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Leménager P, Franck YK, Corlin F, Bouscaren N, Nacher M, Adenis A. Aetiological and morphological spectrum of cardiomyopathies in French Guiana: a retrospective study. Open Heart 2020; 7:openhrt-2019-001206. [PMID: 32404486 PMCID: PMC7228657 DOI: 10.1136/openhrt-2019-001206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/18/2020] [Accepted: 04/13/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction Cardiomyopathies are a heterogeneous heart diseases group in terms of morphology and aetiology. Hypothesising a tropical specificity and given an absence of data in French Guiana, the primary objective of our study was to describe morphologies and aetiologies of cardiomyopathies observed at Cayenne General Hospital. Methods A cross-sectional study was conducted in Cayenne Hospital from 1 January 2009 to 1 June 2014 in the hospital database. Only patients with the definition of the European Society of Cardiology (ESC) were included, based on the first transthoracic ultrasonography found during the study period. Medical files were consulted. Results With 182 patients included, the prevalence of cardiomyopathies among heart diseases was estimated at 4.3% (95% CI 3.7% to 4.9%). Twelve patients had a familial or genetic aetiology (6.6%) and 170 a non-familial or non-genetic aetiology (93.4%). The morphological spectrum was: dilated for 114 patients (62.6%), hypertrophic for 27 (14.8%), unclassified for 1 (0.5%) and non-classifiable for 13 (7.1%). This group was constituted of patients with a systolic and/or diastolic functional impairment without morphological abnormality. The aetiological spectrum found 184 aetiologies including: 70.9% undetermined, 8.7% infectious (with 6.5% chagasic and 0.5% related with human immunodeficiency virus) and 6.0% with toxins. Conclusions Cardiomyopthies are a common and severe clinical problem. The frequency of infectious aetiologies and dilated impairment are arguments for cardiomyopathies with tropical particularities. However, the preponderance of undetermined aetiologies justifies the development of further research programmes.
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Affiliation(s)
- Paul Leménager
- CIC INSERM 1424, Centre Hospitalier Andree Rosemon, Cayenne, French Guiana
| | - Yves-Kenol Franck
- Service de Cardiologie, Centre Hospitalier Andree Rosemon, Cayenne, French Guiana
| | - Florine Corlin
- CIC INSERM 1424, Centre Hospitalier Andree Rosemon, Cayenne, French Guiana
| | - Nicolas Bouscaren
- CIC INSERM 1424, Centre Hospitalier Andree Rosemon, Cayenne, French Guiana
| | - Mathieu Nacher
- CIC INSERM 1424, Centre Hospitalier Andree Rosemon, Cayenne, French Guiana
| | - Antoine Adenis
- CIC INSERM 1424, Centre Hospitalier Andree Rosemon, Cayenne, French Guiana
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Douine M, Lazrek Y, Blanchet D, Pelleau S, Chanlin R, Corlin F, Hureau L, Volney B, Hiwat H, Vreden S, Djossou F, Demar M, Nacher M, Musset L. Predictors of antimalarial self-medication in illegal gold miners in French Guiana: a pathway towards artemisinin resistance. J Antimicrob Chemother 2018; 73:231-239. [PMID: 29045645 DOI: 10.1093/jac/dkx343] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 08/23/2017] [Indexed: 11/15/2022] Open
Abstract
Background Malaria is endemic in French Guiana (FG), South America. Despite the decrease in cases in the local population, illegal gold miners are very affected by malaria (22.3% of them carried Plasmodium spp.). Self-medication seems to be very common, but its modalities and associated factors have not been studied. The aim of this study was to evaluate parasite susceptibility to drugs and to document behaviours that could contribute to resistance selection in illegal gold miners. Methods This multicentric cross-sectional study was conducted in resting sites along the FG-Surinamese border. Participating gold miners working in FG completed a questionnaire and provided a blood sample. Results From January to June 2015, 421 illegal gold miners were included. Most were Brazilian (93.8%) and 70.5% were male. During the most recent malaria attack, 45.5% reported having been tested for malaria and 52.4% self-medicated, mainly with artemisinin derivatives (90%). Being in FG during the last malaria attack was the main factor associated with self-medication (adjusted OR = 22.1). This suggests that access to malaria diagnosis in FG is particularly difficult for Brazilian illegal gold miners. Treatment adherence was better for persons who reported being tested. None of the 32 samples with Plasmodium falciparum presented any mutation on the pfK13 gene, but one isolate showed a resistance profile to artemisinin derivatives in vitro. Conclusions The risk factors for the selection of resistance are well known and this study showed that they are present in FG with persons who self-medicated with poor adherence. Interventions should be implemented among this specific population to avoid the emergence of artemisinin resistance.
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Affiliation(s)
- M Douine
- Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Cayenne Hospital, French Guiana.,Epidemiology of Tropical Parasitoses, EA 3593, Université de Guyane, Cayenne, French Guiana
| | - Y Lazrek
- Laboratoire de Parasitologie, WHO Collaborating Center for Surveillance of Anti-Malarial Drug Resistance, Centre National de Référence du Paludisme, Institut Pasteur de la Guyane, Cayenne, French Guiana
| | - D Blanchet
- Academic Laboratory of Parasitology - Mycology, Cayenne Hospital, Cayenne, French Guiana
| | - S Pelleau
- Laboratoire de Parasitologie, WHO Collaborating Center for Surveillance of Anti-Malarial Drug Resistance, Centre National de Référence du Paludisme, Institut Pasteur de la Guyane, Cayenne, French Guiana
| | - R Chanlin
- Academic Laboratory of Parasitology - Mycology, Cayenne Hospital, Cayenne, French Guiana
| | - F Corlin
- Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Cayenne Hospital, French Guiana
| | - L Hureau
- Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Cayenne Hospital, French Guiana
| | - B Volney
- Laboratoire de Parasitologie, WHO Collaborating Center for Surveillance of Anti-Malarial Drug Resistance, Centre National de Référence du Paludisme, Institut Pasteur de la Guyane, Cayenne, French Guiana
| | - H Hiwat
- Ministry of Health, Malaria Program, Paramaribo, Suriname
| | - S Vreden
- Foundation for Scientific Research Suriname (SWOS), Paramaribo, Suriname
| | - F Djossou
- Epidemiology of Tropical Parasitoses, EA 3593, Université de Guyane, Cayenne, French Guiana.,Infectious and Tropical Diseases Department, Cayenne Hospital, Cayenne, French Guiana
| | - M Demar
- Epidemiology of Tropical Parasitoses, EA 3593, Université de Guyane, Cayenne, French Guiana.,Academic Laboratory of Parasitology - Mycology, Cayenne Hospital, Cayenne, French Guiana
| | - M Nacher
- Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Cayenne Hospital, French Guiana.,Epidemiology of Tropical Parasitoses, EA 3593, Université de Guyane, Cayenne, French Guiana
| | - L Musset
- Laboratoire de Parasitologie, WHO Collaborating Center for Surveillance of Anti-Malarial Drug Resistance, Centre National de Référence du Paludisme, Institut Pasteur de la Guyane, Cayenne, French Guiana
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Douine M, Mosnier E, Le Hingrat Q, Charpentier C, Corlin F, Hureau L, Adenis A, Lazrek Y, Niemetsky F, Aucouturier AL, Demar M, Musset L, Nacher M. Illegal gold miners in French Guiana: a neglected population with poor health. BMC Public Health 2017; 18:23. [PMID: 28716015 PMCID: PMC5513330 DOI: 10.1186/s12889-017-4557-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 06/30/2017] [Indexed: 11/17/2022] Open
Abstract
Background In French Guiana, a French overseas territory in South America, 6 to 10 thousands undocumented persons work illegally in gold mining sites in the Amazonian forest. Precarious life conditions lead to poor health but few data exist on the health status of illegal gold miners in French Guiana. The objective of this article was to describe the sociodemographic and health status of this vulnerable population. Method A prospective cross-sectional survey was conducted in 2015 on gold mine supply sites at the border between French Guiana and Suriname. Health status was assessed through medical examination, past medical history, haemoglobin concentration, and HIV and malaria testing. A questionnaire was used to collect data about the migration itinerary and life conditions on mining sites. Results Among the 421 adults included in the study, 93.8% (395/421) were Brazilian, mainly from Maranhão (55.7%, 220/395), the poorest Brazilian state. The sex ratio was 2.4. Overall, 48% of persons never went to school or beyond the primary level. The median time spent in gold mining was quite long (10 years), with a high turn-over. One third of the surveyed population (37.1%, 156/421) had high blood pressure, and only two had a medical follow-up. Most persons had experienced malaria (89.3%, 376/421). They declared frequent arboviroses and digestive disorders. Active leishmaniasis was observed in 8.3% of gold miners. Among women, 28.5% were anemic. Concerning HIV, 36.6% (154/421) of persons, mainly men, never got tested before and 6 were tested positive, which represented an HIV prevalence of 1.43% (95%CI =0.29–2.5). Conclusion These findings support the hypothesis that mining in remote areas is linked to several specific illnesses. Theoretically, gold miners would be presumed to start their economical migration to French Guiana as a healthy group. However, their strenuous working and living conditions there lead to poor health caused by infectious and non infectious diseases. This description of their health status is precious for health policy planners in French Guiana given the importance of controlling communicable disease, and the severity and range of specific illnesses acquired by this neglected population. Trial registration Clinical trial registration PRS N° NCT02903706. Retrospectively registered 09/13/2016.
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Affiliation(s)
- Maylis Douine
- Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Cayenne Hospital, Av des Flamboyant, BP 6006, 97306 cedex, Cayenne, French Guiana, France. .,Epidemiology of Tropical Parasitoses, EA 3593, Université de Guyane, Cayenne, French Guiana, France.
| | - Emilie Mosnier
- Epidemiology of Tropical Parasitoses, EA 3593, Université de Guyane, Cayenne, French Guiana, France.,Centres Délocalisés de Prévention et de Soins, Cayenne Hospital, Cayenne, French Guiana, France
| | - Quentin Le Hingrat
- INSERM UMR1137, IAME Université Paris Diderot Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat-Claude Bernard, Paris, France
| | - Charlotte Charpentier
- INSERM UMR1137, IAME Université Paris Diderot Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat-Claude Bernard, Paris, France
| | - Florine Corlin
- Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Cayenne Hospital, Av des Flamboyant, BP 6006, 97306 cedex, Cayenne, French Guiana, France
| | - Louise Hureau
- Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Cayenne Hospital, Av des Flamboyant, BP 6006, 97306 cedex, Cayenne, French Guiana, France
| | - Antoine Adenis
- Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Cayenne Hospital, Av des Flamboyant, BP 6006, 97306 cedex, Cayenne, French Guiana, France.,Epidemiology of Tropical Parasitoses, EA 3593, Université de Guyane, Cayenne, French Guiana, France
| | - Yassamine Lazrek
- Laboratoire de parasitologie, WHO Collaborating Center for Surveillance of Anti-Malarial Drug Resistance, Centre National de Référence du paludisme, Institut Pasteur de la Guyane, Cayenne, French Guiana, France
| | - Florence Niemetsky
- Centres Délocalisés de Prévention et de Soins, Cayenne Hospital, Cayenne, French Guiana, France
| | - Anne-Laure Aucouturier
- Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Cayenne Hospital, Av des Flamboyant, BP 6006, 97306 cedex, Cayenne, French Guiana, France.,Centres Délocalisés de Prévention et de Soins, Cayenne Hospital, Cayenne, French Guiana, France
| | - Magalie Demar
- Academic Laboratory of Parasitology - Mycology, Cayenne Hospital, Cayenne, French Guiana, France
| | - Lise Musset
- Laboratoire de parasitologie, WHO Collaborating Center for Surveillance of Anti-Malarial Drug Resistance, Centre National de Référence du paludisme, Institut Pasteur de la Guyane, Cayenne, French Guiana, France
| | - Mathieu Nacher
- Centre d'Investigation Clinique Antilles-Guyane (Inserm 1424), Cayenne Hospital, Av des Flamboyant, BP 6006, 97306 cedex, Cayenne, French Guiana, France.,Epidemiology of Tropical Parasitoses, EA 3593, Université de Guyane, Cayenne, French Guiana, France
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Douine M, Musset L, Corlin F, Pelleau S, Pasquier J, Mutricy L, Adenis A, Djossou F, Brousse P, Perotti F, Hiwat H, Vreden S, Demar M, Nacher M. Prevalence of Plasmodium spp. in illegal gold miners in French Guiana in 2015: a hidden but critical malaria reservoir. Malar J 2016; 15:315. [PMID: 27277831 PMCID: PMC4899929 DOI: 10.1186/s12936-016-1367-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 06/02/2016] [Indexed: 01/19/2023] Open
Abstract
Background Malaria is endemic in French Guiana, an overseas territory of France on the Guiana Shield. Since 2005, notified malaria cases are decreasing. However, new data show that malaria affects many Brazilian gold miners working illegally in French Guiana, the majority of whom are not counted in official data. In addition, one major concern is the usual practice of improper self-treatment in this mining population, raising fear of the development of anti-malarial resistance. This prospective study, conducted in 2015, aimed to estimate the prevalence of Plasmodium spp. in illegal gold miners working in French Guiana. Methods The recruitment of gold miners was carried out in resting sites along the French Guiana-Suriname border, where they go for supplies, medical care or leisure. After recording agreement, three malaria diagnostic methods were performed: rapid diagnostic test, microscopy and PCR. Results Among 421 persons recruited in the study, malaria prevalence, detected by nested-PCR, was 22.3 % (CI [18.3–26.3], n = 94/421) of which 84 % were asymptomatic. Conclusions This significant malaria reservoir in a mobile and illegal population with difficult access to a health care system raises the threat of artemisinin resistance and puts the population of the Guiana Shield at risk of new transmission foci while countries of the region aim at malaria elimination. Even though French legislation may hamper dealing with this population, France must face the reality of malaria in illegal gold miners in order to meet its commitment to malaria elimination.
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Affiliation(s)
- Maylis Douine
- Inserm CIC 1424, Centre d'Investigation Clinique Antilles Guyane, Centre Hospitalier de Cayenne, Rue des Flamboyant, BP 6006, 97306, Cayenne Cedex, France. .,Equipe EA 3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, Cayenne, France.
| | - Lise Musset
- Laboratoire de Parasitologie, WHO Collaborating Centre for Surveillance of Anti-Malarial Drug Resistance, Centre National de Référence du paludisme, Institut Pasteur de la Guyane, Cayenne, France
| | - Florine Corlin
- Inserm CIC 1424, Centre d'Investigation Clinique Antilles Guyane, Centre Hospitalier de Cayenne, Rue des Flamboyant, BP 6006, 97306, Cayenne Cedex, France
| | - Stéphane Pelleau
- Laboratoire de Parasitologie, WHO Collaborating Centre for Surveillance of Anti-Malarial Drug Resistance, Centre National de Référence du paludisme, Institut Pasteur de la Guyane, Cayenne, France
| | - Jérémie Pasquier
- Laboratoire hospitalo-universitaire de Parasitologie-Mycologie, Cayenne Hospital, Cayenne, France
| | - Louise Mutricy
- Inserm CIC 1424, Centre d'Investigation Clinique Antilles Guyane, Centre Hospitalier de Cayenne, Rue des Flamboyant, BP 6006, 97306, Cayenne Cedex, France
| | - Antoine Adenis
- Inserm CIC 1424, Centre d'Investigation Clinique Antilles Guyane, Centre Hospitalier de Cayenne, Rue des Flamboyant, BP 6006, 97306, Cayenne Cedex, France.,Equipe EA 3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, Cayenne, France
| | - Felix Djossou
- Infectious and Tropical Diseases Department, Cayenne Hospital, Cayenne, France
| | - Paul Brousse
- Centres Délocalisés de Prévention et de Soins, Cayenne Hospital, Cayenne, France
| | - Frédérique Perotti
- Pharmacy, Centre Hospitalier de l'Ouest Guyanais, Saint Laurent du Maroni, France
| | - Helene Hiwat
- Malaria Programme, Ministry of Health, Paramaribo, Suriname
| | - Stephen Vreden
- Foundation of Scientific Research Suriname (SWOS), Paramaribo, Suriname
| | - Magalie Demar
- Equipe EA 3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, Cayenne, France.,Laboratoire hospitalo-universitaire de Parasitologie-Mycologie, Cayenne Hospital, Cayenne, France
| | - Mathieu Nacher
- Inserm CIC 1424, Centre d'Investigation Clinique Antilles Guyane, Centre Hospitalier de Cayenne, Rue des Flamboyant, BP 6006, 97306, Cayenne Cedex, France.,Equipe EA 3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de Guyane, Cayenne, France
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