[Use of the Xpert® MTB/RIF test in routine screening of new cases of pulmonary tuberculosis in an endemic area]. / Test Xpert® MTB/RIF et dépistage des nouveaux cas de tuberculose pulmonaire en routine dans une zone de haute endémicité tuberculeuse.

BACKGROUND: Developed initially for the diagnosis of multidrug-resistant tuberculosis, the Xpert® MTB/RIF test has shown to be useful for the diagnosis of tuberculosis, especially among HIV-infected subjects. The objective of the study was to determine the contribution of the Xpert® MTB/RIF test for routine pulmonary tuberculosis diagnosis in an endemic area. METHODOLOGY: We undertook a prospective study among patients presenting with cough and sputum. The sputum was submitted to microscopic examination, to the Xpert® MTB/RIF test and cultured by the Mycobacteria growth indicator tube (MGIT) technique. The study compared cases of pulmonary tuberculosis confirmed by a positive sputum culture and cases with cough but negative sputum culture. RESULTS: In multivariate analysis, the factors associated with positive cultures were the following: male gender, cough for more than 2 weeks, loss of weight and fever. The estimated clinical suspicion score consisted of 4 signs each having a coefficient of 1. The sensitivity of each clinical sign varied between 79 and 94%. In 348 cases of negative microscopic examination (composed of 295 cases with score<4 and 53 cases with score=4), the predictive positive value of the Xpert® MTB/RIF was 80% for a score equal to 4 and 40.9% for a score<4. In cases of negative microscopic examination of the sputum, the Xpert® MRT/RIF test should be undertaken if the score=4. CONCLUSION: The diagnosis of tuberculosis in endemic zones could be improved by using the Xpert® MTB/RIF.

[Comparative diagnosis of bacterial pneumonia and pulmonary tuberculosis in HIV positive patients]. / Diagnostic comparé des pneumopathies bactériennes et de la tuberculose pulmonaire chez les patients VIH.

INTRODUCTION: Immunodepression induced by the human immunodeficiency virus (HIV) modifies the clinical, radiological and microbiological manifestations of pulmonary tuberculosis; leading to similarities between pulmonary tuberculosis and acute community-acquired bacterial pneumonia. A consequence is the high proportion of discordant pre- and post-mortem diagnoses of pneumonia. The aim of our study was to contribute to the improvement in the diagnosis of acute bacterial pneumonia in HIV positive patients in areas where tuberculosis is endemic. METHODS: This retrospective study in HIV positive patients has compared 94 cases of positive smear cases pulmonary tuberculosis and 78 cases of acute community-acquired bacterial pneumonia. RESULTS: Using logistic regression, the following features were positively associated with bacterial pneumonia: the sudden onset of signs (OR=8.48 [CI 95% 2.50-28.74]), a delay in the evolution of symptoms of less than 15 days (OR=3.70 [CI 95% 1.11-12.35]), chest pain (OR=2.81 [CI 95% 1.10-7.18]), radiological alveolar shadowing (OR=12.98 [CI 95% 4.66-36.12) and high leukocytosis (OR=3.52 [CI 95% 1.19-10.44]). These five variables allowed us to establish a diagnostic score for bacterial pneumonia ranging from 0 to 5. The area under the ROC curve was 0.886 [CI 95% 0.84-0.94, P<0.001]). Its specificity was >96.8% for a score of greater than or equal to 4. CONCLUSION: The diagnostic score for acute community-acquired pneumonia may improve the management of bacterial pneumonia in areas where tuberculosis is endemic.

[Clinical manifestations in patients exposed to an environmental toxic accident (Abidjan, Ivory Coast 2006)]. / Manifestations cliniques chez les sujets exposés à un accident toxique environnemental (Abidjan, Côte d'Ivoire 2006).

INTRODUCTION: In 2006, 528 tons of petroleum toxic waste have been released in Abidjan (Ivory Coast) during a major environmental accident. This study was aimed to describe the clinical manifestations provoked by these toxic waste. METHODS: We have analysed the records of patients admitted to the university hospital of Cocody (Abidjan) following exposure to toxic waste. All the information were recorded on specific files or on notification files created by the physicians of the National Institute of Public Health, the authority charged with the supervision of this exercise. The files were completed by the physician in the course of the examination of the patient. RESULTS: Over a period of 3-month-period, 10,598 patients were examined. The clinical manifestations affected all age groups. They were dominated by respiratory symptoms: pulmonary (74.5%) and upper respiratory (31.0%). Pulmonary symptoms included cough (48.8%), chest pain (37.9%), dyspnoea (9.5%) and a few cases of hemoptysis. Digestive symptoms mainly comprised abdominal pain (36.2%), diarrhea (23.0%), abdominal distension (19.9%) and vomiting (9.9%). The other symptoms were neurological, ophthalmic, cardiovascular and gynaecological. More than 96% of patients presented with at least two symptoms. The respiratory symptoms were significantly more frequent in patients over the age of 17 while diarrhea and vomiting were more often found in patients less than 17 years old. Chest pain was significantly more common in men while abdominal pain and vomiting predominated in women (P=0.001). CONCLUSION: The clinical consequences of toxic waste exposure were varied and sometimes serious. A medium- and long-term evaluation of the subjects is required.

Preparation and evaluation of cerium oxide-bovine hydroxyapatite composites for biomedical engineering applications.

The fabrication and characterization of bovine hydroxyapatite (BHA) and cerium oxide (CeO2) composites are presented. CeO2 (at varying concentrations 1, 5 and 10wt%) were added to calcinated BHA powder. The resulting mixtures were shaped into green cylindrical samples by powder pressing (350MPa) followed by sintering in air (1000-1300°C for 4h). Density, Vickers microhardness (HV), compression strength, scanning electron microscopy (SEM) and X-ray diffraction (XRD) studies were performed on the products. The sintering behavior, microstructural characteristics and mechanical properties were evaluated. Differences in the sintering temperature (for 1wt% CeO2 composites) between 1200 and 1300°C, show a 3.3% increase in the microhardness (564 and 582.75HV, respectively). Composites prepared at 1300°C demonstrate the greatest compression strength with comparable results for 5 and 10wt% CeO2 content (106 and 107MPa) which are significantly better than those for 1wt% and those that do not include any CeO2 (90 and below 60MPa, respectively). The results obtained suggest optimal parameters to be used in preparation of BHA and CeO2 composites, while also highlighting the potential of such materials in several biomedical engineering applications.

[Correlation of the manifestations of tuberculosis and the degree of immunosuppression in patients with HIV]. / Corrélations des manifestations de la tuberculose pulmonaire avec le degré d'immunodépression au VIH.

CONTEXT: Correlation of the manifestations of tuberculosis and the degree of immunosuppression in patients with HIV. BACKGROUND: The advent of HIV has contributed to the increase in the number of people with tuberculosis. The clinical and paraclinical of TB/HIV co-infected are polymorphic and function of immune status. OBJECTIVES: To determines the clinical and paraclinical characteristics of TB related to different levels of CD4 lymphocytes. METHODOLOGY: A retrospective case series based on analysis of 450 patients with both TB/HIV co-infections. It focused on the records of patients with pulmonary smear-positive (TPM +) with a positive HIV status. The effect of immunosuppression was analyzed in groups based on the CD4 count (<200/mm(3), of 200-350/mm(3) and>350/mm(3)), in a chronological fashion from April to September 2010 until there were 150 patients in each CD4 group. RESULTS: Among the 450 patients, 71.1% were between 25 and 45years old. The clinical signs were more significant as the level of CD4 fell. The clinical signs were predominantly fever (93%) and weight loss (62.7%). Pulmonary cavitation (59.3%), infiltrates (38.7%) and the location of the lesions at the lung apex (72%) were more common in the third group patients. By contrast, extra pulmonary lesions (mediastinal lymphadenopathy, pleurisy) and normal x-ray (9.3%) were more frequent in patients of the first group. The scarcity of cavitations (22.3% compared to 59.3% CD4>350) and the increase in associated lesions became more marked if patients were immunocompromised. Hematologic, hepatic, renal disorders were more frequent and severe in the most immunocompromised patient group. CONCLUSION: HIV-associated tuberculosis has an atypical clinical, radiological, biological presentation and is more severe when there is significant immunosuppression.

[Non-tuberculous pleural infections versus tuberculous pleural infections]. / Atteintes pleurales non tuberculeuses versus atteintes pleurales tuberculeuses.

INTRODUCTION: In countries where tuberculosis is endemic, the main differential diagnosis for pleural infection by common bacteria is pleural tuberculosis. OBJECTIVE: The purpose of our study was to determine the differences between pleural infection by common bacteria and that caused by pleural tuberculosis. METHODOLOGY: Our study was a retrospective analysis and compared the characteristics of confirmed pleural infection by common bacteria (PIB) and that due to pleural tuberculosis (PT). RESULTS: For the PIB, the signs evolved for 2.4 ± 1.4 weeks versus 5.6 ± 2.2 weeks for the PT (P=0.01). In multivariate analysis, for PIB the onset of symptoms was more abrupt (OR=3.8 [1.5; 9.9]; P=0.01), asthenia was less frequent (OR=0.3 [0.1; 0.9]; P=0.03), pleural liquid was more purulent (OR=40.0 [15.0; 106.7]; P<0.01). The blood neutrophil count was more frequently raised in cases of PIB (OR=2.5 [1.2; 5.4]; P=0.02). Pneumothorax/hydropneumothorax was less frequent in PIB (OR=0.3 [0.1; 1.0]; P=0.04). CONCLUSION: Clinical differences exist between pleural effusions caused by tuberculosis (TB) and those due to other bacterial infections. However, they are not sufficiently sensitive and therefore the search for the tuberculous bacillus must be systematic while waiting for implementation of new diagnostic tests for the organism.

[Clinical manifestations related to kitchen biomass smoke in African women]. / Manifestations cliniques liées à la fumée de cuisine chez les femmes en milieu africain.

CONTEXT: Fires of wood and charcoal play an essential part in the cooking of food in Africa. These fires emit thick smoke that has definite health consequences. OBJECTIVES: To determine the clinical manifestations related to kitchen smoke and to identify the type of fire most often incriminated. METHODS: It was a transverse study comparing the clinical features in women using three types of fire: wood, charcoal and gas. We questioned 200 women in each group who used one type of fire exclusively for five days a week for at least five years. RESULTS: Clinical manifestations associated with the smoke were reported in all the women using wood as opposed to 98.5% using charcoal and 45.5% using gas. More than 80% had physical signs. These comprised 89.1% upper respiratory and 77% pulmonary signs. Upper respiratory signs were the most common, mainly sneezing and nasal obstruction. At the pulmonary level, a predominance of signs was found in women using wood fires (47.3%) and charcoal (36.2%), the difference being statistically significant. The signs included chronic cough, chest pain and dyspnoea. Wheezes were found in 15% of the women. CONCLUSION: Cooking smoke exposes women to complications which are most frequently associated with the use of wood or charcoal.

[Predictive factors of lost to follow-up status during tuberculosis treatment]. / Facteurs prédictifs du statut « perdus de vue ¼ au cours du traitement de la tuberculose.

INTRODUCTION: Patients with contagious tuberculosis who are lost to follow-up risk sowing the disease among their circle of acquaintances. Moreover, a history of inadequate anti-tuberculous treatment is an important risk factor for the development of drug-resistant organisms. The purpose of this study was to identify risk factors for loss to follow-up among patients undergoing treatment for tuberculosis. METHODOLOGY: We performed a prospective cohort study among patients with contagious tuberculosis, beginning with anti-tuberculous treatment followed during six months, after initial education-information about their condition. We compared the characteristics of 152 patients lost to follow-up from tuberculosis treatment against those of 492 patients who were not lost to follow-up. RESULTS: Independent factors associated with a reduction in the risk of being lost to follow-up were: the presence of night-sweats (OR=0.46 [0.24-0.88]; P=0.018), the presence of thoracic pain (OR=0.27 [0.14-0.54]; P<0.001), screening for HIV (OR=0.41 [0.17-0.98]; P=0.045), fact to inform a person of its disease (OR=0.06 [0.01-0.41]; P=0.004), the application of directly observed treatment in the community (OR=0.34 [0.17-0.66]; P<0.001). CONCLUSION: Reducing loss to follow-up during treatment for tuberculosis requires the development of a "good attitude" through education-information about tuberculosis.

[Multi-drug resistance of tuberculosis: 81 patients monitored in an Ivory Coast pneumology unit]. / Tuberculose multirésistante: à propos de 81 patients suivis dans un service de pneumologie en Côte d'Ivoire.

BACKGROUND: The Ivory Coast management of chronic tuberculosis (TB) began in 2000. OBJECTIVES: The aim of this study is to determine the characteristics of the patients monitored for chronic TB and note the difficulties in patient management and outcome. METHOD: A retrospective review of the medical records of the patients receiving second-line treatment for chronic tuberculosis for at least 12 months. RESULTS: Eighty-one medical records were included. The average of age was 33.37 years. The sex ratio was 2.68. All of the patients lived in conditions of promiscuity. The recommendations for the treatment of failures and relapses were not always respected: 33.33% did not comply with the protocols, 53.1% non-prescription of the mycobiogramme and 22.2% non-respect for the follow-up calendar. During the diagnosis of the chronic tuberculosis, bilateral radiological lesions were found in 72.5% of the cases and one lung was destroyed in 14.7% of the cases. The isolates were Mycobacterium tuberculosis. The multi-drug-resistance of Mycobacterium tuberculosis was estimated at 95.5%. The side effects of the treatments were polymorphous with a frequency ranging from 46.4% to 61.3% during the follow-up period. The outcome of the patients is the following: 39.2% dropped out; 15.2% died; 30.4% were in the attack phase; 5.1% were cured; 5.1% were in the consolidation phase. CONCLUSION: The results of the treatment are disappointing. It is urgent to develop a strategy to reduce the number of drop-outs and provide the early diagnosis and treatment of multi-drug resistant tuberculosis.

[Smoking and educational status in Africans]. / Tabagisme et niveau d'instruction en milieu africain.

INTRODUCTION: Tobacco smoking is a scourge that continues to increase in developing countries despite its known consequences. Is the population of the Ivory Coast sufficiently informed about the consequences of smoking? For this reason, we decided to evaluate the knowledge of the effects of smoking among the people of Abidjan. OBJECTIVE: To evaluate the knowledge of the effects of smoking in the population of Abidjan. To relate this knowledge to the educational level and smoking status. METHODS: We evaluated knowledge about smoking and its consequences as a function of educational level and smoking status in the population of Abidjan over the age of 15 years. This was undertaken in 3 months, from November 2005 to January 2006, in the two busiest communes in Abidjan. The minimum number of persons required was 1152 but, in fact, we interviewed 1409. RESULTS: The prevalence of smoking was 36.5% with a predominance of males (sex ratio = 3:11). They were mainly young with a mean age of 27.44 years. This population's main sources of information on the ill effects of smoking were the mass media. In general, the subjects did not have a good understanding of smoking and its consequences. With regard to the diseases related to smoking, bronchial carcinoma and cardiovascular disorders were the best known, in 53.1 and 18.1%, respectively. With regard to the components of tobacco, nicotine was the best known (92.6%). Knowledge was related to the level of education: the subjects of a higher educational level were the most knowledgeable about the consequences of smoking. As a result, these subjects were less attached to smoking than the less educated. CONCLUSION: The consequences of smoking are poorly understood by the general population. With regard to the level of education, the better educated had a better understanding of the effects of smoking and were also those who smoked the least.

[Lyell's syndrome occurring in three HIV-positive patients undergoing anti-tuberculous therapy]. / Syndrome de Lyell chez trois malades VIH (+) sous traitement antituberculeux.

We describe three cases of Lyell syndrome - toxic epidermal necrolysis - occurring in patients under the respiratory service of CHU de Cocody in Abidjan in the Ivory Coast, who were undergoing anti-tuberculous (TB) chemotherapy. All three were adult males who were HIV-positive, but none of them were receiving anti-retroviral treatment. They were on standard anti-TB treatment; rifampicin, isoniazid, pyazinamide and ethambutol. The lesions appeared early during their treatment for TB (14, 20 and 45 days). The patients were on no other medication that might have caused Lyell's syndrome except one who had been on cotrimoxasole for 6 months without complications. Despite admission to the acute care facility and appropriate care two of the three patients died.

Polymerase chain reaction-single strand conformation polymorphism analyses of nuclear and chloroplast DNA provide evidence for recombination, multiple introductions and nascent speciation in the Caulerpa taxifolia complex.

Independent lines of evidence support an Australian origin for the Mediterranean populations of the tropical alga Caulerpa taxifolia. To complement previous biogeographical studies based on nuclear rDNA internal transcribed spacer (ITS), a new chloroplast marker was developed--the cp 16S rDNA intron-2. Sequence variability for both nuclear and chloroplast markers were assessed in 110 individuals using single strand conformation polymorphism. Comparison of intrapopulation genetic diversity between invasive Mediterranean and 'native' Australian populations revealed the occurrence of two divergent and widespread clades. The first clade grouped nontropical invasive populations with inshore-mainland populations from Australia, while the second clustered all offshore-island populations studied so far. Despite our finding of nine distinct nuclear and five distinct chloroplast profiles, a single nucleocytoplasmic combination was characteristic of the invasive populations and sexual reproduction was found to be very rare. C. taxifolia is clearly a complex of genetically and ecologically differentiated sibling species or subspecies.