B. Carme

Paracoccidioïdomycose cutanéo-muqueuse : Premier cas diagnostiqué en Guyane Française

Resume Introduction La paracoccidioidomycose est une mycose profonde due a un champignon dimorphique : Paracoccidioides brasiliensis . Le principal foyer d’endemie est le Bresil. Nous decrivons le premier cas de paracoccidioidomycose, dans sa forme cutaneo-muqueuse, diagnostique en Guyane Francaise. Observation Un homme de 20 ans d’origine bresilienne, residant en Guyane depuis quelques mois, consultait pour des lesions cutanees multiples disseminees mais predominant au visage comprenant de nombreux nodules et deux ulcerations. L’examen clinique revelait par ailleurs de tres volumineuses adenopathies superficielles et des ulcerations pharyngolaryngees. L’examen direct, l’examen anatomopathologique et la culture des biopsies cutanees mettaient en evidence des images specifiques de Paracoccidioides brasiliensis . La serologie VIH etait negative. Un traitement associant cotrimoxazole et itraconazole permettait la disparition des lesions en 1 mois. Discussion Il s’agit probablement dans notre observation d’une maladie d’importation car le malade venait d’arriver en Guyane. Le diagnostic differentiel principal etait la leishmaniose.

Histoplasmose disséminée : forme ulcéreuse atypique chez un malade infecté par le VIH

Resume Introduction Histoplasma capsulatum var capsulatum est un champignon dimorphique, principalement present sur le continent americain. Il est responsable de l’histoplasmose disseminee associee au SIDA. La presentation sous la forme d’une ulceration cutanee est inhabituelle et trompeuse. Observation Un homme de 25 ans consultait en raison de la survenue de 3 ulcerations, de 2 a 4 cm de diametre, localisees a la levre inferieure et aux genoux. Il existait un etat febrile, une alteration de l’etat general et un syndrome interstitiel pulmonaire. Le malade etait seropositif pour le virus de l’immunodeficience humaine (VIH). Son taux de lymphocytes CD4+ etait a 1/mm 3 . Le diagnostic d’histoplasmose etait etabli par l’examen direct et la culture des ulcerations cutanees et du liquide de lavage broncho-alveolaire. Discussion L’aspect clinique des localisations cutanees de l’histoplasmose disseminee est habituellement celui de lesions multiples disseminees a type de papules ou de nodules. Les ulcerations ne representent que moins de 20 p. 100 des cas decrits. Chez le malade presente, l’aspect des lesions faisait avant tout penser a une leishmaniose cutanee. L’examen mycologique direct puis les cultures ont permis le diagnostic.

Influence of meteorological parameters on the clinical presentation of cutaneous leishmaniasis in French Guiana and on the efficacy of pentamidine treatment of the disease.

In French Guiana, marked seasonal fluctuations have been observed in the numbers of individuals who present with cutaneous leishmaniasis (CL). To investigate the seasonal trends further, the clinical characteristics and responses to treatment of 455 cases of CL, who presented over a 3-year period (1995-1998), were compared against data on the weather for the calendar month of presentation (month 0) and for the month before presentation (month-1). Several statistically significant associations were observed. The number of sunlight hours in month -1 was lower for the treatment successes than for the treatment failures [adjusted odds ratio (AOR) for successful treatment=0.28; 95% confidence interval (CI)=0.13-0.6; P=0.001] and for those with long incubation periods than for those with relatively short incubation periods (multiple-regression coefficient=-0.003; P=0.002). However, the radiation intensity for month-1 was higher for the treatment successes than for the treatment failures (AOR=2.1; CI=1.1-3.8; P=0.02). Relatively high numbers of hours of sunlight on month-1 were associated with relatively high numbers of parasites on the skin smears (AOR=1.03; CI=1.01-1.04; P<0.001). Relatively high numbers of hours of sunlight during month 0 were associated with lymphangitis (AOR=0.4; CI=0.19-0.8; P=0.01). These results indicate that meteorological parameters may influence the evolution of CL, at least in French Guiana.

Seasonal fluctuations of incubation, healing delays, and clinical presentation of cutaneous leishmaniasis in French Guiana.

An investigation was conducted to determine whether seasonal variations affected the development of cutaneous leishmaniasis. Data from 499 cases treated between July 1994 and December 1998 were analyzed. The interval between infection and consultation and between treatment and clinical cure varied significantly between cases with an incubation period during the dry season compared with the rainy season (P < 0.001). When the incubation period occurred during the dry season, the standard pentamidine isethionate treatment seemed to be less effective (i.e., the odds ratio for failure was 1.9 [1.1–3.4], P = 0.01). The presence of lymphangitis was more frequent during the dry season (i.e., the odds ratio was 0.26 [0.15–0.45]m P < 0.001). These results suggested that the observed seasonal variations were due to variations in the host/parasite balance. Converging indirect elements that suggest a role for variations in solar ultraviolet radiation are discussed.