Maladie de Castleman et syndrome de Kaposi chez le patient infecté par le VIH (à propos de 6 cas de maladie de Castleman)

Introduction : La Maladie de Castleman multicentrique (MCM) et le syndrome de Kaposi (SK) sont liés tous deux à l'infection par le Virus de l Herpès Humain de type 8 (HHV-8). Chez les patients infectés par le VIH, le SK est beaucoup moins fréquent depuis l ère des trithérapies. La maladie de Castleman, plus rare et moins connue ne semble pas reculer depuis l usage des antirétroviraux. Matériel et méthode Après une revue de la littérature sur la maladie de Castleman, nous rapportons toutes les observations de Maladie de Castleman associées ou non au SK, diagnostiquées dans le Service Universitaire des Maladies Infectieuses et du Voyageur (SUMIV) de Tourcoing. Nous en analysons l épidémiologie, la clinique, les critères diagnostiques et l évolution. Résultats : Cinq des six patients diagnostiqués au SUMIV ont présenté une maladie de Castleman de forme multicentrique avec un SK. Un patient a eu un lymphome plasmoblastique associé. La PCR HHV-8 était positive chez les tous patients ayant eu une formes multicentrique. Discussion : La forte association entre MCM et SK -72%dans littérature- se confirme dans notre série. Le virus HHV-8 demeure le lien infectieux commun entre ces deux pathologies. Si le SK est fréquent chez les hommes ayant des relations sexuelles avec les hommes (HSH), le type de comportement sexuel n est pas bien documenté pour le Castleman. La fièvre persistante, l AEG rapide, les adénomégalies et la splénomégalie doivent d autant plus orienter le diagnostic qu'ils sont associés à un syndrome hémolytique. C est l'immunohistochimie qui confirme le diagnostic et permet la mise en route de la chimiothérapie salvatrice associée, voire même précédée du traitement du VIH. Conclusion : Ce travail permet de retenir chez le patient VIH des caractéristiques épidémiologiques cliniques et biologiques devant faire rechercher un Castleman, notamment pour le dermatologue face à un SK. Sa reconnaissance permet d'associer aux ARV une chimiothérapie précoce indispensable pour une évolution favorable.LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

Repurposing an Old Drug: Aztreonam as a New Treatment Strategy for Gonorrhoea

International audienceObjectives: To determine whether aztreonam is still an effective drug for the treatment of gonorrhoea.Methods: Observational study of patients with gonorrhoea diagnosed by urine multiplex PCR, with a past medical history of allergy to β-lactams or relapse after treatment with a third-generation cephalosporin. Patients received a single 1 g dose of aztreonam in accordance with the manufacturer's instructions.Results: Five patients (four males, one female) were enrolled, comprising two who were allergic to β-lactams and three previously treated with cephalosporins who relapsed. Median age was 38 years (range 23-51). Following treatment with aztreonam all were cured without any adverse event. All the men were free of symptoms, and the woman tested negative for gonorrhoea 1 month after treatment.Conclusion: Aztreonam appears to be an effective alternative to cephalosporins in the treatment of uncomplicated gonorrhoea, particularly when patients are suspected of being infected by strains with reduced susceptibility to ceftriaxone or are known to be allergic to penicillin

Factors Associated with Treatment Failure in Moderately Severe Community-Acquired Pneumonia: A Secondary Analysis of a Randomized Clinical Trial

International audienceImportance: Failure of treatment is the most serious complication in community-acquired pneumonia (CAP). Objective: To assess the potential risk factors for treatment failure in clinically stable patients with CAP. Design, Setting, and Participants: This secondary analysis assesses data from a randomized clinical trial on CAP (Pneumonia Short Treatment [PTC] trial) conducted from December 19, 2013, to February 1, 2018. Data analysis was performed from July 18, 2019, to February 15, 2020. Patients hospitalized at 1 of 16 centers in France for moderately severe CAP who were clinically stable at day 3 of antibiotic treatment were included in the PTC trial and analyzed in the per-protocol trial population. Interventions: Patients were randomly assigned (1:1) on day 3 of antibiotic treatment to receive β-lactam (amoxicillin-clavulanate [1 g/125 mg] 3 times daily) or placebo for 5 extra days. Main Outcomes and Measures: The main outcome was failure at 15 days after first antibiotic intake, defined as a temperature greater than 37.9 °C and/or absence of resolution or improvement of respiratory symptoms and/or additional antibiotic treatment for any cause. The association among demographic characteristics, baseline clinical and biological variables available (ie, at the first day of β-lactam treatment), and treatment failure at day 15 among the per-protocol trial population was assessed by univariate and multivariable logistic regressions. Results: Overall, 310 patients were included in the study; this secondary analysis comprised 291 patients (174 [59.8%] male; mean [SD] age, 69.6 [18.5] years). The failure rate was 26.8%. Male sex (odds ratio [OR], 1.74; 95% CI, 1.01-3.07), age per year (OR, 1.03; 95% CI, 1.01-1.05), Pneumonia Severe Index score (OR, 1.01; 95% CI, 1.00-1.02), the presence of chronic lung disease (OR, 1.85; 95% CI, 1.03-3.30), and creatinine clearance (OR, 0.99; 95% CI, 0.98-1.00) were significantly associated with failure in the univariate analysis. When the Pneumonia Severe Index score was excluded to avoid collinearity with age and sex in the regression model, only male sex (OR, 1.92; 95% CI, 1.08-3.49) and age (OR, 1.02; 95% CI, 1.00-1.05) were associated with failure in the multivariable analysis. Conclusions and Relevance: In this secondary analysis of a randomized clinical trial, among patients with CAP who reached clinical stability after 3 days of antibiotic treatment, only male sex and age were associated with higher risk of failure, independent of antibiotic treatment duration and biomarker levels. Another randomized clinical trial is needed to evaluate the impact of treatment duration in populations at higher risk for treatment failure

A highly virulent variant of HIV-1 circulating in the Netherlands

We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log10 increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence