[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.

[Ivory Coast physician's knowledge and attitudes about smoking in patients with tuberculosis]. / Connaissances et attitudes des médecins ivoiriens vis-à-vis du tabagisme chez les patients atteints de tuberculose.

INTRODUCTION: Smoking promotes, among other health problems, the development of tuberculosis and the discovery of a case of tuberculosis can therefore be an opportunity for tobacco control interventions. METHODS: We conducted a prospective study evaluating the knowledge of 37 Ivorian physicians (32 men and 5 women with 5 active smokers) on the relationship between smoking and tuberculosis and their attitudes to smoking tuberculous patients between February and August 2012 using an anonymous self-administered questionnaire. RESULTS: The response rate to the questionnaire was 88.1%. Among them, 70.3% of Ivorian physicians knew that smoking increased the incidence of tuberculosis, 75.7% said that forms of tuberculosis were more severe in smokers and about 27% thought that the cure rate of tuberculosis was lower in smokers. No significant difference was observed according to respondents' smoking status, or gender. Patients' smoking status was always assessed by 64.9% of physicians and by 78.4% in patients with tuberculosis, again not differing by physicians' smoking status or gender. The risks of smoking were always explained to patients with active pulmonary tuberculosis by 43.2% and benefits of stopping smoking ware always described in 35.1%. An intervention for smoking cessation was systematically offered to smokers having tuberculosis by 59.4% of physicians and 8.1% offered medication for smoking cessation. CONCLUSION: These results strongly support the need to reinforce physician behaviors to address smoking in patients with tuberculosis in Ivory Coast.

[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.

[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.