[Epidemiologic surveillance of dengue fever in the French army from 1996 to 1999]. / Surveillance epidemiologique de la dengue dans les armées françaises de 1996 à 1999.

Dengue fever is a widespread disease that can occur outside tropical areas. Several thousand French military personnel are exposed to this infectious risk each year and exposure is expected to rise with the creation of a professional army and the increasing number of foreign missions. As a result, dengue fever has become a major priority for the Armed Services Health Corps (ASHC). A system of epidemiological surveillance based on the active participation of all military physicians has been designed by the ASHC to collect and analyze all data relevant to cases of dengue fever involving French military personnel stationed overseas or at home. The purpose of this study is to present data compiled for the period from 1996 to 1999. Analysis of these data demonstrated that the incidence of dengue fever peaked in 1997 due to epidemic outbreaks occurring in French Polynesia and Martinique. In response to these outbreaks control measures were adapted especially in regard to vector control. This study shows that the system of surveillance implemented by the ASHC is an effective but still perfectible tool.

[Chronical of a declared meningococcal meningitis epidemic (Goma, Zaire, August 1994)]. / Chronique d'une épidémie annoncée de méningite à méningocoque (Goma, Zaïre, août 1994).

The authors relate their experience controlling an epidemic of meningitis which broke out in the refugee camps of the Goma region, in northern Zaire, after the dramatic events which had happened in Rwanda in April and June 1994. Out of the 348 cases of purulent meningitis diagnosed by the Bioforce team, meningococcal etiology was confirmed 327 times. The isolated meningococci were all of the serogroup A, serotype A; 4; P 1,9. They were resistant to streptomycin and to sulphamides. The epidemic lasted one month, touched people of all ages and spread progressively to all the camps. The epidemic surveillance set up meant that vaccination was carried out very quickly and the epidemic brought rapidly under control, even if other factors did intervene. All those called upon to intervene in such a context should be made aware of the interest of the basic triad to fight these epidemics: rapid vaccination, treatment of cases with oily chloramphenicol and bio-epidemiological surveillance.

[Epidemic of bacillary dysentery in the Rwanda refugee camps of the Goma region (Zaire, North Kivu) in August 1994]. / Epidémie de dysenterie bacillaire dans les camps de réfugiés rwandais de la région de Goma (Zaire, Nord-Kivu) en août 1994.

The authors describe the extension of an outbreak of bacillary dysentery among the Rwandese populations seeking refuge in the region of Goma, Zaire in august 1994. Analysis of the epidemiological surveillance data and of the bacteriological laboratory results of the Bioforce, show that this epidemic was probably facilitated by the preceding cholera outbreak. In such circumstances, rapid sterilization of the virus reservoir, by short course treatments, might be beneficial in limiting the extension of the epidemic.

[Demonstration of subclinical pulmonary alveolitis in spondylarthropathies]. / Mise en évidence d'une alvéolite pulmonaire infraclinique au cours des spondylarthropathies.

Restrictive ventilatory dysfunction, lowered diffusing capacity, and apical fibrosis have been reported in ankylosing spondylitis. To investigate the pathogenesis of these abnormalities, we studied distal airspace cytology by performing bronchoalveolar lavage in 34 spondyloarthropathy patients (ankylosing spondylitis, n = 16; reactive arthritis, n = 4; axial psoriatic arthritis, n = 2; and undifferentiated spondyloarthropathy with HLA B27-positivity in every case but one, n = 12). Mean age was 32.4 +/- 13.7 years. None of the study patients had apical fibrosis, lower respiratory tract infection, or exposure to airborne pollutants other than tobacco smoke. The control group was composed of nine subjects who had no lung or inflammatory diseases and were not using medications. Significantly higher proportions of lymphocytes were found in bronchoalveolar lavage specimens from patients, as compared with controls. This difference was not influenced by smoking or medication use (non steroidal antiinflammatory drugs, sulfasalazopyridine). Alveolar lymphocytosis was not correlated with laboratory tests for disease activity (erythrocyte sedimentation rate, serum IgA levels) or with the presence of restrictive ventilatory dysfunction. Increases in the proportion of lymphocytes were of similar magnitude in patients with ankylosing spondylitis and in those with other spondyloarthropathies. Absolute total cell counts and relative neutrophil counts were similar in patients and controls. However, among the patients with spondyloarthropathies, those with a disease duration of more than five years had a significantly higher proportion of neutrophils than those with a disease duration of less than five years. These findings demonstrate that spondyloarthropathy patients have subclinical lymphocyte alveolitis. Although of unclear significance, this alveolitis may be related to the development of apical fibrosis in some patients with ankylosing spondylitis.

[Cytokines and malaria. A study of TNF-alpha, IL1-beta, IL6 and IL2R in 28 patients]. / Cytokines et paludisme. Etude du TNF alpha, de l'IL1 bêta, de l'IL6 et du RIL2s chez 28 malades.

Authors have studied TNF alpha, IL1 bêta, IL6 and RIL2s in 28 malaria illness patients. Increased levels of TNF, IL1 bêta and RIL2s in serum, are observed on admission to hospital. These cytokine levels are decreased, eight days later, after patients are treated. In discussion, TNF levels as a prognosis component is evocated.

[Short-term ciprofloxacin treatment of bacillary dysentery due to Shigella dysenteriae type 1 in Rwandan refugees]. / Traitement court par la ciprofloxacine de la dysenterie bacillaire à Shigella dysenteriae type 1 chez des réfugiés Ruandais.

In 1994, an outbreak of dysentery caused by Shigella dysenteriae type I resistant to all public health antibiotics in vitro occurred among rwandan refugees in Zaïre. The only active antimicrobial agent available was ciprofloxacin. It was administered to hospitalized patients in a conventional 5-day schedule. To ration the supply for the benefit of the greatest number, a randomized blinded study was performed to compare the effectiveness of short-term treatment (1 g of ciprofloxacin in a single daily doses for 2 days) with that of the standard treatment (1 g of ciprofloxacin in two daily doses for 5 days). The study included 57 refugees over the age of 15 years with dysentery. Shigella dysenteriae type I was identified in 26 patients. Except for sex distribution, there was no significant difference in clinical and bacteriologic features of the two populations. Treatment failed in 12 cases, i.e., 7 of 29 patients who received the short-term treatment and 5 of 28 patients who received the standard treatment. Efficacy of ciprofloxacin was not dependent on the mode of treatment, taking into account clinical or bacteriologic criteria. These results indicated that the duration of ciprofloxacin treatment for dysentery caused by Shigella dysenteriae type 1 could be shortened to two days. Short-term treatment has several advantages. One is cost-effectiveness since fluoroquinolones are costly and scarce. Another is to allow treatment of a greater number of patients by improving compliance.

[Scrotal temperature in 258 healthy men, randomly selected from a population of men aged 18 to 23 years old. Statistical analysis, epidemiologic observations, and measurement of the testicular diameters]. / Etude de la température scrotale chez 258 hommes sains, sélectionnés par tirage au sort dans une population d'hommes de 18 à 23 ans. Analyse statistique, observations épidémiologiques et mesure des diamètres testiculaires.

Scrotal hyperthermia can induce certain alterations in spermatogenesis. The basal scrotal temperature used to define hyperthermia is usually 33 degrees C. However, no study, conducted according to a strict methodology has validated this mean measurement. We therefore randomly selected 258 men between the ages of 18 and 23 years from a population of 2,000 young French men seen at the National Service Selection Centre in order to measure the scrotal temperature over each testis and in the median raphe in order to determine the mean and median values for these temperatures. For a mean room temperature of 23 +/- 0.5 degrees C with a range of 18 to 31 degrees C, the mean right and left scrotal temperature was 34.2 +/- 0.1 degree C and the mean medioscrotal temperature was 34.4 +/- 0.1 degree C. Scrotal temperature was very significantly correlated to room temperature and its variations. It was therefore impossible to define a normal value for scrotal temperature. Only measurement of scrotal temperature at neutral room temperature, between 21 and 25 degrees C, is able to provide a reference value for scrotal temperature. In this study, the mean scrotal temperature under these conditions was 34.4 +/- 0.2 degree C, i.e. 2.5 degrees C less than body temperature. In the 12.9% of cases with left varicocele, left scrotal temperature was significantly higher than in the absence of varicocele and was also higher than right Scrotal temperature. The authors also determined the dimensions of the testes.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cytological study of deep lung in spondyloarthritis. Apropos of 34 cases]. / Etude cytologique du poumon profond au cours des spondylarthropathies. A propos de 34 observations.

Bronchoalveolar lavage (BAL) was performed in 34 consecutive patients with spondyloarthropathy (SA) compared with 9 controls. Lymphocytic alveolitis was found in the SA group with decrease in the ratio of the CD4/CD8 subsets in both lung and blood. Neutrophilic alveolitis was also found in 5 patients with SA of long duration. As with other inflammatory diseases, it seems that a subclinical alveolitis is present in SA patients.

[Difficulties in the epidemiological surveillance of measles in Africa: exemplified by the Ivory Coast]. / Difficultés de la surveillance épidémiologique de la rougeole en Afrique: exemple de la Côte d'Ivoire.

In tropical areas measles cases often are under-reported but the authors comment here two epidemics which had at first been considered as outbreaks of measles but were not. The first epidemic resembled a Chikungunya virus outbreak with important rashes, hyperthermia and pain attacks and was due to Igbo-Ora arbovirus. In the second epidemic children were having rashes with hyperthermia and adenopathy evoking rubella. The authors consider the possibility of over-reporting in view of the surveillance of measles, the target-disease in EPI (Expanded Programme on Immunization). This hypothesis is confirmed by the distribution of reported cases at national level with a high rate of out-season cases and among adults.

[Cutaneous malignant melanomas in New Caledonia. Study of the Cancer Registry (1977-1987)]. / Les mélanomes malins cutanés en Nouvelle-Calédonie. Etude du Registre des Cancers (1977-1987).

Investigation of cancer registration files in New Caledonia over a period of 11 years (1977-1987) draws the following conclusions: --The uncorrected incidence rate of cutaneous malignant melanoma is 3.63/100,000 inhabitants/year, for all ethnic groups together. --The incidence rate in the "non-European" population is 0.6/100,000 inhabitants/year. This low incidence and the anatomo-clinical manifestations observed (lentiginous melanoma of extremities) are common in coloured people. --The incidence rate in the "European" population is 8.75/100,000 inhabitants/year is noticeably higher than the incidence in the metropolitan population. Such conclusions are in accordance with the admitted data regarding epidemiology of cutaneous melanoma in high insolation countries. Cumulated incidence rate and topography of lesions are similar in this series whatever the sex.

Clinical and pathological aspects of human African trypanosomiasis (T. b. gambiense) with particular reference to reactive arsenical encephalopathy.

Fourteen of 330 patients treated with melarsoprol (Mel B) for human African trypanosomiasis (HAT) developed a severe reactive arsenical encephalopathy (RAE). Six of these cases were fatal and postmortem examination was performed on 5 patients. Symptoms of "sleeping sickness" were compared with symptoms after treatment with arsenicals and the subsequent onset of RAE. There are 3 characteristic syndromes of RAE: convulsive status associated with acute cerebral edema, rapidly progressive coma without convulsions, and acute nonlethal mental disturbances without neurological signs. Three subjects revealed hypoxic brain damage with acute cerebral edema, and multiple hemorrhages of brain stem in those comatose. The pathology of the underlying HAT (chronic perivascular inflammation and plasma cytic infiltration of the brain) and the pathology of the RAE (characterized by acute vasculitis) are distinct. RAE occurs in the first as well as in the second stage (CNS involvement) of trypanosomiasis but the reason for this is unclear; an exclusive toxicity of the drug, or a Herxheimer reaction are possible but seem unlikely. Both clinical and laboratory findings point rather to a drug-related, delayed immune response.

[The reaction to viewing slides on tropical medicine. Evaluation study]. / L'impact d'un mur d'images en santé tropicale. Essai d'évaluation.

A series of slides on health priorities in Africa was shown to an audience of 123 people, of which 19 were not medical specialists. The authors of this experiment wanted to verify that the objectives set by the producers were met. The study, conducted in the form of a questionnaire, asked the people questioned to give their opinion on the objectives, the kind of public aimed at, the standard of the various subjects covered and the usefulness and cost-efficiency ratio of the type of audio-visual equipment used. Although the analysis of collected data reveals certain discrepancies as to the professional status of those questioned, the vast majority of participants considered this documentary support to be extremely worthwhile.

[Monkeypox: second human case observed in Ivory Coast (rural health sector of Daloa]. / Monkeypox: second cas humain observé en Côte d'Ivoire (secteur de santé rurale de Daloa).

A second case of human monkeypox (world fifty-forth case) has been observed in Ivory Coast (rural health sector of Daloa). A three years old girl presented a major pox-like eruption which evolved to recovery. The authors describe the eruption, the evolution of the sickness, and the scars observed at the fourth month after recovery. It has not been possible to prove neither animal-human nor interhuman contagion.