[Liposomal amphotericin B as treatment for visceral leishmaniasis in Europe, 2009]

Visceral leishmaniasis (VL) causes an estimated 500,000 new cases of disease and more than 50,000 deaths a year. For more than 60 years, pentavalent antimonies were considered the standard therapy for VL. The emergence of Leishmania strains resistant to antimonials led to the evaluation of other treatments including amphotericin B and its lipidic derivatives. Clinical trials with liposomal amphotericin B demonstrated that total doses of 10 to 20mg/kg, administered according to various regimens, had a 90-98% efficacy in non-immunocompromised patients. Compared to antimonials, liposomal amphotericin B provides favorable efficacy/tolerance and cost efficacy ratios. The WHO recently produced consensus recommendations for the use of liposomal amphotericin B in VL. In Europe, liposomal amphotericin B has progressively become the reference treatment of VL in clinical practice, and it is recommended as the first line therapy.

[Bedbugs (Heteroptera, Cimicidae): biting again]

Bedbugs have been man's faithful companions from his cave days to the present time. After World War II, improvements in household and personal cleanliness and above all widespread use of insecticidal treatment led to a decline in the prevalence of bedbugs so that they became almost unknown to populations in industrialized countries. However in recent years a resurgence of bedbugs has been reported in North America as well as in most European countries. The purpose of this study is to provide an update on the comeback of bedbugs in France and the world, to discuss their impact on public health, and to consider possible causes for the current resurgence.

[Confirmed chikungunya in children in Mayotte. Description of 50 patients hospitalized from February to June 2006]

The French Indian Ocean island Mayotte was hit by an outbreak of chikungunya in January 2005. The purpose of this retrospective study is to report data recorded over a five-month period (February - June 2006) in the pediatric-neonatal department of the Hospital Center in Mayotte. The study cohort includes a total of 50 children in whom chikungunya was confirmed by molecular tools. Mean age was 9.3 years and the male-to-female sex ratio was 1:5. The main symptoms were intense pain (88%), high fever (82%), and skin rash (80%) that was less common in children under 2 years of age. Neurological complications were observed in 46% of patients including hypotonia (22%) that occurred mainly in newborns, meningitis syndrome (18%) and convulsions (16%) that occurred mainly in children over 2 years of age. Infectious complications included pneumonia (4%), pyelonephritis (2%), and possible nosocomial septicemia due to Pseudomonas (6%). The main hematological abnormalities were lymphopenia (27%) and thrombopenia (16%). Serum CRP values were moderately high (mean, 25 mg/l). Elevated AST (24%) and ALT (10%) values were observed. High CSF protein levels were noted in 30% of cases. A total of 25 children required hospitalization for more than 10 days. There were two deaths in newborns infected before the seventh day of life. The main risk factors for hospitalization longer than 10 days were premature birth and age at the time of chikungunya infection.

[Mediterranean leishmaniasis caused by Leishmania infantum. Update on the utility of the IT-Leish and ID-Pagia leishmaniasis tests]

The purpose of this article is to update information about Mediterranean leishmaniasis caused by Leishmania infantum in man and about the canine reservoir. Special emphasis is placed on laboratory diagnosis tests for Mediterranean visceral leishmaniasis (MVL) in humans. In addition two rapid diagnostic tests for human leishmaniasis are compared based on indirect immunofluorescence and Western blot. Findings show that the overall sensitivity of the two tests in immunocompetent and immunodepressed patients ranged from 54% to 97%, a specificity of 97%, with positive predictive value ranging from 75% to 97% and a negative predictive value of around 95%. For diagnosis of cutaneous leishmaniasis, positivity of these tests in one case out of 2 underscores the predictive value of a positive test.

[Relapse of Plasmodium falciparum malaria in a patient treated with artesunate]

Chemoprophylaxis and the curative treatment of malaria are well documented in France. Nevertheless this data is still not accounted for by healthcare professionals and in the global population, and no longer approved treatments may be prescribed. The authors report the case of a 24-year-old female traveler having stayed in Africa where she was used to treat fever with artesunate. Soon after her return, she presented with uncomplicated Plasmodium falciparum malaria once again treated with artesunate. The evolution was initially favorable but a relapse occurred 3 weeks later. A conventional mefloquine treatment lead to a final cure. This observation confirms that artesunate monotherapy in malaria exposes to a risk of relapse. Artesunate should not be used as monotherapy in P. falciparum malaria.

Human trichinellosis due to Trichinella britovi in southern France after consumption of frozen wild boar meat

Six patients were infected with Trichinella britovi in southern France following consumption of frozen wild boar meat, which had been frozen at -35 degrees C for 7 days. Microscopic examination of a sample of frozen wild boar muscle revealed the presence of rare encapsulated Trichinella larvae, identified as T. britovi. People eating wild boar must follow individual prophylactic rules such as efficient cooking of meat (at least 65 degrees C at the core for 1 minute) as recommended by the International Commission on Trichinellosis, or freezing exceeding four weeks at -20 degrees C.

Human trichinellosis due to Trichinella britovi in southern France after consumption of frozen wild boar meat

Six patients were infected with Trichinella britovi in southern France following consumption of frozen wild boar meat, which had been frozen at -35°C for 7 days. Microscopic examination of a sample of frozen wild boar muscle revealed the presence of rare encapsulated Trichinella larvae, identified as T. britovi. People eating wild boar must follow individual prophylactic rules such as efficient cooking of meat (at least 65°C at the core for 1 minute) as recommended by the International Commission on Trichinellosis, or freezing exceeding four weeks at -20°C.

Consensual treatment of plasmodium falciparum malaria does not lead to adequate quinine blood concentrations

Since 1996, we have a common protocol in the Infectious Diseases Department and the Intensive Care Unit for the administration of quinine in case of Plasmodium falciparum malaria. Patients were classified as uncomplicated form of malaria (UFM) or severe form of malaria (SFM) according to WHO criteria, adding parasitemia >5% as a criteria of SFM. Treatment of SFM should consist of a 4 h infusion of 16 mg/kg quinine-base loading dose, followed by 8 mg/kg every 8 h. Patients with UFM receive quinine-base, 8 mg/kg every 8 h. A therapeutic index of 10-15 mg/l was considered adequate. Hypoglycemia and cardiotoxicity were the two main adverse effects of quinine to be investigated. In order to verify that these modalities for quinine administration are associated with adequate quinine blood concentrations, we have reviewed the pharmacological data and the occurrence of adverse effects. Between April 1996 and December 2000, 95 patients were hospitalised: 25 with SFM and 70 with UFM: 78/95 patients (82%) received adequate treatment and 26/95 (28%) of the patients presented an overdosage of quinine. Six severe adverse effects were observed, even in case of adequate quinine administration. Consensual treatment of malaria does not confer adequate quinine blood concentrations, and toxic effects are still common.

[Myiasis caused by Dermatoba hominis after an organized tours in Amazonia]

BACKGROUND

Human cutaneous myiasis is a common disease in endemic tropical zones. The incidence of imported cases follows the development of organized tours in the tropics.

CASE REPORTS

We report 2 cases of Dermatobia hominis furonculoid myiasis in patients who took 2 different organized tours which both visited the same Amazonian site in Peru (Puerto Maldonado).

DISCUSSION

In Latin American countries, D. hominis myiasis is transmitted by Diptera (generally mosquitos, rarely flies) who carry eggs laid by an adult fly to man. This phenomena is called "phoresia" and explains the preferential localization of lesions in exposed areas unlike African myiasis caused by Cordylobia anthropophaga which contaminates clothing soiled when drying.