 patients, lymphoma-like syndrome with large adenopathies and/or splenomegaly was diagnosed in eight patients, uncovering underlying CMV infection. Lymphoma was accompanied by hematoma in two patients. Three patients presented leg purpura (with thrombotic thrombocytopenic purpura in one case), one patient had cutaneous vasculitis and on other a Still's disease. Blood abnormalities were mononucleosis (64%), anemia (20%), and thrombopenia (25%) often of peripheral or hemolytic origin or due to hypersplenia. Electrophoresis of serum proteins showed an increase in immune globulins in 56% of the cases and monoclonal abnormality in nine cases. Immunological assessment was conducted in 18 patients. At least one abnormality was depicted in ten patients, consisting of either antinuclear, anti-platelet or anti smooth muscle antibodies, cryoglobulinemia, rheumatoid factor, or reduced complement fixation. CONCLUSION: Testing for CMV infection can be of value in case of blood or immunological disorders associated with clinical or biological signs. Although hematological disorders occur early, they are rarely severe. Immunological disorders are rarely symptomatic, but often raise issues regarding the potential genesis of immune diseases in at-risk patients.

[Acute severe colitis with recto-vaginal fistula during treatment with non-steroidal anti-inflammatory agents]. / Colite aiguë grave avec fistule recto-vaginale sous anti-inflammatoires non stéroïdiens.

INTRODUCTION: We report the case of severe colitis occurring during treatment with non-steroid anti-inflammatories (NSAI). OBSERVATION: A 57 year-old woman was hospitalized for lumbar pain that had not been relieved by AINS, tramadol and then morphine. The patient presented with septic shock and peritonitis by rectal perforation, followed by acute rectorrhagia. The endoscopic aspect evoked Crohn's disease with a recto-vaginal fistula. Progression was further complicated by two episodes of collapse because of acute rectorrhagia, requiring hemostasis colectomy and abdominal-perineal amputation. CONCLUSION: The diagnosis retained was AINS-induced colitis complicated by acute colectasia on a fecaloma with recto-vaginal fistula.

[The French experience with moxalactam in pneumology]. / L'expérience française de moxalactam en pneumologie.

Twenty-nine patients, aged 19 to 87, were treated for an infection of the lower respiratory tract (pneumonia, bronchopneumonia, bronchitis, pulmonary abscess, pleuritis) due to a pathogen with in vitro sensitivity to the antibiotic (pneumococcus, hemophilus, anaerobic organisms . . .). Patients were given Moxalactam as the only antibacterial treatment. In most instances, excellent results (24 successes, i.e. 84% of cases) were recorded with two daily intramuscular injections of 1 g each. Biologic tolerance was satisfactory. Possible clinical side-effects are rashes and local pain during the injection. We conclude that Moxalactam is very effective in severe lower respiratory tract infections, with a daily dosage of 30 mg/kg.

[Current clinical aspects of tuberculous infection]. / Aspects cliniques actuels de l'infection tuberculeuse.

Case records of 37 patients with tuberculosis were analysed, out of 4 000 patients admitted to our department of internal medicine over a period of four years. The most common localisations are still pulmonary, but these are often atypical. Lymph node involvement is found in immigrants. More exceptional localisations (liver . . .) are reported. Tuberculosis has not yet become obsolete.

[Diffuse hemangioma of the liver. An unsuccessful cobalt therapy (author's transl)]. / Hémangiome hépatique diffus de l'adulte. Echec d'une cobaltothérapie.

With reference to the observation of a diffuse hemangioma of the liver in an adult patient, the authors note the various means of diagnosing the disease and list existing therapeutic possibilities. In the typical case, a laparoscopy points out the tumour but is not sufficiently precise to detect a possible extension. The angiography shows pathognomonic images. Isotopic methods are not specific. Treatment is poorly codified and may take the form of a ligature of the artery, embolization or irradiation. The latter, the most widespread type of treatment may cause more or less severe complications.

[Still's disease in the adult (author's transl)]. / La maladie de Still de l'adulte.

Four new cases of adult Still's disease have been observed in the past three years. Clinical and biological features are high fever, polyarthralgia, macular rash on forearm, pericarditis, splenomegaly, lymphadenopathy, alopecia, anemia, hyper-leucocytosis, raised ESR. Transient neurological findings may also be observed with abnormal reflexes, cranial nerve paralysis. High dose steroids treatment can be used in case of systemic involvement. The long term prognosis is usually good with treatment. In conclusion, the diagnosis of Still's disease is essentially clinical and should not be mistaken for septicemia.

[Variegata porphyria. Up to date concerning a recent case (author's transl)]. / la porphyrie variegata ou mixte. Mise au point à propos du'une nouvelle observation.

Variegata or mixed porphyria, an hereditary disease with autosomal dominant transmission occurs rarely in France. It associates, at the same time or during the evolution, the cutaneous manifestations or porphyria cutanea tarda hereditaria with the abdominal and neuropsychiatric symptoms of acute intermittent porphyria. The diagnosis evoked by the urine color requires confirmation by the dose of the porphyrins in the urine and above all in the feces. The danger in this disease results essentially from untimely prescription of medication which may lead to death by neurological problems. Prevention and detection in asymptomatic carriers of this disease is imperative. The treatment of an acute attack is symptomatic and etiopathogenic trying to reduce the ALA synthetase activity by giving glucose and hematin.

[Articular infections in adults. Peripheral and vertebral involvement with common bacteria and tubercle bacteria]. / Les infections articularies chez l'adulte. Atteintes périphériques et vertébrales à germes banals et à bacilles tuberculeux.

2,166 cases of joint infection in adults were reviewed during a national inquiry. The peripheral infections due to common germs (1,080 cases) and tubercle bacilli (260 cases) were characterised by their frequency after the age of 60, the role of corticotherapy in onset of the infection and the predominance of staphylococci (60%) in pyogenic infections, the low proportion of deaths (4%) and the necessity of early treatment to observe better functional results. The vertebral lesions due to common bacteria (491 cases) were mainly localised in the lumbar regions (70%) whereas tuberculous infections (335 cases) usually affect the lower dorsal vertebrae (50%). Neurological signs and abscess were more frequent during tuberculous involvement. Needle puncture of the vertebral focus should be recommended owing to its help in etiological diagnosis. A cure was generally obtained without operation in the form of complete or incomplete block, this appearance is, however, less frequent than radiological signs of fixed osteolysis. The mortality is just as low as in peripheral infections.