Characterization of New Races of Xanthomonas oryzae pv. oryzae in Mali Informs Resistance Gene Deployment.

Bacterial leaf blight caused by Xanthomonas oryzae pv. oryzae represents a severe threat to rice cultivation in Mali. Characterizing the pathotypic diversity of bacterial populations is key to the management of pathogen-resistant varieties. Forty-one X. oryzae pv. oryzae isolates were collected between 2010 and 2013 in the major rice growing regions in Mali. All isolates were virulent on the susceptible rice variety Azucena; evaluation of the isolates on 12 near isogenic rice lines, each carrying a single resistance gene, identified six new races (A4 to A9) and confirmed race A3 that was previously reported in Mali. Races A5 and A6, isolated in Office du Niger and Sélingué, were the most prevalent races in Mali. Race A9 was the most virulent, circumventing all of the resistance genes tested. Xa3 controlled six of seven races (i.e., 89% of the isolates tested). The expansion of race A9 represents a major risk to rice cultivation and highlights the urgent need to identify a local source of resistance. We selected 14 isolates of X. oryzae pv. oryzae representative of the most prevalent races to evaluate 29 rice varieties grown by farmers in Mali. Six isolates showed a high level of resistance to X. oryzae pv. oryzae and were then screened with a larger collection of isolates. Based on the interactions among the six varieties and the X. oryzae pv. oryzae isolates, we characterized eight different pathotypes (P1 to P8). Two rice varieties, SK20-28 and Gigante, effectively controlled all of the isolates tested. The low association observed among races and pathotypes of X. oryzae pv. oryzae suggests that the resistance observed in the local rice varieties does not simply rely on single known Xa genes. X. oryzae pv. oryzae is pathogenically and geographically diverse. Both the races of X. oryzae pv. oryzae characterized in this study and the identification of sources of resistance in local rice varieties provide useful information to inform the design of effective breeding programs for resistance to bacterial leaf blight in Mali.

[Mortality and morbidity of tetanus in the infectious diseases department, Point G teaching hospital, in Bamako, Mali (2004-2009)]. / Morbidité et mortalité du tétanos dans le service de maladies infectieuses du CHU du Point G à Bamako, Mali (2004-2009).

Our study objectives were to determine annual cases of the tetanus and to describe its clinical, evolutionary and prognostic aspects. It was a transverse study from data records and medical records of patients aged 15 years and above hospitalized for tetanus in the service of infectious diseases of the Point G CHU from January 1, 2004 to December 31, 2009. The tetanus was diagnosed based on clinical (trismus, dysphagia, seizures and point consecutive to an injury) and epidemiological arguments (absence of a correct tetanus immunization, entry way). We collected a total of 119 cases of tetanus out of 1,839 hospitalizations making a prevalence of 6.5%. The hospitalization period was 5 days (73%) for most of the patients. Unskilled laborer and farmers were the most frequent with respectively 30.2 and 21.8% of cases. Tetanus occurred in the course of a traumatic road accident (16%) and from other traumatic causes (48.7%). The clinical form was a generalized type for 94.4% of the cases. A wound was the entry way for 64.7% of the patients. The entry way was located on the lower members 49.6% of the time. The co-morbidity was recorded with infection by Plasmodium falciparum (15 cases, 12.6%) and HIV (1 case). Hospital lethality was 46.2%. The death was statistically linked to clinical severity according to the Dakar score (P = 0.0005) and the Mollaret stage (P = 0.0001). A need for strengthening communication for behaviour change for the gaining of a correct and sustained immunization exists. A strategy based on the capacity building for a rapid tetanus diagnosis and a combined co-morbidities care may reduce the lethality in the context of our limited technical environment.

[Role Of Imaging In The Management Of A Case Of Intrauterine Device Migration]. / Role De L'imagerie Dans La Prise En Charge D'un Cas De Migration De Dispositif Intra-Uterin.

We report a case of intrauterine device (IUD) migration in order to describe the contribution of imaging in its diagnosis. It was a 35-year-old woman received on 06/01/2018 for pelvic ultrasound for pelvic pain. Ultrasound examination revealed a hyperechoic right para-uterine tubular image. A hysterosalpingography revealed an IUD in the pelvis in extra-urine position. Surgical extraction was done without complications. Intrauterine device migration is rare in our context. The radiological means make it possible to specify its topography.

Nous rapportons un cas de migration de dispositif intra-utérin (DIU) dans le but de décrire l'apport de l'imagerie dans son diagnostic. Il s'agissait d'une dame de 35 ans reçue le 01/06/2018 pour une échographie pelvienne dans le bilan d'une douleur pelvienne. L'exploration échographique a objectivé une image hyperéchogène tubulaire para-utérine droite. Une hystérosalpingographie avait objectivé un DIU dans le bassin en position extra-urine. Uneextraction chirurgicale a été faite avec des suites simples. La migration de dispositif intra-utérin est rare dans notre contexte. Les moyens radiologiques permettent de préciser sa topographie.

[Progressive myoclonic epilepsy in the department of neurology of the University Teaching hospital Point "G"]. / EPILEPSIES MYOCLONIQUES PROGRESSIVES AU SERVICE DE NEUROLOGIE DU CENTRE HOSPITALIER UNIVERSITAIRE DU POINT "G".

Background: Progressive Myoclonic Epilepsy (PME) is a heterogeneous group of pathologies associating epileptic seizures and other neurological and non-neurological disorders. Objectives: We aim to characterize patients with symptoms of PME and identify the underlying genetic disorder. Methods: After informed consent, the patients seen in the protocol for hereditary neurological diseases and presenting signs of epilepsy without a secondary cause were clinically evaluated over a three-year period in the Department of Neurology of the CHU Point "G". EEG, brain imaging and laboratory tests were performed to consolidate our diagnosis. DNA was extracted for genetic analysis. Results: 141 families including five families with PME totaling eight cases were enrolled. The predominant symptoms in our patients were myoclonus in 87.5% (N = 8), followed by GTCS and cognitive impairment in 50%, each. A notion of parental consanguinity was found in 60% and autosomal recessive transmission evoked in 80% (N = 5). The EEG was pathological in 62.5% and imaging showed ponto-cerebellar atrophy in 25% (N = 8). The combination of sodium valproate and clonazepam was the main treatment. One case of death was recorded. Conclusion: We report cases of PME in Mali with a possibility of discovering new genes.

Clinical, paraclinical and genetic aspects of autosomal recessive cerebellar ataxias (ARCA) in Mali.

Introduction: Autosomal recessive cerebellar ataxias (ARCA) are a group of rare and heterogynous neurodegenerative diseases mainly characterized by unbalance and walking difficulty and movement incoordination. Objectives: To clinically and paraclinically characterize ARCA in the department of Neurology at the Teaching Hospital of Point G and identify the underlying genetic defect. Patients and method: We have conducted a longitudinal and prospective study from January 2018 to December 2020. Patients with ARCA phenotype seen in the Department of Neurology at the Teaching Hospital of Point "G" were enrolled. Results: We have enrolled 7 families totaling 13 patients after giving an informed verbal and written consent. The sex ratio was 2.2 in favor of males, Kayes region and Fulani ethnic group were respectively the most represented region and ethnic group.Walking difficulty represented the major symptom followed by loss of vibration and joint sense, nystagmus, dysarthria and skeletal deformities. Alpha-foetoprotein level was high in one patient. Genetic testing confirmed Friedreich ataxia in one family and was not conclusive in 4 families. Conclusion: This study showed that ARCA are not uncommon in Mali and genetic testing is crucial to confirm the diagnosis.

Introduction: Les ataxies cérébelleuses autosomiques récessives (ACAR) constituent un groupe de maladies neurodégénératives rares et hétérogènes caractérisées essentiellement par un trouble de l'équilibre et de la marche, et un trouble de la coordination des mouvements. Objectifs: Caractériser les signes cliniques, paracliniques et génétiques des ataxies cérébelleuses autosomiques récessives au Service de Neurologie du CHU du Point "G". Patients et méthodes: Nous avons réalisé une étude de cas enrôlé dans le cadre d'une étude longitudinale et prospective allant de Janvier 2018 à Décembre 2020, portant sur des patients présentant des symptômes d'ACAR et ayant donné leur consentement éclairé. Résultats: Nous avons enrôlé sept familles totalisant 13 patients. Le sexe ratio était de 2,2 en faveur des hommes, la région de Kayes était la plus représentée et l'ethnie peulh était majoritaire. Les troubles de la marche ont représenté les signes majeurs suivis de troubles de la sensibilité profonde, de nystagmus, de dysarthrie, et des déformations ostéoarticulaires. L'alpha-foetoprotéine était élevée chez une patiente. Le test génétique a retrouvé l'ataxie de Friedreich dans une famille et n'a pas été concluant dans quatre autres. Conclusion: Cette étude montre que les ACAR ne sont pas rares au Mali et l'exploration génétique constitue un outil indispensable pour leur diagnostic de certitude.

[Neuromeningeal cryptococcosis in Mali]. / La cryptococcose neuro-méningée au Mali.

Cryptococcal meningitis is the most common fatal central nervous system infection in AIDS patients in Sub-Saharan Africa. The purpose of this prospective study conducted from March 2003 to February 2004 in the internal medicine and infectious diseases departments of the Point G University Hospital Center was to investigate the clinical, prognostic and epidemiological profile of Cryptococcus neoformans infection in patients hospitalized for brain and meningeale infection (BMI). Diagnosis of neuromeningeal cryptococcosis (NMC) was based on positive identification of Cryptococcus by direct exam of the cebrospinal fluid (CSF) after India ink staining and/or culture on Sabouraud medium without actidione. During the study period, a total of 569 patients were hospitalized including 235 (41.3%) with HIV infection. Overall C. neoformans was identified in 14 patients. Median patient age was 39 +/- 8 years. There was a male preponderance with a sex ratio of 1.8 (9 men/5 women). Patients with BMI were HIV-positive in 85.7% of cases (n=12) and HIV-negative in 14.3% (n=2). The overall and HIV-specific prevalence of BMI was 2.5% and 5.1% respectively. The CD4 lymphocyte count was between I and 49 cells/mm3 in 64.3% of cases. The main clinical symptoms were cephalea in 85.7% of cases, altered consciousness in 50% and nausea/vomiting in 35.7%. Neurological manifestations (hemiparesis and cranial nerve deficit) were noted in 14.3%. HIV infection is the main purveyor of NMC in Mali. The actual incidence of cryptococcosis is unclear due to the poor sensitivity of diagnostic techniques. This study highlights diagnostic difficulties related to clinical polymorphism and poor technical facilities. Agglutination testing of blood and CSF is recommended, but mortality remains.

[Clinical and laboratory features of recessive Limb Girdle Muscular dystrophies in the Department Neurology of University Hospital of Point G]. / Aspects Cliniques et Paracliniques des Myopathies des Ceintures Récessives au Service de Neurologie du CHU Point G.

INTRODUCTION: Limb-Girdle Muscular dystrophies (LGMD) is a group of inherited diseases characterized by predominantly proximal and limb muscle weakness. These are rare diseases that have not been well studied in sub-saharan Africa. The aim of our was the clinical and paraclinical characterization of patients with recessive LGMD at the Department of Neurology of the Teaching Hospital of Point G. PATIENTS AND METHODS: We conducted a longitudinal prospective study which took place from March 2014 to May 2019. Patients with recessive LGMD phenotype were enrolled. Sociodemographic, clinical and laboratory data were analyzed. RESULTS: We enrolled 46 families (67 patients), i.e. a frequency of 16.7% among the neurodegenerative diseases seen in the service. Among them, 45.6% came from the Sikasso region. Autosomal recessive inheritance pattern was suspected in 67.4% of the families. Symptoms appeared mainly in the first decade of life. Proximal muscle weakness was found in almost all patients. Cardiac examination showed dilated cardiomyopathy in 4.5% of cases. CONCLUSION: Limb-Girdle muscular dystrophy is a disabling disease that is found in Mali. Further study of these cases could elucidate the underlying genetic defects.

Evaluation of the prevalence of trachoma 12 years after baseline surveys in Kidal Region, Mali.

OBJECTIVE: After prevalence surveys in all eight regions, Mali started a national programme to control trachoma in 1998. In the sparsely populated desert region of Kidal, where active trachoma prevalence was 46.2% in children under 10, no interventions beyond routine eye-care services were implemented. We estimated the prevalence of trachoma in Kidal, 12 years after baseline mapping surveys, to determine whether interventions to control trachoma were warranted. METHODS: A total of 2165 individuals from 477 households were examined for clinical trachoma signs in a cluster survey using the WHO simplified grading system. Individual and household risk factors for trachoma were assessed. RESULTS: The prevalence of follicular trachomatous inflammation (TF) in children 1-9 years of age was 15.6% (95% CI 11.8-19.5%). Trachomatous trichiasis (TT) was observed in 4 persons for an overall prevalence in all ages of 0.16% (95% CI 0.0-0.35%). Estimated household latrine coverage in the region was 33.1% (95% CI 14.0-52.2%). Residents of 52.8% of surveyed households reported access to a water source outside geographical boundaries of their communities. CONCLUSIONS: In the absence of control interventions, the prevalence of clinical signs of trachoma among children was substantially lower than estimates 12 years earlier. The current prevalence of active trachoma remains above the threshold adopted by WHO, yet there is little evidence of chronic blinding trachoma.

[Foreskin Cyst After Circumcision At The Hospital Of Sikasso (MALI)]. / Kyste Du Moignon Preputial Post Circoncision Traditionnelle A L'Hopital De Sikasso (MALI).

Cyst scar post circumcision of the stump of the prepuce is pathology of which we have not found any cases in the literature. The circumcision traditional is still practiced in our regions with its attendant complications, in particular, the high section, the whole or part of the gland, infections. The case we report concerns a patient 24 years of age, having a large cyst of 8cm diameter, evolving for the past 17 years. The patient has not informed his parents that when the desire to marry has become very pressing. The consultation was motivated by the psychological trauma, the discomfort and the pain caused by the infection, and the fistulisation. The treatment was surgical with bedroom suites. This observation underscores the importance of the knowledge of good surgical technique in order to minimize complications; it also sheds light on the taboo side of the pathologies the sphere uro-genitale.

Le kyste cicatriciel post circoncision du moignon du prépuce est une pathologie dont nous n'avons pas trouvé de cas dans la littérature. La circoncision traditionnelle est toujours pratiquée dans nos régions, avec son cortège de complications, notamment l'hémorragie, la section partielle ou totale du gland, les infections. Le kyste cicatriciel post circoncision traditionnelle que nous rapportons concerne un patient de 24 ans présentant un volumineux kyste de 08cm de diamètre, évoluant depuis 17ans. Le patient n'a informé ses parents que lorsque le désir de se marier est devenu très pressant. La consultation fut motivée par le traumatisme psychologique, la gêne et la douleur provoquée par l'infection et la fistulisation. Le traitement a été chirurgical avec des suites simples. Cette observation souligne l'importance de la maitrise de la bonne technique opératoire afin de minimiser les complications de la circoncision traditionnelle, elle met aussi la lumière sur le côté tabou des pathologies touchant la sphère uro-génitale.

[Neuromeningeal cryptococcosis in non-HIV patients to CHU ward of Point G in Bamako (Mali): 3 case report]. / Cryptococcose neuroméningée chez des patients VIH négatif au CHU du Point G de Bamako (Mali): à propos de trois observations cliniques.

We report 3 clinical observations of neuromeningeal cryptococcosis which occurred without any immunodepression related to HIV infection. Our patients were male. They did not present any particular medical history indicating a diagnosis of cryptococcosis. Nevertheless we found a professional exposure to the risk of inhalation of C. neoformans capsules. The diagnosis was based on presence of encapsulated yeast of Cryptococcus in the direct exam by China ink and culture on Sabouraud medium. CD4 lymphocytic count was done in two patients (case 1:899 cells/mm3; case 2:347 cells/mm3). Idiopathic lymphocytopenia was noted in one case. Co-morbidity of 5. pneumoniae meningitis was reported in one patient (case 3). Treatment was based on injectable amphotericin B in monotherapy (case 1), followed by perfusion of fluconazole cure (case 2). Case 3 was treated by perfusion of amphotericin B associated with ceftriaxone (case 2). No secondary prophylactic treatment was administered. Evolution was favorable after follow-up of 5 years (case 1) and of 4 years (case 2). The third patient died during hospitalization.

Longitudinal evaluation of three azithromycin distribution strategies for treatment of trachoma in a sub-Saharan African country, Mali.

OBJECTIVES: Trachoma, caused by repeated ocular infections with Chlamydia trachomatis is an important cause of blindness. Mass azithromycin distribution is part of current recommended strategies for controlling trachoma. In order to ascertain an efficient strategy model at an acceptable cost, an intervention study was conducted in Mali between May 2000 and February 2002. METHODS: Three azithromycin administration strategies were evaluated: mass community-based treatment of all residents (strategy I), treatment of all children under 11 years of age and of women between 15 and 50 (strategy II), and treatment targeted to inhabitants of households where at least one child had clinically active trachoma diagnosed (strategy III). In a particular Malian area in which trachoma was known to be mesoendemic, three villages were selected for each of the three strategies. According to the strategy allocation, adults were eventually given a single dose of 1g azithromycin, and children a unique dose of 20 mg/kg. Moreover, cleanliness and washing of children's faces were assessed, and additional questions were addressed about education, environmental and socio-economic conditions for each household at baseline. Ophthalmic examination was performed at baseline and 1, 6 and 12 months after inclusion. The outcome variable was clinically active trachoma frequency 12 months after intervention among children under 11 years of age. A descriptive analysis was performed, and then logistic regression models were built to test the efficiency of the three strategies. RESULTS: Among children under 11 years of age, the active trachoma prevalence fell dramatically in each strategy, from 23.7% to 6.4% in strategy I, from 20.8% to 6.8% in strategy II, and from 20.2% to 8.5% in strategy III. After adjustment on age (adjusted odds ratio [AOR] = 0.81; 95% confidence interval [95% CI]: 0.75-0.87) and on active trachoma occurrence at baseline (AOR = 3.81; [95% CI]: 2.70-5.39), the multiple logistic regression model showed that both strategies I and II gave similar results, while strategy III appeared significantly less effective (AOR = 1.56; [95% CI]: 1.00-2.43). CONCLUSION: In mesoendemic trachoma areas, targeted treatment to all children under 11 years of age and women between 15 and 50 (strategy II) was as effective as indiscriminate mass distribution (strategy I) and more effective than treatment targeted to inhabitants of households where at least one child had active trachoma diagnosed (strategy III). Strategy II could therefore reduce the prevalence and intensity of trachoma infection at a lower cost than mass community-based treatment of all residents (strategy I).

[Hyperthyroidism in children. Experience in internal medicine in Mali]. / Hyperthyroïdie chez l'enfant. Expérience d'un service de médecine interne au Mali.

INTRODUCTION: Thyroid pathology is frequent in Mali, which is an endemic zone for goiter. But this pathology rarely occurs in children. The purpose of our study was to characterize this illness among children in Mali. METHODS: We report on patients aged less than 15-year old who presented with clinical signs and symptoms with hyperthyroidism at the medicine service at Hospital de Point G from January 1999 and December 2005 to determine the characteristics of hyperthyroidism. RESULTS: The frequency was 9.6 per thousand (38/3972), with an average age of 12.5+/-3.34-year. The sex ratio was 3 girls/1 boys. The most common symptoms were tachycardia (n=30, 78.9%), palpitations (n=15, 34.4%). 31 patients (81.5%) presented with exophthalmoses, 93.5% being bilateral. Weight loss was present in 31.5% (n=12). Goiter was present in 37 patients (97.4%). The goiter was diffuse in 27 patients (73%) and nodular in 10 (27.%). The presence of goiter caused signs of compression in the neck in half of the cases: dyspnea and dysphonia were the most common consequences. TSH less than 0.05 microUI/1 was used to confirm the diagnosis. Graves's disease was the most common cause (n=32, 84.2%), followed by toxic adenoma (n=4, 10.5%). Other causes included toxic multinodular goiter and thyroiditis. Etiologies were independent of sex and age: (p=0.95). All patients were started on medical therapy upon diagnosis. 7 patients (18.4%) were lost to follow-up during the 6 months of treatment. Remission was obtained in 26 patients (83.9%), and relapse occurred in 5 patients (16.1%). CONCLUSION: The frequency of hyperthyroidism in children in Mali is a problem in a goiter endemic zone like Mali. Poor general health in children and signs and symptoms of neck compression are markers of progressive disease.

Tetanus associated with road accidents in the infectious diseases department of Point G University Hospital, Bamako, Mali.

The aim of this study was to describe the epidemiological, clinical, and prognostic aspects of tetanus associated with road accidents and to make recommendations. This observational study collected retrospective clinical data over a 9-year period about adults admitted for trismus and/or generalized or localized paroxysm after a road accident. The study included 25 patients, accounting for 22.12 % of all tetanus cases. Men were massively overrepresented (sex-ratio M/F: 24/1). The median age was 34 ± 8 years. In all, vaccination status was unknown for 4 patients and known to be negative for 21. Immunoprophylaxis was nonexistent in all cases. The generalized clinical form was dominant (96 %). Severity reached level III for 12 % of patients. The points of entry included open leg fractures (4 cases), head wounds (2), mucocutaneous wounds (14), and muscle contusions (5). The mean time to referral for tetanus was 8 ± 7 days, and the median hospital stay 9.08 ± 11 days. Patients were mostly residents of urban (56 %) and suburban areas (28 %) [P = 0.04]. Two cases were complicated by severe malaria. The mortality rate was 60 %, and 52 % of the deaths occurred within the first 72 hours after hospitalization. It is essential to promote serum therapy and tetanus immunization for patients after road accidents. Increasing the awareness of traditional healers of these treatments deserves consideration.

Establishing Reference Ranges of Hematological Parameters from Malian Healthy Adults.

INTRODUCTION: Measurement of immuno-hematological parameters has been historically helpful in the diagnosis and treatment monitoring of many infectious diseases and cancers. However, these parameters have not yet been established in many developing countries where patient care strongly relies on such low-cost tests. This study describes the immuno-hematological parameter ranges for Malian healthy adults. METHODS: A cross sectional study was conducted from August 2004 to May 2013. We included 213 healthy volunteers (173 male and 40 female), aged between 18-59 years. Median, 2.5 and 97.5 percentile ranges for each immuno-hematological parameter are presented. RESULTS: In our study population, the hematological parameters' ranges were mostly different to the universal established ranges. We found in our population a Median white blood cell (WBC) count of 5200 cells/µL [3237.5-11900], Red Blood Cell (RBC) count of 4.94 10^6 [3.56-6.17], hemoglobin (Hb) of 14.2 g/dL [12.2-17.38], platelet count (Plt) of 275 10^3/µL [145.4-614.4], lymphocytes 2050/µL [1200-3800], neutrophils 2200/µL [1040-6220]; monocytes 200/µL [100-660]; eosinophils 131/µL [0-1026]; CD4 902 cells/µL [444-1669] and CD8 485 cells/µL [0-1272]. We found significant gender differences in RBC, Hb level and MPV. However, RBC and Hb were higher in males median values compared to females (median values) (p<0.001), whereas the Mean platelet volume lower values (MPV) in males than females (P<0.047). The hemoglobin level for some West African countries (Mali, Burkina Faso, Togo, and Nigeria) ranged from 13.5 to 15.1 g/dL for males and 12 to 13 g/dL for females. However in East and Southern Africa, the values were anywhere from 14.1 to 16.1 for males and 11.2 to 14.4 for females. CONCLUSION: Our data may help physicians to better define hematological abnormalities in patients. They may also be used to define new "normal hematological values" in Malian population or in the whole West African population.

Treatment seeking behaviour of smear-positive tuberculosis patients diagnosed in Burkina Faso.

SETTING: Yalgado Ouedraogo University Health Centre and National Tuberculosis Centre, Ouagadougou, Burkina Faso. OBJECTIVE: To identify causes and circumstances leading to delays in the diagnosis of sputum-positive tuberculosis (TB). DESIGN: A cross-sectional study conducted between October and December 2001. Data were collected on reasons for consulting and admission to hospital, health units visited and diagnoses. RESULTS: Before obtaining a diagnosis, 24.5% of patients had visited a public health unit, 31% had visited a private health unit, 31% had treated themselves and 6% had visited a traditional healer. In total, 16% of visits to the National Tuberculosis Centre and the Yalgado Ouedraogo University Health Centre were initiated by the patients themselves, 43% by a relative and 41% by a health worker. The average delay to diagnosis was 4 months. Only 24.5% of patients had undergone smear microscopy compared to 44.2% who had undergone chest X-ray. The majority of patients came from the outskirts of Ouagadougou. CONCLUSION: Delays in TB diagnosis seem to be due to the lack of awareness of patients and the incompetence of some health workers. Training and supervision of staff and TB information campaigns targeted at the population (transmission, symptoms and treatment) will improve TB control in Burkina Faso.

Obstacles to the implementation of directly observed treatment in Ouagadougou, Burkina Faso.

SETTING: Five tuberculosis (TB) diagnosis and treatment centres in Ouagadougou, Burkina Faso. OBJECTIVE: To identify obstacles to the direct observation of anti-tuberculosis treatment (DOT) so that it can be adapted to local contexts. DESIGN: A cross-sectional study conducted between August and September 2002 among new and retreatment TB cases in the initial phase of treatment. Information and suggestions were collected on obstacles encountered in DOT. RESULTS: Among 74 patients interviewed, the main difficulties were the lack of assiduity among health personnel, the daily travel, the long distances, the high transportation costs and the high number of tablets. The main suggestions were a reduction in the number of tablets taken at a time, decentralisation of places where tablets are to be taken and weekly provision of drugs. CONCLUSION: Obstacles to DOT should be addressed to optimise the effectiveness of anti-tuberculosis treatment.

Decentralising tuberculosis case management in two districts of Burkina Faso.

SETTING: In West Africa, national tuberculosis programmes (NTPs) face many problems due to the low performance of health care delivery systems and patients' social and cultural environment. OBJECTIVE: To improve the case management of TB in Burkina Faso. DESIGN: Using the operational research process as a tool, TB case management was decentralised from the district hospital to eight primary health care centres in 2003. RESULTS: Twelve months after decentralisation, the quality of case detection remained satisfactory. The delay between the identification of TB suspects with chronic cough and the confirmation of TB was reduced from 13 to 6 days. The detection rate of TB suspects during the study (30%) was twice as high as for 2001 and 2002 (15%). However, the detection rate for smear-positive TB cases decreased from 32.3% in 2001 and 2002 to 6.5% during the year of the study. CONCLUSION: Sufficient time and commitment are essential to obtain a case management system that is decentralised and effective. Efforts therefore need to continue to obtain more information and better results.

Prevalence of common gastrointestinal nematode parasites in scavenging pigs of different ages and sexes in eastern centre province, Burkina Faso.

The range and infestation intensities of gastrointestinal parasitic nematode species depend on the type of swine production system. The present study focused mainly on nematodes of veterinary importance in scavenging pigs in Burkina Faso, and aimed at determining the prevalence of gastro-intestinal nematode parasites by means of faecal egg per gram (EPG) counts. Between November 2001 and October 2002, faecal samples from 383 pigs of different sexes and ages (< 5 months, 5-12 months and > 12 months) were collected from the rectum and examined for gastrointestinal nematodes parasites using the Mc Master method. Of the 383 pigs examined, 91% were infected by one or more parasites. Ascaris suum (40%; 100-1 400 EPG) was the most prevalent parasite followed by Strongyloides ransomi (21%; 100-4200 EPG), Oesophagostomum spp. (18%; 100-1000 EPG), Hyostrongylus rubidus (11%; 100-1 800 EPG), Globocephalus spp. (10%; 100-400 EPG) and Trichuris suis (1 %; 100-200 EPG). The prevalence was significantly higher in female pigs (n = 239) than in males. In addition, females excreted significantly (P < 0.05) more eggs in their faeces than males, except in the case of Globocephalus spp. The age of the animal had no effect on the prevalence of A. suum whereas there were significant differences in age categories concerning S. ransomi, H. rubidus, Oesophagostumum spp. and Globocephalus spp. Unexpectedly, the high prevalence of these common parasites was not accompanied by elevated EPG values, which suggests the existence of moderate infestations. The present work indicates that the common nematode infestations in pigs do not necessarily need a systematic herd anthelmintic treatment, as only a small number of worms is required to induce immunity. A further study is needed to formulate appropriate and cost-effective strategies for the control of gastro-intestinal nematode parasites in pigs in Burkina Faso.

[Intestinal parasitosis during AIDS diarrhoea]. / Parasitoses digestives au cours de la diarrhée du sida.

The main goal of this work was to study the parasitic infections during AIDS diarrhoea. A longitudinal study was carried out from October 2000 to November 2001 in the Hepato-Gastro-Enterology department of Gabriel Toure Hospital and in the Department of Epidemiology and Parasitic infections of Faculty of Medicine, Pharmacy and Odonto-stomatology of Bamako (Mali), concerning HIV positive patients suffering from diarrhoea. Detecting microbes in stools has been done through direct microscopic examination and according to procedures of Henricksen Poblenz Baerman, Kato Katz and the PCR. Among the 70 patients involved, the sex-ratio was 53%, the average age was 35 +/- 8.4 years. Fever weight loss, skin affections and digestive mycosis were often associated. Opportunistic infections have been relatively frequent with Cryptosporidium parvum with 20%, Isospora belli with 8.5% and Microsporidium with 11.5% of cases. Other non-opportunistic microbes were found. Death within the first two weeks seems more important in case of infection by Cryptosporidium parvum. The frequency and the danger of those opportunistic infections require their efficient diagnosis and care management.