From phaeohyphomycosis to disseminated chromoblastomycosis: A retrospective study of infections caused by dematiaceous fungi.

OBJECTIVE: Infections caused by dematiaceous fungi are more common in tropical and subtropical areas. We aimed to describe the clinical, microbiological and therapeutic aspects of case patients diagnosed at a University Hospital located on an Indian Ocean island. PATIENTS AND METHODS: We performed an observational retrospective study of infections caused by dematiaceous fungi diagnosed at the University Hospital of Saint-Pierre, Reunion, from 2000 to 2015. Mycological identifications were performed at the National Reference Center for Invasive Mycosis and Antifungal Agents (Paris). RESULTS: The review of clinical and microbiological data of 11 patients identified revealed that five were infected by dematiaceous fungi. Two had cutaneous phaeohyphomycosis, two had cerebral phaeohyphomycosis and one had cutaneous chromoblastomycosis with brain and potentially medullary dissemination. Skin lesions and cerebral abscesses were quite varied. CONCLUSION: Infections caused by dematiaceous fungi are rare. Medullary and brain localizations are extremely rare, especially for chromoblastomycosis. Cutaneous manifestations of phaeohyphomycosis are varied; diagnosis is thus more difficult. It is therefore important, when confronted with a chronic tumor-like lesion in endemic areas, to perform a biopsy for pathology and fungal culture. While surgical excision is not always sufficient, medical treatment of these infections is not standardized, but relies on an azole, which can be associated with another antifungal agent.

[Polyneuropathies in vitamin B1 deficiency in Reunion and Mayotte islands in 70 patients of Maori and Comorian descent]. / Polyneuropathies par hypovitaminose B1 aux îles de la Réunion et de Mayotte: à propos de 70 cas d'origine mahoraise et comorienne.

Beriberi is an uncommon disorder related to thiamine deficiency. It is mainly found in underdeveloped countries among populations with poorly diversified diet, consisting largely of milled white cereals, a poor source of thiamine. In industrialized countries, thiamine deficiency with cardiac failure is more frequently found than the dry beriberi in high risk groups like chronic alcoholics. Nevertheless our attention was drawn to an outbreak of 70 cases of dry beriberi which occurred from 1997 to 2005 in the French territories of Reunion and Mayotte islands. It was characterized by an acute or sub-acute sensorimotor polyneuropathy with axonal lesions, affecting the lower limbs and occasionally the upper limbs, sometimes associated with cardiac beriberi. It affected young, non alcoholic individuals from the Mahoran and Comorian community who were in apparent good health when the illness occurred. Our study highlighted the feeding habits which are partly responsible for the development of the disease due to a chronic lack of thiamine and which probably contributed together with multiple cofactors to trigger off the illness. But many elements and mainly biological ones, also lead us to think that there is a genetic predisposition to develop this neuropathy.

[Neurological manifestations in Chikungunya: about 23 cases collected in Reunion Island]. / Manifestations neurologiques du chikungunya: à propos de 23 cas colligés à la Réunion.

INTRODUCTION: We are reporting 23 cases of patients presenting neurological symptoms in the setting of a chikungunya outbreak that occurred in the Indian Ocean from March 2005 to April 2006. These symptoms were the cause of admission in our ward, mainly via the emergency room. CASE REPORTS: In the acute phase of their illness, 23 patients presented neurological symptoms associated with positive CSF tests (specific IgM or RT- PCR). Clinical manifestations included disrupted behavior or altered mental status in 95% of patients, headache in 30.4%, seizure in 26%, motor dysfunction in 4.3% and sensorial disorders in 8.7%. Outcome was fatal in two patients during their hospitalisation and several months after discharge in three other elderly bedridden patients with altered general status. CSF analysis was sometimes but not always inflammatory. CT or MRI, when done, showed no recent abnormality. EEG disclosed most often of a diffuse moderately slowed activity with no pseudo-periodic or unusual pattern. A few epileptic aspects were seen in known epileptic patients. The outcome of the neurological symptoms was generally good over a few days, contrasting with persisting impairment of general status and severe joint pains leading to a bedridden state and death in three patients. CONCLUSION: Nervous system involvement was not uncommon during the chikungunya outbreak in Reunion Island in 2005 and 2006. The most frequent expression was moderate confusion occurring during the acute phase of infection. Peripheral nerve involvement in the form of a typical Guillain Barré syndrome was also observed. In general, the neurological outcome was very good. Fatal issues occurring in the early stages or later on (five out of 23 patients) were related to altered general condition in debilitated bedridden elderly patients.