[Clinical, paraclinic and evolutive profile of HIV infected subject compared with that of non-HIV infected subject in pneumology hospitalization at Abidjan]. / Profil clinique, paraclinique et évolutif du sujet infecté par le VIH comparé à celui du sujet non infecté par le VIH en milieu pneumologique hospitalier à Abidjan.

INTRODUCTION: The HIV infection is a problem of public health in Côte d'Ivoire. Voluntary screening is encouraged for the premature management of HIV infected patients before the stage of serious opportunist affections. Antiretroviral therapy became free. The purpose of this study was to describe the characteristics of HIV infected subject infected in hospitalization of pneumology. METHODOLOGY: Our retrospective and analytic study concerned the activity period from January 2001 to December 2012 of pneumology department of Cocody university hospital. RESULTS: On 1141 recorded files, the prevalence of HIV infection was 48.20%. The multi-varied analysis showed the following results. Male patients were less HIV infected (OR=0.490 [0.363-0.661]) as the old patients of more than 64 years (OR=0.150 [0.080-0.280]). In case of HIV infection, infectious pathology, severe anemia and renal insufficiency were dominating respectively with OR=1.763 (1.212-2.564), OR=3.167 (2.125-4.720) and OR=2.054 (1.335-3.161). A stronger mortality was associated with HIV infection (OR=1.920 [1.312-2.809]). CONCLUSION: HIV infection always remains frequented in pneumology hospitalization in Abidjan with late discovery, source of complications and abnormally high death rate.

[Comparative diagnosis of bacterial pneumonia and pulmonary tuberculosis in HIV positive patients]. / Diagnostic comparé des pneumopathies bactériennes et de la tuberculose pulmonaire chez les patients VIH.

INTRODUCTION: Immunodepression induced by the human immunodeficiency virus (HIV) modifies the clinical, radiological and microbiological manifestations of pulmonary tuberculosis; leading to similarities between pulmonary tuberculosis and acute community-acquired bacterial pneumonia. A consequence is the high proportion of discordant pre- and post-mortem diagnoses of pneumonia. The aim of our study was to contribute to the improvement in the diagnosis of acute bacterial pneumonia in HIV positive patients in areas where tuberculosis is endemic. METHODS: This retrospective study in HIV positive patients has compared 94 cases of positive smear cases pulmonary tuberculosis and 78 cases of acute community-acquired bacterial pneumonia. RESULTS: Using logistic regression, the following features were positively associated with bacterial pneumonia: the sudden onset of signs (OR=8.48 [CI 95% 2.50-28.74]), a delay in the evolution of symptoms of less than 15 days (OR=3.70 [CI 95% 1.11-12.35]), chest pain (OR=2.81 [CI 95% 1.10-7.18]), radiological alveolar shadowing (OR=12.98 [CI 95% 4.66-36.12) and high leukocytosis (OR=3.52 [CI 95% 1.19-10.44]). These five variables allowed us to establish a diagnostic score for bacterial pneumonia ranging from 0 to 5. The area under the ROC curve was 0.886 [CI 95% 0.84-0.94, P<0.001]). Its specificity was >96.8% for a score of greater than or equal to 4. CONCLUSION: The diagnostic score for acute community-acquired pneumonia may improve the management of bacterial pneumonia in areas where tuberculosis is endemic.

[Tubeculosis in Abidjan: comparison of children and adults]. / La tuberculose à Abidjan: comparaison entre l'enfant et l'adulte.

Tuberculosis (TB) is a global public health problem, especially in developing countries. Although the extent of TB in children is unknown, children are estimated to account for 5 to 20% of all TB cases. The aim of this study was to specify the differences between tuberculosis in children and in adult outpatients managed in Abidjan. This retrospective study analyzed data from 2617 cases of childhood TB and 36,648 cases of adult TB. The sex ratio was 0.93 in children and 1.50 in adults HIV co-infection was present in 24.5% (174/711) of the children with TB and 44% (5106/11,617) of the adults [OR = 0.413 (0.347, 0.492), p<0.001]. Of the 2610 cases of childhood TB for which complete data were available, 77.24% were pulmonary, including 34.63% smear-positive, and 22.76% were extrapulmonary; in adults, there were 2286 cases of smear-negative tuberculosis, 24,000 smear-positive, and 9348 extrapulmonary (26.2%). The most common locations of extrapulmonary TB in children were lymph nodes (30.1%) and the pleura (26.2%). Treatment failure or death was estimated at 1.9% in children compared with 3.9% in adults [OR = 0.465 (0.326, 0.664), p <0.001]. In Abidjan, TB in children is more frequently smear-negative or located in the lymph nodes than among adults, and it affects girls and boys almost equally.

[Predictive factors of lost to follow-up status during tuberculosis treatment]. / Facteurs prédictifs du statut « perdus de vue ¼ au cours du traitement de la tuberculose.

INTRODUCTION: Patients with contagious tuberculosis who are lost to follow-up risk sowing the disease among their circle of acquaintances. Moreover, a history of inadequate anti-tuberculous treatment is an important risk factor for the development of drug-resistant organisms. The purpose of this study was to identify risk factors for loss to follow-up among patients undergoing treatment for tuberculosis. METHODOLOGY: We performed a prospective cohort study among patients with contagious tuberculosis, beginning with anti-tuberculous treatment followed during six months, after initial education-information about their condition. We compared the characteristics of 152 patients lost to follow-up from tuberculosis treatment against those of 492 patients who were not lost to follow-up. RESULTS: Independent factors associated with a reduction in the risk of being lost to follow-up were: the presence of night-sweats (OR=0.46 [0.24-0.88]; P=0.018), the presence of thoracic pain (OR=0.27 [0.14-0.54]; P<0.001), screening for HIV (OR=0.41 [0.17-0.98]; P=0.045), fact to inform a person of its disease (OR=0.06 [0.01-0.41]; P=0.004), the application of directly observed treatment in the community (OR=0.34 [0.17-0.66]; P<0.001). CONCLUSION: Reducing loss to follow-up during treatment for tuberculosis requires the development of a "good attitude" through education-information about tuberculosis.

[Characteristics of supposedly bacterial community acute pneumonia among HIV-positive patients: prospective preliminary study]. / Pneumonies communautaires d'allure bactérienne chez le sujet infecté par le VIH : étude préliminaire prospective.

INTRODUCTION: Community-acquired pneumonia (CAP) is the second leading cause of hospitalization in the respirology department in Abidjan after tuberculosis. Frequently associated with HIV infection, it has a high mortality rate of about 20% to 30%. The aim of this study is to identify the specificities and severity factors associated with bacterial CAP (BCAP) outcome in HIV-positive patients. METHODS: The authors conducted a prospective and comparative preliminary study on two groups of patients: 29 HIV-positive patients with BCAP and 21 HIV-negative patients with BCAP. All of the patients were hospitalized for BCAP with symptoms of severity according to the usual score of severity. RESULTS: The sociodemographic, clinical and paraclinical characteristics were similar in both groups. Failures and deaths were more frequent in the group with HIV infection. In particular, HIV infected patients with a body mass index under 18.5 and a rate of T CD4 lymphocytes lower than 200/mm(3) presented the least favourable evolution. CONCLUSIONS: A more extensive study should help define the appropriate severity criteria for BCAP associated with HIV infection.