Search

The intralesional expression of cytokines (interleukin [IL]-4, IL-13, IL-10, and interferon-gamma) was analyzed in 65 patients with localized cutaneous leishmaniasis due to Leishmania guyanensis before specific treatment with pentamidine isethionate. The local expression of IL-10 was significantly higher in patients who responded poorly to treatment than in patients whose lesions were regressing. When an IL-10 level >10 (ratio of the concentration of IL-10 [pg/microL] to that of beta-actin [pg/microL]) was used as an indicator of treatment failure, the sensitivity of this test was 78.6, and the specificity was 72.5. Thus, high intralesional expression of IL-10 might predict a poor response to conventional treatment.

Onchocerciasis is caused by the filarial nematode Onchocerca volvulus and is a major public health problem in West and Central Africa. With only partial and long-term treatment currently available, there is a need to develop a suitable vaccine. We analysed the antibody response to infective L3 larvae because this stage is thought to be associated with host protective immunity. In addition, we have related our findings to the age, gender and current infection intensity of our participants: variables that may significantly influence antibody production. Interestingly, whilst 90% of our study group were seropositive for adult specific immunoglobulin (Ig)E, only 23% produced L3 specific IgE. This is in contrast to IgG4 where seropositivity was comparable at 96% and 92%, respectively. Furthermore, IgG levels were significantly affected by age and the intensity of infection but unaffected by host gender. This finding is independent for the IgG subclass (IgG1, IgG2, IgG3 and IgG4) and its specificity (L3 versus adult antigen). In summary, we show that L3 larvae induce little specific IgE and the antibody response shows a different isotype balance than that against adult antigens. Both host and parasite variables can influence antibody production in this disease.

The annual incidence of Q fever in French Guiana was found to have increased in 1996 and was 37/100,000 population over the last 4 years. Subsequent investigations in Cayenne and its suburbs indicated that a wild reservoir of the bacteria was responsible for the epidemiologic pattern. A case-control study showed that residence near a forest and occupations and activities that result in exposure to aerosols of dusts from the soil are risk factors for Q fever. By means of time-series analysis, a strong positive correlation between rainfall and the incidence of Q fever with a time lag of 1-3 months was found. The spatial distribution of the cases showed that transmission occurs widely throughout greater Cayenne, which is incompatible with a pinpoint source of contamination. Transmission from livestock and dissemination of the bacteria by the wind appeared to be unlikely, which strengthens the hypothesis that a wild reservoir is responsible for transmission.

Hemorrhages in the palpebral conjunctiva (HPCs) have been recorded in patients living in an area endemic for loiasis who developed serious reactions after ivermectin treatment. A study was designed to evaluate the frequency of these lesions, and to identify risk factors associated with their appearance. The conjunctivae of 1,682 patients who complained of reactions were systematically examined. HPCs were found in 41 patients. The initial mean Loa loa microfilaremia in the individuals with HPCs was 14,900 microfilariae (mf) per mL, as compared with 14.5 mf/mL in the other patients. Mansonella perstans microfilaremia and male gender were also associated with HPCs. Post-treatment fundus examinations were performed on 37 patients, and a close relationship was found between the occurrence of HPCs and the presence of retinal lesions. The vascular pathological processes leading to the ocular lesions may be similar to those which occur at the cerebral level in patients harboring high L. loa microfilaremia who develop neurologic troubles after ivermectin treatment. Retinal lesions may represent a special feature of the Loa-related encephalopathies useful for differential diagnosis, and the HPCs may be useful as an alarm sign to identify those individuals who might develop serious reactions after ivermectin treatment.

A number of cases of Loa-encephalopathy have been reported following ivermectin (Mectizan) treatment for onchocerciasis in patients with high Loa microfilaraemia. A possible explanation for these severe reactions is the formation of micro-emboli in small brain vessels as a result of massive paralysis of Loa microfilariae in the blood. This suggests that encephalopathy might be prevented by giving an initial low dose of ivermectin to induce a more gradual action on the Loa microfilariae. To test this hypothesis, a trial was conducted on 23 adult patients in Cameroon. Patients were divided into two groups. One group received the recommended dose of 150 micrograms/Kg. The other group received a lower dose of 50 micrograms/Kg (one 3 mg tablet of Mectizan). Blood smears were made daily from day 1 to 7 after treatment and then on days 15 and 30. Results showed no difference in the effect of the dosage level on Loa microfilaraemia. This finding suggests that an initial low dose of 3 mg Mectizan will not prevent encephalopathy following treatment for onchocerciasis.

Background: In 1995, the World Bank launched an African Programme for Onchocerciasis Control to eliminate Onchocerca volvulus disease from 19 African countries by means of community-based ivermectin treatment (CBIT). Several cases of encephalopathy have been reported after ivermectin in people heavily infected with microfilariae of Loa loa (loiasis). We assessed the incidence of serious events in an area where onchocerciasis and loiasis are both endemic., Methods: Ivermectin (at 150 micrograms/kg) was given to 17877 people living in the Lékié area of Cameroon. 50 microL samples of capillary blood were taken during the daytime before treatment from all adults (aged > or = 15 years), and the numbers of L loa and Mansonella perstans microfilariae in them were counted. Patients were monitored for 7 days after treatment. Adverse reactions were classified as mild, marked, or serious. Serious reactions were defined as those associated with a functional impairment that required at least a week of full-time assistance to undertake normal activities. We calculated the relative risk of developing marked or serious reactions for increasing L loa microfilarial loads. Risk factors for serious reactions were identified and assessed with a logistic regression model., Findings: 20 patients (0-11%) developed serious reactions without neurological signs but associated with a functional impairment lasting more than a week. Two other patients were in coma for 2-3 days, associated with L loa microfilariae in cerebrospinal fluid. Occurrence of serious reactions was related to the intensity of pretreatment L loa microfilaraemia. The relative risk of developing marked or serious reactions was significantly higher when the L loa load exceeded 8000 microfilariae/mL; for serious reactions, the risk is very high (odds ratio > 1000) for loads above 50000 microfilariae/mL., Interpretation: Epidemiological surveys aimed at assessing the intensity of infection with L loa microfilariae should be done before ivermectin is distributed for onchocerciasis control in areas where loiasis is endemic. In communities at risk, monitoring procedures should be established and adhered to during CBIT so that people developing serious reactions may receive appropriate treatment.

The control of onchocerciasis remains a priority in sub-Saharan Africa. Jean-Philippe Chippaux, Michel Boussinesq, Jacques Gardon, Nathalie Gardon-Wendel and Jean-Christophe Ernould here outline studies concerning possible severe adverse reactions to ivermectin used to control onchocerciasis in areas where loiasis is also endemic, and discuss precautions that may be advisable during the implementation of such programmes.

During the second half of 1993, a survey to assess awareness, attitudes, habits, and behavior with regard to HIV and AIDS was performed among health care workers in the Cote d'Ivoire. A total of 90 health care workers, 42 in Abidjan and 48 in Daloa, were surveyed. The majority (87%) were women. Understanding of the terms "AIDS" and "seropositivity" was good as was knowledge of AIDS-related symptoms. Awareness was better among newly recruited workers and nurses than among orderlies. Appreciation of risk was strongly linked with the notion of high-risk population. The occupational nature of the risk was clearly understood and anxiety in this regard was increased by uncertainty as to modes of secondary transmission and lack of preventive measures. On the individual and personal level protection consisted mainly in reducing the number of partners and outside activities. There was a great demand for training and information. As a result of the uncertainties revealed in this survey there appears to be a reluctance or refusal to perform certain procedures or treat certain patients and even a tendency to abandon the health care profession.

In the last ten years ivermectin appeared an efficient and safe alternative to diethylcarbamazine which is known to induce severe adverse reactions in loiasis, including encephalitis. After these results, large scale ivermectin treatments against onchocerciasis were carried out in Central Africa where loiasis is also endemic; and seven cases of severe reaction were reported in Cameroon since 1991, during these mass ivermectin treatments. In order to study adverse reactions in patients harbouring high load of Loa loa microfilariae (mf), we realized careful hospital based treatment in 112 patients with more than 3,000 mf/ml (ml) blood. Patients received once 200 micrograms ivermectin per kilogram at day 0 (D0). Clinical examination was made daily during the four following days (D1 to D4). Blood and urine samples were analysed before treatment and at D1 and D3. Lumbar puncture was made at D1 for 39 patients with more than 10,000 mf/ml; at D3 for the 49 following patients without consideration for the level of parasitaemia, and at D0 and D3 for ten voluntary patients. For analysis the patients were distributed in 3 groups according to initial parasitaemia: the first group included 50% out of the patients, those whose parasitaemia was fewer than 15,000 mf/ml blood; the second group included 25% patients whose parasitaemia was between 15,000 and 30,000 mf/ml; the third group included the last 25% patients whose parasitaemia was higher than 30,000 mf per ml blood. Adverse reactions were observed in 71% out of the patients. Symptoms described were fever, pruritus, headache, arthralgia. Most symptoms appeared 24 to 36 hours after treatment. Temperature increased significantly in group 3. Microfilaraemia decreased by 85% in the 3 groups during the 4 days following treatment. C-reactive-protein increased dramatically after treatment in all patients (p < 10(-4)). Some patients presented blood in urine in three groups but haematuria reached 35% of patients in group 3. Proteinuria is noted among 33% of all patients but 20% in group 1 and 2 versus 70% in group 3. Loa loa mf were observed in urine of half the patients, but in low amounts (< 10 mf per 50 ml urine). In cerebro-spinal fluid (CSF), some mf appeared at D1 or D3 in people heavily infected with Loa loa, reaching 80% of the patients of group 3. LP made at D0 in ten patients with parasitaemia higher than 30,000 mf/ml blood confirmed that CSF was naturally microfilaria free before treatment. One patient presented severe troubles with fever, asthenia and conscience troubles beginning at D3, reactive coma at D4, renal impairment with transitory anuria; progressive improvement in 2 weeks and complete recovery at D22; he presented 102 mf/ml CSF at D6. The study confirmed that ivermectin treatment is generally well tolerated. Among people with high Loa loa parasitaemia the symptoms after treatment are frequent but mild. However severe cases with conscience troubles are possible, and may occur in about 1% of subjects with more than 3,000 mf/ml blood. Severity of adverse reactions was linked to level of parasitaemia before treatment. The critical parasitaemia level which could lead to expect serious adverse effects seems to be 30,000 ml/ml blood. These informations should induce carefulness to carry out large scale treatments against filariosis in endemic areas of Loa loa.

During a mass treatment with ivermectin which is contraindicated to pregnant women, authors made a screening for pregnancy by questioning 2,580 women from 15 to 45 years old. 1,409 of these women were also interrogated by a female physician assisted by a native matron to detect pregnant women. In 1,798 women, at least one immunological pregnancy test has been used in the field. A nine months follow-up was made to check answers. Women's knowledge led to a good appreciation of pregnancy as they correctly appreciated their pregnancy from the second month: specificity was good (98%) but sensitivity was moderate (71%). Conclusions made by gynecological team after detailed questionnaire were more sensitive (80%), but specificity decrease dramatically to 59%. Combinations of several items in the questionnaire showed no benefit. Sensitivity of the various immunological pregnancy tests tried was included in 70 to 90% and specificity was varying from 87 to 97%. Simple questioning of women was the most efficient method (efficiency value was 94% against 63% for interview and 92% for pregnancy tests). However, the use of this method induced the risk that about 29% of women have been treated although they were pregnant.

Subsaharian Africa is the most important reservoir of HTLV1 virus but its epidemiology is not well-known. The authors have studied from 1987 to 1990 the situation in 6 countries in Central Africa. The already described routes of transmission are present: through blood transfusions (but it's not such a common practice), heterosexual transmission (but it doesn't seem to be as important as in other continents), and mother to child transmission through breast feeding. Nevertheless, environmental factors--which have to investigated--could play a role for transmission, among them one could think to vectors and parasites.

From simplified in vivo tests, authors set up a cartography of the sensitivity of Plasmodium falciparum to amino-4-quinolines in Cameroon; they also evaluated the clinical and parasitological efficacy of different therapeutic protocols which make use of amino-4-quinolines, quinine, mefloquine and halofantrine. All these drugs are administered orally. They recommend maintaining home medication with chloroquine at the dose of 25 mg/kg over 3 days, conserving quinine for use in the case of a possible failure. The use of most recent antimalarials can be proposed only as a last resort.

When P. falciparum malaria is diagnosed in France in a patient who has not travelled to an endemic area, transmission by blood transfusion or direct contact with an infected person, and indigenous malaria should be considered. With reference to the observation reported in this paper, the manifestations of malarial hepatitis are recalled and their diagnostic significance is discussed. In P. falciparum malaria, malarial hepatitis indicates the development of a complete cycle including the pre-erythrocytic phase; this is strongly in support of indigenous malaria, and against malaria following blood transfusion or direct contact in which there is no pre-erythrocytic phase.

A total of 393 porcine embryos was transported in two trials each lasting more than 30h from Hannover, Federal Republic of Germany to Buenos Aires, Argentina. The embryos were shipped in phosphate buffered saline (PBS) medium supplemented with 10% lamb serum and packaged in 0.25ml straws placed in a modified thermos bottle at 36.5 degrees C. Upon arrival, 359 embryos (90.8%) were evaluated as morphologically intact and were transferred to 19 recipients. Twelve recipients remained pregnant. Three recipients aborted and nine recipients (47.4%) farrowed a mean number of 5.6 +/- 2.6 (x +/- SD) piglets after 115.1 +/- 1.8 d of gestation. The average birthweight was 1.1 +/- 0.2 kg. The percentage of embryos resulting in live piglets was 28.6% in farrowing recipients. These births represented the first piglets from embryos that had been stored for more than 30h in vitro and shipped from Europe to South America.

Two cases of fulminating pneumococcal septicemia (FSP) are reported, and 47 confirmed cases were discovered after a review of the published literature. The syndrome is that of a malignant infection with fever, collapse, and disseminated intravascular coagulation, with a rapid mortal outcome in most cases. Etiologically, FSP is usually the consequence of functional or anatomical asplenia, and the relative frequency of this affection after splenectomy following trauma confirms this observation. Lack of a splenic filter and a deficiency in the phagocytic system are the reasons for microbial proliferation in the blood, and the lymphocytic defence mechanisms are inactive because of the absence of any focus of infection.

Two cancer-prone families are reported. In the first one four first-degree relatives over three generations presented a colonic carcinoma, three of them at a proximal anatomic site. For grandmother and father these occurred at ages of 43 and 54 years, respectively, for the son and the daughter at ages of 26 and 22. The grandmother underwent a palliative ileotransversostomy, surgery typically associated with a bad prognosis, but she survived for forty years that initial neoplasm and had an hysterectomy with oophorectomy at age of 63 for endometrial malignancy; she deceased at age of 83 a few days after surgical treatment of tumoral small bowel obstruction: pathological evaluation disclosed a fourth cancer on first duodenum. The second kindred shows over three generations 11 cancer-affected individuals, three of them with double primary cancer: breast and sigmoid, breast and endometrium, colon and Hodgkin disease. This pedigree includes 8 colorectal neoplasms occurring at 47 years of mean age. These findings are consistent with the cancer-family syndrome and hereditary non-polyposis colon cancer described by Henry Lynch upon four criteria: high frequency of adenocarcinoma, excess of multiple primary malignancies, synchronous or metachronous, early age of onset of cancer and autosomal dominant inheritance. Moreover the hereditary colon cancer is usually localised to the proximal colon, not associated to polyposis coli and allows a prolonged survival. Up to day such families are only identified by pedigree data. The identification of a cancer-prone family calls for an active follow-up of relatives putatively at risk starting at the age of 15 to 20.