[Nasal leishmaniasis: a case report]

OBJECTIVE

To report a nasal leishmaniasis diagnosed by septal perforation biopsy.

MATERIAL AND METHODS

We report a case of septal perforation with crusty rhinosinusitis and nasal vestibulitis in a 54-year-old woman with cirrhosis.

RESULTS

Mucocartilaginous biopsy revealed a mucosal leishmaniasis. Biological and radiologic findings were normal. Clinical follow-up with anti-parasitical treatment showed a regression of the patient's muco-cutaneous lesion and regression of her hepatic insufficiency.

CONCLUSION

Biopsy of septal perforation is a useful diagnostic tool, advocated for differentiate infectious, neoplasic and inflammatory pathology. Leishmaniasis may be evoked in rhinologic pathology.

[A case of post-traumatic Absidia corymbifera fungal endophthalmitis]

Exogenous fungal endophthalmitis is a rare postoperative and posttraumatic complication with, often, a dreadful prognosis. We report one case of Absidia corymbifera endophthalmitis after penetrating injury with a retained intraocular vegetable foreign body. We focus on the risk factors for the development of fungal endophthalmitis (vegetable foreign body, corticotherapy) and the importance of ocular fluid samples for stain and appropriate culture. In this case, the treatment associating contaminated tissue extraction and systemic and intravitreal administration of antifungal agents was efficient.

Evaluation of risk and diagnostic value of quantitative assays for anti-Toxoplasma gondii immunoglobulin A (IgA), IgE, and IgM and analytical study of specific IgG in immunodeficient patients

To determine their prognostic and diagnostic values for toxoplasmosis in immunodepressed subjects, we assayed immunoglobulin A (IgA) and IgE antibodies by means of immunocapture (IC) tests, with revelation done by using a suspension of T. gondii (ICT). We also carried out a simultaneous analytical study of IgG antibodies on cellulose acetate membranes by using the comparative immunological profile method and an enzyme-linked immunofiltration assay (ELIFA). A total of 1,238 samples (serum, cerebrospinal fluid, and aqueous humor from 318 patients) were tested. IgA and IgE antibodies were detected in all heart, kidney, and liver transplant recipients with clinical manifestations of toxoplasmosis; IgA was detected in the aqueous humor of a patient with chorioretinitis. In patients with AIDS-related toxoplasmosis, including the cerebral form, IgA and IgE antibodies or a significant modification of ELIFA IgG values were observed in 38, 19, and 25% of patients, respectively. IgM was detected by ICT only in 12% of patients and aided the diagnosis in 1 of 71 patients. IC tests for specific IgA and IgE alone and combined with ELIFA were positive in 39 and 46% of patients who developed clinical toxoplasmosis, respectively. In a serial study of 16 patients in whom at least one of these three tests was positive, a significant immunological signal sometimes preceded clinical onset by 1, 6, and even 17 months. Similarly, in a group of human immunodeficiency virus-infected patients with evidence of previous exposure to T. gondii but no clinical manifestations, IgA, IgE, and IgA and/or IgE antibodies were detected in only 11, 4, and 12% of patients, respectively. These two situations point to peripheral T. gondii reactivation. IgA and IgE emerged as interesting markers of the risk of toxoplasmosis in immunodepressed patients. They may also provide valuable assistance in the diagnosis of toxoplasmosis, especially because tests for specific IgM are disappointing. However, at least one in two patients with toxoplasmosis showed no detectable immunological reaction, suggesting that this polyisotypic approach should be combined with other noninvasive methods such as gene amplification.

Polymorphism of the thymidylate synthase gene of Pneumocystis carinii from different host species

Pneumocystis carinii is an opportunistic agent found in the lung of various mammals which often causes severe pneumonia in immunocompromised humans, especially in AIDS patients. In the past several years significant additions have been made to the collection of knowledge we have concerning the genetic diversity of P. carinii. These additions provide new understanding of Pneumocystis transmission and the effect of possible reservoirs of Pneumocystis in the various species. In this study, a 400-bp fragment of the thymidylate synthase (TS) gene of P. carinii has been amplified by PCR from 43 parasite isolates obtained from 4 mammalian host species: rat, mouse, rabbit and human. A probe selected from the TS gene sequence of rat-derived P. carinii was hybridized with the amplified products from rat- and mouse-derived P. carinii, but not with rabbit or human P. carinii DNA. Restriction profiles were performed on amplified fragments from all isolates, and the 4 nucleotide sequences of the TS gene fragment amplified from rat, mouse, rabbit and human P. carinii were determined. Differences were detected in the gene fragment in P. carinii isolates from the 4 host species; however no difference was revealed in P. carinii isolates within a single host species, whatever the host strain or its geographic origin. Thus, the sequence differences of the P. carinii TS gene appeared as host-species specific. A specific probe which recognized all human P. carinii isolates was defined.

Elution mode of Pneumocystis carinii cysts in gravitational field-flow fractionation

The simplest field-flow fractionation technique, i.e. gravitational, was used in an attempt to purify a Pneumocystis carinii cyst suspension. This parasite is an opportunistic invader in immunocompromised patients, especially those suffering from AIDS. The cyst stage is spherical and 5 microns in diameter. Unexpected retention times, not systematically related to the size and the density of the parasite, were obtained under various experimental conditions. When silicone-coated walls were used, Pneumocystis carinii cysts were eluted in the void volume, whereas when uncoated walls were used with a sodium dodecyl sulphate-enriched carrier phase, retention was observed. These phenomena are probably related to the high degree of hydrophobicity of these micrometre-sized biological particles; this degree can be easily determined. The use of the gravitational field-flow fractionation technique can be of a great interest for the development of new methods for diagnostic purposes. Particle-wall interactions and their modifications due to the carrier phase or to the wall treatment can be employed in the search for new bronchoalveolar lavage solutions.

Toxoplasma colitis in the acquired immunodeficiency syndrome

In patients with acquired immunodeficiency syndrome (AIDS), toxoplasmosis almost exclusively involves the central nervous system (CNS), and extra-CNS organ infection is rare. We report a case of Toxoplasma gondii colitis in a patient with AIDS characterized by the following: 1) onset of diarrhea was simultaneous with disseminated toxoplasmosis; 2) T. gondii was found in colonic biopsies, whereas other infectious causes of diarrhea had been ruled out; 3) diarrhea was cured by anti-Toxoplasma therapy.

Detection of specific immunoglobulin E in patients with toxoplasmosis

An immunocapture assay was developed to detect Toxoplasma gondii-specific immunoglobulin E (IgE) in sera from adults with acute acquired infection or reactivation and from babies with congenital toxoplasmosis. The components of this assay were monoclonal antibody to human IgE, samples from patients, and T. gondii tachyzoites treated with Formalin. When T. gondii-specific IgE antibodies were present, visually detectable agglutination occurred. Sera, umbilical cord blood, fetal blood, cerebrospinal fluid, and amniotic fluid were tested by this method. Specific IgE antibodies were detected in sera from 25 (86%) of 29 adults who developed specific IgG antibody during pregnancy or had specific IgA and IgM antibodies. Specific IgE was present early during infection, at the time that IgM antibodies were present, and slightly preceding the presence of specific IgA antibodies. In 23 patients tested serially, IgE antibodies never persisted for longer than 4 months. No nonspecific anti-T. gondii IgE was detected in sera from uninfected individuals. Maternal IgE antibodies did not cross the placenta. In sera of patients with congenital toxoplasmosis, specific IgE antibodies were found at birth, during the first year of life, and during immunologic recrudescence following discontinuation of pyrimethamine-sulfonamide therapy. The IgE immunocapture assay is simple to perform. It is especially useful for determining when T. gondii was acquired by recently infected pregnant women.

[Resistance to desiccation of Biomphalaria glabrata adults infested by various miracidia of Schistosoma mansoni]

1200 adult Biomphalaria glabrata were submitted during 6 weeks to anhydrobiosis condition. Some snails were healthy, some were previously infected 3 days or 12 days ago with 8 +/- 2 miracidia of Schistosoma mansoni, others were shedding cercariae. The snails were put on soil or buried into hermetically closed, or ventilated, plastic boxes. There was no survival of snails kept in sealed boxes, or among positive snails, but 44% of control healthy snails and 40.6% of infected (for 3 or 12 days) snails in ventilated boxes were living at the term of the desiccation stage. Survival was better for "on soil" snails than for "buried" snails, but no difference was shown between 3-days and 12-days infection. The surviving desiccated B. glabrata had a lesser death rate and a lesser cercarial production than infected snails kept in water. An inferior production of male cercariae comparatively to female and to "mixed" cercariae was demonstrated by statistical analysis of the cercarial sheddings. In all positive snails, periodic variations of cercarial production was shown, whatever the sex of those cercariae. In addition many pauses of the sheddings were established by the authors.

Two outbreaks of trichinosis caused by horsemeat in France in 1985

Two outbreaks of trichinosis occurred in France in August and October of 1985 and 1,073 cases in all were identified. In the first outbreak, two localities were involved: the town of Melun and the 14th district of Paris. To determine the origin of the contamination, three case-control studies were carried out: among patients' families, among the populations of these two areas, and among the inmates in the prison of Melun. In the second outbreak, cases again occurred in Paris but in a different district (the 12th), in the city's suburbs, and in other towns scattered throughout France. Although no parasites were found in any of the meat examined in either outbreak, results of the study indicate that infection was due to horsemeat consumption and led to the incrimination of two carcasses, one imported from a slaughterhouse in the United States and the other from West Germany. These findings led the French Ministry of Agriculture to order the inspection for trichinosis of all meat from horses slaughtered both in France and in countries exporting horsemeat to France.

[The influence of anhydrobiosis on the infestation of Biomphalaria glabrata by Schistosoma mansoni miracidium]

410 Biomphalaria glabrata (Caribbean strain of Guadeloupe) have been infected with one miracidium of Schistosoma mansoni, 110 snails, used as controls have been kept into water; the survival rate was 96.4% after 4 weeks and 25.4% produced cercariae. 300 snails were kept on wet soil, and submitted for 6 weeks to progressive desiccation. The survival rate was 23.4% but only 9 of them produced cercariae. Periodic variations of the production of male and female larvae have been shown by the weekly test of the cercariae productions. In previously desiccated snails, the production of male and female cercariae is similar while in controls the production of female larvae is more important. In experimental snails, the larval development seems to be stopped during anhydrobiosis. The production of cercariae is just delayed for the length of the dry keeping.

Investigation of drug interactions with pinaverium bromide

A series of studies was carried out at 6 centres to investigate possible drug interaction between the spasmolytic, pinaverium bromide, and cardiac glycosides, anticoagulants and hypoglycaemic agents given to patients as part of the long-term treatment of their condition. The results of clinical and laboratory investigations did not show any evidence of pinaverium bromide interfering with the action or activity of any of the drugs studied.

[Drug-induced respiratory disorders]

Drugs induced respiratory disorders include bronchospasm, extrinsic alveolitis, and diffuse interstitial pulmonary fibrosis. Bronchospasm may be due to the action of pharmacodynamic agents on autonomic control of bronchial tone (beta-blockers, beta-agonists...) or to a hypersensitivity reaction (penicillins, sulfonamides, anti-inflammatory compounds...). Extrinsic alveolitis usually follows administration of anti-infective medication but other drugs may be implicated. Prolonged use of a wide variety of drugs, particularly cytotoxic agents, is necessary to provoke the onset of a diffuse interstitial pulmonary fibrosis.

Influence of propranolol and acebutolol on isoprenaline-induced changes in heart rate and peripheral blood flow in man

The authors studied the variations in the effects of isoprenaline hydrochloride on heart rate (beta 1) and on peripheral blood flow of the upper extremity (beta 2), determined by plethysmography, in a group of 5 men with a mean age of 31 +/- 3 years. The trial was conducted on a single-blind cross-over basis, each subject being infused over 30 min with propranolol (30 microgram/kg), acebutolol (150 microgram/kg) or a placebo (isotonic glucose solution) with at least an 8-day interval between each administration. At the end of the infusion they received isoprenaline (0.01 to 0.075 microgram/kg, in logarithmic progression) every 15 min, for 1 hour. The doses of isoprenaline were injected randomly using a latin square design. The peripheral flow, assessed by the curve of the initial part of the plethysmogram for the first 10 sec, increased with the dose of isoprenaline in the placebo series (Tg alpha = 219.9 log d + 583.4; p less than .01), did not increase in the propranolol series and increased with the dose in the acebutolol series (Tg alpha = 221.5 log d + 567.7; p less than .01); the variations in flow with isoprenaline after placebo and after acebutolol, did not differ significantly. The hear rate increased with the dose of isoprenaline in the placebo series (+55%) although tachycardia was inhibited by propranolol and acebutolol. Under the experimental conditions of this trial, propranolol inhibited beta 1 and beta 2 receptors at the same time, whereas acebutolol inhibited only beta 1 receptors.

[Sero-immunological research by immunofluorescence of rats bilharziosis in Guandeloupe. Epidemiological interest, comparative studies in various biotopes (author's transl)]

A sero-immunological survey by immunofluorescnece has been conducted on 94 rats (R. rattus and R. norvegicus) captured in Guadeloupe, in there different biotopes where the presence of S. mansoni carriers had been reported. These biotopes are those of the "Grand Etang" (Great Pond), the fresh-water mangrove and its back-mangrove area, and the Beaugendre valley. The post-mortem performed on the rats revealed that 92 % of those carrying. S. mansoni eggs of full-grown worms, had a rate of antibodies superior to 40. The rates of antibodies obtained, as well as the percentages of S. mansoni-parasited rats vary according to the biotopes. Two hypotheses can account for these variations: a smaller or greater adaptation of the S. mansoni stock to the rat; a change in the comportment of rats which would thus be more or exposed to reinfestations.

[Detection of schistosomiasis in rats using micro blood sampling and immunofluorescence during an epidemiologic study]

For a study of rat parasitism with Schistosoma mansoni in Guadeloupe, we used a technique of microbloodsampling followed by an immunofluorescence test. This method makes it possible to take the blood of the rats, the latter being then marked and set loose. It informs us of the presence of the parasite, the time of infestation, and the rats' movements relative to waterspots.

[Aspects of rats schistosomiasis in the non-salted mangrove swamps and the backmangrove area in the island of Grande-Terre (Guadeloupe) (author's transl)]

The study of parasitism by Schistosoma mansoni among rats (Rattus rattus and Rattus norvegicus) has been carried on in Guadeloupe. Over half the rats caught in the non-salted mangrove swamps and the back-mangrove area of the island of Grande-Terre are parasitized. It seems possible diagrammatize the characteristics of these sites, where the cycle of rats schistosomiasis develops.

[Experimental trichinasis (IV), study of the action of cyclophosphamide on the transplantation of 18 days old adults of T. spiralis (author's transl)]

The survival and the transplantation of adult trichinae collected in cyclophosphamide treated and untreated mice were studied. 1) The worms'burden harbored by treated mice on the 18th day after the infestation is from 4 to 5 times higher than in untreated ones. The sex ratio is here around one instead of 1/2 in the control lot of mice. 2) The female worms parasitic in treated mice continue to lay larvae. When these adult are transplanted in the gut of treated mice they seem give a greater number of larvae than if they are put in the gut of normal mice.