[Epidemiological, clinical and therapeutics aspects of snakebites in the Gabriel-Touré and Kati national hospitals of Mali: a ten-year retrospective study]. / Aspects épidémiologiques, cliniques et thérapeutiques des morsures de serpent dans les hôpitaux nationaux Gabriel-Touré et de Kati du Mali: étude rétrospective sur dix ans.

A retrospective study has been performed on snakebites from January 1993 to December 2002 in the national hospitals Gabriel-Touré, in Bamako, and Kati. It aimed to establish a synthesis of epidemiological, clinical, and therapeutic aspects from snakebites. Eight hundred thirty-two snakebites were recorded during this period. Men were mostly represented: 72 versus 28% of women. The average age was 28 ± 18 years. Farmers were most affected (28%). Most bites occurred between 16 and 20 hours, during the fieldwork and pasture in 44% cases. Lower limbs (73.8%) were more involved than hands (25.8%). Although the type of snake has not been determined, the clinical picture was that of viper syndrome, the severity of which was assessed by the grade of bleeding, edema, renal involvement (15.8%), and neurological disorders (13.3%). Antivenom was administered to 40.6% of patients whose case fatality rate was 2.8%, whereas it was 8.1% in its absence. The case fatality rate associated with serum therapy varied according to the antivenin, 1.5% with the antivenoms manufactured in Europe and 4% with those manufactured in Asia. Five parturients had a favorable outcome with antivenom. The initial management was carried out by traditional healers in 49.7% of cases. The annual case fatality rate decreased gradually from 12% in 1995 to 3% in 2002. The incidence of snakebite is greatly underestimated in hospitals because of inadequate records.

[Snakebites in the Sudanian and Sahelian zones of Mali: epidemiology, symptoms and treatment]. / Morsures de serpents en zone soudano-sahélienne du Mali epidémiologie, symptomatologie et traitement.

The purpose of this study was to document the epidemiology, symptoms and treatment of snake envenomation in Mali between 2005 and 2006. Data was collected using two methods, i.e., household surveys and retrospective surveys. Household surveys carried out in a village of 597 people showed that the annual average incidence was 164 snakebites per 100,000 inhabitants. Retrospective surveys were conducted in 35 healthcare facilities (5 regional hospitals and 30 district health centers) located in 5 parts of the country. Study periods ranged from 2 to 11 years depending on the location. The mean annual incidence of snakebite including dry-bites without envenomation was 27 per 100,000 inhabitants (range, 15-59). Hospital mortality was 4.7% (67/1433) (range, 2.2-6.7%). The population at risk consisted mainly of working men who accounted for 68.4% (980/1433). Patients between 15 and 30 years accounting for 41.2% (590/1433) of the sample were at highest risk for snakebite (chi2=9.96; p=6.10-3). The frequency of snakebite increased from 9.9% (142/1433) in Mopti in the North to 39.9% (572/1433) in Sikasso in the South (chi2=11.93; p=0,017). Snakebites most frequently occurred during the rainy season (56.6%) but only 0.68% of victims were referred to the health center. Hemorrhagic and inflammatory syndromes were the main complications of envenomation. Treatment was always symptomatic. Antivenom serum requirements ranged from 63 to 200 ampoules per year. Our results show that the frequency of snakebites remains grossly underestimated based on hospital data.

[Epidemiological, clinical and evolutionary aspects of severe traumatic brain injury in the multipurpose intensive care unit of Gabriel Touré Teaching Hospital]. / Aspects epidemiologiques, cliniques et evolutifs des traumatises cranio-encephaliques graves au service de reanimation polyvalente du CHU Gabriel Toure.

Among traumas, cranial involvement occupies a special place due to their severity and the importance of the sequelae that they can cause. They are said to be serious when the Glasgow Scale (GCS) ≤ 8. The frequency of severe brain injury in the population in African studies ranges from 3.5 to 7. Mortality is, however, poorly known in developing countries, which led us to initiate this work, which aimed to study the epidemiological, clinical and evolutionary aspects of severe traumatic brain injury in the multipurpose intensive care unit of Gabriel Touré University Hospital. MATERIAL AND METHOD: 24-month retrospective study, descriptive and analytical, including all severe traumatic brain injury patients hospitalized in the resuscitation department of Gabriel Touré University Hospital during this study period. RESULTS: During the periodof 1165 patients admitted to the service, 72 were hospitalized for severe cranio-encephalic trauma for a prevalence of 6%. The age group of 21 - 40 years was the majority with (23) or 44.4% and the average age was 30.93 ± 18.8 years with extremes of 8 months and 79 years.The male sex was predominant with (65) or 90.3%, and a sex ratio of 9.28. During our study, (57) or 79.2% of serious traumatic brain injuries were due to road accidents with motorcycle-motorcycle collisions as a mechanism in (20) or 27.8%. Shopkeepers, and students were the most affected social strata with respectively (22) or 30.6% and (20) or 27.8%. Patient transport was provided by non-medical ambulances for (31) or 43.1% and admission time was between 30 minutes and 6 hours in (16) or 22.2% of cases. (62) or 86.1% had GCS between 6-8 and bilateral mydriasis was present in (10) or 13.9% of patients. (9)or 12.5% of patients had hypotension (systolic blood pressure<90 mm Hg) on admission and average blood pressure<90 mmHg was observed in (32) or 44.4% of patients. (23) or 31.9% had a SPO2 <90%. Cranio-encephalic scanning was performed in 62 or 86.1% and discovered as lesions (25) or 34.9% hemorrhagic contusions followed by extradural hematomas (13) or 18.1%. (63) or 87.5%, patients were intubated-ventilated-sedated in addition to resuscitation. (28) or 38.9% of patients had undergone a surgical intervention with (9) or 12.5% having osmotherapy.The evolution was marked by death of (48) or 66.7%. CONCLUSION: Severe cranio-encephalic trauma represents a major cause of morbidity and mortality. The establishment of pre-hospital medicine will allow better care and reduction of mortality by early and continuous management of ACSOS and respiratory and / or hemodynamic distress, which are very often associated with severe TCE.

Parmi les traumatismes, les atteintes crâniennes occupent une place particulière du fait de leur gravité et de l'importance des séquelles qu'elles peuvent entraîner. Ils sont dits graves quand le score de Glasgow (GCS) ≤ 8. La fréquence des traumatismes crânio-encéphaliques (TCE) graves au sein de la population dans les études africaines varie entre 3,5 et 7. La mortalité est cependant mal connue dans les pays en voie de développement ce qui nous a conduit à initier ce travail qui avait pour objetd'étudier les aspects épidémiologiques, cliniques et évolution des traumatisés crâniens graves au service de réanimation polyvalente du centre hospitalier universitaire Gabriel Touré. MATÉRIEL ET MÉTHODE: Etude, descriptive et analytique à collecte rétrospective s'étant déroulée sur 24 mois, incluant tous les patients traumatisés crânio-encéphaliques graves hospitalisés dans le service de réanimation du centre hospitalier universitaire Gabriel Touré durant cette période d'étude. RÉSULTATS: Durant la période sur 1165 patients admis dans le service.72 ont été hospitalisés pour traumatisme crânio-encéphalique grave soit une prévalence de 6%. La tranche d'âge de 21 - 40 ans était majoritaire avec(32) soit 44,4% et l'âge moyen était de 30,93 ±18,8 ans avec des extrêmes de 8 mois et 79 ans. Le sexe masculin était prédominant avec (65) soit 90,3%, et un sex-ratio de 9,28. Durant notre étude (57) soit 79,2% des TCE graves étaient dus aux accidents de la voie publique avec comme mécanisme les collisions moto-moto dans (20) soit27,8%. Les commerçants, et les élèves et étudiants étaient les couches sociales les plus touchées avec respectivement(22) soit 30,6% et (20) soit 27,8%. Le transport était assuré par des ambulances non médicalisées à(31) soit 43,1% et le délai d'admission était compris entre 30 minutes et 6 heures dans (16) soit 22,2% des cas.(62) soit 86,1% avaient GCS entre 6-8 et une mydriase bilatérale était présente chez (10) soit 13,9 % des patients. (9) soit 12,5% des patients avaient présenté une hypotension (pression artérielle systolique< 90 mm Hg) à l'admission et une pression artérielle systolique ≤ 90 mm Hg avait été observée chez (32) soit 44,4% des patients. Durant notre (23) soit 31,9% avaient une SPO2 < 90%. Le scanner cranio-encéphalique a été réalisé chez (62) soit 86,1% et retrouvait comme lésions, les contusions hémorragiques (25) soit 34,9% suivis des hématomes extraduraux (13) soit 18,1%.(63) soit 87,5% des patients ontété intubés -ventilés-sédatés en plus à des mesures de réanimation. (28) soit 38,9% des patients avaient subi une intervention chirurgicale associée chez (9) soit 12,5% à une osmothérapie. L'évolution a été marquée par une létalité de (48) soit 66,7%. CONCLUSION: Les traumatismes crânio-encéphaliques graves représentent une cause majeure de morbi-mortalité. La mise en place d'une médecine préhospitalière permettra une meilleure prise en charge et la réduction de lamortalité.Par une prise en charge précoce et continue des ACSOS et des détressés respiratoires et/ou hémodynamiques qui sont très souvent associées au TCE grave.

Status epilepticus in black African patients with hypertensive encephalopathy: a rare entity that must not be underrated.

The severity of a blood pressure spike is more closely associated with serious organ dysfunction, which can be life-threatening in the short term, than with the blood pressure level itself. A hypertensive emergency is defined as the presence of high blood pressure associated with acute organ dysfunction. The specific nature of high blood pressure in black patients may cause more frequent hypertensive emergencies. In this retrospective case study, we report our experience and highlight the specific prognosis for black African patients. We examined three patients, aged 27, 47, and 59 years, admitted to intensive care for a hypertensive emergency with neurological distress, and all in status epilepticus. Average blood pressure was 171 mm HG. Treatment included intubation, ventilation, and induction of a barbiturate coma, plus antihypertensive treatment. The outcome was favorable, with an average stay of 5 days. The frequency of hypertensive emergencies varies according to age, ethnic origin, and period studied. Black patients often suffer from more severe forms of high blood pressure, arising at an earlier age. Hypertensive encephalopathy can occur in patients with or without chronic hypertension. Without treatment, the encephalopathy induces a coma that can quickly become fatal. Its spontaneous course is catastrophic (10-20% survival at one year), but more favorable with adequate treatment (60-80% survival at five years).

Entomological and parasitological parameters of malaria transmission in Douguia, Chad.

Malaria remains a threat for many countries, especially in Chad where it is the leading cause of morbidity and mortality. Few reliable data exist, however, about the entomological and parasitological parameters of malaria transmission. The objective of this study was to investigate the entomological and parasitological parameters of malaria transmission in Douguia, a village located 75 km northeast of Ndjamena (Chad), as part of a training program for participants in Chad's malaria control program. Mosquitoes were collected after morning pyrethroid spraying, with a mouth aspirator. The parasitological data were collected by a rapid diagnosis test or microscopic examination. The study examined 350 subjects aged from 6 months to 80 years. The plasmodic index (PI) of Plasmodium falciparum was 25.4 % (n = 89) and the gametocygenic index (GI) 9.1 % (n = 32); they varied significantly from one age group to another (p = 10- 3). The PI in pregnant women attending antenatal clinics was 18.7 % (n = 12/64). Three Anopheles species were found: Anopheles gambiae s.l, An. arabiensis and An. pharoensis. An. coluzzii accounted for 94.9 % of the An. gambiae s.s. The antigen sporozoite index (SI) was 4.5 %. Our results confirm the endemicity of malaria in Chad (Douguia) and underline the major role of An. gambiae s.l. in its transmission. However, repeated studies using PCR for Plasmodium detection would help to improve our understanding of its epidemiology.

[Epidemiology of schistosomiasis in the periurban area of Sotuba, 10 years mass treatment began in Mali]. / Épidémiologie des schistosomoses dans le village périurbain de Sotuba, dix années après la mise à échelle du traitement de masse au Mali.

OBJECTIVE: The objective of this work was to describe the epidemiology of schistosomiasis 10 years after mass administration of praziquantel began in Sotuba, Mali. METHODOLOGY/RESULTS: This observational cross-sectional survey in Sotuba, a periurban village in the Bamako district, took place from July to September 2010 and collected stool and urine samples from residents at least one year old. Kato-Katz (for stool) and urine filtration techniques were used to detect Schistosoma mansoni and S. hæmatobium eggs, respectively. Overall, 335 urine samples and 300 stool samples were examined. The prevalence rate was 5.4% (18/335) for S. hæmatobium and 8.7% (26/300) for S. mansoni. Excretion of these eggs was most frequent in the 6-15 year-old group: 4.8% (16/335) for S. hæmatobium and 7.7% (23/300) for S. mansoni. Snails of the Biomphalaria pfeifferi and Bulinus truncatus species were the intermediate hosts, captured in the fields at water contact points. The principal clinical symptoms reported by participants were abdominal pain 27.2% (61/169) and headaches 23.2% (52/169). CONCLUSION: Despite the implementation of mass drug administration in Mali a decade ago, our results show that schistosomiasis transmission continues in Sotuba. Assessment of the risk factors for this persistent transmission is strongly needed.

Protein tyrosine phosphatase 1B negatively regulates S100A9-mediated lung damage during respiratory syncytial virus exacerbations.

Protein tyrosine phosphatase 1B (PTP1B) has anti-inflammatory potential but PTP1B responses are desensitized in the lung by prolonged cigarette smoke exposure. Here we investigate whether PTP1B expression affects lung disease severity during respiratory syncytial viral (RSV) exacerbations of chronic obstructive pulmonary disease (COPD). Ptp1b(-/-) mice infected with RSV exhibit exaggerated immune cell infiltration, damaged epithelial cell barriers, cytokine production, and increased apoptosis. Elevated expression of S100A9, a damage-associated molecular pattern molecule, was observed in the lungs of Ptp1b(-/-) mice during RSV infection. Utilizing a neutralizing anti-S100A9 IgG antibody, it was determined that extracellular S100A9 signaling significantly affects lung damage during RSV infection. Preexposure to cigarette smoke desensitized PTP1B activity that coincided with enhanced S100A9 secretion and inflammation in wild-type animals during RSV infection. S100A9 levels in human bronchoalveolar lavage fluid had an inverse relationship with lung function in healthy subjects, smokers, and COPD subjects. Fully differentiated human bronchial epithelial cells isolated from COPD donors cultured at the air liquid interface secreted more S100A9 than cells from healthy donors or smokers following RSV infection. Together, these findings show that reduced PTP1B responses contribute to disease symptoms in part by enhancing S100A9 expression during viral-associated COPD exacerbations.

Type-I interferons induce lung protease responses following respiratory syncytial virus infection via RIG-I-like receptors.

The role of proteases in viral infection of the lung is poorly understood. Thus, we examined matrix metalloproteinases (MMPs) and cathepsin proteases in respiratory syncytial virus (RSV)-infected mouse lungs. RSV-induced gene expression for MMPs -2, -3, -7, -8, -9, -10, -12, -13, -14, -16, -17, -19, -20, -25, -27, and -28 and cathepsins B, C, E, G, H, K, L1, S, W, and Z in the airways of Friend leukemia virus B sensitive strain mice. Increased proteases were present in the bronchoalveolar lavage fluid (BALF) and lung tissue during infection. Mitochondrial antiviral-signaling protein (MAVS) and TIR-domain-containing adapter-inducing interferon-ß-deficient mice were exposed to RSV. Mavs-deficient mice had significantly lower expression of airway MMP-2, -3, -7, -8, -9, -10, -12, -13, and -28 and cathepsins C, G, K, S, W, and Z. In lung epithelial cells, retinoic acid-inducible gene-1 (RIG-I) was identified as the major RIG-I-like receptor required for RSV-induced protease expression via MAVS. Overexpression of RIG-I or treatment with interferon-ß in these cells induced MMP and cathepsin gene and protein expression. The significance of RIG-1 protease induction was demonstrated by the fact that inhibiting proteases with batimastat, E64 or ribavirin prevented airway hyperresponsiveness and enhanced viral clearance in RSV-infected mice.

[Lice in Mali: frequency of infestation, genotyping, infection rate and case management]. / Poux au Mali: fréquence de portage, génotypage, taux d'infection et prise en charge.

OBJECTIVES: Because lice-transmitted infections are a real public health problem, epidemiological studies in different ecoclimatic zones of Africa are useful. This article aims to describe the frequency of lice infestation, their genotypes, and their infection by pathogens in the regions of Koulikoro and Mopti. METHODOLOGY: A cross-sectional survey allowed us to collect lice from rural populations. Techniques of molecular biology (real-time PCR, standard PCR, and genotyping) were used for analysis of lice samples. RESULTS: Infestation rates were 57% (12/21) among subjects in Diankabou, in the Sahelian zone; 91% (39/43) in Doneguebougou, and 86% (59/69) in Zorocoro, in a savanna zone. The overall lice infestation rate in the samples in the three localities was 83% (110/133). Real-time PCR showed 3% (4/92) of Acinetobacter baumanii but no B. quintana in Diankabou. Phylogenetic analysis of the mitochondrial gene (Cytb) showed that head lice in Mali belong to genotype C. CONCLUSIONS: The high frequency of lice infestation in the study population indicates that it would be useful to conduct national epidemiological surveys to estimate the magnitude of this public health problem.

Age-acquired resistance and predisposition to reinfection with Schistosoma haematobium after treatment with praziquantel in Mali.

The effect of age, previous intensity of infection, and exposure on reinfection with Schistosoma haematobium after treatment was studied in a cohort of 468 subjects six years of age and over living in an irrigation scheme area in Mali. Prevalence and intensity of S. haematobium infection were measured each year between 1989 and 1991, but the reinfection study period was restricted to the last year of the follow-up. Observations were made at the principal water contact sites where the number of Bulinus truncatus shedding furcocercous cercariae was recorded. A cumulative index of exposure taking into account time, duration and type of contact, and malacologic data was calculated for each subject. Univariate analysis showed that the reinfection risk decreased with age and increased with exposure and pretreatment intensity. These results were confirmed by fitting a logistic model that showed that this risk was seven times lower among those 15 years of age and older than among the 6-14-year-old children, while linear trends with exposure to infection and pretreatment intensity were significant. This study supports the concept of an age-acquired resistance to reinfection and is in favor of a predisposition to infection that raises the question of a genetic factor controlling susceptibility/resistance to S. haematobium infection.

Comparison of schistosome transmission in a single- and a double-cropped area in the rice irrigation scheme, 'Office du Niger', Mali.

Rice is becoming increasingly important as a staple food in West Africa and there is a need to increase production to meet the demand and one way to achieve this is to harvest two annual crops. It is possible that such intensified irrigation could affect transmission of schistosomes and this study attempts to compare schistosome transmission in single and double-cropped areas of an irrigation scheme, 'Office du Niger', in Mali. Double cropping has been practised for some years in the Niono area while in the Kolongotomo area still only a single crop is grown. Parasitological surveys conducted in 10 villages (5 from each of these 2 areas) showed that Schistosoma haematobium was less prevalent in the area with single cropping than in the area with double cropping. In order to compare transmission patterns between the two areas, all human-water contact sites around four villages (two from each area) were identified and included in transmission studies. From August 1996 to June 1997, eight surveys were conducted, at intervals of approximately 45 days, in each of these sites to record density of the intermediate hosts, density of infected snails, environmental factors (especially density of aquatic macrophytes), and frequency of human-water contacts. Although the data provide useful information on transmission patterns in Niono and Kolongotomo areas, they fail to demonstrate clear-cut differences in snail population dynamics and transmission patterns between the two areas. A key element in snail habitats in both areas is the abundance of aquatic macrophytes, especially the submerged species. Snail control using environmental modification should focus on controlling these plants in human-water contact sites.

Distribution and genetic diversity of Schistosoma haematobium within its bulinid intermediate hosts in Mali.

Random amplified polymorphic DNA (RAPD) markers were used to assess distribution and genetic diversity of Schistosoma haematobium populations within their bulinid intermediate hosts in Mali. Naturally infected snails (Bulinus truncatus and B. globosus) were collected at four sites in the Bamako district. S. haematobium cercariae from single snails were used to infect mice and genotypes of the resultant adult worms were characterized using RAPD markers. Diversity indices were calculated at the scale of one snail, both within and among sites. One third of the molluscs harboured multiple miracidial infections (the maximum number equal to five) with slightly overdispersed distributions in three sites and a random distribution at one site. Similarity indices revealed significantly less variation among populations compared with populations, indicative of the absence of distinct S. haematobium populations within the Bamako district. RAPD markers represent an accurate tool for determining genetic diversity and amount of gene flow among parasite populations contained within different individual snails and among intermediate host populations.

[Distribution of intermediate mollusc hosts in human schistosomiasis in the Office of Niger (Mali).II. Role of different habitats in the transmission]. / Distribution des mollusques hôtes intermédiaires des schistosomiases humaines à l'Office du Niger (Mali). II. Rôle des différents habitats dans la transmission.

To determine the role of habitats in the schistosomiasis transmission all the year, a study on snail hosts distribution was carried out within various parts in the irrigated system of the "Office du Niger". Bulinus truncatus and Biomphalaria pfeifferi were the only snail hosts recorded. Densities were low and 85% (46/54) of breeding sites contained less than 50 snails collected per man/hour. Primary and secondary canals play the most important role in disease transmission because of the stability of these habitats, the pollution of human water contact by remnants of food and wastes which favourised the snail growth and infestation. Prevalences were 23.3% (46/197) in Bulinus truncatus and 2.5% (6/243) in Biomphalaria pfeifferi. The cercariae shedding was permanent, but the infection varied significantly according to the snail species, the period and to the area.

[Prevalence and perception of schistosomiasis in a periurban school of Bamako in Mali]. / Prévalence et perception de la schistosomose en milieu scolaire périurbain de Bamako au Mali.

The prevalence of urinary and intestinal schistosomiasis, the knowledge, attitude and practice (KAP) regarding the disease among both the children and their parents were investigated in Djikoroni para, a Suburban area of Bamako. The prevalence of Schistosoma haematobium and S. mansoni were respectively 69.8% and 8.7%. Compared with the girls, the boys were significantly more infected by S. haematobium (p = 5.10(-3)), but no difference between the sexes was observed for S. mansoni (p = 0.36). Interviews indicated that 88% of children and 91% of adults considered micro-haematuria as a pathology, but did not know anything about intestinal schistosomiasis. The low sensitivity of micro-haematuria (56.8%) and of the criterion "abdominal pains" (66.7%) indicated that they couldn't be relevant diagnosis signs. The symptoms and mode of transmission were generally well understood for S. haematobium but not for S. mansoni. The later parasite, its intermediate host and their interactions were unknown. The main man water contacts are bathing and playing in the Woyowayanko and in the Niger river. Inadequate perception of schistosomiasis contributes to maintain schistosomiasis at a high level of prevalence in Djikoroni.

[Epidemiology of schistosomiasis in a suburban school area of Bamako (Republic of Mali)]. / Epidémiologie de la schistosomiase en milieu scolaire périurbain de Bamako (république du Mali).

Epidemiology of schistosomiasis has been assessed in October, 1990 in three primary schools of a suburban district of Bamako: Magnambougou. It was a cross sectional study which was carried out on an hazardous sample of 549 pupils of 7 to 14 years old. The Kato-Katz and urine filtration methods were used to search schistosome eggs. The prevalence rate was 50% (256/512) in Schistosoma haematobium and 5.6% (26/464) in S. mansoni. Children from 11-14 years old were more infected by Schistosoma haematobium (59.4%), than those from 7-10 years old (35.2%) (p < 0.005). Among these children, 26.2% excreted more than 100 eggs per 10 ml of urine. The infection did not varied significantly no matter what the sex is (53.7 and 44.8% respectively in boys and girls) (p = 0.05). According to the residence, pupils living in Magnambougou were more infected (54.9%) than those of others district (31.1%) (p < 0.001). Likewise, S. haematobium infection was more important in A and C schools (64.9 and 73.2% respectively) than in B school (11.2%) (p < 0.001). Two major snails species which are the intermediate hosts of urine schistosomiasis in Mali (Bulinus truncatus and Bulinus globosus) were found in the shelters: however, B. truncatus was only infected in 13.1% (19/145). Contamination was local and "ruralization" activities (particularly gardening) seemed to be the most important displaying factor.

[Evaluation and treatment of snake bites in Bancoumana village in Mali]. / Evaluation des morsures de serpent et de leur traitement dans le village de Bancoumana au Mali.

A retrospective study was conducted on the epidemiological patterns and treatment of snakebites in the village of Bancoumana, 60 km south-west from Bamako. We analysed a total of 17 cases (8 males and 9 females). The distribution of snakebite cases by gender and by age showed that among subjects aged 5 to 20 years, boys were more exposed than girls (6 vs. 2), whereas, in those of 21 years and above, females were more frequently bitten than males (7 vs. 2) (p = 0.04). The treatment was mainly based on the use of anti-inflammatories and antibiotics, and sometimes of saline, glucose or anti-tetanic serum. Vitamin K was used in 7 cases and no patient was treated specifically. The success of therapy mostly depended on the shortness of delay between the snakebite occurring and patient referral to the health centre, and the low rate of envenomation. All the patients referred the same day they were bitten were cured, whereas three persons referred to the health centre at D3, D7 and D43 after bite died. The surveillance parameters were oedema, bleeding and vomiting.

[Transmission of schistosomiasis in an urban population and prevalence of intestinal helminthiasis in Bamako, Mali ]. / Transmission de la schistosomose urbaine et prévalence des helminthoses intestinales à Bamako, Mali.

Parasitological, malacological and anthropological studies were performed to assess the prevalence of Schistosoma haematobium and S. mansoni in schoolchildren living in the suburban area of Bamako. A total of 1017 schoolchildren aged 6-14 years were selected in two different areas between September 1997 and December 1999. In Djikoroni, the prevalence of S. haematobium and S. mansoni was 80.7% (339/420) and 22.8% (85/372) respectively. There was no significant difference of prevalence and intensity of infection with S. haematobium between schools, gender and age (p > 0.05), whereas, those of S. mansoni were higher in the vicinity of (+/- 100 m from) major sites where infected Biomphalaria pfeifferi were found (p < 0.001). In Niomirambougou, S. haematobium was prevalent in 46.7% (279/597) and S. mansoni in 28.2% (134/475). Boys and children aged 11-14 years were more infected (p < 0.001). Associated intestinal helminths (Hymenolepis nana, Necator americanus and Ascaris lumbricoides) were relatively scarce (prevalence < 1%). The prevalences of schistosome infected snails intermediate host were relatively high, 49.3% (100/203) in B. pfeifferi, 20.6% (88/138) in B. truncatus and 24.1% (7/29) in B. globosus. We recorded a total of 2514 water contacts about which 1130 in December and 1384 in January. Most of the children, 42.9% (1077/2511) were attracted to water bodies for bathing, swimming and playing, suggesting the lack of recreational facilities in these areas. Developing local control programmes in schools located in the vicinity of water bodies would contribute to break the parasite transmission cycle in Bamako.

[Echographic morbidity due to Schistosoma haematobium in a peripheral district of Bamako in Mali, Missabougou]. / Morbidité échographique due à Schistosoma haematobium dans un quartier périphérique de4 Bamako au Mali, Missabougou.

Frequency of urologic lesions was evaluated in 408 children from 6-15 years old in a suburban area of Bamako district in Mali, Missabougou; 65.2% from children were infected by Schistosoma haematobium, 13% by Schistosoma mansoni and 0.2% by Schistosoma intercalatum. Urologic lesions have been demonstrated in 223 cases among which 66 cases of urinary bladder lesions, 108 cases of hydronephrosis and 49 cases of mixed lesions. In order of the frequency we had the following uropathic lesions: wall thickening, wall irregularities, localised hypertrophies and hydronephrosis. We did not found any lesions in 185 children. Infection due to S. haematobium did not varied significantly in spite of age group, sex, schooling of children or the profession of the parents. Lesions were strongly correlated with age group (47.8 and 61.3% in 6-9 and 10-15 years old respectively) (p < 0.01) and with intensity of infection as measured by urinary egg counts (p = 0.0017).

[Epidemiology of human urban schistosomiasis in Bamako in Mali (the case of the "populous" quarter of Bankoni)]. / Epidémiologie des Schistosomiases humaines urbaines a Bamako au Mali (le cas du quartier "populeux" de Bankoni).

From may 1989 to january 1990, we have studied parasitologic index in snails population, stools and urines examination in children (1-15 years) in one of the greatest "spontaneous" quarter of Bamako. 584 stools samples and 563 urines were tested. 4.717 snails were captured during six months. From all these data, we conclude that in Bankoni S. haematobium is mesoendemic (36.6%) and S. mansoni hypoendemic (3.4%). B. truncatus is the most important host for urogenital schistosomiasis. The two seasonal revers (Tienkole and Bankoni) are unfavourable to B. pfeifferi's production. B. globosus and B. forskalii are not frequent in this suburban area. This investigation, shows that a selective mass treatment with praziquantel is the better public health care strategy in Bankoni quarter.

[Onchocerciasis and epilepsy. Epidemiological survey in Mali]. / Onchocercose et épilepsie. Enquête épidémiologique au Mali.

A door-to-door survey was conducted in 18 villages in Mali with a total of 5,243 inhabitants classified according to the endemicity of onchocerciasis. Each epileptic was matched with two controls. The survey protocol included the following steps in cases and controls: census taking, socioeconomic data, screening for epilepsy, clinical examination, laboratory testing to detect parasites in stools and urine, and snip-test. The crude prevalence of epilepsy was 13.35 per 1,000 (n = 70). Epidemiological study provided a number of valuable demographic insights concerning age at onset, type of seizure activity during seizure and personal and family medical history. A transverse study showed that the prevalence of epilepsy was not significantly higher (p = 9.09) in zones of high endemicity of onchocerciasis (16.1 per 1000) than in zones of low endemicity (10.8 per 1000). Case-control findings showed evidence of onchocerciasis in 22.4 p. 100 of epileptics and 21.7 p. 100 of controls (odds ratio = 1.02 IC 95 p. 100: 0.4-2.19, not significant). Various risk factors including genetic factors and low socio-economic status could explain the trend toward a higher incidence of epilepsy as well as higher morbidity rates in zones of high endemicity of onchocerciasis.