Chronic Q fever: diagnosis and follow-up

Sera from 40 patients (25 men, and 15 women) with clinical features compatible with the diagnosis of chronic Q fever were received. Total or partial clinical data were available. All of them had serological evidence of chronic Q fever (IgG class anti-phase I titer greater than 800). The final diagnosis was vascular infection in four cases (with two positive cultures for Coxiella burnetii), bone infection in two patients (one positive culture), chronic hepatitis in one patient, and endocarditis in 32. The last patient had an isolated fever with a chronic Q fever serologic profile. Among the 32 with endocarditis, valve replacement was performed in 59%, and valve cultures were positive in 14/18 patients. Twenty-nine of these patients had previously known valvulopathy; 23 were exposed to cattle, sheep or goats; and four had an immunocompromised situation. Ten patients died; two before any treatment, five of cardiac failure during or a few weeks after surgery, and three during the medical treatment. For antibiotic treatment, tetracycline alone was employed in seven cases. For the other patients, combined therapy including tetracycline and another drug (rifampin, fluoroquinolones, cotrimoxazole, or erythromycin) was initiated. Three patients were considered to be completely cured.

[Treatment of idiopathic thrombocytopenic purpura and thrombocytopenia associated with the HIV virus using anti-Rhesus immunoglobulins]

Fourteen Rhesus-positive patients with idiopathic thrombocytopenic purpura or thrombocytopenia associated with human immunodeficiency virus (HIV) infection were treated with intravenous Rhesus antibodies. The mean total dose was 6,800 micrograms administered over a 3 to 6 days' period. A significant rise in platelet count was observed in 13 of the 14 Rhesus-positive patients, but not in 3 Rhesus-negative patients used as controls. This rise was usually transient, lasting less than 3 weeks, but it persisted for more than 3 months in 2 cases. Treatment was well tolerated; transient signs of haemolysis appeared in 11 patients who did not require transfusion. Rhesus antibodies are quick-acting, the number of platelets being doubled as early as the second day of treatment. Interaction between antibody-coated red blood cells and macrophages is a possible mode of action and a feasible therapeutic approach in selected patients with autoimmune of HIV-mediated thrombocytopenia.

[Extreme hypogammaglobulinemia disclosing large granular lymphocytes with hepatosplenorenal infiltration]

We report a case of large granular lymphocytosis, or chronic "natural killer" lymphocytosis, a newly described entity. We were able to demonstrate the proliferative character of the disease by the finding of karyotype abnormalities. This case was remarkable for the pre-existence, for at least three years, of severe hypogammaglobulinaemia, for the very slow course of the proliferative process and for the progressive and tumoral infiltration of the spleen and liver, then kidney.

[Cerebral abscess. Analysis of 41 cases over a 10-year period]

Although treatment with antibiotics and computerized tomography (CT) of the brain have considerably improved the prognosis of intracranial purulent collections, brain abscess remains a lethal disease in about one out of ten cases. We present a series of 41 brain abscesses diagnosed between 1976 and 1986 and treated surgically. The clinical signs were more often neurological than infectious. Among the exploratory methods, only CT has a real diagnostic value. Treatment is both medical and surgical. Simple aspiration seems to have the triple advantage of producing prompt and effective decompression of brain tissue, enabling the pathogen(s) to be isolated so that the appropriate antibiotic can be chosen, and being a repeatable and little traumatic procedure with less sequelae than surgical excision.

[Plasma lactoferrin and the blood count of polynuclear neutrophils]

Plasmatic lactoferrin measure (LF) by immuno-enzymatic technique combined with neutrophil blood count (PN) on 100 subjects (controls and patients) allows us to show a LF increase proportional to circulating blood neutrophils. In neutropenia, plasmatic lactoferrin measure seems able to divide the central causes from the peripheric ones. Regarding the granulocytosis, LF levels are clearly higher in myeloproliferative diseases than in other causes. Lactoferrin could therefore represent an index of total circulating neutrophil pool but also seems to reflect the granulocyte activation.