Neurocysticercosis, re-infection or inflammation?

International audienc

Serological diagnosis of Toxoplasma gondii infection

International audienc

Histological and molecular biology diagnosis of neurocysticercosis in a patient without history of travel to endemic areas – Case report

Background: in endemic areas, neurocysticercosis appears mainly as a single, large, spherical and non-enhancing intracranial cyst. Case presentation: an atypical case of neurocysticercosis (NCC) in a French Caucasian, without history of travel to endemic areas, was confirmed by histology and molecular speciation. Imaging was atypical, showing several hook-bearing scolices visible in the cyst, while the serology employed was non-contributary. Conclusions: NCC should be considered when multiple taeniid scolices are observed within the same cystic lesion

Toxoplasmose pendant la grossesse : proposition actuelle de prise en charge pratique

International audienceThe burden of congenital toxoplasmosis has become small in France today, in particular as a result of timely therapy for pregnant women, fetuses and newborns. Thus, the French screening and prevention program has been evaluated and recently confirmed despite a decline over time in the incidence of toxoplasmosis. Serological diagnosis of maternal seroconversion is usually simple but can be difficult when the first trimester test shows the presence of IgM, requiring referral to an expert laboratory. Woman with confirmed seroconversion should be referred quickly to an expert center, which will decide with her on treatment and antenatal diagnosis. Although the level of proof is moderate, there is a body of evidence in favor of active prophylactic prenatal treatment started as early as possible (ideally within 3 weeks of seroconversion) to reduce the risk of maternal-fetal transmission, as well as symptoms in children. The recommended therapies to prevent maternal-fetal transmission are: (1) spiramycin in case of maternal infection before 14 gestational weeks; (2) pyrimethamine and sulfadiazine (P-S) with folinic acid in case of maternal infection at 14 WG or more. Amniocentesis is recommended to guide prenatal and neonatal care. If fetal infection is diagnosed by PCR on amniotic fluid, therapy with P-S should be initiated as early as possible or continued in order reduce the risk of damage to the brain or eyes. Further research is required to validate new approaches to preventing congenital toxoplasmosis

Prise en charge de la toxoplasmose oculaire en France : résultats d’une étude Delphi modifiée

International audienceOBJECTIVE: To evaluate diagnostic and therapeutic practices and then establish a consensus on the management of ocular toxoplasmosis in France through a Delphi study. MATERIALS AND METHODS: Twenty-three French experts in ocular toxoplasmosis were invited to respond to a modified Delphi study conducted online, in the form of two questionnaires, in an attempt to establish a consensus on the diagnosis and management of this pathology. The threshold for identical responses to reach consensus was set at 70 %. RESULTS: The responses of 19 experts out of the 23 selected were obtained on the first questionnaire and 16 experts on the second. The main elements agreed upon by the experts were to treat patients with a decrease in visual acuity or an infectious focus within the posterior pole, to treat peripheral lesions only in the presence of significant inflammation, the prescription of first-line treatment with pyrimethamine-azithromycin, the use of corticosteroid therapy after a period of 24 to 48hours, the prophylaxis of frequent recurrences (more than 2 episodes per year) with trimethoprim-sulfamethoxazole as well as the implementation of prophylactic treatment of recurrences in immunocompromised patients. On the other hand, no consensus emerged with regard to the examinations to be carried out for the etiological diagnosis (anterior chamber paracentesis, fluorescein angiography, serology, etc.), second-line treatment (in the case of failure of first-line treatment), or treatment of peripheral foci. CONCLUSION: This study lays the foundations for possible randomized scientific studies to be conducted to clarify the management of ocular toxoplasmosis, on the one hand to confirm consensual clinical practices and on the other hand to guide practices for which no formal consensus has been demonstrated.RésuméObjectifÉvaluer les pratiques diagnostiques et thérapeutiques puis établir un consensus sur la prise en charge de la toxoplasmose oculaire en France grâce à une étude Delphi.MéthodesVingt-trois experts français de la toxoplasmose oculaire ont été invités à répondre à une étude Delphi modifiée menée en ligne, sous forme de deux questionnaires, afin de tenter d’établir un consensus sur le diagnostic et la prise en charge de cette pathologie. Le seuil de réponses identiques pour aboutir à un consensus a été fixé à 70 %.RésultatsLes réponses de 19 experts sur les 23 sélectionnés ont été obtenues au premier questionnaire et de 16 experts au second. Les principaux éléments qui font consensus auprès des experts sont de traiter les patients avec une baisse d’acuité visuelle ou un foyer infectieux au pôle postérieur, l’instauration d’un traitement face à un foyer périphérique seulement en cas d’inflammation importante, la prescription d’un traitement de première intention par l’association pyriméthamine–azithromycine, l’utilisation d’un traitement par corticostéroïdes après un délai de 24 à 48 h, la prophylaxie des récidives fréquentes (plus de 2 épisodes par an) par triméthoprime-sulfaméthoxazole ainsi que la mise en place d’un traitement prophylactique des récidives chez les patients immunodéprimés. En revanche, aucun consensus ne se dégage pour les examens à réaliser pour le diagnostic étiologique (ponction de chambre antérieure, angiographie à la fluorescéine, sérologie…), pour les traitements de seconde intention (en cas d’échec du traitement de première ligne) ni pour le traitement des foyers périphériques.ConclusionLa présente étude pose les bases d’éventuelles études scientifiques randomisées à mener afin de clarifier les prises en charge la toxoplasmose oculaire, d’une part pour confirmer les habitudes cliniques qui font consensus, d’autre part pour guider les pratiques pour lesquelles aucun consensus formel n’est mis en évidence

Dermatophytes and Dermatophytoses: A Thematic Overview of State of the Art, and the Directions for Future Research and Developments

peer reviewe

Baseline and multinormal distribution of ex vivo susceptibilities of Plasmodium falciparum to methylene blue in Africa, 2013–18

International audienc

Molecular and Histological Association Between Candida albicans from Oral Soft Tissue and Carious Dentine of HIV-Positive Children

Candida albicans and caries are frequently investigated among healthy and immunosuppressed individuals. The objective of this study was to demonstrate the presence of C. albicans on both oral soft and hard tissue and to investigate, at molecular level, the genetic subtype of the organism from the two oral sites. Tongue swabs and dentine scrapings from 362 HIV-positive children, referred for the extraction of carious primary teeth, were cultured on CHROMagar and identified to species level with ID32C. Histological staining of extracted carious teeth was also done. In patients with positive C. albicans cultures from both the tongue and carious dentine, DNA fingerprinting of such paired isolates was performed, using Southern blot hybridisation with the Ca3 probe. Yeasts were cultured from the tongue of 151 (41.7 %) individuals and 57 (37.7 %) simultaneously yielded positive C. albicans cultures from carious dentine. Nine different yeast spp. were identified from the tongue using the ID32C commercial system, but C. albicans was the only species recovered from carious dentine and histological investigation demonstrated fungal elements penetrated into the dentine and not limited to superficial debris on the floor of the cavity. Twelve of 13 paired isolates of C. albicans revealed identical fingerprinting patterns. The findings from this study demonstrated that in a particular individual, the same genetic subtype of C. albicans was capable of colonising both oral soft tissue and carious dentine. This renders carious teeth a constant source, or reservoir, of potentially infectious agents and, particularly among immunosuppressed individuals, should therefore not be left unattended.MRC granthttp://link.springer.com/journal/110462016-10-13hb201