[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

[Cryptococcal meningitis in HIV-infected patients at Bobo-Dioulasso hospital (Burkina Faso)]. / La cryptococcose neuroméningée au cours de l'infection par le VIH au Centre hospitalier de Bobo-Dioulasso (Burkina Faso).

Cryptococcus neoformans is an important fungal pathogen in immunocompromised patients. A retrospective study was conducted to investigate the occurrence of Cryptococcus neoformans infection in patients admitted to Bobo-Dioulasso Hospital over a 3 year-period. During this period, cryptococcal meningo-encephalitis was diagnosed in 36 individuals. The median age of the patients under study was 34.25 years. There was a male preponderance (24 males/12 females) in our report. Typical presentations were persistent headaches (27 cases/36), neck stiffness (16/36), altered consciousness (14/36), fever (12/36) and convulsions (9/36). Oral candidiasis coexisted with cryptococcal meningitis in 7 patients. HIV serology was positive in all patients. At diagnosis, lymphocytes counts were < 1500/mm3 in 66.66% patients. CSF examination with India ink helped to the diagnosis of cryptococcosis in all cases. Cryptococcus neoformans was associated with Streptococcus pneumoniae in 4 patients. 15/36 patients died within 1 to 29 days after admission. High mortality was related to delayed diagnosis. Cryptococcal meningitis highly contributes to mortality in HIV-infected patients in Burkina Faso and it may occur in patients not severely immunocompromised patients. A need exists to improve strategies for clinical management of AIDS patients in poor African countries.

Drug Resistance to AIDS; Tuberculosis and Malaria in the African Region

With just 10of the world population; sub-Saharan Africa has the highest burden of HIV/AIDS; tuberculosis and malaria in the world. Both access to and adequate utilization of eff ective treatment with quality-assured medicines are crucial for reducing the disease burden. However; eff orts to improve access to treatment are hampered by the development of HIV; TB and malaria drug resistance. This is a result of genetic mutations and is a major threat to control of HIV/AIDS; TB and malaria. HIV drug resistance can be minimized by good antiretroviral treatment (ART) programmes; removal of barriers to continuous access to ART and reduction of HIVtransmission. Recent surveys conducted at antenatal clinics in several countries in the African Region estimated that HIV resistance to all drug classes is less than 5. A global HIV drug resistance network established in 2001 supports countries in capacity building and guidance on standard procedures for monitoring HIV drug resistance. Multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) are principally a result of inadequate or poorly administered treatment regimens. The new WHO Stop TB Strategy launched in 2006 identifies management of MDR-TB as a core component of TB control. The magnitude of MDR-TB in the African Region is still unknown. In 2007; 27 countries notifi ed MDR-TB cases; and six reported at least one case of XDR-TB. Following widespread resistance to chloroquine and sulphadoxine-pyrimethamine all malaria-endemic countries except two in the Region have changed the treatment policy to artemisinin-based combination therapy (ACT). The main method of monitoring antimalarial drug resistance is through therapeutic efficacy testing. Todate there has been no confi rmed resistance to ACTs in the African Region. Given the emergence and spread of resistance to HIV; TB and malaria drugs; the purpose of this paper is to describe the issues and challenges and propose a way forward with regard to the prevention and control of such resistance

[Peritoneal tuberculosis and HIV infection. Reflection apropos of 22 cases at the National Hospital of Bobo Dioulasso]. / Tuberculose péritonéale et infection par le VIH. Réflexion à propos de 22 cas à l'Hôpital national de Bobo Dioulasso.

Peritonitis tuberculosis is still a frequently encountered pathology in our hospital. Since the AIDS pandemic, cases of peritonitis tuberculosis present increasingly atypical characteristics, largely diverging from classical descriptions. The authors report on 22 cases of peritonitis tuberculosis associated with HIV infection. The study was carried out from June 1997 to December 1999 in the National Hospital Centre Souro SANOU of the Bobo Dioulasso internal office. It concerned 10 women and 12 men of a mean age of 37.9 years. The sex-ratio was 1.2 in favour of men. Diagnosis was established by laparoscopy. Peritonitis tuberculosis associated with HIV accounted for 78.5% of peritonitis tuberculosis cases. The clinical picture was dominated by isolated ascite (100%) associated with an oscillating high fever in 68.2% of cases. Negative results for IDR seemed to reflect poor prognosis. Response to treatment was slow but acceptable. The general prognosis was poor with a mortality rate of 18%.

[Noma and HIV infection: apropos of a case at the National Hospital Center in Bobo-Dioulasso (Burkina Faso)]. / Noma et infection à VIH: à propos d'une observation au Centre Hospitalier National de Bobo-Dioulasso (Burkina Faso).

Noma (Cancrum oris) is a gangrenous stomatitis arising from a periodontal infection and leading to severe soft tissue and bone destruction. The pathology involves numerous factors including local thrombosis, vascularitis, necrotizing gingivitis, immunodeficiency, gram negative and anaerobic infection. It is usually a disease of infants and malnourished children in tropical areas often occurring after a debilitating disease like measles. Recently, cases have been reported in adults especially elderly patients or during immunodeficiency states. Reconstructive surgery is often necessary to deal with destruction and sequel but is rarely accessible in developing countries. We report one case of noma (cancrum oris) in an HIV seropositive patient at the National Hospital in Bobo-Dioulasso. The noma was inaugural of AIDS in a 40 years old labourer coming back from Ivory Coast and no major opportunistic infection was associated. The course was fulminant leading to extensive facial gangrene with recurrent bacterial infections. The disease was fatal in this depressive, malnourished and diarrhoeic patient despite local surgical treatment, prolonged antibiotherapy and supportive care. Pathogenic mechanisms, management and preventive issues are discussed.

[Apropos of a case of rabies occurring despite vaccination after exposure]. / A propos d'un cas de rage survenu malgré une vaccination après exposition.

Rabies is endemic in Sub-Saharan Africa. Control is based on vaccination of subjects at high-risk for exposure and prompt post-exposure treatment. However the severity of some animal bites and early mismanagement can lead to development of rabies despite post-exposure treatment. This danger is illustrated by the case described herein involving a 35-year-old man who was bitten by a rabid dog and treated with 5 doses of antirabies vaccine. The wound, which consisted of two deep punctures on the forearm, was promptly washed with water and disinfected. Despite this treatment, characteristic clinical manifestations of rabies appeared one month after exposure and the patient died 48 hours later. This case raises the question of the causes for failure of the preventive recommendations proposed by the WHO for category III animal bites. In our case, two possible causes of failure and subsequent lethal outcome are that serotherapy was not associated and the incubation period was short. Other possible causes of rabies after post-exposure therapy are discussed with reference to the literature.

[Compared characteristics of peripheral facial paralysis according to HIV status in Bobo-Dioulasso (Burkina Faso)]. / Caractéristiques comparées des paralysies faciales périphériques selon le statut VIH à Bobo-Dioulasso (Burkina Faso).

Facial paralysis is a well-described manifestation of HIV infection. We report 27 cases of peripheral facial paralysis observed at Bobo-Dioulasso Hospital in a prospective study over a period of 9 months: 55 of the cases were HIV positive and 12/15 (80%) were in the 20-39 age group. Nine out of 11 females and 6 out of 16 males were seropositive. 13 of the cases were at stage B of CDC classification and 2 at stage C. ESR was elevated in all the HIV patients. CSF examination revealed lymphocytic pleiocytosis, elevated proteins and a positive HIV serology. CD4 counts were obtained in 8 cases and were under 400/mm3 in 4 cases. The clinical presentation was more severe in HIV seropositives with a longer duration of symptoms. Isolated peripheral facial paralysis associated with an elevated ESR in young adults suggest HIV infection and should lead to HIV counselling and testing.

[Toxoplasma serology in HIV infected patients and suspected cerebral toxoplasmosis at the Central Hospital of Bobo-Dioulasso (Burkina Faso)]. / Sérologie toxoplasmique chez les patients infectés par le VIH et suspects de toxoplasmose cérébrale au Centre hospitalier de Bobo-Dioulasso (Burkina Faso).

A study was conducted in the Internal Medicine unit of Bobo-Dioulasso Hospital. Of the 1828 HIV positive patients admitted in medical wards, 268 presented neurological symptoms. 25.4% had positive Toxoplasma gondii serology. Encephalitis was associated with 12.5% of this latter group and intracranial hypertension with focal neurological defects affected a further 47.5% of them. Presumptive treatment of toxoplasmosis led to significant clinical improvement in 60% of cases. Toxoplasma gondii serology should be part of the standard check-up for every HIV-infected patient, and toxoplasmosis chemoprophylaxis should be given to those with positive toxoplasma serology. Presumptive therapy of toxoplasmosis should be started for all HIV positive patients with focal neurological manifestations in the absence of a cerebral scanner.

[Neurologic manifestations associated with HIV infections at the Bobo-Dioulasso Hospital Center (Burkina Faso)]. / Manifestations neurologiques associées à l'infection par le VIH au Centre hospitalier de Bobo-Dioulasso (Burkina Faso).

Neurological manifestations of HIV infection are frequent and diverse. Diagnosis is often difficult due to geographical factors. 686 of the 3409 patients admitted to the Internal Medicine ward of Bobo-Dioulasso in 1995-1996 were HIV seropositive. This represents a prevalence of 20.1%. The sociodemographic and clinical characteristics of 101 patients with neurological problems during the study period are reported in this paper. This case series represents 14% of the HIV-positive admissions. The mean age was 35.7 years and 43% of the cases were aged 30 to 40 years. Sex-ratio was 1.6 male for 1 female. Focal deficits were observed in 36 of cases. Peripheral neuropathy (37%), meningitis or meningoencephalitis (20%), fitting (8%) and myelitis (8%) were the other clinical presentations. The etiology of the focal deficits was not ascertained because of the lack of tomodensitometry, specific serology and necropsy. Any neurological manifestation in a HIV seropositive patient should prompt investigations in order to diagnose those infections which can be treated, especially Toxoplasma gondii abscess and Cryptococcus neoformans meningitis.

[AIDS-related cryptococcal meningitis at the Bobo-Dioulasso Hospital Center: five case reports]. / La cryptococcose neuro-méningée au cours du SIDA au Centre Hospitalier de Bobo- Dioulasso: à propos de cinq cas.

The authors report five cases of Cryptococcus neoformans meningitis in HIV-positive patients hospitalized in the Souro Sanou National Hospital Center of Bobo-Dioulasso (Burkina Faso). There were 3 men and 2 women with a mean age of 36 years (range: 29 to 47 years). Presenting symptoms were persistent headache and/or mental confusion and neurosensory defects. Cerebrospinal fluid was clear with less than 20 lymphocytes/mm3. Albumin concentration greater than 0.50 g/l was observed in only one case. India ink smear and culture demonstrated strains of Cryptococcus neoformans sensitive to amphotericin B in all five cases, flucytosin in 3 cases, and ketoconazole in two cases. Four patients died within 15 to 32 days after admission (mean 22.5 days). Delayed diagnosis and inconsistent availability of systemic antifungal drugs are major limiting factors in the management of Cryptococcus neoformans meningitis in Burkina Faso.

La meningite a Staphylocoques (staphylococcus aureus) au service des maladies infectieuses du CHU de Dakar

La meningite purulente est une urgente infectieuse d'evolution imprevisible. Le staphylocoque (staphylococcus aureus) est responsable des cas sporadiques. Au service des maladies infectieuses du CHU de Dakar ; 42 cas ont ete colliges en 9 ans soit 2;71 pour cent des meningites. Les grands enfants et les adultes sont majoritaires. La porte d'entree est cutanee dans 2/3 des cas. Le Chloramphenicol est souvent efficace et l'association trimethoprime-sulfamethoxazole souvent active in vitro. Un retard a l'hospitalisation; un coma initial ou d'installation rapide et un terrain debilite sont des facteurs de mauvais pronostic. La mortalite est de 54;76 pour cent sur cette serie. Le traitement precoce des foyers cutanes. O.R.L. et ophtalmologiques doit etre systematique

Etude des hemocultures positives au CHU de Fann Dakar : bilan de trois annees de laboratoire de bacteriologie

Une etude des hemocultures positives concernant les annees 1985-1987 s'est deroulee a la clinique des maladies infectieuses du C.H.U. de Fann. 988 hemocultures positives ont ete recensees sur les registres du laboratoire de bacteriologie sur la periode concernee par l'etude. Les hemocultures positives provenaient pour 95;5 pour cent de patients adresses par les services des maladies infectieuses. Les isolements representent 19;81 pour cent des hemocultures realisees sur la periode d'etude. La progression annuelle montre un doublement des isolements entre 1985 et 1986; et un quintuplement entre 1985 et 1987. Le cumul mensuel des cas montre que les mois de juin et juillet comptent le plus grand nombre de souches isolees. Les tranches d'age 5-14 ans; 15-24 ans et 24-49 ans sont les plus representees. Le sex-ratio est globalement de 1;07. Les sptaphylococcemies; les infections a Pseudomonas touchent egalement plus les hommes. L'hemoculture; examen de choix en pathologie infectieuse devrait voir s'elargir ses indications avec l'avenement d'etats immunodepressifs acquis. Des moyens techniques supplementaires permettraient une exploitation plus exhaustive des prelevements. Une surveillance biologique des germes dominants s'impose pour maintenir la qualite de l'antibiotherapie de premiere intention. L'education sanitaire basee sur l'hygiene individuelle et collective; le traitement precoce des portes d'entrees potentielles s'imposent pour diminuer l'incidence des septicemies acquises en communaute