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[Snake envenomation in French Guiana].

French Guiana is a French Overseas Department in South America. Ninety-five percent of the territory is a tropical rainforest. Its rich fauna includes seven families of snakes but only 3 are potentially venomous. Less than 12% of species and, depending on biotope, 10 to 30% of specimens collected are dangerous for humans. The annual incidence of snakebite is less than 50 bites per 100,000 inhabitants overall but increases to 600 per 100,000 for persons active in the rainforest where the risk is highest. The most common envenomation by Viperidae such as Bothrops, which is abundant throughout French Guiana, induces inflammation, necrosis and hemorrhage. Crotalus durissus, a rattlesnake living in coastal savannah, or Micrurus sp cause neuromuscular poisoning. Coral snakes are encountered throughout French Guiana, but envenomation is very rare. Antivenom therapy must be administered by the intravenous route in association with symptomatic treatment and, if necessary, resuscitation in a specialized care unit.

Animals↗

Risk factors for follow-up interruption of HIV patients in French Guiana.

French Guiana is the region of France where the HIV epidemic is most prevalent. To determine the risk factors for being lost for follow-up, we followed a cohort of 1,213 patients between 1992 and 2002 and determined which variables were related to two definitions of being lost to follow-up: permanently disappearing from HIV clinics and coming back after more than 1 year of missed appointments. The incidence rate for permanent follow-up interruption was 17.2 per 100 person-years. The median time to lost to follow-up was 4.3 years (interquartile range = 1.4-8.4 years). Cox modeling showed that the younger age groups, foreigners, patients with initial CD4 counts at the time of HIV diagnosis less than 500/mm3, and patients followed before the availability of highly active antiretroviral therapy (HAART) were significantly more likely to be permanently lost to follow-up, suggesting that some of the patients may have died. When looking at temporary loss to follow-up, younger age groups, untreated patients, patients consulting before the availability of HAART, and patients with CD4 counts more than 500/mm3 were more likely to not come back for a period of more than 1 year.

Adult↗

Neurodevelopmental investigations among methylmercury-exposed children in French Guiana.

French Guiana, like its neighbors, suffers from environmental pollution with methylmercury from gold mining activities, and Amerindian communities are particularly affected. A neurological and a neurospsychological evaluation were carried out in children of three Amerindian communities with various levels of pollution: 156 children from the Upper Maroni (high exposure), 69 from Camopi on the Oyapock river (median exposure), and 153 from Awala on the Atlantic coast (low exposure). Exposure to methylmercury was measured by determination of total mercury in the hair of the children and their mothers (geometric mean, 12.7 microg/g in Upper Maroni). No major neurologic signs were observed in the children examined. After adjustment for potential confounders, we found a dose-dependent association between maternal hair mercury level and increased deep tendon reflexes, poorer coordination of the legs, and decreased performance in the Stanford-Binet Copying score, which measures visuospatial organization. In this last test, the frequency of rotation errors was high in the 5-6 years age group and increased with mercury exposure. These associations depended on the sex of child and were stronger among boys. The interpretation of these results is limited mainly by the cross-sectional design of the study. It identifies specific neurological and neuropsychological deficits, in some cases modulated by sex, which are consistent with known targets of mercury neurotoxicity.

Child↗

Diversity and ecology of sand flies (Diptera: Psychodidae: Phlebotominae) in coastal French Guiana.

In French Guiana, at least five Leishmania species are known to be sympatically transmitted in sylvatic ecotopes. However, the previous surveys on the phlebotomine sand fly fauna were published 20 years ago. During that period, many ecological changes have occurred. Sand fly collections were conducted with CDC light traps in five stations representing the main ecotopes of French Guiana. A total of 817 sand flies belonging to 2 genera, 18 sub-genera, and 46 different species were identified. The species Lutzomyia umbratilis (16.6% of the collected specimens), Lu. infraspinosa (12.7%), Lu. ininii (8.0%), and Lu. flaviscutellata (6.1%) were the most common species. The stratification by height, activity period, and resting site preferences of the most abundant sand flies were analyzed. Population abundance and diversity were compared for each ecotope. The potential of certain sand fly species in leishmaniasis transmission is discussed.

Altitude↗

[Dermatology in French Guiana].

In French Guayana, climatic and geographic conditions enhance development of numerous fungal, parasitic and microbial skin diseases. The most particular infectious diseases of this French department are lobomycosis, chromomycosis (Phialophora pedrosoi), creeping disease, cutaneous leishmaniasis, tungiasis, mycobacterial ulcus (Mycobacterium ulcerans) and papular dermatitis caused by nettling hairs of lepidoptera (Hylesia urticans). The occurence of these skin diseases is demonstrative of pathological ecology of the Amazonian country.

Chromoblastomycosis↗

[Dengue in French Guiana. History and present status].

The evolution of dengue in French Guiana has the same trend as in most tropical American countries, with emergence of dengue hemorrhagic fever (DHF) and endemicity of the disease. During the 1940's, several dengue-like outbreaks were reported from French Guiana. Then, the only dengue vector, Aedes aegypti, was eradicated between 1950 and 1963, when it started to reinfest the country. By the end of the 1960's, new dengue epidemics with serological confirmation were described. After 1970, the first dengue strains were isolated, firstly dengue-2 strains, then dengue-1 and dengue-4 strains. Between 1970 and 1990, several dengue outbreaks struck French Guiana with 2 to 6 years intervals. In July 1991, started the first DHF outbreak in French Guiana which spread in all the most important towns until October 1992. About 3,000 cases were reported, that is almost 3% of the population, from which about 1/3 had serological confirmation; more than 300 people were hospitalized and some 80 with hemorrhages. Finally 6 deaths were reported, 5 of which had hemorrhages but could not be included into DHF cases according to WHO criteria. The dengue-2 strain responsible for this outbreak is close to the Jamaïcan topotype known to be particularly virulent. Since the beginning of 1993 and actually, dengue is still circulating in French Guiana, but at low level and dengue-1 and dengue-4 strains are occasionally isolated.

Dengue↗

[Anti-Aedes aegypti campaign in French Guiana].

The history of vector control in French Guiana started in 1947 when a small team was recruited for that purpose. In 1949, the first DDT treatments were implemented and Aedes aegypti could not be found until 1960. Between 1966 and 1972 an eradication campaign was carried out which resulted in the elimination of Ae. aegypti from all the department except the city of Cayenne. Malathion and orthodibrom were used as adulticides and temephos (Abate) was sprayed against the larvae. Nevertheless, in 1980, Ae. aegypti was still infesting Cayenne and its surroundings. The pilot project of the "Cité Grant" was developed, but never gave the expected results. In 1986, the vector control agency called "Service départmental de désinfection" was restructured and extended. During the 1990s, collaborations were developed between the different health participants of French Guiana, to improve disease control. Actually, the vector control activities include house inspections, mainly to detect, treat or eliminate the breeding-sources, and also to set up entomological indices. Furthermore, investigations are made on the laboratory confirmed dengue cases to find and treat the place of infection, spatial sprayings are made against the adults, and the community health education has being reinforced. The situation in French Guiana is not optimistic for climatic and logistical reasons, and the lack of participation from the community. The perspectives are to improve vector control through education, collaborations with local authorities, reorganisation of the control teams and regional exchanges.

Aedes↗

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.

Adult↗

[Evaluation of the socioeconomic costs of cutaneous leishmaniasis in French Guiana].

The socio-economic cost of leishmaniasis in French Guiana was estimated using a retrospective survey spreading over a period of one year: 1979-80. The financial cost elements taken into account were the following: dermatological consultations, biological tests, treatments and hospitalisation days. Other elements were not evaluated, such as days of military hospital stays, work days suspended and unavailability of service. The cost of leishmaniasis represented 0.13% of the general budget of French Guiana and 0.43% of the global budget of the French Guiana Social Security.

Absenteeism↗

Genetic diversity and phylogenetic analysis of human immunodeficiency virus type 1 subtypes circulating in French Guiana.

We investigated the characterization of different HIV-1 subtypes present in French Guiana by use of three different methods. Serological methods were used for the initial screening, which were then confirmed by the heteroduplex mobility assay (HMA). The V3 env region was subsequently sequenced for phylogenetic analysis, to confirm the subtype of the samples, and to assign a subtype to samples that gave results that were difficult to interpret or discordant by serology or HMA. A total of 221 HIV-1 seropositive samples were typed; 110 of them were confirmed by HMA and 16 were sequenced. Of the 221 samples tested 210 patients (95%) were found to be infected with subtype B, 10 (4.5%) were infected with subtype A, and one patient was infected with subtype F. Phylogenetic analysis demonstrated that the strains from French Guiana were closely related to the subtype A and B subtypes, and that one strain was closely related to an F subtype (100% bootstrap value). Four strains from French Guiana clustered in the subtype A (99% bootstrap value) and the other strains were associated with subtype B (100% bootstrap value). The geographic position of French Guiana suggested that HIV-1 was probably introduced into the country via several routes, and thus the pattern of the HIV-1 epidemic might evolve in the near future.

AIDS Serodiagnosis↗

Human T-cell Lymphotropic Virus types I and II (HTLV-I/II) in French Guiana: clinical and molecular epidemiology.

We review here the epidemiological studies performed by our group on human retrovirus HTLV-I and HTLV-II infections and the associated diseases in French Guiana since 1984. French Guiana is an overseas French administrative district located between Brazil and Surinam. Its population is characterized by a large variety of ethnic groups, including several populations of African origin and various populations of Amerindian origin. Several epidemiological studies of large samples of pregnant women and in remote villages showed that HTLV-I is highly endemic in this area but is restricted to groups of African origin, especially the Noir-Marrons. In this endemic population, the results of segregation analysis in a genetic epidemiological study were consistent with the presence of a dominant major gene predisposing to HTLV-I infection, especially in children. In contrast, HTLV-II infection appears to be rare in French Guiana, having been found in only a few individuals of Brazilian origin. From a molecular point of view, the HTLV-I strains present in the Noir-Marrons, Creoles and Amerindians appear to originate from Africa, as they belong to the large cosmopolitan molecular subtype A.

Adolescent↗

Comparison between one and two injections of pentamidine isethionate, at 7 mg/kg in each injection, in the treatment of cutaneous leishmaniasis in French Guiana.

In a retrospective study set in French Guiana, the efficacy and tolerance of the intramuscular treatment of cutaneous leishmaniasis (CL) with a single injection of pentamidine isethionate, at 7 mg/kg, were compared with those observed, earlier, using two such injections (given 48 h apart). Although 83.6% of the 281 patients given two injections each were cured, the single-injection protocol was generally as effective, curing 78.8% of 137 patients. The single-injection protocol was also associated with fewer adverse effects than the two-injection. In the treatment of "difficult" cases (those with satellite papules or relatively high numbers of amastigotes in their lesions), however, the two-injection protocol appeared significantly more effective than the single-injection. In French Guiana, therefore, patients with CL should be given one injection with pentamidine isethionate and only be given a second, 48 h later, if they have satellite papules and/or relatively high numbers of amastigotes in their lesions.

Adult↗

Rhizosphere-bacterial community in Eperua falcata (Caesalpiniaceae) a putative nitrogen-fixing tree from French Guiana rainforest.

The rainforest of French Guiana is still largely unaffected by human activity. Various pristine sites like the Paracou Research Station are devoted to study this tropical ecosystem. We used culture-independent techniques, like polymerase chain reaction-temperature gradient gel electrophoresis, and construction of clone libraries of partial 16S rRNA and nifH genes, to analyze the composition of the bacterial community in the rhizosphere of mature trees of Eperua falcata and Dicorynia guianensis, both species within the Caesalpiniaceae family. E. falcata is one of the more abundant pioneer tree species in this ecosystem and so far, no root nodules have ever been found. However, its nitrogen-fixing status is regarded as "uncertain", whereas D. guianensis is clearly considered a non-nitrogen-fixing plant. The rhizospheres of these mature trees contain specific bacterial communities, including several currently found uncultured microorganisms. In these communities, there are putative nitrogen-fixing bacteria specifically associated to each tree: D. guianensis harbors several Rhizobium spp. and E. falcata members of the genera Burkholderia and Bradyrhizobium. In addition, nifH sequences in the rhizosphere of the latter tree were very diverse. Retrieved sequences were related to bacteria belonging to the alpha-, beta-, and gamma-Proteobacteria in the E. falcata rhizoplane, whereas only two sequences related to gamma-Proteobacteria were found in D. guianensis. Differences in the bacterial communities and the abundance and diversity of nifH sequences in E. falcata rhizosphere suggest that this tree could obtain nitrogen through a nonnodulating bacterial interaction.

Bacteria↗

Gold-mining activities and mercury contamination of native amerindian communities in French Guiana: key role of fish in dietary uptake.

In 1994, the French National Public Health Network reported significant mercury exposure of native Amerindians in French Guiana. In 1997, a study was conducted in the Wayana community to quantify the dietary intake and to identify the fish species contributing the most to the contamination. The study was completed by an impregnation analysis based on Hg determination in hair samples. The methodology used was a detailed familial dietary study associated with Hg measurements in fish and some game. The study was conducted over 7 days in two different seasons in the four most populated Wayana villages on the upper part of the Maroni River (521 people; 70% of the Wayana population in French Guiana). Analysis was based on data on consumption obtained from 165 people in a 1-14 day period (i.e., 940 persons [times] days) and involved 270 fish samples from 48 species. Total Hg and monomethylmercury (MMHg) were also determined in hair samples (235 samples for total Hg). The results confirm mercury exposure of the Wayana population related to a diet rich in fish, which are relatively highly contaminated for certain species (up to 1.62 mg/kg fresh weight or 8.1 mg/kg dry weight in skeletal muscle). Results from hair samples showed that 57% of the Amerindians had Hg levels above the World Health Organization (WHO) safety limit (10 microg/g); all those over 1 year of age had a Hg intake greater than the WHO safety limit (200 microg MMHg/week for a 60-kg male). Hg concentrations in fish muscle were closely linked to the feeding regime and position of fish in the food webs. Overall, 14.5% of the fish collected exceeded the 0.5 mg/kg (fresh weight) safety limit. Four carnivorous species accounted for no less than 72% of the metal ingested by the Wayana families, although these represented only 28% of the consumed fish biomass. In conclusion, this study revealed excessive exposure to mercury in the Wayana population in French Guiana related to the consumption of contaminated fish.

Age Factors↗

Phylogenetic relationships and biodiversity in Hylids (Anura: Hylidae) from French Guiana.

We evaluated two biodiversity criteria, higher taxonomic diversity and phylogenetic diversity in French Guiana. For this, we used a recent assessment of the knowledge accumulated since 30 years of study on the amphibian species currently known in French Guiana. We focused on two well-represented genera, Hyla and Scinax, belonging to the subfamily Hylinae. We used partial sequences of two mitochondrial genes (16S rDNA and 12S rDNA, 813 bp) and two nuclear genes (tyrosinase and 18S rRNA, 1590 bp) covering a total of 2403 bp. According to the high bootstrap support in phylogenetic analysis of the complete dataset, the genus Scinax is a homophyletic clade formed by two species groups (rubra and rostrata) in French Guiana. The genus Hyla was confirmed to be a paraphyletic group formed by two species groups as well (30 chromosomes and the 'gladiator frogs'). We confirmed that these genera should be taxonomically reconsidered. Moreover, at the genus, subfamily and family levels, the use of only morphological characters or only molecular DNA markers would hamper estimations of biodiversity. Thus, we strongly advise the combined use of both morphology and molecular data (nuclear and mitochondrial markers).

Animals↗

Mayaro virus fever in French Guiana: isolation, identification, and seroprevalence.

This paper reports the first isolation of Mayaro (MAY) virus from a patient infected in French Guiana. The identification was initially performed using immunofluorescent antibody testing with specific mouse antibody, and confirmed by plaque-reduction neutralization testing and reverse transcription-polymerase chain reaction. To determine if MAY virus infection is widespread in French Guiana, a serosurvey was performed to determine the prevalence of antibody to this virus in various ethnic groups and areas of French Guiana. Human sera (n = 1,962) were screened using the hemagglutination inhibition (HI) test. To determine whether MAY virus circulates in the rain forest, a serosurvey in monkey populations was performed. Monkey sera (n = 150) were also screened for antibody to MAY virus using HI testing. Of the human sera tested, 6.3% were positive for anti-MAY virus antibodies. Significant differences in MAY virus seroprevalence between different age groups were observed. Seroprevalence rates increased with age, with a large increase in people 10-19 years of age in comparison with those less than 10 years of age. After adjustment for age, significant differences were also found between places of residence. The prevalence of anti-MAY virus antibody was higher in people living in contact with the forest, especially in the Haut Oyapock area (odds ratio [OR] = 97.7, 95% confidence interval [CI] = 48.2-197.9) and along the Maroni River (OR = 39.7, 95% CI = 20.6-76.6). The ethnic differences observed in this study were probably due to differences in residence. Among monkeys, higher seroprevalence rates were found in Alouatta seniculus (66.0%) than in Saguinus midas (18.2%). Among Alouatta, the seroprevalence increased significantly with weight (and therefore with age). This study indicates that MAY virus is present in French Guiana, and human infections occur in areas where people live near the tropical rain forest.

Adolescent↗

Molecular characterization and phylogenetic analysis of a human T cell leukemia virus type 2 strain from French Guiana.

Extensive studies have been carried out on native Amerindian populations living in French Guiana in an attempt to detect human T cell leukemia virus type 2 (HTLV-2). However, the first strain of this virus identified in this region was not detected in these populations, but in a Brazilian woman of Amerindian origin. Comparative analyses of the nucleotide sequences of 589 bp of the gp21 env gene and of 625 bp of the long terminal repeat (LTR) showed that this new HTLV-2 strain (HTLV-2 GUY) was of subtype A. Sequence comparison and phylogenetic analyses demonstrated that HTLV-2 GUY was closely related to a group of distinct variants of HTLV-2 subtype A strains originating mostly from Brazilian inhabitants and formerly called HTLV-2 subtype C. As there is a high level of immigration from Brazil in French Guiana, we carried out a seroepidemiological study of 175 Brazilians, mostly women (obtained from a serum databank) and 72 female Brazilian prostitutes living in French Guiana to determine whether HTLV-2 is likely to become an emerging infection in this area. No HTLV-2 infection was detected, indicating that this virus is unlikely to become prevalent in the near future.

Base Sequence↗

Epidemiological and entomological surveillance of the co-circulation of DEN-1, DEN-2 and DEN-4 viruses in French Guiana.

We surveyed the disease epidemiology of dengue in French Guiana after the first dengue haemorrhagic fever epidemic from 1991 to 1993 and during an endemic period from 1993 to 1995. DEN-1, DEN-2 and DEN-4 viruses were isolated from patients and DEN-4 was also isolated from Aedes aegypti mosquitoes. Cases of dengue were reported from all over the country, not only from urban areas, but also from rural areas and isolated human settlements, indicating widespread circulation of the viruses. The mosquito vector A. aegypti was found in all inhabited areas of French Guiana and small outdoor containers were the most common breeding grounds. Some ecological features of A. aegypti, such as larvae breeding in Bromeliad plants in the rainforest, a non-exclusive anthropophily and a high vertical transmission rate for dengue viruses, indicate that A. aegypti can behave as a reservoir for dengue viruses in silent areas. Dengue viruses may survive at an endemic level and cause outbreaks when unknown conditions become more favourable. This finding adds to our knowledge of the natural history of dengue viruses in the Americas.

Aedes↗