Biomedical subjects
Publications and source records attributed to P Bourée.
Parasites are rarely localized only in the urinary system. Schistosoma haematobium infection is very frequent in tropical Africa; it is revealed by a hematuria. Most hydatic cysts are localized in the liver, but a renal infection is possible. Other parasitoses (filariasis, malaria) often result in immune complex glomerulonephritis and are cured by specific treatment of the parasites.
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A POTENTIAL PUBLIC HEALTH PROBLEM: Cercarial dermatitis is caused by the infestation of the skin by cercariae of nonhuman schistosomes whose commonest hosts are aquatic birds. Human contamination can occur during swimming in fresh water infested with cercariae and notably ducks. Its geographic distribution is worldwide and is increasingly described in France during the summer months. FROM A CLINICAL POINT OF VIEW: A diffuse eruption composed of prurigenous maculopapules appears within the 24 hours following exposure. Regression is spontaneous within one day to three weeks. PREVENTION IS ADVISABLE: Treatment is symptomatic in the majority of patients. The optimal prevention, for bathers, is to swim in sufficiently deep water.
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OBJECTIVE: To compare the intrarectal bioavailabilities of two parenteral formulations of quinine most available in French- (Cinchona alkaloid mixture) and English (hydrochloride salt) -speaking areas of Africa. METHODS: The pharmacokinetics of quinine was investigated in four groups of 12 children with acute Plasmodium falciparum malaria receiving 8 mg/kg quinine base every 8 h either as hydrochloride salt or Cinchona alkaloid mixture by a slow 4-h intravenous infusion or intrarectal administration. Body temperature and parasitaemia were monitored, and blood quinine concentrations were measured by means of high-performance liquid chromatography. RESULTS: At 72 h, all the children were aparasitaemic and apyretic. Quinine C(max) values were higher after intravenous infusion of the hydrochloride salt and Cinchona alkaloid mixture (6.9+/-1.9 micro g/ml and 5.2+/-1.3 micro g/ml) than after intrarectal administration (3.5+/-1.4 micro g/ml and 3.1+/-1.6 micro g/ml), but t(max) values were similar (3.6+/-1.5, 4.2+/-1.0, 4.0+/-1.9, and 4.7+/-2.0 h, respectively). Intrarectal relative bioavailabilities of hydrochloride salt solution (57%) and Cinchona alkaloid mixture (62%) were similar. CONCLUSION: Whatever the parenteral formulation of quinine, the blood concentration-time profiles of quinine were similar after intrarectal administration. Intrarectal administration of hydrochloride salt solution is a possible mode of quinine delivery in remote rural areas of Africa.
Isospora belli infection is frequent in patients with acquired immunodeficiency syndrome in tropical areas. It has also been reported in other immunodepressive diseases, such as lymphoblastic leukemia, adult T-cell leukemia, and Hodgkin's disease. To date, no case of non-Hodgkin's lymphoma-related isosporiasis has been reported in a non-HIV-infected patient. We describe a case of non-Hodgkin's lymphoma with chronic diarrhea due to I. belli. In Europe, I. belli can cause severe chronic diarrhea in patients with malignancies whose country of origin is in an endemic area. Trimethoprim-sulfamethoxazole can provide rapid and prolonged clinical and parasitologic cure.
A retrospective study of strongyloidiasis cases was carried out in Sfax University (Tunisia), between 1989 and June 2001. Diagnosis was done by direct stool examination, concentration methods, Baermann larval extraction and fecal culture. Strongyloidiasis was diagnosed in 27 patients of whom 77% were males living in rural areas under low socioeconomic level. Mean age of patients was 47 years (8 to 85 years). Hypereosinophilia was present in 75 % of cases, and 7 patients were treated by systemic corticosteroids. So, it is important to detect this parasite by repeated parasitological stool examinations, particularly before a long corticosteroid treatment.
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Enterocytozoon bieneusi is an agent of intestinal microsporidiosis leading to malabsorption syndrome and diarrhea in AIDS patients. Respiratory tract microsporidiosis due to Encephalitozoon spp. has been reported. To date, however, only two cases of pulmonary involvement of E. bieneusi have been documented for patients with intestinal microsporidiosis. We report here another pulmonary localization of E. bieneusi in a human immunodeficiency virus-infected patient. Clinical features of these three cases are reviewed. E. bieneusi can colonize the respiratory tract but could be considered a simple carriage associated with an intestinal infection.
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Hydatidosis is a widespread zoonosis infecting a large number of animals and humans. Echinococcus granulosus has the smallest taenia adult of the cestodes but with the largest larva. Its morphologic and biologic features were identified with DNA analysis. Different strains were separated according to the intermediate hosts: sheep, cattle, pigs, horses, camels. Definitive host are canids, mostly dogs, where the worm grows to adulthood in several months. The eggs are scattered in the pasture by wind and water and are ingested by various hosts. The larvae migrate through the intestinal wall and penetrate the organs, mostly liver and lungs. The eggs survive several days outside, depending on the temperature, but numerous eggs die in nature because they cannot resist desiccation and extreme temperatures. Dissemination is accomplished by dogs. In Turkana (Kenya) the incidence of hydatidosis is high because of the close relationship between the population and dogs and the habit of leaving their dead bodies in the grasslands. In rural areas, the custom of slaughtering sheep at home, among the dogs, is an important dissemination factor. The circumstances of transmission vary according to the country. In Europe the natural life cycle of E. granulosus granulosus involves dogs as the definitive host and sheep as the intermediate host. In northern Europe E. granulosus borealis infects the canids and deer. E. granulosus canadensis infects wolves and reindeer, but there are no human cases. In the endemic Mediterranean area, sheep and dromedaries are the intermediate hosts. In South America, the life cycle of E. granulosus develops among several definitive and intermediate hosts. Hence the dynamics of transmission vary according to the countries with different hosts.
UNLABELLED: New Caledonia is a French territory of Pacific Ocean, where frequent dengue outbreaks occur. In 1995 and 1996, 3042 cases (including 18.3% children) were diagnosed in Pasteur Institute of Noumea. PATIENTS AND METHODS: This work was a clinical and biological study of 68 in-patients of different ethnical groups in children. Among these young patients, 14 cases of dengue hemorrhagic fever occurred. RESULTS: The children were admitted to hospital after an average of 2.7 days of complaint, and during 6.7 days. The most important symptoms were fever at 39 degrees C (100%) during 2.2 days, sweatings (100%), malaise (57%) and headache (50%). Forty children had, at least, one hemorrhagic symptom. Leucopenia was noticed in 42 children, on an average of 4.2 days. A thrombocytopenia (mean 114,746 platelets/mm3) occurred in 5.3 days in 34 children (six cases with less than 10,000 platelets/mm3). A bacterial infection arised in 23.5% of children. CONCLUSION: Dengue is an important problem of public health, which occurs in all population, including the young children. The fight against dengue fever by a rapid destruction of larvae and adult mosquitoes led to the decrease of the outbreak.
Disseminated candidiasis, especially ocular infections such as endophthalmitis, is uncommon in HIV-infected patients. We report a case of candidal endophthalmitis in an HIV-positive non-drug-user patient, following candidemia from a cutaneous abscess at the site of a peripheral catheter. Ocular disease was revealed by a visual decrease in the left eye. DNA analysis using RAPD showed identical patterns of Candida albicans isolated from the skin and eye. Combination therapy with high-dose fluconazole and intravenous amphotericin B was performed. Two intravitreal amphotericin B injections and a vitrectomy were administered because of an amblyopic right eye and severe vitritis. The outcome was favorable without relapse at 18 months.
We report the first case of a scalp pseudomycetoma due to Trichophyton schoenleinii in a 15-year-old girl from Senegal. The lesion was not associated with tinea capitis. Long-term antifungal therapy with itraconazole and terbinafine was unsuccessful but a favourable outcome was obtained after surgical removal of the lesion. Between 1973 and 1999, only 12 previous cases of dermatophyte pseudomycetoma of the scalp were reported in the literature. Clinical features and therapeutic outcomes of these cases are reviewed.