[Followup of pregnant women in the context of malaria: two case reports]. / Suivi de la grossesse dans le cadre du Paludisme: à propos de deux observations.

Whether or not a pregnant women should travel to regions where malaria is highly endemic will always be open to question as no prophlaxis can guarantee complete protection in every case. No chemoprophylaxis is 100% effective or entirely without side-effects, particularly for pregnant women whose immune status provides a favourable environment for the emergence of this parasitosis. The advice given will depend on the country and the region, a possible resistance of the parasite to treatment, the season, the length and circumstances of the stay and individual factors. The choice of treatment is very limited as many therapies are contra-indicated in pregnancy; in addition it is extremely important to give a sufficiently clear explanation concerning precautions and prophylaxis as well as of how a possible bout of malaria should be treated, particularly in case of extended stay.

A seroepidemiological study on toxoplasmosis.

Using the microparticle capture enzyme-immunoassay (MEIA) based on IMx technology (Abbott), we determined the current prevalence of toxoplasmosis in 784 pregnant women followed up during 1990, and in 1,839 randomly selected blood donors. They all came from the Brabant Wallon area and the South-East of Brussels. Specimens yielding low IgG immunity (6-15 units) [corrected], were further tested with a sensitive direct agglutination assay (Toxo-Screen DA, bioMerieux). Overall, the prevalence was 67% among blood donors and 50% in pregnant women. In blood donors, the prevalence in women was not statistically different from the prevalence in men: X2 = 2.95 NS. In the two populations, a progressive age-related increasing prevalence of up to 60% for pregnant women and 77% for blood donors was observed. In females, the prevalence was higher among female blood donors than among pregnant women: 63% versus 50%, X2 = 16, P < 0.001. However, when the prevalences were compared within three age subgroups of women (< or = 33 yrs, 34 to 41 yrs, > or = 42 yrs), there were no statistically significant differences between pregnant women and blood donors. Thus, the overall observed difference was due to an age effect. Therefore, the distribution of IgG titers was established in each of the six age and sex subgroups. The 25th, 50th and 75th percentiles of those distributions ranged between 14 IU and 20 IU, 24 IU and 35 IU, and 40 IU and 64 IU, respectively. The annual seroconversion rate was 0.8% in pregnant women, against 0.2% amongst non-immune blood donors over 3 months. In conclusion, our findings confirm the general prevalence of 50% of toxoplasmosis and an annual seroconversion rate of 0.8% in these two populations.

Primary infection of ascitic fluid with Clostridium difficile.

A case of a primary infection of ascitic fluid with a toxigenic strain of Clostridium difficile is described. The strain belonged to the serogroup H which is often implicated in pseudomembranous colitis. Nevertheless, our patient did not have any sign of colitis or diarrhoea before the ascitic infection. She was successfully treated by the intravenous administration of metronidazole but relapsed a few weeks later. A similar strain of serogroup H was again isolated.