[Analysis of national leprosy surveillance data in Mauritania from 2009 to 2019]. / Analyse des données nationales de surveillance de la lèpre en Mauritanie de 2009 à 2019.

Introduction: Leprosy is a chronic infectious disease that mainly affects the skin, mucous membranes and the peripheral nervous system. Its elimination as a public health problem seems to lead to its ignorance and therefore to a risk of late diagnosis. An analysis of leprosy surveillance data in Mauritania was conducted to determine epidemiological trends and clinical forms of reported cases. Material and method: The retrospective study was based on the epidemiological records of leprosy in Mauritania from 2009 to 2019. The diagnosis of leprosy was made on the basis of the diagnostic criteria of the World Health Organization (WHO). Data were analyzed using Epi Info version 7.2.5.0. The frequencies, proportions, and rates were calculated. Results: Over the past 11 years, 164 cases have been notified. Among the notified cases, 96/164 (58.5%) were males and 68/164 (41.5%) females, with a sex ratio of 1.4. The mean age (± standard deviation) was 44.0 ± 17.1 years [range, 9 - 86 years], and the median was 45 years [interquartile range, 32.5; 57.5]. Children under the age of 16 accounted for 9/164 (5.5%). The wilayas (i.e. "regions") of Nouakchott were the most endemic regions in the country. The multibacillary form (MB) represented 109/164 (66.5%) cases among the observed clinical forms. The average annual incidence was 0.3 case/100,000 population for MB and 0.1 case/100,000 for PB (paucibacillary). All reported cases were treated with multidrug therapy. Conclusion: The results of leprosy surveillance showed a persistence of this disease in Mauritania. It is necessary to relaunch leprosy services at all levels in order to continue to reduce the morbidity associated with this disease, and eventually eliminate it from the country.

Investigation Around Cases of Crimean-Congo Hemorrhagic Fever-Mauritania, 2022.

Background: Crimean-Congo hemorrhagic fever (CCHF) is a zoonotic arbovirosis. Humans are infected by tick bites or contact with blood of infected animals. CCHF can be responsible for severe outbreaks due to human-to-human transmission. Our aims were to increase awareness and promote the search for risk factors and disease monitoring to prevent CCHF epidemic, capacity building, appropriate measures to treat patients, and information for the local population. Methods: During the outbreak of hemorrhagic fever from February to May 2022, blood samples were collected from 88 patients suspected to be infected with the virus. Diagnosis was established by reverse-transcription polymerase chain reaction (RT-PCR) and/or enzyme-linked immunosorbent assay. Results: CCHF was confirmed by RT-PCR in 7 of 88 (8%) patients. Ticks were found in cattle, sheep, or goats in the areas where the subjects resided, with the exception of 1 CCHF-positive patient in close contact with fresh animal meat. Exposure to potential risk factors was found in all patients. The interval between the onset of symptoms and hospital admission was 2-3 days. All 7 patients were admitted to our hospital and treated promptly by blood transfusion. Two patients died. Conclusions: Mortality is high in patients with the hemorrhagic form of CCHF. Disease prevention is necessary by strengthening vector control, avoiding contact and consumption of organic products from diseased animals, and vaccinating animals in areas where the disease is endemic. Furthermore, it is essential to establish management procedures for patients infected with CCHF virus.

Diagnosis and management of rabies encephalitis in two patients in northwest Africa: A case series.

In persons bitten by a stray dog, prompt administration of post-exposure rabies vaccination, anti-rabies immunoglobulin, and wound care can save lives. However, rabies is often fatal once the patient develops signs and symptoms. Here, we describe two fatal cases of rabies following a long delay after dog bites.

Management of COVID-19 infection in patients undergoing hemodialysis.

Coronavirus disease 2019 (COVID-19), a pandemic affecting the world's population, is particularly threatening to dialysis patients. The purpose of this study was to propose recommendations for prevention and containment of COVID-19 in hemodialysis center situated in a regional hospital in Mauritania. Both COVID-19-infected (n = 11) and -uninfected (n = 16) dialysis patients were hospitalized up to three weeks to improve patient management. All COVID-19-infected patients were cured. Patient care and hygiene in a safe environment are the key factors for a favorable outcome, even in resource-limited settings.

Molecular Epidemiology of G6PD Genotypes in Different Ethnic Groups Residing in Saharan and Sahelian Zones of Mauritania.

Plasmodium vivax malaria is endemic in Mauritania. Individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency may develop acute hemolytic anemia when exposed to 8-aminoquinoline antimalarial drugs, which are indispensable for a complete cure. The prevalence of G6PD allelic variants was assessed in different ethno-linguistic groups present in Mauritania. A total of 996 blood samples (447 males and 549 females; 499 white Moors and 497 individuals of black African ancestry) were collected from febrile patients in 6 different study sites: Aleg, Atar, Kiffa, Kobeni, Nouakchott, and Rosso. The presence of the African-type G6PD A- (G202A, A376G, A542T, G680T, and T968C mutations) and the Mediterranean-type G6PD B- (C563T) variants was assessed by PCR followed by restriction fragment length polymorphism and/or DNA sequencing. The prevalence of African-type G6PD A- genotype was 3.6% (36/996), with 6.3% (28/447) of hemizygote (A-) males and 1.5% (8/549) of homozygous (A-A-) females. Forty of 549 (7.3%) women were heterozygous (AA-). The following genotypes were observed among hemizygous men and/or homozygous women: A376G/G202A (22/996; 2.2%), A376G/T968C Betica-Selma (12/996; 1.2%), and A376G/A542T Santamaria (2/996; 0.2%). The Mediterranean-type G6PD B- genotype was not observed. The prevalence rates of G6PD A- genotype in male (10/243; 4.1%) and heterozygous female (6/256; 2.3%) white Moors were lower (p < 0.05) than those of males (18/204; 8.8%) and heterozygous females (34/293; 11.6%) of black African ancestry. There were only a few homozygous women among both white Moors (3/256; 1.2%) and those of black African ancestry (5/293; 1.7%). The prevalence of G6PD deficiency in Mauritania was comparable to that of neighboring countries in the Maghreb. Because of the purportedly close ethnic ties between the Mauritanian white Moors and the peoples in the Maghreb, further investigations on the possible existence of the Mediterranean-type allele are required. Moreover, a surveillance system of G6PD phenotype and/or genotype screening is warranted to establish and monitor a population-based prevalence of G6PD deficiency.

Clinical Features and Mortality Associated with Severe Malaria in Adults in Southern Mauritania.

Severe malaria in adults is not well-studied in Sahelian Africa. Clinical features and mortality associated with severe Plasmodium falciparum malaria in adult patients hospitalized in Kiffa, southern Mauritania, were analysed. Patients over 15 years old admitted for severe malaria between August 2016 and December 2019 were included in the present retrospective study. The World Health Organization (WHO) criteria were used to define severe malaria. The presenting clinical characteristics and outcome were compared. Of 4266 patients hospitalized during the study period, 573 (13.4%) had a positive rapid diagnostic test for malaria, and 99 (17.3%; mean age, 37.5 years; range 15-79 years; sex-ratio M/F, 2.1) satisfied the criteria for severe malaria. On admission, the following signs and symptoms were observed in more than one-fourth of the patients: fever (98%), impairment of consciousness (81.8%), multiple convulsions (70.7%), cardiovascular collapse (61.6%), respiratory distress (43.4%), severe anaemia ≤ 80 g/L (36.4%), haemoglobinuria (27.3%), and renal failure (25.3%). Patients were treated with parenteral quinine or artemether. Fourteen (14.1%) patients died. Multiple convulsions, respiratory distress, severe anaemia, haemoglobinuria.

Crimean-Congo Hemorrhagic Fever, Mauritania.

The distribution of Crimean-Congo hemorrhagic fever (CCHF), a tickborne arboviral disease, is not well known in West Africa. We report 2 recent human cases of CCHF with infectious syndrome and severe bleeding in Mauritania. CCHF was diagnosed by ELISA and real time reverse transcription PCR. No secondary CCHF cases were found.

Miliary tuberculosis and acute respiratory distress syndrome.

BACKGROUND: Miliary tuberculosis is a serious and uncommon form of tuberculosis due to hematogenous dissemination of Mycobacterium tuberculosis. OBJECTIVE: This study aimed to describe the epidemiological and clinical features of miliary tuberculosis. PATIENTS AND METHODS: Data were collected from clinical files between August 2016 and July 2018. RESULTS: In 2 years, 24 cases were recorded, representing a proportional morbidity of 13%. Among them, 71% were smokers and 38% had diabetes. The presence of a BCG vaccination scar was observed in 2 patients (8%). Human immunodeficiency virus (HIV) serology was positive in 4 cases (17%). The symptomatology was dominated by: fever (100%), cough (83%), and chest pain (79%). Radiological images with micronodular opacities were the most common (54%), followed by macronodular densities (33%), and reticulonodular densities (13%). The evolution was favorable in 77%, with no patient lost to follow-up, but 7/24 (29%) died, either before the initiation of therapy (n = 2) or during therapy (n = 5). CONCLUSION: Miliary tuberculosis is an acute and severe form of life-threatening tuberculosis. It requires a prompt and accurate diagnosis and treatment. An improved accessibility to early diagnosis and treatment and prevention of TB infection should reduce its prevalence.

Contribution of Computed Tomography Scan to the Diagnosis of Spinal Tuberculosis in 14 Cases in Assaba, Mauritania.

BACKGROUND: The incidence of tuberculosis has increased in recent years in both developed and developing countries. OBJECTIVE: This retrospective study aimed to review all cases of spinal tuberculosis diagnosed at the Department of Internal Medicine and Infectious Diseases in Kiffa Regional Hospital and assess the role of computed tomography (CT) scan in establishing definite diagnosis. PATIENTS AND METHODS: Data were collected from clinical records of patients admitted to the hospital for rachialgia between August 2016 and July 2018. RESULTS: Fourteen (12.2%) adults with spinal tuberculosis were found among 115 patients with all forms of tuberculosis during the study period. The mean (± standard deviation) age of our patients was 47.5 ± 22.0 years old with male:female (8/6) sex ratio of 1.3. The mean duration of evolution of the disease was 15 months. The presenting signs and symptoms included rachialgia in most patients (93%), associated with segmental spinal stiffness (50%) and/or neurological complications (50%). Diagnosis was established on the basis of clinical history, clinical examination, standard vertebral column radiography, and CT scan. Vertebral imaging showed a clear predominance of lumbar lesions (57%), followed by dorsal (36%) and cervical (7%) involvement. The evolution under treatment was favorable, with the exception of two cases of medullary compression. CONCLUSION: Spinal tuberculosis is the most common form of osteoarticular tuberculosis. It affects predominantly lumbar and dorsal vertebrae. In the absence of histological confirmation, the presence of back pain associated with major radiological signs of spondylosis disc disease seems to justify the use of CT scan to confirm the diagnosis of this pathology.

Two Cases of Delayed Diagnosis of Leprosy in Mauritania.

Leprosy is a chronic infectious disease that mainly affects the skin, mucous membranes, and peripheral nervous system. The clinical manifestations of leprosy are numerous and polymorphic with the most frequent signs involving skin and neurological damage. Some of its manifestations, such as joint pain, are unusual. Its elimination as a public health problem in many countries seems to lead to a lack of practical knowledge among health care personnel and as a consequence a risk of late diagnosis. As in other countries, leprosy has become rare in Mauritania. We report two cases of misdiagnosed leprosy in two male patients aged 17 and 65 years. Clinical manifestations included polyarthritis, bilateral plantar perforation, and severely deformed hands and feet in the first case and lichenoid lesions, hypopigmented papules, and unilateral bronchial rales in the second case. The duration of development and persistence of clinical signs before establishment of correct diagnosis was seven to ten years despite the presence of anesthetic, hypochromic maculopapular skin lesions and neurologic signs suggestive of leprosy in both cases. A multilevel chemotherapeutic regimen recommended by the World Health Organization (WHO) was effective, and the patients' condition evolved satisfactorily. The scarcity of leprosy in our health care facilities often leads to a wrong diagnosis. It is imperative to inform physicians to increase their vigilance for appropriate screening and reporting of these cases. The prognosis depends largely on early diagnosis and appropriate treatment.

Generalized tetanus in adults without antitetanus booster vaccination in southern Mauritania.

Tetanus has become rare in countries with high levels of vaccination coverage and hygiene but may still occur in adults without booster vaccination. In addition to the expanded program on immunization for children and maternal immunization against neonatal tetanus, a systematic vaccination of the population, including boosters, is recommended.

Forms of Stigma and Discrimination in the Daily Lives of HIV-Positive Individuals in Mauritania.

SUMMARY: People living with HIV/AIDS (PLWHA) are often discriminated against in their daily lives. The objective of this descriptive and transversal study was to describe the experiences of PLWHA followed at a specialized outpatient center in Nouakchott to assess the forms of stigma from the perspective of those who suffer from discrimination. METHODS: All HIV-positive patients over the age of 18 years who were aware of their HIV status and provided consent to participate in the study were included from June 1 to 29, 2015. Data collection was conducted using a pre-tested questionnaire. RESULTS: A total of 210 PLWHA were interviewed. Men accounted for 54% of the sample population with a sex ratio of 1.2. About half of respondents were married (51%) and resided in Nouakchott (55%). Subjects who had never attended school represented 42% of the cases. Among our respondents, 64% knew their HIV status for over a year and admitted that they refused to reveal this information to any person. The distribution of forms of stigma experienced by PLWHA by demographic category was, in descending order, stigma in interpersonal relationships (78%), self-stigma (20%), and stigma in health services (2%). There was a significant association between the form of stigma and marital status (p = 0.007) and between the form of stigma and knowledge of HIV status for a period greater than one year (p = 0.02). CONCLUSION: The forms of stigma can be sources of discrimination and are a major obstacle to reintegration and support of PLWHA. This creates a vicious circle that, on the one hand, leads to the suffering, marginalization, and isolation of PLWHA, and on the other hand, has deleterious effects on their family and social relationships, self-esteem and self-confidence.

Estimation of seroprevalence of HIV, hepatitis B and C virus and syphilis among blood donors in the hospital of Aïoun, Mauritania.

INTRODUCTION: To estimating the seroprevalence of HIV, hepatitis B, hepatitis C and syphilis among blood donors in the Aïoun hospital. METHODS: This is a retrospective study from 1 January 2010 to 31 December 2015. RESULTS: On the five-year study period, 1,123 donors were collected. Of these, 182 were HIV-positive, an overall prevalence of 16.2% with predominance in male with a sex ratio Man/Woman of 5.2. The average age of donors was 32.7 ± 10 years (range 17-73 years). The most represented that age group 21-30 years (40.5%). The seroprevalence found were 1.2% for HIV, 11.8% for HBV, HCV 0.2% and 3% for syphilis. Co-infection was found in 0.7% of which 0.5% of dual HIV HBV/Syphilis and 0.2% in HBV/HIV. CONCLUSION: The transmission of infectious agents related to transfusion represents the greatest threat to transfusion safety of the recipient. Therefore, a rigorous selection and screening of blood donors are highly recommended to ensure blood safety for the recipient.

Severe Human Illness Caused by Rift Valley Fever Virus in Mauritania, 2015.

BACKGROUND: Rift Valley Fever epizootics are characterized by numerous abortions and mortality among young animals. In humans, the illness is usually characterized by a mild self-limited febrile illness, which could progress to more serious complications.Objectives. The aim of the present prospective study was to describe severe clinical signs and symptoms of Rift Valley Fever in southern Mauritania. PATIENTS AND METHODS: Suspected cases were enrolled in Kiffa (Assaba) and Aleg (Brakna) Hospital Centers from September 1 to November 7, 2015, based on the presence of fever, hemorrhagic or meningoencephalitic syndromes, and probable contact with sick animals. Suspected cases were confirmed by enzyme-linked immunosorbent assay (ELISA) and reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: There were thirty-one confirmed cases. The sex ratio M/F and the average age were 2.9 and 25 years old [range, 4-70 years old], respectively. Mosquito bites, direct contact with aborted or dead animals, and frequent ingestion of milk from these animals were risk factors observed in all patients. Hemorrhagic and neurological manifestations were observed in 81% and 13% of cases, respectively. The results of laboratory analysis showed high levels of transaminases, creatinine, and urea associated with thrombocytopenia, anemia, and leukopenia. All patients who died (42%) had a hemorrhagic syndrome and 3 of them had a neurological complication. Among the cured patients, none had neurologic sequelae. CONCLUSION: The hemorrhagic form was the most common clinical manifestation of RVF found in southern Mauritania and was responsible for a high mortality rate. Our results justify the implementation of a continuous epidemiological surveillance.

Acute kidney injury in a shepherd with severe malaria: a case report.

Malaria is one of the main reasons for outpatient consultation and hospitalization in Mauritania. Although four Plasmodium species, ie, Plasmodium (P.) falciparum, P. vivax, P. malariae, and P. ovale, cause malaria in Mauritania, recent data on their frequency is lacking. Since infections with P. falciparum generally result in serious disease, their identification is important. We report a case of oliguric renal injury associated with malaria in a 65-year-old shepherd. Clinical manifestations included anemia, oliguria, and elevated creatinine and urea. The rapid diagnostic test for malaria and microscopic examination of blood smears were positive for P. falciparum. On the basis of this, the patient was diagnosed as having acute kidney injury as a complication of severe malaria. The patient was treated for malaria with intravenous quinine for 4 days, followed by 3 days of oral treatment. Volume expansion, antipyretic treatment, and diuretics were administered. He also had two rounds of dialysis after which he partially recovered renal function. This outcome is not always the rule. Prognosis depends much on early diagnosis and appropriate supportive treatment.

[Severe hemorrhagic forms of Rift Valley fever: about 5 cases]. / Formes hémorragiques graves de la fièvre de la vallée du Rift: à propos de 5 cas.

Rift Valley fever (RVF) is an arbovirus caused by an RNA virus belonging to family Bunyaviridae (genus phlebovirus). It is a zoonosis that primarily affects animals but it also has the capacity to infect humans, either by handling meat, runts of sick animals or, indirectly, by the bite of infected mosquitoes (Aedes sp, Anopheles sp, Culex sp). In most cases, RVF infection in humans is asymptomatic, but it can also manifest as moderate febrile syndrome with a favorable outcome. However, some patients may develop hemorrhagic syndrome and/or neurological damages with a fatal evolution. We present a case study of the development of 5 patients with RVF associated with hemorrhagic fever syndrome admitted to the internal medicine department at National Hospital Center in Nouakchott (Mauritania), in October 2015. The outcome was favorable for two of the five patients. The other 3 died, two of hemorrhagic shock and one of septic shock.

[Hemorrhagic form of dengue fever observed at the Infectious Diseases Department CHU Yalgado Ouédraogo, Burkina Faso]. / Formes hémorragiques de Dengue observées dans le service des maladies infectieuses du CHU Yalgado Ouédraogo, Burkina Faso.

Dengue is a re-emerging arboviral disease in tropical countries. Haemorrhagic form may be associated with circulatory failure and produce hypovolemic shock, which is often fatal. We report a series of three cases of hemorrhagic dengue observed at the Infectious Diseases Department CHU Yalgado Ouédraogo, Ouagadougou, in order to describe its epidemiological, clinical, and evolutive characteristics. Our study included young females who had an onset age of between 35 years and 45 years, residing in the city of Ouagadougou. Despite multiple concentrated platelets transfusions and symptomatic treatment, we mourned a death. The development of antivirals and of new vaccines is a silver lining to prevent dengue lethality.

Emerging role of Raoultella ornithinolytica in human infections: a series of cases and review of the literature.

BACKGROUND: Raoultella ornithinolytica is known to inhabit aquatic environments. The clinical features and outcomes of human infections caused by R. ornithinolytica have been reported for only a limited number of cases. METHODS: A retrospective study of cases of infection caused by R. ornithinolytica managed at four university hospital centres during the period before and after the introduction of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) was performed. The aim was to describe the clinical and microbiological characteristics, treatments, and outcomes. RESULTS: Among 187 R. ornithinolytica isolates identified for which clinical information was available, 71 were considered colonizers and 116 were pathogenic. A total of 112 cases of R. ornithinolytica infection were identified. Urinary tract infections, gastrointestinal infections, wound and skin infections, and bacteraemia were observed in 36%, 14%, 13%, and 5% of cases, respectively. Associated infections that have been poorly reported, such as respiratory infections, i.e. pneumonia and pleural effusion, were observed in 24% of cases. Additional diseases reported here for the first time included osteomyelitis, meningitis, cerebral abscess, mediastinitis, pericarditis, conjunctivitis, and otitis. The proportion of R. ornithinolytica isolates resistant to antibiotics was found to be relatively high: 4% of isolates were resistant to ceftriaxone, 6% to quinolones, and 13% to co-trimoxazole. The mortality rate related to infection was 5%. CONCLUSIONS: R. ornithinolytica is an underreported, emerging hospital-acquired infection and is particularly associated with invasive procedures. R. ornithinolytica should never be considered simply a saprophytic bacterium that occasionally contaminates bronchial lavage or other deep respiratory samples or surgical sites. Physicians should be aware of the high rates of antimicrobial resistance of R. ornithinolytica isolates so that immediate broad-spectrum antibiotic treatment can be established before accurate microbiological results are obtained.