[Couple life and management of HIV infection in the pneumology department of the Teaching hospital center of Cocody, Abidjan, Côte d'Ivoire]. / Vie de couple et prise en charge de l'infection à VIH au service de pneumologie du CHU de Cocody, Abidjan, Côte d'Ivoire.

Introduction: The life of a couple is a place of emotional support. It can allow the management of patients infected with HIV on antiretroviral therapy to be optimized.The objective of our study was to analyze the impact of married life on the therapeutic follow-up of patients living with HIV. Methodology: We carried out a mono-centric, prospective, descriptive and analytical study in the care unit of patients living with HIV of the pneumology service of the Cocody Teaching Hospital in Abidjan. The investigation took place from September 1, 2015 to March 31, 2016. Results: We included 411 patients. The sex ratio was 0.51. The average age was 43.2 years with extremes of 19 and 69 years. The patients lived as a couple in 59.1% of cases. Couple life was associated with severe immunosuppression at 12 months in 23.3% (42/180) of cases [p = 0.043 OR = 1.735 (0.964 - 3.121)], the appearance of new opportunistic conditions between the 6th and the 12th month of treatment in 5.6% (13/232) of cases [p = 0.006; OR = 9.438 (1.222 - 72.890)], information sharing with the partner before the start of treatment in 92.4% (208/225) of cases [p = 0.035; OR = 1.976 (1.005-3886)] and the existence of sexual intercourse since the discovery of the disease in 92.6% (225/243) of cases [p < 0.001; OR = 14.423 (8.174 - 25.448)]. Sexual relationships were less protected among people living in a couple 65.9% (149/226) versus 78% (64/82) among others [p = 0.027; OR = 0.544 (0.301 - 0.923)]. The loss of the sexual partner at the onset of the disease was observed regardless of marital status (p = 0.203). Conclusion: The life of a couple negatively influences the management of HIV infection. It appears necessary to set up counseling and testing programs for couples.

[Extrapulmonary tuberculosis versus pulmonary tuberculosis: epidemiological, diagnosis and evolutive aspects]. / Tuberculose extrapulmonaire versus tuberculose pulmonaire : aspects épidémiologiques, diagnostiques et évolutifs.

INTRODUCTION: Tuberculosis remains a public health problem around the world. Several factors can influence its location. The objective of this research is to analyze the factors influencing the diagnostic and evolutive aspects of extra-pulmonary tuberculosis (PET) compared to pulmonary tuberculosis (PT) at the anti-tuberculosis center of Adjame (Ivory Coast). PATIENTS AND METHODS: This is a retrospective comparative study between PET and PT's patients based on the diagnostic and evolutive aspects of tuberculosis cases reported from January 1st, 2010 to December 31st, 2012 at the Adjame anti-tuberculosis center. RESULTS: During the study period, 9442 patients were enrolled. Patients at advanced ages, were more affected by PET while younger adults were more affected by PT (P=0.001). Women and Adjame's residents were respectively more affected by PT compared to men and non-Adjame's residents. The majority of patients suffering from PET were HIV-positive while those suffering from PT were predominantly HIV-negative (P=0.001). The proportion of new cases was higher among populations with PET than in subjects with PT (P=0.001). Both groups of patients (PT and PET) were positively responsive to treatments.

[Use of the Xpert® MTB/RIF test in routine screening of new cases of pulmonary tuberculosis in an endemic area]. / Test Xpert® MTB/RIF et dépistage des nouveaux cas de tuberculose pulmonaire en routine dans une zone de haute endémicité tuberculeuse.

BACKGROUND: Developed initially for the diagnosis of multidrug-resistant tuberculosis, the Xpert® MTB/RIF test has shown to be useful for the diagnosis of tuberculosis, especially among HIV-infected subjects. The objective of the study was to determine the contribution of the Xpert® MTB/RIF test for routine pulmonary tuberculosis diagnosis in an endemic area. METHODOLOGY: We undertook a prospective study among patients presenting with cough and sputum. The sputum was submitted to microscopic examination, to the Xpert® MTB/RIF test and cultured by the Mycobacteria growth indicator tube (MGIT) technique. The study compared cases of pulmonary tuberculosis confirmed by a positive sputum culture and cases with cough but negative sputum culture. RESULTS: In multivariate analysis, the factors associated with positive cultures were the following: male gender, cough for more than 2 weeks, loss of weight and fever. The estimated clinical suspicion score consisted of 4 signs each having a coefficient of 1. The sensitivity of each clinical sign varied between 79 and 94%. In 348 cases of negative microscopic examination (composed of 295 cases with score<4 and 53 cases with score=4), the predictive positive value of the Xpert® MTB/RIF was 80% for a score equal to 4 and 40.9% for a score<4. In cases of negative microscopic examination of the sputum, the Xpert® MRT/RIF test should be undertaken if the score=4. CONCLUSION: The diagnosis of tuberculosis in endemic zones could be improved by using the Xpert® MTB/RIF.

[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.

Rapid detection of Mycobacterium tuberculosis complex in sputum Samples using PURE TB-LAMP assay.

OBJECTIVE/BACKGROUND: Lack of rapid and accurate diagnostic testing is a critical obstacle to global tuberculosis (TB) control. Sensitivity of sputum smear microscopy (SSM) is not optimal; however, it remains the most prevalent tool for TB confirmation in poor countries. As a part of passive case finding of TB detection, this study was conducted to determine the clinical performance of PURE TB-LAMP assay using liquid culture medium as the gold standard. METHODS: Centre Antituberculeux de Yopougon is one of the 17 intermediate Tuberculosis centers in Côte d'Ivoire. A standardized questionnaire was submitted to patients with signs and symptoms consistent with tuberculosis by a trained caregiver. After obtaining signed consent forms, sputum samples were collected according to National TB Control Programme guidelines (spot-morning). SSM after Ziehl-Neelsen staining and TB-LAMP assay were blindly performed on the first sample. Samples transported to Institut Pasteur de Côte d'Ivoire were decontaminated according to the N-acetyl-L-Cystein method. In Mycobacteria Growth Indicator Tube (MGIT), 500mL of pellets were inoculated and incubated in the MGIT 960 system. MPT64 antigen was detected in positive cultures. RESULTS: Of the 500 patients enrolled, 469 (232men and 239 women) patients were included. The mean ages of men and women were 36.9 (15-86) and 37.3 (15-37.3) years, respectively. There were 56 (12.2%) HIV-infected patients, including 14 women. Clinical isolates of M. tuberculosis complex were detected for 157 (33.5%) patients. Compared with culturing, the overall sensitivity and specificity of SSM were 86% (95% confidence interval [CI]=81-91) and 96% (95% CI=94-98), respectively. The overall sensitivity and specificity for TB-LAMP was 92% (95% CI=0.88-0.96) and 94% (95% CI=0.91-0.97), respectively. Positive likelihood ratios for TB-LAMP and SSM were 15.3 and 21.5, respectively, and negative likelihood ratios for TB-LAMP and SSM were 0.09 and 0.15, respectively. Among the 469 patients, active tuberculosis was detected using TB-LAMP assay and SSM in 162 (34.5%) and 147 (31.3%) patients, respectively. CONCLUSION: For accurate diagnostic of pulmonary TB, TB-LAMP could be used as a tool of the first intention.

[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.

[Dynamic of indicators of ambulatory care of tuberculosis in the antituberculous center of Adjamé]. / Dynamique des indicateurs de la prise en charge ambulatoire de la tuberculose au centre antituberculeux d'Adjamé.

INTRODUCTION: Tuberculosis (TB) remains a real problem of public health in Côte d'Ivoire. The aim of our study is to describe the dynamic of anti-TB fight indicators in anti-TB center (CAT) of Adjamé. METHODOLOGY: We realized a retrospective study, comparing the anti-TB activities of two periods (1999-2001 versus 2010-2012) at the CAT of Adjamé. Over two periods, 24,520 cases of TB were recorded in the registers of TB declaration. RESULTS: Logistic regression results were the following ones. The proportion of the patients of Adjamé municipality increased to detriment of the patients coming from other municipalities. Our study showed an increase of TB contagious forms, a reduction of new cases of TB. The rate of screening of HIV infection increased. We noted a reduction of TB-HIV co-infection prevalence. The proportion of smear positive at the 2nd month decreased. We noted an increase of the rate therapeutic success and a reduction of lost at follow-up. CONCLUSION: Important progresses were realized in the TB fight and TB-HIV co-infection.

[Influence of care pathways on the time of initiation of TB treatment]. / Influence du parcours de soins sur le délai d'initiation du traitement antituberculeux.

INTRODUCTION: Untreated positive pulmonary TB smear has both individual implications, increasing morbidity and mortality, and collective implications, increasing the contagiousness of the disease. The present study aims to identify the course of patient care and the influence of care pathway on the time of initiation of TB treatment in Abidjan. METHODS: We conducted a prospective and comparative study between two groups with pulmonary smear-positive: 38 with a conventional course (use of only the health facilities) and 198 with mixed driving (combining health facilities, self-medication and traditional medicine). RESULTS: The average time between onset of symptoms and initiation of treatment for patients with conventional path was significantly different from that observed in patients with mixed course (4.28 weeks versus 8.57 weeks, P < 0.001). Multivariate analysis mixed route was related to level of education (OR=2.728 [1.165-6.386]; P=0.02), the district of residence (OR=2.690 [1.168-6.195]; P=0.02), the mode of onset of symptoms (OR=0.33 [0.101-0.6607]; P=0.013) and weight loss (OR=0.259 [0.139-0.798]; P=0.004). CONCLUSIONS: The course of patients are multiple and can induce delays in starting treatment for tuberculosis. The sensitization of the population and the involvement of traditional healers in TB screening may contribute to the early therapeutic management.

[Clinical, microbiological and evolutionary profile of patients experiencing failures and relapses of tuberculosis in Ivory Coast]. / Profil clinique, microbiologique et évolutif des patients en situation d'échecs et de rechutes de tuberculose en Côte d'Ivoire.

INTRODUCTION: Multidrug-resistant tuberculosis (MDR-TB) is a major obsession for TB control. The main risk factor for MDR-TB remains a history of TB treatment especially bad conduct. The objective of this study is to describe the profile of patients in situations of failure and relapse of tuberculosis. METHODS: We performed a retrospective survey of the analysis of records of patients starting TB retreatment for failure or relapse of tuberculosis. We used 193 cases with results of culture-sensitivity. RESULTS: The proportion of failure is 59/193 (30.6 %) and cases of relapse are 134/193 (69.4 %). The proportion of married life is 23.4 % (11/47) in chess against 41.5 % (51/123) in relapse of TB [P=0.021, OR=0.431 (0.201 to 0.927)]. Patients failing therapy have more chest pain [5.8 % (3/52) versus 0 % (0/126) with P=0.024]. The proportion of MDR-TB was 61.4 (38/59) in case of failure against 41 % (55/134) in case of relapse [P=0.002, OR=2.599 (1.378 to 4.902)]. The evolution is the same whatever the indication of reprocessing. CONCLUSION: The proportion of MDR-TB is very important in case of reprocessing failure and relapse of tuberculosis.

[Clinical manifestations in patients exposed to an environmental toxic accident (Abidjan, Ivory Coast 2006)]. / Manifestations cliniques chez les sujets exposés à un accident toxique environnemental (Abidjan, Côte d'Ivoire 2006).

INTRODUCTION: In 2006, 528 tons of petroleum toxic waste have been released in Abidjan (Ivory Coast) during a major environmental accident. This study was aimed to describe the clinical manifestations provoked by these toxic waste. METHODS: We have analysed the records of patients admitted to the university hospital of Cocody (Abidjan) following exposure to toxic waste. All the information were recorded on specific files or on notification files created by the physicians of the National Institute of Public Health, the authority charged with the supervision of this exercise. The files were completed by the physician in the course of the examination of the patient. RESULTS: Over a period of 3-month-period, 10,598 patients were examined. The clinical manifestations affected all age groups. They were dominated by respiratory symptoms: pulmonary (74.5%) and upper respiratory (31.0%). Pulmonary symptoms included cough (48.8%), chest pain (37.9%), dyspnoea (9.5%) and a few cases of hemoptysis. Digestive symptoms mainly comprised abdominal pain (36.2%), diarrhea (23.0%), abdominal distension (19.9%) and vomiting (9.9%). The other symptoms were neurological, ophthalmic, cardiovascular and gynaecological. More than 96% of patients presented with at least two symptoms. The respiratory symptoms were significantly more frequent in patients over the age of 17 while diarrhea and vomiting were more often found in patients less than 17 years old. Chest pain was significantly more common in men while abdominal pain and vomiting predominated in women (P=0.001). CONCLUSION: The clinical consequences of toxic waste exposure were varied and sometimes serious. A medium- and long-term evaluation of the subjects is required.

[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.

Exercise-induced bronchospasm related to different phenotypes of rhinitis without asthma in primary schoolchildren: the French Six Cities Study.

BACKGROUND: Exercise-induced bronchospasm (EIB) is frequent among asthmatic children. However, opinions differ on the relation between EIB and rhinitis in the absence of asthma. OBJECTIVES: We assessed the relationship between EIB and various phenotypes of rhinitis according to asthmatic status at the general population level in the Six Cities Study. METHODS: Of 7781 schoolchildren with a mean age of 10 years underwent an EIB test and skin prick test to assess allergic sensitization. Their parents completed a standardized questionnaire recording asthma-like symptoms and past-year rhinoconjunctivitis, ever hay fever (EHF), and a score for allergic rhinitis (SFAR) ≥7 as a marker of 'past-year allergic rhinitis'. Exercise-induced bronchospasm was defined as a fall in peak expiratory flow rate ≥15% after exercise. RESULTS: Of the 6813 schoolchildren retained for analysis, 227 (3.33%) experienced EIB after exercise. Odds ratios [95% confidence intervals] between EIB and allergic rhinitis phenotypes in the absence of asthma were 1.56 [0.92-2.63] for EHF, 1.97 [1.16-3.35] for past-year rhinoconjunctivitis, and 1.84 [1.16-2.91] for a SFAR ≥7. Results were unchanged after adjustment for confounders. Multiple correspondence analysis showed that EIB, although related to asthma, constitutes a separate entity. Exercise-induced bronchospasm was not significantly related to familial history of asthma. CONCLUSION: In our large population-based sample of children, different phenotypes of atopic rhinitis were associated with EIB, independently of asthma. Exercise-induced bronchospasm, although related to asthma, seems to constitute a separate entity. CLINICAL RELEVANCE: In this large (6813) sample of 10-year children drawn from the general population, EIB is associated with rhinitis phenotypes in the absence of asthma. Furthermore, it constitutes an entity independent from asthma and is not related to a familial history of asthma. Thus, investigating these symptoms could be important in this disease, as a specific nasal treatment might improve EIB in these children.

Tuberculosis of the temporomandibular joint.

INTRODUCTION: Extrapulmonary and extra-spinal tuberculosis (TB) is rare, even in countries where the disease is endemic. Ten percent of these localizations are cervico-facial. Involvement of the temporomandibular joint (TMJ) is very unusual. We present the features of such a case. REVIEW: We looked for patients managed for TMJ TB in 2 Maxillofacial Surgery departments and in 1 Pneumology & Phthisiology Department since 1992. The second part of the study was a literature review. One case was found in our departments and 15 other cases were found in published data. Most patients were women with mean age of 39.9 years (5 to 68). Pre-auricular swelling was the predominant functional sign, often without fever or change in the health status. The biological and radiological abnormalities were non-specific (osteolysis, joint pinching, etc.). No lung involvement was observed. The joint recovered its normal function after appropriate management. DISCUSSION: Tuberculosis of the TMJ is difficult to diagnose given its rarity and the non-specific nature of clinical and paraclinical signs. It must be considered in the differential diagnosis for common diseases of the TMJ whether TB is endemic or not.

[Evaluation of multidrug-resistant tuberculosis treatment in Ivory Coast from 2008 to 2010]. / Évaluation du traitement de la tuberculose multi-résistante en Côte d'Ivoire de 2008 à 2010.

This is a retrospective study conducted from January 2008 to December 2010 on sectional descriptive analysis of records of patients treated for MDR-TB and whose follow-up was in the thoracic department of Centre Hospitalier Universitaire (CHU) of Cocody in Abidjan Côte d'Ivoire. We selected eight patients who met the inclusion criteria of 21 MDR-TB patients registered during the study period. The average age was 29.25years ranging from 21 to 39. Males accounted for 75% of the patients (6 males and 2 females). The students represented the professional social layer most affected with 37.5% of the patients. All patients had a history of tuberculosis and only one patient was HIV positive under anti-retroviral (zidovudin, lamivudin and efavirenz). All cultures found Mycobacterium tuberculosis. The resistance profile in addition to isoniazid and rifampicin, found two cases of resistance to ethambutol and streptomycin. The chest radiograph at the time of initiation of second-line treatment showed essentially excavations in 75% of cases and infiltrates in 25%. The lesions were bilateral in 7 of 8 patients (87.5%). The main side effects observed during treatment were limited to cochleovestibular disorders (2 patients) and neuropsychiatric disorders (2 patients) and digestive disorders in half of the patients with removal of the offending molecule kanamycin. After 24months of treatment, it was numbered five cures (62.5%), two failures and one death.

[Correlation of the manifestations of tuberculosis and the degree of immunosuppression in patients with HIV]. / Corrélations des manifestations de la tuberculose pulmonaire avec le degré d'immunodépression au VIH.

CONTEXT: Correlation of the manifestations of tuberculosis and the degree of immunosuppression in patients with HIV. BACKGROUND: The advent of HIV has contributed to the increase in the number of people with tuberculosis. The clinical and paraclinical of TB/HIV co-infected are polymorphic and function of immune status. OBJECTIVES: To determines the clinical and paraclinical characteristics of TB related to different levels of CD4 lymphocytes. METHODOLOGY: A retrospective case series based on analysis of 450 patients with both TB/HIV co-infections. It focused on the records of patients with pulmonary smear-positive (TPM +) with a positive HIV status. The effect of immunosuppression was analyzed in groups based on the CD4 count (<200/mm(3), of 200-350/mm(3) and>350/mm(3)), in a chronological fashion from April to September 2010 until there were 150 patients in each CD4 group. RESULTS: Among the 450 patients, 71.1% were between 25 and 45years old. The clinical signs were more significant as the level of CD4 fell. The clinical signs were predominantly fever (93%) and weight loss (62.7%). Pulmonary cavitation (59.3%), infiltrates (38.7%) and the location of the lesions at the lung apex (72%) were more common in the third group patients. By contrast, extra pulmonary lesions (mediastinal lymphadenopathy, pleurisy) and normal x-ray (9.3%) were more frequent in patients of the first group. The scarcity of cavitations (22.3% compared to 59.3% CD4>350) and the increase in associated lesions became more marked if patients were immunocompromised. Hematologic, hepatic, renal disorders were more frequent and severe in the most immunocompromised patient group. CONCLUSION: HIV-associated tuberculosis has an atypical clinical, radiological, biological presentation and is more severe when there is significant immunosuppression.

[Etiologies of non tuberculous empyema in adult patients infected with HIV in a service of pneumology, Abidjan (Ivory Coast)]. / Étiologies des pleurésies purulentes non tuberculeuses chez les patients adultes infectés par le VIH dans un service de pneumologie à Abidjan (Côte d'Ivoire).

OBJECTIVES: To identify the main bacteria that cause thoracic empyema of HIV-infected patients. METHODS: Retrospective study analyzing the etiology of thoracic empyema in patients admitted to the pneumology clinic of the university hospital center in Abidjan from January 1998 to December 2010. We included all patients with bacteriologically confirmed thoracic empyema and had serological test for HIV. We compared the different pathogens based on HIV status. RESULTS: There were 42 patients of thoracic empyema composed of 24 (63.3%) HIV-infected patients [15 (62.5%) males and nine (37.5%) women] and 18 (36.7%) HIV-negative patients [13 (72.22%) men and five (27.78%) women]. The average age of HIV-infected patients was 41.2 years and 44.8 years for HIV-negative patients. HIV status was known only for 4.76% patients at admission, and most of them had a severe stage of immune suppression, (the average T CD4 cell count was 96/mm(3)). Pleurisy was monomicrobial in 83.33% HIV-infected patients and 94.4% HIV-negative patients. It was polymicrobial in 16.67% immunocompromised patients and 5.56% HIV-negative patient. Gram-negative bacteria were isolated from 58.33% HIV-infected patients. Streptococcus Pneumoniae was observed in 61.11% HIV-negative patients. CONCLUSIONS: Gram-negative bacteria are the main causes of thoracic empyema in patients HIV-infected.

[Domestic hypersensitivity pneumonitis]. / Pneumopathies d'hypersensibilité domestiques. Alvéolites allergiques extrinsèques domestiques.

INTRODUCTION: Domestic hypersensitivity pneumonitis (HP) cases are relatively widespread, with an overall annual incidence of approximately 1/100,000 reported in a British study covering several million patients. All-causes mortality is three times higher within HP-affected patients than amongst the general population. STATE OF THE ART: Cases of HP are usually diagnosed as 'farmer's lung' (FL) and 'bird fancier's lung' (BFL) diseases, however we suggest that other domestic causes, such as humidifier lung, hot tub pneumonitis, feather duvet and domestic exposure to moulds may be more frequent than widely suggested. Usually, the diagnosis is established on the basis of characteristic clinical, functional, radiological and broncho-alveolar lavage findings or recurrence of respiratory symptoms after returning home. PERSPECTIVES: In the absence of a common cause (FL or BFL), physicians must have a high index of clinical suspicion and should consider an environmental antigen source. Detailed questioning of HP patients on their living conditions and, where appropriate, a home inspection conducted by an environmental health expert are necessary for identifying causative antigens. CONCLUSION: The cornerstone of therapy is antigen avoidance.

[Tuberculosis in the elderly: Epidemiology and outcomes of ambulatory followed-up in Abidjan]. / La tuberculose du sujet âgé : épidémiologie et devenir des patients suivis en ambulatoire à Abidjan.

BACKGROUND: Very few works approach elderly's tuberculosis (TB) in developing countries. The aim of this study is to present elderly's TB epidemiology and the outcomes of the ambulatory follow-up of the tuberculous patients aged more than 65years old (TBE) compared to the TB among patients less than 65years old (TBY). METHODS: Our study is retrospective covering period of January 1999 to June 2006 activities of Adjamé's antituberculous center. It is a comparative study between patients of at least 65 years and patients of less than 65years when the diagnosis of TB was made. RESULTS: Among 36,923 cases of TB, the proportion of TBE is 2.33%. In case of TBE, the sex-ratio is 2.16 versus 1.50 among TBY (P<0.001). Localization of TB is pulmonary in 61.70% among TBE versus 67.26% among TBY (P=0.058). Among elderly's TB, the osteoarticular localization is more frequent. TB-VIH co-infection prevalence is estimated to 9.05% among elderly's TB versus 44.38% among patients of less than 65 years (P<0.001). The therapeutic success rate within elderly patients is 52.16% years versus 61.42% when it was patients of less than 65 years. The proportion of lost at follow-up and the rate of patient transfers within the elderly's TB are the most raised. CONCLUSION: The elderly's TB is rare with a more masculine predominance. TB-VIH co-infection is not important among elderly's TB. The aged patient follow-up must be improved.

[Dynamic of respiratory pathology in a service of pneumology in black Africa in the context of HIV infection from 1998 to 2007]. / Dynamique de la pathologie respiratoire dans un service de pneumologie en Afrique noire dans le contexte de l'infection à VIH de 1998 à 2007.

INTRODUCTION: The pneumology in developing countries is practiced in a singular context: population mostly younger, endemic tuberculosis, high prevalence of HIV infection and growing pollution. OBJECTIVE: The aim of this study is to present respiratory pathology evolution in hospitalization of pneumology department in black Africa. METHODOLOGY: Our study is retrospective and descriptive. We consulted the register of hospitalization activities from January 1998 to December 2007. RESULTS: The age group of 20-49 years represents 78.36% of all patients. Tuberculosis (TB) remains the first affection from 1998 to 2007 with a frequency varying between 38.2% and 45.2%. The cases of pneumonia are in regression since 2001, but cases of febrile alveolar interstitial pneumonia (FAIP) increase. The pathologies bound to tobacco addiction are rare. HIV infection is associated to TB (82.86%), to pneumonia (77.22%), to FAIP (92.23%). On 832 cases of death recorded, 46.15% of deaths are assigned to TB, 15.98% to pneumonia and 14.66% to FAIP. The global lethality of the TB and the pneumonia is respectively 20.1% and 17.6%. The one of FAIP is 32.5%. Mortality attributable to TB and pneumonia decreases progressively but the one attributable to FAIP remains important. CONCLUSION: Respiratory pathology is dominated by TB, pneumonia and FAIP. These pathologies associated to HIV infection cause a strong mortality.