We assessed the correlations between some plasma markers of immune activation (soluble receptors of interleukin 2 (sIL2-R) and TNFαp75 (sTNFII-R) and usual markers of HIV infection in patients treated with protease-inhibitors (PI). Forty-six PI-naive HIV-1-infected adults were included in a 1-year prospective cohort from the initiation of a PI-containing regimen (M0). Measurements of CD4+cell count, plasma HIV-RNA, sIL2-R and sTNFII-R were performed at M0, M6, and M12. The evolution of sIL2-R from baseline to M12 was significantly different between immunological responders (IR) (CD4+count above 200/mm3 for subject having less than 200 CD4 +/mm3 at inclusion, or increase of at least 50 CD4+/mm3 for others) (58 UI/ml) and non-IR (+28 UI/ml) (P =0.01). The evolution of sTNFII-R between M0 and M12 was significantly different between virological responders (VR) (plasma HIV-1 RNA less than 500 copies/ml at M12) (−2.5 ng/ml) and non-VR (+0.2 ng/ml) (P =0.02). Our study shows significative correlations between the evolutions of soluble interleukin-2 and TNFR-II receptors and those of CD4+T-lymphocytes or HIV-RNA responses in patients under HAART.

The authors report the first case of cutaneous vasculitis presenting as an acute purpura related to sparfloxacin intake.

Trente observations de leptospiroses survenues de 1980 à 1992 dans trois départements d'Aquitaine, ont été colligé rétrospectivement dans trois services de médecine interne et un service de néphrologie du CHU de Bordeaux. La transmission est le plus souvent indirecte au cours de loisirs ou dans certaines professions exposées. Le début est brutal avec une fièvre associée le plus souvent à un syndrome algique, plus rarement à une suffusion conjonctivale. Les atteintes viscérales sont dominées par l'ictère de type cholestatique (70%), l'insuffisance rénale aiguë (67%), le syndrome méningé clinique (50%) et les signes hémorragiques (50%). Le diagnostic est toujours confirmé sérologiquement par le microagglutination test. Le sérogroupe L ictero-haemorrhagiae prédomine. L'évolution est favorable chez 22 patients, émaillée de complications réversibles chez six (cinq insuffisances rénales avec hémodialyse, myocardite et œdème pulmonaire chez deux dialysés, polyradiculonévrite) et létales deux fois (syndrome de détresse respiratoire aigu et méningoencéphalite avec syndrome hémorragique diffus chez deux dialysés). Cette série se caractérise par une fréquence élevée du syndrome hépatorénal compte tenu de la participation d'un service de néphrologie : elle confirme la gravité pronostique des complications pulmonaires, rénales hémorragiques et neurologiques de la leptospirose. Il n'apparaît pas de relation absolue entre la symptomatologic clinique et biologique et le sérovar du leptospire. La pénicilline est reconnue comme le traitement étiologique de première intention et doit être administré précocement afin d'éviter des complications viscérales graves.

Bad dreams, confusion, agitation, hallucinations, bilateral acute visual loss and acquired dyschromatopsia developed in an old patient treated with ciprofloxacin. The neurologic side-effects disappeared after cessation of this antibiotic.

Visceral leihmaniasis occurs frequently during HIV infection. Thus, this zoonosis can be encountered in nonimmunocompromised patients. We report 2 cases.

The use of pyrimethamine plus clindamycine has been validated as an effective treatment of toxoplasmic encephalitis in AIDS patients : this combination was assessed in 21 patients (10 in first intention therapy, 11 as an alternative regimen to pyrimethamine plus sulfadiazine). In the ten first days of treatment 7 patients experienced a mild to severe skin rash with fever which resolved after discontinuation of clindamycin. A one-day specific desensitization regimen was completed under careful monitoring : the initial dose of intravenous clindamycine was 0,15 mg. The dosage was two-fold increased every hour so as to get the 1,2 g unit dose after 18 hours. In 6 of the 7 patients the clinical tolerance of the regimen was good and the pyrimethamine-clincamycin combination could so be completed not only for acute but also for maintenance therapy. On the other hand, in one patient, the occurrence of a new rash during the desensitization led us to stop the test. These data suggest that rush desensitization to clindamycin could be used to allow AIDS patients who experienced clindamycin related skin rash to complete bitherapy regimen of toxoplasmic encephalitis.

The authors report an exceptional observation where splenic abscesses revealed a multiple myeloma in a 42-year-old man.

The authors report 33 cases of primary CMV infections in non-immunocompromised adults. The usual feature is a prolonged, well tolerated febrile illness, associated with hyperlymphocytosis and mild cytolysis. A careful follow-up is needed to detect the rare but serious complications.

In France, cryptococcal meningitis is the second most common life-threatening opportunistic infection involving central nervous system in AIDS patients. The authors report the clinical and biological caracteristics of 24 cases of cryptococcal miningitis observed in a University Hospital over a 5 years period.

Kingella indologenes is a normal commensal of the upper respiratory tract. It is a gram negative bacillus which does not grow readily on the usual media. The authors report here the second case of K. indologenes endocarditis known in the literature.

The Mycobacterium avium complex infections have become increasingly important in clinical medicine, specially in patients with HIV infection. The authors report on clinical and microbiological characteristics of 50 patients with AIDS and disseminated MAC infection.

The authors report 33 cases of primary CMV infections in non-immunocompromised adults. The usual feature is a prolonged, well tolerated febrile illness, associated with hyperlymphocytosis and mild cytolysis. A careful follow-up is needed to detect the rare but serious complications.

The Mycobacterium avium complex infections have become increasingly important in clinical medicine, specially in patients with HIV infection. The authors report on clinical and microbiological characteristics of 50 patients with AIDS and disseminated MAC infection.

483 cases of HIV infection in women are reported. Intravenous drug use is the main at-risk behaviour but heterosexually acquired infection increased rapidly. Excluding Kaposi Sarcoma, no significant difference between men and women is observed in the overall distribution of AIDS defining events and in the course of HIV infection.

We conducted a rush desensitization to clindamycine by seven AIDS patients who experienced clindamycine-allergic skin rash during treatment for acute toxoplasmic encephalitis (TE). Its tolerance and efficacy (6/7) led us to think that this method could be used to allow allergic patients to complete a bitherapy regimen when treated for T.E.