[Bowel parasites and faecal eosinophilia]. / Les parasites intestinaux et l'éosinophilie fécale.

The staining of polynuclear eosinophils (PE) in the stools, easily performed and adapted from the technique of WHEATLEY, presents important advantages over the May-Grünwald-Giemsa: less colouring of the bacteria, no dissolution of the lipids, less importance of the stools pH. The stools samples must show mucus or have a soft, loose or liquid consistency: the polynuclear eosinophils are preserved in stools for 1 year and more, which allows if necessary to postpone for a few days the direct examination. The PE are found among patients having a helminthiasis or an intestinal coccidiosis in half of the cases, whereas they are not found in other intestinal protozoosis. They are also found among patients having an intestinal allergy. Faecal eosinophilia reveals an intestinal eosinophilia of the tissue and is influenced by several factors in particular: importance, duration, repetition of the infestation. It allows the observation of many elements related to the mechanism of eosinophilia, not to be found in blood eosinophilia, in particular the release of the eosinophil granule, the formation of Charcot-Leyden crystals and the presence of lipid bodies similar to those of stearrhoea.

[Malaria in splenectomized patients. Three fatal cases]. / Paludisme grave chez des patients splénectomisés. Trois cas mortels.

INTRODUCTION: Splenectomy, the surgical removal of the spleen, is increasingly practiced in malaria-endemic tropical countries. The procedure leaves patients more susceptible to serious bacterial and parasitic infections, including malaria. CASES: We report here three fatal cases of malaria from P. falciparum in splenectomized patients. One operation followed abdominal trauma, while the other two were performed to treat one large-cell and one B-cell lymphoma. Despite prolonged intravenous quinine treatment all three patients died. DISCUSSION: Malaria in splenectomized patients can be very serious and is fatal in half the cases transmitted by P. falciparum. Permanent chemoprophylaxis is required for these patients when they travel to or live in endemic areas.

Microscopic diagnosis of blood parasites following a cytoconcentration technique.

An isotonic fixative (formalin and thimerosal) solution, with a saponin additive to lyse erythrocytes and platelets, has been developed. The formalin and thimerosal ensure good preservation of blood parasites. This fixative has led to the development of a new concentration technique using cytocentrifugation (cytospin) in the search for Plasmodium spp., Leishmania spp., and microfilariae, as well as leukocytes in which parasites or pigment may be present. The concentration of the parasites present in the sediment from 100 microl of blood spread on a 6-mm diameter circle results in good morphology that is well stained using the usual Giemsa or Wright techniques. This new technique has the advantage of a relatively low cost and offers the possibility of isolating and identifying in the same sediment the main blood-stage parasites, with the exception of young trophozoites, of Plasmodium falciparum.

Anisakidosis: report of 25 cases and review of the literature.

Anisakidosis (previously known as anisakiasis) is a disease caused by the accidental ingestion of larval nematodes (Anisakis and sometimes Pseudoterranova) in raw fish. Two groups of patients are studied: 5 clinical cases and 20 serological diagnoses. 55 French cases are already published. Most of them complained of acute symptoms, which occurred within 12 h of eating the seafood meal--epigastric pain, occlusion, diffuse abdominal pain, and appendicitis. Larvae were attached to the gastric mucosa (25 cases), including an inflammatory response (erythema, oedema ulceration). Diagnosis of anisakiasis is made by gastroscopy which allows removal of the worms, and cures the patients. In gastro-intestinal tract X-rays, oedema in the mucosa, pseudo tumour formation, and filling defects (worm) were observed. In chronic infections, cases with intermittent feelings of ill health and abdominal pain, lasting from several weeks to months, were misdiagnosed as another intestinal disease. Positive serological reactions are helpful, and surgery is necessary for resection of the lesion; diagnosis is made histologically by an eosinophilic granuloma, and the presence of a larva with Y shaped lateral cords. Infestation rate is high in fishes: cod (88%), rock fish (86%), herring (88%), salmon, mackerel. Public health education should discourage the eating of raw fish. Thorough cooking to 70 degrees C or adequate freezing to -20 degrees C for 72 h are the best preventive measures. Such legislation is only in force in the Netherlands, where cases have decreased dramatically.

[Current status and trends in quality control in parasitology and mycology]. / Réalisations et perspectives du contrôle de qualité en parasitologie et mycologie.

The survey of the results of the control quality in Parasitology and Mycology showed in general an improvement in the correct diagnosis for the specimen analysed (preparations of parasites, smears, stools, sera, fungal cultures). The wrong diagnosis of Ascaris lumbricoides eggs in stools diminished from 5% to 1.5%. The trichrome Gomori-Wheatley stain technic on smears in PVA was introduced. 16 reference or national standards sera for the parasitological serology, including 6 for toxoplasmosis and one for candidiasis were established. The increasing number of participants (more than 4,000) and particularly for the serology of toxoplasmosis showed the interest of the biologists for the quality of their tests.

[Biological diagnosis of pulmonary parasitoses and mycoses]. / Actualités du diagnostic biologique des parasitoses et mycoses pulmonaires.

Pulmonary involvement in parasitic disease is now due above all to the visceral Larva migrans syndrome, the diagnosis of which is serological, and to imported distomatosis due to Paragonimus sp, confirmed by the discovery of eggs in the sputum. An immature immunological status or immunodepression is necessary for the development of Pneumocystis carinii, where all of the stages of diagnosis, including that of the obtaining of sample material, are difficult. Pulmonary mycoses are represented above all by candidiosis, aspergillosis and rarely cryptococcosis which also commonly occur in the presence of an impaired underlying state. Diagnosis of these opportunistic fungi is sometimes difficult and it is necessary to take all clinical, laboratory and immunological data together in order to obtain confirmation.

[Opportunistic aspects of parasitosis]. / Aspects opportunistes des parasitoses.

Parasitosis opportunist are becoming clearer thanks to a better knowledge of immunological mechanisms, especially in AIDS. Child immunological immaturity and corticotherapy are the two other main immunodeficiencies among opportunist parasitosis. For the protozoosis, coccidiosis (especially toxoplasmosis), cryptosporidiosis, but isosporosis too and microsporidiosis represent a privileged group among opportunistic infections. Among adult, leishmaniasis caused by L. infantum is an opportunist parasistosis, favoured by corticotherapy or AIDS, but among children, it is the child's immunological immaturity which is involved in the immunodeficiency. Babesia occurs among splenectomized people. Giardiasis is more frequent and more severe among IgA immunodeficiencies especially secretories IgA. Among helminthiasis, generalised strongyloidiasis is very severe among patients under corticotherapy, but AIDS is not involved.

[Entamoeba histolytica (Schaudinn 1903) and Entamoeba dispar (E. Brumpt 1925) are 2 different species]. / Entamoeba histolytica (Schaudinn 1903) et Entamoeba dispar E. Brumpt 1925 sont deux espèces différentes.

On the basis of epidemiologic and clinical data in humans, and of experimental studies in kittens, E. Brumpt in 1925 showed that Entamoeba histolytica producing quadrinucleate cysts was a complex of 2 species. He differentiated a pathogenic and invasive form, from a non pathogenic and non invasive one that he called Entamoeba dispar. His explanation gained little support until recently, when Sargeaunt reported a study of isoenzyme typing and allow then the classification of amoebae resembling E. histolytica in pathogenic and non pathogenic species. Monoclonal antibodies and PCR have recently been used and have shown to react specifically with the two forms of amoebae. Genetic evidence has also demonstrated that the pathogenic and non pathogenic amoebae represent different species.

Asymptomatic amoebic infection: Entamoeba histolytica or Entamoeba dispar? That is the question.

Two cases of amoebic infection were diagnosed in a heterosexual couple. The cases, a Frenchman with previous trips to various African countries and his sexual partner, a Cameroonese woman immigrant living outside the community, were both asymptomatic; the infection had been diagnosed by chance in the man at the time of his employment in a hospital kitchen. Based on what is known of the epidemiology of amoebic infection, it may be acquired and then transmitted within a couple via the indirect faecal-oral route or, in greater likelihood, by sexual practices. Both amoebic isolates were characterised by isoenzyme electrophoresis as non-pathogenic Entamoeba dispar, zymodemel. Other diagnostic tools, such as ELISA direct stool antigen detection tests and serological assays were employed, confirming the diagnosis of E. dispar infection. Given there are a number of asymptomatic cyst passers of Entamoeba histolytica, besides human carriers of saprophyte E. dispar, we stress the importance of applying, when possible, advanced protocols of diagnosis to distinguish the microscopically identical pathogenic species from the non-pathogenic one.

[Triple malaria infection in twin sisters from the Democratic Republic of Congo]. / Triple infestation plasmodiale chez deux soeurs jumelles originaires de la République Démocratique du Congo.

Infections with 3 species of malaria parasites are rarely encountered and observed in less than 0.05% of cases. We came across such an infection in four year-old, monozygote twin sisters, coming from Kinshasa (Democratic Republic of Congo). In both of them, parasitemia was low or very low for P. falciparum and P. ovale and of 0.1-0.2% for P. malariae. The twin sisters presented with an iron deficiency anaemia, associated with an heterozygous sickle-cell anaemia and a moderate splenomegaly. The biological tests results were similar. They responded well to treatment. We point out the difficulty in recognizing the concomitant presence of several species of hematozoaire on blood smear.

[Apropos of 1 case of anisakiasis contracted in Sicily]. / A propos d'un cas d'anisakiase contractée en sicile.

The authors describe a case of anisakiasis in Sicily. The diagnosis was based on the knowledge that a contaminated fish, Lepidopus caudatus, had probably been absorbed, as well as on clinical intestinal symptoms, intestinal lesions observed by endoscopy and O.G.D.S, duodenal infiltration by eosinophilic polymorphonuclear, positive ELISA anisakis serology and successful treatment by albendazole.

[Encephalopathy and memory disorders during treatments with mefloquine]. / Encéphalopathie et troubles mnésiques au cours des traitements par la méfloquine.

Benign psychiatric side effects have been frequently associated with mefloquine therapy. On the other hand, severe psychiatric disorders due to mefloquine are rare but must be detected by physicians. Two such cases are reported. In the first case, excessive curative mefloquine therapy caused an acute psychotic state which ultimately regress without treatment. The second report concerns a transient memory failure following prophylactic mefloquine treatment. The causative role of this compound is being discussed and the importance of a differential diagnosis of neuropsychiatric disorders from toxic or parasitic origin is underlined. Circumstances aggravating such neuropsychiatric side effects and actual recommendations concerning the prescription of mefloquine are recalled.

[Familial eosinophilia: contribution of parasitology to its diagnosis]. / Les éosinophilies familiales: apports de la parasitologie à leur diagnostic.

It has been observed, at the turn of the century, that members of some families showed a peripheral blood hypereosinophilia. Despite all possible investigations at that time, it was not possible to link it up with a known and well established disease. It was named "family acquired eosinophilia" by Di Guglielmo. nowadays, it has been established that some congenital defects such as the Omenn syndrome and the Wiskott-Aldrich syndrome are associated with hypereosinophilia. Eosinophilia is well known as a sign of allergy, but contaminations with helminths are an important cause of familial hypereosinophilia. In a case of familial distomatosis by Fasciola hepatica, several members of the same family were infected after eating wild cress. An epidemiological study was carried out on 22 families whose several members in a same family had an hypereosinophilia, a parasitosis was serologically diagnosed using such methods as immunoelectrophoresis, Elisa or Western blot. Among these 22 families, 10 had contracted fascioliasis and 4 who had eaten contaminated horse meat contracted trichinosis. For some other families, eosinophilia was not well documented, it concerned cysticercosis for 3 couples after eating meat of raw pork, one family with intestinal distomatosis to F. buski after consumption of aquatic plants and lastly toxocarosis, zoonosis whose contamination is acquired by geophagy but also by eating raw vegetables (salad), fruit (strawberries) and by drinking contaminated water, affected 5 families. In one family, anisakiasis with hypereosinophilia had been contracted by eating raw fish. In another one, trichostrongyloidiasis was contracted by eating raw vegetables from the family garden. The diagnosis is often oriented, for the members of a same family, who are asymptomatic or pauci-symptomatic, by the blood cell count that shows an hypereosinophilia. Furthermore, a collective outbreak of strongyloidiasis epidemic among 115 individuals by oral route is reported, showing that such a way of transmission is possible.

[Seroepidemiological data on anisakiasis: prophylactic consequences in fish products]. / Données séroépidémiologiques sur l'anisakiase: conséquences prophylactiques pour les produits de la pêche.

The Western blotting method allowed us to confirm the diagnosis in 7 cases of acute anisakiasis, to assess it in 5 cases of chronic anisakiasis, and to follow up the evolution. These chronic frames according to the question of their long term evolution, and the part played by Anisakis simplex in fish nutritional allergy increase the negative score of that parasite. This situation should leave to discuss preventive rules.

[Ascaridiasis zoonoses: visceral larva migrans syndromes]. / Zoonoses d'origine ascaridienne: les syndromes de Larva migrans visceral.

The syndrome of Visceral Larva Migrans is a zoonotic disease due to the migration in human of nematodes larval, specially ascarid. Since the larvae fail to complete their migrating cycle in humans, the diagnosis of Toxocariasis infection remains only serologic. We have been able to demonstrate by the technique of agar diffusion and the Western-blotting method that the etiology due to Toxocara canis was twice as much frequent as the one due to Toxocara cati in the syndrome of Visceral and Ocular Larva Migrans. The use of numerous antigens from adult nematodes, mainly Ascaris suum, has shown, than in France, in the syndrome of VLM at least 12% of the cases were certainly due to other nematodes. Nippostrongylus brasiliensis (or another similar nematode) of the rat might be responsible. The existence of numerous clinical and biological cases found negative in serology, allow us to suggest that some other larval nematodes, may be from wild animals, might play an etiological role.

[Study of 6 cases of malaria acquired near Roissy-Charles-de-Gaulle in 1994. Necessary prevention measures in airports]. / Etude de six cas de paludisme contractés près de Roissy-Charles-de-Gaulle en 1994. Mesures de prévention nécessaires dans les aéroports.

During the very hot 1994 summer, six new cases of airport malaria have been observed in and around Roissy-Charles-de-Gaulle airport. Four patients were regular or occasional airport employees. The two other cases were inhabitants of a city at 7 km. Entomological investigations suggest that cars of airport employees served to disseminate anophelines outside the airport areas. The six cases were very severe. One patient died. Apparently, W.H.O. recommendations on aircraft disinsecting procedures have not been fully followed. There is obviously a threat for areas near the airports.

[Prevention of AIDS transmission by syringes and needles in France and Africa]. / Prévention de la transmission par les seringues et aiguilles du V.I.H. en France et en Afrique.

A study made among drug addicts in the Northern suburbs of Paris enables establishing a stabilisation of positive H.I.V. serology prevalence among them, a fact related to the free sale of syringes and needles. In Africa, the nosocomial transmission of H.I.V. by non-sterilisable but reused needles and syringes is demonstrated, and two cases are described. Its importance is certain but must be precise. The prevention of this epidemiological modality must be done by systematic use of reusable and sterilisable injectable material.

PIP: Reuse of disposable needles and syringes plays an important role in the transmission of HIV in France as in Africa. From September 1985-March 1986, 51% of drug addicts systematically screened in the northern suburbs of Paris were found to be HIV positive. Studies in the same population through 1988 indicated that the rate of HIV infection had remained stable, as had the average age of addicts, duration of addiction, and sex ratio. Stabilization of seropositivity rates among drug addicts in the northern suburbs in believed to have been due to information programs alerting addicts to the risk of contamination through sharing of needles and to the legal sale of syringes and needles instituted in May 1987. HIV transmission through reuse of disposable needles and syringes has been demonstrated in Africa. It is attributable to the poverty of health services and of the general population. The significance of HIV transmission by reuse of disposable materials in the health services appears to be considerable but is difficult to quantify. Prevention of transmission by this means will require correct use of sterilizable needles and syringes.

[On the discovery of the parasite of malaria by A. Laveran: Bône 1878 - Constantine 1880]. / A propos de la découverte de l'hématozoaire du paludisme par A. Laveran Bône 1878 - Constantine 1880.

Books published on malaria and parasites do not mention the exact place and date of the discovery of the hematozoa. We think it is important to specify this point of the history of medicine. From Laveran's three main writings about this subject, the first one written on the 8th of November 1880 was summarized at the "Académy de Médecine" on the 23rd of November by Colin but never published. We got it from the archives. The parasite of malaria, Laveran's great discovery, was the result of a patient work and long microscopic examinations which started in Bône in 1878 where he first saw pigmented and crescent shaped bodies of Plasmodium falciparum. Then, on November 6, 1880 in Constantine, he was definitively convinced when he saw pigmented spherical bodies with flagella, that is to say exflaggelations. Nearly ten years passed before this etiology was universally admitted.

[Francesco Redi and the birth of experimental parasitology]. / Francesco Redi et la naissance de la parasitologie expérimentale.

Francesco Redi (1626-1697) born in Arezzo (Tuscany, Italy), an encyclopedic mind simultaneously naturalist, physician and poet is the founder of scientific and experimental parasitology by his works published in 1668 and 1684. In the first he showed the impossibility of spontaneous generation of insects (flies) and in the second are described over hundred species of parasites (helminths, mites, insects) from vertebrates and invertebrates with excellent illustrations. He has also recommended various antiparasitic remedies and specified their pharmacological action. It is besides under his influence that two of his disciples: Bonomo and Cestoni will rediscover and redescribe in 1687 the itch-mite (Sarcoptes scabiei var. hominis).

[A challenged Nobel Prize: Johannes Fibiger, 1926]. / Un prix Nobel discuté: Johannes Fibiger, 1926.

Johannes Fibiger born in Denmark in 1867 died in 1928 from a cancer of the colon. First interested in bacteriology he became later (1900) professor of pathological anatomy. His chief work on the alleged cancerigenous role of a nematode Gonglyonema neoplasticum in some species of rats allowed him to receive the Nobel Prize in medicine in 1926. The difficulties met later (species of Gongylonema spp. from rats, dietary, lack of vitamin A) and even the impossibility to reproduce his results have brought a contestation of his work. However the cancerigenous action of some parasitic heminths such as Schistosoma is now recognized.