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Recent shark attacks in New Caledonia have prompted local authorities to elaborate a risk-management plan. The objective of the present paper is to produce detailed data on shark attacks that occurred in New Caledonian waters for the last few decades, as well as on the injuries of the victims, in order to inform rescue and medical services as well as authorities in charge of educating the public and providing security.Incidents involving sharks and humans in New Caledonia for the last six decades were included into a database. Sharks were tentatively identified to species according to the shape, size and other external characteristics of injuries to the victims, together with witness accounts. The severity of shark bites was evaluated against the scale proposed by A.K. Lentz and co-authors (Am Surg. 2010;76:101-6).Sixty-seven shark-attack cases were recorded in New Caledonia from 1958 to 2020, of which 13 were lethal. The majority of the attacks concerned spearfishers and freedivers collecting invertebrates (58.5% of total). In the last decades, shark attacks may have increased towards bathers, swimmers and snorkelers (18.5%), and people taking part in water sports including surf, kitesurf, windsurf and SUP foil (14%). One scuba diver was also attacked (1.5%). Twenty attacks including 8 lethal ones were ascribed to the tiger sharkFeeding incentive appeared to be a frequent factor triggering attacks. The education of the public should be promoted as a preventive measure aiming to reduce the risk of such accidents.

Sea bathing is often a priority activity for travelers, with widely recognized health benefits. The dangers, in contrast, are underestimated, especially in tropical seas. We describe the scope of marine envenoming, trauma, and infections, representing 1-3 % of tropical and travel medicine consultations in the literature. Our review includes the eco-epidemiology, clinical approach, and prevention of envenoming by invertebrates (jellyfish, anemone, sea-urchin, starfish, octopus, sea cone) and some vertebrates (stingrays, stone fish, snakes). We include penetrating trauma (by stingray, stonefish, sea urchin, coral) and infections (mycobacteria, marine bacteria). Eating-related dangers (ciguatera, fugu, parasites) are not described here. We also present antidotes, antivenoms, and first-aid.Les baignades en mer aux bienfaits reconnus font souvent partie des activités prioritaires des voyageurs. Mais les dangers, notamment en mer tropicale, sont sous-estimés. Nous décrivons l’éventail des envenimations, traumatismes et infections marins, soit 1 à 3 % des consultations de médecine tropicale et des voyages dans la littérature. Notre revue inclut l’éco-épidémiologie, l’approche clinique et la prévention des envenimations par des invertébrés (méduses, anémones, oursins, étoiles de mer, poulpes et cônes) et certains vertébrés (raies, poissons-pierre, serpents). Elle inclut les traumatismes pénétrants (raies, poissons-pierre) et les infections par contact (mycobactéries, bactéries marines). Les dangers alimentaires (ciguatera, fugu, parasites) ne sont pas décrits ici. Les antidotes, antivenins et premiers secours sont également présentés.

Rabies is a zoonosis of viral origin responsible for tens of thousands of human deaths each year in countries where dog rabies is not controlled and where post-exposure prophylaxis -PEP- is not available to populations the most vulnerable. In France, the epidemiology of rabies has changed for 20 years and our territory is currently declared free from rabies in terrestrial animals since 2001. This favorable epidemiology no longer justifies the administration of PEP in individuals exposed to an animal -except bats- in France except in French Guiana because of the risk of desmodin-type rabies in South America.RAGE La rage est une zoonose d’origine virale responsable de plusieurs dizaines de milliers de décès humains chaque année dans les pays où la rage du chien n’est pas contrôlée et où la prophylaxie post-exposition n’est pas accessible aux populations les plus vulnérables. En France, l’épidémiologie de la rage a changé depuis 20 ans et notre territoire est actuellement déclaré indemne de rage des mammifères terrestres depuis 2001. Cette épidémiologie favorable ne justifie plus l’administration de prophylaxie post-exposition chez les individus exposés à un animal -hors chauve-souris- en France, sauf en Guyane en raison du risque de rage desmodine en Amérique du Sud.

In Sibut (CAR), the increase in bites by stray dogs and two cases of human rabies alerted health authorities in 2019. The answers were the vaccinations of humans and of dog (780 dogs). Among the 127 humans bitten and identified, 87% received a first injection of post-exposure prophylaxis. The drop-out between the first and third doses was 41%. Communication on rabies and the provision of vaccines and serums to the population are necessary, but difficult to achieve in the crisis conditions of the country.À Sibut (RCA), la multiplication des morsures par des chiens en divagation et deux cas de rage humaine ont alerté les autorités sanitaires en 2019. Les réponses ont été la vaccination de 780 chiens. Parmi les 127 humains mordus et identifiés, 87 % ont reçu une première dose de prophylaxie postexposition. Le taux d'abandon vaccinal entre la première et la troisième dose a été de 41 %. La communication sur la rage et la mise à la disposition de la population de vaccins et sérums sont nécessaires, difficiles à réaliser dans les conditions de crise que connaît le pays.

Animal and human bites are a common cause of admission to the emergency room and the infections are common, although they are often trivialized. Complications can range from simple cellulitis to septic shock especially in asplenic patients with Capnoyctophaga canimorsus infection. Other less common infections are possible such as rat-bite fever, leptospirosis, tularemia, and evaluation of post-exposure prophylaxis (anti-tetanus, anti-rabies, HIV, HBV) is essential. Antibiotic prophylaxis remains controversial but is recommended for certain groups of patients and must cover common bite pathogens.Les morsures animales et humaines sont un motif fréquent d’admission aux urgences et leur infection est fréquente, alors qu’elles sont souvent banalisées. Les complications peuvent aller d’une simple dermohypodermite au choc septique, notamment chez les patients aspléniques lors d’infection à Capnocytophaga canimorsus. D’autres infections moins communes sont possibles comme la « rat-bite fever », la leptospirose, la tularémie, et l’évaluation des prophylaxies postexpositionnelles (antitétanique, antirabique ; VIH, VHB en cas de morsures humaines) est primordiale. L’antibioprophylaxie reste controversée, mais est recommandée pour certains groupes de patients, et se doit de couvrir les germes retrouvés fréquemment lors de morsures.

Animal and human bites are a common cause of admission to the emergency room and the infections are common, although they are often trivialized. Complications can range from simple cellulitis to septic shock especially in asplenic patients with Capnoyctophaga canimorsus infection. Other less common infections are possible such as rat-bite fever, leptospirosis, tularemia, and evaluation of post-exposure prophylaxis (anti-tetanus, anti-rabies, HIV, HBV) is essential. Antibiotic prophylaxis remains controversial but is recommended for certain groups of patients and must cover common bite pathogens.

Lyme disease is currently a hot topic in France due to a high incidence in some areas. Its clinical polymorphism can lead to misdiagnosis on one hand and to unjustified treatment on the other hand. Clinical symptoms vary considerably according to involved organs (skin, central and/or peripheral nervous system, joints, heart, eyes) and may be limited to or associated with general non-specific signs. Biological exams must be guided by clinical symptoms to help diagnosis and treatment decision according to clinical history, presentation, time of onset and duration of symptoms. However, to date, no serologic test can discriminate between past and active disease. The role of the internist is two-fold: make a diagnosis when faced with general or focal symptoms and avoid inappropriate attribution to Lyme disease of symptoms related to alternate diagnoses.

Meningitis and septicaemia due to Capnocytophaga canimorsus are extremely rare and described as emerging zoonoses because of their low incidence and prevalence, but also because of the challenges in bacterial identification, thus, the real number of cases is probably underestimated. We report the case of a 61-year-old man, with a history a chronic alcoholism, who developed, following a recent dog bite, meningitis with normoglycorachia and concomitant sepsis, and had a favorable outcome after intravenous probabilistic antibiotherapy combining ceftazidime and metronidazole. This association aimed to cover the risks represented by Pseudomonas spp and anaerobic bacteria, once the microorganisms commonly associated with meningitis were excluded using molecular biology tools. In addition to the unusual biological results (normoglycorachia and bacterial morphology after Gram staining), we present the biological diagnostic approach (molecular, biochemical and physical tools successively used to lead, by exclusion and confirmation, to this diagnosis), closely linked to the clinical expertise. This is, to our knowledge, the first described case of meningitis with normoglycorachia and septicaemia due to Capnocytophaga canimorsus successfully treated with ceftazidime and confirmed by identification by MALDI-TOF mass spectrometry.

A female jogger was attacked by a common buzzard (Buteo buteo) and was scratched lightly at the back of the head. One week later she was taken ill with high fever and headache which was later diagnosed as ulcero-glandular tularemia in regional lymph nodes, caused by Francisella tularensis. Recovery was only achieved after several weeks of systemic antibiotic treatment (Gentamicin/ Ciprofloxacine). Tularemia is a well known zoonotic disease, called "rabbit fever", mainly affecting rabbits and hares, but also small rodents. Human infection occurs often following tick bites or bloodsucking insects, or in hunters or slaughterers handling infected animals. Bites by mice have also been reported as a cause of tularemia. For the first time we report this case of tularemia as a result of an attack by a bird of prey. We assume that the bird acted as a vector just carrying the F. tularensis on its claws or beak, but we cannot exclude an infection of the bird itself. Several other joggers had also been attacked by a common buzzard in the same area shortly after the above described event and one of these also became infected with F. tularensis.Eine Joggerin erkrankt nach einem Angriff durch einen Mäusebussard (Buteo buteo) an einer bakteriellen Infektion mit Francisella tularensis. Initial bestand nur eine minimale Kratzverletzung, daraus entwickelte sich eine fieberhafte Allgemeinerkrankung mit Kopfschmerzen und später entwickelte sich eine Lymphadenopathie, die als ulceroglanduläre Tularämie in den regionalen Lymphknoten diagnostiziert wurde. Diese heilte erst nach intensiver mehrwöchiger Behandlung mit Antibiotika (Gentamicin/Ciprofloxacin) ab. F. tularensis ist zoonotisch und v.a. bei Hasen, Kaninchen und kleinen Nagetieren als Erreger der sog. „Hasenpest“ bekannt. Menschliche Infektionen entstehen meist nach Zeckenstich, durch blutsaugende Insekten, oder durch kleine Verletzungen beim Hantieren mit infizierten Tierkörpern (Metzger, Jäger). Auch Bisse von infizierten Mäusen können eine Infektion auslösen. Dass auch von aggressiven Greifvögeln eine Infektionsgefahr ausgeht, wurde bisher noch nie berichtet. Im vorliegenden Fall könnte eine Kontamination der Krallen oder des Schnabels durch Bakterien eines geschlagenen Beutetieres vorgelegen haben. Allerdings ist auch eine Infektion des Vogels nicht auszuschliessen, zumal in der gleichen Gegend einige Tage nach dem hier beschrieben Vorfall weitere Jogger angegriffen wurden, und bei einem der Opfer trat ebenfalls eine Tularämie auf.

International audience; The recent emergence or re-emergence of vector-borne diseases (VBD) and, more specifically, VBD associated with arboviruses such as dengue, chikungunya, Zika or yellow fever are not new events. The globalization of trade and travels as well as the unplanned urbanization of many tropical and subtropical cities have created the conditions suitable for the establishment of vector mosquitoes offering opportunities for arbovirus introduction. This review describes the major arboviruses important for human health and their epidemic vectors, and the conditions leading to their emergence.; L’émergence ou la ré-émergence récente des maladies à transmission vectorielle et plus précisément, celle associée aux arbovirus tels que la dengue, le chikungunya, le Zika ou encore la fièvre jaune ne sont pas des phénomènes nouveaux. Aujourd’hui, la mondialisation des échanges commerciaux, des déplacements des voyageurs ainsi que l’urbanisation anarchique de nombreuses villes tropicales et subtropicales créent les conditions propices à l’installation durable des moustiques vecteurs et par conséquent, à l’introduction des arbovirus. Cette revue décrit les principaux arbovirus importants en santé humaine et leurs vecteurs épidémiques, ainsi que les conditions facilitant leur émergence.

Children represent a population at risk, because of their short size, their naivety and their attraction to animals. The face and hands are the most specific locations in young children. Wounds are often multiple. In more than half the cases, the child knows the animal, which are dogs and cats by frequency argument. The bite episode occurs mostly when the child is alone with the pet without direct supervision, while playing or stroking the animal. As in all bites, pediatric lesions are infectious, functional and aesthetic emergencies, but the goal of this work was primarily to make a point on principles of surgical management of animal bites in children, highlighting pediatric specificities. Animal bites require psychological, anesthetic and surgical treatment, adapted to the child, in a specialized structure. Hospitalization and general anesthesia are more frequent in children. Any suspicion of mistreatment (and/or abuse) should lead to the child's hospitalization, even if wounds do not justify monitoring in a surgical environment. Emergency surgery is essential to limit functional and aesthetic consequences. The healing capacities of the child and the frequent lack of co-morbidity allow a conservative surgical treatment with suture, repositioning skin flaps and controlled healing in the first place. Immobilization, drainage, and antibiotics will complete the surgery. The healing process, however, leads to a specific management during scar remodeling phase and growth. Psychological care of the child and parents should not be forgotten, and has to start at the same time as surgical treatment at in acute phase.

A large proportion of viral pathogens that have emerged during the last decades in humans are considered to have originated from various animal species. This is well exemplified by several recent epidemics such as those of Nipah, Severe Acute Respiratory Syndrome, Avian flu, Ebola, Monkeypox, and Hantaviruses. After the initial interspecies transmission per se, the viruses can disseminate into the human population through various and distinct mechanisms. Some of them are well characterized and understood, thus allowing a certain level of risk control and prevention. Surprisingly and in contrast, the initial steps that lead to the emergence of several viruses, and of their associated diseases, remain still poorly understood. Epidemiological field studies conducted in certain specific high-risk populations are thus necessary to obtain new insights into the early events of this emergence process. Human infections by simian viruses represent increasing public health concerns. Indeed, by virtue of their genetic andphysiological similarities, non-human primates (NHPs) are considered to be likely the sources of viruses that can infect humans and thus may pose a significant threat to human population. This is well illustrated by retroviruses, which have the ability to cross species, adapt to a new host and sometimes spread within these new species. Sequence comparison and phylogenetic studies have thus clearly showed that the emergence of human immunodeficiency virus type 1 (HIV-1) and HIV-2 in humans have resulted from several independent interspecies transmissions of different SIV types from Chimpanzees and African monkeys (including sooty mangabeys), respectively, probably during the first part of the last century. The situation for Human T cell Lymphotropic virus type 1 (HTLV-1) is, for certain aspects, quite comparable. Indeed, the origin of most HTLV-1 subtypes appears to be linked to interspecies transmission between STLV-1-infected monkeys and humans, followed by variable periods of evolution in the human host. In this review, after an introduction on emerging viruses, we will briefly present the results of a large epidemiological study performed in groups of Bantus and Pygmies living in villages and settlements located in the rain forest of the South region of Cameroon. These populations are living nearby the habitats of several monkeys and apes, often naturally infected by different retroviruses including SIV, STLV and simianfoamy virus. Most of the persons included in this study were hunters of such NHPs, thus at high risk of contact with infected body fluids (blood, saliva,...) during hunting activities. After reviewing the current available data on the discovery, cross-species transmission from monkeys and apes to humans of the simian foamy retroviruses, we will report the results of our study. Such infection is a unique natural model to study the different mechanisms of restriction of retroviral emergence in Humans.

Une arthrite septique sur PTG est due essentiellement au Staphylococcus aureus suivie des staphylocoques à coagulase négative, et les streptocoques. Au cours de ses 40 dernières années très peu de cas d'infection sur arthroplastie à Pasteurella multocida ont été rapporté. La présentation clinique n'a rien de spécifique.la contamination survient après une morsure, griffure ou léchage d'un chat. L'interrogatoire et l'examen bactériologique est la clé du diagnostique. Nous rapportons le cas d'une patiente de 84 ans qui présente une infection a Pasteurella multocida suite à une morsure du chat 06 jours au paravent. Elle a bénéficié d'une prise en charge chirurgicale par lavage et synovectomie et une bi-antibiothérapie avec bonne évolution.

Children are often victims of dog or cat bites, but human bites are rarer. Infection is the most frequent complication. A very large number of bacterial species, anaerobic and aerobic often associated, are found in local samples. Antibiotic therapy is not systematic and should be discussed on a case-by-case basis taking into account the risk factors: the type of animal bite, the location and depth of the bite, and the time to treatment. Immunodepressed patients or those having undergone splenectomy are at a high risk of severe infections or from unusual bacteria and should be treated preventively. The association of amoxicillin and clavulanic acid is the most active antibiotic on the majority of bacteria responsible for infections. Treatment should be initiated rapidly and continue for 3-5 days with monitoring of local signs.

We report a case of box-jellyfish related envenomation in a 40 year old tourist that occurred in Sihanoukville, Cambodia, in the Gulf of Thailand. Symptoms that appeared within a few minutes associated intense pain, hand edema and large edematous and erythematous flagellations in the stung skin areas. Antibiotics and corticosteroids were delivered. Inflammatory signs and skin lesions disappeared within 15 days followed by crusts then scars. Jellyfish at risk for humans are generally found in tropical seas and their geographic distribution seems to spread. As it is difficult to prevent this kind of accident, travelers should be aware of the first acts to perform, such as appropriate cleaning of the wound, the interest of vinegar usage, the administration of analgesics and corticosteroids in case of significant inflammatory signs.

French Guiana, by its geographical situation, its climate and its biodiversity, is often called "the green hell". Indeed, this French department of America shelters a wildlife rich, abundant among which many species of arthropods, some of which are responsible for envenomations. These accidents consist of scorpion's or hymenoptera's stings or spider's bites. The associated clinical aspect is variable, from simple pain to circulatory collapse, or lung oedema. However, symptomatology is generally mild; four deaths associated to arthropod envenomations have been reported in the past 25 years. This article focuses on envenomations in French Guiana, describing favoring human behavior, risks and venoms associated with the main related animal species.

Despite the availability of effective anti-rabies vaccine, rabies keeps affecting people in developing countries such as Côte d'Ivoire. The low compliance with Post Exposure Prophylaxis (PEP) partially explains this situation. This study was aiming at studying the reasons to abandon PEP. This descriptive and cross-sectional study has taken place at the anti-rabies Center of Abidjan from October 1st to December 2009. Data were collected in two steps: we first interviewed all the patients at the anti-rabies center during their first consultation, and then phone interviews were conducted one month later, only with exposed patients who abandoned their PEP. These phone calls allowed us to complete the questionnaire (the status of the animal and PEP discontinuation). Patients' verbal informed consent was obtained prior to data collection. Besides, patients were explained the risks they were exposed to and were advised to complete immunization. The results obtained revealed that, out of 220 people included in the study, 116 (52.7%) abandoned the PEP. The compliance was lower with the protocol of five injections compared to that of four injections. More than half of the patients abandoned PEP after the first injection. In 32.8% of patients who abandoned PEP, the animal was dead, disappeared, was destroyed or there were no information about it one month after bite or scratch. Animal owners' refusal of taking in charge the victims (20%) and the lack of financial resources for purchasing the vaccine (13.6%) were the most frequent reasons to abandon PEP. To increase the protection of the human population against rabies and to increase the compliance with PEP protocols, the improvement of financial accessibility to the vaccine for population and the elaboration of compulsory regulations for animal owners to take in charge the PEP are necessary.

A 4-year-old girl was playing with her neighbour's dog. The dog became excited and bit the girl on the forearm, leaving a puncture wound. As a result of the injury, she has presented to my office. Should she be treated with antibiotics? If so, which antibiotic should be used and for how long?Initiation of prophylactic antibiotics is indicated if the dog bite has undergone primary closure; if there is a moderate or severe bite wound; for puncture wounds (especially if penetration of bone, tendon sheath, or joint), facial bites, bites to the hands or feet, or genital area bites; or wounds sustained by victims who are immunocompromised or asplenic. The first-line choice of antibiotic is amoxicillin-clavulanate. Appropriate tetanus and rabies prophylaxis as indicated should also be a part of caring for a patient who has sustained a dog bite, as well as local debridement and thorough cleaning of the wound.

This article provides a brief overview of some diseases transmitted by ticks. These vectors do not transmit only Lyme disease and tickborne-encephalitis, even in Switzerland. Several tick-borne diseases cause nonspecific flu-like symptoms. Nevertheless sometimes severe, some of these diseases can be treated with specific treatments. Repellents, appropriate clothes impregnated with permethrine and prompt removal of the tick are effective preventive measures to limit the risk of infection. There is an effective vaccine which protects against tick-borne encephalitis.

Rickettsial diseases are arthropod-borne zoonosis. They are still misdiagnosed in Switzerland. Since development in molecular genetics, number of pathogenic species increased dramatically. In recent years, the incidence rise worldwide. Climatic conditions and development of tropical travels could explain it. In a near future, the Swiss general practitioner may face an increase of cases. Clinical presentation is unspecified. The eschar is the key diagnostic element but can be easily overlooked. Serology, the indirect immunofluorescence assay is the reference method. PCR can give the diagnosis in acute phase. However empirical treatment should be prescribed as soon as diagnosis is suspected. No vaccine is currently available and use of repellent is still the best way of prevention.

This article provides a brief overview of some diseases transmitted by ticks. These vectors do not transmit only Lyme disease and tickborne-encephalitis, even in Switzerland. Several tick-borne diseases cause nonspecific flu-like symptoms. Nevertheless sometimes severe, some of these diseases can be treated with specific treatments. Repellents, appropriate clothes impregnated with permethrine and prompt removal of the tick are effective preventive measures to limit the risk of infection. There is an effective vaccine which protects against tick-borne encephalitis.

The purpose of this study is to describe the epidemiological profile of subjects exposed to rabies in the anti-rabies center of Abidjan in Ivory Coast. The paper is based on a cross-sectional study conducted among all people exposed to the risk of rabies and followed in the anti-rabies center from January to December 2008. During the study period, 2,673 subjects were exposed, i.e. 5 exposures for every 10,000 persons. 1,534 patients (57.4%) were male. The most exposed age groups were the 0-9 and 10-19 age groups (22.4% and 29.5% respectively). In Abidjan, 608 individuals (22.7%) were exposed in Cocody, 471 individuals (17.6%) in Abobo, and 310 individuals (11.6%) in Yopougon. Exposure occurred in 76.9% of cases (2,055 subjects) at home and exclusively concerned visitors of the family. Exposures by animal bites represented 88.1% (2,354 subjects) of all cases, while 23.2% (620 subjects) of exposures were category III. The average period between exposure and consultation was 10 days. Subjects were exposed as a result of contact with a dog in 92.1 % of cases (2,462 subjects). The animal was found alive in 74.9% (2,002 cases) and was not immunized in 87.2% of cases (2,331). Post-exposure prophylaxis was given up by 1,470 persons (55.2%). 13 subjects were received at the stage of clinical rabies. Increased knowledge of the epidemiological profile of rabies exposure will contribute to improving the management of the disease in Ivory Coast.

Animal bite is frequently involved in children labial defect. The need for labial surgical repair is to restore anatomy and function. Local and regional flap is usually described for labial reconstructions. Few authors recommend mucosal and skin graft. In the present study, we described skin and mucosal graft for reconstruction of complex labial defect. This surgical technique can be applied in very young children with reasonable expectations of excellent functional and aesthetic outcome.

The face is the area most vulnerable for dog bites in children. Surgical management is an emergency to prevent infection, functional and aesthetic outcomes. The aim of this study was to define a new gravity scale, and to determine a prevention policy.In our maxillofacial and plastic surgery department, we conducted a retrospective study from 2002 to 2010, including 77 children under 16 years old, victims of facial dog bite. We analyzed epidemiological, clinical data, surgical outcomes.The mean age was 5.36 years. Dogs were principally represented by class I and II dogs; 27,7% of them had ever bitten before. In almost all the cases, the dogs belong to the family or closers. Twenty-one percent of children belong to an unfavourable social environment; 71.43% of dog bites interested the central area of the face. The bites were deep in 77% of cases with amputation or extensive loss of substance in 31% of cases. The healing time was 10.54 months. Nearly a third of patients required several surgeries; 41.56% of patients had aesthetic and functional sequelae; 35.1% of children had psychological problems afterward.Facial children dog bites require a multidisciplinary approach, and a long-term follow-up. We propose a new classification of dog bite severity, more appropriate to the face.

The scorpion envenomation is a major public health problem in Algeria. Given this fact, the Ministry of Health has developed a national strategy for prevention and control based on the training of health personnel, information, education and communication, and standardization of care on the basis of a therapeutic consensus. The monitoring and evaluation activities are carried out by epidemiological indicators through the implementation of an information system based in the services of Epidemiology, INSP (National Institute of Public Health) and Prevention Department of the Health Ministry. The information carriers are report cards implemented in different health facilities that collect data on bites and deaths from scorpion envenomation. Summaries of notifications from the wilayas are collected monthly, and processed by the Epi info software using monitoring indicators. From 1991 to 2010, there has been a stagnation in the number of stings with an average of 50,000 cases per year, but mortality decreased from more than 100 deaths in the last fifty years to 50 nowadays. The higher proportion of stings was recorded during the summer period. The most affected group is from 15 to 49 years which constitute the workforce, but children from 5 to 14 years rank first in terms of mortality. But these rates vary across years and regions. Despite all these efforts, the scorpion envenomation in Algeria remains of concern and our main challenges are to strengthen cross-sectional actions at the local level and improving the quality of care.

Although stingray injuries have always been frequent in the Republic of Djibouti, it was not until July 2008 that the Bouffard Hospital developed a standardised management protocol. The purpose of this report is to describe that protocol and evaluate its impact on the outcome of stingray injuries based on a prospective study for the period between July 2008 and July 2009. During the study period, 12 stingray stings were treated. The treatment protocol that is based on a multidisciplinary approach involving the intensivist, anaesthesiologist, and surgeon achieved wound healing within one month. This outcome contrasts with previous publications that have generally described longer healing times with frequent infectious complications.

Pulse oxymetry is frequently used in anaesthesia, notably in paediatric anaesthesia. This device can however present artefacts. We report the case of a sudden decrease in pulse oxymetry during surgical exploration of wound of the face in a child. This was preceded by the injection of patent blue, used for vascular cartography, and interfering with pulse oxymetry. After excluding real oxygen desaturation, this error of measurement has to be confirmed by arterial gazometry. In our case, pulse oxymetry normalized few hours later, without complication.

Spirochetal infections present with a variety of clinical syndromes and epidemiologic features. Diagnosis remains challenging for the clinician because of the often protean clinical presentation and poor performance of stan-dard microbiological tests. We present 3 clinical cases, illustrating interesting or unusual features of these infections. First, we present a case of leptospirosis acquired in Switzerland after a rat bite. We then present a case of early disseminated Lyme disease with multiple erythema migrans, lymphopenia, thrombocytopenia and liver enzyme elevation. Finally, we present a case of secondary syphilis in an HIV-positive man, complicated by sensorineural deafness. For each case we highlight and discuss the specific epidemiological, clinical and therapeutic features.