[Impact of market place activity on the spread of STI/AIDS in Sikasso, Mali]. / Impact des fêtes foraines dans la propagation des IST/sida à Sikasso au Mali.

Since the beginning of the global HIV pandemic, more than 47 million people have been infected and more than 14 millions of people have died with 95% living in developing countries. Mali is located in West Africa that has been relatively less affected. However Mali is a country with a migratory culture. This study was conducted in primary health care centers located on the main road to neighboring countries with higher HIV prevalence. Attention was focused on healthcare services provided around market places in the main cities where diverse populations converge on a weekly basis. Attendance measured at five health centers on market day was compared with attendance on the other days of the week. In addition the level of sexually transmitted infections (STI) diagnosed on market days was determined to compare prevalence in the resident versus non-resident population in function of market activity. Attendance at all the centers was significantly higher on market days. This increase was due mainly to the non-resident population (60.2% vs. 46.5%; p=0.005). Findings also showed that the proportion of STI diagnosed was higher in the non-resident than resident population, but the difference was not statistically significant (15.6% vs. 11.3%; p=0.320). These results indicate that migration has an impact on the spread of STI. This is probably the same for HIV since these pathologies are known to be linked. Control strategies to fight against STI/AIDS could be improved by taking into account market place activity that is common in all localities of Mali and Africa.

[Tetanus in a hospital setting in Bamako, Mali]. / Tétanos en milieu hospitalier à Bamako, Mali.

AIM: The purpose of this study was to describe the epidemiological, clinical, and prognostic profile of tetanus patients managed in the infectious diseases department of the "Hopital du Point G", in Bamako, Mall. PATIENTS AND METHODS: This retrospective descriptive study was conducted from July 2001 to August 2004. The following data were collected: age, sex, infection route, clinical features, delay to hospitalization, and outcome. RESULTS: A total of 54 patients hospitalized for tetanus were included. Men accounted for 68.5% of cases. Ages ranged from 15 to 66 years with a mean of 39 years. The most common professional activity was farming: 27.8%. The route of infection was determined in 87% of cases and involved cuts in 46.3% of cases located on the lower limbs in 42.6%. Generalized paroxystic tetanus with opisthotonos was the most prevalent form accounting for 18.5% of cases. Localized tetanus accounted for 12.9% of cases. Outcome was unfavorable with a death rate of 38.9%. All deaths occurred within the first week of hospitalization. CONCLUSION: Mass vaccination of the population should be a national priority to reduce tetanus-related morbidity and mortality to levels observed in industrialized countries.

Prevalence of extended-spectrum beta-lactamase phenotypes in enterobacteria isolated from blood cultures of patients at admission to the University Hospital of Bamako.

The aim of our study was to determine the frequency of extended-spectrum beta-lactamase (ESBL) phenotypes among the enterobacteria present in blood cultures of patients at admission to two university hospitals of Bamako (Mali). During a period of three months, we isolated enterobacteria from blood cultures from patients upon admission to the Point G and Gabriel Toure University Hospitals. The ESBL-positive enterobacteria were initially identified by API 20E strips and VITEK®2 and then confirmed in France by MALDI-TOF mass spectrometry at the Bichat Hospital bacteriology laboratory. Antibiotic susceptibility was determined by the diffusion method as recommended by EUCAST. The species isolated were K. pneumoniae (14/40, 35.0 %), E. coli (11/40, 27.5 %), and E. cloacae (9/40, 22.5 %); 21/34 (61.8 %) had an ESBL phenotype, including 10/14 (71.4 %) K. pneumoniae, 8/11 (72.7 %) E. coli, and 3/9 (33 3 %), E. cloacae. The ESBL strains of K. pneumoniae, E. coli, and E. cloacae were associated, respectively, with resistance to the following antibiotics: gentamicin (10/10, 100 %; 6/8, 75%; 2/3, 67%), amikacin (2/10, 20 %; 0/8, 0%; 0/3, 0%), ofloxacin (8/10, 80. %; 7/8, 87%; 3/3, 100%), cotrimoxazole (10/10, 100 %; 6/8, 75%; 3/3, 100%). Almost two thirds (61.8%) of the enterobacteria isolated from blood cultures produced extended-spectrum beta-lactamases. They retained regular sensitivity only to carbapenems and amikacin.

[Epidemiological aspects of human and animal rabies in the urban area of Bamako, Mali]. / Aspects épidémiologiques de la rage humaine et animale en milieu urbain à Bamako, Mali.

The district of Bamako is the political and economical capital city of Mali with 1,800,000 inhabitants. The goal of the present retrospective study was to determine the frequency of animal bites, human and animal rabies on the one hand and to determine the frequency and the nature of mad animals on the other hand from January 2000 to December 2003 (4 years). To achieve this goal, we have analysed registers and documents related to rabies in the department of prevention and fight against diseases, the central veterinary laboratory, and also at the lazaret clinic involved in caring for human rabies cases. Human rabies diagnosis has been brought up based upon the following clinical arguments: agitation and lethal hydrophobia within few days following bites by known or unknown animal. Agitation and aggressiveness followed by the animals' death within an observation period of 15 days maximum, allowed to evoke the diagnosis in animals. In Bamako an average of 1470 persons have been bitten each year. In 97.1% of the cases, the mad animal was a dog; cats (1.6%), donkeys, horses, cattle and rats (1.4%) have also been identified on a total of 5870 cases of notified human bites by animals; 10 cases of notified human rabies have been recorded. The dog has been incriminated in 6 cases of human rabies out of 10, in the 4 other cases, it has not been possible to identify the mad animal. Among the 3924 mad animals in observation at the veterinary clinic, 187 have been clinically mad that is 4.8%. The rabies virus has also been researched by direct immunofluorescence in 121 specimens of dead mad animals brain. This research has been positive in 119 cases among which 116 dogs, 2 sheep and 1 cow. Anyway the vaccinal status of people bitten by mad animals has not been clearly established. According to these results, we recommend the implementation of a national specific program to eradicate rabies in Bamako.

Prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae isolated from blood cultures in Africa.

Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae have been isolated from many regions of the world. Epidemiological studies are being conducted in Europe, North America, and Asia. No study has however been conducted in Africa to determine the prevalence and distribution of ESBLs on the continent. This literature review aimed at describing the prevalence of ESBL-producing Enterobacteriaceae isolated from blood cultures, as well as the ESBL genes involved at the international level. Our focus was mainly on Africa. We conducted a literature review on PubMed. Articles related to our study field and published between 1996 and 2014 were reviewed and entirely read for most of them, while we only focused on the abstracts of some other articles. Relevant articles to our study were then carefully reviewed and included in the review. The prevalence of ESBL-producing Enterobacteriaceae differs from one country to another. The results of our literature review however indicate that class A ESBLs prevail over the other types. We took into consideration articles focusing on various types of samples to assess the prevalence of ESBL-producing Enterobacteriaceae, but information on isolates from blood cultures is limited. The worldwide prevalence of ESBL-producing Enterobacteriaceae has increased over time. Evidence of ESBL-producing Enterobacteriaceae can be found in all regions of the world. Studies conducted in Africa mainly focused on the Northern and Eastern parts of the continent, while only rare studies were carried out in the rest of the continent.

[RESAOLAB: West African network of laboratories to enhance the quality of clinical biology]. / RESAOLAB : le Réseau d'Afrique de l'Ouest des Laboratoires pour renforcer la qualité de la biologie clinique.

The Fondation Mérieux, in partnership with the Ministries of Health of Burkina Faso, Mali and Senegal, implemented for four years a project to reinforce the laboratory sector in the three participating countries: the RESAOLAB project (West African Network of Biomedical Analysis Laboratories).The objective of RESAOLAB project, in partnership with the WHO Office for West Africa and the West African Health Organization, was to strengthen the systems of biomedical laboratories to improve diagnostic services, access, monitoring and management of infectious diseases. Following the successful results achieved under the RESAOLAB project and due to the demand of the neighbour countries ministries, the RESAOLAB project is now extended to four other countries of the West African region: Benin, Guinea-Conakry, Niger and Togo. The RESAOLAB project has become the RESAOLAB programme, its purpose is to strengthen the quality of the medical biology services thanks to a regional and transversal approach.

Genetic subtypes of HIV type 1 and HIV type 2 strains in commercial sex workers from Bamako, Mali.

In Africa the highest HIV infection rate has been reported among female commercial sex workers (CSWs) who are at increasing risk of acquiring and transmitting HIV infection. In October 1995, 176 CSWs were studied in Bamako, the capital city of Mali. The ages of the CSWs ranged from 15 to 50 years old (mean, 28.8 years). Only 20.45% of the 176 CSWs were Malian; the majority were from Nigeria (32.9%) and Ghana (31.8%), and the remaining were from other African countries. Forty-one percent were active for less than 1 year as a commercial sex worker, and the length of prostitution for the remaining women ranged from 1 to 15 years (mean, 2.76). A total of 81 (46.02%) of the 176 CSWs were positive for HIV antibodies; 63 (35.8%) were HIV-1 positive, (3.9%) were HIV-2 positive, 11 (6.2%) had antibodies to HIV-1 and HIV-2, and none of them had antibodies to group O viruses. For all HIV antibody-positive samples, PBMCs were separated and genetic subtypes of HIV-1 were determined using the heteroduplex mobility assay (HMA), with ED5-ED12 as outer and ES7-ES8 as inner primers. Among the 66 HIV-1 strains characterized, 53 (80.3%) were subtype A, 2 (3.1%) belonged to subtype C, 1 (1.5%) belonged to subtype D, and 10 (15.1%) were identified as subtype G. Among the 10 subtype G strains, 8 were obtained from women who were very recent CSWs, with an activity of 1 year or less, assuming that there is a high probability that these infections occurred recently. Genetic subtypes of five HIV-2 viruses were determined by sequencing of the env and/or gag genes followed by phylogenetic analysis, and all of them belonged to subtype A. Comparison of HIV-1 and HIV-2 seroprevalence data from our study with previous data from Mali shows a significant rise in HIV-1 prevalence and a significant decrease in HIV-2 prevalence and confirms similar trends observed in neighboring countries. We have found four different genetic subtypes of HIV-1; however, subtype A is predominant and accounts for 80% of the cases and 15% of the HIV-1 infections were subtype G. It is important to continue the surveillance of subtypes on a systematic basis in order to see to what extent the proportions of the different subtypes will change over time.

PIP: The genetic variability of HIV-1 was investigated in a 1995 study of 176 commercial sex workers (CSWs) recruited in different areas in Bamako, Mali. 36 CSWs (20.45%) were born in Mali; 58 (32.9%) were from Nigeria and 56 (31.8%) were from Ghana. They ranged in age from 15-50 years (mean, 28.8 years). 41% of sex workers had been active for less than 12 months; the remaining women had been CSWs for 1-15 years (mean, 2.76 years). Of the 81 CSWs (46.02%) who were HIV-positive, 63 (35.8%) were infected with HIV-1, 7 (3.9%) with HIV-2, and the remaining 11 (6.2%) had antibodies to both HIV-1 and HIV-2. In contrast to other studies conducted among CSWs in Africa, none of these sex workers had antibodies to group O viruses. HIV-1 prevalence increased with age and length of time in prostitution and was higher among women with a history of sexually transmitted diseases. Among the 66 HIV-1 strains characterized, 53 (80.3%) were subtype A, 2 (3.1%) belonged to subtype C, 1 (1.5%) belonged to subtype D, and 10 (15.1%) were identified as subtype G. These results indicate a significant rise in HIV-1 prevalence and significant decreases in HIV-2 and combined HIV-1 and HIV-2 prevalence (10%, 15%, and 13%, respectively, in 1985). Ongoing surveillance of HIV-1 subtypes in Africa is important to identify shifts in the proportions of different subtypes over time. The genetic diversity of HIV has important implications for vaccine development.

[In vitro sensitivity of Vibrio cholerae serotype 0:139 to an intestinal antiseptic tiliquinol-tilbroquinol combination]. / Sensibilité in vitro de Vibrio cholerae du sérotype O:139 à un antiseptique intestinal l'association tiliquinol-tilbroquinol.

O:139 is a new serotype of Vibrio cholerae that is not agglutinated by an O:1 antiserum but causes epidemics of cholera. Strains of O:139 serotype are resistant to O/129 compound and many antibiotics but are sensitive to tetracyclines and tiliquinol-tilbroquinol (Intétrix). The clinical management of the patients infected with serotype O:139 is identical to that of usual choleric patients. However, the immunological difference with O:1 serotype must lead to reconsider both the diagnosis and the vaccinating strategies of cholera.

[Simplified vibriocidal antibody titer performed on a drop of blood]. / Titrage simplifié des anticorps vibriocides à partir d'une goutte de sang.

We report a simplified technique for vibriocidal antibody test in underprivileged people in tropical area. The test is performed on a drop of blood sampled on a disc of blotting paper. It avoid taking of large quantities of blood in timid underfed people who are often solicited. Its reading is rapid and easy by the naked eye owing to staining viable germs violet by the neotetrazolium succinate. Tested in mice and humans, the simplified method gave data well correlated to those obtained with the standard test on serum for vibriocidal titres higher than (or equal to) 1/40.

[Bacteriological aspects of purulent meningitis in Bamako district. Apropos of 1,541 bacterial strains collected from 1979 to 1991]. / Aspects bactériologiques des méningites purulentes dans le district de Bamako. A propos de 1,541 souches bactériennes recueillies de 1979 à 1991.

This study is about bacteriological aspects of purulent meningitis in Bamako area upon 1,541 strains collected from 1979 to 1991. It showed that N. meningitidis, S. pneumoniae and H. influenzae b are responsible. In general, N. meningitidis is the most frequent, but this depends on years and months. Since 1988, N. meningitidis serogroup C has supplanted serogroup A. N. meningitidis is predominant between 7 to 30 years. S. pneumoniae between 1-28 days and 31 to 68 years, H. influenzae between 1 month to 6 years. The frequency of these species is the same in male and female. The 3 species are quite sensitive to antibiotics tested except sulphonamides and cotrimoxazole. Meanwhile, the appearance of strains of S. pneumoniae to penicillin and H. influenzae to ampicillin must be followed with interest to check any time the importance of the phenomenon.

[Epidemiologic aspects of whooping cough in a village of the central district of Kolokani in Mali]. / Etude de certains aspects épidémiologiques de la coqueluche dans un village de l'arrondissement central de Kolokani au Mali.

Epidemiologic aspects of a whooping cough outbreak are studied in a village of a rural precinct of Kolokani in Mali. The survey shows that the village as been contaminated by two children coming from Bamako, an urban center. Spreading of the epidemic is due to the lack of suitable therapy and vaccination. Seventeen cases are noticed within 83 children aged 0 to 13 years (20.5%) from October 12th, 1988, to January 22nd, 1989. The attack rate is the same in males and females. Knowledge, attitudes and practices of the population to face whooping cough are noted. Measures are proposed for therapy and prevention.

[Resistance of Vibrio cholerae 0:1 to the 0/129 compound and multiresistance to antibiotics]. / Résistance de Vibrio cholerae O:1 au composé O/129 et multirésistance aux antibiotiques.

The authors present a study of the in vitro susceptibility to O/129 compound and usual antibiotics of 29 strains of V. cholerae O:1 biotype El Tor isolated during epidemics in miscellaneous countries over the world from 1982 to 1991. Several identical isolates from the same epidemic are represented by one strain. Susceptibility testing by diffusion method and MICs by agar dilution method are used. The data show that the resistance to O/129 compound is often associated with the resistance to usual antibiotics such as trimethoprim, sulphonamides, chloramphenicol, ampicillin and tetracycline. This resistance to the vibrostatic compound leads to a double problem of diagnosis and therapy. The nitrofuranes derivatives and tiliquinol-tilbroquinol association, an intestinal antiseptic, are the most active antimicrobial agents as well on the strains O/129 sensitive as on the strains O/129 resistant.

[Seroprevalence of human immunodeficiency virus infection (HIV) in Mali on 3,496 sera]. / Etude de la séroprévalence de l'infection par le virus de l'immunodéficience humaine (VIH) au Mali sur 3,496 sérums.

Our main objective has been geared toward the appreciation of the importance of the infection by human immunodeficiency virus in Mali. Our study was based on 3,496 sera deducted from March 1987 to January 1989. All positive sera at ELISA have been confirmed by Western Blot. The total seroprevalence of the study is 8.41%. This fact has been noticed higher in prostitutes, young men, more in women than in men in widows and divorced couples, in traders, in travellers of high endemic countries. The seropositivity is proportional to the number of sexual partners. The heterosexual way of transmission has been dominant. There has been no relationship between seropositivity and transfusion, antecedent of surgery, sexually transmitted diseases, of sexual intercourse type. The HIV2 has been more frequent than HIV1. Taking into account the importance of this infection, precautionary measures must be taken to avoid an evolution toward a catastrophic situation.

[Gastrointestinal manifestations of AIDS in adults in Mali]. / Manifestations digestives du sida chez l'adulte au Mali.

Our main objective consists in evaluating the frequency of digestive signs and digestive opportunistic infections in AIDS patients with diarrhea. The prospective study occurred from January 1997 to July 1998 in Bamako hospitals. The patients underwent a clinical examination, blood and stools tests, and sometimes upper digestive endoscopy. Among 434 cases of AIDS, 426 patients (98%) had at least one digestive sign. The main digestive signs were diarrhea (80.1%), abdominal pains (62.2%), vomiting (47.2%) and dysphagea (36.6%). Isospora belli and Cryptosporidium parvum have been pointed up in respectively 9% and 16.3% of examined specimen. Echerichia coli was found in 8.6% of stool cultures and in 2.9% in the case of Salmonella Arizonae. Twenty cases of Kaposi's sarcoma were diagnosed and mycosis was found in 71.9% of patients. In conclusion, digestive change is a constant phenomenon in AIDS patients. Patients survival could be improved by early management, improvement of diagnosis and provisioning of medicines.

[Contribution of radiography and repeat microscopy in the diagnosis of pulmonary tuberculosis in the hospital environment of Bamako]. / Apport de la radiographie et de la bacilloscopie répétée dans le diagnostic de la tuberculose pulmonaire en milieu hospitalier à Bamako.

WHO and IUAT-LD recommend repeated microscopy in order to improve the detection of contagious cases of pulmonary tuberculosis. Our aim was to determine the contributions of radiology and microscopy in the diagnosis of pulmonary tuberculosis. From January 1998 to April 1999 radiography and microscopy were performed for 275 patients who were admitted to the pneumology service. Pulmonary tuberculosis prevalence was higher among women aged 10 to 29 years than among men of the same age (p = 10(-6)). 188 (68.4%) women tested positive, 49 (17.8%) tested positive at the second microscopy and 1 (0.36%) at the the third. The main radiological lesions were nodules + infiltrats (46.2%), nodules + infiltrats + cavity (26.2%) and infiltrats + cavity (6.5%). Repeated microscopy significantly increased the proportion of pulmonary tuberculosis cases detected (from a prevalence 68.4% to 86.5%).

[Value of vibriocidal antibody research in endemic areas of Vibrio cholerae 0:1]. / Intérêt de la recherche des anticorps vibriocides en zones d'endémie à Vibrio cholerae O:1.

We made vibriocidal antibody titration in the serum of some populations in Algeria and in Mali either during or between cholera epidemics. The seropositivity rate was 43.3% in healthy contacts in Alger in 1990 during an epidemic of cholera. For 12/16 healthy contacts examined two times in a 25-day interval, the seropositivity rate increased during the epidemic and the mean of antibody titres rose 8.88 folds. In Constantine, 53% of 195 blood donors had significant titres of vibriocidal antibodies in 1992, 6 years after an epidemic of cholera. The seropositivity rate in population seemed decreasing during this year. In Bamako, 46% of selected patients had significant vibriocidal antibody titres 8 years after the last epidemic of cholera in Mali. Seven of 10 children born after the epidemic had vibriocidal antibodies. These data confirm the persistence of vibriocidal antibodies in population during many years. The importance of the seropositivity rate in healthy contacts and in children born during a non epidemic period shows that asymptomatic infection is frequent and that Vibrio cholerae O:1 may be circulating in population between epidemics. As part of surveillance of cholera outbreaks in endemic areas, it might be of interest to study on a regular basis the vibriocidal antibody seropositivity rate in populations.

[Evaluation of eight diagnostic tests for HIV infection in Lome (Togo)]. / Evaluation de la performance de huit tests de diagnostic de l'infection à VIH à Lome (Togo).

This study to evaluate the performance of eight diagnostic tests for HIV/AIDS infection was conducted at the National Reference Center for HIV/AIDS/STD in Lomé, Togo. The tests were as follows: Enzymum test anti HIV Combi, Enzymum tests anti-HIV1 + 2 + subtype O, Genscreen HIV 1/2, Ice 1.0.2, Vironostika HIV Uni-Form II Plus O, Genie II HIV 1/2, SFD HIV 1/2 PA and DETERMINE HIV 1/2. A total of 238 serum specimens collected consecutively between January and April 1999 were studied. They were from 161 occasional blood donors and 77 patients. New Lav-Blot I and Ii (western blot) were used as reference tests. Test sensitivity ranged from 90 to 100%. Specificity ranged from 96 to 100%. The Enzymum test anti HIV Combi used only on serum samples from blood donors demonstrated a sensitivity and specificity of 100%. Tests based on Elisa (Emzymum Combi, Enzymum HIV 1 + 2 + subtype O, Genscreen, Ice 1.0.2 and Vironostika) allowed acceptable diagnosis of HIV/AIDS as alternatives to western blot. Two of the three rapid assays tested provided acceptable results, i.e., Genie II HIV 1/2 and SFD HIV 1/2. They are suitable for screening to prevent HIV transmission by blood transfusion in areas where Elisa is unfeasible.

[Radiographic and bacteriologic data on pulmonary tuberculosis in Bamako as a function of HIV status]. / Données radiographiques et bactériologiques de la tuberculose pulmonaire à Bamako en fonction du statut VIH.

This prospective study included patients treated for tuberculosis between January 998 and April 1999 in the pneumology unit of the Point G Hospital in Bamako. The purpose was to analyze chest x-ray and bacteriological findings in HIV+ and HIV- patients. All patients had clinical and radiographic signs suggestive of tuberculosis with one or several sputum samples and HIV serology. Among the 127 patients, 36 were HIV positive (28.3%). There was no sex predominance in the HIV+ patients (p = 0.3). The most common radiographic aspect associated nodules and infiltration irrespective of the immune status (p = 0.014). Characteristic features of the chest x-rays in HIV-positive patients were: frequent military forms and rare cavernous forms (p = 0.007). Sputum tests were positive more often in HIV-negative than HIV-positive patients (p = 0.0003). The diagnosis of tuberculosis was retained in 11.7% of the patients with negative microbiology despite repeated samples. A normal chest x-ray was observed solely in one HIV-negative patient.

[Clones of Neisseria meningitidis strains in Mali]. / Clones des souches de Neisseria meningitidis au Mali.

OBJECTIVE: The purpose of our study was to identify strains of Neisseria meningitidis isolated from 2005 to 2007 in Mali. PATIENTS AND METHOD: We carried out a cross-sectional and descriptive study of 1573 meningitidis suspected case cerebrospinal fluid (CSF) samples before antibiotherapy. The identification of isolated germs was serogroup, serotype, subtype, sequence type, and clonal complexes. RESULTS: CSF samples were taken from children under 1 (30.1%), children between 1 and 4 (26.3%), and children between 5 and 14 years of age (25.7%). Neisseria meningitidis was identified in 144 out of 244 CSF positive samples. Streptococcus pneumoniae (73/244), and Haemophilus influenzae b (44/244) were also present. The most frequent Neisseria meningitidis serogroups were A, W135, and Y. Genotyping of the 33 live Neisseria meningitidis strains showed that three clonal complexes were present, especially serogroup A complex ST-5 with sequence type ST-7 and ST-2859, serogroup W135 complex ST-11 with sequence type ST-11, and serogroup Y complex ST-167 with sequence type ST-167 and ST-192. DISCUSSION: The introduction of tetravalent vaccine ACYW135 should be considered in Mali and West Africa.