[Internal Hemorroïd Disease In Digestive Endoscopy Center Of Chu Gabriel Toure Of Bamako]

the goal of this study was to investigate the internal hemorroid disease in our endoscopic center.

METHOD

This transversal study went from December 2011 to December 2012.

RESULTS

Sixty cases of internal hemorroid desease were enroled with36 men and 24 women and a middle age of 47 ±14.4 years. Clinical signs were frequently: bleeding (66.7%), constipation (58.4%), anal pain (58.3%) and hemorrhoid prolapsed (18.3%). The anal and rectum scopy found only internal hemorrhoid in 78.4% of cases and the grade I was about 81.7% of cases. All patients were beneficied of medical treatement.

CONCLUSION

hemorrhoid disease is a frequent pathology in general population mainly around third decade.

[Epidemiology and prognosis aspects of upper gastrointestinal bleeding of NianankoroFomba hospital in segou]

AIMS

The goal of our work was to clarify the epidemiologicals, clinicals, etiologicals and prognostics of upper gastrointestinal bleeding at Segou Regional Hospital.

PATIENTS AND METHODS

This cross-sectional study, which took place from October 1, 2017 to September 31, 2018, involved patients hospitalized for digestive hemorrhage.

RESULTS

Upper gastrointestinal bleeding represented 9.7% of all hospitalizations. The mean age of the patients was 50, 94 ± 21, 6 years with a sex ratio of 1.6 in favor of men. Housewives and farmers were represented in 37.7% and 34% of cases. The main modes of disclosure were hematemesis and melena. Evolution was favorable with a mortality of around 34%.

CONCLUSION

upper gastrointestinal bleeding is relatively common in our context. High mortality is linked to delayed treatment.

[Infection with the Hepatitis B virus in pregnant women in the Gynecology and Obstetrics Department of the Gabriel Touré University Hospital Center]

PURPOSE

The purpose of this study was to study hepatitis B virus infection in pregnant women.

METHOD

This was a one-year descriptive cross-sectional study carried out in the Gynecology-Obstetrics Department of the Gabriel Touré University Hospital.

RESULT

During this period, 796 pregnant people were seen in antenatal consultations. Ween rolled 500 pregnant women in whom the search for HBs Ag was carried out, a rate of 62.81%. Of these pregnant 85 had HBs Ag a prevalence of 17%. The average age of these women was 26.9±5.6 years. Our patients were paucipare sin 52.9%. Of these, 17.7% had a family history of chronic liver disease and 37.6% had once given birth in a referral health centre. Blood transfusion, polygamous focus and tattooing/scarification were the risk factors associated with HBs Ag carriage. Alarming clinical signs were absent in 95.2% of cases. Hepatic cytolysis and anaemia were foundin 28.8% and 76.3% of cases respectively; viral replication was observed in 13.6% of pregnant women with a high viral loadin 37.2%. Abdominal ultra sound was normal in 90.8% of cases and esophageal varices were present in 6% of women who performed eso-gastroduduedenal fibroscopy. Fibrosis was significant according to an APRI score in 3.4%.

CONCLUSION

The prevalence of HBs A in pregnant women followed remains high.

Epidemiology and spatio-temporal distribution of gastrointestinal parasites infection and accuracy of FAMACHA test in sheep in traditional farming systems in Burkina Faso

Blood and faecal samples from 2086 Sahelian and Djallonke sheep have been collected to assess the epidemiology and spatio-temporal distribution of gastrointestinal parasites. A survey with a questionnaire allowed collecting data on individual animal and farms. Faecal samples were analysed using the McMaster technique, while anaemia was assessed using FAMACHA score test and packed cell volume. The overall prevalence of gastrointestinal parasites was 91%, and strongyles (70.7%), Eimeria sp. (60.4%), Moniezia sp. (5.7%), Stronyloides sp. (0.9%) were identified. There was no significant association between the region and strongyles infection (P ˃ 0.05). Animals sampled during the rainy season (n = 565; P = 82.2%, mean EPG = 154.8 ± 12.02) were mostly and heavily infected than those from the hot dry (n = 518; P = 74.2%; mean EPG = 97.7 ± 17.4) and the cold dry season (n = 392; P = 55.5%; mean EPG = 24.5 ± 19.5) (P ˂ 0.05). Females (n = 1027; P = 72.1%; mean EPG = 77.6 ± 17) were most infected than males (n = 448; P = 67.7%; mean EPG = 61.6 ± 19.5) (P ˂ 0.05). Animals that were treated, at most 3 months before sampling (n = 166; P = 61.5%; mean EPG = 41.7 ± 21.4), were less infected than those, which received this treatment after three months before sampling (n = 199; P = 74.8%; mean EPG = 89.1 ± 15.8) (P ˂ 0.05). Data from blood samples indicate that 6.5% of sheep was anaemic (PCV ≤ 19%), while 59.7% was noted anaemic regarding FAMACHA scores. PCV values varied significantly for FAMACHA scores, and the highest mean value was noted for score 1 (27.6) (P ˂ 0.05). The Cohen's kappa score between FAMACHA and PCV was 0.02. These findings suggest that strongyles infections are significantly associated with season, and heavier infections were noted during rainy season.

[Helicobacter pyloriinfection and gastric mucosa in cirrhotic patient]

The goal of this work was to study helicobacter pylori (HP) infection and gastric mucosa in cirrhotic patient.

METHOD

The study was comparative (case-indicator) and transversal from October 2015 to June 2016 in the gastroenterology and hepatology center of CHU Gabriel Touré of Bamako. Hp was identified in pathologic center of CHU du point "G" de Bamako.

RESULTS

At the end of the study Hp infection frequency was 73.6% without significative differency with the comparative group (p= 0,200). The mean age was 46,3 ± 20,8 years. The sex ratio was 2,11. The home workers women were more represented (32.1%). Ascites and jaundice were the main signs respectively in 64.3% and 53.6% cases. The upper endoscopy found varices in 89.2% of cases. His worsen histological lesions were mucosal atrophy (17.8%) and intestinal metaplasy (14.2%).

CONCLUSION

Helicobacter pylori infection is frequent in cirrhotic patient in our country with sometimes worsen histological lesions.

[Iron deficiency in adults : to understand what biological evaluation should be carried out]

Iron is a major mineral in the human body. It participates in various metabolisms, including oxygen transport in hemoglobin. Iron deficiency (ID) is characterized by a deficit in circulating iron. There are two types of ID : 1) absolute ID (AID), in case of decrease in iron reserves and circulating iron, or 2) functional ID (FID), in case of decrease in circulating iron, while reserves are preserved or increased. AID is mainly due to bleeding, usually gastrointestinal, while FID is linked to the inflammatory syndrome. AID is characterized by low serum ferritin and transferrin saturation (TS). Hypochromic microcytic anemia is frequent. FID is characterized by elevated serum ferritin, normal or low TS, and normal sTfR levels. Furthermore, C-reactive protein levels are high, and there is non-regenerative non-macrocytic anemia. New biological tests (serum hepcidin) may be useful in case of doubt. However, they are not yet commonly used.

Pediculosis capitis in Abidjan, Côte d'Ivoire: Epidemiological profile and associated risk factors

Pediculosis capitis (PC) is a parasitic infestation, common in children's communities caused by Pediculus humanus capitis. Various factors including infestation-related stigma, treatment cost and health risks make this infestation deserves special attention. This study aims to determine epidemiological profile of pediculosis capitis twenty years after the last study in Abidjan, Côte d’Ivoire.

An epidemiological cross-sectional survey was carried out from April to June 2018 across 40 public primary schools in the ten districts of Abidjan. Data from schoolchildren and parents and/or guardians were collected using a pretested questionnaire after agreement and signature of the informed consent form. Head lice were identified visually with a magnifying glass, and then collected using fine combs and hairbrushes. The positive diagnosis was made by the detection of living lice in the hair.

Of the 4, 805 included participants, 28 (0.58%) were hosting living lice in hair. Analysis of associated factors showed that gender related-status was associated with PC. In this case, girls were more affected than boys (p=0.018). Plateau, Treichville and Port Bouët municipalities were the most affected (p=0.018). The length hair was associated with the occurrence of PC (p<0,001). Schoolchildren from families with low monthly income was most infected by PC (p=0.023). Some parameters such as promiscuity and collective use of washing facilities and bedding, were not found to be associated to head lice infestation.

This study shows a drastic decrease of PC prevalence in Abidjan corresponding to 97%. This could be due to the improvement in the quality of life and education of the population of Abidjan. The establishment of hygiene committees and the teaching of basic hygiene practices from the first school years have contributed to these achievements. Maintaining these measures will contribute to the sustainable elimination of CP among children in Abidjan.

[Endoscopic And Therapeutic Aspects Of The Colo-Rectal Polyps At The Gabriel Toure Hospital And At The "Promenade Des Angevins" Clinic In Bamako]

INTRODUCTION

The term polyp refers to any relief formation on the digestive mucosa.The therapeutic endoscopic polypectomy is an effective method to colorectal polyp resection.

OBJECTIVE

The maingoal of this work is to study the endoscopic aspects of colo-rectal polyps and to bring our experience on their treatment with endoscopic polypectomy.

PATIENTS AND METHOD

Our study was retrospective and descriptive from January 2013 to December 2017 in the endoscopic centers of hepato-gastroenterology department of CHU Gabriel Touré and clinic of "Promenade des angevins". The study concerned in whom polypectomy was performed.

RESULTS

A total of 49 patients were included in our study. The main age of our patients was 26.2 2±1.7 years and the sex-ratio was 3.9. The sessile polyps were more frequents with 53.1%. The average size of polyps was 8.7±3.7 mm. The rectum localization was more reported (40.8%). All polyps(100%) were resected in monoblock and we used diathermol cove in 57.1% patients and the cold clamp in 42.9%. Histologically, we had 18 cases of hyperplasia (36.7%), 8 cases of tubulous adenoma (16.3%), 2 cases of tubulo-vilous adenoma (4.1%) and 2 cases of juvenil adenoma (4.1%). One patient was died by perforation five days after the polypectomy.

CONCLUSION

The frequency of colorectal polyps is not negligible in our context.Endoscopic colorectal polypectomy is effective therapeutic method for resection of colorectal polyps.

[Evaluation of "SD Bioline Malaria Antigen pf® (HRP2)" test in Plasmodium falciparum malaria diagnosis in child at the Yopougon teaching hospital (Côte d'Ivoire)]

Evaluation of "SD Bioline Malaria Antigen Pf ^® (HRP2)" test for the confirmation of children's Plasmodium falciparum malaria in a hospital setting. In the present study, a Rapid Diagnostic Test (RDT) for the diagnosis of malaria has been compared to the thick smear in 243 children suspected with malaria in Youpogon's University Hospital pediatrics' consultation and emergency room from the 1^st of February to November 11, 2016. Conformity between the two exams was observed in 90.5% of the cases (p=0.01). Factors which statistically influenced the RDT's reliability were children's age, presence of difficulty in breathing (p=0.046) and extreme parasitaemia (too high or too low) (p=0.0096). Diagnostic performances were the following, sensitivity: 92.7%, specificity: 87.1 %, positive predictive value: 87.1%, negative predictive value: 88 %, positive likelihood ratio: 7.2 and negative likelihood ratio: 0.1. Authors insist on the necessity of a permanent access to RDT when a thick smear cannot be done in reference sanitary systems. However, caution is needed concerning RDT's results in children less than 6 months old and those who had low or large parasitaemia.

[Hepatic Amoebic Abscess: Clinical Aspects And Prognosis At CHU De Gabriel Touré De Bamako]

The main goal of this study was to analyze hepatic amoebiasis abscess at the service of gastroenterology of CHU Gabriel Touré, Bamako- Mali.

MATERIAL AND METHOD

It was longitudinal and prospective study from January 2013 to February 2014 and concerned patients having hepatic abscess diagnosed by echography and amoebic serology or chocolate pus finding.

RESULT

During the study the frequency of disease was 2.4% (24/970). The sex-ratio was 2 with a mean age of 36.8±10.9 years. Smoking was observed in 58.8% of cases. Abdominal pain, fever and hepatomegaly were found respectively in 87.5%, 83.3% and 79.3% of patients. The abscess was mainly located in right lobe. HIV serology was performed among 18 patients and was negative in all cases. The medical treatment by the metronidazol was systematically proposed and was associated to abscess tap in 42.2% of patients. A total recovery was observed in 23 patients and 1 patient was died by abscess rupture in the peritoneum.

CONCLUSION

An early management cans evord complication.

[Uper Digestive Tractus Caustic Injuries In Adult Patient In Bamako: Epidemiological, Semiological And Prognostic Aspects]

The main objective of this longitudinal and prospecting study from February 2013 to January 2014 was to analyze uper digestive tractus caustic injuries in adult patients at the service of gastroenterology of CHU Gabriel Touré Bamako-Mali.

PATIENTS AND MÉTHOD

We include patients (age more than 16 years) hospitalized for digestive caustic injuries.

RESULTS

During the period a hospital frequency was 2.1% (20/970). The mean age was about 33.1 ± 9 years. Over toxic substances was discovered in 45 % of patients. The caustic ingestion was intentional in 18 patients. Psychoaffective disorders were the main reason of caustic consumption. At the entry haematemesis was the main sign. The endoscopic lesions were in majority at stage IIIb of the Zargar et al classification. A case of inhalation pneumonia, a case of digestive perforation and 6 cases of digestive obstruction were the main complications of the caustics injuries. Early death was found in 3 patients.

CONCLUSION

Upper digestive tractus caustic injuries are more and more met in our context. Preventive measures are necessary to prevent these serious lesions.

Oropharyngeal candidiasis prevalence among HIV-infected patients at the teaching hospital of Treichville (Abidjan, Côte d'Ivoire)

AIM OF THE STUDY

The aim of this study was to determine the mycological profile of oropharyngeal candidiasis among HIV-infected patients from Internal Medicine, Infectious and Tropical Diseases, and Pneumo-Phthisiology Diseases departments of the Teaching Hospital of Treichville in Abidjan, Côte d'Ivoire.

PATIENTS AND METHODS

This was a cross-sectional study carried out on patients with lesions suggestive of oropharyngeal candidiasis from October 2010 to April 2011. Oral swabs were cultured, and Candida species were identified using a germ tube test, a chlamydospore formation assay, and the API 20C system.

RESULTS

A total of 286 patients were included, among whom 99.1% were infected with HIV. The prevalence of oropharyngeal candidiasis was 79.4% (CI_95%=74.4-83.8). Five different species of Candida were identified, with the predominant species being Candida albicans (95.2%). Most affected patients were female (54.6%, P<0.0001) between the ages of 30 and 45 (78.4%, P<0.0001). The most lesion types observed were thrush (87.8%). Patients infected with HIV1 (95.6%), with a primary school level of education (52.8%), under antiretroviral therapy (88.5%) and with tuberculosis as an associated pathology (62.5%) were the most commonly affected. Patients were mostly under ART first line treatment (86.4%) and at the beginning of the treatment (86.4%).

CONCLUSION

Oropharyngeal candidiasis is frequent among HIV-infected patients. Better and early management of this vulnerable population should allow for a reduction in the high prevalence observed.

[Effectiveness of three biological larvicides and of an insect growth regulator against Anopheles arabiensis in Senegal]

Urban malaria is a major public health problem in Africa. In Senegal, the environmental changes seem to favor the persistence of malaria transmission in Dakar suburbs by creating, throughout the year, potential breeding sites of malaria vectors. In such a situation and in a context of a growing threat of insecticide resistance in anopheline vectors, the larval control making use of products from biological origin or growth regulators could represent an additional tool to the current strategies developed against anophelines. In this study conducted in 2012, the efficiency and residual effect of three biological larvicides (VectoBac^® WG, Vecto-Max^® CG, and VectoBac^® GR) and an insect growth regulator (MetaLarv™) were evaluated on Anopheles gambiae s.l. larvae in seminatural conditions (experimental station) and natural breeding sites in the suburbs of Dakar. The formulations were tested according to the manufacturer recommendations, namely 0.03 g/m² for VectoBac^® WG, 0.5 g/m² for VectoBac^® GR, 0.75 g/m² for VectoMax^® CG, and 0.5 g/m² for MetaLarv™. In experimental station, the treatment with larvicides was effective over a period of 14 days with a mortality ranging between 92% and 100%. The insect growth regulator remained effective up to 55 days with a single emergence recorded in the 27th day after treatment. In natural conditions, a total effectiveness (100% mortality) of larvicides was obtained 48 hours after treatment, then a gradual recolonization of breeding sites was noted. However, the insect growth regulator has reduced adult emergence higher than 80% until the end of follow-up (J28). This study showed a good efficiency of the larvicides and of the growth regulator tested. These works provide current data on potential candidates for the implementation of larval control interventions in addition to that of chemical adulticide for control of urban malaria.

[Internal hemorroïd disease at the digestive endoscopy center of the Gabriel Toure University Hospital of Bamako]

The goal of this study was to investigate internal hemorrhoid disease. This cross-sectional study was conducted at the digestive endoscopy center of the Gabriel Toure University Hospital from December 2011 to December 2012. Sixty cases of internal hemorrhoid disease were found - 36 men and 24 women and an average age of 47 ±14.4 years. Clinical signs were frequently: bleeding (66.7%), constipation (58.4%), anal pains (58.3%) and prolapsed hemorrhoids (18.3%). The rectoscopy found isolated internal hemorrhoids in 78.4% of cases and stage I of the illness in 81.7% of cases. All patients were given medical treatment.

CONCLUSION

Hemorrhoid disease is a frequent pathology in the general population mainly around the third decade of life.

[Epidemiological characteristics and prognosis of gastric Cancer in urban areas of Mali]

Stomach cancer remains a public health problem. It is increasingly found in our regions, probably because of the greater availability and improvement of diagnostic facilities. The goal of this work was to study the epidemiological characteristics and prognosis of gastric cancer in the hepato-gastroenterology and general surgery wards of the Gabriel Toure university hospital.

METHODS

We conduct a descriptive retrospective study on patients from June 2008 to May 2009, and the enrollment of patients lasted from June 2009 to May 2010.

RESULTS

We examined the records of 68 cases of gastric cancer in 115 cases of digestive cancers a frequency of 59.1%.

The mean age of patients was 56.51 ± 14.8 years with extremes of 27 and 90 years. The sex ratio was 1.6 in favor for men. The social and professional groups (housewives and farmers) were the most represented with 50 cases (73.5%). Salting, smoking, consumption of tô (cereal dough) with potash were the most found risk factors in 80.9%, 94.2% and 80.6% of cases respectively. The localization of antro-pyloric site was most represented (60.3%). Adenocarcinoma was the most common histological type (94.1%), one case of Gastrointestinal Stromal Tumor (GIST), two cases of non hodgkin malignant lymphoma were found.The curative surgery was performed in 8.9% of our patients. The overall survival rate after any surgery with two-year follow-up was 9.4%. Post curative surgery survival was 83.3% at two years follow-up.

CONCLUSION

Stomach cancer is common in our context, but its management is suffering from delayed diagnosis.

[Epidemiology of anguillulosis among public school children in Abidjan, Cote d'Ivoire]

PURPOSE

Strongyloides stercoralis is a neglected soil-transmitted helminth species. In Cote d'Ivoire, as elsewhere, there is a lack of parasitologic and epidemiologic data pertaining to this parasite. The purpose of this study was to evaluate the prevalence and impact of sociodemographic factors on anguillulosis among public school children in Abidjan, Cote d'Ivoire.

METHODS

Testing for Strongyloides stercoralis was performed in a random sample of 411 children from 10 public primary schools in Abidjan. Detection methods included direct examination of stool smears, the Baermann test and helminth coproculture study.

RESULTS

The overall prevalence of anguillulosis was 2.7% (N=411) (IC95% = 1.34-4.73). The M/F sex-ratio was 1. No correlation was found between prevalence and sex (p = 0.12). Prevalence was higher among children who reported contact with swamps and rivers (respectively 80% and 7.9%) than those who did not report such contact (respectively 1.7% and 1.5%) (p <0.01).

CONCLUSION

Contact with swamps and rivers is correlated with an increase in anguillulosis prevalence. Avoiding these areas and proper sanitation could help to reduce the prevalence of anguillulosis in Abidjan.

[Changing aspects of cirrhotic disease in a hepato-gastroenterology service in Mali]

The main goal of our study was to evaluate cirrhosis course on one year. The study was prospective and longitudinal from January 2005 to December 2006 in the center of hepatology and gastro-enterology of CHU Gabriel Touré. The patients had one year follow up and examinated every three months. In this study 57 patients were included. Mean age was 41,5 + 15,3 years. Ascite and jaundice were the main clinical signs respectively 70.2% and 54.4%. Ascite or its increase was the most complication in 67.5% of cases (p = 0.002). The global mortality was 82.5% and it was high in the three first months, caused by hepatocellular carcinoma, digestive bleeding and hepatic encephalopathy respectively 33.3%, 27.3% and 15.2%. Abdomen pain, ascite and jaundice have an predictive value for high mortality (p between 3.10-3 et 10-7). Early examination, therapeutic observance and good management of cirrhosis complications could reduce the mortality.

[Undesirable effects of medicine in the Internal Medicine Service of the University Hospital Center du Point G]

The aim of this study was to determine the frequency of adverse reactions to drugs, the WHO grade, describe the clinical features and identify the drug responsible. This was a descriptive cross-sectional study which took place from February 2005 to January 2006 in the Internal Medicine Department at the hospital point G. Were included in this study, all patients hospitalized during the study period, which presented adverse drug reactions (ADRs) that the relation of cause and effect was certain or likely. Thus, 47 ADRs were identified in 39 patients of 426 admitted during the same period a frequency of 9.2%. The average age of our patients was 48.5 ± 16.5 years. The sex-ratio was 1.6 for women. Eighty-two percent of our patients had an ADR and 18% more than one. The WHO grade 1 was the most met or 36.2%, followed by grades 4 and 2 respectively 27.7% and 25.5%. Antidiabetics were responsible for adverse reactions in 46.8% and 21.3% in TB. Adverse events were neurological in 53.2% and type of manifestations of hypoglycemia 46.8% (22/47 cases), polyneuritis 6.4% (3 / 47 cases) and 29.8% in digestive cases dominated by vomiting 12.8% (6 / 47 cases), the epigastria pain 6.4% (3 / 47 cases). The outcome was favorable in 87.2% of cases, however, 3 cases of death among those over 60 years all grade 4 WHO. ADRs deserve special attention to this high death rate (6.4% 3/47 cases) where the interest to search systematically for all patients under medical treatment with a good clinical examination and questioning some thoroughly.

[Neuromeningeal cryptococcosis in non-HIV patients to CHU ward of Point G in Bamako (Mali): 3 case report]

We report 3 clinical observations of neuromeningeal cryptococcosis which occurred without any immunodepression related to HIV infection. Our patients were male. They did not present any particular medical history indicating a diagnosis of cryptococcosis. Nevertheless we found a professional exposure to the risk of inhalation of C. neoformans capsules. The diagnosis was based on presence of encapsulated yeast of Cryptococcus in the direct exam by China ink and culture on Sabouraud medium. CD4 lymphocytic count was done in two patients (case 1:899 cells/mm3; case 2:347 cells/mm3). Idiopathic lymphocytopenia was noted in one case. Co-morbidity of 5. pneumoniae meningitis was reported in one patient (case 3). Treatment was based on injectable amphotericin B in monotherapy (case 1), followed by perfusion of fluconazole cure (case 2). Case 3 was treated by perfusion of amphotericin B associated with ceftriaxone (case 2). No secondary prophylactic treatment was administered. Evolution was favorable after follow-up of 5 years (case 1) and of 4 years (case 2). The third patient died during hospitalization.

Interferon regulatory factor-1 polymorphisms are associated with the control of Plasmodium falciparum infection

We describe the haplotypic structure of the interferon regulatory factor-1 (IRF-1) locus in two West African ethnic groups, Fulani and Mossi, that differ in their susceptibility and immune response to Plasmodium falciparum malaria. Both populations showed significant associations between IRF-1 polymorphisms and carriage of P. falciparum infection, with different patterns of association that may reflect their different haplotypic architecture. Genetic variation at this locus does not therefore account for the Fulani-specific resistance to malaria while it could contribute to parasite clearance's ability in populations living in endemic areas. We then conducted a case-control study of three haplotype-tagging single nucleotide polymorphisms (htSNPs) in 370 hospitalised malaria patients (160 severe and 210 uncomplicated) and 410 healthy population controls, all from the Mossi ethnic group. All three htSNPs showed correlation with blood infection levels in malaria patients, and the rs10065633 polymorphism was associated with severe disease (P=0.02). These findings provide the first evidence of the involvement in malaria susceptibility of a specific locus within the 5q31 region, previously shown to be linked with P. falciparum infection levels.

[Digestive parasitic diseases to HIV/AIDS infected patients of internal medicine and infectious diseases wards of the hôpital du Point "G" Bamako - Mali]

We conducted a prospective study in internal medicine and infectious diseases wards of the hospital of Point " G " in Bamako, Mali from January to December 2002. Overall 112 patients HIV positive, thirty-five patients (31,25%) had at least a digestive parasitic disease. We found that the most frequent parasite in stools sample were protozoa (82,85%). The second most frequent parasites were helminthes (20,33%). HIV/AIDS opportunistic parasites represented 40% of all parasites found. These included 25,71% cases of Cryptosporidium sp, 8,57% cases of Isospora belli and 5,71 % for microsporidia. The functional signs of our patients were mostly asthenia and weight loss. The physical signs were conjunctive pallor (71, 42%) and diarrhea (85, 71%). Generalized itching was present in 54, 28% of cases and abdominal pains in 25, 71% of cases. The global lethality was 37, 14% (13/35). The deaths were due to the HIV infection. The parasites appear even frequent at patients infected by HIV/AIDS, in spite of the advent of antiretroviral therapy. The efficient molecule research against the opportunist parasite must constitute one of our priorities in tropical area.

Genetic complexity and gametocyte production of Plasmodium falciparum in Fulani and Mossi communities in Burkina Faso

We have examined Plasmodium falciparum gametocyte prevalence, density and their genetic complexity among children of 2 sympatric ethnic groups (Mossi and Fulani) in villages in Burkina Faso. The 2 groups are known to have distinct differences in their susceptibility and immune responses to malaria. We used RT-PCR and sequence-specific probes to detect and type RNA of the gametocyte-specific protein Pfs48/45. There were no differences in detection rates of asexual forms and gametocytes among the 2 groups, using PCR and RT-PCR, respectively. However, there were significant differences in densities of asexual forms and gametocytes, which were both higher among Mossi than Fulani. Both asexual forms and gametocyte densities were influenced by age and ethnicity. Multiple-clone infections with more than 1 gametocyte genotype were equally prevalent among Fulani and Mossi. These differences can most probably be attributed to genetic differences in malaria susceptibility in the 2 ethnic groups.

Incidence et présentation des manifestations neurologiques centrales au cours de la granulomatose de Wegener : analyse monocentrique d’une série de 14 malades

PURPOSE

Central nervous system manifestations are rare clinical features of Wegener's granulomatosis, and occur in 4-8% of the patients, but few studies were dedicated to them.

METHODS

This retrospective study (1988-2001) include 14 consecutive patients suffering from Wegener's granulomatosis. Involvement of central nervous system was defined as follows: suggestive neurological signs, compatible cerebral imaging, efficacy of the specific treatment of the granulomatosis.

RESULTS

Four patients had a central nervous system manifestation (29%), including three women (average age 51 years). The signs were inaugural in a case. The manifestations were the following: sensibility disturbance (three cases), motor weakness (two cases), aphasia (one case), and mood disorders (two cases). Cranial nerves were constantly involved. Cerebral magnetic resonance imaging findings were: pachymeningitis and venous thrombosis (one case), vasculitis (two cases). Under steroid therapy associated with cyclophosphamide, in spite of a recurrence at 27 months in one patient, all patients had a complete remission. There was no death, with a median follow-up of 66 months. Except the ocular signs, that were more common (three cases), these patients had the usual characteristics of the Wegener's granulomatosis: rhinosinusitis (four cases), pulmonary (three cases), renal (three cases), and peripheral nervous system involvement (three cases).

CONCLUSIONS

Our study, based on precise criteria, indicates that the frequency of the central neurologic manifestations of Wegener's granulomatosis is probably under estimated. Cranial nerves involvement is highly evocative. The long-term prognosis seems good, in spite of the associated multivisceral disorder.