Idiopathic dilatation of the submandibular gland duct

Lithiasis and stenosis may cause salivary duct dilatation due to the increased pressure in the duct upstream of the obstruction. Idiopathic dilatations, also called megaducts, with no associated increase in pressure, have only been described in the parotid gland. The aim of this study was to describe the characteristics of submandibular duct dilatation unrelated to lithiasis, stenosis, or an imperforate duct, to report the existence of submandibular megaducts. This retrospective single-centre study included patients treated at La Conception University Hospital, Marseille, France, between 2007 and 2019. Patients with submandibular duct dilatation of ≥4 mm confirmed by magnetic resonance imaging sialography (sialo-MRI), who also underwent sialendoscopy to identify any associated stenosis, were included. Patients with lithiasis, stenosis, an imperforate ostium, or a history of trauma or surgery to the floor of the mouth were excluded. Five patients (three female, two male) aged 30-76 years with idiopathic duct dilatations in nine submandibular glands were included. The most commonly reported symptoms were submandibular swelling, pruritus, and discomfort, mostly outside mealtimes. Recurrence of symptoms after treatment was frequent. This study is novel in describing submandibular megaducts as opposed to dilatation caused by high pressure associated with stenosis, with confirmation by sialo-MRI and sialendoscopy.

[Epidemiology of Cutaneous Leishmaniasis in West Africa: a Systematic Review]

Cutaneous leishmaniasis (CL) has been described in West Africa (WA) since the beginning of the 20th century. The incidence of cases has markedly increased during the last decades in several countries of the region. Despite that, data remain scarce and fragmentary. The current incidence and geographic distribution of the disease as well as the involved vectors and reservoirs remain poorly documented. The objective of this review was to collect and analyze available data about CL in WA in order to improve the management of cases and the control of the disease transmission. A systematic literature review was performed using the Pubmed, Google Scholar and Hinari databases. Publications focusing on epidemiological aspects of CL, involved parasite species, sand flies and potential reservoir hosts were searched without any restrictions. Unpublished studies were extracted from Google. Manuscripts without full text or summary available were excluded as well as those whose summaries did not contain any usable data. One hundred and fifteen studies were recorded. Among them, 93 filled selection criteria. CL has been reported in 10 West African countries with outbreaks described in five countries. Burkina Faso, where the average incidence of the disease is around 928 cases per year, and Ghana seem to be the most affected. Cases have been confirmed in the majority of studies by microscopy sometimes associated with culture or histology. The exposure rate to Leishmania infection based on leishmanin skin test was relatively high with an overall average of 30.2%. Leishmania major was the only species identified with a predominance of MON-74 (62%) and MON-26 (30.6%) zymodemes. Phlebotomus duboscqi is retained as the vector whereas Sergentomyia darlingi and Sergentomyia ingrami were found naturally infected. Rodents including Arvicanthis niloticus, Gerbilliscus gambiana and Mastomys spp. are reported as the main reservoir hosts. Additional studies are needed to better characterize CL in WA in order to optimize the management of cases and to organize the control of the disease transmission.

[Arthrocentesis of the temporomandibular joint and intra-articular injections : An update]

INTRODUCTION

Arthocentesis of the temporomandibular joint combined with intra-articular washout and, more recently, intra-articular injection of pharmacological agents has been developed from the 1990s and is nowadays extensively in use for the treatment of temporomandibular dysfunctions (TMDs). The goal of our work was to answer 3 questions: 1. Is intra-articular washout effective for the treatment of TMDs ? 2. What kind of pharmacological agents may nowadays be injected in addition to washout and are these injections useful ? 3. What is the place of these treatments in the treatment strategies of TMDs ?

MATERIAL AND METHODS

A bibliographic research has been carried out in the PubMed database using following keywords arthrocentesis, temporomandibular joint. The 27 articles published between 1991 and 2016, indicating patient's inclusion criterions and objectively evaluating the clinical results (mouth opening, intra-articular noises, pain) were selected. Pharmacological agents were noticed when used.

RESULTS

1. All authors concluded to the efficacy of intra-articular washout. No prognostic factor for arthrocentesis efficacy could be identified. 2. Main pharmacological agents used were steroids, hyaluronic acid, morphine-based drugs and platelet rich plasma. Superiority of ith-injection protocols failed to win unanimous support. All authors who compared with- and without-injection protocols concluded to the superiority of with-injection protocols, whatever the agent.

DISCUSSION

Numerous studies have proven the efficacy of intra-articular washout for the treatment of TMDs resistant to noninvasive treatments. The advantage of any kind of pharmacological agent is not clear. Mechanisms of action are not all elucidated. No pharmacological agent showed any superiority over another. Study methodologies are often defective: imprecise inclusion criterions, short follow-up, confounding variables not taken into account, few comparison between pharmacological agents.

[A multifocal form of cutaneous leishmaniasis caused by Leishmania infantum in an immunocompetent child treated with a short course of liposomal amphotericin B]

BACKGROUND

Cutaneous leishmaniasis (CL) is a parasitic infestation caused by various species of Leishmania protozoa transmitted by the bite of phlebotomine sand flies. Herein we report a case of multifocal CL due to Leishmania infantum in an immunocompetent child treated with liposomal amphotericin B.

PATIENTS AND METHODS

A 10-month-old baby was referred for multiple ulcerated nodules of the face and upper limbs present for 5 months and following travel to North Morocco. Histological and parasitological examinations resulted in a diagnosis of CL due to L. infantum. The child was treated with intravenous liposomal amphotericin B in accordance with the schedule for visceral leishmaniasis (10mg/kg over 2 days), and rapid improvement of the lesions was seen within 10 days.

DISCUSSION

Clinical polymorphism of CL exists according to the infecting species. The multifocal presentation in our patient is very unusual for CL due to L. infantum in an immunocompetent child. To our knowledge, there have been no previous reports of successful use of parenteral liposomal amphotericin B for CL caused by L. infantum as described in our case.

A century of leishmaniasis in Alpes-Maritimes, France

A century of publications on leishmaniasis in Alpes-Maritimes, in southern France, is here reviewed. Autochtonous human and canine leishmaniasis were first recognised in this département, which lies by the Mediterranean Sea and near the Italian border, in 1918 and 1925, respectively. The parasite responsible for the leishmaniasis, Leishmania infantum, is transmitted by Phlebotomus perniciosus and P. ariasi. The human leishmaniasis is zoonotic, with domestic dogs acting as the main 'reservoir' hosts. In prospective surveys over the last two decades, a mean of 12% of the domestic dogs checked in Alpes-Maritimes have been found seropositive for L. infantum but only about 50% of the seropositive animals showed any clinical signs of infection at the time of the surveys. During the last 30 years, 178 cases of human visceral leishmaniasis have been recorded in the area. Such cases are sporadic and often opportunistic, occurring predominantly in children (29% of the 178 cases) or HIV-positive subjects (31%). Recently, it has been demonstrated that, in Alpes-Maritimes, approximately 20% of those found seropositive in leishmanin skin tests are asymptomatic carriers, with amastigotes in their peripheral blood.

Surveillance of leishmaniases in France, 1999 to 2012

Leishmaniasis is endemic in the south of France, where autochthonous disease is caused by Leishmania infantum, and affects both humans and dogs. The prevalence of canine leishmaniasis is between 3 and 66% depending on the region and the methods used. Human leishmaniases are also imported into France, mainly from French Guiana and North Africa. The surveillance of autochthonous and imported human leishmaniases is based on passive notification to the National Reference Centre for Leishmaniases (NRCL) created in 1998. Between 1999 and 2012, 317 autochthonous and 1,154 imported cases were notified to the NRCL. The average number of autochthonous cases notified per year was 22.6, mainly cases of visceral leishmaniasis (84.5%). All cases were infected in the south of France. Leishmaniasis incidence is 0.22 per 100,000 inhabitants in the endemic area. Imported cases were more frequent (annual mean of 82.4 cases) and consisted predominantly in cutaneous leishmaniasis (CL) cases (91%), essentially L. major CL imported from Maghreb and Sub-Saharan Africa, and L. guyanensis CL from French Guiana. This national notification system allowed a better understanding of the incidence and distribution of the disease; it is also useful to assess the temporal-spatial evolution of the disease in France, which appears relatively stable.

Surveillance of leishmaniases in France, 1999 to 2012

Leishmaniasis is endemic in the south of France, where autochthonous disease is caused by Leishmania infantum, and affects both humans and dogs. The prevalence of canine leishmaniasis is between 3 and 66% depending on the region and the methods used. Human leishmaniases are also imported into France, mainly from French Guiana and North Africa. The surveillance of autochthonous and imported human leishmaniases is based on passive notification to the National Reference Centre for Leishmaniases (NRCL) created in 1998. Between 1999 and 2012, 317 autochthonous and 1,154 imported cases were notified to the NRCL. The average number of autochthonous cases notified per year was 22.6, mainly cases of visceral leishmaniasis (84.5%). All cases were infected in the south of France. Leishmaniasis incidence is 0.22 per 100,000 inhabitants in the endemic area. Imported cases were more frequent (annual mean of 82.4 cases) and consisted predominantly in cutaneous leishmaniasis (CL) cases (91%), essentially L. major CL imported from Maghreb and Sub-Saharan Africa, and L. guyanensis CL from French Guiana. This national notification system allowed a better understanding of the incidence and distribution of the disease; it is also useful to assess the temporal-spatial evolution of the disease in France, which appears relatively stable.

Parasitic genotypes appear to differ in leishmaniasis patients compared with asymptomatic related carriers

For numerous infectious diseases affecting humans, clinical manifestations range from asymptomatic forms to severe pathologies. The originality of this study was its focus on asymptomatic carriers of Leishmania infantum in southern France. The fundamental interest in these asymptomatic carriers is that they can be a reservoir of potentially pathogenic microorganisms. It remains to be established whether the parasitic genomes from asymptomatic carriers differ from those of patients. Multilocus microsatellite typing was used to investigate the genetic variation among 36 French strains of L. infantum. Nine Leishmania strains isolated from blood donors (asymptomatic carriers) were compared with 27 strains of L. infantum belonging to zymodemes, MON-1, -33 and -183. These strains were isolated from HIV positive or negative patients with visceral leishmaniasis, cutaneous leishmaniasis, from canine leishmaniasis or from phlebotomine sandflies. Multilocus microsatellite typing data generated using 33 loci were analyzed by a Bayesian model-based clustering algorithm and construction of a phylogenetic tree based on genetic distances. Both analyses structured the MON-1 sample into two main clusters. Furthermore, genetic analysis demonstrated that these nine asymptomatic carrier strains are divided into two clusters grouped with the MON-1 strains. One cluster with seven strains is related to, but different from, human symptomatic strains from the Alpes-Maritimes region whereas the other cluster has the two remaining strains together with canine leishmaniasis strains as well as one strain from a visceral leishmaniasis patient. Genetic diversity among asymptomatic carrier was very weak since the nine Leishmania strains belong to only two genotypes. Genetic differentiations were evidenced between asymptomatic carrier strains and non-asymptomatic carrier strains and especially between asymptomatic carrier and HIV+ populations, although these findings require confirmation with a larger sample size. We believe that our data explore for the first time, the genetic diversity among L. infantum from asymptomatic human carriers and reveal a weak polymorphism compared with Leishmania parasites isolated from human patients.

[A case of feline leishmaniasis in the south of France]

Cet article rapporte un cas de leishmaniose féline disséminée chez un chat (Felis catus) de 14 ans, séropositif pour le FIV et vivant dans les Alpes-Maritimes (sud de la France). Le chat présente des papules érythémateuses ulcérées sur la face et l’encolure, et une lésion proliférative ulcérée sur l’oreille gauche. C’est l’examen histopathologique des lésions cutanées qui permet le diagnostic d’une leishmaniose disséminée, associée à un carcinome épidermoïde de l’oreille. 100 mg d’allopurinol administrés une fois par jour per os pendant quatre mois ont permis la rémission totale des lésions cutanées. Des prélèvements post mortem ont révélé la persistance du parasite dans l’organisme après six mois de traitement. Cet article discute de la sensibilité du chat à la leishmaniose et de son rôle potentiel de réservoir.

Diversity and evolution of methods and practices for the molecular diagnosis of congenital toxoplasmosis in France: a 4-year survey

The prenatal diagnosis of congenital toxoplasmosis is currently based upon molecular biology using a sample of amniotic fluid. The vast majority of centres globally (and all centres in France) performing this diagnosis use 'in house' or laboratory-developed PCR assays. This may be the source of considerable inter-laboratory variation in the performances of the assays, hampering any valuable comparison of data among different centres. The present study was based upon questionnaires that were sent to 21-25 centres between 2002 and 2005 enquiring about methods and practices of the PCR-based prenatal diagnosis of congenital toxoplasmosis. An extreme diversity of PCR methods and practices was observed. Thus, in 2005, 35 PCR methods, differing in one of the main steps of the whole process, were reported as being in use for routine diagnosis, with nine centres using two or three methods. We provide comprehensive information on the extraction methods, DNA targets, primer pairs and detection methods used for this diagnosis, as well as their evolution, during the period of study. Interestingly, in this period (2002-2005), a rapid progression of the number of laboratories using real-time PCR technology, which increased from four to 19, was observed. We also studied general PCR practices concerning, for example, the number of reaction tubes used for each biological sample and the inclusion of controls. The return of information in a yearly report provided the opportunity for writing proposals aiming to improve laboratory practices for this diagnosis at the national level. The high diversity of methods and practices currently used emphasizes the need for external quality assessment of the performances of the molecular diagnostic methods.

[Leishmaniases in France: an update]

Leishmaniases are parasitic diseases due to a flagellate protozoan of the genus Leishmania. They are transmitted from mammal to mammal by the bite of an arthropod vector: a female sandfly. Among the different clinical presentations, the zoonotic visceral leishmaniasis (ZVL) is due to Leishmania infantum. Dogs are the reservoir and can develop a deadly disease. ZVL is described in China, Pakistan, Latin America and in the Mediterranean region, particularly in the South of France. In recent years, many asymptomatic carriers have been described. Despite the fact that cases in immunocompromised adults are the majority, the classic Mediterranean ZVL in young children is still observed. The classic triad of symptoms is: fever, pallor, splenomegaly and hepatomegaly in half of the cases. The biological orientation is a low blood count (anemia, leuconeutropenia, and thrombocytopenia) and an inflammatory syndrome. Serological tests are useful, but the diagnosis is made by the identification of the parasite in a bone marrow sample. Today, the treatment is done by the liposomal amphotericin B (AmBisome) and the total dose must to be 20 mg/kg.

[Multinodular hepatopathy with fever in a tropical climate: hepatic amebiasis with multiple abscesses]

Hepatic amebiasis is common in tropical zones. Solitary abscess is the classical form but multinodular presentation does not rule out amebiasis as the underlying cause. Definitive diagnosis cannot be based on clinical and radiologic findings alone. Serological testing for amebiasis is necessary. In zones where serology is unavailable, response to presumptive metronidazole treatment is still a useful for diagnosis.

[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.

[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.

Portable PIT detector as a new tool for non-disruptively locating individually tagged amphibians in the field: a case study with Pyrenean brook salamanders (Calotriton asper)

Passive Integrated Transponder (PIT) telemetry has recently been adapted for locating PIT-tagged fish in shallow waters using portable detectors. In the present study, we tested this method for adult amphibians (Pyrenean brook salamanders, Calotriton asper) PIT-tagged with 12-mm transponders in a headwater rocky stream. PIT telemetry performances were compared with a conventional hand-capture method, i.e. visual searching and overturning movable stones in the streambed. The mean efficiency of the portable detector (88.2% ± 5.2, s.e.) was significantly higher than hand-capture (51.1% ± 6.4) and the operator progressed, on average, four times faster. Time efficiencies were, on average, 0.92 (±0.15) and 0.12 (±0.04) adult salamanders per minute with the portable detector and by hand-capture, respectively. The efficiency of the portable detector was negatively correlated with the percentage of large stones on the streambed. The time needed to prospect a section was positively correlated with the abundance of PIT-tagged adult salamanders, spring inlets and undercut banks. Because PIT telemetry is less disruptive than hand-capture for both salamanders and their habitat, it is a promising and non-disruptive method for developing studies on the ecology and management of amphibians in shallow waters.