[Drepanocytosis with alpha and beta(o) thalassemia: a case report]. / Drépanocytose beta(o) thalassémique associée à une alpha thalassémie: à propos d'un cas.

We describe the case of a Sickle Cell Trait associated with alpha and beta(o) thalassemia at an young man without clinical abnormality. Capillary electrophoresis showed S haemoglobin at 67%, F haemoglobin at 29%, A2 haemoglobin at 4% and an absence of A haemoglobin. Accurate diagnosis was found by techniques of molecular biology.

[Supraventricular tachycardia with wide QRS complexes during Vaughan-Williams class I anti-arrhythmic treatment. Diagnostic and therapeutic implications]. / Tachycardie supraventriculaire à QRS larges survenant sous antiarythmique de la classe 1 de Vaughan-Williams. Implications diagnostiques et thérapeutiques.

The authors report 8 cases of regular tachycardia with wide QRS complexes during treatment with Vaughan-Williams class 1 antiarrhythmic drugs. These antiarrhythmics, prescribed to prevent atrial fibrillation (3 patients) and atrial flutter (5 patients), were flecainide in 4 cases, propafenone in 2 cases and cibenzoline and hydroquinidine respectively associated with digitoxine and propranolol. These wide complex tachycardias were regular atrial tachycardias with 1/1 conduction to the ventricle. The action of the drug, more pronounced on intra-atrial conduction velocities than on atrioventricular node refractoriness resulted in transformation of flutter at 300 cycles/min with 2/1 conduction and a ventricular rate of 150 cycles/min to atrial flutter at 210 cycles/min with 1/1 ventricular conduction. This acceleration of the ventricular rate was accompanied by widening of the QRS complex. Using the new ventricular tachycardia criteria recently published by Brugada resulted in a diagnostic error in 7 out of the 8 cases. The recording of a wide QRS complex tachycardia in a patient on class 1 antiarrhythmic therapy for an atrial arrhythmia should alert the physician to 1/1 atrial tachycardia despite morphological electrocardiographic criteria of ventricular tachycardia. The 1/1 atrial tachycardia may be poorly tolerated and require emergency treatment. The preventive association of a drug which slows conduction through the atrioventricular node is not always effective.

[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.

[Danger of malaria self-treatment. Acute neurologic toxicity of mefloquine and its combination with pyrimethamine-sulfadoxine]. / Danger de l'auto-traitement de réserve du paludisme. Toxicité neurologique aiguë de la méfloquine et de l'association pyriméthamine-sulfadoxine.

BACKGROUND: Mefloquine and pyrimethamine-sulfadoxine combination are recommended, as is quinine, for self-administered malaria prophylaxis. Patients should be carefully informed about appropriate use of this therapeutic scheme and advised on the importance of strict compliance to avoid overdose. CASE REPORT: We report the case of a patient who did not follow the prescribed dosage and who developed acute neurological disorders after overdosing. The patient developed seizures attributable to the sulfadoxine-pyrimethamine combination and mefloquine encephalopathy. DISCUSSION: Sulfadoxine-pyrimethamine-related seizures are exceptional and result from an overdose of pyrimethamine. The neurotoxicity of mefloquine is well-known and is particularly frequent at curative dosage. Toxic encephalopathy is a serious neurological manifestation which is slowly reversible depending on individual predisposition. Anti-malaria prophylaxis requires concerted efforts on the part of the traveler and the prescribing physician. Self-administration schemes can be both most useful and dangerous due to expected benefits and potential risks.

[Plasmodium vivax: therapy update]. / Plasmodium vivax: actualités thérapeutiques.

IMPACT OF PLASMODIUM VIVAX WORLDWIDE: Plasmodium vivax is the most widespread malanal agent in the world. Unlike Plasmodium falciparum, P. vivax can cause early or late recurrence and is not fatal (benign tertian malaria). EMERGENCE OF RESISTANT STRAINS: P. vivax strains resistant to chloroquine, then primaquine, have emerged over the last decade, creating the need for a new therapeutic strategy. TREATMENT OF PRIMARY DISEASE: Generally, chloroquine is the first intention treatment, excepting patients who also have P. falciparum infection or a strain with suspected resistance to chloroquine. Mefloquine, quinine and halofantrine are also logical alternatives. TREATMENT OF RECURRENT DISEASE: A schizonticidal agent should be given followed by a hypnozoitocidal agent, primaquine. Primaquine dosage should now be raised or adjusted to the patient's weight. THERAPEUTIC PERSPECTIVES: Tafenoquine, delayed-release amino-8-quinoleine, is a potential alternative for primaquine for the treatment of recurrences. Studies are also in progress to evaluate the role of primaquine as a prophylaxic agent.

[Acute encephalitis concurrent with primary infection by Schistosoma mansoni]. / Encéphalite aiguë contemporaine d'une primo-invasion bilharzienne à Schistosoma mansoni.

A 24-year-old man returning from a trip to Mali was hospitalized for acute encephalitis and fever in association with acute primary infection by Schistosomiasis mansoni. Bilharziasis was suspected from the epidemiological context and presence of eosinophilia. Diagnosis was confirmed by serological testing. Specific treatment using praziquantel and corticotherapy was successful. Central nervous system involvement attributable to embolization of eggs or ectopic migration of adult worms has been reported in association with chronic Schistosomiasis by S. japonicum or S. mansoni. There have been few reports of acute neuroschistosomiais during the acute primary phase of infestation by S. mansoni. Etiology probably involves immunoallergic mechanisms.

[Analytical interference in determination of procalcitonin by PCT-Q (Brahms)]. / Interférence analytique dans le dosage semi-quantitatif de la procalcitonine (PCT-Q Brahms).

Procalcitonin (PCT) is a biological marker of infection. We present the cas of a patient who has presented a high concentration of PCT with PCT-Q test (Brahms). At the same time, the concentration of CRP is remained low, which is no physiological. Then, PCT concentration has been determinated with an automatic system (Kryptor-Brahms) and finded at low than 0.5 microg/l. Brahms company has searched an analytical interference: human anti-mouse antibodies (HAMA) were positive. If PCT concentration stay a marker of infection for the most part, this case show that biologists have to keep in mind that immunological assays remain submitted to interferences.