Mathieu Glaizal

Health impact of unicellular algae of the Ostreopsis genus blooms in the Mediterranean Sea: experience of the French Mediterranean coast surveillance network from 2006 to 2009

Objective. Ostreopsis ovata and Ostreopsis siamensis are tropical unicellular algae that have been found recently in the Mediterranean. Both of these dinoflagellates produce palytoxin (PTX)-like toxins that are powerful vasoconstrictors in mammals. Since 2003, Ostreopsis blooms in Italy and Spain have been accompanied by reports of respiratory problems and skin/mucosa irritation in persons in contact with toxic microalgal cells (epiphytes, plankton, or sea spray) or associated toxins. Methods. In France, a surveillance network has been set up to monitor water conditions and to protect swimmers from contamination due to Ostreopsis. Results. Between 2006 and 2009, a total of nine blooms were observed on the French Mediterranean coast including five that led to manifestations in divers, swimmers, and shoreline inhabitants. A total of 47 patients presented symptoms of involving benign or mild skin, mucosal, and/or respiratory irritation that regressed spontaneously without treatment within 12–72 h (4–12 h with nonsteroidal anti-inflammatory drugs). During the study period, five beaches were temporarily closed. Discussion. In the Mediterranean, Ostreopsis blooms induce skin and respiratory disorders when human beings are exposed to saltwater with a high concentration of algal cells. However, palytoxin dosages carried out on the food chain (urchins, mussels) indicate that this risk of toxins accumulation in seafood must be taken into account and that the surveillance network should be upgraded accordingly.

Asp Viper (Vipera aspis) envenomation: experience of the Marseille Poison Centre from 1996 to 2008.

A retrospective case review study of viper envenomations collected by the Marseille’s Poison Centre between 1996 and 2008 was performed. Results: 174 cases were studied (52 grade 1 = G1, 90 G2 and 32 G3). G1 patients received symptomatic treatments (average hospital stay 0.96 day). One hundred and six (106) of the G2/G3 patients were treated with the antivenom Viperfav* (2.1+/-0.9 days in hospital), while 15 of them received symptomatic treatments only (plus one immediate death) (8.1+/-4 days in hospital, 2 of them died). The hospital stay was significantly reduced in the antivenom treated group (p < 0.001), and none of the 106 antivenom treated patients had immediate (anaphylaxis) or delayed (serum sickness) allergic reactions. Conclusion: Viperfav* antivenom was safe and effective for treating asp viper venom-induced toxicity.

Intoxications accidentelles par cannabis chez l’enfant : expérience du centre antipoison de Marseille

OBJECTIVE To assess the frequency and severity of accidental cannabis poisoning in children. METHODS A retrospective study of cases of accidental cannabis poisoning in people aged under 18 years old, reported to the Marseille poison center from 1993 through 2007. We excluded cases where cannabis was definitively ruled out, and neonatal withdrawal syndromes in newborns from cannabis users. RESULTS We collected 93 cases, including 56 boys and 37 girls, 86% of whom were younger than 3 years. The principal form was cannabis resin (hashish), reported in 80% of the cases and belonging to one of the parents or a household member. In almost all cases, the poisoning took place at the childs home. The frequency has risen in recent years, with 2/3 of the cases occurred in the second half of the study period. Five serious cases were reported, two with convulsions. CONCLUSION Considering the observed increase in cases each year, mostly benign but potentially serious, prevention and information efforts have to be improved for drug users with young children and for healthcare professionals led to manage this kind of accident.

Efficacité variable de l'antivenin Viperfav® pour traiter les envenimations vipérines avec neurotoxicité

1 Les auteurs tiennent à noter que les antihistaminiques, corticoïdes et anticoagulants préventifs n’ont aucun intérêt lors de la prise en charge d’une telle envenimation. Au sein d’une même espèce de serpent venimeux, la qualité et la composition du venin peuvent être variables [1–3]. Ainsi, il existe dans le Sud-Est de la France une population neurotoxique de vipères aspics en cours d’extension (sous-espèce nominale Vipera aspis aspis) [2–6]. De même, la sous-espèce Vipera aspis zinnikeri vivant dans le Sud-Ouest du pays est elle aussi caractérisée par des populations neurotoxiques en Aveyron et dans l’Hérault [2,5–7]. Quelle que soit la sous-espèce de vipère impliquée, plusieurs publications font état d’une bonne efficacité de l’antivenin Viperfav actuellement utilisé en France métropolitaine sur les symptômes neurotoxiques [8,9]. Les auteurs publient ici deux observations d’envenimation vipérine avec signes de neurotoxicité soulevant plusieurs interrogations.

Suicidal poisonings with methadone in France: Results of a two year national survey by the Toxicovigilance Network

Context. Methadone is used in France since March 1995, only for opioid maintenance treatment, in a syrup form. For the launching of a capsule form in April 2008, French health authorities requested a prospective survey of all cases involving exposure to methadone in either of the two available pharmaceutical forms. Objective. The aim was to document, in different circumstances and compare the safety of the new capsule form to the syrup. This report presents the findings of one arm of the study, devoted to methadone-related suicide attempts. Materials and method. From April 15, 2008 to April 15, 2010, all self-injurious methadone poisonings notified to or managed by the French Toxicovigilance Centers network were included. Analysis mainly focused on patients’ age and gender, estimated quantity ingested, eventual concomitantly taken substances, distribution of symptoms, and site of treatment. Results. 135 methadone-related suicide attempts were recorded. Analysis showed identical epidemiologic and clinical patient characteristics for the two pharmaceutical forms. Ten deaths occurred. The only discrepancy was a higher incidence of suicide attempts in the capsule group. However, as the number of capsule-treated patients increased during the second year, this difference remained significant but tended to decrease. Discussion. Combining these results with Pharmacovigilance and Addictovigilance arms, health authorities estimated that the benefit/risk balance of this new pharmaceutical form remains positive. They revised their position on requirements for prescribing and dispensing of the capsule form, and made them slightly easier. Following this, this “suicide” arm of Toxicovigilance survey was suspended, whereas the second one, concerning accidental pediatric methadone-related poisonings, has been extended until April 2014. Conclusion. In France, suicide attempts were more likely to occur with the capsule formulation. The clinical severity of intoxication was similar between the capsule and liquid forms.

One collective case of type A foodborne botulism in Corsica

Foodborne botulism is rare in 21st century Western Europe. The purpose of this report is to describe a collective case of type A botulism caused by ingestion of artisanal-produced food (canned green beans and/or salted roast pork). Five of the seven persons who shared the meal presented signs of severe intoxication leading to the fatal respiratory failure in one 18-year-old girl. Three patients required mechanical ventilation for durations ranging from 37 to 78 days and developed severe infectious, respiratory and/or psychiatric complications. In 4 out of the 5 patients, trivalent antitoxin was administered between days 2 and 7 but did not avoid the need for long-term intubation/mechanical ventilation. Treatment with 3,4-diaminopyridine was ineffective in the 26-year-old man who required long-term breathing assistance. This case of collective foodborne botulism illustrates the potential severity of this hazard.

Ciguatera contracted by French tourists in Mauritius recurs in Senegal

Ciguatera contracted by French tourists in Mauritius recurs in Senegal 11 months earlier presented symptoms. The other guests who ate the same fi sh did not develop symptoms. Patients with a history of ciguatera poisoning must avoid eating any type of tropical fi sh for a long period of time. The exact duration of this abstinence period remains unclear. Alcohol is another risk factor for recurrence. 2,3,5

Syndrome ischémique distal sévère après injection intra-artérielle volontaire de buprénorphine

High dosage buprenorphine (HDB) is a sublingual maintenance treatment of opioid dependence which have proved its substantial Public Health results, but it is also known to be frequently abused and diverted, in particular for intravenous injection, with deleterious consequences. Intra-arterial use is more rarely reported with this substance, just like its complications, mainly ischemic, potentially necrotic, phenomena. We report here such a case, with a 30 years-old man suffering from severe ischemia of the thumb, the forefinger and the middle finger few hours after direct injection of a suspension of buprenorphine crushed tablets in right radial arteria. A treatment combining surgery (video-thoracoscopic thoracic sympathectomy) and medicines (heparin, iloprost and piribedil mesilate), permitted a semi-complete digital rehabilitation (only forefinger pulp necrosis persisted and required a distal amputation), and the patient was discharged after 2 weeks.

Child poisonings with methadone in France: A 6-year prospective national survey since the availability of capsules in 2008.

Abstract Background. Methadone for opiate substitution was available only in syrup formulation prior to 2008. In 2007, the French Health Authorities made solid forms available. A national survey was performed in order to evaluate the modification of child poisonings induced by such a new pharmaceutical formulation. Methods. A prospective study was set up (April 15, 2008 to April 15, 2014) with the analysis of cases of unintentional ingestion of methadone by patients under 18 years old and managed by the 10 French poison control centers at the national level. As soon as a new pediatric exposure was recorded in the informatics data bank of the Poison Centers, a telephone survey was performed by the Marseilles’ Poison Center to obtain the evolution and all the necessary details. Results. 87 cases of child poisonings with the 2 forms were reviewed (syrup, 56 patients; capsules, 31 patients). Comparison shows that patients were similar for both formulations (no significant difference concerning age [median 2 years], sex ratio [M/F 0.85], previous history, and ingested quantities of methadone). There was a similar severity profile with both formulations proving that methadone can lead to lethal child intoxications (1 death with capsules and 4 with syrup). The relative risk of pediatric accidents is also the same with 2 formulations, leading the health authorities, in collaboration with laboratories, to design and distribute flyers. The aim was to inform patients who are also parents about the high danger risk of their treatment for children, whatever the formulation of methadone present in the house. Discussion. The results of this survey were similar to those of another national study by the French Poison Centers concerning adult suicide attempts with methadone. Both prospective studies led to the conclusion that methadone must be considered as a dangerous molecule for patients and their families. The recent availability of a solid formulation in France did not change the profile of poisonings with this opiate substitute treatment.

A rarely described use of neostigmine in a case of acute anticholinergic poisoning

La Presse Medicale - In Press.Proof corrected by the author Available online since samedi 5 novembre 2016