[A rare aetiology of acute respiratory distress syndrome in adult: leptospirosis]. / Une étiologie rare de syndrome de détresse respiratoire aiguë de l'adulte: la leptospirose.

We report the case of an 18-year-old man with pulmonary leptospirosis presenting as an atypical pneumonia with alveolar haemorrhage, without icterus. Has he developed ARDS the patient was admitted in intensive care unit. This patient was contaminated when swimming in a lake. The purpose of this article is to remind doctors that in patient presenting atypical pneumopathy with haemoptysis, the pulmonary leptospirosis should be considered.

Imported Plasmodium vivax malaria in France: geographical origin and report of an atypical case acquired in Central or Western Africa.

A total of 73 cases of Plasmodium vivax infections acquired in Western or Central Africa were diagnosed on microscopical criteria in French travellers from 1995 to 1998. We report a case of P. vivax infection in a non immune traveller confirmed by polymerase chain reaction and presenting an atypical P. ovale morphology. The infection was acquired in Western or Central Africa. These microscopical observations, together with the molecular evidence for P. vivax in Western and Central Africa suggest that P. vivax is transmitted in this area despite lacking the Duffy receptor in autochthonous population.

[Candida albicans induced empyema: mode of revelation of a spontaneous oesophageal disrupture]. / Pyopneumothorax à Candida albicans révélant une perforation spontanée de l'oesophage.

Oesophagus perforation, despite an often-loud symptomatology, is lately diagnosed. A similar course is illustrated by the observation of a patient who presented a Candida albicans-induced empyema. The oesophagus rupture was diagnosed by thoracoscopy made because of extensive hydropneumothorax on the thoracic CT 3 days after ablation of the thoracic drain. Temporary oesophagus exclusion and pleural drainage in close proximity of the perforation were performed. A nosocomial pneumonia complicated the development but the patient could endly issue from ICU. This mode of revelation was unusual and the authors recommend thinking of the diagnosis of oesophagus rupture when a patient is admitted for a candidosis empyema.

[Severe malaria in intensive care units in 2003]. / Le paludisme grave en réanimation en 2003.

Malaria requiring intensive care is characterized by failure of one or more organ systems and/or development of several metabolic disorders secondary to the presence of Plasmodium faliciparum in the blood. Severe imported malaria in non-immunized adults causes multiple organ failure with variable degrees of altered mental status. Acute pulmonary edema is frequent, jaundice associated with mild disturbance of liver function is consistent, arterial hypertension due to hypovolemia is usual, and acute renal insufficiency is uncommon. Coagulation disorders are generally low-grade, acidosis is an unfavorable prognostic factor, severe hypoglycemia can occur after the beginning of quinine treatment, and anemia is an consistent but discrete symptom. In endemic areas emphasis should be placed on the complications of severe malaria in pregnant women due to the high incidence of hypoglycemia and pulmonary edema. Severe malaria can develop early in children in endemic zones. Presenting signs include cerebral malaria in older children and severe anemia in young children. Quinine is the reference treatment with a bolus of 17 mg/kg followed by a daily maintenance dose of 24 mg/kg. Use of artemether should be restricted to quinine-resistant forms. Total blood exchange transfusion is not recommended. Supportive symptomatic treatment, e.g. mechanically assisted ventilation and kidney dialysis, is required. In endemic zones over 90% of deaths involve children without access to intensive care facilities. Mortality rates associated with management of severe imported malaria in intensive care range from 10 to 30%.