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Master Thesis

Pneumopathie aiguë communautaire de l’adulte immunocompétent et fièvre Q : connaissances et perceptions des médecins généralistes de Guyane française

Abstract : INTRODUCTION : The Q fever, or Coxiella burnetii infection, was described for the first time in French Guianain 1955. Community-acquired pneumonias (CAPs) represent about 90% of symptomatic Q fever. Generalist practitioners (GPs) being at the forefront of the management of these two pathologies, the aim of this thesis is to evaluate the knowledge and perception GPs of French Guiana on these two related topics. METHOD: A self-questionnaire was distributed to GPs of French Guiana between February and July 2017. GPs practicing in hospitals were excluded from the study. RESULTS: Of the 113 GPs identified during the study period, 54 (47.8%) answered the questionnaire. The average age was 47.9 years old (± 11.6) and the sex ratio (M / F) was 1.25. Concerning the CAP, they saw less than 5 / month for 90.7% of them (49/54). 59.2% (32/54) systematically prescribed a chest X ray, 64.8% (35/54) use damoxicillin for young people with no specific antecedent, and 77.8% (41/54) amoxicillin + clavulanic acid for a chronic heart failure patient. Finally, 79.8% (42/54) systematically reconvened their patients and a little over half of them reconvened them within 48 hours (24/42, 57.1%). On the other hand, 75.9% (41/54) did not use a severity score and 61.1% (33/54) did not know the latest recommendations. The youngest GPs (<40 years old) were significantly more up to date in the treatment of CAP in young (p = 0.014) or older patients (p =0.04). Regarding the Q fever, GPs had knowledge but do not necessarily put it into practice in case of CAP in French Guiana. Compared to the doctors of the other communes, the GPs of Cayenne and surroundings (N = 33, 61.1%) answered significantly that the incidence of the Q fever in French Guiana was increasing these last 20 years (p= 0.02), and that an echocardiography was necessary in case of positive diagnosis (p = 0.011). They significantly prescribed Q fever serology once a week or once a month (p<0.001) out of <5 CAPs supported each month. The profile significantly associated with the prescription of amoxicillin + doxycycline in a young patient without antecedent was the fact of exercising on the island (p = 0.046). 59.3% (32/54) of GPs in our study feel insufficiently informed about the Q fever and 98.1% (53/54) would be interested in postgraduate education. DISCUSSION / CONCLUSION: The majority of the GPs who were questioned did not take note of the latest recommendations on pneumonias, which is in agreement with the literature. The Q fever is still little known to GPs, despite its incidence in French Guiana but we can see that in Cayenne, they seem to be more aware and updated on some points of the treatment or additional examinations. The management of CAP and Q fever is not optimal in city medicine. Training actions could be able to raise the awareness of many actors for better managements of CAP and Q fever in ambulatory.
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Master Thesis
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Oriane Denis. Pneumopathie aiguë communautaire de l’adulte immunocompétent et fièvre Q : connaissances et perceptions des médecins généralistes de Guyane française. Médecine humaine et pathologie. 2018. ⟨dumas-01916720⟩

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