Éditeur(s) : HAL CCSD Public Library of Science
Résumé : International audience
BACKGROUND:Dengue fever is the most important arboviral infection that affects humans, particularly in tropical and subtropical regions. Here, we provide the first comprehensive overview of the severity of dengue epidemics in French Guiana.METHODOLOGY/PRINCIPAL FINDINGS:We monitored hospitalized cases between 2008 and 2013. Detailed clinical features and biological parameters were collected on a daily basis from all cases. Among the 1,356 cases, 216 (16%) were classified according to the WHO 2009 classification as dengue without warning signs (WS), 926 (68%) were classified as dengue with WS and 214 (16%) were classified as severe dengue. The severity rates were similar between the three major epidemics that occurred during the study period, whereas the hospitalization rate was highest in 2013. Fluid accumulation, aspartate aminotransferase (ASAT) counts>193 IU/L and platelet counts<75,000 cells/mm3 were associated with dengue severity.CONCLUSIONS/SIGNIFICANCE:Our findings provide a recent epidemiological description of the severity of dengue epidemics in French Guiana. These results highlight the potential impacts and consequences of implementing the WHO 2009 classification on hospital activity. Future studies should include virological and immunological investigations of well-documented serum samples
ISSN: 1932-6203

inserm-01481447
http://www.hal.inserm.fr/inserm-01481447
http://www.hal.inserm.fr/inserm-01481447/document
http://www.hal.inserm.fr/inserm-01481447/file/2017%2C%20Flamand%20-%20Epidemiological%20assessment%20of%20the%20severity%20of%20dengue%20epidemics%20in%20French%20Guiana.pdf
DOI : 10.1371/journal.pone.0172267.t003

Éditeur(s) : HAL CCSD SAGE Publications
Résumé : International audience
In Western French Guiana there was a dramatic increase in HIV-prevalence between 1990 and 2000. The present study describes the causes of fever among HIV patients hospitalized in the medical ward of the only hospital in the western part of French Guiana. A retrospective descriptive study was conducted between January 1st 2008 and June 30th 2010 in the department of medicine of Saint Laurent du Maroni Hospital. The main characteristics of 67 patients having presented with fever in the first 48 hours of hospitalization were described. Among patients with CD4<200/mm3 the main febrile opportunistic infection was disseminated histoplasmosis (41.1%). Among patients with CD4 counts <50/mm3 and fever without focal points 85.7% had disseminated histoplasmosis. Three patients died and all had disseminated histoplasmosis. Disseminated histoplasmosis is the most common febrile opportunistic infection in western French Guiana. Primary prophylaxis with itraconazole among immunocompromised patients seems warranted.
ISSN: 0956-4624

inserm-01082409
http://www.hal.inserm.fr/inserm-01082409
http://www.hal.inserm.fr/inserm-01082409/document
http://www.hal.inserm.fr/inserm-01082409/file/2014%2C%20Vantilcke%20-%20Fever%20and%20HIV.pdf
http://www.hal.inserm.fr/inserm-01082409/file/Histoplasmosis_tab_2%5B1%5D%20revised.pdf

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
Liposomal amphotericin B (LAmb) may fail to heal Leishmania infantum visceral leishmaniasis (VL) in the immunodeficient host. There are currently no guidelines on how to treat such patients and efficacy of miltefosine monotherapy seems limited in this indication. We present 2 cases of patients with VL and AIDS for which LAmb had to be interrupted (one because of toxicity, one because of treatment failure) and who were treated effectively with pentamidine followed by miltefosine.
ISSN: 1383-5769

hal-01509592
https://hal.archives-ouvertes.fr/hal-01509592
PUBMED : 27353022

Éditeur(s) : HAL CCSD Lippincott, Williams & Wilkins
Résumé : International audience
BACKGROUND:Fever in infants younger than 3 months is generally a cause for concern because of the risk for a serious bacterial infection. The aim of this study was to describe clinical and biological features of Chikungunya infection in infants < 3 months of age hospitalized in Cayenne Hospital during the 2014-2015 outbreak.METHODS:We performed a preliminary retrospective study followed by a prospective study from March 2014 to February 2015. All infants younger than 3 months presenting with fever and hospitalized in Cayenne Hospital were included. The main diagnostic criteria were fever and positive Chikungunya PCR.RESULTS:One hundred and twenty infants were hospitalized with fever. The mean age was 46 days (SD± 22 days). The mean hospitalization duration was 7.4 days (SD± 6.1 days). Chikungunya infection was diagnosed in 26 children. The most important clinical findings were high (80.8% [77.5-84]) and prolonged fever (76.9%, [73.4-80.4]), irritability (96.2% [94.5-97.7]) and skin rash. (69.2%, [65.4-73]). Half of the infants presented edema of the extremities (hands and feet principally). However, in 15 %, Chikungunya infection was associated with a serious bacterial infection. Infants who presented with irritability, high fever and elevated PCT were at high risk for Chikungunya: OR 39, [9.2-243] (p < 0.001), with a specificity of 96.7 % and a negative predictive value of 89.4%. The area of the ROC curve was 0.96 CONCLUSIONS:: Our results confirm that Chikunguyna infection is a cause of high fever in infants younger than 3 months. Our data should be confirmed by larger studies.
ISSN: 0891-3668

inserm-01476019
http://www.hal.inserm.fr/inserm-01476019
http://www.hal.inserm.fr/inserm-01476019/document
http://www.hal.inserm.fr/inserm-01476019/file/2017%2C%20Elenga%20-%20Chikungunya%20Infection%20in%20hospitalized%20febrile%20infants.pdf
DOI : 10.1097/INF.0000000000001541

Éditeur(s) : HAL CCSD Public Library of Science
Résumé : International audience
French Guiana is a South American French territory, where HIV prevalence consistently exceeds 1% in the adult population. In the only correctional facility, HIV prevalence fluctuates at around 4%.
After describing the population of HIV-positive inmates, we aimed to evaluate mortality after release from the correctional facility, and to identify its predictive factors.
Outside North American settings, data on treatment outcome and vital status of HIV-positive former inmates are scarce. There were no data in French Guiana. Filling this gap represents a basis for potential improvements.
All HIV-infected adults released from an incarceration of 30 days or more, between 2007 and 2013, were enrolled in a retrospective cohort study. Mortality was described over time, one to seven years following release, using Kaplan-Meier estimates. Factors associated with mortality were identified through a non-parametric survival regression model.
147 former inmates were included. The male to female ratio was 4.4. The median age was 37.3 years. The majority were migrants, 25.8% were homeless, 70.1% suffered from substance abuse, with 34.0% of crack-cocaine users. On admission, 78.1% had an early HIV-stage infection (CDC-stage A), with a median CD4 count of 397.5/mm3, 34.0% had one comorbidity, mainly hypertension. Upon release, 50.3% were on ART. Reasons for not being treated were not fulfilling the criteria for 74.6%, and refusing for 15.1%. Before release, 84.5% of the patients on ART had a viral load≤200cp/ml. After release, 8.2% of the cohort had died, with a crude incidence of 33.8/1000 person-years. All recorded deaths were males, with an incidence of 42.2/1000 person-years. Comparing with the age-specific mortality rates for males in French Guiana, the standardized mortality ratio was 14.8. In multivariate analysis, factors associated with death were age and CD4 count before release.
Despite access to ART while incarcerated, with good virological outcome, the post-release mortality was very high for males, almost 15 times what is observed in the general male population living in French Guiana, after age standardization. Access to ART in correctional facilities may be a necessary, but not sufficient condition to protect male inmates from death after release.
ISSN: 1932-6203

inserm-01519987
http://www.hal.inserm.fr/inserm-01519987
http://www.hal.inserm.fr/inserm-01519987/document
http://www.hal.inserm.fr/inserm-01519987/file/2017%2C%20Huber%20-%20Mortality%20HIV%20prisoners%20after%20release.pdf
DOI : 10.1371/journal.pone.0175740.t002

Éditeur(s) : HAL CCSD Springer Verlag
Résumé : International audience
ISSN: 0342-4642

inserm-01622988
http://www.hal.inserm.fr/inserm-01622988
http://www.hal.inserm.fr/inserm-01622988/document
http://www.hal.inserm.fr/inserm-01622988/file/2017%2C%20Mutricy%20-%20Predictors%20of%20complications%20of%20snake%20enven_omation%20in%20Cayenne%2C%20French%20Guiana%2C%202007%E2%80%932015.pdf
DOI : 10.1007/s00134-017-4929-3

Éditeur(s) : HAL CCSD Instituto de Medicina Tropical
Résumé : International audience
Malaria is a major health problem for people who live on the border between Brazil and French Guiana. Here we discuss Plasmodium vivax distribution pattern in the town of Oiapoque, Amapá State using the circumsporozoite (CS) gene as a marker. Ninety-one peripheral blood samples from P. vivax patients have been studied. Of these, 64 individuals were from the municipality of Oiapoque (Amapá State, Brazil) and 27 patients from French Guiana (August to December 2011). DNA extraction was performed, and a fragment of the P. vivax CS gene was subsequently analyzed using PCR/RFLP. The VK210 genotype was the most common in both countries (48.36% in Brazil and 14.28% in French Guiana), followed by the P. vivax-like (1.10% in both Brazil and French Guiana) and VK247 (1.10% only in Brazil) in single infections. We were able to detect all three CS genotypes simultaneously in mixed infections. There were no statistically significant differences either regarding infection site or parasitaemia among individuals with different genotypes. These results suggest that the same genotypes circulating in French Guiana are found in the municipality of Oiapoque in Brazil. These findings suggest that there may be a dispersion of parasitic populations occurring between the two countries. Most likely, this distribution is associated with prolonged and/or more complex transmission patterns of these genotypes in Brazil, bordering French Guiana.
ISSN: 0036-4665

inserm-01408935
http://www.hal.inserm.fr/inserm-01408935
http://www.hal.inserm.fr/inserm-01408935/document
http://www.hal.inserm.fr/inserm-01408935/file/2016%2C%20Gomes%20-%20Evaluation%20of%20circumsporozoite%20protein%20of%20Plasmodium%20vivax.pdf
DOI : 10.1590/S1678-9946201658072

Éditeur(s) : HAL CCSD Chicago, IL : American Medical Association, [2013]-
Résumé : International audience
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ISSN: 2168-6068

Droits : info:eu-repo/semantics/OpenAccess
inserm-01491176
http://www.hal.inserm.fr/inserm-01491176
http://www.hal.inserm.fr/inserm-01491176/document
http://www.hal.inserm.fr/inserm-01491176/file/2017%2C%20Cordel%20-%20main%20characteristics%20of%20zika%20virus%20exanthema%20in%20Guadeloupe.pdf
http://www.hal.inserm.fr/inserm-01491176/file/2017%20Cordel%20-%20main%20characteristics%20of%20zika%20virus%20exanthema%20in%20Guadeloupe-Fig1.pdf

Éditeur(s) : HAL CCSD
Résumé : National audience
A l'aire des stratégies d'accès aux traitements antirétroviraux mondialisées, la question des inégalités territoriales, questionne leur mise en place. Si les PVVIH sont particulièrement fragiles face aux violences structurelles, sociales et économiques, leur prise en charge aux frontières est souvent oubliée. Ce travail entend donc mettre en exergue une analyse de l'impact des frontières sur les PVVIH en Guyane mais aussi d'interroger de nouveaux modèles de pratiques médicales d'interface. En Guyane française, les configurations territoriales génèrent une situation singulière dans la mesure où les populations gravitent/évoluent entre une instabilité géographique (barrages policiers routiers et fluviaux, nomadisme et mobilité des populations) et des logiques d'intégration. De là, apparaît, un renforcement des vulnérabilités (psychologique, socio-économique, sanitaire, spatiale, (…) etc.), notamment chez les PVVIH. Afin d'améliorer la prise en charge de ces patients un relais avancé a été mis en place au sein du centre de santé à la frontière avec le Brésil à S t Gorges de l'Oyapock. Des médiateurs communautaires en santé sont au centre du dispositif avec les soignants du dispensaire local et un système de délocalisation des examens biologiques et avis spécialisés a été réalisé. En un an la file active de PVVIH suivis a été multipliée par 4. Cette action a permis de diminuer les délais de prise en charge des patients, réduisant également le nombre de perdus de vus. Il a été rendus possible pour exemple une prise en charge « familiale » du dépistage et des traitements impossible jusqu'à alors. Sur le plan médico-social des « staffs » transfrontaliers ont réalisés améliorant la gestion des patients dans leur globalité. Cet exemple de coopération inter-culturelle renforcée avec valorisation de l'espace comme carrefour géographique de différents flux migratoires que constitue la frontière Franco-Brésilienne fait de cet espace un lieu privilégié de médiation médicale.
Congrès 2016 de la Société française de lutte contre le sida
Montpellier, France

inserm-01475951
http://www.hal.inserm.fr/inserm-01475951
http://www.hal.inserm.fr/inserm-01475951/document
http://www.hal.inserm.fr/inserm-01475951/file/2016%2C%20Mosnier%20-%20Fronti%C3%A8res%20%20limites%20ou%20espaces%20innovants%20dans%20la%20lutte%20contre%20le%20VIH.pdf