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1. Prognostic value of residual vegetation after antibiotic treatment for infective endocarditis: A retrospective cohort study

Author

Valérie Houard, Lydie Porte, Clémence Delon, Didier Carrié, Pierre Delobel, Michel Galinier, Olivier Lairez, and Yoan Lavie-Badie

Subjects
Infective endocarditis, Heart valve disease, Vegetation, Prognostic, Embolism, Residual vegetation, Infectious and parasitic diseases, RC109-216
Abstract

Background: The prognostic impact of residual vegetation (RV) after medical treatment for endocarditis remains unknown. Methods: 134 consecutive patients hospitalized for infective endocarditis, not surgically treated, with the presence of vegetation at diagnosis, were included retrospectively. The follow-up started at the end of antibiotic treatment when healing was complete. The presence or absence of RV was assessed at this time. The primary endpoint was a composite of the occurrence of embolic events, recurrence of endocarditis, or death from any cause. Results: Eighty-five patients were men (63%), mean age was 69 ± 15 years, and median follow-up was 16.3 (IQR: 5–30) months. Sixty-six patients (49%) had RV, 15 (11%) had RV > 10 mm and nine (7%) had RV with an increase in size relative to that of the diagnosis. The primary endpoint occurred in 23 patients (35%) in the group with RV, and in 16 patients (24%) without RV, which was not statistically relevant (HR 1.70; 95% confidence interval (CI) 0.89–3.22; p = 0.10). Based on univariate Cox regression analysis, the occurrence of the primary endpoint was associated with RV that increased (HR 3.90 95% CI 1.61–9.43; p < 0.01), RV size (HR 1.05; 95% CI 1.01–1.09; p < 0.01) or RV > 10 mm (HR 3.35; 95% CI 1.51–7.39; p < 0.01). Only RV > 10 mm remained significant in multivariate Cox regression: HR3.29; 95% CI 1.20–8.96; p = 0.02. Conclusions: RV is frequent but has no clear prognostic impact in itself; however, its size, particularly in comparison with the start-of-treatment data, merits particular attention as being potentially associated with increased risk.

Published
2020
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2. Improved survival of HIV-1-infected patients with progressive multifocal leukoencephalopathy receiving early 5-drug combination antiretroviral therapy.

Author

Jacques Gasnault, Dominique Costagliola, Houria Hendel-Chavez, Anne Dulioust, Sophie Pakianather, Anne-Aurélie Mazet, Marie-Ghislaine de Goer de Herve, Rémi Lancar, Anne-Sophie Lascaux, Lydie Porte, Jean-François Delfraissy, Yassine Taoufik, and ANRS 125 Trial Team

Subjects
Medicine, Science
Abstract

Progressive multifocal leukoencephalopathy (PML), a rare devastating demyelinating disease caused by the polyomavirus JC (JCV), occurs in severely immunocompromised patients, most of whom have advanced-stage HIV infection. Despite combination antiretroviral therapy (cART), 50% of patients die within 6 months of PML onset. We conducted a multicenter, open-label pilot trial evaluating the survival benefit of a five-drug cART designed to accelerate HIV replication decay and JCV-specific immune recovery.All the patients received an optimized cART with three or more drugs for 12 months, plus the fusion inhibitor enfuvirtide during the first 6 months. The main endpoint was the one-year survival rate. A total of 28 patients were enrolled. At entry, median CD4+ T-cell count was 53 per microliter and 86% of patients had detectable plasma HIV RNA and CSF JCV DNA levels. Seven patients died, all before month 4. The one-year survival estimate was 0.75 (95% confidence interval, 0.61 to 0.93). At month 6, JCV DNA was undetectable in the CSF of 81% of survivors. At month 12, 81% of patients had undetectable plasma HIV RNA, and the median CD4+ T-cell increment was 105 per microliter. In univariate analysis, higher total and naive CD4+ T-cell counts and lower CSF JCV DNA level at baseline were associated with better survival. JCV-specific functional memory CD4+ T-cell responses, based on a proliferation assay, were detected in 4% of patients at baseline and 43% at M12 (P = 0.008).The early use of five-drug cART after PML diagnosis appears to improve survival. This is associated with recovery of anti-JCV T-cell responses and JCV clearance from CSF. A low CD4+ T-cell count (particularly naive subset) and high JCV DNA copies in CSF at PML diagnosis appear to be risk factors for death.ClinicalTrials.gov NCT00120367.

Published
2011
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4. Infective endocarditis in pregnant women without intravenous drug use: a multicentre retrospective case series

Author

Laura Escolà-Vergé, Pau Rello, Charles Declerck, Vincent Dubée, Fréderic Rouleau, Xavier Duval, Gilbert Habib, Yoan Lavie-Badie, Guillaume Martin-Blondel, Lydie Porte, Kevin Bouiller, François Goehringer, Christine Selton-Suty, Cristiane da Cruz Lamas, Francisco Nacinovich, Nahema Issa, Clémence Richaud, Nadjib Hammoudi, Francisco José Barranco, Benito Almirante, Pierre Tattevin, Nuria Fernández-Hidalgo, Universitat Autònoma de Barcelona (UAB), Instituto de Salud Carlos III [Madrid] (ISC), Vall d'Hebron University Hospital [Barcelona], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Service de cardiologie Pédiatrique [Marseille], Hôpital de la Timone [CHU - APHM] (TIMONE), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service Maladies infectieuses et tropicales [CHU Toulouse], Pôle Inflammation, infection, immunologie et loco-moteur [CHU Toulouse] (Pôle I3LM Toulouse), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Laboratoire Chrono-environnement (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service des Maladies Infectieuses et Tropicales [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de Cardiologie [CHRU Nancy], Instituto Evandro Chagas, CHU Bordeaux [Bordeaux], Institut Mutualiste de Montsouris (IMM), Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), CHU Pontchaillou [Rennes], ARN régulateurs bactériens et médecine (BRM), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), This work was carried out as part of our routine work. Laura Escolà-Vergé has a Juan Rodés contract in the call 2020 Strategic Action Health from Instituto de Salud Carlos III of Spanish Health Ministry for the years 2021–24 (JR20/00020)., Jonchère, Laurent, and Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)

Subjects
Pharmacology, Microbiology (medical), Endocarditis, Staphylococcus, [SDV]Life Sciences [q-bio], Infant, Newborn, Infant, Endocarditis, Bacterial, [SDV] Life Sciences [q-bio], Infectious Diseases, Pregnancy, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, [SDV.MHEP.MI] Life Sciences [q-bio]/Human health and pathology/Infectious diseases, Humans, Pharmacology (medical), Female, Pregnant Women, Retrospective Studies
Abstract

Objectives To describe the clinical features and outcomes of infective endocarditis (IE) in pregnant women who do not inject drugs. Methods A multinational retrospective study was performed at 14 hospitals. All definite IE episodes between January 2000 and April 2021 were included. The main outcomes were maternal mortality and pregnancy-related complications. Results Twenty-five episodes of IE were included. Median age at IE diagnosis was 33.2 years (IQR 28.3–36.6) and median gestational age was 30 weeks (IQR 16–32). Thirteen (52%) patients had no previously known heart disease. Sixteen (64%) were native IE, 7 (28%) prosthetic and 2 (8%) cardiac implantable electronic device IE. The most common aetiologies were streptococci (n = 10, 40%), staphylococci (n = 5, 20%), HACEK group (n = 3, 12%) and Enterococcus faecalis (n = 3, 12%). Twenty (80%) patients presented at least one IE complication; the most common were heart failure (n = 13, 52%) and symptomatic embolism other than stroke (n = 4, 16%). Twenty-one (84%) patients had surgery indication and surgery was performed when indicated in 19 (90%). There was one maternal death and 16 (64%) patients presented pregnancy-related complications (11 patients ≥1 complication): 3 pregnancy losses, 9 urgent Caesarean sections, 2 emergency Caesarean sections, 1 fetal death, and 11 preterm births. Two patients presented a relapse during a median follow-up of 3.1 years (IQR 0.6–7.4). Conclusions Strict medical surveillance of pregnant women with IE is required and must involve a multidisciplinary team including obstetricians and neonatologists. Furthermore, the potential risk of IE during pregnancy should never be underestimated in women with previously known underlying heart disease.

Published
2022

5. Dangerous Liaisons: Pelvic Variant of Lemierre Syndrome by Right Common Iliac Vein Thrombophlebitis After Sexual Intercourse

Author

Ludwig Duazo Cassin, Fabien Vidal, Olivier Parant, Helene Pol, Martin Baujat, Paul Guerby, Elodie Chantalat, Amanda Tournemire, and Lydie Porte

Subjects
0301 basic medicine, medicine.medical_specialty, Adolescent, Radiography, 030106 microbiology, Right common iliac vein, Iliac Vein, Thrombophlebitis, Pelvis, 03 medical and health sciences, 0302 clinical medicine, X ray computed, medicine, Humans, Lemierre Syndrome, Lung Abscess, business.industry, Coitus, Obstetrics and Gynecology, General Medicine, medicine.disease, Sexual intercourse, Fusobacterium necrophorum, 030220 oncology & carcinogenesis, Fusobacterium Infections, Female, Radiography, Thoracic, Radiology, business, Tomography, X-Ray Computed
Published
2017

6. Quinine unbound concentration is the best marker for therapeutic drug monitoring

Author

Didier Concordet, Michel Lavit, Etienne Chatelut, Patrick Seraissol, François Fraissinet, Peggy Gandia, Carlos de Pablos-Martinez, Antoine Berry, Lydie Porte, Institut Fédératif de Biologie - Laboratoire de Pharmacocinétique et Toxicologie, Centre Hospitalier Universitaire de Purpan (CHU Purpan), Département des Maladies Infectieuses, CHU Grenoble, Individualisation des traitements des cancers ovariens (ITCO), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut Universitaire du Cancer Toulouse - Oncopôle (IUCT), ToxAlim (ToxAlim), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Ecole Nationale Vétérinaire de Toulouse (ENVT), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Ecole d'Ingénieurs de Purpan (INPT - EI Purpan), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Recherche Agronomique (INRA), Institut Fédératif de Biologie - Laboratoire de Pharmacologie et Toxicologie, Institut Fédératif de Biologie - Laboratoire de Pharmacocinétiqueet et Toxicologie, and Institut Fédératif de Biologie - Laboratoire de Pharmacocinétique etToxicologie

Subjects
Unbound fraction, [SDV]Life Sciences [q-bio], Pharmacology, Therapeutic drug monitoring, 030226 pharmacology & pharmacy, Antimalarials, 03 medical and health sciences, 0302 clinical medicine, Area under curve, parasitic diseases, Humans, Medicine, Pharmacology (medical), Quinine, Chromatography, medicine.diagnostic_test, business.industry, medicine.disease, Malaria, 3. Good health, Fraction libre, Area Under Curve, 030220 oncology & carcinogenesis, Drug Monitoring, business, Suivi pharmacologique thérapeutique, Protein Binding, medicine.drug
Abstract

Quinine monitoring should be based on unbound concentration due to variable unbound fraction in malaria patients.

Published
2016

7. Quinine unbound concentration has to be used for therapeutic drug monitoring

Author

Michel Lavit, Patrick Seraissol, Carlos de Pablos-Martinez, Etienne Chatelut, Peggy Gandia, Antoine Berry, Lydie Porte, François Fraissinet, Didier Concordet, Institut Fédératif de Biologie - Laboratoire de Pharmacocinétique et Toxicologie, Centre Hospitalier Universitaire de Purpan (CHU Purpan), Département des Maladies Infectieuses, CHU Grenoble, Institut Universitaire du Cancer Toulouse - Oncopôle (IUCT), ToxAlim (ToxAlim), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Ecole Nationale Vétérinaire de Toulouse (ENVT), Institut National Polytechnique (Toulouse) (Toulouse INP), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Ecole d'Ingénieurs de Purpan (INPT - EI Purpan), and Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Recherche Agronomique (INRA)

Subjects
Male, [SDV]Life Sciences [q-bio], Plasma protein binding, Pharmacology, 030226 pharmacology & pharmacy, Antimalarials, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Pharmacology (medical), Malaria, Falciparum, ComputingMilieux_MISCELLANEOUS, Quinine, medicine.diagnostic_test, business.industry, Therapeutic drug monitoring, 030220 oncology & carcinogenesis, Female, Drug Monitoring, business, Malaria falciparum, Protein Binding, medicine.drug
Abstract

International audience

Published
2016

8. Decreased Semen Volume and Spermatozoa Motility in HIV-1-Infected Patients Under Antiretroviral Treatment

Author

Martin Sergerie, Patrice Massip, Louis Bujan, Stéphanie Martinet, Lydie Porte, Christophe Pasquier, Myriam Daudin, and Nathalie Moinard

Subjects
Adult, Male, endocrine system, Urology, Endocrinology, Diabetes and Metabolism, Physiology, Motility, HIV Infections, Semen, Semen quality, Endocrinology, Acquired immunodeficiency syndrome (AIDS), medicine, Humans, Sida, Sperm motility, biology, urogenital system, biology.organism_classification, medicine.disease, Sperm, Anti-Retroviral Agents, Reproductive Medicine, Lentivirus, Immunology, HIV-1, Sperm Motility
Abstract

Inconsistent results have been reported for the semen quality in HIV-infected men, due to the biases inherent in some studies. The objective of the present study was to investigate the semen parameters in HIV-1-infected patients and to compare their sperm characteristics with those of a control group of fertile, noninfected men. Factors implicated in semen alterations in HIV-1 patients were also analyzed. HIV-infected men (n=190), of whom 91% were undergoing antiretroviral therapy, and 218 fertile men were studied. Infertility risk factors were recorded and clinical examinations were performed for both groups. Records of history of HIV infection, antiretroviral treatment, and HIV-1 RNA detection in the blood as well as HIV-1 genome detection in the semen were obtained for the infected patients. Semen volumes, percentages of progressive motile spermatozoa, total sperm counts, and polymorphonuclear cell counts were decreased, while the pH values and spermatozoa multiple anomaly indices were increased in HIV-infected patients. Even after adjustment for possible sources of bias, the decreases in semen volume and progressive motility and the increase in pH remained significant. The present study demonstrates sperm motility and ejaculate volume alterations in HIV-1-infected patients, most of whom were receiving antiretroviral therapy. In HIV-1 patients, further longitudinal studies are required to analyze the impact of treatment regimen on sperm parameter alterations.

Published
2006

9. Giant Cell Arteritis and Spinal Cord Compression: An Overlap Syndrome?

Author

Leonardo Astudillo, Philippe Arlet, Lydie Porte, Sophie Le Guellec, Emmanuelle Uro-Coste, I. Catalaa, S. Ollier, Bertrand Couret, Patrice Massip, and Laurent Sailler

Subjects
Male, Pathology, medicine.medical_specialty, Biopsy, Giant Cell Arteritis, Thoracic Vertebrae, Diagnosis, Differential, Central nervous system disease, Spinal cord compression, Humans, Medicine, Glucocorticoids, Aged, Anti-neutrophil cytoplasmic antibody, medicine.diagnostic_test, business.industry, Meninges, Overlap syndrome, Syndrome, General Medicine, medicine.disease, Magnetic Resonance Imaging, Giant cell arteritis, medicine.anatomical_structure, Drug Therapy, Combination, Female, Tomography, X-Ray Computed, business, Vasculitis, Spinal Cord Compression, Immunosuppressive Agents, Follow-Up Studies
Abstract

We describe 2 patients with spinal cord compression that occurred in the course of biopsy-proven giant cell arteritis (GCA). One case was due to an epidural tumorlike inflammatory lesion, the other to a concentric inflammatory thickening of the meninges. Both patients were highly corticodependent; they had low-titer anti-neutrophil cytoplasmic antibodies but no antimyeloperoxidase or antiproteinase 3 autoantibodies. The diagnosis was established by surgical biopsy. The histological pattern was reminiscent of Wegener granulomatosis. Both patients experienced relapse, despite high doses of corticosteroids, and experienced remission after the introduction of cyclophosphamide. Intravenous immunoglobulin perfusions were added for 1 patient. To our knowledge, spinal cord compression by a spinal pseudotumor or inflammatory meningitis has not been reported in the course of GCA. An overlap syndrome between GCA and Wegener granulomatosis is discussed.

Published
2006

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