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Lamoureux C, Drak Alsibai K, Pradinaud R, Sainte-Marie D, Couppie P, Blaizot R. Kaposi Sarcoma with Mucocutaneous Involvement in French Guiana: An Epidemiological Study between 1969 and 2019. Acta Derm Venereol 2022; 102:adv00709. [DOI: 10.2340/actadv.v102.581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Data on Kaposi sarcoma in French Guiana are scarce and out of date. This territory presents unique epidemiological features. The objectives of this retrospective study were to analyse the clinical features, outcome and incidence of the different forms of Kaposi sarcoma in patients diagnosed between 1969 and 2019. The study population comprised a total of 52 patients. Clinical forms included epidemic Kaposi sarcoma (n=30), endemic (n=18), iatrogenic (n=2), classic (n=1) and unclassified Kaposi sarcoma (n=1). The mean annual incidence rate of epidemic Kaposi reached a peak in the 1990s (0.93/100,000) then decreased in the 2000s (0.33/100,000), while the incidence of endemic Kaposi sarcoma reached a peak in the 1980s (0.82/100,000) before decreasing in the 2000s (0.12/100,000). Factors associated with the epidemic form were: sexual intercourse between men (p=0.0054) and Haitian origin (p=0.035). The presence of nodules and/or tumour, lesions limited to the lower limbs, and age >65 years were associated with the endemic form. While Creole populations seem to be as affected by endemic Kaposi sarcoma as their African counterparts, the dynamics of Kaposi sarcoma in French Guiana are now dominated by the epidemic form.
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Nacher M, Leitao TS, Gómez BL, Couppié P, Adenis A, Damasceno L, Demar M, Samayoa B, Cáceres DH, Pradinaud R, Sousa ADQ, Arathoon E, Restrepo A. The Fight against HIV-Associated Disseminated Histoplasmosis in the Americas: Unfolding the Different Stories of Four Centers. J Fungi (Basel) 2019; 5:jof5020051. [PMID: 31212897 PMCID: PMC6617033 DOI: 10.3390/jof5020051] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 11/17/2022] Open
Abstract
Disseminated histoplasmosis is a major opportunistic infection of HIV-infected patients, killing thousands in Latin America each year. Yet, it remains a neglected disease that is often confused with tuberculosis, for lack of simple, affordable, and rapid diagnostic tools. There is great heterogeneity in the level of histoplasmosis awareness. The purpose of this report was to describe how the historical “awakening” to the threat of histoplasmosis came to be in four different centers that have actively described this disease: In Brazil, the Sao José hospital in Fortaleza; in Colombia, the Corporación para Investigaciones Biológicas in Medellin; in French Guiana, Cayenne Hospital; and in Guatemala, the Association de Salud Integral in Guatemala city. In Brazil and French Guiana, the search for leishmaniasis on the buffy coat or skin smears, respectively, led to the rapid realization that HIV patients were suffering from disseminated histoplasmosis. With time and progress in fungal culture, the magnitude of this problem turned it into a local priority. In Colombia and Guatemala, the story is different because for these mycology centers, it was no surprise to find histoplasmosis in HIV patients. In addition, collaborations with the CDC to evaluate antigen-detection tests resulted in researchers and clinicians developing the capacity to rapidly screen most patients and to demonstrate the very high burden of disease in these countries. While the lack of awareness is still a major problem, it is instructive to review the ways through which different centers became histoplasmosis-aware. Nevertheless, as new rapid diagnostic tools are becoming available, their implementation throughout Latin America should rapidly raise the level of awareness in order to reduce the burden of histoplasmosis deaths.
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Affiliation(s)
- Mathieu Nacher
- Centre d'Investigation Clinique Antilles Guyane, Inserm CIC1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana.
- EA3593 Ecosystèmes Amazoniens et Pathologie Tropicale (EPaT), Université de Guyane, DFR Santé, 97300 Cayenne, French Guiana.
| | - Terezinha Silva Leitao
- Departamento de Doenças Infecciosas, Universidade Federal do Ceará, Fortaleza, 60020-181 Ceará, Brasil.
| | - Beatriz L Gómez
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, 110111 Bogota, Colombia.
| | - Pierre Couppié
- EA3593 Ecosystèmes Amazoniens et Pathologie Tropicale (EPaT), Université de Guyane, DFR Santé, 97300 Cayenne, French Guiana.
- Service de Dermatologie Vénéréologie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana.
| | - Antoine Adenis
- Centre d'Investigation Clinique Epidémiologie Clinique Antilles Guyane CIC INSERM 1424, Cayenne General Hospital, Cayenne, French Guiana.
| | - Lisandra Damasceno
- Departamento de Doenças Infecciosas, Universidade Federal do Ceará, Fortaleza, 60020-181 Ceará, Brasil.
| | - Magalie Demar
- EA3593 Ecosystèmes Amazoniens et Pathologie Tropicale (EPaT), Université de Guyane, DFR Santé, 97300 Cayenne, French Guiana.
- Laboratoire de Parasitologie-Mycologie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana.
| | - Blanca Samayoa
- Asociación de Salud Integral & Hospital General San Juan de Dios, 01001 Guatemala City, Guatemala, .
| | - Diego H Cáceres
- Studies in Translational Microbiology and Emerging Diseases (MICROS) Research Group, School of Medicine and Health Sciences, Universidad del Rosario, 110111 Bogota, Colombia.
| | - Roger Pradinaud
- Service de Dermatologie Vénéréologie, Centre Hospitalier de Cayenne, 97300 Cayenne, French Guiana.
| | | | - Eduardo Arathoon
- La Clinica Familiar de Luis Angel Garcia, 01001 Guatemala City, Guatemala.
| | - Angela Restrepo
- Corporacion para Investigaciones Biologicas, Hospital Pablo Tobon Uribe, 11001 Medellin, Colombia.
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Ouedraogo E, Blaizot R, Douine M, Nacher M, Sainte-Marie D, Caumes E, Pradinaud R, Couppie P. Évolution du traitement de l’infection à Mycobacterium ulcerans en Guyane de 1971 à 2015. Ann Dermatol Venereol 2018. [DOI: 10.1016/j.annder.2018.09.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Douine M, Gozlan R, Nacher M, Dufour J, Reynaud Y, Elguero E, Combe M, Velvin C, Chevillon C, Berlioz-Arthaud A, Labbé S, Sainte-Marie D, Guégan JF, Pradinaud R, Couppié P. L’infection à Mycobacterium ulcerans (ulcère de Buruli) en Guyane ; transition d’un profil épidémiologique africain vers un profil australien. Ann Dermatol Venereol 2017. [DOI: 10.1016/j.annder.2017.09.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Douine M, Gozlan R, Nacher M, Dufour J, Reynaud Y, Elguero E, Combe M, Velvin CJ, Chevillon C, Berlioz-Arthaud A, Labbé S, Sainte-Marie D, Guégan JF, Pradinaud R, Couppié P. Mycobacterium ulcerans infection (Buruli ulcer) in French Guiana, South America, 1969-2013: an epidemiological study. Lancet Planet Health 2017; 1:e65-e73. [PMID: 29851583 DOI: 10.1016/s2542-5196(17)30009-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/08/2017] [Accepted: 03/09/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Mycobacterium ulcerans infection is the third most common mycobacterial disease in the world after tuberculosis and leprosy. To date, transmission pathways from its environmental reservoir to humans are still unknown. In South America, French Guiana has the highest reported number of M ulcerans infections across the continent. This empirical study aimed to characterise the epidemiology of M ulcerans infection in French Guiana between 1969 and 2013. METHODS Data were collected prospectively mainly by two dermatologists at Cayenne Hospital's dermatology department between Jan 1, 1969, and Dec 31, 2013, for age, date of diagnosis, sex, residence, location of the lesion, type of lesion, associated symptoms, and diagnostic method (smear, culture, PCR, or histology) for all confirmed and suspected cases of M ulcerans. We obtained population data from censuses. We calculated mean M ulcerans infection incidences, presented as the number of cases per 100 000 person-years. FINDINGS 245 patients with M ulcerans infections were reported at Cayenne Hospital's dermatology department during the study period. M ulcerans infection incidence decreased over time, from 6·07 infections per 100 000 person-years (95% CI 4·46-7·67) in 1969-83 to 4·77 infections per 100 000 person-years (3·75-5·79) in 1984-98 and to 3·49 infections per 100 000 person-years (2·83-4·16) in 1999-2013. The proportion of children with infections also declined with time, from 42 (76%) of 55 patients in 1969-83 to 26 (31%) of 84 in 1984-98 and to 22 (21%) of 106 in 1999-2013. Most cases occurred in coastal areas surrounded by marshy savannah (incidence of 21·08 per 100 000 person-years in Sinnamary and 21·18 per 100 000 person-years in Mana). Lesions mainly affected limbs (lower limbs 161 [66%] patients; upper limbs 60 [24%] patients). We diagnosed no bone infections. INTERPRETATION The decrease of M ulcerans infection incidence and the proportion of children with infections over a 45 year period in this ultra-peripheral French territory might have been mostly driven by improving living conditions, prophylactic recommendations, and access to health care. FUNDING Agence Nationale de la Recherche.
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Affiliation(s)
- Maylis Douine
- Centre d'Investigation Clinique, Institut National de la Santé et de la Recherche Médicale 1424, Cayenne Hospital, Cayenne, French Guiana; Université de Guyane, EA3593 Epidémiologie des Parasitoses Tropicales, Cayenne, French Guiana
| | - Rodolphe Gozlan
- Institut de Recherche pour le Développement Unité Mixte de Recherche Biologie des Organismes et Ecosystèmes Aquatiques, Université Pierre et Marie Curie, Muséum National d'Histoire Naturelle, Paris, France
| | - Mathieu Nacher
- Centre d'Investigation Clinique, Institut National de la Santé et de la Recherche Médicale 1424, Cayenne Hospital, Cayenne, French Guiana; Université de Guyane, EA3593 Epidémiologie des Parasitoses Tropicales, Cayenne, French Guiana
| | - Julie Dufour
- Service de Dermatologie, Cayenne Hospital, Cayenne, French Guiana
| | - Yann Reynaud
- Institut Pasteur de la Guadeloupe, Tuberculosis and Mycobacteria Unit, Morne Jolivière, Les Abymes, Guadeloupe, France
| | - Eric Elguero
- Unité Mixte de Recherche Maladies Infectieuses et Vecteurs: Ecologie, Génétique, Evolution et Contrôle Institut de Recherche pour le Développement-Centre National de la Recherche Scientifique-Université de Montpellier, Centre Institut de Recherche pour le Développement de Montpellier, Montpellier, France
| | - Marine Combe
- Unité Mixte de Recherche Maladies Infectieuses et Vecteurs: Ecologie, Génétique, Evolution et Contrôle Institut de Recherche pour le Développement-Centre National de la Recherche Scientifique-Université de Montpellier, Centre Institut de Recherche pour le Développement de Montpellier, Montpellier, France
| | - Camilla J Velvin
- Unité Mixte de Recherche Maladies Infectieuses et Vecteurs: Ecologie, Génétique, Evolution et Contrôle Institut de Recherche pour le Développement-Centre National de la Recherche Scientifique-Université de Montpellier, Centre Institut de Recherche pour le Développement de Montpellier, Montpellier, France
| | - Christine Chevillon
- Unité Mixte de Recherche Maladies Infectieuses et Vecteurs: Ecologie, Génétique, Evolution et Contrôle Institut de Recherche pour le Développement-Centre National de la Recherche Scientifique-Université de Montpellier, Centre Institut de Recherche pour le Développement de Montpellier, Montpellier, France
| | - Alain Berlioz-Arthaud
- Institut Pasteur de la Guyane, Laboratoire de Biologie Médicale, Cayenne, French Guiana
| | - Sylvain Labbé
- Service D'Anatomie-Pathologique, Cayenne Hospital, Cayenne, French Guiana
| | | | - Jean-François Guégan
- Unité Mixte de Recherche Maladies Infectieuses et Vecteurs: Ecologie, Génétique, Evolution et Contrôle Institut de Recherche pour le Développement-Centre National de la Recherche Scientifique-Université de Montpellier, Centre Institut de Recherche pour le Développement de Montpellier, Montpellier, France; Future Earth United Nations International Programme, OneHealth Research Initiative, Montréal, QC, Canada
| | - Roger Pradinaud
- Service de Dermatologie, Cayenne Hospital, Cayenne, French Guiana
| | - Pierre Couppié
- Service de Dermatologie, Cayenne Hospital, Cayenne, French Guiana; Université de Guyane, EA3593 Epidémiologie des Parasitoses Tropicales, Cayenne, French Guiana.
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Nacher M, Carme B, Sainte Marie D, Couppié P, Clyti E, Guibert P, Pradinaud R. Influence of clinical presentation on the efficacy of a short course of pentamidine in the treatment of cutaneous leishmaniasis in French Guiana. Annals of Tropical Medicine & Parasitology 2016. [DOI: 10.1080/00034983.2001.11813645] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Carme B, Aznar C, Pradinaud R. Absence of a proven resurgence of Chagas disease or cutaneous leishmaniasis in French Guiana over the last two decades. Annals of Tropical Medicine & Parasitology 2016. [DOI: 10.1080/00034983.2001.11813677] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Clyti E, Caumes E, Deligny C, Sainte-Marie D, Couppie P, Pradinaud R. Folliculite ankylostomienne en Guyane française. Ann Dermatol Venereol 2016; 143:665-666. [DOI: 10.1016/j.annder.2016.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/18/2016] [Accepted: 05/18/2016] [Indexed: 11/29/2022]
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Linck V, Sambourg E, Demar M, Graille J, Blanchet D, Darrigade AS, Dufour J, Sainte-Marie D, Pradinaud R, Labbe S, Aznar C, Couppie P. La lobomycose en Guyane française : à propos de 20 observations. Ann Dermatol Venereol 2014. [DOI: 10.1016/j.annder.2014.09.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Roussel M, Nacher M, Frémont G, Rotureau B, Clyti E, Sainte-Marie D, Carme B, Pradinaud R, Couppié P. Comparison between one and two injections of pentamidine isethionate, at 7 mg/kg in each injection, in the treatment of cutaneous leishmaniasis in French Guiana. Annals of Tropical Medicine & Parasitology 2013; 100:307-14. [PMID: 16762111 DOI: 10.1179/136485906x105561] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In a retrospective study set in French Guiana, the efficacy and tolerance of the intramuscular treatment of cutaneous leishmaniasis (CL) with a single injection of pentamidine isethionate, at 7 mg/kg, were compared with those observed, earlier, using two such injections (given 48 h apart). Although 83.6% of the 281 patients given two injections each were cured, the single-injection protocol was generally as effective, curing 78.8% of 137 patients. The single-injection protocol was also associated with fewer adverse effects than the two-injection. In the treatment of "difficult" cases (those with satellite papules or relatively high numbers of amastigotes in their lesions), however, the two-injection protocol appeared significantly more effective than the single-injection. In French Guiana, therefore, patients with CL should be given one injection with pentamidine isethionate and only be given a second, 48 h later, if they have satellite papules and/or relatively high numbers of amastigotes in their lesions.
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Affiliation(s)
- M Roussel
- Service de Dermatologie, Centre Hospitalier Andrée Rosemon, Avenue des Flamboyants, 97 300 Cayenne, French Guiana
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Bommenel T, Launay O, Meynard JL, Gilquin J, Katlama C, Lascaux AS, Mahamat A, Martinez V, Pradier C, Rouveix E, Simon A, Costagliola D, Abgrall S, Abgrall S, Barin F, Bentata M, Billaud E, Boue F, Burty C, Cabie A, Costagliola D, Cotte L, de Truchis P, Duval X, Duvivier C, Enel P, Gasnault J, Gaud C, Gilquin J, Grabar S, Katlama C, Khuong MA, Lang JM, Lascaux AS, Launay O, Mahamat A, Mary-Krause M, Matheron S, Meynard JL, Pavie J, Pialoux G, Pilorge F, Poizot-Martin I, Pradier C, Reynes J, Rouveix E, Simon A, Tattevin P, Tissot-Dupont H, Viard JP, Viget N, Brosseau M, Salomon V, Jacquemet N, Guiguet M, Lanoy E, Lievre L, Selinger-Leneman H, Lacombe JM, Potard V, Bricaire F, Herson S, Desplanque N, Girard PM, Meyohas MC, Picard O, Cadranel J, Mayaud C, Clauvel JP, Decazes JM, Gerard L, Molina JM, Diemer M, Sellier P, Honore P, Jeantils V, Tassi S, Mechali D, Taverne B, Bouvet E, Crickx B, Ecobichon JL, Picard-Dahan C, Yeni P, Berthe H, Dupont C, Chandemerle C, Mortier E, Tisne-Dessus D, Weiss L, Salmon D, Auperin I, Roudiere L, Fior R, Delfraissy JF, Goujard C, Jung C, Lesprit P, Vittecoq D, Fraisse P, Rey D, Beck-Wirth G, Stahl JP, Lecercq P, Gourdon F, Laurichesse H, Fresard A, Lucht F, Bazin C, Verdon R, Chavanet P, Arvieux C, Michelet C, Choutet P, Goudeau A, Maitre MF, Hoen B, Elinger P, Faller JP, Borsa-Lebas F, Caron F, Daures JP, May T, Rabaud C, Berger JL, Remy G, Arlet-Suau E, Cuzin L, Massip P, Thiercelin Legrand MF, Pontonnier G, Yasdanpanah Y, Dellamonica P, Pugliese P, Aleksandrowicz K, Quinsat D, Ravaux I, Delmont JP, Moreau J, Gastaut JA, Retornaz F, Soubeyrand J, Galinier A, Ruiz JM, Allegre T, Blanc PA, Bonnet-Montchardon D, Lepeu G, Granet-Brunello P, Esterni JP, Pelissier L, Cohen-Valensi R, Nezri M, Chapadaud S, Laffeuillade A, Raffi F, Boibieux A, Peyramond D, Livrozet JM, Touraine JL, Trepo C, Strobel M, Bissuel F, Pradinaud R, Sobesky M, Contant M. Comparative effectiveness of continuing a virologically effective first-line boosted protease inhibitor combination or of switching to a three-drug regimen containing either efavirenz, nevirapine or abacavir. J Antimicrob Chemother 2011; 66:1869-77. [DOI: 10.1093/jac/dkr208] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Deligny C, Sainte-Marie D, Clyti E, Couppié P, Arfi S, Piette JC, Pradinaud R. Faible incidence du lupus systémique en Guyane française : rôle du paludisme ? Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Clyti E, Deligny C, Versapuech J, Couppie P, Gessain A, Pradinaud R. [Acral crusted scabies in two HTLV1-infected patients]. Ann Dermatol Venereol 2010; 137:232-3. [PMID: 20227570 DOI: 10.1016/j.annder.2010.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 12/18/2009] [Indexed: 10/19/2022]
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Deligny C, Clyti E, Sainte-Marie D, Couppie P, Huong DLT, Piette JC, Arfi S, Pradinaud R. Incidence of chronic cutaneous lupus erythematosus in French Guiana: A retrospective population-based study. Arthritis Care Res (Hoboken) 2010; 62:279-82. [DOI: 10.1002/acr.20079] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Clyti E, Couppie P, Pradinaud R, del Giudice P, Sainte-Marie D, Nacher M, Deligny C. An Urban Epidemic of Human Myiasis Caused by Dermatobia hominis in French Guiana. Am J Trop Med Hyg 2008. [DOI: 10.4269/ajtmh.2008.79.797] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Clyti E, Deligny C, Nacher M, Del Giudice P, Sainte-Marie D, Pradinaud R, Couppie P. An urban epidemic of human myiasis caused by Dermatobia hominis in French Guiana. Am J Trop Med Hyg 2008; 79:797-798. [PMID: 18981525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
We report the onset of an urban epidemic of human myiasis caused by Dermatobia hominis. To our knowledge, this is the first urban epidemic described for D. hominis. The epidemic was most likely related to exceptional weather conditions and notably high rainfall in January 2000, which may have facilitated the maturation of the pupae.
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Affiliation(s)
- Emmanuel Clyti
- Institut Guyanais de Dermatologie Tropicale, Service de Dermatologie, Centre Hospitalier de Cayenne, BP 6006, 97306 Cayenne, France.
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Clyti E, Pages F, Pradinaud R. [Update on Dermatobia hominis: South American furuncular myiasis]. Med Trop (Mars) 2008; 68:7-10. [PMID: 18478762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Furuncular myiasis is an infestation of the skin caused by Dermatobia hominis larvae known as "ver macaque" in French Guyana, "berne" in Brazil, "torsalo" in Colombia, or "human botfly" in English-language literature. It has identical features in man and domestic mammals. The primary lesion consists of a boil-like inflammatory papule with a central punctum exuding a serosanguinous discharge. The respiratory sinus of the D. hominis larvae may be visible through the punctum. Myiasis secondary to D. hominis accounts for 10% of imported tropical dermatosis observed in Paris. Diagnosis of furuncular myiasis should be considered in any patient with a history of travel or residence in an endemic area. Treatment depends mainly on mechanical removal that may be facilitated by injection of lidocaine into the lesion or prior application of a 1% solution of ivermectin.
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Affiliation(s)
- E Clyti
- Service de dermatologie, Institut Guyanais de dermatologie Tropicale, Centre hospitalier de Cayenne, France.
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Clyti E, Klisnik J, Sainte-Marie D, Pradinaud R, Couppié P. Placards papulo-croûteux prurigineux des régions malaires. Ann Dermatol Venereol 2007; 134:79-80. [PMID: 17384555 DOI: 10.1016/s0151-9638(07)89001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- E Clyti
- Service de Dermatologie, Centre Hospitalier Andrée Rosemon de Cayenne, BP 6006, 97306 Cayenne Cedex.
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Pradinaud R. C10 - L’infection à Mycobacterium ulcerans ne doit plus être restreinte à l’impropre appellation « ulcère de Buruli ». Ann Dermatol Venereol 2007. [DOI: 10.1016/s0151-9638(07)89031-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Demodecidosis is an ectoparasitosis that is infrequently observed in subjects with human immunodeficiency virus (HIV) infection. It has a rosacea-like presentation. We present three cases in patients with acquired immunodeficiency syndrome (AIDS). Two of these patients had a profuse eruption, and all three cases were cured by ivermectin. The single-dose treatment could be repeated in cases of subsequent recurrence. Ivermectin thus seems to be a good alternative in the treatment of demodecidosis in patients with HIV infection.
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Affiliation(s)
- Emmanuel Clyti
- Institut Guyanais de Dermatologie Tropicale, Service de Dermatologie, Center Hospitalier de Cayenne, Cayenne, France.
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Costagliola D, Potard V, Duvivier C, Pradier C, Dupont C, Salmon D, Duval X, Billaud E, Boué F, Costagliola D, Duval X, Duvivier C, Enel P, Fournier S, Gasnault J, Gaud C, Gilquin J, Grabar S, Khuong MA, Lang JM, Mary-Krause M, Matheron S, Meyohas MC, Pialoux G, Poizot-Martin I, Pradier C, Rouveix E, Salmon-Ceron D, Sobel A, Tattevin P, Tissot-Dupont H, Yasdanpanah Y, Aronica E, Tirard-Fleury V, Tortay I, Abgrall S, Costagliola D, Grabar S, Guiguet M, Lanoy E, Leneman H, Lièvre L, Mary-Krause M, Potard V, Saidi S, Matheron S, Vildé JL, Leport C, Yeni P, Bouvet E, Gaudebout C, Crickx B, Picard-Dahan C, Weiss L, Tisne-Dessus D, Tarnier-Cochin GH, Sicard D, Salmon D, Gilquin J, Auperin I, Viard JP, Roudière L, Boué F, Fior R, Delfraissy JF, Goujard C, Lesprit P, Jung C, Meyohas MC, Meynard JL, Picard O, Desplanque N, Cadranel J, Mayaud C, Pialoux JF, Rozenbaum W, Bricaire F, Katlama C, Herson S, Simon A, Decazes JM, Molina JM, Clauvel JF, Gerard L, Widal GHLF, Sellier P, Diemer M, Dupont C, Berthé H, Saïag P, Mortier E, Chandemerle C, de Truchis P, Bentata M, Honoré P, Tassi S, Jeantils V, Mechali D, Taverne B, Laurichesse H, Gourdon F, Lucht JF, Fresard A, de Dijon C, de Belfort CH, Faller JP, Eglinger P, Bazin C, Verdon R, de Grenoble C, de Lyon C, Peyramond D, Boibieux A, Touraine JL, Livrozet JM, Trepo C, Cotte L, Ravaux I, Tissot-Dupont H, Delmont JP, Moreau J, Gastaut JA, Poizot-Martin I, Soubeyrand J, Retornaz F, Blanc PA, Allegre T, Galinier A, Ruiz JM, d'Arles CH, d'Avignon CH, Lepeu G, Granet-Brunello P, Pelissier L, Esterni JP, de Martigues CH, Nezri M, Cohen-Valensi R, Laffeuillade A, Chadapaud S, de Nîmes JRCHG, May T, Rabaud C, Raffi F, Billaud E, Pradier C, Pugliese P, Michelet C, Arvieux C, Caron F, Borsa-Lebas F, Lang JM, Rey D, de Mulhouse PFCH, Massip P, Cuzin L, Arlet-Suau E, Legrand MFT, Rangueil CHU, de Tourcoing CH, Yasdanpanah Y, Sobesky M, Pradinaud R, Gaud C, Contant M. Impact of Newly Available Drugs on Clinical Progression in Patients with Virological Failure after Exposure to Three Classes of Antiretrovirals. Antivir Ther 2005. [DOI: 10.1177/135965350501000406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To study the prognosis of HIV-infected patients with virological failure after exposure to three classes of antiretroviral drugs (ARVs). Design Cohort study. Setting: French Hospital Database on HIV. Patients Patients previously exposed to at least two nucleoside reverse transcriptase inhibitors (NRTIs), two protease inhibitors and one non-NRTI, with viral load (VL) values of >5000 copies/ml after the exposure criteria were met and a new treatment initiated between 1998 and 2001 with VL >5000 copies/ml. Main outcome measures Risk of new AIDS-defining-events (ADEs) or death from first introduction of a drug never used before occurring between 1998 and 2001 defined as baseline. Results The main baseline characteristics of the 1092 patients were: previous ADE in 49% of cases, median CD4 cell count 181 μl, median VL 4.9 log10 copies/ml, median duration of ARV therapy 5.0 years and previous exposure to a median of nine ARVs. The crude progression rates were 20.1/100 patient-years among patients included in 1998, 15.1 in 1999, 11.1 in 2000 and 8.6 in 2001. After adjustment for baseline characteristics, the calendar year of inclusion was associated with the risk of clinical progression ( P<0.001). When the types of newly available drugs used at baseline or during follow-up were introduced into the model, year of inclusion was no longer associated with the risk of clinical progression ( P=0.42), while exposure to amprenavir/r, lopinavir/r, abacavir or tenofovir was associated with a lower risk. Conclusions The clinical prognosis of heavily pretreated patients experiencing virological failure improved between 1998 and 2001, mainly thanks to the use of newly available drugs with more favourable resistance profiles.
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Affiliation(s)
| | | | - Valérie Potard
- INSERM U720, Université Pierre et Marie Curie, Paris, France
| | - Claudine Duvivier
- INSERM U720, Université Pierre et Marie Curie, Paris, France
- CHU Pitié-Salpétrière, AP-HP, Paris, France
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- Hôpital Bichat-Claude Bernard
| | | | | | | | | | - L Weiss
- Hôpital Européen Georges Pompidou
| | | | | | - D Sicard
- Hôpital Européen Georges Pompidou
| | - D Salmon
- Hôpital Européen Georges Pompidou
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Couppié P, Clyti E, Sobesky M, Bissuel F, Del Giudice P, Sainte-Marie D, Dedet JP, Carme B, Pradinaud R. Comparative study of cutaneous leishmaniasis in human immunodeficiency virus (HIV)-infected patients and non-HIV-infected patients in French Guiana. Br J Dermatol 2005; 151:1165-71. [PMID: 15606511 DOI: 10.1111/j.1365-2133.2004.06226.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Few data are available on cutaneous leishmaniasis caused by dermotropic species in human immunodeficiency virus (HIV)-infected patients. OBJECTIVES To describe nine cases of cutaneous leishmaniasis in HIV+ patients and to compare their clinical features and their response to treatment with those of HIV- patients with the forms of leishmaniasis commonly found in French Guiana. METHODS A case-control study was carried out between July 1994 and December 2000 in French Guiana. We compared the following variables in nine HIV-infected patients with leishmaniasis and 27 matched controls: clinical type of leishmaniasis, number of lesions, presence of lymphangitis and adenopathy, the rate of recovery after treatment, and recurrence or reinfection. RESULTS Eight of the HIV-infected patients had localized cutaneous leishmaniasis and one had mucocutaneous leishmaniasis. All of the controls had localized cutaneous leishmaniasis. Leishmania guyanensis was the only species isolated from HIV-infected subjects. HIV-Leishmania coinfected patients had a higher rate of recurrence or reinfection (P < 0.02) and a lower rate of recovery after one treatment cycle with pentamidine (P < 0.02) than did HIV- subjects. The CD4+ lymphocyte counts exceeded 200 mm(-3) in all HIV+ patients at the time of the diagnosis with leishmaniasis. CONCLUSIONS In French Guiana, cutaneous leishmaniasis in moderately immunosuppressed HIV-infected subjects (> 200 CD4+ T cells mm(-3)) is characterized by a higher rate of recurrence or reinfection and is more difficult to treat than that in HIV- subjects.
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Affiliation(s)
- P Couppié
- Institut Guyanais de Dermatologie Tropicale, Service de Dermatologie, Centre Hospitalier de Cayenne, Rue des Flamboyants, BP 6006, 97300 Cayenne, French Guiana.
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Pradinaud R. [The mycobacterium infection cannot be called "Buruli ulcer" any longer]. Bull Soc Pathol Exot 2005; 98:26-7. [PMID: 15915969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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Abstract
THE SITUATION: Buruli's ulcer is a severe necrotic cutaneous infection due to Mycobacterium ulcerans. It is a major public health problem in developing countries. FROM A CLINICAL POINT OF VIEW: The early stage of the infection corresponds to a painless cutaneous nodule, whereas the late stage corresponds to ulceration with detachment of the edges. There is currently no other treatment than surgical excision combined with heat therapy. FROM A DIAGNOSTIC POINT OF VIEW: Three methods can be used: direct examination of swabs stained according to Ziehl-Neelsen's method, culture in specific medium at 32 degrees C and the polymerization chain reaction assay (PCR). The latter is the technique of choice.
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Affiliation(s)
- G Prévot
- Laboratoire d'immunologie des leishmanioses, Institut Pasteur, Cayenne, Guyane française.
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Sarazin F, Sainte-Marie D, Demar M, Aznar C, Sarrouy J, Pradinaud R, Carme B, Couppié P. Paracoccidioïdomycose cutanéo-muqueuse Premier cas diagnostiqué en Guyane Française. Ann Dermatol Venereol 2005; 132:136-9. [PMID: 15798564 DOI: 10.1016/s0151-9638(05)79225-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION 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. OBSERVATION 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. DISCUSSION Because the patient had just moved to Guiana, this observation probably corresponded to an imported disease. The principle differential diagnosis was leishmaniosis.
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Affiliation(s)
- F Sarazin
- Service de Dermatologie, Centre Hospitalier, Cayenne, Guyane Française
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26
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Denion E, Dalens PH, Couppié P, Aznar C, Sainte-Marie D, Carme B, Petitbon J, Pradinaud R, Gérard M. External ophthalmomyiasis caused by Dermatobia hominis. A retrospective study of nine cases and a review of the literature. ACTA ACUST UNITED AC 2004; 82:576-84. [PMID: 15453857 DOI: 10.1111/j.1600-0420.2004.00315.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To report nine cases of external ophthalmomyiasis caused by Dermatobia hominis. METHODS Retrospective, non-comparative, interventional case series. Participants consisted of patients (n = 9) presenting at Cayenne Hospital between 1968 and 2003. The location and number of larvae, the larval stage, and the medical and surgical procedures applied were studied in each case. RESULTS Seven patients had palpebral myiasis (including one with three larvae) and two had conjunctival myiasis. Every patient had palpebral oedema. The larval respiratory pore was located on the palpebral skin or free margin or on the conjunctiva. Movements were present within the lesion in at least three patients. Petroleum ointment or ivermectine solution was used in at least four patients to smother or kill the larvae. Extraction under local anaesthesia was possible in six patients, while three required general anaesthesia. CONCLUSION Several larvae may be present in a patient. Topical ivermectine may help to kill the larvae before extraction is attempted.
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Affiliation(s)
- Eric Denion
- Ophthalmology Department, Cayenne Hospital, Cayenne, French Guiana.
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27
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Couppié P, Clyti E, Sainte-Marie D, Dedet JP, Carme B, Pradinaud R. Disseminated cutaneous leishmaniasis due to Leishmania guyanensis: case of a patient with 425 lesions. Am J Trop Med Hyg 2004; 71:558-60. [PMID: 15569784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
Disseminated cutaneous leishmaniasis is characterized by the presence of a large (> or =10) number of lesions at several anatomic sites (head, limbs, and trunk). Most of the lesions are small, papular, and appear simultaneously with or secondarily to one or several ulcerated lesions of localized cutaneous leishmaniasis. We report the first case of disseminated cutaneous leishmaniasis in French Guiana. It concerns a 24-year-old woman who tested negative for human immunodeficiency virus (HIV). The disease began with three lesions that became ulcerated. One week later, multiple papulo-nodular lesions appeared. We counted a total of 425 lesions. Leishmania were observed in the lesions. The species involved was L. guyanensis, which has never been described in a case of disseminated cutaneous leishmaniasis. The patient was rapidly cured by a single course of pentamidine. Disseminated cutaneous leishmaniasis should be distinguished from other types of leishmaniasis with multiple lesions. These include anergic diffuse cutaneous leishmaniasis, post-kala-azar leishmaniasis, and leishmaniasis associated with HIV infection.
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Affiliation(s)
- P Couppié
- Institut Guyanais de Dermatologie Tropicale, Service de Dermatologie et Service Hospitalo-Universitaire de Parasitologie-Mycologie, Centre Hospitalier de Cayenne, Cayenne, French Guiana
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Deligny C, Martin K, Clyti E, Couppie P, Sainte Marie D, Pradinaud R. P17-4 Incidence du lupus systémique dans la population de la Guyane française (1995-1999). Rev Epidemiol Sante Publique 2004. [DOI: 10.1016/s0398-7620(04)99382-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
INTRODUCTION Azithromycine is recommended in the treatment of donovanosis with a 7-day treatment cycle. We report the efficacy of a single cure of 1 gram in two patients. OBSERVATIONS Four patients, presenting with donovanosis, were treated with azithromycine according to 2 regimens. The first used 500 mg/d the molecule during 1 week, the second used azithromycine in single cure of 1 gram. The latter led to the complete cure of 2 patients. DISCUSSION Many antibiotics are used in the treatment of donovanosis. Since 1996, Australian authors have used azithromycine in this indication. A single dose of this molecule appears effective in recent and confined donovanosis.
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Affiliation(s)
- E Clyti
- Service de Dermatologie, Centre Hospitalier Andrée Rosemon, BP 6006, 97306 Cayenne, Guyana.
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30
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Clyti E, Reynier C, Couppie P, Kazanji M, Sainte-Marie D, Prevost G, Aznar C, Pradinaud R. [Infective dermatitis and recurrent strongyloidiasis in a child]. Ann Dermatol Venereol 2004; 131:191-3. [PMID: 15026748 DOI: 10.1016/s0151-9638(04)93569-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Infective dermatitis is a chronic childhood dermatosis, associated with HTLV-1 infection. We report the observation of a young Haitian girl in French Guyana. OBSERVATION An 8 year-old girl presented recurring dermatosis on the scalp and armpits since she was 2 years old. The initial clinical examination showed the presence of centro-facial micro-papules, associated with a nasal pyodermatitis. A bacteriological culture isolated a Staphylococcus aureus. Phenotypic analysis did not indicate any production of exfoliatin or leucocidin. Serologic tests for HTLV1 were positive. In addition, the child presented recurring symptomatic anguillulosis, despite numerous antihelmintic treatments. A clinical and parasitological cure was obtained with a monthly treatment of ivermectin. COMMENTS This is the first case of infective dermatitis reported in french Guyana. The clinical analysis that led to this diagnosis showed a minor form of this dermatosis. The phenotypic analysis of the Staphylococcus aureus isolated from the cutaneous lesions did not indicate any factors of virulence habitually associated with pyodermatitis in Guyana. This is the first case of chronic digestive anguillulosis (a parasitic complaint usually associated with an adult HTLV-1 infection) associated with an infective dermatitis.
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Affiliation(s)
- E Clyti
- Service de Dermatologie, Centre Hospitalier Andrée Rosemon, BP 6006, 97306 Cayenne Cedex.
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Abstract
Concurrent infection with Taenia solium and HIV would be expected to occur more frequently because of the increasing frequency of HIV infection in endemic areas of cysticercosis. However, little is known about the influence of HIV infection on the frequency and the clinical course of cysticercosis. Giant cysts and racemose forms of neurocysticercosis seem to be more frequent in HIV-infected patients and may be secondary to an uncontrolled parasitic growth because of an impaired cell-mediated immune response. We report an unusual case of epidural spinal racemose neurocysticercosis revealed by compression of cauda equina in an HIV-infected man and discuss the potential interactions between T. solium and HIV infections.
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Affiliation(s)
- P Delobel
- Department of Infectious and Tropical Diseases, Purpan University Hospital, Toulouse, France.
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Abstract
Leishmania species can cause a wide spectrum of cutaneous disease in HIV-positive patients: asymptomatic, localized cutaneous, mucosal, muco-cutaneous, diffuse cutaneous or post-kala-azar leishmaniasis. In such cases, which are usually severely immunocompromised, the leishmanial parasites reach the skin of the human host by dissemination after either a new infection (resulting from the bite of infected sandfly or, probably, the sharing of contaminated syringes by intravenous-drug users) or the re-activation of a latent infection. Recent experience and past observations on the dermatology of leishmaniasis in those with Leishmania/HIV co-infection are reviewed here.
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Affiliation(s)
- L Puig
- Departamento de Dermatología, Hospital de la Santa Creu I Sant Pau, Avenida de Sant Antoni Maria Claret, 167, 08025 Barcelona, Spain.
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Prévot G, Bourreau E, Pascalis H, Pradinaud R, Tanghe A, Huygen K, Launois P. Differential production of systemic and intralesional gamma interferon and interleukin-10 in nodular and ulcerative forms of Buruli disease. Infect Immun 2004; 72:958-65. [PMID: 14742541 PMCID: PMC321599 DOI: 10.1128/iai.72.2.958-965.2004] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2003] [Revised: 09/08/2003] [Accepted: 11/14/2003] [Indexed: 11/20/2022] Open
Abstract
Buruli disease, caused by Mycobacterium ulcerans, is the third most important mycobacterial disease in humans besides tuberculosis and leprosy. We have compared systemic and intralesional cytokine production in patients presenting with a nodular form and a necrotizing, ulcerative form of the disease. Gamma interferon (IFN-gamma) levels in response to whole M. ulcerans and Mycobacterium bovis BCG bacilli and in response to purified Ag85 protein from BCG were lower in peripheral blood mononuclear cells (PBMC) cultures from Buruli disease patients than in PBMC from healthy purified protein derivative-positive contacts. Interleukin-4 (IL-4) and IL-13 content was below the detection threshold in these PBMC cultures. IFN-gamma production after stimulation with M. ulcerans was significantly lower (P < 0.05) in PBMC cultures from patients with ulcers than in those from patients with nodules. On the other hand, PBMC from Buruli disease patients produced significant levels of IL-10 in response to M. ulcerans (but not to M. bovis BCG) and production was highest in patients with the ulcerative form. Third, semiquantitative reverse transcription-PCR analysis demonstrated a similar difference in the local, intralesional cytokine profile for the two forms of the disease: high IFN-gamma but low IL-10 mRNA levels in nodular lesions and high IL-10 but low IFN-gamma mRNA levels in ulcerative lesions. Intralesional IL-4 and IL-13 mRNA levels were low and only detected in patients with the ulcerative form. Our results indicate, although they do not formally prove, that production of IL-10 rather than production of IL-4 or IL-13 by Th2-type T cells may be involved in the low M. ulcerans-specific IFN-gamma response in Buruli disease patients.
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Affiliation(s)
- Ghislaine Prévot
- Immunologie des Leishmanies, Institut Pasteur de la Guyane, Cayenne, French Guyana
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Couppié P, Sobesky M, Aznar C, Bichat S, Clyti E, Bissuel F, El Guedj M, Alvarez F, Demar M, Louvel D, Pradinaud R, Carme B. Histoplasmosis and acquired immunodeficiency syndrome: a study of prognostic factors. Clin Infect Dis 2003; 38:134-8. [PMID: 14679459 DOI: 10.1086/379770] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2003] [Accepted: 08/06/2003] [Indexed: 11/03/2022] Open
Abstract
We aimed to identify prognostic factors for AIDS-associated disseminated histoplasmosis. In a multivariate analysis, we found that dyspnea, a platelet count of <100,000 platelets/mm3, and lactate dehydrogenase levels of >2 times the upper limit of the normal range were significantly independently associated with the death of the patient during the first 30 days of antifungal treatment.
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Affiliation(s)
- Pierre Couppié
- Service de Dermatologie-Vénéréologie, Centre Hospitalier de Cayenne, French Guiana.
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35
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Delobel P, Launois P, Djossou F, Sainte-Marie D, Pradinaud R. American cutaneous leishmaniasis, lepromatous leprosy, and pulmonary tuberculosis coinfection with downregulation of the T-helper 1 cell response. Clin Infect Dis 2003; 37:628-33. [PMID: 12942392 DOI: 10.1086/376632] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2003] [Accepted: 04/04/2003] [Indexed: 11/03/2022] Open
Abstract
Cutaneous leishmaniasis, leprosy, and tuberculosis are caused by intracellular pathogens whose development depends on impaired cell-mediated immunity. We report an exceptional triple association of American cutaneous leishmaniasis, lepromatous leprosy, and pulmonary tuberculosis in a man with no recognized immunodeficiency. Normal immunological assessment of the interferon-gamma pathway does not support the hypothesis of a genetic defect in any of the genes involved in the T helper (Th)-1 cytokine cascade in this patient. Unresponsiveness to interleukin (IL)-12 of his T cells after stimulation with Leishmania guyanensis, Mycobacterium bovis bacille Calmette-Guérin, and Mycobacterium leprae antigens suggested the inability to mount an appropriate Th cell response to upregulate the IL-12 receptor expression.
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MESH Headings
- Adult
- Animals
- Brazil
- Down-Regulation/immunology
- French Guiana
- Humans
- Leishmania guyanensis/drug effects
- Leishmania guyanensis/immunology
- Leishmania guyanensis/isolation & purification
- Leishmaniasis, Cutaneous/blood
- Leishmaniasis, Cutaneous/complications
- Leishmaniasis, Cutaneous/diagnosis
- Leishmaniasis, Cutaneous/drug therapy
- Leprosy, Lepromatous/blood
- Leprosy, Lepromatous/complications
- Leprosy, Lepromatous/diagnosis
- Leprosy, Lepromatous/drug therapy
- Male
- Mycobacterium leprae/drug effects
- Mycobacterium leprae/immunology
- Mycobacterium leprae/isolation & purification
- Mycobacterium tuberculosis/drug effects
- Mycobacterium tuberculosis/immunology
- Mycobacterium tuberculosis/isolation & purification
- Radiography, Thoracic
- Receptors, Interleukin/biosynthesis
- Receptors, Interleukin-12
- T-Lymphocyte Subsets/immunology
- Th1 Cells/immunology
- Tuberculosis, Pulmonary/blood
- Tuberculosis, Pulmonary/diagnosis
- Tuberculosis, Pulmonary/diagnostic imaging
- Tuberculosis, Pulmonary/drug therapy
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Affiliation(s)
- Pierre Delobel
- Department of Infectious and Tropical Diseases, Purpan University Hospital, Toulouse, France.
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36
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Clyti E, Couppie P, Sainte-Marie D, Pradinaud R. [Post-traumatic ulcerations]. Ann Dermatol Venereol 2003; 130:791-2. [PMID: 14576613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- E Clyti
- Service de Dermatologie de Cayenne, BP 6006, 97306 Cayenne
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37
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Pascalis H, Lavergne A, Bourreau E, Prévot-Linguet G, Kariminia A, Pradinaud R, Rafati S, Launois P. Th1 cell development induced by cysteine proteinases A and B in localized cutaneous leishmaniasis due to Leishmania guyanensis. Infect Immun 2003; 71:2924-6. [PMID: 12704171 PMCID: PMC153268 DOI: 10.1128/iai.71.5.2924-2926.2003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The cysteine proteinases CPA and CPB from Leishmania major induced Th1 responses in patients with leishmaniasis due to Leishmania guyanensis. Furthermore, cysteine proteinases induced neither interleukin 4 (IL-4) nor IL-13 and low levels of IL-10 in controls and patients. The results suggest that CPs would be quite good candidates for a vaccine against different Leishmania species.
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Affiliation(s)
- Hervé Pascalis
- Immunologie des Leishmanioses, Institut Pasteur de le Guyane Française, Institut d'Etudes Supérieures de la Guyane, Université Antilles-Guyane, Cayenne, French Guiana
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Delobel P, Pradinaud R. Rhabdomyolysis associated with pentamidine isethionate therapy for American cutaneous leishmaniasis. J Antimicrob Chemother 2003; 51:1319-20. [PMID: 12668576 DOI: 10.1093/jac/dkg195] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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39
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Bourreau E, Gardon J, Pradinaud R, Pascalis H, Prévot-Linguet G, Kariminia A, Pascal L. Th2 responses predominate during the early phases of infection in patients with localized cutaneous leishmaniasis and precede the development of Th1 responses. Infect Immun 2003; 71:2244-6. [PMID: 12654849 PMCID: PMC152072 DOI: 10.1128/iai.71.4.2244-2246.2003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Intralesional Th2 responses preceded the development of Th1 responses in localized cutaneous leishmaniasis due to Leishmania guyanensis. Although the number of parasites increased in Th2 lesions, no correlation was found between the levels of cytokine expression and the number of parasites. In contrast, the decreased number of parasites in Th1 lesions is negatively correlated to gamma interferon expression.
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Affiliation(s)
- Eliane Bourreau
- Immunologie des Leishmaniose, Institut Pasteur, Institut Guyanais de Dermatologie Tropicale, E.A. 2188, Centre Hospitalier Andrée Rosemon, 97306 Cayenne Cedex, French Guiana
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40
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Clyti E, Couppie P, Deligny C, Jouary T, Sainte-Marie D, Pradinaud R. [Effectiveness of 20% salicylated vaseline in the treatment of profuse tungiasis. Report of 8 cases in French Guiana]. Bull Soc Pathol Exot 2003; 96:412-4. [PMID: 15015851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
The treatment of tungiasis involves the mechanic extraction of the gravid females of Tunga penetrans. We have observed on 8 patients profuse tungiasis diagnosed in the centre hospitalier de Cayenne. We have carried out different types of treatment, including the occlusive application of 20% of salicylated vaseline during 12 or 24 hours. This procedure causes the death of the parasites and facilitates their extraction.
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Affiliation(s)
- E Clyti
- Service de dermatologie, Centre hospitalier de Cayenne, Guyane Française
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41
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Lipsker D, Dréno B, Pradinaud R, Le Maître M, Duhard E, Reuter G, Rousseau L. [The Internet: its usefulness in dermatology]. Ann Dermatol Venereol 2003; 130:84-8. [PMID: 12656086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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42
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Ménard A, Couppié P, Sainte-Marie D, Pradinaud R. [Diagnosis of Mycobacterium ulcerans infection by PCR: report of 3 cases observed in French Guiana]. Bull Soc Pathol Exot 2003; 96:403-5. [PMID: 15015848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Mycobacterium ulcerans infection is the third most important mycobacterial infection in the world. It has been described in many different countries including French Guiana. The diagnosis of M. ulcerans infection by culture is often difficult because culture is hard to perform in endemic areas and their sensitivity is not reliable. As a result the diagnosis of this infection is often delayed. However, molecular methods are now available to diagnose rapidly infections by M. ulcerans and distinguish it from other mycobacteria. We report three cases of skin infection due to M. ulcerans observed in French Guiana. Diagnosis was initially made by polymerase chain reaction and was confirmed later by culture (in two patients) and inoculation to mice (in one patient). A faster diagnosis of M. ulcerans infection should lead to a better prognosis of this infection.
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Affiliation(s)
- A Ménard
- Service des maladies infectieuses et tropicales, CHU Nord, chemin des Bourrelys, 13015 Marseille, France.
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43
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Nacher M, Couppié P, Carme B, Clyti E, Sainte Marie D, Guibert P, Pradinaud R. Influence of meteorological parameters on the clinical presentation of cutaneous leishmaniasis in French Guiana and on the efficacy of pentamidine treatment of the disease. Ann Trop Med Parasitol 2002; 96:773-80. [PMID: 12625931 DOI: 10.1179/000349802125002266] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In French Guiana, marked seasonal fluctuations have been observed in the numbers of individuals who present with cutaneous leishmaniasis (CL). To investigate the seasonal trends further, the clinical characteristics and responses to treatment of 455 cases of CL, who presented over a 3-year period (1995-1998), were compared against data on the weather for the calendar month of presentation (month 0) and for the month before presentation (month-1). Several statistically significant associations were observed. The number of sunlight hours in month -1 was lower for the treatment successes than for the treatment failures [adjusted odds ratio (AOR) for successful treatment=0.28; 95% confidence interval (CI)=0.13-0.6; P=0.001] and for those with long incubation periods than for those with relatively short incubation periods (multiple-regression coefficient=-0.003; P=0.002). However, the radiation intensity for month-1 was higher for the treatment successes than for the treatment failures (AOR=2.1; CI=1.1-3.8; P=0.02). Relatively high numbers of hours of sunlight on month-1 were associated with relatively high numbers of parasites on the skin smears (AOR=1.03; CI=1.01-1.04; P<0.001). Relatively high numbers of hours of sunlight during month 0 were associated with lymphangitis (AOR=0.4; CI=0.19-0.8; P=0.01). These results indicate that meteorological parameters may influence the evolution of CL, at least in French Guiana.
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Affiliation(s)
- M Nacher
- Service de Dermatologie Vénérologie, Centre Hospitalier de Cayenne, Rue des Flamboyants, 97300 Cayenne, French Guiana.
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44
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Couppié P, Clyti E, Nacher M, Aznar C, Sainte-Marie D, Carme B, Pradinaud R. Acquired immunodeficiency syndrome-related oral and/or cutaneous histoplasmosis: a descriptive and comparative study of 21 cases in French Guiana. Int J Dermatol 2002; 41:571-6. [PMID: 12358826 DOI: 10.1046/j.1365-4362.2002.01590.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Oral or cutaneous acquired immunodeficiency syndrome (AIDS)-related histoplasmosis is a rare presentation of disseminated histoplasmosis. OBJECTIVE To describe this clinical presentation and to compare it with other forms of AIDS-related disseminated histoplasmosis. METHODS A cross-sectional study of patients with AIDS-related disseminated histoplasmosis was performed. CD4 counts and survival were compared between patients with oral or cutaneous histoplasmosis and patients with nonmucocutaneous disseminated histoplasmosis. RESULTS The mean CD4 lymphocyte count was lower in patients with mucocutaneous lesions than in patients with nonmucocutaneous disseminated histoplasmosis (29 vs. 72/mm3, P = 0.002). The proportion of survivors 1 month after diagnosis did not differ significantly between the two groups (13/21 vs. 32/45, P = 0.4). At 6 months, the proportion of survivors was significantly lower for patients with mucocutaneous lesions (6/21 vs. 22/39, P = 0.03). CONCLUSIONS These results suggest that mucocutaneous lesions occur at a later stage of human immunodeficiency virus infection, but are not, in themselves, associated with a higher level of mortality. The excess mortality at 6 months reflects deaths from other complications of severe immunodepression. This study confirms the polymorphism of mucocutaneous lesions, emphasizing the need for systematic testing for Histoplasma in all cases of mucocutaneous lesions in AIDS patients.
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Affiliation(s)
- Pierre Couppié
- Institut Guyanais de Dermatologie Tropicale, Service de Dermatologie C.H.G. de Cayenne, Laboratoire de Biologie Polyvalente, Cayenne, French Guiana.
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45
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Bourreau E, Prévot G, Gardon J, Pradinaud R, Hasagewa H, Milon G, Launois P. LACK-specific CD4(+) T cells that induce gamma interferon production in patients with localized cutaneous leishmaniasis during an early stage of infection. Infect Immun 2002; 70:3122-9. [PMID: 12011006 PMCID: PMC128026 DOI: 10.1128/iai.70.6.3122-3129.2002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The profile of cytokines induced by soluble leishmania antigen (SLA) and the Leishmania homologue of the mammalian receptor for activated C kinase (LACK), a candidate vaccine against leishmaniasis, and the cellular source of the cytokines produced in response to these antigens were analyzed in patients infected with Leishmania guyanensis. Gamma interferon (IFN-gamma) and interleukin-10 (IL-10) were produced in response to LACK. Although LACK-specific CD4(+) cells producing IFN-gamma were isolated only during the early phase of infection (less than 30 days following the onset of infection), cells producing IL-10 in response to LACK were detected in all patients. CD4(+) T cells producing IFN-gamma and IL-13 were produced in response to SLA in all patients. SLA- and LACK-specific T cells are effector memory cells, as they are CD45RA(-) CCR7(-) CD4(+) T cells. CD4(+) T cells producing IFN-gamma are CD62L(-), and CD4(+) T cells producing IL-10 are CD62L(+), indicating that these cells have different tissue-homing capacities. These findings show that SLA and LACK induce both type 1 (IFN-gamma) and type 2 (IL-10 or IL-13) cell responses.
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MESH Headings
- Amino Acid Sequence
- Animals
- Antigens, Protozoan/immunology
- Biomarkers
- CD4-Positive T-Lymphocytes/immunology
- Cells, Cultured
- Humans
- Interferon-gamma/biosynthesis
- Interleukin-10/metabolism
- Interleukin-13/biosynthesis
- L-Selectin
- Leishmania guyanensis/immunology
- Leishmaniasis, Mucocutaneous/blood
- Leishmaniasis, Mucocutaneous/immunology
- Leishmaniasis, Mucocutaneous/pathology
- Leukocyte Common Antigens
- Leukocytes, Mononuclear/cytology
- Leukocytes, Mononuclear/immunology
- Molecular Sequence Data
- Peptides/immunology
- Protein Tyrosine Phosphatase, Non-Receptor Type 1
- Protozoan Proteins/immunology
- Receptors, CCR7
- Receptors, Chemokine
- Time Factors
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Affiliation(s)
- Eliane Bourreau
- Immunologie des Leishmanioses. Service d'Epidémiologie, Institut Pasteur de Cayenne, 97306 Cayenne Cedex, France
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46
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Clyti E, Strobel M, Pradinaud R. ["Kokoti": a ritual on the way to extinction among the black half-casts of Guyana]. Ann Dermatol Venereol 2002; 129:165-6. [PMID: 11937951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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47
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Lightburn E, Meynard JB, Morand JJ, Garnotel E, Kraemer P, Hovette P, Banzet S, Dampierre H, Lepage J, Carme B, Pradinaud R, Morillon M, Dedet JP, Chouc C, Boutin JP. [Epidemiologic surveillance of cutaneous leishmaniasis in Guiana. Summary of military data collected over 10 years]. Med Trop (Mars) 2002; 62:545-53. [PMID: 12616949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
This report describes the results of epidemiological surveillance of cutaneous leishmaniasis in French military personnel in French Guiana. Data was collected regarding microscopic diagnosis, clinical manifestations, and lesion location as well as compliance with vector control measures. Year-to-year variations in the incidence in the general population have been attributed to changes in climatic conditions. Monitoring incidence and density curves, correlation of findings with local epidemiological data, and analysis of the most recent epidemic in 1998/99 (326 cases, attack rate 3.2% men years) highlight the importance of behavioral factors. The proportion of total cases involving military personnel varied widely from 20 to 85%. Investigation consistently showed that failure to apply elementary protective measures against sandfly bites was the most determinant factor in this proportion. Strict compliance with these measures appears to reduce the risk of infection considerably.
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Affiliation(s)
- E Lightburn
- Service de Dermatologie, HIA Laveran, 13998 Marseille-Armées, France.
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48
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Bourreau E, Prévot G, Gardon J, Pradinaud R, Launois P. High intralesional interleukin-10 messenger RNA expression in localized cutaneous leishmaniasis is associated with unresponsiveness to treatment. J Infect Dis 2001; 184:1628-30. [PMID: 11740743 DOI: 10.1086/324665] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2001] [Revised: 08/16/2001] [Indexed: 11/03/2022] Open
Abstract
The intralesional expression of cytokines (interleukin [IL]-4, IL-13, IL-10, and interferon-gamma) was analyzed in 65 patients with localized cutaneous leishmaniasis due to Leishmania guyanensis before specific treatment with pentamidine isethionate. The local expression of IL-10 was significantly higher in patients who responded poorly to treatment than in patients whose lesions were regressing. When an IL-10 level >10 (ratio of the concentration of IL-10 [pg/microL] to that of beta-actin [pg/microL]) was used as an indicator of treatment failure, the sensitivity of this test was 78.6, and the specificity was 72.5. Thus, high intralesional expression of IL-10 might predict a poor response to conventional treatment.
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Affiliation(s)
- E Bourreau
- Immunologie des Leishmanioses, Institute Pasteur, Cayenne, French Guiana.
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49
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Gravet A, Couppié P, Meunier O, Clyti E, Moreau B, Pradinaud R, Monteil H, Prévost G. Staphylococcus aureus isolated in cases of impetigo produces both epidermolysin A or B and LukE-LukD in 78% of 131 retrospective and prospective cases. J Clin Microbiol 2001; 39:4349-56. [PMID: 11724844 PMCID: PMC88548 DOI: 10.1128/jcm.39.12.4349-4356.2001] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Clinical symptoms of impetigo and staphylococcal scalded skin syndrome may not only be expressed as the splitting of cell layers within the epidermis but are often accompanied by some localized inflammation. Toxin patterns of Staphylococcus aureus isolates originating from patients with impetigo and also from those with other primary and secondary skin infections in a retrospective isolate collection in France and a prospective isolate collection in French Guiana revealed a significant association (75% of the cases studied) of impetigo with production of at least one of the epidermolysins A and B and the bicomponent leucotoxin LukE-LukD (P < 0.001). However, most of the isolates were able to produce one of the nonubiquitous enterotoxins. Pulsed-field gel electrophoresis (PFGE) of genomic DNA hydrolyzed with SmaI showed a polymorphism of the two groups of isolates despite the fact that endemic clones were suspected in French Guiana and France. The combination of toxin patterns with PFGE fingerprinting may provide further discrimination among isolates defined in a given cluster or a given pulsotype and account for a specific virulence. The new association of toxins with a clinical syndrome may reveal principles of the pathological process.
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Affiliation(s)
- A Gravet
- Institut de Bactériologie de la Faculté de Médecine de Strasbourg--Hôpitaux Universitaires de Strasbourg, F-67000 Strasbourg, France
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50
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Nacher M, Carme B, Sainte Marie D, Couppié P, Clyti E, Guibert P, Pradinaud R. Seasonal fluctuations of incubation, healing delays, and clinical presentation of cutaneous leishmaniasis in French Guiana. J Parasitol 2001; 87:1495-8. [PMID: 11780850 DOI: 10.1645/0022-3395(2001)087[1495:sfoihd]2.0.co;2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
An investigation was conducted to determine whether seasonal variations affected the development of cutaneous leishmaniasis. Data from 499 cases treated between July 1994 and December 1998 were analyzed. The interval between infection and consultation and between treatment and clinical cure varied significantly between cases with an incubation period during the dry season compared with the rainy season (P < 0.001). When the incubation period occurred during the dry season, the standard pentamidine isethionate treatment seemed to be less effective (i.e.. the odds ratio for failure was 1.9 [1.1-3.4], P = 0.01). The presence of lymphangitis was more frequent during the dry season (i.e., the odds ratio was 0.26 [0.15-0.45], P < 0.001). These results suggested that the observed seasonal variations were due to variations in the host/parasite balance. Converging indirect elements that suggest a role for variations in solar ultraviolet radiation are discussed.
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Affiliation(s)
- M Nacher
- Service de Dermatologie Vénérologie, Centre Hospitalier de Cayenne, Guyane Française.
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