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M Demar,
D Hommel,
F Djossou,
C Peneau,
R Boukhari,
D Louvel,
A-M Bourbigot,
V Nasser,
D Ajzenberg,
M-L Darde,
B Carme
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ABSTRACT: Atypical Toxoplasma gondii strains, unrelated to archetypal clonal lineages (I, II, III), have been reported more frequently over the last decade in areas other than Europe and North America. A newly described form of toxoplasmosis, 'Amazonian toxoplasmosis' (AT), has been reported since 2002 in French Guiana. It is characterized by severe cases and atypical strains linked to a neotropical forest-based cycle. We report on the cases of AT that required intensive care management. We performed a prospective observational study on hospitalized adults in the Intensive Care Unit (ICU) from 2002 to 2008. Clinical and laboratory data, microbiological findings and outcomes were recorded. Data, including the ICU simplified acute physiology score and the pneumonia severity index, were calculated. Epidemiological risk factors for AT were assessed through questionnaires. Eleven non-immunodeficient patients were admitted to the ICU in Cayenne for life-threatening pneumonia associated with disseminated toxoplasmosis. Mechanical ventilation was necessary in seven patients, four of whom required immediate orotracheal intubation. Cardiac and ophthalmological abnormalities were found in five and four patients, respectively. One patient died from multiple organ failure. The genetic characterization of Toxoplasma DNA using six microsatellite markers revealed unique and atypical genotypes in eight patients. All patients presented epidemiological risk factors for AT. In French Guiana, significant T. gondii-related infectious syndrome associated with the lungs, a high level of LDH activity and the reported risk factors for AT was strongly suggestive of disseminated toxoplasmosis with a possible trend toward life-threatening pneumonia.
Clinical Microbiology and Infection 08/2011; 18(7):E221-31. · 4.54 Impact Factor
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ABSTRACT: Like domestic cats, wild felids are involved in the complete infective cycle of Toxoplasma gondii because they can host in their gastrointestinal tract sexually mature parasites and shed infective oocysts in their feces. We report, to our knowledge, the first isolation and molecular characterization of a T. gondii strain from the heart tissue of a free-living jaguar (Panthera onca) in French Guiana. Sequencing at six polymorphic markers indicated that the jaguar isolate had an atypical genotype, including an allele at TgM-A previously found only in isolates from South America, and an allele at GRA6, which was previously reported only in Californian sea otter isolates. These findings are consistent with the recent description of atypical T. gondii strains involved in severe toxoplasmoses in immunocompetent patients in French Guiana that seemed to be linked to a neotropical forest-based cycle involving wild cats and their prey.
The American journal of tropical medicine and hygiene 03/2008; 78(2):195-7. · 2.59 Impact Factor
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ABSTRACT: Histoplasma capsulatum var capsulatum is a dimorphic fungi predominating on the American continent. It is responsible for disseminated histoplasmosis associated with AIDS. The presentation in the form of cutaneous ulceration is uncommon and misleading.
A 25 year-old man presented with 3 ulcerations, of 2 to 4 cm in diameter, localized on the lower lip and knees. The patient exhibited fever, alteration in his general status of health and a pulmonary interstitial syndrome. He was seropositive for the human immunodeficiency syndrome (HIV). His lymphocyte CD4+ level was of 1/mm3. Diagnosis of histoplasmosis was established by direct examination and culture of the cutaneous ulcerations and bronchoalveolar washing fluid.
The clinical aspect of cutaneous localizations of disseminated histoplasmosis is usually multiple, disseminated, papular or nodular-type lesions. Ulcerations represent less than 20% of the cases described. In our patient, the aspect of the lesions at first evoked cutaneous leishmaniosis. Direct mycological examination followed by culture confirmed the final diagnosis.
Annales de Dermatologie et de Vénéréologie 03/2005; 132(2):133-5. · 0.72 Impact Factor
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ABSTRACT: Paracoccidio-domycosisis a deep mycosis due to a dimorphic fungus:Paracoccidioides brasiliensis. The principle endemic country is Brazil. We describe the first case of paracoccidio-domycosis, in its cutaneous-mucosal form, diagnosed in French Guiana.
A 20 year-old Brazilian man, having mover to French Guiana a few months earlier, presented with multiple disseminated cutaneous lesions, predominating on the face, and composed of multiple nodules and two ulcerations. The clinical examination also revealed voluminous superficial lymph nodes and ulcerations of the pharynx and larynx. Direct examination, anatomopathology and culture of cutaneous biopsies revealed specific images of Paracoccidioides brasiliensis. HIV serology was negative. Treatment combining cotrimoxazole and itraconazole eliminated the lesions in one month.
Because the patient had just moved to Guiana, this observation probably corresponded to an imported disease. The principle differential diagnosis was leishmaniosis.
Annales de Dermatologie et de Vénéréologie 03/2005; 132(2):136-9. · 0.72 Impact Factor
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ABSTRACT: The majority of Toxoplasma gondii strains from a variety of human and animal sources have been grouped into three highly clonal but closely related lineages. The low occurrence of nucleotide differences among the three predominant lineages and their unusual dimorphic allelic composition suggest that they have arisen from a recent common ancestry. Less than 1% of the previously studied strains contain unique genotypes and high divergence of DNA sequence, and therefore are considered 'exotic' or 'atypical' strains. The seemingly low genetic diversity in T. gondii may have been underestimated because most parasite strains in previous studies were collected from human patients and domestic animals in North America and Europe. To investigate the genetic diversity of T. gondii, we analysed parasite strains isolated from remote geographical regions by multilocus microsatellite sequencing and phylogenetic analysis. The genetic diversity indices, the molecular analysis of microsatellite genotypes and the constructed phylogram considered together suggest that the global T. gondii population is highly diversified and not characteristic of a clonal organism. The most parsimonious hypothesis is that T. gondii presents a complex population structure with a mix of clonal and sexual propagation as a function of the environmental conditions. The comparison between domestic strains data on one hand and wild strains data on the other hand is in favour of more frequent sexual recombinations in wild environment even though Toxoplasma subpopulation in human and domestic animals is largely clonal.
International Journal for Parasitology 10/2004; 34(10):1185-96. · 3.39 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the efficacy and tolerance of mefloquine treatment in children, especially in infants of less than 15 kg, in an endemic area of malaria (French Guiana).
This 5-years (1996-2000) retrospective study included 61 children aged 6 months to 16 years who had been treated with mefloquine for acute Plasmodium falciparum malaria. Twenty-six of these children weighted less than 15 kg. The efficiency of the treatment was evaluated using clinical and parasitic data that had been validated according to the criteria of the World Health Organization (WHO). Tolerance was compared with the data in the medical literature.
None of the 59 patients who were given the treatment correctly presented signs of early therapeutic failure as defined by the WHO. Apyrexia was obtained in 48 h on average (CI 95%: 39-57; median: 36 h). The mean time required to obtain negative parasitism was 91 h (CI 95%: 80-101; median: 96 h) among the 51 patients in whom this was measured. Mild side effects were observed in 27.8% of the cases affecting mainly the digestive system. No differences were observed regarding efficacy or tolerance for children who weighed less than 15 kg.
Mefloquine represents an efficient treatment for acute uncomplicated P. falciparum malaria in children and is well-tolerated even in infants.
Pathologie Biologie 10/2003; 51(8-9):534-9. · 1.53 Impact Factor
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La Presse Médicale 09/2003; 32(26):1222. · 0.67 Impact Factor
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ABSTRACT: Only a limited number of treatments are available for use in young children with malaria.
The aim of this study was to evaluate the efficacy and tolerance of mefloquine treatment in children, especially in infants of less than 15 kg, in an endemic area of malaria (French Guiana).
This five-years (1996-2000) retrospective study included 61 children aged six months to 16 years who have been treated with mefloquine for acute P. falciparum malaria. Twenty-six of these children weighted less than 15 kg. The efficiency of the treatment was evaluated using clinical and parasitic data that had been validated according to the criteria of the World Health Organization (WHO). Tolerance was compared with the data in the medical literature.
None of the 59 patients who were given the treatment correctly presented signs of early therapeutic failure as defined by the WHO. Apyrexia was obtained in 47.8 h on average (CI 95%: 39-57; median: 36 h). The mean time required to obtain negative parasitism was 90.8 h (CI 95%: 80-101; median: 96 h) among the 51 patients in whom this was measured. Mild side effects were observed in 27.8% of the cases affecting mainly the digestive system. No differences were observed regarding efficacy or tolerance for children who weighed less than 15 kg.
Mefloquine represents an efficient treatment for acute uncomplicated P. falciparum malaria in children and is well tolerated even in infants.
Archives de Pédiatrie 02/2003; 10(1):25-30. · 0.30 Impact Factor
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B Carme,
F Bissuel,
D Ajzenberg,
R Bouyne,
C Aznar, M Demar,
S Bichat,
D Louvel,
A M Bourbigot,
C Peneau,
P Neron,
M L Dardé
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ABSTRACT: 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.
Journal of Clinical Microbiology 12/2002; 40(11):4037-44. · 4.15 Impact Factor
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ABSTRACT: 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.
Vector Borne and Zoonotic Diseases 02/2002; 2(1):11-7. · 2.44 Impact Factor
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ABSTRACT: IntroductionParacoccidio-domycosisis a deep mycosis due to a dimorphic fungus: Paracoccidioides brasiliensis.The principle endemic country is Brazil. We describe the first case of paracoccidio-domycosis, in its cutaneous-mucosal form, diagnosed in French Guiana.ObservationA 20 year-old Brazilian man, having mover to French Guiana a few months earlier, presented with multiple disseminated cutaneous lesions, predominating on the face, and composed of multiple nodules and two ulcerations. The clinical examination also revealed voluminous superficial lymph nodes and ulcerations of the pharynx and larynx. Direct examination, anatomopathology and culture of cutaneous biopsies revealed specific images of Paracoccidioides brasiliensis. HIV serology was negative. Treatment combining cotrimoxazole and itraconazole eliminated the lesions in one month.DiscussionBecause the patient had just moved to Guiana, this observation probably corresponded to an imported disease. The principle differential diagnosis was leishmaniosis.
Annales de Dermatologie et de Vénéréologie 132(2):136-139. · 0.72 Impact Factor
