Molecular epidemiology identifies the expansion of the DENV2 epidemic lineage from the French Caribbean Islands to French Guiana and mainland France, 2023 to 2024.

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.

Desert dust episodes during pregnancy are associated with increased preterm delivery in French Guiana.

Preterm deliveries are a major multifactorial public health problem in French Guiana. Desert dust episodes have been associated with preterm delivery in Guadeloupe, a territory with similarities to French Guiana. We thus tried to replicate this finding in the context of French Guiana. A retrospective ecological cohort study combined daily PM10 concentration measurements during pregnancy and term at delivery extracted from French Guiana's computerized pregnancy delivery registry. Daily PM10 concentrations during the course of pregnancy were analyzed as mean concentrations and as the proportion of intense dust episodes (≥55 µg PM10/m3). These exposure variables were studied in relation to the outcome of preterm delivery. Overall, 3,321 pregnant women with complete daily PM10 measurements were included, of whom 374 (11.26%) delivered prematurely. Among preterm deliveries, 168 (44.9%) were spontaneous deliveries and 206 (55.1%) were induced. Rank-sum tests showed that, for spontaneous and induced spontaneous deliveries, both mean PM10 concentrations and proportions of intense desert dust episodes were significantly greater among preterm births than among term births. Although the proportion of intense desert dust episodes during pregnancy was significantly associated with spontaneous preterm deliveries, the relation was U-shaped, with an adjusted odds ratio (AOR) = 2 (95%CI = 1.2-3.1) for lowest values relative to median values and AOR = 5.4 (95%CI = 3.2-8.9) for the highest values relative to median values. Similarly, the proportion of intense desert dust episodes during pregnancy was also significantly associated with induced preterm deliveries in a U-shaped manner (AOR = 2.7 (95%CI = 1.6-4.5) for the lowest relative to median values and AOR = 6.8 (95%CI = 3.9-11.9) for the highest relative to median values). Although in our study the relation between PM10 concentrations appeared non-linear, the highest mean concentrations and intense desert dust episodes were indeed associated with both spontaneous and induced preterm delivery.

Multi-locus sequence analysis unveils a novel genus of filarial nematodes associated with ticks in French Guiana.

Filarial nematodes of the Dipetalonema lineage include tick-borne filarioids that infect both domestic and wild vertebrate hosts, but they remain understudied in many cases. In this study, we conducted a molecular characterization of a Dipetalonema-like filarioid (DLF) recently identified in two tick species in French Guiana, South America. While the cox1 mitochondrial gene was the sole marker initially sequenced for describing DLF, its classification and phylogenetic relationship with other members of the Dipetalonema lineage were unclear. Therefore, we better characterized DLF through the sequencing of six additional gene markers and conducted phylogenetic analyses. Based on this multi-locus typing scheme, DLF exhibited significant divergence from known genera and species of filarioids, or other sequences available in public databases, suggesting its potential classification as a novel genus within the Dipetalonema lineage. Phylogenetic analyses further unveiled a close evolutionary relationship between DLF and all other filarioids associated with Acari (ticks and mites) within a robust monophyletic subclade in the Dipetalonema lineage. Overall, these findings confirm the existence of a specialized, Acari-borne group of filarioids and underscore the need for comprehensive investigations into their epidemiology and potential impact on animal health.

Title: Une analyse de séquences multi-locus dévoile un nouveau genre de nématodes filaires, associé aux tiques en Guyane française. Abstract: Les filaires de la lignée Dipetalonema comprennent des espèces transmises par les tiques qui infectent à la fois des hôtes vertébrés domestiques et sauvages, mais qui restent sous-étudiées dans de nombreux cas. Dans cette étude, nous avons réalisé une caractérisation moléculaire d'un filarioïde ressemblant à Dipetalonema (FRD) récemment identifié dans deux espèces de tiques en Guyane française. Alors que la séquence du gène mitochondrial cox1 était le seul marqueur génétique initialement séquencé pour décrire FRD, sa classification et sa relation phylogénétique avec d'autres membres de la lignée Dipetalonema étaient incertaines. Par conséquent, nous avons caractérisé plus précisément DLF en séquençant six gènes supplémentaires et en réalisant des analyses phylogénétiques. Sur la base de ce typage multi-locus, FRD présentait une divergence significative par rapport aux genres et espèces connus de filarioïdes, ou à d'autres séquences disponibles dans les bases de données publiques, suggérant sa classification potentielle en tant que nouveau genre au sein de la lignée Dipetalonema. Les analyses phylogénétiques ont en outre révélé une relation évolutive étroite entre FRD et tous les autres filarioïdes associés aux tiques et acariens au sein d'un sous-clade monophylétique dans la lignée Dipetalonema. Dans l'ensemble, ces résultats confirment l'existence d'un groupe spécialisé de filarioïdes transmis par les tiques et acariens et soulignent la nécessité d'études approfondies sur leur épidémiologie et leur impact potentiel sur la santé animale.

Tuberculosis in prison: What about after release? The example of French Guiana.

INTRODUCTION: Tuberculosis is a major cause of mortality worldwide. Prisoners in Guiana have multiple risk factors. The primary objective of this study was to describe tuberculosis occurring in prison and after release in French Guiana between 2008 and 2020. Secondary objectives were to identify tuberculosis risk factors and determine annual incidences. METHODS: A retrospective cohort study of tuberculosis cases was carried out at the Guiana prison between 2008 and 2020. Data were collected from prison registers and cross-referenced with the list of tuberculosis notifications in French Guiana. RESULTS: A total of 36 cases of tuberculosis were studied. Incidence was high, at 263/100,000 per year, higher than elsewhere in France and comparable to that in Brazil. Despite visibly effective screening on entry, with little evidence of intra-prison circulation of tuberculosis, 39% of patients were diagnosed within two years of leaving prison (76% were symptomatic). This could be explained by the high prevalence of latent forms (LTI). DISCUSSION: Continued screening on entry, in combination with annual radiological and clinical screening, and reinforced follow-up on release seem indicated to improve patient management and the search for possible LTI.

Wastewater sequencing as a powerful tool to reveal SARS-CoV-2 variant introduction and spread in French Guiana, South America.

The origin of introduction of a new pathogen in a country, the evolutionary dynamics of an epidemic within a country, and the role of cross-border areas on pathogen dynamics remain complex to disentangle and are often poorly understood. For instance, cross-border areas represent the ideal location for the sharing of viral variants between countries, with international air travel, land travel and waterways playing an important role in the cross-border spread of infectious diseases. Unfortunately, monitoring the point of entry and the evolutionary dynamics of viruses in space and time within local populations remain challenging. Here we tested the efficiency of wastewater-based epidemiology and genotyping in monitoring Covid-19 epidemiology and SARS-CoV-2 variant dynamics in French Guiana, a tropical country located in South America. Our results suggest that wastewater-based epidemiology and genotyping are powerful tools to monitor variant introduction and disease evolution within a tropical country but the inclusion of both clinical and wastewater samples could still improve our understanding of genetic diversity co-circulating. Wastewater sequencing also revealed the cryptic transmission of SARS-CoV-2 variants within the country. Interestingly, we found some amino acid changes specific to the variants co-circulating in French Guiana, suggesting a local evolution of the SARS-CoV-2 variants after their introduction. More importantly, our results showed that the proximity to bordering countries was not the origin of the emergence of the French Guianese B.1.160.25 variant, but rather that this variant emerged from an ancestor B.1.160 variant introduced by European air plane travelers, suggesting thus that air travel remains a significant risk for cross-border spread of infectious diseases. Overall, we suggest that wastewater-based epidemiology and genotyping provides a cost effective and non-invasive approach for pathogen monitoring and an early-warning tool for disease emergence and spread within a tropical country.

Molecular epidemiology of Candida africana isolates collected from vagina swabs in French Guiana.

Previous molecular studies have shown that Candida africana corresponds to the clade 13 of Candia albicans. It has been mostly involved in vulvovaginal candidiasis worldwide but few data exist in South America. The aim of our study was to investigate the prevalence of C. africana in women living in French Guiana. For this, we first set up a fluorescent-intercalating-dye-real time Polymerase Chain Reaction (PCR) targeting the hyphal wall protein 1 gene. The test was applied to 212 C. albicans isolates collected from May to August 2019 from vaginal swabs, allowing the identification of six women harboring C. africana (eight isolates). The in vitro susceptibility of these eight isolates to six antifungal drugs was also evaluated. No demographics or clinical-specific features could be demonstrated. Genetic diversity of those isolates was analyzed through multilocus sequence typing and showed that diploid sequence type 182 was predominant (n = 6) and allowed the report of a new diploid sequence type.

Candida africana, the clade 13 of C. albicans, is characterized by specific genetic and phenotypic traits. Using a new molecular technique, we report a high prevalence of C. africana in vaginal swabs from patients living in French Guiana. The worldwide predominant genotype was detected in all but one patient.

Etiology of Acute Febrile Illnesses in Adults in the Defense Community in French Guiana.

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.

Migration in French Guiana: Implications in health and infectious diseases.

In French Guiana, more than a third of the population, and nearly half of the adults, are of foreign origin. This immigration is explained by the French standard of living, which is attractive to nationals of surrounding countries. Infectious diseases remain in the top 10 causes of premature death, often in the most precarious populations. In this context we aimed to synthesize the state of the knowledge regarding immigration and infectious diseases in French Guiana and the general implications that follow this diagnosis. For HIV, although the majority of patients are of foreign origin, estimates of the presumed date of infection based on CD4 erosion modelling and from molecular analyses suggest that the majority of transmissions in foreign-born individuals occur in French Guiana and that the Guiana shield has been a crossroad between Latin America and the Caribbean. Among key populations bridging these regions illegal gold miners are very mobile and have the greatest proportion B Caribbean HIV viruses. Gold miners have been a key vulnerable population for falciparum malaria and other tropical diseases such as leishmaniasis, leprosy, or leptospirosis. The complex history of migrations in French Guiana and on the Guiana Shield is also reflected in the fingerprinting of mycobacterium tuberculosis and the high incidence of tuberculosis in French Guiana, notably in immigrants, reflects the incidences in the countries of origin of patients. The high burden of infectious diseases in immigrants in French Guiana is first and foremost a reflection of the precarious living conditions within French Guiana and suggests that community-based proactive interventions are crucial to reduce transmission, morbidity, and mortality from infectious diseases.

Chest CT findings in community-acquired pneumonia due to Coxiella burnetii (Q fever) compared to Streptococcus pneumoniae, a cross sectional study in French Guiana, 2013-2017.

OBJECTIVES: Few and small studies previously examined chest CT-scan characteristics of Coxiella burnetii (Cb) community-acquired pneumonia (CAP). Larger studies are needed to guide physicians towards diagnosis of Q fever in case of pneumonia. METHODS: We conducted a single-center retrospective observational study between 2013 and 2017. All patients with Cb or Streptococcus pneumoniae (Sp) CAP who had a chest CT-scan on admission at Cayenne Hospital (French Guiana) were included. Chest CT-scan were all analyzed by the same expert radiologist. RESULTS: We included 75 patients with Cb CAP and 36 with Sp CAP. Fifty-nine percent of all patients were men (n = 66) and median age was 52 [IQR = 38-62]. Chest CT-scans of Cb CAP patients revealed 67 alveolar condensations (89 %), 52 ground-glass opacities (69 %), 30 cases of lymphadenopathy(ies) (40 %) and 25 pleural effusions (33 %). Parenchyma lesions caused by Cb were predominantly unilateral (67 %). We found high numbers of alveolar condensations in both Cb and Sp CAP (89 % and 75 %; respectively), but the presence of ground-glass opacities was significantly associated with Cb CAP (69 % versus 30 %; p < 0.01). Cb CAP were associated with more lymphadenopathies (40 % vs 17 %; p = 0.01) while Sp CAP showed more bronchial thickening (19 % versus 3 %; p < 0.01) and (micro)nodule(s) ≤1 cm (25 % vs 3 %, p < 0.01). CONCLUSIONS: This large study shows that the most typical aspect of chest CT-scan in case of Cb CAP in French Guiana is a unilateral alveolar consolidation associated with ground glass opacities and lymphadenopathies. C. burnetti and S. pneumoniae both most often cause alveolar consolidations, but present some significantly different CT-scan patterns. This could help physicians through therapeutic choices.

Is there Lyme borreliosis in French Guiana? Descriptive study among patients referred for a suspected Lyme borreliosis in an Amazonian hospital between 2010 and 2022.

Lyme borreliosis (LB) existence in South America is debated, especially in the Amazon region. The infection with Lyme borreliae has never been reported in French Guiana where Borrelia burgdorferi sensu lato is not found in ticks. We describe the final diagnosis and presumed place of acquisition in patients consulting for suspicion of LB. We retrospectively collected data from all consecutive patients consulting for a suspicion of LB between 2010 and 2021 at Cayenne Hospital, French Guiana. Patients were classified by an adjudication committee as confirmed LB if they met the criteria of the French consensus, as possible LB if they had compatible symptoms and a good outcome after appropriate treatment, or excluded when a differential diagnosis was found. The place of acquisition was discussed in case of possible or confirmed case. Twenty-six patients were included. Rheumatologic symptoms were the most reported (88 %) followed by neurological symptoms (61 %). Twenty-four (92 %) of these patients were born out of French Guiana. Diagnosis of LB was considered as confirmed in 2 patients (8 %), for whom the place of acquisition was likely mainland France, and as possible in 3 patients (11 %) with early localized LB presumably acquired in French Guiana. Functional somatic disorders were diagnosed in 13 (50 %) patients whereas 9 (35 %) were found with another disease. This study did not confirm the acquisition of LB in French Guiana. However, three possible autochthonous cases encourage clinicians working in the Amazon area to stay aware of LB.

Hunger in French Guiana, an endemic plague worsened by the health crisis / La faim en Guyane française : un fléau endémique amplifié par la crise sanitaire

In 2020, food shortages occurred at the beginning of the confinement period that was supposed to curb the COVID-19 pandemic. In French Guiana, where a major part of the population lives under the poverty line, health workers voiced major concerns. Alongside massive food aid distributions, a first transversal study was carried out in August 2020 targeting poor neighborhoods in Cayenne. The results were particularly worrying. More than 80% of households had been suffering from hunger during that month, with a median decrease of 46% in revenue. Two other investigations followed in February and then in August of 2021. With the relaxing of the health measures, the situation improved in the Cayenne region, but two out of three were still affected, showing signs of quantitative deficiencies and insufficient food diversity. The situation seemed particularly grave for children. In light of this situation, we propose to create an observatory of food insecurity in Guiana, while maintaining this topic as a health priority. In addition, the fight against food insecurity cannot be limited to multi-sectorial material and strategic aide. It must be thought about in a more global manner, including health and social questions, territorial management policies, access to land and water, access to rights and social inclusion. Targeted actions helping the most exposed and vulnerable people is also an important stake, independent of the administrative situation and residency rights of the concerned people.

En 2020, des pénuries alimentaires sont survenues dès l'entrée en vigueur du confinement destiné à contrôler la pandémie de COVID-19. En Guyane Française, où une forte proportion de la population vivait déjà sous le seuil de pauvreté, des alertes préoccupantes ont émané d'acteurs de santé. En parallèle du déploiement d'une aide alimentaire massive, une première enquête transversale a été menée en août 2020, ciblant les quartiers précaires des environs de Cayenne. Les résultats étaient particulièrement inquiétants : plus de 80 % des ménages avaient souffert de la faim dans le mois, avec une baisse médiane de revenus de 46 %. Deux autres enquêtes ont suivi, en février, puis en août 2021. Avec l'allègement des mesures sanitaires, la situation s'était sensiblement améliorée dans la région de Cayenne, mais deux ménages sur trois restaient impactés, avec des carences quantitatives et une diversité alimentaire insuffisante. La situation semblait particulièrement critique parmi les enfants. Au vu de cette situation, nous proposons de créer un observatoire de l'insécurité alimentaire en Guyane, tout en maintenant ce sujet en tête des priorités sanitaires. En outre, la lutte contre l'insécurité alimentaire ne peut se limiter à l'aide matérielle : la stratégie, multisectorielle, doit être pensée en globalité, intégrant les problématiques sanitaires et sociales, les enjeux de l'aménagement du territoire, de l'accès à la terre et à l'eau, de l'accès aux droits et à l'insertion sociale. Un ciblage juste des actions vers les publics les plus exposés et vulnérables est également un enjeu important, indépendamment de la situation administrative et du droit au séjour des personnes concernées.

Social determinants of health among people working on informal gold mines in French Guiana: a multicentre cross-sectional survey.

INTRODUCTION: Social determinants of health, such as living and working conditions, economical and environmental context and access to care, combine to impact the health of individuals and communities. In French Guiana (FG), the persons working in informal artisanal and small-scale gold mining in the rainforest are a particularly vulnerable population which lives in precarious conditions and far from the health system. Previous studies have demonstrated their high morbidity due to infectious diseases. This study aims to describe the social determinants of health in this specific population. METHODS: This international multicentre cross-sectional survey included people working on the informal FG gold mines at the crossing points located at both borders with Suriname and Brazil. After collecting written informed consent, a structured questionnaire was administered. RESULTS: From September to December 2022, 539 gold miners were included. These poorly educated migrants, mainly from Brazil (99.1%) did not have access to drinkable water (95.4%), lived in close contact with wild fauna by hunting, eating bushmeat or being bitten and were exposed to mercury by inhalation (58.8%) or ingestion (80.5%). They report frequent accidents (13.5%) and chronic treatment interruptions (26.6% of the 11.9% reporting chronic treatment). Half of them considered themselves in good health (56.4%). CONCLUSION: This study shows a singular combination of adverse exposures of gold miners working in FG such as zoonoses, heavy metal poisoning, aggression of wild fauna. For ethical as well as public health reasons, actions towards health equity must be considered at different levels: individual, community, environmental, systemic and global level. As end users of minerals, we must assume our responsibilities for the well-being of the extractors by including health in political decisions to engage together in global health. TRIAL REGISTRATION NUMBER: NCT05540470.

Representations of COVID-19: the pandemic in the context of international commuting migration from mining.

OBJECTIVE: To analyze the conceptions about COVID-19 among Brazilians who carry out commuting to work in clandestine mines located on the borders between Brazil, French Guiana and Suriname. METHOD: This is qualitative research, from an analytical perspective, based on Social Representation Theory. Semi-structured, audio-recorded interviews were carried out with 10 Brazilians who experience work routine in clandestine mining on the border between Brazil, French Guiana and Suriname. RESULTS: Two analytical categories emerged: "The disease of otherness"; and "Health access dimension". CONCLUSION: Disease severity was attributed to another or a human body organ, and not to individuals as a whole. Access to health services was established on issues of inequity, violence and illegal practices. The nature of a transient population, which carries out commuting and informal and clandestine work, demonstrates vulnerability to COVID-19 and a lower propensity to receive care.

Infant mortality in French Guiana between 2001 and 2017 : Trends and comparisons with mainland France.

BACKGROUND: French Guiana is a French overseas territory which combines a well-funded universal health system and a population where half are under the poverty line. In this context, we aimed to measure and describe the causes of infant mortality and, because French Guiana is a French territory, to compare them with mainland France. METHODS: National death certificate data between 2001 and 2017 was used. RESULTS: Overall, 6.9 % of deaths before 65 years concerned infants <1 year (in mainland France 2.6%). The infant mortality rate over the 2001-2017 period was 2.6 times that of mainland France (1159.5 vs 446.2 per 100,000 infants <1 year) with excess incidence in perinatal causes, malformations and chromosomal anomalies, accidents, infectious causes, and in poorly defined conditions. Over time, there seemed to be a reduction of infant mortality for all the main causes, except for congenital malformations and chromosomal anomalies, which, on the contrary, seemed to increase. The data sources did not allow to study the weight of social factors or place of residence. CONCLUSIONS: All causes of infant mortality seemed to decline over time except malformations and chromosomal anomalies, which increased. Although exposure to heavy metals, infectious diseases are potential explanations we cannot pinpoint the cause of this increase with the available data. The present results suggest infant mortality and malformations should benefit from more detailed data sources in order to better assess and alleviate the burden of infant mortality in French Guiana.

Causes and consequences of fever in Amazonian pregnant women: A large retrospective study from French Guiana.

OBJECTIVE: The aim of this study was to describe different causes and consequences of fever during pregnancy in Western French Guiana and along the Maroni River. STUDY DESIGN: A retrospective single-center study including all patients with a history of documented fever ≥ 38°C during pregnancy at the West French Guiana Hospital for 9 years. Postpartum fever and nosocomial infections were excluded. We focused on medical history and on clinical and biological findings. Causes were characterized as confirmed or uncertain and then classified as preventable or non-preventable. RESULTS: A total of 940 pregnant women who experienced at least one episode of fever were included and compared to 23,811 deliveries who occurred during the same period without documented fever. Among them, 43.7% (411/940) were in labor. About 3.7% (35/940) of febrile pregnant women had at least two episodes of fever, while 0.3% (3/940) had a coinfection at the time of diagnosis, resulting in a total of 978 febrile episodes. Among them, causes remained unknown or uncertain in 7.6% (75/978) and 0.9% (9/978) of cases, respectively. Among confirmed causes of fever throughout pregnancy (n = 483), the most common known cause was arbovirus infection (146/483, 30.2%), followed by urinary tract infection (134/483, 27.7%), chickenpox (27/483, 5.6%), and gastrointestinal (14/483, 2.9%) and pulmonary infections (10/483, 2%). Mothers with fever had a higher risk of cesarean section (19.8% vs 15.5%, aOR 1.3 [95% CI 1.14-1.6], stillbirth (5.5% versus 1.9%, aOR 2.7 [95% CI 2-3.7]), and preterm delivery < 34 weeks of gestation (7.2% vs 4.7%, aOR 1.5 [95% CI 1.2-2]. CONCLUSIONS: In the Amazon region, causes of fever are diverse and often associated with epidemic waves, notably arboviruses. This must be considered when exploring possible causes of fever during pregnancy in these localities, including fetal anomalies and/or fetal loss. Physicians should consider the epidemiological context and avoid generalizations. Given the impact of emergent agents such as arboviruses on pregnancy, particular attention must be paid to the epidemiological context. This study can also help clinicians when managing fever in pregnant travelers or in their partner after having visited exposed areas. In this context, fetal abnormalities and adverse obstetric outcomes should be explored accordingly.

Pulmonary Histoplasmosis in People Living with Human Immunodeficiency Virus in French Guiana: Clinical Epidemiology, Medical Imaging and Prognostic.

BACKGROUND: Histoplasmosis is mainly described as a disseminated disease in people living with HIV (PLHIV). Compared to historical descriptions in immunocompetent individuals, knowledge is lacking on the detailed clinical and radiological findings and outcomes of pulmonary histoplasmosis (PH). Overlooked or misdiagnosed with other AIDS-defining condition, prognostic of PLHIV may be at risk because of inappropriate care. METHODS: A retrospective multicentric study was conducted in PLHIV from French Guiana between January 1988 and October 2019. Proven PH were documented through mycological direct examination, culture, or histology. Patients with concomitant respiratory infections were excluded. RESULTS: Among 65 patients, sex ratio M:F was 2.4 with a median age of 39 years [IQR 25-75%: 34-44]. Median CD4 count was 24 cells/mm3 [11-71], with histoplasmosis as the AIDS-defining condition in 88% and concomitant AIDS-defining conditions in 29%. Clinical findings were fever (89%), cough (58%), dyspnea (35%), expectoration (14%), and hemoptysis (5%). Sixty-one X-rays and 24 CT-scans were performed. On X-rays, an interstitial lung disease was mainly found (77%). On CT-scans, a nodular pattern was predominant (83%): mostly miliary disease (63%), but also excavated nodules (35%). Consolidations were present in 46%, associated with miliary disease in 21%. Thoracic lymphadenopathies were found in 58%, mainly hilar and symmetric (33%). Despite antifungal treatment, case-fatality rate at one month was 22%. CONCLUSION: When faced with an interstitial lung disease on X-rays or a miliary pattern on CT-scans in advanced PLHIV, physicians in endemic areas, apart from tuberculosis or pneumocystosis, should include histoplasmosis as part of their differential diagnoses.

Clinical and immunological spectra of human cutaneous leishmaniasis in North Africa and French Guiana.

Cutaneous leishmaniasis (CL) caused by infection with the parasite Leishmania exhibits a large spectrum of clinical manifestations ranging from single healing to severe chronic lesions with the manifestation of resistance or not to treatment. Depending on the specie and multiple environmental parameters, the evolution of lesions is determined by a complex interaction between parasite factors and the early immune responses triggered, including innate and adaptive mechanisms. Moreover, lesion resolution requires parasite control as well as modulation of the pathologic local inflammation responses and the initiation of wound healing responses. Here, we have summarized recent advances in understanding the in situ immune response to cutaneous leishmaniasis: i) in North Africa caused by Leishmania (L.) major, L. tropica, and L. infantum, which caused in most cases localized autoresolutives forms, and ii) in French Guiana resulting from L. guyanensis and L. braziliensis, two of the most prevalent strains that may induce potentially mucosal forms of the disease. This review will allow a better understanding of local immune parameters, including cellular and cytokines release in the lesion, that controls infection and/or protect against the pathogenesis in new world compared to old world CL.

Diabetes in a hospital cohort of persons living with HIV: a descriptive and comparative study in French Guiana.

BACKGROUND: In French Guiana (population 294,000) the prevalence of type 2 diabetes (10%) and of HIV(1.1%) are very high. Our objective was to determine the prevalence of diabetes and its complications in a HIV cohort. MATERIALS AND METHODS: We enrolled HIV-infected persons followed in Cayenne, Kourou, and Saint Laurent du Maroni hospitals between January 1, 1992 and December 31, 2021 in the French Hospital Database for HIV (FHDH) a national database compiling data from all French regions. RESULTS: There was no difference of diabetes prevalence between men (8.2%) and women (8.8%), P = 0.4. Patients with diabetes were older (56 years ± 13.4) than those without diabetes (44.7 years ± 13.6) and prevalence increased with age. The proportion of persons with diabetes was greater among virologically suppressed persons (10%) than those with a detectable viral load under antiretroviral treatment (5.8%). Persons with diabetes had substantially greater CD4 counts at diagnosis than persons without diabetes. The majority of macro and microvascular complications were observed in people with diabetes. Persons with diabetes and HIV were significantly less likely to have had AIDS (1.6 versus 2.2 per 100 person-years, respectively). Overall, 374 persons living with HIV of 4167 had died (9%) the proportion of persons with diabetes among the dead was greater than those who did not die 11.7% versus 8.1%, respectively, p = 0.017. However, persons with diabetes were older and hence died older, 62.3 years (SD = 1.9) for deceased persons with diabetes versus 50.4 years (SD = 0.8), P < 0.0001. However, using Cox regression to adjust for age, initial CD4 count, country of birth there was no significant difference in the Hazard for death between persons with diabetes and persons without diabetes (aHR = 0.99, 95%CI = 0.65-1.5), P = 0.9. CONCLUSIONS: The prevalence of diabetes in our HIV cohort was high. Persons with diabetes had greater CD4 counts, earlier care, and greater virological suppression than persons without diabetes. There were no significant differences between persons with diabetes and without diabetes in terms of survival.

Complex Sex Differences in Life Expectancy in French Guiana.

In the complex context of French Guiana, different vulnerabilities and different risk factors between genders may lead to complex differences in health outcomes, mortality, and life expectancy. Our aim was, thus, to compare male and female mortality and life expectancy, to compare it between French Guiana and mainland France, and to look at temporal trends and the main specific causes of death in order to identify actionable singularities. National databases were used to obtain life expectancy at birth, at 20, 40, and 60 years, and mortality statistics. Standardized death rates and causes of death for French Guiana and mainland France were obtained through the CEPIDC, which analyzes information from death certificates. When comparing with mainland France, life expectancy at birth was significantly shorter both in males and females (mean = -2.9 years); life expectancy at 20 years, which allows to remove the effect of the greater child mortality in French Guiana, was also shorter in French Guiana for males (mean = -1.8 years) and females (mean = -2 years). The differences between mainland France and French Guiana regarding life expectancy at 40 and 60 years (mean = -1.5 and -1.3 years) was mainly found among females, males in French Guiana life expectancy at 40 and 60 years was closer to that in mainland France (mean = -0.8 and -0.6 years). Although they have a greater life expectancy at birth than men, women in French Guiana are substantially more affected by overweight/obesity and type 2 diabetes. The observed patterns of life expectancy at different ages presumably reflect the burden of external causes and AIDS in males and perhaps metabolic diseases in women.

Molecular detection of Cercopithifilaria, Cruorifilaria and Dipetalonema-like filarial nematodes in ticks of French Guiana.

Filarial nematodes of the Dipetalonema lineage are widespread parasites and include some species that are transmitted by ticks. In this study, we conducted a large molecular survey of ticks in French Guiana, South America, to understand the overall diversity of tick-borne filarioids in this remote region largely covered by dense tropical forests. Out of 682 ticks belonging to 22 species and 6 genera, 21 ticks (3.1%) of the species Amblyomma cajennense, A. oblongoguttatum, A. romitii, Ixodes luciae and Rhipicephalus sanguineus sensu lato were positive for infection by filarioids. Molecular typing and phylogenetic analysis identified all these filarioids as members of the Dipetalonema lineage. While the filarioid of R. sanguineus sensu lato is a previously described species, the canine worm Cercopithifilaria bainae Almeida & Vicente, 1984, all other filarioids detected in this study are related but distinct to already known species in the genera Cercopithifilaria, Cruorifilaria and Dipetalonema. Their vertebrate host range may include a wide variety of mammals present in French Guiana, but dogs, capybaras, and opossums are the best candidate hosts for some of these filarioids. Although the detection of members of the Dipetalonema lineage in ticks of significant medical or veterinary interest is of concern, the risk of contracting a tick-borne filarial infection is still largely unknown. The pathogenicity of these filarioids, their epidemiology, developmental cycles, and mechanisms of transmission by South American tick species now require further study.

Title: Détection moléculaire des nématodes filaires de type Cercopithifilaria, Cruorifilaria et Dipetalonema chez les tiques de Guyane française. Abstract: Les nématodes filaires de la lignée Dipetalonema sont des parasites répandus dont plusieurs espèces sont transmises par les tiques. Dans cette étude, nous avons mené une vaste surveillance moléculaire des tiques en Guyane française, en Amérique du Sud, afin de caractériser la diversité des filaires transmis par les tiques dans cette région largement couverte de forêts tropicales denses. Sur 682 tiques appartenant à 22 espèces et 6 genres, 21 tiques (3.1 %) des espèces Amblyomma cajennense, A. oblongoguttatum, A. romitii, Ixodes luciae et Rhipicephalus sanguineus sensu lato étaient positives pour la détection des filaires. Le typage moléculaire et l'analyse phylogénétique ont permis d'identifier toutes ces filaires comme des membres de la lignée Dipetalonema. Alors que la filaire de R. sanguineus sensu lato est une espèce décrite, la filaire canine Cercopithifilaria bainae Almeida & Vicente, 1984, toutes les autres filaires détectées ici sont apparentées mais distinctes des espèces déjà connues au sein des genres Cercopithifilaria, Cruorifilaria et Dipetalonema. Leur spectre d'hôtes vertébrés pourrait inclure une grande variété de mammifères présents en Guyane française, mais les chiens, les capibaras et les opossums sont les hôtes candidats probables pour certaines de ces filaires. Bien que la détection de membres de la lignée Dipetalonema chez des tiques d'intérêt médical ou vétérinaire soit préoccupante, le risque de contracter une filariose à tiques est encore largement inconnu. La pathogénicité de ces filaires à tiques, leur épidémiologie, leurs cycles de développement et les mécanismes de transmission par les espèces de tiques sud-américaines doivent maintenant être étudiés plus en détail.