Nebulised liposomal amphotericin-B as maintenance therapy in allergic bronchopulmonary aspergillosis: a randomised, multicentre trial.

BACKGROUND: In allergic bronchopulmonary aspergillosis (ABPA), prolonged nebulised antifungal treatment may be a strategy for maintaining remission. METHODS: We performed a randomised, single-blind, clinical trial in 30 centres. Patients with controlled ABPA after 4-month attack treatment (corticosteroids and itraconazole) were randomly assigned to nebulised liposomal amphotericin-B or placebo for 6 months. The primary outcome was occurrence of a first severe clinical exacerbation within 24 months following randomisation. Secondary outcomes included the median time to first severe clinical exacerbation, number of severe clinical exacerbations per patient, ABPA-related biological parameters. RESULTS: Among 174 enrolled patients with ABPA from March 2015 through July 2017, 139 were controlled after 4-month attack treatment and were randomised. The primary outcome occurred in 33 (50.8%) out of 65 patients in the nebulised liposomal amphotericin-B group and 38 (51.3%) out of 74 in the placebo group (absolute difference -0.6%, 95% CI -16.8- +15.6%; OR 0.98, 95% CI 0.50-1.90; p=0.95). The median (interquartile range) time to first severe clinical exacerbation was longer in the liposomal amphotericin-B group: 337 days (168-476 days) versus 177 days (64-288 days). At the end of maintenance therapy, total immunoglobulin-E and Aspergillus precipitins were significantly decreased in the nebulised liposomal amphotericin-B group. CONCLUSIONS: In ABPA, maintenance therapy using nebulised liposomal amphotericin-B did not reduce the risk of severe clinical exacerbation. The presence of some positive secondary outcomes creates clinical equipoise for further research.

[Bacterial and fungal co-infection: an association of criminals to look for]. / Co-infection bactérienne et fongique : une association de malfaiteurs à chercher.

INTRODUCTION: Mucorales are fungi that cause opportunistic infections. Its incidence increases. CASE REPORT: We report case of a 68-year-old woman with myelodysplastic syndrome responsible for prolonged neutropenia, hospitalized for pneumonia and sinusitis caused by Pseudomonas aeruginosa. But, despite antibiotic therapy, the patient's health deteriorated with discovery of systemic emboli on CT-scan and died. Sinus biopsies performed before her death diagnosed invasive fungal infection (Mucorales). CONCLUSION: Mucorales co-infections are rare but have already been described. Any invasive fungal infection should be searched on the event of any clinical suspicion: ground (neutropenia), lack of response to well-conducted antibiotic therapy, rapidly unfavorable outcome. The presence of other microbiological documentation do not must stop the search of invasive fungal infection, because it could have short-term life-threatening impact.

[Duodenal ulcers caused by chloroquine-proguanil association]. / Ulcérations duodénales dues à l'association chloroquine-proguanil.

Chloroquine-proguanil association is recommended for prophylaxis against falciparum malaria in countries with a low prevalence of chloroquine resistance. It is usually well tolerated with mild side effects consisting mainly of transient digestive discomfort and buccal manifestations (mouth sores or ulcers). The purpose of this report is to describe a case of duodenal ulcers presenting as epigastric pain with 10-kg weight-loss in a 32-year-old man taking chloroquine-proguanil for malaria prophylaxis during a stay in Haiti. No other causes of duodenal ulcers or weight-loss were found. Chloroquine-proguanil prophylaxis was discontinued and replaced by omeprazole for four weeks. Symptoms improved quickly and full recovery was observed within one month. To our knowledge, the occurrence of duodenal ulcers under chloroquine-proguanil association is quite rare, but possibly severe. Upper digestive endoscopy should be performed if a patient under chloroquine-proguanil develops abdominal pain especially in association with weight-loss. If endoscopy reveals duodenal ulcers, chloroquine-proguanil should be discontinued and replaced by another prophylactic regimen.

Evaluation of pneumococcal urinary antigen testing for respiratory tract infection investigations.

OBJECTIVE: The pneumococcal urinary antigen test enables rapid bacteriological diagnosis in respiratory tract infections. The objective was to identify factors associated with a positive pneumococcal urinary antigen test result. PATIENTS AND METHODS: This seven-year retrospective monocentric study was performed on consecutive patients presenting with respiratory tract infections reported as pneumococcal-positive. Epidemiological, biological, and radiological factors were analyzed, and severity scores were calculated. RESULTS: A total of 223 patients were included. Significant associations were observed between positive test results and age over 65years (P=0.01), positive test results and immunosuppression factors (blood disease [25% Ag+ group vs. 4% Ag- group, P=0.001], immunosuppressive therapy [10% Ag+ group vs. 0% Ag- group, P=0.02]). Clinically, fever (64% Ag+ group vs. 42% Ag- group, P=0.01) and cough (46% Ag+ group vs. 19% Ag- group, P<0.01) were associated with a positive result, as were radiological alveolar opacities (67% Ag+ group vs. 44% Ag- group, P=0.01). High PSI score was associated with the Ag+ group (79% vs. 56% Ag- group, P=0.001). CONCLUSION: Age, immunosuppressive factors, typical pneumococcal symptoms, and PSI scores were associated with a positive pneumococcal urinary antigen result.

[Erlotinib and nonsmall cell lung cancer with brain metastases: a case study with a complete and prolonged response over 17 months]. / Erlotinib et métastases cérébrales d'un cancer bronchique non à petites cellules : une réponse complète et prolongée de 17 mois.

The prognosis of stage IV nonsmall cell lung cancer, in particular with brain metastases, is extremely poor. The impact of targeted therapy, in particular erlotinib, on patient survival has still not been determined. The authors report the case of a patient diagnosed with nonsmall cell lung cancer with bone and brain metastases. The patient presented a complete cerebral response for 17 months with erlotinib prescribed as a third line therapy.

[Disseminated nocardiosis caused by Nocardia nova with brain abscesses and osteomyelitis in an immunocompetent patient]. / Nocardiose disséminée à Nocardia nova avec abcès cérébraux et ostéomyélite chez un patient immunocompétent.

INTRODUCTION: Nocardia is an opportunist bacteria involved in patients with cellular immunodepression or chronic lung disease. The most frequent portals of entry are the respiratory tract by inhalation or direct inoculation through a cutaneous effraction. Nocardiosis may be localised or disseminated. CASE REPORT: We report a rare case of disseminated nocardiosis to Nocardia nova with pulmonary, cutaneous, cerebral attacks and femoral osteomyelitis. The diagnosis was confirmed by prolonged cultures of the bronchoalveolar fluid and the pus extracted from a cutaneous lesion. The outcome was favorable under adapted and prolonged antibiotherapy with imipenem and amikacine and then cotrimoxazole. CONCLUSION: This observation is original because it involves a immunocompetent patient with an association of two exceptional locations for N. nova: brain abscesses and femoral osteomyelitis. Screening for cerebral involvement should be systematic, even in the lack of neurological signs. An adapted and prolonged antibiotherapy must be conducted.

[A case of atypical pericarditis]. / Une péricardite atypique.

INTRODUCTION: An acute viral pericarditis may reveal a congenital pericardial abnormality. CASE HISTORY: We report the case of a young man of 29 years in whom the development of rapidly progressive dyspnoea and fever led to the echocardiographic diagnosis of a pericardial tumour. The thoracic CT scan showed a mass arising in the superior mediastinum with no evidence of spread. Surgical exploration allowed the excision of a soft mutilobular mass adherent only to the aorta. Histological examination revealed an intrapericardial bronchogenic cyst. CONCLUSION: After a review of bronchogenic cysts we point out the properties of this rare intra-pericardial localisation, one of which is the frequently observed secretion of CA 19-9.

[Positron emission tomography in the diagnosis and follow up of non-small cell lung cancer]. / 18F-FDG-TEP : sa place dans le diagnostic et la surveillance du cancer bronchique non à petites cellules.

In the space of a few years 18F-FDG PET scanning has acquired a place in the management of all stages of the clinical care of patients with lung cancer. Its contributions are being more and more precisely understood during the assessment of mediastinal and metastatic extension and it carries the hope of better therapeutic management and surveillance.

[Comparison of specific composition and mosquitoes population dynamics in two villages of the centre of Côte-d'Ivoire, with and without irrigated rice growing area]. / Comparaison de la composition spécifique et de la dynamique des populations de moustiques dans deux villages du centre de la Côte-d'Ivoire, avec et sans périmètre de riziculture irriguée.

Entomological surveys were undertaken between October 1994 and August 1995 and from April to August 1995 in the villages of Kafiné and Pékaha, respectively These villages are located in the centre of Côte-d'Ivoire in a humid savannah area in the prefecture of Niakaramandougou. Rice plots are located to about 500 meters from the first habitations of Kafiné. They also form an enclosure around the village causing a great culicidian nuisance. On the other hand in the village of Pékaha, situated at 8 km from the enclosure, one can find a non-developed low ground area with swamps according to the season which has caused the multiplication of anthropophilic Culicidae. Five genera of mosquito were caught in the two villages: Anopheles, Aedes, Culex, Mansonia and Uranotaenia. The genus Anopheles is by far the most predominant in Kafiné with 84.3% (n=17556). Mansonia, Culex and Aedes respectively constitute 12%, 3% and 0.01% of the total anthropophilic mosquitoes. In the contrary the genus Mansonia was the most predominant in Pékaha with 78.2% (n=6642). Anopheles, Aedes and Culex respectively represent 13.2%, 8.3% and 0.1% of the total number of mosquitoes caught during the surveys. If in the village of Kafiné, the culicidian nuisance is mainly due to anopheles mosquitoes (84.3%) and particularly to An. gambiae s.s. (70.6%), in the village of Pékaha, dwellers suffer more from Mansonia (78.2%) bites than those of Anopheles (13.2%).

[Mycobacterial pulmonary infection due to Mycobacterium simiae]. / Mycobactériose pulmonaire à Mycobacterium simiae.

INTRODUCTION: Mycobacterium simiae pulmonary infections remain exceptional in France. CASE REPORT: We report a case of M. simiae lung infection and a 10-year follow-up in a non-immunocompromised host. CONCLUSION: This case emphasizes the difficulties of choosing the appropriate drugs and their side effects in the absence of any existing gold standard.

[Mycobacterium simiae pneumonia: a case report]. / Pneumopathie à Mycobacterium simiae: à propos d'un cas.

We report a case of Mycobacterium simiae pneumonia in an immunocompetent women aged 55 years, after a stay in Thailand. The diagnosis was based on culture isolation of non-tuberculous mycobacteria from bronchoalveolar lavage. The culture isolate was identified as M. simiae by biochemical and molecular methods. The patient was treated. Her condition remained stable for 5 years. During the sixth years, a relapse occurred, and a new treatment was prescribed. This is a rare case in view of the absence of any predisposing factor. M. simiae should be considered a possible causative agent of pulmonary disease, even in immunocompetent patients.

Release of Mesocyclops aspericornis (Copepoda) for control of larval Aedes polynesiensis (Diptera: Culicidae) in land crab burrows on an atoll of French Polynesia.

On Tereia Island, Rangiroa Atoll, 14,321 land crab burrows were treated with the copepod Mesocyclops aspericornis from January to June 1986, to control larvae of Aedes polynesiensis marks. In October 1987, the entire island of Tereia was retreated (17,300 burrows), and the neighboring island, Voisin, was left untreated as a control. From 5 to 15 mo after treatment, burrows with M. aspericornis contained an average of 2 Ae. polynesiensis immatures compared with 97 immatures from untreated burrows. Long-term larval control was successful in low-lying areas where burrows remained wet or were reflooded. Although there may have been other contributing factors, the major reason for lack of persistence of M. aspericornis in burrows over the entire island appeared to be poor resistance to desiccation. From all treated burrows in October 1987, M. aspericornis subsequently was found in 89.5, 39.1, and 24.1% of burrows sampled 5, 8, and 15 mo after treatment, respectively. The broad-scale results for Tereia indicated that there was no reduction of adult biting indices when compared with Voisin. Mark-release experiments on four occasions indicated that Ae. polynesiensis had a limited flight range and that the probability for interisland movement was low.

Distribution of organophosphate and carbamate resistance in Culex pipiens quinquefasciatus (Diptera: Culicidae) in West Africa.

The distribution of organophosphate and carbamate resistance was investigated in 33 samples of Culex pipiens quinquefasciatus Say from 25 cities in Côte d'Ivoire and Burkina Faso. Organophosphate resistance levels were higher in Côte d'Ivoire than in Burkina Faso. Chlorpyrifos resistance ratios at LC95 ranged from 4 to 30 times in Côte d'Ivoire and from 3 to 6 times in Burkina Faso. For temephos, ratios ranged from 3 to 18 and from 1 to 2, respectively. Of 27 samples from Côte d'Ivoire, 25 also displayed cross resistance to carbamates as shown by a mortality plateau in bioassays with propoxur and carbosulfan (similar to chlorpyrifos). Cross resistance to organophosphates and carbamates was caused by an insensitive acetylcholinesterase allele (AceR). This gene was absent from Burkina Faso, except in Niangoloko near the Côte d'Ivoire border. Organophosphate resistance also was associated with the presence of A2-B2 overproduced esterases which had higher frequencies in Côte d'Ivoire (75-100%) than in Burkina Faso (40-50%). Two other esterases with the same electrophoretic mobility as C2 from Puerto Rico and B1 from California were identified for the 1st time in West Africa. "C2" was widespread, whereas "B1" was present in only a few mosquitoes from Côte d'Ivoire. These differences in resistance patterns should be taken into consideration in planning urban mosquito control strategies within 2 countries.

An episode of resistance to permethrin in larvae of Simulium squamosum (Diptera: Simuliidae) from Cameroon, after 3 1/2 years of control.

Because of the biting nuisance from females of Simulium squamosum, a 30 km section of the Sanaga River (Cameroon) was treated since 1987 with permethrin for the control of larval populations. In 1990, resistance to permethrin occurred in a small proportion of the larvae, with a resulting 2-4x increase of the LC95 for dead larvae (moribund larvae considered as live). In 1991, after a 6-month interruption of the treatments, susceptibility to permethrin returned to the initial level, and was similar to the susceptibility of S. squamosum larvae from a non-treated section of the Sanaga. In the context of a small-scale control program, resistance to permethrin can be reversible, and it can be avoided by rotation with other types of insecticides such as Bacillus thuringiensis serovar, israelensis.

[Natural vector capacity level of Simulium damnosum s.l. (Diptera: Simuliidae) at the ecology station of Tai (Côte d'Ivoire)]. / Capacités vectrices naturelles du complexe Simulium damnosum s.l. (Diptera:Simuliidae) au niveau de la station écologique de Taï (Côte d'Ivoire).

Several studies have been carried out on the transmission of Onchocerciasis by Simulium damnosum s.l. in the forest zone of Côte d'Ivoire. This study, carried out in 1979-1980 was devoted to determine the risk of onchocerciasis transmission inside and outside the rain forest of Taï (5 degrees 50' N-7 degrees 25' W). We present the vectorial capacity of S. sanctipauli in the region of Taï before massive flow of refugees from areas of Liberia without any control Programme. The results of micromorphological technics for determination of S. damnosum adults, showed that mainly females of S. sanctipauli were present. The studied populations had low parturity rates: 39.2% outside and 30.9% of parous flies inside the rain forest. The parasitic rates (0.4% of infectious females outside and 0.1% inside) and their parasitic loads (15 and 3 infective larvae per 1000 parous female respectively outside and inside the rain forest) were low, consequently their vectorial capacity with Onchocerca volvulus was almost non-existent in natural conditions. Before massive flow of refugees including persons carrying microfilariae, there were no problem of onchocerciasis within and outside the rain forest of Taï. However, the massive flow of refugees and the deforestation for growing crops can create situations favourable to the installation of more efficient vectors, increase man/vector contact and contribute to more intense onchocerciasis transmission. The monitoring of onchocerciasis transmission is necessary.

[Window traps and displacement of adult Simulium damnosum s.l. along a line of breeding sites in a forest zone of Côte d'Ivoire]. / Vitres-pièges et déplacement des adultes de Simulium damnosum s.l. le long d'une ligne de gîtes en zone forestière de Côte d'Ivoire.

The displacement of adult black flies along a line of breeding sites has been studied in savannah area and in pre-forest zone. This paper presents the results of studies carried out in forest zone of Côte d'Ivoire. Interception traps made with sticky window traps were vertically displayed cross the river. The results showed that the displacement of adult S. damnosum s.l. along a line of breeding sites is correlated with the river flow. In a period of low discharge, adult black flies present a marked tendency to fly up stream. But in period of heavy discharge, they do not show any tendency; they may fly ever up stream or down stream. They fly essentially at the water level during the period of low flow and at a height between 0.5 to 1.5 m during heavy flow of the river.

[Evaluation of the efficacy of Bacillus sphaericus Neid 1904 applied to previously cleaned gutters for Culex quinquefasciatus Say 1823 control in Abidjan (Côte d'Ivoire)]. / Evaluation de l'efficacité de Bacillus sphaericus neid 1904 appliqué dans des caniveaux préalablement nettoyés, pour lutter contre Culex quinquefasciatus Say 1823 à Abidjan (Côte d'Ivoire).

In the framework of a pluri-institutional research project, led in Abidjan and aimed at defining measures to fight against mosquitoes in Abidjan area, a test to struggle for C. quinquefasciatus larvae was carried out in 1990. This test was conducted in Koumassi, which is one of Abidjan district, in which environmental conditions are very favourable for developing C. quinquefasciatus non-adult stages. The test consisted essentially in spreading a Bacillus sphaericus waterish solution (dose: 10 g.m-2) in previously cleaned gutters. The efficiency of the fight test was essentially assessed through: -the size of C. quinquefasciatus non-adult stages populations according to their development stage (egg, larva, nymph); -variations of both, C. quinquefasciatus females aggressive density and their physiological age. The gutters cleaning did not reduce significantly C. quinquefasciatus non-adult stages populations. On the other hand, the effectiveness of B. sphaericus was convincing. Its effects were tested to last for four weeks. The results were confirmed by the observations made on C. quinquefasciatus adult populations.

[Dynamics of malaria transmission in Kafiné, a rice growing village in a humid savannah area of Côte d'Ivoire]. / La dynamique de la transmission du paludisme à Kafiné, un village rizicole en zone de savane humide de Côte d'Ivoire.

A study on malaria transmission based on samples of mosquitoes caught on human subjects was conducted from February to August 1995 in the rice growing area of Kafine, a village located in the Niakaramandougou district of northern Côte d'Ivoire. The village is surrounded by 117,500 acres of rice fields. Irrigation is sub-permanent in the rice field and harvests number two a year. During the 6 months of the study, 12.353 mosquitoes were caught. The average biting rate was 118.8 bites per man per night (b/m/n). Mansonia, Culex and Aedes represented only 17.5% of the total number of mosquitoes caught. Anopheles accounted for 82.5% of the number of anthropophilic mosquitoes. Anopheles gambiae s.s. represented 83.7% of the total Anopheles species. As a whole, the average biting rate recorded for the Anopheles was 98 b/m/n. The average biting rate of An. gambiae was 90.4 b/m/n. The highest rate (121.5 b/m/n) was recorded in April. During the dry and rainy season, the indoor biting cycle per hour of An. gambiae s.s. was studied from 6 p.m. to 6 a.m. In both seasons, a marked biting activity was noticed between 10 p.m. and 5 a.m. The average annual parity rate reached 40.2% but it ranged from 59.8% (n = 82) in February to 19% (n = 63) in May. The mean sporozoitic index of An. gambiae throughout the study period was 1.1% (14 positive salivary glands/1.251 dissected). The index ranged from 0 in April, May and June to 6.2 (n = 192) in July. The rate did not vary with rainfall but with the different stages of rice growing. The non-synchronisation of agricultural practises for each growing cycle seemed to be a conclusive factor in the transmission of malaria in this locality. Malaria transmission at Kafine can be characterised by 3 main elements: transmission is intensive with an estimated inoculation rate of 1 ib/m/n; transmission is more related to double phase rice cultivation (regardless of synchronisation on plots) than to rainfall; transmission shows particular variations linked to rice cultivation cycles with an increase during periods of ripeness and harvest. The nuisance caused by higher mosquito density has brought people to comply with use of pyrethroid impregnated bed nets advocated for wide use by the National Malaria Control Program.

[Neurinoma of the intratemporal facial nerve. Anatomo-clinical classification of 12 cases]. / Neurinomes du nerf facial intra-temporal. Classification anatomo-clinique de 12 cas.

Neuromas of the intratemporal facial nerve are uncommon benign tumors, mostly schwannomas. An anatomo-clinical classification is proposed in view of the 12 cases reported here: neuromas of the internal auditory canal and of the cerebello-pontine angle, presented as a sensorineural hearing loss; neuromas of the geniculate ganglion area, presented as a progressive facial palsy, or mimicking a facial palsy a frigore; tympano-mastoid neuromas, presented as a retro-tympanic mass or a tumor extended into the external auditory canal, associated with a conductive hearing loss. Complete excision of the tumor requires the resection of a segment of the nerve that is immediately restored with end-to-end anastomosis or placement of a cable-graft. In some cases, however, the facial nerve can be preserved.

[Surgical protocol of velo-palatal and labio-nasal clefts]. / Protocole chirurgical des fentes vélopalatines et labionarinaires.

Based on a series of 52 cases of velopalatine and labionarinal clefts treated according to the same principle of therapeutic chronology, the authors define their recent surgical protocol for the primary repair of these clefts. Satisfactory functional repair of the tongue and platysma muscles of the face determine the good anatomical results and, in particular, the development of the maxilla together with the results on speech and middle ear pathology. Pathophysiological elements argue in favour of staphylorrhaphy as the first operative stage in unilateral labiovelopalatine clefts associated, at the same time, with cheilorhinoplasty; passive orthodontia is generally performed until the secondary palatoplasty. The surgical repair technique is closely related to this therapeutic timing in terms of the muscular and periosteal detachments.