A retrospective study of 230 consecutive patients hospitalized for presumed travel-related illness (2000-2006).

A good knowledge of morbidity profiles among ill-returned travelers is necessary in order to guide their management. We reviewed the medical charts of 230 patients hospitalized in one infectious diseases department in France for presumed travel-related illnesses. The male-to-female ratio was 1.6 and the median age was 33 years (interquartile range [IQR], 25-50). Most patients (70.9%) were returning from sub-Saharan Africa. The median duration of travel was 28 days (IQR, 15-60) and the median time from return of travel to hospitalization was 13 days (IQR, 7-21). Malaria was the most frequent diagnosis (49.1%), which was especially encountered in patients returning from sub-Saharan Africa (95.6%), without adequate chemoprophylaxis (78.2%). Imported diseases at risk of secondary transmission were also diagnosed, including pulmonary tuberculosis (n = 8), viral hepatitis (n = 8), typhoid fever (n = 6), human immunodeficiency virus (HIV) (six new diagnosis), non-typhoid salmonellosis (n = 5), severe acute respiratory syndrome, and Crimean-Congo hemorrhagic fever. This study underlines the need to maintain tropical expertise for infectious diseases physicians, even in Europe.

Comparison of epidemiological, clinical, and biological features of invasive aspergillosis in neutropenic and nonneutropenic patients: a 6-year survey.

BACKGROUND: Invasive aspergillosis is an opportunistic infection that occurs mainly among patients with prolonged neutropenia. Few data are available on invasive aspergillosis in nonneutropenic patients. METHODS: The aim of this survey was to compare neutropenic and nonneutropenic patients who had received a diagnosis of invasive aspergillosis at our institution during a 6-year period. RESULTS: Among the 88 cases of invasive aspergillosis analyzed here, 12 were histologically proven, 52 were probable, and 24 were possible. Forty-seven percent of cases were diagnosed in the intensive care unit, and 40% were diagnosed in hematology units. Neutropenia was a risk factor for 52 patients (59%), most of whom had hematological or solid malignancies. Among the 36 nonneutropenic patients (41%), the main underlying conditions were steroid-treated chronic obstructive pulmonary disease, asthma, rheumatoid arthritis, giant-cell arteritis, and microvascular disorders; 10 patients were recipients of solid-organ transplants, and 1 patient was seropositive for human immunodeficiency virus. The distribution of proven and probable invasive aspergillosis was similar for neutropenic and nonneutropenic patients. The mortality rate was 71.5% overall and was significantly higher among nonneutropenic patients than among neutropenic patients (89% vs. 60%; P<.05). Compared with neutropenic patients, nonneutropenic patients were significantly less likely to have symptoms of invasive aspergillosis and more likely to have frequent intercurrent pneumonia due to another microorganism. The sensitivity of mycological examination of bronchoalveolar lavage fluid specimens was higher for nonneutropenic patients than for neutropenic patients (85% vs. 58%; P<.05), whereas the sensitivity of antigenemia was the same for the 2 populations (65% vs. 64%). Findings on thoracic computed tomographs were similar, except that segmental areas of consolidation occurred more frequently among neutropenic patients. CONCLUSION: This survey at a whole institution underlines the high number of cases of invasive aspergillosis among nonneutropenic patients, with an overall mortality rate that was significantly higher than that for neutropenic patients.

[Human trichostrongyloidosis: case report and microscopic difficulties to identify ankylostomidae eggs]. / Diagnostic microscopique différentiel des oeufs de type Ankylostomidé: à propos d'un cas de trichostrongyloïdose.

We present the case of a 53 year old woman living in a rural area and which suffered from gastric pain and high blood eosinophil polymorphonuclear counts for several years. The parasitological stool examination showed Trichostrongylus sp. larvae and eggs. Clinical and biological signs resolved after 2 courses of treatment with albendazole. We also report the microscopic difficulties to identify Ankylostomidae eggs.

[Cryptococcal infections in non-HIV infected patients. Study of four cases and review of literature]. / Infections à cryptocoque chez des patients non VIH. A propos de quatre cas et revue de la littérature.

BACKGROUND: Cryptococcal infections are frequent in HIV-infected patients and are regularly looked after. This infection may occur in others immunosuppressives situations and, in those cases, diagnosis is often delayed. METHODS: We report four cases of cryptococcal infections in patients whose immunosuppression isn't related with HIV infection but due to chronic lymphocytic leukemia, giant cell temporal arteritis, gastric neoplasm and lupus. Diagnosis, prognostic and treatment are detailed. RESULTS: Four patients aged from 25 to 76 presented a cryptococcal infection (three meningitis). A woman died at the admission. Another died seven years later. The two others are still alive under treatment. When infected, all patients were immunodeficiency. CONCLUSION: Cryptococcal infection may occur in patients non-HIV-infected patients. Early detection is needed to improve prognostic.

In vitro susceptibility testing of Candida and Aspergillus spp. to voriconazole and other antifungal agents using Etest: results of a French multicentre study.

Minimum inhibitory concentrations (MICs) of the antifungal agent voriconazole were determined using the Etest and compared with those of amphotericin B, itraconazole and fluconazole using 1986 clinical isolates of Candida spp. Voriconazole MICs were also compared with those of amphotericin B and itraconazole using 391 clinical isolates of Aspergillus spp. Voriconazole was found to have more potent activity and lower MIC values than amphotericin B, itraconazole and fluconazole against C. albicans, C. tropicalis, C. parapsilosis and C. kefyr. Against C. glabrata and C. krusei, voriconazole was more active than either of the other two azole antifungals but had similar activity to amphotericin B. For species of Aspergillus, MIC values of voriconazole were lower than those of amphotericin B and itraconazole against A. fumigatus and A. flavus, and were similar to those of amphotericin B against A. niger. Against A. terreus, MIC values for voriconazole and itraconazole were similar. A. terreus is known to be resistant to amphotericin B, and this was reflected in higher MIC values compared with those of voriconazole and itraconazole. Voriconazole therefore compares very favourably with other antifungal agents against a large number of clinical isolates of Candida and Aspergillus spp.

[Bird fleas (Insecta: Siphonaptera): taxonomic diversity, biogeographical distribution]. / Les Puces (Insecta : Siphonaptera) parasites d'Oiseaux: diversité taxonomique et dispersion biogéographique.

If Mammals are the primary hosts of Siphonaptera, 6% of them have changed their trophic appetency for Birds. What are the reasons, what are the adaptations to be adopted by Fleas, what are the families or species groups of fleas concerned, and at last what are the host-families? As to this last question, it is clear that deviation was ecological but not phyletical.

Use of DNA fingerprinting and biotyping methods to study a Candida albicans outbreak in a neonatal intensive care unit.

During a 15-day period, 7 premature infants hospitalized in a neonatal intensive care unit presented with sepsis caused by Candida albicans. The local environment and hands of all 54 persons involved in the intensive care unit were examined for the presence of this organism. Five techniques were used in the analysis of the isolates recovered from blood cultures of the children, the hands of personnel and 10 control isolates. The methods used were serotype determination, genetic fingerprinting, morphotyping, resistotyping and killer yeast typing. Morphotyping and genetic fingerprinting proved to be the most discriminatory techniques, and only combined analysis of the results obtained with these various methods allowed the source of the outbreak to be identified. An isolate from the hands of a healthy staff member and isolates from infected children all belonged to the same strain.

Light microscopic changes in Plasmodium falciparum from Gabonese children treated with artemether.

The changes in Plasmodium falciparum in four Gabonese children suffering from severe malaria and treated with pure artemether were observed in thin blood smears fixed and stained with Giemsa and examined by light microscopy. Peripheral blood samples were taken every 8 hr up to 72 hr from three children and every 3 hr up to 9 hr from the other child. The morphologic changes involved all development stages (trophozoites, schizonts, and gametocytes); they were first seen 3 hr after the start of treatment and all parasites were abnormal after 24 hr. After two days of treatment, all infected erythrocytes disappeared except for a few with necrotic trophozoites. The morphologic changes were similar to the ultrastructural changes previously described in vivo and in vitro in experimental models. They confirm the rapid effect of artemisinin derivatives on parasite clearance and clinical recovery, particularly in cases of cerebral malaria.

Efficacy of antiseptics and disinfectants on clinical and environmental yeast isolates in planktonic and biofilm conditions.

The aim of this study was to evaluate the efficacy of five antiseptics, three surface disinfectants and UV radiation against a wide range of clinical and environmental yeast isolates. Their efficacy against pure cultures, yeast mixtures and biofilms (prepared by culturing yeasts in Sabouraud broth containing a final concentration of 8% glucose) was tested. Three clinical isolates of Candida albicans, Cryptococcus neoformans and Rhodotorula rubra, and two environmental isolates of Candida albicans and Cryptococcus uniguttulatus were selected. For seven out of eight biocides tested (Betadine, Dermacide, Chlorhexidine, Dosisepsine, hydrogen peroxide, sodium hypochlorite, 70% alcohol, 0.5% Ecodiol) and for UV radiation, susceptibility did not differ according to genus, species or origin. Hydrogen peroxide, 0.25% Ecodiol and UV radiation were ineffective against the five isolates tested. On pure planktonic cultures, and, to a lesser extent, on free-living yeast mixtures, the other products were active and were then tested against biofilms: eight out of nine biocides were ineffective. Chlorhexidine at 0.5% was the only fungicidal agent on pure cultures, yeast mixtures and biofilms. The importance of the test method, including agent concentration, is discussed.

Prophylactic use of itraconazole for the prevention of invasive pulmonary aspergillosis in high risk neutropenic patients.

Invasive pulmonary aspergillosis (IPA) is an increasing cause of morbidity and mortality in patients with hematologic malignancies. A major program of construction work close to our unit prompted us to evaluate the efficacy of itraconazole prophylaxis in preventing IPA in these patients. During September 1994 to December 1995, 77 patients undergoing 96 neutropenic episodes (mean duration, 19.3 days +/- 9.1) received itraconazole as antifungal prophylaxis. All patients were treated in laminar air flow rooms. Itraconazole was administered at a loading dose of 600mg/d, (day 1 to day 3) and 400mg/d on the following days, in 87 instances. In the remaining episodes, the daily dose was 200 or 400mg. Oral doses were adjusted to reach a plasma itraconazole level (PIL) above 1000ng/l. In cases of inadequate PIL or poor oral intake, IV AmphoB was started at a 20 mg daily dose. Five cases of IPA (proven n = 2, probable n = 3) were observed. This represents an incidence of 5.2% of the total number of episodes. One out of 67 (2%) treatment episodes with adequate PIL were associated with IPA as compared to 4 of 29 (14%) episodes with inadequate PIL, (p < 0.02). AmphoB was added in 28 cases because of low PIL (n = 25), and/or antibiotic-resistant fever persistent pulmonary infiltrate (n = 8). These results need to be interpreted with caution, because of the absence of randomization or a control group. The efficacy of Itraconazole in neutropenic patients with high risk IPA has to be confirmed on larger and prospective studies.

Observations on the subgenus Argas (Ixodoidea: Argasidae: Argas). 19. Description of the larva of the Palearctic cormorant parasite A. (A.) macrostigmatus.

Larvae of 19 of the 21 species of the Argas subgenus Argas are already described. One of the two exceptions is A. (A.) macrostigmatus; we describe the larva of this species from wet nests of the crested cormorant, Phalacrocorax aristotelis, from Corsica, France. As in the adult and nymphal stages, this larva has an uncovered Haller's organ, a character shared in Palearctic members of this large genus only with A. (A.) polonicus, a Central European parasite of rock pigeons. Available larval samples of both species are indistinguishable. However, adult and nymphal A. (A.) macrostigmatus are unique for their exceptionally large spiracular plates. These are the only Argas (Argas) species which differ distinctly as adults and nymphs but hardly or not at all as larvae. Argas (A.) macrostigmatus was previously known only from a nest of the crested cormorant in the Black Sea. Ukrainian SSR.

[Can arboviruses from seabird colonies in Brittany infect man?]. / Les arbovirus des colonies d'oiseaux de mer de Bretagne peuvent-ils infecter l'homme?

Four tick-borne arboviruses circulate heavily and permanently among the seabirds colonies located along the coasts of Brittany: Soldado, Zaliv Terpeniya, Avalon and a member of Tyuleniy subgroup of flaviviruses. In order to appreciate the ability of these viruses to infect man, the authors studied for antibodies the sera of farmers living in South-Finistere, in the vicinity of Cape Sizun seabirds reserve. Antibodies were actually found on 14 of 474 farmers, or 3.0 per cent, substantiating the reality of infection by these agents. The possible mechanisms of the contamination and the eventual pathologic results of these viral infections are discussed.

[The colonization of forested areas by Ixodes ricinus (Linné, 1758) in France: use of the roe deer, Capreolus capreolus (L. 1758) as a biological marker]. / La colonisation des massifs forestiers par Ixodes ricinus (Linné, 1758) en France: utilisation du chevreuil, Capreolus capreolus (L. 1758) comme marqueur biologique.

The roe-deer is a wild animal for which Ixodes ricinus has a particular fondness. Its territory is similar to that of the ticks and it is a species which is found throughout France yet which rarely leaves its territory. Given these conditions, a systematic parasitological examination of the ungulate can provide pertinent information concerning the forests inhabited by the tick. Since it is difficult to conduct a thorough examination of a large number of roe-deer over a limited space of time and on a large territory, the best solution is to examine the hind feet (hooves and tarsus) of the animal which are widely covered by the preimaginal stages of the tick. This biological material is easily available to the extent that the measurements of the animals are often used for game management. A preliminary study was conducted in Dordogne (southwestern France). Out of the 137 pairs of feet examined more than 50% carried the tick species (larvae or nymphs). The critical analysis of the results obtained throughout the investigation enables us to be more specific about the conditions of application of the advocated method.

[The present status of the conquest of tropical Africa by Pulex irritans Linnaeus, 1758]. / Actualité de la conquête de l'Afrique intertropicale par Pulex irritans Linné, 1758.

Owing to human parasites, two fleas, namely Pulex irritans Linné, 1758 and Tunga penetrans (L., 1758) were brought from America to intertropical Africa. The conquest of Africa by Pulex irritans, was really effective since the fifties, evidently by european strains. Some examples selected in occidental and oriental Africa show the reality of this fact. Accordingly, the epidemiological modalities in plague's african foci can be strongly changed.

[Malaria in the infant in a rural area of maritime Guinea (Guinea Conakry). I. Immune and parasitic status of the mother and the newborn]. / Impaludation du nourrisson dans une zone rurale de Guinée maritime (Guinée Conakry). I. Statuts immunitaire et parasitaire de la mère et du nouveau-né.

Among 216 women who had given birth in the rural health maternity centre of Maférinyah (Guinea), 32% had parasitemia with no clinical signs. Antimalarial antibodies could be measured only for 156 women and were present in all of them. Serological antimalarial tests were carried out on 133 newborns, all of whom had antibodies. The serological results of 122 mother infant pairs are given in this article. The absence of parasitemia in 122 newborns confirms the rarity of congenital malaria and would seem to favour the protective role of transmitted maternal antibodies.

[Malaria in infants in a rural area of maritime Guinea (Guinea Conakry). II. Development of antimalarial antibodies and malaria during the first year of life]. / Impaludation du nourrisson dans une zone rurale de Guinée maritime (Guinée Conakry). II-Evolution des anticorps antipaludéens et impaludation au cours de la première année de vie.

A transversal investigation carried out on 551 children and a longitudinal study of 55 infants showed the disappearance of maternal anti-plasmodium antibodies during the first year of life. Out of 212 new-borns surveyed for one year, 59 (28%) were infested by Plasmodium, but never during the first two months of life. This infestation was not related to the age of the infant nor to the season. For 46% of cases, infestation was completely asymptomatic, for 18% of cases respiratory signs were present and for 20% digestive signs not specific to malaria. Fever was present in 14 cases (24%) and isolated in 6 cases. Only 7 infants received a specific antimalarial treatment. Evolution under medical surveillance was favourable in all cases. These findings prove the difficulties inherent to the diagnosis of malaria, especially in the absence of laboratories for diagnosing other infections--such as typhoid--which do not appear in sanitary statistics. The findings also raise the question as to the efficiency of systematic antimalarial treatment in case of fever in the infant or child. Asymptomatic parasitemia can be explained by the existence of antitoxic immunity different from antiplasmodia immunity.

[Keratomycosis, from head injury to aspergillosis]. / Kératomycose, du traumatisme initial à la tête aspergillaire.

Keratomycosis due to Aspergillus fumigatus occurs most often in immuno-competent patients who live and work in a fungus-rich atmosphere. Previous trauma with epithelial lesion are reported by most authors. While the new antifungal drugs may be effective, corneal graft is the most effective solution in uncontrolled cases. When performed early, good visual recovery was observed in most cases as reported in the literature and in our case.

[Serum IgE values in human scabies: study of 79 cases (author's transl)]. / IgE sériques et gale humaine. A propos de 79 cas.

The authors studied seric IgE levels in 79 patients with scabies: 48 p. 100 had significant elevated concentration of IgE (greater than 300 U. I./ml) (p less than 0,001). This is the fact of scabies infestation and is not the result of internal parasitic infestation, associated illnesses or atopic disease. There is a statistically significant correlation between high IgE levels and degree of extension (p less than 0,1) and, overall, eczematization (or) and superinfection (p less than 0,001).