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Background During the COVID-19 pandemic, national and local measures were implemented on the island of Mayotte, a French overseas department in the Indian Ocean with critical socioeconomic and health indicators. Aim We aimed to describe the COVID-19 outbreak in Mayotte from March 2020 to March 2021, with two waves from 9 March to 31 December 2020 and from 1 January to 14 March 2021, linked to Beta (20H/501Y.V2) variant. Methods To understand and assess the dynamic and the severity of the COVID-19 outbreak in Mayotte, surveillance and investigation/contact tracing systems were set up including virological, epidemiological, hospitalisation and mortality indicators. Results In total, 18,131 cases were laboratory confirmed, with PCR or RAT. During the first wave, incidence rate (IR) peaked in week 19 2020 (133/100,000). New hospitalisations peaked in week 20 (54 patients, including seven to ICU). Testing rate increased tenfold during the second wave. Between mid-December 2020 and mid-January 2021, IR doubled (851/100,000 in week 5 2021) and positivity rate tripled (28% in week 6 2021). SARS-CoV-2 Beta variant (Pangolin B.1.351) was detected in more than 80% of positive samples. Hospital admissions peaked in week 6 2021 with 225 patients, including 30 to ICU. Conclusion This massive second wave could be linked to the high transmissibility of the Beta variant. The increase in the number of cases has naturally led to a higher number of severe cases and an overburdening of the hospital. This study shows the value of a real-time epidemiological surveillance for better understanding crisis situations.

Severe hemolytic anemia is a rare complication of glucose-6-phosphate dehydrogenase (G6PD) deficiency. It occurs with the Mediterranean (Med) variant corresponding to a class 2 deficiency according to the World Health Organization (WHO) classification, and it correlates with a severe deficiency in G6PD activity. In Mayotte, the majority of patients have the African (A-) variant as a WHO class 3 deficiency. Yet we have observed numerous cases of severe hemolytic anemia defined by a hemoglobin level of6 g/dL. In this study, we aimed to describe the epidemiological, clinical, and biological features as well as the treatment modalities of children presenting with a severe hemolytic crisis secondary to G6PD deficiency in Mayotte. The secondary objective was to study the disease genotype when this information was available. Between April 2013 and September 2020, 73 children presented with severe anemia because of G6PD deficiency in Mayotte. The median hemoglobin level during the hemolytic crises was 3.9 g/dL. All of the patients underwent a transfusion and hospitalization. Twenty patients had a disease genotype: 11 had the African mutation and 9 had the Med mutation. Although they are among the most common triggers of G6PD acute hemolytic anemia, drugs were found to not be present and fava bean ingestion was found in only 1 child. One of the specific triggers was traditional medicine, including Acalypha indica . Severe hemolytic crisis in children because of G6PD deficiency is a frequent occurrence in Mayotte. The patients had severe disease symptoms, but the severity did not correlate with the genotype: the African (A-) variant and the Med variant resulted in the same level of disease severity.

In February 2021, an explosion of cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia overwhelmed the only hospital in Mayotte. To report a case series of patients with acute respiratory failure (ARF) due to SARS-CoV-2 who were evacuated by air from Mayotte to Reunion Island.This retrospective observational study evaluated all consecutive patients with ARF due to SARS-CoV-2 who were evacuated by air from Mayotte Hospital to the intensive care unit (ICU) of Félix Guyon University Hospital in Reunion Island between February 2, and March 5, 2021.A total of 43 patients with SARS-CoV-2 pneumonia were evacuated by air, for a total flight time of 2 hours and a total travel time of 6 hours. Of these, 38 patients (88.4%) with a median age of 55 (46-65) years presented with ARF and were hospitalized in our ICU. Fifteen patients were screened for the SARS-CoV-2 501Y.V2 variant, all of whom tested positive. Thirteen patients (34.2%) developed an episode of severe hypoxemia during air transport, and the median paO2/FiO2 ratio was lower on ICU admission (140 [102-192] mmHg) than on departure (165 [150-200], P = .022). Factors associated with severe hypoxemia during air transport was lack of treatment with curare (P = .012) and lack of invasive mechanical ventilation (P = .003). Nine patients (23.7%) received veno-venous extracorporeal membrane oxygenation support in our ICU. Seven deaths (18.4%) occurred in hospital.Emergency air evacuation of patients with ARF due to SARS-CoV-2 was associated with severe hypoxemia but remained feasible. In cases of ARF due to SARS-CoV-2 requiring emergency air evacuation, sedated patients receiving invasive mechanical ventilation and curare should be prioritized over nonintubated patients. It is noteworthy that patients with SARS-CoV-2 pneumonia related to the 501Y.V2 variant were very severe despite their young age.

In march 2020, a pandemic of respiratory infection due to the SARS-CoV2 is underway, dengue fever epidemics are at the same time present in many regions of the inter-equatorial zone. We report the first cases of covid19-dengue co-infection, which occurred in Mayotte, a French island in the Indian Ocean.

Stingray injuries to the chest are rare but potentially life-threatening. They may occur in remote areas where advanced emergency healthcare services are unavailable. We describe the case of a 24-year-old man with tension pneumothorax due to a Himantura fai stingray injury to the left chest. The chest wound was unremarkable, with no external bleeding or evidence of a foreign body. Decompression was performed at the scene with an improvised knife procedure and a hollow writing pen, which served as a chest tube. At the local hospital, a standard-sized chest tube was inserted, the wound cleaned, and the patient given antibiotics active against marine organisms. Computed tomography visualized the stinger and revealed hemopneumothorax and pneumomediastinum. The local hospital did not have a thoracic surgeon, and the patient was transferred to a larger hospital with a thoracic surgery center. After surgical removal of the stinger, segmental lung resection was required to control bleeding. Management of life-threatening stingray injuries to the chest should begin at the scene. After stabilization, the patient should be transferred to a hospital equipped for cardiovascular and thoracic surgery. Surgery may be required to remove the retroserrated stinger and can be challenging.

Resume L’angiostrongylose humaine ou angiostrongylose nerveuse est une maladie parasitaire rare liee a un nematode, Angiostrongylus cantonensis. L’homme est un hote accidentel et developpe une pathologie neurologique a type de meningite et/ou encephalite a eosinophiles d’evolution souvent favorable chez l’adulte mais parfois tres severe chez l‘enfant. Le diagnostic repose sur l’association de signes neurologiques avec une hypereosinophilie dans le LCR chez un individu vivant ou revenant d’une zone d’endemie. Le diagnostic microbiologique n’est pas toujours possible, et repose sur la serologie dans le sang voire dans le LCR, ou la sensibilite est meilleure, mais aussi sur la PCR dans le LCR disponible depuis quelques annees. Le traitement est mal codifie, et les formes severes justifient l’association d’une corticotherapie et d’albendazole. Si la maladie est cosmopolite dans les regions intertropicales, elle est particulierement frequente en Chine, a Taiwan, en Thailande et dans les iles du Pacifique. On l’a retrouve egalement de facon eparse dans des iles de l’Ocean Indien, mais aussi en Jamaique et au Bresil. Le mode de transmission est variable d’un lieu a l’autre. En Chine, en Thailande et dans l’Ocean Pacifique, la contamination se fait souvent via la consommation de crustaces mal cuits. Dans l’Ocean Indien, a Taiwan, au Bresil et a Hawai, le principal mode de contamination est l’ingestion par contact direct ou indirect de bave de l’escargot geant africain (Achatina fulica) : cette espece consideree comme invasive, est presente dans la plupart des regions intertropicales du globe. Les cliniciens et parasitologues doivent evoquer systematiquement cette etiologie devant un tableau de meningite a eosinophiles chez un patient retournant ou vivant en zone tropicale.

Introduction Human angiostrongyliasis (HA) is a neurological helminthic disease caused by the lung worm Angiostrongylus cantonensis. It is suspected in the combination of travel or a residence in an endemic area and eosinophilic meningitis. In Mayotte, an island in the Indian Ocean, cases are rare but regular. The main objective of our study was to describe the epidemiological and diagnosis clues of HA in Mayotte. The secondary objectives were to evaluate the contribution of Real-Time Polymerase Chain Reaction (RT- PCR) for the diagnosis of HA, delineate the characteristics of the local transmission and ascertain the presence of A. cantonensis in Achatina fulica, the potential vector of the disease. Materials and Methods Between 2007 and 2012, all cases of eosinophilic meningitis were retrospectively included and investigated by RT- PCR in the CSF. Descriptive analysis was conducted for clinical, biological and radiological features, and were analyzed for all patients together with the search for prognostic factors for mortality. Concurrently, geolocalization and temporal parameters were studied to correlate the occurrence of the cases with rainfall seasons and snails were collected to enhance a parasitic carriage with real time PCR. Results During the 6-year period of the study, 14 cases were identified (2.3 cases/year) and 9 among 10 remaining CSF were positive in PCR. Among 14 cases of EM, 13 were less than 2 year-old children. The 1 year mortality rate was 5/14 (35.7%). Among survivors, 3/7 (42.8%) presented neurological sequelae. Factors associated with mortality were dysfunction of cranial nerves, abnormal brain imaging, and CSF glucose level inferior to 2 mmol/l. Occurrence of cases was temporarily and spatially correlated to the rainy season. Among the 64 collected giant snails, 6 (9.4%) were positive with A. cantonensis PCR. The likely main route of transmission was the children licking snails, carriers of the parasite. Conclusion In Mayotte, HA was mainly found in paediatric cases under 2 years old, and evidenced a life-threatening disease. PCR seems to be a promising tool in the definitive diagnosis of HA. Population should be aware of the role of A. fulica, and not let the children have direct contact with the snails., Author Summary Human angiostrongyliasis is a neurological helminthic disease caused by the lung worm Angiostrongylus cantonensis, and most cases are reported from Asia, particularly Thailand and China. In Mayotte, an overseas French Territory in the Indian Ocean, cases are rare but regular, with life-threatening clinical pictures in very young children, though the medical literature describes this disease as mild, even in children. We aimed to study this disease in the specific context of the Indian Ocean. We found that, although this disease is quite rare: 14 cases in a study period of 6 years, with evidence among children, and mainly (13/14) those less than 2 years old, and its prognosis is poor as the 1-year mortality rate was 35.7%, and neurological sequelae 42.7% of the survivors. The real time PCR performed on the CSF was a sensitive tool. The occurrence of cases was temporarily and geographically linked to rain, and 9.4% of the collected Achatina fulica, the giant African snails, were positive for the parasite with high parasitic loads. The specific epidemiology is linked to the bad habit of the young children to lick the snails, which are present everywhere on the island, and have a severe presentation due to the high parasitic load.

Introduction – objectifs L’angiostrongylose nerveuse (AN) est suspectee sur l’association d’un sejour en zone d’endemie et d’une meningite a eosinophiles (ME) +/- encephalite. En 2010 a ete publiee une PCR en temps reel (RT-PCR) pour la recherche d’Angiostrongylus cantonensis (AC) chez l’hote intermediaire. A Mayotte, 9 cas probables d’AN ont ete rapportes entre 1996 (date du 1er cas) et 2006. L’objectif de notre etude etait d’evaluer l’apport de la RT-PCR pour le diagnostic de l’AN et de confirmer la presence d’AC chez le gasteropode Achatina fulica. Materiels et methodes Les cas de ME survenus entre 2007 et 2012 ont ete repertories et des achatines ont ete prelevees dans les communes de residence des patients. AC a ete recherche par RT-PCR dans le LCR des patients et chez les achatines. Resultats Sur 6 ans, 14 cas ont ete identifies (2,3 cas/an) et 9/10 LCR retrouves etaient positifs en PCR alors que la serologie etait positive dans 4/10 cas. Parmi eux, 11/14 etaient des garcons, 13 avaient Conclusion L’AN est une maladie presque exclusivement pediatrique a Mayotte, rare mais avec une letalite tres elevee. La RT-PCR semble un outil performant et prometteur dans le diagnostic de certitude. Pour la 1re fois sur l’ile, la presence d’AC chez l’achatine est confirmee, qui est probablement responsable de l’infection chez le nourrisson par contact direct. Si l’eradication du vecteur est illusoire, une information aupres de la population est indispensable.

Background : Severe hemolytic anemia is a rare complication of Glucose-6 Phosphate dehydrogenase (G6PD) deficit. It is described in Mediterranean variant corresponding to severe G6PD activity deficit according to the WHO classification. In Mayotte, the majority of patients are African variant with moderate deficit activity. Yet we observe a lot of severe hemolytic anemia defined by a hemoglobin rate lower than 6 g/dL. In this study, we aimed to describe the epidemiological, clinical, biological and treatment of children, presenting severe hemolysis crisis secondary to G6PD deficiency in Mayotte. The secondary objective was to study genotype when it was available. Method : A retrospective collection of children with severe hemolytic anemia related to G6PD deficiency hospitalized in Mayotte hospital from April 1st 2013 to September 16th of 2020 was made.Results : 73 children had severe anemia due to G6PD deficit in Mayotte. The median of hemoglobin during hemolysis crisis was 3.9 g/dl. All patients benefited for a transfusion and hospitalization. Twenty patients had a genotype: eleven had African mutation and 9 had a Mediterranean mutation.Discussion : Among the most common triggers of G6PD acute hemolysis anemia, drugs were not present and fava bean ingestion was found in only one child. One of the particular triggers was traditional medicine, including Acalypha Indica.Severe hemolysis crisis of children due to G6PD deficiency is frequent in Mayotte. Patients are more serious, and severity is not correlated with genotype: African (A-) variant and Mediterranean variant have the same gravity.; L'anémie hémolytique est une complication rare chez les patients atteints de déficit en G6PD. Elle est surtout décrite chez les patients porteurs de la mutation Méditerranéenne qui sont décrits par l'OMS comme ayant une activité G6PD sévèrement altérée. A Mayotte, la majorité des patients sont porteurs du variant Africain connu pour avoir une activité G6PD modérée. Nous observons à Mayotte beaucoup d'anémies hémolytiques sévères avec une hémoglobine inférieure à 6g/dL. Dans cette étude nous avons voulu décrire l'épidémiologie, la clinique, la biologie et la prise en charge des enfants présentant une crise hémolytique sévère secondaire à un déficit en G6PD. Le second objectif était d'analyser leur génotype quand il était disponible.Les données de patients ayant présenté une anémie hémolytique sévère entre le 1er Avril 2013 et le 16 septembre 2020 ont été recueillies de manière rétrospective.73 enfants ont présenté une anémie hémolytique sévère durant cette période à Mayotte. La médiane de l'hémoglobine était de 3,9g/dL. Tous les patients ont bénéficié d'une transfusion et d'une hospitalisation. Vingt enfants ont eu un génotype : 11 étaient porteurs de la mutation Africaine et 9 de la mutation Méditerranéenne.Des éléments déclenchant habituellement retrouvés, la prise de médicaments ne faisait pas partie des éléments déclenchant de notre cohorte, et l'ingestion de fèves a été retrouvée chez un seul enfant. La médecine traditionnelle est très présente et l'une des plante souvent utilisées est Acalypha Indica.Les anémies hémolytiques sévères dues au déficit en G6PD sont fréquentes à Mayotte. L'atteinte clinique est sévère mais n'est pas correlée au génotype.