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We report a case of cerebral phaeohyphomycosis, a fungal brain infection due to a dark (dematiaceous) fungi in a 6-year-old French Guyanese boy. The child presented fever and drowsiness due to several paraventricular brain abscesses. Neurological surgeries were performed to reduce intracranial hypertension and to obtain abscess biopsies. Mycological cultures of intraoperative samples led to the diagnosis of cerebral phaeohyphomycosis due to Cladophialophora bantiana. The patient neurological status deteriorated and remained critical after several weeks of combination antifungal therapy with voriconazole 8 mg/kg/day, liposomal amphotericin B 10 mg/kg/day and flucytosine 200 mg/kg/day. A complete surgical resection was not possible because of multiple small abscesses. A multidisciplinary ethical staff decided on home medical care with palliative ventriculoperitoneal shunt, nasogastric feeding and analgesics. One year later, the patient's neurological condition had improved and cerebral lesions had regressed, while he had not received any antifungal treatment but only traditional medicines. Cerebral phaeohyphomycosis are rare diseases affecting immunocompromised but also apparently non-immunocompromised patients, as in this case. A complete surgical resection is not always possible and mortality rates are high in spite of treatments with a combination of antifungals. The diagnosis may be difficult because of these dematiaceous fungi's slowly growing and their potential pathogenicity for laboratory staff.

International audience; We conducted an observational study to describe the characteristics of infective endocarditis (IE) in French West Indies (FWI) and to identify variables associated with in-hospital case fatality. The records of the patients admitted for IE to the University Hospital of Martinique between 2000 and 2012 were collected using an electronic case report form. Only Duke-Li definite cases were considered for this analysis. Variables associated with in-hospital mortality were tested using univariate logistic regression analysis. The analysis included 201 patients (median age 58 years, sex ratio: two males to one female). There was no previously known heart disease in 45.8%, a prosthetic valve in 21.4%, and previously known native valve disease in 32.8% of the cases. Community-acquired IE represented 59.7% of all cases, health-care-associated IE represented 38.3% and injection-drug-use-acquired IE represented 1.5%. Locations of IE were distributed as follows: 42.3% were mitral valve IE, 34.8% were aortic valve IE, and 7% were right-sided IE. Microorganisms recovered from blood cultures included 30.4% streptococci, 28.9% staphylococci, and 5% enterococci. Blood cultures were negative in 20.9% of the cases. Surgical treatment was performed in 53% of the patients. In-hospital case fatality rate was 19%. Advanced age, Staphylococcus aureus IE, and health-care-associated IE were associated with in-hospital case fatality. The epidemiological and microbiological profile of IE in FWI is in between those observed in developed countries and developing countries: patients were younger, blood cultures were more frequently negative, and IE due to group D streptococci and enterococci were less common than in industrialized countries.

National audience; Leptospirosis is a neglected disease which affects all tropical regions, particularly South America and the Caribbean. Its incidence and case-fatality rates are poorly known, and probably highly underestimated. In order to estimate the real incidence of leptospirosis in the French West Indies, an incidence study was performed in 2011 using the three prevailing available biological tests for diagnosis: Microscopic Agglutination Test (MAT), IgM ELISA and PCR. The study investigated inpatients as well as outpatients, and used active case ascertainment from data provided by a general practitioners’ sentinel network.The incidence of leptospirosis was estimated respectively at 69 and 61 annual cases per 100,000 inhabitants respectively in Guadeloupe and Martinique, representing an incidence 100 times higher than in Mainland France for the study period. The results also show that using PCR-real time for diagnosis has allowed identifying cases many more cases than that would not have been detected without having recourse to this test. It also contributes to early detection of the disease, reducing the risk of complications due to leptospirosis through the prescription of an antibiotic therapy.It has also been possible to describe the epidemiology of the disease in terms of severity, demographic characteristics and seasonal patterns. Besides, these results support the relevance of developing an integrated management strategy for surveillance, prevention and control of the disease in the French West Indies.; La leptospirose est l'une des maladies dites négligées des pays du Sud, en particulier en Amérique latine et dans la Caraïbe. Son incidence réelle et sa létalité sont incertaines, cette dernière étant probablement élevée. Afin d'estimer l'impact sanitaire réel de la maladie aux Antilles françaises, une étude d'incidence a été conduite en 2011, en mettant en oeuvre l'ensemble des outils diagnostiques aujourd'hui disponibles : le test de micro-agglutination (MAT), la sérologie Elisa IgM et la PCR. Cette étude a pris en compte non seulement les patients hospitalisés mais également, grâce aux réseaux de médecins généralistes sentinelles, les patients ambulatoires pris en charge par leur médecin traitant. L'incidence de la leptospirose a été estimée à 69 et 61 cas annuels pour 100 000 habitants, respectivement en Guadeloupe continentale et en Martinique, soit une incidence plus de 100 fois supérieure à celle de la métropole à la période de l'étude. Les résultats montrent également que l'accès au diagnostic par PCR conduit à un nombre de cas aux Antilles très largement supérieur à celui dénombré antérieurement ; il permet en outre de diagnostiquer la maladie en phase précoce, limitant le risque de complications de la leptospirose par la prescription d'un traitement antibiotique. L'épidémiologie de la maladie a pu être également décrite en termes de sévérité, de caractéristiques démographiques et de saisonnalité. Les résultats confirment la pertinence de la mise en place d'un système de surveillance épidémiologique à visée d'alerte, étroitement articulé avec une stratégie de prévention et de contrôle de la maladie.

International audience; A syphilis outbreak began in Martinique, French Antilles, in 2004, initially among men who had sex with men (MSM) and who were living with human immunodeficiency virus (HIV). The outbreak subsequently affected all groups at risk, leading to a first epidemic peak in 2008. After an initial decrease, the outbreak started growing again in 2014 among patients living with HIV with unprecedented incidence among MSM. Herein, we describe the change in medical and social parameters of the outbreak since 2005.

Shewanella spp. are saprophytic bacteria that are part of the marine microflora in warm climates and are rarely pathogenic. However, Shewanella spp. infections are being increasingly reported, and there has been no comprehensive review of the literature describing these infections. This article reports 16 cases of Shewanella spp. infections in Martinique since 1997 and reviews another 239 cases reported in the literature since 1973. Patients experienced soft tissue infections, ear infection, or abdominal and biliary tract infections. A skin or mucosal portal of entry was found for 53% of the patients and exposure to the marine environment was reported for 44%; 79% of patients had an underlying condition. Bacteriema were frequent (28%). Most (87%) patients recovered, although ear infections can become chronic. Death occurred in 13% of the patients. Most Shewanella spp. isolates are susceptible to cefotaxime (95%), piperacillin and tazobactam (98%), gentamicin (99%), and ciprofloxacin (94%).

National audience; En 2004 a débuté une épidémie de syphilis en Martinique chez les hommes ayant des rapports sexuels avec des hommes (HSH) et vivant avec le VIH, pour se généraliser secondairement à l’ensemble des groupes à risque. L’objectif de cette étude était d’estimer l’évolution, depuis 2005, de l’incidence et des caractéristiques des cas de syphilis récente dans la cohortede patients vivant avec le VIH (PVVIH) suivis en Martinique.

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 La melioidose est une anthropozoonose bacterienne tropicale, due a un bacille Gram negatif saprophyte tellurique, Burkholderia pseudomallei. Elle est endemique en Asie du Sud et au Nord de l’Australie, mais des cas ont ete decrits sur le continent americain et aux Antilles. Bien que la culture sur milieux usuels de B. pseudomallei soit une technique sensible, seulement 11 cas de melioidose avaient ete recenses sur cette ile des Antilles depuis 1994. En 2016, deux nouveaux cas graves, ayant conduit a des deces, ont eu lieu suite au passage de la tempete tropicale Matthew. Materiels et methodes Revue retrospective de tous les cas de melioidose diagnostiques sur une ile de la Caraibe. Description des donnees cliniques et epidemiologiques. Resultats La melioidose a ete responsable d’infections systemiques, principalement chez des hommes, d’âge median 57 ans. Ces cas groupes ont ete diagnostiques a l’issue d’evenements pluviometriques abondants, chez des personnes sejournant dans la partie sud de l’ile plus sujette aux inondations. Tous les patients presentaient des comorbidites ou des plaies cutanees. L’antibiotherapie probabiliste prescrite initialement etait rarement adaptee au phenotype de resistance naturel de la bacterie. Cinq patients sont decedes, dont un homme jeune au retour d’un voyage sur l’ile. Conclusion La melioidose est une pathologie communautaire emergente aux Antilles. Elle survient sous la forme d’epidemies sporadiques, dans les suites d’episodes pluviometriques exceptionnels. La gravite de la pathologie est liee a son caractere opportuniste chez des patients presentant des comorbidites, et au potentiel invasif de la bacterie a l’origine d’une letalite elevee. Sa resistance naturelle aux antibiotherapies communautaires majore le retard a une prise en charge adaptee. Cette infection grave peut toucher le voyageur de retour des Antilles.

Background Key symptoms observed during the febrile phase of dengue may identify patients who are likely to progress to severe disease. Objectives To test this hypothesis, we examined the relationships between symptoms reported by patients at presentation and the development of severe outcomes. Study design Retrospective analysis of data recorded prospectively in 560 adult dengue patients admitted to an emergency department. A logistic regression analysis was used to quantify the association between symptoms reported at presentation and outcome. Results Plasma leakage was observed in 95 patients (17%), severe thrombocytopenia (platelet counts 9 /L) in 93 patients (16.6%) and acute hepatitis in 42 patients (7.5%). Severe thrombocytopenia developed in 57% of patients with plasma leakage and 40.5% of patients with hepatitis. Patients who developed a plasma leakage syndrome were older, mainly male, and reported more often an abdominal pain and a cough. Diarrhea and taking paracetamol >60 mg/kg/day before admission were associated with the development of acute hepatitis. Seven patients died. The mortality rate was 6/95 (6.3%) in patients who developed plasma leakage, 3/42 (7.1%) in patients who developed hepatitis, 5/93 (5.4%) in patients with severe thrombocytopenia, and 3/12 (25%) in the patients who demonstrated together all these severe manifestations. Conclusion Plasma leakage, severe thrombocytopenia and acute hepatitis identified subgroups of adult dengue patients with increased mortality rates. Key symptoms reported by the patients at presentation such as abdominal pain, cough or diarrhea were significantly associated with the development of severe manifestations and should be considered as warning signs.

Syphilis reemerged in Martinique in 2004 and initially affected 3 HIV-infected patients. By March 2008, syphilis was diagnosed for 37 men and 18 women. As of October 31, 2009, this outbreak had not yet been brought under control. It initially affected mainly men who had sex with men before it spread to heterosexual persons, minority group members, and crack cocaine users.

Skin and soft tissue infections (SSTI) are a leading cause of cutaneous problems in travelers. Sixty travelers who presented with an SSTI were prospectively included over a 20-month period. Bacterial analysis and research for Panton-Valentine leukocidine (PVL) were performed according to clinical and bacterial presentation. The SSTI appeared abroad in 73% and were predominantly localized on lower limbs (75%). The main clinical forms were impetigo (35%) and cutaneous absess (23%). Insect bites were significantly associated with impetigo and ecthyma. Methicillin-susceptible Staphylococcus aureus (MSSA) was identified in 15 patients (43%), Group A Streptococcus (GAS) in 12 patients (34%), and an association of both in 8 (23%) among the 35 patients for whom bacteria were identified. The MSSA producing PVL were found in 4 patients. Travelers should be advised on how to prevent arthropod exposure and susceptibility testing should be recommended considering that methicillin-resistant S. aureus (MRSA) is increasingly reported, although not identified in our study.

Objectives Data are lacking on the spectrum of sexually transmitted diseases (STDs) diagnosed in returning travelers. Study Design All consecutive travelers consulting our tropical unit between November 1, 2002 and October 31, 2003 were included if they presented within 1 month after their return from the tropics, with mucocutaneous signs suggesting STDs. Results Forty‐nine patients (12 women and 37 men; median age 36.4 y, 35 heterosexuals) were included. Four patients had traveled with their usual sexual partner and 45 patients had casual sex while abroad (31 with locals and 14 with other tourists). The main diagnoses were gonococcal urethritis ( n = 18), herpes simplex virus 2 infection ( n = 12), urethritis of undetermined origin ( n = 9), Chlamydia trachomatis infection ( n = 4), primary syphilis ( n = 4), and primary human immunodeficiency virus infection ( n = 2). Conclusions These results illustrate the broad spectrum of STDs contracted by travelers to the tropics. They suggest the need to also inform travelers of the risks of STD and to promote the use of condoms in case of casual sex while abroad.

Mycobacterium abscessusis an emerging rapidly growing mycobacterium that causes tuberculous-like lesions in humans. We studied the immune control of this organism in C57BL/6 mice challenged intravenously with 107CFU. Bacteria were eliminated from both the spleen and the liver within 90 days, and liver histology showed organized granulomatous lesions. A T- and B-cell requirement was investigated by challengingRag2−/−,Cd3ε−/−, and μMT−/−mice.Rag2−/−andCd3ε−/−mice were significantly impaired in the ability to clearM. abscessusfrom the liver and spleen, and μMT−/−mice were significantly impaired in the ability to clearM. abscessusfrom the liver, suggesting that infection control was primarily T cell dependent in the spleen and both T and B cell dependent in the liver. The liver granulomatous response was similar to that of wild-type controls in μMT−/−mice but completely absent inCd3ε−/−andRag2−/−mice. We studied the involvement of gamma interferon (IFN-γ) and tumor necrosis factor (TNF) by challenging C57BL/6 mice deficient in the IFN-γ receptor (Ifngr1−/−) and in TNF (Tnf−/−).Ifngr1−/−mice were significantly impaired inM. abscessuscontrol both in the spleen and in the liver, and granulomas were profoundly altered. The effect was even more substantial inTnf−/−mice; they failed to controlM. abscessusinfection in the liver and died within 20 to 25 days after infection with many hepatic inflammatory foci and major lesions of ischemic necrosis in the liver and kidney. These features were not observed with the closely related speciesM. chelonae. T-cell immunity, IFN-γ, and TNF are central factors for the control ofM. abscessusin C57BL/6 mice, as they are for the control of pathogenic slowly growing mycobacteria.

Cutaneous larva migrans (CLM) is the most frequent travel‐associated skin disease of tropical origin. 1,2 This dermatosis first described as CLM by Lee in 1874 was later attributed to the subcutaneous migration of Ancylostoma larvae by White and Dove in 1929. 3,4 Since then, this skin disease has also been called creeping eruption, creeping verminous dermatitis, sand worm eruption, or plumber’s itch, which adds to the confusion. It has been suggested to name this disease hookworm‐related cutaneous larva migrans (HrCLM). 5 Although frequent, this tropical dermatosis is not sufficiently well known by Western physicians, and this can delay diagnosis and effective treatment. Indeed, misdiagnosis or inappropriate treatment affects 22% to 58% of the travelers with CLM. 6–8 In one case report, the time lag between the onset of disease and the diagnosis was 22 months. 9 Five large (>40 patients each) published studies of imported cases of CLM in returning travelers have greatly helped improve knowledge of this disease. 2,6–8,10 This is particularly true as regards its natural history and response to treatment in short‐term travelers without possibility of recontamination. We reviewed the epidemiological, clinical, and therapeutic data drawn from studies of CLM in travelers. The aim of this review was to contribute to a better definition and description of the disease known as HrCLM. HrCLM is one of the leading causes of dermatologic disorders observed in ill returned travelers. 1,2,11 Risk factors for developing HrCLM have specifically been investigated in one outbreak in Canadian tourists: less frequent use of protective footwear while walking on the beach was significantly associated with a higher risk of developing the disease, with a risk ratio of 4. Moreover, affected patients were somewhat younger than unaffected travelers (36.9 vs 41.2 yr, p = 0.014). There was no correlation between the reported amount of time … Corresponding Author: Eric Caumes, MD, Departement des Maladies Infectieuses et Tropicales, Hopital Pitie‐Salpetriere, 45‐83 Bld de l’hopital, F‐75013 Paris, France. E‐mail: eric.caumes{at}psl.aphp.fr

International audience; To identify factors associated with disease severity, we examined 102 patients with quantitative PCR-confirmed leptospirosis in Martinique during 2010-2013. Associated factors were hypotension, chest auscultation abnormalities , icterus, oligo/anuria, thrombocytopenia, prothrombin time

Background Few on-site studies involving local doctors have been published. Methods We conducted a prospective on-site study of health problems occurring among French tourists to Nepal between 1 January 2001 and 31 December 2001, and compared the results with those of an identical study performed in 1984. Results Of the 21,457 French tourists who visited Nepal in 2001, 276 (1.3%) consulted the French Embassy doctor in Kathmandu with health complaints. The main reasons for seeking medical advice were diarrhea (26.8%), high-altitude illness (15.6%), lower respiratory tract infections (11.6%), dermatoses (8.7%), and fever (8.7%). Fifteen patients (5.4%) required hospitalization, five required medical evacuation (1.8%), and 14 (5%) were rescued by helicopter in the Himalayas. One patient died of cardiovascular disease. Relative to the 1984 cohort, significantly more patients consulted for high-altitude illness (p

Lymph node tuberculosis is the most frequent form of extrapulmonary tuberculosis, especially in immunocompromised patients. We have studied patients with proven lymph node tuberculosis in the Department of Infectious Diseases at Pitie-Salpetriere Hospital, Paris, between January 1997 and January 2002. Clinical presentation, microbiological diagnosis and treatment were analyzed in 13 HIV infected and 19 non-HIV infected patients. A risk factor for tuberculosis was present in all cases (HIV infection, immigration, life in community, poverty, past history of tuberculosis and IVDU). The median duration between the onset of symptoms and diagnosis was longer for HIV infected (2 months) compared with non-HIV infected patients (1 month). At the time of the diagnosis, general symptoms were present in >50% of patients of both groups. In HIV infected patients, abdominal lymph node involvement was more frequent (P < 0.05). All the non-HIV infected and 85% of HIV infected patients had peripheral adenopathies. A pulmonary tuberculosis was noted in more than half of the cases (53% non-HIV and 69% HIV patients). Inflammatory parameters and liver function tests were frequently abnormal in both groups. Hyponatremia was more frequent in HIV patients (P < 0.05). TB skin testing was more frequently positive and phlyctenular in non-HIV infected patients (P < 0.05). In this study, direct examination of the needle aspirate from infected lymph nodes was rarely positive; cultures were more frequently positive after biopsy compared to needle-aspiration. The median duration of treatment was 9 months for the two groups (6-24 months). Three HIV infected patients were infected by mycobacteria resistant to at least one antibiotic (isoniazid, 1; rifampicin, 1; isoniazid, streptomycin, etambutool, 1). All the patients recovered.

Background Leptospirosis is a potentially life-threatening but curable zoonosis whose prognosis depends on accurate and timely diagnosis. Because of its non-specific clinical presentation, laboratory testing is essential to confirm the diagnosis. Here, we aimed to assess the performance of two enzyme-linked immunosorbent assays (ELISAs) (ELISA Serion and ELISA-Hb Pasteur) and one immunodot (GenBio) using quantitative PCR (qPCR) as gold standard, instead of the traditional microscopic agglutination test, for the diagnosis of acute leptospirosis in an endemic area. Methodology/Principal findings Between January 2011 and December 2012, a total of 122 patients were diagnosed with leptospirosis, as confirmed by qPCR at the University Hospital of Martinique. Among them, 103 had at least one serum sample available for analysis. Performance of each serological assay was evaluated according to days' post onset of symptoms (DPO) and local species diversity (which included L. santarosai, L. interrogans, L. kirschneri, L. borgpetersenii, L. noguchii, and L. kmetyi). Several thresholds were tested to optimize accuracy. When considering the manufacturer's threshold, the sensitivity of ELISA Serion, ELISA-Hb Pasteur and GenBio immunodot was 75%, 67% and 64%, while specificity was 92%, 98% and 100%, respectively. Moreover, the threshold optimization allowed a significant improvement in specificity for the ELISA Serion from 92% to 99% (p, Author summary Leptospirosis is a ubiquitous zoonosis caused by spirochetes. This infection is responsible for a wide range of symptoms mimicking many other diseases. Laboratory tests are thus essential to confirm the diagnosis. Furthermore, earlier diagnosis helps to prevent severe outcomes by a prompt initiation of antibiotic therapy. In early phase, quantitative Polymerase Chain Reaction (qPCR) was proved to be more efficient than the traditional microagglutination test (MAT), which remains the ‘gold standard’ for diagnosis of leptospirosis. However, both tests are seldom available in resource-limited settings, where leptospirosis burden is highest. To find a suitable alternative to qPCR and MAT in the early phase (i.e., within the first 2 weeks) of the disease, we compared 3 serological assays (2 ELISAs plus one immunodot) using sera collected from patients with a qPCR-confirmed diagnosis of leptospirosis. This work reveals high performances for all serological assays after (but not before) 6 days’ post onset of symptoms, regardless of the species studied. Excellent specificity, as found after threshold optimization, suggests that these tests could useful in high prevalence areas.

International audience; Two gendarmes who participated in canyoning activities on 27 June 2011 on the Caribbean island of Martinique were diagnosed with leptospirosis using quantitative real-time polymerase chain reaction (qPCR), 9 and 12 days after the event. Among the 45 participants who were contacted, 41 returned a completed questionnaire, of whom eight met the outbreak case definition. The eight cases sought medical attention and were given antibiotics within the first week after fever onset. No severe manifestations of leptospirosis were reported. In seven of the eight cases, the infection was confirmed by qPCR. Three pathogenic Leptospira species, including L. kmetyi, were identified in four of the cases. None of the evaluated risk factors were statistically associated with having developed leptospirosis. Rapid diagnostic assays, such as qPCR, are particularly appropriate in this setting - sporting events with prolonged fresh-water exposure - for early diagnosis and to help formulate public health recommendations. Participants in such events should be made specifically aware of the risk of leptospirosis, particularly during periods of heavy rainfall and flooding.

Few data related to the care of children injured in an earthquake are available. The objective of our study was to analyze the results of clinical and microbiologic characteristics of children treated in a Fort de France hospital after the Haiti earthquake. Bacteria were mainly Gram-negative bacteria. Some of these infections seemed to be environmental; a significant portion was related to acquisition during hospitalization.

Many wild and domestic animals serve as reservoirs for pathogenic Leptospira strains and contaminate the environment by shedding the organisms in their urine. Humans are usually infected through abraded skin or mucous membrane contact with water contaminated by the urine of animal reservoirs, and less frequently by direct contact with animals or their urine. The mean incubation period is 10 days, with a usual range of 2–20 days. 1 Clinical manifestations are protean and the spectrum of symptoms range from subclinical or mild anicteric febrile illness to acute renal failure. Weil’s disease and respiratory distress syndrome are associated with high mortality. 1 Over the preceding decades, ecotourism and sporting events in tropical and sub-tropical areas have become more popular among travelers and athletes. These recreational activities in tropical areas have served to increase the risk of human exposure to these pathogens and consequently outbreaks of leptospirosis have been reported in these settings. 3, 4

Aeromonas species are Gram-negative bacilli of the water environment whose survival appears facilitated by warm climates. There have been no reports on Aeromonas hydrophila complex (A. hydrophila, A. caviae, A. veronii) in the Caribbean to date. Our aim was to describe clinical and bacteriological features in patients presenting with such bacteremia in Martinique and Guadeloupe. During a 14-year period, we retrospectively identified 37 patients. The mean age was 55 years and in 89% of cases underlying disease such as digestive diseases, cutaneous wounds, and malignancy were identified. One case was related to severe strongyloidiasis and one with snake bite. Polymicrobial bacteremia was identified in 38%, essentially with Enterobacteriaceae. All Aeromonas isolates were resistant to amoxicillin but extended-spectrum beta-lactam and fluoroquinolone were active against more than 95%. During hospitalization 10 patients died (27%). Older age, occurrence of multiorgan failure, and impaired renal function were associated with in-hospital mortality.

Dermatoses are a leading cause of health problems in travelers. They cover a large spectrum of diseases, which includes infectious skin diseases of exotic or cosmopolitan origin as well as environmental skin diseases. The purposes of this review were to identify the most common travel‐related skin infections and to familiarize health providers with their epidemiology, clinical features, prevention, diagnosis, and treatment. During travel, dermatoses have been reported by 8% of 784 American travelers worldwide in a questionnaire‐based survey published in 2000. Of the 63 dermatoses reported in this cohort, 14 were related to insect bites or stings, 10 to sun exposure, 7 to dermatophytes, 7 to contact allergy, 5 to infectious cellulites, 4 to miscellaneous causes, and 16 were from unknown causes.1 Similarly, on‐site studies of health impairment described dermatoses as being one of the three main reasons for consultation in travelers abroad. In Nepal, three studies showed that dermatoses were the third to the fourth most frequent presenting illness among tourists: skin diseases accounted for 12% of health impairments among 838 French tourists in 1984, 8.7% of consultations among 276 French tourists in 2001, and 10% of 19,616 presentations of patients of all nationalities at a private clinic in the 1980s.2,3 In two of these three Nepalese studies, bacterial and fungal skin infections as well as scabies infestation were the most common travel‐associated dermatoses reported.2 Considering a different environment in the Maldives and Fiji, dermatoses were the most frequent presenting illnesses in tourists, with sunburns, superficial injuries (including those due to contact with marine creatures), and skin infections documented most often.4,5 In Burkina Faso, among 100 Westerners with 106 dermatoses diagnosed through teledermatology, the most frequently observed skin diseases were bacterial (21%), viral (12%), and fungal (17%) infections; arthropod‐induced dermatitis (8%); and dermatoses of another … Corresponding Author: Eric Caumes, MD, Departement des Maladies Infectieuses et Tropicales, Hopital Pitie‐Salpetriere, 45‐83 Bld de l’hopital, F‐75013 Paris, France. E‐mail: eric.caumes{at}psl.aphp.fr

Febrile exanthema frequently presents as an acute condition in travelers. Sixty-two travelers who presented with febrile exanthema were prospectively included over a 20-month period. Diagnostic tests were performed according to clinical presentation and risk exposures. Symptoms occurred after return in 56% of these travelers, and the median interval between return and symptom onset was 2 days. The 3 main travel destinations were the Indian Ocean (35%), Africa (21%), and Asia (18%). The 3 main etiologies were chikungunya (35%), dengue (26%), and African tick bite fever (ATBF) (10%). Travel to the Indian Ocean and South Africa was significantly associated with respectively chikungunya and ATBF. Arthralgias were significantly more frequent in chikungunya than in dengue, whereas leucopenia, neutropenia, and thrombopenia were significantly more frequent in dengue. Travelers presenting with febrile exanthema should therefore be screened for arboviral infections according to the area visited.

The largest described outbreak of chikungunya virus has been occurring on the islands of the southwest Indian Ocean since March 2005. We describe the manifestations of chikungunya virus infection in travelers returning from these islands, with focus on skin manifestations.

Background Leptospirosis is one of the most important neglected tropical bacterial diseases in Latin America and the Caribbean. However, very little is known about the circulating etiological agents of leptospirosis in this region. In this study, we describe the serological and molecular features of leptospires isolated from 104 leptospirosis patients in Guadeloupe (n = 85) and Martinique (n = 19) and six rats captured in Guadeloupe, between 2004 and 2012. Methods and Findings Strains were studied by serogrouping, PFGE, MLVA, and sequencing 16SrRNA and secY. DNA extracts from blood samples collected from 36 patients in Martinique were also used for molecular typing of leptospires via PCR. Phylogenetic analyses revealed thirteen different genotypes clustered into five main clades that corresponded to the species: L. interrogans, L. kirschneri, L. borgpetersenii, L. noguchi, and L. santarosai. We also identified L. kmetyi in at least two patients with acute leptospirosis. This is the first time, to our knowledge, that this species has been identified in humans. The most prevalent genotypes were associated with L. interrogans serovars Icterohaemorrhagiae and Copenhageni, L. kirschneri serovar Bogvere, and L. borgpetersenii serovar Arborea. We were unable to identify nine strains at the serovar level and comparison of genotyping results to the MLST database revealed new secY alleles. Conclusions The overall serovar distribution in the French West Indies was unique compared to the neighboring islands. Typing of leptospiral isolates also suggested the existence of previously undescribed serovars., Author Summary Leptospirosis is an emerging zoonotic disease caused by infection with pathogenic strains of Leptospira. Isolation of Leptospira strains is rare, making it difficult to assess their distribution worldwide. In this study, we characterized cultures of Leptospira obtained from more than one hundred leptospirosis patients from the French West Indies by serology and various molecular typing methods to identify the strains circulating in this endemic region. Typing of leptospiral isolates showed that causative agents of leptospirosis in the French West Indies are mainly from the serogroups Icterohaemorrhagiae and Ballum, but we also identified new genotypes. We also found that the distribution of the predominant pathogenic leptospiral serovars differed between the Caribbean islands. A better understanding of the epidemiology of leptospirosis will improve our knowledge in the distribution of this emerging neglected tropical disease worldwide. The identification of the circulating etiological agents of leptospirosis in the French West Indies will also help establish appropriate control and prevention measures in this area where the disease is endemic.

Introduction et objectifs Les Aeromonas sont des bacilles a Gram negatif, dont le reservoir naturel est l’environnement hydrique et dont la multiplication est fonction des conditions de temperature. L’homme se contamine par voie digestive ou transcutanee a l’occasion d’une plaie souillee et les principales manifestations cliniques sont des gastro-enterites, des infections cutanees et/ou des tissus mous et des bacteriemies communautaires. Materiels et methodes Nous avons etudie retrospectivement les dossiers des patients ayant presente une bacteriemie a Aeromonas hyrophila pris en charge dans les CHU de Martinique et de Guadeloupe entre 1996 et 2008. Resultats Au cours de cette periode, 27 patients ont ete identifies, 18 (67 %) etaient des hommes, l’âge moyen etait de 57 ans [19-87] et 23 (85 %) d’entre eux etaient porteurs d’au moins une des pathologies sous-jacente suivantes : 9 (33 %) presentaient une hepatopathie chronique, 8 (30 %) une immunodepression (4 hemopathies, 3 cancers digestifs et 1 infection par le VIH), 7 (30 %) une plaie recente et/ou un accident de la voie publique. Chez 9 patients (33 %) une deuxieme espece bacterienne etait identifiee et il s’agissait dans 6 cas d’une enterobacterie. L’antibiotherapie prescrite etait une betalactamine dans 96 % des cas, associee a un aminoside chez 44 % des patients. Chez deux patients l’apparition d’une souche resistante a l’antibiotique prescrit (un patient sous cefotaxime, l’autre sous ceftazidime) a ete observee. La mortalite hospitaliere etait de 33 % et le deces survenait en mediane 9 jours [1-38 j] apres la date de positivite de l’hemoculture. Conclusion Les bacteriemies a Aeromonas hydrophila surviennent le plus souvent dans un contexte d’hepatopathie, d’immunodepression ou de plaie traumatique. L’evolution est fatale dans un tiers des cas.

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.