[Epidemiological aspects of autism in mental health care structures in the district of Bamako, Mali]. / Aspects Epidemiologiques de L'Autisme dans les Structures de Prise en Charge en Sante Mentale du District de Bamako au Mali.

AIMS: Autism is a global and early developmental disorder that appears before the age 3 years old. It is characterized by a triad of symptoms affecting the following domains: social interaction, verbal and non-verbal communication, imagination and behaviors. This work aimed to determine the frequency of autism and to identify its risk factors in Malians aged 0-17 years old. METHOD: In a cross sectional and prospective study, we reviewed clinical data in 2068 medical charts dating from 1992 to 2012 from all the mental health care centers in Bamako. RESULTS: We found a frequency of 7.8% (162/2068). The age range 0-5 years old was the most represented. The sex ratio was 1.7. The autistic child was issued from a consanguineous marriage in 25.4% (41/162) of the cases. To have parents in divorce, being the first child, and male gender were associated with autism with statistical significance. Our data suggest an elevated number of autism cases in Mali. We plan to carry out a larger prospective study to determine other autism risk factors and importantly to identify autistic families for a molecular genetic study.

BUT: L'autisme est un trouble global et précoce du développement qui apparait avant l'âge de 3 ans. Il se caractérise par une triade de symptômes affectant les domaines d'interaction sociale, la communication verbale et non verbale, l'imagination, et les comportements. Le but de ce travail était de déterminer la fréquence de l'autisme et d'identifier les facteurs favorisants chez les sujets maliens de 0­17ans. MÉTHODE: Il s'agissait d'une étude transversale rétrospective de dossiers médicaux de 1992 à 2012 à partir des données cliniques dans les structures de prise en charge en santé mentale dans le district de Bamako au Mali. RÉSULTAT: Sur les 2068 dossiers constitués durant la période d'étude, nous avons colligé 162 dossiers de troubles autistiques (de janvier à décembre 2012), soit une fréquence de 7,8% (162/2068). La tranche d'âge de 0 ­ 5 ans était la plus représentée. Le sex-ratio était de1,7. La consanguinité entre les deux parents était présente dans 25,4% (41/162) des cas. Avoir les parents en divorce, être le premier enfant, et surtout du sexe masculin étaient associés de façon statistiquement significative à la présence de l'autisme. Nos données témoignent du nombre de cas élevé d'autisme au Mali. Une étude prospective plus élaborée pour déterminer les autres facteurs favorisants de l'autisme et surtout d'identifier les familles autistes pour une étude génétique moléculaire est à planifier.

Information about medications in the district of Bamako, Mali.

The aim of our study was to investigate the quality of information about pharmaceutical products in Mali. The study surveyed 98 prescribers, 60 pharmacists, and the package inserts of a basket of 30 generic medicines, compared to those of the corresponding proprietary versions. We made a rational choice of 98 doctors from various specialties and levels of the health system and randomly selected 60 of the 215 pharmacies in the district of Bamako (Mali). A rational sampling of generic medicines provided us with a basket of 30 drug notices for the antimalarial, antibiotic, antalgic, antipyretic, and anti-inflammatory agents used most in the Republic of Mali. This study showed that the pharmaceutical industry, through its sales representatives, are the main sources of drug information and that this information is not always adequate. The study also found that the content provided with generic medicines is sometimes different from the information for the proprietary brand-name drugs.

[The clinical and biological tolerance of nevirapine among patients with AIDS under treatment at the Hospital of the Point G]. / La tolerance clinique et biologique de la nevirapine chez les malades du SIDA sous traitement a l' Hopital du point G.

The national policy of assumption of responsibility of the PVVIH decided to put 80% of new inclusions under Triomune, 1st therapeutic line made up of 3TC + D4T + Nevirapine. The use of Nevirapine among patients VIH+ plays a very important part in improvement of the quality of their life. The goal of this study was to evaluate the clinical and biological tolerance of Nevirapine at the PVVIH under treatment ARV and having Nevirapine in their diagram. We had collected 102 files of patients. The average age was 38 years. Association Lamivudine + Stavudine + Nevirapine was the diagram most frequently prescribed (82.4%). The skin, mucous and neurological signs, digestive disorders, muscular signs, cardiopulmonary signs were frequently observed in the first month of the treatment but these symptoms became less frequent in the third month and disappeared at the 6th month. We observed disorders in hepatic and renal functional parameters, rise in the lymphocytes. We obtained a considerable increase in the rate of CD4 between the beginning of the treatment and the 6th month. The treatment schema of 3TC + D4T + Nevirapine gives an excellent clinical and biological tolerance. But, the study must continue to confirm these results over a longer period.

[Factors associated with antiretroviaral treatment observance at Point "G" hospital]. / Les Facteurs associés à l'observance du traitement antirétroviral à l'hôpital du Point G.

OBJECTIVE: To study the factors associated with the observance of treatment ARV among patients followed in hospital medium to Bamako. METHOD: Inquire longitudinal with collection of the data near the patients followed in one of the three greater sites of assumption of responsibility of the people reached with the VIH/SIDA to Mali. The people were regarded as observing if they took at least 95% of their treatment the moment of the investigation. RESULTS: The patients were between 1 and 40 months of treatment the moment of the investigation. The average age was 44 years with extremes going from 19 to 70 years. Association Lamivudine +Stavudine + Nevirapine (triomune) was the most prescribed antiretroviral therapy (34.2%). The bad observance was noted at 58.5% of the patients. The principal causes of bad observance were: the lapse of memory 47.5% (96/202) and difficulties of access to the hospital 34.6% (70/202). The changes of molecules were due primarily to the out-of-stock condition, and the side effects. The factor associated with a good observance was the assistance of the patient by a member of the family informed of seropositivity. CONCLUSION: The interest of HIV patient to his treatment could contribute to enhance antiretroviral Adherence particularly in this hospital and generally in Mali.

[First major epidemic caused by Neisseria meningitidis serogroup W135 in Africa?]. / Premiere epidemie de garnde amplier provoquee par Neisseria meningitidis W135 en Afrique?

Neisseria meningitidis serogroup W 135 (N.m. W 135) has caused sporadic infections and small epidemics such as those that occurred during religious pilgrimages in Saudi Arabia in 2000 and in 2001. It is routinely isolated from specimens coming from African countries. The first major epidemic involving N.m. W 135 occurred in Burkina Faso between January and May 1992. There were more than 1300 cases including 1500 deaths. Enhanced surveillance of circulating strains showed that N.m. W 135 accounted for 83% of the 203 positive cerebrospinal fluid specimen cultures. The offending organism was identical to the strain that caused the smaller epidemic in Saudi Arabia in 2000. Due to the shortage of tetravalent meningococcal vaccine against N.m. W 135, the Health Ministry based its response to the epidemic on treatment of symptomatic patients using chloramphenicol and ampicillian. These drugs were distributed free. The emergence of N.m. W135 has impacted public health in Africa. Repeated identification of this serogroup in Burkina Faso during 2002 raises the risk that similar outbreak will occur in the meningitis belt during the next epidemic season. The high cost of tetravalent meningococcal vaccine compounded with the only progressive increase in production capacity underline the need to reinforce surveillance of circulating strains and available treatment facilities. Control strategy for epidemic meningitis is currently the focus of close collaboration between the WHO and the health authorities and corresponding institutions in the countries involved.

The identification of a complex A/G/I/J recombinant HIV type 1 virus in various West African countries.

In this sequence note we describe the full-length genome sequence of an HIV-1 isolate originating from the west African country of Mali. The phylogenetic tree analysis from the near full-length genome shows that the 95ML84 strain forms a separate cluster, supported by 100% of the bootstrap values, with the previously described A/G/J/? mosaic virus BFP90 from Burkina Faso. Additional analysis showed that throughout the genome the lowest diversity was seen between the 95ML84 and the BFP90 viruses, and bootscan analysis showed a similar complex genomic structure. In addition to the initial report describing the BFP90 virus as an A/G/J/? recombinant, our data show that for the BFP90 and 95ML84 strains the unclassified region corresponds to subtype I. The A/G/I/J BFP90 and 95ML84 strains represent the fifth and most complex circulating recombinant form of HIV-1 detected so far, and our data show its presence in various West African countries. Subtype I and J sequences, initially considered rare, seem to have broadened their geographical spread by way of these recombinant forms.

A single dose of live oral cholera vaccine CVD 103-HgR is safe and immunogenic in HIV-infected and HIV-noninfected adults in Mali.

Despite considerable experience with single-dose, live, oral cholera vaccine CVD 103-HgR in Asia, Europe, and the Americas, the vaccine had not been evaluated in sub-Saharan Africa or on individuals infected with human immunodeficiency virus (HIV). We therefore conducted a randomized, placebo-controlled, double-blind, cross-over clinical trial in 38 HIV-seropositive (without clinical acquired immunodeficiency syndrome (AIDS)) and 387 HIV-seronegative adults in Mali to assess its safety and immunogenicity. Adverse reactions (fever, diarrhoea and vomiting) were observed with similar frequency among vaccine and placebo recipients. The vaccine strain was not isolated from the coprocultures of any subject. The baseline geometric mean titre (GMT) of serum vibriocidal antibody was significantly lower in HIV-seropositives (1:23) than in HIV-seronegatives (1:65) (P = 0.002). Significant rises in vibriocidal antibody were observed in 71% of HIV-seronegatives and 58% of HIV-seropositives, and in 40% of HIV-seropositives with CD4+ counts below 500 per microliter. Following immunization, the peak vibriocidal GMT in HIV-seronegatives was 1:584 versus 1:124 in HIV-seropositives (P = 0.0006); in HIV-seropositives with CD4+ counts < 500 per microliter, the peak vibriocidal GMT was 1:40 (P = 0.03 versus other HIV-seropositives). CVD 103-HgR was safe in HIV-infected Malian adults, although serological responses were significantly attenuated among HIV-seropositives (particularly in those with CD4+ counts < 500 per microliter) relative to HIV-seronegatives. These results encourage further evaluations of this single-dose, oral cholera vaccine in high-risk populations such as refugees in sub-Saharan Africa.

PIP: In response to the 1994 cholera outbreak that swept through Rwandan refugee camps near Goma, Zaire, in 1994, the World Health Organization explored the immunogenicity of a new generation of single-dose, live oral cholera vaccines. One such vaccine, CVD 103-HgR, has been evaluated in Asia, Europe, and the Americas, but not in sub-Saharan Africa or in individuals infected with HIV. Therefore, the present study evaluated the safety and immunogenicity of this new vaccine in a randomized, placebo-controlled, double-blind, crossover clinical trial in Mali. Enrolled were 38 HIV-positive individuals without full-blown AIDS and 387 HIV-negative adults. Adverse reactions (fever, diarrhea, and vomiting) occurred with equal frequency in vaccine and placebo recipients. The vaccine strain was not isolated from the coprocultures of any subject. The baseline geometric mean titre (GMT) of serum vibriocidal antibody was significantly lower in HIV-positive subjects (1:23) than HIV-negatives (1:65). Significant rises in vibriocidal antibody were observed in 71% of HIV-seronegatives and 58% of HIV-positives and in 40% of HIV-positives with CD4 counts below 500/mcl. After immunization, the peak vibriocidal GMT in HIV-negative subjects was 1:584 compared with 1:124 in HIV-positive subjects. In HIV-positives with a CD4 count below 500/mcl, the peak vibriocidal GMT was 1:40. Although serologic responses were significantly attenuated among HIV-positive subjects, especially those with CD4 counts below 500/mcl, CVD 103-HgR was safe in HIV-infected Malian adults. Further evaluations of this single-dose oral cholera vaccine are recommended in high-risk populations such as refugees in sub-Saharan Africa.

Genetic subtypes of HIV type 1 and HIV type 2 strains in commercial sex workers from Bamako, Mali.

In Africa the highest HIV infection rate has been reported among female commercial sex workers (CSWs) who are at increasing risk of acquiring and transmitting HIV infection. In October 1995, 176 CSWs were studied in Bamako, the capital city of Mali. The ages of the CSWs ranged from 15 to 50 years old (mean, 28.8 years). Only 20.45% of the 176 CSWs were Malian; the majority were from Nigeria (32.9%) and Ghana (31.8%), and the remaining were from other African countries. Forty-one percent were active for less than 1 year as a commercial sex worker, and the length of prostitution for the remaining women ranged from 1 to 15 years (mean, 2.76). A total of 81 (46.02%) of the 176 CSWs were positive for HIV antibodies; 63 (35.8%) were HIV-1 positive, (3.9%) were HIV-2 positive, 11 (6.2%) had antibodies to HIV-1 and HIV-2, and none of them had antibodies to group O viruses. For all HIV antibody-positive samples, PBMCs were separated and genetic subtypes of HIV-1 were determined using the heteroduplex mobility assay (HMA), with ED5-ED12 as outer and ES7-ES8 as inner primers. Among the 66 HIV-1 strains characterized, 53 (80.3%) were subtype A, 2 (3.1%) belonged to subtype C, 1 (1.5%) belonged to subtype D, and 10 (15.1%) were identified as subtype G. Among the 10 subtype G strains, 8 were obtained from women who were very recent CSWs, with an activity of 1 year or less, assuming that there is a high probability that these infections occurred recently. Genetic subtypes of five HIV-2 viruses were determined by sequencing of the env and/or gag genes followed by phylogenetic analysis, and all of them belonged to subtype A. Comparison of HIV-1 and HIV-2 seroprevalence data from our study with previous data from Mali shows a significant rise in HIV-1 prevalence and a significant decrease in HIV-2 prevalence and confirms similar trends observed in neighboring countries. We have found four different genetic subtypes of HIV-1; however, subtype A is predominant and accounts for 80% of the cases and 15% of the HIV-1 infections were subtype G. It is important to continue the surveillance of subtypes on a systematic basis in order to see to what extent the proportions of the different subtypes will change over time.

PIP: The genetic variability of HIV-1 was investigated in a 1995 study of 176 commercial sex workers (CSWs) recruited in different areas in Bamako, Mali. 36 CSWs (20.45%) were born in Mali; 58 (32.9%) were from Nigeria and 56 (31.8%) were from Ghana. They ranged in age from 15-50 years (mean, 28.8 years). 41% of sex workers had been active for less than 12 months; the remaining women had been CSWs for 1-15 years (mean, 2.76 years). Of the 81 CSWs (46.02%) who were HIV-positive, 63 (35.8%) were infected with HIV-1, 7 (3.9%) with HIV-2, and the remaining 11 (6.2%) had antibodies to both HIV-1 and HIV-2. In contrast to other studies conducted among CSWs in Africa, none of these sex workers had antibodies to group O viruses. HIV-1 prevalence increased with age and length of time in prostitution and was higher among women with a history of sexually transmitted diseases. Among the 66 HIV-1 strains characterized, 53 (80.3%) were subtype A, 2 (3.1%) belonged to subtype C, 1 (1.5%) belonged to subtype D, and 10 (15.1%) were identified as subtype G. These results indicate a significant rise in HIV-1 prevalence and significant decreases in HIV-2 and combined HIV-1 and HIV-2 prevalence (10%, 15%, and 13%, respectively, in 1985). Ongoing surveillance of HIV-1 subtypes in Africa is important to identify shifts in the proportions of different subtypes over time. The genetic diversity of HIV has important implications for vaccine development.

Geographical distribution of HIV-1 group O viruses in Africa.

OBJECTIVE: To determine to what extent HIV-1 group O strains are present in different African countries. MATERIALS AND METHODS: A total of 14,682 samples of sera from a range of patients from 12 different African countries were tested. All the sera were tested with an enzyme-linked immunosorbent assay (ELISA) using a combination of V3 peptides from ANT-70 and MVP-5180. Samples reactive in ELISA were retested in a line immunoassay (LIA-O). Samples reactive in ELISA were also retested with an in-house Western blot to determine the presence of antibodies to gp120 of HIV-1 ANT-70. Polymerase chain reaction was performed on HIV-1 group O and group O indeterminate sera. RESULTS: Of all the sera samples tested, only 19 sera had antibodies to group O V3 peptides exclusively and 46 were indeterminate for group O infection in LIA-O. The highest prevalence of HIV-1 group O infection among HIV-positive sera was observed in Cameroon (2.1%) and neighbouring countries, 1.1% in Nigeria and 0.9% in Gabon. The lowest rates were seen in west Africa: 0.07% in Senegal, 0.14% in Togo, 0.16% in Chad and 0.3% in Niger. Group O sera were observed in almost all the population categories tested. The ANT-70 V3 peptide in LIA-O was reactive with all of the sera considered to be HIV-1 group O antibody positive by LIA, versus 78.9% for the MVP-5180 peptide. Thirteen out of 19 group O samples of sera were tested in PCR. Eight samples were identified as group O by specific group O pol and/or V3 primers; in the remaining five samples no HIV RNA could be detected. Of the indeterminate sera samples, two were identified as group O. CONCLUSION: In eight of the 12 countries tested, antibodies to group O viruses were identified. Numbers of HIV-1 group O viruses are low. Their presence is not restricted to Cameroon and neighbouring countries but can also be found in west and south-east Africa.

PIP: An enzyme-linked immunosorbent assay (ELISA), using a combination of V3 peptides and ANT-70 and MVP-5180, was used to test 14,682 sera samples from people living in Burkina Faso, Burundi, Cameroon, Chad, Congo, Gabon, Mali, Niger, Nigeria, Senegal, Togo, and Zambia to examine the geographic spread of HIV-1 group O viruses in Africa. An in-house Western blot and a line immunoassay (LIA-O) were used to detect the presence of antibodies to gp120 of HIV-1 ANT-70 of samples reactive in ELISA and then a polymerase chain reaction (PCR) on HIV-1 group O and group O indeterminant sera. HIV-1 group O antibodies were present in 8 countries (Cameroon, Chad, Gabon, Niger, Nigeria, Senegal, Togo, and Zambia). Among these 8 countries, the prevalence of HIV-1 group O sera ranged from 2.1% in Cameroon to 0.07% in Senegal. Cameroon and its neighboring countries had a higher prevalence than the West African countries (0.9-2.1% vs. 0.07-0.3%) and Zambia. HIV-1 group O virus was more or less evenly distributed among the population groups tested. The ANT-70 V3 peptide in LIA-O had a higher reactivity rate with HIV-1 group O sera than MVP-5180 V3 peptide in LIA-O (100% vs. 78.9%). 8 of the 13 samples tested in PCR were identified as group O by specific group O pol and/or V3 primers. Among the remaining 5 indeterminant sera samples, 2 were identified as group O. Prospective studies are needed to monitor the true prevalence of HIV-1 group O viruses in Cameroon, its neighboring countries, and West Africa. They are also needed to determine the risk factors associated with group O infection. Monitoring these viruses will allow adaptation of HIV testing strategies for blood screening and serodiagnosis if required.

[Molecular epidemiology of meningococcal meningitis in Mali: isolation of a new class 1 protein variant (P1.y)]. / Epidémiologie moléculaire de la méningite à méningocoque au Mali: isolement d'un nouveau variant (P1.y) de la protéine de classe 1.

The study deals with 570 strains of Neisseriaceae isolated between 1989 and 1994 in Mali: 396 of the strains were isolated from samples of cerebrospinal fluid and 174 from the throat. Serogroup C accounted for 55% of all strains. Antigenic structure was determined by ELISA, SDS-PAGE and transfer to nitrocellulose membrane for immunoblotting with monoclonal antibodies produced at the Max Planck Institute for Molecular Genetics. For serogroup A, the class 1 protein types found were P1.7 for strains isolated prior to 1994 and P1.9 for strains isolated in 1994. P1.7 is specific to clone IV-1 and P1.9 to clone III-1, which was responsible for the 1994 epidemic. All strains of serogroup C isolated from fluid CSF and most strains isolated from the throat exhibit a new type of class 1 protein which the authors have designated P1.y. P1.y is characteristic of Malian strains of serogroup C; it is rare or absent in strains from other countries (Burkina Faso, Ghana, Italy, USA). The nucleotide sequence of the gene expressing P1.y and the corresponding amino acid sequence were determined at the National Institute for Biological Standards and Control, England.

Infirmites lepreuses observees chez les patients de l'Essai/OMS/OFLO/MALI a l'inclusion

Cette etude decrit les infirmites lepreuses observees chez les 275 nouveaux patients de l'essai multicentrique; OMS/THMYEC des regions combines associant l'oflaxacine rifampicine dans le traitement de la lepre; au moment de l'inclusion. Cet essai a debute en octobre 1992 et a ete realise dans la region de Koulikoro au Mali. Sur les 275 inclus 76 (26;7 pour cent) etaient porteurs d'infirmites au depistage dont 40 (14;5 pour cent) de degre 2. La repartition de ses infirmites a montre une predominance masculine 47 cas (33;8 pour cent p=0.02); une predominance dans la forme MB 36 cas (43;9 pour cent p=0.01) et une augmentation en fonction de l'age de 21 cas (20;6 pour cent) chez les sujets jeunes a 30 cas (41;7 pour cent) chez les sujets ages (p=0.01)

Neisseria meningitidis du sérogroupe A clone II-1 responsable de la récente épidemie de méningite survenue au Mali

Le clone III-1 de Neisseria meningitidis sérogroupe A était inconnu en Afrique jusqu'en 1988. Depuis cette date; nous assistons à une vague épidémique secouant la plupart des pays de l'Afrique centrale et de l'Afrique de l'Est. Nous avons montré une étude des protéines de membrane externe; que la souche de méningocoque responsable de l'épidémie du Mali depuis 1994 est le clone III-I

Comparison of three human-murine heteromyeloma cell lines for formation of human hybridomas after electrofusion with human peripheral blood lymphocytes from meningococcal cases and carriers.

Peripheral blood lymphocytes from meningitis patients and healthy meningococcal carriers were fused by electrofusion with the three human-murine heteromyeloma cell lines CB-F7, K6H6B5 and H7NS. 934 hybridomas producing human immunoglobulins were obtained in 30 fusions. Heteromyeloma K6H6B5 yielded a significantly higher proportion of hybridomas producing IgG antibodies than did the two other cell lines. CB-F7 and K6H6B5 yielded comparable numbers of hybridomas whose supernatants reacted with homologous bacteria, whereas the cell line H7NS was less efficient.

[Rhinopharyngeal carriage of Neisseria meningitidis serogroup C in the collectivity around the patients of Mali. Apropos of 1,033 subjects sampled]. / Etude du portage rhinopharyngé de Neisseria meningitidis sérogroupe C dans la collectivité autour des patients au Mali. A propos de 1,033 sujets prélevés.

This study showed that the carriage rate is nul or low in collectivity not in close contact, but high in collectivity in close contact (schools, particularly coranic schools). In this later case, the duration of the carriage may reach several weeks (2 to 6 in our study) at variable rates (3.7 to 9.6%; 12.5 to 62.5%; 14.3 to 42.9% according to the coranic school visited). For the strains of N. meningitidis serogroup C isolated, the rate of resistance to sulfamides and cotrimoxazole is 86.8%. These results explain why during epidemics, it is necessary to close schools and avoid to use for the chemoprophylaxis, sulfamids and their associations because of resistance.

Immunogenicity and evolutionary variability of epitopes within IgA1 protease from serogroup A Neisseria meningitidis.

Five murine epitopes were defined and mapped within IgA1 protease produced by Neisseria meningitidis. Epitopes 1 and 2 were present in IgA1 protease from all strains, and from Neisseria gonorrhoeae. Epitopes 3 through to 5 varied between subgroups of serogroup A meningococci, but have remained constant over decades within the subgroups, except for epitope 4, which changed between 1983 and 1987 during the spread of subgroup III meningococci from Asia to Africa. Binding of monoclonal antibodies to epitopes 1, 4 and 5 neutralized enzymatic function. Human sera containing antibodies to IgA1 protease as a result of natural infection inhibited binding of monoclonal antibodies to epitope 4 but not to the other epitopes.

Antigenic and epidemiologic properties of the ET-37 complex of Neisseria meningitidis.

A special collection of 336 Neisseria meningitidis strains was established that spanned the genetic variability, as defined by multilocus enzyme electrophoresis, of the ET-37 complex (228 strains isolated in different continents between the 1960s and the 1980s) and of other serogroup C meningococci (108 strains). Of the strains in the ET-37 complex, 90% were serogroup C and 10% were serogroup B. Most ET-37 complex strains were serotype 2a and serosubtype P1.5,2 or P1.5,y; most expressed class IIb pilin. Twenty-six Opa proteins differing in electrophoretic mobility or reactivity with monoclonal antibodies were variably expressed by different members of the ET-37 complex, although only four opa genes were detected in individual strains. Despite this overall diversity, most isolates from any one outbreak were fairly homogeneous.

[Bacteriological aspects of purulent meningitis in Bamako district. Apropos of 1,541 bacterial strains collected from 1979 to 1991]. / Aspects bactériologiques des méningites purulentes dans le district de Bamako. A propos de 1,541 souches bactériennes recueillies de 1979 à 1991.

This study is about bacteriological aspects of purulent meningitis in Bamako area upon 1,541 strains collected from 1979 to 1991. It showed that N. meningitidis, S. pneumoniae and H. influenzae b are responsible. In general, N. meningitidis is the most frequent, but this depends on years and months. Since 1988, N. meningitidis serogroup C has supplanted serogroup A. N. meningitidis is predominant between 7 to 30 years. S. pneumoniae between 1-28 days and 31 to 68 years, H. influenzae between 1 month to 6 years. The frequency of these species is the same in male and female. The 3 species are quite sensitive to antibiotics tested except sulphonamides and cotrimoxazole. Meanwhile, the appearance of strains of S. pneumoniae to penicillin and H. influenzae to ampicillin must be followed with interest to check any time the importance of the phenomenon.