Colonic obstruction and perforation related to heavy Trichuris trichiura infestation.

Heavy Trichuris trichiura infestation is rare in developed countries, and complications requiring surgical intervention have been described rarely in human trichuriasis. A case of colonic obstruction and perforation related to heavy whip-worm infection is described in an 84 year old woman. The woman was admitted to hospital because of a chest infection. Two days after admission she suffered nausea and vomiting followed a day later by bowel stoppage. Laparotomy indicated intestinal obstruction by a tumour. A partial right sided ileocolectomy was performed. Pathological examination of the resected bowel revealed heavy infestation with T trichiura causing a pseudotumour following a proliferative inflammatory response.

Immunological studies in amebiasis: isotypic characterization of specific antibodies by enzyme-linked immunofiltration assay.

Fifty sera from 17 cases of invasive amebiasis (15 hepatic localizations, 1 ameboma, 1 diffused colic localization) were studied by enzyme-linked immunofiltration assay (ELIFA). IgM and IgE anti-Entamoeba histolytica were detected in 10 and 15, respectively, of the 17 patients studied. IgM and IgE antibodies were found simultaneously in 10 cases; these 2 isotypes were only recognized twice in the same serum by the same antigenic components. During post-therapy monitoring, in less than 90 days IgE or IgM-Ab regressed completely in half the cases. If they appeared or reappeared after the third month, prognosis was bad. In addition to its value for diagnosis and prognosis, the ELIFA allowed us to detect the functional antigenic components revealed more particularly by some IgG, IgM, IgE, or IgA antibodies.

A case of chromomycosis treated by a combination of cryotherapy, shaving, oral 5-fluorocytosine, and oral amphotericin B.

A case of chromomycosis from Comoro Islands was first treated without success with high doses of oral amphotericin B (3 g per day). Treatment with itraconazole (400 mg per day) was also unsuccessful. Then, in vitro tests were done to study the susceptibility of this Fonsecaea pedrosoi strain to antifungal drugs. It was resistant to itraconazole, sensitive to 5-fluorocytosine, and the combination of 5-fluorocytosine with amphotericin B was synergistic. The patient was then treated with this last combination of drugs, which seemed to be effective. The patient stopped this treatment after six months, and relapse occurred two years later. The best therapeutic strategy in cases of chromomycosis seems to be a combination of two drugs chosen according to the results of prior antifungal susceptibility testing.

Further description of blood stages of Plasmodium petersi from Cercocebus albigena monkey.

Additional information is given on the erythrocytic stages of Plasmodium petersi (Poirriez, Baccam, Dei-Cas, Brogan et Landau, 1933), which was found in a Cercocebus albigena monkey from the Central-African Republic. The first colour pictures of P. petersi are presented. In 60% of young trophozoites, the vacuole is divided into two or three parts by thin cytoplasmic streaks. In young trophozoites and almost mature schizonts, 80% of nuclei are oval or kidney-shaped; they are two-coloured; measurement of their surface area shows that it is about twice that of the nuclei of P. gonderi at the same stages. Studies using polarised light show that most of the pigment granules are elongated (spindle-shaped) and found at the periphery of old trophozoites and schizonts. P. petersi can easily be distinguished from P. gonderi and P. georgesi, the two other species found so far in Cercocebus monkeys, which are regarded as the African equivalents of the Asian macaques.

[Human anisakiasis: 5 cases in northern France]. / Anisakiase humaine: 5 cas dans le nord de la France.

We report 5 cases of human anisakiasis revealed respectively by an acute intestinal obstruction due to multiple small bowel stenosis, an acute inflammatory ileitis simulating appendicitis, ulcer type epigastralgia, purulent peritonitis and a latent small bowel tumor. Diagnosis was established in 4 cases on microscopic analysis of bowel specimens (eosinophilic granulomas and/or parasitic fragments) and in 1 case at gastroscopy. Serodiagnosis was positive in 2 of 4 cases and the consumption undercooked fishes was found in 4. In small samples we estimated the infestation (1 to 50 parasites) by anisakis larvae of 3 fish species: 80 p. 100 for herrings, 63 p. 100 for mackerels and 100 p. 100 for whitings. This work emphasizes the role of anisakiasis as a source of digestive symptoms and intestinal eosinophilic granuloma.

A three years follow-up of total serum IgE levels in three patients treated for strongyloidiasis.

A three years follow-up of the level of serum total IgE was made for the first time in three patients with strongyloidiasis after efficient treatment. The decrease of IgE was slow and progressive, showing a logarithmic curve. This regular decrease of total serum IgE could be used as an additional criterion for the evaluation of the efficiency of drug therapy in patients with strongyloidiasis. The persistence of high levels of total IgE two or three years after the elimination of the intestinal parasites, after the return of blood eosinophils to a normal level (within six months), and after the disappearance of specific antibodies, shows that the regulation of the IgE elimination seems to be a complex mechanism.

Relapsing Plasmodium vivax malaria with atypical parasite forms and phagocytosis by peripheral neutrophils.

A case of atypical Plasmodium vivax malaria is presented. The clinical follow-up has allowed to characterize three consecutive malaria clinical episodes within one year. At the first attack, 39% of the infected red blood cells were parasitized by gametocytes. Furthermore, rare crisis forms, exceptional "pseudoparthenogenesis" forms, a few equatorial trophozoites, malaria pigment-containing leucocytes and phagocytized parasites were also found in the thin blood smears. At the second malaria episode, morphological aspects were quite similar, but the gametocyte percentage decreased and that of the equatorial trophozoite forms increased. Only at the third attack, was the morphology typical of P. vivax. The Plasmodium species and the absence of mixed infection were unequivocally confirmed using polymerase chain reaction. Atypical strains of P. vivax are relatively frequent. Nevertheless, to our knowledge, neither so high a gametocyte percentage, nor extensive P. vivax peripheral phagocytosis were previously reported.

[Autochthonous strongyloidiasis in the north of France]. / Anguillulose autochtone dans le nord de la France.

The authors discuss four cases of indigenous strongyloidiasis, which were detected in northern France during the past twenty years. In our hemisphere, the limits of this helminthiasis range between the 50th and the 53rd parallels of latitude. In two cases, indoor contamination must be suspected; in the third case, transmission has been facilitated by insalubrity and crowding; the fourth case was related to the activities of a dustman in camping sites. Nose bleedings were noticed in two cases and the haemorrhagic manifestations in strongyloidiasis are mentioned.

[Malaria in the Dunkerque hospital center from December 1979 to December 1990]. / Le paludisme au centre hospitalier de Dunkerque de décembre 1979 à décembre 1990.

Seventy-one cases of malaria were diagnosed in the hospital of Dunkerque from 1979 to 1990. Forty-five patients have been infected in the Comores islands. Among the 24 other imported cases, 17 (71%) have been contaminated in Western or Central Africa. One case of congenital malaria and one of malaria acquired by blood transfusion are also reported. Plasmodium falciparum was detected in 84.5% of the patients. The four human species were found among the Comorians. Two cases with abnormal forms of Plasmodium vivax were observed.

[Parasitologic study of feces: simultaneous performance of Faust's, Janecko-Urbanyi's and Ritchie's concentration technics]. / Examen parasitologique de selles: réalisation simultanée des techniques de concentration de Faust, de Janeckso-Urbanyi et de Ritchie.

The authors propose the simultaneous use of Faust's, Janeckso-Urbanyi's and Ritchie's techniques according to a protocol which combines the effectiveness of the three techniques, with a saving in reagents, a significant simplification of the manipulations (a single dilution of the stools, a single straining and a total of three centrifugations) and the possibility of conducting valid comparative studies, as the three techniques are performed from the same faecal aqueous suspension.

[Comparison of ELIFA and IGM-immunocapture technics in the diagnosis of 50 cases of congenital toxoplasmosis]. / Comparaison entre les techniques ELIFA et immunocapture-IgM dans le diagnostic de cinquante cas de toxoplasmose congénitale.

The authors have compared the diagnostic value in congenital toxoplasmosis of two recently developed immunological techniques, Enzyme Linked immunofiltration Assay (ELIFA) and IgM-immunocapture (or immunosorbent agglutination assay). The study involved 50 children suffering from congenital toxoplasmosis and 300 unscathed control children, whose mothers suffered from toxoplasmosis during their pregnancies. The ELIFA technique showed a sensitivity of 74 p. cent at the end of the first month after birth (day 30) and 84 p. cent after two months (day 60), whereas the IgM-immunocapture technique gave a sensitivity of 64 p. cent at day 30 and 70 p. cent at day 60. Both methods were at least 95 p. cent specific. The two techniques seem to be complementary to each other, and their association allowed the diagnosis to be confirmed in 80 p. cent of cases at day 30 and in 90 p. cent of cases at day 60. A serum sample taken on the tenth day after birth (day 10) was important both to eliminate the rare cases (5 p. cent) of transplacental transmission of maternal IgM antibodies and to detect transient neonatal synthesis of IgG or IgM toxoplasmic antibodies.

[Comments on hepatitis B vaccination in France]. / Quelques commentaires sur la vaccination contre l'hépatite B en France.

We recall the selective preventive measures which led to a significant reduction in the rate of acute hepatitis B cases detected in France prior to generalized vaccination. These measures, screening for HBs antigens in blood donors and pregnant women, vaccination of high risk groups, suggest the need to better define risk groups and to develop better epidemiology information on the evolution of hepatitis B incidence, both in at risk groups and in subjects outside these groups. The importance of serological screening among chronic carriers in at risk groups is underlined. For health carers who have already been vaccinated, we propose determining anti-HBs titer prior to booster vaccinations, whatever the age. Finally, an active surveillance system to register the secondary effects of vaccination (linked to the Regional Drug Monitoning Center) is needed. The issues of the content of anti-hepatitis B vaccine (dose, adjuvant, antigenic fraction, molecular mimetism) and injection route remain timely.

[Early diagnosis and surveillance of congenital toxoplasmosis. The comparative immunological profiles method]. / Diagnostic précoce et surveillance de la toxoplasmose congénitale. Méthode des profils immunologiques comparés.

More than 8000 samples (sera, cord blood, CSF, etc.) from patients who had, or were likely to have, toxoplasmosis were studied by the CIP-ELIFA technique. The first stage in this technique is immunoelectrodiffusion on a microporous cellulose acetate membrane. In the second stage, immunodetection and isotypic characterization of the precipitating systems are rapidly carried out by immunofiltration with anti-IgG, IgM, IgA or IgE-labelled antibodies (enzyme-linked immunofiltration assay or ELIFA). Several samples are jointly laid out on the same membrane for compared immunological profiles (CIP). When applied to the mother-foetus relationship in toxoplasmosis, this procedure provides an early diagnosis of congenital infestation in 85% of the cases. Positive criteria are based on evidence of specific IgM, IgE or IgA in the child, but also on the detection of foetal or neonatal antitoxoplasmosis IgG which can be distinguished from the IgG transmitted by the mother. Polyisotypic supervision is of considerable value for assessment of prognosis and of therapeutic effectiveness at the end of treatment. Satisfactory isotypic characterization can only be achieved by using particular functional antigens.

[Increase in the size of an hepatic amebic abscess treated with metronidazole: value of immunologic surveillance with the ELIFA method]. / Augmentation de volume d'un abcès amibien hépatique traité par le métronidazole: intérêt de la surveillance immunologique par la méthode ELIFA.

The authors report a case of amoebic liver abscess regularly increasing in size for a period of 20 days (iterative controls by echography), in spite of a metronidazole treatment. Immunological studies by the ELIFA method, on the successive sera of the patient, show IgG, IgM, IgE and IgA antibodies within one particular precipitating system; the specific IgA disappeared after surgical drainage of the abscess.