[Digestive parasitic diseases. A continuous current problem].
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Biomedical subjects
Publications and source records attributed to M S Ben Rachid.
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We report a case of double primary amoebic brain abscess in a 22 year old man, with signs of intracranial hypertension and deficit. Computed tomography found two hypodense lesions, not suggestive of pyogenic abscesses. Aspiration of one of the two abscesses, revealed the organism, and the two abscesses regressed in response to medical treatment. The authors insist on the rarity of these abscesses, their gravity, and the difficulty of the diagnosis.
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In order to assess canine leishmaniasis prevalence rate in Enfidha area, considered to be the most important kala-azar focus in Sousse Governorate, a serological survey was carried out in 6 localities. 265 sera were examined by DAT and IFAT. 16 (6.03%) showed positive results for anti-leishmania antibodies with significant variations according to the locality. A fairly DAT-IFAT good correlation was observed.
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In the present study, sera of 56 children suffering from visceral Mediterranean leishmaniasis were analysed. The incidence of circulating immune complexes (CIC) by ELISA technique using the conglutinin binding assay was 39% before treatment, 28% after the first treatment, and nil at the end of the second one. The C4 levels remain low even after treatment. The anti-leishmania antibodies (AAL) account for 95% of the cases before treatment and 84% after treatment. The rheumatoid factor (FR) also remains with more or less the same frequency (74%) before and after treatment. The search for a correlation between the presence of CIC and the other immunological factors show that the average titre of AAL is higher in the group of patients that have CIC than in the group that does not. The C4 levels are significantly reduced in the CIC positive group of patients, whereas the rate of IgG is significantly increased in the same group. The study of the evolution of CIC under treatment in nine patients shows that they disappear at the end of the treatment, and that the FR reduces but does not disappear.
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Sera from 77 rodents (Psammomys obesus: 64; Meriones (M.) shawi: 10; M. libycus: 3) trapped in a focus of zoonotic cutaneous leishmaniasis (ZCL) (Leishmania (L.) major) were examined for the presence of anti-leishmanial antibodies by the indirect fluorscence antibody technique (IFAT) (L. major antigens) using homologous antiglobulins and/or anti-Rattus conjugates. Sera from 21 animals were positive with titres that ranged from 1: 20 up to 1: 640. The investigation revealed that a good correlation existed between the occurrence of antileishmanial antibodies in the sera and amastigotes in the rodents' ears. The data also suggest the suitability of the IFAT as an epidemiological tool to estimate rates of infection by L. major in Psammomys obesus and Meriones Spp. in foci of ZCL.
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From an analysis of 1,546 cases of cutaneous leishmaniasis collected throughout Tunisia three clinico-epidemiological forms could be determined. These forms are due to three different species of Leishmania and are observed in different geographical areas. Sporadic cutaneous leishmaniasis (SCL), 63 cases. This form is found in Northern Tunisia, in known foci of Kala-azar. 96% of the patients have a single, small, ulcerated and crusty lesion on the face surrounded by an important zone of infiltration. Amastigotes are less than 4 microns in diameter, and it is very difficult to maintain the parasites in cultures. This form is probably due to Leishmania infantum, as has been demonstrated in Algeria in a similar form evolving in the same biotope as the Tunisian form. The vector and reservoirs of SCL are unknown. Zoonotic cutaneous leishmaniasis (ZCL), 1,412 cases. The disease is epidemic in Central and Southern Tunisia. The lesions are multiple; they affect the limbs more frequently than the face and heal in less than 8 months. They are polymorphous, usually large and superinfected. There is a seasonal occurrence of the outbreaks (summer and autumn). Amastigotes are large (4 to 6.5 microns in diameter) and the parasites easily grow in cultures. This form is caused by Leishmania major, and its vector is Phlebotomus papatasi. Three species of rodents harbour the parasite. Anthroponotic cutaneous leishmaniasis (ACL), 71 cases. This form is endemic in South-Eastern Tunisia. 70% of the patients present with single lesions, one half of which affect the face. Dry and proliferating lesions are the most frequent.(ABSTRACT TRUNCATED AT 250 WORDS)
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The serum of Ctenodactylus gondi, a Tunisian rodent, contains a unique inhibitor of the terminal complement pathway. The auto-inhibitor has been partially characterized as a heat-stable euglobulin that is slightly retarded on a DEAE-ion exchange column at pH 7 and elutes as a symmetrical peak on Sephacryl S-300 in the mol. wt region of approximately 200,000. The inhibitor acts by preventing attachment of cytolytic C5b-9 complexes to natural target cells. It does not appear to affect formation and function of C3-convertase, does not exert inhibitory effects at stages later than C5b-7 formation, and also does not prevent formation of SC5b-9 in serum. That the factor prevents attachment of C5b-7/C5b-9 to cells has been demonstrated in hemolysis model systems using sheep EA + human serum, and in the C3-independent reactive lysis system with the use of ELISA methods and quantitative assays with radioiodinated C8. Addition of partially purified inhibitory factor to human sera or to sera of other animal species abolishes the hemolytic activities of these sera. The inhibitory factor of Gondi serum is the first inhibitor of the terminal pathway which has been shown to be capable of preventing cytolysis of cells undergoing complement attack under physiological conditions. The presence of this factor is probably partially responsible for the remarkable susceptibility of C. gondi towards bacterial and parasitic infections.
The parasite-burden, which is indicative of the macrophage activity, was determined before treatment in 84 kala azar cases (L. infantum) and compared to non specific immune response parameters (serum IgG, and IgM), to the specific antibody levels as detected by immunofluorescence and IgG and IgM-ELISA, as well as to rheumatoid factor titers. In 57 cases presenting with less than 3 months from the first appearance of symptoms and despite some individual variations, high parasite-burden levels were accompanied with high specific and non specific immune response parameters and inversely. The data suggest that, during kala azar, low and high immune responders could be distinguished in the humans in the way it was demonstrated by Biozzi in mice. Data collected from 27 cases with more than 3 months duration showed a poor correlation. However, at highest antibody levels, some decreasing in parasite-burden was noticed. The prognostic value of the parasite-burden determination is emphasized. Genetic studies of populations would improve control measures.
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The presence of Phlebotomus papatasi naturally infected with Leishmania (2 females out of 24), is reported for the first time, in a Tunisian zoonotic cutaneous leishmaniasis focus.
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