Date: Thu 28 May 2015
Source: HCPLive [edited]

An outbreak of a Brazilian strain of cutaneous leishmaniasis (CL) in French Guiana among 24 visiting scientists has alarmed tropical disease experts at the US Centers for Disease Control and Prevention (CDC).

The CDC alerts US physicians to be aware of possible infection in travellers returning from the region. They also note that this strain responds differently to treatment than other strains.

The disease is caused by a protozoan parasite and transmitted by the bite of the sand fly. "The geographic extension of and numeric increase in _L. braziliensis_ cases in the Guiana ecoregion complex, as observed in the rest of South America, are worrisome, and continuous epidemiologic surveillance is needed," Guillaume Martin-Blondel, MD and colleagues at Toulouse University Hospital in Toulouse, France, wrote this month in the CDC's Emerging Infectious Disease journal.  CL infection with _L. braziliensis_ "is emerging and has potential to disseminate," the team wrote.

The scientists, a multi-national group, were on a field mission in Saul, French Guiana in the Amazonian rainforest. 7 came down with symptoms a mean period of 19 days after they returned home. The disease results in ulcers mostly on lower limbs but also on upper limbs and ears. It can also cause nodular lymphangitis, adenitis, and superficial phlebitis. It can also cause ulcers in the mucous membranes of the lips, nose, soft palate or larynx.

Infection is confirmed by microscopic examination of skin scrapings to look for typical amastiotes, or by a positive Leishmania species PCR result.

Treatment is intramuscular meglumin antimoniate or intravenous liposomal amphotericin B. The Brazilian strain does not respond to pentamidine isethionate, the 1st-line treatment for another strain, _L. guyanensis_ CL. "Leishmaniasis is increasingly seen among travellers returning from Latin American countries, particularly from Bolivia, Belize and French Guiana," the CDC noted.

The transmission cycle of the parasitic disease involves reservoir hosts including dogs and rodents and is spread by sand fly vectors. "Changing human activities that affect these factors may have resulted in the emergence of species with distinct pathogenic potentials and responses to therapy," the authors wrote.

Until this outbreak, _L. braziliensis_ infection had been seen only in Argentina, Brazil, Panama and Venezuela. An increase in tourism and more development of the Amazon rain forest could be to blame for the spread of the infection, the team wrote.  

See more at:
<>.  [Byline: Gale Scott]
[An attack rate as reported here of 7 out of 24 exposed people is high. A recent review of leishmaniasis in France and French territories report that cutaneous leishmaniasis in French Guiana has an annual incidence of around 2 per 1000 population. The reservoir is rodents. - ProMed Mod.EP]

[A HealthMap/ProMED-mail map can be accessed at:
Date: Thu, 10 Jul 2014 12:14:07 +0200 (METDST)

PARIS, July 10, 2014 (AFP) - France's health minister warned Thursday of a serious epidemic in the Antilles and French Guiana after 33 deaths were reported in connection with the chikungunya virus.  "This is a major epidemic, with about 5,000 new cases every month," Marisol Touraine told BFMTV. "The disease has indirectly caused 33 deaths in vulnerable elderly people, affected nearly 100,000 people and resulted in 1,000 hospitalisations in the French Americas."

Touraine said she was going to the region next week to deal with what she called "a major public health issue".   The Antilles, also known as the French West Indies, are a group of Caribbean islands under French sovereignty, while French Guiana is a territory on the north Atlantic coast of South America, bordered by Brazil and Suriname.

The mosquito-born chikungunya virus has been spreading through the Caribbean and Central America.   The virus -- rarely fatal, but nevertheless serious -- sparks high fevers and severe joint aches, as well as headaches, nausea and extreme fatigue.   It does not kill directly but in combination with other illnesses can lead to death.
Date: Thu 17 Apr 2014
Source: ECDC Communicable Disease Threats Week 16, 13-19 Apr 2014 [edited]

As of 11 Apr 2014, there have been more than 25,000 probable and confirmed cases in the region; 6 fatalities have been reported.

Update of the week [13-19 Apr 2014]
During the past week, new cases have been reported in most of the affected areas. In the French Antilles the number of new cases is generally decreasing or constant. In French Guiana, the number of autochthonous cases is increasing.

The Department of Health of the Dominican Republic has reported cases of chikungunya [virus infection] on the island affecting the province of San Cristobal, with 17 laboratory confirmed cases and 767 suspected cases.

The number of cases is also increasing in Dominica and Anguilla (WHO). To date, islands with confirmed cases are Saint Martin/Saint Maarten, Martinique, Saint Barthelemy, Guadeloupe, British Virgin Islands, Anguilla, Dominica, Aruba, Saint Kitts and Nevis, Saint Lucia, Dominican Republic and French Guiana in mainland South America. In most of the territories of the French Antilles, given the caseload, the health authorities decided not to seek laboratory confirmation for all suspected cases.
Date: Fri 28 Mar 2014
Source: Guyane [in French, trans. & summ. ProMed Mod.TY, edited]

Of the 35 cases reported to date, almost 2/3rds are in Kourou, the only city where one can talk about epidemic outbreaks. These are concentrated in a series of contiguous areas, city 205 or Gonfolo Balata in particular. On 17 Mar [2014], strong action has been taken by the mosquito control services of the General Council; nearly 2 dozen officers were on the ground for chemical treatment of [vector mosquito] breeding sites spotted in the sector.
Communicated by:
Roland Hubner
Superior Health Council
Date: Fri 7 Mar 2014
Source: France-Guyane [in French, machine trans., edited]

In a report, the city of Sinnamary indicated that there is a suspicious chikungunya [fever] case in the community. In order to avoid the spread of the disease, the city is requesting that all inhabitants take all the necessary measures to destroy breeding sites in and around homes, to protect themselves from mosquito bites by using repellents and isolating themselves with bed nets as an option.

In case of fever and joint pain in the extremities, it is indicated that inhabitants quickly consult with their physician.
Communicated by:
Roland Hubner
Superior Health Council
[Sinnamarie city is on the coast of French Guiana, between Kourou, where there has been local transmission of chikungunya virus, and Suriname. If this is a locally acquired case, it is an indication that the virus is spreading in the country.

A map showing the major towns and cities in French Guiana, and the location of the city of Sinnamarie, can be accessed at <> and a HealthMap/ProMED-mail map showing the location of French Guiana in northeastern South America at <>. - ProMed Mod.TY]
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