Antibiotic susceptibility of cultivable microbiota from the oral cavity of captive Bothrops atrox and Bothrops lanceolatus: Implications for the treatment of snakebite-associated infections in the French departments of America.

INTRODUCTION: Secondary infection is a frequent complication after bites by Bothrops atroxin French Guiana or B. lanceolatus in Martinique. Knowledge of the bacteria present in snake mouths is a valuable aid for determining probabilistic antibiotherapy after Bothrops bite. The objectives of this study were to describe the cultivable bacteria of the oral microbiota of the specimens of B. atrox and B. lanceolatus kept in captivity, and to study their susceptibility to antibiotics. METHODS: Fifteen B. atrox and 15 B. lanceolatus were sampled. Bacterial cultures were performed and each morphotype on plates was identified using MALDI-TOF mass spectrometry. Antibiotic susceptibility was studied using the agar disk diffusion method, with possible determination of the MICs. RESULTS: One hundred and twenty-two isolates were identified: 52 isolates and 13 species in B. atrox, 70 isolates and 23 species in B. lanceolatus. The main species were Providencia rettgeri, Morganella morganii, Pseudomonas aeruginosa, Staphylococcus xylosus, and Paeniclostridium sordellii (only in B. lanceolatus mouths). For B. atrox, 96% of isolates were susceptible to piperacillin/tazobactam, cefepime, imipenem and meropenem, 94% to ciprofloxacin and 76% to cefotaxime and ceftriaxone. For B. lanceolatus, 97% of isolates were susceptible to meropenem, 96% to cefepime, 93% to imipenem and piperacillin/tazobactam, 80% to ciprofloxacin, and 75% to cefotaxime and ceftriaxone. Many isolates were resistant towards amoxicillin/clavulanate. CONCLUSION: Among currently recommended antibiotics, cefepime and piperacillin/tazobactam seem more suitable than cefotaxime or ceftriaxone in the event of a Bothrops bite. Ciprofloxacin may also be considered for B. atrox.

[Impact of COVID-19 on public health in sub-Saharan Africa]. / Impact de la COVID-19 sur la santé publique en Afrique subsaharienne.

Objective: This work aimed to assess the impact of COVID-19 on healthcare supply in sub-Saharan Africa except South Africa. Method: A search through PubMed® between April 2020 and August 2022 selected 135 articles. The impact of COVID-19 was assessed on comparisons with the months prior to the onset of COVID-19 or an identical season in previous years. Results: The decline of health services, associated with a reduction in their quality, and the closure of specialized health units have been reported. Many control programs and public health interventions have been interrupted, with the risk of an increase of the corresponding diseases. Social disorganization has generated mental health issues among the population, including health personnel. The impact was heterogeneous in space and time. The main causes were attributed to containment measures (transport restrictions, trade closures) and the lack of human and material resources. The increase in costs, in addition to the impoverishment of the population, and the fear of being contaminated or stigmatized have discouraged patients from going to health centres. The studies mention the gradual return to normal after the first epidemic wave and the resilience of the healthcare system. Conclusion: Several articles make recommendations aimed at reducing the impact of future epidemics: support for community workers, training of health workers and reorganization of services to improve the reception and care of patients, technological innovations (use of telephones, drones, etc.) and better information monitoring.

[Envenoming: What Information Do We Need Today and How Do we Present the Data?] / Envenimations : quelles sont les informations pertinentes et comment les présenter ?

The number of papers regarding envenoming is increasing but they often miss information and presentation to assess the needs for proper management. The author suggests some criteria to make data more informative and makes recommendations to improve the presentation of the method and results used for the study, and build argued discussion.

Le nombre d'articles concernant les envenimations s'accroît, mais ils y manquent encore trop souvent les informations et la présentation nécessaires à l'évaluation des besoins pour une prise en charge appropriée. L'auteur propose quelques critères pour rendre les données plus informatives et fait des recommandations pour améliorer la présentation de la méthode et des résultats, et construire une discussion argumentée.

Management of scorpion stings in Africa and the Mediterranean region.

Common in the southern and eastern Mediterranean basin, scorpion stings can develop into a severe medical emergency, especially in young children. Here we review several principles of diagnosis and treatment. The indications for antivenom and symptomatic treatment are detailed according to the symptoms and clinical severity of envenomation.

[Management of Snakebites in Sub-Saharan Africa]. / Prise en charge des morsures de serpent en Afrique subsaharienne.

Although common in sub-Saharan Africa, snakebites remain a neglected topic. The paper reviews some diagnostic and therapeutic rules for this medical and surgical emergency that occurs mainly in remote health centers. Intravenous administration of polyvalent antivenom is the preferred treatment in any proven envenomation. Antivenom should be associated with symptomatic treatment. Patient surveillance is well codified and the management of complications is specified.

[Evaluation of a new polyvalent antivenom against snakebite envenomation (Inoserp® Panafricain) in two different epidemiological settings: Northern Benin and Maritime Guinea]. / Évaluation d'un nouvel antivenin polyvalent contre les envenimations ophidiennes (Inoserp(®) Panafricain) dans deux contextes épidémiologiques: le Nord Bénin et la Guinée Maritime.

OBJECTIVES: The authors evaluated the safety and efficacy of Inoserp(®) Pan Africa, a new polyvalent antivenom composed of highly purified and lyophilized fragments of F(ab')2 immunoglobulins, recently registered in Benin and Guinea. METHODS: We treated 100 patients in northern Benin (Atacora) and 109 in Maritime Guinea (Kindia) with confirmed envenomation. Treatment consisted of intravenous administration of 1 vial for uncomplicated envenomation, and 2 vials for hemorrhagic or neurotoxic envenomation. The dose was repeated when bleeding or signs of neurotoxicity persisted or appeared. RESULTS: In Atacora, on arrival at the hospital, 90% of patients had incoagulable blood, and 50% were bleeding. The resolution of these bleeding disorders was obtained in less than 3 hours for 50% of the patients and in less than 24 hours for 98%. Four patients died. In Kindia, 96 patients (88%) presented viper bites with pain + edema and 13 (12 %) others showed elapid (ptosis, dyspnea) envenomation. One patient bitten by a member of the Elapidae family, died despite early treatment. In Benin, protocol deviations for 60% of patients led to significant underdosing of the antivenom; the proportion was much lower (2%) in Guinea. Signs of intolerance after Inoserp(®) Pan Africa administration were reported in 8% of patients. All these symptoms were mild and disappeared rapidly after an antihistamine or corticosteroid treatment. CONCLUSION: Treatment using intravenous Inoserp(®) Pan Africa appeared to be well tolerated and effective against snakebite envenomation in both epidemiological settings.

[Perineoscrotal gangrene after a snake bite: a case report]. / Un cas de gangrène périnéoscrotale consécutive à une morsure de serpent.

The authors describe a case of perinoscrotal gangrene in a patient who had been bitten by a snake. He was treated with antivenom immunotherapy and surgery. The outcome was good. They present a brief review of the literature regarding the epidemiological, clinical, and treatment issues.

[Alternative medicine, beliefs, and management of people with HIV in Gabon]. / Médecines alternatives, croyances et prise en charge des personnes vivant avec le VIH au Gabon.

BACKGROUND: According to WHO, 80% of the population in Africa has used alternative medicine for primary health care at least once. Gabon continues to have a high prevalence of HIV, estimated in 2011 at 5.2%. Overall, 22 253 PLWHA (people living with HIV/AIDS) - adults and children - are being treated, including 9976 on ARVs (antiretroviral drugs). The procedures for ARV initiation are very long, ARVs are frequently out of stock, and treatment in care centers for PLWHA is stigmatized: all these factors favor the development of alternative medicine for HIV care in Gabon. OBJECTIVE: To analyze the impact of alternative medicine in the treatment of PLWHA in Gabon. METHODOLOGY: This cross-sectional survey was conducted during a total of four months between May 2009 and September 2010 among PLWHA older than 18 years who had been receiving ARVs for at least 6 months and consented to participate (7 centers) and among physicians and other caregivers of these centers (8 centers). We used a simple random sample method. Epidata software was used for data collection, and the analyses were performed with SAS™ software. RESULTS: Of the 5752 patients on ARVs followed at the 7 study sites, 422 PLWHA were interviewed (58.3% of them women): 284 (67.29%) in Libreville and 138 (38.7) in the provinces. Christians accounted for 90.5% (including 21.5% from Protestant evangelical churches), and Muslins for 5.68%, while 4% stated that they had no religion. 12.5% of doctors referred their patients to religious or spiritual groups. CONCLUSION: Our study showed that half of PLWHA did not know the procedures for access to ARV treatment and that beliefs about HIV/AIDS differed strongly according to place of residence. Finally, the cultural context related to alternative medicine is very present in the PLWHA treatment settings in Gabon. Although PLWHAs have easy access to ARVs, their association with organized and controlled alternative medicine can be beneficial.

Prevalence of Chagas disease in pregnant women and incidence of congenital transmission in Santa Cruz de la Sierra, Bolivia.

Congenital transmission of Chagas disease stand out as a major public health problem since the vector control was performed in all endemic areas and has shown its effectiveness. An epidemiological study was performed in three maternity hospitals of the city of Santa Cruz de la Sierra, Bolivia from 2006 to 2008. The serological screening for Trypanosoma cruzi infection was carried out in 15,767 pregnant women. Chagas infection was detected in 3725 women (23.6%), who gave birth to 125 newborns infected by T. cruzi at birth, representing an incidence of 790 per 100,000 births during a period of 16 months and a vertical transmission rate by 3.4%. There was a significant difference between hospitals that might be explained by socio-economic origins of mothers and diagnostic constraints.

[Clinical study of tolerance and effectiveness of a F(ab')(2) polyvalent antienom for African snake bites in Kindia, Guinea]. / Étude clinique de la tolérance et de l'efficacité d'un sérum anti-ophidien polyvalent F(ab')(2) pour l'Afrique à Kindia, Guinée.

An open, pragmatic, phase IV clinical trial was undertaken to measure tolerance and assess the effectiveness of Antivipmyn® Africa, antivenom composed of lyophilized F(ab')(2) fragments of immunoglobulin G in field conditions. The study was conducted at the Institut Pasteur of Guinea (IPG) from August 2009 to February 2010. Two hundred twenty-eight victims of snakebites presented at the processing center of the IPG during this period, including one hundred fifty (65.8%) envenomations, mostly young men. One hundred twenty-four of them (82.7%) suffered from viper envenomations and 26 (17.3%) from elapid ones. All patients were treated by intravenous Antivipmyn® Africa, averaging 1.4 (± 1.0) vials, more in patients with neurotoxic envenomation than others (P < 10(-5)). Four patients (2.7%), showing cobralike envenomation, died shortly after their arrival at the IPG despite the administration of the antivenom. Ten patients showed mild side effects (rash or pruritus), out of which 5 (3.3%) were probably due to treatment. This study confirms the efficacy and safety of Antivipmyn® Africa.

[Preliminary study of snake fauna in the Lama forest, South Benin]. / Étude préliminaire de la faune ophidienne de la forêt classée de la Lama, Sud Bénin.

The following study aims at assessing the ophidian diversity of the Lama Forest, a classified area, situated in the South of Benin. One can distinguish three types of habitat according to the degree of human activity: the remaining dense forest at the centre, the intermediate plantation area, and finally the area around the edge which has been entirely subjected to human habitation. Each day for two weeks we have been working on various plots of study (by day), patrolled along transect routes (by night), and installed a trap in the central area. As a result, we were able to observe 32 snake specimens, 24 of which we captured. Nearly all were able to be identified, and have been classified into 13 genera and 17 species.

[Report of the 4th International Conference on Envenomations by Snakebites and Scorpion Stings in Africa, Dakar, April 25-29, 2011]. / 4(e) Conférence internationale sur les envenimations par morsures de serpent et piqûres de scorpion en Afrique : Dakar, 25-29 avril 2011.

The authors present a summary of the proceedings and the recommendations of the Fourth International Conference on Envenomations by Snakebites and Scorpion Stings in Africa, held from 25 to 29 April 2011 in Dakar. After a two-day workshop for Senegalese health personnel on the most relevant aspects of the management of envenomations, about 270 participants met to share their experiences in the field. Nearly a hundred oral and poster presentations were made on the epidemiology of snakebites and scorpion stings in Africa, the composition and action of venoms and the manufacture and use of antivenoms. The last day was devoted to an institutional debate involving experts, representatives of national health authorities and concerned professionals (physicians, pharmacists, nurses and traditional healers) as well as members of the pharmaceutical industry to discuss and elaborate a set of recommendations. It was agreed that it is necessary to improve knowledge of the epidemiological situation by case reporting. Quality control of antivenoms and procedures for their registration at the level of national health authorities should aim at improving the distribution of safe and effective antivenoms in peripheral health centers for the better assessment of victims. It was also recommended that adequate training should be provided for health personnel in all aspects of medical management of envenomations. Equitable distribution of funding and the establishment of a network of African experts were also discussed in the conference.

Snakebite on the hand: lessons from two clinical cases illustrating difficulties of surgical indication

Snakebite is a particularly important health problem in rural areas of tropical regions. A large number of victims survive with permanent physical sequelae due to local tissue necrosis. However, necrosis may be associated with compartment syndrome especially when the bite is on the hands or feet. Herein, we describe two cases reported at a rural district hospital in Central African Republic. The present study suggests that active multidisciplinary management may improve patient prognosis while evidencing how difficult it is to decide on surgical intervention.(AU)

Incidence and severity of scorpion stings in Algeria

Scorpion stings are a public health problem in the Maghreb region. In Algeria, epidemiological data were collected over the past twenty years by the Algerian health authorities. This study is an analysis of morbidity and mortality data collected from 2001 to 2010. Annual incidence and mortality due to scorpion envenoming were 152 ± 3.6 stings and 0.236 ± 0.041 deaths per 100,000 people (95% CI), respectively. The risk of being stung by a scorpion was dramatically higher in southern areas and central highlands due to environmental conditions. Incidence of envenoming was especially higher in the adult population, and among young males. In contrast, mortality was significantly higher among children under 15 years, particularly ages 1-4. Upper limbs were more often affected than lower limbs. Most stings occurred at night, indoors and during the summer. Data collected since 2001 showed a reduction of mortality by nearly 50%, suggesting that the medical care defined by the national anti-scorpion project is bearing fruit.(AU)

Dangerous scorpion fauna of Mali

Although the main Malian scorpion species of medical interest, Androctonus amoreuxi, is responsible for severe envenomings and perhaps some deaths, it has hitherto been considered not dangerous for humans. This population is located in the Saharian North-Eastern regions of Mali where it is accompanied by Leiurus quinquestriatus, a well known dangerous species of the Sahara. In the Gao district, divided by the Niger River, less desolate than the Tessalit and Kidal regions, one specimen of the dangerous species Androctonus australis was found. To summarize, Mali harbors at least three dangerous scorpion species: Leiurus quinquestriatus, Androctonus amoreuxi and A. australis, the latter recently having been identified in Mali for the first time. The absence of Androctonus aeneas is surprising in this context because it is found in neighboring countries (Algeria, Niger) and should be detected by new surveys. The possibility of preparing a single scorpion antivenom intended for Saharian and sub-Saharian populations is discussed.(AU)

African Society of Toxinology: a new opportunity for integrating the control of envenomations in Africa

In Africa, snakebites and scorpion stings have long been oppressive for indigenous peoples, frightening for foreign travelers and confusing for medical personnel... In many tropical countries, studies were performed to assess the importance and management of envenomations. Since the 18th century, many works have addressed Indian venomous snakes and treatment of their bites (1, 2). In Brazil, studies began in the late 19th century (3). In Africa, apart from some systematic zoological studies in the early or mid 20th century, sustained research commenced mainly after the end of the colonial era (4-8). However to date, the incidence and mortality in Africa remain poorly known, limiting the organization of management and prediction of therapeutic needs (9). The development of research on venomous animals, venoms and envenomation truly started in North Africa in the 1960s, followed in sub-Saharan Africa in the early 1970s. The number of published studies increased significantly over the past decade, particularly with regard to sub-Saharan Africa. Considering the publications indexed in major bibliographic databases either printed (Bulletin de l'Institut Pasteur since 1903, Tropical Diseases Bulletin since 1912, Bulletin Signalétique du CNRS since 1940) or online (Pascal since 1971, Medline since 1972), the number of publications, excluding books, increased almost fivefold compared to the 1970s showing the emergence of the first African teams involved in research toxinology (Figure 1). However, publishing articles is highly dependent on congresses which are opportunities to present works completed by researchers and explain why the level of publications is so irregular from one year to the next... In addition, it should be emphasized that the clinical and epidemiological studies represent more than two thirds of published works.(AU)