[Imported malaria in Moselle: 75 cases in three years]. / Paludisme d'importation en Moselle: à propos de 75 cas en trois ans.

PURPOSE: Imported malaria frequency is increasing in France. Moselle, a north-east French county, with high concentration of servicemen going in endemic areas, follows the same trend. METHODS: Clinical, epidemiological aspects and treatment of all malaria attacks diagnosed over 3 years (from 1st january 1996 to 31st january 1999) were studied. Data pertaining to antimalaria prophylaxis and the reasons for prophylaxis failure were analyzed. RESULTS: Seventy-five patients developed a paroxysmal episode of malaria. No severe malaria and no death were noted. Ninety-six percent of the patients came from Africa (96%), 64% of them coming from western Africa (Ivory coast, Senegal, and Togo). Plasmodium falciparum was responsible for 90% of the cases. Giemsa staining, quantitative buffy coat diagnosis system and parasight rapid dipstick antigen capture assay help guide diagnosis. Halofantrine (64%) and quinine (28.6%) were used as curative treatment. Investigation about prophylactic means showed than 37.9% of interviewed patients did not comply with the preventive treatment. The primary prophylaxis (avoiding bites) was in existent or badly done. CONCLUSION: Although the best choice for chemoprophylaxis is still debated, travelers going to endemic areas should be aware of the risks for malaria and persuaded to take a preventive treatment, even though its efficacy may not be complete. They also should wear insecticide-treated clothes in order to decrease the number of potentially infective mosquito bites.

[Djibouti, history of 2 epidemics of cholera: 1993-1994]. / Djibouti, histoire de deux épidémies de choléra: 1993-1994.

When two cholera epidemics broke out in Djibouti, respectively in 1993 and 1994, Bioforce was obliged to intervene. The first time, three goals were pursued: setting up a rehydration centre in a tent, organizing epidemiological surveillance and training local personnel in treatment and diagnosis techniques. The next year, the epidemic followed serious flooding. The epidemiological analysis showed that cholera had become endemic in the poor neighbourhoods of the town and that epidemic break-outs were favoured by contaminated surface water and disturbances in the distribution of drinking water. The epidemic of 1997, likewise following flooding, only confirmed this point of view.

Activity of two doses of rifampin against Mycobacterium leprae.

In the course of a clinical trial designed to re-examine the bactericidal efficiency of 600-mg doses of rifampin (RMP) against Mycobacterium leprae, two doses of RMP, either 600 mg or 1200 mg, were administered 28 days apart to 29 previously untreated patients with lepromatous or borderline leprosy. Seven, 28, and 35 days after the start of the trial, skin biopsies were performed and immunologically normal mice were inoculated with 5 x 10(3) or 10(4) M. leprae in each hind foot pad. The patients assigned to the two regimens did not differ significantly in terms of sex, age, disease classification, bacterial index, or the concentration of M. leprae in the skin lesion biopsied for the inoculation of mice. The concentrations of organisms in the skin-biopsy specimens did not change significantly over the course of the trial among the patients, whether they were being treated by the first or the second regimen. The M. leprae recovered from specimens obtained from 21 of the patients, before beginning treatment, multiplied in a majority of the mice inoculated. The results of mouse inoculation confirmed the rapid bactericidal effects of RMP against M. leprae: a single dose of RMP rendered the organisms obtained from all but two of the patients incapable of multiplying in mice. No significant difference was demonstrated between the two regimens, nor was an additional effect of the second dose of RMP observed.

Short-term trial of clofazimine in previously untreated lepromatous leprosy.

Forty-five previously untreated lepromatous leprosy patients were allocated randomly to three groups and treated, respectively, with Regimen A, standard dosage of clofazimine (CLO) in multidrug therapy (MDT) regimen; Regimen B, CLO 600 mg once every 4 weeks; and Regimen C, CLO 1200 mg once every 4 weeks. The duration of the trial was 24 weeks. By the end of the trial, although a few patients in each group did not improve at all clinically, the majority of patients showed clinical amelioration but the responses were slow. While the mean morphological index dropped to the baseline after 24 weeks of treatment, the mean bacterial index did not change significantly. About 80% of the patients in each group remained nasal-smear positive at the end of the trial, but the bacterial loads steadily declined. No significant difference has been detected in these parameters among the three groups. The patients tolerated the regimens very well and the side effects were mild. The results of serial mouse foot pad inoculation demonstrated that the positivity rates of multiplication of Mycobacterium leprae in mice and the proportions of viable organisms reduced gradually in all groups. Because the positivity rate at week 24 in Group C did not differ significantly from Group A, but was significantly smaller than that of Group B, we conclude that Regimen C was as active as Regimen A and could be applied for monthly supervised treatment along with rifampin; Regimen B is less effective and should not be used for the treatment of leprosy.

Evaluation of five treatment regimens, using either dapsone monotherapy or several doses of rifampicin in the treatment of paucibacillary leprosy.

The objective of the present study was to define short-course treatment regimens for PB leprosy and to compare them with the 'classical' dapsone treatment and the WHO-PB regimen. Five treatment regimens were studied and evaluated by the histologic evolution. The regimens were: (1) dapsone 100 mg daily, non-supervised for 3 years; (2) RMP 900 mg supervised, once weekly, 8 doses; (3) idem 12 doses; (4) RMP 600 mg, once monthly, supervised, 6 doses and during this treatment dapsone 100 mg daily unsupervised; (5) RMP 600 mg together with dapsone 100 mg daily, supervised for 6 days. For each of these regimens there were between 114 and 195 person-years of follow-up. Results are comparable for the 5 treatment regimens, and reach 65-75% cure rates at 36 months and 80-90% at 48 months after the start of therapy. The relapse rate for all groups is about 0.5% per year. The difficulty for the diagnosis of relapse in PB leprosy is discussed. It is concluded that treatment of PB leprosy can be relatively simple but that a relatively long time is needed to evaluate its effect.

The incubation time of relapses after treatment of multibacillary leprosy with rifampicin containing regimens.

In order to determine the duration of follow-up needed to evaluate the efficacy of short-course bactericidal regimens for multibacillary leprosy, information is needed on the incubation time of relapses after stopping treatment. Several groups of patients, who had been on rifampicin-containing regimens, were followed up for periods ranging from 4 to 10 years. Two groups of relapses were observed: early relapses occurring within 3.5 years after stopping treatment, with a median incubation time of 1 year and 10 months (upper limit of 95% confidence interval: 2 years); and late relapses occurring more than 3.5 years after stopping treatment, with a median incubation of 5 years. Early relapses are probably due to insufficient treatment, and late relapses to persisting bacilli or to reinfection. It is concluded that the efficacy of short-course RMP-containing therapeutic regimens can be evaluated by observing the occurrence of early relapses, 50% of which occur before 2 years after the end of therapy.

[Evaluation of endemic leprosy in an urban zone--sampling survey at the household level: results at Bamako, Republic of Mali]. / Evaluation de l'endémie lépreuse en zone urbaine--enquête par sondage au niveau des ménages: résultats à Bamako, République du Mali.

A sample survey on households was conducted in Bamako (capital of the Republic of Mali) in order to estimate epidemiological and logistical indexes relating to Hansen's disease. With a prevalence rate reaching 7.37 +/- 1.83 per thousand, a detection rate reaching 0.91 +/- 0.49 per thousand the city is a high level endemic area. All observed parameters (age, sex, racial, hygiene status, geographic distribution) seem to have no influence on disease aspect. The majority of the patients (80%) are treated by monotherapy with Dapsone, generally for excessive duration. The sociocultural impact of the Hansen's disease is very important, the physical and sensorial handicaps are frequent (34%). The survey's results could be used in order to elaborate a strategy for leprosy control based on multi-drug therapy in urban areas.

[Suspicion of paucibacillary leprosy resistant to dapsone: importance of follow-up]. / Suspicion de lèpre paucibacillaire résistante à la dapsone: importance du suivi.

Behind the story of one paucibacillary patient treated by dapsone monotherapy, the authors discussed on the possibility of relapse. But the therapy course, observed by DDS/Urine examination shows a default of the patient. The problems of follow up and attendance of the patient are discussed.

[Efficacy of combined treatments comprising 6 months' administration of rifampicin in multibacillary leprosy]. / Efficacité de traitements combinés comportant six mois d'administration de rifampicine dans la lèpre multibacillaire.

Ten patients infected with mouse proven DDS-resistant bacilli were treated with the following combined regimen: RMP 600 2/7 6 months, ETH 500 7/7 6 months and DDS 100 7/7 12 months. Follow up was for 27-54 months, without relapses. Added to patients from previous study (Int. J. Lepr. 1984, 52, 297-303) the 95% confidence limit decreases from 12 to 9%.

[Comparison of 3 therapeutic regimens in paucibacillary leprosy. Preliminary note]. / Comparaison de trois régimes thérapeutiques dans la lèpre paucibacillaire. Note préliminaire.

Between 1980 et 1983 all PB patients presenting at the Institut Marchoux, Bamako, took part in a prospective randomized therapeutic trial and were allocated to one of the following regimens: DDS 100 mg 7/7 3 years, RMP 900 mg 1/7 8 doses, RMP 900 mg 7/7 12 doses. At this moment 24, 29 and 22 patients respectively have been followed for periods of 24 to 56 months. With the exception of some irregular drug intake in the DDS patients followed either by relapse or delay in improvement, the efficacity as judged by histopathological examinations did not reveal any difference between the regimens. The study continues.

[Principle findings connected with the problems of implementing the multi-drug therapy for leprosy in West Africa]. / Principales données sur les problèmes de la mise en pratique de la polychimiothérapie de la lèpre en Afrique de l'Ouest.

The Implementation of Multidrug Therapy (MDT) in the states of West Africa oblige to analyse new restraints, in order to modify the existing health structures. The planning of Hansen's programs based on MDT needs to consider the technical and logistic parameters. Solutions are proposed for health workers training course, flow chart, drug supply system and supervision system. The advocated method uses at the existing resources, and aims at the integration into general health services, reinforced by specialized teams.

[Inadequate treatment in multibacillary leprosy and incubation times for relapses]. / Traitements insuffisants dans la lèpre multibacillaire et temps d'incubation des rechutes.

Among a population of over 500 PB patients treated with different regimens, 6 multibacillary relapses were detected: 5 in patients erroneously classified as PB but in reality MB with a low bacterial load, one patient was PB at the start. Treatment regimens had been: 10 weekly doses of RMP either 600 mg (1 case) or 900 mg (1 case) two successive doses of RMP 1500 mg (1 case) a single dose of RMP 40 mg/K (3 cases). Four MB patients with proven DDS-R relapsed after a single dose of RMP either 20 mg/K (1 case) or 40 mg/K (3 cases). The two strains isolated were RMP sensitive. Seven of the 10 relapses appeared within 24 months after start of treatment.

[Histological progression of paucibacillary leprosy during treatment with various therapeutic regimens]. / Evolution histologique de la lèpre paucibacillaire au cours du traitement par divers régimes thérapeutiques.

Histopathological examination of skin biopsies from PB patients during the first 12-18 months of treatment did not reveal any significant difference in the time necessary for disappearance of the lesions. The regimens studied were: DDS 100 mg 7/7, RMP 600 mg 1/30 6x, RMP 600 mg 6/6 6x, RMP 900 mg 1/7 8x and 12x, RMP 1500 mg 1x and 1 year of DDS, RMP 4 mg/K 1x.

[Necrotic course of erythema nodosum leprosum]. / Erythema nodosum leprosum à évolution nécrotique.

During 2 years, 25 lepromatous patients were hospitalised in the Hansen complications room of Institut Marchoux. Between these patients, 9 developed a Necrotic Erythema Nodosum Leprosum. A review of the observed clinic effects is established and 3 types of signs are isolated and discussed: necrotic extension after big nodes on chest and arms, a punch crater complicating small nodes, and a sclerous xylodermia on arms and legs. The course of this complication is estimated about six months average, with pauses and relapses with general and subjectives symptoms. The final course shows side effects: anemia, denutrition, functional disabilities of joint movements and cutaneous straps. In the group of 9 patients, 3 died. We did not find relations between the necrotic phenomenon and therapy or occurred diseases. The best drug to stop the necrotic processus is thalidomide 400 mg daily and decrease 100 mg when the signs fall near normality. One or two mg/kg each day coricosteroides were tested: the effect is unconstant, the duration of action is shorter. Side effects occur rapidly and patient will become corticosteroïd dependent. The importance of bath with disinfectants is high. We did not observed surinfection.

[Integration of leprosy polychemotherapy into general health services]. / Intégration de la polychimiothérapie anti-hansénienne dans les structures collectives de santé.

The actual control of leprosy must conciliate difficulties of multidrug therapy (MDT) application and integration of general health services. The getting up of multidrug therapy needs a logistic with clinical and bacteriological track off, patient categorisation, supervision of treatment, follow up of the drug compliance and control of the disease evolution. The management of such system must be perfectly mastered in order to avoid the uncontroled circulation of rifampicine. Solutions are proposed in order to increase specialized teams efficiency and integration of non specialized officers incumbent tasks.