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.

[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.

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.

[Implementation of in vitro culture of Mycobacterium ulcerans from clinical samples versus detection of acid-fast bachilli and bacterial genome in Abidjan, Côte d'Ivoire]. / Mise en place de la culture in vitro de Mycobacterium ulcerans à partir d'éhantillons cliniques versus recherche de BAARet détection du génome bactérien à Abidjan, Côte d'Ivoire

Mycobacterium ulcerans infections are a public health problem in Céte d'Ivoire. The etiological diagnosis of this disease made by culture remains a big concern due to the slowness and difficulties encountered. This detection by culture of M. ulcerans represents a big interest as it allows obtaining the circulating strains for research. The purpose of this study was to determine on a routine basis in a poorly equipped laboratory, in vitro culture of M. ulcerans from exudates of skin ulcerations and from biopsy of patients with suspected Buruli ulcer. A particular attention was paid to the conditioning of the sample forwarded to the laboratory and inoculation in Lowenstein-Jensen medium supplemented with glycerol. The results of the three methods for the analysis showed 26.7, 57.4 and 17.8% positive rate respectively in the microscopy examination by nested PCR and by culture. In all the analysis, the positive rate from biopsy is higher than that obtained from exudates. The overall contamination rate by invasion of the three tubes of culture by fungi is 15.8 with 14.3 and 19.4% respectively,from exudates and biopsies. All positive samples in Ziehl-Neelsen staining and in culture were also positive by nested PCR. The nested PCR confirmed the positive strains found in culture, which were responsible for skin ulcerations. After culture, only one strain was nPCR negative. This strain was identified as Mycobacterium Gordonae. Our culture conditions showed that M. ulcerans was not the only strain identified and that other strains were present in the culture. We can conclude that the culture of M. ulcerans, in spite of the growth difficulties of the bacterium can be performed in laboratory in developing countries despite the lack of reagent and consumables. The implementation of this culture is the only way to determine sensitivity tests in vitro and in vivo in order to treat patients with Buruli ulcer.

Detection of viral RNA by RT-PCR from serum for molecular diagnosis of measles.

Measles continues to be a cause of morbidity and mortality in Côte d'Ivoire although the death rates are weak (2.4%). The monitoring and elimination programme of this disease require a laboratory confirmation testing by diverse methods of diagnosis needing diverse biological products. Serum is usually used for IgM detection. This study has therefore assessed the importance of the measles virus RNA detection from sera of measles suspected cases for confirmation of the case and determination of the genotype. A total of 45 sera tested were split into two groups according to the interval between the rash appearance and the day of blood collection: Group 1 (day 1 to day 3); group (2 day 4 to day 7). Four sera from Group 1 of the 45 (8.9 %) were positive by RT-PCR technique while 10 (22.2%) sera were positive for IgM anti- measles virus by ELISA test. RT-PCR and ELISA showed the same performance in group 1 with a positivity rate of 13.79 %. The B3 genotype was found. This result showed that the viral RNA can be detected in the serum but only from those sera collected the first 3 days after the rash appearance and could be used as palliative in case it is impossible to obtain other biological products.

[Is the mother a risk factor for transmission of Helicobacter pylori infection in children between the ages of 6 months and 5 years in Côte d'Ivoire?]. / La mère est-elle un facteur de risque de transmission de l'infection a Helicobacter pylori a l'enfant de 6 mois a 5 ans en Côte d'Ivoire?

OBJECTIVES: The goals of this study were to determine the prevalence of H. pylori antibodies in children, to establish the relationship between child and mother serostatus, and to identify potential risk factors for contamination. MATERIAL AND METHODS: A cross-sectional study was conducted over a 3-month period. All children between 6 months and 5 years of age examined in the Pediatrics Department of the University Hospital Center in Yopougon, Côte d'Ivoire were included after obtaining informed consent from their mothers. Testing for H. pylori antibodies using Pylorix (Acon) was performed in both children and mothers. Based on test results, children were divided into two groups, i.e. case group with H. pylori antibodies and control group without H. pylori antibodies. Case and control groups were compared according to the H. pylori status of their mother and several potential lifestyle and environmental factors. RESULTS: A total of 101 children and 101 mothers were included. The prevalence of H. pylori antibodies was 40.6% in mothers and 24.8% in children. The mean age of children (53% male) was 22.8 +/- 15.6 months (median, 18 months). The mean age of the mothers was 29.6 +/- 5.5 years (range, 19 to 46 years; median, 29 years). Most mothers, i.e., 78.2%, lived in two-parent households but 19% lived in single-parent settings (community or shacks). The number of persons living in the same house ranged from 2 to 20 people (mean, 7.2 +/- 3.8; median, 6 people). Mean monthly household income was 226,188 +/- 161,425 FCFA (range: 30,000 - 750,000 FCFA). In the case group, 80% of children had mothers infected with H. pylori. In the control group, 73.7% of children had non-infected mothers (OR = 11.2, p < 0.001). Median income was less than 150 000 FCA in 76% of families with seropositive children in comparison to 46.1% of families with seronegative children (p = 0.009). CONCLUSION: This study confirms the early occurrence of H. pylori infection in children. Findings also showed that poor socio-economic condition was a risk factor for infection but the greatest risk factor was living with a mother infected with H. pylori.

[Evaluation of first void urine in the detection of Neisseria gonorrhoeae in patients less symptomatic in Abidjan (Côte d'Ivoire)]. / Evaluation du premier jet d'urine dans la détection de Neisseria gonorrhoeae chez des patients paucisymptomatiques à Abdidjan (Côte d'Ivoire).

Various diagnostic methods have been described to detect Neisseria gonorrhoeae. Collection of first void urine is advantageous because it is non-invasive, reproducible, and painless; and provides specimens that have already been used for detection of N. gonorrhoeae by molecular tools. The purpose of this study was to assess the usefulness of first void urine for detection of N. gonorrhoeae using conventional bacteriologic techniques in patients with low-grade symptoms. Investigation was focused on first void urine and urethral secretion specimens collected from 87 male patients who were undergoing diagnotic workup for suspicion of sexually transmitted infection. Direct microscopic examination of smears stained using the Gram technique and cultures on modified Thayer-Martin medium and on cooked blood agar were performed on each specimen. The prevalence of urethritis was 58.0%. Gonorrhoea was diagnosed in 7.5% of cases. The sensitivity and specificity of microscopic examination of first void urine for detection of Gram-negative diplococci were 85.7% and 97.5% respectively. First void urine was less productive than urethral secretion for detection of urethritis: sensitivity, 44.4% and specificity, 100%, and urethral flora: sensitivity, 59% and specificity of 96.9%. The good performance of first void urine specimens for detection of Gram-negative diplococci by microscopy may justify their use for identification of N. gonorrhoeae in level 1 laboratories. First void urine could also be useful for epidemiological studies and large-scale screening surveys.

[Diagnosis of non Poliovirus enteroviruses in Abidjan from 1996 to 2004]. / Diagnostic des entérovirus non Poliovirus à Abidjan de 1996 à 2004.

Non Poliovirus enteroviruses (NPEV) are infectious agents which can determine various infections. They are more and more isolated within the context of the surveillance of acute flaccid paralysis (AFP) and raise a problem of antigenic identification. In Côte d'Ivoire the serotypes of NPEV circulating are unknown. In order to determine the epidemiological and virology characteristics of human (NPEV) stemming from virology investigations from 1996 to 2004, enteroviruses strains isolated from stools and from cerebrospinal fluid have been analysed. The biological products have been tested according to the procedures recommended by the World Health Organisation (WHO) within the context of the virology surveillance of acute flaccid paralysis and the antigenic identification by seroneutralization and serotyping has been done. Out of 144 isolates obtained from 10187 specimens, 637 were Poliovirus strains and 807 NPEV strains (7.9%). Among them 16.3% have been isolated during carrier studies and 83.7% were associated with cases of AFFP Out of the 807 strains of NPE, 218 strains have been tested by serotyping and the serotype of 77 strains (35.32%) has been determined: Coxsackievirus B (41.6%) and different serotypes of Echovirus (58.4%). The proportion of untypable strains (62.3%) confirms the difficulties to identify NPEV with the conventional available reagents. The molecular diagnosis is becoming necessary in order to establish a list of the serotypes of NPEV circulating and associated with clinical features in the country

[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.

[Detection by RT-PCR of the 1st cases of Astrovirus in human stools in Abidjan, Côte d'Ivoire]. / Détection par RT-pCR des premiers cas d'Astrovirus dans les selles humaines à Abidjan, Côte d'Ivoire.

Viral gastroenteritis are a problem of public health because of the high rate of morbidity and mortality, particularly in children. Among the etiologic agents, human Astroviruses are the third agents most often incriminated after Rotaviruses and Caliciviruses. Symptoms of gastroenteritis caused by Astroviruses are generally moderated compared with those observed with Rotaviruses and rarely involve hospitalization. In sub-Saharan Africa, particularly in Côte d'Ivoire, the majority of viral gastroenteritis is attributed to Rotavirus with rates varying from 20 to 26%. No study on the circulation of human Astroviruses has been carried out in Côte d'Ivoire. Our objective was to detect human Astroviruses in the diarrhoeal stools in Abidjan. Seventy-two samples of human diarrhoeal stools were collected in ambulatory patients. This population was made up of 44 patients from 0 to 15 and 28 patients over 15 years old. The concentration of the viral particles of the samples was followed by the extraction of the RNA by the modified method of Boom. The extracted RNA were amplified by RT-PCR by using specific primers targeting a portion of the 3' end of the open reading frame ORF la of the genome of human Astroviruses. The amplified fragment was 192 pb. The genome of human Astroviruses was detected in 3 stools out of the 72 samples. That is a frequency of 4%. Among these 3 stools, 2 came from 4 month and 3 year-old children and the 3rd stool came from a 33 year-old patient. For the first time this survey has pointed out the circulation of human Astroviruses in the Côte d'Ivoire population. This survey also showed that human Astroviruses could be found in children as well as in adults.

[Epidemiological and virological aspects Rotavirus diarrhoea in Abidjan, Côte d'Ivoire (1997-2000)]. / Aspects épidémiologiques et virologiques des diarrhées dues aux Rotavirus à Abidjan, Côte d'Ivoire (1997-2000).

Viruses, mainly rotaviruses are aetiological agents in more than 80% of the cases of acute diarrhoea in children. In order to determine the epidemiological characteristics and genotypes of human rotaviruses involved in gastroenteritis in diarrheic children aged from 0 to 5 years old in Abidjan, 642 specimens of stools were collected between 1997 and 2000 in the urban health centres and University Teaching Hospitals in Abidjan. The antigenic detection of rotaviruses carried out by ELISA test was followed by the antigenic (VP6 sub-groups) and molecular characterization: polyacrylamide gel electrophoresis and genetic typing. The general prevalence of Rotavirus diarrhoea was 27.9%. Among the children who were found positive, those whose age ranged from 0 to 11 months old accounted for 45.8% against 41.3% and 12.9% for those whose age ranged from 1 to 2 and 3 to 5 years old respectively proving thus the precocity of rotavirus infection. From an electrophoretypical and antigenic point of view 74.5% of 141 extracts of RNA had a "long" profile and belonged to the VP6 II sub-group against 24.8% of "short" profile belonging to sub-group I. The electrophoretypes with short profile were identified in majority in infants whose age ranged from 0 to 2 years old. Out of the P genotypes identified, the P [8] genotype (59.6%) was predominant followed by the P [6] genotype (26.2%), P [4] (2.8%) and one mosaic genotype P[6,8] which represented 11.4%. These results will need to be completed by the determination of VP7 genotypes in order to provide interesting information on rotaviruses before the introduction of anti-Rotavirus vaccines in the country.

[Results of two-year surveillance of flu in Abidjan, Côte d'Ivoire]. / Bilan de deux années de surveillance de la grippe à Abidjan.

Influenza (flu) is a seasonal viral disease that may have a favorable outcome or be associated with a high morbidity and mortality rate during epidemics. In view of the lack of epidemiological and virological data about flu in Côte d'Ivoire, a surveillance network was set up in Abidjan to monitor the spread of flu and characterize isolated viruses. Over the 24-month period from January 2003 to December 2004, nasal secretions were collected in patients presenting with flu syndrome at various heath care centers in Abidjan. Laboratory identification of viruses was performed by the ELISA technique using anti-A and anti-B monoclonal antibodies (immunocapture) and by isolation on MDCK cells. A fraction of the original samples and isolates was sent for confirmation to the Pasteur Institute in Paris, France and to the National Institute for Communicable Diseases (NICD) in Johannesburg, South Africa. Amongst the 211 samples analyzed, 30 (12.8%) proved positive for flu virus. Twenty-two isolates were positive for influenza virus A including 21 for A (H3N2) type and one for A (H1N1) type. The remaining 8 isolates were positive for influenza virus B. Most of these strains were isolated from patients in two age ranges, i.e. 0 to 5 years (34%) and 15 to 59 years (47%). More than 60% of the strains were isolated in June and October but the study duration was too short to define a flu season. Further surveillance data will allow better determination of flu season and definition of clinical and biological characteristics as a prerequisite for a preventive immunization program.

[Direct sputa examination limits in tuberculosis active detection in 200 immigrant candidates in United States of America]. / Limites de l'examen direct des expectorations dans le dépistage actif de la tuberculose chez 200 candidats à l'émigration aux Etats-Unis.

The Côte-d'Ivoire Pasteur Institute unit of Tuberculous and Nontuberculous Mycobacteria carried out 600 smears stained by Ziehl-Neelsen in 200 immigrant candidates for the U.S.A. The sputa of 44 of them were put in culture on Lowenstein-Jensen medium. Eight (4%) candidates had active pulmonary tuberculosis among whom 5 had smear negative sputum. The pulmonary tuberculosis active detection performed on target population with accessible and sensitive tool can contribute to strengthen the fight against tuberculosis in endemic areas.

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.

Prevalence of methicillin-resistant Staphylococcus aureus in eight African hospitals and Malta.

Methicillin-resistant Staphylococcus aureus (MRSA) poses a serious therapeutic problem worldwide, and its frequency in most African countries has not been reported. This study was aimed at determining the prevalence and antibiotic susceptibility patterns of MRSA in eight large hospitals (>500 beds) in Africa and Malta, from 1996 to 1997. Susceptibility to methicillin (oxacillin) and to other drugs was determined by E test (AB Biodisk, Solna, Sweden) on a total of 1440 clinical isolates of S. aureus. Methicillin resistance was detected in 213 (15%) of the 1440 isolates tested. The rate of MRSA was relatively high in Nigeria, Kenya, and Cameroon (21-30%), and below 10% in Tunisia, Malta, and Algeria. All MRSA isolates were sensitive to vancomycin, with MICs 60%) of MRSA strains were multiresistant. There is a need to maintain surveillance and control of MRSA infections in Africa.

Primary resistance to antituberculosis drugs: a national survey conducted in Côte d'Ivoire in 1995-1996. Ivoirian Study Group on Tuberculosis Resistance.

SETTING: A national survey of resistance to the antituberculosis drugs used in Côte d'Ivoire was conducted in 1995-1996. OBJECTIVE: To determine the rate of primary resistance to antituberculosis drugs. METHODS: Consecutive new tuberculous patients with positive smear were recruited from tuberculosis centres and rural health centres. Drug susceptibility testing was performed according to the proportion method. Positive cultures were tested against streptomycin, isoniazid, rifampicin, and ethambutol. All resistant strains and 10% of all randomly sampled cultures were sent to an external laboratory for quality control. Human immunodeficiency virus (HIV) tests were performed for consenting patients at the tuberculosis centres. RESULTS: Among the 430 samples, 320 were available for analysis. Primary resistance to antituberculosis drugs was observed for 13.4% of the patients (43/320); multidrug resistance (to at least isoniazid and rifampicin) was observed for 5.3% of the patients; 14.2% of HIV-negative and 16.2% of HIV-positive patients were resistant to at least one antituberculosis drug (P = 0.70). CONCLUSION: This study is representative of antituberculosis drug resistance in Côte d'Ivoire. The rate of primary resistance is high and emphasises the need for a sentinel survey of tuberculous resistance. The National Tuberculosis Control Programme needs to make improvements in its management of tuberculosis cases.

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.