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

Thirty-two patients have been hospitalised in Marseilles since 1979 for recurrent oedema following their return from a tropical region. In spite of strong suspicion, the diagnosis of Loa loa was confirmed only five times. One patient was diagnosed with filariasis due to Mansonella perstans. The diagnosis of loiasis was usually presumptive and there were often wide variations in the laboratory findings. Two patients were thought to have an allergic reaction to diethylcarbamazine. Another patient was felt to have an allergy to streptococcal antigen. One patient who had lived in the Extreme Orient presented with an inflammatory fasciitis. Two patients presented with neurological manifestations: one with eosinophilic meningo-encephalitis, one with a neuropathy of the median nerve. In one case, the oedema was attributed to congenital lymphoedema.

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.

The filariasis of W. bancrofti with nocturnal periodicity is, together with malaria, the principal endemic disease in the Comoros Islands. Well studied on Mayotte island, which remained a French Territorial Collectivity, its prevalence and distribution are less known in the Grand Comoros, Anjouan and Moheli islands which form the Federal Islamic Republic of the Comoros. The study of the nocturnal microfilariae in the Grand Comoros and Moheli in 1987 is the opportunity to assess the situation of the disease on this archipelago.

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.

In a study involving 104 children hospitalized with diarrhoea, 9% were infected with oocyst Cryptosporidium spp. add 56% with such yeast-fungus as Candida (C. Candida 38%). The manifestations noted in cryptosporidiosis infected children are acute diarrhea, vomiting and hyperthermia. One subject out of five who were tested for antibody to HIV appeared to be antibody positive. The patients immunity from the disease was not checked. A mycological test must be systematically carried out in case of children diarrheal outbreak.

During and after a Rift Valley fever epidemic in Southern Mauritania, we observed 348 patients infected by RVF virus. 17 of them had encephalitis. These belonged to 2 groups, acute febrile forms with short duration and possibility of death, and sub-acute forms, with a longer duration and with sequelae. They were pure encephalitis, without clinical or biological meningeal signs. We also noticed 5 brutal ocular attacks, running very slowly, with sequelae.

Twelve children, 2 to 15 years of age, with falciparum malaria (parasitaemia 4,500 to 170,000/mm3) have taken 24 mg/kg body weight of halofantrine hydrochloride (Halfan) per os in three divided doses given within 12 hours. The symptomatology improved after 24 to 48 hours, with no more fever 5 to 90 hours after treatment and with a decrease of splenomegaly in 80% of the cases. The parasitic clearance was obtained after 24 to 60 hours. The haematocrit started raising again in 58% of the cases. Halofantrine hydrochloride is an efficient antimalarial drug in semi-immune patients. It is well tolerated and well accepted, thus representing an alternative for the cure of chloroquine-resistant falciparum malaria.

The RFI des Comores is classified by WHO as an area where P. falciparum resistance to chloroquine is rare or low. After reviewing the existing data, the authors are giving the results of an in vivo research in 1988-1989. 1.35 of the tests with 25 mg/kg were positive the 7th day, 3.38% of 207 tests with 20 mg/kg, 10.77% of 232 tests with 10 mg/kg, 21.56% of 51 tests on 5 mg/kg.

During a three-year period (1985-1987), in Reunion Island, 252 cases of leptospirosis were clinically diagnosed in humans, and serologically confirmed. The epidemiological study showed a significant male predominance, presence during all ages of life; no month and no geographical zone are spared but maximal incidences are noted during periods of and in localities with the most important rainfall. Severe forms are frequent but mortality remains low.