Imported loiasis in France: a retrospective analysis of 47 cases.

BACKGROUND: French physicians occasionally encounter travelers (immigrants, expatriates, others) seeking care for loiasis. METHODS: We describe the clinical and biological patterns and treatment of 47 cases of imported loiasis seen at three French hospitals over a 15-year period (1998-2012). RESULTS: Most patients acquired their infection in Cameroon, Gabon, and Central African Republic. Overall, Calabar swellings were observed in 63% patients, and eye worm migration in 29%. Peripheral blood microfilariae were detected in 48% of patients and eosinophilia in 90% respectively. Calabar swellings and eosinophilia were more common among expatriates and travelers, whereas African immigrants were more likely to present with eye worm migration and have microfilaremia. First-line treatment was ivermectin in most cases (51%), followed by diethylcarbamazine (23%), albendazole (8%) or a combination of drugs (8%). Forty-one patients underwent clinical and parasitological follow-up for a mean period of 422 days [range 30-3600 days]. Clinical relapse and/or persistence/reappearance of blood microfilaria occurred in 10 patients. CONCLUSIONS: Clinical and biological features were comparable with the largest monocentric series of imported loiasis. There was a marked rate of failure after first-line treatment and rare adverse effects were reported. The treatment of patients with imported loiasis would benefit from standardization with guidelines for the choice of first and second line drugs, the length of follow-up and criteria for cure.

False-negative serologies in amebic liver abscess: report of two cases.

Amebiasis, the parasitic disease caused by Entamoeba histolytica, may result in extra-intestinal diseases among which liver abscess is the most common manifestation. We report two cases of amebic liver abscess illustrating the inequal sensitivity of serologic tests detecting anti-amebic antibodies.

[An asymptomatic chronic hypokalaemia]. / Une hypokaliémie chronique asymptomatique.

We report the case of an asymptomatic patient presenting a severe chronic renal hypokalaemia. Once being sure of no diuretics use, two hypothesis can be mentioned for a normotensive patient presenting an hypokalaemia associated with a metabolic alcalosis: Bartter syndrome or Gitelman syndrome. The highlighting of low magnesaemia and hypocalciuria strongly concentrates the diagnosis on Gitelman syndrome. First, this has been strengthened by the results of renal function tests and later it has confirmed by molecular diagnosis with the identification of a known homozygous mutation on SLC12A3 gene. In the patient family, the same chromosomal abnormality has been found in the young sister. For these two patients the treatment ordered is an antikaliuretic diuretic, magnesium and potassium supplements. This case shows the difficulty to diagnose Gitelman syndrome: it is frequently mistaken for Bartter syndrome. The main differences between these two syndromes are magnesaemia and calciuria. Furthemore , patients with Gitelman syndrome are often asymptomatic, this explains why prevalence of this illness is probably underestimated.

Cluster of eosinophilic meningitis attributable to Angiostrongylus cantonensis infection in French policemen troop returning from the Pacific Islands.

BACKGROUND: Outbreaks of eosinophilic meningitis are reported rarely, even in regions of endemic infestation with the roundworm Angiostrongylus cantonensis, such as the Pacific Basin. We report a cluster of eosinophilic meningitis presumably attributable to A. cantonensis among French policemen returning from French Polynesia. METHODS: A retrospective cohort study among French policemen who had stayed in Tahiti was conducted using a clinical definition of eosinophilic meningitis that included severe headache within 30 days after return and eosinophilia, and who consumed locally exotic ethnic dishes with uncooked freshwater prawns. RESULTS: Five persons met the case definition for eosinophilic meningitis. Corticosteroid therapy associated with antihelminthic regimen led to improvement of symptoms in one patient. Other patients were treated with albendazole alone. All patients recovered. CONCLUSION: Among travellers at risk, the presence of severe headache and eosinophilia combined with a consistent exposure history to exotic food should alert to the possibility of A. cantonensis infestation. Travellers should be aware of the risk of infection associated with eating exotic ethnic dishes.