Search

Unlabelled: The lack of clinical practice recommendations for the care of the Unaccompanied Refugee Minors (URM) causes significant disparities depending on which department they arrive. By studying their global health we're willing to promote a standard of care for them., Methods: Data descriptive study from a systematic medical procedure proposed to URM who came in Gironde between January, 2011 and December, 2013., Results: 235 URM were included, from Africa (71%), Asia (21%) and from Eastern Europe (8%). Among them, 143 medical files were complete. The most frenquently diagnosed diseases, and/or the most serious, were digestive parasitoses (50%), schistosomiasis (7%), filariasis (6%), hepatitis B (chronic 6%, seroprevalence 28%), iron deficiency (26%, 4 % with anaemia), G6PD deficiency (8%) and tooth decays (29%). About mental disorders, 45% of the URM had a clinical presentation compatible with post-traumatic stress disorder, 4% had suicidal thoughts., Conclusion: URM accumulate the health risks of teenagers and those of illegal immigrants. Consequently they require an oriented and particular care.

In Western countries, France accounts for the most concerned by imported malaria. The objective of the present study was to describe the epidemiological and clinical features of imported malaria in adults attending the University Hospital Center (UHC) ofBordeaux and to compare these findings with the French national epidemiological data. A retrospective analysis of all patients aged over 15 years with parasitologically confirmed malaria in patients recruited between January 1, 2000 and December 31, 2007 has been performed. A total of 526 cases fitted the inclusion criteria with two-thirds of males and a mean age of 37 years. Patients were less frequently native from sub-Saharan Africa (SA), Madagascar, and Comoros than those from the French national data register (29 versus 72%). Hence, SA was the main destination (2/3 travelling to Western Africa and 1/3 to Central Africa). The recourse to an adequate chemoprophylaxis (CPL) for stays in areas of chemoresistance had been reported in about one-third of the patients. From these, two thirds were noncompliant. The recourse to chloroquine less frequent (6 versus 24%) among patients from Bordeaux compared to those from the national data register whereas the recourse to mosquito net use more frequent in patients from Bordeaux (36 versus 3%). Plasmodium falciparum was the main infective species.Malaria was more frequently associated with hospitalization (89 versus 71%) and with severe disease (9 versus 4%) in Bordeaux than in national data register. Two deaths were declared. Atovaquone-proguanil (AP) combination therapy wasmore frequently used in Bordeaux compared to the national data (64 versus 20%). This AP combination treatment was the most frequently prescribed for uncomplicated malaria, whereas intravenous quinine was mainly used for complicated malaria and for patients with vomiting. The lack of CPL, the diagnosis or therapeutic delay, and the lethality of malaria among travellers infected by malaria imported from SA argue for the implementation of continuing medical training and health education targeted at travellers from France to high malaria-endemic areas such as SA, Madagascar, and Comoros.

Mayotte is a French territory island, part of the Comoros Archipelago in the Indian Ocean with 200,000 inhabitants. The tuberculosis control program started in 1976, although available epidemiological data remains incomplete. We conducted a retrospective hospital-based survey in 202 outpatients and hospital medical records from the Hospital Centre of the main city to contribute to the epidemiological evaluation of tuberculosis patterns. The tuberculosis frequency remains unchanged since 2000. It affects a young population partly coming from the other neighbouring Comoro Islands (69%) with illegal immigrate status (53% in 2004). The systematic diagnostic screening efficiency of the condition appears marginal. Pulmonary involvement is the most frequent clinical manifestation (78%), although severe extrapulmonary manifestations are not exceptional. Co-infection with HIV and multi resistance to antituberculosis agents are not frequent. Up to 60% of cases have been proven to be bacteriologically linked. The notification rate remains critically low with an estimate of 39% of notifications to the local sanitary authorities in charge of secondary cases screening. The case coverage seems limited both by low socio-economical status and poor health facility accessibility The loss of follow up is dramatically high, 41% on the overall period, and up to 51% in 2004. Our results make mandatory the reinforcement of a tuberculosis survey and control involvement within the context of this French territory. Screening, care and follow up are to be implemented particularly for vulnerable and precarious groups and for patients.

Mayotte, a French territory island located in the Indian Ocean near Madagascar, remains a leprosy endemic area. In 2006, leprosy was still a problem of public health with a prevalence of 3.94 per 10,000 inhabitants. There is practically no formal consensus about active screening (AS) on an index case. According to teams and their related staffs, the AS concerns intradomicilary contact individuals (IDC) restrictively or extended to extra-domicilary social and professional contacts. Date, number and frequency of these investigations depend on each team. Between 1997 and 2003, there was no AS planned in Mayotte, but all index case individuals have been encouraged to propose a screening to their relatives through specific campaign information and education. This procedure allowed to identify 10 new cases of leprosy infection among the IDC. Concurrently 12 IDC cases have been diagnosed by health workers. In 2003, we performed a postponed AS within IDC of every Mahorais case registered by passive detection between 1997 and 2003. 325 IDC have been examined and 15 new cases have been detected. All these new cases showed early leprosy features: 14 were paucibacillary forms, among which 9 cases with an isolated cutaneous lesion (7 had an infracentimetric lesion). One patient had multibacillary disease although he presented with an isolated skin lesion which developed within the 6 previous months. None presented with disability. Our results suggest that passive detection even reinforced by repeated individual information and education about leprosy is neither appropriate nor effective. The postponed AS seems to favour an increased self-esteem and a better involvement of the index patient in sanitary education together with the screening of his relatives. In the Mayotte background, the postponed AS has not been associated with a significant delay for diagnosis. Although WHO recommandations are to abandon immediate AS of IDC and to promote self-screening for leprosy our study suggests an intermediate position, namely delayed active screening for an enhanced effective detection.

The isle of Mayotte is a part of the Comoros archipelago, its political status is that of a French Territory Despite a birth control programme helping to space out the births rather than restricting their number, the Mayotte population growth is soaring. Since the visit of the President in May 2001 the subcutaneous etonogestrel implant became available for the population of Mayotte. We then carried out a study to evaluate the response given by 50 post-partum women to this new contraceptive method. 38% of the women declared to be willing to use this contraceptive device while 52% instead didn't wish to try. Although not clearly expressed, the wish to have large families is still there and can be explained by religious and cultural factors. Considering the study results, this contraceptive method could certainly be useful in Mayotte. However a well-balanced education campaign, neither too negative nor too enthusiastic, should be necessary to avoid false expectations which in that case could induce widespread negative rumour towards the birth control method.

Conidiobolus entomophthoromycosis is a rare mycosis due to an ubiquitary telluric fungus. Although the organism is found around the world, it is more concentrated in warm, wet climates. Cases have been described in West Africa, Australia, South America and India. Conidiobolus spp was also to be found in animal like horse. The transmission mode of Conidiobolus has not been established but probably occurs via inhalation of fungal spores covering the nasal mucous membrane or from a minor trauma such as an insect bite. The clinical syndromes include intranasal tumour, nasal obstruction, broadening of the nose bridge, paranasal sinuses, cheeks and upper lip. Diagnostic is made by demonstrating distinctive non-septate hyphea with surrounding eosinophilic sleeve (Splendore-Hoeppli phenomenom) in tissue sections. We report here two cases contracted in Comoro Islands. The first one was a 26 year-old man treated by amphotericin B during six weeks and then by itraconazole, with a clear improvement. The second one was a 37 year-old woman. She has been treated by amphotericin B, subsequently by imidazoles. There was a clear benefit on life duration, but the results for aesthetic aspect are not satisfactory. In the discussion, we review treatment efficacy and failure; in fact, surgery which includes removal of infected tissue and reconstructive procedures, is seldom curative. Several combinations of drugs have been used with different degrees of success. Nevertheless imidazoles remain more efficient than amphotericin B.

Mayotte is a little French island, located in the Indian ocean, between Madagascar and Mozambic. Officially there is a population of 150000 inhabitants, but in fact, there are probably about 200000 people, largely due to numerous illegal immigrants, especially coming from Anjouan the nearest Comorian island. There is only one hospital, with 252 beds. The malaria incidence reaches about 3000 cases per year; and treatments until august 2001 were generally haphazard. This is changing with the use of the Optimal rapid diagnostic test (DiaMed, Cressier Switzerland). More precise statistics should be available in the coming years. In 2000, 252 patients were hospitalised with malaria fever. Preventive measures were scarce. These have been reenforced this year, with the arrival of an entomologist, the use of reenforced pesticide pulverisation in high-risk areas, the distribution of impregnated bednets to pregnant women, and media based information campaigns. Common drugs resistance is becoming a real concern in Mayotte. First-line treatment was: chloroquine; second-line: sulfadoxine-pyrimethamine, and third-line: quinine. In vitro studies have shown high levels of resistance, therefore another antimalarial drug therapy will be introduced at the end of the year: first-line: artemether-lumefantrine, second-line: mefloquine or halofantrine, third-line: quinine. To conclude, solutions exist but a real policy from the decision makers is necessary to implement them. The eradication of malaria remains a dream, but we can expect "zero death" in Mayotte, considering that the fight against this disease may help to start a regional health program.

Mayotte is a little French island, located in the Indian ocean, between Madagascar and Mozambic. Officially, the population goes up to 150,000 inhabitants, but in fact, it probably comes up to about 200,000 people, because of a very numerous illegal immigration, especially coming from Anjouan, the nearest Comorian island. Up to now there are no data about HIV in Mayotte. There is only one adult medical unit (except intensive care). All patients detected as seropositive for HIV are sent for treatment in this unit. The only case of systematically proposed HIV serology is pregnancy, and this since 1994. 70% to 80% of women accept it. There are annually 6000 deliveries in Mayotte. When a seropositivity is detected, screening is systematically proposed to other members of the family. Epidemiology does not seem to worsen, even if detection is increasing: 8675 tests done in 1998, 9142 in 1999, 12,085 in 2000. All cases of seropositivity attended to at present time in our unit have been registered and studied, apart from patients who died before this study, and those who did not consult for more than two years. There were 8 HIV positive people who died since 1990 in Mayotte, most of them in 1991, 1992. There was no death in the last years, nor sanitary evacuation, except one. 50 people are registered: 20 males, 30 females. Average age is 34. 39 Comorian people, 10 metropolitans, and one from another origin. Contamination was heterosexual in 43 cases, intravenous drug user in 1 case, homosexual in 2 cases, professional in 1 case, unknown in 3 cases. There are 4 double contamination Ag Hbs/HIV, and 2 HCV/HIV. 39 subjects are at A stage, 5 B, 6 C. The beginning of the epidemic in Mayotte took place probably around 1990, among militaries and prostitutes. Now, transmission keeps going on, in most cases, heterosexual, as it occurs in the nearby Africa. Polygamy, official or officious, has a leading role. Females who were detected during pregnancy have obtained zidovudine, or have been able to pursue previous therapy. Medical care and therapy are free in Mayotte, but sometimes there are delays in supplying medicines or in returning results. Epidemic has not increased up to now; even though screening has. There are very few pediatric cases: only 4 cases were notified in Mayotte until now: one who died very soon, one who has gone to live in Reunion island, and two who are still in Mayotte: one is 12 years old, and another one 5 years old.

Increasing numbers of people are travelling to Vietnam. From december 1st 1998 to april 31 1999, we surveyed by questionnaire 191 travellers who consulted at health centres attached to French diplomatic representations (Hanoi, Ho-Chi-Minh Ville) in order to evaluate their prophylaxis practices with regard to malaria; 59% of these travellers were taking no preventive measures whatsoever, while the rest were following an often ill-adapted treatment.

Lipoperoxidation final products represented by the TBARS (substances reacting with the Thiobarbituric acid), inflammatory reaction proteins and sera tocopherol have been studied in homozygous forms as well as in heterozygous forms of sickle cell diseases. The significant increase of TBARS (P < 0.001) measured by spectrofluorimetry, the considerable decrease of the sera alpha gamma tocopherol, measured by HPLC (P < 0.005) in all sickle cell patients, especially in crisis homozygous form, reinforce our previous study (22, 23, 24). The absence of links between the TBARS and the tocopherols (fig. 1) suggests that other defence mechanisms occur without vitamin E. The collapse of haptoglobinemia in homozygous sickle cell patients associated with the fall of hemoglobinemia indicates a severe tissue and intravascular hemolysis as a consequence of LPO. Furthermore, the simultaneous decrease of cholesterolemia seems to indicate important lipoperoxide activity detected in sickle cell patients.

Oxidative stress has been suggested to be implicated in malaria. But it is not clear whether its major role is to kill intraerythrocytic parasites or to cause damage to host tissues. We have studied it in 24 European subjects hospitalized in Saint-André hospital, Bordeaux, France for Plasmodium falciparum access returning from a tropical trip, and in a group control of 16 subjects. Malondialdehyde, one of the oxidative stress markers is significantly increased in patients compared to the control group (m = 5.24 vs 2.14 mol/l). At the same time, it is observed a significative decrease in antioxidant factors, vitamin A and vitamin E. We found no relationship of the severity of malaria to the importance of the oxidative stress, and the question whether the oxidative stress attack host tissues or kill parasites remains entire. These observations should be completed by larger studies, particularly to improve malaria treatments available nowadays.

This study is based upon 727 questionnaires completed by French travellers 10 days after intercontinental travel. The response rate was 40%. Two out of 5 travellers had generally mild health problems: fever (12%), diarrhoea (36%). Forty-six of them took drugs, which they had brought with them during their travel. Ten per cent had a satisfactory visit to a local physician. Medical informations given before departure appears to be sufficient, useful and relevant in more than 90% of cases. The traveller would like to receive them from his own physician or from vaccination centers. Other informations as insurance, assistance, administration, finances, appeared to have been incorrectly perceived by 20% of the travellers. The travel agent is the one who should provide adequate information. The traveller, in general, plans to do more travelling for his own well being if not for his work. Would not the bigger risk for him be "not to travel at all".

Simultaneous vaccination against hepatitis A and yellow fever has been studied in our unit: Santé-Voyage, Bordeaux. This randomised study included 108 healthy subjects: 36 received hepatitis A vaccine (Havrix, SKF), 36 received yellow fever vaccine and 36 received both. For hepatitis A vaccine protocol comprised one injection at day zero, one at D15, and one booster dose at 6 months. Those who received yellow fever vaccine had it at D0. Simultaneous vaccination is well tolerated and immunogenicity is as good as it is for each vaccine separately. This is particularly interesting for tropical travellers who are at risk for hepatitis A.

Incidence and malignant forms of imported Plasmodium falciparum malaria are increasing, and chemoprevention is more and more replaced by stand-by treatment and radical cure in preventing access on return from malaria areas. Halofantrine is recommended for this radical cure: it's an habitually well-tolerated amino-alcohol with very few side-effects. We report three cases of long QT-interval due to halofantine: three different young women coming back from Africa took halofantrine (500 mg (2 tablets) six hourly for three doses on the first and the seventh day) and all presented with syncopal episodes. Serum electrolyte concentrations and echocardiograms were normal. In one case only, a diagnosis of Plasmodium falciparum malaria was made, without severe manifestations, and in the two other cases, treatment was a radical cure. In two cases, several bursts of torsades de pointes ventricular tachycardia due to halofantrine were proven and electrophysiological cardiac tests concluded that they had a congenital long QT-interval/Romano-Ward syndrome). So far halofantrine cardiac toxicity was unknown with single dose of 24 mg/kg/d. This phenomenon can be very severe in case of preexisting cardiopathy. In spite of the rarity on the congenital Romano-Ward syndrome, systematic electrocardiogram is necessary before giving halofantrine.