[Efficacy and tolerance of tenofovir-lamivudine-efavirenz combination in HIV-1 patients in Fann Teaching Hospital in Dakar]. / Efficacité et tolérance de l'association ténofovir-lamivudine-éfavirenz chez les patients VIH-1 à la clinique des maladies infectieuses du CHNU de Fann à Dakar.

We conducted a study to evaluate the efficacy and tolerance of the tenofovir (TDF), lamivudine (3TC) and efavirenz (EFV) combination regimen in HIV-1 patients by a descriptive analytical retrospective study of all HIV-1 patients receiving TDF-3TC-EFV combination between 2007 and 2011. Collected data was analysed using EpiInfo™ version 6.04. One hundred patients were included, with an average follow-up duration of 27 months and 19 days (± 21 months and 14 days).We observed an average increase in body weight of about 8 kg per annum, with an average rise in CD4 count of 100/mm(3) by the end of the second year. A reduction in viral load with 71% of patients in therapeutic success at 24 month of treatment was noted. Ninety-two patients presented with at least one side effect, mostly being Grade 1 or 2 (96.36%). Neurological (24 patients) and digestive (20 patients) complaints comprised the commonest reported side effects. Four patients had adverse effects severe enough to warrant a change in treatment regimen, principally due to renal insufficiency. Thirteen subjects died. Patients receiving TDF-3TC-EVF combination therapy need rigorous surveillance because this combination, although efficient, is not without significant adverse effects.

[Cerebral toxoplasmosis in the infectious diseases department of the CHU du Point G in people living with HIV]. / La toxoplasmose cerebrale dans le service de maladies infectieuses du CHU du Point G chez les personnes vivant avec le VIH.

Toxoplasmosis is defined as a cosmopolitan protozoan disease caused by an obligate intracellular coccidia, Toxoplasma gondii. The advent of HIV infection has made cerebral toxoplasmosis one of the most widespread neurological opportunistic infections. METHOD: We conducted a descriptive cross-sectional study with retrospective review of files of cerebral toxoplasmosis on HIV infected patients who had been hospitalized in the infectious diseases department of Point G University Hospital between January 1st, 2014 and September 30th, 2019. RESULTS: During the study period, the frequency of cerebral toxoplasmosis was 10.1% and in 46.4% of the patients, the diagnosis led to the discovery of HIV co-infection. The clinical features were characterized by fever, headaches, and motor deficit at 86.6%, 84.5% and 69.1% respectively. Roundel image on computed tomography was most represented and was found in 24.4% of patients. Anti-toxoplasma treatment based on trimethoprim /sulfamethoxazole (TMP/SMX) associated with folinic acid was initiated in 78 patients out of 90, but 19 patients had a contraindication or adverse effects to this combination and were treated with clindamycin. HAART was initiated in 31 patients out of 45 (68.9%) newly diagnosed. The overall prognosis was limited with a mortality rate of 42%. CONCLUSION: The prevalence of cerebral toxoplasmosis was high in our study, 10.1%. To reduce this prevalence, chemoprophylaxis should be initiated in all HIV-infected patients with a CD4 count below 200 cells/mm3.

INTRODUCTION: La toxoplasmose est une protozoose cosmopolite due à Toxoplasmagondii. Avec l'avènement du VIH, la toxoplasmose cérébrale est une des infections opportunistes neurologiques les plus répandues. MÉTHODE: Nous avons mené une étude transversaledescriptive à collecte rétrospective portant sur des cas de toxoplasmoses cérébrales sur terrain d'immunodépression aux VIH ayant séjourné en hospitalisation dans le service des maladies infectieuses du CHU de Point G du 1er janvier 2014 au 30 septembre 2019. RÉSULTATS: La prévalence de la toxoplasmose cérébrale était de 10,1%. Chez 46,4% des patients, le diagnostic de toxoplasmose cérébrale avait permis la découverte d'une coïnfection à VIH. Le tableau clinique était dominé par la fièvre, les céphalées et le déficit moteur soit respectivement 86,6%, 84,5% et 69,1%. L'image en cocarde à la tomodensitométrie a été retrouvée chez 24,4% des patients. Le traitement anti-toxoplasmique à base de triméthoprime/sulfaméthoxazole (TMP/ SMX) associée à l'acide folinique a été conduit chez 78 patients sur 90. Dix-neuf patients avaient une contre-indication ou des effets indésirables à l'association TMP/ SMX et ont été traités par la clindamycine. Le traitement ARV a été initié chez trente-un patients sur 45 nouvellement dépistés soit 68,9%. Le pronostic chez nos patients était réservé et marqué par une mortalité de 42%. CONCLUSION: La prévalence de la toxoplasmose cérébrale était élevée dans notre étude soit 10,1%. Pour diminuer cette prévalence, la chimio-prophylaxie doit être instaurée chez tous les patients infectés par le VIH et ayant un taux de CD4 inférieur à 200 cellules/mm3.

The effectiveness of Mesocyclops longisetus (Copepoda) for the control of container-inhabiting mosquitoes in residential environments.

The cyclopoid crustacean Mesocyclops longisetus was evaluated for its predatory potential to reduce container-inhabiting mosquitoes in 5 suburban Florida backyards. Aedes albopictus, Ae. triseriatus, and Culex quinquefasciatus were the predominant species collected from containers. At an initial inoculation rate of approximately 120 copepods per container, M. longisetus populations eliminated resident mosquito larvae for a minimum of 14 wk in 30-liter plastic buckets and up to 29 wk in 0.4-liter ceramic flowerpots and 0.3-liter glass jars depending on species. Copepod populations generally peaked 13 wk after introduction (August) in ceramic flowerpots and glass jars and about 1 month later in tires, plastic buckets, and plastic flowerpots. At the time of peak abundance, average predator numbers ranged between 900 (glass jar) to >3000 (30-liter bucket) individuals per container. Although all mosquito species were eliminated from all containers sometime during the 35-wk study, M. longisetus appeared to preferably prey on Aedes larvae compared with Culex. Operationally, the use of M. longisetus as a tool for control of container-inhabiting mosquitoes in urban/suburban settings proved to be relatively inexpensive, required little labor for colony maintenance, was easily transported, and easily applied.

[Current profile of HIV-infected patients hospitalized in Dakar (Senegal)]. / Profil actuel des patients infectés par le VIH hospitalisés à Dakar (Sénégal).

Ten years after the introduction of the Senegalese Antiretroviral Drug Access Initiative in 1998, we conducted a retrospective study of the epidemiological and clinical profiles and outcome of HIV-infected patients hospitalized in the Infectious Diseases Clinic of Fann Teaching Hospital in Dakar between 2007 and 2008. During these 2 years, 527 HIV-positive patients were included. The average age of the patients was 41 ± 10 years, and the sex-ratio (F/M) was 1.1; 56% of patients were married. The average interval before admission was 40 ± 57 days. Fever (83%), loss of weight (83%) and cough (54%) were the principal symptoms. Tuberculosis (40.9%) and gastrointestinal candidiasis (38.9%) were the commonest opportunistic infections. Most patients were diagnosed at the AIDS stage (88%) and the CD4+ T lymphocyte count was ≤ 200/mm3 in 86% of cases. Hospital fatality was 44% (231/527). Tuberculosis (36%), bacterial pneumonia (18%) and encephalitis (12%) were the most frequent causes of death. Despite the availability of and free access to antiretroviral drugs in Senegal, the mortality associated with HIV infection remains very high due to late diagnosis. The population must be educated to boost early screening and care.

[Human rabies: diagnostic pitfalls]. / La rage humaine, un diagnostic parfois difficile.

The purpose of this report is to describe two cases of human rabies in Senegal that illustrate possible diagnostic and therapeutic pitfalls even in an endemic area. Although outcome is almost always fatal and interhuman transmission is uncommon, prompt diagnosis of rabies is important since delay increases the risk of exposure to the virus for the entourage.

[Descriptive study of COVID-19 cases in the third Municipality of Bamako, from March 26 to August 27, 2020]. / Etude descriptive des cas de COVID-19 en Commune III de Bamako du 26 Mars au 27 Aout 2020.

INTRODUCTION: A public health emergency of international concern, COVID-19 is an acute respiratory disease responsible in eight months of approximately 843,158 deaths worldwide, including 29,425 deaths in Africa. The objective was to describe the COVID-19 cases in the health district of Commune III of Bamako. METHODS: This was a descriptive cross-sectional study of COVID-19 surveillance data from March 26 to August 27, 2020. Our variables were extracted from the surveillance database and analyzed on Epi-Info 7.2. Frequencies, rates and proportions were calculated. RESULTS: A positivity rate of 14.86% identified 126 confirmed cases out of an 848 notified suspect. The median age of confirmed cases was 34 years with a minimum of 8 months and a maximum of 93 years. The sex ratio was 2.7 males to females. Civil servants accounted for 32.54% of the positive cases. All the health subdistricts have recorded positive cases. The lethality was 7.94% affecting those over 65 years old. Among asymptomatic people 10.75% were confirmed positive for COVID-19. CONCLUSION: Our study suggests that young males were more likely to be infected with COVID-19. We recommend systematic screening of all contacts and involvement of the community in surveillance.

INTRODUCTION: Urgence de santé publique de portée internationale, la COVID-19 est une maladie respiratoire aiguë responsable en huit mois d'environ 843 158 décès dans le monde dont 29 425 décès en Afrique. L'objectif était de décrire les cas de la COVID-19 en Commune III de Bamako. MÉTHODES: Il s'agissait d'une étude transversale descriptive des données de surveillance de la COVID-19 du 26 Mars au 27 Août 2020. Nos variables ont été extraites de la base de données de surveillance et analysées sur Epi-Info 7.2. Les fréquences, taux et proportions ont été calculés. RÉSULTATS: Un taux de positivité de 14,86% a permis d'identifier 126 cas confirmés sur un 848 suspect notifié. L'âge médian des cas confirmés était de 34 ans avec un minimum de 8 mois et un maximum de 93 ans. Le sex-ratio était de 2,7 en faveur des hommes. Les fonctionnaires représentaient 32,54% des positifs. Toutes les aires de santé ont enregistré des cas confirmés. La létalité était de 7,94% affectant les plus de 65 ans. Parmi les personnes asymptomatiques 10,75% ont été confirmés positives à la COVID-19. CONCLUSION: Notre étude suggère que les jeunes de sexe masculin étaient plus susceptibles d'être infectés par la COVID-19. Nous recommandons le dépistage systématique de tous les contacts et une implication de la communauté dans la surveillance.

[Study of factors associated with maternal mortality by the audit method in the Segou region]. / Etude des facteurs lies aux deces maternels par la methode d'audit a l'hopital nianankoro fomba de Segou.

INTRODUCTION: Maternal mortality remains a public health problem in developing countries, including Mali. Among the factors associated with maternal mortality are sociodemographic and economicfactors, but also dysfunctions related to the health care system. It is in this context that this study was conducted in the gynecology and obstetrics department of the Nianankoro Fomba Hospital in Ségou to determine the factors associated with maternal deaths by the audit method in the Segouregion. METHOD: It was a cross-sectional, descriptive and retrospective study that was conducted from January 2014 to December 2015. The data were captured and analyzed on Epi Info version 2003. RESULTS: The analysisincluded 41 auditeddeaths out of 79 maternaldeathsreportedduring the period, amaternalmortality rate of 51.90%. Direct obstetric causes accounted for the majority (51.23%). Of these causes hemorrhagewas the main with 17.08% followed by eclampsia (14.63%). 31.71% of deathswerepreventable. The main riskfactorsidentifiedwere: delayed care, referral / evacuationdelay, diagnostic errors (hospitallevel), non-availability of blood. CONCLUSION: Continueddeath audits at the healthfacilitylevelcouldbe an approach to improving the quality of care and reducingmaternal and perinataldeaths.

INTRODUCTION: La mortalité maternelle demeure un problème de santé publique dans les pays en voie de développement dont le Mali. Parmi les facteurs associés à la mortalité maternelle on peut citer notamment les facteurs sociodémographiques et économiques, mais aussi les dysfonctionnements liés au système de soins. C'est dans ce cadre que cette étude été menée dans le service de gynéco-obstétrique de l'hôpital Nianankoro Fomba de Ségou pour déterminer les facteurs associés aux décès maternels par la méthode d'audit dans la région de Ségou. MÉTHODE: Il s'agissait d'une étude transversale, descriptive et rétrospective qui a étéréaliséede janvier 2014 à décembre 2015. Les données ont été saisies et analysées sur Epi Info version 2003. RÉSULTATS: L'analyse a porté sur 41 décèsaudités sur 79 décès maternels notifiés au cours de la période, soit un taux de décès maternels audités de 51,90%.Les causes obstétricales directes étaient majoritaires (51,23%).Parmi ces causes l'hémorragieétait la principale avec 17,08% suivie de l'éclampsie (14,63%). 31,71% des décès étaient évitables.Les principaux facteurs de risques identifiés ont été :le retard de prise en charge, le retard de référence / évacuation, les erreurs de diagnostic (niveau hôpital), la non disponibilité du sang. CONCLUSION: La poursuite des audits des décès au niveau des établissements de santé pourrait être une approche d'amélioration de la qualité des soins et de réduction des décès maternels et périnatals.

[Surgery wound infection at surgery "A" department of the University Hospital Point G]. / Infection du site operatoire dans le service de chirurgie « A ¼ du CHU du Point G.

AIM: To determine the frequency of the surgery wound infection, its favoring factors, causative germs and its antibiotic treatment of choice in the surgery "A" department of the University Hospital Point G. METHOD: In a retrospective descriptive study over a 6-month period in the surgery "A" department of the University Hospital Point G, we enrolled all patients who underwent surgery necessitating at least 48 hours of hospital admission during our study period and in conformity with the Atlanta CDC criteria. Surgery patients with less than 48 hours postoperative hospital stay and those admitted to the hospital without surgery were not included.After the surgery, the nature and location of the infection have been clarified. In this work, ethical considerations have been respected and there is no conflict of interest. RESULTS: Two hundred and sixty-five (n=265) patient files were collected including 24 cases of surgery wound infection (a hospital frequency of 9%. The average age was 41.41 years (y.o) old with extremes of 7 y.o and 102 y.o. The sex ratio was 0.9 in favor of women. The commonly studied pathologies were digestive surgery in 52.8%, gynecological surgery in 24.5%, etc… Patients were seen in regular outpatient surgery visits in 75.8% and surgical emergencies in 24.2%. Of the patients urgently admitted, 26.5% presented an ISO; for those received in ordinary consultation it was 3.48%. Fifteen (15) cases were classified ASA III and two (2) ASA II. Based on the Altemeier classification, surgery was clean in 66.8% of our patients, contaminated clean in 12.4%, contaminated in 12.1%, and dirty in 8.7% (including half resulting in surgery wound infection). In total, 79% of patients whose surgeries lasted more than two (2) hours presented a surgery wound infection. Postoperative infection of patients was superficial in 58.3% and deep in 33.3%. In 8.3% of cases, it was a space infection. At the cytobacteriological examination of the pus from the operative site, Escherichia coli (E. coli) was the most common germ with 58.3%. E. coli was sensitive to amoxicillin-clavulanic acid in 57.14%. Surgically, a re-intervention was performed in 20.8% of cases, a secondary suture in 12.5%, and a single dressing in 66.7%. The average postoperative stay was 6.5 days with extremes of 2 days and 69 days. In 3 months postoperatively we recorded 4 cases of death. CONCLUSION: The surgery wound infection constitutes a major complication in a surgical environment starting with surgical act itself.Particular emphasis should be placed on prevention, which will reduce the risks of ISO occurrence.

BUT: déterminer la fréquence des infections du site opératoire (ISO), les facteurs favorisants la survenue des ISO, les germes responsables et les antibiotiques actifssur les infections du site opératoire dans le service chirurgie « A ¼ du CHU du Point G. MÉTHODE: Il s'agissait d'une étude rétrospective et descriptive sur une période de 6 mois réalisée dans le service chirurgie « A ¼ du CHU du Point G. Ont été inclus tous les patients ayant subi une intervention chirurgicale pendant cette période et hospitalisés au moins 48 heures après, et qui ont répondu aux critères du CDC d'Atlanta. N'ont pas été inclus, les patients opérés dont le séjour post opératoire a été inférieur à 48 heures, les patients hospitalisés dans le service mais non opérés, et ceux opérés dans le service et non hospitalisés. En postopératoire la nature et le siège de l'infection ont été précisées. Dans ce travail les considérations éthiques ont été respectées et il n'y a pas de conflit d'intérêt. RÉSULTATS: deux cent soixante-cinq dossiers de patients ont été colligés dont 24 cas d'ISO soit 9% des cas. L'âge moyen a été de 41,41 ans avec des extrêmes de 7ans et 102 ans. Le sex ratio a été de 0,2 en faveur des femmes. Les principales pathologies étudiées ont été la chirurgie digestive dans 52,8%, la chirurgie gynécologique dans 24,5%. La majorité des patients ont été reçus en consultation ordinaire dans 75,8% des cas, et en urgences dans 24,2 %. Parmi les patients reçus en urgence 26,5% ont présenté une ISO ; pour ceux reçus en consultation ordinaire elle a été de 3,48%.Parmi les patients infectés 15 étaient classés ASA III et 2 ASA II. Selon la classification Altemeier, la chirurgie propre a occupé 66,8% des patients, la chirurgie propre contaminée 12,4%, la chirurgie contaminée 12,1%, et la chirurgie sale 8,7%. Parmi les patients opérés de chirurgie sales 50% ont présenté une ISO.L'ISO était présente chez 79% des patients ayant effectué plus de 2 heures d'intervention.En postopératoire l'infection était superficielle chez 58,3% des patients, et profonde chez 33,3% des patients. Dans 8,3% des cas, il s'agissait d'une infection d'espace. A l'examen cytobactériologique du pus Escherichia coli (E coli) avec 58,3% a été le germe le plus fréquent sur le site opératoire. E coli était sensible à l'association amoxicilline - acide clavulanique dans 57,14%. Sur le plan chirurgical une réintervention a été réalisée dans 20,8% des cas, une suture secondaire dans 12,5%, et un pansement seul dans 66,7%. La durée moyenne de séjour post opératoire était de 6,5 jours avec des extrêmes de 2 jours et 69 jours. En 3 mois postopératoire nous avons enregistré 4 cas de décès. CONCLUSION: L'ISO constitue une complication majeure en milieu chirurgical compromettant l'acte chirurgical. Un accent particulier doit être mis sur la prévention qui diminuerai les risques de survenue de l'ISO.

[Knowledge, behaviors and practices among ironworkers about tetanus in Senegal]. / Connaissances, attitudes et pratiques a propos du tétanos chez les ferronniers a Dakar, Sénégal.

Tetanus is still a major health problem in Sénégal. In order to understand some of these reasons, we conducted a study. The aim of this study is to assess ironworkers' knowledge, behaviors and practices about tetanus. This knowledge, behaviors and practices survey was carried out in ironworks of two neighborhoods of Dakar from April 5 to May 10, 2008. 41 ironworks were identified and 32 agreed to participate in the study. In this ironworks, 120 ironworkers were interviewed. Their average age was 29 years +/- 15, education in French schools was low and 78.3% of them had a source of information. Despite some inaccuracies, most ironworkers were aware of tetanus (97.5%), severity (93.3%), causes (89.2%). However 35% did not evaluate the risk of tetanus and almost all the ironworkers or 96.7% had no preventive measures after injury. Moreover, no ironworker was fully immunized against tetanus. In some occupations at risk, awareness of tetanus should be increased by all available channels and methods emphasizing the importance of prevention.

[Tolerance study of a triple first-line antiretroviral combination zidovudine, lamivudine and efavirenz in Dakar, Senegal]. / Etude de la tolérance d'une trithérapie antirétro- virale de première intention associant zidovudine, lamivudine et efavirenz à Dakar, Sénégal.

This study aimed at describing the side-effects reported in patients infected with HIV-1 treated initially by the association zidovudine, lamivudine and efavirenz between 2002 and 2007 in the Regional Centre of Clinical Research and Training in Dakar as part of the cohort of the Senegalese Initiative Access to Antiretroviral. Adverse effects were entered and analysed using the software Epi Info version 6.04. The average age of the patients was 38 years old. During the follow-up (average = 741 days), adverse effects were reported 75 times and 39 patients were concerned. The most frequent type of side-effects was neuropsychiatric (47%), digestive (20%) and dermatological (16%). They were severe in 13% of cases and severe anaemia was noted in eight cases. These required a change of therapy in 19%, mainly for severe anaemia (15%). The association zidovudine, lamivudine and efavirenz doesn't seem to induce severe side-effects. Nevertheless, considering the frequency of neuropsychiatric side-effects and severity of hematological side-effects, attention should be paid to neuropsychiatric and blood examination of patients undergoing this combination antiretroviral therapy.

Postpartum infections in a tropical environment: The experience of the infectious diseases department at Fann Teaching Hospital of Dakar (Senegal).

To describe the epidemiology, clinical characteristics, and outcomes of infections in postpartum women admitted to the infectious diseases department at Fann Teaching Hospital. This retrospective descriptive study examined the records of women admitted for infectious diseases within 42 days after childbirth during the five-year period (2007-2011). Data were collected from medical files and analyzed with Sphinx plus2 V5 software. In all, 54 women were admitted for infections during the postpartum period. Their mean age was 27.4 ± 6.2 years. Fifty women (93%) had had vaginal deliveries. The average interval from delivery to admission was 15.4 ± 11.0 days. Tuberculosis (14 cases), vaginitis (13 cases), and severe malaria (7 cases) were the most frequent infectious diseases. The average duration of hospitalization was 12.1 ± 9.0 days. The mortality rate was 30%, with the main causes of death tuberculosis (25 %) and severe pneumonia of unknown causes (25 %). Tropical diseases remain frequent during the postpartum period, with a high lethality rate, as this study shows. Early diagnosis during pregnancy and better follow-up after delivery should be the best ways of reducing morbidity and mortality from these infections.

[Cerebral malaria in adults at the Infectious Diseases Clinic in the Fann Hospital in Dakar, Senegal]. / Neuropaludisme de l'adulte a la clinique des mala- dies infectieuses du CHU de Fann de Dakar, Sénégal.

This study aimed at describing cerebral malaria cases findings in the Fann Hospital in Dakar. Data were collected from patients files recorded from 2001 to 2005. One hundred and twenty nine cases of cerebral malaria were admitted to the clinic, accounting for 21.4% of all malaria cases. The sex-ratio M/F was 2.48 and the mean age of patients 28.24 years old +/- 13.7 [12-85 years old]. Patients presented with either coma (91.4%) or mental confusion (10.07%) along with fever (80.6%), convulsions (33.3%). Other severe malaria conditions were observed: jaundice (7 cases), severe anaemia (5 cases), acute renal failure (3 cases), and circulatory collapse (3 cases). Acute pulmonary infection (4 cases) and Salmonella bacteraemia (2 cases) occurred as complications during patient's hospitalisation. The case fatality rate was 20.2% (26 deaths). No neurological sequelae were found among survivors. Cerebral malaria lethality is still high enough to urge for the improvement of working conditions in our clinic. Together with promotion of preventive measures in the community better health care services will help to reduce malaria related morbidity and mortality.

[Post-circumcision tetanus in Dakar, Senegal]. / Le tétanos post-circoncision a Dakar, Sénégal.

This study aimed at describing the epidemiology, clinical features and prognosis of post-circumcision tetanus at the infectious diseases clinic in Fann Hospital in Dakar. Data were collected retrospectively for analysis from patients' files recorded from January 1, 1999 to December 31, 2006. 54 cases were included, accounting for 4% of all tetanus cases admitted to the clinic during the study period (54 cases/1291). The patients' average age was 9 +/- 3.7 years old (range = 1-17 years) and 52% of them were schoolboys. In most cases (76%), tetanus symptoms occurred beyond 7 days after circumcision. The average delay from onset of the disease to admission was 2.3 days (range = 0-6 days). The circumcision took place at home in 39% of cases, in health center in 35% of cases and in unspecified area in 26% of cases. The majority of patients (85%) had never received tetanus vaccine and, in 72% of the cases, the circumciser was designated as a male nurse. Generalized tetanus was observed in all cases, most of which was a mild form of the disease (63%). During hospitalisation, thirteen patients (24%) had complications among which diaphragmatic and intercostal muscle spasms (3 cases), bacteraemia (5 cases), respiratory infection (4 cases), urinary tract infection (4 cases), and fracture of the vertebrae (1 case). The case fatality rate was 7.4% (4 deaths). Vaccination together with health education of the population as well as a better sensitization of the practitioners are necessary to eradicate tetanus after circumcision.

[Neuromeningeal cryptococcosis in patients apparently non-immunodeficient: report of 3 cases in Dakar, Senegal]. / Cryptococcose neuroméningée chez des patients apparemment non-immunodéprimes: à spropos de 3 cas à Dakar, Sénégal.

Cryptococcal infection is common in immunocompromised patients. Its occurrence in immuno-competent patients is rare. We report here 3 cases of neuromeningeal cryptococcosis in patients without any immunosuppressive documented factors. They were respectively 25, 36 and 50 years old presenting clinical signs of chronic meningo-encephalitis. The HIV test was negative for all of them and the CD4 counts were normal. One patient died on the seventh day of the treatment with amphotericin B; the second was discharged on parents' request, while the third patient improved with intravenous fluconazole. This study suggests that when facing a sub-acute or chronic meningitis, an investigation for cryptococcal infection is recommended as before AIDS epidemic.

[Adult purulent meningitis caused by Streptococcus pneumoniae in Dakar, Senegal]. / Les méningites purulentes à Streptococcus pneumoniae de l'adulte à Dakar.

The purpose of this retrospective study was to describe epidemiological, clinical, bacteriological and outcome features of purulent meningitis caused by Streptococcus pneumoniae in adult patients hospitalized in the infectious diseases clinic of the Fann University Hospital in Dakar, Senegal from 1995 to 2004. A total of 73 cases of pneumococcal meningitis were recorded during the study period. Streptococcus pneumoniae was the second cause of purulent meningitis after meningococcal infection. Sickle-cell disease (n=3) and HIV infection (n=9) were the main underlying factors and pneumonia was the main portal of entry into the CNS (51.8%). Coma was a frequent complication (61.6%). Penicillin-nonsusceptible Streptococcus pneumoniae (PNSP) accounted for 27.3% of isolated strains. However strains were sensitive to third-generation cephalosporin (100%) and chloramphenicol (68.2%) which were the most frequently used antibiotics. The mortality rate was 69.8% and neurological complications occurred in 13.7% of patients. The main unfavorable prognostic factors were cardiovascular collapse and/or coma at the time of admission and detection of pneumococcal strains by direct examination of CSF. The high mortality of pneumococcal meningitis in adult patients in Dakar shows the need to improve intensive care facilities and the growing incidence of PNSP underlines the requirement for better control of antibiotic prescription.

[The place of malaria in an infectious disease department in Dakar, Senegal]. / Place du paludisme dans un service de pathologie infectieuse a Dakar (Sénégal).

The aims of this study were to determine the place of malaria at the Infectious Disease Clinic in Dakar, Senegal, to identify diseases associated with malaria, and to assess malaria mortality with or without co-morbidity. The files of all patients hospitalized from 2001 to 2003 in whom at least one test for malaria (thick films/spears) was performed to detect malaria parasites were reviewed. Malaria was diagnosed in patients presenting fever and positive thick films demonstrating asexual blood stages of Plasmodium. Data were collected from hospital charts. A total of 416 patients presented malaria (prevalence rate, 25.9%). The male-to-female sex ratio was 1:7 and mean age was 33 +/- 18 years. Of the 416 patients diagnosed with malaria, 273 (65.6%) presented severe forms. The overall mortality rate of malaria with or without co-morbidity was 25.7% (107/416). There was not a statistically significant difference between mortality due to isolated malaria and malaria associated with tuberculosis (23.4% versus 18.5%) (p = 0.7) or tetanus (23.4% versus 17.6%) (p = 0.34). Conversely mortality of malaria in HIV-positive patients was higher (58% versus 19%) (p = 10(-6)). Thus, malaria is of major concern in our department.

[Nontyphoidal Salmonella bacteremia cases in AIDS patients in a Dakar University Hospital (Senegal)]. / Etude descriptive des bactériémies àSalmonella non typhi chez les patients infectés par le VIH au CHU de Dakar (Sénégal).

OBJECTIVES: This study had for aim to describe epidemiological, clinical and bacteriological aspects of nontyphoidal Salmonella bacteremia in patients with AIDS in the Dakar University Hospital Infectious Diseases Clinic. METHOD: This study was made on data recorded between 1January1996 and 31December2005. The strains were identified according to biochemical (API 20E, BioMérieux) and antigenic features. Their susceptibility to antibiotic drugs was tested by antibiogram. Screening for strains secreting of an extended-spectrum betalactamase was performed. RESULTS: Sixty-two cases of nontyphoidal Salmonella bacteremia were recorded in AIDS patients as follows: Salmonellaenteritidis bacteremia (32 cases), Salmonellatyphimurium bacteremia (11 cases), and Salmonella spp bacteremia (11 cases). The strains were susceptible to ciprofloxacin, ceftriaxone, aztreonam, amoxicillin plus clavulanic acid in at least 92% of the cases. Only 79% of them were susceptible to cotrimoxazole. The lethality rate was 55%. DISCUSSION: This lethality rate of nontyphoidal Salmonella bacteremia is high in AIDS patients. Therefore, the priority should be put on prevention and, in patients with AIDS, on food hygiene measures, antiretroviral treatment and efficient chemoprophylaxis. This should prove efficient to reduce incidence of nontyphoidal Salmonella bacteremia.

[Post-circumcision Tetanus: Epidemiological, Clinical, Prognostic and Evolutionary Aspects of 16 Cases Collected at the Department of Infectious and Tropical Diseases in Fann Hospital (Dakar)]. / Tétanos postcirconcision : à propos de 16 cas colligés à la Clinique des maladies infectieuses du CHNU de Fann (Dakar).

This retrospective, descriptive study carried out in the Infectious Diseases Department of CHNU, Fann from 1st January 2012 to 3st December 2016 aimed to describe the epidemiological aspects and the course of post-circumcision tetanus and to formulate public health recommendations. During our study period, 16 cases of post-circumcision tetanus were collected out of a total of 452 patients with tetanus, equivalent to a rate of 3.5%. The median age was 8 years (3-40). None of the patients had a vaccination card. In 63% of cases, circumcision was performed at home, by a practitioner whose qualification was not documented in 63% of cases. All signs of tetanus were found with trismus (100%), dysphagia (63%) and paroxysms (88%). These were mostly Mollaret stage II forms in 14 cases, and grade 3 Dakar score in 7 cases. The median duration of hospitalization was 10 days [6-15]. Mechanical or infectious complications were noted in two cases, with a lethality rate of 13%. Post-circumcision tetanus is a reality in Senegal. Good community awareness, continuous training of staff and implementation of vaccination catch-up strategies for children of circumcised age should eradicate this form of tetanus.

Cette étude rétrospective descriptive, réalisée à la Clinique des maladies infectieuses du CHNU de Fann du 1er janvier 2012 au 31 décembre 2016 avait pour but de décrire les aspects épidémiologiques et évolutifs du tétanos postcirconcision et de formuler des recommandations en termes de prévention. Durant la période d'étude, 16 cas de tétanos postcirconcision ont été colligés sur un total de 452 patients atteints de tétanos, soit une fréquence hospitalière de 3,5 %. L'âge médian était de huit ans (3­40). Aucun des patients ne disposait de carnet de vaccination. Dans 63 % des cas, la circoncision a été effectuée à domicile, par un praticien dont la qualification n'a pas été documentée dans 63 % des cas. Tous les signes du tétanos ont été retrouvés avec le trismus (100 %), la dysphagie (63 %) et les paroxysmes (88 %). Il s'agissait surtout de formes de moyenne gravité classées au stade II de Mollaret dans 14 cas, et au score 3 de Dakar dans sept cas. La durée médiane d'hospitalisation était de dix jours [6­15]. Des complications mécaniques ou infectieuses ont été notées dans deux cas, avec une létalité de 13 %. Le tétanos postcirconcision est une réalité au Sénégal. Une bonne sensibilisation de la communauté, la formation continue du personnel et la mise en place de stratégies de rattrapage vaccinal des enfants en âge d'être circoncis devraient permettre d'éradiquer cette forme de tétanos.

[Acute Vibrio parahaemolyticus gastroenteritis in Dakar]. / Gastroentérites aiguës à Vibrio parahaemolyticus à Dakar.

OBJECTIVES: The aim of this study was to describe the epidemiological, clinical and bacteriological features of gastroenteritis due to Vibrio parahaemolyticus diagnosed during the 2004 and 2005 cholera outbreak in Senegal. PATIENTS AND METHODS: This retrospective study was made on data recorded between October 11, 2004 and December 31, 2005 at Dakar Fann Hospital. The diagnosis of V. parahaemolyticus was made after identification in stool cultures. RESULTS: Thirty-five cases of V. parahaemolyticus gastroenteritis were identified, accounting for 8.7% of bacterial gastroenteritis (35/403) and 1.18% of all cholera-like gastroenteritis (35/2942). The patients' median age was 26 years [range=10-70 years] and the M/F sex ratio was 1.5. Most patients came from Dakar city (30 cases). Contamination occurred within the family in 27 cases, and food was suspected to be the source of contamination in 33 cases. Clinical presentation upon admission included acute watery diarrhea with dehydration (35 cases), vomiting (30 cases), abdominal pain (25 cases), muscular cramps (12 cases), and fever (4 cases). All V. parahaemolyticus isolates were susceptible to amoxicillin, quinolones, cotrimoxazole, chloramphenicol, and cyclines. Patients were treated by rehydration and doxycycline. The outcome was favorable in all cases, with a mean hospital stay of 24 hours [range=4-72 hours].

[Cholera and pregnancy: epidemiological, clinical, and evolutionary aspects]. / Choléra et grossesse: aspects épidémiologiques, cliniques et évolutifs.

OBJECTIVES: This descriptive study had for objective to describe the epidemiological, clinical, therapeutic, and evolutionary aspects of the association cholera and pregnancy during the cholera epidemic in Senegal in 2004 and 2005. MATERIAL AND METHOD: We analyzed the files of pregnant women admitted in the infectious diseases department of the Fann national University Hospital for suspicion of cholera, from October 11, 2004 to December 31, 2005. RESULTS: Fifty-two pregnant women were hospitalized and accounted for 1.76% of the patients admitted for cholera in the department. They were an average of 24+/-4.9 years of age and came from the Dakar suburbs in 60% of cases. The source of contagion was food and/or water in 70% of cases. These patients contracted the disease during the summer term of the pregnancy in 31% of cases. Clinically, they presented with a typical choleriform syndrome in 90% of cases, emesis in 100% of cases, and severe dehydration in 27% of cases. The coproculture for 14 women was positive for Vibrio cholerae in 12 cases. For treatment, these patients benefited from intravenous rehydration in 75% of cases and antibiotherapy with doxycyclin 300 mg in unidose. The following complications were noted: 6 abortions, 2 premature childbirths, and a maternal death. CONCLUSION: The association cholera and pregnancy presents high risks for the fetus and for the mother, requiring a fast and adequate management.