Éditeur(s) : HAL CCSD Public Library of Science
Résumé : International audience
Diagnosis of toxoplasmic encephalitis (TE) in patients with AIDS is not straightforward because clinicians rely initially on an empiric diagnosis based on clinical and radiographic improvement to specific anti-Toxoplasma gondii therapy. There is therefore a need for biological tools to improve the diagnosis of TE, especially in tropical areas where this diagnosis is likely to be underestimated. The use of PCR testing in blood samples for the diagnosis of TE has been limited by its poor sensitivity in the studies conducted in Europe. In tropical South America, the results of PCR sensitivity in blood samples were controversial. Considering that T. gondii strains from tropical South America have substantial genetic and pathogenic differences with those from USA and Europe, it is therefore important to re-evaluate the performance of the PCR assay in blood samples for the diagnosis of TE in AIDS patients from this region. Our results showed that the only interest of PCR would be in the most severe forms of TE with altered consciousness because PCR is more likely to be positive. We also provided important genotyping data on T. gondii strains isolated in human cases of toxoplasmosis in the Caribbean and in South America.
ISSN: 1935-2727

hal-01503761
https://hal-unilim.archives-ouvertes.fr/hal-01503761
https://hal-unilim.archives-ouvertes.fr/hal-01503761/document
https://hal-unilim.archives-ouvertes.fr/hal-01503761/file/journal.pntd.0004790.pdf
DOI : 10.1371/journal.pntd.0004790

Éditeur(s) : HAL CCSD Mary Ann Liebert
Résumé : International audience
Little information is available on the molecular epidemiologic profile of HIV-1 in French Guiana, the French department with the highest HIV/AIDS incidence. To follow the evolution of HIV-1 diversity, we carried out a molecular analysis of HIV-1 isolates from 305 treatment-naive patients between 2006 and 2012. Protease and reverse-transcriptase sequences were obtained for subtype characterization, polymorphism analysis, and identification of drug resistance mutations. Of 305 HIV-1 strains, 95.1% were subtype B viruses. The overall prevalence of transmitted drug-resistance mutations (TDRMs) was 4.6% (14/305), ranging from 1.9% to 7.1% depending on the year. This study shows a low level of HIV-1 genetic diversity and a moderate prevalence of TDRMs with no evidence of an increasing trend over the study period. Nevertheless, the strong genetic polymorphism observed on both genes may be of concern for long-term treatment of people living with HIV-1 and thus deserves continuous monitoring.
ISSN: 0889-2229

pasteur-01583613
https://hal-riip.archives-ouvertes.fr/pasteur-01583613
https://hal-riip.archives-ouvertes.fr/pasteur-01583613/document
https://hal-riip.archives-ouvertes.fr/pasteur-01583613/file/2016%20Darcissac%20et%20al.%20ARHR.pdf
DOI : 10.1089/aid.2016.0048

Éditeur(s) : HAL CCSD Public Library of Science
Résumé : International audience
ISSN: 1935-2727

inserm-00919502
http://www.hal.inserm.fr/inserm-00919502
http://www.hal.inserm.fr/inserm-00919502/document
http://www.hal.inserm.fr/inserm-00919502/file/2013_Nacher_-_Disseminated_histo_in_hiv_in_south_america_a_neglected_killer_continues_on_its_rampage.pdf
DOI : 10.1371/journal.pntd.0002319

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

hal-01477201
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01477201
DOI : 10.1371/journal.pone.0172267
PUBMED : 28196111

Éditeur(s) : HAL CCSD Public Library of Science
Résumé : International audience
BACKGROUND: Histoplasmosis is an endemic fungal infection in French Guiana. It is the most common AIDS-defining illness and the leading cause of AIDS-related deaths. Diagnosis is difficult, but in the past 2 decades, it has improved in this French overseas territory which offers an interesting model of Amazonian pathogen ecology. The objectives of the present study were to describe the temporal trends of incidence and mortality indicators for HIV-associated histoplasmosis in French Guiana. METHODS: A retrospective study was conducted to describe early mortality rates observed in persons diagnosed with incident cases of HIV-associated Histoplasma capsulatum var. capsulatum histoplasmosis admitted in one of the three main hospitals in French Guiana between 1992 and 2011. Early mortality was defined by death occurring within 30 days after antifungal treatment initiation. Data were collected on standardized case report forms and analysed using standard statistical methods. RESULTS: There were 124 deaths (45.3%) and 46 early deaths (16.8%) among 274 patients. Three time periods of particular interest were identified: 1992-1997, 1998-2004 and 2005-2011. The two main temporal trends were: the proportion of early deaths among annual incident histoplasmosis cases significantly declined four fold (χ2, p<0.0001) and the number of annual incident histoplasmosis cases increased three fold between 1992-1997 and 1998-2004, and subsequently stabilized. CONCLUSION: From an occasional exotic diagnosis, AIDS-related histoplasmosis became the top AIDS-defining event in French Guiana. This was accompanied by a spectacular decrease of early mortality related to histoplasmosis, consistent with North American reference center mortality rates. The present example testifies that rapid progress could be at reach if awareness increases and leads to clinical and laboratory capacity building in order to diagnose and treat this curable disease.
ISSN: 1935-2727

inserm-01065109
http://www.hal.inserm.fr/inserm-01065109
http://www.hal.inserm.fr/inserm-01065109/document
http://www.hal.inserm.fr/inserm-01065109/file/PLOS_Neglected_Tropical_Dis_2014.pdf
http://www.hal.inserm.fr/inserm-01065109/file/2014_Adenis_-_HIV-associated_histoplasmosis_early_mor.pdf

Éditeur(s) : HAL CCSD Taylor & Francis (Routledge)
Résumé : International audience
Border areas are particular “hot spots” generating high levels of HIV vulnerability and facing great challenges to control epidemics. The objective of this study is to describe the sociodemographic, clinical and biological profiles of newly HIV diagnosed people at the French Guiana - Suriname border, to construct an HIV care cascade and compare it with the Surinamese one. HIV-patients aged over 15 years newly diagnosed in western French Guiana in 2011 and 2012 were included in a retrospective cohort study. Patients were identified using different sources (n=121). The male-to-female ratio was 0.8, 85% of the patients were of foreign origin, 72% were undocumented migrants, 21% were living in Suriname and 48% had baseline CD4 cell counts <200 cells/mm3. After one year, 34% were lost to follow-up, 54% received treatment, 34% had controlled viremia and 6% died. We observed a disappointing HIV cascade, like that of Suriname, requiring to develop a coordinated healthcare offer on both sides of the border. Targeted efforts through a bi-national collaboration are needed to address the specific issues of cross-border patients to reach the 90*3 UNAIDS’s diagnosis, link to care and treatment targets and better control the local epidemic
ISSN: 0954-0121

inserm-01476267
http://www.hal.inserm.fr/inserm-01476267
http://www.hal.inserm.fr/inserm-01476267/document
http://www.hal.inserm.fr/inserm-01476267/file/2017%20Jaries%20-%20Population%20movements%20and%20the%20HIV%20cascade-1.pdf
DOI : 10.1080/09540121.2017.1291899

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