[Congenital malaria. A case observed in twins born to an asymptomatic mother]. / Paludisme congénital. Un cas survenu chez des jumeaux de mère asymptomatique.

Even in endemic zones, congenital malaria, first described in 1876, is rarely encountered. The incidence has greatly increased however over the last 10 years suggesting several diagnostic problems. We observed a case of infected twins born to an asymptomatic mother which would throw some light on the pathophysiology involved in congenital transmission. A 2-month old infant was hospitalized for surgical cure of an umbilical hernia. Haemolytic anaemia (6.3 g/dl) and fever (39 degrees C) were observed during the postoperative period. A wide spectrum antibiotherapy was prescribed but the temperature remained at 39 degrees C. A blood swab cultured one week after the operation revealed Plasmodium falciparum. The infant's twin sister was in apparently good health but was also found to be anaemic (6.1 mg/dl Hg) and a blood sample was positive for P. falciparum. For the mother, the search for parasites was negative. Serology tests performed at diagnosis revealed anti-P. falciparum antibodies at 1/1600, 1/3200 and 1/6400 in the infant, his twin sister and the mother. Outcome was favourable. The mother had arrived in France from Togo 14 months earlier and had not returned to an endemic zone. She had had frequent episodes of fever in Togo and had taken quinine, but no episode of fever had occurred during the pregnancy or delivery. This twin case of vertical mother-infant transmission is the equivalent to transfusional malaria since red cells pass the placental barrier near the end of pregnancy, even when no placental lesion exists. Congenital transfusional malaria must however be dissociated from congenital infective malaria resulting from early primoinfection in endemic areas.

Pure dysgerminoma of the ovary in childhood: treatment results and sequelae.

Thirty-five children with pure dysgerminoma of the ovary were all treated at the Institut Gustave Roussy (IGR) from 1956-1985. The median follow-up is 8.5 years. The crude 5-year survival rate is 94.1% (+/- 4.1). The disease-free 5-year survival rate is 81.8% (+/- 6.7). Fourteen patients who had stage I disease were treated by unilateral salpingooophorectomy and prophylactic radiotherapy (20 Gy) to ipsilateral iliac, lumbar-aortic, and subclavicular lymph nodes. All are alive without sequelae. Eighteen patients with stage II and III disease were treated by surgery and radiotherapy (30-40 Gy) to the tumor volume. All are alive but radio-induced sequelae are severe. Five relapses of stage I, II, and III tumors occurred and were cured by a second line treatment. Two of the three patients with stage IV disease died. Four patients received a cisplatinum-containing regimen for disseminated disease or because of a relapse before radiotherapy. Three achieved a complete response of measurable tumor. Given the high efficacy of this kind of chemotherapy and the severe sequelae induced by abdomino-pelvic irradiation, we propose initial chemotherapy for widespread disease and radiotherapy in the event of residual tumor.