P Bossi

..In the case of a bioterrorist attack, the United States and most of the EC countries propose to vaccinate only the health professionnals most exposed to the virus and those having contacted identified cases...

..For the other clinical types of the disease, patients should be isolated for the first 48 hours after the initiation of treatment...

..This vaccine must be administered as rapidly as possible in symptomatic patients. A single case of botulism acquired by inhalation corresponds to an act of terrorism...

..There is no established antiviral treatment for smallpox. The most effective prevention is vaccination before exposure...

..A dead cell vaccine exists, but its efficacy in terms of protection from primary pneumonia appears inadequate...

..Ribavirin is recommended for the treatment and the prophylaxis of the arenaviruses and the bunyaviruses, but is not effective for the other families. All patients must be isolated and receive intensive supportive therapy...

..IN GENERAL PRACTICE: Tularemia is a disease that requires official notification. Many guidelines exist for the treatment and prophylaxis of patients having been exposed to F. tularensis...

..Trivalent equine antitoxins (A,B,E) must be given to patients as soon as possible after clinical diagnosis. Heptavalent human antitoxins (A-G) are available in certain countries...

..The combination of ofloxacin plus rifampicin is associated with good results. Even if there is little evidence to support its utility for post-exposure prophylaxis, doxycycline plus rifampicin is recommended for 3 to 6 weeks...

..In this manuscript, we describe the clinical features, biological findings, virological tests, radiological assessment, outcome and treatments of this infection. FUTURE: Research on specific therapies and vaccines is on-going...

..In fact C. burnetii would more likely be used as a disabling weapon...

..Post-exposure prophylaxis with trimethoprim-sulfamethoxazole is recommended in case of a biological attack. There is no vaccine available for humans...

..Treatment consists of massive doses of antibiotics and supportive care. Isolation is not necessary. Antibiotics such as ciprofloxacin are recommended for post-exposure prophylaxis during 60 days...

..Many guidelines have been published with recommendations for the treatment and prophylaxis of anthrax. Prognosis remains poor in the systemic form of the disease...

..The possible usefulness of regular drug assays for adjusting treatment doses in case of therapeutic escape remains to be assessed in prospective trials...

..More than 180 pathogens have been reported to be potential agents for bioterrorism. The following is an overview of several agents that could be involved in a biological attack...

....

..Nevertheless, treatment can shorten the duration of illness and decrease the risk of complications such as endocarditis. Post-exposure prophylaxis is recommended after the exposure in the case of a bioterrorist attack...

..Genetic susceptibility probably intervenes, genetic variability playing either a protective or a deleterious role (the interest of Toll-like receptors)...

..We report a case of severe acute disseminated toxoplasmosis acquired by an immunocompetent patient in French Guiana and review the literature...

..INFECTIONS THAT REQUIRE RECOGNITION: The role of practitioners in the rapid recognition of bioterrorism-related infections is crucial. Hence, updated knowledge on these potentially emerging or reemerging infections is required...

..To evaluate the benefits of therapeutic drug monitoring (TDM) in association with genotypic resistance testing and expert advice to optimize therapy in multiexperienced patients infected with HIV-1...

..There is no effective drug therapy for the treatment of these diseases and treatment is mainly supportive, but vaccines protecting against some of these viruses do exist...

..CONCLUSION: After the introduction of HAART (1996), the incidence of PCNSL has decreased drastically and survival was increased...

..We have to consider these agents as possible biological warfare agents. Europeans guidelines for treatment and post-exposure prophylaxis are detailed...

..Three HIV infected patients were infected by mycobacteria resistant to at least one antibiotic (isoniazid, 1; rifampicin, 1; isoniazid, streptomycin, etambutool, 1). All the patients recovered...

..Quinolone is an effective alternative drug. No isolation measures for patients with pneumonia are necessary. Streptomycin, gentamicin, doxycycline or ciprofloxacin are recommended for post-exposure prophylaxis...

....

..The patient's condition improved with pyrimethamine and sulfadiazine. Only the standard treatment for toxoplasmosis was effective, whereas intravenous immunoglobulins were ineffective...

..P-gps have been detected on peripheral CD4 blood cells in HIV-1-infected, but antiretroviral-naive patients...

....

..At present, heterosexuality is the most frequent risk factor for HIV-infection (51%). Pneumocystis pneumonia remains the most common opportunistic illness in HIV-infected patients (28%)...

..The purpose of this study was to determine the frequency and potential consequences of a lack of dosage adjustment in hospitalized patients with renal impairment...

..Except for yellow fever, there is no vaccination for the other forms of viral haemorrhagic fever...

....

..We describe the case of a patient infected with HIV and a concomitant HHV-6 encephalitis. The patient experienced virological failure following cidofovir treatment. RT-PCR was used both for early diagnosis and follow-up...

..This atypical recurrence was more likely to be a reinfection than a reactivation, as attested by the genotypic analysis of the Toxoplasma gondii strain recovered from the patient...

..The aim of terrorist groups who would use this type of weapon is more to provoke panic and disorganisation than to kill as many people as possible...

..CONCLUSION: In patients with HIV mutations conferring resistance to all antiretroviral drug classes, foscarnet markedly reduced plasma HIV load and improved immunological status...

..There was no relation between the resistance pathways selected with either APV or ritonavir plasma minimal concentration, but higher APV plasma minimal concentration were associated with a lower rate of resistance mutations selection...

..These findings provide strong circumstantial evidence that the M(318)V change of the PK gene is associated with resistance to GCV and raise the question of cross resistance to this drug among different betaherpesviruses...

..Three-quarters of the subjects had a proliferative response. This response was lower after the age of 55 years but could be reactivated by revaccination...

..Also, we have described 8 new HHV-8 T cell epitopes in LANA-1, K12, and K15, including 2 CD4 T cell epitopes. These data provide new insight into HHV-8 cellular immunity...

..This program included the establishment of a preoutbreak national team that could be revaccinated against smallpox...

..Given this, we suggest that investigation for cryptococcosis-related lesions is merited, even in the absence of neurological abnormality, if a high fungal burden is suspected on the basis of high serum and/or CSF antigen titers...

..Analysis of VEGF and pro-inflammatory cytokines led us to hypothesize that Kaposi's sarcoma could be promoted by the tuberculosis immune response...

....

..Anti-inflammatory therapy such as NSAIDs could reduce CSF inflammation and modify the clinical outcome in patients with bacterial meningitis. However, the use of NSAIDs is not recommended in bacterial meningitis due to a lack of studies...

..The reservoir of the virus, which may be animal, is still unknown. The epidemic seems to be controlled, but sporadic or epidemic re-emergences may occur and have been observed in China during January 2004...

..We describe the manifestations of chikungunya virus infection in travelers returning from these islands, with focus on skin manifestations...

..Travellers to endemic areas should be encouraged to use personal protective measures...

..We reviewed retrospectively the demographic, clinical, biological characteristics and outcomes of 11 patients with HSV meningitis...

..The improved survival of patients since the use of highly active antiretroviral treatments has lead to the reporting of non-AIDS defining tumors, such as lung cancer...

..Intensive insulin therapy is aimed at maintaining normal glycemia in the patients for as long as possible...

..Pox and Monkeypox are "virtually emerging" viruses that have potential for use in bioterrorism. The management and treatment of these emerging infectious diseases calls for new approaches, organizations and infrastructures...

..Recurrent cryptococcal infection should be suspected in patients whose serum cryptococcal antigen test results revert back to positive after discontinuation of maintenance therapy...

..The practical approach varies depending on the drug responsible, the clinical form of the toxiderma and the possible alternatives...

..The administration of chemotherapy with HAART does not seem to increase toxicity...

....

..However, the morbidity of this agent should not be underrated since it leads to chronic and disabling pathologies...

..In this pictorial essay, we describe different thoracic imaging of MCD, with particular emphasis on computed tomography findings, in 13 HIV-infected patients with histologically proved MCD...

....