[Contribution of the Xpert MTB / Rif test in the diagnosis of tuberculosis of any form in Saint-Louis]. / Apport du test Xpert MTB/Rif dans le diagnostic de la tuberculose toute forme a Saint-Louis.

INTRODUCTION: The Xpert MTB / RIF assay has a dual advantage on the one hand, the rapid diagnosis of even difficult cases by the standard technique of direct microscopic examination and on the other hand by the detection of resistance to rifampicin. Our objective was to determine the contribution of the Xpert test in the diagnosis of tuberculosis of all forms. MATERIALS AND METHOD: retrospective, descriptive and analytical study carried out in the Pneumophtisiology department of the CHRU of Saint-Louis. All suspected tuberculosis cases who had received an Xpert test from 2018 to 2020 were included. The parameters studied were socio-demographic, clinical and biological data. RESULTS: 524 patient records included in the study with a sex ratio of 1.3. The mean age of the patients was 37 +/-15 years. There were 285 positive GeneXpert samples, of which 224 were of pulmonary origin and 61 of extra-pulmonary origin. The number of rifampicin resistant samples was five, all of respiratory origin. CONCLUSION: the Xpert test is a new molecular technique recommended by the WHO in the diagnosis of pulmonary tuberculosis.

INTRODUCTION: le test Xpert MTB/RIF présente un double avantage d'une part le diagnostic rapide des cas mêmes difficiles par la technique standard de l'examen direct à la microscopie et d'autre part par la détection de la résistance à la rifampicine. Notre objectif était de déterminer l'apport du test Xpert dans le diagnostic de la tuberculose toutes formes confondues. MATÉRIELS ET MÉTHODE: étude transversale, descriptive à collecte rétrospective menée dans le service de Pneumophtisiologie de CHRU de Saint-Louis. Tous les cas suspects de tuberculose qui avaient bénéficié d'un test Xpert de 2018 à 2020avec un dossier médical accessible et exploitable ont été inclus. Les paramètres étudiés étaient les données sociodémographiques, cliniques et biologiques. RÉSULTATS: Nous avions colligés 524dossiers de malades avec un sex-ratio de 1,3. L'âge moyen des patients était de 37 ans+/-15 ans. Il y'avait 285 prélèvements positifs au GeneXpert dont 224 d'origine pulmonaire et 61d'origine extra pulmonaire. Le nombre d'échantillons résistants à la rifampicine était de cinq, tous d'origine respiratoire. CONCLUSION: le test Xpert est une nouvelle technique moléculaire recommandée par l'OMS dans le diagnostic de la tuberculose pulmonaire. Toutefois il doit être évaluer dans le diagnostic de la tuberculose extra pulmonaire.

[Epidemiology of primary lung cancer among non-smokers in Senegal]. / Épidémiologie des cancers bronchopulmonaires primitifs des non-fumeurs au Sénégal.

INTRODUCTION: According to global data for 2002, one quarter of new cases of primary bronchopulmonary cancer were non-smokers. We undertook this study with the aim of describing the epidemiological characteristics of non-smokers with primary bronchopulmonary cancer in the Dakar region of Senegal. METHODS: A multicenter descriptive study that included all non-smokers who presented with primary bronchopulmonary cancer between January 1st 2014 and December 31st 2015. The data were captured on an Excel file and then transferred to Epi InfoTM 7 software for analysis. RESULTS: The rate of diagnosis for primary bronchopulmonary cancers was 72.1 %. The prevalence of non-smokers was 33.3 %. The sex ratio was 1.27. The average age was 54.6 years. More than a third of the sample were housewives. Carpenters and craftsmen exposed to metals predominated. Exposure to cooking oils was reported in one case. Three patients presented sequelae of pulmonary tuberculosis. Adenocarcinoma was the most common histological type and predominated in young subjects. CONCLUSION: The proportion of primary bronchopulmonary cancers diagnosed among non-smokers is increasing in Dakar. An analytical study of suspected risk factors would be helpful for prevention.

[Pédiatric haemophilus influenzae b meningitis in Dakar]. / Méningite pédiatrique à haemophilus influenzae b à Dakar.

OBJECTIVE: This study had for aim to determine the etiology of Haemophilus b pediatric meningitis. DESIGN: A retrospective study of 216 biologically confirmed cases was carried out during 6 years (January 1995- December 2000) on children 0 to 15 years of age, hospitalized at the Albert Royer Children Hospital Center. RESULTS: Haemophilus influenzae b is the first cause of pediatric meningitis (19.7%) followed by Nesseria meningitidis (14.5%), and Streptococcus pneumoniae (13.6%). The Haemophilus influenzae b meningitis cases are distributed all year round with a peak between January and March, that is to say, during the dry and cool season. They affect children at an average age of 11.7 months, with a sex ratio of 1.1 for boys. Almost all of the patients live in the low-socio-economic areas of the Dakar suburbs (92.8%). More than 90% of the H. influenzae b isolates are sensitive to ceftriaxone (96%) chloramphenicol (93%), and to ampicillin (91%). Clinical evolution is marked by death (17.8%) and recovery with psychological, sensory, and motor sequels (19.9%). CONCLUSION: This report should help to include the combined vaccine Antihaemophilus influenzae b in the Senegalese Broad Vaccination Program. The final aim is the reduction of morbidity and mortality of infections due to Haemophilus influenzae b.

[Contribution of the Xpert MTB/RIF to the etiological diagnosis of tuberculous pleurisy]. / Apport de l'Xpert MTB/RIF dans le diagnostic étiologique des pleurésies tuberculeuses.

INTRODUCTION: Performance of the Xpert MTB/RIF for the detection of Mycobacterium tuberculosis in pleural liquid is poorly described. The aim of this study was to determine its usefulness for the etiological diagnosis of a tuberculous pleurisy. PATIENTS AND METHOD: We performed a descriptive cross-sectional study, with analytical design, including all the patients having a unilateral serofibrinous pleurisy, exudative, lymphocytic, and sterile. The diagnosis of pleural tuberculosis was considered based on epidemiological, clinical, paraclinical and therapeutic arguments. The Xpert MTB/RIF of the pleural fluid was carried out among all patients. RESULTS: Pleural tuberculosis was confirmed in 301 patients. The median age was 32years. Our study has included 217 men (72.1%) with a final sex ratio of 2.6. The cost of the pleural biopsy coupled with histology made it practicable in only 90 patients (29.9%) with a yield of 80%. The Xpert MTB/RIF of the pleural liquid was positive in only 10 patients (3.3% of the cases). CONCLUSION: Gene amplification by Xpert MTB/RIF of the pleural liquid is much less effective in establishing the diagnosis of tuberculous pleurisy than pleural biopsy, which remains the gold standard.

Hepatic cytolysis and bicytopenia after 15 days of four-drug tuberculosis treatment in Senegal.

We report the case of a 31-year-old immunocompetent woman residing in Senegal, with localized microscopy-proved pulmonary tuberculosis, complicated by macrophage activation syndrome and associated with viral hepatitis B, identified due to hepatic cytolysis and a bicytopenia.

Molecular detection of CTX-M-15-type ß-lactamases in Escherichia coli strains from Senegal.

We aimed to detect the extended-spectrum ß-lactamases (ESBLs) secreted by clinical strains of Escherichia coli at Fann University Hospital in Dakar and to characterize them molecularly. We identified 32 isolates producing ESBLs. The CTX-M-15 gene was the most frequently detected ESBL gene, detected in 90.63% of the isolates studied.

[Contribution of fiberoptic bronchoscopy in the diagnosis of pulmonary dragging]. / Apport de la fibroscopie bronchique dans le diagnostic des pneumopathies traînantes.

INTRODUCTION: Bronchoscopy is recommended into the exploration of chronic lung diseases. This one is expensive and invasive. We conducted this study in order to assess the benefit of the bronchoscopy in the etiologic diagnosis of chronic lung diseases. PATIENTS AND METHODS: This study was retrospective, descriptive and analytical, using medical records of outpatients and in patients who has done the bronchoscopy in Pneumology Clinic, Fann hospital, Dakar from January 2010 to December 2014. RESULTS: We have reported 159 cases. The sex ratio was 2.2. Middle age was 44 years. Fever was found in 32.7%. Alveolar syndrome was found in 64.8%. The white blood cells (WBC) were normal in 80.7%. Bronchoscopy was contributive in 74.1%. Specimen analysis isolated banals germs in 69.2%, mainly bacteria in 51.6%. Parasitology of the fluid of broncho-alveolar lavage was positive in 28.6%. CONCLUSION: Bronchoscopy stills a use full exploration while diagnosing chronic lung diseases. It should be systematic in chronic lung diseases with or not fever, this, when sputum microscopy a sputum PCR are negative.

First report of gastroenteritis by genotype G12 rotavirus in Dakar, Senegal.

The genotype G12 rotavirus was isolated from the stool of children 5 years old or younger with acute gastroenteritis during 1 year in three Dakar hospitals. The G12 genotype was the most common (58.25%). VP4 genotyping revealed mixed genotypes (1.94%).

[Prevalence of tobacco smoking in primary and secondary schools in the Department of Dakar, Senegal]. / Prévalence du tabagisme dans l'enseignement moyen et secondaire dans le Département de Dakar, Sénégal.

INTRODUCTION: Tobacco smoke is a global health problem, and the largest avoidable cause of death in the world. The objective of our study was to determine the prevalence of tobacco smoking in schools in Dakar area (Senegal). MATERIEL AND METHODS: This descriptive and analytical cross-sectional study was performed from September 2011 to June 2012 in 27 schools of the Dakar area. RESULTS: We questioned 1654 students over a 9-month school period. The mean age was 15±2.5years (range 11-22). The sample included 848 boys (51.3 %), therefore a sex ratio of 1.05. There were 68 smokers (4.1 %) and 60 ex-smokers (3.6 %). The mean age of the smokers was 16.9±2.2years (range 11-22) with a male preponderance of 70.6 % (n=48). Smoking in family members was the initiating factor most frequently reported by smokers (25 %). The average age of ex-smokers was 16.4±2years. Fear of parents' reactions was the most frequently invoked reason for stopping smoking (41.7 %). CONCLUSION: This study confirms the reality of smoking among school children in Senegal and highlights the urgency of the installation of a prevention policy near the young people.

Pediatric invasive pneumococcal disease in Senegal.

OBJECTIVES: We aimed to describe the clinical, epidemiological, and outcome characteristics of IPD case patients hospitalized at the Albert-Royer National Children's Hospital (French acronym CHNEAR) to evaluate the disease burden of IPDs in a pediatric hospital of Dakar (Senegal). PATIENTS AND METHODS: All children aged 0-15 years hospitalized at the CHNEAR between January 1st, 2008 and December 31st, 2013 for a documented IPD were included in the study. Medical history, risk factors, clinical, bacteriological, and outcome data was collected. Data was then analyzed using the SPSS software, version 16 (Pearson's Chi(2) test: a P-value<0.05 was considered statistically significant). RESULTS: A total of 218 IPD patients were hospitalized at the CHNEAR during the study period (hospital prevalence: 0.79%). The mean age was 36.1 months. The male to female ratio was 1.27 (122 boys and 96 girls). Infants<2 years of age represented 61.46% of patients. Prior antibiotic therapy was found in 54% of patients but details were lacking. Infection sites were mostly meningeal (61%) and pleuropulmonary (28.9%). The main isolated serotypes were 1, 6A, 14, 5, and 23F. Case fatality was 17.4% and it was five times higher for pneumococcal meningitis. CONCLUSION: IPDs are very common in children in Senegal. Infants<2 years of age are particularly affected. The very high case fatality (17%) was significantly associated with meningeal infection sites hence the need for better access to pneumococcal vaccines.

Characterization of M. tuberculosis strains from west African patients by spoligotyping.

Analysis of Mycobacterium tuberculosis strains was carried out using isolates collected from 69 Senegalese and 20 Ivory Coast tuberculosis patients. These 89 isolates were typed by means of the spoligotyping technique, showing clusterized populations of bacterial strains. In the Senegalese patients, 35 genetic profiles were observed with 10 clusters of spoligotypes from 44 isolates. Among Ivory Coast patients, 11 spoligotypes were found for 20 isolates. A particular cluster of isolates was evident both in Senegalese (10) and Ivory Coast (11) patients. These results show the existence of polymorphism of the direct repeat region for African M. tuberculosis strains. However they suggest that additionnal markers are needed for accurate epidemiological studies in areas that are highly endemic for tuberculosis.

[Evaluation of ELISA using A60 antigen from Mycobacterium bovis BCG: specific IGG and IGM in mycobacterial infections]. / Evaluation d'un ELISA utilisant l'antigène A60 de Mycobacterium bovis BCG: IgG et IgM spécifiques au cours des infections mycobactériennes.

The authors have evaluated an ELISA (A60-Tb, Anda biologicals) allowing the detection of specific IgG and IgM against A60 antigen from Mycobacterium bovis BCG during mycobacterial infections. This study included sera from 110 african subjects and from 71 French subjects distributed in 4 clinical groups: 55 tuberculous patients (I), 41 leprous patients (II), 33 pneumopathies (III) and 52 healthy subjects (IV). Serological results were compared taking as reference for the diagnosis of tuberculosis the positivity of culture and/or that of a direct examination, and for leprosy the positivity of a direct examination associated either with a Mitsuda's reaction or with an histopathological examination. IgG were found to be more discriminative than IgM. Considering together the results of groups I and II, the authors found a sensitivity of 95.8 p. cent and a specificity of 75.3 p. cent with threshold of 200 U/ml for specific IgG. Anti-A60 antigen antibodies obtained for groups I and II were significantly higher (IgG: p less than 0.0001; IgM: p less than 0.001) than those observed in other groups. African subjects presented IgG titers higher than those obtained by French subjects (p less than 0.0001). IgM response was more frequent among group II (97.6 p. cent) than group I (21.8 p. cent). However, IgG (26.9 p. cent) and IgM titers (30.8 p. cent) were detected among group IV. This test would allow a control of therapeutic efficacy with an additional interest for classifying borderline forms of leprosy.

[Antibiotic sensitivity of Salmonella strains isolated in a pediatric population in Dakar. Research of beta-lactamase and plasmids]. / Sensibilité aux antibiotiques des souches de Salmonella isolées en milieu pédiatrique dakarois. Recherche de bêta-lactamase et de plasmides.

114 strains of Salmonella were isolated from many samples in the Pediatric Hospital (Hôpital d'Enfants Albert Royer) of Dakar between January 1985 and December 1991. The sensibility to antibiotics were tested, and we studied the production of beta-lactamase and the presence of plasmids in the resistant strains. 27 serovars of Salmonella were identified and Salmonella typhi predominates with 45%. Only 28% of the strains were susceptible to all of the antibiotics, and 17% were found multiresistant; 8% of the strains produce beta-lactamase and plasmids were found in 6 multiresistant strains.

[Bacterial diversity during the cholera epidemic in Dakar, Senegal (1995-1996)]. / Diversité bactérienne au cours de l'épidémie de choléra à Dakar, Sénégal (1995-1996).

Vibrio cholerae O:1, serotype Ogawa and biotype El Tor (76.1%) was responsible of the outbreak of cholera in Dakar, Senegal (1995-1996). However, other bacteria were isolated, particularly Vibrio cholerae non O:1/non O:139, Vibrio fluvialis, Vibrio alginolyticus. Vibrio parahaemolyticus, Salmonella sp.p, Shigella sp.p (23.9%). The Vibrio cholerae O:1 strains are multiresistant to sulfonamide, cotrimoxazole and chloramphenicol. 97% were also resistant to O/129 compound. Fluoroquinolone and 3rd generation cephalosporins were the more efficient antibiotics (100%).

[Bacteriological study of purulent otitis media in children in CHU in the tropical zone]. / Etude bactériologique des otorrhées purulentes de l'enfant dans un CHU en zone tropicale.

BACKGROUND: Haemophilus influenzae and S pneumoniae are the most common causative agents of acute otitis media in Europe and the USA. This work aimed to identify the agents in Senegal and to study their sensitivity to antibiotics. POPULATION AND METHODS: Two hundred and one patients, aged 0 to 15 years, with persistent middle-ear effusion, were included in this study from 1983 to 1993. Purulent samples aspirated from the external canal were analysed for bacteriology and sensitivity testing. RESULTS: Eighty two percent of cultures were positive for Staphylococcus aureus (37%), Pseudomonas aeruginosa (25%), Proteus (18%) and Klebsiella (8%). Positive cultures were found mainly in children aged between 1 and 5 years. Amikacin and cefotaxim were the most active antibiotics against the majority of strains. Staphylococcus aureus was always resistant to penicillin. CONCLUSIONS: Prevalence of Staphylococcus aureus as the causative agent of persistent middle-ear effusion may be explained by late examination. Its resistance to penicillin favors early administration of third generation cephalosporins or pristanimycin.

[Bacteriological study of purulent nasopharyngitis in children in Senegal]. / Etude bactériologique des rhinopharyngites purulentes de l'enfant au Sénégal.

BACKGROUND: S pneumoniae, H influenzae and M catarrhalis are the main bacteria isolated from rhinopharynx in Europe. The purpose of this work was to study the frequency of potential pathogenic bacteria isolated from acute purulent rhinopharyngitis among children in Senegal. POPULATION AND METHODS: Ninety-three children from one month to 7-years old suffering from purulent rhinopharyngitis were recruited from April 1 to July 1996. The withdrawal samples were taken from the cavum with a swab which was immediately immersed in an agar shipping medium. Bacteria's grouping and serotyping were made by immunoagglutination. A standard antibiogram was made for all isolates and furthermore the minimal inhibitory concentration (MIC) were determined for S pneumoniae. RESULTS: Two hundred bacterial strains were isolated: S pneumoniae 28% (60% of the children), C group streptococci: 19% (41% of the children), H influenzae: 15.5% (33% of the children), S pyogenes: 9.5% (20% of the children), S aureus: 8% (17% of the children) and M catarrhalis: 6% (13% of the children). The other isolates were: B and D groups streptococci, P aeruginosa and Klebsiella spp. S pnuemoniae strains belonged to serogroups 6, 19 and 23. Only three strains of H influenzae were capsulated (serotype b). Infants aged from 6 to 18 months were the most affected. No resistance to penicillin was observed for S pneumoniae and S pyogenes. Ampicillin (81%) and chloramphenicol (96%) both inhibited the majority of H influenzae strains. CONCLUSIONS: This descriptive bacterial epidemiology study of children's rhinopharynx's flora in Senegal allowed us to identify three major pathogenic germs: S pneumoniae, H influenzae and S pyogenes contributing to a better knowledge of these microorganisms' serotypes, biotypes and antibiotypes.

[Bacteriology of neonatal septicemia in Dakar]. / Bactériologie des septicémies néonatales à Dakar.

Between February 1983 and February 1991, 471 blood cultures from newborns with neonatal infection, aged from 0 to 30 days, admitted to the Pediatric Hospital Albert Royer, Dakar, were performed. In 141 (30.3 percent) cases, one bacterium was isolated. Three major causative organisms were identified: Klebsiella spp (28.6 percent), E. coli (19.5 percent) and S. aureus (17.4 percent). Altogether, we isolated 99 (69.2 percent) enterobacteria, 7 (4.8 percent) other Gram negative bacilli and 37 (25.8 percent) Gram positive cocci among which 25 S. aureus, 10 streptococci (7 group B, 2 group D, 1 group A and 2 pneumococci). The most efficient antibiotics were amikacin and third generation cephalosporins.

[Causes of infectious gastro-enteritis in children in Dakar]. / Causes des gastro-entérites infectieuses de l'enfant à Dakar.

Between February 1983 and May 1988, 1,157 stools from children aged under 15 years presenting with diarrhoea and admitted to a paediatric hospital in Dakar, Senegal, were examined for the presence of bacterial and parasitic agents. We looked for Campylobacter and rotavirus in only 245 and 111 samples respectively. Enterobacteria were detected most frequently (162/264; 61.3 per cent). Among these, we found 92 (34.8 per cent) strains of enteropathogenic E. coli; 40 strains (15.1 per cent) of Salmonella spp. and 30 strains (11.3 per cent) of Shigella spp. V. cholerae was present in only 2 faecal specimens (0,7 per cent). Eighty-one (30.6 per cent) parasitic agents were isolated, including a high proportion (13.6 per cent) of flagellae. Campylobacter jejuni and retroviruses were found in 2 (0.8 percent) and 15 (13.5 percent) stool respectively. The frequency with which these enteropathogenic agents were isolated remains in keeping with the global situation usually observed in Dakar for several years.

[Neonatal bacterial infections in the tropical zone]. / Infections néonatales bacteriennes en zone tropicale.

One thousand and ten miscellaneous samples collected from infected newborns, were tested at the bacteriology laboratory of A. Royer Children's Hospital from 1983 to 1991. These samples included 471 blood cultures, 114 pus of various origins, 410 cerebrospinal fluids and 15 urines. One bacteria or bacterial soluble antigens were detected in 294 samples (29.2%). Positivity percentage was 29.2% for septicemia, 68.4% for suppurations, 17.8% for meningitidis and 33.3% for urinary tract infections. Altogether, we isolated 156 enterobacteria (53%), 14 Gram negative bacilli (4.7%) and 124 cocci (42.1%) among them 19 streptococci (A, B, C) and 25 pneumococci. Three major species were identified: S. aureus (25.8%), Klebsiella spp (19.7%) and Escherichia coli (14.6%). The most efficient antibiotics against all strains were AKN, CTX, CRO and GEN.

[Prevalence of Delta hepatitis in health workers in Dakar (Senegal)]. / Prévalence de l'hépatite Delta chez les travailleurs de la Santé à Dakar (Sénégal).

708 hospital workers in University Teaching Hospital of Dakar were tested to HBs antigen; among them 128 were positive and tested to Delta antibody, by ELISA Abbott kit. Seven (7) men and one woman were positive. However, the positivity of Delta antibody is neither linked to sex, nor to age of subjects. 87% of the Delta antibody carriers were found among the trainees, and 50% of them studied in the Odonto-Stomatology Institute.