[Can the thick drop/smear examination for malaria be replaced by a rapid diagnostic test in first intention? The Mayotte experience]. / Peut-on remplacer en première intention le frottis/goutte épaisse par un test de diagnostic rapide pour le diagnostic du paludisme ? L'expérience de Mayotte.

SETTINGS: Malaria is a public health problem in the French island of Mayotte (160,000 inhabitants) in the Indian Ocean. In the late 1990, resistance to chloroquine greatly increased, and so did the number of malaria cases, so that a new health policy had to be adopted. Since 2001, the initial smear/thick drop examination, the results of which took too long to obtain, has systematically been replaced by a rapid diagnosis test (Optimal IT Diamed) in all hospitals and public health centers. METHOD: Epidemiological data of malaria on the island was collected and a prospective study was made from March 2005 to February 2006, on two sites (the emergency department of the main hospital and a rural health centre) on all patients presenting with malaria (104 and 139 cases respectively). RESULTS: The first Optimal IT test diagnosed the condition accurately in 88 and 96% of the cases, respectively. Every time symptoms would persist after negative test results and an Optimal IT test was repeated within three days, the parasitemia level was low (0.08 to 0.66%). Very low parasitemia level was very likely to account for a false negative (test result). CONCLUSIONS: These results concerning malaria (and its epidemiological data) in Mayotte show that the initial use of an Optimal IT test instead of the thin/thick blood smear results in a faster management of patients with malaria, although the Optimal IT test is slightly less sensitive and requires training/practice.

[Epidemiology and prevention of malaria in the southwestern islands of the Indian Ocean]. / Epidémiologie et prévention du paludisme dans les iles du sud-ouest de l'Océan Indien.

Malaria epidemiology differs greatly in the geographically close islands of the southwestern Indian Ocean. In Madagascar and the Comoros Union malaria is still a major public health problem. In Mayotte indigenous transmission resumed in 1995 and is currently high in some communities. In the Mascarene Islands (Reunion and Mauritius), indigenous transmission has been eradicated (Reunion) or become rare (Mauritius). The Seychelles Islands are malaria-free since local conditions are unfavorable for Anopheles mosquitoes. The level of resistance to antimalarials also differs from one island to another. Resistance to chloroquine ranges from moderate in Madagascar to high in the Comoros Union. Health recommendations for travelers must be adapted to the epidemiological features on each island.

Efficacy of artemether-lumefantrine treatment in patients with acute uncomplicated Falciparum malaria in Mayotte, a French collectivity of the Comoros Archipelago.

Mayotte is a French island located in the Comoros archipelago in the Indian Ocean. Due to the high level of resistance to chloroquine and sulfadoxine-pyrimethamine in this area, new therapeutic strategies are required. The aim was to assess and to document the efficacy of artemether-lumefantrine (AL) combination in four oral dosages. The follow-up was carried out during 21 days to monitor the antimalarial drug efficacy in an open trial in April-May, 2002. Results were obtained from 51 patients, aged from three to 46 years (12% less than five years). No case of therapeutic failure was observed. At day 2 after treatment, all the patients were apyretic and none of them had parasitaemia until day 21. This first therapeutic trial of the AL combination in the Indian Ocean sub-region shows that this association is safe, effective and rapid. AL should be an alternative treatment of uncomplicated malaria attacks in Comoros Archipelago, and will be of help to manage imported chloroquine-resistant falciparum malaria strains in Madagascar.

Mother-to-child transmission of human T-cell-leukemia/lymphoma virus type I: implication of high antiviral antibody titer and high proviral load in carrier mothers.

In order to gain new insights into the risk factors influencing human-T-cell-leukemia/lymphoma-virus-type-I (HTLV-I) mother-to-child transmission, a retrospective study of HTLV-I infection among children born to HTLV-I-seropositive women was carried out in a highly HTLV-I-endemic population of African origin living in French Guyana. The study covered 81 HTLV-I-seropositive mothers and their 216 children aged between 18 months old and 12 years old. All plasma samples were tested for the presence of HTLV-I antibodies by ELISA, immunofluorescence assay and Western blot. HTLV-I provirus was detected, in the DNA extracted from peripheral-blood mononuclear cells, by polymerase chain reaction (PCR) using primers specific for 3 different HTLV-I genomic regions (LTR, gag and pX) and quantified by a competitive PCR assay. Out of the 216 children, 21 were found to be HTLV-I-seropositive, giving a crude HTLV-I transmission rate of 9.7%, while among the 180 breast-fed children 10.6% were HTLV-I-seropositive. Perfect concordance between serological and PCR results was observed, and none of the 195 HTLV-I-negative children was found HTLV-I-positive by PCR. In conditional (by family) logistic-regression models, HTLV-I seropositivity in children was associated with an elevated maternal anti-HTLV-I-antibody titer (OR 2.2, p = 0.0013), a high maternal HTLV-I proviral load (OR 2.6, p = 0.033) and child's gender, girls being more frequently HTLV-I-infected than boys: OR 3.6, p = 0.0077 in the model including maternal anti-HTLV-I-antibody titer and OR 4.1, p = 0.002 in the model including the maternal HTLV-I proviral load.

Risk factors for maternal HTLV-I infection in French Guiana: high HTLV-I prevalence in the Noir Marron population.

The aim of this study was to compare rates of human T-cell lymphotropic virus type I (HTLV-I) seroprevalence in pregnant women belonging to different ethnic groups in French Guiana and to determine the risk factors associated with HTLV-I seropositivity. All 1,873 deliveries between 1 July 1991 and 30 June 1993 in the only gynecologic and obstetric unit at Saint Laurent du Maroni were enrolled. Serologic status could be established for 1,727 women, with 75 (4.3%) being HTLV-I seropositive. The HTLV-I seroprevalence rate differed significantly between ethnic groups: 5.7% for Noir-Marron (70/1,302), 6.3% for Haitian (3/50), and 0% for Creole (126), Amerindians (166), and Hmong (64). In Noir-Marron pregnant women, HTLV-I seropositivity was associated with a maternal age of > 35 years [odds ratio (OR), 3.3; 95% confidence interval (CI), 1.4-7.6], prior miscarriage (OR, 1.7; CI, 1-2.8), prior cesarean section (OR, 2.1; CI, 1.1-4.0), a parity > 4 (OR, 4.0; CI, 1.8-8.8), a gravidity > 6 (OR, 4.2; CI, 2.0-7.2), and a negative Rhesus factor (OR, 2.2; CI, 1.1-4.5). Two separate stepwise logistic regressions were done because gravidity and parity were highly correlated. HTLV-I seropositivity remained associated with a gravidity > 6 (OR, 3.9; CI, 2.1-7.4) and a negative Rhesus factor (OR, 2.6; CI, 1.2-5.3) for the first model and with a parity > 4 (OR, 4.1; CI, 1.9-9.0) and a negative Rhesus factor (OR, 2.5; CI, 1.2-5.1) for the second model.(ABSTRACT TRUNCATED AT 250 WORDS)

Clustering and clinical diversity of adult T-cell leukemia/lymphoma associated with HTLV-I in a remote black population of French Guiana.

An epidemiological study was performed in French Guiana (population 115,000) to determine the prevalence and incidence of adult T-cell leukemia/lymphoma (ATL) associated with human T-cell leukemia/lymphoma virus type I (HTLV-I). From January 1990 to December 1993, all suspected cases of ATL were enrolled in this study, and their clinical, epidemiological and immunovirological features were analyzed. Out of the 19 suspected cases, 18 were considered as ATL associated with HTLV-I (8 acute forms, 8 lymphoma types and 2 smoldering cases). Before this study, only 2 ATL cases had been reported in French Guiana over a 10-year period. This demonstrates that the number of ATL cases is greatly under-estimated in most tropical HTLV-I endemic areas unless a specific disease search is performed. The mean age of the patients was 41 years. While HTLV-I antibodies were present in all cases, molecular studies demonstrated a clonal integration of HTLV-I in the tumoral cells in 7 cases out of the 9 tested. Fifteen patients died within a year of diagnosis. The crude incidence rate of ATL in French Guiana is around 3.5/100,000/year, a situation similar to that found in the Caribbean and in HTLV-I-endemic regions of Japan. However it reaches around 30/100,000/year (highest incidence ever described) in a small remote ethnic group of African origin (around 6200 inhabitants). Possible causes of ATL clustering in this ethnic group are presented.

Carcinoma of the uterine cervix and schistosomiasis.

OBJECTIVES: To determine the incidence of carcinoma of the uterine cervix and its relationship to schistosomiasis infection. METHODS: A retrospective analysis of a 10-year period (1980-1990) at the department of histopathology (cancer registry) of the University of Dar es Salaam using statistical evaluation of the proportional rate of histomorphological diagnosis, clinical symptoms and epidemiological aspects. RESULTS: There were 4520 cases classified as cervical carcinoma. Unexpectedly, only 76 of these (1.7%) revealed an association with schistosomiasis. Precancerous lesions of the squamous epithelium of the uterine cervix were a relatively common feature in carcinoma of both groups. Furthermore, epidemiological analysis indicates that the occurrence of cancer and schistosomiasis infection of the cervix is not strictly confined to the population of rural regions, known as endemic areas, with low hygienic and socioeconomic standards. This fact is most probably due to the rural people moving into urban areas, hoping to improve their quality of life. CONCLUSIONS: Our data do not support the assumption of an etiologic role of schistosomiasis in the oncogenesis of cervical carcinoma.