Tetanus associated with road accidents in the infectious diseases department of Point G University Hospital, Bamako, Mali.

The aim of this study was to describe the epidemiological, clinical, and prognostic aspects of tetanus associated with road accidents and to make recommendations. This observational study collected retrospective clinical data over a 9-year period about adults admitted for trismus and/or generalized or localized paroxysm after a road accident. The study included 25 patients, accounting for 22.12 % of all tetanus cases. Men were massively overrepresented (sex-ratio M/F: 24/1). The median age was 34 ± 8 years. In all, vaccination status was unknown for 4 patients and known to be negative for 21. Immunoprophylaxis was nonexistent in all cases. The generalized clinical form was dominant (96 %). Severity reached level III for 12 % of patients. The points of entry included open leg fractures (4 cases), head wounds (2), mucocutaneous wounds (14), and muscle contusions (5). The mean time to referral for tetanus was 8 ± 7 days, and the median hospital stay 9.08 ± 11 days. Patients were mostly residents of urban (56 %) and suburban areas (28 %) [P = 0.04]. Two cases were complicated by severe malaria. The mortality rate was 60 %, and 52 % of the deaths occurred within the first 72 hours after hospitalization. It is essential to promote serum therapy and tetanus immunization for patients after road accidents. Increasing the awareness of traditional healers of these treatments deserves consideration.

[Non-neuromeningeal cryptococcosis in patients with AIDS in Bamako, Mali: 2 case reports]. / Cryptococcose extra-neuroméningée au cours du sida à Bamako, Mali (à propos de 2 observations).

Non-neuromeningeal cryptococcosis forms resulting from disseminated infection are rarely reported in African literature and are non-documented in Malian medical ward. We report two clinical observations. Case 1: a 26-year-old patient, carrying the HIV-1 infection, in which the clinical examination revealed skin lesions simulating molluscum contagiosum and functional impairment of the lower limbs. Radiography of the lumbar spine showed vertebral osteolysis on L4-L5. Cryptococcal research remained negative in the CSF but positive at histological examination of the skin lesions and in pathological products of lumbosacral drainage. The treatment with fluconazole and ARV led to a favorable outcome. Case 2: a 42-year-old patient, admitted for fever cough, known for his non-compliance to ARVs and in which the examination found a syndrome of pleural condensation and a painful swelling of the outer third of the right clavicle (around the acromio-clavicular joint). Paraclinical investigations concluded in osteolysis of the acromial end of the right clavicle and an image of the right lung with abundant effusion. Cryptococcal research was positive in the pleural effusion and in the product of aspiration of acromio-clavicular tumefaction, negative in CSF. It seems important to think of a cryptococcal etiology even in the absence of clinical meningeal signs in front of any cutaneous sign and any fluctuating swelling in HIV+ patient.

[Malian first observation of disseminated African histoplasmosis with predominant bone localizations in an HIV-negative child in Bamako (Mali). Review of the literature]. / Première observation malienne d'histoplasmose africaine disséminée à prédominance osseuse chez un enfant VIH négatif. Revue de la littérature.

Endemic deep fungal infections are still under recognised diseases in daily medical practice because of their rarity in sub-Saharan area. The African histoplasmosis Histoplasma capsulatum var. duboisii (H. capsulatum duboisii) is the most frequent variety described in Mali through limited studies in adult patients, since the first case described by Catanei and Kervran (1945). Our case report is a disseminated histoplasmosis in a young 6-year-old african child. He was male and rural. The infectious localisations were mucosae, skin, lymphnodes, urinary tract and bones. Evolution has been marred by an episode of worsening of symptoms despite initial clinical improvement with ketoconazole. After healing of mucocutaneous lesions, we noticed a limitation of ampliation of both wrists. The radiographic bone lesions were lysis of the right lower end of the right radius and cubitus and fragmentation of cubital epiphysis of the same arm. Lacunes were present on the fifth right finger in metatarsus and phalanx; lacune and blowing aspect of the second phalanx of the left third finger was noted. The disseminated form of African histoplasmosis may occur in HIV-negative subject. The prognosis depends on early diagnosis and administration of appropriate and well-conducted therapy.

[Epidemiological, clinical and evolving HIV-positive patients referred to the University Hospital of Point G, Bamako, Mali]. / Profil épidémioclinique et évolutif de patients VIH positif, référés au CHU du Point G, Bamako, Mali.

We conduct a longitudinal descriptive study in the department of infectious diseases to CHU of Point G during 18 months. It concerned adult patients referred from another care center. All the patients underwent systematic clinical examination and complementary exploration. Our sample was 352 HIV+ patients, with a mean age of 37.8 ± 9.8 years and a sex ratio (M/F)=0.94 shared among patients receiving ARV treatment (ART-s) and not (n-ART). Delay of reference was 5 ± 4.4 days. All patients benefited from clinical and paraclinical examinations. In both groups patients were mostly from level II. On admission, 132 cases were ART-s (38%). The main reasons for consultation were mainly fever [87.9%, p <0.05] and vomiting [17.4%, p =0.005] in the ART-s. Cough (p=0.9), and diarrhoea (p=0.5] were most noted in the n-TARV no statistically significant (no SS). Other reference reasons were similar in the 2 groups: headache (p=0.4), dyspnea (p=0.1). Selected diagnoses were dominated by tuberculosis (p=0.6) for n-ART no SS. Nontuberculosis infectious pneumonia (p=0.8) and cerebral toxoplasmosis (p=0.8) were comparable in the two groups. Severe systemic bacterial infections occurred more noted in the n-TARV (p=0.7). Malaria has been the main non-AIDS defining disease in the n-ART [-p=0.07] no SS. Patients were seen to late stage a corollary of a more collapsed of immunity in n-ART group [93.3%, p <0.05]. The fatality rate was similar in both groups (43.2%). Pathological factors were mainly tuberculosis (p=0.3) no SS. The factors involved significantly in TARV-s were non-tuberculosis bacterial pneumonia (p=0.001). The hospital mortality of HIV and AIDS is still important. Despite free ARVs and the large number of support center, the delay in diagnosis is a key as well as the lack of monitoring of patients factor.

[Upper gastrointestinal endoscopy during Kaposi's sarcoma to the Point G Hospital, Bamako (Mali): case study 20]. / Endoscopie Digestive Haute Au Cours De La Maladie De Kaposi Au CHU Du Point G, Bamako(Mali) : Etude De 20 Cas.

INTRODUCTION: Since the advent of HIV, Kaposi's sarcoma has become one of the most common opportunistic infections and the first cancer in patients with HIV. This cancerous disease occurs most often on the skin but also the viscera. Digestive localization was often observed during the search for other locations before the cutaneous form. No studies in Mali has focused on the upper gastrointestinal location. OBJECTIVES: To describe the epidemiological and clinical aspects of Kaposi's sarcoma in the upper gastrointestinal endoscopy. METHODS: This was a retrospective descriptive study from June 2005 to February 2009 in the center of endoscopy of the Point G Hospital including all patients seen in upper gastrointestinal endoscopy during the study period. RESULTS: 20 cases were reported from a total of 5068 endoscopy performed during this period a frequency of 0.39% hospital. These 20 cases were identified in all 31 patients with cutaneous localization of Kaposi's sarcoma is a frequency of 64.5%. The sex ratio was equal to 0.81. The average age was 36.8 years ± 8.92 years. The stomach and esophagus were found most locations. All patients were HIV positive. The CD4 count below 200 cells/mm3 was observed in 95% of patients.

[Mortality and morbidity of tetanus in the infectious diseases department, Point G teaching hospital, in Bamako, Mali (2004-2009)]. / Morbidité et mortalité du tétanos dans le service de maladies infectieuses du CHU du Point G à Bamako, Mali (2004-2009).

Our study objectives were to determine annual cases of the tetanus and to describe its clinical, evolutionary and prognostic aspects. It was a transverse study from data records and medical records of patients aged 15 years and above hospitalized for tetanus in the service of infectious diseases of the Point G CHU from January 1, 2004 to December 31, 2009. The tetanus was diagnosed based on clinical (trismus, dysphagia, seizures and point consecutive to an injury) and epidemiological arguments (absence of a correct tetanus immunization, entry way). We collected a total of 119 cases of tetanus out of 1,839 hospitalizations making a prevalence of 6.5%. The hospitalization period was 5 days (73%) for most of the patients. Unskilled laborer and farmers were the most frequent with respectively 30.2 and 21.8% of cases. Tetanus occurred in the course of a traumatic road accident (16%) and from other traumatic causes (48.7%). The clinical form was a generalized type for 94.4% of the cases. A wound was the entry way for 64.7% of the patients. The entry way was located on the lower members 49.6% of the time. The co-morbidity was recorded with infection by Plasmodium falciparum (15 cases, 12.6%) and HIV (1 case). Hospital lethality was 46.2%. The death was statistically linked to clinical severity according to the Dakar score (P = 0.0005) and the Mollaret stage (P = 0.0001). A need for strengthening communication for behaviour change for the gaining of a correct and sustained immunization exists. A strategy based on the capacity building for a rapid tetanus diagnosis and a combined co-morbidities care may reduce the lethality in the context of our limited technical environment.

[Neuromeningeal cryptococcosis in Mali]. / La cryptococcose neuro-méningée au Mali.

Cryptococcal meningitis is the most common fatal central nervous system infection in AIDS patients in Sub-Saharan Africa. The purpose of this prospective study conducted from March 2003 to February 2004 in the internal medicine and infectious diseases departments of the Point G University Hospital Center was to investigate the clinical, prognostic and epidemiological profile of Cryptococcus neoformans infection in patients hospitalized for brain and meningeale infection (BMI). Diagnosis of neuromeningeal cryptococcosis (NMC) was based on positive identification of Cryptococcus by direct exam of the cebrospinal fluid (CSF) after India ink staining and/or culture on Sabouraud medium without actidione. During the study period, a total of 569 patients were hospitalized including 235 (41.3%) with HIV infection. Overall C. neoformans was identified in 14 patients. Median patient age was 39 +/- 8 years. There was a male preponderance with a sex ratio of 1.8 (9 men/5 women). Patients with BMI were HIV-positive in 85.7% of cases (n=12) and HIV-negative in 14.3% (n=2). The overall and HIV-specific prevalence of BMI was 2.5% and 5.1% respectively. The CD4 lymphocyte count was between I and 49 cells/mm3 in 64.3% of cases. The main clinical symptoms were cephalea in 85.7% of cases, altered consciousness in 50% and nausea/vomiting in 35.7%. Neurological manifestations (hemiparesis and cranial nerve deficit) were noted in 14.3%. HIV infection is the main purveyor of NMC in Mali. The actual incidence of cryptococcosis is unclear due to the poor sensitivity of diagnostic techniques. This study highlights diagnostic difficulties related to clinical polymorphism and poor technical facilities. Agglutination testing of blood and CSF is recommended, but mortality remains.

[Obstacles to laboratory diagnosis of malaria in Mali--perspectives]. / Problématique du diagnostic biologique du paludisme au Mali--perspectives.

Rapid accurate laboratory diagnosis is necessary for effective malaria management. In Mali, meeting this prerequisite is impeded by underuse of laboratory diagnosis by clinicians, absence of qualified laboratory facilities in some locations, and poor continuous professional education of laboratory technicians. The twofold aim of this investigation was to perform quality control of thick smear readings made by laboratory technicians in 1998 and 1999 and to study the feasibility and diagnostic value of two rapid diagnostic tests (RDT), i.e., ParaSight and OptiMAL, in comparison with the thick smear technique in the period from 1998 to 2003. Quality control of thick smear readings indicated a 56% false positive rate with 49.3% concordance between laboratory technician readings and the reference centre. Trials using RDT showed that the OptiMAL test was more efficient with 97.2% sensibility, 95.4% specificity and 93% concordance in comparison with thick smear. A program of training, refresher courses, and regular didactic supervision (quality control) for laboratory technicians has been set up in Mali under the sponsorship of the "Fondation Mérieux" (ACTION BIOMALI) and the President's Malaria Initiative (PMI). These institutions provide funding for training as well as equipment and consumables in all public medical laboratories in Mali. The thick smear method is still being used as the reference technique, but use of RDT is to be implemented at all levels of the health care pyramid.

[Lymphocytic meningitis in Bamako, Mali]. / Les Meningites Lymphocytaires a Bamako, Mali.

We conducted a prospective survey from January 2001 to March 2002. Our objective was to study etiologic, clinic, and prognostic aspect of lymphocytic meningitis in hospital of Point G to Bamako. We included 35 patients with 25 male (71. 4%) and 10 female (28. 6%), sex - ratio (M / F) equal 2. 5. The median age was of 35 ± 25.4 years (range, 16 - 66 years). HIV serology was positive 26 cases (83. 9%). Clinical presentations were different. We observed 15 cases of encephalitis, 12 cases of meningoencephalitis, 2 cases of meningitis and 6 cases of febrile syndrome. Mean duration of hospitalization was 32. 6 ± 68 days. Mean of lymphocyte was 85.3 ± 25.9% among leukocytes in cerebrospinal fluid of 31 patients. Analysis of cerebrospinal fluid (CSF) identified in 9 cases Cryptococcocus neoformans. In 16 cases etiology was determination based on indirect arguments. In 9 cases viral meningoencephalitis diagnosis was made by exodiagnosis. It concerned 2 cases of TB meningitis, 1 case of cerebral toxoplasmosis, 1 case of decapitate bacterial meningitis and 1 case of cerebral tumor. Malaria thick smear permits to diagnosticate 1 case of cerebral malaria and 1 case of uncomplicated malaria. There are still 10 cases in which the cause remained unknown during study. HIV infection provides principally lymphocytic meningitis. Co morbidity with HIV is associated to lethality at 75%. But no statistical difference with patients without HIV (p = 0.52). Our work puts in exergue all problematic and hold correct of lymphocytic meningitis in our country.

[Efficiency and safety of antiretroviral treatment among the elderly in Abidjan]. / Efficacite et tolerance du traitement antiretroviral chez les sujets ages a Abidjan.

OBJECTIVE: To evaluate the efficacy of antiretroviral treatment in elderly people followed at the Unit for Infectious and Tropical Diseases at the University Hospital in Abidjan. MATERIAL AND METHODS: We performed a retrospective descriptive study of the files of people aged at least 60 years, infected by HIV who were treated and followed-up in the Unit between 1 January 1999 and 31 December 2006. We analysed sociodemographic (age, sex), clinical (weight, Karnofsky scale, CDC, opportunistic infections), biological (HIV, CD4, haemogram, glycaemia, creatininaemia, transaminasaemia) and therapeutic (antiretroviral regimens, evolution, side-effects) parameters. The efficacy of treatment was evaluated as the percentage of patients with < 200 CD4/ml, and its safety was based on deleterious effects. RESULTS: We studied 62 patients (44 men, 18 women), of whom 13 had been treated (21%), 46 had not been treated (74.2%) and 48 (77.4%) were undergoing chemoprophy-laxis with cotrimoxazole. Most were infected with HIV1 (93.6%), 3.2% with HIV2 and 3.2% with both HIV1 and HIV2. The majority (93.3%) was symptomatic, and 67.8% had AIDS. During 34 months of follow-up, 48 patients (77.4%) received first-line treatment, 13 (21%) received second-line and only one patient (1.6%) had third-line treatment. The percentage of patients with more than 200 CD4/ml increased from 20% at baseline to 36% at 6 months and 39% at 12 months. The main clinical side-effect was peripheral neuropathy (30.5%), and the main biological effect was hypertransaminasaemia > 2N (32.3%). The median rate of loss to follow-up was 17.7%, and two patients (3.2%) died. CONCLUSION: Antiretroviral treatment is effective in the elderly, with few biological disorders. A prospective study of a larger sample would elucidate the differences from younger people in the efficacy of such treatment.

[Undesirable effects of medicine in the Internal Medicine Service of the University Hospital Center du Point G]. / Les Effets Indesirables des Medicaments dans le Service de Medecine Interne CHU du Point G.

The aim of this study was to determine the frequency of adverse reactions to drugs, the WHO grade, describe the clinical features and identify the drug responsible. This was a descriptive cross-sectional study which took place from February 2005 to January 2006 in the Internal Medicine Department at the hospital point G. Were included in this study, all patients hospitalized during the study period, which presented adverse drug reactions (ADRs) that the relation of cause and effect was certain or likely. Thus, 47 ADRs were identified in 39 patients of 426 admitted during the same period a frequency of 9.2%. The average age of our patients was 48.5 ± 16.5 years. The sex-ratio was 1.6 for women. Eighty-two percent of our patients had an ADR and 18% more than one. The WHO grade 1 was the most met or 36.2%, followed by grades 4 and 2 respectively 27.7% and 25.5%. Antidiabetics were responsible for adverse reactions in 46.8% and 21.3% in TB. Adverse events were neurological in 53.2% and type of manifestations of hypoglycemia 46.8% (22/47 cases), polyneuritis 6.4% (3 / 47 cases) and 29.8% in digestive cases dominated by vomiting 12.8% (6 / 47 cases), the epigastria pain 6.4% (3 / 47 cases). The outcome was favorable in 87.2% of cases, however, 3 cases of death among those over 60 years all grade 4 WHO. ADRs deserve special attention to this high death rate (6.4% 3/47 cases) where the interest to search systematically for all patients under medical treatment with a good clinical examination and questioning some thoroughly.

Efficacite et tolerance du traitement antiretroviral chez les sujets ages a Abidjan

Objectif : Evaluer l'efficacite du traitement antiretroviral chez les sujets ages suivis dans le service des Maladies Infectieuses et Tropicales a Abidjan. Materiel et Methodes : Il s'agit d'une etude retrospective; descriptive et portant sur l'analyse des dossiers de sujets ages d'au moins 60 ans; infectes par le VIH; traites et suivis dans le service des Maladies Infectieuses et Tropicales entre le 1er janvier 1999 et le 31 decembre 2006. L'analyse a porte sur les parametres sociodemographiques (age; sexe); cliniques ARV; (poids; score Karnofsky; stade CDC; affections opportunistes); biologiques (type de VIH; CD4; hemogramme; glycemie; creatininemie; transaminasemie) et therapeutiques (regimesA RV; evolution; effets secondaires). L'efficacite du traitement etait basee sur le pourcentage de patients ayant un taux de CD4 200 / ml et la tolerance basee sur les effets deleteres. Resultats : L'etude a concerne 62 sujets ages (44 hommes / 18 femmes); dont 13 pretraites (21); 46 naifs (74;20) et 48 (77;42) sous chimioprophylaxie au cotrimoxazole. La majorite de l'effectif etait infectee par le VIH1 (93;60) contre 3;20pour le VIH2 et 3;20pour le VIH 1+2. Ils etaient symptomatiques a 93;3avec 67;8au stade SIDA. En trente quatre mois de suivi; 48 patients ont recu un regime de premiere ligne (77;4) ; 13 de deuxieme ligne (20;96) et un seul patient avait un regime de troisieme ligne (1;6). L'analyse des resultats a montre que le pourcentage des patients ayant un taux des CD4 200 etait croissant; passant de 20a M0 a 36a M6 puis 39a M12. Quant aux effets secondaires; ils etaient cliniquement domines par les neuropathies peripheriques (30;5) et biologiquement par l'hypertransaminasemie 2N (32;3). Le taux median de perdus de vue etait de 17;7; et 2 patients (3;22) sont decedes. Conclusion : Le traitement ARV est efficace chez les personnes agees avec peu d'anomalies biologiques; aussi; une etude prospective sur un plus grand echantillonnage permettrait-elle de mieux percevoir les differences avec le sujet jeune

[Neuromeningeal cryptococcosis in non-HIV patients to CHU ward of Point G in Bamako (Mali): 3 case report]. / Cryptococcose neuroméningée chez des patients VIH négatif au CHU du Point G de Bamako (Mali): à propos de trois observations cliniques.

We report 3 clinical observations of neuromeningeal cryptococcosis which occurred without any immunodepression related to HIV infection. Our patients were male. They did not present any particular medical history indicating a diagnosis of cryptococcosis. Nevertheless we found a professional exposure to the risk of inhalation of C. neoformans capsules. The diagnosis was based on presence of encapsulated yeast of Cryptococcus in the direct exam by China ink and culture on Sabouraud medium. CD4 lymphocytic count was done in two patients (case 1:899 cells/mm3; case 2:347 cells/mm3). Idiopathic lymphocytopenia was noted in one case. Co-morbidity of 5. pneumoniae meningitis was reported in one patient (case 3). Treatment was based on injectable amphotericin B in monotherapy (case 1), followed by perfusion of fluconazole cure (case 2). Case 3 was treated by perfusion of amphotericin B associated with ceftriaxone (case 2). No secondary prophylactic treatment was administered. Evolution was favorable after follow-up of 5 years (case 1) and of 4 years (case 2). The third patient died during hospitalization.

[Peritoneal disease in AIDS at the hospital services in Bamako]. / Pathologie du peritoine au cours du sida dans les services hospitaliers a Bamako.

The objective of this work was to evaluate peritoneum attack in AIDS affected patients. IT was a cross sectional descriptive study from October 2000 to May 2003 in services of Internal Medicine of the Hospital of the Point G and Hepato-Gastro-enterology of the Hospital Gabriel Touré and that concerned patient hospitalization files, registers of laparoscopy and registers of anatomopathology results. Have been included in this study, patients HIV positive presenting an abdominal symptomatology as abdominal pain, ascite, hepatomegaly, splenomegaly and that benefitted a laparoscopy with oriented biopsies of lesions. Anatomopathology exam of biopsy fragments has been made in the National institute of Research in Public Health (INRSP) of Bamako, Mali and in Pharo, Marseille in France. In term of this study 20 patients have been included. The mean age of our patients was 40.1 +/- 11 years with a sex ratio equal 1. Married women were the socio-professional category the most affected (45%). The clinical symptomatology was dominated by ascite (70%), abdominal pain (45%), abdominal meteorism (40%), hepatomegaly (35%), splenomegaly (30%). Peritoneal localization was the most frequent (50%). Granulations were the laparoscopic aspect the most met (80%) and confirmed in 80% cases by histology. Hepato-peritoneal tuberculosis was the most frequent etiology (60%) come then the non specific inflammations (30%), the lipophagic granulome (5%), and non specific granulomatose inflammations (5%). This study is characterized by an increased frequency of hepato-peritoneal tuberculosis during the pathology of peritoneum in AIDS affected patients. It deserves to be searched and treated for patients' survival.

Pathologie du peritoine au cours du Sida dans les services hospitaliers a Bamako

L'objectif de ce travail etait d'evaluer les atteintes peritoneales chez les malades atteints de sida. Il s'agissait d'une etude descriptive transversale d'octobre 2000 a Mai 2003 dans les services de Medecine Interne de l'hopital du point G et d' hepato-gastroenterologie de l'hopital Gabriel Toure et qui a concerne les dossiers d'hospitalisation des malades; les registres de compte rendu laparoscopique et les registres des resultats d'examen anatomopathologique. Ont ete inclus dans cette etude; les patients a VIH positif presentant une symptomatologie abdominale a type de douleur abdominale ou d'ascite; d'hepatomegalie; de splenomegalie et qui ont beneficie d'une laparoscopie avec biopsies dirigees des lesions. L'examen anatomopathologique des fragments biopsiques a ete fait a l'Institut National de Recherche en Sante Publique (INRSP) de Bamako au Mali et au Pharo de Marseille en France. Au terme de cette etude 20 patients ont ete inclus. L'age moyen de nos patients etait de 40;1 plus au moins 11 ans avec un sex ratio egal a 1. Les femmes au foyer etaient la categorie socioprofessionnelle la plus touchee (45). La symptomatologie clinique etait dominee l'ascite (70); la douleur abdominale (45); le meteorisme abdominal (40); l'hepatomegalie (35); la splenomegalie (30). La localisation peritoneale etait la plus frequente (50). Les granulations etaient l'aspect laparoscopique le plus rencontre (80) et confirmees dans 80des cas par l'histologie. La tuberculose hepato-peritoneale etait l'etiologie la plus frequente (60) puis viennent les inflammations non specifiques (30); le granulome lipophagique (5); les inflammations granulomateuses non specifiques (5). Cette etude se caracterise par une frequence elevee de la tuberculose hepato-peritoneale au cours de la pathologie du peritoine chez les patients atteint de SIDA. Elle merite d'etre recherchee et traitee pour la survie des patients

[Association of urinary tract infections and HIV infection in an internal medicine ward of Hospital of Point G-Bamako-Mali]. / L'association infection urinairie st infection VIH a dans le service de medicine interne de l'Hopital du Point G-Bamako-Mali.

We gathered 14 clinical observations of urinary track infections in AIDS patients in Internal Medicine wards from August 1, 1998 to July 31, 1999. Urinary track infection and HIV were both present in 1.75% of 797 hospitalized patients. The specific prevalence was 14.43% among AIDS patients. The sex ratio (female/male) was 1.33. The mean age of patients was 37.2 years with ranges between 25 years and 59 years. Urinary symptoms were discret. Urinary tract infection was primarily evidenced by urine leucocytes > 10(4) organism/ml and a bacteriuria > 10(5) colony-forming units/ml. The main pathogenswere Escherichia coli (42.85%), Klebsiella pneumoniae (28.57%), Colibacilles app. (21.42%) and Enterobacter cloacae (7.14%). All isolated germs were sensible to the gentamicin, to the amikacin, to the nalidixic acid, to the cefoxitine, to the ceftazidime to the cefotaxime and the ciprofloxacin. Cephalosporin of 3rd generation, aminoglycosides, and fluoroquinolone can be used like treatment of first line in urinary tract infection suspicion case in Bamako. Our patients were highly immunosuppressed with the majority of them being in class IV C of CDC of Atlanta (90%) and CD4 count constantly bellow 200 cells/mm3. The main opportunistic affections were non bacilar bacterial pneumopathies (28.57%), oesophagal mycosis (71.42%), the association of cerebral toxoplasmosis and pulmonary tuberculosis (35.71%). All urinary infections were cured by mean of 5 days of treatment. Very few recidivism was found (1 case).

[Digestive parasitic diseases to HIV/AIDS infected patients of internal medicine and infectious diseases wards of the hôpital du Point "G" Bamako - Mali]. / Les parasitoses digestives chez les patients infectés par le VIH/SIDA dans les services de médecine interne et de maladies infectieuses à l'Hôpital du Point "G" Bamako - Mali.

We conducted a prospective study in internal medicine and infectious diseases wards of the hospital of Point " G " in Bamako, Mali from January to December 2002. Overall 112 patients HIV positive, thirty-five patients (31,25%) had at least a digestive parasitic disease. We found that the most frequent parasite in stools sample were protozoa (82,85%). The second most frequent parasites were helminthes (20,33%). HIV/AIDS opportunistic parasites represented 40% of all parasites found. These included 25,71% cases of Cryptosporidium sp, 8,57% cases of Isospora belli and 5,71 % for microsporidia. The functional signs of our patients were mostly asthenia and weight loss. The physical signs were conjunctive pallor (71, 42%) and diarrhea (85, 71%). Generalized itching was present in 54, 28% of cases and abdominal pains in 25, 71% of cases. The global lethality was 37, 14% (13/35). The deaths were due to the HIV infection. The parasites appear even frequent at patients infected by HIV/AIDS, in spite of the advent of antiretroviral therapy. The efficient molecule research against the opportunist parasite must constitute one of our priorities in tropical area.

[Epidemiologic aspects of human immunodeficiency virus and hepatitis virus infections]. / Aspects epidemiologiques de la co-infection par le virus de l'immunodeficience humaine et les virus des hepatites.

In order to determinate the prevalence of hepatitis B virus and hepatitis C virus among patients infected by the HIV, We realized a transverse survey case--control in hepato-gastro-enterological ward and serology unity of National Institute of Research in Public health (INRSP). Our sample was constituted with 100 patients HIV positive compared to 100 controls HIV negative. The viral markers research has been made by methods immuno-enzymatiqueses of ELISA 3rd generation. Tests permitted to get the following results: Hepatitis B surface antigen (HBs Ag) was positive among 21% with patients HIV positive versus 23% among control (p = 0,732); Antibody to hepatitis C virus (anti-HCV ab) was present among 23% with patients HIV positive versus 0% among control (p <0,05). Female was predominant among co-infections patient, but without statistic link (p = 0,9 and p = 0,45); The co-infection HBV- HCV was significatively linked to age beyond 40 years (p = 0,0005). Co-infections with HIV infection and hepatitis virus are not rare and deserve to be investigated.