La lèpre à la Réunion (histoire, épidémiologie et prise en charge actuelle)

La lèpre est une maladie infectieuse chronique à expression cutanée et neurologique. L incubation est longue et l expression est variée. A la Réunion, les premiers cas décrits correspondent au début de sa colonisation. Le climat tropical de l île, l histoire de son peuplement par les colons puis par de multiples ethnies ainsi que l esclavagisme qui y a eu lieu ont été étroitement liés à l histoire de la lèpre dans ce département. Importée par les esclaves en provenance de Madagascar au début du XVIIIème siècle et en l absence de traitement efficace, la lèpre s est propagée sur l île pendant de nombreuses années. L avènement de la polychimiothérapie, les différentes politiques de santé publique menées en partenariat avec l OMS et l amélioration des conditions de vie ont permis une nette diminution de l incidence de la maladie. Mais contrairement aux idées reçues, la lèpre reste présente en France. De nouveaux cas continuent à être diagnostiqués en particulier dans les DOM-TOM, et notamment à La Réunion. Comme l a préconisé l OMS dans le monde, un système de surveillance a été mis en place sur le territoire réunionnais afin de répertorier les nouveaux cas, de suivre les malades et de mettre en oeuvre une politique de prévention et de prise en charge. Ce système de surveillance a permis d effectuer un état des lieux de la lèpre à la Réunion, de caractériser les sujets atteints par la maladie, et de mettre en évidence l existence d une circulation autochtone du Mycobacterium leprae justifiant la poursuite de la lutte contre cette pathologie. En raison de sa persistance à l état d endémie dans certains pays, des flux migratoires de plus en plus importants et de l existence d un traitement efficace, l enseignement de la lèpre et la lutte contre celle-ci doivent être poursuivis dans les pays en voie de développement mais aussi dans les pays développés.LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

Etude prospective de 51 cas d'uvéites intermédiaires (diagnostics associés, évolution et complications.)

STRASBOURG-Medecine (674822101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Chronic Bickerstaff's encephalitis with cognitive impairment, a reality?

International audienceBACKGROUND: Bickerstaff's encephalitis (BE) is an acute post-infectious demyelinating disease with albuminocytological dissociation. A chronic form has rarely been described previously. CASE PRESENTATION: A 44-year-old man was hospitalized for drowsiness, cognitive complaint limb weakness, ataxia and sensory disturbance after diarrhea. Neuropsychological evaluation showed slowing, memory and executive function impairment, while analysis of the CSF showed albuminocytological dissociation. Immunologic tests showed positive anti-ganglioside antibodies (anti-GM1 IgM, anti-GD1a IgG and anti-GD1b IgM). Brain MRI was normal but SPECT showed bilateral temporal and frontal hypoperfusion. Outcome under immunoglobulin treatment (IVIG) was favorable with an initial improvement but was marked by worsening after a few weeks. Consequently, the patient was treated with IVIG every 2 months due to the recurrence of symptoms after 6 weeks. CONCLUSION: This case raises the question of the existence of a chronic form of BE with cognitive impairment, in the same way as chronic inflammatory demyelinating polyneuropathy is considered to be a chronic form of Guillain-Barré syndrome

Cerebral vasculitis associated with <it>Schistosoma mansoni</it> infection

Abstract Background Cerebral involvement in schistosomiasis is not rare, but it is underdiagnosed because of the lack of clinical suspicion and the frequency of asymptomatic forms. Neurologic complications are generally supported by granuloma formation around ectopic eggs which have migrated to the brain. Moreover, vascular lesions and cerebral arteritis have been well documented in histopathological studies. Nevertheless, cerebral vasculitis in later stages of the Schistosoma mansoni infection have not yet been described in living subjects. Case presentation A 28-year-old french woman had a stroke linked with cerebral vasculitis, 6 monthes after returning from Burkina-Faso. At the same time, a S. mansoni disseminated infection was diagnosed. She suffered from a new stroke after undertaking praziquantel therapy, which lead us to associate the S. mansoni infection and cerebral vasculitis. Conclusion This is the first report of such association, since cerebral vasculitis has never been described in later stages of the S. mansoni infection. Although the causal link between the two pathologies could not be proved, we suggest that S. mansoni is able to cause severe vascular damage in cerebral vessels. Schistosomiasis must be investigated in the event of a brain infarct in young people, particularly in patients originating or returning from an endemic area.</p

A fatal neuroinvasive West Nile virus infection in a traveler returning from Madagascar: clinical, epidemiological and veterinary investigations

International audienceA 58-year-old woman living in Reunion Island and returning from Madagascar was hospitalized for neuroinvasive encephalitis and died 1 month later. West Nile virus (WNV) infection was biologically confirmed by detection of immunoglobulin M (IgM) reactive with WNV antigens in both cerebrospinal fluid and serum, and weak neutralizing activity was also detected. A veterinary survey performed in her traveling area showed a seroprevalence ofWNV of 28.7% (95% confidence interval [CI]=21.1–36.3) in adult poultry, confirming an active circulation of the virus.Development of a severe form could be related to a weak antibody response, because the patient presented low IgM and IgG titers. This case report underlines the constant risk of emergence of West Nile in Indian Ocean territories, including Reunion Island where competent vectors are widely present during the whole year

Murine Typhus, Reunion, France, 2011–2013

Murine typhus case was initially identified in Reunion, France, in 2012 in a tourist. Our investigation confirmed 8 autochthonous cases that occurred during January 2011–January 2013 in Reunion. Murine typhus should be considered in local patients and in travelers returning from Reunion who have fevers of unknown origin

Leprosy on Reunion Island, 2005-2013: Situation and Perspectives.

BACKGROUND:Reunion Island is a French overseas territory located in the south-western of Indian Ocean, 700 km east of Madagascar. Leprosy first arrived on Reunion Island in the early 1700s with the African slaves and immigration from Madagascar. The disease was endemic until 1980 but improvement of health care and life conditions of inhabitants in the island have allowed a strong decrease in new cases of leprosy. However, the reintroduction of the disease by migrants from endemic neighbouring countries like Comoros and Madagascar is a real and continuing risk. This observational study was then conducted to measure the number of new cases detected annually on Reunion Island between 2005 and 2013, and to describe the clinical features of these patients. METHODOLOGY/PRINCIPAL FINDINGS:Data were collected over two distinct periods. Incident cases between 2005 and 2010 come from a retrospective study conducted in 2010 by the regional Office of French Institute for Public Health Surveillance (CIRE of Indian Ocean), when no surveillance system exist. Cases between 2011 and 2013 come from a prospective collection of all new cases, following the implementation of systematic notification of all new cases. All patient data were anonymized. Among the 25 new cases, 12 are Reunion Island residents who never lived outside Reunion Island, and hence are considered to be confirmed autochthonous patients. Registered prevalence in 2014 was 0.05 /10 000 habitants, less than the WHO's eradication goal (1/10 000). CONCLUSIONS/SIGNIFICANCE:Leprosy is no longer a major public health problem on Reunion Island, as its low prevalence rate indicates. However, the risk of recrudescence of the disease and of renewed autochthonous transmission remains real. In this context, active case detection must be pursued through the active declaration and rapid treatment of all new cases

Invasive Group B Streptococcal Disease in Non-pregnant Adults, Réunion Island, 2011

International audienceOBJECTIVES: While the prevalence of Group B streptococcus (GBS) colonization is important, little is known about invasive GBS (iGBS) disease in tropical areas. Our objective was to assess the burden of iGBS disease among non-pregnant adults.METHODS: A prospective hospital-based study of all non-pregnant adult patients with iGBS disease was conducted between January and December 2011 in Saint Pierre, Réunion Island, to assess its cumulative incidence rate (CIR). Capsular serotyping and multilocus sequence typing were performed to characterize GBS isolates. Case-control study was done to identify risk factors.RESULTS: The overall CIR of iGBS disease was 10.1 per 100,000. The CIR in elderly patients (≥ 65 yrs) was estimated at 40.6 per 100.000, and that of adults (15-64 years) at 6.7 per 100.000. Aboriginal origin in the Indian Ocean and overweight were both associated with iGBS disease. The most prominent clinical forms were osteo-articular and skin/soft tissue infections, as a consequence of diabetic foot. The serotypes were classic, type-Ia being the most prevalent. The hyper virulent ST-17 (CC17) was associated with type-III.CONCLUSIONS: The incidence of iGBS disease found in Réunion island is twofold that usually reported. This burden is linked to overweight in aboriginal people from the Indian Ocean