[Macro-AST and myeloma: An incidental association?] / Macro-ASAT et myélome : une association fortuite ?

INTRODUCTION: Macro-AST is recognized as a classical aetiology of isolated and persistent increase of serum aspartate aminotransferase (AST) levels. Macro-AST are high molecular weight complexes associating AST and a macromolecule, often an immunoglobulin. Although those macroenzymes of unknown pathogenesis are usually non-pathogenic, association with several diseases, including autoimmune diseases and liver diseases has been described. CASE REPORT: We report here the case of a 45-year-old patient with previously normal liver enzymes in whom an AST elevation and an IgA monoclonal gammopathy were discovered concomitantly. Following the diagnosis of multiple myeloma, we could evidence in the patient's serum a complex between AST and the monoclonal IgA. AST levels course followed closely the progression of monoclonal gammopathy. CONCLUSION: This is the first report demonstrating a clear link between macro-AST and a monoclonal gammopathy.

[Actinomycetoma of the knee due to Nocardia otitidiscaviarum described in the Comoro Islands]. / Actinomycétome du genou àNocardia otitidiscaviarum aux Comores.

BACKGROUND: Mycetoma is a chronic skin and soft tissue infection encountered in the dry tropical regions and are caused by fungi (eumycetoma) or bacteria (actinomycetoma). PATIENTS AND METHODS: A 25-year-old man consulted at the hospital on Mayotte Island for a left knee injury sustained 10 years earlier in a motorcycle accident with broken skin occurring in Anjouan in the Comoro Islands. Clinical and histological diagnosis of mycetoma was made, and in the absence of microbiological diagnosis, empirical antifungal therapy was initiated. Given the poor outcome, new biopsies were performed and resulted in the identification of Nocardia otitidiscaviarum. More than 1 year later, the patient had fully recovered and after administration of several and extended antibiotic courses including cotrimoxazole and linezolid. DISCUSSION: Bacterial mycetomas are usually described in semi-arid regions and the occurrence of this disease is unexpected in humid tropical areas such as the Comoro Islands. N. otitidiscaviarum is rarely involved in this infection, particularly in Africa.

[Polyneuropathies in vitamin B1 deficiency in Reunion and Mayotte islands in 70 patients of Maori and Comorian descent]. / Polyneuropathies par hypovitaminose B1 aux îles de la Réunion et de Mayotte: à propos de 70 cas d'origine mahoraise et comorienne.

Beriberi is an uncommon disorder related to thiamine deficiency. It is mainly found in underdeveloped countries among populations with poorly diversified diet, consisting largely of milled white cereals, a poor source of thiamine. In industrialized countries, thiamine deficiency with cardiac failure is more frequently found than the dry beriberi in high risk groups like chronic alcoholics. Nevertheless our attention was drawn to an outbreak of 70 cases of dry beriberi which occurred from 1997 to 2005 in the French territories of Reunion and Mayotte islands. It was characterized by an acute or sub-acute sensorimotor polyneuropathy with axonal lesions, affecting the lower limbs and occasionally the upper limbs, sometimes associated with cardiac beriberi. It affected young, non alcoholic individuals from the Mahoran and Comorian community who were in apparent good health when the illness occurred. Our study highlighted the feeding habits which are partly responsible for the development of the disease due to a chronic lack of thiamine and which probably contributed together with multiple cofactors to trigger off the illness. But many elements and mainly biological ones, also lead us to think that there is a genetic predisposition to develop this neuropathy.

The accuracy of the FIB-4 index for the diagnosis of mild fibrosis in chronic hepatitis B.

BACKGROUND: The Fib-4 index is a simple and inexpensive biomarker to delineate liver fibrosis in chronic hepatitis C. AIM: To assess the accuracy of the FIB-4 index in chronic hepatitis B. METHODS: We compared the FIB-4 index with 138 synchronous liver biopsies and with 372 synchronous FibroTest performed either in France or in an endemic area (Mayotte, an overseas collectivity of France). RESULTS: The FIB-4 index allowed the correct identification of patients with nil-to-moderate fibrosis with an area under the receiving operating characteristic curve of 0.81 (P < 0.001), increasing as a function of the length of the liver biopsy (up to 0.94 for liver biopsies >or=20 mm). A cut-off value

[Update on HIV infection in Mayotte]. / Le VIH à Mayotte.

Mayotte is a small French island located in the Indian Ocean between Madagascar and Mozambique. It is one of the four Comorian Islands and has a population of about 200,000. The first cases of AIDS were diagnosed in 1989. Since then, the number of serological tests performed annually has stabilized at around 14000. However the number of new cases and treatment reports appears to be increasing slowly. Five of the 15 cases diagnosed in 2005 were at the AIDS stage. In 2006, 74 people were treated at the Mayotte hospital including 5 children. The mean age of the 69 adult patients was 38 years. Contamination was heterosexual for 71% of the adult cases, homosexual in 13% and transfusional in 3%. Women accounted for 59.5% of adult patients because of antenatal screening. All cases in Mayotte involved HIV type 1 infection. Forty-nine patients are undergoing treatment. Viremia is undetectable in 74% as compared to 85% in 2005. This decrease is due to a drop in attendance from 7.2 in 2005 to fold 4.5 in an island environment where HIV is still considered as a shameful disease.

[Vaccination of children against hepatitis B in Mayotte, French Comoros Island]. / Vaccination de l'enfant contre l'hépatite B à Mayotte, île française des Comores.

Hepatitis B virus (HBV) is responsible for a worldwide mortality of 1 million people each year. It constitutes a major public health problem, especially in highly endemic zones, where it concerns the youngest children, primarily by a mother to child transmission, with a strong risk of chronic hepatitis infection and hepatocellular carcinoma. Immunisation of children versus HBV is known to be efficient and safe. In Mayotte, a French overseas territory in Indian Ocean, immunisation versus HBV has been introduced since 1993 in the vaccine schedule, starting at day 1 of life. We report hereby the local experience and practice on HBV infection, state of vaccine coverage, and difficulties met with this major public health issue.

[The subcutaneous etonogestrel implant: a new contraceptive method in Mayotte?]. / L'etonogestrel en implant sous-cutané: un nou- veau moyen de contraception a Mayotte?

The isle of Mayotte is a part of the Comoros archipelago, its political status is that of a French Territory Despite a birth control programme helping to space out the births rather than restricting their number, the Mayotte population growth is soaring. Since the visit of the President in May 2001 the subcutaneous etonogestrel implant became available for the population of Mayotte. We then carried out a study to evaluate the response given by 50 post-partum women to this new contraceptive method. 38% of the women declared to be willing to use this contraceptive device while 52% instead didn't wish to try. Although not clearly expressed, the wish to have large families is still there and can be explained by religious and cultural factors. Considering the study results, this contraceptive method could certainly be useful in Mayotte. However a well-balanced education campaign, neither too negative nor too enthusiastic, should be necessary to avoid false expectations which in that case could induce widespread negative rumour towards the birth control method.

[Rhinofacial entomophthoromycosis. About two new cases in Mayotte]. / Entomophthoromycose rhinofaciale. A propos de deux nouveaux cas diagnostiqués a Mayotte.

Conidiobolus entomophthoromycosis is a rare mycosis due to an ubiquitary telluric fungus. Although the organism is found around the world, it is more concentrated in warm, wet climates. Cases have been described in West Africa, Australia, South America and India. Conidiobolus spp was also to be found in animal like horse. The transmission mode of Conidiobolus has not been established but probably occurs via inhalation of fungal spores covering the nasal mucous membrane or from a minor trauma such as an insect bite. The clinical syndromes include intranasal tumour, nasal obstruction, broadening of the nose bridge, paranasal sinuses, cheeks and upper lip. Diagnostic is made by demonstrating distinctive non-septate hyphea with surrounding eosinophilic sleeve (Splendore-Hoeppli phenomenom) in tissue sections. We report here two cases contracted in Comoro Islands. The first one was a 26 year-old man treated by amphotericin B during six weeks and then by itraconazole, with a clear improvement. The second one was a 37 year-old woman. She has been treated by amphotericin B, subsequently by imidazoles. There was a clear benefit on life duration, but the results for aesthetic aspect are not satisfactory. In the discussion, we review treatment efficacy and failure; in fact, surgery which includes removal of infected tissue and reconstructive procedures, is seldom curative. Several combinations of drugs have been used with different degrees of success. Nevertheless imidazoles remain more efficient than amphotericin B.

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.

[Malaria in Mayotte: epidemiology, diagnostic, prevention and treatment]. / Bilan du paludisme à Mayotte. Epidémiologie, diagnostic, prevention et traitement.

Mayotte is a little French island, located in the Indian ocean, between Madagascar and Mozambic. Officially there is a population of 150000 inhabitants, but in fact, there are probably about 200000 people, largely due to numerous illegal immigrants, especially coming from Anjouan the nearest Comorian island. There is only one hospital, with 252 beds. The malaria incidence reaches about 3000 cases per year; and treatments until august 2001 were generally haphazard. This is changing with the use of the Optimal rapid diagnostic test (DiaMed, Cressier Switzerland). More precise statistics should be available in the coming years. In 2000, 252 patients were hospitalised with malaria fever. Preventive measures were scarce. These have been reenforced this year, with the arrival of an entomologist, the use of reenforced pesticide pulverisation in high-risk areas, the distribution of impregnated bednets to pregnant women, and media based information campaigns. Common drugs resistance is becoming a real concern in Mayotte. First-line treatment was: chloroquine; second-line: sulfadoxine-pyrimethamine, and third-line: quinine. In vitro studies have shown high levels of resistance, therefore another antimalarial drug therapy will be introduced at the end of the year: first-line: artemether-lumefantrine, second-line: mefloquine or halofantrine, third-line: quinine. To conclude, solutions exist but a real policy from the decision makers is necessary to implement them. The eradication of malaria remains a dream, but we can expect "zero death" in Mayotte, considering that the fight against this disease may help to start a regional health program.