Biomedical subjects
Publications and source records attributed to J Cenac.
Microsporidia were infrequent in man until 1985. A new species, Enterocytozoon bieneusi, responsible for diarrhea, was described in AIDS patients in 1985. Little is known about the parasite; its diagnosis is difficult, and its incidence certainly underestimated. This work summarizes current knowledge on microsporidia (parasitology, clinical features, diagnosis and drug therapy).
The study of 11 cases of isosporiasis (Isospora belli) shows that this opportunistic coccidia, alone or with Cryptosporidium, causes severe prolonged diarrhoea which worsens the prognosis and evolution of AIDS patients. A low prevalence (0.7%) is found in subjects from tropical regions. The results of treatment are disappointing. Bactrim is the only drug found to be effective but prolonged parasitological surveillance is required to detect the frequent relapses, and assess the long-time usefulness of this drug.
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The human basophil degranulation test (HBDT) was applied to the diagnosis of schistosomiasis. In 120 cases confirmed by parasitological examination, the test was shown to be extremely sensitive (90% clearly positive responses) and specific. The total immunoglobulin E levels were higher in infested subjects (average value: 2,000 IU/ml) compared to an average of 500 IU/ml in control subjects. However, wide individual variations were observed and other parasitoses can also produce considerable increases. The measurement of specific IgE showed a clear response with high positive levels in patients with bilharziasis whereas the response was always negative in the controls.
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The biological diagnosis of human cryptosporidiosis is made primarily by identifying Cryptosporidium oocysts in stool specimens under the microscope. It is advisable to fix and stain the fecal smears by the technique according to Henriksen. It is possible to examine fresh specimens and to carry out concentration techniques but this requires excellent knowledge of the cytology of the parasite. Cryptosporidium can also be identified from intestinal biopsies.
Twenty immigrants from Mali and West Senegal were treated in Paris. Onchocerciasis was diagnosed by six skin snips using a Holth punch. Ivermectine was given in a single oral dose: ten patients were given 50 mcg/kg, three were given 75 mcg/kg and seven received 100 mcg/kg. No patients had ocular symptoms. The results were as follows: Pruritus disappeared rapidly in 9 out of 11 patients who itched before treatment. The microfilarial load decreased rapidly, especially in cases treated with 75 mcg/kg and 100 mcg/kg as all patients tested on day 60 were negative. Clinical signs of the Mazzotti reaction and ocular reactions were not observed following the treatment. Pruritus was briefly aggravated in only two patients. No cardiovascular, hematological, hepatic or renal toxicity was noted.
Albendazole, a new broad spectrum anthelmintic, has been tested in 66 adult patients infected by S. stercoralis. 77.2% cure rate was observed following 800 mg once a day for 3 consecutive days, based on repeated fecal examinations using a concentration technic (Junod) and a Baermann test, carried out during 6 to 9 months following treatment. Associated ancylostomiasis caused by N. americanus and trichuriasis were also completely cured (100%). Based on clinical side effects and laboratory investigations, the drug did not produce any significant adverse reactions.
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Diagnosis of small intestine parasitosis can be realized by string-test. This examination, easily performed, does not produce side-effects in ninety percent of cases. The main problems are: good string unrollment and duodenal passing over. When Necator ova or gardia cysts are found in the stools by the Junod's technic, string-test is always positive. In one case, this latter even showed Schistosoma mansoni ova. Among 18 patients with unexplained hypereosinophilia, in spite of a parasitologic check up involving three stools examinations, the string-test showed Necator ova. With regard to strongyloidiasis, when properly performed, string-test is positive in seventy percent of cases. Therefore, this technic seems very useful on the field or in laboratories which do not usually realize the Junod's technic.
The human basophil degranulation test was applied to the diagnosis of strongyloidiasis. The preliminary results show an excellent response. 33 of the 35 cases give a definite positive result and in the 15 control cases, with no parasitosis or an other helminthiasis, the test was negative. If these results are confirmed by a more important study of sensitivity and specificity, the test would be of interest when the parasitosis is of difficult evidence and especially by patients needing immunodepressive therapy.
Fecal samples of 61 patients were investigated for Cryptosporidium: it was identified in four cases of acquired immunodeficiency syndrome, five cases of lymphadenopathic syndrome, one case of immunosuppressive therapy. One person was immunocompetent but in close contact with one of the patient. The authors report clinical and epidemiological characteristics of the 11 patients.
The microscopic investigation of 3 500 faecal samples with a method of concentration combining the ether treatment and flottation, has allowed to spot 5 cases (out of 700) of isosporosis (Isospora belli) among subjects coming all from the tropical area and showing an occasionally serious symptomatology which has been treated by tinidazole. Besides 2% samples were infested by Sarcocystis hominis. The subjects affected were also from tropical origin, but did not present clinical disorders directly to be attributed to this parasite. These observations permit to review the last bibliography and to make a parasitological and clinical review in the field of coccidiosis.
Two group of patients including 63 urinary schistosomiasis and 49 intestinal schistosomiasis were studied with the following investigations: microscopic examination of stools and urines, rectal mucosae biopsy, total IgE dosages, plasmatic proteins values and indirect immunofluorescence. The data obtained led to the following conclusions: --Recovery must be based on the microscopic observation of stools and/or urines and R. M. B. --I. F. I. and IgE dosages alone were not sufficient. --Protides evaluations (IgA, IgG, IgM, orosomucoid, haptoglobin) did not show any informative values and did not seem to be linked with the parasitologic disease.