Clusterin facilitates apoptotic cell clearance and prevents apoptotic cell-induced autoimmune responses.

Clusterin (Clu), an extracellular chaperone, exhibits characteristics of soluble innate immunity receptors, as assessed by its ability to bind some bacteria strains. In this study, we report that Clu also binds specifically to late apoptotic cells but not to live, early apoptotic, or necrotic cells. Histones, which accumulate on blebs during the apoptotic process, represent privileged Clu-binding motifs at the surface of late apoptotic cells. As a consequence, Clu potentiates, both in vitro and in vivo, the phagocytosis of late apoptotic cells by macrophages. Moreover, the increased phagocytosis of late apoptotic cells induced by Clu favors the presentation and cross-presentation of apoptotic cell-associated antigens. Finally, we observed that, in a model of apoptotic cell-induced autoimmunity, and relative to control mice, Clu(-/-) mice develop symptoms of autoimmunity, including the generation of anti-dsDNA antibodies, deposition of immunoglobulins and complement components within kidneys, and splenomegaly. These results identify Clu as a new molecule partner involved in apoptotic cell efferocytosis and suggest a protective role for Clu in inflammation and autoimmune diseases.

[French survey of neuromuscular relaxant use in anaesthetic practice in adults]. / Enquête de pratique sur l'utilisation en France des curares chez l'adulte en anesthésie.

Guidelines about the use of neuromuscular blocking agents based on a national consensus conference have been published in 2000. A survey was carried out to assess adherence to these guidelines. An online questionnaire was designed from the different guidelines concerning the use of muscle relaxant for tracheal intubation and surgery, monitoring and antagonism of neuromuscular blockade. In addition, question about the knowledge of the pharmacodynamics of neuromuscular blocking agents were asked. Analysis concerned 1230 answers from senior anaesthetists. Tracheal intubation is facilitated by the use of a competitive agent or by succinylcholine by 58 and 8% of responders respectively. Atracurium and cisatracurium were most frequently used (49 and 44%, respectively). The duration of effect of an intubating dose of atracurium, vecuronium or rocuronium was estimated equal or below 60 min by more than half of responders, whereas that of cisatracurium was longer. Fifty-two or 74% of responders used neuromuscular monitoring, whether a single or repeated dose of muscle relaxant was administered. Antagonism of neuromuscular blockade was systematic, frequent, and episodic or excluded by 6, 26, 55 and 13% of responders, respectively. Monitoring and antagonism of neuromuscular blockade are underused despite the guidelines. Underestimation of the risk of postoperative residual curarization is linked to the underestimation of the duration of competitive neuromuscular blocking agents.

Evidence for distinct effects of GH and IGF-I in the metabolic syndrome.

AIMS: The metabolic syndrome is a cluster of cardiovascular risk factors which include central obesity, dyslipidaemia, glucose intolerance and hypertension. These risk factors are common in patients with growth hormone (GH) deficiency, suggesting a role for the somatotropic axis in the development of metabolic syndrome. METHODS: We used factor analysis to investigate the relationships linking serum levels of GH and insulin-like growth factor I (IGF-I) to metabolic syndrome variables (high-density lipoprotein cholesterol, triglycerides, fasting glucose, blood pressure and waist circumference). We studied 359 men and 388 women from the Data from an Epidemiological Study on the Insulin Resistance syndrome (DESIR). Their age range was 30-64 years. RESULTS: Three independent latent factors explained 61% of the total variance in women and four factors explained 73% in men. In both men and women, IGF-I showed a strong positive correlation with the lipid factor and a negative correlation with the obesity/glucose factor. In women, GH showed a strong negative correlation with the obesity/glucose factor but not the lipid factor. In men, GH was unrelated to the lipid and obesity/glucose factors. The blood pressure factor was not related to GH or IGF-I. In contrast with IGF-I, GH was significantly lower in women with metabolic syndrome (1575 +/- 449 pg/ml) than in the other women (2121 +/- 520 pg/ml, P = 0.002). No significant difference was observed in men for GH or IGF-I. CONCLUSION: Our results support a link between the somatotropic axis and several features of the metabolic syndrome, and suggest distinct effects of GH and IGF-I on these parameters.

Are smear-positive pulmonary tuberculosis patients a 'sentinel' population for the HIV epidemic in Cameroon?

OBJECTIVE: To assess whether the human immunodeficiency virus (HIV) seroprevalence rate in adults with smear-positive pulmonary tuberculosis (PTB) can serve as a sentinel group for the estimation of HIV prevalence in the general adult population in Cameroon. DESIGN AND METHODS: A systematic review of reported HIV seroprevalence rates in the general adult population and in adults aged 15 years and over with PTB in Cameroon, using indexed and non indexed articles, publications, and reports from 1989 to 2000. Reconstruction of the evolution of the HIV seroprevalence in the two populations was done, and the relationship between these was established by the regression equation and the calculation of the correlation coefficient r. RESULTS: During the period 1989-2000, the evolution of HIV seroprevalence in the general adult population and in adults with PTB showed a steady increase, with a strong linear relationship (r = 0.96, df 7, P < 0.01). Each percentage increase of HIV seroprevalence among PTB patients corresponded to an increase of seroprevalence of about 0.3% in the general population. CONCLUSIONS: HIV seroprevalence in PTB patients in Cameroon could serve as a 'sentinel' for HIV seroprevalence in the general population.

Interactions between Schistosoma haematobium and Schistosoma mansoni in humans in north Cameroon.

OBJECTIVES: To analyse the relationships between the frequency of ectopic localizations of Schistosoma haematobium and S. mansoni eggs. METHODS: Studies were conducted in 11 villages in north Cameroon, around Bessoum, a village where an epidemic of bloody diarrhoea caused by S. mansoni occurred in 1997. RESULTS: The results revealed infection prevalence rates of 70.5% for S. haematobium and 30.8% for S. mansoni. Interestingly, S. mansoni eggs were found in 14.5% of the urine samples and S. haematobium eggs in 3% of the stool samples. These ectopic eliminations of schistosome eggs resulted from sexual interactions between the two species of schistosomes, and from a spill-over of high infection loads. The clinical study showed that the morbidity was lower in individuals with mixed infections and high loads of S. haematobium than in those with S. mansoni infections only, suggesting a possible lowering effect of S. haematobium infection on S. mansoni morbidity. DISCUSSION: The results obtained in human populations are discussed in relation to the known schistosome interspecific interactions in animal models.

HIV-1 group O infection in Cameroon, 1986 to 1998.

We report a survey of HIV-1 group O infection in Cameroon during 1986 to 1998. The prevalence of HIV-1/O decreased from 0.6% to 0.4%, while HIV-1/M increased from 19.2% to 31.5% from 1994 to 1998. We concluded that HIV-1/O infection is stable in Cameroon and may be declining slightly.

[Bacterial meningitis in Yaoundé (Cameroon) in 1999-2000]. / Les méningites d'étiologie bactérienne à Yaoundé (Cameroun) en 1999-2000.

All cephalo-spinal fluid (CSF) samples sent to the Yaoundé Pasteur Centre in Cameroon, between July 1999 and June 2000, were cultured and tested for soluble antigens. The percentage of positive samples was 10.4%. The main etiological agents detected were Streptococcus pneumoniae (56.2%), Haemophilus influenzae (18.5%) et Neisseria meningitidis (13.4%). Most of these cases of bacterial meningitis were children (86.7%). The susceptibility of the isolates to antibiotics was investigated. The streptococci and meningococci were mostly susceptible to beta-lactams, but the Gram-negative bacteria were not. Combinations of amino-penicillin and aminoside or chloramphenicol continue to be effective, as are third generation cephalosporins used alone. Meningococci appear to have emerged during the year 1999/2000, with 23 such isolates identified, of which 17 were serogroup A, subtype P1-9, clone III-1, which was responsible for the second pandemic. It should also be noted that 4 strains of N. meningitidis of serogroup W135 were isolated in Yaoundé.

Acquired anti-tuberculosis drug resistance in Yaounde, Cameroon.

SETTING: Tuberculosis centre of Hôpital Jamot, Yaounde, Cameroon. OBJECTIVES: To determine the prevalence of acquired resistance (ADR) to the main anti-tuberculosis drugs, and to identify risk factors associated with its occurrence in Yaounde. DESIGN: A total of 111 previously treated adults admitted consecutively to the tuberculosis centre with sputum smear-positive pulmonary tuberculosis between June 1996 and July 1997 were included in the study. Information on potential risk factors for ADR was obtained from each patient, and human immunodeficiency virus (HIV) serostatus was determined. Drug susceptibility testing to the main anti-tuberculosis drugs was performed on cultures of Mycobacterium tuberculosis complex isolated from sputum samples of each patient by the indirect proportion method. All patients whose isolates tested resistant to at least one anti-tuberculosis drug were defined as having ADR. RESULTS: Growth of M. tuberculosis complex was obtained from sputum specimens of 98 (88.3%) of the 111 patients studied; 57 (58.2%) of these were resistant to at least one anti-tuberculosis drug. Resistance to isoniazid was the most common (54.1%), followed by resistance to rifampicin (27.6%), streptomycin (25.5%) and ethambutol (12.2%). Multidrug resistance was observed in 27 (27.6%) of the cases. In a multivariate logistic regression analysis, ADR was significantly associated only with monotherapy use in previous tuberculosis treatment(s) (P = 0.03). CONCLUSION: The rate of ADR of M. tuberculosis is quite high in Yaounde. Acquired resistance to rifampicin alone or in combination with isoniazid is also high. Monotherapy in previous anti-tuberculosis treatment(s) is a significant predictor of ADR in previously treated patients in Yaounde. These results underscore the urgent need for the re-establishment of a tuberculosis control programme, using the DOTS strategy, in Cameroon.

Anti-tuberculosis drug resistance in the West Province of Cameroon.

SETTING: All 15 district hospitals of the West Province of Cameroon, between July 1997 and June 1998. OBJECTIVE: To determine the prevalences of initial and acquired resistance to the main anti-tuberculosis drugs 2 years after the implantation of a tuberculosis control programme in the province. METHODS: A total of 615 adults consecutively admitted to the 15 district hospitals with sputum smear-positive pulmonary tuberculosis were systematically studied. Sputum specimens collected from each patient were cultured on Lowenstein-Jensen medium. Testing of susceptibility to the major anti-tuberculosis drugs was performed by the indirect proportion method. RESULTS: Growth of Mycobacterium tuberculosis complex strains was obtained from specimens of 566 (92%) of the 615 patients. The overall resistance rate (one or more drugs) was 26.9%, with initial resistance being 19.7% (86/437) and acquired resistance 51.1% (66/129). Initial resistance to isoniazid was the most common (12.1%), followed by streptomycin (11.7%), ethambutol (2.5%) and rifampicin (2.1%). Initial resistance was noted as 13.5% to one drug, 4.3% to two, 1.1% to three and 0.7% to four. Acquired resistance to isoniazid was the most frequent (41.1%), followed by streptomycin (26.4%), rifampicin (14.7%) and ethambutol (9.3%). Acquired resistance was 25.6% to one drug, 14.7% to two, 7% to three and 3.9% to four. CONCLUSION: The proportion of resistant tuberculosis in the West Province is quite high. This underscores the need for the improvement of the control programme by introducing the DOTS strategy.

Epidemic Schistosoma mansoni in a known S. haematobium area.

An epidemic of bloody diarrhoea was observed in 1997 and 1998 in Bessoum, north Cameroon. Of 1176 inhabitants, 16.7% went for medical consultation to a public health centre located 10 km away. This epidemic was probably due to the recent introduction of Schistosoma mansoni in an ancient focus of S. haematobium, following the development of irrigated farming. The prevalences amongst primary school children were 76.6% for S. haematobium in urine, and 60.9% for S. mansoni in stool. S. mansoni was found in urine in 28.1%. This epidemic emergence may be secondary to interspecific competition between the 2 schistosomes.

An epidemic of bloody diarrhea: Escherichia coli O157 emerging in Cameroon?

Between November 1997 and April 20, 1998, bloody diarrhea sickened 298 persons in Cameroon. Laboratory investigation of the epidemic (case-fatality rate, 16.4%) documented amoebiasis in one of three patients and three types of pathogens: multidrug-resistant Shigella dysenteriae type 1, S. boydii, and enterohemorrhagic Escherichia coli. We report the first isolation of E. coli O157:H7 in Cameroon and the second series of cases in the Central African region.

[The microbial etiology of genital discharges in Nouakchott, Mauritania]. / Etiologie microbienne des écoulements génitaux à Nouakchott, Mauritanie.

The survey carried on 579 patients of both sexes, consulting for genital discharges (spontaneous or referred), showed that in 61.1% men cases, STD agents were isolated (Neisseria gonorrhoeae 51.5%) and 64.4% in women cases (Gardnerella vaginalis 24%, Candida albicans 20%. Trichomonas vaginalis 14%). 17% of Neisseria gonorrhoeae strains were penicillinase-producing (PPNG).

[Difficulties in the epidemiological surveillance of measles in Africa: exemplified by the Ivory Coast]. / Difficultés de la surveillance épidémiologique de la rougeole en Afrique: exemple de la Côte d'Ivoire.

In tropical areas measles cases often are under-reported but the authors comment here two epidemics which had at first been considered as outbreaks of measles but were not. The first epidemic resembled a Chikungunya virus outbreak with important rashes, hyperthermia and pain attacks and was due to Igbo-Ora arbovirus. In the second epidemic children were having rashes with hyperthermia and adenopathy evoking rubella. The authors consider the possibility of over-reporting in view of the surveillance of measles, the target-disease in EPI (Expanded Programme on Immunization). This hypothesis is confirmed by the distribution of reported cases at national level with a high rate of out-season cases and among adults.

[A rural epidemic of Igbo Ora virus (with interhuman transmission) in the Ivory Coast 1984-1985]. / Epidémie rurale a virus "Igbo Ora" (avec transmission inter-humaine) en Cote-d'Ivoire en 1984-1985.

The first outbreak caused by Igbo Ora virus is described. Virus circulation has been demonstrated up on thirty-three sick persons in Yamoussoukro area (Ivory Coast).