[Group A beta-hemolytic Streptococcus: an unusual etiology of perianal dermatitis in an adult?]. / Le streptocoque beta-hémolytique du groupe a: une étiologie exceptionnelle de dermite péri-anale chez l'adulte?

BACKGROUND: Perianal dermatitis usually occurs in children between 1 and 8 years of age. We report a sixth case in an adult. CASE REPORT: A 33 year-old woman complained of perianal itching which quickly extended to the vulva and persisted in spite of anti-hemorrhoid and anti-fungal treatments. After 12 days, she had painful defecation, a well demarcated perianal and vulvar erythema and anal collection. Culture from a perianal swab isolated group A beta-hemolytic Streptococcus (ABHS). After surgical treatment of the collection and a 7 days oral amoxicillin regimen, the patient recovered with no recurrence. DISCUSSION: Symptoms of perianal dermatitis are unspecific, leading to delayed diagnosis and underestimated frequency. Symptoms consist in perianal erythema. Swab culture shows ABHS. The mechanism of colonization of perianal area is not well defined. Although treatment with oral penicillin is usually effective, failures and relapses have also been reported. Complications such as deep infection or abcess formation are infrequent. A bacterial swab should be made in patients with persisting perianal erythma.

[Management of foreign tourists' diseases at the American Hospital in Neuilly]. / Prise en charge des touristes étrangers malades à l'Hôpital américain de Neuilly.

More and more foreign tourists are being treated at the American Hospital of Paris. The main reasons for this are the presence of a 24 hour medical and dental emergency service, in addition to the availability of MRI, CT scan and comprehensive laboratory facilities. The hospital is multidisciplinary, where short stay hospitalizations are the rule. English is the second most commonly used language. There is a permanent Japanese language service for Japanese patients. Qualitative data is presented concerning the management of patients according to specialty and nationality. American and Japanese patients admitted to the hospital in 1997 are surveyed according to their mean age, reasons for admission and appropriate specialty as well as mean length of stay noted. The greatest number of hospitalizations in decreasing order and according to nationality are as follows: American, Japanese, Moroccan Egyptian and Saudi Arabian. The consultations and hospitalizations of Japanese patients between 1990 and 1997 are compared.

Exacerbations of clinical symptoms in human immunodeficiency virus type 1-infected patients with multicentric Castleman's disease are associated with a high increase in Kaposi's sarcoma herpesvirus DNA load in peripheral blood mononuclear cells.

The epidemiologic link between multicentric Castleman's disease (MCD) and Kaposi's sarcoma (KS) and the high frequency of KS herpesvirus (KSHV) detection in both diseases raise the question of a role of this new virus in the pathogenesis of MCD. To explore this hypothesis, the KSHV DNA load was investigated in peripheral blood mononuclear cells of 3 human immunodeficiency virus (HIV)-infected patients with MCD at different points during the clinical course. Clinical parameters, such as fever and the presence of lymphadenopathy, were systematically assessed. Hemogram and C-reactive protein level determinations were performed as standard procedures. KSHV DNA load was investigated by means of semiquantitative polymerase chain reaction assay using peripheral blood mononuclear cells of the patients. A correlation between the variation in clinical and biologic parameters related to MCD and KSHV DNA load was found, suggesting a close relationship between KSHV and MCD in HIV-1-infected patients.

[Hepatic involvement in AIDS. A retrospective clinical study in 71 patients]. / Atteintes hépatiques au cours du SIDA. Etude anatomo-clinique rétrospective chez 71 patients.

In order to determine the extent of liver abnormalities occurring during acquired immunodeficiency syndrome, the available histological analyses of liver samples (32 biopsies, 52 autopsies) from 71 AIDS patients, for the period 1982-1986, were studied retrospectively. Hepatomegaly was the most common clinical symptom (23 patients, 32.4%), while jaundice was rare, being seen in only 5 cases (7%). Progressive anicteric cholestasis was the most frequently observed biological anomaly (29/52, 55.7%). Ten patients had liver infections: 2 Mycobacterium tuberculosis, 8 Mycobacterium avium intracellulare. Cytomegalovirus was present in 3 patients and 1 individual was infected with Cryptococcus neoformans. Granulomatous hepatitis was associated with these infectious agents in 11 patients, but remained unexplained in 11 others. Three patients had cholangitis (2 with CMV inclusions, 1 unexplained). Among the 32 biopsies, 5 elucidated the origin of unexplained fever. Kaposi's sarcoma of the liver was found in 10/52 autopsy samples (19%) and hepatic lymphoma in 2 cases. Non-specific histological lesions were common: inflammation of the portal spaces (48 cases, 67.6%), steatosis (32 patients, 45%), peliosis hepatis (9 cases, 12.6%) and sinusoidal dilations (39 cases, 54.9%).

[Arsenical-induced encephalopathy during the treatment of African trypanosomiasis. Apropos of a case with a favorable outcome]. / Encéphalopathie arsenicale au cours du traitement de la trypanosomiase africaine. A propos d'un cas d'évolution favorable.

We describe one case of reactive encephalopathy as a complication during treatment of human trypanosomiasis (T.b. gambiense) with melarsoprol (Arsobal, Mel B.). A 37 year white man who had typical T. gambiense sleeping sickness and secondary convulsions, coma and hemiplegia after three days of treatment by melarsoprol. Within 48 hours of intensive care the symptoms and signs released. In the encephalomeningeal period of trypanosomiasis the therapy currently available is the parenteral administration of organic arsenicals as melarsoprol used since the 1940s. This drug remains highly effective but severe untoward reactions occur and the incidence of mortality attributable to melarsoprol is not negligible. Choice and optimal condition of treatment are discussed.

Acute bronchopulmonary infections: treatment with i.v. spiramycin.

This paper reports the results of an open study to assess the efficacy (433 patients) and tolerance (453 patients) of spiramycin adipate given by slow intravenous infusion to treat severe acute bronchopulmonary infections in adults. Efficacy was good in 80.4% of patients. More specifically, high efficacy was obtained in 76.5% of 85 pneumococcal respiratory infections, 72% of 50 Haemophilus influenzae and H. parainfluenzae infections, 100% of 18 Mycoplasma infections, 100% of 16 Chlamydia infections and 93% of 14 Legionella infections. Tolerance was good in 83.5% of patients, moderate in 15.4% and poor in 6%. Venous irritation was the most frequent complication, observed in 16.3% of patients. No serious complication or sequel was observed. The authors conclude that spiramycin adipate constitutes an appropriate first-line treatment of acute bronchial and/or pulmonary infections in adults. While inferior to benzylpenicillin against Mycoplasma, Chlamydia and Legionella, spiramycin is as active as, and better tolerated than, erythromycin.

Pentamidine aerosol in prophylaxis and treatment of murine Pneumocystis carinii pneumonia.

The efficacy and tolerance of pentamidine aerosol were evaluated in the prophylaxis and therapy of murine Pneumocystis carinii pneumonia. P. carinii pneumonia was induced in rats by corticosteroid immunosuppression. Pentamidine was administered three times weekly via a Bird micronebulizer. The actual amount of pentamidine inhaled was estimated by monitoring the ventilation of the rats during the aerosol administration. Pentamidine levels in blood, lung, liver and kidney samples were determined by high-pressure liquid chromatography after completion of the treatment. Efficacy was evaluated by examination of lung imprints. In the prophylactic treatment, 4.8- and 8.6-mg/kg doses of aerosolized pentamidine administered three times weekly for 7 weeks were effective in preventing P. carinii pneumonia in 80 and 100% of the rats, respectively. In the therapeutic studies, a 14.6-mg/kg dose of aerosolized pentamidine administered three times weekly for 3 weeks was effective both in curing the pneumonia and in clearing P. carinii cysts in 70% of the rats. In the remaining animals, although the pneumonia was cured, the cysts persisted. A dose-dependent effect of the drug was demonstrated in both prophylactic and therapeutic treatments. High lung/kidney and lung/liver ratios of pentamidine levels were demonstrated and were associated with good clinical, biological, and histologic tolerance.

Penicillins and macrolides in the treatment of community-acquired respiratory tract infections.

The use of penicillins and macrolides in the management of community-acquired respiratory tract infections is evaluated in relation to such factors as antimicrobial activity, stability, pharmacokinetics and adverse reactions. Attention is directed to the side effects of drugs, e.g. to the clear advantages of 16 (e.g. spiramycin) vs. 14 (e.g. erythromycin)-membered ring macrolides, and examples are drawn to illustrate the tactics of antimicrobial therapy in the management of pneumonias.

In vitro and in vivo anti-leishmanial activity of chlorpromazine alone and combined with N-meglumine antimonate.

Chlorpromazine (CPZ) was effective in vitro against leishmanial promastigotes and amastigotes. CPZ at 7.5 micrograms ml-1 killed the promastigotes of Leishmania mexicana, L. aethiopica and L. major within 24 hours of exposure. A higher concentration was required to achieve the same effect against L. donovani. N-meglumine antimonate (MGA) was only partially effective against the promastigotes of the four strains studied. Even at 1000 micrograms ml-1 total destruction of the parasites did not occur within four days of treatment. Combination chemotherapy of CPZ and MGA generally showed an additive effect against promastigotes. However, a synergistic effect was observed in the case of L. donovani promastigotes and L. major amastigotes in vitro. No significant effect was obtained against the amastigotes of L. major and L. mexicana in vivo, in cutaneous lesions of BALB/c mice.

Respiratory and pulmonary alterations in experimental Pneumocystis carinii pneumonia in rats.

Pneumocystis carinii (P.c.) pneumonia was induced in 40 rats by a prolonged corticosteroid treatment (group 1); 40 healthy rats of equal weight constituted the control group (group 2); 9 rats received the same corticosteroid treatment as group 1, together with trimethoprim-sulfamethoxazole (TMP-SFZ) in order to prevent P.c. multiplication (group 3). We could distinguish the respiratory effects induced by corticosteroids from those caused by P.c. pneumonia (group 3 vs group 1). For six weeks the blood leukocyte count, the weight of the spleen and the thymus and the pulmonary status were monitored. Blood gases and acid-base status were measured in conscious rats. There was no pulmonary oedema. The infected P.c. rats had a low PaCO2 and a slight disturbance of blood oxygenation, exemplified by A-aDO2 of 30 mmHg, compared with 17.5 mmHg in control rats and 17 mmHg in TMP-SFZ treated rats. P.c. infected rats had a lymphocyte depletion induced by corticosteroids. They did not exhibit respiratory distress. P.c. pneumonia alone in rats did not cause frank hypoxemia.

[Treatment of acute pneumopathies in a tropical zone]. / Le traitement des pneumopathies aiguës en zone tropicale.

This treatment must take into account the high frequency of Streptococcus pneumoniae and Haemophilus influenzae which represent over 50% of causes of all bacterial pneumopathies, up to 75% in children under 2 years old. Benzyl-penicillin and injectable delayed action penicillin are drugs of choice and early utilisation reduces considerably the mortality. Other possible antibiotics are macrolides because of their wide range of efficacy and low toxicity, and chloramphenicol which is still one of the best drugs against penicillin-resistant Haemophilus influenzae.