A severe case of Plasmodium falciparum malaria imported by a French traveler from Cameroon to French Guiana despite regular intake of Artemisia annua herbal tea

The use of herbal tea with Artemisia annua by travelers and traditional communities in Africa has increased in recent years as a supposed form of malaria prophylaxis, although its use is not recommended due to lack of efficacy. The risk of severe malaria complications that can lead to death is real regarding said behavior, and awareness needs to be raised. We report a case of severe Plasmodium falciparum malaria imported in the Amazon rainforest by a traveler returning from Cameroon who treated himself with Artemisia annua herbal tea

Staphylococcus aureus endocarditis: Identifying prognostic factors using a method derived from morbidity and mortality conferences

ObjectivesLethality of Staphylococcus aureus (Sa) infective endocarditis (IE) is high and might be due to yet unidentified prognostic factors. The aim of this study was to search for new potential prognostic factors and assess their prognostic value in SaIE.Materials and methodsWe used a two-step exploratory approach. First, using a qualitative approach derived from mortality and morbidity conferences, we conducted a review of the medical records of 30 patients with SaIE (15 deceased and 15 survivors), randomly extracted from an IE cohort database (NCT03295045), to detect new factors of possible prognostic interest. Second, we collected quantitative data for these factors in the entire set of SaIE patients and used multivariate Cox models to estimate their prognostic value.ResultsA total of 134 patients with modified Duke definite SaIE were included, 64 of whom died during follow-up. Of the 56 candidate prognostic factors identified at the first step, 3 had a significant prognostic value in multivariate analysis: the prior use of non-steroidal anti-inflammatory drugs [aHR 3.60, 95% CI (1.59–8.15), p = 0.002]; the non-performance of valve surgery when indicated [aHR 1.85, 95% CI (1.01–3.39), p = 0.046]; and the decrease of vegetation size on antibiotic treatment [aHR 0.34, 95% CI (0.12–0.97), p = 0.044].ConclusionWe identified three potential SaIE prognostic factors. These results, if externally validated, might eventually help improve the management of patients with SaIE

Tuberculosis in prison: What about after release? The example of French Guiana

Introduction Tuberculosis is a major cause of mortality worldwide. Prisoners in Guiana have multiple risk factors. The primary objective of this study was to describe tuberculosis occurring in prison and after release in French Guiana between 2008 and 2020. Secondary objectives were to identify tuberculosis risk factors and determine annual incidences.Methods: A retrospective cohort study of tuberculosis cases was carried out at the Guiana prison between 2008 and 2020. Data were collected from prison registers and cross-referenced with the list of tuberculosis notifications in French Guiana.Results: A total of 36 cases of tuberculosis were studied. Incidence was high, at 263/100,000 per year, higher than elsewhere in France and comparable to that in Brazil. Despite visibly effective screening on entry, with little evidence of intra-prison circulation of tuberculosis, 39% of patients were diagnosed within two years of leaving prison (76% were symptomatic). This could be explained by the high prevalence of latent forms (LTI).Discussion Continued screening on entry, in combination with annual radiological and clinical screening, and reinforced follow-up on release seem indicated to improve patient management and the search for possible LTI

Profil des usagers d’une consultation hospitalière de Médecine Infectieuse et Tropicale en Amazonie française : des vulnérabilités spécifiques ?

International audienceThe specific epidemiological, cultural and social characteristics of tropical zones make the care they provide complex. As a result, the healthcare professionals working there have to be able to adapt to new situations on an ongoing basis. The UMIT consultation service is located at the CHC in Cayenne and its team consists of 7 doctors, 1 nurse and 1 secretary, who see 4,250 patients a year.Les soins prodigués en zone tropicale sont complexes du fait des spécificités épidémiologiques, culturelles et sociales. Les soignants y exerçant doivent ainsi faire preuve de capacités d’adaptation permanentes. Le service de consultations UMIT est situé au CHC de Cayenne et son équipe est composée de 7 médecins, 1 IDE et 1 secrétaire qui accueillent 4250 patients/an

A Simple Predictive Score to Distinguish between Disseminated Histoplasmosis and Tuberculosis in Patients with HIV

Disseminated histoplasmosis is a common differential diagnosis of tuberculosis in disease-endemic areas. We aimed to find a predictive score to orient clinicians towards disseminated histoplasmosis or tuberculosis when facing a non-specific infectious syndrome in patients with advanced HIV disease. We reanalyzed data from a retrospective study in Cayenne Hospital between January 1997–December 2008 comparing disseminated histoplasmosis and tuberculosis: 100 confirmed disseminated histoplasmosis cases and 88 confirmed tuberculosis cases were included. A simple logit regression model was constructed to predict whether a case was tuberculosis or disseminated histoplasmosis. From this model, a score may be obtained, where the natural logarithm of the probability of disseminated histoplasmosis/tuberculosis = +3.917962 × WHO performance score (1 if >2, 0 if ≤2) −1.624642 × Pulmonary presentation (1 yes, 0 no) +2.245819 × Adenopathies > 2 cm (1 yes, 0 no) −0.015898 × CD4 count − 0.001851 × ASAT − 0.000871 × Neutrophil count − 0.000018 × Platelet count + 6.053793. The area under the curve was 98.55%. The sensitivity of the model to distinguish between disseminated histoplasmosis and tuberculosis was 95% (95% CI = 88.7–98.3%), and the specificity was 93% (95% CI = 85.7.3–97.4%). In conclusion, we here present a clinical-biological predictive score, using simple variables available on admission, that seemed to perform very well to discriminate disseminated histoplasmosis from tuberculosis in French Guiana in well characterized patients

A Simple Predictive Score to Distinguish between Disseminated Histoplasmosis and Tuberculosis in Patients with HIV

Disseminated histoplasmosis is a common differential diagnosis of tuberculosis in disease-endemic areas. We aimed to find a predictive score to orient clinicians towards disseminated histoplasmosis or tuberculosis when facing a non-specific infectious syndrome in patients with advanced HIV disease. We reanalyzed data from a retrospective study in Cayenne Hospital between January 1997–December 2008 comparing disseminated histoplasmosis and tuberculosis: 100 confirmed disseminated histoplasmosis cases and 88 confirmed tuberculosis cases were included. A simple logit regression model was constructed to predict whether a case was tuberculosis or disseminated histoplasmosis. From this model, a score may be obtained, where the natural logarithm of the probability of disseminated histoplasmosis/tuberculosis = +3.917962 × WHO performance score (1 if &gt;2, 0 if ≤2) −1.624642 × Pulmonary presentation (1 yes, 0 no) +2.245819 × Adenopathies &gt; 2 cm (1 yes, 0 no) −0.015898 × CD4 count − 0.001851 × ASAT − 0.000871 × Neutrophil count − 0.000018 × Platelet count + 6.053793. The area under the curve was 98.55%. The sensitivity of the model to distinguish between disseminated histoplasmosis and tuberculosis was 95% (95% CI = 88.7–98.3%), and the specificity was 93% (95% CI = 85.7.3–97.4%). In conclusion, we here present a clinical-biological predictive score, using simple variables available on admission, that seemed to perform very well to discriminate disseminated histoplasmosis from tuberculosis in French Guiana in well characterized patients.</jats:p

Staphylococcus aureus infective endocarditis: New Prognostic Factors Identified by an Exploratory Method Derived from Morbidity and Mortality Conferences

International audienceStaphylococcus aureus (Sa) has become the most frequent pathogen responsible for infective endocarditis (IE). Despite medical progress, the SaIE’s lethality stayed high. Morbidity and mortality conferences (MMC) are designed to improve the quality of healthcare by addressing errors in patient’s management. This approach could be helpful to identify candidate prognostic factors in SaIE.The aim of this study was to search for new potential prognostic factors in SaIE.We used data from EI 2008 cohort (NCT03295045), a one-year longitudinal cohort study conducted in France in 2008, which enrolled IE patients according to Duke-Licriteria. We used an exploratory two-step approach that included:1) The first step was a qualitative approach derived from MMC [3] to identify candidate prognostic factors in SaIE.2) The second step was a multivariate Cox model to estimate the prognostic value of each candidate prognostic factors.Should the prognostic value of the factors we identified be confirmed by other studies, the management of patients with SaIE could be improved accordingly, for example by limiting the use of NSAIDs, considering valve surgery when indicated even though the probability of post-operative death is high, and re-examining therapeutic strategy

Staphylococcus aureus endocarditis: Identifying prognostic factors using a method derived from morbidity and mortality conferences

International audienceObjectives: Lethality of Staphylococcus aureus (Sa) infective endocarditis (IE) is high and might be due to yet unidentified prognostic factors. The aim of this study was to search for new potential prognostic factors and assess their prognostic value in SaIE.Materials and methods: We used a two-step exploratory approach. First, using a qualitative approach derived from mortality and morbidity conferences, we conducted a review of the medical records of 30 patients with SaIE (15 deceased and 15 survivors), randomly extracted from an IE cohort database (NCT03295045), to detect new factors of possible prognostic interest. Second, we collected quantitative data for these factors in the entire set of SaIE patients and used multivariate Cox models to estimate their prognostic value.Results: A total of 134 patients with modified Duke definite SaIE were included, 64 of whom died during follow-up. Of the 56 candidate prognostic factors identified at the first step, 3 had a significant prognostic value in multivariate analysis: the prior use of non-steroidal anti-inflammatory drugs [aHR 3.60, 95% CI (1.59-8.15), p = 0.002]; the non-performance of valve surgery when indicated [aHR 1.85, 95% CI (1.01-3.39), p = 0.046]; and the decrease of vegetation size on antibiotic treatment [aHR 0.34, 95% CI (0.12-0.97), p = 0.044].Conclusion: We identified three potential SaIE prognostic factors. These results, if externally validated, might eventually help improve the management of patients with SaIE

Staphylococcus aureus infective endocarditis: New Prognostic Factors Identified by an Exploratory Method Derived from Morbidity and Mortality Conferences

International audienceStaphylococcus aureus (Sa) has become the most frequent pathogen responsible for infective endocarditis (IE). Despite medical progress, the SaIE’s lethality stayed high. Morbidity and mortality conferences (MMC) are designed to improve the quality of healthcare by addressing errors in patient’s management. This approach could be helpful to identify candidate prognostic factors in SaIE.The aim of this study was to search for new potential prognostic factors in SaIE.We used data from EI 2008 cohort (NCT03295045), a one-year longitudinal cohort study conducted in France in 2008, which enrolled IE patients according to Duke-Licriteria. We used an exploratory two-step approach that included:1) The first step was a qualitative approach derived from MMC [3] to identify candidate prognostic factors in SaIE.2) The second step was a multivariate Cox model to estimate the prognostic value of each candidate prognostic factors.Should the prognostic value of the factors we identified be confirmed by other studies, the management of patients with SaIE could be improved accordingly, for example by limiting the use of NSAIDs, considering valve surgery when indicated even though the probability of post-operative death is high, and re-examining therapeutic strategy