Pulmonary localization of Enterocytozoon bieneusi in an AIDS patient: case report and review

Enterocytozoon bieneusi is an agent of intestinal microsporidiosis leading to malabsorption syndrome and diarrhea in AIDS patients. Respiratory tract microsporidiosis due to Encephalitozoon spp. has been reported. To date, however, only two cases of pulmonary involvement of E. bieneusi have been documented for patients with intestinal microsporidiosis. We report here another pulmonary localization of E. bieneusi in a human immunodeficiency virus-infected patient. Clinical features of these three cases are reviewed. E. bieneusi can colonize the respiratory tract but could be considered a simple carriage associated with an intestinal infection.

[Dengue in New Caledonia. Study of 68 pediatric cases]

New Caledonia is a French territory of Pacific Ocean, where frequent dengue outbreaks occur. In 1995 and 1996, 3042 cases (including 18.3% children) were diagnosed in Pasteur Institute of Noumea.

PATIENTS AND METHODS

This work was a clinical and biological study of 68 in-patients of different ethnical groups in children. Among these young patients, 14 cases of dengue hemorrhagic fever occurred.

RESULTS

The children were admitted to hospital after an average of 2.7 days of complaint, and during 6.7 days. The most important symptoms were fever at 39 degrees C (100%) during 2.2 days, sweatings (100%), malaise (57%) and headache (50%). Forty children had, at least, one hemorrhagic symptom. Leucopenia was noticed in 42 children, on an average of 4.2 days. A thrombocytopenia (mean 114,746 platelets/mm3) occurred in 5.3 days in 34 children (six cases with less than 10,000 platelets/mm3). A bacterial infection arised in 23.5% of children.

CONCLUSION

Dengue is an important problem of public health, which occurs in all population, including the young children. The fight against dengue fever by a rapid destruction of larvae and adult mosquitoes led to the decrease of the outbreak.

Unusual etiology of visual loss in an HIV-infected patient due to endogenous endophthalmitis

Disseminated candidiasis, especially ocular infections such as endophthalmitis, is uncommon in HIV-infected patients. We report a case of candidal endophthalmitis in an HIV-positive non-drug-user patient, following candidemia from a cutaneous abscess at the site of a peripheral catheter. Ocular disease was revealed by a visual decrease in the left eye. DNA analysis using RAPD showed identical patterns of Candida albicans isolated from the skin and eye. Combination therapy with high-dose fluconazole and intravenous amphotericin B was performed. Two intravitreal amphotericin B injections and a vitrectomy were administered because of an amblyopic right eye and severe vitritis. The outcome was favorable without relapse at 18 months.

Dermatophyte pseudomycetoma of the scalp: case report and review

We report the first case of a scalp pseudomycetoma due to Trichophyton schoenleinii in a 15-year-old girl from Senegal. The lesion was not associated with tinea capitis. Long-term antifungal therapy with itraconazole and terbinafine was unsuccessful but a favourable outcome was obtained after surgical removal of the lesion. Between 1973 and 1999, only 12 previous cases of dermatophyte pseudomycetoma of the scalp were reported in the literature. Clinical features and therapeutic outcomes of these cases are reviewed.

Hydatidosis: dynamics of transmission

Hydatidosis is a widespread zoonosis infecting a large number of animals and humans. Echinococcus granulosus has the smallest taenia adult of the cestodes but with the largest larva. Its morphologic and biologic features were identified with DNA analysis. Different strains were separated according to the intermediate hosts: sheep, cattle, pigs, horses, camels. Definitive host are canids, mostly dogs, where the worm grows to adulthood in several months. The eggs are scattered in the pasture by wind and water and are ingested by various hosts. The larvae migrate through the intestinal wall and penetrate the organs, mostly liver and lungs. The eggs survive several days outside, depending on the temperature, but numerous eggs die in nature because they cannot resist desiccation and extreme temperatures. Dissemination is accomplished by dogs. In Turkana (Kenya) the incidence of hydatidosis is high because of the close relationship between the population and dogs and the habit of leaving their dead bodies in the grasslands. In rural areas, the custom of slaughtering sheep at home, among the dogs, is an important dissemination factor. The circumstances of transmission vary according to the country. In Europe the natural life cycle of E. granulosus granulosus involves dogs as the definitive host and sheep as the intermediate host. In northern Europe E. granulosus borealis infects the canids and deer. E. granulosus canadensis infects wolves and reindeer, but there are no human cases. In the endemic Mediterranean area, sheep and dromedaries are the intermediate hosts. In South America, the life cycle of E. granulosus develops among several definitive and intermediate hosts. Hence the dynamics of transmission vary according to the countries with different hosts.

[Significance of post-partum diagnosis of congenital toxoplasmosis primary maternal infection at the end of the pregnancy]

We report two cases of congenital toxoplasmosis following maternal primary infection occurring late during pregnancy. These congenital infections are often asymptomatic at birth and can be recognized only by an appropriate serological screening program performed in mothers after delivery.

A case of disseminated histoplasmosis likely due to infection from a liver allograft

Disseminated histoplasmosis in immunosuppressed patients rarely occurs in nonendemic areas. Reported here is a case of disseminated histoplasmosis in a patient who had undergone orthotopic liver transplantation and had never traveled outside of France. The infection was most likely transmitted via the liver allograft, since the organ donor had lived in an area highly endemic for the disease (French Guiana) 20 years earlier. Two years post-transplantation, none of the other patients who received allografts (heart, cornea, kidneys) from the same donor had developed signs of infection.

[Epidemiologic and clinical study of leptospirosis in Bourail (New Caledonia)]

Leptospirosis is a frequent zoonosis in New Caledonia, mostly in the Bourail area, with an incidence of 9.5/1000 inhabitants. This town is an important cross-roads between the main town, Noumea, and the bush. An agricultural show takes place every year in this town, concentrating a great number of domestic animals and several thousand people coming from all over the island. A study was carried out on 78 patients with leptospirosis. The patients were mostly men (70%) of all ages of Melanesian and European origin. People who were living in the bush were more often attacked by leptospirosis than people living in towns. There were two annual peak values (March-April and July-August). Three symptoms (fever, headache, myalgia) were frequent (56%). Leucocytosis increased in 45% of cases. The serogroup icterohaemorrhagiae was the more common (38%). After treatment by penicillin, patients recovered in 83% of cases, but a fatal outcome occurred in 4 patients. An information campaign was necessary in order that people seek medical care as soon as the first symptoms appeared. At present, vaccination does not seem to be possible in such a context.

[Isolated intramedullary cysticercosis. Case report]

BACKGROUND AND PURPOSE

Cysticercosis is the most common parasitic disease affecting the central nervous system. Although it is still very rare in Europe, the frequency will increase due to the influx of immigrants from the endemic areas and increasing trips in these countries. Spinal intramedullary cysticercosis is an uncommon manifestation of neurocysticercosis.

CLINICAL PRESENTATION

We report a case of pure intramedullary cysticercosis in a young white French girl, presenting as a progressive paraplegia with a cystic lesion in T4 on MRI. The diagnosis was made only after surgery by pathological examination.

CONCLUSIONS

A preoperative diagnosis of spinal intramedullary cysticercosis must be suspected not only in an endemic area in the presence of multiple soft tissue calcifications and segmental lesions revealed by myelography or MRI studies, but also for all cystic lesion of central nervous system even in no endemic area. Surgery is the unique treatment which can be used for spinal intramedullary cysticercosis and with the use of the microsurgical techniques for medullar surgery the outcome is not as dismal as reported earlier.

[Cerebral toxoplasmosis and AIDS in Martinique]

This study was carried out in 60 AIDS patients who presented toxoplasma encephalitis in Martinique (French West Indies). Diagnosis was based on a combination of fever, neurologic signs, and characteristic CT-scan images in patients with positive HIV serology. There were 46 males and 14 females with a mean age of 40 years. The mode of transmission was heterosexual in most cases (68.3%). The incidence of drug-related transmission was low (6.7%). Neurotoxoplasmosis was the most frequent presenting symptom of AIDS (53.3%) followed by esophageal candidosis (20%) and pneumocystosis (10%). Clinical symptoms were headache (56.5%), fever (48.3%), hemiparesia (36.6%), and confusion (36.6%). CT-scan showed most lesions to be multiple (70%), hypodense (89%), and subject to contrast uptake (93%). Mean lymphocyte level was 1128/mm3 with 88 CD4/mm3 and a CD4-to-CD8 ratio of 0.14. Conventional treatment using a combination of pyrimethamine and sulfadiazine led to skin rash and neutropenia and had to be discontinued in 30% of cases. Clinical symptoms and mean survival (327 days) were the same as comparable findings from Europe and North America.

[Malaria: what treatment today?]

Morbidity and mortality due to malaria remains an important health problem for travelers visiting endemic zones. In this population, typical episodes of chills and fever followed by diaphoresis are not always observed; inaugural signs may limited to low-grade fever accompanying digestive disorders. Early diagnosis is nevertheless essential to prevent progression to acute pernicious malaria. Blood smears, quantitative butty coat (QBC) test or the Parasight test can give rapid diagnosis. Chloroquine is the drug of choice for Plasmodium vivax, P. ovale or P. Malariae infection, but chloroquine-resistant P. falciparum is widespread in tropical zones and resistant P. vivax has been reported in Indonesia. Currently, halofantrine is the best treatment for P. falciparum infection, although cardiac toxicity may occur in patients with a long QT on the electrocardiogram. Mefloquine can be alternative. The sulfadoxine-pyrimethamine combination is also used in many tropical zones because of its low cost and availability, but many resistant strains of P. falciparum have been identified. Use of quinine is also widespread in tropical zones. This basic antimalarial is rapidly effective but is also rapidly eliminated, necessitating repeated oral doses. Intramuscular injection may provoke necrosis. The main indication for quinine is acute pernicious P. falciparum malaria, but the drug is also used for simple episodes of fever in many tropical zones. Symptomatic care including fluid replacement, oxygen, transfusion, diuretics, respiratory assistance and dialysis may also be required in some cases. Use of corticosteroids or exsanguinotransfusion remains a question of debate. When administered rapidly, fever should regress within a few days. Neurological sequellae are exceptional after acute pernicious malaria in adults but may occur approximately 5% of children, emphasizing the importance of associating chemoprophylaxis and protection against insect bites. There has been much publicity concerning a vaccine, but results to date have been disappointing.