Incidental finding of Pott's disease with abscesses of the psoas simulating an appendicular syndrome.

Pott's disease or tuberculous spondylodiscitis is the disco-vertebral localization of Koch's bacillus. It causes progressive spinal lesions, with abscesses forming in the perivertebral soft tissues and epidural spaces. Medical imaging plays an indisputable role in the diagnosis and management of Pott's disease. Magnetic resonance imaging (MRI) enables early positive diagnosis and assessment of spinal damage. Computed tomography (CT) is currently the best interventional imaging method for the drainage of soft tissue abscesses and disco-vertebral biopsies for bacteriological and histological purposes. We report a case of accidental discovery of Pott's disease with abscesses of the psoas simulating an appendicular syndrome and describe its epidemiological, clinical, and radiological aspects through a review of the literature.

Neuromeningeal Cryptococcosis and Tuberculosis Coinfection in Bamako: A One-Year Case Series.

Cryptococcosis and tuberculosis are life-threatening opportunistic infections that occur in apparently immunocompetent or severely immunocompromised individuals worldwide. As both infections are strongly linked to HIV infection, they may share certain clinical manifestations, and the interaction of their treatments should be considered. However, despite their similarity, concurrent tuberculosis and cryptococcal infections have rarely been reported in West Africa. Herein, we present 3 cases of neuromeningeal cryptococcosis and lung tuberculosis coinfection collected prospectively over a year at the Department of Infectious Diseases of the Point G Teaching Hospital in Bamako. Two patients had HIV disease, and the third patient had no underlying immunosuppressive illnesses. Thus, active screening for tuberculosis and cryptococcosis, particularly in individuals with HIV, can reduce misdiagnosis and ensure appropriate coinfection management. Moreover, this may reduce mortality due to AIDS-related opportunistic infections in resource-limited settings.

[Ear tuberculosis concomitant with pulmonary localization in an HIV-immunosuppressed patient, in Bamako, Mali]. / Tuberculose auriculaire concomitante à une localisation pulmonaire chez un patient immunodéprimé par le VIH, à Bamako, Mali.

Introduction/Rationale: Tuberculosis remains a major public health issue. It is an opportunistic pathology, very common in HIV-immunocompromised persons, classifying it at the WHO stage 4. Ear tuberculosis remains a rare and under-diagnosed clinical form. We report here a case of ear tuberculosis concomitant with pulmonary localization in an HIV-immunosuppressed person on triple antiretroviral therapy aged 32 years hospitalized in Bamako (Mali) to discuss the diagnostic and therapeutic difficulties posed by this rare localization. Description of the case: The patient had a chronic productive cough, otalgia and right chronic purulent otorrhea. The search for acid-resistant bacilli was positive for direct examination in gastric casing fluid and swabbing of the ear pus, confirming the diagnosis of tuberculosis. Anti-tuberculosis treatment instituted for 6 months associated with adjuvants resulted in complete healing of the patient. Discussion/conclusion: Although rare, ear localization must be actively sought. Etiological treatment must be instituted upon confirmation of the diagnosis to avoid complications and sequelae.

[Ultrasound Profile Of Thyroid Spheres At The University Hospital Of Bouaké (Côte d'Ivoire)]. / Profil Echographique Des Nodules Thyroïdiens Au Centre Hospitalo-Universitaire De Bouake (Cote D'Ivoire).

INTRODUCTION: Ultrasound is the first-line examination in the morphological exploration of the thyroid. It is an excellent diagnostic and prognostic tool in nodular thyropathy. OBJECTIVE: to determine the profile of thyroid nodules on ultrasound according to the EU-TIRADS classification. MATERIAL AND METHODS: descriptive cross-sectional study carried out in the radiology department of the University Hospital of Bouaké during one year. We included all thyroid ultrasound reports of patients with thyroid nodules. Data were analysed using Epi Info 7 software. RESULTS: A total of 60 patients had nodules out of 97 referred for thyropathy (60.8%). The mean age was 45.6 years [13-82 years]. Females predominated with 82.7%. Anterior cervical swelling was the main indication in 72%. Thyroid volume was increased in 63% of patients with a mean volume of 71 cm3. Solitary nodules were present in 46.55%. Spongiform nodules were predominant in 32%. The nodules were solid in 29.8% and mixed in 16.5%. Hypoechogenicity was found in 44.8% of solid nodules. Lesions were classified as EU-TIRADS 2 in 58.8%, EU-TIRADS 3 in 23.5%, EU-TIRADS 4 in 14.7% and EU-TIRADS 5 in 2.9%. CONCLUSION: The characterisation and classification of thyroid nodules is an important step in the management of patients. In our study, these nodules are essentially benign (EU-TIRADS 2 and 3) with a female predominance. A decision tree taking into account the clinical and cytopathological elements would be more useful for possible surgery.

INTRODUCTION: l'échographie est l'examen de première intention dans l'exploration morphologique de la thyroïde. Elle constitue un excellent outil diagnostique et pronostique dans les thyropathies nodulaires. OBJECTIF: déterminer le profil des nodules thyroïdiens à l'échographie selon la classification EU-TIRADS. MATÉRIEL ET MÉTHODES: étude transversale descriptive réalisée dans le service de radiologie du CHU de Bouaké durant une année. Nous avons inclus tous les comptes rendus d'échographie thyroïdienne des patients ayant des nodules thyroïdiens. Les données ont été analysées à l'aide du logiciel Epi Info 7. RÉSULTATS: Au total, 60 patients présentaient des nodules sur 97 reçus pour thyropathies soit 60,8%. L'âge moyen était de 45,6 ans [13-82 ans]. Legenre féminin prédominait avec 82,7%. La tuméfaction cervicale antérieure était la principale indication dans 72%. Le volume thyroïdien était augmenté chez 63%des patients avec un volume moyen de 71 cm3. Il s'agissait de nodule solitaire dans 46,55%. Les nodules spongiformes prédominaient dans 32%. Les nodules étaient solides dans 29,8% et mixtes dans 16,5.%. L'hypo-échogénicité était retrouvée dans 44,8% des cas de nodules solides. Les lésions étaient classées EU-TIRADS 2 dans 58,8%, EU-TIRADS 3 dans 23,5%, EU-TIRADS 4 dans 14,7% et EU-TIRADS 5 dans 2,9%. CONCLUSION: la caractérisation et la classification des nodules thyroïdiens constituent une étape importante pour la prise en charge des patients. Ces nodules dans notre étude sont essentiellement d'allure bénigne (EU-TIRADS 2 et 3) avec une prédominance féminine. Un arbre décisionnel tenant compte des éléments cliniques et cytopathologiques servirait davantage pour d'éventuelles chirurgies.

[ECHOGRAPHIC Appearance Of Left Inguinal Hernia Of The Bladder: About A Bouake Case]. / Aspect ECHOGRAPHIQUE De La Hernie Inguinale Gauche De La Vessie : A Propos d'Un Cas Bouake.

Inguinal hernia is one of the most frequent pathologies in surgery and is defined by the passage of abdominal or pelvic contents through the inguinal orifice [1]. However, an inguinal hernia is said to be of the bladder when the contents involve the bladder [2]. It is rare and most often discovered intraoperatively [3]. We report a case of left inguinal bladder hernia diagnosed by ultrasound. This was a 74-year-old patient who consulted for dysuria associated with bilateral inguino-scrotal swelling. A vesico-prostatic ultrasound was performed using a Samsung ultrasound scanner equipped with high and low frequency probes and a pulsed and color Doppler mode. At the end of this examination, the diagnosis of a left inguinal hernia of the bladder was made.

La hernie inguinale est l'une des pathologies les plus fréquentes en chirurgie et se définit par le passage du contenu abdominal ou pelvien à travers l'orifice inguinal [1]. Cependant la hernie inguinale est dite de la vessie lorsque le contenu intéresse la vessie [2]. Elle est rare et découverte le plus souvent en per-opératoire [3]. Nous rapportons un cas de hernie inguinale gauche de la vessie dont le diagnostic a été posé à l'échographie. Il s'agissait d'un patient de 74 ans qui a consulté pour une dysurie associée à une tuméfaction inguino-scrotale bilatérale. Une échographie vésico-prostatique a été réalisée à l'aide d'un échographe de marque Samsung doté de sondes haute et basse fréquence et un mode Doppler pulsé et couleur. À l'issue de cet examen le diagnostic d'une hernie inguinale gauche de la vessie a été posé.

Influence of CYP2B6 and CYP3A4 polymorphisms on the virologic and immunologic responses of patients treated with efavirenz-containing regimen.

OBJECTIVES: The main objective of this study was to evaluate the effect of CYP2B6 and CYP3A4 polymorphisms on the virological and immunologic responses of HIV patients. A total of 153 HIV-positive patients were enlisted for the study. PATIENTS AND METHODS: Viral load and median CD4 T cell counts were evaluated at baseline and month 6 (M6). Samples were identified using TaqMan genotyping assays. RESULTS: The AG in CYP2B6 rs2279343 was associated with VLS compared to homozygous AA. In the dominant model, the AG/GG genotypes were associated with VLS compared to the AA genotype. Moreover, in overdominant model, the AG genotype was associated with VLS compared to AA/GG. Regarding immunological response, only the AG in SNP rs2279343 CYP2B6 was associated with an increase in CD4 cell count between baseline and M6. In CYP2B6 rs3745274, the CD4 cell count at M6 was higher than that of baseline for GG carriers and for GT carriers. In CYP3A4 rs2740574, the TC carriers showed a higher median CD4 count at M6 compared to that of the baseline count, as well as for CC carriers. The best genotypes combination associated with CD4 cell count improvement were AA/AG in SNP rs2279343 and GG/GT in SNP rs3745274. CONCLUSION: Our findings support the fact that CYP2B6 rs2279343 could help in the prediction of VLS and both SNPs rs3745274 and rs2279343 in CYP2B6 and CYP3A4 rs2740574 were associated with immune recovery in Malian HIV-positive patients.

Raoultella planticola and urinary tract infection: The first laboratory-confirmed case in an HIV-infected patient in Mali.

Raoultella planticola is a Gram-negative, aerobic, non-motile bacterium, abundant in the environment, but rarely associated with pathology in humans. Notably, few urinary tract infections caused by R. planticola have been reported. To our knowledge, we are presenting here the first case of urinary tract infection caused by R. planticola in an HIV-infected individual. It is a 50-year-old female, with a history of HIV-1 infection treated for three years. At admission, her CD4 count was 70 cells/mL, and the main complaints were severe diarrhea and cough. She was diagnosed and treated for pulmonary tuberculosis (TB) and E. Coli enteritis. Initially, we observed a good evolution. However, on day 21 of hospitalization, she presented with fever and dysuria. Urinalysis revealed the presence of R. planticola with resistance to multiple antibiotics. We also detected that she has an HIV-2 but not HIV-1 infection. After receiving the right regimen, she was confirmed cured of her bacterial infections.

Incidence and Predictors of Imported Cases of COVID-19 in Burkina Faso.

BACKGROUND: To limit the spread of COVID-19 due to imported cases, Burkina Faso has set up quarantine measures for arriving passengers. We aimed to determine the incidence and predictors of imported cases of COVID-19 in Burkina Faso. METHODS: A prospective cohort study was performed using data from passengers arriving at the airport from April 9 to August 31, 2020. The data was extracted from the District Health Information Software 2 (DHIS2) platform. Cox regression was used to identify predictors of imported cases of COVID-19. RESULTS: Among 6,332 travelers who arrived in the study period, 173 imported cases (2.7%) were recorded. The incidence rate was 1.9 cases per 1,000 traveler-days (95%CI: 1.6-2.2 per 1,000). Passengers arriving in April (Adjusted hazard ratio [aHR] = 3.56; 95%CI: 1.62-7.81) and May (aHR = 1.92; 95% CI: 1.18-3.12) were more at risk of being tested positive compared to those arriving in August, as well as, passengers presenting with one symptom (aHR = 3.71; 95% CI: 1.63-8.43) and at least two symptoms (aHR = 10.82; 95% CI: 5.24-22,30) compared to asymptomatic travelers. CONCLUSIONS: The incidence of imported cases was relatively low in Burkina Faso between April and August 2020. The period of travel and the presence of symptoms at arrival predicted the risk of being tested positive to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This is essential in the context of the high circulation of virus variants worldwide and the low local capacity to perform genotyping tests to strengthen the surveillance and screening capacities at the points of entry into the country.

[Neuromeningeal cryptococcosis in an HIV-negative patient with pulmonary tuberculosis in the Infectious and tropical diseases department of the University teaching hospital Point G of Bamako, Mali]. / Cryptococcose neuroméningée chez une patiente séronégative pour le VIH atteinte de tuberculose pulmonaire au service de Maladies infectieuses et tropicales du CHU du Point G de Bamako, Mali.

Neuromeningeal cryptococcosis and pulmonary tuberculosis are respectively serious mycotic and bacterial infections occurring in a subject regardless of its HIV serological status. We report here a case of neuromeningeal cryptococcosis associated with pulmonary tuberculosis and malnutrition in an HIV-seronegative patient with a CD4 count of 750/mm3, to highlight some particularities opposed to certain literatures. This is an 18-year-old patient, housewife, from Bamako, admitted in the Infectious and tropical diseases department of the University teaching hospital Point G of Bamako on March 13, 2022 for fever and impaired consciousness. Her symptomatology appears to have gradually set in over a month, preceded by headache resistant to paracetamol, jet vomiting and irregular dry cough, initially treated with ceftriaxone, artesunate and paracetamol for confirmed malaria and suspicion of bacterial meningitis before admission. In whom no known medical-surgical history, no use of topical corticosteroids, no immunosuppressive therapy, no alcohol or tobacco, and no immunosuppressive pathology was found. The diagnoses of neuromeningeal cryptococcosis, pulmonary tuberculosis and undernutrition were retained in view of clinical and microbiological arguments. Diabetes, sickle cell disease, viral hepatitis B and C, kidney failure and cancer, which are immunosuppressive pathologies, were not found. She was successfully treated with first-line oral antituberculous drugs and fluconazole infusion. Three interests are drawn from this clinical case: neuromeningeal cryptococcosis is not only the prerogative of HIV-positive subjects, a high CD4 count does not always mean immunocompetence and fluconazole is an effective therapeutic alternative for neuromeningeal cryptococcosis.

[Angiomyolipoma of the psoas: a case report and literature review]. / Angiomyolipome du psoas : a propos d'un cas et revue de la litterature.

The psoas major muscle is one of the three muscle chiefs of the ilio-psoas muscle. The pathological processes concerning it are dominated by tumor lesions which are mostly malignant. The diagnostic approach is based on the clinic and the abdomino-pelvic scanner. If necessary, it will make it possible to direct a puncture and / or a biopsy. We report the observation of a 33-year-old patient admitted to the Bouaké University Hospital presenting with a mass in the left iliac fossa and an intermittent claudication of chronic evolution in whom the diagnosis of a psoas tumor was diagnosedthrough the abdomino-pelvic scanner and the pathology concluded to an angiomyolipoma.

Le muscle psoas major ou grand psoas est un des trois chefs musculaires du muscle ilio-psoas. Les processus pathologiques le concernant sont dominés par les lésions tumorales qui sont pour la plupart malignes.La démarche diagnostique s'appuie sur la clinique et l'imagerie médicale où le scanner abdomino-pelvien est un examen majeur. Il permettra le cas échéant de guider une ponction et ou une biopsie à visée étiologique et ou thérapeutique. Nous rapportons l'observation d'un patient de 33 ans admis au CHU de Bouaké (Côte d'Ivoire) présentant une masse de la fosse iliaque gauche et une claudication intermittente d'évolution chronique chez qui le diagnostic d'une tumeur du psoas a étésuspecté auscanner abdomino-pelvien et l'anatomo-pathologie a conclu àun angiomyolipome.

[Quality of Medical Imaging examination requests in Bouaké (Cote d'Ivoire): about 3129 requests]. / Qualite des demandes d'examen d'Imagerie Medicale a Bouake (Cote d'Ivoire) : a propos de 3129 cas.

OBJECTIVE: Assess the quality of medical imaging exam requests in order to facilitate their successful completion. MATERIAL AND METHODS: This was a prospective study, carried out at the Bouaké UniversityHospital over a period of 4 months. This study covered 3129 requests for examination. The aim was to evaluate the conformity of the different requests established by the CDEI indicator. Data analysis was carried out using Epi Info 7 software. RESULTS: Requests for medical imaging exams were under-informed in 98.66% of cases by prescribers as defined by the CDEI indicator. The requests included the patient's name in 99.78% of cases, first name(s) in 98.91% of cases, age in 51.45%, and sex in 60.95% of cases. 84.79% of the reports came from the Bouaké CHU and 98.43% were dated. The patient's hospitalized status was not specified in 99.97% of the requests for analysis. The indication was included in 92.78% of the reports and diagnostic hypotheses were mentioned in only 94.76%. The imaging medium requested was specified in 99.78% with conventional radiography predominating in 80.88%. The anatomical region was mentioned in 92.49%. The identity and contact information of the prescribers represented 92% and 48% of the requestsrespectively. CONCLUSION: The quality of writing of medical imaging examination requests was unsatisfactory overall with a high rate of non-compliance. Much effort to be made by the different actors.

OBJECTIF: Evaluer la qualité des demandes d'examen en imagerie médicale pour faciliter leur bonne réalisation. MÉTHODES: Il s'agissait d'une étude prospective, réalisée au CHU de Bouaké sur une période de 4 mois. Cette étude a porté sur 3129 demandes d'examen.Il était question d'évaluer la conformité des différentes demandes établies par l'indicateur CDEI. Les données ont été analysées avec le logiciel Epi Info 7. RÉSULTATS: Les demandes d'examen d'imagerie médicale étaient insuffisamment renseignées dans 98,66% des cas par les prescripteurs selon l'indicateur CDEI. Les demandes comportaient le nom du patient dans 99,78% des cas, leur(s) prénom(s) dans 98,91% des cas, l'âge dans 51,45% des cas et le sexe dans 60,95% des cas. Les demandes d'examen provenaient du CHU de Bouaké dans 84,79% des cas et ils étaient datés dans 98,43% des cas. Le statut hospitalisé du patient n'était pas précisé dans 99,97% des cas. L'indication y figurait dans 92,78% et les hypothèses diagnostiques n'étaient pas mentionnées dans 94,76%. Le moyen d'imagerie demandé figurait dans 99,78 % avec une prédominance de la radiographie standard dans 80,88%. La région anatomique était mentionnée dans 92,49%. L'identité et les coordonnées des prescripteurs étaient indiquées respectivement dans 92% des cas et 48% des cas sur les demandes d'examen. CONCLUSION: La qualité de rédaction des demandes d'examen d'imagerie médicale était insatisfaisante d'une manière globale avec un taux élevé de non conformités. Beaucoup d'efforts restent à faire de la part des différents acteurs.

Distribution of alleles, genotypes and haplotypes of the CYP2B6 (rs3745274; rs2279343) and CYP3A4 (rs2740574) genes in the Malian population: Implication for pharmacogenetics.

ABSTRACT: Cytochrome P450 enzymes play a central role in the phase I biotransformation process of a wide range of compounds, including xenobiotics, drugs, hormones and vitamins. It is noteworthy that these enzymes are highly polymorphic and, depending on the genetic makeup, an individual may have impaired enzymatic activity. Therefore, the identification of genetic variants in these genes could facilitate the implementation of pharmacogenetic studies and genetic predisposition to multifactorial diseases. We have established the frequencies of CYP2B6 (rs3745274; rs2279343) and CYP3A4 (rs2740574) alleles and genotypes in 209 healthy Malian subjects using TaqMan drug metabolism genotyping assays for allelic discrimination. Allele frequencies were 37% for CYP2B6 rs3745274; 38% for CYP2B6 rs2279343; and 75% for CYP3A4 rs2740574 respectively. Overall, the frequencies observed in Mali are statistically comparable to those reported across Africa except North Africa. The major haplotypes in CYP2B6 rs3745274 and CYP2B6 rs2279343 were represented by GA (60.24%) followed by TG (35.36%). We noted a strong linkage disequilibrium between CYP2B6 rs3745274 and CYP2B6 rs2279343 with D' = 0.91 and r2 = 0.9. The frequencies of the genotypic combinations were 43.5% (GT/AG), 37.3% (GG/AA) and 11.5% (TT/GG) in the combination of CYP2B6-rs3745274 and CYP2B6-rs2279343; 26.8% (GT/CC), 25.4%, (GT/CT), 17.2% and GG/CT in the combination CYP2B6-rs3745274-CYP3A4-rs2740574; 26.8% (AG/CC), 23.9% (AA/CC), 19.1% (AG/CT), and 11% (AA/CT) in the combination CYP2B6-rs2279343-CYP3A4-rs2740574, respectively. The most common triple genotype was GT/AG/CC with 24.9%, followed by GG/AA/CC with 23.9%, GT/AG/CT with 16.7%, and GG/AA/CT with 10%. Our results provide new insights into the distribution of these pharmacogenetically relevant genes in the Malian population. Moreover, these data will be useful for studies of individual genetic variability to drugs and genetic predisposition to diseases.

Meningeal tuberculoma mimicking a brain tumor.

Meningeal tuberculoma is one of the most serious sites of tuberculosis. Its incidence varies depending on the geographical area, rare in Western countries and frequent in developing countries where it represents 5% to 10% of intracranial masses. We report the case of a 21-year-old male patient with no particular medical history from Africa and living in Europe for more than a year, is hospitalized for an isolated inaugural, generalized, afebrile seizure in whom the scanner and cerebral magnetic resonance imaging (MRI) revealed a meningeal mass with significant glove finger edema suggesting a primary brain tumor. Surgical excision and anatomopathological analysis of the excisional piece allowed the diagnosis of tuberculoma. Meningeal tuberculoma is a source of diagnostic error because its clinical and radiological expression can mimic a brain tumor. This is an etiology that should not be ignored in the face of a meningeal mass in any subject coming from or living in a region with a high endemic tuberculosis.

[Localised tetanus with no obvious entry site: about a case in Bamako (Mali)]. / Tétanos localisé sans porte d´entrée apparente: à propos d´un cas à Bamako (Mali).

Tetanus is a major public health problem in sub-Saharan Africa. Localised tetanus is rare, unlike generalized tetanus which has been sufficiently described in the literature. We report a case of localised tetanus with no obvious entry site managed in the Department of Infectious Diseases in Bamako. The study involved a retired nurse aged 59 years who had not undergone tetanus booster immunisation within the last 10 years, corresponding to the date of her last delivery. She was referred to our Hospital with dysphagia associated with inability to open the buccal cavity. Patient's history was characterized by long-term therapy associated with many specialized consultations without any improvement. The diagnosis of localised tetanus with no obvious entry site was retained after having excluded any other local disorder. Outcome was favorable ten days after adequate management. Underdiagnosed or unknown to health-care providers, localised tetanus may mimic other diseases delaying diagnosis and management. Targeted campaign to build awareness should be implemented in order to improve adherence with immunization schedules.

Genetic polymorphism of drug metabolism enzymes (GSTM1, GSTT1 and GSTP1) in the healthy Malian population.

Glutathione S-transferase genes, known to be highly polymorphic, are implicated in the process of phase II metabolism of many substrates, including xenobiotics, anticancer and anti-infective drugs. The detoxification activity is linked to individual genetic makeup. Therefore, the identification of alleles and genotypes in these genes within a population may help to better design genetic susceptibility and pharmacogenetic studies. We performed the present study to establish the frequencies of the GSTM1, GSTT1, and GSTP1 c. 313A > G (rs1695) polymorphisms in 206 individuals of the Malian healthy population. GSTM1 and GSTT1 were genotyped by using multiplex polymerase chain reaction, whereas genotypes of GSTP1 were identified by polymerase chain reaction followed by restriction fragment length polymorphism. The frequencies of GSTM1-null and GSTT1-null genotypes were respectively 24.3 and 41.3%. The observed genotype frequencies for GSTP1 were 25.73% homozygous wild-type AA, 49.03% heterozygous AG and 25.24% homozygous mutant GG. The frequency of GSTP1-A allele was 50.24% versus 49.76% for the GSTP1-G allele. The distribution of these three genes was homogeneous between men and women (p > 0.05). We found no statistical association between the presence of a particular profile of GSTM1 or GSTT1 with the genotypes of GSTP1 (p > 0.05). Nevertheless, we noticed that the majority of the individuals harboring the GSTM1-present or the GSTT1-present harbor also the GSTP1-AG genotype. In addition, the triple genotype GSTM1-present/GSTT1-present/AG was the most frequent with 25.2%. Our findings will facilitate future studies regarding genetic associations of multifactorial diseases and pharmacogenetic, thus opening the way to personalized medicine in our population.

[Tuberculosis and HIV coinfection complicated by nosocomial infection caused by Klebsiella pneumoniae: about 4 cases in a Department of Infectious diseases in Mali]. / Co-infection tuberculose-VIH compliquée d'une sur infection nosocomiale à Klebsiella pneumoniae: à propos de 4 observations dans un Service de Maladies Infectieuses au Mali.

Nosocomial infections are a real global public health problem. Pulmonary tuberculosis and HIV co-infection increases the incidence of nosocomial infections because of immunosuppression and iterative hospitalizations. We here report four cases of patients aged 28, 36, 42 and 52 years co-infected with HIV and tuberculosis (multifocal tuberculosis in 2 patients, miliary tuberculosis, bacteriologically confirmed tuberculosis), all with CD4 < 100 cells/mm3. During the intensive-phase, patients received antitubercular drugs and antiretroviral therapy (ART). They had been admitted to the Department of Infectious Diseases at the G-Point University Hospital with productive cough and/or hyperthermia following hospital stay greater than 48 hours. Patients' history revealed that one patient had not been compliant with tuberculosis treatment because of adverse reactions classified as minor. There had been no clinical improvement in the three remaining patients despite their optimal compliance to different treatments. Cytobacteriological examination of sputum and/or testing of the feeding tubes, blood cultures and specific samples allowed to identify multidrug-resistant Klebsiella pneumoniae. The clinical course of these patients was favorable under specific antibiotic therapy. Nosocomial infections may be misinterpreted and associated with poor therapeutic response in patients receiving TB treatment. Cytobacteriological examination of the biological fluids should be systematic in patients co-infected with HIV and tuberculosis and hospitalized for at least 48 hours, in whom pulmonary signs and/or fever persist despite their good compliance to treatment.

Comparing Treatment Outcomes of Antiretroviral Therapy in HIV-1 and HIV-2 Infected Patients, in Bamako, Mali.

BACKGROUND: HIV-2 leads to a less-severe disease than HIV-1 but is known to be resistant to Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs). We goaled to evaluate the clinical and biological outcomes of HIV-1 and HIV-2 infected-patients under Antiretroviral Therapy (ART) that do not include NNRTIs. METHODS: This is a case-control study of 100 participants (half in each group) to measure the frequency of clinical and biological adverse effects, and disease outcome at 6 and 12 months of treatment (M6 and M12) We included. RESULTS: Opportunistic infections were more frequent in HIV-1 infected patients with 82% when compared to HIV-2, 68%. However, the prevalence of treatment adverse events was slightly higher in HIV-2 infected patients. The average increase of CD4 cell count at M6 of treatment was 139.93 and 159.41 cells/mm3, for HIV-2 and HIV-1 groups respectively, and at 153 and 217 cells/mm3, at M12 for HIV-2 and HIV-1 respectively. A total of nine HIV-2 and six HIV-1 deaths were reported during the study. CONCLUSION: This study has shown that ART regimens that do not include NNRTIs are effective equally in the treatment of HIV-1 and HIV-2 infections. Nevertheless, we recommend regular and continuous laboratory monitoring for all HIV treated patients.

Usefulness of Noninvasive Predictors of Oesophageal Varices in Black African Cirrhotic Patients in Côte d'Ivoire (West Africa).

Aims. To determine the usefulness of platelet count (PC), spleen diameter (SD) and platelet count/spleen diameter ratio (PC/SD ratio) for the prediction of oesophageal varices (OV) and large OV in black African patients with cirrhosis in Côte d'Ivoire. Materials and Methods. Study was conducted in a training sample (111 patients) and in a validation sample (91 patients). Results. Factors predicting OV were sex: (OR = 0.08, P = 0.0003), PC (OR = 12.4, P = 0.0003), SD (OR = 1.04, P = 0.002) in the training sample. The AUROCs (±SE) of the model (cutoff ≥ 0.6), PC (cutoff < 110500), SD (cutoff > 140) and PC/SD ratio (cutoff ≤ 868) were, respectively; 0.879 ± 0.04, 0.768 ± 0.06, 0.679 ± 0.06, 0.793 ± 0.06. For the prediction of large OV, the model's AUROC (0.850 ± 0.05) was superior to that of PC (0.688 ± 0.06), SD (0.732 ± 0.05) and PC/SD ratio (0.752 ± 0.06). In the validation sample, with PC, PC/SD ratio and the model, upper digestive endoscopy could be obviated respectively in 45.1, 45.1, and 44% of cirrhotic patients. Prophylactic treatment with beta blockers could be started undoubtedly respectively in 36.3, 41.8 and 28.6% of them as having large OV. Conclusion. Non-invasive means could be used to monitor cirrhotic patients and consider treatment in African regions lacking endoscopic facilities.

[Cholera epidemics in Mali between 1995 and 2004]. / Les epidémies de choléra au Mali de 1995 & 2004.

INTRODUCTION: Cholera represents a public health problem in developing countries like Mali. AIM: This work aims to describe the characteristics of the cholera epidemics which occurred in Mali between 1995 and 2004. METHOD: A retrospective survey was conducted within the Division of the fight against the diseases of epidemic potential and the Institute of Public Health and Research of the Ministry of Health of Mali. Individual medical records tracking the follow-up of patients as well as the registers of these structures were used as sources to collect data for the study. RESULTS: There were 12,176 cases of cholera recorded, including 1,406 deaths, from 1995 to 2004. Cholera outbreaks in Mali have been a regular occurrence every year since 2001. The regions of Mopti and Segou seem to be the most impacted by these epidemics. The lethal rates were higher than 1% at the time of each of these epidemics during this period. Vibrio cholerae O: 1, biotype El Tor were responsible for the epidemics, and the serotype Ogawa was prevalent. CONCLUSION: Cholera epidemics have been constant in Mali since the beginning of the 21st century in spite of the efforts which have been made to prevent and control them. A rigorous analysis of the factors which support this persistence and appropriate measures are essential to reverse cholera in this country.