Medecine tropicale et sante internationale最新文献

This article recalls the conditions under which the first Nobel Prizes were awarded. The scientific personalities who nominated Alphonse Laveran for the prize from 1901 to 1907 are recalled, among them Ronald Ross, winner in 1902. In 1907, Karl Axel Hampus Mörner submitted Alphonse Laveran for the prize. He was then the rector of the Karolinska Institutet, as well as the chairman of the Nobel Committee and the Nobel Assembly, and had never before expressed an interest in one scientist more than another. The previous year, the Nobel Assembly had for the first time awarded the prize for physiology or medicine to two laureates, Camillo Golgi and Santiago Ramón y Cajal "in recognition of their work on the structure of the nervous system". In 1907, the numerous, repeated and simultaneous nominations of Élie Metchnikoff and Paul Ehrlich were probably the subject of an important debate, which finally turned out in favour of Alphonse Laveran. We explain why we think the choice of the president prevailed. In 1908, when Laveran became one of the nominators of the prize, his main competitors of 1907 were finally crowned simultaneously "in recognition of their work on immunity".The long delay between the discovery of the malarial parasite (1880) and the award of the prize "in recognition of his work on the role played by protozoa in the appearance of diseases" is put into perspective and illustrates what will almost always be the practice, contrary to Alfred Nobel's rule of awarding the prize within a year after the discovery. The particular circumstances of the award of the prize in 1907 are described.The donation that Alphonse Laveran made on December 22nd 1907 to the Pasteur Institute out of the amount of his prize was 100,000 francs, i.e. a little more than half of the 190,000 francs grant received from the Nobel Committee. Its value, in terms of purchasing power in euros 2021, is estimated at over 400,000 euros. The use made of it by the Pasteur Institute is clearly shown in the minutes of its Board of Directors in 1908, as having been mainly devoted to the fitting out and equipment of the Laboratory of Tropical Diseases that Laveran was calling for in the buildings recently purchased on Rue Falguière (Paris); the donation was not used for the construction of new buildings.

In 1880, Laveran observed the causative agent of malaria. As early as 1884, he considered that mosquitoes could be responsible for the transmission of haematozoa, a hypothesis which resulted from the observation and reflection of an informed hygienist. But, as Laveran himself said, "the opinion that I defended was considered by most observers to be highly unlikely".Nearly 15 years after the discovery of the haematozoan, the elucidation of the mechanism of transmission still proved difficult to establish. A link with the existence of swamps had been established a long time before, but the true mode of transmission remained a mystery until the end of the 19th century. The implication, by Manson in 1877, of mosquitoes in the cycle of the Bancroftian filaria, then other observations of the same order, ended up attracting the attention of malariologists. Laveran himself was quickly convinced of the role of mosquitoes in carrying out the natural cycle and propagating Plasmodium, but this theory had as many detractors as supporters.In 1897, Ross showed the presence of oocysts on the stomach of mosquitoes previously gorged on a malaria patient, then in 1898, of sporozoites of bird plasmodia in mosquitoes. He was convinced that, through their bite, these insects were responsible for the transmission of human malaria agents, without being able to prove it. The results obtained by Ross were immediately confirmed in Italy by Grassi and his collaborators who, in November 1898, described the stages of Plasmodium in man and, through various experiments carried out in collaboration with British researchers, showed the role of Anopheles, a result far from being accepted by all. Skepticism persisted for a long time.An excellent protozoologist, Laveran was not an entomologist. He was however among the first defenders of the anopheline theory. He worked extensively on establishing the relationships between Anopheles mosquitoes and malaria and took a close interest in the environmental conditions of the transmission. In his mind, malaria fever should henceforth be classified as a preventable disease. An era of hope thus dawned: malaria prophylaxis, based on fight against mosquitoes, could begin.

Human African Trypanosomiasis (HAT) is caused by Trypanosoma brucei which is transmitted by the tsetse fly insect vector (Glossina spp). It is one of the 20 Neglected Tropical Diseases (NTD) listed by the WHO. These diseases affect the poorest and most vulnerable communities, for which the WHO has established a dedicated 2021-2030 roadmap. At the time of Alphonse Laveran, HAT devastated the African continent. In the 1960s, the disease was nearly under control, but it strongly re-emerged in the 1990s. A coordinated effort of all stakeholders, with national control programs as the main actors, a strong contribution of research and important donations by the private sector, allowed to decrease the HAT burden significantly. Since 2018, less than 1000 cases are detected annually. We here review new diagnostics, treatments and vector control tools that have been implemented jointly and successfully in several endemic countries.The next key challenge will be to sustain the gains. Newly emerging research questions include long-term carriage of trypanosomes and adaptation of tools to low prevalence contexts. Challenges out of the research area comprise the continued need of funding, maintenance of dedicated human resources, and the key question of access. Sustainable elimination as "interruption of transmission", which is the 2030 NTD roadmap target, can be reached, if these challenges are solved. We stress the importance of continuing to combine the efforts in the fight against the disease, because sustainable elimination of HAT is the best long-term prevention strategy against re-emergence. As such, HAT elimination can serve as an example for other infectious diseases.

Son of Louis-Theodore Laveran, holder of the Chair of Diseases and Epidemics in the Armies at the Val-de-Grâce and grandson of an artillery commander through his mother, Alphonse, born in Paris on June 18, 1845, follows in his father's footsteps by entering the Imperial School of Military Health in Strasbourg at the age of 18.After his thesis, he participated in 1870 in the war against Prussia. He was taken prisoner in Metz. He then prepared for the competitive examination to become a professor, which he passed in 1874. He was appointed to the Chair of the Val-de-Grâce, which his father had created. He then went to Algeria. It was at the military hospital in Constantine on November 6, 1880 that he indisputably discovered the haematozoa responsible for malaria in the blood of a soldier in the crew train.In 1884, he was appointed to the Chair of Military Hygiene and Legal Medicine at Val-de-Grâce. At the end of his professorship in 1894, after being refused a posting to Paris to continue his research and not being consulted for the preparation of the Madagascar expedition, which turned into a health disaster in 1895, he retired prematurely in 1897. Hosted by Émile Duclaux and Émile Roux at the Pasteur Institute in Paris, he continued his research mainly on protozoa as agents of human and animal diseases until his death. His work in medical protozoology earned him the Nobel Prize in Physiology or Medicine in 1907. During the Great War, with the benefit of his experience, he warned the Minister of War in January 1916 about the risk of malaria incurred by the army of the East in the delta of the Vardar River in Salonika. The spring would prove him right.An illustrious military doctor and scientist of international renown, Laveran died on May 18, 1922 in Paris.

In November 1880, Alphonse Laveran, stationed at the Constantine military hospital, addressed to the Academy of Medicine a "Note on a new parasite found in the blood of several patients with malaria fever". Léon Colin, professor at the Val-de-Grâce school, is the rapporteur, but he is not convinced by these observations, nor by two additional notes sent by Laveran in December 1880 and October 1881. This skepticism is shared by other academicians such as Joseph Laboulbène and Émile Duclaux.Twelve years will be necessary for Laveran to overcome the disbelief of the French scientific community. Three fundamental books donated to the Academy testify to the tenacity with which he gradually succeeded in convincing most of his colleagues: Traité des fièvres palustres avec la description des microbes du paludisme in 1884, Des hématozoaires du paludisme in 1887, and Du paludisme et de son hématozoaire in 1891.Laveran was elected to the Academy of Medicine on December 26, 1893. His resignation from the Military Health Corps enabled him to participate assiduously in meetings and to intervene in debates concerning infectious and tropical diseases, hygiene and prophylaxis. Obtaining the Nobel Prize in 1907 for his work on malaria, trypanosomiasis and colonial diseases crowned his work while honoring the Academy. Laveran was elected vice-president for the year 1919 and president for 1920, the year of the centenary of the Academy, the celebration of which he organized to the detriment of his health. He died two years later, having fulfilled his duty to the end of his strength.

The army has always been particularly exposed to the risk of infection, which Alphonse Laveran already analyzed in 1875 in his Traité des maladies et épidémies des armées. Nowadays, the risk of infection is still present, which is why the Armed Forces Health Service (SSA) employs modern research resources in this area structured around the Armed Forces Biomedical Research Institute (IRBA) supported by the Military Training Hospitals (HIA), the Armed Forces Epidemiology and Public Health Center (CESPA), and the Val-de-Grâce School.These resources meet current research needs in infectious and tropical diseases and are preparing to respond to future emergences.Recently, the SSA research has stood out in several epidemics and emergences that have affected the French Armed Forces and the national population.

Background-rationale: The diagnosis of Loa loa microfilaremia consists in the observation, using a microscope, of microfilariae in a sample of peripheral blood spread on a slide and subsequently stained (the "blood smear technique"). The accurate quantification of Loa loa microfilaremia is important because the choice of the first intention treatment depends on the patient's microfilaremia: severe adverse events can occur in individuals with high microfilarial densities when treated with ivermectin or diethylcarbamazine, the latter drug being the only one which can definitively cure the infection. However, despite the widespread usage of this technique and its role in guiding clinical management of the patient, estimates of its reliability remain scarce.

Materials and methods: We evaluated the reliability (reproducibility and repeatability) of blood smear technique using several sets of 10 L. loo-positive slides, randomly selected, and considered the results with regard to regulatory requirements. The slides had been prepared as part of a clinical trial conducted in Sibiti, Republic of Congo, a region where loiasis is endemic.

Results: The estimated and acceptable coefficients of repeatability (NB: the lower, the better) were 13.6% and 16.0%, respectively. The estimated and acceptable coefficients of intermediate reliability (reproducibility) were 15.1% and 22.5%, respectively. The poorest coefficient of intermediate reliability was 19.5% when the tested parameter was related to the technician who performed the readings (10.7% when the reading day was changed). The inter-technician coefficient of variation assessed using 1876 L. loo-positive slides was 13.2%. The coefficient of inter-technician variation considered acceptable was estimated at 18.6%. Discussion-Conclusion. All estimated coefficients of variability were lower than the calculated acceptable coefficients suggesting reliability of the technique, although the lack of laboratory references precludes any conclusion on the quality of this diagnosis. It is imperative to implement a quality system and standardization of procedures for the diagnosis of L. loo microfilaremia, both in endemic countries and in the rest of the world, where the demand for diagnosis has been increasing for years.

A 4-year-old child living with his parents in Kolokani, a town about 100 km from Bamako, was bitten on the left index finger by a snake of the species Echis ocellatus (fonfoni in local language). After 2 weeks of traditional treatment, local complications were observed. The child was admitted to the Néné clinic in Kati (Mali) on 19 July 2022. The signs observed were correlated with the degree of envenomation and the whole blood coagulation test showed coagulation disorders, which justified the administration of antivenom. Necrosis of the whole index finger required amputation of the finger, which was not followed by any complications. Snakebites require proper management to prevent complications such as necrosis and infection of the bite site. Administration of antivenom is necessary if coagulation disorders persist. Surgical treatment and broad-spectrum antibiotic therapy may improve the prognosis.

A 8-year-old schoolgirl from West Africa with no previous pathological history was admitted to the haematology department of the Brazzaville University Hospital for the management of cervical adenopathy. The diagnosis of sinus histiocytosis or Destombes-Rosaï-Dorfman disease was retained and the patient was treated with PO corticosteroids (methylprednisolone 32 mg/d then 16 mg/d). Given the rarity and uncertain aetiopathogeny of this syndrome, treatment is poorly codified. It includes corticosteroid therapy, immunomodulators and sometimes chemotherapy, radiotherapy or surgery, indicated in case of clinical manifestations of local organ compression. The disease may regress spontaneously. Its benignity does not justify systematic treatment in the absence of complications.