[Two cases of Crimean-Congo haemorrhagic fever (CCHF) in two tourists in Senegal in 2004]. / Deux cas de fièvre hémorragique de Crimée-Congo (FHCC) contractée au Sénégal, en 2004, par des résidentes temporaires.

Two cases of Crimean-Congo haemorrhagic fever (CCHF) occurred in two French tourists during their visit in Senegal in November 2004. Febrile and hemorrhagic syndrome with ulorrhagia, petechiae, haematemesis, haematomas associated with biological signs of disseminated intramuscular coagulation were observed. For the first case who had a medical evacuation to France before diagnosis, Crimean-Congo virus infection was revealed by laboratory tests performed by the National Reference Center for Hemorrhagic Fevers (NRCHF, Institut Pasteur, Lyon) and secondly by the Centre de Référence OMS sur la Recherche des Arbovirus et des virus des Fièvres Hémorragiques (CRORA) in the Dakar Pasteur Institute (DPI). The second case diagnosed by the CRORA died after clinical deterioration with liver failure and severe haemorrhages. Healthcare workers and family members who had contact with tissue or blood from patients were followed up after the putative exposure either in France or in Senegal.

Plasmodium falciparum clinical malaria in Dielmo, a holoendemic area in Senegal: no influence of acquired immunity on initial symptomatology and severity of malaria attacks.

Six hundred eighty-nine Plasmodium falciparum malaria attacks were observed during a three-year period among 226 inhabitants of the village of Dielmo, Senegal, an area of high malaria transmission. Malaria attacks were defined as clinical episodes with fever (body temperature > or = 38.0 degrees C) or reporting of fever or headache or vomiting, associated with a parasite:leukocyte ratio above an age-dependent pyrogenic threshold identified in this population. The symptom frequencies were tested against age, gender, and parasite density using a random-effect logistic regression model and the study of distinguishable clinical presentations was carried out by multi-correspondence analysis. There was little difference between the severity of symptoms during the initial course of attacks in young children and adults, and this severity was not correlated with the duration of the pathologic episode. It was not possible to distinguish objectively different malaria attack types according to the severity of clinical manifestations. In contrast, the duration of fever, symptoms, and parasite clearance were significantly longer among the youngest children than among the oldest children and adults. These findings suggest that of the two components of protective immunity, anti-parasite immunity and anti-toxic immunity, only the first would play a major role as age increases. They suggest also that the initial clinical presentation of malaria attacks is not predictive of the level of protective immunity.

[Thyrotoxic neuromyopathies]. / Neuromyopathies thyréotoxiques.

Chronic thyreotoxic neuromyopathy was observed in four patients. The first two cases were observed in a 43-year-old woman and a 60-year-old man. In the man, muscle disorders were the first manifestation and in the woman they were preceded by Graves' hyperthyroidism. Muscle signs were seen as functional impotency with amyotrophy of the girdle which was major in the man and minor in the woman. In a third case, a pyramidal syndrome was associated with polyneuropathy in a 28-year old man. Laboratory tests showed hyperthyroidism, neurological signs regressed with antithyroid drug therapy. A fourth case presented as thyrotoxic hypokaliemic periodic palsy in a 37-year-old man who had loss 12 kg over a two month period after a psychological stress. This man then experienced two acute episodes of hypokaliemia and hypotonic tetraplegia. These signs were linked to Graves' hyperthyroidism. Clinical course was good under carbimazole and then radioactive iodine. These four cases illustrate the reality of thyrotoxic neuromyopathies in black Africans.