Estimates of serious fungal infection burden in Côte d'Ivoire and country health profile.

Due to limited access to more powerful diagnostic tools, there are few data on the burden of fungal infections in Côte d'Ivoire, despite a high HIV and TB burden and many cutaneous diseases. Here we estimate the burden of serious fungal infections in this sub-Saharan country with a health profiling description. National demographics were used and PubMed searches to retrieve all published articles on fungal infections in Côte d'Ivoire and other bordering countries in West Africa. When no data existed, risk populations were used to estimate frequencies of fungal infections, using previously described methodology by LIFE (www.LIFE-Worldwide.org). The population of Côte d'Ivoire is around 25 million; 37% are children (≤14 years), and 9% are>65 years. Tinea capitis in children is common, measured at 13.9% in 2013. Considering the prevalence of HIV infection (2.6% of the population, a total of ∼500,000) and a hospital incidence of 12.7% of cryptococcosis, it is estimated that 4590 patients per year develop cryptococcosis. For pneumocystosis, it is suggested that 2640 new cases occur each year with the prevalence of 11% of newly diagnosed HIV adults, and 33% of children with HIV/AIDS. Disseminated histoplasmosis is estimated a 1.4% of advanced HIV disease - 513 cases. An estimated 6568 news cases of chronic pulmonary aspergillosis (CPA) occur after pulmonary tuberculosis (a 5-year prevalence of 6568 cases [26/100,000]). Allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitisation (SAFS) were estimated in 104/100,000 and 151/100,000 respectively, in 1,152,178 adult asthmatics. Vulvovaginal candidiasis (VVC) is common and recurrent VVC affects ∼6% of women in their fertile years - 421,936 women. An unknown number develop candidaemia and invasive aspergillosis. The annual incidence of fungal keratitis is estimated at 3350. No cases of sporotrichosis, mucormycosis and chromoblastomycosis are described, although some cases of mycetoma and Conidiobolus infection have been reported. This study indicates that around to 7.25% (1.8 million) of the population is affected by a serious fungal infection, predominently tinea capitis in children and rVVC in women. These data should be used to inform epidemiological studies, diagnostic needs and therapeutic strategies in Côte d'Ivoire.

[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.

Antibacterial activity of the stem bark of Tieghemella Heckelii Pierre ex. A Chev against methicillin-resistant Staphylococcus aureus.

BACKGROUND: Tieghemella heckelii (Sapotaceae) is a medicinal plant used in Africa, particularly in Côte d'Ivoire for treating various diseases including infections. Identification of prospective antibacterial compounds from stem bark of this plant as a result of its medicinal virtue, led to screening activity against methicillin resistant bacteria. METHODS: Six extracts (hexane, chloroform, ethyl acetate, ethanol, methanol and sterile distilled water) were prepared and tested on methicillin resistant Staphylococcus aureus (MRSA) using broth microdilution method for activity assessment. From this experiment, the minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) of the plant extracts were determined in sterile 96-well microplates in order to search for both bacteriostatic and bactericidal effects. Afterwards, data analysis was performed using GraphPad Prism5 software (One-way ANOVA and Turkey Multiple Comparison test). The results were then presented as Mean ± SD for experiment repeated three times. RESULTS: Four extracts (ethyl acetate, methanol, ethanol and sterile distilled water) showed credible potency, with strong, significant, and moderate growth inhibition of the MRSA tested. The MIC values which varied from 45 µg/mL to 97 µg/mL according to microbial phenotype, resolutely established the activity of the plant extracts. Additionally, the MBC values which varied, depending on the type of bacteria strain, revealed the bacteriostatic and bactericidal effects of the active extracts against Methicillin-resistant Staphylococcus aureus. CONCLUSION: The present study is a confirmation of the therapeutic potential of Tieghemella heckelii and its promising contribution to the discovery of a novel antibacterial drug pertaining to these resistant strains.

Rapid detection of Mycobacterium tuberculosis complex in sputum Samples using PURE TB-LAMP assay.

OBJECTIVE/BACKGROUND: Lack of rapid and accurate diagnostic testing is a critical obstacle to global tuberculosis (TB) control. Sensitivity of sputum smear microscopy (SSM) is not optimal; however, it remains the most prevalent tool for TB confirmation in poor countries. As a part of passive case finding of TB detection, this study was conducted to determine the clinical performance of PURE TB-LAMP assay using liquid culture medium as the gold standard. METHODS: Centre Antituberculeux de Yopougon is one of the 17 intermediate Tuberculosis centers in Côte d'Ivoire. A standardized questionnaire was submitted to patients with signs and symptoms consistent with tuberculosis by a trained caregiver. After obtaining signed consent forms, sputum samples were collected according to National TB Control Programme guidelines (spot-morning). SSM after Ziehl-Neelsen staining and TB-LAMP assay were blindly performed on the first sample. Samples transported to Institut Pasteur de Côte d'Ivoire were decontaminated according to the N-acetyl-L-Cystein method. In Mycobacteria Growth Indicator Tube (MGIT), 500mL of pellets were inoculated and incubated in the MGIT 960 system. MPT64 antigen was detected in positive cultures. RESULTS: Of the 500 patients enrolled, 469 (232men and 239 women) patients were included. The mean ages of men and women were 36.9 (15-86) and 37.3 (15-37.3) years, respectively. There were 56 (12.2%) HIV-infected patients, including 14 women. Clinical isolates of M. tuberculosis complex were detected for 157 (33.5%) patients. Compared with culturing, the overall sensitivity and specificity of SSM were 86% (95% confidence interval [CI]=81-91) and 96% (95% CI=94-98), respectively. The overall sensitivity and specificity for TB-LAMP was 92% (95% CI=0.88-0.96) and 94% (95% CI=0.91-0.97), respectively. Positive likelihood ratios for TB-LAMP and SSM were 15.3 and 21.5, respectively, and negative likelihood ratios for TB-LAMP and SSM were 0.09 and 0.15, respectively. Among the 469 patients, active tuberculosis was detected using TB-LAMP assay and SSM in 162 (34.5%) and 147 (31.3%) patients, respectively. CONCLUSION: For accurate diagnostic of pulmonary TB, TB-LAMP could be used as a tool of the first intention.

[Detection of the IS2404 insertion sequence and ketoreductase produced by Mycobacterium ulcerans in the aquatic Heteroptera in the health districts of Dabou and Tiassalé in Côte d'Ivoire]. / Mise en évidence de la séquence d'insertion IS2404 et de la kétoréductase (Kr) produite par Mycobacterium ulcerans chez les Hétéroptères aquatiques dans les districts sanitaires de Dabou et Tiassalé en Côte d'Ivoire.

Buruli ulcer (BU) disease, caused by Mycobacterium ulcerans, is a major public health problem in Côte d'Ivoire. Until now, the mode of BU transmission was unknown, but recent studies implicate aquatic Heteroptera in the chain of transmission. This study was launched in Côte d'Ivoire to search for specific genetic markers for M. ulcerans in these bugs, including the insertion sequence IS2404 and ketoreductase (Kr), both involved in the synthesis of mycolactone, a toxin produced by these mycobacteria. Samples of aquatic Heteroptera were collected monthly with deep nets from ponds near villages in the health districts of Dabou and Tiassalé. After identification and enumeration of the bugs, batches of the same taxon underwent real-time PCR to search for the IS2404 target and Kr. Saliva of 69 specimens of Diplonychus sp randomly selected in the samples was also analyzed by PCR. In all, 283 single-taxon batches were created. Thus, PCR identified 26 batches belonging to the families of Belostomatidae, Naucoridae, Corixidae, Ranatridae, and Nepidae as positive for both targets. The IS2404 insertion sequence and Kr were present in 6 of the 69 samples analyzed in the saliva of Diplonychus sp. These aquatic Heteroptera suspected of infection by M. ulcerans might release it into the environment because of their ability to fly. They might thus be the source of human contamination.

Erratum.

[This corrects the article on p. 166 in vol. 4, PMID: 25215193.].

Antibacterial properties studies of trunk barks of Terminalia ivorensis, a commercial and medicinal species on some methicillin-resistant Staphylococci species strains.

BACKGROUND: Methicillin-resistant Staphylococcus aureus, Staphylococcus epidermidis and coagulase-negative Staphylococcus infections are a worldwide concern. Terminalia ivorensis, of Combretaceae family plant, is widely used traditional medicinal in Côte d'Ivoire to treat dermal diseases (affection in which Staphylococci are implied) including local inflammation and also to treat voice-loss. OBJECTIVES: This study focused to investigate the effect in vitro of the extracts of trunk barks of Terminalia ivorensis on some methicillin/oxacillin-resistant strains of Staphylococcus aureus, S. epidermidis, coagulase-negative S. and reference strain of S. aureus ATCC 25923. METHODS: Antibacterial activity of aqueous, 70% ethanolic 70% and aqueous residue extracts was assessed using agar disc-diffusion method and liquid medium microdilution method in 96 multi-well micro-titer plates. This method led us to determine minimum inhibition concentration (M.I.C.) and minimum bactericidal concentration (M.B.C.). The presence of chemical groups major was detected qualitatively. RESULTS: Aqueous and 70% ethanolic 70% extracts showed significant activity against all the bacteria except aqueous residue when compared with the standard antibiotic oxacillin (5 µg/ml). M.I.C. for aqueous and 70% ethanolic 70% extracts ranged from 0,83-16,67 mg/ml and 0,156-13,33 mg/ml respectively. Viable cell determination revealed the bactericidal nature of the two barks extracts. The 70% ethanolic 70% extract exhibited the highest activity according to the M.B.C. values. The phytochemical analysis indicates the presence of tannins, saponins, flavonoids, terpen/sterols, coumarins, polyphenols and traces of alkaloid. CONCLUSION: The in-vitro antibacterial efficacy shown by the barks of this plant and his lushness in chimical compounds, would justify use of this one in the traditional treatment of some diseases of microbial origin. These compounds could be suggested to provide alternative solution to the development of new therapeutic agents.

Assessment of the genotype MTBDRplus assay for rifampin and isoniazid resistance detection on sputum samples in Cote d'Ivoire.

We conducted an evaluation study on the GenoType MTBDRplus assay's ability to detect mutations conferring resistance to rifampin and isoniazid directly from sputum taken from 120 smear positive pulmonary patients from tuberculosis (TB) centers in Cote d'Ivoire. The sputum was decontaminated by N-acetyl-l-cysteine (NALC) and comparatively analyzed with the MTBDRplus assay version 2.0 and the mycobacterial growth indicator tube (MGIT) 960 automated drug susceptibility testing (MGIT-DST). The Gene-Xpert Mycobacterium tuberculosis (MTB)/rifampicin (RIF) assay was performed for 21 sputa with absence of hybridization for at least one rpoB wild-type probes. Four and seven, respectively, discordant and concordant results were also analyzed. The mutations in the rpoB gene were 21 (17.5%), 20 (16.7%), 7 (5.8%), and 10 (8.3%), respectively, for D516V, H526Y, H526D, and S531L. S315T mutation in katG gene associated or not with mutation in promoter of inhA was detected in 76 (63.3%) of the sputum. Compared to MGIT-DST, the sensitivity and specificity of the MTBDRplus for rifampin resistance detection were 100% (75-100%) and 73.2% (61.3-84%), respectively. For isoniazid resistance detection, the sensitivity and specificity were, respectively, 95% (90-|99) and 95.1% (88.5-100%). Interpretation of 16 sputa without hybridization of rpoB wild-type probe 8 compared to those obtained with MGIT-DST and GeneXpert MTB/RIF was discordant and concordant, respectively, for 11 and 5.

[Investigation of urinary schistosomiasis outbreak in the primary school of the village Guébo 2, Abidjan, Côte d'Ivoire]. / Investigation d'un foyer épidémique de bilharziose urinaire dans l'école primaire du village de Guébo 2, Abidjan, Côte d'Ivoire.

We report the results of an outbreak investigation of urinary schistosomiasis in 2012 among school children at Guébo 2. Among the 250 school children, 107 (42.8%) had confirmed urinary schistosomiasis. Age ≥ 10y (OR = 2.6 [1.1 to 6.2]) and self-reported bathing in the river (OR = 14.0 [4.7 to 42.5]) were associated with the presence of S.h. in the adjusted analyses. A massive deworming of the population of Guébo-1&2 was conducted as epidemic-response.

Detection of Enteroviruses in Water Samples from Yopougon, Côte d'Ivoire by Cell Culture and Polymerase Chain Reaction.

The objective of this study was to compare sensitivities of enterovirus isolation from wastewater in different cell lines as well as to compare the sensitivity and specificity of isolation in cell culture with direct detection by reverse transcription polymerase chain reaction (RT-PCR). Sixty-eight samples of wastewaters were collected between September 2008 and January 2009 in Yopougon, Abidjan. Enteroviruses were concentrated according to World Health Organization recommendations. Viruses were inoculated into various cell lines while direct RT-PCR was performed on water concentrates. The buffalo green monkey kidney cell line was the most sensitive with 58.8 % of viral isolation. This was followed by the rhabdomyosarcoma cell line with sensitivity of 51.6 %, with human epidermoid carcinoma cell line showing sensitivity of 50 % and fibroblastic cells derived from transgenic mice LTK-1 (L20B) cell showing 23.50 % sensitivity. However, a lower specificity of 2.9 % was observed with the L20B cell line. 44.1 % of the samples were positive by direct RT-PCR detection while 51.47 % samples were positive by using RT-PCR on infected cell cultures. No difference in percentage positivity was observed using RT-PCR on infected tissue culture isolates or using RT-PCR directly on wastewater samples.

Use of rapid molecular test for multidrug-resistant tuberculosis detection among relapse cases in Cote d'Ivoire.

UNLABELLED: Tuberculosis is explicitly recognized as a major global public health problem. In Côte d'Ivoire, relapse cases represent 66.5% of patients eligible for retreatment according to the National Tuberculosis Control Program. This study objective was to detect multidrug-resistance tuberculosis among relapse cases. Patients were recruited in tuberculosis centers in routine. A standardized questioning was administrated. Two sputum samples were collected and transported at Institut Pasteur. Sputum samples were decontaminated by NALC method. The DNA extraction was realized with 500µl of decontaminated sputum sample with smear-positive. MTBDRplus assay version 2.0 was performed according to the manufacturer's instruction. An internal quality control program with positive and negative controls was implemented for interpretation of results. In total 146 relapse cases with smear positive were studied. Out of selected patients, 130 had received the 2RHZE/4RH regimen and 16, the 2RHZES/1RHZE/5HRE. In group of relapse cases previously treated with 2RHZE/4RH regimen, 40 (31.3%, IC95%: [0.23; 0.39]) had punctual mutations at codon 526 in rpoB gene. Although, in patients under treated with 2RHZES/1RHZE/5HRE, a mutation in rpoB gene was identified in 12 of 16 sputum samples. Thirteen mutations conferring a resistance to Isoniazid were observed of which 9 in katG gene and 4 in katG and promoter region of inhA gene. The comparison (Chi-square with Yates correction) of resistance rates to Rifampin estimated showed a statistically significant difference. CONCLUSION: Use of a rapid method to detect drug-resistance in recurrent TB cases has permitted to identify patients eligible for first-line drugs or not.

[Epidemiology of bacterial infection materno-fetal at Abidjan- Ivory Cost: prospective study of eighty (80) cases]. / Epidemiologie de l'infection bacterienne materno-fœtale a Abidjan-Cote d'Ivoire: etude prospective a propos de 80 cas.

The aim of our study was to describe the risk factors, clinical symptoms and bacteria isolated during fetal-maternal bacterial infections in hospitals. MATERIALS AND METHODS: This was a prospective, descriptive study conducted from August 2, 2007 to October 3, 2007 at the neonatology department and the delivery room of the Yopougon teaching hospital . All newborn babies presenting a risk factor of infection have been included in this study. A bacteriological evaluation including containing central, peripheral and gastric fluid samples was performed. Bacteriological tests (NFS, CRP, PCT) were also performed on those newborn babies. RESULTS: Eighty newborn babies were included. The maternal risk factors were dominated by prolonged breaking of membranes 62.5%. In the newborn bad APGAR score 56.3% and prematurity 18.8%, were noted. The main clinical symptoms were neurological, , respiratory and digestive 52.5%, 44.4% 37.5%, respectively. The main pathogens isolated were 65.5% Staphylococcus coagulase negative, 13.8% Staphylococcus aureus, 6.9% Pseudomonas aeruginosa, 3,4% Klebsiella pneumoniae, and 3.4% Acinetobacter Sp. CONCLUSION: The clinical symptoms of the fetal-maternal bacterial infections are polymorphic. Germs found in our study differ from those usually found in the fetal-maternal bacterial infections in Europe.

L'objectif de notre étude était de décrire les facteurs de risques, la symptomatologie clinique et les bactéries isolées au cours des infections bactériennes materno-fœtales (IBMF) en milieu hospitalier. MATÉRIEL ET MÉTHODES: Il s'agissait d'une étude prospective à visée descriptive menée du 2 août 2007au 3 octobre 2007 dans le service de néonatalogie et la salle d'accouchement du CHU de Yopougon. Tous les nouveau-nés présentant un facteur de risque infectieux ont été inclus dans l'étude. Un bilan bactériologique comportant des prélèvements centraux, périphériques et liquide gastrique à été effectué. Un bilan biologique (NFS, CRP, PCT) a également été réalisé chez ces nouveau-nés. RÉSULTATS: Quatre vingt nouveau-nés ont été inclus. Les facteurs de risques maternels étaient dominés par la rupture prolongée des membranes 62,5%. Chez le nouveau-né on notait le mauvais APGAR 56,3 %, la prématurité 18,8%. Les principales manifestations cliniques étaient neurologiques 52,5%, respiratoires 44,4% et digestifs 37,5%. Les principaux germes isolés étaient Staphylocoque coagulase négative 65 ,5%, Staphyloccus aureus 13,8%, Pseudomonas aeruginosa 6,9%; Klebsiella pneumoniae 3,4 %; Acinetobacter Sp 3,4%. CONCLUSION: La symptomatologie clinique des IBMF est polymorphe. Les germes retrouvés au cours de notre étude diffèrent de ceux habituellement retrouvés au cours des IBMF en Europe.

[Detection of enteroviruses in urban wastewater in Yopougon, Abidjan]. / Détection d'entérovirus dans les eaux usées urbaines à Yopougon, Abidjan.

AIM: The aim of this study was to determine prevalence of enteroviruses in raw municipal wastewater and specify serotypes circulating. METHODS: After virus concentration by WHO recommend method, aqueous phase of 68 samples was inoculate on BGM, RD, L20B and Hep2 cells lines. Typing after titration was performed by microplate neutralization test with specific horse immune serum against EV (kit RIVM/WHO). NPEV strains were confirmed by RT-PCR test in 5'NC genomic region. Antigenic and molecular tests of Polioviruses intratypic differentiation were performed to determine vaccine or wild origin of Poliovirus strains. RESULTS: Viral isolation obtained 43/68 (65.15 %) positives samples. Among these 35/43 (81. 39%) were EV and 8/43 (19.04 %) non EV strain. Among EVs, 34/35 (97.14 %) were NEPV and 2/35 (5.71 %) vaccinal Poliovirus strains type 2 (Sabin-like). NEPV typing gave 77 % untypeable strains by conventionally method. The average virus concentration estimated in the raw sewage is 4.28×10(5) PFU/L. CONCLUSION: Various contacts between people and these waters expose them to health risks.

[Micronecta sp (Corixidae) and Diplonychus sp (Belostomatidae), two aquatic Hemiptera hosts and/or potential vectors of Mycobacterium ulcerans (pathogenic agent of Buruli ulcer) in Cote d'Ivoire]. / Micronecta sp (Corixidae) et Diplonychus sp (Belostomatidae), deux hémiptères aquatiques hôtes et/ou vecteurs potentiels de Mycobacterium ulcerans agent pathogène de l'ulcère de Buruli en Côte d'Lvoire.

Buruli ulcer is currently a major public health problem in Côte d'Ivoire. It is a neglected tropical disease closely associated with aquatic environments. Aquatic insects of the Hemiptera order have been implicated in human transmission of Mycobacterium ulcerans, the pathogenic agent of Buruli ulcer. The purpose of this preliminary study using the polymerase chain reaction (PCR) method was to evaluate aquatic insects in Sokrogbo, a village in the Tiassalé sanitary district where Buruli ulcer is endemic. Findings identified two water bugs hosting Mycobacterium ulcerans, i.e., one of the Micronecta genus in the Corixidae family and another of the Diplonychus genus in the Belostomatidae family. The PCR technique used revealed the molecular signatures of M. ulcerans in tissue from these two insects. Based on these findings, these two water bugs can be considered as potential hosts and/or vectors of M. ulcerans in the study zone. Unlike Diplonychus sp., this is the first report to describe Micronecta sp as a host of M. ulcerans. Further investigation will be needed to assess the role of these two water bugs in human transmission of M. ulcerans in Côte d'Ivoire.

Molecular characterization and genotyping of human rotavirus strains in Abidjan, Cote d'Ivoire.

In this study, we characterized human rotavirus strains recovered from infants and young children with acute diarrhea in Abidjan, Cote d'Ivoire, during 2000-2004. In total, 719 fecal specimens were collected from children aged 1-60 months with acute infantile gastroenteritis. Examination with a commercial enzyme-linked immunosorbent assay showed the presence of group A rotavirus antigen in 208 diarrheal specimens (28.9%). Polyacrylamide gel electrophoresis of the RNA extracted from rotavirus-positive stools yielded a variety of "long" and "short" RNA electropherotypes, which were used to help select strains for VP4 and VP7 genotyping. VP7 genotype G1 strains were circulating most commonly during the study period (53%), followed by G2 (22%) and G3 (5%) strains. Strains with multiple VP7 genotype reactivity were observed in 7.6% of specimens, and a similar number (8%) could not be typed at all. VP4 P[6] and P[8] strains circulated at similar levels (33%). Strains demonstrating multiple VP4 types were quite common (9%); however, 20% of the strains were untypeable by the methods used. Rotavirus strain diversity in Cote d'Ivoire was similar to that observed in other West African countries.

[Cryptococcal meningitis in two HIV-negative children]. / Cryptococcose neuroméningée chez deux enfants VIH négatif.

Cryptococcal meningitidis is rare, occurring particularly in adults infected with the HIV virus. The authors report the cases of 2 immunocompetent girls who were 3 and 13 years old. The authors describe the risk factors, the clinical symptoms, and the biological characteristics of the cerebrospinal fluid.

[Epidemiologic monitoring of human rabies in an endemic canine rabies area in the Ivory Coast]. / Surveillance épidémiologique de la rage humaine dans un contexte d'endémie de rage canine en Cote d'Ivoire.

AIM: The objective of this study was to analyze the epidemiologic monitoring of human rabies in the rabies medical center of Abidjan. PATIENT: A cross-sectional study was undertaken based on files of patients having consulted in the rabies center after exposure and suspicion of human rabies between January 2001 and June 2009. RESULTS: Twenty-six cases of human rabies were reported in 10,706,136 inhabitants (annual incidence of 0.028 cases per 100,000). The number of detected cases increased considerably after reinforcing the monitoring of the disease. Most cases occurred in an urban environment and concerned both sexes. The most concerned age range was under 31 years. The patients' were mostly school children and housewives. In all cases, the rabid animal was a dog and the type of exposure was a bite. Fifty-six percent of the victims had not received any local treatment and almost all no post-exposure prophylaxis. The mean delay before the first symptoms was 49.5 days after exposure and for death, 4 days after the onset of symptoms. Virological diagnosis was made in four cases. CONCLUSION: In spite of the increase of cases observed since 2006, certainly due to reinforcement of the monitoring network, improvement is needed to assess the real incidence of rabies in the Ivory Coast.