Cerebral venous thrombosis in a sub-saharan African country: A preliminary monocentric study of a 70 case series at the neurology department of Fann teaching hospital in Dakar - Senegal.

INTRODUCTION: Cerebral venous thrombosis (CVT) are underdiagnosed in sub-saharan Africa where publications are uncommon. Our study aim was to describe the CVT diagnostic and therapeutic features through a senegalese case series. PATIENTS AND METHOD: A monocentric retrospective and prospective study was conducted at the adult Neurology department of Fann Teaching Hospital in Dakar (Senegal), between January 01, 2013 and April 30, 2020. It had included all CVT cases diagnosed by neurovascular imaging. RESULTS: Seventy CVT cases were collected including 48 women (68.6%). The average age of the patients was 35.2±14 years. The main neurological signs were headache (92.8%) and motor deficit (41.4%), with subacute onset in 67.2% of cases. The superior sagittal sinus (54.3%) and the transverse sinus (38.6%) were the most affected with multiple involvements in 27 patients (38.6%). Thirty patients (42.8%) had indirect parenchymal signs such as venous infarction (15.7%), cerebral edema (11.4%) or intracerebral hemorrhage (12.8%). The etiological factors were mostly infectious (41.4%) with meningoencephalitis (12.8%) and otorhinolaryngological infection (10%). Gyneco-obstetric factors (27%) and Behçet's disease (7%) were the main aseptic factors. In the short-term clinical course, curative anticoagulation (98.6%) had enabled a favourable outcome (mRS 0-1) in half of the patients. CONCLUSION: Our study, the largest series in sub-saharan Africa to this date, confirms that CVT is a young women disease. Infectious etiology is the most frequent at the Fann national teaching hospital (41.4% in Dakar against 6.5% in Germaine Bousser's series) even if the etiological assessment is limited by financial constraints (no coagulopathy/thrombophilia check-up).

[Neuro-Behçet in a Sub-Saharan Africa Country: a Series of Sixteen Patients in Fann Teaching Hospital, Dakar, Senegal]. / Neuro-Behçet dans un pays d'Afrique subsaharienne : une série de 16 patients au centre hospitalier national universitaire de Fann de Dakar, Sénégal.

Neuro-Behçet (NB) African studies are mainly North African, but Sub-Saharan Africa is not to be outdone. Our aim was to describe diagnostic and therapeutic features of NB in a Senegalese series collected in Dakar. This was a descriptive and retrospective study conducted at the Neurology department of Fann Teaching Hospital in Dakar, Senegal. All patients who met the NB's diagnostic criteria were included. Sixteen patients were collected, 14 males and 2 females with an average age of 40 years [18-71]. The main neurological signs were motor deficit (13 cases), headache (10 cases), and language disorders (4 cases). Extra-neurological signs were dermatological (14 cases), ocular (2 cases), and articular (2 cases) with aseptic unilateral gonarthritis. Fever was present in 9 patients. Neurological involvement was mostly isolated parenchymal (8 cases) or mixed (6 cases). The main clinical forms of NB were rhombencephalitis (8 cases) and retrobulbar optic neuritis (4 cases). Seven patients had a cerebral angio-Behçet with cerebral venous thrombosis (3 cases), ischemic stroke (2 cases), and intracerebral hematoma (2 cases). Under prednisone (16 cases) and azathioprine (3 cases), the short-term clinical outcome was mostly favorable (14 cases) with a modified Rankin scale at 2. NB is an under-diagnosed adult male disease in Sub-Saharan Africa and further studies are needed.

Les études africaines sur le neuro-Behçet (NB) sont majoritairement maghrébines, mais l'Afrique noire n'est pas en reste. L'objectif de l'étude était de décrire les particularités diagnostiques et thérapeutiques du NB dans une série sénégalaise colligée à Dakar. Il s'agit d'une étude rétrospective à visée descriptive menée à la clinique de neurologie du centre hospitalier universitaire de Fann de Dakar, au Sénégal. Tous les patients répondant aux critères diagnostiques de NB ont été inclus. Seize patients ont été colligés, 14 hommes et deux femmes avec un âge moyen de 40 ans [18­71]. Les principaux signes neurologiques étaient un déficit moteur (13 cas), des céphalées (10 cas) et un trouble du langage (4 cas). Les signes extraneurologiques étaient dermatologiques (14 cas), oculaires (2 cas) et articulaires (2 cas) à type de gonarthrite unilatérale aseptique. Une fièvre était présente chez neuf patients. L'atteinte neurologique était majoritairement parenchymateuse isolée (8 cas) ou mixte (6 cas). Les principales formes cliniques de NB étaient la rhombencéphalite (8 cas) et la névrite optique rétrobulbaire (4 cas). Sept patients avaient un angio-Behçet cérébral à type de thromboses veineuses cérébrales (3 cas), d'infarctus cérébraux (2 cas) et d'hématomes intracérébraux (2 cas). Sous prednisone (16 cas) et azathioprine (3 cas), l'évolution clinique à court terme était majoritairement favorable (14 cas) avec un score de Rankin modifié de 2 au moment de l'exeat. Le NB est une maladie de l'homme adulte sous-diagnostiquée en Afrique noire. Des études ultérieures multicentriques nationales et sous-régionales sont souhaitables.

[Prevalence of nosocomial infections in a university hospital (Dakar, Senegal)]. / Résultats de l'enquête de prévalence des infections nosocomiales au CHNU de Fann (Dakar, Sénégal).

UNLABELLED: Nosocomial infections constitute today a great public health problem that is still ignored or poorly mastered in our health institutions. METHOD: A prevalence study initiated by the CLIN (committee for the prevention of nosocomial infections) was recently conducted at the Fann teaching hospital. A questionnaire was prepared and submitted to all patients that were hospitalized on the day of the study; the questionnaire allowed gathering a lot of information on exposure factors and clinical and microbiological arguments in favor of nosocomial infections. RESULTS: One hundred and seventy-five patients (59.9% of all available beds) participated in the study. Nosocomial infections were found mostly among people between 20 and 44 years of age and predominantly in women. Fifty-eight percent of those cases were found in the neurology unit. The infections were mostly urinary (40%) and pulmonary (25%). The germs responsible were multiresistant bacteria: Enterobacter cloacae secreting broad-spectrum betalactamase, methicillinresistant Staphylococcus aureus, and Pseudomonas aeruginosa. The infected patients were usually under antibiotic treatment (80%) with various protocols, mainly monotherapy. The antibiotics used were betalactams, fluoroquinolones, and nitroimidazoles.

[Hand washing at Fann hospital: investigation among health workers]. / Lavage des mains au chnu de Fann: enquête auprès du personnel de soins.

INTRODUCTION: Handwashing is usually neglected in hospital settings. The objective of this study was to draw attention of health workers in Fann hospital as part of the prevention of hospital-acquired infections. MATERIALS AND METHODS: This study was carried out prospectively from April 26h to May 25th. An anonymous questionnaire was administered by 20 formed investigators to health workers, along with an inventory of available resources for hand washing in the study site allowing to collect the data by interview. RESULTS: A total of 256 health workers were investigated. The mean age was 35.3 +/- 9.4 years [range = 20-71] with a sex ratio of 0.62. As for the education level, the secondary and university predominated. The concept of Manu carrying was ignored by 59.3% of the personnel. This proportion was higher among people with low education level. Possibility of resident and transitional floras in the hand was ignored by most of the investigated personnel. The hand washing technique to be applied while putting vesicle probe was ignored by 59% of the personnel, and 34% declared using hand towel to dry hands. Half of the personnel ignored that bread soap was not recommended. The availability of hydro alcoholic solutions was variable according to the hospital wards. The lavabo/bed ratio was 1/7 and was unacceptable. CONCLUSION: In Fann hospital, the importance and the techniques of hand washing are not well known, that's why a training of the hospital's Personnel and an improvement of resources for handwashing are necessary for a good hospital's hygiene.

Molecular detection of CTX-M-15-type ß-lactamases in Escherichia coli strains from Senegal.

We aimed to detect the extended-spectrum ß-lactamases (ESBLs) secreted by clinical strains of Escherichia coli at Fann University Hospital in Dakar and to characterize them molecularly. We identified 32 isolates producing ESBLs. The CTX-M-15 gene was the most frequently detected ESBL gene, detected in 90.63% of the isolates studied.

[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.

[Nosocomial Klebsiella pneumoniae infections at the Fann University Hospital Center, Dakar]. / Infections nosocomiales à Klebsiella pneumoniae au CHU de Fann, Dakar.

Twenty one (21) strains of Klebsiella pneumoniae are isolated from patients hospitalized since 48 hours for neurological affections, and from medical staff hands. Eighteen (18) other strains isolated from other clinics were studied for comparison. The identification used API20 E system (BioMérieux), and the susceptibility to antibiotics was tested by disc diffusion test (antibiogram). Production of extended-spectrum beta-lactamase was studied by synergy test method. Arbitrarily primed Polymerase Chain Reaction (AP-PCR) was used to compare the electrophoretic profiles of the strains. Nosocomial strains are more resistant than the other: 57.14% vs 16.67% (p = 0.02) and 28.57% among them are extended-spectrum beta-lactamase positive. Amikacin (87.5%) and Ciprofloxacin (100%) are the most efficient antibiotics, when Cotrimoxazole inhibits 31.25% of the strains. The electrophoretic profiles show an important diversity of strains and suggest an external contamination.

[Parasitic and bacterial etiologies of diarrhea among people living with HIV hospitalized in Fann hospital (Senegal)]. / Etiologies Bacteriennes Et Parasitaires De Diarrhees Chez Les Personnes Vivants Avec Le VIH/SIDA Au Chnu De Fann (Senegal).

Diarrhea is the most common opportunistic infection in AIDS. We conducted at the Fann National University Hospital in Dakar, a study of all patients living with HIV, hospitalized in the the Clinical service of Infectious Diseases from 1 January 2003 to December 31, 2006, with diarrhea and having received an bacteriological and / or a parasitological examination of stools. The aim of this study was to identify the various pathogens isolated in the laboratory and responsible for those diarrhea. In total, 351 patients were collected, their average age was 39.93 years and the extreme ages 15 and 72 years. HIV1 serological profile was found in 90.77% of patients; 34.42% of patients received a dosage of CD4 count, among them 21.09% had a rate <200/mm3. Fifteen stool cultures were positive with the following breakdown: - Shigella (10 strains): 7 strains of Shigella flexneri, 2 of Shigella sp, one of Shigella sonnei; antibiotics most active on the Shigella strains were third generation cephalosporins and quinolones. - Salmonella (5 strains) with Salmonella Typhimurium and Salmonella Enteritidis, strains sensitive to an association of amoxicillin + clavulanic acid, to cephalosporins and to ciprofloxacin. 289 patients received a parasitological examination of the stools (KOP) and the positive number of KOP was 90 a 30,14% rate. The parasites most frequently found were: Cryptosporidium parvum, representing 10.38% of positive KOP, Isospora belli 6.23%, and Entamoeba coli 5.19%. These parasites were found predominantly in patients infected with HIV1 (61 cases/90). Cases of cobacterial and parasitic co-infections were also found. Diarrhea is one of the leading causes of death among people living with HIV. The etiologies of diarrhea, multiple, are yet to be identified and this should go through an improvement of the technical capacity and quality of our laboratories.