When local phytotherapies meet biomedicine. Cross-sectional study of knowledge and intercultural practices against malaria in Eastern French Guiana.

ETHNOPHARMACOLOGICAL RELEVANCE: In French Guiana, traditional phytotherapies are an important part of self-healthcare, however, a precise understanding of the interactions between local phytotherapies and biomedicine is lacking. Malaria is still endemic in the transition area between French Guiana and Brazil, and practices of self-treatment, although difficult to detect, have possible consequences on the outcome of public health policies. AIM OF THE STUDY: The objectives of this research were 1) to document occurences of co-medication (interactions between biomedicine and local phytotherapies) against malaria around Saint-Georges de l'Oyapock (SGO), 2) to quantify and to qualify plant uses against malaria, 3) and to discuss potential effects of such co-medications, in order to improve synergy between community efforts and public health programs in SGO particularly, and in Amazonia more broadly. MATERIALS AND METHODS: This cross-sectional study was conducted in 2017 in SGO. Inhabitants of any age and nationality were interviewed using a questionnaire (122 questions) about their knowledge and habits regarding malaria, and their use of plants to prevent and treat it. They were invited to show their potential responses on a poster illustrating the most common antimalarial plants used in the area. In order to correlate plant uses and malaria epidemiology, all participants subsequently received a medical examination, and malaria detection was performed by Rapid Diagnostic Test (RDT) and Polymerase Chain Reaction (PCR). RESULTS: A total of 1566 inhabitants were included in the study. Forty-six percent of them declared that they had been infected by malaria at least once, and this rate increased with age. Every person who reported that they had had malaria also indicated that they had taken antimalarial drugs (at least for the last episode), and self-medication against malaria with pharmaceuticals was reported in 142 cases. A total of 550 plant users was recorded (35.1% of the interviewed population). Among them 95.5% associated pharmaceuticals to plants. All plants reported to treat malaria were shared by every cultural group around SGO, but three plants were primarily used by the Palikur: Cymbopogon citratus, Citrus aurantifolia and Siparuna guianensis. Two plants stand out among those used by Creoles: Eryngium foetidum and Quassia amara, although the latter is used by all groups and is by far the most cited plant by every cultural group. Cultivated species accounts for 91.3% of the use reports, while wild taxa account for only 18.4%. CONCLUSIONS: This study showed that residents of SGO in French Guiana are relying on both traditional phytotherapies and pharmaceutical drugs to treat malaria. This medical pluralism is to be understood as a form of pragmatism: people are collecting or cultivating plants for medicinal purposes, which is probably more congruent with their respective cultures and highlights the wish for a certain independence of the care process. A better consideration of these practices is thus necessary to improve public health response to malaria.

Knowledge, attitudes, practices about HIV and implications in risk and stigma prevention among French Guianese and Brazilian border inhabitants : Beliefs about HIV among border inhabitants.

BACKGROUND: The border area between French Guiana and Brazil is an active HIV-transmission zone. The aim of the present study was to describe HIV knowledge, risk and the level of stigma among inhabitants of this border area. METHODS: A cross-sectional study was conducted among 621 inhabitants over 18 years of age in the border cities of Saint-Georges-de-l'Oyapock in French Guiana and Oiapoque in Brazil. It was conducted between October 2017 and February 2018. An anonymous standardized questionnaire was filled out by culturally-trained mediators, then analyzed using STATA 12. RESULTS: Almost half (45.9%) of the individuals had a low education level. Participants whose native language was Portuguese or French demonstrated better HIV knowledge than other populations, notably native Amerindian and creole-speaking people. HIV risk behavior was more frequent in men and in younger age groups. People with good HIV knowledge reported having performed more HIV tests in the last year than participants with poor knowledge. The stigma level was high and reported in 74.8% of respondents. CONCLUSIONS: These results illustrate the need for initiatives to improve HIV prevention among autochthonous populations on both sides of this border area. Cross-border collaboration on health policies could produce common key messages adapted to the education level and multi-linguistic populations who live in this area.

Decreased antibiotic susceptibility of Enterobacteriaceae causing community-acquired urinary tract infections in French Amazonia.

OBJECTIVES: Urinary tract infections (UTIs) have rarely been studied in the Amazon region. We aimed to describe the epidemiology of bacteria causing UTIs in French Guiana. PATIENTS AND METHODS: We performed a monocenter retrospective study of adults consulting at the emergency department of Cayenne Hospital in 2014 with a diagnosis of UTI. The bacterial species and resistance profile were described. RESULTS: Two-hundred-and-eighty-nine patients presenting with UTI were included: 82 (28.4%) presented with cystitis, 166 (57.4%) with pyelonephritis, and 41 (14.2%) with male UTI. E. coli was predominant (74.1%), and had decreased susceptibility to ampicillin, amoxicillin-clavulanic acid, fluoroquinolones, co-trimoxazole, and furans compared with data from metropolitan France. Extended-spectrum beta-lactamases (ESBL) was isolated in 3.1% of E. coli and 31.6% of K. pneumoniae. CONCLUSIONS: Antibiotic susceptibility in UTI is lower than reported in metropolitan France without evidence for an excessive consumption of antibiotics.

[Pediatric Morbidity of a Native American Village in French Guiana (2009-2016)]. / Morbidité pédiatrique d'un village amérindien en Guyane française (2009­2016).

The situation of the Amerindian village of Camopi in French Guiana is particular because of its geographical isolation and its socio-cultural environment. Does this unique context affect the morbidity of the children? This study describes the morbidity of children aged 0-5 years in Camopi. The study population included all the children living in Camopi, born between 01/01/2009 and 31/12/2013. Sociodemographic and medical data were collected from Child Health Record until 05/01/2016, with a maximum of five years. 149 children were included and received 5916 consultations during the period of study. ENT and upper respiratory diseases were the most frequent diseases that were followed by digestive disorders. Lower respiratory conditions were the leading cause of hospitalization. Tropical diseases were rare. Antibiotics were delivered in 32.5% of the consultations. The vaccination coverage exceeded 95% for BCG, DTP, HBVand yellow fever, remove than that of MMR which was little lower (89.9%) and only 4 children were vaccinated against pneumococcus. Despite the Amazonian context, the morbidity of Camopi's children mainly includes classic disorders. Traumas seem uncommon but can be violent. Facilitating access to rapid diagnostic tests, setting up protocols, and training staff could reduce the prescription of antibiotics.

La situation du village amérindien de Camopi en Guyane française est particulière de par son isolement géographique et son environnement socioculturel. Ce contexte singulier influe-t-il sur la morbidité des enfants de ce village ? Le but de cette étude était de décrire lamorbidité des enfants âgés de zéro à cinq ans dans ce village. La population étudiée comprenait tous les enfants résidant à Camopi, nés entre le 1er janvier 2009 et le 31 décembre 2013. Des données sociodémographiques et médicales ont été recueillies à partir des carnets de santé jusqu'au 1er mai 2016, avec une durée maximale de suivi de cinq ans. Les 149 enfants inclus ont bénéficié de 5 916 consultations au cours de la période étudiée. Les pathologies ORL et respiratoires hautes étaient les plus fréquentes suivies par les affections digestives. Les affections respiratoires basses étaient la première cause d'hospitalisation. Les pathologies tropicales étaient peu fréquentes. La prescription d'antibiotiques concernait 32,5 % des consultations. La couverture vaccinale dépassait les 95 % pour le BCG, le DTP, le VHB et la fièvre jaune, celle du ROR un peu inférieure (89,9 %), et seuls quatre enfants avaient été vaccinés contre le pneumocoque. Malgré le contexte amazonien, la morbidité des enfants de Camopi regroupe majoritairement des affections classiques. Les traumatismes semblent peu fréquents, mais peuvent être violents. La facilitation de l'accès aux tests de diagnostic rapide, la mise en place de protocoles et la formation du personnel devraient permettre de diminuer la prescription d'antibiotiques.

Asymptomatic Plasmodium falciparum and vivax infection in the neighborhood of Blondin, Saint-Georges-de-l'Oyapock District, French Guiana.

Optimized elimination strategies are needed to control transmission of malaria. As part of an elimination campaign, active detection of asymptomatic Plasmodium carriers by highly sensitive methods is deemed necessary. Asymptomatic carriage leads to complex scientific, ethical, and operational issues regarding individual or collective detection and treatment. To address this issue, a crosssectional study was carried out in French Guiana to determine the prevalence of asymptomatic Plasmodium carriage during an inter-epidemic season in the whole population of a neighborhood of Saint-Georges-de-l'Oyapock, along the Brazilian border. Fifty-eight participants out of 63 residents were screened. The median age was 23.3 years (range: 2 months-72 years), with a male/female sex-ratio of 0.56. The majority of the participants (74%, N = 43/58) reported a history of malaria, 12% (N = 7/58) during the past 12 months. All rapid diagnostic tests for malaria were negative. Among the 58 participants, malaria prevalence detected by nested-PCR (Polymerase Chain Reaction) was 3.6% (N = 2/56). Two asymptomatic carriers of Plasmodium were identified: one child with Plasmodium vivax and one adult with Plasmodium falciparum. These two carriers were treated and did not develop malaria within the eight months following the diagnosis. This study confirmed the presence of asymptomatic parasitaemias outside hyperendemic areas. However, the benefits of such an active detection and patient treatment to eliminate malaria in French Guiana need to be evaluated at a larger scale.

[Leptospirosis in French Guiana and the Guiana shield: Current knowledge in 2016]. / La leptospirose en Guyane française et sur le bouclier des Guyanes. État des connaissances en 2016.

Leptospirosis is a cosmopolitan zoonosis caused by bacteria of the genus Leptospira. Whether the distribution is worldwide, the hot and humid climate of the tropics is particularly conducive to its expansion. In most French overseas departments and territories, leptospirosis is considered as a public health problem. In French Guiana, a French department located in the northeastern part of the Amazon rainforest, it is supposed to be rare. The objective of this review was to make an inventory of the knowledge on human and animal leptospirosis in French Guiana and neighboring countries. A comprehensive search was conducted through the indexed and informal medical literature in English, French, Spanish and Portuguese. Thus, respectively ten and four publications were identified on human and animal leptospirosis in French Guiana, published between 1940 and 1995 in the form of case reports or case series. The publications concerning this disease in the other countries of the Guiana Shield, eastern Venezuela, Guyana, Suriname, and Brazilian state of Amapá, also scarce or nonexistent. However recent data from the French National Centre of leptospirosis showed a recent and sudden increase in the number of cases in the department, probably partly due to the development of diagnostic tools such as Elisa IgM serology. It is likely that leptospirosis is a neglected disease in the region, due to the lack of diagnostic tools readily available, the lack of knowledge of the local clinicians on this disease and the existence of many other pathogens with similar clinical presentation such as malaria, arboviruses and Q fever and Amazonian toxoplasmosis. The establishment of more large-scale studies on animal and human leptospirosis is necessary and urgent to know the true burden of this disease in our region.

[Zika virus outbreak in Latin America: what are the challenges for French Guiana in April 2016?]. / Épidémie de virus Zika en Amérique latine : quels enjeux pour la Guyane française en avril 2016 ?

Started in 2015 in Brazil, an outbreak linked to a little known arbovirus, Zika virus spread throughout Latin America. This virus, considered until recently as responsible of only mild symptoms, made mention of previously unsuspected complications, with severe neurological manifestations in adults and malformations of the central nervous system, including microcephaly, in newborns of mother infected during the pregnancy. While the continent is more accustomed to the succession of arbovirus epidemics, suspected complications and the many unknowns keys of the latter arriving raise many public health issues. French Guiana, a French territory located in the north-east of the continent, combines both European level of resources and climate and issues specific to the Amazon region and Latin America. We discuss here the issues for 2016 Zika virus epidemic in our region, many of them are generalizable to neighboring countries.

[Paradoxical reactions and responses during antibiotic treatment for Mycobacterium ulcerans infection (Buruli ulcer). Four cases from French Guiana]. / Réponses et réactions paradoxales au cours du traitement médicamenteux de l'infection à Mycobacterium ulcerans (ulcère de Buruli). Quatre observations en Guyane française.

BACKGROUND: In recent years, first-line therapy for Mycobacterium ulcerans infection in French Guiana has consisted of antibiotics active against this organism. Two regimens are used comprising rifampicin associated with clarithromycin or amikacin. PATIENTS AND METHODS: We describe four patients presenting apparent worsening of their lesions during treatment: ulceration of a nodular lesion in a 32-year-old woman and worsening of an ulcerated lesion in three patients aged 16, 27 and 79 years. DISCUSSION: In these 4 patients, we concluded that the symptoms were caused by a paradoxical response or a reaction, a phenomenon already described in tuberculosis and leprosy. Such worsening is transient and must not be misinterpreted as failure to respond to treatment. The most plausible pathophysiological hypothesis involves the re-emergence of potentially necrotizing cellular immunity secondary to the loss of mycolactone, a necrotizing and immunosuppressive toxin produced by M. ulcerans, resulting from the action of the antibiotics.

Association between hepatitis E and neurological disorders: two case studies and literature review.

Hepatitis E (HEV) is an emerging disease in our developed countries, but is not routinely tested for in case of liver cytolysis. However, a growing number of extra-hepatic manifestations of HEV infection associated with acute hepatitis are reported. In this article, we discuss two cases of HEV with neurological symptoms, one with encephalitis, and the other with Parsonage Turner syndrome. All these disorders appeared concomitantly with liver cytolysis and disappeared quickly, following the viral kinetics. Only twenty cases of neurological manifestation of HEV have been described before. The use of HEV serology in patients with concurrent liver cytolysis and neurological symptoms has to be improved.

[Incidence of malaria among United Nations troops deployed in the Ituri district of Democratic Republic of Congo (ex-Zaire) during a 12-month period spanning 2005 and 2006]. / Evaluation de l'importance du paludisme chez les militaires de l'ONU déployés sur le district de i'Ituri en ex-Zaïre pendant une période de 12 mois des années 2005-2006.

The purpose of this study was to determine the incidence of malaria in United Nations (UN) troops deployed in northeastern Democratic Republic of Congo (ex-Zaire). A one-year study was conducted from June 2005 to May 2006. The study was retrospective for the first six months and prospective for the second. During the study period, a total of 99 cases of malaria requiring hospitalization at the UN Level II Hospital in the town of Bunia, Democratic Republic of Congo were recorded among UN troops. Malaria accounted for approximately 36% of all hospitalizations for medical diseases. The offending species in 98% of cases was Plasmodium falciparum. Transmission was highest from April to September. There were no deaths. Parasitemia was less than or equal to 2% in 91% of cases.

Evaluation of the environmental implications of the incorporation of feed-use amino acids in the manufacturing of pig and broiler feeds using Life Cycle Assessment.

The incorporation of feed-use (FU) amino acids (AAs) in diets results in a reduced use of protein-rich ingredients such as soybean meal, recognized to have elevated contributions to environmental impacts. This study investigated whether the incorporation of L-lysine.HCl, L-threonine and FU-methionine reduces the environmental impacts of pig and broiler feeds using Life Cycle Assessment. The following impact categories were considered: climate change, eutrophication, acidification, terrestrial ecotoxicity, cumulative energy demand and land occupation. Several feeds were formulated either to minimize the cost of the formulation (with or without AA utilization), to maximize AA incorporation (i.e. the cost of AA was considered to be similar to that of soybean meal), or to minimize greenhouse gas emissions. For both pig and broiler feeds, calculations were made first using only cereals and soybean meal as main ingredients and then using cereals and several protein-rich ingredients (soybean meal, rapeseed meal and peas). In addition, these calculations were performed using two types of soybean meal (from Brazil, associated with recent deforestation or not). For broiler feeds, two types of maize (from France, irrigated, with mineral fertilization v. not irrigated, with animal manure fertilization) were also tested. Regarding the feeds formulated to minimize cost, incorporation of AA decreased the values for eutrophication, terrestrial ecotoxicity and cumulative energy demand of both pig and broiler feeds, regardless of the base ingredients. Reduction in climate change and acidification due to the incorporation of AA depended on the nature of the feed ingredients, with the effect of AA incorporation being greater when combined with ingredients with high impacts such as soybean meal associated with deforestation. Feeds formulated to maximize AA incorporation generally had a similar composition to those formulated to minimize cost, suggesting that the costs of AA were not the limiting factor in their incorporation. Feeds formulated to minimize greenhouse gas emissions had the lowest values for climate change and cumulative energy demand, but not for other impacts. Further research is needed to elucidate whether the incorporation of additional AA (tryptophan and valine) along with L-lysine, L-threonine and FU-methionine could decrease on the environmental impacts of pig and broiler feeds further.

Reduced feed intake of lactating primiparous sows is associated with increased insulin resistance during the peripartum period and is not modified through supplementation with dietary tryptophan.

The aim of this experiment was to investigate whether insulin resistance is related to the dietary concentration of Trp and the ADFI of primiparous sows having similar body conditions. Twenty-four primiparous sows were catheterized on d 97 of pregnancy. Blood samples were collected during 3 tests: after the ingestion of 1.5 kg of feed (meal test), after the intravenous infusion of 0.5 g of glucose/kg of BW (glucose tolerance test), and during an euglycemic hyperinsulinemic clamp with an infusion rate of 100 ng of insulin x kg of BW(-1) x min(-1). Both tests were performed at 4 stages at approximately d 103 and 110 of pregnancy and at d 3 and 10 of lactation. Sows were fed a diet containing 0.16 or 0.26% of total Trp (suboptimal vs. slight excessive Trp supply according to recommendations for lactating sows) from d 104 of pregnancy after the first clamp until weaning. The dietary treatment did not result in differences in ADFI, BW, and backfat changes, and growth of piglets during lactation. Plasma Trp concentration was greater for the sows allocated to the slight excessive Trp diet than for the sows allocated to the suboptimal Trp diet (P < 0.05). Plasma glucose, NEFA, and urea profiles during the meal tests were not affected by the dietary treatment. At d 3 of lactation, the insulin concentration at 105 (P = 0.03) and 120 min (P = 0.04) after meal intake was less for the sows allocated to the slight excessive Trp diet than for the sows allocated to the suboptimal Trp diet. On d 10 of lactation, the glucose half life (P = 0.03) and the time needed to reach 25% of the area under the insulin curve (P = 0.04) during the tolerance test were less for the sows allocated to the slight excessive Trp diet than for the sows allocated to the suboptimal Trp diet. The glucose infusion rate during euglycemic hyperinsulinemic clamps was similar in the 2 Trp groups of sows. Irrespective of the dietary treatment, the ADFI of the sows was negatively related to the glucose half life during the glucose tolerance test and positively related to the glucose infusion rate during the clamp (P < 0.05). This relationship observed with the tests performed during early lactation was already found with the tests performed during late pregnancy (P < 0.02). Present findings indicate that a dietary Trp supply of 0.26% does not increase feed intake in lactating primiparous sows. This result indicates that the interest in a Trp supplementation during the peripartum period can be questioned. Irrespective of the dietary treatment, the reasons why sows with similar rearing conditions develop different rates of insulin resistance during pregnancy remain to be elucidated.

Feed intake in the multiparous lactating sow: its relationship with reactivity during gestation and tryptophan status.

Voluntary feed intake in sows after parturition may be related to the capacity of the sow to cope with the numerous changes occurring around farrowing. This experiment was undertaken to investigate whether the feed intake during lactation was related to the reactivity of the sow during gestation and plasma Trp and cortisol concentrations. On d 58 of pregnancy, 37 sows were individually placed in a novel environment, and their behavior was observed during a 5-min open-field test. This test allowed the selection of 12 reactive (R) and 8 nonreactive (NR) sows for the study. Sows were fed 3 kg of a standard gestation diet/d before farrowing and a standard lactation diet ad libitum thereafter. The behavioral reactivity of sows when a human touched their neck in the farrowing crate was evaluated on d 72 of gestation, and their behavior during farrowing was analyzed. Sows were catheterized on d 70 of gestation, and blood samples were taken after an overnight fast on d 37 before farrowing, daily during the week before and the week after parturition, and on d 14 and 21 of lactation for plasma Trp and cortisol determination. The NR sows were less reactive to human contact (P=0.02), had a shorter farrowing duration (P=0.02), and tended to have a shorter birth interval between piglets (P=0.09) than the R sows. Feed intake was greater for the NR sows than for the R sows during wk 1 of lactation (P=0.02), as well as during the whole lactation (P=0.03). Plasma cortisol concentration was maximal on the day after farrowing (P=0.01) and returned to basal concentration within 4 d postpartum. No relationship was observed between sow behavior and plasma concentration of cortisol. For both groups of sows, plasma concentrations of Trp between d 2 and 4 postpartum were less than during gestation (P<0.05). The NR sows had decreased plasma Trp concentrations compared with the R sows during wk 1 of lactation (P=0.02). A low reactivity during gestation was associated with behavior of the sow that was favorable to piglet survival during farrowing, increased feed intake, and decreased plasma Trp concentration during wk 1 of lactation. Further research is needed to elucidate whether Trp or Trp metabolites are related to reactivity and ADFI of the reproducing sow.