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Human babesiosis in Europe is caused by multiple zoonotic species. We describe a case in a splenectomized patient, in which a routine Babesia divergens PCR result was negative. A universal Babesia spp. PCR yielded a positive result and enabled classification of the parasite into the less-described Babesia crassa–like complex.

Background Cryptosporidium sp. are common intracellular parasites responsible of severe diarrhea in T-cell-immunocompromised patients. We report the first case of a woman who contracted cryptosporidiosis after treatment with fingolimod, a drug labeled for multiple sclerosis and responsible for marked lymphopenia. Case presentation A 60-year-old woman was admitted for abdominal pain diarrhea and fever. The patient suffered from multiple sclerosis and had been treated with fingolimod from august 2017 to september 2018 time of occurrence of the first digestive symptoms. Stool culture was negative but parasitological examination was positive for Cryptosporidium sp. Blood biological examination profound lymphopenia of 240/mm3 [17 CD4/mm3 (7%) and 32 CD8/mm3 (14%)]. Fingolimod was stopped, and the patient was put on nitazoxanide 500 mg bid for 7 days. The diarrhea resolved and no relapse was observed. Six other cases were found in the Pharmacovigilance database. Conclusion Physicians should be aware of this association and screen for Cryptosporidium in cases of diarrhea in patients treated with fingolimod. Patients should be aware of this risk and advise to take appropriate measures to avoid such contamination.

BackgroundUndernutrition and schistosomiasis are public health problems and often occur in low and middle-income countries. Protein undernutrition can alter the host-parasite environment system and aggravate the course of schistosomiasis. This study aimed to assess the impact of a protein-deficient diet on the efficacy of praziquantel.Methodology/principal findingsThirty-day-old mice were fed with a protein-deficient diet, and 40 days later, they were individually infected with fiftySchistosoma mansonicercariae. A 28-day-treatment with praziquantel at 100 mg/kg for five consecutive days followed by distilled water begins at the 36thday post-infection. Mice were sacrificed on the 64thday post-infection. We determined the parasitological burden, liver and intestine histomorphometry, liver injury, and immunomodulation parameters. Praziquantel treatment of infected mice fed with a standard diet (IN-PZQ) resulted in a significant reduction of worm and egg burdens and a normalization of iron and calcium levels. The therapy also improved schistosomiasis-induced hepatopathy and oxidative stress. The anti-inflammatory and immunomodulatory activities of praziquantel were also significant in these mice. When infected mice receiving the protein-deficient diet were treated with praziquantel (ILP-PZQ), the body weight loss and hepatomegaly were not alleviated, and the worm and liver egg burdens were significantly higher than those of IN-PZQ mice (P< 0.001). The treatment did not reduce the increased activities of ALT and γ-GGT, the high malondialdehyde concentration, and the liver granuloma volume. The iron and calcium levels were not ameliorated and differed from those of IN-PZQ mice (P< 0.001 andP< 0.05). Moreover, in these mice, praziquantel treatment did not reverse the high level of IL-5 and the low mRNA expression of CCL3/MIP-1α and CXCL-10/IP-10 induced byS. mansoniinfection.Conclusion/significanceThese results demonstrated that a protein-deficient diet reduced the schistosomicidal, antioxidant, anti-inflammatory, and immunomodulatory activities of praziquantel.Authors summaryAlmost 90% of people requiring schistosomiasis preventive chemotherapy in 2018 lived in sub-Saharan Africa. Besides, 205.3 million children under five years suffer and die of undernutrition in low- and middle-income countries. The physiopathology of schistosomiasis mansoni involves liver damage, oxidative stress, and perturbation of the immune response. These disturbances are intensified by undernutrition. Praziquantel is used to treat schistosomiasis, but its efficacy on the comorbidity ofS. mansoniinfection and undernutrition has not been investigated. We conducted this study to assess the effectiveness of praziquantel onS. mansoniinfection in mice fed with a protein-deficient diet. We recorded growth retardation, hepatomegaly, and high worm and egg burdens in mice fed with a protein-deficient diet and treated with PZQ. Moreover, the treatment did not reverse the liver function injury, oxidative stress, high iron level, and low calcium level. The proinflammatory cytokine IL-5 was still high, and the gene expression of some macrophage-associated chemokines was reduced. Therefore, this study demonstrated that in a murine model of a protein-deficient diet, the efficacy of praziquantel onS. mansoniinfection was reduced. It also underlines the importance of targeting protein deficiency and malnutrition in populations living in schistosomiasis endemic areas for efficient disease control.

Interactions between the prokaryotic microbiome and eukaryotic parasites in the vertebrate gut may affect overall host health and disease. While intertropical areas exhibit a high rate of parasites carriers, such interactions are understudied in these populations. Our objectives were to (1) describe the gut microbiome of individuals living in Madagascar, (2) identify potential associations between bacterial taxa and parasites colonizing the digestive tract and (3) highlight main determinants of the gut microbiota composition in this developing country. Metadata (socioeconomic, diet, clinical) and fecal samples were collected from 219 volunteers from North-West Madagascar (Mahajanga). Fecal microbiome was assessed through 16S rRNA gene sequencing and metabolomics, and related to dietary habits and parasites carriage. We highlight important Malagasy gut microbiome peculiarities. Out of three detected enterotypes, only one is similar to that observed in Westernized countries (Ruminococcus-driven). Functions associated with the two others (Clostridium sensu stricto-driven and Escherichia/Shigella-driven) are mostly directed toward amino acids biosynthesis and degradation, respectively. Diet and protozoan carriage were the main drivers of microbiota composition. High protozoan carriage was associated with higher diversity, richness and microbial functionalities. The gut microbiome of Malagasy strongly differs from that of Westernized countries. Asymptomatic protozoan carriage and dietary habits are the external factors with the deepest impact on gut microbiome. Further studies are needed to understand whether gut microbial richness constitute a predilection niche for protozoans colonization, due to their gazing features, or whether the parasites themselves induce a higher bacterial richness.

In endemic areas, one-third of Loa loa-infected subjects do not present microfilaremia, defining ‘occult loiasis’. Here, we report the diagnostic difficulties we faced in such a case and review the literature to propose a diagnostic algorithm based, particularly, on the use of molecular tools for confirmation of loiasis.

Diphyllobothriasis is a parasitic fish-borne disease caused by tapeworms of the genus Dibothriocephalus (=Diphyllobothrium). The majority of reported cases are attributed to D. latum, based on morphological identification of eggs or proglottids. However, numerous reports in recent years suggested that other Dibothriocephalus species could be involved in human infections, mainly after consumption of salmonid fish. Among these, D. nihonkaiense has been predominantly reported from Eastern Asia and probably underestimated in the rest of the world. We report here a clinical case of D. nihonkaiense in a French patient (without history of travel abroad) after consumption of salmon. Suspected on morphological characteristics, the final identification of D. nihonkaiense was performed using molecular methods by sequencing nad1, cox1, and 5.8S rRNA (containing ITS1 and 2) genes sequences. The patient was successfully treated by a single dose of praziquantel. Reports of diphyllobothriasis due to D. nihonkaiense are rare outside Asia, but worldwide demand of seafood could lead to the globalization of cases and reflect the need to monitor the distribution of Dibothriocephalus species. Thus, clinical parasitologists should be aware of this risk and able to raise the possibility of infections by non-endemic Dibothriocephalus species in order to use the proper molecular tools.

BackgroundUndernutrition and schistosomiasis are public health problems and often occur in low and middle-income countries. Protein undernutrition can alter the host-parasite environment system and aggravate the course of schistosomiasis. This study aimed to assess the impact of a low-protein diet on the efficacy of praziquantel.Methodology/Principal findingsThirty-day-old mice were fed with a low-protein diet, and 40 days later, they were individually infected with fiftySchistosoma mansonicercariae. A 28-day-treatment with praziquantel at 100 mg/kg for five consecutive days followed by distilled water begins on the 36thday post-infection. Mice were sacrificed on the 64thday post-infection. We determined the parasitological burden, liver and intestine histomorphometry, liver injury, and immunomodulation parameters. Praziquantel treatment of infected mice fed with a standard diet (IN-PZQ) resulted in a significant reduction of worm and egg burdens and a normalization of iron and calcium levels. The therapy also improved schistosomiasis-induced hepatopathy and oxidative stress. The anti-inflammatory and immunomodulatory activities of praziquantel were also significant in these mice. When infected mice receiving the low-protein diet were treated with praziquantel (ILP-PZQ), the body weight loss and hepatomegaly were not alleviated, and the worm and liver egg burdens were significantly higher than those of IN-PZQ mice (P< 0.001). The treatment did not reduce the increased activities of ALT and γ-GGT, the high malondialdehyde concentration, and the liver granuloma volume. The iron and calcium levels were not ameliorated and differed from those of IN-PZQ mice (P< 0.001 andP< 0.05). Moreover, in these mice, praziquantel treatment did not reverse the high level of IL-5 and the low mRNA expression of CCL3/MIP-1α and CXCL-10/IP-10 induced byS.mansoniinfection.Conclusion/SignificanceThese results demonstrated that a low-protein diet reduced the schistosomicidal, antioxidant, anti-inflammatory, and immunomodulatory activities of praziquantel.

L'objectif de cette étude est de voir si, à long terme et à court terme, l'ouverture commerciale stimule la croissance économique en mettant l'accent sur l'Afrique sur la période 1999 à 2019 pour 35 pays africains (20 pays francophones et 15 pays anglophones). Nous utilisons des tests de cointégration de panel et un modèle d’estimation du Pooled Mean Group (PMG) de Pesaran, Shin & Smith (1999) en utilisant trois mesures d’ouverture commerciale (COM, EXP et IMP) pour explorer la relation entre la croissance économique et l’ouverture commerciale. Les résultats montrent des preuves d'une relation de cointégration entre les variables d'intérêt et révèlent que l'ouverture commerciale peut avoir un impact favorable sur la croissance à long terme. Ils montrent que les avantages du commerce ne sont pas automatiques. Les effets de l'ouverture des échanges sur la croissance peuvent différer selon le niveau d'ouverture des échanges. Les résultats des estimations révèlent un lien positif à long terme entre les variables d’ouverture du Modèle 1 et Modèle 2 et la croissance économique et un lien négatif pour la variable d’ouverture du Modèle 3 à long terme. À court terme les variables d’ouverture révèlent par contre un lien négatif avec la croissance économique dans tous les modèles. Nos résultats suggèrent que l'ouverture commerciale doit s'accompagner de politiques complémentaires visant à améliorer l'accessibilité aux investissements et le capital humain qui peuvent être considérés comme une source de commerce de haute technologie et de savoir-faire technologique qui nous permet de consolider les industries à forte intensité de hautes technologies et les capacités d'innovation des entreprises nationales compétitives afin d'améliorer les performances du commerce international et, par conséquent, la croissance économique. Les pays africains devraient améliorer la qualité des institutions et la capacité de s'adapter et d'acquérir de nouvelles compétences. La mondialisation des échanges ne doit donc pas être considérée isolément. Des politiques supplémentaires sont nécessaires pour renforcer son impact sur la croissance économique.

L'objectif de cette étude est de voir si, à long terme et à court terme, l'ouverture commerciale stimule la croissance économique en mettant l'accent sur l'Afrique sur la période 1999 à 2019 pour 35 pays africains (20 pays francophones et 15 pays anglophones). Nous utilisons des tests de cointégration de panel et un modèle d’estimation du Pooled Mean Group (PMG) de Pesaran, Shin & Smith (1999) en utilisant trois mesures d’ouverture commerciale (COM, EXP et IMP) pour explorer la relation entre la croissance économique et l’ouverture commerciale. Les résultats montrent des preuves d'une relation de cointégration entre les variables d'intérêt et révèlent que l'ouverture commerciale peut avoir un impact favorable sur la croissance à long terme. Ils montrent que les avantages du commerce ne sont pas automatiques. Les effets de l'ouverture des échanges sur la croissance peuvent différer selon le niveau d'ouverture des échanges. Les résultats des estimations révèlent un lien positif à long terme entre les variables d’ouverture du Modèle 1 et Modèle 2 et la croissance économique et un lien négatif pour la variable d’ouverture du Modèle 3 à long terme. À court terme les variables d’ouverture révèlent par contre un lien négatif avec la croissance économique dans tous les modèles. Nos résultats suggèrent que l'ouverture commerciale doit s'accompagner de politiques complémentaires visant à améliorer l'accessibilité aux investissements et le capital humain qui peuvent être considérés comme une source de commerce de haute technologie et de savoir-faire technologique qui nous permet de consolider les industries à forte intensité de hautes technologies et les capacités d'innovation des entreprises nationales compétitives afin d'améliorer les performances du commerce international et, par conséquent, la croissance économique. Les pays africains devraient améliorer la qualité des institutions et la capacité de s'adapter et d'acquérir de nouvelles compétences. La mondialisation des échanges ne doit donc pas être considérée isolément. Des politiques supplémentaires sont nécessaires pour renforcer son impact sur la croissance économique.

Ancylostoma ceylanicum is the second most common hookworm species infecting humans in Southeast Asia and Oceania. We performed a 3 years multicenter study to assess its frequency in hookworm infecting patients returning from tropical areas to France and found that A. ceylanicum was the second most frequent hookworm species isolated.

The discovery of exogenous particles in the broncho-pulmonary tree is frequently described in forensic literature, especially in lung samples, in the context of aspirated gastric content during the death agony period or during resuscitation. We report an original observation of a multi-visceral dispersion of exogenous particles detected, in an 8-year-old boy, who allegedly fell from a 2-m high brick-wall. The autopsy found major liver fracture and diaphragm rupture with massive internal hemorrhage without gastric wall rupture. The histological analyses have identified round to oval bodies in the lung bronchi, alveoli, and, rarely, in vascular sections, and also on the surface of several samples. These particles stained strongly pink by the periodic acid Schiff method, evoking dried vegetables. Two hypotheses were invoked: aspirated vegetable particles into the bronchial tree or parasitic infection, like pinworm larva. In order to characterize the nature of these particles, different legumes were cooked, embedded in paraffin wax, and examined under light microscope. Simultaneously, morphological comparison between the gastric content and pinworm larva and lentils was made and a PCR analysis was performed on gastric fluid sample. The DNA sequencing showed a Fabaceae plant family, Lens culinaris. The possibility of a hematogenous dissemination of the starch grains during a perimortem aspiration of gastric content seems unlikely, and a contamination from the gastric content of the organs samples during the autopsy or the pathologic macroscopic and microscopic processes seems to be the principal hypothesis. The formal identification of such particles is important to avoid the misdiagnosis of a potential parasitic infection. The risk of confusion can be detrimental in some circumstances.

Fleas are ectoparasites of various animals, including Homo sapiens Linnaeus, 1758 (Primates: Hominidae). Among the species relevant to the human health field, either due to their dermatopathological potential or because of their role as vectors of microorganisms responsible for infectious diseases, such as plague or murine typhus, are the human flea, oriental rat flea, closely related cat and dog fleas, and chigoe flea. However, other species can accidentally infest humans. We have herein reported two unusual cases of humans infested and bitten by Archaeopsylla erinacei, the hedgehog flea. This species has been identified using stereomicroscopy, on the base of key characteristics. Furthermore, a brief literature review has revealed that hedgehog fleas could carry human-infectious agents, such as Rickettsia felis Bouyer et al. 2001 (Rickettsiales: Rickettsiaceae) or Bartonella henselae Regnery et al.1992 (Rhizobiales: Bartonellaceae). Using molecular biology, we thus tested nine A. erinacei specimens taken from these patients, for several bacteria species commonly associated with hematophagous arthropods, implicated in human pathology. However, all our samples were proven negative. The role of A. erinacei in human epidemiology has never been evaluated to date. This report sought to remind us that these fleas can be accidental parasites in humans. In addition, recent findings pertaining to bacteria of medical interest that are present in these insects should be brought to the fore, given that the question of their role as vectors in human infections remains unanswered and deserves further investigation.

The burden of nosocomial Pneumocystis infections in transplantation units in France was evaluated through a retrospective survey. Over 12 years, 16 outbreaks occurred, including 13 among renal transplant recipients (RTRs). We performed Pneumocystis jirovecii genotyping in 5 outbreaks, which suggested that specific strains may have been selected by RTRs.

International audience; Microsporidia cause opportunistic infections in highly immunodeficient individuals. Few studies on the epidemiology of these infections have been conducted in France. Between 2014 and 2016, we undertook a study to estimate the prevalence and circulating genotypes of this fungus-related microorganism among the population of Strasbourg University Hospital. Samples were collected from hospitalized patients and analyzed using microscopy and molecular assays. Strains from positive subjects were sequenced for genotyping. Only 7/661 patients (1.1%) were positive for microsporidia, and the only species identified was Enterocytozoon bieneusi. Two patients presented immunodeficiency linked to AIDS, and five transplant recipients presented immunodeficiency linked to immunosuppressive therapies. Only five patients received specific antimicrosporidial treatment, but clinical outcomes were good in all cases. We identified four genotypes: A and D in patients with AIDS, and C and S9 in transplant recipients. To date, genotype S9 has been described only once. This genotype is similar to those found in farm animals in China. Because some of these animals have been introduced to Central Europe, we postulate that this genotype might be of Asian origin. Thus, genotyping microsporidial strains may be of epidemiological and clinical interest to identify potential outbreak sources depending on the infecting strains.

International audience; Background: Several cases of infections due to Echinococcus multilocularis, Taenia martis and Taenia crassiceps were recently described in various species of captive non-human primates (NHPs) harbored in the Strasbourg Primate Center (SPC). Furthermore, one of the first cases of human cysticercosis due to T. martis was described in the Strasbourg region. These data suggest the existence of zoonotic cycles of tapeworm infections in the direct environment of the SPC. The aim of our study was to assess the prevalence of larval cestode infections among intermediate and definitive hosts in the close neighborhood of the center. We analyzed carnivore mammal fecal samples as well as rodent carcasses, collected inside or near the SPC, using PCR. Furthermore, we performed serology for Echinococcus spp. and Taenia spp. on NHP sera. Results: We found that 14.5% (95% CI [8.6; 20.4]) of 138 carnivore feces were positive for E. multilocularis-DNA, as well as 25% (95% CI [5.5; 57.2]) of 12 rodent carcasses , and 5.1% (95% CI [1.4; 8.7]) for T. martis or T. crassiceps. Of all NHPs tested, 10.1% (95% CI [3.8; 16.4]) were seropositive for Echinococcus spp. and 8.2% (95% CI [1.3; 15.1]) for Taenia spp. Conclusions: Our data support the existence of zoonotic cycles of larval cestode infections in the direct environment of the primatology center affecting NHPs harbored in the SPC, potentially threatening the human population living in this area. Since this zoonotic risk is borne by local wildlife, and given the severity of these infections, it seems necessary to put in place measures to protect captive NHPs, and further studies to better assess the risk to human populations. Ré sumé-Des cestodoses chez des primates non humains suggèrent l'existence de cycles zoonotiques dans la région du centre de primatologie de Strasbourg. Contexte : Plusieurs cas de cestodoses larvaires dues à Echinococcus multilocularis, Taenia martis et T. crassiceps ont été récemment décrits chez des primates non-humains (PNH) captifs appartenant à diverses espèces, hébergés au Centre de Primatologie de Strasbourg (CdP). De plus, un des premiers cas humains de cysticercose due à T. martis a été décrit dans la région de Strasbourg. Ces données suggèrent l'émergence d'un nouveau foyer parasitaire dans l'environnement direct du CdP. Le but de notre étude était d'évaluer la prévalence des cestodoses larvaires chez les hôtes intermédiaires et définitifs de ces parasites dans le proche voisinage du CdP. Nous avons analysé des échantillons de selles de mammifères carnivores, ainsi que des carcasses de rongeurs, collectés à l'intérieur ou aux alentours du CdP. De plus, nous avons réalisé des sérologies pour Echinococcus spp. et Taenia spp. sur des sérums de PNH. Résultats : Nous avons trouvé que 14,5 % (IC95 % [8,6 ; 20,4]) des 138 selles de carnivores étaient positives pour E. multilocularis, ainsi que 25 % (IC95 % [5,5 ; 57,2]) des 12 carcasses de rongeur, et 5,1 % (IC95 % [1,4 ; 8,7]) pour T. martis ou T. crassiceps. De tous les PNH testés, 10,1 % (IC95 % [3,8 ; 16,4]) étaient positifs pour Echinococcus spp. et 8,2 % (IC95 % [1,3 ; 15,1]) pour Taenia spp. Conclusions : Nos données suggèrent l'existence de cycles zoonotiques de cestodoses larvaires dans l'environnement direct du centre de primatologie, affectant les PNH This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. OPEN ACCESS RESEARCH ARTICLE hébergés au CdP et menaçant potentiellement les populations humaines vivant dans cette zone. Ce risque zoonotique étant porté par la faune sauvage locale, et comptes tenus de la sévérité de ces infections, il semble nécessaire de mettre en place des mesures afin de protéger les PNH captifs, et de plus larges études afin d'évaluer le risque pour les populations humaines environnantes.

Introduction Pneumocystis jirovecii est un champignon parasite, pathogene opportuniste responsable de pneumopathies severes chez les patients immunodeprimes. L’avenement des nouveaux traitements immunosuppresseurs et des chimiotherapies pour les patients presentant des hemopathies malignes, des transplantations d’organes solides ou des maladies auto-immunes nous a fait nous interroger sur les facteurs de risques cliniques et medicamenteux associes a la mortalite des patients presentant un prelevement positif a P. jirovecii. Materiels et methodes Nous avons realise une etude retrospective unicentrique sur 3 ans de 2016 a 2018 inclus et analyse les dossiers de tous les patients ayant presente un prelevement positif pour P. jirovecii sur cette periode afin de determiner les facteurs predictifs de survie a 12 semaines (S12) du diagnostic biologique. Resultats Nous avons analyse 188 dossiers de patients, dont seulement 19 (10,1 %) ne presentaient pas d’immunodepression connue. Parmi les autres, 83 (44,1 %) etaient sous corticoides, 52 (27,7 %) sous traitement anti-metabolites tel que le methotrexate, 49 (26,1 %) etaient atteints d’hemopathie, 43 (22,9 %) de maladie auto-immune, 31 (16,5 %) de tumeur solide ou avaient un antecedent de transplantation d’organe solide et 15 (8 %) vivaient avec le VIH. De ces patients, 173 (92,0 %) presentaient une symptomatologie respiratoire et 115 (61,2 %) une imagerie compatible avec une pneumocystose. Seuls 105 patients (55,9 %) ont ete traites, majoritairement par TMP-SMX (88 soit 83,8 %). Le statut vital a S12 etait connu pour 165 patients, dont 113 (68,5 %) etaient toujours vivants. En analyse univariee, les facteurs lies a une surmortalite a S12 etaient l’âge et le score de Charlson (correlation positive) au moment du diagnostic biologique, tandis que l’antecedent de greffe d’organe solide etait predictif de survie a S12. En analyse multivariee, seul ce dernier element etait significatif. L’administration, ou non, d’un traitement specifique de la pneumocystose ne modifiait pas significativement la mortalite a S12. Le score de Charlson representait un bon modele predictif de la mortalite a S12 chez les patients ayant presente un prelevement respiratoire positif a P. jirovecii. Conclusion Malgre la detection de P. jirovecii chez tous les sujets, associee dans une grande majorite de cas a une symptomatologie respiratoire, tous ne beneficiaient pas d’un traitement specifique de la pneumocystose. Cependant, ce traitement ne changeait pas la probabilite de survie a S12, qui etait faible, et le seul element predictif de survie etait un antecedent de transplantation d’organe solide. Le fait que le score de Charlson soit un bon modele predictif de la survie a S12 de la detection de P. jirovecii montre bien que la gravite de l’infection est toujours liee au terrain sur lequel elle survient. Le developpement de therapies plus ciblees, visant a remplacer les anciennes molecules immunosuppressives, pourrait constituer une avancee dans la prevention de cette infection.

International audience; INTRODUCTION: Intestinal parasitic infections are a major public health problem in inter-tropical areas. The aim of our study was to describe the situation in Mahajanga, Madagascar with a particular focus on two protozoa, Dientamoeba fragilis and Blastocystis sp.METHODS: This was a prospective study from February to June 2015. Stool samples from symptomatic hospitalized patients and asymptomatic volunteers were submitted to microscopy and molecular assays in order to detect parasites.RESULTS: A wide panel of intestinal parasites were identified among the 265 included subjects, protozoa being the most prevalent with 72.8% whereas the prevalence of helminths and microsporidia was of 7.9% and 4.5%, respectively. Blastocystis sp. was the most prevalent protozoa (64.5% of the entire cohort) followed by various amoebas (35.5%) and flagellates (27,5%). We only detected subtypes 1, 2 and 3 of Blastocystis sp. Among the patients positive for D. fragilis (9.4%), 23 carried genotype 1 and 1 genotype 2. For the first time, we detected in 4 human stools the DNA of a recently described protozoon, Simplicimonas similis. Interestingly, subjects living in urban areas harbored significantly more different parasitic species than subjects living in rural areas with a correlation between sanitary level of neighborhood and protozoan infection. However, there was no difference in prevalence of digestive symptoms between parasite-free and parasite-infected subjects, except for Giardia intestinalis which had more symptomatic carriers.DISCUSSION: Our study reveals a high overall parasite prevalence, similar to what had been found in 2003 in the same city and to other prevalence studies conducted in Africa. The poor access of the population to sanitary infrastructures may explain this result. Data from our study provide valuable key for sanitation programs and prevention of fecal-related infectious diseases.

Purpose To assess the amoebicidal effect of titanium dioxide (TiO2)/UV-A combination against Acanthamoeba sp trophozoites and cysts. Methods The amoebicidal effect of the TiO2/UV-A combination was tested on trophozoites and cysts of clinical isolates of Acanthamoeba hatchetti and Acanthamoeba sp genotype T4, obtained from two severe cases of ulcerative keratitis. Samples of cultured Acanthamoeba were transferred to a 96-well plate. We tested the effect of sterile water (blank control), TiO2 alone, UV-A alone, TiO2 and additional UV-A exposure, chlorhexidine 0.02% alone, chlorhexidine 0.02% and TiO2, chlorhexidine and UV-A, chlorhexidine 0.02% and TiO2, and additional UV-A exposure. Cell viability assessment was done using the trypan blue dye exclusion method. Results The combination of TiO2 with UV-A demonstrated antitrophozoite and anticyst activity (P < 0.05). This in vitro study showed a synergistic effect of the association of chlorhexidine with TiO2 and UV-A on cysts (P < 0.001). Conclusions Given the in vitro synergistic effectiveness of the association of chlorhexidine with TiO2 and UV-A against cysts, the treatment of Acanthamoeba keratitis could be improved by this new therapeutic approach.