[Cholera in Senegal from 2004 to 2006: lessons learned from successive outbreaks]. / Le choléra au Senegal de 2004 à 2006: les enseignements d'épidémies successives.

Between October 2004 and March 2006, a series of cholera outbreaks occurred in the West African nation of Senegal. The purpose of this study was to describe and analyze these outbreaks as a basis for prevention and control. A total of 29556 cases were reported during the 18-month epidemic. The attack rate ranged from 0.6 to 100 per 10(4) inhabitants depending on region. The epidemic unfolded in three phases. The first phase (11 weeks) was promptly contained using basic control measures such as public information campaigns and environmental hygiene. The second and longest phase (12 months) was marked by two outbreaks caused by massive religious gatherings and severe flooding. Cities particularly the capital Dakar (25.5% of cases) and the religious district of Touba in the north (41.1% of cases) were most affected due to the many social and environmental problems related to poor urban infrastructure. The isolated strains of Vibrio cholerae O1, biotype El Tor, were susceptible to doxycycline and fluoroquinolones (100%) but resistant to cotrimoxazole (90.3%). The overall death rate was 1.38%. Unfavorable prognostic factors included age over 60 years, delayed treatment and severe dehydration at the time of admission. Despite lower mortality this cholera epidemic was more widespread and longer than the previous outbreaks in Senegal and was associated with a trend to endemicity in urban areas.

[Adult purulent meningitis caused by Streptococcus pneumoniae in Dakar, Senegal]. / Les méningites purulentes à Streptococcus pneumoniae de l'adulte à Dakar.

The purpose of this retrospective study was to describe epidemiological, clinical, bacteriological and outcome features of purulent meningitis caused by Streptococcus pneumoniae in adult patients hospitalized in the infectious diseases clinic of the Fann University Hospital in Dakar, Senegal from 1995 to 2004. A total of 73 cases of pneumococcal meningitis were recorded during the study period. Streptococcus pneumoniae was the second cause of purulent meningitis after meningococcal infection. Sickle-cell disease (n=3) and HIV infection (n=9) were the main underlying factors and pneumonia was the main portal of entry into the CNS (51.8%). Coma was a frequent complication (61.6%). Penicillin-nonsusceptible Streptococcus pneumoniae (PNSP) accounted for 27.3% of isolated strains. However strains were sensitive to third-generation cephalosporin (100%) and chloramphenicol (68.2%) which were the most frequently used antibiotics. The mortality rate was 69.8% and neurological complications occurred in 13.7% of patients. The main unfavorable prognostic factors were cardiovascular collapse and/or coma at the time of admission and detection of pneumococcal strains by direct examination of CSF. The high mortality of pneumococcal meningitis in adult patients in Dakar shows the need to improve intensive care facilities and the growing incidence of PNSP underlines the requirement for better control of antibiotic prescription.

[Resistance of bacteria and antibiotic prescription in Fann University Teaching Hospital, Dakar]. / Résistance bactérienne et prescription d'antibiotiques au CHU de Fann, Dakar.

The objective of this study conducted in Fann University Teaching Hospital in Dakar, is to establish correlation beetwen the prescription and consummation of antibiotics in the one hand, and the susceptibility of strains isolated in this hospital on the other hand. An interview of medical practitioners and pharmacists was realised to appreciate the antibiotics used in the clinics, the bacteria taken aim, the criteria of choice, the place of antibiogram, the place of antibiotics in orders of medicines and pharmacists, the consummest family of antibiotics. In the lab, all of pathogen bacteria were tested by disc diffusion test (antibiogram) to appreciate the susceptibility to antibiotics. The results show that Enterobacteria represented 60.8% of isolates and among them, Escherichia coli (30.6%) was the most representative specie in hospitalized and non hospitalized patients. 52% of the strains of E. coli were susceptible to aminopenicillins in external patients, versus less than 35% in hospitalized. In Neurosurgery, Pseudomonas aeruginosa was the most frequent bacteria and all of the strains were susceptible to imipenem, dibekacin and ciprofloxacin. Beta-lactams were the most used drugs in the first place (78.8%), related to habits of prescription of medical staff and to avaibility of antibiotics. The choice of antibiotics must take the susceptibility of strains into account.