Cutaneous basidiobolomycosis: Seven cases in southern Benin.

BACKGROUND: Cutaneous basidiobolomycosis is the most common form of entomophthoramycosis. Herein we report seven cases of cutaneous basidiobolomycosis. PATIENTS AND METHODS: A retrospective observational study was conducted at the Buruli ulcer treatment centre in Pobè and at the national teaching hospital in Cotonou from 2010 to 2015. RESULTS: Seven cases of cutaneous basidiobolomycosis were diagnosed. The mean patient age was 9.53 years. There were 4 female and 3 male patients, all from southeast Benin. Clinically, the disease presented in all cases as a hard, well-defined, subcutaneous plaque with little inflammation, and which could easily be lifted from the deep structures but remained attached to the surface structures. The overlying skin was hyperpigmented. Plaques were localized to the buttocks or thighs. All patients had inflammatory anaemia with an accelerated erythrocyte sedimentation rate (30 to 70mm over the first hour), and a low haemoglobin count (8.7 to 11.4g/dL). Blood hypereosinophilia (650 to 3784elements/mm3) was present in six of the seven subjects. Histopathology (performed for 5 of the 7 subjects) showed granulomatous lesions with foreign-body giant cells, and inflammatory cells, with occasional eosinophils surrounding fungal hyphae (Splendore-Hoeppli phenomenon). Mycological analysis revealed Basidiobolus ranarum in three cases. The patients were treated with ketoconazole (5/7) and itraconazole (2/7), with good outcomes after 10 to 24 weeks of therapy. DISCUSSION: Cutaneous basidiobolomycosis is uncommon in southern Benin, with only seven cases being diagnosed over 6 years. The diagnosis of cutaneous basidiobolomycosis is a challenge in the field in Benin due to the non-specific clinical presentation, the lack of technical resources, and the existence of numerous differential diagnoses. CONCLUSION: Cutaneous basidiobolomycosis is an uncommon fungal infection in southern Benin chiefly affecting children.

[Neuromeningeal cryptococcosis in Mali]. / La cryptococcose neuro-méningée au Mali.

Cryptococcal meningitis is the most common fatal central nervous system infection in AIDS patients in Sub-Saharan Africa. The purpose of this prospective study conducted from March 2003 to February 2004 in the internal medicine and infectious diseases departments of the Point G University Hospital Center was to investigate the clinical, prognostic and epidemiological profile of Cryptococcus neoformans infection in patients hospitalized for brain and meningeale infection (BMI). Diagnosis of neuromeningeal cryptococcosis (NMC) was based on positive identification of Cryptococcus by direct exam of the cebrospinal fluid (CSF) after India ink staining and/or culture on Sabouraud medium without actidione. During the study period, a total of 569 patients were hospitalized including 235 (41.3%) with HIV infection. Overall C. neoformans was identified in 14 patients. Median patient age was 39 +/- 8 years. There was a male preponderance with a sex ratio of 1.8 (9 men/5 women). Patients with BMI were HIV-positive in 85.7% of cases (n=12) and HIV-negative in 14.3% (n=2). The overall and HIV-specific prevalence of BMI was 2.5% and 5.1% respectively. The CD4 lymphocyte count was between I and 49 cells/mm3 in 64.3% of cases. The main clinical symptoms were cephalea in 85.7% of cases, altered consciousness in 50% and nausea/vomiting in 35.7%. Neurological manifestations (hemiparesis and cranial nerve deficit) were noted in 14.3%. HIV infection is the main purveyor of NMC in Mali. The actual incidence of cryptococcosis is unclear due to the poor sensitivity of diagnostic techniques. This study highlights diagnostic difficulties related to clinical polymorphism and poor technical facilities. Agglutination testing of blood and CSF is recommended, but mortality remains.

[Travelers' knowledge of vaccines. A survey including 400 people having consulted an international vaccination center]. / Connaissances des voyageurs à propos des vaccins. Enquête auprès de 400 personnes consultantes d'un centre de vaccinations internationales.

UNLABELLED: The authors conducted a survey in an international vaccination centre. The aim of the study was to assess the travelers' knowledge of vaccines and to check their health record to determine the vaccination rate. We used a self-administered questionnaire and added vaccination certificates to the document. RESULTS: Most of the travelers knew about complications due to vaccinations, but ignored their contraindications. Knowledge decreased over the age of thirty. The travelers agreed with antihepatitis B vaccination and only 10% mentioned the risk of multiple sclerosis. The list of compulsory vaccinations and their schedule were well-known but some of the travelers ignored their vaccine status and said they trusted their general practitioner. Only 40% of people over 20years of age were able to present their national or international vaccination certificate, a reason for underestimating the vaccination rate. CONCLUSION: It would be necessary to have a "World Health Organization" type vaccination certificate available for all French people over 20years of age, while improving the smart health card and training practitioners to better inform their patients about vaccinations.

[Neuromeningeal cryptococcosis in non-HIV patients to CHU ward of Point G in Bamako (Mali): 3 case report]. / Cryptococcose neuroméningée chez des patients VIH négatif au CHU du Point G de Bamako (Mali): à propos de trois observations cliniques.

We report 3 clinical observations of neuromeningeal cryptococcosis which occurred without any immunodepression related to HIV infection. Our patients were male. They did not present any particular medical history indicating a diagnosis of cryptococcosis. Nevertheless we found a professional exposure to the risk of inhalation of C. neoformans capsules. The diagnosis was based on presence of encapsulated yeast of Cryptococcus in the direct exam by China ink and culture on Sabouraud medium. CD4 lymphocytic count was done in two patients (case 1:899 cells/mm3; case 2:347 cells/mm3). Idiopathic lymphocytopenia was noted in one case. Co-morbidity of 5. pneumoniae meningitis was reported in one patient (case 3). Treatment was based on injectable amphotericin B in monotherapy (case 1), followed by perfusion of fluconazole cure (case 2). Case 3 was treated by perfusion of amphotericin B associated with ceftriaxone (case 2). No secondary prophylactic treatment was administered. Evolution was favorable after follow-up of 5 years (case 1) and of 4 years (case 2). The third patient died during hospitalization.

[Yeasts from the CTG clade (Candida clade): Biology, impact in human health, and biotechnological applications]. / Les levures du clade CTG (clade Candida) : biologie, incidence en santé humaine et applications en biotechnologie.

Among the subdivision of Saccharomycotina (ascomycetes budding yeasts), the CTG clade (formerly the Candida clade) includes species that display a particular genetic code. In these yeasts, the CTG codon is predominantly translated as a serine instead of a leucine residue. It is now well-known that some CTG clade species have a major impact on human and its activities. Some of them are recognized as opportunistic agents of fungal infections termed candidiasis. In addition, another series of species belonging to the CTG clade draws the attention of some research groups because they exhibit a strong potential in various areas of biotechnology such as biological control, bioremediation, but also in the production of valuable biocompounds (biofuel, vitamins, sweeteners, industrial enzymes). Here we provide an overview of recent advances concerning the biology, clinical relevance, and currently tested biotechnological applications of species of the CTG clade. Future directions for scientific research on these particular yeasts are also discussed.

The search for virulence determinants in Aspergillus fumigatus.

The development of aspergillosis in an immunodeficient host depends on interactions between fungal and host components. The recognition by Aspergillus fumigatus of fibrinogen and laminin, and the secretion of extracellular proteinases and ribonucleotoxin have been suggested to mediate adherence to mucosal surfaces and subsequently to bring about host-tissue invasion.

Attachment of spores of the human pathogenic fungus Rhizopus oryzae to extracellular matrix components.

Fungi of the order Mucorales determine various infections involving principally the respiratory tract. In spite of their medical importance, little is known about their mechanisms of adherence to the host tissues. Thus we have attempted to define the morphological stages involved in the adherence process of Rhizopus oryzae which is the main causative agent of mucormycoses. The study of the kinetics of germination and adherence to plastic revealed that attachment occurred prior to germination and decreased dramatically with germ tube formation. This correlates with important modifications of the cell wall of the fungus with respect to both carbohydrate composition and distribution of anionic sites. Moreover, the attachment of spores to extracellular matrix components immobilized onto wells of polystyrene microtiter plates has been investigated. Spores adhered readily to immobilized laminin or type IV collagen, but not to fibronectin or the glycosaminoglycans. Attachment to laminin and collagen was dose-dependent and specific. Adhesion was not inhibited by the different carbohydrates tested, suggesting that a lectin was not involved in these interactions. Finally, immunofluorescence revealed that laminin and type IV collagen interacted exclusively with spores and mother cells of germ tubes. Thus, the recognition of laminin or collagen by spores may participate in their adherence to epithelial basement membranes exposed after epithelial tissue damage which frequently accompanies the predisposing factors for mucormycoses.

Purification and characterization of a fibrinogenolytic serine proteinase from Aspergillus fumigatus culture filtrate.

A fibrinogenolytic proteinase has been isolated from Aspergillus fumigatus culture filtrate by ammonium sulfate precipitation followed by successive chromatographies on Sephadex G-75 and immobilized phenylalanine. The purified proteinase exhibited a molecular weight of about 33 kDa. When analysed by SDS-polyacrylamide gels containing co-polymerized fibrinogen, the proteinase appeared as a broad band at the top of the gels, which could correspond to polymerization of the enzyme, as suggested by SDS-PAGE analysis of the unboiled eluate. The isoelectric point was 8.75 and the enzyme was not glycosylated. Proteinase activity was optimum at pH 9 and between 37 and 42 degrees C, although a decrease in activity was observed above 37 degrees C. PMSF and chymostatin markedly inhibited the proteinase activity, and good kinetic constants were obtained for the synthetic substrate, N-Suc-Ala-Ala-Pro-Phe-pNA. These results provide direct evidence that this enzyme belongs to the chymotrypsin-like serine proteinase group.

Extracellular fibrinogenolytic enzyme of Aspergillus fumigatus: substrate-dependent variations in the proteinase synthesis and characterization of the enzyme.

To get a better understanding of the role of the previously reported fibrinogenolytic enzyme of Aspergillus fumigatus, we investigated the in vitro conditions of enzyme synthesis and attempted to characterize it. Modification of the nitrogen source did not influence the extracellular serine-proteinase profile, but resulted in important quantitative differences in the yields in batch cultures. The enzyme synthesis appeared to be an inducible phenomenon in A. fumigatus since it was initiated exclusively in the presence of proteins or protein hydrolysate. Free amino acids or inorganic nitrogen compounds could not promote significant enzyme production. Moreover, peptone at a concentration of 0.1% appeared to be the best inducer of enzyme synthesis. Conversely, modification of the carbon source did not affect fungal growth or enzyme synthesis. However, the production of chymotrypsin was highly sensitive to the carbohydrate level in the culture medium and, with peptone as nitrogen source, highest yields were obtained in the presence of 0.3 or 0.5% glucose. Culture filtrates of A. fumigatus CBS 113.26 grown with peptone or nitrate as nitrogen source were analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Comparison of the protein patterns suggested for the proteinase a molecular mass of 33 kDa which was confirmed by chromatographic purification of the enzyme through (N alpha-CBZ)-D-phenylalanine agarose.

[Pulmonary mycoses and parasitosis]. / Les mycoses et parasitoses pulmonaires.

Lungs can be the target of many fungal parasitic organisms. Some of them are specific to the lung (Pneumocystis); while others will migrate there in the course of their life cycle (Ascaris) or be caught in it (Paragonimus, Echinococcus). Sometimes, they also generate hypersensitivity reactions (fungi). In making a diagnosis one has to consider the present state of health or the disease history of the patient. A great number of parasites or mycetes are opportunist agents found in immuno-compromised patients. The epidemiological investigation giving details of a trip, even a long time ago, in a tropical region allows the suspicion of an imported parasitosis or an exotic mycosis. At present, we have on one hand, the mixing of populations, and on the other hand, many immuno-compromised situations which has given rise to a renewed interest in fungal and parasitic lung diseases.

[Peritoneal dirofilariasis fortuitously disclosed]. / Dirofilariose péritonéale de découverte fortuite.

Peritoneal dirofilariasis probably due to Dirofilaria repens is reported from a 52 years old woman. The parasite discovery is fortuitous during a surgical cure of intestinal adenocarcinoma. The patient lives in Provence and Corsica (Southern France), an endemic region. The authors present the histological aspects of the parasite.

[Cutaneous ulcer from Mycobacterium ulcerans. Apropos of 1 case in French Guiana]. / L'ulcère cutané à Mycobacterium ulcerans. A propos d'une observation en provenance de Guyane française.

Skin ulcer due to Mycobacterium ulcerans is presented. The patient come from East of French Guyana. Growth of this mycobacteria is obtained with diphasic Lowenstein medium at 30 degrees C. Diagnostic of M. ulcerans results from mycolic acids study.

[Candida endocarditis: retrospective study in 12 patients]. / Endocardites à Candida: étude rétrospective de 12 patients.

PURPOSE: Candida endocarditis are rare, with a poor prognosis. Actually, the principal problem concerns the growing incidence of nosocomial fungal infections. The objective of the present investigation is to assess a disease which risks becoming more pronounced in the future. METHODS: We have collected observations of Candida sp. endocarditis between 1985 to 1997 from three French university hospitals. RESULTS: Twelve of the observations fit the Duke criteria of acute endocarditis. Patients were eight men and four women, with a mean age of 46 years. An immunodepression was found in seven cases, and four patients were active drug addicts. Six had an underlying heart disease at risk to acute endocarditis. Candidemia risk factors were found in nine cases, with an average of 2.7 risk factors per patient. The fungal agents detected were Candida albicans (eight cases), C. tropicalis (one case), C. parapsilosis (two cases), and C. glabrata (one case). These vegetations were on aortic (seven cases), mitral (three cases), tricuspid valves (two cases) or in other areas (three cases), with multiple localizations (two cases). In three observations, vegetations were associated with myocardium abscesses. Eight patients had embolic complications, two had a cardiac insufficiency leading to death. The treatment was medical in all of the cases and combined with a surgical treatment in ten cases. The surgery was performed, on an average, 17 days after diagnosis, allowing seven surviving patients. Among them, five received a secondary prophylaxis and no recurrence was recorded. CONCLUSIONS: Prognosis remains severe because of the voluminous, friable and necrotic vegetations, which favor embolic migrations and which are not easily accessible to antifungals, which penetrate poorly into these vegetations. Therapy is based on a medical treatment combined with a valve replacement which needs to be done early on, and is followed by a relapse prevention which can occur several years after the initial episode.

[Yeast count in urine. Review of the literature and preliminary results of a multicenter prospective study carried out in 15 hospital centers]. / Intérêt de la numération des levures dans les urines. Revue de la littérature et résultats préliminaires d'une enquête multicentrique réalisée dans 15 centres hospitaliers universitaires.

Candida spp. are increasingly involved in nosocomial infections in severely ill patients and the diagnosis is difficult. In this context, the significance of candiduria remains unclear. Management of this condition is still equivocal, because of the lack of information about its natural history and its predictive value for disseminated infection. Little is known about the discriminant value of colony count. After a comprehensive review of the available published data, the preliminary results of a multicentric prospective survey in critically ill patients hospitalised in intensive care units are given. The aim of the study was to search for correlations between quantitative candiduria and known risk factors for disseminated candidiasis. There is a statistically significant correlation (p = 0.003) between heavy candiduria (> 10(4) cfu.mL-1) and high Pittet colonisation index (> or = 0.5). Quantification of candiduria could be useful to select patients at high risk for disseminated candidiasis.

[Can we evaluate the frequency of onychomycosis?]. / Peut-on chiffrer la fréquence des onychomycoses?

Onychomycosis represents one of the most common nail diseases. Difficult to bear by some patients, onychomycosis is one of the most frequent reasons for consulting by lack of uniformity and group-control a mycological centre. However, frequency of onychomycosis is miss appreciable. The studies of prevalence concern the general population (2 to 13 per cent according to the different authors) consulting a medical practitioner or specialist (dermatologist). Recent surveys done a large scale in Europe in adults indicated high prevalence: 20 to 30 per cent, depending on whether the investigator is a general practitioner or a dermatologist. In any case, all the studies concur in the opinion that onychomycosis has been in constant progression over the last twenty years. Rarely observed in children, frequent in adults, onychomycosis principally affects particularly the elderly. In Western Europe and in North America, onychomycosis involves principally the feet--especially in males. By contrast, in Southern Europe, in the Middle and Far East, the prevalence is highest in women's fingernails (often associated with paronychia). Among the factors promoting fungal nail invasion, some are local depending on the patient (trophic troubles and circulatory impairment overlapping of digits, etc.), some are due to general factors such as immunosuppression, diabetes mellitus or psoriasis. There are also behavioural factors (occupation, lifestyle, sports) which favor the meeting with the pathogenic fungus.

[Cutaneous alternariosis revealing Cushing's disease. A case with ultrastructural study]. / Alternariose cutanée révélatrice d'une maladie de Cushing. Un cas avec étude ultrastructurale.

This case concerned a 67 old farmer who presented a vegetating and crusted tumor of the right knee. Histological examination revealed intracellular round structures PAS + within an inflammatory dermal granuloma, including epithelioid and giant cells. Alternaria could be isolated on cultures from biopsies of the tumor. Ultrastructural study specifies the morphological aspects of Alternaria within dermal granuloma; furthermore, large numerous myelinic bodies were present within the parasitic cells. The clinical aspect of the patient led to hormonal explorations and a Cushing's disease yet unrecognized was ascertained, that probably represented the "special terrain" which made the growth of Alternaria possible. The survey of the available literature revealed two cases of alternariosis and Cushing's syndrome, but in these two cases the diagnosis of the endocrinopathy was already established when the cutaneous infection developed. The lesion cleared within a month after electrocoagulation, local iodine compound and griseofulvine per os, with nonrelapse 12 months after.

[Cutaneous Scedosporium infection revealed by bullous-necrotic purpura]. / Scédosporiose cutanée révélée par un purpura bullo-nécrotique.

BACKGROUND: Non-mycetomatous cutaneous scedosprium is an uncommon mycosis observed in immunodepressed subjects. We report a case with an inaugural presentation of bullous and necrotic purpura. CASE REPORT: A 79-year-old man on intermittent corticosteroid therapy for bronchospasm was admitted for bullous and necrotic purpura and fever. Subcutaneous nodules with a sporotrichoid aspect developed despite wide-spectrum antibiotics. Microbiology samples cultured on Sabouraud medium evidenced Scedosporium apiospermum. The pathogenic nature of the infection was proven on a skin biopsy showing numerous myceleal filaments with Gomori-Grocott staining despite negative PAS. No pulmonary involvement was evidenced. The patient was treated unsuccessfully with itraconazole. A Pseudomonas lung infection was fatal. DISCUSSION: Scedosporium apiospermum, an ubiquitous ascomycetes anamorphous to Pseudallescheria boydii, is the cause of a growing number of human infections due to widespread use of immunosuppressors. Skin and lung localizations predominate. The inaugural bullous and necrotic purpural skin manifestations in this case are unusual. In addition, the patient was only minimally immunodepressed and despite demonstrated in vitro sensitivity, itraconazole was ineffective clinically. Treatment is not well defined, but surgery is essential in combination with empirically chosen antifungals.

[Evaluation of the health status of nomadic and semi-nomadic populations of the Gourma-Mali: epidemiologic approach. I. Introduction, material and methods]. / Evaluation de l'état sanitaire des populations nomades et semi-nomades du Gourma-Mali--approche épidémiologique. I.--Présentation-matériel et méthode.

The authors set out the methodology and the practical way used in transverse epidemiological investigation with a descriptive aim which was made in natural area: Gourma-Mali. This part of the Sahel, hard to reach, is placed deep in the bend of the Niger river. The population is estimated at 100.000. The weather, ecological and human conditions have been unsettled by the drought. Sometimes, it was difficult to collect the data among the nomadic and seminomadic populations (Tamachèques, Peuls, Maures, Bellahs, Sonraïs). This investigation shows well the practical problems that this kind of study sets out in difficult bioclimatological and ethnological conditions.

[Evaluation of the health status of nomadic and semi-nomadic populations of the Gourma-Mali: epidemiologic approach. II. Overall results and conclusions]. / Evaluation de l'état sanitaire des populations nomades et semi-nomades du Gourma-Mali--approche épidémiologique II.--Résultats globaux et conclusion.

The authors report the main clues of morbidity, infant mortality, fecundity as well as the main endemic affections detected in the nomadic and seminomadic populations in Gourma that they have noticed during a descriptive epidemiological investigation. The worse clues of general morbidity come from children and among the ethnic groups studied from those of the Tamachèques and the Maures. Malaria, brucellosis, treponematosis (bejel) have a high rate of frequency. The few cases of tuberculosis detected incidentally encourage to search for the real effect of this affection. Urinary schistosomiasis is present in Gossi where durable ponds exist. Intestinal helminthiasis, tineas, and hemoglobinopathies seem not to be problems of public health in the area. Pterygiums and conjunctivitis are frequent while trachoma is absent in Gourma.

[Larva migrans]. / Le larbish.

Larbish, cutaneous larva migrans or creeping eruption, is a serpiginous cutaneous eruption caused by skin penetration of infective larva from various animal nematodes. Hookworms (Ancylostoma brasiliense, A. caninum) are the most common causative parasites. They live in the intestines of dogs and cats where their ova are deposited in the animal feces. In sandy and shady soil, when temperature and moisture are elevated, the ova hatch and mature into infective larva. Infection occurs when humans have contact with the infected soil. Infective larva penetrate the exposed skin of the body, commonly around the feet, hands and buttocks. In humans, the larva are not able to complete their natural cycle and remain trapped in the upper dermis of the skin. The disease is widespread in tropical or subtropical regions, especially along the coast on sandy beaches. The diagnosis is easy for the patient who is returning from a tropical or subtropical climate and gives a history of beach exposure. The characteristic skin lesion is a fissure or erythematous cord which is displaced a few millimeters each day in a serpiginous track. Scabies, the larva currens syndrome due to Strongyloides stercoralis, must be distinguished from other creeping eruptions and subcutaneous swelling lesions caused by other nematodes or myiasis. Medical treatments are justified because it shortens the duration of the natural evolution of the disease. Topical tiabendazole is safe for localized invasions, but prolonged treatment may be necessary. Oral thiabendazole treatment for three days is effective, but sometimes is associated with adverse effects. Trials using albendazole for one or four consecutive days appear more efficacious. More recent trials using ivermectine showed that a single oral dose can cure 100% of the patients; thus, this drug looks very promising as a new form of therapy. Individual prophylaxis consists of avoiding skin contact with soil which has been contaminated with dog or cat feces. Keeping dogs and cats off the beaches is illusory in tropical countries.