[Nocardia aroensis and lung infection: first case report in Africa ]. / Infection pulmonaire à Nocardia aroensis: première observation en Afrique.

Nocardiosis is a rare disease that is difficult to diagnose. Pulmonary forms are most common in association with a variety of nonspecific symptoms. Up to now isolation of the offending species, i.e., Nocardia aroensis, has been reported only once during the first description in Japan. The purpose of this article is to report the second world case of isolation of the Nocardia aroensis in a 50-year-old immunocompetent African woman.

[Shoulder pain revealing tuberculosis of the humerus]. / Une épaule douloureuse révélant une tuberculose osseuse inhabituelle.

Tuberculous spondylitis is the most common form of musculoskeletal tuberculosis. However, extraspinal manifestations have been described with tuberculosis of the wrist, femur, foot or shoulder, as in the patient presented. Because of an often-indolent clinical presentation, the diagnosis is delayed and antituberculous treatment is not able to prevent serious bone destruction.

[Pleuro-pulmonary manifestations disclosing hepatic amoebiasis]. / Manifestations pleuropulmonaires révélatrices de l'amibiase hépatique.

During a mission in ex-Yugoslavia between 2001 and 2004, three French soldiers were sent home because of right pneumopathy, right pleurisy after appendicectomy, haemoptysis and liver haematoma, respectively. They previously were stationed in Africa and/or South America. The initial diagnosis was quickly modified: pleuropulmonary manifestations of amoebic hepatic abscess in two cases, and pleuropulmonary amoebiasis in the last case. The outcome was favourable with standard anti-amoebic treatment. The reports illustrate the possibility of hepatic amoebiasis with local pleuropulmonary manifestations and an exceptional case of pleuropulmonary amoebiasis with hepatobronchial fistula. The authors report this experience because it demonstrates that amoebiasis in European countries remains an often forgotten diagnosis. Although known for a long time in developing countries, amoebiasis in the military or in tourists should be systematically considered.

[Perception of nosocomial risk among healthcare workers at "Hopital Principal" in Dakar, Senegal (survey 2004)]. / Perception du risque nosocomial parmi le personnel hospitalier de l'Hôpital Principal de Dakar.

Nosocomial Infection (NI) is also observed in healthcare facilities in non-Western countries. The purpose of this report is to describe the findings of a survey undertaken to evaluate hygiene procedures implemented at the "Hopital Principal" in Dakar, Senegal and to assess perception and awareness of nosocomial risk among the hospital staff. A total of 264 healthcare workers were interviewed. Mean age was 39 years (range, 18-60) and the sex ratio was 1.3 (150 men/114 women). Sixty (22.7%) had university degrees, 106 (40.2%) had secondary school diplomas, 50 (18.9%) had attended middle school, and 13 (4.9%) had no schooling. Analysis of interview data showed that 56.1% (157/264) defined NI as infection acquired at the hospital but that only 9.8% (n=26) knew that a minimum 48-hour delay was necessary to distinguish nosocomial from community acquired infection. While understanding about NI was correlated with education level, data showed that 1 out of 3 physicians (13/39) failed to give the exact definition. Hand contact was cited as the second route of transmission. Isolation precautions were understood by 22.7% of personnel (60/264). Systematic handwashing was reported by 363% (96/264) but observation demonstrated that it was not performed properly regardless of the category of personnel. Care protocols were understood by 54.6% of persons interviewed (144/264). A hygiene-training course had been attended by 52.2% (n=138). Two thirds of the staff (69.7%: 54/264) was able to identify the hygiene nurse. Ninety-eight health care providers (37.1%) were familiar with the CLIN (Comités de Lutte contre les Infections Nosocomiales).

[Poster presentations]. / La communication affichée.

Posters have become an essential tool for dissemination of study findings at medical meetings. By presenting a quick snapshot, posters can be an effective means of communicating the main findings of the research quickly and of stimulating rewarding exchanges with the people in attendance. Success depends on catching and holding the attention of passing attendees long enough to establish contact and share knowledge and experience. The purpose of this article is to provide a few guidelines and techniques for preparing and presenting effective and clear research posters at scientific meetings.

[Management of type 2 diabetes in subsaharan Africa: update and perspective]. / Prise en charge du diabète de type 2 en Afrique subsaharienne: constats actuels et perspectives.

Management of type II diabetes in sub-Saharan Africa presents a number of aspects that must be analyzed successively. Regarding the continent of Africa, implementing a strategy to control diabetes will require extensive information and education campaigns not only for health care workers but also for the general population as well as the creation of adequate infrastructure to optimize the availability of treatment. Regarding care modalities in Africa, the overall principles of management are the same as anywhere in the world. However these modalities must be adapted to the sociocultural environment of the patient. Objectives must be simplified without compromising the scientific requirements. Regarding patients, African perceptions about the disease are very different from those taught in Western schools. The different ethnocultural components of the disease must be recognized in order to optimize overall patient management.

[Using PubMed subject headings to enhance reference searches]. / Utiliser les descripteurs dans PubMed pour améliorer une recherche bibliographique.

The PubMed search engine is an essential tool to stay abreast of the latest medical literature on specific topics. While the basic search techniques are common knowledge, the ability to use medical subject headings properly is an essential in obtaining valuable references. The purpose of this article is to explain what medical subject headings are and how they can be used to improve the results of reference searches in PubMed.

[Empiric antituberculous therapy in patients with unexplained exsudative pleural effusion. Is it valid in Senegal?]. / Le traitement antituberculeux présomptif est-il licite dans la pleurésie lymphocytaire exsudative inexpliquée au Sénégal?

AIM: Pleural biopsy and adenosine deaminase activity are not available at our center and the treatment begins without substantiation diagnosis in patients with tuberculous pleural effusion (PE). METHODS: In order to evaluate the validity of an empiric antituberculous therapy in exsudative PE with high prevalence of lymphocytes, we conducted a retrospective study during 1 year. Patient was enrolled if no signs of tuberculous infection, pneumonia or cancer were present. RESULTS: During 1 year, 38 patients were enrolled (23 males, mean age=36 years). PE was major (> 2/3 of the lung) in 14 cases, moderate (between 1/3 and 2/3) In 18 cases and minor (<1/3) in 6 cases. Tuberculous contagion was observed in 10 patients. Tuberculinic test was positive in all patients (12-24 mm). Clinical and radiological cure was obtained in 37 cases, except 1 patient who died from acute heart failure. No recurrence of PE was observed after 1 year follow-up. CONCLUSION: In our endemic areas, empiric antituberculous treatment seems to be an effective strategy in patients with exsudative PE.

[Therapeutic alternatives in case of failure of first-line treatment of intestinal helminthiasis in adults]. / Alternatives thérapeutiques en cas d'échec d'un premier traitement dans les helminthiases digestives de l'adulte.

Development of antiparasite medications over the last 15 years has greatly reduced the number of treatment failures for intestinal helminthiasis. Benzimidazole derivatives, ivermectine, praziquantel and triclabendazole are easy to use, well tolerated and generally curative. First-line treatment are currently so reliable that failure should lead first to investigation of possible "false failure" causes such as misdiagnosis, poor identification of the parasite, inadequate or incorrect treatment, and repeat contamination, before concluding that genuine parasite resistance is involved and that alternative therapy is needed. Nitazoxanide is an alternative treatment for fascioliasis and teniasis. Albendazole can be beneficial for taeniasis and strongyloidiasis. Metronidazole can be effective for fascioliasis. Artemisinine derivatives are useful for schistosomiasis. Combined therapies are necessary for refractory ankylostomiasis.

[A mild blackwater fever]. / Une fièvre bilieuse hémoglobinurique de gravite moyenne.

We report a highly probable case of moderately severe blackwater fever. A French woman, living in Guinea Bissau, was used to taking self-medication halofantrine for malaria. On this occasion, she felt unusual chills and pyrexia after a non documented bout of malaria, followed by nausea, then jaundice with dark-red urines despite another treatment with halofantrine. A sepsis was eliminated by two negatives thick peripheral blood drop examinations. Hemolysis was noted with 8.1 g/dl of hemoglobin, Coombs positive, and LDH at 1,452 IU/l, associated to renal failure with 34 ml per minute of clearance. The outcome was favourable with rehydration. Blackwater fever has been described with the three aminoalcohols, but mainly in severe presentations. Clinicians are not familiar with this disease, even though it has major therapeutic implications: quinine, halofantrine, and mefloquine become strictly contra-indicated. Moderate forms may be unknown, and this observation should be taken into account to prevent mistreatment in future patients.

[An unusual mediastinal opacity]. / Une opacité médiastinale inhabituelle.

A 36-year old immunocompetent male from Senegal with an uneventful history was admitted for exploration of a bullous collection in the posterior mediastinum. Multifocal tuberculosis was diagnosed. Computed tomography-guided drainage removed 600 cc of caseum. The diagnosis as rupture of intrathoracic Pott's abscess complicated by a probably esophageal fistula. The clinical course was rapidly favorable with later development of mediastinal fibrosis. This uncommon case illustrates the contribution of interventional radiology recently developed in the Principal Hospital in Dakar, Senegal.

[Primary arterial pulmonary hypertension and sildenafil: a case report from Dakar]. / Hypertension artérielle pulmonaire primitive et sildénafil: a propos d'un cas a Dakar.

INTRODUCTION: We report our experience of using sildenafil in treatment on primary arterial pulmonary hypertension. PATIENT: This case concern a 38 years old senegalese woman. She was hospitalised for global cardiac failure with right signs predominance and grade IV dyspnea related to pulmonary hypertension. RESULTS: No evident cause of the pulmonary hypertension had been found after explorations. Adding sildénafil to her symptomatic treatment provided fast favourable evolution quantified by clinical test and Doppler-ultrasound heart examination. However the patient died three month later by cerebral hemorrhage due to overdose of antivitamine K. CONCLUSION: We suggest using sildenafil in the treatment of primary arterial pulmonary hypertension on the way going to cardio-pulmonary transplantation.

[Leg ulcer due to hydroxyurea. A case report]. / Ulcère de jambe lié a l'hydroxyurée. A propos d'une observation.

Hydroxyurea is an antineoplasic agent usually used in myeloproliferative syndromes, but also in other benign pathological circumstances. Several dermatological manifestations have been recognized as being secondary to its prolonged use, of which the leg ulcer. We report an observation. Mrs. L.D, 47 years, were hospitalized on July 14, 2004 for an ulcer of left ankle in a feverish context. She was followed since 2001 for a chronic myelogenous leukaemia, and took hydroxyurea at a rate of 1500 mg per day, with a good clinical and hematologic answer. She presented a painful ulcer compared to the left external malleolus, with purulent bottom, without signs of vascular attack. The hemogram showed a hyperleucocytosis with 24.000 white elements/mm3 with neutrophilic polynucleosis. Pus sample on the ulcer showed Pseudomonas aeruginosa, and the blood culture was negative. The cure was obtained two months after stopping hydroxyurea. The ulcer of leg related to hydroxyurea is a seldom described pathology. Its occurrence imposes the final stop of the treatment.

[Cryoglobulins: detection, type determination and quantitation. A study of healthy subjects and patients with chronic hepatitis C]. / Cryoglobuline: recherche, typage et quantification. Etude chez le sujet sain et chez des patients atteints d'une hépatite C chronique.

Cryoglobulins are immunoglobulins or immune complexes which precipitate at a temperature lower than 37 degrees C and re-dissolve when rewarmed. So their collection and processing are critical. We describe the methodology used in the biochemical laboratory of Military hospital Laveran (Marseille) for detection determination of type and quantitation of cryoglobulins. In this study, we have found cryoglobulins in 53% of healthy subjects and in 77% of patients with chronic hepatitis C.

[Clinical and laboratory features of typhoid fever in Senegal. A 70-case study]. / Aspects clinique et biologique de la fièvre typhoïde au Senegal: étude de 70 cas.

Clinical and laboratory features, complications and treatment were retrospectively studied in 70 patients with bacteriologically documented typhoid fever, treated between January 1995 and June 2002 at Principal Hospital in Dakar, Senegal. Data analysis was done on a global basis as well as comparatively between the 37 children (under 15 years) and 33 adults. Mean age was 16.7 years (range, 1 to 52). The sex ratio was 1.4. Clinical manifestations included fever (97%), headache (50%), vomiting (71%), abdominal pain (54%), diarrhoea (49%), nnd splenomegaly (10%) without statistically significant difference between children and adults. Lyinphopenia was found in 51% of patients and anaemia in 78%. Coexisting illnesses Included malaria in 25.5% (mainly children) and hepatitis (transminases > 10N) in 24%. Complications included cholecystitis in 3 patients, gastrointestinal haemorrhage in 2, peritonitis in one, endocnrditis in one and osteomyelitis in one. Only one patient (HIV-positive) died. The incidence of antibiotic resistance was low, i.e., ainoxicilline: 2%, nalidixic acid: 1% and cotrimoxazole: 8.2%. No multidrug resistance was observed. This study shows that typhoid fever remains a major health problem in Dakar with slow resolution and potential complications. Amoxicililne and chloramphenicol can still be used for first-line treatment of typhoid fever. Little difference was found between children and adults.

[Exercise-induced dyspnea and hilar enlargement]. / Dyspnée d'effort et gros hiles.

We report the case of a 46-year-old man with an uneventful history who was hospitalized for suspected pulmonary embolism. The chest x-ray did not reveal any parenchymatous anomaly but disclosed pseudo-tumoral enlargement of the pulmonary arteries. There was no right ventricular overload at cardiac echography and the pulmonary arterial pressure was normal. Helicoidal angioscan demonstrated aneurismal dilatation of the both pulmonary arteries, complicated by a thrombus on the right. Outcome was favorable with anticoagulation. After ruling out acquired aneurysm, the diagnosis retained was idiopathic aneurysm of the pulmonary arteries.

[Cryoglobulinemia]. / Les cryoglobulinémies.

Cryoglobulins are immunoglobulins or immune complexes which precipitate at a temperature lower than 37 degrees C and redissolve when rewarmed. Cryoglobulins can be asymptomatic. When not, clinical features are in most cases cutaneous, renal or neurological. Cryoglobulinemia are associated with malignant haematological disorder, connective tissue disease or infection process especially infection with hepatitis C virus. In some case, no aetiology can be found, in theses cases cryoglobulinemia are called primary or essential cryoglobulinemia. For the last ten years it has been widely demonstrated that virus C infection causes the most part of essential cryoglobulinemia.

[Falciparum malaria in French residents in Yaounde]. / Le paludisme a Plasmodium falciparum chez les Français résidants a Yaoundé.

In South Cameroon, malaria is a disquieting problem. It represented 2.6% of consultants and concerned each year 10% among French residents. We have included 310 cases of Falciparum malaria between January 1, 1990 and December 31, 1990. There were 207 adults and 103 children with a mean age of 26 years. The duration of the stay was over one year in 137 cases and lower than 1 year in 183 patients. The chemoprophylaxis was correct in 194 patients according to the dose and duration. Forty-nine patients followed a combination of chloroquine and proguanil. Malaria attack was observed in 272 patients. Among them, there were 95 children. A severe malaria occurred in 38 cases. Mean parasitemia was of 0.24% (range: 0.002-7.5%). Therapy regimen was quinine: 36 cases, halofantrine: 266 cases, amodiaquine: 7 cases and association MFP (Fansimef) in 12 patients. The study shows the importance of malaria in an endemic area among expatriates despite the observance of chemoprophylactics regimens including proguanil.

[Sicca syndrome and low-grade chronic viral hepatitis C. Apropos of a series of 50 cases]. / Syndrome sec et hépatite virale chronique C de bas grade. A propos d'une série de 50 cas.

Systemic manifestations are described in chronic hepatitis C. Haddad et al have showed the prevalence of sicca syndrome with lymphocytic sialadenitis. We analysed prevalence in 50 patients suffering from chronic hepatitis C with histologic low rank. 50% of them have pronounced abnormality of lachrymal secretion without sialadenitis. It seems that sicca syndrome is present in low rank hepatitis. In that case xerophtalmia preceded xerostomia.

[Eosinophilic gastroenteritis. Apropos of a case]. / Gastro-entérite à éosinophiles. A propos d'un cas.

The authors report a new case of this rare and not well-know disease, the eosinophilic gastroenteritis. The medical imaging techniques allowed to correlate all the clinical signs to the observed parietal lesions.