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Background American histoplasmosis is a mycosis caused by Histoplasma capsulatum. A variety of clinical features of histoplasmosis have been commonly described ranging from asymptomatic infections to severe pulmonary infections. In immunocompromised individuals, progressive disseminated forms are frequent, leading to fatal outcome if untreated. However, H. capsulatum sinusitis is unusual with a few cases documented over the last three decades and may be underdiagnosed or confused with other fungal aetiologies, especially outside endemic regions. Case presentation In this study, we report an atypical case of Histoplasma capsulatum sinus fungus ball-like in a patient with Acquired Immunodeficiency Syndrome due to Human Immunodeficiency Virus complicated by a disseminated histoplasmosis with a death ending. Diagnosis relied on CT-Scan imaging and on both direct examination of H. capsulatum yeast forms (Gomory methenamine Grocott) in the sinus specimen (aspirate, biopsy) and on positivity of the culture further confirmed by qPCR. Conclusions Since last few decades, among the eight reviewed patients, H. capsulatum sinusitis occurred mostly in HIV-immunocompromised patients and for three cases as a sinusitis with disseminated histoplasmosis. Even if this is a rare clinical presentation, its diagnosis is crucial as it could represent an early expression of an Histoplasma capsulatum exposure that can evolve into a disseminated fatal infection when immunity decreases.

Anti-leishmaniasis drug resistance is a common problem worldwide. The aim of this study was to inventory the general in vitro level of sensitivity of Leishmania isolates circulating in French Guiana and to highlight potential in vitro pentamidine-resistant isolates. This sensitivity study was conducted on 36 patient-promastigote isolates for seven drugs (amphotericin B, azithromycin, fluconazole, meglumine antimoniate, miltefosine, paromomycin, and pentamidine) using the Cell Counting Kit-8 viability test. The IC50 values obtained were heterogeneous. One isolate exhibited high IC50 values for almost all drugs tested. Pentamidine, which is the first-line treatment in French Guiana, showed efficacy at very low doses (mean of 0.0038 μg/mL). The concordance of the in vitro pentamidine results with the patients' clinical outcomes was 94% (K = 0.82).

Resume Introduction La paracoccidioidomycose est une infection fongique systemique frequente en Amerique latine. Les atteintes cutanees sont frequentes et habituellement multiples, le plus souvent associees a des lesions de la muqueuse oro-pharyngee. La forme cutanee isolee est rare. Observation Nous rapportons un cas de paracoccidioidomycose cutanee isolee de l’oreille chez un homme immunocompetent de 43 ans. La lesion formait un placard partiellement ulcere du pavillon de l’oreille gauche. L’examen mycologique direct, l’examen anatomopathologique et la PCR permettaient de mettre en evidence, dans la lesion cutanee, des levures identifiees comme Paracoccidioides brasiliensis. Discussion Les localisations a l’oreille de la paracoccidioidomycose peuvent etre confondues avec d’autres pathologies tropicales frequentes en region amazonienne, notamment la leishmaniose, la lepre ou la lobomycose. Le caractere unique de cette localisation cutanee faisait discuter son origine primitive ou secondaire.

Pathogens, which have recently colonized a new host species or new populations of the same host, are interesting models for understanding how populations may evolve in response to novel environments. During its colonization of South America from Africa, Plasmodium falciparum, the main agent of malaria, has been exposed to new conditions in distinctive new human populations (Amerindian and populations of mixed origins) that likely exerted new selective pressures on the parasite's genome. Among the genes that might have experienced strong selective pressures in response to these environmental changes, the eba genes (erythrocyte-binding antigens genes), which are involved in the invasion of the human red blood cells, constitute good candidates. In this study, we analysed, in South America, the polymorphism of three eba genes (eba-140, eba-175, eba-181) and compared it to the polymorphism observed in African populations. The aim was to determine whether these genes faced selective pressures in South America distinct from what they experienced in Africa. Patterns of genetic variability of these genes were compared to the patterns observed at two housekeeping genes (adsl and serca) and 272 SNPs to separate adaptive effects from demographic effects. We show that, conversely to Africa, eba-140 seemed to be under stronger diversifying selection in South America than eba-175. In contrast, eba-181 did not show any sign of departure from neutrality. These changes in the patterns of selection on the eba genes could be the consequence of changes in the host immune response, the host receptor polymorphisms and/or the ability of the parasite to silence or express differentially its invasion proteins. © 2014 John Wiley & Sons Ltd.

Leishmania infantum is the only species occurring in metropolitan France; located in the Mediterranean part of the country, it is responsible for a highly enzootic canine disease, while the human endemicity is low, with about 23 cases yearly reported to the National Reference Centre of Leishmaniases, mainly visceral forms. In French Guyana, five Leishmania species occur in the Amazonian forest, of which L. guyanensis is the predominant species, and L. braziliensis is responsible for the most critical forms. The most frequent clinical feature is cutaneous leishmaniasis, with a mean annual incidence reaching 2 p. 1000, with some inter-annual fluctuations. In Martinique Island, recent studies have confirmed the presence of an ancestral Leishmania species, responsible for small cutaneous lesions, of mild evolution; the life cycle of this species remains unknown. In Guadeloupe Island, a few autochthonous visceral leishmaniasis cases have been reported, needing a prospective study.

Background The two main plasmodial species in French Guiana are Plasmodium vivax and Plasmodium falciparum whose respective prevalence influences the frequency of mixed plasmodial infections. The accuracy of their diagnosis is influenced by the sensitivity of the method used, whereas neither microscopy nor rapid diagnostic tests allow a satisfactory evaluation of mixed plasmodial infections. Methods In the present study, the frequency of mixed infections in different part of French Guiana was determined using real time PCR, a sensitive and specific technique. Results From 400 cases of malaria initially diagnosed by microscopy, real time PCR showed that 10.75 % of the cases were mixed infections. Their prevalence varied considerably between geographical areas. The presence, in equivalent proportions, of the two plasmodial species in eastern French Guiana was associated with a much higher prevalence of mixed plasmodial infections than in western French Guiana, where the majority of the population was Duffy negative and thus resistant to vivax malaria. Conclusion Clinicians must be more vigilant regarding mixed infections in co-endemic P. falciparum/P. vivax areas, in order to deliver optimal care for patients suffering from malaria. This may involve the use of rapid diagnostic tests capable of detecting mixed infections or low density single infections. This is important as French Guiana moves towards malaria elimination.

International audience; Toxoplasma gondii is highly virulent in New World monkeys, but despite numerous outbreaks observed in captive populations there are few reports of molecular characterization of strains. In this article, we describe two outbreaks of toxoplasmosis that occurred in 2001 and 2006 in an outdoor captive breeding colony of squirrel monkeys (Saimiri sciureus) kept by the Institut Pasteur in French Guiana. A microsatellite DNA analysis of the biological samples collected in the 2001 and 2006 outbreaks showed that two different Toxoplasma strains were involved. The 2001 strain exhibited a type II genotype whereas the 2006 strain showed a combination of type I, type III and atypical alleles. Infection could be related to oocysts contaminating water or food, or to ingestion of rats by monkeys. In 2006, a second episode was observed 3 weeks after the first, and was believed to be related to direct contamination by tachyzoites of bronchopulmonary origin from dying monkeys of the first event. During both outbreaks, a total of 50 monkeys died and none recovered spontaneously, confirming the virulence of both type II and non-type II Toxoplasma strains in New World monkeys.

Dengue-malaria co-infection reports are scarce. Of 1,723 consecutive febrile patients in Cayenne Hospital, 238 had dengue (174 early dengue fever cases) and 393 had malaria (371 acute malaria); 17 had both. Diagnosis of 1 of these 2 infections should not rule out testing for the other infection.

Resume En Europe et aux Etats-Unis, la toxoplasmose est une infection benigne sauf en cas d'immunodepression severe ou de passage trans-placentaire au debut de la grossesse. La contamination humaine est liee au cycle domestique de Toxoplasma gondii entre le chat et des animaux destines a la consommation de masse comme le mouton ou le porc. Les souches de toxoplasme sont reparties en seulement 3 lignees clonales ou types I, II et III, avec un type II largement majoritaire dans les infections humaines et animales. Cette vision ,≪ occidentale≫ de la toxoplasmose sur un plan clinique, epidemiologique et de genetique des souches ne doit pas occulter le fait que Toxoplasma gondii est un parasite cosmopolite par excellence. Or, paradoxalement, nous ne savons pas grand-chose sur la toxoplasmose dans des regions aussi vastes et peuplees que I'Amerique du Sud et centrale, I'Afrique et I'Asie ou des specificites cliniques et epidemiologiques associees a des souches particulieres pourraient exister. En Guyane francaise, depuis une dizaine d'annees, des dizaines de cas de toxoplasmose disseminee, menacant le pronostic vital, sont decrites chez des sujets immunocompetents. Ces formes severes, connues Iocalement sous le nom de toxoplasmose ,≪guyanaise≫, remettent en cause la vision ≪occidentale≫ d'une infection toujours benigne chez I'immunocompetent, liee a un cycle domestique du toxoplasme avec seulement 3 souches clonales. En effet, dans le plateau des Guyanes, les souches a I'origine de ces formes severes sont liees au cycle sauvage du toxoplasme dans la foret amazonienne et sont genetiquement atypiques et tres diverses.

Introduction.- Foreword.- Introductive chapter: The context of tropical Medicine.- PUBLIC HEALTH ASPECTS.- Geography and socioeconomics of the tropical areas.- Epidemiology of cancer in the tropical areas.- Management of cancers in countries with limited resources.- Access to Expensive drugs and Ethical considerations.- Precarity, social organization and outcome on cancer management in the tropical areas.- Cancer screening and prevention in the tropical areas.- Pathology and cancer research.- Cancer perception in different cultures of the tropical areas Cross-cultural mediation.- Cancer clinical trials in the tropical area.- BASIC SCIENCE BACKGROUND.- Spectrum of cancers due to micro-organisms (virus, bacteria, parasites).- HIV and cancer scientific background: Epidemiology and mechanism of carcinogenesis of the retrovirus HIV.- HTLV1 and cancer scientific background: Epidemiology and mechanism of carcinogenesis of the retrovirus HTLV1.- Hepatitis virus scientific background : Epidemiology and mechanism of carcinogenesis of the virus HBV.- Hepatitis virus scientific background : Epidemiology and mechanism of carcinogenesis of the virus HCV.- EBV and cancer scientific background: Epidemiology of EBV and mechanisms of carcinogenesis.- HPV and cancer scientific background: Epidemiology and mechanism of carcinogenesis of the virus HPV.- HHV8 and cancer scientific background: Epidemiology and mechanism of carcinogenesis of the virus HHV8.- Parasites and cancer: Epidemiology and mechanism of carcinogenesis of schitosoma.- Helicobacter and cancer: Epidemiology of Helicobacter Pylori and mechanisms of carcinogenesis.- HEMOPATHIES.- ATL (lymphoma et leukemia).- Extranodal NK/T-cell lymphoma, nasal type.- High-grade lymphomas: Diffuse large B-cells lymphomas (with a special paragraph on CNS lymphomas).- High-grade lymphomas: Burkitt lymphoma Physiopathology and treatment of EBV associated lymphomas.- Mantle cell lymphoma.- Indolent lymphomas, follicular lymphomas, HVC associated marginal zone B-cell lymphomas and Waldenstrom disease.- Chronic myeloproliferative syndroms.- Myelodysplasic syndroms.- Acute leukemias.- CANCERS.- Breast cancer.- Cervix cancer.- Oesophageal cancer.- Gastric cancer.- Colorectal cancer.- Hepatocarcinoma.- Cholangiocarcinoma.- Pancreas cancer.- Lung cancer.- Head and neck cancers.- Bladder cancer.- Prostate cancer.- Renal cancer.- Cutaneous cancers (including melanoma).- Ovarian cancer.- Endometrial cancer.- Cancer of the penis, anus and vulva.- Gestational trophoblastic tumors.- CNS tumors.- Thyroid cancer.- Uncommon cancers.- CANCER TREATMENT IN TROPICAL AREAS.- Pediatric oncology.- Geriatric oncology.- Surgery.- Radiotherapy.- Medical treatments (chemotherapy, hormone therapy, targeted drugs).- HIV and cancer treatments.- Supportive cares.- Palliative cares.

Histoplasmosis due to Histoplasma capsulatum var capsulatum is a frequent systemic fungal infection in the Americas. Diagnostic and therapeutic options differ between North and South America. Disseminated histoplasmosis is an AIDS-defining infection. Prognostic factors of potentially severe presentations must be evaluated in order to facilitate the initial therapeutic choice.Patients with HIV with disseminated infections presenting with severe pulmonary and renal impairment have a poor prognosis. Cutaneous presentations are more frequent in HIV patients in South America than in North America. A murine model has shown that South American isolates have a greater virulence that North American isolates. These differences are due in part to diagnostic delays in resource-poor countries.Direct examination of May-Grünwald-Giemsa-stained smears or tissues in suspected histoplasmosis is a simple means of confirming the diagnosis in resource-poor settings. Studies of prognostic factors should further refine indication criteria to guide first-line treatment choice between amphotericin B and itraconazole. The association of tuberculosis and histoplasmosis is frequent in HIV patients and presents diagnostic and therapeutic challenges that may be difficult to resolve in resource-poor settings. It is important that affordable generic drugs for treating histoplasmosis be made widely available in resource-poor countries.

At least 13 characterizedLeishmaniaspecies are known to infect humans in South America. Five of these parasites are transmitted in the sylvatic ecotopes of the whole French Guianan territory and responsible for cutaneous leishmaniasis. For the diagnosis of cutaneous leishmaniasis, restriction fragment length polymorphism (RFLP) analyses have shown promising results. Thus, the end of the small subunit and internal transcribed spacer 1 of the rRNA genes were sequenced and targeted by PCR-RFLP analysis in the 10 main New World (NW)Leishmaniaspecies from the two subgenera. Then, the procedure was tested on 40 samples from patients with cutaneous leishmaniasis, and its results were compared with those of conventional methods. (i) The results of this simple genus-specific method were in agreement with those of previous isoenzyme analyses. (ii) This method distinguished the most medically relevantLeishmaniaspecies with only one enzyme (RsaI). (iii) This method could be performed directly on human biopsy specimens (sensitivity of 85.7%). Performing NWLeishmaniaspecies typing rapidly and easily in the field constitutes a very valuable improvement for detection ofLeishmaniaspp. Revealing great diversity with several enzymes, this method could also be useful for taxonomic, ecological, and epidemiological studies in space and time.

Resume En Guyane, 3500 a 4500 acces palustres sont denombres chaque annee. Dans 90 % des cas, les contaminations proviennent des deux grands foyers d'endemie situes le long des fleuves frontaliers : le Maroni a l'ouest (frontiere avec le Surinam) et l'Oyapock a l'est (frontiere avec le Bresil). Plasmodium falciparum predomine largement le long du Maroni, particulierement en « pays Noir Marron(∼ 90 %). Dans le foyer de l'Oyapock, P. vivax est largement implique. P. malariae est plus rare. Une recrudescence touchant avant tout des immigres bresiliens adultes est notee depuis la fin 2001 particulierement dans l'est du departement avec des repercussions dans les zones du littoral a proximite de Cayenne. Elle est liee en grande partie aux activites d'orpaillage. Les moyens disponibles dans ce departement francais rendent compte, malgre des caracteristiques epidemiologiques defavorables (regions d'acces difficile, deplacements continuels et difficilement previsibles des populations, preponderance de P. falciparum, forte chimioresistance…), de la relative rarete des formes graves. Celles-ci se traduisent par des defaillances multiviscerales. Anopheles darlingi constitute depuis toujours le principal vecteur. Le diagnostic repose dans les laboratoires, hospitaliers ou prives, sur la visualisation du Plasmodium sur frottis et/ou goutte epaisse et par les tests de diagnostic rapide dans les cas ou un diagnostic microscopique fiable ne peut etre porte sans retard. Dans ces cas, un controle parasitologique est toujours realise. Le diagnostic presomptif sur les seuls arguments epidemiologiques et cliniques ne doit etre qu'exceptionnel.

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

This study includes malaria cases diagnosed by the Parasitology Unit of the Cayenne Hospital (French Guiana) using the same procedure from 1996 to 2003. We provide data for two main rural communities in slightly inland areas of eastern French Guiana (Cacao, Regina) and for Cayenne, the capital of this French department. The frequency of bouts of malaria has been increasing rapidly since mid-2001, in these regions that were virtually considered to be malaria-free. This substantial increase of malaria appears mainly to involve Plasmodium vivax and recent Brazilian immigrants. Other plausible explanations which could account for the observed trend are discussed.

Summary Background Few data are available on cutaneous leishmaniasis caused by dermotropic species in human immunodeficiency virus (HIV)-infected patients. Objectives To describe nine cases of cutaneous leishmaniasis in HIV+ patients and to compare their clinical features and their response to treatment with those of HIV– patients with the forms of leishmaniasis commonly found in French Guiana. Methods A case–control study was carried out between July 1994 and December 2000 in French Guiana. We compared the following variables in nine HIV-infected patients with leishmaniasis and 27 matched controls: clinical type of leishmaniasis, number of lesions, presence of lymphangitis and adenopathy, the rate of recovery after treatment, and recurrence or reinfection. Results Eight of the HIV-infected patients had localized cutaneous leishmaniasis and one had mucocutaneous leishmaniasis. All of the controls had localized cutaneous leishmaniasis. Leishmania guyanensis was the only species isolated from HIV-infected subjects. HIV–Leishmania coinfected patients had a higher rate of recurrence or reinfection (P 200 CD4+ T cells mm−3) is characterized by a higher rate of recurrence or reinfection and is more difficult to treat than that in HIV– subjects.

Purpose: To report nine cases of external ophthalmomyiasis caused by Dermatobia hominis. Methods: Retrospective, non-comparative, interventional case series. Participants consisted of patients (n = 9) presenting at Cayenne Hospital between 1968 and 2003. The location and number of larvae, the larval stage, and the medical and surgical procedures applied were studied in each case. Results: Seven patients had palpebral myiasis (including one with three larvae) and two had conjunctival myiasis. Every patient had palpebral oedema. The larval respiratory pore was located on the palpebral skin or free margin or on the conjunctiva. Movements were present within the lesion in at least three patients. Petroleum ointment or ivermectine solution was used in at least four patients to smother or kill the larvae. Extraction under local anaesthesia was possible in six patients, while three required general anaesthesia. Conclusion: Several larvae may be present in a patient. Topical ivermectine may help to kill the larvae before extraction is attempted.

We aimed to identify prognostic factors for AIDS-associated disseminated histoplasmosis. In a multivariate analysis, we found that dyspnea, a platelet count of100,000 platelets/mm3, and lactate dehydrogenase levels of2 times the upper limit of the normal range were significantly independently associated with the death of the patient during the first 30 days of antifungal treatment.

A serologic survey for Toxoplasma gondii in 18 free-ranging forest mammal species (n = 456) in French Guiana was undertaken with a direct agglutination test. Serum antibody prevalence varied from 0-71%. The relationships between ecologic features of the species and seroprevalence were investigated. Terrestrial mammals were significantly more exposed to T. gondii than other mammals. This result is concordant with oral exposure to T. gondii related to ground dwelling behavior and/or carnivory.

Histoplasmosis is an endemic fungal infection that causes no symptoms or minor self-limited illnesses in most cases. Severe forms are commonly reported in patients with immunodeficiency disorders; histoplasmosis is considered to be an opportunistic infection in patients with AIDS. We report a case of disseminated histoplasmosis in a patient with no induced active suppression of the immune response. The infection was fulminant, and antifungal treatment was delayed because of a misdiagnosis of tuberculosis.

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

Background Oral or cutaneous acquired immunodeficiency syndrome (AIDS)-related histoplasmosis is a rare presentation of disseminated histoplasmosis. Objective To describe this clinical presentation and to compare it with other forms of AIDS-related disseminated histoplasmosis. Methods A cross-sectional study of patients with AIDS-related disseminated histoplasmosis was performed. CD4 counts and survival were compared between patients with oral or cutaneous histoplasmosis and patients with nonmucocutaneous disseminated histoplasmosis. Results The mean CD4 lymphocyte count was lower in patients with mucocutaneous lesions than in patients with nonmucocutaneous disseminated histoplasmosis (29 vs. 72/mm3, P = 0.002). The proportion of survivors 1 month after diagnosis did not differ significantly between the two groups (13/21 vs. 32/45, P = 0.4). At 6 months, the proportion of survivors was significantly lower for patients with mucocutaneous lesions (6/21 vs. 22/39, P = 0.03). Conclusions These results suggest that mucocutaneous lesions occur at a later stage of human immunodeficiency virus infection, but are not, in themselves, associated with a higher level of mortality. The excess mortality at 6 months reflects deaths from other complications of severe immunodepression. This study confirms the polymorphism of mucocutaneous lesions, emphasizing the need for systematic testing for Histoplasma in all cases of mucocutaneous lesions in AIDS patients.

Introduction Malgre sa reputation de benignite, l’infection a Plasmodium vivax presente parfois des criteres de gravite. Ces formes graves d’infection sont peu decrites, notamment en Amerique latine. Le critere de gravite le plus souvent retrouve est l’anemie profonde. Les objectifs de notre etude etaient de determiner la frequence de l’anemie profonde au cours d’infection a P. vivax et de mettre en evidence leurs caracteristiques sociologiques, cliniques et biologiques. Materiels et methodes Etude observationnelle, retrospective, monocentrique, cas–temoin appariee realisee de 2007 a 2014 a Cayenne. Etaient inclus tous les patients avec un frottis-goutte epaisse positif a P. vivax (sans co-infection avec P. falciparum) et une hemoglobine 12 g/dL et apparie sur la date du diagnostic. Ces deux groupes ont ete compares en analyse univariee puis multivariee. Resultats Parmi les 1542 patients avec acces palustre a P. vivax sur la periode 8 ans, 27 presentaient une anemie profonde, soit 1,75 % des acces palustres a P. vivax et mediane 1,5 cas par an (min.–max. 1–12 ; Q25–Q75 1–3). Les variables significativement associees a l’anemie profonde au cours d’un acces palustre a P. vivax en analyse bivariee etaient : l’âge 38 °C, la duree entre l’apparition de la fievre et le diagnostic de paludisme > 7 jours, la presence de saignements exteriorises, la presence d’autres signes de gravite (selon les criteres d’infection grave a P. falciparum de la SPILF 2008), et au bilan biologique, une microcytose, une lymphopenie 100 G/L, une creatinine > 110 μM, une glycemie 23 mM. En analyse multivariee, les variables associees a l’anemie profonde etaient l’âge 100 G/L et une microcytose Conclusion L’anemie severe reste un phenomene rare au cours de l’acces a P. vivax. Deux hypotheses peuvent etre formulees concernant la survenue d’anemie profonde au cours des acces a P. vivax : survenue d’acces palustres simples chez des patients avec terrain predispose a l’anemie (grossesse, enfants carences des communes isolees) et existence de forme graves de P. vivax comme on le retrouve au cours des acces a P. falciparum, associee alors a d’autres signes de gravite tels que definis par l’OMS.

Diaporthe phaseolorum (syn. Phomopsis phaseoli) is a frequent fungal parasite of plants, present on all continents around the world. It has rarely been involved in human diseases. We report a case of eumycetoma with osteomyelitis of the forefoot caused by this fungus and diagnosed by molecular biology. The patient had positive HTLV-1 serology and was a farmer from French Guiana who walked barefoot. He was successfully treated with long-term oral itraconazole (400 mg/day). A review of the literature underlines the essential roles of plants and host immunosuppression in this infection and the favourable outcome with a triazole antifungal treatment.

Background Histoplasmosis is an endemic fungal infection in French Guiana. It is the most common AIDS-defining illness and the leading cause of AIDS-related deaths. Diagnosis is difficult, but in the past 2 decades, it has improved in this French overseas territory which offers an interesting model of Amazonian pathogen ecology. The objectives of the present study were to describe the temporal trends of incidence and mortality indicators for HIV-associated histoplasmosis in French Guiana. Methods A retrospective study was conducted to describe early mortality rates observed in persons diagnosed with incident cases of HIV-associated Histoplasma capsulatum var. capsulatum histoplasmosis admitted in one of the three main hospitals in French Guiana between 1992 and 2011. Early mortality was defined by death occurring within 30 days after antifungal treatment initiation. Data were collected on standardized case report forms and analysed using standard statistical methods. Results There were 124 deaths (45.3%) and 46 early deaths (16.8%) among 274 patients. Three time periods of particular interest were identified: 1992–1997, 1998–2004 and 2005–2011. The two main temporal trends were: the proportion of early deaths among annual incident histoplasmosis cases significantly declined four fold (χ2, p, Author Summary Histoplasmosis is an endemic fungal infection in French Guiana. It is the most common AIDS-defining illness and the leading cause of AIDS-related deaths. Diagnosis is difficult, but in the past 2 decades, it has improved. The objectives of the present study were to describe the temporal trends of incidence and mortality indicators for HIV-associated histoplasmosis in French Guiana. A retrospective study was conducted to describe early mortality rates observed in persons diagnosed with incident cases of HIV-associated histoplasmosis admitted in one of the three main hospitals of French Guiana between 1992 and 2011. Early mortality was defined by death occurring within 30 days after antifungal treatment initiation. Data were collected on standardized case report forms and analysed using standard statistical methods. Among 274 patients there were 46 early deaths (16.8%). The two main temporal trends were: the proportion of early deaths significantly divided four fold and the number of annual incident histoplasmosis cases increased three fold. The present example testifies that rapid progress could be at reach if awareness increases and leads to clinical and laboratory capacity building in order to diagnose and treat this curable disease.

In French Guiana, leishmaniasis is an essentially cutaneous infection. It constitutes a major public health problem, with a real incidence of 0.2 to 0.3%. Leishmania guyanensis is the causal species most frequently encountered in French Guiana. The treatment of leishmaniasis is essentially drug based, but the therapeutic compounds available have major side effects (e.g., liver damage and diabetes) and must be administered parenterally or are costly. The efficacy of some of these agents has declined due to the emergence of resistance in certain strains of Leishmania . There is currently no vaccine against leishmaniasis, and it is therefore both necessary and urgent to identify new compounds effective against Leishmania . The search for new drugs requires effective tests for evaluations of the leishmanicidal activity of a particular molecule or extract. Microculture tetrazolium assays (MTAs) are colorimetric tests based on the use of tetrazolium salts. We compared the efficacies of three tetrazolium salts—3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), 2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2 H -tetrazolium-5-carboxanilide (XTT), and 2-(2-methoxy-4-nitrophenyl)-3-(4-nitrophenyl)-5-(2,4-disulfophenyl)-2 H -tetrazolium (WST-8)—for quantification of the promastigotes of various species of Leishmania . We found that the capacity of Leishmania to metabolize a tetrazolium salt depended on the salt used and the species of Leishmania . WST-8 was the tetrazolium salt best metabolized by L. guyanensis and gave the best sensitivity.

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.

International audience; In disease-endemic areas, histoplasmosis is the main differential diagnosis for tuberculosis among human immunodeficiency virus (HIV)-infected patients. However, no study has compared the two diseases. Thus, the objective of this study was to compare tuberculosis and histoplasmosis in HIV-infected patients. A population of 205 HIV-infected patients (99 with tuberculosis and 106 with histoplasmosis) hospitalized in Cayenne, French Guiana during January 1, 1997-December 31, 2008 were selected retrospectively from the French Hospital Database on HIV. Multivariate analysis showed that tuberculosis was associated with cough (adjusted odds ratio [AOR] = 0.20, 95% confidence interval [CI] = 0.05-0.73) and a C-reactive protein level > 70 mg/L (AOR = 0.98, 95% CI = 0.97-0.99). Variables associated with disseminated histoplasmosis were a γ-glutamyl transferase level > 72 IU/L (AOR = 4.99, 95% CI = 1.31-18.99), origin from French Guiana (AOR = 5.20, 95% CI = 1.30-20.73), disseminated localization (AOR = 6.40, 95% CI = 1.44-28.45), a concomitant opportunistic infection (AOR = 6.71, 95% CI = 1.50-29.96), a neutrophil count < 2,750 cells/mm(3) (AOR = 10.54, 95% CI = 2.83-39.24), a CD4 cell count < 60 cells/mm(3) (AOR = 11.62, 95% CI = 2.30-58.63), and a platelet count < 150,000/mm(3) (AOR = 19.20, 95% CI = 3.35-110.14). Tuberculosis and histoplasmosis have similarities, but some factors show a greater association with one of these diseases. Thus, adapted therapeutic choices can be made by using simple clinical and paraclinical criteria.

International audience; Human immunodeficiency virus (HIV)-associated disseminated Histoplasma capsulatum capsulatum infection often mimics tuberculosis. This disease is well know in the United States but is dramatically underdiagnosed in Central and South America. In the Amazon region, given the available incidence data and the regional HIV prevalence, it is expected that, every year, 1,500 cases of histoplasmosis affect HIV patients in that region alone. Given the mortality in undiagnosed patients, at least 600 patients would be expected to die from an undiagnosed but treatable disease. The lack of a simple diagnostic tool and the lack of awareness by clinicians spiral in a vicious cycle and made a major problem invisible for 30 years. The HIV/acquired immunodeficiency syndrome community should tackle this problem now to prevent numerous avoidable deaths from HIV-associated histoplasmosis in the region and elsewhere.

The cure 'rates' achieved using intramuscular pentamidine isethionate (two injections of 4 mg/kg separated by an interval of 48 h) were investigated in French Guiana, in 198 consecutive patients with cutaneous leishmaniasis caused by Leishmania braziliensis guyanensis. One aim was to see if initial clinical presentation could be used to predict treatment failure. The cure rate after one course of pentamidine isethionate was 87% and almost all (80%) of the treatment failures responded to an identical second course. Although many of the patients complained of adverse effects, most commonly of pain at the injection site (54%), none of these effects was severe. Although frequently associated with discomfort, the two-injection course, giving a total of 8 mg pentamidine isethionate/kg, appears to be an effective treatment for cutaneous leishmaniasis in French Guiana. The observation of satellite papules on presentation was associated with a significantly increased risk of failure of the first course of treatment (P = 0.01), with an odds ratio (and 95% confidence interval) estimated at 3.5 (1.3-11.1), after adjusting for other clinical presentations and lesion size and number. The presence of satellite papules perhaps indicates that the patient's immune system is unable to control the progression of the parasite. Patients with more than three lesions were also less likely to be cured after one course of pentamidine than those with fewer lesions (P = 0.01).

Among over 40 mammal species threatened by the filling of a hydroelectric dam reservoir in French Guiana, three species of primates have been translocated, comprising 124 red howler monkeys, six white-faced sakis, and 95 golden-handed tamarins. Health status of the animals was evaluated by direct physical examination and by hematological, biochemical, virological, and parasitological surveys of collected blood. The physical condition of the howlers was slightly worse toward the end of the capture period, but that of sakis and tamarins remained satisfactory. Several ectoparasites (ticks, larvae of dipterous insects, fleas, and lice) were collected, and various wounds, apparently nondebilitating, were recorded in howlers. Hematological and biochemical profiles determined for the three species revealed a slight anemia in howlers. Entamoeba, Strongyloides, and Trypanoxyurus were common in fecal samples of howlers. A survey of blood smears from the three species revealed infection by several types of microfilaria, Trypanosoma rangeli-like and Plasmodium brasilianum in all three, and Trypanosoma cruzi-like in howlers. These infections had no significant impact on the health status or the hematological profiles. Serologic investigations revealed occasional reactions against Toxoplasma gondii, a strong anti-Plasmodium response in the two Cebidae species, and a weaker one in tamarins. Attempts to isolate arbovirus failed, but antibody responses to Mayaro and yellow fever viruses were strong, especially in the howlers. A strong correlation between age and serological status led to a better understanding of the epidemic cycles. Our survey indicates French Guianan primates are reservoirs for several anthropozoonoses, including malaria, Chagas disease, and arboviruses.

In South America, disseminated histoplasmosis due to Histoplasma capsulatum var. capsulatum (H. capsulatum), is a severe and frequent opportunistic infection in AIDS patients. In areas outside the USA where specific-Histoplasma antigen detection is not available, the diagnosis is difficult. With the galactomannan antigen (GM) detection, a test commonly used for invasive aspergillosis diagnosis, there is a cross-reactivity with H. capsulatum that can be helpful for the diagnosis of histoplasmosis. The aim of this study was to evaluate the GM detection for the diagnosis of disseminated histoplasmosis in AIDS patients. The performance of the GM detection was evaluated with serum collected in French Guiana where H. capsulatum is highly endemic. Sera from AIDS patients with disseminated histoplasmosis occurring from 2002 to 2009 and from control HIV-positive patients without histoplasmosis were tested with the GM detection and Histoplasma-specific antibody detection (IEP). In 39 AIDS patients with proven disseminated histoplasmosis, the sensitivity of the Histoplasma IEP was only 35.9% and was linked to the TCD4+ lymphocyte level. For the GM detection, the sensitivity (Se) was 76.9% and specificity (Sp) was 100% with the recommended threshold for aspergillosis diagnosis (0.5). The test was more efficient with a threshold of 0.4 (Se: 0.82 [95% CI: 0.66-0.92], Sp: 1.00 [95% CI: 0.86-1.00], LR+: >10, LR-: 0.18). This study confirms that the GM detection can be a surrogate marker for the diagnosis of disseminated histoplasmosis in AIDS patients in endemic areas where Histoplasma EIA is not available.

Objective To determine whether dengue epidemics are associated with an increase in adverse obstetrical outcomes. Methods Semi-ecological study combining individual data on obstetrical events from the perinatal registry and aggregated exposure data from the epidemiologic surveillance of dengue in Cayenne, French Guiana between 2004 and 2007. Results After adjustment for individual risk factors, analysis showed that an epidemic level of dengue transmission during the first trimester was associated with an increased risk of post-partum haemorrhage and preterm birth. The associated risks seemed to depend on the epidemic level. Conclusions Despite its limitations, this study suggests that dengue in the first trimester may be related to preterm birth and to post-partum bleeding, thus leading to specific hypotheses that should be tested in prospective studies. Objectif Determiner si les epidemies de dengue sont associees a une augmentation des resultats obstetricaux adverses. Methodes Etude semi-ecologique combinant les donnees individuelles sur les evenements obstetricaux du registre perinatal et les donnees d'exposition cumulees, provenant de la surveillance epidemiologique de la dengue a Cayenne, en Guyane francaise entre 2004 et 2007. Resultats Apres ajustement pour les facteurs de risque individuels, l'analyse a montre qu'un niveau epidemique de transmission de la dengue au cours du premier trimestre etait associe a un risque accru d'hemorragie postpartum et de prematurite. Les risques associes semblaient dependre de l'ampleur de l’epidemie. Conclusions Malgre ses limitations, la presente etude suggere que la dengue au cours du premier trimestre peut etre liee a la prematurite et a des saignements postpartum, ce qui conduit a des hypotheses specifiques qui devraient etre testees dans des etudes prospectives. Objetivo Determinar si las epidemias de dengue estan asociadas con un aumento en los resultados obstetricos adversos. Metodos Estudio semiecologico que combina datos individuales sobre eventos obstetricos desde el registro perinatal y datos agregados de exposicion de la vigilancia epidemiologica del dengue en Cayenne, Guayana Francesa entre 2004 y 2007. Resultados Despues de ajustar para factores de riesgo individuales, el analisis mostro que un nivel epidemico de transmision de dengue durante el primer trimestre estaba asociado con un aumento en el riesgo de hemorragias posparto y nacimientos prematuros. El riesgo asociado parece depender del nivel epidemico. Conclusiones A pesar de sus limitaciones, este estudio sugiere que el dengue, en el primer trimestre, podria estar relacionado con el nacimiento prematuro y el sangrado postparto, conllevando a la hipotesis especifica de que deberia evaluarse en estudios prospectivos.

International audience; Histoplasmosis is the first cause of acquired immunodeficiency syndrome (AIDS) and AIDS-related deaths in French Guiana. Cohort data were used to determine whether primary prophylaxis with 100 mg itraconazole for patients with CD4 counts < 150/mm(3) was cost-effective with different scenarios. For a scenario where 12% of patients died, 60% were aware of their human immunodeficiency virus (HIV) infection and adherence was only 50%, primary prophylaxis would prevent 1 death and 9 cases of histoplasmosis for a cost of 36,792 Euros per averted death, 1,533 per life-year saved, 4,415 Euros per averted case, when only counting the costs of itraconazole prophylaxis. Taking into account the total costs of hospitalization showed that primary prophylaxis would allow a savings of 185,178 Euros per year. Even in a scenario of low adherence, primary prophylaxis would be cost-effective in French Guiana, and presumably in the rest of the Guianas and the Amazon.