Retrospective study of pneumonia due to Panton-Valentine leukocidin-producing Staphylococcus aureus in Reunion.

OBJECTIVE: Panton-Valentine leukocidin-producing Staphylococcus aureus necrotizing pneumonia is an unusual cause of community-acquired pneumonia, although associated with a high case fatality. This infection mainly affects young individuals, without any history, and is most often preceded by flu-like symptoms. METHOD: We focused on patients presenting with Staphylococcus aureus necrotizing pneumonia in Reunion (Indian Ocean) admitted to the emergency department. We performed a retrospective study based on data collected from laboratory registers and medical files of patients presenting with Staphylococcus aureus necrotizing pneumonia in Reunion between December 2014 and December 2017. RESULTS: A total of 16 patients were recruited for this study, with a median age of 40.5 years. More than half of patients had previously been admitted to the emergency department for acute respiratory distress syndrome or severe sepsis. Fourteen patients were admitted to the intensive care unit and six patients died (five premature deaths). CONCLUSION: Physicians should be aware of this infection during the flu season and quickly adapt the specific antibiotic treatment, including a drug inhibiting toxin production. As methicillin-resistant Staphylococcus aureus is very rarely observed in Reunion, physicians can still adapt the empirical treatment, without glycopeptides.

Human pentastomiasis in Sub-Saharan Africa.

Pentastomiasis is a rare zoonotic infection but it is frequently observed in Africa and Asia. Most human infections are caused by members of the Armillifer armillatus species. They are responsible for visceral pentastomiasis in Western and Central Africa. Humans may be infected by eating infected undercooked snake meat or by direct contact with an infected reptile. An increasing number of infections are being reported in Congo, Nigeria, and Cameroon. Despite an occasionally high number of nymphs observed in human viscera, most infections are asymptomatic and often diagnosed by accident during surgery or autopsy. The clinical presentation of pentastomiasis is quite varied and depends on infected tissues. The liver, lungs, and pleura are most frequently involved. Abdominal emergencies have been reported. Diagnostic delays always occur and diagnosis focuses on the patient's lifestyle and living environment. It is mainly based on the morphological description of the parasite's calcified cuticle, the site of the lesion, and the parasite's region of origin. Most patients do not require any treatment. Personal measures such as avoidance of contact with snake droppings are recommended to prevent transmission. Imported pentastomiasis has been observed in African migrants.

[Vesicular contact dermatitis due to Paederus in Cameroon and review of the literature]. / Dermatite vésicante à Paederus au Cameroun et revue de littérature.

This irritant blister dermatitis is caused by the genus Paederus whose geographical distribution is worldwide, with a higher incidence in tropical areas. It is induced by direct skin contact with pederin, a blistering and caustic substance found in the abdomen (coelome) of Paederus insects (insect order Coleoptera: family Staphylinidae). The diagnosis is based on the presence of typical clinical features combined with compatible epidemiological features. Our goal is to describe the epidemiological and clinical features of this irritant contact dermatitis in Cameroon through a retrospective study conducted at the end of the rainy season at the Oku Hospital in Northwest Cameroon and to also include cases reported at the medical center of the French Embassy in Yaounde during this same timeframe. In addition, we conducted a literature review of paederus dermatitis. Nineteen patients were included in this study. More than half of the patients presented with more than two lesions predominantly localized to the face or the neck; less than half had complications manifesting as either localized or respiratory reactions and three patients presented periorbital involvement. This study confirms the presence of paederus dermatitis in Cameroon. It is mainly localized in the unusual geoclimatic region of the western high mountains within the country, as well as the usual warm, moist areas of Yaounde. The clinical evolution of this dermatitis is usually one of spontaneous and uneventful resolution with complications being rare. Curative treatment is one of localized topical therapies while oral antibiotic therapy should be reserved for more complicated cases.

[Descriptive analysis of Plasmodium falciparum malaria in an expatriate community in Yaounde-Cameroon]. / Analyse descriptive du paludisme à Plasmodium falciparum dans une communauté expatriée à Yaoundé-Cameroun.

Malaria is an endemic disease in Cameroon. Expatriate population is also affected by malaria risk. Many studies are published on malaria, but few are focused on the expatriate population. The objective was to describe epidemiological characteristics andmanagement ofmalaria at Plasmodium falciparum in Yaounde expatriate population. This is a retrospective analysis of all patients treated at health center of the French Embassy in Yaounde in 2013 with a diagnosis of malaria. 103 cases were recruited. Out of them, 32.7% came from the outskirts of Yaounde, 25.2% from the coastal area of Cameroon, and 20.4% from the center of Yaounde. 22 patients were hospitalized, including 6 in Emergency department. 3 deaths were reported during this period. Severe malaria cases are regularly detected in expatriate population inYaounde and preferentially patients, who are over 50 years old, long stay residents in Cameroon and they paid less attention on prevention and vector control. This study confirms the presence of urban malaria in Yaounde and the need to adopt measures including prophylaxis. To the ignorance of risk and the poor adherence to prophylactic measures, it appears important that the various embassies in northern countries have specific information to their expatriates living in endemic areas.

Red blood cell phenotyping after transfusion: an in vitro model.

Recipients red blood cell (RBC) phenotyping using serologic techniques, within 3 months of a transfusion, is considered unreliable. We conducted in vitro experiments to determine how long recipients RBC phenotyping results would be compromised. In vitro models were created to mimic in vivo posttransfusion ratios of "transfused" RBCs with either a single or a double dose of an antigen at 10-day intervals from day 0 to day 90 in hypothetical recipients with varying weights and hematocrits (Hct) receiving varying numbers of RBC units. In general, a reliable recipient RBC phenotype was possible earlier after transfusion in larger recipients, those with higher Hct, and those transfused with fewer RBC unit and if the transfused units had the antigen of interest in single, rather than double, dose. We believe that a reliable RBC phenotype, using routine serologic techniques, can often be obtained well before 3 months after transfusion. Similar studies with other donors, antigens, antisera, and methods and in actual patients will be useful.

[Outbreak of influenza pandemic virus A(H1N1) 2009 infections in the Emergency Department, Saint-Pierre, Réunion Island, July-September 2009]. / Caractéristiques des syndromes grippaux pris en charge aux urgences du centre hospitalier régional de Saint-Pierre, île de la Réunion, au cours de l'épidémie à virus pandémique A(H1N1) 2009 (juillet-septembre 2009).

A new H1N1 virus originating from swine recently emerged as the first influenza pandemic of the 21st century. On July 3, 2009, this new influenza A(H1N1) virus (S-OIV) of swine origins was identified in Réunion Island, a French overseas department located in the southern hemisphere. The present study describes the characteristics of the epidemic from July 3 to September 30, 2009. Among the 479 patients included in our study (236 males, 37.3 ± 19.0 years), 255 (53.2%) were reported to have comorbidities or risk factors (RF) for complications. Complications occurred in 160 patients (33.4%). The most common complications were bronchial hyperreactivity (52.7%), pneumonia (32.1%), and decompensation caused by comorbidity (17.9%). 111 patients (23.2%) required hospitalization. Patients aged 65 and over, accounted for 11.9% of all patients, 32.4% of hospitalized patients and 22.5% of complicated S-OIV infections. Regardless of age, comorbidity and/or RF were reported in 80.0% of complicated S-OIV infections and 91.0% of hospitalized patients. Recommendations for surveillance, prevention and policy for persons with RF, particularly respiratory disease, are justified. However, the absence of risk factors did not prevent the occurrence of complications, present in 14.3% of the cases.

[Paederus dermatitis: A retrospective study of 74 cases occurring in 2008 in Guinea-Conakry]. / Dermatite àPaederus : étude rétrospective de 74 cas survenus en 2008 à Conakry, Guinée.

BACKGROUND: Paederus dermatitis is an unusual form of contact dermatitis caused by pederine, a secretion of insects belonging to the genus Paederus. These insects are found worldwide, although the concentration is higher in tropical and subtropical areas. Diagnosis is based on the presence of typical clinical features (erythematobullous lesions of sudden onset with a stinging, burning sensation on exposed areas of the body) combined with a compatible epidemiological context. In West Africa, more particularly in Guinea-Conakry, paederus dermatitis is common at the end of the rainy season. Our aim is to define the clinical and epidemiological characteristics of this disease. PATIENTS AND METHODS: Herein we report data from a series of cases of paederus dermatitis among French expatriates living in Guinea-Conakry and attending the sociomedical center of the French Embassy at Conakry between October 20 and December 12, 2008. RESULTS: Seventy-four patients with the disease were included in the study (age range: 2-66; sex-ratio: 1:1). Most presented one or two lesions, with 36% of lesions situated on the face and neck region. Three patients presented with oculoconjunctival involvement. Complete remission occurred spontaneously within 8 to 10 days in 90% of patients. Systemic antibiotic therapy was initiated in less than 3% of patients. CONCLUSION: Preventive measures to repel the insects remain vital, in conjunction with curative methods (e.g. immediate cleansing of skin coming into contact with the irritant substance).

[Human African trypanosomiasis in mangrove epidemiologic area. Presentation, diagnosis and treatment in Guinea, 2005-2007]. / La trypanosomose humaine africaine en faciès épidémiologique de mangrove. Présentation, déterminants et prise en charge dans le contexte de la Guinée (2005 à 2007).

UNLABELLED: Gambiense human African trypanosomiasis is still assumed to be endemic in many part of West Africa, particularly in Guinea coastal area with mangrove swamp. Diagnosis is usually made during active medical screening or by passive initiative. OBJECTIVES: To describe clinical and epidemiological characteristics of Gambiense human African trypanosomiasis in the coastal area of Guinea. METHODS: Exhaustive and retrospective analysis of all patients attending the trypanosomiasis center in the coastal area of Guinea between January 2005 and December 2007 with a diagnosis of human African trypanosomiasis. RESULTS: A total of 196 patients were recruited for the study. Out of them, 55 % of the 73 patients diagnosed during active screening were classified stage 1 (haemolymphatic stage) or early stage 2 (meningoencephalitic stage). Contrarily, 115 of the 120 diagnosed by passive procedure were classified late stage 2, which features more specific signs and neurological symptoms, and leads to coma and death. More than 90 % of all cases presented cervical lymph nodes with identification of trypanosome on direct examination of fluid puncture. Less than one third of the patients were reexamined three months later. DISCUSSION: In the coastal area of Guinea with mangrove swamp, direct examination of lymph node fluid puncture seems to be the most contributive test for the diagnosis of human African trypanosomiasis. Hence, associating clinical examination of cervical lymph nodes area and direct examination of fluid puncture may allow an early diagnosis of Gambiense human African trypanosomiasis and favor the implementation of efficient therapeutic strategies.

Maternal IgM anti-D, borderline foetal Doppler middle cerebral artery velocities and absent neonatal haemolysis.

Anti-D was detected for the first time at 36 weeks gestation in a group A RhD-negative primigravida without prior sensitizing events or anti-D administration. Simultaneously, foetal ultrasound showed middle cerebral artery maximum velocity (MCA V(max)) at the 95th centile but no hydrops. Labour was induced at 37 weeks. Although neonatal anaemia was anticipated, the baby, who was group O RhD-positive, was born with a normal haemoglobin and negative direct antiglobulin test and antibody screen. Retrospectively, the maternal anti-D proved to be exclusively immunoglobulin M (IgM), which does not cross the placenta. Foetal Doppler MCA V(max) measurements can give false positive results especially late in the third trimester. Thus, antibody class, especially in first pregnancies without prior sensitizing events, and the timing of foetal Doppler MCA velocity measurements should be considered when evaluating the likelihood and severity of haemolytic disease of the foetus and newborn.

[Reconstruction of the anterior cruciate ligament: arthrotomy versus arthroscopy]. / Reconstruction du ligament croisé antérieur: arthrotomie versus arthroscopie.

The aim of this study was to compare the results of arthroscopic with open arthrotomy reconstruction of the anterior cruciate ligament, as treatment of chronic anterior laxity. 54 knees (among 63) were evaluated, 33 reconstructions were performed according to Kenneth Jones technique with arthrotomy (from 1990 to may 1993) and 21 were arthroscopically-assisted (from may 1993 to 1996). Meniscectomy was associated respectively in 22 and 7 cases. The average interval between initial injury and surgery was 18 and 18.6 months. Follow-up was one year at least. We evaluated mobility, amyotrophy and quadriceps and hamstrings muscular deficit: static at 1 month and using Cybex isokinetic tests at 2, 3 and 6 months and 1 year. Postoperative residual laxity and Arpege cotation were evaluated at 1 year. Student and Mann Whitney tests were used for statistical evaluation. As complication we noted respectively after arthrotomy and after arthroscopy: 7 (21.2 p. 100) and 4 (19 p. 100) algodystrophy, 1 (3 p. 100) and 1 (4., 7 p. 100) Cyclops syndrome, and 2 (6 p. 100) and 1 (4.7 p. 100) anterior knee pain. Lack of extension and flexion were respectively -5.4 degrees/130 degrees and -1.9 degrees/136 degrees at 3 months (p = 0.04) and -3.5/134 degrees and -1.5 degrees/138 degrees at 6 months (not significative). At 1 month, static hamstrings deficit was 41.3 p. 100 after open arthrotomy and 29.6 p. 100 after arthroscopic assisted (p = 0.05). At 2 months, isokinetic hamstrings deficit was lower after arthroscopic assisted (21.6 p. 100 at 60 degrees; 20.8 p. 100 at 180 degrees) than after open arthrotomy (32.8 p. 100; 32.5 p. 100) (p = 0.039 and 0.008). This difference was found for hamstrings until 3 months. At 6 months and 1 year, no difference was found for Cybex tests. In Arpege score, at 1 year, 73.3 p. 100 were very satisfied or satisfied after open arthrotomy and 77.7 p. 100 after arthroscopy. Global results were excellent or good in 66 p. 100 after open arthrotomy and 83 p. 100 after arthroscopy. Radiological laxity was less than 5 mm in 88 p. 100 after open arthrotomy and 92 p. 100 after arthroscopic assisted. So, after arthroscopically assisted procedure, the number of algodystrophy and anterior knee pain was lower, and until 3 months, range of motion was better and hamstrings deficit was lower. After 6 months, difference about range of motion or muscular deficit were not significative. At 1 year, after arthroscopic procedure, results seemed better with a lower rate of residual laxity and better global results, but the number of medial meniscectomies was lower in this group. In conclusion, the arthroscopic-assisted procedure seems to allow a faster rehabilitation.

[High-dosage oral gestagen therapy as a failure-regime in metastatic breast cancer]. / Orale hochdosierte Gestagentherapie als Versagerschema beim metastasierten Mammakarzinom.

High-dosage medroxyprogesterone (Farlutal, 1 g/d orally) was administered to 42 female patients with progressive disseminated carcinomas of the breast after conventional cytostatic and hormonal treatment had failed. Besides evaluation of success of treatment the pharmacokinetics of medroxyprogesterone were investigated. A remission rate of 37% (total and partial remissions) indicated that high-dosage oral treatment with gestagens can be used as "failure-regime" in patients at the end of conventional treatment. The plasma level of the gestagen approached values corresponding to high-dosage intramuscular application.