[Disseminated strongyloidiasis]

ENDEMIC ZONES: Strongyloidiasis is an intestinal parasitosis which is frequently found in tropical and subtropical regions. RISK: The "autoinfection" cycle during this helminthiasis explains why the infection can be perpetuated without further exposure to exogenous, infective larvae. Hyperinfection may occur by dissemination of Strongyloides stercoralis in immuno-compromised patients, particularly those under corticotherapy. DISSEMINATATED STRONGYLOIDIASIS: Disseminated strongyloidiasis is characterized by severe gastrointestinal and respiratory tract involvement, meningitis, skin rash, or Gram-negative bacteremia. Since disseminated stronglyoidiasis is fatal in 80% of cases it is imperative to diagnose and treat this condition before long-term corticotherapy. Ivermectin is currently recommended because it is effective and well tolerated.

[A 2500 year-old patient. Nosological study of a statue of the Nok culture, Nigeria]

The authors describe a terra cotta statue of the Nok culture (Nigeria) dating from between 450 and 50 B. C. Amongst thousands of the same origin, this statue is the only one representing a pathological state of cirrhosis, aetiology of which may be viral, parasitological or iatrogenic. Although no precise diagnosis can be made, this statue pays tribute to the power of observation of the artist who conceived it.

[Parasitic diseases and fecal hazards: diseases due to helminths]

Ascaris, trichocephalus, hookworm, necator and anguillula--all of which are human parasites--are closely linked to fecal peril and especially prevalent among populations in developing countries, where fecal hygiene is insufficient or lacking. Epidemiological surveys seeking to evaluate the frequency of the various intestinal helminths are usually intermittent, few in number, and especially difficult to compare because of the different coprological techniques used. However this may be, the respective prevalence of these worms depends on geographical, climatic, economic, and human conditions. Their effect on health is not negligible, especially on children's health and in particular when malnutrition also occurs. To fight effectively against these verminoses, education and economic development must be promoted, but the present situation of the economy in most developing countries is postponing indefinitely the fight against fecal peril especially as its control is not seen as a priority.

[Apropos of 1 case of hepatogastric fascioliasis in Cape Verde]

The authors report a case of Fascioliasis sp. distomiasis with a double hepatic and gastric location primitively associated with a gastric cancer metastazed to the liver. The parasitic origin of the lesions suspected from the histological specimen of the gastric biopsy (the presence of eggs) was confirmed by serology with the presence of the arc 2 specific to immunoelectrophoretic analysis, while the parasitological examination of the stools was always negative. The patient grew well after a day's cure of triclabendazole (375 mg x 2). Although the ectopic locations of Fascioliasis are classic, they are usually in the abdominal wall, less frequently in the gastric or colic wall. The fact that the contamination originated on the Cape Verde is indiscutable, since the patient had never left the island. It is the 5th case described in medical literature, thus confirming the presence of Fasciola hepatica (or gigantica) on the islands of the Cape Verde, whose population is of both Portuguese and African origin and has kept the eating habits of the former colonial power (Portugal is a zone of high endemicity for human fascioliasis). It would be interesting to look for Limnaea and contaminated bovine on the Cape Verde islands.

[Apropos of 5 new cases of onchocerciasis edema]

We report 5 cases of onchocerciasis presenting as limb's swelling collected in the tropical disease unit of a parisian hospital between 1982 and 1993. They are 5 men which have lived between 3 weeks and 4 years in forested areas of Cameroon in four cases and Côte d'Ivoire in one case. The incubation period varied from 5 months to 2 years. The limb oedema was always located to one arm. It was associated with a blood eosinophilia above 2000/mm3 in 4 of 5 patients. The skin detection of microfilaria of Onchocerca volvulus was positive in every case. The serodiagnostic tests were negative for indirect immunoflurescent assay and immunoelectrophoresis with exception of one patient. These patients were cured with ivermectine and/or diethylcarbamazine. In addition, 26 other cases described in the literature are discussed.

[Symptoms and development of Schistosoma haematobium infestation seen in a metropolis]

Urogenital schistosomiasis is often diagnosed in France where, contrary to its severity, its initial presentation (mainly haematuria) has not changed. The frequency of major renal abnormalities seems to have diminished since 1965, but above all cystoscopy and intravenous urography have been superseded by ultrasonography, a totally harmless and painless method which provides the same information as that obtained with the previous two methods, except as regards the ureters. In particular, cystoscopy is now indicated only when tumours of the bladder are suspected at ultrasonography. Cutaneous schistosomiasis, with its characteristic features, deserves to be known and recognized.

[Epidemiology and prevention of distomatosis in France]

Only the large liver fluke Fasciola hepatica is frequently encountered in France. The small fluke is exceptional, owing to its mode of transmission. Opithorchiasis is observed among refugees from South-East Asia. The prevention of all types of distomatosis rests on food control.

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.

[Health consequences of the economic development of tropical countries]

If the usefulness of industrial development of the Third World is not really discussed, nevertheless it appears more and more necessary to evaluate carefully its advantages and disadvantages on the health status and the well being of the population concerned. Indeed, the evil consequences are well known: new outbreak of bilharziosis, malaria, onchocerciasis, but also arbovirosis, tuberculosis and S.T.D. On the other hand, we must consider the positive aspects of economic development: improvement of hygiene, constructions of health centers, increased food production. In order to minimize the drawbacks, some measures have to be taken, f.i.: to set up the sanitary files of the population to be displaced, the organization of the redwelling zones. For all these reasons, the cost evaluation must take into account the sanitary sector, keeping in mind the difficulty to appraise the consequential effects on climate and fauna.

[Human cryptosporidiosis: a propos of 4 cases]

Cryptosporidiae are ubiquitous protozoan belonging to the coccidiae family which parasite many wild and domestic animals bowels. Man gets infested by ingestion oocysts. The parasite complete cycle takes place on the surface of intestinal epithelial cells microvillosities. Human cases that we described occurred among patients presenting (or not) with acquired or congenital immunity depression. Diarrhea is the main symptom. Diagnosis is based on parasitological stool examination and pathological study of intestinal biopsies. At the present time no specific treatment is known and only the immunity deficit correction can possibly cure cryptosporidiosis.

[Colonic amebiasis due to venereal transmission. Apropos of 2 cases]

Intestinal amebiasis is an ubiquitous disease which is hyperendemic among high promiscuity homosexual males living under temperate climates. Sexual behaviour, especially oroanal contacts which are common in this population, as well as the multiplicity and sometimes anonymity of partners are responsible for this high prevalence. Individual prophylaxis involves local hygiene before intercourse and a decrease in the number of sexual contacts with different partners. Community prophylaxis is essential and consists in information of general practitioners and "gays" about the different means of transmission of amebiasis, its clinical manifestations and the necessity of routine parasitological stool examinations at regular intervals. We report on two cases and discuss these various considerations in the light of data from the literature.

[Muscular hydatidosis. Apropos of 2 cases]

Muscular hydatid disease is uncommon. It usually consists in a primary single cyst which remains asymptomatic. Diagnosis is made upon pathological examination after a surgical procedure carried out to establish the cause of a swelling. Indeed, in most cases serology is not helpful and, moreover, it rapidly becomes negative after surgery. We report two cases and discuss the features of this condition.

[Immunopathology of Schistosoma mansoni bilharziasis]

Immunological manifestations during S. mansoni bilharziasis are present at all stages of the disease and their mechanisms begin to be well known: --delayed hypersensitivity and cell mediation immunity, responsible for the formation of bilharzial granuloma; --synthesis of various antibodies. Beside their diagnostic interest, they might participate in the immunological tolerance as well as in the processing of circulating immune complex; --various immunizing mechanisms making schistosomes able to escape hostile reactions of their host, and limiting infestation to a level acceptable for both the host and the worms, that is the basic notion of parasitism.

[Pentastomosis. A serological study of 193 Ivorians]

Pentastomosis is the infection caused by the larvae of a worm resorting to Armillifer genus, the adults living in the lungs of big african snakes. Eggs are released with snakes slime and dejecta and ingested by man and various animals. Larvae are disseminated through lymphatic vessels in peritoneum, liver, spleen, lungs, pleurae, and rarely in kidneys, brain or even eye. Most often the infection is fortuitously detected during a radiologic control or a surgical inspection. The serological prevalence was of 4.2 p. 100 as a whole, somewhat lower than that given by post mortem examinations but higher than the prevalence resulting of radiologic controls. Children under 5 are concerned with a prevalence of 7 p. 100.

[Bilharzial granuloma - immunological aspects (author's transl)]

Living eggs of schistosoma are responsible for the tissular granulomatous reactions of the parasitized organism. It has been demonstrated that this process resorts to a reaction of delayed hypersensitivity related to the complex immunologic mechanisms involving egg specific antigens and immunocompetent cells (lympho-plasmocytic cells). In long duration infections, the granulomatous reaction disappears (endogenic desensitization by immunological processes).

[Evaluation of the main intestinal parasitosis in 860 Ivory Coast children from thirteen different villages (author's transl)]

A survey has been carried out in 2 forest villages, 9 savanna villages and 2 Abidjan suburb districts. A total sample of 860 children aged between 6 and 15, has been examined. Data tabulation indicated a prevalence of the main intestinal nematodes, of S. mansoni and of E. histolytica, with variable respective percentage. Ascaris lumbricoides affected 26 p. 100 of children but is less frequent in the savanna areas than in the forest areas. Trichiuris trichiura affected 1 child out of 4 but infestation rate reached 76 p. 100 in the Abidjan suburb district. Necator americanus is the most frequently detected parasite (67 p. 100) and is more frequent in the forest areas than in the 2 savanna villages. E. histolytica has an uniform and low (5 p. 100) geographical distribution. S. mansoni has such an irregular distribution that no extrapolation is possible from the results obtained to the geographical area considered. Its infestation rates is from 1 p. 100 to 60 p. 100 with important differences inside small geographical zones.

[Paragonimiasis in Black Africa. A recent infection focus in Ivory Coast]

The authors recapitulate in short the distribution of Paragonimiasis in West Africa. They establish and show keys for determination of adults and eggs of the agents of the disease (Paragonimus uterobilateralis, P. africanus, Poikilorchis congolensis). The first intermediate host is unknown but two species of snails are suspected (Afropomus balanoides, Potadoma sanctipauli). A very abundant crab (Liberonautes latidactylus) seems to be the second intermediate host.

[1st case of eosinophilic meningitis in Ivory Coat with the presence of a Parastrongylus sp. in the cerebrospinal fluid]

The authors report the first observation, in West Africa, of eosinophilic meningitis in an ivorian child who ingested raw Achatina sp. The presence of a Parastrongylus. sp. in the cerebrospinal fluid was detected.

[A survey of schistosomiasis in Ivory Coast (author's transl)]

S. intercalatum has not yet been observed in Ivory Coast whereas S. mansoni and S. haematobium are frequent. S. mansoni schistosomiasis is distributed in limited foci as a consequence of the vital requirements of Biomphalaria. Its clinical detection is uneasy and stool control is necessary. Kato's technique is recommended. Prevalence has great topographic variations with an average value of 0,7 p. 100. Complications are not frequent, and can be detected only with rather sophisticated techniques available only in hospital. S. haematobium schistosomiasis is much more widespread according to the strong resistence of the mollusc host. Its clinical syndrome is significant and the diagnosis is easily controlled by a microscopic examination of the urine centrifugation deposit. The average prevalence is about 20-25 p. 100. Detection of complication requires hospital equipments.

[Antimalaria fluorescent antibodies evolution in young children living in a stable malaria area (author's transl)]

The detection of malarial fluorescent antibodies have been performed in an Abidjan dispensary on 30 newborn babies with their mothers, 30 children 3 months old and 120 children from 6 to 24 months. This survey took place during the small rainy season and it demonstrates that: --synthesis of specific antibodies is significantly starting after the 3rd month; --the rise, after six months, of the malarial antibodies is parallel to the plasmodic index checked during the same period in the same area; --the rate of antibodies in 2 years old babies is almost the same that in adults; --living conditions in rural areas accelerate the synthesis of antibodies which, adversely, is slowed down by regular chemoprophylaxis; --Plasmodium berghei is a valuable antigen for mass survey; --Abidjan town is an hypoendemic zone of stable malaria in a mesoendemic area.

[Generalized and lethal pentastomiasis due to Armillifer grandis (Hett, 1915)]

The authors described a case of generalised and lethal Pentastomiasis by a five years old girl. The most heavy parasitised organs are the lungs and the brain. Considering the age of the child and the uncommon density of the parasites, the authors suggest that the symptoms may follow the casual ingestion of a gravid female worm.

[Hepatitic amoebiasis (75 cases observed in Treichville University Hospital Abidjan--Ivory Coast) (author's transl)]

Reporting 75 original cases the authors review the clinical radiological and biological syndroma of hepatitic amoebiasis. They emphasize the recent advances in medical treatments which frequently give opportunity of avoiding surgery. But surgical intervention cannot be systematically discarded and has been necessary in 11 p. 100 of the reported cases. Drainage strengthens drugs efficiency. Antibiotherapy is generally useless.

[Distributions of Ascaris lumbricoides, Necator americanus and Trichuris trichiura in 6 villages of Ivory Coast (author's transl)]

Results of stool controls (Kato's technic) in 425 children from 7 to 14 years old in 6 villages of the south districts of Ivory Coast. Necator and Trichuris have a high prevalence (75 p. 100) versus 40 p. 100 for Ascaris-Trichuris is specially frequent in urban and suburban areas.

[Efficacy of UK 4271 (oxamniquine, Pfizer) in Schistosoma mansoni bilharziasis in western Africa (parasitological and serological study of 252 children)]

This study was conducted on 252 childrens afflicted with Schistosomiasis (S. mansoni and S. haematobium) living in endemic area and treated with doses of 15 mg/kg to 60 mg/kg of Oxamniquine. During eight months, parasitologic and serologic (Indirect fluorescent antibody test) controls were continued. A single per os dose of 15 mg/kg appears best and 87% cure rates were obtained with only 12% reinfestation. Antibody studies indicate, at this dosage, an antigenic stimulation that lasts at least 8 months, thus conferring a "vaccinating" action possible to be used with large population groups. Further studies show acceptable tolerance clinically of Oxamniquine and its ineffectiveness against S. haematobium. As mentioned by others, it appears that Oxamniquine has usefulness in treatment of schistosomiasis due to S. mansoni.

[Value of indirect immunofluorescence test in the diagnosis and prognosis of intestinal and extra-intestinal amoebiasis in endemic areas (author's transl)]

A comparative study of 108 patients with patient amoebiasis and a reference group of 85 free of the disease but living in endemic area. The positivity of the test has been more frequent and has given higher titers in the extra-intestinal forms than in the intestinal ones. The positivity rate in the reference group has been 15 per 100.

[Epidemiological study of pulmonary hydatid cyst in the Ivory Coast. 3 cases]

No cases of echinococcus have been reported up to this time in Ivory Coast, where it has been considered non-existant in either pulmonary or hepatic form. The three cases of pulmonary echinococcus reported here show the classic paucity of clinical symptoms associated with classical radiological findings. The epidemiological research confirms in one case definite infection occurring in Ivory Coast and the other two either in the Ivory Coast or in closely neighbouring areas.

[Value of immunology in the diagnosis of cutaneous onchocerciasis]

In a study of 135 cases, the authors present the dermatologic lesions occasioned by onchocercosis, study and discuss the value of the following three diagnostic procedures: the skin Snip technic, the Mazzotti test, and indirect fluorescent antibody test as used in a region of Africa where onchocercosis is, with dipetalonemosis, the principal filariasis. The skin Snip showed positive in only 11,8% of cases while each of the other technics permitted diagnosis of more than 80% of cases studied. Use of the Mazzotti test in conjunction with indirect fluorescent antibody test proved the origin of dermatologic lesions to be onchocercotic in 100% of the study group while both tests remained negative for subjects in the control group. The authors conclude that, in individual practice the 3 tests should be used conjointly, while, for purposes of mass screening, the determination of fluorescent antibodies must be performed as an adjunct to clinical examination and skin Snip.

[Value of indirect immunofluorescence in the diagnosis of "Trypanosoma gambiense" trypanosomiasis. 46 cases (author's translation)]

Several indirect fluorescents reactions were performed on 46 trypanosomepositive specimens which had been confirmed by parasitologic diagnosis. 38 sera analysed before the commencement of treatment were found to have a G.M.R.T. equal to I:I, 350 and the titer of antibody was, in all cases, greater than I:320. In all cases in the first phase, the titer was I:640 or higher. Four cases were followed beyond the second month and their titers decreased slowly, becoming negative in the fifth month. In 12 cases in the second phase, the cerebrospinal fluid demonstrated fluorescent antibodies although 10 cases in the first phase were negative for these antibodies. Three cerebrospinal fluid were faintly positive and these corresponded to the second phase biologically. In the treatment of individuals (using the analysis of cerebrospinal fluid for antibody) the I.F.A.T. permits the classification of the patient into one of the two phases and enables the clinician to follow the course of therapeutic effectiveness. In mass screening, apparently healthy individuals possessing a serum titer of I:640 or higher are shown to need definitive treatment for trypanosomiasis, while those with titers of I:320 are those who may either be treated with Lomidine or tested regularly for change in serum titer.

[Coprologic survey in Bilharzia infected children of the Adzope region (Ivory Coast)]

During a stool examination survey on 174 bilharzia attained children living in a rural area of Ivory Coast, 93% were found to have intestinal parasites mainly Entamoeba coli, Necator americanus and Ascaris lumbricoides. The prevalence of the cysts of Entamoeba histolytica (4,7%) is lower than the one found in France (7%). Concerning the other intestinal parasites, their respective occurrence have been compared with those noted in other regions of Ivory Coast and of Africa.