Lyme borreliosis and other tick-borne diseases. Guidelines from the French scientific societies (II). Biological diagnosis, treatment, persistent symptoms after documented or suspected Lyme borreliosis.

The serodiagnosis of Lyme borreliosis is based on a two-tier strategy: a screening test using an immunoenzymatic technique (ELISA), followed if positive by a confirmatory test with a western blot technique for its better specificity. Lyme serology has poor sensitivity (30-40%) for erythema migrans and should not be performed. The seroconversion occurs after approximately 6 weeks, with IgG detection (sensitivity and specificity both>90%). Serological follow-up is not recommended as therapeutic success is defined by clinical criteria only. For neuroborreliosis, it is recommended to simultaneously perform ELISA tests in samples of blood and cerebrospinal fluid to test for intrathecal synthesis of Lyme antibodies. Given the continuum between early localized and disseminated borreliosis, and the efficacy of doxycycline for the treatment of neuroborreliosis, doxycycline is preferred as the first-line regimen of erythema migrans (duration, 14 days; alternative: amoxicillin) and neuroborreliosis (duration, 14 days if early, 21 days if late; alternative: ceftriaxone). Treatment of articular manifestations of Lyme borreliosis is based on doxycycline, ceftriaxone, or amoxicillin for 28 days. Patients with persistent symptoms after appropriate treatment of Lyme borreliosis should not be prescribed repeated or prolonged antibacterial treatment. Some patients present with persistent and pleomorphic symptoms after documented or suspected Lyme borreliosis. Another condition is eventually diagnosed in 80% of them.

Lyme borreliosis and other tick-borne diseases. Guidelines from the French Scientific Societies (I): prevention, epidemiology, diagnosis.

Lyme borreliosis is transmitted en France by the tick Ixodes ricinus, endemic in metropolitan France. In the absence of vaccine licensed for use in humans, primary prevention mostly relies on mechanical protection (clothes covering most parts of the body) that may be completed by chemical protection (repulsives). Secondary prevention relies on early detection of ticks after exposure, and mechanical extraction. There is currently no situation in France when prophylactic antibiotics would be recommended. The incidence of Lyme borreliosis in France, estimated through a network of general practitioners (réseau Sentinelles), and nationwide coding system for hospital stays, has not significantly changed between 2009 and 2017, with a mean incidence estimated at 53 cases/100,000 inhabitants/year, leading to 1.3 hospital admission/100,000 inhabitants/year. Other tick-borne diseases are much more seldom in France: tick-borne encephalitis (around 20 cases/year), spotted-fever rickettsiosis (primarily mediterranean spotted fever, around 10 cases/year), tularemia (50-100 cases/year, of which 20% are transmitted by ticks), human granulocytic anaplasmosis (<10 cases/year), and babesiosis (<5 cases/year). The main circumstances of diagnosis for Lyme borreliosis are cutaneous manifestations (primarily erythema migrans, much more rarely borrelial lymphocytoma and atrophic chronic acrodermatitis), neurological (<15% of cases, mostly meningoradiculitis and cranial nerve palsy, especially facial nerve) and rheumatologic (mostly knee monoarthritis, with recurrences). Cardiac and ophtalmologic manifestations are very rarely encountered.

[The genus Tunga Jarocki, 1838 (Siphonaptera: Tungidae). I: taxonomy, phylogeny, ecology and pathogenicity]. / Le genre Tunga Jarocki, 1838 (Siphonaptera : Tungidae). I - Taxonomie, phylogénie, écologie, rôle pathogène.

This is the first review of the taxonomy and geographical range of the 12 known species of the genus Tunga. Their biology and pathogenic roles are considered, with particular emphasis on their phylogeny, chorology, phenology, sex-ratio, and dermecos.

[Scientific basis for prevention]. / Données fondamentales à la base des mesures préventives.

Lyme Borreliosis is the most common tick-transmitted disease in North America and Europe. Borrelia burgdorferi sensu lato causes Lyme disease and is transmitted by a tick belonging to Ixodes genus. The risk of tick-borne infection depends on the ecology of ticks. The risk of human infection depends on the density of the tick population and its infection rate. The aim of this manuscript is to review the ecology of Ixodes ricinus the main vector of Lyme disease in Western Europe, the reservoir hosts, and studies on locations of Ixodes and Borrelia in France. Ixodes ricinus is widely distributed over the French territory except in Mediterranean areas and land above than 1,500 m.

[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.

[Cutaneous Alternaria infectoria infection after liver transplantation]. / Infection cutanée à Alternaria infectoria après greffe hépatique.

We report a case of cutaneous alternariosis after liver transplantation. This rare phaeohyphomycosis is mainly observed in patients treated by corticosteroids. This case is remarkable for the species isolated: Alternaria infectoria. Clinical and histopathological features are studied and diagnostic problems are discussed.

Prevalence of Borrelia burgdorferi (sensu lato) in Ixodes ricinus (L.) populations in France, according to a phytoecological zoning of the territory.

Ixodes ricinus is considered as the main vector of Lyme Borreliosis in France. The aim of our investigations was to obtain a comprehensive view of the spatial risk linked to the distribution of the species in our country. Previous studies [1] have provided strong evidence that the species populations are widely distributed, so the objective of the present work was to ascertain the bacteriological infection of the tick by the agent of the zoonosis (Borrelia burgdorferi, sensu lato), over the French territory, whatever the ecological conditions may be. For this purpose, we kept the same framework as that used in our acarological investigation, a phytoecological zoning of the territory into 54 geographically separate and ecologically distinct units distributed into three climatic zones. Batches of ticks, picked up in these different phytoecological units (only two thirds of which were sampled), were submitted for bacteriological investigation. A total of 4,673 ticks were examined, individually, for the presence of Borrelia burgdorferi, by immunofluorescence. Percentages of infection according to the various stages of Ixodes ricinus free stages, collected by flagging, were as follows: 4.95% in 3,247 nymphs, 11.2% in 699 males, 12.5% in 727 females. Larvae were ignored. Practically all the tested units harboured the bacterium. The percentage of tick samples (25 ticks or more) absolutely free of Borrelia, wherever they came from, is very low (not exceeding 10 percent of the sampled forests). Our study confirms the assessment of a widespread distribution of the zoonosis in France which was, until now, exclusively based on an approximate distribution of limited human cases observed in the country.

Successful treatment of a brain abscess due to Trichoderma longibrachiatum after surgical resection.

A case of brain abscess due to Trichoderma longibrachiatum in a leukemic patient with prolonged neutropenia is reported. Definitive cure was achieved after neurosurgical resection of the abscess and prolonged antifungal therapy. Trichoderma is a filamentous fungus species, which is only exceptionally pathogenic in humans. This genus and particularly the species Trichoderma longibrachiatum should be added to the growing list of fungi causing infection in immunocompromised patients.

[Ecoepidemiology of Lyme borreliosis in the Rhône-Alps region. Distribution, ecological context, relationship to the distribution of Ixodes ricinus (Linnaeus, 1758)]. / Ecoépidémiologie de la borréliose de Lyme dans la région Rhône-Alpes. Répartition, contexte écologique, relations avec la distribution d'Ixodes ricinus (Linné, 1758).

The aim of the study was to precise the geographical repartition of Lyme borreliosis in the Rhône-Alpes district, to describe the ecological characteristics of the areas propitious to the disease, and to verify the vectorial competence of I. ricinus. The cases of Lyme disease were located by means of a questionnaire sent to 1156 physicians. The vector role of I. ricinus was studied by two ways: firstly by searching a correlation between the geographical repartition of the tick and that of cases, secondly by proving the Borrelia infection of the tick. Lyme disease is widely spread in the study area, mainly at the foothill level, its repartition is largely coinciding with that of I. ricinus which was found infected by B. burgdorferi (s.l.). However a few cases, located near the Mediterranean area, set an unanswered problem.

[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.

[Visceral leishmaniasis in an infant in Brittany: discussion on the modes of transmission out endemic zones]. / Leishmaniose viscérale chez un nourrisson en Bretagne: discussion sur les modes de transmission hors des zones endémiques.

The case of a 13 month-old-boy with visceral leishmaniasis acquired in Brittany, a region of France where leishmaniasis is not endemic, is presented. The mode of contamination remains unclear, although a transfusional origin through blood transfusions during the neonatal period appears the most likely.

[Predictive factors in the bipolarization of depressive disorders]. / Les facteurs prédictifs de la bipolarisation des troubles dépressifs.

Since 1966 maniac-depressive illness has been divided into bipolar disorder (BP) and unipolar disorder (UP). Both groups are still in the process of subtyping (bipolar I,II,III and the tentative subtyping of unipolar group by Winokur). When affective disorder begins with depressive episodes is it possible to predict future mania and anticipate BP diagnosis? Are they variables of good predicting value for bipolarization? The issue is of importance since handicap, evolution, prognosis, treatment are somewhat different for UP and BP. Several studies indicate some possible predictors of bipolarization: pharmacological mania, bipolar familial antecedents, postpartum first episode, hypersomnia and psychomotor retardation, psychotic depression, etc. Special attention is given to switch to mania during antidepressant treatment.