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ABSTRACT: We report a case of Pasteurella dagmatis wound infection in an immunocompromised HIV infected patient after bite by a marine carnivore in Caribbean Sea (Dominican Republic), presumably a muraenidae. Identification of the Pasteurella species from wound sampling was obtained twice by mass spectrometry and confirmed by 16S RNA sequencing.
Travel Medicine and Infectious Disease 04/2013; · 1.50 Impact Factor
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ABSTRACT: The present study evaluated the efficacy of intermittent antiviral treatment administered to HIV-infected patients under stepwise reductions in weekly medication. Forty-eight patients were invited to reduce their antiviral medication to 5 consecutive days per week; after control over HIV activity was ascertained, antiviral drugs were cut to 4 consecutive days per week. Of the 48, 39 then reduced medicines further to 3 d, and 12 of those eventually undertook a 2 d/wk schedule. Clinical and immunological status and plasma HIV load were repeatedly monitored. HIV was unremittingly maintained below detection levels in all patients under either 5- or 4-d/wk treatment regimens, for a mean 56 +/- 40 wk/patient (5-d regimen) and 84 +/- 46 wk/patient (4-d regimen). Of the 39 patients under 3-d regimens, 35 maintained optimal control over HIV activity for a mean 50 +/- 32 wk, as did 10 of the 12 under 2-d regimens, for 24 +/- 10.5 wk. Summing up treatment < or = 5 d/wk, plasma HIV remained below detection levels for a cumulative 8895 wk (170 patient-yr). No major HIV-related clinical event was reported. and CD4(+)T-cell counts and percentages readily increased over the last value noted under the 7-d treatment course. Viral failure was documented in 6 of the 48 patients: 4 under a 3-d/wk regimen, 2 under a 2-d/wk regimen. All 6 patients had their treatment swiftly set back to a 7-d/wk regimen, resulting in rapid control over HIV replication. In summary, intermittent antiretroviral regimens optimally suppressed HIV in patients taking antiviral medicines 5 and 4 d/wk, as well as in a substantial proportion of patients under 3- or 2-d/wk antiviral regimens, reducing both expenses and, possibly, drug toxicity. Controlled prospective clinical trials are warranted before considering short weekly cycles of antiretroviral medicines an alternative in the management of chronically HIV-infected patients.
The FASEB Journal 06/2010; 24(6):1649-55. · 5.71 Impact Factor
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ABSTRACT: Pregnancies in spinal cord-injured (SCI) patients present unique clinical challenges. Because of the neurogenic bladder and the use of intermittent catheterization, chronic bacteriuria and recurrent urinary tract infection (UTI) is common. During pregnancy the prevalence of UTI increases dramatically. Recurrent UTI requires multiple courses of antibiotics and increases the risks of abortion, prematurity, and low birth weight. A weekly oral cyclic antibiotic (WOCA) program was recently described for the prevention of UTI in SCI patients.
To test the impact of WOCA in six SCI pregnant women (four paraplegic, two tetraplegic).
This was a prospective observational study. WOCA consists of the alternate administration of one of two antibiotics once per week.
We observed a significant reduction of UTI (6 UTI/patient/year before pregnancy to 0.4 during pregnancy and under WOCA; p<0.001) and no obstetric complications. Infant outcomes were good.
The WOCA regimen could be useful for UTI prophylaxis in SCI pregnant women.
International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 12/2008; 13(3):399-402. · 2.17 Impact Factor
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ABSTRACT: Cat-scratch disease, primarily caused by Bartonella henselae, typically presents with regional adenopathy, and the role of antibiotics in the treatment is debatable. We present a report of B. henselae infection transmitted by the same kitten to 4 different individuals, each with different clinical characteristics, treatment, and evolution.
Scandinavian Journal of Infectious Diseases 02/2007; 39(8):728-30. · 1.72 Impact Factor
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ABSTRACT: Spinal cord injury (SCI) patients with neurogenic bladder have an increased risk for symptomatic urinary tract infection (UTI). Recurrent UTI requires multiple courses of antibiotic therapy, markedly increasing the incidence of multidrug-resistant (MDR) bacteria.
During an observational prospective study, we determined the safety and efficacy of a weekly oral cyclic antibiotic (WOCA) regimen to prevent UTI in SCI adult patients with neurogenic bladder undergoing clean intermittent catheterization. The WOCA regimen consisted of the alternate administration of an antibiotic once per week over a period of at least 2 years. The antibiotics chosen were efficient for UTI, well tolerated and with low selection pressure.
There was a significant decrease in antimicrobial consumption linked to the dramatic decrease in the incidence of UTI. Before intervention, there were 9.4 symptomatic UTIs per patient-year, including 197 episodes of febrile UTI responsible for 45 hospitalizations. Under the WOCA regimen there were 1.8 symptomatic UTIs per patient-year, including 19 episodes of febrile UTI. No severe adverse events and no new cases of colonization with MDR bacteria were reported.
In this prospective, observational pilot study a novel approach to the prevention and treatment of UTI in SCI was investigated. Our study shows the benefit of WOCA in preventing UTI in SCI patients.
Journal of Antimicrobial Chemotherapy 05/2006; 57(4):784-8. · 5.07 Impact Factor
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ABSTRACT: Surveillance activities first target health problems for which treatment, effective prevention or control measures are available. The data produced by surveillance systems allow prioritising public health actions and defining the objectives of infectious diseases control or prevention. The surveillance of infectious diseases relies on a large number of partners grouped in a public health network in which clinicians have a prominent role. In France, the surveillance of infectious diseases is based on mandatory notification of some diseases, national reference centers, networks of voluntary health professionals and repeated surveys, alerting health authorities in case of threats and identifying the determinants of changes in the population health's status. At hospital, the infectious risk is significant and the risk of epidemic outbreaks very high. A solid system for surveillance is mandatory. An educational program is needed to define the prevention program based on the use of hand disinfection and other standard precautions, antiviral and pneumococcal vaccination. A strong cooperation between general practitioners, healthcare team and relatives is necessary.
La Revue du praticien 12/2005; 55(18):2003-13.
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Louis Bernard,
Anne Lübbeke,
Richard Stern,
Jean Pierre Bru,
Jean Marc Feron,
Dominique Peyramond,
Philippe Denormandie,
Cedric Arvieux,
Catherine Chirouze, Christian Perronne,
Pierre Hoffmeyer
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ABSTRACT: The diagnosis of a prosthetic joint infection is difficult, but crucial for appropriate treatment. Scintigraphy with specific markers for infection (labelled white cells or immunoglobulin-G) has been reported as a more reliable diagnostic tool than clinical assessment (fever, fistula), laboratory studies (polynuclear neutrophil count, erythrocyte rate sedimentation, and C-reactive protein), and preoperative aspiration. In the first part of this study, we retrospectively reviewed 230 patients admitted with a suspected prosthetic joint infection, and examined the validity of the different diagnostic tools for the group as a whole and for subgroups according to the Coventry classification. In the second part, we reviewed 35 articles about preoperative evaluation of infection in prosthetic joints and compared them to our findings. Our study indicates that C-reactive protein and joint aspiration are the most useful tools to diagnose prosthetic joint infection even in situations of chronic infection (Coventry type II).
Scandinavian Journal of Infectious Diseases 02/2004; 36(6-7):410-6. · 1.72 Impact Factor
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Clinical Infectious Diseases 10/2003; 37(6):860; author reply 860-1. · 9.15 Impact Factor
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Louis Bernard,
Albert Vuagnat,
Gilles Peytavin,
Marie-Charlotte Hallouin,
Damien Bouhour,
Thu Huyen Nguyen,
Jean Louis Vildé,
François Bricaire,
Gilles Raguin,
Pierre de Truchis,
David Ghez,
Michel Duong, Christian Perronne
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ABSTRACT: Suboptimal levels of antiretroviral drugs result in virologic failure in HIV-infected patients treated with highly active antiretroviral therapy (HAART).
To assess the relationship between levels of indinavir in hair and virologic outcome.
Cross-sectional study.
7 AIDS clinics in France.
89 HIV-infected patients who received HAART that included indinavir.
Patients were classified as responders or nonresponders on the basis of viremia at the time of hair collection. In nonresponders, levels of indinavir in hair and resistance mutations in the protease gene were assessed at baseline and at the time of indinavir measurement.
Mean indinavir levels (+/-SD) were significantly higher in the 65 responders than in the 24 nonresponders (24.4 +/- 16 microg/g vs. 12.9 +/- 8.6 microg/g) (P < 0.001). Nonresponders with intermediate levels of indinavir in hair had more mutations in the protease gene than did nonresponders with low levels of indinavir in hair.
Indinavir levels in hair are associated with virologic outcome in patients receiving HAART.
Annals of internal medicine 11/2002; 137(8):656-9. · 16.73 Impact Factor
