[Appropriate use of psychotropic drugs in institutionalized elderly presenting acute confusional state (delirium)]. / Usage adéquat des psychotropes chez les personnes âgées institutionnalisées en cas d'état confusionnel aigu (delirium).

Delirium (acute confusion) is a common, morbid, and costly geriatric syndrome that affects onethird of hospitalized older adults. As evidence mounts that delirium may persist for weeks to months, concern about delirium can no longer be restricted to acute hospitals. We present a review about non-pharmacologic and pharmacologic management of delirium in institution.

Le " Delirium " (état confusionnel) est un syndrome gériatrique fréquent et coûteux qui affecte un tiers des personnes âgées hospitalisées ; sa prévalence en institution est mal connue. Il apparaît que ce syndrome peut persister pendant des semaines à des mois, et n'est donc pas limité aux hospitalisations aiguës. Nous présentons une revue de la littérature sur la prise en charge du delirium en institution suivie d'une proposition d'algorithme définissant l'approche pharmacologique et non pharmacologique de ce syndrome gériatrique.

Aspergillus infections in birds: a review.

Aspergillosis is an infectious, non-contagious fungal disease caused by species in the ubiquitous opportunistic saprophytic genus Aspergillus, in particular Aspergillus fumigatus. This mycosis was described many years ago, but continues to be a major cause of mortality in captive birds and, less frequently, in free-living birds. Although aspergillosis is predominantly a disease of the respiratory tract, all organs can be involved, leading to a variety of manifestations ranging from acute to chronic infections. It is believed that impaired immunity and the inhalation of a considerable amount of spores are important causative factors. The pathogenesis, early diagnostic methods and antifungal treatment schedules need to be further studied in order to control this disease. The aim of the present review is to present the current knowledge on aspergillosis with the main emphasis on A. fumigatus infections in captive and free-living birds rather than domestic poultry. The review covers aetiology, epidemiology, pathogenesis, clinical signs and lesions, diagnosis, treatment and prevention.

Voriconazole, a safe alternative for treating infections caused by the Chrysosporium anamorph of Nannizziopsis vriesii in bearded dragons (Pogona vitticeps).

Dermal and systemic infections caused by the Chrysosporium anamorph of Nannizziopsis vriesii (CANV) are highly prevalent in reptiles and may result in severe disease and high mortality. Due to the high incidence of therapeutic failures, optimizing treatment is required. We first determined in this study the minimal inhibitory concentrations (MIC) of itraconazole, voriconazole, amphotericin B and terbinafine against 32 CANV isolates. For voriconazole, amphotericin B and terbinafine a monomodal MIC distribution was seen, whereas a bimodal MIC distribution was present for itraconazole, indicating acquired resistance in one isolate. Fourteen naturally-infected bearded dragons (Pogona vitticeps), from the same owner, were treated orally with either itraconazole (5 mg/kg q24h) or voriconazole (10 mg/kg q24h). The clinical condition, drug plasma concentrations and the presence of CANV in skin samples were followed. The animals were treated until complete clearance of the fungus. The plasma concentrations of voriconazole and itraconazole exceeded the minimal inhibitory concentrations of the CANV isolates. Elimination of CANV was achieved on average after 27 and 47 days of treatment with itraconazole and voriconazole, respectively. Whereas only 2 out of 7 survived after itraconazole treatment, only a single animal died in the voriconazole treated group. In conclusion, based on a limited number of animals, voriconazole applied at a regimen of 10 mg/kg bodyweight (BW) q24h seems to be a safe and effective antimycotic drug to eliminate CANV infections in bearded dragons.

Avian Aspergillus fumigatus strains resistant to both itraconazole and voriconazole.

The in vitro susceptibilities of 59 avian Aspergillus fumigatus strains to amphotericin B, itraconazole, and voriconazole were determined using the standard microdilution broth method (CLSI M38-A2). Four isolates showed acquired resistance to itraconazole and voriconazole, harboring implications for the treatment of aspergillosis in both birds and humans.

Designing voriconazole treatment for racing pigeons: balancing between hepatic enzyme auto induction and toxicity.

Aspergillosis is a major cause of mortality in captive birds and its prognosis is often poor due to treatment failure. Voriconazole is a novel triazole antifungal agent that may be useful for the treatment of this infection in birds as it has shown promise in other animal models of the disease. We examined the pharmacokinetic behaviour of voriconazole in racing pigeons (Columbia livia forma domestica). Intravenous, oral and aerosol administration were investigated in single (10 mg/kg BW PO; 10, 5, 2.5 mg/kg BW IV), multiple dose (10, 20 mg/kg BW PO q12h, q24h) and nebulization (15 min, 10 mg/ml NaCl 0.9%) experiments. Quantitative measurements of voriconazole in plasma, as well as in lung tissue, collected at several time points, were done with a validated high performance liquid chromatography method using ultraviolet detection. Designing a treatment schedule with voriconazole is complicated by dose-dependent pharmacokinetics and induction of its biotransformation. Moreover, hepatic changes were seen in the oral multiple dose regimen at 10 and 20 mg/kg BW twice a day. Taking all features into account our study suggests that the oral dosage schedules of 10 mg/kg BW twice a day or 20 mg/kg BW once a day could be most appropriate in treating pigeons with aspergillosis.

Modelling Aspergillus fumigatus infections in racing pigeons (Columba livia domestica).

In vivo modelling of aspergillosis in birds allows the evaluation of control measures and the study of host-pathogen interactions. In this study the impact of the use of different inoculation routes and immunosuppression on the course of an infection with Aspergillus fumigatus in racing pigeons (Columba livia domestica) was examined. A. fumigatus conidia were inoculated in the thoracic air sac, lung or trachea in immunocompetent or immunosuppressed pigeon squabs. Immunosuppression was induced by three dexamethasone injections before inoculation. Mortality in the A. fumigatus-inoculated groups varied between 1/4 and 4/4. The highest and more acute mortality was seen in immunocompetent pigeons inoculated in the thoracic air sac and in pigeons inoculated in the thoracic air sac or lung after immunosuppression. Pigeons inoculated in the lung or inoculated intratracheally after immunosuppression developed an aspergillosis infection with a slower course of disease and more prominent clinical symptoms. Using microsatellite length polymorphism, it was confirmed that all mycoses were caused by the inoculated strain except for one isolate in a dexamethasone-treated pigeon. In conclusion, inoculation in the lung is selected as the preferred model for chronic aspergillosis in pigeons, and inoculation in the thoracic air sac as the preferred model for acute aspergillosis. The use of immunosuppressed birds seems to be contra-indicated due to the risk of opportunistic infections.