The use of IgM capture ELISA for surveillance of dengue in Martinique is described. This only pathogenic for human population arbovirus infection, which the transmission is caused by bites of haematophagous diptera like Aedes (Aedes aegypti principally) show an active circulation in Martinique. Clinical evolution was always benign among the adults and the children. To date no case of dengue haemorrhagic fever/dengue shock syndrome (the World Health Organization criteria) was not reported in Martinique.
In French Guiana, the distribution of malaria in foci inhabited by quite different ethnic groups calls for specific studies. Along the Oyapock on the Brasilian border and along the Litani on the Surinam border, incidence among American Indians and Creoles ranges from 300 and 900 per thousand; Plasmodium falciparum accounts for 65% and P. vivax for 35%. Along the middle and lower Maroni on the Surinam border, the Boni and Ndjukas Negroes move freely through the frontier and since the civil strife Surinamese used to attend health centres of Guiana. Therefore it is difficult to find the sources of contamination and the incidence among French citizens; P. falciparum is the only parasite recorded in this focus. In 1987 a small outbreak mainly due to P. vivax, occurred in a Lao refugees village in the hinterland. The coastal foci harbour large communities of Haitian and Brazilian migrants. The vector is Anopheles darlingi and up to now there is no evidence that other species could be involved. The rise of malaria despite of control measures involves several factors: the house spraying is no more accepted by a large percentage of house holders and the alternative larviciding has only a limited efficacy; the houses of American Indians have no walls to be sprayed; there is a continuous introduction of parasites by migrants. It has been said that vectors have change their behaviour toward exophily but such a statement has not yet been supported by evidence. All these factors should be taken in account to improve malaria control.
Are presented in this study results on the Sionas-Secoyas' subsistence pattern and health and nutrition status. Sionas-Secoyas still preserved a traditional way of life despite considerable demographic and environmental changes in the province. They are entirely self sufficient. The degree to which they meet their energy requirements appeared to be low but their intakes are obviously underestimated due to an important extra-household food consumption. Protein intakes are high; consumption of foods of animal origin is important. The quality of their alimentation is reasonably good. There are no cases of undernutrition; children growth is steady despite their smallness; they have a robust physical constitution. Parasitic burden is not heavy compared with other surveys in Amazonia. Infectious diseases are not frequent too. However this very propice situation is jeopardized by the process of agricultural development and the unceasing trespassing of the reservation boundaries. State officials should pay more attention to the preservation of Sionas-Secoyas' interests and must protect them from the covetousness of outsiders.
A 3 years study was decided in 12 villages of the South-West Burkina Faso to compare the chemoprophylaxis and the chemotherapy of febrile cases as potential malaria control strategies. During the first year pretreatment data were collected. During the two following years a programme carried out (I) prophylaxis (10 mg chloroquine/kg body weight) was given weekly to all children under 14 years old in 5 villages, and (II) therapy (10 mg chloroquine/kg body weight) was given in a single dose to all febrile cases in 7 other villages. Chloroquine tablets were distributed by health workers belonging to the community. Both prophylaxis and therapy reduced the gametocyte rate in children (2-9 years) respectively of 63% and 45%. The analysis of the evolution after the first year of the sporozoite rate of anopheline was made difficult by concomitant natural variations of mosquitoes longevity and by mosquitoes displacements. Significant variations of sporozoite rate can be explained by natural variations of mosquitoes longevity. But data from the rice field villages support evidence that reduction of the pool of parasite infective for vectors induced the decrease of Anopheles gambiae s. l. sporozoite rate. Therefore our results reflect a trend more than a strict reduction of malaria transmission.
A young woman living in a malaria endemic area in West Africa, was contaminated twice with placental infection by Plasmodium falciparum, in two successive pregnancies. No parasites were observed on blood smears both in mother peripheral blood and in cord blood. A parasitemia was described in the intervillous space in the placental. The first placental infection was attributed to a febrile illness ten days before the end of gestation. No reliable symptoms of malaria were found for the second infection. Treatment for fever during pregnancy were given, at 6 and 9 months for the first gestation, and at 4 months for the second gestation. Investigations are correlated with the age of the two placental infections, the second infection is a very young and synchronous parasitemia. No foetal diseases, no low birth weight o congenital malaria were observed on newborns during the both gestations.
With regard to an acute disease, Rift Valley fever, we tried to establish a prognostic score to help physicians to set prognosis and to choose a health management suitable in their context. Using clinical and biological data collected during the 1987 RVF epidemic in Southern Mauritania, we established a prognosis score card. Data analysis allows to prognosticate forms of possible severe evolution as an association of four syndromes: fever over 39 degrees, hemorrhagic syndrome, icterus and neurological signs. Using 12 clinical symptoms and 3 biological signs, it is possible to prognosticate cases with fatal evolution.
Authors searched by mean of radio-immuno-essay A and C anti-meningococcal antibodies in two villages from Niger (181 and 92 patients) in a meningitidis endemic area, which one profited 10 months ago of a mass vaccination campaign (A and C polysaccharides). A and C antibodies quantities and percentages of protected patients are not significantly different between the two villages. In one hand anti-C levels increase with patients age. In the other hand, there is a correlation between C meningococcal antibodies and anti-Hbc antibodies.
24 cases cutaneous schistosomiasis are presented. Among these cases, 6 patients have localization of perineum and 18 patients have local blotch pigmented papules. These frequent and typical lesions allow an early diagnostic of this disease and particularly in the child.
Administration of ivermectin (Mectizan) in Loa loa filariasis induces a significant decrease of microfilaria load within 3 to 15 days. The excellent tolerability of the drug in patients infested simultaneously by O. volvulus and Loa loa allows to use ivermectin in mass treatments in geographical areas where the same patients can be affected by several filariasis. There is almost no efficacy against Mansonella perstans. A second administration one month after the first one in Loa loa affected patients has not led to a complete disappearance of microfilaria; the tolerability has still been good. Efficacy on Ascaris lumbricoides appears to be excellent; further studies are necessary in the cases of trichuriasis, ancylostomiasis and strongyloidiasis.
The amazonian region of Ecuador is the site of a powerful migratory influx for colonizing new lands. 1/3 of the settlers come from the coastal part of the country and 2/3 from the andean part (Sierra). To cope with their new situation, people carry out cash crop cultivations and adopt stereotyped food consumption patterns. Though they do not suffer from any important food shortages, the dietary quality of foods is poor and nutritional deficiencies are observed. Prevalence rate of parasitic infestation is high and infectious diseases are common. About 10% of the children are moderately undernourished and more than 50% denote growth retardation. The extent of growth retardations varies according to the geographical origin of families. Children from the coast having a faster growth than their andean counterparts. The differences could be explained by the fact that coastal families, coming from an area with ecological and climatic characteristics closed to those encountered in Amazonia, are less out of their element than the Sierra's. It seems that fortune of settlers improve with time, however the evolution of the colonization process and its consequences on the health status of populations is almost unknown. The magnitude of this phenomenon, the number of countries involved and people concerned emphasize the need for more substantial research on the scope.
Human infestation by retrolentivirus which are incriminated in human disease called AIDS turns to be a "serious endemic". Once adequate medicine and vaccine discovered, it could perhaps be jugulated or eradicated in ethno-ecosystems combining a high socioeconomic level and a heavy attendance of efficient biomedicine. These criteria fit in neither with Quarter, nor with Third World, nor with worlds which do not think or live Health, Illness, Death, Misfortune in the same terms than those inspired by biomedical philosophies. Native logic apprehends AIDS as any form of sequence of misfortune, without taking care of its physiopathologic and epidemiologic specificity.
Before 1949 malaria was highly prevalent in the whole territory of French Guiana. When malaria control based on house-spraying and drug prophylaxis was implemented in 1950 the disease sharply dropped below 20 cases per year. Since 1976 despite vector control malaria is rising again. In 1987, 3,269 cases have been notified giving an incidence of 37.6 per thousand for the whole country population; only four deaths were recorded. All the age groups were concerned but the transmission was restricted to some foci along the Oyapock river (prevalence rate 25%), along the Maroni river (prevalence 2.3%) and in a few places of the coastal area. The main cities remain malaria free. In vivo resistance to chloroquine was observed in 22% of the cases which could be cleared by amodiaquine or quinine.
A research was made on one hundred cases of diarrhoeas in Aids-patients by stool examination including examination of duodenal aspirated liquid. Concerning the examination of duodenal fluid, we founded the parasites in almost one hundred patients of the cases. Among parasites observed, Isospora belli was the most frequent (20% of cases), followed by Cryptosporidium (15%). Strongyloides stercoralis represented 10% of the cases. The majority of other parasites was miscellaneous protozoa and some helminths.
A 13-year old Yemeni boy who presented with flaccid paraplegia was thought to have a spinal cord tumor on myelography. Microscopic examination of surgically excised material revealed bilharzial granulomas. Brief review of relevant literature on schistosomiasis of the spinal cord, with particular reference to the Middle East, is presented.
Two cases of very high hypereosinophilia (28,160 and 11,232/mm3) observed in congolese patients are presented. Although microfilaraemia was not detectable, loiasis was diagnosed, given the clinical manifestations, epidemiological data, history of sub-conjunctival migration of the adult worm (in one case), spectacular recovery (clinical and biological) after treatment with diethylcarbamazine. This "allergic form" of filariasis is often considered unusual in indigenous subjects.
880 suspect sera were analysed for HIV2 antibodies (ELISA, Western Blot) during the 2nd and 3rd trimester of 1988. Results show that Kinshasa is not yet an endemic zone for this virus. The authors recommend the use of a mixed test for diagnostics.
The efficacy of praziquantel has been studied in human hydatic disease due to E. granulosus, using parasitological and pharmacological criteria of improvement. This evaluation uses a prospective therapeutic trial in 15 patients with one or several hydatic cysts in different sites. Before surgery, nine of these received daily 75 mg/kg of praziquantel in 2 courses of 10 days each. The other six patients are considered as controls. The protoscolices vitality is determined by direct optic microscopy and by intraperitoneal mouse inoculation. According to the results of optic microscopy, praziquantel sterilizes hydatic cysts: 19 sterilized cysts out of 26 coming from treated patients, and 4 out of 11 in control group. This effect seems to be emphasized in hepatic localization. Nevertheless, according to the results of mouse inoculation, praziquantel does not significantly reduce the pathogenicity of inoculated proscolices and germinal layer: 11 mice out of 39 are healthy in the treated group, and 5 out of 15 in controls. Moreover, the determination with a fluorimetric method has not detected praziquantel in the hydatid liquid issued from treated patients. The drug does not pass through the cyst wall, and so, cannot have a scolicidal activity. Praziquantel cannot be considered as a medical treatment in human hydatidosis.
Within the framework of the preparation (acceptability and feasibility) of an integrated malaria control including insecticide impregnated bednets notably, a Knowledge Attitude Practice survey (home cluster sample) was carried through in March, 1988 in Yaoundé City to identify the current major mosquito behaviour control methods: insecticide sprays, mosquito coils and bednets and the motivations in the use of these control methods. The cost of vector control and cares for diseases attributed to mosquitoes have been evaluated. The survey shows that insecticide impregnated bednets represent an accessible and suitable control method subject to regular supply with reasonable prices and implementation of demonstration stations for the impregnation.
A 76 year old patient is admitted in an intensive care unit with severe acute pneumococcal meningitis. He dies 2 days after admission besides antibiotherapy by ampicillin. Interest of measures for preventing the infections after lumbar puncture is discussed.
