Epidémiologie de la leptospirose aux Antilles françaises : apports du diagnostic par biologie moléculaire dans l'étude des facteurs de risques, des facteurs pronostiques et de l'incidence

Leptospirosis is the most widespread zoonosis in the world and its incidence is higher in in tropical areas where its fatality rates can exceed 10%. Availability of rapid diagnostic tools is a top-priority, since antibiotic is more efficient when given early. In this work, we rely on molecular diagnosis (RT-PCR) to contribute to the study of leptospirosis epidemiology in the Caribbean. In the first two papers, we describe for the first time in Martinique outbreaks of leptospirosis after sporting events (trail running, canyoning). The occurrence of cutaneous abrasions was identified as a risk factor for infection and data from those outbreaks suggest that rapid diagnostic assays such as PCR are particularly appropriate in this setting for early diagnosis, information of exposed participants, and treatment during acute phase of the disease. The third paper is a cohort study of 102 patients and we report that high level leptospiremia at the time of admission was associated with severity of the disease. The main clinical findings at the time of admission that were associated with severe leptospirosis included: hypotension, chest auscultation abnormalities, icterus, and oligoanuria. Identification of Leptospira interrogans species, serovar Icterohaemorrhagiae/Copenhageni, and the presence of rats in the house were also associated with severity. Detection methods using RT-PCR allowed us to contribute to the study of risk and prognostic factors, but also to have a better understanding of leptospirosis public health impact in the Caribbean.Leptospirose est la zoonose bactérienne la plus répandue dans le monde et son incidence est plus forte dans les régions tropicales où le taux de mortalité peut excéder 10%. Un diagnostic rapide est fondamental car le traitement a plus de chance d’être efficace lorsqu’il est précoce. Nous avons utilisé le diagnostic par biologie moléculaire (RT-PCR) pour contribuer à mieux connaitre l’épidémiologie de la leptospirose aux Antilles. Dans les deux premiers articles, nous rapportons pour la première fois en Martinique la survenue de cas groupés de leptospirose après des événements sportifs (course à pied, canyoning). La présence d’abrasions cutanées a été identifiée comme facteur de risque de l’infection et ces travaux ont mis en évidence l’intérêt du diagnostic par RT-PCR pour informer rapidement les personnes exposées et débuter tôt les antibiotiques. Le troisième travail est une étude de cohorte prospective portant sur 102 patients et nous rapportons l’association entre l’élévation de la concentration sanguine de leptospires mesurée à l’admission et la sévérité de la maladie. Les principaux éléments cliniques initiaux associés à la sévérité étaient l’hypotension, les anomalies auscultatoires, l’ictère et l’anurie. L’identification de l’espèce Leptospira interrogans, le sérovar Icterohaemorrhagiae /Copenhageni, et la présence de rats à domicile étaient aussi associés à la sévérité. L’utilisation du diagnostic par biologie moléculaire nous a permis de contribuer à l’étude de facteurs de risque et des facteurs pronostiques de la leptospirose, mais aussi à mieux connaître le poids réel de la maladie aux Antilles

Reemergence of Syphilis in Martinique, 2001–2008

Syphilis reemerged in Martinique in 2004 and initially affected 3 HIV-infected patients. By March 2008, syphilis was diagnosed for 37 men and 18 women. As of October 31, 2009, this outbreak had not yet been brought under control. It initially affected mainly men who had sex with men before it spread to heterosexual persons, minority group members, and crack cocaine users

First Perihelion of EUI on the Solar Orbiter mission

Context. The Extreme Ultraviolet Imager (EUI), onboard Solar Orbiter consists of three telescopes: the two High Resolution Imagers in EUV (HRIEUV) and in Lyman-{\alpha} (HRILya), and the Full Sun Imager (FSI). Solar Orbiter/EUI started its Nominal Mission Phase on 2021 November 27. Aims. EUI images from the largest scales in the extended corona off limb, down to the smallest features at the base of the corona and chromosphere. EUI is therefore a key instrument for the connection science that is at the heart of the Solar Orbiter mission science goals. Methods. The highest resolution on the Sun is achieved when Solar Orbiter passes through the perihelion part of its orbit. On 2022 March 26, Solar Orbiter reached for the first time a distance to the Sun close to 0.3 au. No other coronal EUV imager has been this close to the Sun. Results. We review the EUI data sets obtained during the period 2022 March-April, when Solar Orbiter quickly moved from alignment with the Earth (2022 March 6), to perihelion (2022 March 26), to quadrature with the Earth (2022 March 29). We highlight the first observational results in these unique data sets and we report on the in-flight instrument performance. Conclusions. EUI has obtained the highest resolution images ever of the solar corona in the quiet Sun and polar coronal holes. Several active regions were imaged at unprecedented cadences and sequence durations. We identify in this paper a broad range of features that require deeper studies. Both FSI and HRIEUV operate at design specifications but HRILya suffered from performance issues near perihelion. We conclude emphasising the EUI open data policy and encouraging further detailed analysis of the events highlighted in this paper

Epidemiology of leptospirosis in French West Indies : contributions of diagnosis by molecular biology in the study of risk factors, pronostic factors, and incidence

Leptospirose est la zoonose bactérienne la plus répandue dans le monde et son incidence est plus forte dans les régions tropicales où le taux de mortalité peut excéder 10%. Un diagnostic rapide est fondamental car le traitement a plus de chance d’être efficace lorsqu’il est précoce. Nous avons utilisé le diagnostic par biologie moléculaire (RT-PCR) pour contribuer à mieux connaitre l’épidémiologie de la leptospirose aux Antilles. Dans les deux premiers articles, nous rapportons pour la première fois en Martinique la survenue de cas groupés de leptospirose après des événements sportifs (course à pied, canyoning). La présence d’abrasions cutanées a été identifiée comme facteur de risque de l’infection et ces travaux ont mis en évidence l’intérêt du diagnostic par RT-PCR pour informer rapidement les personnes exposées et débuter tôt les antibiotiques. Le troisième travail est une étude de cohorte prospective portant sur 102 patients et nous rapportons l’association entre l’élévation de la concentration sanguine de leptospires mesurée à l’admission et la sévérité de la maladie. Les principaux éléments cliniques initiaux associés à la sévérité étaient l’hypotension, les anomalies auscultatoires, l’ictère et l’anurie. L’identification de l’espèce Leptospira interrogans, le sérovar Icterohaemorrhagiae /Copenhageni, et la présence de rats à domicile étaient aussi associés à la sévérité. L’utilisation du diagnostic par biologie moléculaire nous a permis de contribuer à l’étude de facteurs de risque et des facteurs pronostiques de la leptospirose, mais aussi à mieux connaître le poids réel de la maladie aux Antilles.Leptospirosis is the most widespread zoonosis in the world and its incidence is higher in in tropical areas where its fatality rates can exceed 10%. Availability of rapid diagnostic tools is a top-priority, since antibiotic is more efficient when given early. In this work, we rely on molecular diagnosis (RT-PCR) to contribute to the study of leptospirosis epidemiology in the Caribbean. In the first two papers, we describe for the first time in Martinique outbreaks of leptospirosis after sporting events (trail running, canyoning). The occurrence of cutaneous abrasions was identified as a risk factor for infection and data from those outbreaks suggest that rapid diagnostic assays such as PCR are particularly appropriate in this setting for early diagnosis, information of exposed participants, and treatment during acute phase of the disease. The third paper is a cohort study of 102 patients and we report that high level leptospiremia at the time of admission was associated with severity of the disease. The main clinical findings at the time of admission that were associated with severe leptospirosis included: hypotension, chest auscultation abnormalities, icterus, and oligoanuria. Identification of Leptospira interrogans species, serovar Icterohaemorrhagiae/Copenhageni, and the presence of rats in the house were also associated with severity. Detection methods using RT-PCR allowed us to contribute to the study of risk and prognostic factors, but also to have a better understanding of leptospirosis public health impact in the Caribbean

Epidemiology of leptospirosis in French West Indies : contributions of diagnosis by molecular biology in the study of risk factors, pronostic factors, and incidence

Leptospirose est la zoonose bactérienne la plus répandue dans le monde et son incidence est plus forte dans les régions tropicales où le taux de mortalité peut excéder 10%. Un diagnostic rapide est fondamental car le traitement a plus de chance d’être efficace lorsqu’il est précoce. Nous avons utilisé le diagnostic par biologie moléculaire (RT-PCR) pour contribuer à mieux connaitre l’épidémiologie de la leptospirose aux Antilles. Dans les deux premiers articles, nous rapportons pour la première fois en Martinique la survenue de cas groupés de leptospirose après des événements sportifs (course à pied, canyoning). La présence d’abrasions cutanées a été identifiée comme facteur de risque de l’infection et ces travaux ont mis en évidence l’intérêt du diagnostic par RT-PCR pour informer rapidement les personnes exposées et débuter tôt les antibiotiques. Le troisième travail est une étude de cohorte prospective portant sur 102 patients et nous rapportons l’association entre l’élévation de la concentration sanguine de leptospires mesurée à l’admission et la sévérité de la maladie. Les principaux éléments cliniques initiaux associés à la sévérité étaient l’hypotension, les anomalies auscultatoires, l’ictère et l’anurie. L’identification de l’espèce Leptospira interrogans, le sérovar Icterohaemorrhagiae /Copenhageni, et la présence de rats à domicile étaient aussi associés à la sévérité. L’utilisation du diagnostic par biologie moléculaire nous a permis de contribuer à l’étude de facteurs de risque et des facteurs pronostiques de la leptospirose, mais aussi à mieux connaître le poids réel de la maladie aux Antilles.Leptospirosis is the most widespread zoonosis in the world and its incidence is higher in in tropical areas where its fatality rates can exceed 10%. Availability of rapid diagnostic tools is a top-priority, since antibiotic is more efficient when given early. In this work, we rely on molecular diagnosis (RT-PCR) to contribute to the study of leptospirosis epidemiology in the Caribbean. In the first two papers, we describe for the first time in Martinique outbreaks of leptospirosis after sporting events (trail running, canyoning). The occurrence of cutaneous abrasions was identified as a risk factor for infection and data from those outbreaks suggest that rapid diagnostic assays such as PCR are particularly appropriate in this setting for early diagnosis, information of exposed participants, and treatment during acute phase of the disease. The third paper is a cohort study of 102 patients and we report that high level leptospiremia at the time of admission was associated with severity of the disease. The main clinical findings at the time of admission that were associated with severe leptospirosis included: hypotension, chest auscultation abnormalities, icterus, and oligoanuria. Identification of Leptospira interrogans species, serovar Icterohaemorrhagiae/Copenhageni, and the presence of rats in the house were also associated with severity. Detection methods using RT-PCR allowed us to contribute to the study of risk and prognostic factors, but also to have a better understanding of leptospirosis public health impact in the Caribbean

Infective Endocarditis in French West Indies: A 13-Year Observational Study

International audienceWe conducted an observational study to describe the characteristics of infective endocarditis (IE) in French West Indies (FWI) and to identify variables associated with in-hospital case fatality. The records of the patients admitted for IE to the University Hospital of Martinique between 2000 and 2012 were collected using an electronic case report form. Only Duke-Li definite cases were considered for this analysis. Variables associated with in-hospital mortality were tested using univariate logistic regression analysis. The analysis included 201 patients (median age 58 years, sex ratio: two males to one female). There was no previously known heart disease in 45.8%, a prosthetic valve in 21.4%, and previously known native valve disease in 32.8% of the cases. Community-acquired IE represented 59.7% of all cases, health-care-associated IE represented 38.3% and injection-drug-use-acquired IE represented 1.5%. Locations of IE were distributed as follows: 42.3% were mitral valve IE, 34.8% were aortic valve IE, and 7% were right-sided IE. Microorganisms recovered from blood cultures included 30.4% streptococci, 28.9% staphylococci, and 5% enterococci. Blood cultures were negative in 20.9% of the cases. Surgical treatment was performed in 53% of the patients. In-hospital case fatality rate was 19%. Advanced age, Staphylococcus aureus IE, and health-care-associated IE were associated with in-hospital case fatality. The epidemiological and microbiological profile of IE in FWI is in between those observed in developed countries and developing countries: patients were younger, blood cultures were more frequently negative, and IE due to group D streptococci and enterococci were less common than in industrialized countries

Importance of T Cells, Gamma Interferon, and Tumor Necrosis Factor in Immune Control of the Rapid Grower Mycobacterium abscessus in C57BL/6 Mice▿

Mycobacterium abscessus is an emerging rapidly growing mycobacterium that causes tuberculous-like lesions in humans. We studied the immune control of this organism in C57BL/6 mice challenged intravenously with 107 CFU. Bacteria were eliminated from both the spleen and the liver within 90 days, and liver histology showed organized granulomatous lesions. A T- and B-cell requirement was investigated by challenging Rag2−/−, Cd3ɛ−/−, and μMT−/− mice. Rag2−/− and Cd3ɛ−/− mice were significantly impaired in the ability to clear M. abscessus from the liver and spleen, and μMT−/− mice were significantly impaired in the ability to clear M. abscessus from the liver, suggesting that infection control was primarily T cell dependent in the spleen and both T and B cell dependent in the liver. The liver granulomatous response was similar to that of wild-type controls in μMT−/− mice but completely absent in Cd3ɛ−/− and Rag2−/− mice. We studied the involvement of gamma interferon (IFN-γ) and tumor necrosis factor (TNF) by challenging C57BL/6 mice deficient in the IFN-γ receptor (Ifngr1−/−) and in TNF (Tnf−/−). Ifngr1−/− mice were significantly impaired in M. abscessus control both in the spleen and in the liver, and granulomas were profoundly altered. The effect was even more substantial in Tnf−/− mice; they failed to control M. abscessus infection in the liver and died within 20 to 25 days after infection with many hepatic inflammatory foci and major lesions of ischemic necrosis in the liver and kidney. These features were not observed with the closely related species M. chelonae. T-cell immunity, IFN-γ, and TNF are central factors for the control of M. abscessus in C57BL/6 mice, as they are for the control of pathogenic slowly growing mycobacteria

Chikungunya Infection in Travelers

The largest described outbreak of chikungunya virus has been occurring on the islands of the southwest Indian Ocean since March 2005. We describe the manifestations of chikungunya virus infection in travelers returning from these islands, with focus on skin manifestations