Case Report: Bothrops lanceolatus Snakebite Surgical Management-Relevance of Fasciotomy.

Bothrops lanceolatus is an endemic Crotalidae species in Martinique, where approximately 30 cases of envenoming are managed yearly. Envenoming characteristics from Bothrops species include local tissue damage, systemic bleeding, and hemodynamic alterations. We hereby report a case of severe envenomation following B. lanceolatus snakebite to the right calf. Severe local manifestations developed progressively up to the lower limb despite adequate antivenom therapy. Systemic manifestations of venom also occurred, resulting in intensive care therapy. Surgery exploration revealed soft tissue necrosis, friability of the deep fascia, and myonecrosis. The patient needed multiple debridement procedures and fasciotomy of all leg compartments and anterior compartment of the thigh. Diagnosis of necrotizing fasciitis was confirmed by positive Aeromonas hydrophila blood cultures. This clinical case illustrates that major soft tissue infection, including necrotizing fasciitis may occur after snakebite. Abnormal coagulation tests should not delay surgical management, as severe envenoming is a life-threatening condition.

Lonomia caterpillar envenoming in French Guiana reversed by the Brazilian antivenom: A successful case of international cooperation for a rare but deadly tropical hazard.

In the American continent, larval forms (caterpillars) of the Lonomia genus can cause systemic reactions in human beings. In this Paper, we report the third case of Lonomia envenoming recorded in French Guiana in 25 years, and the first in which specific antivenom was administered. Severe symptoms of the envenoming were observed in our patient including pain; coagulopathy and systemic hemorrhage. They are caused by skin contact with caterpillars. Recovery, however, was quite satisfactory thanks to the international cooperation of the health authorities in both France and Brazil.

Snake Bites by Bothrops lanceolatus in Martinique.

Bothrops lanceolatus, a member of the Viperidae family and Crotalinae subfamily, is the only snake causing envenomation in Martinique, which is the only place it exists in the world. Any bite by this snake may result in severe thrombotic complications including cerebral, pulmonary, and myocardial infarction and affecting the patient's vital or functional prognosis. The exact composition of the venom as well as the mechanisms of toxicity involved are still debated today. The first specific antivenom immunotherapy (AVI), Bothrofav1, manufactured in 1991, reduced mortality and morbidity significantly. In 2004, however, an increase in the number of cases of Bothrops lanceolatus envenomation-induced ischemic strokes despite early AVI administration, raised questions about its effectiveness and encouraged the development of a second AVI, Bothrofav2, which became available in February 2011. Causes of the failures with the first AVI remain hypothetical, and the effectiveness of the second is under evaluation. This article reviews the published data available on this rare envenomation, present in one of our French overseas departments and discusses its fascinating scientific and medical issues.

Inter-regional medical cooperation in the Caribbean : a major asset for the influence of the French medicine.

Martinique was accepted as an associate member by the Council of Ministers of the Organization of Eastern Caribbean State since February 2015. This membership constitutes a major asset in bringing Martiniquais closer to the other Caribbean populations and should play a key role as it relates to regional cooperation especially in the domain of healthcare. Martinique and several Caribbean countries share common health issues such as; dengue, chikungunya virus, Zika Virus leptospirosis, snakebite, severe cardiovascular diseases (CVD), HTLV-1, sickle cell diseases and so on. This medical cooperation is mainly based in three important areas: training, teaching and transport (medical evacuations). The Inter-regional cooperation between the French Departments of the Americas and all other Caribbean countries is essential for the implementation and improvement of health care. It is urgent for the Caribbean professionals to discuss the possibilities of developing common solid relationships in training, collective scientific research, and continuous medical education.

[Interhospital transfer of ECMO-assisted patients in Martinique]. / Transfert interhospitalier sous assistance circulatoire extracorporelle (ECMO): l'expérience martiniquaise.

OBJECTIVE: The transportation of critically ill patients in the French West Indies represents a real challenge; in order to ensure territorial continuity of health care provision, the cardiac surgical department of the Fort-de-France Hospital created a mobile ECMO/ECLS unit. The aim of our work is to describe the logistical, technical and financial aspects of the interhospital transfer of ECMO/ECLS-assisted patients in the French Caribbean. PATIENTS AND METHODS: All ECMO/ECLS-assisted patients in the French Antilles-Guyane area subsequently repatriated towards the Fort-de-France Hospital were included from December 29th, 2009 to September 30th, 2011. Indication and type of the extracorporeal assistance used, location of departure, type of transport vehicle, complications during transfer, survival after hospital discharge and direct costs were collected. RESULTS: Nineteen patients were supported by our mobile unit far away from our centre (sex-ratio 0.63, median age 34years old [16-64]). Twelve were assisted by ECMO for a refractory ARDS, and seven were assisted by ECLS for a refractory cardiogenic shock. Four patients were transferred by ambulance (7-29km), seven by helicopter (190-440km), and eight by plane (440-1430km). No patient died during transfer. No major adverse event occurred during these transfers. Fifteen patients survived. An economic assessment was conducted. CONCLUSION: Interhospital transfer of ECMO/ECLS-assisted patients by land or air is technically feasible under perfectly secure conditions in our area. Prior coordination of this activity has helped to make it affordable.

[Descriptive study of the patients admitted to an intensive care unit during the heat wave of August 2003 in France]. / Etude descriptive des patients admis en réanimation pour coup de chaleur au cours de la canicule d'août 2003.

INTRODUCTION: Several thousands of deaths were attributed to heat stroke during August 2003 in France. To date, only a very few studies have analyzed the prognosis in the intensive care unit (ICU) of the most severely hyperthermic patients. METHOD: Descriptive observational study of the patients admitted to the intensive care unit at the Lariboisière hospital in Paris, for heat stroke defined by an elevated core body temperature above 40 degrees C with central nervous system dysfunction, in the absence of other etiologies explaining the hyperthermia. RESULTS: In the Lariboisière hospital, an elevation in the ICU (+143%) and hospital mortality rate (+191%) were registered during August 2003, in comparison with August 2002. Fifteen patients (10 men, 5 women, median age: 57 years) were admitted to the ICU for heat stroke between the 4th and 14th of August 2003. Seven of them (47%) died. On admission, the occurrence of a pre-hospital cardiac arrest, the presence of coagulation abnormalities (reduction in prothrombin time and in platelet count) or of an elevation in plasma lactate concentration were significantly associated with the risk of death in the ICU. Conversely, age, body temperature, coma depth on admission and convulsions were not predictive of death. Neurological after effects (cerebellar syndrome, polyneuropathy and residual brain damage) were noted in 50% of the survivors. DISCUSSION: Although it is possible that heat alone precipitated the death of very sick people, our study clearly showed that young and valid patients died of heat stroke and suggests the possible increase in the 2003 death rate secondary to the heat wave. Moreover, it is still difficult at the moment to really appreciate the long-term consequences for survivors who presented serious neurological after effects. CONCLUSION: The August 2003 heat wave resulted in an elevation of the hospital and ICU death rates in the Lariboisière hospital in Paris. Despite adequate cooling and supportive therapies, the mortality of patients admitted to the ICU for heat stroke remained elevated and the neurological after effects severe. These preliminary results should be confirmed by larger cohort studies.

Isospora belli infection in a patient with non-Hodgkin's lymphoma.

Isospora belli infection is frequent in patients with acquired immunodeficiency syndrome in tropical areas. It has also been reported in other immunodepressive diseases, such as lymphoblastic leukemia, adult T-cell leukemia, and Hodgkin's disease. To date, no case of non-Hodgkin's lymphoma-related isosporiasis has been reported in a non-HIV-infected patient. We describe a case of non-Hodgkin's lymphoma with chronic diarrhea due to I. belli. In Europe, I. belli can cause severe chronic diarrhea in patients with malignancies whose country of origin is in an endemic area. Trimethoprim-sulfamethoxazole can provide rapid and prolonged clinical and parasitologic cure.