UNLABELLED:Takayasu arteritis is an uncommon inflammatory arteritis especially in children. We report a case.CASE REPORT:A 11-year-old boy presented dorsalgia with inflammatory syndrome. One year later, the investigation of an hypertension with asymmetric blood pressure revealed an aortic coarctation and a bilateral renal arteries stenosis leading to Takayasu's arteritis diagnosis.CONCLUSION:Takayasu's arteritis must be evokated in young children in case of associated hypertension and inflammatory syndrome.

Takayasu arteritis is an uncommon inflammatory arteritis especially in children. We report a case.Case report. - A 11-year-old boy presented dorsalgia with inflammatory syndrome. One year later, the investigation of an hypertension with asymmetric blood pressure revealed an aortic coarctation and a bilateral renal arteries stenosis leading to Takayasu's arteritis diagnosis.Conclusion. - Takayasu's arteritis must be evokated in young children in case of associated hypertension and inflammatory syndrome. (C) 2004 Publie par Elsevier SAS.

The authors carried out a prospective study of the urinary trypsin inhibitory activity (UTIa) levels in febrile HIV-infected patients, so as to determine its diagnostic value. Six groups of patients were made from 54 patients with CD4+ < 100/mm(3): 14 bacterial infections excluding Mycobacterium avium complex MAC (group 1); 10 MAC infections (group 2); 12 parasitic or fungal infections (group 3); 5 viral infections (group 4); 4 miscellaneous (group 5) and 9 without diagnosis (groupe 6), Whereas the median value in non-HIV control was 12 UI/g urinary creatinine (UC), UTIa level was significantly higher when MAC infections occurred (median = 192 UI/g UC), Moreover, an excellent negative predictive value (100 %) of MAC infection diagnosis was found with a threshold at 60 UI/g UC in febrile HIV-patients with a CD4+ < 100/mm(3). This parameter was more selective than C-reactive protein dosage for the diagnosis of MAC infection. AATU is an easy, inexpensive, and rapid test which could help the physician in deciding whether to undertake or not empirical anti-MAC treatment.

We estimated the incidence of the first episodes of cytomegalovirus (CMV) dise Cases were retrospectively investigated using standardized definition criteria. Retinitis was confirmed by an ophthalmologist. Gastro-intestinal lesions were confirmed histologically. Encephalitis was histologically confirmed; it was considered possible if TDM or magnetic resonance imaging (MRI) and symptomatology suggested this diagnosis. Pneumopathy was probable in case of hypoxemia, interstitial X-Ray images and response to CMV treatment; it was confirmed if intranuclear inclusions were identified on biopsy or brushing specimen. In the cohort (n = 3525) followed for an average of 46 months, 158 patients had a first episode of CMV disease. The cumulative incidence was 4.5% and the incidence rate (IR) 1.2 per 100 person-years. The IR was higher for homosexuals (2.0) than for heterosexuals (1.0) and intravenous drug users (0.5). Retinitis was the most frequent site (90 cases), followed by digestive system (40), lung (three confirmed and 17 probable) and central nervous system (eight confirmed and three possible). Sixty-eight percent of the patients were at the AIDS stage when CMV disease was diagnosed, with a mean CD4 count of 42/mm(3). The cumulative probability of developing CMV disease 2 years after falling below 200 CD4 lymphocytes/mm(3) was 8.0%. Retinitis is by far the most common site for CMV disease. Homosexual transmission of HIV, clinical AIDS and low CD4 count are associated with the occurrence of the first episode of CMV disease.

The present case report describes a case of invasive pulmonary aspergillosis with cerebromeningeal invasion in an asthmatic non-immunocompromised patient. This fatal complication occurred despite early anti-fungal antibiotherapy after a 2-week course of intravenous corticosteroid therapy for treatment of an exacerbated asthma. Diagnostic and therapeutic procedures are discussed.

Brucellosis is an infection found worldwide, the incidence of which has diminished in recent years in France. The authors report a retrospective study on 59 cases of brucellosis occuring between 1980 and 1996 in the University hospitals of Bordeaux, in internal medicine, infectious diseases, and rhumatology units. Fifty-nine patients (45 men, 14 women) mean age 44 years (7 to 83), were diagnosed with brucellosis. 68% had a predisposing factor (risk profession, consumption of dairy products). 31 presented an acute form with fever that tended to be irregular and vesperal (31), sweating (25), marked asthenia (16), weight loss (9), arthralgias (9), splenomegaly (7), and/or hepatomegaly (6), 26 had a localized form, mainly osteoarticular (10 spondylitis with discitis, 5 coxitis, 4 sacroiliitis, 1 arthritis of the knee, 1 arthritis of the ankle), but also genital (1 orchitis, 1 salpingitis), cardiac (1 endocarditis, 1 myocarditis), neurological (1 meningoencephalitis), and splenic (1 patient had multiple splenic abscesses). Two patients presented clinical signs consistent with a chronic brucellosis. Moderate hepatitis was noted in 29. Blood cultures were positive in 23, 10 among the localized forms (B. melitensis 10 cases, B. abortus 3 cases, B. suis 2 cases, 8 cases remained unidentified). The pathogen was isolated 8 times by guided specimen collection. Serologic tests were positive in all cases. The melitin skin test was positive in both patients presenting a chronic form. Treatment mainly relied upon the association of rifampin and doxycycline. Seven patients were managed by monotherapy (ofloxacin or doxycycline). Fever subsided an average of 7 days after beginning treatment (from 2 to 30 days), hepatic cytolysis in less than a month, while a low neutrophil count sometimes persisted up to 3 months. Eight patients initially presenting an acute form underwent a localized relapse.

Hypersensitivity reactions induced by tetracyclines are uncommon. A 41-year-old man developed a hypersensitivity pneumonitis following treatment with minocycline. The disease responded to withdrawal of the drug. T-lymphocytes may play a central role in the pathogenesis of this pneumonitis. This observation shows that minocycline, despite its mild toxicity profile, can give rise to serious adverse effects.

Objective-To evaluate the prevalence of antibodies to hepatitis C virus and serological markers for hepatitis B virus infection in patients with HIV.Design-Cross sectional survey.Setting-Aquitaine, southwestern France, 1991-94.Subjects-1935 HIV positive patients seen at least once since June 1991.Main outcome measures-Presence of antibodies to hepatitis C virus were detected by second or third generation enzyme linked immunosorbent assay (ELISA) and recombinant immunoblot assay (RIBA) and markers for hepatitis B virus detected by ELISA.Results-The prevalence was 42.5% (823) for antibodies to hepatitis C virus, 56.4 (507) for antibodies to hepatitis B core antigen, 6.9% (133) for hepatitis B surface antigen, 30.2% (584) for antibodies to hepatitis B core and surface antigen with no detectable surface antigen, 26.2% (507) for antibodies to core antigen only, and 4.8% (92) for antibodies to surface antigen only. The prevalence of antibodies to hepatitis C virus was 86.1% (726/843) in subjects who had bloodborne HIV infection and 7.3% (66/899) in those with sexually acquired infection. The prevalence of markers for hepatitis B was higher among homosexuals than in the other groups of patients, except for antibodies to surface antigen alone. The relation between markers for hepatitis B and hepatitis C virus was negative among men but positive among women.Conclusions-The results favour the hypothesis that hepatitis C virus is sexually transmitted much less commonly than either HIV or hepatitis B virus.

Objective: To describe trends in the incidence of HIV infection diagnosis since 1985 in different at-risk groups in Aquitaine, south-west France. Methods: We analyzed the data from two regional surveillance systems on HIV infection: the hospital-based system of the Groupe d'Epidemiologie Clinique du SIDA en Aquitaine (GECSA) and the laboratory-based system of the Observatoire Regional de la Sante d'Aquitaine (ORSA), The number of intravenous drug users (TVDUs) in Aquitaine was estimated from two sources: a study performed by the GECSA in IVDUs treatment centers (1990-1991 data) and the annual surveys undertaken by the Ministry of Health (SESI) in all the health facilities and social services of the region from 1988 to 1993. Results: As of December 31st, 1993, 3478 HIV-infected patients had been reported to the GECSA, including 3031 Aquitaine residents, Among those, 1096 were TVDUs without any other at-risk behavior (36.2%), the largest transmission category, The annual incidence of HIV diagnoses has steadily and considerably changed over time for IVDUs: 175 new cases diagnosed in 1985, 218 in 1987, then falling to 38 in 1993, During the same period, there was no marked decrease for homosexuals and the incidence of diagnoses of heterosexually-acquired HIV infections increased, Between 1989 and 1993, the number of HIV tests performed by the laboratories involved in the ORSA surveillance system increased steadily from 80,310 to 176,250 per year, when the number of first positive tests in Aquitaine residents decreased from 744 to 319 per year (-57%), This decrease was greater for IVDUs (-80%) than for the other groups, The survey performed by the GECSA estimated that 990 IVDUs were followed annually by treatment centres in Aquitaine in 1990-1991, This figure was stable and in agreement with the results of the SESI surveys performed throughout the period. Conclusion: The incidence of new diagnoses of HIV infection has been decreasing in Aquitaine since 1988, particularly among IVDUs, suggesting that the epidemic is slowing down, It is essential to maintain these systems of epidemiological surveillance as a component of the HIV prevention program.

Introduction. – La néphrocalcinose est une complication peu fréquente des néphrites interstitielles que l’on peut observer dans le syndrome de Gougerot-Sjögren. Elle précède parfois le syndrome sec.Observation. – Nous rapportons l’observation d’une patiente de 50 ans affectée d’un syndrome de Gougerot-Sjögren dont les premiers signes cliniques sont apparus 10 ans auparavant par le biais d’une néphrocalcinose.Conclusion. – Cette observation soulève l’intérêt de rechercher un syndrome de Gougerot-Sjögren latent dans le bilan de néphrocalcinose avec acidose tubulaire distale.Introduction. – Nephrocalcinosis is a rare complication of chronic tubulointerstitial nephritis observed in primary Sjögren’s syndrome. It can precede subjective sicca symptoms.Observation. – We report the case of a 50-year-old woman who presented with a primary Sjögren’s syndrome. The first symptoms appeared 10-years-ago while she was affected with a nephrocalcinosis.Conclusion. – Autoimmune investigations for Sjögren’s syndrome should be initiated in any patient presenting with nephrocalcinosis and distal renal tubular acidosis.

Oxidative stress has been suggested to be implicated in malaria. But it is not clear whether its major role is to kill intraerythrocytic parasites or to cause damage to host tissues. We have studied it in 24 European subjects hospitalized in Saint-André hospital, Bordeaux, France for Plasmodium falciparum access returning from a tropical trip, and in a group control of 16 subjects. Malondialdehyde, one of the oxidative stress markers is significantly increased in patients compared to the control group (m = 5.24 vs 2.14 mol/l). At the same time, it is observed a significative decrease in antioxidant factors, vitamin A and vitamin E. We found no relationship of the severity of malaria to the importance of the oxidative stress, and the question whether the oxidative stress attack host tissues or kill parasites remains entire. These observations should be completed by larger studies, particularly to improve malaria treatments available nowadays.

L'efficacité du bacille de Calmette-Guérin dans le traitement des tumeurs superficielles de vessie a été rapportée pour la première fois par Morales en 1976. Plusieurs autres auteurs ont depuis confirmé cette efficacité dans le traitement des tumeurs superficielles de vessie à haut risque de récidive et de progression (pT1G3, CIS). Les résultats récents rapportés par Lamm suggèrent que l'utilisation d'un traitement d'entretien par trois instillations hebdomadaires complémentaires à 3, 6, 12, 18, 24, 30 et 36 mois pourrait améliorer les résultats en terme de survie sans récidive. Cependant l'utilisation d'un traitement d'entretien semble limitée par de nombreuses manifestations réactionnelles indésirables qui posent le problème de leur prise en charge thérapeutique. Les auteurs, en réalisant une revue générale des effets indésirables associés au BCG, proposent une classification de ces effets indésirables et une mise au point concernant leurs facteurs favorisants. Ils proposent de plus, des attitudes thérapeutiques systématiques (adaptées au type d'effet indésirable) et applicables en pratique clinique.The efficacy of Bacillus Calmette-Guérin (BCG) in the treatment of superficial bladder cancer was first reported by Morales in 1976. Several authors have since demonstrated the efficacy of BCG in the prophylaxis and treatment of high-risk superficial bladder tumors (pT1G3, CIS). Although BCG is now recommended as an adjunctive treatment for superficial bladder tumors, the optimal treatment schedule remains to be defined. Results reported by Lamm suggest that an initial induction cycle of six weekly intravesical BCG instillations is suboptimal unless maintenance therapy (three consecutive weekly instillations) is given 3, 6, 12, 18, 24, 30 and 36 months later. However, the use of maintenance therapy is hindered by troublesome adverse reactions. This article reviews adverse reactions associated with BCG treatment, proposed a classification and discusses their prevention and treatment.