[Disseminated cutaneous and visceral fusariosis in an aplastic patient: an unusual digestive entry]. / Fusariose cutanée et viscérale disséminée chez un malade en aplasie: une porte d'entrée digestive inhabituelle.

INTRODUCTION: The hyalohyphomycetes, Fusarium spp, are very common in our environment. Some of them have been recognized as being opportunistic agents responsible for localized as well as generalized infections, especially in the case of malignant blood diseases. Their poor sensitivity to standard antifungal therapeutics makes them very dangerous. We report a case of cutaneous and systemic fusariosis due to Fusarium moniliforme in a patient with acute lymphoblastic leukemia. CASE-REPORT: A 20 year-old male student was suffering from acute type 6 myeloblastic leukemia. During the second consolidation schedule with a combined therapy of aracytine and amsacrine, this patient whose food diet was exclusively based on cereals, showed evidence of febrile aplasia, associated with myalgia, abdominal pain and diarrhoea. Microbiological samples were sterile. Ten days later, we noted the appearance of painful, diffuse and purple dermohypodermal cutaneous nodules surrounded by an erythematous ring. Histological and microbiological examination of the hypodermis biopsies of the skin nodules revealed invasion by Fusarium moniliforme. Treatment with voriconazole in association with transfusions of leukocytes led to clinical and microbiological cure. DISCUSSION: In our case report, the clinical pattern starting with digestive symptoms suggested dissemination from a digestive site, which is very unusual in Europe. In our patient, the malnutrition, together with a diet exclusively based on contaminated cereals in a context of malignant hemopathy, resulted in the colonization of the digestive tract by these moulds and the aplasia-inducing chemotherapy schedules enhanced their pathogen potential.

Cross-sectional survey of trachoma in school age children in the region of Thiès (Senegal).

BACKGROUND: Trachoma is a leading cause of blindness in West Africa. In Senegal previous studies have shown that the endemicity is high. AIMS: To verify the extent of the pathology and to study the epidemiologic characters of this infectious disease in a population of school age children in a rural zone, located in the Thiès region (Senegal). METHODS: A cross-sectional survey in six villages in the region of Thiès was performed in a population of school age children (5 to 15 years old). Sixty variables (individual, family, village, etc.) with morbidity indicators for trachoma cases were collected and analyzed. RESULTS: The cross-sectional survey confirmed the extent of the prevalence of trachoma in the childhood population; 208 of the 388 children (mean age, 9.19 years) included had trachoma (53.6%). Significant statistical correlations were found among the occurrence of trachoma and ethnic origins, the village of residence, the father's profession and the daily quantity of water ingested and its origin. Inversely no correlation could be found between the occurrence of trachoma and sex, age (except for florid trachoma), the size of the sibship, whether the mother washes the child, washing their hands before eating, the number of cospouses and the number of children per mother. CONCLUSIONS: The data obtained confirmed the extent of this endemic disease in the region of Thiès, because dispensing antibiotic eye drop has limited efficacy over time. Information should be provided to the population on the extent of the disease and its epidemiologic characteristics and more widespread well drilling, and use of that water should be encouraged.

Low rate of Candida parapsilosis-related colonization and infection in hospitalized preterm infants: a one-year prospective study.

We determined the rate of Candida parapsilosis colonization in preterm neonates (NN) and the relationship between colonization and systemic infection through a prospective study in the Neonatal Intensive Care Unit of a university hospital. All NN born at a gestational age of 32 weeks or less were included. Specimens from rectum, mouth and retro-auricular skin were obtained at admission and weekly thereafter. All samples were inoculated on to Sabouraud agar, CHROMagar and Dixon media. Candida species were identified using API Candida and API 20C. DNA analysis was performed using pulse field gel electrophoresis.Fifty-four patients were included (mean age: 30 +/- 1.5 weeks; mean birthweight: 1347 +/- 301 g; male: 40%). Fungal colonization was detected in 43 (79.6%). Causative agents were C. parapsilosis (N= 7);Malassezia furfur (N= 30);C. albicans (N= 21), C. guillermondii (N= 1). No sample was positive for two different yeasts at the same time. C. parapsilosis colonization included anal (N= 6), buccal (N= 1), and skin (N= 2). The average age at time of colonization was 17.8+/-9.8 days. Neither fungal septicaemia nor death were observed in colonized infants. Two central venous catheters were found to be colonized, one with C. parapsilosis and one with M. furfur. Logistic regression showed a link between colonization and gestational age alone. Three different DNA profiles were observed. This study suggests that in our units, the occurrence of C. parapsilosis colonization is low and bears no relation to systemic infection. The systematic identification of C. parapsilosis carriers for the purposes of isolation and preventive treatment does not appear to be warranted.

[Imported malaria in Brest hospitals from 1981 to 1990]. / Le paludisme d'importation dans les hôpitaux de Brest de 1981 a 1990.

From 1981 to 1990, 96 confirmed hospital cases of imported malaria occurred in Brest. An important increasing of the annual number was observed in 1986. A high proportion of infection was due to Plasmodium falciparum, mainly from black Africa. Most of the patients was French young men, without or with inadequate chemoprophylaxis. Every case of malaria due to P. falciparum appeared during the 2 months following their return from an endemic area. Two patients had a clinical profile of visceral evolutive malaria and 5 a cerebral malaria. Three patients died.

[First cases of keratitis caused by free-living amoebas of the genus Acanthamoeba diagnosed in Mali]. / Premiers cas de kératites a amibes libres du genre Acanthamoeba diagnostiqués au Mali.

The authors present the first three cases of keratitis with Acanthamoeba sp. which have been diagnosed in healthy persons. Two of them are children and in two cases there had been a local traumatism.

[Disseminated and central nervous system Histoplasma capsulatum infection mimicking neoplasm: difficulties in diagnosis, failure in management]. / Miliaire cérébrale pseudonéoplasique révélatrice d'une histoplasmose disséminée à Histoplasma capsulatum: difficultés diagnostiques, échec thérapeutique.

INTRODUCTION: Infection with Histoplasma capsulatum (Hc) is a rare importing disease in metropolitan France, the most often minor but sometimes letal in its spread form. EXEGESIS: A 58 years old French man, HIV seronegative, was admitted for an alteration of its general condition, disorder and buccal ulcerations. He had a prostate cancer history and came back in France after 17 years in Central Africa. The imaging showed numerous cerebral nodes, a bilateral adrenal tumor, and pulmonary calcifications. Histoplasmosis diagnosis has been done after neurosurgical cerebral biopsy which displayed characteristic Hc. The sick man died 4 months later with multivisceral failures, in spite of amphotericine B treatment followed by oral then intraveinous itraconazole. CONCLUSION: Even in an old tropical residence, ones can be able to conjure up a deep exotic fungal infection, and most specifically Hc histoplasmosis, in front of meaningful multivisceral lesions. Disseminated histoplasmosis (HD) with neurological location is misleading, mimicking tuberculosis or cancer. In order to obtain formal mycological evidence, ones have to make adapted biopsies. Antifungal agents must take into account medicinal interaction. Therefore, prognosis is bad, according to inoculum, immunodeficiency, age of disease and diagnosis delay.

[Amoebic keratitis caused by Acanthamoeba sp. May HSV1 infection play a role?]. / Kératite amibienne à Acanthamoeba sp. L'infection par HSV1 aurait-elle un rôle?

Many cases of human keratitis with Acanthamoeba sp. have a pseudo-herpetic appearance. The authors therefore evaluated the importance of co-infection with this virus in the onset of amoebic cornean lesions. After herpetic and amoebic co-infection rabbits showed severe cornean lesions, the viral aspect of cornea received a specific treatment. The amoebic co-infection progressed unchecked with severe lesions until day 37 p.i., in which trophozoites and cysts were numerous. The possible favourising role of HSV1 and Acanthamoeba sp. co-infection may exist in humans, just as it certainly exists in the rabbit.

[In vitro study of propamidine isethionate: value in the follow-up of Acanthamoeba amebic keratitis]. / Etude in vitro de l'iséthionate de propamidine: intérêt dans le suivi des kératites amibiennes à Acanthamoeba.

Propamidine isethionate eye drops is one of the treatments which are used against amebic keratitis with Acanthamoeba. Several strains of Acanthamoeba, having been tested with this drug during several weeks, did show off a resistance. The authors come to the conclusion that in vitro sensitivity must be examined and therapy must be perfect since the beginning.

[Hydrophilic contact lenses and pathogenic microorganisms]. / Lentilles cornéennes hydrophiles et microorganismes pathogènes.

A first study was conducted on 243 hydrophilic contact lenses: 65 were macroscopically abnormal and 100 were infected with fungi. Moreover on Sabouraud's medium with chloramphenicol, 30 bacterial strains were isolated of which 25 Pseudomonas sp. (10 Ps. cepacia) and 1 Serratia liquefaciens. Then a second study was conducted on 107 among the 243 lens solutions: the 50 of the B trade mark were spoiled with 12 X 10(7) bacteria/ml and the 57 of the C trade mark with 5 X 10(7) bacteria/ml. This quantitative bacterial difference was confirmed with a qualitative one: from B trade-mark 6 Pseudomonas aeruginosa strains were isolated and from C only one. The authors emphasize the importance of Ps. aeruginosa in corneal ulcers associated with contact lenses, of lens solution composition, and of preservative usefulness.

[Acanthamoeba keratitis. Epidemiologic and parasitologic study]. / Kératite amibienne á Acanthamoeba. Etude épidémiologique et parasitologique.

The amebic keratitis with Acanthamoeba are until now rare, but however increasing as their diagnosis is better, and the contact lens wearers more numerous. The authors present the clinical and parasitological features of cases they did diagnose since 1986. In the immunological sphere, the T4 lymphocytes were 20% less than the normal for the first patient, and the third one had a very low level of immunoglobulins A. In the evolution sphere, the first one did received a keratoplasty; the second one has been successfully treated with propamidine isethionate; for the third one, the treatment with propamidine isethionate was nonuseful and a keratoplasty which was finally performed did show off numerous amebic cysts. In the parasitologic sphere, Acanthamoeba polyphaga was isolated from the first case, Acanthamoeba quina from the second one and Acanthamoeba lugdunensis from the last one. These last two cases are the first which did permit to isolate these amoebae, morphologically near to the first species.

[Acanthamoeba keratitis in subjects with contact lenses]. / Kératite amibienne à Acanthamoeba chez le porteur de lentilles cornéennes.

A new case of Acanthamoeba keratitis in a young woman using contact lenses is reported. Although the patient strictly complied with decontamination rules, she developed a huge corneal abscess invading the anterior chamber. After a misleading initial phase, the diagnosis was suspected on clinical grounds and was confirmed by parasitologists. The infection followed a favourable course, thereby avoiding surgery and its unpredictable consequences, but an opaque speck remained in the centre of the cornea. This case illustrates a pathology which is getting less and less exceptional, even in France where such pathogens can be found in the water for normal household use. Subjects wearing contact lenses and who are particularly exposed should be warned of the risk of infection they incur. Doctors should be taught to bear this diagnosis in mind in order to guide parasitological investigations and to obtain confirmation as early as possible.

[Little savage mammalians: free-living amoebae vectors? (author's transl)]. / Les petits mammifères sauvages: vecteurs d'amibes libres?

We tried to prove the part of the little savage mammalians as active intermediate hosts to the intestine level for some free-living limax amoebae of limax group. For this we participated to several trapping-season in Britanny and in Tunisia. From 273 samplings, we studied 224 with the results thereafter: the rodents are the first (213/224) and the 3 most frequent species are also the most often hosts: 20/128 A. sylvaticus, 9/58 C. glareolus and 4/16 M. spretus. There must be a double positive factor: life in burrow near the earth and meal type. The 78 samplings for which we checked the free-living amoebae by stool examination, are the most poor by culture: 2/78 (2.5 p. 100). This lack explains the negative stool examination. The isolated amoebae belong for 31/34 to the genus Acanthamoeba, of one potentially pathogenic: A. hatchetti. Moreover the Finistere biotop appears particularly poor (2.5 p. 100 carriers in front of 21 p. 100 in Ille-et-Vilaine and 24 p. 100 in Tunisia).

[Acanthamoeba keratitis: search for a healthy carrier in Mali]. / Kératites à Acanthamoeba: recherche d'un portage oculaire sain au Mali.

The first cases of Acanthamoeba keratitis in Africa were reported in 1990 at the Institute of African Tropical Ophthalmology (IOTA) in Bamako, Mali. From 1990 to 1995, a total of 22 cases of corneal ulcers involving Acanthamoeba sp. were diagnosed at the IOTA. To improve our understanding of the epidemiological characteristics of these lesions in tropical areas, we attempted to identify healthy carriers of Acanthamoeba sp. by studying the normal eye flora of 149 patients examined at the IOTA in February 1996. Acanthamoeba sp. was not detected in any sample. Fungi were detected in 22.15 p. 100 of the samples. Thus, it would appear that, unlike fungi, Acanthamoeba sp. is not present in normal eye flora in Mali. This findings suggests that the occurrence of Acanthamoeba in corneal ulcers is not an accident. Our results also emphasize the need for screening to detect Acanthamoeba in developing countries such as Mali. However, further study will be needed to confirm these findings in a larger group of subjects more closely matched with the patients presenting the corneal ulcers diagnosed at the IOTA, especially with regard to geographical origin.

[Presence of free-living amoebae in urban and communal water-supply systems of the Brest area]. / Présence d'amibes libres dans les réseaux d'alimentation urbaine et communale de la région brestoise

During a preliminary study, from October 1975 until June 1976, we tried to find free-living limax amoebae in the waters proceeding from 6 systems which partly cover the wants of Brest and its bay (Finistère). From the 32 analysed samples, 19 were positive, of which 10 were able to grown at the first at 37 degrees C. The free-living amoebae belong to 3 genus: Harmanella, Vahlkampfia and Acanthamoeba. We have not found Naegleria species.

[Taxonomy-trial of the free-living amoebae belonging to the genus Acanthamoeba (Protozoa, Amoeba) by means of the cyst-features in scanning electron microscopy (author's transl)]. / Essai de taxonomie des amibes libres du genre Acanthamoeba (Protozoa, Amoebida) par l'analyse des caractères kystiques en microscopie électronique à balayage.

In order to verify the contribution of scanning electron microscopy to the taxonomic study of free-living amoebae, the authors studied at the encysted stage 21 strains of free-living amoebae representing 20 species (1 Naegleria gruberi, 1 Tetramitus rostratus and 18 Acanthamoeba sp). The method utilized is satisfactory for distinguishing the different genera. Using optical methods, it is possible to differentiate three groups (I, II, III) of Acanthamoeba, including 3, 10 and 5 species, respectively. The results obtained with scanning electron microscopy, however, are less precise. In particular, group II can be divided into only four sub-groups and group III into only two sub-groups and one species, A. culbertsoni. The method remains valid for group I.