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INTRODUCTION: Community-acquired acute bacterial pneumonia (ABP) is an acute, non-suppurative, non-tuberculosis lower respiratory infection of the lung parenchyma acquired within the community. They have an atypical clinical presentation and a poor prognosis in the elderly. MATERIALS AND METHODS: This was a prospective cross-sectional study conducted in the Pneumology department of the University Hospital Center (CHU) of Point-G, from October 30, 2018 to September 30, 2019. The objective was to determine the clinical, etiological, therapeutic and progression of BAP in the elderly. Were included any age ≥ 65 years, presenting clinical and radiological signs of a PAB. RESULTS: During the study period, 85 patients met the inclusion criteria out of 178 hospitalized. The sex ratio was 3/1. About 2/3 were smokers and 11% were HIV positive. Fever was not constant recorded in 51.76% of cases. Respiratory signs were dominated by cough (96.47%), dyspnea (94.11%) and extra respiratory by impaired consciousness. Klebsiella pneumoniae was the most found germ. The most commonly used antibiotic was amoxicillin-clavulanic acid. The average length of hospitalization was 9 days. Mortality was 19%. CONCLUSION: The PAB in the elderly is of a frustrating clinical symptomatology. It is serious with excess mortality.
INTRODUCTION: Les pneumopathies aiguës bactériennes (PAB) communautaires sont des infections respiratoires basses aiguës, non suppurées, non tuberculeuses du parenchyme pulmonaire acquises au sein de la communauté. Elles ont une présentation clinique atypique et un mauvais pronostic chez le sujet âgé. MATÉRIELS ET MÉTHODES: Il s'agissait d'une étude transversale prospective menée au service de pneumologie du centre hospitalier universitaire (CHU) du Point-G, du 30 Octobre 2018 au 30 Septembre 2019. L'objectif était de déterminer les particularités cliniques, étiologiques, thérapeutiques et évolutives de la PAB chez le sujet âgé. Ont été inclus tout âge ≥ 65 ans, présentant des signes cliniques et radiologiques d'une PAB. RÉSULTATS: Durant la période d'étude 85 patients répondaient aux critères d'inclusion sur 178 hospitalisés. Le sex-ratio était de 3/1. Environ 2/3 étaient tabagiques et 11% était positif au VIH. La fièvre n'était pas constante enregistrée dans 51,76% des cas. Les signes respiratoires étaient dominés par la toux (96, 47%), la dyspnée (94, 11%) et extra respiratoires par le trouble de la conscience. Le Klebsiellapneumoniae était le germe le plus retrouvé. L'antibiotique le plus utilisé était l'amoxicilline-acide clavulanique. La durée moyenne d'hospitalisation était de 9 jours. La mortalité était de 19%. CONCLUSION: La PAB chez le sujet âgé est d'une symptomatologie clinique frustre. Elle est grave avec une surmortalité.
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INTRODUCTION: Prison constitutes a risk factor for the emergence of multi-drug resistance of tuberculosis (MDR-TB). The aim of this work was to study MDR-TB in a black African carceral center. MATERIAL AND METHODS: Prospective study from January to December 2016 at the central house of arrest for men, Bamako. The study population was composed of tuberculous detainee. The suspicion of MDR-TB was done in any tuberculosis case remained positive in the second month of first-line treatment or in contact with an MDR-TB case. RESULT: Among 1622 detainee, 21 cases of pulmonary tuberculosis were notified (1.29%), with an annual incidence of 13 cases/1000 detainee, they were 16 cases of SP-PTB (microscopy smear positive tuberculosis) and five cases of microscopy smear negative tuberculosis. The mean age was 28±7 years, extremes of 18 and 46 years. A negative association was found between the notion of smoking and occupation in the occurrence of tuberculosis (OR=0.036, [95% CI: 0.03-0.04], P=0.03. Among the 21 tuberculosis cases notified, one confirmed case of MDR-TB was detected (4.7%). In the first semester of 2016 cohort, we notified a cure rate of 87.5% (7/8 SP-PTB cases), and the confirmed MDR-TB case on treatment (21-month regimen), evolution enameled of pulmonary and hearing sequelae at seven months treatment. CONCLUSION: It was the first case of MDR-TB detected in a prison in Mali. Late diagnosis, evolution is enameled of sequelae and side effects.
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Antituberculosos/uso terapêutico , Tuberculose Resistente a Múltiplos Medicamentos/etnologia , Tuberculose Pulmonar/etnologia , Adolescente , Adulto , Negro ou Afro-Americano , Humanos , Incidência , Masculino , Mali/epidemiologia , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Prisões/estatística & dados numéricos , Estudos Prospectivos , Fatores de Risco , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Tuberculose Pulmonar/tratamento farmacológico , Adulto JovemRESUMO
INTRODUCTION: The measures for people in specific situations such as prisoners are part of the Millennium Development Goals (MDGs). The objective of this study was to assess respiratory pathologies in a black African carceral center. METHODS: Retrospective study about the prevalence of respiratory pathologies in the arrest central house for men in Bamako (Mali), from May 2012 to April 2013. The admission records have served as data checking support on detainee's records. Statistical significance was investigated by the SAS 9.3 software with a threshold of 5%. RESULTS: Of 2740 admissions, 207 concerned respiratory pathologies (7.5%). All men, were of mean age 30±13 years (range 19-71). The respiratory diseases found were: pneumonia (33.8%), chronic bronchitis (26.6%), acute respiratory infection (14%), asthma (13.5%) and tuberculosis (5.3%). A definite diagnosis was made in 42% of cases. A tobacco intoxication was found in all age groups (CI 95%, R-square=0.01), without significant difference between the occurrence of cough in smoking and non-smoking men. CONCLUSION: According to their relative frequencies, the management of respiratory diseases requires collaboration between carceral health facilities and pneumological specialized services.
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População Negra/estatística & dados numéricos , Prisões/estatística & dados numéricos , Transtornos Respiratórios/epidemiologia , Adulto , África/epidemiologia , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Pneumologia/estatística & dados numéricos , Transtornos Respiratórios/etiologia , Estudos Retrospectivos , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Tuberculose/epidemiologia , Adulto JovemRESUMO
Tuberculoma of the cerebellum is a rare presentation of human tuberculosis and the presence of this disease in central nervous system in particular. We report the case of an immunocompetent 53 year old man who initially had an instability when walking, bitemporo-occipital headaches and insomnia, secondarily complicated state of agitation accepted into psychiatric care. The diagnosis was possible with MRI that revealed a mass in the cerebellar tonsil, not taking the contrast after gadolinium injection. The evolution under treatment for tuberculosis was positive. The control MRI performed at 15 months showed no more damage.
Le Tuberculome du cervelet est une présentation rarissime de la tuberculose humaine en général et de l'atteinte par cette maladie du système nerveux central en particulier. Nous rapportons le cas d'un homme de 53 ans immunocompétent qui présentait initialement une instabilité à la marche, des céphalées bitemporo-occipitales et une insomnie, compliquée secondairement d'état d'agitation prise en charge en psychiatrie. Le diagnostic a été possible grâce à l'IRM qui a mis en évidence une masse de l'amygdale cérébelleux, ne prenant pas le contraste après l'injection de gadolinium. L'évolution sous traitement antituberculeux a été favorable. L'IRM de contrôle réalisée à 15 mois ne montrait plus de lésion.
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INTRODUCTION: The well-digger is a craftsman who hollows wells often manually; this trade can be source of inhalation of the particles of silica. The whole of the radio clinical signs linked to this profession is known under the term "Well-digger's lung". The goal was to study the radio clinical aspects and progression in black African's pulmonological environment. METHODS: Retrospective and descriptive study concerning the respiratory involvement of well-diggers in the Pulmonology service of the Teaching Hospital of Bamako, from January 2001 to December 2010. The admission registers were used as data verification support. RESULTS: Among 4158 admissions for lung affection, we have collected 39 cases of well-digger's lung (0.9%), all young male adults. The average of exposition period was 13 ± 9 years, correlated to the patient's age (p<0.001). The principal reason of consultation was dyspnea (94.8%). The complications were frequent (cardiac, infectious, pleural). The radiological pictures were made of bilateral big opacities associated with small opacities. The evolution was unfavorable in the majority of the cases. CONCLUSION: The well-digger's lung is a young adult pneumoconiosis linked to the inhalation of the particles of silica during the trade (profession) of well-digger that complicates frequently in chronic respiratory insufficiency.
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Doenças Profissionais/epidemiologia , Pneumoconiose/epidemiologia , Poços de Água , Adolescente , Adulto , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Mali/epidemiologia , Pessoa de Meia-Idade , Doenças Profissionais/diagnóstico por imagem , Doenças Profissionais/terapia , Pneumoconiose/diagnóstico por imagem , Pneumoconiose/etiologia , Pneumoconiose/terapia , Radiografia Torácica , Estudos Retrospectivos , Dióxido de Silício/toxicidade , Poços de Água/química , Adulto JovemRESUMO
INTRODUCTION: Pleurisy represents a worrying situation because of the difficulty of aetiological diagnosis. The aim of this study was to evaluate the contribution of pleural puncture biopsy (PPB) in the diagnosis of pleurisy. METHODS: A prospective study of the contribution of the pleural puncture biopsy in the pulmonary service of Bamako (Mali) from 2005 to 2009. PPB was used in the investigation of exudative, non-purulent pleurisy of unknown aetiology. Castelin biopsy forceps were used. RESULTS: Pleurisy was the reason for 20% of the total admissions of 6374 patients. The PPB was performed in 390 patients or 30.6% of the cases of pleurisy. The HIV test was performed in 341 patients (87.4%), of whom 72 cases (21.1%) were positive. The pleural biopsies were: lymphocytic (68.7%), mixed cellular (17.1%). Histological interpretation was possible in 367 biopsy specimens, a yield of 94.1%. Tuberculous granulomata were found in 65.1% with a close relationship to HIV status (P<0.004). Pleural cancer was found in 16.1%. CONCLUSION: The PPB is easy to perform at a low cost. It permits the diagnosis of tuberculous and neoplastic pleurisy, particularly in low income countries with a high prevalence of TB/HIV.
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Biópsia por Agulha , Pleurisia/diagnóstico , Tuberculose Pleural/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/efeitos adversos , Biópsia por Agulha/economia , Biópsia por Agulha/métodos , Comorbidade , Países em Desenvolvimento , Doenças Endêmicas , Feminino , Infecções por HIV/epidemiologia , Humanos , Linfócitos/patologia , Masculino , Mali/epidemiologia , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico , Derrame Pleural/epidemiologia , Derrame Pleural/patologia , Derrame Pleural Maligno/diagnóstico , Derrame Pleural Maligno/epidemiologia , Derrame Pleural Maligno/patologia , Neoplasias Pleurais/diagnóstico , Neoplasias Pleurais/epidemiologia , Neoplasias Pleurais/patologia , Pleurisia/epidemiologia , Pleurisia/patologia , Pneumotórax/etiologia , Estudos Prospectivos , Método Simples-Cego , Tuberculoma/diagnóstico , Tuberculoma/epidemiologia , Tuberculoma/patologia , Tuberculose Pleural/epidemiologia , Tuberculose Pleural/patologia , Adulto JovemRESUMO
UNLABELLED: The spinal tuberculosis or Pott's disease is the most common form of osteoarticular tuberculosis in countries with high prevalence of tuberculosis and HIV / AIDS, but the definitive diagnosis remains difficult. The aim of this work was to study the epidemiological, clinical, radiological and evolutionary aspects of Pott's disease in the absence of evidence bacteriologically and histologically. METHOD: This is a retrospective study focused on records collected in the service of pneumo-phtisiology UHC of Point G, January 2005-December 2009. Were selected, all folders with the probable diagnosis of spinal tuberculosis and whose antibiotic treatment was instituted. RESULTS: In total, 178 cases of Pott's disease were reported on 3560 cases of tuberculosis all forms 5%, with an average of 35 ± 6 cases per year. We noted a male predominance (102 men against 76 women) with a sex ratio of 1.3. The average age of patients was 41 ± 15 years. Signs regularly found with their high frequencies more than 80% are impaired general condition, tiredness, vesperal fever, inflammatory spinal pain, elevated velocity settling, spondylodiscitis, back to the apyrexia, improving general health. HIV serology was positive in 5.2% of 152 patients tested. CONCLUSION: Pott's disease is increasing gradually. The diagnosis is often very presumptive. Also, must you know the time to start TB treatment, for minimizing the post-treatment sequelae.