Assuntos
Foliculite/parasitologia , Infecções por Uncinaria/diagnóstico , Animais , Humanos , MasculinoRESUMO
The objective of this study was to examine the characteristics of cutaneous lupus erythematosus, excluding systemic lupus erythematosus (SLE), in patients of African descent. Indeed, since the description of subacute cutaneous lupus erythematosus (SCLE), which had been included in chronic cutaneous lupus erythematosus (CCLE), there has been no description of the disease in black patients. In 2000, we performed a retrospective epidemiological study by querying multiple sources to identify all patients with lupus in French Guiana--a part of France in South America having western living conditions, free healthcare and 157,000 inhabitants, most of whom are of African origin. We found 45 patients with pure cutaneous lupus, which included CCLE (mostly discoid), SCLE and bullous lupus. The disease characteristics of these patients exhibited few differences compared with those of the Caucasian patients cited in the literature. However, the age of onset for our patients of African descent was younger than that of Caucasian patients. In contrast to the race-related differences reported for SLE, we found no major differences in terms of demographic, clinical and biological presentation between this cohort of pure cutaneous lupus erythematosus patients of African origin and Caucasian patients with similar forms of lupus.
Assuntos
População Negra , Lúpus Eritematoso Cutâneo/etnologia , Adolescente , Adulto , Idade de Início , Anticorpos Antinucleares/sangue , Biomarcadores/sangue , Criança , Feminino , Guiana Francesa/epidemiologia , Humanos , Lúpus Eritematoso Cutâneo/sangue , Lúpus Eritematoso Cutâneo/diagnóstico , Lúpus Eritematoso Cutâneo/imunologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Pele/patologia , População Branca , Adulto JovemRESUMO
Furuncular myiasis is an infestation of the skin caused by Dermatobia hominis larvae known as "ver macaque" in French Guyana, "berne" in Brazil, "torsalo" in Colombia, or "human botfly" in English-language literature. It has identical features in man and domestic mammals. The primary lesion consists of a boil-like inflammatory papule with a central punctum exuding a serosanguinous discharge. The respiratory sinus of the D. hominis larvae may be visible through the punctum. Myiasis secondary to D. hominis accounts for 10% of imported tropical dermatosis observed in Paris. Diagnosis of furuncular myiasis should be considered in any patient with a history of travel or residence in an endemic area. Treatment depends mainly on mechanical removal that may be facilitated by injection of lidocaine into the lesion or prior application of a 1% solution of ivermectin.
Assuntos
Dípteros , Furunculose/parasitologia , Miíase/parasitologia , Animais , Furunculose/diagnóstico , Furunculose/epidemiologia , Furunculose/cirurgia , Humanos , Larva , Miíase/diagnóstico , Miíase/epidemiologia , Miíase/cirurgia , América do Sul , ViagemRESUMO
French Guyana borders Brazil with the second highest number of cases of leprosy in the world. The purpose of this retrospective study of leprosy cases diagnosed in Guyana between January 1997 and December 2006 was to calculate the incidence of the disease and to identify any special clinical and epidemiological features. A total of 90 new cases were recorded during the study period for a mean incidence of 0.53 cases/10,000 inhabitants/year. Since this incidence is below the 1/10,000 threshold defined by the World Health Organization, leprosy is no longer considered as a major public health issue in French Guyana. However it must be noted that while the number of "native leprosy" cases has declined, the number of Brazilian cases has increased (p<0.01). Brazilian leprosy has different epidemiological features, i.e., dominance of multibacillary forms and high incidence in gold panning and western regions of the country where the incidence is over 1/10,000 inhabitants/year.
Assuntos
Hanseníase/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Guiana/epidemiologia , Humanos , Incidência , Hansenostáticos/uso terapêutico , Hanseníase/diagnóstico , Hanseníase/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por SexoRESUMO
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.
Assuntos
Antiprotozoários/administração & dosagem , Leishmaniose Cutânea/tratamento farmacológico , Pentamidina/administração & dosagem , Adulto , Antiprotozoários/efeitos adversos , Esquema de Medicação , Feminino , Guiana Francesa/epidemiologia , Humanos , Injeções Intramusculares , Leishmaniose Cutânea/epidemiologia , Masculino , Pentamidina/efeitos adversos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Immune reconstitution syndrome (IRIS) is an unusual inflammatory reaction to an opportunistic infection in an HIV-positive patient. This syndrome occurs when immunity is restored in the first months of an effective highly active antiretroviral treatment (HAART). First, we described all patients with a cutaneous form of IRIS. Then, between 1992 and 2004 we conducted a retrospective cohort study comparing Herpes Zoster and Herpes Simplex infections among untreated patients, patients treated by HAART for < or = six months, and patients treated for > six months. We observed three cases of atypical leprosy and three original observations: two of these were fistulisation of lymph node histoplasmosis and tuberculosis, the third one reports the recurrence of a treated cutaneous leishmaniasis. Multivariate analysis showed that, after controlling for age, sex and CD4 counts, patients receiving HAART for < or = six months were more likely to develop Herpes Zoster or herpes simplex infections (p < 0.005). Herpes Simplex and Herpes Zoster infections are the two most frequent dermatological manifestations in our tropical setting. Although mycobacterial infections are more rarely observed than in visceral IRIS, the increased incidence of leprosy may be quite significant when the availability of HAART spreads to developing countries.
Assuntos
Terapia Antirretroviral de Alta Atividade , Dermatite/etiologia , Infecções por HIV/tratamento farmacológico , Hanseníase/complicações , Dermatopatias Infecciosas/etiologia , Abscesso/etiologia , Adulto , Estudos de Coortes , Fístula Cutânea/etiologia , Dermatite/imunologia , Suscetibilidade a Doenças , Feminino , Fístula/etiologia , Guiana Francesa/epidemiologia , Infecções por HIV/complicações , Herpes Simples/etiologia , Herpes Simples/imunologia , Herpes Zoster/etiologia , Herpes Zoster/imunologia , Histoplasmose/complicações , Histoplasmose/imunologia , Humanos , Hospedeiro Imunocomprometido , Memória Imunológica , Leishmaniose Cutânea/complicações , Leishmaniose Cutânea/imunologia , Hanseníase/imunologia , Doenças Linfáticas/etiologia , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Dermatopatias Infecciosas/imunologia , Tuberculose dos Linfonodos/complicações , Tuberculose dos Linfonodos/imunologiaRESUMO
BACKGROUND: Few data are available on cutaneous leishmaniasis caused by dermotropic species in human immunodeficiency virus (HIV)-infected patients. OBJECTIVES: To describe nine cases of cutaneous leishmaniasis in HIV+ patients and to compare their clinical features and their response to treatment with those of HIV- patients with the forms of leishmaniasis commonly found in French Guiana. METHODS: A case-control study was carried out between July 1994 and December 2000 in French Guiana. We compared the following variables in nine HIV-infected patients with leishmaniasis and 27 matched controls: clinical type of leishmaniasis, number of lesions, presence of lymphangitis and adenopathy, the rate of recovery after treatment, and recurrence or reinfection. RESULTS: Eight of the HIV-infected patients had localized cutaneous leishmaniasis and one had mucocutaneous leishmaniasis. All of the controls had localized cutaneous leishmaniasis. Leishmania guyanensis was the only species isolated from HIV-infected subjects. HIV-Leishmania coinfected patients had a higher rate of recurrence or reinfection (P < 0.02) and a lower rate of recovery after one treatment cycle with pentamidine (P < 0.02) than did HIV- subjects. The CD4+ lymphocyte counts exceeded 200 mm(-3) in all HIV+ patients at the time of the diagnosis with leishmaniasis. CONCLUSIONS: In French Guiana, cutaneous leishmaniasis in moderately immunosuppressed HIV-infected subjects (> 200 CD4+ T cells mm(-3)) is characterized by a higher rate of recurrence or reinfection and is more difficult to treat than that in HIV- subjects.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/patologia , Leishmaniose Cutânea/patologia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Adulto , Idoso , Antiprotozoários/uso terapêutico , Contagem de Linfócito CD4 , Estudos de Casos e Controles , Feminino , Humanos , Hospedeiro Imunocomprometido , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Cutânea/imunologia , Masculino , Pessoa de Meia-Idade , Pentamidina , Recidiva , Resultado do TratamentoRESUMO
Disseminated cutaneous leishmaniasis is characterized by the presence of a large (> or =10) number of lesions at several anatomic sites (head, limbs, and trunk). Most of the lesions are small, papular, and appear simultaneously with or secondarily to one or several ulcerated lesions of localized cutaneous leishmaniasis. We report the first case of disseminated cutaneous leishmaniasis in French Guiana. It concerns a 24-year-old woman who tested negative for human immunodeficiency virus (HIV). The disease began with three lesions that became ulcerated. One week later, multiple papulo-nodular lesions appeared. We counted a total of 425 lesions. Leishmania were observed in the lesions. The species involved was L. guyanensis, which has never been described in a case of disseminated cutaneous leishmaniasis. The patient was rapidly cured by a single course of pentamidine. Disseminated cutaneous leishmaniasis should be distinguished from other types of leishmaniasis with multiple lesions. These include anergic diffuse cutaneous leishmaniasis, post-kala-azar leishmaniasis, and leishmaniasis associated with HIV infection.
Assuntos
Leishmania guyanensis , Leishmaniose Cutânea/diagnóstico , Adulto , Animais , Antiprotozoários/uso terapêutico , Dorso , Mama , Diagnóstico Diferencial , Feminino , Dedos , Guiana Francesa , Humanos , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Cutânea/patologia , Masculino , Pentamidina/uso terapêuticoRESUMO
INTRODUCTION: Azithromycine is recommended in the treatment of donovanosis with a 7-day treatment cycle. We report the efficacy of a single cure of 1 gram in two patients. OBSERVATIONS: Four patients, presenting with donovanosis, were treated with azithromycine according to 2 regimens. The first used 500 mg/d the molecule during 1 week, the second used azithromycine in single cure of 1 gram. The latter led to the complete cure of 2 patients. DISCUSSION: Many antibiotics are used in the treatment of donovanosis. Since 1996, Australian authors have used azithromycine in this indication. A single dose of this molecule appears effective in recent and confined donovanosis.
Assuntos
Antibacterianos/administração & dosagem , Azitromicina/administração & dosagem , Granuloma Inguinal/tratamento farmacológico , Adulto , Idoso , Humanos , MasculinoRESUMO
The treatment of tungiasis involves the mechanic extraction of the gravid females of Tunga penetrans. We have observed on 8 patients profuse tungiasis diagnosed in the centre hospitalier de Cayenne. We have carried out different types of treatment, including the occlusive application of 20% of salicylated vaseline during 12 or 24 hours. This procedure causes the death of the parasites and facilitates their extraction.
Assuntos
Anti-Infecciosos/administração & dosagem , Ectoparasitoses/tratamento farmacológico , Vaselina/administração & dosagem , Ácido Salicílico/administração & dosagem , Sifonápteros , Adulto , Animais , Criança , Pré-Escolar , Feminino , Guiana Francesa , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Arte , Cicatriz , Características Culturais , Etnicidade , Adolescente , Adulto , Feminino , Guiana Francesa , Humanos , MasculinoRESUMO
In French Guiana, marked seasonal fluctuations have been observed in the numbers of individuals who present with cutaneous leishmaniasis (CL). To investigate the seasonal trends further, the clinical characteristics and responses to treatment of 455 cases of CL, who presented over a 3-year period (1995-1998), were compared against data on the weather for the calendar month of presentation (month 0) and for the month before presentation (month-1). Several statistically significant associations were observed. The number of sunlight hours in month -1 was lower for the treatment successes than for the treatment failures [adjusted odds ratio (AOR) for successful treatment=0.28; 95% confidence interval (CI)=0.13-0.6; P=0.001] and for those with long incubation periods than for those with relatively short incubation periods (multiple-regression coefficient=-0.003; P=0.002). However, the radiation intensity for month-1 was higher for the treatment successes than for the treatment failures (AOR=2.1; CI=1.1-3.8; P=0.02). Relatively high numbers of hours of sunlight on month-1 were associated with relatively high numbers of parasites on the skin smears (AOR=1.03; CI=1.01-1.04; P<0.001). Relatively high numbers of hours of sunlight during month 0 were associated with lymphangitis (AOR=0.4; CI=0.19-0.8; P=0.01). These results indicate that meteorological parameters may influence the evolution of CL, at least in French Guiana.
Assuntos
Antiprotozoários/uso terapêutico , Leishmaniose Cutânea/epidemiologia , Pentamidina/uso terapêutico , Tempo (Meteorologia) , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Guiana Francesa/epidemiologia , Humanos , Incidência , Lactente , Leishmaniose Cutânea/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prevalência , Estações do Ano , Luz Solar , Falha de TratamentoRESUMO
The cure 'rates' achieved using intramuscular pentamidine isethionate (two injections of 4 mg/kg separated by an interval of 48 h) were investigated in French Guiana, in 198 consecutive patients with cutaneous leishmaniasis caused by Leishmania braziliensis guyanensis. One aim was to see if initial clinical presentation could be used to predict treatment failure. The cure rate after one course of pentamidine isethionate was 87% and almost all (80%) of the treatment failures responded to an identical second course. Although many of the patients complained of adverse effects, most commonly of pain at the injection site (54%), none of these effects was severe. Although frequently associated with discomfort, the two-injection course, giving a total of 8 mg pentamidine isethionate/kg, appears to be an effective treatment for cutaneous leishmaniasis in French Guiana. The observation of satellite papules on presentation was associated with a significantly increased risk of failure of the first course of treatment (P = 0.01), with an odds ratio (and 95% confidence interval) estimated at 3.5 (1.3-11.1), after adjusting for other clinical presentations and lesion size and number. The presence of satellite papules perhaps indicates that the patient's immune system is unable to control the progression of the parasite. Patients with more than three lesions were also less likely to be cured after one course of pentamidine than those with fewer lesions (P = 0.01).
Assuntos
Antiprotozoários/uso terapêutico , Leishmaniose Cutânea/tratamento farmacológico , Pentamidina/uso terapêutico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/patologia , Intervalos de Confiança , Guiana Francesa , Humanos , Injeções Intramusculares , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/patologia , Modelos Logísticos , Razão de Chances , Contagem de Ovos de Parasitas , Sensibilidade e Especificidade , Falha de Tratamento , Resultado do TratamentoAssuntos
Cromoblastomicose/patologia , Idoso , Antifúngicos/uso terapêutico , Biópsia , Cromoblastomicose/complicações , Cromoblastomicose/tratamento farmacológico , Cromoblastomicose/microbiologia , Cladosporium , Diabetes Mellitus Tipo 2/complicações , Diagnóstico Diferencial , Feminino , Guiana Francesa , Humanos , Hipertensão/complicações , Itraconazol/uso terapêutico , Joelho , Naftalenos/uso terapêutico , TerbinafinaRESUMO
An investigation was conducted to determine whether seasonal variations affected the development of cutaneous leishmaniasis. Data from 499 cases treated between July 1994 and December 1998 were analyzed. The interval between infection and consultation and between treatment and clinical cure varied significantly between cases with an incubation period during the dry season compared with the rainy season (P < 0.001). When the incubation period occurred during the dry season, the standard pentamidine isethionate treatment seemed to be less effective (i.e.. the odds ratio for failure was 1.9 [1.1-3.4], P = 0.01). The presence of lymphangitis was more frequent during the dry season (i.e., the odds ratio was 0.26 [0.15-0.45], P < 0.001). These results suggested that the observed seasonal variations were due to variations in the host/parasite balance. Converging indirect elements that suggest a role for variations in solar ultraviolet radiation are discussed.
Assuntos
Leishmaniose Cutânea/epidemiologia , Estações do Ano , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Suscetibilidade a Doenças , Feminino , Guiana Francesa , Humanos , Lactente , Leishmaniose Cutânea/tratamento farmacológico , Linfangite/complicações , Linfangite/epidemiologia , Masculino , Pessoa de Meia-Idade , Pentamidina/uso terapêutico , Pele/patologia , TripanossomicidasRESUMO
BACKGROUND: Histioplasmosis is a usually asymptomatic fungal infection. In the immunocompetent patient, it leads to chronic disseminated infection. Mucosal involvement is common and can provide the diagnosis. CASE REPORT: A metropolitan Frenchman with a history of alcoholism and smoking and living in Guyana consulted for lingual and tonsil erosion. Squamous cell carcinoma was suspected but not confirmed at pathology. The patient had bi-apical infiltration on the chest x-ray and was treated empirically for tuberculosis. The diagnosis of histoplasmosis was reached when rare Histoplasma capsulatum were evidenced from a buccal swab. Itraconazole led to cure in 6 months. DISCUSSION: This case illustrates the importance of mucosal signs in the diagnosis of disseminated histoplasmosis in immunocompetent subjects. Histoplasmosis is rarely the cause of active infection in immunocompetent subjects. In these patients, the fungal infection generally progresses to chronic dissemination. Mucosal signs are frequent in this from but are rare in the case of cutaneous histoplasmosis. Itraconazole (200 mg/d) is indicated for 6 months. (AU)
Assuntos
Pessoa de Meia-Idade , Humanos , Masculino , Relatos de Casos , Histoplasmose/diagnóstico , Doenças da Língua/microbiologia , Tonsila Palatina/microbiologia , Alcoolismo/complicações , Antifúngicos/uso terapêutico , Carcinoma de Células Escamosas/diagnóstico , Doença Crônica , Diagnóstico Diferencial , Imunocompetência , Itraconazol/uso terapêutico , Tabagismo/efeitos adversos , Neoplasias da Língua/diagnóstico , Tuberculose Pulmonar/diagnósticoRESUMO
OBJECTIVE: We evaluated pertinent features of impetigo in French Guyana due to the increasing number of therapeutic failures with macrolides and fusidic acid. PATIENTS AND METHODS: A prospective study study was conducted over a 14-month period in the dermatology unit of the Cayenne hospital. Two groups of patients were identified: group 1 included patients with impetigo and group 2 patients with infected skin reactions. Epidemiological, bacteriological, toxinological (exofoliatines, leukocidine) and antibiotic data were recorded. RESULTS: Forty-one patients with impetigo and 31 patients with infected skin reactions were included. Staphylococcus infection alone was identified in most patients (68 p. 100) in the impetigo group. Exfoliatine-producing strains were strongly associated with Staphylococcus-induced bullous and non-bullous impetigo (93 p. 100) compared with other origins (impetigo with streptococcal infection or infected skin reactions). Resistance to macrolides was high (erythromycin 41 p. 100, fusidic acid 42 p. 100) for all isolated strains of Staphylococcus aureus. CONCLUSION: A sub-group of patients with impetigo was identified. These patients had pure staphylococcal infections characterized by strong association with exfoliatine production. The rate of resistance to macrolides was particularly high in this sub-group. Resistance to fusidic acid was high for all Staphylococcus strains isolated.
Assuntos
Impetigo , Adolescente , Antibacterianos/uso terapêutico , Criança , Clortetraciclina/uso terapêutico , Diagnóstico Diferencial , Feminino , Ácido Fusídico/uso terapêutico , Humanos , Impetigo/diagnóstico , Impetigo/tratamento farmacológico , Josamicina/uso terapêutico , Masculino , Oxacilina/uso terapêutico , Penicilinas/uso terapêutico , Estudos Prospectivos , Roxitromicina/uso terapêuticoRESUMO
A case of balantidial dysentery is reported in a patient infected with the HIV in French Guiana. This case is the first described in medical literature. The patient presented also a disseminated histoplasmosis. Immunosuppression probably favoured the evolution of asymptomatic carriage to clinical dysentery. This clinical case did not present any complications. Treatment with doxycycline had to be carried out for 20 days in order to obtain a clinical and parasitological cure.