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We report 78 cases of toxoplasmosis diagnosed between 1987 and 1992, from an autopsy study of 205 patients infected by the human immunodeficiency virus (HIV). Of the 78 patients 22 were females (28%) and 56 males (72%). Risk factors were as follows: intravenous drug addiction (44 cases, 56%), homosexuality or bisexuality (18 cases; 36%) and multiple blood transfusions (6 cases). Cerebral toxoplasmosis (CT) was diagnosed in 73 cases (93%) and was characterized by abscesses (59 cases), diffuse encephalitic lesions (8 cases), isolated cysts without inflammation (3 cases) and hemispheric involvement with ventricular hemorrhage (3 cases). Cerebral involvement were isolated (55/78 cases; 70%) or associated with multi-visceral diffusion (18/78 cases; 23%). Isolated extracerebral localization was observed in 5 cases. The most frequent extracerebral sites were: cardiac (21 cases), pulmonary (14 cases) and pancreatic (7 cases). Immunohistochemical study with anti Toxoplasma gondii antibodies allowed to a diagnosis of extracerebral localization in 8 cases. Ultrastructural features of Toxoplasma gondii were studied on post mortem myocardial samples (2 cases) open lung biopsy (1 case) and bladder biopsy specimen (1 case). Antemortem diagnosis of cerebral toxoplasmosis was performed on CT-scan in 59/73 (80%). Antemortem diagnosis of extracerebral toxoplasmosis was performed or suspected in 8/23 cases (34%): by isolation of trophozoites in bronchoalveolar lavage (2 cases), on an open lung biopsy (1 case) and on a bladder biopsy specimen (1 case), and by clinical and echocardiographic data (4 cases). Anti-toxoplasmic serology allowed to the diagnosis of toxoplasmosis in 12/78 cases (15%) by showing high levels of IgG in the serum.(ABSTRACT TRUNCATED AT 250 WORDS)

We report the case of a 29 year-old man who died from rabies in France, following a dog-bite during a trip in Mexico. Although it was clinically suspected, the diagnosis was uncertain until he died because of digestive, cardiac and psychiatric misleading symptoms associated to the neurologic disorders. Post mortem diagnosis was based upon virological study in immunofluorescence on cerebral smears, viral isolation on cell-culture, and ELISA. It was confirmed by light microscopy examination which showed numerous Negri bodies, and ultrastructural study of the rhabdovirus in the central nervous system. Extranervous lesions, especially myocarditis and pancreatitis, were observed and their meaning is discussed. The physician is exceptionally confronted to the diagnosis of human rabies in France. Nevertheless, the lack of compulsory antirabic vaccination and the increase of touring in enzootic countries increase the risk of infection. As an intra vitam diagnosis in frequently lacking, the diagnosis of rabies infection needs a complete post mortem virological study as well as an histological and ultrastructural examination of the central nervous system.