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Coustal C, Goulabchand R, Labauge P, Guilpain P, Carra-Dallière C, Januel E, Jeziorski E, Salle V, Viallard J, Boutboul D, Fieschi C, Gobert D, Aladjidi N, Rullier P, Graveleau J, Piel-Julian M, Suarez F, Neven B, Mahlaoui N, Ayrignac X. Atteintes neurologiques multifacettes des déficits en CTLA4 : étude observationnelle nationale. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Fieschi C, Viallard JF. [Common variable immunodeficiency disorders: Updated diagnostic criteria and genetics]. Rev Med Interne 2021; 42:465-472. [PMID: 33875312 DOI: 10.1016/j.revmed.2021.03.328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 02/26/2021] [Accepted: 03/21/2021] [Indexed: 12/24/2022]
Abstract
Common variable immunodeficiency disorders (CVID) are a heterogeneous group of conditions with hypogammaglobulinemia as the common denominator. These are the most common symptomatic primary immunodeficiency disorder in adults. Two different clinical forms are described: one group only develops infections, while a second includes (sometimes without infections, at least at the onset of disease course) a variety of non-infectious autoimmune, inflammatory, granulomatous and/or lymphoproliferative manifestations, sometimes revealing the disease and often observed in Internal Medicine. The international diagnostic criteria for CVID were updated in 2016 and are the subject of several comments in this general review. The recent use of new sequencing techniques makes it possible to better genetically define CVID. The identification of such a genetic disease makes it possible to treat pathophysiologically, in particular autoimmune and lymphoproliferative complications, with targeted treatments, sometimes used in other diseases. Determining a genetic disease in these patients also makes it possible to provide appropriate genetic counseling, and therefore to monitor mutated individuals, symptomatic or not.
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Affiliation(s)
- C Fieschi
- Département d'immunologie, Assistance Publique hôpitaux de Paris (AP-HP), Université de Paris, Paris, France; Inserm U976, institut de recherche Saint-Louis, hôpital Saint-Louis, centre constitutif déficit immunitaire chez l'adulte, CEREDIH, Paris, France
| | - J-F Viallard
- Service de médecine interne et maladies infectieuses, hôpital Haut-Lévêque, CHU de Bordeaux, 5, avenue de Magellan, 33604 Pessac, France; Université de Bordeaux, Bordeaux, France.
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Viallard JF, Lebail B, Begueret H, Fieschi C. [Common variable immunodeficiency disorders: Part 2. Updated clinical manifestations and therapeutic management]. Rev Med Interne 2021; 42:473-481. [PMID: 33516581 DOI: 10.1016/j.revmed.2020.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 12/04/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
Common variable immunodeficiency disorders (CVID) are the most common symptomatic primary antibody deficiency in adults with an estimated prevalence of 1/25,000. The most frequent clinical manifestations are upper respiratory tract infections (including pneumonia, bronchitis, and sinusitis) predominantly with Streptococcus pneumoniae or H. influenzae. However, CVID are complicated in 20 to 30 % of cases of non-infectious manifestations which have been well characterized in recent years. Several complications can be observed including autoimmune, lymphoproliferative, granulomatous or cancerous manifestations involving one or more organs. These complications, mostly antibody-mediated cytopenias, are correlated with a decrease in the number of circulating switched memory B cells. Replacement therapy with polyvalent gammaglobulins has greatly improved the prognosis of these patients but it remains poor in the presence of digestive complications (especially in the case of chronic enteropathy and/or porto-sinusoidal vascular disease), pulmonary complications (bronchiectasis and/or granulomatous lymphocytic interstitial lung disease) and when progression to lymphoma. Much progress is still to be made, in particular on the therapeutic management of non-infectious complications which should benefit in the future from targeted treatments based on knowledge of genetics and immunology.
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Affiliation(s)
- J F Viallard
- Service de médecine interne et maladies infectieuses, hôpital Haut-Lévêque, CHU de Bordeaux, 5, avenue de Magellan, 33604 Pessac, France; Université de Bordeaux, Bordeaux, France.
| | - B Lebail
- Université de Bordeaux, Bordeaux, France; Service d'anatomopathologie, hôpital Pellegrin, place Amélie-Rabat-Léon, 33076 Bordeaux, France
| | - H Begueret
- Service d'anatomopathologie, CHU Bordeaux, hôpital Haut-Lévêque, 5, avenue de Magellan, 33604 Pessac, France
| | - C Fieschi
- Département d'immunologie, université de Paris, AP-HP, France; INSERM U1126, centre Hayem, hôpital Saint-Louis, Paris, France
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guillet S, Loustau V, Zarour A, Boutin E, Comont T, Odile S, Costedoat-Chalumeau N, Pan-Petesch B, Gobert D, Cheze S, Jean-François V, Morin A, Sauvetre G, Cliquennois M, Royer B, Masseau A, Terriou L, Fieschi C, Michel M, Godeau B. Évolution du purpura thrombopenique immunologique pendant la grossesse : Résultats d’une étude cas-contrôles observationnelle prospective multicentrique. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Delestre F, Fieschi C, Fusaro M, Battistella M, Jachiet M. Hémophagocytose et albinisme partiel révélant un syndrome de Griscelli de type 2 chez une patiente de 67 ans. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Guillet S, Loustau V, Zarour A, Boutin E, Comont T, Odile S, Costedoat-Chalumeau N, Pan-Petesch B, Gobert D, Cheze S, Jean-François V, Morin A, Sauvetre G, Cliquennois M, Royer B, Masseau A, Terriou L, Fieschi C, Michel M, Godeau B. Facteurs de risques de thrombopénie immunologique néonatale chez les nouveau-nés de femmes atteintes de purpura thrombopénique immunologique : résultats d’une étude multicentrique prospective. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mahévas T, Bertinchamp R, Battistella M, Reygagne P, Oksenhendler E, Fieschi C, Bachelez H. Efficacy of oral sirolimus as salvage therapy in refractory lichen planus associated with immune deficiency. Br J Dermatol 2018; 179:771-773. [DOI: 10.1111/bjd.16555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- T. Mahévas
- Dermatology Department; AP-HP Hôpital; Saint-Louis, Paris France
| | - R. Bertinchamp
- Clinical Immunology Department; AP-HP Hôpital; Saint-Louis, Paris France
| | - M. Battistella
- Pathology Department; AP-HP Hôpital; Saint-Louis, Paris France
- Sorbonne Paris Cité Université Paris Diderot; Paris France
| | - P. Reygagne
- Sabouraud Center; Saint-Louis Hospital; Paris France
| | - E. Oksenhendler
- Clinical Immunology Department; AP-HP Hôpital; Saint-Louis, Paris France
- Sorbonne Paris Cité Université Paris Diderot; Paris France
| | - C. Fieschi
- Clinical Immunology Department; AP-HP Hôpital; Saint-Louis, Paris France
- Sorbonne Paris Cité Université Paris Diderot; Paris France
| | - H. Bachelez
- Dermatology Department; AP-HP Hôpital; Saint-Louis, Paris France
- Sorbonne Paris Cité Université Paris Diderot; Paris France
- UMR INSERM 1163; Institut Imagine; Hôpital Necker; Paris France
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Ferrari M, Zanette E, Sideri G, Giannini I, Fieschi C, Carpi A. Effects of Carotid Compression, as Assessed by near Infrared Spectroscopy, upon Cerebral Blood Volume and Haemoglobin Oxygen Saturation. J R Soc Med 2018; 80:83-7. [PMID: 3560151 PMCID: PMC1290676 DOI: 10.1177/014107688708000208] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Near infrared spectroscopy, a recently developed optoelectronic technique, has been studied as a possible method of monitoring the adequacy of cerebral perfusion in 22 patients who were candidates for carotid endarterectomy. Using this technique, changes in haemoglobin volume, haemoglobin oxygen saturation and redox level of cytochrome-coxidase were recorded from the frontoparietal region during routine carotid compression tests performed under continuous electroencephalographic (EEG) monitoring. A highly significant association was found between EEG slowing, indicating impaired cerebral function, and a fall in haemoglobin volume and oxygen saturation, indicating a reduced blood and oxygen supply to the brain (Fisher exact test, P < 10−5). In a few tests haemoglobin volume and oxygen saturation were reduced without changes in the EEG recording. This study raises new issues concerning the compensatory mechanisms taking place during carotid occlusion and suggests that near infrared spectroscopy might be useful in monitoring the blood and oxygen supply to the brain during carotid endarterectomy.
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Seta V, Saussine A, Galicier L, Fieschi C, Bagot M, Bouaziz JD, Rybojad M. Lésions cutanées type Crohn associées au syndrome lymphoprolifératif lié à l’X de type 2. Ann Dermatol Venereol 2016. [DOI: 10.1016/j.annder.2016.09.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Crickx E, Goulabchand R, Fieschi C, Galicier L, Coppo P, Delarue R, Moulis G, Michel M, Haioun C, Godeau B, Gaulard P, Mahevas M. Caractéristiques cliniques, évolution et prise en charge des cytopénies auto-immunes associées aux lymphomes T de type LAI : une étude multicentrique rétrospective comparative. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Salvetti M, Ristori G, Fiori P, Buttinelli C, Fieschi C, Pozzilli C, Battistini L, Brosnan C. V-delta2+ gamma/delta T cells directly recognize 70-kD heat shock proteins: relevance to MS. Mult Scler 2016. [DOI: 10.1177/135245859600200513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- M Salvetti
- Department of Neurological Sciences, University of Rome ‘La Sapienza’, v.le del'Università 30, 00185-Rome, Italy
| | - G Ristori
- Department of Neurological Sciences, University of Rome ‘La Sapienza’, v.le del'Università 30, 00185-Rome, Italy
| | - P Fiori
- Department of Neurological Sciences, University of Rome ‘La Sapienza’, v.le del'Università 30, 00185-Rome, Italy
| | - C Buttinelli
- Department of Neurological Sciences, University of Rome ‘La Sapienza’, v.le del'Università 30, 00185-Rome, Italy
| | - C Fieschi
- Department of Neurological Sciences, University of Rome ‘La Sapienza’, v.le del'Università 30, 00185-Rome, Italy
| | - C Pozzilli
- Department of Neurological Sciences, University of Rome ‘La Sapienza’, v.le del'Università 30, 00185-Rome, Italy
| | - L Battistini
- Department of Neurological Sciences, University of Rome ‘La Sapienza’, v.le del'Università 30, 00185-Rome, Italy
| | - C Brosnan
- Department of Neurological Sciences, University of Rome ‘La Sapienza’, v.le del'Università 30, 00185-Rome, Italy
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Audemard-Verger A, Descloux E, Ponard D, Deroux A, Fantin B, Fieschi C, John M, Bouldouyre A, Karkowsi L, Moulis G, Auvinet H, Valla F, Lechiche C, Davido B, Martinot M, Biron C, Lucht F, Asseray N, Froissart A, Buzelé R, Perlat A, Boutboul D, Fremeaux-Bacchi V, Isnard S, Bienvenu B. Infections Revealing Complement Deficiency in Adults: A French Nationwide Study Enrolling 41 Patients. Medicine (Baltimore) 2016; 95:e3548. [PMID: 27175654 PMCID: PMC4902496 DOI: 10.1097/md.0000000000003548] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Complement system is a part of innate immunity, its main function is to protect human from bacterial infection. As genetic disorders, complement deficiencies are often diagnosed in pediatric population. However, complement deficiencies can also be revealed in adults but have been poorly investigated. Herein, we describe a case series of infections revealing complement deficiency in adults to study clinical spectrum and management of complement deficiencies.A nationwide retrospective study was conducted in French university and general hospitals in departments of internal medicine, infectious diseases enrolling patients older than 15 years old who had presented at least one infection leading to a complement deficiency diagnosis.Forty-one patients included between 2002 and 2015 in 19 different departments were enrolled in this study. The male-to-female ratio was 1.3 and the mean age at diagnosis was 28 ± 14 (15-67) years. The main clinical feature was Neisseria meningitidis meningitis 75% (n = 31/41) often involving rare serotype: Y (n = 9) and W 135 (n = 7). The main complement deficiency observed was the common final pathway deficiency 83% (n = 34/41). Half of the cohort displayed severe sepsis or septic shock at diagnosis (n = 22/41) but no patient died. No patient had family history of complement deficiency. The mean follow-up was 1.15 ± 1.95 (0.1-10) years. Half of the patients had already suffered from at least one infection before diagnosis of complement deficiency: meningitis (n = 13), pneumonia (n = 4), fulminans purpura (n = 1), or recurrent otitis (n = 1). Near one-third (n = 10/39) had received prophylactic antibiotics (cotrimoxazole or penicillin) after diagnosis of complement deficiency. The vaccination coverage rate, at the end of the follow-up, for N meningitidis, Streptococcus pneumonia, and Haemophilius influenzae were, respectively, 90% (n = 33/37), 47% (n = 17/36), and 35% (n = 14/34).This large study emphasizes that complement deficiencies can be revealed in adults by infectious episodes. Most of them were meningococcal infections revealing common final pathway deficiency. To avoid undiagnosis or late diagnosis, adult displaying first episode of N meningitidis infection should be tested for complement deficiency.
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Affiliation(s)
- A Audemard-Verger
- From the CHU de Caen, Department of Internal Medicine, Caen (AA-V, BB), Department of Infectious Diseases, Nouvelle Calédonie University Hospital, Nouvelle Calédonie (ED, MJ), Laboratory of Immunology, Grenoble University Hospital, Grenoble (DP, AD), Department of Internal Medicine, Grenoble University Hospital, Grenoble, Department of Internal Medicine, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris (BF), Department of Clinical Immunology, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris (CF, DB), Department of Internal Medicine, Robert Ballanger General Hospital, Aulnay sous Bois (MAB), Department of Internal Medicine, Hôpital d'Instruction des Armées, Metz (LK), Department of Internal Medicine, Toulouse University Hospital, UMR 1027 INSERM University of Toulouse; CIC 1436, Toulouse (GM), Department of Internal Medicine, Brest University Hospital, Brest (HA), Department of Paediatric Intensive Care Unit, Lyon University Hospital, Lyon (FV), Department of Infectious Diseases, Nîmes University Hospital, Nîmes (CL), Department of Infectious Diseases, Raymond Poincaré University Hospital, Garches (BD), Department of Medicine, Colmar General Hospital, Colmar (MM), Department of Infectious Diseases, Nantes University Hospital, Nantes (CB, NA), Department of Infectious Diseases, Saint Etienne University Hospital, Saint Etienne (FL), Department of Internal Medicine, Créteil Hospital, Créteil (AF), Department of Infectious Diseases, Tours University Hospital, Tour (RB), Department of Internal Medicine, Rennes University Hospital, Rennes (AP), Laboratory of Immunology, Team Dentritic Cells Physiology, Cochin Institute (SI); and Laboratory of Immunology, Européen Georges Pompidou University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris (VF-B), France
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Audemard A, Descloux E, Deroux A, Fantin B, Fieschi C, Bouldouyre M, Karkowski L, Moulis G, Froissart A, Fremeaux-Bacchi V, Ponard D, Bienvenu B. Déficits en complément révélés à l’âge adulte par un épisode infectieux. Résultats des 41 patients inclus dans l’étude DECORAPI. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.03.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Levy R, Mahevas M, Galicier L, Boutboul D, Fain O, Khellaf M, Limal N, Fieschi C, Vekhoff A, Ebbo M, Michel M, Godeau B. Survenue d’une hypogammaglobulinémie symptomatique à distance d’un traitement par rituximab dans le cadre d’un purpura thrombopénique immunologique : une complication potentiellement grave qui doit être recherchée. À propos de trois observations. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.03.256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gouilleux-Gruart V, Chapel H, Chevret S, Lucas M, Malphettes M, Fieschi C, Patel S, Boutboul D, Marson MN, Gérard L, Lee M, Watier H, Oksenhendler E. Efficiency of immunoglobulin G replacement therapy in common variable immunodeficiency: correlations with clinical phenotype and polymorphism of the neonatal Fc receptor. Clin Exp Immunol 2013; 171:186-94. [PMID: 23286945 DOI: 10.1111/cei.12002] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2012] [Indexed: 01/22/2023] Open
Abstract
Treatment of common variable immunodeficiency disorders (CVID) is based on replacement therapy using intravenous (i.v.) or subcutaneous (s.c.) immunoglobulin (Ig)G. Interindividual variation of IgG dose is common. A total of 380 CVID patients on stable IgG replacement from two prospective cohorts were analysed. An 'efficiency' index was defined as the ratio of serum IgG trough level minus IgG residual to the average weekly dose of IgG infusion. A reduced efficiency of IgG was associated independently with the i.v. route (P < 0·001) and with the presence of at least one CVID disease-related phenotype (lymphoproliferation, autoimmune cytopenia or enteropathy) (P < 0·001). High IgG efficiency was noted in patients homozygotes for the variable number tandem repeat (VNTR) 3/3 polymorphism of the neonatal Fc receptor gene [IgG Fc fragment receptor transporter alpha chain (FCGRT)] promoter, and this was particularly significant in patients treated with IVIG (P < 0.01). In a multivariate analysis, FCGRT VNTR 3/3 genotype (P = 0·008) and high serum albumin (P < 0·001) were associated independently with increased efficiency of i.v. Ig.
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Affiliation(s)
- V Gouilleux-Gruart
- CNRS UMR 7292, Université François Rabelais, CHRU de Tours, Tours, France
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Pavic M, Pasquet F, Fieschi C, Malphettes M, Sève P. Granulomatoses au cours des déficits immunitaires primitifs de l’adulte. Rev Med Interne 2013; 34:154-8. [DOI: 10.1016/j.revmed.2012.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 02/14/2012] [Indexed: 12/13/2022]
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Dossier A, Meignin V, Fieschi C, Boutboul D, Oksenhendler E, Galicier L. Human herpesvirus 8-related Castleman disease in the absence of HIV infection. Clin Infect Dis 2012; 56:833-42. [PMID: 23223599 DOI: 10.1093/cid/cis1009] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Castleman disease (CD) in the context of human immunodeficiency virus (HIV) infection is well described. It is almost always multicentric (MCD) and linked to human herpesvirus 8 (HHV-8). There are limited published data surrounding HHV-8-related CD among HIV-negative patients. METHODS From January 1995 through June 2012, we identified in a single center 18 HIV-seronegative patients with HHV-8-related CD. We report on their clinical, pathological, and laboratory features. RESULTS All cases were multicentric. Patients were aged 42-83 years and were referred with a relapsing remitting syndrome of fever (94%), constitutional symptoms (100%), peripheral lymphadenopathy (100%), splenomegaly (72%), hepatomegaly (50%), and edema (28%). Kaposi sarcoma was observed in 9 cases. Anemia and serum markers of inflammation were present in all cases. Polymerase chain reaction for HHV-8 DNA was positive on blood samples in all cases, whereas only 12 of 16 patients tested had positive HHV-8 serology at diagnosis. All cases showed the classic histological features of MCD, and LANA-1 immunostaining identified HHV-8-infected plasmablasts in 16 of 16 tested cases. Reactive hemophagocytic syndrome (44%), autoimmune hemolytic anemia (33%), and lymphoma (22%) were the commonest associated complications. Remission was obtained with etoposide in 13 of 15 cases. Rituximab allowed prolonged remission off therapy in 10 cases. Death occurred in 3 patients not treated with rituximab. These features were similar to those described in HIV-positive HHV-8-related MCD. Comparison between these 18 cases and 12 HIV-negative HHV-8-unrelated MCD cases showed marked discrepancies. CONCLUSIONS HHV-8-associated MCD may be considered as a single clinicopathological entity regardless of HIV status.
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Affiliation(s)
- A Dossier
- Department of Clinical Immunology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris and Univ Paris Diderot
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Fieschi C, Rasura M, Anzini A, Castro S, Gianfilippo G, Valesini G, Violi F, Zanette E. A diagnostic approach to ischemic stroke in young and middle-aged adults. Eur J Neurol 2011. [DOI: 10.1111/j.1468-1331.1996.tb00225.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Fieschi C, Gasperini C, Ristori G, Bastianello S, Girmenia F, Leuzzi V, Buttinelli C, Pozzilli C, Rasura M. Diagnostic problems in “clinically definite” multiple sclerosis patients with normal CSF and multiple MRI abnormalities. Eur J Neurol 2011; 1:127-33. [DOI: 10.1111/j.1468-1331.1994.tb00060.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Le Guenno G, Galicier L, Fieschi C, Meignin V, Chabrol A, Oksenhendler E. Dramatic efficiency of pegylated interferon in sinus histiocytosis with massive lymphadenopathy. Br J Dermatol 2010; 164:213-5. [PMID: 20849465 DOI: 10.1111/j.1365-2133.2010.10051.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hervier B, Haroche J, Galicier L, Charlotte F, Brousse N, Fieschi C, Bloch Queyrat C, Saadoun D, Frances C, Leguenno G, Wechsler B, Amoura Z. Maladie de Rosai-Dorfman-Destombes : à propos de 12 cas. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.03.362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fieschi C, Sette G, Fiorelli M, Argentino C, Toni D, De Michele M, Bragoni M, Aguglia F, Bertazzoni G, Bozzao L. Clinical Presentation and Frequency of Potential Sources of Embolism in Acute Ischemic Stroke Patients: The Experience of the Rome Acute Stroke Registry. Cerebrovasc Dis 2010. [DOI: 10.1159/000107828] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Marshall J, Fieschi C. Discussions and Comments to Section XVI on Regional Cerebral Blood Flow in Apoplexy. Scandinavian Journal of Clinical and Laboratory Investigation 2010. [DOI: 10.3109/00365516809169069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Georgin-Lavialle S, Gossot D, Galicier L, Oksenhendler E, Fieschi C. [Accessory spleens after splenectomy in a patient with common variable immunodeficiency]. Rev Med Interne 2009; 31:41-5. [PMID: 19740575 DOI: 10.1016/j.revmed.2009.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 06/03/2009] [Accepted: 06/25/2009] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Blood cells are mainly destroyed in the spleen during autoimmune cytopenia. Amongst the various therapeutic strategies, splenectomy is sometimes necessary during the disease course. However, splenosis or accessory spleens can account for autoimmune cytopenia relapse after initial splenectomy in these patients. CASE REPORT We report an 18-year-old male with common variable immunodeficiency who presented with immunological thrombocytopenia. Splenectomy allowed remission of cytopenia, but a relapse was attributed to splenosis, because Jolly bodies were absent on blood smear. Laparoscopic splenectomy of accessory spleens induced long term remission. A literature review is performed. CONCLUSION Fifteen to 20% of relapses of autoimmune cytopenia treated by splenectomy are related to accessory spleens. Ablation of accessory spleens can cure again the patients, including patients with accompanying common variable immunodeficiency.
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Affiliation(s)
- S Georgin-Lavialle
- Département d'immunologie clinique, hôpital Saint-Louis, Paris cedex 10, France
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Conti P, Gigante GE, Cifone MG, Alesse E, Fieschi C, Angeletti PU. Effect of Electromagnetic Fields on Two Calcium Dependent Biological Systems. ACTA ACUST UNITED AC 2009. [DOI: 10.3109/15368378509040375] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Georgin-Lavialle S, Aouba A, Fieschi C, Oksenhendler E, Varet B, Canioni D, Hermine O. Présentation atypique de rates accessoires en immunohématologie : série de 5 cas. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.03.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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27
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Chauchard M, Rousselot P, Kong X, Casanova JL, Fieschi C. Défaut partiel dominant de la première chaîne du récepteur de l’interféron-gamma diagnostiqué lors d’une pneumocystose à l’âge adulte. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Agnoli A, Battistini N, Bozzao L, Fieschi C. Drug action on regional cerebral blood flow in cases of acute cerebro-vascular involvement. Acta Neurol Scand Suppl 2009; 14:142-4. [PMID: 4284283 DOI: 10.1111/j.1600-0404.1965.tb01972.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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31
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Michaux C, Fieschi C, Bassez G, Prinseau J, Baglin A, Hanslik T. Hypogammaglobulinémie symptomatique dans la maladie de Steinert. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.10.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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32
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Georgin-Lavialle S, Rabian C, Malphettes M, Carmagnat M, Viallard JF, Gardembas M, Jaussaud R, Pasquali JL, Oksenhendler E, Gérard L, Fieschi C. Phénotype lymphocytaire T chez 252 patients avec déficit immunitaire commun variable. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.03.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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33
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Buttinelli C, Clemenzi A, Borriello G, Denaro F, Pozzilli C, Fieschi C. Mitoxantrone treatment in multiple sclerosis: a 5-year clinical and MRI follow-up. Eur J Neurol 2007; 14:1281-7. [PMID: 17956449 DOI: 10.1111/j.1468-1331.2007.01969.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Mitoxantrone (MTX) is an antineoplastic agent approved for treatment of secondary progressive and rapidly worsening relapsing-remitting multiple sclerosis (MS). We designed a longitudinal open-label prospective study to evaluate the efficacy and toxicity of MTX over a 2-year treatment period with a further 3-year follow-up. Fifty consecutive MS patients were included and received MTX intravenously (8 mg/m(2) every 2 months for a total of 12 infusions). Efficacy was assessed clinically and by brain MRI performed before MTX therapy, at the end of treatment and at the end of each year of follow-up. Forty-nine patients completed the 5-year study, 44 (89.8%) completed the MTX course, five (10.2%) interrupted the treatment because of side effects. Fifteen (30.6%) patients showed Expanded Disability Status Scale (EDSS) progression on treatment and nine (18.4%) during follow-up. Seventeen (34.7%) patients had enhancing lesions at baseline, nine (18.4%) at the end of treatment, but none at the end of follow-up. In conclusion, we observed EDSS progression in about 1/3 of the patients during the treatment period and in 1/5 during the further 3-year follow-up period. This evidence suggests a delayed beneficial effect after MTX treatment is completed with only a minority of patients showing disability progression once the drug was suspended.
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Affiliation(s)
- C Buttinelli
- Department of Neurological Science, Neurological Unit, S. Andrea Hospital, University La Sapienza, Rome, Italy
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34
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Malphettes M, Oksenhendler E, Galicier L, Fieschi C. [Granulomatous disease in common variable immunodeficiency]. Rev Med Interne 2007; 29:28-32. [PMID: 18054123 DOI: 10.1016/j.revmed.2007.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Accepted: 10/02/2007] [Indexed: 11/18/2022]
Abstract
PURPOSE Common variable immunodeficiency (CVID), defined by defective production of immunoglobulins, is the most common primary immunodeficiency in adulthood requiring a medical follow-up. Repeated bacterial infections and/or autoimmune manifestations and/or benign lymphoproliferation (including follicular hyperplasia and/or granulomatous disease) are the hallmark of the disease. This review aims at describing recent advances in the understanding and treatment of granulomatous disease in CVID. CURRENT KNOWLEDGE AND KEY POINTS Clinical features of granulomatous disease in CVID can mimic sarcoidosis, remarkable by the low levels of circulating immunoglobulins. Granulomas may be found in several organs in a single patient, and the main features are pulmonary, lymphoid, cutaneous, hepatic or splenic. The features of CVID is remarkable by the high frequency of autoimmune diseases complicating the immunodeficiency. Some immunological abnormalities have been described in such patients, including lymphopenia, decreased T-cells proliferations to mitogens and antigens. Rare polymorphisms in the gene encoding TNFalpha (Tumor Necrosis Factor) have been identified in CVID patients with granulomatous disease. FUTURE PROSPECTS AND PROJECTS The evolution of the disease is severe, particularly when the lung is involved. Treatment consists in immunoglobulins substitution, immunosuppressive agents (corticosteroids, cyclophosphamide) and anti-TNFalpha antibodies. These treatments are difficult to manage in such immunocompromised patients.
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Affiliation(s)
- M Malphettes
- Département d'immunologie clinique, hôpital Saint-Louis, 1 avenue Claude-Vellefaux, Paris, France
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35
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36
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Chandesris MO, Soulier J, Labaume S, Crinquette A, Repellini L, Chemin K, Malphettes M, Fieschi C, Asli B, Uzunhan Y, Fermand JP, Bories JC, Arnulf B. Detection and follow-up of fibroblast growth factor receptor 3 expression on bone marrow and circulating plasma cells by flow cytometry in patients with t(4;14) multiple myeloma. Br J Haematol 2007; 136:609-14. [PMID: 17223917 DOI: 10.1111/j.1365-2141.2006.06479.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The t(4;14)(p16;q32) translocation, found in 15% of multiple myeloma (MM) cases, indicates a poor prognosis. Plasma cells (PC) with t(4;14) ectopically express the fibroblast growth factor receptor 3 (FGFR3) tyrosine kinase receptor, which has potential transforming activity and may represent a therapeutic target. To detect FGFR3 protein expression, bone marrow (BM) aspirate from 200 consecutive newly diagnosed (n = 116) or relapsing (n = 74) MM patients was studied by flow cytometry (FC) using anti-CD138 and anti-FGFR3 antibodies. FC data was compared to real time quantitative-polymerase chain reaction (RQ-PCR) of the IGH-MMSET and FGFR3 transcripts. An IGH-MMSET transcript was found in 24/200 patients (12%). In 20 of these, FC detected CD138(+)/FGFR3(+) cells. No expression of FGFR3 was detected in the 4 FGFR3(-) cases by RQ-PCR. FGFR3 was never expressed on PC without t(4;14). Circulating PC (CPC) were detected in patients with (11/11) and patients without (13/41) t(4;14). In 2/8 t(4;14) cases studied longitudinally, coexisting FGFR3(+) and FGFR3(-) CPC were observed. Fluorescent in situ hybridisation (FISH) analysis of the FGFR3(-) subclones showed deletion of the der(14) in one patient. In conclusion, as a supplemental method to RQ-PCR or FISH, FC analysis of FGFR3 expression is a reliable and routinely available method for the detection and management of new therapeutic approaches of t(4;14) MM.
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MESH Headings
- Biomarkers, Tumor/blood
- Biomarkers, Tumor/metabolism
- Bone Marrow Cells/metabolism
- Chromosomes, Human, Pair 14/genetics
- Chromosomes, Human, Pair 4/genetics
- Female
- Flow Cytometry/methods
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Multiple Myeloma/genetics
- Multiple Myeloma/metabolism
- Multiple Myeloma/therapy
- Neoplasm Proteins/blood
- Neoplasm Proteins/metabolism
- Plasma Cells/metabolism
- Polymerase Chain Reaction/methods
- Receptor, Fibroblast Growth Factor, Type 3/blood
- Receptor, Fibroblast Growth Factor, Type 3/metabolism
- Translocation, Genetic
- Tumor Cells, Cultured
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Affiliation(s)
- M O Chandesris
- EA 3963, Paris VII University, Saint-Louis Hospital, AP-HP, Paris, France
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37
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Catherinot E, Fieschi C, Feinberg J, Casanova JL, Couderc LJ. Syndrome de susceptibilite mendélienne aux infections mycobacteriennes : défauts de l’axe Interleukine-12 - Interféron. Rev Mal Respir 2005; 22:767-76. [PMID: 16272979 DOI: 10.1016/s0761-8425(05)85634-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Environmental non tuberculous mycobacteria and Bacillus Calmette-Guerin vaccines are weakly virulent mycobacteria. Nevertheless they may cause severe diseases in otherwise healthy children with no overt immunodeficiency. Parental consanguinity and familial forms are frequently observed among these patients, therefore this syndrome was named "Mendelian Susceptibility to Mycobacterial Disease". STATE OF THE ART In the last nine years, fife genes have been found to be mutated in patients with this syndrome: IFNGR1, IFNGR2, STAT1, IL12B, IL12RB1. Allelic heterogeneity accounts for ten distinct genetic disorders. Clinical phenotype differs between patients. The spectrum of disease extends from early-onset overwhelming mycobacterial infection to adult-onset localized disease and tuberculosis. Impaired IFN-gamma-mediated immunity is the common mechanism of the disease, outlining its major role in mycobacterial immunity. PERSPECTIVES AND CONCLUSIONS Better understanding of these disorders reveals an expanding clinical phenotype which justifies studying adult patients with pulmonary non tuberculous mycobacterial infection without known risk factors, severe BCGitis and recurrent tuberculosis. Molecular diagnosis makes it possible to introduce a specific regimen based on physiopathology.
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Affiliation(s)
- E Catherinot
- Laboratoire de Génétique Humaine des Maladies Infectieuses, Université René Descartes - INSERM U550, Faculté de Médecine Necker, Paris, France.
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38
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Fieschi C, Onesti E, Tomassini V. Medical education and MS: getting the training right. Int MS J 2005; 12:21-31, 20. [PMID: 15955275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/30/2004] [Accepted: 11/11/2004] [Indexed: 05/03/2023]
Abstract
Medical education needs continuous improvements to meet the changing demands of medical practice in the 21st century. We need to review the teaching methods used and the curriculum taught during various stages of a doctors training. General practitioners need to recognize the symptoms indicative of MS and refer the patient to a specialist; neurologists should confirm the diagnosis, and effectively treat, manage and support the patient. Training should be adapted to reflect these different tasks and equip the physician accordingly. We suggest a training programme for undergraduate students comprising three lectures and two interactive sessions. These would provide the student with a basic knowledge of MS and its management. For those wishing to specialize in neurology, we recommend a series of eight lectures, interactive sessions discussing case reports with typical and atypical presentations, two magnetic resonance imaging reading sessions with a specialist neuroradiologist and active practice in an MS clinic.
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Affiliation(s)
- C Fieschi
- Department of Neurological Sciences, University of Rome Medical School, Rome 00185, Italy.
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39
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Feigin V, Brainin M, Breteler MMB, Martyn C, Wolfe C, Bornstein N, Fieschi C, Sevcik P, Lima ML, Boysen G, Beghi E, Tzourio C, Demarin V, Gusev E, López-Pousa S, Forsgren L. Teaching of neuroepidemiology in Europe: time for action. Eur J Neurol 2005; 11:795-9. [PMID: 15667409 DOI: 10.1111/j.1468-1331.2004.01024.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Many epidemiological and clinical studies in Europe, especially in Eastern Europe and countries in transition, are of poor methodological quality because of lack of background knowledge in clinical epidemiology methods and study designs. The only way to improve the quality of epidemiological studies is to provide adequate undergraduate and/or postgraduate education for the health professionals and allied health professions. To facilitate this process, the European Federation of Neurological Societies (EFNS) Task Force on teaching of clinical epidemiology in Europe was set up in October 2000. Based on analyses of the current teaching and research activities in neuroepidemiology in Europe, this paper describes the Task Force recommendations aimed to improve these activities.
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Affiliation(s)
- V Feigin
- School of Population Health, Faculty of Health and Medical Sciences, University of Auckland, Auckland, New Zealand.
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40
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Fieschi C, Fiorelli M. How to face stroke. Rev Neurol (Paris) 2004. [DOI: 10.1016/s0035-3787(04)71082-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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41
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Abstract
Retrospective and cross-sectional studies have suggested that both bacterial and viral infections may be risk factors for atherosclerosis, ischemic stroke and acute coronary events. The correlation between Chlamydia pneumoniae and atherosclerosis remains a source of controversy. Our case-control study is aimed at evaluating the frequency of C. pneumoniae infection in a cohort of young adults with recent cerebrovascular disease and in particular etiologic stroke subtypes. Chlamydia pneumoniae IgG, IgM and IgA antibodies were evaluated by microimmunofluorescence method and antibody titers to both recombinant antigens chlamydial outer protein 2 and 60-kDa chlamydial heat shock protein (HSP60) by ELISA. The two groups differed with regard to the prevalence of C. pneumoniae IgA (P < 0.001) and IgG (P < 0.0001), as well as the titer of anti-R-HSP60 IgG (P < 0.001). We found an increase in IgA titers, suggestive of persistent, chronic active infection, in 16 patients in whom the etiology of the cerebral ischemic event was large-vessel atherothrombosis. Persistent, active C. pneumoniae infection may be an additional risk factor for ischemic stroke mainly of atherotrombotic origin in young subjects. However, a large-scale prospective confirmation of our findings is required.
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Affiliation(s)
- A Anzini
- Department of Neurological Sciences, II Faculty of Medicine, University of Rome 'La Sapienza', Rome, Italy
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42
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Rotilio G, Berni Canani R, Barba G, Branca F, Cairella G, Dilaghi B, Fieschi C, Garbagnati F, Gentile MG, Gensini GF, Gualtieri A, Inzitari D, La Massa M, Luisi MLE, Mancia G, Marcelli M, Masini ML, Mastrilli F, Paolucci S, Pratesi L, Rubba P, Sacchetti ML, Salvia A, Scalfi L, Scognamiglio U, Siani A, Strazzullo P. Nutritional recommendations for the prevention of ischemic stroke. Nutr Metab Cardiovasc Dis 2004; 14:115-120. [PMID: 15242244 DOI: 10.1016/s0939-4753(04)80018-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- G Rotilio
- Department of Biology, Tor Vergata University of Rome, Italy
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Catherinot E, Feinberg J, Fieschi C, Valeyre D, Couderc L, Casanova J. 12 Infection pulmonaire à mycobactéries non tuberculeuses de l’adulte sans conditions prédisposantes : anomalie du système interleukine 12-interféron gamma ? Rev Mal Respir 2004. [DOI: 10.1016/s0761-8425(04)71638-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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44
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Onesti E, Bagnato F, Tomassini V, Volante G, Denaro F, Frontoni M, Millefiorini E, Pozzilli C, Fieschi C. Interferon beta treatment of MS in the daily clinical setting: a 3-year post-marketing study. Neurol Sci 2003; 24:340-5. [PMID: 14716530 DOI: 10.1007/s10072-003-0186-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2003] [Accepted: 09/20/2003] [Indexed: 11/29/2022]
Abstract
We performed a post-marketing study of patients with multiple sclerosis (MS) attending the outpatient service to evaluate the impact of interferon beta-1b (IFNbeta-1b) in the daily clinical setting. The absolute changes in relapse frequency and in the mean EDSS score over a three-year period were compared between 83 patients with relapsing remitting MS treated with IFNbeta-1b and 83 RRMS patients who did not take the drug. Annualized relapse frequency significantly decreased in patients undergoing therapy while no statistically significant changes in EDSS score were observed. These findings point out the role of post-marketing studies in evaluating the impact of approved drugs in the daily clinical setting in terms of safety and tolerability. Furthermore, our results confirm the positive effect of immunomodulatory treatment in decreasing the occurrence of inflammatory events.
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Affiliation(s)
- E Onesti
- Department of Neurological Sciences, La Sapienza University of Rome, Viale dell'Università 30, I-00185 Rome, Italy
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Döffinger R, Dupuis S, Picard C, Fieschi C, Feinberg J, Barcenas-Morales G, Casanova JL. Inherited disorders of IL-12- and IFNgamma-mediated immunity: a molecular genetics update. Mol Immunol 2002; 38:903-9. [PMID: 12009568 DOI: 10.1016/s0161-5890(02)00017-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In the last 6 years, considerable advances have been made in the molecular analysis of a rare clinical syndrome: Mendelian susceptibility to mycobacterial disease (MSMD). Infection with poorly virulent environmental non-tuberculous mycobacteria (NTM) or vaccination with bacillus Calmette-Guerin (BCG) may cause disseminating and even fatal disease in individuals suffering from this syndrome. Mutations in five genes (IFNGR1, IFNGR2, STAT1, IL12B and IL12RB1) have been shown to be responsible for MSMD and further allelic heterogeneity accounts for the existence of nine distinct inherited disorders. All of these disorders are caused by impaired IFNgamma-mediated immunity. These results have important medical and biological implications. In this report, we update the disease-causing mutations reported in the literature.
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Affiliation(s)
- R Döffinger
- Laboratory of Human Genetics of Infectious Diseases, Necker Medical School, 156 rue de Vaugirard, 75015 Paris, France
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Abstract
Ischaemic penumbra is defined as the area of brain tissue that maintains some blood flow following ischaemic accident. This zone may be rescued by both neuroprotection and arterial revascularization. Early thrombolysis has been used with encouraging results since 1995 in several trials testing both streptokinase and recombinant tissue plasminogen activator (r-TPA): the r-TPA results are definitely more positive than those of streptokinase, despite an increased incidence of symptomatic haemorrhagic transformation, r-TPA significantly reducing death or dependency at the end of follow-up. Despite the fact that some experimental periods of application of these therapeutic strategies demonstrated real cost-effective benefits, only 1% of patients reaching hospital in time for thrombolysis are currently treated. This is because the profile of patients at risk of haemorrhagic transformation, which is definitely the most feared side-effect of thrombolysis in stroke, is yet to be clearly defined. Extended computerized tomography (CT) signs of the index stroke have been repeatedly indicated as reliable predictors of haemorrhagic transformation even if currently there are significant discrepancies in the criteria adopted by different researchers to define early CT signs. Based on experimental ischaemia, strategies for protecting the basal lamina during thrombolysis are suggested: neuroprotection is the second approach to stroke therapy; pharmacological reperfusion and brain protection are probably mutually dependent.
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Affiliation(s)
- D Toni
- Department of Neurological Sciences, University La Sapienza, Rome, Italy.
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Abstract
"Acute strokes are here to stay": this could be the sad conclusion after decades of stroke research. Generalized prevention of ischemic stroke is not fully successful. After the decline in stroke incidence observed by 1970, partly related to better management of vascular risk factors, there has again been an increase in stroke frequency all around the world. This phenomenon may be explained by the lack of educational modalities for modification of lifestyle behavior, the small impact of high-risk individual prevention strategy, and the lack of rationale and guidelines for multiple approaches. In the meantime, the benefits of acute intensive management of stroke have been demonstrated. There is now considerable evidence that careful monitoring and management of general and cerebral functions in a dedicated stroke unit or by a specialized stroke team are superior to management in a neurologic or general ward. Currently, one way of optimizing limited personnel resources is to connect the stroke unit of a main hospital with peripheral hospitals via a computer network. Experts in the central stroke unit can then make on-line evaluations of CT and ultrasound examinations performed in the local hospital and recommend the best course of patient management. This new approach of treating stroke as an emergency will also require educational programs directed at the general public, general practitioners, and primary and emergency department physicians, to teach the recognition of stroke symptoms and the importance of treating stroke with the same urgency as for myocardial infarction (MI).
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Dupuis S, Dargemont C, Fieschi C, Thomassin N, Rosenzweig S, Harris J, Holland SM, Schreiber RD, Casanova JL. Impairment of mycobacterial but not viral immunity by a germline human STAT1 mutation. Science 2001; 293:300-3. [PMID: 11452125 DOI: 10.1126/science.1061154] [Citation(s) in RCA: 364] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Interferons (IFN) alpha/beta and gamma induce the formation of two transcriptional activators: gamma-activating factor (GAF) and interferon-stimulated gamma factor 3 (ISGF3). We report a natural heterozygous germline STAT1 mutation associated with susceptibility to mycobacterial but not viral disease. This mutation causes a loss of GAF and ISGF3 activation but is dominant for one cellular phenotype and recessive for the other. It impairs the nuclear accumulation of GAF but not of ISGF3 in heterozygous cells stimulated by IFNs. Thus, the antimycobacterial, but not the antiviral, effects of human IFNs are principally mediated by GAF.
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Affiliation(s)
- S Dupuis
- Laboratoire de Génétique Humaine des Maladies Infectieuses, Université de Paris René Descartes-INSERM UMR550, Faculté de Médecine Necker-Enfants Malades, 75015 Paris, France
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Abstract
Ischemic stroke in young adults is rare (5%-10% of all ischemic strokes) and, in absence of other risk factors, may be associated with migraine. We describe the case of a 34-year-old woman, with a history of migraine without aura, who presented a sudden onset of headache with Horner's syndrome, and in whom neuroimaging showed evidence compatible with fibromuscular dysplasia (FMD) and arterial dissection of the extracranial internal carotid artery (ICA) and the carotid siphon. In our opinion, in young women with a long history of migraine, a careful study of the extracranial and intracranial arteries would be useful, although the cost/benefit ratio does not at present justify such a procedure. Our aim in the future is, therefore, to study a larger sample of migraine patients in order to find those patients who are most at risk of arterial dissection and who should, consequently, be carefully studied.
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Affiliation(s)
- C Buttinelli
- Department of Neurological Sciences, La Sapienza University of Rome, Viale dell'Università 30, I-00185 Rome, Italy
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Fieschi C, Dupuis S, Picard C, Smith CI, Holland SM, Casanova JL. High levels of interferon gamma in the plasma of children with complete interferon gamma receptor deficiency. Pediatrics 2001; 107:E48. [PMID: 11335769 DOI: 10.1542/peds.107.4.e48] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We have found that children with complete interferon gamma (IFNgamma) receptor deficiency, unlike patients with other genetic defects predisposing them to mycobacterial diseases, have very high levels of IFNgamma in their plasma. This unexpected observation provides a simple and accurate diagnostic method for complete IFNgamma receptor deficiency in children with clinical disease caused by bacille Calmette-Guérin vaccines or environmental nontuberculous mycobacteria.
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Affiliation(s)
- C Fieschi
- Laboratory of Human Genetics of Infectious Diseases, Necker Medical School, Paris, France
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