A three years follow-up of total serum IgE levels in three patients treated for strongyloidiasis

A three years follow-up of the level of serum total IgE was made for the first time in three patients with strongyloidiasis after efficient treatment. The decrease of IgE was slow and progressive, showing a logarithmic curve. This regular decrease of total serum IgE could be used as an additional criterion for the evaluation of the efficiency of drug therapy in patients with strongyloidiasis. The persistence of high levels of total IgE two or three years after the elimination of the intestinal parasites, after the return of blood eosinophils to a normal level (within six months), and after the disappearance of specific antibodies, shows that the regulation of the IgE elimination seems to be a complex mechanism.

A case of chromomycosis treated by a combination of cryotherapy, shaving, oral 5-fluorocytosine, and oral amphotericin B

A case of chromomycosis from Comoro Islands was first treated without success with high doses of oral amphotericin B (3 g per day). Treatment with itraconazole (400 mg per day) was also unsuccessful. Then, in vitro tests were done to study the susceptibility of this Fonsecaea pedrosoi strain to antifungal drugs. It was resistant to itraconazole, sensitive to 5-fluorocytosine, and the combination of 5-fluorocytosine with amphotericin B was synergistic. The patient was then treated with this last combination of drugs, which seemed to be effective. The patient stopped this treatment after six months, and relapse occurred two years later. The best therapeutic strategy in cases of chromomycosis seems to be a combination of two drugs chosen according to the results of prior antifungal susceptibility testing.

[Comments on hepatitis B vaccination in France]

We recall the selective preventive measures which led to a significant reduction in the rate of acute hepatitis B cases detected in France prior to generalized vaccination. These measures, screening for HBs antigens in blood donors and pregnant women, vaccination of high risk groups, suggest the need to better define risk groups and to develop better epidemiology information on the evolution of hepatitis B incidence, both in at risk groups and in subjects outside these groups. The importance of serological screening among chronic carriers in at risk groups is underlined. For health carers who have already been vaccinated, we propose determining anti-HBs titer prior to booster vaccinations, whatever the age. Finally, an active surveillance system to register the secondary effects of vaccination (linked to the Regional Drug Monitoning Center) is needed. The issues of the content of anti-hepatitis B vaccine (dose, adjuvant, antigenic fraction, molecular mimetism) and injection route remain timely.

Relapsing Plasmodium vivax malaria with atypical parasite forms and phagocytosis by peripheral neutrophils

A case of atypical Plasmodium vivax malaria is presented. The clinical follow-up has allowed to characterize three consecutive malaria clinical episodes within one year. At the first attack, 39% of the infected red blood cells were parasitized by gametocytes. Furthermore, rare crisis forms, exceptional "pseudoparthenogenesis" forms, a few equatorial trophozoites, malaria pigment-containing leucocytes and phagocytized parasites were also found in the thin blood smears. At the second malaria episode, morphological aspects were quite similar, but the gametocyte percentage decreased and that of the equatorial trophozoite forms increased. Only at the third attack, was the morphology typical of P. vivax. The Plasmodium species and the absence of mixed infection were unequivocally confirmed using polymerase chain reaction. Atypical strains of P. vivax are relatively frequent. Nevertheless, to our knowledge, neither so high a gametocyte percentage, nor extensive P. vivax peripheral phagocytosis were previously reported.

Colonic obstruction and perforation related to heavy Trichuris trichiura infestation

Heavy Trichuris trichiura infestation is rare in developed countries, and complications requiring surgical intervention have been described rarely in human trichuriasis. A case of colonic obstruction and perforation related to heavy whip-worm infection is described in an 84 year old woman. The woman was admitted to hospital because of a chest infection. Two days after admission she suffered nausea and vomiting followed a day later by bowel stoppage. Laparotomy indicated intestinal obstruction by a tumour. A partial right sided ileocolectomy was performed. Pathological examination of the resected bowel revealed heavy infestation with T trichiura causing a pseudotumour following a proliferative inflammatory response.

The blood-stages of Plasmodium georgesi, P. gonderi and P. petersi: course of untreated infection in their natural hosts and additional morphological distinctive features

In the blood of a Cercocebus albigena and of a C. galeritus agilis monkey, the infection with Plasmodium gonderi was found to follow its well-known chronic course; P. georgesi seemed to occur as a relapsing type of malaria parasite; P. petersi was found for only a few days and at a low level in C. albigena (end of an attack?). As shown by using polarized light, the pigment granules appeared mostly as fine dots in P. georgesi, short rods in P. gonderi and long needles in P. petersi. The three species can be distinguished by the morphological appearance of the nucleus of the young trophozoites, and also by the measurement of its surface area (Sa): small round nucleus (Sa = 0.81 +/- 0.06 microns 2) in P. gonderi, large 2-coloured nucleus (Sa = 1.43 +/- 0.21 microns 2) in P. petersi, and long crescent-shaped nucleus (Sa = 2.18 +/- 0.25 microns 2) in P. georgesi. The first colour illustrations of the blood-stages of P. georgesi are presented. The dynamics of single and mixed blood infections in primate malaria parasites are discussed, with a proposal to classify them into 3 types.

[Atypical forms of Plasmodium vivax. Apropos of a case]

In one case of human malaria imported from Gabon, abnormal forms of Plasmodium vivax are described; severe multiple infections of the host erythrocytes are noticed (up to 6 amoeboid trophozoites in a single red blood cell). Attention is drawn to the numerous morphologically abnormal intra-erythrocytic stages of P. vivax: severe multiple infections of red cells, parasites "ressembling" P. ovale, mature schizonts of small size, with reduced number of merozoites... The geographical distribution of P. vivax in Central Africa is discussed, with reflections on the factors allowing the importation of few P. vivax cases from this area.

Isotypic characterization of anti-Toxoplasma gondii antibodies in 18 cases of congenital toxoplasmic chorioretinitis

A serological study was carried out by ELIFA (Enzyme Linked Immuno-Filtration Assay) for 50 children with congenital toxoplasmosis diagnosed by several parasitological and serological methods showing that the fetus had been infected by the parasite and had developed it's own specific immune response. At birth, anti-Toxoplasma gondii IgE antibodies were detected in the sera of 66% of the 18 children who had retinochoroiditis and in 32% of the 32 children without this complication. During the 4 months before or at the time of diagnosis of retinochoroiditis, specific IgE antibodies were detected in 70% of the 20 cases (2 children with 2 successive lesions); but during the 4 months following the discovery of ocular lesions, anti-Toxoplasma IgE antibodies were only detected in 30% of the 20 cases. Among all the 50 children, the prolonged detection of specific IgM + IgE association (for at least 4 months) was followed in 46% of cases by the appearance of chorioretinitis (predictive value).

Immunological studies in amebiasis: isotypic characterization of specific antibodies by enzyme-linked immunofiltration assay

Fifty sera from 17 cases of invasive amebiasis (15 hepatic localizations, 1 ameboma, 1 diffused colic localization) were studied by enzyme-linked immunofiltration assay (ELIFA). IgM and IgE anti-Entamoeba histolytica were detected in 10 and 15, respectively, of the 17 patients studied. IgM and IgE antibodies were found simultaneously in 10 cases; these 2 isotypes were only recognized twice in the same serum by the same antigenic components. During post-therapy monitoring, in less than 90 days IgE or IgM-Ab regressed completely in half the cases. If they appeared or reappeared after the third month, prognosis was bad. In addition to its value for diagnosis and prognosis, the ELIFA allowed us to detect the functional antigenic components revealed more particularly by some IgG, IgM, IgE, or IgA antibodies.

Value of isotypic characterization of antibodies to Echinococcus granulosus by enzyme-linked immuno-filtration assay

In order to establish prognostic criteria for patients with hydatid cysts and to identify functional antigenic components of Echinococcus granulosus 87 sera from 36 patients were studied by enzyme-linked immuno-filtration assay (ELIFA) to characterize the four main classes of specific immunoglobulins and to determine compared immunological profiles (CIP) between samples or subjects. This method uses filtration with labelled antibodies to reveal precipitating systems preformed by immuno-electro-diffusion on cellulose acetate strips. IgG antibodies were demonstrated in the arc 5 and in 11 others bands. Specific IgA, IgE and IgM to Echinococcus granulosus was found in 19%, 53% and 69% respectively of patients with hydatids. The presence of IgM and/or IgE antibodies one year after treatment always correlated with disease. Specific IgA was detected more often in patients with pulmonary cysts. Pre- and post-operative monitoring by CIP-ELIFA proved simple and rapid to perform and of decided prognostic value. Two antigens, corresponding to arc 5 and arc X, were frequently associated with the poly-isotypic immune response.

[Increase in the size of an hepatic amebic abscess treated with metronidazole: value of immunologic surveillance with the ELIFA method]

The authors report a case of amoebic liver abscess regularly increasing in size for a period of 20 days (iterative controls by echography), in spite of a metronidazole treatment. Immunological studies by the ELIFA method, on the successive sera of the patient, show IgG, IgM, IgE and IgA antibodies within one particular precipitating system; the specific IgA disappeared after surgical drainage of the abscess.

Enzyme-linked immuno-filtration assay (ELIFA) for the detection of IgG, IgM, IgA and IgE antibodies against Aspergillus fumigatus

The enzyme-linked immuno-filtration assay (ELIFA) permits detection of serological precipitating systems preformed by immunoelectro-diffusion on cellulose acetate strips and simultaneous characterization of immunoglobulins G, M, A and E specific for antigens of Aspergillus fumigatus. We selected 36 sera from 9 patients who were followed up regularly and who suffered from aspergilloma (5 cases), allergic bronchopulmonary aspergillosis (2 cases), Aspergillus bronchitis and invasive aspergillosis (one case each). All of them possessed an IgG-reactive band with chymotrypsin activity. Four different IgE bands were found by ELIFA; one of them was common to all the patients who had anti-A. fumigatus IgE (7 cases out of 9). The IgA and IgM antibodies found in 7 cases out of 9 were both recognized by the same antigenic component but these fractions were distinct from those reacting with the IgE.

[Early diagnosis and surveillance of congenital toxoplasmosis. The comparative immunological profiles method]

More than 8000 samples (sera, cord blood, CSF, etc.) from patients who had, or were likely to have, toxoplasmosis were studied by the CIP-ELIFA technique. The first stage in this technique is immunoelectrodiffusion on a microporous cellulose acetate membrane. In the second stage, immunodetection and isotypic characterization of the precipitating systems are rapidly carried out by immunofiltration with anti-IgG, IgM, IgA or IgE-labelled antibodies (enzyme-linked immunofiltration assay or ELIFA). Several samples are jointly laid out on the same membrane for compared immunological profiles (CIP). When applied to the mother-foetus relationship in toxoplasmosis, this procedure provides an early diagnosis of congenital infestation in 85% of the cases. Positive criteria are based on evidence of specific IgM, IgE or IgA in the child, but also on the detection of foetal or neonatal antitoxoplasmosis IgG which can be distinguished from the IgG transmitted by the mother. Polyisotypic supervision is of considerable value for assessment of prognosis and of therapeutic effectiveness at the end of treatment. Satisfactory isotypic characterization can only be achieved by using particular functional antigens.

Enzyme-linked immunofiltration assay (ELIFA) for the detection of specific antibodies (IgG-IgM-IgA-IgE) in farmer's lung disease

Until now the detection of chymotrypsic or polysaccharidic arcs among precipitating systems indicated a positive diagnosis of Farmer's lung disease (FLD). It was shown that the occurrence of chymotrypsic activity is not absolutely correlated with the presence of clinical disease. The presence of different classes of specific precipitating antibodies was looked for and correlated with clinical symptoms in an attempt to find additional positive criteria for the diagnosis of FLD. The enzyme-linked immunofiltration assay (ELIFA) was adapted to detect the different specific antibody classes. 1400 serum samples were studied from 1350 farmers exposed to mouldy hay. Of 1358 samples examined from asymptomatic subjects tested as part of a systematic screening of the profession, 1356 had either no precipitins or have precipitins detected solely against non-chymotrypsic and non-polysaccharidic antigens. Ten specimens with precipitins joined the study. Only two serum samples from two symptomless individuals showed positive serological criteria for FLD as evidenced by the presence of a chymotrypsic band. The remaining forty-two serum samples from twenty-four patients with clinical signs of extrinsic allergic alveolitis had serological criteria for FLD as either chymotrypsic or polysaccharidic arcs. Only specific IgG in asymptomatic subjects was demonstrated, and when a supplementary class of specific antibody (IgM, IgA or IgE) was detected, there was clinical evidence of FLD in all except one case. Thus ELIFA could prove to be a useful tool for the positive diagnosis and prognosis of patients with FLD. In addition this method allows the recognition of a particular functional antigenic fraction of M. faeni by all classes of specific antibodies between different serum samples.

[Parasitic infestation and haemoglobinopathies in a population of 1170 refugees from South East Asia]

One thousand one hundred and seventy refugees from Cambodia, Laos and Vietnam were examined in the north of France from 1976 to 1980. 58% of them carried digestive parasites, 22% had anti-Plasmodium antibodies and 2% showed circulating Plasmodium. The most frequent parasites were hookworms (28%), Opisthorchiidae (15%) and Giardia intestinalis (12%). Strongyloides stercoralis (5,7%), Entamoeba histolytica (4,5%), tapeworms (3,3%), human coccidia (1,3%) and Trichostrongylus sp. (1%) were less frequent. Four cases of japonicum schistosomiasis were diagnosed by rectal biopsy. Three species of Plasmodium were identified: P. falciparum (10 cases), P. vivax (3 cases) and P. malariae (2 cases). 16% of the refugees displayed E haemoglobin (Hb E). The occurrence of parasitic infestation and Hb E were more frequent in Cambodians and Laotians than in Vietnameses. Specific anti-P. falciparum antibodies were observed with a significant higher frequency in patients carrying Hb E.