Use of four dengue virus antigens for determination of dengue immune status by enzyme-linked immunosorbent assay of immunoglobulin G avidity

We used an enzyme-linked immunosorbent assay (ELISA) of immunoglobulin G avidity to determine the dengue immune status of 105 pairs of serum samples from patients infected with dengue virus. This study shows that a simple avidity test, for which only one acute-phase serum sample is required, is potentially more useful than the hemagglutination inhibition test for the discrimination of primary from secondary dengue virus infection, whatever the type of dengue antigen used.     

Efficacy of permethrin-treated uniforms in combination with DEET topical repellent for protection of French military troops in Côte d'Ivoire

In 2000, 22,000 French military personnel were deployed overseas. The French military health service implemented a vector control strategy including personal protection by the use of permethrin preimpregnated battlefield uniforms (BFUs) and the application on the skin of a topical repellent (50% DEET). In 2000, French forces used an industrial process to impregnate cloth with permethrin by soaking it before cut-out of the BFU. A study was implemented in four experimental huts in C?te d'Ivoire to assess the field efficacy of the impregnated BFUs and their resistance to washing. Taking into account the systematic variations in each variable in the field and using a modeling based on logistic regression and discriminant analysis, this study showed that after 6 h without reapplication, the protective effects of the use of DEET as skin repellent was not significant, perhaps due to the high density of Anopheles mosquitoes during the night catching sessions and an average time of effective repellency of < 2 or 3 h in the field. The analysis also showed that the French process of industrial impregnation of permethrin of the BFU offered in 2000 some protection from mosquito bites but not enough to reduce significantly the incidence of malaria among nonimmune troops. No positive or negative interaction was noted when DEET and the impregnated BFUs were used together.     

Delayed Periocular Hemorrhage After Upper Blepharoplasty

Periocular and orbital hemorrhage are rare complications of blepharoplasty, with a reported incidence of 0.055%. These complications are even less common more than 48?h after surgery. The authors report 2 cases of postoperative hemorrhage 5 and 8 days following uncomplicated upper blepharoplasty in which the initiating factor seems to have been uncontrolled hypertension. Details of the presentation, management and follow-up of each patient are described. These cases serve as an important reminder that patients must be appropriately counseled regarding the postoperative implications of their systemic conditions.     

Induction of micronuclei in peripheral erythrocytes of axolotl larvae following in vivo exposure to mutagenic agents

Previous work from this laboratory demonstrated the presenceof micronuclei in erythrocytes from larvae of the urodele amphibianPleurodeles waltl reared in water containing clastogenic substances.In order to investigate the generality of this finding, larvaefrom another urodele Ambystoma mexicanum (axolotl) were rearedin water containing one of the two following compounds: benzo[a]pyrene(BaP) or ethylmethane sulphonate (EMS). The level of mironucleatederythrocytes on blood smears was compared with control samplesfrom larvae reared in fresh water. The optimum larval stagefor this test system was determined. The effects of the indirectmutagen (BaP), and the direct mutagen (EMS) were found to dependon both dose and exposure to the clastogen. Positive resultswere obtained for BaP after 8 days of treatment at a concentrationof 0.025 p.p.m. After 10 days of treatment at a concentrationof 0.1 p.p.m. numerous micronuclei were seen (> 250% ). Positiveresults were also obtained with EMS after 8 days of treatmentat a concentration of 24 p.p.m. At 62 p.p.m., positive resultswere found after 6 days of treatment, while at 124 p.p.m. positiveresults were found after only 4 days. The results with boththese agents show that the axolotl holds promise as an in vivotest system for the detection of low concentrations of clastogensin an aquatic environment. Address for reprint requests: Unité Associée no. 675 (CNRS) and Université de Toulouse — Le Mirail, Toulouse, France     

Resurgence of measles in the French military forces in 2010

Since the start of 2010 there has been a flare-up of measles in France, following on the resurgence observed in 2008. The aim of this study was to present results of the epidemiological surveillance of measles in the French armed forces and to describe the increase in incidence. Measles was surveyed from 1992 to 2010. Criteria for report were those used for French national compulsory notification. The data, concerning active military personnel, were provided by the physicians in the armed forces using anonymous data collection forms. Between 1992 and July 2010, 689 cases of measles were notified. Since 2002, the mean incidence rate was 1 case per 100,000. A significant increase has been observed for 2010 (13.9 cases per 100,000 in 2010 versus 1.8 in 2009). The 28 cases reported in 2010 involved five clusters and three isolated cases. The mean age of affected subjects was 27?years. Only 30% of cases had been vaccinated. The epidemic resurgence of measles observed in 2010 in the French armed forces follows the same pattern as that observed nationally and at European level, and can be seen as the likely consequence of inadequate vaccination cover.     

Possible dengue sequential infection: dengue spread in a neighbourhood during the 1996/97 dengue-2 epidemic in French Polynesia

A DEN-2 epidemic occurred in French Polynesia from August 1996 to April 1997 after 7 years of DEN-3 circulation. The susceptible population constituted all expatriates and Polynesians under 21. In August 1996, two successive DEN-2 cases occurred in Teroma, a Tahitian neighbourhood close to the international airport of Tahiti. A serological prospective study of persons < 21 years living in Teroma was conducted. The study population was bled in September 1996, October 1996 and June 1997. Analysis of dengue spread in Teroma confirmed that dengue transmission occurs primarily in the house, thus vector control campaigns should incorporate focal insecticide spraying and systematic daily use of insecticide in houses. The evolution in time of the disease demonstrated that among a susceptible population, prevalence and incidence rates are related to the time of exposure, and consequently to age. Comparison of dengue incidence or dengue prevalence between populations therefore requires adjusted age rates. Most studies did not adjust for age, leading to the conclusion that DHF is more frequent during secondary than during primary dengue infection. Prospective studies taking into account the time of dengue exposure are necessary to confirm the sequential infection hypothesis.     

Surveillance épidémiologique specifique de la dengue: Méthode et intérêt lors de l'épidémie de dengue 2 en Polynésie française en 1996

La dengue est une arbovirose présente dans toute la zone intertropicale. Son extension géographique et l'augmentation simultanée de sa létalité sont préoccupantes. En zone d'endémie ou d'épidémie, une surveillance épidémiologique spécifique de la dengue permet d'identifier et de confirmer au plus vite la circulation d'un nouveau sérotype viral de la dengue: avec un délai d'alerte épidémique raccourci, l'efficacité des stratégies de lutte est renforcée. En Polynésie française, alors que seul le sérotype 3 circulait depuis 1989, la menace d'une épidémie de dengue 4 a déclenché la mise en place d'une surveillance épidémiologique spécifique en mai 1996. Devant chaque cas suspect de dengue, 18 médecins répartis sur le territoire polynésien effectuaient un prélèvement sanguin et rédigeaient une fiche de renseignements cliniques. Entre mai et novembre 1996, le laboratoire de virologie de l'Institut Malardé a mis en évidence 21 virus (2 de dengue 3 et 19 de dengue 2) soit par mise en culture, soit par RT-PCR, sur les 302 prélèvements traités. La surveillance spécifique a démontré la circulation d'un virus dengue 2 et elle a permis de raccourcir de 12 à 16 semaines le délai d'alerte épidémiologique par rapport aux précédentes épidémies. Tenant compte du délai de prélèvement, une régression logistique effectuée sur les variables cliniques a montré que seule l'absence de toux était prédictive de la dengue. Construits autour d'objectifs pragmatiques, la performance des systèmes épidémiologiques de surveillance spécifique de la dengue doit encourager leur mise en ?uvre dans tous les pays concernés, en passant, si nécessaire, par une collaboration avec des laboratoires de référence. Dengue fever is present in tropical and subtropical regions and its geographical extension and the simultaneous increase of its mortality are worrisome. In endemic or epidemic countries, the aim of dengue-specific epidemiological surveillance is to confirm as soon as possible the circulation of a new viral dengue serotype, i.e. the beginning of an epidemic. The efficiency of the control strategy is improved by an earlier epidemic alert. In French Polynesia, dengue-3 virus circulated since 1989 at low level and, in May 1996, a specific epidemiological surveillance was undertaken because of the threat of a dengue-4 epidemic. From each suspected dengue case reported by 18 Polynesian physicians located in the Société Islands, a blood sample was taken for virological assay and clinical data were reported. Between May and November 1996, the virology unit of the Institut Malardé isolated 21 viruses (2 dengue-3 and 19 dengue-2) from 302 suspected cases. The dengue-specific epidemiological surveillance confirmed that dengue-2 virus was circulating and reduced the time of the epidemiological alert by 2 or 3 months compared to previous epidemics. Taking into account the day of illness, a logistic regression undertaken on the clinical data showed that the absence of cough was the only predictive sign of dengue diagnosis. The performance of this dengue-specific epidemiological surveillance system led us to consider its implementation in all concerned countries. A collaboration with international reference laboratories could be a solution for the developing countries.     

Measurement of bismuth in bone by pulse polarography with anodic stripping voltammetry. Application to two cases of arthropathy.

Pulse polarography with anodic stripping has shown the presence of very high levels (2 005 microgram/kg and 6 760 microgram/kg) of bismuth in bone of two patients treated with bismuth, one parenterally and the other orally. The presence of high levels of bismuth in bone of these patients must be considered in the etiology of their athropathies. Pulse polarography with anodic stripping now permits very precise measurement of bismuth impregnating bones.     

Prevalence of hepatitis B and C virus, HTLV-1 and HIV in type B lymphoproliferative syndromes in Gabon

B lymphoproliferative disorders (B-LPD) are the most frequent types of lymphoid malignancies encountered in Gabon where HCV, HBV, HTLV-I and HIV are highly prevalent and all known for lymphotropism. Prevalences of HBs Ag, antibodies to HCV, HTLV-I and HIV were compared in 40 patients (21 men, 19 women; 17 < age < 75 years) with newly diagnosed B-LPD (low grade lymphoma = 6, intermediate grade = 21, high grade = 8: chronic lymphocytic leukaemia = 5) and 160 age and sex-matched controls. None of the B-LPD patients had got transfusion or parenteral care from the onset of symptoms to the inclusion day. In the B-LPD group, 13 patients had HBs Ag and antibodies to HCV, HIV and HTLV-1 were detected in 11, 6 and 10 subjects. In monovariate analysis, HBs Ag, antibodies to HIV or HTLV-1 were risk factors for B-LPD but antibodies to HCV were not associated with such diseases. Multivariate analysis showed only a relationship between HBs Ag and B-LPD (OR = 3.86; IC: 1.11-13.48). In such patients, reactivation of B hepatitis by treatment of B-LBD may be an important concern. If a background poor immune system could explain both susceptibility to long standing virus carriage and lymphoma development, a participating action of the HBV in lymphomagenesis could not be excluded.