[Show abstract][Hide abstract] ABSTRACT: Artesunate is the most effective treatment for severe malaria. However, delayed-onset hemolytic anemia has been observed in ≈20% of travelers who receive artesunate, ≈60% of whom require transfusion. This finding could discourage physicians from using artesunate. We prospectively evaluated a cohort of 123 patients in France who had severe imported malaria that was treated with artesunate; our evaluation focused on outcome, adverse events, and postartesunate delayed-onset hemolysis (PADH). Of the 123 patients, 6 (5%) died. Overall, 97 adverse events occurred. Among the 78 patients who received follow-up for >8 days after treatment initiation, 76 (97%) had anemia, and 21 (27%) of the 78 cases were recorded as PADH. The median drop in hemoglobin levels was 1.3 g/dL; 15% of patients with PADH had hemoglobin levels of <7 g/dL, and 1 required transfusion. Despite the high incidence of PADH, the resulting anemia remained mild in 85% of cases. This reassuring result confirms the safety and therapeutic benefit of artesunate.
[Show abstract][Hide abstract] ABSTRACT: Severe malaria patients treated with artesunate sometimes experience a delayed hemolytic episode. Artesunate induces "pitting", a splenic process whereby dead parasites are expelled from their host erythrocytes. These once-infected erythrocytes then return to the circulation. We analyzed hematological parameters in 123 travellers treated with artesunate for severe malaria. Among 60 non-transfused patients followed for more than 8 days, 13 (22%) had delayed hemolysis. The peak-concentration of circulating once-infected erythrocytes was measured during the first week in 21 patients, and was significantly higher in 9 patients with delayed hemolysis than in 12 with other patterns of anemia (0.30 vs. 0.07, p=0.0001). The threshold of 180 million once-infected erythrocytes/L discriminated patients with delayed hemolysis with 89% sensitivity and 83% specificity. Once-infected erythrocytes morphology analyzed using ImageStream° in 4 patients showed an 8.9% reduction in their projected area, an alteration likely contributing to their shorter lifespan. Delayed clearance of infected erythrocytes spared by pitting during artesunate treatment is an original mechanism of hemolytic anemia. Our findings consolidate a new disease framework for post-treatment anemia in malaria where delayed hemolysis is a separate entity. The early concentration of once-infected erythrocytes is a solid candidate marker to predict this potentially severe adverse event.
[Show abstract][Hide abstract] ABSTRACT: In France, young adults are legally freed from parental authority at the age of 18 years and are, thus, responsible for their own vaccine record. This young adult population is more frequently exposed to vaccine-preventable infectious diseases.
[Show abstract][Hide abstract] ABSTRACT: Nous rapportons le cas survenu au Cambodge d’un touriste de 40 ans présentant une envenimation par une cubo-méduse lors d’une baignade à Sihanoukville dans le golfe de Thaïlande. Les symptômes, apparus en quelques minutes, associaient douleur intense de la zone envenimée, lipothymie, oedème de la main et lésions cutanées à type de flagellations linéaires. Une antibiothérapie et une corticothérapie ont permis d’améliorer les signes inflammatoires et les symptômes ont disparu en 15 jours laissant place à des croûtes, puis des cicatrices. Les méduses à risque pour l’Homme sont présentes surtout dans les mers tropicales et leur distribution géographique semble s’étendre. S’il est difficile de prévenir ce type d’accident, les voyageurs doivent être informés des premiers gestes à réaliser, tels que le nettoyage correct de la plaie, l’intérêt potentiel du vinaigre, la prise d’antalgiques et d’une corticothérapie en cas de signes inflammatoires importants.
Bulletin de la Société de pathologie exotique 10/2013; 106(4). DOI:10.1007/s13149-013-0310-4
[Show abstract][Hide abstract] ABSTRACT: We report a case of box-jellyfish related envenomation in a 40 year old tourist that occurred in Sihanoukville, Cambodia, in the Gulf of Thailand. Symptoms that appeared within a few minutes associated intense pain, hand edema and large edematous and erythematous flagellations in the stung skin areas. Antibiotics and corticosteroids were delivered. Inflammatory signs and skin lesions disappeared within 15 days followed by crusts then scars. Jellyfish at risk for humans are generally found in tropical seas and their geographic distribution seems to spread. As it is difficult to prevent this kind of accident, travelers should be aware of the first acts to perform, such as appropriate cleaning of the wound, the interest of vinegar usage, the administration of analgesics and corticosteroids in case of significant inflammatory signs.
Bulletin de la Société de pathologie exotique 09/2013;
[Show abstract][Hide abstract] ABSTRACT: Leptospirosis belongs to the spectrum of travel-related infections.
We retrospectively studied all the consecutive cases of travel-related leptospirosis seen in our department between January 2008 and September 2011. Patients were included with a clinical picture compatible with the disease within 21 days after return, the presence of a thermoresistant antigen or IgM antibodies, Elisa ≥ 1 /400, and a positive microagglutination test (MAT) ≥ 1/100.
Fifteen leptospirosis cases were evaluated. Exposure occurred in Asia (47%), Africa (20%), the Caribbean (20%), and Indian Ocean (13%). Fourteen patients were infected during water-related activities. On admission the most frequent symptoms were fever (100%), headache (80%), and digestive disorders (67%). Relevant laboratory findings included impaired liver function tests (100%), lymphocytopenia (80%), thrombocytopenia (67%), and elevated C-reactive protein (CRP) (67%). Our cases were confirmed by MAT that found antibodies against nine different serovars. Seven patients were cured with amoxicillin, four with doxycycline, two with ceftriaxone, one with ceftriaxone, doxycycline, and spiramycin, whereas one recovered spontaneously (retrospective diagnosis). Eight patients were hospitalized. All patients recovered.
Our cases involved nine different serovars. They were related to travel in Asia, Africa, and the Caribbean. Bathing or other fresh-water leisure activities (canoeing, kayaking, rafting) are the most likely at-risk exposure. Any traveler with fever and at-risk exposure should be investigated for leptospirosis.
Journal of Travel Medicine 07/2013; 20(4):228-31. DOI:10.1111/jtm.12035 · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Most vaccines, including those against influenza, were developed by focusing solely on humoral response for protection. However, vaccination activates different adaptive compartments that might play a role in protection. We took advantage of the pandemic 2009 A(H1N1) influenza vaccination to conduct a longitudinal integrative multiparametric analysis of seven immune parameters in vaccinated subjects. A global analysis underlined the predominance of induction of humoral and CD4 T cell responses, whereas pandemic 2009 A(H1N1)-specific CD8 responses did not improve after vaccination. A principal component analysis and hierarchical clustering of individuals showed a differential upregulation of influenza vaccine-specific immunity including hemagglutination inhibition titers, IgA(+) and IgG(+) Ab-secreting cells, effector CD4 or CD8 T cell frequencies at day 21 among individuals, suggesting a fine-tuning of the immune parameters after vaccination. This is related to individual factors including the magnitude and quality of influenza-specific immune responses before vaccination. We propose a graphical delineation of immune determinants that would be essential for a better understanding of vaccine-induced immunity in vaccination strategies.
The Journal of Immunology 06/2013; 191(2). DOI:10.4049/jimmunol.1203483 · 5.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In France malaria is monitored by the Centre National de Référence (CNR) du Paludisme (French National Malaria Reference Centre). The annual incidence of imported malaria currently ranges from 4 800 to 3 500 cases and has fallen gradually since 2000. However, the proportion of patients with severe P. falciparum malaria is increasing (2.5% in 2000, 7% in 2011), particularly among French residents from sub-Saharan Africa who neglect preventive measures. Overall mortality remains stable at 0.4%, but survival is improving in severe cases. The survival rate is higher among patients of African origin than among Europeans. Nonetheless, between 10 and 20 patients die of malaria every year in France. Two large controlled trials published in 2005 and 2010 showed that IV artesunate, a new treatment for severe falciparum malaria, is associated with a 22-38% absolute reduction in mortality relative to quinine. Artesunate is not licensed in Europe but has been available in France since May 2011 through a named-patient program controlled by the French Agency for Drug Safety [ANSM]. The first 99 patients treated with artesunate up to September 2012 experienced satisfactory efficacy and tolerability. Delayed, sometimes persistent anemia was observed in 13 patients, a rate similar to that noted in recent reports on imported malaria in Europe. This unexpected adverse effect requires further investigation. IV artesunate is now recommended as the first-line treatment for severe falciparum malaria in France.
Bulletin de l'Académie nationale de médecine 03/2013; 197(3):699-714; discussion 714-6. · 0.22 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Treatment of hookworm-related cutaneous larva migrans (HrCLM) with a single dose of oral ivermectin has not been adequately evaluated to date. Response rates reported in three large studies varied from 77% to more than 95%. Objectives
We evaluated the efficacy of ivermectin in the treatment of HrCLM. Methods
We retrospectively studiedall returning travellers with HrCLM who consulted in our institution. Patients were then treated with a single, 200g/kg dose of ivermectin, orally. ResultsSixty-two travellers (35 female, 27 male, mean age 35.6years) with HrCLM and creeping dermatitis were included. Six patients (10%) also had associated hookworm folliculitis. Fifty-nine patients (95%) completely responded with one ivermectin dose. The response rate was 98% in the 56 patients presenting with only creeping dermatitis and 66% in the six patients presenting with additional hookworm folliculitis (P=0.02). Conclusion
The efficacy of a single dose of oral ivermectin is higher in patients with only creeping dermatitis than in those with associated hookworm folliculitis.
Journal of the European Academy of Dermatology and Venereology 02/2013; 28(5). DOI:10.1111/jdv.12097 · 3.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The emergence of multi-resistant bacteria (MRB) in developing countries (DCs) is a worrying phenomenon at regional and international levels with a risk of international spread through travelers. The French guidelines recommend a systematic screening in case of hospitalization, for the travelers who have been repatriated and for those with a history of hospitalization in a foreign country during the past year. A simple travel in DCs is not considered as a risk factor for colonization or infection with a MRB. We report the case of a 56-year-old man with acute prostatitis and epididymitis due to Extended-spectrum β-lactamase-producing Escherichia coli. He was returning from Southeast Asia with no history of hospitalization or recent use of antibiotics. However, he had unprotected sex during his travel. This case report leads us to discuss the different ways of acquiring this resistant bacterium during travel as well as the usefulness of expanding the screening of carriage for MRB in all travelers in case of hospitalization.
Bulletin de la Société de pathologie exotique 11/2012;
[Show abstract][Hide abstract] ABSTRACT: We report two cases of symptomatic neurocysticercosis in two migrants whose negative serology delayed appropriate treatment for 9 and 6 months, respectively. Seroconversion occurred after treatment, which was associated with paradoxical reaction in one patient. Long-term outcome was good in both patients.
Journal of Travel Medicine 10/2012; 19(6):383-6. DOI:10.1111/j.1708-8305.2012.00658.x · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Amebic liver abscesses (ALA) are not commonly described in travelers. The ALA diagnosis is usually based on serology and Entamoeba histolytica polymerase chain reaction (PCR) is a new tool. We retrospectively reviewed all ALA cases diagnosed by PCR on the liver abscess pus aspirate of patients admitted in French hospitals between 2007 and 2011. Fourteen cases (10 male, median age 48 years) were included. The median lag time between return and onset of symptoms was 23 days (interquartile range [IQ] 18-24). All patients had an elevated cardiopulmonary resuscitation level, and 11 had leukocytosis. The ALA was multiple in five patients, localized in the right lobe in 12, and higher than 5 cm in 11. Serology was initially negative in one patient, whereas PCR was positive. There was bacterial co-infection in one patient. The outcome was good. Liver puncture allows a rapid diagnosis of ALA with PCR and helps identify the association with a bacterial dual infection.
The American journal of tropical medicine and hygiene 10/2012; 87(6). DOI:10.4269/ajtmh.2012.12-0366 · 2.74 Impact Factor