Feasibility and performance of in-house red blood cell reagents to detect unexpected antibodies in immunized patients in Burkina Faso.

In sub-Saharan Africa, antibody detection tests remain inaccessible because of the high cost and limited shelf life of red blood cell (RBC) reagents. This study aimed at investigating the feasibility and performance of locally prepared RBC reagents for antibody detection in Burkina Faso. We conducted an experimental study comparing commercial RBC panels and a local panel prepared from phenotyped blood donors in Ouagadougou, Burkina Faso. Antibody detection testing was performed by the indirect antiglobulin test using a gel card filtration column in a low-ionic-strength solution. Judgment criteria were the concordance rate and the kappa agreement coefficient of results generated by the two panels. A total of 302 blood donors were phenotyped for the major antigens of the RH, KEL, MNS, FY, JK, LE, and P1PK blood group systems. From this pool of donors, we designed an RBC detection panel that was used to screen for unexpected antibodies in 1096 plasma samples from 832 patients with a history of transfusion and 264 recently delivered or pregnant women with no history of blood transfusion. A positive antibody detection test was observed in 8.1 percent of the samples using the local panel versus 6.4 percent with the commercial panels. A total of 23 samples were negative with the commercial panels and positive with the local panel, while the findings were reversed for four samples. The concordance rate was 97.5 percent, and the kappa agreement coefficient was 0.815. Our results suggest that the development of local RBC panels can be an alternative to commercial panels in countries with limited resources. It could also be a cost-effective intervention, mainly for children under 5 years of age, women of childbearing age, and pregnant women, all of whom are most at risk for malaria and sickle cell disease complications. Blood services could develop and implement appropriate strategies to make phenotyped donor pools available for the design of suitable RBC panels.

Extended red blood cell antigens and phenotypes in Burkina Faso: potential issues to design local population-sourced red blood cell reagent panels.

To date, 43 blood group systems with 349 red blood cell (RBC) antigens have been recognized. The study of their distribution is useful for blood services to improve their supply strategies for providing blood of rare phenotypes, but also to design indigenous RBC panels for alloantibody screening and identification. In Burkina Faso, the distribution of extended blood group antigens is not known. This study aimed to investigate the extended profiles of blood group antigens and phenotypes of this population and to raise limitations and potential strategies for the design of local RBC panels. We conducted a cross-sectional study that included group O blood donors. Extended phenotyping for antigens in the Rh, Kell, Kidd, Duffy, Lewis, MNS, and P1PK systems was performed using the conventional serologic tube technique. The prevalence of each antigen and phenotype combination was determined. A total of 763 blood donors were included. The majority were positive for D, c, e, and k and negative for Fya and Fyb. The prevalence of K, Fya, Fyb, and Cw was less than 5 percent. The most frequent Rh phenotype was Dce, and the most common probable haplotype was R0R0 (69.5%). For the other blood group systems, the K-k+ (99.4%), M+N+S+s- (43.4%), and Fy(a-b-) (98.8%) phenotypes were the most frequent. Antigenic polymorphism of blood group systems by ethnicity and geography argues for the design and evaluation of population-sourced RBC panels to meet specific antibody profiles. However, some of the specificities identified in our study, such as the rarity of double-dose antigen profiles for certain antigens and the cost of antigen phenotyping tests, are major challenges to overcome.

Genome-wide significant linkage to IgG subclass responses against Plasmodium falciparum antigens on chromosomes 8p22-p21, 9q34 and 20q13.

A genome-wide scan was conducted for the levels of total immunoglobulin G (IgG) and IgG subclasses directed against Plasmodium falciparum antigens in an urban population living in Burkina Faso. Non-parametric multipoint linkage analysis provided three chromosomal regions with genome-wide significant evidence (logarithm of the odds (LOD) score >3.6), and five chromosomal regions with genome-wide suggestive evidence (LOD score >2.2). IgG3 levels were significantly linked to chromosomes 8p22-p21 and 20q13, whereas IgG4 levels were significantly linked to chromosome 9q34. In addition, we detected suggestive linkage of IgG1 levels to chromosomes 18p11-q12 and 18q12-q21, IgG4 levels to chromosomes 1p31 and 12q24 and IgG levels to chromosome 6p24-p21. Moreover, we genotyped genetic markers located within the regions of interest in a rural population living in Burkina Faso. We detected genome-wide significant and suggestive linkage results when combining the two study populations for chromosomes 1p31, 6p24-p21, 8p22-p21, 9q34, 12q24 and 20q13. Because high anti-parasite IgG3 and low anti-parasite IgG4 levels were associated with malaria resistance, the chromosomal regions linked to IgG3 and IgG4 levels are of special interest. Although the results should be confirmed in an independent population, they may provide new insights in understanding both the genetic control of IgG production and malaria resistance.

[Sexuality and risk for sexual transmission of HIV among serodiscordant couples in Ouagadougou, Burkina Faso]. / Sexualité et risque de transmission du VIH chez les couples sérodiscordants suivis à l'hôpital de jour du CHU de Ouagadougou (Burkina Faso).

This article is a contribution to improve the management of serodiscordant couples in Ouagadougou. The aim of the study was to explore sexuality and the risk for sexual transmission of HIV among serodiscordant couples followed-up in CHU-YO. The study consisted of a descriptive cross-sectional study conducted over 6 months, from 1 January 2010 to 30 June 2010. A total of 80 heterosexual serodiscordant couples participated. Women were infected with HIV in most cases (75%). The mean age was 37.5 years for HIV partners and 40 years for seronegatives. Men were significantly older than women (p = 0.01). The couples weremarried (83.7%) or cohabiting (16.3%). The average of serodiscordance duration was 4 years. Seventy-four couples (92.5%) engaged in sexual intercourses, mostly vaginal intercourses. Both partners were satisfied only in 9 couples (12.2%). Although most couples (97.5%) knew the use of condoms for HIV prevention, 59.5% did not use it consistently, particularly when women were the seropositive partners (p = 0.01). The lack of privacy (37.5%) and desire of childbearing (26.25%) were the main reasons for not consistently using condoms among couples. Sexual dysfunction was a concern with 97.5% of the couples. The decrease in libido was most common (37.2%). Sexual intercourses with an outside partner were reported in 20 couples (25%), mostly regarding men (p = 0.03). Specific management could improve the quality of sexual life for couples in the light of the difficulties they face and reduce the risk for HIV transmission to negative partners.

Second nationwide anti-tuberculosis drug resistance survey in Namibia.

SETTING: Namibia ranks among the 30 high TB burden countries worldwide. Here, we report results of the second nationwide anti-TB drug resistance survey.OBJECTIVE: To assess the prevalence and trends of multidrug-resistant TB (MDR-TB) in Namibia.METHODS: From 2014 to 2015, patients with presumptive TB in all regions of Namibia had sputum subjected to mycobacterial culture and phenotypic drug susceptibility testing (DST) for rifampicin, isoniazid, ethambutol and streptomycin if positive on smear microscopy and/or Xpert MTB/RIF.RESULTS: Of the 4124 eligible for culture, 3279 (79.5%) had Mycobacterium tuberculosis isolated. 3126 (95%) had a first-line DST completed (2392 new patients, 699 previously treated patients, 35 with unknown treatment history). MDR-TB was detected in 4.5% (95%CI 3.7-5.4) of new patients, and 7.9% (95%CI 6.0-10.1) of individuals treated previously. MDR-TB was significantly associated with previous treatment (OR 1.8, 95%CI 1.3-2.5) but not with HIV infection, sex, age or other demographic factors. Prior treatment failure demonstrated the strongest association with MDR-TB (OR 17.6, 95%CI 5.3-58.7).CONCLUSION: The prevalence of MDR-TB among new TB patients in Namibia is high and, compared with the first drug resistance survey, has decreased significantly among those treated previously. Namibia should implement routine screening of drug resistance among all TB patients.

Nutritional status and common infections in infants in Burkina Faso: interest of an 'overall morbidity score'.

OBJECTIVE: To study the overall impact of morbidity on the nutritional status of infants in a rural area of Burkina-Faso. METHOD: A cohort of children (n = 114) were monitored from age 6 months to 2 years in 30 villages in north-eastern Burkina Faso. Anthropometric measurements and the incidence of illness were recorded at 6, 9, 12, 15, 18 and 24 months. An overall morbidity score was constructed including the duration of common illnesses and their effect on appetite. Mixed linear regression models were used to analyse the relation between this score and both the weight-for-length (WFL) and the length-for-age (LFA) index. RESULTS: After adjustment for potential confounders, the morbidity score at time T was strongly correlated with the WFL index at time T (P < 0.0001) and weakly correlated with the LFA index at time T + 1 (P = 0.06). When the morbidity score was divided into classes, at time T the mean WFL z-score for children with a high morbidity score was 0.34 z-scores lower than the one for healthy children (P < 0.0001); at time T + 1, the difference in the mean LFA z-scores between the same groups was 0.09 z-score (P = 0.02). However, similar results were obtained using simpler expressions of morbidity. Taken separately, diarrhoea or febrile illness had an effect on WFL (at time T), but only diarrhoea had an effect on LFA (at time T + 1). CONCLUSION: Morbidity was strongly correlated with weight loss in children in the short term and weakly correlated with a slowdown in growth.

[Disseminated subcutaneous cysticercosis: a report of six cases in Burkina Faso]. / Cysticercose sous-cutanée généralisee : a propos de six cas au Burkina faso.

Cysticercosis is an infection resulting from the larval form of the pig tapeworm, Taenia solium. The subcutaneous localizations are frequent and can have serious consequences such as neurological attacks. We report six cases among whom five men and a woman, in order to point out the severity of the disease and its possible dissemination. The patients' age was ranging from 25 to 57 years old. Three of them had neurological complications as convulsions and headaches. The nodules were painful in one case. We recommend sanitary education to eradicate the affection and to sensitize patients in order to consult physicians at early stage.

[Cutaneous leishmaniasis due to Leishmania major involving the bone marrow in an AIDS patient in Burkina Faso]. / Leishmaniose cutanée à Leishmania major avec atteinte de la moelle osseuse chez un malade infecté par le VIH au Burkina Faso.

BACKGROUND: Leishmaniasis covers three well-individualized clinical variants, each due to individual species found in different geographic areas. Herein we report the first case of cutaneous leishmaniasis due to Leishmania major involving bone marrow in an AIDS patient in Burkina Faso. CASE REPORT: A 38-year-old HIV-positive man presented with generalized, copper-coloured, painless, infiltrated, itching, papulonodular lesions present over the previous 10 months. Skin biopsy confirmed the diagnosis of diffuse cutaneous leishmaniasis. The bone-marrow smear showed numerous leishmania. The culture was positive and L. major was identified. The patient was being treated with antiretroviral medication and a pentavalent antimonial compound. The disease progression consisted of attacks and remissions separated by an average of three weeks. DISCUSSION: L. major is the Leishmania species identified in Burkina Faso. It is responsible for typical cutaneous leishmaniasis but particular clinical forms have been described in immunodeficient patients, especially with diffuse cutaneous involvement. The spread of L. major infection to bone marrow could represent a public health problem in our country, where the HIV epidemic is still not under control, and particular vigilance is thus called for.

[Factors associated with the satisfaction of prescribers of blood products in Burkina Faso]. / Facteurs associés à la satisfaction des prescripteurs de produits sanguins labiles au Burkina Faso.

BACKGROUND: The National Blood Transfusion Centre, unique operator of blood transfusion in Burkina Faso is engaged into the quality process according to ISO 9001. Therefore, the assessment of customer satisfaction is a main part of its system. Our study conceives "customer satisfaction" as dependant to the perceived service quality based on SERVQUAL model. OBJECTIVES: To identify factors associated with the satisfaction of blood products prescribers in order to help decision-makers for continuous improvement of services. MATERIAL AND METHODS: We conducted a cross-sectional survey among prescribers of blood components in Ouagadougou, between February 27 and April 30, 2015. We used an anonymous self-administered questionnaire, including 13 items associated to the 5 dimensions of SERVQUAL model. The different satisfaction gaps were calculated and linear regression was used to determine statistical associations with a significance level of 5%. RESULTS: The return rate was 94.5% about the 256 questionnaires distributed. A total of 30% of respondents were satisfied to very satisfied. The overall global gap of satisfaction was -5.74. The product delivery time, the efficacy and safety of blood products, the medical and clinical support, the pro-activity of the communication, the management of blood products reservation and the satisfaction of needs in blood products were the factors associated with the prescribers' satisfaction. CONCLUSION: This first study in blood transfusion services in our context was been useful to assess customer satisfaction and identify the main axes on which targeting priority actions in order to effectively use available resources.

[Role of quality control for improvement of blood components in the Regional Blood Centre of Ouagadougou in Burkina Faso, 2014]. / Apports du contrôle qualité produits finis dans l'amélioration de la qualité des produits sanguins labiles au Centre régional de transfusion sanguine de Ouagadougou (Burkina Faso), 2014.

OBJECTIVES: In Burkina Faso, blood components must comply with national standards. Then, all Transfusion services must implement a quality control process to ensure compliance. Our study aims to establish the main characteristics of blood components of the regional transfusion center of Ouagadougou, and evaluate the capability of this center to improve its manufacturing process. METHODS: We conducted from marsh to December 2014 a pre-post study, assessing blood components' characteristics before and after the implementation of a six months' improvement plan. The assessed parameters were: volume, hematocrit (Ht) and hemoglobin (Hb) levels in RBCs; volume and the number of platelets in PPCs; and volume and concentration of clotting factor VIII in fresh frozen plasma (FFP), respectively. Three hundred and twelve RBCs and 280 PCs were randomly selected for the first series of controls, and 215 RBCs, 54 PCs and 60 FFP were selected for the second series of controls. We compared the mean values of the components parameters and the overall non-compliance rates for each series. RESULTS: The average Hb level of RBCs was respectively 47.8±8.9g and 54.7±7.2g in the first and second series compare to a standard of≥40g. Non-compliance rates of Hb level decreased significantly from 17.6% to 1.4%. For PCs units, the mean number of platelets was 0.14±0.10×1011 and 0.30±0.15×1011 in the first and second period compare to a standard of 0.5×1011. Non-compliance rates for platelets number were high 97.1% and 72.2%. CONCLUSION: The study demonstrates that only RBCs complied with national standards. The study also demonstrates the capability of CRTSO to improve blood components' processing even if for PCs and FFP, NC rates remain high. QC must be maintained and expanded to the others regional blood centers of the country.

[Pernicious anemia: diagnosis and course in Burkina Faso]. / Maladie de Biermer : aspects diagnostiques et évolutifs au Burkina Faso.

Pernicious anemia (also known as Biermer disease or anemia, Addison or Addisonian anemia, and Addison-Biermer anemia) is an autoimmune atrophic gastritis responsible for vitamin B12 malabsorption due to a deficiency of intrinsic factor. We report eight cases of pernicious anemia in Burkina Faso, collected over a 44-month period. The three criteria for diagnosis of pernicious anemia were: vitamin B12 deficiency, gastric disease (gastric histology) with presence of anti-intrinsic factor, and/or anti-gastric parietal cell antibodies in serum. All patients had anemia, with a mean hemoglobin level of 8.75 g/100 mL. The average mean corpuscular volume (MCV) was 122.1 fL the average mean corpuscular hemoglobin (MCH) 39.3 pg, the mean reticulocyte count 12.069 10(9)/L reticulocytes, and the mean rate of megaloblast marrow cells 17.2%. The serum vitamin B12 level ranged from 35 to 71 pmol/L. Antibodies against intrinsic factor were found in all eight patients. All ABO blood groups were present with a predominance (4 cases) of group O. Endoscopy found a normal fundic mucosa in three patients. Histology showed gastric atrophy and intestinal metaplasia for six patients (85.7%). Under B12 vitamin therapy, the course was favorable in all patients; seven patients also had 10 days of iron therapy. We recommend a gastric biopsy even in the absence of macroscopic gastric lesions on the upper gastrointestinal endoscopy.

[Clinical and hematological profile of hemoglobin C Ziguinchor (Cz) in Western Africa]. / Profil clinique et hématologique de l'hémoglobine C Ziguinchor (Cz) en Afrique Occidentale.

The authors report 10 cases of Hb C Ziguinchor share out in 3 features ACz, SCz, Cz-PHHF (HPFH: hereditary persistence of foetal hemoglobin). The clinical and hematological study of the features has allowed the following conclusions: the Hb Cz is a rare mutant specific of the Negro and which original focus may be in Senegal. The heterozygote form (ACz) does not present any clinical manifestation. The association Hb S-Hb Cz brings about a serious hemoglobinopathy which has clinical and hematological features like the sickle cell disease (SS). The association Hb Cz-HPFH is relatively supported in spite of episodic painful crisis.

[Prevalence and clinical profile of hemophilia of black Africans in urban areas of the Ivory Coast]. / Prévalence et profil clinique de l'hémophilie du Noir africain en zone urbaine en Côte d'Ivoire.

The authors report 20 haemophilic cases during a screening performed in urban area (Abidjan) in a population of 2.500 male subjects. They estimate the disease prevalence at 0.8%. The only haemophilia form identified is the A form, which does not seem to prevail in a particular ethnic group. No clinical significant particularity has been observed, otherwise.

[Clinical signs of severe malaria in a pediatric hospital in Ouagadougou]. / Formes cliniques du paludisme grave en milieu hospitalier pédiatrique à Ouagadougou.

During the period of transmission of malaria, from August to November of 1993 and 1994, we conducted a study to determine the frequency of the clinical forms of severe and complicated malaria. The study involved children, from 6 months through 15 years old, admitted to the pediatric ward of the hospital in Ouagadougou, Burkina Faso. The criteria for inclusion followed the definition of severe malaria stated by the World Health Organization. We carefully noted the symptoms and signs on admission. Of the total of 719 children enrolled in the study, there was a prevalence of children under 5 years old. The most frequent clinical forms were those of coma (377 cases, 52.4%), prostration (268 cases, 37.3%), convulsion (152 cases, 21.4%), anemia (115 cases, 15.9%), and hypoglycemia (55 cases, 10.3%). No renal failure form was observed. We also observed the respiratory distress form (35 cases, 4.9%) and the hemorrhagic form (11 cases, 1.5%). Malaria remains a major cause of childhood morbidity and mortality in the developing world. Early therapeutic management of febrile attacks with chloroquine would reduce the incidence of severe and complicated malaria.

Analyzing Thiol-Dependent Redox Networks in the Presence of Methylene Blue and Other Antimalarial Agents with RT-PCR-Supported in silico Modeling.

BACKGROUND: In the face of growing resistance in malaria parasites to drugs, pharmacological combination therapies are important. There is accumulating evidence that methylene blue (MB) is an effective drug against malaria. Here we explore the biological effects of both MB alone and in combination therapy using modeling and experimental data. RESULTS: We built a model of the central metabolic pathways in P. falciparum. Metabolic flux modes and their changes under MB were calculated by integrating experimental data (RT-PCR data on mRNAs for redox enzymes) as constraints and results from the YANA software package for metabolic pathway calculations. Several different lines of MB attack on Plasmodium redox defense were identified by analysis of the network effects. Next, chloroquine resistance based on pfmdr/and pfcrt transporters, as well as pyrimethamine/sulfadoxine resistance (by mutations in DHF/DHPS), were modeled in silico. Further modeling shows that MB has a favorable synergism on antimalarial network effects with these commonly used antimalarial drugs. CONCLUSIONS: Theoretical and experimental results support that methylene blue should, because of its resistance-breaking potential, be further tested as a key component in drug combination therapy efforts in holoendemic areas.

Valeur pronostique péri-opératoire des anomalies de la repolarisation ventriculaire découvertes sur l'ECG pré-opératoire au Centre Hospitalier et Universitaire de Cotonou

But : Le but de cette étude était de déterminer la valeur pronostique des anomalies de la repolarisation ventriculaire découvertes sur l'ECG réalisé avant la chirurgie non cardiaque. Méthode : Cette étude prospective effectuée sur une période de 10 mois a inclus des patients âgés de 18 ans au moins ayant réalisé un ECG préopératoire interprété par un cardiologue. Ces patients ont été suivis pendant l'intervention et jusqu'à H48 après. Les évènements cardiovasculaires anormaux étaient enregistrés pendant l'intervention et les deux premiers jours post-opératoires.Résultats : Quatre-vingt-dix-sept (97) patients ont été inclus. Les anomalies de la repolarisation ont été retrouvées chez 58,8% des patients. L'aspect d'ischémie sous-épicardique et la repolarisation précoce étaient les anomalies de la repolarisation les plus fréquentes avec des fréquences respectives de 42,3% et 14,4%. L'hypotension artérielle était l'évènement cardiovasculaire le plus retrouvé en per-opératoire devant la tachycardie sinusale, la poussée hypertensive, le choc cardiogénique et l'accélération de la fibrillation atriale. L'hypotension artérielle était le seul évènement cardiovasculaire péjoratif en per-opératoire, associé aux anomalies de la repolarisation avec un test statistiquement significatif (55,4% versus 32,5% ; p = 0,02). La période post-opératoire a été marquée par la survenue de deux (2) décès dans le groupe des patients ayant présenté une anomalie de repolarisation.Conclusion : L'ECG des patients subissant une chirurgie non-cardiaque contient des informations pronostiques importantes. Les résultats de notre étude montrent que l'ischémie sous-épicardique doit être considérée comme un facteur de risque indépendant d'hypotension per opératoire

Late introduction and poor diversity were the main weaknesses of complementary foods in a cohort study in rural Burkina Faso.

OBJECTIVE: In developing countries, the complementary feeding period is critical to the growth of children, notably because of inappropriate complementary feeding practices. A longitudinal study was carried out in a food vulnerable area in Burkina Faso to better understand and describe these practices. METHODS: A cohort of 114 children was followed at the ages of 6, 9, 12, 15, 18, and 24 mo. At each visit details on the complementary foods (CF) were recorded and intakes were measured by direct weighing. RESULTS: At 6 mo of age all infants were breastfed and 61% were still breastfed at 24 mo. Infants not receiving any CF were 97% at enrollment, 53% at 9 mo, and 11% at 12 mo (mean age of introduction = 9.2 +/- 1.7 mo). Porridge was the type of CF introduced first (46%) but was of poor diversity; special dishes were less often given but did contain more numerous ingredients. However, less than half of the children received the recommended minimum of four different food groups/d before being 2 y old. At 12 mo and after, more than 75% of the children had at least 3 meals/d. Quantities of CF consumed increased from 133 +/- 121 g/d (19 +/- 17 g per kg of body weight/d) at 9 mo to 480 +/- 237 g/d (49 +/- 25 g/kg/d) at 24 mo (for breastfed children). CONCLUSION: Late introduction of CF and poor diversity of ingredients, more than quantity of food, were the main weaknesses observed in this context. At least part of these issues can be addressed through educational activities.

Viral, HLA and T cell elements in cross-reactive immune responses to HIV-1 subtype A, CRF01_AE and CRF02_AG vaccine sequence in Ivorian blood donors.

Comprehensive understanding of the determinants of cross-subtype immune responses in HIV infection is critical to developing efficacious HIV vaccines against multiple viral subtypes. Because HIV-1 subtype A or recombinants comprising subtype A are prevalent in Africa and parts of Asia where HIV is spreading, we assessed the determinants of cross-subtype immune responses in HIV-infected blood donors from Cote d'Ivoire to peptides from a candidate CRF02_AG vaccine sequence, a subtype A sequence from western Kenya and a CRF01_AE sequence from Thailand. We present evidence that immune recognition of multiple viral subtypes is maintained by recognition of multiple epitopes. Our data suggest that complete escape of HIV from immune recognition is uncommon. Evaluation of these frequently generated cross-reactive responses should be included in immunogenicity trials of HIV vaccines.

Incidence et risque résiduel de transmission des virus de l'hépatite B et C par transfusion sanguine à Bobo-Dioulasso (Burkina Faso) : Étude de cohorte

l'objectif de notre étude était d'évaluer l'incidence et le risque de transmission des virus des hépatites B et C par transfusion. nous avons conduit une étude de cohorte rétrospective de janvier 2009 à décembre 2014 portant sur les dons de 12 969 donneurs bénévoles et réguliers de sang au Centre Régional de Transfusion Sanguine de Bobo-dioulasso. le diagnostic de l'infection par le VhC ou le VhB était obtenu par technique eliSa devant la présence dans le sérum des anticorps anti-VhC pour le VhC ou de l'antigène hBs pour ce qui est du VhB. le taux d'incidence du VhB était de 2,16 pour 100 donneurs-années et celui du VhC était de 2,59 pour 100 donneurs-années. le risque de transmission du VhB était estimé à 1 pour 302 dons et celui du VhC à 1 pour 213 dons. un renforcement de la sélection des donneurs de sang s'avère indispensable devant un risque élevé de transmission des virus de l'hépatite B et/ou C par don de sang provenant des donneurs bénévoles réguliers