In vitro activity of amphotericin B, fluconazole and voriconazole against 162 Cryptococcus neoformans isolates from Africa and Cambodia.

In order to determine the potential role that various antifungal agents might have in the management of cryptococcosis in tropical areas, the in vitro susceptibility of Cryptococcus neoformans isolates from Africa ( n=52) and Cambodia ( n=110) to three antifungal agents (amphotericin B, fluconazole and voriconazole) were compared using the E-test method. The results of this study (i) confirm the value of the E-test for testing the in vitro susceptibility of C. neoformans towards voriconazole; (ii) provide the first evidence demonstrating good activity of amphotericin B, fluconazole and voriconazole against Cambodian isolates; and (iii) show there are differences in susceptibility between African and Asian C. neoformans isolates, with Cambodian isolates appearing less susceptible to the agents tested but with amphotericin B maintaining good activity.

Prevention of Candida colonization prevents infection in a neonatal unit.

This study represents a 1-year surveillance period using our epidemiology-based principles published and successfully followed since 1979: weekly culture for yeasts of oral and anal swabs, treatment with oral nystatin of all colonized newborns, and good hygiene/handwashing. Colonization was demonstrated in 23 out of 791 newborns admitted from October 1998 to September 1999. Twenty-two strains of Candida were identified: 16 C. albicans, 2 C. parapsilosis, 3 C. glabrata, and 1 C. tropicalis. Symptoms were erythema of the buttocks in 6 colonized newborns. No other culture positive for Candida could be found. Previous contamination was the main source (previous stay in an intensive care unit, rarely maternal origin). Contamination in the unit was unlikely. Eradication of Candida could be observed within 1 week. These good results, controversial in the literature, were obtained following epidemiological conclusions and support our guidelines.

White piedra and Trichosporon species in equatorial Africa. I. History and clinical aspects: an analysis of 449 superficial inguinal specimens.

White piedra is a hair infection characterized by nodules composed of fungal elements which envelop the hair shaft. Classically, this infection was considered to be produced by an asexual yeast-like fungus, Trichosporon beigelii. At present, in accordance with studies carried out previously, this species is subdivided into six newly defined distinct species (T. asahii, T. ovoides, T. inkin, T. mucoides, T. asteroides and T. cutaneum), all belonging to the class Basidiomycetes. Although widespread, white piedra has not previously been described in tropical regions of Africa. The present study, carried out in Libreville (Gabon), an equatorial region of Africa, shows that the incidence of this infection is quite high (18% of 449 inguinal specimens) in the female population aged 15-60 years, with a predominance in young patients (15-44 years). The relationship between the clinical manifestations and the specific hair lesions is also detailed. Three species belonging to the genus Trichosporon were identified: T. mucoides, T. asahii and T. inkin.

White piedra and Trichosporon species in equatorial Africa. III. Identification of Trichosporon species by slide agglutination test.

Fifty-two Trichosporon strains isolated from Gabonese female patients 15-60 years, were studied. The identity of these strains was established by two different methods: the method proposed by Guého et al. (1992), based on mycological criteria, and a slide agglutination method performed with monospecific antisera prepared in our laboratory. The final results show a perfect correlation between the two methods, which allowed us to identify 25 strains of T. mucoides, 21 strains of T. inkin and seven strains of T. asahii. The results of the agglutination tests performed with 24-h-old subcultures grown on Sabouraud glucose agar are available in less than 15 mins. In the light of these results, it appears that this method, which is rapid and easy to perform and reproduce, may readily be used in hospital laboratories. In addition, this method allowed us to verify the presence of antigens common to the genera Cryptococcus and Trichosporon, which were easily shown by the use of crude sera. The fact that the anti-Trichosporon monospecific sera lose their capacity to agglutinate Cryptococcus neoformans proves their high specificity.

White piedra and Trichosporon species in equatorial Africa. II. Clinical and mycological associations: an analysis of 449 superficial inguinal specimens.

Eighty-one of 449 Gabonese female patients examined were found to be positive for genitopubic white piedra. The association with trichobacteriosis is frequent (53 cases), and mostly seen with inguinal intertrigo. Fifty-two strains belonging to the genus Trichosporon were isolated from genital hairs as well as from inguinal intertrigo lesions. These strains were identified in accordance with previously defined morphological and biochemical criteria. Three species were recognized: T. mucoides (25 strains), T. inkin (20 strains) and T. asahii (seven strains). Their macroscopic and microscopic morphological properties, as well as their ability to reduce tetrazolium, were determined. In addition, the study of the clinical and pathogenic associations in which each of these strains was involved revealed some of their particular properties.

[Cutaneous Alternaria infection occurring in the course of a treated pemphigus]. / Alternariose cutanée survenant au cours de l'évolution d'un pemphigus traité. A propos de 2 cas.

Alternaria is a very common fungus. Its pathogenic role in human pathology is mainly expressed by asthma. Cutaneous infection is rare and only about 70 cases have been described. Because of its wide distribution in the environment, cutaneous biopsy is necessary to ensure the diagnosis. We report two cases of dermal alternariosis occurring in the course of pemphigus treated with immunosuppressive therapy. Histological examination revealed a hyperplasic epidermis. The upper dermis showed a mixed inflammatory infiltrate with neutrophils, histiocytes and giant cells. Round intracytoplasmic inclusions staining faintly with PAS wer seen in giant cells. Long intercellular filaments were present in the infiltrate. This histopathological aspect is not specific, and cultures of both cutaneous biopsies were necessary. The association of dermal alternariosis and pemphigus is explained both by the immunosuppressive therapy for pemphigus and by the cutaneous fragility induced by the acantholytic disease permitting direct inoculation of Alternaria.

[Development of chloroquine resistance in Plasmodium falciparum in Gabon between 1984 and 1987-88 (in vivo evaluation in a school environment)]. / Evolution de la résistance de Plasmodium falciparum à la chloroquine au Gabon entre 1984 et 1987-88 (evaluation in vivo en milieu scolaire).

Unknown in 1980, suspected in 1983 and scarcely present in 1984-85, Plasmodium falciparum resistance to chloroquine as studied in vivo in schoolchildren in Gabon, has strongly developed in 4 years time. In 1987-88, administration of 25 mg/kg of chloroquine leaves one strain out of four with a parasitic load greater than 10/1.000 red blood cells examined by thick drop technique. The present, unfortunately provisional attitude tends to maintain chloroquine at efficient doses for as long as the resistant strains are ethically and practically controllable. The dispersion without strict control of new and for the time being very efficient drugs might rapidly give rise to a polychemoresistance which would leave us without defence.

[Paraclinical study of onchocercosis in a leprous and non-leprous population]. / Etude paraclinique de l'onchocercose en population lépreuse et non lépreuse.

In a survey dealing with the frequency of onchocerciasis in leprous environments in the Marchoux Institute in Bamako (Mali) evidence is given that 43% of the leprous persons hospitalized there were touched in addition by onchocerciasis whereas, only 14% of the consultants in dermatology have proved to be also onchocercian. This last frequency is consistent with the overall estimation usually recognized for Mali. No difference was shown between leprous and non-leprous persons for snip. In contrast, 33% of microfilariae bearing leprousians showed no positive reaction to diethylcarbamazine whereas no more than 5% of non-leprous persons displayed similar negative response. Similarly leprousian blood yielded most often the microfilariae of Onchocerca volvulus. Surprisingly, hypereosinophilia has proved to be normal or null in 37% of microfilariae bearing leprosians. Though aware of the occurrence of numerous real or possible biases in such an approach the authors wonder what meaning such a difference between leprous populations and non-leprous ones in Mali can have. If a relation is definitely borne out in the future between both pathologies, they further wonder whether leprosy is the bed of onchocerciasis or vice versa.

[Attempt at defining dermatological criteria for surveys of African onchoceriasis based on observations made in 3 Mali villages]. / Essai de définitions des critères dermatologiques pour les enquêtes sur l'onchocercose africaine d'après les constatations faites dans trois villages maliens.

The study done by the authors at the Marchoux Institute of Bamako and in 3 Malian villages of the Koutiala area (two of hyperendemic and one of hypoendemic onchocerciasis) emphasized the interest which can be represented in the epidemiologic investigations on the onchocerciasis: the tibial vitiligo and the cutaneous atrophy. The dyschromia of more suggestive appreciation is less usable. Prurigo, lichenification, hypochromia and hyperchromia have less interest in these investigations because of more other causes which can be attributed to them.