[The ethical approach of small humanitarian medical non-governmental organisations (NGOs) - the example of Biology Without Borders]. / L'approche éthique des petites organisations non gouvernementales (ONG) médicales humanitaires ­ l'exemple de Biologie Sans Frontières.

In France, more than 400 non-governmental organisations (NGOs) work in the field of health; they differ in their missions and means. Nevertheless, their actions question common ethical principles, which include respect for populations and political or financial non-interference. Biologie Sans Frontières has considered these ethical aspects and has formalised a charter on the principles it defends in its actions. The creation of an ethics committee with a single charter would be unifying for all NGOs; it would also be a guarantee of respectability for international bodies such as the World Health Organisation (WHO).

[Epidemiological specificities of COVID-19 in Africa: Current or future public health concern?] / Spécificités épidémiologiques de la COVID-19 en Afrique : préoccupation de santé publique actuelle ou future ?

OBJECTIVES: Africa is the continent which is the least equipped to fight the COVID-19 epidemic. However, Africa, which represents 17 % of the world's population, is estimated to have only 5 % of global cases (source: WHO on 2020/08/04). In this work, the authors try to identify and understand the reasons for these epidemiological data. METHOD: Some follow-up indicators have been carried out, mainly through WHO reports. These data were compared with the literature and the field expertise of the association "Biologie sans frontières" in Africa. RESULTS: The following points mark the particularity of COVID-19 in Africa: (1) insufficient diagnostic capacity (linked to gross national product), (2) a younger population limiting the population at risk and the number of deaths, (3) a favourable climate (hot and humid) which is decreasing viral transmission, (4) some socio-cultural factors that can reduce cases reporting. CONCLUSION: Today, this health crisis is omnipresent while the number of deaths remains limited in Africa. Simultaneously, actions concerning African public health priorities (malaria, diarrhoea, AIDS…) are interrupted or slowed down.

Fatal aspergillosis complicating severe SARS-CoV-2 infection: A case report.

As aspergillosis is a well-known complication of severe influenza, we suggest that SARS-CoV-2 might be a risk factor for invasive aspergillosis (IA). We report the case of an 87 year-old woman, with no history of immune deficit, admitted in our emergency room for severe respiratory distress. Coronavirus disease 2019 (COVID-19) diagnosis was confirmed by a SARS-CoV-2 reverse transcriptase polymerase chain reaction (PCR) on nasal swab. On day 14, pulmonary examination deteriorated with haemoptysis and a major increase of inflammatory response. A computed tomography (CT) scan revealed nodules highly suggestive of IA. Aspergillus antigen was found highly positive in sputum and blood, as was Aspergillusspp PCR on serum. Sputum cultures remained negative for Aspergillus. This patient died rapidly from severe respiratory failure, despite the addition of voriconazole. Considering SARS-CoV-2 acute respiratory distress syndrome (ARDS) as an acquired immunodeficiency, we report here a new case of "probable" IA based on clinical and biological arguments, in accordance with the last consensus definition of invasive fungal disease. On a routine basis, we have detected 30% of aspergillosis carriage (positive culture and antigen in tracheal secretions) in critically ill patients with COVID-19 in our centre. Further studies will have to determine whether sputum or tracheal secretions should be systematically screened for fungal investigations in intensive care unit (ICU) COVID-19 patients to early diagnose and treat aspergillosis.

Inefficacy of alcohol-based hand rub on mites in a patient with hyperkeratotic scabies.

BACKGROUND: The World Health Organization is strongly promoting alcohol-based hand rubs to interrupt transmission of pathogens within the healthcare environment, and in some hospitals they are being recommended in cases of scabies. However, there are no studies that demonstrate the efficacy of such hand rubs against scabies. AIM: To evaluate the viability of Sarcoptes scabiei after the application of various topical antiseptics used for hand hygiene, and the effect of hand washing on the number of parasites present on the skin surface of a patient with scabies. METHODS: We applied three different topical antiseptics (two alcohol-based and one povidone-iodine-based) to the skin of one hand that was affected by scabies, and took a skin scraping of each area to evaluate the viability of the mites over time. A skin scraping of a control area without antiseptic application was also taken. We also tested the antiseptics directly on the mites. Statistical comparison between the percentages of vital mites in the different samples was assessed using the χ(2) test. We also captured a dermoscopic image of the other hand before and after hand washing to count the number of parasites on the skin surface. RESULTS: Topical antiseptics did not reduce the number of living mites compared with control skin, and hand washing did not reduce the number of parasites on the skin surface. CONCLUSIONS: Application of topical antiseptics does not reduce the viability of S. scabiei, and is therefore unable to prevent the transmission of scabies. The usefulness of hand washing in preventing transmission of scabies to new subjects remains to be investigated.

Evaluation of the Aspergillus Western blot IgG kit for diagnosis of chronic aspergillosis.

Immunoprecipitin detection (IPD) is the current reference confirmatory technique for anti-Aspergillus antibody detection; however, the lack of standardization is a critical drawback of this assay. In this study, we evaluated the performance of the Aspergillus Western blot (Asp-WB) IgG kit (LDBio Diagnostics, Lyon, France), a recently commercialized immunoblot assay for the diagnosis of various clinical presentations of chronic aspergillosis. Three hundred eight serum samples from 158 patients with aspergillosis sensu lato (s.l.) were analyzed. More specifically, 267 serum samples were derived from patients with Aspergillus disease, including 89 cases of chronic pulmonary aspergillosis, 10 of aspergilloma, and 32 of allergic bronchopulmonary aspergillosis, while 41 samples were from patients with Aspergillus colonization, including 15 cystic fibrosis (CF) and 12 non-CF patients. For blood donor controls, the Asp-WB specificity was 94%, while the kit displayed a sensitivity for the aspergillosis s.l. diagnosis of 88.6%, with a diagnostic odds ratio (DOR) of 119 (95% confidence interval [CI], 57 to 251). The DOR values were 185.22 (95% CI,78.79 to 435.45) and 43.74 (95% CI, 15.65 to 122.20) for the diagnosis of Aspergillus disease and Aspergillus colonization, respectively. Among the patients, the sensitivities of the Asp-WB in the diagnosis of Aspergillus colonization were 100% and 41.7% in CF and non-CF patients, respectively. The Asp-WB yielded fewer false-negative results than did IPD. In conclusion, the Asp-WB kit performed well for the diagnosis of various clinical presentations of aspergillosis in nonimmunocompromised patients, with an enhanced standardization and a higher sensitivity than with IPD, which is the current reference method.

[Amebic liver abscess and late recurrence with no travel in an endemic area]. / Abcès amibien hépatique avec récidive tardive en l'absence de séjour récent en zone d'endémie.

Amebic liver abscess is the main complication of amebic dysentery. Recurrences after treatment and apparent healing are very uncommon. The purpose of this report is to describe the case of a patient with a very late relapse of an amebic liver abscess, 10 years after the first episode. This recurrence seems due to an incomplete initial treatment. This case illustrates the reason for and importance of complying with the current therapeutic strategy: nitroimidazole followed by a luminal agent to eradicate intestinal amebic colonization.

Antifungal effect of the essential oil of Thymus broussonetii Boiss endogenous species of Morocco.

The aim of the study was to determine the antifungal effects of the essential oil of Thymus broussonetii Boiss (EOT), an endemic plant in Morocco against Candida albicans, Aspergillus fumigatus and the dermatophytes. EOT was extracted by steam distillation. A suspension of up to 500 µL of C. albicans at a concentration of 108 CFU mL⁻¹ and A. fumigatus at a concentration of 10¹° spores mL⁻¹ were inhibited by 20 µL of EOT incorporated in tubes containing 4 mL of Sabouraud broth. In Sabouraud-chloramphenicol agar slants containing different concentrations of essential oil, 5 × 104 A. fumigatus spores were inhibited by 6 µL (0.0015 mL mL⁻¹) of the EOT. It has shown good anti-C. albicans and anti-A. fumigatus activity. All the dermatophytes tested were inhibited by 3 µL (0.00075 mL mL⁻¹) of EOT; the latter has the potential to be a good alternative to the conventional antifungal drugs which are usually expensive and with high toxicity.

Development of high-throughput methods to quantify cysts of Toxoplasma gondii.

Toxplasma is a protozoan parasite, which forms persistent cysts in tissues of chronically infected animals and humans. Cysts can reactivate leading to severe pathologies. They also contribute to the transmission of Toxoplasma infection in humans by ingestion of undercooked meat. Classically, the quantification of cyst burden in tissues uses microscopy methods, which are laborious and time consuming. Here, we have developed automated protocols to quantify cysts, based on flow cytometry or high-throughput microscopy. Brains of rodents infected with cysts of Prugniaud strain were incubated with the FITC-Dolichos biflorus lectin and analyzed by flow cytometry and high-throughput epifluorescence microscopy. The comparison of cyst counts by manual epifluorescence microscopy to flow cytometry or to high-throughput epifluorescence microscopy revealed a good correlation (r = 0.934, r = 0.993, P < 0.001 respectively). High-throughput epifluorescence microscopy was found to be more specific and sensitive than flow cytometry and easier to use for large series of samples. This reliable and easy protocol allow the specific detection of Toxoplasma cysts in brain, even at low concentrations; it could be a new way to detect them in water and in contaminate food.

The effect of essential oils from Thymus broussonetii Boiss on transmission of Toxoplasma gondii cysts in mice.

In this study, we have evaluated the effect of essential oils of Thymus broussonetii Boiss, an endemic plant of Morocco in experimental transmission of Toxoplasma gondii cysts in mice. These oils were obtained by hydrodistillation and were administered to mice at 20 microg/animal orally at the time of infection and for several days thereafter. This resulted in total absence of intracerebral cysts in mice who received the essential oils signifying that these essential oils of thyme have a blocking effect on the appearance of the cysts. In addition, no abnormality was observed in the control mice who received the essential oils of thyme.

[Toxoplasma gondii serology in pregnant woman: characteristics and pitfalls]. / Sérologie de la toxoplasmose chez la femme enceinte : caractéristiques et pièges.

Screening program of congenital toxoplasmosis depends principally on serological testing and follow-up of pregnant women with negative serology from the onset of pregnancy. This program is particularly efficient because the majority of cases of obstetrical seroconversion are diagnosed and followed up. Serological techniques have evolved with time and are many on the market. The "IgG" tests are more and more specific at the detriment of their sensitivity. The latter is variable from one technique to the other. In 2008, despite the presence of an international standard, serological titrations are particularly variable making interpretation of the kinetics impossible between two different series, two techniques or two laboratories. In cases of interpretation discordance or borderline values, it is useful to do a confirmatory technique. The dye test or the western blot are useful in these cases and prevent up to 2 to 8% of unnecessary obstetric follow up. IgM tests are becoming more and more sensitive and precocious. These tests frequently detect "non specific IgM" as well as "residual IgM" (associated with a stable positive IgG titre). In such cases and in the absence of a preceding positive result, a complementary test done by specialized laboratories (such as ISAgA IgM or IgA, IgG avidity test, differential agglutination, etc.) is indispensable in order to prevent any error of interpretation. These complementary tests as well as the serological evolution (control done in 15 days) permit, in a large number of cases, to reassure the patient with full confidence.

A technique for dating toxoplasmosis in pregnancy and comparison with the Vidas anti-toxoplasma IgG avidity test.

A comparative evaluation of 384 selected sera was performed using the Beckman Coulter Access and Abbott Axsym Toxo-IgG assays. The Axsym assay yields positive early results following infection, while the Access assay gives higher titres during chronic infection. The ratio between the two complementary tests, Axsym Toxo-IgG/Access Toxo-IgG (Ax/Ac), was compared with the Vidas anti-Toxoplasma IgG avidity index (AI). The Ax/Ac ratio decreased progressively as the time between infection and sampling increased. The mean Ax/Ac values (+/-SE) were 2.50 (+/-0.26), 2.14 (+/-0.13), 2.33 (+/-0.22), 1.34 (+/-0.09), 1.32 (+/-0.10), 0.92 (+/-0.08) and 0.74 (+/-0.07) for groups of sera sampled at 1, 2, 3, 4-5, 6-8, 9-12 and 13-24 months, respectively, after infection in pregnant women. These values were much smaller for cases with chronic infection (>24 months), i.e., 0.56 (+/-0.03), 0.44 (+/-0.04) and 0.53 (+/-0.04), respectively, for pregnant women and immunodepressed patients with and without reactivation. Taking a ratio of 1 as a threshold for recent infection, the patients in the groups sampled at 1, 2 and 3 months had Ax/Ac ratios >1 in 49/50 (98%), 53/55 (96.4%) and 36/36 (100%) cases, respectively. Thus, an Ax/Ac ratio of <1 in serum from a pregnant woman allows a recent infection (<3 months) to be excluded. This technique has the advantage of yielding positive results that develop much more rapidly than the AI, thereby helping to reassure large numbers of pregnant women and avoiding costly and unnecessary prophylactic treatment and follow-up.

Seroprevalence of T. gondii in sheep from Marrakech, Morocco.

Toxoplasma gondii is a ubiquitous intracellular protozoan parasite transmitted by food. Concerning this parasite, there are few studies done in Morocco. In this study, 261 sera from sheep intended for consumption in Marrakech were subjected to the Toxoplasma ELISA based serology test for the detection of anti-T. gondii specific IgG confirming a past infection. Of the total tested 72 (27.6%) sera were positive for IgG. This result shows that the seroprevalence approaches the world average and is similar to what is found in other cities of Morocco. This has prompted us to investigate other animal species in the region in order to evaluate the degree of contamination by this parasite as well as the potential risk incurred on consumption of their meat.

Efficacy comparison between anti-malarial drugs in Africans presenting with mild malaria in the Central Republic of Africa: a preliminary study.

Drug resistance to Plasmodium falciparum contributes to major health problems in central Africa and, as a consequence, poverty. We have analyzed the efficacy of three currently available antimalarial drugs to treat symptomatic, uncomplicated P. falciparum malaria in semi-immune adults living in Bangui, Central Republic of Africa. 210 consecutive individuals were enrolled in the survey, of which 45 were excluded. Those having received dihydroartemisin proved significantly less parasitemic than those having received quinine per os or sulfadoxin-pyrimethamin (chi2 = 16.93; p < 0.05), and 75% recovered in two days compared to 57 and 44%, respectively. The 25% who did not recover benefited from a second cure with dihydroartemisin, which proved 100% efficient. The most accurate protocol remains to be established by analyzing clinical and parasitological data and taking into account the economics of the country.

[Post-transfusion malaria: is the risk irreconciliable with biological silence?]. / Le risque de paludisme transfusionnel confronté à celui de la mutité biologique: deux données irréconciliables?

Despite the relatively high frequency of imported malaria in metropolitan France, the transmission of malaria by transfusion is exceptional. The screening of donations to determine those at risk is performed by an interview, and by the testing of serology for defined groups of donors. However, the exclusion of a candidate 'at risk' as a blood donor, by a pre-donation interview, is not completely mastered and the discrimination by biological examination lacks sensitivity, as much for methodological reasons as for reasons linked to the complex parasitic pathogenic agent (Plasmodium ssp.), as for the specific host defence system. The risk of introducing an unsafe-potentially dangerous (transfusion-transmitted malaria is often lethal)-element into the transfusional circuit is not completely covered. Is serology testing the most adequate test to avoid the risk of infected donations, in particular by Plasmodium falciparum; what are the alternatives and what will be the eventual added-costs of the biological qualification of such donations? The transfusional risk linked to Plasmodium seems, however, to be reduced to a minimum, concerning the circulation of plasma, which could represent an alternative for donors at real risk (rare) and those with a supposed risk (relatively numerous).

[Toxoplasma gondii: level of carriage in sheep of Marrakech region (Mnabha)]. / Toxoplasma gondii: taux de portage chez les ovins de la région de Marrakech (Mnabha).

Toxoplasma gondii is an ubiquitous parasite with a prevalence variable from country to country. In Morocco very few studies were devoted to this prevalence. To fill this gap we were interested to study the epidemiology of this parasite and to know the level of carriage by the different vectors which are the sources of contamination in humans. The study was done by directly detecting the cysts in the cerebral tissue of the 50 sheep killed and destined for consumption. The results of this preliminary study show that 30% of the cases carry the cysts of T. gondii. To confirm this result and verify the virulence, cerebral specimens were inoculated into mice. These findings are encouraging to complete this study with serological tests and to look for the parasite in cows and goats of this region.