[Prevalence of nosocomial infections in a university hospital (Dakar, Senegal)]. / Résultats de l'enquête de prévalence des infections nosocomiales au CHNU de Fann (Dakar, Sénégal).

UNLABELLED: Nosocomial infections constitute today a great public health problem that is still ignored or poorly mastered in our health institutions. METHOD: A prevalence study initiated by the CLIN (committee for the prevention of nosocomial infections) was recently conducted at the Fann teaching hospital. A questionnaire was prepared and submitted to all patients that were hospitalized on the day of the study; the questionnaire allowed gathering a lot of information on exposure factors and clinical and microbiological arguments in favor of nosocomial infections. RESULTS: One hundred and seventy-five patients (59.9% of all available beds) participated in the study. Nosocomial infections were found mostly among people between 20 and 44 years of age and predominantly in women. Fifty-eight percent of those cases were found in the neurology unit. The infections were mostly urinary (40%) and pulmonary (25%). The germs responsible were multiresistant bacteria: Enterobacter cloacae secreting broad-spectrum betalactamase, methicillinresistant Staphylococcus aureus, and Pseudomonas aeruginosa. The infected patients were usually under antibiotic treatment (80%) with various protocols, mainly monotherapy. The antibiotics used were betalactams, fluoroquinolones, and nitroimidazoles.

[Nontyphoidal Salmonella bacteremia cases in AIDS patients in a Dakar University Hospital (Senegal)]. / Etude descriptive des bactériémies àSalmonella non typhi chez les patients infectés par le VIH au CHU de Dakar (Sénégal).

OBJECTIVES: This study had for aim to describe epidemiological, clinical and bacteriological aspects of nontyphoidal Salmonella bacteremia in patients with AIDS in the Dakar University Hospital Infectious Diseases Clinic. METHOD: This study was made on data recorded between 1January1996 and 31December2005. The strains were identified according to biochemical (API 20E, BioMérieux) and antigenic features. Their susceptibility to antibiotic drugs was tested by antibiogram. Screening for strains secreting of an extended-spectrum betalactamase was performed. RESULTS: Sixty-two cases of nontyphoidal Salmonella bacteremia were recorded in AIDS patients as follows: Salmonellaenteritidis bacteremia (32 cases), Salmonellatyphimurium bacteremia (11 cases), and Salmonella spp bacteremia (11 cases). The strains were susceptible to ciprofloxacin, ceftriaxone, aztreonam, amoxicillin plus clavulanic acid in at least 92% of the cases. Only 79% of them were susceptible to cotrimoxazole. The lethality rate was 55%. DISCUSSION: This lethality rate of nontyphoidal Salmonella bacteremia is high in AIDS patients. Therefore, the priority should be put on prevention and, in patients with AIDS, on food hygiene measures, antiretroviral treatment and efficient chemoprophylaxis. This should prove efficient to reduce incidence of nontyphoidal Salmonella bacteremia.

[Hand washing at Fann hospital: investigation among health workers]. / Lavage des mains au chnu de Fann: enquête auprès du personnel de soins.

INTRODUCTION: Handwashing is usually neglected in hospital settings. The objective of this study was to draw attention of health workers in Fann hospital as part of the prevention of hospital-acquired infections. MATERIALS AND METHODS: This study was carried out prospectively from April 26h to May 25th. An anonymous questionnaire was administered by 20 formed investigators to health workers, along with an inventory of available resources for hand washing in the study site allowing to collect the data by interview. RESULTS: A total of 256 health workers were investigated. The mean age was 35.3 +/- 9.4 years [range = 20-71] with a sex ratio of 0.62. As for the education level, the secondary and university predominated. The concept of Manu carrying was ignored by 59.3% of the personnel. This proportion was higher among people with low education level. Possibility of resident and transitional floras in the hand was ignored by most of the investigated personnel. The hand washing technique to be applied while putting vesicle probe was ignored by 59% of the personnel, and 34% declared using hand towel to dry hands. Half of the personnel ignored that bread soap was not recommended. The availability of hydro alcoholic solutions was variable according to the hospital wards. The lavabo/bed ratio was 1/7 and was unacceptable. CONCLUSION: In Fann hospital, the importance and the techniques of hand washing are not well known, that's why a training of the hospital's Personnel and an improvement of resources for handwashing are necessary for a good hospital's hygiene.

Fortuitous Detection of cmy-2 and dha-1 from ESBL-producing Escherichia coli in Senegal.

Cephalosporinases, which are naturally present in some enterobacterial species, can be mobilized by transposons, migrate to plasmids, and spread into other species such as Escherichia coli. The aim of this study was to characterize genes responsible for the production of extended-spectrum ß-lactamases (ESBL) in E. coli isolates from urinary origin isolated in two hospitals in Senegal. Thus, a fortuitous discovery of plasmidic cephalosporinase in two isolates was noted. One of the isolates produced dha-1 associated with ESBL CTX-M-14, the other produced cmy-2, ESBL CTXM-15, tem-1 penicillinase, and oxa-1. This confirms the circulation of multidrug-resistant bacteria producing plasmidic cephalosporinase in Senegal. However, a large study is needed to better understand the prevalence and the nature of the genes involved.

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.

A longitudinal epidemiological survey of bovine trypanosomosis and its vectors in the White Volta river basin of Northern Ghana.

A longitudinal epidemiological survey of bovine trypanosomosis and its vectors was carried out in the Volta river basin of Northern Ghana to determine the relationship between cattle management and the incidence of bovine trypanosomosis. Two groups of sentinel cattle under different systems of management, classified as "fully-sedentary" and "partially-sedentary" (depending on the type of management) were followed over a 1-year period starting from March 2003 onwards. Cattle were screened at intervals of 3 months using the buffy coat technique (BCT). Buffy coat specimen from animals that were positive for the BCT and those that were negative, but with a packed cell volume (PCV) of less than 21% were further tested using the polymerase chain reaction (PCR). Plasma from all animals were tested for antibody using the indirect antibody enzyme-linked immunosorbent assay (ELISA). Trypanosomosis challenge was determined in tandem with the epidemiological survey with watering sites of sentinel cattle being the foci of interest. The parasitological prevalence at the start of the survey was higher in the fully-sedentary group (9%) than in the partially-sedentary group (3%). In subsequent visits, however, the parasitological incidence was consistently higher in the partially-sedentary group than in the fully-sedentary group. The mean seroprevalence (ELISA) of both groups increased from 3% in March to 54% in December. Statistical analysis of the serological results using a random effect logistic regression, showed a significant difference in incidence of bovine trypanosomosis between the two groups. There was also a significant effect of time. The influence of cattle herding on host-vector-parasite interface and its consequence on the incidence of trypanosomosis are discussed.

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%).

Ten years of research activities on tropical parasitology of dromedaries, cattle, and small ruminants in Mauritania.

In the past, the essential part of the activity of the parasitology laboratory of the Centre National d'Elevage et de Recherches Vétérinaires (CNERV) was represented by diagnostic work that enabled the construction of an inventory of local parasitic fauna and a good collection of specimens. However, the small and irregular number of samples each year, led us to switch our activities in 1990 toward work that could better justify the existence of CNERV. We started work on applied research topics, such as tick-borne diseases, helminthology (nemathelminths and plathelminths), and trypanosomosis. These results were valorized through scientific publication and communication at international meetings. The most valuable information was conveyed to herders.

Some factors affecting the prevalence of Trypanosoma evansi in camels in Mauritania.

A study was conducted on the epidemiology of camel trypanosomosis in Mauritania using 2073 camels of various ages in five regions (Trarza, Gorgol, Adrar, Hodh E1 Chargui, Nouakchott). The prevalence was determined through blood smear and serological tests: card agglutination test for trypanosomiasis (CATT) and immuno fluorescence antibody test (IFAT). The prevalence of the disease was 1.3% using blood smear examinations, 16.2% with CATT and 25.2% with IFAT. The following variations were observed: (1) Camels in Trarza had the highest prevalence; (2) Intraregion was a significant factor; (3) Animals that migrated to the south were more commonly infected than those in the north; and (4) Animals in the 5- to 10-yr age group had the highest prevalence. The study indicated that camel trypanosomosis was widespread in Mauritania, especially in the wooded areas near waterways in the south.

Adaptation to arid environment: Haemonchus longistipes in dromedaries of Saharo-Sahelian areas of Mauritania.

The adaptations of the trichostrongylid nematode Haemonchus longistipes of dromedaries (Camelus dromedarius) to the harsh environment of Saharo-Sahelian climate were assessed by means of (i) an epidemiological survey of dromedary infection in the south-west of Mauritania, (ii) an estimate over a 3 year period of parasite distribution within the host population and of prolificacy of H. longistipes females recovered from natural populations of infected dromedaries sampled at Nouakchott's slaughterhouse, and (iii) experimental infections of young dromedaries during three different periods of the year (end of the rainy season, middle and end of the dry season). Egg excretions (estimated by faecal egg counts), infective larvae derived from eggs as well as female prolificacy showed a marked seasonal pattern: high values in the rainy season and very low values in the dry season (especially March and April). Female prolificacy differed slightly between morphotypes: the knobbed type excreting over a longer period than the linguiform and smooth types. Following experimental infections in young dromedaries, arrest of larval development took place irrespective of the period. The survival strategy of H. longistipes in the dry season was based only on arrested larval development. Patent infections occurred from July to October, i.e. during the rainy season and was facilitated by the conjunction of high prevalence and intensity of adult worm burdens associated with high female prolificacy.

Dry areas: an example of seasonal evolution of helminth infection of sheep and goats in southern Mauritania.

A total of 647 faecal egg counts and 53 necropsies were performed on sheep and goats originating from three sites of a Sahelian region of Mauritania (Gorgol) over a period of 2 years (1990-1992). Haemonchus contortus, Oesophagostomum columbianum and Stilesia globipunctata were the most prevalent species. The seasonal pattern was characterized by long survival of adults and high percentages of arrested fourth-stage larvae in the dry season, suggesting that two different strategies were used to survive from one rainy season to the next. Sheep and goats were equally infected, except for Stilesia globipunctata, which was found more often in sheep. The influence of age was limited, although kids and lambs born in the beginning of the dry season did not become infected until their first grazing in the rainy season.

A cross-sectional epidemiological survey of bovine trypanosomosis and its vectors in the Savelugu and West Mamprusi districts of northern Ghana.

The epidemiology of bovine trypanosomosis was investigated in two districts (Savelugu and West Mamprusi) of Northern Ghana with different land use and environmental characteristics. The land use intensity and environmental change was suspected to be higher in the Savelugu District. A cross-sectional entomological survey conducted along the White Volta river and its tributaries confirmed the presence of only Glossina palpalis gambiensis and G. tachinoides. The challenge index as measured by the product of tsetse density and tsetse infection rate was much higher in the West Mamprusi (19.6) than in the Savelugu district (4.7). A total of 1013 cattle (508 in Savelugu and 505 in West Mamprusi) were bled from a random selection of 16 villages in the Savelugu District and 13 villages in the West Mamprusi District. Blood samples were examined for trypanosomes by the buffy coat technique (BCT). Blood samples that were positive in the BCT or negative in the BCT but with packed cell volume (PCV) values below 21 were further tested with a polymerase chain reaction for trypanosomal DNA. Plasma samples of all cattle were serologically tested with an indirect ELISA for trypanosomal antibodies. The parasitological and serological prevalence of bovine trypanosomoses was significantly higher in West Mamprusi (16 and 53%, respectively) than in Savelugu District (8 and 24%, respectively). An evaluation of animal health at the village herd level, using PCV as an index of anaemia, provided various epidemiological scenarios prevalent in the entire study area.

Helminths of sheep and goats in desert areas of south-west Mauritania (Trarza).

Faecal samples were obtained from sheep and goats before, during and after the rainy season at three locations in south-west Mauritania. Several animals were also necropsied at the same time. Haemonchus contortus was the most prevalent worm. Infection by digestive-tract strongyles and Strongyloides papillosus was always very light (prevalence less than 20%). Sheep were more heavily infected than goats but animals under 1 year of age were not infected by digestive-tract strongyles. It is likely that young small ruminants became infected during the rainy season and that the parasites so acquired are inhibited in their development and/or survive nearly one year as adults.

[Parasitic and bacterial etiologies of diarrhea among people living with HIV hospitalized in Fann hospital (Senegal)]. / Etiologies Bacteriennes Et Parasitaires De Diarrhees Chez Les Personnes Vivants Avec Le VIH/SIDA Au Chnu De Fann (Senegal).

Diarrhea is the most common opportunistic infection in AIDS. We conducted at the Fann National University Hospital in Dakar, a study of all patients living with HIV, hospitalized in the the Clinical service of Infectious Diseases from 1 January 2003 to December 31, 2006, with diarrhea and having received an bacteriological and / or a parasitological examination of stools. The aim of this study was to identify the various pathogens isolated in the laboratory and responsible for those diarrhea. In total, 351 patients were collected, their average age was 39.93 years and the extreme ages 15 and 72 years. HIV1 serological profile was found in 90.77% of patients; 34.42% of patients received a dosage of CD4 count, among them 21.09% had a rate <200/mm3. Fifteen stool cultures were positive with the following breakdown: - Shigella (10 strains): 7 strains of Shigella flexneri, 2 of Shigella sp, one of Shigella sonnei; antibiotics most active on the Shigella strains were third generation cephalosporins and quinolones. - Salmonella (5 strains) with Salmonella Typhimurium and Salmonella Enteritidis, strains sensitive to an association of amoxicillin + clavulanic acid, to cephalosporins and to ciprofloxacin. 289 patients received a parasitological examination of the stools (KOP) and the positive number of KOP was 90 a 30,14% rate. The parasites most frequently found were: Cryptosporidium parvum, representing 10.38% of positive KOP, Isospora belli 6.23%, and Entamoeba coli 5.19%. These parasites were found predominantly in patients infected with HIV1 (61 cases/90). Cases of cobacterial and parasitic co-infections were also found. Diarrhea is one of the leading causes of death among people living with HIV. The etiologies of diarrhea, multiple, are yet to be identified and this should go through an improvement of the technical capacity and quality of our laboratories.

[Comparison of the pathogenic effect in mice between stocks of Trypanosoma evansi from Mauritania and from Kenya, Niger, Chad and China]. / Comparaison du pouvoir pathogène pour la souris d'un stock de Trypanosoma evansi de Mauritanie avec celui de stocks en provenance du Kenya, du Niger, du Tchad et de la Chine.

The pathogenicity to mice of a stock of Trypanosoma evansi from Mauritania has been compared to that of stocks from Kenya, Niger, Chad and China, using doses of 5.10(5), 2.10(6) and 5.10(6) trypanosomes per mouse. The survival of mice inoculated with stocks from Kenya, Niger and China is short, on average 2.1 to 6.5 days. Mice inoculated with stocks from Mauritania and Chad survive longer, 12.5 to 22.7 days, depending on the dose.

[Camel trypanosomiasis caused by Trypanosoma evansi (Steel 1885), Balbiani 1888, in Islamic Republic of Mauritania: results of surveys in the Trarza region]. / La trypanosomose cameline à Trypanosoma evansi (Steel 1885), Balbiani 1888, en République islamique de Mauritanie: résultats d'enquêtes dans le Trarza.

A first survey concerning camel trypanosomiasis due to Trypanosoma evansi was carried out in the Trarza region (south-western Mauritania). Blood smears were made from 218 animals and 160 were submitted to an indirect immunofluorescence test. Young calves below one year old seem to be free of T. evansi infection, while in dairy females, average rates of infection of 7.3% (blood smears) and 24.5% (serological results) were found. The type of herd management seems to be an important risk factor: the herds that frequent, even temporarily, the wooded areas of the Senegal river valley or permanent water collections (R'kiz lake) show the highest infection rates. Recommendations are presented to camel rearing owners, especially those with dairy camel herds in the South of the country.

[Trypanosomiasis caused by Trypanosoma evansi (Steel 1885), Balbiani 1888 in small ruminants in Mauritania: results of experimental inoculation and field surveys]. / La trypanosomose à Trypanosoma evansi (Steel 1885), Balbiani 1888 chez les petits ruminants de Mauritanie: résultats d'inoculation expérimentale et d'enquêtes sur le terrain.

In order to define the eventual role of small ruminants in the epidemiology of T. evansi infection in Southern Mauritania, the following experiments were carried out: the intravenous inoculation of a ewe and a goat with a local strain of T. evansi isolated from a dairy camel; surveys of small ruminant flocks which graze with infected camels in the South of the Trarza region. The experimental inoculation allowed to show that local sheep and goats are receptive. Only the ewe showed a clinical episode with loss of weight and abortion. During 220 days after inoculation the blood of the goat remained constantly infectious for the mouse whereas in the same period the ewe's blood showed an alternation of infectious and non-infectious phases. However in the field, none of 381 blood smears of small ruminants (207 goats, 174 sheep) were positive and none of the 187 serums (109 goats, 78 sheep). Therefore, it seems that the small ruminants of the South Mauritania do not play any role in the epidemiology of T. evansi camel trypanosomosis even if they are receptive to experimental inoculation.