Publications by authors named "Philippe Abboud"

32 Publications

HIV-Associated Disseminated Histoplasmosis and Rare Adrenal Involvement: Evidence of Absence or Absence of Evidence.

Front Cell Infect Microbiol 2021 15;11:619459. Epub 2021 Mar 15.

Département Formation Recherche (DFR) Santé, Université de Guyane, Cayenne, French Guiana.

Adrenal histoplasmosis and primary adrenal insufficiency are mostly described in immunocompetent patients. This particular tropism is attributed to the presence of cortisol within the adrenal gland, a privileged niche for growth. In French Guiana, disseminated histoplasmosis is the main opportunistic infection in HIV patients. Our objective was to search in our HIV-histoplasmosis cohorts to determine how frequent adrenal insufficiency was among these patients. Between January 1, 1981 and October 1, 2014, a multicentric retrospective, observational study of histoplasmosis was conducted. Patients co-infected by HIV and histoplasmosis were enrolled in French Guiana's histoplasmosis and HIV database. Among 349 cases of disseminated histoplasmosis between 1981 and 2014, only 3 had adrenal insufficiency (0.85%). Their respective CD4 counts were 10, 14 and 43 per mm3. All patients had regular electrolyte measurements and 234/349 (67%) had abdominal ultrasonography and 98/349 (28%) had abdominopelvic CT scans. None of these explorations reported adrenal enlargement. Overall, these numbers are far from the 10% reports among living patients and 80-90% among histoplasmosis autopsy series. This suggests 2 conflicting hypotheses: First, apart from acute adrenal failure with high potassium and low sodium, less advanced functional deficiencies, which require specific explorations, may have remained undiagnosed. The second hypothesis is that immunosuppression leads to different tissular responses that are less likely to incapacitate the adrenal function. Furthermore, given the general immunosuppression, the adrenal glands no longer represent a particular niche for proliferation.
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http://dx.doi.org/10.3389/fcimb.2021.619459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005706PMC
March 2021

The Epidemiology of COVID 19 in the Amazon and the Guianas: Similarities, Differences, and International Comparisons.

Front Public Health 2021 11;9:586299. Epub 2021 Mar 11.

Département Formation Recherche (DFR) Santé, Université de Guyane, Cayenne, French Guiana.

The COVID 19 epidemic submerged many health systems in the Amazon. The objective of the present study was to focus on the epidemic curves of the COVID 19 epidemic in different centers, and to look at testing and mortality data. Publicly available datasets were used. The log of the daily cumulated number of cases starting from the day the territory reached 100 cumulated cases was plotted to compare the magnitude, shape and slope of the different curves. The maximum daily testing efforts were plotted for each territory in relation to the maximum daily number of diagnoses. The case fatality rate was computed by dividing the number of COVID 19 deaths by the number of confirmed cases. In the Amazonian regions in general the speed of growth was generally lower than in Europe or the USA, or Southern Brazil. Whereas, countries like South Korea or New Zealand "broke" the curve relatively rapidly the log linear trajectory seemed much longer with signs of a decline in growth rate as of early July 2020. After a very slow start, French Guiana had the lowest slope when compared to other Amazonian territories with significant epidemics. The Amazonian states of Roraima, Amazonas, Parà, and Amapà had among the highest number of cases and deaths per million inhabitants in the world. French Guiana had significantly fewer deaths relative to its number of confirmed cases than other Amazonian territories. French Guiana had a late epidemic surge with intense testing scale-up often exceeding 4,000 persons tested daily per million inhabitants. Brazil was an outlier with low daily testing levels in relation to the number of daily diagnoses. There were marked heterogeneities mortality rates suggesting that socioeconomic, political factors, and perhaps ethnic vulnerability led to striking outcome differences in this Amazonian context.
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http://dx.doi.org/10.3389/fpubh.2021.586299DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7990879PMC
April 2021

Reduced Severity in Patients With HIV-Associated Disseminated Histoplasmosis With Deep Lymphadenopathies: A Trench War Remains Within the Lymph Nodes?

Front Cell Infect Microbiol 2020 8;10:598701. Epub 2021 Feb 8.

DFR Santé, Université de Guyane, Cayenne, French Guiana.

Background: Disseminated histoplasmosis is a major killer of patients with advanced HIV. It is proteiform and often hard to diagnose in the absence of diagnostic tests. We aimed to describe disseminated histoplasmosis with lymphadenopathies in French Guiana and to compare survival and severity of those patients to patients without lymphadenopathies.

Methods: A retrospective cohort study was performed on data records collected between January 1, 1981 and October 1, 2014.

Results: Among 349 cases of disseminated histoplasmosis 168 (48.3%) had superficial lymphadenopathies and 133(38.1%) had deep lymphadenopathies. The median LDH concentration, ferritin concentration, TGO concentration, and WHO performance status were lower among patients with deep lymphadenopathies than those without deep lymphadenopathies. There was a significant decrease in the risk of early death (<1 month) among those with deep lymphadenopathies relative to those without (OR=0.26 (95%CI=0.10-0.60), P=0.0006) and in the overall risk of death (OR=0.33 (95%CI=0.20-0.55), P<0.0001). These associations remained strongly significant after adjusting for time period, CD4 counts, age, delay between beginning of symptoms and hospital admission, antifungal and antiretroviral treatment.

Conclusions: The present data show that in patients with advanced HIV and disseminated histoplasmosis, the presence of deep lymphadenopathies is associated with fewer markers of severity and a lower risk of death. To our knowledge it is the first study to show this. The presence of deep lymphadenopathies is hypothesized to reflect the patient's partially effective defense against .
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http://dx.doi.org/10.3389/fcimb.2020.598701DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7897652PMC
February 2021

Relationship between influenza and dengue outbreaks, and subsequent bacterial sepsis in French Guiana: A time series analysis.

J Public Health Res 2021 Jan 21;10(1):1768. Epub 2021 Jan 21.

Centre d'Investigation Clinique Antilles Guyane, CIC INSERM 1424.

Influenza has been shown to increase the risk for severe bacterial infection, in the tropics the seasonality of influenza epidemics is less marked, and this may not be the case. Dengue is often followed by prolonged asthenia and some physicians hypothesized increased susceptibility to infections based on anecdotal observations. Time series of influenza and dengue surveillance were confronted bacterial sepsis admissions to test the hypotheses. Monthly surveillance data on influenza and dengue and aggregated sepsis data in Cayenne hospital were matched between 24/10/2007 and 27/09/2016. An ARIMA (1,0,1) model was used. The series of the number of monthly cases of sepsis was positively associated with the monthly number of cases of influenza at time t (β=0.001, p=0.0359). Forecasts were imperfectly correlated with sepsis since influenza is not the only risk factor for sepsis. None of the ARIMA models showed a significant link between the dengue series and the sepsis series. There was thus no link between dengue epidemics and sepsis, but it was estimated that for every 1,000 cases of flu there was one additional case of sepsis. In this tropical setting, influenza was highly seasonal, and improved vaccination coverage could have benefits on sepsis.
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http://dx.doi.org/10.4081/jphr.2021.1768DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7856828PMC
January 2021

Gastrointestinal disseminated histoplasmosis in HIV-infected patients: A descriptive and comparative study.

PLoS Negl Trop Dis 2021 Jan 22;15(1):e0009050. Epub 2021 Jan 22.

DFR Santé, Université de Guyane, Cayenne, Cayenne, French Guiana.

Disseminated histoplasmosis is one the main AIDS-defining opportunistic infections in HIV-infected patients, notably in Latin America. The non-specific and proteiform clinical presentation leads to diagnostic delays that may lead to fatal outcomes. This retrospective multicentric study aimed to describe the frequency and manifestations of gastrointestinal histoplasmosis in French Guiana, and to compare patients with disseminated histoplasmosis with or without gastrointestinal involvement. Between January 1, 1981 and October 1, 2014 co-infections with HIV and histoplasmosis were enrolled. Inclusion criteria were: age >18 years, confirmed HIV infection; first proven episode of histoplasmosis. Among 349 cases of disseminated histoplasmosis, 245 (70%) had a gastrointestinal presentation. Half of patients with gastrointestinal signs had abdominal pain or diarrhea, mostly watery. Half of patients with abdominal pain had diarrhea (63/124) and half of those with diarrhea (63/123) had abdominal pain. A significant proportion of patients also had hepatomegaly and, to a lesser degree, splenomegaly. After adjusting for potential confounding, the presence of lymphadenopathies >2cm (AOR = 0.2, IC95 = 0.04-0.7, P = 0.01), Haitian origin (AOR = 0.04, IC95 = 0.004-0.4, P = 0.006) were associated with a lower prevalence of gastrointestinal signs and positive gastrointestinal presence of H. capsulatum. Persons with a gastrointestinal H. capsulatum were more likely to have a decreased prothrombin time, lower ferritin, lower liver enzymes, and lower concentrations of LDH than those without gastrointestinal signs and symptoms. They also had a shorter interval between symptoms onset and diagnosis. Patients with a positive gastrointestinal identification of H. capsulatum were less likely to die at 1 month than those without a gastrointestinal presentation (respectively, 4.6% vs 18.5%, P = 0.01). Subacute or chronic gastrointestinal presentations are very frequent during disseminated histoplasmosis, they seem less severe, and should lead to suspect the diagnosis in endemic areas. There were populational or geographic differences in the frequency of gastrointestinal manifestations that could not be explained.
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http://dx.doi.org/10.1371/journal.pntd.0009050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7857560PMC
January 2021

Risk Factors for Mortality among HIV-Infected Patients with Disseminated Histoplasmosis.

J Fungi (Basel) 2020 Nov 30;6(4). Epub 2020 Nov 30.

DFR Santé, Université de Guyane, 97300 Cayenne, France.

Identifying prognostic factors is important in order to guide the choice of first-line therapy for disseminated histoplasmosis. Our objective was to identify factors associated with death among a cohort of 330 patients compiled over 34 years of clinical practice in French Guiana. Survival analysis was performed with death as the failure event and date of symptom onset as the origin event. Incidence rates were and Cox proportional hazards models were computed. Overall, 330 HIV-infected patients with disseminated histoplasmosis were included in the analysis, with 126 deaths occurring. One-quarter of all patients died within 6 months of the first symptoms. Patients with dyspnea, renal failure, arterial blood pressure < 90 mmHG, and a WHO performance score > 2 had a greater incidence of death. Bivariate analyses showed that patients with increased LDH, low hemoglobin, low serum protein, low CD4 counts, and low platelets tended to have a greater incidence of death. After adjusting for potential confounders, patients with dyspnea, a WHO performance score > 2, serum protein < 60 g/L, and hemoglobin < 8.9 g/dL had an increased risk of dying. The interaction terms showed that patients treated with liposomal amphotericin B had a marked reduction in death among patients with renal failure; among renal failure patients, the elevation of LDH was associated with a significant risk of death.
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http://dx.doi.org/10.3390/jof6040326DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712551PMC
November 2020

Hemophagocytic Lymphohistiocytosis During HIV Infection in Cayenne Hospital 2012-2015: First Think Histoplasmosis.

Front Cell Infect Microbiol 2020 24;10:574584. Epub 2020 Sep 24.

Centre d'Investigation Clinique Antilles Guyane, INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana.

Haemophagocytic Lymphohistiocytosis (HLH), during HIV infection is a rare complication with a poor prognosis. There are few data on HLH within the Amazon region. The objective was to describe epidemiological, clinical and therapeutic features of HIV-related HLH in French Guiana. A retrospective analysis of adult HIV patients at Cayenne hospital with HLH between 2012 and 2015. A diagnosis of HLH was given if the patient presented at least 3 of 8 criteria of the HLH-2004 classification. Fourteen cases of HLH were tallied during the study period. The mean age was 46 years with a sex ratio of 1.8. The most frequent etiology of HLH was an associated infection (12/14). Confirmed disseminated histoplasmosis, was found in 10 of 14 cases, and it was suspected in 2 other cases. The CD4 count was below 200/mm in 13/14 cases. An HIV viral load >100,000 copies/ml was observed in 13/14 cases. An early treatment with liposomal amphotericin B was initiated in 12/14 cases. The outcome was favorable in 12/14 of all cases and in 10/12 cases involving histoplasmosis. Case fatality was 2/14 among all cases (14.3%) et 1/10 among confirmed disseminated histoplasmosis with HLH (10%). During the study period 1 in 5 cases of known HIV-associated disseminated histoplasmosis in French Guiana was HLH. Histoplasmosis was the most frequent etiology associated with HLH in HIV-infected patients in French Guiana. The prognosis of HLH remains severe. However, a probabilistic empirical first line treatment with liposomal amphotericin B seemed to have a favorable impact on patient survival.
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http://dx.doi.org/10.3389/fcimb.2020.574584DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7542182PMC
September 2020

Heterogeneity of Clinical Presentations and Paraclinical Explorations to Diagnose Disseminated Histoplasmosis in Patients with Advanced HIV: 34 Years of Experience in French Guiana.

J Fungi (Basel) 2020 Sep 8;6(3). Epub 2020 Sep 8.

Département Formation Recherche Santé, Université de Guyane, 97300 Cayenne, French Guiana.

We aimed to describe the ways patients with disseminated histoplasmosis-a multifaceted and often lethal disease-present themselves and are explored. A retrospective, observational, multicentric study spanned the period between 1 January 1981 and 1 October 2014. Principal component analysis was performed for the sampling sites and for the clinical signs and symptoms. The factor loadings of the principal components were selected for eigenvalues > 1. The most frequent signs and symptoms were an alteration of the WHO general performance status, fever, digestive tract, respiratory signs and symptoms and lymphadenopathies. The most common sites sampled were bone marrow, respiratory tract, blood, lymph node and liver biopsies, with significant variations in the number of sites from which samples were taken to try to identify the pathogen. The principal component analysis clinical signs and symptoms leading to the diagnosis showed four main lines of variation. The factor loadings of the four main components were compatible with four broad types of clinical presentations and four types of exploration strategies. Extracting simple algorithms was difficult, emphasizing the importance of clinical expertise when diagnosis depends on obtaining a sample where Histoplasma can be seen or grown. antigen detection tests will help simplifying the algorithms.
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http://dx.doi.org/10.3390/jof6030165DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7558389PMC
September 2020

Disseminated Histoplasmosis in HIV-Infected Patients: A Description of 34 Years of Clinical and Therapeutic Practice.

J Fungi (Basel) 2020 Sep 7;6(3). Epub 2020 Sep 7.

Département Formation Recherche Santé, Université de Guyane, Cayenne, 97300 Cayenne, French Guiana, France.

Disseminated histoplasmosis is the main AIDS-defining infection of French Guiana. We aim to describe our therapeutic experience for 349 patients with disseminated histoplasmosis between 1 January 1981 and 10 January 2014 in French Guiana. Survival, delays for treatment initiation, duration of induction therapy, and associated initial treatments are described. The death rate was 14.9 per 100 person-years, with an early drop in survival. Among those who died, >1/3 died within a year of HIV diagnosis, and ¾ of all patients with histoplasmosis had been diagnosed for HIV within a year. As induction treatment, 29% received liposomal amphotericin B, 12.9% received deoxycholate amphotericin B, 54% received itraconazole alone, and 21.8% received liposomal amphotericin B and itraconazole. The median delay between symptoms-onset and hospitalization was 19.5 days (IQR = 5-105). Liposomal amphotericin B or itraconazole was initiated shortly after admission. Treatment initiation was often presumptive for liposomal amphotericin B (27%) and itraconazole (20%). The median duration of liposomal amphotericin B treatment was 7 days (IQR = 5-11 days). The present study shows that ¾ of the patients were profoundly immunocompromised and had been diagnosed for HIV within the past year. Antifungal treatment was often initiated presumptively on admission. Over time there was a significant gradual decline in early death.
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http://dx.doi.org/10.3390/jof6030164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7557823PMC
September 2020

What is AIDS in the Amazon and the Guianas in the 90-90-90 era?

PLoS One 2020 24;15(7):e0236368. Epub 2020 Jul 24.

DFR Santé, Université de Guyane, Cayenne, French Guiana.

Introduction: In the past decade, new diagnostic methods and strategies have appeared, HIV testing efforts and the generalization of antiretroviral therapy may have influenced the number of opportunistic diagnoses and mortality of HIV-infected patients. To test this hypothesis we compiled data on the top opportunistic infections and causes of early death in the HIV cohort of French Guiana.

Methods: HIV-infected persons followed in Cayenne, Kourou, and Saint Laurent du Maroni hospitals from 2010 to 2019 were studied. Annual incidence of different opportunistic infections and annual deaths are compiled. For patients with opportunistic infections we calculated the proportion of early deaths.

Results: At the time of analysis, among 2 459 patients, (treated and untreated) 90% had a viral load <400 copies, 91% of the patients in the cohort were on antiretroviral treatment, and 94.2% of patients on treatment for over 6 months had undetectable viral loads. Only 9% of patients had CD4 counts under 200 per mm3. Histoplasmosis clearly remained the most frequent (128 cases) opportunistic infection among HIV-infected persons followed by cerebral toxoplasmosis (63 cases) and esophageal candidiasis (41 cases). Cryptococcal meningitis was ranked 5th most frequent opportunistic infection as was tuberculosis (31 cases). The trend for a sharp decline in early deaths continued (3.9% of patients).

Conclusions: Despite the successes of antiretrovirals, patients presenting with advanced HIV are still common and they are still at risk of dying. Improved diagnosis, and notably systematic screening with appropriate tools are still important areas of potential progress.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236368PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7380608PMC
September 2020

HIV patients dying on anti-tuberculosis treatment: are undiagnosed infections still a problem in French Guiana?

BMC Res Notes 2020 Apr 10;13(1):209. Epub 2020 Apr 10.

Département de Formation et de Recherche Santé (DFR Santé), Université de Guyane, 97300, Cayenne, French Guiana.

Objective: Despite scaling-up testing and antiretroviral treatment in Latin America, advanced HIV remains a significant public health problem. The objective of the present study was look for historical risk factors for death in French Guiana's HIV cohort taking into account the immunological status, the main opportunistic infections, and their treatment. A retrospective cohort study was conducted on data collected between 1992 and 2008 to identify factors associated with death in a cohort 2323 patients.

Results: There were 370 deaths for a total 9608 patient-years. Being on tuberculosis treatment was associated with a greater hazard of death. The diagnosis of confirmed tuberculosis, of histoplasmosis, of toxoplasmosis, and pneumocystosis were independently associated with death. Interactions terms between cotrimoxazole treatment and pneumocystosis, or between confirmed tuberculosis and tuberculosis treatment showed a protective treatment-effect. All patients having received anti-tuberculosis treatment (n = 347) did not have a final diagnosis of tuberculosis (n = 93). For histoplasmosis, 199 patients received antifungal treatment while 141 were diagnosed as having histoplasmosis. The number of patients on anti-tuberculosis drugs was far greater that the number of patients with confirmed tuberculosis, and these patients on treatment without confirmed tuberculosis had a twofold greater risk of dying.
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http://dx.doi.org/10.1186/s13104-020-05054-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7149834PMC
April 2020

Emergence of Plasmodium vivax Resistance to Chloroquine in French Guiana.

Antimicrob Agents Chemother 2019 11 22;63(11). Epub 2019 Oct 22.

Department of Infectious and Tropical Diseases, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana, France

In South America, resistance to chloroquine was recently reported in Brazil and Bolivia. The objective of this study was to collect data on chloroquine resistance in French Guiana by associating a retrospective evaluation of therapeutic efficacy with an analysis of recurrent parasitemia from any patients. Patients with infection, confirmed by microscopy and a body temperature of ≥37.5°C, were retrospectively identified at Cayenne Hospital between 2009 and 2015. Follow-up and treatment responses were performed according to the World Health Organization protocol. Parasite resistance was confirmed after dosage of a plasma concentration of chloroquine and microsatellite characterization. The and genes were analyzed for sequence and gene copy number variation. Among the 172 patients followed for 28 days, 164 presented adequate clinical and parasitological responses. Eight cases of treatment failures were identified (4.7%;  = 8/172), all after 14 days. The therapeutic efficacy of chloroquine was estimated at 95.3% (95% confidence interval [CI], 92.5 to 98.1%;  = 164/172). Among the eight failures, five were characterized: two cases were true chloroquine resistance (1.2%; 95% CI, 0 to 2.6%;  = 2/172), and three cases were found with subtherapeutic concentrations of chloroquine. No particular polymorphism in the and genes was identified in the resistant parasites. This identified level of resistance of to chloroquine in French Guiana does not require a change in therapeutic recommendations. However, primaquine should be administered more frequently to limit the spread of resistance, and there is still a need for a reliable molecular marker to facilitate the monitoring of resistance to chloroquine.
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http://dx.doi.org/10.1128/AAC.02116-18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6811453PMC
November 2019

Estimation of the duration between HIV seroconversion and HIV diagnosis in different population groups in French Guiana: Strategic information to reduce the proportion of undiagnosed infections.

PLoS One 2018 22;13(6):e0199267. Epub 2018 Jun 22.

Service de Dermatologie Vénéréologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana.

Background: Given the great efforts put into the strategic objective of reducing the proportion of HIV-infected patients that are undiagnosed, the aim of the present study was to review the temporal trends between 1997 and 2016 for median estimates of infection duration and median CD4 count at diagnosis for the main patient origins in French Guiana.

Methods: CD4 cell count at HIV sero-conversion and square root of CD4 cell decline were obtained using the CD4 decline in a cohort of HIV-infected persons in the UK, fitting random effect (slope and intercept) multilevel linear regression models. Multivariate analysis used robust regression for modeling the delay between estimated HIV seroconversion and diagnosis and quantile regression for CD4 at HIV diagnosis.

Results: The median interval between the estimated HIV seroconversion and HIV diagnosis was 8 years for patients fromBrazil, 4.5 years for those from Haiti, 6.6 years for those from Suriname, 3.3 years for patients from Guyana, and 3.1 years for French patients. A simple robust regression model with French patients as reference group adjusting for sex and age at the time of diagnosis showed that the interval was significantly longer for Brazilian (β = +3.7 years, P = 0.001), Surinamese (β = +4.2 years, P<0.0001), Haitian origins (β = +1.5 years, P = 0.049) but not for those originating from Guyana (β = -0.03 years, P = 0.9); Men independently had a longer interval than women (β = +3.5 years, P<0.0001).

Conclusions: Despite great efforts in French Guiana regarding HIV testing both in terms of diversification and intensification we still need to tailor the offer to better reach the communities in need. These results should help authorities scale up and optimize initiatives to reduce the proportion of patients who are unaware of their infection. They also raise the question of the role of stigma and discrimination as a barrier to HIV testing in small communities, and further emphasize the importance of reducing it.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0199267PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6014655PMC
April 2019

Primaquine 30 mg/day versus 15 mg/day during 14 days for the prevention of Plasmodium vivax relapses in adults in French Guiana: a historical comparison.

Malar J 2018 Jun 19;17(1):237. Epub 2018 Jun 19.

Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Andrée Rosemon, Rue de Flamboyants, 97300, Cayenne, French Guiana.

Background: The preventive treatment of Plasmodium vivax relapse recommended by the World Health Organization is primaquine at a dose of 15 mg/day for 14 days, except for malaria cases from Asia and Oceania. Since 2006, CDC recommends the use of primaquine at 30 mg/day for 14 days. In France, all cases of malaria due to P. vivax are treated with 30 mg of primaquine. This systematically increased dosage needs to be evaluated according to epidemiological context. The aim of the study was to compare relapses after 14 days of primaquine at 15 or 30 mg/day.

Methods: All patients treated with primaquine after a vivax malaria episode in French Guiana, between 1 January, 2007 and 1 August, 2016, were studied. Based on the compulsory hospital pharmacy forms for primaquine delivery, adult patients who received 15 or 30 mg of primaquine during 14 days for hypnozoite eradication were included. The recommended dose was initially 15 mg and was changed to 30 mg in 2011. Vivax malaria recurrences within 2 months after primaquine treatment, and vivax malaria recurrences 2-6 months after primaquine in each treatment group were analysed using survival analysis at 2, 3 and 6 months.

Results: Out of 544 patients included, 283 received 15 mg/day and 261 received 30 mg/day of primaquine. At 2 and 3 months after primaquine treatment, the number of recurrences was 7 (2.5%) and 19 (7.3%), and 9 (3.4%) and 15 (5.3%), in the 15 and 30 mg groups (p = 0.51 respectively 0.35), respectively. Within 3 months, the median time to recurrence was 2.05 months in the 15 and 30 mg groups. At 6 months after primaquine treatment, the number of recurrences was 25 (8.8%) and 31 (11.9%) at 15 and 30 mg, respectively (p = 0.24). The median time to recurrence was 2.38 months at 15 mg/day and of 2.64 months at 30 mg/day.

Conclusions: There were no significant differences between primaquine at 15 or 30 mg/day for 14 days in the prevention of P. vivax relapses at 2, 3 and 6 months after primaquine treatment in French Guiana.
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http://dx.doi.org/10.1186/s12936-018-2378-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6009032PMC
June 2018

A predictive score for hypotension in patients with confirmed dengue fever in Cayenne Hospital, French Guiana.

Trans R Soc Trop Med Hyg 2016 12;110(12):705-713

Equipe d'Accueil EA3593 Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, 97300 Cayenne, French Guiana.

Background: Identifying patients at risk of developing severe dengue is challenging. The objective of the present study was to determine the incidence of hypotension and its predictive factors during the Dengue 2 epidemic in 2013.

Methods: In 2013, a longitudinal study was performed using data from all confirmed cases of dengue seen in Cayenne General Hospital. The analysis used Cox proportional modeling to obtain adjusted hazards ratios for hypotension.

Results: A total of 806 confirmed patients were included 78 (9.6%) of whom developed hypotension. Extensive purpura, cutaneomucous hemorrhage, serous effusion and age 1-15 years were associated with subsequent hypotension whereas 'aches' and a rash were associated with a lower incidence of hypotension. The biological variables independently associated with hypotension were: increase of hematocrit, low protein concentrations, low sodium concentration and lymphocytes over 1400/ml. A risk score was computed from the scaled Cox model coefficient.

Conclusions: From a clinician's perspective, extensive purpura, cutaneomucous hemorrhage, serous effusion, age 1-15 years, hematocrit increase, low protein, low sodium, lymphocytosis and the absence of aches or of a rash, may be important warning signs to predict subsequent hypotension and shock. Over half of the patients with the highest risk score subsequently developed hypotension. The prognostic score had a 48.2% sensitivity with less than 10% of false positives. This score requires external validation before its impact on clinical practice is evaluated.
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http://dx.doi.org/10.1093/trstmh/trx004DOI Listing
December 2016

A Large Outbreak of Thiamine Deficiency Among Illegal Gold Miners in French Guiana.

Am J Trop Med Hyg 2017 05;96(5):1248-1252

Centre d'Investigation Clinique Epidémiologie Clinique Antilles Guyane, Cayenne, French Guiana, France.

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-sided 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.
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http://dx.doi.org/10.4269/ajtmh.15-0906DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5417225PMC
May 2017

Fatal case of chikungunya and concomitant thrombotic thrombocytopenic purpura in French Guiana during air flight medical evacuation.

J Travel Med 2017 Sep;24(5)

Infectious and Tropical Diseases Unit, Centre Hospitalier Andrée Rosemon, Cayenne F-97300, French Guiana, France.

Thrombotic thrombocytopenic purpura (TTP) is a thrombotic microangiopathy associated to severe ADAMTS13 deficiency. It has been linked to various viral infections. Among arboviruses, only Crimean-Congo haemorrhagic fever and dengue fever have been linked to this severe disease. We report the first documented case of TTP concomitant to Chikungunya virus infection.
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http://dx.doi.org/10.1093/jtm/tax028DOI Listing
September 2017

Epidemiological assessment of the severity of dengue epidemics in French Guiana.

PLoS One 2017 14;12(2):e0172267. Epub 2017 Feb 14.

Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana.

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.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0172267PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5308833PMC
August 2017

Incidence and predictive factors of transaminase elevation in patients consulting for dengue fever in Cayenne Hospital, French Guiana.

Trans R Soc Trop Med Hyg 2016 Feb;110(2):134-40

Equipe d'Accueil EA3593 Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, 97300 Cayenne, French Guiana Centre d'Investigation Clinique Antilles Guyane, INSERM 1424, Centre Hospitalier de Cayenne, French Guiana

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 transaminase 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. .
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http://dx.doi.org/10.1093/trstmh/trv117DOI Listing
February 2016

Combined antiparasitic treatment for neurocysticercosis.

Lancet Infect Dis 2015 Mar;15(3):264-5

Unité des Maladies Infectieuses Tropicales et Hygiène, Centre hospitalier Andrée Rosemon, 97300 Cayenne, French Guiana, France; EA 3595, Université des Antilles et de la Guyane, Cayenne, France.

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http://dx.doi.org/10.1016/S1473-3099(15)70031-9DOI Listing
March 2015

Histoplasmosis or tuberculosis in HIV-infected patients in the amazon: what should be treated first?

PLoS Negl Trop Dis 2014 Dec 4;8(12):e3290. Epub 2014 Dec 4.

Equipe EA3593, Ecosystèmes amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, French Guiana, France; Service de Dermatologie Vénérologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana, France.

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http://dx.doi.org/10.1371/journal.pntd.0003290DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4256267PMC
December 2014

AIDS-related Pneumocystis jirovecii genotypes in French Guiana.

Infect Genet Evol 2015 Jan 5;29:60-7. Epub 2014 Nov 5.

University of Brest, LUBEM EA 3882, SFR 148, Brest, France; Laboratory of Parasitology and Mycology, Brest University Hospital, Brest, France. Electronic address:

The study described Pneumocystis jirovecii (P. jirovecii) multilocus typing in seven AIDS patients living in French Guiana (Cayenne Hospital) and seven immunosuppressed patients living in Brest, metropolitan France (Brest Hospital). Archival P. jirovecii specimens were examined at the dihydropteroate synthase (DHPS) locus using a PCR-RFLP technique, the internal transcribed spacer (ITS) 1 and ITS 2 and the mitochondrial large subunit rRNA (mtLSUrRNA) gene using PCR and sequencing. Analysis of typing results were combined with an analysis of the literature on P. jirovecii mtLSUrRNA types and ITS haplotypes. A wild DHPS type was identified in six Guianese patients and in seven patients from metropolitan France whereas a DHPS mutant was infected in the remaining Guianese patient. Typing of the two other loci pointed out a high diversity of ITS haplotypes and an average diversity of mtLSUrRNA types in French Guiana with a partial commonality of these haplotypes and types described in metropolitan France and around the world. Combining DHPS, ITS and mtLSU types, 12 different multilocus genotypes (MLGs) were identified, 4 MLGs in Guianese patients and 8 MLGs in Brest patients. MLG analysis allows to discriminate patients in 2 groups according to their geographical origin. Indeed, none of the MLGs identified in the Guianese patients were found in the Brest patients and none of the MLGs identified in the Brest patients were found in the Guianese patients. These results show that in French Guiana (i) PCP involving DHPS mutants occur, (ii) there is a diversity of ITS and mtLSUrRNA types and (iii) although partial type commonality in this territory and metropolitan France can be observed, MLG analysis suggests that P. jirovecii organisms from French Guiana may present specific characteristics.
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http://dx.doi.org/10.1016/j.meegid.2014.10.021DOI Listing
January 2015

Q fever in French Guiana.

Am J Trop Med Hyg 2014 Oct 4;91(4):771-6. Epub 2014 Aug 4.

Unité de Recherche sur Les Maladies Infectieuses et Ttropicales Émergentes, Unités Mxtes de Rcherche, Centre National de la Recherche Scientifique 7278, Institut de Recherche pour le Développement 198, Institut National de la Santé et de la Recherche Médicale Unite 1095, Faculté de Médecine, Aix Marseille Université, Marseille, France; Unité de Maladies Infectieuses et Tropicales, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana

Coxiella burnetii, the causative agent of Q fever, is present worldwide. Recent studies have shown that this bacterium is an emerging pathogen in French Guiana and has a high prevalence (24% of community-acquired pneumonia). In this review, we focus on the peculiar epidemiology of Q fever in French Guiana. We place it in the context of the epidemiology of the disease in the surrounding countries of South America. We also review the clinical features of Q fever in this region, which has severe initial presentation but low mortality rates. These characteristics seem to be linked to a unique genotype (genotype 17). Finally, we discuss the issue of the animal reservoir of C. burnetii in French Guiana, which is still unknown. Further studies are necessary to identify this reservoir. Identification of this reservoir will improve the understanding of the Q fever epidemic in French Guiana and will provide new tools to control this public health problem.
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http://dx.doi.org/10.4269/ajtmh.14-0282DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4183403PMC
October 2014

Comparison between emerging Q fever in French Guiana and endemic Q fever in Marseille, France.

Am J Trop Med Hyg 2014 May 17;90(5):915-9. Epub 2014 Mar 17.

Aix Marseille Université, Marseille, France; Department of Infectious and Tropical Disease, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana.

Q fever is an emergent disease in French Guiana. We compared the incidence clinical and serologic profiles between patients from Cayenne, French Guiana and Marseille in metropolitan France during a four-year period. The annual incidence of diagnosed acute Q fever was significantly higher in Cayenne (17.5/100,000) than in Marseille (1.9/100,000) (P = 0.0004), but not the annual incidence of endocarditis (1.29 versus 0.34/100,000). Most patients had fever (97%) and pneumonia (83%) in Cayenne versus 81% and 8% in Marseille (P < 0.0001 and P < 0.0001, respectively) but transaminitis was more common in patients from Marseille (54% versus 32%; P < 0.0001). The proportion of patients with cardiovascular infections was significantly lower in Cayenne (7%) than in Marseille (17%) (P = 0.017), although they showed a stronger immune response with higher levels of phase I IgG (P = 0.024). The differing epidemiology, clinical, and serologic responses of patients from Cayenne and Marseille suggest a different source of infection and a different strain of Coxiella burnetii.
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http://dx.doi.org/10.4269/ajtmh.13-0164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4015587PMC
May 2014

Predictive factors of HTLV1-HIV coinfections in French Guiana.

Am J Trop Med Hyg 2013 Sep 12;89(3):549-53. Epub 2013 Aug 12.

Departement des Maladies Infectieuses, Cayenne General Hospital, French Guiana.

French Guiana, the French territory most affected by human immunodeficiency virus (HIV) (1.3% of pregnant women), is also endemic for human T lymphotropic virus 1 (HTLV1). The objective of this study was to determine if the HTLV1/HIV coinfected patients had particular characteristics. All HIV-infected patients having a computerized medical file containing an HTLV1 serology were included: there were 1,333 HIV monoinfections and 76 HTLV1/VIH coinfections. The prevalence of HTLV1/HIV coinfections was 5.39%. Women (odds ratio [OR] = 1.91[1.13-3.24]), subjects > 40 years of age, and patients of Surinamese origin (OR = 2.65 [1.25-5.61]) were overrepresented among the coinfected. CD4 count at the time of diagnosis and viral loads were higher among coinfected patients. The clinical stage was not significantly different between the two groups. The number of CD4 cells was not higher among the coinfected, unlike most reports from the literature. Prevalence of HTLV1 among HIV-infected patients is high in French Guiana, and physicians seem to omit the prescription of serology for this potentially serious coinfection.
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http://dx.doi.org/10.4269/ajtmh.12-0769DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3771298PMC
September 2013

Unique clone of Coxiella burnetii causing severe Q fever, French Guiana.

Emerg Infect Dis 2013 Jul;19(7):1102-4

Centre Hospitalier Andree Rosemon, Cayenne, French Guiana

Acute Q fever is an emergent and severe disease in French Guiana. We obtained 5 Coxiella burnetii isolates from samples of patients from Cayenne and found an epidemic clone circulating in Cayenne. This clone has caused pneumonia and endocarditis and seems to be more virulent than previously described strains.
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http://dx.doi.org/10.3201/eid1907.130044DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3713989PMC
July 2013

Atypical forms of syphilis: two cases.

Joint Bone Spine 2009 May 16;76(3):293-5. Epub 2009 Mar 16.

Service de Rhumatologie, CHU-Hôpitaux de Rouen, & Inserm, U905, IFRMP23, Institut de Biologie Clinique, Rouen, France.

Syphilis is a sexually transmitted disease caused by the spirochete Treponema pallidum. A chancre usually develops initially. Organ involvement and neurological complications may occur, sometimes several years after the initial exposure. We managed two patients with syphilis responsible for joint or neurological manifestations, diagnosed in 2008. One patient presented with oligoarthritis involving the knees and right elbow, coinciding with a maculopapular and pustular eruption. In the other patient, meningoradiculitis involving the T8, T9, and T10 metameres prompted a test for Lyme disease, which was weakly positive, leading to evaluation for false-positivity due to a cross-reaction. Neither patient was infected with the HIV.
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http://dx.doi.org/10.1016/j.jbspin.2008.10.012DOI Listing
May 2009

Imported malaria in HIV-infected patients enrolled in the ANRS CO4 FHDH study.

J Acquir Immune Defic Syndr 2008 Sep;49(1):55-60

INSERM, U720, Paris, F-75013 France.

Background: To describe episodes of imported malaria in human immunodeficiency virus type 1-infected patients and to study the risk factors for severe Plasmodium falciparum malaria.

Methods: Patients enrolled in the French Hospital Database on HIV who were diagnosed with a first episode of malaria between 1996 and 2003 were included. The severity of P. falciparum imported malaria was graded with World Health Organization criteria. Geographic areas were classified according to P. falciparum chemoresistance. Risk factors for severe malaria were identified with logistic regression.

Results: We studied 190 patients infected by P. falciparum in 178 cases. All but four of the patients were infected in sub-Saharan Africa, and half were returning from a country with a high P. falciparum chloroquine resistance. Their median age was 37.5 years, and 57% came from a country endemic with malaria. The median CD4 cell count was 299/mm, and the median plasma human immunodeficiency virus type 1 RNA load was 4.5 log10 copies/mL. Sixty-five (36.5%) episodes of P. falciparum malaria were severe. Severe imported malaria was associated with CD4 cells/mm <350 (odds ratio = 2.58; 95% confidence interval: 1.19 to 5.57). The risk of severe malaria was lower in patients returning from a country with a high prevalence of chemoresistance (odds ratio = 0.50; 95% confidence interval: 0.25 to 0.99).

Conclusions: Severe imported malaria in human immunodeficiency virus type 1-infected patients is associated with decreased CD4 cell count. The risk seems lower when P. falciparum infection was acquired in areas of high prevalence of chemoresistance.
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http://dx.doi.org/10.1097/QAI.0b013e31817e635bDOI Listing
September 2008