[Emergence of Chagas' disease in Europe: description of the first cases observed in Latin American immigrants in mainland France]. / Emergence de la maladie de Chagas en Europe: à propos des premiers cas observés chez des migrants latino-américains en France métropolitaine.

This article describes the first cases of imported Chagas' disease detected in Paris, France. A total of 18 cases were recorded in two teaching hospitals between 2004 and 2007. There were 12 women and six men with a mean age of 38 years. All patients were Latin American immigrants who had recently arrived in France from Bolivia (Cochabamba and Santa-Cruz departments) 17 cases and from Salvador in 1. Eleven patients presented an asymptomatic indeterminate form of the chronic disease. Seven presented chronic Chagas cardiomyopathy including two with severe symptoms requiring placement of a pacemaker. Obtaining serological tests to confirm the diagnosis was difficult. All except one patient who was older than 50 years were treated with benznidazole. Based on these findings, the main priorities for management imported Chagas' disease in France are improvement of serological diagnosis and prevention of vertical transmission.

[Chagas disease in France: estimated number of infected persons and cardiac diseases in 2009, by risk groups]. / Maladie de Chagas en France: estimation du nombre de personnes infectées et d'atteintes cardiaques en 2009, selon les groupes & risque.

An estimation of the number of Trypanosoma cruzi infected individuals and expected number of Chagasic cardiomyopathies in France (excluding French Guyana) was conducted in June, 2009 by InVS. Different risk groups were identified: Latino-Americans (LA) from endemic area (naturalized, legal and illegal migrants, adopted children), children born from LA's mother, French Guyanese living in Metropolitan France, expatriated and travellers from endemic countries. Prevalence rates by country of origin were applied to official data on risk populations obtained from the International Adoption Agency, Tourism Direction and French ministries (Finances, Foreign Affairs and Migrations). Around 157,000 individuals were potentially exposed. It is estimated than 1,464 [895-2,619] are infected by T. cruzi, of which 63 to 555 may evolve towards a chronic cardiomyopathy. This figure is within the range of earlier estimations of InVS and Guerri-Guttenberg. Taking into account illegal immigrants, the expected number of infected individuals in France should increase greatly this estimation.

Prognostic value of c-myc proto-oncogene overexpression in early invasive carcinoma of the cervix.

The prognostic effect of c-myc oncogene overexpression was assessed in a multivariate analysis of 93 patients with invasive carcinoma of the cervix, stage Ib, IIa, and IIb proximal. The treatment was based on the association of brachytherapy-colpohysterectomy and lymphadenectomy. Analysis of c-myc gene expression was done using Northern and slot blot hybridization techniques. Overexpression of c-myc (ie, levels at least three times the mean observed in normal tissues) was present in 33% of the tumors. The proportion of carcinomas with c-myc overexpression significantly increased with the size of the primary tumor (P = .04). No relationship was found between c-myc overexpression and the other clinical and histologic parameters, including the nodal status. The relative risk of relapse (overall, pelvic failure, distant metastases) was analyzed in a Cox's proportional hazards model. Three factors were significantly related to the risk of overall relapse when the multivariate analysis was performed, namely, the tumor size, the nodal status, and c-myc expression. A combination of c-myc expression and the nodal status provided a very accurate indication of the risk of relapse. Indeed, patients with negative nodes had a 3-year disease-free survival rate of 93% (95% confidence interval [Cl], 79% to 98%) when c-myc was expressed at a normal level, whereas this rate was only 51% (95% Cl, 26% to 63%) when c-myc was overexpressed (log-rank test, P = .02). In addition, in the subgroup of patients with positive nodes, this rate was 44% (95% Cl, 25% to 77%) and 15% (95% Cl, 4% to 49%) when c-myc gene was expressed at normal level, or overexpressed, respectively. Finally, c-myc gene overexpression was, in the multivariate analysis, the first factor selected by the model regarding the risk of distant metastases.

The risk of tropical spastic paraparesis differs according to ethnic group among HTLV-I carriers in Inongo, Zaire.

Following the finding in 1990 of six HTLV-I-positive cases of tropical spastic paraparesis (TSP/HAM) is a field survey carried out in the city of Inongo (Bandundu, Zaire), the prevalence of HTLV-I infection has been studied by detection of specific antibodies on a randomized sample of the general population. Among the 1,162 subjects surveyed, 36 (3.1%) were found to be HTLV-I seropositive, giving a seroprevalence of 3.2% (CI: 2.1, 4.3) estimated by direct standardization on age and sex distribution given by the census in the city. Among the five major ethnic groups, the Bolia showed the highest prevalence rate (6.5%) but with no detected TSP/HAM cases, while all six TSP/HAM cases were found among the Ntomba, who showed a prevalence rate of only 2.2%. This finding suggests that besides HTLV-I infection, critical environmental and/or genetic cofactors play a part in the development of TSP/HAM.

Long-term effects in skin and thyroid after radiotherapy for skin angiomas: a French retrospective cohort study.

To evaluate the long-term effects of skin angioma irradiation, a recall programme was established which included the systematic recalculation of the radiation dose to the skin and the thyroid. 22% of the 6229 patients contacted had a dermatological examination which revealed cutaneous dystrophy in 81% of the 1137 exposed angiomas and in 39% of the 208 unexposed angiomas. The risk of dystrophy (telangiectasia, hypopigmentation, superficial and subcutaneous atrophy) was 12.1 higher (P less than 0.0001) among patients who had received a surface skin dose above 30 Gy than among those who had received a dose of 10 Gy or less. The relative risk for each dystrophy component increased significantly (P less than 0.001) with surface skin dose. Furthermore, 14 basal cell carcinomas (BCC) were observed in 12 patients from the exposed group for all quantities of radiation, with a mean latency period of 22 years. No BCC was observed for a surface skin dose below 10 Gy. Thyroid testing was done on a subgroup of 431 patients whose thyroid gland had been particularly exposed during angioma irradiation. After recalculation, the dose delivered to the gland was below 1 Gy in 98% of patients. Only 13 thyroid nodules were discovered (1 hot and 12 cold). 1 patient with a cold nodule had a malignant thyroid tumour 21 years after irradiation. He belonged to the group of 7 patients who had received a thyroid dose above 1 Gy. Although no morphological abnormality was found in 98% of the tested patients, most (92%) had a thyroid iodine content below 15 mg (the standard French value), while a raised serum thyroglobulin level (greater than 30 ng/ml) was observed in 17%. This might confer a higher risk of subsequently developing thyroid nodules.

Epidemiology of toxoplasmosis among pregnant women in the Paris area.

A survey was performed using a sample of pregnant women selected at one of the biggest test centres in the Paris area. These women were serologically screened for toxoplasmosis between October 1981 and September 1983 (according to the prevention protocol for congenital toxoplasmosis established by the French health ministry). The prevalence rate of specific antibodies for toxoplasmosis was estimated from the 1074 women who were tested for the first time during the study. The prevalence rate among pregnant women in the Paris area was derived by direct standardization according to age and geographical origin. A standardized prevalence rate of 71% +/- 4% among French women, of 51.4% +/- 5% among immigrant women and a global adjusted prevalence rate of 67.3% +/- 3% for pregnant women in the Paris area was found. An incidence rate of 1.6% was estimated for the 2216 non-immune pregnant women included in the sample. There is no significant difference between the probabilities of seroconversion among French and immigrant women (2.3% +/- 1% and 1.6% +/- 0.8% respectively). Comparison of the data with previous study results show a decrease in the prevalence rate of specific antibodies for toxoplasmosis in the Paris area over the last 20 years that cannot be explained by changes in age and geographical origin. No data were available to support an aetiological hypothesis for a decrease in toxoplasma transmission to humans. Since immigration and a decrease in toxoplasma transmission to humans has led to a larger population of women at risk of infection during pregnancy in France, it is therefore important to perform studies to investigate risk factors and markers of acquired toxoplasmosis during pregnancy in order to improve the prevention of congenital toxoplasmosis.

Human papillomavirus testing in women with mild cytologic atypia.

OBJECTIVE: To evaluate the efficiency of human papillomavirus (HPV) testing by Hybrid Capture II (Digene Diagnostics Inc., Silver Spring, MD) with regard to detecting biopsy-confirmed cervical intraepithelial neoplasia (CIN) or high-grade CIN in women with mild atypia, compared with the efficiencies of polymerase chain reaction (PCR), Southern blot hybridization, and cytology. METHODS: We prospectively studied 378 women with atypical squamous cells of undetermined significance (ASCUS) (n = 111) or low-grade squamous intraepithelial lesions (SILs) (n = 267) demonstrated by referral cytology. We did repeat cytology, sampling for detection of HPV DNA by Hybrid Capture II, PCR, and Southern blot hybridization, and colposcopic evaluation with cervical biopsies. RESULTS: All participants underwent the Hybrid Capture II test and 320 underwent the three HPV tests. Sensitivities of Hybrid Capture II for detecting CIN and high-grade CIN (0.81 and 0.86, respectively) were similar to those of cytology (0.83 and 0.82, respectively) and PCR (0.77 and 0.95, respectively), and higher than those of Southern blot hybridization (0.48 and 0.45, respectively). Compared with cytology, combined triage with Hybrid Capture II improved sensitivities for detecting CIN (0.94 versus 0.83, P <.001) and high-grade CIN (0.96 versus 0.85), though the latter difference was not significant (P =.17). In women with ASCUS, sensitivities of combined triage and cytology for detecting CIN were 0.94 and 0.71, respectively (P =.01), and sensitivities of the two methods for detecting high-grade CIN were 0.92 and 0.66, respectively (P =.13). The increase in sensitivity was lower among women with low-grade SILs; for these women, cytology had high sensitivity (0.86 for CIN and 1.00 for high-grade CIN). The specificity of combined triage was significantly lower than that of cytology in both groups. CONCLUSION: Compared with repeat cytology, combined triage with HPV testing markedly improves sensitivity for detecting CIN in women with ASCUS, but at the expense of specificity.

Papanicolaou smears in human immunodeficiency virus-seropositive women during follow-up.

OBJECTIVE: To assess the outcome of cervical squamous intraepithelial lesions (SIL) in human immunodeficiency virus (HIV)-seropositive women. METHODS: Papanicolaou smears were followed-up prospectively in a group of 60 HIV-positive women every 6 months for 18 months. RESULTS: The cumulative incidence of SIL at 18 months was 9% in 27 women who presented with normal Papanicolaou smears at entry. In 33 women who initially presented with SIL, the rate of persistence of cervical lesions was 95% (18 of 19) in untreated patients and 61% (eight of 13) in women who underwent surgery. In women with low-grade SIL, the persistence or progression of cervical lesions was observed in 92% of the cases (12 of 13). No invasive cancer was observed during the 18 months of the study period. CONCLUSION: Although the long-term outcome of SIL in this population remains unknown, our results emphasize the high rate of persistence of SIL and the relative inefficiency of conventional treatment in HIV-infected women. These findings contrast with the natural history of SIL in immunocompetent women.

Lack of behavioural risk factors for squamous intraepithelial lesions (SIL) in HIV-infected women.

HIV-infected women have a high prevalence of abnormal Papanicolaou smears and cervical intraepithelial neoplasia. A multiparametric analysis of epidemiological and behavioural risk factors has been performed in a cohort of 204 HIV-infected women in an outpatient clinic with the aim to investigate risk factors associated with squamous intraepithelial lesions (SIL) in HIV-seropositive women. The prevalence of SIL in the study population was 35.7%. Univariate and multivariate analysis of demographic, behavioural and immunological variables only identified cigarette smoking > 20/day and CD4+ cell counts < or = 200 x 10(6)/L as risk factors significantly associated with SIL in the study population. We found no epidemiological/behavioural risk factors specifically associated with SIL in HIV-infected women as compared with the general population. The results suggest that the high prevalence of SIL in HIV disease is related to acquired immune deficiency in HIV-seropositive women.

Imported and autochthonous kala-azar in France.

OBJECTIVE: To study the epidemiological, clinical, and biological features of imported and autochthonous kala-azar in France. DESIGN: Prospective survey of all patients in France with kala-azar diagnosed over the two years 1986-7. Information was obtained from parasitology laboratories in regional hospitals and all hospital laboratories and haematology departments capable of diagnosing leishmaniasis in the south of France. SETTING: 107 public hospitals in France. PATIENTS: 89 patients with kala-azar. INTERVENTIONS: All patients were treated with drugs. In the first instance meglumine antimonate was given to all but two patients. MAIN OUTCOME MEASURES: Prevalence of the various clinical and biological features of kala-azar; proportion of patients with HIV infection. RESULTS: Half (44) of the patients were children under 8 years old. Seventy patients acquired the disease in France. Imported kala-azar was acquired mainly in Mediterranean countries (9/18 cases). Only 46 (52%) of the patients had all three of the classic associated clinical features of fever, splenomegaly, and hepatomegaly. Anaemia was the commonest biological sign, and the association of the four usual biological signs--anaemia, leucopenia, thrombocytopenia, and hypergammaglobulinaemia--was present in only 14 (33%) of the children under 8 and 26 (60%) adults. Fourteen of the patients over 8 years old were infected with HIV. CONCLUSION: Doctors must be aware of kala-azar in Mediterranean areas, especially as patients often present without the characteristic features and the disease affects young children preferentially.

[Chagas disease (American trypanosomiasis) in France]. / La maladie de Chagas (ou trypanosomose américaine) en France.

Chagas disease is an anthropozoonotic infection caused by Trypanosoma cruzi, transmitted by a hematophagous triatomine insect vector belonging to the Reduviidae family, while taking a blood meal. There is a large reservoir of wild and domestic mammals. Human contamination may come via vectorial, transplacental, and digestive routes, blood transfusion, organ or tissue transplantation, and by accident. The disease has two phases. The acute phase, oligosymptomatic, is frequently undiagnosed. It is followed by a chronic phase. Most of the infected patients remain asymptomatic all life-long. But 10 or 25 years later, one third of infected patients present with cardiac or digestive complications. Chagas disease is endemic in Latin America, from Mexico to Argentina. In French Guyana, the prevalence of the infection was estimated at 0.25% and 0.5% (from 500 to 1000 infected patients) on blood samples collected from 1992 to 1998. In 2000 and 2009, 192 cases were diagnosed. In this district, there is no established domestic vector and the transmission risk is low. The vector is very easily found in forest habitats and even in the peridomestic persistent forest, with an infection rate of 46 to 86%. Vectorial eradication is impossible. Fighting against Chagas disease in French Guyana relies more on individual protection, control of blood transfusion, prevention of mother-to-child transmission, diagnosis, and treatment of infected patients than on vectorial control.

[Serodiagnosis of toxoplasmosis developing during pregnancy and of congenital toxoplasmosis]. / Sérodiagnostic de la toxoplasmose évolutive en cours de grossesse et de la toxoplasmose congénitale.

During the first prenatal serodiagnosis of toxoplasmosis, the test must permit to differentiate between immunized and non-immunized patients and to screen recently contracted toxoplasmosis. In a group of 33 women affected with toxoplasmosis during pregnancy a critical study of serodiagnosis criteria is carried out by comparing the theoretical protocol of the evolution of the serology during acquired toxoplasmosis with the situations observed under usual prenatal monitoring. Seroconversion was noted in 26 women and the variability of the results emphasizes the difficulties in determining the date of the contamination when an evolutive form of toxoplasmosis is suspected at the first examination, which is the case in 7 other patients. In children, 11 congenital toxoplasmosis were diagnosed, all on laboratory examinations. It must be emphasized that 16 children were prematurely lost to follow-up. It should be necessary to devote our energies to screening and information in order to validate the protocol of prevention of congenital toxoplasmosis.

What is known about the prevention of congenital toxoplasmosis?

The French programme for the prevention of congenital toxoplasmosis consists of the diagnosis and treatment with spiramycin of acute infections during pregnancy and monthly follow-up of all identified seronegative women. The major flaw is that the efficacy of spiramycin in preventing contamination of the fetus, or at least in reducing the extent of the infection, has never been evaluated in a randomised placebo-controlled clinical trial. Its evaluation would require the follow-up of children born to mothers contaminated during pregnancy for more than 6 months, a goal that is difficult to obtain in current practice. The cost of the programme depends largely on the proportion of non-immune women of childbearing age. Since the modes of contamination are known and are linked to living habits, it should be possible to reduce the risk of infection during pregnancy by adequate health education. This approach is still to be evaluated.

Association between poor prognosis in early-stage invasive cervical carcinomas and non-detection of HPV DNA.

Human papilloma virus (HPV) DNA sequences (HPV types 16, 18, 33, 35 or uncharacterized) were detected by Southern blot hybridisation and polymerase chain reaction in 84% of 106 early-stage invasive carcinomas of the uterine cervix. Among HPV-positive patients, the risk of overall relapse did not differ with individual HPV types. Compared with HPV-positive patients, those with no detectable HPV DNA had a 2.6 times higher risk of overall relapse (p less than 0.05) and 4.5 times higher risk of distant metastases (p less than 0.01). The 24-month relapse-free survival rate in HPV-positive patients was significantly higher than that in HPV-negative patients (77% vs 40%), and the difference was similar (91% vs 56%) among those who were node-negative. These data indicate that HPV-negative cervical carcinomas may represent a biologically distinct subset of tumours that carry a poorer prognosis than do HPV-positive cancers.

Expression of ActA, Ami, InlB, and listeriolysin O in Listeria monocytogenes of human and food origin.

Expression of proteins involved in the adhesion of Listeria monocytogenes to mammalian cells or in the intracellular life cycle of this bacterium, including listeriolysin O (LLO), ActA, Ami, and InlB, was used to compare two populations of L. monocytogenes strains. One of the populations comprised 300 clinical strains, and the other comprised 150 food strains. All strains expressed LLO, InlB, and ActA. No polymorphism was observed for LLO and InlB. Ami was detected in 283 of 300 human strains and in 149 of 150 food strains. The strains in which Ami was not detected were serovar 4b strains. Based on the molecular weights of the proteins detected, the strains were divided into two groups with Ami (groups Ami1 [75% of the strains] and Ami2 [21%]) and into four groups with ActA (groups ActA1 [52% of the strains], ActA2 [18%], ActA3 [30%], and ActA4 [one strain isolated from food]). Logistic regression showed that food strains were more likely to belong to group ActA3 than human strains (odds ratio [OR] = 2.90; P = 1 x 10(-4)). Of the strains isolated from patients with non-pregnancy-related cases of listeriosis, bacteremia was predominantly associated with group Ami1 strains (OR = 1.89; P = 1 x 10(-2)) and central nervous system infections were associated with group ActA2 strains (OR = 3.04; P = 1 x 10(-3)) and group ActA3 strains (OR = 3.91; P = 1 x 10(-3)).