[Impact and forecasting of hepatitis A immunization in French armed forces, 1990-2004]. / Impact et modélisation des effets attendus de la stratégie de vaccination contre les hépatites A chez les militaires français, 1990-2004.

BACKGROUND: Hepatitis A is a public health problem specially for migrants or travellers from industrialized countries with a low hepatitis A endemic level. French armed forces adopted an immunization strategy which first targeted overseas forces and subsequently was extended to all armed forces. In this work we studied the impact of this policy. METHODS: Epidemiological surveillance data from 1990 to 2004 was analyzed by Poisson regression and exponential models of decrease used to forecast future rates. RESULTS: From the 826 cases of hepatitis A reported during the study period, 266 (32.2%) occurred in overseas forces and 560 (67.8%) in forces stationed in France. Three periods could be identified in the decline of annual incidence: before 1994, with an average rate of 23.2 per 100,000; from 1994 to 1998: 10.2; and after 1998: 1.2 for all French armed forces. For overseas armed forces, the average rate was 117 per 100,000 before 1994 and 17.1 from 1994 to 1998 (p<0.001). For armed forces stationed in France, the average rate was 12.2 per 100,000 before 1998 and 0.9 after (p<0.001). For overseas armed forces, models clearly described the declining incidence subsequent to targeted immunization in 1995 and for armed forces stationed in France, the decline with generalized immunization starting in 1998. DISCUSSION: The impact of immunization against hepatitis A virus was significant both in an overseas population and in a population staying in France where the risk level can be considered low due to the low endemic rate in France. These results suggest that immunization should be proposed not only for travellers but also for the general population based on real knowledge of the situation and cost-effectiveness analyses.

[Amebic lung abscess: an unexpected diagnosis]. / Amibiase pleuropulmonaire: un diagnostic inattendu.

Pleuropulmonary amebiasis is a very rare complication of amebiasis infection and direct pulmonary involvement is exceptional. The clinical diagnosis is difficult without any intestinal or extraintestinal manifestations. A percutaneous drainage is necessary to aspirate pus. We report herein the case of a 56-year-old man presenting with an amebic lung abscess in his right lower lung and pleural effusion. The diagnosis was suspected by our laboratory from a serological assay (antiamebic antibodies reaching 320 by IHA) and established from a direct examination of the pus in which rare trophozoites of Entamoeba were detected. We pointed out the importance of the communication between the clinician and the biologist. Protozoan infection should be suspected in pleuropulmonary infection when antibiotics failed even in France. This patient left endemic area a long time ago and the way of his amebiasis contamination is unknown: recurrence of amebic infection is rare and prevalence in industrialized countries reaches only 1%. Several hypothesis are exposed.

[Value of anti-cyclic citrullinated peptides antibodies in comparison with rheumatoid factor for rheumatoid arthritis diagnosis]. / Intérêt des anticorps antipeptides cycliques citrullinés par rapport aux facteurs rhumatoïdes pour le diagnostic de la polyarthrite rhumatoïde.

The detection of anti-cyclic citrullinated peptides (CCP) antibodies is a new marker for diagnosis of rheumatoid arthritis. We screened 100 patients suffering from rheumatic pathologies or from other affections where rheumatoid factor is frequently detected. The screening was assessed by a second generation ELISA (Immunoscan RA) in comparison with agglutination assay (Latex and Waaler-Rose) and specific ELISA (IgM, IgG and IgA). The sensitivity of the anti-CCP is good (>70%) with an excellent specificity (98%). In our study the predictive value of the Immunoscan RA reached 71% and more among patients with joints symptoms. Anti-CCP antibody test could serve as a better diagnosis marker than rheumatoid factor.

[Invasive infections by Streptococcus pyogenes]. / Infection fulminante à Streptococcus pyogenes chez l'adulte.

Invasive infections by Streptococcus pyogenes continually increase both in France and in others industrialized countries. Because of the seriousness, the rapidity of the evolution and the epidemic potentialities, guidelines for managing these infections are requested by the Superior Council of Public Hygiene of France. The authors report herein a case of an adult stricken down by a violent evolution due to Streptococcus pyogenes. They point up how diagnosis, treatment and prophylaxis for family circle are difficult.

[Isolated pleural amebiasis: about one case in France]. / Amibiase pleurale isolée.

INTRODUCTION: Isolated pleural amebiasis is exceptional in the world and specially in France. CASE REPORT: We report a case of acute isolated pleural amebiasis in a 56 year old man who did not travelled in endemic countries for the 20 past years. Chocolate-colored pus from the pleural puncture suggested the diagnosis. Positive amebic serology and above all, trophozoites (Entamoeba histolytica) in the pleural liquid confirmed the diagnosis of pleural amebiasis. Drainage was required and metronidazole was introduced. Other antibiotics were necessary to treat bacterial co-infection, which is frequent. Of interest, a nurse developed an acute intestinal amebiasis probably infected by pleural pus, an indirect confirmation of diagnosis. CONCLUSION: This diagnosis should be suspected even in low endemic areas in case of infectious pleurisy resistant to traditional antimicrobial regimens.

[Contribution of molecular biology to biotyping in epidemiological surveys of nosocomial infectious outbreaks]. / Apport de la biologie moléculaire et de la biotypie dans l'enquête épidémiologique au cours des épidémies d'infections nosocomiales.

During the period between the end of 1993 and the beginning of 1994 there was a large epidemic rush from severe nosocomial infection essentially in the form of septicemia. Authors implemented a classification of these epidemics and some strains were sent to the Institute Pasteur Paris for a further examination. These strains went under nuclear biology test (study of DNA plasmidic profiles and RNA ribosomal profiles) and passed through an identification by an acheiring biotypic system using 99 sources or carbones--biotype 99. These studies have shown that its about real epidemic, because the same strains were transmitted from one patient to another. This show the precarious condition of our hospital hygiene, involving the necessity of an efficient training of our health staff.

[Five cases of non-typhoid salmonellosis in patients infected with the human immunodeficiency virus in Senegal]. / A propos de cinq cas de salmonelloses non typhiques au cours de l'infection par le virus de l'immunodéficience humaine au Sénégal.

Among the opportunistic infections observed during infection with human immunodeficiency virus, recurrent non-typhoid salmonella bacteriemia has not been widely documented in Black Africa. This retrospective study identified 5 cases of non-typhoid salmonellosis in a series of 27 seropositive patients, i.e. 18.5%, hospitalized over a two-year period in an internal medicine department in Senegal. All 27 patients presented general or digestive manifestations and were in the stage of full-blown AIDS. The diagnosis was salmonella septicemia in 60% of cases. The incidence of salmonella is higher in immunocompromised patients than in healthy subjects, particularly in Africa. These infections frequently lead to bacteriemia, have a strong tendency to recur, and are highly indicative of immunodeficiency. Salmonellosis which is curable should be suspected in seropositive African patients presenting general and/or digestive manifestations.

[Chlamydia trachomatis in a urogenital practice: 435 specimens collected at a Senegalese hospital]. / Chlamydia trachomatis et sphère uro-génitale: a propos de 435 prélèvement effectués en milieu hospitalier sénégalais.

Between March 1993 and April 1994, tests to detect Chlamydia trachomatis were performed by direct immunofluorescence on genital discharges from 99 men and 336 women at the Medical Biology Laboratory of Principal Hospital in Dakar, Senegal. Chlamadyial infection was demonstrated in 30 men (30.3%) and 31 women (9.2%). Working women who tested positive for Chlamydia trachomatis were significantly older than those who tested negative (p < 0.05). The opposite was true for working men (p < 0.05). The incidence of positive findings was significantly higher in students (20.5%) than in non-students (10.7%) (p < 0.05). From a clinical standpoint urethral discharge was noted in only 24% of infected men whereas vaginal discharge was present in 96% of infected women. For most infected women the motive for consultation was infertility. The findings of this study attest to the prevalence of Chlamydial infection in the population studied and underline the need for further study to determine its role in the etiology of infertility.

[Nosocomial septicemias due to multiresistant enterobacteria: preliminary considerations in 32 cases observed in the African hospital environment]. / Septicémies nosocomiales à enterobactéries multirésistantes aux antibiotiques: considérations préliminaires à propos de 32 cas observés in milieu hospitalier africain.

In hospital settings in Africa the many other concerns of sanitary officials and the lack of available resources often make hospital hygiene and nosocomial infection secondary problems. To illustrate the importance of these issues in an African pediatric setting, this report describes a series of 32 cases of nosocomial septicemia that occurred within a 2-month period in the Pediatric Department of Principal Hospital in Dakar. There were 10 deaths. The infecting organisms were similar to those observed in industrial countries. Klebsiella Pneumoniae was identified in 16 cases, Escherichia coli in 5, and an association of both bacteria in 5. A profile of beta-lactamase enzymes with a classic epidemiologic spectrum was observed in 15 of 21 strains of Klebsiella pneumoniae and in 3 of 10 strains of Escherichia coli. The authors discuss the conditions that may have encouraged the outbreak of septicemia, regret the lack of a service to monitor hospital hygiene, and propose prophylactic measures using laboratory tests that are feasible in a hospital setting in Africa.

[Vitamin deficiency pancytopenia]. / Les pancytopénies carentielles.

Eight patients with vitamin deficiency pancytopenia were admitted, within a year, in a department of internal medicine. Folic acid and vitamin B12 metabolism and the clinical and haematological symptoms are discussed. These vitamin deficiencies are frequent in underdeveloped countries and are responsible of megaloblastic anaemia. Such deficiencies may also influence the granulocyte and platelet lines and may be mistaken for leukaemia. A therapeutic test may be undertaken, giving rapid diagnosis and avoiding high mortality.

Evolution des resistances aux antibiotiques: comparaison des principaux germes isoles de pus en 1989 et 1992 a l'Hopital Principal de Dakar

Le controle de l'apparition et de l'extension des resistances des germes aux antibiotiques est un imperatif pour les laboratoires de bacteriologie hospitaliers. Afin d'etablir les bases de donnees utiles et d'initier une surveillance; le Laboratoire de Biologie de l'Hopital Principal de Dakar a compare les niveaux de resistance des principaux germes isoles de pus d'hospitalises en 1989 et 1992. Les auteurs montrent un accroissement des resistances aux molecules utilisees depuis longtemps et expriment leurs craintes vis-a-vis de l'utilisation inadequate d'antibiotiques recemment introduits

[Broad spectrum beta-lactamases: results in Principal Hospital of Dakar (February 1st 1992 - February 1st 1993)]. / Béta-lactamases à spectre élargi: bilan sur un an à l'Hôpital Principal de Dakar (1er Février 1992 - 1er Février 1993).

The intensive, unreasonable use of antibiotics makes resistant strains growing particularly in hospital areas where the selection pressure is important. During the last years, the outstanding event was the emergence of resistant strains against 3rd generation of cephalosporin. In many cases this resistance is linked with Extended broad spectrum Beta-lactamase. After the description of a simple method to detect these particular strains, the authors report the epidemiologic situation in Hopital Principal of Dakar from February 1992 to January 1993. The emergence of these resistant strains creates heavy problems in intensive care services and Pediatrics. As conclusion, principal measures to prevent this phenomen are exposed.

[Viral markers of acute hepatitis: A, B, C, D, and E in Dakar. October 92 - October 93]. / Marqueurs viraux des hépatites aiguës: A, B, C, D et E à Dakar. Octobre 92-Octobre 93.

Inside of 95 patients presented in Hospital with presumed hepatitis: 77 were recruted with liver cytolysis (Amino-Transferases AT > 80 UI/ml) and included in this study. Study of serologic viral markers (A, B, C, D and E type) permited to prove viral acute hepatitis infection and 49 patients were recruted inside the 77 cytolytic cases. Inside these 49 cases: 44% presented enteritic contamination with HAV/HEV markers, 36% with HBV markers: HBs/HBc, 6% with HBs/HBe markers, 10% with HDV marker, 4% with HCV marker. 28 patients presented any viral acute hepatitis marker and in this case can be evocated other hepatitis origin: viral hepatitis type (EBV), CMV, chronic hepatitis evolution, malaria hepatitis or toxic hepatitis.