Bulletin de la Societe de pathologie exotique et de ses filiales最新文献

One hundred and twenty patients out of 220 in a previous study were retreated after 6 months or one year with doses of 100, 150 or 200 mcg/kg of ivermectin. The tolerance was excellent due probably to the small number of skin microfilariae obtained with the first treatment. The annual treatment with 150 to 200 mcg/kg, better than with 100 mcg/kg, keeps for the year following the second treatment the microfilariae number between 6 and 11% of the initial level. The half-yearly administration keeps it between 1 and 7% and especially 94 to 100% of these retreated patients have a level of microfilariae less than 5 mf/mg. The results obtained with the half-yearly treatment show a considerable reduction of the number of microfilariae in the anterior chamber of the eye and the percentage of positive patients. Ivermectin is a very efficient microfilaricidal drug for the treatment of onchocerciasis and the prevention of ocular complications. Its rational use in mass campaigns should reduce, if not interrupt, the transmission of this parasitic disease.

The etiological importance of Ancylostomidae in miners' anaemia has been discovered in 1880 by Perroncito during the boring of the Saint-Gothard tunnel in a dreadful epidemic. Thereafter in France, the illness disappeared between 1930 and 1940 because of the preventive dispositions realized. Two present cases of contamination in the coal mines of Lorraine due to N. americanus drive us to remember the interest of systematic faecal examinations of the miners at the engagement and every five years.

In French Guiana, the distribution of malaria in foci inhabited by quite different ethnic groups calls for specific studies. Along the Oyapock on the Brasilian border and along the Litani on the Surinam border, incidence among American Indians and Creoles ranges from 300 and 900 per thousand; Plasmodium falciparum accounts for 65% and P. vivax for 35%. Along the middle and lower Maroni on the Surinam border, the Boni and Ndjukas Negroes move freely through the frontier and since the civil strife Surinamese used to attend health centres of Guiana. Therefore it is difficult to find the sources of contamination and the incidence among French citizens; P. falciparum is the only parasite recorded in this focus. In 1987 a small outbreak mainly due to P. vivax, occurred in a Lao refugees village in the hinterland. The coastal foci harbour large communities of Haitian and Brazilian migrants. The vector is Anopheles darlingi and up to now there is no evidence that other species could be involved. The rise of malaria despite of control measures involves several factors: the house spraying is no more accepted by a large percentage of house holders and the alternative larviciding has only a limited efficacy; the houses of American Indians have no walls to be sprayed; there is a continuous introduction of parasites by migrants. It has been said that vectors have change their behaviour toward exophily but such a statement has not yet been supported by evidence. All these factors should be taken in account to improve malaria control.

After a short summary of the occurrence, sources, phenotypic characteristics, epidemiologic markers, virulence factors and pathogenicity of the 7 species of Klebsiella, the author reported (1) an infection due to K. pneumoniae K5 in a breed of squirrel monkey. These animals were suffering from sub-cutaneous abcesses (Pasteur Institute of Cayenne, French Guyana). (2) The second example refers a fatal infection due to K. pneumoniae K2 in a colony of lemurs, at Mulhouse zoological garden (East of France). Both animal colonies were protected against infection by the use of specific anti-K. pneumoniae capsular polysaccharide vaccine.

The authors expose the strategy put into effect to identify quickly, and fight against the pathogenic agents responsible for epidemic outbreak in rural areas, which, until now--were not properly controlled.

The diagnosis of malaria attack in regions for highly endemic P. falciparum is difficult. It is more so since the wide use of antimalarials by the infected populations and the spread of drug resistance. A positive test is not evidence for a malarial attack since in certain schools, in both rural regions and in some districts of big towns, over 3/4 of the children attending school are carriers of Plasmodium. On the other hand, true attacks, even severe forms, can occur without evidence of parasitaemia. The parasitic load is thus an important factor but the following must be taken into consideration: age, level of immunity, the extent of transmission and whether if is continuous or not, self medication and the initial systematic treatments, the possibility of drug resistance, ... The difficulties are illustrated by data collected in the Congo.

The use of ivermectin for mass treatment in human onchocerciasis is justified, because no other drug was available. But, as this compound is ineffective on adult filariae and as the emergence of drug resistance is quite possible, the evaluation of new chemical compounds for their macrofilaricidal activity should be continued. Several new compounds of interest are presented.