Pernicious anemia presenting as catatonia: correlating vitamin B12 levels and catatonic symptoms.

Pernicious anemia has been associated with various psychiatric manifestations, such as depression, mania and psychosis. Psychiatric symptoms can sometimes occur without hematological and neurological abnormalities and can be prodromal of vitamin B12 deficiency. We report a case of autoimmune B12 deficiency presenting as catatonia without signs of anemia or macrocytosis, in which a correlation was found between the patient's B12 blood levels and catatonic symptoms over time. This catatonic episode was successfully treated with only lorazepam and adequate doses of cyanocobalamin.

The nonstructural protein NSs induces a variable antibody response in domestic ruminants naturally infected with Rift Valley fever virus.

Rift Valley fever (RVF) is an emerging zoonosis in Africa which has spread to Egypt, the Arabian Peninsula, Madagascar, and Comoros. RVF virus (RVFV) (Bunyaviridae family, Phlebovirus genus) causes a wide range of symptoms in humans, from benign fever to fatal hemorrhagic fever. Ruminants are severely affected by the disease, which leads to a high rate of mortality in young animals and to abortions and teratogenesis in pregnant females. Diagnostic tests include virus isolation and genome or antibody detection. During RVFV infection, the nucleoprotein encapsidating the tripartite RNA genome is expressed in large amounts and raises a robust antibody response, while the envelope glycoproteins elicit neutralizing antibodies which play a major role in protection. Much less is known about the antigenicity/immunogenicity of the nonstructural protein NSs, which is a major virulence factor. Here we have developed a competitive enzyme-linked immunosorbent assay (ELISA) enabling detection of low levels of NSs-specific antibodies in naturally infected or vaccinated ruminants. Detection of the NSs antibodies was validated by Western blotting. Altogether, our data showed that the NSs antibodies were detected in only 55% of animals naturally infected by RVFV, indicating that NSs does not induce a consistently high immune response. These results are discussed in light of differentiation between infected and vaccinated animals (DIVA) tests distinguishing naturally infected animals and those vaccinated with NSs-defective vaccines.

Prevalence of Toscana virus antibodies in volunteer blood donors and patients with central nervous system infections in southeastern France.

Toscana virus (TOSV) is a sandfly-borne phlebovirus causing meningitis and encephalitis during the summer period. A significant proportion of infection results in asymptomatic or pauci-symptomatic forms. Although seroprevalence studies had been conducted in Italy, Spain, Greece, and Cyprus, no data were available from France at the outset of this study. We present here results of seroprevalence studies conducted in volunteer blood donors and in patients presenting with central nervous system (CNS) infections. Twelve percent of sera from blood donors and 18.9% of sera from patients hospitalized for CNS infection contained immunoglobulin G (IgG) reacting against TOSV or TOSV-related phleboviruses. This study confirms that TOSV and possibly TOSV-related phleboviruses actively circulates in southeastern France and demonstrates that a significant proportion of healthy blood donors and patients with CNS infections have a history of TOSV or TOSV-related phlebovirus infection.

Chikungunya virus, Cameroon, 2006.

We report the isolation of chikungunya virus from a patient during an outbreak of a denguelike syndrome in Cameroon in 2006. The virus was phylogenetically grouped in the Democratic Republic of the Congo cluster, indicating a continuous circulation of a genetically similar chikungunya virus population during 6 years in Central Africa.

Antibody responses to several malaria pre-erythrocytic antigens as a marker of malaria exposure among travelers.

Protective devices against vectors are used by travelers in malaria-endemic areas but their efficacy for protection against mosquitoes has rarely been evaluated. The level of exposure to malaria transmission of 205 soldiers deployed in Africa and the efficacy of their anti-vector prophylaxis was evaluated by comparison of their IgM and IgG responses against five pre-erythrocytic Plasmodium falciparum antigens (circumsporozoite protein, sporozoite threonine- and asparagine-rich protein, sporozoite- and liver-stage antigen, liver stage antigen 1, and SR11.1) before and at the end of their deployment, and three months after returning to France for 106 of these soldiers. The immune responses increased significantly during the mission in 35% (95% confidence interval = 28-42%) of the individuals. The permanent use of insecticide-treated bed nets and long-sleeve battle dress at night were associated with protective efficacy. The analysis of these antibody responses was sensitive enough to evaluate exposure to malaria transmission and the efficacy of anti-vector devices in travelers using antimalarial chemoprophylaxis.

West Nile Virus in horses, sub-Saharan Africa.

To evaluate the presence and extension of West Nile virus where French soldiers are stationed in Africa, specific antibody prevalence was determined by using ELISA and Western blot. Among 245 horses living in close proximity to the soldiers, seroprevalence was particularly high in Chad (97%) and Senegal (92%).

Acute meningitis owing to phlebotomus fever Toscana virus imported to France.

Acute lymphocytic meningitis, seen in France in summer, is often due to enteroviruses. Arboviruses as West Nile and tick-borne encephalitis do exist in Europe, but other viruses are rarely considered in patients unless they have had recent tropical travel. Toscana virus infection, which is endemic, especially in Italy,1-3 has been documented in some European travelers returning from Italy,4-6 but surprisingly was not documented in France until recently.7 We report a case of meningitis caused by Toscana virus imported to France.

[West Nile virus: in France again, in humans and horses]. / Virus West Nile: à nouveau en France chez l'homme et les chevaux.

West Nile virus (WNV) is a common arbovirosis, transmitted by mosquitoes mainly Culex. WNV is commonly responsible for equine epizootics and epidemics in humans in sub-Saharan Africa. It has been occasionally described in Southern Europe and in some Mediterranean countries. Since 1994, WNV clinical aspects seem to change with an increase of central neurological involvement and a higher mortality, especially among people older than 50 years. In 1999, WNV reached New York, being responsible for severe clinical manifestations. It spread all over North America in less than four years Four (only four states of the United States are free). As a consequence of an equine epizootic in Camargue in 2000, French medical authorities settled a survey of the WNV circulation in the South of France. During 2003, this efficient action led to identify 6 human cases in a formerly WNV-free French Mediterranean coast, but not in Camargue.

Rift Valley fever in Chad.

To evaluate the importance of human exposure to Rift Valley fever virus in Chad, investigations were carried out to determine specific antibody prevalence in domestic ruminants during the 2002 rainy season. Results highlighted recent, substantial, active transmission of this virus.

Quality control assessment for the serological diagnosis of dengue virus infections.

BACKGROUND: A major drawback of modern society's rapidly increasing mobility is the ease with which dangerous infections can be imported into Europe. Often these infections are not diagnosed because physicians are not familiar with the symptoms and laboratory tests are not always available in local diagnostic centres. Improving diagnostics is the most important step in detecting and dealing with these pathogens and quality control measures are, therefore, essential tools. OBJECTIVES: To assess the diagnosis of imported dengue virus infections in Europe by (1) running a pre-evaluation panel (four serum samples, sent out in 1999) and optimising sample preparation and shipping procedures and (2) initiating an External Quality Assurance (EQA) program (20 serum samples, sent out in 2002). STUDY DESIGN: All serum samples sent out were to be tested for the presence of dengue virus-specific IgM and IgG. For the pre-evaluation panel, four samples were distributed (one sample IgM+/IgG+, one sample IgM-/IgG+, two samples IgM-/IgG-) and for the EQA 20 samples (12 samples IgM+/IgG+, five samples IgM-/lgG+, one sample lgM+/IgG- two samples IgM-/IgG-). 13 laboratories took part in the pre-evaluation panel and 18 laboratories participated in the first EQA run. RESULTS: For the pre-evaluation panel, the participants reported concurrent and correct results for 88% of the IgG-positive samples and for 100% of the IgG-negative samples. The results for the IgM-positive sample were correct in 91% of the reported tests and in 97% of the IgM-negative samples. For the EQA, the participants reported concurrent and correct results for 71% of the IgG-positive samples and 89% of the IgG-negative samples. 58% concurrent and correct results were reported for the IgM-positive samples and 97% for the IgM-negative samples. CONCLUSIONS: The results presented here demonstrate the importance of quality measures for imported viral pathogens like dengue viruses and clearly indicate the need for improving the existing test systems.

Rift Valley Fever

To evaluate the importance of human exposure to RiftValley fever virus in Chad; investigations were carried outto determine specific antibody prevalence in domestic ruminantsduring the 2002 rainy season. Results highlighted recent; substantial; active transmission of this virus

Genetic characterization of newly reintroduced dengue virus type 3 in Martinique (French West Indies).

Dengue type 3 viruses were isolated from patients in Martinique between 1999 and 2002. This serotype had not been detected on the island in the last 20 years. Genomic sequence determination and analysis showed great stability of the virus during the period studied.

[Dengue fever: outbreak in southern Europe?]. / La dengue: bientôt en Europe du Sud?

Epidemiology of dengue fever is changing dramatically. The worldwide incidence is rising and clinical symptoms are worsening. Reports describing forms associated with haemorrhages or shock syndrome involving both children and adults are increasingly frequent in regions beyond Southeast Asia where the first cases were observed. Many mechanisms could be implicated in these changes, including modifications of the virus, host, vector, or socio-economic factors. The new facilities in the laboratory diagnostic (MAC-ELISA; molecular biology), the commercialization of these assays allow not only assessment of morbidity and mortality in endemic areas and early detection of epidemic outbreaks but also evaluation of socio-economic impact and effectiveness of control measures. Now, the efficiency of the fight must be better, otherwise dengue will grow up during this new century.

Detection of Astrakhan fever rickettsia from ticks in Kosovo.

Astrakhan fever is a summer spotted fever resembling Mediterranean spotted fever, endemic in Astrakhan, a region of Russia located by the Caspian sea. Its agent is a spotted fever group rickettsia, member of the Rickettsia conorii complex, transmitted to humans by Rhipicephalus sanguineus and Rhipicephalus pumilio ticks. In Summer 2001, French United Nations troops in Kosovo collected 2 ticks on asymptomatic soldiers (1 R. sanguineus and 1 Hyalomma marginatum) and 10 ticks on dogs (7 R. sanguineus, 2 Ixodes ricinus, and 1 H. marginatum) in the Morina region. By PCR amplification of both the gltA and ompA genes, we detected a rickettsia in 4 R. sanguineus, i.e., 3 of those collected on dogs and those taken from military personnel. As ticks were preserved in alcohol, culture was not possible. The sequences obtained from these PCR products identified, with a 100% homology, Astrakhan fever rickettsia. None of the other collected tick species was positive. The patient with the positive tick remained asymptomatic. Our study demonstrates, for the first time, the presence of Astrakhan fever rickettsia in ticks outside Russia. We suspect that the area of distribution of this rickettsia could be wider than initially suspected. Moreover, as R. sanguineus ticks bite humans, Astrakhan fever might be a cause of spotted fever in Kosovo.