[Visceral leishmaniasis without splenomegaly. A pediatric case report]. / Leishmaniose viscérale sans splénomégalie. À propos d'un cas chez un nourrisson.

Pediatric visceral leishmaniasis is caused by Leishmania infantum, a dog parasite transmitted to humans by the bite of the female phlebotomine sand fly. The well-known clinical triad is fever, pallor, and splenomegaly. A secondary macrophage activation syndrome (MAS) can complicate this infection, which is lethal when not treated. When MAS is observed without any explanation, a visceral leishmaniasis is highly recommended. We report a case of visceral leishmaniasis in a 21-month-old child complicated by a macrophage activation syndrome without splenomegaly. No immunodeficiency was diagnosed that could explain this unusual clinical condition. To our knowledge, this is the first case of visceral leishmaniasis without splenomegaly reported to date.

Sarcoptes scabiei mites in humans are distributed into three genetically distinct clades.

Scabies is an ectoparasitic infestation caused by the mite Sarcoptes scabiei. Currently, S. scabiei is taxonomically divided into different varieties on the basis of host origin. Genetics-based research on scabies has been conducted, but the data on genetic diversity of populations of this mite in humans in Europe are lacking. We evaluated the genetic diversity of populations of S. scabiei. A large series of mites obtained from humans in France and the data of mites from various hosts and geographical areas retrieved from GenBank were included to investigate whether mites are divided into distinct populations. The study of cytochrome c oxidase subunit 1 gene polymorphisms were found to be best suited for phylogenetic analysis. S. scabiei mites were distributed into three genetically distinct clades, with most mites clustering in clades B and C. The Fst value and the Nm value calculated for mites included in clades B and C indicated a strong population structure and a very low gene flow between mites of those clades. The results of the present study not only support the rejection of the hypothesis of panmixia for S. scabiei in humans but also suggest that mites belonging to different clades are genetically isolated. Moreover, the results suggest that the subdivision of S. scabies in varieties according to animal or human hosts is not warranted. In conclusion, S. scabiei mites in humans do not constitute a homogeneous population. Further investigations are now required to assess whether different clinical forms of scabies are associated with particular haplotypes or clades.

Virus isolation, genetic characterization and seroprevalence of Toscana virus in Algeria.

Toscana virus (TOSV; Bunyaviridae, Phlebovirus) is transmitted by sandflies of the genus Phlebotomus in the Mediterranean area. One strain of TOSV was isolated from a total of almost 23 000 sandflies collected in Kabylia, Algeria. The complete genome was sequenced, and phylogenetic studies indicated that it was most closely related with TOSV strain from Tunisia within lineage A, which also includes Italian, French and Turkish strains. A seroprevalence study performed on 370 sera collected from people living in the same area showed that almost 50% possessed neutralizing antibodies against TOSV, a rate much higher than that observed in Southern Europe. Sandfly species distribution in the study area suggests that the vector of TOSV in this region belongs to the subgenus Larroussius. These data support the rapid implementation of the diagnosis of TOSV in clinical microbiology laboratories to estimate the burden in patients presenting with neuroinvasive infections and febrile illness.

Wombats acquired scabies from humans and/or dogs from outside Australia.

According to previous studies, Sarcoptes mites of wombats were relatively recently introduced into Australia by colonizers and/or their dogs. However, that affirmation has been called into question due to apparent flaws in the design of the phylogenetic studies. With the aim of providing a definitive answer to this question, a part of the mitochondrial gene coding for 12S rRNA of S. scabiei mites from 23 humans and one dog collected in France was sequenced and a phylogenetic analysis including the sequences previously deposited in Genbank was performed. Phylogenetic analysis did not show host segregation or geographical isolation of the mites. Conversely, the present work suggested that mange in wombats is indeed due to the introduction of S. scabiei into Australia by immigrating individuals and/or their companion animals.

Arthropods as a source of new RNA viruses.

The discovery and development of methods for isolation, characterisation and taxonomy of viruses represents an important milestone in the study, treatment and control of virus diseases during the 20th century. Indeed, by the late-1950s, it was becoming common belief that most human and veterinary pathogenic viruses had been discovered. However, at that time, knowledge of the impact of improved commercial transportation, urbanisation and deforestation, on disease emergence, was in its infancy. From the late 1960s onwards viruses, such as hepatitis virus (A, B and C) hantavirus, HIV, Marburg virus, Ebola virus and many others began to emerge and it became apparent that the world was changing, at least in terms of virus epidemiology, largely due to the influence of anthropological activities. Subsequently, with the improvement of molecular biotechnologies, for amplification of viral RNA, genome sequencing and proteomic analysis the arsenal of available tools for virus discovery and genetic characterization opened up new and exciting possibilities for virological discovery. Many recently identified but "unclassified" viruses are now being allocated to existing genera or families based on whole genome sequencing, bioinformatic and phylogenetic analysis. New species, genera and families are also being created following the guidelines of the International Committee for the Taxonomy of Viruses. Many of these newly discovered viruses are vectored by arthropods (arboviruses) and possess an RNA genome. This brief review will focus largely on the discovery of new arthropod-borne viruses.

Presence of sandflies infected with Leishmania infantum and Massilia virus in the Marseille urban area.

Leishmaniasis is considered a rural disease in Europe. However, circumstantial evidence has indicated urban transmission of leishmaniasis and phleboviruses in the urban area of Marseille, France. To investigate this urban transmission, sandflies were trapped in 33 locations in the urban area (horse farms, public gardens and a residential area). Sandflies were always captured: 87.8% were Phlebotomus perniciosus, a vector of Leishmania infantum and Toscana and Massilia viruses. RT-PCR and cell culture inoculation identified the Massilia virus in 2/99 pools of sandflies, and PCR identified Leishmania in 5/99. No dual infection was observed, but both pathogens were detected in samples from the same trapping site.

Molecular survey of knockdown resistance to pyrethroids in human scabies mites.

There are growing concerns about the emergence of resistance of Sarcoptes scabiei to permethrin and other pyrethroid derivatives. Sarcoptes scabiei mites collected from 40 patients visiting two hospitals near Paris, France, were genotypically characterized considering two parts of their voltage-sensitive sodium channel gene. No nucleotide polymorphism resulting in a codon change at codon 733 or other positions associated with knockdown resistance in other arthropods has been identified. These data may establish a reference line for future surveys of the susceptibility of S. scabiei in the area.

First detection of Toscana virus in Corsica, France.

Toscana virus (TOSV) was detected for the first time from Phlebotomus perniciosus sandflies in Corsica, a French Mediterranean island. Genetic analysis showed that Corsican TOSV belongs to lineage A, together with Italian, Tunisian, Turkish and other French strains. The demonstration of TOSV in Corsica indicates that autochthonous and tourist populations are at risk of infection. Hence, physicians must consider TOSV as a possible cause of aseptic meningitis and unidentified febrile illness during the warm season.

Infestation by pyrethroids resistant bed bugs in the suburb of Paris, France.

Bed bugs are hematophagous insects responsible for a re-emerging and challenging indoor pest in many countries. Bed bugs infestations may have health consequences including nuisance biting, cutaneous and systemic reactions. This resurgence can probably be attributed to factors such as increased international travel and development of resistance against insecticides. Resistance against pyrethroids has been reported several times from the USA and rarely in Europe. In France, very few data on bed bugs are available. The present study aimed to assess the infestation by bed bugs of a complex of two high-rise apartment buildings in the suburb of Paris and to evaluate their susceptibility to pyrethroid insecticides. We inspected for bed bugs 192 out of 198 apartments units (97%) and interviewed their residents. 76 (39.6%) apartments were infested. Among the 97 residents living in infested apartments, 53 (54.6%) reported bed bug bites. A total of 564 bed bugs were collected in the infested units. Bioassays showed that 54 out of 143 bed bugs were resistant to pyrethroids (37.8%; 95% confidence interval: 29.9-45.7%). DNA sequencing showed that all bed bugs tested (n=124) had homozygous L925I kdr-like gene mutation. The level of pyrethroid resistance found indicates that this phenomenon was already established in the site and prompts the need to reevaluate the wide use of pyrethroids to control bed bugs.

[The five pillars of family and individual protection against mosquitoes, vectors of pathogenic agents]. / Les cinq piliers de la protection familiale et personnelle de l'homme contre les moustiques vecteurs d'agents pathogènes.

Except for yellow fever and encephalitis B, effective vaccines remain unavailable against most infectious diseases, and prevention is based mainly upon vector control and chemoprophylaxis. The increasing resistance of, respectively, mosquitoes and parasites to insecticides and drugs is thus a matter of great concern. The best approach is to combine chemoprophylaxis and entomoprophylaxis, that is, to use several methods of vector control at different levels to reduce the risk of infection and illness from these infectious diseases.

Insecticide resistance in head lice: clinical, parasitological and genetic aspects.

Insecticide treatment resistance is considered to be a major factor in the increasing number of infestations by head lice. The large insecticide selection pressure induced by conventional topical pediculicides has led to the emergence and spread of resistance in many parts of the world. Possible mechanisms of resistance include accelerated detoxification of insecticides by enzyme-mediated reduction, esterification, oxidation that may be overcome by synergistic agents such as piperonyl butoxide, alteration of the binding site, e.g. altered acetylcholinesterase or altered nerve voltage-gated sodium channel, and knockdown resistance (kdr). Clinical, parasitological and molecular data on resistance to conventional topical pediculicides show that treatments with neurotoxic insecticides have suffered considerable loss of activity worldwide. In particular, resistance to synthetic pyrethroids has become prominent, probably because of their extensive use. As other treatment options, including non-insecticidal pediculicides such as dimeticone, are now available, the use of older insecticides, such as lindane and carbaryl, should be minimized, owing to their loss of efficacy and safety concerns. The organophosphorus insecticide malathion remains effective, except in the UK, mostly in formulations that include terpineol.

[Epidemiology of cutaneous leishmaniasis in five villages of Dogon country, Mali]. / Épidémiologie clinique et parasitologique de la leishmaniose cutanée dans cinq villages du Pays Dogon, Mali.

The epidemiology of the cutaneous leishmaniasis (CL) with Leishmania major is poorly documented in Mali. Following reports of CL in the tourist areas of the Dogon country (Bandiagara Escarpment), a joint French and Malian bio-clinical team conducted a field study from 16 to 27 January, 2010. The population of 5 villages has been examined by a dermato-infectiologist and cases were selected by visual inspection of skin lesions. Smears and biopsies (from the lesions) and venous blood were obtained from suspected cases of CL. Diagnosis was performed by light microscopy, in vitro cultures, serology and molecular biology. Fifty patients with skin lesions have been examined. Twenty-one have been suspected as CL. At least one sample was obtained from 18 patients. The lesions were predominantly old, more or less scarring and secondary infected. A skin smear was performed for 15 patients, a skin biopsy for 14 patients: smears and cultures were all negative. The PCR (Leishmania spp.) made on 14 biopsies was positive for 12 patients (86%). The low amount of amplified DNA obtained did not allow the sequencing and identification of the species of Leishmania. Western blot (WB) serology was positive in 11 cases out of 12 (92%). This investigation showed the presence of cutaneous leishmaniasis in Bandiagara. A further investigation is required during transmission period (September-October) to confirm the presence of Leishmania major epidemic in Dogon country.

Record of Phlebotomus (Transphlebotomus) mascittii Grassi, 1908 and Phlebotomus (Larroussius) chadlii Rioux, Juminer & Gibily, 1966 female in Algeria.

We report for the first time the presence of Phlebotomus mascittii and the female of Phlebotomus chadlii in Algeria. These two species were collected during an entomological study conducted in endemic visceral leishmaniasis focus from the north part of the country, Kabylia.

Low seroprevalence of sandfly fever Sicilian virus antibodies in humans, Marseille, France.

A seroprevalence study was carried out in the region of Marseille (south-eastern France) to address the public health importance of sandfly fever Sicilian virus (SFSV) and SFSV-like viruses, as recently recognized vectors of those viruses are present in this area. The low seroprevalence rate observed in this study suggests that SFSV is not likely to be of major medical importance in the Marseille area.

First entomological documentation of Aedes (Stegomyia) albopictus (Skuse, 1894) in Algeria.

In August 2010, during an entomological programme targeting sandflies, in the region of Larbaa-Nath-Iraten, Wilaya of Tizi-Ouzou (Algeria), a female Aedes albopictus was trapped alive and partially engorged. To our knowledge, this is the first report of Ae. albopictus in Algeria and more widely in the Maghreb.

Clinical efficacy and safety in head lice infection by Pediculus humanis capitis De Geer (Anoplura: Pediculidae) of a capillary spray containing a silicon-oil complex.

Head lice are endemic worldwide. Resistance to permethrin and doubts about the safety of pesticides promoted the use of physical therapies (wet-combing, dry-on suffocation). The aim of our study was to test the pediculicidal and ovicidal effects of one application of a silicon-oil complex composed of dimethiconol and castor oil. The study was a prospective cohort of 108 infested patients (11 males, 97 females; 58 children, 50 adults), in Sri-Lanka. Pediculicidal efficacy was evaluated as the percentage of patients free of live lice one hour after the application of the treatment and at day 1 (wet combing). Ovicidal efficacy was calculated as the proportion of subjects without larval stages at days 1 and 7 among subjects followed up all over the study. In normal conditions of use, in this open cohort, a pediculicidal effect of a dimethiconol-castor-oil lotion was.shown one hour after application in 99/108 (91.7%) treated subjects and at day 1 in 86/99 (87%) subjects and an ovicidal effect at day 7 in 79/108 (73.2%) treated subjects. A second application of the same product was necessary to increase the cure rate to 79.6% (86/108) at day 8. In our study, the second application of the same product was performed seven days later, but the best time for additional applications should be defined in further studies. However, the efficacy of this safe physical treatment was similar to that of chemical pediculicides (malathion, permethrin).

A century of leishmaniasis in Alpes-Maritimes, France.

A century of publications on leishmaniasis in Alpes-Maritimes, in southern France, is here reviewed. Autochtonous human and canine leishmaniasis were first recognised in this département, which lies by the Mediterranean Sea and near the Italian border, in 1918 and 1925, respectively. The parasite responsible for the leishmaniasis, Leishmania infantum, is transmitted by Phlebotomus perniciosus and P. ariasi. The human leishmaniasis is zoonotic, with domestic dogs acting as the main 'reservoir' hosts. In prospective surveys over the last two decades, a mean of 12% of the domestic dogs checked in Alpes-Maritimes have been found seropositive for L. infantum but only about 50% of the seropositive animals showed any clinical signs of infection at the time of the surveys. During the last 30 years, 178 cases of human visceral leishmaniasis have been recorded in the area. Such cases are sporadic and often opportunistic, occurring predominantly in children (29% of the 178 cases) or HIV-positive subjects (31%). Recently, it has been demonstrated that, in Alpes-Maritimes, approximately 20% of those found seropositive in leishmanin skin tests are asymptomatic carriers, with amastigotes in their peripheral blood.

[Phlebotomine sandflies and transmission of disease agents around the Mediterranean basin]. / Phlébotomes et transmission d'agents pathogènes autour du Bassin Méditerranéen.

Around 800 species of phlebotomine sandflies are widely distributed in tropical and temperate areas. Some sand flies are documented vectors of human disease agents including parasitic protozoa, (Leishmania spp), bacteria (Bartonella bacilliformis) and viruses (phlebovirus). In addition to presenting morphologic, taxonomic and biologic aspects of Phlebotomine sandflies, this report focuses on ecologic, epidemiologic, ethologic, and anthropic factors contributing to the proliferation of sand flies as exemplified by zoonotic cutaneous and visceral leishmaniases around the Mediterranean basin.