Endarteritis and false aneurysm complicating aortic coarctation

We report a tricky case of endocarditis because of the localization, aortic coarctation, and the pathogenic bacteria Actinobacillus actinomycetemcomitans. Furthermore, we underline the leading role of transesophageal echocardiography in the diagnosis of aortic endarteritis. First, aortitis was treated with antibiotics and, second, successfully operated on.

[Group B streptococcal meningitis revealing an inner ear congenital malformation. A case report in an adult]

INTRODUCTION

Group B streptococcal meningitis is unusual in adults. It occurs in patients with a chronic disease.

EXEGESIS

We report a case of group B streptococcal meningitis that occurred in a 32-year-old woman, uncovering inner ear congenital malformation associated with cerebrospinal fluid fistula. There was no recurrent episode of meningitis during a 2-year period following surgical correction of the malformation.

CONCLUSION

Clinical signs suggesting cerebrospinal fluid fistula should be considered in any adult patient with severe group B streptococcal infection.

[Non-Hodgkin's malignant lymphoma with parotid gland and ovarian localization]

INTRODUCTION

Parotidean and ovarian lymphoma often indicate the existence of non-Hodgkin's lymphoma, involving 1-5% and 0.2% of the cases, respectively. EXEGENESIS: The authors report the case of a 70-year-old woman who presented B cell lymphoma of the parotid gland revealed by a rapid increase in the parotid size. CT scan showed the existence of a tumor located in the left ovary, later confirmed by biopsy. The proposed diagnosis was diffuse B cell type lymphoma with double glandular localization. Adenopathy and bone marrow involvement were both lacking.

CONCLUSION

Lymphoma with glandular localizations always require diagnosis confirmation via histological examination and immunophenotyping, and must be considered as the local sign of a general disease.

Foscarnet decreases HIV-1 plasma load

OBJECTIVE

To evaluate the effect of foscarnet on HIV-1 replication in vivo.

PATIENTS AND METHODS

Seventeen AIDS patients with cytomegalovirus (CMV), herpes simplex virus (HSV), varicella-zoster virus (VZV) infection, Kaposi's sarcoma (KS), or a combination of these were treated with foscarnet. HIV RNA quantification (bDNA 2.0, Chiron, Emeryville, CA, U.S.A.), CMV pp65 antigenemia (Argene Biosoft, Varilhes, France), and CMV viremia were determined before and during therapy.

RESULTS

Four patients had CMV retinitis (1 with KS), 2 patients had CMV pneumonia (1 with KS), 1 patient had CMV cholecystitis, 2 patients had VZV infection (1 with KS), 1 patient had HSV-2 infection, and 7 patients had KS alone. The decrease in HIV-1 load was -0.73 +/- 0.39 log copies/ml (p = 2.10(-6)) after 3 days of treatment and -1.15 +/- 0.49 log copies/ml (p < 10(-7)) after 10 days of treatment, compared with day 0. Furthermore, reduction of HIV-1 plasma load during foscarnet therapy did not depend on the presence or absence of CMV disease or on a positive pp65 antigenemia at day 0.

CONCLUSION

We observed decreased HIV-1 plasma load in all patients treated with foscarnet, regardless of presence or absence of clinical or biologic CMV infection. This decrease supports the proposition that foscarnet anti-HIV-1 activity may be of clinical importance.

[Xanthomonas maltophilia nosocomial infections. A new threat. Apropos of 30 cases]

In an attempt to further characterize infections due to Xanthomonas maltophilia, we reviewed 20 colonisations and 30 infections observed in our institution from january 1990 to december 1992, Xanthomonas maltophilia is emerging as an important nosocomial pathogen in immunocompromised patients, especially those receiving broad spectrum antimicrobial antibiotherapy. Distinction between colonisation and infection is often difficult. Xanthomonas maltophilia presents a therapeutic challenge because of its tendency to exhibit multiple resistance.

[A new threat: Xanthomonas maltophilia infection. Apropos of 50 cases]

In an attempt to further characterize infections due to Xanthomonas maltophilia (XM), we reviewed 50 case reports observed in our institution. XM is emerging as an important nosocomial pathogen in immunocompromised patients, especially those receiving broad spectrum antimicrobial antibiotherapy. Distinction between colonisation and infection is often difficult. XM presents a therapeutic challenge because of its tendency to exhibit multiple resistance.