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Résumé La symptomatologie du paludisme est protéiforme. Elle varie selon l’espèce plasmodiale infectante, le terrain du patient et le délai de prise en charge. Le tableau clinique est le plus souvent aigu et se présente sous forme d’un accès palustre simple ou d’un accès grave. Des atteintes subaiguës ou chroniques d’infections viscérales sont rapportées. Certaines espèces de Plasmodium entraînent des récurrences. Summary The symptomatology of malaria is multi-faceted. It varies depending on the infecting plasmodium species, the patient's predisposition and how soon treatment is provided. The clinical picture is usually acute and is presented in the form of uncomplicated or severe malaria. Subacute or chronic visceral infections are reported. Some species of Plasmodium cause relapses. [ABSTRACT FROM AUTHOR]

Résumé: Introduction: En République démocratique du Congo (RDC), les données sur l’insuffisance rénale aiguë (IRA) au cours du paludisme grave sont fragmentaires. L’objectif est de déterminer les différentes formes graves de paludisme de l’enfant et leurs associations avec l’IRA à Kinshasa, RDC. Méthodologie: Une étude prospective de cohorte était menée de du 1er janvier 2008 au 31 décembre 2008 auprès des enfants admis aux urgences pour paludisme grave dans cinq formations médicales de la ville de Kinshasa. Résultats: L’échantillon était constitué de 378 sujets (226 garçons et 152 filles). De cette série, 194 (51,3 %) de ces enfants avaient moins de cinq ans. L’IRA était observée chez 89 enfants (23,6 %) dont 87 (97,8 %) avaient la forme hémoglobinurique. Cette forme était prédominante chez les enfants de plus de cinq ans (94,8 %). La quinine était la molécule la plus impliquée dans l’hémolyse (76,0 %). La dialyse indiquée dans 23 cas d’IRA (24 %) était effective chez 21 enfants (91,3 %). La technique de la dialyse péritonéale était la seule utilisée. Le taux de décès lié à l’insuffisance rénale était de 12,6 % (n =87). La récupération de la fonction rénale a été normale chez les autres enfants. Conclusion: Cette étude confirme l’émergence de la forme hémoglobinurique chez les enfants de plus de cinq ans considérés dans ce milieu comme semi-immuns ainsi que sa place dominante dans la survenue de l’IRA chez les enfants au cours du paludisme grave. [Copyright &y& Elsevier]

Abstract: Toll-like receptors (TLRs) are a central component of innate immune system and play a major role as the initiator of the innate immune responses to defend against bacteria, viruses, parasite and other pathogens. During malaria infection, TLRs signaling pathways are initialed with the recognition of Plasmodium glycosylphosphatidylinositols (GPI) and hemozoin as pathogen-associated molecular patterns (PAMPs). And then, activation of TLRs signaling induces specific biological responses against malaria parasites invasion. However, TLRs are also involved in malaria pathogenesis and enhancement of immune tolerance and evasion for malaria infection. Moreover, malaria parasites regulate selectively TLRs expression on immune cells. Thus, these evidences indicated that TLRs have contrary roles on malaria infection. Understanding the complicated roles of TLRs on malaria infection will contribute us to design more effective anti-malaria drugs or vaccines. [Copyright &y& Elsevier]

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Leptospirosis is a zoonotic infection endemic in Hawai'i. This review discusses the incidence of documented human cases in Hawai'i and current recommendations for diagnosis, prevention, and treatment of leptospirosis. [ABSTRACT FROM AUTHOR]

Summary: This is a report of a case of blackwater fever in a 28-year-old Nigerian man who was admitted to hospital with fever, jaundice and passing dark urine. Abdominal examination revealed splenomegaly and an examination of the peripheral smear of the patient showed the ring form of the trophozoites of Plasmodium falciparum (P. falciparum). Serum creatinine was 200μmol/L. Treatment with quinine and doxycycline was started and intravenous fluids were administered with close monitoring of the urine output and serum electrolytes. Due to the alarming amount of fluid accumulation and his exacerbated azotaemia the decision was made to haemodialyse the patient; the patient required five haemodialysis sessions during his stay in the hospital. He was discharged on the sixteenth day after admission with a serum creatinine level of 160μmol/L. [Copyright &y& Elsevier]

Summary: Massive haemoglobinuria is encountered rarely during the course of malaria. It is usually considered a diagnostic criterion for severe malaria, together with anaemia, acute renal failure and jaundice. Haemoglobinuria can also present among expatriates travelling to endemic areas following repeated exposure to quinoline or arylaminoalcohol drugs. A case is described of haemoglobinuria developing in a 38-year-old French expatriate diagnosed concurrently with numerous tropical infections, and treated on presumptive basis with an antimalarial regimen containing artemisinin derivatives. Haemoglobinuria resolved spontaneously within a few days. Although this case does not definitely indicate a causal link between haemoglobinuria and artemisinin derivatives, the risk of such infrequent side-effects should be taken into account in pharmacovigilance monitoring. Moreover, the patient illustrates the multifaceted pathology that can be encountered with tropical infections. [Copyright &y& Elsevier]

The first reported case of haemoglobinuria in a patient treated with co-artemether for falciparum malaria is described. [Copyright &y& Elsevier]