Jean-Paul Escande

Herpesvirus-like DNA sequences in patients with Mediterranean Kaposi's sarcoma

DNA sequences closely related to herpesvirus-like sequences have been found in AIDS-associated Kaposis sarcoma. Using PCR, we found herpesvirus-like DNA sequences in Kaposis lesions and normal adjacent skin in five patients with Mediterranean Kaposis sarcoma. We did not find these sequences in tissues from patients without Kaposis sarcoma. Semi-quantitative PCR revealed many more herpesvirus-like sequences in Kaposis lesions than in unaffected skin. Our results reinforce the hypothesis that an infectious agent closely related to gamma-herpesvirus is implicated in the pathogenesis of Mediterranean and AIDS-associated Kaposis sarcoma.

Detection and Quantification of Mycoplasma genitalium in Male Patients with Urethritis

Detection and quantification of Mycoplasma genitalium were evaluated in 83 patients with urethritis (group 1), 60 patients with urethral symptoms but no urethritis (group 2), and 50 asymptomatic men (group 3). Quantification of M. genitalium was carried out using real-time polymerase chain reaction (PCR) analysis of first-pass urine samples. The rate of detection of M. genitalium was significantly higher in group 1 than in groups 2 and 3 (P<.0001). The mean observed concentration of M. genitalium was 1.2x10(4) equivalent genomes/mL of urine (range, 50 to 8x10(4) equivalent genomes/mL). Analysis of M. genitalium load in serial urine samples collected before and after the administration of antibacterial treatment showed an association between clinical and microbiological responses, with a shift to negative PCR results in symptom-free patients. Our results illustrate the usefulness of monitoring the M. genitalium load in evaluating the susceptibility of M. genitalium to antibacterial treatment.

The influence of highly active antiretroviral therapy on AIDS-associated Kaposi's sarcoma.

To assess the clinical and biological benefit of highly active antiretroviral therapy on AIDS‐associated Kaposis sarcoma (KS), 13 patients with AIDS‐associated Kaposis sarcoma (five pulmonary KS and eight cutaneous KS) were prospectively followed for a mean duration of 12 months. Six patients were treated with specific anti‐KS chemotherapy before or simultaneously with the introduction of antiretroviral therapy. Clinical response was assessed according to the AIDS Clinical Trial Group (ACTG) criteria. CD4 cell counts, plasma HIV‐1 RNA and human herpesvirus 8 (HHV‐8) viraemia were measured at baseline and at different points. Among patients with pulmonary KS, we observed three complete responses (CR), one partial response (PR) and one progression. The median survival time after the diagnosis of pulmonary KS was 15 months with a median duration of the response after the discontinuation of specific chemotherapy for KS of 8 months. Among patients with cutaneous KS, we observed four CR, three PR and one stable response. A complete response was significantly associated with a reversal in HHV‐8 viraemia (five of six vs. one of six; P = 0.02, Mann–Whitney test).

Successful treatment of the pruritus of human immunodeficiency virus infection and acquired immunodeficiency syndrome with psoralens plus ultraviolet A therapy

nor detectable by the consumer. 4 Although it was initially thought to possess anticholinesterase activity, it is now known that the toxin opens voltage-dependent sodium channels in the cell membrane. 4.s Several recent reviews 3,4,6,7 provide detailed information about the clinical aspects of ciguatera poisoning. The distinctive clinical presentation is typified by our patient. Nausea, vomiting, abdominal cramps, and diarrhea generally occur about 2 to 8 hours after ingestion of contaminated fish and usuaUy last no more than a day or two. Neurologic manifestations may occur concurrently or shortly after gastrointestinal symptoms, but in contrast, may persist for months. The distinctive features are perioral and distal extremity paresthesia and an uncomfortable burning sensation that occurs after contact with a cold substance. Myalgia, arthralgia, generalized or lower extremity weakness, headache, watery eyes and/or eye pain, and ataxia occur frequently. In more than half the cases, pruritus, exacerbated by exercise or consumption of ethanol, is noted. Occasionally, the neurologic or cutaneous symptoms are the only clinical manifestations. Other cutaneous lesions include a nonspecific eruption, which occur in about 20% of more than 3500 patients reported from the South Pacific4,6; this has not been observed as frequently in other reports. 3,7 Treatment is supportive, with fluid replacement as needed for the gastrointestinal phase of the illness and antihistamines for the pruritus. The neurologic symptoms have reportedly responded to atropine, s aspirin, 9 or amitriptyline, 1~ but there are no controlled studies to confirm their efficacy.

Prevalences of herpesviruses DNA sequences in salivary gland biopsies from primary and secondary Sjogren's syndrome using degenerated consensus PCR primers

BACKGROUND Sjögrens syndrome (SS) is an autoimmune exocrinopathy associated with multiple autoantibodies, lymphocyte infiltration of various organs, and functional deficiency of T cells. Several viruses have been implicated by PCR based studies, but their contribution to the pathophysiology of SS is still controversial. OBJECTIVES In an attempt to explore the presence of human herpesviruses DNA sequences in salivary glands biopsies from patients suffering of SS, a recently developed strategy based on PCR with consensus degenerated primers that allowed to detect known and eventually unknown herpesviruses was used. STUDY DESIGN Salivary glands biopsies from 55 patients suffering of primary and SS syndrome were explored by herpesviruses consensus PCR primers and all the PCR products were sequenced. RESULTS Nine out of 55 salivary glands were positive by PCR and sequence analyses allowed to identify Epstein-Barr virus (EBV) in 6 cases and herpes simplex virus (HSV)-1 in 3 cases. We did not detect any sequences that could be related to a new herpesvirus. CONCLUSION In view of the good sensitivity of the technique used, our study is not consistent with SS being associated with an unknown herpesvirus. However, our results suggest that EBV and HSV-1 could be implicated in a subset of SS cases and this possibility needs to be explored, to assess the potential benefit of antiviral drugs in some cases.

Syndrome hémophagocytaire et infection par le VIH

We report 3 cases of hemophagocytic syndrome in AIDS patients. The relation between this syndrome and the infection with HIV is discussed.