Alain Berlioz-Arthaud

Aetiology of community-acquired pneumonia in hospitalized adult patients in New Caledonia.

Objectiveu2002 To describe the aetiology of community‐acquired pneumonia (CAP) in hospitalized adult patients in New Caledonia, a French archipelago in the South Pacific.

10 year assessment of infant hepatitis B vaccination program, in the Loyalty Islands (New Caledonia)

OBJECTIVES OF THE STUDYnTo evaluate the decrease of hepatitis B prevalence in New Caledonia 10 years after the implementation of a neonatal vaccination program and discuss the need of any booster in preadolescents.nnnMETHODnA survey was conducted in the Loyalty Islands, involving 593 children aged 8-11 years. Serological profiles were determined using three parameters: antibodies to core and surface antigens and HBs Ag.nnnRESULTSnThe vaccine coverage rate is 93 and 89% of the children are protected against hepatitis B. However, 8% of them did have contact with the virus and 1.3% are carriers. Thirty-eight percent of the vaccinated children had their first injection later than the age of 3 months.nnnCONCLUSIONnThis study attests that the neonatal immunisation is accepted and followed. The prevalence reduction is not as great as expected, probably due to excess delay in primary vaccination. Hepatitis B eradication could be achieved in New Caledonia by starting immunisation at birth, and by implementing a global catch-up program among preadolescents.

Isolation of Trichophyton concentricum from chronic cutaneous lesions in patients from the Solomon Islands

Tinea imbricata, also known as Tokelau, is an uncommon superficial mycosis caused by the anthropophilic dermatophyte Trichophyton concentricum. Cutaneous lesions appear characteristically as scaly and concentric rings that may cover all parts of the body. Often acquired in childhood, tinea imbricata is a chronic disease and lichenification is extremely common due to pruritus. The dermatophytosis mainly occurs in the South Pacific, but also in some regions of Southeast Asia and Central or South America. Tinea imbricata usually affects people living in primitive and isolated conditions. Mycological analysis is required for the diagnosis. The epidemiological and mycological study reported here took place in the Solomon Islands from June-September 2006. Skin scrapings were collected from 29 Melanesian patients (aged 8 months to 58 years) with chronic cutaneous lesions and were analysed mycologically in the Laboratory of Parasitology and Mycology of Angers University Hospital (France). Ten patients showed very evocative lesions with a positive direct examination, but T. concentricum was only isolated from three patients. Identification of the strains was confirmed by sequencing of the internal transcribed spacer (ITS) regions. With the increase in international travel, one cannot disregard that this very rare species may be isolated by mycologists in temperate areas from patients coming from endemic foci.

Q Fever in French Guiana: Tip of the Iceberg or Epidemiological Exception?

Q fever is a cosmopolitan zoonosis caused by an intracellular bacterium, Coxiella burnetii. Since its discovery in 1935 in Australia, its presence has been reported almost worldwide in animals and humans [1]. In most developed countries, this infection has been widely described, and its life cycle, exposure factors, and clinical and biological pictures are well known. The incidence of Q fever is generally quite low, and most of the cases are diagnosed during short outbreaks related to direct or indirect contact of humans with cattle, sheep, or goats, which are the main reservoirs. In developing countries, information on endemicity is generally scarce and limited to seroprevalence studies in exposed populations or case reports. This presumably reflects misdiagnosis, rather than lower incidence. The diagnosis of acute Q fever mostly relies on the elevation of anti-C. burnetii antibodies by 15 to 21 days after the onset of the symptoms, detected by Immunofluorescence Assay, which is the gold standard for C. burnetii detection. However, these diagnostic techniques are often not available in tropical areas and, apparently, in numerous Latin American settings. Indeed, an exhaustive review of the literature in English, French, Spanish, and Portuguese showed that publications on Q fever in Latin America are scarce despite the worldwide presence of the disease (Table 1). Seven countries have never reported any cases of Q fever according to the available literature (Belize, Costa Rica, Guatemala, Guyana, Honduras, Paraguay, Suriname); three havent reported any since 1990, but some older studies do exist (Bolivia, Pan-ama, Venezuela); seven countries reported one or two publications since 1990 (Argentina, Chile, Ecuador, El Salvador, Peru, Trinidad, Uruguay); and Colombia, Mexico, and Brazil published several publications, including mostly case reports of chronic Q fever, one case of acute Q fever, several seroprevalence studies in exposed populations, and some studies based on an acute febrile or acute respiratory syndrome approach. Recently, Q fever was confirmed in patients and animals in parts of the Brazilian Atlantic Forest. Thus, there are no publications on Q fever in the Amazon region except in French Guiana and Ecuador.

La Leptospirose: Une Zoonose Sous Surveillance En Nouvelle-Calédonie Et Dans Le Pacifique

Resume La leptospirose est connue comme lune des pathologies infectieuses majeures de la Nouvelle-Caledonie. Sur un fond dendemie present tout au long de lannee, des foyers epidemiques sont habituellement constates pendant les mois chauds et pluvieux, principalement de decembre a mars. Les contaminations humaines sont classiquement rencontrees dans les zones delevage bovin de la cote ouest et en milieu rural melanesien le long de la cote est ou la pluviometrie est la plus importante (cote sous les alizes). Le pronostic de cette zoonose est parfois severe avec une mortalite associee importante. Le diagnostic clinique de cette spirochetose est difficile, les symptomes etant peu specifiques allant de la simple forme grippale (fievre, cephalees, myalgies) a la maladie de Weil associant atteintes hepatique et renale. Le diagnostic biologique specifique comprenant lisolement de lagent pathogene, la serologie (MAT, ELISA) et les techniques de biologie moleculaire issues de la PCR restent lapanage de structures specialisees comme en possede lInstitut Pasteur de Nouvelle-Caledonie, dont le laboratoire est associe au Centre national de reference des leptospires. Presente dans dautres etats et territoires insulaires du Pacifique, la leptospirose est une priorite du Reseau oceanien de surveillance de la Sante publique (ROSSP) cree en 1996 sous legide de la Communaute du Pacifique Sud et de lOrganisation mondiale de la Sante. Lensemble des donnees recueillies en reseau permettra aux services de sante concernes de sensibiliser les populations, mettre en place des mesures preventives et favoriser lutilisation des outils diagnostiques disponibles.

Mycobacterium ulcerans infection (Buruli ulcer) in French Guiana, South America, 1969–2013: an epidemiological study

BACKGROUNDnMycobacterium ulcerans infection is the third most common mycobacterial disease in the world after tuberculosis and leprosy. To date, transmission pathways from its environmental reservoir to humans are still unknown. In South America, French Guiana has the highest reported number of M ulcerans infections across the continent. This empirical study aimed to characterise the epidemiology of M ulcerans infection in French Guiana between 1969 and 2013.nnnMETHODSnData were collected prospectively mainly by two dermatologists at Cayenne Hospitals dermatology department between Jan 1, 1969, and Dec 31, 2013, for age, date of diagnosis, sex, residence, location of the lesion, type of lesion, associated symptoms, and diagnostic method (smear, culture, PCR, or histology) for all confirmed and suspected cases of M ulcerans. We obtained population data from censuses. We calculated mean M ulcerans infection incidences, presented as the number of cases per 100u2008000 person-years.nnnFINDINGSn245 patients with M ulcerans infections were reported at Cayenne Hospitals dermatology department during the study period. M ulcerans infection incidence decreased over time, from 6·07 infections per 100u2008000 person-years (95% CI 4·46-7·67) in 1969-83 to 4·77 infections per 100u2008000 person-years (3·75-5·79) in 1984-98 and to 3·49 infections per 100u2008000 person-years (2·83-4·16) in 1999-2013. The proportion of children with infections also declined with time, from 42 (76%) of 55 patients in 1969-83 to 26 (31%) of 84 in 1984-98 and to 22 (21%) of 106 in 1999-2013. Most cases occurred in coastal areas surrounded by marshy savannah (incidence of 21·08 per 100u2008000 person-years in Sinnamary and 21·18 per 100u2008000 person-years in Mana). Lesions mainly affected limbs (lower limbs 161 [66%] patients; upper limbs 60 [24%] patients). We diagnosed no bone infections.nnnINTERPRETATIONnThe decrease of M ulcerans infection incidence and the proportion of children with infections over a 45 year period in this ultra-peripheral French territory might have been mostly driven by improving living conditions, prophylactic recommendations, and access to health care.nnnFUNDINGnAgence Nationale de la Recherche.

La leptospirose en Guyane française et sur le bouclier des Guyanes. État des connaissances en 2016

Leptospirosis is a cosmopolitan zoonosis caused by bacteria of the genus Leptospira. Whether the distribution is worldwide, the hot and humid climate of the tropics is particularly conducive to its expansion. In most French overseas departments and territories, leptospirosis is considered as a public health problem. In French Guiana, a French department located in the northeastern part of the Amazon rainforest, it is supposed to be rare. The objective of this review was to make an inventory of the knowledge on human and animal leptospirosis in French Guiana and neighboring countries. A comprehensive search was conducted through the indexed and informal medical literature in English, French, Spanish and Portuguese. Thus, respectively ten and four publications were identified on human and animal leptospirosis in French Guiana, published between 1940 and 1995 in the form of case reports or case series. The publications concerning this disease in the other countries of the Guiana Shield, eastern Venezuela, Guyana, Suriname, and Brazilian state of Amapá, also scarce or nonexistent. However recent data from the French National Centre of leptospirosis showed a recent and sudden increase in the number of cases in the department, probably partly due to the development of diagnostic tools such as Elisa IgM serology. It is likely that leptospirosis is a neglected disease in the region, due to the lack of diagnostic tools readily available, the lack of knowledge of the local clinicians on this disease and the existence of many other pathogens with similar clinical presentation such as malaria, arboviruses and Q fever and Amazonian toxoplasmosis. The establishment of more large-scale studies on animal and human leptospirosis is necessary and urgent to know the true burden of this disease in our region.

HIV-1 Pol Gene Polymorphism and Antiretroviral Resistance Mutations in Treatment-Naive Adult Patients in French Guiana Between 2006 and 2012.

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.

Epidemiology of Human Leptospirosis in French Guiana (2007–2014): A Retrospective Study

Leptospirosis is a worldwide zoonotic bacterial infection with a rising incidence. French Guiana is mostly covered by Amazonian rain forest. Despite a potentially favorable environment, leptospirosis has been barely studied in French Guiana. The objective of this study was to describe the current trends of leptospirosis epidemiology in French Guiana. A cross-sectional study was performed in the two main hospitals of French Guiana. Cases of leptospirosis from 2007 to 2014 were retrospectively identified with a systematic screening of serological and polymerase chain reaction results to classify them as confirmed, probable, or excluded cases. Medical files were reviewed to collect epidemiological data. Among the 72 included patients, 55 (76.4%) cases were confirmed and 17 (23.6%) were probable. The median age was 39 years (range: 16-82 years) and the M/F sex ratio 6.2. Sixty-two (86.1%) patients required hospitalization, including 12 (16.7%) in the intensive care unit. Three (4.2%) patients died. The monthly distribution of cases was correlated with rainfall (P = 0.004) and moisture (P = 0.038). Professional exposure was frequently identified (especially gold mining and construction). Among 16 different serogroups identified by microagglutination test, Icterohaemorrhagiae was the most frequent (38.0%). This study revealed an epidemiology close to that observed in Brazilian regions, and professional and climatic risk factors. The high diversity of serogroups may reveal a complex environmental reservoir requiring further investigations. Only 20% of leptospirosis patients were suspected as such on hospital admission, thus emphasizing the need to inform local physicians.

PADS 2-07 - La leptospirose en Guyane française : 1re étude transversale multicentrique 2007-2014.

Introduction La leptospirose est une zoonose de repartition mondiale avec une incidence en augmentation. Elle represente un probleme de sante publique en zone tropicale. L’objectif de notre etude etait de faire un etat des lieux de la leptospirose en Guyane Francaise afin d’en ameliorer la prise en charge.