Review of Scorpion Stings and Snakebites Treated by the French Military Health Service During Overseas Operations Between 2015 and 2017.

INTRODUCTION: Depending on their theatre of operation, French soldiers may potentially be exposed to scorpion stings and snakebites. Following the recommendations of a French military health service (FMHS) technical committee for envenomation, the FMHS provides antivenoms appropriate to each deployment. This work aimed to evaluate this risk of envenomation and to assess the antivenoms used by the FMHS in operational theatres since the creation of this committee in 2015. METHODS: Cases were identified based on a review of temporary authorization of use application forms for the use of antivenom. Data were collected retrospectively from these forms, and prescribing physicians were contacted for any missing data. RESULTS: Between 2015 and 2017, 28 requests for temporary authorization of use were identified: 19 for Scorpifav (Sanofi-Pasteur, Lyon, France) and 9 for Fav-Afrique (Sanofi-Pasteur). The FMHS treated 15 soldiers and 4 civilians for scorpion envenomation with Scorpifav: 15 in Mali, 3 in Chad, and 1 in Niger. Systemic signs were observed in 7 patients. Two soldiers and 7 civilians were treated with Fav-Afrique for ophidian envenomation: 5 in Djibouti, 3 in Mali, and 1 in the Republic of Côte d'Ivoire. These 28 patients were treated without sequelae. Other than moderate erythema that resolved with an antihistamine, no adverse effects were reported. Medical evacuation to France was unnecessary. CONCLUSIONS: This study shows that the risk of envenomation for soldiers on deployment is low but real. Antivenoms used by the FMHS were efficient and well tolerated, preserving the operational capacity of deployed troops.

Tsetse fly ecology and risk of transmission of African trypanosomes related to a protected forest area at a military base in the city of Abidjan, Côte d'Ivoire.

African trypanosomoses, whose pathogens are transmitted by tsetse flies, are a threat to animal and human health. Tsetse flies observed at the military base of the French Forces in Côte d'Ivoire (FFCI base) were probably involved in the infection and death of military working dogs. Entomological and parasitological surveys were carried out during the rainy and dry seasons using "Vavoua" traps to identify tsetse fly species, their distribution, favorable biotopes and food sources, as well as the trypanosomes they harbor. A total of 1185 Glossina palpalis palpalis tsetse flies were caught, corresponding to a high average apparent density of 2.26 tsetse/trap/day. The results showed a heterogeneous distribution of tsetse at the FFCI base, linked to more or less favorable biotopes. No significant variation in tsetse densities was observed according to the season. The overall trypanosomes infection rate according to microscopic observation was 13.5%. Polymerase chain reaction (PCR) analyses confirmed the presence of Trypanosoma vivax and T. congolense forest type, responsible for African animal trypanosomosis. Our findings suggest that there is a risk of introduction and transmission of T. brucei gambiense, responsible for human African trypanosomiasis, on the study site. This risk of transmission of African trypanosomes concerns not only the FFCI base, but also inhabited peripheral areas. Our study confirmed the need for vector control adapted to the eco-epidemiological context of the FFCI base.

Title: Écologie des mouches tsé-tsé et risque de transmission des trypanosomes africains lié à une zone forestière protégée dans une base militaire de la ville d'Abidjan, Côte d'Ivoire. Abstract: Les trypanosomoses africaines, dont les agents pathogènes sont transmis par les mouches tsé-tsé, constituent une contrainte pour la santé animale et humaine. Des mouches tsé-tsé observées dans la base militaire des Forces françaises en Côte d'Ivoire (base FFCI) ont probablement été impliquées dans l'infection et la mort de chiens militaires. Des enquêtes entomologiques et parasitologiques ont été menées pendant la saison pluvieuse et la saison sèche à l'aide de pièges "Vavoua" afin d'identifier les espèces de mouches tsé-tsé, leur distribution, les biotopes favorables et leur source de nourriture ainsi que les trypanosomes qu'elles hébergent. Au total 1185 mouches tsé-tsé de l'espèce Glossina palpalis palpalis ont été capturées, ce qui correspond à une densité apparente moyenne élevée de 2,26 tsé-tsé/piège/jour. Les résultats ont montré une distribution hétérogène des tsé-tsé dans la base FFCI en lien avec des biotopes plus ou moins favorables. Aucune variation significative des densités de tsé-tsé n'a été observée en fonction de la saison. Le taux d'infection global par les trypanosomes était de 13,5 % selon l'observation microscopique. Les analyses PCR ont confirmé la présence de Trypanosoma vivax et T. congolense type forêt, responsable de la trypanosomose animale africaine. Nos résultats suggèrent qu'il existe un risque potentiel d'introduction et de transmission de T. brucei gambiense responsable de la trypanosomiase humaine africaine dans la zone d'étude. Ce risque de transmission des trypanosomes africains concerne non seulement l'intérieur de la base FFCI, mais aussi les espaces périphériques habités. Notre étude a confirmé la nécessité de mener une lutte antivectorielle adaptée au contexte éco-épidémiologique de la base FFCI.

Detection of Potential Zoonotic Bartonella Species in African Giant Rats (Cricetomys gambianus) and Fleas from an Urban Area in Senegal.

Bartonellae are bacteria associated with mammals and their ectoparasites. Rodents often host different species of Bartonella. The aim of this study was to investigate the presence of Bartonella spp. in African giant pouched rats (Cricetomys gambianus) and their ectoparasites in Dakar, Senegal. In 2012, 20 rats were caught, and their fleas were identified. DNA was extracted from 170 selected fleas and qPCR was carried out to detect Bartonella spp. Subsequently, a Bartonella culture was performed from the rat blood samples and the isolated strains (16S rRNA, rpoB, ftsZ and ITS3) were genotyped. A total of 1117 fleas were collected from 19 rats and identified as Xenopsylla cheopis, the tropical rat flea. Bartonella DNA was detected in 148 of 170 selected fleas (87.1%). In addition, Bartonella strains were isolated from the blood of 17 rats (85%). According to Bartonella gene-sequence-based criteria for species definition, the isolated strains were identified as B. massiliensis (four strains) and two potential new species related to the zoonotic B. elizabethae. In this paper, these potentially new species are provisionally called Candidatus Bartonella militaris (11 strains) and Candidatus Bartonella affinis (two strains) until their description has been completed. Cricetomys gambianus and its fleas could constitute a public health risk in Dakar due to the high prevalence of Bartonella infection reported.

Great diversity of Piroplasmida in Equidae in Africa and Europe, including potential new species.

Piroplasms are Apicomplexa tick-borne parasites distributed worldwide. They are responsible for piroplasmosis (theileriosis and babesiosis) in Vertebrata and are therefore of medical and economic importance. Herein, we developed a new real time PCR assay targeting the 5.8S rRNA gene and three standard PCR assays, targeting 18S rRNA, 28S rRNA, and cox1 genes, for the detection of piroplasmids. These assays were first optimized and screened for specificity and sensitivity. Then, they were used to study a total of 548 blood samples and 97 ticks collected from Equidae in four sub-Saharan countries (Senegal, Democratic Republic of the Congo, Chad, and Djibouti) and France (Marseille and Corsica). DNA of piroplasms was detected in 162 of 548 (29.5%) blood samples and in 9 of 97 (9.3%) ticks. The highest prevalence in blood samples was observed in Chad in 2016 with 72.9% positivity rate. Sequencing allowed the identification of four species of piroplasms, including two potentials new species. Theileria equi was mainly found. The highest prevalence was observed in Senegal (14 positive out of 23, 60.87%). Babesia caballi was detected in one horse in Senegal. Two new potential Theileria species were detected: Theileria sp. "Africa", observed in all areas excepted in Marseille and Theileria sp. "Europa", observed in Marseille and Corsica. In conclusion, sensitive and specific PCR assays were developed for epidemiological studies of Piroplasmida. The circulation of multiple species of piroplasms, including two potentials new species, observed among Equidae from sub-Saharan Africa and France.

Leptospirosis, one neglected disease in rural Senegal.

A serological study was carried out in two Senegalese villages located in the Sine-Saloum region in order to estimate the presence of anti-leptospiral antibodies in humans and animals, and to identify the predominant serogroups. Seven hundred and forty-nine serum samples were collected from humans (n = 545), dogs (n = 33), donkeys (n = 20), goats (n = 52), sheep (n = 43) and N'Dama cattle (n = 56), all originated from Dielmo and Ndiop villages. All samples were tested for different serovars of pathogenic Leptospira species by the microscopic agglutination test. Considering titres ≥ 1:100, 7.7% [CI 95:5.5 to 9.9] on the 545 human blood samples tested and 42.2% [CI95 :35.4 to 48.9] on the 204 animal blood samples tested were found to be positive to one or more serovars. The results obtained indicate that the Australis serogroup is the most prevalent serogroup in human (67.3%) and cattle (27.3%). Serogroup Icterohaemorhagiae is the most frequent serogroup in goat (55.6%) and donkey (37.5%). Canicola (23.4%), Icterohaemorhagiae (21.1%) and Australis (12.5%) serogroups are the most prevalent serogroups in dogs. This study shows that diverse Leptospira serovars occur in a wide range of wild and domestic mammal species, as well as in humans in Senegal. However, further studies are needed to better understand the complexity of Leptospira epidemiology in Africa, identify the reservoirs of different serogroups and estimate its impact on livestock. Understanding the multi-host epidemiology of leptospirosis is essential to control and prevent the disease.

Morning blisters: cantharidin-related Meloidae burns.

We report several cases of Meloidae-related blisters in French soldiers deployed to Mali. Blister beetles of the Meloidae family produce cantharidin, a blistering agent, for defensive purposes. These virtually cosmopolitan Coleoptera can cause significant nuisance to travellers and deployed soldiers especially during the rainy season in the Sahel region.

Mind the eye-squirter! An Anthia sexmaculata sexmaculata-related necrotic burn.

We report the case of an Anthia sexmaculata sexmaculata-associated necrotic burn in a French expatriate in Mauritania. Anthia spp.-related injury is a common though underreported health issue in the Sahelo-Saharan area. Deployed soldiers and travellers should be aware of these beetles when adventuring in this region.

Usefulness of a rapid immuno-migration test for the detection of canine monocytic ehrlichiosis in Africa.

A rapid immuno-migration test for the serological detection of canine monocytic ehrlichiosis, Witness® Ehrlichia (WE) (Zoetis, France), was evaluated in 528 serum samples from dogs living in endemic areas of West and East Africa: Senegal (N=208), Ivory Coast (N=7), Sudan (N=27), and Djibouti (N=286). Of these dogs, 200 were French military working dogs (MWD) temporarily residing in Africa. The WE test results were compared with those obtained by indirect immunofluorescence (IFA). The sensitivity of WE was 97% [94.2, 98.7] with a specificity of 100% [98.6, 100]. In MWD, the seroprevalence (IFA) was 7%; in native dogs, it reached 77.1%. This significant difference can be explained by prophylactic measures from which MWD benefit. The WE test represents a simple, fast and reliable test for the detection of anti-Ehrlichia canis antibodies. Its implementation for the diagnosis of clinical cases has been validated in the field, and its use allows easy detection of asymptomatic dogs that may be carriers of E. canis.

Study of ehrlichiosis in kennel dogs under treatment and prevention during seven months in Dakar (Senegal).

In Dakar kennels where morbidity and mortality attributed to diseases transmitted by ticks were high, we conducted a field study to assess the prevalence of Ehrlichia canis, Anaplasma platys and Babesia spp. infections in two kennels (n = 34 dogs) and to study the impact of tick protection. The first day of the study, the E. canis PCR were positive in 18 dogs (53%). A. platys was found in one dog and all dogs were negative for Babesia spp. After one month of doxycycline treatment, the number of PCR positive dogs decreased significantly to 2 (5.9%). During seven months, all dogs were treated monthly topically with a novel combination (Certifect(®), Merial) delivering at least 6.7 mg fipronil/kg body weight, 8.0mg amitraz/kg and 6 mg (S)-methoprene/kg. The number of PCR positive dogs remained stable all over the seven months, with 4 dogs being positive at Day 90 and 2 at Day 210. The combination of treatment and monthly prevention had a significant effect in the two kennels. All dogs remained healthy, which was not the case in previous years.

First detection of Rickettsia aeschlimannii in Hyalomma dromedarii ticks from Tunisia.

Tick-borne rickettsioses have long been described in North Africa. These human diseases and their causative agents occur in several countries in this region, including Mauritania, Morocco, Algeria, Tunisia, Libya, and Egypt. In Tunisia, the first described and most well-known rickettsiosis is Mediterranean spotted fever, which is caused by Rickettsia conorii conorii. Cases of R. aeschlimannii infections have been documented by serology, but the agent has never actually been detected in patients or arthropods in the country. In October 2008, ticks were collected from a dromedary (Camelius dromedarii) in Douz, Central Tunisia. All of the ticks were identified as Hyalomma dromedarii and were tested using polymerase chain reaction to determine the presence of rickettsiae. Our results indicate the first molecular detection of R. aeschlimannii in ticks from Tunisia.

Subchronic administration of pyridostigmine or huperzine to primates: compared efficacy against soman toxicity.

Organophosphonate (OP) nerve agents, such as soman, are potent irreversible inhibitors of central and peripheral acetylcholinesterases (AChEs). Pre-treatment of OP poisoning relies on the subchronic administration of a reversible AChE inhibitor. In the present limited study, the protective effects against soman toxicity of such compounds, i.e., the current pre-treatment pyridostigmine and huperzine, a proposed pre-treatment, are compared in primates. This is the first time primates are used to study the potential of pre-treatment with hyperzine. Indeed, previous studies with huperzine used nonprimate models which are not the most appropriate for pre-treatment in humans. Each medication is given via a subcutaneous mini-osmotic pump for 6 days at a delivery rate providing about 20% inhibition of red cell AChE activity. In this trial with only four primates, huperzine selectively inhibits red cell AChE activity whereas pyridostigmine also inhibits plasma butyrylcholinesterase (BuChE). This latter may act as endogenous scavenger of OP compounds helping to confer additional protection against OPs. During intoxication, the cumulative dose of soman needed to produce convulsions and epileptic activity is 1.55-fold higher in the animals pre-treated with huperzine compared to those pre-treated with pyridostigmine. Thus, replacing PYR by HUP for a subchronic pre-treatment of primates gives them better tolerance to the epileptic effects of soman.