[Conjunctival dirofilariasis caused by Dirofilaria repens: report of a French case]. / Dirofilariose conjonctivale à Dirofilaria repens: à propos d'un cas français.

Dirofilariasis involving Dirofilaria repens is an exceedingly rare event in France. Most cases have involved subcutaneous lesions but ocular and peri-ocular involvement have been observed. The present report describes a case of dirofilariasis involving the conjunctiva in a 61 year-old-man in France. Onset was characterized by the sudden appearance of painful conjunctival cyst. Clinical examination and laboratory tests did not allow diagnosis. Opening the cyst and extracting the parasite allowed diagnosis and treatment. Microscopic examination identified the parasite as a female Dirofilaria repens. This new case of ocular dirofilariasis emphasizes that this parasitic disease is present and probably underestimated in mainland France. Opening of the conjunctival cyst allowed identification of the parasite and successful treatment without sequels.

Pneumocystis carinii: a review.

Pneumocystis carinii has been increasingly recognized as an important cause of opportunistic infection in immune-deficient hosts. The prevalence of pneumocystis pneumonia (PCP) in Africa used to be neglected and underestimated due to difficult methods of isolating the infection. In this review, the authors discuss the nature of the parasite, and methods of diagnosis.

[In vitro production of specific antibodies: preliminary results]. / L'IVAP ou production d'anticorps specifiques in vitro: resultats preliminaires.

In vitro production of specific antibodies or IVPA is a technique that involves isolating mononuclear cells from blood, placing them in culture, and detecting antibodies in the culture supernatant. The presence of antibodies confirms active production by B lymphocytes and is proof of ongoing infection. To validate this technique for routine laboratory use, we tested 16 subjects: 11 for toxoplasmosis and cytomegalovirus and 5 for viral hepatitis type A or B. The results obtained using IVPA were compared with those obtained using conventional serologic methods. IVPA documented IgM for cytomegalovirus in the only subject in whom serology showed IgM for that virus. The test was also positive in 2 subjects undergoing vaccination for viral hepatitis type B and suffering from acute viral hepatitis type A. These concordant results demonstrate that IVPA is a valuable adjuvant technique for diagnosis of ongoing infection especially insofar as it avoids the need for antibody kinetic studies or isolation of the virus. It also provides a simpler and less expensive alternative to gene amplification and cell culture.

[Cutaneous malignant melanoma in New Caledonia (South Pacific) 1973-1991. A study of 97 cases]. / Le mélanome malin cutané en Nouvelle-Calédonie (Pacifique Sud) 1973-1991. Etude de 97 observations.

The Cancer Registries have been operational in the South Pacific since 1958 (Papua New Guinea), Fiji (1965) and New Caledonia (1977) and complete cancer incidence rates are available, based on histologic data. We studied 97 melanomas, histologically confirmed, which were diagnosed in New Caledonia from 1973 to 1991. New Caledonia is located in the same latitude as Queensland in Australia, known for having the highest incidence of melanoma in the world. Standardised incidence rates (world population) were 9.82 and 7.65/100,000/year for European males and females, compared to 1.65 and 1.05 for Melanesian and Polynesian males and females. The European population is exposed and Melanesians/Polynesians are relatively protected as are black Americans or Africans. The mixed populations are protected, but no study is available as to the exact proportion of mixed people (20%?) in the entire population. For Europeans, among males, the main areas in which melanomas occur are the trunk (45%) the arm (13%) and the leg (13%). Among females, the main areas are the leg (27%), the trunk (20%) and the head (18%). Screening for melanoma has been more effective in the last 6 years, a period in which we diagnosed half the total cases and generally at earlier stages. Prognosis was poor for this period (1973-1991): the five year survival rates were 64% +/- 8%, not as good as in Europe or Australia, but these lesions were diagnosed between 1973 and 1985 and were generally more invasive. A better prognosis will probably be observed in a few years, and another evaluation of melanoma screening should be made in the future as well the study of precursors and early lesions.

Pharmacokinetics of quinine and doxycycline in patients with acute falciparum malaria: a study in Africa.

The pharmacokinetics of quinine was investigated in patients with acute falciparum malaria treated with quinine alone or in the presence of doxycycline. Twenty-six patients divided into two groups of equal number were enrolled in the study. In the absence of doxycycline, the volume of distribution of quinine (mean +/- SD) was estimated to be 1.32 +/- 0.32 L/kg, and its clearance was 0.125 +/- 0.47 L/h/kg, which was only in partial agreement with previously published data. No effect of doxycycline on the pharmacokinetics of quinine was observed.

Staining methods for the diagnosis of cryptosporidiosis: appraisal.

Simple methods which can be used in any modest laboratory for the diagnosis of Cryptosporidiosis in human and animal faeces are described. These methods may be applied to duodenal and lung aspirations. The Ziehl-Nelseen and Köster modified methods were found to be suitable in the diagnosis of Cryptosporidium due to their specificity and simplicity as compared to other staining methods. Köster modified method is more specific in demonstrating the sporozoïtes.

AIDS-associated cryptococcosis in Bujumbura, Burundi: an epidemiological study.

Cryptococcus neoformans var. neoformans was isolated from domestic dust in 54% of houses occupied or recently occupied by AIDS+ cryptococcosis patients and in 20% of control houses randomly chosen in Bujumbura, Burundi. It was not isolated from wards of similar patients in the University Hospital. This seems to prove that patients could not contaminate their own environment and that the presence of C. neoformans var. neoformans had another origin. In 40% of the cases, patients admitted contact with pigeons in the city and pigeon coops are frequently positive. We are convinced that the pigeon coops of the city play a part in the contamination of HIV+/AIDS patients; however, some patients denied any contact with pigeons and in these cases, the only possible source of contamination identified thus far is domestic dust, although the origin of the yeast remains unknown.

PIP: Researchers took 800 samples from the environment in Bujumbura, Burundi to examine the role of Cryptococcus neoformans var. neoformans in HIV positive/AIDS patients. Specifically they took 375 dust samples from 25 houses of 24 AIDS patients with cryptococcosis (1 patient had 2 homes). 5 of the these patients lived in 1 area. So the researchers also took control samples from the same area. They also obtained contact plate samples from 10 internal medicine wards (4 with AIDS/Cryptococcosis patients, 2 AIDS patients who did not have cryptococcosis, and 4 vacant wards) in Kamenge University Hospital. The researchers isolated C. neoformans var. neoformans in the dust of 54% of the homes either occupied or recently occupied by the patients and in the dust of 20% of the control homes. Further 40% of the patients reported contact with pigeons. In fact, the researchers were able to sample the avian source of 25% (6) of all patients. They detected high doses of C. neoformans in 5 of the 6 pigeon coops. In those patients who did not report contact with pigeons, the researchers assumed these patients contracted cryptococcosis from spores in domestic dust. No spores were evident in the hospital wards including those with AIDS patients with cryptococcosis. Even though the researchers experiments with dissemination of spores did not reveal the extent of contamination they expected, they were sure that pigeon coops do play a contributory role in contaminating HIV positive and AIDS patients. Further they were concerned that AIDS patients who have received successful cryptococcosis treatment could be reinfected by returning to a home contaminated with dust harboring spores.

[Extra-abdominal desmoid fibroma and pulmonary metastases. (New Caledonia)]. / Fibrome desmoïde extra-abdominal et métastases pulmonaires. (La Nouvelle-Calédonie).

A 22 years old Melanesian patient had a tumor in the anterior and external side of the left leg. Three times, this tumor had a surgical treatment, by resection, then an amputation of the leg. Always, its histological aspect was agreeing with a desmoid fibroma. After an evolution of 23 months time, metastases appeared in the lungs. Most of the authors don't agree the existence of metastases in these tumors. Four observations were reported in the literature, including one in 1989. They emphasize the difficulties of the histological diagnosis of these tumors. The metastases seems to be an argument in the evolution, which incites to modify the initial diagnosis as a fibrosarcoma in spite of the lack of obvious histological malignancy.

[Cryptococcosis in Bujumbura, Burundi. Apropos of 80 observed cases in 42 months]. / La cryptococcose à Bujumbura, Burundi. A propos de 80 cas observés en42 mois.

Cryptococcosis is a systemic fungal disease and meningeal or meningoencephalitis involvement is the most serious complication. This is a retrospective analysis of 80 patients admitted from December 1983 to October 1985 (30 cases) and June 1987 to December 1988 (50 cases) in hospital of Bujumbura, Burundi, Central Africa. All patients have an AIDS. Clinically, the meningeal and meningoencephalitis attack prevails in 87% cases. The diagnosis in our study is essentially based on the examination of the CRL. Before the new antifungals, the treatment involved the association of amphotericin B and 5-fluorocytosine, during 6 to 8 weeks. This treatment was badly tolerated and the second falls, when the therapy was stopped, were frequent. Presently, the fluconazole is the best treatment of this affection (ailment?): it enables maintenance therapy for a disease in which the risks of recurrence and reinfection by the environment are not negligible in Africa.

Isolation of Cryptococcus neoformans from houses of AIDS-associated cryptococcosis patients in Bujumbura (Burundi).

Cryptococcus neoformans var. neoformans, which is responsible for AIDS-associated cryptococcosis in Bujumbura, was isolated in the domestic environment of seven out of 20 patients with AIDS-associated cryptococcosis. The findings prove that in his own domestic environment, the HIV-positive patient in central Africa is frequently exposed to the yeast and these observations lead us to insist on the suitability of carrying out a systematic survey by means of soluble antigens-sensitized latex in every HIV-positive patient. This also proves the importance of a follow-up of the 'cured' patients who easily can be recontaminated after their return home.

PIP: Soil, pigeon droppings, and dust were collected from 20 houses in Bujumbura which were inhabited by AIDS-associated cryptococcosis patients. Cryptocococcus neoformans variant neoformans was isolated from samples in 7 of the houses. This finding suggests that all HIV-positive patients should be tested for cryptococcal antigen and that patients cured of cryptococcosis may be reinfected on their return home.

[Infectious diarrhea in African acquired immunodepression syndrome (AIDS). Apropos of 100 patients studied in Bujumbura (Burundi)]. / Diarrhées infectieuses au cours du syndrome d'immunodépression acquise africain (SIDA). A propos de 100 malades étudiés à Bujumbura (Burundi).

The authors carried out a prospective survey on 100 cases of AIDS in order to find out the different etiologies of infections diarrhoea in terms of frequency and diagnosis behaviour. 84 out of 100 patients got diarrhoea. All 100 patients had their stools examined, 78 underwent high digestive fibroscopy with irrigation and aspiration of duodenal liquid (IADL), 40 duodenal biopsies. 98 infecting agents were revealed in stool exams, 50 in IADL, 7 at the occasion of histopathological exam of duodenal biopsies. All together, stool exams and IADL gave evidence that Isospora belli and Cryptosporidium are the opportunistic infecting agents most often revealed (16.2 and 13.1 p.c., respectively). The role of yeasts in diarrhoea is not evident, but esophageal candidosis is the most frequent opportunistic digestive infection (48 p.c.). Anguillula is the only intestinal worm appearing to play a role: the role of bacteria and viruses cannot be evaluated precisely, but histopathological study revealed neither an atypical mycobacteriosis nor a virus disease (herpes, cytomegalovirus). If diagnosis appears to be still difficult in 1989 when confronted with AIDS and diarrhoea, it seems highly advisable to examine the stools, to perform high digestive fibroscopy with IADL and biopsies. On the other hand, indications for colonoscopy appear to be restricted.

[Principle aspects of acquired immunodeficiency syndrome (AIDS) in adults in Burundi]. / Principaux aspects du syndrome d'immunodepression acquise (SIDA) de l'adulte au Burundi.

The authors describe their experience of the infection by the virus of the human immunodeficiency HIV-1 in Burundi. The acquired immunodeficiency syndrome was brought to light in 1983 by the emergence of cryptococcal meningitis, Kaposi's sarcomas, disseminated candidiasis. 109 cases of infection by the virus of the human immunodeficiency (HIV) AIDS related complex, or acquired immunodeficiency syndromes, were observed in 8 months and are related in this paper. The authors elucidate the spread and amplify the role played by lorry drivers. The frequency of recent case history: tuberculosis, zona, sexually transmitted diseases (41%). Clinical manifestations have been studied according to their clinical stage: 28 patients are AIDS related complex (25%), 81 are acquired immunodeficiency syndrome. One have to notice the frequency of tuberculosis at the stage of acquired immunodeficiency syndrome, of digestive parasitoses, not only coccidiosis, but also strongyloidiasis and colonic amoebiasis, cryptococcal meningitis, and encephalopathies caused by the virus of human immunodeficiency (HIV) at the period of AIDS. Lethal evolution is fast: 28 out of the 81 AIDS were observed up to their end, occurring in less than 60 days, as an average. Lastly, numerous opportunistic infections cannot be diagnosed because the lack of technical facilities.

[Current strategies in the campaign against Plasmodium falciparum malaria in an area resistant to 4-aminoquinolines]. / Nouvelles stratégies de lutte contre le paludisme à Plasmodium falciparum en zone de résistance aux amino-4-quinoléines.

Confronted with the extension of chemoresistance of P. falciparum and the gradual renunciation of the fight against the vectors, it is important nowadays to manage better the means of fighting in the zones where chloroquine resistance exists. If preventive treatment of chills by 4-aminoquinolines is still able to realize prevention of mortality, treatment of all confirmed chills by P. falciparum has to combine sulfadoxine-pyrimethamine with quinine or amodiaquine.