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Abstract Background The aim of the present work was to assess i) ex vivo activity of pyronaridine (PND) and piperaquine (PPQ), as new components of artemisinin-based combination therapy (ACT), to define susceptibility baseline, ii) their activities compared to other partner drugs, namely monodesethylamodiaquine (MDAQ), lumefantrine (LMF), mefloquine (MQ), artesunate (AS) and dihydroartemisinin (DHA) against 181 Plasmodium falciparum isolates from African countries, India and Thailand, and iii) in vitro cross-resistance with other quinoline drugs, chloroquine (CQ) or quinine (QN). Methods The susceptibility of the 181 P. falciparum isolates to the nine anti-malarial drugs was assessed using the standard 42-hours 3H-hypoxanthine uptake inhibition method. Results The IC50 values for PND ranged from 0.55 to 80.0 nM (geometric mean = 19.9 nM) and from 11.8 to 217.3 nM for PPQ (geometric mean = 66.8 nM). A significant positive correlation was shown between responses to PPQ and PND responses (rho = 0.46) and between PPQ and MDAQ (rho = 0.30). No significant correlation was shown between PPQ IC50 and responses to other anti-malarial drugs. A significant positive correlation was shown between responses to PND and MDAQ (rho = 0.37), PND and LMF (rho = 0.28), PND and QN (rho = 0.24), PND and AS (rho = 0.19), PND and DHA (rho = 0.18) and PND and CQ (rho = 0.16). All these coefficients of correlation are too low to suggest cross-resistance between PPQ or PND and the other drugs. Conclusions In this study, the excellent anti-malarial activity of PPQ and PND was confirmed. The absence of cross-resistance with quinolines and artemisinin derivatives is consistent with the efficacy of the combinations of PPQ and DHA or PND and AS in areas where parasites are resistant to conventional anti-malarial drugs.

Background: Chloroquine (CQ) was the main malaria therapy worldwide from the 1940s until the 1990s. Following the emergence of CQ-resistant Plasmodium falciparum, most African countries discontinued the use of CQ, and now promote artemisinin-based combination therapy as the first-line treatment. This change was generally initiated during the last decade in West and Central Africa. The aim of this study is to describe the changes in CQ susceptibility in this African region, using travellers returning from this region as a sentinel system., Methods: The study was conducted by the Malaria National Reference Centre, France. The database collated the pfcrtK76T molecular marker for CQ susceptibility and the in vitro response to CQ of parasites from travellers' isolates returning from Senegal, Mali, Ivory Coast or Cameroon. As a proxy of drug pressure, data regarding CQ intake in febrile children were collated for the study period. Logistic regression models were used to detect trends in the proportions of CQ resistant isolates., Results: A total of 2874 parasite isolates were genotyped between 2000-2011. The prevalence of the pfcrt76T mutant genotype significantly decreased for Senegal (from 78% to 47%), Ivory Coast (from 63% to 37%), Cameroon (from 90% to 59%) and remained stable for Mali. The geometric mean of the 50% inhibitory concentration (IC50) of CQ in vitro susceptibility and the proportion of resistant isolates (defining resistance as an IC50 value > 100 nM) significantly decreased for Senegal (from 86 nM (59%) to 39 nM (25%)), Mali (from 84 nM (50%) to 51 nM (31%)), Ivory Coast (from 75 nM (59%) to 29 nM (16%)) and Cameroon (from 181 nM (75%) to 51 nM (37%)). Both analyses (molecular and in vitro susceptibility) were performed for the 2004-2011 period, after the four countries had officially discontinued CQ and showed an accelerated decline of the resistant isolates for the four countries. Meanwhile, CQ use among children significantly deceased in this region (fixed effects slope = -0.3, p < 10-3)., Conclusions: An increase in CQ susceptibility following official withdrawal of the drug was observed in travellers returning from West and Central African countries. The same trends were observed for molecular and in vitro analysis between 2004-2011 and they correlated to the decrease of the drug pressure.

Acute Plasmodium falciparum malaria occurred during summer 1993 in two inhabitants living close to Marseille harbour. History of blood transfusion and travel outside France were excluded as was also discarded airport malaria. Entomological investigations confirmed the absence of Anopheles breeding sites in the port area. An hypothesis is a vectorial transmission following introduction of one or several anopheles arrived on a ship coming from tropical Africa. During this season, the weather conditions were favourable to the survival of anopheles and the completion of P. falciparum sporogonic cycle. Physicians were advised to take into consideration malaria in the differential diagnosis of fever from unknown origin in any patient working or living inside or around the harbour area regardless history of previous travel in malaria endemic region.

Since the occurrence of the chloroquino-resistance, chemoprophylaxis for all is not anymore the sound principle to malaria prophylaxis for travellers and expatriates. Protection against malaria has now to be based on comprehensive actions (chemoprophylaxis, control of infecting bites, treatment of malaria cases as soon as first symptom occur), they have to be combined, as a whole or not, according to the area, the duration and the type of tropical stay, and even sometimes according to some parameters peculiar to an individual. The development of concepts concerning the epidemiology of human malaria and the use of antimalarial drugs, either as protective or curative, lead more and more to the necessity for any traveller or expatriate to take medical advice from a specialized physician.

An outbreak of trichinosis following meals in a rural area of Provence is reported. The epidemiologic parameters reconstitute the contamination cycle (man-pig: fox-rat) which indicated indisputably the diagnosis, the appropriate therapy, and also evidenced a rural zoonosis of trichinosis in Provence. The clinical picture among twenty-one people included morbilliform rash in 38% of cases and an enanthema in 24% of cases, uncommon findings, with respect to their frequency, and the other usual signs. Early laboratory diagnosis was made possible by blood analysis for hypereosinophilia and immunoassay (ELISA) for antigen-specific IgE. Treatment with benzimidazoles was quite effective.

This paper is a survey of possible reservoir hosts of Plasmodium among donors of the blood transfusion Center of Marseille, by IFA test with P. falciparum and P. cynomolgi bastianellii antigens. It was found 15,7 per cent of positivity among 644 sera carefully selected during 6 months. Nord Africa and West Africa were the most dangerous countries, the former because of the great number of donors (332 of 744), the later because of the high rate (15,8 per cent) of positivity. The incidence of the say (frequency and long time) in infested countries and the interval from tate (15,8 per cent) of positivity. The incidence of the stay (frequency and long time) in infested countries and the interval from the last infestation possibility to the IFA test are very important factors. A prevention scheme is proposed: The donors staying during a very long time in infested countries will generally be used only for preparing plasma fractions by ethanol precipitations. For the others donors the blood will be used for preparing whole blood, red cells, fresh or frozen plasma, platelets and leucocytes preparation, in which a few parasites can be present, inly if a IFA test is negative 4 months after their coming back in our country.

3 cases of inappropriate vasopressin secretion during one case of anaplastic carcinoma of the lung, one case of carcinoma of the prostate with bony metastases and one case of acute intermittent porphyria are presented. The plasma levels of vasopressin, measured by radioimmunoassay were high. Treatment with demeclocycline was attempted in one case. The clearance of free water was positive but the treatment was poorly tolerated by the digestive tract.

The authors recorded clinical histories and tested serum for the presence of malaria fluorescent antibodies in 160 healthy Europeans who had been living for more than 4 weeks in West or Central Africa. Malaria or fever of unknown origin occurred in 37 of 50 subjects who were careless about taking prophylactic drugs while abroad. Out of 110 people regularly taking suppressive amino-4-quinoline therapy, 21 had presented febrile attacks but serological tests were only positive in 8 cases. Positive serological reactions at low titers were obtained in 3 subjects with no history of past infection and who had faithfully taken suppressive medications. These results confirm the value of the malaria immunofluorescence test for the detection of occult malaria in blood donors outside endemic areas, and explain the necessity to consider previous regular, irregular or absent chemoprophylaxis before interpreting the serological results of a febrile patient returning from overseas.

A case report of trypanosomiasis (T. rhodesiense), observed in a French tourist is described. The clinical picture associated a cytolytic hepatic jaundice, a thrombopenia with hemorrhagic manifestations, a renal insufficiency and secondarily a neutropenia with anemia. Moderate and transitory anomalies in the cerebrospinal fluid were noted. The cure was effectuated by administration of pentamidine.