[Causes of death among HIV infected adults in French Guyana and the French West Indies in the era of highly active antiretroviral therapy (HAART)]. / Causes de décès des adultes infectés par le VIH dans les départements français d'Amérique à l'ère des traitements antirétroviraux hautement actifs.

OBJECTIVE: The survey "Mortality 2000" had for aim to describe the distribution of causes of death in HIV-infected adults in France. METHOD: Hospital wards involved in the management of HIV infection prospectively reported deaths occurring in 2000. The causes of death were documented using a standardized questionnaire. RESULTS: In French Guyana and the French West Indies the five referent wards reported 81 deaths. The main underlying causes of death were AIDS-related (67%), non-AIDS and non-hepatitis related cancer (9%), cardiovascular disease (7%), bacterial infections (5%), and end stage liver disease (4%). Among AIDS-related deaths, the more frequent diseases were histoplasmosis and toxoplasmosis in Guyana and atypical mycobacterial infection, tuberculosis, and cytomegalovirus disease in the West Indies. Median age was 43 years, transmission of HIV infection was heterosexual in 79%; 56% lived in poor socio-economic conditions, and 30% were born abroad. One out of five had been recently diagnosed with HIV infection and one out of three had never received antiretroviral treatment. CONCLUSION: In 2000, two in three death cases in HIV-infected adults were AIDS-related in French Guyana and the French West Indies. Improved strategies for screening HIV infection before the occurrence of AIDS are still needed taking into consideration poor socio-economic and migrant conditions.

[Emergence of dengue hemorrhagic fever in French Antilles. 3 initial fatal cases in Guadeloupe]. / Emergence de la dengue hémorragique aux antilles françaises. Trois premiers décès en Guadeloupe.

BACKGROUND: Two outbreaks of dengue hemorrhagic fever occurred in Guadeloupe (French West Indies) in successive epidemics in 1994 and 1995. The first outbreak was caused by DEN-2 virus and the second by DEN-1. CASE REPORTS: Seven life-threatening infections (WHO grade 3/4) were identified. Three previously healthy adults (including two brothers) died. Autopsy reports (2 patients) disclosed hemorrhagic serous effusions, disseminated intravascular coagulation, and in one case a spontaneous spleen rupture. DISCUSSION: Dengue fever is an emerging disease. Its severe hemorrhagic form tends to an uprising incidence and can no longer be considered a disease limited to children in Far-Eastern Asia. Fatalities may occur very suddenly and unexpectedly, even in optimal health care settings, in healthy adults living or travelling in endemic areas, notably the Caribbean.

[Cowden disease: treatment with acitretine]. / Maladie de Cowden: traitement par acitrétine.

INTRODUCTION: Cowden's disease is a rare hereditary skin disease which is important to recognize due to the risk of cancer. CASE REPORT: A 40-year-old man was hospitalized for psoriasis. He presented florid papillomatous lesions involving the lip and the buccal cavity, a thyroid adenoma and polyposis of the gut. The diagnosis of Cowden's disease was retained. Treatment with acitretin, 0.75 mg/kg/d was initiated for the psoriatic lesions. Hypertrophic lesions of the lip and mouth regressed during treatment but reappeared when the drug dose was tapered of then withdrawn. The course of the polyposis was not verified. DISCUSSION: This case demonstrates the frequency of digestive tract involvement in Cowden's disease and the favorable, though transient, effect of oral retinoids on mucosal lesions in Cowden's disease.

[Tropical sprue: diagnostic difficulties. Apropos of 2 cases in Guadeloupe]. / Sprue tropicale: difficultés diagnostiques. A propos de deux cas en Guadeloupe.

The authors report two cases of tropical sprue occurring in Guadeloupe, in the French Lesser Antilles, a region in which this disease had previously been reported only once. One of the patients was treated with quinolone (ofloxacin).

[Digestive histoplasmosis in a patient with AIDS from Guadeloupe]. / Histoplasmose digestive chez un malade Guadeloupéen atteint du SIDA.

The authors report the case of a 45-year-old HIV and HTLV1 antibody positive male patient form French West-Indies who was infected by disseminated histoplasmosis presenting as acute diarrhea. Esophagogastroduodenoscopy revealed gastric mass and colonoscopy patchy erythematous mucosa. The diagnosis was made by histology of bone marrow specimens, upper gastrointestinal tract and colon biopsies, and late skin lesions. Initial therapy with amphotericin B and itraconazole was successful, but maintenance therapy with itraconazole alone did not prevent relapse and a fatal outcome. Disseminated histoplasmosis in AIDS patients may be present as gastrointestinal manifestations and should be kept in mind in non endemic areas such as the French West Indies.

[Preliminary study of the effect of supplementation of iron, copper, cobalt and zinc on cellulolytic activity in the cecum of the pony]. / Etude préliminaire de l'effet d'une supplémentation en fer, cuivre, cobalt et zinc sur l'activité cellulolytique dans le caecum du poney.

We studied a caecum-cannulated pony fed hay libitum in order to determine the mineral elements likely to cause deficiencies which decrease microbial activity in the caecum. During four successive 1-month periods, we observed the effects of adding 50 mg of iron, 1 mg of cobalt, 40 mg of copper and 200 mg of zinc, respectively. Except for the introduction of zinc, which greatly diminishes cellulolytic activity measured with the nylon bag technique, there was no significant modification in that activity as shown by pH, NH3-nitrogen, total nitrogen and volatile fatty acid production (table 1). It can be concluded that endogenous secretion in the pre-caecal part of the digestive system of the mineral elements used was sufficient to guarantee good symbiosis between the microbial population of the caecum and the organism.