[Multifocal tuberculosis. Apropos of 49 cases in the midwest region. GERICCO (Group for Epidemiology and Research in Clinical Infections of the Central West of France), 1991-1993]. / Tuberculose multifocale. A propos de 49 cas dans la région Centre-Ouest (Géricco, 1991-1993).

Diffuse or multifocal tuberculosis (TB) accounts for 9% to 10% of cases of extrapulmonary TB and carries a poor prognosis with a mortality rate of 16% to 25%. Forty-nine cases of multifocal TB defined as involvement of two extrapulmonary sites with or without pulmonary TB were reviewed. Mean patient age (+/- SD) was 50 +/- 18 years. Twenty-three per cent of patients were immigrants. A history of TB and contact with a TB patient were found in 23% and 18% of cases, respectively. Of the 52% of immunocompromised patients, 38% were HIV-positive. The skin tuberculin test was positive in 67% of cases. Mean time from symptom onset to admission was 80 +/- 77 days (median, 58 days). The 49 patients had a total of 128 TB foci. Six patients had positive blood cultures. The tubercle bacillus was recovered from the extrapulmonary sites in 88% of cases. Mean treatment duration was nine months. Recovery from the TB was achieved in 64% of cases. The overall mortality rate was 47%, and 33% of patients died as the direct result of TB. Most deaths occurred in immunocompromised patients. A high index of suspicion for multifocal TB should be maintained in immunocompromised patients, even those who test negative for the HIV.

[Drug resistance in malaria, what to do? Apropos of 3 cases]. / Chimio-résistance du paludisme, que proposer? A propos de 3 observations.

The authors report three clinical observations of drug resistance; two of them have their origin in French Guiana and the third one in East Africa. They note that these cases are linked to bad advice of prevention concerning the risk of malaria, diagnosis carried out sometimes late for these zones of resistance; they recommend: to inform and teach the patient how to use a self-treatment in case of bout of malaria, to give better advice to the Physicians concerning the reality of malaria in 1985 instead of using a complex diagram of chemoprophylaxis.