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.

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)

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.

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.

In a longitudinal survey conducted in savanna area (Burkina Faso, West Africa) where malarial transmission is seasonal, we studied modifications of T, B lymphocytes, NK cells, and CD4+, CD8+ and activated T subpopulations of 61 patients (31 adults and 30 children, among them 20 showed at least one malarial attack during the survey). Analysis was made by direct immunofluorescence on a cytofluorimeter. Our study did not show any significant differences in lymphocytes subpopulations according to age or presence of malarial attack. None of the lymphocyte markers in the peripheral blood are related to premunition, may be because host/parasite conflict mainly occurs in deep organs.

Two hundred and twenty adult males living in endemic onchocerciasis areas in Ivory Coast, with a mean of 59 to 64 mf/mg of skin microfilariae, having or not ocular lesions, were divided into 4 homogeneous groups and treated by placebo or by a single oral dose of 100, 150 or 200 mcg/kg of ivermectin. Parasitological, clinical, ophthalmological, biological data were gathered before treatment (J less than 1) and at day 4 and 3, 6, 12 months post treatment. The doses of 150 to 200 mcg/kg gave the best results with a reduction of microfilariae of 75 to 79% at day 4 and of 97 to 99% at 3 months. A slight increase appears at six months reaching to 10% of the initial level, at 12 months. These posologies reduce also the number of ocular microfilariae 12 months after treatment. The percentage of patients presenting microfilariae in the cornea varies from 4 to 14% according to the given dose whereas it was initially between 26 and 33%, and in the anterior chamber from 22 to 16% instead of 62 to 67%. In patients who were still positive after treatment the detected number of ocular microfilariae was very small. Side effects starting 12 to 24 hours after treatment are similar to those appearing during the normal evolution of onchocerciasis. They were observed in 36% of subjects receiving a placebo and 56 to 65% of treated subjects. Statistically they are neither correlated with the intensity of parasitism nor to the given posology and disappear spontaneously few days later or after administration of aspirin and/or antihistaminic. Ivermectin given at a single oral dosage of 150 to 200 mcg/kg is a powerful microfilaricidal drug with a rapid and prolonged action and without major side effects.

One hundred and three male and female children of 6 to 14 years old with onchocerciasis, having or not ocular involvement and a mean skin microfilariae level of 36.1 mf/mg, received, in October 1986, a single oral dose of 150 mcg/kg ivermectin and controlled at day 4, 3 months, 6 months and 12 months post treatment. After the last control they were retreated with the same dose. The skin microfilariae count fell down to 94% of the initial level at day 4 and to 99% at 3 months. At 6 months the microfilariae count was 2% of the initial level and 5% at 12 months. The percentage of patients having microfilariae in the anterior chamber of the eye which was 33% before treatment fell down to 6% at 12 months. The percentage of patients having microfilariae in the cornea was 39% before treatment and 18% at 12 months. In the cornea and anterior chamber there was a very reduced number of microfilariae still present. 65% of the children had lesions of keratitis before treatment and 34% two months later. Adverse effects (fever, headache, pruritus, oedemas, myalgias, arthralgias) occurred in 64% of children after the first treatment and 50% after the second. They were of weak or moderate intensity and receded rapidly after administration of aspirin and/or anti-histaminic. The administration of ivermectin is an efficient and well tolerated drug in children above 5 years old.