Mansonella ozzardi and its vectors in the New World: an update with emphasis on the current situation in Haiti.

Mansonella ozzardi (Nematoda: Onchocercidae) is a little studied filarial nematode. This human parasite, transmitted by two families of dipteran vectors, biting midges (most of them members of the genus Culicoides) and blackflies (genus Simulium), is endemic to the Neotropical regions of the New World. With a patchy geographical distribution from southern Mexico to north-western Argentina, human infection with M. ozzardi is highly prevalent in some of the Caribbean islands, along riverine communities in the Amazon Basin, and on both sides of the border between Bolivia and Argentina. Studies conducted in Haiti between 1974 and 1984 allowed the first complete description of the adult worm and permitted clarification of the taxonomic position of this filarial species. This paper reports the known geographical distribution of M. ozzardi in Neotropical regions of the Americas, and focuses on the current situation in Haiti where this filariasis remains a completely neglected public health problem.

[Update of knowledge on Neglected Diseases in Haiti: Mansonelliasis, Tungiasis, Leprosy, and Anthrax]. / Mise à jour des connaissances concernant quatre maladies délaissées en Haïti : mansonellose, tungose, lèpre, charbon.

Haiti, like most limited-resources countries in the world, faces numerous neglected infectious diseases. They represent a real public health issue with lethal consequences especially in children. We are reviewing here the available literature on four neglected infectious diseases, mansonelliasis, tungiasis, leprosy and anthrax. Filariasis, due to Mansonella ozzardi, has been totally neglected since its discovery in 1920 in Haiti; it persists in coastal homes with a high prevalence in adults when an effective treatment is available. The skin lesions caused by Tunga penetrans have existed since the pre-Columbian period in Haiti. They persist in the most retreated and hard-to-reach areas where the population lives in precarious conditions and in extreme poverty. New available research data show the importance of the problem with very high prevalence rates in some rural communities far away from any healthcare center. Cases of leprosy are recently reemerging as no monitoring program has been in place since 2004. Finally, anthrax is still endemic; small epidemics resurfacing periodically in families in rural areas. Screening of people for these diseases and managing the cases are necessary to improve health and reduce morbidity and mortality in Haiti.

Comme dans la plupart des pays pauvres de la planète, les maladies infectieuses négligées sont nombreuses en Haïti où elles représentent un réel problème de santé publique avec des conséquences létales, surtout pour les enfants. Nous faisons le point des données accessibles pour quatre d'entre elles. Totalement délaissée depuis la découverte de sa présence en Haïti en 1920, la filariose due à Mansonella ozzardi persiste en foyers côtiers avec une prévalence élevée chez les adultes alors qu'un traitement efficace est disponible. Connues depuis la période précolombienne dans l'île d'Hispaniola, les lésions cutanées dues à Tunga penetrans persistent dans les régions les plus reculées et difficiles d'accès où la population vit dans des conditions précaires et dans une très grande pauvreté. Nous rapportons les données d'enquêtes récentes qui montrent l'importance de cette ectoparasitose en Haïti où les taux de prévalence sont très élevés dans certaines communautés rurales isolées. Des cas de lèpre resurgissent en Haïti alors qu'aucun programme de surveillance n'est effectif depuis 2004. Enfin, la maladie du charbon est endémique dans les régions d'élevage où des épidémies familiales resurgissent périodiquement en milieu rural. Le dépistage des personnes atteintes de ces maladies et leur prise en charge sont nécessaires pour une amélioration de la santé et une baisse de la mortalité en Haïti.

[Simplified Protocols for Cholera Diagnosis in the National Public Health Laboratory, Port-au-Prince, Haiti]. / Protocoles simplifiés de diagnostic du choléra au Laboratoire national de santé publique, Port-au-Prince, Haïti.

While the incidence of cholera is decreasing in Haiti, the time required to render stool culture results with antibiogram using the standard method practiced at the National Public Health Laboratory (LNSP) remains at an average of 80 hours. This delay can be further lengthened by the process of rendering the analysis reports to the sites of care which significantly delays the community responses to cholera. Through this study, we have aimed to assess the reliability of partial results. We have studied 250 stool samples that were analyzed between January and September 2017 at the LNSP by determining the specificity, positive predictive value and positive likelihood ratio of i) the identification of yellowish colonies and ii) the identification of yellowish colonies with a positive oxidase assay in comparison to the stool culture. Compared to the entire process, the identification of yellowish colonies showed a specificity of 56%, a positive predictive value of 69% and a positive likelihood ratio of 2.27. The identification of yellowish colonies with a positive oxidase assay showed a specificity of 77%, a positive predictive value of 81% and a positive likelihood ratio of 4.31. The communication of partial results at these steps would likely guide community interventions despite a relative decrease in reliability of the results.

Le temps nécessaire au rendu des résultats de culture des selles avec antibiogramme par la méthode classique pratiquée au Laboratoire national de santé publique (LNSP) d'Haïti s'étale sur une durée de 80 heures en moyenne. Ce délai peut être encore allongé par le processus de rendu des rapports d'analyse aux sites de prise en charge, ce qui retarde de manière significative les réponses communautaires face au choléra. Cette étude vise à évaluer la fiabilité de résultats partiels par rapport au processus complet. Nous avons inclus 250 échantillons de selles analysés au LNSP de janvier à septembre 2017 en déterminant la spécificité, la valeur prédictive positive et le rapport de vraisemblance positif de l'identification des colonies jaunâtres et de l'identification des colonies jaunâtres oxydase positive. Par rapport au processus complet de culture des selles, l'identification des colonies jaunâtres a montré une spécificité de 56 %, une valeur prédictive positive de 69 % et un rapport de vraisemblance positif de 2,27. Quant à l'identification des colonies jaunâtres oxydase positive, la spécificité est de 77 %, la valeur prédictive positive de 81 % et le rapport de vraisemblance positif de 4,31. La communication de résultats partiels aux équipes de terrain à ces étapes serait utile pour guider les interventions en dépit d'une relative diminution de leur fiabilité par rapport au gold standard.

[Changes in malaria prevalence and management of fevers from 2000 to 2012 in Casamance, Senegal]. / Évolution de la prévalence du paludisme et de la prise en charge des fièvres de 2000 et 2012 en Casamance, Sénégal.

Before 2006 in Senegal, in the absence of clinical diagnosis, all fever cases were considered as malaria and treated with chloroquine. Between 2004-2006, to face the dramatic increase of Plasmodium falciparum resistance to chloroquine, the combination of amodiaquine plus sulfadoxine-pyriméthamine was recommended for treatment. In 2006, rapid diagnostic tests were introduced and the treatment with a combination of artesunate plus amodiaquine (ASAQ) became the national recommendation for malaria treatment in 2007. This coincided with a decrease of the prevalence of malaria cases and change in fever management. Since 1995 in Mlomp in Casamance, thin and thick blood smear examination has systematically been done in patients with fever and clinical signs of malaria, and treatment with ASAQ given as experimental procedure. Between 2000 and 2012, 70,892 outpatients were attending the health center, and 51.2% of them for fever. Among these fever cases, 72.4% were suspected of malaria and 27.6% were identified as bacterial and viral infections. Confirmed malaria cases decreased dramatically from 1365 in 2000 to 53 in 2012. While comparing the 2 periods 2000-2006 and 2007-2012, the number of fever cases decreased by half, the number of fever identified as non malaria doubled and malaria treatment given decreased by 86%. Improvement of fever management in Mlomp has contributed to a better identification of their cause and to a decrease of inappropriate malaria treatments.

[Gametocyte carriage in asymptomatic Plasmodium falciparum infections in Haiti (2010-2013)]. / Portage de gamétocytes de Plasmodium falciparum en Haïti en 2010-2013.

A survey conducted from May 2010 to October 2013 in five from ten departments of Haiti among 5,342 persons aged from 1 to 107 years showed a gametocytic rate = 3.2%. However, it varies greatly from one Department to another, ranging from 0.5% in Grande Anse Department to 5.9% in Southeast Department. Malaria is present in Haiti in heterogeneous coastal foci. Gametocytes occur at all ages, but two times most often in male under 20 years. Entomological studies in Haiti are needed to better characterize the relationships between man and the vector Anopheles albimanus, adapting the fight more effectively.

[Epidemiological characteristics of malaria in the village of Corail, Grand'Anse, Haiti]. / Caractéristiques épidémiologiques du paludisme dans la commune de Corail, Grande Anse, Haïti.

Malaria is considered to be a major problem of public health in Haiti. However the impact of Plasmodium falciparum on health is poorly known in this country. The objective of this study is to verify the incidence of malaria as the cause of hospital consultation and to evaluate the rate of P. falciparum gametocytes carriage among the population living in a municipality within the Department of Grand'Anse where the prevalence of malaria is considered one of the strongest in Haiti. Analysis of hospital statistics of Corail (Grand'Anse) showed that only 17.4% of consultations of patients presenting with fever are due to microscopically confirmed malaria. The fraction of the population most affected is that of adults aged 15-39 years (55% of cases). Children under five represent only 11% of the cases. A community survey showed the rarity of the carriage of gametocytes in asymptomatic persons (0.9%). In Haiti, the epidemiological characteristics of malaria must have specified and documented field studies in order to adapt a strategy for fighting against this parasitic disease with greater efficiency.

[Prevalence of Plasmodium falciparum during the rainy season (June-December) in the southeast district of Haiti]. / Prévalence de Plasmodium falciparum pendant la saison humide (juin-décembre) dans le département du Sud-Est, Haïti

This malaria prevalence survey was conducted in Haiti from June through November 2010. The Plasmodium falciparum rate was assessed in 16 municipalities and villages of the southeast district, by examination of thick films from a randomly drawn population sample. The study included 2,126 people aged one to 90 years. P. falciparum was detected among 201 non-febrile subjects. This district, with a P. falciparum rate of 9.5%, is in a low endemic area for malaria. Nonetheless, the infection rates varied considerably from one area to another. Along the coast, the P. falciparum rate ranged from 0 to 34.5%, in four separate categories: four highly infected (mean P. falciparum rate = 21.4% and mean gametocyte rate = 15.3%), four moderately infected (mean P. falciparum rate = 6.1% and gametocyte rate = 5.9%), five slightly infected (mean P. falciparum rate = 3.3% and gametocyte rate = 1.1%) and one uninfected in the interior. No cases of infection were detected in two areas located at an altitude above 600 m. The trophozoite and gametocyte rates varied little as a function of age and thus indicated a low level of protection within the population. This study shows the persistence of endemic malaria at highly variable prevalence levels in this district of Haiti. The development of this region that could be highly desirable to tourists requires the establishment of an appropriate disease control program.

Cross-sectional serological survey of human fascioliasis in haiti.

Fasciola hepatica, the aetiological agent of fascioliasis in the Caribbean region, occurs throughout the major islands of the Greater Antilles and in localised zones on two islands (Martinique and Saint Lucia) of the Lesser Antilles. However, apart from Puerto Rico, information regarding human fascioliasis in islands of the Caribbean is out of date or unavailable, or even nonexistent as in Haiti. The authors conducted a retrospective, cross-sectional serological survey in Port-au-Prince using a Western blotting test (LDBIO Diagnostics) on human fascioliasis in Haiti. A total of 216 serum samples obtained from apparently healthy adults were tested. The frequency of antibodies in serum samples of the study population was 6.5% (14/216). The immunodominant bands recognised in Western blots were 27-28 kDa (100%), 42 kDa (64%), 60 kDa, and 8-9 kDa (28%). This is the first survey to reveal a relatively low proportion of asymptomatic F. hepatica-infected humans in Haiti.

Seroprevalence of human Taenia solium cysticercosis in Haiti.

Human Taenia solium cysticercosis is common in developing countries due to poor sanitary conditions and economics based on breeding livestock, especially pigs, with low hygiene standards. Neurocysticercosis, caused by migration of the larvae of the tapeworm in the nervous system, is the leading cause of acquired epilepsy in adults in Central and South America, sub-Saharan Africa, and East and South Asia. This makes neurocysticercosis a large public health problem in developing countries. Two clinical cases of neurocysticercosis have been observed recently in Haiti. In order to evaluate the prevalence of human T. solium cysticercosis in this country, in 2007 we conducted a cross-sectional serological retrospective survey using a Western blotting test (LDBIO Diagnostics) in Port-au-Prince, where sewage systems are rare and swine usually roam freely throughout the area. A total of 216 serum samples, obtained from healthy adults seen in the work setting of periodical medical visits, were tested after storage at - 20 degrees C. The frequency of antibodies in serum samples of the study population was 2.8% (6/216). The immunodominant bands recognized in Western blots were 23-26 kDa (100%), 39 kDa (67%), 45 kDa and 6-8 kDa (50%), 50-55 kDa (33%). These results confirm for the first time an endemic situation of cysticercosis in humans in Haiti, with similar prevalence as that reported in other Latin American and African countries. It reinforces the urgent need for control and prevention measures to be taken by local public health services.

[Bilharziasis caused by Schistosoma mansoni in a traveler returning from Guinea: failure of serodiagnostic testing]. / Bilharziose à Schistosoma mansoniau retour de Guinée: défaillance du sérodiagnostic.

The purpose of this report is to describe a case of febrile hypereosinophilic syndrome in a traveler three weeks after returning from a sightseeing trip to Guinea. Laboratory testing demonstrated an inflammatory response syndrome and hepatic cytolysis. Parasite serology led to suspicion of toxocariasis that was treated using albendazole. Follow-up tests at two months showed the presence of Schistosoma mansoni eggs in stools despite negative standard serodiagnostic testing (hemagglutination). Secondarily Western blot testing of serum samples at one, two and 14 months after returning from Guinea continued to show only protein bands specific to toxocariasis with no bands specific to bilhariziasis. These findings provide further evidence of the limitations of serological testing for detection of bilharziasis in travelers and the difficulty of diagnosis. Guinea is a high-risk tourist destination. Intestinal and urinary bilharziasis are endemic over three-fourths of country. Travelers planning even short stays in areas where bilharziasis is endemic should be advised on preventive measures.

[Worldwide human zoonotic cryptosporidiosis caused by Cryptosporidium felis]. / La cryptosporidiose zoonosique humaine due à Cryptosporidium felis dans le monde.

Cryptosporidium is an important enteric pathogen worldwide distributed causing diarrhoeal illness in humans and animals. Identifying Cryptosporidium species using conventional criteria, such as oocyst morphology, is inadequate. The advent of molecular techniques has conducted to characterize different species and genotypes of Cryptosporidium infecting humans. The vast majority of human cases of cryptosporidiosis in the world are caused by both species, Cryptosporidium hominis and Cryptosporidium parvum. However other species including Cryptosporidium felis can infect humans too. In this review, we analyse 58 reported cases of human C. felis infection in different parts of the world. To date this emerging protozoan disease is present in humans around the world, except in Australia and Oceania. Adults and children are infected, more often when immunocompromised by HIV infection (83 % of reported cases). Apparently immunocompetent individuals are also infected by C. felis. In developing countries, inhabitants are more likely infected by C. felis probably through the oocyst contamination of drinking or recreational water. The public health importance of C. felis infection in tropical countries remains to be evaluated.

[Hepatobiliary fascioliasis and echinococcosis/hydatidosis in domestic animals in Haiti]. / Distomatose hépatobiliaire et échinococcose- hydatidose des animaux domestiques en Haïti.

In Haiti, hepatobiliary fascioliasis and hepatic hydatid cysts cause major economic losses among livestock. Surveys show high prevalence rates for bovine distomatosis caused by Fasciola hepatica (10.7% to 22.78%). Among small ruminants, the prevalence of distomatosis is low (sheep: 3.2%, goats: 0.9%) although Dicrocoelium dendriticum is found in 1.1% of sheep. Hepatic hydatidosis is more common among pigs (5.2%) and sheep (2.1%) than among goats (0.9%) and cattle (0.3%). In the case of dogs, 21% excrete egg-bearing segments in their faeces and 25% harbour Echinococcus granulosus in the small intestine. As a result of local dietary habits (consumption of raw cress), environmental pollution by animal faeces, poverty and poor standards of hygiene in Haiti, these flatworms pose serious health risks to the population, even though this is largely unknown at present.

[Enteric parasites and AIDS in Haiti: utility of detection and treatment of intestinal parasites in family members]. / Parasites intestinaux et sida en Haïti: faut-il déparasiter l'entourage familial?

Intestinal parasites and human immunodeficiency virus (HIV) are major health problems in Haiti. Both entities are known to interact strongly with cell-mediated immunity. The purpose of this study undertaken in Port-au-Prince, Haiti was to evaluate the risk of enteric parasite transmission between HIV-infected patients and family members. Routine examination of stool specimens for parasites was conducted in 90 HIV-infected undergoing treatment for intestinal disorders due mainly to Cryptosporidium sp. (62%) and 123 healthy family member volunteers. A stool sample preserved in 10% formalin solution was examined to detect protozoa (MIF, modified Ziehl-Neelsen stain, Uvibio fluorescence technique, Weber stain) and helminth ova (Bailenger technique). In addition to Cryptosporidium sp., 14 parasitic species were identified: 6 Rhizopoda, 3 Flagellata (including Giardia duodenalis), 1 Coccidia (Cyclospora cayetanensis), 3 Nematoda (mainly Ascaris lumbricoides) and 1 Cestoda (Hymenolepis nana). This is the first time that 5 protozoa, i.e., Blastocystis hominis, Entamoeba hartmanni, E. polecki, Chilomastix mesnili, and Enteromonas hominis, have been reported in Haiti. As expected, enteric parasites were less common in HIV-infected subjects undergoing medical treatment (11.1%) than in uninfected family members (41.5%) (p = 0.0000). Multiple intestinal parasitism (infection by 2 to 4 parasites) was observed in 19.5% of family members. The findings of this study indicate that detecting and treating intestinal parasites in subjects living in close contact with HIV-infected patients as well as informing family members of the importance of personal hygiene in Haiti are highly recommended measures to preserve the health of AIDS patients.

[Intestinal helminthiasis in school children in Haiti in 2002]. / Helminthoses intestinales en milieu scolaire en Haïti en 2002.

A survey on intestinal helminths in school children was conducted in Haiti in 2002. This first nationwide study involving the entire country was stratified by department according to urban and rural zones using the cluster method. Focusing on elementary school children (n=5792; age range 3 to 20 years), it involved 26 urban and 49 rural schools randomly selected. Stools were preserved in formalin and examined by the Ritchie technique. Thirty-four per cent of stools (1981/5792) tested positive for intestinal helminths with the following parasites identified: Ascaris lumbricoides (27.3%), Trichuris trichiura (7.3%), Necator americanus (3.8%), Hymenolepsis nana (2%), Taenia sp. (0.3%) and Strongyloides stercoralis (0.2%). The helminth prevalence was higher in rural (38.4%) compared to urban areas (30%). There was no significant difference in prevalence by sex and age. The importance of geohelminths changed from one department to another with the highest prevalence found in the Southern department of Grande Anse (73.7%) and the lowest prevalence in the Center department (20.6%). Five out of the country's nine departments had a similar prevalence varying from 25.5% to 28.2%. Intestinal helminthic polyparasitism was observed in a percentage of infested school children comprise between 3.4% and 28.6% according in relation to the geographical area. A program to fight against geohelminths in school children should be initiated as a public health priority. Albendazole is the drug of choice. Frequency of drug distribution should be based on the prevalence of geohelminths in each department.

Comparison of aerobic standard medium with specific fungal medium for detecting fusarium spp in blood cultures.

In order to compare the performances of a specific fungal medium and a standard aerobic medium for detecting growth of Fusarium spp. in blood, simulated blood cultures were performed. For lower inocula (10(2) and 10(3) cfu/ml taken together), fungal growth was detected significantly earlier using the fungal medium. The mean difference in the time to detection between the two media was 22.33 h at 10(2) cfu/ml, with the maximum difference being achieved for Fusarium verticilloides at 37.05 h. These in vitro test results suggest fungal medium could be useful for obtaining more rapid blood culture results when evaluating patients at risk for invasive infection with Fusarium spp.

Invasive infections due to Trichoderma species: report of 2 cases, findings of in vitro susceptibility testing, and review of the literature.

Trichoderma species are filamentous fungi that were previously considered to be culture contaminants. We report 2 well-documented cases of invasive Trichoderma infections, and we comprehensively review the literature on this topic. Trichoderma species are mainly responsible for continuous ambulatory peritoneal dialysis-associated peritonitis (7 cases) and invasive infections in immunocompromised patients (9 cases) with a hematologic malignancy or solid-organ transplant. Definitive diagnosis is difficult to achieve because of the lack of specific diagnosis tools. Species identification can benefit from a molecular approach. Trichoderma longibrachiatum is the most common species involved in these infections. Regardless of the type of infection, the prognosis was poor, with 8 deaths among 18 cases. This may be partially because of the resistance of these organisms to the majority of available antifungal agents, including amphotericin B. Trichoderma species now should be added to the growing list of emerging filamentous fungal pathogens.

[Difficulties in diagnosis of human dirofilariasis outside known enzootic areas]. / Problèmes soulevés par le diagnostic de la dirofilariose humaine à distance d'une région enzootique connue.

INTRODUCTION: Human non-visceral dirofilariasis, a mosquito-borne disease of carnivores (dogs), is chiefly due to Dirofilaria repens in France and is well known in the Mediterranean basin. This zoonosis can be misdiagnosed in northern areas of France. We present and discuss two human cases diagnosed in Abbeville and Amiens (Picardy) by histological examination. EXEGESIS: The former case appeared as an axillary tumefaction occurring in a 41-year-old women 6 months after holidays in Montauban (southwestern France), the other as an intraorbital 'tumor' in a 53-year-old man who travelled for professional purposes in Central Europe and North America. Morphological, clinical, and epidemiological data of these human infections are discussed and the diagnostic features in tissue sections for species identification are reviewed. CONCLUSION: Increasing travel customs during the last decades favour the emergence of zoonotic parasites unusually in human hosts. Outside known enzootic areas, diagnosis is often delayed until pathological examination. In France, the incidence of human dirofilariasis has steadily increased and must be considered in the workup of cutaneous or intraorbital nodules.

Medullary gnathostomiasis in a white patient: use of immunodiagnosis and magnetic resonance imaging.

A 48-year-old French diplomat presented with a sensory-motor paraparesis of rapid onset, leading to paraplegia. Successive magnetic resonance image scans showed lesions of the thoracic spinal cord that were at different levels from one examination to the next. Specific anti-gnathostome antibodies were detected by means of enzyme-linked immunosorbent assay and Western blot test in both plasma and cerebrospinal fluid. Albendazole treatment prevented disease progression, but only partial regression of the neurologic symptoms was obtained.

Trypanosomatidae from wild mammals in the neotropical rainforest of French Guiana.

The initial filling of the reservoir behind the Petit Saut hydro-electric dam, on the Sinnamary River in French Guiana, threatened the terrestrial and arboreal animals living in the neotropical rainforest being flooded. During a rescue programme between 24 October and 12 November in 1994, many of these animals were checked for infection with trypanosomatids. Overall, 45 blood samples and 54 skin biopsies were collected from 53 mammals (of 13 species representing five orders) and blood samples were also taken from each of nine reptiles (six species from four families). When the skin biopsies and the buffy-coats from the blood samples were cultured in NNN medium, 10 of the cultures, each initiated with mammalian blood, were found to be positive for trypanosomatids. Multilocus enzyme electrophoresis (MLEE) on cellulose acetate plates, with 20 enzyme systems, was then used to investigate each of the positive cultures. The results were analysed by clustering from a genetic distance matrix, using the unweighted pair group method with arithmetic averages (UPGMA), and applying a bootstrap procedure to Wagner parsimony trees. A stock obtained from Didelphis marsupialis was identified as a zymodeme of Trypanosoma cruzi (Miles' zymodeme 1) known to cause Chagas disease in French Guiana. Five stocks (one each from Bradypus tridactylus, Tamandua tetradactyla and Alouatta seniculus and two from Saguinus midas) were of a single zymodeme close to Trypanosoma rangeli reference stock RGB. This is the first confirmation of the presence of Tr. rangeli in French Guiana, and the first time that it has been identified, by iso-enzyme analysis, in the neotropical primates A. seniculus and S. midas. Two other stocks, isolated from Choloepus didactylus, were related to Endotrypanum schaudinni reference stock LEM 2790. Although the remaining stocks, one from C. didactylus and the other from A. seniculus, clustered together on UPGMA and in a Wagner tree, they did not appear to be related to any of the reference stocks included in the UPGMA dendrogram.