[Evaluation of stool microscopy and culture to assist the diagnosis of pulmonary tuberculosis in a tuberculosis endemic country]. / Évaluation de la microscopie et de la culture des selles dans le diagnostic de la tuberculose pulmonaire dans un pays d'endémie tuberculeuse.

OBJECTIVE: the aim of this study is to evaluate the performance of stool microscopy and culture in the diagnosis of pulmonary tuberculosis (PTB). MATERIAL AND METHOD: In resource-limited settings, PTB is mainly diagnosed in sputum by microscopy methods. In patients unable to provide sputum, invasive procedures are necessary to obtain alternative respiratory tract specimens. Because Mycobacterium tuberculosis complex (MTC) organisms are known to survive in gastric fluid, we hypothesized that swallowed MTC organisms would be detectable in stool samples. We compared the presence of MTC organisms in sputum and stool specimens collected at the same time from the same patients. RESULTS: We included samples routinely submitted to our laboratory of microbiological diagnosis from patients with suspected PTB. In addition, a stool specimen was collected within 24 h of the sputum collection or gastric aspirate. In the 57 patients included, sputum microcopy and culture confirmed respectively 9 (21%) and 15 (26%) cases. Stool samples made it possible to confirm 9 cases by microscopy and 5 cases by culture. The sensitivity of microscopy was 60% and that of culture 33%. Sputum analysis was negative for one HIV-infected patient, but the stool sample was positive and permitted the diagnosis of PTB. CONCLUSION: This study proves that despite the low sensitivity of stool cultures it can be an alternative or additional interesting sample for the diagnosis of PTB in patients who have difficulty expectorating.

[Etiology of vaginal infections in Ouagadougou (Burkina Faso)]. / Étiologies des infections vaginales à Ouagadougou (Burkina Faso).

OBJECTIVE: to determine the specific antimicrobial activity of the drugs proposed in the national algorithm for treatment of vaginal infections. METHOD: Over a three-month period, the bacteriological laboratory of the Yalgado-Ouédraogo University Hospital in Ouagadougou analyzed vaginal swabs from women seen at 5 health-care facilities in that city. RESULT: The study included 404 women with a mean age of 29 years. The microbes with the highest incidence rates were various species of Candida (20%), Gardnerella and/or Mobiluncus (18.8%), and Ureaplasma/Mycoplasma (10.9%). The agents isolated were highly susceptible to ciprofloxacin, erythromycin, fluconazole, miconazole, and nystatin. CONCLUSION: This study demonstrated the continuing efficacy of the drugs in the national algorithm for treatment of vaginal infections, which is associated with compliance with the recommended diagnostic procedure and therapeutic protocol.

Streptococcus pneumoniae invasive infections in Burkina Faso, 2007 to 2011.

OBJECTIVE: We had for aim to determine the epidemiology of meningeal and lung invasive infections due to Streptococcus pneumoniae in Burkina Faso. MATERIAL AND METHODS: We screened for S. pneumoniae with the usual bacteriology techniques and with real time polymerase chain reaction (rt-PCR) in 7917 samples of cerebrospinal fluid (CSF) and pleural fluid (PF) collected in the Ouagadougou Yalgado Ouedraogo Teaching Hospital, from 2007 to 2011. RESULTS: S. pneumoniae was identified in 476 (6%) samples including 455 (5.7%) in CSF and 21 (0.3%) in PF. Sixty-seven percent of invasive infections occurred in patients 15 years of age or less, without any significant sex ratio difference. The infections occurred most frequently between January and August, with the first and most important peak between January and May (dry season) and the second peak between June and August (at the beginning of rain season). The introduction of rt-PCR proved the under diagnosing of invasive infections by usual bacteriological methods (latex agglutination assay and culture). CONCLUSION: Invasive pneumococcal infections occur mainly in patients 15 years of age or less, without any difference in sex ratio and with peaks in the dry season. Vaccinal schedules should include all age ranges in Burkina Faso.

[Infectious Etiologies of the acute diarrheas of the child from 0 to 5 years at the Pediatric University hospital Charles de Gaulle (Ouagadougou, Burkina Faso)]. / Etiologies infectieuses des diarrhees aiguës de l'enfant de 0 a 5 ans au centre Hospitalier Universitaire Pediatrique Charles de Gaulle (Ouagadougou, Burkina Faso).

To identify the infectious agents responsible for acute diarrheas in children from 0 to 5 years, with the aim of improving care, we led a cross-sectional prospective study at the Pediatric University hospital Charles de Gaulle from January 1st - November 30th, 2009. A sample of 103 children's stools hospitalized for acute diarrhea was analyzed. The average age of the patients was of 9.5 months and the most affected age bracket was the one from 0 to 12 months. More than half of the cases of diarrheas (60.2%) had an infectious etiology of which 33% of viral origin, 21.4% bacterial, 9.7% parasitic and in 9.7% of the cases a co-infection. In the viral diarrheas, rotavirus was observed in 17.5% of the cases and serotypes adenoviruses 40, 41 in 15.5% of the cases. The isolated bacteria were essentially represented by enteropathogenic Escherichia coli (21 cases). This bacterium had a strong resistance to amoxicillin, cotrimoxazole (90%) as well as in the amoxicillin+Clavulanic acid (57%). The ascendancy of rotavirus in the etiology of the acute diarrheas of children from 0 to 5 years hints to a need for vaccination against this infectious agent. Aside from the ineffectiveness of group A penicillins and of the cotrimoxazole against most of the isolated bacteria calls to medical prescribers to reconsider antibiotic treatment in the diarrheas of the children.

Afin d'identifier les agents infectieux responsables des diarrhées aigues chez les enfants de 0 à 5 ans, dans le but de mieux les prendre en charge, nous avons mené une étude prospective transversale au Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle du 01 janvier au 30 novembre 2009. Un échantillon de 103 selles d'enfants hospitalisés pour diarrhée aigue a été analysé. L'âge moyen des patients était de 9,5 mois et la tranche d'âge la plus touchée était celle de 0 à 12 mois. Plus de la moitié des cas de diarrhées (60,2 %) avaient une étiologie infectieuse dont 33% d'étiologie virale, 21,4 % bactérienne, 9,7% parasitaire et dans 9,7 % des cas il y avait une co-infection. Dans les diarrhées virales, les rotavirus ont été observés dans 17,5 % des cas et les adénovirus serotypes 40, 41 dans 15,5 % des cas. Les bactéries isolées étaient représentées essentiellement par Escherichia coli entéropathogène (21 cas). Cette bactérie avait une forte résistance à l'amoxicilline, au cotrimoxazole (90 %) ainsi qu'à l'amoxicilline+Acide clavulanique (57 %). La prépondérance du rotavirus dans l'étiologie des diarrhées aiguës de l'enfant de 0 à 5 ans commande la promotion de la vaccination contre cet agent infectieux. Par ailleurs l'inefficacité des pénicillines du groupe A et du cotrimoxazole contre la plupart des bactéries isolées interpelle les prescripteurs à la rationalisation de l'antibiothérapie dans les diarrhées des enfants.

[Bacteriological profile of chronic otitis media in the ENT and neck surgery department at the Ouagadougou University Hospital Center (Burkina Faso)]. / Profil bactériologique des otites moyennes chroniques au CHU de Ouagadougou (Burkina Faso).

UNLABELLED: The specific germs that cause chronic otitis media determine the treatment necessary. The purpose of this study was to identify the pathogens involved in this disease and to determine the sensitivity of the antibiotics commonly used in order to improve treatment. METHODS: This prospective study took place over 12 months and recorded 53 cases of chronic otorrhea in the ENT department of Ouagadougou University Hospital: 41 underwent cytologic and bacteriologic analysis. RESULTS: We identified 34 cases of bacterial infection (83%), 2 cases of fungal infection (5%) and 5 sterile cultures (12%). The bacteria isolated most frequently were Staphylococcus aureus (29%), Pseudomonas aeruginosa (26%) and Proteus mirabilis (18%). These organisms were most sensitive to fluoroquinolones (84%) and third-generation cephalosporins (77%). However, amoxicillin and tetracycline were fairly active against these pathogens, with sensitivity rates of respectively 19% and 7%. CONCLUSION: These data could help guide regional practitioners in choosing probabilistic antibiotic treatment. Sensitivity testing nonetheless remains needed in chronic otorrhea, to verify the efficacy of initial treatment and guide adequate care.

Diarrhoeagenic Escherichia coli detected by 16-plex PCR in children with and without diarrhoea in Burkina Faso.

The importance of diarrhoeagenic Escherichia coli (DEC) in Africa is poorly understood, and is unknown in Burkina Faso. This study investigated the occurrence of five major DEC pathogroups in primary cultures of stool samples from 658 Burkinabe children under 5 years old using 16-plex PCR for virulence-associated genes. At least one DEC pathogroup was detected in 45% of 471 children with diarrhoea and in 29% of 187 children without diarrhoea (p <0.001). More than one DEC pathogroup was detected in 11% of children with and 1% of children without diarrhoea (p <0.001). Enteroaggregative E. coli was the most common pathogroup in both children with diarrhoea (26%) and children without diarrhoea (21%). Enteropathogenic E. coli and enterotoxigenic E. coli were detected significantly more often in children with diarrhoea (16% and 13%) than in children without diarrhoea (5% and 4%; p <0.001 for both pathogroups). Shiga toxin-producing E. coli and enteroinvasive E. coli were detected only in children with diarrhoea (2% and 1%, respectively). Diarrhoeagenic E. coli, especially enteropathogenic and enterotoxigenic, may be important, unrecognized causes of childhood diarrhoea in Burkina Faso.

[Susceptibility to antibiotics of Staphylococcus strains isolated in Ouagadougou, Burkina Faso]. / Sensibilite aux antibiotiques des souches de Staphylocoques isolees a Ouagadougou, Burkina Faso.

INTRODUCTION: The sensibility of bacteria in a general way decreased a lot, staphylococci present a resistance to the penicillin in more than 80% of the cases. The aim of our work was to determine the level of sensibility of staphylococci, particularly that of resistant Staphylococcus aureus to Meticilline (SARM). MATERIAL AND METHODS: It is a retrospective study concerning the profile of sensibility of the isolated strains of staphylococci of diverse pathological products.The antibiogramme was realized according to the classic technique and for the test in the oxacilline, the Mueller Hinton + 5% of NaCl was used. RESULTS: during the period of study 1296 strains of staphylococcus were isolated, 153 from hospital Staphylococcus aureus were little sensitive to the penicillin G (10%); however the oxacilline, the gentamicine and the erythromycine were very active (more than 80% of sensibility.The meticillino-sensitive Staphylococcus aureus were also sensitive to the gentamycine, erythromycine and ciprofloxacine; the character of meticillino resistant did not influence the activity of antibiotics as pristinamycin and the vancomycine (100%); however we note a resistance crossed with the erythromycine in more than 95% of the cases. CONCLUSION: the existence although weak of the strains meticillino resistant brings us to propose a regular surveillance of the SARM and to hold as active antibiotics of first line the pristinamycine, ciprofloxacine, gentamicine, with vancomycine as the alternative of last choice in a hospital environment.

[Salmonella meningitis in Ouagadougou, Burkina Faso, from 2000 to 2004]. / Méningites dues à Salmonella au CHU de Ouagadougou, Burkina Faso (2000-2004).

56 strains of Salmonella were isolated from the cerebro-spinal fluids (CSF) from meningitis suspected patients at the Yalgado-Ouédraogo University hospital center in Burkina Faso, from January 2000 to December 2004. 75% of the patients were less than 3 years old; 71.4% of the CSF were purulent, with an average of 523 leucocytes/mm3 and 78% of neutrophile polynuclears. The strains identified belonged mostly to Salmonella O: 4.5 group (51.8%). In vitro, 92.7% of the strains were resistant to ampicillin and this resistance was partially restored with amoxicillin/clavulanic acid; however no strain was resistant to ceftriaxone. For the overall 56 patients, 20 different antibiotherapy regimes were used and they were successful in only 27% cases while 71% of patients died and 2% escaped from the hospital. Neurologic sequels were found in a patient treated with both ceftriaxone and chloramphenicol. These results showed that the illness occurred mainly in infants and was associated with high mortality rate. Most of the Salmonella strains were multi-drug resistant. In spite of strains multi-antibiotics resistance, adequate definition of therapeutic lines and early treatment including ceftriaxone could lead to higher cure rates and may improve the outcome.

Population genetic data for 18 STR loci in Costa Rica.

Allele frequencies for 18 STR autosomal loci (D3S1358, VWA, FGA, D8S1179, D21S11, D18S51, D5S818, D13S317, D7S820, D16S539, TH01, TPOX, CSF1PO, Penta D, Penta E, D19S433, D2S1338 and SE33) were obtained from a sample of 191-500 unrelated individuals from Costa Rica, Central America.

[W135 meningococcus meningitis: study of 148 cases observed in 2002 and 2003 at the National Teaching Hospital of Ouagadougou, Burkina Faso]. / Méningites à méningocoque du sérogroupe W135: étude de 148 cas observes en 2002 et en 2003 au CHU-YO de Ouagadougou, Burkina Faso.

The purpose of this report is to describe the bacteriological features, clinical signs and therapeutic outcome of 148 cases of W135 meningococcus meningitis observed during meningitis outbreaks in Burkina Faso in 2002 and 2003. Diagnosis was based on microbiological study of cerebrospinal fluid. Cases of meningococcus meningitis were recorded throughout the study period with the peak number of cases occurring around the 14th week. There was a slight male predominance (56.1%) and young patients between one and 15 years accounted for 81.7% of cases. The mean interval between onset of symptoms and hospitalization was 2.6 days and the mean duration of hospitalization was 5.5 days. The most common clinical signs were fever (98.6%), stiff neck (90.5%),Brudzinski's sign (85.1%),Kernig's sign (66.2%), altered consciousness (41.9%), vomiting (36.5%) and headaches (34.5%). In most cases treatment with a singie dose of chiorazuphenicol in oil was curative. Overall mortality was 15.5% idth no correlation with sex or age. Seventeen of the 23 deaths occurred within 24 hours after their admission to the hospital. The other six deaths occurred on the second day after admission inS cases and fifth day in one case. Convulsions, shock and altered consciousness were consistent poor prognostic signs. A correlation was found between mortality and interval for hospitalization with better survival in patients receiving prompt treatment. Study of the susceptibility of 102 samples showed that W135 meningococcus was sensitive to penicillin G, ampicillin,ceftriaxone and chloramphenicol but resistant to sulfamides (cotrimoxazole). Bacterial meningitis is an Important factor of morbidity and mortality worldwide. Our findings indicate that the bacteriological, clinical and epidemiological characteristics of W135 meningococcus is do not differ greatly from those of meningococcus A. Since W135 meningitis is susceptible to antibiotics used to cure meningitis, campaigns to promote early detection and treatment must be continued.

STR data for 11 autosomal STR markers from Costa Rica, Central America.

Allele frequencies for 11 STR autosomal loci (F13A01, F13B, FESFPS, LPL, CSF1PO, TH01, TPOX, VWA, D16S539, D7S820 and D13S317) were obtained from a sample of 200 unrelated individuals from Costa Rica, Central America.

Molecular characteristics of Neisseria meningitidis strains isolated in Burkina Faso in 2001.

In the course of an epidemic of meningitis in Burkina Faso in 2001, 27 cerebrospinal fluid samples from patients in 7 districts were forwarded to Norway for isolation and characterization of the causative agents. Neisseria meningitidis was isolated from 13 (48%) samples. The isolates were analysed using serological and genetic methods. Of the 13 strains, 4 were serogroup A, serotype 21:P1.9, sequence type (ST)-5 and belonged to clonal subgroup III, while the remaining 9 strains were serogroup W135, serotype 2a:P1.5,2, ST-11 and belonged to the electrophoretic type-37 complex. PCR analyses revealed meningococcal DNA in 13/14 culture-negative samples. Sequence analysis of the PCR products demonstrated that at least 3 different meningococcal strains were responsible for these 13 cases. Our results show that the W135 strain associated with the 2000 hajj (Muslim pilgrimage) outbreak was a significant cause of disease in Burkina Faso in 2001. Further studies are warranted to determine whether W135 is about to replace serogroup A in sub-Saharan Africa.

[Laryngo-tracheo-bronchial foreign bodies in children at the University Hospital Center of Ouagadougou (analysis of 96 cases)]. / Les corps étrangers laryngo-trachéo-bronchiques chez l'enfant au CHU de Ouagadougou (une analyse de 96 observations).

Over a 10-year period, a series 96 patients were treated for laryngotracheal and bronchial foreign bodies in the ENT department of the Ouagadougou University Hospital Center (Burkina Faso). The purpose of this study was to analyze the epidemioclinical features and therapeutic pitfalls encountered in that series and to propose measures to improve management. The age of patients ranged from 10 months to 14 years. The male-female ratio was 1.7. Anamnesis documented foreign body aspiration was obtained in 77% of cases. The foreign body was organic in 78 cases (81.2%) including vegetal material in 56 cases. Management was delayed due to late diagnosis since only 59.3% of the patients were admitted to the hospital within the 48 first hours. Endoscopic removal was performed in all cases but such procedures remain challenging in developing countries due to a lack of proper anesthetic facilities, skilled personnel and adequate equipment. Tracheostomy was performed in 10.4% of cases mainly in patients with foreign bodies located in larynx. One patient died during extraction. In addition to providing more information and education on prevention of laryngotracheal and bronchial foreign bodies, better management requires better training of medical personnel and improvement of technical facilities.

Haemoglobin C protects against clinical Plasmodium falciparum malaria.

Haemoglobin C (HbC; beta6Glu --> Lys) is common in malarious areas of West Africa, especially in Burkina Faso. Conclusive evidence exists on the protective role against severe malaria of haemoglobin S (HbS; beta6Glu --> Val) heterozygosity, whereas conflicting results for the HbC trait have been reported and no epidemiological data exist on the possible role of the HbCC genotype. In vitro studies suggested that HbCC erythrocytes fail to support the growth of P. falciparum but HbC homozygotes with high P. falciparum parasitaemias have been observed. Here we show, in a large case-control study performed in Burkina Faso on 4,348 Mossi subjects, that HbC is associated with a 29% reduction in risk of clinical malaria in HbAC heterozygotes (P = 0.0008) and of 93% in HbCC homozygotes (P = 0.0011). These findings, together with the limited pathology of HbAC and HbCC compared to the severely disadvantaged HbSS and HbSC genotypes and the low betaS gene frequency in the geographic epicentre of betaC, support the hypothesis that, in the long term and in the absence of malaria control, HbC would replace HbS in central West Africa.

[Pityriasis rosea in secondary schools in Ouagadougou, Burkina Faso]. / Pityriasis rosé de Gibert dans les écoles secondaires à Ouagadougou (Burkina-Faso).

BACKGROUND: Pityriasis rosea is a spontaneously regressive benign erythematous squamous dermatosis. A better understanding of this condition in developing countries would be useful. PATIENTS AND METHODS: We conducted a cross section study based on one-day surveys in Ouagadougou, Burkina Faso, secondary schools. The stratified cluster sampling method described by Henderson was used. Six thousand pupils were examined to collect epidemiology and clinical data and to determine the presence of complications and results of complementary explorations performed. RESULTS: Thirty-six cases of pityriasis rosea were observed (0.6 p. 100). Prevalence was higher in children from an unfavorable social and economic background. A typical eruption was often observed with classical localizations and morphology in 86.1 p. 100 of the cases. Pruritus was often observed with an inaugural lesion (61.1 p. 100) predominantly on the upper limbs (54.6 p. 100) and the trunk (31.8 p. 100) measuring 1 to 3 cm. A typical second eruption was found in most cases, situated on the trunk (75 p. 100), distal portions of the limbs (64.4 p. 100), proximal portions of the limbs (33.3 p. 100) and the neck (30.5 p. 100). The eruption evolved for 1 week to 1 month in most cases (61 p. 100). In 55.5 p. 100 of the cases, therapeutic abstention was the rule. Secondary treatment-related complications occurred in 38.9 p. 100 of the cases. Stool studies generally demonstrate ameba cysts. Syphilis serology was negative. DISCUSSION: Our sampling technique in the secondary school setting provided a representative sample of the urban population of African cities. This work demonstrated the variability of prevalence by social and economic conditions and is in favor of an infections cause, demonstrating several similar features with other series reported in the literature. Generally, a stool study is not necessary and syphilis serology is negative in typical cases. Health care workers should be more aware of pityriasis rosea in order to avoid poorly adapted treatment.