Medecine tropicale : revue du Corps de sante colonial最新文献

After a brief overview of the history of arbovirus epidemics in the Indian Ocean in XIXth and XXth centuries, a full evaluation of the chikungunya epidemic that occurred in 2005-2006 is provided including both lessons learned and future perspectives. On the positive side, the epidemic has allowed improvement of clinical and pathophysiological knowledge, epidemiological surveillance, vector control, awareness of entomology, avenues for research, and understanding of economic and societal repercussions. On the negative side, the epidemic revealed the limitations of a health care system in an island setting, need for an effective sanitary policy, low public-spiritedness, poor diffusion and understanding of public health announcements, endemization of chikungunya virus in the Indian Ocean, absence of vaccine, and global spread of tropical disease. Discussion of perspectives for future arbovirus disease outbreaks in the Indian Ocean is set against the background of climatic change, unequal socioeconomic progress, and high population growth in the Indian Ocean region.

The XIXth century is the period of the sugar industrialization in Réunion. In spite of the abolition of the slaves trade in 1817 and the English abolition of the slavery of 1833, the sugar industry imported large numbers of African and Asian workers which exceeded in number the white population and that of the slaves. As the public health and the health controls came under the governor, the prevention was insufficient in the XIXth century. There were several establishments of "decontamination", sanitary observation in Saint-Denis under the authority of the colonial doctor. However, in the absence of a lazaret, the ship which transported imported workers had to be suspected to be contaminated not to be granted access. The lazaret of La grande chaloupe opened lately around 1850. Under the pressure of the industry, traders and captains, not all immigrants passed by the lazaret before entering the island. Therefore, the public health relative to the massive immigration in Réunion depended more on the private domain than on the public domain because the immigration was linked with major economic interests.

Unlabelled: In 2005-2006, an unexpected, massive outbreak of chikungunya occurred on Reunion Island, a French overseas territory in the Indian Ocean. This arboviral infection transmitted by a mosquito of the Aedes genus is usually benign. A surprising feature of the Reunion Island epidemic was the occurrence of rare severe forms involving adults as well as children.

Objectives: The purpose of this report is to describe severe forms of chikungunya observed in children hospitalized in a pediatric intensive care unit.

Patients and methods: This retrospective single-center study was conducted from January 1st to April 30th, 2006. Children between 1 month and 15 years admitted to the pediatric intensive care unit with proven chikungunya infection were included.

Results: A total of 9 children were included. The main manifestations were extensive skin blisters in 5 cases, neurological symptoms (encephalopathy) in 4, cardiac complications (myocarditis, hemodynamic disorders) in 5 and bleeding in 1. Two children died. The causes of death were circulatory failure associated with coma and massive hemorrhage in one case and post-infectious encephalitis in the other. Three survivors present long-term neurologic or dermatologic sequels.

Discussion: Severe cases of chikungunya in children provide a stark reminder of the cardiac and neurological tropism of the virus and its hemorrhagic forms with high potential mortality and morbidity. These cases underline the need for personal protection measures and for research to develop specific antiviral therapy and vaccines to prevent potentially lethal forms of the disease.

The chikungunya epidemic that occurred on Reunion Island between 2005 and 2006 was covered by the French health insurance system. This coverage involved a major increase in the number of paid sick leave days and prescription drug refunds in the first quarter of 2006. Special governmental measures such as full reimbursement of certain medications and waiving of the waiting period for sick leave in case of relapse greatly reduced the impact of the epidemic. Five years after, the database of the health insurance systems indicates a low incidence of chronic forms. Only cases managed on an outpatient basis were included in this study.

The chikungunya outbreak on Reunion Island in 2005-2006 was followed by a high incidence of persistent arthralgia. A small group of patients developed chronic, sometimes destructive, post-chikungunya inflammatory rheumatism presenting as rheumatoid polyarthritis or spondylarthritis that required disease-modifying antirheumatic drugs such as methotrexate. We describe two patients under this treatment confronted with financial health insurance issues due to the lack of administrative recognition of post-chikungunya rheumatism as a long-term affliction or an occupational disease.

This article relates the problems initially encountered by an elected official of the French Republic in drawing the attention of authorities to the ravages of the chikungunya epidemic that occurred on Reunion Island in 2005-2006. Due to inadequate medical knowledge, the benign reputation of the disease, and slow reaction of authorities, the virus affected more than one third of the population. A great deal of further study will be needed to understand this public health crisis and to transform the lessons learned into a decisive breakthrough that will doubtless be of equal benefit for mainland France.

This article deals with the impact of health crisis on governance of public health. It tries to show that, in accordance with the thought of Michel Foucault, emergency measures issued during health crisis are akin to those issued during wartime.

Chikungunya virus is an arbovirus (alphavirus) transmitted by Aedes albopictus in Reunion Island. A huge chikungunya outbreak swept Reunion Island in 2005- 2006. We report the first case of chikungunya neonatal infection and the 5-years outcome of the 18 neonates hospitalized in neonatal intensive care unit between June 2005 and March 2006.

The purpose of this cross-sectional study was to describe epidemiological, clinical and therapeutic aspects of high-grade atrioventricular block in Lomé. Out of 2245 patients hospitalized between June 2004 and May 2009, a total of 22 cases of high-grade atrioventricular block were detected thus a prevalence of 1%. The main symptoms were syncope and presyncope (73%) and dyspnea (50%). There was 77.2% of chronic grade III atrioventricular block and 22.8% of grade II atrioventricular block. A pacemaker has been established in 8 patients (40% of the patients presenting a class I indication) in VVI (R) mode. We noted 59% of deaths among patients who did not benefited from any cardiac pacing.

Amoebic abscess is the most frequent type of liver abscess in tropical areas, including in immunocompromised patients. Abscesses affect the right lobe in 74% of cases and are solitary in more than 80%. The ultrasonographic features of liver abscess vary according to stage, viscosity of liquid contents, amount of debris inside and presence of gas bubbles. Multiple small abcesses are mainly associated with pyogenic abscess and are promoted by HIV infection.