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Biomedical subjects

B Carme

Publications and source records attributed to B Carme.

At least 37 records · Page 2Linked to original sources
PubMed2003

[Perinatal care and mortality in French Guyana. From 1992-1999].

BACKGROUND: The purpose of this study was to describe child deliveries in French Guyana and describe changes in perinatal mortality in different population groups between 1992 and 1999. MATERIAL AND METHODS: All deliveries in health centers and maternity wards in French Guyana between January 1, 1992 and December 31, 1999 were included in the study. Social, demographic, and clinical data were collected at the time of delivery. Infants with a birth weight of 500 g or term 22 weeks were included. RESULTS: From 1992 to 1995, the number of deliveries in health centers declined 5.7% and the number in public maternity wards increased 69.7%. The same trend was observed in 1998 - 1999 (2.4% and 85.7% respectively), an expression of the policy of antenatal referral implemented by the network of childbirth professionals. Perinatal mortality decreased significantly between 1995 and 1998 from 35.4 to 15.2 for the Creole population (p=0.06), from 46 to 16.5 for the Black-Marron Surinam population (p<0.0007), and from 36 to 10.2 for the Black-Marron French population (p<0.009). This drop in mortality in high-risk population groups may have contributed to the overall decline in perinatal mortality observed over the study period. The rate of preterm birth remained stable (at 13.5%) and the proportion of low-weight infants increased only slightly (12.8% to 13.7%). Mortality among preterm infants declined considerably, undoubtedly because of improved neonatal intensive care. CONCLUSION: Despite significant improvement, the perinatal mortality in French Guyana (18.9 in 1999) remains almost three times that in metropolitan France (7.4 in 1999). The mothers are young (17% aged less than 20 years) and the proportion of primiparous and grand multiparous mothers is high. With the absence or insufficiency of prenatal care, the problem of perinatal mortality remains a public health priority and challenge in French Guyana.

Birth Rate↗
PubMed2003

Malaria in Guadeloupe (French West Indies) 1991-2000.

The only islands in the Caribbean that still have endemic malaria are Haiti and the Dominican Republic. Cases of imported malaria occur on the other islands, particularly Martinique and Guadeloupe, due to the movement of people to and from endemic regions that are geographically and/or culturally close. The re-emergence of transmission cannot be ruled out due to the local persistence of the potential vectors, the anopheles mosquitoes. This retrospective study, over a ten year-period (1991-2000), included all of the cases of malaria confirmed by blood tests at Pointe-à-Pitre University Hospital. This hospital is the main healthcare facility in Guadeloupe. Fifty-nine bouts of malaria occurred in 56 patients. The annual incidence was estimated at 2 to 2.5 cases per 100,000 inhabitants. Plasmodium falciparum largely predominated, accounting for over 80% of cases. The only pernicious case observed resulted in the death of the patient. In all cases the patient had recently travelled to an endemic region, except in one case, caused by P ovale which has never been endemic in the Caribbean. African countries accounted for 43% of cases. No Asian or Pacific strains were identified. In all cases, anti-malarial drugs were not taken, taken incorrectly or were inappropriate. All of the cases of malaria reported in Guadeloupe in the last decade were imported and this region cannot be considered to be at risk of malaria infection. However, long-term epidemiological monitoring is necessary, together with specific entomological monitoring.

Adolescent↗
PubMed2002

Intestinal parasitoses among Wayampi Indians from French Guiana.

Intestinal parasitism and its epidemiological characteristics were studied in an isolated Amerindian population from Upper Oyapock (French Guiana) that has retained its traditional social and cultural specificities. This population consisted of 138 Wayampi Indians, 68 adults and 70 children (below the age of 15 years), with a sex ratio (M/F) of 0.86, spread over the four villages of the community of Trois Sauts, corresponding to more than two thirds of the population recorded as inhabiting the sector in the last census (375 inhabitants). Fecal examination combined the direct examination of fresh feces with the quantitative techniques of Kato-Katz method, Baermann and MIF staining. Overall, 92% of the subjects were found to have intestinal parasites, 85% if only direct examination of fresh stools was taken into account. Fourteen species of human parasite were identified: seven protozoa and seven helminths. We observed in particular 1) a high frequency of hookworm infection due to Necator americanus. Over 50% of subjects were affected, with a range of 25% to 75% according to the village, but with only moderate parasite loads; 2) a high level of parasitism by E. histolytica/E. dispar (17%), Stongyloides stercoralis (16%) and Hymenolepis nana (18%); 3) a lower level of parasitism by Ascaris lumbricoides and very low levels (almost absent) of Trichiuris trichiura; 4) the absence of Schistosoma and fluke eggs. With the exception of H. nana, which was more frequent in children than in adults, there was no significant difference in the level of parasitism according to sex and age. Although the Wayampi of French Guiana are French citizens and consequently have quite high incomes and ready access to clinics and medicines, intestinal parasites are far from under control in this population. A lack of fecal hygiene and the habit of walking barefoot are widespread in the unchanging Amazonian environment and contribute to this phenomenon.

Adolescent↗
PubMed2002

Serologic survey of Toxoplasma gondii in noncarnivorous free-ranging neotropical mammals in French Guiana.

The aim of this study was to determine the frequency of Toxoplasma infection in wild mammals, particularly noncarnivorous species, and to identify possible sources of infection for humans. A serological study was conducted that included 310 animals representing 10 species of terrestrial mammals from the same region (primary tropical rain forest inhabited by humans). Toxoplasmosis was diagnosed using a direct agglutination test using formalin-treated Toxoplasma gondii. The prevalence of antibodies for toxoplasmosis differed greatly between species and ranged from 0% to 62%. The seroprevalence of toxoplasmosis was zero or very low for tree-dwelling animals, which included sloth, porcupine, and howler monkey. Conversely, the prevalence of infection was 46-62% among granivores, insectivores, and burrowing animals, such as peccary, paca, and armadillo. We conclude that wild mammals in French Guiana constitute a reservoir of T. gondii parasites. Given the absence of domestic cats from the forest, noncarnivorous species may be infected by the ingestion of oocysts that are eliminated into the soil or water in the stools of wild cats and then dispersed.

Agglutination Tests↗
PubMed2002

Severe acquired toxoplasmosis in immunocompetent adult patients in French Guiana.

The most common presentation of symptomatic postnatally acquired toxoplasmosis in immunocompetent patients is painless cervical adenopathy. Acute visceral manifestations are associated in rare cases. We report 16 cases of severe primary toxoplasmosis diagnosed in French Guiana during a 6.5-year period. All of the subjects were immunocompetent adults hospitalized with clinical presentations consisting of a marked, nonspecific infectious syndrome accompanied by an altered general status with at least one visceral localization, mainly pulmonary involvement (14 cases). Acute toxoplasmosis was diagnosed according to the results of serological tests suggestive of recent primary infection and the absence of an alternative etiology. Recovery was rapid following specific antitoxoplasmosis treatment. Thirteen of the 16 patients had consumed game in the 2 weeks before the onset of the symptoms, and in eight cases the game was considered to have been undercooked. Toxoplasma strains, which were virulent in mice, were isolated from three patients. Microsatellite analysis showed that all of these isolates exhibited an atypical multilocus genotype, with one allele found only for isolates of this region.

Acute Disease↗
PubMed2002

Influence of meteorological parameters on the clinical presentation of cutaneous leishmaniasis in French Guiana and on the efficacy of pentamidine treatment of the disease.

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.

Adolescent↗
PubMed2002

[Epidemiologic surveillance of cutaneous leishmaniasis in Guiana. Summary of military data collected over 10 years].

This report describes the results of epidemiological surveillance of cutaneous leishmaniasis in French military personnel in French Guiana. Data was collected regarding microscopic diagnosis, clinical manifestations, and lesion location as well as compliance with vector control measures. Year-to-year variations in the incidence in the general population have been attributed to changes in climatic conditions. Monitoring incidence and density curves, correlation of findings with local epidemiological data, and analysis of the most recent epidemic in 1998/99 (326 cases, attack rate 3.2% men years) highlight the importance of behavioral factors. The proportion of total cases involving military personnel varied widely from 20 to 85%. Investigation consistently showed that failure to apply elementary protective measures against sandfly bites was the most determinant factor in this proportion. Strict compliance with these measures appears to reduce the risk of infection considerably.

Animals↗
PubMed2001

[Human parasitoses in French Guiana].

MALARIA: This review summarises current knowledge of the epidemiological situation regarding parasitoses in French Guiana. Malaria is the most prevalent infection. The most common species is Plasmodium falciparum which is responsible for three quarters of all bouts of malaria. Plasmodium vivax is mostly present in endemic areas inhabited by Amerindian communities. Plasmodium malariae is rarer. CHAGAS' DISEASE, LEISHMAMIASIS AND TOXOPLASMOSIS: Four acute cases of cardiac Chagas' disease were observed between 1994 and 1996. These cases serve as a warning concerning the possible emergence of this type of parasitosis among the poor in Latin America. Cutaneous leishmaniasis is still highly endemic, with an incidence of about 2 cases per 1,000 inhabitants, which has remained essentially unchanged for 15 years. The identification of severe primary toxoplasmosis in immunocompetent individuals in recent years seems to be associated with an as yet poorly known, natural, Amazonian cycle. INTESTINAL PARASITOSES: Improvements in living conditions, hygiene and treatments are such that intestinal parasitoses, other than anguilluliasis, are no longer a major problem in the urban or coastal areas. The situation is very different in the central areas of the country and in the Amerindian and black half-cast communities, with high prevalences of ankylostomiasis (hookworm disease), anguilluliasis and amoebal disease (Entamoeba histolytica/E. dispar). OTHERS: Lymphatic filariasis is no longer endemic; tropical schistosomiasis and distomiasis have never been endemic. Parasitic pests (cutaneous larva migrans and insect or dust-mite ectoparasites) are more spectacular than severe, and constitute a classic "exotic" component of the spectrum of diseases in French Guiana.

Chagas Disease↗
PubMed2001

Health evaluation of translocated free-ranging primates in French Guiana.

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.

Animal Diseases↗
PubMed2001

Influence of clinical presentation on the efficacy of a short course of pentamidine in the treatment of cutaneous leishmaniasis in French Guiana.

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).

AIDS-Related Opportunistic Infections↗
PubMed2001

Seasonal fluctuations of incubation, healing delays, and clinical presentation of cutaneous leishmaniasis in French Guiana.

An investigation was conducted to determine whether seasonal variations affected the development of cutaneous leishmaniasis. Data from 499 cases treated between July 1994 and December 1998 were analyzed. The interval between infection and consultation and between treatment and clinical cure varied significantly between cases with an incubation period during the dry season compared with the rainy season (P < 0.001). When the incubation period occurred during the dry season, the standard pentamidine isethionate treatment seemed to be less effective (i.e.. the odds ratio for failure was 1.9 [1.1-3.4], P = 0.01). The presence of lymphangitis was more frequent during the dry season (i.e., the odds ratio was 0.26 [0.15-0.45], P < 0.001). These results suggested that the observed seasonal variations were due to variations in the host/parasite balance. Converging indirect elements that suggest a role for variations in solar ultraviolet radiation are discussed.

Adolescent↗
PubMed2000

[Coinfection with HIV and HTLV-I infection and survival in AIDS stage. French Guiana Study. GECVIG (Clinical HIV Study Group in Guiana)].

OBJECTIVE: The purpose of this study was to investigate the effect of HTLVI infection on survival in AIDS patients in French Guiana. PATIENTS AND METHODS: A cohort of 151 adult patients with AIDS were followed from January 1992 through June 1996. Kaplan-Meier survival curves were established. Using the Cox model, multivariate analysis was performed to examine different factors affecting survival. RESULTS: The incidence of HTLVI infection in this cohort was 11.9% and 57.6% of the patients died during the study period. Multivariate analysis disclosed that older age at diagnosis of AIDS (over 45 years) and low CD4 count (< 100/mm3) were predictors of poor survival. HIV-HTLVI co-infection was strongly correlated with reduced survival (p = 0.02; RR = 2.2; CI = 1.1-4.5). CONCLUSION: In our region, all patients with HIV infection should be screened for HTLVI infection. In case of co-infection, early care should included adapted antiretroviral regimens.

Acquired Immunodeficiency Syndrome↗
PubMed2000

[Histoplasmosis due to Histoplasma capsulatum capsulatum and HIV infection].

PURPOSE: Histoplasmosis due to Histoplasma capsulatum is a granulomatous fungic infection which appears opportunistic and disseminated in immunocompromised patients, especially among HIV patients in whom it can lead to death. Histoplasmosis is endemic in numerous areas worldwide, but in Europe most of the cases reported are imported. We describe the clinical features and the available diagnosis methods issued from our experience in French Guyana. METHODS: Contamination occurs by inhalation of spores contained in dust. Most endemic areas are located on the American continent, including the French West Indies, where the incidence of histoplasmosis among HIV patients in French Guyana varies from 1.2 to 2.2% per year. In non-immunocompromised patients, histoplasmosis is asymptomatic most of the time. In HIV patients, the disseminated form is common and may occur many years after exposure to the fungus. RESULTS: Non-specific symptoms, similar to those of either tuberculosis or other opportunistic infections, may reveal disseminated histoplasmosis in patients with AIDS. Early treatment (amphotericin B or itraconazole) is effective; however, it should be followed by a lifelong antifungic treatment (itraconazole) to prevent relapse. CONCLUSION: The infection should be suspected in any febrile HIV-infected patient with CD4 blood cell count < 200/mm3, if he/she ever travelled in an endemic zone. Direct examination of smear relating to clinical symptoms help guide diagnosis, while culture will confirm it after at least 4 weeks. Efficient serologic techniques for HIV-infected patients are not available in Europe.

AIDS-Related Opportunistic Infections↗