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Background Imported loiasis is a rare cause of consultation at the return of stay in central Africa, which often poses difficult diagnostic and therapeutic questions to practitioners especially those who are unaccustomed to tropical medicine. These difficulties can lead to risks for the patients especially if inappropriate treatment is given. Large series of imported loiasis are scarce. Methods We retrospectively studied the data including outcome in patients diagnosed with imported loiasis between 1993 and 2013 in the Paris area on the basis of a parasitological diagnosis (microfilaremia > 1/ml and/or serologic tests). We compared sub-Saharan and non sub-Saharan African patients. Results Of the 177 identified cases, 167 could be analysed. Sex ratio was 1, mean age 41 years and 83% were sub-Saharan Africans. Cameroon was the main country of exposure (62%). Incubation time may be long (up to 18 months). Of the 167 cases, 57% presented with characteristic symptoms (Calabar swellings, creeping dermatitis, eyeworm) whereas 43% were diagnosed fortuitously. Microfilaremia was evidenced in 105 patients (63%), and specific antibodies in 53%. Compared to sub-Saharan Africans, other patients were presenting less frequently with eyeworm migration and microfilaremia whereas they had higher eosinophilia and positive serology. Prevalence of Calabar swellings was not significantly different between the two groups. Cure rates were 52% with ivermectin alone, and 77% with ivermectin followed by diethylcarbamazine. No severe adverse event was reported. Conclusions Presentation of imported loiasis varies according to ethnicity. A systematic screening should be recommended in patients with potential exposure in endemic country. Treatment with ivermectin followed by diethylcarbamazine could be a valuable option.

For administration of multiple live attenuated vaccines, the Advisory Committee on Immunization Practices recommends either simultaneous immunization or period of at least 28 days between vaccines, due to a possible reduction in the immune response to either vaccine. The main objective of this study was to compare the immune response to measles (alone or combined with mumps and rubella) and yellow fever vaccines among infants aged 6–24 months living in a yellow fever non-endemic country who had received measles and yellow fever vaccines before travelling to a yellow fever endemic area. Subjects and methods: A retrospective, multicenter case-control study was carried out in 7 travel clinics in the Paris area from February 1st 2011 to march 31, 2015. Cases were defined as infants immunized with the yellow fever vaccine and with the measles vaccine, either alone or in combination with mumps and rubella vaccine, with a period of 1–27 days between each immunization. For each case, two controls were matched based on sex and age: a first control group (control 1) was defined as infants having received the measles vaccine and the yellow fever vaccine simultaneously; a second control group (control 2) was defined as infants who had a period of more than 27 days between receiving the measles vaccine and yellow fever vaccine. The primary endpoint of the study was the percentage of infants with protective immunity against yellow fever, measured by the titer of neutralizing antibodies in a venous blood sample. Results: One hundred and thirty-one infants were included in the study (62 cases, 50 infants in control 1 and 19 infants in control 2). Of these, 127 (96%) were shown to have a protective titer of yellow fever antibodies. All 4 infants without a protective titer of yellow fever antibodies were part of control group 1. Discussion: The measles vaccine, alone or combined with mumps and rubella vaccines, appears to have no influence on humoral immune response to the yellow fever vaccine when administered between 1 and 27 days. The absence of protective antibodies against yellow fever was observed only among infants who received both vaccines simultaneously. Conclusion: These results may support a revision of current vaccination recommendations concerning the administration of these two live attenuated vaccines either on the same day or at least 28 days apart. Our findings show no statistically significant difference if the interval between both vaccines is more than 24 h, but the immune response seems to be reduced when the two vaccines are given at the same time.

Zika virus is a flavivirus isolated in non human primates in 1647, then in humans 1954 (Uganda). It emerged on Micronesia (island af Yap) in 2007, then in French Polynesia in 2013-2014, in South America (mostly in Brazil and Colombia) in 2015 and in French West Indies in 2016. It is transmitted by the bite of Aedes mosquitoes. Zika virus infection is symptomatic in only 20% of cases and clinical presentation is associated with mild illness. But several neurological complications are reported (as Guillain-Barré syndrome: 48 cases in French Polynesia) and congenital malformations (microcephaly). Laboratory diagnosis is based on virus isolation by PCR. There is no specific treatment or vaccine available against the Zika virs. Prevention is based on measures of protection from mosquitoes bites.

Prevention is an important but neglected issue in geriatric medicine. Vaccination plays a major role in prevention of infectious diseases, but its implementation in clinical practice is far from perfect. To improve practice, a group of French experts composed of geriatricians and infectious disease specialists prepared a set of educational material about vaccination for older subjects. The tool has been designed to be used by medical teachers to help them teach this topic to other physicians, nursing staff and students. The group first defined teaching objectives and reviewed the scientific literature on the efficacy and use of various vaccines in the elderly. Results were recorded in 217 slides. These slides were grouped to allow their use for short presentations: the immune system in the elderly and general information about vaccination; universal vaccines, influenza vaccines, pneumococcal vaccines, Herpes zoster vaccine, pertussis vaccine, vaccines for old travellers. Written comments were added to most slides to help presenters teach the topics. The content and design of the slides were analyzed and discussed by the whole group. The set was collected in a CD with ready-to-use files for oral presentations. This educational tool was presented and given to French teachers in geriatrics. It has been used for educational sessions in geriatric hospital wards, for continuous medical education for general practitioners and for courses for physicians learning geriatrics. It has also been proposed to physicians in charge of medical coordination of nursing homes and is available on a web site.

Ebola virus, described in 1976 in Zaire, causes severe hemorrhagic fever with a high mortality rate in humans and nonhuman primates. Epidemics occurred since this time to nowadays in Sudan, Gabon, Congo and currently in Guinea, Liberia, Sierra-Leone, Nigeria and Senegal. Specific treatment and vaccine are not available. So, to prevent the virus transmission with live and dead patients, we must use strict individual and collective measures which are not always understood by local populations and make contact tracing; it is the only way to curb the epidemic.

Since about a year, a new pulmonary pathology occurred in Saudi Arabia and some cases are imported in Europa. This disease is due to a coronavirus named MERS-CoV (Middle East Respiratory Syndome Coronavirus). The main symptoms are fever, pulmonary and digestive troubles, with a risk of nosocomial transmission and a mortality of about 42%. The reservoir is probably the dromedary camel and the bat is the vector. There is no specific treatment or vaccine.

Hydatidosis is a widespread zoonosis infecting a large number of animals and humans. Echinococcus granulosus has the smallest taenia adult of the cestodes but with the largest larva. Its morphologic and biologic features were identified with DNA analysis. Different strains were separated according to the intermediate hosts: sheep, cattle, pigs, horses, camels. Definitive host are canids, mostly dogs, where the worm grows to adulthood in several months. The eggs are scattered in the pasture by wind and water and are ingested by various hosts. The larvae migrate through the intestinal wall and penetrate the organs, mostly liver and lungs. The eggs survive several days outside, depending on the temperature, but numerous eggs die in nature because they cannot resist desiccation and extreme temperatures. Dissemination is accomplished by dogs. In Turkana (Kenya) the incidence of hydatidosis is high because of the close relationship between the population and dogs and the habit of leaving their dead bodies in the grasslands. In rural areas, the custom of slaughtering sheep at home, among the dogs, is an important dissemination factor. The circumstances of transmission vary according to the country. In Europe the natural life cycle of E. granulosus granulosus involves dogs as the definitive host and sheep as the intermediate host. In northern Europe E. granulosus borealis infects the canids and deer. E. granulosus canadensis infects wolves and reindeer, but there are no human cases. In the endemic Mediterranean area, sheep and dromedaries are the intermediate hosts. In South America, the life cycle of E. granulosus develops among several definitive and intermediate hosts. Hence the dynamics of transmission vary according to the countries with different hosts.

International audience; BACKGROUND: Each year, thousands of cases of uncomplicated malaria are imported into Europe by travellers. Atovaquone-proguanil (AP) has been one of the first-line regimens used in France for uncomplicated malaria for almost ten years. While AP's efficacy and tolerance were evaluated in several trials, its use in "real life" conditions has never been described. This study aimed to describe outcome and tolerance after AP treatment in a large cohort of travellers returning from endemic areas. METHODS: Between September 2002 and January 2007, uncomplicated malaria treated in nine French travel clinics with AP were followed for 30 days after AP initiation. Clinical and biological data were collected at admission and during the follow-up. RESULTS: A total of 553 patients were included. Eighty-eight percent of them were born in Africa, and 61.8 % were infected in West Africa, whereas 0.5 % were infected in Asia. Migrants visiting friends and relatives (VFR) constituted 77.9 % of the patients, the remainder (32.1 %) were backpackers. Three-hundred and sixty-four patients (66 %) fulfilled follow-up at day 7 and 265 (48 %) completed the study at day 30. Three patients had treatment failure. One-hundred and seventy-seven adverse drug reactions (ADR) were reported during the follow-up; 115 (77 %) of them were digestive ADR. Backpackers were more likely to experiment digestive ADR compared to VFR (OR = 3.8; CI 95 % [1.8-8.2]). Twenty patients had to be switched to another regimen due to ADR. CONCLUSION: This study seems to be the largest in terms of number of imported uncomplicated malaria cases treated by AP. The high rate of reported digestive ADR is striking and should be taken into account in the follow-up of patients since it could affect their adherence to the treatment. Beside AP, artemisinin combination therapy (ACT) is now recommended as first-line regimen. A comparison of AP and ACT, in terms of efficacy and tolerance, would be useful.

Background Worldwide, amoebic liver abscess (ALA) can be found in individuals in non-endemic areas, especially in foreign-born travelers. Methods We performed a retrospective analysis of ALA in patients admitted to French hospitals between 2002 and 2006. We compared imported ALA cases in European and foreign-born patients and assessed the factors associated with abscess size using a logistic regression model. Results We investigated 90 ALA cases. Patient median age was 41. The male:female ratio was 3.5∶1. We were able to determine the origin for 75 patients: 38 were European-born and 37 foreign-born. With respect to clinical characteristics, no significant difference was observed between European and foreign-born patients except a longer lag time between the return to France after traveling abroad and the onset of symptoms for foreign-born. Factors associated with an abscess size of more than 69 mm were being male (OR = 11.25, p, Author Summary Amœbiasis is caused by Entamoeba histolytica (E. histolytica), a protozoan specific to humans which infects humans by ingestion of contaminated food and water. According to some authors, amœbiasis could be the second leading cause of death from parasitic disease worldwide. It is endemic in tropical countries but can also be diagnosed in industrialized countries, essentially in travelers. One of its main clinical manifestations is amoebic liver abscess (ALA). Abscess can be medically treated by metronidazole, but percutaneous aspiration of the abscess is sometimes performed. Few studies have been performed so far regarding the existence of cases of ALA in the industrialized world. The results of our study reported the existence of 90 cases of imported ALA in France which should raise interest among physicians as well as tourists traveling to endemic areas. Male adults and foreign-born patients presented larger abscesses, suggesting that hormonal and immunological factors could be involved in ALA physiopathology. Foreign-born patients had a longer lag time between the return to France after traveling abroad and the onset of symptoms than European-born ones. This must be highlighted to clinicians who should think about this diagnostic even if a recent travel in a tropical area is not notified by patients.

Leprosy, known since antiquity, is a world infectious disease due to Mycobacterium leprae. The transmission is probably via nasal droplets. The clinical range, from tuberculoid to lepromatous leprosy is a result of variation in the cell-mediated immune response, with a chronic inflammation in skin and peripheral nerves. Diagnosis of leprosy is clinical with anesthetic skin lesion and skin smears detect acid fast bacilli. Besides the classification of patients due to the Ridley scale which is clinically useful, WHO proposed is a simple field classification based on the number of skin patches (paucibacillary or multibacillary). Despite an effective multidrug therapy, leprosy has not been eliminated and remains an important health problem.

Bitumen, which results of the storage of organic material and of the decomposition in process of time, was used since ancient times for cosmetic, art and the caulk of boats. So, mummies were treated by bitumen to improve their preservation. But bitumen was held to be useful to cure varying pulmonary, digestive, ENT troubles and even to set fractures. Besides, bitumen was used to realize the first photograph. In Iran, bitumen is yet used to improve the quality of the skin, but mixed with to limit its toxicity.

International audience; 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%.

Eosinophilic meningitis, or angiostrongyliasis, is a common disease in Asia, in the Caribbean and in the Pacific islands. It is caused by a rat lungworm Angiostrongylus cantonensis. Infection occurs by consumption of raw or undercooked snails. Diagnosis is based on epidemiological criteria, clinical manifestations, elevated count of eosinophils in the cerebrospinal fluid and serological tests. Treatment is symptomatic and supportive.

The benefits of vaccination in older adults are well documented yet there is poor uptake of such preventive measures, and one of the main reasons in France is a lack of recommendation and support from healthcare professionals. To address this issue a multidisciplinary group of experts has developed an educational tool, Vaxisenior, to assist in the training of physicians/healthcare workers who can act as advocates for immunization programs. The tool comprises of eight sections (general introduction; immunosenescence; diphtheria-tetanus-poliomyelitis; influenza; pneumococcus; pertussis; herpes zoster; and vaccines for travelers). In addition, it includes national immunization schedules and recommendations, practical information regarding opportunities to expand vaccine coverage that is convenient to the patient and a questions and answers section covering topics relating to particular usage and responsibilities. Implementation of vaccination policies for older adults is a major issue and will require extensive promotional campaigns, as well as active support from healthcare and public health professionals to improve overall vaccine coverage.

International audience; In 2002, the French Food Safety Agency drew attention to the lack of information on the prevalence of human cryptosporidiosis in the country. Two years later, the ANOFEL Cryptosporidium National Network (ACNN) was set up to provide public health authorities with data on the incidence and epidemiology of human cryptosporidiosis in France. Constituted on a voluntary basis, ACNN includes 38 hospital parasitology laboratories (mainly in university hospitals). Each laboratory is engaged to notify new cases of confirmed human cryptosporidiosis, store specimens (e.g. stools, duodenal aspirates or biopsies) and related clinical and epidemiological data, using data sheet forms. From January 2006 to December 2009, 407 cryptosporidiosis cases were notified in France and 364 specimens were collected. Of the notified cases, 74 were children under four years of age, accounting for 18.2%. HIV-infected and immunocompetent patients represented 38.6% (n=157) and 28% (n=114) of cases, respectively. A marked seasonal pattern was observed each year, with increased number of cases in mid to late summer and the beginning of autumn. Genotyping of 345 isolates from 310 patients identified C. parvumin 168 (54.2%) cases, C. hominis in 113 (36.4%) and other species in 29 (9.4%), including C. felis (n=15), C. meleagridis (n=4), C. canis (n=4), Cryptosporidium chipmunk genotype (n=1), Cryptosporidium rabbit genotype (n=1) and new Cryptosporidium genotypes (n=4). These data represent the first multisite report of laboratory-confirmed cases of cryptosporidiosis in France.

Tungiasis is an infestation of the skin due to the sand flea chigger (or Tunga penetrans). After penetration under the nails of the feet, this ectoparasite enlarged and the lesion becomes painful. Diagnosis is made on the past history (travel in tropical areas) and the inspection. Treatment consists of extraction the insect entire, and administration of topical antiseptic lotion.

Aspergillosis, due to moulds belonging to the genus Aspergillus, occurs in patients with residual lung cavities. The clinical manifestations are determined by the host immune response, ranging from a local inflammatory response to the systemic dissemination. Haemoptysis is the most common symptom. The chest X-ray reveals a round mass with a radio-lucent crescent of air. The antifungal treatments are successful.

Immune reconstitution after initiation of antiretroviral therapy may unmask a latent infection. We report a case of disseminated Histoplasma capsulatum capsulatum infection associated with a hemophagocytic syndrome in an HIV-infected patient, three weeks after initiation of antiretroviral therapy. The immune reconstitution inflammatory syndrome might be a risk factor for hemophagocytosis.

Cyclospora cayetanensis is an emerging coccidian pathogen known in animal since a long time, but recognized in human in last two decade. The present study of cyclosporiasis specified its characteristic features. An epidemiological, clinical and biological retrospective study was carried out on 6 patients, 24 to 67 years old, who complained of diarrhea and weight loss, after a travel abroad. The only pathogenic agent found in every patient was Cyclospora cayetanensis. The patients returned back from Asian countries and from Madagascar. They were cured by Trimethoprim-sulfamethoxazole (TMZ). Diarrhoea was the main symptom of infection by C. cayetanensis. Undoubtedly, transmission occurred by the oro-fecal route, and/or by consumption of infected water or foods. Diagnosis was asserted, recovery of this protozoan parasite in the stools samples. TMZ proved to be the most effective and possibly replaced Ciprofloxacine. The prophylaxis recommended control measure of water supply and foods. Cyclospora should be considered in the assessments of patients with unexplained prolonged diarrhoea, if the investigation for bacterial and parasitological diarrhoea or the traveler's diarrhoea were negative.

Ekbom syndrome or delusional parasitosis is mainly described in presenile women who are unmarried or living alone. The presenting dermatological symptom is persistent pruritus, and the patients take medical advice in several practitioners one after another. The typical symptom is the behaviour of bringing sample of the allegered parasites inside small containers, defined as the "matchbox sign". The patient is so convincing that she shares delusion of infestation by his familiars who complaint of pruritus. The Ekbon syndrome is defined as the most contagious of psychiatric syndromes. Beyond psychotherapy, pimozide is the drug of choice in such a syndrome.

In tropical areas, parasitic diseases are very frequent during pregnancy. Malaria is the most frequent, with different complications in pregnant women (anaemia, cerebral malaria, abortion) and in the fetus (low birthweight, congenital malaria), mostly after first pregnancies. Diagnosis must be confirmed rapidly and the treatment is effective with most of antimalarial drugs. Prophylaxis is possible by intermittent sulfadoxine-pyrimethamine treatment. Hookworms infestation increases the anemia. Schistosomiasis can be liable to sterility or dystocia. Congenital transmission of visceral leishmaniasis is exceptional. Digestive parasitosis give few repercussion on pregnancy and their treatment is useful only if clinical troubles are important.

After a trip to tropical areas, diarrhea is frequent and is most often due to a parasite. Amebiasis is the principal cause of acute diarrhea. The other intestinal parasites cause chronic diarrhea, including in temperate countries; these include Giardia, Cryptosporidium, and Microsporidium species in immunocompromised patients. Helminthic diseases, either cosmopolitan (Ascaris, Enterobius, and Taenia) or tropical (hookworms, Strongyloides, and Schistosoma), cause diarrhea with blood hypereosinophilia. Diagnosis is based on the examination of stool. Treatment is rapid, effective and well tolerated, while prophylaxis is often difficult to explain to the populations concerned.

Patients with human immunodeficient virus (HIV) must make special preparations before traveling. They have a higher risk of infection than the general population. They are more likely to develop malaria and the clinical episodes will be more severe, particularly in pregnant women. Prescriptions for malaria prophylaxis and treatment must take into account their interactions with antiretroviral drugs. Vaccination decisions require consideration of the risk and severity of the vaccine preventable diseases in the destination area, the nature of the vaccine, the patient's immune status, and the risk of virological rebound as a consequence of vaccination. Some countries have entry restriction for travelers with HIV. Special precautions may be necessary for transporting and storing antiretroviral medications.

Tropical sprue associates prolonged diarrhea, a malabsorption syndrome, and nutritional deficiency in patients who live in or have visited tropical areas. Pathogenesis is still unknown but an infectious cause is suspected. Macrocytic anemia and hypoalbuminemia are present, together with progressive villus atrophy of the small intestine. Treatment with tetracycline, folic acid and proper nutritional support generally results in full recovery.

Describe the epidemiology of Tinea capitis in three hospitals in the Val de Marne (suburban district southeast of Paris) and evaluate the usefulness of screening the families of index cases.The study included 3 hospitals: Henri Mondor Hospital, Creteil Intermunicipal Hospital Center and Bicêtre Hospital. Index patients had a positive culture for dermatophytes during visits to the mycology-dermatology or pediatric clinics from January 1998 through December 2002. The diagnostic procedure was identical in all centers. In two centers, scalp samples were taken routinely from family members, even in the absence of clinical lesions. Species were identified according to the phenotypic features of the cultures. We recorded the age, sex, and geographic origin of each patient, when available.Samples were obtained from 487 outpatients (including family members): 383 were positive (356 children under 16 years, 27 adults). Of the children with positive cultures, 214 were boys (60%); of the adults, 18 (66%) were women. Distribution of geographic origin was: sub-Saharan Africa (71%), Europe (10%), Caribbean (5%) and North Africa (4,7%). Species identification confirmed the predominance of anthropophilic species, with 46% of the isolates Trichophyton soudanense and 33% Microsporum langeronii. T. violaceum was reported in 5.5% of cases and T. tonsurans in 2.8%. M. canis (9%), found in 34 Europeans, was the main zoophilic species. Family screening accounted for 263 of the 487 outpatients. Of 242 children from 86 families, 153 (63%) had positive cultures. Of the 21 parents, 5 had a positive culture. Globally, the family screening identified 158 cases in 263 tests (60%).Tinea capitis in the Val de Marne is mainly due to anthropophilic species and involves children of African origin. The frequency of family contamination indicates that routine screening of family members of infected children is valuable.

Scorpion stings represent a major public health problem in Mexico. Their annual incidence is estimated at 150,000 cases; 800-1,000 people die from them each year, 72.5% of whom are children younger than 5 years old. The states most affected are Aguascalientes, Colima, Durango, Guanajuato, Guerrero, Jalisco, Michoacán, Morelos, Oaxaca, Puebla, Sinaloa, and Zacatecas. Morelos is an endemic zone, and scorpion stings are relatively frequent, but the indigenous population underestimates the risks. In this locality, scorpion stings lead to high morbidity, with an average of 10,219 cases each year, and a prevalence varying from 584.86 per 100,000 inhabitants in 1994 to 2043.3 per 100,000 inhabitants in 2003. Because of this upsurge, systematic medical supervision and serum therapy are necessary if scorpion poisoning is suspected in a child. The indigenous community as well as tourists visiting Mexico must be informed about the substantial risk of scorpion poisoning.

Blood hypereosinophilia (eosinophilia count of more than 500 per microliter, i.e., 0.5.10(9)/L) is a laboratory finding that requires a careful workup. Review of the patient's medical history and clinical examination can usually rule out non-parasitic causes. Parasitic infections must be sought by examination of stool, urine, and blood examinations and by serological tests. These examinations, with special techniques for cosmopolitan and tropical parasites and for digestive or tissular parasites, must be repeated. Improvement of blood eosinophilia and of the serum antibody titers is one criterion of treatment effectiveness.

We assessed the frequency of parasitic diseases and the efficacy of presumptive treatment when no cause was found.This prospective study took place in the Tropical Disease department of Bicêtre Hospital over a two-year period and included patients with eosinophil counts exceeding 500/mm(3).The study included 117 patients with blood eosinophilia. A parasitic infection was identified for 48 (41%), and appropriate treatment resulted in a return to normal eosinophil counts for all of them. No parasite was identified in 45 patients (38.5%), but parasitic disease was suspected on the basis of clinical or epidemiologic evidence. These patients received presumptive treatment with antiparasitic drugs (ivermectin, albendazole and praziquantel, alone or in combination). Of the 30 patients in this group not lost to follow-up, eosinophil counts returned to normal for 20. Finally, a cause other than parasitosis was suspected for 15 of the 117 patients (13%): 9 (7.5%) of them were lost to follow-up.Parasites remain the leading cause of blood eosinophilia. Because the sensitivity of additional testing for these parasites is low and these antiparasitic drugs are safe (except for patients with loiasis), presumptive treatment appears appropriate.

We report a case of visceral larva migrans in an adult with fever, night sweats, weight loss, hilar and mediastinal lymphadenopathy, bilateral pleural effusion, and eosinophilia-mimicking lymphoma. Visceral larva migrans was diagnosed subsequently because of negative findings for malignancy and positive serologic test result for Toxocara canis. Progressive improvement was observed with albendazole therapy.

Enterocytozoon bieneusi is an agent of intestinal microsporidiosis leading to malabsorption syndrome and diarrhea in AIDS patients. Respiratory tract microsporidiosis due to Encephalitozoon spp. has been reported. To date, however, only two cases of pulmonary involvement of E. bieneusi have been documented for patients with intestinal microsporidiosis. We report here another pulmonary localization of E. bieneusi in a human immunodeficiency virus-infected patient. Clinical features of these three cases are reviewed. E. bieneusi can colonize the respiratory tract but could be considered a simple carriage associated with an intestinal infection.

The authors report a case of Schistosoma haematobium infection with delayed occurrence of Salmonella bacteriuria following treatment of schistosomiasis. Standard models of interaction between these two pathogens may not be fully satisfactory in such a case of co-infection. The role played by a decreased host immune response following schistosomiasis may thus be highlighted to explain a delayed or prolonged infection with Salmonella.

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.

Disseminated histoplasmosis in immunosuppressed patients rarely occurs in nonendemic areas. Reported here is a case of disseminated histoplasmosis in a patient who had undergone orthotopic liver transplantation and had never traveled outside of France. The infection was most likely transmitted via the liver allograft, since the organ donor had lived in an area highly endemic for the disease (French Guiana) 20 years earlier. Two years post-transplantation, none of the other patients who received allografts (heart, cornea, kidneys) from the same donor had developed signs of infection.

We report the cases of two patients with spondylodiskitis due to Candida albicans who were successfully treated with fluconazole. On the basis of findings from these cases and a review of 52 mycologically proven cases in the literature, we describe the main characteristics of candidal spondylodiskitis. In 60% of the cases, candidal spondylodiskitis was a late complication of candidemia (mean delay, 5.2 months) ; it was determined to be a complication on the basis of the results of previously positive blood cultures (19 cases), and it was presumed to be a complication in iv drug addicts (12 cases). As spondylodiskitis can be a late complication of candidemia, all episodes of candidemia should be treated with systemic antifungal agents. Clinical and radiological signs of candidal spondylodiskitis were nonspecific. Any bone or joint symptoms in a patient who has had candidemia should be considered to be of fungal origin at the time of presentation. The definitive diagnosis of candidal spondylodiskitis was made on the basis of the results of percutaneous puncture in 26 of 30 cases. The overall prognosis for patients with candidal spondylodiskitis was good, with the full recovery rate ranging from 67% to 100%. The preliminary results of treating candidal spondylodiskitis with triazole derivatives, particularly fluconazole, were satisfactory ; there was excellent tolerance of this drug.

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.

Background Little is known about the most severe forms of Pneumocystis jiroveci pneumonia (PCP) in HIV-negative as compared with HIV-positive patients. Improved knowledge about the differential characteristics and management modalities could guide treatment based on HIV status. Methods We retrospectively compared 72 patients (73 cases, 46 HIV-positive) admitted for PCP from 1993 to 2006 in the intensive care unit (ICU) of a university hospital. Results The yearly incidence of ICU admissions for PCP in HIV-negative patients increased from 1993 (0%) to 2006 (6.5%). At admission, all but one non-HIV patient were receiving corticosteroids. Twenty-three (85%) HIV-negative patients were receiving an additional immunosuppressive treatment. At admission, HIV-negative patients were significantly older than HIV-positive patients (64 [18 to 82] versus 37 [28 to 56] years old) and had a significantly higher Simplified Acute Physiology Score (SAPS) II (38 [13 to 90] versus 27 [11 to 112]) but had a similar PaO2/FiO2 (arterial partial pressure of oxygen/fraction of inspired oxygen) ratio (160 [61 to 322] versus 183 [38 to 380] mm Hg). Ventilatory support was required in a similar proportion of HIV-negative and HIV-positive cases (78% versus 61%), with a similar proportion of first-line non-invasive ventilation (NIV) (67% versus 54%). NIV failed in 71% of HIV-negative and in 13% of HIV-positive patients (p < 0.01). Mortality was significantly higher in HIV-negative than HIV-positive cases (48% versus 17%). The HIV-negative status (odds ratio 3.73, 95% confidence interval 1.10 to 12.60) and SAPS II (odds ratio 1.07, 95% confidence interval 1.02 to 1.12) were independently associated with mortality at multivariate analysis. Conclusion The yearly incidence of ICU admissions for PCP in HIV-negative patients in our unit increased from 1993 to 2006. The course of the disease and the outcome were worse in HIV-negative patients. NIV often failed in HIV-negative cases, suggesting that NIV must be watched closely in this population.

Mefloquine hydrochloride is now one of the major antimalarial drugs used both in prophylactic and therapeutic regimens. Large-scale studies have shown that it is efficacious and relatively well tolerated. However, some severe side effects, particularly neuropsychiatric reactions, have been described. We describe two young men with no previous medical history who experienced severe psychiatric reactions during prophylactic and curative mefloquine therapy. In both cases, full recovery was rapid after cessation of the therapy. There is no explanation for these reactions. Serum levels of mefloquine were within the normal range. The absence of contraindications and minor side effects during an initial course of mefloquine should be confirmed before another course is prescribed. (Arch Intern Med. 1994;154:2360-2362)

• Three patients with trichinosis developed central nervous system complications. Cerebral computed tomography showed multifocal hypodense lesions in two patients. The lesions were associated with contrast enhancement and cortical gyral enhancement in the first case, suggesting hypoxia and infarction. In the second patient, magnetic resonance imaging showed multiple high-signalintensity lesions. Early cerebral computed tomography was normal in the third patient. All patients recovered after treatment with antiparasitic drugs and corticosteroids. We suggest that neurologic complications of trichinosis should be treated by corticosteroids and flubendazole.