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ABSTRACT: BACKGROUND: Treatment of hookworm-related cutaneous larva migrans (HrCLM) with a single dose of oral ivermectin has not been adequately evaluated to date. Response rates reported in three large studies varied from 77% to more than 95%. OBJECTIVES: We evaluated the efficacy of ivermectin in the treatment of HrCLM. METHODS: We retrospectively studied all returning travellers with HrCLM who consulted in our institution. Patients were then treated with a single, 200 μg/kg dose of ivermectin, orally. RESULTS: Sixty-two travellers (35 female, 27 male, mean age 35.6 years) with HrCLM and creeping dermatitis were included. Six patients (10%) also had associated hookworm folliculitis. Fifty-nine patients (95%) completely responded with one ivermectin dose. The response rate was 98% in the 56 patients presenting with only creeping dermatitis and 66% in the six patients presenting with additional hookworm folliculitis (P = 0.02). CONCLUSION: The efficacy of a single dose of oral ivermectin is higher in patients with only creeping dermatitis than in those with associated hookworm folliculitis.
Journal of the European Academy of Dermatology and Venereology 02/2013; · 2.98 Impact Factor
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ABSTRACT: The emergence of multi-resistant bacteria (MRB) in developing countries (DCs) is a worrying phenomenon at regional and international levels with a risk of international spread through travelers. The French guidelines recommend a systematic screening in case of hospitalization, for the travelers who have been repatriated and for those with a history of hospitalization in a foreign country during the past year. A simple travel in DCs is not considered as a risk factor for colonization or infection with a MRB. We report the case of a 56-year-old man with acute prostatitis and epididymitis due to Extended-spectrum β-lactamase-producing Escherichia coli. He was returning from Southeast Asia with no history of hospitalization or recent use of antibiotics. However, he had unprotected sex during his travel. This case report leads us to discuss the different ways of acquiring this resistant bacterium during travel as well as the usefulness of expanding the screening of carriage for MRB in all travelers in case of hospitalization.
Bulletin de la Société de pathologie exotique 11/2012;
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ABSTRACT: OBJECTIVES: The aim of the study was to evaluate the performance of Quantiferon Gold-In-Tube(®) (QFN) for the diagnosis of tuberculosis (TB) during hospitalization in an infectious diseases department. PATIENTS AND METHODS: QFN was performed in 245 patients recently hospitalized for suspected TB. Subsets of patients underwent tuberculin skin tests (TST), and microbiological cultures were performed. RESULT: TB was diagnosed in 57 (23%) patients: pulmonary in 23 (40%), extrapulmonary in 16 (28%), and disseminated in 18 (32%). Seventeen (30%) of these TB patients were immunocompromised, including 12 with HIV infection. The sensitivity of QFN was 74%, its specificity 56%, its positive predictive value 43% and negative predictive value (NPV) 92%. The sensitivity was similar in pulmonary and extrapulmonary TB but lower in disseminated TB, although not significantly so. The sensitivity was also lower (P=0.04) in immunocompromised patients. The specificity was lower in migrants than in native French patients (P=0.01), and lower in patients with a history of TB than in those without (P<0.001). Finally, combining culture with QFN significantly increased the sensitivity (P=0.008), and produced a higher NPV, as for the combination with TST, but not significantly different than with QFN alone. CONCLUSION: The performance of QFN was weak in this context, especially in subgroups at high risk for latent TB. However, combined negative results of QFN or TST and culture could be useful to rule out active TB.
Médecine et Maladies Infectieuses 11/2012; · 0.72 Impact Factor
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Médecine et Maladies Infectieuses 12/2011; 41(12):667-8. · 0.72 Impact Factor
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Médecine et Maladies Infectieuses 11/2011; 41(11):623-4. · 0.72 Impact Factor
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Médecine et Maladies Infectieuses 03/2011; 41(5):264-6. · 0.72 Impact Factor
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ABSTRACT: A large outbreak of measles is taking place in Europe and is related to a low vaccination coverage. Measles is observed in adults.
We retrospectively studied all the consecutive cases of measles seen in adults between the 1/1/2007 and the 30/4/2009 in four Parisian hospitals.
Twenty-one patients were included. Six patients (29%) were health care workers (HCW) including five (83%) who were vaccinated. Twenty (95%) patients were hospitalized. All patients presented with febrile exanthema, cough and rhinitis in association with hepatic involvement in 71%. Neither death nor sequelae were reported.
Measles may occur in HCW, most of them being insufficiently covered by the vaccination. Therefore, since 2010, one injection of measles vaccine is now recommended in France, for HCW without history of measles or vaccination with two doses. Furthermore, adequate respiratory precautions should be taken when seeing patients with febrile exanthema and cough.
Annales de Dermatologie et de Vénéréologie 02/2011; 138(2):107-10. · 0.72 Impact Factor
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Médecine et Maladies Infectieuses 11/2010; 41(3):152-3. · 0.72 Impact Factor
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ABSTRACT: Dermatoses are one of the three most common causes of health problem in returning travelers. These dermatoses include infections, environmental diseases (sunburns, arthropod-related reactions) and superficial injuries. Skin infections are the most common cause of consultation after return. They include bacterial infections of cosmopolitan origin (pyoderma, abcess, cellulites) and tropical diseases (hookworm-related cutaneous cutaneous larva migrans, localized cutaneous leishmaniasis, tungiasis, myiasis...). Travelers abroad must be appropriately vaccinated against tetanus and specifically instructed to avoid arthropods bites and sun overexposure. Travel first aid kits should include antibiotics effective against bacterial skin infection, oral antihistamines and corticosteroid ointments.
Revue médicale suisse 05/2010; 6(248):960-4.
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ABSTRACT: In non-endemic countries, acute (invasive) schistosomiasis (AS) is typically seen in non-immune travellers, whereas chronic schistosomiasis is more frequently diagnosed in immigrants. Travellers with AS initially present with non-specific signs such as fever, cough, headache, and urticaria. Life-threatening cardiac and neurological complications may occur. The positive diagnosis of AS relies on seroconversion, which appears together with hypereosinophilia approximately 3 weeks after the onset of symptoms. When prescribed during AS, praziquantel usually does not prevent the chronic phase of the disease and is associated with exacerbation of signs and symptoms in approximately 50% of cases. According to the published literature, corticosteroids may be recommended alone or in association with praziquantel. When associated with corticosteroids, pharmacokinetic interactions may impair the efficacy of praziquantel. We suggest that corticosteroids should be restricted to use in patients with systemic complications of AS, whereas praziquantel should be initiated only when ova are detected in either stools or urine, depending on the culprit species.
Clinical Microbiology and Infection 03/2010; 16(3):225-31. · 4.54 Impact Factor
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ABSTRACT: We report the case of a patient infected with human immunodeficiency virus who presented with fever and a disseminated papulous eruption, diagnosed as cutaneous miliary tuberculosis. The diagnosis was made by histological examination of a skin biopsy, which showed numerous acid-fast bacilli. A culture grown from a skin biopsy isolated a resistant Mycobacterium tuberculosis strain. The papules disappeared within a few days after starting treatment with pyrazinamide, isoniazid and moxifloxacin.
Clinical and Experimental Dermatology 08/2009; 34(8):e690-2. · 1.20 Impact Factor
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ABSTRACT: Human African trypanosomiasis (sleeping sickness), an endemic disease, is currently reemerging in Africa with an estimated incidence of 45,000 new cases per year. It is caused by Trypanosoma brucei subspecies and transmitted by day-biting tsetse flies.
We report a case of West African trypanosomiasis due to Trypanosoma brucei gambiense involving a Frenchman living in Libreville, Gabon. The patient presented with fever and polyadenopathies as well as two skin ulcerations highly suggestive of trypanosomiasis. Microscopic examination of cutaneous and peripheral blood smears confirmed the diagnosis of haemolymphatic infection with T. b. gambiense with trypanosomal chancres. Examination of the cerebrospinal fluid was normal. The patient was successfully treated with pentamidine isethionate.
Recognition of cutaneous manifestations may allow a rapid diagnosis of African trypanosomiasis that is essential for timely and efficient treatment and survival.
Annales de Dermatologie et de Vénéréologie 05/2009; 136(4):341-5. · 0.72 Impact Factor
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ABSTRACT: There are no established guidelines for the treatment of disseminated strongyloidiasis in immunosuppressed patients, and many different treatment regimens have been used. Here, the case of a 48-year-old, HIV-positive, Congolese man, who was hospitalized for disseminated tuberculosis but developed life-threatening disseminated strongyloidiasis, is described. This patient died, with relapsing disseminated strongyloidiasis, 3 months after being treated with ivermectin. The reasons for this poor outcome and the various treatment options for strongyloidiasis in HIV-infected patients are discussed.
Annals of Tropical Medicine and Parasitology 01/2009; 102(8):693-8. · 1.43 Impact Factor
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ABSTRACT: The aim was to evaluate the association between dermatological findings in HIV-infected patients in Senegal and degree of immunosuppression and HIV stage.
All consecutive HIV infected patients followed up at three dermatology centres in Senegal from 01 January 2004 to 01 January 2006 were evaluated retrospectively regarding dermatological findings, CD4 cell count and HIV stage.
One hundred and forty-nine patients with 331 skin diseases were evaluated. The most common forms of dermatosis were oral candidiasis (53%), herpes zoster (24%), prurigo (24%) and dermatophytosis (16%). An increasing number of skin diseases was significantly associated with CD4 counts of below 200 per cubic millimeter and Aids diagnosis. A significant association (p<0.05) was found between two types of dermatosis (oral candidiasis and chromonychia) and CD4 counts of below 200 per cubic millimeter and between four types of dermatosis (straightened hair, herpes, oral candidiasis and xerosis) and Aids diagnosis.
Dermatological findings are of great diagnostic and prognostic significance. We found some features specific to black skin: longitudinal melanonychia and blue ungueal pigmentation potentially related to immunosuppression and straightened hair, associated with Aids, probably resulting from denutrition.
Annales de Dermatologie et de Vénéréologie 04/2008; 135(3):187-93. · 0.72 Impact Factor
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ABSTRACT: Tuberculosis (TB) is frequent in human immunodeficiency virus (HIV) infected patients, but its treatment is hampered by adverse events and paradoxical reactions.
To examine the impact of HIV infection and other factors on the risk and spectrum of adverse events related to anti-tuberculosis treatment in a prospective cohort study conducted between January 2003 and August 2004.
Of 105 patients treated for TB, 30 were HIV-infected. The overall incidence of adverse events was 122.5 +/- 18.5 per 100 patient-years (py) and the incidence of severe adverse events was 45.2 +/- 11.3/100 py. Age >50 years (OR 2.2, 95%CI 1.01-4.8, P = 0.046) and HIV infection (OR 3.9, 95%CI 2.1-7.5, P < 0.001) were independently associated with a higher risk of adverse events. Hepatitis (30.5/100 py) and neuropathy (28.6/100 py) were the most frequent adverse events. Hepatitis C virus infection was associated with hepatitis (OR 4.2, 95%CI 1.2-15.0, P = 0.028) and neuropathy with HIV infection (OR 3.8, 95%CI 1.1-13.7, P = 0.040).
Adverse reactions to anti-tuberculosis drugs are frequent. HIV infection and age >50 years are factors associated with such reactions, while hepatitis C virus infection is a risk factor for hepatitis.
The international journal of tuberculosis and lung disease: the official journal of the International Union against Tuberculosis and Lung Disease 11/2007; 11(11):1203-9. · 2.73 Impact Factor
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ABSTRACT: Schistosomiasis is a tropical helminthic infection, observed in travelers as well as local populations. It is most often due to Schistosoma mansoni or Schistosoma haematobium and can be diagnosed at the invasive phase. Migration of the schistosomulae (larvae) in the body leads to acute parasitic toxemia, which includes a hypersensitivity reaction and circulating immune complexes. The invasive stage occurs generally 2 to 6 weeks after the exposure and combines fever, asthenia, faintness and headaches. Other signs include diarrhea, dry cough, dyspnea, urticarial rash, arthralgia, myalgia, and enlargement of liver and spleen. Although rare, neurological and cardiac complications may be fatal. This diagnosis should be considered in travelers returning from the tropics with compatible clinical signs and delayed hypereosinophilia, if they report exposure in an endemic area. It is later confirmed by seroconversion for schistosomiasis and then by observation of schistosome eggs in stool or urine (according to species). The standard treatment of acute schistosomiasis with praziquantel is ineffective and can aggravate clinical outcome during this phase. Corticosteroid treatment is recommended for serious forms with neurological or cardiac manifestations.
La Presse Médicale 01/2006; 34(21):1641-5. · 0.67 Impact Factor
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ABSTRACT: Cysticercosis is an helminthic disease which is usually observed in endemic areas or in immigrants coming from these areas. Cases described in travellers coming back from endemic areas are rare. We describe a case of neurocysticercosis that was revealed by a paradoxical reaction. This reaction occurred during the early phase of the treatment of cutaneous cysticercosis by albendazole in a tourist coming back from the sub Indian continent. This case report leads to discuss the modes of infestation in tourists, and the management of cutaneous cysticercosis and paradoxical reaction that may impair the outcome of cysticercosis during the treatment with antihelminthic drugs.
Bulletin de la Société de pathologie exotique 12/2004; 97(4):250-2.
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ABSTRACT: Hepatitis C virus (HCV) is usually transmitted via the parenteral route, but there are widely discrepant findings on its possible sexual transmission. Thus there are no recommendations concerning protected sex for couples in which only one partner is HCV-infected. Whether HIV or other sexually transmitted diseases could favour HCV transmission remains unclear, but recent data suggesting an increasing incidence of acute HCV in HIV-infected men underline the major public health implications of this issue.
Between June 2002 and July 2003, five HIV-infected homosexually active men presented with primary (n=4) and secondary (n=1) syphilis and concomitant abnormal liver function tests revealing acute asymptomatic HCV seroconversion. Other causes of acute viral hepatitis were inquired into and excluded. Highly at-risk sexual behaviour, including unprotected anal intercourse and unsafe oral sex, with concomitant syphilis, was found to be the only identifiable important risk factor for transmission of HCV.
Sexual transmission may be fuelling a significant increase in HCV seroconversions among HIV-infected men who have highly risky sexual behaviours. Given the recent data suggesting the spread of sexually transmitted infections among HIV-infected gay men, specific recommendations concerning safe sex are urgently needed.
HIV Medicine 08/2004; 5(4):303-6. · 3.01 Impact Factor
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ABSTRACT: Lymph node tuberculosis is the most frequent form of extrapulmonary tuberculosis, especially in immunocompromised patients. We have studied patients with proven lymph node tuberculosis in the Department of Infectious Diseases at Pitié-Salpêtrière Hospital, Paris, between January 1997 and January 2002. Clinical presentation, microbiological diagnosis and treatment were analyzed in 13 HIV infected and 19 non-HIV infected patients. A risk factor for tuberculosis was present in all cases (HIV infection, immigration, life in community, poverty, past history of tuberculosis and IVDU). The median duration between the onset of symptoms and diagnosis was longer for HIV infected (2 months) compared with non-HIV infected patients (1 month). At the time of the diagnosis, general symptoms were present in >50% of patients of both groups. In HIV infected patients, abdominal lymph node involvement was more frequent (P < 0.05). All the non-HIV infected and 85% of HIV infected patients had peripheral adenopathies. A pulmonary tuberculosis was noted in more than half of the cases (53% non-HIV and 69% HIV patients). Inflammatory parameters and liver function tests were frequently abnormal in both groups. Hyponatremia was more frequent in HIV patients (P < 0.05). TB skin testing was more frequently positive and phlyctenular in non-HIV infected patients (P < 0.05). In this study, direct examination of the needle aspirate from infected lymph nodes was rarely positive; cultures were more frequently positive after biopsy compared to needle-aspiration. The median duration of treatment was 9 months for the two groups (6-24 months). Three HIV infected patients were infected by mycobacteria resistant to at least one antibiotic (isoniazid, 1; rifampicin, 1; isoniazid, streptomycin, etambutool, 1). All the patients recovered.
Pathologie Biologie 10/2003; 51(8-9):496-502. · 1.53 Impact Factor
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ABSTRACT: Since Laennec's description of the "prosector's wart" in 1826, science has made great strides forward. The cutaneous forms of the infection with Mycobacterium tuberculosis are various. The most common clinical forms of cutaneous tuberculosis are lupus vulgaris and scrofuloderma. The clinical forms of cutaneous tuberculosis are usually classified according to the patient's immune status, and the way through which the skin has been infected. Nonetheless, as in leprosy, a classification based on the importance of the bacterial inoculum in situ is possible. Subsequently the diagnosis should be considered as easy in the multibacillary forms and much more difficult in the paucibacillary forms. In the former, the diagnosis should rely on bacteriological data. In the latter, the diagnosis will rely on the association of epidemiological, clinical and histological data whereas genomic amplification with PCR may be of potential interest.
Bulletin de la Société de pathologie exotique 02/2003; 96(5):362-7.
