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1.
Ann. Univ. Mar. Ngouabi ; 17(1): 10-16, 2017. ilus
Artigo em Francês | AIM (África) | ID: biblio-1258832

RESUMO

Introduction : La prise ne charge de l'hépatite virale C a connu un tournant décisif depuis la découverte des antiviraux directs. Sa prévalence au Congo-Brazzaville est estimée à 10% avec prédominance du génotype 4 et son traitement se heurte à plusieurs écueils notamment l'accessibilité au traitement. Nous avons réalisé une étude dont l'objectif a été d'évaluer les possibilités de diagnostic et de prise en charge thérapeutique des malades infectés par le virus de l'hépatite C à Pointe-Noire.Méthodes: Il s'est agi d'une étude expérimentale, prospective, descriptive et analytique réalisée dans le service de Gastroentérologie de l'hôpital général de Loandjili de Pointe-Noire.Résultats: Au total notre file active comptaient 81 dossiers des cas d'hépatite C et 34 (41,9%) cas traités ont été inclus. Il s'agissait de 21(61,76%) hommes et de 13(38,24%) femmes d'âge médian 50ans. Il y avait 15 (44,1%) patients alcooliques; 4 (11,8%) patients fumeurs; 15 (44,1%) patients sans intoxication. L'hépatite C était découverte lors d'un dépistage chez 19(55,8%) patients et suite aux symptômes chez 15 (44,1%) patients. Parmi ces 34 malades; 6 (17,6%) étaient du génotype 1 et 23 (67,6%) étaient du génotype 4; chez 5 (14,7%) patients le génotype était inconnue. Le financement du traitement était assuré par l'assurance maladie pour 5 (14,7%) patients; l'employeur pour 13 (38,2%); l'argent personnel pour 12 (35,3%); l'aide des parents pour 3 (8,8%) patients; non identifié chez 1 (2,9%) patient. Sur 34 patients traités par bithérapie pégylée 13(38,2%) étaient guéris et 21(61,7%) n'étaient pas guéris. Il restait 21 patients non guéris dont 2 patients traités par sofosbuvir + ribavirine (24 semaines) et 2 malades traités par sofosbuvir +daclastavir (12 semaines); tous ces 4 malades étaient guéris. Il restait 17 patients non guéris et non traités par les antiviraux directs faute de financement. En analyse uni et multivariée la charge virale était un facteur influençant l'efficacité du traitement.Conclusion : La prise en charge optimale de l'hépatite C chronique est possible au Congo-Brazzaville. Cependant la non disponibilité des médicaments, le prix exorbitants des antiviraux et le manque de couverture sociale, constituent des freins exposant les malades aux complications mortelles. Ainsi la création du programme national de lutte contre les hépatites virales au Congo Brazzaville pourrait lever ces obstacles inadmissibles en 2016


Assuntos
Congo , Gerenciamento Clínico , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/tratamento farmacológico , Prevalência
2.
Pathol Biol (Paris) ; 58(6): 434-6, 2010 Dec.
Artigo em Francês | MEDLINE | ID: mdl-19375247

RESUMO

The role for Mycoplasma pneumoniae and Chlamydophila pneumoniae in lower and upper respiratory tract infections in childhood increased by use of specialised diagnostic techniques, more and more performant for the early diagnosis of these infections. However, the prevalence of M. pneumoniae and C. pneumoniae as a cause of severe pneumoniae among hospitalized children has been rarely described. We report a case of M. pneumoniae et C. pneumoniae coinfection in a 10-year-old child hospitalized with a respiratory distress.


Assuntos
Anticorpos Antibacterianos/sangue , Infecções por Chlamydophila/complicações , Chlamydophila pneumoniae/isolamento & purificação , DNA Bacteriano/sangue , Mycoplasma pneumoniae/isolamento & purificação , Pneumonia Bacteriana/complicações , Pneumonia por Mycoplasma/complicações , Síndrome do Desconforto Respiratório/etiologia , Criança , Infecções por Chlamydophila/diagnóstico , Chlamydophila pneumoniae/genética , Chlamydophila pneumoniae/imunologia , Infecções Comunitárias Adquiridas/microbiologia , Diagnóstico Diferencial , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Mycoplasma pneumoniae/genética , Mycoplasma pneumoniae/imunologia , Pneumonia Bacteriana/diagnóstico , Pneumonia por Mycoplasma/diagnóstico , Reação em Cadeia da Polimerase , Kit de Reagentes para Diagnóstico , Hipersensibilidade Respiratória/complicações , Sensibilidade e Especificidade , Fatores de Tempo , Viroses/diagnóstico
3.
J Clin Microbiol ; 47(9): 2906-11, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19625478

RESUMO

Human immunodeficiency viruses (HIV) have a high level of genetic diversity. The outlier variants of HIV type 1 (HIV-1) group O are distantly related to HIV-1 group M. Their divergence has an impact on serological diagnosis, with a risk of false-negative results. In this study, we report 20 failure cases, involving patients with primary or chronic infection, in France and Cameroon between 2001 and 2008. Our results indicate that some assays detected group O infection much less efficiently than others. Two major reasons for these false-negative results were identified: the presence or absence of a group O-specific antigen (and the designed sequence) for the detection of antibodies and the greater envelope variability of group O than of group M strains. This study highlights the complexity of screening for these divergent variants and the need to evaluate test performance with a large panel of strains, due to the extensive diversity of group O variants.


Assuntos
Reações Falso-Negativas , Anticorpos Anti-HIV/sangue , Antígenos HIV/sangue , Infecções por HIV/diagnóstico , HIV-1/classificação , HIV-1/imunologia , Testes Sorológicos/métodos , Camarões , Feminino , França , Variação Genética , Humanos , Masculino
4.
Med Mal Infect ; 39(1): 41-7, 2009 Jan.
Artigo em Francês | MEDLINE | ID: mdl-18954951

RESUMO

INTRODUCTION: Dengue fever is the main emerging vector-borne disease worldwide. It was estimated that 40% of the world population is at risk. A potential vector (Aedes albopictus) is present in four French departments of the southeast area of metropolitan France. METHOD: The authors tried to document the number of imported cases of dengue diagnosed from 2001 to 2006, inclusive, as well as their main features. RESULTS: Between 12 and 28 cases of imported dengue were diagnosed every month during that period (eight to 18 cases per month except for years 2001-2002 during which an important dengue epidemic was documented in the French West Indies). Nearly 40% of the cases were imported between June and September during which the vector is active in the metropolitan area. CONCLUSION: This data underlines the strong and close link between the endemic zones of the French territory (French West Indies and Guyana) and the risk of imported cases to metropolitan France. The identification of this "importation track" entails strengthening the system for detecting and managing imported dengue cases in metropolitan France when a dengue epidemic is detected in the French West Indies.


Assuntos
Dengue/epidemiologia , Viagem , Aedes , África , Animais , Sudeste Asiático , França/epidemiologia , Humanos , Índia , Madagáscar , Estações do Ano , América do Sul , Sri Lanka , População Urbana
5.
Gynecol Obstet Fertil ; 34(4): 312-6, 2006 Apr.
Artigo em Francês | MEDLINE | ID: mdl-16581283

RESUMO

OBJECTIVE: Analyse the performance of human papillomavirus testing with hybrid capture II on liquid-based CYTO-screen system for women diagnosed with atypical squamous cells of undetermined significance according to the age. PATIENTS AND METHODS: Were included all women diagnosed with atypical squamous cells of undetermined significance for whom human papillomavirus testing was performed and cytological and histological procedures were available over a follow-up period of 6 to 18 months. RESULTS: Human papillomavirus testing was performed in 3,047 patients, and results were compared to cytological and histological follow-up diagnosis in 1,880 cases (61.7%). The sensitivity for diagnosing cervical intraepithelial neoplasia was 93.3% in women less than 30 of age and 89.7% in women more than 30 of age. Specificity was 44.9% in women less than 30 of age and 64.4% in women more than 30 of age. Likelihood ratios confirmed these results as they show a low discriminatory power in case of positive result specifically in women less than 30 of age but an excellent performance in case of negative result. DISCUSSION AND CONCLUSION: The use of human papillomavirus testing after a diagnosis of atypical squamous cells of undetermined significance with the residual material of Cyto-screen system is a possible triage procedure to identify patients needing a colposcopy. Its specificity is better for women over 30.


Assuntos
Envelhecimento , Citodiagnóstico/métodos , Papillomaviridae/isolamento & purificação , Doenças do Colo do Útero/patologia , Doenças do Colo do Útero/virologia , Adulto , Biópsia , Feminino , Humanos , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Displasia do Colo do Útero/diagnóstico , Displasia do Colo do Útero/virologia
6.
Pathol Biol (Paris) ; 52(8): 462-8, 2004 Oct.
Artigo em Francês | MEDLINE | ID: mdl-15465265

RESUMO

AIM OF THE STUDY: To evaluate the performance of two commercial methods for identification of Mycobacterium species: InnoLiPA Mycobacteria first version (Innogenetics) versus Genotype MTBC and Genotype Mycobacterium (HAIN) on, respectively, 2123 and 2164 distinct isolates. MATERIALS AND METHODS: Both techniques are based on the reverse hybridization of PCR products to their complementary probes immobilized on membrane strips. The InnoLiPA assay targets the 16S-23S rRNA spacer region. The HAIN test is composed of two kits: Genotype MTBC, for identification of tuberculosis complex mycobacteria, is based on gyrB DNA sequence polymorphism. Genotype Mycobacterium kit targets the 23S rDNA for identification of mycobacteria other than tuberculosis (MOTT) and tuberculosis complex mycobacteria. Both assays identify complex tuberculosis mycobacteria and respectively, eight and 12 species of MOTT. Moreover, the Genotype MTBC allows species differentiation within the M. tuberculosis complex. RESULTS: Eighty-eight percent and 95% of mycobacteria were identified by InnoLiPA and HAIN, respectively. Hybridization remained negative for 11% of isolates with InnoLiPA and 4% with HAIN. An identification of MOTT was obtained by conventional identification in all cases after the use of InnoLiPA. MOTT and one M. tuberculosis was obtained after HAIN procedure. Unidentified species were complementary to a specific probe in 5% of the cases with InnoLiPA and 17% with HAIN. CONCLUSION: HAIN identifies more mycobacteria species than does InnoLiPA and allows identification in the M. tuberculosis complex. However, failure in identification occurs only with MOTT with InnoLiPA when one M. tuberculosis was found among mycobacteria non identified with HAIN.


Assuntos
Mycobacterium/genética , DNA Bacteriano/genética , Genótipo , Humanos , Mycobacterium/classificação , Mycobacterium/isolamento & purificação , Infecções por Mycobacterium/microbiologia , Hibridização de Ácido Nucleico/métodos , Reação em Cadeia da Polimerase/métodos , RNA Bacteriano/genética , RNA Ribossômico 16S/genética , RNA Ribossômico 23S/genética
7.
J Viral Hepat ; 9(5): 385-9, 2002 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12225334

RESUMO

The performance of the recently developed, standardized direct sequencing assay for hepatitis C virus (HCV) genotyping [TRUGENE HCV 5'-NC (noncoding)] was assessed in comparison with the reverse hybridization-based assay INNO-LIPA HCV II. Both assays allow HCV genotyping starting from amplification products generated by the diagnostic Roche AMPLICOR HCV test. HCV amplicons from 205 patients were used for this study: 34 were tested prospectively by both methods, while 171 had been stored at -20 degrees C for up to 2 years after LiPA genotyping. The TRUGENE procedure failed to determine a genotype in six low-titered samples (3.5 +/- 0.3 log UI/mL vs. 5.2 +/- 0.5 UI/mL for typable samples). Type and subtype could be determined by sequencing for 199 samples (97%). Among them, five were considered as coinfections by the LiPA method. Three LiPA patterns suggesting type 1 and 4 coinfection were not supported by sequence analysis while one 1a/2b and one 1a/3a coinfection was backed up by direct sequencing. For the remaining 194 samples, type assignment was concordant in 100% of the cases. LiPA subtyping was available for 162 samples (83.5%). Sub-typing results concurred in 128 cases (79%). NS5B sequencing of discrepant samples underscored the limitation of the 5'-noncoding region (NCR) in correct subtype assignment. In conclusion, the TRUGENE HCV 5'-NC genotyping kit appeared to be a specific and reliable method that can be used in the current indication of HCV genotyping.


Assuntos
Regiões 5' não Traduzidas/genética , Hepacivirus/genética , Kit de Reagentes para Diagnóstico , Regiões 5' não Traduzidas/análise , Técnicas Genéticas , Genótipo , Hepacivirus/classificação , Hepacivirus/isolamento & purificação , Humanos , Reação em Cadeia da Polimerase/métodos , Estudos Prospectivos , Estudos Retrospectivos , Análise de Sequência de DNA
9.
AIDS ; 14(12): 1775-84, 2000 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-10985315

RESUMO

OBJECTIVES: To assess the impact of HIV-related immunodeficiency and antiretroviral treatment on the occurrence and evolution of abnormal Papanicolaou tests. STUDY DESIGN: Cohort of 485 HIV-infected women with a known date of infection, enrolled during May 1993-April 1998 in 23 centres (gynaecology, infectious disease or STD clinics, or drug treatment centres) in 12 European countries; in 21 centres, follow-up was performed every 6 months (median follow-up: 2 years). METHODS: Human papillomavirus (HPV) was detected at inclusion by Southern blot and PCR. The prevalence of squamous intraepithelial lesions (SIL), the incidence of SIL and regression from low-grade SIL were studied according to CD4 count after controlling for HPV detection results. RESULTS: Compared with women with CD4 cell counts > 500 x 10(6)/l, women with CD4 cell counts < 200 x 10(6)/l had a twofold increase in both prevalence and incidence of SIL and in non-regression from untreated low-grade SIL; in addition, these women had a lower response rate to treatment of high-grade cervical intraepithelial neoplasia. The increase in SIL incidence associated with a low CD4 cell count was significant in women not receiving antiretroviral treatment (relative risk, CD4 cell count 200-499 x 10(6)/l, 1.9; CD4 cell count < 200 x 10(6)/l, 2.9; CD4 cell count > 500 x 10(6)/l, reference), whereas it was less marked and not statistically significant in treated women. CONCLUSIONS: Severe HIV-related immunodeficiency strongly increases the risk of occurrence of SIL; antiretroviral treatment may reduce this risk, probably by restoring or at least preserving immune function.


Assuntos
Infecções por HIV/complicações , Neoplasias de Células Escamosas/epidemiologia , Displasia do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Adolescente , Adulto , Idoso , Contagem de Linfócito CD4 , Estudos de Coortes , Europa (Continente)/epidemiologia , Feminino , Seguimentos , Infecções por HIV/diagnóstico , Infecções por HIV/imunologia , Humanos , Incidência , Pessoa de Meia-Idade , Neoplasias de Células Escamosas/imunologia , Papillomaviridae/imunologia , Papillomaviridae/isolamento & purificação , Prevalência , Estudos Prospectivos , Fatores de Risco , Neoplasias do Colo do Útero/imunologia , Displasia do Colo do Útero/imunologia
10.
Ann Dermatol Venereol ; 127(1): 40-5, 2000 Jan.
Artigo em Francês | MEDLINE | ID: mdl-10717561

RESUMO

INTRODUCTION: A specific link between human papillomavirus (HPV) types 16, 18, 31, and 33 and genital carcinomas and between HPV type 5 and cutaneous extragenital carcinomas in patients with epidermodysplasia verruciformis and renal transplant has been previously found. The aim of this prospective study was to detect HPV in cases of cutaneous extragenital Bowen's disease (BD) from non-immunosuppressed patients. PATIENTS AND METHODS: Twelve cases of cutaneous extragenital BD or Bowen's carcinoma (BC), seen in the period 1994-1996 and confirmed by histologic examination, were included in the study. Tissue sections were studied by in situ hybridization with a mixture of HPV DNA probes and specific HPV DNA probes. In addition, study on fresh materiel from 1995 included: Southern blot hybridization with various usual HPV probes (6, 11, 16, 18, 31, 33, 35, 39, 42), polymerase chain reaction (PCR) with hybridization using consensus HPV probes and probes specific for HPV types 6, 11, 16, 18 and 33. In positive samples with conventional PCR, in situ PCR with probes specific for HPV types 6/11 and 16 was performed on tissue sections. RESULTS: In situ hybridization was negative in all the cases. Southern blot hybridization was negative in our 9 studied cases. Three cases studied by consensus PCR were positive. PCR with specific HPV probes revealed positivity on two of these cases: HPV 6 in one, and HPV 16 in another. In situ PCR was positive with a mixed 6/11 HPV probe in the third positive consensus PCR case. DISCUSSION: Our study revealed the presence of HPV in 3 out of 12 cases of cutaneous extragenital BD and BC. HPV type 16, found in BC of skull, was the most usually found type in the literature. HPV types 6/11, detected in 2 cases, were rarely found in cutaneous extragenital BD and BC and these results are in favor of the oncogenic effect of these virus types. In our study, in situ hybridization and Southern blot hybridization were negative in all the cases; HPV was only found in 3 cases by conventional PCR and in 1 case by in situ PCR. The low range of detection of HPV in cutaneous extragenital BD may be due to the used methods, to difficulties related to sampling and/or to a low number of copies of the HPV genoma.


Assuntos
Doença de Bowen/virologia , Papillomaviridae/isolamento & purificação , Neoplasias Cutâneas/virologia , Idoso , Idoso de 80 Anos ou mais , Southern Blotting , Sondas de DNA , DNA Viral/análise , Feminino , Genes Virais , Humanos , Imunocompetência , Hibridização In Situ , Masculino , Papillomaviridae/genética , Reação em Cadeia da Polimerase , Estudos Prospectivos
11.
J Virol Methods ; 85(1-2): 117-24, 2000 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-10716345

RESUMO

The aim of this study was to determine whether multicentre quality controls for the detectability of viral genomes could contribute to the improvement of diagnostic performance in the participating laboratories. The study was carried out during two successive rounds, during which 18 laboratories specialized in nucleic acid testing analyzed, through a polymerase chain reaction (PCR) assay, a common panel of GB virus C (GBV-C)/hepatitis G virus (HGV) RNA-positive and -negative samples. During the first round, the laboratories used either an 'in-house' PCR procedure or a partly standardized commercial test. After decoding the results of the first round, the procedures of the participating laboratories were compared in order to establish a consensus procedure deduced from those of the laboratories which provided the best results. During the second round, each participating laboratory could use the resulting consensus procedure, or its own procedure, or both. The results of this quality control study indicated that, whatever method used, even specialized and trained laboratories may give false-negative or false-positive results. The commercial assay did not guarantee a systematic high quality level of results. The striking heterogeneity of results observed among laboratories using the same commercial assay confirm that molecular biology methods need skilled technicians. The results of this quality control study suggest that full standardization of viral genome detection, including all steps of the procedure, is necessary and that the laboratories performing PCR should participate in repeated quality control studies, whatever technique is being used.


Assuntos
Flaviviridae/genética , Genoma Viral , Hepatite Viral Humana/virologia , RNA Viral/análise , Hepatite Viral Humana/diagnóstico , Humanos , Reação em Cadeia da Polimerase/métodos , Valor Preditivo dos Testes , Controle de Qualidade , Sensibilidade e Especificidade , Estatísticas não Paramétricas
13.
J Virol Methods ; 79(2): 227-35, 1999 May.
Artigo em Inglês | MEDLINE | ID: mdl-10381092

RESUMO

The objective of the study was to compare the clinical sensitivity and specificity of versions 1.0 and 2.0 of the branched DNA (bDNA)-based hepatitis C virus (HCV) RNA quantification assay, and also to compare the values yielded by the two versions according to the HCV genotype. Serum samples from 268 patients tested routinely by a non-quantitative HCV RNA PCR assay (group A) were tested with version 2.0 of the bDNA assay. Samples from 342 HCV PCR-positive patients with chronic hepatitis C eligible for interferon treatment (group B) were tested with both version 1.0 and version 2.0 of the bDNA assay. Version 2.0 had a clinical sensitivity of 92% (95% confidence interval (CI): 87-97%) in group A and 89% (86-92%) in group B. In group B, the gain in sensitivity with bDNA 2.0 was 16% relative to bDNA 1.0 (P < 0.001). The log values of the two assays correlated with samples positive by both assays (r = 0.83, P < 0.0001), but the distribution of values was larger in samples containing HCV genotypes 2 and 3. The mean ratio of assay 2.0/assay 1.0 values was 1.69 +/- 1.44 (range: 0.33-13.43). The mean ratio was close to 1 with samples containing genotype 1 or 4, but ranged from 0.33 to more than 5. The mean ratio was close to 3 with samples containing genotype 2 or 3, and ranged from 0.5 to more than 13. HCV RNA levels were significantly lower in samples containing genotype 4 than in those containing other genotypes. Sera from 200 anti-HCV-negative, HCV RNA PCR-negative blood donors (group C), and from 164 anti-HCV-negative patients with symptoms of chronic liver disease (group D) were used to assess the clinical specificity of bDNA 2.0. In addition, samples with an HCV RNA titer between 0.2 (assay cutoff) and 0.5 MEq/ml from a group of 546 patients tested routinely for HCV RNA load by bDNA 2.0 (group E) were retested by bDNA 2.0 and by qualitative PCR. The specificity of bDNA 2.0 was 100% (98-100%) in group C and 99% (97-100%) in group D. Among the 41 samples from group E, 38 were positive by bDNA 2.0 retesting (36 were PCR-positive) and three were negative by bDNA 2.0 retesting (all were PCR-positive). It is concluded that version 2.0 of the bDNA assay is markedly more sensitive than version 1.0 and has a good specificity. In contrast with version 1.0, version 2.0 is not influenced by the HCV genotype. The relationship between values obtained with assays 1.0 and 2.0 on clinical specimens is not linear, indicating that HCV RNA titers cannot reliably be calculated from the results of version 1.0.


Assuntos
DNA Viral , Hepacivirus/genética , Hepatite C Crônica/virologia , Técnicas de Amplificação de Ácido Nucleico , RNA Viral/sangue , Genótipo , Hepatite C Crônica/sangue , Humanos , Kit de Reagentes para Diagnóstico , Sensibilidade e Especificidade
14.
Emerg Infect Dis ; 5(3): 429-32, 1999.
Artigo em Inglês | MEDLINE | ID: mdl-10341180

RESUMO

The first case of yellow fever in French Guiana since 1902 was reported in March 1998. The yellow fever virus genome was detected in postmortem liver biopsies by seminested polymerase chain reaction. Sequence analysis showed that this strain was most closely related to strains from Brazil and Ecuador.


Assuntos
Febre Amarela/epidemiologia , Vírus da Febre Amarela/genética , DNA Viral/análise , Evolução Fatal , Feminino , Guiana Francesa/epidemiologia , Humanos , Fígado/virologia , Filogenia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Análise de Sequência de DNA , Febre Amarela/virologia , Vírus da Febre Amarela/isolamento & purificação
15.
J Med Microbiol ; 47(7): 615-21, 1998 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-9839566

RESUMO

Chlamydia pneumoniae is a common respiratory tract pathogen. Serological methods currently used for the diagnosis of C. pneumoniae infection lack specificity, give ambiguous results from a single serum sample and often provide only a retrospective diagnosis. A prospective study was undertaken to assess whether PCR could be a useful addition to the serological techniques routinely practised for diagnosis. This study investigated 68 adult patients with a diagnosis of acute respiratory infection. Acute and convalescent serological determination of antibodies to C. pneumoniae were performed by means of an rELISA test and a micro-immunofluorescence (MIF) test. Nasopharyngeal aspirates or bronchoalveolar lavage specimens and bronchial aspirates obtained from the 68 patients were evaluated by PCR-enzyme immunoassay (PCR-EIA) for the presence of C. pneumoniae and by immunofluorescence assay and cell culture for virus identification. Mycoplasma pneumoniae serology was also performed. Eight patients (11.8%) were positive by either rELISA or PCR-EIA, or both, with an infection rate of 5 (18.5%) of 27 in patients with community-acquired pneumonia, 2 (9%) of 22 in asthmatic patients and 1 (5%) of 19 in patients with an exacerbation of chronic obstructive pulmonary disease. Serological evidence of acute infection was found in four of these patients with the rELISA test and in three others with the MIF test. PCR-EIA detected C. pneumoniae DNA in four specimens, but there were concordant results with both rELISA and PCR-EIA in only one patient A positive PCR-EIA was also obtained in a patient who did not show an antibody response in acute serum. The discrepancy between serological and PCR-EIA results reflects the difficulties in routine laboratory diagnosis of C. pneumoniae infection and the necessity for further studies with optimised techniques.


Assuntos
Infecções por Chlamydia/diagnóstico , Chlamydophila pneumoniae/isolamento & purificação , Infecções Respiratórias/diagnóstico , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antibacterianos/sangue , Asma/complicações , Brônquios/microbiologia , Líquido da Lavagem Broncoalveolar/microbiologia , Chlamydophila pneumoniae/genética , Chlamydophila pneumoniae/imunologia , Infecções Comunitárias Adquiridas/diagnóstico , DNA Bacteriano/análise , Ensaio de Imunoadsorção Enzimática , Feminino , Técnica Direta de Fluorescência para Anticorpo , Humanos , Técnicas Imunoenzimáticas , Masculino , Pessoa de Meia-Idade , Nasofaringe/microbiologia , Pneumonia Bacteriana/diagnóstico , Reação em Cadeia da Polimerase , Estudos Prospectivos , Sensibilidade e Especificidade
16.
J Fr Ophtalmol ; 21(8): 588-90, 1998 Oct.
Artigo em Francês | MEDLINE | ID: mdl-9833225

RESUMO

Whipple's disease is a multisystem bacterial disease usually characterized by malabsorption, diarrhea and polyarthritis. Ocular manifestations include uveitis, vitreitis, retinis, myositis, papilledema and optic atrophy. We report a case of a chronic bilateral vitreitis in a 63 year-old man who had been treated for a Whipple's disease with gastrointestinal involvement 30 years before. The jejunal biopsy was negative but the polymerase-chain-reaction (PCR) revealed the presence of Trophyrema Whippelii in the vitreous prelevement of both eye. This new, original strategy of PCR is specific and more sensitive than histological diagnosis.


Assuntos
Actinomyces/isolamento & purificação , Reação em Cadeia da Polimerase , Uveíte/diagnóstico , Corpo Vítreo/microbiologia , Doença de Whipple/diagnóstico , Actinomyces/genética , Biópsia , Diagnóstico Diferencial , Humanos , Jejuno/patologia , Masculino , Pessoa de Meia-Idade , RNA Ribossômico 16S/genética , Uveíte/microbiologia , Doença de Whipple/microbiologia
17.
Ophthalmology ; 105(10): 1891-6, 1998 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-9787360

RESUMO

OBJECTIVE: To report an unusual case of Whipple's disease, including uveitis, seronegative spondylarthropathy, meningitis, and lymphadenopathy, associated with an Arthrobacter sp. infection. DESIGN: Interventional case report. PATIENT AND INTERVENTION: A 60-year-old white man presenting with severe chronic uveitis and systemic inflammatory manifestations was treated efficiently for Whipple's disease after histopathologic analysis of vitreous and inguinal adenopathy biopsy specimens. The authors performed a retrospective, laboratory-based evaluation of stored tissue specimens. MEASUREMENTS: Molecular analysis based on 16S ribosomal RNA gene amplification was applied to pretreatment biopsy specimens of inguinal lymph node to identify a causative bacterial agent. RESULTS: Tropheryma whippelii genome was not detected in these specimens. However, an amplification product was obtained after the first polymerase chain reaction run and subsequently was sequenced. It corresponded to an Arthrobacter sp., a gram-positive agent presenting diagnostic patterns and therapeutic management similar to those of Whipple's disease caused by T. whippelii. CONCLUSION: The absence of T. whippelii identification by molecular amplification during a clinically and histologically oriented Whipple's syndrome should not rule out the diagnosis. Arthrobacter infection may represent a new bacterial etiology of systemic inflammatory disorders involving the eye and associated with periodic acid-Schiff-positive inclusions.


Assuntos
Arthrobacter/genética , Infecções por Bactérias Gram-Positivas/microbiologia , Antígeno HLA-B27/análise , Doenças Linfáticas/microbiologia , Meningites Bacterianas/microbiologia , Espondilite Anquilosante/microbiologia , Uveíte/microbiologia , Doença de Whipple/microbiologia , Doença Crônica , DNA Ribossômico/análise , Amplificação de Genes , Infecções por Bactérias Gram-Positivas/diagnóstico , Humanos , Linfonodos/microbiologia , Doenças Linfáticas/diagnóstico , Masculino , Meningites Bacterianas/diagnóstico , Pessoa de Meia-Idade , Reação do Ácido Periódico de Schiff , Reação em Cadeia da Polimerase , RNA Bacteriano/análise , RNA Ribossômico 16S/análise , Estudos Retrospectivos , Espondilite Anquilosante/diagnóstico , Uveíte/diagnóstico , Doença de Whipple/diagnóstico
18.
AIDS ; 12(9): 1047-56, 1998 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-9662202

RESUMO

OBJECTIVE: To investigate the impact of HIV infection on the prevalence, incidence and short-term prognosis of squamous intraepithelial lesions (SIL), in a prospective study with 1-year follow-up. METHODS: Between 1993 and 1995, 271 HIV-positive and 171 HIV-negative women at high risk of HIV infection were recruited, 365 (82.6%) of whom completed the 1-year follow-up. The women underwent a Papanicolaou smear test at inclusion and at 6 and 12 months. Human papillomavirus (HPV) was detected at inclusion by Southern blot and PCR. RESULTS: The SIL prevalence ranged from 7.5% for HIV-negative to 31.3% for HIV-positive women with CD4 cell counts < 500 x 10(6)/l (P < 0.001). Other factors associated independently and significantly with SIL prevalence were HPV-16, 18, 33 and related types, HPV-31, -35, -39 and related types, lifetime number of partners, younger age, past history of SIL and lack of past cervical screening. The SIL incidence ranged from 4.9% in HIV-negative women to 27% in HIV-positive women with CD4 cells < 500 x 10(6)/l (P < 0.001). Progression from low- to high-grade SIL during follow-up was detected in 38.1% of HIV-positive women with CD4 cells < or = 500 x 10(6)/l but in no HIV-negative nor HIV-positive women with CD4 cells > 500 x 10(6)/l. HPV-16, 18, 33 and related types were also associated with higher incidence of SIL and progression from low- to high-grade SIL. CONCLUSION: HIV-induced immunodeficiency is associated with high prevalence, incidence and persistence/progression of SIL. A pejorative influence of HIV infection without marked immunodeficiency is less clear. HIV-positive women with SIL may thus benefit from early treatment when a useful immune response is still present.


Assuntos
Infecções por HIV/complicações , Neoplasias de Células Escamosas/complicações , Neoplasias de Células Escamosas/epidemiologia , Displasia do Colo do Útero/complicações , Displasia do Colo do Útero/epidemiologia , Adulto , Feminino , Seguimentos , Humanos , Incidência , Prevalência , Prognóstico , Estudos Prospectivos , Fatores de Risco
19.
Sex Transm Infect ; 74(1): 32-4, 1998 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-9634298

RESUMO

OBJECTIVE: We assessed the clinical, histological, and virological features of anogenital human papillomavirus (HPV) infection, according to their immune status in HIV-1 infected men, referred for an anogenital examination or treatment, in comparison with immunocompetent patients. METHODS: The study population comprised 33 HIV-1 infected heterosexual or homosexual men and 38 HIV negative men seen in a screening and treatment centre for anogenital HPV infections. All patients were examined with a colposcope. Biopsies were carried out on all subjects with anogenital lesions for histological studies and HPV detection by Southern blot. RESULTS: The HIV infected patients had a balanopreputial HPV infection in 70%, anal in 30%, and urethral in 37%, while HIV negative patients had balanopreputial lesion in 72%, anal in 26%, and urethral in 16%. Diffuse anogenital lesions were present in 33% of the HIV infected cases and in 10.5% of HIV negative cases (p < 0.02). Among the HIV infected patients, the genital HPV lesions were condylomatous in 67.5% of the cases and dysplastic in 57%. HIV negative patients had condylomatous lesions in 86% of the cases and dysplasic in 14%. The condylomatous lesions of HIV infected patients had a low grade malignant histological aspect in 36% of the cases and high grade histological criteria were found in 22% of the dysplasias. Oncogenic HPVs were detected more frequently in HIV infected patients (35% v 12%) and more than one HPV type was found in 21.5% of cases. Neither the anogenital diffusion of the HPV lesions nor their morphological, histological, and virological features differed significantly in patient with CD4 cell counts > or < 200 x 10(6)/l. In contrast, patients with CD4 cell counts < 50 x 10(6)/l had a higher risk of several types of HPVs and of developing a diffuse anogenital infection. CONCLUSION: HIV-1 infected patients had an increased frequency of high grade anogenital dysplastic lesions and a higher frequency of HPV infection with multiple and diffuse sites of involvement. These characteristics of HPV infection were independent of the patients' immune status up to CD4 cell counts > 50 x 10(6)/l but showed an increased risk when the CD4 cell count was < 50 x 10(6)/l. The higher frequency of diffuse anogenital infections among HIV infected men calls for rapid treatment, laser or surgery, given the association of histological features of intraepithelial neoplasia and the presence of multiple HPV infection sites which may be the consequence of immune disturbances, most of which are transmissible potentially oncogenic HPVs.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/patologia , HIV-1 , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/patologia , Infecções Tumorais por Vírus/patologia , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Infecções Oportunistas Relacionadas com a AIDS/virologia , Adulto , Contagem de Linfócito CD4 , Condiloma Acuminado/imunologia , Condiloma Acuminado/patologia , Condiloma Acuminado/virologia , Humanos , Imunocompetência , Masculino , Pessoa de Meia-Idade , Papillomaviridae/classificação , Infecções por Papillomavirus/imunologia , Infecções por Papillomavirus/virologia , Infecções Tumorais por Vírus/imunologia , Infecções Tumorais por Vírus/virologia , Neoplasias Urogenitais/imunologia , Neoplasias Urogenitais/patologia , Neoplasias Urogenitais/virologia
20.
C R Acad Sci III ; 321(11): 941-51, 1998 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-9879471

RESUMO

The antiquity of tuberculosis in the Old World is controversial because the morphology of the lesion in skeletal remains is non-specific. We report the recovery of a DNA fragment from a 5,400-year-old Predynastic Egyptian skeleton that exhibits a kyphotic, 'hunchback' spinal deformity consistent with Pott's disease and suggestive of tuberculous vertebral involvement. The recovered DNA fragment was sequenced and is consistent with an original Mycobacterium sequence. We cannot prove that it is M. tuberculosis, M. bovis or an ancient mycobacteria resembling the two current forms because the observed modifications in the sequence could be attributed to the antiquity of Mycobacterium and/or to the effects of Taq polymerase. This provides the most specific evidence for the antiquity of human Mycobacterium disease in the world.


Assuntos
DNA Bacteriano/análise , Antropologia Forense , Mycobacterium/genética , Tuberculose da Coluna Vertebral/genética , Sequência de Aminoácidos , Sequência de Bases , Criança , Egito , Humanos , Dados de Sequência Molecular , Reação em Cadeia da Polimerase
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