New guidelines for the prevention of imported malaria in France.

Prevention of malaria is based on personal vector-control measures (PVCMs) to avoid mosquito bites at night and chemoprophylaxis if justified by the risk of contracting the disease. The most effective PVCM is the use of insecticide-treated mosquito nets. The decision to prescribe chemoprophylaxis, mainly to prevent Plasmodium falciparum infection, depends on the benefit-risk ratio. Overall, the risk of contracting malaria is 1,000-fold lower during a stay in the tropical regions of Asia or the Americas than in sub-Saharan Africa. For "conventional" stays (less than one month with nights spent in urban areas) in low-risk settings in tropical Asia and America, the risk of being infected with Plasmodium parasites (≤1/100,000) is equivalent or lower than that of experiencing serious adverse effects caused by chemoprophylaxis. Preventive medication is therefore no longer recommended. By contrast, in other settings and particularly in sub-Saharan Africa, chemoprophylaxis is the most effective measure against malaria. However, it is worth noting that no single preventive measure provides full protection. Regardless of the level of risk or chemoprophylaxis-related indication, protection against mosquito bites and rapid management of febrile illness after returning from an endemic area are also critical to prevent malaria. Finally, migrants of sub-Saharan origin visiting friends and relatives in their country of origin form a high-risk group who should be recommended chemoprophylaxis in the same way as any other travelers-with a preference for the least expensive molecules (doxycycline).

Successful treatment of a recurrent Aspergillus niger otomycosis with local application of voriconazole.

Fungal otitis (otomycosis) is a common infection encountered by otolaryngologists. Nevertheless, its management can be challenging because of its high recurrence rate and of the limited therapeutic options. A 45-year-old woman suffered from recurrent otomycosis. The ineffectiveness of successive antibiotic cures and repeated topical treatments with nystatin and then with econazole cream led to perform microbiological analyses. Culture of ear swab grew Aspergillus niger. The use of a 1% voriconazole sterile solution previously validated for treatment of eye infections was considered after ensuring the absence of known ototoxic effects of the antifungal and of the excipients. The patient was advised to apply locally this voriconazole solution daily for 14 days (3 drops, 3-4 times a day). Full recovery was obtained at the end of the treatment, and no relevant side effects were noticed. More than one year after completion of therapy, there was no recurrence. Our observation shows that voriconazole 1% solution is an interesting option for treating otomycosis which failed to respond to usual therapeutic options. Further prospective studies are now warranted to confirm these findings.

Post-international adoption medical follow-up at the Angers university hospital between 2009 and 2012.

OBJECTIVE: The authors had for aim to describe infectious diseases in internationally adopted child at arrival in France. PATIENTS AND METHODS: We made a retrospective descriptive study of the children's files having undergone medical check-ups between 2009 and 2012. RESULTS: One hundred and eighty-two files were included: 80% of the children came from Africa, 15% from South America and the Caribbean, 3% from Asia, and 2% from Europe. Forty-three percent were diagnosed with tinea. HIV, hepatitis C, and syphilis blood tests were all negative. Six children presented with acute or chronic hepatitis B, another 5 children with acute hepatitis A. One blood test for cysticercosis was positive. Two children presented with malaria. 58% of the children carried an intestinal parasite; the most prevalent was Giardia duodenalis. Bacteriological stool culture was positive for 17 children, for 9 with an antibiotic resistant bacterium. Twenty-seven children had a positive virological stool culture, 2 for a poliovirus. CONCLUSION: A systematic infectious check-up should be performed for a child adopted internationally when he/she arrives in France. This allows diagnosing diseases requiring an emergency treatment, or asymptomatic but severe diseases when chronic. Some blood tests must be double-checked when the child arrives, because of possible false negative initial tests results in the country of origin. Screening, early treatment, and implementing prophylaxis can decrease the risk of transmission to relatives. It also allows monitoring the antimicrobial resistance of some pathogens and the reintroduction of the poliovirus in France.

[Rhinofacial conidiobolomycosis associated with cervical, thoracic and brachial localizations: one clinical case in Nigeria]. / Conidiobolomycose rhinofaciale avec localisations cervicales, thoraciques et brachiales: à propos d'un cas nigérian.

We report here the clinical case of a Nigerian adult patient who received medical care during October 2010, at the Center for Diagnosis and Treatment of Buruli ulcer in Pobè (Benin). He presented a massive facial tumor associated with several subcutaneous (cervical, thoracic and upper limbs) nodules, evolving since several years. Tissue samples collected at Pobè medical center were addressed to the mycology and histology laboratories of Angers University Hospital (France), according to the medical exchange agreement between the two institutions about the diagnosis and treatment of Buruli ulcer disease. Histological examination showed a Splendore-Hoeppli phenomenon, consisting of a granulomatous reaction made of eosinophilic polynuclear cells surrounding rare, large and irregular, non-septate hyphae. A filamentous fungus was isolated by cultivation of the clinical samples, which was identified as Conidiobolus coronatus. The patient was treated orally with daily doses of ketoconazole (400 mg per day). After 4 months of treatment, a marked regression of the facial lesion was obtained. A first constructive facial surgery was achieved, but the patient did not attend the second step. This case report allows us to remind the mycological diagnosis of this exotic mycosis, but also to emphasize the main difficulties encountered in medical management in the developing countries.

Use of Sysmex XE-2100 and XE-5000 hematology analyzers for the diagnosis of malaria in a nonendemic country (France).

INTRODUCTION: Most studies dealing with automated hematology analyzers (HAs) and malaria diagnosis are conducted in endemic countries. METHODS: We retrospectively studied cell blood counts (CBCs) performed with Sysmex XE-2100 and XE-5000 HAs in our center (Angers, France) regarding 67 patients returning from endemic areas and infected with various Plasmodium species. RESULTS: In 83% of infected samples with Plasmodium vivax (Pv), ovale (Po), or malariae (Pm), extra clouds of dots were present in neutrophil and/or eosinophil area(s) on routine differential (DIFF) scattergrams. In contrast, samples infected with Plasmodium falciparum (Pf) failed to show such DIFF scattergrams, or any other suggesting malaria infection (0/ 49 pts). Abnormal areas from DIFF scattergrams were related to the presence of mature schizonts and gametocytes, undestroyed by lysis agent, the latter not observed in Pf-infected patients from our series. The internal parameter WBC[DIFF] - WBC[BASO] raised in parallel to parasitemia in Pv, Po, and Pm samples but could not be used as a surrogate for parasitemia. In Pf infection, reticulocyte/ immature reticulocyte fraction (IRF) ratio showed a significant correlation with parasitemia (P < 0.05). A diagnostic model developed for Pf in endemic countries showed sensitivity of 77%. CONCLUSION: Using SYSMEX analyzers, Pv, Po, and Pm infections are easy to ascertain as DIFF scattergrams are almost specific (specificity = 99.9%). Pf infection diagnosis by CBC may be a more promising tool.

[Assessment of vaccination coverage among travelers to areas where yellow fever is endemic (Senegal)]. / Évaluation de la couverture vaccinale des voyageurs se rendant en zone d'endémicité amarile (Sénégal).

This prospective survey, conducted at the Dakar airport from August 18, 2011, to May 8, 2012, asked a sample of travelers living in France and returning there after a stay in Senegal to complete a questionnaire. The aim of the study was to assess the determinants of vaccination coverage against yellow fever. The study included 10 298 travelers, with a median age of 48 years (interquartile range: 27-58); 52% were tourists, and 22% were traveling for business purposes. The measured level of anti-yellow fever vaccination coverage was 39.3%. Vaccination coverage was influenced by the travelers' level of knowledge and their perception of the risk.

[Travelers' knowledge of vaccines. A survey including 400 people having consulted an international vaccination center]. / Connaissances des voyageurs à propos des vaccins. Enquête auprès de 400 personnes consultantes d'un centre de vaccinations internationales.

UNLABELLED: The authors conducted a survey in an international vaccination centre. The aim of the study was to assess the travelers' knowledge of vaccines and to check their health record to determine the vaccination rate. We used a self-administered questionnaire and added vaccination certificates to the document. RESULTS: Most of the travelers knew about complications due to vaccinations, but ignored their contraindications. Knowledge decreased over the age of thirty. The travelers agreed with antihepatitis B vaccination and only 10% mentioned the risk of multiple sclerosis. The list of compulsory vaccinations and their schedule were well-known but some of the travelers ignored their vaccine status and said they trusted their general practitioner. Only 40% of people over 20years of age were able to present their national or international vaccination certificate, a reason for underestimating the vaccination rate. CONCLUSION: It would be necessary to have a "World Health Organization" type vaccination certificate available for all French people over 20years of age, while improving the smart health card and training practitioners to better inform their patients about vaccinations.

[Management of malaria for children in France in 2008]. / Actualité sur la prise en charge du paludisme de l'enfant en France.

France is the most important country out for imported malaria. Malaria epidemiological data managed by the malaria national reference center shows that the malaria of children concerns migrant who travel in Africa during summer to visit family. Preventing and treatment recommendations are formerly published by "Haut conseil de la santé publique". Revision 2007 of the 1999 consensus conference about management and prevention of imported Plasmodium falciparum malaria were published in February 2008. This article presents the actuality of these recommendations for clinical pratice.

Pneumocystis carinii pneumonia in patients with hematologic malignancies: a descriptive study.

Objectives. A retrospective multicentric study was conducted over a five-year period to evaluate the clinical and laboratory characteristics and outcome of patients with proven Pneumocystis carinii pneumonia (PCP) complicating hematologic malignancies.Results. The study included 60 HIV-negative patients with 18 non-Hodgkin's malignant lymphoma (30%), 13 chronic lymphocytic leukaemia (21.7%), 10 acute leukemia (16.6%), 5 multiple myeloma (8.3%), 4 Waldenström's diseases (6.6%), 4 chronic myeloid leukemia (6.6%), 3 myelodysplasia (5%), 2 Hodgkin's diseases (3.3%) and 1 thrombopenia. Bronchoalveolar lavage was diagnostic in all patients. Forty-nine patients received cytotoxic drugs (81.7%), 25 (41.7%) a long-term corticotherapy and 15 (25%) underwent bone marrow transplantation. Twenty-seven patients (45%) required admission in the intensive care unit, 35 (58.3%) received an adjunctive corticotherapy and 18 mechanical ventilation (30%). Twenty patients (33.3%) died of PCP. A previous long-term corticotherapy (p=0.04), high respiratory (p=0.05) and pulse rates (p=0.02), elevated C reactive protein (p=0.01) and mechanical ventilation (OR=13.37; IC: 1.9-50) were associated with a poor prognosis. Adjunctive corticotherapy did not modify the prognosis.Conclusions. These results suggest that PCP can occur during the course of various hematologic malignancies, not only lymphoproliferative disorders. Prognosis remains poor. The diagnosis should be advocated more frequently and earlier to improve the prognosis.

Analysis of underlying diseases and prognosis factors associated with Pneumocystis carinii pneumonia in immunocompromised HIV-negative patients.

The aim of this retrospective study was to determine the underlying diseases associated with Pneumocystis carinii pneumonia (PCP) in immunocompromised HIV-negative patients and to identify prognosis factors in this population. One hundred three cases of PCP were diagnosed over a 5-year period. Diagnosis was established on the basis of clinical features and by detection of Pneumocystis carinii cysts in bronchoalveolar lavage fluid. Underlying diseases comprised hematologic malignancies (n=60; 58%), inflammatory diseases (n=27; 26%), and solid tumors (n=18; 17.5%); 9 (8%) patients were solid organ transplant recipients. Seventy-one (69%) patients received cytotoxic drugs, 57 (55%) were treated with long-term corticotherapy, and 15 (14.7%) underwent bone marrow transplantation. Fifty-eight (56%) patients were admitted to the intensive care unit, and 52 (41%) required mechanical ventilation. Thirty-nine (38%) patients died of PCP; data from these patients were compared with those from surviving patients. The following factors were associated with a poor prognosis: high respiratory rate (P=0.005), high pulse rate (P=0.0003), elevated C-reactive protein (P=0.01), elevated serum lactate dehydrogenase level (P=0.02), and mechanical ventilation (OR, 14.4; 95%CI, 5-50). The results suggest that PCP can occur during the course of many immunosuppressive diseases, particularly various hematologic malignancies. The diagnosis of PCP should be considered more frequently and advocated earlier in immunocompromised HIV-negative patients, since prompt diagnosis may improve the prognosis of these patients.

[Loffler's fibroblastic endocarditis. A report of a case complicating toxocarosis]. / Endocardite fibroblastique de Löffler. A propos d'un cas compliquant une toxocarose.

The authors report a case of Löffler's fibroblastic endocarditis complicating a toxocarosis infection. Parasitic infestation with toxocara canis is usually asymptomatic, but this was a very rare observation of cerebral involvement associated with symptomatic Löffler's endocarditis. This is an unusual form of restrictive cardiac disease constantly accompanied by prolonged hypereosinophilia. In addition to the classical signs of cardiac failure, an acute febrile illness imitating a connective tissue disease may be observed. Echocardiography helps diagnosis by showing endomyocardial fibrosis and adherent thrombosis at one or both ventricular apices. The management of cardiac failure should include, whenever possible, radical treatment of the hypereosinophilia. At an advanced stage, surgical endocardial decortication is the only means of improving symptoms and the prognosis of these patients.

[Urticaria and parasites]. / Urticaire et parasites.

Urticaria has many etiology and during its exploration, it's important to mind about parasitic disease. The authors present briefly ten of them potentially associated with this eruption. For each disease (ascaridiosis, trichinellosis, fasciolosis, giardiosis, toxocarosis, anisakidosis, cercarial dermatitis, schistosomiasis, strongyloidosis, hydatidosis), they precise epidemiological situation for contamination and simple diagnosis approach.

[Individual prevention of malaria caused by Plasmodium falciparum]. / Prévention individuelle du paludisme à Plasmodium falciparum.

Individual protection against Plasmodium falciparum malaria is based on a simultaneous observance of a preservation from mosquitos bites during the night and an adapted chemioprophylaxis. It is suitable to personalize chemioprophylaxis advices according to the ground (intolerance to anti paludic drugs, drugs interactions, pregnancy...) to the context of the transmission (visited countries, seasons, resistance level of malaria strains) and at last the local way of the medical assistance under taken against this disease. Nevertheless, it is good to remind that there is no preventive mean which gives full protection by itself. All fever that happens after a trip in an endemic zone for malaria has to be considered firstly as due to malaria and investigations have to be made under this condition.

Pulmonary toxoplasmosis after allogeneic bone marrow transplantation: case report and review.

We report an isolated case of toxoplasma pneumonitis in a 27-year-old man. This acute infection occurred after induction chemotherapy for AMLo relapsing 3 years post-allogeneic BMT. The detection of Toxoplasma gondii in the bronchoalvolar lavage (BAL), by culture in fibroblast cell line MRC5 enabled us to make the diagnosis. Pyrimethamine and sulfadiazine were effective.

Pleural effusion and toxocariasis.

The case history is described of a woman who presented with bilateral pleural effusions caused by Toxocara canis infestation. The condition responded rapidly to treatment.

[Cercarial dermatitis in Europe: a new public health problem?]. / La dermatite cercarienne en Europe: un problème de santé publique nouveau?

Cercarial dermatitis is a parasitic impasse that has worldwide distribution. The condition manifests itself as a highly pruriginous skin rash and is due to penetration of the dermis by larval stages (furcocercariae) of avian trematodes. Many species may be responsible for this disease. In Europe the genus Trichobilharzia is widely represented, in particular by the species T. ocellata; the definitive host is the duck (Anas platyrhinchos); the intermediate hosts are snails of the genus Lymnea (L. ovata or L. stagnalis). In France, cases of cercarial dermatitis were reported in June and July 1994 to the health authorities of three départements in the Pays de la Loire Region (western France). The epidemiological situation, common to the three maintained ponds that were concerned, is as follows: high level of eutrophication of the sites, colonization of the ponds by L. ovata, and settlement by many duck colonies. The simultaneous occurrence of these three phenomena, combined with long hours of sunshine in the summer, is responsible for most of the foci of cercarial dermatitis recently described in Europe. Control of this condition is difficult, requiring strict maintenance of bodies of water and if necessary the use of molluscicides such as niclosamide. The use of praziquantel in baits for treating the definitive hosts appears to interrupt the natural cycle of the avian Schistosomatidae. In the light of the observations reported here and the analysis of recent publications, cercarial dermatitis may be regarded as an emerging disease. Its public health impact needs to be evaluated at the global level.