Detection of zoonotic pathogens in animals performed at the University Hospital Institute Méditerranée Infection (Marseille - France).

At the University Hospital Institute Méditerranée Infection (IHU, Marseille, France), for almost thirty years, veterinarians have been carrying out epidemiological investigations, together with doctors, on animals living near human cases of zoonoses, on the one hand, and on the other hand, transverse and longitudinal epidemiological surveillance studies on animals which are reservoirs, vectors or sentinels of potentially zoonotic infections,. This article presents the methods adopted and the results obtained from these studies. They have been the subject of 76 peer-reviewed publications relating to wild animals (37 publications) and/or domestic animals (48 publications). These studies were often carried out in the field with veterinarians from the French army's health service (39 publications). They were at the origin of the detection of some thirty zoonotic pathogens in the laboratories of the IHU (64 publications) and/or other French laboratories (18 publications). Our approach is an original embodiment of the "One Health" concept.

Enzootic Hepatic Capillariasis (Calodium hepaticum) in Street Rats (Rattus norvegicus) from Marseille City, France.

Hepatic capillariasis is a rare and neglected zoonosis affecting wild and synanthropic small rodents. It is caused by infection with Calodium hepaticum in liver. Despite the worldwide distribution of the host Rattus norvegicus (brown or street rats) in the urban area, the epidemiological status of this parasitosis remains unknown. In the present study, we examined a total of 27 brown rats from the city centre and a garden (four km from the city centre) of Marseille, France. All rats were autopsied and 52% showed the presence of C. hepaticum eggs in the liver. This result draws general attention to public health risks, since street rats are living near the human population.

Seroprevalence of Crimean-Congo Hemorrhagic Fever in Domesticated Animals in Northwestern Senegal.

Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne disease that can be contracted by direct contact with viremic animals or humans. In West Africa, recurrent CCHF outbreaks have been constantly observed in Mauritania and Senegal. Moreover, acquisition and epidemiology of the infection in humans are correlated with the occurrence and the seroprevalence of the virus in livestock. The main objective of this study is to provide updated information on the local spread of CCHF in animals in the northern region of Senegal. Out of a total of 283 animal sera collected, CCHF-specific antibodies were identified in 92 (32.5%; confidence interval [CI]95% 27.1-38.3) sera by double antigen sandwich enzyme-linked immunosorbent assay (ELISA) test. The prevalence of CCHF virus (CCHFV) infection among horses, cattle, sheep, dogs, donkeys, and goats was 70.3% (45/64), 57.1% (8/14), 22.1% (30/136), 18.2% (2/11), 17.2% (5/29), and 6.9% (2/29), respectively. The antibody titers were found significantly affected by age (p < 0.0001) and gender (p < 0.05). High tick infestation by Rhipicephalus spp. and Hyalomma spp. was recorded on horses. The high seroprevalence to CCHFV among animals in the northern region of Senegal observed in this study indicates the permanent presence of the infection in the northern region of the country suggesting the need to strengthen surveillance plans for CCHF in Senegal.

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.

Management of war-related vascular wounds in French role 3 hospital during the Afghan campaign.

OBJECTIVES: To describe the management of war-related vascular injuries in the Kabul French military hospital. METHODS: From January 2009 to April 2013, in the Kabul French military hospital, we prospectively included all patients presenting with war-related vascular injuries. We collected the following data: site, type, and mechanism of vascular injury, associated trauma, type of vascular repair, amputation rate and complications. RESULTS: Out of the 922 soldiers admitted for emergency surgical care, we recorded 45 (5%) patients presenting with vascular injuries: 30 (67%) gunshot-related, 11 (24%) explosive device-related, and 4 (9%) due to road traffic accident. The majority of injuries (93%) involved limbs. Vascular injuries were associated with fractures in 71% of cases. Twelve (26.7%) had an early amputation performed before evacuation. Twenty (44.4%) patients underwent fasciotomy and three (6.6%) sustained a compartment syndrome. CONCLUSIONS: This was the first French reported series of war-related vascular injuries during the last decade's major conflicts. The majority of injuries occurred in the limbs. Autologous vein graft remains the treatment of choice for arterial repair. Functional severity of these injuries justifies specific training for military surgeons.

Management of War-Related Ballistic Craniocerebral Injuries in a French Role 3 Hospital During the Afghan Campaign.

INTRODUCTION: France deployed to Afghanistan from 2001 to 2014 within the International Security and Assistance Force. A French role 3 hospital was built in 2009 in the vicinity of Kabul International Airport (KaIA). The objectives of this study were to describe the epidemiology, management, and outcome of war-related craniocerebral injuries during the Afghan campaign in a French role 3 hospital. METHODS: From March 1, 2010 to September 30, 2012, we conducted a retrospective descriptive study in Kabul, Afghanistan. All patients presenting with a ballistic craniocerebral injury to the KaIA role 3 hospital were included. RESULTS: We analyzed 48 records. Mean age was 21.9 years (1-46 years) with a 37:11 (male:female) sex ratio and a majority Afghan population (n = 41). Civilians represented 64.6% (n = 31) of casualties. On the battlefield, mean Glasgow Coma Scale score was 9.4 [3-15]. On arrival at the KaIA field hospital, 20 of the 48 patients were hemodynamically unstable. All patients underwent a full-body computed tomography scan. The majority of our casualties had associated injuries. Neurosurgery was indicated for 42 (87.5%) patients. The surgery consisted of wound debridement plane by plane associated with decompressive craniectomy (n = 11), debridement craniectomy (n = 19), and craniotomy (n = 12). A total of 32.4% wounded died at the point of injury, 8.4% at the emergency department, and 16.9% after surgery. CONCLUSIONS: War casualties with ballistic head injuries were predominantly multitraumatized patients with hemodynamic compromise requiring neurosurgical damage control management and multidisciplinary care. The neurosurgeon has thus an essential role to play.

Seroprevalence of Toxoplasma gondii in hunted wild boars (Sus scrofa) from southeastern France.

Toxoplasma gondii (Nicolle et Manceaux, 1908) is an obligate intracellular, parasitic protozoan within the phylum Apicomplexa that causes toxoplasmosis in mammalian hosts (including humans) and birds. Since meat of wild boar, Sus scrofa (Linnaeus), has been demonstrated to be a potential source of human infection, a careful evaluation of the prevalence of infection with T. gondii in hunted animals is needed to protect public health. In the Var area in southeastern France, we performed a spatio-temporal survey in order to investigate the prevalence of IgG antibodies in wild boars shot by hunters in the Canjuers military camp during two subsequent hunting seasons. Of 841 wild boars screened, antibodies (IgG) to T. gondii (modified agglutination test, cut-off 1 : 6) were found in 141 (16.8%) muscle extract samples. A significant association (p < 0.001) was found between positivity and age, but not gender, and hunting districts. The results obtained indicate that consumption of raw or undercooked meat from wild boars carries an important risk of infection with T. gondii. Wild boars may be considered as a bioindicator of parasite circulation in this ecosystem.

Serological Survey of West Nile Virus in Domestic Animals from Northwest Senegal.

In Africa, infection with West Nile virus (WNV) is frequent but almost always asymptomatic in humans and equids. The aim of this study was to identify whether any other domestic animal living in the same enzootic locality may be the sentinel of WNV circulation. In northwest Senegal, blood samples were collected from 283 adult domestic animals (136 sheep, 64 horses, 29 donkeys, 29 goats, 14 cattle, and 11 dogs), in three localities near Keur Momar Sarr. Each serum was tested for WNV immunoglobulin G using enzyme-linked immunosorbent assay. The prevalence among donkeys, horses, dogs, goats, cattle, and sheep was 86.2%, 68.7%, 27.3%, 6.9%, 0%, and 0%, respectively. This survey confirms that equids and dogs could be the best sentinel animals for surveillance of WNV. The ruminants do not play a role in WNV epidemiology.

Serological survey of canine leptospirosis in three countries of tropical Africa: Sudan, Gabon and Ivory Coast.

A cross-sectional survey was conducted to estimate the presence of leptospiral antibodies among 475 dogs from three countries of tropical Africa: Sudan (n=62), Gabon (n=255) and Ivory Coast (n=158). Sixteen reference strains belonging to seven serogroups were used as antigen in the microscopic agglutination test. Overall, considering titres ≥1:40, 453 samples were positive towards one or several serovars of pathogenic leptospires. Focusing on high titres, i.e. ≥1:320, the seroprevalence was 40.8%. In Gabon, the seroprevalence was higher in rural areas than in an urban environment (p<0.001). In Ivory Coast, the seroprevalence for serogroups Icterohaemorrhagiae and Canicola was not statistically different according to the vaccinal status. Predominant serogroups varied according to the countries but Grippotyphosa and Sejroë were the most common, while Icterohaemorragiae and Canicola were dominant in Sudan. In these three countries, dogs are heavily exposed to pathogenic Leptospira and humans living in the same environment are also at risk of infection.

Spectrum and impact of health problems during deployment: a prospective, multicenter study of French soldiers operating in Afghanistan, Lebanon and Côte d'Ivoire.

BACKGROUND: More than 15 000 French soldiers are continuously deployed abroad. Along with combat-related injuries, they are exposed to non-combat-related diseases with an underestimated burden. Our objectives were to assess the incidence and impact of health problems on their operating capacity. METHODS: A prospective multicenter study was conducted over more than three months in Lebanon, Côte d'Ivoire and Afghanistan including exclusively French soldiers. RESULTS: We collected 4349 consultations (Afghanistan {n = 719}, Lebanon {n = 1401} and Côte d'Ivoire {n = 2229}) encompassing 4600 health problems. Injuries (21%), diarrhea (19%), dermatoses (17.5%) and respiratory tract infections (10.45%) were the most frequent health issues. Infectious diseases represented 41% of all health problems. Almost nine out of ten patients were managed as outpatients. Ten combat-related deaths were observed. We reported 68 (1.5%) medical repatriations of which 28 and 26 were psychiatric and trauma cases respectively. Partial or complete incapacity was estimated 724 days/1000 men/month. Etiological spectrum was similar in all three countries however, the incidence of diarrhea (p < 0.05) as well as inpatient management and medical evacuation rates were higher (p < 0.0001) in Afghanistan. CONCLUSIONS: There was a wide spectrum of health problems occurring during military deployments with a predominance of common infections. Non-combat-related pathology represented an important burden for the loss of operating capacity.

Epidemiological study of animal leptospirosis in new caledonia.

Leptospirosis is an important zoonotic disease in the world and a real public health concern for many years in New Caledonia. A cross-sectional survey was carried out on domestic and wild animals from New Caledonia in April 2009. Blood samples were collected from 30 cattle, 29 deers, (Cervus timorensis russa), 25 horses, 51 dogs, and 8 cats and were tested for 23 serovars of pathogenic Leptospira species by the microscopic agglutination test. From the total number of 143 samples, 84 (58.7%) were found to be positive towards one or several serovars of pathogenic leptospires. According to the species, the positive sera were obtained from 43% of 30 cattle, 72% of 29 Rusa deer, 80% of 25 horses, and 43% of 51 dogs, and fromall of the 8 cats tested. This study shows the broad dispersion and the high prevalence of the different serogroups of pathogenic Leptospira species tested, particularly among deer and horses. The disease is endemic in domestic animals and concerns all the species.

A twenty-year follow-up of canine leishmaniosis in three military kennels in southeastern France.

BACKGROUND: Canine leishmaniosis (CanL) is enzootic in southeastern France, and military working dogs (MWD) posted in this area are highly exposed. To assess the efficiency of prevention, we performed a serological and clinical follow-up of 80 MWD in the Var and Corsica regions during the 20-year period from 1993 to 2012. The systematic and specific prevention of CanL using a deltamethrin-impregnated collar (DMC) was implemented in 2002. FINDINGS: Out of 80 dogs tested annually, the cumulative serological and clinical incidence was 42.5% (34/80) and 21.2% (17/80) respectively, during the first period, and these numbers decreased to 6.2% (5/80) and 2.5% (2/80) during the second period (p < 0.00001). Considering the incidence of serology since 2002, the CanL risk has been reduced by 85.2% and the level of protection of MWD reached 93.8%. Dogs without collars had a 10.4-fold greater chance of becoming infected than protected dogs. Although other ecological factors might have influenced the epidemiology of CanL, DMC usage was the main factor affecting dog exposure to CanL. CONCLUSIONS: The prevention strategy based on DMC proved highly efficient in our population of MWD, as it effectively controlled the disease. This result is also of interest to public health, as dogs are reservoirs for Leishmania infantum.

Rickettsiae in arthropods collected from red foxes (Vulpes vulpes) in France.

The aim of our study was to detect the presence of Rickettsia spp. and Bartonella spp. in ticks and fleas collected from red foxes (Vulpes vulpes) in southeastern France during 2008. Using a genus-specific quantitative PCR (qPCR) assay, which was followed by a species-specific qPCR assay for the positive samples, 45.2% (33/73) of ticks (Rhipicephalus turanicus) were found to be infected with Rickettsia massiliae. 10.5% (2/19) of the fleas (Archaeopsylla erinacei) collected in the study tested positive for Rickettsia felis. A genus-specific qPCR assay did not reveal any Bartonella species in any of the ticks or fleas collected. The role of red foxes in the epidemiology of spotted fever caused by Rickettsiae species requires further investigation.

Canine leishmaniasis in south-east of France: screening of Leishmania infantum antibodies (western blotting, ELISA) and parasitaemia levels by PCR quantification.

Leishmania infantum leishmaniasis is endemic in south-east of France. The main goal of our study was to evaluate the real prevalence of asymptomatic carriage in dogs by means of real time quantitative PCR (qPCR) and serology. We included prospectively 140 military dogs wearing deltamethrine-impregnated collars. Parasitaemia levels were then measured by means of quantitative real time PCR targeting kinetoplast DNA with TaqMan chemistry. ELISA and western blotting (WB) were used for serological screening. The number of dogs working in three areas was the following: Var (n=48), Bouches-du-Rhône (n=61) and Corsica (n=31). Prevalence of symptomatic dogs was 0.7% (n=1). ELISA and WB were positive in one (0.71%) and 19 (14%) dogs, respectively. Fifty-eight dogs (41.4%) had a positive parasitaemia. Global prevalence (positive WB and/or positive qPCR) was 50% (n=70). Mean parasitaemia was 0.018 parasites/mL in the global population and 0.043 parasites/mL in positive dogs [min: 0.0002 to max: 2]. The concordance percent for WB and qPCR results was 55% (n=77). Regarding the prevalence of positive parasitaemia, a significant difference was noticed between dogs living in the Var region and those coming from the two other areas. Parasitaemia was rapidly positive within the first semester of stay in an enzootic area. Despite the use of deltamethrine-impregnated collars, the proportion of dogs with low parasitaemia is important. Thus, it may be relevant to evaluate the effect of screening and treating asymptomatic canine reservoirs on human infection by performing further studies comparing both populations.