Biomedical subjects
Publications and source records attributed to J J Floch.
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 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.
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.
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.
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.
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.
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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.
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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.
The incidence rate of respiratory (lung and upper respiratory tract) cancer related to the nickel industry was studied in the male population of New Caledonia over a 7-year period (1978-1984). The findings show no excess incidence of lung or upper respiratory tract (larynx, pharynx, nasal cavities) cancer cases in the population of nickel workers compared with the rest of the male population in New Caledonia. This result was corroborated by a case-control study which does not indicate any particular role of hazards specific to the nickel mining and refining industry. Our findings, which may be specific for the type of ore processed in New Caledonia, must nevertheless be confirmed by extending the study to a total of 10 years (1978-1987). The incidence rate of male respiratory cancer in New Caledonia was also compared to that of cancers of this type reported in certain regions of industrialized countries (Australia, France, U.K., USA). Such findings are very similar to those observed in New Caledonia, thereby confirming a predominant role of tobacco and alcohol consumption in a territory which, despite certain characteristics of a developing country, has life-style habits similar to those of industrialized countries.
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Destombes, Rosai and Dorfman's sinus histiocytosis (HS) is a rare disease. Many cases have been reported in Africans, particularly in children. Case reported here is the second malian clinical report. Its particularities are difficulties for the histological diagnosis with confusion with Hodgkin's disease, a temporary decrease of adenopathies after vincristine therapy, an eosinophilic infiltrate of lymph nodes and a long evolution during at least 4 years. The pathological physiology of HS remains uncertain. The benign natural course of the disease does not justify employment of chemotherapy.
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In a test area (suburbs of Nouméa), a survey on acute infantile gastro-enteritis showed an annual incidence of 2.2% and a hospitalization rate of 27.5%. The 0 to 23 months age group was the most exposed. The factors of severity were: a low age, a high frequency of liquid stool, vomits, fever and associated acute respiratory infection. The etiologic diagnosis was possible in 76% of cases: 49.5% enteropathogens (22% bacteria, 27.5% viruses), 26.5% non-intestinal infections. The asymptomatic carriers were 11.5% for bacteria and 27.4% for viruses. In regard to epidemiology, the housing hygiene, the potable water supply and the presence of suitable water closet were over 90%. On the contrary, the individual hygiene was neglected, especially the hand washing. The pathogens are transmitted by the dirty hands of asymptomatic carriers. Mass media campaigns and health education of parents and children are the recommended prophylactic measures.
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