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Biomedical subjects

B Carme

Publications and source records attributed to B Carme.

At least 55 records · Page 3Linked to original sources
PubMed2000

[Epidemiologic surveillance of dengue fever: non specific alert system in the hospital milieu in Cayenne].

A retrospective study was carried out in the General Hospital of Cayenne, the main city in French Guiana, where malaria is endemic and dengue fever constitutes a permanent threat. The aim of this study was to test an alert system for epidemic outbreaks of dengue fever. Patients attending the emergency ward and for whom a search of Plasmodium was prescribed were included. In 90% of cases, patients were febrile, presenting clinical symptoms compatible with malaria or dengue fever-like syndrome. The period of survey covered 39 months (January 1996 to March 1999). Three indices were studied; two non specific: EMN (Emergency Malaria Negative--UPN in French): number of negative malaria blood tests for patients having consulted the emergency ward; EMNT (Emergency Malaria Negative Thrombopenia--UPNT in French): UPN with platelets < 150.000; and one more specific; number of hospitalised dengue fever cases according to data from a hospital programme on medical systems information. EMN weekly follow-ups led to three epidemic alerts, two of which turned out to be crucial for dengue. Accounting for thrombopenia (EMNT) reinforced the specificity. This simple and reactive alert system should incite increased serological and virological surveillance and contribute to precocious antivectorial control measures in districts where several dengue fever cases are suspected.

Dengue↗
PubMed1999

Risk factors for Toxoplasma infection in pregnancy: a case-control study in France.

Each year an estimated 4900 cases of primary Toxoplasma infection occur in pregnant women in France, a country with a high prevalence. Since 1992 all pregnant women at risk of Toxoplasma infection have been required to undergo monthly serological testing. This case-control study, the first of its kind in France, was undertaken to identify risk factors for Toxoplasma infection during pregnancy, with a view to improving primary prevention among non-immune pregnant women. A total of 80 pregnant women who seroconverted to Toxoplasma were matched with 80 pregnant women who had repeatedly negative tests. The women were interviewed by telephone, using a standardized questionnaire, to determine socio-demographic characteristics, exposure to possible risk factors and the type of information on prevention received during pregnancy. The risk factors for Toxoplasma infection included in a multivariate analysis were poor hand hygiene (OR = 9.9; 95%CI: 0.8-125), consumption of undercooked beef (OR = 5.5; 95%CI: 1.1-27), having a pet cat (OR =4.5; 95%CI: 1.0-19.9), frequent consumption of raw vegetables outside the home (OR = 3.1; 95%,CI: 1.2-7.7) and consumption of undercooked lamb (OR = 3.1; 95%CI: 0.85-14). Receipt of documentary advice on prevention was associated with a lower risk of infection. Prevention campaigns among pregnant women in France could be improved and should focus on eating habits, hand hygiene and cats.

Adult↗
PubMed1999

[Disseminated histoplasmosis detected by lingual and tonsillar erosions in an immunocompetent patient].

BACKGROUND: Histioplasmosis is a usually asymptomatic fungal infection. In the immunocompetent patient, it leads to chronic disseminated infection. Mucosal involvement is common and can provide the diagnosis. CASE REPORT: A metropolitan Frenchman with a history of alcoholism and smoking and living in Guyana consulted for lingual and tonsil erosion. Squamous cell carcinoma was suspected but not confirmed at pathology. The patient had a bi-apical infiltration on the chest x-ray and was treated empirically for tuberculosis. The diagnosis of histoplasmosis was reached when rare Histoplasma capsulatum were evidenced from a buccal swab. Itraconazole led to cure in 6 months. DISCUSSION: This case illustrates the importance of mucosal signs in the diagnosis of disseminated histoplasmosis in immunocompetent subjects. Histoplasmosis is rarely the cause of active infection in immunocompetent subjects. In these patients, the fungal infection generally progresses to chronic dissemination. Mucosal signs are frequent in this form but are rare in case of cutaneous histoplasmosis. Itraconazole (200 mg/d) is indicated for 6 months.

Alcoholism↗
PubMed1999

[Malaria in the Americas].

In 1996, malaria involving Plasmodium vivax, Plasmodium falciparum, and, to a lesser extent, Plasmodium malariae was endemic in 21 countries in the Americas. The Amazon river basin and bordering areas including the Guyanas were the most affected zones. Until the mid 1970s, endemic malaria appeared to be under control. However in the ensuing 15 year period, the situation deteriorated drastically. Although trends varied depending on location, aggregate indexes indicated a twofold increase with recrudescence in previously settled areas and emergence in newly populated zones. Since 1990, the situation has worsened further in some areas where increased incidences have been associated with a high levels of drug-resistant Plasmodium falciparum. However this species remains in minority except in the Guyanas where the highest annual incidences (100 to 500 cases per 1000) and the most drug-resistant Plasmodium have been reported. The causes underlying this deterioration are numerous and complex. In regions naturally prone to transmission of the disease, outbreaks have been intensified by unrestrained settlement. The resulting deforestation has created new breeding areas for Anopheles darlingi, the main vector of malaria in the Americas. Migration of poor populations to newly opened farming and mining areas has created highly exposed areas for malaria infection. Implementation of adequate medical care and prevention measures has been hindered by a lack of money and sociopolitical unrest. Climatic phenomenon related the El Nino have also been favorable to the return of malaria to the region. Except with regard to financial resources and political unrest, the same risk factors for malaria are present in French Guiana.

Animals↗
PubMed1998

[No variation in chloroquine resistance (Plasmodium falciparum) from 1986 to 1996 in semi-immune children in Brazzaville (Congo)].

A simplified Plasmodium falciparum in vivo test was carried out in Brazzaville (Congo) in April 1996. Chloroquine was prescribed at 25 mg/kg for 3 days in asymptomatic Brazzavillian school children who presented parasitemia > 800 P. falciparum trophozoïtes and lived in a highly endemic district. A massive decrease of parasitemia was observed on day 2. The percentage of resistance (presence of P. falciparum trophozoïte on day 7 in a thick blood film) was 43.5, 28 and 21 respectively (IC: 95%: 29-57, 15-41 & 10-34) at the threshold of 6, 50 and 100 parasites/microliter. In positive children on day 7 the reduction of parasitemia was > 95% and no case of R3 resistance was detected. A comparison with previous studies carried out in 1985, 1986, 1990 and 1993 in the same school using the same methodology proves the long-lasting stabilization of chloroquino-resistance for this semi-immune indigenous population.

Child↗
PubMed1998

[A case of coinfection by Balantidium coli and HIV in French Guiana].

A case of balantidial dysentery is reported in a patient infected with the HIV in French Guiana. This case is the first described in medical literature. The patient presented also a disseminated histoplasmosis. Immunosuppression probably favoured the evolution of asymptomatic carriage to clinical dysentery. This clinical case did not present any complications. Treatment with doxycycline had to be carried out for 20 days in order to obtain a clinical and parasitological cure.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Compliance with and tolerance of mefloquine and chloroquine + proguanil malaria chemoprophylaxis in French short-term travellers to sub-Saharan Africa.

To compare the compliance with and tolerance of mefloquine (MQ) and chloroquine + proguanil (CQ-PRO) chemoprophylaxis, we conducted a study using a self-reported questionnaire in 2 groups of native French adult visitors to Senegal or Kenya. CQ (100 mg daily) + PRO (200 mg daily) prophylaxis was prescribed for all patients travelling to Senegal and for those going to Kenya when MQ was contraindicated; MQ (250 mg weekly) was prescribed for the other subjects. There were no significant differences in age, sex, exposition and measures of protection against mosquito bites, concomitant drug use or mean duration of chemoprophylaxis between the 2 groups, and compliance during travel was excellent in both. Chemoprophylaxis was more frequently interrupted prematurely in the MQ group. The rates of overall side-effects attributed to malaria chemoprophylaxis were 16% for MQ against 12% CQ-PRO (not significant). However, nonserious neuropsychiatric adverse events are more frequent with MQ: 11.5% compared to 2% with CQ-PRO. MQ should be used with caution.

Adult↗
PubMed1997

[Malaria chemoprophylaxis: tolerance and compliance with mefloquine and proguanil/chloroquine combination in French tourists].

To determine if mild adverse events attributed to mefloquine (MQ) and chloroquine + proguanil (CQ-PRO) were experienced with the same frequency, we carried out a study in two groups of French native adult short-term visitors to Africa originating from Amiens. CQ (100 mg daily) + PRO (200 mg daily) prophylaxis was prescribed for all patients travelling to Senegal and those for Kenya when MQ was contraindicated, including all the patients with an history of any neuropsychiatric events, even mild (group 1). MQ (250 mg weekly) was prescribed for the others subjects (group 2). The self-reported questionnaire has been sent by mail to 534 travellers between one to three months after the end of their travels for obtaining information about travel conditions and health problems, mainly those attributed to anti-malarial drugs taken for chemoprophylaxis. We have received 377 available responses (71%): 183 in group 1 and 194 in group 2. There are no significant differences for age, sex, exposition and measures of protection against mosquito bites, concomitant drug use, mean duration of chemoprophylaxis. The compliance during the travel is excellent in each group. CP was interrupted prematurely (< 15 days after returning) in 13.8% of the case with MQ against 4.2% only with CQ-PRO (OR = 3.7; CI 95% = 1.5-9.1). The rates of overall side effects attributed to malaria chemoprophylaxis are respectively: 15.8% for MQ against 12.4% for CQ-PRO (difference not significant). However non-serious neuropsychiatric adverse events (dizziness, headache, mood change and sleep disturbance) are more frequent with MQ: 11.5% against 2.1% with CQ-PRO (OR = 6.2; CI 95% = 2.2-17.2). Although all side effects were transient and judged to be mild to moderate by the subjects themselves, these results back up the fact that mefloquine should be used with caution.

Adult↗
PubMed1995

[Plasmodium falciparum index and level of parasitemia: diagnostic and prognostic value in the Congo].

Parasitological data of various malarial studies performed in the Congo where Plasmodium falciparum malaria is holo-endemic in rural and suburban zones, between 1988 and 1991, were analyzed with the intention of establishing diagnosis and prognosis value of Plasmodium falciparum parasitaemia in areas with high perennial transmission. In such an area congolese school-children (6-10 years old) had 88% P. falciparum index, this is the same percentage as that for children hospitalized with a pernicious attack. However, the parasite load is distributed differently; parasitaemia is greater than 6,000 asexual form of P. falciparum/microliters (afPf/microL) in only 4.6% of cases in the former group versus 67% in the second group. A threshold of 10,000 afPf/microliters, above which the Plasmodium infection triggers a febrile attack in semi-immune children, is confirmed in school children in a rural context where the factor of taking antimalarial drugs within the preceding days is negligible; three out of four children with levels above this threshold are febrile versus 4.1% (7 out of 170) with lower blood parasite levels. Some adults were also asymptomatic carriers but much less frequently and with lower mean parasitaemia levels. The parasite load mirrors the clinical severity although this concept can be misleading as an individual prognostic criterion and for hospital studies carried out in areas where multiple drug administration before hospitalisation is common. For the studies recently performed in Brazzaville, the 5% threshold level of parasitized red cells, the WHO severity criterion, was never reached in asymptomatic subject or in cases of simple attack; it was reached in one out of two cases of pernicious attack.

Adolescent↗
PubMed1995

In vitro drug sensitivity and clinical aspects of Plasmodium falciparum malaria in African children.

In vitro Plasmodium falciparum drug sensitivity was investigated in 115 brazzavillians children, between 1 year and 10 years of age. On the basis of clinical aspects, four groups were constituted: Group 1: 39 asymptomatic school children, Group 2: 16 children with uncomplicated malaria, Group 3: 40 with severe but not pernicious malaria and Group 4: 20 with pernicious malaria. The drugs tested were chloroquine (CQ), quinine (QN) and mefloquine (MQ). The sensitivity level was assessed by a 48-hour in vitro maturation test involving the uptake of tritiated hypoxanthine, the initial blood level of parasite being > or = 0.1% in all cases. For QN and MQ, the median IC50 values showed no significant difference related to clinical status, age or parasitaemia levels. For CQ, the proportion of resistant strains and the 50 inhibitory concentration (IC50) values were greater in the cases of children hospitalised for malaria but there were no differences related to clinical severity of these hospitalised children nor, within each group, to the age or parasitaemia levels. The percentage of subjects with an IC50 value greater than the 90 percentile of the IC50 of the asymptomatic group, which we propose as the severity index related to chemoresistance, was 15% for uncomplicated malaria, 38% for severe but non-pernicious forms and 35% for pernicious malaria. The IC50 for QN was significantly higher in CQ-resistant strains and there was a positive correlation for CQ vs QN and for QN vs MQ.

Animals↗
PubMed1994

Cerebral malaria in African children: socioeconomic risk factors in Brazzaville, Congo.

Current epidemiologic and clinical research on cerebral malaria is directed towards prognostic criteria and neurologic sequelae. However, the assessment of risk factors related to the environment and the socioeconomic standard of the family is of practical as well as theoretical interest. A prospective survey was carried out in March 1990 in Brazzaville, Congo by interviewing subjects in two groups: 1) 600 households representative of the Brazzaville population and 2) 84 households with a child who had been hospitalized for cerebral malaria between January 1, 1988 and June 30, 1989 (i.e., 9-27 months prior to the interview). The mothers' knowledge and attitudes with regard to the prevention and treatment of malaria in children were assessed, as was the socioeconomic standards of the households. The group in which at least one child had been hospitalized for cerebral malaria had a lower socioeconomic standard than the control group. Other differences in this group included a greater number of offspring and a higher average number of decreased children, less chemoprophylaxis, antimalarials available less often in the household, less early treatment of fever at home, and drugs bought more often at the market. There was no significant difference between the groups with regard to using the correct dosage of chloroquine, ownership of a mosquito net, or the use of insecticides or repellents.

Adult↗