[Chagas disease (American trypanosomiasis) in France]. / La maladie de Chagas (ou trypanosomose américaine) en France.

Chagas disease is an anthropozoonotic infection caused by Trypanosoma cruzi, transmitted by a hematophagous triatomine insect vector belonging to the Reduviidae family, while taking a blood meal. There is a large reservoir of wild and domestic mammals. Human contamination may come via vectorial, transplacental, and digestive routes, blood transfusion, organ or tissue transplantation, and by accident. The disease has two phases. The acute phase, oligosymptomatic, is frequently undiagnosed. It is followed by a chronic phase. Most of the infected patients remain asymptomatic all life-long. But 10 or 25 years later, one third of infected patients present with cardiac or digestive complications. Chagas disease is endemic in Latin America, from Mexico to Argentina. In French Guyana, the prevalence of the infection was estimated at 0.25% and 0.5% (from 500 to 1000 infected patients) on blood samples collected from 1992 to 1998. In 2000 and 2009, 192 cases were diagnosed. In this district, there is no established domestic vector and the transmission risk is low. The vector is very easily found in forest habitats and even in the peridomestic persistent forest, with an infection rate of 46 to 86%. Vectorial eradication is impossible. Fighting against Chagas disease in French Guyana relies more on individual protection, control of blood transfusion, prevention of mother-to-child transmission, diagnosis, and treatment of infected patients than on vectorial control.

[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.

[Chagas disease in France: estimated number of infected persons and cardiac diseases in 2009, by risk groups]. / Maladie de Chagas en France: estimation du nombre de personnes infectées et d'atteintes cardiaques en 2009, selon les groupes & risque.

An estimation of the number of Trypanosoma cruzi infected individuals and expected number of Chagasic cardiomyopathies in France (excluding French Guyana) was conducted in June, 2009 by InVS. Different risk groups were identified: Latino-Americans (LA) from endemic area (naturalized, legal and illegal migrants, adopted children), children born from LA's mother, French Guyanese living in Metropolitan France, expatriated and travellers from endemic countries. Prevalence rates by country of origin were applied to official data on risk populations obtained from the International Adoption Agency, Tourism Direction and French ministries (Finances, Foreign Affairs and Migrations). Around 157,000 individuals were potentially exposed. It is estimated than 1,464 [895-2,619] are infected by T. cruzi, of which 63 to 555 may evolve towards a chronic cardiomyopathy. This figure is within the range of earlier estimations of InVS and Guerri-Guttenberg. Taking into account illegal immigrants, the expected number of infected individuals in France should increase greatly this estimation.

Expression of ActA, Ami, InlB, and listeriolysin O in Listeria monocytogenes of human and food origin.

Expression of proteins involved in the adhesion of Listeria monocytogenes to mammalian cells or in the intracellular life cycle of this bacterium, including listeriolysin O (LLO), ActA, Ami, and InlB, was used to compare two populations of L. monocytogenes strains. One of the populations comprised 300 clinical strains, and the other comprised 150 food strains. All strains expressed LLO, InlB, and ActA. No polymorphism was observed for LLO and InlB. Ami was detected in 283 of 300 human strains and in 149 of 150 food strains. The strains in which Ami was not detected were serovar 4b strains. Based on the molecular weights of the proteins detected, the strains were divided into two groups with Ami (groups Ami1 [75% of the strains] and Ami2 [21%]) and into four groups with ActA (groups ActA1 [52% of the strains], ActA2 [18%], ActA3 [30%], and ActA4 [one strain isolated from food]). Logistic regression showed that food strains were more likely to belong to group ActA3 than human strains (odds ratio [OR] = 2.90; P = 1 x 10(-4)). Of the strains isolated from patients with non-pregnancy-related cases of listeriosis, bacteremia was predominantly associated with group Ami1 strains (OR = 1.89; P = 1 x 10(-2)) and central nervous system infections were associated with group ActA2 strains (OR = 3.04; P = 1 x 10(-3)) and group ActA3 strains (OR = 3.91; P = 1 x 10(-3)).

Human papillomavirus testing in women with mild cytologic atypia.

OBJECTIVE: To evaluate the efficiency of human papillomavirus (HPV) testing by Hybrid Capture II (Digene Diagnostics Inc., Silver Spring, MD) with regard to detecting biopsy-confirmed cervical intraepithelial neoplasia (CIN) or high-grade CIN in women with mild atypia, compared with the efficiencies of polymerase chain reaction (PCR), Southern blot hybridization, and cytology. METHODS: We prospectively studied 378 women with atypical squamous cells of undetermined significance (ASCUS) (n = 111) or low-grade squamous intraepithelial lesions (SILs) (n = 267) demonstrated by referral cytology. We did repeat cytology, sampling for detection of HPV DNA by Hybrid Capture II, PCR, and Southern blot hybridization, and colposcopic evaluation with cervical biopsies. RESULTS: All participants underwent the Hybrid Capture II test and 320 underwent the three HPV tests. Sensitivities of Hybrid Capture II for detecting CIN and high-grade CIN (0.81 and 0.86, respectively) were similar to those of cytology (0.83 and 0.82, respectively) and PCR (0.77 and 0.95, respectively), and higher than those of Southern blot hybridization (0.48 and 0.45, respectively). Compared with cytology, combined triage with Hybrid Capture II improved sensitivities for detecting CIN (0.94 versus 0.83, P <.001) and high-grade CIN (0.96 versus 0.85), though the latter difference was not significant (P =.17). In women with ASCUS, sensitivities of combined triage and cytology for detecting CIN were 0.94 and 0.71, respectively (P =.01), and sensitivities of the two methods for detecting high-grade CIN were 0.92 and 0.66, respectively (P =.13). The increase in sensitivity was lower among women with low-grade SILs; for these women, cytology had high sensitivity (0.86 for CIN and 1.00 for high-grade CIN). The specificity of combined triage was significantly lower than that of cytology in both groups. CONCLUSION: Compared with repeat cytology, combined triage with HPV testing markedly improves sensitivity for detecting CIN in women with ASCUS, but at the expense of specificity.

Evidence for high genetic diversity and long-term endemicity of hepatitis C virus genotypes 1 and 2 in West Africa.

During 1994 and 1995, the prevalence of hepatitis C virus (HCV) and its genotypes were studied in several rural and urban populations in three West African countries: Guinea, Burkina Faso, and Benin. The following groups were screened for antibodies to HCV (anti-HCV): 459 villagers in the forest region of Guinea; 965 individuals in urban, suburban, and rural populations of the Bobo Dioulasso area, Burkina Faso; and 582 blood donors in Cotonou, Benin. In Benin, 60 patients with sickle cell anemia (30 with and 30 without history of multiple transfusion) and 13 hospital patients with liver disease were also tested. RT-PCR detection of HCV-RNA was carried out on all anti-HCV positive samples, followed by genotyping and sequencing of unrecognized subtypes. The prevalence rates of anti-HCV were 1.1% in the Guinean population group, 1.4% among blood donors in Benin, and 4.9% in residents of Burkina Faso. In patients with sickle cell anemia, five of the 30 polytranfused patients (17%) had anti-HCV, whereas none of the patients without a history of blood transfusion had anti-HCV (P < 0.05). Among the 13 patients with liver disease, five had anti-HCV, of whom four had history of blood transfusion. HCV-RNA was detected in 41 anti-HCV positive sera. All belonged to genotypes 1 or 2, with a high genomic diversity; 18 different subtypes were identified, including 2c, 2d, and 16 new subtypes. Such genetic diversity poses a challenge for vaccine development and also implies that HCV infection is long-established in these West African regions.

Lack of behavioural risk factors for squamous intraepithelial lesions (SIL) in HIV-infected women.

HIV-infected women have a high prevalence of abnormal Papanicolaou smears and cervical intraepithelial neoplasia. A multiparametric analysis of epidemiological and behavioural risk factors has been performed in a cohort of 204 HIV-infected women in an outpatient clinic with the aim to investigate risk factors associated with squamous intraepithelial lesions (SIL) in HIV-seropositive women. The prevalence of SIL in the study population was 35.7%. Univariate and multivariate analysis of demographic, behavioural and immunological variables only identified cigarette smoking > 20/day and CD4+ cell counts < or = 200 x 10(6)/L as risk factors significantly associated with SIL in the study population. We found no epidemiological/behavioural risk factors specifically associated with SIL in HIV-infected women as compared with the general population. The results suggest that the high prevalence of SIL in HIV disease is related to acquired immune deficiency in HIV-seropositive women.

Characterization of HIV-related periodontitis in AIDS patients: HIV-infected macrophage exudate in gingival crevicular fluid as a hallmark of distinctive etiology.

In an attempt to clarify the immunobiological events featuring periodontitis lesions of AIDS patients in the late stage of the disease, peripheral blood (PB) and gingival crevicular fluid (GCF) leucocytes from periodontitis lesions of 23 late-stage AIDS patients were analysed by three-colour flow cytometry for detection and identification of intracytoplasmic p24+ cell fractions. The cells were reacted with CD14 and CD68 for mononuclear phagocytes or with CD4 and CD14 for Th cells, then with anti-p24 MoAb. To detect HIV proviral sequences and intracellular p24 RNA sequences, genomic DNA and cellular RNA from leucocytes were extracted for semi-nested polymerase chain reaction (PCR) amplification. CD68+/p24+ and CD14+/CD68+/p24+ fractions were larger in GCF than in PB (P<0.0001; P < 0.003). CD14+/p24+ fraction was lower in GCF than in PB (P < 0.05). The fluorescence intensities (FI) for intracellular p24 in CD68+ and CD14+/CD68+ cells were higher in GCF than in PB (P < 0.003; P < 0.02), whereas those of CD14+ macrophages did not differ. The p24 FI of CD68+ macrophages in GCF correlated with CD4+ lymphocyte counts in PB (P < 0.005). p24 FI levels of CD14+ monocytes in GCF and PB significantly correlated (P < 0.02), whereas that of CD68+ macrophages did not. PCR and reverse transcriptase (RT)-PCR of cellular DNA and RNA yielded positive signals, demonstrating viral integration and production in GCF leucocytes. These results show that periodontitis lesions in AIDS patients can be characterized by a rapid macrophage turnover, and these HIV-infected macrophage exudates in GCF may be considered as a within-mouth source of virus.

Apport de l'ELISA et du Test Immunoblot deuxieme generation dans le diagnostic des hepatopathies virales C : a propos de 13 cas colliges au C.N.H.U. de Cotonou

Treize patients presentant une hepathopathie ont ete soumis au depistage des marqueurs seriques du virus de l'hepatite C (VHC) par la methode ELISA suivie de la confirmation par un test immunoblot de deuxieme generation. Cinq patients sur les treize etaient porteurs d'anticorps specifiques anti-VHC. Ce resultat preliminaire suggere que le VHC jouerait un role non negligeable dans le developpement des hepatopathies au Benin

HCV infection in a rural population of the Central African Republic (CAR): evidence for three additional subtypes of genotype 4.

The prevalence of hepatitis C virus (HCV) antibodies, HCV infection, and genotypes was studied in a rural population of the Central African Republic. In five villages, blood samples were taken from all the inhabitants present during the survey, belonging to Pygmies (299) and to Bantu and Banda ethnic groups (247). Using a second-generation ELISA screening and confirmation by immunoblot assay for the detection of HCV antibodies, all the Pygmies were negative, whereas seven Bantus/Bandas, aged > 35 years and with no familial relationship, were positive, giving a prevalence of 2.8% in this ethnic group. Five samples were also PCR positive; all belonged to genotype 4, but with three new subtypes identified by phylogenic analysis. These results indicate the co-existence of different HCV subtypes and raise questions about the natural transmission of HCV in this secluded population.

Papanicolaou smears in human immunodeficiency virus-seropositive women during follow-up.

OBJECTIVE: To assess the outcome of cervical squamous intraepithelial lesions (SIL) in human immunodeficiency virus (HIV)-seropositive women. METHODS: Papanicolaou smears were followed-up prospectively in a group of 60 HIV-positive women every 6 months for 18 months. RESULTS: The cumulative incidence of SIL at 18 months was 9% in 27 women who presented with normal Papanicolaou smears at entry. In 33 women who initially presented with SIL, the rate of persistence of cervical lesions was 95% (18 of 19) in untreated patients and 61% (eight of 13) in women who underwent surgery. In women with low-grade SIL, the persistence or progression of cervical lesions was observed in 92% of the cases (12 of 13). No invasive cancer was observed during the 18 months of the study period. CONCLUSION: Although the long-term outcome of SIL in this population remains unknown, our results emphasize the high rate of persistence of SIL and the relative inefficiency of conventional treatment in HIV-infected women. These findings contrast with the natural history of SIL in immunocompetent women.

Environmental and dietary risk factors for nasopharyngeal carcinoma: a case-control study in Zangwu County, Guangxi, China.

A case-control study was conducted on 88 incident cases of histologically confirmed undifferentiated nasopharyngeal carcinoma (NPC) in Zangwu County, China, and 176 age- sex- and neighbourhood-matched controls. The design of this study was defined after an anthropological survey on living habits in regions of high NPC incidence and the evidence of carcinogenic substances in some commonly consumed preserved foods. Subjects were interviewed regarding living conditions and diet in the year preceding the diagnosis of NPC and, with the help of their families, during childhood and weaning. After adjustment for a living conditions score to eliminate a confounding effect, an increased risk associated with consumption of salted fish during weaning and childhood was confirmed, especially for salted fish in rice porridge. The consumption of leafy vegetables was associated with a reduced risk for NPC, and consumption of melon seeds between 2 and 10 years of age with an increased risk. After multivariate analysis and adjustment according to the living conditions score, the consumption of salted fish in rice porridge before age 2 (OR = 3.8, P = 0.005), exposure to domestic woodfire (OR = 5.4, P = 0.01) and consumption of herbal tea (OR = 4.2, P = 0.02) were found to be independently related to the risk of NPC. The excess risk associated with the use of domestic wood fire increased if there were no windows in the house and with poor ventilation and cooking outside the house in a shack. As well as confirming the importance of the consumption of salted fish in childhood, this study has been the first to provide unequivocal evidence for two other factors implicated in increasing the risk of NPC in China, the adult consumption of traditional medicines (herbal tea) and exposure to domestic wood fumes.

The risk of tropical spastic paraparesis differs according to ethnic group among HTLV-I carriers in Inongo, Zaire.

Following the finding in 1990 of six HTLV-I-positive cases of tropical spastic paraparesis (TSP/HAM) is a field survey carried out in the city of Inongo (Bandundu, Zaire), the prevalence of HTLV-I infection has been studied by detection of specific antibodies on a randomized sample of the general population. Among the 1,162 subjects surveyed, 36 (3.1%) were found to be HTLV-I seropositive, giving a seroprevalence of 3.2% (CI: 2.1, 4.3) estimated by direct standardization on age and sex distribution given by the census in the city. Among the five major ethnic groups, the Bolia showed the highest prevalence rate (6.5%) but with no detected TSP/HAM cases, while all six TSP/HAM cases were found among the Ntomba, who showed a prevalence rate of only 2.2%. This finding suggests that besides HTLV-I infection, critical environmental and/or genetic cofactors play a part in the development of TSP/HAM.

Introduction of HIV-1 in a rural city of Zaire.

In the rural city of Inongo (Bandundu region, Zaire), the prevalence of HIV-1 infection has been investigated during a survey on HTLV-I infection and associated neurological diseases, using a cluster sampling technique. Thirteen individuals were infected by HIV-1, 11 adults and 2 children, giving a crude prevalence rate in the cluster sample of 1.1%. More women were infected than men. After direct standardization on the age and sex structure given by the 1984 census, the prevalence of HIV-1 in the city may be estimated at 1.0% for the whole population and 1.6% for the population above 15 years of age. The importance is stressed of protecting rural populations, particularly women of childbearing age from the HIV epidemic, by information campaigns focused on the male migrant population, including both seasonal and travelling workers.

Increased risk of nasopharyngeal carcinoma among males of French origin born in Maghreb (north Africa).

A study on the incidence of nasopharyngeal carcinoma (NPC) has been performed in the Provence-Alpes-Côte d'Azur (PACA) region, South of France, where Maghrebian migrants represent 10% of the population. During the years 1986-1990, 76 cases of NPC were diagnosed, of which 44 were French by birth, 25 were Maghrebian migrants and 7 were other migrants. We found that 36% of the French patients were either born in endemic areas or had lived there for more than 15 years. Standardized annual incidence rates of NPC among Maghrebian migrants remained close to those observed in North Africa, while, standardized annual incidence rates for French by birth in the PACA region were similar to those observed in cancer registries in other regions of France and countries of low incidence. However, for males of French origin born in Maghrebian countries, the incidence of NPC (all cases being of undifferentiated type) was 5.7 times higher than that of males of French origin born in France (p = 0.00001). These results favor a critical role of environmental factors in the risk of NPC.