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

Rapidly rising cases with Omicron in Senegal.

•Omicron variant continues to progress in Senegal with the appearance of new contaminations.•IRESSEF detected the first positive case of the Omicron variant on Friday, December 3, 2021.•Since this date, the number of Omicron variant infections has increased over the weeks.•Molecular surveillance of the Omicron variant is carried out in real time to inform the medical authorities.

Cerebral venous thrombosis in a sub-saharan African country: A preliminary monocentric study of a 70 case series at the neurology department of Fann teaching hospital in Dakar - Senegal.

INTRODUCTION: Cerebral venous thrombosis (CVT) are underdiagnosed in sub-saharan Africa where publications are uncommon. Our study aim was to describe the CVT diagnostic and therapeutic features through a senegalese case series. PATIENTS AND METHOD: A monocentric retrospective and prospective study was conducted at the adult Neurology department of Fann Teaching Hospital in Dakar (Senegal), between January 01, 2013 and April 30, 2020. It had included all CVT cases diagnosed by neurovascular imaging. RESULTS: Seventy CVT cases were collected including 48 women (68.6%). The average age of the patients was 35.2±14 years. The main neurological signs were headache (92.8%) and motor deficit (41.4%), with subacute onset in 67.2% of cases. The superior sagittal sinus (54.3%) and the transverse sinus (38.6%) were the most affected with multiple involvements in 27 patients (38.6%). Thirty patients (42.8%) had indirect parenchymal signs such as venous infarction (15.7%), cerebral edema (11.4%) or intracerebral hemorrhage (12.8%). The etiological factors were mostly infectious (41.4%) with meningoencephalitis (12.8%) and otorhinolaryngological infection (10%). Gyneco-obstetric factors (27%) and Behçet's disease (7%) were the main aseptic factors. In the short-term clinical course, curative anticoagulation (98.6%) had enabled a favourable outcome (mRS 0-1) in half of the patients. CONCLUSION: Our study, the largest series in sub-saharan Africa to this date, confirms that CVT is a young women disease. Infectious etiology is the most frequent at the Fann national teaching hospital (41.4% in Dakar against 6.5% in Germaine Bousser's series) even if the etiological assessment is limited by financial constraints (no coagulopathy/thrombophilia check-up).

COVID-19 et maladies auto-immunes dans un centre de traitement des épidémies à Dakar / COVID 19 and autoimmune diseases in an outbreak treatment center in Dakar

Introduction : Les patients présentant une affection systémique ont un risque accru d'infections. Leur prise en charge au cours de la pandémie au COVID19 constitue un défi qui doit prendre en considération plusieurs aspects. Nous rapportons les caractéristiques épidémiologiques, cliniques, et évolutives des patients COVID positifs suivis pour une maladie auto-immune (MAI). Patients et méthode : étude rétrospective, descriptive et analytique menée au centre de traitement des épidémies du centre hospitalier universitaire (CHU) Le Dantec de Dakar durant les périodes du 30 Avril au 30 Octobre 2020 puis du 30 Décembre 2020 au 30 Avril 2021. Etaient inclus tous les dossiers des patients suivis pour une maladie systémique hospitalisés pour COVID-19 confirmée à la RT-PCR. Résultats : treize patients étaient inclus dans l'étude, composés de 8 femmes et de 5 hommes. L'âge moyen était de 59 ans [16 à 74 ans]. Il s'agissait de 8 cas de maladies auto-immunes systémiques (MAIS) : polyarthrite rhumatoïde (n=3 ; 37,5%), Sjögren primitif (n=2 ; 25%), lupus systémique, dermatomyosite, arthrite à cellules géantes chacun 1 cas (12,5%) et 5 cas de maladies auto-immunes spécifiques d'organes (MASO) : maladie de Basedow (n=1 ; 20% de MASO), thyroïdite de Hashimoto (n=1 ; 20%), myasthénie (n=1 ; 20%), diabète de type 1 (n=1 ; 20%) et maladie de Biermer (n=1 ; 20%). Les formes cliniques étaient modérées (6 cas ; 46,1%), sévères (2cas ; 15,4%) et critiques (2cas ; 15,4%). Huit patients (8/13) avaient au moins une comorbidité associée. Deux décès (2/13) étaient notés. Conclusion : il n'a pas été trouvé une augmentation des complications sévères dues au COVID-19 chez les patients suivis pour une maladie auto-immune. Leur pronostic n'est pas différent de celui de la population générale.

[Neuro-Behçet in a Sub-Saharan Africa Country: a Series of Sixteen Patients in Fann Teaching Hospital, Dakar, Senegal]. / Neuro-Behçet dans un pays d'Afrique subsaharienne : une série de 16 patients au centre hospitalier national universitaire de Fann de Dakar, Sénégal.

Neuro-Behçet (NB) African studies are mainly North African, but Sub-Saharan Africa is not to be outdone. Our aim was to describe diagnostic and therapeutic features of NB in a Senegalese series collected in Dakar. This was a descriptive and retrospective study conducted at the Neurology department of Fann Teaching Hospital in Dakar, Senegal. All patients who met the NB's diagnostic criteria were included. Sixteen patients were collected, 14 males and 2 females with an average age of 40 years [18-71]. The main neurological signs were motor deficit (13 cases), headache (10 cases), and language disorders (4 cases). Extra-neurological signs were dermatological (14 cases), ocular (2 cases), and articular (2 cases) with aseptic unilateral gonarthritis. Fever was present in 9 patients. Neurological involvement was mostly isolated parenchymal (8 cases) or mixed (6 cases). The main clinical forms of NB were rhombencephalitis (8 cases) and retrobulbar optic neuritis (4 cases). Seven patients had a cerebral angio-Behçet with cerebral venous thrombosis (3 cases), ischemic stroke (2 cases), and intracerebral hematoma (2 cases). Under prednisone (16 cases) and azathioprine (3 cases), the short-term clinical outcome was mostly favorable (14 cases) with a modified Rankin scale at 2. NB is an under-diagnosed adult male disease in Sub-Saharan Africa and further studies are needed.

Les études africaines sur le neuro-Behçet (NB) sont majoritairement maghrébines, mais l'Afrique noire n'est pas en reste. L'objectif de l'étude était de décrire les particularités diagnostiques et thérapeutiques du NB dans une série sénégalaise colligée à Dakar. Il s'agit d'une étude rétrospective à visée descriptive menée à la clinique de neurologie du centre hospitalier universitaire de Fann de Dakar, au Sénégal. Tous les patients répondant aux critères diagnostiques de NB ont été inclus. Seize patients ont été colligés, 14 hommes et deux femmes avec un âge moyen de 40 ans [18­71]. Les principaux signes neurologiques étaient un déficit moteur (13 cas), des céphalées (10 cas) et un trouble du langage (4 cas). Les signes extraneurologiques étaient dermatologiques (14 cas), oculaires (2 cas) et articulaires (2 cas) à type de gonarthrite unilatérale aseptique. Une fièvre était présente chez neuf patients. L'atteinte neurologique était majoritairement parenchymateuse isolée (8 cas) ou mixte (6 cas). Les principales formes cliniques de NB étaient la rhombencéphalite (8 cas) et la névrite optique rétrobulbaire (4 cas). Sept patients avaient un angio-Behçet cérébral à type de thromboses veineuses cérébrales (3 cas), d'infarctus cérébraux (2 cas) et d'hématomes intracérébraux (2 cas). Sous prednisone (16 cas) et azathioprine (3 cas), l'évolution clinique à court terme était majoritairement favorable (14 cas) avec un score de Rankin modifié de 2 au moment de l'exeat. Le NB est une maladie de l'homme adulte sous-diagnostiquée en Afrique noire. Des études ultérieures multicentriques nationales et sous-régionales sont souhaitables.

The University Hospital Institute Mediterrannée Infection from Marseille to Dakar.

In Senegal, we have developed technology-driven research based on observation and technology transfer especially in molecular biology, genomics, culturomics, and proteomics with the use of the first Maldi-TOF mass spectrometer in clinical microbiology in Africa. This strategy is associated with a policy of training students from the South and helping them to return back. This technology transfer and expertise has enabled us to explore the causes of non-malarial fevers of unknown causes, with the study of the repertoire of infectious pathogens in humans and arthropod vectors, to diagnose infectious diseases in rural areas with Point of Care laboratories, to isolate new bacteria, and to study pathologies linked to mass gatherings. They have also allowed us to develop transdisciplinary research including the study of the microbiota in malnourished children. We wish to continue this technological development, which provides the foundation for high-level research in Senegal.

Macrophage activation syndrome, a rare complication of primary Sjögren's syndrome: a case report.

BACKGROUND: The association of macrophage activation syndrome and primary Sjögren's syndrome has been rarely reported in the literature. We report the first observation of this association in Africa, south of the Sahara, and we discuss the diagnosis and therapeutic challenge. CASE PRESENTATION: A 26-year-old Mauritanian and Berber woman was followed for primary Sjögren's syndrome. After a voluntary cessation of her usual background treatment, she was admitted to our department for an outbreak of her illness. A clinical examination revealed anemic syndrome, peripheral polyarthritis, coughing rales at both pulmonary bases, and fever at 39.5 °C. On biologic examination, there was bicytopenia with anemia at 5.70 g/dl, lymphopenia at 796/mm3, a biological inflammatory syndrome with a sedimentation rate at 137 mm in the first hour, C-reactive protein at 97 mg/l, hyperferritinemia at 1778 mg/l (9 normal value), and hypergammaglobulinemia at 20.7 g/l of polyclonal appearance. The triglycerides were 1.95 g/l (1.4 normal value) and the lactate dehydrogenase level was 491 IU/l (1.5 normal value). Cytological examination of a medullary puncture revealed an image of hemophagocytosis. An infectious screening was negative. Thoracic computed tomography showed non-specific interstitial lung disease. A diagnosis of macrophage activation syndrome complicating primary Sjögren's syndrome was selected with a probability of 97.2%, according to H-Score. The evolution was favorable under a treatment including etoposide (VP-16). CONCLUSION: Macrophage activation syndrome is a rare entity, rarely reported during primary Sjögren's syndrome. Its spontaneous evolution is invariably fatal. There is no consensus on therapeutic treatment. Etoposide is a therapeutic option especially in forms refractory to corticosteroid therapy.

Retentissement des pleurésies exsudatives sur les activités professionnelles

La pleurésie est une affection fréquente en Afrique, d'origine souvent infectieuse. Le but de notre travail était d'évaluer le retentissement de la pleurésie sur les activités professionnelles. Il s'agit d'une étude transversale, réalisée dans un service de médecine physique et réadaptation fonctionnelle, sur une durée de 9 mois. Etaient inclus les patients présentant une pleurésie avec ou sans atteinte parenchymateuse, menant une activité professionnelle. Les données pleuropulmonaires, l'état psychiatrique, et les capacités professionnelles ont été étudiés. 25 patients ont été inclus, d'âge moyen de 37,4ans et le sex-ratio de 2,1. Les travailleurs de force était plus représentés (60 %). Le syndrome d'épanchement pleural persistait dans 60% des cas. (60%). L'anxio-dépression était associée chez 92% des patients. Les autres signes associés à la pleurésie sont les réveils nocturnes (56%), la somnolence diurne (40%) et la fatigue (40%). Une répercussion sur les activités professionnelles (48% ) a été notée. Les facteurs déterminants de cette reprise d'activités sont la douleur(p=0,04), l'existence de céphalées matinales (p=0,03), les réveils nocturnes (p=0,09) et la rééducation (p=0,034). Conclusion : La limitation de ces conséquences professionnelles de la pleurésie, nécessite une prise en charge de la douleur sur tous ces aspects et de l'état psychologique

Childhood arterial ischemic stroke in Senegal (West Africa).

Etiological factors of childhood ischemic stroke depend on the epidemiological context. The purpose of this study was to determine the risk factors, the clinical and radiologic features, and the outcome of arterial ischemic stroke in a case series of Senegalese children. We carried out a retrospective registry-based study on arterial ischemic stroke in children hospitalized in the neurology department of Fann Teaching Hospital and Albert Royer Children's Hospital, from January 2005 to December 2015. We enrolled 116 cases with an age range from 2 months to 18 years. The mean age at stroke occurrence was 71.5 months. The most common manifestations were hemiparesis (84%), aphasia (19%), and partial motor seizures (10%). The middle cerebral artery was the most affected (81%). Risk factors were predominantly sickle cell disease (38%), embolic heart disease (9%), and anemia (3%). Twenty-eight percent of patients were lost to follow-up, 62% had neurological impairments, and 4% died. Secondary prevention was based on antithrombotic agents. Prevention must be prioritized and public health actions need to focus on sickle cell disease, rheumatismal disease, anemia, and related disorders. It will be necessary to set up policies that fight against consanguineous marriage, endemic infections, and argue for better nutrition.

Comorbidities and Neuromyelitis Optica - Spectrum Diseases : What are the current Data ?

Neuromyelitis optica (NMO-SD) or Devic disease is an acute transverse myelitis associated with an optic neuritis united -or bilateral. It is an inflammatory disease very disabling evolving by thrust. The long-term prognosis is also difficult to predict due to comorbidities which determine the evolution and the quality of life of patients. The objective of our study was to determine the different types of co-morbidities found in patients with NMO -SD.Methods: It was a descriptive study through a review of the literature on PubMed with the combination (Neuromyelitis optica, comorbidity). The data analysis was made on the software SPSS 23 Results: Total 27 articles were published and available on PubMed (June 2017). Among these 27 work we included ten (10) specific studies of co-morbidities in the NMO-SD. Three categories of illnesses have been reported in these 10 articles including coexisting diseases with the NMO-SD without any risk factor common or similar

[Ito hypomelanosis: Four case reports]. / Hypomélanose d'Ito : à propos de 4 cas.

Ito hypomelanosis is a rare neurocutaneous condition. We report on four observations in infants aged between 8 and 20 months. They all presented with epilepsy, psychomotor delay, and diffuse hypomelanosis. The electroencephalograms showed diffuse irritative abnormalities. Brain imaging was normal in two infants and showed hemispheric atrophy in another case. Despite antiepileptic treatment and physical therapy, no significant progression was noted and all children continued to have drug-resistant epilepsy and psychomotor delay.

[Myeloradiculitis due to Schistosoma haematobium: about an observation in Dakar (Senegal)]. / Myéloradiculite à Schistosoma haematobium : à propos d'une observation à Dakar (Sénégal).

Nervous localisations of schistosomiasis are rare. We report the case of a 25 year-old Senegalese patient admitted for a progressive myeloradiculitis onset, over a one week period. The diagnosis of Schistosoma haematobium myeloradiculitis was made in front of a positive serum serology for S. haematobium, presence of S. haematobium eggs in urine, hyperproteinorachia, endemicity of S. haematobium in the region where the patient was originating and a past medical history of macroscopic hematuria in a context of river bathing. There was also no arguments for another cause to these neurological manifestations. Our patient was treated with praziquantel, prednisone and physiotherapy. Evolution was marked 6 weeks after the beginning of treatment by a significant improvement of motor deficit, enabling the patient to walk again. There was also a regression of genitosphincter dysfunction. Work-up for patients presenting with paraplegia in tropical countries, should also include search for S. heamatobium infection.

[Epilepsy and reproductive health: Senegalese cohort]. / Épilepsie et santé de la reproduction : cohorte sénégalaise.

INTRODUCTION: Epilepsy is a public health problem in Senegal and Africa because of its severity and its social importance. It occurs at any age sparing no sex. It can influence sexual life and reciprocally. Our aims were to study the effects of antiepileptic drugs on the sexual lives of women with epilepsy, the influence of these drugs on pregnancy and breastfeeding. METHODS: We conducted a prospective study from 1st March to 31st August 2011 in the neurological department of the Fann-Dakar teaching hospital Senegal. Only women with epilepsy were included. RESULTS: We collected 120 patients aged 16-64years with a mean age of 30.58years, 45% married, 44.16% were uneducated preponderant. All patients were taking antiepileptic drugs, 89.16% was alone. Fifty-five percent of our patients had epilepsy for at least 6years; 45.83% had generalized epilepsy; 44.17% of partial seizures. In our cohort, 64.16% were under phenobarbital, 69.16% had good adherence. As side effects of drugs, 90% had sexual problems. Seventy-five percent enjoyed an active sex life. A decrease in the number of sex per week for the disease [31/55=56.66%] was noted. In addition, 51.17% were using contraception, including 38.7% of oral kind and 64.86% had noticed an increase in seizure frequency during their pregnancies. Of the 74 women who had contracted a pregnancy, 41.89% had premature infants, 16.21% have made abortions and 61.17% had psychosocial life affected. DISCUSSION AND CONCLUSION: People with epilepsy often experience sexual problems that may be caused by epilepsy, antiepileptic and/or reactions of the partner and the other facing the diagnosis of epilepsy.

Idiopathic sclerosing encapsulating peritonitis: a case in an adolescent girl.

Encapsulating peritonitis or "abdominal cocoon" is characterised by part or all of the digestive tube being encased in a thick membrane forming a sort of "cocoon". In addition to secondary forms related to peritoneal dialysis or those with drug related, inflammatory or tumour aetiologies, rare idiopathic forms have been described. We report here a case of an idiopathic form in a 15-year-old adolescent girl.

[Management of neurological emergencies in developing country: example of Senegal]. / Prise en charge de l'urgence neurologique dans un pays en développement : exemple du Sénégal.

Senegal, like many African countries is facing the so-called demographic and epidemiological transition leading to the development of neurological diseases. These diseases dominated by stroke and status epilepticus are public health priorities with a high prevalence, high lethality and high cost of care. These diseases are managed at the department of neurology, Fann Teaching Hospital, Dakar-Senegal (the only one) with a 65 beds capacity. Unfortunately, access care to the clinic is lately associated with human and material resource scarcity. To improve the management of patients at the clinic, it is important to increase resources (human and material), sensitize the population on early access to health services and prevention of risk factors.

[Cryptococcal meningitis in children: description of 3 cases]. / Cryptococcose neuroméningée de l'enfant : à propos de 3 cas.

Cryptococcal meningitis is much less common in children than adults. The purpose of this report is to describe 3 cases of cryptococcal meningitis observed in children admitted to the Neurology Department of the Fann University Hospital Center in Dakar, Senegal between July 2003 and November 2008. There were 2 girls whose ages were 8 and 15 years and one 9-year-old boy. All 3 patients presented acute or chronic meningoencephalitis. Diagnosis was based on direct microscopic examination of India ink preparations of cerebrospinal fluid (CSF) showing Cryptococcus neoformans at direct exam. Two patients were immunocompromised including one presenting severe protein-caloric malnutrition and one infected by HIV-1. The third patient was immunocompetent. All 3 patients were treated by intravenous Fluconazole. The immunocompetent boy died after 1 month of hospitalization due to cardiovascular and respiratory insufficiency. Both girls survived with severe neurosensory sequels. Cryptococcal meningitis that is relatively frequent in adulthood may be underestimated in children and should be tested for in any children presenting meningoencephalitis of undetermined cause.

[Meningoencephalitis due to Morganella morganii: a case report]. / Méningoencéphalite à Morganella morganii : à propos d'un cas.

A central nervous system infection due to Morganella morganii is uncommon. We report a case diagnosed at the neurological department of Fann teaching hospital in Dakar, Senegal. A 12-year-old boy was hospitalized for acute meningoencephalitis. The CT scan was normal and the study of cerebrospinal fluid (CSF) revealed cytological and biochemical abnormalities and M. morganii. HIV and syphilitic serologies were negative and blood CD4 lymphocyte count showed 354 per mm(3). The treatment with cefotaxime associated with gentamicin for 6 weeks was successful. The outcome of infection depends on many factors such as the onset and quality of treatment, the virulence of the germ and the status of immune system.