Antimalarial drug resistance has historically arisen through convergent
mutations in
parasite populations in Southeast Asia and South America. For the past decade in Southeast Asia, artemisinins, the ...core component of first-line antimalarial therapies, have experienced delayed parasite clearance associated with several
mutations, primarily C580Y. We report that mutant
has emerged independently in Guyana, with genome analysis indicating an evolutionary origin distinct from Southeast Asia.
C580Y parasites were observed in 1.6% (14/854) of samples collected in Guyana in 2016-2017. Introducing
C580Y or R539T mutations by gene editing into local parasites conferred high levels of
artemisinin resistance.
growth competition assays revealed a fitness cost associated with these
variants, potentially explaining why these resistance alleles have not increased in frequency more quickly in South America. These data place local malaria control efforts at risk in the Guiana Shield.
While some clinical signs may point to COVID-19 or dengue in case series, at the individual patient scale, the imperfect positive predictive value and clinical variability do not guarantee a ...diagnosis of certainty (Table 1). ...some studies report 25% of patients with confirmed dengue having a cough and 20% with upper respiratory tract symptoms 14. Because of this great disruption in the organization of care, until recently it was only after receiving the results (24–48 hours for negative results) that further explorations were performed, which for a while led to potentially dangerous diagnostic delays in patients with dengue. According to the context and clinical presentation, physicians may prescribe a malaria test, blood and urine cultures, serologies, or molecular diagnosis of differential diagnoses. The extinction of the dengue virus epidemic is less likely when increased human movement enhances the rescue effect. ...modeling suggests that infection hubs and reservoirs can be locations people
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French Guiana (FG) was the first country in South America to declare chikungunya virus infection (CHIKV). The outbreak affected about 16,000 persons between February 2014 and October 2015, with ...several atypical cases, but only two fatal cases. We aimed to describe the clinical presentation of patients hospitalized for CHIKV infection, to estimate and identify risk factors of unusual and severe forms in adult patients.
A monocentric retrospective study was conducted in Cayenne hospital, the main city and the main hospital in FG, from March 1st 2014 to August 31st 2015. All patients admitted for at least one night with a biological diagnosis of CHIKV infection during the 2014/2015 outbreak were included, except pregnant women and children under 15 years.
During the study period, 285 patients with a diagnosis of CHIKV infection were hospitalized in Cayenne hospital, among whom 96 nonpregnant adults were studied. Five were classified as severe forms (5.2%) and 23 as unusual forms (23.9%). The most frequent atypical and/or severe form was neurological (n = 20), followed by cardio-respiratory failure (acute respiratory failure n = 4, acute heart failure n = 2), digestive and hepatic disorders (acute hepatitis n = 3, acute pancreatitis n = 2), renal disorders (acute renal failure n = 5) and muscular impairment (rhabdomyolysis n = 3).
During the outbreak, hospitalizations were frequent, particularly for common forms, driven by algic clinical presentations and concerns due to the novelty of this infection. Despite atypical neurological and liver forms of CHIKV infection, case-fatality was low in French Guiana. No specific risk factor of atypical and/or severe forms was found in our study.
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About the Authors: Mathieu Nacher * E-mail: mathieu.nacher66@gmail.com Affiliation: CIC INSERM 1424, Centre Hospitalier de Cayenne, rue des Flamboyants, Cayenne French Guiana ORCID logo ...http://orcid.org/0000-0001-9397-3204 Pierre Couppié Affiliation: Dermatology Department, Centre Hospitalier de Cayenne, rue des Flamboyants, Cayenne French Guiana Loic Epelboin Affiliation: Infectious Diseases Department, Centre Hospitalier de Cayenne, rue des Flamboyants, Cayenne French Guiana Félix Djossou Affiliation: Infectious Diseases Department, Centre Hospitalier de Cayenne, rue des Flamboyants, Cayenne French Guiana Magalie Demar Affiliations Parasitology-Mycology laboratory, Centre Hospitalier de Cayenne, rue des Flamboyants, Cayenne French Guiana, UMR Tropical Biome and Immuno-pathophysiology, Université de Guyane, Cayenne French Guiana Antoine Adenis Affiliation: CIC INSERM 1424, Centre Hospitalier de Cayenne, rue des Flamboyants, Cayenne French Guiana ORCID logo http://orcid.org/0000-0003-4000-4981 Citation: Nacher M, Couppié P, Epelboin L, Djossou F, Demar M, Adenis A (2020) Disseminated Histoplasmosis: Fighting a neglected killer of patients with advanced HIV disease in Latin America. ...in Panama, 7.6% of patients had culture-proven histoplasmosis 9; in Venezuela, histoplasmosis was documented in 43 of 200 (21.3%) 10; in Fortaleza, Brazil, of 378 consecutive hospitalized HIV patients, 164 (43.4%) had disseminated histoplasmosis 11; A recent screening study in hospitalized HIV patients in Brazil found high Histoplasma antigen prevalence, ranging from 8.8% in Porto Alegre to 44.8% in Natal. 12 In French Guiana, with an overall incidence of 1.5 per 100 person years and 10 per 100 person years for patients with cluster of differentiation lymphocytes 4 (CD4) counts less than 50 per mm3, disseminated histoplasmosis has been the first AIDS-defining illness and the first cause of death in French Guiana; 13,14 among hospitalized HIV-infected patients with advanced HIV, 42% had disseminated histoplasmosis, among those with CD4 counts less than 50 per mm3, 85% had histoplasmosis. Increasing publication numbers helped the Global Action Fund for Fungal Infections (GAFFI) to make the case for the inclusion of itraconazole in the WHO essential drugs list (2017) and Histoplasma antigen detection tests in the WHO list of essential diagnostic tests (2019).
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From 1998 through 2006, 44 cases of severe primary toxoplasmosis were observed in French Guiana in immunocompetent adults. Toxoplasma gondii isolates exhibited an atypical multilocus genotype. Severe ...disease in humans may result from poor host adaptation to neotropical zoonotic strains of T. gondii circulating in a forest-based cycle.
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Introduction In the past decade, new diagnostic methods and strategies have appeared, HIV testing efforts and the generalization of antiretroviral therapy may have influenced the number of ...opportunistic diagnoses and mortality of HIV-infected patients. To test this hypothesis we compiled data on the top opportunistic infections and causes of early death in the HIV cohort of French Guiana. Methods HIV-infected persons followed in Cayenne, Kourou, and Saint Laurent du Maroni hospitals from 2010 to 2019 were studied. Annual incidence of different opportunistic infections and annual deaths are compiled. For patients with opportunistic infections we calculated the proportion of early deaths. Results At the time of analysis, among 2 459 patients, (treated and untreated) 90% had a viral load 400 copies, 91% of the patients in the cohort were on antiretroviral treatment, and 94.2% of patients on treatment for over 6 months had undetectable viral loads. Only 9% of patients had CD4 counts under 200 per mm3. Histoplasmosis clearly remained the most frequent (128 cases) opportunistic infection among HIV-infected persons followed by cerebral toxoplasmosis (63 cases) and esophageal candidiasis (41 cases). Cryptococcal meningitis was ranked 5.sup.th most frequent opportunistic infection as was tuberculosis (31 cases). The trend for a sharp decline in early deaths continued (3.9% of patients). Conclusions Despite the successes of antiretrovirals, patients presenting with advanced HIV are still common and they are still at risk of dying. Improved diagnosis, and notably systematic screening with appropriate tools are still important areas of potential progress.
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In 2017, inhabitants along the border between French Guiana and Brazil were affected by a malaria outbreak primarily due to Plasmodium vivax (Pv). While malaria cases have steadily declined between ...2005 and 2016 in this Amazonian region, a resurgence was observed in 2017.
Two investigations were performed according to different spatial scales and information details: (1) a local study on the French Guiana border, which enabled a thorough investigation of malaria cases treated at a local village health center and the entomological circumstances in the most affected neighborhood, and (2) a regional and cross-border study, which enabled exploration of the regional spatiotemporal epidemic dynamic. Number and location of malaria cases were estimated using French and Brazilian surveillance systems.
On the French Guianese side of the border in Saint-Georges de l'Oyapock, the attack rate was 5.5% (n = 4000), reaching 51.4% (n = 175) in one Indigenous neighborhood. Entomological findings suggest a peak of Anopheles darlingi density in August and September. Two female An. darlingi (n = 1104, 0.18%) were found to be Pv-positive during this peak. During the same period, aggregated data from passive surveillance conducted by Brazilian and French Guianese border health centers identified 1566 cases of Pv infection. Temporal distribution during the 2007-2018 period displayed seasonal patterns with a peak in November 2017. Four clusters were identified among epidemic profiles of cross-border area localities. All localities of the first two clusters were Brazilian. The localization of the first cluster suggests an onset of the outbreak in an Indigenous reservation, subsequently expanding to French Indigenous neighborhoods and non-Native communities.
The current findings demonstrate a potential increase in malaria cases in an area with otherwise declining numbers. This is a transborder region where human mobility and remote populations challenge malaria control programs. This investigation illustrates the importance of international border surveillance and collaboration for malaria control, particularly in Indigenous villages and mobile populations.
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Zika virus (ZIKV) infection has been associated with complications during pregnancy. Although the presence of symptoms might be a risk factor for complication, the proportion of ZIKV-infected ...pregnant women with symptoms remains unknown. Following the emergence of ZIKV in French Guiana, all pregnancies in the territory were monitored by RT-PCR and/or detection of ZIKV antibodies. Follow-up data collected during pregnancy monitoring interviews were analysed from 1 February to 1 June 2016. We enrolled 3,050 pregnant women aged 14-48 years and 573 (19%) had laboratory-confirmed ZIKV infection. Rash, arthralgia, myalgia and conjunctival hyperaemia were more frequently observed in ZIKV-positive women; 23% of them (95% confidence interval (CI): 20-27) had at least one symptom compatible with ZIKV infection. Women 30 years and older were significantly more likely to have symptoms than younger women (28% vs 20%). The proportion of symptomatic infections varied from 17% in the remote interior to 35% in the urbanised population near the coast (adjusted risk ratio: 1.6; 95% CI: 1.4-1.9.). These estimates put findings on cohorts of symptomatic ZIKV-positive pregnant women into the wider context of an epidemic with mainly asymptomatic infections. The proportion of symptomatic ZIKV infections appears to vary substantially between populations.
In French Guiana, five species are associated with Cutaneous Leishmaniasis (CL). Though infections with Leishmania guyanensis, L. (V.) braziliensis and L. (L.) amazonensis have been extensively ...described, there are few available clinical and genetic data on L. (V.) lainsoni and L. (V.) naiffi. We determined the clinical and epidemiological features of all cases of CL due to L. (V.) naiffi and L. (V.) lainsoni diagnosed in French Guiana between 2003 and 2019. Phylogenetic analysis was performed by sequencing a portion of HSP70 and cyt b genes. Five cases of L. naiffi and 25 cases of L. lainsoni were reported. Patients infected by L. (V.) lainsoni were usually infected on gold camps, mostly along the Maroni river (60%), while L. naiffi was observed in French patients infected on the coast (100%). A high number of pediatric cases (n = 5; 20%) was observed for L. (V.) lainsoni. A mild clinical course was observed for all cases of L. (V.) naiffi. HSP70 and cyt b partial nucleotide sequence analysis revealed different geographical clusters within L. (V.) naiffi and L. (V.) lainsoni but no association were found between phylogenetic and clinical features. Our data suggest distinct socio-epidemiological features for these two Leishmania species. Patients seem to get infected with L. (V.) naiffi during leisure activities in anthropized coastal areas, while L. (V.) lainsoni shares common features with L. (V.) guyanensis and braziliensis and seems to be acquired during professional activities in primary forest regions. Phylogenetic analysis has provided information on the intraspecific genetic variability of L. (V.) naiffi and L. (V.) lainsoni and how these genotypes are distributed at the geographic level.
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An outbreak of severe acute respiratory syndrome coronavirus 2 caused by the Gamma variant of concern infected 24/44 (55%) employees of a gold mine in French Guiana (87% symptomatic, no severe ...forms). The attack rate was 60% (15/25) among fully vaccinated miners and 75% (3/4) among unvaccinated miners without a history of infection.
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