[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.

[Antibacterial Susceptibility Patterns of Bloodstream Isolates in 74 HIV-Infected Patients Hospitalized at the Clinic of Infectious and Tropical Diseases of Fann University Hospital, Dakar from 2013 to 2016]. / Profils de Sensibilité aux Antibactériens des Isolats Sanguins Chez 74 Patients Infectés Par le VIH Hospitalisés à la Clinique des Maladies Infectieuses et Tropicales du Chu de Fann, Dakar de 2013 à 2016.

Introduction: Bacteremia is associated with high lethality in HIV-infected patients. The widespread use of cotrimoxazole prophylaxis and misuse of antibiotics promote antibacterial resistance. Only few studies have considered this issue in HIV-infected patients. Thus, the objective of this study was to describe the etiology and antibacterial susceptibility patterns of bloodstream isolates in patient living with HIV. Material and methods: This is a retrospective cross-sectional and descriptive study conducted at the clinic of Infectious and Tropical Diseases of Fann university hospital from March 2013 to December 2016. Data were collected from patients' files according to a pre-establish survey form made of demographic, clinical, bacteriological and biological parameters. Results: Seventy-four cases of bacteremia were registered, 51.4% of which in women. Participants' median age was 45 years old [18-73 years old] and average CD4 count 83.3 cells/µl. The most commonly isolated bacteria were coagulase negative staphylococci (14%) followed by Escherichia coli (10%) and Klebsiella pneumoniae (10%). Rates of methicillin resistance for coagulase negative staphylococci and Staphylococcus aureus were 35.7% (5/14) and 22% (2/9), respectively. The most frequent ESBL producing germs were Escherichia coli 50% (5/10), Klebsiella pneumoniae 40% (4/10) and Enterobacter sp 25% (2/8). Pseudomonas sp were the most (22.2%) germs resistant to carbapenems. Conclusion: The result of this study advocates the need for ongoing surveillance of antibacterial resistance in HIV-infected patients and empirical antibiotic therapy based on surveillance data.

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.

[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.

[Tuberculosis Abscess of the Chest Wall on an Immunocompetent Patient in the Teaching Hospital of Dakar (Senegal)]. / Abcès tuberculeux de la paroi thoracique chez une patiente immunocompétente au centre hospitalier universitaire de Dakar (Sénégal).

Tuberculosis remains a problem of public health, in spite of the numerous significant advances noted in the diagnosis in recent years. The involvement of the thoracic wall is a rare extra lung shape. Its clinical presentation is not specific and a collected thoracic tumefaction is the main clinical demonstration. The diagnosis is improved by the use of non-invasive tools such as the Xpert MTB/Rif® test with a good sensibility on the pus. Medical care is based on medical treatment and sometimes associated with surgical treatment.

La tuberculose demeure un problème de santé publique, malgré les nombreuses avancées significatives notées dans le diagnostic ces dernières années. L'atteinte de la paroi thoracique est une forme extrapulmonaire rare. Sa présentation clinique est non spécifique, et une tuméfaction thoracique collectée en est la principale manifestation clinique. Le diagnostic est amélioré par l'utilisation d'outils non invasifs tels que le test Xpert MTB/Rif® avec une bonne sensibilité sur le pus. La prise en charge repose sur le traitement médical quelquefois associé à un traitement chirurgical.

Prevalence of TB/HIV coinfection in antiretroviral-naïve patients at the Fann Ambulatory Treatment Center in Dakar.

To determine the prevalence of tuberculosis and describe its epidemiological, clinical, paraclinical, and therapeutic characteristics and its outcome in patients with HIV. This retrospective, descriptive, and analytical study examined the records of patients with HIV at our outpatient treatment center and selected those who were antiretroviral-naive and presented tuberculosis between January 2008 and December 2012. Among a total of 757 HIV-positive patients, 76 had tuberculosis, for a prevalence of 10 %. The sex ratio of 1.23 favored men. The average age was 42.5 years (range: 25 to 69 years. Nearly all these patients (71 cases) had HIV-1. A history of tuberculosis was reported by 39.5 %. Seventeen patients were malnourished. Management included chemoprophylaxis with cotrimoxazole for 64 patients. The pulmonary form predominated (72.4 %). Among these forms, there were 34 cases of negative microscopy tuberculosis and 21 cases of positive microscopy tuberculosis. The extrapulmonary forms (21 cases) were dominated by tuberculosis in the lymph nodes (11 cases), the pleura (7), pericardium (2), and peritoneum (1). Anemia was found in 44 patients. Severe immunosuppression was noted in 90 %, with CD4+ cell counts <350/mm3. Lethality was 7.9 %. TB/HIV coinfection is a major public health problem in Africa. Better coordination of activities in support of programs for tuberculosis and HIV/AIDS are needed.

[Malaria associated with bacterial infection in the department of infectious diseases at the National and University Hospital of Fann, Dakar]. / Paludisme grave et infections bacteriennes associees au service des maladies infectieuses du centre hospitalier National et Universitaire de Fann a Dakar.

OBJECTIVES: To describe severe malaria cases with bacterial infection. PATIENTS AND METHODS: We conducted a prospective, descriptive and analytical study over 8 months. RESULTS: 15 of the 86 severe malaria cases had bacterial infections: enteritis (7 cases), urinary tract infection (4 cases), meningitis (4 cases), pneumonia (cases), sepsis (1 case), and sinusitis (1 case). Convulsions, jaundice, abnormal bleeding, pulmonary edema were more frequent in patients with associated infections. The average number of leukocytes and CRP were significantly higher in patients with bacterial infection. The mean parasite density was higher in patients without bacterial infection (56,362/mm3 vs. 239,162.2 ± 3326/mm 3 ± 7175.3). Lethality was higher in patients with bacterial infection (20% versus 16.9%). CONCLUSION: Bacterial infections are common in severe malaria and may influence the prognosis.

OBJECTIFS: Décrire les cas de paludisme grave avec infection bactérienne associée. PATIENTS ET MÉTHODES: Etude prospective, descriptive et analytique sur 8 mois. RÉSULTATS: Parmi les 86 cas de paludisme grave, 15 avaient des infections bactériennes: Entérite (7 cas), Infections urinaires (4 cas), méningites (4 cas), pneumopathies (cas), septicémie (1 cas), sinusite (1 cas). Les convulsions, l'ictère, le saignement anormal, l'œdème pulmonaire étaient plus fréquents chez les patients présentant des infections associées. Le nombre de leucocytes moyen et la CRP était significativement plus élevé chez les patients avec infection bactérienne. La densité parasitaire moyenne était plus élevée chez les patients sans infection bactérienne (56362/mm3 ± 239162,2 Vs 3326/mm3 ±7175,3). La létalité était plus élevée chez les patients avec infection bactérienne (20% contre 16,9%). CONCLUSION: Les infections bactériennes ne sont pas rares au cours du paludisme grave et peuvent en influencer le pronostic.

[Interest of ambulatory simplified acute physiology score (ASAPS) applied to patients admitted in an intensive care unit of an infectious diseases unit in Dakar]. / Intérêt de l'indice de gravité simplifié ambulatoire (IGSA) appliqué à des patients admis dans l'unité de soins intensifs (USI) d'un service de pathologie infectieuse à Dakar.

The evaluation of patients by a scale of gravity allows a better categorization of patients admitted in intensive care unit (ICU). Our study had for objective to estimate interest of Ambulatory Simplified Acute Physiologic Score (ASAPS) applied to patients admitted in ICU of infectious diseases department of FANN hospital. It was about a descriptive and analytical retrospective study, made from the data found in patients' files admitted into the USI infectious diseases department of FANN hospital in Dakar, from January 1(st), 2009 till December 31st, 2009.The data of 354 patients' files were analyzed. The sex-ratio was 1.77 with an average age of 37.6 years ± 19.4 years old [5-94 years]. The majority of the patients were unemployed paid (39.6%). The most frequent failures were the following ones: neurological (80.5%), cardio-respiratory (16.7%). The average duration of stay was 6.2 days ± 8.2 days going of less than 24 hours to more than 10 weeks. The deaths arose much more at night (53.1%) than in the daytime (46.9%) and the strongest rate of death was recorded in January (61.5%), most low in October (26.7%). The global mortality was 48.3%. The rate of lethality according to the highest main diagnosis was allocated to the AIDS (80.5%). The average ambulatory simplified acute physiology score was 5.3 ± 3.6 with extremes of 0 and 18. The deaths in our series increased with this index (p = 0.000005). The female patients had a rate of lethality higher than that of the men people, 55.5% against 44.2% (p = 0.03). In spite of a predictive score of a high survival (ASAPS < 8), certain number of patients died (n = 105) that is 61.4% of the deaths. The metabolic disturbances, hyperleukocytosis or leukopenia when realised, the presence of a chronic disease, seemed also to influence this lethality. ASAPS only, although interesting, would not good estimate the gravity of patients, where from the necessity thus of a minimum biological balance sheet. It seems better adapted for patients with a high value (ASAPS≥8). This score when it is low, is not correlated, in our study, at a high survival rate as waited in this population.

Association between passive smoking and atopic dermatitis in dogs.

Onset of atopic dermatitis and occurrence of related skin lesions are influenced by various environmental factors in humans, and companion animals. Several studies have demonstrated an association between passive smoking and the development of atopic dermatitis in children. This association has never been investigated in the dog to our knowledge. We enrolled 161 dogs seen at dermatology and vaccination consultations over a six-month period for this study. Dog owners were asked to complete a questionnaire, to evaluate the exposure of the dog to tobacco smoke. The atopic or non-atopic status of the dog was assessed on the basis of Favrot's criteria (history, clinical examination and cutaneous cytology for Malassezia). Analysis of the data for the 161 dogs enrolled revealed a significant association between high levels of passive exposure to tobacco smoke (cigarette consumption divided by the area of the home) and the presence of atopic dermatitis in the dogs (OR, 4.38; 95% CI, 1.10-17.44; p=0.03; NNH (number needed to harm) 3, 95% CI 2-52). The prevalence of atopic dermatitis showed a slight, but non-significant association with breed predisposition. Dogs with high levels of exposure to tobacco smoke may have a higher risk of atopic dermatitis than non-exposed dogs.

[Evaluation of tolerance of zidovudine-lamivudine-nevirapine combination in HIV 1 patients in Fann Teaching Hospital in Dakar]. / Évaluation de la tolérance de l'association zidovudine-lamivudine-névirapine chez les patients VIH-1 au Centre hospitalier de Fann à Dakar.

We conducted a study to evaluate the tolerance of the zidovudine (AZT), lamivudine (3TC) and nevirapine (NVP) combination regimen in HIV-1 patients by a descriptive analytical retrospective study of all HIV-1 patients receiving AZT-3TC-NVP combination between 2008 and 2011. Seventy patients were included. Two thirds of the patients presented at least one side effect (44 cases). The digestive disorders (15 cases) and neuropsychiatric (14 cases) were the most frequent. Epigastralgia (20%), headaches (20%) and arthralgias (13%) were main side effects. A maculo-papular exanthema was noted in three cases. During the follow-up, five patients presented with anemia. No patient presented hepatic cytolysis due to NVP. All the patients followed for more than six months presented a side effect against 29.7% when the duration of treatment was equal to or less than 6 months (p=10(-5)). Most of the side effects due to the association AZT/3TC/NVP are minor. The evaluation of the clinical and biological tolerance must be maintained during all the follow-up.