A century of leishmaniasis in Alpes-Maritimes, France.

A century of publications on leishmaniasis in Alpes-Maritimes, in southern France, is here reviewed. Autochtonous human and canine leishmaniasis were first recognised in this département, which lies by the Mediterranean Sea and near the Italian border, in 1918 and 1925, respectively. The parasite responsible for the leishmaniasis, Leishmania infantum, is transmitted by Phlebotomus perniciosus and P. ariasi. The human leishmaniasis is zoonotic, with domestic dogs acting as the main 'reservoir' hosts. In prospective surveys over the last two decades, a mean of 12% of the domestic dogs checked in Alpes-Maritimes have been found seropositive for L. infantum but only about 50% of the seropositive animals showed any clinical signs of infection at the time of the surveys. During the last 30 years, 178 cases of human visceral leishmaniasis have been recorded in the area. Such cases are sporadic and often opportunistic, occurring predominantly in children (29% of the 178 cases) or HIV-positive subjects (31%). Recently, it has been demonstrated that, in Alpes-Maritimes, approximately 20% of those found seropositive in leishmanin skin tests are asymptomatic carriers, with amastigotes in their peripheral blood.

[Mediterranean leishmaniasis caused by Leishmania infantum. Update on the utility of the IT-Leish and ID-Pagia leishmaniasis tests]. / La leishmaniose méditerranéenne due a Leishmania infantum Mise au point--intérêts des tests de diagnostic rapide: IT-Leish et ID-Pagia leishmaniasis.

The purpose of this article is to update information about Mediterranean leishmaniasis caused by Leishmania infantum in man and about the canine reservoir. Special emphasis is placed on laboratory diagnosis tests for Mediterranean visceral leishmaniasis (MVL) in humans. In addition two rapid diagnostic tests for human leishmaniasis are compared based on indirect immunofluorescence and Western blot. Findings show that the overall sensitivity of the two tests in immunocompetent and immunodepressed patients ranged from 54% to 97%, a specificity of 97%, with positive predictive value ranging from 75% to 97% and a negative predictive value of around 95%. For diagnosis of cutaneous leishmaniasis, positivity of these tests in one case out of 2 underscores the predictive value of a positive test.

Human trichinellosis due to Trichinella britovi in southern France after consumption of frozen wild boar meat.

Six patients were infected with Trichinella britovi in southern France following consumption of frozen wild boar meat, which had been frozen at -35 degrees C for 7 days. Microscopic examination of a sample of frozen wild boar muscle revealed the presence of rare encapsulated Trichinella larvae, identified as T. britovi. People eating wild boar must follow individual prophylactic rules such as efficient cooking of meat (at least 65 degrees C at the core for 1 minute) as recommended by the International Commission on Trichinellosis, or freezing exceeding four weeks at -20 degrees C.

[Gnathostomiasis: an emerging parasitic disease?]. / La gnathostomose, une parasitose émergente?

INTRODUCTION: Human gnathostomiasis is a parasitic disease caused by the ingestion of foods contaminated with the larvae of various species of Gnathostoma. This zoonosis is currently endemic in Asia and Central America. CASE REPORT: A 46-year-old French woman resident in Vietnam presented with intermittent pruritic swelling of the hand, present for one year, coupled with eosinophilia. The patient's history and serological testing confirmed the suspected diagnosis of gnathostomiasis. A favorable outcome was attained on treatment with albendazole. DISCUSSION: This case, together with several others recently reported in France and Europe, underlines the need to inform travelers and migrants to endemic regions of the risks associated with eating raw or marinated fish.

[Kidney transplant and Candida albicans arteritis. The importance of analysing the transplant conservation liquid]. / Greffe rénale et artérite du greffon à Candida albicans. Importance de l'analyse du liquide de conservation du greffon.

INTRODUCTION: Candida arteritis can compromise the functional prognosis of the graft or even the life of the transplant recipient. The infection can be transmitted by the graft. OBSERVATION: A 46 year-old woman contracted a Candida albicans ateritis of the graft following a kidney transplant that led to a detransplantation. The yeast was probably transmitted by the graft from the donor, source of an unknown candida infection: it was found in the conservation liquid of the graft itself, and in the renal artery and vascular pedicle. Analysis of of these three elements by enzymatic electrophoresis showed that they were identical. COMMENTARIES: This case report underlines the need to establish guidelines and sanitary safety measures, notably that of systematically placing in culture the concervation solutions and alerting the transplant team if any fungi are isolated.

Consensual treatment of plasmodium falciparum malaria does not lead to adequate quinine blood concentrations.

Since 1996, we have a common protocol in the Infectious Diseases Department and the Intensive Care Unit for the administration of quinine in case of Plasmodium falciparum malaria. Patients were classified as uncomplicated form of malaria (UFM) or severe form of malaria (SFM) according to WHO criteria, adding parasitemia >5% as a criteria of SFM. Treatment of SFM should consist of a 4 h infusion of 16 mg/kg quinine-base loading dose, followed by 8 mg/kg every 8 h. Patients with UFM receive quinine-base, 8 mg/kg every 8 h. A therapeutic index of 10-15 mg/l was considered adequate. Hypoglycemia and cardiotoxicity were the two main adverse effects of quinine to be investigated. In order to verify that these modalities for quinine administration are associated with adequate quinine blood concentrations, we have reviewed the pharmacological data and the occurrence of adverse effects. Between April 1996 and December 2000, 95 patients were hospitalised: 25 with SFM and 70 with UFM: 78/95 patients (82%) received adequate treatment and 26/95 (28%) of the patients presented an overdosage of quinine. Six severe adverse effects were observed, even in case of adequate quinine administration. Consensual treatment of malaria does not confer adequate quinine blood concentrations, and toxic effects are still common.

In vivo involvement of polymorphonuclear neutrophils in Leishmania infantum infection.

BACKGROUND: The role of lymphocytes in the specific defence against L. infantum has been well established, but the part played by polynuclear neutrophil (PN) cells in controlling visceral leishmaniasis was much less studied. In this report we examine in vivo the participation of PN in early and late phases of infection by L. infantum. RESULTS: Promastigote phagocytosis and killing occurs very early after infection, as demonstrated by electron microscopy analyses which show in BALB/c mouse spleen, but not in liver, numerous PN harbouring ultrastructurally degraded parasites. It is shown, using mAb RB6-8C5 directed against mature mouse granulocytes, that in chronically infected mice, long-term PN depletion did not enhance parasite counts neither in liver nor in spleen, indicating that these cells are not involved in the late phase of L. infantum infection. In acute stage of infection, in mouse liver, where L. infantum load is initially larger than that in spleen but resolves spontaneously, there was no significant effect of neutrophils depletion. By contrast, early in infection the neutrophil cells crucially contributed to parasite killing in spleen, since PN depletion, performed before and up to 7 days after the parasite inoculation, resulted in a ten-fold increase of parasite burden. CONCLUSIONS: Taken together these data show that neutrophil cells contribute to the early control of the parasite growth in spleen but not in liver and that these cells have no significant effect late in infection in either of these target organs.

A case of gnathostomiasis in a European traveller returning from Mexico.

Hundreds of human cases of gnathostomiasis have recently been reported from Mexico, where the disease is becoming a public health problem. We report a case of gnathostomiasis in a French tourist returning from Mexico. Tourists travelling in endemic countries are at risk of gnathostomiasis and should be advised about the risks of eating raw fish as a suspected source of infection.

Quantitation of Leishmania infantum in tissues of infected BALB/c mouse by sandwich ELISA.

In this report, a sandwhich ELISA was developed to quantify spleen and liver burdens from L. infantum-infected BALB/c mice. Amastigote antigens obtained following Nonidet P40 extraction of parasite-harbouring tissues were captured by anti-L. infantum human IgG insolubilized onto microtiter plate and subsequently revealed with anti-L. infantum F(ab)' fragments labelled with peroxidase. The method was easy to perform, precise and capable to specifically and accurately detect 5 x 10(4) amastigotes/100 mg tissue. Parasite burdens from infected BALB/c mice, in various conditions, were measured by ELISA and Giemsa-stained touch imprint reference methods, and compared. Both techniques agreed well with close values for liver burdens, but the spleen loads measured by the ELISA were, on average, 10.7 times higher than those calculated from imprints. This difference was attributed partly to the underestimation brought by Stauber's formula. However, it did not preclude the usefulness of this newly developed test, since results obtained in kinetics studies and evaluation of the efficiency of leishmanicidal drugs allowed us to draw identical conclusions.

Sustained parasite burden in the spleen of Leishmania infantum-infected BALB/c mice is accompanied by expression of MCP-1 transcripts and lack of protection against challenge.

We analyzed differential responses of spleen and liver, major organ targets for viscerotropic Leishmania species, to experimental infection and examined if resistance to challenge was organ-specific. In liver, parasites were spontaneously cleared and iNOS trancripts expression paralleled that of amastigote load. In the spleen, amastigote multiplication was only partly controlled, and iNOS transcripts expression was transient. Total numbers of spleen cells, B cells, and T cells were decreased, while F4/80(+) and Mac1(+) cells were conserved. Expression of splenic MCP-1 transcripts remained constant, indicating its possible contribution to immigration of Leishmania host cells and to sustained parasite load. Spleen cells produced both, Th1- and Th2-type cytokines and Th2-type response was dominant, compatible with the sustained MCP-1 expression. Challenge experiments showed that in contrast to the liver, where initial infection conferred a progressively established immunity, in the spleen there was no induced protection against reinfection. Organ-specific resistance against challenge could be important for designing antileishmanial vaccines.

[Confirmation of Leishmania infantum MON-24, agent of cutaneous leishmaniasis in southern France]. / Confirmation de Leishmania infantum MON-24, agent de leishmaniose cutanée dans le sud-est de la France.

Leishmania infantum MON-24, an agent causing cutaneous leishmaniasis, has only been reported once in Southern France. The authors report an additional case which confirms the presence of this zymodeme as agent of cutaneous leishmaniasis in this area. Treatment with a single course of liposomal amphotericine B did not show convincing efficacy.