Prevalence of vulvovaginal candidiasis in pregnancy at three health centers in Burkina Faso.

INTRODUCTION: Pregnant women are more susceptible to vaginal colonization and infection by yeast. The role of Candida colonization in the occurrence of preterm birth is well established. The knowledge of local epidemiology and identification of risk factors for preterm birth is important for the prevention and management strategies. The purpose of the study was to determine the prevalence of Candida sp. in vaginal swabs of pregnant women. METHODS: Pregnant women attending routine antenatal visits in three primary health centres in Bobo-Dioulasso (Burkina Faso) were enrolled into a cross-sectional study carried out from February to April 2015. Vaginal swabs samples were taken from participants after obtaining oral consent. The swabs were inoculated into Sabouraud's glucose agar supplemented with chloramphenicol and incubated at 37°C for 24 to 48hours under aerobic conditions in order to perform fungal culture. The identification of the Candida species was done by culture on HiCrome Candida Differential Agar at 35°C for 48h for production of species-specific colors. RESULTS: A total of 229 pregnant women were included. The prevalence of vulvovaginal candidiasis (VVC) was 22.71%, (95% CI [17.45-28.69]). Candida albicans accounted for 40.39% and non-Candida albicans species for 59.61% of the isolates, with mainly C. glabrata (32.69%), C. tropicalis (15.38%) and C. krusei (11.54%). CONCLUSIONS: This study revealed a high prevalence of non-C. albicans species. The syndromic management guidelines for VVC in Burkina Faso will be revised to include a specific protocol for pregnant women.

Infections des espaces profonds du cou et de la face dans le service d'ORL et de chirurgie Cervico-Faciale du Centre Hospitalier Universitaire Souro Sanou de Bobo-Dioulasso

Objectif : Décrire les aspects épidémiologiques, diagnostiques, thérapeutiques et évolutifs des Infections des Espaces Profonds du Cou et de la Face (IEPCF) dans le service d'ORL et de Chirurgie Cervico-faciale du CHU Souro Sanou. Matériel et méthodes : Une étude rétrospective réalisée dans le service d'ORL et de Chirurgie Cervico-faciale du CHU Souro Sanou sur la période du 1er janvier 2012 au 31 décembre 2016 a permis de colliger les dossiers cliniques de 41 malades hospitalisés pour une IPCF. Résultats : Les tranches d'âges de 0-5 ans, 20-25 ans et 25-30 ans représentaient 41,47% des cas. Le sex- ratio était de 1,16. La tuméfaction cervicale, la fièvre et la dysphagie représentaient les principaux signes fonctionnels présentés par les patients. Les cellulites cervicales et cervico-thoracique représentaient 36,59% des cas d'IEPCF. L'antibiothérapie à large spectre associée à un acte chirurgical dans 60,97% des cas avait été le principe du traitement. Les taux de guérison et de létalité étaient respectivement de 88% et de 5%. Conclusion : Les IEPCF sont susceptibles de donner des complications évolutives imprévisibles et graves pouvant mettre en jeu le pronostic vital du patient. La prise en charge correcte nécessite des moyens diagnostiques performants en imagerie médicale, un traitement antibiotique à large spectre et une connaissance anatomique des espaces cervicaux profonds du cou et de la face

Dyspnées en milieu hospitalier ORL du CHU Souro Sanou : aspects épidémiologiques, étiologiques, thérapeutiques et évolutifs

Objectif : Décrire les aspects épidémiologiques, étiologiques, thérapeutiques et évolutifs des cas de dyspnées dans le service d'ORL/CCF du CHU Souro Sanou. Méthodologie : Il s'agit d'une étude rétrospective et descriptive qui a colligé les dossiers cliniques de 151 patients hospitalisés pour une dyspnée dans le service au cours de la période de janvier 2012 à décembre 2016. Résultats : Les patients de 0 à 5 ans et de 5 ans à 10 ans représentaient 53,64% et 12,58%. Les corps étrangers des voies respiratoires étaient les plus fréquents avec 28,48% des étiologies. Les amygdalites hypertrophiques et obstructives associées aux végétations adénoïdes et les végétations adénoïdes isolées représentaient chacune 12,88%. Les taux de guérison et de décès étaient de 84,11% et de 9,27%. Le cancer de l'hypopharynx était la principale cause de décès avec 21,43% des cas. Conclusion : Les dyspnées en ORL sont des urgences diagnostiques et thérapeutiques. Les causes variées nécessitent un plateau technique adapté et du personnel qualifié

Microbiological characteristics of community-acquired peritonitis at Souro Sanou Teaching Hospital of Bobo Dioulasso.

The purpose of this study was to describe the microbiological characteristics of community-acquired peritonitis at the Souro Sanou teaching hospital of Bobo Dioulasso, Burkina Faso. This 10-month prospective study, from July 2012 through May 2013 included all cases of community-acquired peritonitis who underwent surgery at our hospital and had a pus sample taken at that time. Bacteriological analyses were performed according to the hospital laboratory's protocol. The study included 72 patients (45 men and 27 women with a sex-ratio of 1.6). Their mean age was 27.3 years (range: 14 months to 67 years). The analysis of 72 samples of pus enabled confirmation of 39 cases and led to the identification of 53 bacterial strains. The most common families were enterobacteriaceae in 58% and Gram-positive cocci in 36%. The most common enterobacteria species was Escherichia coli (47%) followed by Streptococcus species (22%). The microbiological confirmation of peritonitis was most frequent in the 20-30 year-old age group. These bacteria appeared most susceptible to gentamycin, ceftriaxone, and ciprofloxacin, while we observed resistance to amoxicillin and the combination of clavulanic acid-amoxicillin. These findings suggest that the best probabilistic antibiotic treatment for the peritonitis in our context would combine a third-generation cephalosporin with aminoglycosides, with imidazole to cover potential anaerobic bacteria.

[Metabolic syndrome and cardiovascular risk patients under antiretrovirals in a day hospital at Bobo-Dioulasso (Burkina Faso)]. / Syndrome métabolique et risque cardiovasculaire chez des patients sous antirétroviraux à l'hôpital de jour de Bobo-Dioulasso (Burkina Faso).

Highly active antiretroviral therapy (HAART) has reduced morbidity and mortality of HIV but has led to an increasing metabolic cardiovascular risk. A cross-sectional study was conducted from May to September 2011 in Day Care Hospital for HIV-Patients of Bobo-Dioulasso. We included in this study 400 patients infected by HIVon antiretroviral therapy ≥ 6 months selected by a random draw. Metabolic syndrome was assessed according to the definitions of the IDF and ATP-III. The high risk of cardiovascular disease in 10 years was defined by a Framingham score ≥ 20%. The average age of our patients was 41.4 years [20-76]. 17% received an IP. The average duration of PI exposure was 35.5 months and 50.1 months for NNRTI. The prevalence of diabetes was 1.3% (95% CI: 0.5-3) and that of hypertension of 12.0 % (95% CI: 9.3-16). The prevalence of metabolic syndrome according to IDF was 10% (95% CI: 7.3-13.5) and the metabolic syndrome according to ATP-III 12.3% (95% CI: 9.3-16). The body mass index was higher (BMI 25.2 vs. 22.5 kg/m(2), p <10(-3) with ATPIII and BMI 26.6 vs. 22.4 kg/m(2), p <10(-3) with IDF), and duration exposure to ARVs longer in patients with metabolic syndrome regardless of the definition used (58.6 months vs 27.9 months). High cardiovascular risk was present in 1.8% (95% CI: 0.8 to 3.7) of our patients, all male more than half (n=4/7) of them were smoking. The choice of antiretroviral therapy must take into account its potential long-term toxicity. It should also strengthen supervision.

[Impact of a conjugated anti meningococcal A vaccine on notification of bacterial meningitis in West Burkina Faso (2009-2012)]. / Impact d'un vaccin conjugué antiméningococcique « A ¼ sur les méningites bactériennes notifiées à l'ouest du Burkina Faso (2009-2012).

Burkina Faso is a sub-saharan African country completely included in the meningococcal meningitis belt. The western part of the country suffered from many meningococcal A epidemics, in spite of reactive collective campaigns with polysaccharide A vaccine. On 6th December 2010, Burkina Faso was the first African country to conduct a collective vaccination campaign of all the 1-29 years old population with a new conjugated meningococcal Avaccine (MenAfriVac™). Before this campaign, in Western Burkina (4,064,928 inhabitants, 27.5% of total population), a rehearsal of the staff of all peripheral medical laboratories has been conducted, with delivery of laboratory equipment, reactants, and possibility to transfer CSF specimens at the central level to confirm bacteriologic species in cause by latex, culture and PCR analysis. For this campaign, an administrative coverage of 100.3% was reached. A nearly complete disappearance of meningitis due to meningococcus A was recorded, but an increase of cases due to meningococcus X, W135. With the increase of quality of surveillance, and MenAfriVac™ vaccination showed its beneficial effect on meningococcus A meningitis. If we want however to impact on the number of recorded acute bacteriological meningitis, we will have to use multi-antigenic, if possible conjugated, meningococcal vaccines against locally circulating meningococcal species, the number of pneumococcal meningitis being contained by the recent inclusion in EPI of a 13-valent conjugated pneumococcal vaccine.

[W135 meningococcus meningitis: study of 148 cases observed in 2002 and 2003 at the National Teaching Hospital of Ouagadougou, Burkina Faso]. / Méningites à méningocoque du sérogroupe W135: étude de 148 cas observes en 2002 et en 2003 au CHU-YO de Ouagadougou, Burkina Faso.

The purpose of this report is to describe the bacteriological features, clinical signs and therapeutic outcome of 148 cases of W135 meningococcus meningitis observed during meningitis outbreaks in Burkina Faso in 2002 and 2003. Diagnosis was based on microbiological study of cerebrospinal fluid. Cases of meningococcus meningitis were recorded throughout the study period with the peak number of cases occurring around the 14th week. There was a slight male predominance (56.1%) and young patients between one and 15 years accounted for 81.7% of cases. The mean interval between onset of symptoms and hospitalization was 2.6 days and the mean duration of hospitalization was 5.5 days. The most common clinical signs were fever (98.6%), stiff neck (90.5%),Brudzinski's sign (85.1%),Kernig's sign (66.2%), altered consciousness (41.9%), vomiting (36.5%) and headaches (34.5%). In most cases treatment with a singie dose of chiorazuphenicol in oil was curative. Overall mortality was 15.5% idth no correlation with sex or age. Seventeen of the 23 deaths occurred within 24 hours after their admission to the hospital. The other six deaths occurred on the second day after admission inS cases and fifth day in one case. Convulsions, shock and altered consciousness were consistent poor prognostic signs. A correlation was found between mortality and interval for hospitalization with better survival in patients receiving prompt treatment. Study of the susceptibility of 102 samples showed that W135 meningococcus was sensitive to penicillin G, ampicillin,ceftriaxone and chloramphenicol but resistant to sulfamides (cotrimoxazole). Bacterial meningitis is an Important factor of morbidity and mortality worldwide. Our findings indicate that the bacteriological, clinical and epidemiological characteristics of W135 meningococcus is do not differ greatly from those of meningococcus A. Since W135 meningitis is susceptible to antibiotics used to cure meningitis, campaigns to promote early detection and treatment must be continued.

Meningites a meningocoque du serogroupe W135 : etude de 148 cas observes au Burkina-Faso

L'objectif de ce travail etait d'etudier les aspects bacteriologique; clinique et evolutif de la meningite a meningocoque du serogroupe W135 observee au cours des epidemies de meningites qui ont frappe le Burkina Faso en 2002 et en 2003 a trave rs l'etude de 148 cas identifies grace a l'examen bacteri o l ogique du LCR. Les meningites a meningocoque W135 ont ete observ e e s tout au long de l'annee; avec un maximum de cas autour de la 14e semaine. Il ap p a rait une legere predominance masculine (56;1) et les jeunes de un a 15 ans ont ete les plus touches avec 81;7des cas. Le delai moyen d'hospitalisation a ete 2;6 jours et la duree moyenne d'hospita- lisation de 5;5 jours. Les signes cliniques les plus frequents ont ete la fievre (98;6); la raideur de la nuque (90;5); les signes de Brudzinski (85;1); les signes de Kernig (66;2); les tro u bles de la conscience (41;9); les vomissements (36;5) et les cephalees (34;5). Dans la majorite des cas; le traitement curatif a ete fait par administra- tion de chloramphenicol huileux en dose unique. La letalite globale qui a ete de 15;5ne semble influencee ni par le sexe ni par l'age. Sur les 23 cas de deces; 17 sont surve nus dans les 24 heures qui ont suivi l'hospitalisation des patients; cinq le deuxieme jour et un dernier le 5eme jour. Les signes cliniques constamment associes a un mauvais pronostic ont ete les troubles de la conscience; les etats de choc et les convulsions. Il apparait une association letalite/delai d'hospitalisation en effet; plus tot le patient est pris en charge plus ses chances de survie sont importantes. L'etude de la sensibilite de 102 souches a montre la grande sensibilite des meningocoques W135 a la penicilline G; a l'ampicilline; a la ceftriaxone et au ch l o ramphenicol et leur resistance aux sulfamides. En defi n i t ive; le meningocoque W135 semble peu diff e rent du meningocoque A sur les plans cl i n i q u e; epidemiologique et bacteri o l ogique d'ou la necessite de continuer a maintenir des actions de sensibilisation pour une prise en charge rapide des cas

Short communication: impact of long-term (14 years) bi-annual ivermectin treatment on Wuchereria bancrofti microfilaraemia.

Ivermectin has been and continues to be extensively used to control onchocerciasis in areas of hyper and mesoendemicity within the African Programme of Onchocerciasis Control. As programmes to eliminate lymphatic filariasis (LF) caused by Wuchereria bancrofti expand, areas of coendemicity with onchocerciasis will be incorporated into LF programmes. This study reports that in villages which were hyperendemic for onchocerciasis after some 14 years of treatment with ivermectin, no W. bancrofti could be detected in a population of 1210 individuals whilst in adjacent villages a prevalence of around 3% was found. Despite the long period of ivermectin treatment Mansonella perstans did not appear to respond to ivermectin in this setting.

Impact of long-term ivermectin (Mectizan) on Wuchereria bancrofti and Mansonella perstans infections in Burkina Faso: strategic and policy implications.

Parasitological and clinical surveys were used to determine the long-term impact of ivermectin on the prevalence of Wuchereria bancrofti and Mansonella perstans filarial infections, when the drug was given under community-directed-treatment strategies for onchocerciasis control. The study was undertaken in 11 communities in south-western Burkina Faso. Six of the villages investigated had been treated with ivermectin at least once a year for five of 6 years, with a mean coverage of approximately 65% in each round. The other five, adjacent villages, which were matched with the ivermectin-treated communities by size, ethnicity and social and economic activities, had never been treated because they were not endemic for onchocerciasis. Each subject was checked by the microscopical examination of a smear of 'night' blood, by measurement of the level of circulating antigens from adult W. bancrofti, and by clinical examination for hydrocele (if male) and lymphoedema. The prevalences of lymphoedema and hydrocele in the treated villages were similar to those in the untreated. The prevalences and intensities of W. bancrofti and M. perstans microfilaraemia were, however, significantly lower in the ivermectin-treated communities. The implications of this study are discussed in relation to the old Onchocerciasis Control Programme (OCP) and to the ongoing African Programme for Onchocerciasis (APOC), where extensive and sustained ivermectin distribution is planned through community-based treatment programmes. As with onchocerciasis in Africa, the success of annual treatments to control lymphatic filariasis will depend not only on the number of regular rounds of treatment given but on adequate coverages being achieved in each round. Wherever ivermectin is being distributed alone, for onchocerciasis control, its impact on other filarial infections, notably W. bancrofti, should be evaluated routinely. Any opportunity to add donated albendazole to such distributions should be taken, both to limit the transmission of W. bancrofti and for the wider public-health benefits.

The use of spatial analysis in mapping the distribution of bancroftian filariasis in four West African countries.

The geographical distribution of human infection with Wuchereria bancrofti was investigated in four West African countries (Benin, Burkina Faso, Ghana and Togo), using a commercial immunochromatographic test for filarial antigen. Efforts were made to cover each health-system implementation unit and to ensure no sampling point was >50 km from another, but otherwise the 401 study communities were selected at random. The aim was to enable spatial analysis of the data, to provide a prediction of the overall spatial relationships of the infection. The results, which were subjected to an independent random validation in Burkina Faso and Ghana, revealed that prevalence in the adult population of some communities exceeded 70% and that, over large areas of Burkina Faso, community prevalences were between 30% and 50%. Most of Togo, southern Benin and much of southern Ghana appeared completely free of the infection. Although there were foci on the Ghanaian coast with prevalences of 10%-30%, such high prevalences did not extend into coastal Togo or costal Benin. The prevalence map produced should be useful in prioritizing areas for filariasis control, identifying potential overlap with ivermectin-distribution activities undertaken by onchocerciasis-control programmes, and enabling inter-country and sub-regional planning to be initiated. The results indicate that bancroftian filariasis is more widely distributed in arid areas of Burkina Faso than hitherto recognized and that the prevalences of infection have remained fairly stable for at least 30 years. The campaign to eliminate lymphatic filariasis as a public-health problem in Africa will require significantly more resources (human, financial, and logistic) than previously anticipated.

Blood flow vs. venous pressure effects on filtration coefficient in oleic acid-injured lung.

On the basis of changes in capillary filtration coefficient (Kfc) in 24 rabbit lungs, we determined whether elevations in pulmonary venous pressure (Ppv) or blood flow (BF) produced differences in filtration surface area in oleic acid-injured (OA) or control (Con) lungs. Lungs were cyclically ventilated and perfused under zone 3 conditions by using blood and 5% albumin with no pharmacological modulation of vascular tone. Pulmonary arterial, venous, and capillary pressures were measured by using arterial, venous, and double occlusion. Before and during each Kfc-measurement maneuver, microvascular/total vascular compliance was measured by using venous occlusion. Kfc was measured before and 30 min after injury, by using a Ppv elevation of 7 cmH2O or a BF elevation from 1 to 2 l . min-1 . 100 g-1 to obtain a similar double occlusion pressure. Pulmonary arterial pressure increased more with BF than with Ppv in both Con and OA lungs [29 +/- 2 vs. 19 +/- 0.7 (means +/- SE) cmH2O; P < 0. 001]. In OA lungs compared with Con lungs, values of Kfc (200 +/- 40 vs. 83 +/- 14%, respectively; P < 0.01) and microvascular/total vascular compliance ratio (86 +/- 4 vs. 68 +/- 5%, respectively; P < 0.01) increased more with BF than with Ppv. In conclusion, for a given OA-induced increase in hydraulic conductivity, BF elevation increased filtration surface area more than did Ppv elevation. The steep pulmonary pressure profile induced by increased BF could result in the recruitment of injured capillaries and could also shift downstream the compression point of blind (zone 1) and open injured vessels (zone 2).

Capillary pressure estimates from arterial and venous occlusion in intact dog lung.

We performed pulmonary venous occlusions in order to check the validity of the pulmonary capillary pressure measurements obtained using pulmonary arterial occlusion in the intact animal. The venous and arterial postocclusion pressure profiles were recorded using balloon catheters introduced, respectively, into a left lower lobe vein and into a right pulmonary artery in the anaesthetized open-chest dog. The pressure profiles were fitted by a biexponential function with an early exponential and a late exponential presenting, respectively, a short and a long time constant. We used the zero-time extrapolation of the late slow exponential to obtain an arterial (Pc,ao) and a venous (Pc,vo) estimate of the pulmonary capillary pressure. Each Pc,ao and Pc,vo made it possible to calculate a fractional arterial or venous pressure gradient when referenced to the arteriovenous pressure gradient measured during the occlusion process. In nine dogs, when referenced to the whole lung, the arterial, middle and venous fractional pressure gradients were 37 +/- 11, 10 +/- 6, and 53 +/- 12%, respectively. As the middle fractional pressure gradient is low, we conclude that pulmonary capillary pressure estimates from arterial occlusion are close to the venous occlusion estimates of capillary pressure in the intact dog lung.