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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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Zika virus (ZIKV) is an arthropod-borne virus (arbovirus) that recently caused outbreaks in the Americas. Over the past 60 years, this virus has been observed circulating among African, Asian, and ...Pacific Island populations, but little attention has been paid by the scientific community until the discovery that large-scale urban ZIKV outbreaks were associated with neurological complications such as microcephaly and several other neurological malformations in fetuses and newborns. This paper is a systematic review intended to list all mosquito species studied for ZIKV infection or for their vector competence. We discuss whether studies on ZIKV vectors have brought enough evidence to formally exclude other mosquitoes than Aedes species (and particularly Aedes aegypti) to be ZIKV vectors. From 1952 to August 15, 2017, ZIKV has been studied in 53 mosquito species, including 6 Anopheles, 26 Aedes, 11 Culex, 2 Lutzia, 3 Coquillettidia, 2 Mansonia, 2 Eretmapodites, and 1 Uranotaenia. Among those, ZIKV was isolated from 16 different Aedes species. The only species other than Aedes genus for which ZIKV was isolated were Anopheles coustani, Anopheles gambiae, Culex perfuscus, and Mansonia uniformis. Vector competence assays were performed on 22 different mosquito species, including 13 Aedes, 7 Culex, and 2 Anopheles species with, as a result, the discovery that A. aegypti and Aedes albopictus were competent for ZIKV, as well as some other Aedes species, and that there was a controversy surrounding Culex quinquefasciatus competence. Although Culex, Anopheles, and most of Aedes species were generally observed to be refractory to ZIKV infection, other potential vectors transmitting ZIKV should be explored.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
In French Guiana, community-acquired pneumonia (CAP) represents over 90% of
Coxiella burnetii
acute infections. Between 2004 and 2007, we reported that
C. burnetii
was responsible for 24.4% of the ...131 CAP hospitalized in Cayenne. The main objective of the present study was to determine whether the prevalence of Q fever pneumonia remained at such high levels. The secondary objectives were to identify new clinical characteristics and risk factors for
C. burnetii
pneumonia. A retrospective case-control study was conducted on patients admitted in Cayenne Hospital, between 2009 and 2012. All patients with CAP were included. The diagnosis of acute Q fever relied on titers of phase II IgG ≥ 200 and/or IgM ≥ 50 or seroconversion between two serum samples. Patients with Q fever were compared with patients with non-
C. burnetii
CAP in bivariate and multivariate analyses. During the 5-year study, 275 patients with CAP were included. The etiology of CAP was identified in 54% of the patients.
C. burnetii
represented 38.5% (106/275; 95% CI: 31.2–45.9%). In multivariate analysis, living in Cayenne area, being aged 30–60 years, C-reactive protein (CRP) > 185 mg/L, and leukocyte count < 10 G/L were independently associated with Q fever. The prevalence of Q fever among CAP increased to 38.5%. This is the highest prevalence ever reported in the world. This high prevalence justifies the systematic use of doxycycline in addition to antipneumococcal antibiotic regimens.
Dengue virus is a flavivirus transmitted by
mosquitoes and is an important cause of illness worldwide. Data on the severity of travel-associated dengue illness are limited.
To describe the ...epidemiology, clinical characteristics, and outcomes among international travelers with severe dengue or dengue with warning signs as defined by the 2009 World Health Organization classification (that is, complicated dengue).
Retrospective chart review and analysis of travelers with complicated dengue reported to GeoSentinel from January 2007 through July 2022.
20 of 71 international GeoSentinel sites.
Returning travelers with complicated dengue.
Routinely collected surveillance data plus chart review with abstraction of clinical information using predefined grading criteria to characterize the manifestations of complicated dengue.
Of 5958 patients with dengue, 95 (2%) had complicated dengue. Eighty-six (91%) patients had a supplemental questionnaire completed. Eighty-five of 86 (99%) patients had warning signs, and 27 (31%) were classified as severe. Median age was 34 years (range, 8 to 91 years); 48 (56%) were female. Patients acquired dengue most frequently in the Caribbean (
= 27 31%) and Southeast Asia (
= 21 24%). Frequent reasons for travel were tourism (46%) and visiting friends and relatives (32%). Twenty-one of 84 (25%) patients had comorbidities. Seventy-eight (91%) patients were hospitalized. One patient died of nondengue-related illnesses. Common laboratory findings and signs were thrombocytopenia (78%), elevated aminotransferase (62%), bleeding (52%), and plasma leakage (20%). Among severe cases, ophthalmologic pathology (
= 3), severe liver disease (
= 3), myocarditis (
= 2), and neurologic symptoms (
= 2) were reported. Of 44 patients with serologic data, 32 confirmed cases were classified as primary dengue (IgM+/IgG-) and 12 as secondary (IgM-/IgG+) dengue.
Data for some variables could not be retrieved by chart review for some patients. The generalizability of our observations may be limited.
Complicated dengue is relatively rare in travelers. Clinicians should monitor patients with dengue closely for warning signs that may indicate progression to severe disease. Risk factors for developing complications of dengue in travelers need further prospective study.
Centers for Disease Control and Prevention, International Society of Travel Medicine, Public Health Agency of Canada, and GeoSentinel Foundation.
Abstract
Background
As Q fever, caused by Coxiella burnetii, is a major health challenge due to its cardiovascular complications, we aimed to detect acute Q fever valvular injury to improve ...therapeutic management.
Methods
In the French national reference center for Q fever, we prospectively collected data from patients with acute Q fever and valvular injury. We identified a new clinical entity, acute Q fever endocarditis, defined as valvular lesion potentially caused by C. burnetii: vegetation, valvular nodular thickening, rupture of chorda tendinae, and valve or chorda tendinae thickness. To determine whether or not the disease was superimposed on an underlying valvulopathy, patients’ physicians were contacted. Aortic bicuspidy, valvular stenosis, and insufficiency were considered as underlying valvulopathies.
Results
Of the 2434 patients treated in our center, 1797 had acute Q fever and 48 had acute Q fever endocarditis. In 35 cases (72%), transthoracic echocardiography (TTE) identified a valvular lesion of acute Q fever endocarditis without underlying valvulopathy. Positive anticardiolipin antibodies (>22 immunoglobulin G-type phospholipid units GPLU) were independently associated with acute Q fever endocarditis (odds ratio OR, 2.7 95% confidence interval {CI}, 1.3–5.5; P = .004). Acute Q fever endocarditis (OR, 5.2 95% CI, 2.6–10.5; P < .001) and age (OR, 1.7 95% CI, 1.1–1.9; P = .02) were independent predictors of progression toward persistent C. burnetii endocarditis.
Conclusions
Systematic TTE in acute Q fever patients offers a unique opportunity for early diagnosis of acute Q fever endocarditis and for the prevention of persistent endocarditis. Transesophageal echocardiography should be proposed in men, aged >40 years, with anticardiolipin antibodies >60 GPLU when TTE is inconclusive or negative.
Acute Q fever endocarditis is a new clinical entity. Underlying valvulopathy is frequently unknown or absent, and anticardiolipin antibodies constitute a predictive biological marker. Immediate transthoracic echocardiography will optimize the detection of valvular injury in case of acute Q fever.
Abstract
Background
A steady decline in the number of cases of malaria was observed in the 2000s in French Guiana. This enabled regional health policies to shift their public health goal from control ...to elimination. To include inhabitants in this strategy, the main objective of this study was to describe knowledge about malaria, and related attitudes and practices in persons living in the French Guiana border.
Methods
We conducted a survey in people over 15 years old living in the twelve neighbourhoods of Saint-Georges de l’Oyapock with the highest malaria incidence. It comprised a 147-item questionnaire which collected data on socio-demographic characteristics and included a Knowledge Attitude and Practices survey on malaria. Knowledge-related data were studied using exploratory statistical methods to derive summary variables. A binary variable assessing level of knowledge was proposed and then assessed using exploratory approaches.
Results
The mean age of the 844 participants was 37.2 years 15.8, the male/female sex ratio was 0.8. In terms of nationality, 485 (57.5%) participants were Brazilian and 352 (41.7%) French. One third (305, 36.1%) spoke Brazilian Portuguese as their native language, 295 (34.9%) the Amerindian language Palikur, 36 (4.3%) French. The symptoms of malaria and prevention means were poorly known by 213 (25.2%) and 378 (44.8%) respondents, respectively. A quarter (206, 24.4%) did not know that malaria can be fatal. Overall, 251 people (29.7%) had an overall poor level of knowledge about malaria. Being under 25 years old, living in a native Amerindian neighbourhood, having an Amerindian mother tongue language, having risk behaviours related to gold mining were significantly associated with a poor level of knowledge.
Conclusions
This study is the first to describe the poor level of knowledge about malaria in populations living in the malaria endemic border area along the Oyapock river in French Guiana. Results will allow to reinforce, to diversify and to culturally adapt prevention messages and health promotion to increase their effectiveness with a view to quickly reaching the goal of malaria elimination through empowerment.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
Background
Biomarkers prove valuable for diagnosing postoperative bacterial infection, but data in elderly patients are scarce. Here we analyze how procalcitonin and C-reactive protein (CRP) ...perform for bacterial infection diagnosis after traumatic orthopedic surgery in elderly patients.
Methods
We included all patients admitted to our perioperative geriatrics unit after traumatic orthopedic surgery. Patients on antibiotics, presenting preoperative bacterial infection, or without procalcitonin measurement were excluded. Clinical and biological data were collected prospectively. Medical charts were reviewed by three experts blinded to biomarker results to assess bacterial infection diagnosis. Areas under the curve and 90%-specificity thresholds were analyzed for baseline procalcitonin and CRP levels and relative variations.
Results
Analysis included 229 patients (median age 86 years, hip fracture 83%), of which 40 had bacterial infection (pneumonia n = 23, urinary tract infection n = 8; median delay to onset: 2 days post-admission). For bacterial infection diagnosis, the computed areas under the curve were not significantly different (procalcitonin–baseline 0.64 95% confidence interval: 0.57–0.70; procalcitonin–relative variation 0.65 0.59–0.71; CRP–baseline 0.68 0.61–0.74; CRP–relative variation 0.70 0.64–0.76). The 90%-specificity thresholds were 0.75 µg/L for procalcitonin–baseline, +62% for procalcitonin–variation, 222 mg/L for CRP–baseline, +111% for CRP–variation.
Conclusions
Diagnostic performances of procalcitonin and CRP were not significantly different. Baseline levels and relative variations of these biomarkers showed little diagnostic value after traumatic orthopedic surgery in elderly patients.
Tonate virus (TONV) is an arbovirus discovered in 1973 in French Guiana (FG) belonging to the Venezuelan equine encephalitis virus complex, Alphavirus genus. Only few publications and cases have been ...reported in FG. The objectives of the present study were to describe the clinical picture of TONV and to compare its presentation with that of dengue virus (DENV). A retrospective study was performed in Cayenne hospital from 2003 to 2016 including all patients exclusively positive for TONV IgM and not for other alphaviruses. They were classified as high probability: typical clinical picture of arbovirus infection (i.e., fever, chills, headaches, muscle, and joint pains) and IgM seroconversion; medium probability: typical clinical picture + single positive IgM on a unique serum sample without control; and low probability: atypical clinical picture of infection and single positive IgM. Only patients with high and medium probability were included in the analysis and compared with a gender- and age-matched control group of DENV diagnosed by NS1 antigen (two controls per case). During the study period, 45 cases of TONV were included and compared with 90 cases of DENV. Twenty-eight (62.2%) were men; the median age was 34 years (IQ 22-49). In the bivariate analysis, variables significantly associated with TONV versus DENV were the presence of cough (33.3% versus 10.3%) and anemia (32.5% versus 11.1%) and the absence of nausea (4.4% versus 32.2%), rash (2.2% versus 27.4%), fatigue (17.8% versus 41.0%), anorexia (6.7% versus 30.1%), muscle pain (42.2% versus 61.4%), headache (53.3% versus 70.8%), leukopenia (9.8% versus 44.4), and lymphopenia (42.5% versus 89.9%). There were no cases with severe neurological involvement, and there were no deaths. Tonate virus may be evoked as a cause of fever in patients living or returning from the Amazonian area. Positive TONV IgM does not prove the diagnosis and should not preclude from searching for alternative infectious diagnoses.
Abstract
Background
Histoplasmosis is among the main acquired immunodeficiency syndrome (AIDS)–defining conditions in endemic areas. Although histoplasmosis has a worldwide distribution, ...histoplasmosis-associated immune reconstitution inflammatory syndrome (IRIS) in people living with human immunodeficiency virus (PLHIV) is rarely reported.
This study aimed to describe the incidence and features of histoplasmosis-associated IRIS in a cohort of PLHIV.
Methods
A retrospective multicenter study was conducted in French Guiana from 1 January 1997 to 30 September 2017. The target population was represented by PLHIV who presented an episode of histoplasmosis within 6 months after antiretroviral therapy initiation. We used a consensual IRIS case definition, submitted to the agreement of 2 experts. Each case was described using a standardized questionnaire, and all patients gave informed consent.
Results
Twenty-two cases of histoplasmosis-associated IRIS were included (14 infectious/unmasking and 8 paradoxical), with an overall incidence rate of 0.74 cases per 1000 HIV-infected person-years (95% confidence interval, 0.43–1.05). Mean age was 40.5 years. The ratio of males to females was 1:4. Median time to IRIS was 11 days (interquartile range 7–40 days) after antiretroviral therapy initiation. The main clinical presentation was fever, without any specific pattern, and disseminated disease. We reported 2 severe cases and partial or complete recovery at 1 month was the rule. Twenty-two cases were identified in the literature with similar characteristics.
Conclusions
Histoplasmosis-associated IRIS incidence was low but generated significant morbidity in PLHIV. In endemic areas, screening for latent or subclinical histoplasmosis should be implemented before antiretroviral therapy initiation.
Histoplasmosis-associated immune reconstitution inflammatory syndrome (IRIS) in people living with human immunodeficiency virus (PLHIV) is rarely reported. We describe a low incidence of histoplasmosis-associated IRIS along with significant morbidity. A histoplasmosis screening strategy is required in PLHIV initiating antiretroviral therapy.
Mayaro Virus is an emerging arbovirus which can be responsible of important outbreaks in tropical regions. A retrospective study was performed in French Guiana, an ultraperipheral region of Europe in ...Amazonia. We identified 17 human cases between 2003 and 2019. The clinical and biological picture was close to Chikungunya with fever and arthralgia. One patient had acute meningo-encephalitis, and 4 had persistent arthralgia. Physicians should be aware of this virus, as imported cases in Europe have already occurred.
Latin America has experienced several epidemics of arboviruses in recent years, some known for a long time, such as the dengue virus, and others of more recent introduction such as the chikungunya or Zika viruses. There are other arboviruses for the moment more discreet which are rife with low noise in several countries of the continent, such as the Mayaro virus. This alphavirus, with a presentation similar to that of the chikungunya virus, is currently confined to transmission by forest mosquitoes, but its potential to be transmitted by coastal mosquitoes such as Aedes aegypti, make it a potential candidate for a continent-wide epidemic. It therefore seems necessary to know this virus as well as possible in order to anticipate the occurrence of a possible new epidemic. We present here a both demographic and clinical study of this endemic arbovirus disease in French Guiana.
•Mayaro virus may present as a “chikungunya-like” clinical picture.•Like the chikungunya virus, Mayaro virus can be the cause of prolonged clinical articular forms in the course of the acute episode.•This virus can be responsible for acute central nervous system infection such as acute meningitis and acute meningoencephalitis.•Due to the greater frequency of other arboviruses, clinicians do not often think of looking for this virus, which should, however, be mentioned before any clinical table with fever or febrile polyarthralgia for anyone living or returning from Latin America.
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