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

Leprosy is commonly thought to have been introduced during the 19th century and can still be considered as a public health problem in Vanuatu. From 1965 to 1984, 651 cases were notified throughout the country, with a total incidence rate of 5.85%. The 1984 survey reported 273 active cases and 190 inactive cases, most of them were paucibacillary cases. Sex ratio H/F is 1.7. Geographical distribution is clustered into two major and two minor foci. Prevalence rate is 2.1%. Annual incidence rate is decreasing with 21 cases in 1985 and 15 cases in 1986. Reported figures are smaller than those reported in the neighbouring countries.

During and after a Rift Valley fever (RVF) epidemic in Southern Mauritania, we collected 600 clinical observations. 348 were confirmed to be RVF cases. Among the 5 clinical forms we observed, some are benign but others, especially those with hemorrhagic signs are serious. We observed 48 icterohemorrhagic forms with 25 deaths. An icterus was associated with hemorrhagic signs, varying from gingivorrhagia to abundant bleeding. Biological hepato-nephritis was always present in major hemorrhagic forms. Fulminant forms, spectacular and characteristic are excellent markers for epidemiological studies in the field.

A group of 300 young European adults visiting Gabon for relatively short periods was surveyed monthly for malaria from a parasitological, clinical, immunological, hematological point of view. The regular increase of fevers due to malaria from 1984 to 1988 and the multiplication of cases of amino-4-quinoline resistance in the plasmodial parasites call for new prophylactic considerations for this group residing in this heavily malaria infested area.

Chemoresistant P. falciparum malaria emerged in South Sahara Africa during 1978 and is now more than half of the imported malaria in F. Houphouet-Boigny Hospital in Marseilles (France), consequently the annual number of malaria cases has doubled as compared to the previous years. In our study of 47 chemoresistant malaria cases, collected in 1985-1986-1987, mostly contracted in French-speaking Africa, residents and travellers were both equally affected. Curative treatment was quinine IV for severe malaria (34%), sulfadoxine-pyrimethamine (46.8%), and mefloquine (51%).

The spread of chloroquine resistant strains of P. falciparum requires new approaches to treatment especially in tropical Africa. A single dose of 3 tablets of sulfadoxine-pyrimethamine (Fansidar) is a suitable and relatively inexpensive alternative. But under drug pressure resistance to this compound has developed in some South-East Asian countries and in Brazil, giving rise to multiple resistant strains of P. falciparum. A similar pattern has arisen with quinine to which almost 50% of P. falciparum strains have become resistant in Thailand. However the combination treatment of quinine with tetracycline given for 7 days is still successful in most cases. Unfortunately compliance to this regimen is rather poor in out-patients. Mefloquine (Lariam), recently marketed, and if used as 750 mg dose in semi-immune adult patients weighing less than 60 kg, has made possible a single-dose treatment schedule for falciparum malaria. In controlled studies conducted in South-East Asia the success rate of mefloquine was 97% in 445 patients. Since there is some fear of the appearance of resistance of P. falciparum to mefloquine, a combination of this compound with sulfadoxine and pyrimethamine was developed (MSP or Fansimef). Various controlled studies in South-East Asia have shown a success rate of this compound of 97% in 278 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

The sulfadoxine-pyrimethamine combination has not been recommended for the prophylaxis of malaria since 1985 following serious accidents in the USA. However, this drug is worth considering for treatment since it has the advantage over mefloquine of being cheaper, having fewer side effects and it avoids using mefloquine. A study of Plasmodium falciparum resistance to Fansidar should be carried out on cases imported to France to determine an adapted utilisation of this drug. This would be an appreciable advantage for tropical Africa.

One hundred and ten patients with severe falciparum malaria have been admitted between 1985 and 1987. All had received quinine to the same protocol: 8.3 mg base/kg infused intravenously over 3 hours every eight hours. A systematic glycaemic supervision by capillary glycaemia every eight hours has been employed. Hypoglycaemia occurred in 17 patients (15.5%). Despite an early injection of glucose, recurrent hypoglycaemia was almost constant (16 over 17). The mortality of the group with hypoglycaemia is significantly higher (41% to 25%; 00.5 less than p less than 0.1). We have not found any connection between the risk of hypoglycaemia and elements of gravity of the access. If the part of the patient (age, pregnancy), high parasitemia and impaired hepatic gluconeogenesis have been finding, our results suggest than quinine-induced insulin secretion is the principal mechanism of this hypoglycaemia. Its high incidence and its severity impose preventive measures.

A research was made on one hundred cases of diarrhoeas in Aids-patients by stool examination including examination of duodenal aspirated liquid. Concerning the examination of duodenal fluid, we founded the parasites in almost one hundred patients of the cases. Among parasites observed, Isospora belli was the most frequent (20% of cases), followed by Cryptosporidium (15%). Strongyloides stercoralis represented 10% of the cases. The majority of other parasites was miscellaneous protozoa and some helminths.

Three hundred and seven patients, 130 children and 207 adults, from a hyperendemic village, underwent an ultrasonography of bladder and kidneys. Prevalence of bladder lesions is 79.3% in children and 61.9% in adults, prevalence of hydronephrosis is 36.1% in children and 9.7% in adults. These study confirms the importance of urologic lesions from schistosomiasis in the irrigation schemes of the Niger river. There is no relationship between frequency and importance of lesions and urinary egg count.