[Epidemiology of systemic lupus erythematosus in Reunion Island, Indian Ocean: A case-series in adult patients from a University Hospital]. / Caractéristiques du lupus érythémateux systémique à La Réunion : étude rétrospective en population adulte au CHU de Saint-Denis.

OBJECTIVES: The study aimed at assessing the epidemiology and clinical features of systemic lupus erythematosus (SLE) in Reunion Island, South West of Indian Ocean. PATIENTS AND METHODS: A retrospective study was conducted at the University Hospital of La Reunion (Saint-Denis) by charts review from 2004 to 2015. Patients with a SLE diagnosed over 15 years according to SLICC 2012 criteria were included. Incidence and prevalence were inferred from national health insurance database and population census results. RESULTS: In total, 123 patients met inclusion criteria: 116 were women (94%) and mean age at diagnosis was 34.7±13.4 years. Ten percent of all patients had a least one parent with autoimmune disease, and 4% with lupus. The main manifestations were musculoskeletal (89%) and mucocutaneous with acute or subacute lesions (76%), alopecia (25%), ulcers (15%) and discoid lupus (11%). Lupus nephropathy occurred in 39%, serositis in 31% and neurological features in 15%. Antinuclear antibodies were positive in 99% (threshold >1/80), and associated to anti-DNA (70%), anti-SSA (47%), anti-RNP (42%), and anti-Sm (37%). APL syndrome was diagnosed in 15%. The average annual standardized incidence between 2010 and 2016 was 6.3 cases per 100,000 inhabitants (95% confidence interval [CI]: 5.6-6.9). The prevalence was 76 cases per 100,000 inhabitants in 2016 (95% CI: 70-82). CONCLUSION: Lupus in the multi-ethnic population of Reunion Island is characterized by high incidence and high rates of articular and renal manifestations, as well as anti-ENA antibodies.

[Pneumococcal septic arthritis revealing a multiple myeloma]. / Arthrite à pneumocoque révélant un myélome.

INTRODUCTION: The most common presenting features of multiple myeloma are bone pain, anemia, renal failure or hypercalcemia. Bacterial infection as the initial presentation of this desease is rare. CLINICAL CASE: We report the case of a 62-year-old man with pneumococcal septic arthritis of the knee revealing a multiple myeloma. DISCUSSION: Pneumococcal infection should lead to a suspicion of underlying illness and especially the multiple myeloma.

[Intermittent fever: rare expression of an adenocarcinoma of the ampulla of Vater]. / Fièvre intermittente: expression rare d'un adénocarcinome de l'ampoule de Vater.

PURPOSE: Prolonged intermittent fevers are frequently seen in internal medicine and they constitute a real diagnosis challenge. Infection, auto-immune disease and neoplasy are the most common causes. EXEGESIS: We report here a 48 year-old man with a prolonged intermittent fever. At first, all his assessments were negative and it's only secondary, as clinical and biological disturbances occur that the diagnosis of adenocarcinoma of the ampulla has been done. CONCLUSION: Neoplasms represent a rare cause of intermittent prolonged fever, but we must always keep them in mind. In this case, any specific symptom was initially present to end up quickly to the solution.

[Epidemiology and prevention of malaria in the southwestern islands of the Indian Ocean]. / Epidémiologie et prévention du paludisme dans les iles du sud-ouest de l'Océan Indien.

Malaria epidemiology differs greatly in the geographically close islands of the southwestern Indian Ocean. In Madagascar and the Comoros Union malaria is still a major public health problem. In Mayotte indigenous transmission resumed in 1995 and is currently high in some communities. In the Mascarene Islands (Reunion and Mauritius), indigenous transmission has been eradicated (Reunion) or become rare (Mauritius). The Seychelles Islands are malaria-free since local conditions are unfavorable for Anopheles mosquitoes. The level of resistance to antimalarials also differs from one island to another. Resistance to chloroquine ranges from moderate in Madagascar to high in the Comoros Union. Health recommendations for travelers must be adapted to the epidemiological features on each island.

[Reactive arthritis due to Escherichia coli urinary tract infection]. / Arthrite réactionnelle dans les suites d'une infection urinaire à Escherichia coli.

Reactive arthritis following Escherichia coli urinary tract infection is very rare. We report a 25-year-old woman with acute oligoarthritis associated with bilateral anterior uveitis after an episode of urinary tract infection due to E. coli. The diagnosis of reactive arthritis was considered and the patient treated with non-steroidal anti-inflammatory agents. Disease course was rapidly successful and at 6-month follow-up the patient was asymptomatic. Reactive arthritis is associated with intestinal infection but also with common urinary tract infection.

[Hepatic localization of cat scratch disease in an immunocompetent patient]. / Localisation hépatique de la maladie des griffes du chat chez un immunocompétent.

INTRODUCTION: The cat-scratch disease is a benign inoculation disease and a well-known cause of localized lymphadenopathy. Visceral localizations are rare and occur mostly in immunocompetent patients. CASE: We report the case of a 57-year-old-man with lymphadenopathy of the right arm with hepatic nodules related to a Bartonella henselae infection. CONCLUSION: The cat-scratch disease must be screened for in case of hepatic and/or splenic nodules. A cause of immunodeficiency should be investigated.

Severe community-acquired pneumonia: assessment of microbial aetiology as mortality factor.

Community-acquired pneumonia (CAP) remains a major cause of mortality. The aetiology of CAP has rarely been identified as a mortality risk factor. A prospective study was conducted to assess the prognostic factors of CAP patients admitted to the intensive care unit (Centre Hospitalier Departmental Felix Guyon, St Denis de la Reunion, France), with a special emphasis on microbial aetiology. All variables assessing severity were collected, with a special emphasis on microbial investigations. Among 112 immunocompetent patients (mean+/-SD age 54.7+/-15.1 yrs), 84% were male. Severity of CAP was demonstrated by mortality rate (43%), shock (48%), simplified acute physiology score (SAPS; 46.4+/-21.6) and mechanical ventilation support (82%). Mean risk factor score was 2.2+/-1.2. Microbiological identification was obtained in 78.6% of cases, with positive blood culture in 33%. Most frequently, microbial agents were Streptococcus pneumoniae and Klebsiella pneumoniae (42% and 22%, respectively). The univariate analysis recorded the usual mortality variables: age, alcohol consumption, SAPS, shock, mechanical ventilation, positive end expiratory pressure level, positive blood culture, multilobar infiltrates on chest radiograph, neutropenia, and acidosis, and found K. pneumoniae (versus S. pneumoniae, and all CAP) as a mortality factor. The multivariate analysis demonstrated that septic shock (relative risk (RR) 141), K. pneumoniae CAP (RR 27), SAPS (RR 10.7) and positive blood culture (RR 2.7) were independent factors related to death. In conclusion, the present study found that the microbial aetiology, Klebsiella pneumoniae, was an independent risk factor for mortality in severe community-acquired pneumonia.