ABSTRACT
We report a patient who presented a severe Panton-Valentine-secreting methicillin-susceptible Staphylococcus aureus pneumonia with threatening multi-organ failure including acute respiratory distress syndrome, cardiac failure, renal failure and disseminated intravascular coagulation. Clinical and biological disease course using empiric therapy with treatment directed against toxin production (linezolid, clindamycin and intravenous immunoglobulins) was found to be quickly effective.
Subject(s)
Anti-Infective Agents/therapeutic use , Bacterial Toxins/biosynthesis , Exotoxins/biosynthesis , Immunoglobulins, Intravenous/therapeutic use , Leukocidins/biosynthesis , Pneumonia, Bacterial/drug therapy , Staphylococcal Infections/drug therapy , Acetamides/therapeutic use , Adult , Clindamycin/therapeutic use , Humans , Linezolid , Male , Multiple Organ Failure/drug therapy , Multiple Organ Failure/etiology , Oxazolidinones/therapeutic use , Respiratory Distress Syndrome/drug therapy , Respiratory Distress Syndrome/etiologyABSTRACT
Waldenström's macroglobulinemia is a rare disease with an indolent clinical course. The median age of the affected patient is 65 years. Nevertheless, we report a case of Waldenström's macroglobulinemia revealed by a splenomegaly and severe pancytopenia, in a 51-year-old man without previous medical history. According to the recent consensus recommendations for the clinicopathological definition of Waldenström's macroglobulinemia, diagnosis was made through morphological and immunophenotypic data of medullary cells. The reduced survival of the patient is associated with the importance of the cytopenia.
Subject(s)
Waldenstrom Macroglobulinemia/diagnosis , Chromosome Mapping , Chromosomes, Human, Pair 14 , Chromosomes, Human, Pair 9 , Diagnosis, Differential , Humans , Male , Middle Aged , Pancytopenia/etiology , Splenomegaly/etiology , Translocation, Genetic , Waldenstrom Macroglobulinemia/blood , Waldenstrom Macroglobulinemia/genetics , Waldenstrom Macroglobulinemia/pathologyABSTRACT
We report the case of febrile fatal coma in a 51-year-old man from Burkina Faso. Magnetic resonance imaging (MRI) shows cerebral fat embolism. Haemoglobin electrophoresis shows probably haemoglobinopathy SC. A short review of the literature demonstrate the need to consider this complication in patients with neurological or respiratory disorders, in areas where this disease is highly prevalent, irrespective of age. It also emphasizes the diagnostic contribution of MRI and discusses the mechanism, the diagnosis as well as the difficulty of choosing the appropriate therapeutic course.
Subject(s)
Anemia, Sickle Cell/diagnosis , Coma , Embolism, Fat/diagnosis , Intracranial Embolism/diagnosis , Multiple Organ Failure/etiology , Anemia, Sickle Cell/complications , Brain/pathology , Burkina Faso/ethnology , Diagnosis, Differential , Fever , France , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Multiple Organ Failure/diagnosisABSTRACT
Scytalidium dimidiatum is a fungus found mainly in tropical and subtropical zones. Infection can cause a benign disease closely resembling dermatophytosis. In immunocompromised hosts, Scytalidium dimidiatum can also lead to phaehyphomycosis. Although awareness of these hyphae remains limited in developed countries, their incidence is growing due to increasing immigration and tourism. The rising incidence is well illustrated by three patients who presented onyxis and squamous-like manifestations on the arch of the foot upon returning from trips overseas and in whom various treatments were unsuccessful. In all three cases, culture in non-selective Sabouraud medium identified Scytalidium dimidiatum. These findings underline the need for laboratory testing before undertaking local or systemic treatment of onyxis especially since this pathogen can cause systemic disease. Study of ribosome genes showed that Scytalidium hyalinum is an homologous unpigmented mutant form of Scytalidium dimidatum. No antifungal agent has been effective for management of superficial manifestations and prevention depends mainly on the use of appropriate footwear in endemic areas.
Subject(s)
Dermatomycoses/diagnosis , Dermatomycoses/microbiology , Foot Dermatoses/diagnosis , Foot Dermatoses/microbiology , Mitosporic Fungi , Onychomycosis/diagnosis , Onychomycosis/microbiology , Adult , Aged , Dermatomycoses/epidemiology , Dermatomycoses/therapy , Diagnosis, Differential , Emigration and Immigration , Endemic Diseases , Female , Foot Dermatoses/epidemiology , Foot Dermatoses/therapy , Humans , Incidence , Male , Mitosporic Fungi/classification , Mitosporic Fungi/genetics , Mycological Typing Techniques , Onychomycosis/epidemiology , Onychomycosis/therapy , Risk Factors , TravelABSTRACT
Autoimmune cholangitis is a rare cause of chronic liver disease which has recently been described and associates the clinical, biological, and histological patterns of primary biliary cirrhosis without serum anti-mitochondrial antibodies. We report a case of this disease in a 67-year-old female. The patient presented with jaundice and marked biological cholestasis associated with pulmonary fibrosis and salivary and lacrymal sicca syndrome. Serum anti-smooth muscle antibodies were found without anti-mitochondrial antibodies. Corticotherapy resulted in rapid improvement of clinical and hepatic abnormalities, as well as of pulmonary lesions. The patient was still healthy 18 months later, with low dose corticotherapy. This report emphasizes the possible effectiveness of corticotherapy in autoimmune cholangitis.
Subject(s)
Autoimmune Diseases/drug therapy , Cholangitis/drug therapy , Glucocorticoids/therapeutic use , Prednisone/therapeutic use , Aged , Cholangitis/immunology , Female , Humans , Treatment OutcomeABSTRACT
A patient with a commun variable immunodeficiency (CVID) is hospitalized for chronic symptoms of malabsorption (weigh loss and diarrhea). The duodenal histology show a total villous atrophy. Investigations are negative and a gluten free diet is given. Symptoms of malabsorption disappear and improvement is histologically confirmed. Our observation suggest that the coincidence of gluten sensitive enteropathy and CVID is possible and clinicians should be aware of this association and should consider giving a gluten free diet. The sensitivity of serologic testing in this conditions is unknown.
Subject(s)
Agammaglobulinemia/complications , Celiac Disease/complications , Agammaglobulinemia/therapy , Atrophy , Celiac Disease/diagnosis , Celiac Disease/diet therapy , Humans , Intestinal Mucosa/pathology , Male , Middle AgedABSTRACT
To compare the rate of antinuclear antibodies (ANA) in HTLV-I carriers and negative individuals in French Guiana, 350 sera (175 HTLV-I carriers, either symptomatic or not, and 175 controls) were screened for ANA, using an immunofluorescence assay. All positive sera were tested for autoantibodies against extractable nuclear antigens, histones and double stranded DNA. ANA were detected in 9.71% of the HTLV-I carriers and 3.43% of the control group (p < 0.05). There was no difference in ANA distribution by age, sex, or ethnic group. Neither was there any difference between asymptomatic and symptomatic HTLV-I individuals. However, ANA of medical interest were significantly higher (p < 0.04) in HTLV-I seropositive Creoles than in seropositive Noir-Marrons.
Subject(s)
Antibodies, Antinuclear/blood , HTLV-I Infections/immunology , Human T-lymphotropic virus 1/immunology , Antibodies, Antinuclear/analysis , Carrier State/immunology , Female , French Guiana/epidemiology , HTLV-I Infections/ethnology , Humans , Male , Middle AgedABSTRACT
The authors studied, with a time-kill curve method, in a derived Hafiz medium broth the bactericidal effect of 7 antibiotics and 4 associations against N. meningitidis. Their results show a better bactericidal effect for penicillin G, ampicillin and chloramphenicol. Pefloxacin and ceftriaxon are less efficient. The association ampicillin + chloramphenicol in vitro shows no antagonism and has a good bactericidal activity at the early stages of bactericidal killing with N. meningitidis.
Subject(s)
Ampicillin/pharmacology , Chloramphenicol/pharmacology , Neisseria meningitidis/drug effects , Pefloxacin/pharmacology , Penicillin G/pharmacology , Ceftriaxone/pharmacology , Dose-Response Relationship, Drug , Drug Synergism , Drug Therapy, Combination/pharmacology , In Vitro Techniques , Rifampin/pharmacology , Spiramycin/pharmacologyABSTRACT
Pseudomonas aeruginosa strains belonging to the serogroup O:11 exhibiting susceptibility to ticarcillin (TIC) and resistance to the ticarcillin-clavulanic acid (CA) combination were found in 19 inpatients over a 14 month period. Mean inhibition diameters obtained using the agar diffusion method were 21.75 mm around the TIC disks (75 micrograms) and 15.96 mm around the TIC+CA disks (75 + 10 micrograms). With control PaO:11 strains, these diameters were 25.27 and 25 mm, respectively. MIC for ticarcillin determined using the checkerboard method rose to 64 mg with CA levels of 16 mg/l or more. CA exhibited dose-dependent antagonism on TIC killing curves when TIC levels approximated the MIC; this effect was no longer present with higher TIC levels. In the crude bacterial extract, a betalactamase of the cephalosporinase type was detected in the absence of induction and increased threefold after exposure to cefoxitin (100 mg/l) and fourfold after exposure to CA (5 mg/l). All these PaO:11 strains exhibited the same antimicrobial resistance phenotype with decreased susceptibility to ureidopenicillins and resistance to aminoglycosides and fluoroquinolones. The induction of a chromosome-encoded cephalosporinase by CA proved useful as an epidemiologic marker. Nosocomial spread of this phenotype was likely the result of selection due to use of antimicrobials.