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Pefloxacin was compared to erythromycin in the treatment of guinea pigs severely infected with Legionella pneumophila. In this experimental model, two single intraperitoneal injections of either pefloxacin (10 mg/kg at 48 h and 5 mg/kg at 55 h) or erythromycin (40 mg/kg at 48 and 55 h) were administered 48 h postinfection (2 × 107 virulent L. pneumophila intraperitoneally). Counts of bacteria in blood monocytes and lungs of animals killed at different times after the completion of treatment, demonstrated a quick and highly significant reduction of the pretreatment bacterial load in pefloxacin-treated guinea pigs. Conversely, in erythromycin-treated animals the number of bacteria was only slightly reduced 17 h after the completion of the treatment and then multiplication up to pre-treatment levels occurred. The overall mortality was significantly lower in pefloxacin-treated animals with this therapeutic protocol. The remarkable results of pefloxacin in this model, were obtained with serum and lung levels of this drug lower than those achieved in man with the currently accepted regimens. Thus, pefloxacin appears to be a new promising antimicrobial agent for Legionnaires' disease. [ABSTRACT FROM PUBLISHER]

Of 296 incidences of infectious endocarditis seen between 1971 and 1980, 29 cases of late prosthetic valve endocarditis (10%) occurred in 26 patients who had undergone valve replacement more than two months previously. The prosthesis was mitral in 8 cases, aortic in 9 cases, and multiple in 12 cases. The clinical picture consistently associated fever together with a regurgitation murmur in 12 cases (41%), a splenomegaly in 7 cases, a neurologic accident in 13 cases and other signs of endocarditis in 10 cases. Blood cultures were positive in 28 cases. The diagnosis was confirmed anatomically in 11 cases. Thirty-one causative agents were identified: 15 streptococci (48%), most of them were group D (11/15), 11 staphylococci (35%) 6 Staphylococcus aureus, 5 Staphylococcus coagulase negative and 5 other species. Two relapses and 3 recurrent infections were noted. The death rate was 58% with some factors being associated with a higher death rate: non-streptococcal microorganism (87%) regurgitation murmur (83%) cardiac failure with dysfunction of the prosthesis (89%) neurologic complication (91%). Eight valve replacements were performed within a mean period of 32 days after the onset of the antibiotherapy with a death rate of 75%. It decreased to 50% for patients treated with antibiotics alone, and as low as 23% for Streptococcal endocarditis. These results suggest that earlier and more frequent indications for cardiac valve replacement could be an alternative to improve the prognosis. [ABSTRACT FROM PUBLISHER]

The sensitivity of an indirect immunofluorescence antibody test (IFAT) and a rapid microagglutination test (RMAT) for the diagnosis of Legionnaires' disease caused by Legionella pneumophila serogroup 1 was evaluated using serum specimens from 119 patients with bacteriologically confirmed infections. The sensitivity of both assays was found to be about 80%. In addition, antibody titres suggestive of L pneumophila infection were found in 40% of patients in the first week after admission to hospital. These data show that both assays can be used with confidence in the early diagnosis of Legionnaires' disease. [ABSTRACT FROM PUBLISHER]

Reductions in the percentage and absolute number of CD4+ lymphocytes, as well as abnormally high levels of activated peripheral T lymphocytes (CD3+ HLA-DR+ phenotype) and an increased proportion of CD8+ cells coexpressing the CD57 surface antigen (involved in natural killer activity) have been reported in HIV infection and associated with disease progression. We prospectively measured these subsets of lymphocytes in 34 patients with advanced AIDS-related complex (ARC) treated with azidothymidine (AZT). Peripheral blood lymphocyte phenotyping was performed before treatment, then at weeks 12 and 24. A striking fall in the proportion of activated T lymphocytes from baseline was observed (P<0.001) at week 24. In contrast, the percentage of CD4 cells showed a slight and transient rise at week 12 (P<0.05). No modification in levels of CD8+ or CD8+ CD57+ cells was detected during the study. Of the 34 patients, 11 developed AIDS, and 23 remained AIDS-free during 51 weeks of follow-up. Similar patterns of change in CD4+ and HLA-DR+CD3+ lymphocytes were found in the AIDS progressors and nonprogressors. Likewise, HIV p24 antigenaemia showed parallel decreases in both groups of patients. Although changes in CD4+cells, p24 antigenaemia and HLA-DR-reactive T lymphocytes were not predictive of clinical outcome, large differences existed between the two groups prior to the initiation of therapy. The short-term onset of AIDS was associated with lower CD4+ cell numbers, higher levels of serum p24 antigen and a greater proportion of activated T lymphocytes. Our results suggest that the possible interest of T lymphocyte activation markers, in conjunction with conventional phenotyping, should be investigated further. [ABSTRACT FROM AUTHOR]

Two strains of Legionella pneumophila of different virulence were examined for their influence on the metabolic oxidative activity of human polymorphonuclear leukocytes. The leukocytes exhibited decreased rates of oxygen consumption and diminished chemiluminescence activity following phagocytosis of a virulent strain of L. pneumophila serogroup 1. In contrast, phagocytosis of its multipassaged derivative rendered avirulent, was accompanied by increased rates of both oxygen consumption and chemiluminescence activity. Although no differences were observed in oxygen uptake induced by the virulent legionellae compared to leukocytes at rest, statistically significant differences were observed in the chemiluminescence responses. These observations were not unexpected, since the luminol-enhanced chemiluminescence assay, is more sensitive than the oxygen uptake assay. In spite of decreased metabolic activity of PMN in the presence of virulent legionellae, electron microscope studies showed higher numbers of intracellular L. pneumophila than the avirulent subtype. Thus, virulent and avirulent L. pneumophila can be differentiated on the basis of oxygen consumption and chemiluminescence assays.

The central nervous system was examined in 135 adult AIDS patients who died between August 1982 and December 1990. Twenty two brains showed non-diagnostic changes including microglial nodules, discrete myelin pallor with reactive astrocytosis, mineralization of blood vessels and granular ependymitis. In 105 brains with specific changes, toxoplasmosis was the most frequent finding (55 cases) manifested by multifocal necrotic lesions or diffuse pseudo-encephalitic process. Other opportunists included cytomegalovirus (21 case), progressive multifocal leukoencephalopathy (1 cases), cryptococcosis (6 cases), mycobacterium avium intracellulaire (2 cases), varicella-zoster virus (2 cases), aspergillosis (1 case) and multiple bacterial microabscesses (1 case). Multinucleated giant cells were found in 52 cases. In 40 cases, they were widely disseminated throughout the brain and in 39 cases, they were associated with diffuse or multifocal white matter changes. Fifteen cases had a cerebral lymphoma, 9 hepatic encephalopathy, 1 centropontine myelinolysis and 1 focal pontine leukoencephalopathy. Three cases had a cerebral haemorrhage due to disseminated intravascular coagulation, antithrombin therapy and amyloid angiopathy. Spinal changes in 13 cases included vacuolar myelopathy (7 cases), HIV myelitis (1 case) and ganglio-radiculitis (1 cases), cytomegalovirus myelo-radiculitis (1 case) secondary spread from a lymphoma (1 case) and spinal infarcts due to disseminated intravascular coagulation (1 case). These lesions were frequently atypical and various combinations of all these pathologies were encountered in the same brain, sometimes in the same area and occasionally in the same cell. Chronological variations in the incidence of some complications could be related to changes in treatment.

Two immunocompromised children, aged 3 years and 1 1/2 month, developed an hospital-acquired Legionnaire's disease. In one case, Legionella pneumophila serotype 1 was identified by culture in pleural fluid; LP1 was isolated in all the warm water samples in the hospital. Clinical, epidemiological data and laboratory findings are discussed.

A case of Lyme disease with purely neurological manifestations is reported in an 11 year-old girl. Positive blood and cerebrospinal fluid serology allowed for diagnosis. Treatment with Penicillin led to favourable outcome. Atypical manifestations and treatment of Lyme disease are reviewed.

Forty-three immunosuppressed patients presenting with varicella or generalized herpes zoster were treated with adenine arabinoside (as monophosphate in 10 patients). All those who received the recommended 5-day course were rapidly cured without relapse; the skin lesions were virus-free after the 5th days of treatment. Five patients with malignant varicella involving several organs and who had only been treated for a few hours died. It is concluded that adenine arabinoside is a useful drug in VZ virus infections, although it has no immediate action. The monophosphate presentation, more soluble and requiring lesser amounts of solvent, is easier to administer and as effective as the ordinary presentation.

During the summer of 1980, 3 sporadic cases of Legionnaires disease (ML) were recognized in the northern suburbs of Paris. The clinical picture was characterized by an extensive pneumonia, high fever with repeated rigors (3 cases), a confusional state (2 cases), and transitory watery diarrhea (3 cases). Blood cultures, evidence of bacterial antigens in blood or urine, and serology notably for chlamydia and mycoplasma pneumoniae were all negative. The diagnosis of ML (serotype I) was confirmed by serology using indirect immunofluorescence against Legionella pneumophila (LP) with an antigen prepared by Taylor. In one patient treated early with erythromycin (4 g/day), there was a quick and favorable response. Two other patients died, and in their case erythromycin therapy was started late. At necropsy, the lesions were solely thoracic, and were characterized by an alveolitis with many macrophages, and intense leukocytosis, and rich in fibrin; in one case, extensive fibrosis was noted; in the other, LP was diagnosed by direct and indirect immunofluorescence on a lung specimen. In the pneumology department of Hôpital Avicenne, two other patients with acute pneumonias and similar clinical and radiological pictures had elevated titres to LP (1/64), but they did not rise or fall. The diagnosis of ML is probably nevertheless, particularly as the serology was negative for both Mycoplasma pneumoniae and the Chlamydias. Two of the three cases presented were among seventeen acute febrile pneumonias admitted to the pneumology department of Hôpital Avicenne between the 1st of July and the 1st of October 1980, showing the relative frequency of this infection.

The first case of legionnaires' disease indigenous to France is reported. Since rapid bacteriological and/or serological diagnostic procedures are lacking, the disease should be suspected clinically in patients presenting with febrile pneumonia typically associated with neurological, digestive and renal disorders. Antibiotic treatment with erythromycin should be initiated as early as possible.