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Introduction There are insufficient data regarding the efficacy and safety of vaccination in patients with auto-immune disease (AID) and/or drug-related immune deficiency (DRID). The objective of this study was to obtain professional agreement on vaccine practices in these patients. Methods A Delphi survey was carried out with physicians recognised for their expertise in vaccinology and/or the caring for adult patients with AID and/or DRID. For each proposed vaccination practice, the experts’ opinion and level of agreement were evaluated. Results The proposals relating to patients with AID specified: the absence of risk of AID relapse following vaccination; the possibility of administering live virus vaccines (LVV) to patients not receiving immunosuppressants; the pertinence of determining protective antibody titre before vaccination; the absence of need for specific monitoring following the vaccination. The proposals relating to patients with DRID specified that a 3–6 month delay is needed between the end of these treatments and the vaccination with LVV. There is no contraindication to administering LVV in patients receiving systemic corticosteroids prescribed for less than two weeks, regardless of their dose, or at a daily dose not exceeding 10 mg of prednisone, if this involves prolonged treatment. Out of 14 proposals, the level of agreement between the experts was “very good” for eleven, and “good” for the remaining three. Conclusion Proposals for vaccine practices in patients with AID and/or DRID should aid with decision-making in daily medical practice and provide better vaccine coverage for these patients.

Bioterrorism is defined by the intentional or threatened of microorganisms or toxins derived from living organisms to cause death or diseases in humans, animals or plants on which we depend. The other major point is to generate fear in the population. More than 180 pathogens have been reported to be potential agents for bioterrorism. The following is an overview of several agents that could be involved in a biological attack.

Position du probleme Une epidemie de leishmaniose cutanee est survenue chez des militaires, au decours d’un sejour de quatre mois en Guyane, durant lequel differentes missions ont ete effectuees. L’enquete epidemiologique avait pour objectifs de a) decrire l’epidemie et b) determiner les facteurs de risque de leishmaniose cutanee. Methodes Tous les sujets atteints ont beneficie d’une prise en charge hospitaliere. Les lesions ont ete biopsiees, puis mises en culture pour identification de l’espece. Un questionnaire standardise a ete administre individuellement a la personne interrogee par un medecin ou un infirmier. Les donnees recueillies ont ete saisies et analysees avec les logiciels EpiInfo 6.04d et SAS™. Resultats L’âge moyen des 71 militaires de l’unite etait de 25,9 ans (19-37 ans), douze d’entre eux ont presente des lesions (taux d’attaque: 16,9 pour 100). Le nombre total de lesions etait de 56, dont 13 ont ete observees sur le tronc, une zone corporelle normalement protegee par les vetements. L’espece en cause etait Leishmania (Viannia) guyanensis. L’analyse multivariee (regression logistique) a mis en evidence deux facteurs de risque: un stage en foret profonde effectue durant une periode a haut risque de transmission (OR = 11,2; p . Conclusion Le commandement devrait limiter les sejours en foret profonde pendant la periode a haut risque de transmission. L’application des mesures de lutte antivectorielle individuelles (vetements longs, repulsifs…) est indispensable. Les cadres de contact doivent motiver les soldats, notamment les plus jeunes, a utiliser les moyens de protection et doivent superviser les mesures de lutte antivectorielle. L’ecotourisme etant une activite qui se developpe, les touristes sejournant en foret, ainsi que les travailleurs, doivent etre informes et eduques sur la facon de se proteger.

Points essentiels • Les manifestations cutanees possibles du bioterrorisme infectieux sont multiples et variables selon l’agent biologique utilise. • Un syndrome cutane ulcereux et/ou necrotique et/ou un syndrome de lymphadenite regionale sont possibles en cas de maladie du charbon, de tularemie, de peste bubonique, d’emission de mycotoxines trichothecenes. • Un syndrome vesiculo-pustuleux febrile est le fait de la variole, de la melioidose, de la morve. • Un syndrome purpurique et/ou hemorragique s’observe lors des fievres hemorragiques virales et de la peste septicemique. • Ces atteintes cutanees ont une valeur d’orientation et d’alerte d’autant plus forte qu’elles surviennent dans un contexte de situation a risque, que plusieurs cas sont observes dans une population a priori non exposee, qu’il existe un syndrome extradermatologique. Elles peuvent permettre une mise en œuvre precoce du traitement.

The first identification of the Leishmania species responsible for visceral leishmaniasis in Djibouti is described. Four strains, obtained from three autochthonous cases, were identified by starch-gel electrophoresis and iso-enzyme analysis of 15 enzymatic systems. The strains were found to belong to two newly recognized zymodemes of L. donovani: MON-268 and MON-287.

The variola virus was the first biological agent to be used as a military weapon. It is considered as one of the main agents that could potentially be used in the context of bioterrorism. Smallpox was declared eradicated in 1980. So, in case of a confirmed or suspected case of smallpox, a deliberate, intentional origin must be considered. The early diagnosis of the first case is essential for initiating an epidemiological alert. All physicians should be well informed of the epidemiological, clinical, diagnostic, and therapeutic aspects of smallpox.

Resume Le traitement antiparasitaire du paludisme grave d'importation, pris en charge en France metropolitaine, fait appel a des molecules antipaludiques schizonticides, actives sur les souches de Plasmodium falciparum chloroquinoresistantes. La quinine, toujours tres efficace, reste la base de ce traitement. Ses proprietes pharmacocinetiques et pharmacodynamiques ont fait l'objet de nombreux travaux. Sa toxicite neurosensorielle et cardiovasculaire est bien etablie. L'artemether offre une alternative interessante en presence de souches poly-chimioresistantes. Une neurotoxicite a ete retrouvee lors d'etudes animales. La conduite pratique du traitement antiparasitaire privilegie l'utilisation de la quinine par voie intraveineuse. II existe des disparites dans l'expression des doses, les protocoles therapeutiques, les posologies maximales. Le recours a une dose de charge est l'objet de controverses. Les modalites de la surveillance du traitement ne sont pas formellement etablies. L'utilisation des antibiotiques et de l'artemether releve d'indications precises.

Campylobacter fetus subspecies fetus is an opportunist Gram-negative bacillus, which is known to be a cause of systemic infections, mainly in immunocompromised patients. We report a C. fetus bacteremia and cellulitis complicating a venous access port infection in a patient with acquired immunodeficiency syndrome (AIDS). This bacillus seems to have a predilection for the vascular endothelium and its isolation is difficult. Physicians should be aware of C. fetus infection in patients with vascular devices. Microbiologists should accurately isolate this organism from clinical specimens by modifying incubation techniques and performing molecular biology. The prognosis seems to be improved by a prolonged betalactam antibiotic regimen, especially amoxicilline plus clavulanic acid. In HIV infected patients, quinolones that were successful in our case, should be used with caution because of increasing resistance to antibiotics.

Resume Deux cas de cholangite alithiasique avec atteinte vesiculaire sont rapportes chez deux patients atteints de SIDA. Le diagnostic repose sur l'association de signes cliniques, biologiques et/ou d'imagerie. La cholecystectomie pourrait parfois etre effectuee precocement a titre antalgique, pour eradiquer un reservoir infectieux et determiner les germes pathogenes. Le cytomegalovirus (CMV) (le plus frequemment en cause), des cryptosporidies et des microsporidies ont ete retrouves dans les deux vesicules. Mycobacterium chelonae y etait associe dans un cas. La responsabilite des germes dans les symptomes est la moins contestee pour le CMV. La sphincterotomie sous endoscopie est a pratiquer selon des criteres cliniques et radiologiques precis. Le benefice du traitement d'attaque par phosphonoformate existe si le CMV est present dans les voies biliaires et que les douleurs persistent apres la chirurgie. L'efficacite de la paromomycine sur les cryptosporidies est a evaluer dans ce contexte.

We analyzed the potential causes of the increased susceptibility to apoptosis of peripheral lymphocytes from a large cohort of HIV-infected persons that we followed during a 3-yr period. By using quantitative cytofluorometric methods, we demonstrate that all lymphocyte populations were contributing proportionally to the apoptotic population in both groups of donors, but the percentage of T and B cells involved in this cell death process was significantly increased in HIV-infected persons. To study the relationship between the increased apoptosis in HIV infection and the activation state of the immune system, we analyzed cell surface expression of activation markers on apoptotic and nonapoptotic cells. We found that in the chronic phase of HIV infection, 50 to 60% of the apoptotic cells exhibited an activated phenotype (they were HLA-DR+, CD38+, CD45RO+, and Fas+), and interestingly, the CD45RO+ subset appeared to be more prone to apoptosis in HIV-positive persons. This study also indicates that the activated phenotype found on apoptotic cells was not a distinctive feature of patients' lymphocytes since it was in similar proportion in apoptotic cells from control lymphocytes. However, a significant correlation was found between the intensity of anti-CD3-induced apoptosis in both CD4 and CD8 T cells from HIV-infected persons and their in vivo expression of CD45RO and HLA-DR molecules. Finally, a significant correlation was found between the intensity of spontaneous or anti-CD3-induced apoptosis in total lymphocytes and disease progression; this was confirmed when the CD4 and CD8 T cell subsets were analyzed separately. Altogether these observations indicate that the increased susceptibility to apoptosis of peripheral T cells from HIV-infected persons correlates with disease progression and support the hypothesis that the chronic activation of the immune system occurring throughout HIV infection is the primary mechanism responsible for this cell deletion process.

Resume De tous temps, les militaires en campagne ont paye un lourd tribut aux infections, notamment aux epidemies. Aujourd'hui, 40 000 militaires servent hors metropole pour des missions et dans des operations, de duree variable et dans des pays tres divers. Des risques infectieux persistent malgre la mise en oeuvre des mesures de prophylaxie ; ils sont d'abord lies aux carences de l'hygiene du milieu, a la vie en collectivite et a la situation operationnelle : diarrhees bacteriennes, amibiase, hepatites virales A et E. D'autres relevent de l'environnement tropical ; le paludisme reste preoccupant du fait de la chimioresistance ; les bilharzioses peuvent donner lieu a de petites epidemies; les leishmanioses cutanees ne sont pas rares en Guyane. Des infections exceptionnelles mais graves sont observees. Les risques infectieux lies a la guerre sont rappeles : guerre biologique, infections des blesses, des brules et des irradies.

Resume L'identification recente du virus de l'hepatite E a permis de reconnaitre sa responsabilite dans les hepatites non-A, non-B a transmission enterale. Les hepatites E ont une vaste repartition, se manifestant sur un mode epidemique ou endemo-sporadique dans de nombreux pays defavorises. Elles sont essentiellement transmises par voie fecale-orale. Dans les pays developpes, elles realisent une pathologie d'importation. Leurs aspects cliniques principaux sont comparables a ceux de l'hepatite A, mise a part leur particuliere gravite chez la femme enceinte. Nous rapportons les aspects epidemiologiques, cliniques et evolutifs de 39 hepatites virales E d'importation (27 venant du Tchad, 6 de Guyane, 6 de Somalie) observees chez des militaires dans le service des maladies infectieuses et tropicales de l'Hopital Begin.

Resume L'emergence d'enterocoques resistants aux aminosides, aux s-lactamines et/ou aux glycopeptides a permis l'observation d'epidemies principalement nosocomiales. Les reservoirs de germes sont des patients colonises ou infectes ayant recu des antibiotherapies anterieures, au terrain debilite et dont le sejour hospitalier est prolonge. La transmission intrahospitaliere est favorisee par la promiscuite; le role des mains des personnels soignants comme facteur de risque est demontre. Les passages des malades et des personnels d'un hopital a l'autre contribuent a la propagation des infections. Les infections communautaires a enterocoques sont suspectees dans l'emergence des epidemies hospitalieres. L'utilisation des marqueurs epidemiologiques est precisee en fonction des situations epidemiques.

Bioterrorism is defined by the intentional or threatened of microorganisms or toxins derived from living organisms to cause death or diseases in humans, animals or plants on which we depend. The other major point is to generate fear in the population. More than 180 pathogens have been reported to be potential agents for bioterrorism. The following is an overview of several agents that could be involved in a biological attack.

An outbreak of cutaneous leishmaniasis occurred among 71 soldiers who had participated in various missions during a 4-month's period in French Guiana. The aims of this study were (i) to describe outbreak and (ii) to determine risk factors of cutaneous leishmaniasis.All patients were hospitalised. Cutaneous lesions were biopsied and cultured for species identification. Individual information was collected by a physician or a nurse, using on a standardised, anonymous chart. Data were processed with EpiInfo 6.04 and SAS.Mean age of the 71 soldiers was about 25.9 years (19-37 years). Twelve soldiers presented 56 lesions due to Leishmania (Viannia) guyanensis (attack rate = 16.9 for 100). Among 56 lesions, 13 lesions were localized on the trunk, usually an unexposed body area. Logistic regression highlighted military exercises in the forest during a high risk period of leishmaniasis transmission (OR = 11.2; p0.01), and the young age (OR = 1.33; p = 0.04). Vector control measures were not statistically significant.Military authorities should restrict deep forest activities during periods of high risk transmission. Vector control measures are essential. Officers should motivate their soldiers and supervise vector control measures. As ecotourism is developing, tourists as well as workers staying in deep forest must be informed of the risk and about vector control measures.

Campylobacter fetus subspecies fetus is an opportunist Gram-negative bacillus, which is known to be a cause of systemic infections, mainly in immunocompromised patients. We report a C. fetus bacteremia and cellulitis complicating a venous access port infection in a patient with acquired immunodeficiency syndrome (AIDS). This bacillus seems to have a predilection for the vascular endothelium and its isolation is difficult. Physicians should be aware of C. fetus infection in patients with vascular devices. Microbiologists should accurately isolate this organism from clinical specimens by modifying incubation techniques and performing molecular biology. The prognosis seems to be improved by a prolonged betalactam antibiotic regimen, especially amoxicilline plus clavulanic acid. In HIV infected patients, quinolones that were successful in our case, should be used with caution because of increasing resistance to antibiotics.

In the ALBI trial, 151 antiretroviral-naive patients with plasma human immunodeficiency virus type 1 (HIV-1) RNA levels of 10,000 to 100,000 copies/ml and CD4 cell countsor = 200 cells/mm3 received 24 weeks of treatment with stavudine/didanosine (n=51), zidovudine/lamivudine (n=51) or stavudine/didanosine for 12 weeks followed by zidovudine/lamivudine (n=49). Baseline plasma HIV-1 RNA and CD4 cell counts were comparable in the treatment groups. The mean decrease in plasma HIV-1 RNA at 24 weeks in the stavudine/didanosine group (2.26 log10) was significantly greater than that in either the zidovudine/lamivudine group (1.26 log10) or the alternating treatment group (1.58 log10) (P0.0001 for both). Proportions of patients with plasma HIV-1 RNA level500 copies/ml (91% vs 42% and 60%) and50 copies/ml (47% versus 4% and 9%) were significantly greater in the stavudine/didanosine group (P0.001 for pairwise comparisons). Stavudine/didanosine was associated with a mean increase in CD4 cell count (124 cells/mm3) significantly greater than that in the zidovudine/lamivudine group (62 cells/mm3, P0.01) and comparable to that in the alternating group (118 cells/mm3). All study regimens were well tolerated. These findings, indicating superiority of stavudine/didanosine over zidovudine/lamivudine in virological and immunological response over 24 weeks, suggest that the combination should be considered as a basis for highly active antiretroviral therapy.

The possible cutaneous manifestations of infectious biological warfare are multiple and vary depending on the agent used. An ulcerous and/or necrotic syndrome and/or regional lymphadenitis syndrome are possible with anthrax, tularaemia, bubonic plague and emission of trichotecene mycotoxins. A vesiculo-pustular syndrome with fever is provoked by smallpox, melioidosis and glanders. A purpural and/or haemorrhagic syndrome is seen during haemorrhagic fever viruses and septicaemic plague. These cutaneous manifestations are excellent markers that orient and alert when they occur in a context of a situation at risk, when several cases are observed in a usually non-exposed population and with extra-dermatological syndromes. They permit the early initiation of treatment.

The variola virus was the first biological agent to be used as a military weapon. It is considered as one of the main agents that could potentially be used in the context of bioterrorism. Smallpox was declared eradicated in 1980. So, in case of a confirmed or suspected case of smallpox, a deliberate, intentional origin must be considered. The early diagnosis of the first case is essential for initiating an epidemiological alert. All physicians should be well informed of the epidemiological, clinical, diagnostic, and therapeutic aspects of smallpox.

Pentavalent antimony (PA) compounds remain the main therapeutic agents of cutaneous leishmaniasis (CL). CL infection resistant to PA is difficult to cure, limited by severe side effects and requiring a long course treatment of parenteral administration of recommended second line drugs. We report a case of CL unresponsive to meglumine antimoniate contracted in Djibouti, successfully treated with a short course treatment of AmBisome. In this case the subject had a recurrent thick crusted erythematous lesion on his left elbow associated with spreading micropapula on arms and thorax. The diagnosis of CL was confirmed by direct examination and genomic amplification by PCR of skin samples, cultures were negative. A short course treatment of parenteral AmBisome (18 mg/kg) has lead to clinical cure with no side effects and no relapse. In our hospital, the high cost of medication was counterbalanced by easiest administration, reduction of hospitalization duration, absence of adverse events and a gain of comfort. For this patient, a short course treatment of AmBisome proved to be a suitable alternative to traditional drugs used in CL resistant to PA.

Long considered as a theoretical menace, or even a simple myth, bioterrorism has now become a reality in the aftermath of the events which occurred in the USA in autumn 2001. To deal with such a risk, therapeutic and prophylactic resources against the main potential agents must be available. In France today, the vaccine protection against bioterrorism agents is limited to smallpox, the only disease for which there is a vaccine. The current situation and perspectives of this smallpox vaccine are described., Longtemps considéré comme une menace théorique, voire un simple mythe, le bioterrorisme est devenu une réalité à la suite des événements de l’automne 2001, aux États-Unis. La prise en compte de ce risque nécessite de disposer de moyens thérapeutiques et prophylactiques vis-à-vis des principaux agents potentiellement utilisables. Actuellement, la protection vaccinale contre les agents du bioterrorisme ne concerne, en France, que la variole, seule maladie contre laquelle nous disposons d’un vaccin. Nous envisageons l’état actuel et les perspectives de ce vaccin antivariolique., Debord T. Vaccins et bioterrorisme: vaccins anti-varioliques. In: Bulletin de l'Académie Vétérinaire de France tome 156 n°3, 2003. pp. 63-67.

Spontaneous splenic ruptures are rare but life-threatening complications of infectious diseases. Splenectomy is still the treatment of choice but numerous recent reports have documented favorable outcome with conservative treatment.We report three cases of splenic rupture occurring respectively with infectious mononucleosis, P. vivax infection and dengue fever. Diagnosis, treatment and indications are reviewed, an approach to management is suggested. The study included three military men respectively aged 23, 24 and 35 years, admitted for acute abdominal pain in the left upper quadrant. The abdominal computed tomography confirmed partial rupture (splenic hematoma) in the first two cases, and an hemoperitoneum in the dengue case. Splenic ruptures can reveal or complicate an evolving infection. Rupture can happen spontaneously or as a result of trauma, which may be minor and unnoticed. The typical presentation is acute, but progressive forms are described. The diagnosis is made by ultrasound and CT scan. Splenectomy dogma tends to be supplanted by conservative treatment. Non-operative management can be successful if appropriate criteria and a long period of follow-up are applied in carefully selected cases. When an operative approach is selected, conservative surgical treatment is attractive. Splenectomy should be reserved for patients with uncontrollable rupture or with recurrent splenic bleeding.Spontaneous splenic rupture are uncommon in infectious diseases. A multidisciplinary management is necessary. A conservative treatment should be considered in selected, closely monitored patients.

Anthrax is a zoonotic disease caused by Bacillus anthracis. Skin disease is the most common form in humans. Pulmonary anthrax related to the inhalation of airborne germs develops after a silent incubation period of several days and followed by acute respiratory distress. Diagnosis is a difficult task and generally based on demonstration of Bacillus anthracis on direct examination. Despite the sensitivity of B. anthracis to penicillin, treatment is rarely successful.

Hepatitis viruses of oral-fecal origin are responsible for a high morbidity and mortality throughout the world, even if they never result in chronic hepatitis. Two viruses, the virus of hepatitis A (VHA) and of hepatitis E (VHE) are at present the cause of severe viral hepatitis of enteric origin. Water is the principle vector in the spread of these viruses. However, the epidemiological aspects vary according to the pathogenic agent. VHA is excreted in a highly concentrated form in the feces for a relatively short period of time. Since it resists in an exterior environment, the virus remains infectious for a long time. VHE is excreted for a short period of time and in low concentrations. The viral particles are fragile in vitro and their variability in the environment is little known. The possible reservoir role of certain animals has been envisaged. Epidemics arise especially in countries suffering from poor hygiene and massive water pollution. Hepatitis A should no longer be considered a benign disease of childhood. The progress made in hygiene and economic development in industrialized countries have made contacts with this virus scarce, rendering the populations more receptive to it and epidemics more widespread. When the sickness occurs later in life, infection is more often symptomatic and can be serious, resulting sometimes long-term indisposition. Hepatitis E has a vast distribution throughout the world and manifests itself either in epidemic or endemic-sporadic form in many poor countries. In developed countries, it comes about mostly as a result of imported pathology, even if there exists a "substratum" of infection in these areas. The main clinical aspects, such as we were able to study them in 39 cases of military men from Tchad, Guyana and Somalia, are comparable to those of hepatitis A. The reasons for the particular gravity of symptoms in pregnant women are unknown. These affections have no specific treatment. In the field of prevention, vaccination is at present the best means for hepatitis A prophylaxis. Until a vaccine against hepatitis E is found, prevention depends on hygiene, sanitation measures et distribution of drinking water.

Human Vgamma9Vdelta2 T cells contribute to immunity against intracellular pathogens and recognize nonpeptidic antigens, such as the mycobacterial phosphoantigen TUBAg. HIV infection is associated with a polyclonal decrease of peripheral Vgamma9Vdelta2 T cells and we previously reported that the remaining cells show a proliferative anergy to stimulation with Mycobacterium tuberculosis in 60% of patients. Because of alterations in the Th1/Th2 cytokine balance reported in HIV infection, we analyzed, at the single-cell level, the influence of exogenous IL-4, IL-10, IL-12 and IL-15 on the response to mycobacterial phosphoantigens of gammadelta T cells from HIV-infected patients and healthy donors. We report that the strong gammadelta T cell response to TUBAg is characterized by the rapid and selective production of the Th1/proinflammatory cytokines IFN-gamma and TNF-alpha in responder HIV-infected donors. In addition, a positive regulation by IL-12 and IL-15 of the production of these cytokines by Vgamma9Vdelta2 T cells in response to nonpeptidic ligands was observed, whereas IL-4 and IL-10 had no effect. In contrast, Vgamma9Vdelta2 T cells from the anergic HIV-infected donors had lost the ability to produce Th1 cytokines and were not shifted towards a Th2 profile. Furthermore, neither IL-12 nor IL-15 could reverse this functional anergy. The consequences of these observations are discussed in the context of HIV pathogenesis.

We report a case of disseminated tuberculosis involving the middle ear, the central nervous system, the spine and the lung. The tuberculous epidural abscess and otomastoiditis don't have any specific imaging features. But their coexistence with an other tuberculous involvement might suggest their tuberculous nature. The epidural abscess may result from direct extension from otomastoiditis.

We have previously reported significant alterations of gamma delta subset distribution in the peripheral blood of HIV-infected donors. These modifications are characterized by the depletion of the V delta 2 subset associated with a strong increase in peripheral V delta 1 T cells. In addition, the latter exhibit ex vivo an activated phenotype and show a restricted complementarity-determining region 3 (CDR3) repertoire. In the present report we first address the question of the origin of these expanded cells. The lack of expansion and the Gaussian complementarity-determining region 3 size distribution of lymph node V delta 1 T cells suggest that lymph nodes do not represent the site of specific activation of this subset. The function of blood V delta 1 T cells was also explored. We report that patients' V delta 1 T cells express high levels of perforin and display an in vitro cytotoxic activity, whose characteristics are different from those of NK and LAK cells. In addition, single cell analysis of cytokine production revealed that, in contrast to V delta 1 T cells from control donors, patients' V delta 1 T cells are primed in vivo for IFN-gamma and TNF-alpha production. Together, these results indicate that in the course of HIV infection, expanded blood V delta 1 T cells are differentiated into a functional subset and raise the question of the contribution of this subset to AIDS pathogenesis.

Serum levels of HRP-2 antigens against Plasmodium falciparum in 568 venous blood samples collected at two general hospitals were evaluated using the ParaSight-F (Becton-Dickinson) alone (568/568 samples) or in combination (156/568 samples) with the new ICT-Malaria P.f. (ICT-diagnostic). Comparison with the reference method (thin and thick blood smears assessed by two experienced parasitologists) showed that both tests were highly sensitive (93% and 96% respectively) and specific (98% and 98% respectively). The positive predictive values of the two tests were equal (96%) and the negative predicative values were close (96% and 98% respectively). Although both tests provided results within 10 minutes and required no special equipment for interpretation, the ICT-Malaria P.f. test seemed simpler and easier to use than the ParaSight-F test. The ParaSight-F test alone was used to monitor serum antigen levels after treatment in 24 patients. Antigen levels remained positive for at least three days after disappearance of circulating parasites (range: 3 to 28 days). Evaluation of serum levels of HRP-2 antigens can be useful for emergency diagnosis, especially in patients with low circulating parasite levels. The ICT-Malaria P.f. test seems especially suited for in-field use.

Military personnel in operations have always paid a high toll to infections, particularly epidemics. Currently, 40 000 servicemen serve overseas in various missions and operations of various durations in various countries. Infectious hazards persist in spite of the implementation of preventive measures. They are primarily due to poor sanitation, promiscuous living conditions, and the operational situation : bacterial diarrhea, amoebiasis, viral hepatitis A and E are relatively frequent. Others are due to the tropical environment ; malaria remains a concern due to its chemoresistance ; bilharziosis can also cause small epidemics, cutaneous leishmaniasis is not rare in Guyana. Exceptional but serious infections are observed. Infectious hazards associated with warfare are reviewed : biological warfare, infections of wounded, burnt and irradiated soldiers.

Cerebromeningitis after travel abroad is often acute and febrile and is a serious event. The most frequent and severe cause is pernicious malaria due to Plasmodium falciparum; diagnosis is rapid by thick blood film and thin blood smear; it requires specific emergency treatment. Many other aetologies exist but they are rare; they must nonetheless be considered, keeping in mind that cosmopolitan infections can be favoured by travel conditions.

La tularemie est une zoonose due a Francisella tularensis , coccobacille a Gram negatif a tropisme intracellulaire capable de traverser la peau saine et plus facilement encore la peau excoriee. Parmi les principales manifestations cliniques, la forme ulceroganglionnaire constitue l'expression la plus frequente de la maladie et sa localisation epitrochleenne traduit generalement un contact avec un leporide (lievre et lapin de garenne). Nous rapportons ici un cas d'adenite suppuree a Francisella tularensis confirme bacteriologiquement, permettant ainsi l'etude de la sensibilite aux antibiotiques.