[Inter-arm blood pressure difference does not always mean dissection]. / Une anisotension ne signifie pas toujours dissection.

A man presents an atypical neurological disorder. The diagnosis of aortic dissection is evoked with anisotension, but it consists in a paradoxical embolism in the presence of a permeable foramen oval since he presents with a proximal pulmonary embolus and a thrombus in the humeral artery.

Un homme se présente avec un trouble neurologique d'allure atypique. Le diagnostic de dissection aortique est évoqué devant une anisotension, mais il s'agit ici d'un tableau d'embolie paradoxale sur foramen ovale perméable puisqu'il présente une embolie pulmonaire proximale et un thrombus dans l'artère humérale.

Emergence of Plasmodium ovale malaria among the French Armed Forces in the Republic of Ivory Coast: 20 years of clinical and biological experience.

BACKGROUND: French military surveillance identified an increase in Plasmodium ovale attacks among soldiers in Ivory Coast. This emergence and the low sensitivity of biological tests raise the question of a possible role of P. ovale variant species. METHODS: Epidemiological data about P. ovale attacks from 1993 to 2012 were studied; the species diagnosis was based on a thin blood smear and/or a quick diagnostic test. Clinical and biological features in soldiers hospitalized in 2 French military hospitals were also reviewed. Malaria polymerase chain reaction followed by genotyping was performed when available. RESULTS: French military physicians declared 328 P. ovale attacks over the 20-year study. A peak of incidence occurred in 2005. Among patients with positive blood smears, the quick diagnostic test was positive in 33 of 101 tests performed. The hospital study showed that symptoms and biological changes were not specific, which made diagnosis challenging: fever, anemia, and thrombocytopenia were not present in 20%, 71%, and 23% of the 45 confirmed cases, respectively. It was possible to perform molecular investigations on 19 clinical isolates: 18 were classic haplotypes with additional polymorphism and 1 was variant. CONCLUSIONS: This emergence of P. ovale malaria enabled a good description to be made in nonimmune patients. The lack of sensitivity of both clinical features and quick diagnostic tests suggests an underestimation. Reasons for this outbreak are especially intense exposure to the vectors and the insufficient efficacy of doxycycline against P. ovale. The polymorphism of classic haplotypes of P. ovale rather than variant forms could be involved.

Malaria attacks due to P. vivax or P. ovale in two French military teaching hospitals (2000 to 2009).

CONTEXT: Non-falciparum malaria is less studied than Plasmodium falciparum malaria, both in endemic and non-endemic zones. PATIENTS AND METHOD: A retrospective study was made of the medical files of patients managed for attacks of malaria due to Plasmodium vivax or Plasmodium ovale, between 2000 and 2009, in two French military teaching hospitals. RESULTS: Seventy-five percent of attacks occurred after a stay in French Guiana, in the Comoros Archipelago, or in the Ivory Coast Republic. The most frequent symptoms two months after coming back were a flu-like syndrome with headaches, and occasional digestive symptoms, without any difference between the first attack and recurrence. One third of patients presented with anemia, 78% with thrombocytopenia, and 12% with liver dysfunction. DISCUSSION: This study was the most important made in France on imported non-falciparum malaria. Military patients and immigrants accounted for a majority of patients due to the specificity of military hospitals and local recruitment. Clinical and biological features were not specific and did not allow guiding the diagnosis. Diagnostic tools were less sensitive for P. ovale. CONCLUSION: Patient management could be optimized by more efficient diagnostic tools, specific guidelines for the diagnostic and therapeutic management, and a dedicated medical training for family practitioners as well as hospitals practice.