[Treatment of human alveolar echinococcosis with flubendazole. Clinical, morphological and immunological study]. / Traitement de l'échinococcose alvéolaire humaine par le flubendazole. Etude clinique, morphologique et immunologique.

Flubendazole has been given at a daily dosage of 50 mg/kg for 16 months (extremes 10 and 24 months) to 10 patients with hepatic alveolar echinococcosis. Clinical, morphological and immunological evaluations have been performed every 2 months during the treatment, and in 6 patients after discontinuation of the drug for 24 months. Jaundice persisted or occurred in 7 patients; infectious complications were observed in 4 patients; portal hypertension appeared in 5 patients; metastatic spread was suspected in 2 patients. Subjective improvement and weight gain were reported by 6 patients during the first 4 months of treatment. Severe complications occurring during the period of FZ therapy or within 2 months after withdrawal of the drug led to surgery in 6 patients, and death occurred in 3 cases. These observations demonstrate the inefficacy of FZ in this series of 10 patients with alveolar echinococcosis, possibly related to the extremely poor bioavailability of FZ. Higher plasma concentrations obtained with mebendazole and albendazole could explain the better efficacy of these two drugs despite their similar chemical structures and experimental toxicity upon larval cestodes.

[Multicenter study of 435 yeast strains isolated from 116,000 hemocultures]. / Etude multicentrique de 435 souches de levures isolées de 116000 hémocultures.

During a multicentric study on the diagnosis of yeast septicemia, 5 blood culture media have been compared. 435 yeast strains have been isolated from 116,372 blood cultures received during year 1989 in the mycological laboratories of 5 university hospitals from east of France. The results show that Candida albicans is always the first septicemia agent with 52% of yeasts isolation from blood. C. parapsilosis comes next with 17%, then C. glabrata, 6.2%. The average delay of yeasts isolation is 2.3 days for Bactec NR and Sabouraud media, 3.7 days for other bacteriological media. Compared with polyvalent media, Sabouraud diphasic medium is significantly the best for yeasts isolation. It is recommended to add chloramphenicol in the medium, to culture 10 ml of blood and to keep blood cultures for at least 8 days, better 15 days.

[Laryngeal leishmaniasis in a patient from the Jura. Unusual cause of epitheloid and giant cell granulomatosis]. / Leishmaniose laryngée chez un Jurassien. Cause insolite de granulomatose épithélioïde et giganto-cellulaire.

A case of laryngeal leishmaniasis in a patient living in eastern France is reported. Mucosal leishmaniasis appears to be frequent in the New World but rare in the Old World, where only 9 cases have been published, including 3 from France. In this particular patient, there probably was some relationship between the laryngeal lesion and an unexplained malaria-like fever contracted in Algeria 19 years before. This case provides evidence that leishmaniasis is one single nosological entity throughout the world, its different clinical forms (cutaneous, mucosal, visceral) merely reflecting the adaptation of the parasite to its environment.

[Cutaneous and lymphatic cryptococcosis after transient lymphopenia in an immunocompetent patient]. / Cryptococcose cutanee et ganglionnaire au decours d'une lymphopenie transitoire chez une malade immunocompetente.

INTRODUCTION: Cryptococcosis is an opportunistic infection, that rarely occurs in immunocompetent patients. CASE REPORT: We report a case of a 82 year-old woman who suffered from a bacterial pneumonia associated with lymphopenia. During the hospitalisation, she developed a cutaneous and ganglionnary cryptococcosis. No other cause of immunosuppression was found. The lymphopenia disappeared with the healing of the pneumonia treated with systemic antibiotics. Treatment with fluconazole was effective in 2 months on the cryptococcosis. COMMENTS: To our knowledge, this is the first case of cryptococcosis after a transitory lymphopenia, occurring in a immunocompetent patient.

[Septicemic cutaneous localization of cryptococcosis following renal transplantation in a female]. / Localisations cutanées septicémiques d'une cryptococcose chez une greffée rénale.

Cryptococcosis is a systemic disease caused by the yeast-like fungus Cryptococcus neoformans. Cutaneous manifestations, although rare, may precede other organ involvements. A case of cutaneous cryptococcosis is described herein. The skin lesions in our patient (a 47-year old female with renal transplant) consisted of acute cellulitis over her left and right thighs, revealing a septicemic infection. The patient received immunosuppressive drugs (prednisone, azathioprine). Clinical, mycological and histopathological data are described in details. Amphotericin B and fluconazole were initially successful, but a relapse with Cryptococcus meningitis required the adjunction of itraconazole to treatment. This case report underlines the insufficient effectiveness of fluconazole and the success of itraconazole.

[Oropharyngeal candidiasis resistant to fluconazole in patients infected by HIV]. / Candidoses oropharyngées résistantes au fluconazole chez des malades infectés par le VIH.

PURPOSE: To study the susceptibility to fluconazole of Candida albicans strains in oral candidiasis of HIV positive patients. PATIENTS AND METHODS: Eleven HIV positive patients with confirmed oral candidiasis were included in a 4 to 10 months prospective study. In addition, 23 HIV positive patients were evaluated in a restrospective study (14 with oral candidiasis and 9 control subjects). The MICs to fluconazole of C. albicans were characterized by genotyping (electrophoretic karyotype). RESULTS: Thirty patients were evaluable. Oral candidiasis was found in 21 patients; 7/21 patients (33,3 p. 100) developed resistant C. albicans strain (MIC > 32 mg/ml) after a mean fluconazole cumulative dose of 18 g. In this study, the electrophoretic karyotype confirmed the persistence of the same C. albicans strain in each patient. In addition increased colonization by C. krusei or C. glabrata was found in 6/21 patients (28.5 p. 100). DISCUSSION: Our data demonstrate that prolonged treatment with fluconazole dose higher than 13 g induces the emergence of resistant C. albicans with persistence of the same C. albicans strain. Fluconazole has to be reserved to oral candidiasis after failure of a local treatment or to severe cases.

[Toxocara sp in the playgrounds and sand pits in Besançon. Impact in urban hygiene. Prophylactic measurements for a clean city]. / Toxocara sp dans les aires de jeux et bacs à sable à Besançon. Impact en hygiène urbaine. Mesures prophylactiques pour une ville propre.

The authors presents the results of parasitology study to determine the prevalence of Toxocara species eggs in 29 playgrounds and sandpits of Besançon. Eggs of Toxocara were found in 25 of sandpits. This results were compared with these found in the world literature.

Interference by hydroxyethyl starch used for vascular filling in latex agglutination test for cryptococcal antigen.

The glucuronoxylomannan component of the Cryptococcus neoformans capsular polysaccharide confers serotype specificity, and its detection in cerebrospinal fluid or serum by the latex agglutination test is used for diagnosis. Low-molecular-weight hydroxyethyl starches can be used as an alternative to albumin for vascular filling. This study reports the occurrence of a false-positive result with the Pastorex Cryptococcus test (Sanofi Diagnostics Pasteur, Marnes la Coquette, France) for a patient receiving hydroxyethyl starch characterized by a substitution ratio of 0.6 (Elohes, Biosedra, Sèvres, France).

Skin manifestations associated with toxocariasis: a case-control study.

BACKGROUND: Human toxocariasis is one of the most common zoonotic helminthiases. The recent development of sensitive and specific diagnostic laboratory tests has led to identify a large spectrum of diseases, including cutaneous diseases, induced by Toxocara infection. OBJECTIVE: The purpose of our study was to assess the risk of having a positive Toxocara ELISA test in patients with different cutaneous symptoms. METHODS: The diagnosis of toxocariasis was based on an ELISA test which was performed in 653 patients suffering from different skin conditions during a prospective case-control study. RESULTS: The excess of risk (adjusted odds ratio) of having a positive result in the Toxocara ELISA was statistically significant for 134 patients with urticaria (whatever the clinical presentation) and for 22 patients with prurigo compared to a control group (249 patients). No statistical excess of risk was observed for patients with atopic dermatitis, pruritus or non-atopic eczema. CONCLUSION: The authors conclude that patients suffering from urticaria or prurigo should be tested for Toxocara infection. Whether these patients should be treated with anthelminthic drugs remains to be determined in further studies.

Humoral and cellular immunity in patients with hepatic alveolar echinococcosis. A 2 year follow-up with and without flubendazole treatment.

Parameters of humoral and cellular immunity were assessed in 12 patients with alveolar echinococcosis (AE) of the liver before, during and after discontinuation of treatment with flubendazole (FZ). In infected patients, before any medical treatment values of serum IgG, IgA, total haemolytic complement and C4 were significantly higher than those observed in control subjects; IgA levels were higher in jaundiced patients. Specific antibodies assayed by indirect haemagglutination and immunoelectrophoresis were present only in infected patients and were shown to decrease by the sixth month of treatment; however, similar fluctuations were observed without treatment. The percentage and absolute number of B lymphocytes, and total circulating lymphocytes, were significantly lower in patients with AE. An impairment of functional activity of T cells assayed by the leucocyte migration test, with PPD and Candidin as antigens, was demonstrated despite a normal percentage of SRBC rosettes. The 'score' of migration index still decreased during FZ treatment and returned to initial values after the year of follow-up without treatment. These results suggest that human AE is associated with important immunological disturbances. Changes in humoral immunity can be unequivocally considered to be a consequence of the parasite infection. The primary or secondary nature of the impairment of cellular immune responses and its mechanisms remain to be elucidated. Flubendazole could be responsible for an increase of cellular immune alterations in these patients.

[Circulating and basophil-fixed specific IgE in human alveolar echinococcosis]. / IgE spécifiques circulantes et fixées aux basophiles dans l'échinococcose alvéolaire humaine.

Biological parameters of immediate type hypersensitivity were assessed in 19 patients with alveolar echinococcosis. Serum total IgE concentrations were higher than normal values in 12 patients, and parasite-specific IgE were present in 9 patients. A significant relationship was observed between these two parameters. Evolution of specific IgE during a 1-year period appeared to correlate with surgical removal of parasitic material; it did not correlate with the clinical evolution in patients treated with mebendazole. Specific basophil fixed-IgE were demonstrated using both a basophil degranulation test and a histamine release test in the 19 patients under study, including serologically negative and circulating specific IgE-negative patients.

Influence of mode of storage and drying of fodder on thermophilic actinomycete aerocontamination in dairy farms of the Doubs region of France.

Airborne contamination by thermophilic actinomycetes, micromycetes and Gram negative bacteria was determined on 34 dairy farms and related to fodder drying and storage methods. Eighteen farms had a barn drying system, eight with additional heating; the remaining 16 had traditional fodder storage methods. Three air samples were obtained for each farm with a six stage Andersen sampler. The thermophilic actinomycetes were identified as Streptomyces and the dominant micromycetes as Aspergillus spp; there was no relation between the levels of these organisms. There were fewer thermophilic actinomycete colonies per Petri dish (stage 5 on the Anderson sampler) on farms with barn drying than on those with traditional storage (median (range) 7 (0-2628) and 56 (4-2628) respectively). The three farms where no thermophilic actinomycetes were found had barn drying with heating and the four most modern farms had lower thermophilic actinomycete colony counts than the others (median (range) 3 (0-10) and 48 (0-2628)). The level of thermophilic actinomycetes and, to a lesser degree, of micromycetes was higher where the farmer had farmer's lung. Thermophilic actinomycetes of the genus Streptomyces are probably the antigens associated with farmer's lung in the Doubs, and modern farms with barn drying and heating furnish some protection against this disease.

Fluconazole-resistant recurrent oral candidiasis in human immunodeficiency virus-positive patients: persistence of Candida albicans strains with the same genotype.

Thirty human immunodeficiency virus-positive patients carrying Candida albicans in their oropharynx were treated with fluconazole and were monitored for 90 to 570 days. Fluconazole-resistant C. albicans (MIC, > 32 micrograms/ml) appeared only in seven patients and only after 90 days of treatment corresponding to a total dose of more than 10 g. Resistance was not associated with resistance to other azole derivatives. Susceptible and resistant strains from each patient had the same genotype (as defined by electrophoretic karyotype and restriction fragment length polymorphism). Thus, the resistant strains were selected by the antimycotic treatment from the susceptible strain present in each case.