[Diabetes mellitus and high blood pressure over risk in HIV-infected people followed at Souro Sanou University Hospital Day Hospital, Bobo-Dioulasso 2018]. / Sur-risque de diabète sucré et d'hypertension artérielle chez les personnes infectées par le VIH suivies à l'hôpital de jour du CHU Souro Sanou, Bobo-Dioulasso, Burkina Faso, 2018.

BACKGROUND: Non-communicable diseases (NCDs) represent the leading causes of death worldwide. HIV also increases the risk of developing NCDs including diabetes mellitus and hypertension. METHODS: A cross-sectional study, based on an analysis of the cohort database of the day hospital of the Souro Sanou teaching hospital in Bobo-Dioulasso (Burkina Faso). Diabetes mellitus was defined by the undergoing of anti-diabetic treatment or two successive measurements of fasting blood sugar above 7mmol/l and high blood pressure by the undergoing of antihypertensive treatment or two successive measurements of blood pressure above 140/90mmHg. Comparison of the frequency of diabetes and hypertension in the people living with HIV/AIDS (PLWHA) population on antiretroviral therapy (ART) with that of the general population of Burkina Faso was made by indirect standardization according to age and gender. RESULTS: A total of 4259 patients including 3148 women (73.9%) were included in this study. The median age of the patients was 45 years (IQR: 38-52); the median body mass index (BMI) was 19.6kg/m2 (IQR: 15.4 - 22.7) and 48.3% of patients had a BMI≥25kg/m2. The median CD4 count was 590 cells/mm3 (IQR: 417-785). The median ART duration was 8.2 years (IQR: 4.7-11.2). The majority of patients (82.9%) were on treatment combinations consisting in 2 INTI+1 NNRTI. Prevalence of hypertension was 39.8%; it was statistically higher in men than in women (45.8% versus 37.8%). Prevalence of hypertension was 87.0% higher in the PLWHA population than among same-sex and same-age subjects in the general population. Prevalence of diabetes mellitus was 7.3%. Diabetes mellitus was more common in men than in women (10.1% versus 6.3%; P<10-3). Prevalence of diabetes mellitus was 36.0% higher in the PLWHA population than among same-sex and same-age subjects in the general population. CONCLUSION: Prevalence of diabetes mellitus and hypertension was higher among PLHWA undergoing ART than in the general population. Care for the PLHWA population should more widely include NCD treatment.

Prevalence case-control study of epilepsy in three Burkina Faso villages.

PURPOSE: To estimate the association between the prevalence of epilepsy and potential risk factors in three Burkina Faso villages. METHODS: Three villages were selected based on local reports of high numbers of epilepsy cases and pig-rearing practices. One person aged 7 or older was selected at random from all households of selected concessions for epilepsy screening and blood sampling. Epilepsy was confirmed by a physician using the ILAE definition. The cross-sectional associations between epilepsy and selected factors and seroresponse to the antigens of Taenia solium were estimated using a Bayesian hierarchical logistic regression. Prevalence odds ratios (POR) and their 95% Bayesian Credible Intervals (95% BCI) were estimated. RESULTS: Of 888 individuals interviewed, 39 of 70 screened positive were confirmed to have epilepsy for a lifetime prevalence of 4.5% (95% CI: 3.3; 6.0). The prevalence of epilepsy was associated with a positive reaction to cysticercosis Ag-ELISA serology (POR = 3.1, 95% BCI = 1.0; 8.3), past pork consumption (POR = 9.7, 95% BCI = 2.5; 37.9), and being salaried or a trader compared to a farmer or housewife (POR = 2.9, 95% BCI = 1.2; 6.4). DISCUSSION: Several factors were associated with prevalent epilepsy, with Ag-ELISA suggesting the presence of neurocysticercosis. The association between epilepsy and some occupations may reflect differences in local attitudes toward epilepsy and should be further explored.

[Meningitis epidemic: assessment of surveillance and treatment of cases in the health centers of a Burkina Faso district]. / Épidémie de méningite: évaluation de la surveillance et du traitement des cas dans les formations sanitaires d'un district du Burkina Faso.

Meningococcal meningitis remains a periodical threat in the African meningitis belt. The countries concerned, such as Burkina Faso, provided guidelines for its surveillance, diagnosis, treatment, and prevention during outbreaks. The objective of this study is to assess the quality of the surveillance system and case management during an outbreak in Fada N'Gourma district. A retrospective study of the meningitis outbreak in 2007 was conducted by literature review and interviews of health caretakers across 27 health centers (CSPS) and three units in the regional hospital in the district.We reported all data available about surveillance and case management, and then we compared it with the guidelines of the Ministry of Health. The case definition and notification forms were available in all centers and units. During the outbreak, 861 cases were recorded, but only 89% was notified at the upper level and 87% of notification forms were available. The age is marked on all the forms, while the interval between the onset of symptoms and consultation is noted only in 90.7%. The forms were distributed weekly at the district level. Cerebrospinal fluid (CSF) Gram coloration was performed for a limited number of cases (150/349 samples, 42.9%); it showed Gram-negative diplococcus in 86%. Culture was performed for a limited number of patients (7 cases). According to the results of a central level laboratory study, the outbreak was due to Group A Neisseria meningitidis. The case management guidelines were available in all the centers and units which were supervised during the outbreak. Anti-biotherapy was appropriate in 93.6% of the cases. A shortage of antibiotics (free prepositioning) was observed in 7 centers (23.3%). The mortality rate was 3.5%. This assessment shows an under-notification of cases, despite the existence of a surveillance system and supervision, a weak laboratory contribution in germ identification, appropriate case management, and shortage of antibiotics during the outbreak. Management of a meningitis outbreak may become more efficient by improving the notification, the laboratory's capabilities, and the availability of drugs.

Knowledge, Attitudes, and Management of General Practitioners of the Hospital Districts of Ouagadougou about Migraine (Burkina Faso).

BACKGROUND: Migraine is a common neurological disorder characterized by severe headache attacks that may be debilitating. The objective of this study is to determine the knowledge and attitudes of general practitioners in the hospital districts of the city of Ouagadougou on migraine. METHODS: This cross-sectional study was carried out in hospital districts of Ouagadougou. The data were collected during three months from February 1 to April 30, 2020. RESULTS: The study included 116 general practitioners. Thirteen percent of them were suffering from migraine. All participants had previous experience with migraine diagnosis before the survey. Eighty percent of general practitioners had a good level of knowledge of ICDH-3 criteria (knowing 6-7 criteria). The most widely recognized IHS criteria were pulsatility quality (93.1%), photophobia or sonophobia (80.2%), and mild-to-moderate intensity (80%). Ninety-five (81.9%) general practitioners rarely ordered brain imaging. The most common acute treatments were nonsteroidal inflammatory drug (39.47%), paracetamol (44.74%), and derivate of ergot (3.95%). The most common preventive treatments were amitriptyline (27.8%), derivate of ergot (18.9%), and NSAID (16.7%). The majority of general practitioners (56.9%) have referred headache patients to a colleague or specialist. CONCLUSIONS: Our study found that diagnostic criteria and acute treatment of migraine were well known by the majority of general practitioners, in contrast of preventive treatment.

[Polyneuropathies in patients treated with HAART in Bobo-Dioulasso hospital, Burkina Faso]. / Les polyneuropathies chez les patients traités par les ARV au CHU de Bobo-Dioulasso, Burkina Faso.

Peripheral neuropathies (PN) represent the most common neurological manifestation in patients with HIV infection. Introduction of highly active antiretroviral therapy (HAART) had a significant impact on the epidemiology of HIV-associated neuropathies even in poor-resources countries. HIV-infected patients were followed up over a 2-years period from January 2002 to December 2003. PN was clinically diagnosed based on abnormalities of ankle reflexes or vibratory perception and if patients described pain, paresthesia or numbness. Electromyography was not performed in this study Among the 133 HIV-infected patients treated with HAART 31 patients (23 females and 8 males) with 38.8 of mean age were followed up for PN. 95.5% among them were HIV1-infected. According to the availability of the antiretroviral therapy, 9 patients were treated with protocol A including lamivudine + stavudine + nevirapine, 12 patients with protocol B including combination of stavudine + lamivudine + efavirenz, and 10 patients with protocol C with other combinations of antiretroviral therapies. Average CD4 cell count was 229.3/microl and 60% of the sample had < 200 CD4 cell counts at the time of diagnosis. PN occurred within 5.6 months from the institution of the HAART and 80% less than 3 months after the beginning of the treatment. Burning feet syndrome was found in 16.1% of the sample. 45.2% of polyneuropathies occurred in late stage of HIV infection (< 200 CD4/microl). The presence of PN was related to decreased CD4 cells counts and neurotoxic antiretroviral therapy Introduction of HAART has modified the course and the prognosis of HIV infection even in poor resources setting. The incidence of toxic neuropathies is increasing with longer patients' life expectancy and represents a major factor in treatment limitation and the neurological side effects of HAART should be well identified by physicians.

Depression and HIV: Epidemiological and clinical aspects at the Bamako University Hospital (Mali).

Depression plays an important role in clinical worsening, morbidity and mortality related to HIV/AIDS. To describe the epidemiological and clinical aspects of depressive disorders in people with HIV in Mali. This prospective study took place in the department of psychiatry and infectious diseases at the Bamako University Hospital from July 2004 through October, 2005 and included all HIV-positive antiretroviral-naive patients with depression, diagnosed according to ICD-10 criteria. The study included 84 HIV-positive patients with a depressive disorder; our total population of HIV-positive patients was 316 during the study period, for a prevalence rate of 26.7 % in this population. The mean age of these depressed patients was 36.7 ± 8.5 years (range: 20-57); 63.1% were women, 47.7% had not attended or at least not completed primary school; 66.6% were married, and 92.9% lived in urban areas. Sad mood, anxiety, and refusal to eat were reported by 27.7%, 10.9%, and 9.1%, respectively, as a reason for consultation. Depression was associated with an anxiety disorder in 33 (39.3%) and a delusional disorder in 14 (16.7%). Severe depression was associated with low BMI and at a CD4 count <200 cells/mm3. Depression was found at a high frequency in our study. Its detection, operational research about it, and improved management are recommended to improve the health of people living with HIV.

[Epidemiology of epilepsy in sub-Saharan Africa: a review]. / Epidémiologie de l'épilepsie en Afrique subsaharienne : une revue de la littérature.

Epilepsy is, above all tropical, moreover, very african in its frequency and gravity. Data on the prevalence of epilepsy shows it to be two or three times more prevalent in tropical zones than in industrialized countries in non tropical areas, however it is rare to find data on the incidence and prognosis of epilepsy in sub-Saharan Africa. It is difficult to determine the relative contribution of each of the causes of epilepsy. Only a few case-control studies have been carried out in sub-Saharan Africa. Infectious diseases, in particular parasitic diseases such as neurocysticercosis or cerebral malaria, seem to be the cause of the majority of the cases of epilepsy. However it is necessary to do additional epidemiological studies to determine the etiologies of epilepsy more precisely in sub-Saharan Africa.

[Pathologies in internal medicine: concerning Burkina Faso]. / Les pathologies en medicine interne: Cas du Burkina Faso.

The objective of our study was to determining the epidemiological, diagnosis and evolutionary aspects of pathologies admitted for care in the service of internal medicine between January 1, 2007 to December 31, 2009. MATERIALS AND METHODS: A cross-sectional retrospective and descriptive study was conducted over three years, from the review of medical records of patients admitted to the Department of internal medicine of the Souro Sanou university hospital. RESULTS: Our study concerned 5362 patients. The average age had been 43.10 years old ±12.2. The sex ratio was 1.16: 1. The majority of our patients were from a low socio-economic background. HIV/AIDS had been the most frequent condition with the rate of admission of 24%, followed by cerebral vascular accidents with 8.6%. The recovery rate was of 53.9% and an overall mortality of 33.3%. This mortality had been dominated by infectious and parasitic diseases including HIV/AIDS with a rate of 27.8% of the overall mortality. Early mortality remains high with a rate of 37.4%. CONCLUSION: In spite of the epidemiological transition marked by the emergence of the cardio-metabolic diseases in the countries of the South, infection by HIV always constitutes the main pathology met in the Department of internal medicine of the Souro Sanou university hospital, it is responsible for a high mortality cause of mortality. The emphasis must be placed on early treatment and especially the communication for the change of behavior aiming at an early screening of the HIV. This would allow to reduce effectively the AIDS-related lethality to internal medicine.

L'objectif de notre étude était de déterminer les aspects épidémiologique, diagnostique et évolutif des pathologies prises en charge en hospitalisation dans le service de médecine interne du 1er janvier 2007 au 31 décembre 2009. MÉTHODES: nous avons mené une étude transversale rétrospective à visée descriptive sur trois ans, à partir de revue de dossiers médicaux de patients admis dans le service de médecine interne du Centre Hospitalier Universitaire Souro Sanou (CHU SS). RÉSULTATS: étaient concernés 5362 patients. L'âge moyen était de 43,10 ans ± 12,2, avec un sex- ratio de 1,16 :1. La majorité de nos patients avaient un faible niveau de vie socio-économique. L'infection par le VIH/SIDA était l'affection la plus fréquente avec un taux d'admission de 24%, suivi des AVC avec 8,6%. Le taux de guérison était de 53,9% et celui de la mortalité globale de 33,3%. Cette mortalité était dominée par maladies infectieuses notamment l'infection par le VIH/SIDA avec un taux de 27,8%. La mortalité précoce était de 37,4% (< 3 jours). CONCLUSION: malgré la transition épidémiologique marquée par l'émergence des maladies cardiométaboliques dans les pays du sud, l'infection par le VIH constitue toujours la principale pathologie rencontrée dans le service de médecine interne du CHUSS, elle est responsable d'une mortalité élevée. L'accent doit être mis sur le traitement précoce et surtout la communication pour le changement de comportement visant un dépistage précoce du VIH. Ceci permettrait de réduire efficacement la létalité li&e au sidia en médecine interne.

[Guillain-Barré syndrome in HIV-infected patients at Bobo-Dioulasso Hospital (Burkina Faso)]. / Syndrome de Guillain-Barré chez les patients infectés par le VIH à Bobo-Dioulasso (Burkina Faso).

Neurological manifestations of human immunodeficiency virus (HIV) infection are frequent and several associated peripheral neuropathies have been recognized. Among them, Guillain-Barré syndrome (GBS) may occur either early or during the course of the illness. We present a prospective study of 32 consecutive cases of GBS managed over a 5-Year period at Bobo-Dioulasso Hospital where HIV prevalence reaches 20.1p.cent. Male gender predominated (24/32). GBS occurred during the dry season for 65.7p.cent of the patients. Prior infections were found in 84.4p.cent. The motor deficit was paraplegia or tetraplegia. Clinically, paraplegia was associated with transient urinary sphincteric involvement in 24 HIV-infected patients and 3 HIV negative patients. Facial nerve paralysis was found in 3 patients. Among the 32 patients with GBS, 27 were tested positive for HIV. Two patients were infected by HIV1 and HIV2. Cerebrospinal fluid examination showed albumin-cell dissociation and elevated albumin level in 75p.cent of the samples. Autonomic neuropathies were seen in 9 HIV-infected patients. The CD4 counts were above 200/mm3 in 10 among 18 HIV-infected patients. The clinical presentations were more severe in HIV-positive patients with a longer duration of symptoms. HIV-infected patients walked unaided within 51.1 days of peak paralysis. No fatal event occurred. This study indicates clearly that GBS in young adults is strongly associated with HIV infection and should be considered as an indicator of HIV infection in Black Africans. In the tropical context GBS should lead to HIV screening.

[Sociocultural aspects of epilepsy in secondary school students in Bobo-Dioulasso (Burkina Faso)]. / Aspects socioculturels de l'épilepsie en milieu scolaire à Bobo-Dioulasso (Burkina Faso).

In Black Africa, epilepsy is usually affected by sociocultural attitudes. A school survey concerning epilepsy was conducted in February 1999 in Bobo-Dioulasso, an Islamic region. Knowledge and attitudes towards epilepsy in secondary school students was evaluated through focus group discussions done in secondary schools. Epilepsy was supposed to be a chronic disease attributed to brain damage, or spiritual. The students usually described the "Grand Mal" generalized tonic-clonic form of epilepsy. Epilepsy is believed to have hereditary causes and the students believed it to be contagious through saliva and physical contact. For students, epilepsy cannot be cured. When a treatment was proposed, only traditional medicine was supposed to be competent. If burns occur in the course of the disease, the prognosis is supposed to be bad. Generally fear and mistrust are dominant feelings among students despite the fact they are literate urban population. Their belief in the contagiousness of epilepsy could be a major reason for discriminating against an epileptic person. Our data suggest that there is a need to make additional efforts in order to increase the knowledge of the general population and the level of formal education. Poor knowledge and lack of information explained secondary school students attitudes towards epilepsy in Bobo-Dioulasso.

[Diagnostic problems of expansive intracranial process in HIV infected patients of the Bobo-Dioulasso Central Hospital (Burkina Faso)]. / Problèmes diagnostiques des processus expansifs intracrâniens chez les patients infectés par le VIH au Centre hospitalier de Bobo-Dioulasso (Burkina Faso).

In HIV infection, cerebral focal lesions are relatively frequent and raise many kinds of diagnostic problems. In tropical practice, neuroradiology is scarcely available and necropsy is still not developed. Therefore, diagnosis of intracerebral masses among patients is not easily performed. We examined a total of 72 patients who presented over a 3-year period. Patients were allocated to presumed diagnostic categories of toxoplasma encephalitis (TE), primary central nervous system lymphoma (PCNSL) or progressive multifocal leukoencephalopathy (PML), based on clinical and therapeutic criteria. In an internal medicine ward, we examined 72 suspected cases of intracerebral masses in a sample of 43 males (60%) and 29 females (40%). The average age was 38 years with extremes ranging from 21 to 72 years. Because of diagnostic problems, the presumption of a TE has been retained in 54 cases (75% of the sample) owing to the efficiency of the treatment of antitoxoplasmic proof. As for the other intracerebral masses, despite insufficient diagnostic means, the assumption of PCNSL was made for 8 cases and PML for 6 cases on the basis of evolutional criteria. In 4 cases, no diagnosis could be retained because of insufficient diagnostic means and treatment failure. Since brain tomodensitometry and brain biopsy are not available, treatment of toxoplasmosis has to be systematically set up whenever there is a presumption of intracerebral masses among patients with HIV infection. It is only in case of failure of this treatment that other hypotheses can be contemplated, especially as they are not entirely reliable.

[Peripheral neuropathies revealing HIV infection at the Hospital Center of Bobo-Dioulasso (Burkina Faso)]. / Neuropathies périphériques révélatrices de l'infection par le VIH au Centre hospitalier de Bobo-Dioulasso (Burkina Faso).

Several peripheral neuropathies are associated with human immuno-deficiency virus (HIV) infection. In Africa, certain diseases are of particular importance. In the present work, we report peripheral neurological involvement as revealing signs of HIV infection within the internal medicine unit of a large city over a 2-year period. All adult subjects with a positive HIV serology revealed by a peripheral neuropathy observed in the National Hospital Centre of Bobo-Dioulasso over a two-year period (1 January 1999 and 31 December 2000) were included in the study. 46 cases of peripheral neuropathies revealing HIV infection were screened. Peripheral facial paralysis concerned 25 patients, 15 women and 10 men, in the early stages of HIV infection. The average age was 34 years. For 80% of the patients, he CD4 count was over 200. 5/10 cases of polyneuropathy occurred at the early stage of the HIV infection. Herpes zoster occurred in the early stages in 5/7 cases. 3/4 cases of polyradiculopathy occurred at a later stage with CD4 count under 200. Our study indicates clearly that isolated peripheral facial paralysis, sensitive polyneuropathy, herpes zoster and polyradiculopathy in young adults should lead to HIV testing.

[Toxoplasma serology in HIV infected patients and suspected cerebral toxoplasmosis at the Central Hospital of Bobo-Dioulasso (Burkina Faso)]. / Sérologie toxoplasmique chez les patients infectés par le VIH et suspects de toxoplasmose cérébrale au Centre hospitalier de Bobo-Dioulasso (Burkina Faso).

A study was conducted in the Internal Medicine unit of Bobo-Dioulasso Hospital. Of the 1828 HIV positive patients admitted in medical wards, 268 presented neurological symptoms. 25.4% had positive Toxoplasma gondii serology. Encephalitis was associated with 12.5% of this latter group and intracranial hypertension with focal neurological defects affected a further 47.5% of them. Presumptive treatment of toxoplasmosis led to significant clinical improvement in 60% of cases. Toxoplasma gondii serology should be part of the standard check-up for every HIV-infected patient, and toxoplasmosis chemoprophylaxis should be given to those with positive toxoplasma serology. Presumptive therapy of toxoplasmosis should be started for all HIV positive patients with focal neurological manifestations in the absence of a cerebral scanner.

[Compared characteristics of peripheral facial paralysis according to HIV status in Bobo-Dioulasso (Burkina Faso)]. / Caractéristiques comparées des paralysies faciales périphériques selon le statut VIH à Bobo-Dioulasso (Burkina Faso).

Facial paralysis is a well-described manifestation of HIV infection. We report 27 cases of peripheral facial paralysis observed at Bobo-Dioulasso Hospital in a prospective study over a period of 9 months: 55 of the cases were HIV positive and 12/15 (80%) were in the 20-39 age group. Nine out of 11 females and 6 out of 16 males were seropositive. 13 of the cases were at stage B of CDC classification and 2 at stage C. ESR was elevated in all the HIV patients. CSF examination revealed lymphocytic pleiocytosis, elevated proteins and a positive HIV serology. CD4 counts were obtained in 8 cases and were under 400/mm3 in 4 cases. The clinical presentation was more severe in HIV seropositives with a longer duration of symptoms. Isolated peripheral facial paralysis associated with an elevated ESR in young adults suggest HIV infection and should lead to HIV counselling and testing.

[Comparative study of neonatal bacterial meningitis in Lomé, Bobo-Dioulasso, Casablanca and Lyon]. / Analyse comparative des méningites bactériennes néonatales à Lomé, Bobo-Dioulasso, Casablanca et Lyon.

UNLABELLED: Bacterial meningitis in new-borns remains a serious event because of its high mortality and morbidity rates in Africa. OBJECTIVE: To identify the clinical and bacteriological epidemiology and the outcome of neonatal bacterial meningitis in three African cities. METHOD: We have analysed and compared three hospital studies done in humid tropical, Sahelian, and desert Africa with a European study. RESULTS: Compared with the European study this African study is characterized by a high mean frequency of neonatal meningitis (6 cases per year against 1.4), more important risk factors linked to pregnancy and childbirth (50% against 33%), high rates of death (61 to 68% against 5%) and sequelae (25 to 40% against 30%), rarity of Streptococcus agalactiae (7 to 15% against 38%) and absence of Listeria. Enterobacteriaceae were predominant both in African (50 to 68%) and European (43%) studies. E. coli appeared as the most frequent germ in both European and African studies and Salmonella as more frequent in Sub-Saharan Africa than in occidental countries. CONCLUSION: The epidemiological, bacteriological and evolutional aspects of the neonatal meningitis were identical in the three African cities. The African studies were different from the European only by their high incidence, the rarity of S. agalactiae and Listeria and the difficulties of bacterial diagnosis and management, all might explain the high rates of death and sequelae. An epidemiological survey and adequate antimicrobial therapy according to antibiotic susceptibility may improve the outcome.

[New-onset seizures in patients with immunodeficiency virus infection in Bobo-Dioulasso Hospital (Burkina Faso)]. / Crises d'épilepsie d'apparition récente et infection par le VIH au Centre hospitalier de Bobo-Dioulasso (Burkina Faso).

Seizures are common in advanced stages of immunodeficiency virus (HIV) infection. HIV-infected outpatients and inpatients in the national hospital in Bobo-Dioulasso among whom seizures occurred had been recruited over four years. There were mainly male (30/13) with an average age of 35 years with extremes ranging from 22 to 60 years. New-onset generalised seizures occurred in all cases of cryptococcal meningitis or partial motor secondary generalised in 64% among patients with suspected cerebral toxoplasmosis due to the efficiency of the treatment of the antitoxoplasmic proof. Identified causes such as suspected cerebral toxoplasmosis (65%), suspected tuberculous meningitis (7%) as CSF culture is not available, cryptococcal meningitis (16%) were found in this study. In four cases among 43 patients, no identified causes could be determined. CD4 lymphocytes count which was available in 24 patients was under 200/41 in 74% of the cases. This study indicates clearly that seizures in young adults are strongly associated with focal brain lesions and cerebral toxoplasmosis is becoming an important cause of seizure in tropical area. This should imply a screening of toxoplasmosis with new-onset seizure in young people.

[Sleeping sickness in children at Bobo-Dioulasso Hospital Center: apropos of 3 cases]. / La maladie du sommeil chez l'enfant au Centre hospitalier de Bobo-Dioulasso: à propos de 3 observations.

The authors report three observations of trypanosomiasis in children aged 3 to 13 years from Ivory Coast and Burkina Faso. Two cases were imported from Côte d'Ivoire and one originated from an old endemic area of Bobo-Dioulasso region in Burkina Faso. Clinical features were comparable to classical descriptions in adults but neurological findings were dominant. Two children were at the lymphatic stage. Treatment with melarsoprol in two cases and eflornithine in one case led to complete recovery. Active epidemiologic surveillance of this zoonosis should be maintained and the devastating pandemic of the beginning of the century should be remembered.

[Peritoneal tuberculosis and HIV infection. Reflection apropos of 22 cases at the National Hospital of Bobo Dioulasso]. / Tuberculose péritonéale et infection par le VIH. Réflexion à propos de 22 cas à l'Hôpital national de Bobo Dioulasso.

Peritonitis tuberculosis is still a frequently encountered pathology in our hospital. Since the AIDS pandemic, cases of peritonitis tuberculosis present increasingly atypical characteristics, largely diverging from classical descriptions. The authors report on 22 cases of peritonitis tuberculosis associated with HIV infection. The study was carried out from June 1997 to December 1999 in the National Hospital Centre Souro SANOU of the Bobo Dioulasso internal office. It concerned 10 women and 12 men of a mean age of 37.9 years. The sex-ratio was 1.2 in favour of men. Diagnosis was established by laparoscopy. Peritonitis tuberculosis associated with HIV accounted for 78.5% of peritonitis tuberculosis cases. The clinical picture was dominated by isolated ascite (100%) associated with an oscillating high fever in 68.2% of cases. Negative results for IDR seemed to reflect poor prognosis. Response to treatment was slow but acceptable. The general prognosis was poor with a mortality rate of 18%.

[Cryptococcal meningitis in HIV-infected patients at Bobo-Dioulasso hospital (Burkina Faso)]. / La cryptococcose neuroméningée au cours de l'infection par le VIH au Centre hospitalier de Bobo-Dioulasso (Burkina Faso).

Cryptococcus neoformans is an important fungal pathogen in immunocompromised patients. A retrospective study was conducted to investigate the occurrence of Cryptococcus neoformans infection in patients admitted to Bobo-Dioulasso Hospital over a 3 year-period. During this period, cryptococcal meningo-encephalitis was diagnosed in 36 individuals. The median age of the patients under study was 34.25 years. There was a male preponderance (24 males/12 females) in our report. Typical presentations were persistent headaches (27 cases/36), neck stiffness (16/36), altered consciousness (14/36), fever (12/36) and convulsions (9/36). Oral candidiasis coexisted with cryptococcal meningitis in 7 patients. HIV serology was positive in all patients. At diagnosis, lymphocytes counts were < 1500/mm3 in 66.66% patients. CSF examination with India ink helped to the diagnosis of cryptococcosis in all cases. Cryptococcus neoformans was associated with Streptococcus pneumoniae in 4 patients. 15/36 patients died within 1 to 29 days after admission. High mortality was related to delayed diagnosis. Cryptococcal meningitis highly contributes to mortality in HIV-infected patients in Burkina Faso and it may occur in patients not severely immunocompromised patients. A need exists to improve strategies for clinical management of AIDS patients in poor African countries.

[Neurologic manifestations associated with HIV infections at the Bobo-Dioulasso Hospital Center (Burkina Faso)]. / Manifestations neurologiques associées à l'infection par le VIH au Centre hospitalier de Bobo-Dioulasso (Burkina Faso).

Neurological manifestations of HIV infection are frequent and diverse. Diagnosis is often difficult due to geographical factors. 686 of the 3409 patients admitted to the Internal Medicine ward of Bobo-Dioulasso in 1995-1996 were HIV seropositive. This represents a prevalence of 20.1%. The sociodemographic and clinical characteristics of 101 patients with neurological problems during the study period are reported in this paper. This case series represents 14% of the HIV-positive admissions. The mean age was 35.7 years and 43% of the cases were aged 30 to 40 years. Sex-ratio was 1.6 male for 1 female. Focal deficits were observed in 36 of cases. Peripheral neuropathy (37%), meningitis or meningoencephalitis (20%), fitting (8%) and myelitis (8%) were the other clinical presentations. The etiology of the focal deficits was not ascertained because of the lack of tomodensitometry, specific serology and necropsy. Any neurological manifestation in a HIV seropositive patient should prompt investigations in order to diagnose those infections which can be treated, especially Toxoplasma gondii abscess and Cryptococcus neoformans meningitis.