Alternative observational designs to estimate the effectiveness of one dose of oral cholera vaccine in Lusaka, Zambia.

We conducted a matched case-control (MCC), test-negative case-control (TNCC) and case-cohort study in 2016 in Lusaka, Zambia, following a mass vaccination campaign. Confirmed cholera cases served as cases in all three study designs. In the TNCC, control-subjects were cases with negative cholera culture and polymerase chain reaction results. Matched controls by age and sex were selected among neighbours of the confirmed cases in the MCC study. For the case-cohort study, we recruited a cohort of randomly selected individuals living in areas considered at-risk of cholera. We recruited 211 suspected cases (66 confirmed cholera cases and 145 non-cholera diarrhoea cases), 1055 matched controls and a cohort of 921. Adjusted vaccine effectiveness of one dose of oral cholera vaccine (OCV) was 88.9% (95% confidence interval (CI) 42.7-97.8) in the MCC study, 80.2% (95% CI: 16.9-95.3) in the TNCC design and 89.4% (95% CI: 64.6-96.9) in the case-cohort study. Three study designs confirmed the short-term effectiveness of single dose OCV. Major healthcare-seeking behaviour bias did not appear to affect our estimates. Most of the protection among vaccinated individuals could be attributed to the direct effect of the vaccine.

Prevalence of Vibrio spp. in raw shrimps (Parapenaeus longirostris) and performance of a chromogenic medium for the isolation of Vibrio strains.

UNLABELLED: Vibrios are natural inhabitants of estuarine ecosystems and some species may pose public health problem as agents of sporadic or collective food-borne infections associated with the consumption of fish or shellfish. Samples of raw shrimp (n = 299), fished in coastal areas of the city of Agadir, Morocco, and collected from its fish marketplace, were examined for the presence of pathogenic vibrios. Microbiological analysis was carried out according to a protocol using thiosulphate citrate bile sucrose (TCBS) agar and CHROMagar Vibrio (CV) as selective media. Presumptive-positive colonies were identified by biochemical and species-specific PCR systems, and further tested by PCR for the presence of pathogenicity factors. The overall prevalence of Vibrio spp. in shrimps was 55·8%. Vibrio parahaemolyticus was recovered from 25 of 299 samples (8·4%), Vibrio cholerae from six samples (2%) and Vibrio alginolyticus from 161 samples (53·8%). No virulence genes were found among V. parahaemolyticus and V. cholerae isolates. The CHROMagar Vibrio plating medium was found to be more efficient than the Thiosulphate Citrate Bile salt Sucrose (TCBS) Agar in the isolation of Vibrio organisms. SIGNIFICANCE AND IMPACT OF THE STUDY: A significant proportion of shrimps marketed and consumed in Morocco are caught in the coastal region of the city of Agadir. This study provides interesting data of prevalence of Vibrio spp. in raw shrimps as well as better understanding of their potential virulence. It is apparent from this study that genes and primers used in multiplex PCR for identification and detection of virulence factors, can be used to monitor shrimps for the presence of potentially pathogenic strains of Vibrio cholerae and Vibrio parahaemolyticus. The results highlight the added value of using a chromogenic medium for research and isolation of pathogenic Vibrio in seafood, more specific and accurate than TCBS.

[Cases of imported cholera in France, summer 2005. A. Tarantola for the incident management teams]. / Cas de choléra d'importation en France, été 2005. A. Tarantola pour les groupes de gestion des incidents.

Cholera is a bacterial infection, which causes digestive symptoms and massive diarrhoea. It may lead to dehydration and death if appropriate medical management is not rapidly initiated. Most cases of infection by choleric vibrio, however, remain symptom-free or may mimic common gastroenteritis. A review of two cases of imported cholera in France in the summer of 2005 and the community- and hospital-based investigation, which they triggered, enabled the incident management teams to assess risks of transmission. There were no secondary cases among 58 hospital contacts and 15 family contacts of the cases. Clinicians will find a discussion of possible clinical presentations and the risk of secondary transmission, in the context of progressing epidemics in countries, which have maintained close ties with France.

Non-O1, non-O139 Vibrio cholerae bacteraemia: case report and literature review.

Non-O1, non-O139 Vibrio cholerae (NOVC) are increasingly frequently observed ubiquitous microorganisms occasionally responsible for intestinal and extra-intestinal infections. Most cases involve self-limiting gastroenteritis or ear and wound infections in immunocompetent patients. Bacteraemia, which have been described in patients with predisposing factors, are rare and poorly known, both on the clinical and therapeutic aspects. We describe a case of NOVC bacteraemia and a systematic literature review in PubMed conducted up to November 2014 using a combination of the following search terms: "Vibrio cholerae non-O1" and "bacter(a)emia". The case was a 70 year-old healthy male subject returning from Senegal and suffering from NOVC bacteraemia associated with liver abscesses. Disease evolution was favourable after 2 months' therapy (ceftriaxone then ciprofloxacin). Three hundred and fifty cases of NOVC bacteraemia have been identified in the literature. The majority of patients were male (77 %), with a median age of 56 years and presenting with predisposing conditions (96 %), such as cirrhosis (55 %) or malignant disease (20 %). Diarrhoea was inconstant (42 %). Mortality was 33 %. The source of infection, identified in only 25 % of cases, was seafood consumption (54 %) or contaminated water (30 %). Practitioners should be aware of these infections, in order to warn patients with predisposing conditions, on the risk of ingesting raw or undercooked seafood or bathing in potentially infected waters.

Ribotyping of Chryseobacterium meningosepticum: its use as an epidemiological tool and its correlation with serovars.

Chryseobacterium meningosepticum (basonym, Flavobacterium meningosepticum King 1959) is associated with neonatal meningitis and is isolated from normal and immunocompromised adults. AAF-labelled Escherichia coli 16 + 23S rRNA was used as a probe for ribotype analysis of 92 clinical isolates from tracheal exsudate, blood culture, cerebrospinal fluid, urine and pus. The 92 isolates belonged to the 15 described serovars of C. meningosepticum, and included 21 strains isolated during an outbreak in an intensive care unit, all belonging to serovar G. Three restriction endonucleases, EcoRI, HindIII and PstI, were selected for use in ribotyping after preliminary experiments. Epidemiologically unrelated isolates were discriminated by ribotyping and could be classified into 48 ribotypes according to the hybridization banding patterns obtained after restriction with the three enzymes. Strains which were not discriminated by combined ribotype analysis belonged to the same serovar, and were of identical geographic origin. In one case, analysis with an additional enzyme, PvuII, was necessary for separating strains from two different serovars. However, three strains from different serovars (two isolated from the same place and one elsewhere within eight years) showed the same combined ribotype. Analysis of the rRNA gene patterns revealed 6 different patterns for clinical isolates of the outbreak, suggesting unrelated sources of infection. In three patients, isolation of C. meningosepticum with different combined ribotypes suggested superinfection. Ribotyping enabled differentiation between isolates belonging to the same serovar as well as between isolates of different serovars and provided a useful molecular epidemiological tool for the study of C. meningosepticum. Combined ribotype analysis with several restriction endonucleases increased the discriminating power of the method. However, there was only a partial correlation between serovars and the extent of DNA relatedness.

Western blot analysis of antibodies to Leishmania infantum antigens: potential of the 14-kD and 16-kD antigens for diagnosis and epidemiologic purposes.

When infected with Leishmania species, patients develop specific antibodies that constitute the basis of serodiagnosis. Using Western blot analysis, we studied the specificity of anti-L. infantum antibodies in patients with visceral leishmaniasis (including patients with acquired immunodeficiency syndrome [AIDS]) and in healthy subjects living in an endemic area. Sera from patients with visceral leishmaniasis recognized numerous antigens that had a molecular mass range of 12-120 kD. The 14-, 16-, 28-30-, 46-, and 68-kD antigens were recognized by 92%, 95%, 63%, 80%, 69%, and 89% of the patients' sera, respectively. The 14-16-kD antigens had the greatest specificity for leishmaniasis. The same pattern was found with sera from AIDS patients with proven leishmaniasis, but the 14-kD band was not present in some cases; recognition of the 16-kD band was constant. In these patients, Western blotting characterized specific antibodies even when the results of classic serologic tests (indirect immunofluorescent antibody test and enzyme-linked immunosorbent assay) were negative. Western blotting was found to be more sensitive than the IFA and ELISA, and it was used to detect antibodies to the 14-, 16-, 22-, and 24-kD antigens in subjects living in an endemic area. The detection of antibodies for the 14-kD and 16-kD Leishmania antigens would be a valuable tool both in the diagnosis of visceral leishmaniasis and in epidemiologic studies.

Characterization of a circulating antigen involved in immune complexes in visceral leishmaniasis patients.

Complications of visceral leishmaniasis are explained in part by immune complex pathology, particularly nephritis. Using the polyethylene glycol precipitation method, we identified among these complexes a Leishmania infantum circulating antigen by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and immunoblotting. Monoclonal antibodies were produced to specifically detect this antigen. This protein (molecular weight 51 kD) is a cytoplasmic antigen of L. infantum and its synthesis by promastigotes is related to stationary-phase culture. It was present in sera from dogs whose leishmaniasis was associated with nephritis, and it was found in the sera of 30% of human patients with visceral leishmaniasis. It was also detected in the sera of patients with cutaneous leishmaniasis, and it persists in the sera of clinically cured subjects.

Isolation and characterization of a repetitive DNA sequence from Leishmania infantum: development of a visceral leishmaniasis polymerase chain reaction.

To construct a DNA probe specific for protozoa that cause visceral leishmaniasis, we cloned Pst I fragments of Leishmania infantum genomic DNA into a Bluescript II SK vector. A clone of 4.3 kb that contained a highly repetitive sequence was isolated and cut with three restriction enzymes: Hae III, Rsa I, and Sau 3A. After a new molecular cloning step, we isolated and sequenced a 140-basepair (bp) fragment. Two oligonucleotides were synthesized to be used as primers for a polymerase chain reaction. Using this probe, we detected an amount of DNA equivalent to one promastigote of L. infantum. This probe showed a high specificity; all protozoa tested that cause visceral leishmaniasis and L. major (one of the causative agents of Old World cutaneous leishmaniasis) showed a 100-bp amplified sequence, whereas other Leishmania strains showed a signal of a different size or else no signal. Moreover, no amplified sequence was obtained with other pathogenic parasites tested (Trypanosoma brucei, T. cruzi, Plasmodium falciparum, Pneumocystis carinii, and Toxoplasma gondii).

Choice of therapy for imported cases of falciparum malaria in children: a retrospective study of 100 cases seen in Marseilles, France.

We have carried out a retrospective study on 100 children in hospital in Marseilles, France with a diagnosis of Plasmodium falciparum malaria. On admission, the main clinical features were anaemia (90 cases), fever (83 cases, > 40 degrees C in 22 cases), hepatomegaly (44 cases), vomiting (29 cases), neurological signs (22 cases), thrombocytopenia (13 cases), hyperparasitaemia (6 cases), jaundice (4 cases), shock (1 case) and hypoglycaemia (1 case). Severe malaria, as defined by the World Health Organization Malaria Action Programme, was rare in our study (only 2 cases) and the prognosis was good (no death, no sequela). The search for neurological signs such as impaired consciousness, prostration or convulsions is an effective and simple way to diagnose potentially severe cases. In the presence of these signs, intravenous quinine treatment resulted in a shortened duration of fever (30 h instead of 63 h) and thereby avoided patients becoming worse. In children without neurological signs or persistent vomiting, oral therapy may be used even if there is high fever or hyperparasitaemia, but close surveillance is required. Patients treated with halofantrine or mefloquine had a shorter stay in hospital than those treated with chloroquine (mean = 4 d instead of 5.7 d). The resistance of some strains to chloroquine may explain this difference.

Ecdysteroid-like compounds in human urine: they can occur in the absence of any parasitic infection.

Ecdysteroids (compounds related to 20-hydroxyecdysone, the insect molting hormone) can appear in the blood and urine of man, as a result of an infection with helminths. It has been assumed that the products are released by parasites. However, we found that the phenomenon is not restricted to helminthiases, but is widely spread among patients suffering from various diseases or injuries: twenty percent of hospital in-patients had urine highly positive in our test. This was due to the appearance of immunoreactive compounds not found in healthy people. Among them, one was remarkable for being largely predominant in some patients. These findings indicate that the origin and significance of ecdysteroids in man should be reconsidered. Since they appear only in association with severe pathological conditions, they could be of potential interest as a clinical marker.

[Leishmaniasis in south-eastern France- -ecology, epidemiology, prophylaxis]. / Les leishmanioses du sud-est de la France ecologie - epidemiologie - prophylaxie

A study of the ecology, epidemiology and prophylaxis of Leishmaniasis in the southeast of France is reported; different methods of the survey are recorded. Between 1965 and 1975, 972 cases of canine Leishmaniasis and from 1968 to 1975 89 cases of visceral human Leishmaniasis and only 3 cases of oriental sore were observed in the "Bouches du Rhône", "Var" and "Vaucluse" Departments. The strains isolated from canine and human visceral Leishmaniasis had a malate dehydrogenase XI whereas Leishmania tropica had a MDH I; no wild animals have been found with Leishmaniasis. The suburbs of the towns, the hills in the center of Marseilles or surrounding Toulon as well as the villages are the principal foci of Phlebotomus perniciousus (96%) as the vector. The biotopes are isolated houses with little gardens surrounded by dry-stone walls exhibiting holes named "barbacanes", with chalky soil and xerophytes. The killing of infected dogs is the best protection of men whereas keeping dogs in sandfly-proof kennels from twilight until one hour after sunrise is best in order to protect this animal. This is quite different from the observations made by RIOUX in the Cevennes.

[Toxoplasmosis in the Republic of Mali. An epidemiologic approach]. / La toxoplasmose en République du Mali. approche épidémiologique

1664- sera from children and adults were collected in rural and urban areas of Mali and were tested in Toxoplasmosis serology. Immunofluorescent antibody tests and direct agglutination test have been used for this purpose. 65 per cent of adults from urban area and 56 to 58 per cent of adults from rural area gave positive results. Before the age sixteen, only 33 to 40 percent of children are positive in urban area while 51 to 53 per cent are so in rural area. The study of hundreds of sera collected from various animals allows to explain the different ages of the serological changes. In rural area children have been infected very early after catching birds, reptiles and above all, rodents and eating them not cooked enough. In urban area the infection occurs all along the life and, particularly, in adults, after consuming grilled meat. The recent description of three cases of congenital toxoplasmosis demonstrates the interest of such an epidemiological study.

Ecdysteroids in urine of African patients infected with helminths.

The insect molting hormone and related compounds (ecdysteroids) have been found in patients infected with helminths. To investigate this phenomenon, we quantified and analyzed the urinary ecdysteroids in Malian subjects suffering from various helminthiases, as well as in Europeans. Very high titers (up to 100 nM) were found in some patients, whereas healthy persons had a basic level of 4 nM only. The high RIA activity was mainly due to two compounds. One of them was remarkable for being present in all the positive samples; it comigrated with the 20-hydroxyecdysone standard, both in HPLC and in TLC. The origin and the physiological significance of these compounds are questionable, since there was no clear relationship between their levels and the severity of the diseases. Numerous patients who were heavily infected had normal titers. Nevertheless, there is no doubt that high concentrations of ecdysteroid-like compounds in human urine indicate a pathological condition.

[Human brucellosis in Mali. Results of a seroepidemiological study]. / La brucellose humaine au Mali. Rèsultats d'une enquête séro-épidémiologique.

Prevalence of human brucellosis was evaluated in three contrasted ecoclimatic zones with different peopling of Mali. Rose bengal plate agglutination tests were carried out on capillary blood microsamples taken from 2173 subjects and indirect immunofluorescence tests were performed on 148 blood samples collected on filter paper disks. These seroepidemiological studies demonstrate the presence of the anthropozoonosis in the entire country and the influence of ecoclimatic and demographic factors on human brucellosis distribution in Mali. The high prevalence (24.4%) found in the sahelian region of Gourma shows the necessity of a national control programme. A similar prevalence has been found in other countries of tropical Africa which were formerly considered as almost free of human brucellosis. The findings suggest that seroimmunological tests should be performed systematically to detect brucellosis in immigrants coming to Europe from tropical Africa as well as in Europeans who have been travelling or staying in this region.

Ritodrine sulphation in the human liver and duodenal mucosa: interindividual variability.

The beta2-adrenoceptor agonist ritodrine has a bioavailability of 30% due to its presystemic metabolism and sulphation is an important metabolic route. The interindividual variability in the rate of ritodrine sulphation in 100 specimens of human liver and duodenum is reported. The final concentrations of ritodrine were 2 mM (duodenum) and 20 mM (liver). The mean estimates of ritodrine sulphation rate were 490 pmol x min(-1) x mg(-1) (duodenum) and 140 pmol x min(-1) x mg(-1) (liver). There was a 4-5-fold variation within +/- 2 SD units in the hepatic and duodenal rates of ritodrine sulphation. Statistical analysis revealed the presence of at least two subgroups of ritodrine sulphation. In the liver, 30% and 70% of the population fell into two subgroups with the mean estimates of ritodrine sulphation rate of 114 and 149 pmol x min(-1) x mg(-1), respectively (P < 0.05). In the duodenum, 25% and 75% of the population fell into two subgroups and the mean estimates of ritodrine sulphation rate were 332 and 538 pmol x min(-1) x mg(-1), respectively (P < 0.05). The rates of ritodrine and 4-nitrophenol sulphation correlated highly in the liver (r = 0.865; P < 0.001) and the rates of ritodrine and dopamine sulphation correlated highly (r = 0.914; P < 0.001) in the duodenum. In both tissues, the rates of ritodrine and (-)-salbutamol sulphation underwent a similar extent of variation and correlated highly. The intrinsic clearance of ritodrine sulphation was over one order of magnitude higher in the duodenum than in the liver suggesting that the duodenum is an important site of ritodrine sulphation.

[Optimization of sensitivity tests to ketoconazole. Value of experience planning in the choice of a medium]. / Optimisation des tests de sensibilité au kétoconazole. Intérêt des plans d'expériences dans le choix d'un milieu.

Using factorial design, the authors evaluate the factors which influence in vitro, the anti-fungal activity of ketoconazole against a strain of Candida albicans (CBS 562). With the four mediums most frequently used, (Sabouraud, Casitone, MEM, YNB) they precise the results concerning inoculum, pH, incubation temperature, growth time, serum concentration, and shaking. This method allows the evaluation of each factor in optimal conditions of test. In most cases, the best results are obtained with a 10(4) UFC/ml inoculum, a pH = 7, in absence of serum and without shaking. The influence of temperature is very small. In these conditions, the Casitone medium seems the most satisfactory.

[Synergic effect of 5-fluorocytosine and imidazole derivatives against yeast strains resistant to 5-fluorocytosine]. / Effet synergique entre la 5-flurocytosine et les dérivés imidazolés vis-à-vis de souches de levures résistantes à la 5-fluorocytosine.

Antifungal agents associations are widely used in therapy of deep mycotic diseases, particularly amphotericin B-5-fluorocytosine association. Synergistic effect has also been described between 5-fluorocytosine and imidazole derivates. The authors have tested here eventual synergy between 5-fluorocytosine and imidazole derivatives (miconazole, ketoconazole, fluconazole, itraconazole) against 57 years isolates resistant to 5-fluorocytosine by a semi-automated methods in liquid medium (Yeast Nitrogen Base and Brain Heart Infusion). The synergistic effect between 5-fluorocytosine and antifungal imidazoles varies widely with the drug tested. It's more frequent with ketoconazole. Itraconazole and fluconazole present very little synergistic effects in vitro.

[Vibrio vulnificus septicemia transmitted through a wound caused by a crustacea]. / Septicémie à Vibrio vulnificus secondaire à une blessure par écrevisse.

INTRODUCTION: Vibrio vulnificus proliferates during the summer in salt water where it infects the crustaceans. Expression of its pathogenicity depends on the underlying condition and mode of contamination. OBSERVATION: A 65 year-old man presented with a Vibrio vulnificus septicaemia of cutaneous origin, transmitted when he cut himself with a crawfish. The severity of the infection was enhanced by severe immuno-depression and haemochromatosis. The infection regressed with appropriate antibiotherapy. COMMENTS: Severe V. vulnificus infections are rare. Depending on the underlying condition and mode of contamination, one can distinguish between benign gastro-enteritis, local occasionally devastating infections and usually fatal septicaemia. CONCLUSION: Even the most severe forms of V. vulnificus infections may be cured with early and well adapted anti-infectious treatment.

[Agents of mycetomas: a bacteriological and parasitological study (author's transl)]. / Les agents des mycétomes: étude bactériologique et parasitologique.

Microscopic agents responsible of Mycetomas are reviewed. They may be bacteria belonging to the Actinomycetalae order (Nocardia, Actinomadura, Streptomyces) or very various fungi belonging to the classes of Adelomycetes or Ascomycetes (Madurella, Leptosphaeria, Neotestudina, etc.). Though the procedures for collecting and transporting samples are the same, direct microscopic examination gives possibility to choose among the selective culture media the most appropriate ones to isolate either fungi or Actinomycetalae. Technics of identification for the most important bacterial agents are given, but fungi can be identified in only very specialized laboratories. Immunological methods may bring valuable indications for helping diagnosis or treatment supervision.

[Biological diagnosis of leishmaniasis (author's transl)]. / Le diagnostic biologique des leishmanioses.

Serochematological, immunological and direct parasitological methods used in the diagnosis of man, dog and wild host reservoirs of Leishmaniasis are described. From their own investigations of more than 5.000 cases, the authors compare the respective technical advantages and the specific indications of each method.