[Migrant foreign body of the oesophagus: report of a case]

OBJECTIVE

Evaluate the risk brought by the traditional practice in the evolution of the foreign bodies of the aesophagus.

CASE REPORT

30 years old male with migration from the oesophagus of a fish bone in soft tissue of the neck, which could have been favored by the traditional practice. The diagnosis of migration was suspected when a laterocervical mass appeared after a traditional processing. The rigid aesophagoscopy was negative and the scanner allowed to identify the foreign body in an extraluminal location. It was removed by cervicotomy. Postoperative was uneventful.

Re-emergence of Rift Valley fever virus in Barkedji (Senegal, West Africa) in 2002-2003: identification of new vectors and epidemiological implications

The Rift Valley fever virus (RVFV) is a threat that must not be neglected, as the consequences of RVFV are dramatic, both for human and animal health. This virus is a zoonotic virus that already has demonstrated a real capacity for re-emerging after long periods of silence, as observed in Barkedji (Senegal, West Africa) in 2002. In this article we present the 2nd emergence in Barkedji after the 1st manifestation in 1993, and for the 1st time the circulation of RVFV during 2 consecutive years among mosquito populations in Senegal. As part of the entomological surveillance program undertaken since 1990 to detect circulation of the RVFV in Barkedji, 108,336 mosquitoes belonging to 34 species and 5 genera were collected in 2002-2003. Aedes vexans and Culex poicilipes, previously known to be vectors of RVFV in Senegal, comprised 88.7% of the total collection. In 2002, Ae. vexans was the most abundant mosquito, followed by Cx. poicilipes; the opposite situation was observed in 2003. In 2002, 29 and 10 RVFV isolates were obtained from Cx. poicilipes (minimum infection rate [MIR] = 0.13%) and Ae. vexans (MIR = 0.02%) pools, respectively and the MIR for the 2 species were significantly different (chi2 = 34.65; df = 1, P < 0.001). In 2003, 7 RVFV strains were isolated from Cx. poicilipes (3, MIR = 0.03), Mansonia africana (2, MIR = 0.08), Ae. fowleri (1), and Ma. uniformis (1, MIR = 0.05). The 3 latter species were found to be associated with RVFV for the 1st time in Senegal. A significant decrease in MIR was observed from 2002 to 2003 (chi2 6.28; df = 1, P = 0.01) for Cx. poicilipes, the only species involved in the transmission during the 2 sampling years.

[Implementation of hemovigilance in Sub-Saharan Africa]

PURPOSE OF THE STUDY

Hemovigilance being an essential part of blood transfusion safety, many countries have set legislation for its organization and its establishment. In Sub-Saharan Africa, where transfusion practice is facing many challenges, hemovigilance does not always appear as a priority. Nevertheless, in 2000, Burkina Faso decided to reorganize its blood transfusion system according to the World Health Organisation recommendations and other international standards. A national blood transfusion center and regional blood transfusion centers were created. From 2005 to 2009, a hemovigilance pilot project was conducted by the regional blood transfusion center of Bobo-Dioulasso.

METHODS

The implementation of this hemovigilance project included the following steps: training of medical and paramedical personnel of the health facilities provided with blood and blood products by the regional blood transfusion center, distribution of post transfusion and hemovigilance forms, and the creation of a hemovigilance and transfusion committee.

RESULTS

During the period 2005-2009, 34,729 blood products were distributed for 23,478 patients. The return rate of the post-transfusion and hemovigilance forms (number of files completed partially or completely and returned to the regional blood transfusion center compared to the number of units distributed) raised from 83.1 to 94.8%, the rate of traceability (rate of forms returned to the regional blood transfusion center and totally completed) raised from 71.6 to 91.6%, and the concordance between the patient for which the blood was delivered and the patient transfused moved from 92.9 to 98.0%. The notification rate of transfusion incidents raised from 1.1 to 16.1 per 1000 units transfused during that period.

CONCLUSION

The implementation of a hemovigilance system is possible in the Sub-Sahara African countries. This constitutes a major element in the improvement of different steps of transfusion safety. The implementation of a hemovigilance system requires negotiations between transfusion centers and the hospital personnel, and should be facilitated by the official regulation on blood transfusion practices.

[Bilateral chronic subdural hematoma, concerning 20 cases]

From January 2005 to December 2009, 20 patients have been treated for bilateral chronic subdural hematoma at the Grand Yoff General Hospital in Dakar, Senegal. This was a retrospective study concerning clinical, imaging, and therapeutic issues faced and comparing them to unilateral chronic subdural hematoma issues recorded during the same time period. Median age was 71 years old, ranging from 35 to 95 years old. 17 patients were male and were 3 female. Previous head trauma had been reported for 55% of the patients, high blood pressure - associated or not with diabetes mellitus - had been recorded in 45% of the patients. Clinical symptoms were marked by high intracranial pressure and motor deficits in 70% of cases and 40% showed a mental confusion. Brain CT scans were the key diagnostic tools; all patients undertook a scan and results demonstrated blood subdural collection with variable density in the right brain hemisphere (in 30% of cases). The focus of the surgical treatment was a bilateral burr hole, evacuation of the hematoma and no more than 3 days of postoperative drainage. The medical treatment consisted of an adapted hydro-electrolytic rehydration. The outcome of treatment was positive for 17 patients (85%), 2 patients suffered from subsequent hematoma and 1 patients passed away.

[Neuromeningeal cryptococcosis in Mali]

Cryptococcal meningitis is the most common fatal central nervous system infection in AIDS patients in Sub-Saharan Africa. The purpose of this prospective study conducted from March 2003 to February 2004 in the internal medicine and infectious diseases departments of the Point G University Hospital Center was to investigate the clinical, prognostic and epidemiological profile of Cryptococcus neoformans infection in patients hospitalized for brain and meningeale infection (BMI). Diagnosis of neuromeningeal cryptococcosis (NMC) was based on positive identification of Cryptococcus by direct exam of the cebrospinal fluid (CSF) after India ink staining and/or culture on Sabouraud medium without actidione. During the study period, a total of 569 patients were hospitalized including 235 (41.3%) with HIV infection. Overall C. neoformans was identified in 14 patients. Median patient age was 39 +/- 8 years. There was a male preponderance with a sex ratio of 1.8 (9 men/5 women). Patients with BMI were HIV-positive in 85.7% of cases (n=12) and HIV-negative in 14.3% (n=2). The overall and HIV-specific prevalence of BMI was 2.5% and 5.1% respectively. The CD4 lymphocyte count was between I and 49 cells/mm3 in 64.3% of cases. The main clinical symptoms were cephalea in 85.7% of cases, altered consciousness in 50% and nausea/vomiting in 35.7%. Neurological manifestations (hemiparesis and cranial nerve deficit) were noted in 14.3%. HIV infection is the main purveyor of NMC in Mali. The actual incidence of cryptococcosis is unclear due to the poor sensitivity of diagnostic techniques. This study highlights diagnostic difficulties related to clinical polymorphism and poor technical facilities. Agglutination testing of blood and CSF is recommended, but mortality remains.

[Unusual presentation of mycetoma caused by Actinomadurella pelletieri on the scalp]

INTRODUCTION

Mycetoma is chronic inflammatory process characterized by areas of tumefaction with draining sinus tracts. It affects the foot in 80% of cases. The purpose of this report is to describe a case that posed a diagnostic challenge due to unusual scalp location and clinical presentation.

OBSERVATION

A 23-year-old woman residing in a rural zone of Senegal consulted for indolent lesions ongoing on the scalp for 2 years. Physical examination showed two soft tumid lesions measuring about 3 cm in diameter on the vertex. The surface of the lesions was crusty but showed no sign of granules. Skull x-ray was normal. Skin biopsy demonstrated a polymorphous granulomatous infiltrate with foci of suppuration circumscribing small, irregular grains with radiating filaments. Mycological culture on Lowenstein medium demonstrated Actinomadurella pelletiere. Treatment with cotrimoxazole for 8 months led to significant regression of the lesions.

DISCUSSION

The mycetoma described in this report posed a diagnostic challenge because of its unusual scalp location and especially its tumoral or pseudo-cystic presentation. This clinical form of mycetoma must be taken into account for diagnosis in any patient from endemic areas.

[Disseminated histoplasmosis due to Histoplasma capsulatum var. duboisii in Senegal. A case in HIV-infected patient]

INTRODUCTION

Histoplasmosis, a disease due to Histoplasma capsulatum, is an invasive opportunistic fungal infection, endemic in Africa. So, the occurrence of african histoplasmosis associated with HIV infection has been rarely reported despite the high prevalence of both pathogens in this area. We report the first case of disseminated african histoplasmosis in an HIV-infected Senegalese patient.

OBSERVATION

A patient, 50-year-old has been admitted for umbilicate, necrotic and disseminated papulonodular lesions with oral infection, fever and reduction of total body mass. HIV1 test was positive, and CD4 count was 4/mm(3). Direct examination of ulcerated lesions shown extracellular, large, doubly contoured yeasts. After culture, we obtain brownish colonies, septate hyphae, echinulated chlamydospores characteristic of Histoplasma. Cutaneous biopsy revealed polymorphous granulomatous infiltrate, giant cells containing numerous large, doubly contoured, thick-wall yeast-bodies characteristic of H. capsulatum var. duboisii.

DISCUSSION

The association AIDS and histoplasmosis frequency is probably underestimated because the difficult diagnosis and the ignorance of the medical staff.

[Merkel cell carcinoma of the gingival mucosa in a black young adult]

Merkel cell carcinoma (MCC) is a rare and aggressive primary neuroendocrine neoplasm of the skin with a poor prognosis. It occurs mainly in the skin of white elderly patients. Its occurrence in intraoral mucosal sites is rare. We report a rare case of MCC that arose in the gingival mucosa of young black adult.

[Cystic lymphangioma of the scrotum]

The cystic lymphangioma is a relatively frequent affection. The scrotum is the least common sites. It is a benign tumor discovered during an examination or in a fortuitous way. The diagnosis is done with ultrasonography and the treatment of the limited and circumscribed cases, is a surgical excision. We reported the case of a child of 2 years old which was presented to the surgery emergency for the scrotum traumatism. The clinical and paraclinical exams founded a cystic mass. After mass excision, histopathology founded a cystic lymphangioma.

[Tuberculoma of the posterior fossa: 3 cases in the departement of neurosurgery, university hospital of Gabriel Toure]

The cerebral tuberculoma is an expansive process of slow evolution of the tuberculous bacillus. Bacteriological diagnosis is rarely made. It is usually radiological or histological. The treatment is medical and surgical. We conducted a retrospective study from March 2007 to February 2010 which focused on three cases of cerebral tuberculoma. Two of our patients were male, 75% against 25% female: The age of our three patients was respectively 47, 23, and 4 years. The history of extrapulmonary tuberculosis was found in one case. The heaviness of the head was the pattern in a patient operated on for Pott's disease. The diagnosis was suspected by neuroradiology in 3 patients and histological confirmation was made in 2 cases. The polychimiotherapy of 12 months was established and the improvement has been obtained from the third month of treatment.

Evaluation of the efficiency of bird-baited traps for sampling potential West Nile fever mosquito vectors (Diptera: Culicidae) in Senegal

The efficiency of bird-baited traps and collection heights for sampling potential West Nile mosquito vectors was studied during the 2006 rainy season (between September 27 and November 26) in Barkedji area situated in the sahelian area of Senegal (West Africa). Each night, two traps were set on the ground-level and two on the canopylevel (approximately 3 m) each containing either a chicken or a pigeon, the traps being rotated the following nights. A total of 1,030 mosquitoes were collected using 66 traps-nights. Culex species were predominant and represented 92.2% of the fauna of which 63% belonged to Cx. neavei group Theobald whereas 23.8% were Cx poicilipes (Theobald). The species of the Cx. neavei group were mainly collected by the pigeon-baited trap at canopy while Cx. poicilipes was captured similarly by pigeons and chickens placed at the canopy and ground. The implication of these results in West Nile vectors surveillance is discussed.

[Head and neck injuries: 184 cases in Mali]

This prospective descriptive study was carried out from August 2007 to January 2008 in the emergency surgery department of Gabriel Touré Hospital in Bamako, Mali. A series of 184 patients treated for head and neck injuries was compiled. Patients presenting strictly neurosurgical lesions were excluded. Most of the patients included in this series were young single city-dwelling males (mean, age, 27 years; M/F sex ratio, 4.3. Most injuries were sustained in road traffic accidents (93%). The most common injuries were epistaxis and multiple fractures of facial bones, cervical spine and petrosal bone. These injuries ere often associated with avulsive wounds involving the external ear and nose. The main complication risks fell into four categories, i.e., circulatory loss, upper airway obstruction, functional and/or morphological impairment, and coma-related death (Glasgow score < 8). Shortage of medication and/or disposable treatment kits was a major handicap for optimal management of head and neck injuries.

[Dermatomyositis and polymyositis: 21 cases in Senegal]

Dermatopolymyositis (DPM) is a term describing a group of disorders comprising multiple distinct entities depending on interactions between genetic and environmental factor. There is a paucity of studies on DPM in black Africa. The purpose of this report is to describe epidemiological, clinical, laboratory and therapeutic aspects of dermatomyositis (DM) and polymyositis (PM) observed at the Principal Hospital in Dakar, Senegal. A retrospective review as conducted of patients hospitalized for DM and PM in Medical Departments of Principal Hospital. Diagnosis of DRM was based on the criteria of Bohan and Peter's in all cases. A series of 21 black African patients was compiled including 15 with DM and 6 with PM. Mean age was 52 years and the M/F sex ratio was 0.6. The mean delay for diagnosis was 6 weeks (range, 3 to 12 weeks). Initial signs were dermatological in 12 patients, pulmonary in one and muscular in the remaining cases. The most common dermatological sign was erythema characterized by a zebra-like aspect on the extended limbs. Erythema was frequently pruriginous with a flagellate aspect on the back. Muscular signs were observed in 18 patients and included pharyngeal manifestations in 10 patients. Amyopathic DM was not observed. Cardiac abnormalities included tachycardia (4 cases), AVB (1), ischemic lesion (1), relaxation disturbances (4), pericardial effusion (3), myocarditis (2) and pulmonary hypertension (1). The most common pulmonary manifestation was interstitial lung disease observed in 6 patients. Gastrointestinal signs were noted in 9 patients including endoscopic evidence of superficial erosion in 4 cases. Electromyography (EMG) tracings revealed myogenic disease in 14 cases including 2 associated with reduced peripheral nervous conduction speed. Severe lymphopenia was observed in 3 patients but HIV serology was negative in all cases. Paraneoplasic DM was observed in 3 cases. Death occurred in 5 cases due to the cancer-related, pulmonary and infectious complications. Based on the findings of this study, the three main features of DM and PM in Senegal are flagellated and often pruriginous erythema, cardiac and interstitial lung disease, and peripheral neural involvement.

[Obstacles to laboratory diagnosis of malaria in Mali--perspectives]

Rapid accurate laboratory diagnosis is necessary for effective malaria management. In Mali, meeting this prerequisite is impeded by underuse of laboratory diagnosis by clinicians, absence of qualified laboratory facilities in some locations, and poor continuous professional education of laboratory technicians. The twofold aim of this investigation was to perform quality control of thick smear readings made by laboratory technicians in 1998 and 1999 and to study the feasibility and diagnostic value of two rapid diagnostic tests (RDT), i.e., ParaSight and OptiMAL, in comparison with the thick smear technique in the period from 1998 to 2003. Quality control of thick smear readings indicated a 56% false positive rate with 49.3% concordance between laboratory technician readings and the reference centre. Trials using RDT showed that the OptiMAL test was more efficient with 97.2% sensibility, 95.4% specificity and 93% concordance in comparison with thick smear. A program of training, refresher courses, and regular didactic supervision (quality control) for laboratory technicians has been set up in Mali under the sponsorship of the "Fondation Mérieux" (ACTION BIOMALI) and the President's Malaria Initiative (PMI). These institutions provide funding for training as well as equipment and consumables in all public medical laboratories in Mali. The thick smear method is still being used as the reference technique, but use of RDT is to be implemented at all levels of the health care pyramid.

[Bladder rhabdomyosarcoma apropos of a case in the Urology Service, University Hospital Center du Point G]

The bladder rhabdomyosarcoma in children is a rare tumor. We report a case of bladder rhabdomyosarcoma in a child 3 years, who consulted for more dysuria hematuria. The aim of this work is to remind the symptomatology and clinical aspects of para-clinical examinations of this disease in children after a review of the literature of this disease and discuss treatment options. The rhabdomyosarcoma should be discussed before any symptoms of dysuria associated with hematuria in children. His diagnosis is suspected by medical imaging and confirmed by pathology. Our attitude has been resection of the tumor, then chemotherapy.

[About an autochtonous case of neurocysticercosis in Mali]

Cysticercosis has been reported in Muslim countries in workers coming from endemic regions for Taenia solium. For the first time in Mali, the authors report a case of autochtonous neurocysticercosis where Muslim religion is predominent. The patient was a woman student with fever, arthralgia, headaches, consciousness troubles followed by partial motor epilepsy. Diagnosis was confirmed by clinic, serology ELISA and Western blotting and cephalic tomodensitometry analysis. The medical treatment was successfully based on combination of albendazole and praziquantel. The origin of contamination remains unknown and further investigations are needed, particularly with veterinary research team and the National League against epilepsy recently founded in Mali.

[Anthropological analysis of interactions between health care providers and children in some paediatrics services in Western Africa (Abidjan, Bamako, Conakry)]

Africa represents a major part of infant global mortality. But if the medical causes of these deaths are well-known, the quality of the medical care provided to the children and the way it affects them are not really studied. Our study conducted in three countries of western Africa describes how much the care given to children involves a part of violence and emphasizes how the social status and the children educational popular modes influence the quality of care. The article underlines how the improvement of the quality of care in pediatrics services cannot be limited to a simple improvement of techniques but must also include all these socio-emotional aspects which constitute the foundations of real ethics.

Tenofovir-Emtricitabine-Efavirenz in HIV-I-Infected Adults in Senegal: A 96-Week Pilot Trial in Treatment-Naive Patients

We report the results of a pilot open-label trial of a tenofovir (TDF)/emtricitabine (FTC)/efavirenz (EFV) combination conducted in Dakar, Senegal. Forty HIV-1-infected patients, naive of antiretroviral treatment and without active opportunistic disease, were included and followed through 96 weeks. At weeks 48 and 96, respectively, 82.5% and 85% of patients had HIV-1 RNA <400 copies/mL (72.5% and 77.5% with HIV-1 RNA <50 copies/mL). Between baseline and week 96, the mean (SD) CD4 count increased from 126 (102) to 338 (155) cells/mm3. The mean (SD) creatinine clearance decreased from 92 (36) to 73 (19) mL/min (P = .001). Treatment adherence was at least 94% at all scheduled visits. The efficacy and tolerability of a TDF/FTC/EFV combination were high and similar to those observed in Northern countries. This drug combination can be recommended in limited-resource countries, as did the World Health Organization (WHO) and should be made readily available as a fixed-dose combination.

[Two cases of Crimean-Congo haemorrhagic fever (CCHF) in two tourists in Senegal in 2004]

Two cases of Crimean-Congo haemorrhagic fever (CCHF) occurred in two French tourists during their visit in Senegal in November 2004. Febrile and hemorrhagic syndrome with ulorrhagia, petechiae, haematemesis, haematomas associated with biological signs of disseminated intramuscular coagulation were observed. For the first case who had a medical evacuation to France before diagnosis, Crimean-Congo virus infection was revealed by laboratory tests performed by the National Reference Center for Hemorrhagic Fevers (NRCHF, Institut Pasteur, Lyon) and secondly by the Centre de Référence OMS sur la Recherche des Arbovirus et des virus des Fièvres Hémorragiques (CRORA) in the Dakar Pasteur Institute (DPI). The second case diagnosed by the CRORA died after clinical deterioration with liver failure and severe haemorrhages. Healthcare workers and family members who had contact with tissue or blood from patients were followed up after the putative exposure either in France or in Senegal.

[Impact of care pathway on the delay for initiation of antituberculosis treatment in Conakry, Guinea]

Complex care pathways can result in detrimental treatment delay particularly in tuberculosis patients. The purpose of this retrospective study was to assess the care pathways followed by tuberculosis patients prior to diagnosis and to assess impact on the delay for initiation of treatment in Conakry, Guinea. A total of 112 patients were interviewed at the time of first admission for pulmonary tuberculosis with positive bacilloscopy. Based on interview data, pathways were classified as conventional (use of health care facilities only) and mixed (use of health care facilities, self-medication, and traditional medicine). The correlation between patient characteristics and type of pathway was assessed by univariate and multivariate analysis and the two groups, i.e., conventional vs. mixed, were compared with regard to delay for initiation of treatment. The care pathway was classified as mixed in two out of three patients. Multivariate analysis showed that this type of pathway was only correlated with schooling (p=0.02). The mean delay for treatment was similar, i.e., 13.4 and 12.8 weeks for conventional and mixed pathways respectively (p<0.68). The percentage of pathways including three consultations at health care facilities was significantly higher in the conventional than mixed group (72% vs. 30%, p<0.001). The main reasons given for delayed use of health care facilities were poor knowledge of tuberculosis symptoms (26%) and high cost of care (12%). The findings of this study indicate that tuberculosis patients follow a variety of care pathways that can lead to delayed treatment. An information campaign is needed to increase awareness among the population and care providers.

[Contribution of sonography in the diagnosis of degenerative pathology of the shoulder]

The patients besides 50 years represented 58% with a sex ratio of 1.22 in favor of the women. A limited painful of the movements of shoulder has been noted in 75% of cases of the right shoulder (90%). The sonography was abnormal in 95% of patients, the recovered lesions were : calcifications 58%, ruptures 23.6%, extrusion 15.7%. The supraspinatus muscle and the m.biceps brachii (caput longum) were the more involved in respectively 55.3% and 26.3% . A comparison made between the results of the clinical tests and those of the sonography study show that there is not a homology. Summarise The sonography is a good means diagnosis of the degenerative pathology of the shoulder especially in the beginning where classic x ray examination is less contributive.

[Morbidity of the tumours of the sphere head and neck in Bamako]

This work reports the results of one year (November 2004-October 2005) descriptive study of tumours located in the head and neck areas in the ENT department of the University-Hospital of Gabriel Toure in Bamako. Were included in the study patients whose files showed epidemiology data: age, sex, profession, residence and period of the medical checking, and exposition factors: anatomic location, results of histology and image data of the tumours. Where excluded from the study the patients whose file were not completed and those that have had eye and brain tumours From the data base of the department, a total of 60 cases of tumours were monitored and 25 others cases were excluded according to the criteria. Among the 60 cases, 24 tumours (40%) were malign and 36 were benign. Goiter was the most found benign tumor according to the results of the hystology analysis. In most cases (15 out of 36, 41.67%) the histology analysis showed an colloid adenoma Other rare tumors like rhinoscleroma (5 cases out of 36, 13.89%), nose invertus papilloma (2 cases out of 36, 5.55%) where found. These were easily diagnosed and treated. In the group of malign tumors, the pharyngolaryngeal cancer was the most found (11 cases out of 24) and the most predominant histology of these cancers was the epidermoid carcinoma. Two of these cancers were found in patients below fifteen years of age, but no other risk factors like expositions was noted in the files of these two patients. Other malign tumors have been found: nose and sinusal cancers and thyroid carcinoma. In most cases these tumors were diagnosed at an advanced stage.

[Use of insecticide-treated cattle to control Rift Valley fever and West Nile virus vectors in Senegal]

Rift Valley Fever (RVF) and West Nile fever (WN) viruses are transmitted by several mosquito species and share the same vectors in Northern Senegal (West Africa). In absence of an effective treatment and vaccines, vector control remains an alternative method of prevention and control of these vector-borne diseases. The methods targeting adults' pest mosquitoes and malaria vectors which are currently used by the population in the Barkedji area (insecticides treated nets, bombs and copper coil) would not be effective against these vectors because of their exophagic and zoophilic behavior. Thus, we decided to evaluate the effectiveness of insecticide-treated cattle as a method to control these vectors. We evaluated the effects of this treatment on the mortality and the behaviour (attractiveness and engorgement) of the main vectors and subsidiary the whole mosquito fauna. Our study was conducted during September 2005, and between July and November 2006, at Niakha pond located 4 km from the Barkedji village in the Sahelian region of Senegal. A bull-calf was treated with 25 mg/m2 of deltamethrin and compared to an untreated calf of the same weight used as a control. The assays were conducted using two net-traps placed at the edge of the pond from 19:00 PM to 22:00 PM each night for 4 nights per week for 4 consecutive weeks after each treatment. The risk that host- seeking mosquitoes that do not have possibility to feed on cattle might turn to men cohabiting with these cattle was evaluated simultaneously during the bioassay. The deltamethrin treatment led to a significant reduction in the average number of mosquitoes attracted by the treated-calf compared to the control during the first 2 weeks post-treatment both for all species and for the main vectors such as Ae. vexans, Ae. ochraceus, Cx. poicilipes, Cx. neavei and Ma. uniformis. However these means were comparable for the last two weeks post-treatment both for the whole mosquito fauna and the main vectors with the exception of Cx. neavei. The treatment resulted in a significant reduction in the rates of engorged females during the first two weeks post-treatment. Indeed, the females' engorgement rate on the treated-calf compared to the control has been reduced by 57.3% for Ae. vexans, 39.8% for Ae. ochraceus, 76.4% for Cx. poicilipes, 82.4% for Cx. neavei, 84.6% for Ma. uniformis and 64.1% for the whole mosquito fauna. This effect of the treatment was maintained in the second fortnight post-treatment only for Cx. neavei. Mortality rates were higher among mosquitoes collected with the treated-calf compared to the control in the first fortnight of the test. This impact of the insecticide has been maintained in the second fortnight post-treatment excepted for Cx. neavei. However a significant variation of the mortality of the mosquitoes collected with the treated-cattle was observed between the two fortnights. In fact, the mortality rate of the mosquitoes collected on the treated-cattle decreased by 43.8% for the mosquito fauna as a whole, 47.5% for Cx. poicilipes and 82.4% for Ae. vexans, 76% for Ae. ochraceus, and 63.3% for Ma. uniformis. No deviation of host-seeking mosquitoes, from treated calf to men, has been observed since the average number of host-seeking mosquitoes collected on men close to the two calves was statistically comparable. The insecticide-treated cattle may be a good method for controlling RVF and WN vectors and associated mosquitoes in Senegal. However there is a need to develop new formulations or new strategies of application that could improve the duration of the effectiveness of the treatment.

[Randomized clinical trial of two malaria prophylaxis regimens for pregnant women in Faladie, Mali]

From June 2003 to May 2004 we carried out a comparative study of two malaria prophylaxis regimens for pregnant women. The purpose was to compare the efficacy of two regimens using chloroquine (CQ) or sulfadoxine-pyrimethamine (SP) during pregnancy and delivery in a village located in an endemic area of Mali. The study was carried out in Faladié (District of Kati) located 80 km from Bamako. Prophylaxis was administered during the second and third trimesters of pregnancy (except the 9th month for SP). A total of 301 pregnant women were enrolled including 150 in the CQ group and 151 in the SP group. At the onset of the study, the two groups were comparable with regard to socio-demographic and malaria factors. At the time of delivery, malaria infection was reduced by 43.3% in the CQ group (P < 10-6), and by 79.1% in the SP group (p < 10-6). The anemia rate was reduced by 57.5% in the CQ group (Ch2 of McNemar = 0.017), and by 74.8% in the SP group (Ch2 of McNeamar = 0.025). The incidence of placental infection was 20.6 % in the CQ group versus 8.3 % in the SP group (p = 4.10-3). Overall 16.7% of newborns presented low birth weight at delivery including 70.4% in the CQ group. The findings of this study suggest that intermittent presumptive treatment using SP is more effective than intermittent presumptive treatment using CQ in protecting both the mother and newborn against intra-uterine malaria transmission and its consequences.

[Human subcutaneous dirofilariosis due to Dirofilaria repens. A case diagnosed in Strasbourg, France]

We report a case of human dirofilariosis in a 35 year-old man living in Alsace (North-East France), who presented a subcutaneous nodule of the left cheek, strongly simulating an epidermic cyst. Surgical excision and histopathological examination unexpectedly established the diagnosis by the presence of nematode worm sections identified as Dirofilaria (Nochtiella) repens. This patient living in a rural area of Strasbourg spent one week in Toulon, Southern France. This new observation of cutaneous dirofilariosis constitutes the third Alsatian case described in literature, and emphasizes the presence of this parasitic disease in Southern France.

[Integrated approach to yellow fever surveillance: pilot study in Senegal in 2003-2004]

The aim was to undertake a pilot study of integrated surveillance of yellow fever (YF) in Senegal, based on i) a human surveillance involving healthcare centers in the 11 administrative regions of the country ii) an entomological surveillance including domestic and sylvatic environment and iii) screening mosquitoes for YF virus using RT-PCR method. The integrated approach of human and entomological surveillance was conducted for 2 years (2003-2004). Surveillance in human population was based on screening samples of YF suspected cases (i.e. patients with acute (< or = 15 days) febrile illness with jaundice) for YF specific IgM antibodies. The entomological surveillance was carried out by collecting mosquitoes using human landing catch method and attempt to detect YF virus on them by RT-PCR. Forty five percent of the healthcare centres notified at least one suspected YF case during 2003-2004 periods. Among the 342 sera collected over 2 years, 2 revealed anti-YF IgM antibodies leading to investigations which allowed identification of the source and place of infection and implementation of a reactive focused YF immunization campaign. In addition, YFV was detected by RT-PCR from 49 out of 1762 mosquitoes tested and distributed as follows: in the sylvatic environment, 29 from Aedes furcifer and 1 from Aedes aegypti while in the domestic area, 15 Aedes aegypti and 4 Aedes furcifer. RT-PCR was found more sensitive and rapid than viral isolation for YF virus detection in mosquitoes. The pilot study in Senegal for YF surveillance integrating human and entomological parameters in domestic and sylvatic areas showed that this approach is very efficient in detecting yellow fever virus circulation due to the complementarity of the two systems. Therefore, in the light of the encouraging results presented herein, similar studies in different context and areas are needed to further validate and allow the extension of its application to other endemic regions of Africa.

[Evaluation of primary health care activities at the Albert Schweitzer hospital in Lambarene, Gabon]

In 1999 the Albert Schweitzer Hospital in Lambrene, Gabon set up a community health care service that provides immunization campaigns and mother/child health care and manages 9 village health care centers in a district with a population of approximately 64000 inhabitants. An evaluation conducted in April 2006 showed that collection of a consultation charge (15 euros) could cover the basic costs of operating these centers and purchasing necessary medicines. Three of the four centers evaluated demonstrated good quality indicators including properly kept records, posting of information bulletins for patients, appropriate referrals, and good relations with village authorities. At the center that performed poorly, the nurse apparently received no pay or lodging. Analysis of data about pediatric activity showed that diagnosis of diarrhea, malnutrition and anemia has fallen while hospitalization for tuberculosis and urinary schistomiasis is now being recorded. At the same time, village health centers are increasingly concerned with problems related to management and prevention of AIDS, malaria and urinary schistomiasis. This service shows that with good supervision it is possible to improve the quality of primary health care with partial but adequate recovery of costs and that basic health care workers are able to provide overall management for complicated patients, facilitate the work of reference hospital, and report new health problems.

[In vitro cultivation of fields isolates of Plasmodium falciparum in Mali]

Malaria immunology, molecular biology and pathogenicity studies often require the adaptation of Plasmodium falciparum field isolates to continuous in vitro cultivation. For this purpose we have established propagation protocols of asexual erythrocytic stages of P. falciparum samples from malaria patients or asymptomatic carriers in Mali. The parasites were grown in standard culture medium supplemented by human serum and in a culture medium without human serum but supplemented by AlbuMax 1. The candle jar environment and tissue culture flasks gassed with 5% CO2, 5% O2 and 90% N2 obtained from a portable gas mixer were used. Protocols for parasite cultivation in a resource-poor setting were developed. These protocols were successfully applied to fresh isolates in Mali as well as to blood samples frozen in liquid nitrogen and shipped to a laboratory in U.S.A.

[Antiphospholipid antibodies syndrome in dermatology in Dakar: 11 case report]

INTRODUCTION

Our aim was to report the cutaneous features of antiphospholipid antibodies syndrome in Dermatology in Dakar.

METHODS

Our study was retrospective from January 2000 to December 2001. All patients were diagnosed according to the criteria of the international consensus statement in 1999 on the antiphospholipid antibodies.

RESULTS

Eleven cases (all female) were collected with a median age of 28 years. A systemic lupus was associated in 7 cases, a scleroderma in 1 case and mix connectivity in 1 case. The dermatological manifestations found in all patients were necrosis of the extremities (4 cases), purpuric lesions (4), cutaneous ulcers (3), acrocyanosis (2), livedo (1) and subungual splinter hemorrhage (1). The obstetrical incidents were noted in 82% of cases; there were precocious and repeated abortions (in 5 cases), foetal loss (in 4 patients), precocious delivery (in 2 cases), lateness of growth in uterus (in 1 case). It was an arterial thrombosis in 2 cases. The mean level of anticardiolipin antibodies was 60 UGPL and a dissociation of the syphilitic serology was present in 9 patients. A severe thrombopenia in 1 case was observed. The evolution was favorable in 7 patients. In other cases, we noted foetal loss in 2 cases and distal necrosis relapse in 2 cases.

CONCLUSION

Cutaneous manifestations are diverse. They can be lupus involvements or microcirculatory thrombosis and they make the diagnostic easy.

[Cutaneous side effects of antiretroviral drugs]

The goal of our study was to report cutaneous side effects of anti retroviral drugs. For this purpose we performed a transversal prospective trial during 6 month in the dermatological department and in the out patients management department of Dakar. Heighty four (84) cutaneous side effects were encounted in 38 HIV infected patients. There were 6,1% of toxidermies, severe in 3 cases (2 Stevens Johnson syndrome d 1 DRESS), 3,5% of immunitary restauration syndrome (2 zonas, 4 herpes) and 3,9% of lipodystrophy. The putative drugs of toxidermies were Nevirapine, Effavirenz and Zidovudine and antiproteases and Stavudine were the cause of lipodystrophy. The duration before apparitions of the lesions was 16,9 days for toxidermies, 45,5% for immunitary restauration syndrome and 40,72 months for the lipodystrophy.

[Elephantiasic pretibial myxoedema: study of five cases]

INTRODUCTION

Elephantiasic myxoedema is very rare. We report 5 pretibial myxoedema cases observed in the Dermatological department of Le Dantec hospital in Dakar.

PATIENTS AND METHODS

Our 5 cases were 3 women (age: 52, 45 and 18 years) and 2 men (age: 54 and 32 years).

RESULTS

All the cases were enormous, multinodular pachydermic, bilateral, elephantiasis in the low leg and associated to Graves 'disease. The duration was 4 month to 12 year. In 3 cases there was a Diamond syndrome which is a severe form. The cutaneous lesions were not influenced by medical treatment of thyroid disease. Systemic steroids achieved improvement of the elephantiasis in 1 case.

CONCLUSION

Elephantiasis is a very unusual presentation of pretibial myxoedema and its occurrence doesn't depend to the intensity of thyrotoxicosis and its evolution. However in our cases, it was a severity indicator factor, like Diamond syndrome. Local and systemic steroids give very rarely improvement.

[Feeding pattern of Rift Valley Fever virus vectors in Senegal. Implications in the disease epidemiology]

During the rainy season 2003, an entomological survey was undertaken in the Sahelian bioclimatic zone of the Ferlo area in northern Senegal, in order to evaluate the degree of interaction between Rift valley fever (RVF) virus vectors and domestic animals and to determine the role of natural vertebrate hosts in the transmission and maintenance cycle. The study of vector-host contact was carried out under bed net traps using man, cow, sheep, chicken as bait whereas the RVFV vectors-vertebrate host interactions were studied through the analysis by an ELISA technique of the origin of the blood meals from naturally engorged females collected by aspiration. Blood meals sources were determined using a set of eight antibodies. Overall, the different known RVFV vectors (Culex poicilipes, Aedes vexans and Aedes ochraceus) were opportunistic although the bovine-baited net was, as far the more effective trap with 53.6% of collected mosquitoes. It was followed by the sheep-baited net (16.7%), man-baited net (12.6%) and chicken-baited net (11.6%). The more effectiveness of the bovine-baited net confirms the degree of implication of this host in RVF epidemiology. The study of vector-hosts interactions in nature showed that among the 1,112 mosquito blood meals tested, 701 were identified of which 693 were from Aedes vexans. The percentage of non-reacting blood meal was 36.7% whereas 16.9 % of the blood meals were taken at least on two vertebrate hosts. Overall, 53.2% of the blood meals from Ae. vexans were taken on equine, 18.6% on bovines, 7.1% on sheep and 0.6% on human. No blood meal was taken on rodent. The greatest diversity was observed in August. These host feedings patterns show that although equine is known to play a minor role in RVF epidemiology a thorough attention should be made to this host with regard to the percentage of blood meals taken in this host. The low percentage of blood meals taken on human could probably explain the low human infection rate observed up to now in Senegal. With the high percentage of non-reacting blood meals, our results also underline the necessity of an improvement of ELISA techniques and the use of more reliable tools as molecular markers for an exhaustive identification of vertebrates hosts involved in RVF epidemiological cycle.

Differences in circulating dendritic cell subtypes in peripheral, placental and cord blood in African pregnant women

Dendritic cells (DC) are important for induction of primary immune responses and immunological tolerance. Changes in the frequency of DC subsets were analyzed in peripheral blood from pregnant women (mPB) and compared to placental blood (PB) and cord blood (CB). DCs were identified by flow cytometry in whole blood as lineage negative and HLA-DR-positive cells. Different DC subtypes were identified with CD123 and CD11c markers. In these data, the percentage of DC was significantly lower in mPB, PB and CB than in control women, but the absolute number of DC was higher in CB, suggesting that numbers of DC in CB do not explain the decrease of the immune response in newborn infants. Myeloid DCs (MDC) decreased in all compartments of pregnant women compared to control women, especially in mPB where MDC became lower than lymphoid DCs. An increase of less differentiated DC was observed in mPB and CB from pregnant women. DCs in pregnant women were mainly immature DC with a proportion of CD83-positive DC, identical as control women. The levels of IFNgamma, TNFalpha, IL-2, IL-4, IL-5 and IL-10 were not different in the three compartments (mPB, PB, CB). In conclusion, the phenotype and subset of DCs were different in pregnant women than in control women, suggesting a role in maintenance of immune tolerance against the fetus. The distribution of DC subsets was different in mPB, PB and CB. Their role in the regulation of immune response remains to be elicited.

[Sickle cell beta-thalassemia leading to serious ischemic retinopathy: a study of 18 patients in Abidjan]

The authors in this study intended to demonstrate that S-beta thalassemia can lead to severe ocular hemorrhagic risks, as is true of the sickle cell form. Both forms are also comparable in terms of the risk of aseptic necrosis of the femoral head. Out of the 18 patients studied, 13 (72.2%) had sickle cell retinopathy. Three of 13 patients had already developed new vessels and risked intravitreous hemorrhage. The authors recommend that more vigilance be mounted for the detection of S-beta thalassemia so as to benefit from rigorous and systematic follow-up and early treatment. Retinal argon laser photocoagulation is only effective if a clear diagnosis is made early.

[Imaging of pediatric urinary tract malformations: a series of 32 cases]

PURPOSE

To determine the incidence of pediatric malformative uropathies and to point out the radiological aspects.

MATERIAL AND METHODS

Exploratory studies of 32 cases of malformative uropathies were assessed between January 1998 to June 1999 in the Radiology Departement of Gabriel Touré Hospital of Bamako. Patients aged from 3 days to 15 years underwent sonographic and radiological examinations.

RESULTS

The sex ratio was 4 males to 1 female. The main findings were: prune belly syndrome (6 cases), posterior urethral valves (13 cases), bladder exstrophy (3 cases), renal ectopy (6 cases), ureterocele (1 case), hypospadias (1 case), megauretere (1 case) and pyelo-ureteral junction syndrome (1 case). Radiological signs were mainly related to hydronephrosis and bladder lesions.

CONCLUSION

Malformations of the urinary tract are frequent in daily practice. Imaging plays a key role in the assessment and diagnosis.