Chloroquine-resistant Plasmodium falciparum in Cameroon.
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Biomedical subjects
Publications and source records attributed to G Charmot.
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Between April and June 1984, eight chloroquine-resistant P. falciparum malaria cases were observed in non-immune patients after their emergency sanitary return from NE Mozambique. In vivo resistance to amodiaquine and pyrimethamine were demonstrated from two isolates. Radical cure was obtained with mefloquine in all cases. These patients came from an expatriate community of 35 adult men among which six other chloroquine-resistant malarial cases were probable. The epidemic pattern of this chloroquine-resistant focus is underlined.
Two new cases of Lyme disease are reported. Both were contracted in western France. In the first case, a tick bite was followed by a typical erythema chronicum migrans and then a subacute arthritis. High levels of specific antibodies were demonstrated. In the second case, only erythema chronicum migrans developed and serology remained negative. At least, 16 typical cases of Lyme disease have now been reported in France from several geographical areas.
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With reference to an exceptional observation of arthritis due to Loa loa filariasis with eosinophils predominating in the joint fluid, the causes of such joint effusions are reviewed. These effusions are neither specific of nor consistent in articular manifestations of parasitic infections. Demonstration of a high eosinophil count in joint fluid should always suggest a parasitic disease. However, synovial eosinophilia may be found in many other conditions and may even appear to be primary.
In a village of 841 inhabitants, we were able to examine 553 subjects, 357 of whom had urinary egg excretion. The patients were treated with a single dose of 35 mg/kg oltipraz which was given under surveillance together with either whole milk or herrings in oil. The tolerance of the product was very good as only 3% of the patients reported vomiting and 3% paresthesias of the fingers. 66% of the patients examined on day 30 and/or on day 90 were egg-negative and egg excretion was reduced by at least 90% in 22 other subjects, bringing the percentage of good results to 74%. On day 90, the mean egg excretion was reduced by 82.5% in the overall population and by 80.9% in the 5 to 14 year-olds.
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The authors describe their experience of 16l patients (151 adults and 10 children) with hepatic amebiasis. Diagnosis and treatment were carried out at the Treichville Hospital University Center in Abidjan over a three-year period, from September 1976 to November 1979. Diagnosis was established without question in all cases. The indirect immunofluorescence reaction was particularly helpful. All patients were treated by metronidazole or it's derivatives. Semiology, course and therapy are described in detail. A comparison is made with cases published in the literature during the last 15 years. Most of the classical pictures were encountered in this study. The clinical picture may be misleading, for instance when it is suggestive of cancer or when jaundice is present. Immunology is particularly interesting in atypical forms. The authors insist on the unvarying and high morbidity due to this disease which accounts for 2% of all hospitalizations. Prognosis has improved, the mortality rate among adults was 4.5%. A fall in the number of surgical procedures was recorded. Only 10% of the patients underwent surgery. The therapeutic principles advocated by the authors are described. They can be used even when echotomography is not available, as is usually the case in regions where the disease is endemic.
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In a patients with P. falciparum malaria contracted in Thailand, the course of the disease under treatment suggested resistance to both chloroquine and pyrimethamine-sulfadoxine, as well as reduced sensitivity to quinine. This was confirmed by in vitro tests on continuous culture of the strain. Therapeutic success was obtained with a quinine-cycline combination. The problems raised by the emergence of P. Falciparum strains resistant to polychemotherapy are emphasized.
Asiatic dengue was detected in nine tourists. In eight patients it was of the classical benign type, the ninth case being associated with severe thrombopenia (4 000/mm3), but without signs of shock. A brief summary is given of the physiopathology of the hemorrhagic forms of the disease: acquired sensitivity from a primary attack and reinfection with a heterologous virus; selection of virulent strains by an atypical vector; genetic recombination producing a strongly pathogenic virus.
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