[Prevalence of intestinal parasites at Saint-Camille medical center in Ouagadougou (Burkina Faso), 1991 to 2010]. / Prévalence des parasites intestinaux de 1991 à 2010 au centre médical Saint-Camille de Ouagadougou (Burkina Faso).

BACKGROUND: Intestinal parasitoses continue to be a major public health problem in developing countries. OBJECTIVES: This study sought to evaluate the prevalence of intestinal parasites and their coinfection rates in patients attending the Saint-Camille medical center in Ouagadougou. Methodology. This retrospective study covers the period from 1991 through 2010. RESULTS: In all, 292,148 stool samples were analyzed, and 177,672 contained at least one parasite, for a prevalence rate of 60.82%. Protozoans accounted for 90.53% of the parasites identified (160,838) and helminthes 9.47% (16,834). The most common protozoans were Entamœba histolytica/dispar (39.88%), Trichomonas intestinalis (25.78%) and Giardia intestinalis (24.83%). The helminthes encountered most frequently were Hymenolepis nana (3.99%) and Ancylostoma spp (3.65%). Globally, the prevalence of parasites decreased over the 20-year study period. The prevalence of E. histolytica/dispar decreased while that of Giardia intestinalis became more frequent. The most common parasitic associations were E. histolytica/dispar-G. intestinalis (26.24%) and G. intestinalis-T. intestinalis (20.09%). CONCLUSION: Our results indicate that Burkina Faso is a zone at high prevalence of intestinal parasitosis, even though this prevalence appears to be decreasing. Appropriate strategies should be developed to accelerate the reduction in the incidence of these parasites.

[Antiretroviral prophylaxis after non-occupational exposure to HIV in Abidjan (Cote d'Ivoire)]. / Prophylaxie antirétrovirale après expositions non professionnelles au VIH à Abidjan (Cote d'Ivoire).

OBJECTIVE: The aim of this study was to assess the tolerability and adherence to all non-occupational post-exposure prophylaxis (PEP) for cases of HIV exposure in Abidjan. METHOD: We retrospectively studied all post-exposure prophylaxis for non-occupational exposures to HIV prescribed from January 1st, 2000 to December 31st, 2007 in the Abidjan infectious diseases department. We analyzed the types of exposure, socio-demographic characteristics of patients, antiretroviral therapy regimens, adherence and tolerability, duration of the treatment, and post-exposure follow-up. RESULTS: Over these eight years, we managed 128 consultations for non-professional exposures to HIV (50 male [39%], 78 female patients [61%]), average age 24.8 years (four-54 years). The most frequent exposures were due to rape (n=74), condom rupture (n=29), and occasional unprotected sex (n=21). The average delay before consultation was 20.8 hours. The antiretroviral chemoprophylaxis included a protease inhibitor in 93% of the cases; 80.5% of patients completed 28 days of chemoprophylaxis, while 8.6% interrupted the treatment, and 10.9% were lost to follow-up. The most frequent adverse effects were gastrointestinal, reported by 79 patients (61.7%). Only 34 patients (26.6%) returned for clinical and biological post-exposure follow-up with HIV control at third month, without documented seroconversion. CONCLUSION: Cases of sexual exposure to HIV are the main indication for post-exposure prophylaxis in Abidjan, except for occupational exposure to blood. However, post-exposure prophylaxis should be available in the units of primary care, such as emergencies departments.

[Efficiency and safety of antiretroviral treatment among the elderly in Abidjan]. / Efficacite et tolerance du traitement antiretroviral chez les sujets ages a Abidjan.

OBJECTIVE: To evaluate the efficacy of antiretroviral treatment in elderly people followed at the Unit for Infectious and Tropical Diseases at the University Hospital in Abidjan. MATERIAL AND METHODS: We performed a retrospective descriptive study of the files of people aged at least 60 years, infected by HIV who were treated and followed-up in the Unit between 1 January 1999 and 31 December 2006. We analysed sociodemographic (age, sex), clinical (weight, Karnofsky scale, CDC, opportunistic infections), biological (HIV, CD4, haemogram, glycaemia, creatininaemia, transaminasaemia) and therapeutic (antiretroviral regimens, evolution, side-effects) parameters. The efficacy of treatment was evaluated as the percentage of patients with < 200 CD4/ml, and its safety was based on deleterious effects. RESULTS: We studied 62 patients (44 men, 18 women), of whom 13 had been treated (21%), 46 had not been treated (74.2%) and 48 (77.4%) were undergoing chemoprophy-laxis with cotrimoxazole. Most were infected with HIV1 (93.6%), 3.2% with HIV2 and 3.2% with both HIV1 and HIV2. The majority (93.3%) was symptomatic, and 67.8% had AIDS. During 34 months of follow-up, 48 patients (77.4%) received first-line treatment, 13 (21%) received second-line and only one patient (1.6%) had third-line treatment. The percentage of patients with more than 200 CD4/ml increased from 20% at baseline to 36% at 6 months and 39% at 12 months. The main clinical side-effect was peripheral neuropathy (30.5%), and the main biological effect was hypertransaminasaemia > 2N (32.3%). The median rate of loss to follow-up was 17.7%, and two patients (3.2%) died. CONCLUSION: Antiretroviral treatment is effective in the elderly, with few biological disorders. A prospective study of a larger sample would elucidate the differences from younger people in the efficacy of such treatment.

Efficacite et tolerance du traitement antiretroviral chez les sujets ages a Abidjan

Objectif : Evaluer l'efficacite du traitement antiretroviral chez les sujets ages suivis dans le service des Maladies Infectieuses et Tropicales a Abidjan. Materiel et Methodes : Il s'agit d'une etude retrospective; descriptive et portant sur l'analyse des dossiers de sujets ages d'au moins 60 ans; infectes par le VIH; traites et suivis dans le service des Maladies Infectieuses et Tropicales entre le 1er janvier 1999 et le 31 decembre 2006. L'analyse a porte sur les parametres sociodemographiques (age; sexe); cliniques ARV; (poids; score Karnofsky; stade CDC; affections opportunistes); biologiques (type de VIH; CD4; hemogramme; glycemie; creatininemie; transaminasemie) et therapeutiques (regimesA RV; evolution; effets secondaires). L'efficacite du traitement etait basee sur le pourcentage de patients ayant un taux de CD4 200 / ml et la tolerance basee sur les effets deleteres. Resultats : L'etude a concerne 62 sujets ages (44 hommes / 18 femmes); dont 13 pretraites (21); 46 naifs (74;20) et 48 (77;42) sous chimioprophylaxie au cotrimoxazole. La majorite de l'effectif etait infectee par le VIH1 (93;60) contre 3;20pour le VIH2 et 3;20pour le VIH 1+2. Ils etaient symptomatiques a 93;3avec 67;8au stade SIDA. En trente quatre mois de suivi; 48 patients ont recu un regime de premiere ligne (77;4) ; 13 de deuxieme ligne (20;96) et un seul patient avait un regime de troisieme ligne (1;6). L'analyse des resultats a montre que le pourcentage des patients ayant un taux des CD4 200 etait croissant; passant de 20a M0 a 36a M6 puis 39a M12. Quant aux effets secondaires; ils etaient cliniquement domines par les neuropathies peripheriques (30;5) et biologiquement par l'hypertransaminasemie 2N (32;3). Le taux median de perdus de vue etait de 17;7; et 2 patients (3;22) sont decedes. Conclusion : Le traitement ARV est efficace chez les personnes agees avec peu d'anomalies biologiques; aussi; une etude prospective sur un plus grand echantillonnage permettrait-elle de mieux percevoir les differences avec le sujet jeune

[Impact of access to antiretroviral therapy in Côte d'Ivoire]. / Bilan de l'accès aux antirétroviraux en Côte d'Ivoire.

In 1998 UNAIDS implemented the national drug access initiative (DAI) in Côte d'Ivoire. The Ivorian government took the DAI over in 2000 with the support of the Global Fund and Presidential Emergency Program For AIDS Relief (PEPFAR). The ensuing affordability of antiretroviral therapy (ART), medical staff training, and healthcare equipment allowed Ministry of Health to improve HIV care throughout the country. Since 2008 ART and follow-up monitoring have been free of charge for people living with HIV/AIDS (PLWHA). In January 2009 a total of 57,833 PLWHA received ART and follow-up at 274 HIV care centers. Use of ART has improved the life expectancy of PLWHA. However morbidity and mortality remained high during the first year of ART implementation with respective frequencies of 5-10% person-year (PY) and 2-3% PY. Morbidity was mainly related to infectious disease (tuberculosis and bacteriaemia) and earlier onset of adverse events (AE). In most cases ART has been well tolerated. The main adverse effects have been anemia, neuropathy, skin toxicity and liver enzyme elevation. The incidence of stage 3/4 AE has been low (< 2 %PY). Although overall compliance has been good (<80%), data among children and adults suggest the need for further work to reinforce support mechanisms. Convincing results have been obtained in the management of PLWHA. Nevertheless greater funding and commitment must be given to management of opportunistic infections and side effects and to development of nutrition support services.

Bilan de l'acces aux antiretroviraux en Cote d'Ivoire

L'initiative nationale d'acces aux antiretroviraux en Cote d`Ivoire a debute en 1998 sous l'egide de l'ONUSIDA. Le relais a ete assure par le gouvernement ivoirien en 2000 avec le soutien du FondsMondial et du PEPFAR (President Emergency Program ForAids Reliefs). L'accessibilite financiere; la formation du personnel de soins et l'equipement des structures sanitaires ont permis la decentralisation de la prise en charge sur tout le territoire national. Depuis aout 2008; le traitement antiretroviral est gratuit de meme que le suivi biologique. Fin janvier 2009; l'on denombrait 57 833 patients sous antiretroviraux; suivis dans 274 centres de prise en charge. L'utilisation des multitherapies antiretrovirales a considerablement modifie le pronostic avec une amelioration de l'esperance de vie des patients infectes par le VIH. Cependant la morbidite et la mortalite restent encore preoccupantes au cours de la premiere annee suivant la mise en route du traitement avec des incidences respectives variant entre 5 et 10patients-annee (PA) et 2 et 3PA. La morbidite est principalement en rapport avec les infections (tuberculose; bacteriemies) et les effets secondaires precoces. Les traitements antiretroviraux sont globalement bien toleres; les principaux effets secondaires etant l'anemie; les neuropathies; les reactions cutanees et les hypertransaminasemies. Les effets secondaires de grade 3 et 4 ont une incidence faible (2PA). L'observance est bonne; estimee a 80; mais des donnees obtenues chez les enfants et sur certains sites de prise en charge incitent a renforcer les dispositifs d'appui a l'observance. Des resultats probants ont ete obtenus dans la prise en charge antiretrovirale des personnes vivant avec l eVIH .Aussi les efforts sont-ils a poursuivre pour le financement et la prise en charge des infections opportunistes et des effets secondaires et pour l'appui nutritionnel

[Hyperactive malarious splenomegaly: diagnosis and therapeutic problems in adults]. / Splénomégalie palustre hyperactive: problèmes diagnostiques et thérapeutiques chez l'adulte.

The chronic forms of malaria are scarce. We report a case of an hyperactive malarious splenomegaly. This case concerns a 69 year-old man residing in a village of Côte d'Ivoire. He had massive splenomegaly type IV. He was admitted in hospital for progressive loss of weight and moderate fever He presented also asthenia, anaemia and regular hepatomegaly. The haematological, biochemical, immunological and radiological exams ruled out trypanosomiasis, visceral leishmaniasis, tuberculosis, bilharziasis diseases and neoplasia process. His age, the massive splenomegaly, the anaemia, the high antimalarial IgM antibodies in immunofluorescence and the favourable response to the prolonged administration of antimalarial treatment led to the diagnosis of hyperactive malarious splenomegaly despite the detection of Plasmodium falciparum in blood. This observation allows to underline the frequency of this possible underestimated chronic form of malaria in Africa and shows the necessity to consider it seriously when facing massive splenomegaly.

[Generalized tetanus complicating a traditional medicine applied for snakebite]. / Tétanos généralisé compliquant un traitement traditionnel instauré après une morsure de serpent.

In many of Africa's rural areas, snakebite victims often resort to traditional healers for first line treatment. This may be source of infectious complications. We report a case of generalized tetanus which occured after 15 days in a 13-years old boy who had applied a traditional, plant-based concoction on a snake bite. He presented with trismus, generalized contractures and fever extended musculo-aponevrotic necrosis of the right upper limb, without loss of consciousness. The only accompanying biological sign was an increased leukocyte count (11,200/mm3) with a predominance of neutrophils (84%). Platelets count, creatinin and AST/ALT titers and haemostasis were all normal, as was the radiogram of the right hand. The clinical outcome was favourable after 3 weeks hopital care (antibiotic, muscle relaxants, antitetanus serotherapy and local wounds care). This clinical observation shows that traditional care for snake bite wounds can be an entry point for tetanus. Appropriate treatment of snake bites in a hospital setting is of the utmost importance, in addition to vaccination against tetanus, in order to reduce the incidence of tetanus in African countries.

[Management of accidental exposure to blood in the Treichville teaching hospital, Abidjan (Côte-d'Ivoire)]. / Prise en charge des accidents d'exposition au sang au CHU de Treichville, Abidjan (Côte-d'Ivoire).

OBJECTIVE: The aim of this study was to assess care and preventive measures for accidental exposure to blood (AEB) in Abidjan. METHODS: A retrospective study of all AEB reported in the Infectious and Tropical Diseases Center of the Treichville University Hospital was made between January 2000 and December 2005. Epidemiology, management, clinical and biological post-exposure follow-up were analyzed. RESULTS: One hundred eighty-two AEB were managed over 6 years (151 needlesticks, 14 ocular projections of blood, 12 cuts, and 5 mucocutaneous exposure to blood). 94 men (51.6%) and 68 women (48.4%) were included [sex ratio 1.4] mean age 33.8 years+/-7.4 years. Physicians (29.1%), nurses (19.8%), assistant nurse (12.1%), and medical students (11.4%) were the professional categories which declared most accidents. Among them, only 51.1% was correctly vaccinated against hepatitis B. The average delay of consultation was 26.5 hours (1-240 hours), and 82.9% of victims consulted before the 48th hour. Antiretroviral prophylaxis was prescribed to 151 patients among whom 45% with bitherapy (Zidovudine and Lamivudine), and 55% with HAART including an antiprotease. Only 60 patients had one actual month of treatment. Despite the weak follow-up, no case of HIV seroconversion was reported 6 month after exposure. CONCLUSION: This work underlines once again the high frequency of AEB in Abidjan despite a under reporting, and calls for the implementation of a policy to train health care workers on AEB preventive measures.

Cure de hernie inguinale sans tension : technique de Lichtenstein modifiee par Chastan

L'etude a porte sur 40 patients presentant une hernie inguinale. L'objectif etait d'evaluer les resultats de la technique de LICHTENSTEIN modifiee Chastan ( sans tension ). Il s'agit d'une etude prospective de 15 mois realisee dans le service de chirurgie A de l'Hopital National du Point G; allant de Mai 2002 a Aout 2003. Les resultats de l'etude ont montre une predominance masculine de 85; avec un sexe ratio de 5;67 en faveur des hommes. Les motifs de consultation ont ete la tumefaction et la douleur inguinale (75). La hernie siegeait a gauche en majorite 47;5. Le type oblique externe etait plus represente 57;5. Les etiologies ont ete l'age et l'effort avec 40. 10 recidives ont ete opere 25. L'anesthesie peridurale 52;5a ete plus utilisee ; anesthesie locale 11 cas dont 4 cas en ambulatoire ; la rachianesthesie 8 cas. 2O cas de resection du sac herniaire ont ete observes. La duree moyenne du temps operatoire a ete de 55;75 minutes. L'antibiotique etait systematique avec une duree moyenne de 12;17 jours. L'analgesie a dure en moyenne 1;92 jours. Les compli- cations immediates ont ete : 2 cas d'infections parietales (5) et 8 cas de douleurs (20). La duree moyenne d'hospitalisation etait de 1;44 jours. La duree moyenne d'arret du travail a ete de 21;21 jours. A 1 mois de suivi un cas de tumefaction testiculaire etait observe 2;5. A 3 mois de suivi nous avons eu 1 cas de nevralgie (2;5) et 1 cas de recidive (2;5). Le cout total de l'intervention etait en moyenne 99 454;10 F CFA. Les patients ont ete satisfaits en majorite 95. Cette etude nous a permis de verifier que cette technique sans tension est pratiquable dans les conditions du Mali et peut se faire en ambulatoire (4 cas / 40 cas). Le cout de la prothese est eleve mais le risque de recidive est peu eleve