[Tuberculosis in chronic hemodialysis patients at the Teaching Hospital of Point G (CHU) in Bamako]

AIMS

To determine the frequency and the diagnostic difficulties of tuberculosis of haemodialysis patients.

PATIENTS AND METHODS

The study was about a retrospective analyse of patients haemodialysis records treated for tuberculosis within January 2003 to April 2006. The tuberculosis check-up contained a questioning, a meticulous clinic examination, thorax radiography, a tuberculosis intra dermoreaction (IDR) and the search of Koch Bacillus (BK) in biological liquids.

RESULTS

Tuberculosis was identified to 15.52% of haemodialysis patients (10/95). The average age of our patients was from 44.3 years, with a ratio sex of 2.5 in favour of men. Tuberculosis infection happened on average 27.4 months after the beginning of the haemodialysis. We found out 50% of extra pulmonary tuberculosis (three peritoneales and two pleurales); and 50% of pulmonary tuberculosis. The IDR was positive in two cases (2/6). The search of BK didn't succeed. We reported three deaths.

CONCLUSION

The effect of tuberculosis to chronic haemodialysis patients is very high. The diagnostic is sometimes difficult and is based only on specific therapeutic test.

[Systemic vasculitis: study of 27 cases in Senegal]

Studies on vasculitis in black Africa are rare. The purpose of this report is to describe a retrospective study of systemic vasculitis managed in the internal medicine, ORL and cardiolology departments of the Aristide le Dantec University Hospital in Dakar, Senegal from 1995 to 2007. A series of 27 cases involving 7 men and 20 women with a mean age of 49 years was compiled. Primary vasculitis included Horton disease in 3 cases, Wegener disease in 2, Takayasu disease in 1, and Buerger disease in 1. Secondary vasculitis included mixed cryoglobulinemia with Gougerot Sjögren syndrome in 7 cases, primary Goujeröt syndrome in 4, rheumatoid arthritis in 3, nodosa periarteritis with hepatitis B in 2, SHARP syndrome in 1, and polymyositis in 1. The remaining two cases involved abdominal periaortitis including one associated with retrosperitoneal fibrosis and tuberculosis and the other with spondylarthropathy. Corticotherapy in combination with anticoagulants, immunosuppressive therapy, and surgery, when necessary, allowed effective management in 24 cases. The findings of this study show that systemic vasculitis can have numerous etiologies and indicate that secondary forms are the most common. Appropriate care modalities are needed to prevent severe outcome in Senegalese hospitals.

[Is it possible to detect Staphylococcus aureus colonization or bacteriuria before orthopedic surgery hospitalization?]

AIM OF THE STUDY

Evaluate the feasibility of Staphylococcus aureus nasal colonization and bacteriuria screening in outpatients before realizing a decolonization treatment in S. aureus carriers and a bacteriuria treatment before hospitalization.

METHODS

All patients undergoing hip, knee or back surgery in which prosthesis were implanted between October 2007 until the end of June 2008 were included. Microbiological studies were performed before hospitalization. Notice for S. aureus decolonization regimen was delivered to each patient and to the general practitioner only if the patient had nasal carriage.

RESULTS

Only 91.2% (240/263) of patients had microbiological results. Prevalence of S. aureus colonization was 21.4% (48 positives/224). Three patients were colonized with methicillin-resistant staphylococci. Decolonization regimen was applied before surgery to 70.8% (n=34) of the colonized patients. Among the patients, 8.9% (20/225) had bacteriuria, Escherichia coli being the most frequent micro-organism (n=16).

CONCLUSION

Preoperative search and management of S. aureus colonization and of bacteriuria in outpatients is possible. Monitoring record must be performed by a member of the hospital staff.

Haemophilus influenzae Type B conjugate vaccine introduction in Mali: impact on disease burden and serologic correlate of protection

In Bamako, Mali, where surveillance revealed a high incidence of Haemophilus influenzae type b (Hib) invasive disease, Hib conjugate vaccine was introduced into the Expanded Program on Immunization and the impact assessed. Annual confirmed Hib hospitalizations for infants 0-11 months of age fell from 175/10(5) to 44/10(5) (P < 0.001); among infants 6-7 months of age Hib hospitalizations fell from 377/10(5) to 69/10(5), (82% decrease, P < 0.001). Invasive Streptococcus pneumoniae hospitalizations remained unchanged. In a baseline serosurvey, only 3/200 infants 6-7 months of age (1.5%) had protective anti-polyribosylribitol phosphate (PRP) titers > or = 0.15 microg/mL and 1(0.5%) had >or = 1.0 microg/mL. In serosurveys 18 and 30 months after vaccine introduction, 168/201 (84%) and 184/200 (92%) infants, respectively, had titers > or = 0.15 microg/mL and 141/201 (70%) and 163/200 (82%) had titers > or = 1.0 microg/mL. Introduction of Hib vaccine led to rises in anti-PRP seroprevalence, significant reductions in Hib disease, and all-cause hospitalizations, whereas S. pneumoniae disease remained unchanged.

[Contribution of coloscopy to diagnosis of rectal bleeding in Dakar (Senegal)]

INTRODUCTION

Rectal bleeding is a common reason for seeking medical attention and can lead to diagnosis of serious disease. The purpose of this report is to describe lesions discovered by coloscopy in patients assessed for rectal bleeding in Dakar, Senegal.

PATIENTS AND METHODS

This retrospective study was carried out from January 2006 to December 2008 at the Aristide Le Dantec University Medical Center in Dakar. Coloscopy reports involving patients presenting with rectal bleeding were compiled. Age, quality of preparation, use of sedation, and lesions observed were analyzed.

RESULTS

A total of 143 patients underwent coloscopy for rectal bleeding. Mean patient age was 51.3 years (range, 2 to 85 years) and the sex ratio was 1.7 (90 men). Preparation was considered as good in 55.5% of cases. Sedatives were used in 57% of cases. Coloscopy findings were normal in 9.8% of cases. The most common lesions were hemorrhoids (53.14%), rectocolitis (17.5%), cancer (11.9%), polyps (11.2%), and diverticulosis (11.2%). Multiple lesions were found in 20 patients (14%).

CONCLUSION

Coloscopy for assessment of rectal bleeding in Dakar revealed a range of lesions with hemorrhoids and rectocolitis accounting for most.

[Tuberculosis and systemic diseases: study of 8 Senegalese cases]

PATIENTS AND METHODS

A retrospective study (2000-2007) of the tuberculosis observations during systemic diseases was conducted in the service of Internal Medicine of hospital Aristide Le Dantec of Dakar.

RESULTS

8 (4 men and 4 women) has been received. The mean age was 54.5 years. The localization of tuberculosis was lung (n=8) with pleurisy (n=2), ganglionic (n=1), vertebral (n=1) and an abscess of the psoas (n=1). The diagnosis of tuberculosis had been carried with the bacteriological analysis of the expectorations (n=7), the histology (n=1). The systemic diseases was: rheumatoid arthritis and Sjögren's syndrome (n=3), primary Sjögren's syndrome (n=4), autoimmune thrombopenia (n=1). The diagnosis of systemic diseases was previous to that of tuberculosis in 7 cases and concomitant in 1 cases. Under chemotherapy and corticosteroid therapy, the evolution was favorable in 6 patients.

CONCLUSION

our study confirms the frequently character spread by the tuberculosis in patients affected by systemic diseases. This association enhances diagnostic and therapeutic problems.

[Periodontal status of Senegalese patients with Sjögren's syndrome. A case control study at the Service of Internal Medicine]

The aim of this study is to compare the periodontal status of patients with Gougerot-Sjögren syndrome (GSS) to healthy subjects in order to investigate the relation between periodontal disease and GSS. To achieve this aim, one hundred and three patients, among whom 36 with primary GSS and 67 with secondary GSS, were selected and compared with one hundred and three (103) control subjects. The hygiene level was evaluated with Silness and Löe plaque index (PI) and inflammation level with Löe and Silness gingival index (GI). Probing depth and clinical attachment loss was measured with Williams periodontal probe. Mean plaque indices were identical for both groups (1.27 +/- 0.1 versus 1.22 +/- 0.1, p = 0.67). Compared with control subjects, the inflammation index scores were significantly higher among SSG patients (IG = 1.1 +/- 0.1 versus 0.44 +/- 0.2, p < 0,001). The logistical regression model applied to the whole sample showed that patients with GSS had a higher risk of developing periodontal disease (IG : OR 5.508, state 95% CI [1.66-9.60] ; PP : OR = 4.51 95% CI [1.692-12.024]). A training program for GSS patients seems essential, in order to manage the deleterious effects of defective oral-dental ground. It would allow convincing patients about the interest of prevention through regular surveillance and care.

[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.

[The socio-economic impact of asthmatic disease at Bamako about 131 cases]

With an aim of evaluating the socio-economic impact of the asthmatic disease in Mali, a cross-sectional study was carried out of July 1st to September 30, 2006 in the district of Bamako. The study proceeded with the service of Pneumo-phthisiology of the CHU of the point G and in 4 of the 6 drawn health center of reference of the district to the fate. 131 asthmatic patients were indexed on 1595 consultations is a frequency of 8, 24%. The average age was 31 years, the sex-ratio was of 1,2 in favour of the men. August recorded the greatest number of consultation is 50.4%. The antecedent of family asthma was found in 46, 6% of the cases, the nicotinism in 13% of the cases. The average therapeutic cost per annum rose of 75.750 is 115, 47 EUROS without hospitalization with 222.750 FCFA (339, 57 EUROS) FCFA with hospitalization. The hospital expenses rose on average to. 147000 FCFA (224, 09 EUROS) that is to say 66, 21% of the costs of assumption of responsibility. The intermediate duration of hospitalization was 5,5 days 1 to 4 days without activity was noted at 50.4% of the cases, on average 312 days of absence. The professional damage was announced in 13, 7%. The economic burden was supported by the father in 29% of the cases. In 42% of the cases in charge one of expenditure was civil servant. Asthma is a social disease from its impact on the family economy.

[A pioneer in the fight against AIDS in Nigeria]

The Association MVS (French acronym for Mieux Vivre avec le Sida) founded by a physician in Niger in 1994 was the first entity to provide medical and psychological care to symptomatic HIV-infected patients from Niger as well as neighboring countries (Nigeria, Burkina Faso). It has often been at the forefront by offering voluntary screening, undertaking patient management as early as 1998, decentralizing in 2003, and setting up a innovative training facility. Despite these achievements and a solid reputation for excellence in Niger, the Association MVS receives practically no government funding with state subsidies accounting for only 1% of the budget in the last two years. Over the 5-year period ending in 2006, more than 10,000 voluntary screenings were performed with a growing number of requests from women and unsolicited requests. More than 124 patients receive regular follow-up including 73 undergoing ARV treatment. The Association MSV has branches in Tahoua, Zinder, and Agadez. The years 2006 and 2007 have been turning points for the Association MVS because the management facilities need renovation and the awareness unit was forced to close. The screening and patient follow-up center has been able to remain effective since it is located in a quiet area but it is far away from popular neighborhoods. Plans should be made to centralize all activities in a single community friendly location. The experience of the Association MVS underlines the increasing importance of civilian involvement in managing daily problems faced by people and, insofar as possible, in political decision-making on such issues.

[Monoclonal gammapathy of undetermined significance and autoimmune disease: description of three cases in Senegal]

Monoclonal gammapathy of undetermined significance (MGUS) has rarely been reported in African literature. The purpose of this article is to describe 3 cases of MGUS observed in women aged 63, 54, and 44 years in Senegal. All three patients had previously documented autoimmune disease, i.e., auto-immune thrombopenia, multiple auto-immune disease (comprising Sjögren's syndrome, polymyositis and vitiligo), and Sjögren's syndrome. Diagnosis of MGUS was made thanks to routine protein electrophoresis that demonstrated a monoclonal peak in the gammaglobulin area in all patients. Serum protein binding showed the IgG lambda subtype in one case and IgG kappa subtype in two cases. Medullogram findings were unremarkable with nondystrophic plasma cell rates ranging from 1 to 4%. Bisphophonate therapy was undertaken along with the recommended treatments for the associated autoimmune diseases, i.e., prednisone, hydroxychloroquine, and methotrexate. Treatment was successful in all three patients with stabilization of the associated diseases and of the monoclonal peak on subsequent electrophoresis. As of this writing, the mean duration of follow-up was 3 years. MGUS that has been uncommon in the African hospital setting should be screened for in all older patients or in patients presenting infection (especially due to virus) or autoimmune disease (as in the three cases presented herein). More systematic use of serum protein electrophoresis should reveal an increased incidence of MGUS. Diagnosis of MGUS requires regular clinical and laboratory surveillance due to the risk for complications of malignant hemopathies, especially multiple myeloma.

[Epidemiologic aspects of pulmonary tuberculosis with positive bacilloscopy in the decade of 1995-2004]

The purpose of this study is to make an epidemiological description of pulmonary tuberculosis with sputum smear positive in Mali. This is a retrospective study conducted from January 1st, 1995 to December 31st, 2004 by the National Program for fighting against tuberculosis (located at the National Department of health), and where data were centralized. From this ten years period, 33,000 cases of tuberculosis (all forms of TB) have been notified in Mali, which represented an annual rate of 2750. Of those, 22,275 cases (67.5%) were sputum smear positive (with Ziehl Nielsen), this represented 1856 as annual rate. The prevalence of pulmonary TB with sputum smear positive is 185/100,000. During the study period a total of 13,638 (61.22%) cases of 22,275 cases of pulmonary TB with sputum smear positive have been given ant tuberculosis drugs; From these patients under therapy 2371 cases (17.38% ) disappear before the end of treatment.; 5851 cases (42.90%) have been considered as cured; 161 (1.18%) cases of treatment failure and 523 (3.93%) cases of death. The sex-ratio was 3.57 with young adults representing the majority of cases. Pulmonary TB with sputum smear positive treatment remains a challenge for National Programs for fighting against TB as well as its prevention.

[Profile of deceased patients who died as a result of microscopy-positive pulmonary tuberculosis: impact of HIV status]

In order to study the profile of patients who died of pulmonary tuberculosis with positive smear under tuberculosis chemotherapy and the impact of HIV status, a prospective study over eight months from 1 November 2005 to 30 June 2006 was conducted in tuberculosis department CHU point G. Among patients hospitalized for tuberculosis all forms, 73 cases of pulmonary tuberculosis were recorded including 54 sputum smear-positive (73.9%). The analysis focused on 28 deaths among pulmonary tuberculosis smear positive (prevalence of 51,85%). The age group of 16-35 years was the most represented with a sex ratio of 2.5. The different causes of morbidity which had a negative influence on the lethality of TB patients in order of importance were: the extent of the lesions (71.4%), HIV/AIDS status (63.15%), smoking (50 %) and a history of tuberculosis (25%) (p = 0.02). The deaths occurred early during the first week of hospitalization. The search for morbidity factors in any patient with tuberculosis should be systematical to improve their care.

[Diffuse interstitial lung disease and connective tissue diseases: study of seven cases in Dakar]

INTRODUCTION

The diagnosis of diffuse interstitial lung disease non specific in connective tissue disease is difficult because of many differential diagnoses. Lung involvement can affect functional or vital prognosis. We report 7 cases.

CASES

We collected data from 60 years old mean patients. Pulmonary localisation was diagnosed after 19 years of evolution of the auto-immune disease. Discovering circumstances were dyspnea and chronic cough. The radiographic and scannographic signs were diffuse because of long diagnosis delay. The underlying auto immune disease was scleroderma, rheumatoid arthritis, Sjögren's syndrome, ankylosing spondylitis, Sharp's syndrome, and multiple autoimmune syndrome. The main treatment was corticosteroids and respiratory physiotherapy.

CONCLUSION

Throughout these 7 cases we discuss clinical, radiological and evolutive aspects and we focus on the need of early diagnosis for a better prognosis.

Male circumcision and HIV in the Malian military

In the goal of determine the impact of circumcision in transmission of HIV in military area. A retrospective study has been carried out from January 2000 to December 2005 at the infirmary of Genie military garrison about all HIV positive serology registered in that structure. It was a study of circumcised militaries and uncircumcised militaries as control group. Among 1183 militaries, 1102 were men (93.2%). Among these 1102, 57 were HIV positive (5.1%). Among 1102 military, 154 were uncircumcised and among them 20 were HIV positive (12.9 %). Among 948 of circumcised militaries 37 were HIV positive (3.9%). Circumcision reduces the risk of infection by HIV; however it has to be considered as supplement among other prevention methods.

Ethnobotanical survey and antibacterial activity of some plants used in Guinean traditional medicine

A total of 418 healers have been interviewed in Guinea, a coastal country of West Africa, ranging between 7 degrees 30 and 12 degrees 30 of northern latitude and 8 degrees and 15 degrees of western longitude. Plant species used by the local inhabitants to treat infectious diseases were identified using ethnobotanical, ethnographic and taxonomic methods. During these investigations, 218 plants were registered, of which the following were the most frequently used: Erythrina senegalensis, Bridelia ferruginea, Crossopteryx febrifuga, Ximenia americana, Annona senegalensis, Cochlospermum tinctorium, Cochlospermum planchonii, Lantana camara, Costus afer, Psidium guajava, Terminalia glaucescens, Uapaca somon and Swartzia madagascariensis. Most plants, and especially the leaves, were essentially used as a decoction. In order to assess antibacterial activity, 190 recipes were prepared and biologically tested, among which six showed activity (minimal inhibitory concentration<125 microg/ml) against Bacillus cereus, Mycobacterium fortuitum, Staphylococcus aureus, or Candida albicans, i.e., Entada africana, Chlorophora regia, Erythrina senegalensis, Harrisonia abyssinica, Uvaria tomentosa, and a mixture of six plants consisting of Swartzia madagascariensis, Isoberlinia doka, Annona senegalensis, Gardenia ternifolia, Terminalia glaucescens and Erythrina senegalensis.

Reconstitution of immune responses occurs very rapidly after initiation of therapy for tuberculosis (43.54)

Introduction: Immune reconstitution syndrome is a potentially fatal sequelae of HAART therapy in 20% of patients with HIV and 3–5% with tuberculosis who begin treatment. The role of CD4+T cells in its pathogenesis is poorly understood.

Methods: This study was done under an IRB approved protocol to study MTb specific immunity. Groups based on HIV status and local or disseminated MTb were evaluated for CD4+ T cell counts, Purified Protein Derivative (PPD) induced proliferation and cytokine induction using intracellular cytokine staining for IFN γ, IL2, TNFα and CFSE dilution at predefined times before and after starting therapy.

Results: In preliminary results, the first 3 HIV negative patients with MTb exhibited striking increase in MTb specific immunity in the first week of therapy. Percentage of IFN γ producing CD4+T cells increased from 1.96 and 0.48 to 4.46 and 1.34, and of TNF α producing cells increased from 0.85 and 0.45 to 3.96 and 1.06 in 2 patients. Proliferative responses also showed marked increases. Percent dividing cells increased from 4.3, 4.4 and 16.3 at baseline to 36.9, 11.9 and 39.6 at 1 week and 54.8 and 72.3 at 4 weeks of therapy. Total number of CD4+ T cells also increased.

Conclusions: Tuberculosis like HIV causes quantitative and qualitative changes in CD4+T cells . These are rapidly reversed when therapy is begun .This data provides insight into the pathogenesis of the immune reconstitution syndrome.

[Undesirable effects of methothrexate during treatment of rheumatoid arthritis]

INTRODUCTION

Methotrexate used as antimetabolite since 40 years in cancerology, is curretly pointed out at weak dose in the treatment of rheumatoid arthitis. However, the intervening of undesirable effects is currently the principal factor limiting its use. The main of our study was evaluate the nature and the frequency of undesirable effects during treatement of rhumatoid arthritis by methotrexate in a prospective study in the department of internal medecine of A.L.D hospital.

MATERIAL AND METHODS

Fifty patients were included in the study, they were 43 female and 7 male (sex ratio of 0.161).The mean age were 40.8 years, ranging from 18 to 68. The mean last of MTX treatment was 16.58 months, ranging from 1 to 64.

RESULTS

Twenty seven patients (54%) had at least one undesirable effect. Undesirable effect appeared early in 74.1%. they were 61.5% when MTX was associated with others drugs versus 27.3% when MTX was used alone. Undesirable effects mostly were digestives (38%), general (30%), mucouscutaneous (8%) and hepatics (2%).for patients undesirable effects had involved. They were responsable of definitive stopping treatment in two cases of pulmonary tuberculosis.

[Still disease in adult: a Senegalese case report]

INTRODUCTION

The adult Still's disease is a systematic disease rarely reported in the black Africans. We are reporting a case characterized among other difficulties by its diagnostic difficulties.

OBSERVATION

It is about a 29 years old black Senegalese woman patient, without particular antecedents, which presented a systematic chronic syndrome composed of a pharyngitis, a polyarthritis and general symptoms (fever, chills, sweats, change of the general state), a cutaneous eruption, a polyadenopathy, a hepatosplenomegaly. The biological analyses showed among others, an inflammatory syndrome (VS at 115 mm in the 1st hour, CRP at 100 mg/L, WBC at 10,400/mm3 with neutrophilia), a hyperferritinemia in 643 ng/l with collapse of the glycosylated ferritin at 13% (N between 60 in 80%). After elimination of any autoimmune or neoplastic suppurative infectious pathology in the decline of a check up as exhaustive as possible, the diagnosis of a Still disease in adult had been retained. Their was improvement under the combination of prednisone and methotrexate.

CONCLUSION

Although it is exceptional in black African, this pathology shall be however part of the differential diagnoses of any unexplained systematic sign. The dosage of the ferritinemia and its glycosylated fraction as well as the resort to the criteria of Yamaguchi and Fautrel's classification of Still Disease in Adult shall allow to establish more prematurely the diagnosis of this potentially severe affection.

[Diffuse infiltrative lymphocytosis syndrome (DILS) associated with HIV-1 infection: first Senegalese case report]

INTRODUCTION

The "Diffuse Infiltrative Lymphocytosis Syndrome" [DILS] is a seldom complication and even very particular case of HIV-1 infection, characterized by a merely syndrome and a systemic symptomatology superimposable to the figure met during the Gougerot-Sjögren Syndrome. GSS is nevertheless underlied by a lymphocyte infiltrate composed mainly of TCD8+ lymphocytes, while in the Gougerot-Sjögren syndrome (GSS), the lymphocyte infiltrate is essentially composed of TCD4+ lymphocytes. Despite the antiquity and significance of the HIV/AIDS pandemic, the DILS is not according to our knowledge individualized in the African literature.

OBSERVATION

We are reporting a case revealed by a polyarthritis associated among others with a merely syndrome and a HIV-1 infection in a 32 years old Senegalese patient. Her CD4 rate was 327/mm3 and her viral load 17052. The biopsy of the accessory salivary glands showed a 4 grade lymphocite sialoadenitis according to Chisholm classification. The investigation of rheumatoid factors et anti-nuclear antibodies was negative. Under prednisone, hydroxychloroquine, methotrexate and tritherapy treatment, the evolution was favourable with a current return of 2 years. The rarity of DILS has pushed us to study its epidemiological, clinical, paraclinical, physiopathological and therapeutical aspects.

[HIV/AIDS impact in pulmonary tuberculosis with negative microscopy in pneumology service at Point "G" hospital]

This study was opened and conducted from colligated patient folders during 5 years (from January 1999 to December 2003). The main objective was the description of epidemiological, diagnostically and prise and prise of charge aspects of microscopy negative pulmonary tuberculosis. Patients were enrolled in this study in accordance to WHO criteria. During these 5 years, pulmonary tuberculosis has constituted 72.2% on all froms of tuberculosis with 20.2% of microscopy negative pulmonary tuberculosis. The BCG vaccine scar has been observed in 50.8% of cases. The IDR was negative in 21.3% of cases; this rate was about 68.1% in HIV positive patients. More than 60% of the patients have more than 3 negative bacilloscopy. The 69.4% of our patients have been hospitalized and 64% have been treated with III category system.

[Current aspects of systemic lupus erythematosus in Dakar. About 74 cases]

INTRODUCTION

previously reported studies on systemic lupus erythematosus in Senegal were more then ten years old and reported few cases of patients. Our objectives were to update epidemiological, clinical, laboratory and evolutive aspects of systemic lupus erythematosus throughout a study of 74 patients.

PATIENTS AND METHODS

we conducted a retrospective study in the internal medicine and the dermatology units of the university teaching hospital Aristide Le Dantec from January 1993 to December 2002. All patients with systemic lupus erythematosus according to the ACR criteria were included. Those who didn't meet ACR criteria were excluded.

RESULTS

we included 74 patients; their mean age was 32 years and the sex ratio 0.1 (male to female). At the entry general symptoms were constants, and cutaneous signs were found in 96% of cases, joints signs in 58.1% and renal sign in 56.8%. Haematological and immunologic abnormalities were nearly constant. All the patients received corticosteroids and in 35.71% they had in addition immunosuppressive drugs. Shorts term evolution was satisfactory. At the medium term 27.02% of the patients were lost and 10.81% of them died.

CONCLUSION

currents aspects of systemic lupus erythematosus in Dakar are improved by the early diagnosis when the disease is pauci-symptomatic and by the use immunosuppressive drugs in association with corticosteroids.

[Polyarticular gout in young adults: a curable rheumatic disease]

Juvenile chronic gout in its polyarticular deformative form has rarely been described in medical literature. We report a rare case of destructive polyarticular tophaceous gout in a 31-year-old Senegalese man. He consulted for bilateral asymmetric polyarthritis with deformities of the hands and feet that had been ongoing in recurrent episodes since the age of 18 years in association with tophus. He had received no previous medication. All laboratory investigations were normal except hyperuricemia 104 mg/l. Radiographs of affected joints demonstrated evidence of destructive polyarthritis, i.e., articular narrowing and osteo-condensation of the left great toe. The patient responded favourably to colchicine, allopurinol and diet. Gouty arthropathy must be differentiated from rheumatoid arthritis, psoriasic arthritis and distal chronic osteoarthrosis. In our case, definitive diagnosis of gouty arthropathy was based on chronic polyarthritis associated with tophus, hyperuricemia and therapeutic response to colchicine. Polyarticular gout can be suspected in case of chronic seronegative polyarthritis and diagnosis can be confirmed on the basis of plain radiographs and laboratory investigations showing uricemia. Treatment is effective, well tolerated and inexpensive.

[Etiology of pleurisy in the Service of Pneumology, Point G]

This study describes epidemiologic, etiologic and evaluative aspects of Pleurisy pneumology department of Point "G". From 1st January 1998 to 31 December 2002 was realised a study about hospitalized patients in the department. Pleurisy represented 15; 9% of hospitalizations. The sex Ratio was 2,3 en for men aged of 41 years 55 of pleurisy were located on right. In 60% of cases the liquid was sero-fibrin, purulent in 25% of cases and haemorrhagic in 15%. Tuberculosis was the most frequent etiology with 37% of cases. According to liquid aspect tuberculosis represented 54, 3% of sero-fibrin pleurisy in one hand, on the other 60% of haemorrhagic pleurisy was due to cancer. The serology HIV have been realised on 89 patients and it was positive on 56% of cases. Association pleurisy/HIV tuberculosis etiology represented 56% of cases. Among 369 patients we have counted 100 deaths, 27% and 86% of these death occurred before a month of hospitalization. Even if the prevalence of neoplastic pleurisy increases, tuberculosis still the 1st etiology of pleurisy. It co-infection with HIV is the principal cause of morbidity and mortality.

[Senegalese case of thromboangeitis obliterans or Buerger's disease]

INTRODUCTION

Thromboangeitis obliterans (TAO) is an inflammatory, non atheromatous arteriopathy of smoking young adults. It is diagnosed on an association of non specific criteria that we discuss throughout this case.

CASE REPORT AND DISCUSSION

A forty years old tabagical, Senegalese black man, had peripheral destructive lesions preceded by Raynaud phenomenon. He was admitted in our Internal Medicine department in November 2002. Actually this clinical presentation was evolving since 11 years. At that time, hypo aesthesia and ulceration of the fingers led to successive amputations in the leprology centre. The diagnosis of Hansen disease had been suspected but there were no evidence of mycobacterium. At the admission in our service, biological tests showed a moderated non-specific inflammatory syndrome. Ultra sound Doppler and arteriography showed a peripheral arterial stenosis without atheromatous lesions, in favour of TAO. To meet all the criteria the patient didn't have any thrombotic or systemic disease. The evolution was favourable after tobacco weaning.

CONCLUSION

TAO can bring to difficulties of diagnosis by its way of presentation. Physicians should practice a systematic vascular screening in case of distal arteriopathy.

[Seroprevalence of hepatitis C virus (HCV) in Senegalease blood donors]

INTRODUCTION

Hepatitis C virus (HCV) is an important problem of public health in the world according to its transmission mode and its pathogenesis. The risk of blood transmission has led to be the systematic screening of blood donors in the world. In Senegal no study about HCV prevalence on the general population and also has been done. The aim of our study was to determine HCV prevalence in blood donors and the rate of co-infection with hepatitis B (HCV/HBV) or with HIV infection (HCV/HIV).

MATERIALS AND METHODS

This study had been done in the National Blood Transfusion Centre (CNTS) in Dakar. Two different techniques has been used for the assessment HCV: 1/ ELISA technique and 2/ Immunoblot RIBA as confirmation test.

RESULTS

Our study relates to 1565 blood donors recruited in CNTS during 2002. 369 of them were new blood donors with 365 females and 1200 males. The mean average was 30.5 +/- 9.5 years, ranged from 18 to 59 years. HCV ELISA test were positive in 22 plasma samples and one of them were co-infected with hepatitis B (HCV/HBV). Four out of these 22 samples have been confirmed positive to RIBA test and three of them were not determined. HCV seroprevalence were 1.4% after ELISA and 0.25% after RIBA testing. This seroprevalence were similar in male and in female and higher in new blood donors than in regular blood donors.

CONCLUSION

Our results reinforce the necessity to screen hepatitis C virus in all Senegalese blood transfusion centres.

[Problems with lung cancer in the pneumology service at G Barnako Hospital, Mali]

The authors report the results of a retrospective study on the bronchial cancers observed in the service of PPH of the hospital of the point G of Bamako during the time active of January 1, 1999 to December 31, 2003. The goal was to describe the epidemiological, clinical and therapeutic aspects of bronchial cancer On 669 in-patients, 36 cases of bronchial cancer were diagnosed either a prevalence of 5.36%. the average age of the patients was 54.5 years with the extreme ones going from 35 to 80 years. Our series was made up of 27 men and 9 women with a sex ratio of 3 in favor of the men. The nicotinic was the principal factor of risk (69.4%) with an average of 20,9 packages year. The mode of prevalent nicotinic was the cigarette (92%). The functional signs most frequent were the thoracic pain (72.2%); cough (56.6%); dyspnea (22.2%). The histological type was found in 19.4% of the cases, carcinomas épidermoíde were more frequents (42.9%). 93.4% of the patients had profited only from one palliative treatment. Bronchial cancer poses enormous problems with the experts of the countries under equipped. Its appalling forecast is related to the delays and insufficiencies diagnostic and therapeutic

Burden of invasive disease caused by Haemophilus influenzae type b in Bamako, Mali: impetus for routine infant immunization with conjugate vaccine

BACKGROUND

Population-based, bacteriologically confirmed disease burden data aid decision makers in African countries pondering whether to introduce Haemophilus influenzae type b (Hib) immunization for infants.

METHODS

A bacteriology laboratory was established in Hopital Gabriel Toure, serving Bamako, Mali. Children age 0-15 years with fever > or =39 degrees C or syndromes compatible with invasive bacterial disease (meningitis, etc.) were eligible. From 2 to 5 mL of blood or relevant body fluid were inoculated into Bactec Ped Plus/F medium for automated culture; body fluids were also inoculated directly onto solid media. Hib was confirmed by standard microbiologic techniques and antibiograms generated by disk diffusion.

RESULTS

From June 1, 2002 to May 31, 2004, 3592 (87.8%) of 4092 children admitted to Hopital Gabriel Toure with high fever or suspected invasive bacterial disease were cultured, including 1745 who were 0-11 months old, 1132 who were 1-4 years old and 715 who were 5-15 years old. Hib was isolated from 207 Bamako children, 81 from blood alone and 124 from cerebrospinal fluid (with or without positive blood culture). Of 207 cases 204 (98.5%) occurred in children younger than age 5 years (annual incidence, 45.2/10) and 159 (77%) in infants age 0-11 months (annual incidence, 158.4/10). Peak incidence (370.0 cases/10) and 12 of 21 Hib deaths occurred in 6- to 7-month-olds. Of the Hib isolates, 11.1% were resistant to ampicillin, 32% to chloramphenicol and 0.5% to ceftriaxone.

CONCLUSIONS

The substantial burden of invasive Hib disease documented in Bamako has prompted the Malian government to introduce routine infant immunization with Hib conjugate.

Investigation of the risk factors for tuberculosis: a case-control study in three countries in West Africa

BACKGROUND

Host-related and environment-related factors have been shown to play a role in the development of tuberculosis (TB), but few studies were carried out to identify their respective roles in resource-poor countries.

METHODS

A multicentre case-control study was conducted in Guinée, Guinea Bissau, and The Gambia, from January 1999 to March 2001. Cases were newly detected smear positive TB patients. Two controls were recruited for each case, one within the household of the case, and one in the community.

RESULTS

Regarding host-related factors, univariate analysis by conditional logistic regression of 687 matched pairs of cases and household controls showed that TB was associated with male sex, family history of TB, absence of a BCG scar, smoking, alcohol, anaemia, HIV infection, and history and treatment of worm infection. In a multivariable model based on 601 matched pairs, male sex, family history of TB, smoking, and HIV infection were independent risk factors of TB. The investigation of environmental factors based on the comparison of 816 cases/community control pairs showed that the risk of TB was associated with single marital status, family history of TB, adult crowding, and renting the house. In a final model assessing the combined effect of host and environmental factors, TB was associated with male sex, HIV infection, smoking (with a dose-effect relationship), history of asthma, family history of TB, marital status, adult crowding, and renting the house.

CONCLUSION

TB is a multifactorial disorder, in which environment interacts with host-related factors. This study provided useful information for the assessment of host and environmental factors of TB for the improvement of TB control activities in developing countries.

[Not Available]

It is about a 77 years old man admitted for a small hemoptysia and a tuberculosis history that hemoptysia had been developing in a context of 38,5 0 c fever plus some crepitate rales in the right pulmonary area. After tuberculosis has been eliminated trough the bacilloscopy procedure, investigations of aspergillus in the splits have been negative. A pulmonary x ray revealed a retractile standard opacity in right pulmonary area. Amoxicilline based treatment has been conducted for two weeks in vain. Finally the pulmonary aspergillosis diagnosis pulmonary was then accepted following highly positive aspergillary serology.

[Dakar physicians' therapeutic attitude towards non complicated peptic ulcer disease]

Peptic ulcer disease is topic of guidelines in developed countries. In South area, without consensus conference, physicians' attitude towards this disease is varied. So, we aimed to describe therapeutic decisions of physicians in Dakar, regarding literature and the role of Helicobacter pylori in gastro-intestinal diseases. From 2001 december first to 2002 January 31, a survey was made in a sample of 171 physicians in Dakar with a questionnaire. All generalists, internists and gastroenterologists working in public or private health places of Dakar were concerned. The rate of responses was 68%. 65.5% of physicians had not read guidelines about peptic ulcer disease and H. pylori but 89% of them had read articles on these topics. Most of the physicians (76%) ordered systematically or mainly treatment to eradicate H. pylori. 95% of them did not require proof of infection before treatment. Association of gastric antisecretory drug with amoxicillin and metronidazole was mostly used (77.5%). Double dose of antisecretory drug was prescribed by 51.5% of physicians. For 40.5% of them, the duration of treatment was 7 days while 53.5% prolonged duration to 10 or 14 days. Complementary antisecretory drug was systematic for most of physicians (83.5%). These multiple therapeutic options, sometimes not in accordance with recommandations, militate in favour of more intensive participation of Dakar physicians to scientific meetings, in order to rationalize their therapeutic attitude towards peptic ulcer disease and take into account local data.

Invasive pneumococcal infections among hospitalized children in Bamako, Mali

BACKGROUND

Prevention of invasive pneumococcal disease (IPD) in children is a global public health priority, and determination of the most common serotypes is crucial for vaccine development and implementation.

METHODS

We performed prospective surveillance for IPD in hospitalized children in Bamako, Mali. All febrile children and others suspected to have invasive bacterial disease had an admission blood culture and cultures of additional anatomic sites when indicated. Standard microbiologic methods were used to identify, serotype and determine antibiograms for pneumococcal isolates.

RESULTS

Of 2,049 children enrolled, 106 (5%) had an IPD, including 47 cases of meningitis and 44 bacteremic pneumonias. The incidence was highest in infants (84/100,000/year). The overall IPD case fatality rate was 24%. Only 2 of 96 isolates were nonsusceptible to penicillin. The serotypes isolated were 5 (54%), 2 (14%), 7F (10%), 19F (8%), 6A/B (3%), 9V (3%), 1 (2%) and 14 (1%).

CONCLUSIONS

IPD is common and frequently fatal among hospitalized children in Mali, but surprisingly little resistance has occurred. Notably, 91% of the serotypes causing IPD in Bamako children are found in the 11-valent pneumococcal conjugate vaccine.

A capillary gas chromatography/mass spectrometric method for the quantification of hydroxysteroids in human plasma

A specific and sensitive methodology for the quantitative determination of hydroxysteroids dehydroepiandrosterone and pregnenolone and their main metabolites in human plasma is described. Hydroxysteroids were extracted using methanol and steroids were further separated by reverse-phase high-performance liquid chromatography, allowing for minimization of the possible chromatographic interferences. Eluted fractions were collected, pooled, and analyzed by gas chromatography-mass spectrometry as trimethylsilyl ether derivatives. The quantification was performed with single-ion monitoring of the highly abundant m/z 129 or m/z 358 fragments. The combination of the chromatographic characteristics to the specific fragments ensured the selectivity and specificity of the method. Under these conditions the method was linear (typical R2 is superior to 0.98 for all hydroxysteroids studied) over the concentration range of 2 x 10(-9) to 10(-6)M with good precision and accuracy.

[Diagnosis delay of multiple myeloma: report of 22 cases in an internal medicine department of Dakar]

Reported is a retrospective study conducted on in patients with multiple myeloma diagnosed from January 1990 to December 2000 in the departement of Internal Medicine I of Dakar University Hospital. Twenty-two patients were included. The mean age was 55 years (range 29-76). The sex ratio (male to female) was 2.6 (they were 16 males and 6 females). The presenting clinical features were dominated by bone manifestations with diffuse pain (41%) followed by pathologic fractures (22.27%) and lumbar pain (13.6%). At the hospital admission the type of clinical manifestations recorded were related to bone (91% general (60%), neurologic (36%) and infection (36%). The biological exams documented an anemia in 20 cases (91%) and increased serum protein in 13 cases (59%) and hypercalcemia in 11 cases (50%) and renal insufficiency in 6 cases (27%). Immunoelectrophoresis had been performed in 6 cases and revaled 4 cases of IgG and 2 cases of light chain myeloma. On the skeletal radiological exams it has been found lytic bone lesions in 66.6 % of cases. diffuse bone rarefaction (38.88%), pathological fractures (38.88%) and vertebral collapses (18.18%). The bone marrow aspiration showed in 17 cases over 19 a medullary dystrophic plasmocytosis. According to the Salmon and Durie classification 68% of the patients were pointed in stage III. Comparing our results to the series, we figure out our patients younger at the time of the diagnosis and an important diagnosis delay as previously suggested in the African litterature. This is confirmed by the fact that 68% of patients were one Salmon and Durie stage III. the frequency of severe anemia and pathological fractures We invite practitionners to conduct systematic exploration of mild symptoms like lumbar pain.

[Epidemiological and clinical features of the knee osteoarthritis]

The knee osteoarthritis is one of the most common causes of pain affecting elderly people. The main clinical features are pain and fonctional disability. The aim of this prospective study was to determine the epidemiological and clinical features of the knee in our regions. It was conducted from January 1st through June 30st 2002, on patients with gonarthrosis successively remited from the department of medicine, rheumatology out patient clinic. The diagnosis criteria was based on the Kellgreen and Lawrence scheme. The Lequesne functional index have been used to evaluate the patients disability. Fifty patients were included in the study, they were 33 females and 17 male (sex ratio of 0.51). The mean age was 61.96 years, ranging from 45 to 81 years. The aetiologic factors was dominated by a family history of inflammatory joint desease (72%) and the knees physical stress (60%). Constitutional abnormality were found only among women, with 4 cases of valgum, 3 cases of varum and one cases of the patella extrernal abnormality. Obesity appeared to be very common associated condition. Forty three patients got a body mass index greater than 25. The knee pain was unilateral in 52% of cases, mostly on the right knee and was a mechnical type with no particularity. The functional disability was proportional to average disease duration, and was not associated to the patients age.

[Severe acute renal failure revealing membranous glomerulonephritis]

We report a 30-year-old female admitted for an acute renal failure (ARF) as initial sign of idiopathic membranous glomerulonephritis. Severe ARF needed hemodialysis and renal biopsy after three weeks of evolution. Pathological examination revealed membranous glomerulonephritis mixed focal segmental glomerulosclerosis. Oral corticosteroids with hemodialysis allowed to obtain complete regression of ARF and partial remission of membranous glomerulonephritis. This case report call also to answer the question about existence of "tropical extramembranous glomerulonephritis" described in Dakar, more than twenty years ago.

[Parasitic risks (bilharziosis and intestinal parasitosis) to Mboune's valley revitalisation (Senegal)]

In order to assess the parasitic risks related to M'Boune's valley water launching, a study has been carried out from September 16 to November 24, 1998 in 12 villages: four villages surrounding the Guiers lake, four villages surrounding Ferlo already water launched 10 years ago, and four villages within M'Boune not water launched. The prevalence rate of urinary bilharziosis is 0.002% in the frist area, 1.3% in the second one and 13.7% in the third area. In these areas, intestinal parasitosis are prevaling respectively at rates of 38.2%, 36.4% and 21.3%. Although, there is no reason to fear immediately a worsening of the epidemiological situation due to M'Boune's valley revitalisation project, nevertheless, appropriate steps should be taken right now aiming at tackling the extension of conditions related to hydric medium.