[Reflections on Three Episodes of Louis Pasteur's Life as Seen in the William Dieterle's Movie (1936)]. / Réflexions sur trois épisodes de la vie de Louis Pasteur vus au travers du film de William Dieterle (1936).

Despite the criticism and reservations made about him still nowadays, Louis Pasteur may be considered one of the most important scientists of the last two centuries in public health, even if the work of the numerous scientists who preceded him have largely contributed to the successes he obtained without following too much to the rules of deontology and ethics currently in force in the world of research and medicine. He has definitively put down, by his experiments, the "theory of spontaneous generation" in force since antiquity, validated that of "germs or microbes", enacted the first rules of asepsis, while inspiring those of the antisepsis applied by Joseph Lister, and developed a certain number of vaccinations in veterinary and human medicine, including the anti-rabies, the one which made him famous all over the world. All this was not done without difficulty and Pasteur encountered for a large part of his life the misunderstanding of his contemporaries and the hostility of the medical world to which he did not belong. The authors comment in this text the movie The Story of Louis Pasteur by William Dieterle, filmed in 1936, based on the knowledge acquired since that date and doing the part of the real and the fiction.

Malgré les critiques et les réserves dont il est l'objet aujourd'hui, Louis Pasteur peut être considéré comme l'un des scientifiques les plus importants de ces deux derniers siècles en matière de santé publique, même si les apports des nombreux hommes de science qui l'ont précédé ont largement contribué aux succès qu'il obtint sans trop se soucier des règles de déontologie et d'éthique actuellement en vigueur dans le monde de la recherche et de la médecine. Il a mis définitivement à bas, par ses expériences, la « théorie de la génération spontanée ¼ en vigueur depuis l'Antiquité, validé celle « des germes ou microbes ¼, édicté les premières règles de l'asepsie tout en inspirant celles de l'antisepsie appliquée par Joseph Lister et mit au point un certain nombre de vaccinations en médecine vétérinaire puis humaine, notamment celle contre la rage, ce qui le rendit célèbre dans le monde entier. Tout cela ne s'est pas fait sans difficulté, et Pasteur s'est heurté pendant une grande partie de sa vie à l'incompréhension de ses contemporains et à l'hostilité du monde médical auquel il n'appartenait pas. Les auteurs commentent dans ce texte le film L'Histoire de Louis Pasteur de William Dieterle, tourné en 1936, en s'appuyant sur les connaissances acquises depuis cette date et en faisant la part du réel et de l'imaginé.

Threats to the Effectiveness of Malaria Treatment.

In reaction to the speed and ease with which a high level of resistance against P. falciparum was induced in vivo in a mouse NOD/SCID IL-Ry-/- model by sub-therapeutic doses of artesunate [2], this text begins a plea for concrete measures to limit the risk of eventually appearing the same phenomenon in the field, including a strengthening of the fight against the use of artesunate oral monotherapy, tablet often under-dosed or artemisinin herbal tea and the adoption of more reliable and more efficient means than those currently used to detect the emergence of resistance earlier and a relaunch of the search for new antimalarials.

[Threats to the Effectiveness of Malaria Treatment]. / Menaces sur l'efficacité du traitement contre le paludisme.

Une résistance de très haut niveau de P. falciparum vient d'être induite expérimentalement in-vivo dans un modèle souris NOD/SCID IL-Ry - / - par des doses infrathérapeutiques d'artésunate [2]. En réaction à la facilité et à la rapidité avec lesquelles cela s'est fait, ce texte amorce un plaidoyer pour la prise de mesures concrètes afin de limiter le risque de voir à terme apparaitre le même phénomène sur le terrain. Ces mesures comprennent notamment un renforcement de la lutte contre l'utilisation de l'artésunate en monothérapie par voie orale, en comprimés souvent sousdosés ou de l'artémisinine en tisane, et l'adoption de moyens plus fiables et plus performants que ceux utilisés actuellement pour détecter plus précocement l'apparition des résistances ainsi qu'une relance de la recherche de nouveaux antipaludiques.

[The third and new face of Chagas disease]. / Le troisième et nouveau visage de la maladie de Chagas.

After the publication of the results of the BENEFIT study concluding that the benznidazole (5 mg/kg/d/60 d) is ineffective to stop the progression of the established Chagas' cardiomyopathy in adults, the author evokes the new experiences and the new challenges of 2016 regarding Chagas disease while speculating on its future and by calling back some elements little known of his history, in particular the fact that it is Chagas who invented about it to some extent the concept of "neglected disease".

No, Chagas disease is not the new AIDS of the Americas!.

Chagas disease and AIDS: the same terminology cannot be used to associate, let alone confuse, these two diseases with one another without distorting reality, as was done in a recent medical article entitled: Chagas disease: "The New HIV/AIDS of the Americas". Even though Chagas disease, like many other "neglected diseases", bears some superficial resemblance to AIDS in certain ways, it nevertheless differs from the latter in many other significant ones.

[Combined infection with HTLV-1 and Strongyloides stercoralis]. / Co-infections HTLV-1-Strongyloides stercoralis.

Infection of carriers of strongyloides by the human oncogenic retrovirus HTLV-1 significantly augments the number of larval parasites in the stools and impairs the action of anti-helminthic agents, resulting in an increase in immediate and longer term failure of therapy. The proliferation of cytokine type 1 secreting lymphocytes, the preferred target for viral infection, shifts the Th1/Th2 balance in favour of a Th1 response with a consequent increase in the production of gamma interferon (INF-γ). In addition to other effects, this causes a decrease in the secretion of cytokines IL-4, IL-5 and IL-13, which results in substantial reduction in total and specific IgE; failure of activation of eosinophils or stagnation in or reduction of their numbers; and an increased risk of development of a severe form of strongyloidiasis. This risk is clearly correlated with the level of anti-HTLV-1 antibodies and the amplitude of the proviral load of peripheral lymphocytes. The polyclonal expansion of infected CD4 cells might be partly due to the activation of the IL-2/IL-2R system by parasite antigens together with the action of the virus type 1 Tax protein. The fact that adult T cell leukaemia arises significantly earlier and more often in individuals with combined infection is an argument in favour of the parasite's role as a leukaemogenic co-factor. In practice it is, therefore, appropriate to initiate all available measures to eliminate parasites from co-infected hosts although this does present difficulties, and one should not reject the possibility of a diagnosis of strongyloidiasis in the absence of hypereosinophilia. In all cases of chronic strongyloidiasis without hypereosinophilia, co-infection with HTLV-1 should be looked for routinely. The same applies to carriers of strongyloides with repeated treatment failures. Finally, corticosteroids and immunosuppressants should be used only with care in HTLV-1-positive patients who seem not to be co-infected, even if they have received precautionary therapy.

[Tutankhamun and sickle-cell anaemia]. / Toutankhamon et sicklanémie.

After casting doubt on malaria as the cause of death for Tutankhamun, the author points out that the hypothesis of homozygotic sickle-cell anaemia, or a double HbS/ß0thal heterozygosis, is hardly more credible. To have any chance of being valid, any such hypothesis would have to involve a combination of at least three rare factors: survival until the age of 19 of a subject with homozygotic sickle-cell anaemia, with a probability at birth as to a life expectancy of more than five years probably standing at less than 5%, and with, for all bone sequelae and anomalies, osteonecrosis whose location is characteristic, not of sickle-cell anaemia, but rather of a case of Freiberg-Kohler syndrome, which is also rare, but which is on the other hand fully compatible with the condition of the mummy's skeleton.

[Characterisation of the exoerythrocytic stage of the asexual cycle of the human plasmodia: a painstaking process]. / Cycle exoérythrocytaire asexué des plasmodiums humains : une découverte laborieuse.

The difficulties encountered in the discovery of the exoerythrocytic stage of the asexual cycle of the human plasmodia are described. These illustrate how deference towards scientific orthodoxy and a degree of reluctance to question and to criticize can delay advances in knowledge.

[A mosquito net for everyone in 2010]. / Une moustiquaire pour tous en l'an 2010.

At less than two hundred days of the 2010 deadline for the "Roll Back Malaria" initiative which committed itself to reduce by half, before that date, mortality due to malaria in the world and relying on the latest WHO reports pointing out, in Africa, major shortcomings concerning the accessibility to treatment combinations consisting of artemisinin and on the acknowledged fact that an insufficient number of pregnant women receive an intermittent treatment, the author notes that a coverage, so-called universal, with the use of long action insecticide treated mosquito nets has become the Grail of the battle against malaria, with the perverse effects entailed, namely that of blinding realities or throwing discredit on other types of possible interventions that are not consistent with an accounting logic. He also notes that the average figure of estimated deaths due to malaria was at a quasi stagnation in 2008 and that the lives of 34,000 African children of less than 5 years of age saved between 2006 and 2008 was achieved in the context of the reduction in infant mortality resulting from a series of causes among which it is impossible to individualise malaria with certainty. He finally points out that Eritrea, Rwanda, Zambia, São Tome y Principe and the Tanzanian island of Zanzibar which quite regularly serve as showcases to RBM and UNICEF and which report spectacular progress in the field of prevention of malaria accompanied by a parallel reduction in its mortality, are, for different reasons, far from being representative of the totality of African countries and that they should be considered as exceptions rather than examples to be exploited without restraint. On the other hand, the author considers that deluding the grand public into thinking that a few watchwords, slogans and simple, even simplistic, ideas would enable eradicating malaria given that large sums of money are made available, is not quite honest and may finally prove to be dangerous. He warns against the false hopes concerning the impact of coming discoveries on the antimalarial battle often conjured up to take over today's actions, by recalling that a century of scientific, technological and medical progress has not positively translated into any decisive progress in the prevention or treatment of this disease, in spite of the issue of scientific publications on the subject at every 20 minute interval since more than thirty years. Although the author willingly agrees that huge financial means are essential and for a long time to come, he however believes that they would not suffice to enable, in countries with high rates of transmission, the elimination of a disease that is not solely linked to biological, ecological and entomological parameters, but that is also anchored to the economic, societal, social and cultural contexts that are quite often forgotten and on which it is difficult, but essential, to act in order to obtain long lasting results. He recalls, on this occasion, that man, as an individual in relationship with his surroundings, should also be at the heart of the battle on the same footing as the anopheles and the plasmodium, even if this, at times, leads to clashes between medical logic and native social, traditional, popular, scholarly or religious logics. He regrets, similarly and within the spirit of the Abuja declaration, that the educational systems of African countries having a high transmission rate do not play the role they had to assume in the battle against malaria and are not mobilised much better than they are, by including, for example, in the primary and secondary curriculum of public and private schools, on the same footing as the learning of the alphabet or of the multiplication tables, a compulsory adapted instruction in malaria, so that children not only become victims but also "actors in the battle against malaria". The author finally underlines the absolute necessity to rapidly strengthen health care facilities of the most affected countries, particularly in the rural area, and plead that this intensification becomes a true priority financed on its own merits. The Global Malaria Action Plan, that will take over from the RBM and would have the advantage of masking the insufficient results obtained by the latter, would have to face two huge challenges: an ancient but recurring one that concerns, in the context of a world economic crisis, the financing of the battle against malaria and the other one, new and associated with the development of resistance by Plasmodium falciparum to artemisinin, a first- and last-line antimalaria drug.

[Sword of Damocles or Russian roulette ... what everyone knows or ought to know about Chagas disease]. / Entre epée de Damoclès et roulette russe ... ce que tout le monde sait ou devrait savoir sur la maladie de Chagas.

In 2006 the Pan American Health Organisation (PAHO) roughly estimated the prevalence of Chagas disease or American Human Trypanosomiasis, due to Trypanosoma cruzi, still to be eight million cases. The migration of people from the country into towns has resulted, in recent decades, in the urbanisation of this rural disease. Up to the mid-20th century, the epidemiology of the disease was closely linked to the extreme poverty of the peasant population and to their housing, the rancho, which offers a suitable habitat for the vectors and encourages their proliferation. A further barrier has recently been crossed with the arrival in non-endemic areas of numerous seropositive individuals. We shall draw attention in this article to the main clinical signs and to the manner of progression of the disease as well as to the problems posed by treatment of the different phases of this unique condition. It is not fanciful to describe it as resembling an adventure story, because of the place and manner of its discovery and of how the disease unfolds.