Airport malaria : four new cases in suburban Paris during summer 1999.

During the summer 1999, four clustered cases of airport malaria were observed in France. The cases analysis revealed that airport malaria, which is a rare disease whose diagnosis is difficult, can be observed outside occupations at risk, in people livin

[Malaria in airports and their neighborhoods]. / Paludisme des aéroports et de leurs alentours.

Though very rare compared to imported malaria, airport malaria should not be disregarded considering its very special gravity often due to late diagnosis. In most cases, it could be avoided if airlines and airports applied disinsecting measures vigilantly.

Origin and prevention of airport malaria in France.

Since 1969, 63 cases of airport malaria have been reported in Western Europe, 24 of which occurred in France. Most were due to Plasmodium falciparum. In 1994, 7 cases occurred in and around Roissy Charles de Gaulle airport (CDG), showing 4 types of contamination: among employees working on airstrips or opening containers, among residents living near the airport, among people living at some distance from the airport after a secondary transport of vectors, and by vectors transported in luggage. In-flight or stop-over infection is not considered as airport malaria. The infective anophelines originated from airports where malaria transmission occurs, mostly in subsaharan Africa. A tentative list is given taking into account aerial traffic with France. Surveys in the airports of Dakar (Senegal), Cotonou (Benin), Abidjan (Cote d'Ivoire) and Yaoundé (Cameroun) found potential vectors in all of these from July to September. After 1994, the Contrôle Sanitaire aux Frontières (CSF) in charge at CDG concentrated its efforts on the flights at risk, as well as information and sensitization of airline companies, which resulted in 73% and 87% of the flights at risk being properly disinsected in 1995 and 1996. Despite pyrethroid resistance in Anopheles gambiae s.s. in West Africa, the efficacy of aircraft spraying with permethrin aerosols is still acceptable. However, surveillance of resistance should be improved and search for nonpyrethroid insecticides suitable for aircraft strongly encouraged.

Lipid products of phosphoinositide 3-kinase and phosphatidylinositol 4',5'-bisphosphate are both required for ADP-dependent platelet spreading.

We have shown previously that ADP released upon platelet adhesion mediated by alphaIIb beta3 integrin triggers accumulation of phosphatidylinositol 3',4'-bisphosphate (PtdIns-3,4-P2) (Gironcel, D. , Racaud-Sultan, C., Payrastre, B., Haricot, M., Borchert, G., Kieffer, N., Breton, M., and Chap, H. (1996) FEBS Lett. 389, 253-256). ADP has also been involved in platelet spreading. Therefore, in order to study a possible role of phosphoinositide 3-kinase in platelet morphological changes following adhesion, human platelets were pretreated with specific phosphoinositide 3-kinase inhibitors LY294002 and wortmannin. Under conditions where PtdIns-3, 4-P2 synthesis was totally inhibited (25 microM LY294002 or 100 nM wortmannin), platelets adhered to the fibrinogen matrix, extended pseudopodia, but did not spread. Moreover, addition of ADP to the medium did not reverse the inhibitory effects of phosphoinositide 3-kinase inhibitors on platelet spreading. Although synthetic dipalmitoyl PtdIns-3,4-P2 and dipalmitoyl phosphatidylinositol 3',4', 5'-trisphosphate restored only partially platelet spreading, phosphatidylinositol 4',5'-bisphosphate (PtdIns-4,5-P2) was able to trigger full spreading of wortmannin-treated adherent platelets. Following 32P labeling of intact platelets, the recovery of [32P]PtdIns-4,5-P2 in anti-talin immunoprecipitates from adherent platelets was found to be decreased upon treatment by wortmannin. These results suggest that the lipid products of phosphoinositide 3-kinase are required but not sufficient for ADP-induced spreading of adherent platelets and that PtdIns-4,5-P2 could be a downstream messenger of this signaling pathway.

Pitfalls in the diagnosis of airport malaria. Seven cases observed in the Paris area in 1994.

Clinical and biological pitfalls that lead to incorrect or delayed diagnoses of airport malaria are described based on 7 cases reported from the Paris region in the summer of 1994. We also report the outcome and the epidemiological features of these patients.

The sea urchin larva, a suitable model for biomineralisation studies in space (IML-2 ESA Biorack experiment '24-F urchin').

By the ESA Biorack 'F-24 urchin' experiment of the IML-2 mission, for the first time the biomineralisation process in developing sea urchin larvae could be studied under real microgravity conditions. The main objectives were to determine whether in microgravity the process of skeleton formation does occur correctly compared to normal gravity conditions and whether larvae with differentiated skeletons do 'de-mineralise'. These objectives have been essentially achieved. Postflight studies on the recovered 'sub-normal' skeletons focused on qualitative, statistical and quantitative aspects. Clear evidence is obtained that the basic biomineralisation process does actually occur normally in microgravity. No significant differences are observed between flight and ground samples. The sub-normal skeleton architectures indicate, however, that the process of positioning of the skeletogenic cells (determining primarily shape and size of the skeleton) is particularly sensitive to modifications of environmental factors, potentially including gravity. The anatomical heterogeneity of the recovered skeletons, interpreted as long term effect of an accidental thermal shock during artificial egg fertilisation (break of climatisation at LSSF), masks possible effects of microgravity. No pronounced demineralisation appears to occur in microgravity; the magnesium component of the skeleton seems yet less stable than the calcium. On the basis of these results, a continuation of biomineralisation studies in space, with the sea urchin larva as model system, appears well justified and desirable.

[Diagnostic and prognostic importance of laboratory tests in malaria in airports. Study of six recent cases]. / Importance diagnostique et pronostique des examens de laboratoire au cours du paludisme des aéroports. Etude de six cas récents.

During the summer 1994, six cases of airport malaria occurred in France, near the Roissy-Charles-de-Gaulle airport. Due to Plasmodium falciparum, all cases underwent rapid and severe deterioration, and in one case, the patient died. The role of laboratory tests is essential to establish the diagnosis of persons who have never resided in the endemic malaria areas and follow up with the patients already under treatment to detect possible complications.

[Indigenous, introduced and airport malaria in Europe.]. / Paludisme autochtone et introduit en Europe.

Mainly due to P. vivax, the autochtonous malaria - sometimes caused by P. malaria, scarcely by P. falciparum - is spread in the whole Europe until the 18th century, decreasingly during the second part of the 19th century, while the latest documented cases were noticed in Macedonia, 1974. In France malaria spontaneously disappeared in 1943 on the mainland, and after, DDT house-spraying, in Corsica, 1959-60 (in spite of a temporarily reintroduction run in 1970). Malaria is now eradicated from Europe officially since 1975. Since 1969, approximatively 60 cases of autochtonous "airborne or airport malaria" have been officially reported from various European countries : Belgium, Germany, Italy, Netherlands, United Kingdom, Spain, Swiss, and France. Most of the 23 cases run into France were due to P. falciparum and appeared during summer. All patients were living, working or both, in the vicinity of an international airport or harbour (2 cases). Few of theses cases queerly involved a second-step carriage of Anopheles. The illness is usually severe and case fatality rate is therefore high, because of the subject's absence of premunition and no history of tropical travel, and then, the infection may be unfortunately misdiagnosed. According to the International Health Regulations, disinsection of aircrafts must be systematically done and even enhanced as soon as possible. On the other hand some of new methods for the aircraft disinsection and improved international vector control must be developped.

[The value of rectosigmoidoscopy and the bacteriologic culture of colon biopsies in the etiologic diagnosis of acute diarrhea of adults. A prospective study of 65 patients]. / Intérêt de la rectosigmoïdoscopie et de la culture bactériologique de biopsies coliques dans le diagnostic etiologique de diarrhée aiguë de l'adulte. Etude prospective sur 65 patients.

The goal of this study was to evaluate the contribution of sigmoidoscopy with bioptic microbiology to the etiologic diagnosis of acute diarrhea in adults. Patients and methods. Sixty-five patients with acute diarrhea were included prospectively from February 1993 to November 1994. Ages ranged from 17 to 83 years. In each patient, two stool samples were cultured and three examined for parasites. Clostridium difficile toxin was looked for in the 18 patients who had taken antimicrobials before onset of the diarrhea. Sigmoidoscopy with collection of biopsy specimens for bacteriologic cultures was performed routinely. Results. A pathogenic organism was identified in 35 patients (54%). Eighteen patients (28%) had positive stool cultures. Clostridium difficile toxin was detected in six patients. Colonic biopsy cultures were positive in 26 patients (40%). Endoscopic findings established the diagnosis of pseudomembranous colitis with negative tests for C. difficile toxin in two patients, diverticulitis in one, ischemic colitis in two, and cryptogenic colitis in seven. Conclusions. Sigmoidoscopy ensured the diagnosis in over 72% of cases of acute diarrhea. This investigation complements stool cultures and should be done routinely in adults with severe acute diarrhea.

[Comparison of the efficacy of 2 antiseptic solutions in the prevention of infection from peridural catheters]. / Comparaison de l'efficacité de deux antiseptiques dans la prévention de l'infection liée aux cathéters périduraux.

Two antiseptic solutions (iodine polyvidone and chlorhexidine) were compared-in a prospective non-randomized study including 294 parturient women. This study aimed to assess their efficacy against infections through epidural catheters. All catheters were subsequently cultivated. Cultures were significantly positive in 3% of cases after iodine polyvidone and 1% after chlorhexidine decontamination (not significant). No clinical or biological infections were detected. Notwithstanding some apparently unavoidable but moderate contaminations, prevention of infections post epidural analgesia depends principally on a complete adherence to asepsia rules.

[Human diffusion of arthropod disease vectors throughout the world]. / La diffusion anthropique des arthropodes vecteurs de maladie dans le monde.

The present distribution of animals and plants throughout the world is the result of an evolutionary process involving tectonic, climatic and biotic factors. Humans, since their appearance, have contributed to the spreading of many species including disease vectors and pests. When humans left their native African home, they brought with them ectoparasites such as lice and acarids. During the neolithic era, humans were leading domesticated animals which carried their own parasites into new areas. Dwelling commensals, flea, bugs, triatomids, flies, and cockroaches followed human migrations. In the second millennium, sailboats transported mosquito species which were resistant and reproduced on board, including Culex quinquefasciatus, Aedes aegypti, and Ae. albopictus. Steamers further shortened the length of trips and allowed the transport of anophelines. The opening of the Tamatave-Port-Louis line was immediately followed by the transport of An. gambiae from Madagascar to Mauritius and Reunion, and epidemics of malaria occurred on the two islands which had been free of the disease. Also, An. gambiae was transported from Senegal to Brazil. Old tires destined for recycling carried Ae. albopictus to the USA, Brazil, and then Italy. The pandemic of the plague at the end of the nineteenth century was propagated from harbour to harbour by steamers carrying both infected rats and their fleas Xenopsylla cheopsis. Aircrafts have reduced the travel time so much that in less than two days an insect could reach every point of the world. As soon as the airports had been built on the islands of French Polynesia, they were all colonized by Ae. aegypti. The same phenomenon occurred with midges (Fig. 2). Also, the construction of the airport on a Galapagos Island coincided with the importation of the blackfly Simulium bipunctatum from the continent. In addition, infected malaria mosquitos imported from tropical countries reached Europe and contaminated airport employees and local inhabitants. Six cases of malaria were recorded during the summer of 1994 around the Charles de Gaulle Airport, north of Paris, suggesting that the anophelines could have been imported from West and Central African countries which are served by this airport. The serious threat of vector importation is moderated by the vector's difficulty in adapting to new conditions. However any prediction is questionable.

[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.

[Mycobacterium kansasii infection in patients with human immunodeficiency virus infection]. / Infection à Mycobacterium kansasii chez des patients infectés par le virus de l'immunodéficience humaine.

We report a retrospective study of 12 caucasian men infected with HIV who had developed Mycobacterium kansasii infection (Mk). All patients had a low blood lymphocyte CD4 count (1-130, mean 15/mm3) and ten met the diagnostic criteria for AIDS. The 12 patients had pulmonary symptoms (dyspnea, cough) and fever. On chest X-ray, nodular, interstitial or diffuse parenchymal infiltrates, mediastinal and hilar adenopathies were observed. Two patients had pleural effusion, but none had cavitary lung disease. Mk was isolated by culture of sputum (n = 7), blood (n = 3), bronchial biopsy (n = 2) or bone marrow (n = 1). No patient had clinical extra-pulmonary disease. Survival after diagnosis was in average 7 months. Potential for therapeutic response is reviewed and documented.

[Serotyping of group B streptococcus in microbiological samples at the Robert-Ballanger hospital]. / Sérotypage du streptocoque du groupe B dans les prélèvements microbiologiques a l'hôpital Robert-Ballanger.

From February to September 1993, we have established the serotype of group B Streptococcus (GBS) taken from diverse microbiological samples, in particular from gastric liquids. The method utilized was a technic of coagglutination (Dako Group B Streptococcus Serotyping Test, France) allowing the search for serotypes Ia, Ib, II, III, IV and V. All in all, 169 samples have been tested: 117 vaginal samples, 17 diverse samples, 26 gastric samples, 3 placentas and 7 ammmiotic liquids. Serotypes are spread as follow: III (41), II (33), Ia (26) et V (23).... Usually, serotype III was the most frequently found and the most virulent, particularly in infections in neonates.

[Epidemiology of aminoglycoside resistance in Streptococcus except in group D Streptococcus and Enterococcus]. / Epidémiologie de la résistance aux aminosides de Streptococcus à l'exception des streptocoques du groupe D et des entérocoques.

During a ten month period (march-december 1989), all streptococcal strains isolated from clinical specimens sent to our laboratory were routinely tested for high-level resistance to aminoglycosides. High-level resistance was detected in 16 out of 475 streptococci: streptomycin (two strains), kanamycin (four strains), streptomycin and kanamycin (ten strains).

[Biological diagnosis of malaria: dangers of the automated blood differential count]. / Diagnostic biologique du paludisme: dangers de l'automatisation de la formule sanguine.

Automated differential counting systems deprive laboratories of blood smear study and so malaria risks not to be diagnosed if plasmodium search is not prescribed by the physician. Some abnormalities (atypical lymphocytes called LUC and thrombopenia) can induce a blood smear. But a study of 96 patients shows that, during the first analysis, these abnormalities can miss for nearly a third of one's case. So it is very important to prescribe malaria search on blood smears when there is the least clinical symptom.