[Bowel parasites and faecal eosinophilia]. / Les parasites intestinaux et l'éosinophilie fécale.

The staining of polynuclear eosinophils (PE) in the stools, easily performed and adapted from the technique of WHEATLEY, presents important advantages over the May-Grünwald-Giemsa: less colouring of the bacteria, no dissolution of the lipids, less importance of the stools pH. The stools samples must show mucus or have a soft, loose or liquid consistency: the polynuclear eosinophils are preserved in stools for 1 year and more, which allows if necessary to postpone for a few days the direct examination. The PE are found among patients having a helminthiasis or an intestinal coccidiosis in half of the cases, whereas they are not found in other intestinal protozoosis. They are also found among patients having an intestinal allergy. Faecal eosinophilia reveals an intestinal eosinophilia of the tissue and is influenced by several factors in particular: importance, duration, repetition of the infestation. It allows the observation of many elements related to the mechanism of eosinophilia, not to be found in blood eosinophilia, in particular the release of the eosinophil granule, the formation of Charcot-Leyden crystals and the presence of lipid bodies similar to those of stearrhoea.

[Malaria in splenectomized patients. Three fatal cases]. / Paludisme grave chez des patients splénectomisés. Trois cas mortels.

INTRODUCTION: Splenectomy, the surgical removal of the spleen, is increasingly practiced in malaria-endemic tropical countries. The procedure leaves patients more susceptible to serious bacterial and parasitic infections, including malaria. CASES: We report here three fatal cases of malaria from P. falciparum in splenectomized patients. One operation followed abdominal trauma, while the other two were performed to treat one large-cell and one B-cell lymphoma. Despite prolonged intravenous quinine treatment all three patients died. DISCUSSION: Malaria in splenectomized patients can be very serious and is fatal in half the cases transmitted by P. falciparum. Permanent chemoprophylaxis is required for these patients when they travel to or live in endemic areas.

[Triple malaria infection in twin sisters from the Democratic Republic of Congo]. / Triple infestation plasmodiale chez deux soeurs jumelles originaires de la République Démocratique du Congo.

Infections with 3 species of malaria parasites are rarely encountered and observed in less than 0.05% of cases. We came across such an infection in four year-old, monozygote twin sisters, coming from Kinshasa (Democratic Republic of Congo). In both of them, parasitemia was low or very low for P. falciparum and P. ovale and of 0.1-0.2% for P. malariae. The twin sisters presented with an iron deficiency anaemia, associated with an heterozygous sickle-cell anaemia and a moderate splenomegaly. The biological tests results were similar. They responded well to treatment. We point out the difficulty in recognizing the concomitant presence of several species of hematozoaire on blood smear.

The demonstration, staining and prevalences, in pathological and non-pathological specimens, of eosinophils in faeces.

Although eosinophils are occasionally reported in mucus there has been no description of them in faecal samples. Attempts were made to demonstrate eosinophils in stool samples using several different staining techniques. Use of an acid dye, Acid Red 29, was found to be the simplest and most direct method of revealing eosinophils, producing very characteristic, orange-brown, sometimes red, staining of the intracellular granules that contain eosinophil cationic protein. In stool samples held at room temperature, without preservative, eosinophils remained demonstrable for a mean of 15 days and occasionally for a year. The peroxidase in the eosinophilic granules may help to preserve the cells. Eosinophils were found in 32 (14%) of 223 stool samples from patients with intestinal disease (including the results of several parasitic infections) but in none of 72 samples from apparently healthy hospital personnel (P<0.001). Eosinophils were never found in formed stool specimens that did not contain mucus. The demonstration of eosinophils in faecal samples may be a useful indicator of infection with intestinal helminths or of drug- or food-related digestive allergies.

Asymptomatic amoebic infection: Entamoeba histolytica or Entamoeba dispar? That is the question.

Two cases of amoebic infection were diagnosed in a heterosexual couple. The cases, a Frenchman with previous trips to various African countries and his sexual partner, a Cameroonese woman immigrant living outside the community, were both asymptomatic; the infection had been diagnosed by chance in the man at the time of his employment in a hospital kitchen. Based on what is known of the epidemiology of amoebic infection, it may be acquired and then transmitted within a couple via the indirect faecal-oral route or, in greater likelihood, by sexual practices. Both amoebic isolates were characterised by isoenzyme electrophoresis as non-pathogenic Entamoeba dispar, zymodemel. Other diagnostic tools, such as ELISA direct stool antigen detection tests and serological assays were employed, confirming the diagnosis of E. dispar infection. Given there are a number of asymptomatic cyst passers of Entamoeba histolytica, besides human carriers of saprophyte E. dispar, we stress the importance of applying, when possible, advanced protocols of diagnosis to distinguish the microscopically identical pathogenic species from the non-pathogenic one.

[Apropos of 1 case of anisakiasis contracted in Sicily]. / A propos d'un cas d'anisakiase contractée en sicile.

The authors describe a case of anisakiasis in Sicily. The diagnosis was based on the knowledge that a contaminated fish, Lepidopus caudatus, had probably been absorbed, as well as on clinical intestinal symptoms, intestinal lesions observed by endoscopy and O.G.D.S, duodenal infiltration by eosinophilic polymorphonuclear, positive ELISA anisakis serology and successful treatment by albendazole.

[Familial eosinophilia: contribution of parasitology to its diagnosis]. / Les éosinophilies familiales: apports de la parasitologie à leur diagnostic.

It has been observed, at the turn of the century, that members of some families showed a peripheral blood hypereosinophilia. Despite all possible investigations at that time, it was not possible to link it up with a known and well established disease. It was named "family acquired eosinophilia" by Di Guglielmo. nowadays, it has been established that some congenital defects such as the Omenn syndrome and the Wiskott-Aldrich syndrome are associated with hypereosinophilia. Eosinophilia is well known as a sign of allergy, but contaminations with helminths are an important cause of familial hypereosinophilia. In a case of familial distomatosis by Fasciola hepatica, several members of the same family were infected after eating wild cress. An epidemiological study was carried out on 22 families whose several members in a same family had an hypereosinophilia, a parasitosis was serologically diagnosed using such methods as immunoelectrophoresis, Elisa or Western blot. Among these 22 families, 10 had contracted fascioliasis and 4 who had eaten contaminated horse meat contracted trichinosis. For some other families, eosinophilia was not well documented, it concerned cysticercosis for 3 couples after eating meat of raw pork, one family with intestinal distomatosis to F. buski after consumption of aquatic plants and lastly toxocarosis, zoonosis whose contamination is acquired by geophagy but also by eating raw vegetables (salad), fruit (strawberries) and by drinking contaminated water, affected 5 families. In one family, anisakiasis with hypereosinophilia had been contracted by eating raw fish. In another one, trichostrongyloidiasis was contracted by eating raw vegetables from the family garden. The diagnosis is often oriented, for the members of a same family, who are asymptomatic or pauci-symptomatic, by the blood cell count that shows an hypereosinophilia. Furthermore, a collective outbreak of strongyloidiasis epidemic among 115 individuals by oral route is reported, showing that such a way of transmission is possible.

[Francesco Redi and the birth of experimental parasitology]. / Francesco Redi et la naissance de la parasitologie expérimentale.

Francesco Redi (1626-1697) born in Arezzo (Tuscany, Italy), an encyclopedic mind simultaneously naturalist, physician and poet is the founder of scientific and experimental parasitology by his works published in 1668 and 1684. In the first he showed the impossibility of spontaneous generation of insects (flies) and in the second are described over hundred species of parasites (helminths, mites, insects) from vertebrates and invertebrates with excellent illustrations. He has also recommended various antiparasitic remedies and specified their pharmacological action. It is besides under his influence that two of his disciples: Bonomo and Cestoni will rediscover and redescribe in 1687 the itch-mite (Sarcoptes scabiei var. hominis).

[A challenged Nobel Prize: Johannes Fibiger, 1926]. / Un prix Nobel discuté: Johannes Fibiger, 1926.

Johannes Fibiger born in Denmark in 1867 died in 1928 from a cancer of the colon. First interested in bacteriology he became later (1900) professor of pathological anatomy. His chief work on the alleged cancerigenous role of a nematode Gonglyonema neoplasticum in some species of rats allowed him to receive the Nobel Prize in medicine in 1926. The difficulties met later (species of Gongylonema spp. from rats, dietary, lack of vitamin A) and even the impossibility to reproduce his results have brought a contestation of his work. However the cancerigenous action of some parasitic heminths such as Schistosoma is now recognized.

Microscopic diagnosis of blood parasites following a cytoconcentration technique.

An isotonic fixative (formalin and thimerosal) solution, with a saponin additive to lyse erythrocytes and platelets, has been developed. The formalin and thimerosal ensure good preservation of blood parasites. This fixative has led to the development of a new concentration technique using cytocentrifugation (cytospin) in the search for Plasmodium spp., Leishmania spp., and microfilariae, as well as leukocytes in which parasites or pigment may be present. The concentration of the parasites present in the sediment from 100 microl of blood spread on a 6-mm diameter circle results in good morphology that is well stained using the usual Giemsa or Wright techniques. This new technique has the advantage of a relatively low cost and offers the possibility of isolating and identifying in the same sediment the main blood-stage parasites, with the exception of young trophozoites, of Plasmodium falciparum.

[Serodiagnosis of toxoplasmosis: a comparative multicenter study of a standard scale through various actual tests and expression of the results in international units. Groupe de travail toxoplasmose du Contrôle national de qualité en parasotologie. Syndicat des fabricants de réactifs de laboratoire. Groupe de travail standardisation des tests sérologiques du Réseau européen de lutte contre la toxoplasmose congénitale]. / Le sérodiagnostic de la toxoplasmose: etude comparative multicentrique d'une gamme étalon, par les différents tests actuels et avec expression des résultats en unités internationales. Groupe de travail toxoplasmose du Contrôle national de qualité en parasitologie, Syndicat des fabricants de réactifs de laboratoire, Groupe de travail standardisation des tests sérologiques du Réseau européen de lutte contre la toxoplasmose congénitale.

Reported are the results of a multicentre study involving 40 laboratories that was carried out in France to assess all the currently available methods used for the serodiagnosis of toxoplasmosis. For this purpose 10 batches of control sera were prepared with titres in the range 0-260 IU per ml. These sera were tested in nine laboratories using immunofluorescence methods; in three laboratories using dye tests; in forty laboratories using enzyme-linked immunosorbent assay; in four laboratories using direct agglutination and haemagglutination; in seven laboratories using the high-sensitivity IgG agglutination test; and in three laboratories using the latex agglutination test. In this way, 70 series of titrations were carried out using seven procedures and the results were compared with those obtained using the WHO reference serum in 15 cases, with the French national E6 serum in 16 other cases, and in 39 cases using 15 reference sera supplied by the reagent manufacturers. Rigorous comparison of the tests was not possible in all cases because one aim of the study was to ensure that the tests were carried out under the usual working conditions that prevailed in the participating laboratories. The results obtained indicate that the serological tests currently available for toxoplasmosis are acceptable for its serodiagnosis. Presentation of the titres in IU has advantages; however, caution is required since the definition of IU varies according to the test and reagents used. It is therefore essential that the conditions and limits for a positive reaction be carefully defined in each case, especially for commercially available kits.

Leishmaniasis in AIDS patients: results of leukocytoconcentration, a fast biological method of diagnosis.

Leukocytoconcentration is an easy, fast and inexpensive technique for the diagnosis of leishmaniasis from peripheral blood. The technique involves concentration of blood parasites on a small surface of a microscope slide while the red blood cells are removed by lysis. The results, compared with those of other methods (examination of cultures of blood samples and bone marrow smears), were very good and accurate. All but one of our cases of leishmaniasis were patients with HIV co-infection. Leukocytoconcentration facilitates follow-up of cases and fast detection of any relapse.

PIP: The biological diagnosis of an infectious disease is ideally based upon isolating and identifying the pathogenic agent in the host tissue and establishing cultures after direct examination under a microscope. That procedure allows both an accurate diagnosis and an epidemiological survey of the disease. When leishmaniasis occurs in an AIDS patient or any other immunocompromised patient, however, the procedure is often unsatisfactory for the following reasons: the samples are difficult to collect, there may be few parasites, and their growth is slow or impeded by other pathogenic agents. The clinical features, when they are not specific, may be attributed to an etiology other than leishmaniasis. This paper describes an easy, fast, and inexpensive technique for diagnosing leishmaniasis from peripheral blood. Leukocytoconcentration involves concentrating blood parasites on a small surface of a microscope slide while the red blood cells are removed by lysis. The results, compared with those derived from examining cultures of blood samples and bone marrow smears, were very good and accurate. All but one of the cases of leishmaniasis studied were patients co-infected with HIV. Leukocytoconcentration facilitates the follow-up of cases and fast detection of any relapse.

Performance of European laboratories testing serum samples for Toxoplasma gondii.

One hundred twenty-nine European laboratories participated in a collaborative, multicentre study designed to evaluate the overall reliability of different serological techniques for diagnosis of Toxoplasma gondii infection. Five freeze-dried reference sera were distributed to each laboratory, each of which analysed the sera with its routine methods. The enzyme-linked immunosorbent assay was the technique used most frequently, followed by the immunofluorescent antibody technique. Only nine laboratories performed the Sabin-Feldman dye test. In general, there was good concordance between qualitative results, but for sera with low concentrations of Toxoplasma gondii-specific IgG antibodies, some false-negative results were found. For specific IgM and IgA antibodies, the immunosorbent agglutination assay proved the most sensitive. The present study demonstrates the need for regular assessment of laboratory serodiagnosis of Toxoplasma gondii infection.

Anisakidosis: report of 25 cases and review of the literature.

Anisakidosis (previously known as anisakiasis) is a disease caused by the accidental ingestion of larval nematodes (Anisakis and sometimes Pseudoterranova) in raw fish. Two groups of patients are studied: 5 clinical cases and 20 serological diagnoses. 55 French cases are already published. Most of them complained of acute symptoms, which occurred within 12 h of eating the seafood meal--epigastric pain, occlusion, diffuse abdominal pain, and appendicitis. Larvae were attached to the gastric mucosa (25 cases), including an inflammatory response (erythema, oedema ulceration). Diagnosis of anisakiasis is made by gastroscopy which allows removal of the worms, and cures the patients. In gastro-intestinal tract X-rays, oedema in the mucosa, pseudo tumour formation, and filling defects (worm) were observed. In chronic infections, cases with intermittent feelings of ill health and abdominal pain, lasting from several weeks to months, were misdiagnosed as another intestinal disease. Positive serological reactions are helpful, and surgery is necessary for resection of the lesion; diagnosis is made histologically by an eosinophilic granuloma, and the presence of a larva with Y shaped lateral cords. Infestation rate is high in fishes: cod (88%), rock fish (86%), herring (88%), salmon, mackerel. Public health education should discourage the eating of raw fish. Thorough cooking to 70 degrees C or adequate freezing to -20 degrees C for 72 h are the best preventive measures. Such legislation is only in force in the Netherlands, where cases have decreased dramatically.

[Study of 6 cases of malaria acquired near Roissy-Charles-de-Gaulle in 1994. Necessary prevention measures in airports]. / Etude de six cas de paludisme contractés près de Roissy-Charles-de-Gaulle en 1994. Mesures de prévention nécessaires dans les aéroports.

During the very hot 1994 summer, six new cases of airport malaria have been observed in and around Roissy-Charles-de-Gaulle airport. Four patients were regular or occasional airport employees. The two other cases were inhabitants of a city at 7 km. Entomological investigations suggest that cars of airport employees served to disseminate anophelines outside the airport areas. The six cases were very severe. One patient died. Apparently, W.H.O. recommendations on aircraft disinsecting procedures have not been fully followed. There is obviously a threat for areas near the airports.

[On the discovery of the parasite of malaria by A. Laveran: Bône 1878 - Constantine 1880]. / A propos de la découverte de l'hématozoaire du paludisme par A. Laveran Bône 1878 - Constantine 1880.

Books published on malaria and parasites do not mention the exact place and date of the discovery of the hematozoa. We think it is important to specify this point of the history of medicine. From Laveran's three main writings about this subject, the first one written on the 8th of November 1880 was summarized at the "Académy de Médecine" on the 23rd of November by Colin but never published. We got it from the archives. The parasite of malaria, Laveran's great discovery, was the result of a patient work and long microscopic examinations which started in Bône in 1878 where he first saw pigmented and crescent shaped bodies of Plasmodium falciparum. Then, on November 6, 1880 in Constantine, he was definitively convinced when he saw pigmented spherical bodies with flagella, that is to say exflaggelations. Nearly ten years passed before this etiology was universally admitted.