IMPORTANCE: Despite annually adapted recommendations to prevent malaria in travelers to endemic areas, France is still the industrialized country reporting the highest number of imported cases of malaria. Better understanding of the epidemiologic context and evolution during the past 2 decades may help to define a better preventive strategy. OBJECTIVE: To study epidemiologic trends of imported cases of malaria in travelers in geographic territories of France on the European continent (metropolitan France) from 1996 through 2016 to potentially explain the persistence of high imported malaria incidence despite national preventive measures. DESIGN, SETTING, AND PARTICIPANTS: In a cross-sectional study, between January 1 and May 31, 2018, data were extracted from the French National Reference Center of Malaria Surveillance. Trends in patients with imported malaria in association with age, sex, ethnicity, purpose of travel, malaria species, severity of illness, case mortality rate, and endemic countries visited were analyzed in 43 333 malaria cases among civilian travelers living in metropolitan France. MAIN OUTCOMES AND MEASURES: Evolution of the main epidemiologic characteristics of patients with imported malaria. RESULTS: Among the 43 333 patients with imported malaria in civilian travelers included in the study, 24949 were male (62.4%), and 8549 were younger than 18 years (19.9%). A total of 28 658 malaria cases (71.5%) were among African individuals, and 10618 cases (26.5%) among European individuals. From 1996 through 2016, the number of confirmed malaria cases peaked at 3400 cases in 2000, then declined to 1824 cases in 2005 and stabilized thereafter to approximately 1720 malaria cases per year. A total of 37065 cases (85.5%) were due to Plasmodium falciparum. The proportion of malaria cases among African individuals rose from 53.5% in 1996 to 83.4% in 2016, and the most frequent motivation for traveling was visiting friends and relatives (25 329 [77.1%]; P<.001). Despite an increase in the proportion of severe cases, which rose from 131 cases (8.9%) in 1996 to 279 cases (16.7%) in 2016 (P<.001), mortality remained stable, being approximately 0.4% during the study period. CONCLUSIONS AND RELEVANCE: Beyond the apparent stability of the number of imported malaria cases in France, significant changes appear to have occurred among the population who developed malaria infection following travel in endemic areas. These changes may imply that adaptation of the preventive strategy is needed to reduce the burden of the disease among travelers.

BACKGROUND:Chikungunya virus (CHIKV), an arbovirus, is responsible for a two-stage disabling disease, consisting of an acute febrile polyarthritis for the first 10 days, frequently followed by chronic rheumatisms, sometimes lasting for years. Up to now, the pathophysiology of the chronic stage has been elusive. Considering the existence of occasional peripheral vascular disorders and some unexpected seronegativity during the chronic stage of the disease, we hypothesized the role of cryoglobulins.METHODS:From April 2005 to May 2007, all travelers with suspected CHIKV infection were prospectively recorded in our hospital department. Demographic, clinical and laboratory findings (anti-CHIKV IgM and IgG, cryoglobulin) were registered at the first consultation or hospitalization and during follow-up.RESULTS:Among the 66 travelers with clinical suspicion of CHIKV infection, 51 presented anti-CHIKV IgM. There were 45 positive with the serological assay tested at room temperature, and six more, which first tested negative when sera were kept at 4 degrees C until analysis, became positive after a 2-hour incubation of the sera at 37 degrees C. Forty-eight of the 51 CHIKV-seropositive patients were screened for cryoglobulinemia; 94% were positive at least once during their follow-up. Over 90% of the CHIKV-infected patients had concomitant arthralgias and cryoglobulinemia. Cryoglobulin prevalence and level drop with time as patients recover, spontaneously or after short-term corticotherapy. In some patients cryoglobulins remained positive after 1 year.CONCLUSION:Prevalence of mixed cryoglobulinemia was high in CHIKV-infected travelers with long-lasting symptoms. No significant association between cryoglobulinemia and clinical manifestations could be evidenced. The exact prognostic value of cryoglobulin levels has yet to be determined. Responsibility of cryoglobulinemia was suspected in unexpected false negativity of serological assays at room temperature, leading us to recommend performing serology on pre-warmed sera.

La maladie du charbon est une zoo-anthroponose touchant les troupeaux et parfois l’homme en contact avec les produits animaux dans un contexte de maladies professionnelles, industrielles ou de toxi-infections alimentaires. Elle se présente sous formes cutanée, digestive et respiratoire. Bacillus anthracis est l’agent responsable de la maladie du charbon. C’est un bacille à Gram positif, immobile, capsulé, non hémolytique formant des spores. Alors qu’il est facile de traiter le charbon cutané par les antibiotiques, le charbon digestif, le charbon méningé et le charbon pulmonaire (ou d’inhalation) sont redoutables. Le cycle du charbon met en jeu une forme sporulée tellurique et une forme végétative capsulée produisant les toxines charbonneuses chez l’hôte. Toujours présente dans l’environnement hydrotellurique des zones d’enzootie, la maladie réémerge périodiquement en fonction des évolutions climatiques et écologiques ou des activités humaines. La grande résistance des spores dans l’environnement et la virulence du bacille du charbon en font un agent potentiel de guerre bactériologique et de bioterrorisme de premier plan. Il est donc important de savoir faire le diagnostic biologique de cette maladie qui s’appuie sur des techniques de bactériologie classique, de biologie moléculaire et d’immunologie.

La recherche de porteurs asymptomatiques de Salmonella spp. parmi le personnel de la restauration est une pratique ancienne et bien connue des professionnels qui en ont la charge.

Le diagnostic au laboratoire des parasitoses oculaires est un sujet peu abordé dans la littérature. Le fait est qu’un grand nombre de parasites est susceptible d’atteindre cet organe en mettant en jeu à chaque fois le pronostic fonctionnel visuel. C’est pourquoi cet article propose une revue de la littérature des moyens disponibles au laboratoire pour le diagnostic des plus fréquentes de ces affections. Les stratégies à mettre en œuvre sont variées. Elles doivent tenir compte d’un certain nombre de contraintes dont les principales sont : la difficulté et la dangerosité des prélèvements et le rendement des techniques diagnostiques utilisées.

A total of 248 Plasmodium falciparum isolates were sampled in travelers with malaria who came to Marseille, France from Comoros to investigate in vitro activities of antimalarial drugs and molecular markers of drug resistance. Of the 248 isolates, 126 were maintained in culture. Of these, 53% were resistant to chloroquine, and 3% had reduced susceptibility to quinine, mefloquine, and atovaquone; 1% had reduced susceptibility to halofantrine and dihydroartemisinin; 7% had reduced susceptibility to monodesethylamodiaquine; 37% had reduced susceptibility to cycloguanil; and none had reduced susceptibility to lumefantrine. Resistance-associated point mutations were screened in 207 isolates. No mutations in the cytochrome b gene were found. Of the 207 isolates, 119 (58%) had a mutation in the P. falciparum dihydrofolate reductase (Pfdhfr) gene at codon 108, 6 (5%) had mutations in both Pfdhfr codon 108 and the P. falciparum dihydropteroate synthase codon 437, and 115 (56%) had the chloroquine resistance-associated K76T mutation in the P. falciparum chloroquine resistance transporter gene. This study represents a unique opportunity to improve surveillance of P. falciparum drug resistance in Comoros with consequences for treatment and chemoprophylaxis guidelines.

In 2001, an outbreak of typhoid fever occurred among the members of the French Armed Forces. All had received a typhoid vaccination as per the immunization schedule practiced in the Armed Forces (every 5 years). A retrospective cohort study was conducted in 94 personnel. The objectives were to confirm the diagnosis, determine the source of contamination and identify the factors associated with defective vaccinal efficacy. Twenty-four cases were clinically identified. A cucumber salad was identified as the contaminating dish (Risk Ratio = 3.6; 95%CI 1.5-8.9). Only one factor was related to defective vaccinal efficacy; the risk of typhoid fever was two-fold higher in people vaccinated more than 3 years previously (Risk Ratio = 2.2; 95%CI, 1.1-4.2). Compliance with food hygiene rules could have prevented 24 cases of typhoid fever. Nevertheless, repeat vaccination against typhoid fever is now conducted every 3 years in the French Forces, in compliance with the manufacturers' recommendations.

Les médecins exerçant en pays tropical sont fréquemment placés dans des situations où une formation minimale aux techniques de laboratoire s'avère très utile. Cette formation courte doit être adaptée à la fois aux besoins et aux techniques réalisables sur place. Elle doit contenir des techniques hématologiques de base, les examens directs en bactériologie et parasitologie en insistant particulièrement sur le diagnostic du paludisme. Le conditionnement et l'expédition des échantillons dans de bonnes conditions de sécurité vers un laboratoire de référence font aussi partie des objectifs pédagogiques. Selon les besoins, les stagiaires pourront aussi être formés à la détection des premiers cas dans le contexte d'épidémies de méningites à méningocoque ou de choléra. Cette formation courte doit enfin être prolongée par des documents pédagogiques et les CD Rom apparaissent comme les supports les mieux adaptés.

L'analyse des catastrophes survenues ces dernières années montre que les moyens médicaux mis en œuvre sont de plus en plus sophistiqués, permettant d'offrir aux victimes un environnement de soins proche de celui réalisé dans les pays les plus industrialisés.

We identified an unusual strain of mycobacteria from two patients with pulmonary tuberculosis by its smooth, glossy morphotype and, primarily, its genotypic characteristics. Spoligotyping and restriction fragment length polymorphism typing were carried out with the insertion sequence IS6110 patterns. All known cases of tuberculosis caused by Mycobacterium canetti have been contracted in the Horn of Africa.