[Leishmania (Viannia) braziliensis Vianna, 1911 in French Guiana. Clinical, therapeutic and epidemiological considerations in the ninth human diagnosed case]

The authors report the ninth case of cutaneous Leishmaniasis without mucosal involvement due to Leishmania (Viannia) braziliensis (isoenzymatic profile related to zymodeme MON-44) diagnosed in a legionnaire who recently arrived in French Guiana. The skin lesion as a single ulcerated nodule of the dorsum of the left ringfinger was cured after two courses of four intramuscular injections of pentamidine isothionate (total posology of pentamidine-base: 16.6 mg/kg). The transmission occurred during nocturnal trekking in forest and swamps just behind the coastal belt at Degrad Saramaka (7 km South of Kourou). In French Guiana, the good level of medical care and the early treatment of the majority of the cases of Leishmaniasis may explain the rarity of mucosal lesions. Since the clinical aspect of the lesion is not sufficient to prejudge the identity of the causative species, it is necessary to perform cultivation of Leishmania for iso-enzymatic identification. The adaptation of pentamidine doses and long term follow up of patients infected by L. (V.) braziliensis could be defined more precisely.

[Disseminated histoplasmosis: 2 cases in patients with human immunodeficiency virus infection in French Guiana]

The authors report two cases of disseminated histoplasmosis occurring in HIV-infected patients living in French Guiana. The first case was an acute disseminated histoplasmosis with a rapid fatal evolution. The second case was diagnosed on a mucosal localisation, and improved under itraconazole therapy. These two cases show the diversity of the clinical course of this opportunistic infection. The authors focus on the difficulty of the diagnosis and the need for direct microscopic examination to identify histoplasma and to enable a swift therapeutic intervention.

Clustering and clinical diversity of adult T-cell leukemia/lymphoma associated with HTLV-I in a remote black population of French Guiana

An epidemiological study was performed in French Guiana (population 115,000) to determine the prevalence and incidence of adult T-cell leukemia/lymphoma (ATL) associated with human T-cell leukemia/lymphoma virus type I (HTLV-I). From January 1990 to December 1993, all suspected cases of ATL were enrolled in this study, and their clinical, epidemiological and immunovirological features were analyzed. Out of the 19 suspected cases, 18 were considered as ATL associated with HTLV-I (8 acute forms, 8 lymphoma types and 2 smoldering cases). Before this study, only 2 ATL cases had been reported in French Guiana over a 10-year period. This demonstrates that the number of ATL cases is greatly under-estimated in most tropical HTLV-I endemic areas unless a specific disease search is performed. The mean age of the patients was 41 years. While HTLV-I antibodies were present in all cases, molecular studies demonstrated a clonal integration of HTLV-I in the tumoral cells in 7 cases out of the 9 tested. Fifteen patients died within a year of diagnosis. The crude incidence rate of ATL in French Guiana is around 3.5/100,000/year, a situation similar to that found in the Caribbean and in HTLV-I-endemic regions of Japan. However it reaches around 30/100,000/year (highest incidence ever described) in a small remote ethnic group of African origin (around 6200 inhabitants). Possible causes of ATL clustering in this ethnic group are presented.

Granulomatous reaction and tissue remodelling in the cutaneous lesion of chromomycosis

The cell-mediated immune reaction was studied in the cutaneous lesion of chromomycosis, using monoclonal antibodies against polymorphonuclear neutrophils, macrophage and lymphocyte subsets, endothelial and fibroblast cells. In addition, immunostaining of the main degradative enzymes (neutrophil elastase and interstitial collagenase) and certain important cytokines (transforming growth factor-beta, tumour necrosis factor-alpha and interferon-gamma) suggested an explanation for the granulomatous reaction and the associated tissue remodelling. The distribution pattern of neutrophils and macrophage subsets, observed by computer-aided image analysis, suggests that the in situ persistence of fungi is the main pathological factor.

[Prurigo in tropical area. Importance of its association with HIV infection]

The term prurigo applies to a classic chronic skin disease of children (P. strophulus) which is becoming found very seldom in developed countries, but remains extraordinarily prevalent in tropical areas. This striking geographical distribution relies on its ectoparasitic origin. Some peculiar aspects of prurigo, observed in French Guyana (South America), are reported. The original point is a new aspect of adult acquired prurigo, associated with HIV infection, which appears to be one of the features characteristic of tropical AIDS. This HIV associated prurigo (HAP) is the revelating event, in as high as 20% of HIV infected people, significatively those with less than 200 CD4 cells. HAP appears as a marker of HIV infection with poor sensitivity, but much higher specificity (92%), with no correlation with acquisition's risk factors. Just like infantile prurigo, HAP can be considered an arthropod bite reaction which seems to be enhanced in HIV infected people living in tropical environment.

Virus excretion in the cervicovaginal secretions of pregnant and nonpregnant HIV-infected women

In order to estimate the prevalence of viral excretion in cervicovaginal secretions, we made a cross-sectional study of 55 HIV-infected women. The patient population was diverse, including pregnant and nonpregnant women in different disease stages from three centers. Virus replication was found in the cell-free supernatant from 12 of 55 cervicovaginal samples (21.8%) by coculture on the CD4-positive cell line CEM-C113. In addition, cell-associated virus was detected in five of a subgroup of 22 samples testing negatively on cell-free supernatant. The prevalence of HIV in the cell-free supernatant was not related to disease stage, zidovudine therapy, transmission group, or history of sexually transmitted diseases. Excretion of HIV was significantly higher in our population of pregnant women (eight of 21, 38%) compared with an unmatched group of nonpregnant women (four of 34, 11.8%; p = 0.04). These results provide evidence of cell-free virus shedding as well as the presence of cell-associated virus in the genital secretions of HIV-infected women.

Cell-matrix patterns in the cutaneous lesion of chromomycosis

Chromomycosis is a chronic fungal infection characterized by dermal fibrosis with persisting fungi in situ, generally leading to a verrucous skin lesion. The absence of good clinical results under specific treatment suggests irreversibility of the fibrotic lesion. Frozen and paraffin-embedded skin biopsies of eleven patients with chromomycosis due to Phialophora pedrosoi were studied by immunohistochemistry and electron microscopy. Distinct cell-matrix patterns were found in different tissue localizations: neutrophilic abscesses with oedema and necrotic keratinocytes in the epidermis; dense connective matrix around inflammatory infiltrates, mainly composed of macrophages and giant cells, and organized granuloma in the dermis. Active fibroblasts and mast cells were constantly observed. The inability of fibrotic tissue to be remodelled seems correlated to the nature and the organization of the matrix components but, the factors triggering the initial fibrogenic events remain to be characterized.

Chromoblastomycosis with malignant transformation and cutaneous-synovial secondary localization. The potential therapeutic role of itraconazole

A case of neoplastic transformation of lesions of chromoblastomycosis is reported in a 67-year-old farmer from French Guyana. An interesting aspect of this case was the appearance of new cutaneous lesions of chromoblastomycosis, in a different site from the original lesion, and the presence of an infected synovial cyst. The potential therapeutic role of itraconazole is discussed.

Epidemiological aspects of human cutaneous leishmaniasis in French Guiana

A follow-up study of 219 patients infected with parasitologically confirmed cutaneous leishmaniasis in French Guiana was made between 1981 and 1987. Cutaneous leishmaniasis appeared to be common in young male adults entering the forest for professional activities (84.2% of the cases). The lesions were generally of the classical ulcerative type. They were limited to the skin and preferentially located on the legs and forearms (20.7% and 19.8% respectively). Most of the cases (86.6%) represented primary infections, but 6.8% had a recurrent lesion at the site of an old, previously cured lesion.

[Infection by the human immunodeficiency virus (HIV) in French Guyana. Dermato-venereologic problems]

Dermato-venereal manifestations in HIV infection and its severe evolution stage, AIDS, is of particular importance in tropical zones: We may be suspicious of the viral infection and consequently to request serologic tests to confirm it. We get an explanation of the virus transmission during heterosexual relations by the frequent occurrence and importance of the genital manifestations, leading to consider AIDS as a true sexually transmitted disease. Beside the classical opportunistic infections, the authors draw the attention to three types of manifestations: prurigo, already well known in Haïti and Africa capillary dystrophies, already reported in Haïti donovanosis that, because its epidemiological and etiopathological peculiarities, should be listed within the possible opportunistic infection if we take into consideration the regional pathological environment. In an other correction, syphilis, lepra and cutaneous leishmaniasis have to be carefully monitored, because they are capable to evaluate unexpectedly in some immunodepressive diathesis. Importance of dermato-venereal pathology in black people in tropical zone is explained by the weakness of cutaneous corneal stratum, immunologic disorders linked up to accumulated parasitic pathologies, socio-cultural life with a sexuality without complex.

[Human immunodeficiency virus (HIV) infection in mothers and infants in French Guyana. Epidemiologic study apropos of 44 women having conceived 55 children]

The French Guyana is an Overseas French Department in South America, with 100,000 inhabitants among them are 20% of Haitian immigrants. At 31 December 1987, 103 AIDS cases have been recorded, 86% by heterosexual transmission. The first case dated May 1979 was retroactively diagnosed in an Haitian parturient, thank to her serum kept in the Pasteur institute of Cayenne. 44 women got their pregnancy during their HIV infection: 5 with clinical and biological evidence of AIDS, 7 developed AIDS after getting pregnant, and 10 out of these 12 women died. All of them were from a rather low social group and, generally, were not married. 43 are black (40 Haitians and 3 Guyanese Creoles), one is Indian and presented some psychic disorders. The mean age was 32 1/2 (from 15 to 51 years old). 55 babies were born: 12 developed AIDS (6 died during the first 15 months of their life); 14 are HIV +, 3 stillborns, 4 never tested and 22 developed negative reaction (with ELISA and Western-Blot) between 7.5 and 10 months of their life. Two Hutchinson's triads were observed. Prurigo is the most commonly skin manifestation observed.

Killer cells in human cutaneous leishmaniasis

In French Guiana, American cutaneous leishmaniasis is localized in the skin. The host response appears to be effective since few extra- or intracellular organisms can be found in tissue lesions, and we never observed any cutaneous dissemination or visceral involvement. However, this response is not fully effective since lesions may last for months. By using immunoperoxidase techniques and monoclonal antibodies directed against various cell populations, we examined the local immune response in skin biopsies. We found a high percentage of cells with the K/NK phenotype, a variable but usually high percentage of cells with the T cell phenotype bearing TAC receptors, and moderate numbers of monocytes and B cells. These results suggest that K/NK cells could play a role in the local control of parasite dissemination.

[Genital ulcers in French Guyana. Apropos of 231 cases screened in 2 years]

In fight against Sexually Transmitted Diseases (STD), 231 cases of genital ulcers were observed, in 1985 and 1986, in Cayenne (French Guiana) according to a clinical and laboratory study protocol described by the authors. The diagnosis shown, in 146 cases, one STD agent, with a high frequency of chancroid, herpes genitalis and primary syphilis. In addition, 18 cases of mixed genital infections are described: emphasis is laid on the great diversity of these associated diseases. 67 genital ulcers had not been caused by a STD agent, however in each case a complete laboratory investigation was done, and each patient received a treatment according to the diagnosis.

[Between Yucatan, Florida and French Guiana does lobomycosis exist in the Antilles?]

Lobomycosis, or Blastomicose queloidiforme de Jorge Lobo, has been described in men around the North of South America, Central America, and the case reported in Yucatan, Mexico, is the northest. The same disease has been seen in Dolphins in Florida, where the humans cases are unknown. Epidemiology, pathogenic curiosities, and diagnosis are presented for all practicians in the geographic area.

[24 cases of donovanosis in French Guiana]

24 cases of Donovanosis (Granuloma inguinale) have been observed at the Dermatology Clinic of the Centre Hospitalier of Cayenne (French Guyana) between 1970 and 1980, representing a high rate for a 60,000 population. All the patients were coloured people. The disease is more important in the cutaneous parts of the ano-genital areas, than on the mucous parts. The "carcinoid" aspects of some histopathological exams must be considered with the bacteriological research and the very soft clinical aspects. It is often caused by intrarectal sexual contacts whether homo- or heterosexual. The high rate of Donovanosis within the homosexual population is a good argument for an intestinal localisation of the germ Calymnatobacterium granulomatis. All the cases diagnosed show an individual susceptibility to this disease. A deficit of cellular immunity as found in lepromatous leprosy seems a very attractive hypothesis. The treatment with 4 g of streptomycin by day during 5 days or more is considered as the best actually.

[Dermatology in French Guiana]

In French Guayana, climatic and geographic conditions enhance development of numerous fungal, parasitic and microbial skin diseases. The most particular infectious diseases of this French department are lobomycosis, chromomycosis (Phialophora pedrosoi), creeping disease, cutaneous leishmaniasis, tungiasis, mycobacterial ulcus (Mycobacterium ulcerans) and papular dermatitis caused by nettling hairs of lepidoptera (Hylesia urticans). The occurence of these skin diseases is demonstrative of pathological ecology of the Amazonian country.