Histoplasmosis Caused by Histoplasma capsulatum var. duboisii: A Comprehensive Review of Cases From 1993 to 2019.

BACKGROUND: Histoplasmosis caused by Histoplasma capsulatum var. duboisii (Hcd) is a rare, but probably underestimated, endemic infection described in intertropical Africa. Therefore, the epidemiology of the infection remains unclear, and there is no consensus on therapeutic management. METHODS: Using a comprehensive search on different Internet databases, we collected case reports of Hcd infection published from 1993 to 2019. Epidemiological and clinical charts and therapeutic strategies were analyzed. RESULTS: We found 94 well-documented cases of Hcd infection, and 30.1% of the patients were under 18 years old. Symptoms occurred in some patients several decades after leaving the endemic area. Cutaneous/subcutaneous lesions, bone infections, and lymphadenopathies, both isolated and combined, were the most frequent presentations. The human immunodeficiency virus (HIV) coinfection rate was at 20.8%, with fever, lymphadenopathies, and an absence of bone infection being the differentiating elements from patients living without HIV. The rate of disseminated forms (60.6% in our review) significantly increased as compared to studies published before 1993, but without correlation with HIV infection. The global mortality rate was at 23.4% by the end of follow-up. The outcome was not correlated with the antifungal drug prescribed, nor with HIV serologic status, but was correlated with the initiation of an antifungal therapy. CONCLUSIONS: Hcd histoplasmosis is a severe fungal infection for which the precise mode of acquisition remains to be determined. There is a need for affordable and more specific diagnostic tools. Itraconazole and amphotericin B are the best therapeutic alternatives and should be available in all low-income countries of the endemic area.

Imported malaria in pregnant women: report from a French University Centre.

OBJECTIVE: To describe malaria during pregnancy outside endemic areas. MATERIALS AND METHODS: We retrospectively reviewed all cases of imported malaria during pregnancy, diagnosed over a 11-year period in a French hospital. RESULTS AND CONCLUSION: We recovered 18 cases, all from sub-Saharan countries. The infection could appear distantly from arrival in France (up to 36 months), was asymptomatic in 3 cases, with anemia being the most common marker of infection (n = 14). The adverse consequences for the fetus (n = 3) or the newborn (n = 4) were frequent. Physicians should be aware of these atypical presentations in order to anticipate the diagnosis and improve the maternal and fetal prognosis.

[Malaria among immigrants, experience of a Parisian hospital (2006-2010)]. / Paludisme chez les migrants, expérience d'un hôpital parisien (2006-2010).

In recent days immigrants represent the main risk group for imported malaria in northern countries. Most of them are migrants returning to their country of origin to visit friends and relatives (VFR). We retrospectively examined the main clinical, biological, and therapeutic data of all malaria cases in immigrants from 2006 to 2010 in Tenon hospital, Paris. The hospital is situated in a Paris district with an important African community. During the study period 239 imported malaria cases were observed in adults of which 199 were immigrants, 186 VFR, and 13 recently arrived. Most cases were from sub-Saharan Africa and Comoro islands. Chimioprophylaxis was not taken in 81.2% of VFR. It was inadequate in 43.7% and not taken correctly in 84.4%. Plasmodium falciparum was the most frequent species identified: 190/199 (95.5%). Severe P. falciparum malaria was observed in 25 cases (13.2%); two of them were recently arrived. One patient, African VFR, died. In this series two high-risk groups were represented: HIV-infected patients and pregnant women. Six of the HIV patients had severe malaria and all pregnant women had anemia. Our results are similar to those observed recently in other European countries. Mean age of VFR is increasing and the risk for severe P. falciparum malaria became identical to the one observed in non-immune travelers. Protection measures remain still insufficient in this population of travelers.

Black grain mycetoma caused by Leptosphaeria tompkinsii.

Leptosphaeria tompkinsii is a dematiaceous fungus which is rarely reported as an agent of black-grain mycetoma. We present a case involving a mycetoma of the hand of a former farmer from Mali, West Africa, who has been a resident in France for 27 years. The patient was successfully treated with surgery and the use of oral itraconazole for 6 months. Species identification was based on sexual reproductive structures observed on potato-carrot agar media and the use of internal transcribed spacer sequencing.

Evaluation of a rapid enzyme-linked immunosorbent assay for diagnosis of strongyloidiasis.

Diagnosis of strongyloidiasis using stool examination remains unsatisfactory due to the lack of sensitivity and fastidious techniques. In this work, we investigated the value of an anti-Strongyloides IgG enzyme immunoassay (EIA), using a panel of 207 sera retrospectively collected from patients with definitive diagnoses of strongyloidiasis (n=57), other helminthic infections (n=46), eosinophilia without parasitic infection diagnosis (n=54), and digestive disturbances following a tropical journey (n=30) and from 20 negative controls. By following a receiver operating characteristic (ROC) curve analysis, it was possible to optimize the test to reach a sensitivity of 91.2% and a specificity of 93.3%, with 92.8% of patients correctly classified. Considering the incidence of strongyloidiasis diagnosed in our own laboratory, the negative predictive value was calculated at 99.9%. In conclusion, this test is very rapid and easy to perform and may be valuable for diagnosis of strongyloidiasis both in cases where the infection is unrevealed by a parasitological stool examination and in patients at risk for severe clinical forms, such as patients receiving immunosuppressive therapy.

[Emergence of Chagas' disease in Europe: description of the first cases observed in Latin American immigrants in mainland France]. / Emergence de la maladie de Chagas en Europe: à propos des premiers cas observés chez des migrants latino-américains en France métropolitaine.

This article describes the first cases of imported Chagas' disease detected in Paris, France. A total of 18 cases were recorded in two teaching hospitals between 2004 and 2007. There were 12 women and six men with a mean age of 38 years. All patients were Latin American immigrants who had recently arrived in France from Bolivia (Cochabamba and Santa-Cruz departments) 17 cases and from Salvador in 1. Eleven patients presented an asymptomatic indeterminate form of the chronic disease. Seven presented chronic Chagas cardiomyopathy including two with severe symptoms requiring placement of a pacemaker. Obtaining serological tests to confirm the diagnosis was difficult. All except one patient who was older than 50 years were treated with benznidazole. Based on these findings, the main priorities for management imported Chagas' disease in France are improvement of serological diagnosis and prevention of vertical transmission.

[Experience of targeted screening of Chagas disease in Ile-de-France]. / Expérience de dépistage ciblé de la maladie de Chagas en Ile-de-France.

2009 is marked by the centenary of the discovery by Carlos Chagas of Human American Trypanosomiasis. As a result of international cooperation its incidence has been falling in endemic areas, whereas North America and Europe are witnessing an increase in the number of imported cases. In metropolitan France, 18 such cases were reported between 2004 and 2007. Recently, estimates based on immigration figures have been made and suggest that about 1,500 imported cases can be expected in France. The object of this article is to assess the value of targeted screening of an at-risk population, originally from Latin America and now living in the Ile-de-France (area centred on Paris). The serological techniques employed were indirect immunofluorescence (IIF) and, depending on the case, 2 or 3 Elisa tests (Biomérieux, Biokit and Wiener). Trypanosoma cruzi serology was considered positive when the IIF was superior or equal to 200, or when two Elisa's were > 1, or when the IIF was superior or equal to 100 with at least one Elisa > 1. PCR was performed in 48 cases, which were considered to be positive. The tests were carried out on a voluntary basis after a publicity campaign within the Latin American community in the Ile-de-France. In this article, we present the findings of the first year of screening. Two hundred and fifty-four individuals were screened for Chagas' disease between June 2008 and June 2009. The median age was 33 years [11-63], the male/female ratio 102/152. Overall prevalence of positive serology was 23.6% (60/254). For six patients, the results were classified as "uncertain" (discordant serological tests). Of the seropositive group, 87.4% were Bolivian and 100% presented as a chronic form. Of these, 23.6% presented with functional cardiac manifestations and 22% with gastro-intestinal problems. The PCR was positive in 61% of the seropositive individuals. Clinical evaluation together with other investigations and therapeutic intervention is being carried out at present. These results confirm that metropolitan France is subject to the emergence of Chagas' disease in a non-endemic zone. This confirms the value of screening in at-risk populations, in particular because of the recent broadening of indications for antiparasitic treatment. In addition it is relevant to the prevention of vertical transmission or infection via organ donation, which could arise in France. These results also demonstrate continuing difficulties in the interpretation of serological results and the usefulness of PCR, which might increase sensitivity substantially.

[Chagas disease]. / Maladie de Chagas.

Chagas disease (human American trypanosomiasis) is a zoonose caused by the protozoan Trypanosoma cruzi. Vectors are Triatoma spp. insects. T. cruzi can also be transmitted by blood transfusion, organ transplantation, and transplacentally. Infection is generally acquired during infancy. The acute infection is rarely symptomatic and is followed by a chronic phase. Chronic infected people are asymptomatic (indeterminate stage) and may remain at this stage for the rest of their lives. About a third of infected people will develop a chronic Chagas disease which affects the heart and the digestive tract. Morbidity and mortality of chronic Chagas cardiomyopathy (CCC) are high. Specific treatment of asymptomatic infected individual could reduce the risk of progression to CCC. With control initiatives case incidence declined in most endemic countries. American trypanosomiasis has become an emerging imported disease in North America and Europe because of the migration of population originating from endemic zones. They are only two available drugs for specific treatment of Chagas disease: benznidazole and nifurtimox. Both have frequent side effects and variable efficacy according the phase of the disease. There is an urgent need for new treatments and better serological tests. Policies must be developed to avoid the risk of transmission trough blood transfusion and transplantation in developed countries.

A case of ciguatera fish poisoning in a French traveler.

Ciguatera is a toxic poisoning due to ingestion of fish and is rarely reported in France. Little is known about this imported tropical disease. We present a case observed in Paris in a traveller returning from the Dominican Republic.

[Prevalence of opportunistic digestive parasitic infections in Kinshasa, Democratic Republic of Congo. Results of a preliminary study in 50 AIDS patients]. / Prévalence des infections opportunistes digestives parasitaires a Kinshasa (République Démocratique du Congo), résultats d'une enquête préliminaire chez 50 patients au stade sida.

In the Democratic Republic of Congo (DRC), as in many African countries, AIDS and its procession of opportunistic infections are a major cause of morbidity and mortality. In Kinshasa, the estimated prevalence rate of HIV-infected persons is between 4 and 5%, corresponding to more than 200,000 people. Due to the lack of trained laboratory personnel and appropriate diagnostic equipment, no local investigation has been carried out to determine the prevalence of the opportunistic digestive parasitic infection in HIV-infected persons. As a step to obtaining this information that is needed for implementation of an adequate care policy, a preliminary investigation was carried out in Paris, France on 50 stool samples from 50 AIDS-patients hospitalized in 3 reference hospitals in Kinshasa. Eleven patients (22%) had digestive symptoms with a diarrhea syndrome. Further study using specialized techniques demonstrated 2 cases of digestive infection related to opportunistic parasites (4%). The first involved a Cryptosporidium sp. The second represented the first case of Enterocytozoon bieneusi infection reported in the literature from the DRC.

[Cancer and mycoses and literature review]. / Cancer et mycoses et revue de la littérature.

Various infectious agents are classical risk factors for cancer including bacteria, viruses and parasites. There is less evidence concerning the implication of fungal infection in carcinogenesis. The role of chronic Candida infection in the development of squamous cell carcinoma has been suspected for years. Candida sp are more prevalent in potentially malignant disorder and cancer of the oral mucosa. Other epidemiological evidence of a link between Candida infection and cancer is what is observed in patients with Autoimmune Polyendocrinopathy Candidiasis Ectodermal Dystrophy (APECED). Oral and oesophagal carcinoma are frequent in these patients with chronic mucocutaneous candidiasis. Production of nitrosamine and metabolism of procarcinogen are mecanisms in which Candida sp may be involved in oral cancer development. In chromomycosis and lobomycosis chronic lesions may have a risk of malignant transformation. A diagnosis of paracoccidioidomycosis appears to increase the risk of lung cancer.

[Imported gnathostomiasis acquired in Myanmar]. / Gnathostomose d'importation contractée au Myanmar.

We report a case of cutaneous gnathostomiasis acquired in Myanmar where this parasitic zoonosis was considered as non-endemic until a recent outbreak. Myanmar must be added to the list of countries where the infection can be acquired in Southeast Asia. Despite a treatment with ivermectin the patient relapsed after an apparent cure. A double-dose of ivermectin is now recommended for the treatment of gnathostomiasis.

[Mycetoma and their treatment]. / Les mycétomes et leur traitement.

Mycetoma are chronic subcutaneous infections, endemic in dry tropical regions. It can be caused either by actinomycetes or by fungi, presenting as filamentous grains in vivo. The foot is the most common localization. The main complication is osseous involvement. Patients are rural workers living in areas situated far from medical centers. Too often, they reach well-equipped hospitals with advanced mutilating lesions. Early case detection is the first condition for good therapeutic results. Clinical presentations of actinomycetoma and eumycetoma are similar, only biological diagnosis can distinguish the two etiological forms. This distinction is essential as medical therapy for each is radically different. Precise identification of the causal agent is required for targeted treatment but it can only be realized in rare specialized laboratories. For actinomycetoma, standard therapy is trimethoprim-sulphamethoxazole (STX). Duration of treatment period is one-year minimum. In case of poor response to STX or high risk of dissemination, a combination with amikacin gave high cure rate. Other options as amoxicillin-clavulanate are available. Medical cure of actinomycetoma is generally obtained with antibiotic treatments and surgical indications are exceptional. Disappointing results were observed using antifungal in the treatment of eumycetoma and medical therapy must be completed with surgical excision. Itraconazole is now the most used drug, new triazoles are on evaluation.

Mycetomas in Mali: causative agents and geographic distribution.

Although Mali is situated in the African zone endemic for mycetomas, no report has been published on the characteristics of the disease in this country. We report a series of 54 cases observed in Bamako. The causative agents were Madurella mycetomatis in 20 patients, Leptosphaeria sp. in one patients, Actinomadura madurae in 12 patients, A. pelletieri in 15 patients, and Streptomyces somaliensis in three patients. In this series, the observed geographic distribution of the causative agents was in agreement with data on the causative agents and their geographic distribution in neighboring countries, and with those suggesting a relationship between the type of infectious agent and the annual rainfall.

Cutaneous leishmaniasis in Niger.

This is the first report of cutaneous leishmaniasis in Niger subsequent to the initial finding in 1911 and the report of a second case in 1943. The clinical, histopathological, and epidemiological features of 64 parasitologically confirmed cases are described. Lesions were mostly multiple, situated on exposed areas of skin, but rarely on the face. Two clinical forms were predominant: ulcero-crusted and humid-ulcerous. Nodular lymphangitis was not uncommon. Patients were mostly from rural areas, but urban transmission did occur. The majority of lesions appeared during the June-October rainy season. All features appeared to be similar to those of this disease in other countries in the sahelian endemic zone.

Mycetoma in the Republic of Niger: clinical features and epidemiology.

Mycetoma is a common disease in the Republic of Niger. In two hospitals 133 cases were observed. The major site of lesions was the foot. Actinomycetomata were seen more often than eumycetomata. Streptomyces somaliensis is prevalent in the north desert zone while Actinomadura pelletieri is common in the southern part of the country. Madurella mycetomatis, the usual etiologic agent of eumycetoma, is seen in both regions. The species incidence and distribution in Niger differs from those of the west and east African endemic areas.

Urinary tract lesions due to Schistosoma haematobium infection assessed by ultrasonography in a community based study in Niger.

The comparative prevalences of urinary tract lesions in 2 villages where urinary schistosomiasis was endemic and in a control village free from infection were assessed by ultrasonography. Of the 822 residents greater than 4 years of age in the first village (Sébéri) where the prevalence of infection was 57%, 279 were examined by ultrasonography. The prevalence of bladder lesions was 71% in those 5-14 years of age, 57% among adult men, and 24% among women in this endemic village, compared to 10%, 16%, and 6%, respectively, in the control village. Renal lesions were infrequent among adults and there was no significant difference in the rates between Sébéri and the control village. Among children, moderate hydronephrosis was absent in the control village, but was observed in 19% of the boys 5-14 years of age and 2% of the girls 5-14 years of age in Sébéri. Sixty schoolchildren of the second endemic village with urinary egg counts greater than or equal to 100 eggs/10 ml of urine were examined by ultrasonography. The overall prevalence and the severity of bladder lesions in the 2 endemic villages were significantly related to the urinary egg count.

Consequences of Schistosoma haematobium infection on the iron status of schoolchildren in Niger.

The relationship between iron status and degree of infection by Schistosoma haematobium was studied in 174 schoolchildren from Niger in an area endemic for urinary schistosomiasis. Iron deficiency was defined by a combination of three reliable indicators: a low serum ferritin level combined with a low transferrin saturation, a high erythrocyte protoporphyrin level, or both. Hematuria and proteinuria were found in 76.4% and 79.9% of the children, respectively, while 95.4% excreted eggs (geometric mean egg count of 31.5 eggs per 10 ml of urine). Anemia was observed in 59.7% of the subjects. The prevalence of iron deficiency was 47.1%. Anemia was associated with iron deficiency in 57.7% of the cases. The hemoglobin level and transferrin saturation decreased significantly when the degree of hematuria increased, while prevalence of anemia and prevalence of iron deficiency increased significantly. The hemoglobin level and the hematocrit were negatively correlated with egg count, while prevalence of anemia increased with increasing egg count. This inverse relationship between degree of infection by S. haematobium and iron status shows a deleterious consequence of urinary schistosomiasis on nutrition and hematopoietic status, which should be considered in the design of nutrition intervention programs.

PIP: The relationship between iron status and degree of infection by Schistosoma haematobium was examined in 174 schoolchildren from Niger in an area endemic for urinary schistosomiasis. Iron deficiency was defined by a combination of 3 reliable indicators: a low serum ferritin level combined with a low transferrin saturation, a high erythrocyte protoporphyrin level, or both. Hematuria and proteinuria were seen in 76.4% and 79.9% of the children, respectively, while 95.4% excreted eggs (geometric mean egg count of 31.5 eggs/10 ml of urine). Anemia was seen in 59.7% of the subjects. The prevalence of iron deficiency was 47.1%. Anemia was associated with iron deficiency in 57.7% of the cases. Hemoglobin level and transferrin saturation decreased significantly when the degree of hematuria increased, while prevalence of anemia and iron deficiency increased significantly. The hemoglobin level and hematocrit were negatively correlated with egg count, while anemia prevalence increased with increasing egg count. This inverse relationship between degree of infection by s. haematobium and iron status shows a deleterious consequence of urinary schistosomiasis on nutrition and hematopoietic status, which should be considered in the design of nutrition intervention programs.

Hepatitis B, C, and D virus infections in patients with chronic hepatitis, cirrhosis, and hepatocellular carcinoma: a comparative study in Niger.

Eighty-nine Sahelian African patients with chronic active hepatitis (CAH) (14), cirrhosis (49), hepatocellular carcinoma (HCC) (26), and 47 controls were tested for hepatitis B virus (HBV, hepatitis B surface antigen [HBsAg]) and hepatitis D virus (HDV, anti-HDV antibody). Seventy-three percent of the patients were positive for HBsAg versus 29.8% of the controls (P < 0.0001). With anti-HDV test, 55.0% of the patients were positive versus 17.0% of the controls (P < 0.0001). To assess the prevalence of antibody to hepatitis C virus (HCV), we used an enzyme-linked immunosorbent assay for screening (anti-HCV2): 19.1% of the patients were positive versus 6.4% of the controls (P < 0.05). An association between HBsAg and anti-HDV-positive test results was found in 46.1% of the patients versus 6.4% of the controls (P < 0.0001). A combination of HBsAg and anti-HCV2-positive test results was found in 13.5% of the patients versus 2.2% of the controls (P < 0.05). Anti-HDV and anti-HCV2 test results were positive in 13.5% of the patients versus 2.2% of the controls (P < 0.05). Triple-positive test results (HBsAg, anti-HDV, and anti-HCV2) were found in 11.2% of the patients but in none of the controls (P < 0.025). Triple-negative test results were found in 14.6% of the patients versus 57.4% of the controls (P < 0.0001). The predominant association of the chronic HBV infection with CAH, cirrhosis, and HCC is confirmed in Sahelian Africa. The HDV superinfection (chronic HBV plus HDV infections) may be a major etiology.(ABSTRACT TRUNCATED AT 250 WORDS)

Premenstrual syndrome in Sahelian Africa. A comparative study of 400 literate and illiterate women in Niger.

From March to November 1984, the authors examined 400 African women 14 to 30 years old. They were classed as urban or rural, literate or illiterate, wage-earning or not. Signs of premenstrual syndrome (PMS) were analysed and the intensity of symptoms evaluated. Only 5% of the women were asymptomatic. 31% described socially debilitating severe symptoms. The most common signs were painful breasts, lower abdominal pains and nervousness. Oedema of the legs was rare. PMS was more frequent in young, literate, urban women; illiterate rural women were more often asymptomatic and, when they were symptomatic, signs were less intense than in urban women. These differences are related to pregnancies and breast-feeding. Urban illiterate women were protected from PMS by the cycle of pregnancy-breast feeding-weaning-new pregnancy. In this group menstruation was rare because of the length of gravidic amenorrhea.