Search

Out of 11 patients suffering from Mycobacterium xenopi lung disease, 9 were treated with an empiric antituberculous triple chemotherapy until specific identification and antibiogram were available. Despite the important ''in vitro'' resistance to drugs, most of the patients improved; in the other patients, the impairment was always due to the underlying pathology. We conclude that the ''in vivo'' response of M. xenopi infections to antituberculous drugs is little influenced by the ''in vitro'' sensitivity.

SCOPUS: ar.j, info:eu-repo/semantics/published

Background. We studied the efficacy of a short-course regimen of chemotherapy for pulmonary tuberculosis in Kinshasa, Zaire. We also assessed whether, among patients with human immunodeficiency virus (HIV) infection, treatment should be extended from 6 to 12 months. Methods. HIV-seropositive and HIV-seronegative outpatients with pulmonary tuberculosis were treated with rifampin, isoniazid, pyrazinamide, and ethambutol daily for two months, followed by rifampin plus isoniazid twice weekly for four months. The HIV-positive patients who had no evidence of tuberculosis were then randomly assigned to receive either rifampin plus isoniazid or placebo twice weekly for a further six months. We also followed a comparison group of HIV-seronegative patients who received no further treatment for tuberculosis after six months. Results. After six months, 260 of 335 HIV-seropositive and 186 of 188 HIV-seronegative participants could be evaluated, and their rates of treatment failure were similar: 3.8 and 2.7 percent, respectively. At 24 months, the HIV-seropositive patients who received extended treatment had a relapse rate of 1.9 percent, as compared with 9 percent among the HIV-seropositive patients who received placebo for the second 6 months (P<0.01). Extended treatment did not improve survival, however. Among the HIV-seronegative patients, 5.3 percent relapsed. Conclusions. Among HIV-seropositive patients with pulmonary tuberculosis, extending treatment from 6 to 12 months reduces the rate of relapse but does not improve survival. The six-month program of partly intermittent antituberculous treatment may be an acceptable alternative when resources are limited.

Tuberculosis (TB) is the most common opportunistic infection in African patients who die from AIDS, yet the stage of immunodeficiency at which TB develops is uncertain. We studied the immune status of HIV-infected outpatients with pulmonary TB in relation to their clinical presentation in a cross-sectional study of 216 HIV-seropositive and 146 HIV-seronegative ambulatory incident cases of smear-positive and culture-positive pulmonary TB in Kinshasa, Zaire. HIV-seropositive and seronegative patients had median CD4 lymphocyte counts of 316.5/muL and 830.5/muL, respectively. Of the HIV-seropositive patients, 32 9% had less than 200 CD4 lymphocytes/muL, 37% between 200 and 499, and 30.1% 500 or more. Clinical AIDS, as defined by the WHO clinical case-definition ora modified version, was of similar limited use as a predictor of immunodeficiency. Among HIV-seropositive patients, oral candidosis, lymphopenia, a negative tuberculin purified protein derivative test, and cutaneous anergy were strongly associated with CD4 counts of less than 200/muL, and seemed to be better markers of immune dysfunction. We conclude that pulmonary TB develops across a broad spectrum of HIV-induced immunodeficiency and that a diagnosis of pulmonary TB is of limited use as a marker of stage of HIV disease in African HIV-infected outpatients.

We report the observation of a cutaneous, pulmonary and osseous nocardiosis in a 45-year-old man. He was iatrogenously immunocompromised because of a "self-medication" with 32 mg per day of methylprednisolone during 30 months for gouty arthropathies. Under treatment with several antibiotics, a favourable evolution was obtained.

We report the observation of a cutaneous, pulmonary and osseous nocardiosis in a 45-year-old man. He was iatrogenously immunocompromised because of a ''self-medication'' with 32 mg per day of methylprednisolone during 30 months for gouty arthropathies. Under treatment with several antibiotics, a favourable evolution was obtained.

Propionic acid producing strains of Corynebacterium minutissimum were isolated from three patients with opportunistic infections. One neutropenic patient was undergoing chemotherapy for prolymphocytic leukemia; the other two patients were undergoing hemodialysis and peritoneal dialysis respectively. An unusual feature of these three strains was their resistance to several antibiotics, which is seldom seen in diphtheroids other than Corynebacterium jeikeium and CDC group D2.

Liver abscess is a rare complication of Crohn's disease. The authors describe a case of liver abscess associated with inactive regional enteritis which recovered completely under antibiotic treatment alone.

Serum fructosamine was determined in 115 diabetic patients with a C-Peptide secretion (0.84 +/- 0.06 pmol/ml, mean +/- SEM) (Group A) and in 30 type I C-peptide negative totally insulin-dependent subjects (less than 0.05 pmol/ml) (Group B). A significant correlation between fructosamine and HbA1 values (r = 0.70, p less than 0.001) was evidenced in Group A. In contrast, such a correlation was not found in Group B (r = 0.33, p greater than 0.05). Fructosamine levels were also in good agreement with the physician's ratings of the degree of glycemic control in Group A, but not in Group B. It is concluded that the fructosamine measurement represents a complement rather than an alternative to HbA1, in particular in unstable diabetic patients.

We conducted a study to determine the safety of guidewire exchange of central venous catheters suspected of causing catheter-related sepsis (CRS). Out of a total of 146 patients studied prospectively 41 (28%) suspected of having CRS, were randomly allocated to have their catheters changed over a guidewire (group I) or replaced by a new contralateral venipuncture (group II). One hundred and five patients (group III) requiring only one catheterization served as a control group. Positive semiquantitative cultures (greater than or equal to 15 colonies per plate) of the catheter tip constituted a reliable index of CRS (positive and negative predictive value of 100%). No significant difference in catheter contamination rate and CRS rate was found between group I and II (p = 0.13) and between group I and II versus group III. Nevertheless, there were fewer problems of insertion in the guidewire group (p = 0.03). We conclude that changing a central venous catheter over a guidewire is as safe and has better patient acceptability than inserting a new one, as the proven CRS rate is low (2%) despite a high (27%) suspected rate.