[Histoplasmosis, caused by Histoplasma capsulatum, and AIDS]

Histoplasma capsulatum histoplasmosis occurs frequently in endemic areas and with the AIDS outbreak, it appears as an opportunistic fungus involved in disseminated disease. We report the clinical, biological and treatment features of seven cases diagnosed in the CISIH of the Eastern part of Paris. Clinically, four patients were suffering from pulmonary symptoms, in three cases digestive disorders and in three cutaneous lesions. In all cases, the mycologic diagnosis was necessary. Amphotericin B and itraconazole were used as treatment for five patients (two died before the diagnosis was completed). Among these five subjects, four died (death was attributed to histoplasmosis in only one case). These observations emphasize the importance of this infection in HIV-infected patients coming from endemic areas.

Anti-P30 IgA antibodies as prenatal markers of congenital toxoplasma infection

This study extends a previous study and confirms that the detection of anti-P30 IgA antibodies is very helpful in the diagnosis of acute acquired or congenital toxoplasmosis. Moreover, we demonstrate that an anti-P30 IgA response can be mounted in the fetuses infected by Toxoplasma gondii during their intra-uterine life as early as week 23 of gestation. A double-sandwich ELISA described in our previous work was used to detect anti-P30 IgA antibodies in 1378 human serum samples collected from 551 patients, including 162 fetuses whose mothers had been infected by T. gondii during pregnancy, 46 congenitally infected and 90 uninfected newborns and 253 women suspected of having been infected during pregnancy, including the mothers of fetuses and newborns previously described. Anti-P30 IgA antibodies were detected in all cases of acute toxoplasmosis but in no case of chronic toxoplasmosis: in the majority of cases, the IgA antibody titre fell below cut-off in 3-9 months. Among the 46 congenitally infected newborns, anti-P30 IgA antibodies were detected in sera of 41 infected newborns (38 at birth, two in the first months of life, one in the seventh month of life), while anti-P30 IgM antibodies were detected in only 30 cases at birth and in one case during the first month of life. Among 162 fetuses, anti-P30 IgA response was observed in five infected fetuses, but was not detected in either 152 uninfected fetuses or in five fetuses considered as infected. The absence or presence of anti-P30 IgA antibodies in the fetus is discussed in relation to the date of maternal infection and collection of the fetal blood. It clearly appears from our study that the combined testing of both IgM and IgA in the fetus and the newborn is essential for a more efficient diagnosis of infection.

[Diagnosis of cerebral toxoplasmosis in AIDS patients. Value of antibodies evaluation in cerebrospinal fluid]

The purpose of this study was to evaluate the diagnostic value of search for intrathecally synthesized specific antibodies in cerebral toxoplasmosis. Intrathecal synthesis of antibodies was measured by calculating the immunity load coefficient (ILC) in both serum and cerebrospinal fluid. In this retrospective study the records of 42 AIDS patients with clinically on the basis of computerized tomography and therapeutic results, and was excluded in 31 patients (control group). Specific immunoglobulins G were found in the cerebrospinal fluid of 9 out of the 11 patients with toxoplasmosis, but also in 14 of the 31 controls. Since ILC measurements in serum and cerebrospinal fluid identified 7/11 cases other hand, since the ILC value was higher than the positivity threshold in controls, the specificity of the test was assessed at 68 percent.

[Drug resistance of Plasmodium falciparum and Plasmodium vivax strains in Cambodia (Cardamone Massif). Morphological characteristics of Plasmodium vivax]

The authors report some failures of chemoprophylaxis and curative treatment of Plasmodium falciparum and Plasmodium vivax malaria. These infections were contracted in the area of the cambodian-thaï border by 8 Europeans treated by various regimens and 34 Cambodians treated by quinine. In the latter group, the quinine failure rate in Plasmodium falciparum infections was about 47% (RII or RIII?) and 17,5% in Plasmodium vivax. Total cure of vivax malaria with usual doses of Primaquine among the Europeans, failed in 3 out of the 6 treated patients. Morphological particularities (abnormal pigment, lack of Schüffner dots) were noticed in these Primaquine resistant vivax strains. A possible relation is considered between Primaquine resistance and these morphological particularities.

[Epidemiologic study of 2 foci of Schistosoma mansoni bilharziasis in Togo (Lama Kara and Kpalimé). Comparative efficacy of oltipraz (RP 35972)]

The authors note a very high prevalence of schistosomiasis mansoni in the two foci studied in Togo (Lama Kara in the North and Kpalimé in the South-West); however, the prevalence is significantly higher in Lama Kara (79.5%) than in Klonou (54.7%); this was calculated on both coprological and serological basis. The parasite burden is identical in the two foci; but, the GMRT is higher in Lama Kara than in Klonou (31.7 and 8) which might be explained by a different immunogenicity of the two strains. It is noticed schistosomiasis mansoni might be responsible for hepatosplenomegaly found in the two foci, especially in Lama Kara, which might be explained by a higher virulence in this location. The treatment by oltipraz (RP 35972) had a 91.9% success rate in Klonou (similar to our results in Paris). However, in Lama Kara, even though the drug was taken with some food--increasing its biodisponibility--, the treatment was less effective at day 180 (76.5%). The authors wonder whether the difference of oltipraz efficiency between the two foci is based on a difference of biology between the two strains of Schistosoma mansoni in Lama Kara and in Klonou.

[The peculiar features of Plasmodium vivax on the Cambodian-Thailand frontier (Sokh-Sann region)]

The authors report an untypical strain of Plasmodium vivax found in the area of Sokh-Sann (Thaï-Cambodian border). This strain is remarkable by: multiple infections and two chromatin dots occur commonly in the early trophozoite stage; the pigment is coarser and darker in the older stages, and Schüffner dots are seldom found. The incubation period is longer and the symptomatology more severe.

[Congenital toxoplasmosis. Remarks apropos of serologic surveillance in 15,000 pregnant women]

The risk of acquired toxoplasmosis during pregnancy (1.2% of susceptible women) and of transmission of Toxoplasma gondii to the fetus (1% of neonates) was estimated from results of serial serological tests done in 15 132 pregnant women from 1977 to 1982. Congenital toxoplasmosis was studied in the product of 47 induced abortions and in 34 neonates. In aborted fetuses, congenital toxoplasmosis was established by serological tests in 3 cases and based on histological findings in 4. Among the neonates, 11 cases are reported; the 5 severe cases are due to early contamination.

[Treatment of 700 cases of bilharziasis with the new drugs oxamniquine, oltipraz, praziquantel]

The authors study the results of a treatment of 700 cases of bilharziasis seen in Paris and in two foci in Togo, by oxamniquine, oltipraz or praziquantel. The three drugs are well tolerated; only a few mild side-effects were reported such as discomfort, nausea, headaches (two cases of acrodynia with oltipraz ). The three drugs are very efficacious in the case of schistosomiasis mansoni (85,5% success rate with oxamniquine, 92,9% with praziquantel, from 76,5 to 92% with oltipraz depending on the different strains) at day 180. As far as schistosomiasis haematobium is concerned, oltipraz and praziquantel have a 87,5% success rate with oltipraz and 80% with praziquantel; however, in the case of oltipraz , it is necessary to increase the dose. The action of praziquantel seems to be slower on Schistosoma haematobium than on S. mansoni. By the study of the evolution of antibodies, the fast action of praziquantel was noticed, explaining the peak of serological titers and of eosinophilia as early as day 10 after treatment; in the case of oltipraz , the apparition of this peak is only recorded at the 30th day. The slower effect of oltipraz on worms implicates not to judge its efficacy by too early controls.

[Dirofilariasis in humans. Report of a case with localization in the cheek (author's transl)]

Cutaneous dirofilariasis usually affects animals (dogs and cats) but can occur in human-beings. Occasionally, this cosmopolitan disease is seen in France. Our case-report is the sixteenth registered in France. The patient, a forty-two-year-old man, was infected in Corsica. He presented with a tumor of the right cheek from which a pregnant adult Dirofilaria (Nochtiella) repens was extracted.

[Imported malaria: serological diagnostic and prevention of transfusional malaria (author's transl)]

Some particular aspects, epidemiological, clinical, serological of imported malaria are studied about 137 cases seen in the department of Tropical and Parasitologic Diseases of Cochin Hospital. The interest of studying several antigens, homologous and heterologous, in detection of fluorescent antibodies is discussed. In the case of any infesting Plasmodium species, the use of homologous antigen gives very superior titers. Systematic use of two antigens helps to detect possible antimalaria antibodies in blood donors and prevent transfusion given malaria.

[ELISA in schistosomiasis. Limits. Possibility of application (author's transl)]

Sera from patients with schistosomiasis and various infections were examined by an enzyme-linked immunosorbant assay technique (ELISA) using soluble antigens prepared from adult worms and eggs of Schistosoma mansoni. Marked false positive reactions were observed in cases of certain parasitic (hydatidosis) and non parasitic diseases (liver cirrhosis). Equivalent results with the techniques of immunofluorescence and immunoenzymology (done on adult sections) were obtained with adult worm antigen read at a higher optic-density limit. At present, this technique might be useful in seroepidemiological surveys; however, further purification of the antigen will increase its sensibility and specificity.