Prevalence of vulvovaginal candidiasis in pregnancy at three health centers in Burkina Faso

INTRODUCTION

Pregnant women are more susceptible to vaginal colonization and infection by yeast. The role of Candida colonization in the occurrence of preterm birth is well established. The knowledge of local epidemiology and identification of risk factors for preterm birth is important for the prevention and management strategies. The purpose of the study was to determine the prevalence of Candida sp. in vaginal swabs of pregnant women.

METHODS

Pregnant women attending routine antenatal visits in three primary health centres in Bobo-Dioulasso (Burkina Faso) were enrolled into a cross-sectional study carried out from February to April 2015. Vaginal swabs samples were taken from participants after obtaining oral consent. The swabs were inoculated into Sabouraud's glucose agar supplemented with chloramphenicol and incubated at 37°C for 24 to 48hours under aerobic conditions in order to perform fungal culture. The identification of the Candida species was done by culture on HiCrome Candida Differential Agar at 35°C for 48h for production of species-specific colors.

RESULTS

A total of 229 pregnant women were included. The prevalence of vulvovaginal candidiasis (VVC) was 22.71%, (95% CI [17.45-28.69]). Candida albicans accounted for 40.39% and non-Candida albicans species for 59.61% of the isolates, with mainly C. glabrata (32.69%), C. tropicalis (15.38%) and C. krusei (11.54%).

CONCLUSIONS

This study revealed a high prevalence of non-C. albicans species. The syndromic management guidelines for VVC in Burkina Faso will be revised to include a specific protocol for pregnant women.

Nationwide Trends in Bacterial Meningitis before the Introduction of 13-Valent Pneumococcal Conjugate Vaccine-Burkina Faso, 2011-2013

BACKGROUND

Following introduction of Haemophilus influenzae type b vaccine in 2006 and serogroup A meningococcal conjugate vaccine in 2010, Streptococcus pneumoniae (Sp) became the leading cause of bacterial meningitis in Burkina Faso. We describe bacterial meningitis epidemiology, focusing on pneumococcal meningitis, before 13-valent pneumococcal conjugate vaccine (PCV13) introduction in the pediatric routine immunization program in October 2013.

METHODS

Nationwide population-based meningitis surveillance collects case-level demographic and clinical information and cerebrospinal fluid (CSF) laboratory results. Sp infections are confirmed by culture, real-time polymerase chain reaction (rt-PCR), or latex agglutination, and CSF serotyped using real-time and conventional PCR. We calculated incidence rates in cases per 100,000 persons, adjusting for age and proportion of cases with CSF tested at national reference laboratories, and case fatality ratios (CFR).

RESULTS

During 2011-2013, 1,528 pneumococcal meningitis cases were reported. Average annual adjusted incidence rates were 26.9 (<1 year), 5.4 (1-4 years), 7.2 (5-14 years), and 3.0 (≥15 years). Overall CFR was 23% and highest among children aged <1 year (32%) and adults ≥30 years (30%). Of 1,528 cases, 1,036 (68%) were serotyped: 71% were PCV13-associated serotypes, 14% were non-PCV13-associated serotypes, and 15% were non-typeable by PCR. Serotypes 1 (45%) and 12F/12A/12B/44/46 (8%) were most common. Among children aged <1 year, serotypes 5 (15%), 6A/6B (13%) and 1 (12%) predominated.

CONCLUSIONS

In Burkina Faso, the highest morbidity and mortality due to pneumococcal meningitis occurred among children aged <1 year. The majority of cases were due to PCV13-associated serotypes; introduction of PCV13 should substantially decrease this burden.

[W135 meningococcus meningitis: study of 148 cases observed in 2002 and 2003 at the National Teaching Hospital of Ouagadougou, Burkina Faso]

The purpose of this report is to describe the bacteriological features, clinical signs and therapeutic outcome of 148 cases of W135 meningococcus meningitis observed during meningitis outbreaks in Burkina Faso in 2002 and 2003. Diagnosis was based on microbiological study of cerebrospinal fluid. Cases of meningococcus meningitis were recorded throughout the study period with the peak number of cases occurring around the 14th week. There was a slight male predominance (56.1%) and young patients between one and 15 years accounted for 81.7% of cases. The mean interval between onset of symptoms and hospitalization was 2.6 days and the mean duration of hospitalization was 5.5 days. The most common clinical signs were fever (98.6%), stiff neck (90.5%),Brudzinski's sign (85.1%),Kernig's sign (66.2%), altered consciousness (41.9%), vomiting (36.5%) and headaches (34.5%). In most cases treatment with a singie dose of chiorazuphenicol in oil was curative. Overall mortality was 15.5% idth no correlation with sex or age. Seventeen of the 23 deaths occurred within 24 hours after their admission to the hospital. The other six deaths occurred on the second day after admission inS cases and fifth day in one case. Convulsions, shock and altered consciousness were consistent poor prognostic signs. A correlation was found between mortality and interval for hospitalization with better survival in patients receiving prompt treatment. Study of the susceptibility of 102 samples showed that W135 meningococcus was sensitive to penicillin G, ampicillin,ceftriaxone and chloramphenicol but resistant to sulfamides (cotrimoxazole). Bacterial meningitis is an Important factor of morbidity and mortality worldwide. Our findings indicate that the bacteriological, clinical and epidemiological characteristics of W135 meningococcus is do not differ greatly from those of meningococcus A. Since W135 meningitis is susceptible to antibiotics used to cure meningitis, campaigns to promote early detection and treatment must be continued.

Short communication: Impact of long-term (14 years) bi-annual ivermectin treatment on Wuchereria bancrofti microfilaraemia

Ivermectin has been and continues to be extensively used to control onchocerciasis in areas of hyper and mesoendemicity within the African Programme of Onchocerciasis Control. As programmes to eliminate lymphatic filariasis (LF) caused by Wuchereria bancrofti expand, areas of coendemicity with onchocerciasis will be incorporated into LF programmes. This study reports that in villages which were hyperendemic for onchocerciasis after some 14 years of treatment with ivermectin, no W. bancrofti could be detected in a population of 1210 individuals whilst in adjacent villages a prevalence of around 3% was found. Despite the long period of ivermectin treatment Mansonella perstans did not appear to respond to ivermectin in this setting.

Impact of long-term ivermectin (Mectizan) on Wuchereria bancrofti and Mansonella perstans infections in Burkina Faso: strategic and policy implications

Parasitological and clinical surveys were used to determine the long-term impact of ivermectin on the prevalence of Wuchereria bancrofti and Mansonella perstans filarial infections, when the drug was given under community-directed-treatment strategies for onchocerciasis control. The study was undertaken in 11 communities in south-western Burkina Faso. Six of the villages investigated had been treated with ivermectin at least once a year for five of 6 years, with a mean coverage of approximately 65% in each round. The other five, adjacent villages, which were matched with the ivermectin-treated communities by size, ethnicity and social and economic activities, had never been treated because they were not endemic for onchocerciasis. Each subject was checked by the microscopical examination of a smear of 'night' blood, by measurement of the level of circulating antigens from adult W. bancrofti, and by clinical examination for hydrocele (if male) and lymphoedema. The prevalences of lymphoedema and hydrocele in the treated villages were similar to those in the untreated. The prevalences and intensities of W. bancrofti and M. perstans microfilaraemia were, however, significantly lower in the ivermectin-treated communities. The implications of this study are discussed in relation to the old Onchocerciasis Control Programme (OCP) and to the ongoing African Programme for Onchocerciasis (APOC), where extensive and sustained ivermectin distribution is planned through community-based treatment programmes. As with onchocerciasis in Africa, the success of annual treatments to control lymphatic filariasis will depend not only on the number of regular rounds of treatment given but on adequate coverages being achieved in each round. Wherever ivermectin is being distributed alone, for onchocerciasis control, its impact on other filarial infections, notably W. bancrofti, should be evaluated routinely. Any opportunity to add donated albendazole to such distributions should be taken, both to limit the transmission of W. bancrofti and for the wider public-health benefits.

The use of spatial analysis in mapping the distribution of bancroftian filariasis in four West African countries

The geographical distribution of human infection with Wuchereria bancrofti was investigated in four West African countries (Benin, Burkina Faso, Ghana and Togo), using a commercial immunochromatographic test for filarial antigen. Efforts were made to cover each health-system implementation unit and to ensure no sampling point was >50 km from another, but otherwise the 401 study communities were selected at random. The aim was to enable spatial analysis of the data, to provide a prediction of the overall spatial relationships of the infection. The results, which were subjected to an independent random validation in Burkina Faso and Ghana, revealed that prevalence in the adult population of some communities exceeded 70% and that, over large areas of Burkina Faso, community prevalences were between 30% and 50%. Most of Togo, southern Benin and much of southern Ghana appeared completely free of the infection. Although there were foci on the Ghanaian coast with prevalences of 10%-30%, such high prevalences did not extend into coastal Togo or costal Benin. The prevalence map produced should be useful in prioritizing areas for filariasis control, identifying potential overlap with ivermectin-distribution activities undertaken by onchocerciasis-control programmes, and enabling inter-country and sub-regional planning to be initiated. The results indicate that bancroftian filariasis is more widely distributed in arid areas of Burkina Faso than hitherto recognized and that the prevalences of infection have remained fairly stable for at least 30 years. The campaign to eliminate lymphatic filariasis as a public-health problem in Africa will require significantly more resources (human, financial, and logistic) than previously anticipated.

Blood flow vs. venous pressure effects on filtration coefficient in oleic acid-injured lung

On the basis of changes in capillary filtration coefficient (Kfc) in 24 rabbit lungs, we determined whether elevations in pulmonary venous pressure (Ppv) or blood flow (BF) produced differences in filtration surface area in oleic acid-injured (OA) or control (Con) lungs. Lungs were cyclically ventilated and perfused under zone 3 conditions by using blood and 5% albumin with no pharmacological modulation of vascular tone. Pulmonary arterial, venous, and capillary pressures were measured by using arterial, venous, and double occlusion. Before and during each Kfc-measurement maneuver, microvascular/total vascular compliance was measured by using venous occlusion. Kfc was measured before and 30 min after injury, by using a Ppv elevation of 7 cmH2O or a BF elevation from 1 to 2 l . min-1 . 100 g-1 to obtain a similar double occlusion pressure. Pulmonary arterial pressure increased more with BF than with Ppv in both Con and OA lungs [29 +/- 2 vs. 19 +/- 0.7 (means +/- SE) cmH2O; P < 0. 001]. In OA lungs compared with Con lungs, values of Kfc (200 +/- 40 vs. 83 +/- 14%, respectively; P < 0.01) and microvascular/total vascular compliance ratio (86 +/- 4 vs. 68 +/- 5%, respectively; P < 0.01) increased more with BF than with Ppv. In conclusion, for a given OA-induced increase in hydraulic conductivity, BF elevation increased filtration surface area more than did Ppv elevation. The steep pulmonary pressure profile induced by increased BF could result in the recruitment of injured capillaries and could also shift downstream the compression point of blind (zone 1) and open injured vessels (zone 2).

Capillary pressure estimates from arterial and venous occlusion in intact dog lung

We performed pulmonary venous occlusions in order to check the validity of the pulmonary capillary pressure measurements obtained using pulmonary arterial occlusion in the intact animal. The venous and arterial postocclusion pressure profiles were recorded using balloon catheters introduced, respectively, into a left lower lobe vein and into a right pulmonary artery in the anaesthetized open-chest dog. The pressure profiles were fitted by a biexponential function with an early exponential and a late exponential presenting, respectively, a short and a long time constant. We used the zero-time extrapolation of the late slow exponential to obtain an arterial (Pc,ao) and a venous (Pc,vo) estimate of the pulmonary capillary pressure. Each Pc,ao and Pc,vo made it possible to calculate a fractional arterial or venous pressure gradient when referenced to the arteriovenous pressure gradient measured during the occlusion process. In nine dogs, when referenced to the whole lung, the arterial, middle and venous fractional pressure gradients were 37 +/- 11, 10 +/- 6, and 53 +/- 12%, respectively. As the middle fractional pressure gradient is low, we conclude that pulmonary capillary pressure estimates from arterial occlusion are close to the venous occlusion estimates of capillary pressure in the intact dog lung.