[Systemic microsporidiosis and toxoplasmosis in a patient with T prolymphocytic leukemia]. / Microsporidiose et toxoplasmose disséminées chez une patiente présentant une leucémie prolymphocytaire T.

We report a case of microsporidiosis in a 72-year-old woman presenting with prolymphocytic leukemia. The underlying conditions 7 months after leukemia was diagnosed were pancytopenia and immunosuppression due to alemtuzumab and pentostatin. The patient's status had worsened and she presented with dysuria. Urine cultures for bacteria were repeatedly negative. She was first empirically treated with broad-spectrum antibiotics. Three months later, urinary symptoms were persisting. Her blood lymphocyte count was 90/microl. Urine examination was positive for microsporidia using modified trichrome staining and Uvitex 2B fluorescence. Microsporidia were also detected in stools. The patient was cured by albendazole. This was consistent with an infection due to Encephalitozoon sp. Concurrently, disseminated toxoplasmosis was diagnosed. Toxoplasma gondii was detected in bone marrow, broncho-alveolar lavage and cerebrospinal fluid. She was successfully treated with sulfadiazine-pyrimethamine. Four cases of microsporidiosis in myeloid leukemic patients have been already described. The present case in a patient with lymphoid leukemia is the first to be reported.

Predictive value of oral colonization by Candida yeasts for the onset of a nosocomial infection in elderly hospitalized patients.

The incidence of nosocomial yeast infections has increased markedly in recent decades, especially among the elderly. The present study was therefore initiated not only to determine the predictive value of oral colonization by yeasts for the onset of a nosocomial Candida infection in elderly hospitalized patients (> 65 years), but also to clarify the factors that promote infection and to establish a relationship between the intensity of oral carriage and the onset of yeast infection. During this prospective cohort study, 256 patients (156 women and 100 men with a mean age of 83 +/- 8 years) were surveyed for yeast colonization or infection. Samples were collected every 4 days from day 0 to day 16 from four sites in the mouth, and intrinsic and extrinsic factors that might promote infection were recorded for each patient. Pulsed field gel electrophoresis was performed on Candida albicans isolates from all infected patients. Poor nutritional status was observed in 81 % of the patients and hyposalivation in 41 %. The colonization level was 67 % on day 0 (59 % C. albicans) and a heavy carriage of yeasts (> 50 c.f.u.) was observed for 51 % of the patients. The incidence of nosocomial colonization reached 6.9 % on day 4 (6.1 % on day 8 and 2.7 % on day 12), and that of nosocomial infection was 3.7 % on day 4 (6.8 % on day 8, 11.3 % on day 12 and 19.2 % on day 16). Of the 35 patients infected, 57 % were suffering from oral candidiasis. The principal risk factors for colonization were a dental prosthesis, poor oral hygiene and the use of antibiotics. The risk factors for infection, in addition to those already mentioned for colonization, were endocrine disease, poor nutritional status, prolonged hospitalization and high colony counts. Genotyping revealed person-to-person transmission in two patients. Thus, this study demonstrates a significant association between oral colonization and the onset of yeast infections in elderly hospitalized patients. Therefore, oral samples should be collected at admission and antifungal treatment should be administered in cases of colonization, especially in patients presenting a heavy carriage of yeasts. Genotyping of the strains confirmed the possibility of person-to-person transmission.

[Fungal keratitis in a daily disposable soft contact lens wearer]. / Kératite fongique et lentilles cornéennes jetables Journalières.

A case of fungal keratitis was diagnosed in a young female who had been wearing daily disposable soft contact lenses for 2 Years. No risk factor was demonstrated and specific treatment was effective. This case emphasizes that patients must be aware of the importance of hygiene as daily disposable contact lenses must be discarded daily.

Two cases of systemic Candida glabrata infection following in vitro fertilization and embryo transfer.

Presented here are two cases of systemic Candida glabrata infection diagnosed in two expectant mothers and their fetuses at 34 and 22 weeks' gestation. The underlying risk factors in case 1 were in vitro fertilization and embryo transfer, recurrent yeast vaginitis and two intravenous injections of betamethasone. The risk factors in case 2 were in vitro fertilization and embryo transfer, recurrent yeast vaginitis, antibiotics for treatment of a urinary tract infection due to Morganella morganii and amniocentesis. In both cases, vaginal fluid yielded growth of a yeast that was not identified. Candida glabrata was isolated from samples obtained from the mothers and their babies. Since Candida glabrata lacks hyphae, membranitis and infection of the fetuses were demonstrated only on slides stained with Gomori Grocott and periodic acid-Schiff. Both cases suggest that for such pregnancies the follow-up of vaginal fluid should include the identification of any yeasts grown on selective Candida medium. In case of premature rupture of membranes, systematic sampling of mothers and their infants or fetuses should be associated with microscopic study of placentas, membranes and stillborn fetuses with Gomori Grocott and periodic acid-Schiff staining techniques.

[Disseminated and central nervous system Histoplasma capsulatum infection mimicking neoplasm: difficulties in diagnosis, failure in management]. / Miliaire cérébrale pseudonéoplasique révélatrice d'une histoplasmose disséminée à Histoplasma capsulatum: difficultés diagnostiques, échec thérapeutique.

INTRODUCTION: Infection with Histoplasma capsulatum (Hc) is a rare importing disease in metropolitan France, the most often minor but sometimes letal in its spread form. EXEGESIS: A 58 years old French man, HIV seronegative, was admitted for an alteration of its general condition, disorder and buccal ulcerations. He had a prostate cancer history and came back in France after 17 years in Central Africa. The imaging showed numerous cerebral nodes, a bilateral adrenal tumor, and pulmonary calcifications. Histoplasmosis diagnosis has been done after neurosurgical cerebral biopsy which displayed characteristic Hc. The sick man died 4 months later with multivisceral failures, in spite of amphotericine B treatment followed by oral then intraveinous itraconazole. CONCLUSION: Even in an old tropical residence, ones can be able to conjure up a deep exotic fungal infection, and most specifically Hc histoplasmosis, in front of meaningful multivisceral lesions. Disseminated histoplasmosis (HD) with neurological location is misleading, mimicking tuberculosis or cancer. In order to obtain formal mycological evidence, ones have to make adapted biopsies. Antifungal agents must take into account medicinal interaction. Therefore, prognosis is bad, according to inoculum, immunodeficiency, age of disease and diagnosis delay.

The extent of oral fungal flora in 353 students and possible relationships with dental caries.

An epidemiological study was conducted on 353 students to determine the potential relationships between oral saprophytism with Candida albicans and dental status. For each student included, an interview, a dental examination, a mycological investigation and determination of oral pH were conducted. Various factors liable to affect the presence of oral fungus were investigated using the chi(2) test. 58.6% of samples were positive when cultured, with C. albicans in 93.7% of cases. The mean DMF index was 7.6. C. albicans was more frequently isolated in men, smokers, when pH was lower than 7, when dental plaque was abundant and when the time since the teeth had last been brushed was more than 8 h. DMF and F indexes were greater when C. albicans was present but not when it was abundant, while decay was more often present in subjects with abundant C. albicans. Although the specific role of the various factors is difficult to establish, the results suggest that further research to elucidate the possible role of C. albicans in caries aetiology would be valuable.

Cross-sectional survey of trachoma in school age children in the region of Thiès (Senegal).

BACKGROUND: Trachoma is a leading cause of blindness in West Africa. In Senegal previous studies have shown that the endemicity is high. AIMS: To verify the extent of the pathology and to study the epidemiologic characters of this infectious disease in a population of school age children in a rural zone, located in the Thiès region (Senegal). METHODS: A cross-sectional survey in six villages in the region of Thiès was performed in a population of school age children (5 to 15 years old). Sixty variables (individual, family, village, etc.) with morbidity indicators for trachoma cases were collected and analyzed. RESULTS: The cross-sectional survey confirmed the extent of the prevalence of trachoma in the childhood population; 208 of the 388 children (mean age, 9.19 years) included had trachoma (53.6%). Significant statistical correlations were found among the occurrence of trachoma and ethnic origins, the village of residence, the father's profession and the daily quantity of water ingested and its origin. Inversely no correlation could be found between the occurrence of trachoma and sex, age (except for florid trachoma), the size of the sibship, whether the mother washes the child, washing their hands before eating, the number of cospouses and the number of children per mother. CONCLUSIONS: The data obtained confirmed the extent of this endemic disease in the region of Thiès, because dispensing antibiotic eye drop has limited efficacy over time. Information should be provided to the population on the extent of the disease and its epidemiologic characteristics and more widespread well drilling, and use of that water should be encouraged.

[Acanthamoeba keratitis: search for a healthy carrier in Mali]. / Kératites à Acanthamoeba: recherche d'un portage oculaire sain au Mali.

The first cases of Acanthamoeba keratitis in Africa were reported in 1990 at the Institute of African Tropical Ophthalmology (IOTA) in Bamako, Mali. From 1990 to 1995, a total of 22 cases of corneal ulcers involving Acanthamoeba sp. were diagnosed at the IOTA. To improve our understanding of the epidemiological characteristics of these lesions in tropical areas, we attempted to identify healthy carriers of Acanthamoeba sp. by studying the normal eye flora of 149 patients examined at the IOTA in February 1996. Acanthamoeba sp. was not detected in any sample. Fungi were detected in 22.15 p. 100 of the samples. Thus, it would appear that, unlike fungi, Acanthamoeba sp. is not present in normal eye flora in Mali. This findings suggests that the occurrence of Acanthamoeba in corneal ulcers is not an accident. Our results also emphasize the need for screening to detect Acanthamoeba in developing countries such as Mali. However, further study will be needed to confirm these findings in a larger group of subjects more closely matched with the patients presenting the corneal ulcers diagnosed at the IOTA, especially with regard to geographical origin.