[Epidemiological aspects of autism in mental health care structures in the district of Bamako, Mali]. / Aspects Epidemiologiques de L'Autisme dans les Structures de Prise en Charge en Sante Mentale du District de Bamako au Mali.

AIMS: Autism is a global and early developmental disorder that appears before the age 3 years old. It is characterized by a triad of symptoms affecting the following domains: social interaction, verbal and non-verbal communication, imagination and behaviors. This work aimed to determine the frequency of autism and to identify its risk factors in Malians aged 0-17 years old. METHOD: In a cross sectional and prospective study, we reviewed clinical data in 2068 medical charts dating from 1992 to 2012 from all the mental health care centers in Bamako. RESULTS: We found a frequency of 7.8% (162/2068). The age range 0-5 years old was the most represented. The sex ratio was 1.7. The autistic child was issued from a consanguineous marriage in 25.4% (41/162) of the cases. To have parents in divorce, being the first child, and male gender were associated with autism with statistical significance. Our data suggest an elevated number of autism cases in Mali. We plan to carry out a larger prospective study to determine other autism risk factors and importantly to identify autistic families for a molecular genetic study.

BUT: L'autisme est un trouble global et précoce du développement qui apparait avant l'âge de 3 ans. Il se caractérise par une triade de symptômes affectant les domaines d'interaction sociale, la communication verbale et non verbale, l'imagination, et les comportements. Le but de ce travail était de déterminer la fréquence de l'autisme et d'identifier les facteurs favorisants chez les sujets maliens de 0­17ans. MÉTHODE: Il s'agissait d'une étude transversale rétrospective de dossiers médicaux de 1992 à 2012 à partir des données cliniques dans les structures de prise en charge en santé mentale dans le district de Bamako au Mali. RÉSULTAT: Sur les 2068 dossiers constitués durant la période d'étude, nous avons colligé 162 dossiers de troubles autistiques (de janvier à décembre 2012), soit une fréquence de 7,8% (162/2068). La tranche d'âge de 0 ­ 5 ans était la plus représentée. Le sex-ratio était de1,7. La consanguinité entre les deux parents était présente dans 25,4% (41/162) des cas. Avoir les parents en divorce, être le premier enfant, et surtout du sexe masculin étaient associés de façon statistiquement significative à la présence de l'autisme. Nos données témoignent du nombre de cas élevé d'autisme au Mali. Une étude prospective plus élaborée pour déterminer les autres facteurs favorisants de l'autisme et surtout d'identifier les familles autistes pour une étude génétique moléculaire est à planifier.

Information about medications in the district of Bamako, Mali.

The aim of our study was to investigate the quality of information about pharmaceutical products in Mali. The study surveyed 98 prescribers, 60 pharmacists, and the package inserts of a basket of 30 generic medicines, compared to those of the corresponding proprietary versions. We made a rational choice of 98 doctors from various specialties and levels of the health system and randomly selected 60 of the 215 pharmacies in the district of Bamako (Mali). A rational sampling of generic medicines provided us with a basket of 30 drug notices for the antimalarial, antibiotic, antalgic, antipyretic, and anti-inflammatory agents used most in the Republic of Mali. This study showed that the pharmaceutical industry, through its sales representatives, are the main sources of drug information and that this information is not always adequate. The study also found that the content provided with generic medicines is sometimes different from the information for the proprietary brand-name drugs.

Geographical distribution of HIV-1 group O viruses in Africa.

OBJECTIVE: To determine to what extent HIV-1 group O strains are present in different African countries. MATERIALS AND METHODS: A total of 14,682 samples of sera from a range of patients from 12 different African countries were tested. All the sera were tested with an enzyme-linked immunosorbent assay (ELISA) using a combination of V3 peptides from ANT-70 and MVP-5180. Samples reactive in ELISA were retested in a line immunoassay (LIA-O). Samples reactive in ELISA were also retested with an in-house Western blot to determine the presence of antibodies to gp120 of HIV-1 ANT-70. Polymerase chain reaction was performed on HIV-1 group O and group O indeterminate sera. RESULTS: Of all the sera samples tested, only 19 sera had antibodies to group O V3 peptides exclusively and 46 were indeterminate for group O infection in LIA-O. The highest prevalence of HIV-1 group O infection among HIV-positive sera was observed in Cameroon (2.1%) and neighbouring countries, 1.1% in Nigeria and 0.9% in Gabon. The lowest rates were seen in west Africa: 0.07% in Senegal, 0.14% in Togo, 0.16% in Chad and 0.3% in Niger. Group O sera were observed in almost all the population categories tested. The ANT-70 V3 peptide in LIA-O was reactive with all of the sera considered to be HIV-1 group O antibody positive by LIA, versus 78.9% for the MVP-5180 peptide. Thirteen out of 19 group O samples of sera were tested in PCR. Eight samples were identified as group O by specific group O pol and/or V3 primers; in the remaining five samples no HIV RNA could be detected. Of the indeterminate sera samples, two were identified as group O. CONCLUSION: In eight of the 12 countries tested, antibodies to group O viruses were identified. Numbers of HIV-1 group O viruses are low. Their presence is not restricted to Cameroon and neighbouring countries but can also be found in west and south-east Africa.

PIP: An enzyme-linked immunosorbent assay (ELISA), using a combination of V3 peptides and ANT-70 and MVP-5180, was used to test 14,682 sera samples from people living in Burkina Faso, Burundi, Cameroon, Chad, Congo, Gabon, Mali, Niger, Nigeria, Senegal, Togo, and Zambia to examine the geographic spread of HIV-1 group O viruses in Africa. An in-house Western blot and a line immunoassay (LIA-O) were used to detect the presence of antibodies to gp120 of HIV-1 ANT-70 of samples reactive in ELISA and then a polymerase chain reaction (PCR) on HIV-1 group O and group O indeterminant sera. HIV-1 group O antibodies were present in 8 countries (Cameroon, Chad, Gabon, Niger, Nigeria, Senegal, Togo, and Zambia). Among these 8 countries, the prevalence of HIV-1 group O sera ranged from 2.1% in Cameroon to 0.07% in Senegal. Cameroon and its neighboring countries had a higher prevalence than the West African countries (0.9-2.1% vs. 0.07-0.3%) and Zambia. HIV-1 group O virus was more or less evenly distributed among the population groups tested. The ANT-70 V3 peptide in LIA-O had a higher reactivity rate with HIV-1 group O sera than MVP-5180 V3 peptide in LIA-O (100% vs. 78.9%). 8 of the 13 samples tested in PCR were identified as group O by specific group O pol and/or V3 primers. Among the remaining 5 indeterminant sera samples, 2 were identified as group O. Prospective studies are needed to monitor the true prevalence of HIV-1 group O viruses in Cameroon, its neighboring countries, and West Africa. They are also needed to determine the risk factors associated with group O infection. Monitoring these viruses will allow adaptation of HIV testing strategies for blood screening and serodiagnosis if required.

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.

The identification of a complex A/G/I/J recombinant HIV type 1 virus in various West African countries.

In this sequence note we describe the full-length genome sequence of an HIV-1 isolate originating from the west African country of Mali. The phylogenetic tree analysis from the near full-length genome shows that the 95ML84 strain forms a separate cluster, supported by 100% of the bootstrap values, with the previously described A/G/J/? mosaic virus BFP90 from Burkina Faso. Additional analysis showed that throughout the genome the lowest diversity was seen between the 95ML84 and the BFP90 viruses, and bootscan analysis showed a similar complex genomic structure. In addition to the initial report describing the BFP90 virus as an A/G/J/? recombinant, our data show that for the BFP90 and 95ML84 strains the unclassified region corresponds to subtype I. The A/G/I/J BFP90 and 95ML84 strains represent the fifth and most complex circulating recombinant form of HIV-1 detected so far, and our data show its presence in various West African countries. Subtype I and J sequences, initially considered rare, seem to have broadened their geographical spread by way of these recombinant forms.

[Rhinopharyngeal carriage of Neisseria meningitidis serogroup C in the collectivity around the patients of Mali. Apropos of 1,033 subjects sampled]. / Etude du portage rhinopharyngé de Neisseria meningitidis sérogroupe C dans la collectivité autour des patients au Mali. A propos de 1,033 sujets prélevés.

This study showed that the carriage rate is nul or low in collectivity not in close contact, but high in collectivity in close contact (schools, particularly coranic schools). In this later case, the duration of the carriage may reach several weeks (2 to 6 in our study) at variable rates (3.7 to 9.6%; 12.5 to 62.5%; 14.3 to 42.9% according to the coranic school visited). For the strains of N. meningitidis serogroup C isolated, the rate of resistance to sulfamides and cotrimoxazole is 86.8%. These results explain why during epidemics, it is necessary to close schools and avoid to use for the chemoprophylaxis, sulfamids and their associations because of resistance.

[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.

[Various sociocultural findings concerning sexual impotence in Senegal]. / Quelques données socio-culturelles dans l'impuissance sexuelle au Sénégal.

This study emphasizes the role of the socio-cultural status and consequently of psychologic factors in sexual impotence of the black African in Senegal: --role of age, related to the perception of a dual status; --role of the ethnic group giving or not preeminence to sex; --rank in the brotherhood which may raise a conflict with ancestor; --matrimonial situation having significance of an acceptance of the cultural code about sex; --somatizations expressing the sexual potentialities; --non structured neurosis as expression of psychic and sexual inhibition; --religious behaviour with opportunities of conflicts with the religious authorities.

[First major epidemic caused by Neisseria meningitidis serogroup W135 in Africa?]. / Premiere epidemie de garnde amplier provoquee par Neisseria meningitidis W135 en Afrique?

Neisseria meningitidis serogroup W 135 (N.m. W 135) has caused sporadic infections and small epidemics such as those that occurred during religious pilgrimages in Saudi Arabia in 2000 and in 2001. It is routinely isolated from specimens coming from African countries. The first major epidemic involving N.m. W 135 occurred in Burkina Faso between January and May 1992. There were more than 1300 cases including 1500 deaths. Enhanced surveillance of circulating strains showed that N.m. W 135 accounted for 83% of the 203 positive cerebrospinal fluid specimen cultures. The offending organism was identical to the strain that caused the smaller epidemic in Saudi Arabia in 2000. Due to the shortage of tetravalent meningococcal vaccine against N.m. W 135, the Health Ministry based its response to the epidemic on treatment of symptomatic patients using chloramphenicol and ampicillian. These drugs were distributed free. The emergence of N.m. W135 has impacted public health in Africa. Repeated identification of this serogroup in Burkina Faso during 2002 raises the risk that similar outbreak will occur in the meningitis belt during the next epidemic season. The high cost of tetravalent meningococcal vaccine compounded with the only progressive increase in production capacity underline the need to reinforce surveillance of circulating strains and available treatment facilities. Control strategy for epidemic meningitis is currently the focus of close collaboration between the WHO and the health authorities and corresponding institutions in the countries involved.

[Human immunodeficiency virus (HIV) infection in Mali]. / L'infection par le virus de l'immunodéficience humaine (VIH) au Mali.

This review summarises epidemiological and clinical data of HIV infection who was recognized in Mali since 1985. The most important rate of seropositivity for HIV is observed in the prostitutes group (40%). The estimated seroprevalence for adult population is between 1% and 5%. 46 cases for AIDS are reported in both sexes. The mean age is 35 years. Main signs are weight loss (91%), fever (80%), diarrhea (70%) and lymphadenopathy (50%). Three among the five cases of Kaposi's sarcoma are aggressive. 19.5% of AIDS have antibodies to HIV1, 41.3% to HIV2 and 39.1% to HIV1 and HIV2. Death rate is more than 50%. These data are compared with other countries of Africa.

[Factors associated with antiretroviaral treatment observance at Point "G" hospital]. / Les Facteurs associés à l'observance du traitement antirétroviral à l'hôpital du Point G.

OBJECTIVE: To study the factors associated with the observance of treatment ARV among patients followed in hospital medium to Bamako. METHOD: Inquire longitudinal with collection of the data near the patients followed in one of the three greater sites of assumption of responsibility of the people reached with the VIH/SIDA to Mali. The people were regarded as observing if they took at least 95% of their treatment the moment of the investigation. RESULTS: The patients were between 1 and 40 months of treatment the moment of the investigation. The average age was 44 years with extremes going from 19 to 70 years. Association Lamivudine +Stavudine + Nevirapine (triomune) was the most prescribed antiretroviral therapy (34.2%). The bad observance was noted at 58.5% of the patients. The principal causes of bad observance were: the lapse of memory 47.5% (96/202) and difficulties of access to the hospital 34.6% (70/202). The changes of molecules were due primarily to the out-of-stock condition, and the side effects. The factor associated with a good observance was the assistance of the patient by a member of the family informed of seropositivity. CONCLUSION: The interest of HIV patient to his treatment could contribute to enhance antiretroviral Adherence particularly in this hospital and generally in Mali.

[The clinical and biological tolerance of nevirapine among patients with AIDS under treatment at the Hospital of the Point G]. / La tolerance clinique et biologique de la nevirapine chez les malades du SIDA sous traitement a l' Hopital du point G.

The national policy of assumption of responsibility of the PVVIH decided to put 80% of new inclusions under Triomune, 1st therapeutic line made up of 3TC + D4T + Nevirapine. The use of Nevirapine among patients VIH+ plays a very important part in improvement of the quality of their life. The goal of this study was to evaluate the clinical and biological tolerance of Nevirapine at the PVVIH under treatment ARV and having Nevirapine in their diagram. We had collected 102 files of patients. The average age was 38 years. Association Lamivudine + Stavudine + Nevirapine was the diagram most frequently prescribed (82.4%). The skin, mucous and neurological signs, digestive disorders, muscular signs, cardiopulmonary signs were frequently observed in the first month of the treatment but these symptoms became less frequent in the third month and disappeared at the 6th month. We observed disorders in hepatic and renal functional parameters, rise in the lymphocytes. We obtained a considerable increase in the rate of CD4 between the beginning of the treatment and the 6th month. The treatment schema of 3TC + D4T + Nevirapine gives an excellent clinical and biological tolerance. But, the study must continue to confirm these results over a longer period.

[Bacteriologic characteristics of 25 strains of Vibrio cholerae, biotype eltor isolated in Mali]. / Etude des caractères bactériologiques de 25 souches de Vibrio cholerae, biotype eltor isolées au Mali.

This work studies bacteriological characters of 25 strains of V. cholerae isolated in Mali during the outbreak of 1984-1987. These strains were precisely identified by biochemistry characters, toxin secretion, presence of a structure considered as attachment factor. Antibiotic susceptibility study confirmed the great sensibility of V. cholerae to this products, and allowed to classify them according to their Cl90. This contribution of the laboratory is very interesting for the control of the disease and the choice of standardized scheme of treatment.

[Comparison of two methods of evaluation of gentamicin in man : bioassay and enzyme immunoassay (author's transl)]. / Comparaison de deux techniques de dosage de la gentamicine chez l'homme. Méthodes microbiologique et immunoenzymatique.

This study compares two methods of gentamicin determination in blood : bioassay and enzyme immunoassay. Results for 145 patients serums showed a correlation coefficient of 0,895 between the two methods. The accuracy and reproducibility were tested on 10 known samples. Each sample was titrated 10 times. Values obtained and real values are near between 0 and 5 mcg/ml and significantly move away between 6 and 10 mcg/ml by the two methods. Advantages and disadvantages are discussed for each method.

[Structure-activity relationships in the quinolone group: antibacterial activity of two new compounds (author's transl)]. / Relations structure-activité dans le groupe des quinolones: étude de l'activité antibactérienne de deux nouveaux composés.

Authors describe structure-activity relationships in quinolone group and report a study of the antibacterial activity of two new compounds: pefloxacin and its demethyl derivative, AM-715. These two products take place in the field of researches carried out for extending indications of this group of antimicrobial agents by obtaining derivatives more active, with broader spectrum, less biotransformed and susceptible to be used in general infections and not only in urinary tract infections.

Prevalence of antibodies against respiratory viruses in children of Koulikoro (Mali).

The prevalence of antibodies to viruses associated with respiratory illnesses (influenza, corona, R.S., adeno, parainfluenza Mycoplasma pneumoniae) has been investigated in 119 children under 3 years of age (Koulikoro region Mali) and 50 persons 15-19 years of age (Bamako/Mali). In the surveillance period (March 1982-September 1982) an outbreak of respiratory disease in association with RS virus took place. A rise of CF titer has been found in 90.8% of the children; 59.1% of them presented a fourfold or greater increase of titer. The GMT values rose from 1:7 to 1:48. Concerning influenza viruses a higher incidence of positive reactions has been observed only for H3N2 viruses. A fourfold CF rise of titer has been observed for adenovirus and mycoplasma pneumoniae in 3 cases each, for parainfluenza type I and III in 2 cases each, and for parainfluenza II in 1 case. In persons 15-19 years of age the incidence of positive CF reactions was relatively high (68%-98%), but the GMT values were moderate (1:12-1:25). These data confirm that the frequency of viral respiratory diseases is the same in tropical countries as in countries with a temperate climate.

[Naturally acquired tetanus antitoxin in the serum of children and adults in Mali]. / Uber natürlich erworbene Tetanusantitoxine im Serum von Kindern und Erwachsenen in Mali.

Among 48 adults without a history of tetanus immunization, we found with the aid of indirect hemagglutination test 20 individuals with protective tetanus antibody titers, 23 with low levels of antitoxin (under 0,1 I.U./ml) and 5 devoid of tetanus antitoxin. In two blood samples of 99 unvaccinated children under 3 years of age (taken at 7 months intervall) 12,1% showed tetanus antitoxin in the first serum sample and 16,2% in the second sample. Protective antibody titers could be found only in 4 children in each of the first and second serum sample. The data suggest a silent oral immunization by tetanus bacilli thus boosting under unhygienic conditions the tetanus immunity with advancing age.

[Differences in rubella immunity in Mali and Hamburg and their consequences]. / Die Unterschiede in der Rötelndurchseuchung in Mali und Hamburg und ihre Konsequenzen.

The rare occurrence of rubella embryopathy in Mali stimulated us to investigate the rubella immunity of the population. Sera from females from Hamburg (n = 97) between 16 and 42 years old were in 84,5% seropositive (hemolysin-in-gel test) whilst a sample of Malien females (n = 99) were positive in 92,9%. Our investigations showed that the Malien children were significantly (p = less than 0.001) earlier infected by rubella than in Hamburg (Mali: children under 8 years [n = 196] in 46.9%; Hamburg [n = 151] in 20.5%). In Mali 7-8 years old children were already in 87.5% seropositive (Hamburg: only in 46.7%). The early immunity in childhood is due to the bigger African family in comparison with the smaller European family. The height of rubella serum titers was in grown-ups identical, but the relationship was vice versa in both studied newborn populations. Newborns from Mali showed lower rubella antibody titers than their mothers (newborns from Hamburg had a tendency to higher titers). Similar relationships were found already in the amount of neutralizing polioantibodies in newborns from both countries. A rubella immunisation in Mali seems not to be indicated.