Risk factors for cytomegalovirus infection in BMT recipients transfused exclusively with seronegative blood products.

Risk factors for developing cytomegalovirus (CMV) infection and pneumonitis were analysed in 100 unselected consecutive patients undergoing allogenic BMT. This series is homogeneous because of the same diagnostic procedures, BMT technique and supportive care (exclusive seronegative blood products, no CMV immunoglobulin, no prophylactic antiviral). The incidence of CMV infection and CMV interstitial pneumonitis (CMV-IP) were 44% and 13% respectively, of whom five patients died. Variables such as age, sex, underlying disease, conditioning regimen and occurrence of GVHD were not found as significant risk factors. We confirm that the only major factor was recipient's serology as CMV infection and IP occurred in 4% and 0% respectively among negative recipients (R-) compared with 79% and 25% among positive R. In contrast to some studies among R+, neither donor's immunity nor recipient's CMV humoral response improved the clinical outcome. This study validates the good predictive value of viremia and urinary virus excretion for the occurrence of CMV-IP (respectively positive in 11 and 13 patients out of 13 with IP), always preceding IP by a median of 37 and 27 days. The highest risk patients for lethal CMV-IP were older recipients (> 30 years). Thus, prospective prophylactic trials with antiviral agents are suggested in such viremic or viruric patients. Furthermore, the use of seronegative blood products is highly effective and sufficient to prevent CMV infection in R-patients.

[Cerebral arteritis, carotid thrombosis and rubella: relation or coincidence?]. / Artérite cérébrale, thrombose carotidienne et rubéole: relation ou coïncidence?

A 10 year-old boy presented with an acute transitory right hemiparesis with aphasia. On CT-scan there was a left temporal low density. The cerebral angiography showed a total obstruction of the left terminal internal carotid with a "beading" of the posterior cerebral artery on the same side. Blood serologies and the presence of specific IgM in the cerebrospinal fluid gave evidence for recent rubella. An other arteriogram after a follow-up of 3 months showed a persistent obstruction of the internal carotid but a disappearance of the cerebral posterior artery abnormalities.

[Infectious complications of the treatment of acute lymphoblastic leukemia in children]. / Complications infectieuses du traitement des leucémies aiguës lymphoblastiques de l'enfant.

The authors report the infectious complications observed during the treatment of acute lymphoblastic leukemia in 70 children, followed by a same team, with the same protocole, for a period of 6 years (mean follow-up: 42.3 months). The complications were mainly bacterial during induction phase, mainly staphylococcic the microbiological follow-up and a rapid empiric antibiotic therapy allowed to control more than 80% of the febrile episodes. There was one death from fulminant pyocyanic infection.

[Care and outcome of 55 children born to HIV seropositive mothers]. / Prise en charge et devenir de 55 enfants nés de mères VIH séropositives.

We report our experience with vertically transmitted HIV infection in infants. Fifty-five children were prospectively followed for a period of 3 years. The neonatal diagnosis of HIV infection is not always possible and doubts about contamination may create familial anxiety which requires support by a multidisciplinary structure. Long-term prognosis is difficult to predict and it depends on the severity of the immune deficiency, the early onset of neurologic disease and the frequency of opportunistic infections.