[Tuberculosis in the elderly: Epidemiology and outcomes of ambulatory followed-up in Abidjan]. / La tuberculose du sujet âgé : épidémiologie et devenir des patients suivis en ambulatoire à Abidjan.

BACKGROUND: Very few works approach elderly's tuberculosis (TB) in developing countries. The aim of this study is to present elderly's TB epidemiology and the outcomes of the ambulatory follow-up of the tuberculous patients aged more than 65years old (TBE) compared to the TB among patients less than 65years old (TBY). METHODS: Our study is retrospective covering period of January 1999 to June 2006 activities of Adjamé's antituberculous center. It is a comparative study between patients of at least 65 years and patients of less than 65years when the diagnosis of TB was made. RESULTS: Among 36,923 cases of TB, the proportion of TBE is 2.33%. In case of TBE, the sex-ratio is 2.16 versus 1.50 among TBY (P<0.001). Localization of TB is pulmonary in 61.70% among TBE versus 67.26% among TBY (P=0.058). Among elderly's TB, the osteoarticular localization is more frequent. TB-VIH co-infection prevalence is estimated to 9.05% among elderly's TB versus 44.38% among patients of less than 65 years (P<0.001). The therapeutic success rate within elderly patients is 52.16% years versus 61.42% when it was patients of less than 65 years. The proportion of lost at follow-up and the rate of patient transfers within the elderly's TB are the most raised. CONCLUSION: The elderly's TB is rare with a more masculine predominance. TB-VIH co-infection is not important among elderly's TB. The aged patient follow-up must be improved.

[Couple life and management of HIV infection in the pneumology department of the Teaching hospital center of Cocody, Abidjan, Côte d'Ivoire]. / Vie de couple et prise en charge de l'infection à VIH au service de pneumologie du CHU de Cocody, Abidjan, Côte d'Ivoire.

Introduction: The life of a couple is a place of emotional support. It can allow the management of patients infected with HIV on antiretroviral therapy to be optimized.The objective of our study was to analyze the impact of married life on the therapeutic follow-up of patients living with HIV. Methodology: We carried out a mono-centric, prospective, descriptive and analytical study in the care unit of patients living with HIV of the pneumology service of the Cocody Teaching Hospital in Abidjan. The investigation took place from September 1, 2015 to March 31, 2016. Results: We included 411 patients. The sex ratio was 0.51. The average age was 43.2 years with extremes of 19 and 69 years. The patients lived as a couple in 59.1% of cases. Couple life was associated with severe immunosuppression at 12 months in 23.3% (42/180) of cases [p = 0.043 OR = 1.735 (0.964 - 3.121)], the appearance of new opportunistic conditions between the 6th and the 12th month of treatment in 5.6% (13/232) of cases [p = 0.006; OR = 9.438 (1.222 - 72.890)], information sharing with the partner before the start of treatment in 92.4% (208/225) of cases [p = 0.035; OR = 1.976 (1.005-3886)] and the existence of sexual intercourse since the discovery of the disease in 92.6% (225/243) of cases [p < 0.001; OR = 14.423 (8.174 - 25.448)]. Sexual relationships were less protected among people living in a couple 65.9% (149/226) versus 78% (64/82) among others [p = 0.027; OR = 0.544 (0.301 - 0.923)]. The loss of the sexual partner at the onset of the disease was observed regardless of marital status (p = 0.203). Conclusion: The life of a couple negatively influences the management of HIV infection. It appears necessary to set up counseling and testing programs for couples.

[Contribution of the surgical treatment of drug-resistant tuberculosis during medical follow-up (experience of the pneumology department of the CHU of Cocody, in connection with five observations)]. / Apport du traitement chirurgical de la tuberculose à bacilles résistants au cours du suivi médical (expérience du service de pneumologie du CHU de Cocody : à propos de cinq observations).

Multidrug resistance is defined as a resistance to two major antituberculosis drugs, which are isoniazid and rifampicin. The aim of the study was to specify the place of the thoracic surgery during the medical follow-up of the TB-MDR. Five files were kept over six years during this retrospective study. On the clinical and radiological level, localised lesions and a negative HIV serology were noted in the five patients. The completion date of the surgery varied between the third month and the 22nd after the beginning of the medical treatment. This delay in carrying out the surgery was encouraged by the social conditions of the patients. Three series of expectoration culture post-surgery were all negative. After surgery, the medical treatment was drawn out over six and 12 months depending on the clinical condition of the patient. No recurrence was observed. Only one patient died one year after the surgery from hemoptysis in relation to pulmonary sequelae.

[Antituberculous retreatement in case of failure to category I regimen]. / Le retraitement antituberculeux en cas d'échec au régime de catégorie I.

INTRODUCTION: In Côte d'Ivoire, since April 2002, the antituberculous regime for category I patients (ARC-I) passed from 2RHZ/4RH to 2RHZE/4RH, without modification of the antituberculous regime for category II (ARC-II) for treatment of cases of the failures to respond to treatment with ARC-I (FARC-I) and patients with a relapse of tuberculosis (TR). The objective of this study was to determine the outcome of patients treated by ARC-II (2RHZES/1RHZE/5RHE). METHODOLOGY: This study was retrospective and compared outcomes during patient follow-up under ARC-II between 1999-2000 (period 1=267 cases) and 2004-2005 (period 2=434 cases). The ARC-II regime has been prescribed for 297 cases of FARC-I and 404 cases of TR. RESULTS: The failure rate of the ARC-II regime was estimated to be 11.98% during the first period compared to 5.53% during the second (P<0.001). Among FARC-I cases, therapeutic failure was estimated to 20.54% versus 5.92% in TR group (P<0,001). We noted a positive sputum smear among FARC-I : 16.16% at the second month, 13.13% to the third month and 20.54% at the fifth month versus 4.20% at the second month, 1.48% to the third month and 5.92% at the fifth month within TB cases (P<0.001). CONCLUSION: Management of failures to the ARC-I regime must be reviewed to prevent the development of multidrug resistant TB.

Assessing allergic rhinitis in developing countries.

BACKGROUND: Allergic rhinitis (AR) affects 5% to 40% of the general population. In developing countries, AR is poorly documented and tracked due to a lack of appropriate diagnostic tools. OBJECTIVE: 1) To validate a questionnaire standardised in industrialised countries to ascertain AR, the Score For Allergic Rhinitis (SFAR), in developing countries; 2) to better understand AR prevalence previously reported from developing countries by comparing results from the SFAR and the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires. METHODS: Six African countries were selected for their climates. In each country, 70 individuals with and 30 without nasal symptoms filled out the SFAR and the ISAAC questionnaires. Skin prick tests (SPTs) for allergens were performed by the physician if necessary. RESULTS: The SFAR presented a close match with the gold standard (the physician's diagnosis of AR backed up by SPT where necessary) in terms of various performance parameters. In particular, it showed high sensitivity (0.84) and specificity (0.81). Compared to the ISAAC questionnaire, the SFAR had greater sensitivity and equal specificity. CONCLUSIONS: In the absence of a medical visit, the SFAR is a useful standardised screening instrument for the collection of information needed for the identification of AR in developing countries.

Prevalence of symptoms of asthma, rhinitis and eczema in 13- to 14-year-old children in Africa: the International Study of Asthma and Allergies in Childhood Phase III.

Phase I of the International Study of Asthma and Allergies in Childhood has provided valuable information regarding international prevalence patterns and potential risk factors in the development of asthma, allergic rhinoconjunctivitis and eczema. However, in Phase I, only six African countries were involved (Algeria, Tunisia, Morocco, Kenya, South Africa and Ethiopia). Phase III, conducted 5-6 years later, enrolled 22 centres in 16 countries including the majority of the centres involved in Phase I and new centres in Morocco, Tunisia, Democratic Republic of Congo, Togo, Sudan, Cameroon, Gabon, Reunion Island and South Africa. There were considerable variations between the various centres of Africa in the prevalence of the main symptoms of the three conditions: wheeze (4.0-21.5%), allergic rhinoconjunctivitis (7.2-27.3%) and eczema (4.7-23.0%). There was a large variation both between countries and between centres in the same country. Several centres, including Cape Town (20.3%), Polokwane (18.0%), Reunion Island (21.5%), Brazzaville (19.9%), Nairobi (18.0%), Urban Ivory Coast (19.3%) and Conakry (18.6%) showed relatively high asthma symptom prevalences, similar to those in western Europe. There were also a number of centres showing high symptom prevalences for allergic rhinoconjunctivitis (Cape Town, Reunion Island, Brazzaville, Eldoret, Urban Ivory Coast, Conakry, Casablanca, Wilays of Algiers, Sousse and Eldoret) and eczema (Brazzaville, Eldoret, Addis Ababa, Urban Ivory Coast, Conakry, Marrakech and Casablanca).