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Émergence de zoonoses en Amazonie : épidémiologie comparée de la leptospirose et de la fièvre Q en Guyane française

Abstract : Among the numerous infectious diseases of interest in French Guiana (FG), two of them, two zoonoses, have recently experienced a revival of interest leading in a few years to a marked improvement in their knowledge. Several studies allowed as well discovering unexpected epidemiological features that have led us to question their emerging or reemerging character.Although cosmopolitan and with tropical a tropism, leptospirosis has been barely described in FG and on the Guiana Shield. The literature is old and reports only clinical cases or series, the most recent publication dating back to 1995. Several studies are presented in this work which have allowed to know a little more about this bacterial infection: exhaustive review of the literature, retrospective study of the reference national center reports, a retrospective multicenter study on leptos-piroses managed in FG between 2007 and 2014, with analysis of its determinants, demographic, ecological, clinical, sero-epidemiological, and a study comparing Guianese severe forms to those of North Africa.Although its presence had been suspected as early as the 1950s in FG, Q fever or Coxiella burnetii infection had not aroused interest locally until the late 1990s. The work here presents the progression of the knowledge of this bacterial infection, also cosmopolitan, but with unusual local specificities. In the course of the discoveries around this Guianese outbreak, we will present the contribution of our team to the progression of knowledge on this pathology and the contribution of answers bringing as much new questions. Thus the discussion will focus on this particular genotype, MST17, found exclusively in FG, which results in the highest incidence of Q fever in the world, a prevalence among pneumonias never found elsewhere. Moreover, the epidemiological cycle of the bacterium, usually based on livestock, seems to follow a completely different path and find its reservoir in wildlife. We also wonder about the contrast between the major public health problems that this disease represents in FG and the anecdotal character in the rest of Latin America.Finally, although these two zoonotic diseases may be described as "new diseases" in FG, it is likely that leptospirosis presents a recent increase in the number of cases related to the improvement of diagnostic techniques and the sensitization of physicians to this disease, but without real emergence, while Q fever seems to present a true emergent profile, with a recent increase in its incidence, and many unknowns linked to a very particular genotype.Many questions concerning these two infections remain unanswered, and the work is immense to better understand the stakes of these two diseases, both on the scale of FG and that of the Amazonian region and the Latin American continent.
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Loïc Epelboin. Émergence de zoonoses en Amazonie : épidémiologie comparée de la leptospirose et de la fièvre Q en Guyane française. Maladies infectieuses. Université des Antilles-Guyane, 2017. Français. ⟨NNT : 2017YANE0013⟩. ⟨tel-01839211⟩

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