Michel Le Bras

Cardiac complications of halofantrine: a prospective study of 20 patients

Halofantrine, increasingly used for treatment of Plasmodium falciparum malaria, is a normally well-tolerated amino-alcohol with very few side-effects, but torsades de pointes ventricular tachycardia due to halofantrine has been reported in a few patients with a congenital long QT interval (Romano-Ward syndrome). We performed a prospective study of the cardiac effect of halofantrine in 20 patients with 48 h ambulatory electrocardiographic (ECG) monitoring; the halofantrine levels in their serum were also determined. Minimal ECG changes were noted, with lengthening of the QT interval without clinical symptoms. This effect was dose-dependent and can be very severe in cases of pre-existing cardiopathy; it also occurs in patients without any pre-existing cardiopathy. In order to reduce the likelihood of such incidents, which are admittedly rare, we suggest performing electrocardiography on all patients before initiating treatment with halofantrine.

Postvaccinal inflammatory neuropathy: peripheral nerve biopsy in 3 cases

Abstract  Autoimmune inflammatory polyneuropathy (PN) can be triggered by vaccination. We report 3 such cases. A 36‐year‐old female nurse presented 15 days after a hepatitis B vaccination (HBV) with acute sensory disturbances in the lower limbs. She had severe ataxia but no weakness. Cerebrospinal fluid (CSF) protein level was 84 mg/100 mL, with 3 lymphocytes. A 66‐year‐old man presented 21 days after HBV with severe motor and sensory PN involving all 4 limbs. A 66‐year‐old man presented 15 days after a yellow fever vaccination with progressive motor and sensory PN involving all 4 limbs and bilateral facial paralysis. CSF protein level was 300 mg/100 mL, with 5 lymphocytes. Six weeks later, a tracheostomy was performed. In these 3 patients, the nerve deficits lasted for months. In each case, peripheral nerve biopsy showed KP1‐positive histiocytes but no T‐lymphocytes in the endoneurium. On ultrastructural examination, there was axonal degeneration in the first 2 cases; in case 2, a few myelinated fibers exhibited an intra‐axonal macrophage but the myelin sheath was preserved. There was only 1 example of macrophage‐associated demyelination in case 2, but these were numerous in case 3. It is likely that in the first 2 cases, an autoimmune reaction against some axonal or neuronal components was triggered by HBV. It induced an acute sensory ataxic PN in case 1 and an acute motor and sensory axonal neuropathy (AMSAN) in case 2. The third patient had a chronic inflammatory demyelinating PN, likely triggered by yellow fever vaccination.

High HBsAg and anti-delta carrier rate among asymptomatic Africans living on the campus of the University of Niamey, Niger.

In 1984 and 1985, a non-random survey was conducted among healthy Africans living on the campus of the University of Niamey, Niger. Of 238 asymptomatic subjects, 17.6% carried hepatitis B surface antigen (HBsAg) in their serum, while 50.8% demonstrated protective anti-HBs antibodies. Antibodies to delta virus were detected in 29.3% of HBsAg-positive sera. This suggests that hepatitis B virus (HBV) and hepatitis delta virus (HDV) are common in Niger, and the factors that increase the likelihood of HBV transmission may also enhance the risk of HDV transmission.

Leishmaniose viscérale acquise en région pyrénéenne chez un sujet immunocompétent

Resume Introduction Une leishmaniose viscerale peut survenir chez un sujet immunocompetent expose, lors d’activites sportives de plein air, a un risque d’infestation. Observation Une femme de 35 ans, ayant sejourne 8 mois auparavant dans une region lacustre des Pyrenees ariegeoises, a ete hospitalisee pour alteration de l’etat general avec fievre, hepatomegalie, splenomegalie, et pancytopenie, d’installation progressive au decours de ce sejour. Le diagnostic de leishmaniose a ete fait grâce a la serologie et a la presence de Leishmania infantum a la ponction sternale. Un traitement par antimoniate de meglumine a ete efficace. Commentaires Cette observation est originale par l’importance de l’organomegalie et par sa survenue apres un sejour dans une zone eloignee des foyers classiques.