[Neuromeningeal hypodermyiasis complicated by hydrocephaly. Value of nuclear magnetic resonance imaging]. / Hypodermose neuroméningée compliquée d'hydrocéphalie. Intérêt de l'imagerie par résonance magnétique nucléaire.

A 9-year old country boy developed blepharitis with inflammation of the face and, 1 month later, eosinophilic meningitis with paralysis of 3 limbs and of an abducent nerve. Nuclear magnetic resonance imaging of the central nervous system disclosed a lesional signal beneath the floor of the 4th ventricle, which was compatible with the presence of a larva of fly. Treatment with thiabendazole was tried, and the clinical signs regressed. Six months later, an asymmetrical hydrocephalus due to obstruction of Monroe's foramen by an inflammatory granuloma was discovered. Human hypodermyasis, due to migration in tissues of larvae of flies, is not rare in cattle-breeding areas. Neuromeningeal disorders are observed in 12% of the cases, consisting of eosinophilic meningitis sometimes associated with neurological deficit or seizures. Such complications as intracerebral haematoma or meningeal haemorrhage may occur during the usually benign course of the disease.

[Value of the immunosorbent agglutination assay (ISAGA) in the early diagnosis of congenital toxoplasmosis]. / Intérêt de la méthode ISAGA dans le diagnostic précoce de la toxoplasmose congénitale.

An IgM immunosorbent agglutination assay (ISAGA) test was evaluated for detection of IgM antibodies in diagnosis of congenital toxoplasma infection, and compared with IgM IFI test. Of 36 sera from infants with congenital infection, the IgM ISAGA test was positive in 19 cases (52%), whereas the IgM IFI test was positive in only 4 cases (11%). Of those sera obtained during the first 90 days of life from the infected infants, 70% were positive in the IgM ISAGA test whereas only 23% in the IgM IFI test. Neonatal sera from 10 infants suspected, but in whom this diagnosis was ruled out, were also evaluated: one false positive was found with the ISAGA test, but without control 15 days later. The ISAGA test is a simple, sensitive and probably highly specific test for diagnosis of congenital toxoplasma infection.

[Praziquantel in the treatment of opisthorchiasis in Southeast Asian refugees. Evaluation of 153 cases]. / Le praziquantel dans le traitement des opisthorchiases chez des réfugiés du Sud-Est asiatique. Bilan de 153 cas.

153 patients coming to France from Southeast Asia were treated with Praziquantel for Opisthorchiasis. All these patients, 52 children and 101 adults were examined 30 to 90 day after arrival in France. They came from Laos (118 cases), Vietnam (10 cases) and Cambodia (25 cases), generally via Thailand. 7 heavy (10.000-29.999 Eggs Per Gram of faeces, EPG), 55 moderate (1.000-9.999 EPG) and 91 light infections (1-999 EPG) were detected. Praziquantel was given at a dose of 25 mg/kg body weight, orally, three times on a single day at intervals of 4-6 hours. Clinical tolerability was perfect in 59 patients and pretty good in the 94 remaining cases. We only observed, for one or two days, lassitude, headache, drowsiness, nausea, epigastric pain or arthralgia-myalgia, always of weak or moderate intensity and for 1 or 2 days. The biological tolerability was excellent without any variation of the biological norm values (47 parameters). The therapeutic efficacy was remarkable with 100% cure in all patients, who were followed-up for 40 days. All earlier controls (7th, 20th days) were always negative except for two patients who were completely negative on day 40th and later.

Parasitological examinations and immunodiagnostic advances in fluke infections.

A reliable diagnosis of fluke infections should be based on the demonstration of parasite eggs in either faeces, duodenal liquid or sputum, depending on the type of infection. Such an examination permits the identification of the species, and counting eggs establishes the intensity of infection. Unfortunately this examination is useful only when intensity is rather high. The diagnosis of slight infections is uncertain and can vary considerably from one sample to another. In this area of parasitological diagnosis no significant progress has been made in the last few years. On the other hand, in serodiagnosis many recent studies have been published. It should be noted that there are cross reactions between various human fluke species and Schistosoma mansoni. The common antigen varies accordingly. There are 4 groups of parasites that are antigenically close: F. hepatica and F. gigantica; Clonorchis sinensis and Opisthorchis viverrini; P. westermani; P. africanus, P. uterobilateralis, P. ecuadoriensis. The cross reactions between these groups are not very intense and forbid the use of heterologous antigens. On the other hand, among the Paragonimus spp., P. westermani is antigenically quite distinct from the others. Antigens extracted from these various species can be purified. The main progress in this area has been made with Fasciola hepatica. Certain authors have suggested the use of excreted-secreted antigens that seem to improve the specificity. For early serodiagnosis, IFI (indirect immunofluorescence) and the ELISA test (enzyme linked immunosorbent assay) are probably the best (positive two weeks after experimental infection of mice with F. hepatica).(ABSTRACT TRUNCATED AT 250 WORDS)

Therapeutic results in opisthorchiasis with praziquantel in a reinfection-free environment in France.

108 patients coming to France from Southeast Asia were treated with praziquantel (2-cyclohexylcarbonyl-1,2,3,6,7,11b-hexahydro-4H-pyrazino[2,1-a] isoquinolin-4-one, EMBAY 8440, Biltricide) for opisthorchiasis. All patients, 31 children and 77 adults, were examined at the Department of Parasitic Diseases 30 to 90 days after arrival in France. They came from Laos (79 cases), Viet Nam (4 cases) and Cambodia (25 cases), generally via Thailand. 6 heavy (10 000-19 999 eggs per gram of faeces, EPG), 23 moderate (1000-9999 EPG) and 79 light infections (1-999 EPG) were detected. Praziquantel was given at a dose of 25 mg/kg body weight, three times on a single day at intervals of 4 h. The biological tolerability was excellent without any variation of the biological norm values (47 parameters). Clinical tolerability was perfect in 48 patients and pretty good in the 60 remaining cases. We only observed, for one or two days, lassitude, headache, drowsiness, nausea, epigastric pain or arthralgia-myalgia always of weak or moderate intensity. The therapeutic efficacy is remarkable with 100% cure in all patients who were followed-up for 90 days. All earlier controls (7th, 20th, 40th days) were always negative except for one child with a light infection still weakly positive at the 7th, 20th and 40th day controls but negative, too, after 90 days.

Fatal septicemia due to amphotericin B-resistant Candida lusitaniae.

Five yeast strains, causally associated with septicemia and death in a patient after peritonitis, were identified as Candida lusitaniae van Uden et do Carmo-Sousa by standard methods. The organism was initially susceptible to 5-fluorocytosine but strongly resistant to amphotericin B, requiring 50 micrograms/ml for complete inhibition at 48 h.

[Praziquantel in the treatment of Far Eastern hepatic distomiasis caused by Clonorchis sinensis or Opisthorchis viverrini]. / Le praziquantel dans le traitement des distomatoses hépatiques extrême-orientales a Clonorchis sinensis ou Opistorchis viverrini.

Forty-six patients infected with Opistorchis viverrini and/or Clonorchis sinensis, 24 males and 22 females, all Laotian or Vietnamese, aged 7 to 68, weighing 18 to 70 kg, were detected by parasitological stool examinations, numeration of Eggs Per Gram of feces (E.P.G.). In this manner we observed 23 light infestations (1-999 E.P.G.), 20 moderate infestations (10,000-29,999 E.P.G.). Before treatment, all these patients were submitted to a complete history and clinical examination with biological controls that totaled up 47 parameters. These controls were repeated daily from the eve of the treatment to 5 days after. The treatment was given orally at the dose of 75 mg/kg of body weight in three doses 4 to 6 hours apart during the same day. The tolerance was excellent in the children who did not have any trouble even minor. The adults had only slight side-effects such as fatigue (18 cases), dizziness (19 cases) and headaches (16 cases). Light or moderate, these troubles spontaneously disappeared after one or at the most two days. Biological controls did not show any significant variation. The therapeutic efficiency appears excellent with 100% cure in 46 patients treated who were controlled daily during the first week, at the 20th and 40th day and for some of them up to seven month after treatment. These results are all the more remarkable since certain patients were severely infected and that of all the far-eastern liver flukes O. viverrini is probable the most resistant to known drugs. Very efficient and very well tolerated, praziquantel offers the advantage of one day treatment in the cure of opistorchiasis and hospitalization is not necessary.

[Study on the tolerability of high doses of praziquantel in Laotians with parasitic liver infections (author's transl)]. / Etude détaillée de la tolérance clinique et biologique à des doses élevées de praziquantel chez des Laotiens atteints d'infections parasitaires hépatiques.

41 patients (20 females and 21 males aged from 8 to 68 years) were prescribed 2-cyclohexylcarbonyl-1,2,3,6,7,11b-hexahydro-4H-pyrazino[2,1-a]isoquinolin-4-one(praziquantel, EMBAY 8440, Biltricide) at a dose of 25 mg/kg body weight given three times on a single day at intervals of 4 h, for the treatment of opisthorchiasis. Clinical as well as biological tolerance was followed up very closely, first during a hospitalization period of 6 days, then on day 20, 40, 90 or more after treatment. None of the biological controls consisting of a total of 47 parameters (haematological, biochemical, urinary) showed any variation from before to after treatment. Clinical examinations, recorded in very carefully prepared case report sheets, served for systematically screening general signs and symptoms (fever, headache, etc.), digestive manifestations or neurological signs. Tolerability was absolutely perfect in 10 patients. In the remaining 31 cases the following signs were observed: lassitude or vertigo (15 times), headache (14 times), drowsiness and nausea (5 times), epigastric pain (9 times), arthralgia-myalgia (3 times), sweating (1 time). All these signs lasted one or two days only and were of weak or moderate intensity, thus allowing the conclusion that even at higher dosages tolerability to praziquantel is excellent.

[Clinical trial of niclofolan (Bay 9015) in the treatment of human opisthorchiasis. Apropos of 51 cases]. / Essais de traitement des opistorchiases humaines par le niclofolan (Bay 9015). A propos de 51 cas.

51 refugees from South east Asia infected with Opisthorchis viverrini or Clonorchis sinensis were included in a therapeutic study with Niclofolan (Bay 9015) at a dose of 1 mg/kg body weight given three times at intervals of 48 hours. Clinical and biological tolerance was carefully controlled and in all cases proved to be very good or excellent particularly in several patients with various haemoglobinopathies or erythrocytal enzymopathies (G-6-PD deficiency). Of the total of 51 cases, 17 were cured. These comprised mainly those with light or moderate infections (less than 10,000 eggs/gram stool). Treatment was, however, not effective in the more severe infections, even when repeated after an interval of 30 days. Between day 30 and 60 after treatment, only a transitory reduction of eggs/gram stool was observed, these values increasing again after day 90. Niclofolan did not reveal to be the ideal treatment of opisthorchiasis. Nevertheless its excellent tolerance should be pointed out which justifies its tentative application in light infections and above all its use in the treatment of paragonimiasis against which it appears to be one of the best drugs available at present.

[Cryptococcosis: serodiagnosis by immunoenzymology (ELISA) (author's transl)]. / Cryptococcose: séro-diagnostic par immuno-enzymologie (ELISA).

For the first time ELISA test was applied for the human cryptococcosis serodiagnosis. We have used the somatic and metabolic antigene extracted from culture of Cryptococcus neoformans. It seems that metabolic antigenosis more specific and more actif. For two cryptococcosis conformated cases (9 sera), ELISA test was always and intensely positive and, in one case after curative treatment, we have seen an importante antibodies decrease. If this first results were confirmated, the ELISA test should give some new perspectives for the sero diagnosis of the cryptococcosis and for the survey of the treatment, that was until now in practice unrealizable.

[Hemoglobin abnormalities and glucose 6 phosphate dehydrogenase deficiency (G6PD) in 101 refugees from southeast Asia]. / Anomalies de l'hémoglobine et déficit en glucose 6 phosphate déshydrogénase (G6PD) chez 101 réfugiés du sud-est asiatique.

Hematological studies were performed systematically in 101 refugees from South-Eastern Asia living in the Grenoble area at the present time. We found: --4 haemoglobin E homozygosity, --29 haemoglobin E heterozygosity, --2 beta-thalassemia heterozygosity, --4 alpha-thalassemia heterozygosity, --14 glucose 6 phosphate dehydrogenase deficiencies.

[Report of two cases of acute or cerebral malaria with atypic on-set (author's transl)]. / Deux cas de paludisme aigu ou accés pernicieux de paludisme á dèbut atypique.

Report and comments on one case of cerebral malaria with myocardial infarction, icterus and renal insufficiency, and of another one with a black-water-like syndrome with complete recovery under quinine treatment.

[Epidemic of autochthonous hepatic and intestinal amebiasis in a place near Grenoble]. / Epidémie d'amibiase autochtone hépatique et intestinale dans une localité proche de Grenoble

We had the opportunity of studying an epidemic of autochthonous amoebiasis occurring in the autumn of 1974 in a small town of 4000 inhabitants 30 km from Grenoble. Attention was originally attracted by the occurrence in this town of two cases of hepatic amoebiasis and one of intestinal amoebiasis identified by rectoscopy. Systematic investigations (coproctic examinations and serological tests for amoebiasis by indirect antibody fluorescence) were then carried out on everyone in the locality with digestive disorders which were possibly referable to amoebiasis, and on the other members of their families. A total number of 148 coproctic examinations were made and in two cases revealed the presence of vegetative forms of Entamoeba histolytica. In both cases the infestation provoked few symptoms (asthenia, vague abdominal discomfort, intermittent and apparently banal diarrhoea). On the other hand 20 out of 94 serological tests revealed positive results, 14 of which were equal to or greater than a titre of 1/100, a level at which all risks of non-specificity are virtually ruled out under our experimental conditions. Material reasons made it impossible to subject these cases to repeated faecal checks, but in two of them at least the rectoscopic appearances were very suggestive of subacute intestinal amoebiasis. Moreover, amoebic disease appears to be well confirmed by the results obtained among the patients as a whole by treatment with Metroinidazole. A variety of hypotheses on the origin of this epidemic have been put forward and then abandoned (market garden produce, receipt by certain families of exotic frut from overseas). In actual fact water seems to be the point of departure, for, although specimens of water taken at 7 different levels in the water supply system failed to reveal the presence of a single amoeba, bacteriological analyses during autumn 1974 showed signs of faecal contamination. The locality, which is situated at the foot of the Chartreuse massif, receives its water solely from springs but there is a holiday camp for the staff of an international airline situated above the main water catchment.