Klebsiella pneumoniae resistant to third-generation cephalosporins in five African and two Vietnamese major towns: multiclonal population structure with two major international clonal groups, CG15 and CG258.

The molecular epidemiology of third-generation cephalosporin-resistant (3GC-R) Klebsiella pneumoniae in developing countries is poorly documented. From February 2007 to March 2008, we collected 135 3GC-R K. pneumoniae isolates from seven major towns in Maghreb (Morocco), West Africa (Senegal, Côte d'Ivoire), Central Africa (Cameroon), East Africa (Madagascar) and Southeast Asia (Vietnam). Their genetic diversity, assessed by multilocus sequence typing, was high (60 sequence types), reflecting multiclonality. However, two major clonal groups, CG15 (n = 23, 17% of isolates) and CG258 (n = 18, 13%), were detected in almost all participating centres. The two major clonal groups have previously been described in other parts of the world, indicating their global spread. The high diversity of enterobacterial repetitive intergenic consensus sequence-PCR banding patterns at the local level indicates that most isolates were epidemiologically unrelated. The isolates were characterized by the presence of multiple resistance determinants, most notably the concomitant presence of the aac(6')-Ib-cr, qnr and blaCTX-M-15 genes in 61 isolates (45%) belonging to 31 sequence types. These isolates were detected across a large geographical area including Cameroon (n = 1), Vietnam (n = 4), Madagascar (n = 10), Côte d'Ivoire (n = 12), Morocco (n = 13) and Senegal (n = 21). These results have major implications for patient management and highlight a potential reservoir for resistance determinants.

Epidemiology of methicillin-susceptible Staphylococcus aureus lineages in five major African towns: high prevalence of Panton-Valentine leukocidin genes.

The epidemiology of methicillin-susceptible Staphylococcus aureus (MSSA) in Africa is poorly documented. From January 2007 to March 2008, 555 S. aureus isolates were collected from five African towns in Cameroon, Madagascar, Morocco, Niger, and Senegal; among these, 456 unique isolates were susceptible to methicillin. Approximately 50% of the MSSA isolates from each different participating centre were randomly selected for further molecular analysis. Of the 228 isolates investigated, 132 (58%) belonged to five major multilocus sequence typing (MLST) clonal complexes (CCs) (CC1, CC15, CC30, CC121 and CC152) that were not related to any successful methicillin-resistant S. aureus (MRSA) clones previously identified in the same study population. The luk-PV genes encoding Panton-Valentine leukocidin (PVL), present in 130 isolates overall (57%), were highly prevalent in isolates from Cameroon, Niger, and Senegal (West and Central Africa). This finding is of major concern, with regard to both a source of severe infections and a potential reservoir for PVL genes. This overrepresentation of PVL in MSSA could lead to the emergence and spread of successful, highly virulent PVL-positive MRSA clones, a phenomenon that has already started in Africa.

Epidemiology of methicillin-resistant Staphylococcus aureus lineages in five major African towns: emergence and spread of atypical clones.

The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in Africa is poorly documented. From January 2007 to March 2008, we collected 86 MRSA isolates from five African towns, one each in Cameroon, Madagascar, Morocco, Niger and Senegal. Although one or two major clones, defined by the sequence type and staphylococcal cassette chromosome mec type, predominated at each site, genetic diversity (ten clones) was relatively limited in view of the large geographical area studied. Most of the isolates (n = 76, 88%) belonged to three major clones, namely ST239/241-III, a well-known pandemic clone (n = 34, 40%), ST88-IV (n = 24, 28%) and ST5-IV (n = 18, 21%). The latter two clones have only been sporadically described in other parts of the world. The spread of community-associated MRSA carrying the Panton-Valentine leukocidin genes is a cause for concern, especially in Dakar and possibly throughout Africa.

Role of contaminated aspiration tubes in nosocomial outbreak of Klebsiella pneumoniae producing SHV-2 and CTX-M-15 extended-spectrum beta-lactamases.

Klebsiella pneumoniae resistant to ceftazidime was isolated from ten neonates hospitalised between February and March 2006 in two Antananarivo hospitals, Madagascar. The main environmental source, for one hospital in particular, was the liquid used to rinse aspiration tubes in the paediatric wards. The risk of contamination from aspiration tubes is very high in the hospitals of Antananarivo since tap water used to rinse the tubes is not regularly changed. Phenotypical (biotyping and antibiotyping) and genotypical (pulsed-field gel electrophoresis) analysis of all the clinical isolates indicated that nine cases were due to a single clone. This clone carried the genes encoding SHV-2 and CTX-M-15 beta-lactamases. This is the first description of an epidemic due to an ESBL-producing member of the family Enterobacteriaceae in Malagasy hospitals.

Herpes genital et grossesse: mesures efficaces en prevention de l'herpes neonatal

L'herpes genital est une infection virale due a Herpes Simplex 1 ou 2. Chez la femme enceinte; elle peut avoir des consequences redoutables chez l'enfant a naitre. Nous rapportons 2 observations qui ont souleve le probleme de diagnostic et de prise en charge. La premiere concernait une primipare de 29 ans dont le diagnostic est etabli vers 38 semaines d'amenorrhee devant une notion d'eruptions peniennes chez le conjoint et des leucorrhees rebelles. La deuxieme concernait une primipare de 22 ans de diagnostic etabli vers 36 semaines d'amenorrhee pour des eruptions vesiculo-suintantes vulvo-vaginales. Les particularites de la prise en charge sont discutees pour prevenir l'herpes neonatal. L'evolution favorable confirme que la cesarienne en urgence associee a un traitement anti-viral pour la mere et l'enfant reste le traitement de choix

Herpes genital et grossesse : mesures efficaces en prevention de l'herpes neonatal

L'herpes genital est une infection virale due a Herpes Simplex 1 ou 2. Chez la femme enceinte; elle peut avoir des consequences redoutables chez l'enfant a naitre. Nous rapportons 2 observations qui ont souleve le probleme de diagnostic et de prise en charge. La premiere concernait une primipare de 29 ans dont le diagnostic est etabli vers 38 semaines d'amenorrhee devant une notion d'eruptions peniennes chez le conjoint et des leucorrhees rebelles. La deuxieme concernait une primipare de 22 ans de diagnostic etabli vers 36 semaines d'amenorrhee pour des eruptions vesiculo-suintantes vulvo-vaginales. Les particularites de la prise en charge sont discutees pour prevenir l'herpes neonatal. L'evolution favorable confirme que la cesarienne en urgence associee a un traitement anti-viral pour la mere et l'enfant reste le traitement de choix

[Preliminary results in the clinical, epidemiological and parasitological study of Bancrofti filariasis in Madagascar]. / Résultats préliminaires de l'enquête épidémio-clinique et parasitologique sur la filariose de Bancroft à Madagascar.

In 1958, a large study on the distribution of Bancroft filariasis was set up in Madagascar. In order to update these data, the authors have studied in the same areas the parasitological and clinical prevalence of Bancroft filariasis. Here are the preliminary results of this study, concerning 1862 people, aged 10 years and more. The mean prevalence rate of microfilaria-carriers was of 22.9%, and the average parasitic density was of 3.6 parasits/20 microliters of blood. The prevalence rate of chronic clinical symptoms was of 14.7% for men (elephantiasis, hydroceles, chyluria) and of 2% for women (elephantiasis). These were usually mild symptoms, which very little impact on way of life.