Polluter identification with spaceborne radar imagery, AIS and forward drift modeling.

This study defines and assesses a new operational concept to identify the origin of pollution at sea, based on Synthetic Aperture Radar, Automatic Identification System, and a forward drift model. As opposed to traditional methodologies where the SAR detected pollution is backtracked in the past, our approach assumes that all the vessels pollute all along their way. Based on all the AIS data flows, the forward-tracked simulated pollutions are then compared to the detected pollution, and the potential polluter can be finally identified. Case studies are presented to showcase its usefulness in a variety of maritime situations with a focus on orphan pollutions in a dense traffic area. Out of the identification of the suspected polluters, the age and eventually the type of the pollution can be retrieved.

[Evaluation of two automated methods for blood lactate levels]. / Evaluation de deux méthodes de dosage de la concentration sanguine de lactate.

We evaluated two automated methods for measuring blood levels of lactates with Integra 800 (Roche Diagnostics) and ABL 725 (Radiometer). Our evaluation had shown a within run imprecision of 1% (Intégra 800) and 2% (ABL 725) and a between-assay imprecision of 2% (Intégra 800) and 5% (ABL 725). The two methodologies appeared very well associated. The selective electrode remains expensive but it is very interesting because it saves a blood sample.

[Congenital malaria as a result of Plasmodium malariae in an infant born to a HIV-seropositive woman]. / Paludisme congénital à Plasmodium malariae chez un nouveau-né de mère séropostive pour le VIH.

Congenital malaria is uncommon in France. The purpose of this report is to describe a case involving a six-week-old infant who was hospitalized with fever, hepatosplenomegaly, anemia and thrombopenia. Thick and thin blood smears were positive for Plasmodium malariae. The infant responded favorably to chloroquine. Based on this experience, we performed a search of the literature to find case reports on congenital malaria in France and compare clinical and epidemiologic data with series reported in the United States and from endemic areas. The placenta appears to provide an effective barrier against Plasmodium since infection is much more common than disease. The delay for onset of clinical symptoms is longer in temperate zones than in endemic areas. The type of parasite could account for this difference since African congenital malaria are due to Plasmodium falciparum while most cases described in the United States are due to Plasmodium vivax. We also discuss the possible implications of coinfection by HIV in the mother.

Immunocapture diagnostic assays for malaria using Plasmodium lactate dehydrogenase (pLDH).

We have developed two diagnostic assays based on the specific detection of Plasmodium lactate dehydrogenase (pLDH) activity. These assays exploit a panel of monoclonal antibodies that capture the parasite enzyme and allow for the quantitation and speciation of human malaria infections. An immunocapture pLDH activity assay (ICpLDH) allows for the rapid purification and measurement of pLDH from infected blood using the NAD analog APAD, which reacts specifically with Plasmodium LDH isoforms. An immunochromatographic test (the OptiMAL assay) was also formatted and allowed the detection of parasite infections of approximately 200 parasites/microl of blood. By using a combination of antibodies, both tests can not only detect but differentiate between P. falciparum and non-P. falciparum malaria. Both assays show a sensitivity comparable with other commercial nonmicroscopic tests; importantly, we found very few instances of false-positive samples, especially with samples from patients recently cleared of malaria infection. Furthermore, we find that when one uses the quantitative ICpLDH assay, the levels of pLDH activity closely mirror the levels of parasitemia in both initial diagnosis and while following patient therapy. We conclude that diagnostic tests based on the detection of pLDH are both sensitive and practical for the detection, speciation, and quantitation of all human Plasmodium infections and can also be used to indicate drug-resistant infections.

Systematic review of amodiaquine treatment in uncomplicated malaria.

BACKGROUND: Opinion and policy over the use of amodiaquine for treating malaria vary. Amodiaquine is more palatable than chloroquine and may be more effective but serious adverse events have been reported in travellers taking it as prophylaxis. It is not recommended as first-line treatment. In the light of the global debate over the use of this drug, we conducted a systematic review of the effectiveness and tolerability of amodiaquine in the treatment of uncomplicated falciparum malaria. METHODS: This is a systematic review of published and unpublished randomised or pseudorandomised trials of amodiaquine. Observational reports were also systematically identified and reviewed to access evidence of serious adverse events. FINDINGS: 40 trials met the inclusion criteria. Symptomatic patients were enrolled in 24 studies in comparisons of amodiaquine (n = 1071) with chloroquine (n = 1097). Amodiaquine was significantly more effective than chloroquine, with odds ratios and 99% confidence intervals (OR [99% CI]) of 4.29 (3.30-5.58) on day 7 and 6.00 (3.97-9.06) on day 14. Time to parasite clearance was significantly shorter with amodiaquine and fever clearance times were marginally faster. Eight studies compared amodiaquine with chloroquine in asymptomatic parasitaemia, with effects on parasitological outcomes similar to those for symptomatic malaria. At twelve sites, 692 amodiaquine and 679 sulfadoxine/pyrimethamine (S/P) recipients were enrolled. The two drugs did not differ significantly on day 7 (OR 0.74 [0.48-1.15]) but the odds ratios favoured S/P on day 14 (OR 0.51 [0.28-0.93]) and on day 28 (OR 0.30 [0.16-0.55]). The time to parasitological clearance was similar in the two groups; fever clearance times were significantly shorter with amodiaquine. Tolerability was assessed for both comparative and non-comparative trials. The rates of adverse events in controlled trials were 10.7%, 8.8%, and 14.3% with amodiaquine, chloroquine, and S/P, respectively. No life-threatening adverse events and no significant shifts in laboratory indices were reported. INTERPRETATION: This systematic review of published and unpublished trials supports the use of amodiaquine in the treatment of uncomplicated malaria. However, there is partial cross-resistance between chloroquine and amodiaquine, and monitoring of the effectiveness of this drug and surveillance for evidence of toxicity must continue.

PIP: Amodiaquine is more palatable than chloroquine and may be more effective in treating malaria, but serious adverse events have been reported among travellers taking it as prophylaxis. Amodiaquine is not recommended as first-line treatment. The authors report their findings from a systematic review of published and unpublished randomized or pseudorandomized trials on the effectiveness and tolerability of amodiaquine in the treatment of uncomplicated falciparum malaria. Observational reports were also systematically identified and reviewed to access evidence of serious adverse events. The review supports the use of amodiaquine in the treatment of uncomplicated malaria. There is, however, partial cross-resistance between chloroquine and amodiaquine. Monitoring the effectiveness of amodiaquine and surveillance for evidence of toxicity must continue.

Response to fluconazole by 23 patients with human immunodeficiency virus infection and oral candidiasis: pharmacological and mycological factors.

The MICs of fluconazole for strains of Candida species and the levels of fluconazole in serum were determined at day 0 and day 14 for 23 human immunodeficiency virus-infected patients with oral candidiasis who were treated orally with 100 mg of fluconazole per day for 14 days. Among the 23 patients, 11 (48%) were not clinically cured and had persistent isolation of Candidiasis albicans (n = 10) and/or presence of non-C. albicans (n = 6). Clinical response could be predicted by the susceptibility of the strain to fluconazole determined at day 0. All 12 patients who were cured were infected with a strain for which the MIC was < 0.78 mg/liter. All four patients who were infected with a strain for which the MIC was > 3.12 mg/liter experienced clinical failure. These data suggest that a C. albicans strain could be defined as being susceptible when the MIC of fluconazole is < 0.78 mg/liter and as being resistant when the MIC is > 3.12 mg/liter.

[Epidemiological surveillance of infection by the human immunodeficiency virus (HIV) and of the acquired immunodeficiency syndrome (AIDS) in French Polynesia in 1991]. / Surveillance épidémiologique de l'infection par le virus de l'immunodéficience humaine (VIH) et du syndrome d'immunodéficience acquise (SIDA) en Polynésie Française en 1991.

The authors make out a statement about HIV infection in French Polynesia at the date of 1991 December 31. 96 cases all together of seropositive and AIDS infected people were recorded. These patients are young generally (78 p.c. between 21 and 40 years old) sexually contaminated (72 out of 96) and live in Tahiti island (94 p.c.). Sex-ratio is 2.8 male/1 female. Among them, we noted 55 p.c. of Europeans, 38 p.c. of Polynesians and 7 p.c. of Asiatic people. Epidemiological monitoring of the infection was made easy because of a set of laws and possibilities of detection highly favourable. Progress of the infection is constant, with 20 new cases detected each year with a prevalence of 150 cases of AIDS per 1 million of inhabitants, French Polynesia could be classified as the 5th or 6th region of France as far as the importance of the disease. Clinical, biological and epidemiological taking of charge of patients is detailed as well as the prevention campaign.

PIP: Serological surveillance of HIV infection in accordance with World Health Organization guidelines has taken place in French Polynesia since 1985. 20,000 tests are conducted annually in a population not exceeding 200,000. 30% of tests are among blood donors. An average of 20 new cases of HIV infection are diagnosed each year. A total of 96 cases of HIV infection or AIDS were reported to the public health authorities between 1985 and December 31, 1990. 78% of the 96 persons were aged 21-40 years. The sex ratio was 2.8 men per woman. 55% were in Europeans (53 cases among 24,000 European residents), and 7% were in Asians (7 cases among 10,000 Asians). 94% of the patients were inhabitants of Tahiti. 44 of the 96 patients were male homosexuals or bisexuals, 18 were heterosexuals with multiple partners, 13 received transfusions before 1985, 10 were sex partners of seropositive persons, 9 were former addicts, 1 was the infant of an infected mother, and 1 had no known risk factor. ELISA tests were conducted in 6 different laboratories in the island of Tahiti, with confirmation by Western blot at the laboratory of the Louis Mallarde Territorial Medical Research Institute. Contacts are traced and tested, and seropositive individuals are followed regularly, with consultations at 6 month intervals for seropositive persons. Of the 46 patients present in the territory as of December 1990, 36 were at stage 1, 2 at stage 2, 5 at stage 3, and 3 at stage 4 according to the World Health Organization guidelines. 20 of the other 50 had died and 30 left the territory.

Activities of pefloxacin and ciprofloxacin against experimental malaria in mice.

We investigated the in vivo antimalarial activities of pefloxacin and ciprofloxacin in Swiss albino mice infected intravenously with 5 x 10(6) Plasmodium yoelii N67 parasites 1 h before treatment. Groups of 20 mice received a subcutaneous injection of 40, 80, or 160 mg of ciprofloxacin or pefloxacin per kg of body weight every 8 h for 3 days. Parasitologic activity was assessed on day 4, and survival was assessed on day 21. Control mice had a fulminant course with a parasitemia of 61.3% +/- 12.1% on day 4, and 90% of the mice were dead on day 21. The lower dosages of pefloxacin and ciprofloxacin (40 and 80 mg/kg) were not efficient. With 160 mg/kg, ciprofloxacin achieved an 85.8% reduction in parasitemia and 17 of 20 mice survived. Pefloxacin achieved a 92.8% reduction in parasitemia, and all mice survived. All treated, noninfected control mice survived. With ciprofloxacin, the antimalarial activity was similar with injections of 240 mg/kg every 12 h but was strongly diminished with injections of 160 mg/kg every 12 h. With pefloxacin, similar activities were observed with injections of 160 mg/kg every 8 h or injections of 160 or 240 mg/kg every 12 h. With both drugs, this activity was highly reduced when the treatment was delayed by 24 h. This underlines the need to provide treatment within the first hours after infection to achieve an optimal effect in this rapidly lethal experimental model of malaria. Pefloxacin and, to a lesser extent, ciprofloxacin are potent antimalarial drugs which might prove useful in the treatment of less rapidly aggressive human malaria.

[Adult cerebral malaria. Actual experience of the Infectious Diseases Intensive Care Department at the Claude Bernard Hospital]. / Accès pernicieux palustre de l'adulte. Expérience actuelle de la Clinique de Réanimation des maladies infectieuses de l'Hôpital Claude Bernard.

22 cases of adult cerebral malaria were observed between July 1987 and June 1989, either associated or not: parasitemia 5%, consciousness disorders, acute renal failure, thrombocytopenia. Two patients died (9%). Increased frequency of attacks is underlined. They are due to chloroquino-resistant parasite strains, even polychemoresistant, occurred in French speaking Tropical Africa since 1985. Therapeutic strategy is described. The necessity to use increased doses of quinine has been admitted, correlatively underlining importance of strict monitoring of the patients because, in first instance, the risk of hypoglycemia (eased by injecting too quickly high doses of quinine) and of acute pulmonary oedema (eased by too quick perfusions and/or transfusions).

[Epidemiologic aspects of malaria in Gabon]. / Aspects épidémiologiques du paludisme au Gabon.

The authors report the results of 3 sample surveys carried out in Libreville, Ngounié and Haut-Ogooué Provinces to evaluate the main malarial indexes among 0 to 15 years old children in Gabon. These investigations would suggest that malaria is mesoendemic in the three areas. The systematic presumptive antimarial treatment of fever attacks is widely used in Libreville but not so frequent in rural areas.

Divided-dose kinetics of mefloquine in man.

The kinetics of mefloquine was investigated following oral divided-doses in 10 healthy Caucasian volunteers. They received 500 or 750 mg followed by 500 mg 8 h later. Unchanged mefloquine (M) and its carboxylic acid metabolite (MM) were measured in whole blood and plasma for 50 days by h.p.l.c. Maximum blood and plasma M concentrations of 1872 +/- 362 ng ml-1 (mean +/- s.d.) and 1900 +/- 434 ng ml-1, respectively, were found within 6-10 h after the second dose. The terminal plasma elimination half-life was 20.1 +/- 3.7 days (mean +/- s.d.) and the oral clearance was 22.3 +/- 6.7 ml h-1 kg-1 (mean +/- s.d.). Plasma concentrations of MM exceeded those of M by 2-3 fold within 2 days. The whole blood concentration of MM was lower than that in plasma but also exceeded the whole blood concentration of M.

Role of immune serum and complement in stimulation of the metabolic burst of human neutrophils by Plasmodium falciparum.

Interaction between human neutrophils (polymorphonuclear leukocytes [PMN]) and Plasmodium falciparum in the natural defense of the host remains to be elucidated. In patients with acute malaria, oxygen consumption (QO2) of PMN at rest and after stimulation by zymosan was significantly increased compared with that in the controls. With 10% immune serum, both QO2 and chemiluminescence of normal PMN were significantly increased after stimulation by a P. falciparum erythrocyte culture. This activation was not observed with a nonparasitized erythrocyte culture and was correlated with parasitemia. Immune serum and complement were required to trigger this metabolic activation of normal PMN. With normal serum or heat-inactivated immune serum, a parasitized erythrocyte culture did not significantly stimulate QO2 or chemiluminescence of normal PMN. The classical complement pathway was essential for this stimulation, whereas the alternate pathway was less involved. Hyperimmune sera from subjects residing in endemic areas were more able to trigger the metabolic burst than were immune sera from subjects from other sources. The use of synchronous cultures showed that PMN were more stimulated by cultures rich in merozoites than by the same cultures which contained only intraerythrocytic forms. Giemsa staining showed granules of hemozoin and occasional merozoites or parasitized erythrocytes within PMN. This increase in production of activated oxygen radicals could damage intra-or extraphagocytic parasitic forms. As P. falciparum is sensitive to oxidant stress and PMN is the phagocyte with the most intense metabolic burst, the role of PMN in defense against malaria should be considered.