Liver involvement in dengue: A systematic review.

Liver involvement is an unusual yet frequently overlooked dengue complication. Pivotal for an efficient clinical management, the early diagnosis of dengue-associated liver involvement relies on an accurate description of its clinical and biological characteristics, its prognosis factors, its association with severe dengue and its clinical management. We conducted a systematic review by searching PubMed and Web of Science databases for original case reports, cohort and cross-sectional studies reporting the clinical and/or biological features of dengue-associated liver involvement. The study was registered in PROSPERO (CRD42021262657). Of the 2552 articles identified, 167 were included. Dengue-associated liver involvement was characterised by clinical features including abdominal pain, hepatomegaly, jaundice, nausea/vomiting, and an echogenic liver exhibiting hepatocellular necrosis and minimal inflammation. Elevated Aspartate Aminotransferase and Alanine Aminotransferase but also elevated bilirubin, Alkaline Phosphatase, gamma-glutamyl transferase, increased International Normalised Ratio, creatinine and creatine kinase, lower albumin and prolonged prothrombin and activated partial thromboplastin time were prevalent in dengue-associated liver involvement. Cardiovascular and haematological systems were frequently affected, translating in a strong association with severe dengue. Liver involvement was more common in males and older adults. It was associated with dengue virus serotype-2 and secondary infections. Early paracetamol intake increased the risk of liver involvement, which clinical management was mostly conservative. In conclusion, this systematic review demonstrates that early monitoring of transaminases, clinical assessment, and ultrasound examination allow an efficient diagnosis of dengue-associated liver involvement, enabling the early identification and management of severe dengue.

Mucocutaneous Manifestations in Patients with Dengue Fever: From the EPIDENGUE Cohort on Reunion Island.

Nearly 4 billion people live in a dengue risk area worldwide. The prevalence of dengue-related mucocutaneous manifestations and their association with severe dengue differ across studies. The aim of the study was to describe the characteristics of patients with dengue-related mucocutaneous manifestations and to investigate those were associated with severe dengue. A retrospective study was conducted in 2019 among patients with a positive RT-PCR for dengue at the University Hospital of Reunion, which has been experiencing a re-emergence of dengue since 2018. Of 847 patients with confirmed dengue, 283 (33.4%) developed mucocutaneous manifestations. Only manifestations of dehydration such as glossitis, dysgeusia, or conjunctivitis were associated with severe dengue, unlike pruritus and rash, in bivariate analysis but not in multivariate analysis. The rash and pruritus of dengue appear to be accompanied by a pronounced flu-like syndrome in younger people without comorbidity or severity, although careful examination of mucous membranes would better identify signs of dehydration and thus cases likely to worsen.

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.

Research challenges and opportunities in the Caribbean area: first bibliometric study in the French West Indies, from 1989 to 2018

[ABSTRACT]. Objective. To analyze, describe, and quantify the collaborations and scientific output of the two university teaching hospitals of Martinique and Guadeloupe, at the regional, national, and international level. Methods. A bibliometrics analysis was performed from the international databases Web of Science and PubMed, for the period from 1989 to 2018, inclusive (30 years). Three types of bibliometric indicators were used, namely quantitative indicators, performance indicators, and organization-specific indicators. Affiliations of the first and last authors were identified from PubMed. Results. Between 1989 and 2018, a total of 1 522 indexed articles were published with at least one author affiliated to either the University Hospital of Martinique (n = 827) or the University Hospital of Guadeloupe (n = 685). The majority of articles were in category Q1 (35.8% for Martinique and 35.2% for Guadeloupe). In Martinique, over the last 30 years, the three main research areas have been clinical neurology, ophthalmology, and surgery, together representing 28.7% of all research areas, with the highest number of articles published in the field of clinical neurology (n = 81). In the University Hospital of Guadeloupe, the area of hematology was largely represented, with 79 articles published. For both hospitals, the first and last authors of the articles published were mainly from mainland France. Conclusions. This quantitative analysis shows the development of medical and scientific research in Martinique and Guadeloupe over the last three decades, as well as the extent of their collaborative partnerships at the national and international levels.

[RESUMEN]. Objetivo. Analizar, describir y cuantificar las colaboraciones y la producción científica de los dos hospitales docentes universitarios de Martinica y Guadalupe, al nivel regional, nacional e internacional. Métodos. Se llevó a cabo un análisis de bibliometría de las bases de datos internacionales Web of Science y PubMed, en el período de 1989 al 2018, inclusive (30 años). Se emplearon tres tipos de indicadores bibliométricos, a saber: indicadores cuantitativos, indicadores de rendimiento e indicadores específicos de organización. Se establecieron las afiliaciones de los primeros y últimos autores de PubMed. Resultados. Entre 1989 y el 2018, se publicaron en total 1 522 artículos indizados con al menos un autor afiliado al Hospital Universitario de Martinica (n = 827) o bien al Hospital Universitario de Guadalupe (n = 685). La mayoría de los artículos estaban en el cuartil 1 (35,8 % en Martinica y 35,2 % en Guadalupe). En Martinica, en los últimos 30 años las tres principales áreas de investigación han sido la neurología clínica, la oftalmología y la cirugía, que juntas representan 28,7 % de todas las áreas de investigación, con el número más alto de artículos publicado en el campo de la neurología clínica (n = 81). En el Hospital Universitario de Guadalupe, el ámbito de la hematología estaba ampliamente representado, con 79 artículos publicados. En ambos hospitales, los primeros y los últimos autores de los artículos publicados eran principalmente de Francia continental. Conclusiones. Este análisis cuantitativo demuestra el desarrollo de la investigación médica y científica en Martinica y Guadalupe en los treinta últimos años, así como el alcance de sus asociaciones colaborativas a los niveles nacional e internacional.

[RESUMO]. Objetivo. Analisar, descrever e quantificar as colaborações e a produção científica dos dois hospitais universitários de Martinica e Guadalupe, no âmbito regional, nacional e internacional. Métodos. Foi realizada uma análise bibliométrica das bases de dados internacionais Web of Science e PubMed, no período de 1989 a 2018, inclusive (30 anos). Três tipos de indicadores bibliométricos foram utilizados: quantitativos, de desempenho e específicos da organização. Afiliações dos primeiros e últimos autores foram identificadas na base PubMed. Resultados. Entre 1989 e 2018, um total de 1 522 artigos indexados foram publicados com pelo menos um autor afiliado ao Hospital Universitário de Martinica (n = 827) ou ao Hospital Universitário de Guadalupe (n = 685). A maioria dos artigos estava na categoria Q1 (35,8% para Martinica e 35,2% para Guadalupe). Na Martinica, nos últimos 30 anos, as três principais áreas de pesquisa foram neurologia clínica, oftalmologia e cirurgia, representando, juntas, 28,7% de todas as áreas de pesquisa, com o maior número de artigos publicados no campo da neurologia clínica (n = 81). No Hospital Universitário de Guadalupe, a área de hematologia foi amplamente representada, com 79 artigos publicados. Para ambos os hospitais, os primeiros e os últimos autores dos artigos publicados eram principalmente da França continental. Conclusões. Esta análise quantitativa demonstra o desenvolvimento da pesquisa médica e científica na Martinica e em Guadalupe nas três últimas décadas, bem como a extensão de suas parcerias colaborativas no âmbito nacional e internacional.

Antibiotic therapy for snakebite envenoming

There are numerous conflicting recommendations available on the use of antibiotics following snakebite. The present letter to the editor presents some recommendations based on recent studies, and aims to stimulate debate on this topic.(AU)