Portrait épidémiologique de la Ciguatera dans le Pacifique-sud

Chateau-Degat, Marie-Ludivine
Philosophiæ doctor (Ph.D.)
Université Laval

FACULTÉ DE MÉDECINE
Doctorat en épidémiologie

Directeur(trice) de recherche : Dewailly, Éric
Co directeur(trice) de recherche : Verreault, René
2005-03

© Marie-Ludivine Chateau-Degat, 2005

Résumé

La ciguatera est une intoxication consécutive à l’ingestion de poissons d’ambiance corallienne contaminés par une micro-algue. Malgré une connaissance séculaire, l’apparente recrudescence de cette maladie, sa répartition géographique, sa variabilité symptomatique sont autant de points qui restent à éclaircir. Ce projet avait pour objectif de dresser le portrait épidémiologique actuel de cet ichtyosarcotoxisme en Polynésie Française afin d’en améliorer la prise en charge. Nos résultats démontrent que l’incidence de la ciguatera dans cette région est relativement stable. Parmi les facteurs écologiques associés aux variations d’incidence, la modélisation de la floraison de l’algue apparaît par nos analyses comme une avenue prometteuse d’une mise en place d’outils de prévention pour réduire l’incidence. Du point de vue clinique, nos résultats confirment la prédominance des symptômes neurologiques qui évoque une polyneuropathie sensitive se résorbant progressivement dont la gravité paraît reliée à la quantité de toxines ingérées.

Abstract

Ciguatera poisoning is an ichtyosarcotoxism found throughout many tropical areas of the world. Even though this intoxication has been known since the 18th century, many epidemiological aspects remain unclear. The main goal of this thesis was to establish the epidemiological portrait of this seafood poisoning in order to improve its management. The first part of this project describes this ichtyosarcotoxism according to its environmental and temporal aspects. The second part addresses clinical aspects of the disease. A global increase of ciguatera incidence has been suggested in the literature. However, results from our retrospective study indicate a relatively constant annual incidence in French Polynesia over the ten years of the study. An analysis of cases grouped by archipelago also revealed differences in incidence rates with the most remote archipelagos having the highest incidence. These high rates observed highlight the need to develop prevention tools in order to reduce the incidence. Results from our model of changes in the incidence of ciguatera disease following algae blooms might be useful for assisting ciguatera risk management initiatives. Indeed, results from the study highlight a clear temporal relation between ciguatera disease and its etiologic agent: Gambierdiscus spp. From a clinical point of view, our results confirm the neurological feature of this intoxication as previously proposed and suggest that several symptoms observed in 183 patients at the acute phase of the disease are still persistent 2 months after the onset. In order to characterize these symptoms, we compared the neurological evaluation of 47 patients with ciguatera disease to 125 ciguatera-free controls. Results showed that ciguatera disease predominantly alters the peripheral sensory system represented mainly by sensory disturbances (light-touch and thermal) and poorer sway performances compared to controls. Over three testing periods, we observed an improvement of sway performances but, light touch threshold remained altered for more than 50% of patient 60 days after of the onset. In summary, results obtained in this thesis confirm the evolution ciguatera disease to chronic stage in the study population and suggest that ciguatera symptoms in acute phase are similar to a sensory polyneuropathy with a progressive recovery.


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