Background. Morbidity control of schistosomiasis relies on a single drug, praziquantel. The antimalarial drug mefloquine possesses interesting antischistosomal properties, yet no clinical studies have been performed.Methods. We conducted a randomized, exploratory open-label trial to assess the efficacy and safety of mefloquine (25 mg/kg), artesunate (3 doses of 4 mg/kg), mefloquine-artesunate (3 doses of 100 mg artesunate plus 250 mg mefloquine), and praziquantel (40 mg/kg) against Schistosoma haematobium. The effects on Schistosoma mansoni, malaria parasitemia, soil-transmitted helminths, and intestinal protozoa were also determined.Results. A total of 83 S. haematobium-infected schoolchildren were included in the study. Cure rates of mefloquine, artesunate, mefloquine-artesunate, and praziquantel against S. haematobium at day 26 after treatment were 21%, 25%, 61%, and 88%, respectively. Both mefloquine-artesunate and praziquantel resulted in egg reduction rates 195%. Significantly lower egg reduction rates were seen in the artesunate (85%) and mefloquine groups (74%). In children coinfected with S. mansoni, praziquantel and mefloquine-artesunate, but not mefloquine and artesunate alone, resulted in high cure rates and egg reduction rates. Mefloquine, artesunate, and mefloquineartesunate completely cured infections due to Plasmodium falciparum. No effects were found against soil-transmitted helminths and intestinal protozoa. Abdominal pain was the most frequent adverse event, with a higher incidence among children treated with mefloquine (89%), mefloquine-artesunate (83%), and artesunate (60%) than among children treated with praziquantel (46%).Conclusions. The high efficacy of mefloquine-artesunate against S. haematobium warrants further investigation. Individuals coinfected with Plasmodium and Schistosoma who were treated with a mefloquine-artesunate combination against malaria might have a dual benefit: clearance of malaria parasitemia and reduction of schistosomiasisrelated morbidity.Clinical trials registration. Current Controlled Trials identifier: ISRCTN06498763.

An up-to-date review on human paragonimiasis in Africa was carried out to determine the current geographical distribution of human cases and analyze the animal reservoir, snails and crustaceans which intervene in the local life cycle of Paragonimus species. Two countries, i.e., Cameroon and Nigeria, were mainly affected by this disease, while the distribution of human cases in the other eight states of the intertropical zone was scattered. Infected patients were currently few in number and two Paragonimus species: P. africanus and P. uterobilateralis, were found. The animal reservoir is mainly constituted by crab-eating mammals. The identity of the host snail remains doubtful and was either a prosobranch, or a land snail. Seven crab species belonging to Callinectes, Liberonautes and Sudanonautes genera are able to harbour paragonimid metacercariae. Due to the current low prevalence of human paragonimiasis recorded in Africa and the high cost of wide-scale screenings for this disease, training of technicians in anti-tuberculosis centers would be the most realistic attitude to detect mycobacteria and/or Paragonimus eggs during the same sputum examination. Key words: Paragonimus spp., Africa, human paragonimiasis, intermediate hosts, tuberculosis RésuméUne revue sur la paragonimose en Afrique a été réalisée pour déterminer la distribution géographique actuelle des cas humains et analyser le réservoir animal, les mollusques et les crustacés qui interviennent dans le cycle local des espèces de Paragonimus. Deux pays, à savoir le Cameroun et le Nigeria, sont principalement affectés par cette maladie tandis que la répartition des cas humains dans les huit autres états de la zone intertropicale est dispersée. Les patients parasités sont actuellement peu nombreux et deux espèces de Paragonimus: P. africanus et P. uterobilateralis, ont été identifiées. Le réservoir animal est principalement constitué par des mammifères mangeurs de crabes. L'identité du mollusque hôte reste douteuse et se rapporte à un prosobranche ou à un mollusque terrestre. Sept espèces de crabes appartenant aux genres Callinectes, Liberonautes et Sudanonautes sont capables d'héberger des métacercaires de Paragonimus. En raison de la faible prévalence actuelle de la paragonimose humaine en Afrique et du coût élevé du dépistage à grande échelle pour cette maladie, la formation des techniciens dans les centres anti-tuberculeux serait l'attitude la plus réaliste pour détecter simultanément les mycobactéries ou les oeufs de Paragonimus, lors de l'examen du même crachat.

In order to determine the potential role that various antifungal agents might have in the management of cryptococcosis in tropical areas, the in vitro susceptibility of Cryptococcus neoformans isolates from Africa ( n=52) and Cambodia ( n=110) to three antifungal agents (amphotericin B, fluconazole and voriconazole) were compared using the E-test method. The results of this study (i) confirm the value of the E-test for testing the in vitro susceptibility of C. neoformans towards voriconazole; (ii) provide the first evidence demonstrating good activity of amphotericin B, fluconazole and voriconazole against Cambodian isolates; and (iii) show there are differences in susceptibility between African and Asian C. neoformans isolates, with Cambodian isolates appearing less susceptible to the agents tested but with amphotericin B maintaining good activity.

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BackgroundParagonimiasis is a neglected tropical disease caused by an infection with lung flukes that is transmitted through the consumption of undercooked crabs. The disease is often confused with tuberculosis. Paragonimiasis is thought to be endemic in south-western Côte d'Ivoire.MethodsTwo cross-sectional surveys were carried out in the first half of 2009 in patients attending two tuberculosis centres of Abidjan. A third cross-sectional survey was conducted in May 2010 in children of two primary schools in Dabou, where crabs are frequently consumed. Patients with chronic cough provided three sputum samples plus one stool sample. Sputum samples were examined for tuberculosis with an auramine staining technique and for Paragonimus eggs using a concentration technique. Stool samples were subjected to the Ritchie technique. Schoolchildren provided a single stool sample, and samples were subjected to the Kato-Katz and an ether-concentration technique. A pre-tested questionnaire was administered to patients and schoolchildren to investigate food consumption habits. Additionally, between June 2009 and August 2010, shellfish were purchased from markets in Abidjan and Dabou and examined for metacercariae.ResultsNo human case of paragonimiasis was diagnosed. However, trematode infections were seen in 32 of the 272 shellfish examined (11.8%). Questionnaire results revealed that crab and pig meat is well cooked before consumption. Among the 278 patients with complete data records, 62 had tuberculosis, with a higher prevalence in males than females (28.8% vs. 13.9%, χ2 = 8.79, p = 0.003). The prevalence of helminths and intestinal protozoa was 4.6% and 16.9%, respectively. In the school survey, among 166 children with complete data records, the prevalence of helminths and intestinal protozoa was 22.3% and 48.8%, respectively. Boys had significantly higher prevalences of helminths and intestinal protozoa than girls. Hookworm was the predominant helminth species and Entamoeba coli was the most common intestinal protozoon species (13.8%).ConclusionsNot a single case of Paragonimus was found in two high-risk groups of Côte d'Ivoire, most likely explained by food consumption habits. However, other helminth and intestinal protozoon infections were common.