Christian Lafaix

Seven years of recurrent severe strongyloidiasis in an HTLV-I-infected man who developed adult T-cell leukaemia

ObjectiveHuman T-cell leukaemia/lymphoma virus type I (HTLV-I) is endemic in Japan, the Caribbean basin and Africa, where it has been aetiologically linked to certain chronic myelopathies and adult T-cell leukamia (ATL). We sought to investigate whether strongyloidiasis, a parasitic disease common in these areas, might be a cofactor in the pathogenesis of ATL, as some reports have suggested. Patients, participantsOne 35-year-old HTLV-l-seropositive French West Indian man with a 7-year history of recurrent strongyloidiasis associated with episodic hyperinfestation presenting at the Centre Hospitalier Intercommunal, Villeneuve St Georges, France. InterventionsTreatment with various chemotherapeutic agents and symptomatic therapy for hypercalcaemia and antiviral therapy (zidovudine and interferon). ResultsThe patient developed ATL and died shortly after, despite chemotherapy. Immunological and virological studies performed during the last 15 months of his life showed an increase of the percentage of peripheral ATL cells, and progression from a polyclonal to a monoclonal integration of HTLV-I proviral DNA in the peripheral blood mononuclear and lymph-node cells. ConclusionsRecurrent strongyloidiasis appears to have been a possible cofactor associated with progression from healthy carrier state to ATL in our patient.

Immunogenicity and safety of a new inactivated hepatitis A vaccine : a clinical trial with comparison of administration route

A bicentre, controlled, randomized, open trial was carried out in order to compare the immunogenicity and the reactogenicity of PASTEUR MERIEUX Sérums et Vaccins inactivated Hepatitis A Vaccine on adults, when used with different routes of administration [intramuscular (i.m.), subcutaneous (s.c.) and needless injection using a Jet injector device]. Vaccines were given at two doses 6 months apart to 147 seronegative subjects. Anti-Hepatitis A virus (HAV) titres were performed at each visit by modified radioimmunoassay assay. After the first dose, 138 subjects except one seroconverted (s.c.). After booster dose, all subjects exhibited high levels of HAV antibodies. The higher titres were observed with Jet injector (GMT: 305 mIU ml-1 after the first dose and 3727 mIU ml-1 after the booster dose), followed by the i.m. route (210 mIU ml-1, 3152 mIU ml-1) and the s.c. route (165 mIU ml-1, 2082 mIU ml-1). No statistically significant differences were observed in the three paired comparisons (i.m. vs jet injector; jet vs s.c., im vs s. c.). This inactivated hepatitis A vaccine appeared to be highly immunogenic after one single dose and one booster 6 months later.

Mother-to-child transmission of human immunodeficiency virus type 1 and type 2 and dual infection: a cohort study in Banfora, Burkina Faso.

A prospective cohort study on the mother-to-child transmission of human immunodeficiency virus type 1 (HIV1), type 2 (HIV2) and dual positivity (HIV1 + HIV2) was carried out in Banfora, West Burkina Faso. The study samples consist of 117 newborns of HTV-seropositive women matched to 234 newborns of HIV-seronegative women. Among cases, 91 were born of HIV1-seropositive mothers, 15 were born of HTV2-seropositive mothers and 11 were born of HTV1 and HTV2 dual-seropositive mothers and were included in an 18-month follow-up. Calculation of the mother-to-child transmission rate was according to the recommendations of the European Economic Community working group. The HTV1 mother-to-child transmission rate was estimated to be 27.8% (95% confidence interval (CD 24.5 to 32.4) with one method and 25.5% (95% CI 13.5 to 37.5) with a second method. For HIV2, this rate was estimated to be 29.5% (95% CI 26.0 to 39.8) and was not statistically different from the HIV1 mother-to-child transmission rate. No case of transmission was observed in children born of dual seropositive mothers. Survival rate at month 18 was significantly lower for children born of HIV1 mothers: 83.7% (95% CI 78.2 to 92.2). Survival rates were similar between children born of HIV2-seroposi-tive (86.7), dual HIV1 + 2-positive (100) and sero-negative mothers (92.0%). Findings suggest a …

Endemic level of Lyme borreliosis in a region of Central France: A sero-epidemiologic examination involving blood donors

[1] which revealed a high incidence of Lyme disease in a region in central France, a sero-epidemiologic investigation was performed with blood donor sera to evaluate the level of contact among the general population of the region. Ten-ml samples were obtained from bona fide blood donations on 17 and 24 May 1995, and on 19 June 1995, in 3 towns in central France: Ste Sévère, La Châtre, Châteaumeillant. These sera (without any anticoagulant) were stored at –80 °C. The method of analysis was as follows: qualitative detection of anti-Borrelia antibodies IgM and IgG (VIDAS LYME IgM/IgG – BioMérieux, Lyon, France); then confirmation by quantitative titration of IgG (note that a positive value is indicated at 35 UGLD/ml for IgG anti-Borrelia antibodies, were UGLD represents a Diagast IgG Lyme unit in terms of the activity of 0.1 μg IgG/ml serum) and qualitative detection of IgM (ELILYME-G/M – Diagast, Lille, France), and by TPHA (TPHA PHASYL DIAGAST – Diagast). Polymerase chain reaction (PCR) was then performed when blood samples were positive for IgM or IgG using a method published elsewhere [4]: (i) extraction of DNA (GENECLEAN kit – BIO 101 Inc., La Jolla, California, USA) before (ii) specific OspA-SL amplification; (iii) solid phase sandwich hybridation of the PCR products (PROBLYME kit – Biocode, Brussels, BELGIUM). Consultations were arranged for those patients whose serologic test results were definitely positive. The samples from a 182 blood donors were included in the study: 84 women and 98 men (sex ratio 0.86), mean age 44.7 ± 10.8 (range 20–66). Six sera were found positive for anti-Borrelia antibodies (four with IgG patients 1, 2, 3, 4-, two with IgM -patients 5, 6-). The patients resided in Ste Sévère and La Châtre (Table 1). The four patients with IgG were asymptomatic (no memory of tick-bite or previous history of Lyme disease, no treatment received). Paired serum sample of patients 5 and 6 gave a negative result with IgG in one case and then a positive result for the other after 2 weeks. PCR test was negative. Only patients 5 and 6 complained of rheumatoid symptoms (arthralgia, fatigue, headache), without memory of a tick-bite. Immediate treatment of patient 6 (amoxicillin 3 g per diem for 14 days, commencing European Journal of Epidemiology 13: 361–362, 1997.  1997 Kluwer Academic Publishers. Printed in the Netherlands.

Epidemiology of lyme disease in France: Lyme borreliosis in the region of Berry sud: A six year retrospective

The purpose of this epidemiologic retrospective is to recognize the endemic nature of Lyme borreliosis in ‘Berry’, region of France. Fifty-nine cases have been reported here during the past six years (1988–1994). An erythema migrans (EM), or a late manifestation concurrent with positive ELISA-test represents the main inclusion criterion (case definition used by the CDC). The results reveal a high incidence considering the limited information available in France. The farmer has been found to be mainly at risk, with EM being observed in 49% of cases. In general, late manifestations are rarely described. Peripheral neurological manifestations occur more frequently than those reported in the USA. The steps taken as a result of our study of Lyme disease are in accordance with the recommendations of the World Health Organization.

Fluconazole. Review and situation among antifungal drugs in the treatment of opportunistic mycoses of human immuno-deficiency virus infections.

Fluconazole is a novel triazole antifungal drug chiefly used in the treatment of opportunistic mycoses in immuno-compromised patients, particularly those with the acquired immuno-deficiency syndrome (AIDS). In comparison with other antifungal drugs, fluconazole has outstanding physical and pharmacokinetic properties, such as an excellent aqueous solubility allowing a parenteral formulation, high bioavailability by the oral route, even distribution throughout the tissues, including the central nervous system and the cerebro-spinal fluid, a long half-life (permitting once daily administration), and low binding to plasma proteins. It is excreted mainly as unchanged drug in the urine. Fluconazole is a broad-spectrum antifungal agent, especially effective against Candida spp., Cryptococcus neoformans and dermatophytes. Its antifungal efficacy was mainly proved by testing in animal models, since there is no relationship between in vitro and in vivo activities. It possesses a low toxicity and it is well-tolerated. Fluconazole is currently marketed for the treatment of oropharyngeal candidiasis in immuno-compromised patients and of atrophic oral candidiasis. Its place in the treatment of opportunistic mycoses in human immuno-deficiency virus-positive patients, in particular cryptococcal meningitis, is still under investigation but is promising.

Haemophilus type B conjugate vaccine: postimmunization kinetics of IgM and IgG antibody responses in ten vaccinated children.

A new Haemophilus type b conjugate vaccine coupling capsular polysaccharide of Haemophilus influenzae b to tetanus toxoid is available in France and other countries. We have studied the kinetics of the immune response in ten children aged 17 to 50 months during the 4 weeks after immunization with one dose of Haemophilus type b conjugate vaccine. Eight serum samples were collected from each child at day 0 (D0), D2, D4, D7, D10, D14, D21 and D28. An ELISA method has been used to discriminate between IgM and IgG classes of anti-polyribosylribitol phosphate antibodies. A high level of IgM appeared at D7 and persisted until D28. The increase in IgG was regular and progressive from D7.