Identification of the causative agent of cutaneous leishmaniasis in Chichaoua province, Morocco.

Cutaneous leishmaniasis (CL) in Morocco is caused by three species, Leishmania major, L. tropica and L. infantum. CL has been known in Chichaoua province since 2000. Using DNA extracted from microscopic slides and parasite cultures, collected in the years 2006 and 2009, we identified for the first time L. tropica as the causative agent of CL in this region. Species identification was achieved by performing the ITS1-PCR-RFLP approach. By using this method it was possible to identify parasites in Giemsa stained slides containing less than five parasites per oil-immersion field even they were conserved for up to four months.

Model of Effective Control of Leishmaniasis in North Central Morocco and Updating the Mapping of the Circulating Species.

Leishmaniasis is among the most important emerging vector-borne protozoal disease in terms of disability adjusted life year (DALY'S). The main objectives of this study are, firstly to evaluate the epidemiological situation of Cutaneous Leishmaniasis (CL) from 2000 to 2015 in Moulay Yacoub Province and Fez Prefecture and secondly to analyze the impact of several factors (geographical and socio-economic factors) on the distribution of CL in these provinces. In addition, this study aims to identify the circulating species of Leishmania in order to justify the cause of the case maintenance and to prevent possible epidemics. The spatio-temporal evolution of CL from 2000 to 2015 in the study area revealed the endemic and epidemic character of the disease with a variation in the number of cases according to provinces, and districts. The sharp decrease of cases observed in the study area could be explained by the several control measures that concern the different actors of leishmaniasis. According to the statistical study, the presence of leishmaniasis is mainly related to population movement and environmental conditions. The results of the clinical identification of cutaneous leishmaniasis in the study area showed a diversity of clinical features with the presence of symptoms miming for L. tropica or L. infantum. This result was confirmed by the molecular study PCR-ITS1-RFLP.

En absence du vaccin et vu la complexité et la diversité des cycles des leishmanioses au Maroc, en plus de la présence des facteurs de risque (urbanisation anarchique, changements climatiques, facteurs socio-économiques…), notre étude s'intègre dans le cadre du Programme national de lutte contre les leishmanioses qui est une des priorités dans les programmes de lutte instaurés par l'OMS. Les objectifs de cette étude sont premièrement d'évaluer la situation épidémiologique depuis le déclenchement de l'épidémie de leishmaniose cutanée (LC) en 2000 jusqu'à 2015 dans la province de Moulay Yacoub et la préfecture de Fès et secondairement d'analyser l'impact de plusieurs facteurs sur la distribution de la LC. Aussi, cette étude vise à identifier les espèces de leishmanies circulantes au niveau de cette région. L'évolution spatio-temporelle de la LC de 2000 à 2015 dans la zone d'étude a révélé le caractère endémoépidémique de la maladie. La nette diminution après le pic de 2001 des cas de la LC peut être liée aux différents moyens de lutte réalisés annuellement et qui ont concerné les différents maillons du cycle. Selon les résultats de l'étude statistique (Ordinary Least Squares Regression [OLSR] et Chi2), la présence de la LC est principalement liée aux mouvements de la population et aux conditions environnementales. Les résultats de l'approche d'identification ont montré une diversité des caractéristiques cliniques avec la présence de symptômes qui indiquent une LC à L. tropica ou à L. infantum. Ce résultat a été confirmé par l'étude moléculaire PCR-ITS1-RFLP.

[A rare infectious etiology of COPD exacerbation]. / Une étiologie infectieuse rare d'exacerbation de bronchopneumopathie chronique obstructive.

Chronic obstructive pulmonary disease (COPD) is a common respiratory disorder. Its exacerbation is infectious in more than half of the cases: with viral priority, while parasitic causes remain exceptional. In this work, we report a case of a COPD exacerbation caused by a visceral leishmaniasis (VL) complicated by a macrophage activation syndrome in an adult living in a Moroccan non-endemic region for this of leismaniasis form. In such atypical clinical feature, the diagnosis of VL was based on the myelogram after presence of peripheral cytopenia. Despite the seriousness of these pathologies, the early and specific treatment of VL allows a quickly improvement in the disorders caused by these diseases.

[Seroprevalence of toxoplasmosis in pregnant women in Rabat, Morocco]. / Séroprévalence de la toxoplasmose chez la femme enceinte dans la ville de Rabat au Maroc.

In Morocco, the seroprevalence of toxoplasmosis in pregnant women living in Rabat, was estimated by analyzing antibodies (IgG, IgM) levels using an ELISA test. The analysis of 2456 serums at the Institut National d'Hygiène showed that the seroprevalence of toxoplasmosis is about 50.6%. According to the questionnaire, the lack of knowledge about this disease and soil contact could be the main causes of toxoplasmosis infection. The use of IgG avidity test has excluded a recent infection in 93.5% of pregnant women with IgM positive sera.

Cutaneous leishmaniasis in Ouazzane and Sidi Kacem provinces, Morocco (1997-2012).

Cutaneous leishmaniasis (CL) is a major public health problem in Morocco. Three distinct parasites are involved; Leishmania tropica, Leishmania major and Leishmania infantum. The objective of this study is to investigate the epidemiological and the clinical features of endemic foci of CL in Sidi Kacem and Ouazzane provinces in the north of Morocco including molecular identification of parasites. We studied the evolution and the distribution of 1,656 CL cases coming from 39 sectors in these provinces between 1997 and 2012. The causative agents of CL in these areas were identified by using the ITS1-PCR-RFLP method. A tendency of seasonality in incidence was observed, showing a peak in April. Most infected patients were from Ouazzane province. The patients' ages ranged from 6 months to 85 years; 54% of them were females. The highest rate lesions were found in the age group of 9 years or less and most lesions were localized in the face (79.6%). The movement of populations from neighboring endemic areas and establishment of habitation in areas where housing conditions are unfavorable favored the emergence of the disease.

Scorpion envenomation and serotherapy in Morocco.

A clinical and biologic study was conducted in Morocco to assess the efficiency of antivenom therapy for treating victims of scorpion stings. Epidemiologic and clinical data were collected from 275 patients envenomed by Androctonus mauretanicus mauretanicus and Buthus occitanus scorpions. Patients received antivenom or other drugs. Blood samples were collected at the time of hospital admission and 1 hr and 3 hr after treatment. Serum venom levels were quantified by using an ELISA. An association was found between clinical signs of envenoming and the level of venom in serum. Patients classified as grade II (moderate envenoming) had higher serum levels of venom level than patients classified as grade I (mild envenoming). At admission to the hospital, the mean venom concentration was not significantly different between the group not treated with antivenom, the group who received 2-5 ml of antivenom, and the group who received 10 ml of antivenom. A significant decrease in serum venom levels and an improvement in the clinical conditions were observed in patients administered 10 ml of antivenom. The lower decrease in serum venom levels in patients who received 2-5 ml of antivenom was due to lower doses of antivenom. No difference in the venom concentration was observed in patients who were not treated with antivenom. The absence of administration of antivenom increased the risk of developing clinical signs at the end of the hospitalization period. However, this risk was much higher when more than 1 hr elapsed between the time of the scorpion sting and the time of hospital admission. The results demonstrate that antivenom is effective in decreasing circulating venom and morbidity. Serotherapy is more efficient when given as soon as possible after envenomation and with adequate quantities of antivenom.

Growth inhibition of Trypanosoma cruzi and Leishmania donovani infantum by different snake venoms: preliminary identification of proteins from Cerastes cerastes venom which interact with the parasites.

Venom from three different snake species was tested in vitro against the protozoan parasites Trypanosoma cruzi and Leishmania donovani infantum. Two of them, Cerastes cerastes and Naja haje, exerted a significant growth inhibition of T. cruzi and L. d. infantum parasites. Heating of the venoms abolished their activity, suggesting that the active factors are thermolabile. Incubation of parasites with 125I-labelled C. cerastes venom proteins allowed preliminary identification of components which interact preferentially with the pathogens.

[Spontaneous hemoperitoneum complicating intraperitoneal paraganglioma]. / Hémopéritoine spontané compliquant un paragangliome intra-péritonéal.

A young man of 27 years was admitted to the medical ward because of increasing ascites over 3 months. There were no signs of portal hypertension and a diagnostic tap produced hemorrhagic liquid. Ultrasound confirmed ascites associated with an abdomino-pelvic mass. Anemia progressed and right aorto-iliac axis arteriography was carried out and demonstrated a poorly vascularised mass. Emergency surgery was carried out and demonstrated an encapsulated firm and cystic abdomino-pelvic mass of 23/18 cm with a rich vascular supply from the greater omentum and a hemoperitoneum of 7 litres secondary to rupture of this pseudo-lymphangiomatous mass. Besides large vessels from the and some loose fibrous adhesions in the pouch of Douglas there was no true implantation site attaching this mass to retroperitoneal structures, gastrointestinal tract or bladder. After ligation of the vessels the entire mass was easily resected. The post-operative course was uncomplicated. Pathological examination confirmed a paraganglioma. A full clinical pathogenic, therapeutic and evolutive study is described.

Rioprostil in the short-term treatment of duodenal ulcer: a multicentre double-blind trial vs. cimetidine.

The efficacy and safety of the new prostaglandin E1 (PGE1) synthetic analogue, rioprostil, 300 micrograms b.d. and cimetidine, 400 mg b.d., on duodenal ulcer healing are compared in an international, multicentre, double-blind study. A total of 257 patients have entered the study; 243 are considered eligible for efficacy analysis and 207 for safety analysis. After 4 and 6 weeks of treatment, the endoscopic healing rates do not significantly differ between the two groups, being 55% and 83% respectively with rioprostil vs. 60% and 78% respectively with cimetidine. The major adverse effect attributable to rioprostil is diarrhoea, which was documented in 11% of patients compared with 1% of patients taking cimetidine. However, central nervous system complaints are twice as frequent in the cimetidine group. Monitoring of clinical laboratory tests show no significant abnormalities when compared with the baseline values during the administration of either drug. This study documents that rioprostil, at the dosage of 300 micrograms b.d., is as effective and safe as cimetidine in the short-term therapy of duodenal ulcer.

[Reflexions and thoughts about one case of acromegalic gigantism (author's transl)]. / Réflexions et rêveries à propos d'un cas d'acromégalo-gigantisme

Having observed a 22 year old man with a case of acromegalic-gigantism (2,30 m.) whose growth still continued after the ablation of a hypophyseal micro-adenoma, by trans-sphenoidale tract, the authors after making various neuroendocrine comments study from a psychological point of view the myth of the giant which appears to be linked to the myth of origins, from a phylogentical point of view (for example Atlantis) as well as from the ontogenetical point of view (identification to the father). The example is particularly ambivalent: at the same time idealized (the Heros), and rejected (the Ogre)--this is explained by the evolution of the father complex, and by the connections between, on the one hand the ego, and on the other hand the ideal ego and the couple ego ideal-super ego.

[An enormous gastro-intestinal hairball (author's transl)]. / Enorme trichobézoard gastro-intestinal

A case of a gastro-duodenal hairball is reported in a neurotic 19 year old woman. The case is remarkable because of the unusual length of the foreign body and the coexistence of two gastric ulcers which led to partial gastrectomy.