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1.
Euro Surveill ; 29(13)2024 Mar.
Article in English | MEDLINE | ID: mdl-38551097

ABSTRACT

In 2023, dengue virus serotype 2 (DENV2) affected most French overseas territories. In the French Caribbean Islands, viral circulation continues with > 30,000 suspected infections by March 2024. Genome sequence analysis reveals that the epidemic lineage in the French Caribbean islands has also become established in French Guiana but not Réunion. It has moreover seeded autochthonous circulation events in mainland France. To guide prevention of further inter-territorial spread and DENV introduction in non-endemic settings, continued molecular surveillance and mosquito control are essential.


Subject(s)
Epidemics , Humans , French Guiana/epidemiology , Molecular Epidemiology , West Indies/epidemiology , France/epidemiology
2.
Emerg Infect Dis ; 28(2): 445-448, 2022 Feb.
Article in English | MEDLINE | ID: mdl-35076005

ABSTRACT

We report a case of vertical transmission of Tonate virus in a pregnant woman from French Guiana. The fetus showed severe necrotic and hemorrhagic lesions of the brain and spinal cord. Clinicians should be made aware of possible adverse fetal outcomes in pregnant women infected with Tonate virus.


Subject(s)
Alphavirus , Brain , Female , French Guiana/epidemiology , Humans , Infectious Disease Transmission, Vertical , Pregnancy
3.
Emerg Infect Dis ; 27(10): 2673-2676, 2021 Oct.
Article in English | MEDLINE | ID: mdl-34289335

ABSTRACT

An outbreak of severe acute respiratory syndrome coronavirus 2 caused by the Gamma variant of concern infected 24/44 (55%) employees of a gold mine in French Guiana (87% symptomatic, no severe forms). The attack rate was 60% (15/25) among fully vaccinated miners and 75% (3/4) among unvaccinated miners without a history of infection.


Subject(s)
COVID-19 , SARS-CoV-2 , French Guiana/epidemiology , Gold , Humans
4.
Emerg Infect Dis ; 27(10): 2711-2714, 2021 10.
Article in English | MEDLINE | ID: mdl-34545800

ABSTRACT

Oropouche fever is a zoonotic dengue-like syndrome caused by Oropouche virus. In August-September 2020, dengue-like syndrome developed in 41 patients in a remote rainforest village in French Guiana. By PCR or microneutralization, 23 (82.1%) of 28 tested patients were positive for Oropouche virus, documenting its emergence in French Guiana.


Subject(s)
Bunyaviridae Infections , Orthobunyavirus , Bunyaviridae Infections/epidemiology , Disease Outbreaks , French Guiana/epidemiology , Humans , Orthobunyavirus/genetics
5.
J Virol ; 92(18)2018 09 15.
Article in English | MEDLINE | ID: mdl-29976674

ABSTRACT

Over the past few decades, a large number of studies have identified herpesvirus sequences from many mammalian species around the world. Among the different nonhuman primate species tested so far for cytomegaloviruses (CMVs), only a few were from the New World. Seeking to identify CMV homologues in New World monkeys (NWMs), we carried out molecular screening of 244 blood DNA samples from 20 NWM species from Central and South America. Our aim was to reach a better understanding of their evolutionary processes within the Platyrrhini parvorder. Using PCR amplification with degenerate consensus primers targeting highly conserved amino acid motifs encoded by the herpesvirus DNA polymerase gene, we characterized novel viral sequences from 12 species belonging to seven genera representative of the three NWM families. BLAST searches, pairwise nucleotide and amino acid sequence comparisons, and phylogenetic analyses confirmed that they all belonged to the Cytomegalovirus genus. Previously determined host taxa allowed us to demonstrate a good correlation between the distinct monophyletic clades of viruses and those of the infected primates at the genus level. In addition, the evolutionary branching points that separate NWM CMVs were congruent with the divergence dates of their hosts at the genus level. These results significantly expand our knowledge of the host range of this viral genus and strongly support the occurrence of cospeciation between these viruses and their hosts. In this respect, we propose that NWM CMV DNA polymerase gene sequences may serve as reliable molecular markers with which to infer Platyrrhini phylogenetics.IMPORTANCE Investigating evolutionary processes between viruses and nonhuman primates has led to the discovery of a large number of herpesviruses. No study published so far on primate cytomegaloviruses has extensively studied New World monkeys (NWMs) at the subspecies, species, genus, and family levels. The present study sought to identify cytomegalovirus homologues in NWMs and to decipher their evolutionary relationships. This led us to characterize novel viruses from 12 of the 20 primate species tested, which are representative of the three NWM families. The identification of distinct viruses in these primates not only significantly expands our knowledge of the host range of this viral genus but also sheds light on its evolutionary history. Phylogenetic analyses and molecular dating of the sequences obtained support a virus-host coevolution.


Subject(s)
Cytomegalovirus/classification , Cytomegalovirus/genetics , DNA-Directed DNA Polymerase/genetics , Exodeoxyribonucleases/genetics , Monkey Diseases/virology , Phylogeny , Platyrrhini/virology , Viral Proteins/genetics , Animals , Central America/epidemiology , Cytomegalovirus/enzymology , DNA, Viral/blood , DNA, Viral/genetics , DNA, Viral/isolation & purification , Evolution, Molecular , Monkey Diseases/blood , Monkey Diseases/epidemiology , Polymerase Chain Reaction/methods , South America/epidemiology
6.
BMC Infect Dis ; 19(1): 260, 2019 Mar 15.
Article in English | MEDLINE | ID: mdl-30876401

ABSTRACT

BACKGROUND: We report hereby a severe case of Hantavirus Pulmonary Syndrome" (HPS) induced by Maripa virus in French Guiana and describe the mechanism of severity of the human disease. CASE PRESENTATION: A 47-year- old patient started presenting a prodromic period with fever, dyspnea, cough and head ache. This clinical presentation was followed by a rapid respiratory, hemodynamic and renal failure leading to admission in the ICU. Biological exams revealed an increased haematocrit level with a paradoxical low protein level. Echocardiographic and hemodynamic monitoring showed a normal left ventricular function with low filling pressures, an elevated extravascular lung water index and pulmonary vascular permeability index. These findings were compatible with a capillary leak-syndrome (CLS). CONCLUSIONS: The severity of HPS caused by the virus Maripa in French Guiana can be explained by the tropism of hantavirus for the microvascular endothelial cell leading to a CLS.


Subject(s)
Capillary Leak Syndrome/etiology , Capillary Leak Syndrome/physiopathology , Hantavirus Pulmonary Syndrome/complications , Hantavirus Pulmonary Syndrome/physiopathology , Orthohantavirus/pathogenicity , Capillary Leak Syndrome/diagnosis , French Guiana , Orthohantavirus/isolation & purification , Hantavirus Pulmonary Syndrome/diagnosis , Humans , Middle Aged
7.
An Acad Bras Cienc ; 91(suppl 3): e20190325, 2019 Aug 26.
Article in English | MEDLINE | ID: mdl-31460594

ABSTRACT

The West Indian (Trichechus manatus) and Amazonian (T. inunguis) manatees have a sympatric occurrence at the mouth of the Amazon River. A result of this interspecific encounter is the occurrence of hybrids, which are frequently found along the coasts of Amapá state in Brazil, French Guiana and Guyana. Here we present new genetic evidence indicating the occurrence of a hybrid swarm along the Guianas Shield coastline, which is an interspecific hybrid zone that also separates T. manatus populations located east (Brazil) and west (Caribbean, Gulf of Mexico, Florida and Antilles). In addition, we suggest that this hybrid population occupies a peculiar mangrove-rich environment under strong influence of the Amazon River plume, which requires an independent management and should be considered a special conservation area.


Subject(s)
Genetic Variation/genetics , Hybridization, Genetic , Species Specificity , Trichechus inunguis/genetics , Trichechus manatus/genetics , Animals , Bayes Theorem , Brazil , Caribbean Region , Guyana , Phylogeny , Population Dynamics , Rivers , Trichechus inunguis/physiology , Trichechus manatus/physiology
9.
Emerg Infect Dis ; 24(9): 1734-1736, 2018 09.
Article in English | MEDLINE | ID: mdl-30124408

ABSTRACT

We report viral RNA loads and antibody responses in 6 severe human cases of Maripa virus infection (2 favorable outcomes) and monitored both measures during the 6-week course of disease in 1 nonfatal case. Further research is needed to determine prevalence of this virus and its effect on other hantaviruses.


Subject(s)
Hantavirus Pulmonary Syndrome/diagnosis , Orthohantavirus/isolation & purification , Adult , Aged , Diagnosis, Differential , French Guiana , Orthohantavirus/immunology , Hantavirus Pulmonary Syndrome/mortality , Hantavirus Pulmonary Syndrome/virology , Humans , Male , Middle Aged , RNA, Viral/blood , Viral Load
10.
J Hered ; 109(4): 393-404, 2018 05 11.
Article in English | MEDLINE | ID: mdl-29228367

ABSTRACT

Social systems are major drivers of population structure and gene flow, with important effects on dynamics and dispersal of associated populations of parasites. Among bats, the common vampire bat (Desmodus rotundus) has likely one of the most complex social structures. Using autosomal and mitochondrial markers on vampires from Mexico, French Guiana, and North Brazil, from both roosting and foraging areas, we observed an isolation by distance at the wider scale and lower but significant differentiation between closer populations (<50 km). All populations had a low level of relatedness and showed deviations from Hardy-Weinberg equilibrium and a low but significant inbreeding coefficient. The associated heterozygote deficiency was likely related to a Wahlund effect and to cryptic structures, reflecting social groups living in syntopy, both in roosting and foraging areas, with only limited admixture. Discrepancy between mitochondrial and nuclear markers suggests female philopatry and higher dispersal rates in males, associated with peripheral positions in the groups. Vampires are also the main neotropical reservoir for rabies virus, one of the main lethal pathogens for humans. Female social behaviors and trophallaxis may favor a rapid spread of virus to related and unrelated offspring and females. The high dispersal capacity of males may explain the wider circulation of viruses and the inefficacy of bat population controls. In such opportunistic species, gene connectivity should be considered for management decision making. Strategies such as culling could induce immigration of bats from neighboring colonies to fill vacant roosts and feeding areas, associated with the dispersal of viral strains.


Subject(s)
Chiroptera/genetics , Disease Reservoirs/virology , Rabies virus/physiology , Rabies/transmission , Social Behavior , Animals , Brazil , Chiroptera/physiology , Chiroptera/virology , Female , French Guiana , Male , Mexico , Population Dynamics , Rabies/virology
11.
Emerg Infect Dis ; 23(10): 1722-1725, 2017 10.
Article in English | MEDLINE | ID: mdl-28930019

ABSTRACT

We report 5 human cases of hantavirus pulmonary syndrome found during surveillance in French Guiana in 2008-2016; of the 5 patients, 4 died. This pathogen should continue to be monitored in humans and rodents in effort to reduce the occurrence of these lethal infections in humans stemming from ecosystem disturbances.


Subject(s)
Antibodies, Viral/blood , Epidemiological Monitoring , Hantavirus Pulmonary Syndrome/epidemiology , Orthohantavirus/isolation & purification , Rodentia/virology , Adult , Aged , Animals , Disease Reservoirs/virology , Ecosystem , French Guiana/epidemiology , Orthohantavirus/classification , Orthohantavirus/genetics , Hantavirus Pulmonary Syndrome/mortality , Hantavirus Pulmonary Syndrome/pathology , Hantavirus Pulmonary Syndrome/virology , Humans , Male , Middle Aged , Phylogeny , Survival Analysis
12.
Arch Virol ; 162(8): 2369-2373, 2017 Aug.
Article in English | MEDLINE | ID: mdl-28389806

ABSTRACT

Vaccinia virus (VACV) circulates in Brazil and other South America countries and is responsible for a zoonotic disease that usually affects dairy cattle and humans, causing economic losses and impacting animal and human health. Furthermore, it has been detected in wild areas in the Brazilian Amazon. To better understand the natural history of VACV, we investigated its circulation in wildlife from French Guiana, a remote region in the Northern Amazon forest. ELISA and plaque reduction neutralization tests were performed to detect anti-orthopoxvirus antibodies. Real-time and standard PCR targeting C11R, A56R and A26L were applied to detect VACV DNA in serum, saliva and tissue samples. No evidence of VACV infection was found in any of the samples tested. These findings provide additional information on the VACV epidemiological puzzle. The virus could nevertheless be circulating at low levels that were not detected in areas where no humans or cattle are present.


Subject(s)
Animals, Wild/virology , Vaccinia virus/isolation & purification , Vaccinia/veterinary , Animals , Antibodies, Viral/blood , Enzyme-Linked Immunosorbent Assay , Forests , French Guiana/epidemiology , Mammals/virology , Saliva/virology , Vaccinia/epidemiology , Vaccinia/virology , Vaccinia virus/immunology , Viral Plaque Assay
13.
Virologie (Montrouge) ; 21(3): 130-146, 2017 Jun 01.
Article in English | MEDLINE | ID: mdl-31967560

ABSTRACT

Among mammals, rodents play a key role in the emergence of viral diseases. In French Guiana, with 36 rodent species recorded in various ecosystems (pristine forests, savannas, anthropized environments), some natural habitats today encounter anthropogenic perturbations that induce changes in community structure and population dynamics. These modifications are sometimes associated with the circulation and emergence of viral pathogens. For 10 years, investigations on the circulation of two rodent-borne viruses, Hantavirus and Mammarenavirus, are underway in rodent populations as well as in humans for hantavirus. These investigations identified viruses from both genera in their potential reservoirs and allow describing the most favourable habitats for the reservoirs of hantavirus where the risk of viral emergence may be higher. We suggest to investigate how anthropic perturbations in rodent communities can drive the emergence of viruses that are currently confined to a small scale and search for evidence of infection in the human population.

14.
Virologie (Montrouge) ; 21(3): E12-E27, 2017 Jun 01.
Article in English | MEDLINE | ID: mdl-31967562

ABSTRACT

Among mammals, rodents play a key role in the emergence of viral diseases. In French Guiana, with 36 rodent species recorded in various ecosystems (pristine forests, savannas, anthropized environments), some natural habitats today encounter anthropogenic perturbations that induce changes in community structure and population dynamics. These modifications are sometimes associated with the circulation and emergence of viral pathogens. For 10 years, investigations on the circulation of two rodent-borne viruses, Hantavirus and Mammarenavirus, are underway in rodent populations as well as in humans for hantavirus. These investigations identified viruses from both genera in their potential reservoirs and allow describing the most favourable habitats for the reservoirs of hantavirus where the risk of viral emergence may be higher. We suggest to investigate how anthropic perturbations in rodent communities can drive the emergence of viruses that are currently confined to a small scale and search for evidence of infection in the human population.

15.
BMC Evol Biol ; 16(1): 229, 2016 10 26.
Article in English | MEDLINE | ID: mdl-27782798

ABSTRACT

BACKGROUND: Although bats are natural reservoirs of many pathogens, few studies have been conducted on the genetic variation and detection of selection in major histocompatibility complex (MHC) genes. These genes are critical for resistance and susceptibility to diseases, and host-pathogen interactions are major determinants of their extensive polymorphism. Here we examined spatial patterns of diversity of the expressed MHC class II DRB gene of three sympatric Neotropical bats, Carollia perspicillata and Desmodus rotundus (Phyllostomidae), and Molossus molossus (Molossidae), all of which use the same environments (e.g., forests, edge habitats, urban areas). Comparison with neutral marker (mtDNA D-loop) diversity was performed at the same time. RESULTS: Twenty-three DRB alleles were identified in 19 C. perspicillata, 30 alleles in 35 D. rotundus and 20 alleles in 28 M. molossus. The occurrence of multiple DRB loci was found for the two Phyllostomidae species. The DRB polymorphism was high in all sampling sites and different signatures of positive selection were detected depending on the environment. The patterns of DRB diversity were similar to those of neutral markers for C. perspicillata and M. molossus. In contrast, these patterns were different for D. rotundus for which a geographical structure was highlighted. A heterozygote advantage was also identified for this species. No recombination or gene conversion event was found and phylogenetic relationships showed a trans-species mode of evolution in the Phyllostomids. CONCLUSIONS: This study of MHC diversity demonstrated the strength of the environment and contrasting pathogen pressures in shaping DRB diversity. Differences between positively selected sites identified in bat species highlighted the potential role of gut microbiota in shaping immune responses. Furthermore, multiple geographic origins and/or population admixtures observed in C. perspicillata and M. molossus populations acted as an additional force in shaping DRB diversity. In contrast, DRB diversity of D. rotundus was shaped by environment rather than demographic history.


Subject(s)
Chiroptera/genetics , Evolution, Molecular , Genetic Variation , Histocompatibility Antigens Class II/genetics , Selection, Genetic , Alleles , Animals , Gastrointestinal Microbiome , Gene Conversion , Genes, MHC Class II , Histocompatibility Antigens Class II/chemistry , Host-Pathogen Interactions/genetics , Phylogeny , Polymorphism, Genetic
16.
J Virol ; 88(22): 13212-20, 2014 Nov.
Article in English | MEDLINE | ID: mdl-25187544

ABSTRACT

UNLABELLED: Primates are naturally infected with herpesviruses. During the last 15 years, the search for homologues of human herpesviruses in nonhuman primates allowed the identification of numerous viruses belonging to the different herpesvirus subfamilies and genera. No simian homologue of human herpesvirus 7 (HHV7) has been reported to date. To investigate the putative existence of HHV7-like viruses in African great apes, we applied the consensus-degenerate hybrid oligonucleotide primers (CODEHOP) program-mediated PCR strategy to blood DNA samples from the four common chimpanzee subspecies (Pan troglodytes verus, P. t. ellioti, P. t. troglodytes, and P. t. schweinfurthii), pygmy chimpanzees (Pan paniscus), as well as lowland gorillas (Gorilla gorilla gorilla). This study led to the discovery of a novel roseolovirus close to HHV7 in each of these nonhuman primate species and subspecies. Generation of the partial glycoprotein B (1,111-bp) and full-length DNA polymerase (3,036/3,042-bp) gene sequences allowed the deciphering of their evolutionary relationships. Phylogenetic analyses revealed that HHV7 and its African great ape homologues formed well-supported monophyletic lineages whose topological resemblance to the host phylogeny is suggestive of virus-host codivergence. Notably, the evolutionary branching points that separate HHV7 from African great ape herpesvirus 7 are remarkably congruent with the dates of divergence of their hosts. Our study shows that African great apes are hosts of human herpesvirus homologues, including HHV7 homologues, and that the latter, like other DNA viruses that establish persistent infections, have cospeciated with their hosts. IMPORTANCE: Human herpesviruses are known to possess simian homologues. However, surprisingly, none has been identified to date for human herpesvirus 7 (HHV7). This study is the first to describe simian homologues of HHV7. The extensive search performed on almost all African great ape species and subspecies, i.e., common chimpanzees of the four subspecies, bonobos, and lowland gorillas, has allowed characterization of a specific virus in each. Genetic characterization of the partial glycoprotein B and full-length DNA polymerase gene sequences, followed by their phylogenetic analysis and estimation of divergence times, has shed light on the evolutionary relationships of these viruses. In this respect, we conclusively demonstrate the cospeciation between these new viruses and their hosts and report cases of cross-species transmission between two common chimpanzee subspecies in both directions.


Subject(s)
Primate Diseases/virology , Roseolovirus Infections/veterinary , Roseolovirus/classification , Roseolovirus/isolation & purification , Africa , Animals , Blood/virology , Cluster Analysis , DNA, Viral/chemistry , DNA, Viral/genetics , Genotype , Hominidae , Molecular Sequence Data , Phylogeny , Polymerase Chain Reaction , Roseolovirus/genetics , Roseolovirus Infections/virology , Sequence Analysis, DNA , Sequence Homology , Viral Proteins/genetics
17.
Am J Trop Med Hyg ; 110(4): 819-825, 2024 Apr 03.
Article in English | MEDLINE | ID: mdl-38377600

ABSTRACT

In tropical countries, acute febrile illnesses represent a complex clinical problem for general practitioners. We describe the prevalence of different etiologies of acute febrile illnesses occurring among French service members and their families, excluding children, in general practice in French Guiana. From June 2017 to March 2020, patients with a fever ≥37.8°C with a duration of less than 15 days who sought medical care at the army medical centers in Cayenne and Kourou were prospectively enrolled. Based on clinical presentation, blood, urine, nasopharyngeal, and stool samples were collected for diagnostic testing for viruses, bacteria, and parasites (by direct examination, microscopic examination of blood smears, culture, serology, or polymerase chain reaction), and standardized biological tests were systematically performed. Among 175 patients retained for analysis, fever with nonspecific symptoms was predominant (46.9%), with 10 Plasmodium vivax malaria cases, 8 dengue infections, and 6 cases of Q fever. The second most frequent cause of acute febrile illness was upper respiratory tract infections (32.0%) due to influenza virus (n = 18) or human rhinovirus (n = 10). Among the causes of acute febrile illness in French Guiana, clinicians should first consider arboviruses and malaria, as well as Q fever in cases of elevated C-reactive protein with nonspecific symptoms and influenza in cases of signs and symptoms associated with upper respiratory tract infections. Despite an expanded microbiological search, the etiology of 51.4% of acute febrile illnesses remain unknown. Further investigations will be necessary to identify the etiology of acute febrile illnesses, including new pathogens, in French Guiana.


Subject(s)
Influenza, Human , Malaria , Q Fever , Child , Adult , Humans , French Guiana/epidemiology , Q Fever/complications , Malaria/complications , Malaria/epidemiology , Malaria/diagnosis , Fever/etiology , Fever/complications , Influenza, Human/complications
18.
J Virol ; 86(9): 5399, 2012 May.
Article in English | MEDLINE | ID: mdl-22492924

ABSTRACT

We report the first complete genome sequence of Maripa virus identified in 2009 from a patient with hantavirus pulmonary syndrome in French Guiana. Maripa virus corresponds to a new variant of the Rio Mamoré virus species in the Bunyaviridae family, genus Hantavirus.


Subject(s)
Genome, Viral , Orthohantavirus/classification , Orthohantavirus/genetics , French Guiana , Genes, Viral , Molecular Sequence Data , Phylogeny
19.
Trop Med Infect Dis ; 8(3)2023 Mar 13.
Article in English | MEDLINE | ID: mdl-36977169

ABSTRACT

The mosquito (Diptera: Culicidae) fauna of French Guiana encompasses 242 species, of which nearly half of them belong to the genus Culex. Whereas several species of Culex are important vectors of arboviruses, only a limited number of studies focus on them due to the difficulties to morphologically identify field-caught females. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) has been reported as a promising method for the identification of mosquitoes. Culex females collected in French Guiana were morphologically identified and dissected. Abdomens were used for molecular identification using the COI (cytochrome oxidase 1) gene. Legs and thorax of 169 specimens belonging to 13 Culex species, (i.e., Cx. declarator, Cx. nigripalpus, Cx. quinquefasciatus, Cx. usquatus, Cx. adamesi, Cx. dunni, Cx. eastor, Cx. idottus, Cx. pedroi, Cx. phlogistus, Cx. portesi, Cx. rabanicolus and Cx. spissipes) were then submitted to MALDI-TOF MS analysis. A high intra-species reproducibility and inter-species specificity of MS spectra for each mosquito body part tested were obtained. A corroboration of the specimen identification was revealed between MALDI-TOF MS, morphological and molecular results. MALDI-TOF MS protein profiling proves to be a suitable tool for identification of neotropical Culex species and will permit the enhancement of knowledge on this highly diverse genus.

20.
Am J Trop Med Hyg ; 108(5): 1014-1016, 2023 05 03.
Article in English | MEDLINE | ID: mdl-36913929

ABSTRACT

We describe the clinical parameters and management of nine confirmed cases of hantavirus pulmonary syndrome reported in French Guiana since 2008. All patients were admitted to Cayenne Hospital. Seven patients were men and the mean age was 48 years (range, 19-71 years). Two phases characterized the disease. The prodromal phase was characterized by fever (77.8%), myalgia (66.7%), and gastrointestinal symptoms (vomiting and diarrhea; 55.6%) starting, on average, 5 days before the illness phase, which was characterized by respiratory failure in all patients. Five patients died (55.6%) and the length of stay in the intensive care unit was 19 days (range, 11-28 days) for survivors. Detection of two back-to-back recent cases highlights the reason to screen for hantavirus infection during the nonspecific phase of the disease, in particular when concomitant pulmonary infection and digestive disorders are observed. Specific longitudinal serological surveys must also be used to identify other potential clinical forms of the disease in French Guiana.


Subject(s)
Hantavirus Pulmonary Syndrome , Orthohantavirus , RNA Viruses , Male , Humans , Middle Aged , Female , French Guiana/epidemiology , Hantavirus Pulmonary Syndrome/diagnosis , Hantavirus Pulmonary Syndrome/epidemiology , Hospitals
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