Paracoccidioïdomycose cutanéo-muqueuse Premier cas diagnostiqué en Guyane Française

INTRODUCTION

Paracoccidio-domycosisis a deep mycosis due to a dimorphic fungus:Paracoccidioides brasiliensis. The principle endemic country is Brazil. We describe the first case of paracoccidio-domycosis, in its cutaneous-mucosal form, diagnosed in French Guiana.

OBSERVATION

A 20 year-old Brazilian man, having mover to French Guiana a few months earlier, presented with multiple disseminated cutaneous lesions, predominating on the face, and composed of multiple nodules and two ulcerations. The clinical examination also revealed voluminous superficial lymph nodes and ulcerations of the pharynx and larynx. Direct examination, anatomopathology and culture of cutaneous biopsies revealed specific images of Paracoccidioides brasiliensis. HIV serology was negative. Treatment combining cotrimoxazole and itraconazole eliminated the lesions in one month.

DISCUSSION

Because the patient had just moved to Guiana, this observation probably corresponded to an imported disease. The principle differential diagnosis was leishmaniosis.

[Efficacy of radical treatment with halofantrine on the prevention of imported Plasmodium falciparum malaria]

We carried out in 1989 a non randomized comparative study in French army units which had been in Central Africa (Central African Republic and Gabon) for 4 months, in order to compare in 758 men on return from malaria areas the usual strategy of chemoprophylaxis with chloroquine and a radical cure by halofantrine (Halfan). Chloroquine was taken by 278 men (100 mg daily for 6 weeks after their return to France); the other 480 men were given two doses of 1,500 mg halofantrine on the third and on the tenth day after their return to France. In Africa both of the units were on chloroquine prophylaxis (100 mg daily for 4 months). The Plasmodium falciparum attack rates were, during a period of 5 months after the return to France, 0.2% in the halofantrine group (1/480) and 4.7% (13/228) in the chloroquine group (P < 10(-4)). The radical cure by halofantrine was more effective than chloroquine prophylaxis in preventing falciparum malaria on return from malaria areas.

[The treatment of imported Plasmodium falciparum malaria with halofantrine. Apropos of 59 case reports (corrected and republished article orginally printed in Med Trop (Mars) 1990 Jan-Mar;50(1):113-7)]

59 cases of Plasmodium falciparum malaria fever occurring in non-immune Caucasian subjects having got a correct chemoprophylaxis by chloroquine were treated by halofantrine (HALFAN). They were given 1500 mg divided in 3 doses of 500 mg every 6 hours from D1 to D8. All them were back from a malarial highly endemic zone with chloroquine resistance. Analysis of the main biological and clinical efficiency parameters displayed very satisfactory results: disappearances of fever (mean 22 H) and parasitemia (mean 36 H) are short. After two months of monitoring, no malaria recrudescence was noted. With an efficacy of 10 p.c. associated to a noticeable clinical and biological tolerance Halofantrine is a first-class treatment of chloroquine resistant malaria fever.

[Human malaria: dysglobulinemia-hypocholesterolemia syndrome]

Comparative study of protein and lipid parameters within a homogenous sample of 144 non-immune subjects having stayed for four months in Central Africa, suggests a dysglobulinemia more significant in the infected group. This dysglobulinemia affects in particular the IgM which are negatively correlated with cholesterol, positively with apoproteins A2 and H.D.L. Such a peculiar profiling involving immunoglobulins, apoproteins and cholesterol is rapidly regressive after stopping exposure to parasitic risk. It appears as an adaptation syndrome--or resistance--to tropical environment.

[Technics for the study of a total leukocyte dialysate and its fractions]

The crude dialysate extracted from human white blood cells from a thousand unselected donors were studied by leukocyte migration inhibition test with measles antigen. This dialysate and its fractions eluted from Biogel P4 and P6 chromatography were compared towards rosette restoration test and nucleotide composition.