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Since 2011, there have been ongoing massive unexplained increases of sargassum seaweed strandings along the coastlines of Caribbean countries. The objective of our study was to describe the clinical characteristics of patients exposed to noxious emissions of decomposing sargassum seaweed.This observational study included patients from January 2018 to December 2018 for complaints attributed to decomposing sargassum seaweed. History and geographical characteristics of sargassum seaweed strandings as well as detection of ambient air hydrogen sulfide (HA total of 154 patients were included. Mean exposure period was 3 months. Neurological (80%), digestive (77%) and respiratory (69%) disorders were the most frequent reasons for medical visit. Temporal distribution of medical visits was related to history of strandings. Geographical origins of patients were consistent with the most impacted areas of strandings as well as the most elevated ambient air HThe toxicological syndrome induced by sargassum seaweed exposure is close to the toxidrome associated with acute H

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.

Objectives To assess the frequency of diagnostic errors in older adults presenting to the emergency department (ED) with symptoms suggestive of Chikungunya virus infection (CVI) and to compare the rates of misdiagnosis of older and younger adults. Design Cross‐sectional study performed in the University Hospitals of Martinique from retrospective cases. Setting Emergency department. Participants Individuals aged 65 and older who attended the ED and underwent reverse transcription polymerase chain reaction (RT‐PCR) testing for CVI between January and December 2014 (n=333, mean age 80±8) were considered eligible and were compared with a randomly selected sample of younger adults (< 65) (n=143, mean age 45±13). Measurements Misdiagnosis rates. Results The rate of misdiagnosis of CVI in the ED was 30.6% in individuals aged 65 and older and 6.3% in those younger than 65 (p

To assess the frequency of diagnostic errors in older adults presenting to the emergency department (ED) with symptoms suggestive of Chikungunya virus infection (CVI) and to compare the rates of misdiagnosis of older and younger adults.Cross-sectional study performed in the University Hospitals of Martinique from retrospective cases.Emergency department.Individuals aged 65 and older who attended the ED and underwent reverse transcription polymerase chain reaction (RT-PCR) testing for CVI between January and December 2014 (n=333, mean age 80±8) were considered eligible and were compared with a randomly selected sample of younger adults (65) (n=143, mean age 45±13).Misdiagnosis rates.The rate of misdiagnosis of CVI in the ED was 30.6% in individuals aged 65 and older and 6.3% in those younger than 65 (p.001). The overdiagnosis rate was 9.0% in individuals aged 65 and older and 3.5% in those younger than 65 (p=.04). The underdiagnosis rate was significantly higher (p.001) in individuals aged 65 and older (21.6%) than in those younger than 65 (2.8%).Misdiagnosis of CVI during an epidemic is statistically more frequent in older than younger adults because clinical presentation is often atypical in older adults. Specific diagnostic tools for older adults and better awareness of ED physicians of different presentations in different age groups could help to reduce the rate of misdiagnosis of CVI in the ED.

Bothrops lanceolatus is an endemic viperid species in the Lesser Caribbean island of Martinique. Envenomings by this species are characterized by local and systemic effects, among which the development of thrombosis in various organs is the most severe complication. An experimental toxicological characterization of this venom was performed using in vivo mouse tests and various in vitro assays. The venom induced lethal, local and systemic hemorrhagic, edema-forming, myotoxic, thrombocytopenic, proteinase and phospholipase A2 activities. The preclinical efficacy of a batch of monospecific Bothrofav® antivenom currently in use in Martinique was assessed. The antivenom was highly effective in the neutralization of all activities tested, in agreement with its described clinical efficacy. This batch of antivenom showed a higher preclinical efficacy as compared to a previous batch used in the past.

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.

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.

Background The practice of platelet (PLT) transfusions has been adopted into the standard clinical practice in many dengue-endemic countries. Because many patients were found to have received unnecessary PLT transfusions, the development of guidelines for the management of dengue patients with thrombocytopenia has become a necessity. Study design and methods An emergency department-based prospective observational study was conducted in Martinique during a dengue outbreak in adult patients presenting with an acute febrile illness. Patients with severe bleeding and/or who underwent invasive intensive care procedures or emergency surgery were given PLT transfusion to achieve PLT counts of more than 50 x 10(9)/L. PLT transfusion was also considered for patients with PLT counts of less than 5 x 10(9)/L and for those with associated risk factors and PLT counts of less than 20 x 10(9)/L. Results A total of 350 patients were admitted with confirmed dengue infections. Most of them had secondary serotype-2 infections. PLT counts of less than 50 x 10(9)/L were recorded in 165 patients (47.1%). PLT transfusion was administered to 9 patients with thrombocytopenia. The indications included severe bleeding (5 cases), invasive procedures (3 cases), emergency surgery (1 case), and/or associated risk factors (2 cases). The median time duration from the onset of fever to PLT transfusion was 6 days (range, 4-10 days). The median amount of PLTs transfused was 3.66 x 10(11) (range, 2.8 x 10(11)-13.2 x 10(11)). The median PLT yield was +12.4% (range, -3.9% to +67.1%). Three patients died. All other patients recovered during the second week after the onset of fever. Conclusion A restrictive strategy for PLT transfusion based on clinical features and low PLT count thresholds proved to be feasible and safe for adult dengue patients.

Introduction L’infection a Zika virus (ZIKV) a ete associee a la survenue du syndrome de Guillain-Barre (SGB) au cours d’etudes retrospectives ou de series cliniques. La confirmation de l’infection a ZIKV etait principalement basee sur des etudes serologiques, comportant une possibilite de reaction croisee avec d’autres Flavivirus. Les objectifs de l’etude etaient de decrire les caracteristiques epidemiologiques et cliniques des SGB associes au ZIKV, et evaluer l’interet de la biologie moleculaire dans le bilan etiologique des SGB pendant l’epidemie d’infections a ZIKV de 2016. Materiels et methodes Patients inclus dans la cohorte CARBO dans une ile des Antilles entre le 01/01/2016 et le 31/10/2016. Analyse des cas de SGB ayant un score diagnostic de 1 ou 2 selon l’algorithme de certitude de la Brighton Collaboration, avec une infection recente par le ZIKV confirmee. Resultats Sur les 34 patients suspects de SGB durant la periode epidemique de 10 mois, le diagnostic de SGB etait retenu dans 30 cas, dont 27 avec une preuve d’infection recente par le ZIKV. Dix-sept cas ont ete confirmes par RT-PCR dans les urines, et 10 par serologies (IgM ZIKV dans 4 cas et seroneutralisations dans 6 cas). Le taux d’attaque du SGB associe au ZIKV etait de 0,7/10 000 habitants. L’âge moyen des cas etait de 61 ans (IQR 55–71), avec un sex ratio de 1,45. Soixante-dix pour cent [19/27] avaient eu un syndrome viral precedent la survenue des troubles neurologiques (delai moyen de 6 jours (IQR 2-8)). La duree moyenne de la phase ascendante etait de 9 jours (IQR 4,5–12), et celle du plateau de 7,5 jours (IQR 3–10,5). Les SGB etaient majoritairement severes (70 % [19/27] des patients ayant des troubles de deglutition, 56 % [15/27] admis en reanimation). Le delai moyen entre la survenue des troubles neurologiques et l’introduction des immunoglobulines polyvalentes etait de 6 jours (IQR 2–9). Vingt-cinq patients ont eu un electromyogramme (EMG) dans un delai moyen de 21 jours (IQR 10–22) apres la survenue des troubles neurologiques, et 13 patients un deuxieme EMG dans un delai moyen de 72 jours (IQR 54–92), en faveur de formes demyelinisantes (AIDP). Conclusion L’infection a ZIKV etait associee a la survenue de SGB graves chez des personnes de plus de 60 ans, majoritairement des hommes. L’etude de la virurie a permis de detecter precocement les cas lies au ZIKV.

Introduction L’infection a Zika virus (ZIKV) a ete associee a la survenue de complications neurologiques centrales au cours de cas cliniques. Les objectifs de l’etude etaient de decrire les caracteristiques epidemiologiques et cliniques des complications neurologiques, hors syndrome de Guillain-Barre (SGB), associees au ZIKV pendant l’epidemie de 2016. Materiels et methodes Patients inclus dans la cohorte CARBO dans une ile des Antilles entre le 01/01/2016 et le 31/10/2016. Analyse des cas de complications neurologiques avec une infection recente par le ZIKV confirmee. Exclusion des cas de SGB prouves par etudes electrophysiologiques. Resultats Quatorze patients ont ete inclus durant la periode epidemique de 10 mois, l’âge moyen etait de 52 ans (IQR 41–67), avec une sex-ratio de 2,25. Le taux d’attaque des manifestations neurologiques hors-SGB, associees au ZIKV, etait de 0,36/10 000 habitants. La majorite des cas (79 % [11/14]) avaient une infection a ZIKV symptomatique (fievre, hyperhemie conjonctivale, eruption cutanee, arthralgies, myalgies). Le delai moyen entre le debut des symptomes d’infection a ZIKV et la survenue des signes neurologiques etait de 2,4 jours (IQR 1–2). Le diagnostic de complication neurologique evocatrice de SGB a ete retenu dans 4 cas (3 cas de diplegies faciales sans polyradiculonevrite des membres, 1 cas de syndrome de Bickerstaff), celui d’infection du systeme nerveux central dans 5 cas (4 cas d’encephalites aigues, 1 cas de cerebellite aigue), et 5 cas d’autres complications neurologiques (un primo-diagnostic de neuromyelite optique, 1 poussee de sclerose en plaques, 2 poussees de myasthenie, 1 accident vasculaire cerebral severe). La moitie des cas avaient un deficit neurologique severe (troubles de conscience [6/14], deficit de la musculature respiratoire necessitant une assistance ventilatoire [1/14]). Un patient est decede. Tous les cas avaient une preuve biologique d’infection recente par le ZIKV. Dix cas avaient une virurie a ZIKV detectable, 5 cas ont ete confirmes par RT-PCR dans le liquide cerebrospinal, 6 cas avaient une viremie concomitante. Un cas a ete diagnostique par seroneutralisation. Conclusion En plus des SGB, l’infection a ZIKV etait associee a la survenue de complications neurologiques, severes dans la moitie des cas. La recherche du virus en biologie moleculaire a permis de detecter precocement les cas lies au ZIKV.

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.