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.

[Epidemiological, clinical and evolving HIV-positive patients referred to the University Hospital of Point G, Bamako, Mali]. / Profil épidémioclinique et évolutif de patients VIH positif, référés au CHU du Point G, Bamako, Mali.

We conduct a longitudinal descriptive study in the department of infectious diseases to CHU of Point G during 18 months. It concerned adult patients referred from another care center. All the patients underwent systematic clinical examination and complementary exploration. Our sample was 352 HIV+ patients, with a mean age of 37.8 ± 9.8 years and a sex ratio (M/F)=0.94 shared among patients receiving ARV treatment (ART-s) and not (n-ART). Delay of reference was 5 ± 4.4 days. All patients benefited from clinical and paraclinical examinations. In both groups patients were mostly from level II. On admission, 132 cases were ART-s (38%). The main reasons for consultation were mainly fever [87.9%, p <0.05] and vomiting [17.4%, p =0.005] in the ART-s. Cough (p=0.9), and diarrhoea (p=0.5] were most noted in the n-TARV no statistically significant (no SS). Other reference reasons were similar in the 2 groups: headache (p=0.4), dyspnea (p=0.1). Selected diagnoses were dominated by tuberculosis (p=0.6) for n-ART no SS. Nontuberculosis infectious pneumonia (p=0.8) and cerebral toxoplasmosis (p=0.8) were comparable in the two groups. Severe systemic bacterial infections occurred more noted in the n-TARV (p=0.7). Malaria has been the main non-AIDS defining disease in the n-ART [-p=0.07] no SS. Patients were seen to late stage a corollary of a more collapsed of immunity in n-ART group [93.3%, p <0.05]. The fatality rate was similar in both groups (43.2%). Pathological factors were mainly tuberculosis (p=0.3) no SS. The factors involved significantly in TARV-s were non-tuberculosis bacterial pneumonia (p=0.001). The hospital mortality of HIV and AIDS is still important. Despite free ARVs and the large number of support center, the delay in diagnosis is a key as well as the lack of monitoring of patients factor.