[Visceral larva migrans in adults with severe pulmonary manifestations]

BACKGROUND

Toxocariosis, the most frequent cause of visceral larva migrans, is usually a disease of children due to ingestion of eggs from the roundworm of dogs (Toxocara canis). Clinical expression varies from an symptomatic state to fuminant disorders; hepatomegaly with fever is frequent. Severe symptoms (rarely in adults) may occur.

CASE REPORT

A 42-year-old male with no past medical history complained of sudden onset pulmonary disorders. Laboratory findings included eosinophilia on blood tests, a severe respiratory obstructive syndrome and positive serum tests for Toxocara canis. All clinical and biological abnormalities regressed in a few weeks.

DISCUSSION

Diagnosis of visceral larva migrans is exceptional in adults and can only be proven by positive serological tests. Correct treatment remains under debate.

Factors associated with microsporidial and cryptosporidial diarrhea in HIV infected patients

Cryptosporidium and microsporidia are increasingly recognized as important agents of chronic diarrhea in human immunodeficiency virus (HIV) infected patients. These protozoa present clinical and biological similarities but coinfection with these two parasites seems uncommon in a population of diarrheic HIV infected patients in the Paris area (France), a comparison study was performed in order to clarify epidemiological differences between these protozoa. From November 1993 to December 1994, 26 microsporidial infected patients were compared to 28 cryptosporidial patients for various factors. Results of a multivariate logistic regression analysis showed that trips to tropical countries remained strongly associated with microsporidic compared with Cryptosporidium adjusted odds ratio [OR] = 4.6, 95% confidence interval [CI] 1.1-19.5). Thus, as compared with cryptosporidiosis, specific epidemiological factors could be associated with microsporidial transmission in tropical countries.

Spondylodiskitis due to Candida albicans: report of two patients who were successfully treated with fluconazole and review of the literature

We report the cases of two patients with spondylodiskitis due to Candida albicans who were successfully treated with fluconazole. On the basis of findings from these cases and a review of 52 mycologically proven cases in the literature, we describe the main characteristics of candidal spondylodiskitis. In 60% of the cases, candidal spondylodiskitis was a late complication of candidemia (mean delay, 5.2 months) it was determined to be a complication on the basis of the results of previously positive blood cultures (19 cases), and it was presumed to be a complication in iv drug addicts (12 cases). As spondylodiskitis can be a late complication of candidemia, all episodes of candidemia should be treated with systemic antifungal agents. Clinical and radiological signs of candidal spondylodiskitis were nonspecific. Any bone or joint symptoms in a patient who has had candidemia should be considered to be of fungal origin at the time of presentation. The definitive diagnosis of candidal spondylodiskitis was made on the basis of the results of percutaneous puncture in 26 of 30 cases. The overall prognosis for patients with candidal spondylodiskitis was good, with the full recovery rate ranging from 67% to 100%. The preliminary results of treating candidal spondylodiskitis with triazole derivatives, particularly fluconazole, were satisfactory; there was excellent tolerance of this drug.

Severe psychiatric side effects observed during prophylaxis and treatment with mefloquine

Mefloquine hydrochloride is now one of the major antimalarial drugs used both in prophylactic and therapeutic regimens. Large-scale studies have shown that it is efficacious and relatively well tolerated. However, some severe side effects, particularly neuropsychiatric reactions, have been described. We describe two young men with no previous medical history who experienced severe psychiatric reactions during prophylactic and curative mefloquine therapy. In both cases, full recovery was rapid after cessation of the therapy. There is no explanation for these reactions. Serum levels of mefloquine were within the normal range. The absence of contraindications and minor side effects during an initial course of mefloquine should be confirmed before another course is prescribed.

[Congenital malaria. A case observed in twins born to an asymptomatic mother]

Even in endemic zones, congenital malaria, first described in 1876, is rarely encountered. The incidence has greatly increased however over the last 10 years suggesting several diagnostic problems. We observed a case of infected twins born to an asymptomatic mother which would throw some light on the pathophysiology involved in congenital transmission. A 2-month old infant was hospitalized for surgical cure of an umbilical hernia. Haemolytic anaemia (6.3 g/dl) and fever (39 degrees C) were observed during the postoperative period. A wide spectrum antibiotherapy was prescribed but the temperature remained at 39 degrees C. A blood swab cultured one week after the operation revealed Plasmodium falciparum. The infant's twin sister was in apparently good health but was also found to be anaemic (6.1 mg/dl Hg) and a blood sample was positive for P. falciparum. For the mother, the search for parasites was negative. Serology tests performed at diagnosis revealed anti-P. falciparum antibodies at 1/1600, 1/3200 and 1/6400 in the infant, his twin sister and the mother. Outcome was favourable. The mother had arrived in France from Togo 14 months earlier and had not returned to an endemic zone. She had had frequent episodes of fever in Togo and had taken quinine, but no episode of fever had occurred during the pregnancy or delivery. This twin case of vertical mother-infant transmission is the equivalent to transfusional malaria since red cells pass the placental barrier near the end of pregnancy, even when no placental lesion exists. Congenital transfusional malaria must however be dissociated from congenital infective malaria resulting from early primoinfection in endemic areas.

[Blind treatment or treatment oriented to intestinal parasitoses in a Parisian health center for refugees]

The Comede health care center for political refugees received 4,414 first arrivals from 70 African, Asian and South American countries in 1989. Many arrived from areas where intestinal parasitic infections are endemic, and where infections by nematodes (Ancyclostoma duodenale, Necator americanus, Ascaris lumbricoides, Trichuris trichiura, Strongyloides stercoralis), trematodes (Schistosoma hematobium, Schistosoma stercoralis) and protozoa (Entamoeba coli) cause significant morbidity. The question that arises is whether we should screen stools and urine only in the case of African refugees, or treat all refugees empirically (mass treatment program). We carried out a retrospective study of 1,425 patients seen for the first time in the Comede from August 1, 1989 to December 31, 1989. Three-quarters of the subjects were men and the mean age was 29 years. 63.2% of the subjects were from 28 African countries, 18.6% from 8 Asian countries, 10% from 5 South American countries and the West Indies, and 6.4% from 4 countries of the Mediterranean basin. 4 countries of the Mediterranean basin. All the subjects were asked to provide stool and urine specimens at the Paris City Laboratory, which were examined using the merthiolate iodo formol direct methods, two concentration methods (MIF and Kato) and Baermann's technique. Patients with infestations were prescribed appropriate treatment at a second visit, compliance with which was good (86%). The prevalence of intestinal parasite infections was 60%. Albendazole was given to 44% of patients, while 45% of African patients were given praziquantel and 2.7% tinidazole.(ABSTRACT TRUNCATED AT 250 WORDS)

[Intestinal bilharziasis with rectal bleeding: apropos of 3 cases]

The authors report three cases of Schistosoma mansoni infection among European women coming back from Burkina-Faso. Six weeks after the infestation, these three patients showed, at first, a bloody diarrhoea, then large oedemas. The treatment, with praziquantel, was not tolerate very well and all the three patients had a high fever after. This case report requests a clarification about the frequency of such symptoms. The authors focus, through this observation, on the necessity of increasing the number of stools parasitologic analysis in order to diagnose. A sole negative analysis cannot eliminate it. Sometimes, only the rectal biopsy can find the eggs of the parasite.

[Value of filariopheresis in the treatment of Loa loa filariasis]

To prevent the side effects as encephalitis, related with diethylcarbamazine treatment in loiasis, an exchange blood transfusion was proposed. To avoid the disadvantage of this heavy technique, the authors are proposing filariopheresis to trap the microfilariae using cytapheresis technique and filtration. They obtained a medium 75 p. cent microfilariae extraction: 55-70 p. cent by cytapheresis and 5-20 p. cent by filtration. The number of blood cells must be supervised as an important decrease of the platelets may occur temporary. This simple and not expensive technique is efficient, but diethylcarbamazine treatment must be instituted very quickly after filariopheresis session. Furthermore, the millions of microfilariae collected can provide useful antigen for immuno-parasitological tests.

[Symptoms and development of Schistosoma mansoni infestation]

Schistosoma mansoni schistosomiasis is widespread in Latin America and Black Africa. Infestation is through the skin where it produces erythema with pruritus. Invasion is manifested by mild or sometimes fairly marked systemic disorders. The gastrointestinal disorders observed in the established phase have no characteristic features. The major complication is portal hypertension due to the portal vein fibrosis provoked by schistosomatic granules with an egg at their centre. The diagnosis rests on the finding of eggs in the faeces and on biopsy of the rectal mucosa. The present treatments are effective and well tolerated, but a portocaval anastomosis may be necessary.

[In vitro evaluation of the activity of butoconazole against Trichomonas vaginalis]

An in vitro study was carried out on ten first clinical isolates of Trichomonas vaginalis. Increasing levels of butaconazole were added to 150 microliters of a dilution in Roiron medium adjusted to 50,000 Trichomonas/ml. Results were read after 1, 2, 6 and 24 hours aerobic incubation at 37 degrees C. Minimum lethal concentration was 93 micrograms/microliters after one hour, 23 micrograms/microliter after six hours and 12 micrograms/microliters after 24 hours. These findings warrant in vivo studies of butoconazole against Trichomonas. This drug, which has already been proved effective in fungal infections, may prove very useful since concomitant infection of the genital tract by Trichomonas and Candida is common.

[Salmonella paratyphi A urinary infection in Schistosoma mansoni bilharziasis]

The authors report a case of urinary tract infection caused by Salmonella paratyphi A in a patient with Schistosoma mansoni bilharziasis and describe the symbiotic relationship between these two micro-organisms. The association was not fortuitous: schistosomes behave as reservoirs of bacteria and can cause bacterial discharges followed by a long carrying period.