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Infections secondary to snakebite occur in a number of patients and are potentially life-threatening. Bothrops lanceolatus bites in Martinique average 30 cases per year and may result in severe thrombotic and infectious complications. We aimed to investigate the infectious complications related to B. lanceolatus bite. A retrospective single-center observational study over 7 years (2011–2018) was carried out, including all patients admitted to the hospital because of B. lanceolatus bite. One hundred seventy snake-bitten patients (121 males and 49 females) were included. Thirty-nine patients (23%) presented grade 3 or 4 envenoming. Twenty patients (12%) developed wound infections. The isolated bacteria were Aeromonas hydrophila (3 cases), Morganella morganii (two cases), group A Streptococcus, and group B Streptococcus (one case each). Patients were treated empirically with third-generation cephalosporin (or amoxicillin–clavulanate), aminoglycoside, and metronidazole combinations. Outcome was favorable in all patients. The main factor significantly associated with the occurrence of infection following snakebite was the severity of envenoming (P < 0.05). Our findings clearly point toward the frequent onset of infectious complications in B. lanceolatus–bitten patients presenting with grade 3 and 4 envenoming. Thus, based on the bacteria identified in the wounds, we suggest that empiric antibiotic therapy including third-generation cephalosporin should be administered to those patients on hospital admission.

International audience

The epidemiology of severe acute poisonings in the French overseas departments of the Americas remains poorly reported. The main objective of this study was to determine the epidemiology and characteristics of severe acutely poisoned adult patients. Methods: A retrospective descriptive study was conducted from 1 January 2000 to 31 December 2010 in severely poisoned patients presenting to the emergency department (ED) of the University Hospital of Martinique, and the general public hospitals of Lamentin and Trinit&eacute, Results: During the study period, 291 patients were admitted for severe poisoning, giving an incidence rate of 7.7 severe cases/100,000 inhabitants. The mean age was 46 &plusmn, 19 years and 166 (57%) were male. Psychiatric disorders were recorded in 143 (49.8%) patients. Simplified Acute Psychological Score (SAPS II) at admission was 39 &plusmn, 23 points and Poisoning Severity Score (PSS) was 2.7 &plusmn, 0.8 points. Death was recorded in 30 (10.3%) patients and hospital length of stay was 6 &plusmn, 7 days. The mode of intoxication was intentional self-poisoning in 87% of cases and drug overdose was recorded in 13% of cases. The toxic agent involved was a therapeutic drug in 58% and a chemical product in 52% of cases. The predominant clinical manifestations were respiratory failure (59%), hemodynamic failure (27%), neurologic failure (45%), gastrointestinal manifestations (27%), and renal failure (11%). Polypnea, shock, ventricular fibrillation or tachycardia, and gastro-intestinal disorders were the main symptoms associated with death. The main biological abnormalities associated with death in our patients were metabolic acidosis, hypokalemia, hyperlactatemia, hypocalcemia, renal injury, rhabdomyolysis, increased aspartate aminotransferases, and thrombocytopenia. Extracorporal membrane oxygenation (ECMO) was used in three patients and specific antidotes were used in 21% of patients. Conclusions: Acute poisonings remain a major public health problem in Martinique with different epidemiological characteristics to those in mainland France, with a high incidence of poisoning by rural and household toxins.

International audience; Background: Guillain-Barré syndrome (GBS) has been reported to be associated with Zika virus (ZIKV) infection in case reports and retrospective studies, mostly on the basis of serological tests, with the problematic cross-reacting antibodies of the Flavivirus genus. Some GBS cases do not exhibit a high level of diagnostic certainty. This prospective study aimed to describe the clinical profiles and the frequency of GBS associated with ZIKV during the ZIKV outbreak in Martinique in 2016.Methods: We recorded prospective data from GBS meeting levels 1 or 2 of diagnostic certainty for the Brighton Collaboration, with proof of recent ZIKV infection and negative screening for etiologies of GBS.Results: Of the sample of 34 patients with suspected GBS during the outbreak, 30 had a proven presence of GBS, and 23 had a recent ZIKV infection. The estimated GBS incidence rate ratio (2016 vs 2006-2015) was 4.52 (95% confidence interval, 2.80-7.64; P = .0001). Recent ZIKV infection was confirmed by urine reverse-transcription polymerase chain reaction (RT-PCR) analysis in 17 cases and by serology in 6 cases. Patients, 65% of whom were male, had a median age of 61 years (interquartile range, 56-71 years) and experienced severe GBS. Electrophysiological tests were consistent with the primary demyelinating form of the disease.Conclusions: ZIKV infection is usually benign, when symptomatic, but in countries at risk of ZIKV epidemics, adequate intensive care bed capacity is required for management of severe GBS cases. Arbovirus RNA detection by RT-PCR should be part of the management of GBS cases.

We report two cases of encephalopathy (one with seizures, one with electroencephalogram changes) in patients with Zika virus infection. The cases occurred on Martinique in February 2016, during the Zika virus outbreak. Awareness of the various neurological complications of Zika virus infection is needed for patients living in areas affected by Zika virus infections or for travellers to these areas.

We report two cases of Guillain–Barré syndrome who had concomitant Zika virus viruria. This viruria persisted for longer than 15 days after symptom onset. The cases occurred on Martinique in January 2016, at the beginning of the Zika virus outbreak. Awareness of this possible neurological complication of ZikV infection is needed.

Introduction : Les morsures de serpent par Bothrops lanceolatus en Martinique, représentent 30 cas en moyenne par an. Toute morsure par ce serpent, unique en Martinique, peut être à l’origine de complications thrombotiques graves à type d’infarctus cérébral, pulmonaire ou myocardique, mettant en jeu le pronostic vital ou fonctionnel. La composition du venin et les mécanismes lésionnels sont à ce jour en cours d’évaluation. Une immunothérapie antivenimeuse spécifique, le Bothrofav2, disponible depuis 2012, a permis une réduction significative de la morbi-mortalité, et des cas d’accidents vasculaires cérébraux ischémiques induits par l’envenimation. Néanmoins, d’autres complications, de type infectieuses, existent et peuvent être tout aussi sévères. L’objectif de cette étude était d’étudier les complications infectieuses des envenimations par morsures de Bothrops lanceolatus. Méthode : Étude descriptive, rétrospective, portant sur une période de 7 ans, allant du 1er février 2011 au 4 septembre 2018, incluant tous les patients admis aux urgences et en réanimation au CHU de Martinique pour morsure de serpent par Bothrops lanceolatus. Les données ont été complétées via les dossiers médicaux à l’aide des logiciels des urgences, Dx Care, x-plore et cyberlab. Les données cliniques et biologiques ont été rapportées et analysées. Résultats : Cent soixante-dix patients (121 hommes et 49 femmes) ont été inclus et 76 ont été exclus. Dix-sept patients (10%) ont été infectés dont 18% présentaient une douleur majorée, 4% un abcès, 11% un érythème, 3% une cellulite, 3% une nécrose et 1% une fasciite nécrosante. Cinq patients avaient une envenimation de grade II, 8 de grade III et 4 de grade IV. Aucun des patients de grade II n’avait reçu d’antibioprophylaxie, 5 des 8 patients de grade III et 3 des 4 patients de grade IV en avaient reçue. Les bactéries retrouvées étaient Aeromonas hydrophila dans 3 cas, Morganella morganii dans 2 cas, streptocoque du groupe A, streptocoque du groupe B, et Klebsielle pneumoniae dans un cas chacun. Conclusion : Les complications infectieuses par morsure de Bothrops lanceolatus surviennent chez environ 10% des patients envenimés, avec une forte prédominance pour les grades III et IV. Une antibiothérapie adaptée à l’écologie bactérienne de la cavité buccale du Bothrops lanceolatus devrait donc être recommandée de façon préventive à tous les patients de grade III et IV ainsi qu’à tout patient présentant une infection documentée quel que soit le grade d’envenimation.