[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: L’émergence des bactéries multirésistantes (BMR) dans les pays en voie de développement (PVD) constitue un phénomène inquiétant à l’échelle locale et internationale. Les recommandations françaises actuelles incitent à dépister de façon systématique en cas d’hospitalisation, les patients rapatriés ou ceux ayant été hospitalisés à l’étranger dans l’année. En revanche, il n’existe pas de recommandation spécifique concernant les patients hospitalisés au retour d’un simple voyage dans les PVD. Nous rapportons le cas d’un homme de 56 ans présentant une épididymite et une prostatite aiguë à Escherichia coli producteur de β-lactamase à spectre étendu (BLSE) au retour d’Asie du Sud-Est sans notion d’hospitalisation ni de prise récente d’antibiotiques, mais avec une histoire de relations sexuelles multiples non protégées. Nous discutons les modalités possibles d’acquisition de cette bactérie et les conséquences potentielles sur les recommandations concernant le risque de portage et d’infection par une BMR au retour des PVD.
Bulletin de la Société de pathologie exotique 08/2013; 106(1).
[show abstract][hide abstract] ABSTRACT: La brucelosis es una antropozoonosis causada por Brucella, especie bacteriana de crecimiento intra y extracelular que ocasiona enfermedades genitales en los animales y se transmite al ser humano, principalmente por consumo de leche o manipulación de productos animales infectados. La enfermedad se distribuye por toda la cuenca mediterránea. Se trata de una infección granulomatosa crónica con manifestaciones clínicas variables, desde la frecuente infección asintomática, hasta la endocarditis con insuficiencia cardíaca aguda. Su signo clínico más constante es la fiebre «ondulante» crónica con sudoración y dolores difusos. El diagnóstico se basa en el aislamiento de la bacteria por cultivo, la seroaglutinación de Wright, las otras pruebas serológicas o el aislamiento de secuencias bacterianas por reacción en cadena de la polimerasa. El tratamiento, de una duración mínima de 6 semanas, implica varios antibióticos. El tratamiento de referencia consiste en administrar una ciclina asociada con rifampicina o con un aminoglucósido. La profilaxis se sitúa fundamentalmente en el ámbito de la sanidad animal, con medidas preventivas en las profesiones expuestas.
[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. · 1.68 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; · 5.52 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 studied all returning travellers with HrCLM who consulted in our institution. Patients were then treated with a single, 200 μg/kg dose of ivermectin, orally. RESULTS: Sixty-two travellers (35 female, 27 male, mean age 35.6 years) 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; · 2.69 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: 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; · 2.53 Impact Factor
[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. · 1.68 Impact Factor
[show abstract][hide abstract] ABSTRACT: We report a lateral rectus muscle paralysis occurring 2 weeks after initiation of an interferon-α and ribavirin treatment in a patient with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) virus co-infection. This patient presented with horizontal diplopia that appeared rapidly and without any other neurological symptoms. Symptoms fully resolved with treatment interruption without any ophthalmological sequelae. This side effect is rare and has never been reported in a HIV-HCV co-infected patient.
Journal of Infection and Chemotherapy 02/2012; · 1.55 Impact Factor
[show abstract][hide abstract] ABSTRACT: Identification of drug-induced liver disease (DILI) is difficult, even among hospitalized patients. The aim of this pilot study was to assess the impact of a specific strategy for DILI screening.
We prospectively compared the number of acute DILI cases identified in one week of a proactive strategy based on centralized elevated ALT values to those identified with a standard of care strategy for 24-week period based on referral cases to the hepatology unit. In the centralized strategy, a designated study biochemist identified patients with ALT greater than 3 times the upper limit of normal values (ULN) and notified the designated hepatologists, who then went to the patients' wards, analyzed the charts, and if necessary, interviewed the identified patients. During these two periods, patients with possible DILI were included after signing an informed consent in an ongoing European diagnostic study (SAFE-T consortium).
During the 24-week period of the standard strategy, 12 (0.04%) patients out of a total of 28,145 were identified as having possible DILI, and 11 of these accepted to be included in the protocol. During the one-week proactive period, 7 patients out of a total of 1407 inpatients (0.498%) [odds ratio vs. standard = 12.1 (95% CI, 3.9-32.3); P<0.0001] were identified with possible DILI, and 5 were included in the protocol.
A simple strategy based on the daily analysis of cases with ALT >3 ULN by designated biochemists and hepatologists identified 12 times more acute cases of drug-induced liver disease than the standard strategy. This pilot cohort is registered on the number AP-HP P110201/1/08-03-2011 and AFSSAPS B110346-70.
PLoS ONE 01/2012; 7(8):e42418. · 3.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: We report three cases of returning travelers evacuated from Algeria, Thailand, and Turkey by aero-medical repatriation, following overseas hospitalization in local intensive care units for accidental injuries or medical problems. All three patients presented with imipenem-resistant Acinetobacter baumannii infections. One died whereas two recovered.
Journal of Travel Medicine 09/2011; 18(5):358-60. · 1.68 Impact Factor
[show abstract][hide abstract] ABSTRACT: Although antiretroviral therapy for HIV infection prevents AIDS-related complications and prolongs life, it does not fully restore health. Long-term treated patients remain at a higher-than-expected risk of complications, including cardiovascular disease, cancer, osteoporosis and other end-organ diseases. The potential effect of HIV on health is perhaps most clearly demonstrated by the immune activation and inflammation that persist despite effective suppression of HIV replication.
Bulletin de l'Académie nationale de médecine 03/2011; 195(3):531-42; discussion 543-4. · 0.16 Impact Factor