RESUMO
BACKGROUND: Strategies for the control of scabies should be adapted to local settings. Traditional communities in French Guiana have non-Western conceptions of disease and health. OBJECTIVES: The objectives for this study were to explore knowledge, attitudes and practices to identify potential factors associated with the failure of scabies treatment in these communities. METHODS: Patients with a clinical diagnosis of scabies, seen at either the Cayenne Hospital or one of 13 health centres between 01 April 2021 and 31 August 2021, were included as participants, and were seen again after 6 weeks to check for persistence of lesions. Factors associated with treatment failure were looked for both at inclusion and at 6 weeks. Semi-structured interviews were conducted with a diversified subsample of participants. RESULTS: In total, 164 participants were included in the quantitative component, and 21 were interviewed for the qualitative component. Declaring that the second treatment dose had been taken was associated with therapeutic success. Western treatments were not always affordable. Better adherence was observed with topical treatments than with oral ivermectin, whereas permethrin monotherapy was associated with failure. Scabies-associated stigma was high among Amerindians and Haitians but absent in Ndjuka Maroons. Participants reported environmental disinfection as being very complex. CONCLUSIONS: The treatment of scabies in traditional Guianan communities may vary depending on local perceptions of galenic formulations, disease-associated stigma and differences in access to health care. These factors should be taken into account when devising strategies for the control of scabies aimed at traditional communities living in remote areas, and migrant populations.
Assuntos
Indígenas Sul-Americanos , Escabiose , Humanos , Escabiose/tratamento farmacológico , Guiana Francesa , Ivermectina , PermetrinaRESUMO
OBJECTIVES: The outcome of American tegumentary leishmaniasis (ATL) may depend on the presence of the Leishmania RNA virus (LRV). This virus may be involved in treatment failure. We aimed to determine whether genetic clusters of LRV1 are involved in this therapeutic outcome. METHODS: The presence of LRV1 was assessed in 129 Leishmania guyanensis isolates from patients treated with pentamidine in French Guiana. Among the 115 (89%) isolates found to carry LRV1, 96 were successfully genotyped. Patient clinical data were linked to the LRV data. RESULTS: The rate of treatment failure for LRV1-positive isolates was 37% (15/41) versus 40% (2/5) among LRV1-negative isolates (p 0.88). Concerning LRV1 genotypes, two predominant LRV1 groups emerged, groups A (23% (22/96)) and B (70% (67/96)). The treatment failure rate was 37% (3/8) for group A and 45% (9/20) for group B (p 0.31). DISCUSSION: Neither the presence nor genotype of LRV1 in patients with L. guyanensis seemed to correlate with pentamidine treatment failure.
Assuntos
Leishmania guyanensis/virologia , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniavirus/classificação , Pentamidina/uso terapêutico , Adulto , Feminino , Guiana Francesa , Variação Genética , Técnicas de Genotipagem , Humanos , Leishmaniavirus/genética , Leishmaniavirus/isolamento & purificação , Masculino , Filogenia , Estudos Retrospectivos , Análise de Sequência de RNA , Falha de Tratamento , Adulto JovemRESUMO
BACKGROUND: French Guiana faces singular health challenges: poverty, isolation, structural lag, difficulties in attracting health professionals. Hospital stays exceed the recommended durations. The present study aimed to model the impact of precariousness and geographic isolation on the hospital duration performance indicator and to recalculate the indicator after incrementing severity by 1 unit when patients were socially precarious. METHODS: Cayenne hospital data for 2017 were used to model the hospital duration performance indicator (IP-DMS) using quantile regression to study the impact of geographic and social explanatory variables. This indicator was computed hypothesizing a 1 unit increment of severity for precarious patients and by excluding patients from isolated regions. RESULTS: Most excess hospitalization days were linked to precariousness: the sojourns of precarious patients represented 47% of activity but generated 71% of excess days in hospital. Quantile regression models showed that after adjustment for potential confounders, patients from western French Guiana and Eastern French Guiana, precarious patients and the interactions terms between residence location and precariousness were significantly associated with IP-DMS increases. Recalculating the IP-DMSafter exclusion of patients from the interior and after increasing severity by 1 notch if the patient was precarious led to IP-DMS levels close to 1. CONCLUSION: The results show the nonlinear relationship between the IP-DMS and geographical isolation, poverty, and their interaction. These contextual variables must be taken into account when choosing the target IP-DMS value for French Guiana, which conditions funding and number of hospital beds allowed in a context of rapid demographic growth.
Assuntos
Procedimentos Clínicos , Acessibilidade aos Serviços de Saúde , Tempo de Internação/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Isolamento Social , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/normas , Procedimentos Clínicos/estatística & dados numéricos , Feminino , Guiana Francesa/epidemiologia , Acessibilidade aos Serviços de Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/normas , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Corpo Clínico/organização & administração , Corpo Clínico/normas , Corpo Clínico/estatística & dados numéricos , Corpo Clínico/provisão & distribuição , Pessoa de Meia-Idade , Administração em Saúde Pública/normas , Administração em Saúde Pública/estatística & dados numéricos , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos , Tempo para o Tratamento/organização & administração , Tempo para o Tratamento/normas , Tempo para o Tratamento/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Adulto JovemAssuntos
Hanseníase , Saúde Pública , Guiana Francesa/epidemiologia , Humanos , Hanseníase/epidemiologiaRESUMO
Case report from French Guiana of an atypical keloid in a Brazilian man: Lobomycosis. Lobomycosis is a rare fungal skin infection, endemic to the Amazon basin. Its clinical manifestations are slow-growing keloid-like nodules, with a granulomatous reaction on histopathology. The etiological agent, Lacazia loboi, has never been isolated in the environment or cultured in a laboratory. Diagnosis is based on the typical appearance on microscopy. Treatment is disappointing, with a high recurrence rate. We report a new case in French Guiana and review the literature. Only 10 cases have been reported outside of the endemic area, 2 involving no travel; the mean time to diagnosis was 21 years. Phylogenetic analysis has recently proved that lobomycosis in dolphins is caused by a fungus more closely related to Paracoccidioides brasiliensis than to L. loboi (two very closely related species). Molecular diagnosis is possible in a few centers. Climate change may result in spreading lobomycosis to currently disease-free areas of the world.
Assuntos
Lacazia , Lobomicose/diagnóstico , Brasil , Diagnóstico Diferencial , Guiana Francesa , Humanos , Queloide/diagnóstico , Lacazia/isolamento & purificação , Lobomicose/microbiologia , Masculino , Pessoa de Meia-IdadeAssuntos
Foliculite/parasitologia , Infecções por Uncinaria/diagnóstico , Animais , Humanos , MasculinoRESUMO
BACKGROUND: In recent years, first-line therapy for Mycobacterium ulcerans infection in French Guiana has consisted of antibiotics active against this organism. Two regimens are used comprising rifampicin associated with clarithromycin or amikacin. PATIENTS AND METHODS: We describe four patients presenting apparent worsening of their lesions during treatment: ulceration of a nodular lesion in a 32-year-old woman and worsening of an ulcerated lesion in three patients aged 16, 27 and 79 years. DISCUSSION: In these 4 patients, we concluded that the symptoms were caused by a paradoxical response or a reaction, a phenomenon already described in tuberculosis and leprosy. Such worsening is transient and must not be misinterpreted as failure to respond to treatment. The most plausible pathophysiological hypothesis involves the re-emergence of potentially necrotizing cellular immunity secondary to the loss of mycolactone, a necrotizing and immunosuppressive toxin produced by M. ulcerans, resulting from the action of the antibiotics.
Assuntos
Amicacina/efeitos adversos , Antibacterianos/efeitos adversos , Úlcera de Buruli/tratamento farmacológico , Claritromicina/efeitos adversos , Rifampina/efeitos adversos , Adolescente , Adulto , Idoso , Amicacina/administração & dosagem , Amicacina/farmacologia , Amicacina/uso terapêutico , Antibacterianos/administração & dosagem , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Ásia/etnologia , Brasil/etnologia , Úlcera de Buruli/patologia , Úlcera de Buruli/cirurgia , Claritromicina/administração & dosagem , Claritromicina/farmacologia , Claritromicina/uso terapêutico , Terapia Combinada , Desbridamento , Quimioterapia Combinada , Europa (Continente)/etnologia , Feminino , Úlcera do Pé/tratamento farmacológico , Úlcera do Pé/etiologia , Úlcera do Pé/cirurgia , Guiana Francesa , Humanos , Imunidade Celular/efeitos dos fármacos , Macrolídeos/metabolismo , Masculino , Mycobacterium ulcerans/efeitos dos fármacos , Mycobacterium ulcerans/metabolismo , Rifampina/administração & dosagem , Rifampina/farmacologia , Rifampina/uso terapêutico , CicatrizaçãoAssuntos
Dermoscopia , Saccharomycetales/isolamento & purificação , Tinha/diagnóstico , Adulto , Criança , Doenças Endêmicas , Feminino , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/microbiologia , Guiana , Dermatoses da Mão/diagnóstico , Dermatoses da Mão/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tinha/microbiologiaRESUMO
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
Histoplasmosis is an endemic fungal infection that causes no symptoms or minor self-limited illnesses in most cases. Severe forms are commonly reported in patients with immunodeficiency disorders; histoplasmosis is considered to be an opportunistic infection in patients with AIDS. We report a case of disseminated histoplasmosis in a patient with no induced active suppression of the immune response. The infection was fulminant, and antifungal treatment was delayed because of a misdiagnosis of tuberculosis.
Assuntos
Erros de Diagnóstico , Histoplasmose/diagnóstico , Pneumopatias Fúngicas/diagnóstico , Doenças Profissionais/diagnóstico , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Antituberculosos/uso terapêutico , Brasil/etnologia , Líquido da Lavagem Broncoalveolar/microbiologia , Diagnóstico Tardio , Coagulação Intravascular Disseminada/etiologia , Evolução Fatal , Guiana Francesa , Soronegatividade para HIV , Histoplasma/isolamento & purificação , Histoplasmose/complicações , Histoplasmose/tratamento farmacológico , Humanos , Imunocompetência , Pneumopatias Fúngicas/complicações , Pneumopatias Fúngicas/tratamento farmacológico , Masculino , Mineração , Doenças Profissionais/tratamento farmacológico , Tuberculose Miliar/diagnósticoRESUMO
Diaporthe phaseolorum (syn. Phomopsis phaseoli) is a frequent fungal parasite of plants, present on all continents around the world. It has rarely been involved in human diseases. We report a case of eumycetoma with osteomyelitis of the forefoot caused by this fungus and diagnosed by molecular biology. The patient had positive HTLV-1 serology and was a farmer from French Guiana who walked barefoot. He was successfully treated with long-term oral itraconazole (400 mg/day). A review of the literature underlines the essential roles of plants and host immunosuppression in this infection and the favourable outcome with a triazole antifungal treatment.
Assuntos
Ascomicetos/isolamento & purificação , Pé/microbiologia , Micetoma/diagnóstico , Antifúngicos/uso terapêutico , Ascomicetos/genética , Ascomicetos/patogenicidade , Biópsia , Feminino , Pé/patologia , Guiana Francesa , Vírus Linfotrópico T Tipo 1 Humano/imunologia , Humanos , Itraconazol/uso terapêutico , Masculino , Pessoa de Meia-Idade , Micetoma/complicações , Micetoma/tratamento farmacológico , Micetoma/microbiologia , Osteomielite/complicações , Osteomielite/microbiologia , Doenças Raras/tratamento farmacológico , Doenças Raras/microbiologiaRESUMO
Thirty years after the first HIV case in French Guiana, the drivers of the epidemic are not clearly known, but the epidemic is usually conceptualized as generalized. Cross-linking results from a study in the general population and a study in the HIV-infected population in Cayenne suggests that in the general population of HIV-positive men, 45% of HIV cases are attributable to having sex with someone they paid. Similarly, for HIV-positive women exchanging sex for presents or money, 10.7% of HIV cases are attributable to transactional sex. A surprising finding was that 16.8% of HIV patients had tried crack cocaine before. On the Maroni river, the female-biased sex ratio suggests the drivers in that remote area may be related to cultural polygyny. These observations have important consequences on communication and prevention strategies.
Assuntos
Surtos de Doenças , Infecções por HIV/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Cocaína Crack , Estudos Transversais , Feminino , Guiana Francesa/epidemiologia , Humanos , Masculino , Assunção de Riscos , Trabalho SexualAssuntos
Terapia Antirretroviral de Alta Atividade , Surtos de Doenças/prevenção & controle , Infecções por HIV/tratamento farmacológico , HIV-1/efeitos dos fármacos , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Contagem de Linfócito CD4 , Guiana Francesa/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Humanos , Risco , Fatores Socioeconômicos , Carga ViralRESUMO
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
Cutaneous leishmaniases are endemic over the entire territory of French Guiana. At least 5 distinct Leishmania species coexist in the sylvatic ecotopes of this French territory. The present paper checks the advances in the ecological research field during the past 5 years. The current epidemiological situation and trends are detailed successively Links between the recrudescence of leishmaniases and gold-mining are highlighted. The potential adaptation of the pathogenic complexes to the newly anthropized habitats is also described.
Assuntos
Doenças Endêmicas/estatística & dados numéricos , Leishmaniose Cutânea/epidemiologia , Animais , Reservatórios de Doenças , Ecossistema , Guiana Francesa/epidemiologia , Humanos , Incidência , Insetos Vetores/parasitologia , Leishmania/classificaçãoRESUMO
Risk factors for death in an HIV-infected cohort in French Guiana were studied in 1374 patients between 1996 and 2005. Of these patients, 48.5% were male and 76% were immigrants. Covariates were measured at the time of consultation. There were 223 deaths. Addictions [adjusted hazard ratio (HR)=13; 95% confidence interval (CI) 5.5-30.6; P<0.001], age>60 years (HR=1.5; 95% CI 0.9-2.5; P=0.13), male gender (HR=1.5; 95% CI 1.03-2.5; P=0.03) and CD4 count<50 cells/microL (HR=9.1; 95% CI 5.1-16.3; P<0.001) were independently associated with death. These results suggest that strategies promoting early diagnosis and better follow-up of addicted patients would have a significant impact on mortality.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Infecções por HIV/mortalidade , HIV , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adulto , Distribuição por Idade , Causas de Morte , Transmissão de Doença Infecciosa , Feminino , Seguimentos , Guiana Francesa/epidemiologia , Infecções por HIV/epidemiologia , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco , Distribuição por Sexo , MigrantesRESUMO
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.