Pneumocystosis: a network survey in the Paris area 2003-2008

The aims of this network group were to collect epidemiological data of PcP cases in 14 hospitals in the Paris area and to determine the Di-Hydro Pteroate Synthase (DHPS) genotypes, genetic markers for possible sulfamide resistance. From January 1, 2003 to December 31, 2008, 993 (mean 166/year) PcP cases have been reported. Sixty-five percent of patients were HIV-positive. The median count of CD4 lymphocytes was 32/mm(3) (30 in HIV-positive patients, 152 in HIV-negative patients). In HIV-positive patients, PcP revealed the HIV infection in 39%. Among 304 PcP occurring in HIV known infected patients, no prophylaxis was prescribed for 64%; cotrimoxazole prophylaxis had been prescribed to 47 patients but only one of them had the right compliance. In HIV-negative patients (264), corticosteroids were prescribed in 59% and cytotoxic chemotherapies in 34%; 78% did not receive prophylaxis. One hundred sixty nine tumoral pathologies and 116 transplantations were notified. The mortality rate was 16% at day 14 (13% in HIV-positive patients, 26% in HIV-negative patients). Mutations in DHPS genes were detected in 18.5% of samples; 12.5% of patients were infected with several strains. The total annual number of cases has been stable for five years but the proportion of HIV-negative patients increased from 25% to 43%.

[Combination of three cutaneous diseases in Mayotte]

This report describes the case of a young woman from Mayotte (Comoros Islands) who presented a combination of three cutaneous diseases, i.e. pityriasis versicolor, scabies, and multibacillary leprosy. Symptoms of leprosy were concealed by those of the other two diseases. After multidrug therapy for leprosy, the patient developed erythema nodosum leprosum that was successfully treated using pentoxifylline. Combination of cutaneous diseases can alter usual presentations and lead to misdiagnosis. It is important to take into account possible disease combination to establish proper diagnosis and prescribe effective treatment.

Disseminated toxoplasmosis, resulting from infection of allograft, after orthotopic liver transplantation: usefulness of quantitative PCR

Disseminated toxoplasmosis is a life-threatening disease in liver transplant recipients that can result from an organ-transmitted infection. We report here a case of fatal disseminated toxoplasmosis after orthotopic liver transplantation from a seropositive donor (immunoglobulin G [IgG](+) and IgM(-)) in a patient who was nonimmune for toxoplasmosis prior to transplantation. Quantitative PCR analyses of various clinical specimens, including serum samples, appeared retrospectively to be a valuable diagnostic tool that might guide therapeutic attitudes.

Study of protein profile in the visceral leishmaniasis

A study of the ten proteins of the protein profile in 7 children infected with visceral leishmaniasis leads to obtain an evocating diagram of the protein profile in this disease. In these patients, the authors have found the association of a polyconal hypergammaglobulinaemia, an inflammatory syndrom (increase of orosomucoid, CRP, alpha-1-antitrypsin, decrease of albumin, prealbumin and transferrin), and an haemolytic syndrom (decrease of haptoglobin). Such a diagram may be an supplementary help to establish the diagnosis of visceral leishmaniasis, in some cases when it is difficult to find the parasites.

Anisakidosis: report of 25 cases and review of the literature

Anisakidosis (previously known as anisakiasis) is a disease caused by the accidental ingestion of larval nematodes (Anisakis and sometimes Pseudoterranova) in raw fish. Two groups of patients are studied: 5 clinical cases and 20 serological diagnoses. 55 French cases are already published. Most of them complained of acute symptoms, which occurred within 12 h of eating the seafood meal--epigastric pain, occlusion, diffuse abdominal pain, and appendicitis. Larvae were attached to the gastric mucosa (25 cases), including an inflammatory response (erythema, oedema ulceration). Diagnosis of anisakiasis is made by gastroscopy which allows removal of the worms, and cures the patients. In gastro-intestinal tract X-rays, oedema in the mucosa, pseudo tumour formation, and filling defects (worm) were observed. In chronic infections, cases with intermittent feelings of ill health and abdominal pain, lasting from several weeks to months, were misdiagnosed as another intestinal disease. Positive serological reactions are helpful, and surgery is necessary for resection of the lesion; diagnosis is made histologically by an eosinophilic granuloma, and the presence of a larva with Y shaped lateral cords. Infestation rate is high in fishes: cod (88%), rock fish (86%), herring (88%), salmon, mackerel. Public health education should discourage the eating of raw fish. Thorough cooking to 70 degrees C or adequate freezing to -20 degrees C for 72 h are the best preventive measures. Such legislation is only in force in the Netherlands, where cases have decreased dramatically.

Leishmaniasis: report of 33 cases and a review of the literature

Leishmaniasis are parasitic diseases in extension. They appear in new foci, because of important displacements of populations, and they affect immunocompromised patients (under chemotherapy, transplanted, or HIV infected). Study of 33 cases of leishmaniasis, 22 visceral and 11 cutaneous, at the Hôpital du Kremlin-Bicêtre, France, showed predominant contamination in Maghreb and in the south of France. In the case of Kala-Azar, fever (18 cases) and hepatosplenomegaly (19 cases) are frequent, and the serodiagnosis and the search of parasites by myelogram are always positive. In HIV-infected individuals, clinical signs are similar, but the serodiagnosis is less reliable. Evolution is bad in transplanted patients who must remain under immunosuppressive drugs. In the case of cutaneous leishmaniasis, diagnosis is based on local sample, while the serodiagnosis remains negative. Treatment is sometimes long, necessitating repeated treatments.

Successful treatment of Taenia saginata and Hymenolepis nana by single oral dose of praziquantel

Infections by adult cestodes are widely distributed in the world, and induced digestive and general disturbances. In this study, 40 patients with Taenia saginata and 15 with Hymenolepis nana were treated by one single oral dose of Praziquantel, at the dosage of 10 mg/kg/day and 20 mg/kg/day respectively. As side effects, no biological disturbances occurred, but 6 patients complained of abdominal pain and diarrhea. The efficiency was complete. Praziquantel, a wide spectrum anti-helminthic day drug, used in schistosomiasis, fascioliasis, cysticercosis, is the best treatment of adult cestodes.

Peripheral facial nerve palsy related to HIV infection: relationship with the immunological status and the HIV staging in Central Africa

Twelve cases of infranuclear facial nerve palsy associated with infection by the human immunodeficiency virus in the heterosexual African are reported with clinical and immunological studies. Eight cases were healthy HIV carriers, three patients manifested AIDS-related complex and one case fulfilled the CDC criteria for AIDS. Nine patients had a typical Bell's palsy, two presented cephalic Herpes zoster infection with Ramsay Hunt syndrome and one, who suffered from progressive facial weakness, could be considered as having a cephalic form of Guillain-Barré syndrome.

Pityriasis versicolor in the Central African Republic: a randomized study of 144 cases

The prevalence and the principal epidemiological characteristics of pityriasis versicolor have been studied in a randomized population of 870 adult individuals (418 males and 452 females) in the Central African Republic. The general clinical prevalence was 16.6%. Males were affected more often than females (20.6% vs. 12.9%). For both sexes, the maximum prevalence was in the 15 to 25-year-old age groups (23.5%). Lesions commonly occurred over the face (49.3%) and upper trunk (48.6%). Different climatic areas within the country, type of urbanization, religion and general hygiene showed no relevance to the disease. The prevalence was higher among people living in rammed-earth houses than in people living in hard-built houses. The sebaceous activity of the skin, a feature which is racially and genetically determined, probably constitutes a primary factor for developing this mycosis, associated with the tropical climate as an additional environmental factor.

[Effects of diethylcarbamazine and ivermectin on the mobilization of microfilariae of Onchocerca volvulus]

Microfilaria of Onchocerca volvulus are localized in superficial dermis. However, they are sometimes noticed in the blood and urines, when there is an important infestation. Diethylcarbamazine (DEC) bring on an increase of microfilaria, successively in the blood and after, in the urines. This study of 30 patients, treated in double blind by placebo, DEC and ivermectin, a new molecule with spectacular action on this filariasis, allowed to compare effect of each one on apparition of microfilariae in the blood and urines. Ivermectin bring on very important increase of microfilaremia without microfilaruria, unlike diethylcarbamazine. This establishment bring to discuss very different physiologic mechanisms between them. It should have an incidence on diagnosis and treatment of this dangerous parasite.

Study of relationship of ABO and Rh blood group, and HLA antigens with parasitic diseases

A study has been performed on 467 cases of differents parasitic diseases and ABO blood groups. With classical statistical methods, we did not find any correlation, but with a large number of variables, we used the factorial analysis, and we obtained maps with relationship O-hookworm and strongloidiasis. A-giardiasis, B-Entamoeba coli. But AB group seems to be far from all parasitosis. Besides, blood group and severity of diseases seem not to be related. With HLA groups, a study by microlymphocytotoxicity on 36 West-African (Sarakole people) showed that HLA B5 is predominant in cases of schistosomiasis.

Extension of multiple drug resistant Plasmodium falciparum malaria in Africa: report of a Central African case

A 24-year-old Caucasian male, living in the Central African Republic, presented with fever due to Plasmodium falciparum infection, although he steadily took chloroquine and sulfadoxine-pyrimethamine chemoprophylaxis. Despite treatment with the same drugs at high doses, the parasitaemia persisted. Clinical and parasitological recovery was obtained by the use of quinine. Chloroquine-resistant Plasmodium falciparum strains have spread in all tropical areas. Multiple drug resistance, already described in Asia, has also begun to appear in Africa.

[Epidemiology of malaria in Tanna (Vanuatu)]

A malaria survey done on the island of Tanna (Southern part of Vanuatu) showed that this island was hypoendemic with a few areas mesoendemicity where permanent breeding site are available for Anopheles farauti. The average spleen rate was 5,25% and the parasite rate 10,43%. Plasmodium vivax was the most prevalent species. The vector Anopheles farauti was found to be endophilic. Recently, chloroquin resistance was observed.

[Imidazoles in larval cestode infections]

The authors report the evaluation of therapeutic efficiency of imidazole derivatives (flubendazole and mebendazole) against human larval cestoda. 31 patients were treated: 28 had hydatid cysts, 2 had alveolar echinococcosis, and 1 had cerebral cysticercosis. Results after several months follow-up (up to 6 years) show an arrest in development of lesions and absence of development of new cyst after leakage of hydatid fluid. Although interpretation of such results is difficult, imidazole derivatives seem efficient in high dosages (100 mg/kg), given over 1 or 2 years, without side effects.

[Purulent pleurisy, esophagopleural fistula and presence of Torulopsis glabrata in the pleura]

The authors report the simultaneous discovery of a septic pleural effusion and an esophagopleural fistula in a 4 year-old patient. The yeast Torulopsis glabrata found in the pleural effusion does not seem to behave as a pathogen but more likely as a witness of a fistula between the gastrointestinal tract and the pleura.

Ebola virus infection in man: a serological and epidemiological survey in the Cameroons

The presence of antibodies to Ebola virus among 1,517 apparently healthy persons in five regions of the Cameroons was tested using indirect immunofluorescence. A positive rate of 9.7% was found, confirming that the virus circulates in the absence of clinical cases. Highest rates were found among Pygmies, young adults, and rain forest farmers.

[Hydatid cyst of the pancreas. One case (author's transl)]

This particular location is rare but should be more frequently detected with the help of ultrasonography, CT and serological tests. The surgical indications, which depend upon the effects of the cyst on pancreatic ducts and vessels, are discussed.

[Trichinosis: review of the epidemic in the south suburbs of Paris in January, 1976 (apropos of 125 cases)]

The authors report the results of the trichinosis epidemic which occurred in the southern suburbs of Paris in January 1976. 125 patients from a total of 65 families were affected. The major signs: oedema of the face and eyelids, fever and myalgia, were commonly found. There were even laboratory abnormalities with eosinophilia, increase in muscle enzymes and positive specific serology. The course over a period of months was very favourable. There were no deaths. The most severe symptoms rapidly regressed. Only myalgia and headache, and above all fatugie, persisted for 3 to 4 months, in the adults. The biological course was marked by the disappearance in one month of the majority of the disturbances seen in the acute phase, apart from the eosinophilia and serological findings which remained pathological after one year in a number of cases. The particular aetiology, due to horsemeat, may be explained by modern industrial rearing techniques and the complexity of current commercial circuits.