Diagnosis of paediatric TB using Xpert® MTB/RIF Ultra on fresh respiratory samples

OBJECTIVE: To evaluate the diagnostic accuracy of Xpert^® MTB/RIF Ultra (Ultra) on fresh respiratory samples for the diagnosis of pulmonary TB (PTB) in children.METHODS: Between July 2017 and December 2019, children with presumed TB were prospectively enrolled at clinical sites in three African countries. Children were assessed using history, physical examination and chest X-ray. Sputum or gastric aspirate samples were analysed using Ultra and culture. The diagnostic accuracy of Ultra was calculated against culture as the reference standard.RESULTS: In total, 547children were included. The median age was 4.7 years, 77 (14.1%) were HIV infected and 77 (14.1%) had bacteriologically confirmed TB. Ultra detected an additional 20 cases in the group of children with negative culture results. The sensitivity of Ultra was 66.3% (95% CI 47-82), and the specificity was 95.4% (95% CI 89-99) when assessed against culture as the reference standard.CONCLUSION: Despite the improved performance of Ultra as compared to Xpert as was previously reported, its sensitivity remains sub-optimal for the detection of TB in children. Ultra detected additional 20 cases which otherwise could not have been detected by culture alone, suggesting that the latter is an imperfect reference standard.

Isoniazid preventive therapy in child household contacts of adults with active TB in Bamako, Mali

BACKGROUND AND OBJECTIVE

Isoniazid preventive therapy (IPT) is known to reduce the risk of developing active TB in about 59% in children aged ⩽15 years. We assessed adherence, completion and adverse events among children who were household contacts of a newly diagnosed adult with smear-positive TB in Bamako, Mali.

METHODS

Children aged <15 years living in the same house with an adult smear-positive index case were enrolled in the study in the Bamako Region after consent was obtained from the parent or legal guardian. Adherence was assessed based on the number of tablets consumed during 6 months.

RESULTS

A total of 260 children aged <15 years were identified as household contacts of 207 adult patients with smear-positive TB during the study period. Among all child contacts, 130/260 (50.0%) were aged 0-4 years and were eligible for IPT; 128/130 (98.5%) were started on IPT and 83/128 (64.8%) completed with good adherence at the end of the 6 months, and without any significant adverse events.

CONCLUSION

We successfully implemented IPT with good acceptance, but low completion rate. The Mali National TB Program and partners should expand this strategy to reach more children in Bamako and the whole country and create greater awareness in the population.

Fluorescein diacetate and rapid molecular testing for the early identification of rifampicin resistance in Mali

BACKGROUND: Non-conversion on auramine smear microscopy indicates a lack of treatment response, possibly associated with initial rifampicin-resistant tuberculosis (RR-TB). However, dead bacteria still stain positive and may be detected. Fluorescein diacetate smear microscopy (FDA) shows live mycobacteria only. Therefore, we studied the potential of 2-month (2M) FDA for the identification of initial RR-TB.METHODS: Between 2015 and 2018, we enrolled new smear-positive pulmonary TB patients from five local centres in Bamako, Mali. After baseline screening, sputum samples were collected at 1M, 2M, 5M and 18M. We used rpoB sequencing to identify initial RR-TB.RESULTS: Of 1359 patients enrolled, 1019 (75%) had rpoB sequencing results. Twenty-six (2.6%, 95%CI: 1.7-3.7) had mutations conferring rifampicin resistance. Most frequent rpoB mutations were located at the codons Asp435Val (42.4%) and Ser450Leu (34.7%). Among patients with initial RR-TB, 72.2% were FDA-negative at 2M (P = 0.2). The positive and negative predictive value of 5M FDA for culture-based failure was respectively 20.0% and 94.7%.CONCLUSION: FDA did not identify the majority of patients with initial RR-TB or culture-based failure. As the full spectrum of mutations identified on sequencing was identified using Xpert, our data support its rapid universal implementation in Mali.

Performance of Mali's biosafety level 3 laboratory in the external quality assessment in preparedness of laboratory accreditation and support to clinical trials

Background:

The external quality assessment (EQA) or external quality control is an evaluation conducted by a certified external organization to inquire about the quality of the results provided by a laboratory. The primary role of EQA is to verify the accuracy of laboratory results. This is essential in research because research data should be published in international peer-reviewed journals, and laboratory results must be repeatable. In 2007, the University Clinical Research Center (UCRC’s) biosafety level 3 (BSL-3) laboratory joined the EQA program with the College of American Pathologists in acid-fast staining and culture and identification of mycobacteria as per laboratory accreditation preparedness. Thus, after 11 years of participation, the goal of our study was to evaluate the performance of our laboratory during the different interlaboratory surveys.

Methods:

We conducted a descriptive retrospective study to evaluate the results of UCRC mycobacteriology laboratory from surveys conducted during 2007 and 2017.

Results:

Of the 22 evaluations, the laboratory had satisfactory (100% of concordance results) in 18 (81.8%) and good (80% of concordance results) in 4 (18.2%). Overall, the laboratory was above the commended/accepted limits of 75%.

Conclusion:

So far, UCRC’s BSL-3 performed well during the first 11 years of survey participation, and efforts should be deployed to maintain this high quality in the preparedness for laboratory accreditation and support to clinical trials.

A new 3-hit mouse model of schizophrenia built on genetic, early and late factors

Whether the etiology of schizophrenia remains unknown, its multifactorial aspect is conversely now well admitted. However, most preclinical models of the disease still rely on a mono-factorial construction and do not allow discover unequivocal treatments, particularly for negative and cognitive symptoms. The main interaction factors that have been implicated in schizophrenia are a genetic predisposition and unfavorable environmental factors. Here we propose a new animal model combining a genetic predisposition (1st hit: partial deletion of MAP-6 (microtubule-associated protein)) with an early postnatal stress (2nd hit: 24 h maternal separation at post-natal day 9), and a late cannabinoid exposure during adolescence (3rd hit: tetrahydrocannabinol THC from post-natal day 32 to 52; 8 mg/kg/day). The 2-hit mice displayed spatial memory deficits, decreased cortical thickness and fractional anisotropy of callosal fibers. The 3-hit mice were more severely affected as attested by supplementary deficits such a decrease in spontaneous activity, sociability-related behavior, working memory performances, an increase in anxiety-like behavior, a decrease in hippocampus volume together with impaired integrity of corpus callosum fibers (less axons, less myelin). Taken together, these results show that the new 3-hit model displays several landmarks mimicking negative and cognitive symptoms of schizophrenia, conferring a high relevance for research of new treatments. Moreover, this 3-hit model possesses a strong construct validity, which fits with gene x environment interactions hypothesis of schizophrenia. The 2-hit model, which associates maternal separation with THC exposure in wild-type mice gives a less severe phenotype, and could be useful for research on other forms of psychiatric diseases.

[Prevalence of the kidney disease at the emergency department of hospital Fousseyni Daou of Kayes]

INTRODUCTION

Kidney disease (KD) is defined as a set of functional, morphological and histological kidney abnormalities. It is a truly global public health problem. Its prevalence is estimated to be 50 times that of end-stage renal disease (ESRD). In Kayes, there is no data on the prevalence of kidney disease, hence the interest of this study.

OBJECTIVES

to determine the prevalence of renal disease, its main causes and the main factors of aggravation of this pathology in the emergency department at hospital Fousseyni DAOU of Kayes.

METHODOLOGY

Retrospective cross-sectional study carried out from January 1, 2014 to February 1, 2015. We included all hospitalized patients in whom a renal damage marker (elevation of plasma creatinine, urinary sediment abnormality, ultrasound, histology and significant proteinuria) has been found.

RESULTS

the prevalence of kidney disease was 9.9% (109/1099). Eighty-nine met the inclusion criteria. The study population was composed of 47 women (52.8%) and 42 men (47.2%), with a sex ratio of 0.89 in favor of women. The average age was 40.09 years with a predominance of patients in the age group [40-59]. The main reasons for consultation were hypercreatininaemia (48.3%), edematous syndrome (16.9%), low back pain (10.1%). High blood pressure (55.1%) and lower extremity edema (46.1%) were the medical history frequently found in our study. The kidney disease found was in order of growth: chronic renal failure (51%); acute renal failure (28%); proteinuria (16%), hematuria (3%), morphological abnormality of the kidneys (2%). Tubulointerstitial nephropathy represented 64% of acute renal failure with P = 0.000306. Vascular nephropathy constituted 46.7% of chronic renal failure with P = 0.000251. No cases of glomerular nephropathy were found in patients over 60 years of age.The most common causes were represented by nephrotoxic drugs injuries; infectious; high blood pressure and diabetes. The most observed aggravating factors are herbal medicine, urinary tract infections, renal hypoperfusion and unbalanced hypertension.

CONCLUSION

kidney disease is not uncommon in the emergency room at Hospital Fousseyni Daou of Kayes. The most common causes are nephrotoxic drugs, hypertension and diabetes.

[Drug-resistant tuberculosis with rifampicin in children co-infected with HIV in Bamako]

Drug-resistant tuberculosis, especially in children, is a major public health challenge. We report a case with rifampicin resistance diagnosed in an HIV co-infected in Bamako. The history of the disease suggests possible father-to-child transmission. After confirmation, MDR-TB treatment was initiated. Global improvement and normalization of biological parameters and X-Ray was obtained. The identification of this case highlights the need to improve diagnosticand treatment algorithms for rapid confirmation and better management.

[Contribution of the University Clinical Research Center's laboratoryin the diagnosis of SARS-CoV-2 in Mali]

INTRODUCTION

The rapid diagnostic capacities of laboratories in Mali have been an essential element in the response to COVID-19. The University Clinical Research center (UCRC) diagnosed the first cases of Mali COVID-19.

OBJECTIVE

The objective was to describe the contribution of the UCRC in the diagnosis of Covid-19 and to clinically and epidemiologically characterize the patients tested in the UCRC laboratory.

MATERIALS AND METHODS

A cross-sectional study was conducted during eight months of intense activity. The samples were sent from the National Institute of Public Health (INSP) to the UCRC.

RESULTS

The UCRC tested 12,406 contacts and suspected samples and confirmed the diagnosis in 1091 patients, or 9%. The most common symptoms were cough (48.78%), headache (34.14%), fatigue / weakness (34.14%), while (33.33%) of the patients were asymptomatic. The sample positivity rate among new cases decreased from May to September 2020, despite almost 230% of the number of samples tested.

CONCLUSION

The laboratory played a major role in the response and there may be a low transmission of the virus in the Malian community.

Impact of seasonal malaria chemoprevention on hospital admissions and mortality in children under 5 years of age in Ouelessebougou, Mali

BACKGROUND

Seasonal malaria chemoprevention is widely implemented in Sahel and sub-Sahel countries in Africa. Few studies have assessed the impact of the SMC on hospital admission and death when it is implemented in the health system. This retrospective study assessed the impact of seasonal malaria chemoprevention (SMC) on hospitalizations and deaths of children under 5 years of age during the second year of implementation of SMC in the health district of Ouelessebougou in Mali.

METHODS

In February 2017, a survey was conducted to assess hospital admissions and deaths in children under 5 years of age in two health sub-districts where SMC was implemented in 2015 and two health sub-districts where SMC was not implemented. The survey reviewed deaths and hospitalizations of children under 5, in the four health sub-districts. The crude and specific incidence rates of hospitalizations and deaths were determined in both groups and expressed per 1000 children per year. A negative binomial regression model and a Cox model were used to estimate the relative risks of hospitalization and death after adjusting for confounders. The R software was used for data analysis.

RESULTS

A total of 6638 children under 5 years of age were surveyed, 2759 children in the SMC intervention areas and 3879 children in the control areas. All causes mortality rate per 1000 person-years was 8.29 in the control areas compared to 3.63 in the intervention areas; age and gender adjusted mortality rate ratio 0.44 (95% CI 0.22-0.91), p = 0.027. The incidence rate of all causes hospital admissions was 19.60 per 1000 person-years in the intervention group compared to 33.45 per 1000 person-years in the control group, giving an incidence rate ratio (IRR) adjusted for age and gender of 0.61 (95% CI 0.44-0.84), p = 0.003.

CONCLUSION

The implementation of SMC was associated with a substantial reduction in hospital admissions and all-cause mortality. Trial registration ClinicalTrials.gov NCT02646410.

Diabetes Mellitus among new tuberculosis patients in Bamako, Mali

Introduction

Diabetes Mellitus (DM) increases worldwide, mostly in low- and middle-income countries. In Mali, the prevalence in the adult population is estimated at 1.8%, but tuberculosis (TB) patients are not systematically screened. The goal of our study was to determine the prevalence of DM among newly diagnosed TB patients.

Methods

We conducted a cross sectional study and a pilot prospective cohort study in four health centers in Bamako. All patients underwent fasting capillary-blood glucose (FCBG) test at Day 0, and repeated after one-week of TB treatment. Venous FBG test was performed for discrepancies between the two FCBG results. Thereafter, FCBG was performed for pilot study at month-2 (M2) and M5 of TB treatment.

Results

Two hundred and one patients were enrolled in this study. Impaired fasting blood glucose was identified in 17 (8.5%), of whom 11 (5.5%) had DM (VFBG >7 mmol/L). Among patients with DM, seven (63.6%) had successful TB treatment outcome, versus 142 (74.7%) of those without DM (p = 0.64), and (OR: 1.69, 95%CI 0.47–6.02).

Conclusion

The prevalence of DM among TB patients in Bamako exceeds that of the general population and screening at TB diagnosis suffices to identify those with DM. Systematic screening of both diseases will allow better treatment.

[Multidrug-resistant tuberculosis (MDR-TB) in a black African carceral area: Experience of Mali]

INTRODUCTION

Prison constitutes a risk factor for the emergence of multi-drug resistance of tuberculosis (MDR-TB). The aim of this work was to study MDR-TB in a black African carceral center.

MATERIAL AND METHODS

Prospective study from January to December 2016 at the central house of arrest for men, Bamako. The study population was composed of tuberculous detainee. The suspicion of MDR-TB was done in any tuberculosis case remained positive in the second month of first-line treatment or in contact with an MDR-TB case.

RESULT

Among 1622 detainee, 21 cases of pulmonary tuberculosis were notified (1.29%), with an annual incidence of 13 cases/1000 detainee, they were 16 cases of SP-PTB (microscopy smear positive tuberculosis) and five cases of microscopy smear negative tuberculosis. The mean age was 28±7 years, extremes of 18 and 46 years. A negative association was found between the notion of smoking and occupation in the occurrence of tuberculosis (OR=0.036, [95% CI: 0.03-0.04], P=0.03. Among the 21 tuberculosis cases notified, one confirmed case of MDR-TB was detected (4.7%). In the first semester of 2016 cohort, we notified a cure rate of 87.5% (7/8 SP-PTB cases), and the confirmed MDR-TB case on treatment (21-month regimen), evolution enameled of pulmonary and hearing sequelae at seven months treatment.

CONCLUSION

It was the first case of MDR-TB detected in a prison in Mali. Late diagnosis, evolution is enameled of sequelae and side effects.

Establishing Reference Ranges of Hematological Parameters from Malian Healthy Adults

INTRODUCTION

Measurement of immuno-hematological parameters has been historically helpful in the diagnosis and treatment monitoring of many infectious diseases and cancers. However, these parameters have not yet been established in many developing countries where patient care strongly relies on such low-cost tests. This study describes the immuno-hematological parameter ranges for Malian healthy adults.

METHODS

A cross sectional study was conducted from August 2004 to May 2013. We included 213 healthy volunteers (173 male and 40 female), aged between 18-59 years. Median, 2.5 and 97.5 percentile ranges for each immuno-hematological parameter are presented.

RESULTS

In our study population, the hematological parameters' ranges were mostly different to the universal established ranges. We found in our population a Median white blood cell (WBC) count of 5200 cells/μL [3237.5-11900], Red Blood Cell (RBC) count of 4.94 10^6 [3.56-6.17], hemoglobin (Hb) of 14.2 g/dL [12.2-17.38], platelet count (Plt) of 275 10^3/μL [145.4-614.4], lymphocytes 2050/μL [1200-3800], neutrophils 2200/μL [1040-6220]; monocytes 200/μL [100-660]; eosinophils 131/μL [0-1026]; CD4 902 cells/μL [444-1669] and CD8 485 cells/μL [0-1272]. We found significant gender differences in RBC, Hb level and MPV. However, RBC and Hb were higher in males median values compared to females (median values) (p<0.001), whereas the Mean platelet volume lower values (MPV) in males than females (P<0.047). The hemoglobin level for some West African countries (Mali, Burkina Faso, Togo, and Nigeria) ranged from 13.5 to 15.1 g/dL for males and 12 to 13 g/dL for females. However in East and Southern Africa, the values were anywhere from 14.1 to 16.1 for males and 11.2 to 14.4 for females.

CONCLUSION

Our data may help physicians to better define hematological abnormalities in patients. They may also be used to define new "normal hematological values" in Malian population or in the whole West African population.

Performance of microscopic observation drug susceptibility for the rapid diagnosis of tuberculosis and detection of drug resistance in Bamako, Mali

OBJECTIVES

In Mali early detection and treatment of multidrug-resistant tuberculosis (MDR-TB) are still challenging due to the cost, time and/or complexity associated with regular tests. Microscopic Observation Drug Susceptibility (MODS) is a low-cost assay validated by WHO in 2010. It is a liquid-culture-based assay to detect the 'cording' characteristic of Mycobacterium tuberculosis complex and to assess susceptibility to both isoniazid and rifampicin defining multidrug-resistant tuberculosis (MDR-TB). In this study we aimed to evaluate the performance of MODS as diagnostic tool compared with a validated method-Mycobacteria Growth Indicator Tube/Antimicrobial Susceptibility Testing/Streptomycin, Isoniazid, Rifampicin and Ethambutol (MGIT/AST/SIRE).

METHODS AND RESULTS

Between January 2010 and October 2015 we included 98 patients with suspected TB in an observational cohort study. The sensitivity and specificity of MODS assay for detecting TB were respectively 94.12% and 85.71% compared with the reference MGIT/7H11 culture, with a Cohen κ coefficient of 0.78 (95% CI 0.517-1.043). The median time to culture positivity for MODS assay and MGIT (plus interquartile range, IQR) was respectively 8 days (IQR 5-11) and 6 days (IQR 5-6). In detecting patients with MDR-TB, the sensitivity and specificity of MODS assay were respectively 100% and 95.92%. The positive predictive value and negative predictive value were, respectively, 66.7% and 100%. The median turnaround times for obtaining MDR-TB results using MODS assay and MGIT/AST/SIRE was respectively 9 days and 35 days. Hence, the MODS assay rapidly identifies MDR-TB in Mali compared with the MGIT/AST/SIRE.

CONCLUSION

As an easy, simple, fast and affordable method, the MODS assay could significantly improve the management of TB.

Tuberculosis drug resistance in Bamako, Mali, from 2006 to 2014

Background

Although Drug resistance tuberculosis is not a new phenomenon, Mali remains one of the “blank” countries without systematic data.

Methods

Between 2006 and 2014, we enrolled pulmonary TB patients from local TB diagnostics centers and a university referral hospital in several observational cohort studies. These consecutive patients had first line drug susceptibility testing (DST) performed on their isolates. A subset of MDR was subsequently tested for second line drug resistance.

Results

A total of 1186 mycobacterial cultures were performed on samples from 522 patients, including 1105 sputa and 81 blood samples, yielding one or more Mycobacterium tuberculosis complex (Mtbc) positive cultures for 343 patients. Phenotypic DST was performed on 337 (98.3%) unique Mtbc isolates, of which 127 (37.7%) were resistant to at least one drug, including 75 (22.3%) with multidrug resistance (MDR). The overall prevalence of MDR-TB was 3.4% among new patients and 66.3% among retreatment patients. Second line DST was available for 38 (50.7%) of MDR patients and seven (18.4%) had resistance to either fluoroquinolones or second-line injectable drugs.

Conclusion

The drug resistance levels, including MDR, found in this study are relatively high, likely related to the selected referral population. While worrisome, the numbers remained stable over the study period. These findings prompt a nationwide drug resistance survey, as well as continuous surveillance of all retreatment patients, which will provide more accurate results on countrywide drug resistance rates and ensure that MDR patients access appropriate second line treatment.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-016-2060-7) contains supplementary material, which is available to authorized users.

Tuberculosis specific responses following therapy for TB: Impact of HIV co-infection

Characterizing perturbations in the immune response to tuberculosis in HIV can develop insights into the pathogenesis of coinfection. HIV+ TB+ and TB monoinfected (TB+) subjects recruited from clinics in Bamako prior to initiation of TB treatment were evaluated at time-points following initiation of therapy. Flow cytometry assessed CD4+/CD8+ T cell subsets and activation markers CD38/HLA-DR. Antigen specific responses to TB proteins were assessed by intracellular cytokine detection and proliferation. HIV+ TB+ subjects had significantly higher markers of immune activation in the CD4+ and CD8+ T cells compared to TB+ subjects. HIV+ TB+ had lower numbers of TB-specific CD4+ T cells at baseline. Plasma IFNγ levels were similar between HIV+ TB+ and TB+ subjects. No differences were observed in in-vitro proliferative capacity to TB antigens between HIV+ TB+ and TB+ subjects. Subjects with HIV+ TB+ coinfection demonstrate in vivo expansion of TB-specific CD4+ T cells. Immunodeficiency associated with CD4+ T cell depletion may be less significant compared to immunosuppression associated with HIV viremia or untreated TB infection.

Virology. Mutation rate and genotype variation of Ebola virus from Mali case sequences

The occurrence of Ebola virus (EBOV) in West Africa during 2013-2015 is unprecedented. Early reports suggested that in this outbreak EBOV is mutating twice as fast as previously observed, which indicates the potential for changes in transmissibility and virulence and could render current molecular diagnostics and countermeasures ineffective. We have determined additional full-length sequences from two clusters of imported EBOV infections into Mali, and we show that the nucleotide substitution rate (9.6 × 10(-4) substitutions per site per year) is consistent with rates observed in Central African outbreaks. In addition, overall variation among all genotypes observed remains low. Thus, our data indicate that EBOV is not undergoing rapid evolution in humans during the current outbreak. This finding has important implications for outbreak response and public health decisions and should alleviate several previously raised concerns.

Post-harvest management of aflatoxin contamination in groundnut

Aflatoxin contamination in groundnut by Aspergillus section Flavi is a major pre- and post-harvest problem causing kernel-quality loss. Post-harvest aflatoxin contamination is caused initially by infestation of aflatoxigenic strains at the pre-harvest stage, resulting in reduced kernel quality after harvest. Improper handling of pods and storage methods after harvest lead to high moisture and ambient temperatures, directly causing aflatoxin contamination. In this review, we report the extent of post-harvest contamination along the groundnut value chain in the Kolokani, Kayes, and Kita districts of Mali in West Africa. Groundnut kernels and paste samples were collected from retailers in selected markets from December 2010 to June 2011, and aflatoxin B1 (AFB1) content was estimated. Aflatoxin was significantly higher in groundnut paste than in kernels. Kolokani recorded the highest toxin levels in both kernels and groundnut paste compared with the other districts. Overall, AFB1 levels in kernels and paste increased during storage at the market level in the three districts and were above permissible levels (≯20 μg/kg). The effect of weather factors on post-harvest contamination and the reasons for aflatoxin build-up in Mali are discussed. This paper also highlights different management tools for reducing post-harvest aflatoxin contamination, such as post-harvest grain handling, post-harvest machinery, physical separation, storage methods and conditions, disinfestation, detoxification, inactivation, filtration, binding agents, and antifungal compounds. Post-harvest management options and enhanced use of good agricultural practices for mitigating this problem in Mali are also presented.

Molecular strain typing of Mycobacterium tuberculosis complex in Bamako, Mali

OBJECTIVE

To identify strains of Mycobacterium tuberculosis complex (MTC) circulating in Bamako and to examine the relationship between the strains and their drug susceptibility profiles.

METHODS

Between 2006 and 2010, we conducted a cross-sectional study using spoligotyping to identify strains of MTC recovered from 126 tuberculosis (TB) patients under treatment in Bamako, Mali.

RESULT

Three members of the MTC were isolated: M. tuberculosis (71.4%), M. africanum (27.8%) and M. bovis (0.8%). Of these, three strains were found to be the most prevalent: M. tuberculosis T1 (MTB T1; 38.9%), M. africanum F2 (MAF2; 26.2%) and M. tuberculosis Latin American and Mediterranean 10 (MTB LAM 10; 10.3%). MAF2 and MTB LAM 10 strains have a lower risk of multidrug resistance (MDR) than MTB T1 (respectively OR 0.1, 95%CI 0.03-0.4 and OR 0.1, 95%CI 0.01-0.8). Age ≥ 32 years (OR 1.4, 95%CI 0.4-3.9), negative human immunodeficiency virus status (OR 0.4, 95%CI 0.1-2.5) and male sex (OR 4, 95%CI 0.9-16.5) were not associated with MDR. The prevalence of MDR among treatment and retreatment failure patients was respectively 25% and 81.8% compared to new patients (2.9%).

CONCLUSION

This study indicates a low level of primary drug resistance in Bamako, affirms the importance of using correct drug regimens, and suggests that the MTB T1 strain may be associated with the development of resistance.

Seroprevalence of HIV/HBV coinfection in Malian blood donors

OBJECTIVES

A cross-sectional study was conducted to assess the prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and their coinfection among blood donors at the National Blood Transfusion Center in Bamako, Mali, from November 2001 to July 2002.

METHODS

Enzyme-linked immunosorbent assay techniques with reagents from Bio-Rad (France) were used to test the blood samples.

RESULTS

11,592 blood donors were tested for HIV and HBV surface antigens. The prevalence of HIV was 4.5% and the prevalence of HBV was 14.9%. The HIV/HBV coinfection rate was only 1.13% in this population.

CONCLUSION

The coinfection rate was unexpectedly low in this blood donor population where monoinfection with HIV or HBV prevalence was high.

[Variability of skin test on both tuberculosis and co infected patients with HIV under tuberculosis treatment]

To evaluate the variability of tuberculin skin test (TST), we did a prospective study in the pneumology unit of the teaching hospital at Point G and in the tuberculosis unit of the health district II at Bamako, Mali TST was applied two times to every patient more than 18 years old: at the beginning before the tuberculosis treatment (tst1) and after 2 months (tst2). For all 113 patients followed in both units, 41 were enrolled in this study (36, 2%). The mean age of patients was 37.9 years and 73.2% were male.(sex proportion was 2.72 for male). The different forms of Tuberculosis were: 63.4% of tuberculosis with smear positive(TSP); 7.3% of tuberculosis with smear negative(TSN); and 29,3% of disseminated tuberculosis. 22% of the patients were HIV positive. The tst1 was positive for 58.5% of the patients(11.11% of the HIV positive patients and 78.13% of the HIV negative). The diameter of indurations of the TST increased considerably during the treatment mainly with patients infected by HIV. The TST test can be an indicator of follow op for these patients who had less AFB most of time?

[Knowledge of the Bamako general population of tuberculosis]

The hope of the World Health Organization (WHO) in the fight against tuberculosis rests today on the implementation of the strategy DOTS. The success of this strategy passes obligatorily by an implication of the parents, neighbors in one word of the population living with the patient; this is why we fixed our objective to study knowledge on the tuberculosis of the people of more than 18 years of the district of Bamako. We carried out a cross-sectional study supplemented by focus-groups in 3 districts of Bamako near the general population (socio-medical personnel, old tuberculous, and helping natural) for the period from the 1st of June to July 15, 2004. Our sample was composed of 246 people for the individual questionnaires and of 47 per 8 meetings of focus group: the sex ratio was 2,5 in favour of the men and 60,2% of our subjects had less than 30 years. In the general population of Bamako 24,8% had a good knowledge, 49,0% an average knowledge and 26,2% a bad knowledge. 48,8 % of those which had a good knowledge were the pupils, students and civils servant. So in general the population had a good knowledge on symptomatology (90,2 %), it on the other hand had the knowledge very limited on the etiology (only 10,6% of the subject knew that tuberculosis is caused by a mycobactery) or on the modes of transmission (cigarettes, soap, meat). The population of Bamako has a very passable level of knowledge on tuberculosis. If this level is good with regard to symptomatology, it is very insufficient on the etiology or on the transmission of the disease. To improve this knowledge one needs a sensitizing supported for television and the radio in the dialects and national languages.

[Intestinal parasitosis during AIDS diarrhoea]

The main goal of this work was to study the parasitic infections during AIDS diarrhoea. A longitudinal study was carried out from October 2000 to November 2001 in the Hepato-Gastro-Enterology department of Gabriel Toure Hospital and in the Department of Epidemiology and Parasitic infections of Faculty of Medicine, Pharmacy and Odonto-stomatology of Bamako (Mali), concerning HIV positive patients suffering from diarrhoea. Detecting microbes in stools has been done through direct microscopic examination and according to procedures of Henricksen Poblenz Baerman, Kato Katz and the PCR. Among the 70 patients involved, the sex-ratio was 53%, the average age was 35 +/- 8.4 years. Fever weight loss, skin affections and digestive mycosis were often associated. Opportunistic infections have been relatively frequent with Cryptosporidium parvum with 20%, Isospora belli with 8.5% and Microsporidium with 11.5% of cases. Other non-opportunistic microbes were found. Death within the first two weeks seems more important in case of infection by Cryptosporidium parvum. The frequency and the danger of those opportunistic infections require their efficient diagnosis and care management.

[Experience with preperitoneal hernioplasty using Stoppa's procedures in the Ivory Coast]

OBJECTIVE

The treatment of groin hernias with a high risk of recurrence often provides therapeutic difficulties in Africa for fear of using mesh due to the potential risk of sepsis. The aim of this retrospective study was to emphasize the simplicity and efficacy of Stoppa's technique.

PATIENTS AND METHODS

From 1994 to 1999, 128 patients with 239 groin hernias underwent hernioplasty with Stoppa's technique. They were all men with a mean age of 54 +/- 8 years. They were classified in stages III and IV (46.8%, n = 60) of Nyhus. One hundred and eleven patients (86.7%) had bilateral hernias and 64 had a factor of recurrence (50%).

RESULTS

Mean operating time was 150 +/- 42 min (50-240 min). Follow-up ranged from 6 months to 6 years, with a mean time of 26 months. Eighteen patients were lost to follow-up. The mortality rate was 0.8% (n = 1). The morbidity rate was 18.7% (n = 24) with five hematomas (3.9%), 11 seromas (8.6%), one parietal infection (0.8%) and one recurrence (0.8%).

CONCLUSION

These results suggest that Stoppa's technique is efficient and technically feasible in our conditions and has to be performed more frequently.

Extension of the prophylactic effect of isometamidium against trypanosome infections in cattle using a biodegradable copolymer

Two trials were carried out in order to compare the prophylactic effect of a subcutaneously implanted sustained release device (SRD) containing a mixture of a biodegradable copolymer, poly(caprolactone-co-L-lactide), and isometamidium (ISMM) with that obtained after intramuscular injection of the drug. In a first experiment under controlled conditions, two groups of cattle were treated with 0.5 mg/kg isometamidium either as a SRD or intramuscularly (i.m.), and exposed at monthly intervals to Glossina morsitans morsitans infected with Trypanosoma congolense. The average protection period was at least 24 months in the SRD treated against 5.7 months in the i.m. treated group. Using an ISMM enzyme-linked immunosorbent assay, the drug could be detected until 140 days post-treatment in the latter group, whereas in the former group, traces of the drug were detectable until 330 days after treatment. Furthermore, a field trial was carried out at the Madina Diassa ranch in Mali involving three groups of N'Dama cattle, each containing 23 or 24 animals. Two groups were treated with 1 mg/kg ISMM either as a SRD or i.m. and a third group served as untreated control. Twelve months after treatment, the cumulative infection rates were 56.5, 87.8 and 91.6% in the SRD implanted, the i.m. treated and the control groups, respectively. The ISMM concentrations were slightly lower than in the laboratory trial, but the overall pattern of drug disappearance from the sera of the SRD treated cattle was very similar in both trials. Statistical analysis showed that the incidence of trypanosomiasis was significantly lower in the SRD treated than in the i.m. treated group.

[Peritonitis by fish bone. Review of the literature. Pathogenic discussion]

From one case of peritonitis by fish bone, we have reviewed medical literature in order to explain the mechanism of this type of peritonitis perforation, which can be assimilated to peritonitis in three phases.

Biodegradable polyesters for controlled release of trypanocidal drugs: in vitro and in vivo studies

Copolymers of epsilon-caprolactone and L-lactide P(CL-LLA), epsilon-caprolactone and D,L-lactide P(CL-DLLA) and epsilon-caprolactone and trimethylene carbonate P(CL-TMC) were synthesized. The composition of comonomers and their sequence lengths were determined by means of 1H and 13C NMR measurements. The effect of the comonomer on the thermal properties was investigated by differential scanning calorimetry (DSC) analysis. The in vitro degradation of the rods obtained by melt extrusion of the synthesized copolymers and the commercial homopolymers poly(epsilon-caprolactone) P(CL) and poly(D,L-lactide) P(DLLA) was carried out in phosphate buffer (PB) pH 7.4 at 37 degrees C. The rate of degradation depends on comonomers and polymer composition. The in vitro release of the selected drugs, isometamidium chloride (IMM) and ethidium bromide (EtBr), from such devices was carried out under the same conditions as used for the in vitro degradation. The release experiments show that the release of IMM is faster than for EtBr. During the first stage, for IMM the release is governed by osmotic pressure whereas for EtBr the release is mainly diffusion-controlled. The in vitro release of these drugs is governed by polymer matrix degradation at the later stage of the release process. Comparative in vitro release study from the different polymers showed that the release depends mainly on the physical properties of the polymer. The in vivo experiments carried out in the field on cattle and in the laboratory on rabbits using the classical treatment (intramuscular injection) and the sustained release devices (SRD) subcutaneously implanted, showed that the prophylactic period is significantly enhanced in the case of SRD as compared to intramuscular injection. The comparative efficacy of SRD containing IMM and EtBr evaluated in the case of rabbits showed that, the SRD (IMM) prophylactic period is much longer than for SRD (EtBr).

[Problems of reoperation after prosthetic repair of groin hernia]

The easy performance and the efficiency of these repairs should make the surgeon attentive to some related drawbacks, which can scarcely appear when reoperating on the bladder or the prostate, also on the iliac vessels. The encountered difficulties are related to the scar sclerosis much or less extensive and/or effective, invading the Retzius and/or the Bogros' spaces. The authors report their intraoperative and anatomical findings. They propose the following solutions: (1) when the cleavage of the Retzius' space is impossible (for bladder or prostate surgery): a subperiosteal retropubic cleavage, either isolated or combined with a transperitoneal approach. (2) When the cleavage of the Bogros' space is impossible (for a surgery on the iliac vessels): a transperitoneal approach; but the prevention of the perivascular sclerosis after the use of large prostheses relies on the easy preservation of the funicular sheath, able to protect the iliac vessels, providing no slit has been done on the mesh prosthesis.

Field evaluation of the prophylactic effect of an isometamidium sustained-release device against trypanosomiasis in cattle

In order to compare the prophylactic effect provided by a poly(D,L-lactide) sustained-release device (SRD) containing isometamidium (ISMM) with that provided by the classical intramuscular injection of the drug, a field trial was carried out at the Madina Diassa Ranch in Mali. One- to 3-year-old N'Dama cattle were randomly divided into three groups. The first group (n = 42) was treated with ISMM at a dose of 1 mg/kg of body weight, the second group (n = 44) received the same dose of the drug via an SRD, which was subcutaneously implanted in the shoulder region, and the third group (n = 36) was kept as an untreated control group. All animals were treated with diminazene aceturate (7 mg/kg of body weight) 2 weeks before the start of the experiment and were tested monthly by the buffy coat technique for a period of 8 months. Glossina morsitans submorsitans was the most important tsetse species, with apparent densities (number of catches/trap/day) varying between 11.9 and 38.7 over the experimental period. Eight months after treatment the cumulative infection rates were 27.7, 58.5, and 77.4% in the group with the SRD implant, the group receiving the intramuscular injection, and the control group, respectively. Statistical analysis showed that the incidence of trypanosomiasis was significantly lower (P = 0.006) in the group which received ISMM via the SRD than in the one which was treated with ISMM intramuscularly.

Prophylactic effects of isometamidium- and ethidium-sustained release devices against Trypanosoma congolense in cattle

Two successive experiments were carried out in which three cows were treated by intramuscular injection of either 0.5 mg/kg isometamidium or 1 mg/kg ethidium and compared with another group of three cows which received a subcutaneously implanted sustained release device (SRD) containing the same dose of drug. The prophylactic effect of both drug formulations was evaluated by exposing the animals at monthly intervals to Glossina morsitans morsitans infected with Trypanosoma congolense. The average protection period using the isometamidium- and the ethidium-SRD was extended by a factor of 3.2 and 2.8, respectively in comparison with the intramuscular injection of the drugs. In the analysis of isometamidium concentrations in the serum of the animals using a competitive drug-ELISA the drugs remained present for much longer periods in the sera of the implanted animals than in those of the intramuscularly treated cattle. The animals were still protected, however, a long time after the disappearance of detectable drug levels in the serum. No difference in drug sensitivity could be observed, when breakthrough isolates were compared from animals which received the ethidium-SRD and those treated intramuscularly, although a slight loss sensitivity occurred in the breakthrough isolates as compared to the parent trypanosome population.

[New amino acid from the antibiotic, ristomycin A]

A new amino acid E was isolated from a mixture of the products of the reductive hydrolysis of ristomycin A 57% HJ in the presence of red phosphorus. Its characterization was performed. The new amino acid was formed as a result of reductive dehydration of the respective beta-oxyamino acid present in the native antibiotic and being completely destroyed during general acid or alkaline hydrolysis.