Impact de la pandémie de COVID-19 sur le suivi des maladies systémiques: enquête transversale multicentrique à Dakar / How the outbreak of COVID-19 did affected the follow-up of patients known for an autoimmune or autoinflammatory systemic diseases in Dakar

Introduction : La pandémie de covid-19 a eu un impact sur les systèmes de santé, entravant la prise en charge optimale des maladies chroniques. L'objectif de notre étude était d'évaluer son impact sur le suivi des pathologies systémiques. Patients - Méthodes : Nous avons mené une enquête transversale multicentrique dans les services de Médecine Interne, de Rhumatologie et de Néphrologie à Dakar. Les patients étaient inclus en accord avec les critères de consensus internationaux. L'enquête a porté sur les dossiers concernant 13 questions et a été complétée par un entretien téléphonique avec 38 questions potentielles. Les réponses étaient collectées grâce à une application Web puis exportées et analysées avec le logiciel SPSS 26.0. Résultats : Du 1er Août au 31 Octobre 2021, 131 patients ont été inclus avec un âge moyen de 41,5 ans (+/-12,4) et un sex-ratio de 0,08. Les pathologies inflammatoires étaient dominées par la polyarthrite rhumatoïde (47,3%) et le lupus systémique (22,9%). Les patients ont rapporté avoir raté un ou plusieurs rendez-vous de suivi dans 45% des cas. Les motifs étaient dominés par une difficulté d'obtenir un rendez-vous de suivi (18,6%) et la peur de fréquenter les hôpitaux (16,9%). Une rupture médicamenteuse a été notée dans 33,6% des cas et concernait notamment l'hydroxychloroquine (40,9%) ou le méthotrexate (47,7%) avec comme raison principale les ruptures de stock en pharmacie et les difficultés économiques. Une poussée de la maladie systémique a été rapportée dans 31% des cas corrélée à la rupture médicamenteuse. Onze (11) patients ont présenté une infection confirmée à SARS CoV-2. Conclusion : La pandémie de covid-19 a eu un impact non négligeable sur le suivi des patients atteints de maladies inflammatoires systémiques. Elle a mis en exergue l'intérêt de la réorganisation de la prise en charge de ces patients en période de crise sanitaire, l'éducation thérapeutique des patients et le recours à la télémédecine pour assurer la continuité des soins.

Introduction: The covid-19 pandemic has had an impact on health systems, compromising the optimal management of chronic diseases such as systemic autoimmune and autoinflammatory diseases. The aim of our study was to assess its impact on the follow-up of systemic diseases in Dakar. Patients - Methods: We conducted a multicentre cross-sectional survey in the departments of Internal Medicine, Rheumatology and Nephrology in Dakar. Patients were included in accordance with international consensus criteria. The survey was based on records of 13 questions and was completed by a telephone interview with 38 potential questions. Responses were collected using a web-based application and then exported and analyzed using SPSS 26.0 software. Results: From 1 August to 31 October, 131 patients were included with a mean age of 41.5 years (+/-12.4) and a sex-ratio of 0.08. Inflammatory diseases were dominated by rheumatoid arthritis (47.3%) and systemic lupus erythematosus (22.9%). Patients reported missing one or more follow-up appointments in 45% of the cases. The reasons were dominated by difficulty in obtaining a follow-up appointment (18.6%) and fear of attending hospitals (16.9%). A drug shortage was also reported in 33.6% of the cases and concerned in particular hydroxychloroquine (40.9%) or methotrexate (47.7%), with the main reason being stock shortages in pharmacies and economic difficulties. A flare-up of the systemic disease was reported in 31% of the cases correlated with the drug rupture. Only 11 patients had a confirmed SARS CoV-2 infection. Conclusion: The covid-19 pandemic has had a significant impact on the follow-up of patients with systemic inflammatory diseases. It highlighted the interest of reorganizing the follow-up of these patients during a health crisis, the patient education and the use of telemedicine to ensure continuity of care

[Clinical, bacteriological and therapeutic aspects of meningococcal meningitis in Dakar in 1999]. / Aspects cliniques, bacteriologiques et therapeutiques des meningites cerebro-spinales a Dakar en 1999.

Two major outbreaks of meningitis due Neisseria meningitidis serogroup A occurred in Senegal in 1998 and 1999. The purpose of this report is to describe clinical, bacteriological and therapeutic findings in 70 patients admitted for cerebrospinal meningitis to the Infectious Disease Clinic at the Fann University Teaching Hospital in Dakar in 1999. Diagnosis was based on direct microscopic examination after Gram staining in 71% of the cases, culture in 76%, and detection of soluble antigens in cerebrospinal fluid in 24%. Median patient age was 20 years. The highest incidence, i.e. 66% of cases, was recorded during February, March and April. Meningitic syndrome and fever were observed with 86% of the cases. The average duration of antibiotic therapy was 8 days. Chloramphenicol was the most commonly used drug (84% of cases). All strains identified in cultures were sensitive to chloramphenicol, ceftriaxone and cefotaxime but resistant to cotrimoxazole. Outcome was favorable in 93% of the cases. Three patients (4%) died and two (3%) developed hearing loss. Despite the low death rate in this series of patients treated in a hospital setting, mass vaccination is still the most effective mean of controlling meningococcal meningitis.

A simple clinical and paraclinical score predictive of CD4 cells counts below 400/mm3 in HIV-infected adults in Dakar University Hospital, Senegal.

In industrialized countries the decision to start co-trimoxazole (CMX) prophylaxis of HIV-related opportunistic infections is based on the CD4+ cell count. The value of CMX prophylaxis has also been demonstrated in Africa, where CD4+ cell counts are rarely available. We therefore developed a simple score predictive of a threshold CD4+ cell count (400/mm3) below which CMX prophylaxis is indicated. In a retrospective cross-sectional study, we collected clinical and biological data on 211 HIV-infected patients recruited from January 1996 through January 1998 at Fann University Hospital in Dakar, Senegal. Several variables were identified as being predictive of a CD4+ cell count below 400/mm3 by stepwise logistic regression. Each variable was weighted according to its regression coefficient, as follows: male sex (+1), weight loss (+2), body mass index < 22 (+2), herpes zoster (+4), tuberculin induration < 5 mm (+3) and haemoglobin < or = 10 g/dL (+1). A score of > or = 4 (sum of weights) selected patients with CD4+ cell counts below 400/mm3 with a sensitivity of 98% and a negative predictive value of 83%. Such a score should be applicable in the African context and should facilitate the management of HIV-infected patients, especially the prescription of CMX prophylaxis.

[Antifungal drug susceptibility of Candida causing oropharyngeal candidiasis in HIV infected patients]. / Sensibilité aux antifongiques des souches de Candida responsables de candidose oropharyngée chez des sujets vivant avec le VIH.

Candidiasis are very usual infections of HIV infected patients. By medicine pressure, susceptibility to antifungal drugs decrease in some Candida strains. This study carded out in 1997 at hospital, aimed to identify the yeast species isolated from HIV infected patients with oropharyngeal candidiasis, test their susceptibility to antifungal drugs and a previous antifungal treatment impact. Thus, 60 patients yielded to questionnary were recruited. Isolated yeast colonies from buccal tract after culture on Sabouraud medium with chloramphenicol were identified with the API 20 C AUX (BioMérieux) system by assimilation of different sugars. Susceptibility was evaluated by ATB FUNGUS (BioMérieux) system. 55 from the 60 isolated yeasts were identified and among them C. albicans and C. tropicalis were the main species with 75% and 11,7% respectively rates. In HIV1 infected patients, all specieswere isolated and C. albicans predominated (80,4%) on the other hand, C. albicans and C. tropicalis were the only isolated yeasts from the HIV2 infected patients with 83,3% and 16,6% respectively rates. Susceptibility of C. albicans was 72,2% to nystatine, 58,3% to amphotericin B, 83,3% to flucytosin, 12,8% to miconazole, 8,5% to econazole and 10,6% to ketoconazole. Susceptibility of C. albicans to polyenes was modified by a previous antifungal treatment. This study indicated emergence of saprophytic yeasts of the buccal mucosa and seemed to be more fostered by HIV1 serotype than HIV2. So, C. albicans's susceptibility to polyenes decreased by untimely use of antifungal drugs and by controlling it one could improve the clinic conditions of HIV infected patients.

Sensibilite aux antifongiques des souches de Candida responsables de Candidose oropharyngee chez des sujets vivant avec le VIH

Cette etude menee en 1997 en milieu hospitalier senegalais se propose d'identifier les differentes especes de Candida isoles chez 60 sujets vivant avec le VIH et porteurs de Candidose oropharyngee. Par la meme occasion; elle tente de determiner leur sensibilite aux antifongiques ainsi que l'impact d'un traitement antifongique anterieurLes resultats de l'etude font ressortir que d'une part le serotype VIH1 favorise l'emergence des levures saprophytes de la muqueuse buccale par rapport au serotype VIH2; d'autre part; et que l'utilisation intempestive des antifongiques diminue la sensibilite de C. albicans aux polyenes. Une meilleure maitrise de ce phenomene contribuerait a ameliorer l'etat clinique des personnes vivant avec le VI

Secretor polymorphism and human immunodeficiency virus infection in Senegalese women.

The FUT2 gene encodes the enzyme alpha (1,2) fucosyltransferase, which determines expression of blood-group antigens on mucosal epithelial cell surfaces and in secretions. Homozygotes for a specific stop mutation in FUT2 (nonsecretors) cannot produce this enzyme and thus are unable to express blood group antigens. Nonsecretor status is associated with a decreased risk of several respiratory viral infections. By use of molecular genotyping, 2 populations of Senegalese women were examined for polymorphisms of the FUT2 gene. Among Senegalese commercial sex workers, absence of FUT2 (nonsecretor genotype) was associated with reduced risk of human immunodeficiency virus (HIV) type 1 infection (odds ratio [OR] adjusted for cervical and vaginal infection, 0.18; 95% confidence interval [CI], 0.04-0.90) and HIV-2 infection (adjusted OR, 0.43; 95% CI, 0.13-1.39), although the latter was not statistically significant. Modification of cell surface carbohydrates at mucosal surfaces determined by the FUT2 gene may underlie the protective association against heterosexual HIV infection.

Risk factors for negative sputum acid-fast bacilli smears in pulmonary tuberculosis: results from Dakar, Senegal, a city with low HIV seroprevalence.

SETTING: Two teaching hospitals in Dakar, Senegal, a West African country with a low prevalence of human immunodeficiency virus (HIV) infection. OBJECTIVE: To determine whether patients with HIV-associated pulmonary tuberculosis have fewer acid-fast bacilli (AFB) in their sputum as assessed by routine microscopy, and to correlate the findings with systematically obtained clinical, radiographic and laboratory variables. DESIGN: Prospective study from November 1995 to October 1996 of 450 consecutive patients diagnosed with pulmonary tuberculosis. RESULTS: Tuberculosis was diagnosed in 380 patients (84.4%) by positive bacteriology, in 61 (13.6%) by a favorable response to anti-tuberculosis chemotherapy, and in nine (2.0%) by the presence of a miliary radiographic pattern. Forty (8.9%) patients were HIV-seropositive. AFB-negative smears were found in 14/40 (35.0%) of the HIV-seropositive patients with pulmonary tuberculosis compared with 71/410 (17.3%) of the seronegative patients (risk ratio [RR] = 2.02, 95% confidence interval [CI] 1.26-3.24, P = 0.01). Multivariate analysis revealed that AFB smear negativity was associated with absence of cavitation (P = 0.002), lack of cough (P = 0.005), the presence of HIV seropositivity (P = 0.02), a CD4+ cell count above 200/mm3 (P = 0.02), and age over 40 years (P = 0.03). CONCLUSIONS: Compared with HIV-seronegative patients with pulmonary tuberculosis, seropositive patients in Dakar, Senegal, are more likely to have negative sputum-AFB smears. This phenomenon has now been observed in seven of eight sub-Saharan African countries with varying HIV seroprevalence from which reports are available.

[Sensitivity to cotrimoxazole of bacteria isolated at the Central University Hospital of Fann, Dakar]. / Sensibilité au cotrimoxazole des bactéries isolées au CHU de Fann-Dakar.

This study concern a survey of bacterial resistance to cotrimoxazole; 510 strains of Enterobacteria (167), Vibrio cholerae(206) and Staphylococcus aureus(137) were tested by disc diffusion and agar dilution methods. An interview was conducted with 86 health personals to appreciate the influence of prescription. Staphylococcus aureus were the most susceptible bacteria (13% of resistance), and Vibrio cholerae the most resistant (95%). Related to the gender, Enterobacteria present 43 to 72% of resistance. The data of interview show a very frequent use of cotrimoxazole, related to the disponibility and the accessibility of this drug.

[Pneumocystosis in HIV infected patients presenting with acid-fast bacilli negative pneumopathy at the Central University Hospital at Dakar]. / La pneumocystose chez les sujets infectés par le VIH presentant une pneumopathie à BAAR négative au CHU de Fann à Dakar.

Pneumocystosis is an opportunist parasitic disease which occurs currently at Europe and United States in HIV infected patients. In Africa, the disease is not current. Pneumocystosis has been detected in the Fann medical universitary center at Dakar from HIV infected patients with acido alcoholo resistant bacilli negative pneumopathy. Analysis of broncho alveolar liquid(BAL) of 29 patients after Giemsa and Blue of Toluidin O staining allowed isolating of two cases of pneumocystosis. A man and a woman were the patients. They were HIV1 positive with at X ray bilateral interstitial syndrome. The CD4 lymphocytes count of the one was lower than 200/mm3 and for the other it was higher than 200/mm3.

[Methicillin-resistant Staphylococcus aureus in Dakar]. / Staphylococcus aureus résistants à la méticilline à Dakar.

This study was carried out at the Fann University Hospital Center in Dakar, Senegal between 1994 and 1996. The purpose was to assess the prevalence of methicillin-resistant Staphylococcus aureus and to propose alternative treatments. A total of 149 stains of Staphylococcus aureus were isolated from a variety of clinical specimens. Sensitivity to various antibiotics was tested by the disc diffusion technique (anti-biogram). Resistance to methicillin was evaluated by the oxacillin disc diffusion technique on Mueller-Hinton agar containing 5% NaCl. The prevalence of methicillin resistance was 66.4%. All strains of Staphylococcus aureus were sensitive to vancomycin. Other highly effective antibiotics included fucidic acid (94%), aminoglycosides (91%), cotrimoxazol (89.6%), and norfloxacin (84.5%). Most strains (70.6%) presented a wide profile against macrolides and related groups. The LSa phenotype (resistance to lincosamines and streptogramines) was the predominant resistant phenotype. The results of this study indicate that the prevalence of methicillin-resistant Staphylococcus aureus is increasing in Senegal. Since these strains respond well to chloramphenicol and cotrimoxazole, clinicians are advised to use these drugs as an alternative first-line treatment.

[Sensitivity profiles of enterobacteria isolated at th Fann University Hospital Center, Dakar]. / Profils de sensibilité des entérobactéries isolées au CHU de Fann, a Dakar.

This study concerns 180 strains of Enterobacteria isolated at Fann University Teaching Hospital (Dakar, Senegal). The susceptibility to antibiotics was tested by disc diffusion test (antibiogram) and by dilution method determining the minimum inhibitory concentration (MIC). All of the species present more resistant profile to beta-lactams (> 55%); however ceftriaxon and aztreonam present the lower MIC 50 (< 0.06 microgram/ml). Fluoroquinolon inhibits more than 90% of the strains of E. Coli and Proteus. Chloramphenicol is active on Salmonella, but ceftriaxon, aztreonam and the fluoroquinolon present good alternatives. Cotrimoxazole is active only on 54% of Shigella strains.

Profil de sensibilite des enterobacteries isolees au CHU de Fann; Dakar

180 souches d'Enterobacteries appartenant a differentes especes isolees entre 1994 et 1996 ont ete etudiees par les techniques de diffusion en gelose au CHU de Fann a Dakar. Les resultats obtenus ont montre une predominance des profils de resistance aux B-lactamases. Cependant on notait une bonne sensibilite aux cephalosporines de 3eme generation et aux monobactams qui ont les CMI 50 les plus basses pour l'ensemble des especes. Les fluoroquinolones inhibent plus de 90 pour cent des souches d'Escherichia coli et de Proteus; et peuvent etre utilisees en 1ere intention dans les infections urinaires. Le chloramphenicol est encore actif sur les souches de salmonelles; tandis que l'efficacite des aminopenicillines est tres moyenne. Le cotrimoxazole est peu actif sur les shigella (54 pour cent de sensibilite) et comme pour les salmonelles; le traitement alternatif peut faire appel aux cephalosporines de 3eme generation; a l'aztreonam et aux fluoroquinolones