[Factors associated to loss of follow-up in patients underwent antiretroviral therapy in an ambulatory HIV treatment center at Conakry]. / Facteurs associés aux perdus de vue des patients sous traitement antirétroviral dans un centre de traitement ambulatoire du VIH à Conakry, Guinée.

BACKGROUND: Late or inadequate therapeutic management increases the risk of mortality associated with HIV/AIDS. The aim of this study was to analyze the proportion and factors associated with loss of follow-up in HIV patients who receiving antiretroviral therapy at Conakry. METHODS: A retrospective cohort study was conducted in HIV patients aged over 15 years and who receiving antiretroviral therapy. Between August 1, 2008 and July 31, 2015, all patients managed by the ambulatory treatment center of the Guinean Women Association against AIDS and sexually and transmissible infection were included. Loss of follow-up was defined as no follow-up visit within 3 months. Kaplan-Meier curves and multivariate Cox regression models were used to analyze factors associated with loss of follow-up. Analyses were performed by using Stata 13 software. RESULTS: 614 patients aged 36.3±11.2 years, mainly females (68.4%) and living in Conakry (80.5%) were included. Among them, 104 were loss to follow-up, corresponding to a proportion rate of 16.9% (95% CI: 14.2-19.7%) or 5.79/100 person-years. The results of multivariate analyses showed that factors independently associated with loss of follow-up were malnutrition (AHR=7.05; 95% CI: 2.05-24.27; P=0.002) and CD4 cells account at the initiation of AHR (2.35; 95% CI: 1.61-6.39; P=0.016) in patients with 201-350 CD4/µL and 5.83 (95% CI: 2.85-11.90; P<0.001) in patients with less than 150CD4/µL. CONCLUSION: Despite efforts of health care workers and free antiretroviral therapy, many patients were loss to follow-up. Multivariate analysis showed that malnutrition and low CD4 account were independently associated with loss to follow-up.

[Acute Flaccid Paralysis Secondary to Poliomyelitis: 11 Years of Monitoring in Guinea (2005-2015)]. / Paralysies flasques aiguës dues à des poliovirus : bilan de 11 années de surveillance en Guinée (2005-2015).

The sustained worldwide use of the two available types of polio vaccines has significantly reduced the incidence of this disease. Our main objective is to report a 11-year monitoring period for acute flaccid paralysis secondary to poliovirus in Guinea. It was a retrospective descriptive study for all cases of acute flaccid paralysis (AFP) in which poliovirus was isolated by stool examination. During 11 years, 768 cases of AFP, including 8 cases of acute anterior poliomyelitis were collected at a frequency of 1%. The average age was 3.5 years with extremes of 1 year and 6 years, the most represented age group was 0-4 years with 7 cases. Six mothers were housewives doing gold panning as a revenue generating activity. The vaccine virus (serotype 2) was the most isolated with 6 cases.

L'utilisation soutenue à l'échelle mondiale des deux types de vaccins antipoliomyélitiques disponibles a considérablement diminué l'incidence de cette affection. Il s'agit ici d'une étude rétrospective de type descriptive, portant sur tous les cas de paralysie flasque aiguë (PFA) due aux poliovirus en Guinée chez lesquels le poliovirus a été isolé des selles, faisant l'état des lieux de 11 années de surveillance de la PFA. En 11 ans, 768 cas de PFA, dont huit cas de poliomyélite antérieure aiguë ont été enregistrés, soit une fréquence de 1 %. L'âge moyen était de 3,5 ans [1­6 ans]. La tranche d'âge de 0­4 ans était la plus représentée avec 7 cas. La majeure partie (6 cas) des mères des enfants étaient des agricultrices exerçant l'orpaillage. Les souches majoritairement isolées étaient dérivées du vaccin VDPV2.

Tetanus: epidemiology and Factors Associated with Death in the Departement of Tropical and infectious diseases of Donka National Hospital, Guinea.

In developing countries, tetanus remains a public health problem because of its frequency, severity, and still high mortality. The objective of this study was to describe the epidemiological profile of patients hospitalized for tetanus and to identify the factors associated with dying from it. This retrospective, descriptive, and analytical study reviewed hospital records of all patients, of all ages and genders who were treated for tetanus in our department over a 5-year period. Among 3549 patients during the study period, 75 had tetanus (2.11%), and 71 of them were included in our study. The median age of patients was 35 years (range: 11-70 years) with a male prevalence of 80%. The most frequently affected socio-professional categories were students (21.1%), farmers (18.3%), workers (15.5%), and shopkeepers and tradespeople (15.5%). The main entry points were post-traumatic (40.9%), cutaneous (33.8%), and post-surgical (16.90%). Paroxysm (95.8%), trismus (93.0%), generalized contracture (67.6%), and dysphagia (46.5%) were the most frequent signs. Among these cases, 40.9% were severe (40.85%), 49.3% moderate (49.30%), and 9.6% benign. We recorded 34 deaths (48%). Factors associated with death were age> 60 years (P = 0.01), fever (P = 0.01), hypertension (P = 0.02), and HIV infection (P = 0.01). Tetanus remains a frequent disease with high lethality. Death is associated with specific factors that should be taken into account in the criteria for assessing its prognosis.

Cholera in pregnant women: the 2012 epidemic at the reference center at the Donka National Hospital in Conakry.

Cholera is an epidemic diarrheal disease transmitted through the digestive tract; it can cause obstetric complications in pregnant women. The objective of this study was to describe the epidemiological, clinical, and therapeutic aspects of cholera in pregnant women, as well as its course, during the 2012 epidemic in Conakry. This retrospective, descriptive studied examined the records of this epidemic over a 7-month period (from May 15 to December 15, 2012). Of 2,808 cholera patients at our hospital, 80 were pregnant, that is, 2.85%. Their mean age was 30 years [range: 15-45 years], 94% were from Conakry (94%), and 69% were in the third trimester of pregnancy. Choleriform diarrhea and vomiting were the main signs, found respectively in 100% and 95% of the women; dehydration was mild for 16%, moderate for 45%, and severe for 39%. Support consisted of rehydration, by plans A (16%), B (45%) or C (39%) and antibiotic treatment based on erythromycin (85%), doxycycline (14%), or azithromycin (1%). Other drugs that were used included phloroglucinol-trimethylphloroglucinol (Spasfon(®)) for 45%, acetaminophen for 65%, and iron/folic acid for 1% of cases. The major obstetric complications were 4 intrauterine deaths (5%), 2 cases of threatened abortion (2%), 1 preterm delivery (1%), and 1 maternal death. The cholera outbreak in 2012 affected a large number of pregnant women in Conakry, most during their third trimester. The classic clinical manifestations were associated with obstetric complications and maternal-fetal risks.

[Epidemic meningitis in 2013 in Republic of Guinea: Nesseria meningitidis W135 emergence]. / Epidémie de méningite en République de Guinée en 2013 : émergence de Nesseria meningitidis W135.

A prospective study conducted from 1 January to 31 December 2013 described a meningitis epidemic in Republic of Guinea. The identification of the germs was based on Gram stain, latex agglutination and culture. During the study period, 480 suspected cases of meningitis were reported by 21 health districts. The average age was 18±8 years and 62.5% were men. The vaccination status was unknown in all patients. The largest attack rates were found in Siguiri (3.2 per 10,000), Kankan (2.6 per 10,000) and Dabola (3.9 per 10,000). The locality of Kintinian in Siguiri was the only one to cross the epidemic threshold. The identified microorganisms were Haemophilus influenzae (1 time), Pneumococcus (2 times), Neisseria meningitidis A (4 times) and W135 (10 times) with a total of 17 positive samples. All of these germs were sensitive to chloramphenicol, ceftriaxone and ciprofloxacin. The average hospital stay was 6.5±2 days. The lethality was 13.8%. This meningitis epidemic was characterized by the emergence of Neisseria meningitidis W135. The monitoring of this serogroup should be increased and future vaccination strategies must include it presence.

Tetanus in women of childbearing age in the infectious disease department in the national hospital of Conakry (Guinea).

OBJECTIVES: This study aimed to determine the hospital prevalence rate of tetanus in women of childbearing age in the infectious disease department of Donka CHU in Conakry and to describe their sociodemographic characteristics and outcomes. METHODOLOGY: This descriptive retrospective study examined the records of all patients aged 15 to 495 years hospitalized for tetanus over a 10-year period. RESULTS: During the study period, 74555 patients were hospitalized - 239 for tetanus. In all, 22 woman of childbearing age had tetanus, that is, 9.2%. Their mean age was 325 years. Most of the women were married (13/22) and lived in Conakry (18/22); 165 were housewives, and 65 patients had begun but not completed the required vaccinations. The incubation period was >75 days for 165 patients. Tetanus infection resulted from medical procedures for 9 women and trauma for 6. We recorded 125 deaths. The average duration of hospitalization was 215 days. CONCLUSION: Preventing tetanus requires a reinforcement of vaccination drives and especially the implementation of policies for booster reminders.

2014 Anthrax epidemic in Koubia prefecture, Guinea-Conakry.

Anthrax disease is an anthropozoonosis caused by a Gram-positive bacterium, Bacillus anthracis. Our objective was to describe the epidemiological, clinical and therapeutic features of the 2014 epidemic in Koubia prefecture. This retrospective study examined all of the anthrax cases reported in Fafaya, Koubia Prefecture. In March and April 2014, there were 39 cases of human anthrax reported, for an incidence of 1.135%. The mean age was 20.9 (± 18.3) with a sex ratio of 2.54 (28/11) in favor of men. Seventy-six percent (23/39) were single. More than one half were students (53.8%). The main clinical signs were fever in 71, 8% (n = 28 /), papules 59% (n = 23), vesicles of 59% (n = 23) Digestive and cutaneous signs represented 35.9 % and 64.1% respectively; 35% had ingested contaminated meat and 17.95% were in direct contact with a sick animal. We didn't find any correlation between the mode of infection and onset of signs. The fatality rate was 28.21%. The 2014 epidemic of anthrax disease in the Koubia prefecture was marked by a high incidence and lethality. Clinical manifestations were cutaneaous and digestive. These results may serve further interventions to fight against anthrax disease. They should mainly focus on an awareness of peasants, surveillance and vaccination of cattle. Other studies seem to be necessary.

[Causes of lymphocytic meningitis in people with HIV admitted to the Infectious Disease department of Conakry]. / Étiologies des méningites lymphocytaires chez les personnes vivant avec le VIH suivies dans le service des maladies infectieuses de Conakry.

OBJECTIVES: The advent of HIV infection has significantly changed the distribution of the causes of lymphocytic meningitis. The objective of this study was to identify these causes among persons with HIV hospitalized in the infectious disease department of the CHU of Conakry. MATERIALS AND METHODS: This retrospective study examined hospital records of patients with HIV infection admitted for lymphocytic meningitis over a 10-year period. RESULTS: Of the 8649 hospitalizations in the department during the study period, 3167 patients had HIV infection, and 85 of the latter were diagnosed with lymphocytic meningitis. Slightly more than half were male (sex ratio M/F = 1.1). Their mean age was 32 years. Of these 85 patients, 73 were positive for HIV-1 only and 12 for HIV1+2. A CD4 count was performed only in 13/85 patients and averaged 140 cells/mm3. The main causes associated with lymphocytic meningitis were cryptococcosis (58%), toxoplasmosis (5%), and tuberculosis (2%). Streptococcus pneumoniae, Neisseria meningitidis, and Hæmophilus influenzae were also identified in 16% of cases. In 18% of cases no microbe was identified. The overall lethality rate was 68%; it reached 100% for tuberculous meningitis and for the cases without any identified cause and was 75%-76% for the patients with toxoplasmosis and cryptococcosis. The survival rate was 100% for all bacterial causes. CONCLUSION: A cause for lymphocytic meningitis was identified in more than 81% of the patients in our series, and the most common microbe was Cryptococcus neoformans. A better microbiological technical platform and improved accessibility to treatment would enable us to provide more relevant results and treatment.

[Canine and human rabies in Conakry: epidemiology and preventive aspects]. / La rage canine et humaine à Conakry : aspects épidémiologique et prophylactique.

In Guinea, stray dogs are present in large numbers in public places and around landfills. The objectives of this study were to determine the frequency of human exposure to rabies risk, the cases of human and canine rabies and to describe the epidemiological profile of the cases. This retrospective and descriptive study was conducted in health and veterinarian facilities within the city of Conakry. All records of patients admitted in these facilities because of animal bites and veterinary records for aggression by domestic animals from 2002 to 2012, so, during an 11-year period, were collected. During the study period, 7 994 people were concerned by domestic animal bites. Males were the most affected with 60.4% of all cases. Students represented the higher class with 36.0%, followed by workers (18%). The majority of injuries were to the lower limbs (54.4%). The dog has been implicated in the attacks in 98.8% of cases. Among the 2 916 biting dogs which were placed under observation, 14 developed clinical rabies. Among those assaulted, 11 cases of rabies were reported. From 7 994 victims of domestic animal bites, 2 634 received post-exposure prophylaxis and the dropout rate was 51%. Rabies is a real risk in Conakry. Provisions in terms of public health strategy must be taken to minimize it.

Ebola outbreak in Conakry, Guinea: epidemiological, clinical, and outcome features.

OBJECTIVES: The authors studied the epidemiological, clinical, and outcome features of the Ebola virus disease in patients hospitalized at the Ebola treatment center (ETC) in Conakry to identify clinical factors associated with death. MATERIALS AND METHODS: A prospective study was conducted from March 25 to August 20, 2014. The diagnosis of Ebola virus infection was made on real-time PCR. RESULTS: Ninety patients, with a positive test result, were hospitalized. Their mean age was 34.12±14.29 years and 63% were male patients. Most worked in the informal sector (38%) and in the medical and paramedical staff (physicians 12%, nurses 6%, and laboratory technicians 1%). Most patients lived in the Conakry suburbs (74%) and in Boffa (11%). The main clinical signs were physical asthenia (80%) and fever (72%). Hemorrhagic signs were observed in 26% of patients. The comparison of clinical manifestations showed that hiccups (P=0.04), respiratory distress (P=0.04), and hemorrhagic symptoms (P=0.01) were more frequent among patients who died. Malaria (72%) and diabetes (2%) were the most frequent co-morbidities. The crude case fatality rate was 44% [95% confidence interval (33-54%)]. The average hospital stay was 7.96±5.81 days. CONCLUSION: The first Ebola outbreak in Conakry was characterized by the young age of patients, discrete hemorrhagic signs related to lethality. Its control relies on a strict use of preventive measures.

[Epidemiology of bacillary pulmonary tuberculosis according to HIV status of patients followed in the department of infectious diseases Conakry (Guinea)]. / Épidémiologie de la tuberculose pulmonaire bacillifère selon le statut VIH des patients suivis dans le service des maladies infectieuses de Conakry (Guinée).

Despite many efforts of prevention and the availability of free treatment, TB/HIV co-infection is still rampant in Guinea. The objective of this study was to describe the epidemiology of smear positive pulmonary tuberculosis according to HIV status among patients hospitalized in the infectious diseases department of Conakry University Hospital. This was a descriptive and analytical retrospective study of patient records admitted for pulmonary tuberculosis from January 2003 to December 2012. During this period, 1953 cases of tuberculosis were collected of which 346 (17.7%) were smear positive. There was a marked male predominance (59.7%). The average age was 38 ± 11 years. The majority of patients originated from the suburbs of Conakry and its surrounding prefectures (76.7%). People without profession were most represented (40.7%). A level of primary education was the most frequently reported (39.7%). Out of 325 patients tested for HIV, the serology was positive in 185 patients (56.9%). A contact with a TB patient was reported in 21.4% of HIV negative patients, and in 6.5% of the HIV-positive group (p = 0.0006). There was no difference between the two groups regarding clinical signs and symptoms. The mean CD4 count was comparable in both groups (p = 0.05). Lethality was higher among co-infected patients (30.4% against 15.56%; p = 0.00037). Strengthening the prevention of TB among PLWHA by the administration of isoniazide seems necessary and warrants further study on this subject in Guinea.

[Scorpion envenomation treated in the Infectious and Tropical Diseases at the Donka National Hospital, Guinea]. / Les envenimations scorpioniques traitées dans le service des maladies infectieuses et tropicales de l'hôpital national Donka, Guinée.

A retrospective descriptive study was conducted from 1(st) October 2010 to 30 November 2012 on the records of patients admitted for scorpion envenomation in the Department of Infectious and Tropical Diseases at the Donka National Hospital. The objective of this study is to describe the epidemiological profile and clinical characteristics of scorpion envenomation in Maritime Guinea, from scorpion stings recently covered in this service. We collected 75 cases of scorpion envenomation. The median age was 21.5 with interquartile 8 and 20 and sex ratio was 1.29. The upper limbs were involved in 55% of cases, followed by the lower limbs (35%), trunk (6%), head and neck (4%). We observed 63% of patients with local signs, 30% mild and general clinical signs of 7% severe systemic symptoms. All patients received an analgesic and a heterologous antitoxin, associated with an antibiotic (87% of patients), a corticosteroid (72%), diazepam (13%) and furosemide (34.6%). The incidence of scorpion envenomation is not negligible despite underreporting of cases, most often treated in traditional medicine.

[The hospital-borne tetanus in the reference service of the Donka National Hospital in Conakry (2001-2011)]. / Le tétanos nosocomial dans le service de référence de l'hôpital National Donka à Conakry (2001-2011).

Become almost non-existent in the developed countries, the hospital-borne tetanus always stays of current events in our country in spite of the forensic problem which it puts. The objectives of this study were to determine prevalence of this affection, to describe its clinical picture and to determine its lethality. It is about a retrospective study of a duration of 11 years realized in the service of the infectious diseases of Conakry. Among 8649 hospitalizations from 2001 till 2012 we brought together 239 cases of tetanus (2.7%) among which 60 hospital-borne tetanus (0.7%). Men represented 73% of these cases, with a sex-ratio M/F of 2.7. The age bracket of 20-40 years was the most affected with 32 cases (53.3%). A single patient had begun his vaccinal calendar which had remained incomplete. Both national hospitals of the CHU of Conakry and private hospitals were the biggest suppliers of this hospital-borne tetanus with respectively 22 and 27 cases (36.6 and 45%). Tetanus related to IM of quinine represented 26 cases (43.3%) whereas the hernial cure was found in 16 cases (26.6%). The average duration of invasion and incubation was respectively 1.5 days and 6 days for the dead (n = 45.7%) and 2 days and 10.5 days for the survivors. Three-quarters of 60 patients died. The fight against this type of tetanus passes inevitably by an improvement of the working conditions, a strict application of the rules of asepsis and the in-service training of the medical and paramedical staff.