Eosinophilic meningitis due to Angiostrongylus cantonensis (AC) is an emerging parasitic disease worldwide but remains endemic in the Pacific region. In New Caledonia, sporadic cases occur each year, and the route of transmission is often unclear. In January 2023, an unusual cluster of three cases occurred in a village on Lifou Island following week-long community festivities, leading to an epidemiological investigation to determine the outbreak scope, the source of contamination, and inform public health interventions. We conducted a retrospective epidemiological and environmental investigation in one month after the suspected exposure. Cases were defined according to international criteria and classified as confirmed, probable, or suspected. Clinical data, attendance at the festivities and food exposures were collected from medical records and interviews. Environmental observations focused on potential contamination sources in food preparation areas. Serological analyses were performed in symptomatic and asymptomatic exposed individuals. Descriptive statistics were used to summarize demographic, clinical, and exposure characteristics. Nineteen cases were identified, including three confirmed and sixteen suspected cases; no probable cases were identified. Headache was the predominant symptom, often associated with vomiting or paresthesias. All cases attended festivities on December 27, 2022 suggesting a common exposure during that day. The median incubation period was 3 weeks (IQR: 2–4). Two exposure hypotheses were identified: beverages diluted with rainwater and contamination of blended fruit juice. Environmental investigations revealed rats and gastropods around rainwater reservoirs and food preparation areas, including on utensils left to dry outdoors. No AC DNA was detected in water samples. Serology for AC was positive in all confirmed cases (3/3), in 13 of 14 tested suspected cases, and in all ten exposed asymptomatic individuals tested 9 months after the outbreak. This investigation highlights the diagnostic and epidemiological challenges of neuroangiostrongyliasis in endemic areas, where mild presentations often remain unconfirmed and where the value of serological testing is limited by the lack of baseline seroprevalence data. The findings support the hypothesis of accidental incorporation of a heavily infected gastropod into blended fruit juice during preparation, potentially facilitated by open-air kitchen practices in rural Pacific settings.
Background: Integrative Medicine (IM) combines conventional and complementary therapies to promote holistic, patient-centred care. Despite its growing recognition, little is known about how physicians practising IM reason and make clinical decisions. Methods : A qualitative descriptive study was conducted on Réunion Island (France). Ten physicians practising both conventional and integrative medicine were recruited via snowball sampling. Semi-structured interviews explored their understanding of IM, their reasoning processes, and their professional experiences. Interviews were transcribed verbatim and analysed thematically using an inductive–deductive approach guided by the Calgary–Cambridge model and Charlin’s framework of clinical reasoning. Results: Analysis revealed five main themes: (1) diverse definitions of IM; (2) transformation of the physician’s reflective posture; (3) the centrality of the therapeutic relationship; (4) distinctive features of reasoning in IM, marked by iterative reflection and integration of complementary knowledge; and (5) perceived benefits and challenges. Physicians described IM as fostering deeper empathy, shared decision-making, and enriched reasoning scripts combining biomedical and holistic perspectives. Conclusion : Practising IM with conventional and complementary therapies encourages a reflective, relational and patient-centred form of reasoning that benefits both patients and physicians. It enhances patient empowerment and clinician well-being, while highlighting the need for institutional recognition, structured training, and further research to strengthen IM’s scientific legitimacy.
Background On Reunion Island, literacy rates are estimated to be 62% for the elderly population. Education is a widely recognized protective factor for major neurocognitive disorders (MNCDs), including Alzheimer's disease, however during cognitive assessments by healthcare professionals, it can also act as a barrier.Objective This study aims to evaluate the concordance of the scores between the French version of the Mini-Mental State Examination (GRECO-MMSE) and an adapted version to the cultural context and literacy levels of the elderly Reunionese population (MMS-Run).Methods A cross-sectional, single-center study was conducted at the University Hospital of Reunion Island from April 14, 2023 to April 12, 2024. The GRECO-MMSE and MMS-RUN were performed one day apart to elderly participants who were hospitalized in the Department of Physical Medicine and Rehabilitation (PM&R) and the Department of Geriatrics. Analyses of concordance, correlation and distribution of scores as well as analyses by cognitive domains and by literacy levels (illiterate or literate) were carried out.Results Among the 61 participants, a discordance between the GRECO-MMSE and MSS-Run was observed (kappa=0.54), especially in the cognitive domains assessing orientation, attention and language (items that benefited most from adaptations). More than half of the participants were self-reported as illiterate (57%), and illiteracy was associated with increased discordance between the two tests.Conclusions The MMS-Run could be better suited for MNCD screening in the elderly Reunionese population. A validation study is necessary to determine appropriate threshold scores in the future.
Mother-to-child peripartum transmission of Chikungunya infection may induce severe illness with neonatal encephalitis/encephalopathy, leading to major neurological sequalae in offspring. There is not, at present, any licensed vaccine or treatment for Chikungunya virus (CHIKV) disease in pregnant women or neonates. However, there are a range of potential treatments, including passive immune therapies by hyperimmune antibodies or blood products, which warrant further investigation. Our study aims to determine whether the early administration of CHIKV convalescent plasma donor is effective in preventing several adverse outcomes in neonates exposed to maternal peripartum CHIKV infection. CONVICTION-CHIK is a multicentre, interventional, phase II, single-arm trial, that will be conducted in two French overseas departments in the Indian Ocean throughout 2026. Neonates with the following criteria will be included: (1) mother with a clinical and/or biological diagnosis of CHIKV infection occurring between day -2 and + 2 around delivery; (2) cared for in a 3rd level neonatal intensive care unit; (3) treatment administration possible within 12 h from diagnosis of maternal infection. The intervention consists in the transfusion of 25 mL/kg of ABO CHIKV convalescent plasma over 4 h. The primary endpoint is the proportion of newborn infants treated with CHIKV convalescent plasma who survive without encephalitis/encephalopathy in the first 5 days of life. This outcome will also be assessed in a parallel cohort of untreated newborn infants exposed to peripartum CHIKV infection. Secondary endpoints are clinical, biological, and brain imaging findings of neonatal CHIKV infection, in treated and untreated neonates. Based on an expected decrease in the primary endpoint from 25
Background Heart failure (HF) in older adults is frequently accompanied by frailty, multimorbidity, cognitive impairment, and functional vulnerability, making standard disease-centred pathways difficult to apply in routine practice. Although frailty-informed care and age-friendly principles are increasingly advocated, detailed real-world descriptions of operational cardiogeriatric service models remain scarce. We therefore describe the development and implementation of a hospital-based cardiogeriatric decision algorithm for older adults with HF, integrating frailty stratification and the 4Ms framework. Methods This study is a descriptive, single-centre service development report conducted in the Department of Cardiogeriatrics at Hôpital La Porte Verte, Versailles, France. Its aim was not to evaluate effectiveness, but to describe the rationale, structure, implementation process, and operationalization of a real-world decision algorithm for older adults with HF. The model was informed by heart failure guidelines, frailty-based clinical reasoning, and the Age-Friendly Health Systems 4Ms framework. It incorporated frailty stratification, comprehensive geriatric assessment, advanced practice nurse coordination, day-hospital management, telemonitoring, therapeutic education, and supportive or palliative care when appropriate. Results From 2023 onwards, the decision algorithm was progressively embedded into routine inpatient, outpatient, day-hospital, and telemonitoring practice. It provided a shared multidisciplinary framework for aligning therapeutic intensity with frailty status, functional reserve, cognitive status, and patient priorities. In practice, the algorithm supported profile-adapted therapeutic orientation across inpatient, ambulatory, and supportive care settings, while helping structure coordination between cardiology, geriatrics, nursing teams, and community care. This report does not present a formal comparative evaluation of clinical outcomes; its findings should therefore be interpreted as descriptive and hypothesis-generating. Conclusions This single-centre experience describes a pragmatic and age-friendly cardiogeriatric decision algorithm for older adults with HF and complex care needs. By integrating frailty assessment, the 4Ms framework, and coordinated multidisciplinary care into routine practice, the model offers a transferable organisational approach for clinicians managing older patients with HF. Formal evaluation is now needed to assess implementation outcomes, patient-centred outcomes, and scalability.
