[Identification of leishmaniasis: current clinical and epidemiological tools].
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Animals↗
Biomedical subjects
R Piarroux
Publications and source records attributed to R Piarroux.
Comparison of PCR with direct examination of bone marrow aspiration, myeloculture, and serology for diagnosis of visceral Leishmaniasis in immunocompromised patients.
A PCR assay amplifying a repeated sequence from the Leishmania infantum genome was compared with direct examination of bone marrow aspirate, myeloculture, and serology for the diagnosis of visceral leishmaniasis in immunocompromised patients. Of 73 patients living in an area endemic for leishmaniasis and where visceral leishmaniasis was suspected by physicians, only 10 had an indisputable diagnosis of visceral leishmaniasis. None of the diagnostic tests performed in the study achieved 100% sensitivity for diagnosing visceral leishmaniasis. PCR exhibited superior sensitivity (82%) in comparison with bone marrow aspirate examination (55%) and myeloculture (55%). Our PCR assay also showed good specificity (97%), negative predictive value (97%), and positive predictive value (82%) even when all unconfirmed PCR results were scored as false positives. Serology exhibited good sensitivity (80%) and excellent specificity (100%), negative predictive value (98%), and positive predictive value (100%) in diagnosing new cases of visceral leishmaniasis but failed to diagnose relapses. We also observed consistent negative serological results using several different immunological detection methods for 2 of the 10 patients with confirmed cases of visceral leishmaniasis. This lack of serological reactivity persisted throughout the course of their infections. These results demonstrate the importance of using PCR as an aid in the diagnosis of visceral leishmaniasis in immunocompromised patients.
AIDS-Related Opportunistic Infections↗
[Pulmonary tuberculosis in infants. Apropos of 6 cases].
BACKGROUND: The present increased incidence of tuberculosis in children can be explained by contacts with infected adults and/or late BCG vaccination. PATIENTS: Six infants, 3 to 18 months-old (mean: 8 months), were admitted from November 1990 to May 1992 for various reasons; only two were admitted with a diagnosis of tuberculosis based on tuberculin test and only one was given a BCG vaccine. The disease produced a broad range of symptoms. Diagnosis was based on tuberculin test and radiographic examination showing lymph node enlargement of mediastinum and segmental consolidation lesions. Mycobacterium tuberculosis was found in two cases. The patients were given isoniazid, rifampin, ethambutol and/or pyrazinamide; corticosteroids were added in five patients. Each patient received four or three drugs for 2-4 months and two drugs (isoniazid plus rifampin) beyond, for a mean total duration of 13 months (range: 9-17 months). Repeated CT scan of thorax was performed to evaluate the efficacy of treatment. Tuberculosis was diagnosed in 11 subjects in contact with these children. CONCLUSION: Tuberculosis in children is not rare, and BCG vaccination of neonates should be seriously considered.
BCG Vaccine↗
Isolation and characterization of a repetitive DNA sequence from Leishmania infantum: development of a visceral leishmaniasis polymerase chain reaction.
To construct a DNA probe specific for protozoa that cause visceral leishmaniasis, we cloned Pst I fragments of Leishmania infantum genomic DNA into a Bluescript II SK vector. A clone of 4.3 kb that contained a highly repetitive sequence was isolated and cut with three restriction enzymes: Hae III, Rsa I, and Sau 3A. After a new molecular cloning step, we isolated and sequenced a 140-basepair (bp) fragment. Two oligonucleotides were synthesized to be used as primers for a polymerase chain reaction. Using this probe, we detected an amount of DNA equivalent to one promastigote of L. infantum. This probe showed a high specificity; all protozoa tested that cause visceral leishmaniasis and L. major (one of the causative agents of Old World cutaneous leishmaniasis) showed a 100-bp amplified sequence, whereas other Leishmania strains showed a signal of a different size or else no signal. Moreover, no amplified sequence was obtained with other pathogenic parasites tested (Trypanosoma brucei, T. cruzi, Plasmodium falciparum, Pneumocystis carinii, and Toxoplasma gondii).
Animals↗
[Pseudo-tumoral form of urinary bilharziasis in a child].
A tumor-like form of urinary schistosomiasis is reported. Diagnosis was established intraoperatively. The finding of hematuria and of a stay in an area where schistosomiasis is endemic suggested the diagnosis but specific investigations were negative. Cystoscopy revealed a budding, hemorrhagic tumor lying against the posterior aspect of the bladder with no other lesions suggestive of schistosomiasis. The true prevalence of these tumor-like forms of urinary schistosomiasis is analyzed. Emphasis is put on the need for using several investigations to reach the correct diagnosis.
Child↗
Choice of therapy for imported cases of falciparum malaria in children: a retrospective study of 100 cases seen in Marseilles, France.
We have carried out a retrospective study on 100 children in hospital in Marseilles, France with a diagnosis of Plasmodium falciparum malaria. On admission, the main clinical features were anaemia (90 cases), fever (83 cases, > 40 degrees C in 22 cases), hepatomegaly (44 cases), vomiting (29 cases), neurological signs (22 cases), thrombocytopenia (13 cases), hyperparasitaemia (6 cases), jaundice (4 cases), shock (1 case) and hypoglycaemia (1 case). Severe malaria, as defined by the World Health Organization Malaria Action Programme, was rare in our study (only 2 cases) and the prognosis was good (no death, no sequela). The search for neurological signs such as impaired consciousness, prostration or convulsions is an effective and simple way to diagnose potentially severe cases. In the presence of these signs, intravenous quinine treatment resulted in a shortened duration of fever (30 h instead of 63 h) and thereby avoided patients becoming worse. In children without neurological signs or persistent vomiting, oral therapy may be used even if there is high fever or hyperparasitaemia, but close surveillance is required. Patients treated with halofantrine or mefloquine had a shorter stay in hospital than those treated with chloroquine (mean = 4 d instead of 5.7 d). The resistance of some strains to chloroquine may explain this difference.
Administration, Oral↗
The use of isoelectric focusing on polyacrylamide gel for the enzymatic analysis of 'Old World' Leishmania species.
Using isoelectric focusing (IEF), a high resolution electrophoresis technique, we analysed 6 enzymes of 24 cloned strains representing all major taxa of 'Old World' Leishmania. The comparison of enzymatic patterns obtained with IEF and starch gel electrophoresis showed that IEF is a more discriminatory and more informative technique for the enzymatic analysis of Leishmania strains; it can detect very slight differences between 2 electromorphs not revealed with starch gel electrophoresis. Moreover, IEF detected several multi-banded patterns which appeared as single bands with starch gel electrophoresis. These multi-banded patterns could not be the result of strain heterogeneity since all the strains had been cloned. Their significance in the biology of Leishmania is discussed.
Animals↗
Combined eco-epidemiological and molecular biology approaches to assess Echinococcus granulosus transmission to humans in Mauritania: occurrence of the 'camel' strain and human cystic echinococcosis.
Mauritania lies between West-Central Africa where human cystic echinococcosis (CE) is considered extremely rare and West Maghreb where CE accounts for a real public health problem. Until 1992, Mauritania was considered as human CE-free even through CE seemed well known in livestock. In 1992, the introduction of ultrasonography led to the diagnosis of the first human CE cases. In 1997, a veterinary study revealed that dogs living around Nouakchott were commonly infected by Echinococcus granulosus. To assess E. granulosus transmission and to identify the most relevant animal reservoir responsible for human CE emerging in Mauritania, a simultaneous eco-epidemiological and molecular biology approach was performed. The fieldwork included sample collection and investigation of relationship between intermediate hosts, definitive hosts and humans. Typing of E. granulosus strains was performed using comparison of polymerase chain reaction (PCR)-amplified DNA sequences with one nuclear (BG 1/3) and 2 mitochondrial (COI, NDI) targets. Results show that the 'camel' strain is actually infectious to humans and circulates between intermediate hosts including camels and cattle. It is suggested that preventive measures at slaughtering places could reduce human contamination.
Animals↗
Use of molecular tools for the diagnosis and typing of a Leishmania major strain isolated from an HIV-infected patient in Burkina Faso.
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AIDS-Related Opportunistic Infections↗
[Toxocariasis].
A COSMOPOLITAN PARASITIC ZOONOSIS: Toxocariasis is a widespread native parasitosis. It is due to the presence of Toxocara-type nematode larvae in the organism, that is at the origin of various clinical pictures. Transmitted by dogs and more rarely by cats, contamination occurs by ingestion of embryos deposited on the ground (animal excrements). MULTIPLE CLINICAL FORMS: The clinical forms are non-specific but frequent and varied (neurological, ophthalmologic, pulmonary, cutaneous and sometimes rheumatological). DIAGNOSIS: Diagnostic presumption is made in the presence of hypereosinophilia, proof of progressing toxocariasis. However, this increase is non-specific and is found in many other parasitosis. Diagnosis should therefore be confirmed using an IgG ELISA test and confirmed by Western Blot. TREATMENT: Currently, there is no consensus regarding treatment, however certain data are available in the literature. Prophylaxis appears to be the best weapon against this little known disease.
Animals↗