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Background: In emergency departments (EDs), the staff continually face stressful situations requiring staff to adopt various coping strategies. Aims: The study aimed to assess work-related stress in ED during the COVID-19 outbreak. Method: The study was a monocentric investigation based on a questionnaire survey that elicits general information and uses the Karasek model to analyse the data. Findings: A total of 117 forms were collected for analysis. The score for decision latitude (or autonomy and skills at work) was 70 (IQR: 64–74) and the score for psychological demand was 25 (IQR: 23-27). The score for social support by the management team was 11 (IQR: 9–12) and the score for social support by colleagues 12 (IQR: 10–12). Of the total number of respondents, job strain was assessed as affecting 24.8%. Conclusion: The study shows high levels of stress among the ED workforce. The findings indicate that it is imperative to develop simple management tools that are capable of measuring the internal causes of stress in order to develop an adapted wellness programme in ED.

Intensive care unit–acquired bloodstream infections (ICU-BSI) are frequent and are associated with high morbidity and mortality rates. We conducted this study to describe the epidemiology and the prognosis of ICU-BSI in our ICU and to search for factors associated with mortality at 28 days. For this, we retrospectively studied ICU-BSI in the ICU of the Cayenne General Hospital, from January 2013 to June 2019. Intensive care unit–acquired bloodstream infections were diagnosed in 9.5% of admissions (10.3 ICU-BSI/1,000 days). The median delay to the first ICU-BSI was 9 days. The ICU-BSI was primitive in 44% of cases and secondary to ventilator-acquired pneumonia in 25% of cases. The main isolated microorganisms were Enterobacteriaceae in 67.7% of patients. They were extended-spectrum beta-lactamase (ESBL) producers in 27.6% of cases. Initial antibiotic therapy was appropriate in 65.1% of cases. Factors independently associated with ESBL-producing Enterobacteriaceae (ESBL-PE) as the causative microorganism of ICU-BSI were ESBL-PE carriage before ICU-BSI (odds ratio [OR]: 7.273; 95% CI: 2.876–18.392; P < 0.000) and prior exposure to fluoroquinolones (OR: 4.327; 95% CI: 1.120–16.728; P = 0.034). The sensitivity of ESBL-PE carriage to predict ESBL-PE as the causative microorganism of ICU-BSI was 64.9% and specificity was 81.2%. Mortality at 28 days was 20.6% in the general population. Factors independently associated with mortality at day 28 from the occurrence of ICU-BSI were traumatic category of admission (OR: 0.346; 95% CI: 0.134–0.894; P = 0.028) and septic shock on the day of ICU-BSI (OR: 3.317; 95% CI: 1.561–7.050; P = 0.002). Mortality rate was independent of the causative organism.

Snakebite envenoming is a neglected tropical disease with a high burden in the Amazon basin. Our review aimed to give information about the epidemiology and the management of SB in the Amazon region. The Amazon basin, which comprises the largest portion of tropical rainforest on earth, includes territories of nine South American countries. The Amazon harbors a rich herpetofauna, among which the species of the Bothrops genus (family Viperidae) cause the highest number of bites and envenomings. The management of snakebite envenomings poses a difficult challenge for the public health systems of these countries for several reasons: bites occur in remote rural locations far from urban centers and health facilities; there are transportation difficulties for; health posts and personnel are in insufficient numbers; and antivenoms are insufficiently available in some regions. In addition, the species causing the highest number of accidents, i.e. Bothrops atrox, often causes severe envenomings. The present review summarizes the main aspects of envenomings by Bothrops sp. snakes in the Amazonia, including the epidemiology, pathophysiology, clinical manifestations, and therapy of envenomings. In a context of global efforts to reduce the impact of snakebite envenomings, there is a need for international cooperative efforts by public health authorities and civil society in these countries.

The aim of our study was to describe the clinical features, the etiologies, and the factors associated with poor outcome of encephalitis in French Guiana. Our study was retrospective, including all cases of encephalitis hospitalized in the Cayenne General Hospital, from January 2007 to July 2017. Patients were included through the 2013 encephalitis consortium criteria and the outcome was evaluated using the Glasgow outcome scale at 3 months from the diagnosis of encephalitis. We included 108 patients, giving an approximate incidence rate of four cases/100,000 inhabitants/year. The origin of the encephalitis was diagnosed in 81 cases (75%), and 72 of them (66.7%) were from an infectious origin. The most common infectious causes were Cryptococcus sp. (18.5%) independently of the immune status, Toxoplasma gondii (13.9%), and Streptococcus pneumoniae (5.5%). In the follow-up, 48 patients (46.6%) had poor outcome. Independent risk factors associated with poor outcome at 3 months were “coming from inside area of the region” (P = 0.036, odds ratio [OR] = 4.19; CI 95% = 1.09–16.06), need for mechanical ventilation (P = 0.002, OR = 5.92; CI 95% = 1.95–17.95), and age ≥ 65 years (P = 0.049, OR = 3.99; CI 95% = 1.01–15.89). The most identified cause of encephalitis in French Guiana was Cryptococcus. The shape of the local epidemiology highlights the original infectious situation with some local specific pathogens.

Hospitals in the French Territories in the Americas (FTA) work according to international and French standards. This paper aims to describe different aspects of critical care in the FTA. For this, we reviewed official information about population size and intensive care unit (ICU) bed capacity in the FTA and literature on FTA ICU specificities. Persons living in or visiting the FTA are exposed to specific risks, mainly severe road traffic injuries, envenoming, stab or ballistic wounds, and emergent tropical infectious diseases. These diseases may require specific knowledge and critical care management. However, there are not enough ICU beds in the FTA. Indeed, there are 7.2 ICU beds/100 000 population in Guadeloupe, 7.2 in Martinique, and 4.5 in French Guiana. In addition, seriously ill patients in remote areas regularly have to be transferred, most often by helicopter, resulting in a delay in admission to intensive care. The COVID-19 crisis has shown that the health care system in the FTA is unready to face such an epidemic and that intensive care bed capacity must be increased. In conclusion, the critical care sector in the FTA requires upgrading of infrastructure, human resources, and equipment as well as enhancement of multidisciplinary care. Also needed are promotion of training, research, and regional and international medical and scientific cooperation.Los hospitales en los territorios franceses de la Región de las Américas funcionan según las normas francesas e internacionales. El objetivo de este artículo es describir distintos aspectos de los cuidados intensivos en los territorios franceses. Para ello, hemos revisado los datos oficiales sobre el tamaño de la población y el número de camas de las unidades de cuidados intensivos (UCI), así como la bibliografía sobre algunos aspectos específicos de las UCI, en los territorios franceses. Las personas que viven en los territorios franceses, o que están de visita en ellos, están expuestas a riesgos específicos: principalmente traumatismos graves causados por el tránsito, envenenamiento por mordeduras, heridas de bala o por apuñalamiento, y enfermedades infecciosas tropicales emergentes. La atención de estos traumatismos y enfermedades puede requerir conocimientos específicos y cuidados intensivos. Sin embargo, no hay suficientes camas de UCI en los territorios franceses. De hecho, hay 7,2 camas de UCI por 100 000 habitantes en Guadalupe, 7,2 en Martinica y 4,5 en Guayana Francesa. Además, los pacientes gravemente enfermos que viven en zonas remotas a menudo tienen que ser trasladados, normalmente por helicóptero, lo que retrasa su ingreso en la unidad de cuidados intensivos. La crisis de la COVID-19 ha puesto de manifiesto que el sistema de atención de salud en los territorios franceses no está preparado para enfrentarse a una epidemia de estas dimensiones y que debe aumentarse la capacidad hospitalaria de las unidades de cuidados intensivos. En conclusión, el sector de los cuidados intensivos en los territorios franceses tiene que mejorar su infraestructura, recursos humanos y equipamiento, así como perfeccionar la atención multidisciplinaria. También es necesario promover la capacitación, la investigación y la cooperación médica y científica, tanto regional como internacional.Os hospitais nos territórios ultramarinos franceses nas Américas funcionam segundo os padrões franceses e internacionais. O objetivo deste artigo é descrever os diversos aspectos da atenção intensiva nesta região. Analisamos os dados oficiais relativos ao tamanho da população e ao número de leitos de unidade de terapia intensiva (UTI) nestes territórios junto com uma revisão da literatura científica sobre as características particulares destes centros de terapia intensiva. Os residentes locais ou visitantes dos territórios ultramarinos franceses nas Américas são expostos a riscos específicos, sobretudo acidentes de trânsito graves, envenenamentos por animais peçonhentos, ferimentos por armas brancas ou armas de fogo e doenças infecciosas tropicais emergentes que requerem conhecimento especializado e atenção intensiva. Porém, não há leitos suficientes de UTI nos territórios ultramarinos franceses nas Américas: são 7,2 leitos de UTI por 100.000 habitantes em Guadalupe, 7,2 na Martinica e 4,5 na Guiana Francesa. Ademais, em áreas remotas, os pacientes em estado crítico frequentemente precisam ser transferidos por helicóptero, o que causa demora na internação em UTI. A crise da COVID-19 demonstra o despreparo do sistema de saúde para enfrentar a pandemia e a necessidade de aumentar o número de leitos de UTI nestes territórios. Em conclusão, é imprescindível modernizar a infraestrutura e os equipamentos, capacitar melhor os recursos humanos e melhorar a atenção multidisciplinar. Incentivar a formação profissional, pesquisa e cooperação médico-científica regional e mundial é também fundamental.

International audience; Leptospirosis is a zoonotic disease with worldwide distribution. In French Guiana, a French overseas department of South America, this bacterial infection is endemic with the increase of human cases since the last 5 years. Nevertheless, the epidemiological data on the circulating infecting strain remains scarce due to the lack of specific symptoms and the used diagnostic approaches. We report a severe case of leptospirosis in a 52-years-old male, working as a street cleaner, hospitalized at the Intensive Care Unit of city capital hospital of French Guiana because of hemodynamic, neurological, renal, and respiratory failure. At ICU admission, the patient was comatose, his temperature was 37.3°C, heart rate 104 beats per minute, blood pressure 84/45mmHg, and oxygen saturation 95% while under mechanical ventilation. Retrospective exploration using molecular and serological approaches from the samples allowed reporting an infection by Leptospira santarosai serogroup Sejroe serovar Hardjo. To our knowledge, this is the first human case infected with this species in French Guiana. Through these analyses, this report provides new epidemiological information about the Leptospira strains circulating in French Guiana. In particular, this emphasizes the importance of accurate diagnosis to characterize with more precision the circulating Leptospira strains in this department.

In the American continent, larval forms (caterpillars) of the Lonomia genus can cause systemic reactions in human beings. In this Paper, we report the third case of Lonomia envenoming recorded in French Guiana in 25 years, and the first in which specific antivenom was administered. Severe symptoms of the envenoming were observed in our patient including pain; coagulopathy and systemic hemorrhage. They are caused by skin contact with caterpillars. Recovery, however, was quite satisfactory thanks to the international cooperation of the health authorities in both France and Brazil.

A workshop on epidemiology and management of snakebites in French Guiana was performed at Cayenne, French Guiana from September 15 to September 16, 2017, under the auspices of the French Regional Health Agency (ARS) and the Pan American Health Organization (PAHO). The activity was attended by experts from France (Angers, Martinique, French Guiana, Guadeloupe, and Paris), Costa Rica, Brazil, Saint Lucia, and Surinam. The epidemiology, clinical manifestations, clinical grading and the management of snakebite in French Guiana were discussed. The conclusions of this symposium illustrated the urgent need to ensure accessibility of effective and safe polyvalent viperid antivenom in French Guiana. Finally, the results of this symposium have forged ties based on mutual goals and objectives.

International audience; We report viral RNA loads and antibody responses in 6 severe human cases of Maripa virus infection (2 favorable outcomes) and monitored both measures during the 6-week course of disease in 1 nonfatal case. Further research is needed to determine prevalence of this virus and its effect on other hantaviruses.

Background We report hereby a severe case of Hantavirus Pulmonary Syndrome” (HPS) induced by Maripa virus in French Guiana and describe the mechanism of severity of the human disease. Case presentation A 47-year- old patient started presenting a prodromic period with fever, dyspnea, cough and head ache. This clinical presentation was followed by a rapid respiratory, hemodynamic and renal failure leading to admission in the ICU. Biological exams revealed an increased haematocrit level with a paradoxical low protein level. Echocardiographic and hemodynamic monitoring showed a normal left ventricular function with low filling pressures, an elevated extravascular lung water index and pulmonary vascular permeability index. These findings were compatible with a capillary leak-syndrome (CLS). Conclusions The severity of HPS caused by the virus Maripa in French Guiana can be explained by the tropism of hantavirus for the microvascular endothelial cell leading to a CLS.

International audience; This study investigated the clinical epidemiology and resistance mechanisms of Acinetobacter baumannii and characterised the clonal diversity of carbapenem-resistant A. baumannii (CRAB) during an ICU-associated outbreak at Cayenne Hospital, French Guiana. All non-duplicate A. baumannii isolates from 2008 to 2014 were tested for antibiotic susceptibility by disk diffusion. Multilocus sequence typing, pulsed-field gel electrophoresis (PFGE) and characterisation of carbapenemase-encoding genes were performed on CRAB. Of the 441 A. baumannii isolates, most were from males (54.0%) and were detected mainly from the ICU (30.8%) and medicine wards (21.8%). In the ICU, strains were mainly isolated from the respiratory tract (44.1%) and bloodstream (14.0%), whereas in medicine wards they mainly were from wound/drainage (36.5%) and bloodstream (25.0%). A. baumannii showed the greatest susceptibility to piperacillin/tazobactam (92.7%), imipenem (92.5%), colistin (95.6%) and amikacin (97.2%), being lower in the ICU and medicine wards compared with other wards. An outbreak of OXA-23-producing CRAB occurred in the 13-bed ICU in 2010. CRAB strains were more co-resistant to other antimicrobials compared with non-CRAB. Molecular genetics analysis revealed five sequence types [ST78, ST107 and ST642 and two new STs (ST830 and ST831)]. Analysis of PFGE profiles indicated cross-transmissions of CRAB within the ICU, between the ICU and one medicine ward during transfer of patients, and within that medicine ward. This study provides the first clinical and molecular data of A. baumannii from French Guiana and the Amazon basin. The ICU was the highest risk unit of this nosocomial outbreak of OXA-23-producing CRAB, which could subsequently disseminate within the hospital.

We report the case of a 7 year old boy which presented acute necrotizing pancreatitis after he was stung by Tityus obscurus scorpion. The diagnosis was made on the basis of elevated amylase and lipase enzymes and on abdominal CT scan showing acute necrotizing pancreatitis involving the body and the tail of pancreas. Under analgesics and symptomatic treatment, the patient improved clinically with return of pancreatic enzymes to normal.

The annual incidence of Q fever in French Guiana was found to have increased in 1996 and was 37/100,000 population over the last 4 years. Subsequent investigations in Cayenne and its suburbs indicated that a wild reservoir of the bacteria was responsible for the epidemiologic pattern. A case-control study showed that residence near a forest and occupations and activities that result in exposure to aerosols of dusts from the soil are risk factors for Q fever. By means of time-series analysis, a strong positive correlation between rainfall and the incidence of Q fever with a time lag of 1-3 months was found. The spatial distribution of the cases showed that transmission occurs widely throughout greater Cayenne, which is incompatible with a pinpoint source of contamination. Transmission from livestock and dissemination of the bacteria by the wind appeared to be unlikely, which strengthens the hypothesis that a wild reservoir is responsible for transmission.

Thousands of cases of dengue fever (DF) and several cases of dengue haemorrhagic fever were recorded in French Guiana during the recent outbreak of dengue-2 virus (1991-1992) and in subsequent years. One case with clinical signs typical of classical DF with neurological complications is reported in this study. The neurological features (encephalitis) appeared during the acute phase, 2 days after the onset of fever. Dengue-2 virus was detected in both the cerebrospinal fluid and blood sample. This case was fatal. This first reported case of classical DF with encephalitis in French Guiana is a new demonstration of the potential neurovirulence of dengue viruses.

Scorpion envenomation is a poorly explored problem in French Guiana. The aim of our study was to describe the epidemiological and clinical features of scorpion stings. Methods Our study is retrospective. It was conducted in the emergency department (ED) of Cayenne General Hospital, over an 8-year period (2003–2010). Results During the study period, 253 patients presented to the emergency department with a history of a scorpion sting. The mean incidence was 32 ± 8 cases per year. The peak of incidence was observed in April and May which are the rainiest months in the year. In most cases, the envenomation occurred between 6:00 and 11:00 am. The site of the sting was on the extremities (hand or foot) in 81% of cases. The scorpion was identified or brought to the hospital in 113 cases. It was described as a slim pincers scorpion in 97 cases. The mean time elapsed between the scorpion sting and admission was 4 ± 5 h. The main clinical symptoms at admission to the ED were local signs in 178 cases (70.4%), digestive disorders in 13 cases, neurologic manifestations in 18 cases, and respiratory manifestations in 7cases. Adrenergic syndrome was found in 117 cases (46.2%), and cholinergic syndrome in 5 cases (2%). Hypertension was found in 80 patients, 14 of them had already a history of chronic hypertension. Overall, a total of 118 patients (46.6%) had Class I envenoming, 131 patients (51.8%) had Class II envenoming, and 4 patients (1.6%) experienced Class III envenoming. The evolution was favorable in all cases and no death was recorded. However, 42 patients (18.2%) were hospitalized in a medical unit and 4 patients were hospitalized in ICU without needing mechanical ventilation, inotropes or vasoactive drugs. Conclusion Scorpion envenomation is an increasing accident in French Guiana. Symptoms vary from mild to severe and can require ICU admission. Practitioners have to be made aware of severe cases found mainly in children.

We report the assessment and the activities for the first year of our airborne circulatory support mobile unit (CSMU) in the French Caribbean.From January 2010 to June 2011, 12 patients (mean age = 35.7 years; range: 15-62 years; sex ratio = 1:1) were attended outside Martinique by our CSMU and transferred to our unit by air.Eight patients had acute respiratory distress syndrome and were assisted by veno-venous extra corporeal membrane oxygenation (ECMO) four had refractory cardiogenic shock, assisted by extra corporeal life support (ECLS). The average air transfer distance for patients was 912 km (range: 198-1585 km). The average flying time was 124 min (range: 45-255 min). The aircraft used were helicopter, military transport or private jet. The setting-up of assistance devices and transfer of patients was uneventful. One patient subsequently benefited from heart transplantation after long-term circulatory support. One patient died under ECMO support after 51 days of assistance and another died on the 60th day after withdrawal of ECLS.CSMUs can be very efficient in providing support to patients in refractory shock, when remote from a cardiac surgery centre. The airborne transfer of patients on ECMO/ECLS can be achieved safely, even over long distances.

Presented in part as an oral communication at the 10th Journées Nationales d’Infectiologie, Marseille, France, June 10-12, 2009.; International audience; On May 27, 2008, a patient died from rabies at the Cayenne Hospital in French Guiana. Postexposure prophylaxis vaccination was implemented for all health care workers exposed to this patient. Examining the management of such a rare risk reveals important factors in the education of personnel who may have contact with a patient with rabies, to permit appropriate risk assessment and reduce unnecessary postexposure prophylaxis, taking into account the risks and costs of adverse events.

Background Until 2008, human rabies had never been reported in French Guiana. On 28 May 2008, the French National Reference Center for Rabies (Institut Pasteur, Paris) confirmed the rabies diagnosis, based on hemi-nested polymerase chain reaction on skin biopsy and saliva specimens from a Guianan, who had never travelled overseas and died in Cayenne after presenting clinically typical meningoencephalitis. Methodology/Principal Findings Molecular typing of the virus identified a Lyssavirus (Rabies virus species), closely related to those circulating in hematophagous bats (mainly Desmodus rotundus) in Latin America. A multidisciplinary Crisis Unit was activated. Its objectives were to implement an epidemiological investigation and a veterinary survey, to provide control measures and establish a communications program. The origin of the contamination was not formally established, but was probably linked to a bat bite based on the virus type isolated. After confirming exposure of 90 persons, they were vaccinated against rabies: 42 from the case's entourage and 48 healthcare workers. To handle that emergence and the local population's increased demand to be vaccinated, a specific communications program was established using several media: television, newspaper, radio. Conclusion/Significance This episode, occurring in the context of a Department far from continental France, strongly affected the local population, healthcare workers and authorities, and the management team faced intense pressure. This observation confirms that the risk of contracting rabies in French Guiana is real, with consequences for population educational program, control measures, medical diagnosis and post-exposure prophylaxis., Author Summary Until 2008, rabies had never been described within the French Guianan human population. Emergence of the first case in May 2008 in this French Overseas Department represented a public health event that markedly affected the local population, healthcare workers and public health authorities. The antirabies clinic of French Guiana, located at Institut Pasteur de la Guyane, had to reorganize its functioning to handle the dramatically increased demand for vaccination. A rigorous epidemiological investigation and a veterinary study were conducted to identify the contamination source, probably linked to a bat bite, and the exposed population. Communication was a key factor to controlling this episode and changing the local perception of this formerly neglected disease. Because similar clinical cases had previously been described, without having been diagnosed, medical practices must be adapted and the rabies virus should be sought more systematically in similarly presenting cases. Sharing this experience could be useful for other countries that might someday have to manage such an emergence.

International audience; Clin Microbiol Infect ABSTRACT: Atypical Toxoplasma gondii strains, unrelated to archetypal clonal lineages (I, II, III), have been reported more frequently over the last decade in areas other than Europe and North America. A newly described form of toxoplasmosis, 'Amazonian toxoplasmosis' (AT), has been reported since 2002 in French Guiana. It is characterized by severe cases and atypical strains linked to a neotropical forest-based cycle. We report on the cases of AT that required intensive care management. We performed a prospective observational study on hospitalized adults in the Intensive Care Unit (ICU) from 2002 to 2008. Clinical and laboratory data, microbiological findings and outcomes were recorded. Data, including the ICU simplified acute physiology score and the pneumonia severity index, were calculated. Epidemiological risk factors for AT were assessed through questionnaires. Eleven non-immunodeficient patients were admitted to the ICU in Cayenne for life-threatening pneumonia associated with disseminated toxoplasmosis. Mechanical ventilation was necessary in seven patients, four of whom required immediate orotracheal intubation. Cardiac and ophthalmological abnormalities were found in five and four patients, respectively. One patient died from multiple organ failure. The genetic characterization of Toxoplasma DNA using six microsatellite markers revealed unique and atypical genotypes in eight patients. All patients presented epidemiological risk factors for AT. In French Guiana, significant T. gondii-related infectious syndrome associated with the lungs, a high level of LDH activity and the reported risk factors for AT was strongly suggestive of disseminated toxoplasmosis with a possible trend toward life-threatening pneumonia.

Hantaviruses are rodent-borne negative-sense RNA viruses belonging to the Bunyaviridae family, genus Hantavirus. These emerging viruses cause cardiopulmonary syndrome in North and South America, which is a respiratory illness following the inhalation of dust contaminated by infectious rodent feces or urine. Until recently, no information was available related to the presence of hantavirus in French Guyana, a French department in South America. Nevertheless, the description of atypical pneumonia cases unrelated to any known etiological agent and the identification of hantavirus reservoirs in neighboring countries led us to conduct a serological study in a collection of sera from patients who had presented compatible symptoms: the prevalence of IgG antibodies to hantavirus in this population was 1.42%. After those retroactive results, systematic hantavirus serology screening was implemented in every newcoming patient with suggestive etiology. This led us to identify a native case in French Guyana. After this first case, a second case was registered 1 year later in December 2009 (in a periurban area). Molecular analyses were conducted to characterize genetically these two strains of hantavirus. Complete sequences of the S segment were obtained and phylogenetic analyses confirmed that strains isolated in French Guyana and tentatively named Maripa virus belong to the Rio Mamore species. Human hantavirus epidemics are associated with fluctuations of rodent populations, caused by climatic, ecological and environmental changes, or growing human activities associated with nature or agriculture. In Guyana, 90% of the land is still tropical rain forest, but economic development results in growing pressures on natural habitats. Continuous surveillance of the virus in the human population would be beneficial. Furthermore, surveys of potential reservoirs may help to understand hantavirus dispersion and to reduce the risk of viral emergence.

International audience; Why severe Plasmodium falciparum malaria occurs in only a small percentage of patients is unclear. The possibility that specific parasite characteristics contribute to severity has been investigated in French Guiana, a hypoendemic area, where parasite diversity is low and all patients with severe cases are referred to a single intensive care unit. Parasite genotyping in geographically and temporally matched patients with mild and severe disease showed that the association of a specific msp-1 allele (B-K1) with a specific var gene (var-D) was over-represented among patients with severe versus mild disease (47% vs. 3%, respectively; P < .001). Moreover, this genotype combination was consistently observed in the most severe clinical cases. Reverse-transcription polymerase chain reaction demonstrated programmed expression of var-D in vivo, which is consistent with its potential implication in severe disease. These results provide field evidence of an association of severe malaria with specific genetic characteristics of parasites and open the way for intervention strategies targeting key virulence factors of parasites.

International audience; Tonate virus, subtype IIIB of the Venezuelan equine encephalitis (VEE) complex, was first isolated in 1973 in French Guiana, South America. However, very little is known about its pathogenicity; it was considered to be responsible for only mild dengue-like syndromes. In 1998, a 2-month-old boy living along the Oyapock river in French Guiana was hospitalized for fever and generalized status myoclonus, and despite treatment the patient died 72 h after admission. Testing showed the presence of IgM specific for viruses of the VEE complex. A sensitive seminested polymerase chain reaction derived from a previous study was developed to detect viruses from the VEE complex, since no virus could be recovered from clinical specimens cultured on mosquito cells or from intracerebral inoculation into newborn mice. The genome of a virus from the VEE complex was detected in postmortem brain biopsies, and Tonate virus was identified by direct sequencing. This is the first reported case of human encephalitis due to Tonate virus.

The first case of yellow fever in French Guiana since 1902 was reported in March 1998. The yellow fever virus genome was detected in postmortem liver biopsies by seminested polymerase chain reaction. Sequence analysis showed that this strain was most closely related to strains from Brazil and Ecuador.

In 1956, the Brazilian government brought honeybees (Apis mellifera andansonii) from South Africa. A group of these bees crossed the Amazon and reached Venezuela where they have killed between 30 and 50 people in the last 4 years [1]. In 1993, we observed the first case of rhabdomyolysis, hepatic dysfunction and acute renal failure (ARF) following multiple stings by African bees (A. mellifera andansonii) in French Guiana.

International audience; Some of the immunologic mechanisms involved in malaria physiopathology remain unclear. In animals, the spleen seems to play a key role in protecting the host against malaria. However, little is known about the effect of spleen dysfunction on human malaria. We report two severe cases of Plasmodium falciparum infection with unusual clinical and parasitologic features in two splenectomized men living in French Guiana. The peripheral blood of these cases showed hyperparasitemia, with a high proportion of mature parasites and leukocytes with malaria pigment. Despite appropriate treatment and adequate absorption, hyperparasitemia persisted. Parasite clearance was delayed and one patient died. Only the patient who died had the merozoite surface protein 1 allele B-K1 and the varD gene genotype, which is considered to be a probable parasite virulence factor. These uncommon cases differ from most of those described in the literature, illustrating the complexity of the mechanisms underlying the protective function of the spleen in human malaria.

International audience; The genetic characteristics of Plasmodium falciparum isolates collected in French Guiana, where malaria transmission is low and occurs in isolated foci, were studied. Blood samples were collected from 142 patients with symptomatic malaria and typed using a polymerase chain reaction-based strategy for merozoite surface protein-(MSP-1) block 2, the MSP-2 central domain, and glutamate-rich protein (GLURP) repeat domain polymorphism. This showed that the parasite population circulating in French Guiana presented a limited number of allelic forms (4, 2, and 3 for MSP-1 block 2, MSP-1, and GLURP, respectively) and a small number of mixed infections, contrasting with the large genetic diversity of parasite populations and infection complexity reported for Africa, Asia, and other parts of South America. Two groups of isolates displaying identical 3 loci allele combinations were further studied for the Pf332 antigen, histidine-rich protein-1, thrombospondin-related anonymous protein, and Pf60 multigene family polymorphism. Within each group, most isolates were identical for all markers tested. This suggests a high rate of self-fertilization of P. falciparum parasites in French Guiana, resulting in homogenization of the population. The implications of these findings for malaria control in areas of low endemicity are discussed.

Two recent cases of human infection with Tonate virus, one of which was a fatal case of encephalitis, have renewed interest in these viruses in French Guiana. The clinical aspects of confirmed and probable cases of infection with this virus indicate that it has pathogenic properties in humans similar to those of other viruses of the Venezuelan equine encephalitis complex. To determine the prevalence of antibodies to Tonate virus in the various ethnic groups and areas of French Guiana, 3,516 human sera were tested with a hemagglutination inhibition test. Of these, 11.9% were positive for the virus, but significant differences in seroprevalence were found by age, with an increase with age. After adjustment for age, significant differences were found between places of residence. The prevalence of antibody to Tonate virus was higher in savannah areas, especially in the Bas Maroni (odds ratio [OR] = 22.2, 95% confidence interval [CI] = 15.2-32.4) and Bas Oyapock areas (OR = 13.4; 95% CI = 9.8-18.4). The ethnic differences observed in this study were due mainly to differences in place of residence, except that whites were significantly less frequently infected than other ethnic groups. This study indicates that Tonate virus infection is highly prevalent in French Guiana, especially in savannah areas.