[Epidemiological and clinical profile childhood cancers with pleural and pulmonary lesions in the pediatric oncology unit of Treichville University Hospital (Abidjan, Côte d'Ivoire)]. / Profil épidémiologique et clinique des cancers pédiatriques avec atteintes pleurales et pulmonaires au service de pédiatrie du CHU de Treichville (Abidjan, Côte d'Ivoire).

INTRODUCTION: Pediatric cancers are a major public health problem in sub-Saharan Africa. However, they are seldom studied, especially as regards in their extensive forms. METHODOLOGY: An eight-year retrospective and descriptive study was carried out so as to specify the epidemiological and clinical characteristics of cancers with pleural and pulmonary involvement in children of 0 to 14years of age in the pediatric oncology unit at the University Hospital of Treichville, Côte d'Ivoire (Ivory Coast). RESULTS: The frequency of pleural and pulmonary involvement in pediatric cancers was 13.8%. Children's average age was 7.2years, with sex ratio at 2.11. Solid tumors were predominant, with a predominance of Burkitt's lymphoma (39.3%) and nephroblastoma (35.7%). The most affected age groups were 10 to 15years (Burkitt's lymphoma) and 0 to 5years (nephroblastoma). Time to diagnosis ranged from 31 and 60days in 40.4% of cases, and time to treatment was at most 30 days, for the overwhelming majority (97.1%) of the children. Chemotherapy was initiated in 67.9% of patients. Hospital mortality was 73.2%. CONCLUSION: Through this study, the authors established the profile of childhood cancers with pleural and pulmonary involvement. Comparative studies of mortality in pediatric cancers with and without pleural and pulmonary involvement could further underline the importance of early management before dissemination.

[Current situation of primary prophylaxis with isoniazid (INH) in children who are contacts of patients with bacillary pulmonary tuberculosis in Abidjan (Cote d'Ivoire)]. / Situation actuelle de la chimioprophylaxie primaire à l'isoniazide (INH) chez les enfants contacts des patients atteints de tuberculose pulmonaire bacillifère à Abidjan (Côte d'Ivoire).

INTRODUCTION: The National tuberculosis program (NTP) in Ivory Coast recommends that children under 5 years living in a family environment with contagious tuberculosis patients, should receive Prophylactic treatment with INH (PTI), whatever the result of the tuberculin skin test (positive or negative) and their BCG status (vaccinated or not), at a dose of 5mg/kg/day for 6 months. We conducted this study to check the implementation of this recommendation in three support services of tuberculosis in Abidjan, the economic capital. MATERIAL AND METHOD: We conducted a multicenter, cross-sectional and descriptive study over 3 years (2011-2013), on consented patients, adolescents and adults aged at least 15 years, with a first episode of infectious pulmonary tuberculosis, in order to look for information on the INH prophylaxis in children under 5 years living under the same roof. We made patients interviews during their visit for bacteriological sputum controls at the second month of TB treatment. RESULTS: Of a total of 412 patients (53% males and 47% females) with a mean age of 34.5 years and with a low level of instruction (66.5%), we noticed 639 children under 5 years living under the same roof with them. Information on the screening of contact children was given to 71% of interviewed patients (291/412). Of the 339 children examined among 639 contacts, 234 (69%) had received only an intradermoreaction (IDR) and PTI was finally administered to 64% of them (217/339). CONCLUSION: High proportion of contact children under 5 not examined is a major concern for the NTP and a missed opportunity to prevent additional cases of tuberculosis among children.

[Multidrug resistant tuberculosis among health personnel in Côte d'Ivoire]. / Tuberculose multirésistante chez le personnel de santé en Côte d'Ivoire.

UNLABELLED: Multidrug resistance tuberculosis (MDR-TB) of health workers raises the question of hospital-borne transmission of infection. OBSERVATIONS: We report 4 cases of MDR-TB confirmed at the health workers over a period of 8 years (January, 2005 to December 2012), in the 2 services of pulmonology from Abidjan to Côte d'Ivoire). It was about young grown-up patients (aged between 28 and 39 years), all HIV negatives, in a no-win situation of antituberculosis treatment (3 patients/4). The most concerned staffs were the male nurses (2/4). Two agents worked in general hospital and the only one in a pulmonology department at the time of the diagnosis. The tuberculosis was of lung seat with bilateral radiographic hurt (3/4) and multiples excavations (4/4). The case index, when it was identified (2/2), was a family case. Among 3 agents who benefited from a second line treatment, 1 died further to an extensive drug resistance and 2 are declared to be cured. The fourth died before the beginning of the treatment. These cases of cure were in touch with a premature care. CONCLUSION: Multidrug resistant tuberculosis at the health workers could have a negative impact on the antituberculosis fight imposing rigorous measures of infection control and better implication of the occupational medicine.

[Extensively drug resistant tuberculosis in Ivory Coast]. / Tuberculose ultrarésistante en Côte d'Ivoire.

INTRODUCTION: The emergence of tuberculosis with ultraresistant bacilli (TB-UR or XDR-TB) came to increase the threat concerning the progress realized in tuberculosis control. This observation establishes the only case of XDR-TB documented and published since the beginning of pharmacoresistant tuberculosis management in Ivory Coast from 2000 till 2010. This case was diagnosed in 2005 at a HIV-negative 32-year-old woman, initially declared MDR-TB. Looking forward to a treatment of category IV, she was treated by therapeutic truncated protocols recombining antituberculous molecules to which the patient was still sensitive. This treatment (PAS, cycloserin, ciprofoxacin, ethionamid, ethambutol and kanamycin) was introduced after 9 months of waiting and was completely led in ambulatory under the supervision of a member of the family. The diagnosis of XDR-TB concerned new tests of sensibility spread to second line antituberculous drugs in front of the absence of spits negativation at the end of 14 months of a second line treatment marked by frequent stock shortages. The death arose at M19 of treatment by chronic heart pulmonary. CONCLUSION: XDR-TB remains dark prognosis and is almost synonymic of "death sentence" in our countries with limited resources. The application of the international recommendations for tuberculosis management and better accessibility to antituberculous second line drugs would allow to prevent the appearance of such forms of tuberculosis.

[Fixed drug eruption after taking ethambutol]. / Érythème pigmenté fixe secondaire à la prise d'éthambutol.

INTRODUCTION: Fixed drug eruption (FDE) is a specific skin reaction and the only exclusively medicinal dermatosis. Among the drugs usually responsible are the antituberculous antibiotics including rifampicin and, less often, isoniazid and pyrazinamide. FDE after taking ethambutol is rarely described. CASE REPORT: A 32-year old HIV negative patient presented a FDE localized to the internal surface of the lips and the interdigital folds during the 4th month of antituberculous treatment comprising rifampicin, isoniazid and ethambutol. The diagnosis was supported by the characteristic appearances of the lesions of FDE and their early reappearance in the same areas after accidental reintroduction of antituberculous triple therapy including ethambutol. Double-agent therapy with rifamicin and isoniazid was tolerated well. CONCLUSION: Discovery of FDE requires a rigorous search for the responsible medicine. During antituberculous treatment, the practitioner has to bear in mind the potential role of ethambutol, which is possibly potentiated by rifampicin.

[Evaluation of multidrug-resistant tuberculosis treatment in Ivory Coast from 2008 to 2010]. / Évaluation du traitement de la tuberculose multi-résistante en Côte d'Ivoire de 2008 à 2010.

This is a retrospective study conducted from January 2008 to December 2010 on sectional descriptive analysis of records of patients treated for MDR-TB and whose follow-up was in the thoracic department of Centre Hospitalier Universitaire (CHU) of Cocody in Abidjan Côte d'Ivoire. We selected eight patients who met the inclusion criteria of 21 MDR-TB patients registered during the study period. The average age was 29.25years ranging from 21 to 39. Males accounted for 75% of the patients (6 males and 2 females). The students represented the professional social layer most affected with 37.5% of the patients. All patients had a history of tuberculosis and only one patient was HIV positive under anti-retroviral (zidovudin, lamivudin and efavirenz). All cultures found Mycobacterium tuberculosis. The resistance profile in addition to isoniazid and rifampicin, found two cases of resistance to ethambutol and streptomycin. The chest radiograph at the time of initiation of second-line treatment showed essentially excavations in 75% of cases and infiltrates in 25%. The lesions were bilateral in 7 of 8 patients (87.5%). The main side effects observed during treatment were limited to cochleovestibular disorders (2 patients) and neuropsychiatric disorders (2 patients) and digestive disorders in half of the patients with removal of the offending molecule kanamycin. After 24months of treatment, it was numbered five cures (62.5%), two failures and one death.

[Effects of war on control of tuberculosis in Côte d'Ivoire from 2002 to 2007]. / Effets de la guerre sur le contrôle de la tuberculose en Côte d'Ivoire de 2002 à 2007.

OBJECTIVES: To specify consequences of armed conflict in Côte d'Ivoire from 2002 to 2007 on treatment outcomes of new cases of smear-positive pulmonary tuberculosis (PTB+) and retreatment cases. METHODOLOGY: Retrospective analysis of treatment outcomes and reprocessing notified to the National Program against Tuberculosis from 2001 to 2008. RESULTS: Totally, 7,4232 cases of TPM+ and 5094 cases of reprocessing had been declared during the war period in Côte d'Ivoire. The global average rate of therapeutic success was 72% with a lower average rate of success in retreatment in Center, Northern et Western (CNO) zone (54%) than in Southern zone (73%). The average rate of lost sight was higher in CNO zone than in the South with respectively 27% and 11%. The average rate of success in retreatment was 60% on the national level with a lower rate in CNO zone (48%) than in the South zone (62%) and the average rate of lost sight in retreatment was higher in CNO zone than in the South zone (28% versus 16%). CONCLUSION: Our results show that there was no early epidemic of tuberculosis during the armed conflict in Côte d'Ivoire which has although severely disrupted activities of tuberculosis management in ex-nongovernmental zone.

[Simvastatin indused chylothorax]. / Chylothorax induit par la simvastatine.

Chylothorax is a rare disorder occurring most often in aftermath of a thoracic surgery or during cancer of mediastinum. We report the clinical history of the world's second case of chylothorax which appeared during treatment with simvastatin.

[Descriptive study of suicidal adolescents conducted in Abidjan]. / Etude descriptive des conduites suicidaires des adolescents à Abidjan.

INTRODUCTION: The answer to the various problems encountered during adolescence is experienced in the form of behavioural thoughts and/or action expressed in conduct. The failure to act could lead to suicidal ideation and its completion. Are there any risk factors? The general aim of this study was to describe the motives and methods of suicide among adolescents observed in Abidjan, in order to contribute to their care. MATERIALS AND METHODS: The prospective study, referred to as descriptive, was initiated in the Mental Health Service of the National Public Health Institute in Abidjan from the 1(st) of June to the 31(st) of October 2005, within the setting of the resuscitation service of the University Hospital centers of Cocody, Treichville and the emergency department of the university hospital of Yopougon. The sociodemographic, clinical, therapeutic and evolutive data of suicidal behaviour was analysed in 42 subjects. RESULTS: The study shows the following observations: a predominance of emotional problems (52.38%) versus 38.10% of family conflicts and 7.14% of failure at school; the subjects had resorted to chemical means dominated by chloroquin (45.62%) followed by psychotropics 14.40%; suicide was completed impulsively in 85.71% of cases; except in one case, suicidal behaviour took place at home and 66.67% in the evening; only three suicidal adolescents were oriented towards a psychiatric unit. CONCLUSION: Our study underlined the difficulties. Once the vital emergency has been managed, the solution would be the immediate orientation of suicidal adolescents towards psychiatric structures. This situation calls for a wider integration of psychiatry in health facilities in the Ivory Coast.

Causes de damande d'hospitalisation des tuberculeux baculliferes adresses par d'autres centres de diagnostic et traitement dans le service de pneumophtisiologie du CHU de Treichville

L'objectif de cette etude est de contribuer a l'amelioration de la prise en charge des tuberculeux bacilliferes depistes et suivis dans d'autres centres de depistage et de traitement et secondairement hospitalises en milieu pneumologique. Pour atteindre cet objectif; nous avons effectue une etude prospective qui a porte sur 52 cas de tuberculose pulmonaire bacilliferes; hospitalises dans le service de pneumophtisiologie du CHU de Treichville et adresses par d'autres centres de diagnostic et de traitement de la tuberculose pendant la periode allant de du 1er Novembre 2004 au 31 Mai 2005. Au cours de ce travail; nous avons identifie le profil epidemiologique; clinique et radiologique de ces patients ainsi que leur evolution. L'analyse des resultats a permis de noter les points suivants: *L'age moyen des patients est de 39 ans. *La tranche d'age la plus touchee est celle de 31 a 50 ans. *Les hommes sont plus concernes par la tuberculose (62.5pour cent). *77pour cent de nos patients sont VIH-positifs (40/52). *L'hospitalisation survenait plus frequemment au premier mois du traitement antituberculeux. *L'alteration de l'etat general (79.5pour cent); la toux chronique (82.5pour cent); la diarrhee (35pour cent); les pertes de connaissance (35pour cent) et la paleur (27.5pour cent) etaient les motifs d'admission les plus frequents chez les patients co-infectes. *L'anemie (95pour cent); les enterites (35pour cent); la candidose buccale (37.5pour cent); la toxoplasmose cerebrale (40pour cent) sont les pathologies frequemment associees a la co-infection VIH/Tuberculose. *Les lesions infiltratives bilaterales predominaient quelque soit le statut serologique; Les adenopathies mediastinales et les pleuresies etaient plus frequentes chez les patients co-infectes. *Le cotrimoxazole et les antifungiques sont les therapeutiques anti-infectieuses les plus associees au traitement antituberculeux. *Les effets secondaires attribuables au traitement antituberculeux sont l'ictere (1.52pour cent); l'agitation (1.52pour cent) et les arthralgies (34.2pour cent). *L'evolution immediate a ete favorable dans 57.69pour cent des cas. *Cependant; la mortalite est elevee: 40pour cent chez les VIH positifs contre 16.6pour cent chez les VIH-negatifs. Nous notons que l'infection par le VIH est frequente dans la population de tuberculeux. La mortalite reste elevee chez ces patients co-infectes dont le pronostic est greve par l'anemie et les autres infections opportunistes