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[Natural history of chromoblastomycosis in Madagascar and the Indian Ocean] [Natural history of chromoblastomycosis in Madagascar and the [Natural history of chromoblastomycosis in Madagascar and the Indian Ocean].

The natural history of chromoblastomycosis was studied in Madagascar by analysing the characteristics of 1323 confirmed cases observed since 1955, including 45 patients receiving a new antifungic drug (terbinafine) during a multicentric study organized in 1995. The surveys data, conserved by the histopathology laboratory in the Institut Pasteur of Madagascar during 40 years, permit this retrospective analysis. The description of two ecosystems, one in the North with Fonsecaea pedrosoi evolving in the tropical rainforest and one in the South with Cladophialophora carrionii (41% of the whole sample) isolated in the spiny desert, demonstrates that the deforestation, in order to product charcoal and to build houses, is the primary factor associated with this disease. The epidemiologic (87% of patients are male and 96% are more than 16 years old, with more than 74% of the lesions located on feet and legs), mycologic (62% of the isolated strains belong to the F. pedrosoi species) and therapeutic (low efficiency of thiabendazole in long-term lesions, high efficiency of terbinafine especially on recent lesions and on Cladophialophora-infected patients) aspects of the natural history of chromomycosis confirmed that Madagascar is the most important focus in the world (global prevalence of about 1 for 8500 inhabitants), with few sporadic cases in the other islands of the Indian Ocean (La Reunion, Comoro islands and Mayotte). In the difficult context of Madagascar, the need for a non-specialized laboratory-applicable diagnostic technique that provides infection and species identification led the Institut Pasteur de Madagascar to develop an ELISA-based technique. A large-scale control throughout the country, with the assessment of effective oral chemotherapy with terbinafine, is seen as possible by the authors with the help of the manufacturer.

Antifungal Agents↗

[Cancer in Madagascar. Experience of the Institut Pasteur de Madagascar from September 1992 to June 1996].

The Unit of the anatomo-pathology in the "Institut Pasteur de Madagascar" (IPM) examined in the period from September 1992 to June 1996 tissue specimens from 10,275 patients. Tumorous pathology presented 40% of the tissues and half of which were of malign etiology. 64% of the cancer diagnosed were in females. Cervical cancer was most frequently observed (17%), followed by breast cancer (16%). Cancer in the gastro-intestinal tract (15%) was most often located in the colon without sex difference. Stomach cancer occurring predominantly in males presented 25% of the total cases of cancer in the gastro-intestinal tract. Cancer of liver is rarely diagnosed despite the high prevalence of infection with hepatitis B virus. Skin cancer constituted 9% of the malign diagnosis and was mainly found in males. Children under 15 years old presented 7.4% of the total cases of malignancy with the haematopoietic tissues (30%) and the eyes (17%) as the most frequent topic locations. Due to a very low seroprevalence of the HIV in Madagascar, malign tumours associated to AIDS were only seen in a few rare cases. The review of cancer cases in the IPM may not be representative for the cancer epidemiology of Madagascar because of a general very low level of health care coverage, especially in the rural areas. Furthermore, a major part of the specimens originates from easily accessible organsystems, whereas other organs seem less investigated due to lack of appropriate available technique. Therefore, it is not feasible for the moment to establish a cancer register in Madagascar, although the Unit of Pathology in the IPM can offer a valid cancer diagnostical service.

Adolescent↗

Influenza outbreak--Madagascar, July-August 2002.

In mid-July 2002, Madagascar health authorities were notified of a substantial number of deaths attributed to acute respiratory illness (ARI) in the village of Sahafata (population: 2,160), located in the rural highlands of Fianarantsoa Province, southeastern Madagascar (Figure 1). This region is approximately 450 km (280 miles) south of the capital Antananarivo. The Madagascar Ministry of Health (MOH) and the Institut Pasteur, Madagascar (IPM) initiated an investigation, which found an attack rate of 70% for ARI, with 27 deaths in Sahafata. Pharyngeal swab specimens were collected from ill persons for viral culture. Of the four influenza A viruses that were isolated at IPM, two were identified as type A (H3N2) viruses. In late July, health authorities investigated a similar outbreak in Ikongo District, Fianarantsoa Province. In August, MOH requested assistance from the World Health Organization (WHO) and CDC in investigating the outbreak. In response, an international team of experts from CDC; Institut de Veille Sanitaire, France; Institut Pasteur, France; and WHO was mobilized from the Global Outbreak Alert and Response Network; the team arrived in Madagascar on August 14. This report summarizes the preliminary epidemiologic and virologic findings, which suggest that the outbreak was attributable to influenza A (H3N2) viruses. Further surveillance and research about the epidemiology of influenza in Madagascar is planned.

Disease Outbreaks↗

Plants traditionally prescribed to treat tazo (malaria) in the eastern region of Madagascar.

BACKGROUND: Malaria is known as tazo or tazomoka in local terminology in Madagascar. Within the context of traditional practice, malaria (and/or malaria symptoms) is commonly treated by decoctions or infusions from bitter plants. One possible approach to the identification of new antimalarial drug candidates is to search for compounds that cure or prevent malaria in plants empirically used to treat malaria. Thus, it is worth documenting the ethnobotanical data, and testing the antiplasmodial activity of the extractive from plants. METHODS: We interviewed traditional healers, known locally as ombiasy, at Andasibe in the eastern, rainy part of Madagascar. We recorded details of the preparation and use of plants for medicinal purposes. We extracted five alkaloids from Z. tsihanimposa stem bark, and tested them in vitro against Plasmodium falciparum FCM29. RESULTS: We found that traditional healers treat malaria with herbal remedies consisting of one to eight different plants. We identified and listed the medicinal plants commonly used to treat malaria. The plants used included a large number of species from different families. Zanthoxylum sp (Rutaceae) was frequently cited, and plants from this genus are also used to treat malaria in other parts of Madagascar. From the plant list, Zanthoxylum tsihanimposa, bitter plant endemic to Madagascar, was selected and examined. Five alkaloids were isolates from the stem bark of this plant, and tested in vitro against malaria parasite. The geometric mean IC50 values ranged from 98.4 to 332.1 micromolar. The quinoline alkaloid gamma-fagarine exhibited the strongest antiplasmodial activity. CONCLUSIONS: The current use of plants for medicinal purposes reflects the attachment of the Malagasy people to their culture, and also a lack of access to modern medicine. The possible extrapolation of these in vitro findings, obtained with plant extracts, to the treatment of malaria and/or the signs evoking malaria is still unclear. If plants are to be used as sources of novel antimalarial compounds, we need to increase our knowledge of their empirical use to improve plant selection. In the hope of preserving useful resources, we should now gather and record ethnobotanical data in Madagascar, and should try to bridge the gaps between empirics and realism.

Animals↗

[Anopheles mascarensis (De Meillon, 1947): main vector of malaria in the region of Fort-Dauphin (south-east of Madagascar)].

Anopheles funestus and Anopheles gambiae s.l. have been considered until now the major vectors of malaria everywhere in Madagascar. Anopheles mascarensis, a mosquito native to Madagascar, has been identified in Sainte-Marie island as a secondary vector only. In 1997, an entomological study was carried out to identify the malaria vectors in the area of Fort-Dauphin, South-East of Madagascar. Every month, mosquitoes were collected from landing catches on human volunteers (from 7:00 am to 5:00 pm inside dwellings and from 7:00 am to 0:00 pm outside) and from knockdown spray-collections indoors. An mascarensis was the most abundant mosquito, the average number of An. mascarensis bites per man/night was 7.6. The sporozoite index was 0.89%. Despite the presence of An. funestus and An. gambiae s.l., An. mascarensis was found to be responsible for 2/3 of the infectious bites (25 infectious bites per man/year). An. mascarensis is widely distributed ih Madagascar but only specimens from the east coast have been found to carry sporozoites of human malaria. Further arguments are thus advanced for the hypothesis according to which a sibling species of An. mascarensis is present in Madagascar.

Animals↗

[Rice: source of life and death on the plateaux of Madagascar].

Since the 17th century, Europeans travelling in Madagascar described the contrast between the fever-free Plateau and the fever-ridden coasts. The former were inhabited by people of Asiatic origins and the latter by African migrants. At the end of the 18th century, "Merina" kings developed land irrigation and rice cultivation, using manpower from the coasts. Since then, rice has become a monoculture covering most of the arable lands of the Highlands. The first malaria epidemic occurred in the Tananarive area in 1878, and rapidly spread throughout the Plateau. The mortality rate was high. A second epidemic in 1895 may have been a resurgence of the previous one. Subsequently, malaria became meso-epidemic despite control measures, mainly consisting of larvivorous fishes, quinine treatment and prophylaxis. In 1949, an eradication program was launched based on DDT house-spraying and chloroquine prophylaxis in children. It was very successful on the Highlands where malaria disappeared, in 1962. Spraying was cancelled and only three small foci remained under surveillance. In 1987 and 1988, a malaria outbreak devastated the plateau. Subsequently, intensive spraying operations brought the situation under control by 1993. The main malaria vector on the Madagascar Highlands is An. funestus. More than 95% of its breeding sites are in the rice fields just before the harvest and afterwards in the fallow lands. The vector peak and the corresponding peak of malaria cases occur between February and May, depending on the farming calender. The second but less important vector, An. arabiensis, breeds in the rice fields just after seeding when the surface water is sunlit. Although rice fields remain the main source of this vector, it also breeds in rainwater pods and borow-pits. Malaria vectors on the plateau are products of human activities of rice cultivation, which is the basis of the economy. The epidemiological importance of rice fields varies greatly from one country to another. In Southeast Asia, the rice fields harbor several anopheline species most of which are only vectors of P. vivax. In West Africa where malaria is holoendemic, they produce large populations of An. gambiae; however, the malaria pattern is unaltered and remains at peak levels. In the dry areas of southern Madagascar, the vector An. funestus and meso-hyperendemic malaria are restricted to areas of cultivated rice. In West and Central Africa, An. funestus is never found in rice fields even though it is common in marshes. In Madagascar, this vector breeds in irrigated rice fields. Because it is practically impossible to control anophelines in rice fields by chemical, biological and ecological methods on the Highlands of Madagascar, house-spraying remains the best method for mass malaria control. Bed-nets impregnated with pesticides may offer an alternative, but their use is resisted by the local population.

Agriculture↗

Implications of recent geological investigations of the Mozambique Channel for the mammalian colonization of Madagascar.

Madagascar separated from continental Africa during the break-up of Gondwanaland early in the Cretaceous. The presence of several terrestrial mammalian groups on Madagascar is paradoxical as (i) these groups postdate the departure of Madagascar from Africa: and ii) terrestrial mammals are poor dispersers across wide water barriers. Recent geological studies focusing on the Davie Fracture Zone of the Mozambique Channel offer a resolution to this situation, by suggesting the presence of a land-bridge from the mid-Eocene to the early Miocene, an interval that matches the ages of Madagascar's mammalian groups.

Africa↗

Arboviruses and lemurs in Madagascar: experimental infection of Lemur fulvus with yellow fever and West Nile viruses.

In previous serological surveys of lemurs in Madagascar, antibodies against flaviviruses were frequently detected. To examine the epidemiological role of Lemur fulvus, experimental infections with yellow fever (YF) virus and West Nile (WN) virus were performed. YF and WN infections were clinically unapparent. A 3 to 4-day-long viremia, with moderate levels was observed with YF virus. WN virus, especially the strain isolated in Madagascar, provoked a 4 to 6-day-long viremia sufficient to infect Aedes aegypti. In all experiments, the antibody response was studied during the following weeks by 3 methods. The results led to the conclusion that Malagasy lemurs could act as amplifying hosts for WN virus present in Madagascar, and as hosts for YF virus if it were introduced on the island. The epidemiological role of these primates is discussed according to their ecology and their contact with potential mosquito vectors in forest areas of Madagascar.

Aedes↗

[The reconquest of the Madagascar highlands by malaria].

A strong malaria epidemic with a high mortality rate occurred on the Madagascar Highlands in 1986-88. Vector control and free access to antimalaria drugs controlled the disease. The authors have searched for the causes of the epidemic to propose a strategy avoiding such events. The Highlands on Madagascar were known as malaria free. In 1878 a very severe epidemic flooded all the country. Development of irrigated ricefields which house both An. arabiensis and An. funestus had created a new anthropic environment. Moreover manpower imported from malarious coastal areas for rice cultivation and also for building large temples, could have brought P. falciparum. After several outbreaks the disease became endemic up to 1949. In 1949 a malaria eradication programme based on DDT spraying and drug chemoprophylaxis and chemotherapy was launched. By 1960 malaria was eliminated and DDT spraying cancelled. Only 3 foci were kept under surveillance with irregular spraying until 1975. The prophylaxis and treatment centres ("centres de nivaquinisation") were kept open up to 1979. The catholic dispensary of Analaroa, 100 km N.E. of Tananarive, opened in 1971 and worked without interruption up to now. The malaria diagnosis has always been controlled by microscopy. Its registers are probably the more reliable source of information on malaria in the area. They show that malaria was already present on the Highlands in 1971 but at a low prevalence; in 1980 when the "centres de nivaquinisation" were closed the number of cases increased by three times the progressive increase of the number of cases became exponential from 1986 to 1988 which was the peak of the epidemic; malaria remained at a high level until the end of 1993; yearly DDT spraying since 1993 have decreased the number of malaria cases among the dispensary attendants by 90%. The epidemic peak of 1988 was well documented by the Pasteur Institute of Madagascar around Tananarive. Before the epidemic started it was observed a come back of An. funestus which had been previously eliminated of most of the villages by DDT spraying. More than an epidemic the malaria increase in 1988 was a reconquest by malaria of the land from which it had been eliminated in the years 1950. This episode became dramatic because the lack of immunity of the population and the shortage of medicaments. The global warming which was advocated to explain the epidemic has no responsibility because the temperature on the Madagascar Highlands has not changed during the last 30 years. Also the cyclones do not seem to have played any role. It is very likely that the gradual decline of control measures, first DDT spraying, later drug distributions, had the main responsibility in the Highlands drama. Everywhere An. funestus reached a high level during the time where the parasite reservoir was rebuilding. They synergised each other. These findings should be taken in account in drawing the strategy planning for the next years.

DDT↗

[AIDS in Madagascar. I. Epidemiology, projections, socioeconomic impact, interventions].

Madagascar is still among the rare states of low prevalence of HIV. The seroprevalence rate is nevertheless rising. The aim of this study is to show the current view of the epidemic, its future tendency, its economical and social impact on people and what measures to be taken at the national scale. In Madagascar, we can state by 1995 20 cases of notified AIDS and probably 130 cases of non-notified AIDS. Seroprevalence data are collected every year by the National Reference Laboratory STD/AIDS. But, they are insufficient to estimate the number of infected people. So, they had been completed by a serosurveillance study of AIDS and syphilis in middle of 1995 and at the beginning of 1996. Pregnant women, persons with STDs and prostitutes are been screened in the six biggest cities of the Island. Results show, not only a high prevalence of syphilis, but also indicate that now, we have about 5,000 seropositive people in the country. Besides, by the number of people with STDs, it is estimated that one million Malgasy adults risk to be infected. Based on estimates of the epidemic, be it the cases of a high scenario, (Kenya) or of a low one (Thailand) by the year 2015, the seroprevalence rate could represent 3% or 15% of adults. Demographic consequences of the epidemic will be serious, particularly if HIV spreads quickly. Nevertheless, it does not stop the increase of population. Therefore, there will be more infected people with the disease, especially young people between 15 and 49 years old. The increase of dead people will be serious. Social consequences of the epidemic (case of high scenario) will be gravely felt, in particular by the rise of the number of AIDS orphans. Tuberculosis outbreak can be observed too. This disease is already a serious problem in Madagascar. At last, the epidemic will bring with it a high increase of money spent on health and will have grave consequences on agriculture, industry and commerce. Nevertheless, Madagascar still benefit a big luck which is the prevention of the epidemic not to be exploded in a near future. For this, struggle against it is particularly effective on its start. In addition to counselling given to infected people and care-given to patients, means of prevention of AIDS contamination in all target groups must be set up quickly. It is about broadcasting information on AIDS, community education, controlling other STDs e.g. (importance of medicaments' program), promoting the use of condoms and screening HIV new cases. Only an urgent coordination of everyone's efforts can control the epidemic of AIDS.

Acquired Immunodeficiency Syndrome↗

[Lemurs of Madagascar. Tests on evolution of primate communities].

The flora and fauna of Madagascar evolved rather independently from the African mainland. In contrast to other oceanic islands, Madagascar is large enough to house most major components of tropical ecosystems, allowing tests of evolutionary hypotheses on the level of complete communities. Taking lemurs, the primates of Madagascar, as an example, evolutionary hypotheses correctly predict the organization of their community structure with respect to ecological correlates. Lemur social systems and their morphological correlates, on the other hand, deviate largely from the typical mammalian pattern. Thus, the traditional hypotheses of behavioral ecology, based solely on resource distribution and predation pressure, are insufficient to explain the existing variability in lemur social systems. Other factors, such as activity patterns and avoidance of infanticide, may be equally important. Due to interspecific variation in these characters, lemurs offer the unique opportunity to determine the relative importance of these factors for the evolution of social systems.

Animals↗

Medicinal plants of the eastern region of Madagascar.

Sixty-eight plants used in the traditional medicinal practices of the Betsimisaraka and Tanala peoples of the eastern region of Madagascar are reported. Preparations and utilizations of these medicinal plants are as varied as the plants themselves. Some of the plants discussed are known to science, but because of the diversity of tribal groups in Madagascar, new preparations and utilizations of these plants were based on the ethnobotanical data collected from the Betsimisaraka and Tanala. Many of the plants discussed remain to be chemically tested. Ethnopharmacological information is in danger of being lost in Madagascar as slash and burn agriculture destroys much of the forest, and the elder traditional healers, often illiterate, pass away without handing down their knowledge.

Databases, Factual↗