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ABSTRACT: La leptospirose est jusqu’à présent peu étudiée et probablement sous-estimée au Cambodge, où existent pourtant des conditions
très favorables à sa circulation. Entre juin 2006 et juillet 2007, 612 patients, admis à l’hôpital de Takéo et à l’hôpital
Calmette de Phnom Penh pour un syndrome compatible avec la leptospirose, ont été recrutés pour recherche des marqueurs biologiques
de cette infection: mise en évidence de l’ADN bactérien par PCR et sérologie par Elisa-IgM et test de microagglutination (MAT).
Cent quatrevingt-trois patients (29,9 %) se sont révélés porteurs d’au moins un marqueur biologique de la leptospirose, dont
88 (14,4 %) présentaient un profil d’infection aiguë objectivé par une PCR positive. La proportion importante de patients
avec un profil de phase immune (15,5 %) suggère des contacts anciens avec les leptospires et la possibilité d’infections peu
ou pas symptomatiques. Treize sérogroupes de Leptospira ont été identifiés, avec prédominance de Panama, Pyrogenes et Australis,
illustrant la grande diversité des hôtes réservoirs. Le sérogroupe Icterohaemorrhagiae n’est retrouvé que dans 4 % des cas.
Aucun lien significatif entre l’infection et le sexe, la classe d’âge ou l’appartenance à une catégorie socioprofessionnelle
n’a pu être établi, suggérant une exposition permanente de la population dans sa vie quotidienne plutôt que l’existence de
groupes à risque majoré. Cette étude, la plus vaste réalisée à ce jour sur la leptospirose au Cambodge, confirme l’importance
de cette zoonose, devant être prise en compte comme un problème réel de santé publique dans ce pays.
Leptospirosis has been so far poorly described in Cambodia and is probably underdiagnosed in the current local medical practices,
although conditions to its active circulation exist in this country. Between June 2006 and July 2007, 612 patients admitted
to Takeo hospital and Calmette hospital in Phnom Penh presenting clinical symptoms compatible with leptospirosis, were recruited
for biological investigation of leptospirosis markers: PCR detection of bacterial DNA and serology using an Elisa-IgM test
and the micro-agglutination reference test (MAT). One hundred eighty-three patients (29.9%) were found to be carrying at least
one biological marker of leptospirosis, 88 (14.4%) showed an acute infection profile, evidenced by a positive PCR. The proportion
of patients with an immune phase profile (15.5%) suggests former contacts with Leptospira and possible infections with little
or no symptoms. Thirteen serogroups of Leptospira have been identified, with predominance of Panama, Pyrogenes and Australia,
illustrating a probable wide range of animal reservoir hosts. Serogroup Icterohaemorrhagiae was found in only 4% of cases,
contrasting with usual features of human leptospirosis. No significant link between infection and sex, age or occupation could
be established, suggesting a permanent exposure of the population in its daily life rather than the existence of risk groups.
This study, the largest conducted to date on leptospirosis in Cambodia, confirms the importance of this zoonotic disease,
that must be considered a real public health issue in this country.
Mots clésLeptospirose-Sérogroupe-Hôpital-Takéo-Phnom-Penh-Cambodge-Asie du Sud-Est
KeywordsLeptospirosis-Serogroup-Hospital-Takéo-Phnom-Penh-Cambodia-South-East Asia
Bulletin de la Société de pathologie exotique 04/2012; 103(2):111-118.
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ABSTRACT: Leptospirosis has been so far poorly described in Cambodia and is probably underdiagnosed in the current local medical practices, although conditions to its active circulation exist in this country. Between June 2006 and July 2007, 612 patients admitted to Takeo hospital and Calmette hospital in Phnom Penh presenting clinical symptoms compatible with leptospirosis, were recruited for biological investigation of leptospirosis markers: PCR detection of bacterial DNA and serology using an Elisa-IgM test and the micro-agglutination reference test (MAT). One hundred eighty-three patients (29.9%) were found to be carrying at least one biological marker of leptospirosis, 88 (14.4%) showed an acute infection profile, evidenced by a positive PCR. The proportion of patients with an immune phase profile (15.5%) suggests former contacts with Leptospira and possible infections with little or no symptoms. Thirteen serogroups of Leptospira have been identified, with predominance of Panama, Pyrogenes and Australia, illustrating a probable wide range of animal reservoir hosts. Serogroup Icterohaemorrhagiae was found in only 4% of cases, contrasting with usual features of human leptospirosis. No significant link between infection and sex, age or occupation could be established, suggesting a permanent exposure of the population in its daily life rather than the existence of risk groups. This study, the largest conducted to date on leptospirosis in Cambodia, confirms the importance of this zoonotic disease, that must be considered a real public health issue in this country.
Bulletin de la Société de pathologie exotique 03/2010; 103(2):111-8.
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ABSTRACT: This study aimed at describing the evolution of the epidemiological pattern of hepatitis A in New Caledonia since 1986 and the recent epidemic which occurred in 2005-2006, regarding particularly its demographic and virological aspects and the public health response implemented. The annual or monthly activity records for Hepatitis A sero-diagnostic performed at the Pasteur Institute of New Caledonia were processed in a retrospective analysis (9723 samples tested for the detection of IgM to hepatitis A). Over the 2004-2006 period, a phylogenetic study of representative strains from New Caledonia and other Pacific islands was carried out by the French National Reference Laboratory for hepatitis A (Paul-Brousse hospital, Villejuif, France). RESULTS: The continuous improvement of hygiene that occurred in New Caledonia during the last two decades led to a dramatic drop in the frequency of hepatitis A among patients tested, ranging from an average value of 79 cases (14%) for the 1986-1999 period to 0 case from 2002. However, in 2005, a strong increasing number of confirmed cases was notified, mainly among young people (78% were under the age of 20). In 2006, this epidemic reached the island of Futuna where it involved more than 1% of the total population (56 cases). The phylogenetic study has confirmed the clonality of the virus circulating during this epidemic, not related to other regional strains (Fiji, Vanuatu, New Zealand) nor with a New Caledonian strain from the previous endemic period. This transition situation, with persistence of a high epidemic risk, should encourage the health authorities to implement adapted response strategies, based in particular on systematic case declaration and targeted immunisation programmes.
Bulletin de la Société de pathologie exotique 11/2008; 101(4):336-42.
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ABSTRACT: The Pasteur Institute in New Caledonia performs for this territory the biological diagnosis of human leptospirosis; therefore its activity locally gives a rather exhaustive description of this pathology. The results presented here cover the 2001-2005 period and describe the principal epidemiological and biological features of human leptospirosis in New Caledonia. The investigated patients were recruited by the main medical structures: territorial and provincial hospitals, public dispensaries, clinics and general practitioners. The laboratory used the microagglutination test for serological investigations and PCR methods for the early detection of Leptospira genome in clinical samples. 239 cases of leptospirosis were biologically confirmed among 6690 tested patients, giving an average incidence of 21 cases per 100000/year, and a lethality rate of 5.4%. The sex-ratio was 1.8 male/female, patients were predominantly belonging to the 20-50 year age group and were inhabitants from the Northern Province. The circulating serogroups were mainly Icterohaemorrhagiae (69%), Australis (8%) and Pyrogenes (6%). The annual incidence peak occurred in April at the end of the warm season, and the importance of annual outbreaks could be linked with El Ninõ, the main regional climatic phenomenon.
Bulletin de la Société de pathologie exotique 06/2007; 100(2):133-8.
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ABSTRACT: Leptospirosis is a severe zoonotic disease that constitutes a major public health problem for the island populations of French Polynesia. Due to protean clinical manifestations and the risk of misdiagnosis with dengue fever, endemic viral disease, laboratory studies are necessary to confirm diagnosis of leptospirosis. At the request of the Pacific Public Health Surveillance Network, a prospective study was conducted in the population of Raieatea in the Windward Islands and the Marquis Islands to determine the epidemiological features of the disease and to define appropriate control measures. A total of 113 patients were enrolled in study between March 2004 and March 2005. Thirty-three cases were confirmed based on demonstration of serum DNA or seroconversion. The estimated annual incidence of leptospirosis was 1.7 per 1000 inhabitants. Cases involved mainly (75%) young men (mean age, 30.5 years) and occurred predominantly during the rainy season. Swimming in fresh water was the only factor showing significant correlation (p < 0.02) with positive diagnosis of leptospirosis. The most frequently identified serotype was Leptospira icterohemorrahgiae (43% of strains), thus suggesting that the rat was the most common human transmission vector. However other serotypes were found, underlining the presence of diverse reservoirs and casting doubt on the efficacy of immunization using a monovalent vaccine. These findings also indicate that enhancement of prevention and control measures for leptospirosis is needed.
Médecine tropicale: revue du Corps de santé colonial 04/2007; 67(2):137-44.
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ABSTRACT: We report a retrospective study of an epidemic of dengue in New-Caledonia (South Pacific) in 2003 among adult inpatients. The aim was to establish clinical and biological criteria for the severity of the infection at the time of admission. During 7 months, all inpatients older than 15 y having a laboratory-confirmed diagnosis of dengue fever (IgM or PCR) were included (n=170). Two groups were defined: severe cases (death and/or transfer to intensive care unit, n=24) and benign cases (n=146). Data were analysed using Epi-Info software. Univariate analysis showed that shock, haemorrhage and neurological complications were significantly more frequent in serious cases, respectively 37.5% vs 0.7%, 62.5% vs 32.2%, 25% vs 9.6% (p<0.05). Relevant biological criteria were: creatinine > 140 micromol/l (OR 12 (95% CI 3.93-37.44)), free bilirubin > 18 micromol/l (OR 12.69 ( 95% CI 2.88-59.5)), amylase > 220 UI/l (OR 27.34 (95% CI 4.57-210)) and platelets < 45,000/mm3 (OR 4.35 (95% CI 1.43-14.2)) with p<0.005 (VPP = 100% for association of 3 criteria). We suggest this combination of 4 biological criteria inclines to severity.
Scandinavian Journal of Infectious Diseases 01/2006; 38(8):675-81. · 1.72 Impact Factor
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ABSTRACT: Evaluation of Toxoplasmosis seroprevalence was conducted in 2416 women of childbearing age by Pasteur Institute of New-Caledonia. The estimated seroprevalence was 56.7%, significantly higher in the North-East part of the territory (79.1%), area characterized by strong precipitations, and in the Melanesian ethnic group (62.1%). The habits of this population could enhance contamination by ingestion of oocysts during childhood or adolescence, particularly in the North-East territory. Melanesian women living in the North-East and being not immunized against toxoplasmosis represent the population with the highest risk for Toxoplasma gondii infection.
Bulletin de la Société de pathologie exotique 12/2004; 97(4):271-3.
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ABSTRACT: To evaluate the HIV prevalence among pregnant women in New-Caledonia and to analyse the uptake of testing among the patients according to their demographic data.
The study was based on statistical exploitation of anonymously recorded HIV test results during the follow-up of pregnant women. The first 12-month assessment of this monitoring (April 1999--March 2000) is reported.
88.6% of the 3380 patients were tested for HIV, significantly less in Wallisian and Melanesian groups of women. Two results were positive, which corresponds to a prevalence of 0.66 +/- 0.45 per thousand (0.21-1.11 per 1000) within the studied group. Although our study is not representative of this situation, lack of testing for women undergoing an abortion was frequent.
This study indicates that offering HIV testing in pregnancy follow-up is fairly systematic and most often accepted. Evidently, there is a need for adjusting of pre-test counselling to the cultural and ethnic characteristics of the woman, to the preparedness of medical staff as well as to the problem of HIV screening in abortion management. Our prevalence data also show that New-Caledonia ranks among countries of low endemicity for HIV where pregnant women are concerned.
Bulletin de la Société de pathologie exotique 07/2002; 95(2):109-14.
