Etest ECVs/ECOFFs for Detection of Resistance in Prevalent and Three Nonprevalent Candida spp. to Triazoles and Amphotericin B and Aspergillus spp. to Caspofungin: Further Assessment of Modal Variability.

Susceptibility testing is an important tool in the clinical setting; its utility is based on the availability of categorical endpoints, breakpoints (BPs), or epidemiological cutoff values (ECVs/ECOFFs). CLSI and EUCAST have developed antifungal susceptibility testing, BPs, and ECVs for some fungal species. Although the concentration gradient strip bioMérieux Etest is useful for routine testing in the clinical laboratory, ECVs are not available for all agent/species; the lack of clinical data precludes development of BPs. We reevaluated and consolidated Etest data points from three previous studies and included new data. We defined ECOFFinder Etest ECVs for three sets of species-agent combinations: fluconazole, posaconazole, and voriconazole and 9 Candida spp.; amphotericin B and 3 nonprevalent Candida spp.; and caspofungin and 4 Aspergillus spp. The total of Etest MICs from 23 laboratories (Europe, the Americas, and South Africa) included (antifungal agent dependent): 17,242 Candida albicans, 244 C. dubliniensis, 5,129 C. glabrata species complex (SC), 275 C. guilliermondii (Meyerozyma guilliermondii), 1,133 C. krusei (Pichia kudriavzevii), 933 C. kefyr (Kluyveromyces marxianus), 519 C. lusitaniae (Clavispora lusitaniae), 2,947 C. parapsilosis SC, 2,214 C. tropicalis, 3,212 Aspergillus fumigatus, 232 A. flavus, 181 A. niger, and 267 A. terreus SC isolates. Triazole MICs for 66 confirmed non-wild-type (non-WT) Candida isolates were available (ERG11 point mutations). Distributions fulfilling CLSI ECV criteria were pooled, and ECOFFinder Etest ECVs were established for triazoles (9 Candida spp.), amphotericin B (3 less-prevalent Candida spp.), and caspofungin (4 Aspergillus spp.). Etest fluconazole ECVs could be good detectors of Candida non-WT isolates (59/61 non-WT, 4 of 6 species).

[Sleeping sickness: forgotten research?]. / Maladie du sommeil: la recherche oubliée?

Has research on sleeping sickness, i.e., human African trypanosomiasis (HAT), been forgotten? To get an idea on funding, we consulted the Medline bibliographic database for the last 14 years. The number of publications on HAT was stagnant over the study period. By comparison there was a steady increase in the number of publications dealing with malaria. These findings suggest that interest in HAT research waned in favor of other endemics even though government or other funding agencies continued to finance research networks. To illustrate this situation, we present the funding and findings of our multidisciplinary working group in a wide range of domains including sleep, endocrine rhythms, identification of biological markers, research on physiopathologic mechanisms of the host-pathogen relationship, and development on new medications. Over the last 14 years, a total of 1 million Euros was spent to produce 68 publications on Medline, i.e., roughly 15000 [symbol: see text] per publication.

[Human African trypanosomiasis: present and future treatment ]. / La trypanosomose humaine africaine: propos sur le traitement actuel et les perspectives.

During his life General Lapeyssonnie coped with the hazards linked to the therapeutics of the human African trypanosomiasis (HAT), sometimes with passion and disappointment, sometimes with revolt and hope. Because of a lack of political and financial concern during the past decades, a real global policy against the disease and a drug research against HAT didn't emerge. Today, some changes seem to take place. They are the result of the frightening spread of the disease and of the moral obligation that forces pharmaceutical companies to intervene. Drug research needs to be increased. New drugs should present no toxicity and should be able to cross through the blood-brain barrier with efficient cerebrospinal fluid concentrations. Moreover, new drugs should be easy to synthesize, easy to use and at a low cost. Today, megazol is the only one product in preclinical development, which seems to reach each of these goals.

[Epilepsy and its impact in northwest region of the Central African Republic]. / L'épilepsie et son vécu au nord-ouest de la République centrafricaine.

In African countries, epilepsy is an important public health problem with major medical, socio-cultural, and economic implications. This study was carried out to evaluate attitudes towards epilepsy in the Central African Republic. A total of 187 epileptic patients were included. Only 20.9% of the study population were married. School attendance never exceeded the elementary level. Epilepsy was active in 98.4% of patients who continued to present attacks despite extensive treatment which was either poorly complied with or inadequate. Attitudes towards epilepsy remain rooted in belief in supernatural phenomenon and evil spirits with use of traditional therapies involving abstinence from certain foods and use of laxative agents to drive out evil forces. Epileptics are excluded from their families and not allowed to attend school but, in our study, they were not prevented from the work place since 70% held jobs. In this study, 54% of epileptics believed that the disease was contagious, 55.6% that it was incurable, and 20.9% that it was due occult or supernatural causes. While precise quantification is impossible, our experience based on interviews with patients and frequent observation of burn wounds suggests that moral and physical suffering is immense among epileptics in the Central African Republic. Epilepsy in Black Africa is a major public health problem requiring serious attention from government officials, health care specialists, and the families of patients. Better information to promote awareness of the non-contagious nature of the disease, greater support for families of patients, and improvement in treatment compliance are essential.

[Seroprevalence of cysticercosis in the lacustrian community of Vekky, Atlantic district (Benin)]. / Séroprévalence de la cysticercose dans la commune lacustre de Vekky, département de l'Atlantique (Bénin).

Cysticercosis is a parasitic disease due to the infection of man with Cysticercus cellulose, the larva of Taenia solium. This disease is frequent in countries with low socio-economic development and is linked to sanitary conditions. The aim is to assess the seroprevalence of cysticercosis in the lacustrine vicinity of Vekky, located on the lake Nokoué, District Atlantic, south Benin, an epidemiological survey was undertaken in April and May 1994. The lacustrian vicinity of Vekky comprises 12 villages including 16, 142 inhabitants. Population has been sampled using cluster sampling method (n = 30) at two levels (village and household). The whole samples consisted in 319 adults (123 females and 196 males, mean of ages: 32.8 +/- 18.3). Titration of cysticercosis antibodies has been made using ELISA. Eleven patients (3 females and 8 males) showed a positive ELISA response for cysticercosis, i.e. the seroprevalence of cysticercosis was 3.5% (CI 95%:1.3-8%). There was no significant difference according to age and sex. The seroprevalence of cysticercosis reached 9.1% in patients who presented history of epilepsy. We failed to find any linkage between seropositivity and i) clinical history of epilepsy or taeniasis, or ii) several studied environmental factors such as consumption of pork, wandering of pigs, lack of veterinary supervision, religion and occupation. Human seroprevalence of cysticercosis reaches 3.5% in vicinity of Vekky, which denotes a high endemic level. Further epidemiological studies are necessary to precise the factors involving cysticercosis in this area.