Un relevé des spores de moisissures présentes dans l'air de la ville de Fort de France a été réal... more Un relevé des spores de moisissures présentes dans l'air de la ville de Fort de France a été réalisé du 1 er juillet 2003 au 30 juin 2004, en utilisant un capteur de type Burkard. Parmi les nombreuses spores retrouvées sur les lames d'aérobiologie, les plus fréquentes appartiennent à cinq genres (Alternaria, Cladosporium, Curvularia, Pithomyces et Torula), à deux familles (Aspergillaceae et Basidiomycetaceae) et six groupes (myxomycètes, helminthosporium, mycélium stérile, ascospores et « Autres spores »). Parallèlement à la réalisation des lames d'aérobiologie, des prélèvements d'air sur milieux gélosés au Rose Bengale additionnés de chloramphénicol, ont été réalisés en parallèle grâce au biocollecteur Air IDEAL ® (BioMérieux). Les moisissures les plus fréquemment retrouvées appartiennent aux genres Aspergillus (22,5 %), Cladosporium (13,5 %), Curvularia (9,3 %), Pénicillium (8,8 %), Fusarium (7 %). De nombreux mycéliums stériles sont également isolés (20 %).
This survey drew up the epidemiological situation of intestinal parasitism in Martinique in 1994-... more This survey drew up the epidemiological situation of intestinal parasitism in Martinique in 1994-1995. 13,978 stool specimens collected in 1994-1995 were tested by parasitologic examination. Stool specimens were from patients hospitalised in the 3 principal hospitals of Martinique or coming to the Laboratoire départemental d'hygiène. The parasitism rate was 8.73%. This study showed a significant reduction of intestinal parasitism between results of 1988 and results of 1994-1995. The oro-faecal parasitism was not very important that reflected the good economic and sanitation level of Martinique. On the other hand, regarding the important prevalence of parasitism with Strongyloïdes stercoralis and hookworm, it would be good to improve detection, sanitary education and know better local contamination factors to decrease the prevalence of this parasitism.
Strongyloidiasis is an parasitic intestinal disease, frequent in tropical countries and fairly ra... more Strongyloidiasis is an parasitic intestinal disease, frequent in tropical countries and fairly rare in temperate areas under certain conditions. Disseminated forms can provoke multivisceral damage. A 75 year-old woman, hospitalized for occlusion, developed multivisceral (cerebral, renal, cardiac pulmonary and hepatic) damage over 48 hours, attributed to strongyloidiasis. The diagnosis was confirmed by isolation of larvae in the tracheal and gastric aspiration fluids. Treatment combined ivermectin and albendazole. Disseminated stronglyloidiasis is essentially observed in immunodepressed patients, under corticosteroids or HTLV1 carriers, although an HIV status does not appear to intervene. Larvae can be found in all the organs. Death occurs by multivisceral failure in 50 to 70% of cases. Broncho-alveolar washing and examination of the gastric fluids is the key to diagnosis. Treatment relies on thiabendazole, ivermectin or albendazole, and the symptomatic management of all the visceral...
Journal de Mycologie Médicale / Journal of Medical Mycology, 2006
Un relevé des spores de moisissures présentes dans l'air de la ville de Fort de France a été réal... more Un relevé des spores de moisissures présentes dans l'air de la ville de Fort de France a été réalisé du 1 er juillet 2003 au 30 juin 2004, en utilisant un capteur de type Burkard. Parmi les nombreuses spores retrouvées sur les lames d'aérobiologie, les plus fréquentes appartiennent à cinq genres (Alternaria, Cladosporium, Curvularia, Pithomyces et Torula), à deux familles (Aspergillaceae et Basidiomycetaceae) et six groupes (myxomycètes, helminthosporium, mycélium stérile, ascospores et « Autres spores »). Parallèlement à la réalisation des lames d'aérobiologie, des prélèvements d'air sur milieux gélosés au Rose Bengale additionnés de chloramphénicol, ont été réalisés en parallèle grâce au biocollecteur Air IDEAL ® (BioMérieux). Les moisissures les plus fréquemment retrouvées appartiennent aux genres Aspergillus (22,5 %), Cladosporium (13,5 %), Curvularia (9,3 %), Pénicillium (8,8 %), Fusarium (7 %). De nombreux mycéliums stériles sont également isolés (20 %).
The American journal of tropical medicine and hygiene, Jan 31, 2017
A syphilis outbreak began in Martinique, French Antilles, in 2004, initially among men who had se... more A syphilis outbreak began in Martinique, French Antilles, in 2004, initially among men who had sex with men (MSM) and who were living with human immunodeficiency virus (HIV). The outbreak subsequently affected all groups at risk, leading to a first epidemic peak in 2008. After an initial decrease, the outbreak started growing again in 2014 among patients living with HIV with unprecedented incidence among MSM. Herein, we describe the change in medical and social parameters of the outbreak since 2005.
in this laboratory. Results This survey showed the high prevalence of anguillulosis, found in 51.... more in this laboratory. Results This survey showed the high prevalence of anguillulosis, found in 51.69% of infested patients and in 4.56% of the population studied, the ever high prevalence of non or scarcely pathogenic amoebas (Endolimax nanus, Dientamoeba fragilis, Entamoeba coli) found in 27.19% of infested patients and 1.88% of the population studied, together with that of hookworms (12.80% of infested patients and 1.13% of the population), and the persistence of lambliasis. This study also revealed the presence of cryptosporidies (7 cases) and microsporidies (4 cases) in the patients infected by the human immunodeficiency virus. Discussion These results confirm the trend of the past twenty years and the results of surveys initiated by the national statistics board (INSERM) in 1978(INSERM) in , 1988(INSERM) in and 1995(INSERM) in -1995 with the regression of bilharziosis and the persistence of anguillulosis and hookworms. Conclusion The improvement in living conditions and hygiene, the combined efforts of the health care workers and authorities in Martinique over the past 30 years in the fight against parasites have led to a great reduction in the prevalence of classical intestinal parasitosis. However, new parasites associated with HIV infection have appeared.
Préciser la prévalence des parasitoses digestives entre le 1° janvier 1997 et le 31 décembre 1999... more Préciser la prévalence des parasitoses digestives entre le 1° janvier 1997 et le 31 décembre 1999 dans le laboratoire de microbiologie du C.H.U de Fort-de-France.Il s’agit d’une analyse rétrospective des résultats de 4684 examens parasitologiques des selles réalisés chez 2 704 patients entre le 1er janvier 1997 et le 31 décembre 1999 dans ce laboratoire.Cette enquête montre la forte prévalence de l’anguillulose, trouvée chez 51,69 % des parasités et 4,56 % de la population étudiée, la prévalence encore élevée des amibes non ou peu pathogènes (Endolimax nanus, Dientamoeba fragilis, Entamoeba coli) trouvées chez 27,19 % des parasités et 1,88 % de la population étudiée, ainsi que celle des ankylostomes (12,80 % des parasités et 1,13 % de la population), la persistance de la lambliase. Cette étude montre aussi la présence de cryptosporidies (7 cas) et de microsporidies (4 cas) chez des patients infectés par le virus de l’immunodéficience humaine.Ces résultats confirment la tendance des vingt dernières années et les résultats des enquêtes initiées par l’Inserm en 1978, 1988 et 1994-95 avec la régression de la bilharziose et la persistance des anguillules et des ankylostomes.L’amélioration des conditions de vie et d’hygiène, l’action conjuguée des soignants et des autorités sanitaires à la Martinique au cours des 30 dernières années dans la lutte anti-parasitaire ont entraîné une diminution importante de la prévalence des parasitoses intestinales classiques. De nouveaux parasites associés à l’infection par le VIH ont fait leur apparition.Determine the prevalence of intestinal parasitosis between January 1, 1997 and December 31, 1999 in the microbiology laboratory of the Fort de France University Hospital.Retrospective study of the results of 4 684 parasitological examinations of stools performed in 2 704 patients between January 1, 1997 and December 31, 1999 in this laboratory.This survey showed the high prevalence of anguillulosis, found in 51.69% of infested patients and in 4.56% of the population studied, the ever high prevalence of non or scarcely pathogenic amoebas (Endolimax nanus, Dientamoeba fragilis, Entamoeba coli) found in 27.19% of infested patients and 1.88% of the population studied, together with that of hookworms (12.80% of infested patients and 1.13% of the population), and the persistence of lambliasis. This study also revealed the presence of cryptosporidies (7 cases) and microsporidies (4 cases) in the patients infected by the human immunodeficiency virus.These results confirm the trend of the past twenty years and the results of surveys initiated by the national statistics board (INSERM) in 1978, 1988 and 1995-1995, with the regression of bilharziosis and the persistence of anguillulosis and hookworms.The improvement in living conditions and hygiene, the combined efforts of the health care workers and authorities in Martinique over the past 30 years in the fight against parasites have led to a great reduction in the prevalence of classical intestinal parasitosis. However, new parasites associated with HIV infection have appeared.
Mycetoma is a chronic subcutaneous tumefaction with presence of grains or granules. Etiological a... more Mycetoma is a chronic subcutaneous tumefaction with presence of grains or granules. Etiological agents include bacteria or filamentous fungi. Mycetoma due to dermatophytes is uncommon, mainly occurring in Africa. To our knowledge, no case has been reported in the West Indies. Only two observations of Micosporum canis mycetoma in humans have been reported in the literature. We report a third case of mycetoma of the scalp caused by this fungus. A 22-year-old woman from Martinique, French West Indies, presented with an indolent tumefaction of the scalp evolving over five years. She had mental retardation due to congenital adrenal hyperplasia with 21-hydroxylase deficiency. The lesion was extracted surgically. Pathology and mycology examinations showed features of Microsporum canis mycetoma. Two months later, the scalp lesion recurred and the patient was treated with griseofulvin after surgical extraction. Mycetoma due to dermatophytes is very uncommon, mainly observed on the scalp and ...
En Martinique on note, depuis 1986, une augmentation du nombre de cas de salmonelloses mineures. ... more En Martinique on note, depuis 1986, une augmentation du nombre de cas de salmonelloses mineures. A la diff6rence de ce qui est observ6 en France m6tropolitaine, Salmonella panama est le s6rotype le plus repr6sent6 (35 % des souches). Nous avons compar6 chez les enfants hospitalis6s dans les services de p6diatrie du CHU de Fort de France entre 1990 et 1994, les caract6ristiques 6pid6miologiques, cliniques et biologiques des infections ~ S. panama (groupe 1; 35 cas) et de celles dues aux antres s6rotypes (groupe 2; 56 cas). Entre les 2 groupes, l'~ge des enfants ne diff6re pas significativement. Des signes cliniques de gravit6 sont pr6sents chez 8 des 35 enfants du groupe 1, et seulement chez 1 des 56 enfants du groupe 2 (p = 0,001). Vingt-sept (77 %) des 35 enfants du groupe 1 ont des h6mocultures positives contre 10 (21%) des 49 enfants du groupe 2 pr61ev6s pour h6moculture (p < 10-4). La plus grande s6v6rit6 des infections dues ~ S. panama parait donc ~tre une r6alit6 clinique et biologique dont t6moignent aussi les diff6rences significatives retrouv6es au nivean des autres parambtres 6tudi6s : temp6rature moyenne ~ l'admission, fr6quence avec laquelle une antibioth6rapie a 6t6 institu6e, choix de cette derni6re et dur6e d'hospitalisation. L'6pid6miologie des infections ~t S. panama reste m6connue. Aucun des cas rapport6s n'entre dans le cadre d'une toxi infection alimentaire collective. S, panama n'est que tr~s rarement isol6e ~ la suite de contr61es d'hygi6ne de l'ean et des aliments (9 sur 196 souches de salmonelles de 1975 1994). Mots-cl6s : Salmonella panama -Martinique. L'6pid6miologie des salmonelloses humaines en Martinique a longtemps 6t6 domin6e par Salmonella typhi et S. paratyphi, responsables de v6ritables 6pid6mies jusqu'en 1966. Actuellement, parmi les salmonelles dites mineures, S. panama est le s6rotype le plus souvent isol6 au CHU de Fort de France. I1 nous a paru int6ressant d'6tudier l'6volution 6pid6miologique de ce s6rotype en Martinique ainsi que les aspects cliniques des infections ?~ S. panama chez 1' enfant.
Mycetoma is a chronic granulomatous infection that is difficult to treat, notably when due to fun... more Mycetoma is a chronic granulomatous infection that is difficult to treat, notably when due to fungi such as Scedosporium apiospermum. Recent antifungal agents could be an option, but cases are rarely reported, and none with posaconazole. Paradoxical responses, defined as initial clinical worsening despite appropriate treatment, are common in tuberculosis but rare in deep mycoses in non-immunocompromised hosts. Hence, paradoxical responses in context other than mycobacterial infection in an immunocompromised host could provide insights into the pathophysiology and the optimal strategy for treatment. We report the first case of a mycetoma caused by S. apiospermum with bone involvement treated with posaconazole, and the paradoxical response observed at the beginning of the treatment. As with mycobacterial infections, a paradoxical response in deep mycosis could represent the earliest marker of therapeutic efficacy.
Among the opportunistic mycoses that are emerging in patients with immunosuppression or severe un... more Among the opportunistic mycoses that are emerging in patients with immunosuppression or severe underlying illness, many isolates lack of characteristic sporulation and until recently could not be identified. Clinical signs are mostly non-specific and therefore such infections have often been disregarded. In the present paper we describe a novel, non-sporulating fungal species causing subcutaneous phaeohyphomycosis in two patients of different origin. One is a 73-year-old female from Martinique who suffered from rheumatoid arthritis, while the other case concerns a 72-year-old male from Mexico who had a history of type 2 diabetes mellitus. Sequencing of the partial ribosomal operon revealed that in both cases a member of the order Pleosporales was concerned which could not be affiliated to any family within this order. Multilocus analysis revealed that the fungus was related to another, unaffiliated agent of human mycetoma, Pseudochaetosphaeronema larense, and therefore the name Pseudochaetosphaeronema martinelli was introduced.
Phaeohyphomycosis is a group of superficial and deep infections due to dematiaceous fungi. They a... more Phaeohyphomycosis is a group of superficial and deep infections due to dematiaceous fungi. They are most common in tropical environments, especially in immunocompromised hosts. We describe the first case of phaeohyphomycosis due to Pleurostoma ootheca in a kidney transplant recipient in Martinique (French West Indies). A 59-year-old man with a kidney graft, treated with mycophenolate mofetil, tacrolimus, and prednisone, presented suppurative tumefaction of the left ankle. Cutaneous and osseous phaeohyphomycosis caused by P. ootheca was diagnosed, based on mycological, histological, and radiological testing. The patient's condition improved with posaconazole treatment. P. ootheca is a known environmental fungus. Immunocompromised hosts are more vulnerable to many infections, due to opportunistic pathogens. Bacteriological, histological, and mycological testing is required for accurate diagnosis and appropriate treatment. Treatment is not well defined and usually relies on antifun...
Un relevé des spores de moisissures présentes dans l'air de la ville de Fort de France a été réal... more Un relevé des spores de moisissures présentes dans l'air de la ville de Fort de France a été réalisé du 1 er juillet 2003 au 30 juin 2004, en utilisant un capteur de type Burkard. Parmi les nombreuses spores retrouvées sur les lames d'aérobiologie, les plus fréquentes appartiennent à cinq genres (Alternaria, Cladosporium, Curvularia, Pithomyces et Torula), à deux familles (Aspergillaceae et Basidiomycetaceae) et six groupes (myxomycètes, helminthosporium, mycélium stérile, ascospores et « Autres spores »). Parallèlement à la réalisation des lames d'aérobiologie, des prélèvements d'air sur milieux gélosés au Rose Bengale additionnés de chloramphénicol, ont été réalisés en parallèle grâce au biocollecteur Air IDEAL ® (BioMérieux). Les moisissures les plus fréquemment retrouvées appartiennent aux genres Aspergillus (22,5 %), Cladosporium (13,5 %), Curvularia (9,3 %), Pénicillium (8,8 %), Fusarium (7 %). De nombreux mycéliums stériles sont également isolés (20 %).
This survey drew up the epidemiological situation of intestinal parasitism in Martinique in 1994-... more This survey drew up the epidemiological situation of intestinal parasitism in Martinique in 1994-1995. 13,978 stool specimens collected in 1994-1995 were tested by parasitologic examination. Stool specimens were from patients hospitalised in the 3 principal hospitals of Martinique or coming to the Laboratoire départemental d'hygiène. The parasitism rate was 8.73%. This study showed a significant reduction of intestinal parasitism between results of 1988 and results of 1994-1995. The oro-faecal parasitism was not very important that reflected the good economic and sanitation level of Martinique. On the other hand, regarding the important prevalence of parasitism with Strongyloïdes stercoralis and hookworm, it would be good to improve detection, sanitary education and know better local contamination factors to decrease the prevalence of this parasitism.
Strongyloidiasis is an parasitic intestinal disease, frequent in tropical countries and fairly ra... more Strongyloidiasis is an parasitic intestinal disease, frequent in tropical countries and fairly rare in temperate areas under certain conditions. Disseminated forms can provoke multivisceral damage. A 75 year-old woman, hospitalized for occlusion, developed multivisceral (cerebral, renal, cardiac pulmonary and hepatic) damage over 48 hours, attributed to strongyloidiasis. The diagnosis was confirmed by isolation of larvae in the tracheal and gastric aspiration fluids. Treatment combined ivermectin and albendazole. Disseminated stronglyloidiasis is essentially observed in immunodepressed patients, under corticosteroids or HTLV1 carriers, although an HIV status does not appear to intervene. Larvae can be found in all the organs. Death occurs by multivisceral failure in 50 to 70% of cases. Broncho-alveolar washing and examination of the gastric fluids is the key to diagnosis. Treatment relies on thiabendazole, ivermectin or albendazole, and the symptomatic management of all the visceral...
Journal de Mycologie Médicale / Journal of Medical Mycology, 2006
Un relevé des spores de moisissures présentes dans l'air de la ville de Fort de France a été réal... more Un relevé des spores de moisissures présentes dans l'air de la ville de Fort de France a été réalisé du 1 er juillet 2003 au 30 juin 2004, en utilisant un capteur de type Burkard. Parmi les nombreuses spores retrouvées sur les lames d'aérobiologie, les plus fréquentes appartiennent à cinq genres (Alternaria, Cladosporium, Curvularia, Pithomyces et Torula), à deux familles (Aspergillaceae et Basidiomycetaceae) et six groupes (myxomycètes, helminthosporium, mycélium stérile, ascospores et « Autres spores »). Parallèlement à la réalisation des lames d'aérobiologie, des prélèvements d'air sur milieux gélosés au Rose Bengale additionnés de chloramphénicol, ont été réalisés en parallèle grâce au biocollecteur Air IDEAL ® (BioMérieux). Les moisissures les plus fréquemment retrouvées appartiennent aux genres Aspergillus (22,5 %), Cladosporium (13,5 %), Curvularia (9,3 %), Pénicillium (8,8 %), Fusarium (7 %). De nombreux mycéliums stériles sont également isolés (20 %).
The American journal of tropical medicine and hygiene, Jan 31, 2017
A syphilis outbreak began in Martinique, French Antilles, in 2004, initially among men who had se... more A syphilis outbreak began in Martinique, French Antilles, in 2004, initially among men who had sex with men (MSM) and who were living with human immunodeficiency virus (HIV). The outbreak subsequently affected all groups at risk, leading to a first epidemic peak in 2008. After an initial decrease, the outbreak started growing again in 2014 among patients living with HIV with unprecedented incidence among MSM. Herein, we describe the change in medical and social parameters of the outbreak since 2005.
in this laboratory. Results This survey showed the high prevalence of anguillulosis, found in 51.... more in this laboratory. Results This survey showed the high prevalence of anguillulosis, found in 51.69% of infested patients and in 4.56% of the population studied, the ever high prevalence of non or scarcely pathogenic amoebas (Endolimax nanus, Dientamoeba fragilis, Entamoeba coli) found in 27.19% of infested patients and 1.88% of the population studied, together with that of hookworms (12.80% of infested patients and 1.13% of the population), and the persistence of lambliasis. This study also revealed the presence of cryptosporidies (7 cases) and microsporidies (4 cases) in the patients infected by the human immunodeficiency virus. Discussion These results confirm the trend of the past twenty years and the results of surveys initiated by the national statistics board (INSERM) in 1978(INSERM) in , 1988(INSERM) in and 1995(INSERM) in -1995 with the regression of bilharziosis and the persistence of anguillulosis and hookworms. Conclusion The improvement in living conditions and hygiene, the combined efforts of the health care workers and authorities in Martinique over the past 30 years in the fight against parasites have led to a great reduction in the prevalence of classical intestinal parasitosis. However, new parasites associated with HIV infection have appeared.
Préciser la prévalence des parasitoses digestives entre le 1° janvier 1997 et le 31 décembre 1999... more Préciser la prévalence des parasitoses digestives entre le 1° janvier 1997 et le 31 décembre 1999 dans le laboratoire de microbiologie du C.H.U de Fort-de-France.Il s’agit d’une analyse rétrospective des résultats de 4684 examens parasitologiques des selles réalisés chez 2 704 patients entre le 1er janvier 1997 et le 31 décembre 1999 dans ce laboratoire.Cette enquête montre la forte prévalence de l’anguillulose, trouvée chez 51,69 % des parasités et 4,56 % de la population étudiée, la prévalence encore élevée des amibes non ou peu pathogènes (Endolimax nanus, Dientamoeba fragilis, Entamoeba coli) trouvées chez 27,19 % des parasités et 1,88 % de la population étudiée, ainsi que celle des ankylostomes (12,80 % des parasités et 1,13 % de la population), la persistance de la lambliase. Cette étude montre aussi la présence de cryptosporidies (7 cas) et de microsporidies (4 cas) chez des patients infectés par le virus de l’immunodéficience humaine.Ces résultats confirment la tendance des vingt dernières années et les résultats des enquêtes initiées par l’Inserm en 1978, 1988 et 1994-95 avec la régression de la bilharziose et la persistance des anguillules et des ankylostomes.L’amélioration des conditions de vie et d’hygiène, l’action conjuguée des soignants et des autorités sanitaires à la Martinique au cours des 30 dernières années dans la lutte anti-parasitaire ont entraîné une diminution importante de la prévalence des parasitoses intestinales classiques. De nouveaux parasites associés à l’infection par le VIH ont fait leur apparition.Determine the prevalence of intestinal parasitosis between January 1, 1997 and December 31, 1999 in the microbiology laboratory of the Fort de France University Hospital.Retrospective study of the results of 4 684 parasitological examinations of stools performed in 2 704 patients between January 1, 1997 and December 31, 1999 in this laboratory.This survey showed the high prevalence of anguillulosis, found in 51.69% of infested patients and in 4.56% of the population studied, the ever high prevalence of non or scarcely pathogenic amoebas (Endolimax nanus, Dientamoeba fragilis, Entamoeba coli) found in 27.19% of infested patients and 1.88% of the population studied, together with that of hookworms (12.80% of infested patients and 1.13% of the population), and the persistence of lambliasis. This study also revealed the presence of cryptosporidies (7 cases) and microsporidies (4 cases) in the patients infected by the human immunodeficiency virus.These results confirm the trend of the past twenty years and the results of surveys initiated by the national statistics board (INSERM) in 1978, 1988 and 1995-1995, with the regression of bilharziosis and the persistence of anguillulosis and hookworms.The improvement in living conditions and hygiene, the combined efforts of the health care workers and authorities in Martinique over the past 30 years in the fight against parasites have led to a great reduction in the prevalence of classical intestinal parasitosis. However, new parasites associated with HIV infection have appeared.
Mycetoma is a chronic subcutaneous tumefaction with presence of grains or granules. Etiological a... more Mycetoma is a chronic subcutaneous tumefaction with presence of grains or granules. Etiological agents include bacteria or filamentous fungi. Mycetoma due to dermatophytes is uncommon, mainly occurring in Africa. To our knowledge, no case has been reported in the West Indies. Only two observations of Micosporum canis mycetoma in humans have been reported in the literature. We report a third case of mycetoma of the scalp caused by this fungus. A 22-year-old woman from Martinique, French West Indies, presented with an indolent tumefaction of the scalp evolving over five years. She had mental retardation due to congenital adrenal hyperplasia with 21-hydroxylase deficiency. The lesion was extracted surgically. Pathology and mycology examinations showed features of Microsporum canis mycetoma. Two months later, the scalp lesion recurred and the patient was treated with griseofulvin after surgical extraction. Mycetoma due to dermatophytes is very uncommon, mainly observed on the scalp and ...
En Martinique on note, depuis 1986, une augmentation du nombre de cas de salmonelloses mineures. ... more En Martinique on note, depuis 1986, une augmentation du nombre de cas de salmonelloses mineures. A la diff6rence de ce qui est observ6 en France m6tropolitaine, Salmonella panama est le s6rotype le plus repr6sent6 (35 % des souches). Nous avons compar6 chez les enfants hospitalis6s dans les services de p6diatrie du CHU de Fort de France entre 1990 et 1994, les caract6ristiques 6pid6miologiques, cliniques et biologiques des infections ~ S. panama (groupe 1; 35 cas) et de celles dues aux antres s6rotypes (groupe 2; 56 cas). Entre les 2 groupes, l'~ge des enfants ne diff6re pas significativement. Des signes cliniques de gravit6 sont pr6sents chez 8 des 35 enfants du groupe 1, et seulement chez 1 des 56 enfants du groupe 2 (p = 0,001). Vingt-sept (77 %) des 35 enfants du groupe 1 ont des h6mocultures positives contre 10 (21%) des 49 enfants du groupe 2 pr61ev6s pour h6moculture (p < 10-4). La plus grande s6v6rit6 des infections dues ~ S. panama parait donc ~tre une r6alit6 clinique et biologique dont t6moignent aussi les diff6rences significatives retrouv6es au nivean des autres parambtres 6tudi6s : temp6rature moyenne ~ l'admission, fr6quence avec laquelle une antibioth6rapie a 6t6 institu6e, choix de cette derni6re et dur6e d'hospitalisation. L'6pid6miologie des infections ~t S. panama reste m6connue. Aucun des cas rapport6s n'entre dans le cadre d'une toxi infection alimentaire collective. S, panama n'est que tr~s rarement isol6e ~ la suite de contr61es d'hygi6ne de l'ean et des aliments (9 sur 196 souches de salmonelles de 1975 1994). Mots-cl6s : Salmonella panama -Martinique. L'6pid6miologie des salmonelloses humaines en Martinique a longtemps 6t6 domin6e par Salmonella typhi et S. paratyphi, responsables de v6ritables 6pid6mies jusqu'en 1966. Actuellement, parmi les salmonelles dites mineures, S. panama est le s6rotype le plus souvent isol6 au CHU de Fort de France. I1 nous a paru int6ressant d'6tudier l'6volution 6pid6miologique de ce s6rotype en Martinique ainsi que les aspects cliniques des infections ?~ S. panama chez 1' enfant.
Mycetoma is a chronic granulomatous infection that is difficult to treat, notably when due to fun... more Mycetoma is a chronic granulomatous infection that is difficult to treat, notably when due to fungi such as Scedosporium apiospermum. Recent antifungal agents could be an option, but cases are rarely reported, and none with posaconazole. Paradoxical responses, defined as initial clinical worsening despite appropriate treatment, are common in tuberculosis but rare in deep mycoses in non-immunocompromised hosts. Hence, paradoxical responses in context other than mycobacterial infection in an immunocompromised host could provide insights into the pathophysiology and the optimal strategy for treatment. We report the first case of a mycetoma caused by S. apiospermum with bone involvement treated with posaconazole, and the paradoxical response observed at the beginning of the treatment. As with mycobacterial infections, a paradoxical response in deep mycosis could represent the earliest marker of therapeutic efficacy.
Among the opportunistic mycoses that are emerging in patients with immunosuppression or severe un... more Among the opportunistic mycoses that are emerging in patients with immunosuppression or severe underlying illness, many isolates lack of characteristic sporulation and until recently could not be identified. Clinical signs are mostly non-specific and therefore such infections have often been disregarded. In the present paper we describe a novel, non-sporulating fungal species causing subcutaneous phaeohyphomycosis in two patients of different origin. One is a 73-year-old female from Martinique who suffered from rheumatoid arthritis, while the other case concerns a 72-year-old male from Mexico who had a history of type 2 diabetes mellitus. Sequencing of the partial ribosomal operon revealed that in both cases a member of the order Pleosporales was concerned which could not be affiliated to any family within this order. Multilocus analysis revealed that the fungus was related to another, unaffiliated agent of human mycetoma, Pseudochaetosphaeronema larense, and therefore the name Pseudochaetosphaeronema martinelli was introduced.
Phaeohyphomycosis is a group of superficial and deep infections due to dematiaceous fungi. They a... more Phaeohyphomycosis is a group of superficial and deep infections due to dematiaceous fungi. They are most common in tropical environments, especially in immunocompromised hosts. We describe the first case of phaeohyphomycosis due to Pleurostoma ootheca in a kidney transplant recipient in Martinique (French West Indies). A 59-year-old man with a kidney graft, treated with mycophenolate mofetil, tacrolimus, and prednisone, presented suppurative tumefaction of the left ankle. Cutaneous and osseous phaeohyphomycosis caused by P. ootheca was diagnosed, based on mycological, histological, and radiological testing. The patient's condition improved with posaconazole treatment. P. ootheca is a known environmental fungus. Immunocompromised hosts are more vulnerable to many infections, due to opportunistic pathogens. Bacteriological, histological, and mycological testing is required for accurate diagnosis and appropriate treatment. Treatment is not well defined and usually relies on antifun...
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