[Dynamics of Egg Excretion of Schistosoma haematobium in a Longitudinal Cohort Under Treatment with Praziquantel over a Five-Year Period in Kalifabougou, Mali]. / Dynamique de l'excrétion ovulaire de Schistosoma haematobium dans une cohorte de Kalifabougou (Mali) sous traitement par le praziquantel (PZQ) durant cinq ans.

This study aim was to evaluate the dynamics of Schistosoma haematobium eggs excretion after the scaling up of "Mass Drug Administration" (MDA) with praziquantel (PZQ) from 2011 to 2016 in a cohort of volunteers living in the village of Kalifabougou, Mali. We conducted a cross-sectional study on 676 volunteers in May 2011 niched in cohort study from 696 volunteers aged three months to 25 years. The eggs of Schistosoma haematobium (Sh) were tested by urine filtration technique, Soil-transmitted helminth and Schistosoma mansoni by the Kato-Katz technique. Maximal MDA/ PZQ population coverage was 83% in 2015 and no MDA/PZQ n 2014. A total of 676 volunteers was included in this prospective cohort. The prevalence rate of Sh showed a significate decreasing from 2011, 2013 to 2014 with respectively 10.2% [95% CI=10.04-10,18], 5.32% [95% CI=5.30-5.33], and 5.25% [95% CI=524.-5.31], followed by an increase to 10.6% [95% CI = 10.47-10.63] in 2015 and a significative decrease in 2016 to 5.4% [95% CI=3.5-7,3]. Children aged from six to 10 years and mostly boys were more infected with Sh, then could serve of parasite reservoir. MDA with PZQ remains an effective strategy for schistosomiasis control against Sh in Kalifabougou. Additional studies on MDA/PZQ average treatment covering human-water contact behaviors and population migration are necessary to understand the persistence of the 5% annual prevalence rate of egg shedding in the cohort of volunteers periodically treated with PQZ. Testing eggs shed viability will be also an added value.

L'objectif de cette étude était d'évaluer la dynamique de l'excrétion ovulaire de Schistosoma haematobium (Sh) après la mise à échelle du « traitement de masse ¼ (TDM) avec le praziquantel (PZQ) de 2011 à 2016 dans une cohorte de volontaires vivant dans le village de Kalifabougou au Mali. Nous avons conduit une étude transversale sur 676 volontaires au mois de mai 2011 nichée dans une étude de cohorte de 695 volontaires, âgés de 3 mois à 25 ans et suivis de 2011 à 2016. Les œufs de Sh ont été recherchés par la technique de filtration d'urines et ceux des géo helminthes et de Schistosoma mansoni avec le Kato-Katz. Le taux de couverture maximum de la population cible de Kalifabougou en TDM/PZQ était de 83 % en 2015 et il n'a pas eu de TDM/PZQ en 2014. Le taux de prévalence de Sh montrait une réduction significative entre 2011, 2013 et 2014 avec respectivement 10,20 % [95 % CI = 10,04-10,18]- 5,32 % [95 % CI = 5,30- 5,33], et 5,25 % [95 % CI = 5,24-5,31], suivi d'une augmentation à 10,60 % [95 % CI = 10,47-10,63] en 2015 et d'une baisse significative en 2016 à 5,40 % [95 % CI = 3,5-7,3]. Les enfants âgés de six à dix ans, et majoritairement les garçons, seraient plus infectés par Sh, et pourraient servir de réservoir de parasites. Le TDM avec le PZQ reste une stratégie efficace pour le contrôle de la schistosomose à Sh à Kalifabougou. Des études complémentaires sur la couverture moyenne en TDM-PZQ, les comportements de contact homme-eau et les mouvements de population sont nécessaires pour comprendre la persistance du taux de prévalence annuel de 5 % de l'excrétion ovulaire dans la cohorte de volontaires traités périodiquement par le PQZ. Un test de viabilité des œufs excrétés serait aussi une valeur ajoutée.

Spectrum of disease among HIV-infected adults hospitalised in a respiratory medicine unit in Abidjan, Côte d'Ivoire.

SETTING: Respiratory medicine wards of the University Teaching Hospital, Abidjan, Côte d'Ivoire. OBJECTIVES: To describe the spectrum of opportunistic infection among human immunodeficiency virus (HIV) infected adults hospitalised in the respiratory medicine unit in Abidjan, and the level of immunosuppression at which these diseases occur. DESIGN: Cross-sectional study. RESULTS: Overall, 75% of patients were HIV-positive: among these patients, the most frequent diagnosis was tuberculosis, in 61%, followed by bacterial pneumonia (15%), Gram-negative septicaemia (particularly non-typhoid Salmonella) (9%) and empyema (5%). Atypical pneumonias appeared to be rare. Most HIV-positive patients had CD4 counts indicative of advanced immunosuppression: 36% had CD4 counts below 100 x 10(6)/l, 19% between 100 and 199 x 10(6)/l, 29% between 200 and 499 x 10(6)/l, and 16% above 500 x 10(6)/l. Overall in-hospital mortality was 27% for HIV-positive patients and 22% for HIV-negative patients (P = 0.5). In a multivariate analysis, the strongest independent risk factors for death were cachexia (odds ratio [OR] 7.4, 95% confidence interval [CI] 2.1-26.3), male sex (OR 4.5, 95% CI 1.2-17.4) and age over 40 (OR 4.1, 95% CI 1.0-17.2). CONCLUSIONS: Tuberculosis and bacterial infections are the major causes of respiratory morbidity in immunosuppressed HIV-infected adults in this population. Efforts to improve the management of HIV-related disease need to focus on prevention and treatment of these infections.

Prevalence of exposure to aflatoxin and hepatitis B and C viruses in Guinea, West Africa.

The prevalence of exposure to aflatoxin, hepatitis B virus (HBV), and hepatitis C virus (HCV), three important risk factors for hepatocellular carcinoma, was examined in Guinea, West Africa. A total of 75 sera were collected from men living in the Kindia region of lower Guinea. The sera were analysed by immunoassay for aflatoxin covalently bound to serum albumin as a marker of aflatoxin exposure. Over 90% of the sera contained detectable adduct levels, the highest level being 385 pg aflatoxin B1-lysine equivalent per mg albumin. Eleven subjects (14.7%) were positive for hepatitis B surface antigen in the serum and these subjects had a tendency to have higher aflatoxin-albumin adduct levels than the other subjects (mean level 70.4 pg/mg compared to 44.1 pg/mg), but the difference was not statistically significant (P = 0.23). Eight subjects were positive for antibodies to HCV antigens and, interestingly, seven of these were from one ethnic group, Mandinka (25% prevalence). These data demonstrate that all three exposures are prevalent in Guinea and that the prevalence of these risk factors is comparable to that observed in other countries in West Africa. It is now important to assess the public health impact of these exposures in this country.