[Current aspects of neuromeningeal cryptococcosis in adults infected with HIV in the internal medicine service of the University Hospital of Treichville Abidjan (Cote d'Ivoire)]. / Aspects actuels de la cryptococcose neuroméningée chez des sujets adultes infectés par le VIH dans le service de médecine interne du CHU de Treichville d'Abidjan (Côte d'Ivoire).

OBJECTIVES: To determine the prevalence of neuromeningeal cryptococcosis (NMC) and reporting sociodemographic, clinical, paraclinical aspects and outcome of patients. METHODS: It was a retrospective study concerning 22 HIV positive patients hospitalized between 2006 to and 2009 in the internal medicine service of University Hospital of Treichville for NMC. RESULTS: The prevalence of NMC in patients infected with HIV was 0.6%. The mean age was 35±4.5 years old. The sex-ratio was 0.5. The average time evolution of the symptomatology was 10±2.1 days. The installation of the disease was progressive (86.4%). The main signs were fever (100%) and headache (95.4%). The cerebrospinal fluid was inflammatory aspect (95.4%) with low glucose (91%), hyper lymphocytosis(100%). There were Cryptococcus neoformans in direct exam by China ink (72.7%) and culture on Sabouraud (100%). Treatment was injectable amphoterin B in monotherapy (54.5%) followed by fluconazole per os (45.5%). The mortality was 54.5%. CONCLUSION: This study shows a reduction of NMC prevalence in our service in relation with tritherapy.

[A new focus of human paragonimosis discovered in Côte d'Ivoire (West Africa): the case of the Lauzoua Island]. / Un nouveau foyer de paragonimose humaine découvert en Côte d'Ivoire (Afrique de l'ouest): le cas de l'île de Lauzoua.

Fifteen cases of human paragonimosis were detected in Ivory Coast from 1974 to 1999. Since no further cases have been reported, an epidemiological survey was carried out in local health centers. The purpose of this paper is to described a new focus of paragonimosis discovered on Lauzoua Island. Clinical and parasitological examinations were performed on 17 patients presenting chronic cough, haemoptysis and/or epilepsy. Stools belonging to cats, dogs and pigs as well as river crustaceans were also examined to identify parasite eggs and metacercariae respectively. Paragonimus eggs were found in stools and/or sputum of five patients. Measurements of these eggs after fixation in formalin allowed division into three groups. Stools from cats, dogs and pigs were negative. Small Paragonimus metacercariae (mean: 277 to 323 microm) were found in three Callinectes marginatus crabs (out of 15 caught near the island). No metacercariae were found in local prawns. The presence of these three Paragonimus egg groups as well as of infected crabs near the island will require further study to identify the species and determine the prevalence of each in human infection.

[Symptomatic and asymptomatic Plasmodium falciparum infection in children from 6 months to 6 years old in the Abobo general hospital (Abidjan, Côte d'Ivoire)]. / Portage symptomatique et asymptomatique de Plasmodium falciparum chez les enfants de 6 mois a 6 ans a l'hôpital général d'Abobo (Abidjan, Côte d'Ivoire).

It is commonly admitted that people living in malarial zone are carrying asymptomatic Plasmodium. Côte d'Ivoire is one of these zones. The studies carried out on malaria in these areas have focused mainly on the clinical forms of the disease and effectiveness of the antimalarial drugs. The purpose of this study was to determine the prevalence of the symptomatic and asymptomatic carriage of Plasmodium falciparum in children of 6 months to 180 months old in the Abidjan area. Over a period of twelve months, 902 feverish subjects and 681 non-feverish subjects were selected among the 7,017 people admitted in the paediatrics service of the Abobo general hospital for detection of malaria parasite. Among 1,583 selected subjects, 358 were carrying Plasmodium falciparum implying a total prevalence rate of 22.6%. The prevalence rate was 13.5% and 29.5% respectively in the asymptomatic subjects and symptomatic subjects. The highest proportions of positive thick smears were observed during the long rainy and dry seasons but, parasitaemia was the highest during the short dry season. In 31.5% of the cases, the asymptomatic carriers had a parasitic density higher or equal to 10,000 trophozoites/microl of blood and fever was not related to parasitic load. The prevalence rates of Plasmodium carriage and malaria were higher during the long rainy season. This study highlighted a considerable proportion of asymptomatic Plasmodium falciparum carriers. Improving environmental conditions should help to reduce this rate of carriage.

[Three new cases of visceral leishmaniasis in Côte d'Ivoire]. / Trois nouveaux cas de leishmaniose viscérale autochtone en Côte d'Ivoire.

The objective of this work is to report three cases of visceral leishmaniasis in non-HIV infected native patients in Côte d'Ivoire. The three observations concerned adults aged of 31 and 65 and a five years old child without particular medical or surgery histories. Factors associated with visceral leishmaniasis regarding the younger and the older adults were respectively young age, chronic lymphoid leukaemia and Burkitt lymphoma. Clinical features in the three cases were chronic fever a myeloproliferative syndrome with wasting syndrome and pancytopenia. The diagnosis was confirmed by the existence of Leishmania in bone marrow, ganglionic juice and splenic samples. The species of Leishmania was not identified. Specific treatment was based on intravenous amphotericin B (Fungizone) relayed by Glucantim in one case because of side effects; however the treatment has been unsuccessful. These three new cases show that visceral leishmaniasis is a reality in Côte d'Ivoire therefore an epidemiological survey is requested in order to identify Leishmania species, reservoirs and vectors.

[Persistence of a paragonimosis focus in the department of Lakota, Côte d'Ivoire (West Africa)]. / Persistance d'un foyer de paragonimose dans le département de Lakota, Côte d'Ivoire (Afrique de l'Ouest).

A field survey was carried out from March to August 2006 in three villages around the town of Lakota (Côte d'Ivoire) to verify the presence of paragonimosis in local people, wild vertebrates, and crabs. Out of the 92 patients who were recruited because of their chronic cough, haemoptysis and/or epilepsy, 3 had Paragonimus eggs in their stools and/or sputa. Examination of stools belonging to 24 wild mammals and a reptile revealed the presence of eggs in three civets (Viverra civetta) and a mongoose (Crossarchus obscurus). Six local crabs (out of the 30 Liberonautes latidactylus dissected) harboured Paragonimus metacercariae having low diameters (299 to 315 pm). The presence of several paragonimid species (at least 2) in the district of Lakota was hypothesized. However, the existence of quantitative variations in metacercarial diameters for the same species of Paragonimus cannot be excluded.

[Identification of yeasts from commercial attiéké in Abidjan (Côte d'Ivoire): Preliminary study]. / Identification des espèces de levures isolées de l'attiéké commercialisé sur les marchés à Abidjan (Côte d'Ivoire) : étude préliminaire.

OBJECTIVE: This study aims to identify yeasts from commercial attiéké. PATIENTS AND METHODS: This descriptive cross-sectional survey involving 103 samples of attiéké sold on the market from August to September 2017. It was conducted from the mycology laboratory of the Institut Pasteur of Côte d'Ivoire. The samples were seeded on YGC medium. The colonies of positive culture were counted and seeded again on chromogen medium. Identification of yeasts species was carried out by MALDI-TOF mass spectrometry (Vitek MS bioMérieux). RESULTS: As a whole, 63 samples were contaminated with fungi i.e. an overall prevalence of 61.1 %. Fifty-nine of yeasts were identified i.e. 57.2 %. Candida rugosa was most frequently isolated (62.7 %), followed by Ccandida albicans (8.5 %), Candida krusei (8.5 %) et Candida tropicalis (8.5 %). Geotrichum candidum represented 6.8 % isolated yeasts. The yeast average load is 10,124×102 CFU/g with high contamination of commercial attiéké in the commune of Abobo. CONCLUSION: The contamination of attiéké by yeasts is a reality. C. rugosa was most frequently isolated. It would be necessary to investigate the food chain to determine the source of contamination.

[Epidemiological profile of the schistosomiasis in school children in the Agneby Region (south-east of Côte-d'Ivoire)]. / Profil epidémiologique des schistosomoses chez les enfants d'age scolaire dans la région de l'Agnéby (sud-est de la Cote-d'Ivoire).

A parasitological survey was conducted in the Agnéby region (south-east Côte-d'Ivoire) from November 2000 to February 2001 in order to establish the epidemiological profile of schistosomiasis in school children in this region. Stools and urines of 724 school children were examined. Faeces were examined by direct analysis completed by Kato and Ritchie methods. Analysis of urine samples was made through the technique of centrifugation (2.000 g for 10 minutes). This survey revealed the importance of schistosomiasis. 20.6% of the subjects were found carriers of Schistosoma mansoni eggs, 12.6% carriers of Schistosoma haematobium eggs and 3.2% were found carriers of eggs of two Schistosoma species. Prevalence was higher in Adzope than in Agboville and Schistosoma mansoni was globally prevalent. Males were significantly more infected than females and older children were more infected than young children. The prevalence distribution among people could be explained by behaviour and occupations.

[Three cases of visceral leishmaniasis in Abidjan, Cote d'Ivoire]. / Leishmaniose viscérale à Abidjan à propos de 3 observations.

Three cases of visceral leishmaniasis were observed in a cohort of 528 patients admitted to the Department of Pulmonary Disease of the Cocody University Hospital Center in Abidjan, Côte d'Ivoire from June 2001 to May 2002. All three patients including 2 women and 1 man were young Ivorians. Assessment of predisposing factors demonstrated that all three patients had diminished immune systems resulting from long-term (2-month) steroid therapy in one patient and AIDS with low rates of CD4 T cells around 100 cells/microl in 2 patients. Clinical features were variable but mainly involved constant refractory fever, anaemia, lymphadenopathy and pleurisy with clear fluid. Despite treatment with meglumine antimoniate, two patients died within the first weeks.

[Revaluation of chloroquine therapeutic efficacy on children with uncomplicated Plasmodium falciparum malaria in eastern Ivory Coast (1999-2002)]. / Efficacité thérapeutique de la chloroquine dans le traitement du paludisme simple à Plasmodium falciparum de l'enfant dans l'est de la Côte-d'Ivoire (1999-2002).

OBJECTIVE: A prospective study was made from November 1999 to May 2002 in order to revaluate the therapeutic efficacy of chloroquine in pediatric Plamodium falciparum malaria in Ivory Coast. DESIGN: This study was included in the national Plasmodium falciparum-susceptibility supervision program. Two hundred and fifty-six out of 594 patients from six to 59 months of age were included. Chloroquine was administered in accordance with the standard 14 day WHO protocol; i.e. administered dose of 25 mg/kg, in split doses, over three days. RESULTS: Two hundred and forty-seven patients completed the treatment. Among these, 217 presented with adequate clinical response (87.8%). The percentage of therapeutic failure was 12.2% with 12 early cases of therapeutic failure and 18 late cases of therapeutic failure. Chloroquine was more efficacious in Agnibilékrou (11.3% of therapeutic failure), Bondoukou (10.4%), and Tanda (10%), than in Abengourou (16.4%). Parasitic reduction on patients with resistant Plasmodium was superior to 90%, from day 0 to day 3. The risk of therapeutic failure was significantly linked to patient age. CONCLUSION: Considering these results, the authors suggest that the first-line treatment with chloroquine must be continued for uncomplicated malaria in humans.

[Epidemiology of otomycoses at the University Hospital of Yopougon (Abidjan-Ivory Coast)]. / Épidémiologie des otomycoses au centre hospitalier et universitaire de Yopougon (Abidjan-Côte d'Ivoire).

OBJECTIVE: Otomycosis is a fungal infection, which leads to a damage of the external auditory meatus. The disease is worldwide in distribution but is said to be more common in tropical countries. Though otomycosis presumably occurs frequently in Africa, reports on its incidence and etiology are rare from Côte d'Ivoire. The objective of this study was to evaluate the prevalence of the disease and to identify aetiological agents as well as the risk factors. MATERIAL AND METHODS: A cross-sectional study was carried out in the Otorhinolaryngology Department of the University Teaching Hospital of Yopougon from September 2007 to February 2008. For laboratory investigation, specimens were collected by means of a sterile swab. Samples were inoculated on Sabouraud's Dextrose Agar with and without antibiotics and incubated at 30°C for a period of 1 to 2 weeks. Identification was performed by direct microscopic examination on Cotton Blue Mount preparation and slide culture examination was used for differentiation of morphology. Biotyping was performed using Carbohydrate Fermentation tests, Carbohydrate Assimilation Tests (galerie Api 20 CAux TM - Sanofi Pasteur), Germ tube Test, detection of chlamydospore formation on corn meal agar. RESULTS: A total of 110 patients (sex-ratio=1.2) with suspected cases of otomycosis were investigated. Itching, otalgia, and hypoacusis were the symptoms reported by the patients and the apparent signs were debris in the ear, scabs and inflammation of the external auditory meatus. Of these, 88 cases (80%) were confirmed specifically of mycotic etiology on the basis of positive culture with 92 isolates consisting of yeasts (65.2%) and moulds (34.8%). The predominant etiological agents were Aspergillus flavus (28.4%), Candida guilliermondii (19.3%) and Candida parapsilosis (18.2%). The predisposing factors included previous otological pathology (P=0.010), frequent scratching of the external ear canal and use of ear drops (RR=3.47; IC 95%=1.3-9.27). CONCLUSION: This study revealed the great prevalence of otomycosis in Abidjan, some predisposing factors and the aetiological agents. Management of otomycosis must include mycological examination for diagnosis and information for changing behaviour patterns leading to infection.

[Intestinal parasites in children in Biankouma, Ivory Coast (mountaineous western region): efficacy and safety of praziquantel and albendazole]. / Parasitoses intestinales infantiles à Biankouma, région des 18 Montagnes (ouest de la Côte d'Ivoire): étude de l'efficacité et de la tolérance du praziquantel et de l'albendazole.

Schistosomiasis and soil-transmitted helminthiasis are a global public health problem, especially among schoolchildren. The purpose of this study was to determine the overall and specific prevalences of intestinal helminth infection and to assess the clinical efficacy, tolerance, and safety of praziquantel and albendazole for treating it. A descriptive cross-sectional study based on random sampling with one degree of freedom was conducted from November 2006 to March 2007 in the primary schools of Biankouma, Côte d'Ivoire. Stool samples were collected from 386 children aged from 4 to 15 years and analyzed by direct examination, with both the simplified Ritchie and Kato techniques. Children infected by schistosomiasis and soil-transmitted helminthiasis eggs were treated with praziquantel (40 mg/kg in a single dose), albendazole (400 mg/kg in a single dose) or both, as deemed necessary. The prevalence rate of intestinal parasite infection was 55.2%, including overall 15.4% with more than one parasite: two in 14.2% and three in 1.2%. Infection was correlated with male gender and older age. The most frequent helminths were Schistosoma mansoni (35.5%) and Necator americanus (25.9%). The efficacy rate for praziquantel, defined as parasite-free stools, was 57.7% on day 14 and 80.9% on day 90. The efficacy rate for albendazole on day 7 was 96.1% for Ascaris lumbricoides, 93% for Necator americanus and 81.3% for Trichuris trichiura. Adverse effects were common (40.8%) but minor (abdominal pain, headache, and itching) within 2 to 4 hours after intake of praziquantel.