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Epelboin L, Abboud P, Abdelmoumen K, About F, Adenis A, Blaise T, Blaizot R, Bonifay T, Bourne-Watrin M, Boutrou M, Carles G, Carlier PY, Carod JF, Carvalho L, Couppié P, De Toffol B, Delon F, Demar M, Destoop J, Douine M, Droz JP, Elenga N, Enfissi A, Franck YK, Fremery A, Gaillet M, Kallel H, Kpangon AA, Lavergne A, Le Turnier P, Maisonobe L, Michaud C, Mutricy R, Nacher M, Naldjinan-Kodbaye R, Oberlis M, Odonne G, Osei L, Pujo J, Rabier S, Roman-Laverdure B, Rousseau C, Rousset D, Sabbah N, Sainte-Rose V, Schaub R, Sylla K, Tareau MA, Tertre V, Thorey C, Vialette V, Walter G, Zappa M, Djossou F, Vignier N. [Overview of infectious and non-infectious diseases in French Guiana in 2022]. MEDECINE TROPICALE ET SANTE INTERNATIONALE 2023; 3:mtsi.v3i1.2023.308. [PMID: 37389381 PMCID: PMC10300792 DOI: 10.48327/mtsi.v3i1.2023.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/15/2022] [Indexed: 07/01/2023]
Abstract
Source of many myths, French Guiana represents an exceptional territory due to the richness of its biodiversity and the variety of its communities. The only European territory in Amazonia, surrounded by the Brazilian giant and the little-known Suriname, Ariane 6 rockets are launched from Kourou while 50% of the population lives below the poverty line. This paradoxical situation is a source of health problems specific to this territory, whether they be infectious diseases with unknown germs, intoxications or chronic pathologies.Some infectious diseases such as Q fever, toxoplasmosis, cryptococcosis or HIV infection are in common with temperate countries, but present specificities leading to sometimes different management and medical reasoning. In addition to these pathologies, many tropical diseases are present in an endemic and / or epidemic mode such as malaria, leishmaniasis, Chagas disease, histoplasmosis or dengue. Besides, Amazonian dermatology is extremely varied, ranging from rare but serious pathologies (Buruli ulcer, leprosy) to others which are frequent and benign such as agouti lice (mites of the family Trombiculidae) or papillonitis. Envenomations by wild fauna are not rare, and deserve an appropriate management of the incriminated taxon. Obstetrical, cardiovascular and metabolic cosmopolitan pathologies sometimes take on a particular dimension in French Guiana that must be taken into account in the management of patients. Finally, different types of intoxication are to be known by practitioners, especially due to heavy metals.European-level resources offer diagnostic and therapeutic possibilities that do not exist in the surrounding countries and regions, thus allowing the management of diseases that are not well known elsewhere.Thanks to these same European-level resources, research in Guyana occupies a key place within the Amazon region, despite a smaller population than in the surrounding countries. Thus, certain pathologies such as histoplasmosis of the immunocompromised patient, Amazonian toxoplasmosis or Q fever are hardly described in neighboring countries, probably due to under-diagnosis linked to more limited resources. French Guiana plays a leading role in the study of these diseases.The objective of this overview is to guide health care providers coming to or practicing in French Guiana in their daily practice, but also practitioners taking care of people returning from French Guiana.
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Affiliation(s)
- Loïc Epelboin
- Unité des maladies infectieuses et tropicales, Centre hospitalier de Cayenne, Cayenne, Guyane
- Centre d'investigation clinique Guyane (Inserm CIC 1424), Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Philippe Abboud
- Unité des maladies infectieuses et tropicales, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Karim Abdelmoumen
- Département des maladies infectieuses, Centre hospitalier de Mayotte, Mamoudzou, Mayotte
| | - Frédégonde About
- Unité des maladies infectieuses et tropicales, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Antoine Adenis
- Centre d'investigation clinique Guyane (Inserm CIC 1424), Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Théo Blaise
- Centre d'investigation clinique Guyane (Inserm CIC 1424), Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Romain Blaizot
- Unité carcérale de soins ambulatoires, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Timothée Bonifay
- Unité carcérale de soins ambulatoires, Centre hospitalier de Cayenne, Cayenne, Guyane
| | | | - Mathilde Boutrou
- Unité des maladies infectieuses et tropicales, Centre hospitalier de Cayenne, Cayenne, Guyane
- Centre d'investigation clinique Guyane (Inserm CIC 1424), Centre hospitalier de Cayenne, Cayenne, Guyane
- Département des maladies infectieuses, Centre hospitalier de Mayotte, Mamoudzou, Mayotte
- Unité carcérale de soins ambulatoires, Centre hospitalier de Cayenne, Cayenne, Guyane
- Service de dermatologie, Centre hospitalier de Cayenne, Cayenne, Guyane
- Service de gynécologie-obstétrique, Centre hospitalier de l'ouest guyanais, Saint-Laurent-du-Maroni, Guyane
- Laboratoire de biologie médicale, Centre hospitalier de l'ouest guyanais, Saint-Laurent-du-Maroni, Guyane
- Agence régionale de santé de Guyane, Cayenne, Guyane
- Santé publique France, Cayenne, Guyane
- Service de neurologie, Centre hospitalier de Cayenne, Cayenne, Guyane
- TBIP (Tropical Biome and ImmunoPhysiopathology), Université de Guyane, Cayenne, Guyane
- Laboratoire hospitalo-universitaire de parasitologie et mycologie, Centre hospitalier de Cayenne Andrée-Rosemon, Cayenne, Guyane
- Université Claude Bernard Lyon 1 et Centre Léon Bérard, Lyon, France
- Service de pédiatrie, Centre hospitalier de Cayenne, Cayenne, Guyane
- Laboratoire de virologie, Institut Pasteur de la Guyane
- Service de cardiologie, Centre hospitalier de Cayenne, Cayenne, Guyane
- Service d'accueil des urgences et SAMU, Centre hospitalier de Cayenne, Cayenne, Guyane
- Pôle des Centres délocalisés de prévention et de soins, Centre hospitalier de Cayenne, Cayenne, Guyane
- Service de réanimation, Centre hospitalier de Cayenne, Cayenne, Guyane
- Service de médecine, Centre hospitalier de Kourou, Kourou, Guyane
- Laboratoire des interactions virus-hôtes, Institut Pasteur de la Guyane, Cayenne, Guyane
- Croix-Rouge française de Guyane, Cayenne, Guyane
- Laboratoire Écologie, évolution, interactions des systèmes amazoniens (LEEISA), CNRS, Université de Guyane, IFREMER, Cayenne, Guyane
- COREVIH (Comité de coordination de la lutte contre les infections sexuellement transmissibles et le virus de l'immunodéficience humaine), Centre hospitalier de Cayenne, Cayenne, Guyane
- Service d'endocrinologie-diabétologie et maladies métaboliques, Centre hospitalier de Cayenne, Cayenne, Guyane
- Service de médecine, Centre hospitalier de l'ouest guyanais, Saint-Laurent-du-Maroni, Guyane
- Direction interarmées du service de santé (DIASS)
- Laboratoire Eurofins Guyane, site de Kourou, Centre hospitalier de Kourou, Guyane
- Service de radiologie, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Gabriel Carles
- Service de gynécologie-obstétrique, Centre hospitalier de l'ouest guyanais, Saint-Laurent-du-Maroni, Guyane
| | | | - Jean-François Carod
- Laboratoire de biologie médicale, Centre hospitalier de l'ouest guyanais, Saint-Laurent-du-Maroni, Guyane
| | | | - Pierre Couppié
- Service de dermatologie, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Bertrand De Toffol
- Centre d'investigation clinique Guyane (Inserm CIC 1424), Centre hospitalier de Cayenne, Cayenne, Guyane
- Service de neurologie, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - François Delon
- Laboratoire Eurofins Guyane, site de Kourou, Centre hospitalier de Kourou, Guyane
| | - Magalie Demar
- TBIP (Tropical Biome and ImmunoPhysiopathology), Université de Guyane, Cayenne, Guyane
- Laboratoire hospitalo-universitaire de parasitologie et mycologie, Centre hospitalier de Cayenne Andrée-Rosemon, Cayenne, Guyane
| | - Justin Destoop
- Service de dermatologie, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Maylis Douine
- Centre d'investigation clinique Guyane (Inserm CIC 1424), Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Jean-Pierre Droz
- Université Claude Bernard Lyon 1 et Centre Léon Bérard, Lyon, France
| | - Narcisse Elenga
- Service de pédiatrie, Centre hospitalier de Cayenne, Cayenne, Guyane
| | | | - Yves-Kénol Franck
- Service de cardiologie, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Alexis Fremery
- Service d'accueil des urgences et SAMU, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Mélanie Gaillet
- Pôle des Centres délocalisés de prévention et de soins, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Hatem Kallel
- Service de réanimation, Centre hospitalier de Cayenne, Cayenne, Guyane
| | | | - Anne Lavergne
- Laboratoire des interactions virus-hôtes, Institut Pasteur de la Guyane, Cayenne, Guyane
| | - Paul Le Turnier
- Unité des maladies infectieuses et tropicales, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Lucas Maisonobe
- Unité des maladies infectieuses et tropicales, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Céline Michaud
- Pôle des Centres délocalisés de prévention et de soins, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Rémi Mutricy
- Service d'accueil des urgences et SAMU, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Mathieu Nacher
- Centre d'investigation clinique Guyane (Inserm CIC 1424), Centre hospitalier de Cayenne, Cayenne, Guyane
| | | | | | - Guillaume Odonne
- Laboratoire Écologie, évolution, interactions des systèmes amazoniens (LEEISA), CNRS, Université de Guyane, IFREMER, Cayenne, Guyane
| | - Lindsay Osei
- Service de pédiatrie, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Jean Pujo
- Service d'accueil des urgences et SAMU, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Sébastien Rabier
- Centre d'investigation clinique Guyane (Inserm CIC 1424), Centre hospitalier de Cayenne, Cayenne, Guyane
- COREVIH (Comité de coordination de la lutte contre les infections sexuellement transmissibles et le virus de l'immunodéficience humaine), Centre hospitalier de Cayenne, Cayenne, Guyane
| | | | - Cyril Rousseau
- Santé publique France, Cayenne, Guyane
- Pôle des Centres délocalisés de prévention et de soins, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Dominique Rousset
- Laboratoire hospitalo-universitaire de parasitologie et mycologie, Centre hospitalier de Cayenne Andrée-Rosemon, Cayenne, Guyane
| | - Nadia Sabbah
- Service d'endocrinologie-diabétologie et maladies métaboliques, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Vincent Sainte-Rose
- Laboratoire hospitalo-universitaire de parasitologie et mycologie, Centre hospitalier de Cayenne Andrée-Rosemon, Cayenne, Guyane
| | - Roxane Schaub
- Centre d'investigation clinique Guyane (Inserm CIC 1424), Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Karamba Sylla
- Service de médecine, Centre hospitalier de l'ouest guyanais, Saint-Laurent-du-Maroni, Guyane
| | - Marc-Alexandre Tareau
- Centre d'investigation clinique Guyane (Inserm CIC 1424), Centre hospitalier de Cayenne, Cayenne, Guyane
- Laboratoire Écologie, évolution, interactions des systèmes amazoniens (LEEISA), CNRS, Université de Guyane, IFREMER, Cayenne, Guyane
| | | | - Camille Thorey
- Service de médecine, Centre hospitalier de l'ouest guyanais, Saint-Laurent-du-Maroni, Guyane
| | - Véronique Vialette
- Laboratoire Eurofins Guyane, site de Kourou, Centre hospitalier de Kourou, Guyane
| | - Gaëlle Walter
- Unité des maladies infectieuses et tropicales, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Magaly Zappa
- Service de radiologie, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Félix Djossou
- Unité des maladies infectieuses et tropicales, Centre hospitalier de Cayenne, Cayenne, Guyane
| | - Nicolas Vignier
- Centre d'investigation clinique Guyane (Inserm CIC 1424), Centre hospitalier de Cayenne, Cayenne, Guyane
- COREVIH (Comité de coordination de la lutte contre les infections sexuellement transmissibles et le virus de l'immunodéficience humaine), Centre hospitalier de Cayenne, Cayenne, Guyane
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Nacher M, Alsibai KD, Adenis A, Blaizot R, Abboud P, Demar M, Djossou F, Epelboin L, Misslin C, Ntab B, Valdes A, Couppié P. Reduced Severity in Patients With HIV-Associated Disseminated Histoplasmosis With Deep Lymphadenopathies: A Trench War Remains Within the Lymph Nodes? Front Cell Infect Microbiol 2021; 10:598701. [PMID: 33628743 PMCID: PMC7897652 DOI: 10.3389/fcimb.2020.598701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/09/2020] [Indexed: 11/13/2022] Open
Abstract
Background Disseminated histoplasmosis is a major killer of patients with advanced HIV. It is proteiform and often hard to diagnose in the absence of diagnostic tests. We aimed to describe disseminated histoplasmosis with lymphadenopathies in French Guiana and to compare survival and severity of those patients to patients without lymphadenopathies. Methods A retrospective cohort study was performed on data records collected between January 1, 1981 and October 1, 2014. Results Among 349 cases of disseminated histoplasmosis 168 (48.3%) had superficial lymphadenopathies and 133(38.1%) had deep lymphadenopathies. The median LDH concentration, ferritin concentration, TGO concentration, and WHO performance status were lower among patients with deep lymphadenopathies than those without deep lymphadenopathies. There was a significant decrease in the risk of early death (<1 month) among those with deep lymphadenopathies relative to those without (OR=0.26 (95%CI=0.10-0.60), P=0.0006) and in the overall risk of death (OR=0.33 (95%CI=0.20-0.55), P<0.0001). These associations remained strongly significant after adjusting for time period, CD4 counts, age, delay between beginning of symptoms and hospital admission, antifungal and antiretroviral treatment. Conclusions The present data show that in patients with advanced HIV and disseminated histoplasmosis, the presence of deep lymphadenopathies is associated with fewer markers of severity and a lower risk of death. To our knowledge it is the first study to show this. The presence of deep lymphadenopathies is hypothesized to reflect the patient's partially effective defense against H. capsulatum.
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Affiliation(s)
- Mathieu Nacher
- CIC INSERM 1424, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana.,DFR Santé, Université de Guyane, Cayenne, French Guiana
| | - Kinan Drak Alsibai
- Department of Pathology, Centre hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Antoine Adenis
- CIC INSERM 1424, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana.,DFR Santé, Université de Guyane, Cayenne, French Guiana
| | - Romain Blaizot
- DFR Santé, Université de Guyane, Cayenne, French Guiana.,Department of Dermatology, Centre hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Philippe Abboud
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier Andrée Rosemon Cayenne, Cayenne, French Guiana
| | - Magalie Demar
- Laboratory, Centre hospitalier Andrée Rosemon Cayenne, Cayenne, French Guiana.,UMR Tropical Biome and Immunopathology, Université de Guyane, Cayenne, French Guiana
| | - Félix Djossou
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier Andrée Rosemon Cayenne, Cayenne, French Guiana
| | - Loïc Epelboin
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier Andrée Rosemon Cayenne, Cayenne, French Guiana
| | - Caroline Misslin
- Service de Médecine, Centre hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, French Guiana
| | - Balthazar Ntab
- Département d'Information Médicale, Centre hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, French Guiana
| | - Audrey Valdes
- Equipe Opérationnelle d'hygiène hospitalière, Centre hospitalier Andrée Rosemon Cayenne, Cayenne, French Guiana
| | - Pierre Couppié
- DFR Santé, Université de Guyane, Cayenne, French Guiana.,Department of Dermatology, Centre hospitalier Andrée Rosemon, Cayenne, French Guiana
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4
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Nacher M, Valdes A, Adenis A, Blaizot R, Abboud P, Demar M, Djossou F, Epelboin L, Misslin C, Ntab B, Louvel D, Drak Alsibai K, Couppié P. Gastrointestinal disseminated histoplasmosis in HIV-infected patients: A descriptive and comparative study. PLoS Negl Trop Dis 2021; 15:e0009050. [PMID: 33481806 PMCID: PMC7857560 DOI: 10.1371/journal.pntd.0009050] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/03/2021] [Accepted: 12/08/2020] [Indexed: 12/13/2022] Open
Abstract
Disseminated histoplasmosis is one the main AIDS-defining opportunistic infections in HIV-infected patients, notably in Latin America. The non-specific and proteiform clinical presentation leads to diagnostic delays that may lead to fatal outcomes. This retrospective multicentric study aimed to describe the frequency and manifestations of gastrointestinal histoplasmosis in French Guiana, and to compare patients with disseminated histoplasmosis with or without gastrointestinal involvement. Between January 1, 1981 and October 1, 2014 co-infections with HIV and histoplasmosis were enrolled. Inclusion criteria were: age >18 years, confirmed HIV infection; first proven episode of histoplasmosis. Among 349 cases of disseminated histoplasmosis, 245 (70%) had a gastrointestinal presentation. Half of patients with gastrointestinal signs had abdominal pain or diarrhea, mostly watery. Half of patients with abdominal pain had diarrhea (63/124) and half of those with diarrhea (63/123) had abdominal pain. A significant proportion of patients also had hepatomegaly and, to a lesser degree, splenomegaly. After adjusting for potential confounding, the presence of lymphadenopathies >2cm (AOR = 0.2, IC95 = 0.04–0.7, P = 0.01), Haitian origin (AOR = 0.04, IC95 = 0.004–0.4, P = 0.006) were associated with a lower prevalence of gastrointestinal signs and positive gastrointestinal presence of H. capsulatum. Persons with a gastrointestinal H. capsulatum were more likely to have a decreased prothrombin time, lower ferritin, lower liver enzymes, and lower concentrations of LDH than those without gastrointestinal signs and symptoms. They also had a shorter interval between symptoms onset and diagnosis. Patients with a positive gastrointestinal identification of H. capsulatum were less likely to die at 1 month than those without a gastrointestinal presentation (respectively, 4.6% vs 18.5%, P = 0.01). Subacute or chronic gastrointestinal presentations are very frequent during disseminated histoplasmosis, they seem less severe, and should lead to suspect the diagnosis in endemic areas. There were populational or geographic differences in the frequency of gastrointestinal manifestations that could not be explained. This retrospective multicentric study aimed to describe the frequency and manifestations of gastrointestinal histoplasmosis in French Guiana, and to compare patients with disseminated histoplasmosis with or without gastrointestinal involvement. Between January 1, 1981 and October 1, 2014 co-infections with HIV and histoplasmosis were enrolled. Inclusion criteria were: age >18 years, confirmed HIV infection; first proven episode of histoplasmosis. Among 349 cases of disseminated histoplasmosis, 245 (70%) had a gastrointestinal presentation. Half of patients with gastrointestinal signs had abdominal pain or diarrhea, mostly watery. Half of patients with abdominal pain had diarrhea (63/124) and half of those with diarrhea (63/123) had abdominal pain. A significant proportion of patients also had hepatomegaly and, to a lesser degree, splenomegaly. After adjusting for potential confounding, the presence of lymphadenopathies >2cm, Haitian origin were associated with a lower prevalence of gastrointestinal signs and presence of H. capsulatum. Persons with a gastrointestinal presentation were more likely to have a decreased prothrombin time, lower liver enzyme concentration, ferritin, and lower concentrations of LDH than those without gastrointestinal signs and symptoms. The delay between symptom’s onset and diagnosis was also shorter and the proportion of deaths at 1 month was significantly lower among those with gastrointestinal presence of H. capsulatum. Subacute or chronic gastrointestinal presentations are very frequent during disseminated histoplasmosis, they seem less severe, and should lead to suspect the diagnosis in endemic areas.
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Affiliation(s)
- Mathieu Nacher
- CIC INSERM 1424, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
- DFR Santé, Université de Guyane, Cayenne, Cayenne, French Guiana
- * E-mail:
| | - Audrey Valdes
- Equipe Opérationnelle d’hygiène hospitalière, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
| | - Antoine Adenis
- CIC INSERM 1424, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
- DFR Santé, Université de Guyane, Cayenne, Cayenne, French Guiana
| | - Romain Blaizot
- DFR Santé, Université de Guyane, Cayenne, Cayenne, French Guiana
- Department of dermatology, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
| | - Philippe Abboud
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
| | - Magalie Demar
- Laboratory, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
- UMR Tropical Biome and Immunopathology, Université de Guyane, Cayenne, French Guiana
| | - Félix Djossou
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
| | - Loïc Epelboin
- Service des Maladies Infectieuses et Tropicales, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
| | - Caroline Misslin
- Service de Médecine, Centre hospitalier de l’Ouest Guyanais, Saint Laurent du Maroni, French Guiana
| | - Balthazar Ntab
- Département d’Information Médicale, Centre hospitalier de l’Ouest Guyanais, Saint Laurent du Maroni, French Guiana
| | - Dominique Louvel
- Service de Médecine B, Gastroentérologie, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Kinan Drak Alsibai
- Service d’Anatomopathologie, Centre Hospitalier Andrée Rosemon, Cayenne, French Guiana
| | - Pierre Couppié
- DFR Santé, Université de Guyane, Cayenne, Cayenne, French Guiana
- Department of dermatology, Centre hospitalier Andree Rosemon Cayenne, Cayenne, French Guiana
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5
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Drak Alsibai K, Couppié P, Blanchet D, Adenis A, Epelboin L, Blaizot R, Louvel D, Djossou F, Demar M, Nacher M. Cytological and Histopathological Spectrum of Histoplasmosis: 15 Years of Experience in French Guiana. Front Cell Infect Microbiol 2020; 10:591974. [PMID: 33194840 PMCID: PMC7658294 DOI: 10.3389/fcimb.2020.591974] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/07/2020] [Indexed: 12/29/2022] Open
Abstract
Background Disseminated histoplasmosis remains a major killer of immunocompromised patients in Latin America. Cytological and histological methods are usually present in most hospitals and may represent a precious diagnostic method. We report 15 years of experience of the department of pathology of the Centre Hospitalier de Cayenne Andrée Rosemon in French Guiana. Methods Specimens from live patients from January 2005 to June 2020 with the presence of H. capsulatum on cytological and/or histological analysis were analyzed. All specimens were examined by an experienced pathologist. The analysis was descriptive. Results Two hundred two cytological and histological samples were diagnosed with histoplasmosis between January 2005 and June 2020. The 202 samples included 153 (75.7%) histopathological formalin-fixed and paraffin-embedded tissues (biopsy or surgical specimens) and 49 (24.3%) cytological analysis from all organs. One hundred thirty-four patients (82.7%) were HIV-positive, 15 patients (9.3%) had immunosuppressant treatment, and 13 patients (8%) were immunocompetent. Seventy-eight of 202 (38.5%) were samples from the digestive tract, mostly the colon (53/78 cases, 70%) and small intestine (14/78 cases, 18%). Microorganisms were more numerous in digestive samples (notably the colon) than in other organs. Lymphocyte and histiocyte inflammation of moderate to marked intensity were observed in all positive specimens. Tuberculoid epithelioid granuloma were present in 16/78 (20,5%) specimens including 14 colon and 2 small intestine specimens. There were 11/202 cases of liver histoplasmosis, 26/202 (12,8%) cases of pulmonary histoplasmosis. Bone marrow involvement was diagnosed in 14 (2%) specimens (8 aspiration and 6 biopsies). Lymph nodes were positive in 42 specimens (31 histology and 11 cytology). Histopathological analysis of the 31 lymph nodes showed a variable histological appearance. Tuberculoid forms were most frequent (24/31, 77,4%). Conclusions From the pathologist perspective, this is the largest series to date showing that digestive involvement was the most frequent, usually with a tuberculoid form and a greater load of Histoplasma. With awareness and expertise, cytology and pathology are widely available methods that can give life-saving results in a short time to help orient clinicians facing a potentially fatal infection requiring prompt treatment.
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Affiliation(s)
- Kinan Drak Alsibai
- Department of Pathology, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
- Centre of Biological Resource (CRB Amazonie), Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Pierre Couppié
- Department of Dermatology, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
- DFR Santé, Université de Guyane, Cayenne, French Guiana
| | - Denis Blanchet
- Laboratory, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Antoine Adenis
- CIC INSERM 1424, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Loïc Epelboin
- 1 Service des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Romain Blaizot
- Department of Dermatology, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Dominique Louvel
- Service de Médecine B, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Félix Djossou
- 1 Service des Maladies Infectieuses et Tropicales, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | - Magalie Demar
- Laboratory, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
- UMR Tropical Biome and Immunopathology, Université de Guyane, Cayenne, French Guiana
| | - Mathieu Nacher
- DFR Santé, Université de Guyane, Cayenne, French Guiana
- CIC INSERM 1424, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
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6
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Nacher M, Valdes A, Adenis A, Blaizot R, Abboud P, Demar M, Djossou F, Epelboin L, Drak Alsibai K, Misslin C, Ntab B, Couppié P. Heterogeneity of Clinical Presentations and Paraclinical Explorations to Diagnose Disseminated Histoplasmosis in Patients with Advanced HIV: 34 Years of Experience in French Guiana. J Fungi (Basel) 2020; 6:jof6030165. [PMID: 32911697 PMCID: PMC7558389 DOI: 10.3390/jof6030165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/03/2020] [Accepted: 09/05/2020] [Indexed: 01/23/2023] Open
Abstract
We aimed to describe the ways patients with disseminated histoplasmosis—a multifaceted and often lethal disease—present themselves and are explored. A retrospective, observational, multicentric study spanned the period between 1 January 1981 and 1 October 2014. Principal component analysis was performed for the sampling sites and for the clinical signs and symptoms. The factor loadings of the principal components were selected for eigenvalues > 1. The most frequent signs and symptoms were an alteration of the WHO general performance status, fever, digestive tract, respiratory signs and symptoms and lymphadenopathies. The most common sites sampled were bone marrow, respiratory tract, blood, lymph node and liver biopsies, with significant variations in the number of sites from which samples were taken to try to identify the pathogen. The principal component analysis clinical signs and symptoms leading to the diagnosis showed four main lines of variation. The factor loadings of the four main components were compatible with four broad types of clinical presentations and four types of exploration strategies. Extracting simple algorithms was difficult, emphasizing the importance of clinical expertise when diagnosis depends on obtaining a sample where Histoplasma can be seen or grown. Histoplasma antigen detection tests will help simplifying the algorithms.
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Affiliation(s)
- Mathieu Nacher
- CIC INSERM 1424, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, French Guiana;
- Département Formation Recherche Santé, Université de Guyane, 97300 Cayenne, French Guiana; (R.B.); (P.C.)
- Correspondence: ; Tel.: +594-594395024
| | - Audrey Valdes
- Equipe Opérationnelle d’Hygiène Hospitalière, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, French Guiana;
| | - Antoine Adenis
- CIC INSERM 1424, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, French Guiana;
- Département Formation Recherche Santé, Université de Guyane, 97300 Cayenne, French Guiana; (R.B.); (P.C.)
| | - Romain Blaizot
- Département Formation Recherche Santé, Université de Guyane, 97300 Cayenne, French Guiana; (R.B.); (P.C.)
- Department of Dermatology, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, French Guiana
| | - Philippe Abboud
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, French Guiana; (P.A.); (F.D.); (L.E.)
| | - Magalie Demar
- Laboratory, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, French Guiana;
- Unité Mixte de Recherche Tropical Biome and Immunopathology, Université de Guyane, 97300 Cayenne, French Guiana
| | - Félix Djossou
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, French Guiana; (P.A.); (F.D.); (L.E.)
| | - Loïc Epelboin
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, French Guiana; (P.A.); (F.D.); (L.E.)
| | - Kinan Drak Alsibai
- Service d’Anatomopathologie, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, French Guiana;
| | - Caroline Misslin
- Service de Médecine, Centre Hospitalier de l’Ouest Guyanais, 97320 Saint Laurent du Maroni, French Guiana;
| | - Balthazar Ntab
- Département d’Information Médicale, Centre Hospitalier de l’Ouest Guyanais, 97320 Saint Laurent du Maroni, French Guiana;
| | - Pierre Couppié
- Département Formation Recherche Santé, Université de Guyane, 97300 Cayenne, French Guiana; (R.B.); (P.C.)
- Department of Dermatology, Centre Hospitalier Andree Rosemon Cayenne, 97300 Cayenne, French Guiana
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