[Incidence of skin and non-skin cancers in Afro-Caribbean renal transplant recipients: Guadeloupe data from 2004 to 2011]. / Incidence des cancers cutanés et non cutanés chez les transplantés rénaux afro-caribéens : données guadeloupéennes de 2004 à 2011.

BACKGROUND: Cancer is the main complication of transplantation surgery. The literature concerning renal transplant recipients among the Afro-Caribbean population is scant. The aim of this study was to determine the incidence of cancer in these patients, with the secondary objective being to identify predisposing factors for cancer. PATIENTS AND METHODS: This was an epidemiological and retrospective study that included all Guadeloupians of phototype V-VI undergoing renal transplantation from 01/01/2004 to 31/12/2011. Skin cancer screening was performed before transplantation and during an annual dermatological consultation following transplantation. Screening for non-cutaneous cancers was guided by clinical symptoms or by the results of the screening examinations recommended in the current guidelines. At the study time-point (31/12/2011), all patients were examined by a dermatologist. RESULTS: One hundred and two patients were included : 42 women and 60 men (mean age: 52.1±11.6 years at transplantation). Eight cancers were diagnosed. The cumulative incidence of cancer was 7.8% at 3 years. Three factors were associated with more rapid onset of cancer: personal history or familial history of cancer, and genital lesion induced by HPV. CONCLUSION: Our results suggest a low incidence of cancer in Afro-Caribbean renal transplant patients. Personal or family history of cancer and HPV-induced genital lesions would appear to accelerate the onset of cancer in this population.

Association of the +874 T/A interferon gamma polymorphism with infections in sickle cell disease.

Infectious complications are a leading cause of morbidity and mortality in patients with sickle cell disease. Several mechanisms are supposed to contribute to this susceptibility. The exact reasons for the susceptibility of sickle cell patients to infection are not clear and are still a matter of debate. Interferon gamma (IFNgamma) is a key cytokine involved mainly in the defence against intracellular pathogens. We investigated a possible association of an IFNgamma +874 T/A polymorphism and infectious complications in sickle cell patients. Seventy-two sickle cell patients were typed for +874 T/A IFNgamma polymorphism. Genotype frequencies were different between cases and controls. Indeed, the T allele frequency was significantly higher in patients with infections than in patients without infections (P = 0.014). Our results suggest that the +874 T/A IFNgamma polymorphism is associated with infectious complications in sickle cell patients. T allele could be involved in infections in sickle cell patients.

High antigenic cross-reactivity of the V3 consensus sequences of HIV-1 gp120.

The principal neutralization determinant (PND) of the human immunodeficiency virus type 1 (HIV-1) is located within the variable V3 region of the external envelope protein gp120. Although it is recognized that V3 sequences induce antibody response with restricted neutralization activity in vitro, we observed that the V3 consensus sequences representing North American/European and African isolates were highly cross-reactive, binding 94 and 77%, respectively, of sera collected from HIV-1 individuals originating from various parts of the world. Even HIV-1-positive sera from some East African residents, infected by strains whose V3 loop sequences are undoubtedly distinct from the North American/European consensus V3 loop sequence, reacted better to the V3 North American/European consensus peptide than to African-specific V3 sequences. Results indicate that the V3 consensus sequences represent the best candidates for optimal cross-reactivity with a wide variety of strains. Furthermore, using immunoassays for antibodies to prototype-specific V3 sequences, it is shown that HIV-1 strains related to the MN group are prevalent in West Africa, indicating either a West African origin of the MN-related viruses or more probably an introduction of this group of viruses through European/North American contacts.

Symptomatic and asymptomatic chlamydial non-gonococcal urethritis in Jamaica: the potential for HIV transmission.

To determine the contribution of Chlamydia trachomatis to non-gonococcal urethritis (NGU) in men attending sexually transmitted disease (STD) clinics in Jamaica we studied men with NGU (n=339), and control groups including asymptomatic men who were STD contacts (n=61), asymptomatic men who were not STD contacts (n=32) and men with gonococcal urethritis (GU) (n=61). Urethral specimens were examined for C. trachomatis and Neisseria gonorrhoeae. Serological tests for syphilis (STS) and HIV-1 infection were also performed. C. trachomatis accounted for 63% of cases of NGU but high prevalences were also found in asymptomatic STD contacts (59%), asymptomatic STD non-contacts (78%) and men with GU (48%). The prevalence of C. trachomatis in men with GU differed significantly from that in men with NGU and asymptomatic STD non-contacts (P<0.05). C. trachomatis infection in men with NGU was associated with multiple sex partners (71% vs 58%; chi2=4.78; odds ratio (OR)=1.76; P<0.05) and previous history of gonococcal infection (83% vs 42%; chi2=59.8; OR=6.8; P<0.0001). Concomitant infection with HIV-1 occurred in 5.2% of cases of NGU and 50% and 90%, respectively, of the HIV-positive men had chlamydia or reactive STS. As a cost effective strategy in the control of STD and HIV we recommend presumptive treatment for C. trachomatis in men seeking STD treatment in Jamaica.

[Prevalence of intestinal parasitism in the public laboratories of Martinique: development from 1988 to 1995]. / Prévalence des parasitoses intestinales dans les laboratoires publics de Martinique: évolution de 1988 à 1995.

This survey drew up the epidemiological situation of intestinal parasitism in Martinique in 1994-1995. 13,978 stool specimens collected in 1994-1995 were tested by parasitologic examination. Stool specimens were from patients hospitalised in the 3 principal hospitals of Martinique or coming to the Laboratoire départemental d'hygiène. The parasitism rate was 8.73%. This study showed a significant reduction of intestinal parasitism between results of 1988 and results of 1994-1995. The oro-faecal parasitism was not very important that reflected the good economic and sanitation level of Martinique. On the other hand, regarding the important prevalence of parasitism with Strongyloïdes stercoralis and hookworm, it would be good to improve detection, sanitary education and know better local contamination factors to decrease the prevalence of this parasitism.

[Epidemiological characteristics of HIV infection in Martinique]. / Caractéristiques épidémiologiques de l'infection à VIH en Martinique.

The epidemiologic study of HIV infected patients in Martinique from 1985 to 1992 allowed to point out a stability of new cases by year, and confirm the heterosexual transmission in this area. The sexual comportment of Martinicans seems to be different of the continental French people and different between men and women. This constation is important to know for the preventive strategy of the infection.

Prevalence of viral and bacterial sexually transmitted pathogens in Jamaican pregnant women.

In this study we investigated the prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, human immunodeficiency virus type I (HIV-I), human T cell lymphotropic virus type 1 (HTLV-1) and hepatitis B virus (HBV) infections in 200 pregnant women attending antenatal clinics at the University Hospital of the West Indies. 19% of the women had at least one pathogen: C. trachomatis was found in 16%, HTLV-1 in 2%, HIV-1, HBV and N. gonorrhoeae each in 0.5% C. trachomatis infection was more prevalent in women less than 20 years of age (31%) than in those 20 years and older (16%; OR = 0.43; chi 2 = 5.66; p < 0.05). The study demonstrates the need for identification of sexually transmitted pathogens in antenatal women for syndromic management of genital infections as part of the strategy for prevention and control of HIV/AIDS (acquired immunodeficiency syndrome) in Jamaica.

Vitamin D deficiency, vitamin D receptor gene polymorphisms and cardiovascular risk factors in Caribbean patients with type 2 diabetes.

AIM: The prevalence of diabetes in the French West Indies is three times higher than in mainland France. We aimed to assess the associations between vitamin D deficiency, vitamin D receptor (VDR) gene polymorphisms and cardiovascular risk factors in Caribbean patients with type 2 diabetes (T2D). METHODS: In this cross-sectional study of 277 patients, 25-hydroxyvitamin D was measured by radioimmunoassay. FokI, BsmI, ApaI and TaqI single nucleotide polymorphisms (SNPs) of the VDR gene were genotyped. Analysis of covariance and logistic regression were performed. RESULTS: The study included 76 patients of Indian descent and 201 patients of African descent. The prevalence of vitamin D deficiency (<20 ng/mL) was 42.6%. When patients were classified into groups with (G1) and without (G2) vitamin D deficiency, there were no significant differences in age, systolic blood pressure, low-density lipoprotein cholesterol and HbA(1c), although body mass index was significantly higher in G1. Vitamin D deficiency was significantly associated with increased diastolic blood pressure and triglyceride levels, and reduced high-density lipoprotein cholesterol (P<0.05). Prevalence of vitamin D deficiency was decreased in patients carrying the f allele of FokI (OR: 0.52; P=0.02) and the aa genotype of ApaI (OR: 0.46; P=0.05). BsmI and TaqI SNPs were not associated with vitamin D deficiency. CONCLUSION: The rate of vitamin D deficiency was high in our T2D patients, and was associated with the VDR gene FokI and ApaI polymorphisms and cardiovascular risk profile. Measurements of vitamin D may help to detect T2D patients with cardiovascular risk, and VDR polymorphisms might explain why vitamin D deficiency is so frequently seen in some T2D patients.

Genetic diversity of KIR natural killer cell markers in populations from France, Guadeloupe, Finland, Senegal and Réunion.

Killer cell immunoglobulin-like receptors (KIRs) belong to a diverse family of natural killer (NK) cell receptors recognizing human leukocyte antigen (HLA) class I molecules. Due to this functional link, KIR molecules are expected to display a high polymorphism, such as their HLA ligands. Moreover, many studies conducted in mouse and human models have shown that NK-KIR receptors play an important role in haematopoietic stem cell transplantation (HSCT). A beneficial impact of peculiar KIR ligand (HLA) mismatching has been reported suggesting a role to this combinatory HLA-KIR polymorphism. It is thus important to investigate KIR diversity in various human populations. To this end, we used polymerase chain reaction-sequence-specific primers to evaluate KIR gene in five selected populations (France, Guadeloupe, Senegal, Finland and Réunion). Genotypic and haplotypic frequencies were computed, as well as genetic distances and dendrogram (phylip package). These data illustrate the genetic relationship of these five populations through the KIR polymorphism. Results revealed a wide diversity in KIR gene frequencies in Guadeloupe and Réunion, and a high specificity in Senegal. The obtained dendrogram indicated small genetic distances between France, Guadeloupe and Réunion as well as between France and Finland. Senegal showed a distant genetic relationship with the other countries and, interestingly, an inverted ratio of coding/non-coding (KIR2DS4/1D) alleles compared with Caucasians. These data expose the broad diversity in KIR genes worldwide and show that KIR genes are pertinent tools in human population genetics. If the role of KIR donor-recipient incompatibilities is confirmed, KIR diversity according to ethnicity should be taken into account during the selection of HSCT donors.

HIV/HTLV-I coinfection and clinical grade at diagnosis.

A total of 963 HIV-infected patients have been identified or followed up in Martinique since 1985. Medical files were used to retrieve information about age, sex, circumstances of diagnosis, HTLV-I status, and HIV clinical grade at first examination according to CDC criteria from 1987. Complete information was available for 774 patients. At the first clinical examination, the clinical grade of 65 coinfected patients was more severe than that of the monoinfected patients (GIV versus GII, OR = 2.60, p < 0.01), but after adjustment for age and sex, this odds ratio was reduced 1.57. Although this study cannot invalidate the hypothesis of a faster progression toward AIDS of coinfected than of monoinfected patients, it shows that one or several other mechanisms contribute to the different grades of severity at the first clinical examination observed between these two categories of patients. We believe that HTLV-I infection acquired during adulthood is a marker of high-risk behavior and that it might be associated with early or multiple HIV infections.

Improvement of cervical Chlamydia detection in asymptomatic family planning attendees by using Amplicor Chlamydia trachomatis assay.

We evaluated the Amplicor C. trachomatis PCR assay (Roche Molecular Systems, N.J.) for the diagnosis of cervical infection in asymptomatic women attending a family planning clinic, aged between 18 and 25 years. Culture onto McCoy cells with fluorescent monoclonal staining was the reference system. Cervical specimens from 485 women were tested. The prevalence of C. trachomatis was 10.5% by culture and 11% by Amplicor. No specimen was positive by culture and negative by PCR. Three PCR-positive, culture-negative specimens were positive by MOMP-PCR and a second plasmid-based PCR. The resolved sensitivity of PCR and culture were 100% and 94.5%, respectively. Specificities for both were 100%, positive and negative predictive values for culture were 100% and 99.3%. Total test efficiency was 99.4%. The Amplicor C. trachomatis assay gave very clear results, quite above or below the cut-off value, and showed high sensitivity and specificity, improved ease of handling and represented a good alternative to culture for large scale diagnosis of asymptomatic C. trachomatis infection.

Screening for Chlamydia trachomatis infection in pregnant women in Martinique.

GOAL OF THIS STUDY: To determine the prevalence of Chlamydia trachomatis urogenital infection and to identify behavioral, demographic, and clinical factors associated with the infection in pregnant women in Martinique. STUDY DESIGN: One-thousand-four-hundred-eleven patients 15-39 years old, at 10-16 weeks of gestation and attending the prenatal clinic at Lamentin Hospital, were tested for Chlamydia trachomatis infection of the cervix and urethra using tissue culture. RESULTS: Chlamydia trachomatis was isolated from 375 (26.7%) women; 34% of them were positive in the cervix and urethra, 58% in the cervix only, and 8% in the urethra only. Factors found by multivariate analysis to be significantly associated with chlamydial infection were age less than 25 years, first intercourse at less than 18 years old, previous induced abortions, mucopurulent cervicitis, and repeated candidiasis. CONCLUSIONS: None of the factors associated with chlamydial infection was sensitive enough to permit efficient selective screening. It is cost effective to recommend a routine screening for chlamydial infection together with an educational program.

PIP: To determine the prevalence of Chlamydia trachomatis urogenital infection among pregnant women in Martinique, 1411 consecutive women presenting to Lamentin Hospital for their initial prenatal visit between 1988-90 underwent specimen collection and extensive interviews. The mean age of study subjects was 27.1 years and the mean number of life-time sex partners was 3.2. C. trachomatis was isolated from 375 women (26.7%), two-thirds of whom were asymptomatic. There was an inverse correlation between age and infection rate; 164 (43.7%) infected women were under 25 years of age. 34% had evidence of infection in both the cervix and urethra, 58% in the cervix only, and 8% in the urethra only. Other sexually transmitted pathogens with a high prevalence in this group included Ureaplasma urealyticum (39.9%), Candida albicans (32%), and Trichomonas vaginalis (13.7%). Factors that correlated significantly with chlamydia infection by multivariate analysis were age less than 25 years, first intercourse less than 18 years, previous induced abortion, cervicitis, and repeated candidiasis. However, no single risk factor or constellation of risk factors was sufficiently sensitive to form the basis of a selective screening program. Considering the serious maternal and infant complications of C. trachomatis infection, routine screening in pregnant women is urged. Given a prevalence rate of 27%, 1630 infected pregnant women should be identified each year in Martinique. The cost of screening and treating these women and their partners would be US$250,000 compared to $1.2 million required to treat chlamydia-related conjunctivitis and pneumonia in infants and postpartum salpingitis in mothers.

Genital Chlamydia trachomatis (serotypes D-K) infection in Jamaican commercial street sex workers.

OBJECTIVES: To determine the prevalence of genital Chlamydia trachomatis infections in commercial street sex workers (CSSW) in Jamaica. METHODS: The prevalence of C trachomatis infection was determined in 129 Jamaican CSSW using the direct fluorescent antibody (DFA) method and the isolation techniques which utilise fluorescent and iodine staining of endocervical cytobrush specimens cultured in McCoy cells. The seroprevalence of C trachomatis in the CSSW was also compared with that in blood donors (n = 435), using the microimmunofluorescence (MIF) test. RESULTS: The DFA detected C trachomatis in 16% (21/129) of the specimens. The prevalence as determined by the iodine and fluorescein stained cultures was 24% (31/129) and 25% (33/129) respectively. The overall prevalence of current chlamydial infection detected by the isolation techniques used was 25% (33/129). As determined by the MIF test, a statistically significantly higher seroprevalence rate of C trachomatis (95%, 61/64) was found in CSSW compared with blood donors (53%, 229/435; OR 22.6; chi 2 = 49.8; p < 0.001). The prevalence of current infection in CSSW as indicated by the isolation of C trachomatis was not influenced by history of previous pelvic inflammatory disease (PID), sexually transmitted disease, or condom use. N gonorrhoeae (9%) and Candida albicans (7%) were found in comparatively low frequencies, while Trichomonas vaginalis (0%) was not found in specimens from the CSSW. CONCLUSIONS: A high seroprevalence rate and a high rate of current infection with C trachomatis occur in Jamaican CSSW. In order to control the spread and prevent the severe clinical complications and sequelae of C trachomatis infection, the diagnosis and treatment in such high risk groups such as CSSW should be optimised.

PIP: The prevalence of Chlamydia trachomatis infection was investigated in 129 commercial sex workers (CSWs) recruited on the streets in Kingston, Jamaica. The direct fluorescent antibody method detected C. trachomatis in endocervical cytobrush specimens from 21 women (16%). When the specimens were cultured, current chlamydial infection was detected by iodine staining in 31 (24%) and by monoclonal antibodies in 33 (25%). The microimmunofluorescence test for chlamydial antibodies was performed on clotted blood samples obtained from 64 CSWs and, as controls, 435 blood bank donors. A significantly higher seroprevalence rate was found among CSWs (95%) than blood donors (53%) (p 0.001). Among CSWs, the most common clinical manifestation of C. trachomatis infection was vaginal discharge. The presence of C. trachomatis infection was not related to previous history of pelvic inflammatory disease, sexually transmitted disease (STD), or condom use. Neisseria gonorrhoeae was isolated from 11 (9%) endocervical swabs. This study confirms the predominance of C. trachomatis among the bacterial causes of STDs in high-risk groups in Jamaica, and suggests a need for screening and treatment to control the spread and prevent the severe clinical sequelae of chlamydial infection.

HTLV-I antibody and cell-mediated immunity status in sickle cell anemia.

Patients with sickle cell anemia (SCA) had an abnormal susceptibility to infections. In Martinique (French West Indies), a human T-cell leukemia/lymphoma virus type I (HTLV-I) endemic area, we found that 17 (10%) of 173 SCA patients had antibodies to HTLV-I. The possible relationship between HTLV-I seropositivity and altered immunity was studied in 13 SCA patients with HTLV-I antibodies compared with 13 matched SCA patients without HTLV-I antibodies. The immunological results, as evaluated by the T-cell subsets analysis, the lymphocyte proliferation responses analyzed after activation with concanavalin A, phytohemagglutinin, or pokeweed mitogen, and the natural killer activity were not statistically different in these two groups of patients (SCA HTLV-I positive vs SCA HTLV-I negative). These data suggest that HTLV-I infection did not result in a major alteration of cellular immunity in this population.

Cell-mediated immunity in patients with sickle cell anaemia.

Homozygous sickle cell disease patients have an increased risk of developing severe infections, probably because of impaired immunity. Cellular immunity was studied in thirty-two patients with S homozygous haemoglobin (SS) and compared to 32 A homozygous haemoglobin (AA) healthy subjects. A leukocytosis was observed but with a significant diminution of T4 and T8 proportions in sickle cell patients. B lymphocytes, concanavalin A, phytohaemagglutinin, and phorbol myristate acetate-induced lymphocyte proliferation were not different between the two groups except for enhanced pokeweed mitogen stimulation in SS patients. In contrast, addition of autologous sera to mitogen-induced cultures resulted in a potentiation of lymphocyte proliferation significantly greater in patients with S homozygous haemoglobin when compared to subjects with A homozygous haemoglobin. This highly amplified mitogen-induced response of lymphocytes by SS autologous sera, when compared to AA autologous sera, was not observed when these sera were added to lymphocytes obtained from an allogenic healthy individual. In vivo interleukin 2 production and natural killer activity were not different between SS and AA individuals. We conclude that there are functional abnormalities of cell-mediated immunity in patients with sickle cell anaemia and the SS lymphocyte activation by autologous sera was probably due to infectious and drepanocytic antigenic determinants contained in SS serum.

Seroepidemiology of human herpesvirus-6 in pregnant women from different parts of the world.

The prevalence of HHV-6 IgG was studied in 11 different countries across several continents: Morocco, Burkina-Faso, Congo, Ivory Coast, Mali, Niger, Senegal, Togo, Ecuador, Martinique, and France. The study group consisted of 550 pregnant women, representative of the general adult population in each country. Antibodies were detected by immunofluorescence assay on HSB-2 cells infected with HHV-6. Each serum was tested at nine dilutions (1:20 to 1:5,120), sera greater than or equal to 20 being considered positive. For the negative antigen control, we used mock-infected HSB-2 cells. Great differences were seen between separate areas: Morocco showed both low prevalence (20%) and a low geometric mean titer (12), whereas sub-Saharan Africa displayed high prevalences (60% to 90%) and variable geometric mean titers (34 to 229). This study revealed a prevalence of 92% for Ecuador, significantly higher than the prevalence for Martinique (50%), yet both countries had very low antibody titers compared with those found in Africa. The prevalence in France (76%) was similar to previous results from other European countries.

[Malnutrition and anemia in children hospitalized in Martinique]. / Malnutrition et anémie chez des enfants hospitalisés en Martinique.

In order to assess prevalences, characteristics and risk factors of malnutrition and anemia, a clinical and biological study was undertaken at Lamentin hospital in 100 hospitalized children aged 6 months to 6 years. Forty seven p. cent of children were underweight and 38 p. cent were anemic. Anemia and iron deficiency predominated in the under-24-month age group, whereas wasting was the dominate finding in older children. Under 2 years of age, risk factors for wasting and anemia were associated with method of breastfeeding. Over 2 years of age, low birthweight was the only risk factor of wasting identified. In Martinique, nutritional deficiency is common in children admitted to hospital and a high index of suspicion is indicated in the hospitalized population. Following the resolution of infections, supplemental iron therapy must be considered for a great number of children under 2 years of age.