[American pulmonary histoplasmosis. Prospective study with 232 soldiers after a 2-year assignment in Guiana]. / Histoplasmose pulmonaire americaine. Etude prospective chez 232 militaires ayant effectue un sejour de 2 ans en Guyane.

The purpose of this report is to describe the results of a prospective study on pulmonary histoplasmosis in French Guiana. Chest radiographs were performed in 232 French legionnaires returning from a two-year assignment in French Guiana. Further examinations were performed in a total of 8 subjects in whom chest radiographs demonstrated the presence of nodules in the lungs. No evidence of cancer or tuberculosis was found. Findings confirmed histoplasmomas in two cases and demonstrated probable histoplasmosis nodules in 6 cases including three involving calcified lesions. Five of these eight patients had been in high-risk rain forest environments. Pulmonary histoplasmosis should be considered as a possible diagnosis in subjects returning from endemic zones. Confirmation depends on a spectrum of findings. Calcified nodules require only radiographic surveillance with follow-up at six months. Non-calcified nodules require further investigation including CT-scan, bronchoscopy, and serological tests. Surgical biopsy may be necessary to achieve exact histological and mycological identification of the lesion and is recommended in smokers.

Spermine increases the active and passive transport across the alveolar epithelium in situ: effect of thiol reagents.

An intact alveolar epithelial barrier is thought to be important for alveolar liquid absorption. However, polycations increase alveolar permeability without affecting alveolar liquid absorption (Saumon et al., Am J Physiol 1995: 269:L185-L194). We have reconsidered this issue using polyamines. The polyamine spermine (10(-3) mol/l) produced a large (up to 20-fold), sustained increase in the permeability of the alveolar barrier to mannitol (PAMan) and in alveolar liquid absorption (Jw, twofold) in isolated rat lungs. These increases were inhibited by 5 x 10(-3) mol/l putrescine and 2 x 10(-3) mol/l spermidine. Because spermine is known to affect the phosphoinositide/Ca2+ signalling pathway, we evaluated the effects of thiol reagents known to interfere with this pathway in different ways. Thimerosal, a thiol reagent which sensitizes the inositol 1,4,5-trisphosphate (IP3) receptor, inhibited the spermine-induced increase in PA(Man) and, to a lesser extent, that of Jw. Mersalyl, a thiol reagent which blocks IP3-gated Ca2+ channels, enhanced spermine's effect, whereas N-ethylmaleimide, a non-specific thiol reagent, had no effect. These observations show that large increases in permeability may coexist with increases in Jw. They also suggest that the phosphoinositide/Ca2+ second messenger pathway is involved in modulating the tightness of the alveolar barrier and alveolar liquid absorption.

[A case of hepatic Loeffler's syndrome]. / Un cas de Loeffler hépatique.

INTRODUCTION: During nematode infection transit of the microorganism in the lung may be associated with transient infiltration lesions accompanied by marked eosinophilia. In the invasion stage of the disease maturation and sexual differentiation of schistosomules is restricted to portal vessels. Liver ultrasonography may show concomitant abnormalities. EXEGESIS: Eosinophilia was diagnosed in a 36-year-old man residing in Central Africa. Clinical examination, chest X-ray and biology were normal. Liver ultrasonography showed numerous hypoechoic lesions, up to 3 cm in diameter. Ultrasonography-directed biopsy demonstrated infiltration of both portal vessels and liver sinusoids, with sometimes microabcesses. No parasite was found in either blood, stool, or rectal biopsy. Immunoelectrophoresis and hemagglutination showed positive bilharziosis serology, whereas serology for other helminthiases was negative. Four months after treatment eosinophilia was still high, liver ultrasonography was normal, and hemagglutination was negative. CONCLUSION: The transient shistosomules maturation-related liver abnormalities detected by ultrasonography should be differentiated from the laying phase of the disease.

[Neisseria meningitidis and meningitis]. / Neisseria meningitidis et méningites.

Meningococcal meningitis epidemics can occur anywhere in the world. However this risk is particularly high during the dry season in the sub-Saharan zone of Africa known as the Lapeyssonnie meningitis belt. This area characterized by hyperendemicity that regularly gives rise to epidemics. Multilocus enzyme electrophoresis has made possible identification and monitoring of the progression of virulent clones of Neisseria meningitidis strains in the world. Monitoring is now possible by multilocus sequence typing and data bank on the Internet. Vaccination is a major prophylactic modality. The usefulness of plain group A plus C polysaccharide vaccines is limited because of poor effectiveness in young children who constitute the highest risk group. During epidemics, mass vaccination should be carried out as early as possible according to the state of alert defined for the area. More recent conjugate vaccines against group A and C, which are effective in young children and provide long-term protection by induction of immunologic memory, may allow routine vaccination in the future. Although clinical signs are often apparent, not all cases are diagnosed by clinical examination unless gravity is taken into account. Untreated the disease is always fatal. The only hope of survival is early institution of appropriate antimicrobial therapy (even prior to hospitalization). Several strains resistant to chloramphenicol have been reported and the number of strains with reduced sensitivity to penicillin is rising constantly. Although treatment remains feasible, the existence of resistant forms raises the need to monitor the sensitivity of meningococci using standardized of antibiograms.

[Cyclophosphamide-induced interstitial pneumopathy. Course data of bronchoalveolar lavage apropos of a case and review of the literature]. / Pneumopathie interstitielle liée au cyclophosphamide. Données évolutives du lavage broncho-alvéolaire à propos d'un cas et revue de la littérature.

A patient treated with cyclophosphamide for breast cancer developed functional and clinicoradiological signs of sub-acute diffuse interstitial pneumopathy. Bronchoalveolar lavage revealed lymphocyte alveolitis. Differential diagnoses were excluded and the course was favorable after cyclophosphamide withdrawal. The bronchoalveolar lavage results obtained initially and at follow-up and two previous lavages reported in the literature demonstrate the importance of this examination in the diagnosis of drug-induced pneumopathy.

[An anterior mediastinal mass]. / Une masse médiastinale antérieure.

A 50-year-old man developed a bronchogenic cyst complicated by hemorrhage. A complete radiographic chest work-up provided a reliable diagnostic approach. Bronchogenic cysts are usually asymptomatic incidental discoveries. Chest ultrasonography confirms the cystic nature of the mediastinal mass. Computed tomography scan and especially magnetic resonance imaging further support the diagnosis and are helpful for guiding surgery. Surgery is required because of the unpredictable risk of hemorrhage, infection or enlargement.

[Use in Mozambique of WHO diagnostic strategies in HIV infection]. / Application au Mozambique de stratégies diagnostiques OMS de l'infection par le VIH.

The lack of expensive equipment and well-trained laboratory technicians in developing countries makes it difficult to use standard methods (2 EIA confirmed by western blotting) to diagnose HIV infection. This led the WHO to develop simplified algorithms based on sequential screening tests, with no confirmation by immunoblotting. These algorithms were tested in the normal diagnosis conditions of a medical unit in Maputo, Mozambique. We tested 402 sera, collected with the consent of the patients concerned. The sera were first tested for HIV according to French regulations (2 EIA with western blot if at least one EIA was positive). This strategy identified 53 sera as positive for HIV1 and 1 serum as positive for HIV2. We then tested who algorithms, one for a predicted rate of prevalence < 10% and the other for a predicted rate of prevalence > 10%. Neither algorithm performed adequately for diagnostic purposes. Further evaluation with a panel of local sera is required to select the most suitable algorithm in terms of specificity and sensitivity, and algorithms should be throughly tested before inclusion in national AIDS control strategies.

Evaluation of the monocyte counting by the ABX Vega. Comparison with the manual method and fluoro-flow cytometry.

This study allowed evaluation and comparison of the precision (20 samples) and agreement (200 samples) of the relative and absolute values of the monocyte count using three methods: microscopic, flow cytometry and the automated ABX Vega hematology analyzer. Flow cytometry is the most precise method, even if the coefficient of variation of the automated analyzer is very similar. The coefficient of correlation between the ABX Vega and the flow cytometer is very satisfactory (r=0.8042). This study of the agreement also made it possible to confirm the difficulty that automated hematology analyzers have in differentiating between some granulocytes and monocytes and their propensity to overstimate the latter when the sample includes immature forms of granulocytes. This fact stresses the importance of the microscopic method, despite its lack of precision. The observed discrepancies did not lead to any difficulties in clinical interpretation; however, this finding should be taken into consideration, particularly in myleoproliferative syndromes and the laboratory monitoring of chemotherapy.

[Establishment of a blood transfusion center at Kabul (Afghanistan)]. / Mise en place d'un centre de transfusion sanguine à Kaboul (Afghanistan)]

Recent events concerning blood transfusion (BT) have led to the number of BT being drastically reduced and to more rigorous checking of blood donations before their use for transfusion. Very few developing countries have been able to set up BT organizations that are both self-sufficient and capable of ensuring a high quality of blood testing. A central blood bank (CBB) was set up in Kabul (Afghanistan) during the 1980s. From 1992 onwards, its activities were curtailed due to the political turmoil, lack of funds and the fact that no blood collection policy was being implemented. A partnership between a development aid agency (Avicen), French public institutions and the local authorities has resulted in the rebirth of this CBB by the injection of financial resources and technical and scientific expertise. An independent committee of BT specialists was responsible for assessing the scientific validity and ethical acceptability of the project. In 1996, the objectives of the project, which had been in operation for one year, were achieved as far as the renovation of the laboratories was concerned. Work has focused mostly on setting up a proper cold chain and on training laboratory technicians in standard biological methods for testing blood from donors (blood group, HIV screening, Ag Hbs, HCV and syphilis). However, due to the shortage of blood donors, it has been difficult to set up a minimum blood bank stock. The results of the first biological tests carried out on the blood of the first 1,281 donors have made it possible to define an appropriate, detailed policy for preventing and controlling the main risks of infection from BT, involving routine testing for HIV, Ag HBs and HCV (0.3% prevalence). BT is a major component of any health care system and it must be reconstructed. The measures proposed here are long-term and require the ongoing participation of all those involved in this project including the local authorities and sources of financial support.

[Standardization of the Neisseria meningitidis antibiogram. Detection of strains relatively resistant to penicillin]. / Standardisation de l'antibiogramme de Neisseria meningitidis. Détection des souches relativement résistantes à la pénicilline.

Studying the susceptibility of 189 Neisseria meningitidis strains to penicillin, amoxicillin, cefotaxime, ceftriaxone, chloramphenicol and rifampicin by determination of minimum inhibitory concentrations (MICs) by agar dilution (reference method), E-test and disc diffusion method on Mueller-Hinton agar at 37 degrees C with 5% CO2 enabled us to standardize the antibiograms. While MIC determination by agar dilution is still the reference method, it is possible to obtain exact or approximate MIC values using the E-test. For laboratories that cannot determine penicillin MICs, it is impossible to detect strains that are relatively resistant to penicillin (RRP strains: 0.1 < or = MIC < or = 1 mg/l) using a 10-U penicillin disc. A 1 microgram-oxacillin disc allows MIC to be determined in most cases when the oxacillin inhibition zone is < or = 10 mm. Such strains must be sent to a reference laboratory for exact MIC determination. Based on our results and literature data on pharmacokinetics, we propose critical concentrations for these various antibiotics as well as critical diameters for chloramphenicol and rifampicin discs.

[Viral hepatitis A: when a changing epidemiology implies a different prophylaxis]. / Hépatite virale A: quand une épidémiologie mouvante implique une prophylaxie adaptée.

Major progress has been made in the epidemiology and prophylaxis of hepatitis A virus (HAV) since it was first discovered in stool samples by MacCallum in 1973. Seven types of the virus have been described. Types 1, 2, 3 and 7 occur in humans and types 4, 5 and 6 in monkeys, but genotype is not correlated with antigenic response. Immunization with the HM175 viral strain or natural infection by any of the virus types gives protection against all types of HAV affecting humans. Serological tests detect all types of the virus and make it possible to carry out epidemiological studies anywhere in the world. HAV is common in very young children in developing countries. Most ten-year-old children are immune and have no clinical signs of the illness. HAV infection has become less common in developed countries due to improvements in hygiene. Less than 40% of people under the age of 30 have been immunized. Non-immune individuals have a high risk of developing clinical hepatitis if they become infected and the older the patient at the time of infection, the more severe the disease is likely to be. The introduction of HAV into groups in which the majority of individuals have not been immunized may result in major local outbreaks. Prophylaxis schemes are developed on the basis of epidemiology. Vaccination is not routinely recommended in developing countries, except for visitors to those countries. Vaccination is recommended for individuals in high-risk groups, such as health workers, cooks, sewer maintenance engineers and tourists, in developed countries. In countries with an intermediate level of risk (East Europe, the Middle East and Southeast Asia), there is a high level of HAV infection and a low level of immunization. Vaccination programs are likely to be of value in these countries.

[Djibouti, history of 2 epidemics of cholera: 1993-1994]. / Djibouti, histoire de deux épidémies de choléra: 1993-1994.

When two cholera epidemics broke out in Djibouti, respectively in 1993 and 1994, Bioforce was obliged to intervene. The first time, three goals were pursued: setting up a rehydration centre in a tent, organizing epidemiological surveillance and training local personnel in treatment and diagnosis techniques. The next year, the epidemic followed serious flooding. The epidemiological analysis showed that cholera had become endemic in the poor neighbourhoods of the town and that epidemic break-outs were favoured by contaminated surface water and disturbances in the distribution of drinking water. The epidemic of 1997, likewise following flooding, only confirmed this point of view.

[Resistance to chloroquine and cycloguanil of Plasmodium falciparum in patients arriving in France after travel in Africa without chemoprophylaxis]. / Résistance à la chloroquine et au cycloguanil de Plasmodium falciparum chez des patients arrivant en France après un voyage en Afrique sans chimioprophylaxie.

The in vitro susceptibility of chloroquine and the genomic profile of dihydrofolate reductase (DHFR) codon 108 was determined against african isolates of P. falciparum (Pf) from imported malaria cases without previous drug intake by an isotopic microtest or PCR + RFLP. Pf resistance to chloroquine or to the DHFR inhibitor was present in 49% and 46% of isolates, respectively. Pf drug resistance was more frequent in permanent than in seasonal malarial transmission areas and chloroquine plus DHFR resistance reached 28% in years 1995-97. Updating the guidelines for the prevention of malaria in travellers to Africa is necessary.

Pulsed-field gel electrophoresis analysis of clonal relationships among Neisseria meningitidis A strains from different outbreaks.

Pulsed-field gel electrophoresis was used to analyze the DNA of 67 Neisseria meningitidis A strains from five African outbreaks occurring between 1988 and 1996. Endonuclease Bg/II was used to cut chromosomal DNA, generating 19 analyzable fragments. This technique allowed comparison of clonal relationships between outbreak strains and revealed that the same pulsotype was responsible for the outbreaks. This pulsotype is closely related to strain B54, subgroup III reference strain, Finland, 1975, showing only two fragment differences.

[Research on three parasitic infestations in rats captured in Marseille: evaluation of the zoonotic risk]. / Recherche de trois infestations parasitaires chez des rats capturés à Marseille: évaluation du risque zoonosique.

A cross sectional survey was carried out on a population of 82 rats (Rattus norvegicus and Rattus rattus alexandrinus) trapped in Marseille. The main histopathological finding was the presence of adults or eggs of Capillaria hepatica in 44% of the animals. 21% were found with fleas (Xenopsylla cheopis). There was no evidence of trichinosis in any of the rats examined. Hepatic capillariasis is a zoonosis seldom described in human beings. About 30 human cases have been reported in the world. Human infestation occurs first by consumption of raw rat liver containing un-embryonated eggs causing only pseudoparasitism without disease. The genuine mode of infestation is the consumption of sullied soil with rats feces containing embryonated eggs. Therefore parasites provoke, true as in rat inflammatory lesions, necrosis and fibrosis of the liver. The treatment associates antiparasitic drugs such as ivermectine, disophenol or pyrantel tartrate. The presence of a large population of infested synanthropic rats requires epidemiological monitoring and extermination of rats. All physicians must be informed of this potential risk.