Éditeur(s) : HAL CCSD
Résumé : National audience
Introduction-objectifsBien que la prise en charge de personnes vivant avec le VIH (PVVIH) s’améliore globalement en Guyane, les disparités régionales et communautaires restent importantes. L’objectif est ici de décrire pour la première fois les caractéristiques épidémiologiques, spatiales et cliniques des PVVIH suivies en zones isolées. Matériels et MéthodesLes données présentées sont issues du suivi clinique réalisé en Centres Délocalisés de Prévention et de Soins (CDPS) de janvier 2014 à novembre 2015. Ces données ont été analysées et comparées aux données des PVVIH suivis dans les 3 centres hospitaliers de Guyane issues du logiciel Nadis®.Résultats 174 PVVIH ont étés pris en charge en CDPS et comparés à 2143 patients suivis sur le littoral. L’évolution du taux annuel de découvertes de séropositivité VIH montre une arrivée plus tardive mais particulièrement active en zones isolées par rapport au littoral, notamment chez les patients d’origine brésilienne (p<0,005). L’âge médian est de 43,8 ans, le sex ratio homme/femme est de 0,98. En zone isolées comme sur le littoral 1/3 des PVVIH sont dépistés tardivement (<200 CD4/mm3). Le succès virologiques après 6 mois de traitement est de 80% vs 88% sur le littoral (p=0,135), la moyenne des derniers CD4 (424 vs 569/mm3) est plus basse que sur le littoral (p<0,005) enfin la charge virale moyenne est plus élevée que sur le littoral (8960 vs 5317 copies /mL) (p<0,005). L’histoplasmose est la première cause d’infection opportuniste retrouvée. La répartition spatiale des patients suivis montre une incidence et prévalence de cas particulièrement élevée dans les villes frontalières charnières que constituent Maripasoula et Saint Georges de l’Oyapock. ConclusionLe caractère particulièrement actif et original de l’épidémie et les indicateurs de suivi moins bons que sur le littoral rappellent l’importance de compléter les moyens de la prise en charge des PVVIH en zones isolées en Guyane.
SFLS 2016 - XVIIème Congrès de la Société française de lutte contre le sida
Montpellier, France

inserm-01475954
http://www.hal.inserm.fr/inserm-01475954
http://www.hal.inserm.fr/inserm-01475954/document
http://www.hal.inserm.fr/inserm-01475954/file/2016%2C%20Mosnier%20-%20Les%20p%C3%A9riph%C3%A9ries%20de%20l%27%C3%A9pid%C3%A9mie%20de%20VIH%20en%20Guyane.pdf

Éditeur(s) : HAL CCSD Public Library of Science
Résumé : International audience
IntroductionLeishmania RNA virus type 1 (LRV1) is an endosymbiont of some Leishmania (Vianna) species in South America. Presence of LRV1 in parasites exacerbates disease severity in animal models and humans, related to a disproportioned innate immune response, and is correlated with drug treatment failures in humans. Although the virus was identified decades ago, its genomic diversity has been overlooked until now.Methodology/Principles findingsWe subjected LRV1 strains from 19 L. (V.) guyanensis and one L. (V.) braziliensis isolates obtained from cutaneous leishmaniasis samples identified throughout French Guiana with next-generation sequencing and de novo sequence assembly. We generated and analyzed 24 unique LRV1 sequences over their full-length coding regions. Multiple alignment of these new sequences revealed variability (0.5%±23.5%) across the entire sequence except for highly conserved motifs within the 5' untranslated region. Phylogenetic analyses showed that viral genomes of L. (V.) guyanensis grouped into five distinct clusters. They further showed a species-dependent clustering between viral genomes of L. (V.) guyanensis and L. (V.) braziliensis, confirming a long-term co-evolutionary history. Noteworthy, we identified cases of multiple LRV1 infections in three of the 20 Leishmania isolates.Conclusions/SignificanceHere, we present the first-ever estimate of LRV1 genomic diversity that exists in Leishmania (V.) guyanensis parasites. Genetic characterization and phylogenetic analyses of these viruses has shed light on their evolutionary relationships. To our knowledge, this study is also the first to report cases of multiple LRV1 infections in some parasites. Finally, this work has made it possible to develop molecular tools for adequate identification and genotyping of LRV1 strains for diagnostic purposes. Given the suspected worsening role of LRV1 infection in the pathogenesis of human leishmaniasis, these data have a major impact from a clinical viewpoint and for the management of Leishmania-infected patients.
ISSN: 1935-2727

pasteur-01583523
https://hal-riip.archives-ouvertes.fr/pasteur-01583523
DOI : 10.1371/journal.pntd.0005764
PUBMED : 28715422

Éditeur(s) : HAL CCSD Public Library of Science
Résumé : International audience
INTRODUCTION:The frequency, the clinical characteristics, and the prognosis of dengue is highly variable. Dengue fever is associated with a range of neurological manifestations. The objective of the present study was to determine the incidence of neurological signs and their predictive factors using data from cases of dengue seen and followed in Cayenne Hospital during the Dengue 2 epidemic in 2013.METHODS:In 2013, a longitudinal study using data from all cases of dengue seen in Cayenne hospital was collected. Medical records used a standardized form to collect demographic information, clinical signs and biological results and the date at which they were present. The analysis used Cox proportional modeling to obtain adjusted Hazard ratios.RESULTS:A total of 1574 patients were included 221 of whom developed central nervous system signs. These signs were spontaneously resolutive. There were 9298person days of follow-up and the overall incidence rate for central nervous system signs was 2.37 per 100 person-days. The variables independently associated with central nervous system anomalies were headache, Adjusted Hazard ratio (AHR) = 1.9(95%CI = 1.4-2.6), bleeding AHR = 2 ((95%CI = 1.3-3.1), P = 0.001, abdominal pain AHR = 1.9 ((95%CI = 1.4-2.6), P<0.001, aches AHR = 2.1 ((95%CI = 1.5-2.9), P<0.001, and fatigue AHR = 1.5 ((95%CI = 1.3-1.7), P<0.001.DISCUSSION:Overall, the present study suggests that neurological signs of dengue are not exceptional even in patients without the most severe features of dengue. These manifestations were spontaneously resolutive. Here it was not possible to distinguish between encephalitis or encephalopathy. Further studies would require more in depth exploration of the patients.
ISSN: 1932-6203

inserm-01421218
http://www.hal.inserm.fr/inserm-01421218
http://www.hal.inserm.fr/inserm-01421218/document
http://www.hal.inserm.fr/inserm-01421218/file/2016%2C%20Djossou%20-%20Incidence%20and%20Predictive%20Factors%20of%20Central%20Nervous%20System%20Dysfunction%20in%20Patients%20Consulting.pdf
DOI : 10.1371/journal.pone.0150828.t003

Éditeur(s) : HAL CCSD
Résumé : National audience
La Guyane française, de par sa situation géographique et climatique équatoriale – entraînant uneimmense biodiversité – et le caractère multiculturel et multiethnique de sa population, est le siège d’unlarge panel de pathologies infectieuses et tropicales, dont certaines sont assez mal connues.La fièvre Q, la toxoplasmose, la cryptococcose ou l’infection à VIH sont communes aux pays tempérés,mais présentent ici de grandes spécificités, entraînant une prise en charge et un raisonnement médicalparfois différents. De nombreuses pathologies tropicales sont par ailleurs présentes sur un mode endémiqueet/ou épidémique : paludisme, leishmaniose, maladie de Chagas, histoplasmose, dengue, chikungunya, etc.Des personnes ayant séjourné en Guyane peuvent présenter des problèmes infectieux spécifiques deretour sur le continent européen, et ces pathologies doivent pouvoir être évoquées par l’infectiologue.
La Lettre de l'Infectiologue

inserm-01407150
http://www.hal.inserm.fr/inserm-01407150
http://www.hal.inserm.fr/inserm-01407150/document
http://www.hal.inserm.fr/inserm-01407150/file/2016%2C%20Epelboin%20-%20L%27infectiologie%20en%20Guyane%20synth%C3%A8se%20med%20trop.pdf

Éditeur(s) : HAL CCSD Oxford University Press (OUP)
Résumé : International audience
Background: The objective of the study was to determine the incidence of transaminase elevation during dengue, and its predictive factors. Methods: In 2013, a longitudinal study was performed using data from all cases of dengue seen in Cayenne Hospital. Cox proportional modeling was used. Signs of major transaminase elevation were defined as an increase in aspartate amino transferase (AST) or alanine amino transferase (ALT) concentration over 10 times the normal value (10N). Results: There were 1574 patients and 13 249 person-days of follow-up. The incidence rate for signs of trans-aminase elevation (10N) was 0.55 per 100 person-days. Six patients had major transaminase elevation with AST.1000 units (0.43 per 1000 patient-days), and 73 patients (4.6%) developed transaminase elevation with AST .10N. The variables independently associated with major transaminase elevation were hyponatremia, low platelets, dehydration, hematocrit increase, food intolerance, positive nonstructural protein 1 (NS1), age over 15 years and the notion of paracetamol intake. Conclusions: Although very frequent, the incidence of major transaminase elevation was lower than reported elsewhere perhaps because of good access to care, or of the particular serotype causing this epidemic. The patients with transaminase elevation tended to be older, more severe and taking paracetamol.
ISSN: 0035-9203

inserm-01475594
http://www.hal.inserm.fr/inserm-01475594
http://www.hal.inserm.fr/inserm-01475594/document
http://www.hal.inserm.fr/inserm-01475594/file/2016%2C%20Djossou%20-%20Incidence%20and%20predictive%20factors%20of%20transaminase.pdf
DOI : 10.1093/trstmh/trv117

Éditeur(s) : HAL CCSD Public Library of Science
Résumé : International audience
A retrospective cohort study was conducted on 1541 HIV-infected patients to determine variables associated with the incidence of herpes zoster. A single failure Cox model showed that herpes zoster incidence increased following the first 6 months of antiretroviral treatment adjusted hazard ratio (AHR)=5 (95%CI=2.6-9.2), P<0.001; in the >60 years age group AHR=2 (95%CI=1-4), P=0.04; in patients in the top CD8 quartile AHR=2.1 (95%CI=1.3-3.6), P<0.001; and in patients previously reported to use crack cocaine AHR=5.9, (95%CI=1.4-25), P=0.02. Herpes zoster incidence increased in patients with CD4 counts<500 per mm(3) and gradually declined since 1992-1996, with AHR=0.3 (95%CI=0.2-0.5), P<0.001 for the 1997-2002 period and AHR=0.24 (95%CI=0.14-0.4), P<0.001 for the 2002-2008 period. Contrary to what has been described elsewhere, there was no specific effect of protease inhibitors on herpes zoster incidence. The present study is the first to suggest that crack cocaine is associated with an increased incidence of herpes zoster. The neurological or immunological effects of crack are discussed.
ISSN: 1932-6203

inserm-00921158
http://www.hal.inserm.fr/inserm-00921158
http://www.hal.inserm.fr/inserm-00921158/document
http://www.hal.inserm.fr/inserm-00921158/file/2013_Nacher_-_Predictive_factorssur herpes_zoster.pdf
DOI : 10.1371/journal.pone.0080187

Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
BACKGROUND:In French Guiana, a French overseas territory in South America, 6 to 10 thousands undocumented persons work illegally in gold mining sites in the Amazonian forest. Precarious life conditions lead to poor health but few data exist on the health status of illegal gold miners in French Guiana. The objective of this article was to describe the sociodemographic and health status of this vulnerable population.METHOD:A prospective cross-sectional survey was conducted in 2015 on gold mine supply sites at the border between French Guiana and Suriname. Health status was assessed through medical examination, past medical history, haemoglobin concentration, and HIV and malaria testing. A questionnaire was used to collect data about the migration itinerary and life conditions on mining sites.RESULTS:Among the 421 adults included in the study, 93.8% (395/421) were Brazilian, mainly from Maranhão (55.7%, 220/395), the poorest Brazilian state. The sex ratio was 2.4. Overall, 48% of persons never went to school or beyond the primary level. The median time spent in gold mining was quite long (10 years), with a high turn-over. One third of the surveyed population (37.1%, 156/421) had high blood pressure, and only two had a medical follow-up. Most persons had experienced malaria (89.3%, 376/421). They declared frequent arboviroses and digestive disorders. Active leishmaniasis was observed in 8.3% of gold miners. Among women, 28.5% were anemic. Concerning HIV, 36.6% (154/421) of persons, mainly men, never got tested before and 6 were tested positive, which represented an HIV prevalence of 1.43% (95%CI =0.29-2.5).CONCLUSION:These findings support the hypothesis that mining in remote areas is linked to several specific illnesses. Theoretically, gold miners would be presumed to start their economical migration to French Guiana as a healthy group. However, their strenuous working and living conditions there lead to poor health caused by infectious and non infectious diseases. This description of their health status is precious for health policy planners in French Guiana given the importance of controlling communicable disease, and the severity and range of specific illnesses acquired by this neglected population.TRIAL REGISTRATION:Clinical trial registration PRS N° NCT02903706 . Retrospectively registered 09/13/2016.
ISSN: 1471-2458

inserm-01566314
http://www.hal.inserm.fr/inserm-01566314
http://www.hal.inserm.fr/inserm-01566314/document
http://www.hal.inserm.fr/inserm-01566314/file/2017%2C%20Douine%20-%20Illegal%20gold%20miners%20in%20French%20Guiana.pdf
DOI : 10.1016/S0140-6736(10)62169-1

Éditeur(s) : HAL CCSD Saint-Maurice (Val de Marne) : Institut de veille sanitaire
Résumé : National audience
Introduction – Le nombre d’accès palustres diminue globalement en Guyane, alors que les orpailleurs travaillantsur les sites illégaux semblent particulièrement touchés par cette pathologie. Les objectifs de cette étudeétaient de déterminer la prévalence du paludisme dans cette population, les comportements associés ainsi quele niveau de résistance des parasites vis-à-vis des dérivés de l’artémisinine.Matériel et méthodes – Les inclusions ont eu lieu sur les sites de repli fréquentés par les orpailleurs le long dufleuve Maroni. Ont été effectués : un test de diagnostic rapide du paludisme, un questionnaire, un prélèvementsanguin pour PCR et un génotypage du gène pfK13 pour les PCR positives à Plasmodium falciparum.Résultats – De janvier à juin 2015, 421 orpailleurs ont été inclus, majoritairement des hommes (70,6%) brésiliens(93,8%). La prévalence du portage de plasmodies déterminée par PCR était en moyenne de 22,3%(IC95%: [18,3-26,3]), à 84% asymptomatiques. Les espèces identifiées étaient principalement P. falciparum(47,9%) puis P. vivax (37,2%), plus 10,6% de co-infections. Lors du dernier accès palustre, 52,4% des orpailleursavaient eu recours à l’automédication, majoritairement avec des dérivés de l’artémisinine (93,8%) avecune mauvaise observance (37,8%). L’analyse du gène pfK13 n’a pas mis en évidence de mutations associéesà la résistance à P. falciparumDiscussion – La prévalence élevée de porteurs asymptomatiques de plasmodies constitue un réservoir importantde transmission dans la région. L’utilisation massive de dérivés de l’artémisinine associée à une mauvaise observancedes traitements sont des facteurs de risque d’émergence de résistance imposant des mesures rapides
ISSN: 0245-7466

inserm-01491193
http://www.hal.inserm.fr/inserm-01491193
http://www.hal.inserm.fr/inserm-01491193/document
http://www.hal.inserm.fr/inserm-01491193/file/2017%2C%20Douine%20-%20Paludisme%20et%20orpaillage%20ill%C3%A9gal%20en%20Guyane.pdf

Éditeur(s) : HAL CCSD
Résumé : International audience
Reports on dengue morbidity in patients with sickle cell disease (SCD) are scarce. Dengue is arthropod-borne viroses due to dengue virus (DENV) and affects populations with a high prevalence of SCD; therefore, the risk of morbidity may be increased.To determine the impact of dengue infection in SCD patients, we reviewed medical records during a vast outbreak of dengue virus serotype-2 (DENV-2) in French Guiana in 2012-2013. We identified 10 cases of laboratory-confirmed dengue infection;these were classified into A, B and C categories based on levels of severity of dengue according to World Health Organisation (WHO). The average age of SCD patients was 18.2 years. 1, 6 and 3 cases were classified as A, B and C WHO severity criteria, respectively. All patients had an important decrease in haematocrit (while one of the WHO severity criteria is the increase of haematocrit). Only one patient had decreased platelet count. Seven cases had vaso-occlusive crisis (VOC), six patients developed acute hepatitis and eight had a simultaneous bacterial infection. Six of them needed a blood transfusion. The results suggested that the WHO severity laboratory criteria of hemoconcentration and platelet counts were not helpful in themanagement of SCD patients. The morbidity was mainly caused by specific complications of SCD, especially VOC, likely facilitated by vascular endothelial damages consecutive to dengue fever, severe haemolysis, hepatitis and bacterial co-infections.
Journal of Virology and Retrovirology

Droits : info:eu-repo/semantics/OpenAccess
inserm-01419456
http://www.hal.inserm.fr/inserm-01419456
http://www.hal.inserm.fr/inserm-01419456/document
http://www.hal.inserm.fr/inserm-01419456/file/2015%2C%20Mosnier%20-%20Dengue%20infection%20in%20sickle%20cell%20patients%20in%20French%20Guiana.pdf

Éditeur(s) : HAL CCSD American Society of Tropical Medicine and Hygiene
Résumé : International audience
From September 2013 to July 2014, several gold miners working in the tropical forest consulted the Maripasoula Health Center in French Guiana for edema and findings consistent with right cardiac failure. Of the 42 cases of beriberi that were diagnosed, one patient died. The laboratory and clinical investigation demonstrated vitamin B1 deficiency in most of the patients tested. Furthermore, 30 of 42 patients responded favorably to 500 mg of intravenous or intramuscular thiamine supplementation. In addition, dietary investigation showed insufficient thiamine intake in these patients. We concluded that patients had acquired beriberi because of diet restrictions, hard labor, and infectious diseases, notably malaria. In 2016, cases were still being reported. We recommend screening for compatible symptoms in gold miners, thiamine supplementation, and nutritional intervention
ISSN: 0002-9637

inserm-01503899
http://www.hal.inserm.fr/inserm-01503899
http://www.hal.inserm.fr/inserm-01503899/document
http://www.hal.inserm.fr/inserm-01503899/file/2017%2C%20Mosnier%20-%20A%20Large%20Outbreak%20of%20Thiamine%20Deficiency%20among%20Illegal%20Gold%20Miners%20in%20French%20Guiana.pdf
DOI : 10.4269/ajtmh.15-0906

Éditeur(s) : HAL CCSD
Résumé : National audience
Une Brésilienne de 39 ans est adressée à l’hôpital de Cayenne pour des céphalées, une confusion fébrile et une altération de l’état général. Six mois plus tôt, une infection par le VIH avait été révélée (charge virale de 147 615 copies/ ml ; CD4 à 56/ mm3), au Brésil, par un tableau de tuberculose pleuro-pulmonaire non documentée. Elle suit depuis un traitement antirétroviral et une quadrithérapie antituberculeuse, sans cotrimoxazole, traitement toujours en cours à son entrée.
La Lettre de l'Infectiologue

Droits : info:eu-repo/semantics/OpenAccess
inserm-01423104
http://www.hal.inserm.fr/inserm-01423104
http://www.hal.inserm.fr/inserm-01423104/document
http://www.hal.inserm.fr/inserm-01423104/file/2015%2C%20Epelboin%20-%20M%C3%A9ningo-enc%C3%A9phalite%20%C3%A0%20histoplasma%20capsulatum.pdf