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1.
Rev Med Interne ; 45(4): 187-193, 2024 Apr.
Artigo em Francês | MEDLINE | ID: mdl-38519305

RESUMO

INTRODUCTION: The life expectancy of ß-thalassemia patients has increased over the last 20 years. In this study, we evaluated the current health status and quality of life of these patients managed in a reference center in Marseille. METHODS: This is a single-center, descriptive study conducted between June and August 2019 in patients over 18 years of age with ß-thalassemia major or intermedia. Clinical and paraclinical data were collected retrospectively and the SF-36 health survey questionnaire was proposed to each patient. RESULTS: 43 of 64 selected patients were included and divided into 2 groups: 35 patients with transfusion-dependent ß-thalassemia and 8 patients with non-transfusion-dependent ß-thalassemia. Liver iron overload is the most frequent complication, present in 80% of transfusion-dependent and 62.5% of non-transfusion-dependent patients. Cardiac iron overload is present only in the transfusion dependent ß-thalassemia group (20%). Hypogonadotropic hypogonadism remains the most common endocrine disorder (41.9%) followed by osteoporosis (37.2%). Among the 31 patients who completed the SF-36 questionnaire, physical and mental quality of life scores were lowered in transfusion dependent (respectively 42.7 and 46.8) as in non-transfusion-dependent patients (respectively 43.8 and 28.9). CONCLUSION: Despite an improvement in medical care, our patients with ß-thalassemia show an alteration in their quality of life that will need to be characterized in the entire French cohort.


Assuntos
Nível de Saúde , Qualidade de Vida , Talassemia beta , Humanos , Talassemia beta/terapia , Talassemia beta/epidemiologia , Talassemia beta/complicações , Talassemia beta/psicologia , França/epidemiologia , Masculino , Feminino , Adulto , Estudos Retrospectivos , Adulto Jovem , Pessoa de Meia-Idade , Transfusão de Sangue/estatística & dados numéricos , Sobrecarga de Ferro/epidemiologia , Sobrecarga de Ferro/etiologia , Inquéritos e Questionários , Adolescente
2.
Rev Med Interne ; 41(7): 489-492, 2020 Jul.
Artigo em Francês | MEDLINE | ID: mdl-31672255

RESUMO

INTRODUCTION: Adrenal hemorrhage is a classical but rare complication of antiphospholipid syndrome, revealing diagnosis in one third of the cases. Anti-vitamin K therapy is the standard treatment but direct oral anticoagulants are discussed as an alternative. In the latest recommendations, it is advised not to use direct oral anticoagulants in the setting of antiphospholipid syndrome. CASE REPORT: We present a case of bilateral adrenal hemorrhage revealing primary antiphospholipid syndrome with triple positive antibody profile, in a 47-year-old man treated by apixaban for previous venous thromboembolism. CONCLUSION: To our knowledge, it is the first case of adrenal hemorrhage occurring during apixaban treatment in a patient with antiphospholipid syndrome. This case illustrates the inefficacy of direct oral anticoagulants to prevent thrombotic events in antiphospholipid syndrome, in accordance with the latest recommendations.


Assuntos
Doenças das Glândulas Suprarrenais/induzido quimicamente , Síndrome Antifosfolipídica/diagnóstico , Hemorragia/induzido quimicamente , Pirazóis/efeitos adversos , Piridonas/efeitos adversos , Doenças das Glândulas Suprarrenais/diagnóstico , Glândulas Suprarrenais/efeitos dos fármacos , Glândulas Suprarrenais/patologia , Síndrome Antifosfolipídica/complicações , Hemorragia/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/induzido quimicamente , Necrose/diagnóstico , Pirazóis/uso terapêutico , Piridonas/uso terapêutico , Tromboembolia Venosa/complicações , Tromboembolia Venosa/tratamento farmacológico
3.
Rev Med Interne ; 41(3): 160-167, 2020 Mar.
Artigo em Francês | MEDLINE | ID: mdl-31301942

RESUMO

INTRODUCTION: Syphilis is a sexually transmitted disease. All organs might be affected, but ocular syphilis only occurs in 0.6 percent of patients. We collected all cases of ocular syphilis requiring hospitalization at the University Hospital Center (UHC) in Marseille in 2017. PATIENTS AND METHODS: This was a retrospective monocentric study. The diagnosis of ocular syphilis was based on the combination of ocular inflammation with a positive syphilitic serology. For each patient, sex, age, HIV status, ocular and extraocular symptoms, initial visual acuity, syphilis serology, cerebrospinal fluid (CSF) analysis if done, treatment and clinical response were collected. RESULTS: Ten men and two women, aged 28 to 86 years, were hospitalized. Two patients were HIV-positive. Ophtalmological lesions were heterogeneous the posterior structures were most affected. Anterior uveitis was isolated in one patient. Five patients had extraocular signs with cutaneous and/or mucosal involvement. No patient had neurological symptoms. Diagnosis of neurosyphilis through CSF analysis was definite for one patient, probable for 5 patients and ruled out for 2 patients. Six patients received treatment with penicillin G and six with ceftriaxone. Visual acuity improved in all cases. DISCUSSION: Ophtalmic cases of syphilis have become more frequent over the past few years in France. The diagnosis should be suspected in cases of eye inflammation even in the absence of favourable clinical presentation or anamnesis. Search for HIV co-infection should be systematic. Our study shows that ceftriaxone remains an effective alternative to penicillin G.


Assuntos
Doenças Transmissíveis Emergentes/epidemiologia , Infecções Oculares Bacterianas/epidemiologia , Sífilis/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Oculares Bacterianas/microbiologia , Feminino , França/epidemiologia , HIV , Infecções por HIV/epidemiologia , Infecções por HIV/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neurossífilis/epidemiologia , Estudos Retrospectivos , Doenças Bacterianas Sexualmente Transmissíveis/epidemiologia , Sífilis/complicações , Sífilis/microbiologia , Uveíte/epidemiologia , Uveíte/microbiologia
4.
Rev Med Interne ; 30(3): 208-14, 2009 Mar.
Artigo em Francês | MEDLINE | ID: mdl-18992971

RESUMO

PURPOSE: During bone-marrow biopsy, one third of patients score their pain as moderate or severe. Combination of analgesic and hypnotic is effective at reducing pain, but prolonged medical surveillance is necessary. The objective of the study was to assess the effectiveness and ease of use of the equimolar nitrous oxide-oxygen mixture (nitrous oxide), a short acting analgesic with little sedative effect, during bone-marrow biopsy. METHODS: As part of a non-controlled prospective observational study, patients undergoing a bone-marrow biopsy received nitrous oxide as an adjuvant to local anaesthesia. Facemask was self-maintained. A questionnaire was given after completion of the procedure to assess the pain (with a numerical-rating scale [RS] ranging from 0 to 10) as the main criterion and the ease of the procedure, the tolerance, and satisfaction, as secondary criteria. The physician noted adverse reactions. RESULTS: Nineteen women and 21 men were included. The median age was 51 years. Ninety percent of patients felt slight pain, less than 5 out of 10 on the RS. Only one patient had difficulty in keeping the mask. A patient experienced nausea and four presented a fleeting euphoria noticed by the physician. Ninety-five of patients wished to use nitrous oxide again should further bone-marrow examinations be necessary. CONCLUSION: Nitrous oxide is an effective analgesic when performing bone-marrow biopsies. Ten percent of patients feel a moderate to severe pain instead of one third. Despite some mild side effects, there is a very good appreciation by patients. Since this study, the authors routinely use nitrous oxide.


Assuntos
Analgésicos não Narcóticos/administração & dosagem , Biópsia por Agulha/efeitos adversos , Exame de Medula Óssea , Medula Óssea/patologia , Óxido Nitroso/administração & dosagem , Oxigênio/administração & dosagem , Dor/etiologia , Dor/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Interpretação Estatística de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Inquéritos e Questionários
5.
Rev Med Interne ; 29(10): 794-800, 2008 Oct.
Artigo em Francês | MEDLINE | ID: mdl-18023939

RESUMO

PURPOSE: Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disorder and early treatment is vital. Here, we review the recent advances in the understanding of the pathophysiology of TTP and its treatment. CURRENT KNOWLEDGE AND KEY POINTS: Recent advances have shown that TTP is caused by deficiency of the (ADAMTS-13) metalloprotease that cleaves von Willebrand factor multimers. Acquired TTP is associated to inhibitory antibodies directed against ADAMTS-13. This has led to assess new therapeutic approaches in refractory and relapsing forms of TTP and the use of rituximab has shown very encouraging results. FUTURE PROSPECTS AND PROJECTS: A better characterization of TTP amongst the other thrombotic microangiopathies has allowed the use of new therapeutic approaches with the use of rituximab. The encouraging results reported with rituximab in some forms of TTP challenge the classic treatment based on plasma exchanges.


Assuntos
Púrpura Trombocitopênica Trombótica/diagnóstico , Púrpura Trombocitopênica Trombótica/terapia , Corticosteroides/uso terapêutico , Diagnóstico Diferencial , Humanos , Troca Plasmática , Inibidores da Agregação Plaquetária/uso terapêutico , Púrpura Trombocitopênica Trombótica/epidemiologia , Púrpura Trombocitopênica Trombótica/fisiopatologia
6.
Rev Med Interne ; 38(11): 769-773, 2017 Nov.
Artigo em Francês | MEDLINE | ID: mdl-28690092

RESUMO

INTRODUCTION: Glycoprotein IIb/IIIa inhibitors (anti-GPIIbIIIa) prevent platelet binding to fibrinogen. Transient sometimes-severe thrombocytopenia is a well-known side effect. OBSERVATION: A 71-year-old patient presented severe thrombocytopenia after the administration of tirofiban (anti-GPIIbIIIa). Corticosteroid treatment was initiated at day 10 because of persistence of severe thrombocytopenia with poor platelet transfusion efficacy. Corticosteroid treatment led to platelet recovery evoking an immune mediated mechanism for thrombocytopenia. CONCLUSION: Anti-GPIIbIIIa are associated with a risk of dramatic thrombocytopenia. The underlying mechanism is poorly understood. The management of these usually transient thrombocytopenias is based on platelet transfusion. As report here, in some cases persistent thrombocytopenia can respond to corticosteroids.


Assuntos
Inibidores da Agregação Plaquetária/efeitos adversos , Trombocitopenia/induzido quimicamente , Tirosina/análogos & derivados , Idoso , Humanos , Masculino , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/antagonistas & inibidores , Índice de Gravidade de Doença , Trombocitopenia/patologia , Fatores de Tempo , Tirofibana , Tirosina/efeitos adversos
7.
Rev Med Interne ; 27(10): 783-6, 2006 Oct.
Artigo em Francês | MEDLINE | ID: mdl-16978745

RESUMO

INTRODUCTION: Familial macrothrombocytopenias are a group of rare autosomal dominant platelet disorders including many syndromes in particular the May-Hegglin anomaly. They are characterized by thrombocytopenia with giant platelets and in some cases neutrophilic inclusions in peripheral blood granulocytes. Recently these different clinical entities have been demonstrated to be linked to mutations in the same gene, MYH9. CASE REPORT: We report in a young African woman presenting as a May-Hegglin anomaly a new mutation of the MYH9 gene. In regard of this case we present a brief review of the MYH9 syndrome. CONCLUSION: The MYH9 syndrome includes now several clinical entities who share some common clinical and biological characteristics such as a thrombocytopenia with giant platelets, presence or absence of other manifestations including Dohle like bodies, nephritis, sensorineural hearing loss, cataract. We report a new case in which a new mutation of the MYH9 gene was evidenced.


Assuntos
Proteínas Motores Moleculares/genética , Cadeias Pesadas de Miosina/genética , Mutação Puntual , Trombocitopenia/genética , Adenina , Adolescente , Éxons , Feminino , Humanos , Síndrome , Timina
8.
Rev Med Interne ; 26(7): 534-40, 2005 Jul.
Artigo em Francês | MEDLINE | ID: mdl-15953662

RESUMO

OBJECTIVE: Anaerobic deep abscesses are rare and may have unusual location leading to severe outcome due to delayed diagnosis and treatment. In order to improve their diagnosis, we report and analyse 5 new cases. METHODS: Patients were seen from 1999 to 2003 in a single department of internal medicine of the university hospital of Marseille. RESULTS: Five new cases were diagnosed consisting in 3 females and 2 males with a medium age of 56,8 years, with unusual location in 4 cases: epidural (2), psoas (1) and sub-diaphragmatic (1) or circumstances in one case of pulmonary abscess unrelated to inhalation. Predisposing conditions thought to compromise resistance to infection were found in all cases: social poverty (4/5), alcoholism (3/5), smoking (4/5), teeth and periodontal disease (4/5), neoplasia (2/5), iatrogenic disease (2/5). Symptoms were insidious (5/5) and unspecific but were always related to the abscess location. Abscesses were frequently found distant from the initial focus of infection because of frequent hematogenous spread (4/5). Drainage of the collection led to bacterial identification in all cases (4/4), although blood cultures could be positive (3/5) and helpful in one case in which drainage was not possible (1/5). The isolated organisms always corresponded to the suspected initial focus (oropharynx 4/5 and digestive 1/5). Finally, combination of surgical drainage and double prolonged antibiotherapy (penicillin+metronidazole) was the elected treatment. CONCLUSION: Since hematogenous diffusion is frequent, anaerobic infection should be suspected in any case of deep abscess affecting patients with predisposing conditions such as poverty, severe teeth disease or iatrogenic procedure.


Assuntos
Abscesso/microbiologia , Bactérias Anaeróbias/isolamento & purificação , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Abscesso/terapia , Adulto , Idoso , Drenagem , Abscesso Epidural/microbiologia , Feminino , Infecções por Bactérias Gram-Negativas/terapia , Infecções por Bactérias Gram-Positivas/terapia , Humanos , Abscesso Pulmonar/microbiologia , Masculino , Pessoa de Meia-Idade , Abscesso do Psoas/microbiologia , Estudos Retrospectivos , Abscesso Subfrênico/microbiologia
9.
Rev Med Interne ; 36(6): 395-404, 2015 Jun.
Artigo em Francês | MEDLINE | ID: mdl-25595874

RESUMO

IgG4-related disease is an inflammatory disorder characterized by a polyclonal lymphoplasmacytic tissue infiltrate, with numerous IgG4+ plasmocytes, evolving toward fibrosis. The disease is heterogeneous and affects several tissues and organs synchroneously or metachroneously. Both the fibrosis and the tumor forming characteristics of the disease can be responsible of irreversible tissue damage. For these reasons treatment is usually necessary. A dramatic response is usually observed with steroid treatment but relapses are frequent. Immunosuppressive agents and rituximab are used as second line treatments. We review here previous studies on treatment and suggest general recommendations for the treatment and follow up of patients with IgG4-related disease.


Assuntos
Doenças Autoimunes/tratamento farmacológico , Glucocorticoides/uso terapêutico , Fatores Imunológicos/uso terapêutico , Imunossupressores/uso terapêutico , Rituximab/uso terapêutico , Doenças Autoimunes/patologia , Fibrose , Humanos , Imunoglobulina G
10.
Rev Med Interne ; 36(7): 487-90, 2015 Jul.
Artigo em Francês | MEDLINE | ID: mdl-25172778

RESUMO

INTRODUCTION: Malignant thymoma or thymic hyperplasia is associated with various autoimmune diseases. Renal disease has rarely been reported in this condition. We report a new case with improvement of renal disease after thymectomy. CASE REPORT: A 77-year-old-women with nephritic syndrome was found to have associated thymic mass. Renal pathology showed membranous nephropathy. The thymic mass pathology showed a B2 type thymoma. After thymectomy the nephrotic syndrome improved. CONCLUSION: Glomerulopathy can be secondary to an acquired thymic disease. Membranous nephropathy but also other glomerular diseases can be observed often presenting with nephritic syndrome. Despite the rarity of this association this clinical observation underlines that a thymoma should be searched in the presence of a glomerulopathy. The glomerulopathy can be improved by the treatment of the thymoma.


Assuntos
Glomerulonefrite Membranosa/complicações , Rim/patologia , Síndrome Nefrótica/complicações , Timoma/complicações , Neoplasias do Timo/complicações , Idoso , Feminino , Humanos , Timectomia , Timoma/cirurgia , Neoplasias do Timo/cirurgia
11.
Medicine (Baltimore) ; 79(2): 109-23, 2000 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-10771709

RESUMO

In order to describe the clinical features and the epidemiologic findings of 1,383 patients hospitalized in France for acute or chronic Q fever, we conducted a retrospective analysis based on 74,702 sera tested in our diagnostic center, National Reference Center and World Health Organization Collaborative Center for Rickettsial Diseases. The physicians in charge of all patients with evidence of acute Q fever (seroconversion and/or presence of IgM) or chronic Q fever (prolonged disease and/or IgG antibody titer to phase I of Coxiella burnetii > or = 800) were asked to complete a questionnaire, which was computerized. A total of 1,070 cases of acute Q fever was recorded. Males were more frequently diagnosed, and most cases were identified in the spring. Cases were observed more frequently in patients between the ages of 30 and 69 years. We classified patients according to the different clinical forms of acute Q fever, hepatitis (40%), pneumonia and hepatitis (20%), pneumonia (17%), isolated fever (17%), meningoencephalitis (1%), myocarditis (1%), pericarditis (1%), and meningitis (0.7%). We showed for the first time, to our knowledge, that different clinical forms of acute Q fever are associated with significantly different patient status. Hepatitis occurred in younger patients, pneumonia in older and more immunocompromised patients, and isolated fever was more common in female patients. Risk factors were not specifically associated with a clinical form except meningoencephalitis and contact with animals. The prognosis was usually good except for those with myocarditis or meningoencephalitis as 13 patients died who were significantly older than others. For chronic Q fever, antibody titers to C. burnetii phase I above 800 and IgA above 50 were predictive in 94% of cases. Among 313 patients with chronic Q fever, 259 had endocarditis, mainly patients with previous valvulopathy; 25 had an infection of vascular aneurysm or prosthesis. Patients with endocarditis or vascular infection were more frequently immunocompromised and older than those with acute Q fever. Fifteen women were infected during pregnancy; they were significantly more exposed to animals and gave birth to only 5 babies, only 2 with a normal birth weight. More rare manifestations observed were chronic hepatitis (8 cases), osteoarticular infection (7 cases), and chronic pericarditis (3 cases). Nineteen patients were observed who experienced first a documented acute infection, then, due to underlying conditions, a chronic infection. To our knowledge, we report the largest series of Q fever to date. Our results indicate that Q fever is a protean disease, grossly underestimated, with some of the clinical manifestations being only recently reported, such as Q fever during pregnancy, chronic vascular infection, osteomyelitis, pericarditis, and myocarditis. Our data confirm that chronic Q fever is mainly determined by host factors and demonstrate for the first time that host factors may also play a role in the clinical expression of acute Q fever.


Assuntos
Febre Q/epidemiologia , Distribuição por Idade , Distribuição de Qui-Quadrado , Feminino , Técnica Indireta de Fluorescência para Anticorpo , França/epidemiologia , Humanos , Incidência , Masculino , Razão de Chances , Gravidez , Prevalência , Febre Q/complicações , Estudos Retrospectivos , Fatores de Risco , Estações do Ano , Inquéritos e Questionários
12.
J Infect ; 46(4): 244-6, 2003 May.
Artigo em Inglês | MEDLINE | ID: mdl-12799150

RESUMO

Cat scratch disease (CSD) is usually associated with Bartonella henselae infection in patients with a history of cat exposure, but Bartonella quintana may also be a cause of chronic lympadenopathy in patients with cat or flea contact. The lymph node histopathology of CSD and tuberculosis may be indistinguishable. We report herein the first description of lymph node coinfection with B. quintana and M. tuberculosis in a 32-year HIV-infected woman. Culture of lymph node biopsy material on Columbia agar with sheep blood and on human endothelial cells in shell vial allowed us to isolate not only B. quintana, but also M. tuberculosis hominis.


Assuntos
Doença da Arranhadura de Gato/complicações , Infecções por HIV/complicações , Doenças Linfáticas/microbiologia , Infecções por Mycobacterium/complicações , Adulto , Bartonella quintana/isolamento & purificação , Doença da Arranhadura de Gato/tratamento farmacológico , Doença da Arranhadura de Gato/microbiologia , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Doenças Linfáticas/complicações , Doenças Linfáticas/tratamento farmacológico , Infecções por Mycobacterium/tratamento farmacológico , Infecções por Mycobacterium/microbiologia , Mycobacterium tuberculosis/isolamento & purificação
13.
Rev Med Interne ; 25(12): 856-65, 2004 Dec.
Artigo em Francês | MEDLINE | ID: mdl-15582165

RESUMO

PURPOSE: To describe clinical, biological characteristics and associated diseases of cold agglutinins in adults. METHODS: Retrospective study in a single department of internal medicine from 1997 to 2002. The inclusion criteria were a positive direct Coombs test and a positive research for cold-reactive autoantibodies. We recorded for each patient: clinical presentation at onset and during follow-up, biological parameters of haemolysis, biological characteristics of the cold agglutinin and associated diseases. RESULTS: Fifty-eight patients (34 females, 24 males), with medium age of 58.8 were included in the study. Clinical presentation was highly variable between acute life-threatening haemolysis and absence of symptoms. Results of direct antiglobulin test were C3 (74%), IgG + C3 (22.4%), IgG (3.4%). Titer, thermal amplitude, strength and specificity of Coombs test were correlated, in all cases except 6, with cold agglutinin haemolytic activity. In 77.6% of cases cold agglutinin was secondary; related to: autoimmune disorders (n = 19), lymphoproliferative disorders (n = 11) and infections (n = 10). CONCLUSION: Clinical presentation of cold agglutinin is highly variable and not always related to the biological characteristics of the bound antibody (titer, thermal amplitude, specificity). In our single center study, diseases associated with cold agglutinin were various with the highest frequency of auto-immune disorders. Our study underlined also the high frequency of lymphoproliferative disorders and justifies a close follow-up of these patients. Finally, we reported a high frequency of hepatitis C virus infection among the infectious aetiologies.


Assuntos
Aglutininas/sangue , Anemia Hemolítica Autoimune/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia Hemolítica Autoimune/complicações , Anemia Hemolítica Autoimune/imunologia , Teste de Coombs , Crioglobulinas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
14.
Rev Med Interne ; 25(1): 78-82, 2004 Jan.
Artigo em Francês | MEDLINE | ID: mdl-14736564

RESUMO

INTRODUCTION: Influenza virus outbreaks occur each year, in France, during autumn and winter. Influenza-associated acute encephalitis were reported during epidemics or pandemics. Sporadic cases are rarely identified probably because influenza virus is not searched among etiology of febrile encephalitis. EXEGESIS: We report a case of influenza-associated encephalitis complicated by adrenal insufficiency in a young woman. Diagnosis was based on seroconversion of serum influenza virus A antibodies (complement fixation test). Follow up of the patient showed a total recovery. CONCLUSION: Influenza must be searched for any febrile encephalitis occurring during winter. Reverse transcriptase polymerase chain reaction (RT-PCR) on cerebrospinal fluid should be assessed. It is not actually a routine technique and we do not know yet if it is accurate enough for diagnosis. So, it is important to identify influenza virus and obtain documentary evidence concerning neurological impairment. Nevertheless, a better understanding of pathogenesis and use of vaccination are needed to improve prognosis.


Assuntos
Encefalite Viral/virologia , Influenza Humana , Adulto , Encefalite Viral/diagnóstico , Feminino , Humanos , Influenza Humana/diagnóstico
16.
Rev Med Interne ; 22(7): 664-7, 2001 Jul.
Artigo em Francês | MEDLINE | ID: mdl-11508161

RESUMO

INTRODUCTION: Acute parvovirus B19 infection induces a transient inhibition of erythroid cell formation, which may induce an erythroblastopenia crisis in patients suffering from chronic hemolytic anemia. EXEGESIS: We report here an exceptional observation of acute erythroblastopenia crisis with good outcome, occurring at the same time in a mother and her son, both suffering from hereditary spherocytosis. Diagnosis of parvovirus infection is based on detection of serum parvovirus B19-specific immunoglobulin M antibodies in the mother and her son and by the positivity of parvovirus B19 DNA detected by PCR in serum in the mother. Outcome was good, with the end of the erythroblastopenia crisis obtained 7 to 10 days later, but requiring blood transfusion in the mother. CONCLUSION: Our observation is a reminder that the contagiosity of parvovirus B19 is high in household contacts and that protection of family members should rapidly be considered in hereditary spherocytosis.


Assuntos
Anemia/genética , Anemia/virologia , Eritema Infeccioso/complicações , Eritema Infeccioso/transmissão , Eritroblastos , Parvovirus B19 Humano , Esferocitose Hereditária/complicações , Doença Aguda , Adulto , Anemia/sangue , Anemia/diagnóstico , Anemia/terapia , Anticorpos Antivirais/sangue , Transfusão de Sangue , Criança , Doença Crônica , Eritema Infeccioso/sangue , Eritema Infeccioso/diagnóstico , Eritema Infeccioso/imunologia , Feminino , Humanos , Imunoglobulina M/imunologia , Imunoglobulinas Intravenosas/uso terapêutico , Masculino , Parvovirus B19 Humano/imunologia , Reação em Cadeia da Polimerase
17.
Rev Med Interne ; 24(2): 78-85, 2003 Feb.
Artigo em Francês | MEDLINE | ID: mdl-12650889

RESUMO

PURPOSE: Tuberculosis involving the central nervous system (CNS) is rarely observed in non immuno-compromised hosts. We report herin the various clinical, biological and radiological manifestations observed in 7 patients with CNS tuberculosis. METHODS: Clinical and biological records of 7 patients with CNS tuberculosis were retrospectively studied. All patients had encephalic CT-scan and MRI in the course of the disease. RESULTS: 5 women and 2 men with a mean age of 38.4 years initially initially presented with headache (n = 6), fever (n = 5), meningeal irritation (n = 3), localizing neurological signs (n = 1). Lumbar punction revealed lymphocytic meningitis (n = 6/7). Mycobacterium tuberculosis or bovis was isolated in 3 patients only. Cerebral tomodensitography or magnetic resonance imaging were initially normal in most of cases (n = 4/7), but discovered in the course of disease basilar meningitis (n = 6), hydrocephalus (n = 6), abcess or tuberculoma (n = 4). In all the patients, initiation of the treatment was complicated by clinical and/or biological deterioration, called paradoxal reaction, leading in all cases to glucocorticoid adjunction, with various final results. Indeed, 4 patients developed neurological sequelae. No patient died. CONCLUSION: CNS tuberculosis is a rare disease in non immunocompromised patients whose diagnostic may be difficult due to the absence of specific clinical symptoms, negative initial radiological examination, as well as delayed and often negative bacterial isolation. Paradoxal reaction appeared to be frequent despite specific antibiotherapy and underlines the beneficial effects of addictive corticosteroids.


Assuntos
Imunocompetência , Tuberculose do Sistema Nervoso Central/diagnóstico , Corticosteroides/uso terapêutico , Adulto , Antituberculosos/uso terapêutico , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Tuberculoma Intracraniano/diagnóstico , Tuberculoma Intracraniano/tratamento farmacológico , Tuberculoma Intracraniano/microbiologia , Tuberculose do Sistema Nervoso Central/tratamento farmacológico , Tuberculose do Sistema Nervoso Central/microbiologia , Tuberculose Meníngea/diagnóstico , Tuberculose Meníngea/tratamento farmacológico , Tuberculose Meníngea/microbiologia
18.
Presse Med ; 28(26): 1428-32, 1999 Sep 11.
Artigo em Francês | MEDLINE | ID: mdl-10518970

RESUMO

EPIDEMIOLOGY: African rickettsiasis is transmitted by Rickettsia africae, a cattle tick. Amblyomma spp. is an emerging rickettsiasis in sub-sehalian Afric described in 1992. Seroepidemiology studies conducted in Africa show that it is probably the most widespread rickettsiasis in the sorld. In addition, the development of tourist activities in southern African countries has led to an increase in the number of reported cases in subjects returning from endemic areas. A high serprevalence of anti R. africae anticodies has been recently reported in the guadeloupe (French East Indies) population as well as one documented infection. CLINIC: The clinical expression of African tick rickettsiasis includes fevder, headache, inoculation scar, locoredgional node enlargement, and an inconsistent sometimes vesicular rash. The diagnosis is made on the basis of serological findings and cross absorption of anti R. africae and R. conorii antibodies and/or isolation or gene amplification of R. africae from inoculation scar biopsies.


Assuntos
Infecções por Rickettsia/epidemiologia , África/epidemiologia , Animais , Bovinos , Humanos
19.
Presse Med ; 31(31): 1451-3, 2002 Sep 28.
Artigo em Francês | MEDLINE | ID: mdl-12395735

RESUMO

OBJECTIVE: Heyde's syndrome associates aortic stenosis and digestive hemorrhage secondary to intestinal angiodysplasia. OBSERVATION: A 61 year-old man presented with anemia due to martial deficiency and melena, the endoscopic examination of which was negative. The existence of a tight aortic stenosis, suspected on auscultation, suggested the diagnosis of Heyde's syndrome. Angiodysplasia is revealed during oriented enteroscopy. Following valve replacement, the need for transfusion disappeared, together with the anemia. DISCUSSION: Although some epidemiological studies deny the existence of this syndrome, the observation of authentic cases of resolution of digestive bleeding following surgical replacement of an aortic valve, such as ours, is an argument in favor of the reality of Heyde's syndrome.


Assuntos
Angiodisplasia/diagnóstico , Estenose da Valva Aórtica/diagnóstico , Hemorragia Gastrointestinal/etiologia , Diagnóstico Diferencial , Endoscopia Gastrointestinal , Humanos , Jejuno/irrigação sanguínea , Masculino , Melena/etiologia , Pessoa de Meia-Idade , Estômago/irrigação sanguínea , Síndrome
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