RESUMO
The purpose of this retrospective analysis was to evaluate the outcome of pentamidine isethionate treatment (4 mg/kg of Pentamidine by the intramuscular route on Days 1 and 3) of cutaneous leishmaniasis in 326 cases that occurred during an outbreak among French military personnel in French Guyana from 1998 to 1999. A great difference was found between the 205 patients treated in French Guyana (series G) and 32 patients treated at the Laveran Military Hospital in Marseille, France (series L). Failure rate, i.e. 25% in series L versus 5% in series G, was significantly correlated with the delay to treatment which was much longer in series L. Extensive rhabdomyolysis was observed in all cases tested: this side-effect has not been reported. Based on these findings and a review of the literature on pentamidine isethionate, the authors recommend prompt treatment using lower doses. Other treatment alternatives for American cutaneous leishmaniasis are also presented including two of the latest developments in the field, i.e., oral treatment using miltefosine and topical treatment using agents such as paromomycine.
Assuntos
Antiprotozoários/administração & dosagem , Leishmaniose Cutânea/tratamento farmacológico , Pentamidina/administração & dosagem , Antiprotozoários/efeitos adversos , França/etnologia , Guiana Francesa , Humanos , Injeções Intramusculares , Militares , Pentamidina/efeitos adversos , Estudos Retrospectivos , Rabdomiólise/induzido quimicamente , Resultado do TratamentoRESUMO
The purpose of this report is to describe the results of a prospective study on pulmonary histoplasmosis in French Guiana. Chest radiographs were performed in 232 French legionnaires returning from a two-year assignment in French Guiana. Further examinations were performed in a total of 8 subjects in whom chest radiographs demonstrated the presence of nodules in the lungs. No evidence of cancer or tuberculosis was found. Findings confirmed histoplasmomas in two cases and demonstrated probable histoplasmosis nodules in 6 cases including three involving calcified lesions. Five of these eight patients had been in high-risk rain forest environments. Pulmonary histoplasmosis should be considered as a possible diagnosis in subjects returning from endemic zones. Confirmation depends on a spectrum of findings. Calcified nodules require only radiographic surveillance with follow-up at six months. Non-calcified nodules require further investigation including CT-scan, bronchoscopy, and serological tests. Surgical biopsy may be necessary to achieve exact histological and mycological identification of the lesion and is recommended in smokers.
Assuntos
Histoplasmose/diagnóstico , Pneumopatias Fúngicas/diagnóstico , Militares , Adulto , Guiana Francesa , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de TempoRESUMO
This report describes the results of epidemiological surveillance of cutaneous leishmaniasis in French military personnel in French Guiana. Data was collected regarding microscopic diagnosis, clinical manifestations, and lesion location as well as compliance with vector control measures. Year-to-year variations in the incidence in the general population have been attributed to changes in climatic conditions. Monitoring incidence and density curves, correlation of findings with local epidemiological data, and analysis of the most recent epidemic in 1998/99 (326 cases, attack rate 3.2% men years) highlight the importance of behavioral factors. The proportion of total cases involving military personnel varied widely from 20 to 85%. Investigation consistently showed that failure to apply elementary protective measures against sandfly bites was the most determinant factor in this proportion. Strict compliance with these measures appears to reduce the risk of infection considerably.
Assuntos
Leishmaniose Cutânea/epidemiologia , Militares , Animais , Clima , Estudos Epidemiológicos , Guiana Francesa/epidemiologia , Humanos , Incidência , Mordeduras e Picadas de Insetos , Controle de Insetos , Insetos Vetores , Vigilância da População , Psychodidae , Fatores de Risco , ZoonosesRESUMO
Guyana is the only department of France in which malaria is a public health problem. The fact that 4,000 new cases including 80% due to Plasmodium falciparum and less than 5 deaths are reported each year shows that the disease is under control but has not been eradicated despite the quantity and quality of the resources that have been implemented. This region of 91,000 km2 with approximately 140,000 inhabitants can be roughly divided into 3 zones. Along the coastline where most of the population lives, malaria is uncommon. In the most remote scarcely populated areas of upper and middle Maroni and upper Oyapock, malaria is stable, perennial and well controlled. In low Maroni and low Oyapock, the impact of malaria is compounded by the high turnover of the population. There is a heavy and poorly controlled movement of migrant people on the two rivers that constitute the natural borders with Brazil and Surinam. Under these conditions strict measures cannot be implemented and malaria remains a problem in Guyana.