[First report of a human case of trichinellosis due to Trichinella britovi after jackal (Canis aureus) meat consumption in Algeria]. / Première observation d'un cas humain de trichi- nellose due à Trichinella britovi en Algérie après consommation de viande de chacal (Canis aureus).

We report a single case of trichinellosis contracted in Algeria (Batna region), in a practising Moslim. Shortly after returning to France in November 2004, the patient developed the typical clinical and biological signs of the disease. Although the patient claimed having only eaten mutton, an unusual host for Trichinella, a meticulous investigation revealed that he also had eaten a grilled leg of jackal (Canis aureus). One of the four Trichinella larvae detected in a muscular biopsy enabled us to identify the parasite as Trichinella britovi by a multiplex PCR analysis. This is the first identification of the etiological agent of sylvatic trichinellosis occurring in North Africa and the first case of symptomatic trichinellosis due to jackal meat consumption in Africa.

Epidemiologic features and clinical presentation of acute Q fever in hospitalized patients: 323 French cases.

PURPOSE: To contribute to the knowledge of epidemiologic and clinical features of patients hospitalized with Q fever in France. METHODS: We conducted a retrospective analysis of 22,496 sera submitted between 1982 and 1990 to the French National Reference Center for Rickettsial Diseases (NRC). The diagnosis of acute Q fever was based on an IgG titer greater than or equal to 1:200 and an IgM titer greater than or equal to 1:25 against phase II Coxiella burnetii antigen on an indirect immunofluorescence test (IFA). Fifteen cases prior to 1985 were diagnosed on the basis of a complement fixation titer greater than or equal to 1:8. A serosurvey of blood donors from Marseille was also conducted in 1988 on 924 sera, using IFA with a cutoff titer of 1:25. RESULTS: The serosurvey conducted in 1988 showed a seroprevalence of 4.03%, without age or sex prediction. The incidence rate of acute Q fever detection at the NRC was 0.58 per 100,000 inhabitants over the 9-year period. Three hundred twenty-three clinical cases were diagnosed, rising from 1 in 1982 to 107 in 1990. In patients hospitalized for acute Q fever, there was a significantly higher sex ratio of males to females (2.3), which, coupled with the age distribution, indicated that elder males, who are overrepresented due to our recruitment bias, are more susceptible to C. burnetii infections. The mean age of the patients was 45.5 years, while the risk was increased in the 30 to 39 age group as well as in the 60 to 69 age group. Usual epidemiologic risk factors were found in 20.1% of the cases. Hepatitis (61.9%) was a more common clinical presentation in our patients with Q fever than pneumonia (45.8%). This might reflect differences in strains of C. burnetii or the biology of the host. However, French farmers and stock breeders commonly drink unpasteurized raw milk from their cattle, which might indicate a relationship between hepatitis and infection via the digestive tract. CONCLUSION: Our results indicate that many cases of acute Q fever are undiagnosed. A greater awareness of the disease and more extensive serologic testing of patients with symptoms compatible with Q fever may improve the situation.

Actinobacillus actinomycetemcomitans endocarditis.

Among the bacteria of the HACEK group, Actinobacillus actinomycetemcomitans is the organism involved most commonly in infective endocarditis. However, the epidemiological and clinical features specifically associated with this species have not been evaluated adequately. Three patients with infective endocarditis caused by A. actinomycetemcomitans seen at the Hospital La Timone (Marseille, France) between 1994 and 2001 are reported. Of 99 cases in the literature, 75% of patients had previous heart disease before infective endocarditis, the portal of entry of which was usually the oral cavity. Among the total of 102 cases, 27 had prosthetic valves. Intermittent fever was observed in all cases, and weight loss and peripheral signs of endocarditis were noteworthy in this study. Anaemia and microscopic haematuria were frequently noted. The disease is insidious, with a mean duration of symptoms of 13 weeks before diagnosis, as confirmed by blood cultures incubated for > 5 days. The aortic valve is most commonly involved, and echocardiographic findings were non-specific. Complications occurred in 63% of patients, with emboli being the most common. The surgery rate was 23.5%. The overall mortality rate was 18%. Of the cases, 76.5% were cured with antibiotics alone, including a simple third-generation cephalosporin or a combination of ampicillin and an aminoglycoside. An antibiotic therapy duration of at least 4 weeks is recommended. Surgical therapy is usually required for haemodynamic reasons. Prophylaxis of A. actinomycetemcomitans endocarditis relies on antibiotic therapy for all cardiac patients at risk before dental procedures. Among 17 patients undergoing dental manipulations, only eight received amoxycillin before the procedure, demonstrating that prophylaxis is far from being systematically prescribed. In conclusion, A. actinomycetemcomitans endocarditis should be highly suspected in patients with previous cardiac disease and for whom symptoms have evolved over a number of weeks or even months.

[Comparative study of visual evoked potentials and magnetic resonance imaging in multiple sclerosis]. / Etude comparative des potentiels évoqués visuels et de l'imagerie par résonnance magnétique dans la sclérose en plaques.

19 patients with clinically definite, probable or possible multiple sclerosis were examined by means of visual evoked potentials and magnetic resonance imaging. The patients were classified in three groups according to the criteria of Mac Alpine. 11 patients had definite multiple sclerosis: 8 of these patients, who had visual disorders evoking an optic neuropathy, had abnormal visual evoked potentials and 7 of these 8 patients had a pathological magnetic resonance imaging. In the other 3 patients of this group without optic neuropathy. 2 of them had abnormal visual evoked potentials and the 3 had a pathological magnetic resonance imaging. Two patients had probable multiple sclerosis, one of them had abnormal visual evoked potentials and a pathological magnetic resonance imaging. Finally, 6 patients had possible multiple sclerosis, one had a optical neuropathy, with abnormal visual evoked potentials but with a normal magnetic resonance imaging. Among the 5 other patients, 2 had abnormal visual evoked potentials and a pathological magnetic resonance imaging. The results obtained in comparison with the other reported in the literature show that magnetic resonance imaging brings a certain number of criteria which when associated with visual evoked potentials seem to be a further development in the diagnosis of the affection. However, despite of the existence of correlations, the lack of specificity of the lesions found with magnetic resonance imaging should lead the clinicians to a cautions optimism.

[Purulent meningitis and bacteremia from Bacteroides fragilis revealing a meningioma]. / Méningite purulente et bactériémie à Bacteroïdes fragilis révélatrices d'un méningiome.

We report the case of a 78-year-old-woman with a meningitis caused by Bacteroides fragilis revealing a malignant tumor. The epidemiologic, etiologic and therapeutic features of these meningitis are reviewed.

Hyperendemic focus of Q fever related to sheep and wind.

Q fever is a worldwide zoonosis which is caused by Coxiella burnetii and presents as both acute or chronic cases. The disease can be transmitted from animal reservoirs to humans by the inhalation of infected aerosols. The authors investigated the epidemiology of Q fever in the Bouches-du-Rhône district of southern France. The study area was centered around the small town of Martigues near the cities of Marseille and Aix-en-Provence, where the incidence of the disease seemed higher than in neighboring areas. Epidemiologic data included sheep breeding and wind. Between 1990 and 1995, Q fever was diagnosed in 289 patients, leading to an incidence rate of 35.4 per 100,000 in the study area (range: 6-132), compared with 6.6 in the area of Marseille, and 11.4 in the area of Aix-en-Provence. There was a graphical and statistical relation between the sheep densities, the incidence of the disease, and the strong, local wind known as the Mistral, which blows from the northwest. Although Coxiella burnetii transmission is multifactorial, we may speculate that the high endemicity in the study area is related to a contamination by aerosols because the Mistral blows through the local steppe where 70,000 sheep are bred. This public health problem requires further studies in order to confirm this hypothesis, and to identify more individual and preventable risk factors.

New tools for the study of Niemann-Pick disease: analogues of natural substrate and Epstein-Barr virus-transformed lymphoid cell lines.

Acid sphingomyelinase activity was determined in Epstein-Barr virus-transformed lymphoid cell lines (LCL) established from patients affected with Niemann-Pick disease (NPD) using several substrates: sphingomyelin derivatives, radiolabeled [14C]sphingomyelin (SM), fluorescent N-(10-(1-pyrene)decanoyl)sphingomyelin (P10-SM) or colored trinitrophenylaminolauryl-sphingomyelin, and the chromogenic non-natural substrate 2-N-(hexadecanoyl)amino-4-nitrophenylphosphoryl-choline. LCL from NPD Type A and Type B showed a severe deficiency of acid sphingomyelinase determined using either substrate, whereas LCL from normal subjects had an activity close to that of blood leukocytes. Sphingomyelinase in normal LCL had the same pH optimum (5.0-5.2) and molecular form (pI 5.8) as the enzyme from other sources; identical profiles and activity levels were obtained using the various analogues of sphingomyelin. However, among these derivatives, the assay using P10-SM appeared as the most useful and sensitive for enzymatic diagnosis of NPD. Electron microscopy of NPD LCL demonstrated the lysosomal storage. These results prove the validity of LCL as an experimental model system for NPD.