Exuberant inflammatory reaction after an infiltration of platelet-rich plasma (PRP)

in Abstract Book of the 3rd Congress of the ECOSEP (2013, April)

Background: PRP, obtained from centrifuged autologous blood, contains a large quantity of growth factors, which may enhance the tissue healing processes. Local infiltration of PRP represents a relatively ... [more ▼]

Background: PRP, obtained from centrifuged autologous blood, contains a large quantity of growth factors, which may enhance the tissue healing processes. Local infiltration of PRP represents a relatively new treatment for tendinopathies. To date, no side effects have been reported after infiltration of PRP to treat tendinopathy. Case report: A 35-year-old patient had a right upper patellar tendinopathy which was resistant to all conservative treatments for more than 6 months. The patient was a type 1 diabetic (well controlled). He had an intratendinous infiltration of 6 mL of PRP (8.105 platelets/mm3, almost no red or white blood cells) after disinfection but without local anaesthetic. Immediately following the infiltration, local cryotherapy was performed for 15 minutes. NSAIDs were avoided, but class-1 or -2 pain-killers were authorised if necessary. A standardised sub-maximal eccentric rehabilitation should have been started 1 week after. However, the patient experienced local swelling with erythema, increased heating and pain which appeared just underneath the patella, but without biological inflammatory syndrome. A great Doppler signal in a thicker patellar tendon was observed by US, but there was no sign of local infectious disease demonstrated by either CT or MRI. However, the local inflammation did not decrease after a progressive 3-week treatment of local cryotherapy, local and oral NSAIDs and colchicine 1 mg. Thus, an insidious infection was suspected, even though there was neither evidence of biological inflammatory syndrome nor sign of infectious lesion on imagery examination. An antibiotic therapy (rifampicine 600 mg + minocycline 100 mg) was initiated for 3 months. Finally, a 3-phase bone scintigraphy suggested the presence of a complex regional pain syndrome type 1 treated by a classical physical therapy and concomitant class-2 pain killers. The evolution was favourable after 6 months of symptomatic treatment, and the pain decreased to a level similar to that before the infiltration of PRP. Discussion/Conclusions: This case report draws attention to potential side effects that are linked to this new therapy by infiltration of platelet rich plasma in case of tendinopathy, in particular when used in patients with type 1 diabetes. Thus, the balance between benefits and risks must be carefully evaluated before using this treatment in patients with type 1 diabetes. Reference: Platelet-rich plasma application in the management of chronic tendinopathies. Acta Orthop Belg 2013; 79: 10-15. [less ▲]

Autoimmune angioneurotic edema in a patient with Helicobacter pylori infection.

in Helicobacter (2009), 14(1), 9-11

Association of acquired autoimmune angioneurotic edema with other diseases is increasing. However, the precise mechanism by which antibodies to C1-esterase inhibitor (C1-INH) are produced, is not ... [more ▼]

Association of acquired autoimmune angioneurotic edema with other diseases is increasing. However, the precise mechanism by which antibodies to C1-esterase inhibitor (C1-INH) are produced, is not elucidated. We describe a patient with IgA antibodies against C1-INH without other autoimmune markers. Our patient had gastritis and Helicobacter pylori infection, proven by biopsy. This case suggests that H. pylori infection can act as triggering factor for acquired autoimmune angioneurotic edema. [less ▲]

HIV-related infections of the brain

in Revue Médicale de Liège (2008), 63(5-6), 342-348

During the natural course of human immunodeficiency virus infection, central nervous system insults are very common. They can consist of infectious complications, consequently to the collapse of the ... [more ▼]

During the natural course of human immunodeficiency virus infection, central nervous system insults are very common. They can consist of infectious complications, consequently to the collapse of the patient's immune system. Alternatively, direct or indirect HIV-mediated lesions of cerebral vascular or neural cells can also occur. It is crucial to detect HIV-related infectious complications since their prognosis will depend on early and accurate treatments. The diagnosis is generally made by means of magnetic resonance imaging and lumbar puncture. [less ▲]

Syphilis en 2008: controverses et attitudes pratiques.

in Revue Médicale Suisse (2008), 4(168), 1823-7

Rising incidence rate of syphilis is observed in economically advanced countries, particularly among homosexual men and subpopulation with low socioeconomic status. The various clinical presentations are ... [more ▼]

Rising incidence rate of syphilis is observed in economically advanced countries, particularly among homosexual men and subpopulation with low socioeconomic status. The various clinical presentations are divided into early and late stages, including neurosyphilis. The latter can occur during any stage of the disease, leading to the question "when to perform lumbar puncture", particularly in HIV positive patients. Penicillin continues to be the first-line therapy for all stages of syphilis. An alternative treatment should be considered as an exemption, after advice from a specialist. All patients require prolonged clinical and serological follow-up after treatment to rule out relapse or re-infection. The diagnosis of syphilis is an opportunity to search and treat other sexually transmitted diseases in patients and their sexual partner(s). [less ▲]

Recombinant gp350 vaccine for infectious mononucleosis: A phase 2, randomized, double-blind, placebo-controlled trial to evaluate the safety, immunogenicity, and efficacy of an Epstein-Barr virus vaccine in healthy young adults

in Journal of Infectious Diseases (2007), 196(12), 1749-1753

Background. To date, there is no commercially available vaccine to prevent infectious mononucleosis, a disease frequently induced by Epstein-Barr virus (EBV) infection in adolescents or adults devoid of ... [more ▼]

Background. To date, there is no commercially available vaccine to prevent infectious mononucleosis, a disease frequently induced by Epstein-Barr virus (EBV) infection in adolescents or adults devoid of preexisting immunity to the virus. Methods. A total of 181 EBV-seronegative, healthy, young adult volunteers were randomized in a double-blind fashion to receive either placebo or a recombinant EBV subunit glycoprotein 350 (gp350)/aluminum hydroxide and 3-O-desacyl-4'-monophosphoryl lipid A (AS04) candidate vaccine in a 3-dose regimen. Results. The vaccine had demonstrable efficacy (mean efficacy rate, 78.0% [95% confidence interval {CI}, 1.0% -96.0%]) in preventing the development of infectious mononucleosis induced by EBV infection, but it had no efficacy in preventing asymptomatic EBV infection. One month after receipt of the final dose of gp350 vaccine, 98.7% of subjects showed seroconversion to anti-gp350 antibodies (95% CI, 85.5%-97.9%), and they remained anti-gp350 antibody positive for > 18 months. Furthermore, there were no concerns regarding the safety or reactogenicity of the gp350/AS04 vaccine. Conclusion. These data support the clinical feasibility of using an EBV vaccine to prevent infectious mononucleosis. [less ▲]

Phase I/II studies to evaluate safety and immunogenicity of a recombinant gp350 Epstein-Barr virus vaccine in healthy adults

in Vaccine (2007), 25(24), 4697-4705

Two double-blind randomised controlled studies (phase I and I/II) were performed to assess for the first time the safety and immunogenicity of a recombinant subunit gp350 Epstein-Barr virus (EBV) vaccine ... [more ▼]

Two double-blind randomised controlled studies (phase I and I/II) were performed to assess for the first time the safety and immunogenicity of a recombinant subunit gp350 Epstein-Barr virus (EBV) vaccine in 148 healthy adult volunteers. All candidate vaccine formulations had a good safety profile and were well tolerated, with the incidence of solicited and unsolicited symptoms within a clinically acceptable range. One serious adverse event was reported in the phase I trial which was considered to be of suspected relationship to vaccination. The gp350 vaccine formulations were immunogenic and induced gp350-specific antibody responses (including neutralising antibodies). (c) 2007 Elsevier Ltd. All rights reserved. [less ▲]

When the book is wrong

in Lancet (2007), 369

Disseminated Penicillium marneffei infection contrated in China

Poster (2007)

Penicillium marneffei infection is a rare fungal disease that cause significant disease in immunosuppressed patients. The geographical distribution of this dimorphic fungus is restricted to Asia ... [more ▼]

Penicillium marneffei infection is a rare fungal disease that cause significant disease in immunosuppressed patients. The geographical distribution of this dimorphic fungus is restricted to Asia, Southeast and Far East, where the disease is considered as an indicator of acquired immunodeficiency syndrome (AIDS). Case report. A 42-year old Congolese woman living in Lubumbashi was admitted at the university hospital of Liège for exploration of a general status impairment. She experienced for three months spiking fever, weight loss, productive cough with bloody expectorations and progressive dyspnoea. She reported also to have non-bloody mild diarrhoea with abdominal pain. The HIV antibody status was positive with a low CD4 T lymphocytes count (28/µl). Pulmonary infiltrates were visualized on chest radiography and the computed tomography revealed the presence of a severe pneumopathy characterised by bilateral micronodular lesions. Mediastinal polyadenopathies associated with hepato- and splenomegaly were also highlighted. Bronchoscopy was performed and bronchial aspirations revealed the presence of numerous leucocytes with the presence of intracellular Gram positive organisms suggestive of yeasts. Ziehl, Giemsa and Gomori-Grocott staining were also performed. Ziehl staining was negative. The morphological aspect given by Giemsa staining excluded infection and the PCR specific for T. gondii B1 gene was negative. However, Gomori-Grocott staining revealed the presence of intracellular oval, elongated, sausage-shaped cells with a single transverse septum (3 to 5 µm). Penicillium marneffei was isolated from blood culture and respiratory samples. Intraveinous amphotericin B treatment was administrated during 15 days followed by itraconazole oral administration (200 mg/j). The antimycotic treatment improved the patient condition and despite other clinical troubles she was prematurely discharged because of financial problems. Conclusion. Opportunistic agents involved in HIV-infected patients differ in Africa and Asia and it is important to be able to make a rapid diagnosis with the aid of an experienced laboratory. [less ▲]

Avancees therapeutiques en pathologie infectieuse au cours de la derniere decennie

in Revue Médicale de Liège (2007), 62(5-6, May-Jun), 377-83

This review focuses on new antibiotics, particularly for gram-positive infections, new antiretroviral drugs, new treatment of fungal infections and indications of miltefosine in the treatment of ... [more ▼]

This review focuses on new antibiotics, particularly for gram-positive infections, new antiretroviral drugs, new treatment of fungal infections and indications of miltefosine in the treatment of leishmaniasis. [less ▲]

L'echinococcose alveolaire: une zoonose d'apparition recente en Wallonie

in Revue Médicale de Liège (2005), 60(11), 867-74

Alveolar echinococcosis is a serious parasitic disease, leading to large hepatic lesions. It must be distinguished from cystic echinococcosis, or hydatic cyst, caused by Echinococcus granulosus. Early ... [more ▼]

Alveolar echinococcosis is a serious parasitic disease, leading to large hepatic lesions. It must be distinguished from cystic echinococcosis, or hydatic cyst, caused by Echinococcus granulosus. Early diagnosis may allow surgical removal of the lesions by segmental hepatectomy, the only curative treatment. Parasitostatic medical treatment with albendazole may promote stabilization of the disease. Until recently, Belgium was considered a country at very low risk for alveolar echinococcosis, as no human case was reported, despite up to 51% of fox infection in southern Belgium autopsy series. Recently four patients presented with alveolar echinococcosis at the University Hospital Center of Liege, leading to the fear of a possible alveolar echinococcosis endemy in southern Belgium. Two of these patients underwent curative hepatectomy, but the other two had already pulmonary metastases at diagnosis and received palliative albendazole therapy. This article presents these cases, and reviews the clinical features of this parasitic disease. [less ▲]